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
('522229954', 'W11015547', 'W11015547', 'UT01', 'South Mountain Sports & Rehab', 'Charles', NULL, 'Numbers', 'MS PT', 'Physical Therapy', NULL, NULL, NULL, 'O', '12226 S 1000 E Ste 1', 'Draper', 'Salt Lake', 'UT', '84020', '8015233415', '8015231843', NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WESTREHAB', 'WUSTDHCPC5', NULL, '0.00', NULL, '65.00', 3, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1437207016', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11015537', 'W11015537', 'UT01', 'MLR Kaysville', 'Trisha', NULL, 'McArthur', 'DPT', 'Physical Therapy', NULL, NULL, NULL, 'O', '1189 W Sportsplex Dr', 'Kaysville', 'Davis', 'UT', '84037', '8015471155', '8015471173', NULL, NULL, 'Davis', NULL, NULL, NULL, NULL, 'WESTREHAB', 'WUSTDHCPC5', NULL, '0.00', NULL, '65.00', 3, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1215121728', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11015538', 'W11015538', 'UT01', 'Wasatch Peak Physical Therapy', 'Sindy', 'Rae', 'McCord', 'OT', 'Physical Therapy', NULL, NULL, NULL, 'O', '1492 W Antelope Dr Ste 100', 'Layton', 'Davis', 'UT', '84041', '8018258091', '8018258142', NULL, NULL, 'Davis', NULL, NULL, NULL, NULL, 'WESTREHAB', 'WUSTDHCPC5', NULL, '0.00', '0.00', '65.00', 3, '2008-10-01', '2008-10-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1265622245', 0, 'N', 0, '2008-11-19', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11015533', 'W11015533', 'UT01', 'Wasatch Peak Physical Therapy', 'Randall', 'W', 'Erickson', 'DPT', 'Physical Therapy', NULL, NULL, NULL, 'O', '1492 W Antelope Dr Ste 100', 'Layton', 'Davis', 'UT', '84041', '8015479462', '8015479116', NULL, NULL, 'Davis', NULL, NULL, NULL, NULL, 'WESTREHAB', 'WUSTDHCPC5', NULL, '0.00', NULL, '65.00', 3, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1366602484', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11015541', 'W11015541', 'UT01', 'Wasatch Peak Physical Therapy', 'Angela', 'Marie', 'Hubble', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'O', '1492 W Antelope Dr Ste 100', 'Layton', 'Davis', 'UT', '84041', '8018258091', '8018258142', NULL, NULL, 'Davis', NULL, NULL, NULL, NULL, 'WESTREHAB', 'WUSTDHCPC5', NULL, '0.00', '0.00', '65.00', 3, '2008-10-01', '2008-10-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1932399912', 0, 'N', 0, '2009-11-30', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11015545', 'W11015545', 'UT01', 'Advanced Motion Physical Therapy', 'Daniel', '', 'Mcatee', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '8089 W  3500 S', 'Magna', 'Salt Lake', 'UT', '84044', '8012506733', '8012505038', '8089 W  3500 S', 'Magna', 'Salt Lake', 'UT', '84044', '8012506733', '8012505038', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '65.00', 3, '2008-10-01', '2009-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215057617', 0, 'N', 0, '2013-09-30', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11015542', 'W11015542', 'UT01', 'Orem Sports Medicine Center', 'Jeffrey', '', 'Kingsolver', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'O', '252 N State St', 'Orem', 'Utah', 'UT', '84057', '8012260599', '8012263145', NULL, NULL, 'Utah', NULL, NULL, NULL, NULL, 'WESTREHAB', 'WUSTDHCPC5', NULL, '0.00', NULL, '65.00', 3, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1972687606', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11015549', 'W11015549', 'UT01', 'Blue Sky Therapeutics', 'Jessica', NULL, 'Kahn', 'MS OTR', 'Physical Therapy', NULL, NULL, NULL, 'O', '1901 Prospector Ste 201', 'Park City', 'Summit', 'UT', '84060', '4356591746', '4356459237', NULL, NULL, 'Summit', NULL, NULL, NULL, NULL, 'WESTREHAB', 'WUSTDHCPC5', NULL, '0.00', '0.00', '65.00', 3, '2008-10-01', '2008-10-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1992905350', 0, 'N', 0, '2009-11-30', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11015553', 'W11015553', 'UT01', 'Herriman Physical Therapy', 'Paul', NULL, 'Smith', 'DPT', 'Physical Therapy', NULL, NULL, NULL, 'O', '5734 W 13400 S', 'Herriman', 'Salt Lake', 'UT', '84065', '8013027232', '8013027237', NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WESTREHAB', 'WUSTDHCPC5', NULL, '0.00', NULL, '65.00', 3, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1023276375', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11015559', 'W11015559', 'UT01', 'Wasatch Physical Therapy Roy', 'Ryan', 'Scott', 'Webb', 'MPT', 'Physical Therapy', NULL, NULL, NULL, 'O', '1967 W 5700 S', 'Roy', 'Weber', 'UT', '84067', '8017748600', '8014795846', NULL, NULL, 'Weber', NULL, NULL, NULL, NULL, 'WESTREHAB', 'WUSTDHCPC5', NULL, '0.00', '0.00', '65.00', 3, '2008-10-01', '2009-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780755025', 0, 'N', 0, '2011-04-19', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11015532', 'W11015532', 'UT01', 'Wasatch Physical Therapy Roy', 'Pamela', '', 'Frinkman', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1967 W 5700 S', 'Roy', 'Weber', 'UT', '84067', '8017748600', '8017748681', '1967 W 5700 S', 'Roy', 'Weber', 'UT', '84067', '8017748600', '8017748681', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '65.00', 3, '2008-10-01', '2009-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699873364', 0, 'N', 0, '2013-12-04', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11015563', 'W11015563', 'UT01', 'Mountain Land Pinnacle', 'Paisley', 'A', 'Hardman', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '29 S Main St', 'Tooele', 'Tooele', 'UT', '84074', '4358437466', '4358439568', NULL, NULL, 'Tooele', NULL, NULL, NULL, NULL, 'WESTREHAB', 'WUSTDHCPC5', NULL, '0.00', '0.00', '65.00', 3, '2008-10-01', '2009-10-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1487811196', 0, 'N', 0, '2009-11-30', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11015546', 'W11015546', 'UT01', 'Mountain Land Rehab/ Pinnacle Tooele ', 'Robert', 'Oliver', 'Pagani', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'O', '29 S Main St', 'Tooele', 'Tooele', 'UT', '84074', '4358437466', '4358439568', NULL, NULL, 'Tooele', NULL, NULL, NULL, NULL, 'WESTREHAB', 'WUSTDHCPC5', NULL, '0.00', NULL, '65.00', 3, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1790977692', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11015564', 'W11015564', 'UT01', 'Mountain Land Pinnacle', 'Debra', 'G', 'Marton', 'PT', 'Physical Therapy', '', '', NULL, 'O', '29  S Main St', 'Tooele', 'Tooele', 'UT', '84074', '4358437466', '4358439568', '29  S Main St', 'Tooele', 'Tooele', 'UT', '84074', '4358437466', '4358439568', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '65.00', 3, '2008-10-01', '2009-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154588143', 0, 'N', 0, '2013-07-08', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11015536', 'W11015536', 'UT01', 'Mountain Land Stansbury', 'Rachel', 'Lyn', 'Giessing', 'MOTR', 'Physical Therapy', NULL, NULL, NULL, 'O', '220 Millpond Ste 109', 'Stansbury', 'Tooele', 'UT', '84074', '4358824144', '4358439568', NULL, NULL, 'Tooele', NULL, NULL, NULL, NULL, 'WESTREHAB', 'WUSTDHCPC5', NULL, '0.00', NULL, '65.00', 3, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1134311939', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11015535', 'W11015535', 'UT01', 'Mountain Land Pinnacle', 'Rachel', 'Lyn', 'Giessing', 'MOTR', 'Physical Therapy', NULL, NULL, NULL, 'O', '29 S Main St', 'Tooele', 'Tooele', 'UT', '84074', '4358437466', '4358439568', NULL, NULL, 'Tooele', NULL, NULL, NULL, NULL, 'WESTREHAB', 'WUSTDHCPC5', NULL, '0.00', NULL, '65.00', 3, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1134311939', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11015555', 'W11015555', 'UT01', 'Rocky Mountain First Med ', 'Matthew', NULL, 'Wilkinson', 'DPT', 'Physical Therapy', NULL, NULL, NULL, 'O', '8822  S Redwood Rd Ste E122', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015667080', '8012561133', NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WESTREHAB', 'WUSTDHCPC5', NULL, '0.00', '0.00', '65.00', 3, '2008-10-01', '2009-10-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1386665917', 0, 'N', 0, '2008-11-19', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11015562', 'W11015562', 'UT01', 'MLR Jordan Tech Center', 'Michael', 'Adam', 'King', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '9301 S Wights Fort Rd Ste 215', 'West Jordan', 'Salt Lake', 'UT', '84088', '8019422729', '8012822222', '9301 S Wights Fort Rd Ste 215', 'West Jordan', 'Salt Lake', 'UT', '84088', '8019422729', '8012822222', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '65.00', 3, '2008-10-01', '2009-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063675304', 0, 'N', 0, '2012-01-10', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11015551', 'W11015551', 'UT01', 'Utah Physical Therapy Specialists', 'Brian', NULL, 'Rodriguez', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'O', '2700 W 8969 S ', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015611061', '8015611061', NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WESTREHAB', 'WUSTDHCPC5', NULL, '0.00', NULL, '65.00', 3, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1336223007', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11015557', 'W11015557', 'UT01', 'Registered Physical Therapy Sandy', 'Joshua', '', 'Harward', 'MPT', 'Physical Therapy', NULL, NULL, NULL, 'O', '9720 S 1300 E Ste W200', 'Sandy', 'Salt Lake', 'UT', '84094', '8015720690', '8015720696', '9720 S 1300 E Ste W200', 'Sandy', 'Salt Lake', 'UT', '84094', '8015720690', '8015720696', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '65.00', 3, '2008-10-01', '2009-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922003417', 0, 'N', 0, '2013-08-15', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11015561', 'W11015561', 'UT01', 'Life Centre Physical Therapy', 'Dawn', 'Nicole', 'Tyler', 'DPT', 'Physical Therapy', NULL, NULL, NULL, 'O', '9844 S 1300 E Ste 150', 'Sandy', 'Salt Lake', 'UT', '84094', '8015710099', '8015724866', NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WESTREHAB', 'WUSTDHCPC5', NULL, '0.00', '0.00', '65.00', 3, '2008-10-01', '2009-02-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1750544235', 0, 'N', 0, '2008-11-19', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11015539', 'W11015539', 'UT01', 'Registered Physical Therapy Sandy', 'Aaron', NULL, 'Hackett', 'DPT', 'Physical Therapy', NULL, NULL, NULL, 'O', '9720 S 1300 E Ste W200', 'Sandy', 'Salt Lake', 'UT', '84094', '8015720690', '8015720696', NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WESTREHAB', 'WUSTDHCPC5', NULL, '0.00', NULL, '65.00', 3, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1215019567', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11015540', 'W11015540', 'UT01', 'MLR Rheumatology', 'Don', NULL, 'Hansen', 'MPT', 'Physical Therapy', NULL, NULL, NULL, 'O', '11333 S 1000 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8015713318', '8015713318', NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WESTREHAB', 'WUSTDHCPC5', NULL, '0.00', NULL, '65.00', 3, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1326253204', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11015552', 'W11015552', 'UT01', 'Mckell Physical Therapy ', 'John', NULL, 'McKell', 'MS PT', 'Physical Therapy', NULL, NULL, NULL, 'O', '504 E 770 N', 'Orem', 'Utah', 'UT', '84097', '8012242177', '8012242195', NULL, NULL, 'Utah', NULL, NULL, NULL, NULL, 'WESTREHAB', 'WUSTDHCPC5', NULL, '0.00', NULL, '65.00', 3, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1629005301', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11015550', 'W11015550', 'UT01', 'Hand & Orthopedic Rehabilitation Specialists', 'Bonnie', 'R', 'Butler', 'PT-CSCS', 'Physical Therapy', '', '', NULL, 'O', '702 E S Temple Ste 102', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013288535', '8013641242', '702 E S Temple Ste 102', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013288535', '8013641242', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '65.00', 3, '2008-10-01', '2008-10-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255332938', 0, 'N', 0, '2011-04-19', NULL, NULL, 0, 0, NULL, NULL),
('133757370', 'W11015598', 'W11015598', 'UT01', 'LabCorp Draw Station', '', '', 'LabCorp of America Holdings', 'GROUP', 'Laboratory', '', '', NULL, 'O', '348 E 4500 S Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012813048', NULL, '348 E 4500 S Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012813048', '          ', 'WULABCORP5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2014-03-21', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902809940', 0, 'N', 0, '2014-03-26', NULL, NULL, 40.6743, -111.881, NULL, NULL),
