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
('870414075', 'W12002971', 'W12002971', 'UT01', 'Cherry Tree Family Practice', NULL, NULL, 'Cherry Tree Family Practice', 'GROUP', NULL, '', '', NULL, 'O', '155 N 400 W', 'Orem', 'Utah', 'UT', '84057', '8012241300', NULL, '155 N 400 W', 'Orem', 'Utah', 'UT', '84057', '8012241300', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000005669', 0, 'Y', 0, '2006-10-19', NULL, NULL, 40.2999, -111.705, NULL, NULL),
('870414075', 'W12002972', 'W12002972', 'UT01', 'Cherry Tree Family Practice', 'Gary', 'E', 'Cripe', 'PA', 'Family Practice', '', '', NULL, 'o', '155 N 400 W Ste B6', 'Orem', 'Utah', 'UT', '84057', '8012241300', '8012253236', '155 N 400 W Ste B6', 'Orem', 'Utah', 'UT', '84057', '8012241300', '8012253236', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-15', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1780801753', 0, 'N', 0, '2006-10-17', NULL, NULL, 40.2999, -111.705, NULL, NULL),
('870414075', 'W12002973', 'W12002973', 'UT01', 'Cherry Tree Family Practice', 'Shelly', 'A', 'Day', 'NP', 'Family Practice', '', '', NULL, 'o', '155 N 400 W Ste B6', 'Orem', 'Utah', 'UT', '84057', '8012241300', NULL, '155 N 400 W Ste B6', 'Orem', 'Utah', 'UT', '84057', '8012241300', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-15', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1235352188', 0, 'N', 0, '2010-07-15', NULL, NULL, 40.2999, -111.705, NULL, NULL),
('870414075', 'W12002974', 'W12002974', 'UT01', 'Cherry Tree Family Practice', 'William', 'D', 'Preston', 'MD', 'Family Practice', '', '', NULL, 'O', '155 N 400 W Ste B6', 'Orem', 'Utah', 'UT', '84057', '8012241300', '          ', '155 N 400 W Ste B6', 'Orem', 'Utah', 'UT', '84057', '8012241300', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-15', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1396709903', 0, 'N', 1, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870441813', 'W12002975', 'W12002975', 'UT01', '', 'Steven', 'D', 'Rowley', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '48 N 1100 E Ste B', 'American Fork', 'Utah', 'UT', '84003', '8013735211', '', '48 N 1100 E Ste B', 'American Fork', 'Utah', 'UT', '84003', '8013735211', '', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-15', '2011-01-31', 0, 0, 0, 'Central Valley Medical Center', '', '', '', 'HCFA|UB|', '1124121538', 0, 'N', 0, '2014-07-23', NULL, NULL, 0, 0, NULL, NULL),
('870471479', 'W12002977', 'W12002977', 'UT01', 'Wasatch Medical Center', 'Thomas', 'R', 'Carn', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '575 S State St', 'Orem', 'Utah', 'UT', '84058', '8012252926', NULL, '575 S State St', 'Orem', 'Utah', 'UT', '84058', '8012252926', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-15', '2011-01-23', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1194774588', 0, 'N', 0, '2013-11-21', NULL, NULL, 0, 0, NULL, NULL),
('870471479', 'W12002978', 'W12002978', 'UT01', 'Wasatch Medical Center', 'Maynard', 'R', 'Olsen', 'MD', 'Family Practice', '', '', NULL, 'O', '575 S State St', 'Orem', 'Utah', 'UT', '84058', '8012252926', NULL, '575 S State St', 'Orem', 'Utah', 'UT', '84058', '8012252926', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-15', '2011-01-23', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1518067347', 0, 'N', 0, '2014-01-24', NULL, NULL, 0, 0, NULL, NULL),
('870471479', 'W12002979', 'W12002979', 'UT01', 'Wasatch Medical Center', 'David', 'N', 'Peterson', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '575 S State St', 'Orem', 'Utah', 'UT', '84058', '8012252926', NULL, '575 S State St', 'Orem', 'Utah', 'UT', '84058', '8012252926', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-15', '2011-01-23', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659321990', 0, 'N', 0, '2013-10-30', NULL, NULL, 0, 0, NULL, NULL),
('870471479', 'W12002980', 'W12002980', 'UT01', 'Wasatch Medical Center', 'Scott', 'D', 'Peterson', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '575 S State St', 'Orem', 'Utah', 'UT', '84058', '8012252926', NULL, '575 S State St', 'Orem', 'Utah', 'UT', '84058', '8012252926', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-15', '2011-01-23', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1427008812', 0, 'N', 0, '2013-09-25', NULL, NULL, 0, 0, NULL, NULL),
('870471479', 'W12002981', 'W12002981', 'UT01', 'Wasatch Medical Center', NULL, NULL, 'Wasatch Medical Center', 'GROUP', NULL, '', '', NULL, 'O', '575 S State St', 'Orem', 'Utah', 'UT', '84058', '8012252926', NULL, '575 S State St', 'Orem', 'Utah', 'UT', '84058', '8012252926', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000009516', 0, 'Y', 0, '2006-10-19', NULL, NULL, 40.2865, -111.69, NULL, NULL),
('870503931', 'W12002982', 'W12002982', 'UT01', 'Southwestern OBGYN', 'Steven ', 'J', 'Dewey', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '39 Professional Way Ste 3', 'Payson', 'Utah', 'UT', '84651', '8014659263', '', '39 Professional Way Ste 3', 'Payson', 'Utah', 'UT', '84651', '8014659263', '', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-15', NULL, 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1356358147', 0, 'N', 0, '2014-07-25', NULL, NULL, 40.0442, -111.712, NULL, NULL),
('870503931', 'W12002983', 'W12002983', 'UT01', 'Southwestern OBGYN', 'Steven ', 'J', 'Dewey', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '777 N 500 W Ste 203', 'Provo', 'Utah', 'UT', '84601', '8013758889', '', '777 N 500 W Ste 203', 'Provo', 'Utah', 'UT', '84601', '8013758889', '', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-15', NULL, 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1356358147', 0, 'N', 0, '2014-07-25', NULL, NULL, 40.244, -111.667, NULL, NULL),
('870507858', 'W12002984', 'W12002984', 'UT01', 'Neurological Associates', '', '', 'Neurological Associates', 'GROUP', 'Neurology', '', '', NULL, 'O', '50 S Medical Dr', 'Payson', 'Utah', 'UT', '84651', '8014654809', NULL, '50 S Medical Dr', 'Payson', 'Utah', 'UT', '84651', '8014654809', '', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912963372', 0, 'Y', 0, '2014-04-15', NULL, NULL, 40.0437, -111.714, NULL, NULL),
('870507858', 'W12002985', 'W12002985', 'UT01', 'Neurological Associates', '', '', 'Neurological Associates', 'GROUP', 'Neurology', '', '', NULL, 'O', '52 N 1100 E', 'American Fork', 'Utah', 'UT', '84003', '8017630901', NULL, '52 N 1100 E', 'American Fork', 'Utah', 'UT', '84003', '8017630901', '', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912963372', 0, 'Y', 0, '2014-04-15', NULL, NULL, 40.3776, -111.769, NULL, NULL),
('870507858', 'W12002986', 'W12002986', 'UT01', 'Neurological Associates', 'Christopher', 'J', 'Reynolds', 'MD', 'Neurology', 'Sleep Medicine', '', NULL, 'O', '50 S Medical Dr Ste 4', 'Payson', 'Utah', 'UT', '84651', '8014654809', NULL, '50 S Medical Dr Ste 4', 'Payson', 'Utah', 'UT', '84651', '8014654809', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-15', '2011-10-26', 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1700843695', 0, 'N', 0, '2013-12-10', NULL, NULL, 0, 0, NULL, NULL),
('870507858', 'W12002987', 'W12002987', 'UT01', 'Neurological Associates', 'Christopher', 'J', 'Reynolds', 'MD', 'Neurology', 'Sleep Medicine', '', NULL, 'O', '52 N 1100 E', 'American Fork', 'Utah', 'UT', '84003', '8017630901', NULL, '52 N 1100 E', 'American Fork', 'Utah', 'UT', '84003', '8017630901', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-15', NULL, 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1700843695', 0, 'N', 0, '2013-12-10', NULL, NULL, 40.3776, -111.769, NULL, NULL),
('870507858', 'W12002988', 'W12002988', 'UT01', 'Neurological Associates', 'Christopher', 'J', 'Reynolds', 'MD', 'Neurology', 'Sleep Medicine', '', NULL, 'O', '700 W 800 N Ste 330', 'Orem', 'Utah', 'UT', '84057', '8014267748', NULL, '700 W 800 N Ste 330', 'Orem', 'Utah', 'UT', '84057', '8014267748', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-15', NULL, 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1700843695', 0, 'N', 0, '2013-12-10', NULL, NULL, 40.3121, -111.713, NULL, NULL),
('870507858', 'W12002989', 'W12002989', 'WY01', 'Neurological Associates', 'Christopher', 'J', 'Reynolds', 'MD', 'Neurology', 'Sleep Medicine', '', NULL, 'O', '196 Arrowhead Dr Ste 5', 'Evanston', 'Uinta', 'WY', '82930', '8662909881', NULL, '196 Arrowhead Dr Ste 5', 'Evanston', 'Uinta', 'WY', '82930', '8662909881', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-15', NULL, 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1700843695', 0, 'N', 0, '2013-12-10', NULL, NULL, 41.2435, -110.998, NULL, NULL),
('870507858', 'W12002990', 'W12002990', 'UT01', 'Neurological Associates', 'Mohammad', 'E', 'Taher', 'MD', 'Neurology', NULL, NULL, NULL, 'O', '50 S Medical Dr Ste 4', 'Payson', 'Utah', 'UT', '84651', '8014654809', NULL, '50 S Medical Dr Ste 4', 'Payson', 'Utah', 'UT', '84651', '8014654809', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-15', NULL, 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1992762918', 0, 'N', 0, '2011-06-10', NULL, NULL, 40.0437, -111.714, NULL, NULL),
('870507858', 'W12002991', 'W12002991', 'UT01', 'Neurological Associates', 'Mohammad', 'E', 'Taher', 'MD', 'Neurology', NULL, NULL, NULL, 'O', '52 N 1100 E', 'American Fork', 'Utah', 'UT', '84003', '8017630901', NULL, '52 N 1100 E', 'American Fork', 'Utah', 'UT', '84003', '8017630901', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-15', NULL, 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1992762918', 0, 'N', 0, '2011-06-10', NULL, NULL, 40.3776, -111.769, NULL, NULL),
('870507858', 'W12002992', 'W12002992', 'UT01', 'Neurological Associates', 'Mohammad', 'E', 'Taher', 'MD', 'Neurology', NULL, NULL, NULL, 'O', '700 W 800 N Ste 330', 'Orem', 'Utah', 'UT', '84057', '8014267748', NULL, '700 W 800 N Ste 330', 'Orem', 'Utah', 'UT', '84057', '8014267748', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-15', NULL, 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1992762918', 0, 'N', 0, '2011-06-10', NULL, NULL, 40.3121, -111.713, NULL, NULL),
('870507858', 'W12002993', 'W12002993', 'WY01', 'Neurological Associates', 'Mohammad', 'E', 'Taher', 'MD', 'Neurology', NULL, NULL, NULL, 'O', '196 Arrowhead Dr Ste 5', 'Evanston', 'Uinta', 'WY', '82930', '8662909881', NULL, '196 Arrowhead Dr Ste 5', 'Evanston', 'Uinta', 'WY', '82930', '8662909881', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-15', NULL, 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1992762918', 0, 'N', 0, '2011-06-10', NULL, NULL, 41.2435, -110.998, NULL, NULL),
