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
('870510192', 'W12010525', 'W12010525', 'UT01', 'Performance West Physical Therapy', 'Trent', 'C', 'Henderson', 'MPT', 'Physical Therapy', '', '', NULL, 'O', '4920 E 2550 N Ste C', 'Eden', 'Weber', 'UT', '84310', '8017453200', '8017453311', '4920 E 2550 N Ste C', 'Eden', 'Weber', 'UT', '84310', '8017453200', '8017453311', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '70.50', 3, '2011-04-01', '2012-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770892366', 0, 'N', 0, '2011-11-01', NULL, NULL, 0, 0, NULL, NULL),
('870510192', 'W12010526', 'W12010526', 'UT01', 'Performance West Physical Therapy', 'Trent', 'C', 'Henderson', 'MPT', 'Physical Therapy', '', '', NULL, 'O', '4920 E 2550 N Ste C', 'Eden', 'Weber', 'UT', '84310', '8017453200', '8017453311', '4920 E 2550 N Ste C', 'Eden', 'Weber', 'UT', '84310', '8017453200', '8017453311', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2012-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770892366', 0, 'N', 0, '2011-11-01', NULL, NULL, 41.3228, -111.844, NULL, NULL),
('870518224', 'W12010527', 'W12010527', 'UT01', 'Physical & Sports Therapy Services', 'Darren', '', 'Averett', 'PT', 'Physical Therapy', '', '', NULL, 'O', '15 S 1000 E Ste 25', 'Payson', 'Utah', 'UT', '84651', '8014655610', '8014655615', '15 S 1000 E Ste 25', 'Payson', 'Utah', 'UT', '84651', '8014655610', '8014655615', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '70.50', 3, '2011-04-01', '2012-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1548232549', 0, 'N', 0, '2011-04-21', NULL, NULL, 0, 0, NULL, NULL),
('870518224', 'W12010528', 'W12010528', 'UT01', 'Physical & Sports Therapy Services', 'Darren', '', 'Averett', 'PT', 'Physical Therapy', '', '', NULL, 'O', '15 S 1000 E Ste 25', 'Payson', 'Utah', 'UT', '84651', '8014655610', '8014655615', '15 S 1000 E Ste 25', 'Payson', 'Utah', 'UT', '84651', '8014655610', '8014655615', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2012-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1548232549', 0, 'N', 0, '2011-04-21', NULL, NULL, 40.044, -111.716, NULL, NULL),
('870518224', 'W12010529', 'W12010529', 'UT01', 'Physical & Sports Therapy Services', 'Darren', '', 'Averett', 'PT', 'Physical Therapy', '', '', NULL, 'B', '380 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8014655610', '8014655615', '380 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8014655610', '8014655615', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '70.50', 3, '2011-04-01', '2012-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1548232549', 0, 'Y', 0, '2011-04-21', NULL, NULL, 0, 0, NULL, NULL),
('870518224', 'W12010530', 'W12010530', 'UT01', 'Physical & Sports Therapy Services', 'Darren', '', 'Averett', 'PT', 'Physical Therapy', '', '', NULL, 'B', '380 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8014655610', '8014655615', '380 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8014655610', '8014655615', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2012-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1548232549', 0, 'Y', 0, '2011-04-21', NULL, NULL, 0, 0, NULL, NULL),
('870518224', 'W12010531', 'W12010531', 'UT01', 'Physical & Sports Therapy Services', 'Kurt', 'Russell', 'Boucher', 'MS, CCC,SLP', 'Physical Therapy', '', '', NULL, 'O', '15 S 1000 E Ste 25', 'Payson', 'Utah', 'UT', '84651', '8014655610', '8014655615', '15 S 1000 E Ste 25', 'Payson', 'Utah', 'UT', '84651', '8014655610', '8014655615', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '70.50', 3, '2011-04-01', '2012-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1871750059', 0, 'N', 0, '2011-12-19', NULL, NULL, 0, 0, NULL, NULL),
('870518224', 'W12010532', 'W12010532', 'UT01', 'Physical & Sports Therapy Services', 'Kurt', 'Russell', 'Boucher', 'MS, CCC,SLP', 'Physical Therapy', '', '', NULL, 'O', '15 S 1000 E Ste 25', 'Payson', 'Utah', 'UT', '84651', '8014655610', '8014655615', '15 S 1000 E Ste 25', 'Payson', 'Utah', 'UT', '84651', '8014655610', '8014655615', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2012-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1871750059', 0, 'N', 0, '2011-12-19', NULL, NULL, 40.044, -111.716, NULL, NULL),
('870518224', 'W12010533', 'W12010533', 'UT01', 'Physical & Sports Therapy Services', 'Kurt', 'Russell', 'Boucher', 'MS, CCC,SLP', 'Physical Therapy', '', '', NULL, 'B', '380 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8014655610', '8014655615', '380 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8014655610', '8014655615', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '70.50', 3, '2011-04-01', '2012-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1871750059', 0, 'Y', 0, '2011-12-19', NULL, NULL, 0, 0, NULL, NULL),
('870518224', 'W12010534', 'W12010534', 'UT01', 'Physical & Sports Therapy Services', 'Kurt', 'Russell', 'Boucher', 'MS, CCC,SLP', 'Physical Therapy', '', '', NULL, 'B', '380 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8014655610', '8014655615', '380 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8014655610', '8014655615', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2012-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1871750059', 0, 'Y', 0, '2011-12-19', NULL, NULL, 0, 0, NULL, NULL),
('870518224', 'W12010535', 'W12010535', 'UT01', 'Physical & Sports Therapy Services', 'Brad', 'A', 'Mangum', 'PT', 'Physical Therapy', '', '', NULL, 'O', '15 S 1000 E Ste 25', 'Payson', 'Utah', 'UT', '84651', '8014655610', '8014655615', '15 S 1000 E Ste 25', 'Payson', 'Utah', 'UT', '84651', '8014655610', '8014655615', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '70.50', 3, '2011-04-01', '2012-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1316992548', 0, 'N', 0, '2013-04-16', NULL, NULL, 0, 0, NULL, NULL),
('870518224', 'W12010536', 'W12010536', 'UT01', 'Physical & Sports Therapy Services', 'Brad', 'A', 'Mangum', 'PT', 'Physical Therapy', '', '', NULL, 'O', '15 S 1000 E Ste 25', 'Payson', 'Utah', 'UT', '84651', '8014655610', '8014655615', '15 S 1000 E Ste 25', 'Payson', 'Utah', 'UT', '84651', '8014655610', '8014655615', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2012-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1316992548', 0, 'N', 0, '2013-04-16', NULL, NULL, 40.044, -111.716, NULL, NULL),
('870518224', 'W12010537', 'W12010537', 'UT01', 'Physical & Sports Therapy Services', 'Brad', 'A', 'Mangum', 'PT', 'Physical Therapy', '', '', NULL, 'B', '380 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8014655610', '8014655615', '380 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8014655610', '8014655615', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '70.50', 3, '2011-04-01', '2012-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1316992548', 0, 'Y', 0, '2013-04-16', NULL, NULL, 0, 0, NULL, NULL),
('870518224', 'W12010538', 'W12010538', 'UT01', 'Physical & Sports Therapy Services', 'Brad', 'A', 'Mangum', 'PT', 'Physical Therapy', '', '', NULL, 'B', '380 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8014655610', '8014655615', '380 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8014655610', '8014655615', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2012-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1316992548', 0, 'Y', 0, '2013-04-16', NULL, NULL, 0, 0, NULL, NULL),
('870656811', 'W12010539', 'W12010539', 'UT01', 'ProRehab Castledale', 'Brody', 'Jack', 'Leroy', 'OT', 'Physical Therapy', 'Occupational Therapy', '', NULL, 'O', '150 E Main Ste Ste ', 'Castle Dale', 'Emery', 'UT', '84513', '4353815100', '4353815099', '150 E Main Ste Ste ', 'Castle Dale', 'Emery', 'UT', '84513', '4353815100', '4353815099', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 6, '2012-04-01', '2012-04-01', 0, 0, 0, '', '', '', '', 'HCFA|', '1386801363', 0, 'N', 0, '2011-11-29', NULL, NULL, 0, 0, NULL, NULL),
('870656811', 'W12010540', 'W12010540', 'UT01', 'ProRehab', 'Brody', 'Jack', 'Leroy', 'OT', 'Physical Therapy', 'Occupational Therapy', '', NULL, 'O', '590 E 100 N Ste Ste 12', 'Price', 'Carbon', 'UT', '84501', '4356131500', '4353815099', '590 E 100 N Ste Ste 12', 'Price', 'Carbon', 'UT', '84501', '4356131500', '4353815099', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '70.50', 6, '2011-04-01', '2011-11-01', 0, 0, 0, '', '', '', '', 'HCFA|', '1386801363', 0, 'N', 0, '2011-11-29', NULL, NULL, 0, 0, NULL, NULL),
('870656811', 'W12010541', 'W12010541', 'UT01', 'ProRehab', 'Brody', 'Jack', 'Leroy', 'OT', 'Physical Therapy', 'Occupational Therapy', '', NULL, 'O', '590 E 100 N Ste Ste Ste 12', 'Price', 'Carbon', 'UT', '84501', '4356131500', '4353815099', '590 E 100 N Ste Ste Ste 12', 'Price', 'Carbon', 'UT', '84501', '4356131500', '4353815099', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 6, '2012-04-01', '2012-04-01', 0, 0, 0, '', '', '', '', 'HCFA|', '1386801363', 0, 'N', 0, '2011-11-29', NULL, NULL, 0, 0, NULL, NULL),
('870656811', 'W12010542', 'W12010542', 'UT01', 'ProRehab', 'Mike', 'A', 'Gagon', 'PT', 'Physical Therapy', '', '', NULL, 'O', '123 S Long St', 'Green River', 'Emery', 'UT', '84525', '4356131500', '4356131501', '123 S Long St', 'Green River', 'Emery', 'UT', '84525', '4356131500', '4356131501', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '70.50', 6, '2011-04-01', '2011-07-15', 0, 0, 0, '', '', '', '', 'HCFA|', '1700807484', 0, 'N', 0, '2012-11-26', NULL, NULL, 0, 0, NULL, NULL),
('870656811', 'W12010543', 'W12010543', 'UT01', 'ProRehab', 'Mike', 'A', 'Gagon', 'PT', 'Physical Therapy', '', '', NULL, 'O', '123 S Long St', 'Green River', 'Emery', 'UT', '84525', '4356131500', '4356131501', '123 S Long St', 'Green River', 'Emery', 'UT', '84525', '4356131500', '4356131501', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 6, '2012-04-01', '2012-04-01', 0, 0, 0, '', '', '', '', 'HCFA|', '1700807484', 0, 'N', 0, '2012-11-26', NULL, NULL, 0, 0, NULL, NULL),
('870656811', 'W12010544', 'W12010544', 'UT01', 'ProRehab Price', 'Mike', 'A', 'Gagon', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 307', 'Altamont', 'Duchesne', 'UT', '84001', '4356131500', '4356131501', 'PO Box 307', 'Altamont', 'Duchesne', 'UT', '84001', '4356131500', '4356131501', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '70.50', 6, '2011-04-01', '2012-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1700807484', 0, 'Y', 0, '2012-11-26', NULL, NULL, 0, 0, NULL, NULL),
('870518224', 'W12010545', 'W12010545', 'UT01', 'Physical & Sports Therapy Services', 'Brian', 'B', 'Lambert', 'PT', 'Physical Therapy', '', '', NULL, 'O', '380 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8014895669', '8014895783', '380 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8014895669', '8014895783', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '70.50', 3, '2011-04-01', '2012-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1639165707', 0, 'N', 0, '2011-04-21', NULL, NULL, 0, 0, NULL, NULL),
('870518224', 'W12010546', 'W12010546', 'UT01', 'Physical & Sports Therapy Services', 'Brian', 'B', 'Lambert', 'PT', 'Physical Therapy', '', '', NULL, 'O', '380 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8014895669', '8014895783', '380 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8014895669', '8014895783', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2012-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1639165707', 0, 'N', 0, '2011-04-21', NULL, NULL, 40.1611, -111.604, NULL, NULL),
('870656811', 'W12010547', 'W12010547', 'UT01', 'ProRehab Price', 'Mike', 'A', 'Gagon', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 307', 'Altamont', 'Duchesne', 'UT', '84001', '4356131500', '4356131501', 'PO Box 307', 'Altamont', 'Duchesne', 'UT', '84001', '4356131500', '4356131501', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 6, '2012-04-01', '2013-05-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1700807484', 0, 'Y', 0, '2013-06-21', NULL, NULL, 0, 0, NULL, NULL),
('870518224', 'W12010548', 'W12010548', 'UT01', 'Physical & Sports Therapy Services', 'Greg', 'R', 'Thorpe', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'O', '380 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8014895669', '8014895783', '380 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8014895669', '8014895783', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '70.50', 3, '2011-04-01', '2012-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1316933500', 0, 'N', 0, '2011-04-21', NULL, NULL, 0, 0, NULL, NULL),
('870518224', 'W12010549', 'W12010549', 'UT01', 'Physical & Sports Therapy Services', 'Greg', 'R', 'Thorpe', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'O', '380 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8014895669', '8014895783', '380 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8014895669', '8014895783', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2012-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1316933500', 0, 'N', 0, '2011-04-21', NULL, NULL, 40.1611, -111.604, NULL, NULL),
('870518224', 'W12010550', 'W12010550', 'UT01', 'Physical & Sports Therapy Services', 'Craig', 'Alan', 'Schultz', 'PT', 'Physical Therapy', '', '', NULL, 'B', '380 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8012242250', '8012242655', '380 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8012242250', '8012242655', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '70.50', 3, '2011-04-01', '2012-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1508852484', 0, 'Y', 0, '2011-10-26', NULL, NULL, 0, 0, NULL, NULL),
('870518224', 'W12010551', 'W12010551', 'UT01', 'Physical & Sports Therapy Services', 'Craig', 'Alan', 'Schultz', 'PT', 'Physical Therapy', '', '', NULL, 'B', '380 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8012242250', '8012242655', '380 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8012242250', '8012242655', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2012-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1508852484', 0, 'Y', 0, '2011-10-26', NULL, NULL, 0, 0, NULL, NULL),
('870518224', 'W12010552', 'W12010552', 'UT01', 'Physical & Sports Therapy Services', 'Craig', 'Alan', 'Schultz', 'PT', 'Physical Therapy', '', '', NULL, 'O', '684 W 800 N Ste 110', 'Orem', 'Utah', 'UT', '84057', '8012242250', '8012242655', '684 W 800 N Ste 110', 'Orem', 'Utah', 'UT', '84057', '8012242250', '8012242655', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '70.50', 3, '2011-04-01', '2012-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1508852484', 0, 'N', 0, '2011-10-26', NULL, NULL, 0, 0, NULL, NULL),
('870518224', 'W12010553', 'W12010553', 'UT01', 'Physical & Sports Therapy Services', 'Craig', 'Alan', 'Schultz', 'PT', 'Physical Therapy', '', '', NULL, 'O', '684 W 800 N Ste 110', 'Orem', 'Utah', 'UT', '84057', '8012242250', '8012242655', '684 W 800 N Ste 110', 'Orem', 'Utah', 'UT', '84057', '8012242250', '8012242655', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2012-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1508852484', 0, 'N', 0, '2011-10-26', NULL, NULL, 40.3121, -111.712, NULL, NULL),
('870656811', 'W12010554', 'W12010554', 'UT01', 'ProRehab Castledale', 'Brad', '', 'Stilson', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '150 E Main', 'Castle Dale', 'Emery', 'UT', '84513', '4353815100', '4353815099', '150 E Main', 'Castle Dale', 'Emery', 'UT', '84513', '4353815100', '4353815099', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '70.50', 6, '2011-04-01', '2012-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1609006741', 0, 'N', 0, '2013-06-21', NULL, NULL, 0, 0, NULL, NULL),
('870656811', 'W12010555', 'W12010555', 'UT01', 'ProRehab Castledale', 'Brad', '', 'Stilson', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '150 E Main', 'Castle Dale', 'Emery', 'UT', '84513', '4353815100', '4353815099', '150 E Main', 'Castle Dale', 'Emery', 'UT', '84513', '4353815100', '4353815099', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 6, '2012-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1609006741', 0, 'N', 0, '2013-06-21', NULL, NULL, 39.2109, -111.02, NULL, NULL),
('870656811', 'W12010556', 'W12010556', 'UT01', 'ProRehab', 'Brad', '', 'Stilson', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '425 S Vernal Ave', 'Vernal', 'Uintah', 'UT', '84078', '4357811502', '4357811505', '425 S Vernal Ave', 'Vernal', 'Uintah', 'UT', '84078', '4357811502', '4357811505', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '70.50', 6, '2011-04-01', '2012-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1609006741', 0, 'N', 0, '2013-06-21', NULL, NULL, 0, 0, NULL, NULL),
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('870546501', 'W12010661', 'W12010661', 'UT01', 'Alpine Pediatrics', 'Aaron', '', 'Sabey', 'PA-C', 'Urology', '', '', NULL, 'O', '77 E Commerce Dr', 'Saratoga Springs', 'Utah', 'UT', '84045', '8019229222', '8019229370', '77 E Commerce Dr', 'Saratoga Springs', 'Utah', 'UT', '84045', '8019229222', '8019229370', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-04-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992824130', 0, 'N', 0, '2013-11-12', NULL, NULL, 40.3848, -111.914, NULL, NULL),
('870622942', 'W12008198', 'W12008198', 'UT01', 'Utah Imaging Associates', 'Daniel', 'G', 'Turner', '', 'Diagnostic Radiology', '', '', NULL, 'B', 'PO Box 1369', 'Bountiful', 'Davis', 'UT', '84011', '8012962113', '8012961715', 'PO Box 1369', 'Bountiful', 'Davis', 'UT', '84011', '8012962113', '8012961715', 'WUUTIMAGE5', '', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457336729', 0, 'N', 0, '2012-06-29', NULL, NULL, 0, 0, NULL, NULL),
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('836000025', 'W12008993', 'W12008993', 'WY01', 'Memorial Hospital of Carbon County', 'Michael ', '', 'Higginbotham', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 460', 'Rawlins', 'Carbon', 'WY', '82301', '3073248252', '3073248368', 'PO Box 460', 'Rawlins', 'Carbon', 'WY', '82301', '3073248252', '3073248368', 'WISEWYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 6, '2011-06-01', NULL, 0, 0, 0, 'Memorial Hospital of Carbon County', '', '', '', 'HCFA|', '1336188150', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W12010664', 'W12010664', 'ID02', 'Primary Health Medical Group', 'Ann', 'M', 'Weiss', 'MD', 'Family Practice', '', '', NULL, 'O', '700 Caldwell Blvd', 'Nampa', 'Canyon', 'ID', '83651', '2084666567', '2084667922', '700 Caldwell Blvd', 'Nampa', 'Canyon', 'ID', '83651', '2084666567', '2084667922', 'IDSTDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2011-06-01', '2013-02-28', 0, 0, 1, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1013094820', 0, 'N', 0, '2013-07-02', NULL, NULL, 43.5968, -116.59, NULL, NULL),
('202630141', 'W12010665', 'W12010665', 'ID02', 'Primary Health Medical Group', 'Ann', 'M', 'Weiss', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 191050', 'Boise', 'Ada', 'ID', '83719', '2088958670', NULL, 'PO Box 191050', 'Boise', 'Ada', 'ID', '83719', '2088958670', '          ', 'IDSTDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2011-06-01', '2013-02-28', 0, 0, 1, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1013094820', 0, 'N', 0, '2013-07-02', NULL, NULL, 0, 0, NULL, NULL),
('275063981', 'W12010666', 'W12010666', 'UTMH1', '', 'M Lisa', '', 'Jackson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1780 W 500 S', 'Salt Lake City', 'Salt Lake', 'UT', '84104', '8017254140', NULL, '1780 W 500 S', 'Salt Lake City', 'Salt Lake', 'UT', '84104', '8017254140', '          ', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2011-04-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134377211', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12010667', 'W12010667', 'UT01', 'Central Utah Clinic PC', 'Gary', '', 'Garner', 'MD', 'Pallative Care', '', '', NULL, 'O', '1055 N 500 W Ste 102', 'Provo', 'Utah', 'UT', '84604', '8013742367', NULL, '1055 N 500 W Ste 102', 'Provo', 'Utah', 'UT', '84604', '8013742367', '          ', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811067762', 0, 'N', 0, '2013-04-09', NULL, NULL, 40.248, -111.667, NULL, NULL),
