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
('364257926', 'QST000156', 'QST000156', 'ILCHIGSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '1431 N Western Ave', 'Chicago', 'Cook', 'IL', '60622', '7732274349', '7732274359', '1431 N Western Ave', 'Chicago', 'Cook', 'IL', '60622', '7732274349', '7732274359', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('364257926', 'QST000157', 'QST000157', 'ILCHIGSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '14475 John Humphrey Dr', 'Orland Park', 'Cook', 'IL', '60462', '7088731897', '7088730472', '14475 John Humphrey Dr', 'Orland Park', 'Cook', 'IL', '60462', '7088731897', '7088730472', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('364257926', 'QST000158', 'QST000158', 'ILCHIGSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '1460 N Halsted St', 'Chicago', NULL, 'IL', '60642', '3123971311', '3123971422', '1460 N Halsted St', 'Chicago', '', 'IL', '60642', '3123971311', '3123971422', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('364257926', 'QST000159', 'QST000159', 'ILCHIGSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '1600 Dempster St', 'Park Ridge', 'Cook', 'IL', '60068', '8477958116', '8477958310', '1600 Dempster St', 'Park Ridge', 'Cook', 'IL', '60068', '8477958116', '8477958310', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('364257926', 'QST000160', 'QST000160', 'ILCHIGSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '17665 Torrence Ave', 'Lansing', 'Cook', 'IL', '60438', '7084748323', '7084748328', '17665 Torrence Ave', 'Lansing', 'Cook', 'IL', '60438', '7084748323', '7084748328', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('364257926', 'QST000161', 'QST000161', 'ILCHIGSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '19150 South Kedzie Ave', 'Flossmoor', 'Cook', 'IL', '60422', '7086478507', '7086478514', '19150 South Kedzie Ave', 'Flossmoor', 'Cook', 'IL', '60422', '7086478507', '7086478514', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('364257926', 'QST000162', 'QST000162', 'ILCHIGSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '2001 N Gary Ave', 'Wheaton', 'Dupage', 'IL', '60187', '6306683035', '6306683350', '2001 N Gary Ave', 'Wheaton', 'Dupage', 'IL', '60187', '6306683035', '6306683350', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('364257926', 'QST000163', 'QST000163', 'ILCHIGSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '2088 Ogden Ave', 'Aurora', 'Dupage', 'IL', '60504', '6306921539', '6306921542', '2088 Ogden Ave', 'Aurora', 'Dupage', 'IL', '60504', '6306921539', '6306921542', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('364257926', 'QST000164', 'QST000164', 'ILCHIGSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '2340 S Highland Ave', 'Lombard', 'Dupage', 'IL', '60148', '6309322175', '6309320361', '2340 S Highland Ave', 'Lombard', 'Dupage', 'IL', '60148', '6309322175', '6309320361', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('364257926', 'QST000165', 'QST000165', 'ILCHIGSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '2500 W Higgins Rd', 'Hoffman Estates', 'Cook', 'IL', '60169', '8477810691', '8477810767', '2500 W Higgins Rd', 'Hoffman Estates', 'Cook', 'IL', '60169', '8477810691', '8477810767', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('364257926', 'QST000166', 'QST000166', 'ILCHIGSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '2591 Compass Rd', 'Glenview', 'Cook', 'IL', '60026', '8476570412', '8476570467', '2591 Compass Rd', 'Glenview', 'Cook', 'IL', '60026', '8476570412', '8476570467', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('364257926', 'QST000167', 'QST000167', 'ILCHIGSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '2800 N Sheridan Rd', 'Chicago', 'Cook', 'IL', '60657', '7734049207', '7733278816', '2800 N Sheridan Rd', 'Chicago', 'Cook', 'IL', '60657', '7734049207', '7733278816', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('364257926', 'QST000168', 'QST000168', 'ILCHIGSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '2972 Indian Trail Rd', 'Aurora', 'Dupage', 'IL', '60504', '6305856859', '6305856921', '2972 Indian Trail Rd', 'Aurora', 'Dupage', 'IL', '60504', '6305856859', '6305856921', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('364257926', 'QST000169', 'QST000169', 'ILCHIGSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '3000 N Halsted', 'Chicago', 'Cook', 'IL', '60657', '7734774783', '7734774869', '3000 N Halsted', 'Chicago', 'Cook', 'IL', '60657', '7734774783', '7734774869', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('364257926', 'QST000170', 'QST000170', 'ILCHIGSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '303 E Army Trail Rd', 'Bloomingdale', 'Dupage', 'IL', '60108', '6303510516', '6303510716', '303 E Army Trail Rd', 'Bloomingdale', 'Dupage', 'IL', '60108', '6303510516', '6303510716', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('364257926', 'QST000171', 'QST000171', 'ILCHIGSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '337 W NW Hwy', 'Palatine', 'Cook', 'IL', '60067', '8479638354', '8479638372', '337 W NW Hwy', 'Palatine', 'Cook', 'IL', '60067', '8479638354', '8479638372', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('364257926', 'QST000172', 'QST000172', 'ILCHIGSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '4126 N Milwaukee Ave', 'Chicago', 'Cook', 'IL', '60641', '7737363814', '7732834529', '4126 N Milwaukee Ave', 'Chicago', 'Cook', 'IL', '60641', '7737363814', '7732834529', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('364257926', 'QST000173', 'QST000173', 'ILCHIGSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '4709 W Golf', 'Skokie', 'Cook', 'IL', '60076', '8476744615', '8476743404', '4709 W Golf', 'Skokie', 'Cook', 'IL', '60076', '8476744615', '8476743404', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('364257926', 'QST000174', 'QST000174', 'ILCHIGSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '471 W Army Trail Rd', 'Bloomingdale', 'Dupage', 'IL', '60108', '6303511955', '6303511722', '471 W Army Trail Rd', 'Bloomingdale', 'Dupage', 'IL', '60108', '6303511955', '6303511722', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('364257926', 'QST000175', 'QST000175', 'ILCHIGSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '4801 W Peterson Ave', 'Chicago', 'Cook', 'IL', '60646', '7737770154', '7737770489', '4801 W Peterson Ave', 'Chicago', 'Cook', 'IL', '60646', '7737770154', '7737770489', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('364257926', 'QST000176', 'QST000176', 'ILCHIGSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '517 Thornhill Dr', 'Carol Stream', 'Dupage', 'IL', '60188', '6308711124', '6308711198', '517 Thornhill Dr', 'Carol Stream', 'Dupage', 'IL', '60188', '6308711124', '6308711198', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('364257926', 'QST000177', 'QST000177', 'ILCHIGSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '533 W N Ave Ll', 'Elmhurst', 'Dupage', 'IL', '60126', '6308332791', '6308336023', '533 W N Ave Ll', 'Elmhurst', 'Dupage', 'IL', '60126', '6308332791', '6308336023', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('364257926', 'QST000178', 'QST000178', 'ILCHIGSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '534 Chestnut St', 'Hinsdale', 'Dupage', 'IL', '60521', '6303232046', '6303232194', '534 Chestnut St', 'Hinsdale', 'Dupage', 'IL', '60521', '6303232046', '6303232194', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('364257926', 'QST000179', 'QST000179', 'ILCHIGSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '610 S Maple Ave', 'Oak Park', 'Cook', 'IL', '60304', '7088480437', '7088480563', '610 S Maple Ave', 'Oak Park', 'Cook', 'IL', '60304', '7088480437', '7088480563', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('364257926', 'QST000180', 'QST000180', 'ILCHIGSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '640 S Washington St', 'Naperville', 'Dupage', 'IL', '60540', '6307788002', '6303554173', '640 S Washington St', 'Naperville', 'Dupage', 'IL', '60540', '6307788002', '6303554173', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('364257926', 'QST000181', 'QST000181', 'ILCHIGSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '7530 Woodward Ave', 'Woodridge', 'Dupage', 'IL', '60517', '6309101142', '6309101385', '7530 Woodward Ave', 'Woodridge', 'Dupage', 'IL', '60517', '6309101142', '6309101385', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('364257926', 'QST000182', 'QST000182', 'ILCHIGSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '7800 W College Dr Room 1 W', 'Palos Heights', 'Cook', 'IL', '60463', '7083619494', '7083619661', '7800 W College Dr Room 1 W', 'Palos Heights', 'Cook', 'IL', '60463', '7083619494', '7083619661', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('364257926', 'QST000183', 'QST000183', 'ILCHIGSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '800 Austin St E Tower', 'Evanston', 'Cook', 'IL', '60202', '8478695663', '8478695774', '800 Austin St E Tower', 'Evanston', 'Cook', 'IL', '60202', '8478695663', '8478695774', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('364257926', 'QST000184', 'QST000184', 'ILCHIGSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '808 E Woodfield Rd', 'Schaumburg', 'Cook', 'IL', '60173', '8476190305', '8476190345', '808 E Woodfield Rd', 'Schaumburg', 'Cook', 'IL', '60173', '8476190305', '8476190345', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('364257926', 'QST000185', 'QST000185', 'ILCHIGSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '82 Miller Dr', 'North Aurora', 'Kane', 'IL', '60542', '6309079232', '6309079239', '82 Miller Dr', 'North Aurora', 'Kane', 'IL', '60542', '6309079232', '6309079239', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('364257926', 'QST000186', 'QST000186', 'ILCHIGSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '8751 S Greenwood Ave', 'Chicago', 'Cook', 'IL', '60619', '7733752949', '7733753197', '8751 S Greenwood Ave', 'Chicago', 'Cook', 'IL', '60619', '7733752949', '7733753197', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('364257926', 'QST000187', 'QST000187', 'ILCHIGSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '8915 W Golf Rd', 'Niles', 'Cook', 'IL', '60714', '8472972342', '8472982246', '8915 W Golf Rd', 'Niles', 'Cook', 'IL', '60714', '8472972342', '8472982246', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000188', 'QST000188', 'TXBEAUSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '230 Strickland Dr', 'Orange', 'Orange', 'TX', '77630', '4096709468', '4096709871', '230 Strickland Dr', 'Orange', 'Orange', 'TX', '77630', '4096709468', '4096709871', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000189', 'QST000189', 'TXBEAUSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '3445 Phelan Blvd', 'Beaumont', 'Jefferson', 'TX', '77707', '4098352554', '4098321214', '3445 Phelan Blvd', 'Beaumont', 'Jefferson', 'TX', '77707', '4098352554', '4098321214', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000190', 'QST000190', 'TXDALSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '1101 Raintree Cir Ste 100', 'Allen', 'Collin', 'TX', '75013', '9727276551', '9727277039', '1101 Raintree Cir Ste 100', 'Allen', 'Collin', 'TX', '75013', '9727276551', '9727277039', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000191', 'QST000191', 'TXDALSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '1151 N Buckner Blvd', 'Dallas', 'Dallas', 'TX', '75218', '2143211577', '2143678965', '1151 N Buckner Blvd', 'Dallas', 'Dallas', 'TX', '75218', '2143211577', '2143678965', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000192', 'QST000192', 'TXDALSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '11613 N Central Expwy', 'Dallas', 'Dallas', 'TX', '75243', '2147509477', '2147509287', '11613 N Central Expwy', 'Dallas', 'Dallas', 'TX', '75243', '2147509477', '2147509287', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000193', 'QST000193', 'TXDALSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '1250 8th Ave', 'Fort Worth', 'Tarrant', 'TX', '76104', '8179209069', '8179207979', '1250 8th Ave', 'Fort Worth', 'Tarrant', 'TX', '76104', '8179209069', '8179207979', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000194', 'QST000194', 'TXDALSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '1411 N Beckley Ave Ste 450', 'Dallas', 'Dallas', 'TX', '75203', '2149435529', '2149435531', '1411 N Beckley Ave Ste 450', 'Dallas', 'Dallas', 'TX', '75203', '2149435529', '2149435531', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000195', 'QST000195', 'TXDALSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '1505 W Wilshire Blvd', 'Burleson', 'Johnson', 'TX', '76028', '8175291777', '8175291779', '1505 W Wilshire Blvd', 'Burleson', 'Johnson', 'TX', '76028', '8175291777', '8175291779', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000196', 'QST000196', 'TXDALSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '1600 W College St', 'Grapevine', 'Tarrant', 'TX', '76051', '8173293913', '8172510920', '1600 W College St', 'Grapevine', 'Tarrant', 'TX', '76051', '8173293913', '8172510920', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000197', 'QST000197', 'TXDALSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '1615 Hospital Pkwy', 'Bedford', 'Tarrant', 'TX', '76022', '8176845243', '8176845248', '1615 Hospital Pkwy', 'Bedford', 'Tarrant', 'TX', '76022', '8176845243', '8176845248', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000198', 'QST000198', 'TXDALSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '1621 N Belt Line Rd', 'Mesquite', 'Dallas', 'TX', '75149', '9722889559', '9722889865', '1621 N Belt Line Rd', 'Mesquite', 'Dallas', 'TX', '75149', '9722889559', '9722889865', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000199', 'QST000199', 'TXDALSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '2128 Mall Cir', 'Fort Worth', 'Tarrant', 'TX', '76116', '8173773735', '8173773744', '2128 Mall Cir', 'Fort Worth', 'Tarrant', 'TX', '76116', '8173773735', '8173773744', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000200', 'QST000200', 'TXDALSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '260 N Rufe Snow Dr', 'Keller', 'Tarrant', 'TX', '76248', '8174314301', '8174314874', '260 N Rufe Snow Dr', 'Keller', 'Tarrant', 'TX', '76248', '8174314301', '8174314874', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000201', 'QST000201', 'TXDALSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '2727 Bolton Boone Dr', 'Desoto', 'Dallas', 'TX', '75115', '9727095363', '9727095374', '2727 Bolton Boone Dr', 'Desoto', 'Dallas', 'TX', '75115', '9727095363', '9727095374', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000202', 'QST000202', 'TXDALSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '3230 I 30 E', 'Mesquite', 'Dallas', 'TX', '75150', '9726864602', '9726864645', '3230 I 30 E', 'Mesquite', 'Dallas', 'TX', '75150', '9726864602', '9726864645', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000203', 'QST000203', 'TXDALSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '3430 W Wheatland Rd', 'Dallas', 'Dallas', 'TX', '75237', '9722980799', '9722980972', '3430 W Wheatland Rd', 'Dallas', 'Dallas', 'TX', '75237', '9722980799', '9722980972', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000204', 'QST000204', 'TXDALSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '3501 N Macarthur Blvd', 'Irving', 'Dallas', 'TX', '75062', '9722580601', '9722524650', '3501 N Macarthur Blvd', 'Irving', 'Dallas', 'TX', '75062', '9722580601', '9722524650', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000205', 'QST000205', 'TXDALSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '3529 Heritage Trace Pkwy', 'Keller', 'Tarrant', 'TX', '76244', '8177418200', '8177418220', '3529 Heritage Trace Pkwy', 'Keller', 'Tarrant', 'TX', '76244', '8177418200', '8177418220', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000206', 'QST000206', 'TXDALSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '3600 Communications Pkwy', 'Plano', 'Collin', 'TX', '75093', '9723783208', '9723783238', '3600 Communications Pkwy', 'Plano', 'Collin', 'TX', '75093', '9723783208', '9723783238', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000207', 'QST000207', 'TXDALSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '3600 Gaston Ave', 'Dallas', 'Dallas', 'TX', '75246', '2148267669', '2148238511', '3600 Gaston Ave', 'Dallas', 'Dallas', 'TX', '75246', '2148267669', '2148238511', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000208', 'QST000208', 'TXDALSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '3801 W 15th St', 'Plano', 'Collin', 'TX', '75075', '9726121887', '9726120126', '3801 W 15th St', 'Plano', 'Collin', 'TX', '75075', '9726121887', '9726120126', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000209', 'QST000209', 'TXDALSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '3900 Junius St', 'Dallas', 'Dallas', 'TX', '75246', '2148277473', '2148277434', '3900 Junius St', 'Dallas', 'Dallas', 'TX', '75246', '2148277473', '2148277434', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000210', 'QST000210', 'TXDALSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '400 N Coit Rd', 'Richardson', 'Dallas', 'TX', '75080', '9726698139', '9726692512', '400 N Coit Rd', 'Richardson', 'Dallas', 'TX', '75080', '9726698139', '9726692512', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000211', 'QST000211', 'TXDALSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '4625 Boat Club Rd', 'Lake Worth', 'Tarrant', 'TX', '76135', '8172389607', '8172388451', '4625 Boat Club Rd', 'Lake Worth', 'Tarrant', 'TX', '76135', '8172389607', '8172388451', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000212', 'QST000212', 'TXDALSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '5224 S State Hwy 360', 'Grand Prairie', 'Dallas', 'TX', '75052', '9726014617', '9726014629', '5224 S State Hwy 360', 'Grand Prairie', 'Dallas', 'TX', '75052', '9726014617', '9726014629', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000213', 'QST000213', 'TXDALSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '546 E Sandy Lake Rd', 'Coppell', 'Dallas', 'TX', '75019', '9723043089', '9723932697', '546 E Sandy Lake Rd', 'Coppell', 'Dallas', 'TX', '75019', '9723043089', '9723932697', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000214', 'QST000214', 'TXDALSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '7555 Oakmont Blvd', 'Fort Worth', 'Tarrant', 'TX', '76132', '8172941105', '8172947122', '7555 Oakmont Blvd', 'Fort Worth', 'Tarrant', 'TX', '76132', '8172941105', '8172947122', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000215', 'QST000215', 'TXDALSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '7630 N Beach St', 'Fort Worth', 'Tarrant', 'TX', '76137', '8176565997', '8177882093', '7630 N Beach St', 'Fort Worth', 'Tarrant', 'TX', '76137', '8176565997', '8177882093', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000216', 'QST000216', 'TXDALSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '777 Walter Reed Blvd', 'Garland', 'Dallas', 'TX', '75042', '9722767526', '9724870949', '777 Walter Reed Blvd', 'Garland', 'Dallas', 'TX', '75042', '9722767526', '9724870949', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000217', 'QST000217', 'TXDALSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '7801 Oakmont Blvd', 'Fort Worth', 'Tarrant', 'TX', '76132', '8173460598', '8173463916', '7801 Oakmont Blvd', 'Fort Worth', 'Tarrant', 'TX', '76132', '8173460598', '8173463916', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000218', 'QST000218', 'TXDALSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '8 Medical Pkwy Plaza Ii', 'Dallas', 'Dallas', 'TX', '75234', '9722435298', '9724880701', '8 Medical Pkwy Plaza Ii', 'Dallas', 'Dallas', 'TX', '75234', '9722435298', '9724880701', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000219', 'QST000219', 'TXDALSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '8230 Walnut Hill Ln Bldg III', 'Dallas', 'Dallas', 'TX', '75231', '2143455194', '2143452927', '8230 Walnut Hill Ln Bldg III', 'Dallas', 'Dallas', 'TX', '75231', '2143455194', '2143452927', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000220', 'QST000220', 'TXDALSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '855 Montgomery St', 'Fort Worth', 'Tarrant', 'TX', '76107', '8177310518', '8177310289', '855 Montgomery St', 'Fort Worth', 'Tarrant', 'TX', '76107', '8177310518', '8177310289', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000221', 'QST000221', 'TXDALSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '9301 N Central Expy', 'Dallas', 'Dallas', 'TX', '75231', '2142651194', '2148909840', '9301 N Central Expy', 'Dallas', 'Dallas', 'TX', '75231', '2142651194', '2148909840', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000222', 'QST000222', 'TXDALSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '9824 Lakeview Pkwy', 'Rowlett', 'Dallas', 'TX', '75088', '9724129212', '9724630193', '9824 Lakeview Pkwy', 'Rowlett', 'Dallas', 'TX', '75088', '9724129212', '9724630193', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000223', 'QST000223', 'TXHOUSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '10680 Jones Rd', 'Houston', 'Harris', 'TX', '77065', '2818949214', '2818949062', '10680 Jones Rd', 'Houston', 'Harris', 'TX', '77065', '2818949214', '2818949062', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000224', 'QST000224', 'TXHOUSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '10837 Katy Fwy', 'Houston', 'Harris', 'TX', '77079', '7134615914', '7134618460', '10837 Katy Fwy', 'Houston', 'Harris', 'TX', '77079', '7134615914', '7134618460', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000225', 'QST000225', 'TXHOUSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '1140 Westmont Dr', 'Houston', 'Harris', 'TX', '77015', '7134550406', '7134551987', '1140 Westmont Dr', 'Houston', 'Harris', 'TX', '77015', '7134550406', '7134551987', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000226', 'QST000226', 'TXHOUSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '11454 Space Ctr Blvd', 'Houston', 'Harris', 'TX', '77059', '2814872531', '2814870198', '11454 Space Ctr Blvd', 'Houston', 'Harris', 'TX', '77059', '2814872531', '2814870198', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000227', 'QST000227', 'TXHOUSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '11717 Highland Meadow Dr', 'Houston', 'Harris', 'TX', '77089', '2814843505', '2814849666', '11717 Highland Meadow Dr', 'Houston', 'Harris', 'TX', '77089', '2814843505', '2814849666', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000228', 'QST000228', 'TXHOUSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '11811 Fm 1960 Rd W', 'Houston', 'Harris', 'TX', '77065', '2819704883', '2819709260', '11811 Fm 1960 Rd W', 'Houston', 'Harris', 'TX', '77065', '2819704883', '2819709260', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000229', 'QST000229', 'TXHOUSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '1200 Binz St', 'Houston', 'Harris', 'TX', '77004', '7135278058', '7135209762', '1200 Binz St', 'Houston', 'Harris', 