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
('752582845', 'ELHT00546', 'ELHT00546', 'TXDALSTD', 'Dallas Diagnostic Association Plano', 'Adrian', 'H', 'Nguyen', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, '', NULL, 'HCFA|UB|', '1578698080', 0, 'N', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('911947573', 'ELHT00547', 'ELHT00547', 'TXDALSTD', 'Health Texas Provider Network', 'Jeffrey', 'A', 'Astbury', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1441 S Midlothian Pkwy Ste 100', 'Midlothian', 'Ellis', 'TX', '76065', '9727231474', '9727239423', '1441 S Midlothian Pkwy Ste 100', 'Midlothian', 'Ellis', 'TX', '76065', '9727231474', '9727239423', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1588607709', 0, 'N', 0, '2013-06-07', NULL, NULL, 32.4671, -96.9768, NULL, NULL),
('911947573', 'ELHT00548', 'ELHT00548', 'TXDALSTD', 'Health Texas Provider Network', 'Jeffrey', 'A', 'Astbury', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '9729231686', '9729239268', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '9729231686', '9729239268', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1588607709', 0, 'N', 0, '2013-06-07', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT01151', 'ELHT01151', 'TXDALSTD', 'Legacy Heart Group', 'Marcus', 'E', 'McKenzie', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '6601 Preston Rd', 'Plano', 'Collin', 'TX', '75024', '4698006300', '4698006351', '6601 Preston Rd', 'Plano', 'Collin', 'TX', '75024', '4698006300', '4698006351', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1588640213', 0, 'N', 0, '2014-01-08', NULL, NULL, 33.0625, -96.7963, NULL, NULL),
('752536818', 'ELHT01152', 'ELHT01152', 'TXDALSTD', 'Legacy Heart Group', 'Marcus', 'E', 'McKenzie', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1588640213', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752600832', 'ELHT00549', 'ELHT00549', 'TXDALSTD', 'MedProvider', 'Paul', 'E', 'Madeley', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3434 Swiss Ave Ste 430', 'Dallas', 'Dallas', 'TX', '75204', '2148285000', '2148285031', '3434 Swiss Ave Ste 430', 'Dallas', 'Dallas', 'TX', '75204', '2148285000', '2148285031', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', 'Baylor Medical Center at Uptown', NULL, NULL, 'HCFA|UB|', '1588676613', 0, 'N', 0, '2013-06-14', NULL, NULL, 32.7915, -96.7824, NULL, NULL),
('911947573', 'ELHT00551', 'ELHT00551', 'TXDALSTD', 'MedProvider Inpatient Care Unit', 'Lisa', 'F', 'Luke', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3500 Gaston Ave Roberts Tower 4th Fl', 'Dallas', 'Dallas', 'TX', '75246', '2148203000', '2148203022', '3500 Gaston Ave 4th floor', 'Dallas', 'Dallas', 'TX', '75246', '2148203000', '2148203022', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1588688584', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.7911, -96.7802, NULL, NULL),
('911947573', 'ELHT00552', 'ELHT00552', 'TXDALSTD', 'MedProvider Inpatient Care Unit', 'Lisa', 'F', 'Luke', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '2148203000', '2148203022', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '2148203000', '2148203022', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1588688584', 0, 'N', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00277', 'ELHT00277', 'TXDALSTD', '', 'John', 'S', 'Appleton', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '3900 Junius St Ste 500', 'Dallas', 'Dallas', 'TX', '75246', '2148237090', '2148231644', '3900 Junius St Ste 500', 'Dallas', 'Dallas', 'TX', '75246', '2148237090', '2148231644', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-05-31', 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1588714661', 0, 'N', 0, '2014-01-30', NULL, NULL, 32.7913, -96.7775, NULL, NULL),
('752536818', 'ELHT00278', 'ELHT00278', 'TXDALSTD', '', 'John', 'S', 'Appleton', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1588714661', 0, 'N', 0, '2014-01-30', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00977', 'ELHT00977', 'TXDALSTD', 'Health Texas Provider Network', 'Elizabeth', 'L', 'Bah', 'DO', 'Family Practice', '', '', NULL, 'O', '601 S Main St Ste 200', 'Keller', 'Tarrant', 'TX', '76248', '8177536888', '8177536885', '601 S Main St Ste 200', 'Keller', 'Tarrant', 'TX', '76248', '8177536888', '8177536885', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Emergency Medical Center at Keller', NULL, '', NULL, 'HCFA|UB|', '1588823363', 0, 'N', 0, '2013-06-07', NULL, NULL, 32.9271, -97.2541, NULL, NULL),
('752536818', 'ELHT00978', 'ELHT00978', 'TXDALSTD', 'Health Texas Provider Network', 'Elizabeth', 'L', 'Bah', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Emergency Medical Center at Keller', NULL, '', NULL, 'HCFA|UB|', '1588823363', 0, 'Y', 0, '2013-06-07', NULL, NULL, 0, 0, NULL, NULL),
('911947573', 'ELHT00979', 'ELHT00979', 'TXDALSTD', 'Baylor Family Medical Center at Ellis County Midlothian', 'Jepsin', 'A', 'Maliyil', 'MD', 'Family Practice', '', '', NULL, 'O', '1441 S Midlothian Pkwy Ste 100', 'Midlothian', 'Ellis', 'TX', '76065', '9727231474', '9727239423', '1441 S Midlothian Pkwy Ste 100', 'Midlothian', 'Ellis', 'TX', '76065', '9727231474', '9727239423', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1588826366', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.4671, -96.9768, NULL, NULL),
('911947573', 'ELHT00980', 'ELHT00980', 'TXDALSTD', 'Baylor Family Medical Center at Ellis County Midlothian', 'Jepsin', 'A', 'Maliyil', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '9729231686', '9729239268', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '9729231686', '9729239268', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1588826366', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00981', 'ELHT00981', 'TXDALSTD', 'Baylor Family Medicine at Plano', 'David', 'S', 'Gartenberg', 'MD', 'Family Practice', '', '', NULL, 'O', '4800 Hedgcoxe Rd Ste 200', 'Plano', 'Collin', 'TX', '75024', '4698006120', '4698006129', '4800 Hedgcoxe Rd Ste 200', 'Plano', 'Collin', 'TX', '75024', '4698006120', '4698006129', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, '', NULL, 'HCFA|UB|', '1588848840', 0, 'N', 0, '2012-12-20', NULL, NULL, 33.0836, -96.7934, NULL, NULL),
('752536818', 'ELHT00982', 'ELHT00982', 'TXDALSTD', 'Baylor Family Medicine at Plano', 'David', 'S', 'Gartenberg', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, '', NULL, 'HCFA|UB|', '1588848840', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00983', 'ELHT00983', 'TXDALSTD', 'Baylor Family Medical Center at Rockwall', 'Victoria', 'E', 'Smithers', 'MD', 'Family Practice', '', '', NULL, 'O', '6435 South FM549 Ste 201', 'Heath', 'Rockwall', 'TX', '75032', '9727719155', '9727712390', '6435 South FM549 Ste 201', 'Heath', 'Rockwall', 'TX', '75032', '9727719155', '9727712390', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1598714719', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.8645, -96.4413, NULL, NULL),
('752536818', 'ELHT00984', 'ELHT00984', 'TXDALSTD', 'Baylor Family Medical Center at Rockwall', 'Victoria', 'E', 'Smithers', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1598714719', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00985', 'ELHT00985', 'TXDALSTD', 'Baylor Family Medicine at Frisco', 'Jennifer', 'M', 'Zomnir', 'MD', 'Family Practice', '', '', NULL, 'O', '2840 Legacy Dr Ste 400 Bldg 4', 'Frisco', 'Denton', 'TX', '75034', '9727123652', '2146183614', '2840 Legacy Dr Ste 400 Bldg 4', 'Frisco', 'Denton', 'TX', '75034', '9727123652', '2146183614', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Frisco', NULL, NULL, NULL, 'HCFA|UB|', '1598718397', 0, 'N', 0, '2013-05-28', NULL, NULL, 33.1028, -96.8415, NULL, NULL),
('752536818', 'ELHT00986', 'ELHT00986', 'TXDALSTD', 'Baylor Family Medicine at Frisco', 'Jennifer', 'M', 'Zomnir', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Frisco', NULL, NULL, NULL, 'HCFA|UB|', '1598718397', 0, 'Y', 0, '2013-05-28', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00987', 'ELHT00987', 'TXDALSTD', 'Baylor Health Center at Park Cities', 'Nazish', 'S', 'Islahi', 'MD', 'Family Practice', '', '', NULL, 'O', '9101 N Central Expwy Ste 300', 'Dallas', 'Dallas', 'TX', '75231', '2143632305', '2143632608', '9101 N Central Expy Ste 300', 'Dallas', 'Dallas', 'TX', '75231', '2143632305', '2143632608', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1598723314', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.873, -96.7706, NULL, NULL),
('752536818', 'ELHT00988', 'ELHT00988', 'TXDALSTD', 'Baylor Health Center at Park Cities', 'Nazish', 'S', 'Islahi', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1598723314', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752600832', 'ELHT00553', 'ELHT00553', 'TXDALSTD', 'MedProvider', 'Robert', 'D', 'Thompson', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3434 Swiss Ave Ste 310', 'Dallas', 'Dallas', 'TX', '75204', '2148285000', '2148285051', '3434 Swiss Ave Ste 310', 'Dallas', 'Dallas', 'TX', '75204', '2148285000', '2148285051', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2014-04-08', 0, 0, 0, 'Baylor All Saints Medical Center', '', '', '', 'HCFA|UB|', '1598778698', 0, 'N', 0, '2014-04-17', NULL, NULL, 32.7915, -96.7824, NULL, NULL),
('911947573', 'ELHT00735', 'ELHT00735', 'TXDALSTD', 'Surgical Oncology Specialists', 'John', 'T', 'Preskitt', 'MD', 'General Surgery', '', '', NULL, 'O', '3410 Worth St Ste 235', 'Dallas', 'Dallas', 'TX', '75246', '2148202302', '2148202303', '3410 Worth St Ste 235', 'Dallas', 'Dallas', 'TX', '75246', '2148202302', '2148202303', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1598787327', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.7886, -96.779, NULL, NULL),
('911947573', 'ELHT00736', 'ELHT00736', 'TXDALSTD', 'Surgical Oncology Specialists', 'John', 'T', 'Preskitt', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '2148208612', '2148202303', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '2148208612', '2148202303', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1598787327', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00989', 'ELHT00989', 'TXDALSTD', 'Supportive and Palliative Care at Plano', 'Alfred', 'E', 'Levy', 'MD', 'Family Practice', '', '', NULL, 'O', '4708 Allilance Blvd Ste 550', 'Plano', 'Collin', 'TX', '75093', '4698006140', '4698006145', '4708 Allilance Blvd Ste 550', 'Plano', 'Collin', 'TX', '75093', '4698006140', '4698006145', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-05-31', 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1598787814', 0, 'N', 0, '2013-06-13', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00990', 'ELHT00990', 'TXDALSTD', 'Supportive and Palliative Care at Plano', 'Alfred', 'E', 'Levy', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1598787814', 0, 'Y', 0, '2013-06-12', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00991', 'ELHT00991', 'TXDALSTD', 'Family Medical Center at Garland', 'April', 'M', 'Day', 'MD', 'Family Practice', '', '', NULL, 'O', '601 Clara Barton Blvd Ste 140', 'Garland', 'Dallas', 'TX', '75042', '9722726561', '9722763067', '601 Clara Barton Blvd Ste 140', 'Garland', 'Dallas', 'TX', '75042', '9722726561', '9722763067', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1598787996', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.9175, -96.662, NULL, NULL),
('752536818', 'ELHT00992', 'ELHT00992', 'TXDALSTD', 'Family Medical Center at Garland', 'April', 'M', 'Day', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1598787996', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT01153', 'ELHT01153', 'TXDALSTD', 'Cardiovascular Consultants of North Texas', 'Phillip', 'J', 'Hecht', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1600 W College Ste 680', 'Grapevine', 'Tarrant', 'TX', '76051', '8179128400', '8179128410', '1600 W College Ste 680', 'Grapevine', 'Tarrant', 'TX', '76051', '8179128400', '8179128410', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-10-31', 0, 0, 0, 'Baylor Medical Center at Waxahachie', 'Baylor Regional Medical Center at Plano', NULL, NULL, 'HCFA|UB|', '1598794802', 0, 'N', 0, '2013-12-09', NULL, NULL, 32.9345, -97.0946, NULL, NULL),
('752536818', 'ELHT01154', 'ELHT01154', 'TXDALSTD', 'Cardiovascular Consultants of North Texas', 'Phillip', 'J', 'Hecht', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', 'Baylor Regional Medical Center at Plano', NULL, NULL, 'HCFA|UB|', '1598794802', 0, 'Y', 0, '2013-12-09', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00045', 'ELHT00045', 'TXDALSTD', 'Dallas Diagnostic Association Garland', 'Qing', '', 'Jia', 'MD', 'Endocrinology', '', '', NULL, 'O', '601 Clara Barton Blvd Ste 300', 'Garland', 'Dallas', 'TX', '75042', '4698002000', '9722722073', '601 Clara Barton Blvd Ste 300', 'Garland', 'Dallas', 'TX', '75042', '4698002000', '9722722073', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1609805506', 0, 'N', 0, '2013-09-16', NULL, NULL, 32.9175, -96.662, NULL, NULL),
('752536818', 'ELHT00046', 'ELHT00046', 'TXDALSTD', 'Dallas Diagnostic Association Garland', 'Qing', '', 'Jia', 'MD', 'Endocrinology', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1609805506', 0, 'N', 0, '2013-09-16', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00993', 'ELHT00993', 'TXDALSTD', 'Baylor Family Health Center at Richardson', 'Amby', 'J', 'Bindra', 'MD', 'Family Practice', '', '', NULL, 'O', '2520 N Central Expwy Ste 100', 'Richardson', 'Dallas', 'TX', '75080', '9722343311', '9726698072', '2520 North Central Expy Ste 100', 'Richardson', 'Dallas', 'TX', '75080', '9722343311', '9726698072', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1609831072', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.986, -96.7108, NULL, NULL),
('752536818', 'ELHT00994', 'ELHT00994', 'TXDALSTD', 'Baylor Family Health Center at Richardson', 'Amby', 'J', 'Bindra', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1609831072', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('751037591', 'ELHT00555', 'ELHT00555', 'TXDALSTD', 'Baylor Senior Health Center Garland', 'Hashim', 'A', 'Majeed', 'MD', 'Internal Medicine', '', '', NULL, 'O', '800 N Shiloh Rd', 'Garland', 'Dallas', 'TX', '75042', '9724875444', '9724853056', '800 N Shiloh Rd', 'Garland', 'Dallas', 'TX', '75042', '9724875444', '9724853056', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1609832930', 0, 'N', 0, '2013-05-30', NULL, NULL, 32.9193, -96.6652, NULL, NULL),
('751037591', 'ELHT00556', 'ELHT00556', 'TXDALSTD', 'Baylor Senior Health Center Garland', 'Hashim', 'A', 'Majeed', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 841540', 'Dallas', 'Dallas', 'TX', '75284', '9724953578', '9724969239', 'PO Box 841540', 'Dallas', 'Dallas', 'TX', '75284', '9724953578', '9724969239', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1609832930', 0, 'N', 0, '2013-05-30', NULL, NULL, 0, 0, NULL, NULL),
('752600832', 'ELHT00557', 'ELHT00557', 'TXDALSTD', 'MedProvider', 'John', 'C', 'Brooks', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3434 Swiss Ave Ste 310', 'Dallas', 'Dallas', 'TX', '75204', '2148285000', '2148285051', '3434 Swiss Ave Ste 310', 'Dallas', 'Dallas', 'TX', '75204', '2148285000', '2148285051', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-06-30', 0, 0, 0, 'Baylor All Saints Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1609886530', 0, 'N', 0, '2013-07-31', NULL, NULL, 32.7913, -96.7821, NULL, NULL),
('752600832', 'ELHT00559', 'ELHT00559', 'TXDALSTD', 'Signature Medicine', 'Fred', 'David', 'Winter', 'MD', 'Internal Medicine', '', '', NULL, 'B', '3434 Swiss Ave Ste 201', 'Dallas', 'Dallas', 'TX', '75204', '2148285006', '2148285080', '3434 Swiss Ave Ste 201', 'Dallas', 'Dallas', 'TX', '75204', '2148285006', '2148285080', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1609889963', 0, 'N', 0, '2013-04-05', NULL, NULL, 32.7913, -96.7821, NULL, NULL),
('752600832', 'ELHT00560', 'ELHT00560', 'TXDALSTD', 'Signature Medicine', 'Fred', 'David', 'Winter', 'MD', 'Internal Medicine', '', '', NULL, 'O', '411 N Washington Ave Ste 3000', 'Dallas', 'Dallas', 'TX', '75246', '2148208361', '2148208106', '411 N Washington Ave Ste 3000', 'Dallas', 'Dallas', 'TX', '75246', '2148208361', '2148208106', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1609889963', 0, 'N', 0, '2013-04-05', NULL, NULL, 32.7885, -96.7752, NULL, NULL),
('752582845', 'ELHT00561', 'ELHT00561', 'TXDALSTD', 'Dallas Diagnostic Association Plano', 'Jennifer', 'K', 'Zimmer', 'MD', 'Internal Medicine', '', '', NULL, 'O', '4708 Alliance Blvd Baylor Med Pl 1', 'Plano', 'Collin', 'TX', '75093', '4698006000', '4698006001', '4708 Alliance Blvd Baylor Med Pl 1', 'Plano', 'Collin', 'TX', '75093', '4698006000', '4698006001', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1619083029', 0, 'N', 0, '2012-12-20', NULL, NULL, 33.0145, -96.7925, NULL, NULL),
('752582845', 'ELHT00562', 'ELHT00562', 'TXDALSTD', 'Dallas Diagnostic Association Plano', 'Jennifer', 'K', 'Zimmer', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1619083029', 0, 'N', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752582845', 'ELHT00079', 'ELHT00079', 'TXDALSTD', 'Dallas Diagnostic Association Plano', 'Matthew', 'J', 'Leveno', 'MD', 'Pulmonary', '', '', NULL, 'O', '4708 Alliance Blvd Baylor Med Pl 1', 'Plano', 'Collin', 'TX', '75093', '4698006000', '4698006001', '4708 Alliance Blvd Baylor Med Pl 1', 'Plano', 'Collin', 'TX', '75093', '4698006000', '4698006001', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, '', NULL, 'HCFA|UB|', '1619186954', 0, 'N', 0, '2012-12-20', NULL, NULL, 33.0145, -96.7925, NULL, NULL),
('752582845', 'ELHT00080', 'ELHT00080', 'TXDALSTD', 'Dallas Diagnostic Association Plano', 'Matthew', 'J', 'Leveno', 'MD', 'Pulmonary', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, '', NULL, 'HCFA|UB|', '1619186954', 0, 'N', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00775', 'ELHT00775', 'TXDALSTD', 'Boland, Clement', 'Clement', 'R', 'Boland', 'MD', 'Gastroenterology', '', '', NULL, 'O', '3500 Gaston Ave Hoblitzelle Tower 2nd Fl', 'Dallas', 'Dallas', 'TX', '75246', '2148202692', '2148189292', '3500 Gaston Ave Hoblitzelle Tower 2nd Fl', 'Dallas', 'Dallas', 'TX', '75246', '2148202692', '2148189292', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1619921038', 0, 'N', 0, '2013-04-17', NULL, NULL, 32.7911, -96.7802, NULL, NULL),
('752536818', 'ELHT00776', 'ELHT00776', 'TXDALSTD', 'Boland, Clement', 'Clement', 'R', 'Boland', 'MD', 'Gastroenterology', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1619921038', 0, 'Y', 0, '2013-04-17', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00563', 'ELHT00563', 'TXDALSTD', 'Baylor Internal Medicine at Heritage', 'Gary', 'M', 'Gibson', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1441 Redbud Blvd Ste 211', 'McKinney', 'Collin', 'TX', '75069', '9725423364', '9725629506', '1441 Redbud Blvd Ste 211', 'McKinney', 'Collin', 'TX', '75069', '9725423364', '9725629506', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2014-04-06', 0, 0, 0, 'Baylor Medical Center at McKinney', '', '', '', 'HCFA|UB|', '1619988466', 0, 'N', 0, '2014-04-17', NULL, NULL, 33.2112, -96.6341, NULL, NULL),
('752536818', 'ELHT00564', 'ELHT00564', 'TXDALSTD', 'Baylor Internal Medicine at Heritage', 'Gary', 'M', 'Gibson', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2014-04-06', 0, 0, 0, 'Baylor Medical Center at McKinney', '', '', '', 'HCFA|UB|', '1619988466', 0, 'N', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT01155', 'ELHT01155', 'TXDALSTD', 'Legacy Heart Group', 'David', 'A', 'Schwartz', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '6601 Preston Rd', 'Plano', 'Collin', 'TX', '75024', '4698006300', '4698006351', '6601 Preston Rd', 'Plano', 'Collin', 'TX', '75024', '4698006300', '4698006351', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1629065156', 0, 'N', 0, '2014-01-08', NULL, NULL, 33.0625, -96.7963, NULL, NULL),
('752536818', 'ELHT01156', 'ELHT01156', 'TXDALSTD', 'Legacy Heart Group', 'David', 'A', 'Schwartz', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1629065156', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT01157', 'ELHT01157', 'TXDALSTD', 'Grapevine Cardiology', 'Richard', 'J', 'Feingold', 'DO', 'Cardiovascular Disease', '', '', NULL, 'O', '1643 Lancaster Dr Ste 203', 'Grapevine', 'Tarrant', 'TX', '76051', '8173297670', '8174160145', '1643 Lancaster Dr Ste 203', 'Grapevine', 'Tarrant', 'TX', '76051', '8173297670', '8174160145', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-10-31', 0, 0, 0, 'Baylor Medical Center at Irving', 'Baylor Medical Center at Waxahachie', NULL, NULL, 'HCFA|UB|', '1629070362', 0, 'N', 0, '2013-12-09', NULL, NULL, 32.9321, -97.0939, NULL, NULL),
('752536818', 'ELHT01158', 'ELHT01158', 'TXDALSTD', 'Grapevine Cardiology', 'Richard', 'J', 'Feingold', 'DO', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', 'Baylor Medical Center at Waxahachie', NULL, NULL, 'HCFA|UB|', '1629070362', 0, 'Y', 0, '2013-12-09', NULL, NULL, 0, 0, NULL, NULL),
('752600832', 'ELHT00565', 'ELHT00565', 'TXDALSTD', 'MedProvider', 'Andrew', 'G', 'Hickl', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3434 Swiss Ave Ste 430', 'Dallas', 'Dallas', 'TX', '75204', '2148285030', '2148285031', '3434 Swiss Ave Ste 430', 'Dallas', 'Dallas', 'TX', '75204', '2148285030', '2148285031', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1629080080', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.7915, -96.7824, NULL, NULL),
('752536818', 'ELHT00995', 'ELHT00995', 'TXDALSTD', 'Baylor Health Center at Park Cities', 'Brent', 'W', 'Walker', 'DO', 'Family Practice', '', '', NULL, 'O', '9101 N Central Expwy Ste 300', 'Dallas', 'Dallas', 'TX', '75231', '2143632305', '2143632608', '9101 N Central Expy Ste 300', 'Dallas', 'Dallas', 'TX', '75231', '2143632305', '2143632608', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1629084793', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.873, -96.7706, NULL, NULL),
('752536818', 'ELHT00996', 'ELHT00996', 'TXDALSTD', 'Baylor Health Center at Park Cities', 'Brent', 'W', 'Walker', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1629084793', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752722718', 'ELHT00997', 'ELHT00997', 'TXDALSTD', 'Baylor Family Medical Center at Riverside', 'Mara', 'L', 'Cunningham', 'DO', 'Family Practice', '', '', NULL, 'O', '2740 N Hwy 360 Ste 100', 'Grand Prairie', 'Dallas', 'TX', '75050', '9726068300', '9726064940', '2740 N Hwy 360 Ste 100', 'Grand Prairie', 'Dallas', 'TX', '75050', '9726068300', '9726064940', 'HTPN', 'TXHCPCHTPN', NULL, '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1629280078', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.797, -97.0554, NULL, NULL),
('752536818', 'ELHT00999', 'ELHT00999', 'TXDALSTD', 'Family Medical Center at North Garland', 'Jane', 'S', 'Sadler', 'MD', 'Family Practice', '', '', NULL, 'O', '5345 N George Bush Fwy', 'Garland', 'Dallas', 'TX', '75040', '9724955888', '9724950588', '5345 N George Bush Fwy', 'Garland', 'Dallas', 'TX', '75040', '9724955888', '9724950588', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639100357', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.9651, -96.6418, NULL, NULL),
('752536818', 'ELHT01000', 'ELHT01000', 'TXDALSTD', 'Family Medical Center at North Garland', 'Jane', 'S', 'Sadler', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639100357', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752722718', 'ELHT01001', 'ELHT01001', 'TXDALSTD', 'Baylor Family Medical Center at Riverside', 'Kevin', 'D', 'Katzen', 'DO', 'Family Practice', '', '', NULL, 'O', '2740 N Hwy 360 Ste 100', 'Grand Prairie', 'Dallas', 'TX', '75050', '9726068300', '9726064940', '2740 N Hwy 360 Ste 100', 'Grand Prairie', 'Dallas', 'TX', '75050', '9726068300', '9726064940', 'HTPN', 'TXHCPCHTPN', NULL, '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639122625', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.797, -97.0554, NULL, NULL),
('752536818', 'ELHT00047', 'ELHT00047', 'TXDALSTD', '', 'Stefanie', 'L', 'Addington', 'MD', 'Endocrinology', '', '', NULL, 'O', '2021 N MacArthur Blvd Ste 515', 'Irving', 'Dallas', 'TX', '75061', '9722593282', '9722592033', '2021 N MacArthur Blvd Ste 515', 'Irving', 'Dallas', 'TX', '75061', '9722593282', '9722592033', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, NULL, NULL, 'HCFA|UB|', '1639197759', 0, 'N', 0, '2014-01-30', NULL, NULL, 32.835, -96.9592, NULL, NULL),
('752536818', 'ELHT00048', 'ELHT00048', 'TXDALSTD', '', 'Stefanie', 'L', 'Addington', 'MD', 'Endocrinology', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, NULL, NULL, 'HCFA|UB|', '1639197759', 0, 'N', 0, '2014-01-30', NULL, NULL, 0, 0, NULL, NULL),
('752722718', 'ELHT01003', 'ELHT01003', 'TXDALSTD', 'Baylor Family Medical Center at Riverside', 'Kenneth', 'L', 'Katzen', 'DO', 'Family Practice', '', '', NULL, 'O', '2740 N Hwy 360 Ste 100', 'Grand Prairie', 'Dallas', 'TX', '75050', '9726068300', '9726064940', '2740 N Hwy 360 Ste 100', 'Grand Prairie', 'Dallas', 'TX', '75050', '9726068300', '9726064940', 'HTPN', 'TXHCPCHTPN', NULL, '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1649226846', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.797, -97.0554, NULL, NULL),
('752582845', 'ELHT00567', 'ELHT00567', 'TXDALSTD', 'Dallas Diagnostic Association Plano', 'Kenneth', 'B', 'Godsey', 'MD', 'Internal Medicine', '', '', NULL, 'O', '4708 Alliance Blvd Baylor Med Pl 1', 'Plano', 'Collin', 'TX', '75093', '4698006000', '4698006001', '4708 Alliance Blvd Baylor Med Pl 1', 'Plano', 'Collin', 'TX', '75093', '4698006000', '4698006001', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1649384116', 0, 'N', 0, '2012-12-20', NULL, NULL, 33.0145, -96.7925, NULL, NULL),
('752582845', 'ELHT00568', 'ELHT00568', 'TXDALSTD', 'Dallas Diagnostic Association Plano', 'Kenneth', 'B', 'Godsey', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1649384116', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752582845', 'ELHT00049', 'ELHT00049', 'TXDALSTD', 'Dallas Diagnostic Association Plano', 'Alvin', 'E', 'Huang', 'MD', 'Endocrinology', '', '', NULL, 'O', '4708 Alliance Blvd Baylor Med Pl 1', 'Plano', 'Collin', 'TX', '75093', '4698006000', '4698006001', '4708 Alliance Blvd Baylor Med Pl 1', 'Plano', 'Collin', 'TX', '75093', '4698006000', '4698006001', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1649384132', 0, 'N', 0, '2012-12-20', NULL, NULL, 33.0145, -96.7925, NULL, NULL),
('752582845', 'ELHT00050', 'ELHT00050', 'TXDALSTD', 'Dallas Diagnostic Association Plano', 'Alvin', 'E', 'Huang', 'MD', 'Endocrinology', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1649384132', 0, 'N', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752582845', 'ELHT00777', 'ELHT00777', 'TXDALSTD', 'Dallas Diagnostic Association Plano', 'Tya-Mae', 'Y', 'Julien', 'MD', 'Gastroenterology', '', '', NULL, 'O', '4708 Alliance Blvd Ste 200', 'Plano', 'Collin', 'TX', '75093', '4698006020', '4698006001', '4708 Alliance Blvd Ste 200', 'Plano', 'Collin', 'TX', '75093', '4698006020', '4698006001', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2014-02-28', 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1649385998', 0, 'N', 0, '2014-03-20', NULL, NULL, 33.0145, -96.7925, NULL, NULL),
('752582845', 'ELHT00778', 'ELHT00778', 'TXDALSTD', 'Dallas Diagnostic Association Plano', 'Tya-Mae', 'Y', 'Julien', 'MD', 'Gastroenterology', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2014-02-28', 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1649385998', 0, 'Y', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT01005', 'ELHT01005', 'TXDALSTD', 'Baylor Family Medicine at Uptown', 'Shari', 'C', 'Gamarnik', 'MD', 'Family Practice', '', '', NULL, 'O', '4161 McKinney Ave Ste 300', 'Dallas', 'Dallas', 'TX', '75204', '2142196655', '2142196660', '4161 McKinney Ave Ste 300', 'Dallas', 'Dallas', 'TX', '75204', '2142196655', '2142196660', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, '', NULL, 'HCFA|UB|', '1649470089', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.8156, -96.7912, NULL, NULL),
('752536818', 'ELHT01006', 'ELHT01006', 'TXDALSTD', 'Baylor Family Medicine at Uptown', 'Shari', 'C', 'Gamarnik', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, '', NULL, 'HCFA|UB|', '1649470089', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT01007', 'ELHT01007', 'TXDALSTD', 'Overn Family Medicine', 'Steven', 'P', 'Overn', 'DO', 'Family Practice', '', '', NULL, 'O', '6210 Virginia Pkwy', 'McKinney', 'Collin', 'TX', '75071', '9725480004', '9725295099', '6210 Virginia Pkwy', 'McKinney', 'Collin', 'TX', '75071', '9725480004', '9725295099', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at McKinney', NULL, '', NULL, 'HCFA|UB|', '1659325462', 0, 'N', 0, '2012-12-20', NULL, NULL, 33.1992, -96.7014, NULL, NULL),
('752536818', 'ELHT01008', 'ELHT01008', 'TXDALSTD', 'Overn Family Medicine', 'Steven', 'P', 'Overn', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at McKinney', NULL, '', NULL, 'HCFA|UB|', '1659325462', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT01159', 'ELHT01159', 'TXDALSTD', 'Health Texas Provider Network', 'Sahil', '', 'Bakshi', 'DO', 'Cardiovascular Disease', '', '', NULL, 'O', '6601 Preston Rd', 'Plano', 'Collin', 'TX', '75024', '4698006300', '4698006351', '6601 Preston Rd', 'Plano', 'Collin', 'TX', '75024', '4698006300', '4698006351', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1659368199', 0, 'N', 0, '2014-01-08', NULL, NULL, 33.0625, -96.7963, NULL, NULL),
('752536818', 'ELHT01160', 'ELHT01160', 'TXDALSTD', 'Health Texas Provider Network', 'Sahil', '', 'Bakshi', 'DO', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1659368199', 0, 'Y', 0, '2013-06-07', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00569', 'ELHT00569', 'TXDALSTD', 'Southlake Family Medicine', 'Keith', 'A', 'Schorn', 'MD', 'Internal Medicine', '', '', NULL, 'O', '731 E Southlake Blvd Ste 100', 'Southlake', 'Tarrant', 'TX', '76092', '8174243366', '8174243426', '731 E Southlake Blvd Ste 100', 'Southlake', 'Tarrant', 'TX', '76092', '8174243366', '8174243426', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1659386944', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.941, -97.1405, NULL, NULL),
('752536818', 'ELHT00570', 'ELHT00570', 'TXDALSTD', 'Southlake Family Medicine', 'Keith', 'A', 'Schorn', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1659386944', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00227', 'ELHT00227', 'TXDALSTD', 'Pediatric and Adolescent Associates of Garland', 'Johanna', 'S', 'Limsenben', 'MD', 'Pediatrics', '', '', NULL, 'O', '601 Clara Barton Blvd Ste 250', 'Garland', 'Dallas', 'TX', '75042', '9722727887', '9722727992', '601 Clara Barton Blvd Ste 250', 'Garland', 'Dallas', 'TX', '75042', '9722727887', '9722727992', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1659389575', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.9175, -96.662, NULL, NULL),
('752536818', 'ELHT00228', 'ELHT00228', 'TXDALSTD', 'Pediatric and Adolescent Assoc of Garland', 'Johanna', 'S', 'Limsenben', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1659389575', 0, 'N', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752582845', 'ELHT00571', 'ELHT00571', 'TXDALSTD', 'Dallas Diagnostic Association Plano', 'Francis', 'G', 'Hill', 'MD', 'Internal Medicine', '', '', NULL, 'O', '4708 Alliance Blvd Baylor Med Pl 1', 'Plano', 'Collin', 'TX', '75093', '4698006000', '4698006001', '4708 Alliance Blvd Baylor Med Pl 1', 'Plano', 'Collin', 'TX', '75093', '4698006000', '4698006001', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1659485134', 0, 'N', 0, '2012-12-20', NULL, NULL, 33.0145, -96.7925, NULL, NULL),
