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
('721594562', 'W40005433', 'W40005433', 'UTMH1', NULL, 'Craig', 'T', 'Mitchell', 'LCSW', 'Mental Health', 'Social Worker', NULL, NULL, 'O', '5922 S 2125 E', 'Ogden', 'Weber', 'UT', '84403', '8016263649', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'UTMA', NULL, NULL, '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, NULL, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1720038060', 0, 'n', 0, '2013-02-28', NULL, NULL, 41.1549, -111.927, NULL, NULL),
('870632875', 'W40020341', 'W40020341', 'UTMH1', '', 'Haley', '', 'Molyneux', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '315 S 100 E', 'Provo', 'Utah', 'UT', '84606', '8013612641', NULL, '315 S 100 E', 'Provo', 'Utah', 'UT', '84606', '8013612641', '          ', 'UTMA', '', '', '0.00', '40.00', '0.00', 6, '2013-02-15', '2014-05-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740391655', 0, 'N', 0, '2014-03-05', NULL, NULL, 40.2295, -111.657, NULL, NULL),
('870632875', 'W40020340', 'W40020340', 'UTMH1', '', 'Haley', '', 'Molyneux', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 1077', 'Springville', 'Utah', 'UT', '84663', '8013612641', NULL, 'PO Box 1077', 'Springville', 'Utah', 'UT', '84663', '8013612641', '          ', 'UTMA', '', '', '0.00', '40.00', '0.00', 6, '2013-02-15', '2014-05-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740391655', 0, 'N', 0, '2014-03-05', NULL, NULL, 0, 0, NULL, NULL),
('201012599', 'W40005751', 'W40005751', 'UTMH1', 'Turning Leaf Wellness Center', 'Richard', 'Y', 'Moody', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '1240 E 100 S Bldg 22 Ste 121', 'St George', 'Washington', 'UT', '84790', '4356521202', NULL, '1240 E 100 S Bldg 22 Ste 121', 'St George', 'Washington', 'UT', '84790', '4356521202', '', 'PHD', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609821693', 0, 'n', 0, '2014-01-28', NULL, NULL, 37.079, -113.56, NULL, NULL),
('300506581', 'W40015529', 'W40015529', 'ID01', 'Living Well Inc', 'Tammy', 'L', 'Morehouse', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '6003 W Overland Rd Ste 101', 'Boise', 'Ada', 'ID', '83709', '2083222412', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'IDMA', NULL, NULL, '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, NULL, '', '', '', '', 'HCFA|UB|', '1558476721', 0, 'n', 0, '2013-02-28', NULL, NULL, 43.5899, -116.256, NULL, NULL),
('830199236', 'W40016792', 'W40016792', 'WY01', 'Yellowstone Behavioral Health Center', 'Laci', 'L', 'Morgan', 'PSYD', 'Mental Health', 'Psychology', '', NULL, 'O', '2538 Bighorn Ave', 'Cody', 'Park', 'WY', '82414', '3075872197', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'PHD', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720227648', 0, 'n', 0, '2013-02-28', NULL, NULL, 44.5334, -109.04, NULL, NULL),
('870623917', 'W40005749', 'W40005749', 'UTMH1', NULL, 'Barbara', '', 'Morrell-Hughes', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1580 W Antelope Dr Ste 280', 'Layton', 'Davis', 'UT', '84041', '8017261388', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'UTMA', NULL, NULL, '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, NULL, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1558415489', 0, 'n', 0, '2013-02-28', NULL, NULL, 41.0893, -111.994, NULL, NULL),
('275415258', 'W40021120', 'W40021120', 'UTMH1', 'Utah Psychological Associates', 'Jennifer', 'A', 'Morrill', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '3325 N University Ave Ste 300D', 'Provo', 'Utah', 'UT', '84604', '8013772014', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'UTPHD', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1881730604', 0, 'N', 0, '2013-02-28', NULL, NULL, 40.2777, -111.658, NULL, NULL),
('528512299', 'W40023639', 'W40023639', 'UTMH1', 'Preferred Family Clinic', 'Laura', 'L', 'Morris', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '1355 N University Ave Ste 200', 'Provo', 'Utah', 'UT', '84604', '8012210223', '8012210291', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'ma', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1831453679', 0, 'N', 0, '2013-02-28', NULL, NULL, 40.2519, -111.659, NULL, NULL),
('529676822', 'W40005572', 'W40005572', 'UTMH1', 'Preferred Family Clinic', 'Summer', 'A', 'Morris', 'LPC', 'Mental Health', 'Counseling', NULL, NULL, 'O', '1355 N University Ave Ste 200', 'Provo', 'Utah', 'UT', '84604', '8012210223', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'MA', NULL, NULL, '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, NULL, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1578767737', 0, 'n', 0, '2013-02-28', NULL, NULL, 40.2519, -111.659, NULL, NULL),
('529676822', 'W40005727', 'W40005727', 'UTMH1', 'Preferred Family Clinic', 'Summer', 'A', 'Morris', 'LPC', 'Mental Health', 'Counseling', NULL, NULL, 'O', '584 E 12300 S Ste 1', 'Draper', 'Salt Lake', 'UT', '84020', '8017482192', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'MA', NULL, NULL, '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, NULL, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1578767737', 0, 'n', 0, '2013-02-28', NULL, NULL, 40.5267, -111.875, NULL, NULL),
('242904849', 'W40005498', 'W40005498', 'UTMH1', '', 'Jennifer', 'L', 'Mowery', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1399 S 700 E Ste 15', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8014832755', NULL, '1399 S 700 E Ste 15', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8014832755', '', 'UTMA', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467472928', 0, 'N', 0, '2014-04-24', NULL, NULL, 40.7393, -111.871, NULL, NULL),
('820371383', 'W40016512', 'W40016512', 'ID02', 'Valley Family Health Care', 'Shirley', 'M', 'Murata', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1441 NE 10th Ave', 'Payette', 'Payette', 'ID', '83661', '2086429376', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'IDMA', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1639108350', 0, 'N', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('820371383', 'W40016511', 'W40016511', 'ID02', 'Valley Family Health Care', 'Shirley', 'M', 'Murata', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '207 E 12th St', 'Emmett', 'Gem', 'ID', '83617', '2083651065', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'IDMA', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1639108350', 0, 'N', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('450618187', 'W40016159', 'W40016159', 'UTMH1', 'Redwood Therapy Group', 'Brian', 'B', 'Murdock', 'LPC', 'Mental Health', '', '', NULL, 'O', '8541 S Redwood Rd Ste C', 'West Jordan', 'Salt Lake', 'UT', '84088', '8018784220', '8018789846', '8541 S Redwood Rd Ste C', 'West Jordan', 'Salt Lake', 'UT', '84088', '8018784220', '8018789846', 'UTMA', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932423522', 0, 'N', 0, '2014-05-06', NULL, NULL, 40.596, -111.939, NULL, NULL),
('450618187', 'W40016160', 'W40016160', 'UTMH1', 'Redwood Therapy Group', 'Brian', 'B', 'Murdock', 'LPC', 'Mental Health', '', '', NULL, 'B', 'PO Box 64', 'West Jordan', 'Salt Lake', 'UT', '84084', '8018784220', '8018789846', 'PO Box 64', 'West Jordan', 'Salt Lake', 'UT', '84084', '8018784220', '8018789846', 'UTMA', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932423522', 0, 'N', 0, '2014-05-06', NULL, NULL, 0, 0, NULL, NULL),
('264382166', 'W40019163', 'W40019163', 'ID01', '', 'Julia', 'R', 'Myers', 'LCPC', 'Mental Health', 'Counseling', '', NULL, 'O', '2971 E Copper Point Dr Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2083765683', '2083765690', '2971 E Copper Point Dr Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2083765683', '2083765690', 'IDMA', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477597011', 0, 'N', 0, '2013-08-16', NULL, NULL, 43.5839, -116.357, NULL, NULL),
('820526341', 'W40008440', 'W40008440', 'ID01', NULL, 'Roberto', '', 'Negron', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '413 N Allumbaugh St Ste 101', 'Boise', 'Ada', 'ID', '83704', '2083231125', NULL, '413 N Allumbaugh St Ste 101', 'Boise', 'Ada', 'ID', '83704', '2083231125', '', 'IDMD', NULL, NULL, '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1932139961', 0, 'n', 0, '2013-03-20', NULL, NULL, 43.6087, -116.266, NULL, NULL),
('529319115', 'W40020182', 'W40020182', 'UTMH1', 'Heather Nelson, LCSW', 'Heather', 'J', 'Nelson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'M', '2861 W 560 S', 'Lehi', 'Utah', 'UT', '84043', '8015203160', '2087339463', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'ma', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1861414310', 0, 'N', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('529319115', 'W40020181', 'W40020181', 'UTMH1', 'Heather Nelson, LCSW', 'Heather', 'J', 'Nelson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '441 W Main Ste B', 'Lehi', 'Utah', 'UT', '84043', '8015203160', '2087339463', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'ma', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1861414310', 0, 'N', 0, '2013-02-28', NULL, NULL, 40.3877, -111.856, NULL, NULL),
('529319115', 'W40020183', 'W40020183', 'UTMH1', 'Heather Nelson, LCSW', 'Heather', 'J', 'Nelson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 1657', 'Twin Falls', 'Twin Falls', 'ID', '83303', '8015203160', '2087339463', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'ma', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1861414310', 0, 'N', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('512341568', 'W40005467', 'W40005467', 'UTMH1', NULL, 'Janice', 'D', 'Nelson', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '2319 Foothill Dr Ste 275', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8014668123', NULL, '2319 Foothill Dr Ste 275', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8014668123', '', 'UTPHD', NULL, NULL, '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942391925', 0, 'n', 0, '2014-05-01', NULL, NULL, 40.7205, -111.811, NULL, NULL),
('512341568', 'W40005468', 'W40005468', 'UTMH1', NULL, 'Janice', 'D', 'Nelson', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'B', 'PO Box 58264', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8014668123', NULL, 'PO Box 58264', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8014668123', '', 'UTPHD', NULL, NULL, '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942391925', 0, 'Y', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
('270968062', 'W40022280', 'W40022280', 'UTMH1', 'The Counseling Center ', 'Newel', '', 'Nelson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '123 W 1550 N', 'Bountiful', 'Davis', 'UT', '84010', '8012982000', '8019511490', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'UTMA', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1588927966', 0, 'N', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('270968062', 'W40022279', 'W40022279', 'UTMH1', 'The Counseling Center ', 'Newel', '', 'Nelson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '386 N Main St', 'Centerville', 'Davis', 'UT', '84014', '8012982000', '8019511490', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'UTMA', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1588927966', 0, 'N', 0, '2013-02-28', NULL, NULL, 40.9214, -111.879, NULL, NULL),
('820420391', 'W40008390', 'W40008390', 'ID01', NULL, 'Zane', 'P', 'Nelson', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '335 N Allumbaugh', 'Boise', 'Ada', 'ID', '83704', '2083761611', NULL, '335 N Allumbaugh', 'Boise', 'Ada', 'ID', '83704', '2083761611', '', 'IDPHD', NULL, NULL, '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750405072', 0, 'N', 0, '2014-05-01', NULL, NULL, 43.6081, -116.266, NULL, NULL),
('820420391', 'W40008387', 'W40008387', 'ID01', NULL, 'Zane', 'P', 'Nelson', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'B', 'PO Box 4363', 'Boise', 'Ada', 'ID', '83711', '2083761611', NULL, 'PO Box 4363', 'Boise', 'Ada', 'ID', '83711', '2083761611', '', 'IDPHD', NULL, NULL, '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750405072', 0, 'y', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
('371555030', 'W40005445', 'W40005445', 'UTMH1', 'Heritage Counseling, PLLC', 'Diana', 'L', 'Newberry', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1747 Heritage Ln Ste B103', 'Syracuse', 'Davis', 'UT', '84075', '8015256975', NULL, '1747 Heritage Ln Ste B103', 'Syracuse', 'Davis', 'UT', '84075', '8015256975', '', 'MA', NULL, NULL, '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629049218', 0, 'n', 0, '2014-04-24', NULL, NULL, 41.0885, -112.062, NULL, NULL),
('870624721', 'W40005446', 'W40005446', 'UTMH1', 'David Newbold & Associates ', 'David', '', 'Newbold', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '370 S 500 E Ste 180', 'Clearfield', 'Davis', 'UT', '84015', '8017761954', NULL, '370 S 500 E Ste 180', 'Clearfield', 'Davis', 'UT', '84015', '8017761954', '', 'UTPHD', NULL, NULL, '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578643771', 0, 'N', 0, '2014-05-01', NULL, NULL, 41.1084, -112.016, NULL, NULL),
('870624721', 'W40005447', 'W40005447', 'UTMH1', 'David Newbold & Associates ', 'David', '', 'Newbold', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'B', 'PO Box 212', 'Kaysville', 'Davis', 'UT', '84037', '8017761954', NULL, 'PO Box 212', 'Kaysville', 'Davis', 'UT', '84037', '8017761954', '', 'UTPHD', NULL, NULL, '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578643771', 0, 'Y', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
('452403057', 'W40012016', 'W40012016', 'UTMH1', 'St. George Children and Family Psychiatric Center', 'Cantril', '', 'Nielsen', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '437 S Bluff St Ste 202', 'St George', 'Washington', 'UT', '84770', '4356521897', NULL, '437 S Bluff St Ste 202', 'St George', 'Washington', 'UT', '84770', '4356521897', '          ', 'MD-3', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1942364435', 0, 'N', 0, '2013-08-27', NULL, NULL, 37.1007, -113.589, NULL, NULL),
('271317243', 'W40013320', 'W40013320', 'ID02', '', 'Paula', 'M', 'Nordstrom', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '408 22nd Ave S', 'Nampa', 'Canyon', 'ID', '83651', '2084468267', NULL, '408 22nd Ave S', 'Nampa', 'Canyon', 'ID', '83651', '2084468267', '          ', 'IDPHD', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1932134350', 0, 'N', 0, '2013-08-12', NULL, NULL, 0, 0, NULL, NULL),
('519929752', 'W40021755', 'W40021755', 'ID02', 'Webb Group', 'Paula', 'M', 'Nordstrom', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '408 22nd Ave S', 'Nampa', 'Canyon', 'ID', '83651', '2084668267', NULL, '408 22nd Ave S', 'Nampa', 'Canyon', 'ID', '83651', '2084668267', '', 'IDPHD', NULL, NULL, '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1932134350', 0, 'n', 0, '2013-08-12', NULL, NULL, 0, 0, NULL, NULL),
('870476172', 'W40005511', 'W40005511', 'UTMH1', 'Shepherds Staff Counseling Center Inc', 'James', 'T', 'Northrop', 'PHD', 'Mental Health', 'Counseling', NULL, NULL, 'O', '575 23RD ST', 'Ogden', 'Weber', 'UT', '84401', '8015619987', '          ', '575 23RD ST', 'Ogden', 'Weber', 'UT', '84401', '8015619987', '          ', 'MA', '', '', '0.00', '40.00', '0.00', 6, '2013-02-15', '2013-08-20', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1700842069', 0, 'N', 0, '2014-05-29', NULL, NULL, 41.2248, -111.966, NULL, NULL),
('870476172', 'W40005510', 'W40005510', 'UTMH1', 'Shepherds Staff Christian Counseling Center', 'James', 'T', 'Northrop', 'PHD', 'Mental Health', 'Counseling', NULL, NULL, 'O', '731 E 8600 S', 'Sandy', 'Salt Lake', 'UT', '84094', '8012681564', '8012681565', '731 E 8600 S', 'Sandy', 'Salt Lake', 'UT', '84094', '8012681564', '8012681565', 'MA', '', '', '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1700842069', 0, 'N', 0, '2014-05-29', NULL, NULL, 40.595, -111.871, NULL, NULL),
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('273291370', 'W40022282', 'W40022282', 'ID02', 'Northwest Neurobehavioral Health', 'Hamilton', '', 'Warren-Sutton', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'B', 'PO Box 16820', 'Boise', 'Ada', 'ID', '83715', '2089557333', '2089557330', 'PO Box 16820', 'Boise', 'Ada', 'ID', '83715', '2089557333', '2089557330', 'IDMD', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1730154345', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL);
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('870271413', 'W40012609', 'W40012609', 'UTMH1', 'Family Counseling Services', 'Curtis', 'W', 'Watson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '3518 Washington Blvd', 'Ogden', 'Weber', 'UT', '84403', '8013991600', '8013991640', '3518 Washington Blvd', 'Ogden', 'Weber', 'UT', '84403', '8013991600', '8013991640', 'UTMA', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477681245', 0, 'N', 0, '2014-04-17', NULL, NULL, 41.1994, -111.971, NULL, NULL),