('870281028', 'W12010669', 'W12010669', 'UT01', 'Central Utah Clinic PC', 'Mark', 'H', 'Jensen', 'MD', 'Plastic Surgery', '', '', NULL, 'O', '1055 N 500 W Ste 207', 'Provo', 'Utah', 'UT', '84604', '8013737350', '8018125401', '1055 N 500 W Ste 207', 'Provo', 'Utah', 'UT', '84604', '8013737350', '8018125401', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-10-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1184602351', 0, 'N', 0, '2013-04-09', NULL, NULL, 40.248, -111.667, NULL, NULL),
('870281028', 'W12010668', 'W12010668', 'UT01', 'Central Utah Clinic PC', 'Mark', 'H', 'Jensen', 'MD', 'Plastic Surgery', '', '', NULL, 'O', '1175 E 50 S Ste 211', 'American Fork', 'Utah', 'UT', '84003', '8014180870', '8014180871', '1175 E 50 S Ste 211', 'American Fork', 'Utah', 'UT', '84003', '8014180870', '8014180871', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-10-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1184602351', 0, 'N', 0, '2013-04-09', NULL, NULL, 40.3757, -111.77, NULL, NULL),
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('870281028', 'W12010671', 'W12010671', 'UT01', 'Central Utah Clinic PC', 'Mark', 'H', 'Jensen', 'MD', 'Plastic Surgery', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013737350', '8018125401', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013737350', '8018125401', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-10-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1184602351', 0, 'N', 0, '2013-04-09', NULL, NULL, 0, 0, NULL, NULL),
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('870470821', 'W12010683', 'W12010683', 'UT01', 'Rocky Mountain Therapy Services', 'Richard', 'D', 'Wortley', 'PT', 'Physical Therapy', '', '', NULL, 'O', '3497 W 3500 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8014175017', '8014175016', '3497 W 3500 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8014175017', '8014175016', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2012-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1689667859', 0, 'N', 0, '2011-11-01', NULL, NULL, 40.6966, -111.975, NULL, NULL),
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('270104373', 'W12010696', 'W12010696', 'WY01', 'Yellowstone Radiology', 'Gregory', 'H', 'Cross', '', 'Diagnostic Radiology', '', '', NULL, 'O', '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075782372', NULL, '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075782372', '          ', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013900547', 0, 'Y', 0, '2011-06-29', NULL, NULL, 44.526, -109.074, NULL, NULL),
('270104373', 'W12011028', 'W12011028', 'WY01', 'Yellowstone Radiology', 'Travis', 'S', 'Graham', '', 'Diagnostic Radiology', '', '', NULL, 'B', 'PO Box 1829', 'Coeur D Alene', 'Kootenai', 'ID', '83816', '2086679334', NULL, 'PO Box 1829', 'Coeur D Alene', 'Kootenai', 'ID', '83816', '2086679334', '          ', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417926528', 0, 'Y', 0, '2011-06-29', NULL, NULL, 0, 0, NULL, NULL),
('270104373', 'W12010698', 'W12010698', 'WY01', 'Yellowstone Radiology', 'Travis', 'S', 'Graham', '', 'Diagnostic Radiology', '', '', NULL, 'O', '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075782372', NULL, '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075782372', '          ', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417926528', 0, 'Y', 0, '2011-06-29', NULL, NULL, 44.526, -109.074, NULL, NULL),
('870656237', 'W12010700', 'W12010700', 'UT01', 'Southern Utah Physical and Rehabilitation', 'Brady', '', 'Englestead', 'PT', 'Physical Therapy', '', '', NULL, 'O', '166 W 1325 N Ste 100', 'Cedar City', 'Iron', 'UT', '84721', '4355860064', '4358671243', '166 W 1325 N Ste 100', 'Cedar City', 'Iron', 'UT', '84721', '4355860064', '4358671243', 'WestRehab', '', '', '0.00', '0.00', '70.50', 3, '2011-04-01', '2012-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164455887', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
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('870656237', 'W12010701', 'W12010701', 'UT01', 'Southern Utah Physical and Rehabilitation', 'Tori', 'B', 'Forsyth', 'PT', 'Physical Therapy', '', '', NULL, 'O', '166 W 1325 N Ste 100', 'Cedar City', 'Iron', 'UT', '84721', '4355860064', '4358671243', '166 W 1325 N Ste 100', 'Cedar City', 'Iron', 'UT', '84721', '4355860064', '4358671243', 'WestRehab', '', '', '0.00', '0.00', '70.50', 3, '2011-04-01', '2012-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417976499', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('870656237', 'W12010703', 'W12010703', 'UT01', 'Southern Utah Physical and Rehabilitation', 'Adam', 'L', 'Mendenhall', 'PT', 'Physical Therapy', '', '', NULL, 'O', '166 W 1325 N Ste 100', 'Cedar City', 'Iron', 'UT', '84721', '4355860064', '4358671243', '166 W 1325 N Ste 100', 'Cedar City', 'Iron', 'UT', '84721', '4355860064', '4358671243', 'WestRehab', '', '', '0.00', '0.00', '70.50', 3, '2011-04-01', '2012-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780600049', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
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('870656237', 'W12010716', 'W12010716', 'UT01', 'Southern Utah Physical and Rehabilitation', 'Randy', '', 'Forsyth', 'PT', 'Physical Therapy', '', '', NULL, 'O', '166 W 1325 N Ste 100', 'Cedar City', 'Iron', 'UT', '84721', '4355860064', '4358671243', '166 W 1325 N Ste 100', 'Cedar City', 'Iron', 'UT', '84721', '4355860064', '4358671243', 'WestRehab', '', '', '0.00', '0.00', '70.50', 3, '2011-04-01', '2012-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598704983', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
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('870492272', 'W12010719', 'W12010719', 'UT01', 'Utah Cardiology  PC', 'Christopher', 'Y', 'Kim', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '2132 N 1700 W Ste 200', 'Layton', 'Davis', 'UT', '84041', '8017760176', '8018253904', '2132 N 1700 W Ste 200', 'Layton', 'Davis', 'UT', '84041', '8017760176', '8018253904', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1457650442', 0, 'N', 0, '2014-04-17', NULL, NULL, 41.0892, -111.997, NULL, NULL),
('870492272', 'W12010720', 'W12010720', 'UT01', 'Utah Cardiology', 'Christopher', 'Y', 'Kim', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', '520 Medical Dr Ste 310', 'Bountiful', 'Davis', 'UT', '84010', '8017760176', NULL, '520 Medical Dr Ste 310', 'Bountiful', 'Davis', 'UT', '84010', '8017760176', '', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1457650442', 0, 'N', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('261741164', 'W12010721', 'W12010721', 'UT01', 'Southern Kidney & Hypertension Institute of St George', 'Carlos', 'A', 'Leon', 'MD', 'Nephrology', '', '', NULL, 'O', '1173 S 250 W Ste 402', 'St George', 'Washington', 'UT', '84770', '4356521135', '4356521190', '1173 S 250 W Ste 402', 'St George', 'Washington', 'UT', '84770', '4356521135', '4356521190', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1932131869', 0, 'N', 0, '2011-06-29', NULL, NULL, 37.1151, -113.593, NULL, NULL),
('261741164', 'W12010722', 'W12010722', 'UT01', 'Southern Kidney & Hypertension Institute of St George', 'Carlos', 'A', 'Leon', 'MD', 'Nephrology', '', '', NULL, 'B', 'PO Box 10348', 'Uniondale', 'Nassau', 'NY', '11555', '4356521135', '4356521190', 'PO Box 10348', 'Uniondale', 'Nassau', 'NY', '11555', '4356521135', '4356521190', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1932131869', 0, 'N', 0, '2011-06-29', NULL, NULL, 0, 0, NULL, NULL),
('870617733', 'W12010724', 'W12010724', 'UT01', 'Utah Eye Centers', 'Claron', 'D', 'Alldredge', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1551 S Renaissance Towne Dr Ste 340', 'Bountiful', 'Davis', 'UT', '84010', '8016771122', '8016771144', '1551 S Renaissance Towne Dr Ste 340', 'Bountiful', 'Davis', 'UT', '84010', '8016771122', '8016771144', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-04-25', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1841200284', 0, 'N', 0, '2013-04-12', NULL, NULL, 40.8737, -111.888, NULL, NULL),
('870617733', 'W12010726', 'W12010726', 'UT01', 'Utah Eye Centers', 'Claron', 'D', 'Alldredge', 'MD', 'Ophthalmology', '', '', NULL, 'O', '4360 Washington Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014760494', '8014793937', '4360 Washington Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014760494', '8014793937', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-04-25', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1841200284', 0, 'N', 0, '2013-04-12', NULL, NULL, 41.1826, -111.971, 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
('870617733', 'W12010725', 'W12010725', 'UT01', 'Mount Ogden Eye Center', 'Claron', 'D', 'Alldredge', 'MD', 'Ophthalmology', '', '', NULL, 'O', '2132 N 1700 W Ste 303', 'Salt Lake City', 'Salt Lake', 'UT', '84081', '8018962024', '8019862024', '2132 N 1700 W Ste 303', 'Salt Lake City', 'Salt Lake', 'UT', '84081', '8018962024', '8019862024', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-04-25', '2013-01-01', 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1841200284', 0, 'N', 0, '2013-04-12', NULL, NULL, 0, 0, NULL, NULL),
('870617733', 'W12010723', 'W12010723', 'UT01', 'Utah Eye Centers', 'Claron', 'D', 'Alldredge', 'MD', 'Ophthalmology', '', '', NULL, 'O', '440 D St Ste 210', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8014083705', '8014083706', '440 D St Ste 210', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8014083705', '8014083706', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-04-25', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1841200284', 0, 'N', 0, '2013-04-12', NULL, NULL, 40.7795, -111.879, NULL, NULL),
('205934739', 'W12010730', 'W12010730', 'ID02', 'Family Medicine Residency of Idaho', 'Margaret', 'K', 'Mortimer', 'NP', 'Family Practice', '', '', NULL, 'O', '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083811775', '2083227018', '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083811775', '2083227018', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2011-04-01', '2011-08-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1770532780', 0, 'N', 0, '2012-05-04', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12010729', 'W12010729', 'ID02', 'Family Medicine Health Center', 'Margaret', 'K', 'Mortimer', 'NP', 'Family Practice', '', '', NULL, 'O', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2083676042', '2083227018', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2083676042', '2083227018', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2011-04-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1770532780', 0, 'N', 0, '2014-06-05', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12010731', 'W12010731', 'UT01', 'Central Utah Clinic PC', 'Larry', 'C', 'Ford', 'MD', 'Infectious Disease', '', '', NULL, 'O', '1055 N 500 W Ste 202 Bldg C', 'Provo', 'Utah', 'UT', '84604', '8013742367', '8013742615', '1055 N 500 W Ste 202 Bldg C', 'Provo', 'Utah', 'UT', '84604', '8013742367', '8013742615', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-10-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', 'Mountain View Regional Hospital', '', '', 'HCFA|UB|', '1144434788', 0, 'N', 0, '2013-04-09', NULL, NULL, 40.248, -111.667, NULL, NULL),
('870281028', 'W12010732', 'W12010732', 'UT01', 'Central Utah Clinic PC', 'Larry', 'C', 'Ford', 'MD', 'Infectious Disease', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013742367', '8013742615', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013742367', '8013742615', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-10-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', 'Mountain View Regional Hospital', '', '', 'HCFA|UB|', '1144434788', 0, 'N', 0, '2013-04-09', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12010733', 'W12010733', 'ID02', 'Family Medicine Residency of Idaho', 'Heather', 'N', 'Owens', 'MD', 'Pediatrics', '', '', NULL, 'O', '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083816102', '2083811776', '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083816102', '2083811776', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2011-05-01', '2012-04-05', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1588688477', 0, 'N', 0, '2014-07-17', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12010734', 'W12010734', 'ID02', 'Family Medicine Residency of Idaho', 'Heather', 'N', 'Owens', 'MD', 'Pediatrics', '', '', NULL, 'O', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '2083227018', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '2083227018', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2011-05-01', '2012-04-05', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1588688477', 0, 'N', 0, '2014-07-17', NULL, NULL, 0, 0, NULL, NULL),
('841367175', 'W12010736', 'W12010736', 'UT01', 'Canyon View Medical Group', 'Brayden', 'T', 'McBride', 'MD', 'Family Practice', '', '', NULL, 'B', '325 W Ctr', 'Spanish Fork', 'Utah', 'UT', '84660', '8014898464', NULL, '325 W Ctr', 'Spanish Fork', 'Utah', 'UT', '84660', '8014898464', '', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-09-01', NULL, 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1831363225', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('841367175', 'W12010735', 'W12010735', 'UT01', 'Canyon View Medical Group', 'Brayden', 'T', 'McBride', 'MD', 'Family Practice', '', '', NULL, 'O', '5 E 400 N', 'Springville', 'Utah', 'UT', '84663', '8014898464', NULL, '5 E 400 N', 'Springville', 'Utah', 'UT', '84663', '8014898464', '', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-09-01', NULL, 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1831363225', 0, 'N', 0, '2014-04-24', NULL, NULL, 40.1723, -111.61, NULL, NULL),
('205934739', 'W12010737', 'W12010737', 'ID02', 'Family Medicine Residency of Idaho', 'Steven ', 'L', 'Schneider', '', 'Family Practice', '', '', NULL, 'O', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83702', '2085142500', '2083227018', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83702', '2085142500', '2083227018', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2011-05-01', '2012-04-05', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1720377476', 0, 'N', 0, '2012-04-05', NULL, NULL, 0, 0, NULL, NULL),
('528819353', 'W12010738', 'W12010738', 'UTMH1', '', 'Kelly', '', 'Morse', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '1199 S Main St Ste 105', 'Centerville', 'Davis', 'UT', '84014', '8019070462', '8019511490', '1199 S Main St Ste 105', 'Centerville', 'Davis', 'UT', '84014', '8019070462', '8019511490', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2011-03-01', '2011-05-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871774596', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12010740', 'W12010740', 'UT01', 'Central Utah Clinic PC', 'Brad', 'S', 'Huber', 'MD', 'Dermatology', '', '', NULL, 'M', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013548225', '8014298150', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013548225', '8014298150', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-07-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1689757973', 0, 'N', 0, '2013-04-09', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12010739', 'W12010739', 'UT01', 'Central Utah Clinic PC', 'Brad', 'S', 'Huber', 'MD', 'Dermatology', '', '', NULL, 'O', '250 N 1200 E Ste 201', 'Lehi', 'Utah', 'UT', '84043', '8014180920', '8014180921', '250 N 1200 E Ste 201', 'Lehi', 'Utah', 'UT', '84043', '8014180920', '8014180921', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-07-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1689757973', 0, 'N', 0, '2013-04-09', NULL, NULL, 40.3916, -111.83, NULL, NULL),
('870281028', 'W12010741', 'W12010741', 'UT01', 'Central Utah Clinic PC', 'Brad', 'S', 'Huber', 'MD', 'Dermatology', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014298180', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014298180', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-07-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1689757973', 0, 'N', 0, '2013-04-09', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W12010819', 'W12010819', 'UTIHCPHY', 'Southwest Spine and Pain-Cedar', 'Joseph', 'D', 'Ferguson', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '1303 N Main St', 'Cedar City', 'Iron', 'UT', '84720', '4358685055', '4358685504', '1303 N Main St', 'Cedar City', 'Iron', 'UT', '84720', '4358685055', '4358685504', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-04-14', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1588773204', 0, 'N', 0, '2011-04-28', NULL, NULL, 37.7003, -113.064, NULL, NULL),
('942854057', 'W12010820', 'W12010820', 'UTIHCPHY', 'Southwest Spine & Pain Center', 'Joseph', 'D', 'Ferguson', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '652 S Medical Ctr Dr Ste 110', 'St George', 'Washington', 'UT', '84790', '4352513700', '4352513701', '652 S Medical Ctr Dr Ste 110', 'St George', 'Washington', 'UT', '84790', '4352513700', '4352513701', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-04-14', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1588773204', 0, 'N', 0, '2011-04-28', NULL, NULL, 37.0498, -113.574, NULL, NULL),
('942854057', 'W12010821', 'W12010821', 'UTIHCPHY', 'Budge Clinic Radiology', 'Gary', 'Lee', 'Harris', 'MD', 'Family Practice', '', '', NULL, 'O', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357520422', '4357530401', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357520422', '4357530401', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-02-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1154330462', 0, 'N', 0, '2011-04-28', NULL, NULL, 41.7565, -111.821, NULL, NULL),
('942854057', 'W12010822', 'W12010822', 'UTIHCPHY', 'Cedar City InstaCare', 'Kim', 'T', 'Heaton', 'MD', 'Urgent Care', 'Emergency Medicine', '', NULL, 'O', '962 Sage Dr', 'Cedar City', 'Iron', 'UT', '84720', '4358653440', '4358653472', '962 Sage Dr', 'Cedar City', 'Iron', 'UT', '84720', '4358653440', '4358653472', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225051089', 0, 'Y', 0, '2012-02-29', NULL, NULL, 37.6608, -113.081, NULL, NULL),
('942854057', 'W12010823', 'W12010823', 'UT01', 'Utah Heart-Riverton', 'Steven', 'Curtis', 'Horton', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', 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, '2011-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043288640', 0, 'N', 0, '2014-05-19', NULL, NULL, 40.5222, -111.98, NULL, NULL),
('942854057', 'W12010825', 'W12010825', 'UTIHCPHY', 'Southwest Spine & Pain Center', 'Dayne', '', 'Johnson', 'PA-C', 'Pain Management', '', '', NULL, 'O', '652 S Medical Ctr Dr Ste 110', 'St George', 'Washington', 'UT', '84790', '4352513700', '4352513701', '652 S Medical Ctr Dr Ste 110', 'St George', 'Washington', 'UT', '84790', '4352513700', '4352513701', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-03-21', '2011-09-09', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669505178', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12010826', 'W12010826', 'UTIHCPHY', 'Southwest Spine and Pain-Cedar', 'Dayne', '', 'Johnson', 'PA-C', 'Pain Management', '', '', NULL, 'O', '1303 N Main St', 'Cedar City', 'Iron', 'UT', '84720', '4358685055', '4358685504', '1303 N Main St', 'Cedar City', 'Iron', 'UT', '84720', '4358685055', '4358685504', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-03-21', '2011-09-09', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669505178', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12010827', 'W12010827', 'UTIHCPHY', 'Sandy Clinic', 'Charles', 'D', 'Katz', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '9500 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8015012100', '8015012107', '9500 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8015012100', '8015012107', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922091230', 0, 'N', 0, '2011-04-28', NULL, NULL, 40.5787, -111.853, NULL, NULL),