'TX', '77004', '7135278058', '7135209762', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000230', 'QST000230', 'TXHOUSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '1201 Dairy Ashford St', 'Houston', 'Harris', 'TX', '77079', '2815565339', '2815565581', '1201 Dairy Ashford St', 'Houston', 'Harris', 'TX', '77079', '2815565339', '2815565581', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000231', 'QST000231', 'TXHOUSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '12121 Richmond Ave', 'Houston', 'Harris', 'TX', '77082', '2817526171', '2817526232', '12121 Richmond Ave', 'Houston', 'Harris', 'TX', '77082', '2817526171', '2817526232', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000232', 'QST000232', 'TXHOUSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '1213 Hermann Dr', 'Houston', 'Harris', 'TX', '77004', '7135228653', '7135228657', '1213 Hermann Dr', 'Houston', 'Harris', 'TX', '77004', '7135228653', '7135228657', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000233', 'QST000233', 'TXHOUSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '12385 Kingsride Ave', 'Houston', 'Harris', 'TX', '77024', '7139732746', '7139732284', '12385 Kingsride Ave', 'Houston', 'Harris', 'TX', '77024', '7139732746', '7139732284', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000234', 'QST000234', 'TXHOUSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '13300 Hargrave Rd', 'Houston', 'Harris', 'TX', '77070', '2814691726', '2814695366', '13300 Hargrave Rd', 'Houston', 'Harris', 'TX', '77070', '2814691726', '2814695366', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000235', 'QST000235', 'TXHOUSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '1331 W Grand Pkwy N Katy', 'Katy', 'Harris', 'TX', '77493', '2813924606', '2813924975', '1331 W Grand Pkwy N Katy', 'Katy', 'Harris', 'TX', '77493', '2813924606', '2813924975', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000236', 'QST000236', 'TXHOUSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '13406 Medical Complex Dr', 'Tomball', 'Harris', 'TX', '77375', '2813511668', '2813511676', '13406 Medical Complex Dr', 'Tomball', 'Harris', 'TX', '77375', '2813511668', '2813511676', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000237', 'QST000237', 'TXHOUSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '15259 SW Fwy', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2814944553', '2814944563', '15259 SW Fwy', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2814944553', '2814944563', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000238', 'QST000238', 'TXHOUSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '1601 Main St', 'Richmond', 'Fort Bend', 'TX', '77469', '2813425069', '2813429320', '1601 Main St', 'Richmond', 'Fort Bend', 'TX', '77469', '2813425069', '2813429320', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000239', 'QST000239', 'TXHOUSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '17070 Red Oak Dr', 'Houston', 'Harris', 'TX', '77090', '2818932578', '2818939234', '17070 Red Oak Dr', 'Houston', 'Harris', 'TX', '77090', '2818932578', '2818939234', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000240', 'QST000240', 'TXHOUSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '1919 N Loop W', 'Houston', 'Harris', 'TX', '77008', '7138619642', '7138697624', '1919 N Loop W', 'Houston', 'Harris', 'TX', '77008', '7138619642', '7138697624', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000241', 'QST000241', 'TXHOUSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '2000 Crawford St', 'Houston', 'Harris', 'TX', '77002', '7136520595', '7136520597', '2000 Crawford St', 'Houston', 'Harris', 'TX', '77002', '7136520595', '7136520597', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000242', 'QST000242', 'TXHOUSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '2200 E Nasa Pkwy 1', 'Nassau Bay', 'Harris', 'TX', '77058', '2813354812', '2813357893', '2200 E Nasa Pkwy 1', 'Nassau Bay', 'Harris', 'TX', '77058', '2813354812', '2813357893', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000243', 'QST000243', 'TXHOUSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '2802 Garth Rd', 'Baytown', 'Harris', 'TX', '77521', '2814223212', '2814223410', '2802 Garth Rd', 'Baytown', 'Harris', 'TX', '77521', '2814223212', '2814223410', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000244', 'QST000244', 'TXHOUSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '3315 Burke Rd', 'Pasadena', 'Harris', 'TX', '77504', '7139477714', '7139477566', '3315 Burke Rd', 'Pasadena', 'Harris', 'TX', '77504', '7139477714', '7139477566', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000245', 'QST000245', 'TXHOUSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '3400 Bissonnet St', 'Houston', 'Harris', 'TX', '77005', '7136683660', '7136680299', '3400 Bissonnet St', 'Houston', 'Harris', 'TX', '77005', '7136683660', '7136680299', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000246', 'QST000246', 'TXHOUSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '350 Kingwood Medical Dr', 'Kingwood', 'Harris', 'TX', '77339', '2813587033', '2813587290', '350 Kingwood Medical Dr', 'Kingwood', 'Harris', 'TX', '77339', '2813587033', '2813587290', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000247', 'QST000247', 'TXHOUSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '407 W Baker Rd', 'Baytown', 'Harris', 'TX', '77521', '2818370240', '2818370241', '407 W Baker Rd', 'Baytown', 'Harris', 'TX', '77521', '2818370240', '2818370241', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000248', 'QST000248', 'TXHOUSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '561 Medical Ctr Blvd', 'Webster', 'Harris', 'TX', '77598', '2813322756', '2813328391', '561 Medical Ctr Blvd', 'Webster', 'Harris', 'TX', '77598', '2813322756', '2813328391', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000249', 'QST000249', 'TXHOUSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '5711 Almeda Rd', 'Houston', 'Harris', 'TX', '77004', '7135295697', '7139428035', '5711 Almeda Rd', 'Houston', 'Harris', 'TX', '77004', '7135295697', '7139428035', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000250', 'QST000250', 'TXHOUSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '6243 Fairmont Pkwy', 'Pasadena', 'Harris', 'TX', '77505', '2819910801', '2819910806', '6243 Fairmont Pkwy', 'Pasadena', 'Harris', 'TX', '77505', '2819910801', '2819910806', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000251', 'QST000251', 'TXHOUSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '6410 Fannin St', 'Houston', 'Harris', 'TX', '77030', '7137919101', '7137919172', '6410 Fannin St', 'Houston', 'Harris', 'TX', '77030', '7137919101', '7137919172', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000252', 'QST000252', 'TXHOUSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '6565 W Loop South', 'Bellaire', 'Harris', 'TX', '77401', '7136600419', '7136620361', '6565 W Loop South', 'Bellaire', 'Harris', 'TX', '77401', '7136600419', '7136620361', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000253', 'QST000253', 'TXHOUSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '7400 Fannin St', 'Houston', 'Harris', 'TX', '77054', '7137911684', '7137911672', '7400 Fannin St', 'Houston', 'Harris', 'TX', '77054', '7137911684', '7137911672', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000254', 'QST000254', 'TXHOUSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '7515 Main St', 'Houston', 'Harris', 'TX', '77054', '7137901465', '7137900930', '7515 Main St', 'Houston', 'Harris', 'TX', '77054', '7137901465', '7137900930', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000255', 'QST000255', 'TXHOUSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '7580 Fannin', 'Houston', 'Harris', 'TX', '77054', '7137901969', '7137907805', '7580 Fannin', 'Houston', 'Harris', 'TX', '77054', '7137901969', '7137907805', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('382084239', 'QST000256', 'QST000256', 'TXHOUSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '7900 Fannin St Ste 1700', 'Houston', 'Harris', 'TX', '77054', '7133830765', '7133830786', '7900 Fannin St Ste 1700', 'Houston', 'Harris', 'TX', '77054', '7133830765', '7133830786', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000257', 'QST000257', 'TXHOUSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '800 Peakwood Dr', 'Houston', 'Harris', 'TX', '77090', '2815832120', '2815830480', '800 Peakwood Dr', 'Houston', 'Harris', 'TX', '77090', '2815832120', '2815830480', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000258', 'QST000258', 'TXHOUSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '800 Riverwood Ct', 'Conroe', 'Montgomery', 'TX', '77304', '9364944324', '9364944327', '800 Riverwood Ct', 'Conroe', 'Montgomery', 'TX', '77304', '9364944324', '9364944327', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000259', 'QST000259', 'TXHOUSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '8200 Wednesbury Ln', 'Houston', 'Harris', 'TX', '77074', '7132713820', '7132715518', '8200 Wednesbury Ln', 'Houston', 'Harris', 'TX', '77074', '7132713820', '7132715518', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000260', 'QST000260', 'TXHOUSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '837 F M 1960 Rd W', 'Houston', 'Harris', 'TX', '77090', '2815831881', '2815832047', '837 F M 1960 Rd W', 'Houston', 'Harris', 'TX', '77090', '2815831881', '2815832047', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000261', 'QST000261', 'TXHOUSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '8830 Long Point Rd', 'Houston', 'Harris', 'TX', '77055', '7137220826', '7137229840', '8830 Long Point Rd', 'Houston', 'Harris', 'TX', '77055', '7137220826', '7137229840', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000262', 'QST000262', 'TXHOUSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '8850 Six Pines Dr', 'The Woodlands', 'Montgomery', 'TX', '77380', '2814654459', '2814654549', '8850 Six Pines Dr', 'The Woodlands', 'Montgomery', 'TX', '77380', '2814654459', '2814654549', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000263', 'QST000263', 'TXHOUSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '8901 Farm To Market 1960 Rd W', 'Humble', 'Harris', 'TX', '77338', '2814460206', '2814460718', '8901 Farm To Market 1960 Rd W', 'Humble', 'Harris', 'TX', '77338', '2814460206', '2814460718', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000264', 'QST000264', 'TXHOUSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '952 S Fry Rd', 'Katy', 'Harris', 'TX', '77450', '2815999603', '2815998137', '952 S Fry Rd', 'Katy', 'Harris', 'TX', '77450', '2815999603', '2815998137', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000265', 'QST000265', 'TXSATSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '102 Palo Alto Rd Ste 330', 'San Antonio', 'Bexar', 'TX', '78244', '2109223614', '2109223536', '102 Palo Alto Rd Ste 330', 'San Antonio', 'Bexar', 'TX', '78244', '2109223614', '2109223536', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000266', 'QST000266', 'TXSATSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '11212 State Hwy 151 Ste 210', 'San Antonio', 'Bexar', 'TX', '78251', '2106802248', '2106802263', '11212 State Hwy 151 Ste 210', 'San Antonio', 'Bexar', 'TX', '78251', '2106802248', '2106802263', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000267', 'QST000267', 'TXSATSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '1139 E Sonterra Blvd Ste 525', 'San Antonio', 'Bexar', 'TX', '78258', '2104902188', '2104902458', '1139 E Sonterra Blvd Ste 525', 'San Antonio', 'Bexar', 'TX', '78258', '2104902188', '2104902458', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST000268', 'QST000268', 'TXSATSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '12709 Toepperwein Rd Ste 207', 'Live Oak', 'Bexar', 'TX', '78233', '2106531129', '2106531193', '12709 Toepperwein Rd Ste 207', 'Live Oak', 'Bexar', 'TX', '78233', '2106531129', '2106531193', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
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('273972429', 'W12049330', 'W12049330', 'IDBOISTD', 'Idaho Center for Regenerative Medicine', 'Bradley', '', 'Gilman', 'MD', 'Family Practice', '', '', NULL, 'O', '500 E Shore Dr Ste 100', 'Eagle', 'Ada', 'ID', '83616', '2089952802', '2089952804', '500 E Shore Dr Ste 100', 'Eagle', 'Ada', 'ID', '83616', '2089952802', '2089952804', 'IDSTDCRM', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609940709', 0, 'N', 1, '2014-07-02', NULL, NULL, 0, 0, NULL, NULL),
('742948798', 'W12049333', 'W12049333', 'TXSATSTD', 'Restorative Home Care', '', '', 'Restorative Health Care', '', 'Home Health Agency', '', '', NULL, 'O', '7330 San Pedro Ave Ste 800', 'San Antonio', 'Bexar', 'TX', '78216', '2102263872', '2102263316', '7330 San Pedro Ave Ste 800', 'San Antonio', 'Bexar', 'TX', '78216', '2102263872', '2102263316', 'RHC', '', '', '0.00', '45.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1760486542', 0, 'N', 1, '2014-07-23', NULL, NULL, 0, 0, NULL, NULL),
('621762570', 'W12049334', 'W12049334', 'UT01', 'Ashley Valley Physician Practices', 'Matthew', 'C', 'Bowen', 'DO', 'Family Practice', '', '', NULL, 'O', '175 N 100 W Ste 205A', 'Vernal', 'Uintah', 'UT', '84078', '4357811200', '4357811230', '175 N 100 W Ste 205A', 'Vernal', 'Uintah', 'UT', '84078', '4357811200', '4357811230', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2030-01-01', NULL, 0, 0, 0, 'Ashley Valley Regional Medical', '', '', '', 'HCFA|UB|', '1407143324', 0, 'N', 1, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('455135464', 'W12049337', 'W12049337', 'ID01', 'Treasure Valley Psychological Services', 'William', 'M', 'Tandy', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '6003 Overland Rd Ste 301', 'Boise', 'Ada', 'ID', '83709', '2086728699', '2086729308', '6003 Overland Rd Ste 301', 'Boise', 'Ada', 'ID', '83709', '2086728699', '2086729308', 'IDPHD', '', '', '0.00', '40.00', '0.00', 6, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407081516', 0, 'N', 0, '2014-07-01', NULL, NULL, 0, 0, NULL, NULL),
('461124545', 'W12049338', 'W12049338', 'ID01', 'Treasure Valley Psychological Services', 'Rachel', 'A', 'Root', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '6003 Overland Rd Ste 301', 'Boise', 'Ada', 'ID', '83709', '2086728699', '2086729308', '6003 Overland Rd Ste 301', 'Boise', 'Ada', 'ID', '83709', '2086728699', '2086729308', 'IDPHD', '', '', '0.00', '40.00', '0.00', 6, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710279807', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('454189323', 'W12049339', 'W12049339', 'UT01', 'Oral & Facial Reconstructive Surgeons of UT', 'Nathan', '', 'Adams', 'DMD', 'Oral Surgeon', '', '', NULL, 'O', '3920 S 1100 E Ste 150', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012627447', '8012627450', '3920 S 1100 E Ste 150', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012627447', '8012627450', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2014-07-07', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1174604128', 0, 'N', 1, '2014-07-01', NULL, NULL, 0, 0, NULL, NULL),
('454189323', 'W12049340', 'W12049340', 'UT01', 'Oral & Facial Reconstructive Surgeons of UT', 'Michael', '', 'Gladwell', 'DMD', 'Oral Surgeon', '', '', NULL, 'O', '3920 S 1100 E Ste 150', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012627447', '8012627450', '3920 S 1100 E Ste 150', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012627447', '8012627450', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2014-07-07', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1639250673', 0, 'N', 1, '2014-07-01', NULL, NULL, 0, 0, NULL, NULL),
('870470946', 'W12049672', 'W12049672', 'UT01', 'Hurricane Family Clinic', 'Walter', '', 'Ogden', 'MD', 'Family Practice', '', '', NULL, 'O', '11 S Main St', 'Hurricane', 'Washington', 'UT', '84737', '4356359444', '4356358148', '11 S Main St', 'Hurricane', 'Washington', 'UT', '84737', '4356359444', '4356358148', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1174519151', 0, 'N', 1, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('364257926', 'QST200007', 'QST200007', 'ILCHIGSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '13332 Village Green Dr', 'Huntley', 'Mchenry', 'IL', '60142', '8476694788', '8476693345', '13332 Village Green Dr', 'Huntley', 'Mchenry', 'IL', '60142', '8476694788', '8476693345', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('364257926', 'QST200008', 'QST200008', 'ILCHIGSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '1450 Busch Pkwy', 'Buffalo Grove', 'Lake', 'IL', '60089', '8472151038', '8472151062', '1450 Busch Pkwy', 'Buffalo Grove', 'Lake', 'IL', '60089', '8472151038', '8472151062', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('364257926', 'QST200009', 'QST200009', 'ILCHIGSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '15 Tower Ct S 170', 'Gurnee', 'Lake', 'IL', '60031', '8473607186', '8473607252', '15 Tower Ct S 170', 'Gurnee', 'Lake', 'IL', '60031', '8473607186', '8473607252', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('364257926', 'QST200010', 'QST200010', 'ILCHIGSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '1854 E Grand Ave', 'Lindenhurst', 'Lake', 'IL', '60046', '8472453943', '8472453987', '1854 E Grand Ave', 'Lindenhurst', 'Lake', 'IL', '60046', '8472453943', '8472453987', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('364257926', 'QST200001', 'QST200001', 'ILCHIGSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '19070 Everett Blvd Unit 111', 'Mokena', 'Will', 'IL', '60448', '7084790904', '7084791365', '19070 Everett Blvd Unit 111', 'Mokena', 'Will', 'IL', '60448', '7084790904', '7084791365', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('364257926', 'QST200011', 'QST200011', 'ILCHIGSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '207 Waukegan Rd', 'Lake Bluff', 'Lake', 'IL', '60044', '8477359954', '8477359967', '207 Waukegan Rd', 'Lake Bluff', 'Lake', 'IL', '60044', '8477359954', '8477359967', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('364257926', 'QST200012', 'QST200012', 'ILCHIGSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '22285 Pepper Rd', 'Barrington', 'Lake', 'IL', '60010', '8478420486', '8478420498', '22285 Pepper Rd', 'Barrington', 'Lake', 'IL', '60010', '8478420486', '8478420498', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('364257926', 'QST200002', 'QST200002', 'ILCHIGSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '24600 W 127th St', 'Plainfield', 'Will', 'IL', '60585', '8152304740', '8152542096', '24600 W 127th St', 'Plainfield', 'Will', 'IL', '60585', '8152304740', '8152542096', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('364257926', 'QST200003', 'QST200003', 'ILCHIGSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '260 E Congress Pkwy', 'Crystal Lake', 'Mchenry', 'IL', '60014', '8154595217', '8154595398', '260 E Congress Pkwy', 'Crystal Lake', 'Mchenry', 'IL', '60014', '8154595217', '8154595398', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('364257926', 'QST200013', 'QST200013', 'ILCHIGSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '2631 Williamsburg Ave', 'Geneva', 'Kane', 'IL', '60134', '6308450547', '6302081496', '2631 Williamsburg Ave', 'Geneva', 'Kane', 'IL', '60134', '6308450547', '6302081496', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('364257926', 'QST200004', 'QST200004', 'ILCHIGSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '310 N Hammes Ave', 'Joliet', 'Will', 'IL', '60435', '8157414814', '8157414395', '310 N Hammes Ave', 'Joliet', 'Will', 'IL', '60435', '8157414814', '8157414395', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('364257926', 'QST200014', 'QST200014', 'ILCHIGSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '3244 Sycamore Rd Unit B', 'Dekalb', 'Dekalb', 'IL', '60115', '8157484211', '8157484212', '3244 Sycamore Rd Unit B', 'Dekalb', 'Dekalb', 'IL', '60115', '8157484211', '8157484212', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('364257926', 'QST200015', 'QST200015', 'ILCHIGSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '3310 W Main St', 'St Charles', 'Kane', 'IL', '60175', '6305840142', '6305840179', '3310 W Main St', 'St Charles', 'Kane', 'IL', '60175', '6305840142', '6305840179', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('364257926', 'QST200016', 'QST200016', 'ILCHIGSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '350 Surryse Rd', 'Lake Zurich', 'Lake', 'IL', '60047', '8474383498', '8474383786', '350 Surryse Rd', 'Lake Zurich', 'Lake', 'IL', '60047', '8474383498', '8474383786', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('364257926', 'QST200005', 'QST200005', 'ILCHIGSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '4119 Shamrock Ln', 'Mchenry', 'Mchenry', 'IL', '60050', '8155788828', '8155788855', '4119 Shamrock Ln', 'Mchenry', 'Mchenry', 'IL', '60050', '8155788828', '8155788855', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('364257926', 'QST200006', 'QST200006', 'ILCHIGSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '484 W Boughton Rd', 'Bolingbrook', 'Will', 'IL', '60440', '6307593773', '6307593993', '484 W Boughton Rd', 'Bolingbrook', 'Will', 'IL', '60440', '6307593773', '6307593993', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('364257926', 'QST200017', 'QST200017', 'ILCHIGSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '565 Lakeview Pkwy', 'Vernon Hills', 'Lake', 'IL', '60061', '8475490649', '8475490662', '565 Lakeview Pkwy', 'Vernon Hills', 'Lake', 'IL', '60061', '8475490649', '8475490662', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('364257926', 'QST200018', 'QST200018', 'ILCHIGSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '750 Fletcher Dr', 'Elgin', 'Kane', 'IL', '60123', '8472142773', '8472142776', '750 Fletcher Dr', 'Elgin', 'Kane', 'IL', '60123', '8472142773', '8472142776', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST200019', 'QST200019', 'TXBEAUSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '2501 Jimmy Johnson Blvd', 'Port Arthur', 'Jefferson', 'TX', '77640', '4097295548', '4097295540', '2501 Jimmy Johnson Blvd', 'Port Arthur', 'Jefferson', 'TX', '77640', '4097295548', '4097295540', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST200020', 'QST200020', 'TXDALSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '1001 W Arbrook Blvd', 'Arlington', 'Tarrant', 'TX', '76015', '8177945905', '8172752794', '1001 W Arbrook Blvd', 'Arlington', 'Tarrant', 'TX', '76015', '8177945905', '8172752794', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST200021', 'QST200021', 'TXDALSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '1010 La Salle Dr', 'Sherman', 'Grayson', 'TX', '75090', '9038135625', '9038682415', '1010 La Salle Dr', 'Sherman', 'Grayson', 'TX', '75090', '9038135625', '9038682415', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST200022', 'QST200022', 'TXDALSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '1105 Sante Fe', 'Weatherford', 'Parker', 'TX', '76086', '8175947319', '8175947378', '1105 Sante Fe', 'Weatherford', 'Parker', 