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('753107416', 'W40015414', 'W40015414', 'UTMH1', NULL, 'Nancy', 'B', 'Webb', 'LMFT', 'Mental Health', 'Marriage & Family Therapy', '', NULL, 'B', 'PO Box 6712', 'North Logan', 'Cache', 'UT', '84341', '4357538863', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'MA', NULL, NULL, '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, NULL, '', '', '', '', 'HCFA|UB|', '1487720181', 0, 'y', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
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('201753484', 'W41015620', 'W41015620', 'ID01', 'Intermountain Center for Autism and Child Development', 'Tyler', 'T', 'Whitney', 'PSYD', 'Mental Health', 'Psychology', '', NULL, 'O', '2273 E Gala St Ste 120', 'Meridian', 'Ada', 'ID', '83642', '2088887104', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'IDPHD', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1467670653', 0, 'Y', 0, '2013-02-28', NULL, NULL, 43.5892, -116.366, NULL, NULL),
('201753484', 'W40021197', 'W40021197', 'ID01', 'Intermountain Center for Autism and Child Development', 'Tyler', 'T', 'Whitney', 'PSYD', 'Mental Health', 'Psychology', '', NULL, 'B', '314 Maxwell Rd Ste 400', 'Alpharetta', 'Fulton', 'GA', '30009', '7704429447', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'IDPHD', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1467670653', 0, 'Y', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('820484941', 'W40006123', 'W40006123', 'ID01', 'Center for Hope and Healing', 'Cathie', 'D', 'Wick', 'LCSW', 'Mental Health', 'Social Worker', 'Counseling', NULL, 'O', '660 E Franklin Rd Ste 260', 'Meridian', 'Ada', 'ID', '83642', '2083430441', '2083434993', '660 E Franklin Rd Ste 260', 'Meridian', 'Ada', 'ID', '83642', '2083430441', '2083434993', 'IDMA', '', '', '0.00', '40.00', '0.00', 8, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497961460', 0, 'N', 0, '2014-05-21', NULL, NULL, 43.6049, -116.384, NULL, NULL),
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('830235231', 'W40015600', 'W40015600', 'WY01', 'Cloud Peak Counseling Center', 'Wendy', 'K', 'Wiecki', 'CMHW', 'Mental Health', 'Social Worker', '', NULL, 'O', '206 S 7th St', 'Worland', 'Washakie', 'WY', '82401', '3073476165', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'MA', NULL, NULL, '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, NULL, '', '', '', '', 'HCFA|UB|', '1760506067', 0, 'n', 0, '2013-02-28', NULL, NULL, 44.0157, -107.96, NULL, NULL),
('202800071', 'W40005158', 'W40005158', 'UTMH1', 'Alpine Center for Personal Growth', 'Christopher', 'D', 'Wightman', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '5689 S Redwood Rd Ste 30', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012681715', '8012681783', '5689 S Redwood Rd Ste 30', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012681715', '8012681783', 'UTMA', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740337864', 0, 'n', 0, '2013-07-24', NULL, NULL, 40.6479, -111.939, NULL, NULL),
('870411148', 'W40020104', 'W40020104', 'UTMH1', 'Child & Family Psychology', 'Robert', 'F', 'Williams', 'PHD', 'Mental Health', 'Pediatric Psychology', '', NULL, 'O', '703 S State St Ste 1', 'Orem', 'Utah', 'UT', '84058', '8012259522', NULL, '703 S State St Ste 1', 'Orem', 'Utah', 'UT', '84058', '8012259522', '', 'PHD', NULL, NULL, '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598808842', 0, 'n', 0, '2013-08-23', NULL, NULL, 40.2841, -111.689, NULL, NULL),
('820486458', 'W40015528', 'W40015528', 'ID01', 'Adult Adolescent & Children Counseling Center', 'Christine', '', 'Wilson', 'LCPC LMFT', 'Mental Health', 'Counseling', 'Marriage & Family Therapy', NULL, 'O', '3318 N Cole Rd', 'Boise', 'Ada', 'ID', '83704', '2083752730', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'IDMA', NULL, NULL, '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, NULL, '', '', '', '', 'HCFA|UB|', '1710002746', 0, 'y', 0, '2013-02-28', NULL, NULL, 43.6353, -116.274, NULL, NULL),
('820486458', 'W40015527', 'W40015527', 'ID01', 'Adult Adolescent & Children Counseling Center', 'Christine', '', 'Wilson', 'LCPC LMFT', 'Mental Health', 'Counseling', 'Marriage & Family Therapy', NULL, 'B', 'PO Box 44671', 'Boise', 'Ada', 'ID', '83711', '2083752730', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'IDMA', NULL, NULL, '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, NULL, '', '', '', '', 'HCFA|UB|', '1710002746', 0, 'Y', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('460906063', 'W40024337', 'W40024337', 'UTMH1', 'The Counseling Center', 'Victoria', '', 'Winsett', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '123 W 1550 N', 'Bountiful', 'Davis', 'UT', '84010', '8012982000', '8019511490', '123 W 1550 N', 'Bountiful', 'Davis', 'UT', '84010', '8012982000', '8019511490', 'ma', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', '2013-09-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629352117', 0, 'N', 0, '2013-09-23', NULL, NULL, 0, 0, NULL, NULL),
('460906063', 'W40024336', 'W40024336', 'UTMH1', 'The Counseling Center', 'Victoria', '', 'Winsett', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '386 N Main St', 'Centerville', 'Davis', 'UT', '84014', '8012982000', '8019511490', '386 N Main St', 'Centerville', 'Davis', 'UT', '84014', '8012982000', '8019511490', 'ma', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629352117', 0, 'N', 0, '2013-09-23', NULL, NULL, 40.9214, -111.879, NULL, NULL),
('830235231', 'W40015636', 'W40015636', 'WY01', 'Cloud Peak Counseling Center', 'Darcie', '', 'Wisehart', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '206 S 7th St', 'Worland', 'Washakie', 'WY', '82401', '3073476165', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'MA', NULL, NULL, '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, NULL, '', '', '', '', 'HCFA|UB|', '1558486621', 0, 'n', 0, '2013-02-28', NULL, NULL, 44.0157, -107.96, NULL, NULL),
('263165745', 'W40016085', 'W40016085', 'ID01', 'Behavioral Health Associates', 'Bruce', 'R', 'Wixson', 'LCPC LMFT', 'Mental Health', 'Marriage & Family Therapy', 'Counseling', NULL, 'O', '600 E Riverpark Ln Ste 200', 'Boise', 'Ada', 'ID', '83706', '2083445457', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'IDMA', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1992838114', 0, 'N', 0, '2013-02-28', NULL, NULL, 43.5907, -116.176, NULL, NULL),
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('547769846', 'W12031222', 'W12031222', 'UT01', 'Val G Mullinax DPM', 'Val', 'G', 'Mullinax', 'DPM', 'Podiatry', '', '', NULL, 'O', '1355 N University Ave Ste 125', 'Provo', 'Utah', 'UT', '84604', '8013743010', '0000000000', '1355 N University Ave Ste 125', 'Provo', 'Utah', 'UT', '84604', '8013743010', '0000000000', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-06-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1528179256', 0, 'N', 0, '2014-06-04', NULL, NULL, 40.2519, -111.659, NULL, NULL),
('263035427', 'W12030788', 'W12030788', 'TXDALSTD', 'Orthopaedic Specialists of Dallas', 'Mohammad', 'U', 'Burney', 'MD', 'Sports Medicine', '', '', NULL, 'O', '1005 W Ralph Hall Pkwy Ste 233', 'Rockwall', 'Rockwall', 'TX', '75032', '9727718111', '9727718103', '1005 W Ralph Hall Pkwy Ste 233', 'Rockwall', 'Rockwall', 'TX', '75032', '9727718111', '9727718103', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932131398', 0, 'N', 0, '2013-05-24', NULL, NULL, 32.8873, -96.4706, NULL, NULL),
('271477039', 'W12030789', 'W12030789', 'ID02', 'Advantage Walk in Chiropractic', 'Jamie', 'M', 'Ricks', 'DC', 'Chiropractic', '', '', NULL, 'O', '3211 N Milwaukee St', 'Boise', 'Ada', 'ID', '83704', '2083362225', NULL, '3211 N Milwaukee St', 'Boise', 'Ada', 'ID', '83704', '2083362225', '          ', 'IDCHIRO1', '', '', '0.00', '35.00', '0.00', 3, '2013-03-04', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1053379610', 0, 'N', 0, '2013-03-07', NULL, NULL, 0, 0, NULL, NULL),
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('870767026', 'W12030791', 'W12030791', 'UT01', 'West Valley Medical Group', 'Lawrence', 'E', 'Banta', 'MD', 'Psychiatry', '', '', NULL, 'B', 'PO Box 277976', 'Atlanta', 'Fulton', 'GA', '30384', '2084594667', '2084593372', 'PO Box 277976', 'Atlanta', 'Fulton', 'GA', '30384', '2084594667', '2084593372', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-05-01', NULL, 0, 0, 0, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1568440295', 0, 'N', 0, '2013-08-16', NULL, NULL, 0, 0, NULL, NULL),
('850275777', 'W12030792', 'W12030792', 'NM01', 'Southwest Medical Associates', 'Willis', 'H', 'Kephart', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '6100 Pan American Fwy NE Ste 100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', '5057974503', '6100 Pan American Fwy NE Ste 100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', '5057974503', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2013-05-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1306872940', 0, 'N', 0, '2013-10-30', NULL, NULL, 35.1537, -106.587, NULL, NULL),
('850275777', 'W12030793', 'W12030793', 'NM01', 'Southwest Medical Associates', 'Willis', 'H', 'Kephart', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '4420 Irving Blvd NW', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5058231010', '5057974503', '4420 Irving Blvd NW', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5058231010', '5057974503', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2013-05-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1306872940', 0, 'N', 0, '2013-10-30', NULL, NULL, 35.1902, -106.665, NULL, NULL),
('841431764', 'W12030794', 'W12030794', 'UT01', 'Eastern Utah Eye Physicians', 'Shane', 'R', 'Jensen', 'OD', 'Optometry', NULL, NULL, NULL, 'O', '200 N Fairgrounds Rd', 'Price', 'Carbon', 'UT', '84501', '4356378689', '4356321123', '200 N Fairgrounds Rd', 'Price', 'Carbon', 'UT', '84501', '4356378689', '4356321123', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154422822', 0, 'N', 0, '2013-04-25', NULL, NULL, 39.6051, -110.835, NULL, NULL),
('870574059', 'W12030796', 'W12030796', 'UT01', 'Mountain Land West Layton', 'Patricia', 'D', 'Clapham', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '3225 W Gordon Ave Ste 3', 'Layton', 'Davis', 'UT', '84041', '8014970800', '8014970807', '3225 W Gordon Ave Ste 3', 'Layton', 'Davis', 'UT', '84041', '8014970800', '8014970807', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2013-03-01', '2013-05-03', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467781070', 0, 'N', 0, '2013-05-10', NULL, NULL, 0, 0, NULL, NULL),
('870574059', 'W12030797', 'W12030797', 'UT01', 'Mountain Land Layton', 'Patricia', 'D', 'Clapham', 'DPT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 711185', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8015479462', '8015479116', 'PO Box 711185', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8015479462', '8015479116', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467781070', 0, 'N', 0, '2013-05-13', NULL, NULL, 0, 0, NULL, NULL),
('870574059', 'W12033218', 'W12033218', 'UT01', 'Mountain Land Movement Specialists Salt Lake', 'David', 'J', 'McGill', 'DPT', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '1153 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012626331', '8012623372', '1153 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012626331', '8012623372', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2013-04-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1346597473', 0, 'N', 0, '2013-05-13', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('721564187', 'W12030825', 'W12030825', 'TXDALSTD', 'Walter X Loyola MD', 'Walter', 'X', 'Loyola', 'MD', 'Neurosurgery', '', '', NULL, 'O', '4320 Windson Centre Ste 200', 'Flower Mound', 'Denton', 'TX', '75028', '9723120607', '9723120805', '4320 Windson Centre Ste 200', 'Flower Mound', 'Denton', 'TX', '75028', '9723120607', '9723120805', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2014-06-17', 0, 0, 0, 'Baylor Regional Medical Center at Plano', '', '', '', 'HCFA|UB|', '1689676520', 0, 'N', 0, '2014-06-17', NULL, NULL, 33.0393, -97.0632, NULL, NULL),
('260553931', 'W12030799', 'W12030799', 'IDBOISTD', 'Saint Alphonsus Medical Group Breast and General Surgery', 'Elizabeth', 'M', 'Prier', 'MD', 'General Surgery', '', '', NULL, 'O', '6140 W Curtisian Ste 102', 'Boise', 'Ada', 'ID', '83704', '2083675050', '2083675151', '6140 W Curtisian Ste 102', 'Boise', 'Ada', 'ID', '83704', '2083675050', '2083675151', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2013-03-04', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'Saint Alphonsus Medical Center Nampa', '', '', 'HCFA|UB|', '1306983689', 0, 'N', 0, '2014-07-09', NULL, NULL, 43.6146, -116.258, NULL, NULL),
('462206306', 'W12034815', 'W12034815', 'ID02', 'Stark Medical Group', 'Jody', 'A', 'Stark', 'NP', 'Family Practice', '', '', NULL, 'O', '932 W Idaho Ave Ste 100', 'Ontario', 'Malheur', 'OR', '97914', '5418892244', '5418892626', '932 W Idaho Ave Ste 100', 'Ontario', 'Malheur', 'OR', '97914', '5418892244', '5418892626', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1851472989', 0, 'N', 0, '2014-01-15', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12030801', 'W12030801', 'IDBOISTD', 'Saint Alphonsus Medical Group Sleep Medicine ', 'Norman "John"', '', 'East', 'MD', 'Pulmonary', NULL, NULL, NULL, 'O', '210 W Georgia Ave Ste 120', 'Nampa', 'Canyon', 'ID', '83686', '2084656952', '2084656956', '210 W Georgia Ave Ste 120', 'Nampa', 'Canyon', 'ID', '83686', '2084656952', '2084656956', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-02-15', '2013-06-01', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1518005701', 0, 'N', 0, '2014-01-24', NULL, NULL, 43.5564, -116.575, NULL, NULL),
('300038860', 'W12043360', 'W12043360', 'TXHOUSTD', 'Lone Star Family Health Center', 'Stephen', 'L', 'McKernan', 'DO', 'Family Practice', '', '', NULL, 'O', '440 Rayford Rd Ste 150', 'Spring', 'Montgomery', 'TX', '77386', '9365394004', '9365393635', '440 Rayford Rd Ste 150', 'Spring', 'Montgomery', 'TX', '77386', '9365394004', '9365393635', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-03-03', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB', '1407855547', 0, 'N', 0, '2014-01-16', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12030803', 'W12030803', 'IDBOISTD', 'Saint Alphonsus Medical Group Sleep Medicine Potomac', 'Norman "John"', '', 'East', 'MD', 'Pulmonary', NULL, NULL, NULL, 'O', '7272 Potomac Dr', 'Boise', 'Ada', 'ID', '83704', '2083678333', '2083672003', '7272 Potomac Dr', 'Boise', 'Ada', 'ID', '83704', '2083678333', '2083672003', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-02-15', '2013-06-01', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1518005701', 0, 'N', 0, '2013-07-31', NULL, NULL, 43.6114, -116.273, NULL, NULL),
('820200895', 'W12030804', 'W12030804', 'IDBOISTD', 'Saint Alphonsus Medical Group Sleep Medicine ', 'Beverlee', 'K', 'Furner', 'NPC', 'Family Practice', '', '', NULL, 'O', '210 W Georgia Ave Ste 120', 'Nampa', 'Canyon', 'ID', '83686', '2084656952', '2084656956', '210 W Georgia Ave Ste 120', 'Nampa', 'Canyon', 'ID', '83686', '2084656952', '2084656956', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-02-15', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1487816500', 0, 'N', 0, '2014-01-24', NULL, NULL, 43.5561, -116.574, NULL, NULL),
('820200895', 'W12030805', 'W12030805', 'IDBOISTD', 'Saint Alphonsus Medical Group Sleep Medicine Georgia', 'Beverlee', 'K', 'Furner', 'NPC', 'Family Practice', '', '', NULL, 'O', '7272 Potomac Dr', 'Boise', 'Ada', 'ID', '83704', '2083678333', '2083672003', '7272 Potomac Dr', 'Boise', 'Ada', 'ID', '83704', '2083678333', '2083672003', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-02-15', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1487816500', 0, 'N', 0, '2013-12-10', NULL, NULL, 43.6114, -116.272, NULL, NULL),
('820200895', 'W12030806', 'W12030806', 'IDBOISTD', 'Saint Alphonsus Medical Group Sleep Medicine ', 'Jennifer', '', 'Hale', 'DO', 'Sleep Medicine', '', '', NULL, 'O', '210 W Georgia Ave Ste 120', 'Nampa', 'Canyon', 'ID', '83686', '2084656952', '2084656956', '210 W Georgia Ave Ste 120', 'Nampa', 'Canyon', 'ID', '83686', '2084656952', '2084656956', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-02-15', '2013-06-01', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1831143338', 0, 'N', 0, '2014-05-06', NULL, NULL, 43.5564, -116.575, NULL, NULL),