('942854057', 'W12010828', 'W12010828', 'UTIHCPHY', 'Utah Valley Womens Center', 'Kari', 'F', 'Lawrence', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1034 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013577009', '8013578132', '1034 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013577009', '8013578132', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508827072', 0, 'N', 0, '2011-04-28', NULL, NULL, 40.2469, -111.667, 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', 'W12010830', 'W12010830', 'UTIHCPHY', 'Sunset Family Practice', 'Scott', 'G', 'Newbold', 'DO', 'Pediatrics', '', '', NULL, 'O', '1739 W Sunset Blvd', 'St George', 'Washington', 'UT', '84770', '4356346000', '4356346033', '1739 W Sunset Blvd', 'St George', 'Washington', 'UT', '84770', '4356346000', '4356346033', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-04-01', '2012-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033393806', 0, 'N', 0, '2013-05-30', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12010832', 'W12010832', 'UTIHCPHY', 'Utah Heart', 'Sheralee', 'D', 'Petersen', 'PA-C', 'Family Practice', '', '', NULL, 'O', '5169 Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', '8015073505', '5169 Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', '8015073505', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-03-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114110921', 0, 'N', 0, '2013-08-27', NULL, NULL, 40.659, -111.894, NULL, NULL),
('942854057', 'W12010833', 'W12010833', 'UTIHCPHY', 'Sandy Clinic', 'Craig', 'N', 'Stevens', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '9500 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8015012100', '8015012107', '9500 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8015012100', '8015012107', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-02-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780606194', 0, 'N', 0, '2014-02-05', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12010834', 'W12010834', 'UTIHCPHY', 'Budge Clinic Radiology', 'Michael', 'John', 'Stones', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357520422', '4357530401', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357520422', '4357530401', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-02-01', '2012-05-31', 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1689684094', 0, 'N', 0, '2012-09-10', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12010836', 'W12010836', 'UTIHCPHY', 'Budge Clinic Radiology', 'Agnes', 'M', 'Szpunar', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357520422', '4357530401', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357520422', '4357530401', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-02-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1033216858', 0, 'N', 0, '2011-04-28', NULL, NULL, 41.7565, -111.821, NULL, NULL),
('942854057', 'W12010838', 'W12010838', 'UTIHCPHY', 'Bountiful KidsCare', 'Matthew', 'A', 'Taintor', 'MD', 'Pediatrics', '', '', NULL, 'O', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012949933', '8012941183', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012949933', '8012941183', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1174776306', 0, 'N', 0, '2011-04-28', NULL, NULL, 40.8935, -111.881, NULL, NULL),
('942854057', 'W12010839', 'W12010839', 'UTIHCPHY', 'Budge Clinic Radiology', 'Bartley', 'Myron', 'Weiss', 'MD', 'General Surgery', '', '', NULL, 'O', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357520422', '4357530401', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357520422', '4357530401', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-02-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1942210364', 0, 'N', 0, '2012-02-29', NULL, NULL, 41.7565, -111.821, NULL, NULL),
('870284475', 'W12010840', 'W12010840', 'UT01', 'Granger Medical Clinic', 'Brandon', 'R', 'Allen', 'MD', 'Family Practice', NULL, NULL, 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, '2011-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1952333106', 0, 'N', 0, '2011-07-06', NULL, NULL, 40.5877, -111.967, NULL, NULL),
('870284475', 'W12010841', 'W12010841', 'UT01', 'Granger Medical Clinic', 'Dana', 'A', 'Andersen', 'MD', 'Family Practice', NULL, NULL, 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, '2011-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1578595724', 0, 'N', 0, '2011-07-01', NULL, NULL, 40.5877, -111.967, NULL, NULL),
('331064921', 'W12010842', 'W12010842', 'UT01', '', 'Ryan', 'K', 'Anderson', 'DPM', 'Podiatry', '', '', NULL, 'O', '3590 W 9000 S Ste 215', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015667297', '8013971938', '3590 W 9000 S Ste 215', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015667297', '8013971938', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-04-01', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053334730', 0, 'N', 0, '2014-02-03', NULL, NULL, 40.5879, -111.976, NULL, NULL),
('870653551', 'W12010843', 'W12010843', 'UT01', 'Park City Healthcare', 'Robert', 'W', 'Barnett', 'MD', 'Family Practice', '', '', NULL, 'O', '750 Round Valley Dr Ste 201', 'Park City', 'Summit', 'UT', '84060', '4356497640', '4356491365', '750 Round Valley Dr Ste 201', 'Park City', 'Summit', 'UT', '84060', '4356497640', '4356491365', 'WURURAL10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1831146752', 0, 'N', 0, '2012-09-06', NULL, NULL, 40.6855, -111.466, NULL, NULL),
('870653551', 'W12010845', 'W12010845', 'UT01', 'Park City Healthcare', 'Cress', 'R', 'Bohnn', 'MD', 'Family Practice', 'Sports Medicine', '', NULL, 'O', '750 Round Valley Dr Ste 201', 'Park City', 'Summit', 'UT', '84060', '4356497640', '4356491365', '750 Round Valley Dr Ste 201', 'Park City', 'Summit', 'UT', '84060', '4356497640', '4356491365', 'WURURAL10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1861423113', 0, 'N', 0, '2012-09-06', NULL, NULL, 40.6855, -111.466, NULL, NULL),
('870284475', 'W12010846', 'W12010846', 'UT01', 'Granger Medical Clinic', 'Craig', 'A', 'Brasher', 'MD', 'Pediatrics', '', '', 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, '2011-05-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1760410666', 0, 'N', 0, '2011-07-01', NULL, NULL, 40.5877, -111.967, NULL, NULL),
('870284475', 'W12010847', 'W12010847', 'UT01', 'Granger Medical Clinic', 'Alton', 'D', 'Burgett', 'MD', 'Obstetrics and Gynecology', NULL, NULL, 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, '2011-05-01', NULL, 0, 0, 0, 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1124059514', 0, 'N', 0, '2012-05-15', NULL, NULL, 40.5877, -111.967, NULL, NULL),
('870284475', 'W12010848', 'W12010848', 'UT01', 'Granger Medical Clinic', 'Dale', 'L', 'Chapman', 'MD', 'Pediatrics', '', '', 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, '2011-05-01', '2011-08-31', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1114959368', 0, 'N', 0, '2014-03-11', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'W12010849', 'W12010849', 'UT01', 'Granger Medical Clinic', 'Peter', 'L', 'Christensen', 'MD', 'Family Practice', NULL, NULL, 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, '2011-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1992737159', 0, 'N', 0, '2011-07-01', NULL, NULL, 40.5877, -111.967, NULL, NULL),
('870284475', 'W12010850', 'W12010850', 'UT01', 'Granger Medical Clinic', 'Steven', 'C', 'Dinger', 'MD', 'Obstetrics and Gynecology', NULL, NULL, 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, '2011-05-01', '2013-09-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770514168', 0, 'N', 0, '2013-08-20', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'W12010851', 'W12010851', 'UT01', 'Granger Medical Clinic', 'Alyson', '', 'Eyre', 'MD', 'Pediatrics', NULL, NULL, 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, '2011-05-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1508897927', 0, 'N', 0, '2011-07-01', NULL, NULL, 40.5877, -111.967, NULL, NULL),
('870284475', 'W12010852', 'W12010852', 'UT01', 'Granger Medical Clinic', 'Randall', 'R', 'Fillmore', 'MD', 'Family Practice', NULL, NULL, 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, '2011-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1386675627', 0, 'N', 0, '2011-07-01', NULL, NULL, 40.5877, -111.967, NULL, NULL),
('870284475', 'W12010853', 'W12010853', 'UT01', 'Granger Medical Clinic', 'Kelly', 'L', 'Hamblin', 'DPM', 'Podiatry', NULL, NULL, 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, '2011-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', 'Pioneer Valley Hospital', NULL, 'HCFA|UB|', '1770515926', 0, 'N', 0, '2011-07-05', NULL, NULL, 40.5877, -111.967, NULL, NULL),
('273851655', 'W12010854', 'W12010854', 'ID02', 'Pioneer Sports and Pain Center', 'Stephen', 'K', 'Burtenshaw', 'DC', 'Chiropractic', '', '', NULL, 'O', '1619 N Linder Rd', 'Kuna', 'Ada', 'ID', '83634', '2089224908', NULL, '1619 N Linder Rd', 'Kuna', 'Ada', 'ID', '83634', '2089224908', '          ', 'IDCHIRO1', '', '', '0.00', '35.00', '0.00', 3, '2011-04-28', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1386652691', 0, 'N', 0, '2013-06-20', NULL, NULL, 0, 0, NULL, NULL),
('870653551', 'W12010855', 'W12010855', 'UT01', 'Park City Healthcare', 'Stefani', 'J', 'Day', 'MD', 'Family Practice', '', '', NULL, 'O', '750 Round Valley Dr Ste 201', 'Park City', 'Summit', 'UT', '84060', '4356497640', '4356491365', '750 Round Valley Dr Ste 201', 'Park City', 'Summit', 'UT', '84060', '4356497640', '4356491365', 'WURURAL10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-05-01', NULL, 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1265439236', 0, 'N', 0, '2014-04-22', NULL, NULL, 40.6855, -111.466, NULL, NULL),
('870653551', 'W12010856', 'W12010856', 'UT01', 'Park City Healthcare', 'Heather', 'D', 'Thoerner', 'MD', 'Family Practice', 'Sports Medicine', '', NULL, 'O', '750 Round Valley Dr Ste 201', 'Park City', 'Summit', 'UT', '84060', '4356497640', '4356491365', '750 Round Valley Dr Ste 201', 'Park City', 'Summit', 'UT', '84060', '4356497640', '4356491365', 'WURURAL10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528103314', 0, 'N', 0, '2013-10-14', NULL, NULL, 40.6855, -111.466, NULL, NULL),
('870653551', 'W12010857', 'W12010857', 'UT01', 'Park City Healthcare', 'Robert', 'J', 'Evers', 'MD', 'Family Practice', '', '', NULL, 'O', '750 Round Valley Dr Ste 201', 'Park City', 'Summit', 'UT', '84060', '4356497640', '4356491365', '750 Round Valley Dr Ste 201', 'Park City', 'Summit', 'UT', '84060', '4356497640', '4356491365', 'WURURAL10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-05-01', NULL, 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1720033905', 0, 'N', 0, '2011-04-28', NULL, NULL, 40.6855, -111.466, NULL, NULL),
('870653551', 'W12010858', 'W12010858', 'UT01', 'Park City Healthcare', 'Joseph', 'P', 'Ferriter', 'MD', 'Family Practice', 'Urgent Care', '', NULL, 'O', '750 Round Valley Dr Ste 201', 'Park City', 'Summit', 'UT', '84060', '4356497640', '4356491365', '750 Round Valley Dr Ste 201', 'Park City', 'Summit', 'UT', '84060', '4356497640', '4356491365', 'WURURAL10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1023063575', 0, 'N', 0, '2014-04-08', NULL, NULL, 40.6855, -111.466, NULL, NULL),
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('364288180', 'W12010862', 'W12010862', 'UT01', '', 'Mark', 'T', 'Hansen', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 6220', 'Logan', 'Cache', 'UT', '84341', '4357139710', '4357538005', 'PO Box 6220', 'Logan', 'Cache', 'UT', '84341', '4357139710', '4357538005', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-06-01', NULL, 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1689646507', 0, 'N', 0, '2014-07-03', NULL, NULL, 0, 0, NULL, NULL),
('364288180', 'W12010861', 'W12010861', 'UT01', '', 'Mark', 'T', 'Hansen', 'MD', 'General Surgery', '', '', NULL, 'O', '2380 N 400 S Ste G', 'Logan', 'Cache', 'UT', '84341', '4357131300', '4357131320', '2380 N 400 S Ste G', 'Logan', 'Cache', 'UT', '84341', '4357131300', '4357131320', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-06-01', NULL, 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1689646507', 0, 'N', 0, '2014-07-03', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'W12010863', 'W12010863', 'UT01', 'Granger Medical Clinic', 'David', 'A', 'Harris', 'MD', 'Pediatrics', NULL, NULL, 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, '2011-05-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1922023324', 0, 'N', 0, '2011-07-05', NULL, NULL, 40.5877, -111.967, NULL, NULL),
('870284475', 'W12010864', 'W12010864', 'UT01', 'Granger Medical Clinic', 'Christopher', '', 'Hutchison', 'MD', 'Obstetrics and Gynecology', NULL, NULL, 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, '2011-05-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', NULL, NULL, 'HCFA|UB|', '1134151384', 0, 'N', 0, '2012-06-21', NULL, NULL, 40.5877, -111.967, NULL, NULL),
('870284475', 'W12010865', 'W12010865', 'UT01', 'Granger Medical Clinic', 'Qamar', 'R', 'Khan', 'DO', 'Physical Medicine and Rehabilitation', 'Pain Management', '', 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, '2011-05-01', '2013-01-15', 0, 0, 0, 'Pioneer Valley Hospital', '', '', '', 'HCFA|UB|', '1407026420', 0, 'N', 0, '2013-11-04', NULL, NULL, 0, 0, NULL, NULL),
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('870284475', 'W12010869', 'W12010869', 'UT01', 'Granger Medical Clinic', 'Karen', 'A', 'Nash', 'NP', 'Pediatrics', '', '', 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, '2011-05-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1770514127', 0, 'N', 0, '2011-06-29', NULL, NULL, 40.5877, -111.967, NULL, NULL),
('870284475', 'W12010870', 'W12010870', 'UT01', 'Granger Medical Clinic', 'Michael', 'J', 'Sanderson', 'MD', 'Family Practice', '', '', 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, '2011-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1215134663', 0, 'N', 0, '2011-04-28', NULL, NULL, 40.5877, -111.967, NULL, NULL),
('870653551', 'W12010871', 'W12010871', 'UT01', 'Park City Healthcare', 'Christopher', 'L', 'Hays', 'MD', 'Family Practice', 'Sports Medicine', 'Urgent Care', NULL, 'O', '750 Round Valley Dr Ste 201', 'Park City', 'Summit', 'UT', '84060', '4356497640', '4356491365', '750 Round Valley Dr Ste 201', 'Park City', 'Summit', 'UT', '84060', '4356497640', '4356491365', 'WURURAL10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-05-01', NULL, 0, 0, 0, 'Park City Medical Center', 'Salt Lake Regional Medical Center', '', '', 'HCFA|UB|', '1144274499', 0, 'N', 0, '2014-04-08', NULL, NULL, 40.6855, -111.466, NULL, NULL),
('870653551', 'W12010872', 'W12010872', 'UT01', 'Park City Healthcare', 'Charles', 'R', 'Morrison', 'MD', 'Family Practice', 'Urgent Care', '', NULL, 'O', '750 Round Valley Dr Ste 201', 'Park City', 'Summit', 'UT', '84060', '4356497640', '4356491365', '750 Round Valley Dr Ste 201', 'Park City', 'Summit', 'UT', '84060', '4356497640', '4356491365', 'WURURAL10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1083669204', 0, 'N', 0, '2014-04-08', NULL, NULL, 40.6855, -111.466, NULL, NULL),
('870653551', 'W12010873', 'W12010873', 'UT01', 'Park City Healthcare', 'William', 'Bryant', 'Pidwell', 'MD', 'Family Practice', '', '', NULL, 'O', '750 Round Valley Dr Ste 201', 'Park City', 'Summit', 'UT', '84060', '4356497640', '4356491365', '750 Round Valley Dr Ste 201', 'Park City', 'Summit', 'UT', '84060', '4356497640', '4356491365', 'WURURAL10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1548208028', 0, 'N', 0, '2012-09-10', NULL, NULL, 40.6855, -111.466, NULL, NULL),
('870653551', 'W12010874', 'W12010874', 'UT01', 'Park City Healthcare', 'Lisa', 'M', 'Saturnino', 'MD', 'Family Practice', '', '', NULL, 'O', '750 Round Valley Dr Ste 201', 'Park City', 'Summit', 'UT', '84060', '4356497640', '4356491365', '750 Round Valley Dr Ste 201', 'Park City', 'Summit', 'UT', '84060', '4356497640', '4356491365', 'WURURAL10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1336362490', 0, 'N', 0, '2013-05-23', NULL, NULL, 40.6855, -111.466, NULL, NULL),
('870653551', 'W12010875', 'W12010875', 'UT01', 'Park City Healthcare', 'Robert', 'T', 'Winn', 'MD', 'Family Practice', 'Pediatrics', 'Urgent Care', NULL, 'O', '750 Round Valley Dr Ste 201', 'Park City', 'Summit', 'UT', '84060', '4356497640', '4356491365', '750 Round Valley Dr Ste 201', 'Park City', 'Summit', 'UT', '84060', '4356497640', '4356491365', 'WURURAL10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-05-01', NULL, 0, 0, 0, 'Park City Medical Center', '', '', '', 'HCFA|UB|', '1912951393', 0, 'N', 0, '2014-04-08', NULL, NULL, 40.6855, -111.466, NULL, NULL),
('621801973', 'W12010877', 'W12010877', 'UT01', 'Salt Lake Regional Womens Clinic', 'Sara Jane', '', 'Hake-Brooks', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '24 S 1100 E Ste 209', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8012147650', '8012147651', '24 S 1100 E Ste 209', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8012147650', '8012147651', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-11', '2012-04-30', 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1174617310', 0, 'N', 0, '2012-05-14', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12010878', 'W12010878', 'UT01', 'Salt Lake Regional Womens Clinic', 'Sara Jane', '', 'Hake-Brooks', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '7852 S Pioneer St', 'Midvale', 'Salt Lake', 'UT', '84047', '8012147650', '8012147651', '7852 S Pioneer St', 'Midvale', 'Salt Lake', 'UT', '84047', '8012147650', '8012147651', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-11', '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, 40.6085, -111.9, NULL, NULL),
('621801973', 'W12010879', 'W12010879', 'UT01', 'Salt Lake Regional Womens Clinic', 'Sara Jane', '', 'Hake-Brooks', 'CNM', '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, '2011-03-11', '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, 0, 0, NULL, NULL),
('263031859', 'W12010880', 'W12010880', 'ID01', 'Connections Counseling Center', 'Laurisa', 'R', 'Lusby', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '6550 W Emerald St Ste 110', 'Boise', 'Ada', 'ID', '83704', '2089213501', '8883098143', '6550 W Emerald St Ste 110', 'Boise', 'Ada', 'ID', '83704', '2089213501', '8883098143', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2011-04-28', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306974365', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12010882', 'W12010882', 'UT01', 'Central Utah Clinic PC', 'Garry', 'T', 'Miller', 'DO', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014298180', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014298180', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-10-01', NULL, 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053568592', 0, 'N', 0, '2013-04-10', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12010881', 'W12010881', 'UT01', 'Central Utah Clinic PC', 'Garry', 'T', 'Miller', 'DO', 'Internal Medicine', '', '', NULL, 'O', '1120 E 100 N Ste 1', 'Payson', 'Utah', 'UT', '84651', '8014654813', '8018125433', '1120 E 100 N Ste 1', 'Payson', 'Utah', 'UT', '84651', '8014654813', '8018125433', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-10-01', NULL, 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053568592', 0, 'N', 0, '2013-04-10', NULL, NULL, 40.045, -111.713, NULL, NULL),
('621801973', 'W12010883', 'W12010883', 'UT01', 'Comprehensive Neurology of Utah ', 'Wonhong', 'D', 'Min', 'MD', 'Neurosurgery', '', '', NULL, 'O', '82 S 1100 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8018197287', '8013504507', '82 S 1100 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8018197287', '8013504507', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-04-14', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1053304204', 0, 'N', 0, '2013-09-20', NULL, NULL, 40.7676, -111.86, NULL, NULL),
('621801973', 'W12010884', 'W12010884', 'UT01', 'Comprehensive Neurology of Utah ', 'Wonhong', 'D', 'Min', 'MD', 'Neurosurgery', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-04-14', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1053304204', 0, 'N', 0, '2013-09-20', NULL, NULL, 0, 0, NULL, NULL),
