INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('942854057', 'W11003472', 'W11003472', 'UTIHCPHY', 'Utah Valley Pulmonary Clinic', 'Krishna', 'M', 'Sundar', 'MD', 'Pulmonary', 'Sleep Medicine', '', NULL, 'o', '1055 N 300 W #500', 'Provo', 'Utah', 'UT', '84604', '8013577291', NULL, '1055 N 300 W #500', 'Provo', 'Utah', 'UT', '84604', '8013577291', '', 'USTDMULT', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1801802186', 0, 'n', 0, '2011-09-26', NULL, NULL, 40.2476, -111.664, NULL, NULL),
('942854057', 'W11003473', 'W11003473', 'UTIHCPHY', 'Budge Clinic Internal Medicine', 'Agnes', 'M', 'Szpunar', 'MD', 'Internal Medicine', '', '', NULL, 'o', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921980', NULL, '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921980', '', 'USTDMULT', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1033216858', 0, 'n', 0, '2011-04-28', NULL, NULL, 41.7565, -111.821, NULL, NULL),
('942854057', 'W11003474', 'W11003474', 'UTIHCPHY', 'South Cache Valley Clinic', 'Matthew', 'Gregg', 'Taylor', 'MD', 'Family Practice', NULL, NULL, NULL, 'o', '190 S Hwy 165', 'Providence', 'Cache', 'UT', '84332', '4357553300', NULL, NULL, NULL, '', NULL, NULL, '', '', 'USTDMULT', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2008-01-01', '2009-06-21', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1033123658', 0, 'n', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11003475', 'W11003475', 'UTIHCPHY', 'River Road Family Practice', 'Bruce', 'L', 'Taylor', 'DO', 'Family Practice', '', '', NULL, 'o', '577 S River Road', 'St George', 'Washington', 'UT', '84790', '4356886000', NULL, NULL, NULL, '', NULL, NULL, '', '', 'USTDMULT', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2008-01-01', NULL, NULL, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1811915135', 0, 'n', 0, '2010-04-23', NULL, NULL, 37.0986, -113.557, NULL, NULL),
('942854057', 'W11003476', 'W11003476', 'UTIHCPHY', 'Hillcrest Pediatrics', 'Mark', 'C', 'Templeman', 'MD', 'Pediatrics', '', '', NULL, 'o', '5063 S Cottonwood St #160', 'Murray', 'Salt Lake', 'UT', '84157', '8015071850', NULL, '5063 S Cottonwood St #160', 'Murray', 'Salt Lake', 'UT', '84157', '8015071850', '', 'USTDMULT', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922120468', 0, 'n', 0, '2013-09-03', NULL, NULL, 40.6615, -111.893, NULL, NULL),
('942854057', 'W11003477', 'W11003477', 'UTIHCPHY', 'Cedar City Clinic', 'Charles', 'J', 'Thinnes', 'MD', 'Family Practice', NULL, NULL, NULL, 'o', '1303 N Main #3C', 'Cedar City', 'Iron', 'UT', '84720', '4358685500', NULL, '1303 N Main #3C', 'Cedar City', 'Iron', 'UT', '84720', '4358685500', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-01-01', '2010-12-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1861415325', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11003478', 'W11003478', 'UTIHCPHY', 'Budge Clinic Obstetrics & Gynecology', 'Angie', 'C', 'Thompson', 'APRN', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'o', '1400 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357161920', NULL, NULL, NULL, '', NULL, NULL, '', '', 'USTDMULT', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1013037886', 0, 'n', 0, '2008-05-14', NULL, NULL, 41.7569, -111.821, NULL, NULL),
('942854057', 'W11003479', 'W11003479', 'UTIHCPHY', 'River Road Family Practice', 'Bradley', 'S', 'Thompson', 'MD', 'Family Practice', NULL, NULL, NULL, 'o', '577 S River Road', 'St George', 'Washington', 'UT', '84790', '4356886000', NULL, NULL, NULL, '', NULL, NULL, '', '', 'USTDMULT', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1487672713', 0, 'n', 0, '2008-05-14', NULL, NULL, 37.0986, -113.557, NULL, NULL),
('942854057', 'W11003480', 'W11003480', 'UTIHCPHY', 'IHC Bountiful Health Center', 'Kathleen', 'A', 'Trach-Moskun', 'MD', 'Pediatrics', NULL, NULL, NULL, 'o', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012941000', NULL, NULL, NULL, '', NULL, NULL, '', '', 'USTDMULT', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1841246410', 0, 'n', 0, '2008-05-14', NULL, NULL, 40.8935, -111.881, NULL, NULL),
('942854057', 'W11003481', 'W11003481', 'UTIHCPHY', 'Sandy Clinic', 'Dale', 'Mark', 'Valentine', 'MD', 'Pediatrics', NULL, NULL, NULL, 'o', '9500 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8015012100', NULL, NULL, NULL, '', NULL, NULL, '', '', 'USTDMULT', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1013028901', 0, 'n', 0, '2008-05-14', NULL, NULL, 40.5787, -111.853, NULL, NULL),
('942854057', 'W11003482', 'W11003482', 'UTIHCPHY', 'Holladay Pediatrics North', 'Jed', 'B', 'VanDenBerghe', 'MD', 'Pediatrics', '', '', NULL, 'o', '2160 E 4500 S', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012784693', NULL, '2160 E 4500 S', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012784693', '', 'USTDMULT', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1922011576', 0, 'n', 0, '2013-12-18', NULL, NULL, 40.6742, -111.829, NULL, NULL),
('942854057', 'W11003483', 'W11003483', 'UTIHCPHY', 'Intermountain Obstetrics & Gynecology Specialists', 'Virginia', '', 'Vierra', 'MD', 'Pediatrics', '', '', NULL, 'o', '5063 S Cottonwood St #120', 'Murray', 'Salt Lake', 'UT', '84157', '8015071800', NULL, '5063 S Cottonwood St #120', 'Murray', 'Salt Lake', 'UT', '84157', '8015071800', '', 'USTDMULT', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437181682', 0, 'n', 0, '2012-01-25', NULL, NULL, 40.6615, -111.893, NULL, NULL),
('942854057', 'W11003484', 'W11003484', 'UTIHCPHY', 'Budge Clinic Pediatrics', 'Michael', 'K', 'Visick', 'MD', 'Pediatrics', 'Pediatrics', NULL, NULL, 'o', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921940', NULL, NULL, NULL, '', NULL, NULL, '', '', 'USTDMULT', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1225048648', 0, 'n', 0, '2008-05-14', NULL, NULL, 41.7565, -111.821, NULL, NULL),
('942854057', 'W11003485', 'W11003485', 'UTIHCPHY', 'Budge Clinic Internal Medicine', 'Corey', 'Wyn', 'Walker', 'MD', 'Rheumatology', 'Internal Medicine', NULL, NULL, 'o', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921980', NULL, NULL, NULL, '', NULL, NULL, '', '', 'USTDMULT', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1295707677', 0, 'n', 0, '2008-05-14', NULL, NULL, 41.7565, -111.821, NULL, NULL),
('942854057', 'W11003486', 'W11003486', 'UTIHCPHY', 'Redrock Pediatrics', 'Adrianne', 'R', 'Walker-Jenkins', 'MD', 'Pediatrics', '', '', NULL, 'o', '1380 E Medical Ctr Dr Ste 3100', 'St George', 'Washington', 'UT', '84790', '4352512740', NULL, '1380 E Medical Center Drive #3100', 'St George', 'Washington', 'UT', '84790', '4352512740', '', 'USTDMULT', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1699820738', 0, 'n', 0, '2011-01-03', NULL, NULL, 37.0998, -113.554, NULL, NULL),
('942854057', 'W11003487', 'W11003487', 'UTIHCPHY', 'River Road Internal Medicine', 'Claude', 'A', 'Warner', 'MD', 'Hospitalist', '', '', NULL, 'o', '577 S River Road', 'St George', 'Washington', 'UT', '84790', '4356886200', NULL, '577 S River Road', 'St George', 'Washington', 'UT', '84790', '4356886200', '', 'USTDMULT', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1376561688', 0, 'n', 0, '2011-09-26', NULL, NULL, 37.0986, -113.557, NULL, NULL),
('942854057', 'W11003488', 'W11003488', 'UTIHCPHY', 'Budge Clinic Surgical Specialists', 'Bartley', 'Myron', 'Weiss', 'MD', 'General Surgery', '', '', NULL, 'o', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921950', NULL, '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921950', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1942210364', 0, 'N', 0, '2012-02-29', NULL, NULL, 41.7565, -111.821, NULL, NULL),
('942854057', 'W11003489', 'W11003489', 'UTIHCPHY', 'River Road InstaCare', 'Thomas', 'H', 'Welsh', 'MD', 'Urgent Care', '', '', NULL, 'B', '577 S River Road', 'St George', 'Washington', 'UT', '84790', '4356886300', NULL, '577 S River Road', 'St George', 'Washington', 'UT', '84790', '4356886300', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-01-01', '2011-08-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487604740', 0, 'N', 0, '2011-06-23', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11003490', 'W11003490', 'UTIHCPHY', 'Budge Clinic Internal Medicine', 'Michael', 'Henry', 'Williams', 'MD', 'Neurology', NULL, NULL, NULL, 'o', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921980', NULL, NULL, NULL, '', NULL, NULL, '', '', 'USTDMULT', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1427068840', 0, 'n', 0, '2008-05-14', NULL, NULL, 41.7565, -111.821, NULL, NULL),
('942854057', 'W11003491', 'W11003491', 'UTIHCPHY', 'Holladay Pediatrics', 'Mark', 'T', 'Witt', 'MD', 'Pediatrics', NULL, NULL, NULL, 'o', '2180 E 4500 S #210', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8019474242', NULL, NULL, NULL, '', NULL, NULL, '', '', 'USTDMULT', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1881707875', 0, 'n', 0, '2008-05-14', NULL, NULL, 40.6742, -111.829, NULL, NULL),
('942854057', 'W11003492', 'W11003492', 'UTIHCPHY', 'Logan InstaCare', 'Eric', 'M', 'Wood', 'MD, MPH', 'Emergency Medicine', '', 'Occupational Therapy', NULL, 'B', '235 E 400 N', 'Logan', 'Cache', 'UT', '84321', '4357521010', NULL, '235 E 400 N', 'Logan', 'Cache', 'UT', '84321', '4357521010', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-01-01', '2012-11-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992719504', 0, 'N', 0, '2013-01-09', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11003493', 'W11003493', 'UTIHCPHY', 'Cardiovascular & Thoracic Surgery - St. George', 'Kory', 'U', 'Woodbury', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'o', '1380 E Medical Ctr Dr Ste 2600', 'St George', 'Washington', 'UT', '84790', '4352512700', NULL, NULL, NULL, '', NULL, NULL, '', '', 'USTDMULT', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1225056575', 0, 'n', 0, '2008-05-14', NULL, NULL, 37.0998, -113.554, NULL, NULL),
('942854057', 'W11003494', 'W11003494', 'UTIHCPHY', 'Hurricane Valley Clinic', 'Daniel', 'K', 'Worwood', 'MD', 'Family Practice', NULL, NULL, NULL, 'o', '75 N 2260 W', 'Hurricane', 'Washington', 'UT', '84737', '4356356400', NULL, '75 N 2260 W', 'Hurricane', 'Washington', 'UT', '84737', '4356356400', '', 'USTDMULT', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1144241647', 0, 'n', 0, '2011-01-26', NULL, NULL, 37.1771, -113.33, NULL, NULL),
('208168225', 'W11003495', 'W11003495', 'UT01', '', 'Daniel', 'J', 'Huff', 'DPM', 'Podiatry', '', '', NULL, 'O', '2380 N 400 E Ste G', 'North Logan', 'Cache', 'UT', '84341', '4357871023', NULL, '2380 N 400 E Ste G', 'North Logan', 'Cache', 'UT', '84341', '4357871023', '', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-03-01', NULL, 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1437364445', 0, 'N', 0, '2014-04-02', NULL, NULL, 41.775, -111.823, NULL, NULL),
('208168225', 'W11003496', 'W11003496', 'UT01', NULL, 'Daniel', 'J', 'Huff', 'DPM', 'Podiatry', '', '', NULL, 'O', '272 N Spring Creek Parkway', 'Providence', 'Cache', 'UT', '84332', '4357871023', NULL, '272 N Spring Creek Parkway', 'Providence', 'Cache', 'UT', '84332', '4357871023', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-03-01', NULL, 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1437364445', 0, 'n', 0, '2014-04-02', NULL, NULL, 41.7135, -111.828, NULL, NULL),
('260726474', 'W11003497', 'W11003497', 'WY01', 'Wind River Clinic', 'Ricardo', 'A', 'Aviles', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1005 College View Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078573488', NULL, '1005 College View Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078573488', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2008-03-01', '2011-06-17', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265625297', 0, 'N', 0, '2011-06-24', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11003498', 'W11003498', 'UTIHC04', 'Bear River Valley Hospital', 'Dellray', 'H', 'Anderson', 'MD', 'Family Practice', NULL, NULL, NULL, 'o', '420 W 600 N', 'Tremonton', 'Box Elder', 'UT', '84337', '4352574444', NULL, NULL, NULL, '', NULL, NULL, '', '', NULL, NULL, NULL, '0.00', '15.00', NULL, 8, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1639166416', 0, 'y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11003499', 'W11003499', 'UTIHC04', 'Bear River Valley Hospital', 'Jay', 'D', 'Argyle', 'CRNA', 'Certified Nurse Anesthetist', NULL, NULL, NULL, 'o', '440 W 600 N', 'Tremonton', 'Box Elder', 'UT', '84337', '4352577441', NULL, NULL, NULL, '', NULL, NULL, '', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1295754513', 0, 'y', 0, '2010-01-12', NULL, NULL, 41.7188, -112.173, NULL, NULL),
('942854057', 'W11003500', 'W11003500', 'UTIHC04', 'Bear River Valley Hospital', 'Jay', 'E', 'Cottle', 'PT', 'Physical Therapy', '', '', NULL, 'O', '440 W 600 N', 'Tremonton', 'Box Elder', 'UT', '84337', '4352577441', NULL, '440 W 600 N', 'Tremonton', 'Box Elder', 'UT', '84337', '4352577441', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134148430', 0, 'N', 0, '2012-08-21', NULL, NULL, 41.7188, -112.173, NULL, NULL),
('942854057', 'W11003501', 'W11003501', 'UTIHC04', 'Bear River Specialists', 'Kevin', 'A', 'Murphy', 'MD', 'General Surgery', 'Internal Medicine', '', NULL, 'o', '935 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '4352074800', NULL, '935 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '4352074800', '', '', NULL, '', '0.00', '15.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, 'Brigham City Community Hospital', '', '', '', 'HCFA|UB|', '1083641385', 0, 'y', 0, '2014-05-12', NULL, NULL, 41.7162, -112.201, NULL, NULL),
('942854057', 'W11003502', 'W11003502', 'UTIHC04', 'Bear River Valley Hospital', 'Layne', 'T', 'Summers', 'CRNA', 'Certified Nurse Anesthetist', '', '', NULL, 'o', '440 W 600 N', 'Tremonton', 'Box Elder', 'UT', '84337', '4352577441', NULL, '440 W 600 N', 'Tremonton', 'Box Elder', 'UT', '84337', '4352577441', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2008-01-01', '2010-03-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528087848', 0, 'N', 0, '2010-06-01', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11003503', 'W11003503', 'UTIHC04', 'Cassia Regional Medical Center', 'Susie', NULL, 'Anderson', 'SLP', NULL, '', '', NULL, 'o', '1501 Hiland Ave', 'Burley', 'Cassia', 'ID', '83318', '2086776532', NULL, '1501 Hiland Ave', 'Burley', 'Cassia', 'ID', '83318', '2086776532', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2008-01-01', '2010-10-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000005037', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11003504', 'W11003504', 'UTIHC04', 'Cassia Regional Medical Center', 'Troy', 'M', 'Anderson', 'PT', 'Physical Therapy', '', '', NULL, 'o', '1501 Hiland Ave', 'Burley', 'Cassia', 'ID', '83318', '2086776530', NULL, '1501 Hiland Ave', 'Burley', 'Cassia', 'ID', '83318', '2086776530', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295881696', 0, 'y', 0, '2010-07-15', NULL, NULL, 42.5342, -113.783, NULL, NULL),
('942854057', 'W11003505', 'W11003505', 'UTIHC04', 'Cassia Regional Medical Center', 'Lanny', 'F', 'Campbell', 'MD', 'Emergency Medicine', '', '', NULL, 'o', '1501 Hiland Ave', 'Burley', 'Cassia', 'ID', '83318', '2086776560', NULL, '1501 Hiland Ave', 'Burley', 'Cassia', 'ID', '83318', '2086776560', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, 'Cassia Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1780790147', 0, 'Y', 0, '2013-01-14', NULL, NULL, 42.5342, -113.783, NULL, NULL),
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('942854057', 'W11003574', 'W11003574', 'UTIHC04', 'Dixie Regional Medical Center', 'David', 'W', 'Branch', 'MD', 'Maternal Fetal Medicine', 'Obstetrics and Gynecology', '', NULL, 'o', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352511000', NULL, '1380 E Medical Center Dr', 'St George', 'Washington', 'UT', '84790', '4352511000', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1922012830', 0, 'y', 0, '2011-06-23', NULL, NULL, 37.0998, -113.554, NULL, NULL),