'TX', '76086', '8175947319', '8175947378', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST200023', 'QST200023', 'TXDALSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '1201 Arista Dr', 'Rockwall', 'Rockwall', 'TX', '75032', '9727226200', '9727226210', '1201 Arista Dr', 'Rockwall', 'Rockwall', 'TX', '75032', '9727226200', '9727226210', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST200024', 'QST200024', 'TXDALSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '124 Industrial Ave', 'Azle', 'Tarrant', 'TX', '76020', '8174445001', '8174447521', '124 Industrial Ave', 'Azle', 'Tarrant', 'TX', '76020', '8174445001', '8174447521', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST200025', 'QST200025', 'TXDALSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '2817 S Mayhill Rd', 'Denton', 'Denton', 'TX', '76208', '9403841807', '9405669062', '2817 S Mayhill Rd', 'Denton', 'Denton', 'TX', '76208', '9403841807', '9405669062', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST200026', 'QST200026', 'TXDALSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '4001 Long Prairie Rd', 'Flowermound', 'Denton', 'TX', '75028', '9723554059', '', '4001 Long Prairie Rd', 'Flowermound', 'Denton', 'TX', '75028', '9723554059', '', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST200027', 'QST200027', 'TXDALSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '4333 N Josey Ln', 'Carrollton', 'Denton', 'TX', '75010', '9729398001', '9729398372', '4333 N Josey Ln', 'Carrollton', 'Denton', 'TX', '75010', '9729398001', '9729398372', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST200028', 'QST200028', 'TXDALSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '4510 Medical Ctr Dr', 'Mckinney', 'Collin', 'TX', '75069', '9725470159', '9725426137', '4510 Medical Ctr Dr', 'Mckinney', 'Collin', 'TX', '75069', '9725470159', '9725426137', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST200029', 'QST200029', 'TXDALSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '500 N Valley Pkwy', 'Lewisville', 'Denton', 'TX', '75067', '9722218117', '9722218836', '500 N Valley Pkwy', 'Lewisville', 'Denton', 'TX', '75067', '9722218117', '9722218836', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST200030', 'QST200030', 'TXDALSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '505 N Ridgeway Dr', 'Cleburne', 'Johnson', 'TX', '76033', '8172028434', '8172028430', '505 N Ridgeway Dr', 'Cleburne', 'Johnson', 'TX', '76033', '8172028434', '8172028430', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST200031', 'QST200031', 'TXDALSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '5575 Warren Pkwy Prof Ste 303 Bldg I', 'Frisco', 'Denton', 'TX', '75034', '2146186470', '2146186473', '5575 Warren Pkwy Prof Ste 303 Bldg I', 'Frisco', 'Denton', 'TX', '75034', '2146186470', '2146186473', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST200032', 'QST200032', 'TXDALSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '805 Hill Blvd Unit 108', 'Granbury', 'Hood', 'TX', '76048', '8172796116', '8172796659', '805 Hill Blvd Unit 108', 'Granbury', 'Hood', 'TX', '76048', '8172796116', '8172796659', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST200033', 'QST200033', 'TXDALSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '902 W Randol Mill', 'Arlington', 'Tarrant', 'TX', '76012', '8177922054', '8177945107', '902 W Randol Mill', 'Arlington', 'Tarrant', 'TX', '76012', '8177922054', '8177945107', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST200034', 'QST200034', 'TXDALSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '990 Hwy 287 N', 'Mansfield', 'Tarrant', 'TX', '76063', '8174771647', '8174771268', '990 Hwy 287 N', 'Mansfield', 'Tarrant', 'TX', '76063', '8174771647', '8174771268', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST200035', 'QST200035', 'TXHOUSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '14025 Delaney St', 'La Marque', 'Galveston', 'TX', '77568', '4099383851', '4099383874', '14025 Delaney St', 'La Marque', 'Galveston', 'TX', '77568', '4099383851', '4099383874', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST200036', 'QST200036', 'TXHOUSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '201 B Hwy 332 W Ste 1000', 'Lake Jackson', 'Brazoria', 'TX', '77566', '9792997457', '9794800410', '201 B Hwy 332 W Ste 1000', 'Lake Jackson', 'Brazoria', 'TX', '77566', '9792997457', '9794800410', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST200037', 'QST200037', 'TXHOUSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '355 A E Parkwood', 'Friendswood', 'Galveston', 'TX', '77546', '2816482633', '2816482685', '355 A E Parkwood', 'Friendswood', 'Galveston', 'TX', '77546', '2816482633', '2816482685', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST200038', 'QST200038', 'TXHOUSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '7111 Medical Ctr Dr', 'Texas City', 'Galveston', 'TX', '77591', '4099331344', '4099331615', '7111 Medical Ctr Dr', 'Texas City', 'Galveston', 'TX', '77591', '4099331344', '4099331615', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST200039', 'QST200039', 'TXSATSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '1652 E Houston St', 'Beeville', 'Bee', 'TX', '78102', '3613622405', '3613589431', '1652 E Houston St', 'Beeville', 'Bee', 'TX', '78102', '3613622405', '3613589431', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST200040', 'QST200040', 'TXSATSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '32665 Us Hwy 281 N', 'Bulverde', 'Comal', 'TX', '78163', '8304381859', '8304388963', '32665 Us Hwy 281 N', 'Bulverde', 'Comal', 'TX', '78163', '8304381859', '8304388963', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'QST200041', 'QST200041', 'TXSATSTD', 'Quest Diagnostics', '', '', 'Quest Diagnostics', '', 'Laboratory', '', '', NULL, 'O', '894 Loop 337', 'New Braunfels', 'Comal', 'TX', '78130', '8306080122', '8306080861', '894 Loop 337', 'New Braunfels', 'Comal', 'TX', '78130', '8306080122', '8306080861', 'QuestDx2014', '', '', NULL, '50.00', '0.00', 3, '2014-08-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|', '1366479099', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
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('770701557', 'W12049349', 'W12049349', 'UT01', 'MountainStar Medical Group St Marks Hospital', 'Benjamin', 'W', 'Blackburn', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', '0000000000', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', '0000000000', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1649380049', 0, 'N', 1, '2014-07-07', NULL, NULL, 0, 0, NULL, NULL),
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('363330928', 'W12049353', 'W12049353', 'ILCHIGSTD', 'Presence Healthcare Services', 'Kelley', '', 'Kozma', 'DO', 'Hematology and Oncology', '', '', NULL, 'O', '2900 N Lake Shore Dr 7 East', 'Chicago', 'Cook', 'IL', '60657', '7736615800', '7736615875', '2900 N Lake Shore Dr 7 East', 'Chicago', 'Cook', 'IL', '60657', '7736615800', '7736615875', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-07-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518168202', 0, 'N', 0, '2014-07-03', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'W12049354', 'W12049354', 'ILCHIGSTD', 'Presence Healthcare Services', 'Kelley', '', 'Kozma', 'DO', 'Hematology and Oncology', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8557647687', '6309142469', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8557647687', '6309142469', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-07-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518168202', 0, 'N', 0, '2014-07-03', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'W12049356', 'W12049356', 'ILCHIGSTD', 'Presence Healthcare Services', 'Rodrigo', 'R', 'Merino', 'MD', 'Neurology', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8557647687', '6309142469', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8557647687', '6309142469', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', '', '', '', 'HCFA|UB|', '1124127139', 0, 'N', 0, '2014-07-03', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'W12049357', 'W12049357', 'ILCHIGSTD', 'Presence Healthcare Services', 'Rodrigo', 'R', 'Merino', 'MD', 'Neurology', '', '', NULL, 'O', '355 Ridge Ave', 'Evanston', 'Cook', 'IL', '60202', '7737925155', '6309142499', '355 Ridge Ave', 'Evanston', 'Cook', 'IL', '60202', '7737925155', '6309142499', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', '', '', '', 'HCFA|UB|', '1124127139', 0, 'N', 0, '2014-07-03', NULL, NULL, 0, 0, NULL, NULL),
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('363330928', 'W12049360', 'W12049360', 'ILCHIGSTD', 'Presence Emergency Medicine', 'Monika', 'M', 'Lusiak', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '7435 W Talcott Ave', 'Chicago', 'Cook', 'IL', '60631', '7737748000', '6309142499', '7435 W Talcott Ave', 'Chicago', 'Cook', 'IL', '60631', '7737748000', '6309142499', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750670337', 0, 'N', 0, '2014-07-03', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'W12049361', 'W12049361', 'ILCHIGSTD', 'Presence Emergency Medicine', 'Monika', 'M', 'Lusiak', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '5645 W Addison St', 'Chicago', 'Cook', 'IL', '60634', '7737947601', '          ', '5645 W Addison St', 'Chicago', 'Cook', 'IL', '60634', '7737947601', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750670337', 0, 'N', 0, '2014-07-03', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'W12049363', 'W12049363', 'ILCHIGSTD', 'Presence Healthcare Services', 'Rosalyn', '', 'Aranas', 'MD', 'Neurology', '', '', NULL, 'O', '355 Ridge Ave', 'Evanston', 'Cook', 'IL', '60202', '8473164000', '6309142499', '355 Ridge Ave', 'Evanston', 'Cook', 'IL', '60202', '8473164000', '6309142499', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-03-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', '', '', '', 'HCFA|UB|', '1568629822', 0, 'N', 0, '2014-07-03', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'W12049364', 'W12049364', 'ILCHIGSTD', 'Presence Healthcare Services', 'Rosalyn', '', 'Aranas', 'MD', 'Neurology', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8557647687', '6309142469', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8557647687', '6309142469', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-03-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', '', '', '', 'HCFA|UB|', '1568629822', 0, 'N', 0, '2014-07-03', NULL, NULL, 0, 0, NULL, NULL),
('364286236', 'W12049366', 'W12049366', 'ILCHIGSTD', 'Presence Ambulatory Services', 'Cynthia', '', 'Weinstein', 'PT', 'Physical Therapy', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8557647687', '6309142469', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8557647687', '6309142469', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053587840', 0, 'N', 0, '2014-07-03', NULL, NULL, 0, 0, NULL, NULL),
('364286236', 'W12049367', 'W12049367', 'ILCHIGSTD', 'Presence Ambulatory Services', 'Cynthia', '', 'Weinstein', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1625 Sheridan Rd', 'Wilmette', 'Cook', 'IL', '60091', '8472511500', '6309142499', '1625 Sheridan Rd', 'Wilmette', 'Cook', 'IL', '60091', '8472511500', '6309142499', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053587840', 0, 'N', 0, '2014-07-03', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12049371', 'W12049371', 'WYT2', 'Memorial Hospital of Sweetwater County', 'Michael', 'W', 'Bowers', 'DO', 'Family Practice', '', '', NULL, 'O', '1180 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528125', '3073528126', '1180 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528125', '3073528126', '', '', '', '0.00', '5.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1104112119', 0, 'N', 1, '2014-07-07', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12049370', 'W12049370', 'WY01', 'Memorial Hospital of Sweetwater County', 'Michael', 'W', 'Bowers', 'DO', 'Family Practice', '', '', NULL, 'O', '1180 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528125', '3073528126', '1180 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528125', '3073528126', '', '', '', '0.00', '5.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1104112119', 0, 'N', 1, '2014-07-07', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12049373', 'W12049373', 'WY01', 'Memorial Hospital of Sweetwater County', 'Michael', 'W', 'Bowers', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 1359', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073623711', '          ', 'PO Box 1359', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073623711', '          ', '', '', '', '0.00', '5.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1104112119', 0, 'N', 1, '2014-07-07', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12049372', 'W12049372', 'WYT2', 'Memorial Hospital of Sweetwater County', 'Michael', 'W', 'Bowers', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 1359', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073623711', '          ', 'PO Box 1359', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073623711', '          ', '', '', '', '0.00', '5.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1104112119', 0, 'N', 1, '2014-07-07', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12049380', 'W12049380', 'WY01', 'Memorial Hospital of Sweetwater County', 'Charles', 'A', 'Bongiorno', 'MD', 'Psychiatry', '', '', NULL, 'O', '1180 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073623711', '          ', '1180 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073623711', '          ', '', '', '', '0.00', '5.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417117714', 0, 'N', 1, '2014-07-24', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12049378', 'W12049378', 'WY01', 'Memorial Hospital of Sweetwater County', 'Charles', 'A', 'Bongiorno', 'MD', 'Psychiatry', '', '', NULL, 'B', 'PO Box 1359', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073623711', '          ', 'PO Box 1359', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073623711', '          ', '', '', '', '0.00', '5.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417117714', 0, 'N', 1, '2014-07-24', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12049376', 'W12049376', 'WYT2', 'Memorial Hospital of Sweetwater County', 'Charles', 'A', 'Bongiorno', 'MD', 'Psychiatry', '', '', NULL, 'B', 'PO Box 1359', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073623711', '          ', 'PO Box 1359', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073623711', '          ', '', '', '', '0.00', '5.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417117714', 0, 'N', 1, '2014-07-24', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12049381', 'W12049381', 'WYT2', 'Memorial Hospital of Sweetwater County', 'Charles', 'A', 'Bongiorno', 'MD', 'Psychiatry', '', '', NULL, 'O', '1180 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073623711', '          ', '1180 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073623711', '          ', '', '', '', '0.00', '5.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417117714', 0, 'N', 1, '2014-07-24', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'W12049385', 'W12049385', 'ILCHIGSTD', 'Presence Healthcare Services', 'Jason', '', 'Satz', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8557647687', '6309142469', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8557647687', '6309142469', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center', '', '', '', 'HCFA|UB|', '1154617199', 0, 'N', 0, '2014-07-03', NULL, NULL, 0, 0, NULL, NULL),
('320346082', 'W12049484', 'W12049484', 'TXSATSTD', 'Allied Institute of Medicine', 'Victor', 'G', 'Rosales', 'DO', 'Family Practice', '', '', NULL, 'O', '12413 Judson Rd STE 100', 'San Antonio', 'Bexar', 'TX', '78233', '2106488200', '2106488204', '12413 Judson Rd STE 100', 'San Antonio', 'Bexar', 'TX', '78233', '2106488200', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-07-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346488905', 0, 'Y', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('751527725', 'W12049382', 'W12049382', 'UT01', 'Kevin Parzych, MD LLC', 'LuAnn ', '', 'Jacobs-Peterson', 'APRN', 'Family Practice', '', '', NULL, 'O', '1151 E 3900 S Ste B299', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8018920135', '8012662362', '1151 E 3900 S Ste B299', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8018920135', '8012662362', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-06-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396918462', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('202500191', 'W12049386', 'W12049386', 'UTMH1', 'Draper Pyschological Services', 'Laura', 'B', 'Oaks', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '668 E 12225 S Ste 202', 'Draper', 'Salt Lake', 'UT', '84020', '8016193569', '8015767540', '668 E 12225 S Ste 202', 'Draper', 'Salt Lake', 'UT', '84020', '8016193569', '8015767540', 'UTMA', '', '', '0.00', '40.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356436018', 0, 'N', 1, '2014-07-10', NULL, NULL, 0, 0, NULL, NULL),
('202500191', 'W12049387', 'W12049387', 'UTMH1', 'Draper Pyschological Services', 'David ', '', 'Nichols', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '668 E 12225 S Ste 202', 'Draper', 'Salt Lake', 'UT', '84020', '8016193569', '8015767540', '668 E 12225 S Ste 202', 'Draper', 'Salt Lake', 'UT', '84020', '8016193569', '8015767540', 'UTMA', '', '', '0.00', '40.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073830352', 0, 'N', 1, '2014-07-10', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100015', 'MNS100015', 'UT01', 'Deseret Health and Rehab at Federal Heights', '', '', 'Deseret Health and Rehab at Federal Heights', '', 'Skilled Nursing Facility', '', '', NULL, 'O', '41 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015323539', '8013649758', '41 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015323539', '8013649758', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', '', '', '', '|UB|', '1063756328', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100016', 'MNS100016', 'UT01', 'Deseret Health and Rehab at Federal Heights', '', '', 'Deseret Health and Rehab at Federal Heights', '', 'Skilled Nursing Facility', '', '', NULL, 'B', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', '', '', '', '|UB|', '1063756328', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100133', 'MNS100133', 'UT01', 'Deseret Health and Rehab at Crosslands', '', '', 'Deseret Health Rehab at Crosslands', '', 'Skilled Nursing Facility', '', '', NULL, 'B', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', '', '', '', '|UB|', '1790029056', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100134', 'MNS100134', 'UT01', 'Deseret Health and Rehab at Crosslands', '', '', 'Deseret Health Rehab at Crosslands', '', 'Skilled Nursing Facility', '', '', NULL, 'O', '575 E 11000 S', 'Sandy', 'Salt Lake', 'UT', '84070', '8015717600', '8015714875', '575 E 11000 S', 'Sandy', 'Salt Lake', 'UT', '84070', '8015717600', '8015714875', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', '', '', '', '|UB|', '1790029056', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100001', 'MNS100001', 'TXSATSTD', 'Westover Hills Rehabilitation and Healthcare Center', '', '', 'Management and Network Services MNS', '', 'Skilled Nursing Facility', '', NULL, NULL, 'B', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', NULL, NULL, NULL, '|UB|', '1003111592', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('311504075', 'MNS100002', 'MNS100002', 'TXSATSTD', 'Westover Hills Rehabilitation and Healthcare Center', '', '', 'Management and Network Services MNS', '', 'Skilled Nursing Facility', '', NULL, NULL, 'O', '9922 State Hwy 151', 'San Antonio', 'Bexar', 'TX', '78251', '2105462273', '2105462274', '9922 State Hwy 151', 'San Antonio', 'Bexar', 'TX', '78251', '2105462273', '2105462274', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', NULL, NULL, NULL, '|UB|', '1003111592', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100003', 'MNS100003', 'UT01', 'Deseret Care Center', '', '', 'Management and Network Services MNS', '', 'Skilled Nursing Facility', '', NULL, NULL, 'B', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', NULL, NULL, NULL, '|UB|', '1023311362', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100004', 'MNS100004', 'UT01', 'Deseret Care Center', '', '', 'Management and Network Services MNS', '', 'Skilled Nursing Facility', '', NULL, NULL, 'O', '950 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014865121', '8014865146', '950 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014865121', '8014865146', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', NULL, NULL, NULL, '|UB|', '1023311362', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100005', 'MNS100005', 'TXDALSTD', 'Ridgecrest Healthcare and Rehabilitation Center', '', '', 'Management and Network Services MNS', '', 'Skilled Nursing Facility', '', NULL, NULL, 'B', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', NULL, NULL, NULL, '|UB|', '1023339900', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100006', 'MNS100006', 'TXDALSTD', 'Ridgecrest Healthcare and Rehabilitation Center', '', '', 'Management and Network Services MNS', '', 'Skilled Nursing Facility', '', NULL, NULL, 'O', '561 E Ridgecrest Rd', 'Forney', 'Kaufman', 'TX', '75126', '9725522420', '9725522481', '561 E Ridgecrest Rd', 'Forney', 'Kaufman', 'TX', '75126', '9725522420', '9725522481', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', NULL, NULL, NULL, '|UB|', '1023339900', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100007', 'MNS100007', 'TXSATSTD', 'Huebner Creek Health and Rehabilitation Center', '', '', 'Management and Network Services MNS', '', 'Skilled Nursing Facility', '', NULL, NULL, 'B', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', NULL, NULL, NULL, '|UB|', '1023443579', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100008', 'MNS100008', 'TXSATSTD', 'Huebner Creek Health and Rehabilitation Center', '', '', 'Management and Network Services MNS', '', 'Skilled Nursing Facility', '', NULL, NULL, 'O', '8306 Huebner Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2106913111', '2106913118', '8306 Huebner Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2106913111', '2106913118', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', NULL, NULL, NULL, '|UB|', '1023443579', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100009', 'MNS100009', 'TXHOUSTD', 'Ashford Gardens', '', '', 'Management and Network Services MNS', '', 'Skilled Nursing Facility', '', NULL, NULL, 'B', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', NULL, NULL, NULL, '|UB|', '1033105366', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100010', 'MNS100010', 'TXHOUSTD', 'Ashford Gardens', '', '', 'Management and Network Services MNS', '', 'Skilled Nursing Facility', '', NULL, NULL, 'O', '7210 Northline Dr', 'Houston', 'Harris', 'TX', '77076', '7136992882', '7136959005', '7210 Northline Dr', 