('870516264', 'W12002994', 'W12002994', 'UT01', 'Utah County Surgical Associates', 'Craig', 'S', 'Cook', 'MD', 'General Surgery', NULL, NULL, NULL, 'O', '3550 N University Ave Ste 250', 'Provo', 'Utah', 'UT', '84604', '8013749625', NULL, '3550 N University Ave Ste 250', 'Provo', 'Utah', 'UT', '84604', '8013749625', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-07-15', '2010-12-31', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1851347090', 0, 'N', 0, '2013-05-06', NULL, NULL, 0, 0, NULL, NULL),
('870516264', 'W12002995', 'W12002995', 'UT01', 'Utah County Surgical Associates', 'David', 'P', 'Garry', 'MD', 'General Surgery', NULL, NULL, NULL, 'O', '3550 N University Ave Ste 250', 'Provo', 'Utah', 'UT', '84604', '8013749625', '8013749690', '3550 N University Ave Ste 250', 'Provo', 'Utah', 'UT', '84604', '8013749625', '8013749690', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-07-15', '2010-12-31', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1497702252', 0, 'N', 0, '2013-05-06', NULL, NULL, 0, 0, NULL, NULL),
('870516264', 'W12002996', 'W12002996', 'UT01', 'Utah County Surgical Assoc', 'Douglas', 'J', 'Lichti', 'MD', 'General Surgery', NULL, NULL, NULL, 'O', '3550 N University Ave Ste 250', 'Provo', 'Utah', 'UT', '84604', '8013749625', NULL, '3550 N University Ave Ste 250', 'Provo', 'Utah', 'UT', '84604', '8013749625', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-07-15', '2010-12-31', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1417995325', 0, 'N', 0, '2013-05-06', NULL, NULL, 0, 0, NULL, NULL),
('870516264', 'W12002997', 'W12002997', 'UT01', 'Utah County Surgical Associates', 'Clark', 'W', 'Sheffield', 'MD', 'General Surgery', '', '', NULL, 'O', '1159 E 200 N Ste 350', 'American Fork', 'Utah', 'UT', '84003', '8017564781', NULL, '1159 E 200 N Ste 350', 'American Fork', 'Utah', 'UT', '84003', '8017564781', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-07-15', '2012-09-30', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1417906181', 0, 'N', 0, '2013-05-06', NULL, NULL, 0, 0, NULL, NULL),
('870516264', 'W12002998', 'W12002998', 'UT01', 'Utah County Surgical Associates', 'Richard', 'M', 'Thomas', 'MD', 'General Surgery', NULL, NULL, NULL, 'O', '3550 N University Ave Ste 250', 'Provo', 'Utah', 'UT', '84604', '8013749625', NULL, '3550 N University Ave Ste 250', 'Provo', 'Utah', 'UT', '84604', '8013749625', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-07-15', '2010-12-31', 0, 0, 0, 'Timpanogos Regional Hospital', 'Mountain View Hospital', '', '', 'HCFA|UB|', '1215977517', 0, 'N', 0, '2013-05-06', NULL, NULL, 0, 0, NULL, NULL),
('870525682', 'W12002999', 'W12002999', 'UT01', 'Retina Associates of Utah', 'Gregory', 'S', 'Brinton', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '1055 N 300 W Ste 420', 'Provo', 'Utah', 'UT', '84604', '8013577999', '8013577020', '1055 N 300 W Ste 420', 'Provo', 'Utah', 'UT', '84604', '8013577999', '8013577020', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-15', '2011-01-31', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053397752', 0, 'N', 0, '2011-09-12', NULL, NULL, 0, 0, NULL, NULL),
('870525682', 'W12003000', 'W12003000', 'UT01', 'Retina Associates of Utah', 'Gregory', 'S', 'Brinton', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '1660 W Antelope Dr Ste 325', 'Layton', 'Davis', 'UT', '84041', '8017758222', '8017758223', '1660 W Antelope Dr Ste 325', 'Layton', 'Davis', 'UT', '84041', '8017758222', '8017758223', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-15', '2011-01-31', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053397752', 0, 'N', 0, '2011-09-12', NULL, NULL, 0, 0, NULL, NULL),
('870525682', 'W12003001', 'W12003001', 'UT01', 'Retina Associates of Utah', 'Gregory', 'S', 'Brinton', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '272 1/2 N Main St', 'Logan', 'Cache', 'UT', '84321', '8013122020', '8013122022', '272 1/2 N Main St', 'Logan', 'Cache', 'UT', '84321', '8013122020', '8013122022', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-15', '2011-01-31', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053397752', 0, 'N', 0, '2011-09-12', NULL, NULL, 0, 0, NULL, NULL),
('870525682', 'W12003002', 'W12003002', 'UT01', 'Retina Associates of Utah', 'Gregory', 'S', 'Brinton', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '5169 S Cottonwood St Bldg B Ste 630', 'Murray', 'Salt Lake', 'UT', '84107', '8013122020', '8013122022', '5169 S Cottonwood St Bldg B Ste 630', 'Murray', 'Salt Lake', 'UT', '84107', '8013122020', '8013122022', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-15', '2011-01-31', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053397752', 0, 'N', 0, '2011-09-12', NULL, NULL, 0, 0, NULL, NULL),
('820309671', 'W12001918', 'W12001918', 'ID02', 'OB/GYN Associates PA (PPO Access Applies to this provider at this location only)', 'Theodore', '', 'Colwell', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '315 E Elm St Ste 310', 'Caldwell', 'Canyon', 'ID', '83605', '2084542035', '2084551784', '315 E Elm St Ste 310', 'Caldwell', 'Canyon', 'ID', '83605', '2084542035', '2084551784', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2010-04-26', '2014-07-14', 0, 0, 1, 'West Valley Medical Center', '', '', '', 'HCFA|UB|', '1598735391', 0, 'N', 0, '2014-07-10', NULL, NULL, 43.6539, -116.695, NULL, NULL),
('820309671', 'W12001920', 'W12001920', 'ID02', 'OB/GYN Associates PA (PPO Access Applies to this provider at this location only)', 'Theodore', '', 'Colwell', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '520 S Eagle Rd Ste 1221', 'Meridian', 'Ada', 'ID', '83642', '2089550350', '2084551784', '520 S Eagle Rd Ste 1221', 'Meridian', 'Ada', 'ID', '83642', '2089550350', '2084551784', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2010-04-26', '2011-01-01', 0, 0, 1, 'West Valley Medical Center', '', '', '', 'HCFA|UB|', '1598735391', 0, 'N', 0, '2014-07-10', NULL, NULL, 43.5995, -116.352, NULL, NULL),
('870525682', 'W12003003', 'W12003003', 'UT01', 'Retina Associates of Utah', 'James', 'G', 'Howard', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1055 N 300 W Ste 420', 'Provo', 'Utah', 'UT', '84604', '8013577999', '8013577020', '1055 N 300 W Ste 420', 'Provo', 'Utah', 'UT', '84604', '8013577999', '8013577020', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-15', '2011-01-30', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1033110119', 0, 'N', 0, '2013-08-01', NULL, NULL, 0, 0, NULL, NULL),
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('870546501', 'W12003036', 'W12003036', 'UT01', 'Alpine Pediatrics', 'William', 'F', 'Edwards', 'MD', 'Pediatrics', '', '', NULL, 'B', '1912 W 930 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8014921999', '8014921991', '1912 W 930 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8014921999', '8014921991', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-15', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1063450328', 0, 'N', 0, '2013-09-25', 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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('870549057', 'W12003065', 'W12003065', 'UT01', 'Utah Valley Pediatrics', 'Melissa', '', 'Kendall', 'MD', 'Pediatrics', '', '', NULL, 'O', '716 W 800 N Ste 300', 'Orem', 'Utah', 'UT', '84057', '8012240421', NULL, '716 W 800 N Ste 300', 'Orem', 'Utah', 'UT', '84057', '8012240421', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-15', '2011-03-31', 0, 0, 0, 'Timpanogos Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1598772089', 0, 'N', 0, '2014-02-06', NULL, NULL, 0, 0, NULL, NULL),
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('870577952', 'W12003134', 'W12003134', 'UT01', 'Western Newborn Specialists', 'Joan', '', 'Nold', 'MD', 'Neonatology', '', '', NULL, 'B', 'PO Box 520691', 'Salt Lake City', 'Salt Lake', 'UT', '84152', '8012687111', NULL, 'PO Box 520691', 'Salt Lake City', 'Salt Lake', 'UT', '84152', '8012687111', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1497708481', 0, 'N', 0, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
('204240264', 'W12003137', 'W12003137', 'UT01', 'Southwest Skin and Cancer', 'Greg ', 'R', 'Jacobsen', 'MD', 'Dermatology', '', '', NULL, 'O', '383 S 300 E', 'St George', 'Washington', 'UT', '84770', '4356282826', NULL, '383 S 300 E', 'St George', 'Washington', 'UT', '84770', '4356282826', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-10', NULL, 0, NULL, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1811105745', 0, 'N', 0, '2011-11-11', NULL, NULL, 37.1016, -113.577, NULL, NULL),
('270573539', 'W12003138', 'W12003138', 'UT01', 'Utah Orthopaedics', 'Zachary', 'D', 'Post', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '5782 Adams Ave Pkwy', 'Ogden', 'Weber', 'UT', '84405', '8019178000', NULL, '5782 Adams Ave Pkwy', 'Ogden', 'Weber', 'UT', '84405', '8019178000', '          ', 'WiseOgOrtho', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-12-01', '2011-11-10', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1962443606', 0, 'N', 0, '2011-11-21', NULL, NULL, 0, 0, NULL, NULL),
('270573539', 'W12003139', 'W12003139', 'UT01', 'Utah Orthopaedics', 'Zachary', 'D', 'Post', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 14', 'Lewiston', 'Cache', 'UT', '84320', '8019178000', NULL, 'PO Box 14', 'Lewiston', 'Cache', 'UT', '84320', '8019178000', '          ', 'WiseOgOrtho', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-12-01', '2011-11-10', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1962443606', 0, 'N', 0, '2011-11-21', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12003141', 'W12003141', 'UT01', 'Jordan Valley Hospital', 'Donna', 'M', 'Thompson', 'APRN', 'Family Practice', '', '', NULL, 'O', '3460 S Pioneer Pkwy', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643100', NULL, '3460 S Pioneer Pkwy', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643100', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-06-07', '2010-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467615476', 0, 'N', 0, '2011-10-06', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12003140', 'W12003140', 'UT01', 'Jordan Valley Hospital', 'Donna', 'M', 'Thompson', 'APRN', 'Family Practice', '', '', NULL, 'O', '3580 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015618888', NULL, '3580 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015618888', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-06-07', '2010-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467615476', 0, 'N', 0, '2011-10-06', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12003142', 'W12003142', 'UT01', 'Jordan Valley Hospital', 'Donna', 'M', 'Thompson', 'APRN', 'Family Practice', '', '', NULL, 'M', '406 W S Jordan Pkwy Ste 450', 'South Jordan', 'Salt Lake', 'UT', '84095', '8019643100', NULL, '406 W S Jordan Pkwy Ste 450', 'South Jordan', 'Salt Lake', 'UT', '84095', '8019643100', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-06-07', '2010-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467615476', 0, 'N', 0, '2011-10-06', NULL, NULL, 0, 0, NULL, NULL),