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('942854057', 'W11003657', 'W11003657', 'UTIHC04', 'Dixie Regional Medical Center', 'Bryan', 'T', 'Oshiro', 'MD', 'Maternal Fetal Medicine', NULL, NULL, NULL, 'o', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884770', NULL, NULL, NULL, '', NULL, NULL, '', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-01-01', '2009-10-26', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1780608489', 0, 'y', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W11003659', 'W11003659', 'UTIHC04', 'Dixie Regional Medical Center', 'Mark', 'L', 'Martinez', 'MD', 'Hospitalist', '', '', NULL, 'o', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84770', '4352512250', NULL, '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84770', '4352512250', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-01-01', '2009-10-26', 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1508861964', 0, 'y', 0, '2013-03-06', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11003660', 'W11003660', 'UTIHC04', 'Dixie Regional Medical Center', 'Michael', 'Locke', 'Ettinger', 'PT', 'Physical Therapy', '', '', NULL, 'o', '1380 E Medical Center Dr Ste 3400', 'St George', 'Washington', 'UT', '84790', '4352512250', NULL, '1380 E Medical Center Dr Ste 3400', 'St George', 'Washington', 'UT', '84790', '4352512250', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2008-01-01', '2010-06-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1003822024', 0, 'N', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W11003662', 'W11003662', 'UTIHC04', 'Dixie Regional Medical Center', 'Samantha', NULL, 'Dumitru', 'PT', 'Physical Therapy', '', '', NULL, 'o', '1380 E Medical Center Dr Ste 3400', 'St George', 'Washington', 'UT', '84790', '4352512250', NULL, '1380 E Medical Center Dr Ste 3400', 'St George', 'Washington', 'UT', '84790', '4352512250', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2008-01-01', '2010-06-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1780802058', 0, 'N', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11003663', 'W11003663', 'UTIHC04', 'Dixie Regional Medical Center', 'Sean', 'W', 'Carey', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'o', '75 N 2260 W', 'Hurricane', 'Washington', 'UT', '84737', '4356356480', NULL, NULL, NULL, '', NULL, NULL, '', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-01-14', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1154337178', 0, 'y', 0, '2010-01-12', NULL, NULL, 37.1771, -113.33, NULL, NULL),
('942854057', 'W11003664', 'W11003664', 'UTIHC04', 'Dixie Regional Medical Center', 'Scott', 'S', 'Munson', 'OT', 'Occupational Therapy', '', '', NULL, 'o', '75 N 2260 W', 'Hurricane', 'Washington', 'UT', '84737', '4356356480', NULL, NULL, NULL, '', NULL, NULL, '', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-01-14', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1104035112', 0, 'y', 0, '2010-01-12', NULL, NULL, 37.1771, -113.33, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('942854057', 'W11003665', 'W11003665', 'UTIHC04', 'Dixie Regional Medical Center', 'Jerold', 'L', 'Hagen', 'MD', 'Internal Medicine', '', '', NULL, 'o', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884800', NULL, '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884800', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2008-02-01', '2011-04-25', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639102635', 0, 'N', 0, '2013-07-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11003666', 'W11003666', 'UTIHC04', 'Fillmore Community Medical Center', 'Matthew', 'J', 'Vernon', 'MD', 'Family Practice', NULL, NULL, NULL, 'o', '674 S Highway 99', 'Fillmore', 'Millard', 'UT', '84631', '4357435857', NULL, NULL, NULL, '', NULL, NULL, '', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-01-01', '2008-01-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000009440', 0, 'y', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11003667', 'W11003667', 'UTIHC04', 'Fillmore Community Medical Center', 'Holly', 'K', 'McCoy', 'MD', 'Family Practice', NULL, NULL, NULL, 'o', '674 S Highway 99', 'Fillmore', 'Millard', 'UT', '84631', '4357435857', NULL, NULL, NULL, '', NULL, NULL, '', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-01-01', '2008-02-25', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000007498', 0, 'y', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11003668', 'W11003668', 'UTIHC04', 'Fillmore Community Medical Center', 'Scott', 'H', 'Beckstead', 'DO', 'Family Practice', NULL, NULL, NULL, 'o', '674 S Hwy 99', 'Fillmore', 'Millard', 'UT', '84631', '4357435857', NULL, NULL, NULL, '', NULL, NULL, '', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1508810854', 0, 'y', 0, '2010-01-12', NULL, NULL, 38.9534, -112.34, NULL, NULL),
('942854057', 'W11003669', 'W11003669', 'UTIHC04', 'Fillmore Community Medical Center', 'Carl', 'M', 'Black', 'MD', 'Vascular Surgery', 'Radiologist', '', NULL, 'o', '674 S Hwy 99', 'Fillmore', 'Millard', 'UT', '84631', '4357435857', NULL, '674 S Highway 99', 'Fillmore', 'Millard', 'UT', '84631', '4357435857', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1891737094', 0, 'y', 0, '2011-11-15', NULL, NULL, 38.9534, -112.34, NULL, NULL),
('942854057', 'W11003670', 'W11003670', 'UTIHC04', 'Fillmore Community Medical Center', 'Annette', 'M', 'Bosworth', 'MD', 'Internal Medicine', '', '', NULL, 'o', '674 S Highway 99', 'Fillmore', 'Millard', 'UT', '84631', '4357435857', NULL, '674 S Highway 99', 'Fillmore', 'Millard', 'UT', '84631', '4357435857', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2008-01-01', '2010-07-22', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1649224478', 0, 'N', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11003671', 'W11003671', 'UTIHC04', 'Fillmore Community Medical Center', 'Gordon', 'D', 'Brown', 'MD', 'Radiologist', '', '', NULL, 'o', '674 S Highway 99', 'Fillmore', 'Millard', 'UT', '84631', '4357435857', NULL, '674 S Highway 99', 'Fillmore', 'Millard', 'UT', '84631', '4357435857', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2008-01-01', '2010-09-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1598710162', 0, 'N', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11003672', 'W11003672', 'UTIHC04', 'Fillmore Community Medical Center', 'Matthew', 'A', 'Brown', 'MD', 'Family Practice', NULL, NULL, NULL, 'o', '674 S Highway 99', 'Fillmore', 'Millard', 'UT', '84631', '4357435857', NULL, NULL, NULL, '', NULL, NULL, '', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-01-01', '2009-01-21', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1144236225', 0, 'y', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11003673', 'W11003673', 'UTIHC04', 'Fillmore Community Medical Center', 'Wayne', 'O', 'Brown', 'MD', 'Family Practice', NULL, NULL, NULL, 'o', '674 S Hwy 99', 'Fillmore', 'Millard', 'UT', '84631', '4357435857', NULL, NULL, NULL, '', NULL, NULL, '', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1003822909', 0, 'y', 0, '2010-01-12', NULL, NULL, 38.9534, -112.34, NULL, NULL),
('942854057', 'W11003674', 'W11003674', 'UTIHC04', 'Fillmore Community Medical Center', 'Brent', 'C', 'Chandler', 'MD', 'Radiologist', NULL, NULL, NULL, 'o', '674 S Hwy 99', 'Fillmore', 'Millard', 'UT', '84631', '4357435857', NULL, NULL, NULL, '', NULL, NULL, '', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1346292026', 0, 'y', 0, '2010-01-12', NULL, NULL, 38.9534, -112.34, NULL, NULL),
('942854057', 'W11003675', 'W11003675', 'UTIHC04', 'Fillmore Community Medical Center', 'Nicole', 'A', 'Clark', 'MD', 'Family Practice', NULL, NULL, NULL, 'o', '674 S Hwy 99', 'Fillmore', 'Millard', 'UT', '84631', '4357435857', NULL, NULL, NULL, '', NULL, NULL, '', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1760598411', 0, 'y', 0, '2010-01-12', NULL, NULL, 38.9534, -112.34, NULL, NULL),
('942854057', 'W11003676', 'W11003676', 'UTIHC04', 'Fillmore Community Medical Center', 'John', 'S', 'Collins', 'MD', 'Vascular Surgery', 'Radiologist', '', NULL, 'o', '674 S Hwy 99', 'Fillmore', 'Millard', 'UT', '84631', '4357435857', NULL, '674 S Highway 99', 'Fillmore', 'Millard', 'UT', '84631', '4357435857', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215974266', 0, 'y', 0, '2011-11-15', NULL, NULL, 38.9534, -112.34, NULL, NULL),
('942854057', 'W11003677', 'W11003677', 'UTIHC04', 'Fillmore Community Medical Center', 'Brian', 'G', 'Crandall', 'MD', 'Cardiovascular Disease', '', '', NULL, 'o', '674 S Hwy 99', 'Fillmore', 'Millard', 'UT', '84631', '4357435857', NULL, '674 S Highway 99', 'Fillmore', 'Millard', 'UT', '84631', '4357435857', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669440269', 0, 'y', 0, '2011-02-16', NULL, NULL, 38.9534, -112.34, NULL, NULL),
('942854057', 'W11003678', 'W11003678', 'UTIHC04', 'Fillmore Community Medical Center', 'David', 'Ray', 'Crimin', 'DO', 'Family Practice', '', '', NULL, 'o', '674 S Hwy 99', 'Fillmore', 'Millard', 'UT', '84631', '4357435857', NULL, '674 S Hwy 99', 'Fillmore', 'Millard', 'UT', '84631', '4357435857', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225044431', 0, 'y', 0, '2013-12-18', NULL, NULL, 38.9534, -112.34, NULL, NULL),
('942854057', 'W11003679', 'W11003679', 'UTIHC04', 'Fillmore Community Medical Center', 'Ronald', 'T', 'Draper', 'CRNA', 'Certified Nurse Anesthetist', NULL, NULL, NULL, 'o', '674 S Hwy 99', 'Fillmore', 'Millard', 'UT', '84631', '4358968271', NULL, NULL, NULL, '', NULL, NULL, '', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, 'Delta Community Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1013004498', 0, 'y', 0, '2010-01-12', NULL, NULL, 38.9534, -112.34, NULL, NULL),
('942854057', 'W11003680', 'W11003680', 'UTIHC04', 'Fillmore Community Medical Center', 'Jared', 'C', 'Dunn', 'MD', 'Family Practice', NULL, NULL, NULL, 'o', '674 S Hwy 99', 'Fillmore', 'Millard', 'UT', '84631', '4357435857', NULL, NULL, NULL, '', NULL, NULL, '', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1003823808', 0, 'y', 0, '2010-01-12', NULL, NULL, 38.9534, -112.34, NULL, NULL),
('942854057', 'W11003681', 'W11003681', 'UTIHC04', 'Fillmore Community Medical Center', 'Val', 'D', 'Dunn', 'MD', 'Radiologist', '', '', NULL, 'o', '674 S Hwy 99', 'Fillmore', 'Millard', 'UT', '84631', '4357435857', NULL, '674 S Highway 99', 'Fillmore', 'Millard', 'UT', '84631', '4357435857', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215975552', 0, 'y', 0, '2010-12-28', NULL, NULL, 38.9534, -112.34, NULL, NULL),
('942854057', 'W11003682', 'W11003682', 'UTIHC04', 'Fillmore Community Medical Center', 'Michael', 'J', 'Gale', 'MD', 'Family Practice', NULL, NULL, NULL, 'o', '674 S Hwy 99', 'Fillmore', 'Millard', 'UT', '84631', '4357435857', NULL, NULL, NULL, '', NULL, NULL, '', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1821003138', 0, 'y', 0, '2010-01-12', NULL, NULL, 38.9534, -112.34, NULL, NULL),
('942854057', 'W11003683', 'W11003683', 'UTIHC04', 'Fillmore Community Medical Center', 'Wendell', 'A', 'Gibby', 'MD', 'Radiologist', NULL, NULL, NULL, 'o', '674 S Hwy 99', 'Fillmore', 'Millard', 'UT', '84631', '4357435857', NULL, NULL, NULL, '', NULL, NULL, '', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1992802235', 0, 'y', 0, '2010-01-12', NULL, NULL, 38.9534, -112.34, NULL, NULL),
('942854057', 'W11003684', 'W11003684', 'UTIHC04', 'Fillmore Community Medical Center', 'Craig', 'M', 'Grose', 'MD', 'Family Practice', NULL, NULL, NULL, 'o', '674 S Hwy 99', 'Fillmore', 'Millard', 'UT', '84631', '4357435857', NULL, NULL, NULL, '', NULL, NULL, '', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1003854878', 0, 'y', 0, '2010-01-12', NULL, NULL, 38.9534, -112.34, NULL, NULL),
('942854057', 'W11003685', 'W11003685', 'UTIHC04', 'Fillmore Community Medical Center', 'Roy', 'C', 'Hammond', 'MD', 'Radiologist', '', '', NULL, 'o', '674 S Hwy 99', 'Fillmore', 'Millard', 'UT', '84631', '4357435857', NULL, '674 S Highway 99', 'Fillmore', 'Millard', 'UT', '84631', '4357435857', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235183781', 0, 'y', 0, '2010-12-28', NULL, NULL, 38.9534, -112.34, NULL, NULL),
('942854057', 'W11003686', 'W11003686', 'UTIHC04', 'Fillmore Community Medical Center', 'Daniel', 'J', 'Hatch', 'MD', 'Vascular Surgery', 'Radiologist', '', NULL, 'o', '674 S Hwy 99', 'Fillmore', 'Millard', 'UT', '84631', '4357435857', NULL, '674 S Highway 99', 'Fillmore', 'Millard', 'UT', '84631', '4357435857', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588608582', 0, 'y', 0, '2010-08-30', NULL, NULL, 38.9534, -112.34, NULL, NULL),
('942854057', 'W11003687', 'W11003687', 'UTIHC04', 'Fillmore Community Medical Center', 'Dennis', 'K', 'Heaston', 'MD', 'Vascular Surgery', 'Radiologist', '', NULL, 'o', '674 S Hwy 99', 'Fillmore', 'Millard', 'UT', '84631', '4357435857', NULL, '674 S Highway 99', 'Fillmore', 'Millard', 'UT', '84631', '4357435857', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1548214224', 0, 'y', 0, '2011-11-17', NULL, NULL, 38.9534, -112.34, NULL, NULL),
('942854057', 'W11003688', 'W11003688', 'UTIHC04', 'Fillmore Community Medical Center', 'David', 'P', 'Henrie', 'MD', 'Family Practice', '', '', NULL, 'o', '674 S Hwy 99', 'Fillmore', 'Millard', 'UT', '84631', '4357435857', NULL, '674 S Hwy 99', 'Fillmore', 'Millard', 'UT', '84631', '4357435857', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2008-01-01', '2013-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427016815', 0, 'N', 0, '2014-03-03', NULL, NULL, 38.9534, -112.34, NULL, NULL),
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('942854057', 'W11003947', 'W11003947', 'UTIHC04', 'Valley View Medical Center', 'Gordon', 'L', 'Larsen', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'o', '1303 N Main', 'Cedar City', 'Iron', 'UT', '84720', '4358685251', NULL, NULL, NULL, '', NULL, NULL, '', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1760479083', 0, 'y', 0, '2010-01-12', NULL, NULL, 37.6711, -113.103, NULL, NULL),
('942854057', 'W11003948', 'W11003948', 'UTIHC04', 'Valley View Medical Center', 'Barbara', 'A', 'Neuenschwander', 'SLP', 'Speech Therapy', 'Speech Language Pathology', NULL, NULL, 'o', '1303 N Main', 'Cedar City', 'Iron', 'UT', '84720', '4358685000', NULL, NULL, NULL, '', NULL, NULL, '', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-01-01', '2009-01-23', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1235155623', 0, 'y', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11003949', 'W11003949', 'UTIHC04', 'Valley View Medical Center', 'Robert', 'D', 'Owen', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'o', '1303 N Main', 'Cedar City', 'Iron', 'UT', '84720', '4358685251', NULL, NULL, NULL, '', NULL, NULL, '', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1114952389', 0, 'y', 0, '2010-01-12', NULL, NULL, 37.6711, -113.103, NULL, NULL),
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('942854057', 'W11003954', 'W11003954', 'UTIHC04', 'Valley View Medical Center', 'Darrell', 'Lynn', 'Wilson', 'MD', 'Psychiatry', 'Emergency Medicine', '', NULL, 'o', '1303 N Main', 'Cedar City', 'Iron', 'UT', '84720', '4358685251', NULL, NULL, NULL, '', NULL, NULL, '', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, 'Valley View Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1922160530', 0, 'y', 0, '2010-01-12', NULL, NULL, 37.6711, -113.103, NULL, NULL),
('942854057', 'W11003955', 'W11003955', 'UTIHC04', 'Valley View Medical Center', 'Michael', 'L', 'Wilson', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'o', '1303 N Main', 'Cedar City', 'Iron', 'UT', '84720', '4358685251', NULL, NULL, NULL, '', NULL, NULL, '', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1497742829', 0, 'y', 0, '2010-01-12', NULL, NULL, 37.6711, -113.103, 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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('942854057', 'W11003957', 'W11003957', 'UTIHC04', 'Valley View Medical Center', 'Jeffery', 'G', 'Gardner', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'o', '1303 N Main St', 'Cedar City', 'Iron', 'UT', '84720', '4358685000', NULL, NULL, NULL, '', NULL, NULL, '', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, 'Valley View Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1588656946', 0, 'y', 0, '2010-01-12', NULL, NULL, 37.7003, -113.064, NULL, NULL),
('820380731', 'W11003958', 'W11003958', 'UT01', 'Malad Valley Clinic', 'Stephen', 'C', 'Johnson', 'DO', 'Family Practice', '', '', NULL, 'O', '230 W 200 N', 'Malad City', 'Oneida', 'ID', '83252', '2087662267', NULL, 'PO Box 167', 'Malad City', '', 'ID', '83252', '', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-03-01', '2009-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427041201', 0, 'n', 0, '2009-03-24', NULL, NULL, 0, 0, NULL, NULL),