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('621801973', 'W12010885', 'W12010885', 'UT01', 'Physician Group of Utah', 'Jeanette', 'C', 'Nelson', 'PA-C', 'Family Practice', '', '', NULL, 'O', '82 S 1100 E Ste 303', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8014245042', '8012938618', '82 S 1100 E Ste 303', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8014245042', '8012938618', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-04-01', '2011-09-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730481912', 0, 'N', 0, '2011-10-11', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12010886', 'W12010886', 'UT01', 'Physician Group of Utah', 'Jeanette', 'C', 'Nelson', 'PA-C', 'Family Practice', '', '', NULL, 'O', '9350 S 150 E Ste 460', 'Sandy', 'Salt Lake', 'UT', '84070', '8014245042', '8012938618', '9350 S 150 E Ste 460', 'Sandy', 'Salt Lake', 'UT', '84070', '8014245042', '8012938618', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-04-01', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730481912', 0, 'N', 0, '2011-10-11', NULL, NULL, 40.5814, -111.887, NULL, NULL),
('621801973', 'W12010889', 'W12010889', 'UT01', 'Physician Group of Utah', 'Jeanette', 'C', 'Nelson', 'PA-C', 'Family Practice', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-04-01', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730481912', 0, 'N', 0, '2011-10-11', NULL, NULL, 0, 0, NULL, NULL),
('870767026', 'W12010893', 'W12010893', 'ID01', 'West Valley Medical Group', 'J Cinda', 'J', 'Bitters', 'MD', 'Family Practice', '', '', NULL, 'O', '16459 M Midland Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2087955075', '2084593372', '16459 M Midland Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2087955075', '2084593372', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2011-09-01', '2012-06-30', 0, 0, 0, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1104089556', 0, 'N', 0, '2013-08-16', NULL, NULL, 43.6116, -116.593, NULL, NULL),
('870767026', 'W12010892', 'W12010892', 'ID01', 'West Valley Medical Group', 'J Cinda', 'J', 'Bitters', 'MD', 'Family Practice', '', '', NULL, 'O', '211 E Logan St Ste 203', 'Caldwell', 'Canyon', 'ID', '83605', '2084594667', '2084593372', '211 E Logan St Ste 203', 'Caldwell', 'Canyon', 'ID', '83605', '2084594667', '2084593372', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2011-09-01', '2012-06-30', 0, 0, 0, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1104089556', 0, 'N', 0, '2013-08-16', NULL, NULL, 43.6554, -116.697, NULL, NULL),
('870767026', 'W12010894', 'W12010894', 'ID01', 'West Valley Medical Group', 'J Cinda', 'J', 'Bitters', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 277976', 'Atlanta', 'Fulton', 'GA', '30384', '8015470747', '2084593372', 'PO Box 277976', 'Atlanta', 'Fulton', 'GA', '30384', '8015470747', '2084593372', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2011-09-01', '2012-06-30', 0, 0, 0, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1104089556', 0, 'N', 0, '2013-08-16', NULL, NULL, 0, 0, NULL, NULL),
('870468377', 'W12010896', 'W12010896', 'UT01', 'University Health Care', 'Kimberly ', 'A', 'Pettit', 'MD', 'Dermatology', '', '', NULL, 'O', '1743 W Redstone Ctr Ste 115', 'Park City', 'Summit', 'UT', '84098', '4356589200', NULL, '1743 W Redstone Ctr Ste 115', 'Park City', 'Summit', 'UT', '84098', '4356589200', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2010-10-05', '2012-09-17', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093789299', 0, 'N', 0, '2012-09-17', NULL, NULL, 0, 0, NULL, NULL),
('870468377', 'W12010895', 'W12010895', 'UT01', 'University Health Care', 'Kimberly ', 'A', 'Pettit', 'MD', 'Dermatology', '', '', NULL, 'O', '4696 Daybreak Rim Way', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015812955', NULL, '4696 Daybreak Rim Way', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015812955', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2010-10-05', '2011-12-18', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093789299', 0, 'N', 0, '2011-12-19', NULL, NULL, 0, 0, NULL, NULL),
('870468377', 'W12010890', 'W12010890', 'UT01', 'University Health Care', 'Kimberly ', 'A', 'Pettit', 'MD', 'Dermatology', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812955', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812955', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2010-10-05', '2012-09-17', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093789299', 0, 'N', 0, '2012-09-17', NULL, NULL, 0, 0, NULL, NULL),
('870468377', 'W12010897', 'W12010897', 'UT01', 'University Health Care', 'Kimberly ', 'A', 'Pettit', 'MD', 'Dermatology', '', '', NULL, 'O', '6095 S 300 E', 'Murray', 'Salt Lake', 'UT', '84107', '8015812955', NULL, '6095 S 300 E', 'Murray', 'Salt Lake', 'UT', '84107', '8015812955', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2010-10-05', '2012-09-17', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093789299', 0, 'N', 0, '2012-09-17', NULL, NULL, 0, 0, NULL, NULL),
('870468377', 'W12010891', 'W12010891', 'UT01', 'U-U Dermatology Division', 'Kimberly ', 'A', 'Pettit', 'MD', 'Dermatology', '', '', NULL, 'B', 'PO Box 3208', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8015876340', NULL, 'PO Box 3208', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8015876340', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2010-10-05', '2012-09-17', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093789299', 0, 'N', 0, '2012-09-17', NULL, NULL, 0, 0, NULL, NULL),
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('273683284', 'W12010899', 'W12010899', 'Sinclair', '(Sinclair Health Services\rProvider) Northern Arizona Podiatry', 'Travis ', '', 'Reber', 'DPM', 'Podiatry', '', '', NULL, 'O', '940 N Switzer Canyon Ste 102', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287795111', '9287791374', '940 N Switzer Canyon Ste 102', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287795111', '9287791374', 'AZSINCLAIRd', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952436446', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('800239738', 'W12010900', 'W12010900', 'UT01', 'Jordan Family Health', 'Annliza', '', 'Piacitelli', 'MD', 'Family Practice', '', '', NULL, 'O', '8846 S Redwood Rd Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', '8846 S Redwood Rd Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2011-12-31', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1205034113', 0, 'N', 0, '2012-06-22', NULL, NULL, 0, 0, NULL, NULL),
('264807854', 'W12010901', 'W12010901', 'UT01', 'Physician Wound Care and Hyperbaric Service', 'Bret', 'R', 'Boyle', 'DO', 'Wound Care', '', '', NULL, 'O', '6508 Canyon Cove Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012720355', '8012789182', '6508 Canyon Cove Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012720355', '8012789182', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598844839', 0, 'N', 0, '2011-11-10', NULL, NULL, 40.6324, -111.793, NULL, NULL),
('954473630', 'W12010902', 'W12010902', 'ID01', 'Armstrong Root Opticians', 'Scott', 'B', 'Wayment', 'OD PA', 'Optometry', '', '', NULL, 'O', '649 Sun Valley Rd', 'Ketchum', 'Blaine', 'ID', '83340', '2087264250', '2087270082', '649 Sun Valley Rd', 'Ketchum', 'Blaine', 'ID', '83340', '2087264250', '2087270082', 'IDOPTOMETRY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770683757', 0, 'N', 0, '2014-07-23', NULL, NULL, 43.6912, -114.357, NULL, NULL),
('954473630', 'W12010903', 'W12010903', 'ID01', 'Armstrong Root Opticians', 'Scott', 'B', 'Wayment', 'OD PA', 'Optometry', '', '', NULL, 'B', 'PO Box 6', 'Sun Valley', 'Blaine', 'ID', '83353', '2087264250', '2087270082', 'PO Box 6', 'Sun Valley', 'Blaine', 'ID', '83353', '2087264250', '2087270082', 'IDOPTOMETRY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770683757', 0, 'N', 0, '2014-07-23', NULL, NULL, 0, 0, NULL, NULL),
('330521340', 'W12010904', 'W12010904', 'UTMH1', '', 'Kenyon', '', 'Tew', 'LMFT', 'Mental Health', 'Marriage & Family Therapy', '', NULL, 'O', '2234 N 5500 E', 'Eden', 'Weber', 'UT', '84310', '8013342431', '8014794768', '2234 N 5500 E', 'Eden', 'Weber', 'UT', '84310', '8013342431', '8014794768', 'PHD', '', '', '0.00', '35.00', '0.00', 3, '2011-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750371951', 0, 'N', 0, '2014-03-31', NULL, NULL, 0, 0, NULL, NULL),
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('330521340', 'W12010905', 'W12010905', 'UTMH1', '', 'Kenyon', '', 'Tew', 'LMFT', 'Mental Health', 'Marriage & Family Therapy', '', NULL, 'M', 'PO Box 775', 'Eden', 'Weber', 'UT', '84310', '8013342431', '8014794768', 'PO Box 775', 'Eden', 'Weber', 'UT', '84310', '8013342431', '8014794768', 'PHD', '', '', '0.00', '35.00', '0.00', 3, '2011-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750371951', 0, 'N', 0, '2014-03-31', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12010909', 'W12010909', 'UT01', 'Salt Lake Regional Womens Clinic', 'Haley', '', 'Summerhays', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '7852 S Pioneer St', 'Midvale', 'Salt Lake', 'UT', '84047', '8012147650', '8012147651', '7852 S Pioneer St', 'Midvale', 'Salt Lake', 'UT', '84047', '8012147650', '8012147651', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', '2011-10-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386951333', 0, 'N', 0, '2011-12-20', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12010910', 'W12010910', 'UT01', 'Salt Lake Regional Womens Clinic', 'Haley', '', 'Summerhays', 'CNM', '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, '2011-03-01', '2011-10-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386951333', 0, 'N', 0, '2011-12-20', NULL, NULL, 0, 0, NULL, NULL),
('870498345', 'W12010911', 'W12010911', 'UT01', '', 'Leonard', 'J', 'Swinyer', 'MD', 'Dermatology', NULL, NULL, NULL, 'O', '1548 E 4500 S Ste 202', 'Salt Lake City', 'Salt Lake', 'UT', '84114', '8012668841', '8012660449', '1548 E 4500 S Ste 202', 'Salt Lake City', 'Salt Lake', 'UT', '84114', '8012668841', '8012660449', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-03', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1538153234', 0, 'N', 0, '2013-11-04', NULL, NULL, 40.6743, -111.846, NULL, NULL),
('870355239', 'W12010912', 'W12010912', 'UT01', 'Advanced Eye Care', 'Francis', 'J', 'Wapner', 'MD', 'Ophthalmology', '', '', NULL, 'O', '3556 W 9800 S Ste 104', 'South Jordan', 'Salt Lake', 'UT', '84095', '8016762020', NULL, '3556 W 9800 S Ste 104', 'South Jordan', 'Salt Lake', 'UT', '84095', '8016762020', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-04-29', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1023110681', 0, 'N', 0, '2013-08-23', NULL, NULL, 40.5732, -111.975, NULL, NULL),
('870498345', 'W12010913', 'W12010913', 'UT01', '', 'Douglas', 'M', 'Woseth', 'MD', 'Dermatology', NULL, NULL, NULL, 'O', '1548 E 4500 S Ste 202', 'Salt Lake City', 'Salt Lake', 'UT', '84114', '8012668841', '8012660449', '1548 E 4500 S Ste 202', 'Salt Lake City', 'Salt Lake', 'UT', '84114', '8012668841', '8012660449', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-03', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1619978970', 0, 'N', 0, '2013-12-04', NULL, NULL, 40.6743, -111.846, NULL, NULL),
('742608033', 'W12010923', 'W12010923', 'TX01', 'Southwest Childrens Center', 'Shannon', 'M', 'Austin', 'MD', 'Pediatrics', '', '', NULL, 'O', '5282 Medical Dr Ste 310', 'San Antonio', 'Bexar', 'TX', '78229', '2106148687', NULL, '5282 Medical Dr Ste 310', 'San Antonio', 'Bexar', 'TX', '78229', '2106148687', '          ', 'TXPEDB', 'TXHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-07-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790965770', 0, 'N', 0, '2011-06-29', NULL, NULL, 29.5087, -98.5879, NULL, NULL),
('742608033', 'W12010924', 'W12010924', 'TX01', 'Southwest Childrens Center', 'Marshall', 'J', 'Benbow', 'MD', 'Pediatrics', '', '', NULL, 'O', '5282 Medical Dr Ste 310', 'San Antonio', 'Bexar', 'TX', '78229', '2106148687', '', '5282 Medical Dr Ste 310', 'San Antonio', 'Bexar', 'TX', '78229', '2106148687', '', 'TXPEDB', 'TXHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-07-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851395636', 0, 'N', 0, '2014-07-21', NULL, NULL, 29.5087, -98.5879, NULL, NULL),
('742608033', 'W12010925', 'W12010925', 'TX01', 'Southwest Childrens Center', 'Tina', 'H', 'Boylston', 'MD', 'Pediatrics', '', '', NULL, 'O', '5282 Medical Dr Ste 310', 'San Antonio', 'Bexar', 'TX', '78229', '2106148687', NULL, '5282 Medical Dr Ste 310', 'San Antonio', 'Bexar', 'TX', '78229', '2106148687', '          ', 'TXPEDB', 'TXHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-07-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508860313', 0, 'N', 0, '2012-01-26', NULL, NULL, 29.5087, -98.5879, NULL, NULL),
('742608033', 'W12010926', 'W12010926', 'TX01', 'Southwest Childrens Center', 'Rose', 'C', 'Cofer', 'MD', 'Pediatrics', '', '', NULL, 'O', '5282 Medical Dr Ste 310', 'San Antonio', 'Bexar', 'TX', '78229', '2106148687', NULL, '5282 Medical Dr Ste 310', 'San Antonio', 'Bexar', 'TX', '78229', '2106148687', '          ', 'TXPEDB', 'TXHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-07-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225032022', 0, 'N', 0, '2011-06-29', NULL, NULL, 29.5087, -98.5879, NULL, NULL),
('742608033', 'W12010927', 'W12010927', 'TX01', 'Southwest Childrens Center', 'Wilson', 'W', 'Grant', 'MD', 'Pediatrics', '', '', NULL, 'O', '5282 Medical Dr Ste 310', 'San Antonio', 'Bexar', 'TX', '78229', '2106148687', NULL, '5282 Medical Dr Ste 310', 'San Antonio', 'Bexar', 'TX', '78229', '2106148687', '          ', 'TXPEDB', 'TXHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-07-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003810888', 0, 'N', 0, '2013-10-15', NULL, NULL, 29.5087, -98.5879, NULL, NULL),
('261703236', 'W12008739', 'W12008739', 'UTMH1', 'Clinical Consultants', 'Natalie', 'L', 'Jenson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '7601 S Redwood Rd Bldg E', 'West Jordan', 'Salt Lake', 'UT', '84084', '8012338670', '8012338682', '7601 S Redwood Rd Bldg E', 'West Jordan', 'Salt Lake', 'UT', '84084', '8012338670', '8012338682', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2011-06-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437478534', 0, 'N', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('742608033', 'W12010928', 'W12010928', 'TX01', 'Southwest Childrens Center', 'Lanning', 'D', 'Jones', 'MD', 'Pediatrics', '', '', NULL, 'O', '5282 Medical Dr Ste 310', 'San Antonio', 'Bexar', 'TX', '78229', '2106148687', '', '5282 Medical Dr Ste 310', 'San Antonio', 'Bexar', 'TX', '78229', '2106148687', '', 'TXPEDB', 'TXHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-07-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811991599', 0, 'N', 0, '2014-07-21', NULL, NULL, 29.5087, -98.5879, NULL, NULL),
('208920300', 'W12010929', 'W12010929', 'UT01', 'Kidney and Hypertension Institute of Utah PLLC', 'Ryan ', 'P', 'McDonald', 'MD', 'Nephrology', '', '', NULL, 'O', '2132 N 1700 W Ste 110', 'Layton', 'Davis', 'UT', '84041', '8014763400', '8014767050', '2132 N 1700 W Ste 110', 'Layton', 'Davis', 'UT', '84041', '8014763400', '8014767050', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1194915561', 1, 'N', 0, '2011-06-29', NULL, NULL, 41.0892, -111.997, NULL, NULL),
('208920300', 'W12010930', 'W12010930', 'UT01', 'Kidney and Hypertension Institute of Utah PLLC', 'Ryan ', 'P', 'McDonald', 'MD', 'Nephrology', '', '', NULL, 'O', '4780 Old Post Rd', 'Ogden', 'Weber', 'UT', '84403', '8014763400', '8014767050', '4780 Old Post Rd', 'Ogden', 'Weber', 'UT', '84403', '8014763400', '8014767050', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1194915561', 0, 'N', 0, '2011-06-29', NULL, NULL, 41.1764, -111.948, NULL, NULL),
('208920300', 'W12010931', 'W12010931', 'UT01', 'Kidney and Hypertension Institute of Utah PLLC', 'Ryan ', 'P', 'McDonald', 'MD', 'Nephrology', '', '', NULL, 'B', 'PO Box 10273', 'Uniondale', 'Nassau', 'NY', '11555', '8014763400', '8014767050', 'PO Box 10273', 'Uniondale', 'Nassau', 'NY', '11555', '8014763400', '8014767050', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1194915561', 0, 'N', 0, '2011-06-29', NULL, NULL, 0, 0, NULL, NULL),
('742608033', 'W12010932', 'W12010932', 'TX01', 'Southwest Childrens Center', 'Shelly', 'M', 'McNair', 'MD', 'Pediatrics', '', '', NULL, 'O', '5282 Medical Dr Ste 310', 'San Antonio', 'Bexar', 'TX', '78229', '2106148687', NULL, '5282 Medical Dr Ste 310', 'San Antonio', 'Bexar', 'TX', '78229', '2106148687', '          ', 'TXPEDB', 'TXHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-07-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184628984', 0, 'N', 0, '2011-06-29', NULL, NULL, 29.5087, -98.5879, NULL, NULL),
('742608033', 'W12010933', 'W12010933', 'TX01', 'Southwest Childrens Center', 'Lewis', 'M', 'Purnell', 'MD', 'Pediatrics', '', '', NULL, 'O', '5282 Medical Dr Ste 310', 'San Antonio', 'Bexar', 'TX', '78229', '2106148687', NULL, '5282 Medical Dr Ste 310', 'San Antonio', 'Bexar', 'TX', '78229', '2106148687', '          ', 'TXPEDB', 'TXHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-07-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376547166', 0, 'N', 0, '2013-10-08', NULL, NULL, 29.5087, -98.5879, NULL, NULL),
('383725436', 'W12010934', 'W12010934', 'UT01', 'University Health Care', 'Michael', 'G', 'Spigarelli', 'MD', 'Internal Medicine', 'Pediatrics', '', NULL, 'O', '50 N Medical Dr Ste ', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015813501', '8015813899', '50 N Medical Dr Ste ', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015813501', '8015813899', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2011-02-17', '2012-07-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053369942', 0, 'N', 0, '2013-01-14', NULL, NULL, 0, 0, NULL, NULL),
('383725436', 'W12010935', 'W12010935', 'UT01', 'Pediatric Adolescent Medicine-Department of University of Ut', 'Michael', 'G', 'Spigarelli', 'MD', 'Internal Medicine', 'Pediatrics', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015853655', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015853655', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2011-02-17', '2012-07-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053369942', 0, 'N', 0, '2013-01-14', NULL, NULL, 0, 0, NULL, NULL),
('237268471', 'W12010937', 'W12010937', 'UT01', 'University Health Care', 'Matthew', 'A', 'Stein', 'MD', 'Diagnostic Radiology', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817553', '8015850520', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817553', '8015850520', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2011-03-04', '2012-08-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700836947', 0, 'N', 0, '2012-08-02', NULL, NULL, 0, 0, NULL, NULL),
('237268471', 'W12010938', 'W12010938', 'UT01', 'University Radiology Associates', 'Matthew', 'A', 'Stein', 'MD', 'Diagnostic Radiology', '', '', NULL, 'B', 'PO Box 413025', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015853655', 'PO Box 413025', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015853655', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2011-03-04', '2012-08-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700836947', 0, 'N', 0, '2012-08-02', 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
('710885968', 'W12010940', 'W12010940', 'ID01', 'U of U Pain Management Physicians Group', 'Adrienne', 'L', 'Aldous', 'RD', 'Dietician', '', '', NULL, 'B', 'PO Box 413034', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413034', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2011-03-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982905386', 0, 'N', 0, '2011-05-02', NULL, NULL, 0, 0, NULL, NULL),