'Houston', 'Harris', 'TX', '77076', '7136992882', '7136959005', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', NULL, NULL, NULL, '|UB|', '1033105366', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100011', 'MNS100011', 'TXSATSTD', 'Atrium Rehabilitation Center', '', '', 'Management and Network Services MNS', '', 'Skilled Nursing Facility', '', NULL, NULL, 'B', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', NULL, NULL, NULL, '|UB|', '1063448439', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100012', 'MNS100012', 'TXSATSTD', 'Atrium Rehabilitation Center', '', '', 'Management and Network Services MNS', '', 'Skilled Nursing Facility', '', NULL, NULL, 'O', '7602 Louis Pasteur', 'San Antonio', 'Bexar', 'TX', '78229', '2106149974', '2106160151', '7602 Louis Pasteur', 'San Antonio', 'Bexar', 'TX', '78229', '2106149974', '2106160151', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', NULL, NULL, NULL, '|UB|', '1063448439', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100013', 'MNS100013', 'TXDALSTD', 'San Remo', '', '', 'Management and Network Services MNS', '', 'Skilled Nursing Facility', '', NULL, NULL, 'O', '3550 Shiloh Rd', 'Richardson', 'Dallas', 'TX', '75082', '9722314810', '9722314813', '3550 Shiloh Rd', 'Richardson', 'Dallas', 'TX', '75082', '9722314810', '9722314813', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', NULL, NULL, NULL, '|UB|', '1063736882', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100014', 'MNS100014', 'TXDALSTD', 'San Remo', '', '', 'Management and Network Services MNS', '', 'Skilled Nursing Facility', '', NULL, NULL, 'B', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', NULL, NULL, NULL, '|UB|', '1063736882', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100121', 'MNS100121', 'TXDALSTD', 'Belmont at Twin Creeks', '', '', 'Management and Network Services MNS', '', 'Skilled Nursing Facility', '', NULL, NULL, 'B', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', NULL, NULL, NULL, '|UB|', '1710124854', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100122', 'MNS100122', 'TXDALSTD', 'Belmont at Twin Creeks', '', '', 'Management and Network Services MNS', '', 'Skilled Nursing Facility', '', NULL, NULL, 'O', '999 Raintree Cir', 'Allen', 'Collin', 'TX', '75013', '9723908088', '9723908089', '999 Raintree Cir', 'Allen', 'Collin', 'TX', '75013', '9723908088', '9723908089', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', NULL, NULL, NULL, '|UB|', '1710124854', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100123', 'MNS100123', 'TXDALSTD', 'Good Samaritan Society - Lake Forest Village', '', '', 'Management and Network Services MNS', '', 'Skilled Nursing Facility', '', NULL, NULL, 'O', '3901 Montecito Dr', 'Denton', 'Denton', 'TX', '76210', '9408910856', '9408910866', '3901 Montecito Dr', 'Denton', 'Denton', 'TX', '76210', '9408910856', '9408910866', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', NULL, NULL, NULL, '|UB|', '1740261742', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100124', 'MNS100124', 'TXDALSTD', 'Good Samaritan Society - Lake Forest Village', '', '', 'Management and Network Services MNS', '', 'Skilled Nursing Facility', '', NULL, NULL, 'B', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', NULL, NULL, NULL, '|UB|', '1740261742', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100125', 'MNS100125', 'TXDALSTD', 'Prairie Estates', '', '', 'Management and Network Services MNS', '', 'Skilled Nursing Facility', '', NULL, NULL, 'O', '1350 Main St', 'Frisco', 'Denton', 'TX', '75034', '2147059108', '2143873481', '1350 Main St', 'Frisco', 'Denton', 'TX', '75034', '2147059108', '2143873481', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', NULL, NULL, NULL, '|UB|', '1740495837', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100126', 'MNS100126', 'TXDALSTD', 'Prairie Estates', '', '', 'Management and Network Services MNS', '', 'Skilled Nursing Facility', '', NULL, NULL, 'B', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', NULL, NULL, NULL, '|UB|', '1740495837', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100127', 'MNS100127', 'TXHOUSTD', 'Clear Brook Crossing Rehab and Healthcare Center', '', '', 'Management and Network Services MNS', '', 'Skilled Nursing Facility', '', NULL, NULL, 'O', '10800 Flora Mae Meadows Rd', 'Houston', 'Harris', 'TX', '77089', '8323282350', '8323282351', '10800 Flora Mae Meadows Rd', 'Houston', 'Harris', 'TX', '77089', '8323282350', '8323282351', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', NULL, NULL, NULL, '|UB|', '1760746499', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100128', 'MNS100128', 'TXHOUSTD', 'Clear Brook Crossing Rehab and Healthcare Center', '', '', 'Management and Network Services MNS', '', 'Skilled Nursing Facility', '', NULL, NULL, 'B', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', NULL, NULL, NULL, '|UB|', '1760746499', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100129', 'MNS100129', 'TXSATSTD', 'Princeton Place Bandera Road', '', '', 'Management and Network Services MNS', '', 'Skilled Nursing Facility', '', NULL, NULL, 'O', '1939 Bandera Rd', 'San Antonio', 'Bexar', 'TX', '78228', '2104340671', '2104320506', '1939 Bandera Rd', 'San Antonio', 'Bexar', 'TX', '78228', '2104340671', '2104320506', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', NULL, NULL, NULL, '|UB|', '1770519159', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100130', 'MNS100130', 'TXSATSTD', 'Princeton Place Bandera Road', '', '', 'Management and Network Services MNS', '', 'Skilled Nursing Facility', '', NULL, NULL, 'B', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', NULL, NULL, NULL, '|UB|', '1770519159', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100131', 'MNS100131', 'TXHOUSTD', 'Legend Oaks Healthcare and Rehab - East Houston', '', '', 'Management and Network Services MNS', '', 'Skilled Nursing Facility', '', NULL, NULL, 'O', '15880 Wallisville Rd', 'Houston', 'Harris', 'TX', '77049', '2814576462', '2814576188', '15880 Wallisville Rd', 'Houston', 'Harris', 'TX', '77049', '2814576462', '2814576188', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', NULL, NULL, NULL, '|UB|', '1780785758', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100132', 'MNS100132', 'TXHOUSTD', 'Legend Oaks Healthcare and Rehab - East Houston', '', '', 'Management and Network Services MNS', '', 'Skilled Nursing Facility', '', NULL, NULL, 'B', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', NULL, NULL, NULL, '|UB|', '1780785758', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100135', 'MNS100135', 'TXDALSTD', 'Carlyle at Stonebridge Park', '', '', 'Management and Network Services MNS', '', 'Skilled Nursing Facility', '', NULL, NULL, 'O', '170 Stonebridge Ln', 'Southlake', 'Tarrant', 'TX', '76092', '8174315778', '8174315667', '170 Stonebridge Ln', 'Southlake', 'Tarrant', 'TX', '76092', '8174315778', '8174315667', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', NULL, NULL, NULL, '|UB|', '1811224264', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100136', 'MNS100136', 'TXDALSTD', 'Carlyle at Stonebridge Park', '', '', 'Management and Network Services MNS', '', 'Skilled Nursing Facility', '', NULL, NULL, 'B', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', NULL, NULL, NULL, '|UB|', '1811224264', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100137', 'MNS100137', 'TXSATSTD', 'Las Colinas of Westover Rehabilitation Center', '', '', 'Management and Network Services MNS', '', 'Skilled Nursing Facility', '', NULL, NULL, 'B', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', NULL, NULL, NULL, '|UB|', '1811244700', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100138', 'MNS100138', 'TXSATSTD', 'Las Colinas of Westover Rehabilitation Center', '', '', 'Management and Network Services MNS', '', 'Skilled Nursing Facility', '', NULL, NULL, 'O', '9738 Westover Hills Blvd', 'San Antonio', 'Bexar', 'TX', '78251', '2103055730', '2103055731', '9738 Westover Hills Blvd', 'San Antonio', 'Bexar', 'TX', '78251', '2103055730', '2103055731', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', NULL, NULL, NULL, '|UB|', '1811244700', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100139', 'MNS100139', 'TXDALSTD', 'Collinwood Care Center', '', '', 'Management and Network Services MNS', '', 'Skilled Nursing Facility', '', NULL, NULL, 'O', '3100 S Rigsbee Rd', 'Plano', 'Collin', 'TX', '75074', '9724236217', '9728817116', '3100 S Rigsbee Rd', 'Plano', 'Collin', 'TX', '75074', '9724236217', '9728817116', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', NULL, NULL, NULL, '|UB|', '1831108745', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100140', 'MNS100140', 'TXDALSTD', 'Collinwood Care Center', '', '', 'Management and Network Services MNS', '', 'Skilled Nursing Facility', '', NULL, NULL, 'B', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', NULL, NULL, NULL, '|UB|', '1831108745', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100141', 'MNS100141', 'TXSATSTD', 'Legend Oaks Healthcare and Rehabilitation', '', '', 'Management and Network Services MNS', '', 'Skilled Nursing Facility', '', NULL, NULL, 'O', '2003 W Hutchins Pl', 'San Antonio', 'Bexar', 'TX', '78224', '2109270800', '2109270806', '2003 W Hutchins Pl', 'San Antonio', 'Bexar', 'TX', '78224', '2109270800', '2109270806', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', NULL, NULL, NULL, '|UB|', '1871516609', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100142', 'MNS100142', 'TXSATSTD', 'Legend Oaks Healthcare and Rehabilitation', '', '', 'Management and Network Services MNS', '', 'Skilled Nursing Facility', '', NULL, NULL, 'B', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', NULL, NULL, NULL, '|UB|', '1871516609', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100143', 'MNS100143', 'TXHOUSTD', 'Beechnut Manor', '', '', 'Management and Network Services MNS', '', 'Skilled Nursing Facility', '', NULL, NULL, 'O', '12777 Beechnut St', 'Houston', 'Harris', 'TX', '77072', '2818798040', '2818799066', '12777 Beechnut St', 'Houston', 'Harris', 'TX', '77072', '2818798040', '2818799066', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', NULL, NULL, NULL, '|UB|', '1871550624', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100144', 'MNS100144', 'TXHOUSTD', 'Beechnut Manor', '', '', 'Management and Network Services MNS', '', 'Skilled Nursing Facility', '', NULL, NULL, 'B', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', NULL, NULL, NULL, '|UB|', '1871550624', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100145', 'MNS100145', 'TXHOUSTD', 'Humble Healthcare Center', '', '', 'Management and Network Services MNS', '', 'Skilled Nursing Facility', '', NULL, NULL, 'B', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', NULL, NULL, NULL, '|UB|', '1871554683', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100146', 'MNS100146', 'TXHOUSTD', 'Humble Healthcare Center', '', '', 'Management and Network Services MNS', '', 'Skilled Nursing Facility', '', NULL, NULL, 'O', '93 Isaacks Rd', 'Humble', 'Harris', 'TX', '77338', '2814467159', '2815481594', '93 Isaacks Rd', 'Humble', 'Harris', 'TX', '77338', '2814467159', '2815481594', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', NULL, NULL, NULL, '|UB|', '1871554683', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100147', 'MNS100147', 'TXHOUSTD', 'West Oaks Rehab and Healthcare Center - Houston', '', '', 'Management and Network Services MNS', '', 'Skilled Nursing Facility', '', NULL, NULL, 'O', '3625 Green Crest', 'Houston', 'Harris', 'TX', '77082', '2815581166', '2815589484', '3625 Green Crest', 'Houston', 'Harris', 'TX', '77082', '2815581166', '2815589484', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', NULL, NULL, NULL, '|UB|', '1881636330', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100148', 'MNS100148', 'TXHOUSTD', 'West Oaks Rehab and Healthcare Center - Houston', '', '', 'Management and Network Services MNS', '', 'Skilled Nursing Facility', '', NULL, NULL, 'B', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', NULL, NULL, NULL, '|UB|', '1881636330', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100149', 'MNS100149', 'TXDALSTD', 'Harrison at Heritage', '', '', 'Management and Network Services MNS', '', 'Skilled Nursing Facility', '', NULL, NULL, 'O', '4600 Heritage Trace Pkwy', 'Ft Worth', 'Tarrant', 'TX', '76244', '8177419360', '8177419361', '4600 Heritage Trace Pkwy', 'Ft Worth', 'Tarrant', 'TX', '76244', '8177419360', '8177419361', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', NULL, NULL, NULL, '|UB|', '1881968808', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100150', 'MNS100150', 'TXDALSTD', 'Harrison at Heritage', '', '', 'Management and Network Services MNS', '', 'Skilled Nursing Facility', '', NULL, NULL, 'B', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', NULL, NULL, NULL, '|UB|', '1881968808', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100151', 'MNS100151', 'TXDALSTD', 'Good Samaritan Society - Denton Village', '', '', 'Management and Network Services MNS', '', 'Skilled Nursing Facility', '', NULL, NULL, 'O', '2500 Hinkle Dr', 'Denton', 'Denton', 'TX', '76201', '9403832651', '9403829306', '2500 Hinkle Dr', 'Denton', 'Denton', 'TX', '76201', '9403832651', '9403829306', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', NULL, NULL, NULL, '|UB|', '1891786174', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100152', 'MNS100152', 'TXDALSTD', 'Good Samaritan Society - Denton Village', '', '', 'Management and Network Services MNS', '', 'Skilled Nursing Facility', '', NULL, NULL, 'B', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', NULL, NULL, NULL, '|UB|', '1891786174', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100153', 'MNS100153', 'TXDALSTD', 'Green Valley Healthcare and Rehabilitation Center', '', '', 'Management and Network Services MNS', '', 'Skilled Nursing Facility', '', NULL, NULL, 'B', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', NULL, NULL, NULL, '|UB|', '1891991584', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100154', 'MNS100154', 'TXDALSTD', 'Green Valley Healthcare and Rehabilitation Center', '', '', 'Management and Network Services MNS', '', 'Skilled Nursing Facility', '', NULL, NULL, 'O', '6850 Rufe Snow Dr', 'Fort Worth', 'Tarrant', 'TX', '76148', '8175144940', '8175142198', '6850 Rufe Snow Dr', 'Fort Worth', 'Tarrant', 'TX', '76148', '8175144940', '8175142198', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', NULL, NULL, NULL, '|UB|', '1891991584', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100155', 'MNS100155', 'TXHOUSTD', 'Courtyards at Pasadena', '', '', 'Management and Network Services MNS', '', 'Skilled Nursing Facility', '', NULL, NULL, 'O', '4048 Red Bluff Rd', 'Pasadena', 'Harris', 'TX', '77503', '7134777877', '7134756533', '4048 Red Bluff Rd', 'Pasadena', 'Harris', 'TX', '77503', '7134777877', '7134756533', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', NULL, NULL, NULL, '|UB|', '1912125683', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100156', 'MNS100156', 'TXHOUSTD', 'Courtyards at Pasadena', '', '', 'Management and Network Services MNS', '', 'Skilled Nursing Facility', '', NULL, NULL, 'B', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', NULL, NULL, NULL, '|UB|', '1912125683', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100157', 'MNS100157', 'TXSATSTD', 'Heights on Huebner', '', '', 'Management and Network Services MNS', '', 'Skilled Nursing Facility', '', NULL, NULL, 'O', '10127 Huebner Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2108580828', '2108580838', '10127 Huebner Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2108580828', '2108580838', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', NULL, NULL, NULL, '|UB|', '1912169988', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100158', 'MNS100158', 'TXSATSTD', 'Heights on Huebner', '', '', 'Management and Network Services MNS', '', 'Skilled Nursing Facility', '', NULL, NULL, 'B', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', NULL, NULL, NULL, '|UB|', '1912169988', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100159', 'MNS100159', 'TXHOUSTD', 'Cedar Bayou Rehabilitation and Healthcare Center', '', '', 'Management and Network Services MNS', '', 'Skilled Nursing Facility', '', NULL, NULL, 'O', '2000 W Baker Rd', 'Baytown', 'Harris', 'TX', '77521', '2814279120', '2814274262', '2000 W Baker Rd', 'Baytown', 'Harris', 'TX', '77521', '2814279120', '2814274262', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', NULL, NULL, NULL, '|UB|', '1912175688', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100160', 'MNS100160', 'TXHOUSTD', 'Cedar Bayou Rehabilitation and Healthcare Center', '', '', 'Management and Network Services MNS', '', 'Skilled Nursing Facility', '', NULL, NULL, 'B', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', NULL, NULL, NULL, '|UB|', '1912175688', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100161', 'MNS100161', 'TXHOUSTD', 'LaPorte Healthcare Center', '', '', 'Management and Network Services MNS', '', 'Skilled Nursing Facility', '', NULL, NULL, 'O', '208 S Utah St', 'La Porte', 'Harris', 'TX', '77571', '2814711810', '2814718809', '208 S Utah St', 'La Porte', 'Harris', 'TX', '77571', '2814711810', '2814718809', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', NULL, NULL, NULL, '|UB|', '1912931015', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100162', 'MNS100162', 'TXHOUSTD', 'LaPorte Healthcare Center', '', '', 'Management and Network Services MNS', '', 'Skilled Nursing Facility', '', NULL, NULL, 'B', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', NULL, NULL, NULL, '|UB|', '1912931015', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100163', 'MNS100163', 'TXSATSTD', 'Paramount Rehabilitation and Healthcare Center', '', '', 'Management and Network Services MNS', '', 'Skilled Nursing Facility', '', NULL, NULL, 'O', '5437 Eisenhauer Rd', 'San Antonio', 'Bexar', 'TX', '78218', '2106469576', '2106533695', '5437 Eisenhauer Rd', 'San Antonio', 'Bexar', 'TX', '78218', '2106469576', '2106533695', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', NULL, NULL, NULL, '|UB|', '1922040468', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100164', 'MNS100164', 'TXSATSTD', 'Paramount Rehabilitation and Healthcare Center', '', '', 'Management and Network Services MNS', '', 'Skilled Nursing Facility', '', NULL, NULL, 'B', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', NULL, NULL, NULL, '|UB|', '1922040468', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100165', 'MNS100165', 'TXDALSTD', 'Sherman Healthcare Center', '', '', 'Management and Network Services MNS', '', 'Skilled Nursing Facility', '', NULL, NULL, 'B', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', NULL, NULL, NULL, '|UB|', '1922064948', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100166', 'MNS100166', 'TXDALSTD', 'Sherman Healthcare Center', '', '', 'Management and Network Services MNS', '', 'Skilled Nursing Facility', '', NULL, NULL, 'O', '817 W Ctr St', 'Sherman', 'Grayson', 'TX', '75090', '9038936348', '9038700767', '817 W Ctr St', 'Sherman', 'Grayson', 'TX', '75090', '9038936348', '9038700767', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', NULL, NULL, NULL, '|UB|', '1922064948', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100167', 'MNS100167', 'TXDALSTD', 'Madison on Marsh', '', '', 'Management and Network Services MNS', '', 'Skilled Nursing Facility', '', NULL, NULL, 'O', '2245 Marsh Ln', 'Carrollton', 'Dallas', 'TX', '75006', '9724161764', '9724165890', '2245 Marsh Ln', 'Carrollton', 'Dallas', 'TX', '75006', '9724161764', '9724165890', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', NULL, NULL, NULL, '|UB|', '1932298064', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100168', 'MNS100168', 'TXDALSTD', 'Madison on Marsh', '', '', 'Management and Network Services MNS', '', 'Skilled Nursing Facility', '', NULL, NULL, 'B', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', NULL, NULL, NULL, '|UB|', '1932298064', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
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('311504075', 'MNS100179', 'MNS100179', 'TXDALSTD', 'Longmeadow Healthcare Center', '', '', 'Management and Network Services MNS', '', 'Skilled Nursing Facility', '', NULL, NULL, 'O', '120 Meadowview Dr', 'Justin', 'Denton', 'TX', '76247', '9406482731', '9406483125', '120 Meadowview Dr', 'Justin', 'Denton', 'TX', '76247', '9406482731', '9406483125', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', NULL, NULL, NULL, '|UB|', '1982033585', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
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('311504075', 'MNS100181', 'MNS100181', 'TXSATSTD', 'Mystic Park Rehabilitation and Healthcare Center', '', '', 'Management and Network Services MNS', '', 'Skilled Nursing Facility', '', NULL, NULL, 'B', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', '5555 Parkcenter Cir Ste 200', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '8009492551', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', NULL, NULL, NULL, '|UB|', '1992747430', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'MNS100182', 'MNS100182', 'TXSATSTD', 'Mystic Park Rehabilitation and Healthcare Center', '', '', 'Management and Network Services MNS', '', 'Skilled Nursing Facility', '', NULL, NULL, 'O', '8503 Mystic Park', 'San Antonio', 'Bexar', 'TX', '78254', '2102560906', '2102560925', '8503 Mystic Park', 'San Antonio', 'Bexar', 'TX', '78254', '2102560906', '2102560925', 'MNS2014', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, NULL, 0, '', NULL, NULL, NULL, '|UB|', '1992747430', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
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('271790052', 'W12049398', 'W12049398', 'IDBOISTD', 'Saint Alphonsus Medical Group Baker Clinic', 'William', 'Z', 'Allen', 'PA-C', 'Family Practice', '', '', NULL, 'O', '3175 Pocahontas Rd', 'Baker City', 'Baker', 'OR', '97814', '5415234415', '5415242399', '3175 Pocahontas Rd', 'Baker City', 'Baker', 'OR', '97814', '5415234415', '5415242399', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-07-09', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1730497520', 0, 'Y', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL);
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('810587644', 'W12049436', 'W12049436', 'UT01', 'Bear Lake Community Health Center', 'Dustin', 'L', 'Burbank', 'PA', 'Family Practice', '', '', NULL, 'O', '325 W Logan Hwy', 'Garden City', 'Rich', 'UT', '84028', '4359463660', '4359468215', '325 W Logan Hwy', 'Garden City', 'Cache', 'UT', '84028', '4359463660', '4359468215', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821307448', 0, 'N', 1, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('465062444', 'W12049440', 'W12049440', 'UT01', 'West Valley OBGYN', 'Theodore', '', 'Colwell', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '315 Elm St Ste 310', 'Caldwell', 'Canyon', 'ID', '83605', '2085452035', '2084541065', '315 Elm St Ste 310', 'Caldwell', 'Canyon', 'ID', '83605', '2085452035', '2084541065', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'West Valley Medical Center', '', '', '', 'HCFA|UB|', '1598735391', 0, 'N', 1, '2014-07-10', NULL, NULL, 0, 0, NULL, NULL),