('820200895', 'W12030807', 'W12030807', 'IDBOISTD', 'Saint Alphonsus Medical Group Sleep Medicine Potomac', 'Jennifer', '', 'Hale', 'DO', 'Sleep Medicine', '', '', NULL, 'O', '7272 Potomac Dr', 'Boise', 'Ada', 'ID', '83704', '2083678333', '2083672003', '7272 Potomac Dr', 'Boise', 'Ada', 'ID', '83704', '2083678333', '2083672003', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-02-15', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1831143338', 0, 'N', 0, '2014-05-06', NULL, NULL, 43.6114, -116.272, NULL, NULL),
('820200895', 'W12030808', 'W12030808', 'IDBOISTD', 'Saint Alphonsus Medical Group Sleep Medicine ', 'Cary', '', 'Jackson', 'MD', 'Pulmonary', 'Sleep Medicine', 'Sleep Disorders', NULL, 'O', '210 W Georgia Ave Ste 120', 'Nampa', 'Canyon', 'ID', '83686', '2084656952', '2084656956', '210 W Georgia Ave Ste 120', 'Nampa', 'Canyon', 'ID', '83686', '2084656952', '2084656956', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-02-15', '2013-06-25', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1932169042', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.5564, -116.575, NULL, NULL),
('820200895', 'W12030809', 'W12030809', 'IDBOISTD', 'Saint Alphonsus Medical Group Sleep Medicine ', 'Cary', '', 'Jackson', 'MD', 'Pulmonary', 'Sleep Medicine', 'Sleep Disorders', NULL, 'O', '7272 Potomac Dr', 'Boise', 'Ada', 'ID', '83704', '2083678333', '2083672003', '7272 Potomac Dr', 'Boise', 'Ada', 'ID', '83704', '2083678333', '2083672003', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-02-15', '2013-06-25', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1932169042', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6114, -116.273, NULL, NULL),
('820200895', 'W12030810', 'W12030810', 'IDBOISTD', '', 'Natalia', '', 'Khochay', 'NPC', 'Pulmonary', 'Sleep Medicine', 'Sleep Disorders', NULL, 'O', '210 W Georgia Ave Ste 120', 'Nampa', 'Canyon', 'ID', '83686', '2084656952', '2084656956', '210 W Georgia Ave Ste 120', 'Nampa', 'Canyon', 'ID', '83686', '2084656952', '2084656956', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-02-15', '2013-06-01', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1255653796', 0, 'N', 0, '2013-07-31', NULL, NULL, 43.5564, -116.575, NULL, NULL),
('820200895', 'W12030811', 'W12030811', 'IDBOISTD', 'Saint Alphonsus Medical Group Sleep Medicine ', 'Natalia', '', 'Khochay', 'NPC', 'Pulmonary', 'Sleep Medicine', 'Sleep Disorders', NULL, 'O', '7272 Potomac Dr', 'Boise', 'Ada', 'ID', '83704', '2083678333', '2083672003', '7272 Potomac Dr', 'Boise', 'Ada', 'ID', '83704', '2083678333', '2083672003', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-02-15', '2013-06-01', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1255653796', 0, 'N', 0, '2014-01-24', NULL, NULL, 43.6114, -116.273, NULL, NULL),
('820200895', 'W12030812', 'W12030812', 'IDBOISTD', 'Saint Alphonsus Medical Group Sleep Medicine ', 'Janat', 'E', 'ODonnell', 'MD', 'Pulmonary', 'Sleep Medicine', 'Sleep Disorders', NULL, 'O', '210 W Georgia Ave Ste 120', 'Nampa', 'Canyon', 'ID', '83686', '2084656952', '2084656956', '210 W Georgia Ave Ste 120', 'Nampa', 'Canyon', 'ID', '83686', '2084656952', '2084656956', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2013-02-15', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1013946391', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.5561, -116.574, NULL, NULL),
('820200895', 'W12030813', 'W12030813', 'IDBOISTD', 'Saint Alphonsus Medical Group Sleep Medicine ', 'Janat', 'E', 'ODonnell', 'MD', 'Pulmonary', 'Sleep Medicine', 'Sleep Disorders', NULL, 'O', '7272 Potomac Dr', 'Boise', 'Ada', 'ID', '83704', '2083678333', '2083672003', '7272 Potomac Dr', 'Boise', 'Ada', 'ID', '83704', '2083678333', '2083672003', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2013-02-15', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1013946391', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6114, -116.272, NULL, NULL),
('820200895', 'W12030814', 'W12030814', 'IDBOISTD', 'Saint Alphonsus Medical Group Sleep Medicine', 'Rory', 'R', 'Ramsey', 'MD', 'Pulmonary', 'Sleep Medicine', 'Sleep Disorders', NULL, 'O', '210 W Georgia Ave Ste 120', 'Nampa', 'Canyon', 'ID', '83686', '2084656952', '2084656956', '210 W Georgia Ave Ste 120', 'Nampa', 'Canyon', 'ID', '83686', '2084656952', '2084656956', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-02-15', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1174634737', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.5561, -116.574, NULL, NULL),
('820200895', 'W12030815', 'W12030815', 'IDBOISTD', 'Saint Alphonsus Medical Group Sleep Medicine', 'Rory', 'R', 'Ramsey', 'MD', 'Pulmonary', 'Sleep Medicine', 'Sleep Disorders', NULL, 'O', '7272 Potomac Dr', 'Boise', 'Ada', 'ID', '83704', '2083678333', '2083672003', '7272 Potomac Dr', 'Boise', 'Ada', 'ID', '83704', '2083678333', '2083672003', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-02-15', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1174634737', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6114, -116.272, NULL, NULL),
('820200895', 'W12030816', 'W12030816', 'IDBOISTD', 'Saint Alphonsus Medical Group Sleep Medicine ', 'Bethany', '', 'Taylor', 'PA-C', 'Pulmonary', 'Sleep Medicine', 'Sleep Disorders', NULL, 'O', '210 W Georgia Ave Ste 120', 'Nampa', 'Canyon', 'ID', '83686', '2084656952', '2084656956', '210 W Georgia Ave Ste 120', 'Nampa', 'Canyon', 'ID', '83686', '2084656952', '2084656956', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-02-15', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1487843322', 0, 'Y', 0, '2014-01-24', NULL, NULL, 43.5561, -116.574, NULL, NULL),
('820200895', 'W12030817', 'W12030817', 'IDBOISTD', 'Saint Alphonsus Medical Group Sleep Medicine Georgia', 'Bethany', '', 'Taylor', 'PA-C', 'Pulmonary', 'Sleep Medicine', 'Sleep Disorders', NULL, 'O', '7272 Potomac Dr', 'Boise', 'Ada', 'ID', '83704', '2083678333', '2083672003', '7272 Potomac Dr', 'Boise', 'Ada', 'ID', '83704', '2083678333', '2083672003', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-02-15', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1487843322', 0, 'Y', 0, '2013-12-11', NULL, NULL, 43.6114, -116.272, NULL, NULL),
('461291873', 'W12030818', 'W12030818', 'ID02', 'Ennis Endocrinology', 'Robert', 'F', 'Ennis', 'MD', 'Endocrinology', '', '', NULL, 'O', '1626 Wells Ave Ste 105', 'Meridian', 'Ada', 'ID', '83642', '2089084541', '2089084542', '1626 Wells Ave Ste 105', 'Meridian', 'Ada', 'ID', '83642', '2089084541', '2089084542', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-04-01', '2014-01-13', 0, 0, 1, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1366647729', 0, 'N', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('519023792', 'W12030820', 'W12030820', 'ID02', 'Tonia Nicholson CRNA', 'Tonia', '', 'Nicholson', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'O', '3630 E Louise Dr', 'Meridian', 'Ada', 'ID', '83642', '2083779515', '2089381109', '3630 E Louise Dr', 'Meridian', 'Ada', 'ID', '83642', '2083779515', '2089381109', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2012-12-19', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1598874760', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('519023792', 'W12030821', 'W12030821', 'ID02', 'Tonia Nicholson CRNA PLLC', 'Tonia', '', 'Nicholson', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'B', 'PO Box 1385 1601 E 17th St', 'Idaho Falls', 'Bonneville', 'ID', '83404', '2083779515', '2089381109', 'PO Box 1385 1601 E 17th St', 'Idaho Falls', 'Bonneville', 'ID', '83404', '2083779515', '2089381109', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2012-12-19', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1598874760', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('721564187', 'W12030826', 'W12030826', 'TXDALSTD', 'Walter X Loyola MD', 'Walter', 'X', 'Loyola', 'MD', 'Neurosurgery', '', '', NULL, 'O', '4510 Medical Center Dr Ste 202', 'Mckinney', 'Collin', 'TX', '75069', '9723120607', '9723120805', '4510 Medical Center Dr Ste 202', 'Mckinney', 'Collin', 'TX', '75069', '9723120607', '9723120805', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2014-06-17', 0, 0, 0, 'Baylor Regional Medical Center at Plano', '', '', '', 'HCFA|UB|', '1689676520', 0, 'N', 0, '2014-06-17', NULL, NULL, 33.1616, -96.6355, NULL, NULL),
('752842177', 'W12030827', 'W12030827', 'TXDALSTD', 'Texas Vascular Associates', 'Dennis', 'R', 'Gable', 'MD', 'Vascular Surgery', '', '', NULL, 'O', '4708 Alliance Blvd Ste 240', 'Plano', 'Collin', 'TX', '75093', '9726659100', '9726654711', '4708 Alliance Blvd Ste 240', 'Plano', 'Collin', 'TX', '75093', '9726659100', '9726654711', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1649233768', 0, 'N', 0, '2013-04-08', NULL, NULL, 33.0145, -96.7925, 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
('352415950', 'W12030829', 'W12030829', 'TXDALSTD', 'Bryan D Brewer MD', 'Bryan', 'D', 'Brewer', 'MD', 'General Surgery', '', '', NULL, 'O', '4323 Josey Ln Ste 204', 'Carrollton', 'Denton', 'TX', '75010', '9722196800', '9722190053', '4323 Josey Ln Ste 204', 'Carrollton', 'Denton', 'TX', '75010', '9722196800', '9722190053', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-08-14', 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, '', '', 'HCFA|UB|', '1487865457', 0, 'N', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('010557074', 'W12030830', 'W12030830', 'TXDALSTD', 'Anesthesia Billing Consultants', 'Alfredo', 'L', 'Marti', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 1123', 'Fort Worth', 'Tarrant', 'TX', '79204', '8178100500', '8178100502', 'PO Box 1123', 'Fort Worth', 'Tarrant', 'TX', '79204', '8178100500', '8178100502', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Surgical Hospital at Fort Worth', NULL, NULL, NULL, 'HCFA|UB|', '1407806326', 0, 'Y', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('751942562', 'W12030831', 'W12030831', 'TXDALSTD', 'Surgical Associates of the Mid Cities', '', '', 'Surgical Assocaites of the Mid Cities', '', 'General Surgery', '', '', NULL, 'O', '1604 Hospital Pkwy Ste 505', 'Bedford', 'Tarrant', 'TX', '76022', '8172672678', '8073540854', '1604 Hospital Pkwy Ste 505', 'Bedford', 'Tarrant', 'TX', '76022', '8172672678', '8073540854', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497882625', 0, 'Y', 0, '2013-07-12', NULL, NULL, 32.8336, -97.1252, NULL, NULL),
('273321637', 'W12030832', 'W12030832', 'UT01', 'Utah Behavior Services, Ins', 'Kristen', '', 'Wilson', 'SLP', 'Speech Therapy', '', '', NULL, 'O', '6013 S Redwood Rd', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012555131', '8012555131', '6013 S Redwood Rd', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012555131', '8012555131', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396975025', 0, 'N', 0, '2013-03-18', NULL, NULL, 40.6418, -111.939, NULL, NULL),
('752919329', 'W12030835', 'W12030835', 'TXDALSTD', 'Neurology Specialists of Dallas', '', '', 'Neurology Specialists of Dallas', '', 'Neurology', '', '', NULL, 'O', '9101 N Central Expwy Ste 450', 'Dallas', 'Dallas', 'TX', '75231', '2143791100', '2143791101', '9101 N Central Expwy Ste 450', 'Dallas', 'Dallas', 'TX', '75231', '2143791100', '2143791101', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154540664', 0, 'Y', 0, '2013-04-08', NULL, NULL, 32.873, -96.7706, NULL, NULL),
('752338371', 'W12030833', 'W12030833', 'TXDALSTD', 'Las Colinas Cancer Center', '', '', 'Gregory A Echt MD PA', '', 'Clinics', '', '', NULL, 'O', '7415 Las Colinas Blvd Ste 100', 'Irving', 'Dallas', 'TX', '75063', '2143792700', '9728693875', '7415 Las Colinas Blvd Ste 100', 'Irving', 'Dallas', 'TX', '75063', '2143792700', '9728693875', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-22', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205863263', 0, 'Y', 0, '2014-01-16', NULL, NULL, 32.909, -96.9538, NULL, NULL),
('752338371', 'W12030834', 'W12030834', 'TXDALSTD', 'Las Colinas Cancer Center', '', '', 'Gregory A Echt MD PA', '', 'Clinics', '', '', NULL, 'B', 'PO Box 674004', 'Dallas', 'Dallas', 'TX', '75267', '2143792700', '9728693875', 'PO Box 674004', 'Dallas', 'Dallas', 'TX', '75267', '2143792700', '9728693875', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-22', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205863263', 0, 'N', 0, '2014-01-16', NULL, NULL, 0, 0, NULL, NULL),
('752338371', 'W12030836', 'W12030836', 'TXDALSTD', 'Las Colinas Cancer Center', 'Gregory', 'A', 'Echt', 'MD', 'Radiation Oncology', '', '', NULL, 'B', 'PO Box 674004', 'Dallas', 'Dallas', 'TX', '75267', '2143792700', '9728693875', 'PO Box 674004', 'Dallas', 'Dallas', 'TX', '75267', '2143792700', '9728693875', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-22', NULL, 0, 0, 0, 'Irving-Coppell Surgical Hospital', NULL, '', '', 'HCFA|UB|', '1689657298', 0, 'N', 0, '2014-01-16', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12030837', 'W12030837', 'UTIHC01', 'Logan Regional Hospital', 'Neal', 'Shane', 'Boyce', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1300 N 500 E Ste 120', 'Logan', 'Cache', 'UT', '84341', '4357162880', NULL, '1300 N 500 E Ste 120', 'Logan', 'Cache', 'UT', '84341', '4357162880', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285791947', 0, 'N', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12030838', 'W12030838', 'UTIHC04', 'Logan Regional Hospital', 'Neal', 'Shane', 'Boyce', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1300 N 500 E Ste 120', 'Logan', 'Cache', 'UT', '84341', '4357162880', NULL, '1300 N 500 E Ste 120', 'Logan', 'Cache', 'UT', '84341', '4357162880', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285791947', 0, 'N', 0, '2013-03-12', NULL, NULL, 41.7563, -111.821, NULL, NULL),
('870476269', 'W12030839', 'W12030839', 'UTIHC01', 'Primary Childrens Medical Center', 'Larry', 'S', 'Green', 'MD', 'Cardiovascular Disease', 'Internal Medicine', 'Pediatric Cardiology', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016625400', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016625400', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2013-03-01', '2013-03-01', 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1982635843', 0, 'N', 0, '2013-08-01', NULL, NULL, 0, 0, NULL, NULL),
('870476269', 'W12030840', 'W12030840', 'UTIHC02', 'Primary Childrens Medical Center', 'Larry', 'S', 'Green', 'MD', 'Cardiovascular Disease', 'Internal Medicine', 'Pediatric Cardiology', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016625400', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016625400', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2013-03-01', '2013-03-01', 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1982635843', 0, 'N', 0, '2013-08-01', NULL, NULL, 0, 0, NULL, NULL),
('870476269', 'W12030841', 'W12030841', 'UTIHC03', 'Primary Childrens Medical Center', 'Larry', 'S', 'Green', 'MD', 'Cardiovascular Disease', 'Internal Medicine', 'Pediatric Cardiology', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016625400', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016625400', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2013-03-01', '2013-03-01', 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1982635843', 0, 'N', 0, '2013-08-01', NULL, NULL, 0, 0, NULL, NULL),
('870476269', 'W12030842', 'W12030842', 'UTIHC04', 'Primary Childrens Medical Center', 'Larry', 'S', 'Green', 'MD', 'Cardiovascular Disease', 'Internal Medicine', 'Pediatric Cardiology', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016625400', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016625400', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2013-03-01', '2013-03-01', 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1982635843', 0, 'N', 0, '2013-08-01', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12030844', 'W12030844', 'UTIHC01', '', 'C', 'Wayne', 'Trice', 'LCSW', 'Social Worker', '', '', NULL, 'O', '5770 S 1500 W Ste C', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8013137940', NULL, '5770 S 1500 W Ste C', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8013137940', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '1201-02-21', '2013-07-05', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336488428', 0, 'N', 0, '2013-07-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12030845', 'W12030845', 'UTIHC02', '', 'C', 'Wayne', 'Trice', 'LCSW', 'Social Worker', '', '', NULL, 'O', '5770 S 1500 W Ste C', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8013137940', NULL, '5770 S 1500 W Ste C', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8013137940', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '1201-02-21', '2013-07-05', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336488428', 0, 'N', 0, '2013-07-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12030846', 'W12030846', 'UTIHC03', '', 'C', 'Wayne', 'Trice', 'LCSW', 'Social Worker', '', '', NULL, 'O', '5770 S 1500 W Ste C', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8013137940', NULL, '5770 S 1500 W Ste C', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8013137940', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '1201-02-21', '2013-07-05', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336488428', 0, 'N', 0, '2013-07-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12030847', 'W12030847', 'UTIHC04', '', 'C', 'Wayne', 'Trice', 'LCSW', 'Social Worker', '', '', NULL, 'O', '5770 S 1500 W Ste C', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8013137940', NULL, '5770 S 1500 W Ste C', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8013137940', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '1201-02-21', '2013-07-05', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336488428', 0, 'N', 0, '2013-07-08', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'W12030851', 'W12030851', 'TXDALSTD', 'Health Texas Provider Network', 'Steven', 'C', 'Strength', 'DO', 'Internal Medicine', '', '', NULL, 'O', '1441 Redbud Blvd Ste 211', 'Mckinney', 'Collin', 'TX', '75069', '9725422673', '9725629506', '1441 Redbud Blvd Ste 211', 'Mckinney', 'Collin', 'TX', '75069', '9725422673', '9725629506', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Baylor Medical Center at McKinney', NULL, NULL, NULL, 'HCFA|UB|', '1518965987', 0, 'N', 0, '2013-03-13', NULL, NULL, 33.2112, -96.6341, NULL, NULL),