('208380921', 'W11003959', 'W11003959', 'WY01', 'Lowham Surgery and Endoscopy', 'Anthony', 'S', 'Lowham', 'MD', 'General Surgery', '', '', NULL, 'O', '195 Capitol', 'Lander', 'Fremont', 'WY', '82520', '3073326222', NULL, '195 Capitol', 'Lander', 'Fremont', 'WY', '82520', '3073326222', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2008-03-01', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1255427985', 0, 'N', 0, '2013-06-17', NULL, NULL, 42.8223, -108.732, NULL, NULL),
('208380921', 'W11003960', 'W11003960', 'WY01', 'Lowham Surgery and Endoscopy', 'Anthony', 'S', 'Lowham', 'MD', 'General Surgery', '', '', NULL, 'B', '1005 College View Dr', 'Riverton', 'Fremont', 'WY', '82501', '3073326222', NULL, '1005 College View Dr', 'Riverton', 'Fremont', 'WY', '82501', '3073326222', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2008-03-01', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1255427985', 0, 'Y', 0, '2013-06-17', NULL, NULL, 0, 0, NULL, NULL),
('593504952', 'W11003961', 'W11003961', 'WY01', 'Wind River Clinic', 'Dennis', 'M', 'Lewis', 'MD', 'General Surgery', '', '', NULL, 'O', '1005 College View Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078575220', NULL, '1005 College View Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078575220', '', '', NULL, NULL, '0.00', '20.00', '0.00', 3, '2008-03-01', NULL, 0, 0, 0, 'SageWest Health Care', '', '', '', 'HCFA|UB|', '1699701524', 0, 'n', 0, '2013-03-05', NULL, NULL, 43.0349, -108.42, NULL, NULL),
('200070263', 'W11003962', 'W11003962', 'WY01', 'Wind River OB/GYN ', 'Maryanne', 'A', 'Hannaney', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1005 College View Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078575217', NULL, '1005 College View Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078575217', '', '', NULL, NULL, '0.00', '20.00', '0.00', 3, '2008-03-01', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1497797260', 0, 'n', 0, '2012-01-17', NULL, NULL, 43.0349, -108.42, NULL, NULL),
('810231784', 'W11003963', 'W11003963', 'WY01', 'Billings Clinic - Occupational Health & Wellness', 'Erin', 'L', 'Turner', 'OT', 'Occupational Therapy', NULL, NULL, NULL, 'O', '2825 8th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382066', 'PO Box 37000', 'Billings', '', 'MT', '59107', '', '', '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2008-02-01', '2009-04-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1497924682', 0, 'N', 0, '2010-01-15', NULL, NULL, 0, 0, NULL, NULL),
('870515631', 'W11003964', 'W11003964', 'UT01', 'University Health Care', 'Scott', 'T', 'Roberts', 'MD', 'Physical Medicine and Rehabilitation', NULL, NULL, NULL, 'o', '590 Wakara Way ', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8015812268', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', NULL, 3, '2006-08-01', '2006-08-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1457480535', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11003965', 'W11003965', 'WY01', 'Billings Clinic - Cancer Center', 'Amber', 'L', 'Ussin-Davey', 'MD', 'Mental Health', 'Licensed Counselor', NULL, NULL, 'O', '2825 8th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382469', 'PO Box 37000', 'Billings', '', 'MT', '59101', '', '', '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2008-02-01', '2009-04-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1225207418', 0, 'N', 0, '2010-01-15', NULL, NULL, 0, 0, NULL, NULL),
('680562677', '289250-12', '289250-1205', 'UT01', 'Intermountain Ear Nose and Throat Specialists', 'John', 'R', 'Bennett', 'MD', 'Ear', ' Nose and Throat', '', '', 'B', '22 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013282522', '', '', '', '', '', '', '', '', 'USTDENT', 'USTDHCPC', '', '0.00', '35.00', '2006.00', 3, '2003-08-13', '2003-08-13', 0, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('680562677', '156578-12', '156578-1205', 'UT01', 'Intermountain Ear Nose And Throat Specialists', 'Richard', 'W', 'Nielsen', 'MD', 'Ear', ' Nose and Throat', '', '', 'O', '22 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013282522', '', '', '', '', '', '', '', '', 'USTDENT', 'USTDHCPC', '', '0.00', '35.00', '2006.00', 3, '2002-04-01', '2006-08-31', 0, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('841411398', '165276-12', '165276-1205', 'UT01', 'Foothill Family Clinic', 'Jon', 'Richard', 'Aoki', 'MD', 'Ear', ' Nose and Throat', '', '', 'O', '2295 Foothill Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8014863021', '8014856339', '', '', '', '', '', '', '', 'UFOOTHIL', 'USTDHCPC', '', '0.00', '35.00', '2006.00', 3, '2002-04-01', '2006-12-31', 0, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870218917', '177877-12', '177877-1205', 'UT01', 'Tanner Memorial Clinic', 'Robert', 'L', 'Mellor', 'MD', 'Ear', ' Nose and Throat', 'Plastic Surgery', '', 'O', '2121 Robins Dr', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8015258151', '', '', '', '', '', '', '', 'UTANNER', 'USTDHCPC', '', '0.00', '35.00', '2006.00', 3, '2001-01-01', '2006-06-30', 0, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870218917', '375086-12', '375086-1205', 'UT01', 'Tanner Memorial Clinic', 'Bryan', 'L', 'Richards', 'MD', 'Ear', ' Nose and Throat', '', '', 'O', '2121 Robins Dr', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8015258151', '', '', '', '', '', '', '', 'UTANNER', 'USTDHCPC', '', '0.00', '35.00', '2006.00', 3, '2001-01-01', '2006-06-30', 0, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('202797407', '5868693-1', '5868693-1205', 'UT01', 'ENT Surgical Associates', 'Peter', 'G', 'Ventura', 'MD', 'Ear', ' Nose and Throat', '', '', 'O', '1244 N Main St Ste 200', 'Tooele', 'Tooele', 'UT', '84074', '4358339600', '4358339601', '', '', '', '', '', '', '', 'USTDENT', 'USTDHCPC', '', '0.00', '35.00', '2006.00', 3, '2005-07-29', '2006-09-30', 0, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870503202', '178486-12', '178486-1205', 'UT01', 'Mountain West Ear Nose and Throat', 'Kelly', 'E', 'Stoker', 'MD', 'Ear', ' Nose and Throat', '', '', 'B', '1660 W Antelope Dr Ste 315', 'Layton', 'Davis', 'UT', '84041', '8017762180', '8017762534', '', '', '', '', '', '', '', 'USTDENT', '', '', '0.00', '35.00', '2006.00', 3, '1999-09-01', '2004-10-22', 0, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870503202', '264339-12', '264339-1205', 'UT01', 'Mountain West Ear Nose And Throat', 'Demetrios', 'G', 'Skedros', 'MD', 'Ear', ' Nose and Throat', '', '', 'O', '1660 W Antelope Dr Ste 315', 'Layton', 'Davis', 'UT', '84041', '8017762180', '8017762534', '', '', '', '', '', '', '', 'USTDENT', 'USTDHCPC', '', '0.00', '35.00', '2006.00', 3, '1999-09-01', '2006-10-31', 0, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870503202', '188579-12', '188579-1205', 'UT01', 'Mountain West Ear Nose And Throat', 'Curt', 'R', 'Stock', 'MD', 'Ear', ' Nose and Throat', '', '', 'O', '1551 Renaissance Towne Dr Ste 310', 'Bountiful', 'Davis', 'UT', '84010', '8012955581', '', '', '', '', '', '', '', '', 'USTDENT', 'USTDHCPC', '', '0.00', '35.00', '2006.00', 3, '1999-09-01', '2006-10-31', 0, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870628665', '371391-12', '371391-1205', 'UT02', 'Southern Utah Ear Nose & Throat', 'Kent', 'E', 'Gardner', 'MD', 'Ear', ' Nose and Throat', '', '', 'O', '1490 E Foremaster Dr Ste 350', 'St George', 'Washington', 'UT', '84790', '4356283334', '4356283375', '', '', '', '', '', '', '', 'USTDENT', '', '', '0.00', '35.00', '2006.00', 3, '2003-04-01', '2006-09-30', 0, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W11004071', 'W11004071', 'UTPEHP', 'Bridgerland Dialysis Center', NULL, NULL, 'Bridgerland Dialysis Center', 'GROUP', 'Dialysis Center', NULL, NULL, NULL, 'B', '1400 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357165314', NULL, NULL, NULL, '', NULL, NULL, '', '', '', NULL, NULL, '0.00', '5.00', '0.00', 8, '2008-01-01', '2008-12-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000005416', 0, 'Y', 0, '2009-01-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004072', 'W11004072', 'UTIHC04', 'Sevier Valley Dialysis Center', NULL, NULL, 'Sevier Valley Dialysis Center', 'GROUP', 'Dialysis Center', NULL, NULL, NULL, 'O', '1100 N Main St Ste D', 'Richfield', 'Sevier', 'UT', '84701', '4358930358', NULL, NULL, NULL, '', NULL, NULL, '', '', '', NULL, NULL, '0.00', '5.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000008663', 0, 'N', 0, '2008-05-14', NULL, NULL, 38.7844, -112.084, NULL, NULL),
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('942854057', 'W11004074', 'W11004074', 'UTPEHP', 'Sevier Valley Dialysis Center', NULL, NULL, 'Sevier Valley Dialysis Center', 'GROUP', 'Dialysis Center', NULL, NULL, NULL, 'O', '1100 N Main St Ste D', 'Richfield', 'Sevier', 'UT', '84701', '4358930358', NULL, NULL, NULL, '', NULL, NULL, '', '', '', NULL, NULL, '0.00', '5.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000008663', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W11004076', 'W11004076', 'UTPEHP', 'Memorial Clinic', 'Gerald', 'L', 'Allred', 'MD', 'Pediatrics', '', '', NULL, 'O', '2000 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8014647500', NULL, '2000 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8014647500', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1174577472', 0, 'N', 0, '2013-05-17', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004077', 'W11004077', 'UTPEHP', 'Utah Valley Pulmonary Clinic', 'William', 'T', 'Alward', 'MD', 'Critical Care', '', '', NULL, 'O', '1055 N 300 W #500', 'Provo', 'Utah', 'UT', '84604', '8013577291', NULL, '1055 N 300 W #500', 'Provo', 'Utah', 'UT', '84604', '8013577291', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609880939', 0, 'N', 0, '2011-07-26', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004078', 'W11004078', 'UTPEHP', 'Budge Clinic Surgical Specialists', 'Allan', 'D', 'Anderson', 'MD', 'General Surgery', '', '', NULL, 'O', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921950', NULL, '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921950', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1710991344', 0, 'N', 0, '2012-02-29', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004079', 'W11004079', 'UTPEHP', 'Budge Clinic Obstetrics & Gynecology', 'Jennifer', '', 'Anderson', 'APRN', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1400 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357161920', NULL, '1400 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357161920', '', 'PEHPMID', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1275547895', 0, 'N', 0, '2012-07-20', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004080', 'W11004080', 'UTPEHP', 'North Sevier Medical Clinic', 'Kevin', 'Kyhl', 'Anderson', 'PA', 'Family Practice', '', '', NULL, 'O', '530 N 250 W', 'Salina', 'Sevier', 'UT', '84654', '4355297411', NULL, '530 N 250 W', 'Salina', 'Sevier', 'UT', '84654', '4355297411', '', 'PEHPMID', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861507675', 0, 'N', 0, '2012-12-31', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004081', 'W11004081', 'UTPEHP', 'Zion Orthopaedics & Sports Medicine', 'Robert', 'J', 'Andruss', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '652 S Medical Ctr Dr Ste 400', 'St George', 'Washington', 'UT', '84790', '4352512650', NULL, '1380 E Medical Center Dr #2100', 'St George', '', 'UT', '84790', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1952326373', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004082', 'W11004082', 'UTPEHP', 'Manti Family Clinic', 'Robert', 'D', 'Armstrong', 'MD', 'Family Practice', '', '', NULL, 'O', '159 N Main', 'Manti', 'Sanpete', 'UT', '84642', '4358353344', NULL, '159 N Main', 'Manti', 'Sanpete', 'UT', '84642', '4358353344', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Sanpete Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1194766782', 0, 'N', 0, '2011-09-26', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004083', 'W11004083', 'UTPEHP', 'Summit Clinic', 'Delwin', 'Barton', 'Avery', 'MD', 'Family Practice', '', '', NULL, 'O', '502 S Main', 'Smithfield', 'Cache', 'UT', '84335', '4355633222', NULL, '502 S Main', 'Smithfield', 'Cache', 'UT', '84335', '4355633222', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1780698316', 0, 'N', 0, '2013-08-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004084', 'W11004084', 'UTPEHP', 'Memorial Clinic', 'Rachel', 'E', 'Baar', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '2000 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8014647500', NULL, '2000 S 900 E', 'Salt Lake City', '', 'UT', '84105', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1740232750', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004085', 'W11004085', 'UTPEHP', 'Memorial Clinic', 'Timothy', 'D', 'Bancroft', 'MD', 'Pediatrics', '', '', NULL, 'O', '2000 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8014647500', NULL, '2000 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8014647500', '          ', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2008-04-01', '2010-06-07', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1649219395', 0, 'N', 0, '2011-02-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004086', 'W11004086', 'UTPEHP', 'Redrock Pediatrics', 'Kelly', 'Dean', 'Beaumont', 'PA', 'Pediatrics', NULL, NULL, NULL, 'O', '1380 E Medical Ctr Dr #3100', 'St George', 'Washington', 'UT', '84790', '4352512740', NULL, '1380 E Medical Center Dr #3100', 'St George', '', 'UT', '84790', '', '', 'PEHPMID', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1548369341', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004087', 'W11004087', 'UTPEHP', 'Budge Clinic Obstetrics & Gynecology', 'James', 'Patton', 'Benedict', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '1400 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357161920', NULL, '500 E 1400 N', 'Logan', '', 'UT', '84341', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1154335651', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004088', 'W11004088', 'UTPEHP', 'Memorial Clinic', 'Louis', 'Frank', 'Bentley', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '2000 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8014647500', NULL, '2000 S 900 E', 'Salt Lake City', '', 'UT', '84105', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1265471429', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004089', 'W11004089', 'UTPEHP', 'River Road InstaCare', 'Nicholas', 'H', 'Bird', 'MD', 'Wound Care', 'Hyperbaric Medicine', 'Urgent Care', NULL, 'B', '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886300', NULL, '577 S River Rd', 'St George', '', 'UT', '84790', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1811092935', 0, 'N', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004090', 'W11004090', 'UTPEHP', 'Utah Valley Pulmonary Clinic', 'Clark', 'T', 'Bishop', 'MD', 'Pulmonary', NULL, NULL, NULL, 'O', '1055 N 300 W #500', 'Provo', 'Utah', 'UT', '84604', '8013577291', NULL, '1055 N 300 W', 'Provo', '', 'UT', '84604', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1841206844', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004091', 'W11004091', 'UTPEHP', 'Logan WorkMed', 'Theral', 'Michael', 'Bishop', 'MD', 'Urgent Care', '', '', NULL, 'O', '412 S 200 E', 'Logan', 'Cache', 'UT', '84321', '4357132850', NULL, '412 S 200 E', 'Logan', 'Cache', 'UT', '84321', '4357132850', '          ', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376584300', 0, 'Y', 0, '2012-12-11', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004092', 'W11004092', 'UTPEHP', 'IHC Bountiful Health Center', 'Craig', 'Dan', 'Black', 'MD', 'Pediatrics', '', '', NULL, 'O', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012941000', NULL, '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012941000', '          ', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679520035', 0, 'N', 0, '2011-11-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004093', 'W11004093', 'UTPEHP', 'North Sevier Medical Clinic', 'Kerry', 'A', 'Blackham', 'MD', 'Family Practice', '', '', NULL, 'O', '530 N 250 W', 'Salina', 'Sevier', 'UT', '84654', '4355297411', NULL, '530 N 250 W', 'Salina', 'Sevier', 'UT', '84654', '4355297411', '          ', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922014273', 0, 'Y', 0, '2013-10-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004094', 'W11004094', 'UTPEHP', 'Cardiovascular & Thoracic Surgery - St George', 'B', 'Jason', 