('710885968', 'W12010941', 'W12010941', 'UT01', 'University Health Care', 'Adrienne', 'L', 'Aldous', 'RD', 'Dietician', '', '', NULL, 'O', '546 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015816393', NULL, '546 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015816393', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2011-03-10', '2012-08-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982905386', 0, 'N', 0, '2012-08-31', NULL, NULL, 0, 0, NULL, NULL),
('870480520', 'W12010944', 'W12010944', 'UT01', 'University Health Care', 'Helen', '', 'Barkan', 'MD', 'Neurology', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015856387', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015856387', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2011-03-02', '2012-08-09', 0, 0, 0, 'Primary Childrens Medical Center', 'University Health Care University Hospital', NULL, NULL, 'HCFA|UB|', '1093898918', 0, 'N', 0, '2012-08-10', NULL, NULL, 0, 0, NULL, NULL),
('870480520', 'W12010943', 'W12010943', 'UT01', 'University of Utah Dept of Neurology', 'Helen', '', 'Barkan', 'MD', 'Neurology', '', '', NULL, 'B', 'PO Box 413027', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413027', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2011-03-02', '2012-08-09', 0, 0, 0, 'Primary Childrens Medical Center', 'University Health Care University Hospital', NULL, NULL, 'HCFA|UB|', '1093898918', 0, 'N', 0, '2012-08-10', NULL, NULL, 0, 0, NULL, NULL),
('870515631', 'W12010946', 'W12010946', 'UT01', 'University Health Care', 'Joseph', 'G', 'Cunniff', 'DO', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812267', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812267', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2011-03-08', '2012-08-22', 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1013980119', 0, 'N', 0, '2012-08-23', NULL, NULL, 0, 0, NULL, NULL),
('870515631', 'W12010945', 'W12010945', 'UT01', 'UUMC Rehab Medicine', 'Joseph', 'G', 'Cunniff', 'DO', 'Physical Medicine and Rehabilitation', '', '', NULL, 'B', 'PO box 413032', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO box 413032', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2011-03-08', '2012-08-22', 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1013980119', 0, 'N', 0, '2012-08-23', NULL, NULL, 0, 0, NULL, NULL),
('870480520', 'W12007585', 'W12007585', 'UT01', 'University Health Care', 'Yuko', '', 'Matsuoka', 'APRN', 'Hematolgy and Oncology', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015856387', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015856387', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-04-21', '2012-08-09', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114151115', 0, 'N', 0, '2012-08-10', NULL, NULL, 0, 0, NULL, NULL),
('870480520', 'W12007586', 'W12007586', 'UT01', 'Dept of Neurology School of Medicine U of U', 'Yuko', '', 'Matsuoka', 'APRN', 'Hematolgy and Oncology', '', '', NULL, 'B', 'PO Box 413027', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413027', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-04-21', '2012-08-09', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114151115', 0, 'N', 0, '2012-08-10', NULL, NULL, 0, 0, NULL, NULL),
('710920170', 'W12010948', 'W12010948', 'UT01', 'University of Utah', 'Yuko', '', 'Matsuoka', 'APRN', 'Hematolgy and Oncology', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015816909', '8015814385', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015816909', '8015814385', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-04-21', '2012-08-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114151115', 0, 'N', 0, '2012-08-21', NULL, NULL, 0, 0, NULL, NULL),
('710920170', 'W12010947', 'W12010947', 'UT01', 'Medical Neuroscience', 'Yuko', '', 'Matsuoka', 'APRN', 'Hematolgy and Oncology', '', '', NULL, 'B', 'PO Box 413030', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413030', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-04-21', '2012-08-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114151115', 0, 'N', 0, '2012-08-21', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W12010951', 'W12010951', 'UT01', 'University Health Care', 'Brandon', 'L', 'Reynolds', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '4696 Daybreak Rim Way', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012134500', NULL, '4696 Daybreak Rim Way', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012134500', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-08', '2011-12-18', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710972641', 0, 'N', 0, '2011-12-19', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W12010950', 'W12010950', 'UT01', 'U of U Hospitals and Clinics', 'Brandon', 'L', 'Reynolds', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876303', NULL, 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876303', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-08', '2012-09-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710972641', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('870483582', 'W12010954', 'W12010954', 'UT01', 'University Health Care', 'Robert', 'A', 'Serpico', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '590 Wakara Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015877109', '8015875411', '590 Wakara Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015877109', '8015875411', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2011-03-10', '2012-08-22', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851628218', 0, 'N', 0, '2012-08-23', NULL, NULL, 0, 0, NULL, NULL),
('870483582', 'W12010953', 'W12010953', 'UT01', 'University of Utah Orthopedic Consultants', 'Robert', 'A', 'Serpico', 'PA', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 413067', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8015813998', NULL, 'PO Box 413067', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8015813998', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2011-03-10', '2012-08-22', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851628218', 0, 'N', 0, '2012-08-23', NULL, NULL, 0, 0, NULL, NULL),
('876151902', 'W12010956', 'W12010956', 'UT01', 'University Health Care', 'Julie', 'B', 'Shelton', 'MD', 'Ophthalmology', '', '', NULL, 'O', '65 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812352', '8015851295', '65 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812352', '8015851295', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2010-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306061320', 0, 'N', 0, '2013-07-25', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('876000525', 'W12010958', 'W12010958', 'UT01', 'University Hospital Physicians', 'Adrienne', 'L', 'Aldous', 'RD', 'Dietician', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812121', '8015816243', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812121', '8015816243', '', '', '1', '0.00', '0.00', '0.00', 6, '2011-03-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1982905386', 0, 'N', 0, '2011-05-02', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('876000525', 'W12010957', 'W12010957', 'UT01', 'University Hospital Physicians', 'Adrienne', 'L', 'Aldous', 'RD', 'Dietician', '', '', NULL, 'O', '590 Wakara Way', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015812727', '8015816243', '590 Wakara Way', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015812727', '8015816243', '', '', '1', '0.00', '0.00', '0.00', 6, '2011-03-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1982905386', 0, 'N', 0, '2011-05-02', NULL, NULL, 40.7558, -111.833, NULL, NULL),
('876000525', 'W12010959', 'W12010959', 'UT01', 'University Hospital Physicians', 'Adrienne', 'L', 'Aldous', 'RD', 'Dietician', '', '', NULL, 'B', 'PO Box 510721', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015812121', '8015816243', 'PO Box 510721', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015812121', '8015816243', '', '', '1', '0.00', '0.00', '0.00', 6, '2011-03-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1982905386', 0, 'N', 0, '2011-05-02', NULL, NULL, 0, 0, NULL, NULL),
('876000525', 'W12010962', 'W12010962', 'UT01', 'University of Utah', 'Gabe', 'L', 'Byars', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812121', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812121', '          ', '', '', '1', '0.00', '0.00', '0.00', 6, '2011-03-11', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083925564', 0, 'N', 0, '2011-05-02', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('876000525', 'W12010961', 'W12010961', 'UT01', 'University of Utah', 'Gabe', 'L', 'Byars', 'OT', 'Occupational Therapy', '', '', NULL, 'B', 'PO Box 510721', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015812121', NULL, 'PO Box 510721', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015812121', '          ', '', '', '1', '0.00', '0.00', '0.00', 6, '2011-03-11', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083925564', 0, 'N', 0, '2011-05-02', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'SACN00587', 'SACN00587', 'SACN', 'Saint Alphonsus Regional Medical Center (this is a reading p', 'Nirmal', 'J', 'Charan', 'MD', 'Pulmonology', '', '', NULL, 'O', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083673722', NULL, '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083673722', '', 'IDSINCLAIRL', NULL, '', '0.00', '15.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1023195708', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('870474130', 'W12010967', 'W12010967', 'UT01', 'Northeastern Utah Medical Group', 'Steven', 'R', 'Turley', 'MD', 'Nephrology', '', '', NULL, 'O', '210 W 300 N Ste 75-3', 'Roosevelt', 'Duchesne', 'UT', '84066', '4357223971', '4357226104', '210 W 300 N Ste 75-3', 'Roosevelt', 'Duchesne', 'UT', '84066', '4357223971', '4357226104', 'WURURAL5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-11-10', NULL, 0, 0, 0, 'Uintah Basin Medical Center', '', '', '', 'HCFA|UB|', '1699986133', 0, 'N', 0, '2011-11-14', NULL, NULL, 40.3034, -109.995, NULL, NULL),
('870474130', 'W12010968', 'W12010968', 'UT01', 'Northeastern Utah Medical Group', 'John', 'S', 'Wells', 'MD', 'Family Practice', '', '', NULL, 'O', '210 W 300 N Ste 75-3', 'Roosevelt', 'Duchesne', 'UT', '84066', '4357223971', '4357226104', '210 W 300 N Ste 75-3', 'Roosevelt', 'Duchesne', 'UT', '84066', '4357223971', '4357226104', 'WURURAL5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-11-10', NULL, 0, 0, 0, 'Uintah Basin Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1831359744', 0, 'N', 0, '2011-11-14', NULL, NULL, 40.3034, -109.995, NULL, NULL),
('870474130', 'W12010970', 'W12010970', 'UT01', 'Northeastern Utah Medical Group', 'Jeffrey', 'L', 'Wheeler', 'DO', 'Family Practice', '', '', NULL, 'O', '210 W 300 N Ste 75-3', 'Roosevelt', 'Duchesne', 'UT', '84066', '4357223971', '4357226104', '210 W 300 N Ste 75-3', 'Roosevelt', 'Duchesne', 'UT', '84066', '4357223971', '4357226104', 'WURURAL5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-11-10', NULL, 0, 0, 0, 'Uintah Basin Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1699942987', 0, 'N', 0, '2011-11-14', NULL, NULL, 40.3034, -109.995, NULL, NULL),
('836000295', 'W12010971', 'W12010971', 'WY01', 'Sweetwater Medical Group', 'Ryan Karl', 'C', 'Fontanilla', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '1204 Hilltop Dr Ste 108', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528125', '3073528126', '1204 Hilltop Dr Ste 108', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528125', '3073528126', '', '', '', '0.00', '5.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1083821110', 0, 'N', 0, '2014-07-23', NULL, NULL, 41.584, -109.232, NULL, NULL),
('870635889', 'W12010972', 'W12010972', 'UT01', 'All seasons obstetrics and gynecology', 'Cullen', 'J', 'Archer', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '196 E 2000 N Ste 104', 'Tooele', 'Tooele', 'UT', '84074', '4358432576', '4358437878', '196 E 2000 N Ste 104', 'Tooele', 'Tooele', 'UT', '84074', '4358432576', '4358437878', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB|', '1376534875', 0, 'N', 0, '2012-06-25', NULL, NULL, 40.5656, -112.294, NULL, NULL),
('870437364', 'W12010974', 'W12010974', 'UT01', '', 'Ace', '', 'Madsen', 'MD', 'Internal Medicine', '', '', NULL, 'O', '175 N 100 W Ste 205B', 'Vernal', 'Uintah', 'UT', '84078', '4357896400', '4357899222', '175 N 100 W Ste 205B', 'Vernal', 'Uintah', 'UT', '84078', '4357896400', '4357899222', 'WURURAL5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-05-01', NULL, 0, 0, 0, 'Ashley Valley Regional Medical', '', '', '', 'HCFA|UB|', '1699745711', 0, 'N', 0, '2014-07-22', NULL, NULL, 40.4582, -109.53, NULL, NULL),
('942854057', 'W12010975', 'W12010975', 'UTIHC03', 'EKG', 'Kimberly', 'M', 'Molina', 'MD', 'Pediatric Cardiology', 'Pediatrics', '', NULL, 'O', '500 E 1400 N', 'St George', 'Washington', 'UT', '84770', '4352511000', NULL, '500 E 1400 N', 'St George', 'Washington', 'UT', '84770', '4352511000', '', '', '', '', '0.00', '15.00', '0.00', 8, '2011-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053494963', 0, 'N', 0, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W12010978', 'W12010978', 'UTIHC03', 'EKG', 'Kimberly', 'M', 'Molina', 'MD', 'Pediatric Cardiology', 'Pediatrics', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4352511000', NULL, '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4352511000', '', '', '', '', '0.00', '15.00', '0.00', 8, '2011-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053494963', 0, 'N', 0, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12010979', 'W12010979', 'UTIHC04', 'EKG', 'Kimberly', 'M', 'Molina', 'MD', 'Pediatric Cardiology', 'Pediatrics', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4352511000', NULL, '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4352511000', '', '', '', '', '0.00', '15.00', '0.00', 8, '2011-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053494963', 0, 'N', 0, '2014-05-27', NULL, NULL, 37.0989, -113.575, NULL, NULL),
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('200494346', 'W12011036', 'W12011036', 'UT01', 'Park City Internal Medicine Pediatrics', 'Amy', 'L', 'Ossian', 'PA', 'Pediatrics', '', '', NULL, 'O', '1612 Ute Blvd Ste 205', 'Park City', 'Summit', 'UT', '84098', '4356553309', '4356553392', '1612 Ute Blvd Ste 205', 'Park City', 'Summit', 'UT', '84098', '4356553309', '4356553392', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, 'Park City Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1417283722', 0, 'N', 0, '2011-06-29', NULL, NULL, 40.7246, -111.542, NULL, NULL),
('870563433', 'W12011037', 'W12011037', 'UT01', 'Alpine Home Medical', '', '', 'Alpine Home Medical', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '4669 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8013930015', '8014754727', '4669 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8013930015', '8014754727', 'DME80', '', '', '0.00', '25.00', '0.00', 3, '2010-01-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000000420', 0, 'N', 0, '2014-01-20', NULL, NULL, 0, 0, NULL, NULL),
('870563433', 'W12011038', 'W12011038', 'UT01', 'Alpine Home Medical', '', '', 'Alpine Home Medical', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '1481 N State St', 'Provo', 'Utah', 'UT', '84604', '8018520077', '8018520055', '1481 N State St', 'Provo', 'Utah', 'UT', '84604', '8018520077', '8018520055', 'DME80', '', '', '0.00', '25.00', '0.00', 3, '2010-01-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000000420', 0, 'N', 0, '2014-01-20', NULL, NULL, 0, 0, NULL, NULL),
('870563433', 'W12011039', 'W12011039', 'UT01', 'Alpine Home Medical', '', '', 'Alpine Home Medical', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '42 S River Rd Ste 10', 'St George', 'Washington', 'UT', '84790', '4356740080', '4356740116', '42 S River Rd Ste 10', 'St George', 'Washington', 'UT', '84790', '4356740080', '4356740116', 'DME80', '', '', '0.00', '25.00', '0.00', 3, '2010-01-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000000420', 0, 'N', 0, '2014-01-20', NULL, NULL, 0, 0, NULL, NULL),
('870563433', 'W12011040', 'W12011040', 'UT01', 'Alpine Home Medical', '', '', 'Alpine Home Medical', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '690 W 1725 N', 'Logan', 'Cache', 'UT', '84341', '4357744500', '4357749986', '690 W 1725 N', 'Logan', 'Cache', 'UT', '84341', '4357744500', '4357749986', 'DME80', '', '', '0.00', '25.00', '0.00', 3, '2010-01-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000000420', 0, 'N', 0, '2014-01-20', NULL, NULL, 0, 0, NULL, NULL),
('330057155', 'W12011041', 'W12011041', 'UT01', 'Apria Healthcare LLC', '', '', 'Apria Healthcare LLC', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '77 W Forest Ave Ste 106', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287732545', NULL, '77 W Forest Ave Ste 106', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287732545', '          ', 'Wpraxair', '', '', '0.00', '20.00', '0.00', 3, '2011-03-04', '2014-01-22', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008248', 0, 'Y', 0, '2014-01-24', NULL, NULL, 0, 0, NULL, NULL),
('330057155', 'W12011042', 'W12011042', 'UT01', 'Apria Healthcare LLC', '', '', 'Apria Healthcare LLC', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '261 Addison Ave', 'Twin Falls', 'Twin Falls', 'ID', '83301', '2087334450', NULL, '261 Addison Ave', 'Twin Falls', 'Twin Falls', 'ID', '83301', '2087334450', '          ', 'Wpraxair', '', '', '0.00', '20.00', '0.00', 3, '2011-03-04', '2014-01-22', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008248', 0, 'Y', 0, '2014-01-24', NULL, NULL, 0, 0, NULL, NULL),
('330057155', 'W12011045', 'W12011045', 'Sinclair', 'Apria Healthcare LLC', '', '', 'Apria Healthcare LLC', '', 'Durable Medical Equipment', '', '', NULL, 'O', '2610 Addison Ave', 'Twin Falls', 'Twin Falls', 'ID', '83301', '2087334450', NULL, '2610 Addison Ave', 'Twin Falls', 'Twin Falls', 'ID', '83301', '2087334450', '          ', 'Wpraxair', '', '', '0.00', '20.00', '0.00', 3, '2011-03-04', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336234194', 0, 'N', 0, '2013-07-31', NULL, NULL, 0, 0, NULL, NULL),
('330057155', 'W12011044', 'W12011044', 'Sinclair', 'Apria Healthcare LLC', '', '', 'Apria Healthcare LLC', '', 'Durable Medical Equipment', '', '', NULL, 'O', '77 W Forest Ave Ste 106', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287732545', NULL, '77 W Forest Ave Ste 106', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287732545', '          ', 'Wpraxair', '', '', '0.00', '20.00', '0.00', 3, '2011-03-04', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336234194', 0, 'N', 0, '2013-07-31', NULL, NULL, 0, 0, NULL, NULL),
('870179340', 'W12011046', 'W12011046', 'UT01', 'Standard Optical', 'Tyler', 'J', 'Barney', 'OD', 'Optometry', '', '', NULL, 'O', '1455 S State St', 'Orem', 'Utah', 'UT', '84057', '8012263044', '8018027326', '1455 S State St', 'Orem', 'Utah', 'UT', '84057', '8012263044', '8018027326', 'WUTALBERT5', '', '', '0.00', '35.00', '0.00', 6, '2010-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528268398', 0, 'N', 0, '2014-07-02', NULL, NULL, 40.2705, -111.683, NULL, NULL),
('621801973', 'W12011047', 'W12011047', 'UT01', 'Gero - Psych', 'Joel', 'S', 'Dario', '', 'Mental Health', '', '', NULL, 'O', '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504111', '8013504522', '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504111', '8013504522', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-01-21', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275547507', 0, 'N', 0, '2011-05-06', NULL, NULL, 40.7694, -111.861, NULL, NULL),
('621801973', 'W12011048', 'W12011048', 'UT01', 'Gero - Psych', 'Joel', 'S', 'Dario', '', 'Mental Health', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-01-21', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275547507', 0, 'N', 0, '2011-05-06', NULL, NULL, 0, 0, NULL, NULL),