('752582845', 'ELHT00572', 'ELHT00572', 'TXDALSTD', 'Dallas Diagnostic Association Plano', 'Francis', 'G', 'Hill', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1659485134', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752582845', 'ELHT00573', 'ELHT00573', 'TXDALSTD', 'Dallas Diagnostic Association Plano', 'Swati', '', 'Namburi', 'MD', 'Internal Medicine', '', '', NULL, 'O', '4708 Alliance Blvd Baylor Med Pl 1', 'Plano', 'Collin', 'TX', '75093', '4698006000', '4698006001', '4708 Alliance Blvd Baylor Med Pl 1', 'Plano', 'Collin', 'TX', '75093', '4698006000', '4698006001', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1659486447', 0, 'N', 0, '2012-12-20', NULL, NULL, 33.0145, -96.7925, NULL, NULL),
('752582845', 'ELHT00574', 'ELHT00574', 'TXDALSTD', 'Dallas Diagnostic Association Plano', 'Swati', '', 'Namburi', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1659486447', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT01009', 'ELHT01009', 'TXDALSTD', 'Baylor Family Medical Center at Grapevine', 'Paul', '', 'Kim', 'MD', 'Family Practice', '', '', NULL, 'O', '2020 West Hwy 114 Ste 200', 'Grapevine', 'Tarrant', 'TX', '76051', '8174167214', '8174164694', '2020 West Hwy 114 Ste 200', 'Grapevine', 'Tarrant', 'TX', '76051', '8174167214', '8174164694', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-07-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659524304', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT01010', 'ELHT01010', 'TXDALSTD', 'Baylor Family Medical Center at Grapevine', 'Paul', '', 'Kim', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2014-03-02', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659524304', 0, 'Y', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT01011', 'ELHT01011', 'TXDALSTD', 'City Square Community Health Services', 'Jacqueline', '', 'Stephen', 'MD', 'Family Practice', '', '', NULL, 'O', '2835 Grand Ave', 'Dallas', 'Dallas', 'TX', '75215', '2148218644', '2148213282', '2835 Grand Ave', 'Dallas', 'Dallas', 'TX', '75215', '2148218644', '2148213282', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659595403', 0, 'N', 0, '2013-06-14', NULL, NULL, 32.7723, -96.7708, NULL, NULL),
('752536818', 'ELHT01012', 'ELHT01012', 'TXDALSTD', 'City Square Community Health Services', 'Jacqueline', '', 'Stephen', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659595403', 0, 'Y', 0, '2013-06-14', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00575', 'ELHT00575', 'TXDALSTD', 'Southlake Family Medicine', 'Hiyas', 'D', 'Fonte', 'MD', 'Internal Medicine', '', '', NULL, 'O', '731 E Southlake Blvd Ste 100', 'Southlake', 'Tarrant', 'TX', '76092', '8174243366', '8174243426', '731 E Southlake Blvd Ste 100', 'Southlake', 'Tarrant', 'TX', '76092', '8174243366', '8174243426', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1669405064', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.941, -97.1405, 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
('752536818', 'ELHT00576', 'ELHT00576', 'TXDALSTD', 'Southlake Family Medicine', 'Hiyas', 'D', 'Fonte', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1669405064', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752582845', 'ELHT00779', 'ELHT00779', 'TXDALSTD', 'Dallas Diagnostic Association Garland', 'Houston', '', 'Bogus', 'MD', 'Gastroenterology', '', '', NULL, 'O', '601 Clara Barton Blvd Ste 300', 'Garland', 'Dallas', 'TX', '75042', '4698002010', '9722722073', '601 Clara Barton Blvd Ste 300', 'Garland', 'Dallas', 'TX', '75042', '4698002010', '9722722073', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', 'Baylor Regional Medical Center at Plano', NULL, NULL, 'HCFA|UB|', '1669418679', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.9175, -96.662, NULL, NULL),
('752582845', 'ELHT00780', 'ELHT00780', 'TXDALSTD', 'Dallas Diagnostic Association Garland', 'Houston', '', 'Bogus', 'MD', 'Gastroenterology', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', 'Baylor Regional Medical Center at Plano', NULL, NULL, 'HCFA|UB|', '1669418679', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT01161', 'ELHT01161', 'TXDALSTD', 'Cardiology Consultants of Texas', 'Shyla', 'T', 'High', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '621 N Hall St Ste 400', 'Dallas', 'Dallas', 'TX', '75226', '2148248721', '2142376529', '621 N Hall St Ste 400', 'Dallas', 'Dallas', 'TX', '75226', '2148248721', '2142376529', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', NULL, 'HCFA|UB|', '1669446670', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.7879, -96.7802, NULL, NULL),
('752536818', 'ELHT01162', 'ELHT01162', 'TXDALSTD', 'Cardiology Consultants of Texas', 'Shyla', 'T', 'High', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', NULL, 'HCFA|UB|', '1669446670', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00135', 'ELHT00135', 'TXDALSTD', 'Advanced Vein Clinic', 'Rodney', 'R', 'Fritz', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '1110 Cottonwood Ln Ste 210', 'Irving', 'Dallas', 'TX', '75038', '9722594781', '9722511820', '1110 Cottonwood Ln Ste 210', 'Irving', 'Dallas', 'TX', '75038', '9722594781', '9722511820', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, NULL, NULL, 'HCFA|UB|', '1669473278', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.8652, -96.9601, NULL, NULL),
('752536818', 'ELHT00136', 'ELHT00136', 'TXDALSTD', 'Advanced Vein Clinic', 'Rodney', 'R', 'Fritz', 'MD', 'Thoracic Surgery', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, NULL, NULL, 'HCFA|UB|', '1669473278', 0, 'N', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('911947573', 'ELHT00073', 'ELHT00073', 'TXDALSTD', 'ENT Consultants of North Texas', 'Lawrence', 'S', 'Weprin', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '7150 N President Bush Hwy Ste 202', 'Garland', 'Dallas', 'TX', '75044', '9724140408', '9724959084', '7150 N President Bush Hwy Ste 202', 'Garland', 'Dallas', 'TX', '75044', '9724140408', '9724959084', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1679528103', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.9814, -96.6634, NULL, NULL),
('911947573', 'ELHT00074', 'ELHT00074', 'TXDALSTD', 'ENT Consultants of North Texas', 'Lawrence', 'S', 'Weprin', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'B', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '9729230620', '9729380528', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '9729230620', '9729380528', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1679528103', 0, 'N', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('911947573', 'ELHT00279', 'ELHT00279', 'TXDALSTD', 'North Texas Orthopaedic Specialists', 'Jonathan', 'S', 'Quinby', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '3600 Gaston Ave Barnett Tower Ste 1101', 'Dallas', 'Dallas', 'TX', '75246', '2148207010', '2148207015', '3600 Gaston Ave Barnett Tower Ste 1101', 'Dallas', 'Dallas', 'TX', '75246', '2148207010', '2148207015', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1679572499', 0, 'N', 0, '2013-09-16', NULL, NULL, 32.7913, -96.7799, NULL, NULL),
('911947573', 'ELHT00280', 'ELHT00280', 'TXDALSTD', 'North Texas Orthopaedic Specialists', 'Jonathan', 'S', 'Quinby', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '2148208350', '2148208355', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '2148208350', '2148208355', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1679572499', 0, 'N', 0, '2013-09-16', NULL, NULL, 0, 0, NULL, NULL),
('911947573', 'ELHT00737', 'ELHT00737', 'TXDALSTD', 'Surgical Oncology Specialists', 'Keith', 'M', 'Cavaness', 'DO', 'General Surgery', '', '', NULL, 'O', '3410 Worth St Ste 235', 'Dallas', 'Dallas', 'TX', '75246', '2148202302', '2148202303', '3410 Worth St Ste 235', 'Dallas', 'Dallas', 'TX', '75246', '2148202302', '2148202303', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1679695068', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.7886, -96.779, NULL, NULL),
('911947573', 'ELHT00738', 'ELHT00738', 'TXDALSTD', 'Surgical Oncology Specialists', 'Keith', 'M', 'Cavaness', 'DO', 'General Surgery', '', '', NULL, 'B', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '2148208612', '2148202303', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '2148208612', '2148202303', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1679695068', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT01013', 'ELHT01013', 'TXDALSTD', 'Baylor Family Medicine at Garland', 'Reese', 'C', 'Graves', 'MD', 'Family Practice', '', '', NULL, 'O', '601 Clara Barton Blvd Ste 340', 'Garland', 'Dallas', 'TX', '75042', '9722726554', '9722729137', '601 Clara Barton Blvd Ste 340', 'Garland', 'Dallas', 'TX', '75042', '9722726554', '9722729137', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, '', NULL, 'HCFA|UB|', '1679757652', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.9175, -96.662, NULL, NULL),
('752536818', 'ELHT01014', 'ELHT01014', 'TXDALSTD', 'Baylor Family Medicine at Garland', 'Reese', 'C', 'Graves', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, '', NULL, 'HCFA|UB|', '1679757652', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT01015', 'ELHT01015', 'TXDALSTD', 'Baylor Family Medicine at Roanoke', 'Beau', 'J', 'Ellenbecker', 'DO', 'Family Practice', '', '', NULL, 'O', '611 Dallas Dr Ste 101', 'Roanoke', 'Denton', 'TX', '76262', '8179128200', '8179128210', '611 Dallas Dr Ste 101', 'Roanoke', 'Denton', 'TX', '76262', '8179128200', '8179128210', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, NULL, NULL, 'HCFA|UB|', '1679774582', 0, 'N', 0, '2012-12-20', NULL, NULL, 33.0007, -97.2218, NULL, NULL),
('752536818', 'ELHT01016', 'ELHT01016', 'TXDALSTD', 'Baylor Family Medicine at Roanoke', 'Beau', 'J', 'Ellenbecker', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, NULL, NULL, 'HCFA|UB|', '1679774582', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT01163', 'ELHT01163', 'TXDALSTD', 'Cottonwood Cardiology', 'Michael', '', 'Rothkopf', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1110 Cottonwood Ln Ste 105', 'Irving', 'Dallas', 'TX', '75038', '9726072525', '9722528837', '1110 Cottonwood Ln Ste 105', 'Irving', 'Dallas', 'TX', '75038', '9726072525', '9722528837', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, NULL, NULL, 'HCFA|UB|', '1689673576', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.8652, -96.9601, NULL, NULL),
('752536818', 'ELHT01164', 'ELHT01164', 'TXDALSTD', 'Cottonwood Cardiology', 'Michael', '', 'Rothkopf', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, NULL, NULL, 'HCFA|UB|', '1689673576', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('911947573', 'ELHT00007', 'ELHT00007', 'TXDALSTD', 'Colon and Rectal Surgical Associates', 'James', 'W', 'Fleshman', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'O', '3410 Worth St Ste 235', 'Dallas', 'Dallas', 'TX', '75246', '2148208612', '2148208614', '3410 Worth St Ste 235', 'Dallas', 'Dallas', 'TX', '75246', '2148208612', '2148208614', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1689692105', 0, 'N', 0, '2013-12-09', NULL, NULL, 32.7886, -96.779, NULL, NULL),
('911947573', 'ELHT00008', 'ELHT00008', 'TXDALSTD', 'Colon and Rectal Surgical Associates', 'James', 'W', 'Fleshman', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'B', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '2148208612', '2148202303', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '2148208612', '2148202303', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1689692105', 0, 'N', 0, '2013-12-09', NULL, NULL, 0, 0, NULL, NULL),
('752582845', 'ELHT00331', 'ELHT00331', 'TXDALSTD', 'Dallas Diagnostic Association Plano', 'Michael', 'P', 'Kellam', 'MD', 'Neurology', '', '', NULL, 'O', '4708 Alliance Blvd Baylor Med Pl 1', 'Plano', 'Collin', 'TX', '75093', '4698006000', '4698006001', '4708 Alliance Blvd Baylor Med Pl 1', 'Plano', 'Collin', 'TX', '75093', '4698006000', '4698006001', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1689789950', 0, 'N', 0, '2012-12-20', NULL, NULL, 33.0145, -96.7925, NULL, NULL),
('752582845', 'ELHT00332', 'ELHT00332', 'TXDALSTD', 'Dallas Diagnostic Association Plano', 'Michael', 'P', 'Kellam', 'MD', 'Neurology', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1689789950', 0, 'N', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('911947573', 'ELHT00577', 'ELHT00577', 'TXDALSTD', 'MedProvider Inpatient Care Unit', 'Miguel', 'A', 'Hernandez', 'DO', 'Internal Medicine', '', '', NULL, 'O', '3500 Gaston Ave Roberts Tower 4th Fl', 'Dallas', 'Dallas', 'TX', '75246', '2148203000', '2148203022', '3500 Gaston Ave Roberts Tower 4th Fl', 'Dallas', 'Dallas', 'TX', '75246', '2148203000', '2148203022', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-10-07', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1689835993', 0, 'N', 0, '2013-12-09', NULL, NULL, 32.79, -96.7806, NULL, NULL),
('911947573', 'ELHT00578', 'ELHT00578', 'TXDALSTD', 'MedProvider Inpatient Care Unit', 'Miguel', 'A', 'Hernandez', 'DO', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '2148203000', '2148203022', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '2148203000', '2148203022', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-10-07', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1689835993', 0, 'Y', 0, '2013-12-09', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00051', 'ELHT00051', 'TXDALSTD', 'Endocrinology Specialists of McKinney', 'Vivienne', '', 'Yoon', 'MD', 'Endocrinology', '', '', NULL, 'O', '5236 W University Dr Ste 2200', 'McKinney', 'Collin', 'TX', '75071', '4698005400', '4698005410', '5236 W University Dr Ste 2200', 'McKinney', 'Collin', 'TX', '75071', '4698005400', '4698005410', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1689899221', 0, 'N', 0, '2013-09-30', NULL, NULL, 33.2183, -96.684, NULL, NULL),
('752536818', 'ELHT00052', 'ELHT00052', 'TXDALSTD', 'Endocrinology Specialists of McKinney', 'Vivienne', '', 'Yoon', 'MD', 'Endocrinology', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1689899221', 0, 'N', 0, '2013-09-30', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00229', 'ELHT00229', 'TXDALSTD', 'Baylor Pediatric Center', 'Jenny', 'T', 'Clifford', 'MD', 'Pediatrics', '', '', NULL, 'O', '9101 N Central Expwy Ste 420', 'Dallas', 'Dallas', 'TX', '75231', '2148232525', '2148260466', '9101 N Central Expy Ste 420', 'Dallas', 'Dallas', 'TX', '75231', '2148232525', '2148260466', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1699705806', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.873, -96.7706, NULL, NULL),
('752536818', 'ELHT00230', 'ELHT00230', 'TXDALSTD', 'Baylor Pediatric Center', 'Jenny', 'T', 'Clifford', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1699705806', 0, 'N', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00003', 'ELHT00003', 'TXDALSTD', 'Cardiology Consultants of Texas', 'Alan', 'S', 'Donsky', 'MD', 'Cardiology', '', '', NULL, 'O', '621 N Hall St Ste 400', 'Dallas', 'Dallas', 'TX', '75226', '2148248721', '2142376529', '621 N Hall St Ste 400', 'Dallas', 'Dallas', 'TX', '75226', '2148248721', '2142376529', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1699734731', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.7879, -96.7802, NULL, NULL),
('752536818', 'ELHT00004', 'ELHT00004', 'TXDALSTD', 'Cardiology Consultants of Texas', 'Alan', 'S', 'Donsky', 'MD', 'Cardiology', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1699734731', 0, 'Y', 0, '2013-03-13', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00579', 'ELHT00579', 'TXDALSTD', 'Baylor Health Center at Park Cities', 'Paul', 'D', 'Wade', 'MD', 'Internal Medicine', '', '', NULL, 'O', '9101 N Central Expwy Ste 300', 'Dallas', 'Dallas', 'TX', '75231', '2143632305', '2143632608', '9101 N Central Expy Ste 300', 'Dallas', 'Dallas', 'TX', '75231', '2143632305', '2143632608', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1699776484', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.873, -96.7706, NULL, NULL),
('752536818', 'ELHT00580', 'ELHT00580', 'TXDALSTD', 'Baylor Health Center at Park Cities', 'Paul', 'D', 'Wade', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1699776484', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT01017', 'ELHT01017', 'TXDALSTD', 'Family Medical Center at Garland', 'Mark', 'S', 'Mlcak', 'MD', 'Family Practice', '', '', NULL, 'O', '601 Clara Barton Blvd Ste 140', 'Garland', 'Dallas', 'TX', '75042', '9722726561', '9722763067', '601 Clara Barton Blvd Ste 140', 'Garland', 'Dallas', 'TX', '75042', '9722726561', '9722763067', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1699797936', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.9175, -96.662, NULL, NULL),
('752536818', 'ELHT01018', 'ELHT01018', 'TXDALSTD', 'Family Medical Center at Garland', 'Mark', 'S', 'Mlcak', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1699797936', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT01019', 'ELHT01019', 'TXDALSTD', 'Baylor Family Medicine at Flower Mound', 'Raul', '', 'Villalon', 'MD', 'Family Practice', '', '', NULL, 'O', '1110 Parker Sq', 'Flower Mound', 'Denton', 'TX', '75028', '9727241707', '9727241407', '1110 Parker Sq', 'Flower Mound', 'Denton', 'TX', '75028', '9727241707', '9727241407', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, NULL, NULL, 'HCFA|UB|', '1699814624', 0, 'N', 0, '2012-12-20', NULL, NULL, 33.0394, -97.0537, NULL, NULL),
('752536818', 'ELHT01020', 'ELHT01020', 'TXDALSTD', 'Baylor Family Medicine at Flower Mound', 'Raul', '', 'Villalon', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, NULL, NULL, 'HCFA|UB|', '1699814624', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00581', 'ELHT00581', 'TXDALSTD', 'NTHCA Inpatient Care Unit', 'Sindura', '', 'Katta', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1901 N MacArthur Blvd', 'Irving', 'Dallas', 'TX', '75061', '9725798485', '9725793972', '1901 N MacArthur Blvd', 'Irving', 'Dallas', 'TX', '75061', '9725798485', '9725793972', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-06-23', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1699917765', 0, 'Y', 0, '2013-07-30', NULL, NULL, 32.8352, -96.961, NULL, NULL),
('752536818', 'ELHT00582', 'ELHT00582', 'TXDALSTD', 'NTHCA Inpatient Care Unit', 'Sindura', '', 'Katta', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-06-23', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1699917765', 0, 'Y', 0, '2013-07-30', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00251', 'ELHT00251', 'TXDALSTD', 'Neurometabolic Consultants', 'Raphael', '', 'Schiffmann', 'MD', 'Pediatric Neurology', '', '', NULL, 'O', '3600 Gaston Ave Wadley Tower Ste 1155', 'Dallas', 'Dallas', 'TX', '75246', '2148204688', '2148204562', '3600 Gaston Ave Wadley Ste 1155', 'Dallas', 'Dallas', 'TX', '75246', '2148204688', '2148204562', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1700037603', 0, 'Y', 0, '2012-12-20', NULL, NULL, 32.7913, -96.7799, NULL, NULL),
('752536818', 'ELHT00252', 'ELHT00252', 'TXDALSTD', 'Neurometabolic Consultants', 'Raphael', '', 'Schiffmann', 'MD', 'Pediatric Neurology', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1700037603', 0, 'N', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752582845', 'ELHT00021', 'ELHT00021', 'TXDALSTD', 'Dallas Diagnostic Association Plano', 'Matthew', 'W', 'Curry', 'MD', 'Critical Care', '', '', NULL, 'O', '4708 Alliance Blvd Baylor Med Pl 1', 'Plano', 'Collin', 'TX', '75093', '4698006000', '4698006001', '4708 Alliance Blvd Baylor Med Pl 1', 'Plano', 'Collin', 'TX', '75093', '4698006000', '4698006001', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1700808797', 0, 'Y', 0, '2012-12-20', NULL, NULL, 33.0145, -96.7925, NULL, NULL),
('752582845', 'ELHT00022', 'ELHT00022', 'TXDALSTD', 'Dallas Diagnostic Association Plano', 'Matthew', 'W', 'Curry', 'MD', 'Critical Care', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1700808797', 0, 'N', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752600832', 'ELHT00583', 'ELHT00583', 'TXDALSTD', 'MedProvider', 'Fay', 'E', 'Simon', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3434 Swiss Ave Ste 410', 'Dallas', 'Dallas', 'TX', '75204', '2148285010', '2148285011', '3434 Swiss Ave Ste 410', 'Dallas', 'Dallas', 'TX', '75204', '2148285010', '2148285011', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1700830171', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.7915, -96.7824, NULL, NULL),
('752536818', 'ELHT01165', 'ELHT01165', 'TXDALSTD', 'Legacy Heart Group', 'David', 'A', 'Rawitscher', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '6601 Preston Rd', 'Plano', 'Collin', 'TX', '75024', '4698006300', '4698006351', '6601 Preston Rd', 'Plano', 'Collin', 'TX', '75024', '4698006300', '4698006351', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1700873247', 0, 'N', 0, '2014-01-08', NULL, NULL, 33.0625, -96.7963, NULL, NULL),
('752536818', 'ELHT01166', 'ELHT01166', 'TXDALSTD', 'Legacy Heart Group', 'David', 'A', 'Rawitscher', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1700873247', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('911947573', 'ELHT00333', 'ELHT00333', 'TXDALSTD', 'Neuro Oncology Associates', 'Isaac', '', 'Melguizo Gavilanes', 'MD', 'Neurology', '', '', NULL, 'O', '3410 Worth St Ste 820', 'Dallas', 'Dallas', 'TX', '75246', '2148208690', '2148208691', '3410 Worth St Ste 820', 'Dallas', 'Dallas', 'TX', '75246', '2148208690', '2148208691', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1710157078', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.7886, -96.779, NULL, NULL),
('911947573', 'ELHT00334', 'ELHT00334', 'TXDALSTD', 'Neuro Oncology Associates', 'Isaac', '', 'Melguizo Gavilanes', 'MD', 'Neurology', '', '', NULL, 'B', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '2148208612', '2148208614', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '2148208612', '2148208614', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1710157078', 0, 'N', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('911947573', 'ELHT00585', 'ELHT00585', 'TXDALSTD', 'Health Texas Provider Network', 'Robert', 'H', 'Beard', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3500 Gaston Ave Roberts Tower 4th Fl', 'Dallas', 'Dallas', 'TX', '75246', '2148203000', '2148203022', '3500 Gaston Ave Roberts Tower 4th Fl', 'Dallas', 'Dallas', 'TX', '75246', '2148203000', '2148203022', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', NULL, 'HCFA|UB|', '1710901764', 0, 'N', 0, '2013-06-12', NULL, NULL, 32.7911, -96.7802, NULL, NULL),
('911947573', 'ELHT00586', 'ELHT00586', 'TXDALSTD', 'Health Texas Provider Network', 'Robert', 'H', 'Beard', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '2148203000', '2148203022', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '2148203000', '2148203022', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', NULL, 'HCFA|UB|', '1710901764', 0, 'Y', 0, '2013-06-12', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT01167', 'ELHT01167', 'TXDALSTD', 'Legacy Heart Group', 'Waenard', 'W', 'Miller', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '6601 Preston Rd', 'Plano', 'Collin', 'TX', '75024', '4698006300', '4698006351', '6601 Preston Rd', 'Plano', 'Collin', 'TX', '75024', '4698006300', '4698006351', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1710974241', 0, 'N', 0, '2014-01-08', NULL, NULL, 33.0625, -96.7963, NULL, NULL),
('752536818', 'ELHT01168', 'ELHT01168', 'TXDALSTD', 'Legacy Heart Group', 'Waenard', 'W', 'Miller', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1710974241', 0, 'Y', 0, '2013-04-05', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT01209', 'ELHT01209', 'TXDALSTD', 'Cottonwood Cardiology', 'Armando', '', 'Yepes', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1110 Cottonwood Ln Ste 105', 'Irving', 'Dallas', 'TX', '75038', '9726072525', '9722528837', '1110 Cottonwood Ln Ste 105', 'Irving', 'Dallas', 'TX', '75038', '9726072525', '9722528837', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', 'Baylor Medical Center at Irving', NULL, NULL, 'HCFA|UB|', '1710987458', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.8652, -96.9601, NULL, NULL),
('752536818', 'ELHT01210', 'ELHT01210', 'TXDALSTD', 'Cottonwood Cardiology', 'Armando', '', 'Yepes', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', 'Baylor Medical Center at Irving', NULL, NULL, 'HCFA|UB|', '1710987458', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00587', 'ELHT00587', 'TXDALSTD', 'Baylor Community Care at Garland', 'Leigh', 'E', 'Nguyen', 'MD', 'Internal Medicine', '', '', NULL, 'O', '601 Clara Barton Blvd Ste 180', 'Garland', 'Dallas', 'TX', '75042', '4698002050', '4698002059', '601 Clara Barton Ste 180', 'Garland', 'Dallas', 'TX', '75042', '4698002050', '4698002059', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1720009095', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.9175, -96.662, NULL, NULL),
('752536818', 'ELHT00588', 'ELHT00588', 'TXDALSTD', 'Baylor Community Care at Garland', 'Leigh', 'E', 'Nguyen', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1720009095', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT01169', 'ELHT01169', 'TXDALSTD', 'LVAD Clinic', 'Brian', 'W', 'Hardaway', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '8080 N Central Expwy Ste 600 LB 82', 'Dallas', 'Dallas', 'TX', '75206', '8663771650', '4694675905', '8080 N Central Expwy Ste 600 LB 82', 'Dallas', 'Dallas', 'TX', '75206', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1720032402', 0, 'N', 0, '2013-11-04', NULL, NULL, 32.8607, -96.7699, NULL, NULL),
('752536818', 'ELHT01170', 'ELHT01170', 'TXDALSTD', 'LVAD Clinic', 'Brian', 'W', 'Hardaway', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1720032402', 0, 'Y', 0, '2013-11-04', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00137', 'ELHT00137', 'TXDALSTD', 'Cardiovascular Surgical Specialists of Irving', 'Larry', 'W', 'Schorn', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '1110 Cottonwood Ln Ste 215', 'Irving', 'Dallas', 'TX', '75038', '9722594781', '4694177947', '1110 Cottonwood Ln Ste 215', 'Irving', 'Dallas', 'TX', '75038', '9722594781', '4694177947', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, NULL, NULL, 'HCFA|UB|', '1720076276', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.8652, -96.9601, NULL, NULL),
('752536818', 'ELHT00138', 'ELHT00138', 'TXDALSTD', 'Cardiovascular Surgical Specialists of Irving', 'Larry', 'W', 'Schorn', 'MD', 'Thoracic Surgery', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, NULL, NULL, 'HCFA|UB|', '1720076276', 0, 'N', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00063', 'ELHT00063', 'TXDALSTD', 'Supportive and Palliative Care Clinic at BUMC', 'Robert', 'L', 'Fine', 'MD', 'Hospice', '', '', NULL, 'O', '3600 Gaston Ave Barnett Tower Ste 605', 'Dallas', 'Dallas', 'TX', '75246', '2148209248', '2148209458', '3600 Gaston Ave Barnett Ste 605', 'Dallas', 'Dallas', 'TX', '75246', '2148209248', '2148209458', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1720090178', 0, 'Y', 0, '2012-12-20', NULL, NULL, 32.7913, -96.7799, NULL, NULL),
('752536818', 'ELHT00064', 'ELHT00064', 'TXDALSTD', 'Supportive and Palliative Care Clinic at BUMC', 'Robert', 'L', 'Fine', 'MD', 'Hospice', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1720090178', 0, 'N', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('911947573', 'ELHT01021', 'ELHT01021', 'TXDALSTD', '', 'Joshua', 'L', 'Gilchrist', 'MD', 'Family Practice', '', '', NULL, 'O', '1405 W Jefferson St', 'Waxahachie', 'Ellis', 'TX', '75165', '9729237144', '9729237145', '1405 W Jefferson St', 'Waxahachie', 'Ellis', 'TX', '75165', '9729237144', '9729237145', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, '', NULL, 'HCFA|UB|', '1720216476', 0, 'N', 0, '2014-01-24', NULL, NULL, 32.3968, -96.865, NULL, NULL),
('911947573', 'ELHT01022', 'ELHT01022', 'TXDALSTD', '', 'Joshua', 'L', 'Gilchrist', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '9729230620', '9729380528', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '9729230620', '9729380528', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, '', NULL, 'HCFA|UB|', '1720216476', 0, 'Y', 0, '2014-01-24', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00589', 'ELHT00589', 'TXDALSTD', 'Internal Medicine Associates at Irving', 'Sherif', 'M', 'Rizkalla', 'DO', 'Internal Medicine', '', '', NULL, 'O', '2021 N MacArthur Blvd Ste 520', 'Irving', 'Dallas', 'TX', '75061', '9722512388', '9722512390', '2021 N MacArthur Blvd Ste 520', 'Irving', 'Dallas', 'TX', '75061', '9722512388', '9722512390', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, NULL, NULL, 'HCFA|UB|', '1720280647', 0, 'N', 0, '2013-01-04', NULL, NULL, 32.835, -96.9592, NULL, NULL),
('752536818', 'ELHT00590', 'ELHT00590', 'TXDALSTD', 'Internal Medicine Associates at Irving', 'Sherif', 'M', 'Rizkalla', 'DO', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, NULL, NULL, 'HCFA|UB|', '1720280647', 0, 'Y', 0, '2013-01-04', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00023', 'ELHT00023', 'TXDALSTD', 'Critical Care and Pulmonary Consultants of Dallas', 'William', 'C', 'Haden', 'MD', 'Critical Care', '', '', NULL, 'O', '3600 Gaston Ave Wadley Tower Ste 550', 'Dallas', 'Dallas', 'TX', '75246', '9724510219', '2148211193', '3600 Gaston Ave Wadley Ste 550', 'Dallas', 'Dallas', 'TX', '75246', '9724510219', '2148211193', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1730119009', 0, 'Y', 0, '2012-12-20', NULL, NULL, 32.7913, -96.7799, NULL, NULL),
('752536818', 'ELHT00024', 'ELHT00024', 'TXDALSTD', 'Critical Care and Pulmonary Consultants of Dallas', 'William', 'C', 'Haden', 'MD', 'Critical Care', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1730119009', 0, 'N', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00191', 'ELHT00191', 'TXDALSTD', 'Physiatric Medicine Associates', 'Rita', 'G', 'Hamilton', 'DO', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '909 N Washington Ave', 'Dallas', 'Dallas', 'TX', '75246', '2148209593', '9724808356', '909 N Washington', 'Dallas', 'Dallas', 'TX', '75246', '2148209593', '9724808356', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', NULL, 'HCFA|UB|', '1730197450', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.7918, -96.7791, NULL, NULL),
('752536818', 'ELHT00192', 'ELHT00192', 'TXDALSTD', 'Physiatric Medicine Associates', 'Rita', 'G', 'Hamilton', 'DO', 'Physical Medicine and Rehabilitation', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', NULL, 'HCFA|UB|', '1730197450', 0, 'N', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00335', 'ELHT00335', 'TXDALSTD', 'Dallas Diagnostic Association Garland', 'Jai', '', 'Kumar', 'MD', 'Neurology', '', '', NULL, 'O', '601 Clara Barton Blvd Ste 300', 'Garland', 'Dallas', 'TX', '75042', '4698002000', '9722722073', '601 Clara Barton Blvd Ste 300', 'Garland', 'Dallas', 'TX', '75042', '4698002000', '9722722073', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1730271768', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.9175, -96.662, NULL, NULL),