('870710584', 'W12003144', 'W12003144', 'UTMH1', 'Jordan West Family Counseling', 'Maggie', '', 'Bowling', 'LCSW', 'Mental Health', '', '', NULL, 'O', '9263 Redwood Rd Bldg 8 Ste B', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660749', '8015667108', '9263 Redwood Rd Bldg 8 Ste B', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660749', '8015667108', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2010-10-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538480058', 0, 'N', 0, '2010-09-20', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12003145', 'W12003145', 'WYBILLINGS', 'Billings Clinic  - Hospitalist', 'April', 'C', 'Donovan', 'APRN', 'Family Practice', '', '', NULL, 'O', '2800 10th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382572', '2800 10th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382572', '', '', '', '0.00', '17.00', '0.00', 3, '2010-06-21', '2013-12-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114044294', 0, 'N', 0, '2014-01-03', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12003146', 'W12003146', 'WY01', 'Memorial Hospital of Sweetwater County', 'Sigsbee', 'W', 'Duck', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '1204 Hilltop Dr Ste 109', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528192', '3073528126', '1204 Hilltop Dr Ste 109', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528192', '3073528126', '', '', '', '0.00', '5.00', '0.00', 3, '2011-01-01', '2014-02-09', 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1235228164', 0, 'N', 0, '2014-03-27', NULL, NULL, 41.584, -109.232, NULL, NULL),
('262102138', 'W12003147', 'W12003147', 'UT01', 'Heiden and Davidson Orthopedics', 'Eric', '', 'Heiden', 'MD', 'Orthopedic Surgery', 'Sports Medicine', '', NULL, 'O', '2200 Park Ave Bldg D Ste100', 'Park City', 'Summit', 'UT', '84060', '4356158822', NULL, '2200 Park Ave Bldg D Ste100', 'Park City', 'Summit', 'UT', '84060', '4356158822', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-12-01', '2013-11-30', 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1386896652', 0, 'N', 0, '2013-12-02', NULL, NULL, 0, 0, NULL, NULL),
('262102138', 'W12003148', 'W12003148', 'UT01', 'Heiden and Davidson Orthopedics', 'Eric', '', 'Heiden', 'MD', 'Orthopedic Surgery', 'Sports Medicine', '', NULL, 'O', '4888 S Highland Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8017038397', NULL, '4888 S Highland Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8017038397', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-12-01', '2013-11-30', 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1386896652', 0, 'N', 0, '2013-12-02', NULL, NULL, 0, 0, NULL, NULL),
('262102138', 'W12003149', 'W12003149', 'UT01', 'Heiden and Davidson Orthopedics', 'Eric', '', 'Heiden', 'MD', 'Orthopedic Surgery', 'Sports Medicine', '', NULL, 'B', 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '4356158822', NULL, 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '4356158822', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-12-01', '2012-01-01', 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1386896652', 0, 'N', 0, '2013-12-02', NULL, NULL, 0, 0, NULL, NULL),
('270573539', 'W12003150', 'W12003150', 'UT01', 'Utah Orthopaedics', 'Dann', 'C', 'Byck', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '5782 Adams Ave Pkwy', 'Ogden', 'Weber', 'UT', '84405', '8019178000', '8019178001', '5782 Adams Ave Pkwy', 'Ogden', 'Weber', 'UT', '84405', '8019178000', '8019178001', 'WiseOgOrtho', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-08-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1679565758', 0, 'N', 0, '2010-10-18', NULL, NULL, 41.1576, -111.967, NULL, NULL),
('270573539', 'W12003151', 'W12003151', 'UT01', 'Utah Orthopaedics', 'Dann', 'C', 'Byck', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'B', 'PO Box 14', 'Lewiston', 'Cache', 'UT', '84320', '8019178000', NULL, 'PO Box 14', 'Lewiston', 'Cache', 'UT', '84320', '8019178000', '          ', 'WiseOgOrtho', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-08-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1679565758', 0, 'N', 0, '2010-10-18', NULL, NULL, 0, 0, NULL, NULL),
('270573539', 'W12003153', 'W12003153', 'UT01', 'Utah Orthopaedics', 'Brandon', 'D', 'Park', 'NP', 'Orthopedic Surgery', NULL, NULL, NULL, 'B', 'PO Box 14', 'Lewiston', 'Cache', 'UT', '84320', '8019178000', NULL, 'PO Box 14', 'Lewiston', 'Cache', 'UT', '84320', '8019178000', '          ', 'WiseOgOrtho', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-08-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1811960123', 0, 'N', 0, '2013-12-02', NULL, NULL, 0, 0, NULL, NULL),
('272356984', 'W12003154', 'W12003154', 'UTMH1', 'Southern Utah Mental Health Inc.', 'David', 'C', 'Heaton', 'LCSW', 'Mental Health', '', '', NULL, 'O', '1760 S Main St Ste 103', 'Cedar City', 'Iron', 'UT', '84721', '4358670644', '4358670645', '1760 S Main St Ste 103', 'Cedar City', 'Iron', 'UT', '84721', '4358670644', '4358670645', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2010-10-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568509354', 0, 'N', 0, '2010-09-28', NULL, NULL, 0, 0, NULL, NULL),
('270573539', 'W12003155', 'W12003155', 'UT01', 'Utah Orthopaedics', 'Alexandra', 'S', 'Rocco', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '5782 Adams Ave Pkwy', 'Ogden', 'Weber', 'UT', '84405', '8019178000', '8019178001', '5782 Adams Ave Pkwy', 'Ogden', 'Weber', 'UT', '84405', '8019178000', '8019178001', 'WiseOgOrtho', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1568633915', 0, 'N', 0, '2010-11-01', NULL, NULL, 41.1576, -111.967, NULL, NULL),
('270573539', 'W12003156', 'W12003156', 'UT01', 'Utah Orthopaedics', 'Alexandra', 'S', 'Rocco', 'PA', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 14', 'Lewiston', 'Cache', 'UT', '84320', '8019178000', NULL, 'PO Box 14', 'Lewiston', 'Cache', 'UT', '84320', '8019178000', '          ', 'WiseOgOrtho', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1568633915', 0, 'N', 0, '2010-11-01', NULL, NULL, 0, 0, NULL, NULL),
('270573539', 'W12003157', 'W12003157', 'UT01', 'Utah Orthopaedics', 'Jeffrey', 'J', 'Rocco', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '5782 Adams Ave Pkwy', 'Ogden', 'Weber', 'UT', '84405', '8019178000', '8019178001', '5782 Adams Ave Pkwy', 'Ogden', 'Weber', 'UT', '84405', '8019178000', '8019178001', 'WiseOgOrtho', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-08-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1306818190', 0, 'N', 0, '2014-02-10', NULL, NULL, 41.1576, -111.967, NULL, NULL),
('270573539', 'W12003158', 'W12003158', 'UT01', 'Utah Orthopaedics', 'Jeffrey', 'J', 'Rocco', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 14', 'Lewiston', 'Cache', 'UT', '84320', '8019178000', NULL, 'PO Box 14', 'Lewiston', 'Cache', 'UT', '84320', '8019178000', '          ', 'WiseOgOrtho', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-08-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1306818190', 0, 'N', 0, '2014-02-10', NULL, NULL, 0, 0, NULL, NULL),
('270041325', 'W12003159', 'W12003159', 'UT01', 'Pinnacle Anesthesia Associates', 'Bryce', '', 'Dougal', 'CRNA', 'Anesthesia', '', '', NULL, 'B', 'PO Box 3750', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '4356374800', NULL, 'PO Box 3750', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '4356374800', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2010-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992027031', 0, 'Y', 0, '2010-08-26', NULL, NULL, 0, 0, NULL, NULL),
('270041325', 'W12003160', 'W12003160', 'UT01', 'Pinnacle Anesthesia Associates', 'Steven', 'C', 'Funk', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3750', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8007484868', '8014322670', 'PO Box 3750', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8007484868', '8014322670', '', '', '', '0.00', '20.00', '0.00', 3, '2010-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245259894', 0, 'Y', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('870481325', 'W12003161', 'W12003161', 'UT01', 'Westside Medical Clinic', 'Jeffrey', 'A', 'Goss', 'NP', 'Family Practice', '', '', NULL, 'O', '1477 N 2000 W Ste C', 'Clearfield', 'Davis', 'UT', '84015', '8017748888', '8018258519', '1477 N 2000 W Ste C', 'Clearfield', 'Davis', 'UT', '84015', '8017748888', '8018258519', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1225221807', 0, 'N', 0, '2014-04-08', NULL, NULL, 41.1353, -112.064, NULL, NULL),
('870481325', 'W12003162', 'W12003162', 'UT01', 'Westside Medical Clinic', 'Jeffrey', 'A', 'Goss', 'NP', 'Family Practice', '', '', NULL, 'M', 'PO Box 708757', 'Sandy', 'Salt Lake', 'UT', '84070', '8017748888', '8018258519', 'PO Box 708757', 'Sandy', 'Salt Lake', 'UT', '84070', '8017748888', '8018258519', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1225221807', 0, 'Y', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('270041325', 'W12003163', 'W12003163', 'UT01', 'Pinnacle Anesthesia Associates', 'Patrick', 'J', 'Knight', 'CRNA', 'Anesthesiologist', '', '', NULL, 'B', 'PO Box 3750', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8007484868', '8014322670', 'PO Box 3750', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8007484868', '8014322670', '', '', '', '0.00', '20.00', '0.00', 3, '2010-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982922928', 0, 'Y', 0, '2013-09-12', 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