('942854057', 'W11015590', 'W11015590', 'UTIHC03', 'Rehab', 'Stacey', 'Rebecca', 'Butler', 'AUD', 'Audiology', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624942', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624942', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2008-09-22', '2012-08-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1831349000', 0, 'N', 0, '2012-08-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11015579', 'W11015579', 'UTIHC02', 'Rehab', 'Michelle', NULL, 'Bunker', 'AUD', 'Audiology', NULL, NULL, NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624949', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '10.00', '0.00', 8, '2008-09-10', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1427209980', 0, 'N', 0, '2008-11-20', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11015582', 'W11015582', 'UTIHC02', 'Rehab', 'Stacey', 'Rebecca', 'Butler', 'AUD', 'Audiology', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624942', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624942', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2008-09-22', '2012-08-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1831349000', 0, 'N', 0, '2012-08-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11015583', 'W11015583', 'UTIHC01', 'Rehab', 'Michelle', NULL, 'Bunker', 'AUD', 'Audiology', NULL, NULL, NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624949', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '10.00', '0.00', 8, '2008-09-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1427209980', 0, 'N', 0, '2008-11-20', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11015586', 'W11015586', 'UTIHC01', 'Rehab', 'Stacey', 'Rebecca', 'Butler', 'AUD', 'Audiology', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624942', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624942', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2008-09-22', '2012-08-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1831349000', 0, 'N', 0, '2012-08-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11015587', 'W11015587', 'UTIHC03', 'Rehab', 'Michelle', NULL, 'Bunker', 'AUD', 'Audiology', NULL, NULL, NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624949', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '10.00', '0.00', 8, '2008-09-10', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1427209980', 0, 'N', 0, '2008-11-20', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11015543', 'W11015543', 'UT01', 'Salt Lake Physical Therapy Associates', 'David', 'William', 'Lerch', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'O', '4888 S Highland Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012649855', '8012938618', NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WESTREHAB', 'WUSTDHCPC5', NULL, '0.00', NULL, '65.00', 3, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1821179995', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11015565', 'W11015565', 'UT01', 'Mountain Land Holladay', 'Cherianne', '', 'Mecham', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '4624 Holladay Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012771028', '8012775987', '4624 Holladay Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012771028', '8012775987', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '65.00', 3, '2008-10-01', '2009-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548437726', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11015560', 'W11015560', 'UT01', 'Rocky Mountain @ Firstmed East', 'Kimberly', 'J', 'Mazzella', 'MPT', 'Physical Therapy', '', '', NULL, 'O', '1950 E 7000 S', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019431041', '8019438805', '1950 E 7000 S', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019431041', '8019438805', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '65.00', 3, '2008-10-01', '2009-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730110982', 0, 'N', 0, '2011-04-20', NULL, NULL, 0, 0, NULL, NULL),
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('820496280', 'W11015655', 'W11015655', 'ID01', 'Dermatology Clinic of ID', 'Stephen', 'J', 'Frelly', 'PA', 'Dermatology', '', '', NULL, 'O', '271 Duffers Ln', 'Cascade', 'Valley', 'ID', '83611', '2083764776', NULL, '271 Duffers Ln', 'Cascade', 'Valley', 'ID', '83611', '2083764776', '', 'IDSTD', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-08-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114966959', 0, 'n', 0, '2013-07-05', NULL, NULL, 44.5085, -116.058, NULL, NULL),
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('820496280', 'W11015656', 'W11015656', 'ID01', 'Dermatology Clinic of ID', 'Alexander', 'J', 'Arhets', 'PA', 'Dermatology', '', '', NULL, 'O', '271 Duffers Ln', 'Cascade', 'Valley', 'ID', '83611', '2083764776', NULL, '271 Duffers Ln', 'Cascade', 'Valley', 'ID', '83611', '2083764776', '', 'IDSTD', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-08-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1013956853', 0, 'n', 0, '2012-05-04', NULL, NULL, 44.5085, -116.058, NULL, NULL),
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('202727934', 'W11015671', 'W11015671', 'ID02', 'Montgomery Counseling Center Inc', 'Phyllis', '', 'Montgomery', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '323 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084630212', NULL, '323 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084630212', '', 'IDMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-12-05', '2013-02-14', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1255412714', 0, 'n', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
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('621658493', 'W11015692', 'W11015692', 'ID01', 'Intermountain Hospital', '', '', 'Intermountain Hospital', 'GROUP', 'Mental Health Facility', '', '', NULL, 'O', '303 N Allumbaugh', 'Boise', 'Ada', 'ID', '83704', '2083778400', NULL, '303 N Allumbaugh', 'Boise', 'Ada', 'ID', '83704', '2083778400', '          ', '', '', 'ID01', '0.00', '100.00', '0.00', 3, '2008-11-01', '2013-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006860', 0, 'N', 0, '2013-05-01', NULL, NULL, 0, 0, NULL, NULL),
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('820440665', 'W11015644', 'W11015644', 'ID02', 'Progressive Nursing Services Inc', '', '', 'Progressive Nursing Services Inc', 'GROUP', 'Home Health Agency', '', '', NULL, 'O', '1514 Shoshone', 'Boise', 'Ada', 'ID', '83705', '2083369898', NULL, '1514 Shoshone', 'Boise', 'Ada', 'ID', '83705', '2083369898', '          ', 'IDHOMEHEALTH', 'DME80', '', '0.00', '35.00', '0.00', 3, '2008-12-15', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1104889526', 0, 'N', 0, '2013-02-26', NULL, NULL, 0, 0, NULL, NULL),
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('200205332', 'W11015659', 'W11015659', 'ID02', NULL, 'D', 'P', 'Reedy', 'MD', 'Neurosurgery', '', '', NULL, 'O', '999 N Curtis Rd Ste 307', 'Boise', 'Ada', 'ID', '83706', '2083677500', NULL, '999 N Curtis Rd Ste 307', 'Boise', 'Ada', 'ID', '83706', '2083677500', '', 'IDSTDPPO', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2009-01-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1588665434', 0, 'n', 0, '2012-06-07', NULL, NULL, 43.6132, -116.255, NULL, NULL),
('820513481', 'W11015665', 'W11015665', 'ID02', 'Hollingshead Eye Center', 'Mark', 'E', 'Hollingshead', 'MD', 'Ophthalmology', '', '', NULL, 'O', '360 E Mallard Dr Ste 110', 'Boise', 'Ada', 'ID', '83706', '2083368700', NULL, '360 E Mallard Dr Ste 110', 'Boise', 'Ada', 'ID', '83706', '2083368700', '', 'IDPPO', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 6, '2008-12-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1689670911', 0, 'n', 0, '2012-11-20', NULL, NULL, 0, 0, NULL, NULL),
('820497083', 'W11015657', 'W11015657', 'ID02', 'Strawn Chiropractic', 'David', 'M', 'Strawn', 'DC', 'Chiropractic', '', '', NULL, 'O', '6013 W Overland Ste 103', 'Boise', 'Ada', 'ID', '83709', '2083445880', NULL, '6013 W Overland Ste 103', 'Boise', 'Ada', 'ID', '83709', '2083445880', '          ', 'IDCHIRO1', '', '', '0.00', '35.00', '0.00', 3, '2008-11-28', '2012-03-31', 0, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1558472365', 0, 'N', 0, '2012-03-07', NULL, NULL, 0, 0, NULL, NULL),
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('562396060', 'W11015672', 'W11015672', 'ID02', 'Boise Family Psychology', 'Roger', 'C', 'Olson', 'PSYD', 'Mental Health', 'Psychology', NULL, NULL, 'O', '3775 N Eagle Rd', 'Boise', 'Ada', 'ID', '83713', '2089381236', NULL, 'PO Box 140037', 'Boise', 'Ada', 'ID', '83714', NULL, NULL, 'IDPHD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-12-05', '2013-02-14', 0, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1538210927', 0, 'n', 0, '2008-12-10', NULL, NULL, 0, 0, NULL, NULL),
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('870503202', 'W11015688', 'W11015688', 'UT01', 'Mountain West Ear Nose and Throat', 'Karen', 'L', 'Walker', 'AUD', 'Audiology', '', '', NULL, 'O', '1551 S Renaissance Towne Dr Ste 310', 'Bountiful', 'Davis', 'UT', '84010', '8012955581', '8017762534', '1551 S Renaissance Towne Dr Ste 310', 'Bountiful', 'Davis', 'UT', '84010', '8012955581', '8017762534', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-12-10', '2011-09-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629102553', 0, 'N', 0, '2011-09-21', NULL, NULL, 0, 0, NULL, NULL),
('870503202', 'W11015687', 'W11015687', 'UT01', 'Mountain West Ear Nose and Throat', 'Amanda', '', 'Milne', 'AUD', 'Audiology', '', '', NULL, 'O', '1551 S Renaissance Towne Dr Ste 310', 'Bountiful', 'Davis', 'UT', '84010', '8012955581', '8017762534', '1551 S Renaissance Towne Dr Ste 310', 'Bountiful', 'Davis', 'UT', '84010', '8012955581', '8017762534', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-12-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801080270', 0, 'N', 0, '2013-08-20', NULL, NULL, 40.8737, -111.888, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
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('870503202', 'W11015683', 'W11015683', 'UT01', 'Mountain West Ear Nose and Throat', 'Amanda', '', 'Milne', 'AUD', 'Audiology', '', '', NULL, 'O', '1660 W Antelope Dr Ste 315', 'Layton', 'Davis', 'UT', '84041', '8017762180', '8017762534', '1660 W Antelope Dr Ste 315', 'Layton', 'Davis', 'UT', '84041', '8017762180', '8017762534', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-12-10', '2011-01-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801080270', 0, 'N', 0, '2013-08-20', NULL, NULL, 0, 0, NULL, NULL),
('870503202', 'W11015685', 'W11015685', 'UT01', 'Mountain West Ear Nose and Throat', 'Tel', 'S', 'Boman', 'AUD', 'Audiology', '', '', NULL, 'O', '1660 W Antelope Dr Ste 315', 'Layton', 'Davis', 'UT', '84041', '8017762180', '8017762534', '1660 W Antelope Dr Ste 315', 'Layton', 'Davis', 'UT', '84041', '8017762180', '8017762534', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-12-10', '2011-01-27', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1972531028', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('330654354', 'W11015662', 'W11015662', 'UT01', 'Avastra Sleep Diagnostics', NULL, NULL, 'Avastra Sleep Diagnostics', 'GROUP', 'Sleep Medicine', NULL, NULL, NULL, 'O', '613 E Fort Union Blvd Ste A102', 'Midvale', 'Salt Lake', 'UT', '84047', '8015237533', NULL, '10532 Acacia St', 'Rancho Cucamonga', 'Salt Lake', 'CA', '91730', NULL, NULL, 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-12-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1306015409', 0, 'n', 0, '2008-12-10', NULL, NULL, 40.6207, -111.874, NULL, NULL),
('621560557', 'W11015645', 'W11015645', 'UT01', 'Morgan Health Center', 'Stephen', 'J', 'Bruce', 'MD', 'Family Practice', '', '', NULL, 'O', '166 N State St', 'Morgan', 'Morgan', 'UT', '84050', '8018293426', NULL, '166 N State St', 'Morgan', 'Morgan', 'UT', '84050', '8018293426', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-11-17', '2011-10-03', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1841269321', 0, 'N', 0, '2014-04-04', NULL, NULL, 0, 0, NULL, NULL),
('870411148', 'W11015682', 'W11015682', 'UTMH1', 'Child & Family Psychology', 'Scott', 'W', 'Seaman', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '703 S State St Ste 1', 'Orem', 'Utah', 'UT', '84058', '8012259522', NULL, '703 S State St Ste 1', 'Orem', 'Utah', 'UT', '84058', '8012259522', '', 'PHD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-12-05', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912100025', 0, 'n', 0, '2011-12-14', NULL, NULL, 0, 0, NULL, NULL),
('870429906', 'W11015639', 'W11015639', 'UT01', NULL, 'John', 'L', 'Bezzant', 'MD', 'Dermatology', '', '', NULL, 'O', '84 S Main St', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017857414', NULL, '84 S Main St', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017857414', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-12-05', NULL, 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1730175720', 0, 'n', 0, '2012-06-04', NULL, NULL, 40.3627, -111.741, NULL, NULL),
('870429906', 'W11015641', 'W11015641', 'UT01', NULL, 'John', 'L', 'Bezzant', 'MD', 'Dermatology', '', '', NULL, 'B', 'PO Box 830', 'Pleasant Grove', 'Utah', 'UT', '84062', '8015876465', NULL, 'PO Box 830', 'Pleasant Grove', 'Utah', 'UT', '84062', '8015876465', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-12-05', NULL, 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1730175720', 0, 'y', 0, '2012-06-04', NULL, NULL, 0, 0, NULL, NULL),
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('820254234', 'W11015764', 'W11015764', 'ID02', 'Brownfields Prosthetic and Orthotics Technologies', '', '', 'Brownfields Prosthetic and Orthotics Technologies', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '122 N 5th St', 'Boise', 'Ada', 'ID', '83702', '2083424659', '          ', '122 N 5th St', 'Boise', 'Ada', 'ID', '83702', '2083424659', '          ', 'IDDME100', '', '', '0.00', '25.00', '0.00', 3, '2008-12-01', '2014-03-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1932166212', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