'Bowles', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '1380 E Medical Ctr Dr Ste 2600', 'St George', 'Washington', 'UT', '84790', '4352512700', NULL, '1380 E Medical Center Dr #2600', 'St George', '', 'UT', '84790', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1114950714', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004095', 'W11004095', 'UTPEHP', 'Holladay Pediatrics', 'Mark', 'R', 'Briesacher', 'MD', 'Pediatrics', '', '', NULL, 'O', '2180 E 4500 S #210', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8019474242', NULL, '2180 E 4500 S #210', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8019474242', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154333029', 0, 'N', 0, '2012-06-01', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004096', 'W11004096', 'UTPEHP', 'Dixie Hospitalists', 'Norman', 'Jose', 'Brito-Dellan', 'MD', 'Internal Medicine', 'Hospitalist', '', NULL, 'O', '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886200', NULL, '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886200', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164409553', 0, 'N', 0, '2011-03-01', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004097', 'W11004097', 'UTPEHP', 'Cedar City InstaCare', 'David', 'M', 'Brooks', 'DO', 'Urgent Care', '', '', NULL, 'B', '962 S Sage Dr', 'Cedar City', 'Iron', 'UT', '84720', '4358653440', NULL, '962 S Sage Dr', 'Cedar City', 'Iron', 'UT', '84720', '4358653440', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Valley View Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1881617348', 0, 'N', 0, '2011-05-24', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004098', 'W11004098', 'UTPEHP', 'Sevier Valley Family Practice', 'Jeffrey', 'J', 'Brown', 'DO', 'Family Practice', '', '', NULL, 'O', '70 E 1100 N', 'Richfield', 'Sevier', 'UT', '84701', '4358968254', NULL, '70 E 1100 N', 'Richfield', 'Sevier', 'UT', '84701', '4358968254', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205840642', 0, 'N', 0, '2013-12-18', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004099', 'W11004099', 'UTPEHP', 'Budge Clinic Pediatrics', 'Nordell', 'T', 'Brown', 'MD', 'Pediatrics', 'Internal Medicine', NULL, NULL, 'O', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921940', NULL, '1350 N 500 E', 'Logan', '', 'UT', '84341', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1144234659', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004100', 'W11004100', 'UTPEHP', 'Fillmore Clinic', 'Wayne', 'O', 'Brown', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '700 S Hwy 99 #3', 'Fillmore', 'Millard', 'UT', '84631', '4357435555', NULL, '700 S Hwy 99', 'Fillmore', '', 'UT', '84631', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1003822909', 0, 'N', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004101', 'W11004101', 'UTPEHP', 'Cedar City Clinic', 'Clint', 'O', 'Bunker', 'DO', 'Family Practice', NULL, NULL, NULL, 'O', '1303 N Main #3C', 'Cedar City', 'Iron', 'UT', '84720', '4358685500', NULL, '1303 N Main', 'Cedar City', '', 'UT', '84720', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Valley View Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1306850011', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004102', 'W11004102', 'UTPEHP', 'Memorial Clinic', 'Mary', 'Dunson', 'Burton', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '2000 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8014647500', NULL, '2000 S 900 E', 'Salt Lake City', '', 'UT', '84105', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1235186511', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004103', 'W11004103', 'UTPEHP', 'River Road Family Practice', 'Larry', 'A', 'Cain', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886000', NULL, '577 S River Rd', 'St George', '', 'UT', '84790', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1972521201', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004104', 'W11004104', 'UTPEHP', 'South Cache Valley Clinic', 'Nathan', 'H', 'Call', 'MD', 'Family Practice', '', '', NULL, 'O', '190 S Hwy 165', 'Providence', 'Cache', 'UT', '84332', '4357553300', NULL, '190 S Hwy 165', 'Providence', '', 'UT', '84332', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1104830884', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004105', 'W11004105', 'UTPEHP', 'Budge Clinic Surgical Specialists', 'Michael', 'Scott', 'Callister', 'MD', 'Urology', '', '', NULL, 'O', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921950', NULL, '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921950', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1811038060', 0, 'N', 0, '2011-01-03', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004106', 'W11004106', 'UTPEHP', 'Bryner Clinic', 'Wayne', 'Hales', 'Cannon', 'MD', 'Pediatrics', '', '', NULL, 'O', '525 E 100 S # 500', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015197100', NULL, '525 E 100 S # 500', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015197100', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1881633428', 0, 'N', 0, '2013-05-30', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004107', 'W11004107', 'UTPEHP', 'Smithfield Family Practice', 'Brian', 'W', 'Carlson', 'MD', 'Family Practice', '', '', NULL, 'O', '291 S Main #D', 'Smithfield', 'Cache', 'UT', '84335', '4355633940', NULL, '291 S Main #D', 'Smithfield', '', 'UT', '84335', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1760498687', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004108', 'W11004108', 'UTPEHP', 'River Road InstaCare', 'Boyd', 'A', 'Carter', 'MD', 'Urgent Care', '', '', NULL, 'B', '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886300', NULL, '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886300', '          ', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1386667202', 0, 'Y', 0, '2011-04-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004109', 'W11004109', 'UTPEHP', 'Sunset InstaCare', 'Kristine', 'Rowe', 'Carter', 'APRN', 'Urgent Care', '', '', NULL, 'B', '1739 W Sunset Blvd', 'St George', 'Washington', 'UT', '84770', '4356346050', NULL, '1739 W Sunset Blvd ', 'St George', '', 'UT', '84770', '', '', 'PEHPMID', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1710937826', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004110', 'W11004110', 'UTPEHP', 'Logan InstaCare', 'David', 'N', 'Casey', 'DO', 'Urgent Care', '', '', NULL, 'B', '235 E 400 N', 'Logan', 'Cache', 'UT', '84321', '4357521010', NULL, '235 E 400 N', 'Logan', 'Cache', 'UT', '84321', '4357521010', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1093723835', 0, 'N', 0, '2010-06-24', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004111', 'W11004111', 'UTPEHP', 'Cedar City Clinic', 'Stephen', 'Chester', 'Castorino', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '1303 N Main #3C', 'Cedar City', 'Iron', 'UT', '84720', '4358685500', NULL, '1303 N Main', 'Cedar City', '', 'UT', '84720', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1942413315', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004112', 'W11004112', 'UTPEHP', 'Intermountain Womens Health Specialists', 'Robert', 'Wallace', 'Chalmers', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '346 E 600 S', 'St George', 'Washington', 'UT', '84770', '4356884600', NULL, '346 E 600 S', 'St George', 'Washington', 'UT', '84770', '4356884600', '', 'IHCPEHP', NULL, '', '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1114973708', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004113', 'W11004113', 'UTPEHP', 'Southwest Cardiology - St George', 'Keshav', '', 'Chander', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1380 E Medical Ctr Dr #1500', 'St George', 'Washington', 'UT', '84790', '4352512500', NULL, '1380 E Medical Ctr Dr #1500', 'St George', 'Washington', 'UT', '84790', '4352512500', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700816600', 0, 'N', 0, '2013-05-17', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004114', 'W11004114', 'UTPEHP', 'Ephraim Clinic', 'Tristy', 'L', 'Christensen', 'MD', 'Family Practice', '', '', NULL, 'O', '525 N Main', 'Ephraim', 'Sanpete', 'UT', '84627', '4352834076', NULL, '525 N Main', 'Ephraim', 'Sanpete', 'UT', '84627', '4352834076', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Sanpete Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1093753469', 0, 'N', 0, '2011-09-26', 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
('942854057', 'W11004115', 'W11004115', 'UTPEHP', 'Bear River Medical Clinic', 'Nichole', 'Michelle', 'Churchman', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '935 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '4352074800', NULL, '420 W 600 N', 'Tremonton', '', 'UT', '84337', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', '2008-10-24', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1700916095', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004116', 'W11004116', 'UTPEHP', 'Southwest Cardiology - St George', 'Bonnie', 'B', 'Clark', 'APRN', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '1380 E Medical Ctr Dr #1500', 'St George', 'Washington', 'UT', '84790', '4352512500', NULL, '1380 E Medical Center Dr #1500', 'St George', '', 'UT', '84790', '', '', 'PEHPMID', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1154355204', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004117', 'W11004117', 'UTPEHP', 'River Road Family Practice', 'Stephen', 'E', 'Clark', 'DO', 'Family Practice', NULL, NULL, NULL, 'O', '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886000', NULL, '577 S River Rd', 'St George', '', 'UT', '84790', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1043238363', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004118', 'W11004118', 'UTPEHP', 'Logan InstaCare', 'Thomas', 'H', 'Clark', 'MD', 'Family Practice', '', '', NULL, 'O', '235 E 400 N', 'Logan', 'Cache', 'UT', '84321', '4357521010', NULL, '235 E 400 N', 'Logan', 'Cache', 'UT', '84321', '4357521010', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1295741114', 0, 'N', 0, '2013-08-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004119', 'W11004119', 'UTPEHP', 'Budge Clinic Pediatrics', 'Derrel', 'Wolter', 'Clarke', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921940', NULL, '1350 N 500 E', 'Logan', '', 'UT', '84341', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1902812829', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004120', 'W11004120', 'UTPEHP', 'Mt Pleasant Clinic', 'Gary', 'Monroe', 'Cole', 'DO', 'Family Practice', '', '', NULL, 'O', '1100 S Medical Dr', 'Mt Pleasant', 'Sanpete', 'UT', '84647', '4354623471', NULL, '1100 S Medical Dr', 'Mt Pleasant', 'Sanpete', 'UT', '84647', '4354623471', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Sanpete Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1598705139', 0, 'N', 0, '2012-03-26', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004121', 'W11004121', 'UTPEHP', 'Mountain View Pediatrics', 'Mitzi', 'D', 'Conover', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '9720 S 1300 E #100', 'Sandy', 'Salt Lake', 'UT', '84094', '8015718550', NULL, '9720 S 1300 E', 'Sandy', '', 'UT', '84094', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1225056013', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004122', 'W11004122', 'UTPEHP', 'Cedar City Clinic', 'Robert', 'D', 'Corry', 'MD', 'Family Practice', '', '', NULL, 'O', '1303 N Main #3C', 'Cedar City', 'Iron', 'UT', '84720', '4358685500', NULL, '1303 N Main #3C', 'Cedar City', 'Iron', 'UT', '84720', '4358685500', '', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Valley View Medical Center', '', '', '', 'HCFA|UB|', '1952324410', 0, 'N', 0, '2014-05-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004123', 'W11004123', 'UTPEHP', 'Logan InstaCare ', 'James', 'S', 'Coy', 'MD', 'Family Practice', 'Urgent Care', NULL, NULL, 'B', '235 E 400 N', 'Logan', 'Cache', 'UT', '84321', '4357521010', NULL, '235 E 400 N', 'Logan', '', 'UT', '84321', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1174555320', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004124', 'W11004124', 'UTPEHP', 'Budge Clinic Obstetrics & Gynecology', 'Kristin', 'F', 'Craig', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '1400 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357161920', NULL, '500 E 1400 N', 'Logan', '', 'UT', '84341', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1225043995', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004125', 'W11004125', 'UTPEHP', 'Sevier Valley Family Practice', 'David', 'Ray', 'Crimin', 'DO', 'Family Practice', '', '', NULL, 'O', '70 E 1100 N', 'Richfield', 'Sevier', 'UT', '84701', '4358968254', NULL, '70 E 1100 N', 'Richfield', 'Sevier', 'UT', '84701', '4358968254', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225044431', 0, 'N', 0, '2013-12-18', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004126', 'W11004126', 'UTPEHP', 'Dixie Hospitalists', 'Kathleen', 'M', 'Daly', 'MD', 'Urgent Care', NULL, NULL, NULL, 'O', '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886200', NULL, '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886200', '          ', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063403723', 0, 'Y', 0, '2012-05-02', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004127', 'W11004127', 'UTPEHP', 'Utah Valley Heart & Lung Surgical Associates', 'James', 'T', 'Dane', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1055 N 300 W Ste 410', 'Provo', 'Utah', 'UT', '84604', '8013577081', NULL, '1055 N 300 W Ste 410', 'Provo', 'Utah', 'UT', '84604', '8013577081', '', 'IHCPEHP', NULL, '', '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083629828', 0, 'N', 0, '2014-06-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004128', 'W11004128', 'UTPEHP', 'Pulmonary Medicine Clinic - St George', 'Samuel', 'Kwame', 'Dartey-Hayford', 'MD', 'Pulmonary', NULL, NULL, NULL, 'O', '1380 E Medical Center Dr #1400', 'St George', 'Washington', 'UT', '84790', '4352512600', NULL, '1380 E Medical Center Dr #1400', 'St George', '', 'UT', '84790', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', '2009-08-27', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1437129285', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004129', 'W11004129', 'UTPEHP', 'River Road InstaCare', 'Daniel', '', 'Davie', 'MD', 'Urgent Care', '', '', NULL, 'B', '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886300', NULL, '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886300', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356376677', 0, 'N', 0, '2010-06-24', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004130', 'W11004130', 'UTPEHP', 'Mt Pleasant Clinic', 'Allen', 'M', 'Day', 'MD', 'Family Practice', '', '', NULL, 'O', '1100 S Medical Dr', 'Mt Pleasant', 'Sanpete', 'UT', '84647', '4354623471', NULL, '1100 S Medical Dr', 'Mt Pleasant', 'Sanpete', 'UT', '84647', '4354623471', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Sanpete Valley Hospital', '', '', '', 'HCFA|UB|', '1518908110', 0, 'N', 0, '2013-04-15', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004131', 'W11004131', 'UTPEHP', 'Memorial Clinic', 'Roland', 'P', 'Dimick', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '2000 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8014647500', NULL, '2000 S 900 E', 'Salt Lake City', '', 'UT', '84105', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1932153145', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004132', 'W11004132', 'UTPEHP', 'DRMC Radiation Oncology', 'Craig', 'W', 'Donaldson', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884175', NULL, '544 S 400 E', 'St George', '', 'UT', '84770', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Valley View Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1295753325', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004133', 'W11004133', 'UTPEHP', 'Southridge Clinic', 'John', 'T', 'Duffy', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '3723 W 12600 S Ste 450', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854543', NULL, '3859 W 12600 S', 'Riverton', '', 'UT', '84065', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1376654285', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004134', 'W11004134', 'UTPEHP', 'Hurricane Valley InstaCare', 'Clifford', 'Vernor', 'Dunn', 'MD', 'Urgent Care', '', '', NULL, 'B', '75 