('752536818', 'ELHT00336', 'ELHT00336', 'TXDALSTD', 'Dallas Diagnostic Association Garland', 'Jai', '', 'Kumar', 'MD', 'Neurology', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1730271768', 0, 'N', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT01023', 'ELHT01023', 'TXDALSTD', 'Diabetes Health and Wellness Institute', 'Folashade', 'F', 'Lester', 'MD', 'Family Practice', '', '', NULL, 'O', '4500 Spring Ave', 'Dallas', 'Dallas', 'TX', '75210', '2143494325', '2149153251', '4500 Spring Ave', 'Dallas', 'Dallas', 'TX', '75210', '2143494325', '2149153251', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1730279704', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.7743, -96.7423, NULL, NULL),
('752536818', 'ELHT01024', 'ELHT01024', 'TXDALSTD', 'Diabetes Health and Wellness Institute', 'Folashade', 'F', 'Lester', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1730279704', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
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('752536818', 'ELHT00140', 'ELHT00140', 'TXDALSTD', 'Cardiac Surgery at Baylor University Medical Center at Dallas', 'Alexis', 'E', 'Shafii', 'MD', 'Thoracic Surgery', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1730354945', 0, 'N', 0, '2014-01-08', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00231', 'ELHT00231', 'TXDALSTD', 'Southlake Family Medicine', 'David', 'O', 'Johnson', 'MD', 'Pediatrics', '', '', NULL, 'O', '731 E Southlake Blvd Ste 100', 'Southlake', 'Tarrant', 'TX', '76092', '8174243366', '8174243426', '731 E Southlake Blvd Ste 100', 'Southlake', 'Tarrant', 'TX', '76092', '8174243366', '8174243426', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1740204692', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.941, -97.1405, NULL, NULL),
('752536818', 'ELHT00232', 'ELHT00232', 'TXDALSTD', 'Southlake Family Medicine', 'David', 'O', 'Johnson', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1740204692', 0, 'N', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00591', 'ELHT00591', 'TXDALSTD', 'Internal Medicine Associates at Southwest Ft Worth', 'Nettie', 'N', 'Davidson', 'MD', 'Internal Medicine', '', '', NULL, 'O', '5701 Bryant Irvin Rd Ste 302', 'Ft Worth', 'Tarrant', 'TX', '76132', '8172949000', '8172949010', '5701 Bryant Irvin Rd Ste 302', 'Ft Worth', 'Tarrant', 'TX', '76132', '8172949000', '8172949010', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', NULL, 'HCFA|UB|', '1740219005', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.6664, -97.4199, NULL, NULL),
('752536818', 'ELHT00592', 'ELHT00592', 'TXDALSTD', 'Internal Medicine Associates at Southwest Ft Worth', 'Nettie', 'N', 'Davidson', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', NULL, 'HCFA|UB|', '1740219005', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT01025', 'ELHT01025', 'TXDALSTD', 'Baylor Occupational and Family Health Center', 'Malea', 'P', 'Maynard', 'MD', 'Family Practice', '', '', NULL, 'O', '13350 Ti Blvd Ste MS327', 'Dallas', 'Dallas', 'TX', '75243', '9726719504', '9726717096', '13350 TI Blvd Ste. 327', 'Dallas', 'Dallas', 'TX', '75243', '9726719504', '9726717096', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1740219229', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.9284, -96.749, NULL, NULL),
('752536818', 'ELHT01026', 'ELHT01026', 'TXDALSTD', 'Baylor Occupational and Family Health Center', 'Malea', 'P', 'Maynard', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1740219229', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00233', 'ELHT00233', 'TXDALSTD', 'Baylor Family Health Center at Mesquite', 'Julian', 'K', 'Lacey', 'MD', 'Pediatrics', '', '', NULL, 'O', '1575 I-30', 'Mesquite', 'Dallas', 'TX', '75150', '4698002800', '4698002801', '1575 I 30', 'Mesquite', 'Dallas', 'TX', '75150', '4698002800', '4698002801', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1740239102', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.8297, -96.6193, NULL, NULL),
('752536818', 'ELHT00234', 'ELHT00234', 'TXDALSTD', 'Baylor Family Health Center at Mesquite', 'Julian', 'K', 'Lacey', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1740239102', 0, 'N', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00281', 'ELHT00281', 'TXDALSTD', 'Orthopedic Associates of Dallas', 'James', 'W', 'Brodsky', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '3900 Junius St Ste 500', 'Dallas', 'Dallas', 'TX', '75246', '2148237090', '2148231644', '3900 Junius St Ste 500', 'Dallas', 'Dallas', 'TX', '75246', '2148237090', '2148231644', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-05-31', 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1740270206', 0, 'N', 0, '2013-07-31', NULL, NULL, 32.7913, -96.7775, NULL, NULL),
('752536818', 'ELHT00282', 'ELHT00282', 'TXDALSTD', 'Orthopedic Associates of Dallas', 'James', 'W', 'Brodsky', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '2148181288', '2148181291', 'PO Box 844128  ', 'Dallas', 'Dallas', 'TX', '75284', '2148181288', '2148181291', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1740270206', 0, 'N', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752582845', 'ELHT00025', 'ELHT00025', 'TXDALSTD', 'Dallas Diagnostic Association Plano', 'Gary', 'E', 'Erwin', 'MD', 'Critical Care', '', '', NULL, 'O', '4708 Alliance Blvd Baylor Med Pl 1', 'Plano', 'Collin', 'TX', '75093', '4698006000', '4698006001', '4708 Alliance Blvd Baylor Med Pl 1', 'Plano', 'Collin', 'TX', '75093', '4698006000', '4698006001', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1750322954', 0, 'Y', 0, '2012-12-20', NULL, NULL, 33.0145, -96.7925, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('752582845', 'ELHT00026', 'ELHT00026', 'TXDALSTD', 'Dallas Diagnostic Association Plano', 'Gary', 'E', 'Erwin', 'MD', 'Critical Care', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1750322954', 0, 'N', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752600832', 'ELHT00593', 'ELHT00593', 'TXDALSTD', '', 'Robert', 'B', 'Allison', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3434 Swiss Ave Ste 430', 'Dallas', 'Dallas', 'TX', '75204', '2148285030', '2148285031', '3434 Swiss Ave Ste 430', 'Dallas', 'Dallas', 'TX', '75204', '2148285030', '2148285031', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', 'Baylor Medical Center at Uptown', NULL, NULL, 'HCFA|UB|', '1750339719', 0, 'N', 0, '2014-01-30', NULL, NULL, 32.7915, -96.7824, NULL, NULL),
('752536818', 'ELHT01027', 'ELHT01027', 'TXDALSTD', 'Baylor Family Medicine at Garland', 'Christine', 'Y', 'Liu', 'MD', 'Family Practice', '', '', NULL, 'O', '601 Clara Barton Blvd Ste 340', 'Garland', 'Dallas', 'TX', '75042', '9722726554', '9722729137', '601 Clara Barton Blvd Ste 340', 'Garland', 'Dallas', 'TX', '75042', '9722726554', '9722729137', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, '', NULL, 'HCFA|UB|', '1750456232', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.9175, -96.662, NULL, NULL),
('752536818', 'ELHT01028', 'ELHT01028', 'TXDALSTD', 'Baylor Family Medicine at Garland', 'Christine', 'Y', 'Liu', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, '', NULL, 'HCFA|UB|', '1750456232', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('911947573', 'ELHT00595', 'ELHT00595', 'TXDALSTD', 'MedProvider Inpatient Care Unit', 'Sharmila', '', 'Dias', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3500 Gaston Ave Roberts Tower 4th Fl', 'Dallas', 'Dallas', 'TX', '75246', '2148203000', '2148203022', '3500 Gaston Ave 4th floor', 'Dallas', 'Dallas', 'TX', '75246', '2148203000', '2148203022', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', NULL, 'HCFA|UB|', '1760403760', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.7911, -96.7802, NULL, NULL),
('911947573', 'ELHT00596', 'ELHT00596', 'TXDALSTD', 'MedProvider Inpatient Care Unit', 'Sharmila', '', 'Dias', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '2148203000', '2148203022', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '2148203000', '2148203022', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', NULL, 'HCFA|UB|', '1760403760', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT01029', 'ELHT01029', 'TXDALSTD', 'Baylor Family Medicine at Frisco', 'Warren', 'B', 'Jenkins', 'DO', 'Family Practice', '', '', NULL, 'O', '2840 Legacy Dr Ste 400', 'Frisco', 'Denton', 'TX', '75034', '9727123652', '2146183614', '2840 Legacy Dr Ste 400', 'Frisco', 'Denton', 'TX', '75034', '9727123652', '2146183614', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Frisco', NULL, NULL, NULL, 'HCFA|UB|', '1760410005', 0, 'N', 0, '2012-12-20', NULL, NULL, 33.1028, -96.8415, NULL, NULL),
('752536818', 'ELHT01030', 'ELHT01030', 'TXDALSTD', 'Baylor Family Medicine at Frisco', 'Warren', 'B', 'Jenkins', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Frisco', NULL, NULL, NULL, 'HCFA|UB|', '1760410005', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT01171', 'ELHT01171', 'TXDALSTD', 'Cardiovascular Consultants of North Texas', 'Thomas', '', 'Waller', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '6300 W Parker Rd MOB II 125', 'Plano', 'Collin', 'TX', '75093', '4698004400', '4698004410', '6300 W Parker Rd MOB II 125', 'Plano', 'Collin', 'TX', '75093', '4698004400', '4698004410', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, '', '', 'HCFA|UB|', '1760410187', 0, 'N', 0, '2013-12-09', NULL, NULL, 33.0451, -96.8374, NULL, NULL),
('752536818', 'ELHT01172', 'ELHT01172', 'TXDALSTD', 'Cardiovascular Consultants of North Texas', 'Thomas', '', 'Waller', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, '', '', 'HCFA|UB|', '1760410187', 0, 'Y', 0, '2013-12-09', NULL, NULL, 0, 0, NULL, NULL),
('911947573', 'ELHT00597', 'ELHT00597', 'TXDALSTD', 'Baylor Family Medical Center at Ellis County Waxahachie', 'Thomas', 'G', 'Ledbetter', 'MD', 'Internal Medicine', '', '', NULL, 'O', '505 N Hwy 77 Ste 200', 'Waxahachie', 'Ellis', 'TX', '75165', '9729231686', '9729377731', '505 N Hwy 77 Ste 200', 'Waxahachie', 'Ellis', 'TX', '75165', '9729231686', '9729377731', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1760426092', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.3965, -96.8453, NULL, NULL),
('911947573', 'ELHT00598', 'ELHT00598', 'TXDALSTD', 'Baylor Family Medical Center at Ellis County Waxahachie', 'Thomas', 'G', 'Ledbetter', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '9729231686', '9729239268', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '9729231686', '9729239268', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1760426092', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('911947573', 'ELHT00599', 'ELHT00599', 'TXDALSTD', 'Baylor Family Medical Center at Ellis County Waxahachie', 'Patti', 'G', 'Powell', 'MD', 'Internal Medicine', '', '', NULL, 'O', '505 N Hwy 77 Ste 200', 'Waxahachie', 'Ellis', 'TX', '75165', '9729231686', '9729377731', '505 N Hwy 77 Ste 200', 'Waxahachie', 'Ellis', 'TX', '75165', '9729231686', '9729377731', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1760428064', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.3965, -96.8453, NULL, NULL),
('911947573', 'ELHT00600', 'ELHT00600', 'TXDALSTD', 'Baylor Family Medical Center at Ellis County Waxahachie', 'Patti', 'G', 'Powell', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '9729231686', '9729239268', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '9729231686', '9729239268', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1760428064', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT01031', 'ELHT01031', 'TXDALSTD', 'Family Medical Center at North Garland', 'Chris', 'A', 'Clark', 'MD', 'Family Practice', '', '', NULL, 'O', '5345 N George Bush Fwy', 'Garland', 'Dallas', 'TX', '75040', '9724955888', '9724950588', '5345 N George Bush Fwy', 'Garland', 'Dallas', 'TX', '75040', '9724955888', '9724950588', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1760457857', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.9651, -96.6418, NULL, NULL),
('752536818', 'ELHT01032', 'ELHT01032', 'TXDALSTD', 'Family Medical Center at North Garland', 'Chris', 'A', 'Clark', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1760457857', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT01033', 'ELHT01033', 'TXDALSTD', 'Baylor Family Medical Center at Grapevine', 'Saira', '', 'Jamal', 'MD', 'Family Practice', '', '', NULL, 'O', '2020 West Hwy 114 Ste 200', 'Grapevine', 'Tarrant', 'TX', '76051', '8174167214', '8174164694', '2020 West Hwy 114 Ste 200', 'Grapevine', 'Tarrant', 'TX', '76051', '8174167214', '8174164694', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-07-14', 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, NULL, NULL, 'HCFA|UB|', '1760496004', 0, 'N', 0, '2013-07-31', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT01034', 'ELHT01034', 'TXDALSTD', 'Baylor Family Medical Center at Grapevine', 'Saira', '', 'Jamal', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, NULL, NULL, 'HCFA|UB|', '1760496004', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00739', 'ELHT00739', 'TXDALSTD', 'Breast Care Specialists of Texas', 'Vaishali', 'T', 'Kent', 'MD', 'General Surgery', '', '', NULL, 'O', '1250 8th Ave Ste 545', 'Ft Worth', 'Tarrant', 'TX', '76104', '8179128080', '8179128089', '1250 8th Ave Ste 545', 'Ft Worth', 'Tarrant', 'TX', '76104', '8179128080', '8179128089', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', NULL, 'HCFA|UB|', '1760649867', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.7312, -97.3437, NULL, NULL),
('752536818', 'ELHT00740', 'ELHT00740', 'TXDALSTD', 'Breast Care Specialists of Texas', 'Vaishali', 'T', 'Kent', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', NULL, 'HCFA|UB|', '1760649867', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00283', 'ELHT00283', 'TXDALSTD', 'Orthopedic Associates of Dallas', 'Veerabhadra', '', 'Reddy', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '7777 Forest Ln Ste C106', 'Dallas', 'Dallas', 'TX', '75230', '2148237090', '2148231644', '7777 Forest Ln Ste C106', 'Dallas', 'Dallas', 'TX', '75230', '2148237090', '2148231644', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-05-31', 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1760685705', 0, 'N', 0, '2013-07-31', NULL, NULL, 32.9114, -96.7743, NULL, NULL),
('752536818', 'ELHT00284', 'ELHT00284', 'TXDALSTD', 'Orthopedic Associates of Dallas', 'Veerabhadra', '', 'Reddy', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '2148181288', '2148181291', 'PO Box 844128  ', 'Dallas', 'Dallas', 'TX', '75284', '2148181288', '2148181291', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1760685705', 0, 'N', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00601', 'ELHT00601', 'TXDALSTD', 'Inpatient Care Unit at Baylor Medical Center Garland', 'Nishant', 'S', 'Jayaswal', 'MD', 'Internal Medicine', '', '', NULL, 'O', '700 Walter Reed Blvd Ste 204', 'Garland', 'Dallas', 'TX', '75042', '9724875462', '9724875277', '700 Walter Reed Blvd Ste 204', 'Garland', 'Dallas', 'TX', '75042', '9724875462', '9724875277', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760713424', 0, 'Y', 0, '2013-05-01', NULL, NULL, 32.9186, -96.6634, NULL, NULL),
('752536818', 'ELHT00602', 'ELHT00602', 'TXDALSTD', 'Inpatient Care Unit at Baylor Medical Center Garland', 'Nishant', 'S', 'Jayaswal', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760713424', 0, 'Y', 0, '2013-05-01', NULL, NULL, 0, 0, NULL, NULL),
('751837454', 'ELHT00603', 'ELHT00603', 'TXDALSTD', 'Health Texas Provider Network', 'Laura', 'Marjorie', 'Farnum', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1650 Republic Pkwy Ste 150', 'Mesquite', 'Dallas', 'TX', '75150', '9722797575', '9722700197', '1650 Republic Pkwy Ste 150', 'Mesquite', 'Dallas', 'TX', '75150', '9722797575', '9722700197', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1770508905', 0, 'N', 0, '2013-08-07', NULL, NULL, 32.8291, -96.6254, NULL, NULL),
('751837454', 'ELHT00604', 'ELHT00604', 'TXDALSTD', 'Health Texas Provider Network', 'Laura', 'Marjorie', 'Farnum', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 844013', 'Dallas', 'Dallas', 'TX', '75284', '2148209480', '2148208995', 'PO Box 844013', 'Dallas', 'Dallas', 'TX', '75284', '2148209480', '2148208995', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1770508905', 0, 'Y', 0, '2013-08-07', NULL, NULL, 0, 0, NULL, NULL),
('752582845', 'ELHT00781', 'ELHT00781', 'TXDALSTD', 'Dallas Diagnostic Association Garland', 'Vincent', '', 'Chan', 'MD', 'Gastroenterology', '', '', NULL, 'O', '601 Clara Barton Blvd Ste 300', 'Garland', 'Dallas', 'TX', '75042', '4698002010', '9722722073', '601 Clara Barton Blvd Ste 300', 'Garland', 'Dallas', 'TX', '75042', '4698002010', '9722722073', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', 'Baylor Regional Medical Center at Plano', NULL, NULL, 'HCFA|UB|', '1770678336', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.9175, -96.662, NULL, NULL),
('752582845', 'ELHT00782', 'ELHT00782', 'TXDALSTD', 'Dallas Diagnostic Association Garland', 'Vincent', '', 'Chan', 'MD', 'Gastroenterology', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', 'Baylor Regional Medical Center at Plano', NULL, NULL, 'HCFA|UB|', '1770678336', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752582845', 'ELHT00783', 'ELHT00783', 'TXDALSTD', 'Dallas Diagnostic Association Plano', 'Roger', 'C', 'Camp', 'MD', 'Gastroenterology', '', '', NULL, 'O', '4708 Alliance Blvd Ste 200', 'Plano', 'Collin', 'TX', '75093', '4698006020', '4698006001', '4708 Alliance Blvd Ste 200', 'Plano', 'Collin', 'TX', '75093', '4698006020', '4698006001', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1770696718', 0, 'N', 0, '2014-01-08', NULL, NULL, 33.0145, -96.7925, NULL, NULL),
('752582845', 'ELHT00784', 'ELHT00784', 'TXDALSTD', 'Dallas Diagnostic Association Plano', 'Roger', 'C', 'Camp', 'MD', 'Gastroenterology', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1770696718', 0, 'Y', 0, '2014-01-08', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00235', 'ELHT00235', 'TXDALSTD', 'Health Texas Provider Network', 'Paul', 'S', 'Bassel', 'MD', 'Pediatrics', '', '', NULL, 'O', '601 Clara Barton Blvd Ste 250', 'Garland', 'Dallas', 'TX', '75042', '9722727887', '9722727992', '601 Clara Barton Blvd Ste 250', 'Garland', 'Dallas', 'TX', '75042', '9722727887', '9722727992', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1780606400', 0, 'N', 0, '2013-06-12', NULL, NULL, 32.9175, -96.662, NULL, NULL),
('752536818', 'ELHT00236', 'ELHT00236', 'TXDALSTD', 'Health Texas Provider Network', 'Paul', 'S', 'Bassel', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1780606400', 0, 'N', 0, '2013-06-12', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT01035', 'ELHT01035', 'TXDALSTD', 'Health Texas Provider Network', 'Dennis', 'M', 'Bell', 'DO', 'Family Practice', '', '', NULL, 'O', '5232 Colleyville Blvd Ste 100', 'Colleyville', 'Tarrant', 'TX', '76034', '8174989920', '8174980635', '5232 Colleyville Blvd Ste 100', 'Colleyville', 'Tarrant', 'TX', '76034', '8174989920', '8174980635', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1780612473', 0, 'N', 0, '2013-06-12', NULL, NULL, 32.8864, -97.1519, NULL, NULL),
('752536818', 'ELHT01036', 'ELHT01036', 'TXDALSTD', 'Health Texas Provider Network', 'Dennis', 'M', 'Bell', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1780612473', 0, 'Y', 0, '2013-06-12', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT01037', 'ELHT01037', 'TXDALSTD', 'Baylor Family Medicine at Uptown', 'Julia', 'C', 'Graves', 'MD', 'Family Practice', '', '', NULL, 'O', '4161 McKinney Ave Ste 300', 'Dallas', 'Dallas', 'TX', '75204', '2142196655', '2142196660', '4161 McKinney Ave Ste 300', 'Dallas', 'Dallas', 'TX', '75204', '2142196655', '2142196660', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, '', NULL, 'HCFA|UB|', '1780646554', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.8156, -96.7912, NULL, NULL),
('752536818', 'ELHT01038', 'ELHT01038', 'TXDALSTD', 'Baylor Family Medicine at Uptown', 'Julia', 'C', 'Graves', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, '', NULL, 'HCFA|UB|', '1780646554', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00065', 'ELHT00065', 'TXDALSTD', 'Schroeder, Timothy', 'Timothy', 'G', 'Schroeder', 'MD', 'Hospice', '', '', NULL, 'O', '3600 Gaston Ave Barnett Tower Ste 605', 'Dallas', 'Dallas', 'TX', '75246', '2148209248', '2148209458', '3600 Gaston Ave Barnett Tower Ste 605', 'Dallas', 'Dallas', 'TX', '75246', '2148209248', '2148209458', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1780665968', 0, 'Y', 0, '2013-04-17', NULL, NULL, 32.7913, -96.7799, NULL, NULL),
('752536818', 'ELHT00066', 'ELHT00066', 'TXDALSTD', 'Schroeder, Timothy', 'Timothy', 'G', 'Schroeder', 'MD', 'Hospice', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1780665968', 0, 'N', 0, '2013-04-17', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT01039', 'ELHT01039', 'TXDALSTD', 'Baylor Family Health Center at Mesquite', 'Eva', 'M', 'Meyrat', 'MD', 'Family Practice', '', '', NULL, 'O', '1575 I-30', 'Mesquite', 'Dallas', 'TX', '75150', '4698002800', '4698002801', '1575 I 30', 'Mesquite', 'Dallas', 'TX', '75150', '4698002800', '4698002801', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1780674168', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.8297, -96.6193, NULL, NULL),
('752536818', 'ELHT01040', 'ELHT01040', 'TXDALSTD', 'Baylor Family Health Center at Mesquite', 'Eva', 'M', 'Meyrat', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1780674168', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00785', 'ELHT00785', 'TXDALSTD', 'Health Texas Provider Network', 'Sumeet', 'K', 'Asrani', 'MD', 'Gastroenterology', '', '', NULL, 'O', '3410 Worth St Ste 860', 'Dallas', 'Dallas', 'TX', '75246', '2148208500', '2148208168', '3410 Worth St Ste 860', 'Dallas', 'Dallas', 'TX', '75246', '2148208500', '2148208168', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1780896894', 0, 'N', 0, '2013-06-07', NULL, NULL, 32.7886, -96.779, NULL, NULL),
('752536818', 'ELHT00786', 'ELHT00786', 'TXDALSTD', 'Health Texas Provider Network', 'Sumeet', 'K', 'Asrani', 'MD', 'Gastroenterology', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1780896894', 0, 'Y', 0, '2013-06-07', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00337', 'ELHT00337', 'TXDALSTD', 'Romero Neurology', 'Jorge', 'A', 'Romero', 'MD', 'Neurology', '', '', NULL, 'O', '3600 Gaston Ave Barnett Tower Ste 901', 'Dallas', 'Dallas', 'TX', '75246', '2148275525', '2148275441', '3600 Gaston Ave Barnett Ste 901', 'Dallas', 'Dallas', 'TX', '75246', '2148275525', '2148275441', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1790708287', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.7913, -96.7799, NULL, NULL),
('752536818', 'ELHT00338', 'ELHT00338', 'TXDALSTD', 'Romero Neurology', 'Jorge', 'A', 'Romero', 'MD', 'Neurology', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1790708287', 0, 'N', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00141', 'ELHT00141', 'TXDALSTD', 'Cardiac Surgery Specialists', 'William', 'H', 'Ryan', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '4716 Alliance Blvd Ste 310', 'Plano', 'Collin', 'TX', '75093', '4698006200', '4698006210', '4716 Alliance Blvd Ste 310', 'Plano', 'Collin', 'TX', '75093', '4698006200', '4698006210', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'The Heart Hospital Baylor Plano', NULL, '', NULL, 'HCFA|UB|', '1790773240', 0, 'N', 0, '2012-12-20', NULL, NULL, 33.0145, -96.7926, NULL, NULL),
('752536818', 'ELHT00142', 'ELHT00142', 'TXDALSTD', 'Cardiac Surgery Specialists', 'William', 'H', 'Ryan', 'MD', 'Thoracic Surgery', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'The Heart Hospital Baylor Plano', NULL, '', NULL, 'HCFA|UB|', '1790773240', 0, 'N', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00285', 'ELHT00285', 'TXDALSTD', 'Orthopedic Associates of Dallas', 'James', 'M', 'Lancaster', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '3900 Junius St Ste 500', 'Dallas', 'Dallas', 'TX', '75246', '2148237090', '2148231644', '3900 Junius St Ste 500', 'Dallas', 'Dallas', 'TX', '75246', '2148237090', '2148231644', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-05-31', 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1790776821', 0, 'N', 0, '2013-07-31', NULL, NULL, 32.7913, -96.7775, NULL, NULL),
('752536818', 'ELHT00286', 'ELHT00286', 'TXDALSTD', 'Orthopedic Associates of Dallas', 'James', 'M', 'Lancaster', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '2148181288', '2148181291', 'PO Box 844128  ', 'Dallas', 'Dallas', 'TX', '75284', '2148181288', '2148181291', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1790776821', 0, 'N', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752600832', 'ELHT00605', 'ELHT00605', 'TXDALSTD', 'MedProvider', 'Alison', 'H', 'Sibley', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3434 Swiss Ave Ste 100', 'Dallas', 'Dallas', 'TX', '75204', '2148285770', '2148285767', '3434 Swiss Ave Ste 100', 'Dallas', 'Dallas', 'TX', '75204', '2148285770', '2148285767', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-06-30', 0, 0, 0, 'Baylor All Saints Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1790798858', 0, 'N', 0, '2013-07-31', NULL, NULL, 32.7913, -96.7821, NULL, NULL),
('752536818', 'ELHT00237', 'ELHT00237', 'TXDALSTD', 'Southlake Family Medicine', 'Eileen', 'M', 'OBrien Su', 'MD', 'Pediatrics', '', '', NULL, 'O', '731 E Southlake Blvd Ste 100', 'Southlake', 'Tarrant', 'TX', '76092', '8174243366', '8174243426', '731 E Southlake Blvd Ste 100', 'Southlake', 'Tarrant', 'TX', '76092', '8174243366', '8174243426', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1790799344', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.941, -97.1405, NULL, NULL),
('752536818', 'ELHT00238', 'ELHT00238', 'TXDALSTD', 'Southlake Family Medicine', 'Eileen', 'M', 'OBrien Su', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1790799344', 0, 'N', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('911947573', 'ELHT00607', 'ELHT00607', 'TXDALSTD', 'MedProvider Inpatient Care Unit', 'Poorya', '', 'Fazel', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3500 Gaston Ave Roberts Tower 4th Fl', 'Dallas', 'Dallas', 'TX', '75246', '2148203000', '2148203022', '3500 Gaston Ave 4th floor', 'Dallas', 'Dallas', 'TX', '75246', '2148203000', '2148203022', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', NULL, 'HCFA|UB|', '1790993483', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.7911, -96.7802, NULL, NULL),
('911947573', 'ELHT00608', 'ELHT00608', 'TXDALSTD', 'MedProvider Inpatient Care Unit', 'Poorya', '', 'Fazel', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '2148203000', '2148203022', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '2148203000', '2148203022', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', NULL, 'HCFA|UB|', '1790993483', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00609', 'ELHT00609', 'TXDALSTD', 'Inpatient Care Unit at Baylor Medical Center Garland', 'Dang', '', 'Hong', 'MD', 'Internal Medicine', '', '', NULL, 'O', '700 Walter Reed Blvd Ste 204', 'Garland', 'Dallas', 'TX', '75042', '9724875462', '9724875277', '700 Walter Reed Blvd Ste 204', 'Garland', 'Dallas', 'TX', '75042', '9724875462', '9724875277', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801056924', 0, 'Y', 0, '2013-05-01', NULL, NULL, 32.9186, -96.6634, NULL, NULL),
('752536818', 'ELHT00610', 'ELHT00610', 'TXDALSTD', 'Inpatient Care Unit at Baylor Medical Center Garland', 'Dang', '', 'Hong', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801056924', 0, 'Y', 0, '2013-05-01', NULL, NULL, 0, 0, NULL, NULL),
('911947573', 'ELHT00611', 'ELHT00611', 'TXDALSTD', 'MedProvider Inpatient Care Unit', 'Kristina', 'J', 'Hernandez', 'DO', 'Internal Medicine', '', '', NULL, 'O', '3500 Gaston Ave Roberts Tower 4th Fl', 'Dallas', 'Dallas', 'TX', '75246', '2148203000', '2148203022', '3500 Gaston Ave 4th floor', 'Dallas', 'Dallas', 'TX', '75246', '2148203000', '2148203022', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', NULL, 'HCFA|UB|', '1801057112', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.7911, -96.7802, NULL, NULL),
('911947573', 'ELHT00612', 'ELHT00612', 'TXDALSTD', 'MedProvider Inpatient Care Unit', 'Kristina', 'J', 'Hernandez', 'DO', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '2148203000', '2148203022', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '2148203000', '2148203022', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', NULL, 'HCFA|UB|', '1801057112', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('911947573', 'ELHT01041', 'ELHT01041', 'TXDALSTD', 'Baylor Family Medical Center at Ellis County Red Oak', 'Katie', 'M', 'Vick', 'MD', 'Family Practice', '', '', NULL, 'O', '301 E Ovilla Rd Ste 100', 'Red Oak', 'Ellis', 'TX', '75154', '9726175225', '9726177922', '301 E Ovilla Rd Ste 100', 'Red Oak', 'Ellis', 'TX', '75154', '9726175225', '9726177922', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1801189378', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.5318, -96.8051, NULL, NULL),
('911947573', 'ELHT01042', 'ELHT01042', 'TXDALSTD', 'Baylor Family Medical Center at Ellis County Red Oak', 'Katie', 'M', 'Vick', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '9729231686', '9729239268', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '9729231686', '9729239268', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1801189378', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00193', 'ELHT00193', 'TXDALSTD', 'Physiatric Medicine Associates', 'Leslie', 'D', 'Porter', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '909 N Washington Ave', 'Dallas', 'Dallas', 'TX', '75246', '2148209593', '9724808356', '909 N Washington', 'Dallas', 'Dallas', 'TX', '75246', '2148209593', '9724808356', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', NULL, 'HCFA|UB|', '1811906308', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.7918, -96.7791, NULL, NULL),
('752536818', 'ELHT00194', 'ELHT00194', 'TXDALSTD', 'Physiatric Medicine Associates', 'Leslie', 'D', 'Porter', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', NULL, 'HCFA|UB|', '1811906308', 0, 'N', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00143', 'ELHT00143', 'TXDALSTD', 'Cardiac Surgery Specialists', 'David', 'O', 'Moore', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '4716 Alliance Blvd Ste 310', 'Plano', 'Collin', 'TX', '75093', '4698006200', '4698006210', '4716 Alliance Blvd Ste 310', 'Plano', 'Collin', 'TX', '75093', '4698006200', '4698006210', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, '', NULL, 'HCFA|UB|', '1811985369', 0, 'N', 0, '2012-12-20', NULL, NULL, 33.0145, -96.7926, NULL, NULL),
('752536818', 'ELHT00144', 'ELHT00144', 'TXDALSTD', 'Cardiac Surgery Specialists', 'David', 'O', 'Moore', 'MD', 'Thoracic Surgery', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, '', NULL, 'HCFA|UB|', '1811985369', 0, 'N', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT01043', 'ELHT01043', 'TXDALSTD', 'Southlake Family Medicine', 'Steven', 'M', 'Morrison', 'MD', 'Family Practice', '', '', NULL, 'O', '731 E Southlake Blvd Ste 100', 'Southlake', 'Tarrant', 'TX', '76092', '8174243366', '8174243426', '731 E Southlake Blvd Ste 100', 'Southlake', 'Tarrant', 'TX', '76092', '8174243366', '8174243426', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1821002296', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.941, -97.1405, NULL, NULL),