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('205529469', 'W11015713', 'W11015713', 'UT01', 'University Health Care', 'Christopher', 'A', 'Gee', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '1493 Lowell Ave', 'Park City', 'Summit', 'UT', '84060', '8015875456', NULL, '1493 Lowell Ave', 'Park City', 'Summit', 'UT', '84060', '8015875456', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-07-12', '2012-08-21', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568570729', 0, 'N', 0, '2012-09-19', NULL, NULL, 0, 0, NULL, NULL),
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('870442129', 'W11015760', 'W11015760', 'ID01', '+240 = 10 mins unit U of U Dept of Anesthesiology', '', '', '+240 = 10 mins unit U of U Dept of Anesthesiology +240 = 10 mins unit', 'GROUP', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 413034', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413034', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', '', '', '1000', '50.85', '25.00', '0.00', 3, '2009-01-01', '2009-12-31', 1, 12, 0, '', '', '', '', 'HCFA|UB|', '1134158322', 0, 'N', 0, '2014-01-07', 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
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('364598541', 'W11015718', 'W11015718', 'UT01', 'University of Utah Surgical Intensive Care Unit', 'Edward', 'W', 'Nelson', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015856336', 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015856336', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-01-01', '2012-09-16', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1518057124', 0, 'N', 0, '2012-09-17', NULL, NULL, 0, 0, NULL, NULL),
('870490866', 'W11015719', 'W11015719', 'UT01', 'University of Utah Surgical Associates', 'Bradford', NULL, 'Sklow', 'MD', 'General Surgery', 'Colon and Rectal Surgery', '', NULL, 'B', 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8015812121', '8015853655', 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8015812121', '8015853655', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2012-09-16', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1518057140', 0, 'N', 0, '2012-09-17', NULL, NULL, 0, 0, NULL, NULL),
('743134262', 'W11015723', 'W11015723', 'UT01', 'University Health Care', 'Ai', 'D', 'Sakonju', 'MD', 'Pediatric Neurology', 'Pediatrics', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015853655', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015853655', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2008-11-16', '2012-07-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1902959323', 0, 'N', 0, '2012-07-31', NULL, NULL, 0, 0, NULL, NULL),
('870683335', 'W11015711', 'W11015711', 'UT01', NULL, 'Steven', 'R', 'Young', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1300 N 500 E Ste 220', 'Logan', 'Cache', 'UT', '84341', '4357535220', NULL, '1300 N 500 E Ste 220', 'Logan', 'Cache', 'UT', '84341', '4357535220', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-12-05', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1962497685', 0, 'n', 0, '2011-12-13', NULL, NULL, 41.7563, -111.821, NULL, NULL),
('870542584', 'W11015746', 'W11015746', 'UT01', 'Bonneville Dialysis Center', '', '', 'Bonneville Dialysis Center', 'GROUP', 'Dialysis Center', '', '', NULL, 'O', '5575 S 500 E', 'Ogden', 'Weber', 'UT', '84405', '8014790351', NULL, '5575 S 500 E', 'Ogden', 'Weber', 'UT', '84405', '8014790351', '          ', '', '', '', '0.00', '40.00', '0.00', 3, '2009-01-01', '2010-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003915513', 0, 'N', 0, '2011-01-10', NULL, NULL, 0, 0, NULL, NULL),
('870542584', 'W11015743', 'W11015743', 'UT01', 'Bonneville Dialysis Center', '', '', 'Bonneville Dialysis Center', 'GROUP', 'Dialysis Center', '', '', NULL, 'O', '5575 S 500 E', 'Ogden', 'Weber', 'UT', '84405', '8014790351', NULL, '5575 S 500 E', 'Ogden', 'Weber', 'UT', '84405', '8014790351', '          ', '', '', '', '0.00', '40.00', '0.00', 3, '2009-11-01', '2010-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003915513', 0, 'N', 0, '2011-01-10', NULL, NULL, 0, 0, NULL, NULL),
('870542584', 'W11015744', 'W11015744', 'UT01', 'Bonneville Dialysis Center', NULL, NULL, 'Bonneville Dialysis Center', 'GROUP', 'Dialysis Center', NULL, NULL, NULL, 'O', '5575 S 500 E ', 'Ogden', 'Weber', 'UT', '84405', '8014790351', NULL, 'PO Box 27071', 'Salt Lake City', 'Weber', 'UT', '84127', NULL, NULL, NULL, NULL, NULL, '0.00', '40.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1003915513', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('870542580', 'W11015736', 'W11015736', 'UT01', 'Provo Dialysis Center', '', '', 'Provo Dialysis Center', 'GROUP', 'Dialysis Center', '', '', NULL, 'O', '1675 N Freedom Blvd', 'Provo', 'Utah', 'UT', '84604', '8013730167', NULL, '1675 N Freedom Blvd', 'Provo', 'Utah', 'UT', '84604', '8013730167', '          ', '', '', '', '0.00', '40.00', '0.00', 3, '2009-01-01', '2010-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194824201', 0, 'N', 0, '2013-10-15', NULL, NULL, 0, 0, NULL, NULL),
('870687050', 'W11015754', 'W11015754', 'UT01', 'Iron Mission Dialysis Center', '', '', 'Iron Mission Dialysis Center', 'GROUP', 'Dialysis Center', '', '', NULL, 'O', '1277 Northfield Rd', 'Cedar City', 'Iron', 'UT', '84720', '4358678175', NULL, '1277 Northfield Rd', 'Cedar City', 'Iron', 'UT', '84720', '4358678175', '          ', '', '', '', '0.00', '40.00', '0.00', 6, '2009-01-01', '2010-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336248855', 0, 'N', 0, '2011-01-10', NULL, NULL, 0, 0, NULL, NULL),
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('330654354', 'W11015766', 'W11015766', 'UT01', 'Avastra Sleep Diagnostics', 'Gregory', 'D', 'Hammond', 'MD', 'Pulmonary', 'Sleep Medicine', '', NULL, 'B', 'Dept LA 23018', 'Pasadena', 'Los Angeles', 'CA', '91185', '8015237533', NULL, 'Dept LA 23018', 'Pasadena', 'Los Angeles', 'CA', '91185', '8015237533', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-12-10', '2012-02-01', 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1942374020', 0, 'N', 0, '2013-05-02', NULL, NULL, 0, 0, NULL, NULL),
('800204545', 'W11015795', 'W11015795', 'UT01', 'Shadow Mountain Family Medicine LLC', 'Joseph', 'F', 'Kasper', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 402044', 'Atlanta', 'Fulton', 'GA', '30384', '8012825952', NULL, 'PO Box 402044', 'Atlanta', 'Fulton', 'GA', '30384', '8012825952', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-12-17', '2009-07-22', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1972581528', 0, 'Y', 0, '2013-03-27', NULL, NULL, 0, 0, NULL, NULL),
('202711377', 'W11015792', 'W11015792', 'WY01', 'Dubois Chiropractic', 'Dean', 'J', 'Lehmkuhler', 'DC', 'Chiropractic', 'Acupuncture', '', NULL, 'O', '116 E Ramshorn Ave', 'Dubois', 'Fremont', 'WY', '82513', '3074552719', NULL, '116 E Ramshorn Ave', 'Dubois', 'Fremont', 'WY', '82513', '3074552719', '', '', NULL, '5004', '0.00', '100.00', '0.00', 3, '2008-10-08', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1689605040', 0, 'n', 0, '2012-05-10', NULL, NULL, 0, 0, NULL, NULL),
('202711377', 'W11015791', 'W11015791', 'WY01', 'Lander Valley Chiropractic', 'Dean', 'J', 'Lehmkuhler', 'DC', 'Chiropractic', 'Acupuncture', '', NULL, 'O', '160 S 4th St', 'Lander', 'Fremont', 'WY', '82520', '3073326148', NULL, '160 S 4th St', 'Lander', 'Fremont', 'WY', '82520', '3073326148', '          ', '', '', '5004', '0.00', '100.00', '0.00', 3, '2008-10-08', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1689605040', 0, 'N', 0, '2013-06-17', NULL, NULL, 42.8329, -108.733, NULL, NULL),
('820371383', 'W11015784', 'W11015784', 'ID02', 'Valley Family Health Care', 'Eddie', 'O', 'Rodriguez-Lopez', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 429', 'Emmett', 'Gem', 'ID', '83617', '2083651065', NULL, 'PO Box 429', 'Emmett', 'Gem', 'ID', '83617', '2083651065', '          ', 'IDSTDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 6, '2009-01-01', '2014-02-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1457352221', 0, 'N', 0, '2014-02-21', NULL, NULL, 0, 0, NULL, NULL),
('820371383', 'W11015783', 'W11015783', 'ID02', 'Valley Family Health Care', 'Bryan', 'A', 'Stone', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 429', 'Emmett', 'Gem', 'ID', '83617', '2083651065', NULL, 'PO Box 429', 'Emmett', 'Gem', 'ID', '83617', '2083651065', '', 'IDSTDPPO', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 6, '2009-01-01', NULL, 0, 0, 1, 'Walter Knox Memorial Hospital', '', '', '', 'HCFA|UB|', '1679574487', 0, 'y', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('820371383', 'W11015785', 'W11015785', 'ID02', 'Valley Family Health Care', 'James', 'D', 'McColly', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 429', 'Emmett', 'Gem', 'ID', '83617', '2083651065', NULL, 'PO Box 429', 'Emmett', 'Gem', 'ID', '83617', '2083651065', '          ', 'IDSTDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 6, '2009-01-01', '2014-02-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1851326045', 0, 'N', 0, '2014-02-24', NULL, NULL, 0, 0, NULL, NULL),
('820371383', 'W11015786', 'W11015786', 'ID02', 'Valley Family Health Care', 'James', 'D', 'McColly', 'PA', 'Family Practice', '', '', NULL, 'O', '207 E 12th St', 'Emmett', 'Gem', 'ID', '83617', '2083651065', NULL, '207 E 12th St', 'Emmett', 'Gem', 'ID', '83617', '2083651065', '          ', 'IDSTDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 6, '2009-01-01', '2014-02-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1851326045', 0, 'N', 0, '2014-02-24', NULL, NULL, 0, 0, NULL, NULL),
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('820463458', 'W11015840', 'W11015840', 'ID02', NULL, 'Jon', 'W', 'Glick', 'LCPC', 'Mental Health', 'Counseling', '', NULL, 'O', '200 Forest St', 'McCall', 'Valley', 'ID', '83638', '2086304248', NULL, '200 Forest St', 'McCall', 'Valley', 'ID', '83638', '2086304248', '', 'IDMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-12-05', '2013-02-14', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1922039262', 0, 'n', 0, '2011-12-27', NULL, NULL, 0, 0, NULL, NULL),
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('870639098', 'W11015828', 'W11015828', 'UT01', 'After Hours Medical Company - American Fork', 'Corey', 'L', 'Newman', 'PA-C', 'Family Practice', 'Emergency Medicine', '', NULL, 'O', '476 N 900 W Ste C', 'American Fork', 'Utah', 'UT', '84003', '8014921611', NULL, '476 N 900 W Ste C', 'American Fork', 'Utah', 'UT', '84003', '8014921611', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-12-05', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629077870', 0, 'Y', 0, '2013-10-23', NULL, NULL, 40.3961, -111.815, NULL, NULL),
('870503202', 'W11015835', 'W11015835', 'UT01', 'Mountain West Ear Nose and Throat', 'Niki', 'L', 'Barwick', 'AUD', 'Audiology', '', '', NULL, 'O', '1551 S Renaissance Towne Dr Ste 310', 'Bountiful', 'Davis', 'UT', '84010', '8012955581', '8017762534', '1551 S Renaissance Towne Dr Ste 310', 'Bountiful', 'Davis', 'UT', '84010', '8012955581', '8017762534', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-12-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952571465', 0, 'N', 0, '2014-05-12', NULL, NULL, 40.8737, -111.888, NULL, NULL),
('870639098', 'W11015825', 'W11015825', 'UT01', 'After Hours Medical Company - Draper', 'Corey', 'L', 'Newman', 'PA-C', 'Family Practice', 'Emergency Medicine', '', NULL, 'O', '1126 E 12300 S', 'Draper', 'Salt Lake', 'UT', '84020', '8015450600', NULL, '1126 E 12300 S', 'Draper', 'Salt Lake', 'UT', '84020', '8015450600', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-12-05', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629077870', 0, 'Y', 0, '2013-10-23', NULL, NULL, 40.5284, -111.859, NULL, NULL),
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('870492272', 'W11015841', 'W11015841', 'UT01', 'Utah Cardiology PC', 'Gaurav', '', 'Aggarwala', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '2132 N 1700 W Ste 200', 'Layton', 'Davis', 'UT', '84041', '8017760174', NULL, '2132 N 1700 W Ste 200', 'Layton', 'Davis', 'UT', '84041', '8017760174', '          ', 'WUUTCARD5', 'WUSTDHCPC5', '', '0.00', '23.00', '0.00', 3, '2008-12-05', '2011-10-15', 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1629098413', 0, 'N', 0, '2012-01-16', NULL, NULL, 0, 0, NULL, NULL),
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('870639098', 'W11015823', 'W11015823', 'UT01', 'After Hours Medical Company - Latyon', 'Corey', 'L', 'Newman', 'PA-C', 'Family Practice', 'Emergency Medicine', '', NULL, 'O', '1550 N Main St Ste E', 'Layton', 'Davis', 'UT', '84041', '8016149030', NULL, '1550 N Main St Ste E', 'Layton', 'Davis', 'UT', '84041', '8016149030', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-12-05', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629077870', 0, 'Y', 0, '2013-10-23', NULL, NULL, 41.0825, -111.993, NULL, NULL),