('870470946', 'W12049435', 'W12049435', 'UT01', 'Hurricane Family Practice', 'Melvin', 'R', 'Carter', 'MD', 'Family Practice', '', '', NULL, 'O', '11 S Main St', 'Hurricane', 'Washington', 'UT', '84737', '4356359444', '4356358148', '11 S Main St', 'Hurricane', 'Washington', 'UT', '84737', '4356359444', '4356358148', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1043277833', 0, 'N', 1, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
('465508401', 'W12049441', 'W12049441', 'UTMH1', 'Aspen Reflections Counseling ', 'Russell "Mark"', '', 'Robertson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '2317 N Hillfield Rd Ste 103', 'Layton', 'Davis', 'UT', '84041', '8015254645', '8017797808', '2317 N Hillfield Rd Ste 103', 'Layton', 'Davis', 'UT', '84041', '8015254645', '8017797808', 'UTMA', '', '', '0.00', '40.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1390363501', 0, 'N', 1, '2014-07-10', NULL, NULL, 0, 0, NULL, NULL),
('262072378', 'W12049573', 'W12049573', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Elizabeth', '', 'Harmer', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '41 E Commerce Dr Ste 2', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017561577', '8012168357', '41 E Commerce Dr Ste 2', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017561577', '8012168357', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992736142', 0, 'N', 1, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('262072378', 'W12049572', 'W12049572', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Elizabeth', '', 'Harmer', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1248 E 90 N Ste 300', 'American Fork', 'Utah', 'UT', '84003', '8017561577', '8012168357', '1248 E 90 N Ste 300', 'American Fork', 'Utah', 'UT', '84003', '8017561577', '8012168357', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992736142', 0, 'N', 1, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('453808279', 'W12049444', 'W12049444', 'TXSATSTD', 'Kellum Physicians Partners', '', '', 'Kellum Physicians Partners', '', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3903 Wiseman Blvd Ste 215', 'San Antonio', 'Bexar', 'TX', '78251', '2106756724', '2106751759', '3903 Wiseman Blvd Ste 215', 'San Antonio', 'Bexar', 'TX', '78251', '2106756724', '2106751759', 'TXOBG', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073880092', 0, 'Y', 1, '2014-07-10', NULL, NULL, 0, 0, NULL, NULL),
('453808279', 'W12049445', 'W12049445', 'TXSATSTD', 'Kellum Physicians Partners', '', '', 'Kellum Physicians Partners', '', 'Obstetrics and Gynecology', '', '', NULL, 'M', '8870 US Hwy 87 E', 'San Antonio', 'Bexar', 'TX', '78263', '0000000000', '0000000000', '8870 US Hwy 87 E', 'San Antonio', 'Bexar', 'TX', '78263', '0000000000', '0000000000', 'TXOBG', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073880092', 0, 'N', 1, '2014-07-10', NULL, NULL, 0, 0, NULL, NULL),
('453808279', 'W12049446', 'W12049446', 'TXSATSTD', 'Kellum Physicians Partners', '', '', 'Kellum Physicians Partners', '', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 88', 'San Antonio', 'Bexar', 'TX', '78291', '2106756724', '2106751759', 'PO Box 88', 'San Antonio', 'Bexar', 'TX', '78291', '2106756724', '2106751759', 'TXOBG', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073880092', 0, 'N', 1, '2014-07-10', NULL, NULL, 0, 0, NULL, NULL),
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('453808279', 'W12049455', 'W12049455', 'TXSATSTD', 'Kellum Physicians Partners', 'Tami', '', 'Rocha', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 88', 'San Antonio', 'Bexar', 'TX', '78291', '2106756724', '2106751759', 'PO Box 88', 'San Antonio', 'Bexar', 'TX', '78291', '2106756724', '2106751759', 'TXOBG', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417123399', 0, 'N', 1, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
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('453808279', 'W12049453', 'W12049453', 'TXSATSTD', 'Kellum Physicians Partners', 'Tami', '', 'Rocha', 'PA', 'Family Practice', '', '', NULL, 'O', '8870 US Hwy 87 E', 'San Antonio', 'Bexar', 'TX', '78263', '2106494257', '2106494170', '8870 US Hwy 87 E', 'San Antonio', 'Bexar', 'TX', '78263', '2106494257', '2106494170', 'TXOBG', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417123399', 0, 'N', 1, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('453808279', 'W12049449', 'W12049449', 'TXSATSTD', 'Kellum Physicians Partners', 'John', '', 'Kellum', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3401 FM 3009', 'Schertz', 'Guadalupe', 'TX', '78154', '2109452121', '2109452221', '3401 FM 3009', 'Schertz', 'Guadalupe', 'TX', '78154', '2109452121', '2109452221', 'TXOBG', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255326989', 0, 'N', 1, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
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('453808279', 'W12049451', 'W12049451', 'TXSATSTD', 'Kellum Physicians Partners', 'John', '', 'Kellum', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 88', 'San Antonio', 'Bexar', 'TX', '78291', '2106756724', '2106751759', 'PO Box 88', 'San Antonio', 'Guadalupe', 'TX', '78291', '2106756724', '2106751759', 'TXOBG', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255326989', 0, 'N', 1, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
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('453808279', 'W12049467', 'W12049467', 'TXSATSTD', 'Kellum Physicians Partners', 'Molly', '', 'Shields', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'M', '8870 US Hwy 87 E', 'San Antonio', 'Bexar', 'TX', '78263', '0000000000', '0000000000', '8870 US Hwy 87 E', 'San Antonio', 'Bexar', 'TX', '78263', '0000000000', '0000000000', 'TXOBG', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396971255', 0, 'N', 1, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
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('364130066', 'W12049472', 'W12049472', 'ILCHIGSTD', '', 'Anthony', '', 'Spitz', 'DPM', 'Podiatry', '', '', NULL, 'O', '2921 W Devon Ave', 'Chicago', 'Cook', 'IL', '60659', '7739730334', '7739730447', '2921 W Devon Ave', 'Chicago', 'Cook', 'IL', '60659', '7739730334', '7739730447', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740392224', 0, 'N', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('364130066', 'W12049470', 'W12049470', 'ILCHIGSTD', '', 'Anthony', '', 'Spitz', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740392224', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('364130066', 'W12049471', 'W12049471', 'ILCHIGSTD', '', 'Anthony', '', 'Spitz', 'DPM', 'Podiatry', '', '', NULL, 'O', '505 N Wolf Rd', 'Wheeling', 'Cook', 'IL', '60090', '8474659311', '8474658223', '505 N Wolf Rd', 'Wheeling', 'Cook', 'IL', '60090', '8474659311', '8474658223', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740392224', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'W12049475', 'W12049475', 'ILCHIGSTD', 'Presence Healthcare Services', 'Shivani', '', 'Batra', 'DO', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '2900 N Lake Shore Dr 12th Fl', 'Chicago', 'Cook', 'IL', '60657', '7736654964', '7736655182', '2900 N Lake Shore Dr 12th Fl', 'Chicago', 'Cook', 'IL', '60657', '7736654964', '7736655182', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-08-11', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871752881', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'W12049474', 'W12049474', 'ILCHIGSTD', 'Presence Healthcare Services', 'Shivani', '', 'Batra', 'DO', 'Physical Medicine and Rehabilitation', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8557647687', '6309142469', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8557647687', '6309142469', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-08-11', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871752881', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'W12049477', 'W12049477', 'ILCHIGSTD', 'Presence Healthcare Services', 'Julie', '', 'Kim', 'MD', 'Hospitalist', '', '', NULL, 'O', '2233 W Division St', 'Chicago', 'Cook', 'IL', '60622', '3127702000', '7739356406', '2233 W Division St', 'Chicago', 'Cook', 'IL', '60622', '3127702000', '7739356406', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568787737', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'W12049478', 'W12049478', 'ILCHIGSTD', 'Presence Healthcare Services', 'Julie', '', 'Kim', 'MD', 'Hospitalist', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8557647687', '6309142469', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8557647687', '6309142469', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568787737', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'W12049482', 'W12049482', 'ILCHIGSTD', 'Presence Healthcare Services', 'Nicholas', 'C', 'Frisch', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1431 N Western Ave Ste 205', 'Chicago', 'Cook', 'IL', '60622', '7732351915', '6309142499', '1431 N Western Ave Ste 205', 'Chicago', 'Cook', 'IL', '60622', '7732351915', '6309142499', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770756215', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'W12049481', 'W12049481', 'ILCHIGSTD', 'Presence Healthcare Services', 'Nicholas', 'C', 'Frisch', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8557647687', '6309142469', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8557647687', '6309142469', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770756215', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('751527725', 'W12049483', 'W12049483', 'UT01', 'Kevin Parzych, MD LLC', 'LuAnn ', '', 'Jacobs-Peterson', 'APRN', 'Family Practice', '', '', NULL, 'B', 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8018920135', '8012662362', 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8018920135', '8012662362', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-06-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396918462', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('201353808', 'W12049486', 'W12049486', 'ID02', 'The Allergy Group', 'Neetu', '', 'Talreja', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '1000 N Curtis Rd Ste 303', 'Boise', 'Ada', 'ID', '83706', '2083774000', '2083758426', '1000 N Curtis Rd Ste 303', 'Boise', 'Ada', 'ID', '83706', '2083774000', '2083758426', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2014-06-06', NULL, 0, 0, 1, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|DEN|', '1326206889', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('911609410', 'W12049488', 'W12049488', 'ID02', 'Physicians Primary Care Center', 'Victor', '', 'Ishida', 'PA-C', 'Family Practice', '', '', NULL, 'O', '335 SW 13th St', 'Ontario', 'Malheur', 'OR', '97914', '5418898410', '5418898093', '335 SW 13th St', 'Ontario', 'Malheur', 'OR', '97914', '5418898410', '5418898093', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2014-06-06', NULL, 0, 0, 1, '', '', '', '', 'HCFA', '1194894113', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('820300537', 'W12049490', 'W12049490', 'ID02', 'Terry Reilly Health Services', 'George', '', 'Kyle', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '223 16th Ave N', 'Nampa', 'Canyon', 'ID', '83653', '2084667869', '2084665359', '223 16th Ave N', 'Nampa', 'Canyon', 'ID', '83653', '2084667869', '2084665359', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2014-06-06', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1225220643', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('820300537', 'W12049491', 'W12049491', 'ID02', 'Terry Reilly Health Services', 'George', '', 'Kyle', 'PA-C', 'Physician Assistant', '', '', NULL, 'B', 'PO Box 9', 'Nampa', 'Canyon', 'ID', '83653', '2084617149', '0000000000', 'PO Box 9', 'Nampa', 'Canyon', 'ID', '83653', '2084617149', '0000000000', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2014-06-06', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1225220643', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('820300537', 'W12049494', 'W12049494', 'ID02', 'Terry Reilly Health Services', 'Higbee', '', 'Logan', 'PA-C', 'Physician Assistant', '', '', NULL, 'B', 'PO Box 9', 'Nampa', 'Canyon', 'ID', '83653', '2084617149', '0000000000', 'PO Box 9', 'Nampa', 'Canyon', 'ID', '83653', '2084617149', '0000000000', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2014-06-06', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1992019202', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('820300537', 'W12049493', 'W12049493', 'ID02', 'Terry Reilly Health Services', 'Higbee', '', 'Logan', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '2005 Arlington', 'Caldwell', 'Canyon', 'ID', '83605', '2084591025', '2084591080', '2005 Arlington', 'Caldwell', 'Canyon', 'ID', '83605', '2084591025', '2084591080', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2014-06-06', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1992019202', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('820300537', 'W12049497', 'W12049497', 'ID02', 'Terry Reilly Health Services', 'Deborah', '', 'Butte', 'CNS', 'Clinical Nurse Specialists', '', '', NULL, 'O', '300 S 23rd St', 'Boise', 'Ada', 'ID', '83702', '2083443512', '2083444898', '300 S 23rd St', 'Boise', 'Ada', 'ID', '83702', '2083443512', '2083444898', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2014-05-28', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1316996309', 0, 'N', 0, '2014-07-10', NULL, NULL, 0, 0, NULL, NULL),
('820300537', 'W12049499', 'W12049499', 'ID02', 'Terry Reilly Health Services', 'Deborah', '', 'Butte', 'CNS', 'Clinical Nurse Specialists', '', '', NULL, 'B', 'PO Box 9', 'Nampa', 'Canyon', 'ID', '83653', '2084617149', '0000000000', 'PO Box 9', 'Nampa', 'Canyon', 'ID', '83653', '2084617149', '0000000000', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2014-05-28', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1316996309', 0, 'N', 0, '2014-07-10', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'W12049501', 'W12049501', 'IDBOISTD', 'Saint Alphonsus Medical Group Podiatry Iowa', 'Robert', 'A', 'Swensen', 'DPM', 'Podiatry', '', '', NULL, 'O', '211 W Iowa Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084657377', '2084657397', '211 W Iowa Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084657377', '2084657397', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2014-06-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1225354244', 0, 'N', 0, '2014-07-10', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'W12049502', 'W12049502', 'IDBOISTD', 'Saint Alphonsus Medical Group Radiation Oncology Caldwell', 'Lindsay', 'R', 'Sales', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '3123 Medical Dr', 'Caldwell', 'Canyon', 'ID', '83605', '2083673131', '2083674860', '3123 Medical Dr', 'Caldwell', 'Canyon', 'ID', '83605', '2083673131', '2083674860', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720248040', 0, 'N', 0, '2014-07-10', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'W12037575', 'W12037575', 'IDBOISTD', 'Saint Alphonsus Medical Group Radiation Oncology Boise', 'Lindsay', 'R', 'Sales', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083673131', '2083674860', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083673131', '2083674860', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2013-08-14', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720248040', 0, 'N', 0, '2014-07-10', NULL, NULL, 0, 0, NULL, NULL),
('830330098', 'W12049503', 'W12049503', 'WY01', 'Hunter Family Medical Center', 'Kurt', 'L', 'Hunter', 'MD', 'Family Practice', '', '', NULL, 'O', '2751 Commerical Way', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073827414', '3073827396', '2751 Commerical Way', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073827414', '3073827396', '', '', '', '0.00', '15.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|', '1538200761', 0, 'N', 1, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('830330098', 'W12049504', 'W12049504', 'WYT1', 'Hunter Family Medical Center', 'Kurt', 'L', 'Hunter', 'MD', 'Family Practice', '', '', NULL, 'O', '2751 Commerical Way', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073827414', '3073827396', '2751 Commerical Way', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073827414', '3073827396', '', '', '', '0.00', '15.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|', '1538200761', 0, 'N', 1, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('850232628', 'W12049505', 'W12049505', 'NM01', 'Womens Specialists of NM', 'Elizabeth', 'A', 'Withnall', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', 'NMWOMENS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1154439354', 0, 'N', 1, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12049507', 'W12049507', 'WYBILLINGS', 'Billings Clinic', 'Keri', 'L', 'Hershberger', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-06-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114210374', 0, 'N', 0, '2014-07-10', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12049509', 'W12049509', 'WYBILLINGS', 'Billings Clinic - Miles City Clinic', 'Keri', 'L', 'Hershberger', 'MD', 'Family Practice', '', '', NULL, 'O', '620 S Haynes', 'Miles City', 'Custer', 'MT', '59301', '4062337000', '4062337070', '620 S Haynes', 'Miles City', 'Custer', 'MT', '59301', '4062337000', '4062337070', '', '', '', '0.00', '17.00', '0.00', 3, '2014-06-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114210374', 0, 'N', 0, '2014-07-10', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12049508', 'W12049508', 'WYBILLINGS', 'Billings Clinic', 'Keri', 'L', 'Hershberger', 'MD', 'Family Practice', '', '', NULL, 'M', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-06-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114210374', 0, 'N', 0, '2014-07-10', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12049511', 'W12049511', 'WYBILLINGS', 'Billings Clinic - Miles City Clinic', 'Lee', 'D', 'Keasal', 'NP', 'Family Practice', '', '', NULL, 'O', '620 S Haynes', 'Miles City', 'Custer', 'MT', '59301', '4062337000', '4062337070', '620 S Haynes', 'Miles City', 'Custer', 'MT', '59301', '4062337000', '4062337070', '', '', '', '0.00', '17.00', '0.00', 3, '2014-06-26', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063827780', 0, 'N', 0, '2014-07-10', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12049512', 'W12049512', 'WYBILLINGS', 'Billings Clinic', 'Lee', 'D', 'Keasal', 'NP', 'Family Practice', '', '', NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-06-26', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063827780', 0, 'N', 0, '2014-07-10', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12049513', 'W12049513', 'WYBILLINGS', 'Billings Clinic', 'Lee', 'D', 'Keasal', 'NP', 'Family Practice', '', '', NULL, 'M', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-06-26', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063827780', 0, 'N', 0, '2014-07-10', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12049515', 'W12049515', 'WYBILLINGS', 'Billings Clinic', 'Melissa', 'D', 'Johnson', 'PA', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-06-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710231139', 0, 'N', 0, '2014-07-10', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12049517', 'W12049517', 'WYBILLINGS', 'Billings Clinic - Internal Medicine', 'Melissa', 'D', 'Johnson', 'PA', 'Internal Medicine', '', '', NULL, 'O', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382771', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382771', '', '', '', '0.00', '17.00', '0.00', 3, '2014-06-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710231139', 0, 'N', 0, '2014-07-10', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12049516', 'W12049516', 'WYBILLINGS', 'Billings Clinic', 'Melissa', 'D', 'Johnson', 'PA', 'Internal Medicine', '', '', NULL, 'M', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-06-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710231139', 0, 'N', 0, '2014-07-10', NULL, NULL, 0, 0, NULL, NULL),
('742927135', 'W12049518', 'W12049518', 'ID01', 'Mountain States Neonatology', 'Amber', '', 'Messier-Gieri', 'MD', 'Neonatology', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083678063', '2083678067', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083678063', '2083678067', 'IDNEONATE', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184763179', 0, 'Y', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('742927135', 'W12049519', 'W12049519', 'ID01', 'Mountain States Neonatology', 'Amber', '', 'Messier-Gieri', 'MD', 'Neonatology', '', '', NULL, 'O', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2083678063', '2083678067', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2083678063', '2083678067', 'IDNEONATE', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184763179', 0, 'Y', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('742927135', 'W12049520', 'W12049520', 'ID01', 'Mountain States Neonatology', 'Amber', '', 'Messier-Gieri', 'MD', 'Neonatology', '', '', NULL, 'M', '4722 N 24th St Ste 150', 'Phoenix', 'Maricopa', 'AZ', '85016', '0000000000', '          ', '4722 N 24th St Ste 150', 'Phoenix', 'Maricopa', 'AZ', '85016', '0000000000', '          ', 'IDNEONATE', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184763179', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('742927135', 'W12049521', 'W12049521', 'ID01', 'Mountain States Neonatology', 'Amber', '', 'Messier-Gieri', 'MD', 'Neonatology', '', '', NULL, 'B', 'PO Box 840532', 'Dallas', 'Dallas', 'TX', '75284', '2083677610', '          ', 'PO Box 840532', 'Dallas', 'Dallas', 'TX', '75284', '2083677610', '          ', 'IDNEONATE', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184763179', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('463567222', 'W12049524', 'W12049524', 'TXDALSTD', 'The Orthopedic and Sports Medicine Institute', 'William', 'J', 'Shaw', 'PA', 'Sports Medicine', '', '', NULL, 'O', '6049 S Hulen Ste 101', 'Fort Worth', 'Tarrant', 'TX', '76132', '8175291900', '8175291910', '6049 S Hulen Ste 101', 'Fort Worth', 'Tarrant', 'TX', '76132', '8175291900', '8175291910', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 6, '2014-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1134258163', 0, 'N', 0, '2014-07-10', NULL, NULL, 0, 0, NULL, NULL),
('205497151', 'W12049523', 'W12049523', 'TXDALSTD', 'The Orthopedic and Sports Medicine Institute', 'William', 'J', 'Shaw', 'PA', 'Sports Medicine', '', '', NULL, 'O', '2901 ACME Brick Plaza', 'Fort Worth', 'Tarrant', 'TX', '76109', '8175291900', '8175291910', '2901 ACME Brick Plaza', 'Fort Worth', 'Tarrant', 'TX', '76109', '8175291900', '8175291910', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 6, '2014-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1134258163', 0, 'N', 0, '2014-07-10', NULL, NULL, 0, 0, NULL, NULL),