('752536818', 'ELHT01044', 'ELHT01044', 'TXDALSTD', 'Southlake Family Medicine', 'Steven', 'M', 'Morrison', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1821002296', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752600832', 'ELHT00613', 'ELHT00613', 'TXDALSTD', '', 'Raymon', 'K', 'Aggarwal', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3434 Swiss Ave Ste 320', 'Dallas', 'Dallas', 'TX', '75204', '2148285060', '2148285061', '3434 Swiss Ave Ste 320', 'Dallas', 'Dallas', 'TX', '75204', '2148285060', '2148285061', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-06-30', 0, 0, 0, 'Baylor All Saints Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1821007279', 0, 'N', 0, '2014-01-30', NULL, NULL, 32.7913, -96.7821, NULL, NULL),
('911982510', 'ELHT01045', 'ELHT01045', 'TXDALSTD', 'Family Medical Center at Terrell', 'Neil', 'N', 'Satyu', 'MD', 'Family Practice', '', '', NULL, 'O', '200 N Virginia St', 'Terrell', 'Kaufman', 'TX', '75160', '9725517500', '9725247418', '200 N Virginia St', 'Terrell', 'Kaufman', 'TX', '75160', '9725517500', '9725247418', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1821015587', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.7372, -96.2749, NULL, NULL),
('911982510', 'ELHT01046', 'ELHT01046', 'TXDALSTD', 'Family Medical Center at Terrell', 'Neil', 'N', 'Satyu', 'MD', 'Family Practice', '', '', NULL, 'B', '306 N Frances St', 'Terrell', 'Kaufman', 'TX', '75160', '9725242914', '9725245847', '306 N Frances St', 'Terrell', 'Kaufman', 'TX', '75160', '9725242914', '9725245847', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1821015587', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('911947573', 'ELHT00069', 'ELHT00069', 'TXDALSTD', 'Baylor Neurosurgery Associates', 'Kyle', 'E', 'Doughty', 'MD', 'Neurosurgery', '', '', NULL, 'O', '3600 Gaston Ave Wadley Tower Ste 1158', 'Dallas', 'Dallas', 'TX', '75246', '2148208585', '2148208590', '3600 Gaston Ave Wadley Ste 1158', 'Dallas', 'Dallas', 'TX', '75246', '2148208585', '2148208590', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1821030479', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.7913, -96.7799, NULL, NULL),
('911947573', 'ELHT00070', 'ELHT00070', 'TXDALSTD', 'Baylor Neurosurgery Associates', 'Kyle', 'E', 'Doughty', 'MD', 'Neurosurgery', '', '', NULL, 'B', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '2148208612', '2148208614', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '2148208612', '2148208614', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1821030479', 0, 'N', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00081', 'ELHT00081', 'TXDALSTD', 'Pulmonary and Critical Care Associates of Garland', 'Jeffrey', 'M', 'Kopita', 'MD', 'Pulmonary', '', '', NULL, 'O', '700 Walter Reed Blvd Ste 203', 'Garland', 'Dallas', 'TX', '75042', '9724941446', '9722765476', '700 Walter Reed Blvd Ste 203', 'Garland', 'Dallas', 'TX', '75042', '9724941446', '9722765476', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-08-31', 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1821034257', 0, 'N', 0, '2013-09-16', NULL, NULL, 32.9192, -96.6635, NULL, NULL),
('752536818', 'ELHT00082', 'ELHT00082', 'TXDALSTD', 'Pulmonary and Critical Care Associates of Garland', 'Jeffrey', 'M', 'Kopita', 'MD', 'Pulmonary', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1821034257', 0, 'N', 0, '2013-09-16', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00615', 'ELHT00615', 'TXDALSTD', 'Inpatient Care Unit at Baylor Medical Center Garland', 'Sireesha', '', 'Rukkannagari', 'MD', 'Internal Medicine', '', '', NULL, 'O', '700 Walter Reed Blvd Ste 204', 'Garland', 'Dallas', 'TX', '75042', '9724875462', '9724875277', '700 Walter Reed Blvd Ste 204', 'Garland', 'Dallas', 'TX', '75042', '9724875462', '9724875277', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821042326', 0, 'Y', 0, '2013-05-01', NULL, NULL, 32.9186, -96.6634, NULL, NULL),
('752536818', 'ELHT00616', 'ELHT00616', 'TXDALSTD', 'Inpatient Care Unit at Baylor Medical Center Garland', 'Sireesha', '', 'Rukkannagari', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821042326', 0, 'Y', 0, '2013-05-01', NULL, NULL, 0, 0, NULL, NULL),
('752582845', 'ELHT00617', 'ELHT00617', 'TXDALSTD', 'Dallas Diagnostic Association Plano', 'Carlyle', 'A', 'Stewart', 'MD', 'Internal Medicine', '', '', NULL, 'O', '4708 Alliance Blvd Baylor Med Pl 1', 'Plano', 'Collin', 'TX', '75093', '4698006000', '4698006001', '4708 Alliance Blvd Baylor Med Pl 1', 'Plano', 'Collin', 'TX', '75093', '4698006000', '4698006001', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1821104381', 0, 'N', 0, '2012-12-20', NULL, NULL, 33.0145, -96.7925, NULL, NULL),
('752582845', 'ELHT00618', 'ELHT00618', 'TXDALSTD', 'Dallas Diagnostic Association Plano', 'Carlyle', 'A', 'Stewart', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1821104381', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT01047', 'ELHT01047', 'TXDALSTD', 'Baylor Family Medicine at Cedar Hill', 'Linda', 'H', 'Thao', 'DO', 'Family Practice', '', '', NULL, 'O', '294 Uptown Blvd Ste 100', 'Cedar Hill', 'Dallas', 'TX', '75104', '9722933569', '9722999513', '294 Uptown Blvd Ste 100', 'Cedar Hill', 'Dallas', 'TX', '75104', '9722933569', '9722999513', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1821250788', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.5923, -96.951, NULL, NULL),
('752536818', 'ELHT01048', 'ELHT01048', 'TXDALSTD', 'Baylor Family Medicine at Cedar Hill', 'Linda', 'H', 'Thao', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1821250788', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT01173', 'ELHT01173', 'TXDALSTD', 'Cardiology Consultants of Texas', 'Sandeep', 'R', 'Singh', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '621 N Hall St Ste 400', 'Dallas', 'Dallas', 'TX', '75226', '2148248721', '2142376529', '621 N Hall St Ste 400', 'Dallas', 'Dallas', 'TX', '75226', '2148248721', '2142376529', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1821260670', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.7879, -96.7802, NULL, NULL),
('752536818', 'ELHT01174', 'ELHT01174', 'TXDALSTD', 'Cardiology Consultants of Texas', 'Sandeep', 'R', 'Singh', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1821260670', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT01049', 'ELHT01049', 'TXDALSTD', 'Baylor Family Medicine at Garland', 'Jeffrey', 'D', 'Kerr', 'MD', 'Family Practice', '', '', NULL, 'O', '601 Clara Barton Blvd Ste 340', 'Garland', 'Dallas', 'TX', '75042', '9722726554', '9722729137', '601 Clara Barton Blvd Ste 340', 'Garland', 'Dallas', 'TX', '75042', '9722726554', '9722729137', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, '', NULL, 'HCFA|UB|', '1831112598', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.9175, -96.662, NULL, NULL),
('752536818', 'ELHT01050', 'ELHT01050', 'TXDALSTD', 'Baylor Family Medicine at Garland', 'Jeffrey', 'D', 'Kerr', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, '', NULL, 'HCFA|UB|', '1831112598', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752600832', 'ELHT00619', 'ELHT00619', 'TXDALSTD', '', 'James', 'R', 'Ampil', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3434 Swiss Ave Ste 310', 'Dallas', 'Dallas', 'TX', '75204', '2148285050', '2148285051', '3434 Swiss Ave Ste 310', 'Dallas', 'Dallas', 'TX', '75204', '2148285050', '2148285051', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1831131721', 0, 'N', 0, '2014-01-30', NULL, NULL, 32.7915, -96.7824, NULL, NULL),
('752536818', 'ELHT00621', 'ELHT00621', 'TXDALSTD', 'Baylor Internal Medicine Associates at McKinney', 'Mark', 'A', 'Troxler', 'DO', 'Internal Medicine', '', '', NULL, 'O', '5236 W University Dr Ste 2000', 'McKinney', 'Collin', 'TX', '75071', '4698005000', '4698005010', '5236 W University Dr Ste 2000', 'McKinney', 'Collin', 'TX', '75071', '4698005000', '4698005010', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at McKinney', NULL, '', NULL, 'HCFA|UB|', '1831165653', 0, 'N', 0, '2012-12-20', NULL, NULL, 33.2183, -96.684, NULL, NULL),
('752536818', 'ELHT00622', 'ELHT00622', 'TXDALSTD', 'Baylor Internal Medicine Associates at McKinney', 'Mark', 'A', 'Troxler', 'DO', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at McKinney', NULL, '', NULL, 'HCFA|UB|', '1831165653', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00787', 'ELHT00787', 'TXDALSTD', 'Liver Consultants of Texas', 'Manjushree', '', 'Gautam', 'MD', 'Gastroenterology', '', '', NULL, 'O', '1250 8th Ave Ste 515', 'Ft Worth', 'Tarrant', 'TX', '76104', '8179224675', '8179224645', '1250 8th Ave Ste 515', 'Ft Worth', 'Tarrant', 'TX', '76104', '8179224675', '8179224645', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1831172725', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.7312, -97.3437, NULL, NULL),
('752536818', 'ELHT00788', 'ELHT00788', 'TXDALSTD', 'Liver Consultants of Texas', 'Manjushree', '', 'Gautam', 'MD', 'Gastroenterology', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1831172725', 0, 'Y', 0, '2012-12-20', 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
('752536818', 'ELHT00071', 'ELHT00071', 'TXDALSTD', 'Comprehensive Pediatric Headache Center', 'Chaouki', 'K', 'Khoury', 'MD', 'Neurology', 'Pediatric Neurology', '', NULL, 'O', '3301 Swiss Ave', 'Dallas', 'Dallas', 'TX', '75204', '2148209812', '2148208441', '3301 Swiss Ave', 'Dallas', 'Dallas', 'TX', '75204', '2148209812', '2148208441', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', NULL, 'HCFA|UB|', '1831223049', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.7904, -96.7831, NULL, NULL),
('752536818', 'ELHT00072', 'ELHT00072', 'TXDALSTD', 'Comprehensive Pediatric Headache Center', 'Chaouki', 'K', 'Khoury', 'MD', 'Neurology', 'Pediatric Neurology', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', NULL, 'HCFA|UB|', '1831223049', 0, 'N', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('911947573', 'ELHT00623', 'ELHT00623', 'TXDALSTD', 'MedProvider Inpatient Care Unit', 'Ankit', 'D', 'Punatar', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3500 Gaston Ave Roberts Tower 4th Fl', 'Dallas', 'Dallas', 'TX', '75246', '2148203000', '2148203022', '3500 Gaston Ave Roberts Tower 4th Fl', 'Dallas', 'Dallas', 'TX', '75246', '2148203000', '2148203022', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1831350461', 0, 'N', 0, '2013-12-26', NULL, NULL, 32.7911, -96.7802, NULL, NULL),
('911947573', 'ELHT00624', 'ELHT00624', 'TXDALSTD', 'MedProvider Inpatient Care Unit', 'Ankit', 'D', 'Punatar', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '2148203000', '2148203022', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '2148203000', '2148203022', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1831350461', 0, 'Y', 0, '2013-12-26', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00625', 'ELHT00625', 'TXDALSTD', 'Internal Medicine at Ft Worth', 'Megan', 'A', 'Smith', 'DO', 'Internal Medicine', '', '', NULL, 'O', '1250 8th Ave Ste 200', 'Ft Worth', 'Tarrant', 'TX', '76104', '8179128020', '8179128030', '1250 8th Ave Ste 200', 'Ft Worth', 'Tarrant', 'TX', '76104', '8179128020', '8179128030', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', NULL, 'HCFA|UB|', '1831359280', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.7312, -97.3437, NULL, NULL),
('752536818', 'ELHT00626', 'ELHT00626', 'TXDALSTD', 'Internal Medicine at Ft Worth', 'Megan', 'A', 'Smith', 'DO', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', NULL, 'HCFA|UB|', '1831359280', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00083', 'ELHT00083', 'TXDALSTD', 'Health Texas Provider Network', 'Omar', '', 'Awad', 'MD', 'Pulmonary', '', '', NULL, 'O', '700 Walter Reed Blvd Ste 203', 'Garland', 'Dallas', 'TX', '75042', '9724941446', '9722765476', '700 Walter Reed Blvd Ste 203', 'Garland', 'Dallas', 'TX', '75042', '9724941446', '9722765476', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1831393594', 0, 'N', 0, '2013-06-07', NULL, NULL, 32.9186, -96.6634, NULL, NULL),
('752536818', 'ELHT00084', 'ELHT00084', 'TXDALSTD', 'Health Texas Provider Network', 'Omar', '', 'Awad', 'MD', 'Pulmonary', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1831393594', 0, 'Y', 0, '2013-06-07', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00195', 'ELHT00195', 'TXDALSTD', 'Physiatric Medicine Associates', 'Christine', 'L', 'Johnson', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '800 N Shiloh Rd', 'Garland', 'Dallas', 'TX', '75042', '9724875574', '9724875139', '800 N Shiloh Rd', 'Garland', 'Dallas', 'TX', '75042', '9724875574', '9724875139', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', NULL, 'HCFA|UB|', '1841209558', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.9193, -96.6652, NULL, NULL),
('752536818', 'ELHT00196', 'ELHT00196', 'TXDALSTD', 'Physiatric Medicine Associates', 'Christine', 'L', 'Johnson', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', NULL, 'HCFA|UB|', '1841209558', 0, 'N', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT01051', 'ELHT01051', 'TXDALSTD', 'Baylor Family Medicine at Garland', 'Rajasree', 'J', 'Nair', 'MD', 'Family Practice', '', '', NULL, 'O', '601 Clara Barton Blvd Ste 340', 'Garland', 'Dallas', 'TX', '75042', '9722726554', '9722729137', '601 Clara Barton Blvd Ste 340', 'Garland', 'Dallas', 'TX', '75042', '9722726554', '9722729137', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, '', NULL, 'HCFA|UB|', '1841213493', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.9175, -96.662, NULL, NULL),
('752536818', 'ELHT01052', 'ELHT01052', 'TXDALSTD', 'Baylor Family Medicine at Garland', 'Rajasree', 'J', 'Nair', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, '', NULL, 'HCFA|UB|', '1841213493', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00027', 'ELHT00027', 'TXDALSTD', 'Critical Care and Pulmonary Consultants of Dallas', 'Hemant', 'P', 'Dand', 'MD', 'Critical Care', '', '', NULL, 'O', '3600 Gaston Ave  Wadley Tower Ste 550', 'Dallas', 'Dallas', 'TX', '75246', '9724510219', '2148211193', '3600 Gaston Ave  Ste 550 Wadley Tower', 'Dallas', 'Dallas', 'TX', '75246', '9724510219', '2148211193', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1841217783', 0, 'Y', 0, '2012-12-20', NULL, NULL, 32.7913, -96.7799, NULL, NULL),
('752536818', 'ELHT00028', 'ELHT00028', 'TXDALSTD', 'Critical Care and Pulmonary Consultants of Dallas', 'Hemant', 'P', 'Dand', 'MD', 'Critical Care', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1841217783', 0, 'N', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00239', 'ELHT00239', 'TXDALSTD', 'North Texas Health Care Associates Pediatrics', 'Michelle', 'M', 'Han', 'MD', 'Pediatrics', '', '', NULL, 'O', '400 W IH 635 Ste 250', 'Irving', 'Dallas', 'TX', '75063', '9724816400', '9728319794', '400 W IH 635 Ste 250', 'Irving', 'Dallas', 'TX', '75063', '9724816400', '9728319794', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, '', NULL, 'HCFA|UB|', '1841223542', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.9125, -96.9492, NULL, NULL),
('752536818', 'ELHT00240', 'ELHT00240', 'TXDALSTD', 'North Texas Health Care Associates Pediatrics', 'Michelle', 'M', 'Han', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, '', NULL, 'HCFA|UB|', '1841223542', 0, 'N', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('751037591', 'ELHT00709', 'ELHT00709', 'TXDALSTD', 'Baylor Senior Health Center Garland', 'Anthony', 'K', 'Nguyen', 'DO', 'Geriatrics', '', '', NULL, 'O', '800 N Shiloh Rd', 'Garland', 'Dallas', 'TX', '75042', '9724875444', '9724853056', '800 N Shiloh Rd', 'Garland', 'Dallas', 'TX', '75042', '9724875444', '9724853056', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1841234333', 0, 'Y', 0, '2013-05-30', NULL, NULL, 32.9193, -96.6652, NULL, NULL),
('751037591', 'ELHT00710', 'ELHT00710', 'TXDALSTD', 'Baylor Senior Health Center Garland', 'Anthony', 'K', 'Nguyen', 'DO', 'Geriatrics', '', '', NULL, 'B', 'PO Box 841540', 'Dallas', 'Dallas', 'TX', '75284', '9724953578', '9724969239', 'PO Box 841540', 'Dallas', 'Dallas', 'TX', '75284', '9724953578', '9724969239', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1841234333', 0, 'Y', 0, '2013-05-30', NULL, NULL, 0, 0, NULL, NULL),
('752600832', 'ELHT00053', 'ELHT00053', 'TXDALSTD', 'MedProvider', 'Alok', '', 'Mohan', 'MD', 'Endocrinology', '', '', NULL, 'O', '3434 Swiss Ave Ste 410', 'Dallas', 'Dallas', 'TX', '75204', '2148285010', '2148285011', '3434 Swiss Ave Ste 410', 'Dallas', 'Dallas', 'TX', '75204', '2148285010', '2148285011', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1841240355', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.7915, -96.7824, NULL, NULL),
('752536818', 'ELHT01175', 'ELHT01175', 'TXDALSTD', 'Cardiology Consultants of Texas', 'Michael', 'G', 'Sills', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '621 N Hall St Ste 400', 'Dallas', 'Dallas', 'TX', '75226', '2148248721', '2142376529', '621 N Hall St Ste 400', 'Dallas', 'Dallas', 'TX', '75226', '2148248721', '2142376529', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1841264850', 0, 'N', 0, '2013-04-05', NULL, NULL, 32.7879, -96.7802, NULL, NULL),
('752536818', 'ELHT01176', 'ELHT01176', 'TXDALSTD', 'Cardiology Consultants of Texas', 'Michael', 'G', 'Sills', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1841264850', 0, 'Y', 0, '2013-04-05', NULL, NULL, 0, 0, NULL, NULL),
('752582845', 'ELHT00627', 'ELHT00627', 'TXDALSTD', 'Dallas Diagnostic Association Plano', 'Trung', 'C', 'Duong', 'MD', 'Internal Medicine', '', '', NULL, 'O', '4708 Alliance Blvd Baylor Med Pl 1', 'Plano', 'Collin', 'TX', '75093', '4698006000', '4698006001', '4708 Alliance Blvd Baylor Med Pl 1', 'Plano', 'Collin', 'TX', '75093', '4698006000', '4698006001', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1841269578', 0, 'N', 0, '2012-12-20', NULL, NULL, 33.0145, -96.7925, NULL, NULL),
('752582845', 'ELHT00628', 'ELHT00628', 'TXDALSTD', 'Dallas Diagnostic Association Plano', 'Trung', 'C', 'Duong', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1841269578', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT01177', 'ELHT01177', 'TXDALSTD', 'Legacy Heart Group', 'Sarah', 'A', 'Samaan', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '6601 Preston Rd', 'Plano', 'Collin', 'TX', '75024', '4698006300', '4698006351', '6601 Preston Rd', 'Plano', 'Collin', 'TX', '75024', '4698006300', '4698006351', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1841287380', 0, 'N', 0, '2014-01-08', NULL, NULL, 33.0625, -96.7963, NULL, NULL),
('752536818', 'ELHT01178', 'ELHT01178', 'TXDALSTD', 'Legacy Heart Group', 'Sarah', 'A', 'Samaan', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1841287380', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00629', 'ELHT00629', 'TXDALSTD', 'Inpatient Care Unit at Baylor Medical Center Garland', 'Yasir', 'A', 'Khan', 'MD', 'Internal Medicine', '', '', NULL, 'O', '700 Walter Reed Blvd Ste 204', 'Garland', 'Dallas', 'TX', '75042', '9724875462', '9724875277', '700 Walter Reed Blvd Ste 204', 'Garland', 'Dallas', 'TX', '75042', '9724875462', '9724875277', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841377215', 0, 'Y', 0, '2013-05-01', NULL, NULL, 32.9186, -96.6634, NULL, NULL),
('752536818', 'ELHT00630', 'ELHT00630', 'TXDALSTD', 'Inpatient Care Unit at Baylor Medical Center Garland', 'Yasir', 'A', 'Khan', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841377215', 0, 'Y', 0, '2013-05-01', NULL, NULL, 0, 0, NULL, NULL),
('911947573', 'ELHT01053', 'ELHT01053', 'TXDALSTD', 'Baylor Family Medical Center at Ellis County Waxahachie', 'Natalia', 'J', 'Southerland', 'MD', 'Family Practice', '', '', NULL, 'O', '505 N Hwy 77 Ste 200', 'Waxahachie', 'Ellis', 'TX', '75165', '9729231686', '9729377731', '505 N Hwy 77 Ste 200', 'Waxahachie', 'Ellis', 'TX', '75165', '9729231686', '9729377731', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1851345391', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.3965, -96.8453, NULL, NULL),
('911947573', 'ELHT01054', 'ELHT01054', 'TXDALSTD', 'Baylor Family Medical Center at Ellis County Waxahachie', 'Natalia', 'J', 'Southerland', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '9729231686', '9729239268', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '9729231686', '9729239268', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1851345391', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752600832', 'ELHT00631', 'ELHT00631', 'TXDALSTD', 'MedProvider', 'Anita', 'K', 'Khetan', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3434 Swiss Ave Ste 205', 'Dallas', 'Dallas', 'TX', '75204', '2148285070', '2148285071', '3434 Swiss Ave Ste 205', 'Dallas', 'Dallas', 'TX', '75204', '2148285070', '2148285071', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1861416851', 0, 'N', 0, '2013-06-14', NULL, NULL, 32.7915, -96.7824, NULL, NULL),
('751837454', 'ELHT00633', 'ELHT00633', 'TXDALSTD', 'Health Texas Provider Network', 'Rodrigo', 'W', 'Sotillo', 'MD', 'Internal Medicine', '', '', NULL, 'O', '4004 Worth St Ste 100', 'Dallas', 'Dallas', 'TX', '75246', '2148206060', '2148206361', '4004 Worth St Ste 100', 'Dallas', 'Dallas', 'TX', '75246', '2148206060', '2148206361', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 6, '2013-01-01', '2013-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861424319', 0, 'N', 0, '2013-08-07', NULL, NULL, 32.7911, -96.7751, NULL, NULL),
('751837454', 'ELHT00634', 'ELHT00634', 'TXDALSTD', 'Health Texas Provider Network', 'Rodrigo', 'W', 'Sotillo', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 844013', 'Dallas', 'Dallas', 'TX', '75284', '2148209480', '2148208995', 'PO Box 844013', 'Dallas', 'Dallas', 'TX', '75284', '2148209480', '2148208995', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 6, '2013-01-01', '2013-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861424319', 0, 'Y', 0, '2013-08-07', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT01055', 'ELHT01055', 'TXDALSTD', 'Family Medical Center at North Garland', 'Kimberly', 'J', 'McMillin', 'MD', 'Family Practice', '', '', NULL, 'O', '5345 N George Bush Fwy', 'Garland', 'Dallas', 'TX', '75040', '9724955888', '9724950588', '5345 N George Bush Fwy', 'Garland', 'Dallas', 'TX', '75040', '9724955888', '9724950588', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1861426751', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.9651, -96.6418, NULL, NULL),
('752536818', 'ELHT01056', 'ELHT01056', 'TXDALSTD', 'Family Medical Center at North Garland', 'Kimberly', 'J', 'McMillin', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1861426751', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00635', 'ELHT00635', 'TXDALSTD', 'Baylor Health Center at Park Cities', 'Paul', 'J', 'Sokal', 'MD', 'Internal Medicine', '', '', NULL, 'O', '9101 N Central Expwy Ste 300', 'Dallas', 'Dallas', 'TX', '75231', '2143632305', '2143632608', '9101 N Central Expy Ste 300', 'Dallas', 'Dallas', 'TX', '75231', '2143632305', '2143632608', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1861428211', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.873, -96.7706, NULL, NULL),
('752536818', 'ELHT00636', 'ELHT00636', 'TXDALSTD', 'Baylor Health Center at Park Cities', 'Paul', 'J', 'Sokal', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1861428211', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00303', 'ELHT00303', 'TXDALSTD', 'Park Lane OB-GYN Associates', 'Maria', 'T', 'Reyes', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '9101 N Central Expwy Ste 250', 'Dallas', 'Dallas', 'TX', '75231', '2148262979', '2148289169', '9101 N Central Expy Ste 250', 'Dallas', 'Dallas', 'TX', '75231', '2148262979', '2148289169', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1861441776', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.873, -96.7706, NULL, NULL),
('752536818', 'ELHT00304', 'ELHT00304', 'TXDALSTD', 'Park Lane OB-GYN Associates', 'Maria', 'T', 'Reyes', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1861441776', 0, 'N', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT01057', 'ELHT01057', 'TXDALSTD', 'Baylor Family Medicine at Flower Mound', 'Bryan', 'H', 'Minton', 'MD', 'Family Practice', '', '', NULL, 'O', '1110 Parker Sq', 'Flower Mound', 'Denton', 'TX', '75028', '9727241707', '9727241407', '1110 Parker Sq', 'Flower Mound', 'Denton', 'TX', '75028', '9727241707', '9727241407', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, NULL, NULL, 'HCFA|UB|', '1861491995', 0, 'N', 0, '2012-12-20', NULL, NULL, 33.0394, -97.0537, NULL, NULL),
('752536818', 'ELHT01058', 'ELHT01058', 'TXDALSTD', 'Baylor Family Medicine at Flower Mound', 'Bryan', 'H', 'Minton', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, NULL, NULL, 'HCFA|UB|', '1861491995', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('911947573', 'ELHT00305', 'ELHT00305', 'TXDALSTD', 'Texas Urogynecology Associates', 'Shayzreen', 'M', 'Roshanravan', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '4700 Dexter Ste 400', 'Plano', 'Collin', 'TX', '75093', '9725963424', '9725963272', '4700 Dexter Ste 400', 'Plano', 'Collin', 'TX', '75093', '9725963424', '9725963272', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, '', NULL, 'HCFA|UB|', '1861502627', 0, 'N', 0, '2012-12-20', NULL, NULL, 33.0182, -96.7893, NULL, NULL),
('911947573', 'ELHT00306', 'ELHT00306', 'TXDALSTD', 'Texas Urogynecology Associates', 'Shayzreen', 'M', 'Roshanravan', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '2148208700', '2148188707', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '2148208700', '2148188707', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, '', NULL, 'HCFA|UB|', '1861502627', 0, 'N', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('911947573', 'ELHT00075', 'ELHT00075', 'TXDALSTD', 'ENT Consultants of North Texas', 'Amol', 'M', 'Bhatki', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '7150 N President Bush Hwy Ste 202', 'Garland', 'Dallas', 'TX', '75044', '9724140408', '9724959084', '7150 N President Bush Hwy Ste 202', 'Garland', 'Dallas', 'TX', '75044', '9724140408', '9724959084', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1861524613', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.9814, -96.6634, NULL, NULL),
('911947573', 'ELHT00076', 'ELHT00076', 'TXDALSTD', 'ENT Consultants of North Texas', 'Amol', 'M', 'Bhatki', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'B', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '9729230620', '9729380528', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '9729230620', '9729380528', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1861524613', 0, 'N', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT01059', 'ELHT01059', 'TXDALSTD', 'Baylor Family Medicine at Frisco', 'Neelay', 'R', 'Gandhi', 'MD', 'Family Practice', '', '', NULL, 'O', '2840 Legacy Dr Ste 400', 'Frisco', 'Denton', 'TX', '75034', '9727123652', '2146183614', '2840 Legacy Dr Ste 400', 'Frisco', 'Denton', 'TX', '75034', '9727123652', '2146183614', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Frisco', NULL, NULL, NULL, 'HCFA|UB|', '1861696825', 0, 'N', 0, '2012-12-20', NULL, NULL, 33.1028, -96.8415, NULL, NULL),
('752536818', 'ELHT01060', 'ELHT01060', 'TXDALSTD', 'Baylor Family Medicine at Frisco', 'Neelay', 'R', 'Gandhi', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Frisco', NULL, NULL, NULL, 'HCFA|UB|', '1861696825', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('030374787', 'ELHT00741', 'ELHT00741', 'TXDALSTD', 'Surgical Institute', 'Lam', 'D', 'Le', 'MD', 'General Surgery', '', '', NULL, 'O', '3600 Gaston Ave Wadley Tower Ste 958', 'Dallas', 'Dallas', 'TX', '75246', '2148266276', '2148266223', '3600 Gaston Ave Wadley Tower Ste 958', 'Dallas', 'Dallas', 'TX', '75246', '2148266276', '2148266223', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1861698052', 0, 'N', 0, '2013-05-22', NULL, NULL, 32.7913, -96.7799, NULL, NULL),
('752536818', 'ELHT00307', 'ELHT00307', 'TXDALSTD', 'Park Lane OB-GYN Associates', 'Jessy', '', 'Joykutty', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '9101 N Central Expwy Ste 250', 'Dallas', 'Dallas', 'TX', '75231', '2148262979', '2148289169', '9101 N Central Expy Ste 250', 'Dallas', 'Dallas', 'TX', '75231', '2148262979', '2148289169', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1871519744', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.873, -96.7706, NULL, NULL),
('752536818', 'ELHT00308', 'ELHT00308', 'TXDALSTD', 'Park Lane OB-GYN Associates', 'Jessy', '', 'Joykutty', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1871519744', 0, 'N', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00637', 'ELHT00637', 'TXDALSTD', 'Baylor Internal Medicine at Heritage', 'Richard', 'M', 'Boatman', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1441 Redbud Blvd Ste 211', 'McKinney', 'Collin', 'TX', '75069', '9725422673', '9725629506', '1441 Redbud Blvd Ste 211', 'McKinney', 'Collin', 'TX', '75069', '9725422673', '9725629506', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-05-03', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871520783', 0, 'N', 0, '2013-05-01', NULL, NULL, 33.2117, -96.6351, NULL, NULL),
('752536818', 'ELHT00638', 'ELHT00638', 'TXDALSTD', 'Baylor Internal Medicine at Heritage', 'Richard', 'M', 'Boatman', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-05-03', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871520783', 0, 'Y', 0, '2013-05-01', NULL, NULL, 0, 0, NULL, NULL),
('911947573', 'ELHT00287', 'ELHT00287', 'TXDALSTD', 'North Texas Orthopaedic Specialists', 'Jay', 'D', 'Mabrey', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '3600 Gaston Ave Barnett Tower Ste 1101', 'Dallas', 'Dallas', 'TX', '75246', '2148207010', '2148207015', '3600 Gaston Ave Barnett Tower Ste 1101', 'Dallas', 'Dallas', 'TX', '75246', '2148207010', '2148207015', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1871521229', 0, 'N', 0, '2013-12-09', NULL, NULL, 32.7913, -96.7799, NULL, NULL),
('911947573', 'ELHT00288', 'ELHT00288', 'TXDALSTD', 'North Texas Orthopaedic Specialists', 'Jay', 'D', 'Mabrey', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '2148208350', '2148208355', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '2148208350', '2148208355', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1871521229', 0, 'N', 0, '2013-12-09', NULL, NULL, 0, 0, NULL, NULL),
('751837454', 'ELHT00639', 'ELHT00639', 'TXDALSTD', 'Health Texas Provider Network', 'Lewis', 'T', 'Edwards', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1650 Republic Pkwy Ste 150', 'Mesquite', 'Dallas', 'TX', '75150', '9722797575', '9722700197', '1650 Republic Pkwy Ste 150', 'Mesquite', 'Dallas', 'TX', '75150', '9722797575', '9722700197', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1871524488', 0, 'N', 0, '2013-08-07', NULL, NULL, 32.8291, -96.6254, NULL, NULL),
('751837454', 'ELHT00640', 'ELHT00640', 'TXDALSTD', 'Health Texas Provider Network', 'Lewis', 'T', 'Edwards', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 844013', 'Dallas', 'Dallas', 'TX', '75284', '2148209480', '2148208995', 'PO Box 844013', 'Dallas', 'Dallas', 'TX', '75284', '2148209480', '2148208995', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1871524488', 0, 'Y', 0, '2013-08-07', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT01061', 'ELHT01061', 'TXDALSTD', 'Family Medical Center at North Garland', 'Bill', 'G', 'Shumate', 'MD', 'Family Practice', '', '', NULL, 'O', '5345 N George Bush Fwy', 'Garland', 'Dallas', 'TX', '75040', '9724955888', '9724950588', '5345 N George Bush Fwy', 'Garland', 'Dallas', 'TX', '75040', '9724955888', '9724950588', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1871527424', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.9651, -96.6418, NULL, NULL),