('870628514', 'W12001979', 'W12001979', 'UT01', 'Avec Eye Center', 'Kevin', 'H', 'Merkley', 'MD', 'Ophthalmology', '', '', NULL, 'O', '8789 S Highland Dr Ste 100', 'Sandy', 'Salt Lake', 'UT', '84093', '8019434999', '8019433876', '8789 S Highland Dr Ste 100', 'Sandy', 'Salt Lake', 'UT', '84093', '8019434999', '8019433876', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-15', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1043256811', 0, 'N', 0, '2011-10-06', NULL, NULL, 40.59, -111.834, NULL, NULL),
('170409406', 'W12003164', 'W12003164', 'UT01', '', 'Jane', 'E', 'Henley', 'LMFT', 'Mental Health', 'Marriage and Family Therapy', '', NULL, 'O', '333 S Main St Ste 212', 'Ketchum', 'Blaine', 'ID', '83340', '2087254049', NULL, '333 S Main St Ste 212', 'Ketchum', 'Blaine', 'ID', '83340', '2087254049', '', 'IDMA', '', '', '0.00', '100.00', '0.00', 3, '2005-07-08', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912072307', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('170409406', 'W12003165', 'W12003165', 'Sinclair', '', 'Jane', 'E', 'Henley', 'LMFT', 'Mental Health', 'Marriage and Family Therapy', '', NULL, 'O', '333 S Main St Ste 212', 'Ketchum', 'Blaine', 'ID', '83340', '2087254049', NULL, '333 S Main St Ste 212', 'Ketchum', 'Blaine', 'ID', '83340', '2087254049', '', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2010-05-21', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912072307', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('170409406', 'W12003167', 'W12003167', 'WY01', '', 'Jane', 'E', 'Henley', 'LMFT', 'Mental Health', 'Marriage and Family Therapy', '', NULL, 'B', 'PO Box 2141', 'Ketchum', 'Blaine', 'ID', '83340', '2087254049', NULL, 'PO Box 2141', 'Ketchum', 'Blaine', 'ID', '83340', '2087254049', '', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2010-05-21', '2010-05-21', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912072307', 0, 'Y', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('170409406', 'W12003168', 'W12003168', 'Sinclair', '', 'Jane', 'E', 'Henley', 'LMFT', 'Mental Health', 'Marriage and Family Therapy', '', NULL, 'B', 'PO Box 2141', 'Ketchum', 'Blaine', 'ID', '83340', '2087254049', NULL, 'PO Box 2141', 'Ketchum', 'Blaine', 'ID', '83340', '2087254049', '', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2010-05-21', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912072307', 0, 'Y', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('870635889', 'W12001834', 'W12001834', 'UT01', 'Tooele Clinic Corp', 'Craig', 'H', 'Yerke', 'PA', 'Physician Assistant', '', '', NULL, 'M', '7100 Commerce Way Ste 180', 'Brentwood', 'Williamson ', 'TN', '37027', '4358433789', NULL, '7100 Commerce Way Ste 180', 'Brentwood', 'Williamson ', 'TN', '37027', '4358433789', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', '', '', '', 'HCFA|UB|', '1275861619', 0, 'N', 0, '2013-03-27', NULL, NULL, 0, 0, NULL, NULL),
('870635889', 'W12001835', 'W12001835', 'UT01', 'Tooele Clinic Corp', 'Craig', 'H', 'Yerke', 'PA', 'Physician Assistant', '', '', NULL, 'B', 'PO Box 848416', 'Boston', 'Suffolk ', 'MA', '02284', '4358433789', NULL, 'PO Box 848416', 'Boston', 'Suffolk ', 'MA', '02284', '4358433789', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', '', '', '', 'HCFA|UB|', '1275861619', 0, 'N', 0, '2013-03-27', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'W12003173', 'W12003173', 'UT01', 'Ogden Clinic', 'Laura', 'A', 'Colvin', 'PA', 'Family Practice', '', '', NULL, 'O', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753000', '8014762670', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753000', '8014762670', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-07-01', '2012-04-02', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447248596', 0, 'N', 0, '2012-04-24', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12003172', 'W12003172', 'WYBILLINGS', 'Billings Clinic - Geriatrics', 'Carolin', '', 'Cassel', 'FNP', 'Mental Health', 'Psychiatry', '', NULL, 'O', '1020 N 27th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382413', '1020 N 27th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382413', '', '', '', '0.00', '17.00', '0.00', 3, '2010-06-14', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154330397', 0, 'N', 0, '2010-07-12', NULL, NULL, 0, 0, NULL, NULL),
('272399747', 'W12003175', 'W12003175', 'UT01', 'Audiology Associates of Salt Lake City', 'C', 'B', 'Fox', 'CCCA', 'Audiology', '', '', NULL, 'O', '1100 N Main St', 'Richfield', 'Sevier', 'UT', '84701', '8002449001', NULL, '1100 N Main St', 'Richfield', 'Sevier', 'UT', '84701', '8002449001', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-06', '2010-07-06', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811938939', 0, 'N', 0, '2014-04-14', NULL, NULL, 0, 0, NULL, NULL),
('272399747', 'W12003176', 'W12003176', 'UT01', 'Audiology Associates of Salt Lake City', 'C', 'B', 'Fox', 'CCCA', 'Audiology', '', '', NULL, 'O', '1100 S Medical Dr', 'Mount Pleasant', 'Sanpete', 'UT', '84647', '8002449001', NULL, '1100 S Medical Dr', 'Mount Pleasant', 'Sanpete', 'UT', '84647', '8002449001', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-06', '2010-07-06', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811938939', 0, 'N', 0, '2014-04-14', NULL, NULL, 0, 0, NULL, NULL),
('272399747', 'W12003177', 'W12003177', 'UT01', 'Audiology Associates of Salt Lake City', 'C', 'B', 'Fox', 'CCCA', 'Audiology', '', '', NULL, 'O', '130 W Main Ste E', 'Lehi', 'Utah', 'UT', '84043', '8002449001', NULL, '130 W Main Ste E', 'Lehi', 'Utah', 'UT', '84043', '8002449001', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-06', '2010-07-06', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811938939', 0, 'N', 0, '2014-04-14', NULL, NULL, 0, 0, NULL, NULL),
('272399747', 'W12003174', 'W12003174', 'UT01', 'Audiology Associates of Salt Lake City', 'C', 'B', 'Fox', 'CCCA', 'Audiology', '', '', NULL, 'O', '1377 E 3900 S Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012721232', '8012721238', '1377 E 3900 S Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012721232', '8012721238', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-06', '2010-07-06', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811938939', 0, 'N', 0, '2014-04-14', NULL, NULL, 0, 0, NULL, NULL),
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('272399747', 'W12003179', 'W12003179', 'UT01', 'Audiology Associates of Salt Lake City', 'C', 'B', 'Fox', 'CCCA', 'Audiology', '', '', NULL, 'O', '57 N 100 E Ste 2', 'Roosevelt', 'Duchesne', 'UT', '84066', '8002449001', NULL, '57 N 100 E Ste 2', 'Roosevelt', 'Duchesne', 'UT', '84066', '8002449001', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-06', '2010-07-06', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811938939', 0, 'N', 0, '2014-04-14', 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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('830182821', 'W12003426', 'W12003426', 'WY01', 'Gottsche Rehabilitation Center', 'Timothy', '', 'Williams', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '148 E Arapahoe', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078642146', '3078642857', '148 E Arapahoe', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078642146', '3078642857', '', '', '', '0.00', '10.00', '0.00', 3, '2030-01-01', '2030-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871723064', 0, 'N', 0, '2013-03-27', NULL, NULL, 0, 0, NULL, NULL),
('830182821', 'W12003427', 'W12003427', 'WY01', 'Gottsche Rehabilitation Center', 'Timothy', '', 'Williams', 'DPT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 790', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078642146', '3078642857', 'PO Box 790', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078642146', '3078642857', '', '', '', '0.00', '10.00', '0.00', 3, '2030-01-01', '2030-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871723064', 0, 'N', 0, '2013-03-27', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'W12003428', 'W12003428', 'UT01', 'Granger Medical Clinic', 'Craig', 'A', 'Coleby', 'MD', 'Internal Medicine', 'Pediatrics', '', NULL, 'O', '12391 S 4000 W', 'Riverton', 'Salt Lake', 'UT', '84065', '8013021700', NULL, '12391 S 4000 W', 'Riverton', 'Salt Lake', 'UT', '84065', '8013021700', '          ', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1386825024', 0, 'N', 0, '2010-10-08', NULL, NULL, 40.5226, -111.987, NULL, NULL),
('942938348', 'W12003430', 'W12003430', 'UTMH1', ' Valley Mental Health Inc', 'Pamela', 'J', 'Bennett', 'LCSW', 'Mental Health', '', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', '          ', 'UTVMHMA', '', '', '0.00', '35.00', '0.00', 6, '2010-07-16', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215196647', 0, 'Y', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('200198361', 'W12003431', 'W12003431', 'UT01', 'West Valley Family and Preventive Medicine', 'Tanya', '', 'Chesley', 'PAC', 'Family Practice', '', '', NULL, 'O', '3336 Pioneer Pkwy Ste 302', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019648726', '8019689836', '3336 Pioneer Pkwy Ste 302', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019648726', '8019689836', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477541506', 0, 'N', 0, '2010-09-07', NULL, NULL, 40.6991, -111.99, NULL, NULL),
('743096310', 'W12003433', 'W12003433', 'UT01', 'St Marks Professional Services', 'Richard', 'L', 'Glines', 'MD', 'Pain Management', 'Anesthesiology', '', NULL, 'O', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687729', '8012703320', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687729', '8012703320', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', 'Davis Hospital', '', '', 'HCFA|UB|', '1790794063', 0, 'N', 0, '2013-10-08', NULL, NULL, 0, 0, NULL, NULL),
('743096310', 'W12003434', 'W12003434', 'UT01', 'St Marks Professional Services', 'Richard', 'L', 'Glines', 'MD', 'Pain Management', 'Anesthesiology', '', NULL, 'B', 'PO Box 271220', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8012687729', '8012703320', 'PO Box 271220', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8012687729', '8012703320', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', 'Davis Hospital', '', '', 'HCFA|UB|', '1790794063', 0, 'Y', 0, '2013-10-08', NULL, NULL, 0, 0, NULL, NULL),