('870179340', 'W12011049', 'W12011049', 'UT01', 'Standard Optical', 'Neil', '', 'Frischknecht', 'OD', 'Optometry', '', '', NULL, 'O', '1901 W Pkwy Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019720203', '8019540054', '1901 W Pkwy Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019720203', '8019540054', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-10-01', '2012-10-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457440687', 0, 'N', 0, '2014-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870179340', 'W12011050', 'W12011050', 'UT01', 'Standard Optical', 'Neil', '', 'Frischknecht', 'OD', 'Optometry', '', '', NULL, 'O', '5289 S State St', 'Murray', 'Salt Lake', 'UT', '84107', '8015061111', '8015062021', '5289 S State St', 'Murray', 'Salt Lake', 'UT', '84107', '8015061111', '8015062021', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-10-01', '2012-10-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457440687', 0, 'N', 0, '2014-01-14', NULL, NULL, 0, 0, NULL, NULL),
('870635889', 'W12011051', 'W12011051', 'UT01', 'Tooele Clinic Corp', 'Jeffrey ', 'D', 'Lee', 'MD', 'Family Practice', '', '', NULL, 'M', '7100 Commerce Way Ste 180', 'Brentwood', 'Williamson', 'TN', '37027', '4358843578', NULL, '7100 Commerce Way Ste 180', 'Brentwood', 'Williamson', 'TN', '37027', '4358843578', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639221526', 0, 'N', 0, '2012-11-02', NULL, NULL, 0, 0, NULL, NULL),
('870179340', 'W12011052', 'W12011052', 'UT01', 'Standard Optical', 'Curtis', 'S', 'Goodman', 'OD', 'Optometry', '', '', NULL, 'O', '196 E 2000 N', 'Tooele', 'Tooele', 'UT', '84074', '4358824815', '4358822917', '196 E 2000 N', 'Tooele', 'Tooele', 'UT', '84074', '4358824815', '4358822917', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-08-19', '2012-04-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497990642', 0, 'N', 0, '2014-01-14', NULL, NULL, 0, 0, NULL, NULL),
('870179340', 'W12011053', 'W12011053', 'UT01', 'Standard Optical', 'Curtis', 'S', 'Goodman', 'OD', 'Optometry', '', '', NULL, 'O', '1076 Layton Hills Mall Ste 2090', 'Layton', 'Davis', 'UT', '84041', '8015460255', '8015460260', '1076 Layton Hills Mall Ste 2090', 'Layton', 'Davis', 'UT', '84041', '8015460255', '8015460260', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-08-19', '2012-04-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497990642', 0, 'N', 0, '2014-01-14', NULL, NULL, 0, 0, NULL, NULL),
('870179340', 'W12011054', 'W12011054', 'UT01', 'Standard Optical', 'Aaron', 'M', 'Hartman', 'OD', 'Optometry', '', '', NULL, 'O', '4305 S Harrison Blvd Ste 9111', 'Ogden', 'Weber', 'UT', '84403', '8014795060', '8014793649', '4305 S Harrison Blvd Ste 9111', 'Ogden', 'Weber', 'UT', '84403', '8014795060', '8014793649', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-08-19', '2013-03-03', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922258375', 0, 'N', 0, '2013-06-04', NULL, NULL, 0, 0, NULL, NULL),
('870179340', 'W12011055', 'W12011055', 'UT01', 'Standard Optical', 'Aaron', 'M', 'Hartman', 'OD', 'Optometry', '', '', NULL, 'O', '1076 Layton Hills Mall Ste 2090', 'Layton', 'Davis', 'UT', '84041', '8015460255', '8015460260', '1076 Layton Hills Mall Ste 2090', 'Layton', 'Davis', 'UT', '84041', '8015460255', '8015460260', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-08-19', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922258375', 0, 'N', 0, '2013-06-04', NULL, NULL, 41.0777, -111.977, NULL, NULL),
('208138626', 'W12011056', 'W12011056', 'UT01', 'Utah Physiatry Associates', 'Stuart', 'W', 'King', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '839 E 1200 S', 'Orem', 'Utah', 'UT', '84097', '8012247100', NULL, '839 E 1200 S', 'Orem', 'Utah', 'UT', '84097', '8012247100', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366518730', 0, 'N', 0, '2014-07-09', NULL, NULL, 40.2751, -111.675, NULL, NULL),
('208138673', 'W12011057', 'W12011057', 'UT01', 'Utah Physiatry Associates', 'Valton', 'N', 'King', 'DO', 'Physical Medicine and Rehabilitation', NULL, NULL, NULL, 'O', '839 E 1200 S', 'Orem', 'Utah', 'UT', '84097', '8012240891', NULL, '839 E 1200 S', 'Orem', 'Utah', 'UT', '84097', '8012240891', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457427817', 0, 'N', 0, '2013-11-27', NULL, NULL, 40.2751, -111.675, NULL, NULL),
('870179340', 'W12011058', 'W12011058', 'UT01', 'Standard Optical', 'Stephen', 'C', 'Lewis', 'OD', 'Optometry', '', '', NULL, 'O', '1438 E Main St Ste 4', 'Lehi', 'Utah', 'UT', '84043', '8017537999', '8017537996', '1438 E Main St Ste 4', 'Lehi', 'Utah', 'UT', '84043', '8017537999', '8017537996', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184653818', 0, 'N', 0, '2012-06-25', NULL, NULL, 40.3884, -111.828, NULL, NULL),
('870179340', 'W12011059', 'W12011059', 'UT01', 'Standard Optical', 'Duane', 'G', 'Lund', 'OD', 'Optometry', '', '', NULL, 'O', '1656 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012555454', '8012551109', '1656 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012555454', '8012551109', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-10-01', '2013-09-13', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932271244', 0, 'N', 0, '2014-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870179340', 'W12011060', 'W12011060', 'UT01', 'Standard Optical', 'Duane', 'G', 'Lund', 'OD', 'Optometry', '', '', NULL, 'O', '5289 S State St', 'Murray', 'Salt Lake', 'UT', '84107', '8015061111', '8015062021', '5289 S State St', 'Murray', 'Salt Lake', 'UT', '84107', '8015061111', '8015062021', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-10-01', '2013-09-13', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932271244', 0, 'N', 0, '2013-09-19', NULL, NULL, 0, 0, NULL, NULL),
('870179340', 'W12011061', 'W12011061', 'UT01', 'Standard Optical', 'Bruce', 'L', 'Lundin', 'OD', 'Optometry', '', '', NULL, 'O', '1076 Layton Hills Mall Ste 2090', 'Layton', 'Davis', 'UT', '84041', '8015460255', '8015460260', '1076 Layton Hills Mall Ste 2090', 'Layton', 'Davis', 'UT', '84041', '8015460255', '8015460260', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750336152', 0, 'N', 0, '2012-03-14', NULL, NULL, 41.0777, -111.977, 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
('870179340', 'W12011062', 'W12011062', 'UT01', 'Standard Optical', 'Michael', 'S', 'Marty', 'OD', 'Optometry', '', '', NULL, 'O', '834 E 9400 S', 'Sandy', 'Salt Lake', 'UT', '84094', '8015729280', '8015721486', '834 E 9400 S', 'Sandy', 'Salt Lake', 'UT', '84094', '8015729280', '8015721486', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-08-19', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497743942', 0, 'N', 0, '2013-03-26', NULL, NULL, 40.5806, -111.868, NULL, NULL),
('870179340', 'W12011063', 'W12011063', 'UT01', 'Standard Optical', 'Michael', 'S', 'Marty', 'OD', 'Optometry', '', '', NULL, 'O', '1656 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012555454', '8012551109', '1656 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012555454', '8012551109', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-08-19', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497743942', 0, 'N', 0, '2013-03-26', NULL, NULL, 40.5877, -111.938, NULL, NULL),
('870179340', 'W12011064', 'W12011064', 'UT01', 'Standard Optical', 'David', 'A', 'Meyer', 'OD', 'Optometry', '', '', NULL, 'O', '834 E 9400 S', 'Sandy', 'Salt Lake', 'UT', '84094', '8015729280', '8015721486', '834 E 9400 S', 'Sandy', 'Salt Lake', 'UT', '84094', '8015729280', '8015721486', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255562740', 0, 'N', 0, '2013-12-23', NULL, NULL, 40.5806, -111.868, NULL, NULL),
('870179340', 'W12011065', 'W12011065', 'UT01', 'Standard Optical ', 'Joan', '', 'Mildenstein', 'OD', 'Optometry', '', '', NULL, 'O', '5289 S State St', 'Murray', 'Salt Lake', 'UT', '84107', '8015061111', '8015062021', '5289 S State St', 'Murray', 'Salt Lake', 'UT', '84107', '8015061111', '8015062021', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1689990517', 0, 'N', 0, '2014-01-08', NULL, NULL, 40.6563, -111.888, NULL, NULL),
('870179340', 'W12011066', 'W12011066', 'UT01', 'Standard Optical', 'Shelly', 'L', 'Nielsen', 'OD', 'Optometry', '', '', NULL, 'O', '5289 S State St', 'Murray', 'Salt Lake', 'UT', '84107', '8015061111', '8015062021', '5289 S State St', 'Murray', 'Salt Lake', 'UT', '84107', '8015061111', '8015062021', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699864801', 0, 'N', 0, '2014-01-17', NULL, NULL, 40.6563, -111.888, NULL, NULL),
('870179340', 'W12011067', 'W12011067', 'UT01', 'Standard Optical', 'Shelly', 'L', 'Nielsen', 'OD', 'Optometry', '', '', NULL, 'O', '834 E 9400 S', 'Sandy', 'Salt Lake', 'UT', '84094', '8015729280', '8015721486', '834 E 9400 S', 'Sandy', 'Salt Lake', 'UT', '84094', '8015729280', '8015721486', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699864801', 0, 'N', 0, '2014-01-17', NULL, NULL, 40.5806, -111.868, NULL, NULL),
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('870179340', 'W12011069', 'W12011069', 'UT01', 'Standard Optical', 'Russell', '', 'Purdy', 'OD', 'Optometry', '', '', NULL, 'O', '1901 W Pkwy Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019720203', '8019540054', '1901 W Pkwy Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019720203', '8019540054', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295823029', 0, 'N', 0, '2014-04-23', NULL, NULL, 40.7164, -111.943, NULL, NULL),
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('000001001', '000001032', '000001032', 'TX02', '', 'Yolanda', '', 'Marcos', 'MD', 'Internal Medicine', '', '', NULL, 'o', '510 Med Ct Ste 210', 'San Antonio', 'Bexar', 'TX', '78258', '2104944290', NULL, '510 Med Court Ste 210', 'San Antonio', 'Bexar', 'TX', '78258', '2104944290', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2011-05-01', '2011-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000001032', 0, 'N', 0, '2012-12-18', NULL, NULL, 29.6248, -98.4928, NULL, NULL),
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('000001001', '000001096', '000001096', 'TX02', 'South Alamo Medical Group', 'Dixie', 'P', 'McCrory', 'MD', 'Family Practice', '', '', NULL, 'o', '740 South Alamo Street', 'San Antonio', 'Bexar', 'TX', '78205', '2102220333', NULL, '740 South Alamo Street', 'San Antonio', 'Bexar', 'TX', '78205', '2102220333', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2011-05-01', '2011-05-01', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1962499590', 0, 'N', 0, '2012-12-18', NULL, NULL, 0, 0, NULL, NULL),
('000001001', '000001139', '000001139', 'TX02', 'South Alamo Medical Group', 'Dixie', 'P', 'McCrory', 'MD', 'Family Practice', '', '', NULL, 'o', '6502  Tezel Ste 101', 'San Antonio', 'Bexar', 'TX', '78250', '2102220333', NULL, '6502  Tezel Ste 101', 'San Antonio', 'Bexar', 'TX', '78250', '2102220333', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2011-05-01', '2011-05-01', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1962499590', 0, 'N', 0, '2012-12-18', NULL, NULL, 0, 0, NULL, NULL),
('000001001', '000001097', '000001097', 'TX02', 'Gonzaba Medical Group', 'Saul', '', 'Montelongo', 'MD', 'Family Practice', '', '', NULL, 'o', '720 Pleasanton', 'San Antonio', 'Bexar', 'TX', '78214', '2109213800', NULL, '720 Pleasanton', 'San Antonio', 'Bexar', 'TX', '78214', '2109213800', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2011-05-01', '2011-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000001097', 0, 'N', 0, '2012-12-18', NULL, NULL, 0, 0, NULL, NULL),
('000001001', '000001015', '000001015', 'TX02', 'Health Texas/Val Verde Clinic', 'Steven', 'A', 'Moralez', 'MD', 'Internal Medicine', '', '', NULL, 'o', '810 SE Military Dr', 'San Antonio', 'Bexar', 'TX', '78214', '2109214200', NULL, '810 SE Military Drive', 'San Antonio', 'Bexar', 'TX', '78214', '2109214200', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2011-05-01', '2011-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427024298', 0, 'N', 0, '2012-12-18', NULL, NULL, 29.3561, -98.4879, NULL, NULL),
('000001001', '000001098', '000001098', 'TX02', '', 'Hugo', 'E', 'Muzza', 'MD', 'Family Practice', '', '', NULL, 'o', '7333 Barlite Blvd Ste 120', 'San Antonio', 'Bexar', 'TX', '78224', '2109238851', NULL, '7333 Barlite Ste 120', 'San Antonio', 'Bexar', 'TX', '78224', '2109238851', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2011-05-01', '2011-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000001098', 0, 'N', 0, '2012-12-18', NULL, NULL, 29.3555, -98.547, NULL, NULL),
('000001001', '000001016', '000001016', 'TX02', '', 'Lubna', '', 'Naeem', 'MD', 'Internal Medicine', '', '', NULL, 'o', '19272 Stone Oak Pkwy Ste 105', 'San Antonio', 'Bexar', 'TX', '78258', '2104903800', NULL, '19272 Stone Oak Parkway Ste 105', 'San Antonio', 'Bexar', 'TX', '78258', '2104903800', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2011-05-01', '2011-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000001016', 0, 'N', 0, '2012-12-18', NULL, NULL, 29.6299, -98.4948, NULL, NULL),
('000001001', '000001099', '000001099', 'TX02', 'North Hills Family Medicine', 'Manual', 'S', 'Naron', 'MD', 'Family Practice', '', '', NULL, 'o', '150 E Sonterra Blvd Ste 220', 'San Antonio', 'Bexar', 'TX', '78258', '2104816800', NULL, '150 E Sonterra Blvd Ste 220', 'San Antonio', 'Bexar', 'TX', '78258', '2104816800', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2011-05-01', '2011-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000001099', 0, 'N', 0, '2012-12-18', NULL, NULL, 29.6152, -98.4924, NULL, NULL),
('000001001', '000001100', '000001100', 'TX02', '', 'LanAnh', '', 'NGO', 'MD', 'Family Practice', '', '', NULL, 'o', '19016 Stone Oak Pkwy Ste 140', 'San Antonio', 'Bexar', 'TX', '78258', '2104949109', NULL, '19016 Stone Oak Parkway Ste 140', 'San Antonio', 'Bexar', 'TX', '78258', '2104949109', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2011-05-01', '2011-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000001100', 0, 'N', 0, '2012-12-18', NULL, NULL, 29.6185, -98.4935, NULL, NULL),
('000001001', '000001101', '000001101', 'TX02', 'Stone Oak Family Doctors PA', 'Wendy', '', 'Nguyen', 'MD', 'Family Practice', '', '', NULL, 'o', '225 E. Sonterra Blvd Ste 100', 'San Antonio', 'Bexar', 'TX', '78258', '2104967999', NULL, '225 E. Sonterra Blvd Ste 100', 'San Antonio', 'Bexar', 'TX', '78258', '2104967999', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2011-05-01', '2011-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000001101', 0, 'N', 0, '2012-12-18', NULL, NULL, 0, 0, NULL, NULL),
('000001001', '000001017', '000001017', 'TX02', 'Health Texas/Metropolitan Clinic', 'Aris', '', 'Nikas', 'MD', 'Internal Medicine', '', '', NULL, 'o', '1200 Brooklyn Ave Ste 240', 'San Antonio', 'Bexar', 'TX', '78212', '2102254511', NULL, '1200 Brooklyn Ave Ste 240', 'San Antonio', 'Bexar', 'TX', '78212', '2102254511', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2011-05-01', '2011-05-01', 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1093781890', 0, 'N', 1, '2013-05-10', NULL, NULL, 29.4403, -98.4903, NULL, NULL),
('000001001', '000001102', '000001102', 'TX02', 'Health Texas/Blanco Clinic', 'Gabriel', '', 'Ortiz', 'MD', 'Family Practice', '', '', NULL, 'o', '7254 Blanco Rd Ste 201', 'San Antonio', 'Bexar', 'TX', '78216', '2103848282', NULL, '7254 Blanco Rd Ste 201', 'San Antonio', 'Bexar', 'TX', '78216', '2103848282', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2011-05-01', '2011-05-01', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, '', '', 'HCFA|UB|', '1093795718', 0, 'N', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('000001001', '000001103', '000001103', 'TX02', 'Alamo City Medical Group', 'Deepa', '', 'Padia', 'MD', 'Family Practice', '', '', NULL, 'o', '5000 Baptist Health Drive Ste 102', 'Schertz', 'Guadalupe', 'TX', '78154', '2105662656', NULL, '5000 Baptist Health Drive Ste 102', 'Schertz', 'Guadalupe', 'TX', '78154', '2105662656', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2011-05-01', '2011-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000001103', 0, 'N', 0, '2012-12-18', NULL, NULL, 0, 0, NULL, NULL),
('000001001', '000001104', '000001104', 'TX02', 'Gonzaba Medical Group', 'David ', '', 'Padilla', 'MD', 'Family Practice', '', '', NULL, 'o', '720 Pleasanton', 'San Antonio', 'Bexar', 'TX', '78214', '2109213800', NULL, '720 Pleasanton', 'San Antonio', 'Bexar', 'TX', '78214', '2109213800', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2011-05-01', '2011-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000001104', 0, 'N', 0, '2012-12-18', NULL, NULL, 0, 0, NULL, NULL),
('000001001', '000001105', '000001105', 'TX02', '', 'Ho', 'David', 'Pak', 'MD', 'Family Practice', '', '', NULL, 'o', '4360 Greco Drive', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', NULL, '4360 Greco Drive', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2011-05-01', '2011-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000001105', 0, 'N', 0, '2012-12-18', NULL, NULL, 0, 0, NULL, NULL),
('000001001', '000001106', '000001106', 'TX02', '', 'Ho', 'David', 'Pak', 'MD', 'Family Practice', '', '', NULL, 'o', '1860 Sequin Street', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', NULL, '1860 Sequin Street', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2011-05-01', '2011-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000001106', 0, 'N', 0, '2012-12-18', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('000001001', '000001107', '000001107', 'TX02', '', 'Solomon', '', 'Paley', 'MD', 'Family Practice', '', '', NULL, 'o', '434 North Loop 1604 West Ste 1204', 'San Antonio', 'Bexar', 'TX', '78232', '2109466677', NULL, '434 North Loop 1604 West Ste 1204', 'San Antonio', 'Bexar', 'TX', '78232', '2109466677', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2011-05-01', '2011-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000001107', 0, 'N', 0, '2012-12-18', NULL, NULL, 0, 0, NULL, NULL),
('000001001', '000001018', '000001018', 'TX02', 'Health Texas/Val Verde Clinic', 'Carmen', '', 'Perez', 'MD', 'Internal Medicine', '', '', NULL, 'o', '810 SE Military Dr', 'San Antonio', 'Bexar', 'TX', '78214', '210214200 ', NULL, '810 SE Military Dr', 'San Antonio', 'Bexar', 'TX', '78214', '210214200 ', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2011-05-01', '2011-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982670790', 0, 'N', 0, '2013-05-10', NULL, NULL, 29.3561, -98.4879, NULL, NULL),
('000001001', '000001108', '000001108', 'TX02', 'Stone Oak Family Doctors PA', 'John', 'N', 'Phillips', 'MD', 'Family Practice', '', '', NULL, 'o', '225 E. Sonterra Blvd Ste 100', 'San Antonio', 'Bexar', 'TX', '78258', '2104967999', NULL, '225 E. Sonterra Blvd Ste 100', 'San Antonio', 'Bexar', 'TX', '78258', '2104967999', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2011-05-01', '2011-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000001108', 0, 'N', 0, '2012-12-18', NULL, NULL, 0, 0, NULL, NULL),
('000001001', '000001019', '000001019', 'TX02', '', 'Leticia', 'A', 'Poret', 'MD', 'Internal Medicine', '', '', NULL, 'o', '4522 Fredericksburg Rd Ste A14', 'San Antonio', 'Bexar', 'TX', '78201', '2107333005', NULL, '4522 Fredricksburg Road Ste A14', 'San Antonio', 'Bexar', 'TX', '78201', '2107333005', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2011-05-01', '2011-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000001019', 0, 'N', 0, '2012-12-18', NULL, NULL, 0, 0, NULL, NULL),
('000001001', '000001109', '000001109', 'TX02', '', 'Carlos', '', 'Porter', 'MD', 'Family Practice', '', '', NULL, 'o', '5282 Medical Drive Ste 250', 'San Antonio', 'Bexar', 'TX', '78229', '2103419614', NULL, '5282 Medical Drive Ste 250', 'San Antonio', 'Bexar', 'TX', '78229', '2103419614', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2011-05-01', '2011-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000001109', 0, 'N', 0, '2012-12-18', NULL, NULL, 0, 0, NULL, NULL),
('000001001', '000001110', '000001110', 'TX02', 'Health Texas/Leon Valley Clinic', 'Manuel', 'M', 'Quinones', 'MD', 'Family Practice', '', '', NULL, 'o', '6428 Bandera Rd.', 'San Antonio', 'Bexar', 'TX', '78238', '2105204455', NULL, '6428 Bandera Rd.', 'San Antonio', 'Bexar', 'TX', '78238', '2105204455', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2011-05-01', '2011-05-01', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1881660686', 0, 'N', 0, '2013-05-10', NULL, NULL, 0, 0, NULL, NULL),