('752536818', 'ELHT01062', 'ELHT01062', 'TXDALSTD', 'Family Medical Center at North Garland', 'Bill', 'G', 'Shumate', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1871527424', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00085', 'ELHT00085', 'TXDALSTD', 'Rosenblatt, Randall', 'Randall', 'L', 'Rosenblatt', 'MD', 'Pulmonary', '', '', NULL, 'O', '621 N Hall St Ste 120', 'Dallas', 'Dallas', 'TX', '75226', '2148206856', '2148201474', '621 N Hall St Ste 120', 'Dallas', 'Dallas', 'TX', '75226', '2148206856', '2148201474', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-12-01', 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1871531004', 0, 'N', 0, '2014-01-08', NULL, NULL, 32.7881, -96.7808, NULL, NULL),
('752536818', 'ELHT00086', 'ELHT00086', 'TXDALSTD', 'Rosenblatt, Randall', 'Randall', 'L', 'Rosenblatt', 'MD', 'Pulmonary', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1871531004', 0, 'N', 0, '2014-01-08', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT01063', 'ELHT01063', 'TXDALSTD', 'Colleyville Family Medicine', 'Jane', '', 'Ensey', 'DO', 'Family Practice', '', '', NULL, 'O', '5232 Colleyville Blvd Ste 100', 'Colleyville', 'Tarrant', 'TX', '76034', '8174989920', '8174980635', '5232 Colleyville Blvd Ste 100', 'Colleyville', 'Tarrant', 'TX', '76034', '8174989920', '8174980635', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1871536672', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.8864, -97.1519, NULL, NULL),
('752536818', 'ELHT01064', 'ELHT01064', 'TXDALSTD', 'Colleyville Family Medicine', 'Jane', '', 'Ensey', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1871536672', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT01065', 'ELHT01065', 'TXDALSTD', 'Baylor Family Medicine at Garland', 'Leslie', 'E', 'Tingle', 'MD', 'Family Practice', '', '', NULL, 'O', '601 Clara Barton Blvd Ste 340', 'Garland', 'Dallas', 'TX', '75042', '9722726554', '9722729137', '601 Clara Barton Blvd Ste 340', 'Garland', 'Dallas', 'TX', '75042', '9722726554', '9722729137', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1871552943', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.9175, -96.662, NULL, NULL),
('752536818', 'ELHT01066', 'ELHT01066', 'TXDALSTD', 'Baylor Family Medicine at Garland', 'Leslie', 'E', 'Tingle', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1871552943', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT01179', 'ELHT01179', 'TXDALSTD', 'Legacy Heart Group', 'David', 'W', 'Prewitt', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '6601 Preston Rd', 'Plano', 'Collin', 'TX', '75024', '4698006300', '4698006351', '6601 Preston Rd', 'Plano', 'Collin', 'TX', '75024', '4698006300', '4698006351', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1871580316', 0, 'N', 0, '2014-01-08', NULL, NULL, 33.0625, -96.7963, NULL, NULL),
('752536818', 'ELHT01180', 'ELHT01180', 'TXDALSTD', 'Legacy Heart Group', 'David', 'W', 'Prewitt', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1871580316', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00289', 'ELHT00289', 'TXDALSTD', 'Orthopedic Associates of Dallas', 'Devesh', '', 'Ramnath', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '3900 Junius St Ste 500', 'Dallas', 'Dallas', 'TX', '75246', '2148237090', '2148231644', '3900 Junius St Ste 500', 'Dallas', 'Dallas', 'TX', '75246', '2148237090', '2148231644', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-05-31', 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1871580621', 0, 'N', 0, '2013-07-31', NULL, NULL, 32.7913, -96.7775, NULL, NULL),
('752536818', 'ELHT00290', 'ELHT00290', 'TXDALSTD', 'Orthopedic Associates of Dallas', 'Devesh', '', 'Ramnath', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '2148181288', '2148181291', 'PO Box 844128  ', 'Dallas', 'Dallas', 'TX', '75284', '2148181288', '2148181291', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1871580621', 0, 'N', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752582845', 'ELHT00055', 'ELHT00055', 'TXDALSTD', 'Dallas Diagnostic Association Plano', 'Terry', 'D', 'Exstrum', 'MD', 'Endocrinology', '', '', NULL, 'O', '4708 Alliance Blvd Baylor Med Pl 1', 'Plano', 'Collin', 'TX', '75093', '4698006000', '4698006001', '4708 Alliance Blvd Baylor Med Pl 1', 'Plano', 'Collin', 'TX', '75093', '4698006000', '4698006001', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1871607424', 0, 'N', 0, '2012-12-20', NULL, NULL, 33.0145, -96.7925, NULL, NULL),
('752582845', 'ELHT00056', 'ELHT00056', 'TXDALSTD', 'Dallas Diagnostic Association Plano', 'Terry', 'D', 'Exstrum', 'MD', 'Endocrinology', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1871607424', 0, 'N', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('911947573', 'ELHT00641', 'ELHT00641', 'TXDALSTD', 'MedProvider Inpatient Care Unit', 'Andrew', 'L', 'Masica', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3500 Gaston Ave Roberts Tower 4th Fl', 'Dallas', 'Dallas', 'TX', '75246', '2148203000', '2148203022', '3500 Gaston Ave 4th floor', 'Dallas', 'Dallas', 'TX', '75246', '2148203000', '2148203022', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1881625440', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.7911, -96.7802, NULL, NULL),
('911947573', 'ELHT00642', 'ELHT00642', 'TXDALSTD', 'MedProvider Inpatient Care Unit', 'Andrew', 'L', 'Masica', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '2148203000', '2148203022', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '2148203000', '2148203022', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1881625440', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752582845', 'ELHT00789', 'ELHT00789', 'TXDALSTD', 'Dallas Diagnostic Association Garland', 'John', 'R', 'Hyatt', 'MD', 'Gastroenterology', '', '', NULL, 'O', '601 Clara Barton Blvd Ste 300', 'Garland', 'Dallas', 'TX', '75042', '4698002100', '9722722073', '601 Clara Barton Blvd Ste 300', 'Garland', 'Dallas', 'TX', '75042', '4698002100', '9722722073', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', 'Baylor Regional Medical Center at Plano', NULL, NULL, 'HCFA|UB|', '1881626091', 0, 'N', 0, '2014-01-08', NULL, NULL, 32.9175, -96.662, NULL, NULL),
('752582845', 'ELHT00790', 'ELHT00790', 'TXDALSTD', 'Dallas Diagnostic Association Garland', 'John', 'R', 'Hyatt', 'MD', 'Gastroenterology', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', 'Baylor Regional Medical Center at Plano', NULL, NULL, 'HCFA|UB|', '1881626091', 0, 'Y', 0, '2014-01-08', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00643', 'ELHT00643', 'TXDALSTD', 'Baylor Family Medicine at Lake Ridge', 'Penny', 'C', 'West', 'MD', 'Internal Medicine', '', '', NULL, 'O', '4927 Lake Ridge Pkwy Ste 100', 'Grand Prairie', 'Dallas', 'TX', '75052', '9726419000', '9726419002', '4927 Lake Ridge Pkwy Ste 100', 'Grand Prairie', 'Dallas', 'TX', '75052', '9726419000', '9726419002', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, NULL, NULL, 'HCFA|UB|', '1881642536', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.6594, -97.037, NULL, NULL),
('752536818', 'ELHT00644', 'ELHT00644', 'TXDALSTD', 'Baylor Family Medicine at Lake Ridge', 'Penny', 'C', 'West', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, NULL, NULL, 'HCFA|UB|', '1881642536', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00241', 'ELHT00241', 'TXDALSTD', 'Health Texas Provider Network', 'Padma', '', 'Bala', 'MD', 'Pediatrics', '', '', NULL, 'O', '1575 I-30', 'Mesquite', 'Dallas', 'TX', '75150', '4698002800', '4698002801', '1575 I-30', 'Mesquite', 'Dallas', 'TX', '75150', '4698002800', '4698002801', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-10-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1881643914', 0, 'N', 0, '2013-12-09', NULL, NULL, 32.8339, -96.6106, NULL, NULL),
('752536818', 'ELHT00242', 'ELHT00242', 'TXDALSTD', 'Health Texas Provider Network', 'Padma', '', 'Bala', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-10-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1881643914', 0, 'Y', 0, '2013-12-09', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00645', 'ELHT00645', 'TXDALSTD', 'McKinney Inpatient Care Unit', 'Badar', 'A', 'Kanwar', 'MD', 'Internal Medicine', '', '', NULL, 'O', '5252 W University Dr', 'McKinney', 'Collin', 'TX', '75071', '4697646950', '4697646954', '5252 W University Dr', 'McKinney', 'Collin', 'TX', '75071', '4697646950', '4697646954', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1881673465', 0, 'Y', 0, '2013-05-01', NULL, NULL, 33.2183, -96.6841, NULL, NULL),
('752536818', 'ELHT00646', 'ELHT00646', 'TXDALSTD', 'McKinney Inpatient Care Unit', 'Badar', 'A', 'Kanwar', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1881673465', 0, 'Y', 0, '2013-05-01', NULL, NULL, 0, 0, NULL, NULL),
('752582845', 'ELHT00647', 'ELHT00647', 'TXDALSTD', 'Dallas Diagnostic Association Plano', 'Joseph', 'H', 'Sample', 'MD', 'Internal Medicine', '', '', NULL, 'O', '4708 Alliance Blvd Baylor Med Pl 1', 'Plano', 'Collin', 'TX', '75093', '4698006000', '4698006001', '4708 Alliance Blvd Baylor Med Pl 1', 'Plano', 'Collin', 'TX', '75093', '4698006000', '4698006001', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1881709376', 0, 'N', 0, '2012-12-20', NULL, NULL, 33.0145, -96.7925, NULL, NULL),
('752582845', 'ELHT00648', 'ELHT00648', 'TXDALSTD', 'Dallas Diagnostic Association Plano', 'Joseph', 'H', 'Sample', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1881709376', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('911947573', 'ELHT01067', 'ELHT01067', 'TXDALSTD', 'Baylor Family Medical Center at Ellis County Waxahachie', 'David', 'L', 'Linguist', 'MD', 'Family Practice', '', '', NULL, 'O', '505 N Hwy 77 Ste 200', 'Waxahachie', 'Ellis', 'TX', '75165', '9729231686', '9729377731', '505 N Hwy 77 Ste 200', 'Waxahachie', 'Ellis', 'TX', '75165', '9729231686', '9729377731', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1891723367', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.3965, -96.8453, NULL, NULL),
('911947573', 'ELHT01068', 'ELHT01068', 'TXDALSTD', 'Baylor Family Medical Center at Ellis County Waxahachie', 'David', 'L', 'Linguist', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '9729231686', '9729239268', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '9729231686', '9729239268', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1891723367', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00161', 'ELHT00161', 'TXDALSTD', 'Dallas Diagnostic Association Garland', 'Robert', 'J', 'Meador', 'MD', 'Rheumatology', '', '', NULL, 'O', '601 Clara Barton Blvd Ste 300', 'Garland', 'Dallas', 'TX', '75042', '4698002000', '9722722073', '601 Clara Barton Blvd Ste 300', 'Garland', 'Dallas', 'TX', '75042', '4698002000', '9722722073', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1891725396', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.9175, -96.662, NULL, NULL),
('752536818', 'ELHT00162', 'ELHT00162', 'TXDALSTD', 'Dallas Diagnostic Association Garland', 'Robert', 'J', 'Meador', 'MD', 'Rheumatology', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1891725396', 0, 'N', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT01069', 'ELHT01069', 'TXDALSTD', 'Baylor Family Medicine at Fort Worth', 'Daria', 'K', 'Greer', 'MD', 'Family Practice', '', '', NULL, 'O', '900 W Magnolia Ave Ste 201', 'Ft Worth', 'Tarrant', 'TX', '76104', '8179216166', '8179219594', '900 W Magnolia Ste 201', 'Ft Worth', 'Tarrant', 'TX', '76104', '8179216166', '8179219594', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1891743902', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.7306, -97.3342, NULL, NULL),
('752536818', 'ELHT01070', 'ELHT01070', 'TXDALSTD', 'Baylor Family Medicine at Fort Worth', 'Daria', 'K', 'Greer', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1891743902', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('911947573', 'ELHT00291', 'ELHT00291', 'TXDALSTD', 'Orthopaedic Consultants of North Texas', 'Anil', 'K', 'Koganti', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '411 N Washington Ave Ste 7300', 'Dallas', 'Dallas', 'TX', '75246', '2148207922', '2148207744', '411 N Washington Ave Ste 7300', 'Dallas', 'Dallas', 'TX', '75246', '2148207922', '2148207744', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1891754131', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.7885, -96.7752, 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
('911947573', 'ELHT00292', 'ELHT00292', 'TXDALSTD', 'Orthopaedic Consultants of North Texas', 'Anil', 'K', 'Koganti', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '2148208350', '2148208355', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '2148208350', '2148208355', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1891754131', 0, 'N', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT01071', 'ELHT01071', 'TXDALSTD', 'Family Medical Center at Baylor', 'Matthew', 'P', 'Sokol', 'MD', 'Family Practice', '', '', NULL, 'O', '3600 Gaston Ave Barnett Tower Ste 1109', 'Dallas', 'Dallas', 'TX', '75246', '2148208300', '2148208313', '3600 Gaston Ave Barnett Ste 1109', 'Dallas', 'Dallas', 'TX', '75246', '2148208300', '2148208313', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1891870507', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.7913, -96.7799, NULL, NULL),
('752536818', 'ELHT01072', 'ELHT01072', 'TXDALSTD', 'Family Medical Center at Baylor', 'Matthew', 'P', 'Sokol', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1891870507', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00649', 'ELHT00649', 'TXDALSTD', 'Supportive and Palliative Care Clinic at BUMC', 'Stephanie', 'Y', 'Houck', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3600 Gaston Ave Barnett Tower Ste 605', 'Dallas', 'Dallas', 'TX', '75246', '2148209248', '2148209458', '3600 Gaston Ave Barnett Ste 605', 'Dallas', 'Dallas', 'TX', '75246', '2148209248', '2148209458', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1902007842', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.7913, -96.7799, NULL, NULL),
('752536818', 'ELHT00650', 'ELHT00650', 'TXDALSTD', 'Supportive and Palliative Care Clinic at BUMC', 'Stephanie', 'Y', 'Houck', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1902007842', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00651', 'ELHT00651', 'TXDALSTD', 'North Texas Health Care Associates Internal Medicine IC', 'Bradley', 'S', 'Jones', 'MD', 'Internal Medicine', '', '', NULL, 'O', '400 W IH 635 Ste 200', 'Irving', 'Dallas', 'TX', '75063', '9724061199', '9725562328', '400 W IH 635 Ste 200', 'Irving', 'Dallas', 'TX', '75063', '9724061199', '9725562328', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, '', NULL, 'HCFA|UB|', '1902824147', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.9125, -96.9492, NULL, NULL),
('752536818', 'ELHT00652', 'ELHT00652', 'TXDALSTD', 'North Texas Health Care Associates Internal Medicine IC', 'Bradley', 'S', 'Jones', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, '', NULL, 'HCFA|UB|', '1902824147', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT01073', 'ELHT01073', 'TXDALSTD', 'Baylor Family Medicine at McKinney', 'Brett', 'D', 'Young', 'MD', 'Family Practice', '', '', NULL, 'O', '5236 W University Dr Ste 1500', 'McKinney', 'Collin', 'TX', '75071', '4698005100', '4698005110', '5236 W University Dr Ste 1500', 'McKinney', 'Collin', 'TX', '75071', '4698005100', '4698005110', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at McKinney', NULL, NULL, NULL, 'HCFA|UB|', '1902849821', 0, 'N', 0, '2012-12-20', NULL, NULL, 33.2183, -96.684, NULL, NULL),
('752536818', 'ELHT01074', 'ELHT01074', 'TXDALSTD', 'Baylor Family Medicine at McKinney', 'Brett', 'D', 'Young', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at McKinney', NULL, NULL, NULL, 'HCFA|UB|', '1902849821', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00145', 'ELHT00145', 'TXDALSTD', 'Cardiac Surgery Specialists', 'William', 'T', 'Brinkman', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '4716 Alliance Blvd Ste 310', 'Plano', 'Collin', 'TX', '75093', '4698006200', '4698006210', '4716 Alliance Blvd Ste 310', 'Plano', 'Collin', 'TX', '75093', '4698006200', '4698006210', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, '', NULL, 'HCFA|UB|', '1902950983', 0, 'N', 0, '2012-12-20', NULL, NULL, 33.0145, -96.7926, NULL, NULL),
('752536818', 'ELHT00146', 'ELHT00146', 'TXDALSTD', 'Cardiac Surgery Specialists', 'William', 'T', 'Brinkman', 'MD', 'Thoracic Surgery', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, '', NULL, 'HCFA|UB|', '1902950983', 0, 'N', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT01075', 'ELHT01075', 'TXDALSTD', 'Irving Interfaith Clinic', 'Roberto', 'B', 'Dela Cruz', 'MD', 'Family Practice', '', '', NULL, 'O', '1302 Ln St Ste 100', 'Irving', 'Dallas', 'TX', '75061', '4698001012', '4698001010', '1302 Ln St Ste 100', 'Irving', 'Dallas', 'TX', '75061', '4698001012', '4698001010', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-09-08', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912101577', 0, 'N', 0, '2013-09-16', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT01076', 'ELHT01076', 'TXDALSTD', 'Irving Interfaith Clinic', 'Roberto', 'B', 'Dela Cruz', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912101577', 0, 'Y', 0, '2013-09-16', NULL, NULL, 0, 0, NULL, NULL),
('752600832', 'ELHT00653', 'ELHT00653', 'TXDALSTD', 'MedProvider', 'Troy', 'M', 'Neal', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3434 Swiss Ave Ste 330', 'Dallas', 'Dallas', 'TX', '75204', '2148285070', '2148285071', '3434 Swiss Ave Ste 330', 'Dallas', 'Dallas', 'TX', '75204', '2148285070', '2148285071', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1912118753', 0, 'N', 0, '2013-06-14', NULL, NULL, 32.7915, -96.7824, NULL, NULL),
('752536818', 'ELHT01077', 'ELHT01077', 'TXDALSTD', 'Baylor Family Medicine at Lake Ridge', 'Omar', '', 'Hernandez', 'MD', 'Family Practice', '', '', NULL, 'O', '4927 Lake Ridge Pkwy Ste 100', 'Grand Prairie', 'Dallas', 'TX', '75052', '9726419000', '9726419002', '4927 Lake Ridge Pkwy Ste 100', 'Grand Prairie', 'Dallas', 'TX', '75052', '9726419000', '9726419002', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, NULL, NULL, 'HCFA|UB|', '1912169210', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.6594, -97.037, NULL, NULL),
('752536818', 'ELHT01078', 'ELHT01078', 'TXDALSTD', 'Baylor Family Medicine at Lake Ridge', 'Omar', '', 'Hernandez', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, NULL, NULL, 'HCFA|UB|', '1912169210', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00147', 'ELHT00147', 'TXDALSTD', '', 'David', 'H', 'Ammons', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '1600 W College Ste 410', 'Grapevine', 'Tarrant', 'TX', '76051', '8173106644', '8173106646', '1600 W College Ste 410', 'Grapevine', 'Tarrant', 'TX', '76051', '8173106644', '8173106646', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, NULL, NULL, 'HCFA|UB|', '1912907809', 0, 'N', 0, '2014-01-30', NULL, NULL, 32.9356, -97.0929, NULL, NULL),
('752536818', 'ELHT00148', 'ELHT00148', 'TXDALSTD', '', 'David', 'H', 'Ammons', 'MD', 'Thoracic Surgery', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, NULL, NULL, 'HCFA|UB|', '1912907809', 0, 'N', 0, '2014-01-30', NULL, NULL, 0, 0, NULL, NULL),
('030374787', 'ELHT00743', 'ELHT00743', 'TXDALSTD', 'Surgical Institute', 'Zelig', 'H', 'Lieberman', 'MD', 'General Surgery', '', '', NULL, 'O', '3600 Gaston Ave Wadley Tower Ste 958', 'Dallas', 'Dallas', 'TX', '75246', '2148266276', '2148266223', '3600 Gaston Ave Wadley Tower Ste 958', 'Dallas', 'Dallas', 'TX', '75246', '2148266276', '2148266223', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1912921776', 0, 'N', 0, '2013-05-22', NULL, NULL, 32.7913, -96.7799, NULL, NULL),
('911947573', 'ELHT00243', 'ELHT00243', 'TXDALSTD', 'Baylor Family Medical Center at Ellis County Midlothian', 'Shirley', 'C', 'Joslin', 'MD', 'Pediatrics', '', '', NULL, 'O', '1441 S Midlothian Pkwy Ste 100', 'Midlothian', 'Ellis', 'TX', '76065', '9727231474', '9727239423', '1441 S Midlothian Pkwy Ste 100', 'Midlothian', 'Ellis', 'TX', '76065', '9727231474', '9727239423', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1912940172', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.4671, -96.9768, NULL, NULL),
('911947573', 'ELHT00244', 'ELHT00244', 'TXDALSTD', 'Baylor Family Medical Center at Ellis County Midlothian', 'Shirley', 'C', 'Joslin', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '9729231686', '9729239268', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '9729231686', '9729239268', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1912940172', 0, 'N', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT01181', 'ELHT01181', 'TXDALSTD', 'LVAD Clinic', 'Shelley', 'A', 'Hall', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '8080 N Central Expwy Ste 600 LB 82', 'Dallas', 'Dallas', 'TX', '75206', '8663771650', '4694675905', '8080 N Central Expwy Ste 600 LB 82', 'Dallas', 'Dallas', 'TX', '75206', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1912961145', 0, 'N', 0, '2013-11-04', NULL, NULL, 32.8607, -96.7699, NULL, NULL),
('752536818', 'ELHT01182', 'ELHT01182', 'TXDALSTD', 'LVAD Clinic', 'Shelley', 'A', 'Hall', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1912961145', 0, 'Y', 0, '2013-11-04', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT01183', 'ELHT01183', 'TXDALSTD', 'Cardiology Consultants of Texas', 'John', 'R', 'Schumacher', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '621 N Hall St Ste 400', 'Dallas', 'Dallas', 'TX', '75226', '2148248721', '2142376529', '621 N Hall St Ste 400', 'Dallas', 'Dallas', 'TX', '75226', '2148248721', '2142376529', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1912971144', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.7879, -96.7802, NULL, NULL),
('752536818', 'ELHT01184', 'ELHT01184', 'TXDALSTD', 'Cardiology Consultants of Texas', 'John', 'R', 'Schumacher', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1912971144', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00655', 'ELHT00655', 'TXDALSTD', 'Health Texas Provider Network', 'Jennifer', 'M', 'Bashour', 'MD', 'Internal Medicine', '', '', NULL, 'O', '400 W IH 635 Ste 220', 'Irving', 'Dallas', 'TX', '75063', '9724816363', '9724062732', '400 W IH 635 Ste 220', 'Irving', 'Dallas', 'TX', '75063', '9724816363', '9724062732', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, NULL, NULL, 'HCFA|UB|', '1922032911', 0, 'N', 0, '2013-06-07', NULL, NULL, 32.9125, -96.9492, NULL, NULL),
('752536818', 'ELHT00656', 'ELHT00656', 'TXDALSTD', 'Health Texas Provider Network', 'Jennifer', 'M', 'Bashour', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, NULL, NULL, 'HCFA|UB|', '1922032911', 0, 'Y', 0, '2013-06-07', NULL, NULL, 0, 0, NULL, NULL),
('752722718', 'ELHT01079', 'ELHT01079', 'TXDALSTD', 'Baylor Family Medical Center at Riverside', 'Ruth', 'T', 'Harvey', 'DO', 'Family Practice', '', '', NULL, 'O', '2740 N Hwy 360 Ste 100', 'Grand Prairie', 'Dallas', 'TX', '75050', '9726068300', '9726064940', '2740 N Hwy 360 Ste 100', 'Grand Prairie', 'Dallas', 'TX', '75050', '9726068300', '9726064940', 'HTPN', 'TXHCPCHTPN', NULL, '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1922054121', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.797, -97.0554, NULL, NULL),
('752536818', 'ELHT01081', 'ELHT01081', 'TXDALSTD', 'Baylor Family Medicine at Keller', 'Manish', 'P', 'Patel', 'DO', 'Family Practice', '', '', NULL, 'O', '601 S Main St Ste 200', 'Keller', 'Tarrant', 'TX', '76248', '8177536888', '8177536885', '601 S Main St Ste 200', 'Keller', 'Tarrant', 'TX', '76248', '8177536888', '8177536885', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Emergency Medical Center at Keller', NULL, '', NULL, 'HCFA|UB|', '1922056357', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.9271, -97.2541, NULL, NULL),
('752536818', 'ELHT01082', 'ELHT01082', 'TXDALSTD', 'Baylor Family Medicine at Keller', 'Manish', 'P', 'Patel', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Emergency Medical Center at Keller', NULL, '', NULL, 'HCFA|UB|', '1922056357', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752582845', 'ELHT00657', 'ELHT00657', 'TXDALSTD', 'Plano IPCU', 'Archana', 'A', 'Parikh', 'MD', 'Internal Medicine', '', '', NULL, 'O', '4700 Alliance Blvd Ste 400', 'Plano', 'Collin', 'TX', '75093', '4698146631', '4698143110', '4700 Alliance Blvd Ste 400', 'Plano', 'Collin', 'TX', '75093', '4698146631', '4698143110', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1922271980', 0, 'N', 0, '2012-12-20', NULL, NULL, 33.0144, -96.7924, NULL, NULL),
('752582845', 'ELHT00658', 'ELHT00658', 'TXDALSTD', 'Plano IPCU', 'Archana', 'A', 'Parikh', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1922271980', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752582845', 'ELHT00711', 'ELHT00711', 'TXDALSTD', 'Dallas Diagnostic Association Plano', 'Mahenaaz', '', 'Haq', 'MD', 'Geriatrics', '', '', NULL, 'O', '4708 Alliance Blvd Baylor Med Pl 1', 'Plano', 'Collin', 'TX', '75093', '4698006000', '4698006001', '4708 Alliance Blvd Baylor Med Pl 1', 'Plano', 'Collin', 'TX', '75093', '4698006000', '4698006001', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1922275098', 0, 'Y', 0, '2012-12-20', NULL, NULL, 33.0145, -96.7925, NULL, NULL),
('752582845', 'ELHT00712', 'ELHT00712', 'TXDALSTD', 'Dallas Diagnostic Association Plano', 'Mahenaaz', '', 'Haq', 'MD', 'Geriatrics', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1922275098', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752600832', 'ELHT00659', 'ELHT00659', 'TXDALSTD', 'MedProvider', 'Jennifer', 'L', 'Edwards', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3434 Swiss Ave Ste 105', 'Dallas', 'Dallas', 'TX', '75204', '2148285000', '2148280014', '3434 Swiss Ave Ste 105', 'Dallas', 'Dallas', 'TX', '75204', '2148285000', '2148280014', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1932111903', 0, 'N', 0, '2013-06-14', NULL, NULL, 32.7915, -96.7824, NULL, NULL),
('752536818', 'ELHT01109', 'ELHT01109', 'TXDALSTD', 'Dallas Diagnostic Association Garland', 'Kendra', 'A', 'Rorrie', 'MD', 'Dermatology', '', '', NULL, 'O', '601 Clara Barton Blvd Ste 300', 'Garland', 'Dallas', 'TX', '75042', '4698002000', '9722722073', '601 Clara Barton Blvd Ste 300', 'Garland', 'Dallas', 'TX', '75042', '4698002000', '9722722073', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1932138856', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.9175, -96.662, NULL, NULL),
('752536818', 'ELHT01110', 'ELHT01110', 'TXDALSTD', 'Dallas Diagnostic Association Garland', 'Kendra', 'A', 'Rorrie', 'MD', 'Dermatology', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1932138856', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('911947573', 'ELHT00661', 'ELHT00661', 'TXDALSTD', 'Baylor Family Medical Center at Ellis County Waxahachie', 'John', 'A', 'Bousquet', 'MD', 'Internal Medicine', '', '', NULL, 'O', '505 N Hwy 77 Ste 200', 'Waxahachie', 'Ellis', 'TX', '75165', '9729231686', '9729377731', '505 N Hwy 77 Ste 200', 'Waxahachie', 'Ellis', 'TX', '75165', '9729231686', '9729377731', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1932145273', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.3965, -96.8453, NULL, NULL),
('911947573', 'ELHT00662', 'ELHT00662', 'TXDALSTD', 'Baylor Family Medical Center at Ellis County Waxahachie', 'John', 'A', 'Bousquet', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '9729231686', '9729239268', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '9729231686', '9729239268', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1932145273', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT01083', 'ELHT01083', 'TXDALSTD', 'Baylor Family Health Center at Mesquite', 'Gary', 'D', 'Garrett', 'MD', 'Family Practice', '', '', NULL, 'O', '1575 I-30', 'Mesquite', 'Dallas', 'TX', '75150', '4698002800', '4698002801', '1575 I 30', 'Mesquite', 'Dallas', 'TX', '75150', '4698002800', '4698002801', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1932158581', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.8297, -96.6193, NULL, NULL),
('752536818', 'ELHT01084', 'ELHT01084', 'TXDALSTD', 'Baylor Family Health Center at Mesquite', 'Gary', 'D', 'Garrett', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1932158581', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00005', 'ELHT00005', 'TXDALSTD', 'Cardiology Consultants of Texas', 'Jay', 'O', 'Franklin', 'MD', 'Cardiology', '', '', NULL, 'O', '621 N Hall St Ste 400', 'Dallas', 'Dallas', 'TX', '75226', '2148248721', '2142376529', '621 N Hall St Ste 400', 'Dallas', 'Dallas', 'TX', '75226', '2148248721', '2142376529', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1932173945', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.7879, -96.7802, NULL, NULL),
('752536818', 'ELHT00006', 'ELHT00006', 'TXDALSTD', 'Cardiology Consultants of Texas', 'Jay', 'O', 'Franklin', 'MD', 'Cardiology', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1932173945', 0, 'Y', 0, '2013-03-13', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT01085', 'ELHT01085', 'TXDALSTD', 'Southlake Family Medicine', 'Smita', 'K', 'Rumalla', 'MD', 'Family Practice', '', '', NULL, 'O', '731 E Southlake Blvd Ste 100', 'Southlake', 'Tarrant', 'TX', '76092', '8174243366', '8174243426', '731 E Southlake Blvd Ste 100', 'Southlake', 'Tarrant', 'TX', '76092', '8174243366', '8174243426', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1932260668', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.941, -97.1405, NULL, NULL),
('752536818', 'ELHT01086', 'ELHT01086', 'TXDALSTD', 'Southlake Family Medicine', 'Smita', 'K', 'Rumalla', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1932260668', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT01087', 'ELHT01087', 'TXDALSTD', 'Baylor Family Medicine at Fort Worth', 'Sarah', 'J', 'Meredith', 'DO', 'Family Practice', '', '', NULL, 'O', '900 W Magnolia Ave Ste 201', 'Ft Worth', 'Tarrant', 'TX', '76104', '8179216166', '8179219594', '900 W Magnolia Ste 201', 'Ft Worth', 'Tarrant', 'TX', '76104', '8179216166', '8179219594', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1932399797', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.7306, -97.3342, NULL, NULL),
('752536818', 'ELHT01088', 'ELHT01088', 'TXDALSTD', 'Baylor Family Medicine at Fort Worth', 'Sarah', 'J', 'Meredith', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1932399797', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00745', 'ELHT00745', 'TXDALSTD', 'Breast Care Specialists of Texas', 'Helen', 'J', 'Bussey', 'MD', 'General Surgery', '', '', NULL, 'O', '1250 8th Ave Ste 545', 'Ft Worth', 'Tarrant', 'TX', '76104', '8176656900', '8179128089', '1250 8th Ave Ste 545', 'Ft Worth', 'Tarrant', 'TX', '76104', '8176656900', '8179128089', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', '', 'HCFA|UB|', '1942201405', 0, 'N', 0, '2013-06-14', NULL, NULL, 32.7312, -97.3437, NULL, NULL),
('752536818', 'ELHT00746', 'ELHT00746', 'TXDALSTD', 'Breast Care Specialists of Texas', 'Helen', 'J', 'Bussey', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', '', 'HCFA|UB|', '1942201405', 0, 'Y', 0, '2013-06-14', NULL, NULL, 0, 0, NULL, NULL),