N 2260 W', 'Hurricane', 'Washington', 'UT', '84737', '4356356550', NULL, '75 N 2260 W', 'Hurricane', 'Washington', 'UT', '84737', '4356356550', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1548468036', 0, 'N', 0, '2012-12-31', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004135', 'W11004135', 'UTPEHP', 'Bryner Clinic', 'George', 'Homer', 'Durham', 'MD', 'Pediatrics', '', '', NULL, 'O', '525 E 100 S # 500', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015197100', NULL, '525 E 100 S # 500', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015197100', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205880499', 0, 'N', 0, '2013-08-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004136', 'W11004136', 'UTPEHP', 'Hurricane Valley Clinic', 'Penny', 'Ann', 'Emett', 'APRN', 'Family Practice', NULL, NULL, NULL, 'O', '75 N 2260 W', 'Hurricane', 'Washington', 'UT', '84737', '4356356400', NULL, '75 N 2260 W', 'Hurricane ', '', 'UT', '84737', '', '', 'PEHPMID', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1417978917', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004137', 'W11004137', 'UTPEHP', 'Mountain View Pediatrics', 'Jeffrey', 'Gus', 'Erickson', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '9720 S 1300 E #100', 'Sandy', 'Salt Lake', 'UT', '84094', '8015718550', NULL, '9720 S 1300 E', 'Sandy', '', 'UT', '84094', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1902850894', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004138', 'W11004138', 'UTPEHP', 'Southridge Clinic', 'Kristina', 'E', 'Esham', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '3723 W 12600 S Ste 450', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854543', NULL, '3859 W 12600 S', 'Riverton', '', 'UT', '84065', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1164533071', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004139', 'W11004139', 'UTPEHP', 'Logan InstaCare ', 'Douglas', 'N', 'Esplin', 'MD', 'Urgent Care', NULL, NULL, NULL, 'B', '235 E 400 N', 'Logan', 'Cache', 'UT', '84321', '4357521010', NULL, '235 E 400 N', 'Logan', '', 'UT', '84321', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1063421451', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004140', 'W11004140', 'UTPEHP', 'Intermountain Womens Health Specialists', 'Robert', 'J', 'Fagnant', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '346 E 600 S', 'St George', 'Washington', 'UT', '84770', '4356884600', NULL, '346 E 600 S', 'St George', 'Washington', 'UT', '84770', '4356884600', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1093734360', 0, 'N', 0, '2012-09-06', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004141', 'W11004141', 'UTPEHP', 'Budge Clinic Obstetrics & Gynecology', 'Jeanette', 'M', 'Falk', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '1400 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357161920', NULL, '500 E 1400 N', 'Logan', '', 'UT', '84341', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', '2008-09-05', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1588673974', 0, 'N', 0, '2009-10-26', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004142', 'W11004142', 'UTPEHP', 'Holladay Pediatrics', 'Paul', 'J', 'Ferreira', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '2180 E 4500 S #210', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8019474242', NULL, '2180 E 4500 S', 'Salt Lake City', '', 'UT', '84117', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1679585541', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004143', 'W11004143', 'UTPEHP', 'Budge Clinic Pediatrics', 'Clinton', 'E', 'Field', 'PhD', 'Mental Health', 'Psychology', '', NULL, 'O', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921940', NULL, '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921940', '', 'PEHPPHD', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1467656900', 0, 'N', 0, '2012-07-02', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004144', 'W11004144', 'UTPEHP', 'South Cache Valley Clinic', 'R', 'Mark', 'Firth', 'MD', 'Family Practice', 'Emergency Medicine', '', NULL, 'O', '190 S Hwy 165', 'Providence', 'Cache', 'UT', '84332', '4357553300', NULL, '190 S Hwy 165', 'Providence', 'Cache', 'UT', '84332', '4357553300', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1477562767', 0, 'N', 0, '2010-11-04', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004145', 'W11004145', 'UTPEHP', 'Mountain View Pediatrics', 'David', 'S', 'Folland', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '9720 S 1300 E #100', 'Sandy', 'Salt Lake', 'UT', '84094', '8015718550', NULL, '9720 S 1300 E', 'Sandy', '', 'UT', '84094', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', '2009-09-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1528080959', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004146', 'W11004146', 'UTPEHP', 'Dixie Hospitalists', 'Christine', 'Kay', 'Foster', 'MD', 'Hospitalist', '', '', NULL, 'O', '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886200', NULL, '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886200', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205875747', 0, 'N', 0, '2013-01-09', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004147', 'W11004147', 'UTPEHP', 'Southwest Cardiology - St George', 'Steven', 'R', 'Fowler', 'PA', 'Sleep Disorders', '', '', NULL, 'O', '1380 E Medical Center Dr #1500', 'St George', 'Washington', 'UT', '84790', '4352512500', NULL, '1380 E Medical Center Dr #1500', 'St George', 'Washington', 'UT', '84790', '4352512500', '', 'PEHPMID', '', '', '0.00', '30.00', '0.00', 8, '2008-04-01', '2012-02-17', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508817628', 0, 'N', 0, '2014-07-10', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004148', 'W11004148', 'UTPEHP', 'Bryner Clinic', 'Jesse', 'Neve', 'Fox', 'MD', 'Pediatrics', '', '', NULL, 'O', '525 E 100 S # 500', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015197100', NULL, '525 E 100 S # 500', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015197100', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750329934', 0, 'N', 0, '2013-05-30', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004149', 'W11004149', 'UTPEHP', 'River Road InstaCare', 'Robert', 'A', 'Frampton', 'MD', 'Family Practice', '', '', NULL, 'B', '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886300', NULL, '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886300', '          ', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1013002898', 0, 'Y', 0, '2012-05-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004150', 'W11004150', 'UTPEHP', 'Manti Family Clinic', 'Michael', 'S', 'Frischknecht', 'MD', 'Family Practice', '', '', NULL, 'O', '159 N Main', 'Manti', 'Sanpete', 'UT', '84642', '4358353344', NULL, '159 N Main', 'Manti', 'Sanpete', 'UT', '84642', '4358353344', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Sanpete Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1629019229', 0, 'N', 0, '2013-11-18', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004151', 'W11004151', 'UTPEHP', 'Bryner Clinic', 'Arthur', 'Y', 'Gardiner', 'MD', 'Pediatrics', '', '', NULL, 'O', '525 E 100 S # 500', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015197100', NULL, '525 E 100 S # 500', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015197100', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528015948', 0, 'N', 0, '2013-05-30', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004152', 'W11004152', 'UTPEHP', 'Canyon View Family Practice', 'Ellen', 'F', 'Gardner', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '15 E 400 N', 'Parowan', 'Iron', 'UT', '84761', '4354773317', NULL, '15 E 400 N', 'Parowan', 'Iron', 'UT', '84761', '4354773317', '          ', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2008-04-01', '2011-08-31', 0, 0, 0, 'Valley View Medical Center', '', '', '', 'HCFA|UB|', '1013939024', 0, 'N', 0, '2011-11-10', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004153', 'W11004153', 'UTPEHP', 'Budge Clinic GI', 'Vikram', NULL, 'Garg', 'MD', 'Gastroenterology', NULL, NULL, NULL, 'O', '1300 N 500 E #340', 'Logan', 'Cache', 'UT', '84341', '4357165900', NULL, '1300 N 500 E #340', 'Logan', '', 'UT', '84341', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1760491054', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004154', 'W11004154', 'UTPEHP', 'Cedar City Clinic', 'Daren', 'O', 'Gatherum', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1303 N Main #3C', 'Cedar City', 'Iron', 'UT', '84720', '4358685500', NULL, '1303 N Main #3C', 'Cedar City', '', 'UT', '84720', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, NULL, 0, 0, 'Valley View Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1770504284', 0, 'N', 0, '2010-04-23', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004155', 'W11004155', 'UTPEHP', 'Mountain View Pediatrics', 'Kim', 'J', 'Gehle', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '9720 S 1300 E #100', 'Sandy', 'Salt Lake', 'UT', '84094', '8015718550', NULL, '9720 S 1300 E #100', 'Sandy', '', 'UT', '84094', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1760400592', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004156', 'W11004156', 'UTPEHP', 'Cardiovascular & Thoracic Surgery - St George', 'Trevor', 'Michael', 'Gerber', 'PA', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '1380 E Medical Ctr Dr #2600', 'St George', 'Washington', 'UT', '84790', '4352512700', NULL, '1380 E Medical Center Dr #2600', 'St George', '', 'UT', '84790', '', '', 'PEHPMID', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1083632335', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004157', 'W11004157', 'UTPEHP', 'Sunset Family Practice', 'William', 'P', 'Goodger', 'MD', 'Hospitalist', '', '', NULL, 'O', '1739 W Sunset Blvd', 'St George', 'Washington', 'UT', '84770', '4356346000', NULL, '1739 W Sunset Blvd', 'St George', 'Washington', 'UT', '84770', '4356346000', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1104833987', 0, 'N', 0, '2011-09-26', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004158', 'W11004158', 'UTPEHP', 'Cardiovascular & Thoracic Surgery - St George', 'Paul', 'Wallace', 'Goodrich', 'PA', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '1380 E Medical Ctr Dr #2600', 'St George', 'Washington', 'UT', '84790', '4352512700', NULL, '1380 E Medical Center Dr #2600', 'St George', '', 'UT', '84790', '', '', 'PEHPMID', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1942234976', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004159', 'W11004159', 'UTPEHP', 'Richfield Family Practice', 'Mark', 'Robert', 'Greenwood', 'MD', 'Family Practice', 'Urgent Care', '', NULL, 'O', '460 N Main', 'Richfield', 'Sevier', 'UT', '84701', '4358965496', NULL, '460 N Main', 'Richfield', 'Sevier', 'UT', '84701', '4358965496', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083620298', 0, 'N', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004160', 'W11004160', 'UTPEHP', 'Richfield Family Practice', 'Mark', 'William', 'Greenwood', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '460 N Main', 'Richfield', 'Sevier', 'UT', '84701', '4358965496', NULL, '460 N Main', 'Richfield', '', 'UT', '84701', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1164437067', 0, 'N', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004161', 'W11004161', 'UTPEHP', 'Fillmore Clinic', 'Craig', 'M', 'Grose', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '700 S Hwy 99 #3', 'Fillmore', 'Millard', 'UT', '84631', '4357435555', NULL, '700 S Hwy 99 #3', 'Fillmore', '', 'UT', '84631', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1003854878', 0, 'N', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004162', 'W11004162', 'UTPEHP', 'Zion Orthopaedics & Sports Medicine', 'K', 'C', 'Hafen', 'PA', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '652 S Medical Ctr Rd Ste 400', 'St George', 'Washington', 'UT', '84790', '4352512650', NULL, '1380 E Medical Center Dr #2100', 'St George', '', 'UT', '84790', '', '', 'PEHPMID', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1194740522', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004163', 'W11004163', 'UTPEHP', 'River Road Internal Medicine', 'Jerold', 'L', 'Hagen', 'MD', 'Internal Medicine', '', '', NULL, 'O', '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886200', NULL, '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886200', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639102635', 0, 'N', 0, '2013-07-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004164', 'W11004164', 'UTPEHP', 'Ephraim Clinic', 'T', 'Randy', 'Hansen', 'MD', 'General Surgery', '', '', NULL, 'O', '525 N Main', 'Ephraim', 'Sanpete', 'UT', '84627', '4352834076', NULL, '525 N Main', 'Ephraim', 'Sanpete', 'UT', '84627', '4352834076', '', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2008-04-01', '2009-02-25', 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB|', '1861433443', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004165', 'W11004165', 'UTPEHP', 'Budge Clinic Surgical Specialists', 'David', 'L', 'Harker', 'MD', 'General Surgery', '', '', NULL, 'O', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921950', NULL, '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921950', '          ', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1710996020', 0, 'N', 0, '2012-02-29', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004166', 'W11004166', 'UTPEHP', 'Budge Clinic Internal Medicine', 'Charlotte', NULL, 'Harris', 'APRN', 'Mental Health', NULL, NULL, NULL, 'O', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921980', NULL, '1350 N 500 E', 'Logan', '', 'UT', '84341', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1801981113', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004167', 'W11004167', 'UTPEHP', 'Summit Clinic', 'Gary', 'Lee', 'Harris', 'MD', 'Family Practice', '', '', NULL, 'O', '502 S Main', 'Smithfield', 'Cache', 'UT', '84335', '4355633222', NULL, '502 S Main', 'Smithfield', 'Cache', 'UT', '84335', '4355633222', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1154330462', 0, 'N', 0, '2011-04-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004168', 'W11004168', 'UTPEHP', 'Memorial Clinic', 'Kevin', 'L', 'Havlik', 'MD', 'Pediatrics', '', '', NULL, 'O', '2000 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8014647500', NULL, '2000 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8014647500', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, NULL, 'Primary Childrens Medical Center', NULL, '', 'HCFA|UB|', '1558315796', 0, 'N', 0, '2013-05-17', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004169', 'W11004169', 'UTPEHP', 'Cedar City InstaCare', 'Anne', 'M', 'Hawkins', 'MD', 'Urgent Care', '', '', NULL, 'B', '962 S Sage Dr', 'Cedar City', 'Iron', 'UT', '84720', '4358653440', NULL, '962 S Sage Dr', 'Cedar City', '', 'UT', '84720', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1801845755', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004170', 'W11004170', 'UTPEHP', 'Cedar City WorkMed', 'Kimberly', 'D', 'Haycock', 'PA-C', 'Family Practice', 'Occupational Therapy', '', NULL, 'O', '962 S Sage Dr', 'Cedar City', 'Iron', 'UT', '84720', '4358653460', NULL, '962 S Sage Dr', 'Cedar City', 'Iron', 'UT', '84720', '4358653460', '', 'PEHPMID', NULL, '', '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205862208', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004171', 'W11004171', 'UTPEHP', 'Cedar City Clinic', 'Bruce', 'A', 'Hendrix', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1303 N Main #3C', 'Cedar City', 'Iron', 'UT', '84720', '4358685500', NULL, '1303 N Main #3C', 'Cedar City', 'Iron', 'UT', '84720', '4358685500', '', 'IHCPEHP', NULL, '', '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Valley View Medical Center', '', '', '', 'HCFA|UB|', '1336153030', 0, 'N', 0, '2014-06-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004172', 'W11004172', 'UTPEHP', 'Snow College Clinic', 'Barbara', 'L', 'Hennagir', 'PA-C', 'Family Practice', '', '', NULL, 'O', '150 E College Ave', 'Ephraim', 'Sanpete', 'UT', '84627', '4352837216', NULL, '150 E College Ave', 'Ephraim', 'Sanpete', 'UT', '84627', '4352837216', '', 'PEHPMID', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538215181', 0, 'N', 0, '2011-09-26', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004173', 