('870354442', 'W12003435', 'W12003435', 'UT01', 'Rocky Mountain Womens Health Center', 'Patricia', 'M', 'James', 'NP', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1580 W Antelope Dr Ste 290', 'Layton', 'Davis', 'UT', '84041', '8017760880', NULL, '1580 W Antelope Dr Ste 290', 'Layton', 'Davis', 'UT', '84041', '8017760880', '          ', 'WRYMTWOM', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2013-01-16', 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1508046772', 0, 'N', 0, '2013-03-20', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12003436', 'W12003436', 'UT01', 'Jordan Valley Surgical Specialists', 'Dinhkim', '', 'Le', 'MD', 'General Surgery', '', '', NULL, 'O', '3584 W 9000 S Ste 304', 'West Jordan', 'Salt Lake', 'UT', '84088', '8016014423', NULL, '3584 W 9000 S Ste 304', 'West Jordan', 'Salt Lake', 'UT', '84088', '8016014423', '          ', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-08-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1588845101', 0, 'N', 0, '2013-07-25', NULL, NULL, 40.5879, -111.976, NULL, NULL),
('752806777', 'W12003443', 'W12003443', 'TX01', 'Toyota Family Health Center', 'Ann-Marie', 'R', 'Mora', 'OD', 'Ophthalmology', '', '', NULL, 'B', '205 Miller Spring Ct', 'Franklin', 'Williamson', 'TN', '37064', '2102635700', '', '205 Miller Spring Ct', 'Franklin', 'Williamson', 'TN', '37064', '2102635700', '', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-07-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1568563344', 0, 'N', 0, '2014-07-23', NULL, NULL, 0, 0, NULL, NULL),
('271933326', 'W12001713', 'W12001713', 'UT01', 'Richens Eye Center', 'Bhupendra', 'C', 'Patel', 'MD', 'Ophthalmology', 'Oculoplastic Surgery', '', NULL, 'O', '165 W 200 N', 'St George', 'Washington', 'UT', '84770', '4356564040', '4356521516', '165 W 200 N', 'St George', 'Washington', 'UT', '84770', '4356564040', '4356521516', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-03-01', NULL, 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1366436412', 0, 'N', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('271933326', 'W12001710', 'W12001710', 'UT01', 'Zion Eye Institute', 'Bhupendra', 'C', 'Patel', 'MD', 'Ophthalmology', 'Oculoplastic Surgery', '', NULL, 'O', '1791 E 280 N', 'St George', 'Washington', 'UT', '84790', '4356562020', '4356734131', '1791 E 280 N', 'St George', 'Washington', 'UT', '84790', '4356562020', '4356734131', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-03-01', NULL, 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1366436412', 0, 'N', 0, '2014-06-23', NULL, NULL, 37.1131, -113.545, NULL, NULL),
('271933326', 'W12001712', 'W12001712', 'UT01', 'Richens Eye Center', 'Bhupendra', 'C', 'Patel', 'MD', 'Ophthalmology', 'Oculoplastic Surgery', '', NULL, 'O', '619 Bluff St Ste 1B', 'St George', 'Washington', 'UT', '84770', '4356564040', '4356521516', '619 Bluff St Ste 1B', 'St George', 'Washington', 'UT', '84770', '4356564040', '4356521516', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-03-01', NULL, 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1366436412', 0, 'N', 0, '2014-06-23', NULL, NULL, 37.0977, -113.587, NULL, NULL),
('271933326', 'W12001711', 'W12001711', 'UT01', 'St George Eye Center', 'Bhupendra', 'C', 'Patel', 'MD', 'Ophthalmology', 'Oculoplastic Surgery', '', NULL, 'O', '676 S Bluff St Ste 208', 'St George', 'Washington', 'UT', '84770', '4356284507', '4356283748', '676 S Bluff St Ste 208', 'St George', 'Washington', 'UT', '84770', '4356284507', '4356283748', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-03-01', NULL, 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1366436412', 0, 'N', 0, '2014-06-23', NULL, NULL, 37.0967, -113.587, NULL, NULL),
('271933326', 'W12001715', 'W12001715', 'UT01', 'Surigcal Associates of St George', 'Bhupendra', 'C', 'Patel', 'MD', 'Ophthalmology', 'Oculoplastic Surgery', '', NULL, 'M', 'PO Box 910744', 'St George', 'Washington', 'UT', '84791', '4356562020', '4356734131', 'PO Box 910744', 'St George', 'Washington', 'UT', '84791', '4356562020', '4356734131', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-03-01', NULL, 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1366436412', 0, 'N', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('870656811', 'W12003453', 'W12003453', 'UT01', 'ProRehab East Carbon', '', '', 'ProRehab Physical Therapy', '', 'Durable Medical Equipment', '', '', NULL, 'B', 'PO Box 307', 'Bountiful', 'Davis', 'UT', '84011', '4358881500', '4356131501', 'PO Box 307', 'Bountiful', 'Davis', 'UT', '84011', '4358881500', '4356131501', 'DME80', '', '', '0.00', '40.00', '0.00', 6, '2010-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '0000014004', 0, 'Y', 0, '2013-11-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12001426', 'W12001426', 'UTPEHP', 'PCMC Neuropsychologist - Outpatient', 'Kimberlee', 'M', 'Roy', 'PhD', 'Mental Health', 'Psychology', '', 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', '          ', 'PEHPPHD', '', '', '0.00', '30.00', '0.00', 8, '2010-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386877397', 0, 'N', 0, '2011-05-03', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12003463', 'W12003463', 'ID01', 'Saint Alphonsus Medical Group Occupational Medicine Associat', 'David', '', 'Lee', 'MD', 'Internal Medicine', '', '', NULL, 'B', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', NULL, '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2010-07-08', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1962501890', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12003461', 'W12003461', 'ID01', 'Saint Alphonsus Medical Group Curtisian Internal Medicine (Moreau Bldg) ', 'David', '', 'Lee', 'MD', 'Internal Medicine', '', '', NULL, 'O', '6140 Curtisian Ste 300', 'Boise', 'Ada', 'ID', '83704', '2083676575', '2083676597', '6140 Curtisian Ste 300', 'Boise', 'Ada', 'ID', '83704', '2083676575', '2083676597', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2010-07-08', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1962501890', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.615, -116.256, NULL, NULL),
('820200895', 'W12003464', 'W12003464', 'ID01', 'Saint Alphonsus Medical Group Neurology Boise', 'Jackie', 'J', 'Whitesell', 'MD', 'Neurology', '', '', NULL, 'O', '901 N Curtis Ste 403', 'Boise', 'Ada', 'ID', '83706', '2083677272', '2083677111', '901 N Curtis Ste 403', 'Boise', 'Ada', 'ID', '83706', '2083677272', '2083677111', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-07-08', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1346367984', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6126, -116.255, NULL, NULL),
('820200895', 'W12003465', 'W12003465', 'ID01', 'Saint Alphonsus Caldwell Multi-Specialty', 'Jackie', 'J', 'Whitesell', 'MD', 'Neurology', '', '', NULL, 'O', '1818 S 10th Ave Ste 200', 'Caldwell', 'Canyon', 'ID', '83605', '2083677272', '2083677111', '1818 S 10th Ave Ste 200', 'Caldwell', 'Canyon', 'ID', '83605', '2083677272', '2083677111', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-07-08', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1346367984', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6538, -116.693, NULL, NULL),
('820200895', 'W12003466', 'W12003466', 'ID01', 'Saint Alphonsus Regional Medical Center - Reading Only', 'Jackie', 'J', 'Whitesell', 'MD', 'Neurology', '', '', NULL, 'O', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083673722', '2083677111', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083673722', '2083677111', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-07-08', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1346367984', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('820200895', 'W12003468', 'W12003468', 'ID01', 'Saint Alphonsus Regional Medical Center - Reading Only', 'Jackie', 'J', 'Whitesell', 'MD', 'Neurology', '', '', NULL, 'B', '3340 E. Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2083677111', '3340 E. Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2083677111', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-07-08', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1346367984', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12003469', 'W12003469', 'ID01', 'Saint Alphonsus Inpatient Pain ', 'Cory', '', 'Huffine', 'NP-C', 'Wound Care', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083674030', '2083674051', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083674030', '2083674051', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-07-08', '2013-11-30', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1700879459', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('820200895', 'W12003470', 'W12003470', 'ID01', 'Saint Alphonsus Inpatient Pain ', 'Cory', '', 'Huffine', 'NP-C', 'Wound Care', '', '', NULL, 'B', 'PO Box 190930', 'Boise', 'Ada', 'ID', '83719', '2083672396', '2083674051', 'PO Box 190930', 'Boise', 'Ada', 'ID', '83719', '2083672396', '2083674051', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-07-08', '2013-11-30', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1700879459', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12003472', 'W12003472', 'ID01', 'Saint Alphonsus Medical Group Pulmonary & Sleep Boise ', 'Brekk', '', 'Macpherson', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'O', '1075 N Curtis Ste 200 Bldg 6', 'Boise', 'Ada', 'ID', '83706', '2083678333', '2083672003', '1075 N Curtis Ste 200 Bldg 6', 'Boise', 'Ada', 'ID', '83706', '2083678333', '2083672003', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-07-08', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1669798286', 0, 'N', 0, '2011-09-19', NULL, NULL, 43.6148, -116.254, NULL, NULL),
('820200895', 'W12003473', 'W12003473', 'ID01', 'Northwest Pulmonary Saint Alphonsus ', 'Brekk', '', 'Macpherson', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'B', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2083672003', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2083672003', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-07-08', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1669798286', 0, 'N', 0, '2011-09-19', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12003475', 'W12003475', 'ID01', 'Saint Alphonsus Medical Group Family Medicine Dominican Health ', 'Mary', '', 'Morgan', 'NP-C', 'Family Practice', 'Nurse Practitioner', '', NULL, 'O', '1118 Nw 16th St Ste A', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2084522140', '1118 Nw 16th St Ste A', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2084522140', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-07-08', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1437381209', 0, 'N', 0, '2014-02-10', NULL, NULL, 44.025, -116.928, NULL, NULL),