('752600832', 'ELHT00663', 'ELHT00663', 'TXDALSTD', 'MedProvider', 'Cynthia', 'K', 'Wilder', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3434 Swiss Ave Ste 100', 'Dallas', 'Dallas', 'TX', '75204', '2148285770', '2148285767', '3434 Swiss Ave Ste 100', 'Dallas', 'Dallas', 'TX', '75204', '2148285770', '2148285767', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1942213392', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.7915, -96.7824, NULL, NULL),
('752536818', 'ELHT00665', 'ELHT00665', 'TXDALSTD', 'Southlake Family Medicine', 'Loree', 'J', 'Lieving', 'MD', 'Internal Medicine', '', '', NULL, 'O', '731 E Southlake Blvd Ste 100', 'Southlake', 'Tarrant', 'TX', '76092', '8174243366', '8174243426', '731 E Southlake Blvd Ste 100', 'Southlake', 'Tarrant', 'TX', '76092', '8174243366', '8174243426', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1942214556', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.941, -97.1405, NULL, NULL),
('752536818', 'ELHT00666', 'ELHT00666', 'TXDALSTD', 'Southlake Family Medicine', 'Loree', 'J', 'Lieving', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1942214556', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00245', 'ELHT00245', 'TXDALSTD', 'Pediatric and Adolescent Associates of Garland', 'Rosemary', 'H', 'Roseberry', 'MD', 'Pediatrics', '', '', NULL, 'O', '601 Clara Barton Blvd Ste 250', 'Garland', 'Dallas', 'TX', '75042', '9722727887', '9722727992', '601 Clara Barton Blvd Ste 250', 'Garland', 'Dallas', 'TX', '75042', '9722727887', '9722727992', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1942218862', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.9175, -96.662, NULL, NULL),
('752536818', 'ELHT00246', 'ELHT00246', 'TXDALSTD', 'Pediatric and Adolescent Assoc of Garland', 'Rosemary', 'H', 'Roseberry', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1942218862', 0, 'N', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752582845', 'ELHT00791', 'ELHT00791', 'TXDALSTD', 'Dallas Diagnostic Association Plano', 'Terilyn', 'R', 'Scott Winful', 'MD', 'Gastroenterology', '', '', NULL, 'O', '4708 Alliance Blvd Ste 200', 'Plano', 'Collin', 'TX', '75093', '4698006020', '4698006001', '4708 Alliance Blvd Ste 200', 'Plano', 'Collin', 'TX', '75093', '4698006020', '4698006001', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1942315460', 0, 'N', 0, '2014-01-08', NULL, NULL, 33.0145, -96.7925, NULL, NULL),
('752582845', 'ELHT00792', 'ELHT00792', 'TXDALSTD', 'Dallas Diagnostic Association Plano', 'Terilyn', 'R', 'Scott Winful', 'MD', 'Gastroenterology', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1942315460', 0, 'Y', 0, '2014-01-08', NULL, NULL, 0, 0, NULL, NULL),
('752582845', 'ELHT00667', 'ELHT00667', 'TXDALSTD', 'Dallas Diagnostic Association Plano', 'Kenda', 'L', 'Ramirez', 'MD', 'Internal Medicine', '', '', NULL, 'O', '4708 Alliance Blvd Baylor Med Pl 1', 'Plano', 'Collin', 'TX', '75093', '4698006000', '4698006001', '4708 Alliance Blvd Baylor Med Pl 1', 'Plano', 'Collin', 'TX', '75093', '4698006000', '4698006001', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1942338470', 0, 'N', 0, '2012-12-20', NULL, NULL, 33.0145, -96.7925, NULL, NULL),
('752582845', 'ELHT00668', 'ELHT00668', 'TXDALSTD', 'Dallas Diagnostic Association Plano', 'Kenda', 'L', 'Ramirez', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1942338470', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('911947573', 'ELHT00669', 'ELHT00669', 'TXDALSTD', 'Baylor Family Medical Center at Ellis County Waxahachie', 'Ella', 'V', 'Farricielli', 'MD', 'Internal Medicine', '', '', NULL, 'O', '505 N Hwy 77 Ste 200', 'Waxahachie', 'Ellis', 'TX', '75165', '9729231686', '9729377731', '505 N Hwy 77 Ste 200', 'Waxahachie', 'Ellis', 'TX', '75165', '9729231686', '9729377731', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, '', NULL, 'HCFA|UB|', '1942399530', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.3965, -96.8453, NULL, NULL),
('911947573', 'ELHT00670', 'ELHT00670', 'TXDALSTD', 'Baylor Family Medical Center at Ellis County Waxahachie', 'Ella', 'V', 'Farricielli', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '9729231686', '9729239268', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '9729231686', '9729239268', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, '', NULL, 'HCFA|UB|', '1942399530', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('911947573', 'ELHT00353', 'ELHT00353', 'TXDALSTD', '', 'Mark', 'R', 'Allen', 'DO', 'Internal Medicine', '', '', NULL, 'O', '3500 Gaston Ave Roberts Tower 4th Fl', 'Dallas', 'Dallas', 'TX', '75246', '2148203000', '2148203022', '3500 Gaston Ave Roberts Tower 4th Fl', 'Dallas', 'Dallas', 'TX', '75246', '2148203000', '2148203022', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', NULL, 'HCFA|UB|', '1942539986', 0, 'N', 0, '2014-01-30', NULL, NULL, 32.7911, -96.7802, NULL, NULL),
('911947573', 'ELHT00354', 'ELHT00354', 'TXDALSTD', '', 'Mark', 'R', 'Allen', 'DO', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '2148203000', '2148203022', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '2148203000', '2148203022', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', NULL, 'HCFA|UB|', '1942539986', 0, 'N', 0, '2014-01-30', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00671', 'ELHT00671', 'TXDALSTD', 'Internal Medicine Associates at Irving', 'Tenesha', 'R', 'Chappell', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2021 N MacArthur Blvd Ste 520', 'Irving', 'Dallas', 'TX', '75061', '9722512388', '9722512390', '2021 N MacArthur Blvd Ste 520', 'Irving', 'Dallas', 'TX', '75061', '9722512388', '9722512390', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, NULL, NULL, 'HCFA|UB|', '1952326605', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.835, -96.9592, NULL, NULL),
('752536818', 'ELHT00672', 'ELHT00672', 'TXDALSTD', 'Internal Medicine Associates at Irving', 'Tenesha', 'R', 'Chappell', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, NULL, NULL, 'HCFA|UB|', '1952326605', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00029', 'ELHT00029', 'TXDALSTD', 'Critical Care and Pulmonary Consultants of Dallas', 'Stephanie', 'M', 'Woolley', 'MD', 'Hospitalist', '', '', NULL, 'O', '3600 Gaston Ave Wadley Tower Ste 550', 'Dallas', 'Dallas', 'TX', '75246', '9724510219', '2148211193', '3600 Gaston Ave Wadley Tower Ste 550', 'Dallas', 'Dallas', 'TX', '75246', '9724510219', '2148211193', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1952332876', 0, 'Y', 0, '2013-08-29', NULL, NULL, 32.7913, -96.7799, NULL, NULL),
('752536818', 'ELHT00030', 'ELHT00030', 'TXDALSTD', 'Critical Care and Pulmonary Consultants of Dallas', 'Stephanie', 'M', 'Woolley', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1952332876', 0, 'N', 0, '2013-08-29', NULL, NULL, 0, 0, NULL, NULL),
('911947573', 'ELHT00247', 'ELHT00247', 'TXDALSTD', 'Baylor Family Medical Center at Ellis County Waxahachie', 'Deborah', 'C', 'Fung', 'MD', 'Pediatrics', '', '', NULL, 'O', '505 N Hwy 77 Ste 200', 'Waxahachie', 'Ellis', 'TX', '75165', '9729231686', '9729377731', '505 N Hwy 77 Ste 200', 'Waxahachie', 'Ellis', 'TX', '75165', '9729231686', '9729377731', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1952347353', 0, 'N', 0, '2013-08-30', NULL, NULL, 32.3965, -96.8453, NULL, NULL),
('911947573', 'ELHT00248', 'ELHT00248', 'TXDALSTD', 'Baylor Family Medical Center at Ellis County Waxahachie', 'Deborah', 'C', 'Fung', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '9729231686', '9729239268', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '9729231686', '9729239268', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1952347353', 0, 'N', 0, '2013-08-30', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00057', 'ELHT00057', 'TXDALSTD', 'Park Lane Endocrinology', 'Emilia', 'M', 'Popa', 'MD', 'Endocrinology', '', '', NULL, 'O', '9101 N Central Expwy Ste 350', 'Dallas', 'Dallas', 'TX', '75231', '2146961500', '2146961502', '9101 N Central Expy Ste 350', 'Dallas', 'Dallas', 'TX', '75231', '2146961500', '2146961502', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1952368045', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.873, -96.7706, NULL, NULL),
('752536818', 'ELHT00058', 'ELHT00058', 'TXDALSTD', 'Park Lane Endocrinology', 'Emilia', 'M', 'Popa', 'MD', 'Endocrinology', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1952368045', 0, 'N', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('911947573', 'ELHT00673', 'ELHT00673', 'TXDALSTD', 'MedProvider Inpatient Care Unit', 'Katie', 'L', 'Johnson', 'DO', 'Internal Medicine', '', '', NULL, 'O', '3500 Gaston Ave Roberts Tower 4th Fl', 'Dallas', 'Dallas', 'TX', '75246', '2148203000', '2148203022', '3500 Gaston Ave 4th floor', 'Dallas', 'Dallas', 'TX', '75246', '2148203000', '2148203022', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', NULL, 'HCFA|UB|', '1952538746', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.7911, -96.7802, NULL, NULL),
('911947573', 'ELHT00674', 'ELHT00674', 'TXDALSTD', 'MedProvider Inpatient Care Unit', 'Katie', 'L', 'Johnson', 'DO', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '2148203000', '2148203022', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '2148203000', '2148203022', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', NULL, 'HCFA|UB|', '1952538746', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00675', 'ELHT00675', 'TXDALSTD', 'Inpatient Care Unit at Baylor Medical Center Garland', 'Shilpa', '', 'Gupta', 'DO', 'Internal Medicine', '', '', NULL, 'O', '700 Walter Reed Blvd Ste 204', 'Garland', 'Dallas', 'TX', '75042', '9724875462', '9724875277', '700 Walter Reed Blvd Ste 204', 'Garland', 'Dallas', 'TX', '75042', '9724875462', '9724875277', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1952596900', 0, 'Y', 0, '2013-05-01', NULL, NULL, 32.9186, -96.6634, NULL, NULL),
('752536818', 'ELHT00676', 'ELHT00676', 'TXDALSTD', 'Inpatient Care Unit at Baylor Medical Center Garland', 'Shilpa', '', 'Gupta', 'DO', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1952596900', 0, 'Y', 0, '2013-05-01', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00677', 'ELHT00677', 'TXDALSTD', 'Internal Medicine Associates at Southwest Ft Worth', 'Michael', 'D', 'Massey', 'MD', 'Internal Medicine', '', '', NULL, 'O', '5701 Bryant Irvin Rd Ste 302', 'Ft Worth', 'Tarrant', 'TX', '76132', '8172949000', '8172949010', '5701 Bryant Irvin Rd Ste 302', 'Ft Worth', 'Tarrant', 'TX', '76132', '8172949000', '8172949010', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', NULL, 'HCFA|UB|', '1962427625', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.6664, -97.4199, NULL, NULL),
('752536818', 'ELHT00678', 'ELHT00678', 'TXDALSTD', 'Internal Medicine Associates at Southwest Ft Worth', 'Michael', 'D', 'Massey', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', NULL, 'HCFA|UB|', '1962427625', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT01089', 'ELHT01089', 'TXDALSTD', 'Baylor Family Health Center at Mesquite', 'Robert', 'G', 'Cynar', 'MD', 'Family Practice', '', '', NULL, 'O', '1575 I-30', 'Mesquite', 'Dallas', 'TX', '75150', '4698002800', '4698002801', '1575 I 30', 'Mesquite', 'Dallas', 'TX', '75150', '4698002800', '4698002801', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1962451070', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.8297, -96.6193, NULL, NULL),
('752536818', 'ELHT01090', 'ELHT01090', 'TXDALSTD', 'Baylor Family Health Center at Mesquite', 'Robert', 'G', 'Cynar', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1962451070', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752722718', 'ELHT00309', 'ELHT00309', 'TXDALSTD', 'Baylor Family Medical Center at Riverside', 'Egle', 'E', 'Berzinskas', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2740 N Hwy 360 Ste 100', 'Grand Prairie', 'Dallas', 'TX', '75050', '9726068300', '9726064940', '2740 N Hwy 360 Ste 100', 'Grand Prairie', 'Dallas', 'TX', '75050', '9726068300', '9726064940', 'HTPN', 'TXHCPCHTPN', NULL, '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1962455402', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.797, -97.0554, NULL, NULL),
('752582845', 'ELHT00031', 'ELHT00031', 'TXDALSTD', 'Dallas Diagnostic Association Plano', 'Jeff', 'E', 'Taylor', 'MD', 'Critical Care', '', '', NULL, 'O', '4708 Alliance Blvd Baylor Med Pl 1', 'Plano', 'Collin', 'TX', '75093', '4698006000', '4698006001', '4708 Alliance Blvd Baylor Med Pl 1', 'Plano', 'Collin', 'TX', '75093', '4698006000', '4698006001', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1962518431', 0, 'Y', 0, '2012-12-20', NULL, NULL, 33.0145, -96.7925, NULL, NULL),
('752582845', 'ELHT00032', 'ELHT00032', 'TXDALSTD', 'Dallas Diagnostic Association Plano', 'Jeff', 'E', 'Taylor', 'MD', 'Critical Care', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1962518431', 0, 'N', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('030374787', 'ELHT00747', 'ELHT00747', 'TXDALSTD', 'Surgical Institute', 'Elizabeth', 'M', 'Papaila', 'MD', 'General Surgery', '', '', NULL, 'B', '3600 Gaston Ave Wadley Tower Ste 958', 'Dallas', 'Dallas', 'TX', '75246', '2148266276', '2148266223', '3600 Gaston Ave Wadley Tower Ste 958', 'Dallas', 'Dallas', 'TX', '75246', '2148266276', '2148266223', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano  ', NULL, '', '', 'HCFA|UB|', '1962601849', 0, 'Y', 0, '2013-05-22', NULL, NULL, 32.791, -96.7798, NULL, NULL),
('030374787', 'ELHT00748', 'ELHT00748', 'TXDALSTD', 'Surgical Institute', 'Elizabeth', 'M', 'Papaila', 'MD', 'General Surgery', '', '', NULL, 'O', '4708 Alliance Blvd Baylor Med Pl 1', 'Plano', 'Collin', 'TX', '75093', '9727584990', '9727584991', '4708 Alliance Blvd Baylor Med Pl 1', 'Plano', 'Collin', 'TX', '75093', '9727584990', '9727584991', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano  ', NULL, '', '', 'HCFA|UB|', '1962601849', 0, 'N', 0, '2013-05-22', NULL, NULL, 33.0145, -96.7925, NULL, NULL),
('752536818', 'ELHT00149', 'ELHT00149', 'TXDALSTD', 'Cardiac Surgery at Baylor University Medical Center at Dallas', 'Themistokles', '', 'Chamogeorgakis', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '3900 Junius St Ste 605', 'Dallas', 'Dallas', 'TX', '75246', '2148207100', '2148206863', '3900 Junius St Ste 605', 'Dallas', 'Dallas', 'TX', '75246', '2148207100', '2148206863', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1962710699', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.791, -96.7782, NULL, NULL),
('752536818', 'ELHT00150', 'ELHT00150', 'TXDALSTD', 'Cardiac Surgery at Baylor University Medical Center at Dallas', 'Themistokles', '', 'Chamogeorgakis', 'MD', 'Thoracic Surgery', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1962710699', 0, 'N', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752600832', 'ELHT00679', 'ELHT00679', 'TXDALSTD', 'MedProvider', 'Reuben', 'J', 'Elovitz', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3434 Swiss Ave Ste 320', 'Dallas', 'Dallas', 'TX', '75204', '2148285060', '2148285061', '3434 Swiss Ave Ste 320', 'Dallas', 'Dallas', 'TX', '75204', '2148285060', '2148285061', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-02-11', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972515377', 0, 'N', 0, '2013-05-08', NULL, NULL, 32.7913, -96.7821, 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
('752600832', 'ELHT00681', 'ELHT00681', 'TXDALSTD', 'MedProvider', 'Denise', 'S', 'Weber', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3434 Swiss Ave Ste 330', 'Dallas', 'Dallas', 'TX', '75204', '2148285000', '2148285071', '3434 Swiss Ave Ste 330', 'Dallas', 'Dallas', 'TX', '75204', '2148285000', '2148285071', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1972516086', 0, 'N', 0, '2013-06-14', NULL, NULL, 32.7915, -96.7824, NULL, NULL),
('752536818', 'ELHT01091', 'ELHT01091', 'TXDALSTD', 'Family Medical Center at Garland', 'Jason', 'P', 'Fisch', 'MD', 'Family Practice', '', '', NULL, 'O', '601 Clara Barton Blvd Ste 140', 'Garland', 'Dallas', 'TX', '75042', '9722726561', '9722763067', '601 Clara Barton Blvd Ste 140', 'Garland', 'Dallas', 'TX', '75042', '9722726561', '9722763067', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1972525293', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.9175, -96.662, NULL, NULL),
('752536818', 'ELHT01092', 'ELHT01092', 'TXDALSTD', 'Family Medical Center at Garland', 'Jason', 'P', 'Fisch', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1972525293', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00683', 'ELHT00683', 'TXDALSTD', 'North Texas Health Care Associates Internal Medicine IC', 'Bryan', 'L', 'Wasson', 'DO', 'Internal Medicine', '', '', NULL, 'O', '400 W IH 635 Ste 200', 'Irving', 'Dallas', 'TX', '75063', '9724061199', '9725562328', '400 W IH 635 Ste 200', 'Irving', 'Dallas', 'TX', '75063', '9724061199', '9725562328', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, '', NULL, 'HCFA|UB|', '1972537801', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.9125, -96.9492, NULL, NULL),
('752536818', 'ELHT00684', 'ELHT00684', 'TXDALSTD', 'North Texas Health Care Associates Internal Medicine IC', 'Bryan', 'L', 'Wasson', 'DO', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, '', NULL, 'HCFA|UB|', '1972537801', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00151', 'ELHT00151', 'TXDALSTD', 'Cardiac Surgery Specialists', 'Robert', 'L', 'Smith', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '4716 Alliance Blvd Ste 310', 'Plano', 'Collin', 'TX', '75093', '4698006200', '4698006210', '4716 Alliance Blvd Ste 310', 'Plano', 'Collin', 'TX', '75093', '4698006200', '4698006210', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'The Heart Hospital Baylor Plano', NULL, '', NULL, 'HCFA|UB|', '1972718633', 0, 'N', 0, '2012-12-20', NULL, NULL, 33.0145, -96.7926, NULL, NULL),
('752536818', 'ELHT00152', 'ELHT00152', 'TXDALSTD', 'Cardiac Surgery Specialists', 'Robert', 'L', 'Smith', 'MD', 'Thoracic Surgery', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'The Heart Hospital Baylor Plano', NULL, '', NULL, 'HCFA|UB|', '1972718633', 0, 'N', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00249', 'ELHT00249', 'TXDALSTD', 'Southlake Family Medicine', 'Agatha', 'A', 'Hunt', 'MD', 'Pediatrics', '', '', NULL, 'O', '731 E Southlake Blvd Ste 100', 'Southlake', 'Tarrant', 'TX', '76092', '8174243366', '8174243426', '731 E Southlake Blvd Ste 100', 'Southlake', 'Tarrant', 'TX', '76092', '8174243366', '8174243426', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1972719417', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.941, -97.1405, NULL, NULL),
('752536818', 'ELHT00250', 'ELHT00250', 'TXDALSTD', 'Southlake Family Medicine', 'Agatha', 'A', 'Hunt', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1972719417', 0, 'N', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('911947573', 'ELHT01093', 'ELHT01093', 'TXDALSTD', '', 'James', 'W', 'Pickens', 'MD', 'Family Practice', '', '', NULL, 'O', '1405 W Jefferson St', 'Waxahachie', 'Ellis', 'TX', '75165', '9729237144', '9729237145', '1405 W Jefferson St', 'Waxahachie', 'Ellis', 'TX', '75165', '9729237144', '9729237145', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1982610408', 0, 'N', 0, '2014-01-24', NULL, NULL, 32.3968, -96.865, NULL, NULL),
('911947573', 'ELHT01094', 'ELHT01094', 'TXDALSTD', '', 'James', 'W', 'Pickens', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '9729230620', '9729380528', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '9729230620', '9729380528', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1982610408', 0, 'Y', 0, '2014-01-24', NULL, NULL, 0, 0, NULL, NULL),
('752600832', 'ELHT00685', 'ELHT00685', 'TXDALSTD', 'MedProvider', 'Jennifer', 'L', 'Wilkerson', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3434 Swiss Ave Ste 320', 'Dallas', 'Dallas', 'TX', '75204', '2148285000', '2148285061', '3434 Swiss Ave Ste 320', 'Dallas', 'Dallas', 'TX', '75204', '2148285000', '2148285061', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-06-30', 0, 0, 0, 'Baylor All Saints Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1982617239', 0, 'N', 0, '2013-07-31', NULL, NULL, 32.7913, -96.7821, NULL, NULL),
('752536818', 'ELHT01095', 'ELHT01095', 'TXDALSTD', '', 'Jeffry', 'F', 'Adcock', 'MD', 'Family Practice', '', '', NULL, 'O', '601 Clara Barton Blvd Ste 140', 'Garland', 'Dallas', 'TX', '75042', '9722726561', '9722763067', '601 Clara Barton Blvd Ste 140', 'Garland', 'Dallas', 'TX', '75042', '9722726561', '9722763067', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1982626461', 0, 'N', 0, '2014-01-30', NULL, NULL, 32.9175, -96.662, NULL, NULL),
('752536818', 'ELHT01096', 'ELHT01096', 'TXDALSTD', '', 'Jeffry', 'F', 'Adcock', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1982626461', 0, 'Y', 0, '2014-01-30', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00197', 'ELHT00197', 'TXDALSTD', 'Physiatric Medicine Associates', 'Sridevi', '', 'Mukkamala', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '909 N Washington Ave', 'Dallas', 'Dallas', 'TX', '75246', '2148209593', '9724808356', '909 N Washington', 'Dallas', 'Dallas', 'TX', '75246', '2148209593', '9724808356', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1982631727', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.7918, -96.7791, NULL, NULL),
('752536818', 'ELHT00198', 'ELHT00198', 'TXDALSTD', 'Physiatric Medicine Associates', 'Sridevi', '', 'Mukkamala', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1982631727', 0, 'N', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('030374787', 'ELHT00749', 'ELHT00749', 'TXDALSTD', 'Surgical Institute', 'John', 'N', 'Littrell', 'MD', 'General Surgery', '', '', NULL, 'B', '3600 Gaston Ave Wadley Tower Ste 958', 'Dallas', 'Dallas', 'TX', '75246', '2148266276', '2148266223', '3600 Gaston Ave Wadley Tower Ste 958', 'Dallas', 'Dallas', 'TX', '75246', '2148266276', '2148266223', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1982633723', 0, 'Y', 0, '2013-05-22', NULL, NULL, 32.791, -96.7798, NULL, NULL),
('030374787', 'ELHT00750', 'ELHT00750', 'TXDALSTD', 'Surgical Institute', 'John', 'N', 'Littrell', 'MD', 'General Surgery', '', '', NULL, 'O', '4708 Alliance Blvd Baylor Med Pl 1', 'Plano', 'Collin', 'TX', '75093', '9727584990', '9727584991', '4708 Alliance Blvd Baylor Med Pl 1', 'Plano', 'Collin', 'TX', '75093', '9727584990', '9727584991', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1982633723', 0, 'N', 0, '2013-05-22', NULL, NULL, 33.0145, -96.7925, NULL, NULL),
('911947573', 'ELHT00687', 'ELHT00687', 'TXDALSTD', 'Baylor Family Medical Center at Ellis County Waxahachie', 'Yolanda', 'C', 'Brady', 'MD', 'Internal Medicine', '', '', NULL, 'O', '505 N Hwy 77 Ste 200', 'Waxahachie', 'Ellis', 'TX', '75165', '9729231686', '9729377731', '505 N Hwy 77 Ste 200', 'Waxahachie', 'Ellis', 'TX', '75165', '9729231686', '9729377731', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1982640736', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.3965, -96.8453, NULL, NULL),
('911947573', 'ELHT00688', 'ELHT00688', 'TXDALSTD', 'Baylor Family Medical Center at Ellis County Waxahachie', 'Yolanda', 'C', 'Brady', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '9729231686', '9729239268', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '9729231686', '9729239268', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1982640736', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('911947573', 'ELHT01097', 'ELHT01097', 'TXDALSTD', 'Baylor Family Medical Center at Ellis County Red Oak', 'Alexander', 'J', 'Hollub', 'MD', 'Family Practice', '', '', NULL, 'O', '301 E Ovilla Rd Ste 100', 'Red Oak', 'Ellis', 'TX', '75154', '9726175225', '9726177922', '301 E Ovilla Rd Ste 100', 'Red Oak', 'Ellis', 'TX', '75154', '9726175225', '9726177922', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1982648366', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.5318, -96.8051, NULL, NULL),
('911947573', 'ELHT01098', 'ELHT01098', 'TXDALSTD', 'Baylor Family Medical Center at Ellis County Red Oak', 'Alexander', 'J', 'Hollub', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '9729231686', '9729239268', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '9729231686', '9729239268', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1982648366', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752600832', 'ELHT00689', 'ELHT00689', 'TXDALSTD', 'MedProvider', 'Michael', 'S', 'Valachovic', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3434 Swiss Ave Ste 420', 'Dallas', 'Dallas', 'TX', '75204', '2148285020', '2148285021', '3434 Swiss Ave Ste 420', 'Dallas', 'Dallas', 'TX', '75204', '2148285020', '2148285021', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1982813028', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.7915, -96.7824, NULL, NULL),
('911947573', 'ELHT00751', 'ELHT00751', 'TXDALSTD', 'Surgical Oncology Specialists', 'Scott', 'A', 'Celinski', 'MD', 'General Surgery', '', '', NULL, 'O', '3410 Worth St Ste 235', 'Dallas', 'Dallas', 'TX', '75246', '2148202302', '2148202303', '3410 Worth St Ste 235', 'Dallas', 'Dallas', 'TX', '75246', '2148202302', '2148202303', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1982872453', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.7886, -96.779, NULL, NULL),
('911947573', 'ELHT00752', 'ELHT00752', 'TXDALSTD', 'Surgical Oncology Specialists', 'Scott', 'A', 'Celinski', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '2148208612', '2148202303', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '2148208612', '2148202303', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1982872453', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00691', 'ELHT00691', 'TXDALSTD', 'Irving Coppell Internal Medicine', 'Pritha', 'C', 'Browning', 'MD', 'Internal Medicine', '', '', NULL, 'O', '400 W IH 635 Ste 220', 'Irving', 'Dallas', 'TX', '75063', '9724816363', '9724062732', '400 W IH 635 Ste 220', 'Irving', 'Dallas', 'TX', '75063', '9724816363', '9724062732', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, NULL, NULL, 'HCFA|UB|', '1992723126', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.9125, -96.9492, NULL, NULL),
('752536818', 'ELHT00692', 'ELHT00692', 'TXDALSTD', 'Irving Coppell Internal Medicine', 'Pritha', 'C', 'Browning', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, NULL, NULL, 'HCFA|UB|', '1992723126', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT01211', 'ELHT01211', 'TXDALSTD', 'Cottonwood Cardiology', 'Jacob', '', 'Chemmalakuzhy', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1110 Cottonwood Ln Ste 105', 'Irving', 'Dallas', 'TX', '75038', '9726072525', '9722528837', '1110 Cottonwood Ln Ste 105', 'Irving', 'Dallas', 'TX', '75038', '9726072525', '9722528837', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, NULL, NULL, 'HCFA|UB|', '1992723241', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.8652, -96.9601, NULL, NULL),
('752536818', 'ELHT01212', 'ELHT01212', 'TXDALSTD', 'Cottonwood Cardiology', 'Jacob', '', 'Chemmalakuzhy', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, NULL, NULL, 'HCFA|UB|', '1992723241', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('751837454', 'ELHT00713', 'ELHT00713', 'TXDALSTD', 'Health Texas Provider Network', 'Aparna', '', 'Kotamarti', 'MD', 'Geriatrics', '', '', NULL, 'O', '1650 Republic Pkwy Ste 150', 'Mesquite', 'Dallas', 'TX', '75150', '9722797575', '9722700197', '1650 Republic Pkwy Ste 150', 'Mesquite', 'Dallas', 'TX', '75150', '9722797575', '9722700197', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1992735609', 0, 'Y', 0, '2013-08-07', NULL, NULL, 32.8291, -96.6254, NULL, NULL),
('751837454', 'ELHT00714', 'ELHT00714', 'TXDALSTD', 'Health Texas Provider Network', 'Aparna', '', 'Kotamarti', 'MD', 'Geriatrics', '', '', NULL, 'B', 'PO Box 844013', 'Dallas', 'Dallas', 'TX', '75284', '2148209480', '2148208995', 'PO Box 844013', 'Dallas', 'Dallas', 'TX', '75284', '2148209480', '2148208995', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1992735609', 0, 'Y', 0, '2013-08-07', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT01099', 'ELHT01099', 'TXDALSTD', '', 'Michael', 'C', 'Ampelas', 'DO', 'Family Practice', '', '', NULL, 'O', '900 W Magnolia Ave Ste 201', 'Ft Worth', 'Tarrant', 'TX', '76104', '8179216166', '8179219594', '900 W Magnolia Ave Ste 201', 'Ft Worth', 'Tarrant', 'TX', '76104', '8179216166', '8179219594', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1992753818', 0, 'N', 0, '2014-01-30', NULL, NULL, 32.7306, -97.3342, NULL, NULL),
('752536818', 'ELHT01100', 'ELHT01100', 'TXDALSTD', '', 'Michael', 'C', 'Ampelas', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1992753818', 0, 'Y', 0, '2014-01-30', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT00693', 'ELHT00693', 'TXDALSTD', 'Baylor Health Center at Park Cities', 'Kay', 'L', 'Philips', 'MD', 'Internal Medicine', '', '', NULL, 'O', '9101 N Central Expwy Ste 300', 'Dallas', 'Dallas', 'TX', '75231', '2143632305', '2143632608', '9101 N Central Expy Ste 300', 'Dallas', 'Dallas', 'TX', '75231', '2143632305', '2143632608', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1992757173', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.873, -96.7706, NULL, NULL),
('752536818', 'ELHT00694', 'ELHT00694', 'TXDALSTD', 'Baylor Health Center at Park Cities', 'Kay', 'L', 'Philips', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1992757173', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'ELHT01213', 'ELHT01213', 'TXDALSTD', 'Cardiology Consultants of Texas', 'Robert', 'C', 'Stoler', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '621 N Hall St Ste 400', 'Dallas', 'Dallas', 'TX', '75226', '2148248721', '2142376529', '621 N Hall St Ste 400', 'Dallas', 'Dallas', 'TX', '75226', '2148248721', '2142376529', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1992779839', 0, 'N', 0, '2012-12-20', NULL, NULL, 32.7879, -96.7802, NULL, NULL),
('752536818', 'ELHT01214', 'ELHT01214', 'TXDALSTD', 'Cardiology Consultants of Texas', 'Robert', 'C', 'Stoler', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1992779839', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752582845', 'ELHT00695', 'ELHT00695', 'TXDALSTD', 'Dallas Diagnostic Association Plano', 'Linda', 'S', 'Krisik', 'MD', 'Internal Medicine', '', '', NULL, 'O', '4708 Alliance Blvd Baylor Med Pl 1', 'Plano', 'Collin', 'TX', '75093', '4698006000', '4698006001', '4708 Alliance Blvd Baylor Med Pl 1', 'Plano', 'Collin', 'TX', '75093', '4698006000', '4698006001', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1992782338', 0, 'N', 0, '2012-12-20', NULL, NULL, 33.0145, -96.7925, NULL, NULL),
('752582845', 'ELHT00696', 'ELHT00696', 'TXDALSTD', 'Dallas Diagnostic Association Plano', 'Linda', 'S', 'Krisik', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1992782338', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752582845', 'ELHT00697', 'ELHT00697', 'TXDALSTD', 'Dallas Diagnostic Association Plano', 'Rick', 'T', 'Waldo', 'MD', 'Internal Medicine', '', '', NULL, 'O', '4708 Alliance Blvd Baylor Med Pl 1', 'Plano', 'Collin', 'TX', '75093', '4698006000', '4698006001', '4708 Alliance Blvd Baylor Med Pl 1', 'Plano', 'Collin', 'TX', '75093', '4698006000', '4698006001', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1992811335', 0, 'N', 0, '2012-12-20', NULL, NULL, 33.0145, -96.7925, NULL, NULL),