('752536818', 'W12030850', 'W12030850', 'TXDALSTD', 'Health Texas Provider Network', 'Steven', 'C', 'Strength', 'DO', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Baylor Medical Center at McKinney', NULL, NULL, NULL, 'HCFA|UB|', '1518965987', 0, 'N', 0, '2013-03-13', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'W12030853', 'W12030853', 'TXDALSTD', 'McKinney Inpatient Care Unit', 'Sameh', 'F', 'Elsaid', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396829552', 0, 'N', 0, '2013-05-01', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'W12030854', 'W12030854', 'TXDALSTD', 'McKinney Inpatient Care Unit', 'Sameh', 'F', 'Elsaid', 'MD', 'Internal Medicine', '', '', NULL, 'O', '5252 W University Dr', 'Mckinney', 'Collin', 'TX', '75071', '4697646950', '4697646954', '5252 W University Dr', 'Mckinney', 'Collin', 'TX', '75071', '4697646950', '4697646954', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396829552', 0, 'Y', 0, '2013-05-01', NULL, NULL, 33.2183, -96.6841, NULL, NULL),
('752582845', 'W12030877', 'W12030877', 'TXDALSTD', 'Dallas Diagnostic Association', 'Eduardo', '', 'Vadia', 'MD', 'Pulmonary', '', '', NULL, 'O', '5252 W University Dr', 'Mckinney', 'Collin', 'TX', '75071', '4697646950', '4697646954', '5252 W University Dr', 'Mckinney', 'Collin', 'TX', '75071', '4697646950', '4697646954', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-04-01', '2013-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265642912', 0, 'N', 0, '2013-09-16', NULL, NULL, 33.2195, -96.685, NULL, NULL),
('752582845', 'W12030876', 'W12030876', 'TXDALSTD', 'Dallas Diagnostic Association', 'Eduardo', '', 'Vadia', 'MD', 'Pulmonary', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-04-01', '2013-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265642912', 0, 'N', 0, '2013-09-16', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'W12030879', 'W12030879', 'WYT2', 'Premier Bone and Joint Centers', 'Ryan', '', 'Aukerman', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '620 4-J Ct Ste A', 'Gillette', 'Campbell', 'WY', '82716', '8004465684', NULL, '620 4-J Ct Ste A', 'Gillette', 'Campbell', 'WY', '82716', '8004465684', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 1, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1417912858', 0, 'N', 0, '2013-03-13', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'W12030878', 'W12030878', 'WY01', 'Premier Bone and Joint Centers', 'Ryan', '', 'Aukerman', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '620 4-J Ct Ste A', 'Gillette', 'Campbell', 'WY', '82716', '8004465684', NULL, '620 4-J Ct Ste A', 'Gillette', 'Campbell', 'WY', '82716', '8004465684', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1417912858', 0, 'N', 0, '2013-03-13', NULL, NULL, 44.3256, -105.525, NULL, NULL),
('911947573', 'W12030881', 'W12030881', 'TXDALSTD', 'Neuro Oncology Associates', 'Maria', 'I', 'Juarez', 'MD', 'Oncology', '', '', NULL, 'B', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '9722832389', '9725724312', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '9722832389', '9725724312', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-03-23', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, NULL, NULL, 'HCFA|UB|', '1447297965', 0, 'N', 0, '2013-04-04', NULL, NULL, 0, 0, NULL, NULL),
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('455195232', 'W12030905', 'W12030905', 'TXHOUSTD', '', 'Hilton', '', 'Yee', 'MD', 'Plastic Surgery', '', '', NULL, 'B', 'PO Box 4248 Dept 183', 'Houston', 'Harris', 'TX', '77210', '2819432740', '8322996593', 'PO Box 4248 Dept 183', 'Houston', 'Harris', 'TX', '77210', '2819432740', '8322996593', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-04-15', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, '', '', 'HCFA|UB|', '1649531609', 0, 'N', 0, '2013-03-21', NULL, NULL, 0, 0, NULL, NULL),
('460795561', 'W12030972', 'W12030972', 'UTMH1', 'Intermountain Psychological Services', 'Rocky', 'C', 'Underwood', 'PhD', 'Mental Health', 'Psychology', '', NULL, 'B', 'PO Box 1088', 'American Fork', 'Utah', 'UT', '84003', '8014408501', NULL, 'PO Box 1088', 'American Fork', 'Utah', 'UT', '84003', '8014408501', '          ', 'UTPHD', '', '', '0.00', '40.00', '0.00', 3, '2013-03-07', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447322904', 0, 'N', 0, '2013-03-15', NULL, NULL, 0, 0, NULL, NULL),
('223941333', 'W12030918', 'W12030918', 'ID01', 'Treasure Valley Eye Center', 'Rob', '', 'Christensen', 'OD', 'Optometry', '', '', NULL, 'O', '3045 E St Lukes Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2082882020', '2082882015', '3045 E St Lukes Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2082882020', '2082882015', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2030-01-01', '2014-02-25', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033302161', 0, 'Y', 1, '2014-06-05', NULL, NULL, 0, 0, NULL, NULL),
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('461482835', 'W12030921', 'W12030921', 'UT01', 'Rocky Mountain Allergy Asthma and Immunology LLC', 'David', 'S', 'Gourley', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '380 E 1500 S Ste 201', 'Heber City', 'Wasatch', 'UT', '84032', '8017759800', '8017759806', '380 E 1500 S Ste 201', 'Heber City', 'Wasatch', 'UT', '84032', '8017759800', '8017759806', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-04-01', '2014-06-30', 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1477555712', 0, 'N', 0, '2014-05-29', NULL, NULL, 40.4892, -111.406, NULL, NULL),
('461482835', 'W12030924', 'W12030924', 'UT01', 'Rocky Mountain Allergy Asthma and Immunology LLC', 'David', 'S', 'Gourley', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '6065 S Fashion Blvd Ste 255', 'Murray', 'Salt Lake', 'UT', '84107', '8012664115', '8012664138', '6065 S Fashion Blvd Ste 255', 'Murray', 'Salt Lake', 'UT', '84107', '8012664115', '8012664138', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-04-01', '2014-06-30', 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1477555712', 0, 'N', 0, '2014-05-29', NULL, NULL, 40.6391, -111.883, NULL, NULL),
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('461482835', 'W12030928', 'W12030928', 'UT01', 'Rocky Mountain Allergy Asthma and Immunology LL', 'Douglas', 'H', 'Jones', 'MD', 'Allergy and Immunology', 'Internal Medicine', '', NULL, 'O', '620 E Medical Dr Ste 150', 'Bountiful', 'Davis', 'UT', '84010', '8017759800', '8017759806', '620 E Medical Dr Ste 150', 'Bountiful', 'Davis', 'UT', '84010', '8017759800', '8017759806', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-04-01', '2013-03-31', 0, 0, 0, 'Davis Hospital', 'Lakeview Hospital', '', '', 'HCFA|UB|', '1346324761', 0, 'N', 0, '2014-05-29', NULL, NULL, 0, 0, NULL, NULL),
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('201780406', 'W12030934', 'W12030934', 'ILCHIGSTD', 'UroPartners', 'Spencer', '', 'Land', 'MD', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-04-15', '2013-04-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639124464', 0, 'N', 1, '2013-04-15', NULL, NULL, 0, 0, NULL, NULL),
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('201780406', 'W12030933', 'W12030933', 'ILCHIGSTD', 'UroPartners', 'Spencer', '', 'Land', 'MD', 'Urology', '', '', NULL, 'O', '675 W North Ave Ste 605', 'Melrose Park', 'Cook', 'IL', '60160', '7084505055', '7083382474', '675 W North Ave Ste 605', 'Melrose Park', 'Cook', 'IL', '60160', '7084505055', '7083382474', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-04-15', '2013-04-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639124464', 0, 'N', 1, '2013-04-15', NULL, NULL, 41.9101, -87.8424, NULL, NULL),
('621801973', 'W12030937', 'W12030937', 'UT01', 'Davis Internal Medicine', 'Emily', 'E', 'Sandberg', 'PA-C', 'Family Practice', '', '', NULL, 'O', '1492 W Antelope Dr Ste 203', 'Layton', 'Davis', 'UT', '84041', '8017737500', '8017737800', '1492 W Antelope Dr Ste 203', 'Layton', 'Davis', 'UT', '84041', '8017737500', '8017737800', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-03-21', '2014-04-30', 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1164440665', 0, 'N', 0, '2013-04-15', NULL, NULL, 41.0893, -111.993, NULL, NULL),
('621801973', 'W12030938', 'W12030938', 'UT01', 'Davis Internal Medicine', 'Sara', 'J', 'Arrington', 'APRN', 'Family Practice', '', '', NULL, 'O', '1492 W Antelope Dr Ste 203', 'Layton', 'Davis', 'UT', '84041', '8017737500', '8017737800', '1492 W Antelope Dr Ste 203', 'Layton', 'Davis', 'UT', '84041', '8017737500', '8017737800', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-03-21', '2014-04-30', 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1093960668', 0, 'N', 0, '2013-03-26', NULL, NULL, 41.0893, -111.993, NULL, NULL),
('621801973', 'W12030939', 'W12030939', 'UT01', 'Davis Internal Medicine', '', '', 'Physician Group of Utah Inc', '', 'Clinic', '', '', NULL, 'O', '1492 W Antelope Dr Ste 203', 'Layton', 'Davis', 'UT', '84041', '8017737500', '8017737800', '1492 W Antelope Dr Ste 203', 'Layton', 'Davis', 'UT', '84041', '8017737500', '8017737800', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-03-21', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477676930', 0, 'Y', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
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('742152396', 'W12030942', 'W12030942', 'UTPEHP', 'KCI USA Inc (Wound Vac Only)', '', '', 'KCI USA Inc. ', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'M', '6103 Farinon Dr', 'San Antonio', 'Bexar', 'TX', '78249', '8002754524', NULL, '6103 Farinon Dr', 'San Antonio', 'Bexar', 'TX', '78249', '8002754524', '          ', 'KCI', '', '', '0.00', '100.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366439507', 0, 'N', 0, '2013-03-15', NULL, NULL, 0, 0, NULL, NULL),
('742152396', 'W12030943', 'W12030943', 'UT01', 'KCI USA Inc (Wound Vac Only)', '', '', 'KCI USA Inc. ', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'M', '6103 Farinon Dr', 'San Antonio', 'Bexar', 'TX', '78249', '8002754524', NULL, '6103 Farinon Dr', 'San Antonio', 'Bexar', 'TX', '78249', '8002754524', '          ', 'KCI', '', '', '0.00', '100.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366439507', 0, 'N', 0, '2013-03-15', NULL, NULL, 0, 0, NULL, NULL),
('870179340', 'W12030944', 'W12030944', 'UT01', 'Standard Optical', '', '', 'Standard Optical', 'GROUP', 'Optometry', '', '', NULL, 'O', '4283 Harrision Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014795060', NULL, '4283 Harrision Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014795060', '          ', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-03-04', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008882', 0, 'N', 0, '2013-12-16', NULL, NULL, 41.1851, -111.949, NULL, NULL),
('870179340', 'W12030945', 'W12030945', 'UT01', 'Standard Optical', 'Tyler', 'J', 'Barney', 'OD', 'Optometry', '', '', NULL, 'O', '4283 Harrision Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014795060', NULL, '4283 Harrision Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014795060', '', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-03-04', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528268398', 0, 'N', 0, '2014-07-02', NULL, NULL, 41.1851, -111.949, NULL, NULL),
('870179340', 'W12030946', 'W12030946', 'UT01', 'Standard Optical', 'Aaron', 'M', 'Hartman', 'OD', 'Optometry', '', '', NULL, 'O', '4283 Harrision Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014795060', NULL, '4283 Harrision Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014795060', '          ', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-03-04', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922258375', 0, 'N', 0, '2013-06-04', NULL, NULL, 41.1851, -111.949, NULL, NULL),
('870179340', 'W12030947', 'W12030947', 'UT01', 'Standard Optical', 'Randall', 'C', 'Himes', 'OD', 'Optometry', '', '', NULL, 'O', '4283 Harrision Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014795060', NULL, '4283 Harrision Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014795060', '          ', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-03-04', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144380478', 0, 'N', 0, '2014-01-08', NULL, NULL, 41.1851, -111.949, NULL, NULL),
('870179340', 'W12030948', 'W12030948', 'UT01', 'Standard Optical', 'Jennifer', 'L', 'Kessler', 'OD', 'Optometry', '', '', NULL, 'O', '4283 Harrision Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014795060', NULL, '4283 Harrision Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014795060', '          ', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-03-04', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811259336', 0, 'N', 0, '2013-03-15', NULL, NULL, 41.1851, -111.949, NULL, NULL),
('870179340', 'W12030949', 'W12030949', 'UT01', 'Standard Optical', 'Duane', 'C', 'Knowles', 'OD', 'Optometry', '', '', NULL, 'O', '4283 Harrision Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014795060', NULL, '4283 Harrision Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014795060', '          ', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-03-04', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306935523', 0, 'N', 0, '2013-07-11', NULL, NULL, 41.1851, -111.949, NULL, NULL),
('870179340', 'W12030950', 'W12030950', 'UT01', 'Standard Optical', 'Benjamin', 'H', 'Leishman', 'OD', 'Optometry', '', '', NULL, 'O', '4283 Harrision Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014795060', NULL, '4283 Harrision Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014795060', '          ', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-03-04', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942438015', 0, 'N', 0, '2013-03-15', NULL, NULL, 41.1851, -111.949, NULL, NULL),
('870179340', 'W12030951', 'W12030951', 'UT01', 'Standard Optical', 'Stephen', 'C', 'Lewis', 'OD', 'Optometry', '', '', NULL, 'O', '4283 Harrision Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014795060', NULL, '4283 Harrision Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014795060', '          ', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-03-04', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184653818', 0, 'N', 0, '2013-03-15', NULL, NULL, 41.1851, -111.949, NULL, NULL),
('870179340', 'W12030952', 'W12030952', 'UT01', 'Standard Optical', 'Bruce', 'L', 'Lundin', 'OD', 'Optometry', '', '', NULL, 'O', '4283 Harrision Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014795060', NULL, '4283 Harrision Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014795060', '          ', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-03-04', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750336152', 0, 'N', 0, '2013-03-15', NULL, NULL, 41.1851, -111.949, NULL, NULL),
('870179340', 'W12030953', 'W12030953', 'UT01', 'Standard Optical', 'Michael', 'S', 'Marty', 'OD', 'Optometry', '', '', NULL, 'O', '4283 Harrision Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014795060', NULL, '4283 Harrision Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014795060', '          ', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-03-04', '2013-03-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497743942', 0, 'N', 0, '2013-03-26', NULL, NULL, 0, 0, NULL, NULL),