('820200895', 'W12003477', 'W12003477', 'ID01', 'Saint Alphonsus Express Care Inc', 'Mary', '', 'Morgan', 'NP-C', 'Family Practice', 'Nurse Practitioner', '', NULL, 'O', '1515 W State St', 'Boise', 'Ada', 'ID', '83702', '2083456768', '2084522140', '1515 W State St', 'Boise', 'Ada', 'ID', '83702', '2083456768', '2084522140', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-07-08', '2013-12-31', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1437381209', 0, 'Y', 0, '2014-06-10', NULL, NULL, 43.6228, -116.21, NULL, NULL),
('820200895', 'W12003478', 'W12003478', 'ID01', 'Saint Alphonsus Regional Medical Center', 'Mary', '', 'Morgan', 'NP-C', 'Family Practice', 'Nurse Practitioner', '', NULL, 'B', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2084526851', '2084522140', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2084526851', '2084522140', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-07-08', '2012-12-13', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1437381209', 0, 'N', 0, '2014-02-10', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12003476', 'W12003476', 'ID01', 'Saint Alphonsus Express Care Inc', 'Mary', '', 'Morgan', 'NP-C', 'Family Practice', 'Nurse Practitioner', '', NULL, 'O', '4700 N Eagle Rd', 'Boise', 'Ada', 'ID', '83713', '2089384797', '2084522140', '4700 N Eagle Rd', 'Boise', 'Ada', 'ID', '83713', '2089384797', '2084522140', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-07-08', '2013-12-31', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1437381209', 0, 'Y', 0, '2014-02-10', NULL, NULL, 43.6474, -116.352, NULL, NULL),
('820200895', 'W12003480', 'W12003480', 'ID01', 'Saint Alphonsus Medical Group Polumnary & Sleep Boise ', 'Nancy', '', 'Nadolski', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'O', '1075 N Curtis Ste 201', 'Boise', 'Ada', 'ID', '83706', '2083678333', '2083672003', '1075 N Curtis Ste 201', 'Boise', 'Ada', 'ID', '83706', '2083678333', '2083672003', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-07-08', '2012-11-30', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1881755023', 0, 'N', 0, '2013-02-19', NULL, NULL, 43.6143, -116.258, NULL, NULL),
('820200895', 'W12003481', 'W12003481', 'ID01', 'Saint Alphonsus Regional Medical Center', 'Nancy', '', 'Nadolski', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'B', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2083672003', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2083672003', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-07-08', '2012-11-30', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1881755023', 0, 'N', 0, '2013-02-19', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12003483', 'W12003483', 'IDBOISTD', 'Saint Alphonsus Medical Group Pulmonary & Sleep Boise ', 'Bethany', '', 'Taylor', 'PA-C', 'Pulmonary', 'Sleep Medicine', 'Sleep Disorders', NULL, 'O', '1075 N Curtis Ste 201', 'Boise', 'Ada', 'ID', '83706', '2083678333', '2083672003', '1075 N Curtis Ste 201', 'Boise', 'Ada', 'ID', '83706', '2083678333', '2083672003', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-07-08', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1487843322', 0, 'N', 0, '2013-12-11', NULL, NULL, 43.6148, -116.254, NULL, NULL),
('820200895', 'W12003484', 'W12003484', 'IDBOISTD', 'Saint Alphonsus Regional Medical Center ', 'Bethany', '', 'Taylor', 'PA-C', 'Pulmonary', 'Sleep Medicine', 'Sleep Disorders', NULL, 'B', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2083672003', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2083672003', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-07-08', '2001-12-01', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1487843322', 0, 'N', 0, '2013-12-11', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'W12003487', 'W12003487', 'ID01', 'Saint Alphonsus Specialty Services Inc', 'Christopher', '', 'Alessi', 'MD', 'Vascular Surgery', 'Cardiovascular Disease', '', NULL, 'B', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2083677798', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2083677798', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-07-08', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1598726960', 0, 'N', 0, '2013-05-07', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'W12003486', 'W12003486', 'ID01', 'Saint Alphonsus Medical Group Vascular Services Boise 102', 'Christopher', '', 'Alessi', 'MD', 'Vascular Surgery', 'Cardiovascular Disease', '', NULL, 'O', '6140 W Curtisian Ave Ste 102', 'Boise', 'Ada', 'ID', '83704', '2083677787', '2083677798', '6140 W Curtisian Ave Ste 102', 'Boise', 'Ada', 'ID', '83704', '2083677787', '2083677798', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-07-08', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1598726960', 0, 'N', 0, '2013-05-07', NULL, NULL, 43.6151, -116.256, NULL, NULL),
('820312175', 'W12003490', 'W12003490', 'ID01', 'Idaho Emergency Physicians PA', 'Andrew', '', 'Nelson', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83704', '2083221730', '2083221731', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83704', '2083221730', '2083221731', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2010-07-08', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1841493665', 0, 'N', 0, '2012-08-13', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('820312175', 'W12003489', 'W12003489', 'ID01', 'Idaho Emergency Physicians PA', 'Andrew', '', 'Nelson', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '1717 Arlington', 'Caldwell', 'Canyon', 'ID', '83605', '2083221730', '2083221731', '1717 Arlington', 'Caldwell', 'Canyon', 'ID', '83605', '2083221730', '2083221731', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2010-07-08', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1841493665', 0, 'N', 0, '2012-08-13', NULL, NULL, 43.6542, -116.696, NULL, NULL),
('820312175', 'W12003492', 'W12003492', 'ID01', 'Idaho Emergency Physicians PA', 'Andrew', '', 'Nelson', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '2312 N Cole Ste B', 'Boise', 'Ada', 'ID', '83704', '2083221730', NULL, '2312 N Cole Ste B', 'Boise', 'Ada', 'ID', '83704', '2083221730', '          ', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2010-07-08', '2011-02-21', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1841493665', 0, 'N', 0, '2012-08-13', NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'W12003491', 'W12003491', 'ID01', 'Idaho Emergency Physicians PA', 'Andrew', '', 'Nelson', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '323 E Riverside Dr', 'Eagle', 'Ada', 'ID', '83616', '2083221730', '2083221731', '323 E Riverside Dr', 'Eagle', 'Ada', 'ID', '83616', '2083221730', '2083221731', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2010-07-08', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1841493665', 0, 'N', 0, '2012-08-13', NULL, NULL, 43.6896, -116.35, NULL, NULL),
('820457426', 'W12003497', 'W12003497', 'ID02', '', 'Shauna', 'T', 'Williams', 'MD', 'General Surgery', 'Colon and Rectal Surgery', '', NULL, 'O', '1072 N Liberty St Ste 201', 'Boise', 'Ada', 'ID', '83704', '2083772273', '2083673059', '1072 N Liberty St Ste 201', 'Boise', 'Ada', 'ID', '83704', '2083772273', '2083673059', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2010-07-12', '2014-07-01', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1821150285', 0, 'N', 0, '2014-06-05', NULL, NULL, 43.6139, -116.261, NULL, NULL),
('820297206', 'W12003498', 'W12003498', 'ID02', 'Boise Surgical Group PA', 'Roberto', 'V', 'Barresi', 'MD', 'General Surgery', '', '', NULL, 'O', '3399 E Louise Ave Ste 400', 'Meridian', 'Ada', 'ID', '83642', '2083643000', '2083643191', '3399 E Louise Ave Ste 400', 'Meridian', 'Ada', 'ID', '83642', '2083643000', '2083643191', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2010-06-17', '2012-09-10', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1740231620', 0, 'N', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
('820297206', 'W12003500', 'W12003500', 'ID02', 'Boise Surgical Group PA', 'Jon', 'B', 'Getz', 'MD', 'General Surgery', NULL, NULL, NULL, 'O', '3399 E Louise Ave Ste 400', 'Meridian', 'Ada', 'ID', '83642', '2083643000', '2083643191', '3399 E Louise Ave Ste 400', 'Meridian', 'Ada', 'ID', '83642', '2083643000', '2083643191', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2010-06-17', '2012-09-10', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1174575138', 0, 'N', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
('820297206', 'W12003501', 'W12003501', 'ID02', 'Boise Surgical Group PA', 'Jonathan', 'V', 'Giles', 'MD', 'General Surgery', '', '', NULL, 'O', '3399 E Louise Ave Ste 400', 'Meridian', 'Ada', 'ID', '83642', '2083643000', '2083643191', '3399 E Louise Ave Ste 400', 'Meridian', 'Ada', 'ID', '83642', '2083643000', '2083643191', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2010-06-17', '2012-09-10', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1457382723', 0, 'N', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
('820297206', 'W12003502', 'W12003502', 'ID02', 'Boise Surgical Group PA', 'Scott', 'A', 'Henson', 'MD', 'General Surgery', '', '', NULL, 'O', '3399 E Louise Ave Ste 400', 'Meridian', 'Ada', 'ID', '83642', '2083643000', '2083643191', '3399 E Louise Ave Ste 400', 'Meridian', 'Ada', 'ID', '83642', '2083643000', '2083643191', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2010-06-17', '2012-09-10', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1023060258', 0, 'N', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
('820297206', 'W12003503', 'W12003503', 'ID02', 'Boise Surgical Group PA', 'Elizabeth', 'M', 'Prier', 'MD', 'General Surgery', '', '', NULL, 'O', '3399 E Louise Ave Ste 400', 'Meridian', 'Ada', 'ID', '83642', '2083643000', '2083643191', '3399 E Louise Ave Ste 400', 'Meridian', 'Ada', 'ID', '83642', '2083643000', '2083643191', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2010-06-17', '2012-04-03', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1036983689', 0, 'N', 0, '2012-04-03', NULL, NULL, 0, 0, NULL, NULL),