('752582845', 'ELHT00698', 'ELHT00698', 'TXDALSTD', 'Dallas Diagnostic Association Plano', 'Rick', 'T', 'Waldo', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1992811335', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752582845', 'ELHT01111', 'ELHT01111', 'TXDALSTD', 'Dallas Diagnostic Association Plano', 'Christy', 'C', 'Riddle', 'MD', 'Dermatology', '', '', NULL, 'O', '4708 Alliance Blvd Baylor Med Pl 1', 'Plano', 'Collin', 'TX', '75093', '4698006000', '4698006001', '4708 Alliance Blvd Baylor Med Pl 1', 'Plano', 'Collin', 'TX', '75093', '4698006000', '4698006001', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2014-07-02', 0, 0, 0, 'Baylor Regional Medical Center at Plano', '', '', '', 'HCFA|UB|', '1992835565', 0, 'N', 0, '2014-07-02', NULL, NULL, 33.0145, -96.7925, NULL, NULL),
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('820200895', 'W12027583', 'W12027583', 'IDBOISTD', 'Saint Alphonsus Medical Group Glycemic SARMC', 'Clara', 'M', 'Flynn', 'RD, LD, CDE', 'Diabetic Education', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676130', '2083677316', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676130', '2083677316', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-12-01', '2013-06-30', 0, 0, 0, '', '', '', '', 'HCFA|', '1659438935', 0, 'N', 0, '2013-07-12', NULL, NULL, 43.6127, -116.254, 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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('820200895', 'W12027585', 'W12027585', 'IDBOISTD', 'Saint Alphonsus Medical Group Glycemic Meridian', 'Clara', 'M', 'Flynn', 'RD, LD, CDE', 'Diabetic Education', '', '', NULL, 'O', '3025 W Cherry Ln', 'Meridian', 'Ada', 'ID', '83642', '2083676130', '2083677316', '3025 W Cherry Ln', 'Meridian', 'Ada', 'ID', '83642', '2083676130', '2083677316', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-12-01', '2013-06-30', 0, 0, 0, '', '', '', '', 'HCFA|', '1659438935', 0, 'N', 0, '2013-07-12', NULL, NULL, 43.6188, -116.431, NULL, NULL),
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('760585021', 'W12027548', 'W12027548', 'TXHOUSTD', '1960 Family Practice', 'Amie', '', 'Curbow', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 4356 Dept 667', 'Houston', 'Harris', 'TX', '77210', '2815863888', '2814402020', 'PO Box 4356 Dept 667', 'Houston', 'Harris', 'TX', '77210', '2815863888', '2814402020', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2014-05-12', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538352281', 0, 'N', 0, '2014-05-12', NULL, NULL, 0, 0, NULL, NULL),
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('760585021', 'W12027523', 'W12027523', 'TXHOUSTD', '1960 Family Practice', 'Quoc', '', 'Le', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 4356 Dept 667', 'Houston', 'Harris', 'TX', '77210', '2815863888', '2814402020', 'PO Box 4356 Dept 667', 'Houston', 'Harris', 'TX', '77210', '2815863888', '2814402020', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-09-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396787396', 0, 'N', 0, '2014-03-12', NULL, NULL, 0, 0, NULL, NULL),
('760585021', 'W12027550', 'W12027550', 'TXHOUSTD', '1960 Family Practice', 'Gunther', '', 'Groning', 'MD', 'Family Practice', '', '', NULL, 'O', '837 FM 1960 W Ste 105', 'Houston', 'Harris', 'TX', '77090', '2815863888', '2814402020', '837 FM 1960 W Ste 105', 'Houston', 'Harris', 'TX', '77090', '2815863888', '2814402020', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1649326216', 0, 'N', 0, '2012-12-21', NULL, NULL, 30.0078, -95.4426, NULL, NULL),
('760585021', 'W12027551', 'W12027551', 'TXHOUSTD', '1960 Family Practice', 'Gunther', '', 'Groning', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 4356 Dept 667', 'Houston', 'Harris', 'TX', '77210', '2815863888', '2814402020', 'PO Box 4356 Dept 667', 'Houston', 'Harris', 'TX', '77210', '2815863888', '2814402020', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1649326216', 0, 'N', 0, '2012-12-21', NULL, NULL, 0, 0, NULL, NULL),
('760585021', 'W12027553', 'W12027553', 'TXHOUSTD', '1960 Family Practice', 'Kim-Thu', '', 'Chu', 'MD', 'Gynecology', '', '', NULL, 'O', '20320 NW Fwy', 'Houston', 'Harris', 'TX', '77065', '2815863888', '2814402020', '20320 NW Fwy', 'Houston', 'Harris', 'TX', '77065', '2815863888', '2814402020', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316090392', 0, 'N', 0, '2012-12-21', NULL, NULL, 29.921, -95.6197, NULL, NULL),
('760585021', 'W12027554', 'W12027554', 'TXHOUSTD', '1960 Family Practice', 'Kim-Thu', '', 'Chu', 'MD', 'Gynecology', '', '', NULL, 'O', '837 FM 1960 W Ste 105', 'Houston', 'Harris', 'TX', '77090', '2815863888', '2814402020', '837 FM 1960 W Ste 105', 'Houston', 'Harris', 'TX', '77090', '2815863888', '2814402020', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316090392', 0, 'N', 0, '2012-12-21', NULL, NULL, 30.0078, -95.4426, NULL, NULL),
('760585021', 'W12027555', 'W12027555', 'TXHOUSTD', '1960 Family Practice', 'Kim-Thu', '', 'Chu', 'MD', 'Gynecology', '', '', NULL, 'B', 'PO Box 4356 Dept 667', 'Houston', 'Harris', 'TX', '77210', '2815863888', '2814402020', 'PO Box 4356 Dept 667', 'Houston', 'Harris', 'TX', '77210', '2815863888', '2814402020', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316090392', 0, 'N', 0, '2012-12-21', NULL, NULL, 0, 0, NULL, NULL),
('203845479', 'W12027600', 'W12027600', 'ILCHIGSTD', 'Illinois Bone and Joint Institute', '', '', 'Illinois Bone and Joint Institute', '', 'Orthopedic Surgery', '', '', NULL, 'B', '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '          ', NULL, '5057 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '          ', '          ', 'CHIG3', 'ORTHOHCPC1', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205922432', 0, 'N', 0, '2014-02-21', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12027604', 'W12027604', 'IDBOISTD', 'Saint Alphonsus Medical Group Iowa', 'Jonathan', 'L', 'Chu', 'MD', 'Family Practice', 'Hospitalist', '', NULL, 'o', '211 W Iowa Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084657377', '2084657397', '211 W Iowa Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084657377', '2084657397', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-12-26', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1972547685', 0, 'N', 0, '2014-03-20', NULL, NULL, 43.5543, -116.574, NULL, NULL),
('363819436', 'W12027607', 'W12027607', 'ILCHIGSTD', 'Cardiac Surgery Associates', '', '', 'Cardiac Surgery Associates', '', 'Cardiology', '', '', NULL, 'B', 'PO Box 153', 'Channahon', 'Will', 'IL', '60410', '6303247900', '6302711813', 'PO Box 153', 'Channahon', 'Will', 'IL', '60410', '6303247900', '6302711813', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2030-01-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043269160', 0, 'N', 0, '2014-02-25', NULL, NULL, 0, 0, NULL, NULL),
('363819436', 'ELCSA0029', 'ELCSA0029', 'ILCHIGSTD', 'Cardiac Surgery Associates', 'David', '', 'De Boer', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '100 N River Rd', 'Des Plaines', 'Cook', 'IL', '60016', '6303247900', '6302711813', '100 N River Rd', 'Des Plaines', 'Cook', 'IL', '60016', '6303247900', '6302711813', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1346242559', 0, 'N', 0, '2013-05-28', NULL, NULL, 42.0545, -87.8881, NULL, NULL),
('363819436', 'W12027611', 'W12027611', 'ILCHIGSTD', 'Cardiac Surgery Associates', 'James', 'M', 'Tuchek', 'DO', 'Thoracic Surgery', '', '', NULL, 'B', 'PO Box 153', 'Channahon', 'Will', 'IL', '60410', '6303247900', '6302711813', 'PO Box 153', 'Channahon', 'Will', 'IL', '60410', '6303247900', '6302711813', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Edward Hospital', 'Presence Saint Joseph Hospital Elgin', NULL, NULL, 'HCFA|UB|', '1598721250', 0, 'N', 0, '2013-07-02', NULL, NULL, 0, 0, NULL, NULL),
('363819436', 'ELCSA0023', 'ELCSA0023', 'ILCHIGSTD', 'Cardiac Surgery Associates', 'Rudolph', 'A', 'Altergott', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '1325 N Highland', 'Aurora', 'Kane', 'IL', '60506', '6303247900', '6302711813', '1325 N Highland', 'Aurora', 'Kane', 'IL', '60506', '6303247900', '6302711813', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Edward Hospital', 'Presence Saint Joseph Hospital Elgin', NULL, NULL, 'HCFA|UB|', '1417910803', 0, 'N', 0, '2013-07-02', NULL, NULL, 41.7856, -88.3289, NULL, NULL),
('363819436', 'W12027615', 'W12027615', 'ILCHIGSTD', 'Cardiac Surgery Associates', 'Rudolph', 'A', 'Altergott', 'MD', 'Thoracic Surgery', '', '', NULL, 'B', 'PO Box 153', 'Channahon', 'Will', 'IL', '60410', '6303247900', '6302711813', 'PO Box 153', 'Channahon', 'Will', 'IL', '60410', '6303247900', '6302711813', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Edward Hospital', 'Presence Saint Joseph Hospital Elgin', NULL, NULL, 'HCFA|UB|', '1417910803', 0, 'Y', 0, '2013-07-02', NULL, NULL, 0, 0, NULL, NULL),
('363819436', 'W12027618', 'W12027618', 'ILCHIGSTD', 'Cardiac Surgery Associates', 'Jeffrey', '', 'Silver', 'MD', 'Thoracic Surgery', '', '', NULL, 'B', 'PO Box 153', 'Channahon', 'Will', 'IL', '60410', '6303247900', '6302711813', 'PO Box 153', 'Channahon', 'Will', 'IL', '60410', '6303247900', '6302711813', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1770585978', 0, 'Y', 0, '2013-05-28', NULL, NULL, 0, 0, NULL, NULL),
('363819436', 'ELCSA0010', 'ELCSA0010', 'ILCHIGSTD', 'Cardiac Surgery Associates', 'David', '', 'De Boer', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '2650 Warrenville Rd Ste 280', 'Downers Grove', 'Dupage', 'IL', '60515', '6303247900', '6302711813', '2650 Warrenville Rd Ste 280', 'Downers Grove', 'Dupage', 'IL', '60515', '6303247900', '6302711813', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1346242559', 0, 'N', 0, '2013-05-28', NULL, NULL, 41.8077, -88.0488, NULL, NULL),
('363819436', 'ELCSA0026', 'ELCSA0026', 'ILCHIGSTD', 'Cardiac Surgery Associates', 'David', '', 'De Boer', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '7435 W Talcott Ave', 'Downers Grove', 'Dupage', 'IL', '60515', '6303247900', '6302711813', '7435 W Talcott Ave', 'Downers Grove', 'Dupage', 'IL', '60515', '6303247900', '6302711813', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1346242559', 0, 'N', 0, '2013-05-28', NULL, NULL, 41.7123, -88.0234, NULL, NULL),
('363819436', 'W12027621', 'W12027621', 'ILCHIGSTD', 'Cardiac Surgery Associates', 'David', '', 'De Boer', 'MD', 'Thoracic Surgery', '', '', NULL, 'B', 'PO Box 153', 'Channahon', 'Will', 'IL', '60410', '6303247900', '6302711813', 'PO Box 153', 'Channahon', 'Will', 'IL', '60410', '6303247900', '6302711813', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1346242559', 0, 'Y', 0, '2013-05-28', NULL, NULL, 0, 0, NULL, NULL),
('363819436', 'ELCSA0028', 'ELCSA0028', 'ILCHIGSTD', 'Cardiac Surgery Associates', 'David', '', 'De Boer', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '800 W Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '6303247900', '6302711813', '800 W Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '6303247900', '6302711813', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1346242559', 0, 'N', 0, '2013-05-28', NULL, NULL, 42.0666, -87.993, NULL, NULL),
('363819436', 'W12027624', 'W12027624', 'ILCHIGSTD', 'Cardiac Surgery Associates', 'Juan', 'J', 'Bonilla', 'MD', 'Thoracic Surgery', '', '', NULL, 'B', 'PO Box 153', 'Channahon', 'Will', 'IL', '60410', '6303247900', '6302711813', 'PO Box 153', 'Channahon', 'Will', 'IL', '60410', '6303247900', '6302711813', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Edward Hospital', 'Presence Mercy Medical Center', NULL, NULL, 'HCFA|UB|', '1558327015', 0, 'Y', 0, '2013-07-02', NULL, NULL, 0, 0, NULL, NULL),
('363819436', 'ELCSA0027', 'ELCSA0027', 'ILCHIGSTD', 'Cardiac Surgery Associates', 'David', '', 'De Boer', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '5645 W Addison St', 'Chicago', 'Cook', 'IL', '60634', '6303247900', '6302711813', '5645 W Addison St', 'Chicago', 'Cook', 'IL', '60634', '6303247900', '6302711813', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1346242559', 0, 'N', 0, '2013-05-28', NULL, NULL, 41.9459, -87.7678, NULL, NULL),
('363819436', 'W12027628', 'W12027628', 'ILCHIGSTD', 'Cardiac Surgery Associates', 'William', '', 'Polito', 'MD', 'Thoracic Surgery', '', '', NULL, 'B', 'PO Box 153', 'Channahon', 'Will', 'IL', '60410', '6303247900', '6302711813', 'PO Box 153', 'Channahon', 'Will', 'IL', '60410', '6303247900', '6302711813', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1992744288', 0, 'N', 0, '2013-05-28', NULL, NULL, 0, 0, NULL, NULL),
('362167784', 'W12030517', 'W12030517', 'ILCHIGSTD', 'Elmhurst Memorial Hospital', '', '', 'Elmhurst Memorial Hospital', '', 'Hospital', '', '', NULL, 'B', 'Dept 4592 Attn Patient Accounts', 'Carol Stream', 'Dupage', 'IL', '60122', '3312211000', NULL, 'Dept 4592 Attn Patient Accounts', 'Carol Stream', 'Dupage', 'IL', '60122', '3312211000', '          ', '', '', 'ELMHURST', '0.00', '0.00', '0.00', 6, '2030-01-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1548306343', 0, 'N', 0, '2013-09-05', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS057', 'ELNCHS057', 'ILCHIGSTD', 'Northwest Community Health Services', 'Mark', '', 'Stefaniuk', 'MD', 'Family Practice', '', '', NULL, 'O', '199 W Rand Rd', 'Mount Prospect', 'Cook', 'IL', '60056', '8476185450', '8476185459', '199 W Rand Rd', 'Mount Prospect', 'Cook', 'IL', '60056', '8476185450', '8476185459', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1013932409', 0, 'N', 0, '2012-12-26', NULL, NULL, 42.0842, -87.9406, NULL, NULL),
('363312906', 'ELNCHS132', 'ELNCHS132', 'ILCHIGSTD', 'Northwest Community Health Services', 'Mark', '', 'Stefaniuk', 'MD', 'Family Practice', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1013932409', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS054', 'ELNCHS054', 'ILCHIGSTD', 'Northwest Community Health Services', 'Nancy', '', 'Koch', 'MD', 'Internal Medicine', '', '', NULL, 'O', '199 W Rand Rd', 'Mount Prospect', 'Cook', 'IL', '60056', '8476185450', '8476185459', '199 W Rand Rd', 'Mount Prospect', 'Cook', 'IL', '60056', '8476185450', '8476185459', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1033195136', 0, 'N', 0, '2012-12-26', NULL, NULL, 42.0842, -87.9406, NULL, NULL),
('363312906', 'ELNCHS129', 'ELNCHS129', 'ILCHIGSTD', 'Northwest Community Health Services', 'Nancy', '', 'Koch', 'MD', 'Internal Medicine', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1033195136', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS013', 'ELNCHS013', 'ILCHIGSTD', 'Northwest Community Health Services', 'Mark', '', 'Charman', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1450 Busch Pkwy', 'Buffalo Grove', 'Lake', 'IL', '60089', '8474597860', '8474594228', '1450 Busch Pkwy', 'Buffalo Grove', 'Lake', 'IL', '60089', '8474597860', '8474594228', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1033197637', 0, 'N', 0, '2012-12-26', NULL, NULL, 42.1717, -87.9275, NULL, NULL),
('363312906', 'ELNCHS088', 'ELNCHS088', 'ILCHIGSTD', 'Northwest Community Health Services', 'Mark', '', 'Charman', 'MD', 'Internal Medicine', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1033197637', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS148', 'ELNCHS148', 'ILCHIGSTD', 'Northwest Community Health Services', 'Thomas', '', 'Oryszczak', 'DO', 'Hospitalist', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1033373717', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS073', 'ELNCHS073', 'ILCHIGSTD', 'Northwest Community Health Services', 'Thomas', '', 'Oryszczak', 'DO', 'Hospitalist', '', '', NULL, 'O', '800 W Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8476181000', NULL, '800 W Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8476181000', '', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1033373717', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.0666, -87.993, NULL, NULL),
('363312906', 'ELNCHS043', 'ELNCHS043', 'ILCHIGSTD', 'Northwest Community Health Services', 'Andreas', '', 'Seidler', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1538 N Arlington Heights Rd', 'Arlington Heights', 'Cook', 'IL', '60004', '8472536464', '8472536501', '1538 N Arlington Heights Rd', 'Arlington Heights', 'Cook', 'IL', '60004', '8472536464', '8472536501', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1063438034', 0, 'N', 0, '2012-12-26', NULL, NULL, 42.1043, -87.9804, NULL, NULL),
('363312906', 'ELNCHS118', 'ELNCHS118', 'ILCHIGSTD', 'Northwest Community Health Services', 'Andreas', '', 'Seidler', 'MD', 'Internal Medicine', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1063438034', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS015', 'ELNCHS015', 'ILCHIGSTD', 'Northwest Community Health Services', 'Christian', '', 'Daniels', 'MD', 'Family Practice', '', '', NULL, 'O', '1450 Busch Pkwy', 'Buffalo Grove', 'Lake', 'IL', '60089', '8474597860', '8474594228', '1450 Busch Pkwy', 'Buffalo Grove', 'Lake', 'IL', '60089', '8474597860', '8474594228', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1063490605', 0, 'N', 0, '2012-12-26', NULL, NULL, 42.1717, -87.9275, NULL, NULL),
('363312906', 'ELNCHS090', 'ELNCHS090', 'ILCHIGSTD', 'Northwest Community Health Services', 'Christian', '', 'Daniels', 'MD', 'Family Practice', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1063490605', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS012', 'ELNCHS012', 'ILCHIGSTD', 'Northwest Community Health Services', 'Daniel', '', 'Cacioppo', 'MD', 'Neurology', '', '', NULL, 'O', '1450 Busch Pkwy', 'Buffalo Grove', 'Lake', 'IL', '60089', '8474597860', '8474030305', '1450 Busch Pkwy', 'Buffalo Grove', 'Lake', 'IL', '60089', '8474597860', '8474030305', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1083662613', 0, 'N', 0, '2013-04-03', NULL, NULL, 42.1717, -87.9275, NULL, NULL),
('363312906', 'ELNCHS087', 'ELNCHS087', 'ILCHIGSTD', 'Northwest Community Health Services', 'Daniel', '', 'Cacioppo', 'MD', 'Neurology', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1083662613', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS039', 'ELNCHS039', 'ILCHIGSTD', 'Northwest Community Health Services', 'Christopher', '', 'Lynch', 'DC', 'Chiropractic', '', '', NULL, 'O', '1538 N Arlington Heights Rd', 'Arlington Heights', 'Cook', 'IL', '60004', '8472536464', '8472536501', '1538 N Arlington Heights Rd', 'Arlington Heights', 'Cook', 'IL', '60004', '8472536464', '8472536501', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-07-22', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124354139', 0, 'Y', 0, '2013-07-22', NULL, NULL, 42.1041, -87.9805, NULL, NULL),
('363312906', 'ELNCHS114', 'ELNCHS114', 'ILCHIGSTD', 'Northwest Community Health Services', 'Christopher', '', 'Lynch', 'DC', 'Chiropractic', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-07-22', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124354139', 0, 'Y', 0, '2013-07-22', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS027', 'ELNCHS027', 'ILCHIGSTD', 'Northwest Community Health Services', 'Susan', '', 'Nelson', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1450 Busch Pkwy', 'Buffalo Grove', 'Lake', 'IL', '60089', '8474597860', '8475379719', '1450 Busch Pkwy', 'Buffalo Grove', 'Lake', 'IL', '60089', '8474597860', '8475379719', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1144208612', 0, 'N', 0, '2013-04-03', NULL, NULL, 42.1717, -87.9275, NULL, NULL),
('363312906', 'ELNCHS102', 'ELNCHS102', 'ILCHIGSTD', 'Northwest Community Health Services', 'Susan', '', 'Nelson', 'MD', 'Internal Medicine', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1144208612', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS018', 'ELNCHS018', 'ILCHIGSTD', 'Northwest Community Health Services', 'Irina', '', 'Goldvekht', 'DO', 'Internal Medicine', '', '', NULL, 'O', '1051 W Rand Rd', 'Arlington Heights', 'Cook', 'IL', '60004', '8473428220', '8473429394', '1051 W Rand Rd', 'Arlington Heights', 'Cook', 'IL', '60004', '8473428220', '8473429394', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1154309755', 0, 'N', 0, '2012-12-26', NULL, NULL, 42.1228, -87.9956, NULL, NULL),
('363312906', 'ELNCHS017', 'ELNCHS017', 'ILCHIGSTD', 'Northwest Community Health Services', 'Irina', '', 'Goldvekht', 'DO', 'Internal Medicine', '', '', NULL, 'O', '1450 Busch Pkwy', 'Buffalo Grove', 'Lake', 'IL', '60089', '8474597860', '8474594228', '1450 Busch Pkwy', 'Buffalo Grove', 'Lake', 'IL', '60089', '8474597860', '8474594228', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1154309755', 0, 'N', 0, '2012-12-26', NULL, NULL, 42.1717, -87.9275, NULL, NULL),
('363312906', 'ELNCHS092', 'ELNCHS092', 'ILCHIGSTD', 'Northwest Community Health Services', 'Irina', '', 'Goldvekht', 'DO', 'Internal Medicine', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1154309755', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS036', 'ELNCHS036', 'ILCHIGSTD', 'Northwest Community Health Services', 'Michael', '', 'Glickman', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1538 N Arlington Heights Rd', 'Arlington Heights', 'Cook', 'IL', '60004', '8472536464', '8472536501', '1538 N Arlington Heights Rd', 'Arlington Heights', 'Cook', 'IL', '60004', '8472536464', '8472536501', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1154347128', 0, 'N', 0, '2012-12-26', NULL, NULL, 42.1043, -87.9804, NULL, NULL),
('363312906', 'ELNCHS111', 'ELNCHS111', 'ILCHIGSTD', 'Northwest Community Health Services', 'Michael', '', 'Glickman', 'MD', 'Internal Medicine', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1154347128', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS033', 'ELNCHS033', 'ILCHIGSTD', 'Northwest Community Health Services', 'Aaron', '', 'Benson', 'MD', 'Gastroenterology', '', '', NULL, 'O', '1538 N Arlington Heights Rd', 'Arlington Heights', 'Cook', 'IL', '60004', '8472536464', '8472536501', '1538 N Arlington Heights Rd', 'Arlington Heights', 'Cook', 'IL', '60004', '8472536464', '8472536501', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1164508453', 0, 'N', 0, '2012-12-26', NULL, NULL, 42.1043, -87.9804, NULL, NULL),
('363312906', 'ELNCHS034', 'ELNCHS034', 'ILCHIGSTD', 'Northwest Community Health Services', 'Aaron', '', 'Benson', 'MD', 'Gastroenterology', '', '', NULL, 'O', '199 W Rand Rd', 'Mount Prospect', 'Cook', 'IL', '60056', '8476185450', '8476185459', '199 W Rand Rd', 'Mount Prospect', 'Cook', 'IL', '60056', '8476185450', '8476185459', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1164508453', 0, 'N', 0, '2012-12-26', NULL, NULL, 42.0842, -87.9406, NULL, NULL),
('363312906', 'ELNCHS108', 'ELNCHS108', 'ILCHIGSTD', 'Northwest Community Health Services', 'Aaron', '', 'Benson', 'MD', 'Gastroenterology', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1164508453', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS144', 'ELNCHS144', 'ILCHIGSTD', 'Northwest Community Health Services', 'Doron', '', 'Galili', 'MD', 'Hospitalist', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1215160320', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS069', 'ELNCHS069', 'ILCHIGSTD', 'Northwest Community Health Services', 'Doron', '', 'Galili', 'MD', 'Hospitalist', '', '', NULL, 'O', '800 W Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8476181000', NULL, '800 W Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8476181000', '', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1215160320', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.0666, -87.993, NULL, NULL),
('363312906', 'ELNCHS135', 'ELNCHS135', 'ILCHIGSTD', 'Northwest Community Health Services', 'Hillary', '', 'Horan', 'NPC', '', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1215211768', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS060', 'ELNCHS060', 'ILCHIGSTD', 'Northwest Community Health Services', 'Hillary', '', 'Horan', 'NPC', '', '', '', NULL, 'O', '423 Dundee Rd', 'Palatine', 'Cook', 'IL', '60074', '8477258620', '8479631393', '423 Dundee Rd', 'Palatine', 'Cook', 'IL', '60074', '8477258620', '8479631393', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1215211768', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS010', 'ELNCHS010', 'ILCHIGSTD', 'Northwest Community Health Services', 'Dipal', '', 'Shah', 'DO', 'Endocrinology', '', '', NULL, 'O', '1051 W Rand Rd', 'Arlington Heights', 'Cook', 'IL', '60004', '8473428220', '8473429394', '1051 W Rand Rd', 'Arlington Heights', 'Cook', 'IL', '60004', '8473428220', '8473429394', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1235386160', 0, 'N', 0, '2012-12-26', NULL, NULL, 42.1228, -87.9956, NULL, NULL),
('363312906', 'ELNCHS085', 'ELNCHS085', 'ILCHIGSTD', 'Northwest Community Health Services', 'Dipal', '', 'Shah', 'DO', 'Endocrinology', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1235386160', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS053', 'ELNCHS053', 'ILCHIGSTD', 'Northwest Community Health Services', 'Philip', '', 'Kiley', 'MD', 'Internal Medicine', '', '', NULL, 'O', '199 W Rand Rd', 'Mount Prospect', 'Cook', 'IL', '60056', '8476185450', '8476185459', '199 W Rand Rd', 'Mount Prospect', 'Cook', 'IL', '60056', '8476185450', '8476185459', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1245211366', 0, 'N', 0, '2012-12-26', NULL, NULL, 42.0842, -87.9406, NULL, NULL),
('363312906', 'ELNCHS128', 'ELNCHS128', 'ILCHIGSTD', 'Northwest Community Health Services', 'Philip', '', 'Kiley', 'MD', 'Internal Medicine', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1245211366', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS008', 'ELNCHS008', 'ILCHIGSTD', 'Northwest Community Health Services', 'Gary', '', 'Meyers', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1051 W Rand Rd', 'Arlington Heights', 'Cook', 'IL', '60004', '8473428220', '8473429394', '1051 W Rand Rd', 'Arlington Heights', 'Cook', 'IL', '60004', '8473428220', '8473429394', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1275511883', 0, 'N', 0, '2012-12-26', NULL, NULL, 42.1228, -87.9956, NULL, NULL),
('363312906', 'ELNCHS083', 'ELNCHS083', 'ILCHIGSTD', 'Northwest Community Health Services', 'Gary', '', 'Meyers', 'MD', 'Internal Medicine', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1275511883', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS065', 'ELNCHS065', 'ILCHIGSTD', 'Northwest Community Health Services', 'Ajay', '', 'Jain', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1375 E Schumaburg Rd Ste 120', 'Schaumburg', 'Cook', 'IL', '60194', '8473522322', '8473522369', '1375 E Schumaburg Rd Ste 120', 'Schaumburg', 'Cook', 'IL', '60194', '8473522322', '8473522369', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1275610917', 0, 'N', 0, '2012-12-26', NULL, NULL, 42.0286, -88.0469, NULL, NULL),
('363312906', 'ELNCHS140', 'ELNCHS140', 'ILCHIGSTD', 'Northwest Community Health Services', 'Ajay', '', 'Jain', 'MD', 'Internal Medicine', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1275610917', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS136', 'ELNCHS136', 'ILCHIGSTD', 'Northwest Community Health Services', 'Irina', '', 'Meshem', 'NPC', '', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1316958010', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS061', 'ELNCHS061', 'ILCHIGSTD', 'Northwest Community Health Services', 'Irina', '', 'Meshem', 'NPC', '', '', '', NULL, 'O', '423 Dundee Rd', 'Palatine', 'Cook', 'IL', '60074', '8477258620', '8479631393', '423 Dundee Rd', 'Palatine', 'Cook', 'IL', '60074', '8477258620', '8479631393', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1316958010', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS058', 'ELNCHS058', 'ILCHIGSTD', 'Northwest Community Health Services', 'Nigel', '', 'Walters', 'MD', 'Internal Medicine', '', '', NULL, 'O', '199 W Rand Rd', 'Mount Prospect', 'Cook', 'IL', '60056', '8476185450', '8476185459', '199 W Rand Rd', 'Mount Prospect', 'Cook', 'IL', '60056', '8476185450', '8476185459', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1326073750', 0, 'N', 0, '2012-12-26', NULL, NULL, 42.0842, -87.9406, NULL, NULL),
('363312906', 'ELNCHS133', 'ELNCHS133', 'ILCHIGSTD', 'Northwest Community Health Services', 'Nigel', '', 'Walters', 'MD', 'Internal Medicine', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1326073750', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS035', 'ELNCHS035', 'ILCHIGSTD', 'Northwest Community Health Services', 'Kelly', '', 'Caruso', 'PAC', '', '', '', NULL, 'O', '1538 N Arlington Heights Rd', 'Arlington Heights', 'Cook', 'IL', '60004', '8472536464', '8472536501', '1538 N Arlington Heights Rd', 'Arlington Heights', 'Cook', 'IL', '60004', '8472536464', '8472536501', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1336214782', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.1043, -87.9804, NULL, NULL),
('363312906', 'ELNCHS110', 'ELNCHS110', 'ILCHIGSTD', 'Northwest Community Health Services', 'Kelly', '', 'Caruso', 'PAC', '', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1336214782', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS025', 'ELNCHS025', 'ILCHIGSTD', 'Northwest Community Health Services', 'Jules', '', 'Marks', 'DO', 'Internal Medicine', '', '', NULL, 'O', '1450 Busch Pkwy', 'Buffalo Grove', 'Lake', 'IL', '60089', '8475377744', '8475379719', '1450 Busch Pkwy', 'Buffalo Grove', 'Lake', 'IL', '60089', '8475377744', '8475379719', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1346228814', 0, 'N', 0, '2012-12-26', NULL, NULL, 42.1717, -87.9275, NULL, NULL),
('363312906', 'ELNCHS100', 'ELNCHS100', 'ILCHIGSTD', 'Northwest Community Health Services', 'Jules', '', 'Marks', 'DO', 'Internal Medicine', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1346228814', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS002', 'ELNCHS002', 'ILCHIGSTD', 'Northwest Community Health Services', 'David', '', 'Charman', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1051 W Rand Rd', 'Arlington Heights', 'Cook', 'IL', '60004', '8473428220', '8473429394', '1051 W Rand Rd', 'Arlington Heights', 'Cook', 'IL', '60004', '8473428220', '8473429394', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1346228954', 0, 'N', 0, '2012-12-26', NULL, NULL, 42.1228, -87.9956, NULL, NULL),
('363312906', 'ELNCHS077', 'ELNCHS077', 'ILCHIGSTD', 'Northwest Community Health Services', 'David', '', 'Charman', 'MD', 'Internal Medicine', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1346228954', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS009', 'ELNCHS009', 'ILCHIGSTD', 'Northwest Community Health Services', 'John', '', 'Rosanova', 'DO', 'Internal Medicine', '', '', NULL, 'O', '1051 W Rand Rd', 'Arlington Heights', 'Cook', 'IL', '60004', '8473428220', '8473429394', '1051 W Rand Rd', 'Arlington Heights', 'Cook', 'IL', '60004', '8473428220', '8473429394', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1366420986', 0, 'N', 0, '2012-12-26', NULL, NULL, 42.1228, -87.9956, 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
('363312906', 'ELNCHS084', 'ELNCHS084', 'ILCHIGSTD', 'Northwest Community Health Services', 'John', '', 'Rosanova', 'DO', 'Internal Medicine', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1366420986', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS011', 'ELNCHS011', 'ILCHIGSTD', 'Northwest Community Health Services', 'Beth', 'Ann', 'Adams', 'MD', 'Dermatology', '', '', NULL, 'O', '1450 Busch Pkwy', 'Buffalo Grove', 'Lake', 'IL', '60089', '8474597860', '8474030305', '1450 Busch Pkwy', 'Buffalo Grove', 'Lake', 'IL', '60089', '8474597860', '8474030305', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1376751255', 0, 'N', 0, '2013-04-03', NULL, NULL, 42.1717, -87.9275, NULL, NULL),