('870470032', 'W11015843', 'W11015843', 'UTMH1', 'A/D Psychotherapy  & Clinical Consulting Inc', NULL, NULL, 'A/D Psychotherapy  & Clinical Consulting Inc', 'MD', 'Mental Health Facility', NULL, NULL, NULL, 'O', '8465 S 700 E', 'Sandy', 'Salt Lake', 'UT', '84070', '8012338577', NULL, 'PO Box 901662', 'Sandy', 'Salt Lake', 'UT', '84090', NULL, NULL, '', NULL, '8', '0.00', '40.00', '0.00', 6, '2008-11-01', NULL, 1, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000003087', 0, 'N', 0, '2008-12-19', NULL, NULL, 40.5975, -111.872, NULL, NULL),
('262388378', 'W11015833', 'W11015833', 'UT01', 'Utah Endocrinology Associates PLLC', 'Tausha', 'M', 'Jensen', 'APRN', 'Endocrinology', '', '', NULL, 'B', 'PO Box 571800', 'Murray', 'Salt Lake', 'UT', '84157', '8012699939', NULL, 'PO Box 571800', 'Murray', 'Salt Lake', 'UT', '84157', '8012699939', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-04-15', '2009-03-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225297542', 0, 'y', 0, '2012-01-18', NULL, NULL, 0, 0, NULL, NULL),
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('870639098', 'W11015824', 'W11015824', 'UT01', 'After Hours Medical Company -Sandy', 'Corey', 'L', 'Newman', 'PA-C', 'Family Practice', 'Emergency Medicine', '', NULL, 'O', '7998 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8012552000', NULL, '7998 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8012552000', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-12-05', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629077870', 0, 'Y', 0, '2013-10-23', NULL, NULL, 40.6056, -111.853, NULL, NULL),
('870639098', 'W11015826', 'W11015826', 'UT01', 'After Hours Medical Company - South Jordan', 'Corey', 'L', 'Newman', 'PA-C', 'Family Practice', 'Emergency Medicine', '', NULL, 'O', '10433 S Redwood Rd', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015010500', '8012560696', '10433 S Redwood Rd', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015010500', '8012560696', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-12-05', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629077870', 0, 'Y', 0, '2013-10-23', NULL, NULL, 40.5602, -111.939, NULL, NULL),
('870639098', 'W11015827', 'W11015827', 'UT01', 'After Hours Medical Company - West Valley', 'Corey', 'L', 'Newman', 'PA-C', 'Family Practice', 'Emergency Medicine', '', NULL, 'O', '3451 S 5600 W Ste F', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019570900', NULL, '3451 S 5600 W Ste F', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019570900', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-12-05', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629077870', 0, 'Y', 0, '2013-10-23', NULL, NULL, 40.6977, -112.025, NULL, NULL),
('262388378', 'W11015832', 'W11015832', 'UT01', 'Utah Endocrinology Associates PLLC', 'Tausha', 'M', 'Jensen', 'APRN', 'Endocrinology', '', '', NULL, 'O', '1250 E 3900 S Ste 420', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012699939', NULL, '1250 E 3900 S Ste 420', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012699939', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-12-17', '2009-03-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225297542', 0, 'n', 0, '2012-01-18', NULL, NULL, 0, 0, NULL, NULL),
('412057748', 'W11015837', 'W11015837', 'UT01', 'Utah Pain and Rehab', 'Russell', 'S', 'Wahlen', 'DC', 'Chiropractic', '', '', NULL, 'O', '1276 S Wall Ave', 'Ogden', 'Weber', 'UT', '84404', '8013374000', NULL, '1276 S Wall Ave', 'Ogden', 'Weber', 'UT', '84404', '8013374000', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-12-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104923168', 0, 'n', 0, '2011-12-13', NULL, NULL, 41.2433, -111.978, NULL, NULL),
('752999346', 'W11015838', 'W11015838', 'UT01', NULL, 'Bruce', 'N', 'Hathaway', 'MD', 'Internal Medicine', 'Infectious Disease', '', NULL, 'O', '777 N 500 W Ste 104', 'Provo', 'Utah', 'UT', '84601', '8013749299', NULL, '777 N 500 W Ste 104', 'Provo', 'Utah', 'UT', '84601', '8013749299', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-12-05', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1891849980', 0, 'n', 0, '2011-12-15', NULL, NULL, 40.244, -111.667, NULL, NULL),
('870499792', 'W11015829', 'W11015829', 'UT01', 'Southwest Surgical Associates', 'Ryan', 'L', 'Lewis', 'DO', 'General Surgery', '', '', NULL, 'O', '1490 E Foremaster Dr Ste 200', 'St George', 'Washington', 'UT', '84790', '4356281641', '4356281660', '1490 E Foremaster Dr Ste 200', 'St George', 'Washington', 'UT', '84790', '4356281641', '4356281660', 'WUSTGEIPA', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-12-15', '2013-06-30', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1942290622', 0, 'N', 0, '2013-10-25', NULL, NULL, 0, 0, NULL, NULL),
('742534122', 'W11015850', 'W11015850', 'UT01', 'CNS Community Nursing Services', '', '', 'CNS Community Nursing Services', 'GROUP', 'Home Health Agency', 'Hospice', '', NULL, 'O', 'Phone Number Only', NULL, 'Wasatch', 'UT', '84082', '8004048138', NULL, 'Phone Number Only', '', 'Wasatch', 'UT', '84082', '8004048138', '', '', NULL, '4', '0.00', '30.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000833771', 0, 'N', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
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('742534122', 'W11015845', 'W11015845', 'UT01', 'CNS Community Nursing Services', '', '', 'CNS Community Nursing Services', 'GROUP', 'Home Health Agency', 'Hospice', '', NULL, 'O', 'Phone Number Only Zip 84513', NULL, 'Emery', 'UT', '84513', '8776138887', NULL, 'Phone Number Only Zip 84513', '', 'Emery', 'UT', '84513', '8776138887', '', '', NULL, '4', '0.00', '30.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000833771', 0, 'N', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
('742534122', 'W11015844', 'W11015844', 'UT01', 'CNS Community Nursing Services', '', '', 'CNS Community Nursing Services', 'GROUP', 'Home Health Agency', 'Hospice', '', NULL, 'O', 'Phone Number Only Zip 84336', NULL, 'Box Elder', 'UT', '84336', '8005010014', NULL, 'Phone Number Only Zip 84336', '', 'Box Elder', 'UT', '84336', '8005010014', '', '', NULL, '4', '0.00', '30.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000833771', 0, 'N', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
('742534122', 'W11015848', 'W11015848', 'UT01', 'CNS Community Nursing Services', '', '', 'CNS Community Nursing Services', 'GROUP', 'Home Health Agency', 'Hospice', '', NULL, 'O', '383 W Vine St Ste 300', 'Murray', 'Salt Lake', 'UT', '84123', '8012336100', NULL, '383 W Vine St Ste 300', 'Murray', 'Salt Lake', 'UT', '84123', '8012336100', '', '', NULL, '4', '0.00', '30.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000833771', 0, 'N', 0, '2012-09-24', NULL, NULL, 40.6632, -111.916, NULL, NULL),
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('742534122', 'W11015851', 'W11015851', 'UT01', 'CNS Community Nursing Services', '', '', 'CNS Community Nursing Services', 'GROUP', 'Home Health Agency', 'Hospice', '', NULL, 'O', '720 S River Rd Ste E101', 'St George', 'Washington', 'UT', '84790', '8666529077', NULL, '720 S River Rd Ste E101', 'St George', 'Washington', 'UT', '84790', '8666529077', '', '', NULL, '4', '0.00', '30.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000833771', 0, 'N', 0, '2012-09-24', NULL, NULL, 37.0958, -113.557, NULL, NULL),
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('820425454', 'W12024570', 'W12024570', 'ID01', 'Boise Anesthesia, PA', 'Brad', '', 'Foss', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'B', 'PO Box 4268', 'Portland', 'Multnomah', 'OR', '97208', '8002758752', NULL, 'PO Box 4268   ', 'Portland', 'Multnomah', 'OR', '97208', '8002758752', '          ', 'IDSAMG3', '', '', '62.80', '10.00', '0.00', 3, '2012-07-01', NULL, 1, 15, 0, '', '', '', '', 'HCFA|UB|', '1831339068', 0, 'N', 0, '2012-10-30', NULL, NULL, 0, 0, NULL, NULL),
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('331078261', 'W11015871', 'W11015871', 'ID01', 'Saint Alphonsus Physicians PA', 'Michael', 'A', 'Codina', 'MD', 'Cardiology', '', '', NULL, 'o', '3025 W Cherry Ln Ste 205', 'Meridian', 'Ada', 'ID', '83642', '2083678484', '2083678456', '3025 W Cherry Ln Ste 205', 'Meridian', 'Ada', 'ID', '83642', '2083678484', '2083678456', 'IDSAMG1', NULL, '', '0.00', '10.00', '0.00', 3, '2008-12-18', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', 'Saint Alphonsus Regional Medical Center', '', '', 'HCFA|UB|', '1871540708', 0, 'n', 0, '2014-07-09', NULL, NULL, 43.6188, -116.431, NULL, NULL),
('820477852', 'W11015864', 'W11015864', 'ID01', 'Saint Alphonsus Medical Group Garrity', 'Amber', 'M', 'Vickers', 'PA-C', 'Family Practice', 'Physician Assistant', '', NULL, 'o', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2008-12-18', '2012-04-03', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1114964616', 0, 'N', 0, '2014-04-14', NULL, NULL, 43.587, -116.549, NULL, NULL),
('331078261', 'W11015870', 'W11015870', 'ID01', 'Saint Alphonsus Physicians PA', 'Michael', 'A', 'Codina', 'MD', 'Cardiology', '', '', NULL, 'o', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2083674278', '2083675200', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2083674278', '2083675200', 'IDSAMG1', NULL, '', '0.00', '10.00', '0.00', 3, '2008-12-18', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', 'Saint Alphonsus Regional Medical Center', '', '', 'HCFA|UB|', '1871540708', 0, 'n', 0, '2014-07-09', NULL, NULL, 43.587, -116.549, NULL, NULL),
('820200895', 'W11015865', 'W11015865', 'ID01', 'Saint Alphonsus Regional Medical Center Behavioral Health', 'Kimberly', 'B', 'Lee', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'o', '131 N Allumbaugh', 'Boise', 'Ada', 'ID', '83704', '2083672175', NULL, '131 N Allumbaugh', 'Boise', 'Ada', 'ID', '83704', '2083672175', '          ', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2008-12-18', '2012-04-03', 0, 0, 0, '', '', '', '', 'HCFA|', '1780838623', 0, 'N', 0, '2012-04-03', NULL, NULL, 43.6059, -116.267, NULL, NULL),
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('820529971', 'W11015859', 'W11015859', 'ID02', 'Childrens Therapy Place Inc', 'Krista', 'M', 'McTeer', 'SLP', 'Speech Therapy', 'Speech Language Pathology', '', NULL, 'O', '6855 W Fairview Ave Ste 120', 'Boise', 'Ada', 'ID', '83704', '2083238888', NULL, '6855 W Fairview Ave Ste 120', 'Boise', 'Ada', 'ID', '83704', '2083238888', '          ', 'WestRehab', '', '', '0.00', '0.00', '65.00', 3, '2009-01-01', '2011-01-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1366628976', 0, 'N', 0, '2012-04-24', NULL, NULL, 0, 0, NULL, NULL),
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('820529971', 'W11015857', 'W11015857', 'ID02', 'Childrens Therapy Place Inc', 'Corrie', 'S', 'Rilling', 'SLP', 'Speech Therapy', 'Speech Language Pathology', '', NULL, 'O', '6855 W Fairview Ave Ste 120', 'Boise', 'Ada', 'ID', '83704', '2083238888', NULL, '6855 W Fairview Ave Ste 120', 'Boise', 'Ada', 'ID', '83704', '2083238888', '          ', 'WestRehab', '', '', '0.00', '0.00', '65.00', 3, '2009-01-01', '2009-07-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1710154802', 0, 'N', 0, '2012-04-24', NULL, NULL, 0, 0, NULL, NULL),
('820529971', 'W11015856', 'W11015856', 'ID02', 'Childrens Therapy Place Inc', 'Charlotte', 'M', 'Roy', 'PT', 'Physical Therapy', '', '', NULL, 'O', '6855 W Fairview Ave Ste 120', 'Boise', 'Ada', 'ID', '83704', '2083238888', NULL, '6855 W Fairview Ave Ste 120', 'Boise', 'Ada', 'ID', '83704', '2083238888', '          ', 'WestRehab', '', '', '0.00', '0.00', '65.00', 3, '2009-01-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1356592737', 0, 'N', 0, '2012-04-26', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W11015866', 'W11015866', 'ID01', 'Saint Alphonsus Regional Medical Center', 'Kimberly', 'B', 'Lee', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'o', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083676238', NULL, '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083676238', '          ', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2008-12-18', '2012-04-03', 0, 0, 0, '', '', '', '', 'HCFA|', '1780838623', 0, 'N', 0, '2012-04-03', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('820200895', 'W11015867', 'W11015867', 'ID01', 'Saint Alphonsus  Medical Group Comprehensive Pain and Spine', 'Nicole', 'M', 'Amideo', 'PA-C', 'Pain Management', 'Physician Assistant', '', NULL, 'o', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083677644', '2083673319', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083677644', '2083673319', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2008-12-18', '2012-12-12', 0, 0, 0, '', '', '', '', 'HCFA|', '1700813714', 0, 'N', 0, '2012-12-13', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('820425454', 'W12024571', 'W12024571', 'ID01', 'Boise Anesthesia PA', 'Matthew', 'B', 'Fowler', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 4268', 'Portland', 'Multnomah', 'OR', '97208', '8002758752', NULL, 'PO Box 4268   ', 'Portland', 'Multnomah', 'OR', '97208', '8002758752', '          ', 'IDSAMG3', '', '', '60.97', '10.00', '0.00', 3, '2011-07-01', '2012-06-30', 1, 15, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1801848130', 0, 'N', 0, '2012-10-30', NULL, NULL, 0, 0, NULL, NULL),