('870179340', 'W12030954', 'W12030954', 'UT01', 'Standard Optical', 'David', 'A', 'Meyer', 'OD', 'Optometry', '', '', NULL, 'O', '4283 Harrision Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014795060', NULL, '4283 Harrision Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014795060', '          ', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-03-04', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255562740', 0, 'N', 0, '2013-12-23', NULL, NULL, 41.1851, -111.949, NULL, NULL),
('870179340', 'W12030955', 'W12030955', 'UT01', 'Standard Optical', 'Joan', '', 'Mildenstein', 'OD', 'Optometry', '', '', NULL, 'O', '4283 Harrision Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014795060', NULL, '4283 Harrision Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014795060', '          ', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-03-04', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1689990517', 0, 'N', 0, '2014-01-08', NULL, NULL, 41.1851, -111.949, 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
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INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('850275777', 'W12031096', 'W12031096', 'NM01', 'Southwest Medical Associates', 'Michael', 'J', 'Smith', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '6100 Pan American Fwy NE Ste 100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', '5057974503', '6100 Pan American Fwy NE Ste 100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', '5057974503', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2013-05-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1215046743', 0, 'N', 0, '2013-04-16', NULL, NULL, 35.1537, -106.587, NULL, NULL),
('850275777', 'W12031097', 'W12031097', 'NM01', 'Southwest Medical Associates', 'Michael', 'J', 'Smith', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '4420 Irving Blvd NW', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5058231010', '5057974503', '4420 Irving Blvd NW', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5058231010', '5057974503', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2013-05-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1215046743', 0, 'N', 0, '2013-04-16', NULL, NULL, 35.1902, -106.665, NULL, NULL),
('870373083', 'W12031098', 'W12031098', 'UT01', 'Heart and Lung Institute of Utah', 'Sandeep', 'L', 'Chowdhary', 'MD', 'Pulmonary', 'Sleep Studies', '', NULL, 'O', '3580 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012632370', '8012651200', '3580 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012632370', '8012651200', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-04-01', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1891726162', 0, 'N', 0, '2013-03-19', NULL, NULL, 40.5879, -111.975, NULL, NULL),
('870373083', 'W12031099', 'W12031099', 'UT01', 'Heart And Lung Institute of Utah', 'Sandeep', 'L', 'Chowdhary', 'MD', 'Pulmonary', 'Sleep Studies', '', NULL, 'O', '3460 S Pioneer Pkwy', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012632370', '8012651200', '3460 S Pioneer Pkwy', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012632370', '8012651200', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-04-01', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1891726162', 0, 'N', 0, '2013-03-19', NULL, NULL, 40.6972, -111.99, NULL, NULL),
('870373083', 'W12031100', 'W12031100', 'UT01', 'Heart and Lung Institute of Utah', 'Sandeep', 'L', 'Chowdhary', 'MD', 'Pulmonary', 'Sleep Studies', '', NULL, 'M', '5979 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012632370', '8012651200', '5979 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012632370', '8012651200', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-04-01', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1891726162', 0, 'N', 0, '2013-03-19', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'W12031101', 'W12031101', 'UT01', 'Heart and Lung Institute of Utah', 'Sandeep', 'L', 'Chowdhary', 'MD', 'Pulmonary', 'Sleep Studies', '', NULL, 'B', 'PO Box 847112', 'Dallas', 'Dallas', 'TX', '75284', '8012632370', '8012651200', 'PO Box 847112', 'Dallas', 'Dallas', 'TX', '75284', '8012632370', '8012651200', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-04-01', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1891726162', 0, 'N', 0, '2013-03-19', NULL, NULL, 0, 0, NULL, NULL),
('461552029', 'W12031102', 'W12031102', 'UTMH1', 'Solstice Counseling & Wellness PC', 'Shawn', 'M', 'Miller', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '722 W 100 S Ste 1', 'Heber City', 'Wasatch', 'UT', '84032', '4356544037', '4356544077', '722 W 100 S Ste 1', 'Heber City', 'Wasatch', 'UT', '84032', '4356544037', '4356544077', 'UTPHD', '', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861605834', 0, 'N', 0, '2013-10-29', NULL, NULL, 40.5068, -111.424, NULL, NULL),
('454041098', 'W12031104', 'W12031104', 'ILCHIGSTD', 'Concentra Primary Care of Illinois PC', 'Parisa', '', 'Amleshi', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 2050', 'Addison', 'Dallas', 'TX', '75001', '8474278801', '8664414306', 'PO Box 2050', 'Addison', 'Dallas', 'TX', '75001', '8474278801', '8664414306', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1689619314', 0, 'N', 0, '2013-03-26', NULL, NULL, 0, 0, NULL, NULL),
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('363915732', 'W12031647', 'W12031647', 'ILCHIGSTD', 'Joliet Oncology Hematology', 'Arvind', '', 'Kumar', 'MD', 'Oncology', '', '', NULL, 'O', '701 Winthrop Ave', 'Glendale Heights', 'Dupage', 'IL', '60139', '6305454900', '0000000000', '701 Winthrop Ave', 'Glendale Heights', 'Dupage', 'IL', '60139', '6305454900', '0000000000', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', NULL, 'HCFA|UB|', '1861590689', 0, 'N', 0, '2013-04-03', NULL, NULL, 41.9149, -88.0598, NULL, NULL),
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('273228599', 'W12031173', 'W12031173', 'TXDALSTD', 'Basanti Vrushab MD', 'Basanti', '', 'Vrushab', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1615 Precinct Line Rd Ste 101', 'Hurst', 'Tarrant', 'TX', '76054', '8172814910', NULL, '1615 Precinct Line Rd Ste 101', 'Hurst', 'Tarrant', 'TX', '76054', '8172814910', '          ', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-05-22', NULL, 0, 0, 0, NULL, NULL, '', '', 'HCFA|UB|', '1366405268', 0, 'N', 0, '2013-06-05', NULL, NULL, 32.8427, -97.1862, NULL, NULL),
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('751494547', 'W12031175', 'W12031175', 'TXDALSTD', '', 'Ronald', 'W', 'Jones', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 758', 'Royse City', 'Rockwall', 'TX', '75189', '9726369577', '9726367048', 'PO Box 758', 'Royse City', 'Rockwall', 'TX', '75189', '9726369577', '9726367048', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-05-22', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255588653', 0, 'N', 0, '2013-06-25', NULL, NULL, 0, 0, NULL, NULL),
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('201412932', 'W12031182', 'W12031182', 'TXDALSTD', 'D Blayne Laws MD', 'D Blayne', '', 'Laws', 'MD', 'Family Practice', '', '', NULL, 'O', '717 W Lampasas St', 'Ennis', 'Ellis', 'TX', '75119', '9728756700', '9728756750', '717 W Lampasas St', 'Ennis', 'Ellis', 'TX', '75119', '9728756700', '9728756750', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-05-22', '2013-08-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306890645', 0, 'N', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('204203827', 'W12031183', 'W12031183', 'UTMH1', 'Resilient Solutions Inc', 'Monica', '', 'Forsman', 'CMHC', 'Mental Health', 'Counseling', '', NULL, 'O', '1355 N Main St Ste 1', 'Bountiful', 'Davis', 'UT', '84010', '8012593883', '8012954201', '1355 N Main St Ste 1', 'Bountiful', 'Davis', 'UT', '84010', '8012593883', '8012954201', 'UTMA', '', '', '0.00', '40.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1164756771', 0, 'N', 0, '2013-06-04', NULL, NULL, 40.9035, -111.879, NULL, NULL),
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('742743906', 'W12031184', 'W12031184', 'TXSATSTD', 'San Antonio Kidney Disease Center', 'Maria', 'G', 'Luna', 'MD', 'Nephrology', '', '', NULL, 'O', '8042 Wurzbach Rd Ste 500', 'San Antonio', 'Bexar', 'TX', '78229', '2106927228', '2106929671', '8042 Wurzbach Rd Ste 500', 'San Antonio', 'Bexar', 'TX', '78229', '2106927228', '2106929671', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-05-22', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1053594994', 0, 'N', 0, '2013-04-16', NULL, NULL, 29.514, -98.5778, NULL, NULL),
('751608686', 'W12031187', 'W12031187', 'TXDALSTD', 'Southwest Cardiac Associates', '', '', 'Southwest Cardiac Asssocaites', '', 'Cardiovascular Disease', '', '', NULL, 'O', '5308 N Galloway Ave Ste 100', 'Mesquite', 'Dallas', 'TX', '75150', '9722260505', '9722899640', '5308 N Galloway Ave Ste 100', 'Mesquite', 'Dallas', 'TX', '75150', '9722260505', '9722899640', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801866579', 0, 'Y', 0, '2013-05-10', NULL, NULL, 32.8354, -96.6356, NULL, NULL),
('751608686', 'W12031189', 'W12031189', 'TXDALSTD', 'Southwest Cardiac Associates', 'Basim', 'M', 'Jishi', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '5308 N Galloway Ave Ste 100', 'Mesquite', 'Dallas', 'TX', '75150', '9722260505', '9722899640', '5308 N Galloway Ave Ste 100', 'Mesquite', 'Dallas', 'TX', '75150', '9722260505', '9722899640', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'The Heart Hospital Baylor Plano', NULL, '', '', 'HCFA|UB|', '1548230345', 0, 'N', 0, '2013-04-05', NULL, NULL, 32.8354, -96.6356, NULL, NULL),
('751608686', 'W12031191', 'W12031191', 'TXDALSTD', 'Southwest Cardiac Associates', 'Larry', 'C', 'Moore', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '5308 N Galloway Ave Ste 100', 'Mesquite', 'Dallas', 'TX', '75150', '9722260505', '9722899640', '5308 N Galloway Ave Ste 100', 'Mesquite', 'Dallas', 'TX', '75150', '9722260505', '9722899640', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, 'The Heart Hospital Baylor Plano', NULL, '', '', 'HCFA|UB|', '1770553174', 0, 'N', 0, '2013-04-05', NULL, NULL, 32.8354, -96.6356, NULL, NULL),
('751608686', 'W12031193', 'W12031193', 'TXDALSTD', 'Southwest Cardiac Associates', 'Luisa', 'Y', 'Gan', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '5308 N Galloway Ave Ste 100', 'Mesquite', 'Dallas', 'TX', '75150', '9722260505', '9722899640', '5308 N Galloway Ave Ste 100', 'Mesquite', 'Dallas', 'TX', '75150', '9722260505', '9722899640', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, 'The Heart Hospital Baylor Plano', NULL, '', '', 'HCFA|UB|', '1659341485', 0, 'N', 0, '2013-04-11', NULL, NULL, 32.8354, -96.6356, NULL, NULL),
('751608686', 'W12031195', 'W12031195', 'TXDALSTD', 'Southwest Cardiac Associates', 'Bobby', 'R', 'Stewart', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '5308 N Galloway Ave Ste 100', 'Mesquite', 'Dallas', 'TX', '75150', '9722260505', '9722899640', '5308 N Galloway Ave Ste 100', 'Mesquite', 'Dallas', 'TX', '75150', '9722260505', '9722899640', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, 'The Heart Hospital Baylor Plano', NULL, '', '', 'HCFA|UB|', '1386614634', 0, 'N', 0, '2013-04-05', NULL, NULL, 32.8354, -96.6356, NULL, NULL),
('751608686', 'W12031197', 'W12031197', 'TXDALSTD', 'Southwest Cardiac Associates', 'Prasad', 'V', 'Maddukuri', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '5308 N Galloway Ave Ste 100', 'Mesquite', 'Dallas', 'TX', '75150', '9722260505', '9722899640', '5308 N Galloway Ave Ste 100', 'Mesquite', 'Dallas', 'TX', '75150', '9722260505', '9722899640', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, 'The Heart Hospital Baylor Plano', NULL, '', '', 'HCFA|UB|', '1902857295', 0, 'N', 0, '2013-04-05', NULL, NULL, 32.8354, -96.6356, NULL, NULL),
('820161600', 'W12031198', 'W12031198', 'IDBOISTD', 'St Lukes Elmore Physician Group', '', '', 'St Lukes Elmore Physician Group', '', 'Clinics', '', '', NULL, 'O', '890 N 6th E', 'Mountain Home', 'Elmore', 'ID', '83647', '2085809806', '2085809807', '890 N 6th E', 'Mountain Home', 'Elmore', 'ID', '83647', '2085809806', '2085809807', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1326388737', 0, 'N', 0, '2013-07-11', NULL, NULL, 43.1392, -115.693, NULL, NULL),
('820161600', 'W12031200', 'W12031200', 'IDBOISTD', 'St Lukes Elmore Physician Group', 'Matthew', 'P', 'Williams', 'MD', 'General Surgery', '', '', NULL, 'O', '890 N 6th E', 'Mountain Home', 'Elmore', 'ID', '83647', '2085809806', '2085809807', '890 N 6th E', 'Mountain Home', 'Elmore', 'ID', '83647', '2085809806', '2085809807', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA', '1720072747', 0, 'N', 0, '2013-05-28', NULL, NULL, 43.1392, -115.693, NULL, NULL),
('742932151', 'W12031201', 'W12031201', 'TXSATSTD', 'Salazar, David MD', 'David', '', 'Salazar', 'MD', 'Pulmonary', '', '', NULL, 'O', '225 E Sonterra Blvd Ste 217', 'San Antonio', 'Bexar', 'TX', '78258', '2104813119', NULL, '225 E Sonterra Blvd Ste 217', 'San Antonio', 'Bexar', 'TX', '78258', '2104813119', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-03-15', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1104810910', 0, 'N', 0, '2013-12-11', NULL, NULL, 29.6164, -98.492, NULL, NULL),
('743020469', 'W12031202', 'W12031202', 'TXSATSTD', 'Sleep Institute of San Antonio', 'Rafael', 'M', 'Santiago', 'MD', 'Pulmonary', '', '', NULL, 'O', '14855 Blanco Ste 304', 'San Antonio', 'Bexar', 'TX', '78216', '2104921680', NULL, '14855 Blanco Ste 304', 'San Antonio', 'Bexar', 'TX', '78216', '2104921680', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-03-15', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053305508', 0, 'N', 0, '2013-05-01', NULL, NULL, 29.5784, -98.5141, NULL, NULL),
('820529971', 'W12031203', 'W12031203', 'ID02', 'Childrens Therapy Place Inc', 'Deanna', 'M', 'Seamans', 'SLP', 'Speech Therapy', '', '', NULL, 'O', '6855 W Fairview Ave Ste 120', 'Boise', 'Ada', 'ID', '83704', '2083238888', '2083238889', '6855 W Fairview Ave Ste 120', 'Boise', 'Ada', 'ID', '83704', '2083238888', '2083238889', 'WestRehab', '', '', '0.00', '0.00', '0.00', 3, '2013-05-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1275806572', 0, 'N', 0, '2013-04-26', NULL, NULL, 0, 0, NULL, NULL),
('272118774', 'W12031205', 'W12031205', 'UT01', 'Advanced Spine and Pain Specialists', 'Vikas', '', 'Garg', 'MD', 'Pain Management', NULL, NULL, NULL, 'O', '195 Overthrust Rd', 'Evanston', 'Uinta', 'WY', '82930', '3074443600', '8012996825', '195 Overthrust Rd', 'Evanston', 'Uinta', 'WY', '82930', '3074443600', '8012996825', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-03-20', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1104852599', 0, 'N', 0, '2013-11-13', NULL, NULL, 41.257, -110.985, NULL, NULL),
('870281028', 'W12031206', 'W12031206', 'UT01', 'Central Utah Clinic PC', 'Allen', 'M', 'Day', 'MD', 'Family Practice', '', '', NULL, 'O', '1125 S Blackhawk Blvd', 'Moroni', 'Sanpete', 'UT', '84646', '4354622044', '4354622043', '1125 S Blackhawk Blvd', 'Moroni', 'Sanpete', 'UT', '84646', '4354622044', '4354622043', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-05-01', NULL, 0, 0, 0, 'Sanpete Valley Hospital', '', '', '', 'HCFA|UB|', '1518908110', 0, 'N', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
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('870281028', 'W12031208', 'W12031208', 'UT01', 'Central Utah Clinic PC', 'Allen', 'M', 'Day', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '4354622044', '4354622043', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '4354622044', '4354622043', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-05-01', NULL, 0, 0, 0, 'Sanpete Valley Hospital', '', '', '', 'HCFA|UB|', '1518908110', 0, 'N', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12031211', 'W12031211', 'UT01', 'Central Utah Clinic PC', 'Charles', 'E', 'Nunn', 'MD', 'Family Practice', '', '', NULL, 'O', '1125 S Blackhawk Blvd', 'Moroni', 'Sanpete', 'UT', '84646', '4354622044', '4354622043', '1125 S Blackhawk Blvd', 'Moroni', 'Sanpete', 'UT', '84646', '4354622044', '4354622043', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-09-01', NULL, 0, 0, 0, 'Sanpete Valley Hospital', '', '', '', 'HCFA|UB|', '1346280955', 0, 'N', 0, '2013-04-15', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12031209', 'W12031209', 'UT01', 'Central Utah Clinic PC', 'Charles', 'E', 'Nunn', 'MD', 'Family Practice', '', '', 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, '2012-09-01', NULL, 0, 0, 0, 'Sanpete Valley Hospital', '', '', '', 'HCFA|UB|', '1346280955', 0, 'N', 0, '2013-04-15', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12031210', 'W12031210', 'UT01', 'Central Utah Clinic PC', 'Charles', 'E', 'Nunn', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014298180', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014298180', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-09-01', NULL, 0, 0, 0, 'Sanpete Valley Hospital', '', '', '', 'HCFA|UB|', '1346280955', 0, 'N', 0, '2013-04-15', NULL, NULL, 0, 0, NULL, NULL),