('820297206', 'W12003505', 'W12003505', 'ID02', 'Boise Surgical Group PA', 'Reese', 'A', 'Verner', 'MD', 'General Surgery', '', '', NULL, 'O', '3399 E Louise Ave Ste 400', 'Meridian', 'Ada', 'ID', '83642', '2083643000', '2083643191', '3399 E Louise Ave Ste 400', 'Meridian', 'Ada', 'ID', '83642', '2083643000', '2083643191', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2010-06-17', '2012-09-10', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1427085281', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('208515551', 'W12003507', 'W12003507', 'ID02', 'West Valley Medical Center', 'Michaela', '', 'Schulte', 'MD', 'Hospitalist', '', '', NULL, 'O', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2084553890', '2084553895', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2084553890', '2084553895', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2010-06-07', '2013-08-12', 0, 0, 1, '', '', '', 'Saint Alphonsus Medical Center Nampa', 'HCFA|UB|', '1821201179', 0, 'N', 0, '2013-09-04', NULL, NULL, 0, 0, NULL, NULL),
('208515551', 'W12003510', 'W12003510', 'ID02', 'West Valley Medical Center', 'Harinder', '', 'Takyar', 'MD', 'Hospitalist', '', '', NULL, 'O', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2084553890', '2084553895', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2084553890', '2084553895', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2010-06-07', '2010-06-07', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1568400596', 0, 'N', 0, '2010-07-20', NULL, NULL, 0, 0, NULL, NULL),
('208515551', 'W12003511', 'W12003511', 'ID02', 'Apogee Medical Group Idaho', 'Harinder', '', 'Takyar', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 708698', 'Sandy', 'Salt Lake', 'UT', '84070', '8013529500', '2084553895', 'PO Box 708698', 'Sandy', 'Salt Lake', 'UT', '84070', '8013529500', '2084553895', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2010-06-07', '2010-06-07', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1568400596', 0, 'N', 0, '2010-07-20', NULL, NULL, 0, 0, NULL, NULL),
('820535616', 'W12003526', 'W12003526', 'ID02', '', 'Lindsay', '', 'Nagelmann', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '2536 N Stokesberry Pl', 'Meridian', 'Ada', 'ID', '83646', '2088550880', '2088550889', '2536 N Stokesberry Pl', 'Meridian', 'Ada', 'ID', '83646', '2088550880', '2088550889', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2010-07-08', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1306168018', 0, 'N', 0, '2012-02-02', NULL, NULL, 0, 0, NULL, NULL),
('481297302', 'W12003529', 'W12003529', 'UTMH1', '', 'Chris', 'C', 'Hakes', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '8537 W 2700 S Ste C', 'Magna', 'Salt Lake', 'UT', '84044', '8015038937', NULL, '8537 W 2700 S Ste C', 'Magna', 'Salt Lake', 'UT', '84044', '8015038937', '', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2010-04-12', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194785378', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W12003530', 'W12003530', 'UT01', 'Chiropractic Health Center', 'Brian', 'J', 'Lundell', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '428 E 2600 N Ste 4', 'Ogden', 'Weber', 'UT', '84414', '8017820987', '8017370810', '428 E 2600 N Ste 4', 'Ogden', 'Weber', 'UT', '84414', '8017820987', '8017370810', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-07-01', '2010-10-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1992756365', 0, 'N', 0, '2006-08-31', 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
('529231136', 'W12003531', 'W12003531', 'ID01', '', 'Lisa', 'M', 'Manery', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '690 S Industry Way Ste 45', 'Meridian', 'Ada', 'ID', '83646', '2082836286', NULL, '690 S Industry Way Ste 45', 'Meridian', 'Ada', 'ID', '83646', '2082836286', '          ', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2010-05-01', '2012-08-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235216466', 0, 'N', 0, '2013-01-08', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W12003532', 'W12003532', 'UT01', '', 'Matthew', 'R', 'Roller', 'DC', 'Chiropractic', '', '', NULL, 'O', '9055 S 255 W', 'Sandy', 'Salt Lake', 'UT', '84070', '8018104325', '8015458744', '9055 S 255 W', 'Sandy', 'Salt Lake', 'UT', '84070', '8018104325', '8015458744', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-07-06', '2010-10-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1740287408', 0, 'N', 0, '2006-08-31', NULL, NULL, 0, 0, NULL, NULL),
('752806777', 'W12003533', 'W12003533', 'TX01', 'Toyota Family Health Center', 'Bethany', '', 'Taylor-Gardner', 'OT/R', 'Occupational Therapy', '', '', NULL, 'O', '1 Lone Star Pass Bldg 46', 'San Antonio', 'Bexar', 'TX', '78264', '2102635700', '2102635701', '1 Lone Star Pass Bldg 46', 'San Antonio', 'Bexar', 'TX', '78264', '2102635700', '2102635701', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-07-16', '2012-08-22', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578736179', 0, 'N', 0, '2012-08-22', NULL, NULL, 0, 0, NULL, NULL),
('752806777', 'W12003534', 'W12003534', 'TX01', 'Toyota Family Health Center', 'Bethany', '', 'Taylor-Gardner', 'OT/R', 'Occupational Therapy', '', '', NULL, 'B', '205 Miller Spring Ct', 'Franklin', 'Williamson', 'TN', '37064', '2102635700', NULL, '205 Miller Spring Ct', 'Franklin', 'Williamson', 'TN', '37064', '2102635700', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-07-16', '2012-08-22', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578736179', 0, 'N', 0, '2012-08-22', NULL, NULL, 0, 0, NULL, NULL),
('752806777', 'W12003536', 'W12003536', 'TX01', 'Toyota Family Health Center', 'Russell', 'T', 'Zepeda', 'PA-C', 'Family Practice', '', '', NULL, 'B', '1 Lone Star Pass Ste 46', 'San Antonio', 'Bexar', 'TX', '78264', '2102635700', '2102635701', '1 Lone Star Pass Ste 46', 'San Antonio', 'Bexar', 'TX', '78264', '2102635700', '2102635701', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-07-16', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518162122', 0, 'Y', 0, '2011-02-14', NULL, NULL, 0, 0, NULL, NULL),
('731714968', 'W12003535', 'W12003535', 'UT01', 'Rocky Mountain Anesthesiology', 'Rebecca', 'J', 'Wood', 'CRNA', 'Certified Nurse Anesthetist', 'Anesthesiology', NULL, NULL, 'B', 'PO Box 3750', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8008803566', '8014322668', 'PO Box 3750', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8008803566', '8014322668', '', '', '', '0.00', '19.00', '0.00', 3, '2010-07-22', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245396167', 0, 'N', 0, '2012-06-29', NULL, NULL, 0, 0, NULL, NULL),
('752806777', 'W12003537', 'W12003537', 'TX01', 'Toyota Family Health Center', 'Russell', 'T', 'Zepeda', 'PA-C', 'Family Practice', '', '', NULL, 'B', '205 Miller Spring Ct', 'Franklin', 'Williamson', 'TN', '37064', '2102635700', NULL, '205 Miller Spring Ct', 'Franklin', 'Williamson', 'TN', '37064', '2102635700', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-07-16', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518162122', 0, 'Y', 0, '2011-02-14', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W12003538', 'W12003538', 'ID02', 'Primary Health Medical Group', 'Julia', 'R', 'Middleton', 'PA', 'Family Practice', '', '', NULL, 'O', '6052 W State St', 'Boise', 'Ada', 'ID', '83703', '2083447799', '2089471945', '6052 W State St', 'Boise', 'Ada', 'ID', '83703', '2083447799', '2089471945', 'IDSTDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2010-10-01', '2010-10-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1215113741', 0, 'N', 0, '2013-02-28', NULL, NULL, 43.6597, -116.264, NULL, NULL),
('202630141', 'W12003539', 'W12003539', 'ID02', 'Primary Health Medical Group', 'Julia', 'R', 'Middleton', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 191050', 'Boise', 'Ada', 'ID', '83719', '2084553545', NULL, 'PO Box 191050', 'Boise', 'Ada', 'ID', '83719', '2084553545', '          ', 'IDSTDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2010-10-01', '2012-09-25', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1215113741', 0, 'N', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('203059260', 'W12003540', 'W12003540', 'TX01', 'BHS Physicians Network', 'Bryan', '', 'Alexander', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', NULL, 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2010-08-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB||', '1588824387', 0, 'Y', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('203059260', 'W12003541', 'W12003541', 'TX01', 'BHS Physicians Network', 'Freddy', '', 'Angulo', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', NULL, 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2010-08-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255472205', 0, 'Y', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('203059260', 'W12003542', 'W12003542', 'TX01', 'BHS Physicians Network', 'Felicia', '', 'Armstrong', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', NULL, 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2010-08-01', '2012-08-19', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB||', '1669652632', 0, 'Y', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12003544', 'W12003544', 'ID02', 'Family Medicine Health Center', 'Ann', 'P', 'Beach', '', 'Family Practice', '', '', NULL, 'O', '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083816102', '2083811776', '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083816102', '2083811776', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2010-08-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1912968892', 0, 'N', 0, '2014-06-05', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12003543', 'W12003543', 'ID02', 'Family Medicine Health Center', 'Ann', 'P', 'Beach', '', 'Family Practice', '', '', NULL, 'O', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '2083676123', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '2083676123', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2010-08-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1912968892', 0, 'N', 0, '2014-06-05', NULL, NULL, 0, 0, NULL, NULL),
('820161600', 'W12003546', 'W12003546', 'ID01', 'Boise Orthopedic Clinic', 'K Russell', '', 'Swainston', 'This Provider will terminate on July 1st', 'Orthopedic Surgery', '', '', NULL, 'O', '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083232600', NULL, '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083232600', '          ', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 8, '2010-06-01', '2011-02-23', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437143161', 0, 'N', 0, '2012-05-31', NULL, NULL, 43.6143, -116.258, NULL, NULL),