('000001001', '000001034', '000001034', 'TX02', 'Gonzaba Medical Group', 'Robert', '', 'Ramirez', 'MD', 'Internal Medicine', '', '', NULL, 'o', '720 Pleasanton  Rd', 'San Antonio', 'Bexar', 'TX', '78214', '2109213800', NULL, '720 Pleasanton Road', 'San Antonio', 'Bexar', 'TX', '78214', '2109213800', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2011-05-01', '2011-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000001034', 0, 'N', 0, '2012-12-18', NULL, NULL, 0, 0, NULL, NULL),
('000001001', '000001111', '000001111', 'TX02', 'Med First/Castle Hills', 'Robert', '', 'Raposo', 'MD', 'Family Practice', '', '', NULL, 'o', '2241 NW Military Hwy Ste 200', 'San Antonio', 'Bexar', 'TX', '78213', '2102976331', NULL, '2241 NW Military Hwy Ste 200', 'San Antonio', 'Bexar', 'TX', '78213', '2102976331', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2011-05-01', '2011-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000001111', 0, 'N', 0, '2012-12-18', NULL, NULL, 0, 0, NULL, NULL),
('000001001', '000001112', '000001112', 'TX02', '', 'Ramon', '', 'Reyes', 'MD', 'Family Practice', '', '', NULL, 'o', '7579 North Loop 1604 West Ste 100', 'San Antonio', 'Bexar', 'TX', '78249', '2106951900', NULL, '7579 North Loop 1604 West Ste 100', 'San Antonio', 'Bexar', 'TX', '78249', '2106951900', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2011-05-01', '2011-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000001112', 0, 'N', 0, '2012-12-18', NULL, NULL, 0, 0, NULL, NULL),
('000001001', '000001020', '000001020', 'TX02', 'Health Texas/Lexington Clinic', 'Richard', 'S', 'Reyna', 'MD', 'Internal Medicine', '', '', NULL, 'o', '215 E. Quincy Ste 500', 'San Antonio', 'Bexar', 'TX', '78215', '2102231600', NULL, '215 E. Quincy Ste 500', 'San Antonio', 'Bexar', 'TX', '78215', '2102231600', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2011-05-01', '2011-05-01', 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1326014069', 0, 'N', 0, '2012-12-18', NULL, NULL, 0, 0, NULL, NULL),
('000001001', '000001021', '000001021', 'TX02', 'Health Texas/Lexington Clinic', 'Rowland', 'S', 'Reyna', 'MD', 'Internal Medicine', '', '', NULL, 'o', '215 E. Quincy Ste 500', 'San Antonio', 'Bexar', 'TX', '78215', '2102231600', NULL, '215 E. Quincy Ste 500', 'San Antonio', 'Bexar', 'TX', '78215', '2102231600', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2011-05-01', '2011-05-01', 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1700852498', 0, 'N', 0, '2012-12-18', NULL, NULL, 0, 0, NULL, NULL),
('000001001', '000001113', '000001113', 'TX02', 'Med First', 'Abe', '', 'Rodriguez', 'MD', 'Family Practice', '', '', NULL, 'o', '2130 NE Loop 410 Ste 325', 'San Antonio', 'Bexar', 'TX', '78217', '2106532693', NULL, '2130 NE Loop 410 Ste 325', 'San Antonio', 'Bexar', 'TX', '78217', '2106532693', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2011-05-01', '2011-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000001113', 0, 'N', 0, '2012-12-18', NULL, NULL, 0, 0, NULL, NULL),
('000001001', '000001022', '000001022', 'TX02', '', 'Javier', 'F', 'Rodriguez', 'MD', 'Internal Medicine', '', '', NULL, 'o', '311 Camden', 'San Antonio', 'Bexar', 'TX', '78215', '2102274278', NULL, '311 Camden', 'San Antonio', 'Bexar', 'TX', '78215', '2102274278', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2011-05-01', '2011-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000001022', 0, 'N', 0, '2012-12-18', NULL, NULL, 29.4347, -98.4923, NULL, NULL),
('000001001', '000001114', '000001114', 'TX02', 'Alamo City Medical Group', 'Joy', 'Ann', 'Rodriguez', 'MD', 'Family Practice', '', '', NULL, 'o', '2235 Thousand Oaks Ste 117', 'San Antonio', 'Bexar', 'TX', '78232', '2104901000', NULL, '2235 Thousand Oaks Ste 117', 'San Antonio', 'Bexar', 'TX', '78232', '2104901000', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2011-05-01', '2011-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000001114', 0, 'N', 0, '2012-12-18', NULL, NULL, 29.5873, -98.4514, NULL, NULL),
('000001001', '000001023', '000001023', 'TX02', 'South Alamo Medical Group', 'Radames', '', 'Rodriguez', 'MD', 'Internal Medicine', '', '', NULL, 'o', '7355 Barlite Blvd Ste 301', 'San Antonio', 'Bexar', 'TX', '78224', '2109211181', NULL, '7355 Barlite Ste 301', 'San Antonio', 'Bexar', 'TX', '78224', '2109211181', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2011-05-01', '2011-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000001023', 0, 'N', 0, '2012-12-18', NULL, NULL, 0, 0, NULL, NULL),
('000001001', '000001115', '000001115', 'TX02', '', 'Alexander', 'S', 'Roka', 'MD', 'Family Practice', '', '', NULL, 'o', '19222 Stone Hue Ste 101', 'San Antonio', 'Bexar', 'TX', '78258', '2104033220', NULL, '19222 Stone Hue Ste 101', 'San Antonio', 'Bexar', 'TX', '78258', '2104033220', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2011-05-01', '2011-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000001115', 0, 'N', 0, '2012-12-18', NULL, NULL, 0, 0, NULL, NULL),
('000001001', '000001116', '000001116', 'TX02', 'South Alamo Medical Group', 'Robert', 'D', 'Ross', 'MD', 'Family Practice', '', '', NULL, 'o', '7355 Barlite Blvd Ste 301', 'San Antonio', 'Bexar', 'TX', '78224', '2109211181', NULL, '7355 Barlite Ste 301', 'San Antonio', 'Bexar', 'TX', '78224', '2109211181', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2011-05-01', '2011-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000001116', 0, 'N', 0, '2012-12-18', NULL, NULL, 0, 0, NULL, NULL),
('000001001', '000001117', '000001117', 'TX02', '', 'Roberto', 'J', 'Ruiz', 'MD', 'Family Practice', '', '', NULL, 'o', '3412 Roosevelt Ave', 'San Antonio', 'Bexar', 'TX', '78214', '2109248146', NULL, '3412 Roosevelt Ave', 'San Antonio', 'Bexar', 'TX', '78214', '2109248146', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2011-05-01', '2011-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000001117', 0, 'N', 0, '2012-12-18', NULL, NULL, 0, 0, NULL, NULL),
('000001001', '000001024', '000001024', 'TX02', 'South Alamo Medical Group', 'Ninza', 'A', 'Sanchez', 'MD', 'Internal Medicine', '', '', NULL, 'o', '4203 E Southcross Blvd', 'San Antonio', 'Bexar', 'TX', '78222', '2103339008', NULL, '4203 E Southcross', 'San Antonio', 'Bexar', 'TX', '78222', '2103339008', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2011-05-01', '2011-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000001024', 0, 'N', 0, '2012-12-18', NULL, NULL, 0, 0, NULL, NULL),
('000001001', '000001118', '000001118', 'TX02', 'North Hills Family Medicine', 'David ', 'J', 'Sandercock', 'MD', 'Family Practice', '', '', NULL, 'o', '3338 Oakwell Ct Ste 107', 'San Antonio', 'Bexar', 'TX', '78218', '2108223646', NULL, '3338 Oakwell Court Ste 107', 'San Antonio', 'Bexar', 'TX', '78218', '2108223646', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2011-05-01', '2011-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000001118', 0, 'N', 0, '2012-12-18', NULL, NULL, 29.5069, -98.4303, NULL, NULL),
('000001001', '000001119', '000001119', 'TX02', 'Gonzaba Medical Group', 'Saul', '', 'Santoscoy', 'MD', 'Family Practice', '', '', NULL, 'o', '7616 Culebra Ste 130', 'San Antonio', 'Bexar', 'TX', '78251', '2105092603', NULL, '7616 Culebra Ste 130', 'San Antonio', 'Bexar', 'TX', '78251', '2105092603', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2011-05-01', '2011-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000001119', 0, 'N', 0, '2012-12-18', NULL, NULL, 0, 0, NULL, NULL),
('000001001', '000001025', '000001025', 'TX02', 'Med First/Broadway Clinic', 'Lorraine', '', 'ShirleyWenzel', 'MD', 'Internal Medicine', '', '', NULL, 'o', '5929 Broadway', 'San Antonio', 'Bexar', 'TX', '78209', '2102976331', NULL, '5929 Broadway', 'San Antonio', 'Bexar', 'TX', '78209', '2102976331', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2011-05-01', '2011-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000001025', 0, 'N', 0, '2012-12-18', NULL, NULL, 0, 0, NULL, NULL),
('000001001', '000001120', '000001120', 'TX02', 'Alamo City Medical Group', 'Michael', '', 'Smith', 'MD', 'Family Practice', '', '', NULL, 'o', '408 Navarro', 'San Antonio', 'Bexar', 'TX', '78205', '2102721741', NULL, '408 Navarro', 'San Antonio', 'Bexar', 'TX', '78205', '2102721741', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2011-05-01', '2011-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000001120', 0, 'N', 0, '2012-12-18', NULL, NULL, 0, 0, NULL, NULL),
('000001001', '000001121', '000001121', 'TX02', 'Allied Institute of Medicine', 'Teresa', '', 'SmithKnuppel', 'MD', 'Family Practice', '', '', NULL, 'o', '1860 S. Seguin St.', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', NULL, '1860 S. Seguin St.', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2011-05-01', '2011-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000001121', 0, 'N', 0, '2012-12-18', NULL, NULL, 0, 0, NULL, NULL),
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('870617336', 'W12011138', 'W12011138', 'UTDT01', 'Monarch Dental', 'John', '', 'Reschke', 'DDS', 'Dentist', '', '', NULL, 'O', '1492 W Antelope Dr Ste 201', 'Layton', 'Davis', 'UT', '84041', '8017766566', NULL, '1492 W Antelope Dr Ste 201', 'Layton', 'Davis', 'UT', '84041', '8017766566', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000008360', 0, 'N', 0, '2011-05-12', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12011139', 'W12011139', 'UTDT01', 'Monarch Dental', 'John', '', 'Reschke', 'DDS', 'Dentist', '', '', NULL, 'O', '5974 S Fashion Pointe Dr Ste 210', 'Ogden', 'Weber', 'UT', '84403', '8014756121', NULL, '5974 S Fashion Pointe Dr Ste 210', 'Ogden', 'Weber', 'UT', '84403', '8014756121', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000008360', 0, 'N', 0, '2011-05-12', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12011140', 'W12011140', 'UTDT01', 'Monarch Dental', 'John', '', 'Reschke', 'DDS', 'Dentist', '', '', NULL, 'O', '370 E South Temple Ste 350', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8013209810', NULL, '370 E South Temple Ste 350', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8013209810', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000008360', 0, 'N', 0, '2011-05-12', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12011141', 'W12011141', 'UTDT01', 'Monarch Dental', 'John', '', 'Reschke', 'DDS', 'Dentist', '', '', NULL, 'O', '10011 S Centennial Pkwy Ste 330', 'Sandy', 'Salt Lake', 'UT', '84070', '8015665987', NULL, '10011 S Centennial Pkwy Ste 330', 'Sandy', 'Salt Lake', 'UT', '84070', '8015665987', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000008360', 0, 'N', 0, '2011-05-12', 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
('870617336', 'W12011147', 'W12011147', 'UTDT01', 'Monarch Dental', 'William', '', 'Sundberg', 'DDS', 'Dentist', '', '', NULL, 'O', '370 E South Temple Ste 350', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8013209810', NULL, '370 E South Temple Ste 350', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8013209810', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000008961', 0, 'N', 0, '2011-05-13', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12011148', 'W12011148', 'UTDT01', 'Monarch Dental', 'William', '', 'Sundberg', 'DDS', 'Dentist', '', '', NULL, 'O', '5974 S Fashion Pointe Dr Ste 210', 'Ogden', 'Weber', 'UT', '84403', '8014756121', NULL, '5974 S Fashion Pointe Dr Ste 210', 'Ogden', 'Weber', 'UT', '84403', '8014756121', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000008961', 0, 'N', 0, '2011-05-13', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12011149', 'W12011149', 'UTDT01', 'Monarch Dental', 'William', '', 'Sundberg', 'DDS', 'Dentist', '', '', NULL, 'O', '1492 W Antelope Dr Ste 201', 'Layton', 'Davis', 'UT', '84041', '8017766566', NULL, '1492 W Antelope Dr Ste 201', 'Layton', 'Davis', 'UT', '84041', '8017766566', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000008961', 0, 'N', 0, '2011-05-13', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12011150', 'W12011150', 'UTDT01', 'Monarch Dental', 'William', '', 'Sundberg', 'DDS', 'Dentist', '', '', NULL, 'O', '24 S 500 W Ste D', 'Bountiful', 'Davis', 'UT', '84010', '8012961606', NULL, '24 S 500 W Ste D', 'Bountiful', 'Davis', 'UT', '84010', '8012961606', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000008961', 0, 'N', 0, '2011-05-13', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12011151', 'W12011151', 'UTDT01', 'Monarch Dental', 'William', '', 'Fisher', 'DDS', 'Dentist', '', '', NULL, 'O', '3730 W 4700 S', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8019551900', NULL, '3730 W 4700 S', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8019551900', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000006256', 0, 'N', 0, '2011-05-13', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12011152', 'W12011152', 'UTDT01', 'Monarch Dental', 'William', '', 'Fisher', 'DDS', 'Dentist', '', '', NULL, 'O', '575 E University Pkwy Ste A-24', 'Orem', 'Utah', 'UT', '84097', '8012253300', NULL, '575 E University Pkwy Ste A-24', 'Orem', 'Utah', 'UT', '84097', '8012253300', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000006256', 0, 'N', 0, '2011-05-13', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12011153', 'W12011153', 'UTDT01', 'Monarch Dental', 'William', '', 'Fisher', 'DDS', 'Dentist', '', '', NULL, 'O', '5419 S Redwood Rd Ste 2', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012636400', NULL, '5419 S Redwood Rd Ste 2', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012636400', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000006256', 0, 'N', 0, '2011-05-13', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12011154', 'W12011154', 'UTDT01', 'Monarch Dental', 'William', '', 'Fisher', 'DDS', 'Dentist', '', '', NULL, 'O', '370 E South Temple Ste 305', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8013209810', NULL, '370 E South Temple Ste 305', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8013209810', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000006256', 0, 'N', 0, '2011-05-13', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12011155', 'W12011155', 'UTDT01', 'Monarch Dental', 'William', '', 'Fisher', 'DDS', 'Dentist', '', '', NULL, 'O', '1492 W Antelope Dr Ste 201', 'Layton', 'Davis', 'UT', '84041', '8017766566', NULL, '1492 W Antelope Dr Ste 201', 'Layton', 'Davis', 'UT', '84041', '8017766566', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000006256', 0, 'N', 0, '2011-05-13', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12011156', 'W12011156', 'UTDT01', 'Monarch Dental', 'William', '', 'Fisher', 'DDS', 'Dentist', '', '', NULL, 'O', '24 S 500 W Ste D', 'Bountiful', 'Davis', 'UT', '84010', '8012961606', NULL, '24 S 500 W Ste D', 'Bountiful', 'Davis', 'UT', '84010', '8012961606', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000006256', 0, 'N', 0, '2011-05-13', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12011157', 'W12011157', 'UTDT01', 'Monarch Dental', 'William', '', 'Fisher', 'DDS', 'Dentist', '', '', NULL, 'O', '476 N 900 W Ste A', 'American Fork', 'Utah', 'UT', '84003', '8017565522', NULL, '476 N 900 W Ste A', 'American Fork', 'Utah', 'UT', '84003', '8017565522', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000006256', 0, 'N', 0, '2011-05-13', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12011158', 'W12011158', 'UTDT01', 'Monarch Dental', 'Phillip', '', 'Olsen', 'DMD', 'Dentist', '', '', NULL, 'O', '3730 W 4700 S', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8019551900', NULL, '3730 W 4700 S', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8019551900', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000007961', 0, 'N', 0, '2011-05-13', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12011159', 'W12011159', 'UTDT01', 'Monarch Dental', 'Phillip', '', 'Olsen', 'DMD', 'Dentist', '', '', NULL, 'O', '575 E University Pkwy Ste A-24', 'Orem', 'Utah', 'UT', '84097', '8012253300', NULL, '575 E University Pkwy Ste A-24', 'Orem', 'Utah', 'UT', '84097', '8012253300', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000007961', 0, 'N', 0, '2011-05-13', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12011160', 'W12011160', 'UTDT01', 'Monarch Dental', 'Phillip', '', 'Olsen', 'DMD', 'Dentist', '', '', NULL, 'O', '5419 S Redwood Rd Ste 2', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012636400', NULL, '5419 S Redwood Rd Ste 2', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012636400', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000007961', 0, 'N', 0, '2011-05-13', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12011161', 'W12011161', 'UTDT01', 'Monarch Dental', 'Phillip', '', 'Olsen', 'DMD', 'Dentist', '', '', NULL, 'O', '10011 S Centennial Pkwy Ste 330', 'Sandy', 'Salt Lake', 'UT', '84070', '8015665987', NULL, '10011 S Centennial Pkwy Ste 330', 'Sandy', 'Salt Lake', 'UT', '84070', '8015665987', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000007961', 0, 'N', 0, '2011-05-13', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12011162', 'W12011162', 'UTDT01', 'Monarch Dental', 'Phillip', '', 'Olsen', 'DMD', 'Dentist', '', '', NULL, 'O', '370 E South Temple Ste 350', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8013209810', NULL, '370 E South Temple Ste 350', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8013209810', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000007961', 0, 'N', 0, '2011-05-13', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12011163', 'W12011163', 'UTDT01', 'Monarch Dental', 'Phillip', '', 'Olsen', 'DMD', 'Dentist', '', '', NULL, 'O', '5974 S Fashion Pointe Dr Ste 210', 'Ogden', 'Weber', 'UT', '84403', '8014756121', NULL, '5974 S Fashion Pointe Dr Ste 210', 'Ogden', 'Weber', 'UT', '84403', '8014756121', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000007961', 0, 'N', 0, '2011-05-13', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12011164', 'W12011164', 'UTDT01', 'Monarch Dental', 'Phillip', '', 'Olsen', 'DMD', 'Dentist', '', '', NULL, 'O', '1492 W Antelope Dr Ste 201', 'Layton', 'Davis', 'UT', '84041', '8017766566', NULL, '1492 W Antelope Dr Ste 201', 'Layton', 'Davis', 'UT', '84041', '8017766566', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000007961', 0, 'N', 0, '2011-05-13', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12011165', 'W12011165', 'UTDT01', 'Monarch Dental', 'Phillip', '', 'Olsen', 'DMD', 'Dentist', '', '', NULL, 'O', '476 N 900 W Ste A', 'American Fork', 'Utah', 'UT', '84003', '8017565522', NULL, '476 N 900 W Ste A', 'American Fork', 'Utah', 'UT', '84003', '8017565522', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000007961', 0, 'N', 0, '2011-05-13', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12011166', 'W12011166', 'UTDT01', 'Monarch Dental', 'Kim', '', 'Roberts', 'DDS', 'Dentist', '', '', NULL, 'O', '5419 S Redwood Rd Ste 2', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012636400', NULL, '5419 S Redwood Rd Ste 2', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012636400', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000008423', 0, 'N', 0, '2011-05-13', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12011167', 'W12011167', 'UTDT01', 'Monarch Dental', 'Kim', '', 'Roberts', 'DDS', 'Dentist', '', '', NULL, 'O', '3730 W 4700 S', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8019551900', NULL, '3730 W 4700 S', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8019551900', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000008423', 0, 'N', 0, '2011-05-13', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12011168', 'W12011168', 'UTDT01', 'Monarch Dental', 'Kim', '', 'Roberts', 'DDS', 'Dentist', '', '', NULL, 'O', '575 E University Pkwy Ste A-24', 'Orem', 'Utah', 'UT', '84097', '8012253300', NULL, '575 E University Pkwy Ste A-24', 'Orem', 'Utah', 'UT', '84097', '8012253300', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000008423', 0, 'N', 0, '2011-05-13', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12011169', 'W12011169', 'UTDT01', 'Monarch Dental', 'Kim', '', 'Roberts', 'DDS', 'Dentist', '', '', NULL, 'O', '10011 S Centennial Pkwy Ste 330', 'Sandy', 'Salt Lake', 'UT', '84070', '8015665987', NULL, '10011 S Centennial Pkwy Ste 330', 'Sandy', 'Salt Lake', 'UT', '84070', '8015665987', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000008423', 0, 'N', 0, '2011-05-13', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12011170', 'W12011170', 'UTDT01', 'Monarch Dental', 'Kim', '', 'Roberts', 'DDS', 'Dentist', '', '', NULL, 'O', '5974 S Fashion Pointe Dr Ste 210', 'Ogden', 'Weber', 'UT', '84403', '8014756121', NULL, '5974 S Fashion Pointe Dr Ste 210', 'Ogden', 'Weber', 'UT', '84403', '8014756121', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000008423', 0, 'N', 0, '2011-05-13', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12011171', 'W12011171', 'UTDT01', 'Monarch Dental', 'Kim', '', 'Roberts', 'DDS', 'Dentist', '', '', NULL, 'O', '1492 W Antelope Dr Ste 201', 'Layton', 'Davis', 'UT', '84041', '8017766566', NULL, '1492 W Antelope Dr Ste 201', 'Layton', 'Davis', 'UT', '84041', '8017766566', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000008423', 0, 'N', 0, '2011-05-13', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12011172', 'W12011172', 'UTDT01', 'Monarch Dental', 'Kim', '', 'Roberts', 'DDS', 'Dentist', '', '', NULL, 'O', '24 S 500 W Ste D', 'Bountiful', 'Davis', 'UT', '84010', '8012961606', NULL, '24 S 500 W Ste D', 'Bountiful', 'Davis', 'UT', '84010', '8012961606', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000008423', 0, 'N', 0, '2011-05-13', NULL, NULL, 0, 0, NULL, NULL),