('205497151', 'W12049528', 'W12049528', 'TXDALSTD', 'The Orthopedic and Sports Medicine Institute', 'Jeffrey', 'D', 'Curtis', 'PA', 'Sports Medicine', '', '', NULL, 'O', '2901 ACME Brick Plaza', 'Fort Worth', 'Tarrant', 'TX', '76109', '8175291900', '8175291910', '2901 ACME Brick Plaza', 'Fort Worth', 'Tarrant', 'TX', '76109', '8175291900', '8175291910', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 6, '2014-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1508040973', 0, 'N', 0, '2014-07-10', NULL, NULL, 0, 0, NULL, NULL),
('463567222', 'W12049529', 'W12049529', 'TXDALSTD', 'The Orthopedic and Sports Medicine Institute', 'Jeffrey', 'D', 'Curtis', 'PA', 'Sports Medicine', '', '', NULL, 'O', '6049 S Hulen Ste 101', 'Fort Worth', 'Tarrant', 'TX', '76132', '8175291900', '8175291910', '6049 S Hulen Ste 101', 'Fort Worth', 'Tarrant', 'TX', '76132', '8175291900', '8175291910', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 6, '2014-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1508040973', 0, 'N', 0, '2014-07-10', NULL, NULL, 0, 0, NULL, NULL),
('450579013', 'W12049530', 'W12049530', 'UT01', 'St Marks Obstetrics & Gynecology Associates', 'Daren', 'A', 'Watts', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1140 E 3900 S Ste 400', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012686811', '0000000000', '1140 E 3900 S Ste 400', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012686811', '0000000000', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1679589600', 0, 'N', 0, '2014-07-10', NULL, NULL, 0, 0, NULL, NULL),
('450579013', 'W12049531', 'W12049531', 'UT01', 'St. Marks Gynecology Oncology Care', 'Daren', 'A', 'Watts', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 198546', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', '0000000000', 'PO Box 198546', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', '0000000000', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1679589600', 0, 'N', 0, '2014-07-10', NULL, NULL, 0, 0, NULL, NULL),
('870673778', 'W12049532', 'W12049532', 'UT01', 'Michael Mumford MD PC', 'Michael', 'I', 'Munford', 'MD', 'General Surgery', '', '', NULL, 'O', '1251 N Field Rd Ste 202', 'Cedar City', 'Iron', 'UT', '84721', '4358070300', '4358070331', '1251 N Field Rd Ste 202', 'Cedar City', 'Iron', 'UT', '84721', '4358070300', '4358070331', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-07-02', NULL, 0, 0, 0, 'Valley View Medical Center', '', '', '', 'HCFA|UB|', '1164494076', 0, 'N', 0, '2014-07-10', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12049538', 'W12049538', 'WYT2', 'Memorial Hospital of Sweetwater County', 'Irina', '', 'Dralyuk', 'MD', 'Pediatrics', '', '', NULL, 'O', '1200 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073623711', '3073528502', '1200 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073623711', '3073528502', '', '', '', '0.00', '5.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1174879738', 0, 'N', 1, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12049537', 'W12049537', 'WY01', 'Memorial Hospital of Sweetwater County', 'Irina', '', 'Dralyuk', 'MD', 'Pediatrics', '', '', NULL, 'O', '1200 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073623711', '3073528502', '1200 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073623711', '3073528502', '', '', '', '0.00', '5.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1174879738', 0, 'N', 1, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12049540', 'W12049540', 'WY01', 'Memorial Hospital of Sweetwater County', 'Irina', '', 'Dralyuk', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 1359', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073623711', '          ', 'PO Box 1359', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073623711', '          ', '', '', '', '0.00', '5.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1174879738', 0, 'N', 1, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12049539', 'W12049539', 'WYT2', 'Memorial Hospital of Sweetwater County', 'Irina', '', 'Dralyuk', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 1359', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073623711', '          ', 'PO Box 1359', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073623711', '          ', '', '', '', '0.00', '5.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1174879738', 0, 'N', 1, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'W12049541', 'W12049541', 'UT01', 'Tanner Memorial Clinic', 'Robert', 'A', 'Summerfield', 'MD', 'Neurology', '', '', NULL, 'O', '2121 Robins Dr', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8015258151', '2121 Robins Dr', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8015258151', 'WUTANNER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1215919659', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'W12049542', 'W12049542', 'UT01', 'Tanner Memorial Clinic', 'Robert', 'A', 'Summerfield', 'MD', 'Neurology', '', '', NULL, 'B', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'WUTANNER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1215919659', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('465589961', 'W12049543', 'W12049543', 'UT01', 'Arches Foot and Ankle Clinic', 'Wade', 'A', 'Christiansen', 'DPM', 'Podiatry', '', '', NULL, 'O', '179 N 1200 E Ste 103', 'Lehi', 'Utah', 'UT', '84043', '8017669947', '8017666022', '179 N 1200 E Ste 103', 'Lehi', 'Utah', 'UT', '84043', '8017669947', '8017666022', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-08-01', NULL, 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB|', '1447482252', 0, 'N', 1, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('870767026', 'W12049544', 'W12049544', 'IDBOISTD', 'West Valley Medical Group', 'Karl', 'P', 'Undesser', 'MD', 'Cardiology', '', '', NULL, 'O', '1906 Fairview Ave Ste 230', 'Caldwell', 'Canyon', 'ID', '83605', '2087955201', '2084593372', '1906 Fairview Ave Ste 230', 'Caldwell', 'Canyon', 'ID', '83605', '2087955201', '2084593372', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013961242', 0, 'N', 1, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('870767026', 'W12049545', 'W12049545', 'IDBOISTD', 'West Valley Medical Group', 'Karl', 'P', 'Undesser', 'MD', 'Cardiology', '', '', NULL, 'B', 'PO Box 277976', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', '0000000000', 'PO Box 277976', 'Atlanta', 'Canyon', 'GA', '30384', '6153737600', '0000000000', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1013961242', 0, 'N', 1, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('870767026', 'W12049546', 'W12049546', 'IDBOISTD', 'West Valley Medical Cardiology Services', 'Karl', 'P', 'Undesser', 'MD', 'Cardiology', '', '', NULL, 'O', '745 S Progress Ave', 'Meridian', 'Ada', 'ID', '83642', '2088956429', '2084593372', '745 S Progress Ave', 'Meridian', 'Ada', 'ID', '83642', '2088956429', '2084593372', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013961242', 0, 'N', 1, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('870767026', 'W12049547', 'W12049547', 'IDBOISTD', 'West Valley Medical Cardiology Services', 'Karl', 'P', 'Undesser', 'MD', 'Cardiology', '', '', NULL, 'O', '506 4th St', 'La Grande', 'Union', 'OR', '97850', '5416632300', '2084593372', '506 4th St', 'La Grande', 'Canyon', 'OR', '97850', '5416632300', '2084593372', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013961242', 0, 'N', 1, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'W12049549', 'W12049549', 'WYT1', 'Community Health Center of Central Wyoming', 'Wesley', '', 'Morris', 'PA', 'Family Practice', '', '', NULL, 'O', '5000 Blackmore Rd', 'Casper', 'Natrona', 'WY', '82609', '3072336000', '3072336089', '5000 Blackmore Rd', 'Casper', 'Natrona', 'WY', '82609', '3072336000', '3072336089', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548517659', 0, 'N', 1, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'W12049548', 'W12049548', 'WY01', 'Community Health Center of Central Wyoming', 'Wesley', '', 'Morris', 'PA', 'Family Practice', '', '', NULL, 'O', '5000 Blackmore Rd', 'Casper', 'Natrona', 'WY', '82609', '3072336000', '3072336089', '5000 Blackmore Rd', 'Casper', 'Natrona', 'WY', '82609', '3072336000', '3072336089', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548517659', 0, 'N', 1, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('161767581', 'W12049550', 'W12049550', 'UT01', 'Layton Family Medicine LLC', 'Spencer', 'C', 'Hibbert', 'PA', 'Family Practice', '', '', NULL, 'O', '2950 N Church St Ste 200', 'Layton', 'Davis', 'UT', '84040', '8015469441', '8017717799', '2950 N Church St Ste 200', 'Layton', 'Davis', 'UT', '84040', '8015469441', '8017717799', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568675213', 0, 'N', 1, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('161767581', 'W12049551', 'W12049551', 'UT01', 'Layton Family Medicine LLC', 'Spencer', 'C', 'Hibbert', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 281221', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', '0000000000', 'PO Box 281221', 'Atlanta', 'Davis', 'GA', '30384', '6153737600', '0000000000', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568675213', 0, 'N', 1, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('450579013', 'W12049553', 'W12049553', 'UT01', 'St Marks Obstetrics & Gynecology Associates', 'Vernon', 'K', 'Yamashiro', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1140 E 3900 S Ste 400', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012686811', '0000000000', '1140 E 3900 S Ste 400', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012686811', '0000000000', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1962417741', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('450579013', 'W12049554', 'W12049554', 'UT01', 'St Marks Obstetrics & Gynecology Associates', 'Vernon', 'K', 'Yamashiro', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 198546', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', '          ', 'PO Box 198546', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1962417741', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('450579013', 'W12049555', 'W12049555', 'UT01', 'St Marks Obstetrics & Gynecology Associates', 'Vernon', 'K', 'Yamashiro', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'M', 'Three Maryland Farms Ste 250', 'Brentwood', 'Williamson', 'TN', '37027', '0000000000', '0000000000', 'Three Maryland Farms Ste 250', 'Brentwood', 'Williamson', 'TN', '37027', '0000000000', '0000000000', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1962417741', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'W12049556', 'W12049556', 'UT01', 'Ogden Clinic Womens Center McKay', 'Bryan', '', 'Palmer', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '4403 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753240', '8014753241', '4403 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753240', '8014753241', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2030-01-01', NULL, 0, 0, 0, 'West Valley Medical Center', '', '', '', 'HCFA|UB|', '1730338161', 0, 'N', 1, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12049557', 'W12049557', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Jaweed', '', 'Sayeed', 'MD', 'Cardiology', '', '', NULL, 'O', '82 Miller Dr Ste 102', 'North Aurora', 'Kane', 'IL', '60542', '6302648800', '6308971729', '82 Miller Dr Ste 102', 'North Aurora', 'Kane', 'IL', '60542', '6302648800', '6308971729', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2014-07-10', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1194772780', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12049559', 'W12049559', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Razan', 'M', 'Massarani-Wafai', 'MD', 'Pathology', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '          ', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '          ', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2014-07-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760462246', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12049560', 'W12049560', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Razan', 'M', 'Massarani-Wafai', 'MD', 'Pathology', '', '', NULL, 'O', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648478', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648478', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2014-07-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760462246', 0, 'Y', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12049561', 'W12049561', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Razan', 'M', 'Massarani-Wafai', 'MD', 'Pathology', '', '', NULL, 'O', '1870 W Galena Blvd', 'Aurora', 'Kane', 'IL', '60506', '6308596700', '6308597299', '1870 W Galena Blvd', 'Aurora', 'Kane', 'IL', '60506', '6308596700', '6308597299', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2014-07-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760462246', 0, 'Y', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('202344885', 'W12049562', 'W12049562', 'NM01', 'New Mexico Chiropractic Center', 'Dominic', '', 'Gutierrez', 'DC', 'Chiropractic', '', '', NULL, 'O', '10555 Montgomery Blvd NE Bldg 1 Ste 30', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052996622', '5053234419', '10555 Montgomery Blvd NE Bldg 1 Ste 30', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052996622', '5053234419', 'NMCHIRO', 'WUSTDHCPC5', '', '0.00', '0.00', '38.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780003004', 0, 'N', 1, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('870617733', 'W12049563', 'W12049563', 'UT01', 'Utah Eye Centers', 'Michael', 'L', 'Bullard', 'MD', 'Pediatric Ophthalmology', '', '', NULL, 'O', '4360 Washington Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014760494', '8014099901', '4360 Washington Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014760494', '8014099901', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326351727', 0, 'N', 1, '2014-07-22', NULL, NULL, 0, 0, NULL, NULL),
('870617733', 'W12049564', 'W12049564', 'UT01', 'Utah Eye Centers', 'Michael', 'L', 'Bullard', 'MD', 'Pediatric Ophthalmology', '', '', NULL, 'O', '1551 S Renaissance Towne Dr Ste 340', 'Bountiful', 'Davis', 'UT', '84010', '8016771122', '8016771144', '1551 S Renaissance Towne Dr Ste 340', 'Bountiful', 'Davis', 'UT', '84010', '8016771122', '8016771144', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326351727', 0, 'N', 1, '2014-07-22', NULL, NULL, 0, 0, NULL, NULL),
('870617733', 'W12049565', 'W12049565', 'UT01', 'Utah Eye Centers', 'Michael', 'L', 'Bullard', 'MD', 'Pediatric Ophthalmology', '', '', NULL, 'B', 'PO Box 30015 Dept 93', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8014760494', '8014099901', 'PO Box 30015 Dept 93', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8014760494', '8014099901', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326351727', 0, 'N', 1, '2014-07-22', NULL, NULL, 0, 0, NULL, NULL),
('202253575', 'W12049566', 'W12049566', 'WY01', 'Yellowstone Chiropractic', 'Ross', 'B', 'Fuller', 'DC', 'Chiropractic', '', '', NULL, 'O', '223 E Main', 'Lovell', 'Big Horn', 'WY', '82431', '3075489338', '          ', '223 E Main', 'Lovell', 'Big Horn', 'WY', '82431', '3075489338', '          ', 'WYCHIRO13', '', '', '0.00', '40.00', '0.00', 3, '2014-07-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1043222748', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('202253575', 'W12049567', 'W12049567', 'WYT1', 'Yellowstone Chiropractic', 'Ross', 'B', 'Fuller', 'DC', 'Chiropractic', '', '', NULL, 'O', '223 E Main', 'Lovell', 'Big Horn', 'WY', '82431', '3075489338', '          ', '223 E Main', 'Lovell', 'Big Horn', 'WY', '82431', '3075489338', '          ', 'WYCHIRO13', '', '', '0.00', '40.00', '0.00', 3, '2014-07-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1043222748', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('262072378', 'W12049575', 'W12049575', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Erica', '', 'Nelson', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '41 E Commerce Dr Ste 2', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017561577', '8012168357', '41 E Commerce Dr Ste 2', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017561577', '8012168357', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1388974525', 0, 'N', 1, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('262072378', 'W12049576', 'W12049576', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Erica', '', 'Nelson', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1248 E 90 N Ste 300', 'American Fork', 'Utah', 'UT', '84003', '8017561577', '8012168357', '1248 E 90 N Ste 300', 'American Fork', 'Utah', 'UT', '84003', '8017561577', '8012168357', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1388974525', 0, 'N', 1, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('465129671', 'W12049580', 'W12049580', 'TXDALSTD', 'Breeze Pediatrics', 'Jill', 'E', 'Breeze', 'MD', 'Pediatrics', '', '', NULL, 'O', '300 N Highland Ste 550', 'Sherman', 'Grayson', 'TX', '75092', '9039577426', '9039577433', '300 N Highland Ste 550', 'Sherman', 'Grayson', 'TX', '75092', '9039577426', '9039577433', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700812914', 0, 'N', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('270535162', 'W12049578', 'W12049578', 'TXDALSTD', 'Heartcare MD PA', 'Neeraj', '', 'Arora', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1600 W College Ste 620', 'Grapevine', 'Tarrant', 'TX', '76051', '8173105840', '8173105857', '1600 W College Ste 620', 'Grapevine', 'Tarrant', 'TX', '76051', '8173105840', '8173105857', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932190956', 0, 'N', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('463233444', 'W12049582', 'W12049582', 'TXDALSTD', 'Questcare Medical Clinics', 'Joseph', 'S', 'Murphy', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3215 Omega Dr', 'Arlington', 'Tarrant', 'TX', '76014', '2142171911', '2142171912', '3215 Omega Dr', 'Arlington', 'Tarrant', 'TX', '76014', '2142171911', '2142171912', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871698316', 0, 'N', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('463233444', 'W12049584', 'W12049584', 'TXDALSTD', 'Questcare Medical Clinics', 'Joseph', 'S', 'Murphy', 'MD', 'Internal Medicine', '', '', NULL, 'M', '12221 Merit Dr Ste 1610', 'Dallas', 'Dallas', 'TX', '75251', '2142171911', '2142171912', '12221 Merit Dr Ste 1610', 'Dallas', 'Dallas', 'TX', '75251', '2142171911', '2142171912', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871698316', 0, 'N', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('463233444', 'W12049583', 'W12049583', 'TXDALSTD', 'Questcare Medical Clinics', 'Joseph', 'S', 'Murphy', 'MD', 'Internal Medicine', '', '', NULL, 'B', '2929 N Central Expy Ste 300', 'Richardson', 'Dallas', 'TX', '75080', '9727583598', '9725999604', '2929 N Central Expy Ste 300', 'Richardson', 'Dallas', 'TX', '75080', '9727583598', '9725999604', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871698316', 0, 'N', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('752145444', 'W12049587', 'W12049587', 'TXDALSTD', 'North Hills Family Practice PA', 'William', 'L', 'Musgrave', 'DO', 'Family Practice', '', '', NULL, 'O', '4351 Booth Calloway Rd Ste 101', 'North Richland Hills', 'Tarrant', 'TX', '76180', '8172846900', '8172844990', '4351 Booth Calloway Rd Ste 101', 'North Richland Hills', 'Tarrant', 'TX', '76180', '8172846900', '8172844990', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770898306', 0, 'N', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('870787398', 'W12049589', 'W12049589', 'TXDALSTD', 'Benjamin C Dagley DO PA', 'Robert', 'J', 'Spicer', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '630 N J Elmer Weaver Fwy Ste 2', 'Cedar Hill', 'Dallas', 'TX', '75104', '9722919165', '4695759975', '630 N J Elmer Weaver Fwy Ste 2', 'Cedar Hill', 'Dallas', 'TX', '75104', '9722919165', '4695759975', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033313556', 0, 'N', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('870787398', 'W12049590', 'W12049590', 'TXDALSTD', 'Benjamin C Dagley DO PA', 'Robert', 'J', 'Spicer', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '318 W Belt Line Rd Ste 303', 'Cedar Hill', 'Dallas', 'TX', '75104', '9722919165', '4695759975', '318 W Belt Line Rd Ste 303', 'Cedar Hill', 'Dallas', 'TX', '75104', '9722919165', '4695759975', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033313556', 0, 'N', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('870787398', 'W12049591', 'W12049591', 'TXDALSTD', 'Benjamin C Dagley DO PA', 'Robert', 'J', 'Spicer', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'B', 'PO Box 222093', 'Dallas', 'Dallas', 'TX', '75222', '0000000000', '0000000000', 'PO Box 222093', 'Dallas', 'Dallas', 'TX', '75222', '0000000000', '0000000000', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033313556', 0, 'N', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('271270423', 'W12049593', 'W12049593', 'TXDALSTD', 'Infinity Foot and Ankle PA', 'Kelly', 'R', 'Lawler', 'DPM', 'Podiatry', '', '', NULL, 'O', '1801 N Hampton Rd Ste 340', 'Desoto', 'Dallas', 'TX', '75115', '9722745708', '9722741471', '1801 N Hampton Rd Ste 340', 'Desoto', 'Dallas', 'TX', '75115', '9722745708', '9722741471', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417068909', 0, 'N', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12049595', 'W12049595', 'WYBILLINGS', 'Billings Clinic', 'Michael', 'S', 'Fenster', 'MD', 'Cardiology', '', '', NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-08-25', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720068471', 0, 'N', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12049596', 'W12049596', 'WYBILLINGS', 'Billings Clinic', 'Michael', 'S', 'Fenster', 'MD', 'Cardiology', '', '', NULL, 'M', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-08-25', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720068471', 0, 'N', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12049597', 'W12049597', 'WYBILLINGS', 'Billings Clinic - Cardiology', 'Michael', 'S', 'Fenster', 'MD', 'Cardiology', '', '', NULL, 'O', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382000', '4062382066', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382000', '4062382066', '', '', '', '0.00', '17.00', '0.00', 3, '2014-08-25', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720068471', 0, 'N', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12049599', 'W12049599', 'WYBILLINGS', 'Billings Clinic - Geriatrics', 'Danielle', '', 'Martin', 'FNP', 'Geriatrics', '', '', NULL, 'O', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382413', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382413', '', '', '', '0.00', '17.00', '0.00', 3, '2014-07-08', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548680051', 0, 'N', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12049600', 'W12049600', 'WYBILLINGS', 'Billings Clinic', 'Danielle', '', 'Martin', 'FNP', 'Geriatrics', '', '', NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-07-08', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548680051', 