('352329743', 'W11015854', 'W11015854', 'UT01', 'Mountain Star Pediatrics', 'Kenneth', 'E', 'Stevenson', 'MD', 'Pediatrics', '', '', NULL, 'O', '5495 S 500 E Ste 120', 'Ogden', 'Weber', 'UT', '84405', '8014790174', NULL, '5495 S 500 E Ste 120', 'Ogden', 'Weber', 'UT', '84405', '8014790174', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-08-01', '2010-08-31', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1245326065', 0, 'N', 0, '2012-06-28', NULL, NULL, 0, 0, NULL, NULL),
('352329743', 'W11015855', 'W11015855', 'UT01', 'Mountain Star Pediatrics', 'Kathie', 'Ellen', 'Coopersmith', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '5495 S 500 E Ste 120', 'Ogden', 'Weber', 'UT', '84405', '8014790174', NULL, '3 Maryland Farms', 'Brentwood', 'Weber', 'TN', '37027', NULL, NULL, 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-08-01', '2009-08-01', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1447359039', 0, 'N', 0, '2009-01-12', NULL, NULL, 0, 0, NULL, NULL),
('201300128', 'W11015873', 'W11015873', 'ID01', 'Idaho Urologic Institute', 'Katy', '', 'Holder', 'PA', 'Urology', '', '', NULL, 'O', '2855 E Magic View Dr', 'Meridian', 'Ada', 'ID', '83642', '2086394900', NULL, '2855 E Magic View Dr', 'Meridian', 'Ada', 'ID', '83642', '2086394900', '', 'IDUROLOGY', 'WUSTDHCPC5', NULL, '0.00', '20.00', '0.00', 3, '2008-12-15', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1427143346', 0, 'n', 0, '2013-07-31', NULL, NULL, 43.599, -116.36, NULL, NULL),
('201300128', 'W11015874', 'W11015874', 'ID01', 'Idaho Urologic Institute', 'Katy', '', 'Holder', 'PA', 'Urology', '', '', NULL, 'O', '333 N 1st', 'Boise', 'Ada', 'ID', '83702', '2086394900', NULL, '333 N 1st', 'Boise', 'Ada', 'ID', '83702', '2086394900', '          ', 'IDUROLOGY', 'WUSTDHCPC5', '', '0.00', '20.00', '0.00', 3, '2008-12-15', '2012-02-24', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1427143346', 0, 'N', 0, '2013-07-31', NULL, NULL, 43.6135, -116.194, NULL, NULL),
('820200895', 'W11015872', 'W11015872', 'ID01', 'Saint Alphonsus Regional Medical Center', 'Michael', 'A', 'Codina', 'MD', 'Cardiology', '', '', NULL, 'o', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083673722', NULL, '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083673722', '', 'IDSAMG1', NULL, '', '0.00', '10.00', '0.00', 6, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', 'Saint Alphonsus Regional Medical Center', '', '', 'HCFA|', '1871540708', 0, 'n', 0, '2014-07-09', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('870559136', 'W11015875', 'W11015875', 'UT01', 'Eye Prosthetics of Utah', '', '', 'Eye Prosthetics of Utah       ', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '7050 Highland Dr Ste 220', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019421600', '8019421717', '7050 Highland Dr Ste 220', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019421600', '8019421717', 'WCSTEPU5', '', '', '0.00', '40.00', '0.00', 3, '2009-01-01', '2011-01-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366475154', 0, 'N', 0, '2011-02-03', NULL, NULL, 0, 0, NULL, NULL),
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INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
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('352329743', 'W11015968', 'W11015968', 'UT01', 'Mountain Star Pediatrics', '', '', 'Mountain Star Pediatrics', 'GROUP', 'Pediatrics', '', '', NULL, 'B', 'PO Box 281721', 'Atlanta', 'Fulton', 'GA', '30384', '8014790174', NULL, 'PO Box 281721', 'Atlanta', 'Fulton', 'GA', '30384', '8014790174', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-08-01', '2010-08-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007723', 0, 'N', 0, '2011-01-14', NULL, NULL, 0, 0, NULL, NULL),
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('830199236', 'W11016035', 'W11016035', 'WY01', 'Yellowstone Behavioral Health Center', 'Steve', '', 'Humphries-Wadsworth', 'LMFT', 'Mental Health', 'Marriage & Family Therapy', '', NULL, 'O', '2538 Bighorn Ave', 'Cody', 'Park', 'WY', '82414', '3075872197', NULL, '2538 Bighorn Ave', 'Cody', 'Park', 'WY', '82414', '3075872197', '', 'PHD', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-12-05', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700026903', 0, 'n', 0, '2013-05-08', NULL, NULL, 0, 0, NULL, NULL),
('010685479', 'W11016036', 'W11016036', 'WY01', 'Powder River Surgery Center', '', '', 'Powder River Surgery Center', 'GROUP', 'Ambulatory Surgery Center', '', '', NULL, 'O', '906 W 6th St Ste C', 'Gillette', 'Campbell', 'WY', '82716', '3076888600', NULL, '906 W 6th St Ste C', 'Gillette', 'Campbell', 'WY', '82716', '3076888600', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2009-01-01', '2011-11-06', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780738153', 0, 'N', 0, '2011-12-22', NULL, NULL, 0, 0, NULL, NULL),
('261900472', 'W11016041', 'W11016041', 'ID02', 'Idaho Skin Surgery Center', 'Jared', '', 'Scott', 'MD', 'Dermatology', '', '', NULL, 'O', '222 N 2nd St Ste 315', 'Boise', 'Ada', 'ID', '83702', '2084331114', NULL, '222 N 2nd St Ste 315', 'Boise', 'Ada', 'ID', '83702', '2084331114', '          ', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2009-01-13', '2012-01-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1992808893', 0, 'N', 0, '2013-08-16', NULL, NULL, 43.6131, -116.195, NULL, NULL),
('205934739', 'W11016050', 'W11016050', 'ID02', 'Family Medicine Health Center', 'Christopher', 'D', 'Gunderson', 'PA', 'Family Practice', '', '', NULL, 'O', '215 W 35th St', 'Boise', 'Ada', 'ID', '83714', '2083676030', '2083227018', '215 W 35th St', 'Boise', 'Ada', 'ID', '83714', '2083676030', '2083227018', 'IDPPO', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1417066143', 0, 'n', 0, '2011-06-29', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11016040', 'W11016040', 'UT01', 'American Fork Surgical Center', NULL, NULL, 'American Fork Surgical Center', 'GROUP', 'Ambulatory Surgery Center', NULL, NULL, NULL, 'O', '1175 E 50 S', 'American Fork', 'Utah', 'UT', '84003', '8013758858', NULL, '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', NULL, NULL, '', NULL, '2', '0.00', '0.00', '0.00', 6, '2009-03-15', NULL, 1, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000005011', 0, 'N', 0, '2009-01-12', NULL, NULL, 40.3757, -111.77, NULL, NULL),
('311543728', 'W11016049', 'W11016049', 'UT01', 'Superior Care Draper', '', '', 'Medway Medical', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '12393 Gateway Park Place', 'Draper', 'Salt Lake', 'UT', '84020', '8776554243', NULL, '12393 Gateway Park Place', 'Draper', 'Salt Lake', 'UT', '84020', '8776554243', '', 'DME80', '', '', '0.00', '35.00', '0.00', 3, '2009-01-13', '2011-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962438358', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'W11016029', 'W11016029', 'UT01', 'Ogden Clinic', 'Rodney', 'K', 'Grogan', 'PA', 'Family Practice', '', '', NULL, 'O', '5430 S 1900 W Ste G1', 'Roy', 'Weber', 'UT', '84067', '8017799975', NULL, '5430 S 1900 W Ste G1', 'Roy', 'Weber', 'UT', '84067', '8017799975', '', 'WUOGDCLIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2008-12-22', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1114915170', 0, 'N', 0, '2013-01-29', NULL, NULL, 41.1651, -112.026, NULL, NULL),
('621801973', 'W11016025', 'W11016025', 'UT01', 'Jordan Valley Internal Medicine', 'Kevin', 'B', 'Johnson', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3570 W 9000 S Ste 100', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015692384', '8015698643', '3570 W 9000 S Ste 100', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015692384', '8015698643', 'WUSTDINT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2007-12-01', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1255456497', 0, 'N', 0, '2011-09-29', NULL, NULL, 40.588, -111.975, NULL, NULL),
('621801973', 'W11016024', 'W11016024', 'UT01', 'Jordan Valley Internal Medicine', 'David', 'R', 'Zackrison', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '3590 W 9000 S Ste 240', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015692384', NULL, '3590 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', NULL, NULL, 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-12-01', '2007-12-01', 0, NULL, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1346364775', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('261488477', 'W11016037', 'W11016037', 'UT01', 'Family Surgical Suite (Oral Surgery Only)', '', '', 'Family Surgical Suite ', 'GROUP', 'Oral Surgery Center', 'Ambulatory Surgery Center', '', NULL, 'O', '151 E 5600 S Ste 104', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8014951064', NULL, '151 E 5600 S Ste 104', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8014951064', '          ', '', '', '2', '0.00', '0.00', '0.00', 6, '2009-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083861165', 0, 'N', 0, '2011-03-30', NULL, NULL, 40.6492, -111.887, NULL, NULL),
('112645333', 'W11016051', 'W11016051', 'UT01', 'Heritage Home Health', '', '', 'Gentiva Health Services USA INC', 'GROUP', 'Home Health Agency', '', '', NULL, 'O', '488 E Winchester Ste 100', 'Murray', 'Salt Lake', 'UT', '84107', '8012611317', NULL, '488 E Winchester Ste 100', 'Murray', 'Salt Lake', 'UT', '84107', '8012611317', '          ', '', '', '4', '0.00', '35.00', '0.00', 3, '2009-01-05', '2010-07-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000607346', 0, 'Y', 0, '2010-07-12', NULL, NULL, 0, 0, NULL, NULL),
('261488477', 'W11016039', 'W11016039', 'UT01', 'Anethesiology Family Surgical Suite', NULL, NULL, 'Anethesiology Family Surgical Suite', 'GROUP', 'Anesthesiology', NULL, NULL, NULL, 'B', 'PO Box 2265', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8014951064', NULL, '151 E 5600 S', 'Murray', 'Salt Lake', 'UT', '84107', NULL, NULL, '', NULL, '1000', '40.90', '0.00', '0.00', 6, '2009-01-01', NULL, 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000005053', 0, 'Y', 0, '2009-01-12', NULL, NULL, 0, 0, NULL, NULL),
('261488477', 'W11016038', 'W11016038', 'UT01', 'Family Surgical Suite', '', '', 'Family Surgical Suite ', 'GROUP', 'Oral Surgery Center', 'Ambulatory Surgery Center', '', NULL, 'B', 'PO Box 2265', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8014951064', NULL, 'PO Box 2265', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8014951064', '          ', '', '', '2', '0.00', '0.00', '0.00', 6, '2009-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083861165', 0, 'Y', 0, '2011-03-30', NULL, NULL, 0, 0, NULL, NULL),
('651229319', 'W11016043', 'W11016043', 'UT01', 'Spinal Interventions', 'Daniel', 'R', 'Faber', 'MD', 'Pain Management', 'Anesthesiology', '', NULL, 'B', 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8012234860', NULL, 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8012234860', '          ', 'WISESTD', 'WUSTDHCPC5', '1000', '48.00', '35.00', '0.00', 6, '2009-01-13', NULL, 1, 12, 0, 'Mountain View Regional Hospital', 'Timpanogos Regional Hospital', '', '', 'HCFA|UB|', '1023049418', 0, 'N', 0, '2011-12-29', NULL, NULL, 0, 0, NULL, NULL),
('262329171', 'W11016045', 'W11016045', 'UT01', 'Sleep Dx', '', '', 'Sleep Dx', 'GROUP', 'Sleep Disorders', '', '', NULL, 'O', '1515 N 400 E Ste 101', 'North Logan', 'Cache', 'UT', '84341', '4357557122', NULL, '1515 N 400 E Ste 101', 'North Logan', 'Cache', 'UT', '84341', '4357557122', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-01-13', '2010-08-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245404920', 0, 'N', 0, '2011-02-10', NULL, NULL, 0, 0, NULL, NULL),
('311543728', 'W11016048', 'W11016048', 'UT01', 'Superior Care Logan', '', '', 'Medway Medical', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '1115 N 200 E Ste 230', 'Logan', 'Cache', 'UT', '84341', '4357559600', NULL, '1115 N 200 E Ste 230', 'Logan', 'Cache', 'UT', '84341', '4357559600', '', 'DME80', '', '', '0.00', '35.00', '0.00', 3, '2009-01-13', '2011-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962438358', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'W11016032', 'W11016032', 'UT01', 'Ogden Clinic', 'Loran', 'A', 'Archuleta', 'NP', 'Family Practice', '', '', NULL, 'O', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753000', NULL, '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753000', '          ', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2008-12-23', '2011-01-03', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770635096', 0, 'N', 0, '2011-01-27', 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
('870286381', 'W11016030', 'W11016030', 'UT01', 'Ogden Clinic', 'Rodney', 'K', 'Grogan', 'PA', 'Family Practice', '', '', NULL, 'O', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753000', NULL, '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753000', '', 'WUOGDCLIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2008-12-22', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1114915170', 0, 'N', 0, '2013-01-29', NULL, NULL, 41.1787, -111.949, NULL, NULL),
('870286381', 'W11016028', 'W11016028', 'UT01', 'Ogden Clinic', 'Tanya', '', 'Chesley', 'PAC', 'Family Practice', '', '', NULL, 'O', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753000', NULL, '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753000', '          ', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2008-12-23', '2010-09-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477541506', 0, 'N', 0, '2010-09-07', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'W11016027', 'W11016027', 'UT01', 'Ogden Clinic', 'Kevin', 'L', 'Stucki', 'DO', 'Orthopedic Surgery', '', '', NULL, 'O', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753000', NULL, '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753000', '', 'WUOGDCLIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2008-12-23', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1306975701', 0, 'N', 0, '2012-01-17', NULL, NULL, 41.1787, -111.949, NULL, NULL),