'W11004173', 'UTPEHP', 'Cedar City WorkMed', 'Erica', 'R', 'Hensman', 'PA', 'Occupational Therapy', '', '', NULL, 'O', '962 S Sage Dr', 'Cedar City', 'Iron', 'UT', '84720', '4358653460', NULL, '962 S Sage Dr', 'Cedar City', 'Iron', 'UT', '84720', '4358653460', '', 'PEHPMID', NULL, '', '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1649287905', 0, 'N', 0, '2014-06-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004174', 'W11004174', 'UTPEHP', 'Canyon View Orthopedics & Podiatry Associates ', 'Thomas', 'O', 'Higginbotham', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1300 N 500 E #130', 'Logan', 'Cache', 'UT', '84341', '4357162800', NULL, '1300 N 500 E #130', 'Logan', '', 'UT', '84341', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1588673800', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004175', 'W11004175', 'UTPEHP', 'Utah Valley Pulmonary Clinic', 'Tracy', 'Arnold', 'Hill', 'MD', 'Pulmonary', NULL, NULL, NULL, 'O', '1055 N 300 W #500', 'Provo', 'Utah', 'UT', '84604', '8013577291', NULL, '1055 N 300 W #500', 'Provo', '', 'UT', '84604', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1992711253', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004176', 'W11004176', 'UTPEHP', 'Bryner Clinic', 'Laurie', 'Lynne', 'Hilyer', 'MD', 'Pediatrics', '', '', NULL, 'O', '525 E 100 S # 500', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015197100', NULL, '525 E 100 S # 500', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015197100', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326093758', 0, 'N', 0, '2013-05-30', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004177', 'W11004177', 'UTPEHP', 'Pulmonary Medicine Clinic - St George', 'Terri', 'L', 'Hoffman', 'MD', 'Internal Medicine', 'Pulmonology', '', NULL, 'O', '1380 E Medical Center Dr #1400', 'St George', 'Washington', 'UT', '84790', '4352512600', NULL, '1380 E Medical Center Dr #1400', 'St George', 'Washington', 'UT', '84790', '4352512600', '          ', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2008-04-01', '2008-06-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871512137', 0, 'N', 0, '2012-03-26', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004178', 'W11004178', 'UTPEHP', 'Canyon View Orthopedics & Podiatry Associates ', 'Eric', 'Wayne', 'Hooley', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '1300 N 500 E #130', 'Logan', 'Cache', 'UT', '84341', '4357162800', NULL, '1300 N 500 E #130', 'Logan', '', 'UT', '84341', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1548230014', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004179', 'W11004179', 'UTPEHP', 'Budge Clinic Pediatrics', 'Tyson', 'Stuart', 'Horkley', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921940', NULL, '1350 N 500 E', 'Logan', '', 'UT', '84341', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1023150851', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004180', 'W11004180', 'UTPEHP', 'Budge Clinic Obstetrics & Gynecology', 'Ernest', 'Brett', 'Horsley', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1400 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357161920', NULL, '500 E 1400 N', 'Logan', '', 'UT', '84341', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, NULL, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1003826439', 0, 'N', 0, '2010-04-23', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004181', 'W11004181', 'UTPEHP', 'Logan WorkMed', 'Michael', 'C', 'Housley', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '1400 N 500 E', 'Logan', 'Cache', 'UT', '84321', '4357132850', NULL, '500 E 1400 N', 'Logan', '', 'UT', '84341', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1295744522', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004182', 'W11004182', 'UTPEHP', 'Logan InstaCare ', 'Karri', NULL, 'Hoyt', 'PA', 'Urgent Care', NULL, NULL, NULL, 'B', '235 E 400 N', 'Logan', 'Cache', 'UT', '84321', '4357521010', NULL, '235 E 400 N', 'Logan', '', 'UT', '84321', '', '', 'PEHPMID', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1659381085', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004183', 'W11004183', 'UTPEHP', 'Budge Clinic Internal Medicine', 'Jeffrey', 'Mark', 'Huffman', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921980', NULL, '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921980', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1760492219', 0, 'N', 0, '2013-12-30', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004184', 'W11004184', 'UTPEHP', 'Tremonton Clinic', 'Melanie', 'C', 'Hughes', 'APRN', 'Family Practice', '', '', NULL, 'O', '935 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '4352074800', '', '935 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '4352074800', '', 'PEHPMID', '', '', '0.00', '30.00', '0.00', 8, '2008-04-01', '2011-01-31', 0, 0, 0, 'Bear River Valley Hospital', '', '', '', 'HCFA|UB|', '1417945023', 0, 'N', 0, '2014-07-24', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004185', 'W11004185', 'UTPEHP', 'Canyon View Orthopedics & Podiatry Associates', 'W', 'Scott', 'Hunt', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '1300 N 500 E #130', 'Logan', 'Cache', 'UT', '84341', '4357162800', NULL, '1300 N 500 E #130', 'Logan', 'Cache', 'UT', '84341', '4357162800', '', 'PEHPMID', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1871503201', 0, 'N', 0, '2011-05-24', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004186', 'W11004186', 'UTPEHP', 'DRMC Radiation Oncology', 'Christian', 'Cooper', 'Hyde', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884175', NULL, '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884175', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316972086', 0, 'N', 0, '2012-09-10', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004187', 'W11004187', 'UTPEHP', 'Cache Valley Family Practice', 'Douglas', 'R', 'Hyldahl', 'MD', 'Family Practice', '', '', NULL, 'O', '412 N 200 E', 'Logan', 'Cache', 'UT', '84321', '4357132800', NULL, '412 N 200 E', 'Logan', 'Cache', 'UT', '84321', '4357132800', '', 'IHCPEHP', NULL, '', '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1083624555', 0, 'N', 0, '2014-06-30', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004188', 'W11004188', 'UTPEHP', 'Isom Plastic Surgery', 'Casey', 'N', 'Isom', 'MD', 'Plastic Surgery', '', '', NULL, 'O', '1350 N 500 E Ste 310', 'Logan', 'Cache', 'UT', '84341', '4357871108', NULL, '1350 N 500 E Ste 310', 'Logan', 'Cache', 'UT', '84341', '4357871108', '          ', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1215964275', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004189', 'W11004189', 'UTPEHP', 'Fillmore Clinic', 'Brent', 'D', 'Jackson', 'MD', 'Family Practice', '', '', NULL, 'O', '700 S Hwy 99 #3', 'Fillmore', 'Millard', 'UT', '84631', '4357435555', NULL, '700 S Hwy 99 #3', 'Fillmore', 'Millard', 'UT', '84631', '4357435555', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962418210', 0, 'N', 0, '2013-05-30', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004190', 'W11004190', 'UTPEHP', 'Ephraim Clinic', 'Eileen', 'K', 'Jackson', 'MD', 'Family Practice', '', '', NULL, 'O', '525 N Main', 'Ephraim', 'Sanpete', 'UT', '84627', '4352834076', NULL, '525 N Main', 'Ephraim', 'Sanpete', 'UT', '84627', '4352834076', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Sanpete Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1518906320', 0, 'N', 0, '2011-09-26', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004191', 'W11004191', 'UTPEHP', 'Mountain View Pediatrics', 'Karen', 'Edith', 'Jackson', 'APRN', 'Pediatrics', NULL, NULL, NULL, 'O', '9720 S 1300 E #100', 'Sandy', 'Salt Lake', 'UT', '84094', '8015718550', NULL, '9720 S 1300 E #100', 'Sandy', '', 'UT', '84094', '', '', 'PEHPMID', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1174545503', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004192', 'W11004192', 'UTPEHP', 'Mountain View Pediatrics', 'Richard', 'L', 'Jackson', 'MD', 'Pediatrics', '', '', NULL, 'O', '9720 S 1300 E #100', 'Sandy', 'Salt Lake', 'UT', '84094', '8015718550', NULL, '9720 S 1300 E #100', 'Sandy', 'Salt Lake', 'UT', '84094', '8015718550', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'St Marks Hospital', 'Jordan Valley Medical Center', '', '', 'HCFA|UB|', '1295780559', 0, 'N', 0, '2013-08-22', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004193', 'W11004193', 'UTPEHP', 'Pulmonary Medicine Clinic - St George', 'Charlie', 'R', 'Jacques', 'APRN', 'Mental Health', 'Advanced Practice Registered Nurse', 'Pulmonary', NULL, 'O', '1380 E Medical Ctr Dr #1400', 'St George', 'Washington', 'UT', '84790', '4352512600', NULL, '1380 E Medical Ctr Dr #1400', 'St George', 'Washington', 'UT', '84790', '4352512600', '', 'PEHPMID', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1336162890', 0, 'N', 0, '2013-09-05', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004194', 'W11004194', 'UTPEHP', 'Southwest Cardiology - St George', 'John', 'H', 'Jentzer', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1380 E Medical Center Dr #1500', 'St George', 'Washington', 'UT', '84790', '4352512500', NULL, '1380 E Medical Center Dr #1500', 'St George', 'Washington', 'UT', '84790', '4352512500', '          ', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2008-04-01', '2011-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366413924', 0, 'N', 0, '2012-04-10', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004195', 'W11004195', 'UTPEHP', 'Zion Orthopaedics & Sports Medicine', 'David', 'S', 'Jevsevar', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '652 S Medical Ctr Rd Ste 400', 'St George', 'Washington', 'UT', '84790', '4352512650', NULL, '1380 E Medical Center Dr #2100', 'St George', '', 'UT', '84790', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1760407183', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004196', 'W11004196', 'UTPEHP', 'Redrock Pediatrics', 'Amanda', 'Melanie', 'Jocelyn', 'APRN', 'Pediatrics', NULL, NULL, NULL, 'O', '1380 E Medical Ctr Dr #3100', 'St George', 'Washington', 'UT', '84790', '4352512740', NULL, '1380 E Medical Center Dr #3100', 'St George', '', 'UT', '84790', '', '', 'PEHPMID', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1376739102', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004197', 'W11004197', 'UTPEHP', 'Cedar City WorkMed', 'Dayne', '', 'Johnson', 'PA-C', 'Pain Management', '', '', NULL, 'O', '962 S Sage Dr', 'Cedar City', 'Iron', 'UT', '84720', '4358653460', NULL, '962 S Sage Dr', 'Cedar City', 'Iron', 'UT', '84720', '4358653460', '', 'PEHPMID', NULL, '', '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669505178', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004198', 'W11004198', 'UTPEHP', 'Cache Valley Family Practice', 'Patricia', 'Suzanne', 'Jones', 'PA', 'Family Practice', NULL, NULL, NULL, 'O', '412 N 200 E', 'Logan', 'Cache', 'UT', '84321', '4357132800', NULL, '550 E 1400 N #X', 'Logan', '', 'UT', '84341', '', '', 'PEHPMID', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1508876079', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004199', 'W11004199', 'UTPEHP', 'River Road Internal Medicine', 'Thomas', 'K', 'Jones', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886200', NULL, '577 S River Rd', 'St George', '', 'UT', '84790', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1861410276', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004200', 'W11004200', 'UTPEHP', 'Redrock Pediatrics', 'Rajiv', 'J', 'Kaddu', 'MD', 'Pediatrics', 'Pediatric Gastroenterology', '', NULL, 'O', '1380 E Medical Ctr Dr #3100', 'St George', 'Washington', 'UT', '84790', '4352512740', NULL, '1380 E Medical Center Dr #3100', 'St George', 'Washington', 'UT', '84790', '4352512740', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1275566291', 0, 'N', 0, '2011-09-26', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004201', 'W11004201', 'UTPEHP', 'Budge Clinic Surgical Specialists', 'Jeffrey', 'S', 'Keyser', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921950', NULL, '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921950', '', 'IHCPEHP', NULL, '', '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1588674055', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004202', 'W11004202', 'UTPEHP', 'Cardiovascular & Thoracic Surgery - St George', 'Michael', 'David', 'Khoury', 'MD', 'Vascular Surgery', NULL, NULL, NULL, 'O', '1380 E Medical Ctr Dr #2600', 'St George', 'Washington', 'UT', '84790', '4352512700', NULL, '1380 E Medical Center Dr #2600', 'St George', '', 'UT', '84790', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1992792659', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004203', 'W11004203', 'UTPEHP', 'Canyon View Orthopedics & Podiatry Associates ', 'Bryan', 'C', 'King', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '1300 N 500 E #130', 'Logan', 'Cache', 'UT', '84341', '4357162800', NULL, '1300 N 500 E #130', 'Logan', '', 'UT', '84341', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1194735670', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004204', 'W11004204', 'UTPEHP', 'Logan InstaCare', 'Kurt', 'V', 'King', 'MD', 'Internal Medicine', 'Emergency Medicine', '', NULL, 'B', '235 E 400 N', 'Logan', 'Cache', 'UT', '84321', '4357521010', NULL, '235 E 400 N', 'Logan', 'Cache', 'UT', '84321', '4357521010', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1649267949', 0, 'N', 0, '2013-08-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004205', 'W11004205', 'UTPEHP', 'Pulmonary Medicine Clinic - St George', 'Michael', 'R', 'Kline', 'MD', 'Pulmonary', 'Family Practice', 'Internal Medicine', NULL, 'O', '1380 E Medical Ctr Dr #1400', 'St George', 'Washington', 'UT', '84790', '4352512600', NULL, '1380 E Medical Ctr Dr #1400', 'St George', 'Washington', 'UT', '84790', '4352512600', '', 'IHCPEHP', NULL, '', '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1073531331', 0, 'N', 0, '2014-06-17', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004206', 'W11004206', 'UTPEHP', 'Dixie Plastic & Reconstructive Surgery', 'Aaron', 'O', 'Klomp', 'MD', 'Plastic Surgery', NULL, NULL, NULL, 'O', '652 S Medical Ctr Dr Ste 300', 'St George', 'Washington', 'UT', '84770', '4352513670', NULL, '348 E 600 S', 'St George', '', 'UT', '84770', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1588611602', 0, 'N', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004207', 'W11004207', 'UTPEHP', 'Logan InstaCare', 'April', 'L', 'Larkin', 'MD', 'Urgent Care', '', '', NULL, 'B', '235 E 400 N', 'Logan', 'Cache', 'UT', '84321', '4357521010', NULL, '235 E 400 N', 'Logan', 'Cache', 'UT', '84321', '4357521010', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1518971134', 0, 'N', 0, '2013-08-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004208', 'W11004208', 'UTPEHP', 'Hurricane Valley Clinic', 'George', 'Gregory', 'Last', 'MD', 'Family Practice', '', '', NULL, 'O', '75 N 2260 W', 'Hurricane', 'Washington', 'UT', '84737', '4356356400', NULL, '75 N 2260 W', 'Hurricane', 'Washington', 'UT', '84737', '4356356400', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1235150731', 0, 'N', 0, '2013-12-30', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004209', 'W11004209', 'UTPEHP', 'Dixie Orthopaedics', 'Zachary', 'R', 'Leitze', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '652 S Medical Ctr Dr Ste 120', 'St George', 'Washington', 'UT', '84790', '4356284460', NULL, '652 S Medical Center Dr Ste 120', 'St George', 'Washington', 'UT', '84790', '4356284460', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053341115', 0, 'N', 0, '2010-06-25', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004210', 'W11004210', 'UTPEHP', 'Southwest Regional Cancer Clinic', 'Robert', 'H', 'Lemon', 'MD', 'Oncology', 'Hematology and Oncology', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356349850', NULL, '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356349850', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992867147', 0, 'N', 0, '2013-04-25', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004211', 'W11004211', 'UTPEHP', 'Memorial Clinic', 'Peter', 'C', 'Lindgren', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '2000 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8014647500', NULL, '2000 S 900 E', 'Salt Lake City', '', 'UT', '84105', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1255370961', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004212', 