('870448870', 'W12011174', 'W12011174', 'UTDT01', '', 'M Scott', '', 'Updyke', 'DDS', 'Dentist', '', '', NULL, 'O', '3369 S 2300 E', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8014845048', NULL, '3369 S 2300 E', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8014845048', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004159', 0, 'N', 0, '2011-05-13', NULL, NULL, 0, 0, NULL, NULL),
('870307397', 'W12011177', 'W12011177', 'UTDT01', '', 'Graydon', '', 'Briggs', 'DDS', 'Dentist', 'Endondontist', '', NULL, 'O', '5292 S College Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8017073424', NULL, '5292 S College Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8017073424', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004160', 0, 'N', 0, '2013-10-08', NULL, NULL, 0, 0, NULL, NULL),
('870307397', 'W12011178', 'W12011178', 'UTDT01', '', 'Graydon', '', 'Briggs', 'DDS', 'Dentist', 'Endondontist', '', NULL, 'O', '263 Country Club Ste 102', 'Tooele', 'Tooele', 'UT', '84074', '8017073424', NULL, '263 Country Club Ste 102', 'Tooele', 'Tooele', 'UT', '84074', '8017073424', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004160', 0, 'N', 0, '2013-10-08', NULL, NULL, 0, 0, NULL, NULL),
('262606404', 'W12011180', 'W12011180', 'UTDT01', '', 'Jason S', '', 'Crozier', 'DDS', 'Dentist', '', '', NULL, 'O', '2152 N Hill Field Rd Ste 2', 'Layton', 'Davis', 'UT', '84041', '8017763300', NULL, '2152 N Hill Field Rd Ste 2', 'Layton', 'Davis', 'UT', '84041', '8017763300', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004161', 0, 'N', 0, '2011-05-13', NULL, NULL, 0, 0, NULL, NULL),
('274419541', 'W12011181', 'W12011181', 'UTDT01', 'Valley View Dental Group PC', 'Mark', '', 'Redd', 'DDS', 'Dentist', 'Pediatrics', '', NULL, 'O', '1792 W 1700 S Ste 101', 'Syracuse', 'Davis', 'UT', '84075', '8016140099', NULL, '1792 W 1700 S Ste 101', 'Syracuse', 'Davis', 'UT', '84075', '8016140099', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000008344', 0, 'N', 0, '2011-05-16', NULL, NULL, 0, 0, NULL, NULL),
('263464518', 'W12011182', 'W12011182', 'UTDT01', '', 'Jon W', '', 'Lloyd', 'DDS', 'Dentist', '', '', NULL, 'O', '1291 W 12600 S Ste 101', 'Riverton', 'Salt Lake', 'UT', '84065', '8014461166', NULL, '1291 W 12600 S Ste 101', 'Riverton', 'Salt Lake', 'UT', '84065', '8014461166', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000007307', 0, 'N', 0, '2011-05-16', NULL, NULL, 0, 0, NULL, NULL),
('870655896', 'W12011184', 'W12011184', 'UTDT01', '', 'Justin', '', 'Tobias', 'DDS', 'Dentist', '', '', NULL, 'O', '5300 S Adams Ave Ste 3', 'Ogden', 'Weber', 'UT', '84405', '8014797600', NULL, '5300 S Adams Ave Ste 3', 'Ogden', 'Weber', 'UT', '84405', '8014797600', '          ', 'UT00MB', '', '', '0.00', '20.00', '0.00', 8, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009110', 0, 'N', 0, '2011-05-13', NULL, NULL, 0, 0, NULL, NULL),
('263926687', 'W12011188', 'W12011188', 'UTDT01', '', 'David M', '', 'McKeller', 'DDS', 'Dentist', '', '', NULL, 'O', '3984 Washington Blvd', 'Ogden', 'Weber', 'UT', '84403', '8013994477', NULL, '3984 Washington Blvd', 'Ogden', 'Weber', 'UT', '84403', '8013994477', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004163', 0, 'N', 0, '2011-05-13', NULL, NULL, 0, 0, NULL, NULL),
('529704443', 'W12011190', 'W12011190', 'UTDT01', '', 'Kelly', '', 'Mangrum', 'DDS', 'Dentist', '', '', NULL, 'O', '7110 Highland Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019436880', NULL, '7110 Highland Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019436880', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-03-01', '2013-08-31', 0, 0, 0, '', '', '', '', 'DEN|', '0000004164', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('270309451', 'W12011192', 'W12011192', 'UTDT01', 'Highland Dental', 'Clinton', '', 'Miller', 'DMD', 'Dentist', '', '', NULL, 'O', '10925 N Alpine Hwy', 'American Fork', 'Utah', 'UT', '84003', '8017562400', NULL, '10925 N Alpine Hwy', 'American Fork', 'Utah', 'UT', '84003', '8017562400', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004165', 0, 'N', 0, '2013-10-08', NULL, NULL, 0, 0, NULL, NULL),
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('273611286', 'W12011232', 'W12011232', 'UTDT01', 'Total Care Dental', 'Austin', '', 'Babcock', 'DDS', 'Dentist', '', '', NULL, 'O', '12 S 1100 E', 'American Fork', 'Utah', 'UT', '84003', '8017563737', NULL, '12 S 1100 E', 'American Fork', 'Utah', 'UT', '84003', '8017563737', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-04-01', '2012-01-01', 0, 0, 0, '', '', '', '', 'DEN|', '0000004174', 0, 'N', 0, '2012-01-20', NULL, NULL, 0, 0, NULL, NULL),
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('274519439', 'W12011238', 'W12011238', 'UTDT01', 'Cottonwood Pediatric Dentistry', 'Chester', 'K', 'Smyth', 'DDS', 'Pedodontist', '', '', NULL, 'O', '7050 S 2000 E Ste 110', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019433233', NULL, '7050 S 2000 E Ste 110', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019433233', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2011-04-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1508800749', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('274519439', 'W12011239', 'W12011239', 'UTDT01', 'Cottonwood Pediatric Dentistry', 'Benjamin', '', 'Menlove', 'DDS', 'Dentist', '', '', NULL, 'O', '7050 S 2000 E Ste 110', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019433233', NULL, '7050 S 2000 E Ste 110', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019433233', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-04-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000007569', 0, 'N', 0, '2011-05-16', NULL, NULL, 0, 0, NULL, NULL),
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('274519439', 'W12011243', 'W12011243', 'UTDT01', 'Cottonwood Pediatric Dentistry', 'Darin', '', 'Knudson', 'DDS', 'Dentist', 'Pedodontist', '', NULL, 'O', '7050 S 2000 E Ste 110', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019433233', NULL, '7050 S 2000 E Ste 110', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019433233', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-04-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000007122', 0, 'N', 0, '2013-06-27', NULL, NULL, 0, 0, NULL, NULL),
('272083389', 'W12011245', 'W12011245', 'UTDT01', 'Ninth East Dental', 'Devon', '', 'Call', 'DDS', 'Dentist', '', '', NULL, 'O', '1234 N 900 E', 'Provo', 'Utah', 'UT', '84604', '8018549140', NULL, '1234 N 900 E', 'Provo', 'Utah', 'UT', '84604', '8018549140', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-04-01', '2011-09-01', 0, 0, 0, '', '', '', '', 'DEN|', '1386801868', 0, 'N', 0, '2013-12-31', NULL, NULL, 0, 0, NULL, NULL),
('270953749', 'W12011246', 'W12011246', 'UTDT01', 'Wendover Dental Care', 'Bradley', '', 'DeVries', 'DMD', 'Dentist', '', '', NULL, 'O', '399 N Aria Blvd', 'Wendover', 'Tooele', 'UT', '84083', '4356652962', NULL, '399 N Aria Blvd', 'Wendover', 'Tooele', 'UT', '84083', '4356652962', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-04-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0001000013', 0, 'N', 0, '2012-01-23', NULL, NULL, 0, 0, NULL, NULL),
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('010778442', 'W12011251', 'W12011251', 'UTDT01', 'Genesis Dental', 'Daniel', '', 'Bishop', 'DMD', 'Dentist', '', '', NULL, 'O', '102 W 1180 N Ste 1', 'Tooele', 'Tooele', 'UT', '84074', '4358828600', NULL, '102 W 1180 N Ste 1', 'Tooele', 'Tooele', 'UT', '84074', '4358828600', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-05-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004180', 0, 'N', 0, '2013-04-01', NULL, NULL, 0, 0, NULL, NULL),
('870327736', 'W12011253', 'W12011253', 'UTDT01', '', 'Val L', '', 'Radmall', 'DDS', 'Dentist', '', '', NULL, 'O', '5300 S Adams Ste 10', 'Ogden', 'Weber', 'UT', '84405', '8014769709', NULL, '5300 S Adams Ste 10', 'Ogden', 'Weber', 'UT', '84405', '8014769709', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-05-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004181', 0, 'N', 0, '2011-05-16', NULL, NULL, 0, 0, NULL, NULL),
('260551595', 'W12011255', 'W12011255', 'UTDT01', 'All About Smiles Dentistry', 'Ryan S', '', 'Gunn', 'DMD', 'Dentist', '', '', NULL, 'O', '409 S Main St', 'Cedar City', 'Iron', 'UT', '84720', '4358659797', NULL, '409 S Main St', 'Cedar City', 'Iron', 'UT', '84720', '4358659797', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-05-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004182', 0, 'N', 0, '2011-05-16', NULL, NULL, 0, 0, NULL, NULL),
('208290617', 'W12011257', 'W12011257', 'UTDT01', 'Cascade Family Dental', 'Brad ', '', 'Strong', 'DDS', 'Dentist', '', '', NULL, 'O', '1392 W Turf Farm Way Ste 1', 'Payson', 'Utah', 'UT', '84651', '8014654490', NULL, '1392 W Turf Farm Way Ste 1', 'Payson', 'Utah', 'UT', '84651', '8014654490', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-05-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1326189846', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('205127384', 'W12011259', 'W12011259', 'UTDT01', 'Heber Valley Dental', 'Brandon', '', 'McKee', 'DDS', 'Dentist', '', '', NULL, 'O', '345 W 600 S', 'Heber City', 'Wasatch', 'UT', '84032', '4356573694', NULL, '345 W 600 S', 'Heber City', 'Wasatch', 'UT', '84032', '4356573694', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-05-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1346452356', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('271406497', 'W12011261', 'W12011261', 'UTDT01', 'Thomas Orthodontics', 'James', '', 'Thomas', 'DDS', 'Orthodontist', '', '', NULL, 'O', '424 N State Rd Ste 198', 'Salem', 'Utah', 'UT', '84653', '8014233030', NULL, '424 N State Rd Ste 198', 'Salem', 'Utah', 'UT', '84653', '8014233030', '          ', '', '', '', '0.00', '20.00', '0.00', 8, '2011-05-01', '2012-01-01', 0, 0, 0, '', '', '', '', 'DEN|', '0000004185', 0, 'N', 0, '2012-01-20', NULL, NULL, 0, 0, NULL, NULL),
('261588673', 'W12011263', 'W12011263', 'UTDT01', 'Barry Family Dental Group', 'Nicolas', '', 'Young', 'DDS', 'Dentist', '', '', NULL, 'O', '165 N 400 W Suite Ste 2A', 'Orem', 'Utah', 'UT', '84057', '8012660441', NULL, '165 N 400 W Suite Ste 2A', 'Orem', 'Utah', 'UT', '84057', '8012660441', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-05-01', NULL, 0, 20, 0, '', '', '', '', 'DEN|', '0000004186', 0, 'N', 0, '2011-12-05', NULL, NULL, 0, 0, NULL, NULL),
('261588673', 'W12011265', 'W12011265', 'UTDT01', 'Barry Family Dental Group', 'Mark', '', 'Barry', 'DDS', 'Dentist', '', '', NULL, 'O', '165 N 400 W Suite Ste 2A', 'Orem', 'Utah', 'UT', '84057', '8012660441', NULL, '165 N 400 W Suite Ste 2A', 'Orem', 'Utah', 'UT', '84057', '8012660441', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-05-01', NULL, 0, 20, 0, '', '', '', '', 'DEN|', '0000004187', 0, 'N', 0, '2011-12-05', NULL, NULL, 0, 0, NULL, NULL),
('870549520', 'W12011267', 'W12011267', 'UTDT01', 'Willow Creek Dental', 'James E', '', 'Hillstrom', 'DDS', 'Dentist', '', '', NULL, 'O', '8757 Highland Dr', 'Sandy', 'Salt Lake', 'UT', '84093', '8019470505', NULL, '8757 Highland Dr', 'Sandy', 'Salt Lake', 'UT', '84093', '8019470505', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-05-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004188', 0, 'N', 0, '2011-05-16', NULL, NULL, 0, 0, NULL, NULL),
('273994988', 'W12011269', 'W12011269', 'UTDT01', 'Avenues Family Dentistry', 'Paul', '', 'Porter', 'DDS', 'Dentist', '', '', NULL, 'O', '215 S 1000 E Ste A', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013284173', NULL, '215 S 1000 E Ste A', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013284173', '', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-05-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004189', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('611644502', 'W12011270', 'W12011270', 'UTDT01', '', 'Brent', '', 'Hutchings', 'DDS', 'Dentist', '', '', NULL, 'O', '440 S 700 E Ste 305', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013631213', NULL, '440 S 700 E Ste 305', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013631213', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-05-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000006818', 0, 'N', 0, '2011-05-16', NULL, NULL, 0, 0, NULL, NULL),
('611644502', 'W12011271', 'W12011271', 'UTDT01', '', 'Michael', '', 'Hutchings', 'DMD', 'Dentist', '', '', NULL, 'O', '440 S 700 E Ste 305', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013631213', NULL, '440 S 700 E Ste 305', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013631213', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-05-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000006819', 0, 'N', 0, '2011-05-16', NULL, NULL, 0, 0, NULL, NULL),
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('203563066', 'W12011273', 'W12011273', 'UTDT01', 'Jones Dental', 'Brian R', '', 'Jones', 'DMD', 'Dentist', '', '', NULL, 'O', '3651 N 100 E Ste 200', 'Provo', 'Utah', 'UT', '84604', '8013748218', NULL, '3651 N 100 E Ste 200', 'Provo', 'Utah', 'UT', '84604', '8013748218', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-05-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000006986', 0, 'N', 0, '2012-11-28', NULL, NULL, 0, 0, NULL, NULL),
('270252868', 'W12011274', 'W12011274', 'UTDT01', 'Smith Dental Care', 'John Josh', '', 'Smith', 'DMD', 'Dentist', '', '', NULL, 'O', '1030 E 11400 S Ste 2', 'Sandy', 'Salt Lake', 'UT', '84094', '8012728609', NULL, '1030 E 11400 S Ste 2', 'Sandy', 'Salt Lake', 'UT', '84094', '8012728609', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-05-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000008764', 0, 'N', 0, '2011-05-16', NULL, NULL, 0, 0, NULL, NULL),
('274162933', 'W12011275', 'W12011275', 'UTDT01', 'Silver Wolf Dental', 'David', '', 'Fischer', 'DDS', 'Dentist', '', '', NULL, 'O', '2894 W 12600 S Ste 100', 'Riverton', 'Salt Lake', 'UT', '84065', '8016198664', NULL, '2894 W 12600 S Ste 100', 'Riverton', 'Salt Lake', 'UT', '84065', '8016198664', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-05-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000006252', 0, 'N', 0, '2011-05-16', NULL, NULL, 0, 0, NULL, NULL),
('274519439', 'W12011278', 'W12011278', 'UTDT01', 'Burg Pediatric Dentistry', 'Jeanne', '', 'Hibler', 'DDS', 'Pedodontist', '', '', NULL, 'O', '7050 S Highland Dr Ste 10', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019433288', NULL, '7050 S Highland Dr Ste 10', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019433288', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2011-05-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004190', 0, 'N', 0, '2013-06-27', NULL, NULL, 0, 0, NULL, NULL),
('263751841', 'W12011277', 'W12011277', 'UTDT01', 'Park City Pediatric Dentistry', 'Jeanne', '', 'Hibler', 'DDS', 'Pedodontist', '', '', NULL, 'O', '1901 Prospectir Ave Ste 26', 'Park City', 'Summit', 'UT', '84060', '4356495001', NULL, '1901 Prospectir Ave Ste 26', 'Park City', 'Summit', 'UT', '84060', '4356495001', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2011-05-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004190', 0, 'N', 0, '2013-06-27', NULL, NULL, 0, 0, NULL, NULL),
('481296063', 'W12011279', 'W12011279', 'UTDT01', 'Sheldon Peck Orhtodontics', 'Sheldon', '', 'Peck', 'DMD', 'Orthodontist', '', '', NULL, 'O', '1792 W 1700 S Ste 201', 'Syracuse', 'Davis', 'UT', '84075', '8015251333', NULL, '1792 W 1700 S Ste 201', 'Syracuse', 'Davis', 'UT', '84075', '8015251333', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2011-05-01', '2011-05-01', 0, 0, 0, '', '', '', '', 'DEN|', '0000008104', 0, 'N', 0, '2013-05-31', NULL, NULL, 0, 0, NULL, NULL),
('870664764', 'W12011280', 'W12011280', 'UT01', 'First Physicians LLC', 'Stephen', 'Cope', 'Taylor', 'DC', 'Chiropractic', '', '', NULL, 'O', '1893 Skyline Dr Ste 110', 'Ogden', 'Weber', 'UT', '84403', '8017823060', '8016053715', '1893 Skyline Dr Ste 110', 'Ogden', 'Weber', 'UT', '84403', '8017823060', '8016053715', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2011-04-01', '2011-09-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750478723', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('200721283', 'W12011281', 'W12011281', 'UT01', 'McClean Clinic', 'Gordon', 'M Jr', 'McClean', 'DC', 'Chiropractic', '', '', NULL, 'O', '385 N 500 W', 'Provo', 'Utah', 'UT', '84601', '8013731035', '8013731038', '385 N 500 W', 'Provo', 'Utah', 'UT', '84601', '8013731035', '8013731038', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2011-05-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053408955', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12011285', 'W12011285', 'ID02', 'Saltzer Medical Group', 'Elaine', 'S', 'Davidson', 'MD', 'Family Practice', '', '', NULL, 'O', '215 E Hawaii Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084685910', '2084633046', '215 E Hawaii Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084685910', '2084633046', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-05-13', '2012-12-31', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1093705022', 0, 'N', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12011286', 'W12011286', 'ID02', 'Saltzer Medical Group', 'Elaine', 'S', 'Davidson', 'MD', 'Family Practice', '', '', 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, '2011-05-13', '2012-12-31', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1093705022', 0, 'N', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12011288', 'W12011288', 'ID02', 'Saltzer Medical Group', 'John', 'C', 'Freeman', 'MD', 'Family Practice', '', '', NULL, 'O', '215 E Hawaii Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084685910', '2084633046', '215 E Hawaii Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084685910', '2084633046', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-05-13', '2012-12-31', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1437279031', 0, 'N', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12011289', 'W12011289', 'ID02', 'Saltzer Medical Group', 'John', 'C', 'Freeman', 'MD', 'Family Practice', '', '', NULL, 'B', '217 W Georgia Ave Ste 115', 'Nampa', 'Canyon', 'ID', '83686', '2084633280', '2084633046', '217 W Georgia Ave Ste 115', 'Nampa', 'Canyon', 'ID', '83686', '2084633280', '2084633046', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-05-13', '2012-12-31', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1437279031', 0, 'N', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL);