('870286381', 'W11016031', 'W11016031', 'UT01', 'Ogden Clinic', 'Loran', 'A', 'Archuleta', 'NP', 'Family Practice', '', '', NULL, 'O', '1159 E 12th St', 'Ogden', 'Weber', 'UT', '84404', '8014753700', NULL, '1159 E 12th St', 'Ogden', 'Weber', 'UT', '84404', '8014753700', '          ', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2008-12-23', '2011-01-03', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770635096', 0, 'N', 0, '2011-01-27', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'W11016026', 'W11016026', 'UT01', 'Ogden Clinic', 'Kevin', 'L', 'Stucki', 'DO', 'Orthopedic Surgery', '', '', NULL, 'O', '6112 S 1550 E', 'South Ogden', 'Weber', 'UT', '84405', '8014753800', NULL, '6112 S 1550 E', 'South Ogden', 'Weber', 'UT', '84405', '8014753800', '          ', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2008-12-23', '2011-11-07', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1306975701', 0, 'N', 0, '2012-01-17', NULL, NULL, 0, 0, NULL, NULL),
('651229319', 'W11016042', 'W11016042', 'UT01', 'Spinal Interventions', 'Daniel', 'R', 'Faber', 'MD', 'Pain Management', 'Anesthesiology', '', NULL, 'O', '280 W  River Park Dr', 'Provo', 'Utah', 'UT', '84604', '8012234860', NULL, '280 W  River Park Dr', 'Provo', 'Utah', 'UT', '84604', '8012234860', '          ', 'WISESTD', 'WUSTDHCPC5', '1000', '48.00', '35.00', '0.00', 6, '2009-01-13', NULL, 1, 12, 0, 'Mountain View Regional Hospital', 'Timpanogos Regional Hospital', '', '', 'HCFA|UB|', '1023049418', 0, 'N', 0, '2011-12-29', NULL, NULL, 40.3037, -111.662, NULL, NULL),
('526543409', 'W11016046', 'W11016046', 'UTMH1', 'Crystal Springs', 'Philip', '', 'Washburn', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'B', '39 Professional Way Ste 2', 'Payson', 'Utah', 'UT', '84651', '8014652035', NULL, '39 Professional Way Ste 2', 'Payson', 'Utah', 'UT', '84651', '8014652035', '          ', 'UTMD-2', '', '', '0.00', '35.00', '0.00', 3, '2008-10-14', '2011-12-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558430470', 0, 'Y', 0, '2011-12-07', NULL, NULL, 0, 0, NULL, NULL),
('526543409', 'W11016047', 'W11016047', 'UTMH1', 'Crystal Springs', 'Philip', '', 'Washburn', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'B', 'PO Box 786', 'Salem', 'Utah', 'UT', '84653', '8014652035', NULL, 'PO Box 786', 'Salem', 'Utah', 'UT', '84653', '8014652035', '          ', 'UTMD-2', '', '', '0.00', '35.00', '0.00', 3, '2008-10-14', '2011-12-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558430470', 0, 'Y', 0, '2011-12-07', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11016053', 'W11016053', 'UT01', 'University Health Care', 'Uaisele', 'F', 'Panisi', 'PA', 'Family Practice', 'Physician Assistant', '', NULL, 'o', '26 S Main St', 'Centerville', 'Davis', 'UT', '84014', '8016937900', NULL, '26 S Main St', 'Centerville', 'Davis', 'UT', '84014', '8016937900', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2008-11-06', '2012-09-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538311691', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11016060', 'W11016060', 'UT01', 'University Health Care', 'Uaisele', 'F', 'Panisi', 'PA', 'Family Practice', 'Physician Assistant', '', NULL, 'o', '1492 W Antelope Ste 150', 'Layton', 'Davis', 'UT', '84041', '8017767804', NULL, '1492 W Antelope Ste 150', 'Layton', 'Davis', 'UT', '84041', '8017767804', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2008-11-06', '2012-09-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538311691', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11016056', 'W11016056', 'UT01', 'University Health Care', 'Uaisele', 'F', 'Panisi', 'PA', 'Family Practice', 'Physician Assistant', '', NULL, 'o', '7495 S State St', 'Midvale', 'Salt Lake', 'UT', '84047', '8012139400', '8012139443', '7495 S State St', 'Midvale', 'Salt Lake', 'UT', '84047', '8012139400', '8012139443', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2008-11-06', '2012-09-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538311691', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11016057', 'W11016057', 'UT01', 'University Health Care', 'Uaisele', 'F', 'Panisi', 'PA', 'Family Practice', 'Physician Assistant', '', NULL, 'o', '145 W University Pkwy', 'Orem', 'Utah', 'UT', '84058', '8012138600', NULL, '145 W University Pkwy', 'Orem', 'Utah', 'UT', '84058', '8012138600', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2008-11-06', '2012-09-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538311691', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11016055', 'W11016055', 'UT01', 'University Health Care', 'Uaisele', 'F', 'Panisi', 'PA', 'Family Practice', 'Physician Assistant', '', NULL, 'o', '220 Millpond Rd Ste 100', 'Stansbury Park', 'Tooele', 'UT', '84074', '4358433000', NULL, '220 Millpond Rd Ste 100', 'Stansbury Park', 'Tooele', 'UT', '84074', '4358433000', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2008-11-06', '2012-09-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538311691', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11016054', 'W11016054', 'UT01', 'University Health Care', 'Uaisele', 'F', 'Panisi', 'PA', 'Family Practice', 'Physician Assistant', '', NULL, 'o', '1091 W South Jordan Pkwy', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012139800', NULL, '1091 W South Jordan Pkwy', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012139800', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2008-11-06', '2012-09-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538311691', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11016058', 'W11016058', 'UT01', 'University Health Care', 'Uaisele', 'F', 'Panisi', 'PA', 'Family Practice', 'Physician Assistant', '', NULL, 'o', '1743 W Redstone Ctr Ste 115', 'Park City', 'Summit', 'UT', '84098', '4356589200', NULL, '1743 W Redstone Ctr Ste 115', 'Park City', 'Summit', 'UT', '84098', '4356589200', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2008-11-06', '2012-09-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538311691', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11016062', 'W11016062', 'UTPEHP', 'Primary Childrens Medical Center', '', '', 'Primary Childrens Medical Center', 'Group (Recognized PPO but not contracted pre-', 'Hospital', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', '', '', '', 'PRYPEHP', '0.00', '0.00', '0.00', 8, '2009-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1235148594', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
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('205934739', 'W11016090', 'W11016090', 'ID02', 'Family Medicine Health Center', 'James', 'C', 'Roscoe', 'MD', 'Family Practice', '', '', NULL, 'O', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '          ', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '          ', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2009-01-14', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1871522086', 0, 'N', 0, '2014-06-05', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W11016091', 'W11016091', 'ID02', 'Family Medicine Health Center', 'James', 'C', 'Roscoe', 'MD', 'Family Practice', '', '', NULL, 'O', '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083811775', '          ', '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083811775', '          ', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2009-01-14', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1871522086', 0, 'N', 0, '2014-06-05', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W11016092', 'W11016092', 'ID02', 'Family Medicine Health Center', 'David', 'E', 'Hall', 'DO', 'Family Practice', '', '', NULL, 'O', '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083811775', NULL, '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083811775', '          ', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2009-01-14', '2012-04-05', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1780671347', 0, 'N', 0, '2012-04-05', NULL, NULL, 0, 0, NULL, NULL),
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('841409176', 'W11016137', 'W11016137', 'UTMH1', 'Northeastern Counseling Center', 'Kevrin', 'J', 'Johnson', 'LMFT', 'Mental Health', 'Marriage & Family Therapy', '', NULL, 'O', '285 W 800 S', 'Roosevelt', 'Duchesne', 'UT', '84066', '4357256300', NULL, '285 W 800 S', 'Roosevelt', 'Duchesne', 'UT', '84066', '4357256300', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2009-01-16', '2011-09-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841373958', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('841409176', 'W11016138', 'W11016138', 'UTMH1', 'Northeastern Counseling Center', 'Ezekiel', 'W', 'Burnett', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '285 W 800 S', 'Roosevelt', 'Duchesne', 'UT', '84066', '4357256300', NULL, '285 W 800 S', 'Roosevelt', 'Duchesne', 'UT', '84066', '4357256300', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2009-01-16', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952487068', 0, 'n', 0, '2013-02-27', 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
('841409176', 'W11016139', 'W11016139', 'UTMH1', 'Northeastern Counseling Center', 'Christi', 'M', 'Harris', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1140 W 500 S', 'Vernal', 'Uintah', 'UT', '84078', '4357896300', NULL, '1140 W 500 S', 'Vernal', 'Uintah', 'UT', '84078', '4357896300', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2009-01-16', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821173394', 0, 'n', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('841409176', 'W11016140', 'W11016140', 'UTMH1', 'Northeastern Counseling Center', 'Deborah', 'J', 'McKee', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1140 W 500 S', 'Vernal', 'Uintah', 'UT', '84078', '4357896300', NULL, '1140 W 500 S', 'Vernal', 'Uintah', 'UT', '84078', '4357896300', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2009-01-16', '2012-10-17', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033324405', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('841409176', 'W11016141', 'W11016141', 'UTMH1', 'Northeastern Counseling Center', 'Jonathan', 'K', 'Beard', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1140 W 500 S', 'Vernal', 'Uintah', 'UT', '84078', '4357896300', NULL, '1140 W 500 S', 'Vernal', 'Uintah', 'UT', '84078', '4357896300', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2009-01-16', '2012-10-17', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659454866', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('841409176', 'W11016142', 'W11016142', 'UTMH1', 'Northeastern Counseling Center', 'Melody', 'A', 'Miller', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '285 W 800 S', 'Roosevelt', 'Duchesne', 'UT', '84066', '4357256300', NULL, '285 W 800 S', 'Roosevelt', 'Duchesne', 'UT', '84066', '4357256300', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2009-01-16', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508949785', 0, 'n', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('841409176', 'W11016143', 'W11016143', 'UTMH1', 'Northeastern Counseling Center', 'Tara', 'G', 'Seyfert', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1140 W 500 S', 'Vernal', 'Uintah', 'UT', '84078', '4357896300', NULL, '1140 W 500 S', 'Vernal', 'Uintah', 'UT', '84078', '4357896300', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2009-01-16', '2012-10-17', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962594218', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('841409176', 'W11016144', 'W11016144', 'UTMH1', 'Northeastern Counseling Center', 'Jonathan', 'K', 'Beard', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 1908', 'Vernal', 'Uintah', 'UT', '84078', '4357896300', NULL, 'PO Box 1908', 'Vernal', 'Uintah', 'UT', '84078', '4357896300', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2009-01-16', '2012-10-17', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659454866', 0, 'Y', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('841409176', 'W11016145', 'W11016145', 'UTMH1', 'Northeastern Counseling Center', 'Tara', 'G', 'Seyfert', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 1908', 'Vernal', 'Uintah', 'UT', '84078', '4357896300', NULL, 'PO Box 1908', 'Vernal', 'Uintah', 'UT', '84078', '4357896300', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2009-01-16', '2012-10-17', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962594218', 0, 'Y', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('841409176', 'W11016146', 'W11016146', 'UTMH1', 'Northeastern Counseling Center', 'Melody', 'A', 'Miller', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 1908', 'Vernal', 'Uintah', 'UT', '84078', '4357896300', NULL, 'PO Box 1908', 'Vernal', 'Uintah', 'UT', '84078', '4357896300', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2009-01-16', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508949785', 