('460906063', 'W12031214', 'W12031214', 'UTMH1', 'The Counseling Center', 'Karen', '', 'Redd', 'CMHC', 'Mental Health', 'Counseling', '', NULL, 'O', '123 W 1550 N', 'Bountiful', 'Davis', 'UT', '84010', '8012982000', '8019511490', '123 W 1550 N', 'Bountiful', 'Davis', 'UT', '84010', '8012982000', '8019511490', 'UTMA', '', '', '0.00', '40.00', '0.00', 3, '2013-06-01', '2013-09-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114266988', 0, 'N', 0, '2013-09-23', NULL, NULL, 0, 0, NULL, NULL),
('460906063', 'W12031213', 'W12031213', 'UTMH1', 'The Counseling Center', 'Karen', '', 'Redd', 'CMHC', 'Mental Health', 'Counseling', '', NULL, 'M', '386 N Main St', 'Centerville', 'Davis', 'UT', '84014', '8012982000', '8019511490', '386 N Main St', 'Centerville', 'Davis', 'UT', '84014', '8012982000', '8019511490', 'UTMA', '', '', '0.00', '40.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114266988', 0, 'N', 0, '2014-03-11', NULL, NULL, 40.9214, -111.879, NULL, NULL),
('870281028', 'W12031216', 'W12031216', 'UT01', 'Central Utah Clinic PC', 'Walter', '', 'Ogden', 'MD', 'Family Practice', '', '', NULL, 'M', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013548225', '8014180941', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013548225', '8014180941', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-08-20', '2014-07-01', 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1174519151', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12031215', 'W12031215', 'UT01', 'Central Utah Clinic PC', 'Walter', '', 'Ogden', 'MD', 'Family Practice', '', '', NULL, 'O', '11 S Main St', 'Hurricane', 'Washington', 'UT', '84737', '4356359444', '4356358148', '11 S Main St', 'Hurricane', 'Washington', 'UT', '84737', '4356359444', '4356358148', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-08-20', '2014-07-01', 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1174519151', 0, 'N', 0, '2014-07-21', NULL, NULL, 37.1763, -113.288, NULL, NULL),
('870281028', 'W12031217', 'W12031217', 'UT01', 'Central Utah Clinic PC', 'Walter', '', 'Ogden', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014298180', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014298180', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-08-20', '2014-07-01', 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1174519151', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('870622942', 'W12032105', 'W12032105', 'UT01', 'Utah Imaging Associates ', 'Mark', 'F', 'Abbott', 'MD', 'Radiologist', '', '', NULL, 'O', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012682111', NULL, '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012682111', '          ', 'WUUTIMAGE5', '', '', '0.00', '35.00', '0.00', 3, '2013-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295993871', 0, 'N', 0, '2013-09-19', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('543481094', 'W12031218', 'W12031218', 'SINCLAIRDEN', '', 'Louis', '', 'Erickson', 'DDS', 'Dentist', '', '', NULL, 'O', '1963 S 1200 E', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8014661212', NULL, '1963 S 1200 E', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8014661212', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-03-26', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000006146', 0, 'N', 0, '2013-03-26', NULL, NULL, 0, 0, NULL, NULL),
('870568619', 'W12031219', 'W12031219', 'SINCLAIRDEN', 'iSmile at Crossroads Dental Group', 'Joel', '', 'Howarth', 'DDS', 'Dentist', '', '', NULL, 'O', '3409 W 12600 S Ste 100', 'Riverton', 'Salt Lake', 'UT', '84065', '8015611559', '          ', '3409 W 12600 S Ste 100', 'Riverton', 'Salt Lake', 'UT', '84065', '8015611559', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-03-26', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1306066659', 0, 'N', 0, '2014-05-23', NULL, NULL, 0, 0, NULL, NULL),
('770640930', 'W12031220', 'W12031220', 'SINCLAIRDEN', 'Professional Dental', 'Matthew', '', 'McInnes', 'DDS', 'Dentist', '', '', NULL, 'O', '32 Red Pine Dr Ste 14', 'Alpine', 'Utah', 'UT', '84004', '8017569595', NULL, '32 Red Pine Dr Ste 14', 'Alpine', 'Utah', 'UT', '84004', '8017569595', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-03-26', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000002045', 0, 'N', 0, '2013-03-27', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12031224', 'W12031224', 'UT01', 'Just Kids Pediatric and Adolescent Clinic', 'John', 'Bryant', 'Freer', 'MD', 'Pediatrics', '', '', NULL, 'O', '3336 S 4155 W  Ste 204', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643492', '8019643493', '3336 S 4155 W  Ste 204', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643492', '8019643493', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-03-01', '2014-04-30', 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1821193947', 0, 'N', 0, '2013-07-10', NULL, NULL, 40.6991, -111.99, NULL, NULL),
('621801973', 'W12031225', 'W12031225', 'UT01', 'Just Kids Pediatrics & Adolescent Clinic', 'Ericka', 'K', 'Tse', 'PA-C', 'Family Practice', '', '', NULL, 'O', '3336 S 4155 W Ste 204', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643492', '8019643493', '3336 S 4155 W Ste 204', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643492', '8019643493', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-03-01', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750650586', 0, 'N', 0, '2013-03-26', NULL, NULL, 40.6991, -111.99, NULL, NULL),
('205934739', 'W12031227', 'W12031227', 'ID02', 'Family Medicine Health Center', 'Jenna', 'L', 'Rovig', 'NP-C', 'Family Practice', '', '', NULL, 'O', '6094 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2085142510', '2085142511', '6094 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2085142510', '2085142511', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1427312347', 0, 'N', 0, '2013-03-26', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12031226', 'W12031226', 'ID02', 'Family Medicine Health Center', 'Jenna', 'L', 'Rovig', 'NP-C', 'Family Practice', '', '', NULL, 'O', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '2083752217', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '2083752217', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1427312347', 0, 'N', 0, '2013-03-26', NULL, NULL, 0, 0, NULL, NULL),
('454041098', 'W12031228', 'W12031228', 'ILCHIGSTD', 'Concentra Primary Care of Illinois PC', '', '', 'Concentra Urgent Care', '', 'Urgent Care', '', '', NULL, 'O', '7126 N Lincoln Ave', 'Lincolnwood', 'Cook', 'IL', '60712', '8475839189', '8475839196', '7126 N Lincoln Ave', 'Lincolnwood', 'Cook', 'IL', '60712', '8475839189', '8475839196', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', '2012-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB', '0000010034', 0, 'Y', 0, '2014-07-15', NULL, NULL, 42.0108, -87.7386, NULL, NULL),
('454041098', 'W12031230', 'W12031230', 'Group', 'Concentra Primary Care of Illinois PC', '', '', 'Concentra Urgent Care', '', 'Urgent Care', '', '', NULL, 'B', 'PO Box 2050', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '8664414306', 'PO Box 2050', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '8664414306', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '0000010034', 0, 'Y', 0, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
('454041098', 'W12031231', 'W12031231', 'ILCHIGSTD', 'Concentra Primary Care of Illinois PC', 'Parisa', '', 'Amleshi', 'MD', 'Family Practice', '', '', NULL, 'O', '7126 N Lincoln Ave', 'Lincolnwood', 'Cook', 'IL', '60712', '8475839189', '8475839196', '7126 N Lincoln Ave', 'Lincolnwood', 'Cook', 'IL', '60712', '8475839189', '8475839196', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1689619314', 0, 'N', 0, '2013-03-26', NULL, NULL, 42.0109, -87.7383, NULL, NULL),
('454041098', 'W12031232', 'W12031232', 'ILCHIGSTD', 'Concentra Primary Care of Illinois PC', 'Saji', NULL, 'Oommen', 'MD', 'Family Practice', '', '', NULL, 'O', '7126 N Lincoln Ave', 'Lincolnwood', 'Cook', 'IL', '60712', '8475839189', '8475839196', '7126 N Lincoln Ave', 'Lincolnwood', 'Cook', 'IL', '60712', '8475839189', '8475839196', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, NULL, NULL, 'HCFA|UB', '1497856330', 0, 'N', 0, '2013-03-26', NULL, NULL, 42.0109, -87.7383, NULL, NULL),
('454041098', 'W12031233', 'W12031233', 'ILCHIGSTD', 'Concentra Primary Care of Illinois PC', 'Saji', NULL, 'Oommen', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 2050', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '8664414306', 'PO Box 2050', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '8664414306', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, NULL, NULL, 'HCFA|UB', '1497856330', 0, 'N', 0, '2013-03-26', NULL, NULL, 0, 0, NULL, NULL),
('454041098', 'W12031234', 'W12031234', 'ILCHIGSTD', 'Concentra Primary Care of Illinois PC', 'Satish', 'K', 'Vij', 'MD', 'Family Practice', '', '', NULL, 'O', '7126 N Lincoln Ave', 'Lincolnwood', 'Cook', 'IL', '60712', '8475839189', '8475839196', '7126 N Lincoln Ave', 'Lincolnwood', 'Cook', 'IL', '60712', '8475839189', '8475839196', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, NULL, NULL, 'HCFA|UB', '1881621043', 0, 'N', 0, '2013-03-26', NULL, NULL, 42.0109, -87.7383, NULL, NULL),
('454041098', 'W12031235', 'W12031235', 'ILCHIGSTD', 'Concentra Primary Care of Illinois PC', 'Satish', 'K', 'Vij', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 2050', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '8664414306', 'PO Box 2050', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '8664414306', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, NULL, NULL, 'HCFA|UB', '1881621043', 0, 'N', 0, '2013-03-26', 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
('760403505', 'W12031237', 'W12031237', 'TXHOUSTD', 'Foot and Ankle Center', '', '', 'Foot and Ankle Center', '', 'Podiatry', '', '', NULL, 'O', '17450 St Lukes Way Ste 190', 'Conroe', 'Montgomery', 'TX', '77384', '9362318500', '0000000000', '17450 St Lukes Way Ste 190', 'Conroe', 'Montgomery', 'TX', '77384', '9362318500', '0000000000', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-22', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009965', 0, 'Y', 0, '2013-03-26', NULL, NULL, 30.1997, -95.458, NULL, NULL),
('760403505', 'W12031238', 'W12031238', 'TXHOUSTD', 'Foot and Ankle Center', 'Scott', '', 'MacTavish', 'DPM', 'Podiatry', '', '', NULL, 'O', '17450 St Lukes Way Ste 190', 'The Woodlands', 'Montgomery', 'TX', '77384', '9362318500', '0000000000', '17450 St Lukes Way Ste 190', 'The Woodlands', 'Montgomery', 'TX', '77384', '9362318500', '0000000000', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-22', NULL, 0, 0, 0, 'Kingwood Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1588609408', 0, 'N', 0, '2013-04-03', NULL, NULL, 30.1997, -95.458, NULL, NULL),
('760403505', 'W12031239', 'W12031239', 'TXHOUSTD', 'Foot and Ankle Center', 'Jason', '', 'Armstrong', 'DPM', 'Podiatry', '', '', NULL, 'O', '827 S Magnolia Blvd Ste 4', 'Magnolia', 'Montgomery', 'TX', '77355', '2813563780', '2813564765', '827 S Magnolia Blvd Ste 4', 'Magnolia', 'Montgomery', 'TX', '77355', '2813563780', '2813564765', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-22', NULL, 0, 0, 0, 'Kingwood Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1053347849', 0, 'N', 0, '2013-03-26', NULL, NULL, 30.211, -95.7538, NULL, NULL),
('760403505', 'W12031240', 'W12031240', 'TXHOUSTD', 'Foot and Ankle Center', 'Turner', '', 'Butts', 'DPM', 'Podiatry', '', '', NULL, 'O', '17450 St Lukes Way Ste 190', 'The Woodlands', 'Montgomery', 'TX', '77384', '9362318500', '0000000000', '17450 St Lukes Way Ste 190', 'The Woodlands', 'Montgomery', 'TX', '77384', '9362318500', '0000000000', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-22', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811923923', 0, 'N', 0, '2013-04-03', NULL, NULL, 30.1997, -95.458, NULL, NULL),
('760403505', 'W12031241', 'W12031241', 'TXHOUSTD', 'Foot and Ankle Center', 'Michael', '', 'Gordon', 'DPM', 'Podiatry', '', '', NULL, 'O', '17450 St Lukes Way Ste 190', 'The Woodlands', 'Montgomery', 'TX', '77384', '9362318500', '0000000000', '17450 St Lukes Way Ste 190', 'The Woodlands', 'Montgomery', 'TX', '77384', '9362318500', '0000000000', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-22', NULL, 0, 0, 0, 'Kingwood Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1073541819', 0, 'N', 0, '2013-04-03', NULL, NULL, 30.1997, -95.458, NULL, NULL),
('760403505', 'W12031242', 'W12031242', 'TXHOUSTD', 'Foot and Ankle Center', 'Scott', '', 'Margolis', 'DPM', 'Podiatry', '', '', NULL, 'O', '17450 St Lukes Way Ste 190', 'The Woodlands', 'Montgomery', 'TX', '77384', '9362318500', '0000000000', '17450 St Lukes Way Ste 190', 'The Woodlands', 'Montgomery', 'TX', '77384', '9362318500', '0000000000', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-22', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740216852', 0, 'N', 0, '2013-04-03', NULL, NULL, 30.1997, -95.458, NULL, NULL),
('363525049', 'W12031243', 'W12031243', 'ID02', 'West Valley Clinic at Middleton', 'Kimberly', 'E', 'Drewrey', 'NP', 'Family Practice', '', '', NULL, 'O', '381 B S Middleton Rd', 'Middleton', 'Canyon', 'ID', '83644', '2085856311', '2085856221', '381 B S Middleton Rd', 'Middleton', 'Canyon', 'ID', '83644', '2085856311', '2085856221', 'IDACN', '', '', '0.00', '15.00', '0.00', 6, '2011-12-01', NULL, 0, 0, 1, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1922388727', 0, 'N', 0, '2013-11-12', NULL, NULL, 0, 0, NULL, NULL),
('363525049', 'W12031244', 'W12031244', 'ID02', 'West Valley Medical Center', 'Kimberly', 'E', 'Drewrey', 'NP', 'Family Practice', '', '', NULL, 'B', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2087955070', '2085856221', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2087955070', '2085856221', 'IDACN', '', '', '0.00', '15.00', '0.00', 6, '2011-12-01', NULL, 0, 0, 1, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1922388727', 0, 'N', 0, '2013-11-12', NULL, NULL, 0, 0, NULL, NULL),
('621560557', 'W12031246', 'W12031246', 'ID02', 'West Valley Clinic at New Plymouth', 'Kimberly', 'E', 'Drewrey', 'NP', 'Family Practice', '', '', NULL, 'O', '112 S Plymouth St', 'New Plymouth', 'Payette', 'ID', '83655', '2082783406', '2082783418', '112 S Plymouth St', 'New Plymouth', 'Payette', 'ID', '83655', '2082783406', '2082783418', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-12-01', NULL, 0, 0, 1, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1922388727', 0, 'N', 0, '2013-11-12', NULL, NULL, 0, 0, NULL, NULL),
('621560557', 'W12031247', 'W12031247', 'ID02', 'West Valley Clinic at Parma', 'Kimberly', 'E', 'Drewrey', 'NP', 'Family Practice', '', '', NULL, 'O', '307 Grove St', 'Parma', 'Canyon', 'ID', '83660', '2087225147', '2087225148', '307 Grove St', 'Parma', 'Canyon', 'ID', '83660', '2087225147', '2087225148', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-12-01', NULL, 0, 0, 1, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1922388727', 0, 'N', 0, '2013-11-12', NULL, NULL, 0, 0, NULL, NULL),
('621560557', 'W12031248', 'W12031248', 'ID02', 'West Valley Clinic at Wilder', 'Kimberly', 'E', 'Drewrey', 'NP', 'Family Practice', '', '', NULL, 'O', '124 5th St Ste A', 'Wilder', 'Canyon', 'ID', '83676', '2084827430', '2084827272', '124 5th St Ste A', 'Wilder', 'Canyon', 'ID', '83676', '2084827430', '2084827272', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-12-01', NULL, 0, 0, 1, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1922388727', 0, 'N', 0, '2013-11-12', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'W12031249', 'W12031249', 'IDBOISTD', 'Saint Alphonsus Medical Group Radiation Oncology Boise', 'Joseph', 'P', 'Brooks', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083673131', '2083674860', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083673131', '2083674860', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2013-04-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1457323693', 0, 'N', 0, '2014-04-17', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('260553931', 'W12031251', 'W12031251', 'IDBOISTD', 'Saint Alphonsus Medical Group Radiation Oncology Caldwell', 'Joseph', 'P', 'Brooks', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '3123 Medical Dr', 'Caldwell', 'Canyon', 'ID', '83605', '2083673131', '2083674860', '3123 Medical Dr', 'Caldwell', 'Canyon', 'ID', '83605', '2083673131', '2083674860', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2013-04-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1457323693', 0, 'N', 0, '2014-04-17', NULL, NULL, 43.6594, -116.659, NULL, NULL),