'W11004212', 'UTPEHP', 'Canyon View Family Practice', 'Donna', 'J', 'Lister', 'APRN', 'Family Practice', NULL, NULL, NULL, 'O', '15 E 400 N', 'Parowan', 'Iron', 'UT', '84761', '4354773317', NULL, '15 E 400 N', 'Parowan', '', 'UT', '84761', '', '', 'PEHPMID', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Valley View Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1104848118', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('942854057', 'W11004213', 'W11004213', 'UTPEHP', 'Hillcrest Pediatrics', 'Kristin', 'A', 'Lynch', 'MD', 'Pediatrics', '', '', NULL, 'O', '5063 S Cottonwood St #160', 'Murray', 'Salt Lake', 'UT', '84107', '8015071850', NULL, '5063 S Cottonwood St #160', 'Murray', 'Salt Lake', 'UT', '84107', '8015071850', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588602320', 0, 'N', 0, '2010-10-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004214', 'W11004214', 'UTPEHP', 'Canyon View Orthopedics & Podiatry Associates', 'Trek', 'Daniel', 'Lyons', 'MD', 'Sports Medicine', '', '', NULL, 'O', '1300 N 500 E #130', 'Logan', 'Cache', 'UT', '84341', '4357162800', NULL, '1300 N 500 E #130', 'Logan', 'Cache', 'UT', '84341', '4357162800', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1043210248', 0, 'N', 0, '2011-11-02', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004215', 'W11004215', 'UTPEHP', 'River Road Internal Medicine', 'Renu', NULL, 'Mahajan', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886200', NULL, '577 S River Rd', 'St George', '', 'UT', '84790', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1609809607', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004216', 'W11004216', 'UTPEHP', 'Southern Utah Behavioral Health', 'Mark', 'E', 'Manley', 'MD', 'Mental Health', '', '', NULL, 'O', '1054 E Riverside Dr #202', 'St George', 'Washington', 'UT', '84790', '4356346100', NULL, '1054 E Riverside Dr #202', 'St George', 'Washington', 'UT', '84790', '4356346100', '          ', 'PEHPPREF2', '', '', '0.00', '30.00', '0.00', 8, '2008-04-01', '2011-06-23', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942225750', 0, 'N', 0, '2011-05-24', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004217', 'W11004217', 'UTPEHP', 'Southern Utah Behavioral Health', 'David', 'R', 'Marchant', 'APRN', 'Mental Health', NULL, NULL, NULL, 'O', '1054 E Riverside Dr #202', 'St George', 'Washington', 'UT', '84790', '4356346100', NULL, '1054 E Riverside Dr #202', 'St George', '', 'UT', '84790', '', '', 'PEHPMID', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1386663649', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004218', 'W11004218', 'UTPEHP', 'Redrock Pediatrics', 'Michael', 'C', 'Marsden', 'DO', 'Pediatrics', NULL, NULL, NULL, 'O', '1380 E Medical Ctr Dr #3100', 'St George', 'Washington', 'UT', '84790', '4352512740', NULL, '1380 E Medical Center Dr #3100', 'St George', '', 'UT', '84790', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, NULL, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1568480804', 0, 'N', 0, '2010-04-23', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004219', 'W11004219', 'UTPEHP', 'Cedar City Clinic', 'Thomas', 'T', 'Marshall', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '1303 N Main #3C', 'Cedar City', 'Iron', 'UT', '84720', '4358685500', NULL, '1303 N Main #3C', 'Cedar City', '', 'UT', '84720', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Valley View Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1770506230', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004220', 'W11004220', 'UTPEHP', 'Budge Clinic Pediatrics', 'Prafulla', 'D', 'Martin-Garg', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921940', NULL, '1350 N 500 E', 'Logan', '', 'UT', '84341', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1437168721', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004221', 'W11004221', 'UTPEHP', 'Budge Clinic Obstetrics & Gynecology', 'Kimberly', 'D', 'McCulloch', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '1400 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357161920', NULL, '500 E 1400 N', 'Logan', '', 'UT', '84341', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1154331585', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004222', 'W11004222', 'UTPEHP', 'Bear River Family Medicine', 'Chad', 'L', 'Merrell', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '935 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '4352074800', NULL, '420 W 600 N', 'Tremonton', '', 'UT', '84337', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, NULL, 0, 0, 'Bear River Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1730176512', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004223', 'W11004223', 'UTPEHP', 'Bear River Family Medicine', 'Rodney', 'W', 'Merrell', 'MD', 'Family Practice', '', '', NULL, 'O', '935 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '4352074800', NULL, '935 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '4352074800', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Bear River Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1932196771', 0, 'N', 0, '2011-08-09', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004224', 'W11004224', 'UTPEHP', 'Cardiovascular & Thoracic Surgery - St George', 'Roger', 'C', 'Millar', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1380 E Medical Center Dr #2600', 'St George', 'Washington', 'UT', '84790', '4352512700', NULL, '1380 E Medical Center Dr #2600', 'St George', 'Washington', 'UT', '84790', '4352512700', '          ', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2008-04-01', '2012-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295753549', 0, 'N', 0, '2012-06-29', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004225', 'W11004225', 'UTPEHP', 'Cedar City Clinic', 'Lisa', 'Ann', 'Mills', 'DO', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '1303 N Main #3C', 'Cedar City', 'Iron', 'UT', '84720', '4358685500', NULL, '1303 N Main #3C', 'Cedar City', '', 'UT', '84720', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', '2009-01-21', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1265421481', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004226', 'W11004226', 'UTPEHP', 'Utah Valley Heart & Lung Surgical Associates', 'John', 'H', 'Mitchell', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1055 N 300 W Ste 410', 'Provo', 'Utah', 'UT', '84604', '8013577081', NULL, '1055 N 300 W Ste 410', 'Provo', 'Utah', 'UT', '84604', '8013577081', '', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2008-04-01', '2008-04-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699781674', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004227', 'W11004227', 'UTPEHP', 'Sunset InstaCare', 'Dennis', 'J', 'Moore', 'MD', 'Family Practice', '', '', NULL, 'B', '1739 W Sunset Blvd', 'St George', 'Washington', 'UT', '84770', '4356346050', NULL, '1739 W Sunset Blvd ', 'St George', '', 'UT', '84770', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1306864624', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004228', 'W11004228', 'UTPEHP', 'Logan Clinic', 'Glenn', 'Owens', 'Mortensen', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '412 N 200 E', 'Logan', 'Cache', 'UT', '84321', '4357132800', NULL, '550 E 1400 N #X', 'Logan', '', 'UT', '84341', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1184634669', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004229', 'W11004229', 'UTPEHP', 'Budge Clinic Obstetrics & Gynecology', 'Ena', 'C', 'Murillo', 'APRN', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '1400 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357161920', NULL, '500 E 1400 N', 'Logan', '', 'UT', '84341', '', '', 'PEHPMID', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1659463404', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004230', 'W11004230', 'UTPEHP', 'Bear River Specialists', 'Kevin', 'A', 'Murphy', 'MD', 'General Surgery', 'Internal Medicine', '', NULL, 'O', '935 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '4352074800', NULL, '935 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '4352074800', '', 'IHCPEHP', NULL, '', '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Brigham City Community Hospital', '', '', '', 'HCFA|UB|', '1083641385', 0, 'N', 0, '2014-05-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004231', 'W11004231', 'UTPEHP', 'Canyon View Orthopedics & Podiatry Associates ', 'David', 'P', 'Murray', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '1300 N 500 E #130', 'Logan', 'Cache', 'UT', '84341', '4357162800', NULL, '1300 N 500 E #130', 'Logan', '', 'UT', '84341', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1417967902', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004232', 'W11004232', 'UTPEHP', 'River Road InstaCare', 'Susan', 'M', 'Myers', 'MD', 'Urgent Care', '', '', NULL, 'B', '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886300', NULL, '577 S River Rd', 'St George', '', 'UT', '84790', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1326063140', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004233', 'W11004233', 'UTPEHP', 'Southridge Clinic', 'Marisa', 'J', 'Nagle', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '3723 W 12600 S Ste 450', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854543', NULL, '3859 W 12600 S', 'Riverton', '', 'UT', '84065', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1417095837', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004234', 'W11004234', 'UTPEHP', 'Budge Clinic Internal Medicine', 'Robert', 'Michael', 'Nash', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921980', NULL, '1350 N 500 E', 'Logan', '', 'UT', '84341', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1033129523', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004235', 'W11004235', 'UTPEHP', 'Cedar City WorkMed', 'Steven', 'Richard', 'Newman', 'MD', 'Family Practice', 'Sports Medicine', 'Occupational Therapy', NULL, 'O', '962 S Sage Dr', 'Cedar City', 'Iron', 'UT', '84720', '4358653460', NULL, '962 S Sage Dr', 'Cedar City', 'Iron', 'UT', '84720', '4358653460', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Valley View Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1134157613', 0, 'N', 0, '2013-04-15', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004236', 'W11004236', 'UTPEHP', 'IHC Bountiful Health Center', 'Douglas', 'B', 'Nielsen', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012941000', NULL, '390 N Main', 'Bountiful', '', 'UT', '84010', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1366481806', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004237', 'W11004237', 'UTPEHP', 'Mt Pleasant Clinic', 'Charles', 'E', 'Nunn', 'MD', 'Family Practice', '', '', NULL, 'O', '1100 S Medical Dr', 'Mt Pleasant', 'Sanpete', 'UT', '84647', '4354623471', NULL, '1100 S Medical Dr', 'Mt Pleasant', 'Sanpete', 'UT', '84647', '4354623471', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Sanpete Valley Hospital', '', '', '', 'HCFA|UB|', '1346280955', 0, 'N', 0, '2013-04-15', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004238', 'W11004238', 'UTPEHP', 'Redrock Pediatrics', 'Martin', 'J', 'Nygaard', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '1380 E Medical Ctr Dr #3100', 'St George', 'Washington', 'UT', '84790', '4352512740', NULL, '1380 E Medical Center Dr #3100', 'St George', 'Washington', 'UT', '84790', '4352512740', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1659305688', 0, 'N', 0, '2011-06-23', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004239', 'W11004239', 'UTPEHP', 'Budge Clinic Pediatrics', 'J', 'Dennis', 'Odell', 'MD', 'Pediatrics', '', '', NULL, 'O', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921940', NULL, '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921940', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1477563864', 0, 'N', 0, '2013-11-20', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004240', 'W11004240', 'UTPEHP', 'Ephraim Clinic', 'Darrel', 'Ward', 'Olsen', 'MD', 'Family Practice', '', '', NULL, 'O', '525 N Main', 'Ephraim', 'Sanpete', 'UT', '84627', '4352834076', NULL, '525 N Main', 'Ephraim', 'Sanpete', 'UT', '84627', '4352834076', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Sanpete Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1649218462', 0, 'N', 0, '2011-09-26', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004241', 'W11004241', 'UTPEHP', 'St George WorkMed', 'Vicky', 'L', 'ONeil', 'APRN', 'Mental Health', 'Advanced Practice Registered Nurse', 'Occupational Therapy', NULL, 'O', '385 N 3050 E', 'St George', 'Washington', 'UT', '84790', '4352512630', NULL, '385 N 3050 E', 'St George', 'Washington', 'UT', '84790', '4352512630', '', 'PEHPMID', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396847380', 0, 'N', 0, '2011-05-03', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004242', 'W11004242', 'UTPEHP', 'Sandy Clinic', 'Lisa', 'D', 'Palmieri', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '9500 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8015012100', NULL, '9500 S 1300 E', 'Sandy', '', 'UT', '84094', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1285742874', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004243', 'W11004243', 'UTPEHP', 'River Road Internal Medicine', 'J', 'Scott', 'Parkinson', 'DO', 'Hospitalist', '', '', NULL, 'O', '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886200', NULL, '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886200', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1316965627', 0, 'N', 0, '2011-09-26', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004244', 'W11004244', 'UTPEHP', 'Utah Valley Pulmonary Clinic', 'Michael', 'J', 'Pearce', 'MD', 'Pulmonary', NULL, NULL, NULL, 'O', '1055 N 300 W #500', 'Provo', 'Utah', 'UT', '84604', '8013577291', NULL, '1055 N 300 W #500', 'Provo', '', 'UT', '84604', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1568478832', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004245', 'W11004245', 'UTPEHP', 'Canyon View Orthopedics & Podiatry Associates', 'Curtis', 'Charles', 'Pedersen', 'DPM', 'Podiatry', '', '', NULL, 'O', '1300 N 500 E #130', 'Logan', 'Cache', 'UT', '84341', '4357162800', NULL, '1300 N 500 E #130', 'Logan', 'Cache', 'UT', '84341', '4357162800', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1366452757', 0, 'N', 0, '2012-11-07', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004246', 'W11004246', 'UTPEHP', 'Rim Rock Orthopaedics', 'Stephen', 'L', 'Penman', 'PA', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '652 S Medical Ctr Dr Ste 120', 'St George', 'Washington', 'UT', '84790', '4352513600', NULL, '736 S 900 E #106', 'St George', '', 'UT', '84790', '', '', 'PEHPMID', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1104850502', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004247', 'W11004247', 'UTPEHP', 'Logan InstaCare', 'Rebecca', 'Copp', 'Phillips', 'MD', 'Urgent Care', '', '', NULL, 'B', '235 E 400 N', 'Logan', 'Cache', 'UT', '84321', '4357521010', NULL, '235 E 400 N', 'Logan', 'Cache', 'UT', '84321', '4357521010', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1871696898', 0, 'N', 0, '2013-08-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004248', 'W11004248', 'UTPEHP', 'Budge Clinic Surgical Specialists', 'Brent', 'D', 'Pitcher', 'PA', 'Urology', '', '', NULL, 'O', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921950', NULL, '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921950', '', 'PEHPMID', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1881876860', 0, 'N', 0, '2013-11-19', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004249', 'W11004249', 'UTPEHP', 'Logan InstaCare ', 'Thomas', 'W', 'Price', 'PA', 'Urgent Care', NULL, NULL, NULL, 'B', '235 E 400 N', 'Logan', 'Cache', 'UT', '84321', '4357521010', NULL, '235 E 400 N', 'Logan', '', 'UT', '84321', '', '', 'PEHPMID', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1053402982', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004250', 'W11004250', 'UTPEHP', 'Southwest Cardiology - St George', 'Mark', 'William', 'Pulsipher', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1380 E Medical Ctr Dr #1500', 'St George', 'Washington', 'UT', '84790', '4352512500', NULL, '1380 E Medical Center Dr #1500', 'St George', 'Washington', 