0, 'Y', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('841409176', 'W11016147', 'W11016147', 'UTMH1', 'Northeastern Counseling Center', 'Patricia', 'S', 'Bennett', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 1908', 'Vernal', 'Uintah', 'UT', '84078', '4357896300', NULL, 'PO Box 1908', 'Vernal', 'Uintah', 'UT', '84078', '4357896300', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2009-01-16', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720161912', 0, 'Y', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('841409176', 'W11016148', 'W11016148', 'UTMH1', 'Northeastern Counseling Center', 'Ezekiel', 'W', 'Burnett', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 1908', 'Vernal', 'Uintah', 'UT', '84078', '4357896300', NULL, 'PO Box 1908', 'Vernal', 'Uintah', 'UT', '84078', '4357896300', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2009-01-16', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952487068', 0, 'Y', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('841409176', 'W11016149', 'W11016149', 'UTMH1', 'Northeastern Counseling Center', 'Christi', 'M', 'Harris', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 1908', 'Vernal', 'Uintah', 'UT', '84078', '4357896300', NULL, 'PO Box 1908', 'Vernal', 'Uintah', 'UT', '84078', '4357896300', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2009-01-16', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821173394', 0, 'Y', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('841409176', 'W11016150', 'W11016150', 'UTMH1', 'Northeastern Counseling Center', 'Theresa', '', 'Ingram', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 1908', 'Vernal', 'Uintah', 'UT', '84078', '4357896300', NULL, 'PO Box 1908', 'Vernal', 'Uintah', 'UT', '84078', '4357896300', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2009-01-16', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003999277', 0, 'Y', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('841409176', 'W11016151', 'W11016151', 'UTMH1', 'Northeastern Counseling Center', 'Kevrin', 'J', 'Johnson', 'LMFT', 'Mental Health', 'Marriage & Family Therapy', '', NULL, 'B', 'PO Box 1908', 'Vernal', 'Uintah', 'UT', '84078', '4357896300', NULL, 'PO Box 1908', 'Vernal', 'Uintah', 'UT', '84078', '4357896300', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2009-01-16', '2011-09-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841373958', 0, 'Y', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
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('841409176', 'W11016153', 'W11016153', 'UTMH1', 'Northeastern Counseling Center', 'Jeffrey', 'M', 'Troutman', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 1908', 'Vernal', 'Uintah', 'UT', '84078', '4357896300', NULL, 'PO Box 1908', 'Vernal', 'Uintah', 'UT', '84078', '4357896300', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2009-01-16', '2012-10-17', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134258718', 0, 'Y', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('364288180', 'W11016154', 'W11016154', 'UT01', 'Gateway Medical', 'Matthew', 'J', 'Welter', 'MD', 'Family Practice', '', '', NULL, 'O', '2380 N 400 E Ste A', 'North Logan', 'Cache', 'UT', '84341', '4357879600', NULL, '2380 N 400 E Ste A', 'North Logan', 'Cache', 'UT', '84341', '4357879600', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000003057', 0, 'N', 0, '2014-01-30', NULL, NULL, 41.775, -111.823, NULL, NULL),
('364288180', 'W11016155', 'W11016155', 'UT01', 'Gateway Medical', 'Matthew', 'J', 'Welter', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 6157', 'North Logan', 'Cache', 'UT', '84341', '4357879600', NULL, 'PO Box 6157', 'North Logan', 'Cache', 'UT', '84341', '4357879600', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2009-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000003057', 0, 'Y', 0, '2014-01-30', NULL, NULL, 0, 0, NULL, NULL),
('263356633', 'W11016156', 'W11016156', 'UT01', 'Cache Valley Eye Associates PLLC', 'Matthew', 'D', 'Parry', 'OD', 'Ophthalmology', '', '', NULL, 'O', '1300 N 500 E Ste 350', 'Logan', 'Cache', 'UT', '84341', '4357527445', '4357533059', '1300 N 500 E Ste 350', 'Logan', 'Cache', 'UT', '84341', '4357527445', '4357533059', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-11-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1639256670', 0, 'N', 0, '2012-01-31', NULL, NULL, 41.7563, -111.821, NULL, NULL),
('263356633', 'W11016157', 'W11016157', 'UT01', 'Cache Valley Eye Associates PLLC', 'David', 'G', 'Waterman', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1300 N 500 E Ste 350', 'Logan', 'Cache', 'UT', '84341', '4357527445', '4357533059', '1300 N 500 E Ste 350', 'Logan', 'Cache', 'UT', '84341', '4357527445', '4357533059', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-11-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1689603284', 0, 'N', 0, '2011-03-18', NULL, NULL, 41.7563, -111.821, NULL, NULL),
('263356633', 'W11016158', 'W11016158', 'UT01', 'Cache Valley Eye Associates PLLC', 'Jon', 'A', 'Siler', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1300 N 500 E Ste 350', 'Logan', 'Cache', 'UT', '84341', '4357527445', '4357533059', '1300 N 500 E Ste 350', 'Logan', 'Cache', 'UT', '84341', '4357527445', '4357533059', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-11-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1407885007', 0, 'N', 0, '2014-03-20', NULL, NULL, 41.7563, -111.821, NULL, NULL),
('201453382', 'W11016159', 'W11016159', 'UT01', 'Park City Gynecology', 'Stephanie', 'M', 'Singer', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1441 W Ute Dr Ste 160', 'Park City', 'Summit', 'UT', '84098', '4352145335', NULL, '1441 W Ute Dr Ste 160', 'Park City', 'Summit', 'UT', '84098', '4352145335', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-01-09', '2009-01-09', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '0118463007', 0, 'N', 0, '2011-10-19', NULL, NULL, 0, 0, NULL, NULL),
('870639098', 'W11016160', 'W11016160', 'UT01', 'After Hours Medical Company - Draper', 'Megan', '', 'Lancaster', 'PA', 'Family Practice', '', '', NULL, 'O', '1126 E 12300 S', 'Draper', 'Salt Lake', 'UT', '84020', '8015450600', NULL, '1126 E 12300 S', 'Draper', 'Salt Lake', 'UT', '84020', '8015450600', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-01-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1174779136', 0, 'Y', 0, '2013-10-23', NULL, NULL, 40.5284, -111.859, NULL, NULL),
('870639098', 'W11016161', 'W11016161', 'UT01', 'After Hours Medical Company -Sandy', 'Megan', '', 'Lancaster', 'PA', 'Family Practice', '', '', NULL, 'O', '7998 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8012552000', NULL, '7998 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8012552000', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-01-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1174779136', 0, 'Y', 0, '2013-10-23', NULL, NULL, 40.6056, -111.853, NULL, NULL),
('870639098', 'W11016162', 'W11016162', 'UT01', 'After Hours Medical Company', 'Megan', '', 'Lancaster', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 1000', 'Draper', 'Salt Lake', 'UT', '84020', '8012552000', NULL, 'PO Box 1000', 'Draper', 'Salt Lake', 'UT', '84020', '8012552000', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-01-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1174779136', 0, 'Y', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('295443048', 'W11016163', 'W11016163', 'UTMH1', NULL, 'Marlo', '', 'Bennett', 'LMFT', 'Mental Health', 'Marriage & Family Therapy', '', NULL, 'O', '1887 Gold Dust Ln Ste 303', 'Park City', 'Summit', 'UT', '84060', '4359013218', NULL, '1887 Gold Dust Ln Ste 303', 'Park City', 'Summit', 'UT', '84060', '4359013218', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2009-01-09', '2009-06-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720059819', 0, 'n', 0, '2012-07-02', NULL, NULL, 0, 0, NULL, NULL),
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INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('263395512', 'W11016251', 'W11016251', 'ID02', NULL, 'Laura', 'D', 'Senderowicz', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '680 N 9th St', 'Boise', 'Ada', 'ID', '83702', '2082721339', NULL, '680 N 9th St', 'Boise', 'Ada', 'ID', '83702', '2082721339', '', 'IDMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2009-01-16', '2013-02-14', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1134151707', 0, 'n', 0, '2014-02-27', NULL, NULL, 0, 0, NULL, NULL),
('820399319', 'W11016229', 'W11016229', 'ID02', 'MRI Centers of Idaho', '', '', 'MRI Centers of Idaho', 'GROUP', 'Imaging Center', '', '', NULL, 'O', '949 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2089477000', '          ', '949 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2089477000', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2008-10-01', '2014-03-13', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1689629917', 0, 'N', 0, '2014-04-11', NULL, NULL, 0, 0, NULL, NULL),
('202075388', 'W11016245', 'W11016245', 'ID02', 'Boise Advanced Imaging', NULL, NULL, 'Boise Advanced Imaging PLLC', 'GROUP', 'Imaging Center', NULL, NULL, NULL, 'O', '949 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2089477000', NULL, NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDACN', NULL, NULL, '0.00', '15.00', '0.00', 3, '2008-10-15', NULL, 0, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1013946235', 0, 'n', 0, '2009-01-21', NULL, NULL, 0, 0, NULL, NULL),
('331078261', 'W11016228', 'W11016228', 'ID01', 'Saint Alphonsus Physicians PA', 'Achini', 'P', 'Dingman', 'MD', 'Rheumatology', '', '', NULL, 'O', '1000 N Curtis Ste 305', 'Boise', 'Ada', 'ID', '83706', '2083677800', '2083678099', '1000 N Curtis Ste 305', 'Boise', 'Ada', 'ID', '83706', '2083677800', '2083678099', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 3, '2008-12-18', '2012-03-01', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1174594758', 0, 'N', 0, '2012-03-01', NULL, NULL, 0, 0, NULL, NULL),
('202075388', 'W11016243', 'W11016243', 'ID02', 'Boise Advanced Imaging PLLC', 'Jeffrey', 'W', 'Grossman', 'MD', 'Radiologist', '', '', NULL, 'B', 'PO Box 9649', 'Boise', 'Ada', 'ID', '83707', '2084728126', NULL, 'PO Box 9649', 'Boise', 'Ada', 'ID', '83707', '2084728126', '          ', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2008-10-15', '2010-08-01', 0, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1083751366', 0, 'Y', 0, '2009-01-21', NULL, NULL, 0, 0, NULL, NULL),
('202075388', 'W11016239', 'W11016239', 'ID02', 'Boise Advanced Imaging PLLC', 'Mark', 'J', 'Baldeck', 'MD', 'Radiologist', '', '', NULL, 'B', 'PO Box 9649', 'Boise', 'Ada', 'ID', '83707', '2084728126', NULL, 'PO Box 9649', 'Boise', 'Ada', 'ID', '83707', '2084728126', '          ', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2008-10-15', '2010-08-01', 0, 0, 1, NULL, NULL, NULL, 'Saint Alphonsus Medical Center Nampa', 'HCFA|UB|', '1295788669', 0, 'Y', 0, '2009-01-21', NULL, NULL, 0, 0, NULL, NULL),
('202075388', 'W11016242', 'W11016242', 'ID02', 'Boise Advanced Imaging PLLC', 'David', 'J', 'Giles', 'MD', 'Radiologist', '', '', NULL, 'B', 'PO Box 9649', 'Boise', 'Ada', 'ID', '83707', '2084728126', NULL, 'PO Box 9649', 'Boise', 'Ada', 'ID', '83707', '2084728126', '', 'IDACN', NULL, NULL, '0.00', '15.00', '0.00', 3, '2008-10-15', NULL, 0, 0, 1, '', '', '', 'Saint Alphonsus Medical Center Nampa', 'HCFA|UB|', '1295787935', 0, 'Y', 0, '2011-06-29', NULL, NULL, 0, 0, NULL, NULL),
('202075388', 'W11016238', 'W11016238', 'ID02', 'Boise Advanced Imaging', NULL, NULL, 'Boise Advanced Imaging PLLC', 'GROUP', 'Imaging Center', NULL, NULL, NULL, 'B', 'PO Box 9649', 'Boise', 'Ada', 'ID', '83707', '2084728126', NULL, NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDACN', NULL, NULL, '0.00', '15.00', '0.00', 3, '2008-10-15', NULL, 0, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1013946235', 0, 'Y', 0, '2009-01-21', NULL, NULL, 0, 0, NULL, NULL),
('202075388', 'W11016241', 'W11016241', 'ID02', 'Boise Advanced Imaging PLLC', 'James', 'A', 'Engelhart', 'MD', 'Radiologist', '', '', NULL, 'B', 'PO Box 9649', 'Boise', 'Ada', 'ID', '83707', '2084728126', NULL, 'PO Box 9649', 'Boise', 'Ada', 'ID', '83707', '2084728126', '          ', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2008-10-15', '2010-07-01', 0, 0, 1, NULL, NULL, NULL, 'Saint Alphonsus Medical Center Nampa', 'HCFA|UB|', '1649222480', 0, 'Y', 0, '2009-01-21', NULL, NULL, 0, 0, NULL, NULL),
('202075388', 'W11016240', 'W11016240', 'ID02', 'Boise Advanced Imaging PLLC', 'Dirk', 'E', 'Bigler', 'DO', 'Radiologist', '', '', NULL, 'B', 'PO Box 9649', 'Boise', 'Ada', 'ID', '83707', '2084728126', NULL, 'PO Box 9649', 'Boise', 'Ada', 'ID', '83707', '2084728126', '          ', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2008-10-15', '2010-08-01', 0, 0, 1, NULL, NULL, NULL, 'Saint Alphonsus Medical Center Nampa', 'HCFA|UB|', '1457304776', 0, 'Y', 0, '2009-01-21', NULL, NULL, 0, 0, NULL, NULL),