('260553931', 'W12031252', 'W12031252', 'IDBOISTD', 'Saint Alphonsus Medical Group Radiation Oncology Meridian', 'Joseph', 'P', 'Brooks', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '2855 Magic View Dr', 'Meridian', 'Ada', 'ID', '83642', '2083673131', '2083674860', '2855 Magic View Dr', 'Meridian', 'Ada', 'ID', '83642', '2083673131', '2083674860', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2013-04-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1457323693', 0, 'N', 0, '2014-04-17', NULL, NULL, 43.5999, -116.359, NULL, NULL),
('820200895', 'W12031254', 'W12031254', 'IDBOISTD', 'Saint Alphonsus Medical Group Family Medicine Fruitland Health Plaza', 'Barry', 'L', 'Acor', 'MD', 'Family Practice', '', '', NULL, 'O', '910 NW 16th St Ste 101', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2084522140', '910 NW 16th St Ste 101', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2084522140', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-03-18', '2013-03-31', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1154633642', 0, 'N', 0, '2014-06-13', NULL, NULL, 44.0254, -116.925, NULL, NULL),
('271789847', 'W12031255', 'W12031255', 'IDBOISTD', 'Saint Alphonsus Medical Group Family Medicine Fruitland Heights Plaza', 'Jocele', 'A', 'Skinner', 'MD', 'Family Practice', '', '', NULL, 'O', '910 NW 16th St Ste 101', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2084522140', '910 NW 16th St Ste 101', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2084522140', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-04-01', '2013-04-30', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1831133164', 0, 'N', 0, '2014-06-13', NULL, NULL, 44.0254, -116.925, NULL, NULL),
('271789847', 'W12031256', 'W12031256', 'IDBOISTD', 'Saint Alphonsus Medical Group Family Medicine Fruitland Heights Plaza', 'John', 'E', 'White', 'MD', 'Family Practice', '', '', NULL, 'O', '910 NW 16th S Ste 101', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2084522140', '910 NW 16th S Ste 101', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2084522140', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-04-01', '2013-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013982081', 0, 'N', 0, '2014-01-23', NULL, NULL, 44.0254, -116.925, NULL, NULL),
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('760512625', 'W12031301', 'W12031301', 'TXHOUSTD', 'Houston Eye Associates', 'Allan', 'H', 'Fradkin', 'MD', 'Ophthalmology', '', '', NULL, 'B', 'PO Box 4958', 'Houston', 'Harris', 'TX', '77210', '7136686828', NULL, 'PO Box 4958', 'Houston', 'Harris', 'TX', '77210', '7136686828', '          ', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-27', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1447258918', 0, 'N', 0, '2013-03-27', NULL, NULL, 0, 0, NULL, NULL),
('760512625', 'W12031302', 'W12031302', 'TXHOUSTD', 'Houston Eye Associates', 'John', 'M', 'Lim', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1229 Cambell Rd', 'Houston', 'Harris', 'TX', '77055', '7134676600', '0000000000', '1229 Cambell Rd', 'Houston', 'Harris', 'TX', '77055', '7134676600', '0000000000', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-27', '2013-05-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508851346', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('760512625', 'W12031303', 'W12031303', 'TXHOUSTD', 'Houston Eye Associates', 'Alison', '', 'Lin', 'MD', 'Ophthalmology', '', '', NULL, 'O', '7777 Southwest Fwy Ste 804', 'Houston', 'Harris', 'TX', '77074', '7137776123', '0000000000', '7777 SW Fwy Ste 804', 'Houston', 'Harris', 'TX', '77074', '7137776123', '0000000000', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-27', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1790758001', 0, 'N', 0, '2013-03-27', NULL, NULL, 29.6947, -95.5234, NULL, NULL),
('760512625', 'W12031304', 'W12031304', 'TXHOUSTD', 'Houston Eye Associates', 'Richard', 'J', 'Ou', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1429 Hwy 6 Ste 102', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2815652020', '0000000000', '1429 Hwy 6 Ste 102', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2815652020', '0000000000', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-27', NULL, 0, 0, 0, 'West Houston Medical Center', NULL, '', NULL, 'HCFA|UB|', '1053319301', 0, 'N', 0, '2013-03-27', NULL, NULL, 29.6021, -95.6325, NULL, NULL),
('760512625', 'W12031305', 'W12031305', 'TXHOUSTD', 'Houston Eye Associates', 'Da Thuy', '', 'Van', 'DO', 'Ophthalmology', '', '', NULL, 'M', '7155 Old Katy Rd Ste N100', 'Houston', 'Harris', 'TX', '77024', '7136686828', NULL, '7155 Old Katy Rd Ste N100', 'Houston', 'Harris', 'TX', '77024', '7136686828', '          ', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-27', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1750375580', 0, 'N', 0, '2013-03-27', NULL, NULL, 0, 0, NULL, NULL),
('760512625', 'W12031306', 'W12031306', 'TXHOUSTD', 'Houston Eye Associates', 'Da Thuy', '', 'Van', 'DO', 'Ophthalmology', '', '', NULL, 'B', 'PO Box 4958', 'Houston', 'Harris', 'TX', '77210', '7136686828', NULL, 'PO Box 4958', 'Houston', 'Harris', 'TX', '77210', '7136686828', '          ', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-27', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1750375580', 0, 'N', 0, '2013-03-27', NULL, NULL, 0, 0, NULL, NULL),
('760512625', 'W12031307', 'W12031307', 'TXHOUSTD', 'Houston Eye Associates', 'Louis', 'E', 'Verstringhe', 'MD', 'Ophthalmology', '', '', NULL, 'O', '333 N Rivershire Dr Ste 160', 'Conroe', 'Montgomery', 'TX', '77304', '9364412020', NULL, '333 N Rivershire Dr Ste 160', 'Conroe', 'Montgomery', 'TX', '77304', '9364412020', '          ', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-27', NULL, 0, 0, 0, 'Houston Methodist Willowbrook Hospital', NULL, '', NULL, 'HCFA|UB|', '1043429046', 0, 'N', 0, '2013-03-27', NULL, NULL, 30.2905, -95.4665, NULL, NULL),
('760512625', 'W12031308', 'W12031308', 'TXHOUSTD', 'Houston Eye Associates', 'Louis', 'E', 'Verstringhe', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1120 Medical Plaza Dr Ste 320', 'The Woodlands', 'Montgomery', 'TX', '77380', '2813632155', NULL, '1120 Medical Plaza Dr Ste 320', 'The Woodlands', 'Montgomery', 'TX', '77380', '2813632155', '          ', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-27', NULL, 0, 0, 0, 'Houston Methodist Willowbrook Hospital', NULL, '', NULL, 'HCFA|UB|', '1043429046', 0, 'N', 0, '2013-03-27', NULL, NULL, 30.1728, -95.455, NULL, NULL),
('760512625', 'W12031309', 'W12031309', 'TXHOUSTD', 'Houston Eye Associates', 'Louis', 'E', 'Verstringhe', 'MD', 'Ophthalmology', '', '', NULL, 'O', '2855 Gramercy', 'Houston', 'Harris', 'TX', '77025', '7136686828', NULL, '2855 Gramercy', 'Houston', 'Harris', 'TX', '77025', '7136686828', '          ', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-27', NULL, 0, 0, 0, 'Houston Methodist Willowbrook Hospital', NULL, '', NULL, 'HCFA|UB|', '1043429046', 0, 'N', 0, '2013-07-22', NULL, NULL, 29.7044, -95.4225, NULL, NULL),
('760512625', 'W12031311', 'W12031311', 'TXHOUSTD', 'Houston Eye Associates', 'Stefan', 'D', 'Trocme', 'MD', 'Ophthalmology', '', '', NULL, 'M', '7155 Old Katy Rd Ste N100', 'Houston', 'Harris', 'TX', '77024', '7136686828', '          ', '7155 Old Katy Rd Ste N100', 'Houston', 'Harris', 'TX', '77024', '7136686828', '          ', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-27', '2013-03-05', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821157199', 0, 'N', 0, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
('760512625', 'W12031312', 'W12031312', 'TXHOUSTD', 'Houston Eye Associates', 'Stefan', 'D', 'Trocme', 'MD', 'Ophthalmology', '', '', NULL, 'B', 'PO Box 4958', 'Houston', 'Harris', 'TX', '77210', '7136686828', '          ', 'PO Box 4958', 'Houston', 'Harris', 'TX', '77210', '7136686828', '          ', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-27', '2013-03-05', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821157199', 0, 'N', 0, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
('461004140', 'W12031314', 'W12031314', 'UT01', '', 'Nicholas', 'G', 'Hanson', 'MD', 'Family Practice', '', '', NULL, 'O', '230 N Hospital Dr Ste 4', 'Price', 'Carbon', 'UT', '84501', '4356372300', '4356371581', '230 N Hospital Dr Ste 4', 'Price', 'Carbon', 'UT', '84501', '4356372300', '4356371581', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Castleview Hospital', 'Castleview Hospital', NULL, NULL, 'HCFA|UB|', '1710149794', 0, 'N', 0, '2013-03-27', NULL, NULL, 39.6039, -110.831, NULL, NULL),
('461004140', 'W12031313', 'W12031313', 'UT01', '', 'Nicholas', 'G', 'Hanson', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 150610', 'Ogden', 'Weber', 'UT', '84415', '4356372300', '4356371581', 'PO Box 150610  ', 'Ogden', 'Weber', 'UT', '84415', '4356372300', '4356371581', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Castleview Hospital', 'Castleview Hospital', NULL, NULL, 'HCFA|UB|', '1710149794', 0, 'N', 0, '2013-03-27', NULL, NULL, 0, 0, NULL, NULL),
('528889668', 'W12031317', 'W12031317', 'SINCLAIRDEN', '', 'David R', '', 'Merrill', 'DDS', 'Dentist', '', '', NULL, 'O', '3795 Kiesel Ave Ste 3', 'Ogden', 'Weber', 'UT', '84405', '8013991330', NULL, '3795 Kiesel Ave Ste 3', 'Ogden', 'Weber', 'UT', '84405', '8013991330', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-03-26', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000007577', 0, 'N', 0, '2013-03-27', NULL, NULL, 0, 0, NULL, NULL),
('880304865', 'W12031318', 'W12031318', 'SINCLAIRDEN', '', 'Larry', '', 'Morris', 'DMD', 'Dentist', '', '', NULL, 'O', '61 N Willow St Ste 1', 'Mesquite', 'Clark', 'NV', '89027', '7023462882', NULL, '61 N Willow St Ste 1', 'Mesquite', 'Clark', 'NV', '89027', '7023462882', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-03-26', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000007704', 0, 'N', 0, '2013-03-27', NULL, NULL, 0, 0, NULL, NULL),
('203074177', 'W12031319', 'W12031319', 'SINCLAIRDEN', 'All Smiles Family Dentistry', 'Hanhngan', '', 'Nguyen-Tran', 'DDS', 'Dentist', '', '', NULL, 'O', '445 E 4500 S Ste 150', 'Murray', 'Salt Lake', 'UT', '84107', '8016718714', NULL, '445 E 4500 S Ste 150', 'Murray', 'Salt Lake', 'UT', '84107', '8016718714', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-03-26', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1861503674', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('263716255', 'W12031320', 'W12031320', 'SINCLAIRDEN', 'Lakeside Dental; Syracuse', 'Bekki', '', 'Patton', 'DDS', 'Dentist', '', '', NULL, 'O', '1662 S 2000 W Ste A1', 'Syracuse', 'Davis', 'UT', '84075', '8018252273', NULL, '1662 S 2000 W Ste A1', 'Syracuse', 'Davis', 'UT', '84075', '8018252273', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-03-26', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000002013', 0, 'N', 0, '2013-03-27', NULL, NULL, 0, 0, NULL, NULL),
('870374099', 'W12031321', 'W12031321', 'SINCLAIRDEN', '', 'Craig B', '', 'Theurer', 'DDS', 'Dentist', '', '', NULL, 'O', '1955 S 1300 E Ste L-1', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8014875805', NULL, '1955 S 1300 E Ste L-1', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8014875805', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-03-26', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009057', 0, 'N', 0, '2013-03-27', NULL, NULL, 0, 0, NULL, NULL),
('262854549', 'W12031323', 'W12031323', 'SINCLAIRDEN', 'Stonehaven Dental', 'Eric', '', 'Tobler', 'DMD', 'Dentist', '', '', NULL, 'O', '181 N 1200 E', 'Lehi', 'Utah', 'UT', '84043', '8017663600', NULL, '181 N 1200 E', 'Lehi', 'Utah', 'UT', '84043', '8017663600', '          ', 'UT000C', '', '', '0.00', '100.00', '0.00', 8, '2013-03-26', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009113', 0, 'N', 0, '2013-03-27', NULL, NULL, 0, 0, NULL, NULL),
('200798210', 'W12031325', 'W12031325', 'SINCLAIRDEN', '', 'Scott', 'D', 'Urban', 'DMD, MD', 'Oral/Maxillofacial Surgery', 'Oral Surgeon', '', NULL, 'O', '7611 S Jordan Landing Blvd Ste 102', 'West Jordan', 'Salt Lake', 'UT', '84084', '8012825363', '', '7611 S Jordan Landing Blvd Ste 102', 'West Jordan', 'Salt Lake', 'UT', '84084', '8012825363', '', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-03-26', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'DEN|', '1750389367', 0, 'N', 0, '2014-07-23', NULL, NULL, 0, 0, NULL, NULL),
('870332707', 'W12031326', 'W12031326', 'SINCLAIRDEN', 'Young Family Dental', 'Bradley', '', 'Walker', 'DMD', 'Dentist', '', '', NULL, 'O', '1834 S State St', 'Orem', 'Utah', 'UT', '84058', '8012240222', NULL, '1834 S State St', 'Orem', 'Utah', 'UT', '84058', '8012240222', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-03-26', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009485', 0, 'N', 0, '2013-03-27', NULL, NULL, 0, 0, NULL, NULL),
('061773891', 'W12031327', 'W12031327', 'SINCLAIRDEN', '', 'Troy', '', 'Walton', 'DDS', 'Dentist', '', '', NULL, 'O', '271 N Spring Creek Pkwy Ste D', 'Providence', 'Cache', 'UT', '84332', '4357556562', NULL, '271 N Spring Creek Pkwy Ste D', 'Providence', 'Cache', 'UT', '84332', '4357556562', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-03-26', '2013-03-26', 0, 0, 0, '', '', '', '', 'DEN|', '0000009495', 0, 'N', 0, '2013-07-12', NULL, NULL, 0, 0, NULL, NULL),
('300295299', 'W12031328', 'W12031328', 'SINCLAIRDEN', '', 'John', '', 'Weber', 'DDS', 'Dentist', '', '', NULL, 'O', '110 S 100 W', 'Payson', 'Utah', 'UT', '84651', '8014654277', NULL, '110 S 100 W', 'Payson', 'Utah', 'UT', '84651', '8014654277', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-03-26', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009549', 0, 'N', 0, '2013-03-27', NULL, NULL, 0, 0, NULL, NULL),
('461627375', 'W12031329', 'W12031329', 'UTDT01', 'Timpanogos Dental', 'Brandon', '', 'Tayler', 'DDS', 'Dentist', '', '', NULL, 'O', '325 E 100 N', 'Lehi', 'Utah', 'UT', '84043', '8017689471', NULL, '325 E 100 N', 'Lehi', 'Utah', 'UT', '84043', '8017689471', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-02-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009012', 0, 'N', 0, '2013-03-27', NULL, NULL, 0, 0, NULL, NULL),
('461533787', 'W12031330', 'W12031330', 'UTDT01', 'Daines Dental Inc', 'Clifford D', '', 'Daines', 'DDS', 'Dentist', '', '', NULL, 'O', '5974 S Fashion Pointe Dr Ste 230', 'Ogden', 'Weber', 'UT', '84403', '8016218440', NULL, '5974 S Fashion Pointe Dr Ste 230', 'Ogden', 'Weber', 'UT', '84403', '8016218440', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-02-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000005875', 0, 'N', 0, '2013-05-31', NULL, NULL, 0, 0, NULL, NULL),
('870650851', 'W12031331', 'W12031331', 'UTDT01', 'Blue Mountain Family Dental', 'David G', '', 'Lee', 'DDS', 'Dentist', '', '', NULL, 'O', '1675 N 200 W Ste 8A', 'Provo', 'Utah', 'UT', '84604', '8013567329', NULL, '1675 N 200 W Ste 8A', 'Provo', 'Utah', 'UT', '84604', '8013567329', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-02-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000007241', 0, 'N', 0, '2013-03-27', NULL, NULL, 0, 0, NULL, NULL),
('870208619', 'W12031333', 'W12031333', 'UT01', 'AquaWorx Physical Therapy and Fitness', 'Angela', '', 'Knowles Smith', 'PT', 'Physical Therapy', '', '', NULL, 'O', '209 W 300 N', 'Logan', 'Cache', 'UT', '84321', '4357168535', '4357168558', '209 W 300 N', 'Logan', 'Cache', 'UT', '84321', '4357168535', '4357168558', 'WestRehab', '', '', '0.00', '0.00', '73.00', 8, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427363191', 0, 'N', 0, '2014-04-14', NULL, NULL, 41.7372, -111.84, NULL, NULL),
('870208619', 'W12031334', 'W12031334', 'UT01', 'AquaWorx Physical Therapy and Fitness', 'Michael', 'C', 'Mumford', 'PT', 'Physical Therapy', '', '', NULL, 'O', '209 W 300 N', 'Logan', 'Cache', 'UT', '84321', '4357168535', '4357168558', '209 W 300 N', 'Logan', 'Cache', 'UT', '84321', '4357168535', '4357168558', 'WestRehab', '', '', '0.00', '0.00', '73.00', 8, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285951467', 0, 'N', 0, '2014-04-14', NULL, NULL, 41.7372, -111.84, NULL, NULL),
('273626476', 'W12031335', 'W12031335', 'WY01', '', 'Cathy', 'L', 'Berens', 'NP', 'Obstetrics and Gynecology', '', '', NULL, 'O', '940 E 3rd St Ste 107', 'Casper', 'Natrona', 'WY', '82601', '3072651500', '3072651506', '940 E 3rd St Ste 107', 'Casper', 'Natrona', 'WY', '82601', '3072651500', '3072651506', '', '', '', '0.00', '25.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Wyoming Medical Center', '', '', '', 'HCFA', '1164533717', 0, 'N', 0, '2013-06-18', NULL, NULL, 42.8477, -106.313, NULL, NULL),