('363312906', 'ELNCHS086', 'ELNCHS086', 'ILCHIGSTD', 'Northwest Community Health Services', 'Beth', 'Ann', 'Adams', 'MD', 'Dermatology', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1376751255', 0, 'Y', 0, '2013-04-03', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS145', 'ELNCHS145', 'ILCHIGSTD', 'Northwest Community Health Services', 'Michael', '', 'Grzelak', 'MD', 'Hospitalist', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1386808913', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS070', 'ELNCHS070', 'ILCHIGSTD', 'Northwest Community Health Services', 'Michael', '', 'Grzelak', 'MD', 'Hospitalist', '', '', NULL, 'O', '800 W Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8476181000', NULL, '800 W Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8476181000', '', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1386808913', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.0666, -87.993, NULL, NULL),
('363312906', 'ELNCHS019', 'ELNCHS019', 'ILCHIGSTD', 'Northwest Community Health Services', 'Michael', '', 'Hersh', 'MD', 'Gastroenterology', '', '', NULL, 'O', '1450 Busch Pkwy', 'Buffalo Grove', 'Lake', 'IL', '60089', '8474597860', '8474030305', '1450 Busch Pkwy', 'Buffalo Grove', 'Lake', 'IL', '60089', '8474597860', '8474030305', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1407076888', 0, 'N', 0, '2013-04-03', NULL, NULL, 42.1717, -87.9275, NULL, NULL),
('363312906', 'ELNCHS094', 'ELNCHS094', 'ILCHIGSTD', 'Northwest Community Health Services', 'Michael', '', 'Hersh', 'MD', 'Gastroenterology', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1407076888', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS046', 'ELNCHS046', 'ILCHIGSTD', 'Northwest Community Health Services', 'Ena', '', 'Hennegan', 'DO', 'Family Practice', '', '', NULL, 'O', '1700 W Central Rd Ste 140', 'Arlington Heights', 'Cook', 'IL', '60005', '8472596200', '8472593540', '1700 W Central Rd Ste 140', 'Arlington Heights', 'Cook', 'IL', '60005', '8472596200', '8472593540', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1407851470', 0, 'N', 0, '2012-12-26', NULL, NULL, 42.0667, -88.0024, NULL, NULL),
('363312906', 'ELNCHS121', 'ELNCHS121', 'ILCHIGSTD', 'Northwest Community Health Services', 'Ena', '', 'Hennegan', 'DO', 'Family Practice', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1407851470', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS055', 'ELNCHS055', 'ILCHIGSTD', 'Northwest Community Health Services', 'Anish', '', 'Pithadia', 'MD', 'Family Practice', '', '', NULL, 'O', '199 W Rand Rd', 'Mount Prospect', 'Cook', 'IL', '60056', '8476185450', '8476185459', '199 W Rand Rd', 'Mount Prospect', 'Cook', 'IL', '60056', '8476185450', '8476185459', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1417074774', 0, 'N', 0, '2012-12-26', NULL, NULL, 42.0842, -87.9406, NULL, NULL),
('363312906', 'ELNCHS130', 'ELNCHS130', 'ILCHIGSTD', 'Northwest Community Health Services', 'Anish', '', 'Pithadia', 'MD', 'Family Practice', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1417074774', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS044', 'ELNCHS044', 'ILCHIGSTD', 'Northwest Community Health Services', 'Nurit', '', 'Crystal', 'MD', 'Family Practice', '', '', NULL, 'O', '1700 W Central Rd Ste 140', 'Arlington Heights', 'Cook', 'IL', '60005', '8472596200', '8472593540', '1700 W Central Rd Ste 140', 'Arlington Heights', 'Cook', 'IL', '60005', '8472596200', '8472593540', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1457350118', 0, 'N', 0, '2012-12-26', NULL, NULL, 42.0667, -88.0024, NULL, NULL),
('363312906', 'ELNCHS119', 'ELNCHS119', 'ILCHIGSTD', 'Northwest Community Health Services', 'Nurit', '', 'Crystal', 'MD', 'Family Practice', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1457350118', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS150', 'ELNCHS150', 'ILCHIGSTD', 'Northwest Community Health Services', 'Karen', '', 'Zimmerman', 'MD', 'Hospitalist', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1457517054', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS075', 'ELNCHS075', 'ILCHIGSTD', 'Northwest Community Health Services', 'Karen', '', 'Zimmerman', 'MD', 'Hospitalist', '', '', NULL, 'O', '800 W Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8476181000', NULL, '800 W Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8476181000', '', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1457517054', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.0666, -87.993, NULL, NULL),
('363312906', 'ELNCHS021', 'ELNCHS021', 'ILCHIGSTD', 'Northwest Community Health Services', 'Gabriel', '', 'Kibrit', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1450 Busch Pkwy', 'Buffalo Grove', 'Lake', 'IL', '60089', '8474597860', '8475379719', '1450 Busch Pkwy', 'Buffalo Grove', 'Lake', 'IL', '60089', '8474597860', '8475379719', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1477531937', 0, 'N', 0, '2013-04-03', NULL, NULL, 42.1717, -87.9275, NULL, NULL),
('363312906', 'ELNCHS096', 'ELNCHS096', 'ILCHIGSTD', 'Northwest Community Health Services', 'Gabriel', '', 'Kibrit', 'MD', 'Internal Medicine', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1477531937', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS149', 'ELNCHS149', 'ILCHIGSTD', 'Northwest Community Health Services', 'Matthew', '', 'Strauch', 'DO', 'Hospitalist', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477780328', 0, 'Y', 0, '2013-07-02', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS074', 'ELNCHS074', 'ILCHIGSTD', 'Northwest Community Health Services', 'Matthew', '', 'Strauch', 'DO', 'Hospitalist', '', '', NULL, 'O', '800 W Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8476186560', NULL, '800 W Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8476186560', '          ', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477780328', 0, 'Y', 0, '2013-07-02', NULL, NULL, 42.0666, -87.993, NULL, NULL),
('363312906', 'ELNCHS051', 'ELNCHS051', 'ILCHIGSTD', 'Northwest Community Health Services', 'Kathryn', '', 'Eubanks', 'MD', 'Internal Medicine', '', '', NULL, 'O', '199 W Rand Rd', 'Mount Prospect', 'Cook', 'IL', '60056', '8476185450', '8476185459', '199 W Rand Rd', 'Mount Prospect', 'Cook', 'IL', '60056', '8476185450', '8476185459', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1487638763', 0, 'N', 0, '2012-12-26', NULL, NULL, 42.0842, -87.9406, NULL, NULL),
('363312906', 'ELNCHS126', 'ELNCHS126', 'ILCHIGSTD', 'Northwest Community Health Services', 'Kathryn', '', 'Eubanks', 'MD', 'Internal Medicine', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1487638763', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS138', 'ELNCHS138', 'ILCHIGSTD', 'Northwest Community Health Services', 'Janet', '', 'Reilly', 'MD', 'Internal Medicine', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1508961129', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS063', 'ELNCHS063', 'ILCHIGSTD', 'Northwest Community Health Services', 'Janet', '', 'Reilly', 'MD', 'Internal Medicine', '', '', NULL, 'O', '500 N Hicks Rd Ste 100', 'Palatine', 'Cook', 'IL', '60067', '8479917440', '8479919348', '500 N Hicks Rd Ste 100', 'Palatine', 'Cook', 'IL', '60067', '8479917440', '8479919348', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1508961129', 0, 'N', 0, '2012-12-26', NULL, NULL, 42.1193, -88.034, NULL, NULL),
('363312906', 'ELNCHS029', 'ELNCHS029', 'ILCHIGSTD', 'Northwest Community Health Services', 'Maria Justina', '', 'Villano', 'MD', 'Endocrinology', '', '', NULL, 'O', '1450 Busch Pkwy', 'Buffalo Grove', 'Lake', 'IL', '60089', '8477258453', '8474030305', '1450 Busch Pkwy', 'Buffalo Grove', 'Lake', 'IL', '60089', '8477258453', '8474030305', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1518186824', 0, 'N', 0, '2012-12-26', NULL, NULL, 42.1717, -87.9275, NULL, NULL),
('363312906', 'ELNCHS104', 'ELNCHS104', 'ILCHIGSTD', 'Northwest Community Health Services', 'Maria Justina', '', 'Villano', 'MD', 'Endocrinology', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1518186824', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS014', 'ELNCHS014', 'ILCHIGSTD', 'Northwest Community Health Services', 'Monika', '', 'Cohen', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1450 Busch Pkwy', 'Buffalo Grove', 'Lake', 'IL', '60089', '8474597860', '8474594228', '1450 Busch Pkwy', 'Buffalo Grove', 'Lake', 'IL', '60089', '8474597860', '8474594228', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1528046224', 0, 'N', 0, '2012-12-26', NULL, NULL, 42.1717, -87.9275, NULL, NULL),
('363312906', 'ELNCHS089', 'ELNCHS089', 'ILCHIGSTD', 'Northwest Community Health Services', 'Monika', '', 'Cohen', 'MD', 'Internal Medicine', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1528046224', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS024', 'ELNCHS024', 'ILCHIGSTD', 'Northwest Community Health Services', 'Wendi', '', 'Marcus', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1450 Busch Pkwy', 'Buffalo Grove', 'Lake', 'IL', '60089', '8474597860', '8475379719', '1450 Busch Pkwy', 'Buffalo Grove', 'Lake', 'IL', '60089', '8474597860', '8475379719', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1548249113', 0, 'N', 0, '2013-04-03', NULL, NULL, 42.1717, -87.9275, NULL, NULL),
('363312906', 'ELNCHS099', 'ELNCHS099', 'ILCHIGSTD', 'Northwest Community Health Services', 'Wendi', '', 'Marcus', 'MD', 'Internal Medicine', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1548249113', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS141', 'ELNCHS141', 'ILCHIGSTD', 'Northwest Community Health Services', 'Victor', '', 'Lesniauskas', 'MD', 'Internal Medicine', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1568509206', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS066', 'ELNCHS066', 'ILCHIGSTD', 'Northwest Community Health Services', 'Victor', '', 'Lesniauskas', 'MD', 'Internal Medicine', '', '', NULL, 'O', '855 E Palatine Rd', 'Palatine', 'Cook', 'IL', '60074', '8473593363', '8473593904', '855 E Palatine Rd', 'Palatine', 'Cook', 'IL', '60074', '8473593363', '8473593904', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1568509206', 0, 'N', 0, '2012-12-26', NULL, NULL, 42.1102, -88.0228, NULL, NULL),
('363312906', 'ELNCHS040', 'ELNCHS040', 'ILCHIGSTD', 'Northwest Community Health Services', 'Fred', '', 'Rahimi', 'DPM', 'Podiatry', '', '', NULL, 'O', '1538 N Arlington Heights Rd', 'Arlington Heights', 'Cook', 'IL', '60004', '8472536464', '8472536501', '1538 N Arlington Heights Rd', 'Arlington Heights', 'Cook', 'IL', '60004', '8472536464', '8472536501', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1588661110', 0, 'N', 0, '2012-12-26', NULL, NULL, 42.1043, -87.9804, NULL, NULL),
('363312906', 'ELNCHS041', 'ELNCHS041', 'ILCHIGSTD', 'Northwest Community Health Services', 'Fred', '', 'Rahimi', 'DPM', 'Podiatry', '', '', NULL, 'O', '199 W Rand Rd', 'Mount Prospect', 'Cook', 'IL', '60056', '8476185450', '8476185459', '199 W Rand Rd', 'Mount Prospect', 'Cook', 'IL', '60056', '8476185450', '8476185459', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1588661110', 0, 'N', 0, '2012-12-26', NULL, NULL, 42.0842, -87.9406, NULL, NULL),
('363312906', 'ELNCHS115', 'ELNCHS115', 'ILCHIGSTD', 'Northwest Community Health Services', 'Fred', '', 'Rahimi', 'DPM', 'Podiatry', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1588661110', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS006', 'ELNCHS006', 'ILCHIGSTD', 'Northwest Community Health Services', 'Robert', '', 'Goldman', 'DO', 'Rheumatology', '', '', NULL, 'O', '1450 Busch Pkwy', 'Buffalo Grove', 'Lake', 'IL', '60089', '8477258453', '8474030305', '1450 Busch Pkwy', 'Buffalo Grove', 'Lake', 'IL', '60089', '8477258453', '8474030305', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1588879571', 0, 'N', 0, '2012-12-26', NULL, NULL, 42.1717, -87.9275, NULL, NULL),
('363312906', 'ELNCHS005', 'ELNCHS005', 'ILCHIGSTD', 'Northwest Community Health Services', 'Robert', '', 'Goldman', 'DO', 'Rheumatology', '', '', NULL, 'O', '199 W Rand Rd', 'Mount Prospect', 'Cook', 'IL', '60056', '8476185450', '8476185459', '199 W Rand Rd', 'Mount Prospect', 'Cook', 'IL', '60056', '8476185450', '8476185459', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1588879571', 0, 'N', 0, '2012-12-26', NULL, NULL, 42.0842, -87.9406, NULL, NULL),
('363312906', 'ELNCHS080', 'ELNCHS080', 'ILCHIGSTD', 'Northwest Community Health Services', 'Robert', '', 'Goldman', 'DO', 'Rheumatology', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1588879571', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS137', 'ELNCHS137', 'ILCHIGSTD', 'Northwest Community Health Services', 'John', '', 'Fox', 'MD', 'Internal Medicine', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1619073145', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS062', 'ELNCHS062', 'ILCHIGSTD', 'Northwest Community Health Services', 'John', '', 'Fox', 'MD', 'Internal Medicine', '', '', NULL, 'O', '500 N Hicks Rd Ste 100', 'Palatine', 'Cook', 'IL', '60067', '8479917440', '8479919348', '500 N Hicks Rd Ste 100', 'Palatine', 'Cook', 'IL', '60067', '8479917440', '8479919348', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1619073145', 0, 'N', 0, '2012-12-26', NULL, NULL, 42.1193, -88.034, NULL, NULL),
('363312906', 'ELNCHS134', 'ELNCHS134', 'ILCHIGSTD', 'Northwest Community Health Services', 'Kimberly', '', 'Hogan', 'APN', '', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1619293669', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS059', 'ELNCHS059', 'ILCHIGSTD', 'Northwest Community Health Services', 'Kimberly', '', 'Hogan', 'APN', '', '', '', NULL, 'O', '423 Dundee Rd', 'Palatine', 'Cook', 'IL', '60074', '8477258620', '8479631393', '423 Dundee Rd', 'Palatine', 'Cook', 'IL', '60074', '8477258620', '8479631393', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1619293669', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS146', 'ELNCHS146', 'ILCHIGSTD', 'Northwest Community Health Services', 'John', '', 'Kaminski', 'MD', 'Hospitalist', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1649426610', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS071', 'ELNCHS071', 'ILCHIGSTD', 'Northwest Community Health Services', 'John', '', 'Kaminski', 'MD', 'Hospitalist', '', '', NULL, 'O', '800 W Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8476181000', NULL, '800 W Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8476181000', '', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1649426610', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.0666, -87.993, NULL, NULL),
('363312906', 'ELNCHS020', 'ELNCHS020', 'ILCHIGSTD', 'Northwest Community Health Services', 'Richard', '', 'Higgins', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1450 Busch Pkwy', 'Buffalo Grove', 'Lake', 'IL', '60089', '8474597860', '8475379719', '1450 Busch Pkwy', 'Buffalo Grove', 'Lake', 'IL', '60089', '8474597860', '8475379719', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1679551139', 0, 'N', 0, '2013-04-03', NULL, NULL, 42.1717, -87.9275, NULL, NULL),
('363312906', 'ELNCHS095', 'ELNCHS095', 'ILCHIGSTD', 'Northwest Community Health Services', 'Richard', '', 'Higgins', 'MD', 'Internal Medicine', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1679551139', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS139', 'ELNCHS139', 'ILCHIGSTD', 'Northwest Community Health Services', 'Evelyn', '', 'White', 'MD', 'Internal Medicine', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1699855924', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS064', 'ELNCHS064', 'ILCHIGSTD', 'Northwest Community Health Services', 'Evelyn', '', 'White', 'MD', 'Internal Medicine', '', '', NULL, 'O', '500 N Hicks Rd Ste 100', 'Palatine', 'Cook', 'IL', '60067', '8479917440', '8479919348', '500 N Hicks Rd Ste 100', 'Palatine', 'Cook', 'IL', '60067', '8479917440', '8479919348', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1699855924', 0, 'N', 0, '2012-12-26', NULL, NULL, 42.1193, -88.034, NULL, NULL),
('363312906', 'ELNCHS007', 'ELNCHS007', 'ILCHIGSTD', 'Northwest Community Health Services', 'Carl', '', 'Lang', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1051 W Rand Rd', 'Arlington Heights', 'Cook', 'IL', '60004', '8473428220', '8473429394', '1051 W Rand Rd', 'Arlington Heights', 'Cook', 'IL', '60004', '8473428220', '8473429394', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1730167339', 0, 'N', 0, '2012-12-26', NULL, NULL, 42.1228, -87.9956, NULL, NULL),
('363312906', 'ELNCHS082', 'ELNCHS082', 'ILCHIGSTD', 'Northwest Community Health Services', 'Carl', '', 'Lang', 'MD', 'Internal Medicine', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1730167339', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS038', 'ELNCHS038', 'ILCHIGSTD', 'Northwest Community Health Services', 'Katherine', '', 'Kotcherian', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1538 N Arlington Heights Rd', 'Arlington Heights', 'Cook', 'IL', '60004', '8472536464', '8472536501', '1538 N Arlington Heights Rd', 'Arlington Heights', 'Cook', 'IL', '60004', '8472536464', '8472536501', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1740215177', 0, 'N', 0, '2012-12-26', NULL, NULL, 42.1043, -87.9804, NULL, NULL),
('363312906', 'ELNCHS113', 'ELNCHS113', 'ILCHIGSTD', 'Northwest Community Health Services', 'Katherine', '', 'Kotcherian', 'MD', 'Internal Medicine', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1740215177', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS048', 'ELNCHS048', 'ILCHIGSTD', 'Northwest Community Health Services', 'Janusz', '', 'Mejer', 'MD', 'Family Practice', '', '', NULL, 'O', '1700 W Central Rd Ste 140', 'Arlington Heights', 'Cook', 'IL', '60005', '8472596200', '8472593540', '1700 W Central Rd Ste 140', 'Arlington Heights', 'Cook', 'IL', '60005', '8472596200', '8472593540', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790836807', 0, 'N', 0, '2014-04-08', NULL, NULL, 42.0667, -88.0024, NULL, NULL),
('363312906', 'ELNCHS123', 'ELNCHS123', 'ILCHIGSTD', 'Northwest Community Health Services', 'Janusz', '', 'Mejer', 'MD', 'Family Practice', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790836807', 0, 'Y', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS042', 'ELNCHS042', 'ILCHIGSTD', 'Northwest Community Health Services', 'Morry', '', 'Rotenberg', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1538 N Arlington Heights Rd', 'Arlington Heights', 'Cook', 'IL', '60004', '8472536464', '8472536501', '1538 N Arlington Heights Rd', 'Arlington Heights', 'Cook', 'IL', '60004', '8472536464', '8472536501', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1801821236', 0, 'N', 0, '2012-12-26', NULL, NULL, 42.1043, -87.9804, NULL, NULL),
('363312906', 'ELNCHS117', 'ELNCHS117', 'ILCHIGSTD', 'Northwest Community Health Services', 'Morry', '', 'Rotenberg', 'MD', 'Internal Medicine', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1801821236', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS032', 'ELNCHS032', 'ILCHIGSTD', 'Northwest Community Health Services', 'Carl', '', 'Bakken', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1538 N Arlington Heights Rd', 'Arlington Heights', 'Cook', 'IL', '60004', '8472536464', '8472536501', '1538 N Arlington Heights Rd', 'Arlington Heights', 'Cook', 'IL', '60004', '8472536464', '8472536501', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1821023243', 0, 'N', 0, '2012-12-26', NULL, NULL, 42.1043, -87.9804, NULL, NULL),
('363312906', 'ELNCHS107', 'ELNCHS107', 'ILCHIGSTD', 'Northwest Community Health Services', 'Carl', '', 'Bakken', 'MD', 'Internal Medicine', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1821023243', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS143', 'ELNCHS143', 'ILCHIGSTD', 'Northwest Community Health Services', 'Ian', '', 'Coelho', 'MD', 'Hospitalist', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1821225533', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS068', 'ELNCHS068', 'ILCHIGSTD', 'Northwest Community Health Services', 'Ian', '', 'Coelho', 'MD', 'Hospitalist', '', '', NULL, 'O', '800 W Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8476181000', NULL, '800 W Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8476181000', '', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1821225533', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.0666, -87.993, NULL, NULL),
('363312906', 'ELNCHS004', 'ELNCHS004', 'ILCHIGSTD', 'Northwest Community Health Services', 'Noreen', '', 'Galanter', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1051 W Rand Rd', 'Arlington Heights', 'Cook', 'IL', '60004', '8473428220', '8473429394', '1051 W Rand Rd', 'Arlington Heights', 'Cook', 'IL', '60004', '8473428220', '8473429394', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, '', NULL, 'HCFA|UB|', '1871514562', 0, 'N', 0, '2012-12-26', NULL, NULL, 42.1228, -87.9956, NULL, NULL),
('363312906', 'ELNCHS079', 'ELNCHS079', 'ILCHIGSTD', 'Northwest Community Health Services', 'Noreen', '', 'Galanter', 'MD', 'Internal Medicine', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, '', NULL, 'HCFA|UB|', '1871514562', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS001', 'ELNCHS001', 'ILCHIGSTD', 'Northwest Community Health Services', 'Stephanie', '', 'Bartels', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1051 W Rand Rd', 'Arlington Heights', 'Cook', 'IL', '60004', '8473428220', '8473429394', '1051 W Rand Rd', 'Arlington Heights', 'Cook', 'IL', '60004', '8473428220', '8473429394', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1871522300', 0, 'N', 0, '2012-12-26', NULL, NULL, 42.1228, -87.9956, NULL, NULL),
('363312906', 'ELNCHS076', 'ELNCHS076', 'ILCHIGSTD', 'Northwest Community Health Services', 'Stephanie', '', 'Bartels', 'MD', 'Internal Medicine', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1871522300', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS026', 'ELNCHS026', 'ILCHIGSTD', 'Northwest Community Health Services', 'Guy', '', 'Mattana', 'DPM', 'Podiatry', '', '', NULL, 'O', '1450 Busch Pkwy', 'Buffalo Grove', 'Lake', 'IL', '60089', '8477258453', '8474030305', '1450 Busch Pkwy', 'Buffalo Grove', 'Lake', 'IL', '60089', '8477258453', '8474030305', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1871599480', 0, 'N', 0, '2012-12-26', NULL, NULL, 42.1717, -87.9275, NULL, NULL),
('363312906', 'ELNCHS101', 'ELNCHS101', 'ILCHIGSTD', 'Northwest Community Health Services', 'Guy', '', 'Mattana', 'DPM', 'Podiatry', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1871599480', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS050', 'ELNCHS050', 'ILCHIGSTD', 'Northwest Community Health Services', 'Nikos', '', 'Christopoulos', 'MD', 'Gastroenterology', '', '', NULL, 'O', '1051 W Rand Rd', 'Arlington Heights', 'Cook', 'IL', '60004', '8473428220', '8473429394', '1051 W Rand Rd', 'Arlington Heights', 'Cook', 'IL', '60004', '8473428220', '8473429394', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1881708444', 0, 'N', 0, '2012-12-26', NULL, NULL, 42.1228, -87.9956, NULL, NULL),
('363312906', 'ELNCHS049', 'ELNCHS049', 'ILCHIGSTD', 'Northwest Community Health Services', 'Nikos', '', 'Christopoulos', 'MD', 'Gastroenterology', '', '', NULL, 'O', '1700 W Central Rd Ste 220', 'Arlington Heights', 'Cook', 'IL', '60005', '8477978750', '8477978756', '1700 W Central Rd Ste 220', 'Arlington Heights', 'Cook', 'IL', '60005', '8477978750', '8477978756', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1881708444', 0, 'N', 0, '2012-12-26', NULL, NULL, 42.0667, -88.0024, NULL, NULL),
('363312906', 'ELNCHS124', 'ELNCHS124', 'ILCHIGSTD', 'Northwest Community Health Services', 'Nikos', '', 'Christopoulos', 'MD', 'Gastroenterology', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1881708444', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS056', 'ELNCHS056', 'ILCHIGSTD', 'Northwest Community Health Services', 'Victoria', '', 'Ryvkin', 'MD', 'Endocrinology', '', '', NULL, 'O', '199 W Rand Rd', 'Mount Prospect', 'Cook', 'IL', '60056', '8476185450', '8476185459', '199 W Rand Rd', 'Mount Prospect', 'Cook', 'IL', '60056', '8476185450', '8476185459', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1881815173', 0, 'N', 0, '2013-02-28', NULL, NULL, 42.0842, -87.9406, NULL, NULL),
('363312906', 'ELNCHS131', 'ELNCHS131', 'ILCHIGSTD', 'Northwest Community Health Services', 'Victoria', '', 'Ryvkin', 'MD', 'Endocrinology', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1881815173', 0, 'Y', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS045', 'ELNCHS045', 'ILCHIGSTD', 'Northwest Community Health Services', 'James', '', 'Ekeberg', 'MD', 'Family Practice', '', '', NULL, 'O', '1700 W Central Rd Ste 140', 'Arlington Heights', 'Cook', 'IL', '60005', '8472596200', '8472593540', '1700 W Central Rd Ste 140', 'Arlington Heights', 'Cook', 'IL', '60005', '8472596200', '8472593540', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1891742995', 0, 'N', 0, '2012-12-26', NULL, NULL, 42.0667, -88.0024, NULL, NULL),
('363312906', 'ELNCHS120', 'ELNCHS120', 'ILCHIGSTD', 'Northwest Community Health Services', 'James', '', 'Ekeberg', 'MD', 'Family Practice', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1891742995', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS031', 'ELNCHS031', 'ILCHIGSTD', 'Northwest Community Health Services', 'Heidi', '', 'Wehlus', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1051 W Rand Rd', 'Arlington Heights', 'Cook', 'IL', '60004', '8473428220', '8473429394', '1051 W Rand Rd', 'Arlington Heights', 'Cook', 'IL', '60004', '8473428220', '8473429394', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1912163130', 0, 'N', 0, '2012-12-26', NULL, NULL, 42.1228, -87.9956, NULL, NULL),
('363312906', 'ELNCHS030', 'ELNCHS030', 'ILCHIGSTD', 'Northwest Community Health Services', 'Heidi', '', 'Wehlus', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1450 Busch Pkwy', 'Buffalo Grove', 'Lake', 'IL', '60089', '8474597860', '8474594228', '1450 Busch Pkwy', 'Buffalo Grove', 'Lake', 'IL', '60089', '8474597860', '8474594228', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1912163130', 0, 'N', 0, '2012-12-26', NULL, NULL, 42.1717, -87.9275, NULL, NULL),
('363312906', 'ELNCHS105', 'ELNCHS105', 'ILCHIGSTD', 'Northwest Community Health Services', 'Heidi', '', 'Wehlus', 'MD', 'Internal Medicine', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1912163130', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS147', 'ELNCHS147', 'ILCHIGSTD', 'Northwest Community Health Services', 'Evgueni', '', 'Minev', 'MD', 'Hospitalist', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1922119643', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS072', 'ELNCHS072', 'ILCHIGSTD', 'Northwest Community Health Services', 'Evgueni', '', 'Minev', 'MD', 'Hospitalist', '', '', NULL, 'O', '800 W Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8476181000', NULL, '800 W Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8476181000', '', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1922119643', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.0666, -87.993, NULL, NULL),
('363312906', 'ELNCHS023', 'ELNCHS023', 'ILCHIGSTD', 'Northwest Community Health Services', 'Gregory', '', 'Lindsay', 'MD', 'Family Practice', '', '', NULL, 'O', '1051 W Rand Rd', 'Arlington Heights', 'Cook', 'IL', '60004', '8473428220', '8473429394', '1051 W Rand Rd', 'Arlington Heights', 'Cook', 'IL', '60004', '8473428220', '8473429394', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1942416607', 0, 'N', 0, '2012-12-26', NULL, NULL, 42.1228, -87.9956, NULL, NULL),
('363312906', 'ELNCHS022', 'ELNCHS022', 'ILCHIGSTD', 'Northwest Community Health Services', 'Gregory', '', 'Lindsay', 'MD', 'Family Practice', '', '', NULL, 'O', '1450 Busch Pkwy', 'Buffalo Grove', 'Lake', 'IL', '60089', '8474597860', '8474594228', '1450 Busch Pkwy', 'Buffalo Grove', 'Lake', 'IL', '60089', '8474597860', '8474594228', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1942416607', 0, 'N', 0, '2012-12-26', NULL, NULL, 42.1717, -87.9275, NULL, NULL),
('363312906', 'ELNCHS097', 'ELNCHS097', 'ILCHIGSTD', 'Northwest Community Health Services', 'Gregory', '', 'Lindsay', 'MD', 'Family Practice', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1942416607', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS037', 'ELNCHS037', 'ILCHIGSTD', 'Northwest Community Health Services', 'Robert', '', 'Kapicka', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1538 N Arlington Heights Rd', 'Arlington Heights', 'Cook', 'IL', '60004', '8472536464', '8472536501', '1538 N Arlington Heights Rd', 'Arlington Heights', 'Cook', 'IL', '60004', '8472536464', '8472536501', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1952302465', 0, 'N', 0, '2012-12-26', NULL, NULL, 42.1043, -87.9804, NULL, NULL),
('363312906', 'ELNCHS112', 'ELNCHS112', 'ILCHIGSTD', 'Northwest Community Health Services', 'Robert', '', 'Kapicka', 'MD', 'Internal Medicine', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1952302465', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS142', 'ELNCHS142', 'ILCHIGSTD', 'Northwest Community Health Services', 'Anju', '', 'Agarwal', 'DO', 'Hospitalist', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1952335671', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS067', 'ELNCHS067', 'ILCHIGSTD', 'Northwest Community Health Services', 'Anju', '', 'Agarwal', 'DO', 'Hospitalist', '', '', NULL, 'O', '800 W Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8476181000', NULL, '800 W Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8476181000', '', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1952335671', 0, 'Y', 0, '2012-12-26', NULL, NULL, 42.0666, -87.993, NULL, NULL),
('363312906', 'ELNCHS016', 'ELNCHS016', 'ILCHIGSTD', 'Northwest Community Health Services', 'Stuart', '', 'Ferber', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1450 Busch Pkwy', 'Buffalo Grove', 'Lake', 'IL', '60089', '8475377744', '8475379719', '1450 Busch Pkwy', 'Buffalo Grove', 'Lake', 'IL', '60089', '8475377744', '8475379719', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1952389413', 0, 'N', 0, '2012-12-26', NULL, NULL, 42.1717, -87.9275, NULL, NULL),
('363312906', 'ELNCHS091', 'ELNCHS091', 'ILCHIGSTD', 'Northwest Community Health Services', 'Stuart', '', 'Ferber', 'MD', 'Internal Medicine', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1952389413', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL),
('363312906', 'ELNCHS052', 'ELNCHS052', 'ILCHIGSTD', 'Northwest Community Health Services', 'Ronnie', '', 'Ghuneim', 'MD', 'Internal Medicine', '', '', NULL, 'O', '199 W Rand Rd', 'Mount Prospect', 'Cook', 'IL', '60056', '8476185450', '8476185459', '199 W Rand Rd', 'Mount Prospect', 'Cook', 'IL', '60056', '8476185450', '8476185459', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1952427700', 0, 'N', 0, '2012-12-26', NULL, NULL, 42.0842, -87.9406, NULL, NULL),
('363312906', 'ELNCHS127', 'ELNCHS127', 'ILCHIGSTD', 'Northwest Community Health Services', 'Ronnie', '', 'Ghuneim', 'MD', 'Internal Medicine', '', '', NULL, 'B', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', '25233 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6303901240', '6303901247', 'CHIG8', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1952427700', 0, 'Y', 0, '2012-12-26', NULL, NULL, 0, 0, NULL, NULL);