('820399319', 'W11016237', 'W11016237', 'ID02', 'MRI Mobile', '', '', 'MRI Mobile', 'GROUP', 'Imaging Center', 'Diagnostic Radiology', '', NULL, 'B', 'PO Box 9589', 'Boise', 'Ada', 'ID', '83707', '2084728105', '          ', 'PO Box 9589', 'Boise', 'Ada', 'ID', '83707', '2084728105', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1881649234', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('202075388', 'W11016244', 'W11016244', 'ID02', 'Boise Advanced Imaging PLLC', 'Daniel', 'J', 'Wegner', 'MD', 'Radiologist', '', '', NULL, 'B', 'PO Box 9649', 'Boise', 'Ada', 'ID', '83707', '2084728126', NULL, 'PO Box 9649', 'Boise', 'Ada', 'ID', '83707', '2084728126', '          ', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2008-10-15', '2010-08-01', 0, 0, 1, '', '', '', 'Saint Alphonsus Medical Center Nampa', 'HCFA|UB|', '1275584997', 0, 'Y', 0, '2011-06-29', NULL, NULL, 0, 0, NULL, NULL),
('870299862', 'W11016220', 'W11016220', 'UTMH1', 'LDS Family Services', 'Faline', 'B', 'Christensen', 'LMFT', 'Mental Health', 'Marriage and Family Therapy', '', NULL, 'O', '94 E Pages Ln Ste A', 'Centerville', 'Davis', 'UT', '84014', '8013363040', NULL, '94 E Pages Ln Ste A', 'Centerville', 'Davis', 'UT', '84014', '8013363040', '', 'MA', '', '', '0.00', '35.00', '0.00', 8, '2009-01-01', '2011-06-09', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770543746', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('870299862', 'W11016219', 'W11016219', 'UTMH1', 'LDS Family Services', 'Michael', 'A', 'Negrette', 'LMFT', 'Mental Health', 'Marriage and Family Therapy', 'Social Worker', NULL, 'O', '930 W Hillfield Rd Ste A', 'Layton', 'Davis', 'UT', '84041', '8013363040', NULL, '930 W Hillfield Rd Ste A', 'Layton', 'Davis', 'UT', '84041', '8013363040', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 8, '2009-01-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255462016', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'W11016223', 'W11016223', 'UT01', 'Granger Medical Clinic', 'Michael', 'S', 'Connolly', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '12391 S 4000 W', 'Riverton', 'Salt Lake', 'UT', '84065', '8013021700', '8019683605', '12391 S 4000 W', 'Riverton', 'Salt Lake', 'UT', '84065', '8013021700', '8019683605', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-12-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', NULL, NULL, 'HCFA|UB|', '1003014374', 0, 'N', 0, '2011-11-21', NULL, NULL, 40.5226, -111.987, NULL, NULL),
('621801973', 'W11016221', 'W11016221', 'UT01', 'Neurology Associates', 'David', 'J', 'Smith', 'MD', 'Neurology', '', '', NULL, 'O', '3590 W 9000 S Ste 120', 'West Jordan', 'Salt Lake', 'UT', '84088', '8013528373', NULL, '3590 W 9000 S Ste 120', 'West Jordan', 'Salt Lake', 'UT', '84088', '8013528373', '          ', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-01-21', '2009-01-21', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578574182', 0, 'N', 0, '2012-01-19', NULL, NULL, 0, 0, NULL, NULL),
('800131999', 'W11016248', 'W11016248', 'UTMH1', '', 'Katherine', 'L', 'Lambert', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1399 S 700 E Ste 2', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8014742349', NULL, '1399 S 700 E Ste 2', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8014742349', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2009-01-15', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730266800', 0, 'Y', 0, '2012-10-12', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W11016249', 'W11016249', 'UT01', 'Copper Canyon Womens Center', 'James', 'R', 'Nelson', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3336 S Pioneer Parkway Ste 310', 'West Valley', 'Salt Lake', 'UT', '84120', '8019643865', '8019643894', '3336 S Pioneer Parkway Ste 310', 'West Valley', 'Salt Lake', 'UT', '84120', '8019643865', '8019643894', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-01-21', '2010-10-20', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1588646350', 0, 'N', 0, '2009-01-21', NULL, NULL, 0, 0, NULL, NULL),
('820371383', 'W11016252', 'W11016252', 'ID02', 'Valley Family Health Care', 'Angela', 'C', 'Hoffman Radimer', 'PA-C', 'Family Practice', '', '', NULL, 'O', '207 E 12th St', 'Emmett', 'Gem', 'ID', '83617', '2083651065', NULL, '207 E 12th St', 'Emmett', 'Gem', 'ID', '83617', '2083651065', '', 'IDSTDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 6, '2009-02-01', NULL, 0, 0, 1, 'Walter Knox Memorial Hospital', '', '', '', 'HCFA|UB|', '1386756849', 0, 'N', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('820371383', 'W11016253', 'W11016253', 'ID02', 'Valley Family Health Care', 'Angela', 'C', 'Hoffman Radimer', 'PA-C', 'Family Practice', '', '', NULL, 'B', 'PO Box 429', 'Emmett', 'Gem', 'ID', '83617', '2083651065', NULL, 'PO Box 429', 'Emmett', 'Gem', 'ID', '83617', '2083651065', '', 'IDSTDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 6, '2009-02-01', NULL, 0, 0, 1, 'Walter Knox Memorial Hospital', '', '', '', 'HCFA|UB|', '1386756849', 0, 'y', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('820371383', 'W11016254', 'W11016254', 'ID02', 'Valley Family Health Care', 'Marcia', 'A', 'Strahn', 'CNM', 'Obstetrics and Gynecology', 'Family Practice', '', NULL, 'O', '207 E 12th St', 'Emmett', 'Gem', 'ID', '83617', '2083651065', NULL, '207 E 12th St', 'Emmett', 'Gem', 'ID', '83617', '2083651065', '          ', 'IDSTDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 6, '2009-02-01', '2014-02-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1215938030', 0, 'N', 0, '2014-02-24', NULL, NULL, 0, 0, NULL, NULL),
('820371383', 'W11016255', 'W11016255', 'ID02', 'Valley Family Health Care', 'Marcia', 'A', 'Strahn', 'CNM', 'Obstetrics and Gynecology', 'Family Practice', '', NULL, 'B', 'PO Box 429', 'Emmett', 'Gem', 'ID', '83617', '2083651065', NULL, 'PO Box 429', 'Emmett', 'Gem', 'ID', '83617', '2083651065', '          ', 'IDSTDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 6, '2009-02-01', '2014-02-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1215938030', 0, 'N', 0, '2014-02-24', NULL, NULL, 0, 0, NULL, NULL),
('900188420', 'W11016256', 'W11016256', 'UT01', 'Gynecology Affiliates', 'Lisa', 'A', 'Morgan', 'MD', 'Gynecology', 'Obstetrics and Gynecology', '', NULL, 'O', '1140 E 3900 S Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012688222', '8012689926', '1140 E 3900 S Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012688222', '8012689926', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-01-09', '2011-03-17', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215904685', 0, 'N', 0, '2011-03-23', NULL, NULL, 0, 0, NULL, NULL),
('820529971', 'W11016257', 'W11016257', 'ID02', 'Childrens Therapy Place Inc', 'Erica', 'A', 'Hubbard', 'SLP', 'Speech Therapy', 'Speech Therapy', '', NULL, 'O', '6855 W Fairview Ave Ste 120', 'Boise', 'Ada', 'ID', '83704', '2083238888', NULL, '6855 W Fairview Ave Ste 120', 'Boise', 'Ada', 'ID', '83704', '2083238888', '          ', 'WestRehab', '', '', '0.00', '0.00', '65.00', 3, '2009-01-22', '2011-09-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1891832655', 0, 'N', 0, '2012-04-24', NULL, NULL, 0, 0, NULL, NULL),
('820529971', 'W11016258', 'W11016258', 'ID02', 'Childrens Therapy Place Inc', 'Kara', 'M', 'Book', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '6855 W Fairview Ave Ste 120', 'Boise', 'Ada', 'ID', '83704', '2083238888', NULL, '6855 W Fairview Ave Ste 120', 'Boise', 'Ada', 'ID', '83704', '2083238888', '          ', 'WestRehab', '', '', '0.00', '0.00', '65.00', 3, '2009-01-22', '2009-05-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1649335506', 0, 'N', 0, '2012-04-26', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W11016259', 'W11016259', 'UT01', 'Davis Internal Medicine', 'Michael', 'T', 'Jacobson', 'MD', 'Family Practice', '', '', NULL, 'B', '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8017737500', NULL, '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8017737500', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-01-22', '2010-08-19', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1902016504', 0, 'Y', 0, '2010-03-17', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W11016260', 'W11016260', 'UT01', 'Davis Internal Medicine', 'Michael', 'T', 'Jacobson', 'MD', 'Family Practice', '', '', NULL, 'O', '1492 W Antelope Dr Ste 203', 'Layton', 'Davis', 'UT', '84041', '8017737500', NULL, '1492 W Antelope Dr Ste 203', 'Layton', 'Davis', 'UT', '84041', '8017737500', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-01-22', '2010-08-19', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1902016504', 0, 'N', 0, '2010-03-17', NULL, NULL, 0, 0, NULL, NULL),
('261703236', 'W11016280', 'W11016280', 'UTMH1', 'Clinical Consultants LLC', 'Christopher', 'M', 'Lang', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '2351 Grant Ave Ste 100', 'Ogden', 'Weber', 'UT', '84401', '8016218670', NULL, '2351 Grant Ave Ste 100', 'Ogden', 'Weber', 'UT', '84401', '8016218670', '          ', 'UTMD', '', '', '0.00', '35.00', '0.00', 6, '2009-01-28', '2011-08-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1174502546', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('519948109', 'W11016261', 'W11016261', 'ID01', 'Copper Creek Counseling', 'Victor', 'W', 'Durnil', 'LCPC', 'Mental Health', 'Counseling', '', NULL, 'O', '2971 E Copper Point Dr Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2083765683', NULL, '2971 E Copper Point Dr Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2083765683', '          ', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2009-01-22', '2012-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528027182', 0, 'N', 0, '2012-11-27', NULL, NULL, 0, 0, NULL, NULL),
('870632874', 'W11016262', 'W11016262', 'UT01', 'Asthma & Allergy Clinic of Utah', 'Kay', 'B', 'Walker', 'MD', 'Allergy and Immunology', 'Asthma', '', NULL, 'O', '1121 E 3900 S Ste C 130', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012811300', '8012815973', '1121 E 3900 S Ste C 130', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012811300', '8012815973', 'WiseSTD8', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-01-26', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1083608095', 0, 'N', 0, '2013-10-30', NULL, NULL, 40.6871, -111.859, NULL, NULL),
('621560557', 'W11016263', 'W11016263', 'IDREC', 'The Clinic at Middleton', '', '', 'The Clinic at Middleton', 'GROUP', 'Family Practice', '', '', NULL, 'O', '201 S 1st Ave', 'Middleton', 'Canyon', 'ID', '83644', '2085856311', '8014797795', '201 S 1st Ave', 'Middleton', 'Canyon', 'ID', '83644', '2085856311', '8014797795', '', '', '', '0.00', '0.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1609818483', 0, 'N', 0, '2014-01-21', NULL, NULL, 0, 0, NULL, NULL),
('621560557', 'W11016264', 'W11016264', 'ID02', 'Physician Services of Utah', NULL, NULL, 'Physician Services of Utah', 'GROUP', 'Family Practice', NULL, NULL, NULL, 'B', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2084553908', '8014797795', '5740 Crestwood Dr', 'Ogden', 'Canyon', 'UT', '84405', NULL, NULL, 'IDACN', NULL, NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000008196', 0, 'y', 0, '2009-01-26', NULL, NULL, 0, 0, NULL, NULL),
('621560557', 'W11016265', 'W11016265', 'ID02', 'The Clinic at Parma', '', '', 'The Clinic at Parma', 'GROUP', 'Family Practice', '', '', NULL, 'O', '307 Grove St', 'Parma', 'Canyon', 'ID', '83660', '2087225147', '8014797795', '307 Grove St', 'Parma', 'Canyon', 'ID', '83660', '2087225147', '8014797795', 'IDACN', NULL, NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1740223502', 0, 'N', 0, '2013-12-05', NULL, NULL, 0, 0, NULL, NULL),
('621560557', 'W11016266', 'W11016266', 'ID02', 'The Clinic at New Plymouth', '', '', 'The Clinic at New Plymouth', 'GROUP', 'Family Practice', '', '', NULL, 'O', '112 S Plymouth', 'New Plymouth', 'Payette', 'ID', '83655', '2082783406', '8014797795', '112 S Plymouth', 'New Plymouth', 'Payette', 'ID', '83655', '2082783406', '8014797795', 'IDACN', NULL, NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000009045', 0, 'N', 0, '2013-12-05', NULL, NULL, 0, 0, NULL, NULL),
('621560557', 'W11016267', 'W11016267', 'ID02', 'The Clinic at Wilder', '', '', 'The Clinic at Wilder', 'GROUP', 'Family Practice', '', '', NULL, 'O', '215 3rd St', 'Wilder', 'Canyon', 'ID', '83676', '2084827430', '8014797795', '215 3rd St', 'Wilder', 'Canyon', 'ID', '83676', '2084827430', '8014797795', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1245267467', 0, 'N', 0, '2013-12-05', NULL, NULL, 43.6779, -116.91, NULL, NULL),
('820277763', 'W11016268', 'W11016268', 'ID01', 'Norco', '', '', 'Norco', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '400 SE 10th St', 'Ontario', 'Malheur', 'OR', '97914', '5418899327', '5418892669', '400 SE 10th St', 'Ontario', 'Malheur', 'OR', '97914', '5418899327', '5418892669', 'DME80', '', '', '0.00', '35.00', '0.00', 3, '2008-07-11', '2014-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902960396', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W11016297', 'W11016297', 'WY01', 'Intermountain Utah Heart Group', 'James', 'Lee', 'Burke', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '702 Onyx St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078774496', NULL, '702 Onyx St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078774496', '', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-01-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154399459', 0, 'N', 0, '2014-05-19', NULL, NULL, 41.7896, -110.541, NULL, NULL),
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