('273626476', 'W12031336', 'W12031336', 'WYT1', '', 'Cathy', 'L', 'Berens', 'NP', 'Obstetrics and Gynecology', '', '', NULL, 'O', '940 E 3rd St Ste 107', 'Casper', 'Natrona', 'WY', '82601', '3072651500', '3072651506', '940 E 3rd St Ste 107', 'Casper', 'Natrona', 'WY', '82601', '3072651500', '3072651506', '', '', '', '0.00', '25.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Wyoming Medical Center', '', '', '', 'HCFA', '1164533717', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('455018230', 'W12031340', 'W12031340', 'TXHOUSTD', 'Sachin Chandrasenan MD', 'Sachin', '', 'Chandrasenan', 'MD', 'Family Practice', '', '', NULL, 'O', '17350 St Lukes Way Ste 350', 'Conroe', 'Montgomery', 'TX', '77384', '2818253344', '2818253340', '17350 St Lukes Way Ste 350', 'Conroe', 'Montgomery', 'TX', '77384', '2818253344', '2818253340', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-22', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487867669', 0, 'N', 0, '2013-08-09', NULL, NULL, 30.2017, -95.4595, NULL, NULL),
('522445279', 'W12031341', 'W12031341', 'TXDALSTD', 'Elleni Wolersenbet MD', 'Elleni', '', 'Woldesenbet', 'MD', 'Infectious Disease', '', '', NULL, 'O', '3132 Matlock Rd Ste 309', 'Arlington', 'Tarrant', 'TX', '76015', '8174170260', '8174174834', '3132 Matlock Rd Ste 309', 'Arlington', 'Tarrant', 'TX', '76015', '8174170260', '8174174834', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-05-22', NULL, 0, 0, 0, 'Baylor Orthopedic and Spine Hospital at Arlington', NULL, '', '', 'HCFA', '1083803787', 0, 'N', 0, '2013-06-05', NULL, NULL, 32.6937, -97.115, NULL, NULL),
('752850266', 'W12031342', 'W12031342', 'TXDALSTD', 'Tarrant County Cardiology', 'Giri', 'D', 'Mundluru', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '800 8th Ave Ste 406', 'Fort Worth', 'Tarrant', 'TX', '76104', '8173364278', '8173351650', '800 8th Ave Ste 406', 'Fort Worth', 'Tarrant', 'TX', '76104', '8173364278', '8173351650', 'DALLAS2', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-05-22', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', '', 'HCFA|UB', '1912904491', 0, 'N', 0, '2013-04-16', NULL, NULL, 32.7365, -97.3437, NULL, NULL),
('423746058', 'W12031344', 'W12031344', 'TXDALSTD', 'Robert L Elliott MD', 'Robert', 'L', 'Elliott', 'MD', 'General Surgery', '', '', NULL, 'O', '1600 Lancaster Dr', 'Grapevine', 'Tarrant', 'TX', '76051', '8174819480', '8178806050', '1600 Lancaster Dr', 'Grapevine', 'Tarrant', 'TX', '76051', '8174819480', '8178806050', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-22', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, NULL, NULL, 'HCFA|UB|', '1346276334', 0, 'N', 0, '2013-06-05', NULL, NULL, 32.9356, -97.0914, NULL, NULL),
('463901815', 'W12031345', 'W12031345', 'TXDALSTD', 'Nancy Kimbrow MD', 'Nancy', 'L', 'Kimbrow', 'MD', 'Family Practice', '', '', NULL, 'O', '212 S Old Betsy Rd', 'Keene', 'Johnson', 'TX', '76059', '8176418141', '8175582305', '212 S Old Betsy Rd', 'Keene', 'Johnson', 'TX', '76059', '8176418141', '8175582305', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-05-22', NULL, 0, 0, 0, '', '', '', '', 'HCFA', '1295799880', 0, 'N', 0, '2013-06-05', NULL, NULL, 32.3948, -97.332, NULL, NULL),
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('760439308', 'W12031354', 'W12031354', 'TXHOUSTD', '', '', '', 'Rafael J DelaFlor Weiss MD PA', 'MD', 'Internal Medicine', '', '', NULL, 'O', '26222 I 45 Ste A', 'Spring', 'Montgomery', 'TX', '77386', '2814197119', '2812921825', '26222 I 45 Ste A', 'Spring', 'Montgomery', 'TX', '77386', '2814197119', '2812921825', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-22', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1649326398', 0, 'N', 0, '2014-06-03', NULL, NULL, 30.1213, -95.4133, NULL, NULL);
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('760439308', 'W12031352', 'W12031352', 'TXHOUSTD', '', '', '', 'Rafael J DelaFlor Weiss MD PA', 'MD', 'Internal Medicine', '', '', NULL, 'O', '705 E Houston St', 'Cleveland', 'Liberty', 'TX', '77327', '2815921115', '2815925988', '705 E Houston St', 'Cleveland', 'Liberty', 'TX', '77327', '2815921115', '2815925988', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-22', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1649326398', 0, 'N', 0, '2014-06-03', NULL, NULL, 30.341, -95.0817, NULL, NULL),
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('760439308', 'W12031357', 'W12031357', 'TXHOUSTD', 'Rafael Jose De La Flor Weiss MD PA', 'Rafael', 'J', 'DelaFlor Weiss', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3000 W Davis St Ste 1', 'Conroe', 'Montgomery', 'TX', '77304', '9362426978', '9362426980', '3000 W Davis St Ste 1', 'Conroe', 'Montgomery', 'TX', '77304', '9362426978', '9362426980', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-22', '2014-01-01', 0, 0, 0, 'Conroe Regional Medical Center', '', '', '', 'HCFA|UB|', '1801822051', 0, 'N', 0, '2014-06-03', NULL, NULL, 30.3228, -95.4897, NULL, NULL),
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('760439308', 'W12031366', 'W12031366', 'TXHOUSTD', '', 'Joseph', 'M', 'Megwa', 'MD', 'Family Practice', '', '', NULL, 'O', '705 E Houston St', 'Cleveland', 'Liberty', 'TX', '77327', '2815921115', '2815925988', '705 E Houston St', 'Cleveland', 'Liberty', 'TX', '77327', '2815921115', '2815925988', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-22', '2014-06-03', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376598730', 0, 'N', 0, '2014-06-03', NULL, NULL, 30.341, -95.0817, NULL, NULL),
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('272288227', 'W12031370', 'W12031370', 'UTMH1', '', 'Kyle', 'M', 'Hancock', 'PHD', 'Mental Health', 'Pediatric Psychology', '', NULL, 'O', '246 E 1260 N', 'Logan', 'Cache', 'UT', '84341', '4357506300', '4357538995', '246 E 1260 N', 'Logan', 'Cache', 'UT', '84341', '4357506300', '4357538995', 'PHD', '', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164748729', 0, 'N', 0, '2014-06-04', NULL, NULL, 41.7547, -111.827, NULL, NULL),
('201435671', 'W12031371', 'W12031371', 'TXHOUSTD', 'Diabetes America', 'Adriana', '', 'Wechsler', 'MD', 'Endocrinology', '', '', NULL, 'B', '13171 Misty Willow Dr', 'Houston', 'Harris', 'TX', '77070', '8322373500', '8882377954', '13171 Misty Willow Dr', 'Houston', 'Harris', 'TX', '77070', '8322373500', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-04-24', '2013-05-05', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477595122', 0, 'N', 0, '2013-04-18', NULL, NULL, 0, 0, NULL, NULL),
('201435671', 'W12031372', 'W12031372', 'TXHOUSTD', 'Diabetes America', 'Adriana', '', 'Wechsler', 'MD', 'Endocrinology', '', '', NULL, 'O', '15200 S US 59 Hwy Ste 360', 'Sugar Land', 'Fort Bend', 'TX', '77478', '8322373500', '8882377954', '15200 S US 59 Hwy Ste 360', 'Sugar Land', 'Fort Bend', 'TX', '77478', '8322373500', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-04-24', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477595122', 0, 'N', 0, '2013-03-28', NULL, NULL, 29.622, -95.6055, NULL, NULL),
('201435671', 'W12031373', 'W12031373', 'TXHOUSTD', 'Diabetes America', 'Adriana', '', 'Wechsler', 'MD', 'Endocrinology', '', '', NULL, 'O', '2495 S Braeswood', 'Houston', 'Harris', 'TX', '77030', '8322373500', '8882377954', '2495 S Braeswood', 'Houston', 'Harris', 'TX', '77030', '8322373500', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-04-24', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477595122', 0, 'N', 0, '2013-03-28', NULL, NULL, 29.697, -95.4177, NULL, NULL),
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('272559167', 'W12031377', 'W12031377', 'TXSATSTD', 'Heart and Vascular Institute of Texas', '', '', 'Heart & Vascular Institute of Texas', '', 'Cardiovascular Disease', '', '', NULL, 'O', '128 S Moss St Ste 100', 'Seguin', 'Guadalupe', 'TX', '78155', '8303039221', NULL, '128 S Moss St Ste 100', 'Seguin', 'Guadalupe', 'TX', '78155', '8303039221', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-03-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831492651', 0, 'Y', 0, '2014-03-25', NULL, NULL, 29.5689, -97.9484, NULL, NULL),
('272559167', 'W12031378', 'W12031378', 'TXSATSTD', 'Heart and Vascular Institute of Texas', '', '', 'Heart & Vascular Institute of Texas', '', 'Cardiovascular Disease', '', '', NULL, 'O', '1300 Cedar', 'Bandera', 'Bandera', 'TX', '78003', '8304607715', NULL, '1300 Cedar', 'Bandera', 'Bandera', 'TX', '78003', '8304607715', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-03-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831492651', 0, 'Y', 0, '2014-03-25', NULL, NULL, 29.7333, -99.0728, NULL, NULL),
('272559167', 'W12031379', 'W12031379', 'TXSATSTD', 'Heart and Vascular Institute of Texas', '', '', 'Heart & Vascular Institute of Texas', '', 'Cardiovascular Disease', '', '', NULL, 'O', '1395 Sattler Rd Ste 6', 'Canyon Lake', 'Comal', 'TX', '78133', '8309643340', NULL, '1395 Sattler Rd Ste 6', 'Canyon Lake', 'Comal', 'TX', '78133', '8309643340', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-03-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831492651', 0, 'Y', 0, '2014-03-25', NULL, NULL, 29.8496, -98.1705, NULL, NULL),
('272559167', 'W12031380', 'W12031380', 'TXSATSTD', 'Heart and Vascular Institute of Texas', '', '', 'Heart & Vascular Institute of Texas', '', 'Cardiovascular Disease', '', '', NULL, 'O', '1583 E Common Ste 105', 'New Braunfels', 'Comal', 'TX', '78130', '8306099058', NULL, '1583 E Common Ste 105', 'New Braunfels', 'Comal', 'TX', '78130', '8306099058', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-03-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831492651', 0, 'Y', 0, '2014-03-25', NULL, NULL, 29.7251, -98.0961, NULL, NULL),
('272559167', 'W12031381', 'W12031381', 'TXSATSTD', 'Heart and Vascular Institute of Texas', '', '', 'Heart & Vascular Institute of Texas', '', 'Cardiovascular Disease', '', '', NULL, 'O', '1901 Ave I', 'Hondo', 'Medina', 'TX', '78861', '8307414331', NULL, '1901 Ave I', 'Hondo', 'Medina', 'TX', '78861', '8307414331', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-03-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831492651', 0, 'Y', 0, '2014-03-25', NULL, NULL, 29.3478, -99.1383, NULL, NULL),
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('870326120', 'W12031445', 'W12031445', 'UTDTSHEET', '', 'O Daniel', '', 'Bluth', 'DDS', 'Oral Surgeon', '', '', NULL, 'O', '515 S 1000 E Ste L2', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013553731', NULL, '515 S 1000 E Ste L2', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013553731', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000005338', 0, 'N', 0, '2013-04-01', NULL, NULL, 0, 0, NULL, NULL),
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('205049412', 'W12031447', 'W12031447', 'UTDTSHEET', 'Orthodontic Specialists', 'Jeff', '', 'Erickson', 'DDS', 'Orthodontist', '', '', NULL, 'O', '640 E 700 S Ste 301', 'St George', 'Washington', 'UT', '84770', '4356739661', NULL, '640 E 700 S Ste 301', 'St George', 'Washington', 'UT', '84770', '4356739661', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004146', 0, 'N', 0, '2013-04-17', NULL, NULL, 0, 0, NULL, NULL),
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('205099898', 'W12031449', 'W12031449', 'UTDTSHEET', 'Haws Family Dentistry', 'Jayson', '', 'Haws', 'DDS', 'Dentist', '', '', NULL, 'O', '862 S Main St Ste 2', 'Brigham City', 'Box Elder', 'UT', '84302', '4357349144', NULL, '862 S Main St Ste 2', 'Brigham City', 'Box Elder', 'UT', '84302', '4357349144', '', 'UT000C', '', '', '0.00', '100.00', '0.00', 8, '2013-04-01', '2013-04-01', 0, 0, 0, '', '', '', '', 'DEN|', '1083747927', 0, 'N', 0, '2014-06-19', NULL, NULL, 0, 0, NULL, NULL),
('870634173', 'W12031450', 'W12031450', 'UTDTSHEET', 'VIP Tooth Care', 'Clive', '', 'Ingram', '', 'Dentist', '', '', NULL, 'O', '780 S 2000 W', 'Syracuse', 'Davis', 'UT', '84075', '8017763000', NULL, '780 S 2000 W', 'Syracuse', 'Davis', 'UT', '84075', '8017763000', '          ', 'UT000B', '', '', '0.00', '100.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0001000005', 0, 'N', 0, '2013-04-01', NULL, NULL, 0, 0, NULL, NULL),
('870387310', 'W12031451', 'W12031451', 'UTDTSHEET', '', 'Russell', '', 'Seamons', 'DMD', 'Dentist', '', '', NULL, 'O', '150 E 200 N Ste B2', 'Logan', 'Cache', 'UT', '84321', '4357528721', NULL, '150 E 200 N Ste B2', 'Logan', 'Cache', 'UT', '84321', '4357528721', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000008644', 0, 'N', 0, '2013-04-09', NULL, NULL, 0, 0, NULL, NULL),
('528230418', 'W12031452', 'W12031452', 'UTDTSHEET', '', 'David', '', 'Stohl', 'DMD', 'Dentist', '', '', NULL, 'O', '1355 S Foothill Dr Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015825787', NULL, '1355 S Foothill Dr Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015825787', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-04-01', '2014-01-01', 0, 0, 0, '', '', '', '', 'DEN|', '1457369415', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('870542442', 'W12031453', 'W12031453', 'UTDTSHEET', 'Timpanogos Dental', 'Brandon', '', 'Tayler', 'DDS', 'Dentist', '', '', NULL, 'O', '325 E 100 N', 'Lehi', 'Utah', 'UT', '84043', '8017689471', NULL, '325 E 100 N', 'Lehi', 'Utah', 'UT', '84043', '8017689471', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009012', 0, 'N', 0, '2013-04-01', NULL, NULL, 0, 0, NULL, NULL),
('300295299', 'W12031454', 'W12031454', 'UTDT01', 'Elite Dental', 'Randy', '', 'Braithwaite', 'DDS', 'Dentist', '', '', NULL, 'O', '218 N W State Rd', 'American Fork', 'Utah', 'UT', '84003', '8017637737', NULL, '218 N W State Rd', 'American Fork', 'Utah', 'UT', '84003', '8017637737', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009821', 0, 'N', 0, '2013-06-11', NULL, NULL, 0, 0, NULL, NULL),
('264000182', 'W12031456', 'W12031456', 'UTDT01', '39th and 13th Street Dental', 'Daniel', '', 'Bishop', 'DMD', 'Dentist', '', '', NULL, 'O', '1345 E 3900 S Ste 206', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012781333', NULL, '1345 E 3900 S Ste 206', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012781333', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-12-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004180', 0, 'N', 0, '2013-04-01', NULL, NULL, 0, 0, NULL, NULL),
('208976652', 'W12031457', 'W12031457', 'UTDT01', 'Rivers Edge Dental', 'Daniel', '', 'Bishop', 'DMD', 'Dentist', '', '', NULL, 'O', '1264 Village Main Dr Ste B', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019781000', NULL, '1264 Village Main Dr Ste B', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019781000', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-12-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004180', 0, 'N', 0, '2013-04-01', NULL, NULL, 0, 0, NULL, NULL),
('528966195', 'W12031461', 'W12031461', 'UTDT01', 'Stephen Luddington DDS MS', 'Stephen', '', 'Luddington', 'DDS', 'Orthodontist', '', '', NULL, 'O', '2317 N Hill Field Rd Ste 105', 'Layton', 'Davis', 'UT', '84041', '8017758000', NULL, '2317 N Hill Field Rd Ste 105', 'Layton', 'Davis', 'UT', '84041', '8017758000', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2012-12-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000010073', 0, 'N', 0, '2013-04-01', NULL, NULL, 0, 0, NULL, NULL),
('528966195', 'W12031460', 'W12031460', 'UTDT01', 'Stephen Luddington DDS MS', 'Stephen', '', 'Luddington', 'DDS', 'Orthodontist', '', '', NULL, 'O', '347 N 300 W Ste 204', 'Kaysville', 'Davis', 'UT', '84037', '8014987400', NULL, '347 N 300 W Ste 204', 'Kaysville', 'Davis', 'UT', '84037', '8014987400', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2012-12-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000010073', 0, 'N', 0, '2013-04-01', NULL, NULL, 0, 0, NULL, NULL),
('454141660', 'W12031464', 'W12031464', 'UTDT01', 'Cameron Orthodontics', 'David', '', 'Cameron', 'DMD', 'Orthodontist', '', '', NULL, 'O', '195 E Gentile St Ste 11', 'Layton', 'Davis', 'UT', '84041', '8015441184', NULL, '195 E Gentile St Ste 11', 'Layton', 'Davis', 'UT', '84041', '8015441184', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2012-11-01', '2012-11-01', 0, 0, 0, '', '', '', '', 'DEN|', '0000010074', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('460898193', 'W12031466', 'W12031466', 'UTDT01', 'Creek Road Dental', 'Tyler', '', 'Carlson', 'DMD', 'Dentist', '', '', NULL, 'O', '7369 Creek Rd', 'Sandy', 'Salt Lake', 'UT', '84093', '8015665577', NULL, '7369 Creek Rd', 'Sandy', 'Salt Lake', 'UT', '84093', '8015665577', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000010075', 0, 'N', 0, '2013-04-01', NULL, NULL, 0, 0, NULL, NULL);