0, 'N', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12049601', 'W12049601', 'WYBILLINGS', 'Billings Clinic', 'Danielle', '', 'Martin', 'FNP', 'Geriatrics', '', '', NULL, 'M', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-07-08', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548680051', 0, 'N', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12049603', 'W12049603', 'WYBILLINGS', 'Billings Clinic', 'Brian', 'C', 'Brauer', 'MD', 'Gastroenterology', '', '', NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-07-08', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659315323', 0, 'N', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12049605', 'W12049605', 'WYBILLINGS', 'Billings Clinic - Gastroenterology', 'Brian', 'C', 'Brauer', 'MD', 'Gastroenterology', '', '', NULL, 'O', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382763', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382763', '', '', '', '0.00', '17.00', '0.00', 3, '2014-07-08', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659315323', 0, 'N', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12049604', 'W12049604', 'WYBILLINGS', 'Billings Clinic', 'Brian', 'C', 'Brauer', 'MD', 'Gastroenterology', '', '', NULL, 'M', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-07-08', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659315323', 0, 'N', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('561249571', 'W12049606', 'W12049606', 'ILCHIGSTD', 'Allergy Partners of Chicago', 'Waheeda', 'M', 'Hirani', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '7447 W Talcott Ave Ste 422', 'Chicago', 'Cook', 'IL', '60631', '7737752600', '7737753115', '7447 W Talcott Ave Ste 422', 'Chicago', 'Cook', 'IL', '60631', '7737752600', '7737753115', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', '', '', '', 'HCFA|UB|', '1659350205', 0, 'N', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('561249571', 'W12049607', 'W12049607', 'ILCHIGSTD', '', 'Waheeda', 'M', 'Hirani', 'MD', 'Allergy and Immunology', '', '', NULL, 'B', '9301 W Golf Rd Ste 301', 'Des Plaines', 'Cook', 'IL', '60016', '8476357300', '7737753115', '9301 W Golf Rd Ste 301', 'Des Plaines', 'Cook', 'IL', '60016', '8476357300', '7737753115', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', '', '', '', 'HCFA|UB|', '1659350205', 0, 'N', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12049609', 'W12049609', 'WYBILLINGS', 'Billings Clinic', 'Julia', 'E', 'Marsik', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-08-04', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740532290', 0, 'N', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12049611', 'W12049611', 'WYBILLINGS', 'Billings Clinic - ENT', 'Julia', 'E', 'Marsik', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062385043', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062385043', '', '', '', '0.00', '17.00', '0.00', 3, '2014-08-04', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1740532290', 0, 'N', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12049610', 'W12049610', 'WYBILLINGS', 'Billings Clinic', 'Julia', 'E', 'Marsik', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'M', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-08-04', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740532290', 0, 'N', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12049613', 'W12049613', 'WYBILLINGS', 'Billings Clinic - Infectious Disease', 'Martin', '', 'Prager Sanchez', 'MD', 'Infectious Disease', '', '', NULL, 'O', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382805', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382805', '', '', '', '0.00', '17.00', '0.00', 3, '2014-06-17', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851624514', 0, 'N', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12049614', 'W12049614', 'WYBILLINGS', 'Billings Clinic', 'Martin', '', 'Prager Sanchez', 'MD', 'Infectious Disease', '', '', NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-06-17', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851624514', 0, 'N', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12049615', 'W12049615', 'WYBILLINGS', 'Billings Clinic', 'Martin', '', 'Prager Sanchez', 'MD', 'Infectious Disease', '', '', NULL, 'M', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-06-17', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851624514', 0, 'N', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('274294367', 'W12049616', 'W12049616', 'ID01', 'Remedy Counseling Center', 'Kristin', 'H', 'Fehrer', 'LPC', 'Mental Health', '', '', NULL, 'O', '750 W Ustick Rd Ste 120', 'Meridian', 'Ada', 'ID', '83646', '2083661601', '2083661602', '750 W Ustick Rd Ste 120', 'Meridian', 'Ada', 'ID', '83646', '2083661601', '2083661602', 'IDMA', '', '', '0.00', '40.00', '0.00', 6, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952715690', 0, 'N', 1, '2014-07-17', NULL, NULL, 0, 0, NULL, NULL),
('454296789', 'W12049618', 'W12049618', 'UTMH1', 'Holbrook Therapeutic Services', 'Garry', 'R', 'Holbrook', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '164 N Main St', 'Richfield', 'Sevier', 'UT', '84701', '4356763020', '4356768322', '164 N Main St', 'Richfield', 'Sevier', 'UT', '84701', '4356763020', '4356768322', 'ma', '', '', '0.00', '40.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013165802', 0, 'N', 1, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('454296789', 'W12049617', 'W12049617', 'UTMH1', 'Holbrook Therapeutic Services', 'Garry', 'R', 'Holbrook', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '609 N Main St Ste 9', 'Panguitch', 'Garfield', 'UT', '84759', '4356763020', '4356768322', '609 N Main St Ste 9', 'Panguitch', 'Garfield', 'UT', '84759', '4356763020', '4356768322', 'ma', '', '', '0.00', '40.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013165802', 0, 'N', 1, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('454296789', 'W12049619', 'W12049619', 'UTMH1', 'Holbrook Therapeutic Services', 'Garry', 'R', 'Holbrook', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 63', 'Panguitch', 'Garfield', 'UT', '84759', '4356763020', '4356768322', 'PO Box 63', 'Panguitch', 'Garfield', 'UT', '84759', '4356763020', '4356768322', 'ma', '', '', '0.00', '40.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013165802', 0, 'N', 1, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('481260190', 'W12049621', 'W12049621', 'Test', '', 'Test', 'Test', 'Testing', 'TEST', 'Test', 'Test', 'Test', NULL, 'B', 'Test @123 Test St Ste Test', 'West Jordan', 'Salt Lake', 'UT', '84084', '800434TEST', '          ', 'Test @123 Test St Ste Test', 'West Jordan', 'Salt Lake', 'UT', '84084', '800434TEST', '          ', '', '', 'BAYHEALTHO', '0.00', '0.00', '0.00', 8, '2014-07-01', NULL, 0, 0, 0, 'San Juan Hospital', '', '', '', 'HCFA|UB|', '0000000001', 0, 'N', 0, '2014-07-23', NULL, NULL, 0, 0, NULL, NULL),
('742948798', 'W12049623', 'W12049623', 'TXSATSTD', 'Restorative Home Care', '', '', 'Restorative Health Care', '', 'Home Health Agency', '', '', NULL, 'O', '144 Landa St Ste 150', 'New Braunfels', 'Comal', 'TX', '78130', '8306242224', '2102263316', '144 Landa St Ste 150', 'New Braunfels', 'Comal', 'TX', '78130', '8306242224', '2102263316', 'RHC', '', '', '0.00', '45.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1760486542', 0, 'N', 1, '2014-07-23', NULL, NULL, 0, 0, NULL, NULL),
('742948798', 'W12049626', 'W12049626', 'TXSATSTD', 'Restorative Pediatrics', '', '', 'Restorative Health Care', '', 'Home Health Agency', '', '', NULL, 'O', '7330 San Pedro Ave Ste 800', 'San Antonio', 'Bexar', 'TX', '78216', '2102263872', '2102263316', '7330 San Pedro Ave Ste 800', 'San Antonio', 'Bexar', 'TX', '78216', '2102263872', '2102263316', 'RHC', '', '', '0.00', '45.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1962606368', 0, 'N', 1, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
('742948798', 'W12049625', 'W12049625', 'TXSATSTD', 'Restorative Pediatrics', '', '', 'Restorative Health Care', '', 'Home Health Agency', '', '', NULL, 'O', '144 Landa St Ste 151', 'New Braunfels', 'Comal', 'TX', '78130', '8306242224', '2102263316', '144 Landa St Ste 151', 'New Braunfels', 'Comal', 'TX', '78130', '8306242224', '2102263316', 'RHC', '', '', '0.00', '45.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1962606368', 0, 'N', 1, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'W12049628', 'W12049628', 'IDBOISTD', 'Saint Alphonsus Medical Group Heart Care Boise Moreau Bldg', 'Jennifer', 'S', 'Anderson', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '6140 W Curtisian Ste 200', 'Boise', 'Ada', 'ID', '83704', '2083674278', '2083675200', '6140 W Curtisian Ste 200', 'Boise', 'Ada', 'ID', '83704', '2083674278', '2083675200', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2014-02-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'Saint Alphonsus Medical Center Nampa', '', '', 'HCFA|UB|', '1093825903', 0, 'N', 0, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
('271790052', 'W12049629', 'W12049629', 'IDBOISTD', 'Saint Alphonsus Medical Group Valley Medical Clinic', 'Charles', 'E', 'Hofmann', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3820 17th St', 'Baker City', 'Baker', 'OR', '97814', '5415234465', '5415234469', '3820 17th St', 'Baker City', 'Baker', 'OR', '97814', '5415234465', '5415234469', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-06-16', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750381224', 0, 'N', 0, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
('271790052', 'W12049632', 'W12049632', 'IDBOISTD', 'Saint Alphonsus Medical Group Baker City', 'Zachary', 'N', 'Bastian', 'MD', 'General Surgery', '', '', NULL, 'O', '3325 Pocahontas Rd', 'Baker City', 'Baker', 'OR', '97814', '5415236461', '5415231709', '3325 Pocahontas Rd', 'Baker City', 'Baker', 'OR', '97814', '5415236461', '5415231709', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2014-06-16', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'Saint Alphonsus Medical Center Nampa', '', '', 'HCFA|UB|', '1447412929', 0, 'N', 0, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
('364755936', 'W12049634', 'W12049634', 'TXDALSTD', '', '', '', 'Baylor Emergency Medical Center', '', 'Hospital', '', '', NULL, 'O', '12500 S Fwy Ste 100', 'Burleson', 'Johnson', 'TX', '76028', '2142946250', '          ', '12500 S Fwy Ste 100', 'Burleson', 'Johnson', 'TX', '76028', '2142946250', '          ', '', '', 'BAYHEALTHD', '0.00', '0.00', '0.00', 3, '2014-05-19', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679903967', 0, 'Y', 0, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
('364755936', 'W12049635', 'W12049635', 'TXDALSTD', '', '', '', 'Baylor Emergency Medical Center', '', 'Hospital', '', '', NULL, 'B', 'PO Box 46079', 'Houston', 'Harris', 'TX', '77210', '2142946250', '          ', 'PO Box 46079', 'Houston', 'Harris', 'TX', '77210', '2142946250', '          ', '', '', 'BAYHEALTHD', '0.00', '0.00', '0.00', 3, '2014-05-19', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679903967', 0, 'N', 0, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W12049636', 'W12049636', 'IDBOISTD', 'Primary Health Medical Group', 'Aaron', 'L', 'Bledsoe', 'PA', 'Family Practice', '', '', NULL, 'O', '6052 W State St', 'Boise', 'Ada', 'ID', '83703', '2083447799', '2089471945', '6052 W State St', 'Boise', 'Ada', 'ID', '83703', '2083447799', '2089471945', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-07-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366724650', 0, 'N', 0, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W12049654', 'W12049654', 'IDBOISTD', 'Primary Health Medical Group', 'Aaron', 'L', 'Bledsoe', 'PA', 'Family Practice', '', '', NULL, 'O', '4815 Cleveland Blvd', 'Caldwell', 'Canyon', 'ID', '83605', '2084553545', '2084549690', '4815 Cleveland Blvd', 'Caldwell', 'Canyon', 'ID', '83605', '2084553545', '2084549690', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-07-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366724650', 0, 'Y', 0, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W12049653', 'W12049653', 'IDBOISTD', 'Primary Health Medical Group', 'Aaron', 'L', 'Bledsoe', 'PA', 'Family Practice', '', '', NULL, 'O', '435 S Eagle Rd', 'Eagle', 'Ada', 'ID', '83616', '2089398200', '2089398222', '435 S Eagle Rd', 'Eagle', 'Ada', 'ID', '83616', '2089398200', '2089398222', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-07-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366724650', 0, 'Y', 0, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W12049652', 'W12049652', 'IDBOISTD', 'Primary Health Medical Group', 'Aaron', 'L', 'Bledsoe', 'PA', 'Family Practice', '', '', NULL, 'O', '3115 E Florence', 'Meridian', 'Ada', 'ID', '83642', '2088958670', '2089550494', '3115 E Florence', 'Meridian', 'Ada', 'ID', '83642', '2088958670', '2089550494', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-07-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366724650', 0, 'Y', 0, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W12049651', 'W12049651', 'IDBOISTD', 'Primary Health Medical Group', 'Aaron', 'L', 'Bledsoe', 'PA', 'Family Practice', '', '', NULL, 'O', '300 W Myrtle St Ste 100', 'Boise', 'Ada', 'ID', '83702', '2084729082', '2084729083', '300 W Myrtle St Ste 100', 'Boise', 'Ada', 'ID', '83702', '2084729082', '2084729083', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-07-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366724650', 0, 'Y', 0, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W12049650', 'W12049650', 'IDBOISTD', 'Primary Health Medical Group', 'Aaron', 'L', 'Bledsoe', 'PA', 'Family Practice', '', '', NULL, 'O', '1907 S Broadway Ave Ste 101', 'Boise', 'Ada', 'ID', '83706', '2083451222', '2083451261', '1907 S Broadway Ave Ste 101', 'Boise', 'Ada', 'ID', '83706', '2083451222', '2083451261', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-07-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366724650', 0, 'Y', 0, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W12049649', 'W12049649', 'IDBOISTD', 'Primary Health Medical Group', 'Aaron', 'L', 'Bledsoe', 'PA', 'Family Practice', '', '', NULL, 'O', '125 E Idaho St Ste 201', 'Boise', 'Ada', 'ID', '83712', '2083859330', '2083810607', '125 E Idaho St Ste 201', 'Boise', 'Ada', 'ID', '83712', '2083859330', '2083810607', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-07-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366724650', 0, 'Y', 0, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W12049648', 'W12049648', 'IDBOISTD', 'Primary Health Medical Group', 'Aaron', 'L', 'Bledsoe', 'PA', 'Family Practice', '', '', NULL, 'O', '1130 E Fairview', 'Meridian', 'Ada', 'ID', '83642', '2088889393', '2088889525', '1130 E Fairview', 'Meridian', 'Ada', 'ID', '83642', '2088889393', '2088889525', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-07-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366724650', 0, 'Y', 0, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W12049647', 'W12049647', 'IDBOISTD', 'Primary Health Medical Group', 'Aaron', 'L', 'Bledsoe', 'PA', 'Family Practice', '', '', NULL, 'O', '11197 W Fairview Ave', 'Boise', 'Ada', 'ID', '83713', '2083788011', '2083228095', '11197 W Fairview Ave', 'Boise', 'Ada', 'ID', '83713', '2083788011', '2083228095', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-07-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366724650', 0, 'Y', 0, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W12049646', 'W12049646', 'IDBOISTD', 'Primary Health Medical Group', 'Aaron', 'L', 'Bledsoe', 'PA', 'Family Practice', '', '', NULL, 'O', '1115 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084981080', '2084981081', '1115 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084981080', '2084981081', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-07-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366724650', 0, 'Y', 0, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W12049655', 'W12049655', 'IDBOISTD', 'Primary Health Medical Group', 'Aaron', 'L', 'Bledsoe', 'PA', 'Family Practice', '', '', NULL, 'O', '6348 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083774400', '2083774416', '6348 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083774400', '2083774416', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-07-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366724650', 0, 'Y', 0, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W12049656', 'W12049656', 'IDBOISTD', 'Primary Health Medical Group', 'Aaron', 'L', 'Bledsoe', 'PA', 'Family Practice', '', '', NULL, 'O', '700 Caldwell Blvd', 'Nampa', 'Canyon', 'ID', '83651', '2083451222', '2083451261', '700 Caldwell Blvd', 'Nampa', 'Canyon', 'ID', '83651', '2083451222', '2083451261', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-07-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366724650', 0, 'Y', 0, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W12049657', 'W12049657', 'IDBOISTD', 'Primary Health Medical Group', 'Eric', 'R', 'Culbertson', 'PA', 'Family Practice', '', '', NULL, 'O', '8971 W Overland', 'Boise', 'Ada', 'ID', '83709', '2083784288', '2083784297', '8971 W Overland', 'Boise', 'Ada', 'ID', '83709', '2083784288', '2083784297', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-07-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134358104', 0, 'N', 0, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W12049658', 'W12049658', 'IDBOISTD', 'Primary Health Medical Group', 'Eric', 'R', 'Culbertson', 'PA', 'Family Practice', '', '', NULL, 'O', '11197 W Fairview Ave', 'Boise', 'Ada', 'ID', '83713', '2083788011', '2083228095', '11197 W Fairview Ave', 'Boise', 'Ada', 'ID', '83713', '2083788011', '2083228095', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-07-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134358104', 0, 'Y', 0, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W12049659', 'W12049659', 'IDBOISTD', 'Primary Health Medical Group', 'Eric', 'R', 'Culbertson', 'PA', 'Family Practice', '', '', NULL, 'O', '1130 E Fairview', 'Meridian', 'Ada', 'ID', '83642', '2088889393', '2088889525', '1130 E Fairview', 'Meridian', 'Ada', 'ID', '83642', '2088889393', '2088889525', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-07-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134358104', 0, 'Y', 0, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W12049660', 'W12049660', 'IDBOISTD', 'Primary Health Medical Group', 'Eric', 'R', 'Culbertson', 'PA', 'Family Practice', '', '', NULL, 'O', '125 E Idaho St Ste 201', 'Boise', 'Ada', 'ID', '83712', '2083859330', '2083810607', '125 E Idaho St Ste 201', 'Boise', 'Ada', 'ID', '83712', '2083859330', '2083810607', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-07-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134358104', 0, 'Y', 0, '2014-07-15', 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
('202630141', 'W12049661', 'W12049661', 'IDBOISTD', 'Primary Health Medical Group', 'Eric', 'R', 'Culbertson', 'PA', 'Family Practice', '', '', NULL, 'O', '1907 S Broadway Ave Ste 101', 'Boise', 'Ada', 'ID', '83706', '2083451222', '2083451261', '1907 S Broadway Ave Ste 101', 'Boise', 'Ada', 'ID', '83706', '2083451222', '2083451261', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-07-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134358104', 0, 'Y', 0, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W12049662', 'W12049662', 'IDBOISTD', 'Primary Health Medical Group', 'Eric', 'R', 'Culbertson', 'PA', 'Family Practice', '', '', NULL, 'O', '300 W Myrtle St Ste 100', 'Boise', 'Ada', 'ID', '83702', '2084729082', '2084729083', '300 W Myrtle St Ste 100', 'Boise', 'Ada', 'ID', '83702', '2084729082', '2084729083', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-07-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134358104', 0, 'Y', 0, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W12049663', 'W12049663', 'IDBOISTD', 'Primary Health Medical Group', 'Eric', 'R', 'Culbertson', 'PA', 'Family Practice', '', '', NULL, 'O', '3115 E Florence', 'Meridian', 'Ada', 'ID', '83642', '2088958670', '2089550494', '3115 E Florence', 'Meridian', 'Ada', 'ID', '83642', '2088958670', '2089550494', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-07-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134358104', 0, 'Y', 0, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W12049664', 'W12049664', 'IDBOISTD', 'Primary Health Medical Group', 'Eric', 'R', 'Culbertson', 'PA', 'Family Practice', '', '', NULL, 'O', '435 S Eagle Rd', 'Eagle', 'Ada', 'ID', '83616', '2089398200', '2089398222', '435 S Eagle Rd', 'Eagle', 'Ada', 'ID', '83616', '2089398200', '2089398222', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-07-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134358104', 0, 'Y', 0, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W12049665', 'W12049665', 'IDBOISTD', 'Primary Health Medical Group', 'Eric', 'R', 'Culbertson', 'PA', 'Family Practice', '', '', NULL, 'O', '6052 W State St', 'Boise', 'Ada', 'ID', '83703', '2083447799', '2089471945', '6052 W State St', 'Boise', 'Ada', 'ID', '83703', '2083447799', '2089471945', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-07-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134358104', 0, 'Y', 0, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W12049666', 'W12049666', 'IDBOISTD', 'Primary Health Medical Group', 'Eric', 'R', 'Culbertson', 'PA', 'Family Practice', '', '', NULL, 'O', '6348 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083774400', '2083774416', '6348 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083774400', '2083774416', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-07-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134358104', 0, 'Y', 0, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W12049667', 'W12049667', 'IDBOISTD', 'Primary Health Medical Group', 'Eric', 'R', 'Culbertson', 'PA', 'Family Practice', '', '', NULL, 'O', '700 Caldwell Blvd', 'Nampa', 'Canyon', 'ID', '83651', '2083451222', '2083451261', '700 Caldwell Blvd', 'Nampa', 'Canyon', 'ID', '83651', '2083451222', '2083451261', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-07-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134358104', 0, 'Y', 0, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
('362670634', 'W12049669', 'W12049669', 'ILCHIGSTD', 'Oak Park Eye Center', 'Manuel', 'D', 'Santiago', 'MD', 'Ophthalmology', '', '', NULL, 'O', '7638 W North Ave', 'Elmwood Park', 'Cook', 'IL', '60707', '7084524257', '7084524283', '7638 W North Ave', 'Elmwood Park', 'Cook', 'IL', '60707', '7084524257', '7084524283', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1154309821', 0, 'N', 0, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
('362670634', 'W12049670', 'W12049670', 'ILCHIGSTD', 'Oak Park Eye Center', 'Manuel', 'D', 'Santiago', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1200 S York Rd Ste 3230', 'Elmhurst', 'Dupage', 'IL', '60126', '6302793673', '6302793843', '1200 S York Rd Ste 3230', 'Elmhurst', 'Dupage', 'IL', '60126', '6302793673', '6302793843', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1154309821', 0, 'N', 0, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