'UT', '84790', '4352512500', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1689631913', 0, 'N', 0, '2012-04-10', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004251', 'W11004251', 'UTPEHP', 'IHC Bountiful Health Center', 'Randy', 'Scott', 'Reese', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012941000', NULL, '390 N Main', 'Bountiful', '', 'UT', '84010', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1669412649', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004252', 'W11004252', 'UTPEHP', 'Bryner Clinic', 'Kim', 'N', 'Rigby', 'MD', 'Pediatrics', '', '', NULL, 'O', '525 E 100 S # 500', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015197100', NULL, '525 E 100 S # 500', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015197100', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568408086', 0, 'N', 0, '2013-05-30', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004253', 'W11004253', 'UTPEHP', 'Logan WorkMed', 'Linda', 'Jones', 'Roberts', 'APRN', 'Family Practice', NULL, NULL, NULL, 'O', '1400 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357165478', NULL, '500 E 1400 N', 'Logan', '', 'UT', '84341', '', '', 'PEHPMID', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1770760563', 0, 'N', 0, '2008-11-05', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004254', 'W11004254', 'UTPEHP', 'Budge Clinic Pediatrics', 'Sheryl', 'A', 'Roper-Hodges', 'APRN', 'Pediatrics', '', '', NULL, 'O', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921940', NULL, '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921940', '', 'PEHPMID', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639188956', 0, 'N', 0, '2013-07-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004255', 'W11004255', 'UTPEHP', 'Utah Valley Pulmonary Clinic', 'Douglas', 'Scott', 'Ross', 'MD', 'Sleep Disorders', 'Pulmonary', NULL, NULL, 'O', '1055 N 300 W #500', 'Provo', 'Utah', 'UT', '84604', '8013577291', NULL, '1055 N 300 W #500', 'Provo', '', 'UT', '84604', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1780690198', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004256', 'W11004256', 'UTPEHP', 'Cedar City WorkMed', 'Gerald', 'Kim', 'Rowland', 'MD', 'Occupational Therapy', 'Emergency Medicine', NULL, NULL, 'O', '962 S Sage Dr', 'Cedar City', 'Iron', 'UT', '84720', '4358653460', NULL, '962 S Sage Dr', 'Cedar City', '', 'UT', '84720', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Valley View Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1457370868', 0, 'N', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004257', 'W11004257', 'UTPEHP', 'Sandy Clinic', 'Jeffrey', 'Cannon', 'Schmidt', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '9500 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8015012100', NULL, '9500 S 1300 E', 'Sandy', '', 'UT', '84094', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1811008790', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004258', 'W11004258', 'UTPEHP', 'Budge Clinic Pediatrics', 'Stephen', 'D', 'Schneider', 'MD', 'Pediatrics', '', '', NULL, 'O', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921940', NULL, '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921940', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962412353', 0, 'N', 0, '2013-10-09', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004259', 'W11004259', 'UTPEHP', 'Richfield Family Practice', 'Spencer', 'Lee', 'Scoville', 'DO', 'Family Practice', '', '', NULL, 'O', '460 N Main', 'Richfield', 'Sevier', 'UT', '84701', '4358965496', NULL, '460 N Main', 'Richfield', 'Sevier', 'UT', '84701', '4358965496', '          ', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2008-04-01', '2012-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821192436', 0, 'N', 0, '2012-05-04', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004260', 'W11004260', 'UTPEHP', 'Cedar City Clinic', 'Julie', 'L', 'Smallwood', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1303 N Main #3C', 'Cedar City', 'Iron', 'UT', '84720', '4358685500', NULL, '1303 N Main #3C', 'Cedar City', 'Iron', 'UT', '84720', '4358685500', '', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2008-04-01', '2013-07-29', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1689697146', 0, 'N', 0, '2014-04-10', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004261', 'W11004261', 'UTPEHP', 'Sandy Clinic', 'Tanya', 'S', 'Jackson', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '9500 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8015012100', NULL, '9500 S 1300 E', 'Sandy', '', 'UT', '84094', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1255445383', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W11004265', 'W11004265', 'UTPEHP', 'Rim Rock Orthopaedics', 'Scott', 'M', 'Smith', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '652 S Medical Ctr Dr Ste 120', 'St George', 'Washington', 'UT', '84790', '4352513600', NULL, '652 S Medical Center Dr Ste 120', 'St George', 'Washington', 'UT', '84790', '4352513600', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588698997', 0, 'N', 0, '2010-08-25', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004266', 'W11004266', 'UTPEHP', 'Logan InstaCare', 'Chad', 'Brent', 'Speth', 'APRN', 'Family Practice', '', '', NULL, 'B', '235 E 400 N', 'Logan', 'Cache', 'UT', '84321', '4357521010', NULL, '235 E 400 N', 'Logan', 'Cache', 'UT', '84321', '4357521010', '', 'PEHPMID', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851301246', 0, 'N', 0, '2011-05-20', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W11004268', 'W11004268', 'UTPEHP', 'Budge Clinic Internal Medicine', 'Michael', 'John', 'Stones', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921980', NULL, '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921980', '          ', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2008-04-01', '2012-05-31', 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1689684094', 0, 'N', 0, '2012-09-10', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004269', 'W11004269', 'UTPEHP', 'Layton Clinic', 'Catherine', 'A', 'Strasser', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '2075 N 1200 W', 'Layton', 'Davis', 'UT', '84041', '8017796200', NULL, '2075 N 1200 W', 'Layton', '', 'UT', '84041', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1609984798', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004270', 'W11004270', 'UTPEHP', 'Budge Clinic Internal Medicine', 'Jeffrey', 'S', 'Strong', 'MD', 'Hospitalist', '', '', NULL, 'O', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921980', NULL, '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921980', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1023028438', 0, 'N', 0, '2013-12-30', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004271', 'W11004271', 'UTPEHP', 'Mountain View Pediatrics', 'Richard', 'K', 'Strong', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '9720 S 1300 E #100', 'Sandy', 'Salt Lake', 'UT', '84094', '8015718550', NULL, '9720 S 1300 E #100', 'Sandy', '', 'UT', '84094', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1083636435', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004272', 'W11004272', 'UTPEHP', 'Southern Utah Surgical Associates', 'Michael', 'G', 'Stults', 'MD', 'General Surgery', '', '', NULL, 'O', '166 W 1325 N #350', 'Cedar City', 'Iron', 'UT', '84720', '4355868192', NULL, '166 W 1325 N #350', 'Cedar City', 'Iron', 'UT', '84720', '4355868192', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Valley View Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1528087236', 0, 'N', 0, '2012-05-01', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004273', 'W11004273', 'UTPEHP', 'Sandy Clinic', 'Jane', 'E', 'Sturtevant', 'APRN', 'Pediatrics', NULL, NULL, NULL, 'O', '9500 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8015012100', NULL, '9500 S 1300 E', 'Sandy', '', 'UT', '84094', '', '', 'PEHPMID', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1699886580', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004274', 'W11004274', 'UTPEHP', 'Utah Valley Pulmonary Clinic', 'Krishna', 'M', 'Sundar', 'MD', 'Pulmonary', 'Sleep Medicine', '', NULL, 'O', '1055 N 300 W #500', 'Provo', 'Utah', 'UT', '84604', '8013577291', NULL, '1055 N 300 W #500', 'Provo', 'Utah', 'UT', '84604', '8013577291', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1801802186', 0, 'N', 0, '2011-09-26', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004275', 'W11004275', 'UTPEHP', 'Budge Clinic Internal Medicine', 'Agnes', 'M', 'Szpunar', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921980', NULL, '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921980', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1033216858', 0, 'N', 0, '2011-04-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004276', 'W11004276', 'UTPEHP', 'River Road Family Practice', 'Bruce', 'L', 'Taylor', 'DO', 'Family Practice', '', '', NULL, 'O', '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886000', NULL, '577 S River Rd', 'St George', '', 'UT', '84790', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, NULL, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1811915135', 0, 'N', 0, '2010-04-23', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004277', 'W11004277', 'UTPEHP', 'South Cache Valley Clinic', 'Matthew', 'Gregg', 'Taylor', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '190 S Hwy 165', 'Providence', 'Cache', 'UT', '84332', '4357553300', NULL, '190 S Hwy 165', 'Providence', '', 'UT', '84332', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1033123658', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W11004279', 'W11004279', 'UTPEHP', 'Cedar City Clinic', 'Charles', 'J', 'Thinnes', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '1303 N Main #3C', 'Cedar City', 'Iron', 'UT', '84720', '4358685500', NULL, '1303 N Main #3C', 'Cedar City', '', 'UT', '84720', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1861415325', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W11004281', 'W11004281', 'UTPEHP', 'River Road Family Practice', 'Bradley', 'S', 'Thompson', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886000', NULL, '577 S River Rd', 'St George', '', 'UT', '84790', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1487672713', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004282', 'W11004282', 'UTPEHP', 'IHC Bountiful Health Center', 'Kathleen', 'A', 'Trach-Moskun', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012941000', NULL, '390 N Main', 'Bountiful', '', 'UT', '84010', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1841246410', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004283', 'W11004283', 'UTPEHP', 'Sandy Clinic', 'Dale', 'Mark', 'Valentine', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '9500 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8015012100', NULL, '9500 S 1300 E', 'Sandy', '', 'UT', '84094', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1013028901', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004284', 'W11004284', 'UTPEHP', 'Holladay Pediatrics North', 'Jed', 'B', 'VanDenBerghe', 'MD', 'Pediatrics', '', '', NULL, 'O', '2160 E 4500 S', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012784693', NULL, '2160 E 4500 S', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012784693', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1922011576', 0, 'N', 0, '2013-12-18', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004285', 'W11004285', 'UTPEHP', 'Hillcrest Pediatrics', 'Virginia', '', 'Vierra', 'MD', 'Pediatrics', '', '', NULL, 'O', '5063 S Cottonwood St #160', 'Murray', 'Salt Lake', 'UT', '84107', '8015071850', NULL, '5063 S Cottonwood St #160', 'Murray', 'Salt Lake', 'UT', '84107', '8015071850', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437181682', 0, 'N', 0, '2012-01-25', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004286', 'W11004286', 'UTPEHP', 'Budge Clinic Pediatrics', 'Michael', 'K', 'Visick', 'MD', 'Pediatrics', 'Pediatrics', NULL, NULL, 'O', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921940', NULL, '1350 N 500 E', 'Logan', '', 'UT', '84341', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1225048648', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004287', 'W11004287', 'UTPEHP', 'Redrock Pediatrics', 'Adrianne', 'R', 'Walker-Jenkins', 'MD', 'Pediatrics', '', '', NULL, 'O', '1380 E Medical Ctr Dr #3100', 'St George', 'Washington', 'UT', '84790', '4352512740', NULL, '1380 E Medical Center Dr #3100', 'St George', 'Washington', 'UT', '84790', '4352512740', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1699820738', 0, 'N', 0, '2011-01-03', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004288', 'W11004288', 'UTPEHP', 'Budge Clinic Internal Medicine', 'Corey', 'Wyn', 'Walker', 'MD', 'Rheumatology', 'Internal Medicine', NULL, NULL, 'O', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921980', NULL, '1350 N 500 E', 'Logan', '', 'UT', '84341', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1295707677', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004289', 'W11004289', 'UTPEHP', 'River Road Internal Medicine', 'Claude', 'A', 'Warner', 'MD', 'Hospitalist', '', '', NULL, 'O', '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886200', NULL, '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886200', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1376561688', 0, 'N', 0, '2011-09-26', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004290', 'W11004290', 'UTPEHP', 'Budge Clinic Surgical Specialists', 'Bartley', 'Myron', 'Weiss', 'MD', 'General Surgery', '', '', NULL, 'O', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921950', NULL, '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921950', '          ', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1942210364', 0, 'N', 0, '2012-02-29', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004291', 'W11004291', 'UTPEHP', 'River Road InstaCare', 'Thomas', 'H', 'Welsh', 'MD', 'Urgent Care', '', '', NULL, 'B', '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886300', NULL, '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886300', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487604740', 0, 'N', 0, '2011-06-23', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004292', 'W11004292', 'UTPEHP', 'Budge Clinic Internal Medicine', 'Michael', 'Henry', 'Williams', 'MD', 'Neurology', NULL, NULL, NULL, 'O', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921980', NULL, '1350 N 500 E', 'Logan', '', 'UT', '84341', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1427068840', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004293', 'W11004293', 'UTPEHP', 'Holladay Pediatrics', 'Mark', 'T', 'Witt', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '2180 E 4500 S #210', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8019474242', NULL, '2180 E 4500 S #210', 'Salt Lake City', '', 'UT', '84117', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1881707875', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004294', 'W11004294', 'UTPEHP', 'Logan InstaCare', 'Eric', 'M', 'Wood', 'MD, MPH', 'Emergency Medicine', '', 'Occupational Therapy', NULL, 'B', '235 E 400 N', 'Logan', 'Cache', 'UT', '84321', '4357521010', NULL, '235 E 400 N', 'Logan', 'Cache', 'UT', '84321', '4357521010', '          ', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992719504', 0, 'Y', 0, '2011-05-20', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004295', 'W11004295', 'UTPEHP', 'Cardiovascular & Thoracic Surgery - St George', 'Kory', 'U', 'Woodbury', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '1380 E Medical Ctr Dr #2600', 'St George', 'Washington', 'UT', '84790', '4352512700', NULL, '1380 E Medical Center Dr #2600', 'St George', '', 'UT', '84790', '', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1225056575', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004296', 'W11004296', 'UTPEHP', 'Hurricane Valley Clinic', 'Daniel', 'K', 'Worwood', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '75 N 2260 W', 'Hurricane', 'Washington', 'UT', '84737', '4356356400', NULL, '75 N 2260 W', 'Hurricane', 'Washington', 'UT', '84737', '4356356400', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1144241647', 0, 'N', 0, '2011-01-26', NULL, NULL, 0, 0, NULL, NULL),
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