('203298020', 'W12049671', 'W12049671', 'UT01', 'Tucker Medical Group', 'Stephen', '', 'Tucker', 'MD', 'Pediatric Internal Medicine', 'Family Practice', '', NULL, 'O', '460 W 2600 S', 'Bountiful', 'Davis', 'UT', '84010', '8016608687', '8663328067', '460 W 2600 S', 'Bountiful', 'Davis', 'UT', '84010', '8016608687', '8663328067', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-07-08', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1538179247', 0, 'Y', 0, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
('870470946', 'W12049674', 'W12049674', 'UT01', 'Hurricane Family Practice', 'Melvin', 'R', 'Carter', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 340', 'Cedar City', 'Iron', 'UT', '84721', '4356359444', '4356358148', 'PO Box 340', 'Cedar City', 'Iron', 'UT', '84721', '4356359444', '4356358148', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1043277833', 0, 'N', 1, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
('870470946', 'W12049675', 'W12049675', 'UT01', 'Hurricane Family Practice', 'Phillip', 'R', 'Carter', 'PA', 'Family Practice', '', '', NULL, 'O', '11 S Main St', 'Hurricane', 'Washington', 'UT', '84737', '4356359444', '4356358148', '11 S Main St', 'Hurricane', 'Washington', 'UT', '84737', '4356359444', '4356358148', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871826990', 0, 'N', 1, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
('870470946', 'W12049676', 'W12049676', 'UT01', 'Hurricane Family Practice', 'Phillip', 'R', 'Carter', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 340', 'Cedar City', 'Iron', 'UT', '84721', '4356359444', '4356358148', 'PO Box 340', 'Cedar City', 'Washington', 'UT', '84721', '4356359444', '4356358148', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871826990', 0, 'N', 1, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
('870470946', 'W12049673', 'W12049673', 'UT01', 'Hurricane Family Practice', 'Walter', '', 'Ogden', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 340', 'Cedar City', 'Iron', 'UT', '84721', '4356359444', '4356358148', 'PO Box 340', 'Cedar City', 'Iron', 'UT', '84721', '4356359444', '4356358148', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1174519151', 0, 'N', 1, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W12049677', 'W12049677', 'IDBOISTD', 'Primary Health Medical Group', 'Christine', '', 'Hall', 'PA', 'Family Practice', '', '', NULL, 'O', '1115 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084981080', '2084981081', '1115 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084981080', '2084981081', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-07-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366494650', 0, 'Y', 0, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W12049678', 'W12049678', 'IDBOISTD', 'Primary Health Medical Group', 'Christine', '', 'Hall', 'PA', 'Family Practice', '', '', NULL, 'O', '1130 E Fairview', 'Meridian', 'Ada', 'ID', '83642', '2088889393', '2088889525', '1130 E Fairview', 'Meridian', 'Ada', 'ID', '83642', '2088889393', '2088889525', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-07-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366494650', 0, 'Y', 0, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W12049679', 'W12049679', 'IDBOISTD', 'Primary Health Medical Group', 'Christine', '', 'Hall', 'PA', 'Family Practice', '', '', NULL, 'O', '125 E Idaho St Ste 201', 'Boise', 'Ada', 'ID', '83712', '2083859330', '2083810607', '125 E Idaho St Ste 201', 'Boise', 'Ada', 'ID', '83712', '2083859330', '2083810607', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-07-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366494650', 0, 'Y', 0, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W12049682', 'W12049682', 'IDBOISTD', 'Primary Health Medical Group', 'Christine', '', 'Hall', 'PA', 'Family Practice', '', '', NULL, 'O', '300 W Myrtle St Ste 100', 'Boise', 'Ada', 'ID', '83702', '2084729082', '2084729083', '300 W Myrtle St Ste 100', 'Boise', 'Ada', 'ID', '83702', '2084729082', '2084729083', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-07-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366494650', 0, 'N', 0, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W12049681', 'W12049681', 'IDBOISTD', 'Primary Health Medical Group', 'Christine', '', 'Hall', 'PA', 'Family Practice', '', '', NULL, 'O', '1907 S Broadway Ave Ste 101', 'Boise', 'Ada', 'ID', '83706', '2083451222', '2083451261', '1907 S Broadway Ave Ste 101', 'Boise', 'Ada', 'ID', '83706', '2083451222', '2083451261', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-07-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366494650', 0, 'Y', 0, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
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('202630141', 'W12049685', 'W12049685', 'IDBOISTD', 'Primary Health Medical Group', 'Christine', '', 'Hall', 'PA', 'Family Practice', '', '', NULL, 'O', '4815 Cleveland Blvd', 'Caldwell', 'Canyon', 'ID', '83605', '2084553545', '2084549690', '4815 Cleveland Blvd', 'Caldwell', 'Canyon', 'ID', '83605', '2084553545', '2084549690', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-07-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366494650', 0, 'Y', 0, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W12049686', 'W12049686', 'IDBOISTD', 'Primary Health Medical Group', 'Christine', '', 'Hall', 'PA', 'Family Practice', '', '', NULL, 'O', '6348 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083774400', '2083774416', '6348 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083774400', '2083774416', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-07-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366494650', 0, 'Y', 0, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W12049687', 'W12049687', 'IDBOISTD', 'Primary Health Medical Group', 'Christine', '', 'Hall', 'PA', 'Family Practice', '', '', NULL, 'O', '700 Caldwell Blvd', 'Nampa', 'Canyon', 'ID', '83651', '2083451222', '2083451261', '700 Caldwell Blvd', 'Nampa', 'Canyon', 'ID', '83651', '2083451222', '2083451261', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-07-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366494650', 0, 'Y', 0, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W12049688', 'W12049688', 'IDBOISTD', 'Primary Health Medical Group', 'Christine', '', 'Hall', 'PA', 'Family Practice', '', '', NULL, 'O', '8971 W Overland', 'Boise', 'Ada', 'ID', '83709', '2083784288', '2083784297', '8971 W Overland', 'Boise', 'Ada', 'ID', '83709', '2083784288', '2083784297', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-07-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366494650', 0, 'Y', 0, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
('870672047', 'W12049690', 'W12049690', 'UTMH1', 'Matt Larson Psychotherapy and Associates', 'April', '', 'Holzer ', 'LMFT', 'Mental Health', 'Counseling', '', NULL, 'O', '1226 W 10600 S Bldg A', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015210699', '8015210688', '1226 W 10600 S Bldg A', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015210699', '8015210688', 'MA', '', '', '0.00', '40.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598191611', 0, 'N', 1, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('870672047', 'W12049689', 'W12049689', 'UTMH1', 'Matt Larson Psychotherapy and Associates', 'April', '', 'Holzer ', 'LMFT', 'Mental Health', 'Counseling', '', NULL, 'O', '24 S 600 E Ste 6', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015210699', '8015210688', '24 S 600 E Ste 6', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015210699', '8015210688', 'MA', '', '', '0.00', '40.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598191611', 0, 'N', 1, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('202743975', 'W12049696', 'W12049696', 'Sinclair', 'Altitude Physical Therapy', 'Sean ', 'R', 'Weatherston', 'PT', 'Physical Therapy', '', '', NULL, 'B', '1906 Fairview Ave Ste 410', 'Caldwell', 'Canyon', 'ID', '83605', '2084659418', '          ', '1906 Fairview Ave Ste 410', 'Caldwell', 'Canyon', 'ID', '83605', '2084659418', '          ', 'WestRehab', '', '', '0.00', '0.00', '73.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073596136', 0, 'N', 1, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('202743975', 'W12049695', 'W12049695', 'Sinclair', 'Altitude Physical Therapy', 'Sean ', 'R', 'Weatherston', 'PT', 'Physical Therapy', '', '', NULL, 'O', '3151 E Greenhurst Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084659418', '          ', '3151 E Greenhurst Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084659418', '          ', 'WestRehab', '', '', '0.00', '0.00', '73.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073596136', 0, 'N', 1, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('741895428', 'W12031745', 'W12031745', 'TXSATSTD', 'Ear Nose and Throat Clinics of San Antonio', 'Diana', 'H', 'Henderson', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '4775 Hamilton Wolfe Rd Ste 1', 'San Antonio', 'Bexar', 'TX', '78229', '2106141326', NULL, '4775 Hamilton Wolfe Rd Ste 1', 'San Antonio', 'Bexar', 'TX', '78229', '2106141326', '', 'TXSURGE', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-04-05', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1083615884', 0, 'N', 0, '2014-07-17', NULL, NULL, 0, 0, NULL, NULL),
('741895428', 'TX0100775', 'TX0100775', 'TXSATSTD', 'Ear Nose & Throat Clinics of San Antonio PA', 'Diana', 'H', 'Henderson', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'B', 'PO Box 29487', 'San Antonio', 'Bexar', 'TX', '78229', '2106160283', NULL, 'PO Box 29487', 'San Antonio', 'Bexar', 'TX', '78229', '2106160283', '', 'TXSURGE', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1083615884', 0, 'y', 0, '2014-07-17', NULL, NULL, 0, 0, NULL, NULL),
('331064921', 'W12049699', 'W12049699', 'UT01', 'Foot & Ankle Specialists of Utah', 'Brian', 'B', 'Liljenquist', 'DPM', 'Podiatry', '', '', NULL, 'O', '1551 S Renaissance Towne Dr Ste 370', 'Bountiful', 'Davis', 'UT', '84010', '8012924425', '8013971938', '1551 S Renaissance Towne Dr Ste 370', 'Bountiful', 'Davis', 'UT', '84010', '8012924425', '8013971938', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841586096', 0, 'N', 1, '2014-07-22', NULL, NULL, 0, 0, NULL, NULL),
('331064921', 'W12049700', 'W12049700', 'UT01', 'Foot & Ankle Specialists of Utah', 'Brian', 'B', 'Liljenquist', 'DPM', 'Podiatry', '', '', NULL, 'O', '425 Medical Dr Ste 215', 'Bountiful', 'Davis', 'UT', '84010', '8012929222', '8012983987', '425 Medical Dr Ste 215', 'Bountiful', 'Davis', 'UT', '84010', '8012929222', '8012983987', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841586096', 0, 'N', 1, '2014-07-22', NULL, NULL, 0, 0, NULL, NULL),
('331064921', 'W12049701', 'W12049701', 'UT01', 'Foot & Ankle Specialists of Utah', 'Brian', 'B', 'Liljenquist', 'DPM', 'Podiatry', '', '', NULL, 'B', 'PO Box 1249', 'Bountiful', 'Davis', 'UT', '84011', '8012924425', '8013971938', 'PO Box 1249', 'Bountiful', 'Davis', 'UT', '84011', '8012924425', '8013971938', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841586096', 0, 'N', 1, '2014-07-22', NULL, NULL, 0, 0, NULL, NULL),
('331064921', 'W12049702', 'W12049702', 'UT01', 'Foot & Ankle Specialists of Utah', 'Brian', 'B', 'Liljenquist', 'DPM', 'Podiatry', '', '', NULL, 'O', '11762 S State St Ste 260', 'Draper', 'Salt Lake', 'UT', '84020', '8013161313', '8013161314', '11762 S State St Ste 260', 'Draper', 'Salt Lake', 'UT', '84020', '8013161313', '8013161314', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841586096', 0, 'N', 1, '2014-07-22', NULL, NULL, 0, 0, NULL, NULL),
('331064921', 'W12049703', 'W12049703', 'UT01', 'Foot & Ankle Specialists of Utah', 'Brian', 'B', 'Liljenquist', 'DPM', 'Podiatry', '', '', NULL, 'M', 'PO Box 27677', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '0000000000', '0000000000', 'PO Box 27677', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '0000000000', '0000000000', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841586096', 0, 'N', 1, '2014-07-22', NULL, NULL, 0, 0, NULL, NULL),
('471135279', 'W12049704', 'W12049704', 'UT01', 'Mountain Peaks Womens Wellness Center', 'David', 'M', 'Wall', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '9600 S 1300 E Ste 305', 'Sandy', 'Salt Lake', 'UT', '84094', '8015725808', '          ', '9600 S 1300 E Ste 305', 'Sandy', 'Salt Lake', 'UT', '84094', '8015725808', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1720393812', 0, 'N', 1, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('900120192', 'W12049706', 'W12049706', 'TXSATSTD', 'Center for Physical Therapy and Sports Performance', 'Stacy', 'L', 'Hoyt', 'PT', 'Physical Therapy', '', '', NULL, 'O', '21 Spurs Ln Ste 340', 'San Antonio', 'Bexar', 'TX', '78240', '2107988585', '2107988580', '21 Spurs Ln Ste 340', 'San Antonio', 'Bexar', 'TX', '78240', '2107988585', '2107988580', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2014-07-17', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013985894', 0, 'N', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('900120192', 'W12049707', 'W12049707', 'TXSATSTD', 'Center for Physical Therapy and Sports Performance', 'Stacy', 'L', 'Hoyt', 'PT', 'Physical Therapy', '', '', NULL, 'O', '5917 Broadway', 'San Antonio', 'Bexar', 'TX', '78209', '2102533451', '2108235429', '5917 Broadway', 'San Antonio', 'Bexar', 'TX', '78209', '2102533451', '2108235429', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2014-07-17', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013985894', 0, 'N', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('743003947', 'W12049708', 'W12049708', 'TXSATSTD', 'The San Antonio Orthopaedic Group', 'Erika', '', 'Jullis', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 2516', 'San Antonio', 'Bexar', 'TX', '78258', '8004454263', '          ', 'PO Box 2516', 'San Antonio', 'Bexar', 'TX', '78258', '8004454263', '          ', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2014-07-17', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007016', 0, 'Y', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('743003947', 'W12049709', 'W12049709', 'TXSATSTD', 'The San Antonio Orthopaedic Group', 'Leroy', '', 'Mendoza', 'PT', 'Physical Therapy', '', '', NULL, 'O', '11212 Hwy 151 Ste 150', 'San Antonio', 'Bexar', 'TX', '78251', '2108045564', '2108045599', '11212 Hwy 151 Ste 150', 'San Antonio', 'Bexar', 'TX', '78251', '2108045564', '2108045599', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2014-07-17', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467762286', 0, 'N', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('743003947', 'W12049710', 'W12049710', 'TXSATSTD', 'The San Antonio Orthopaedic Group', 'Leroy', '', 'Mendoza', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1200 Brooklyn Ave Ste 320', 'San Antonio', 'Bexar', 'TX', '78258', '2103965345', '2103965344', '1200 Brooklyn Ave Ste 320', 'San Antonio', 'Bexar', 'TX', '78258', '2103965345', '2103965344', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2014-07-17', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467762286', 0, 'N', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('743003947', 'W12049711', 'W12049711', 'TXSATSTD', 'The San Antonio Orthopaedic Group', 'Leroy', '', 'Mendoza', 'PT', 'Physical Therapy', '', '', NULL, 'O', '12602 Toepperwein Rd Ste 210', 'San Antonio', 'Bexar', 'TX', '78233', '2108045672', '2108045674', '12602 Toepperwein Rd Ste 210', 'San Antonio', 'Bexar', 'TX', '78233', '2108045672', '2108045674', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2014-07-17', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467762286', 0, 'N', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('743003947', 'W12049712', 'W12049712', 'TXSATSTD', 'The San Antonio Orthopaedic Group', 'Leroy', '', 'Mendoza', 'PT', 'Physical Therapy', '', '', NULL, 'O', '150 E Sonterra Blvd Ste 300', 'San Antonio', 'Bexar', 'TX', '78258', '2104897270', '2104032425', '150 E Sonterra Blvd Ste 300', 'San Antonio', 'Bexar', 'TX', '78258', '2104897270', '2104032425', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2014-07-17', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467762286', 0, 'N', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('743003947', 'W12049713', 'W12049713', 'TXSATSTD', 'The San Antonio Orthopaedic Group', 'Leroy', '', 'Mendoza', 'PT', 'Physical Therapy', '', '', NULL, 'O', '2829 Babcock Rd Ste 710', 'San Antonio', 'Bexar', 'TX', '78229', '2103965270', '2103965271', '2829 Babcock Rd Ste 710', 'San Antonio', 'Bexar', 'TX', '78229', '2103965270', '2103965271', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2014-07-17', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467762286', 0, 'N', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('743003947', 'W12049714', 'W12049714', 'TXSATSTD', 'The San Antonio Orthopaedic Group', 'Leroy', '', 'Mendoza', 'PT', 'Physical Therapy', '', '', NULL, 'O', '400 Concord Plaza Dr Ste 130', 'San Antonio', 'Bexar', 'TX', '78216', '2108045530', '2108045501', '400 Concord Plaza Dr Ste 130', 'San Antonio', 'Bexar', 'TX', '78216', '2108045530', '2108045501', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2014-07-17', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467762286', 0, 'N', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('743003947', 'W12049715', 'W12049715', 'TXSATSTD', 'The San Antonio Orthopaedic Group', 'Leroy', '', 'Mendoza', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 9585', 'Belfast', 'Waldo', 'ME', '04915', '8004454263', '          ', 'PO Box 9585', 'Belfast', 'Waldo', 'ME', '04915', '8004454263', '          ', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2014-07-17', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467762286', 0, 'N', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('743003947', 'W12049716', 'W12049716', 'TXSATSTD', 'The San Antonio Orthopaedic Group', 'Lauren', 'R', 'Krisch', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 2516', 'San Antonio', 'Bexar', 'TX', '78258', '8004454263', '          ', 'PO Box 2516', 'San Antonio', 'Bexar', 'TX', '78258', '8004454263', '          ', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2014-07-17', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336386580', 0, 'Y', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('743003947', 'W12049717', 'W12049717', 'TXSATSTD', 'The San Antonio Orthopaedic Group', 'Jennifer', '', 'Ramirez', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 2516', 'San Antonio', 'Bexar', 'TX', '78258', '8004454263', '          ', 'PO Box 2516', 'San Antonio', 'Bexar', 'TX', '78258', '8004454263', '          ', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2014-07-17', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437347119', 0, 'Y', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('743003947', 'W12049718', 'W12049718', 'TXSATSTD', 'The San Antonio Orthopaedic Group', 'Phyllis', 'K', 'Monroe', 'OT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 2516', 'San Antonio', 'Bexar', 'TX', '78258', '8004454263', '          ', 'PO Box 2516', 'San Antonio', 'Bexar', 'TX', '78258', '8004454263', '          ', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2014-07-17', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598978314', 0, 'Y', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('900120192', 'W12049721', 'W12049721', 'TXSATSTD', 'Center for Physical Therapy and Sports Performance', 'Kara', 'K', 'Powell', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 196', 'San Antonio', 'Bexar', 'TX', '78291', '2103401479', '2103406834', 'PO Box 196', 'San Antonio', 'Bexar', 'TX', '78291', '2103401479', '2103406834', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2014-07-17', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528043908', 0, 'N', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('900120192', 'W12020898', 'W12020898', 'TX01', 'Center for Physical Therapy and Sports Performance', 'Kara', 'K', 'Powell', 'PT', 'Physical Therapy', '', '', NULL, 'O', '21 Spurs Ln Ste 340', 'San Antonio', 'Bexar', 'TX', '78240', '2107988585', '2107988580', '21 Spurs Ln Ste 340', 'San Antonio', 'Bexar', 'TX', '78240', '2107988585', '2107988580', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-01', '2014-07-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528043908', 0, 'N', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
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('743003947', 'W12049753', 'W12049753', 'TXSATSTD', 'The San Antonio Orthopaedic Group', 'Christian', 'A', 'Woodbury', 'MD', 'Hand Surgery', '', '', NULL, 'O', '400 Concord Plaza Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78216', '2108045506', '2108045510', '400 Concord Plaza Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78216', '2108045506', '2108045510', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2014-07-17', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1598965014', 0, 'N', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('331177233', 'W12049756', 'W12049756', 'UT01', 'Ogden Internal Medicine and Urology', 'Richard', '', 'Herold', 'MD', 'Internal Medicine', '', '', NULL, 'O', '5405 S 500 E Ste 203', 'Ogden', 'Weber', 'UT', '84405', '8014797500', '8014750960', '5405 S 500 E Ste 203', 'Ogden', 'Weber', 'UT', '84405', '8014797500', '8014750960', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1891799318', 0, 'Y', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('743003947', 'W12049755', 'W12049755', 'TXSATSTD', 'The San Antonio Orthopaedic Group', 'Christian', 'A', 'Woodbury', 'MD', 'Hand Surgery', '', '', NULL, 'B', 'PO Box 9585', 'San Antonio', 'Bexar', 'TX', '0491', '8004454263', '          ', 'PO Box 9585', 'San Antonio', 'Bexar', 'TX', '0491', '8004454263', '          ', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2014-07-17', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1598965014', 0, 'N', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('462252776', 'W12049759', 'W12049759', 'UT01', 'Premier Family Medical', 'Russell', 'S', 'Anderson', 'DO', 'Family Practice', '', '', NULL, 'O', '226 N 1100 E Ste A', 'American Fork', 'Utah', 'UT', '84003', '8018553841', '8017561705', '226 N 1100 E Ste A', 'American Fork', 'Utah', 'UT', '84003', '8018553841', '8017561705', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-22', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1548407513', 0, 'N', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('462252776', 'W12049758', 'W12049758', 'UT01', 'Premier Family Medical', 'Russell', 'S', 'Anderson', 'DO', 'Family Practice', '', '', NULL, 'O', '275 W 200 N', 'Lindon', 'Utah', 'UT', '84042', '8017961333', '8017561705', '275 W 200 N', 'Lindon', 'Utah', 'UT', '84042', '8017961333', '8017561705', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-22', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1548407513', 0, 'N', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL);