('820161600', 'W12003547', 'W12003547', 'ID01', 'Boise Orthopedic Clinic', 'K Russell', '', 'Swainston', 'This Provider will terminate on July 1st', 'Orthopedic Surgery', '', '', NULL, 'O', '520 S Eagle Rd Ste 3213', 'Meridian', 'Ada', 'ID', '83642', '2088980100', NULL, '520 S Eagle Rd Ste 3213', 'Meridian', 'Ada', 'ID', '83642', '2088980100', '          ', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 8, '2010-06-01', '2012-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437143161', 0, 'N', 0, '2012-05-31', NULL, NULL, 43.5995, -116.352, NULL, NULL),
('271419508', 'W12001169', 'W12001169', 'UT01', 'Utah Pain Relief Institute South', 'Brian', 'H', 'Morgan', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '10464 S Redwood Rd', 'South Jordan', 'Salt Lake', 'UT', '84095', '8014667246', NULL, '10464 S Redwood Rd', 'South Jordan', 'Salt Lake', 'UT', '84095', '8014667246', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-03-10', '2011-10-12', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1598873283', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'W12003429', 'W12003429', 'UT01', 'Granger Medical Clinic', 'Craig', 'A', 'Coleby', 'MD', 'Internal Medicine', 'Pediatrics', '', NULL, 'B', 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '8013021700', '8019653740', 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '8013021700', '8019653740', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1386825024', 0, 'N', 0, '2010-10-08', NULL, NULL, 0, 0, NULL, NULL),
('203059260', 'W12003549', 'W12003549', 'TX01', 'BHS Physicians Network', 'Cristo', '', 'Calle', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', NULL, 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2010-08-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB||', '1134398902', 0, 'Y', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('203059260', 'W12003550', 'W12003550', 'TX01', 'BHS Physicians Network', 'Robert', '', 'Ching', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', NULL, 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2010-08-01', '2012-08-19', 0, 0, 0, 'Mission Trail Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB||', '1770565707', 0, 'Y', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('203059260', 'W12003551', 'W12003551', 'TX01', 'BHS Physicians Network', 'Minh', '', 'Do', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', NULL, 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2010-08-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB||', '1740387695', 0, 'Y', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('203059260', 'W12003552', 'W12003552', 'TX01', 'BHS Physicians Network', 'Renee ', '', 'Dunn', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', NULL, 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2010-08-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB||', '1841387677', 0, 'Y', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('203059260', 'W12003553', 'W12003553', 'TX01', 'BHS Physicians Network', 'Janice ', '', 'Ford', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', NULL, 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2010-08-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB||', '1003857236', 0, 'Y', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('870474130', 'W12003554', 'W12003554', 'UT01', 'Northeastern Utah Medical Group', 'Katarzyna', '', 'Kielczyk', '', 'Internal Medicine', '', '', NULL, 'O', '210 W 300 N Ste 75-3', 'Roosevelt', 'Duchesne', 'UT', '84066', '4357223971', '4357226104', '210 W 300 N Ste 75-3', 'Roosevelt', 'Duchesne', 'UT', '84066', '4357223971', '4357226104', 'WURURAL5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194922203', 0, 'N', 0, '2012-06-29', NULL, NULL, 40.3034, -109.995, NULL, NULL),
('203059260', 'W12003555', 'W12003555', 'TX01', 'BHS Physicians Network', 'Adi ', '', 'Klein', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', NULL, 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2010-08-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB||', '1912929423', 0, 'Y', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('203059260', 'W12003556', 'W12003556', 'TX01', 'BHS Physicians Network', 'Yiching', '', 'Liu', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', NULL, 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2010-08-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB||', '1508902479', 0, 'Y', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('203059260', 'W12003557', 'W12003557', 'TX01', 'BHS Physicians Network', 'Richa', '', 'Mahajan', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', NULL, 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2010-08-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB||', '1730396656', 0, 'Y', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('203059260', 'W12003558', 'W12003558', 'TX01', 'BHS Physicians Network', 'William', '', 'Mallott', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', NULL, 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2010-08-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB||', '1679670624', 0, 'Y', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('203059260', 'W12003559', 'W12003559', 'TX01', 'BHS Physicians Network', 'Thilina ', '', 'Marasinghe', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', NULL, 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2010-08-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB||', '1821160938', 0, 'Y', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('203059260', 'W12003560', 'W12003560', 'TX01', 'BHS Physicians Network', 'Haritha', '', 'Mikkilineni', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', NULL, 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2010-08-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB||', '1891947438', 0, 'Y', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('203059260', 'W12003561', 'W12003561', 'TX01', 'BHS Physicians Network', 'Sowjanya', '', 'Mohan', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', NULL, 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2010-08-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB||', '1467488940', 0, 'Y', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('203059260', 'W12003562', 'W12003562', 'TX01', 'BHS Physicians Network', 'Uma ', '', 'Nair', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', NULL, 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2010-08-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB||', '1962475962', 0, 'Y', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('203059260', 'W12003563', 'W12003563', 'TX01', 'BHS Physicians Network', 'Nhi', '', 'Pham', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', NULL, 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2010-08-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB||', '1366638538', 0, 'Y', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('870474130', 'W12003564', 'W12003564', 'UT01', 'Northeastern Utah Medical Group', 'Elizabeth ', 'R', 'Pollak', '', 'Pathology', '', '', NULL, 'O', '210 W 300 N Ste 75-3', 'Roosevelt', 'Duchesne', 'UT', '84066', '4357223971', '4357226104', '210 W 300 N Ste 75-3', 'Roosevelt', 'Duchesne', 'UT', '84066', '4357223971', '4357226104', 'WURURAL5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376515874', 0, 'N', 0, '2012-06-29', NULL, NULL, 40.3034, -109.995, NULL, NULL),
('203059260', 'W12003565', 'W12003565', 'TX01', 'BHS Physicians Network', 'Maher', '', 'Saloum', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', NULL, 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2010-08-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB||', '1487650487', 0, 'Y', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('203059260', 'W12003566', 'W12003566', 'TX01', 'BHS Physicians Network', 'Wayne', 'H', 'Gordon', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', NULL, 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2007-01-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB||', '1750486858', 0, 'N', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('203059260', 'W12003567', 'W12003567', 'TX01', 'BHS Physicians Network', 'Dicky ', '', 'Huey', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', NULL, 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2010-08-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB||', '1255388609', 0, 'Y', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('203059260', 'W12003568', 'W12003568', 'TX01', 'BHS Physicians Network', 'Claudia', '', 'Santos', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', NULL, 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2010-08-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB||', '1013192970', 0, 'Y', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('203059260', 'W12003569', 'W12003569', 'TX01', 'BHS Physicians Network', 'Michael', '', 'Seawell', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', NULL, 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2010-08-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB||', '1306952296', 0, 'Y', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('203059260', 'W12003570', 'W12003570', 'TX01', 'BHS Physicians Network', 'Ayham', 'F', 'Shneker', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', NULL, 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2010-08-01', '2012-08-19', 0, 0, 0, 'Mission Trail Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB||', '1871557454', 0, 'Y', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('203059260', 'W12003571', 'W12003571', 'TX01', 'BHS Physicians Network', 'Jeff', '', 'Sorrell', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', NULL, 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2010-08-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB||', '1598949083', 0, 'Y', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('203059260', 'W12003572', 'W12003572', 'TX01', 'BHS Physicians Network', 'Edward', '', 'Sternaman', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', NULL, 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2010-08-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB||', '1801994462', 0, 'Y', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('203059260', 'W12003573', 'W12003573', 'TX01', 'BHS Physicians Network', 'Brian ', '', 'Treuhaft', 'DO', 'Hospitalist', '', '', NULL, 'B', 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', NULL, 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2010-08-01', '2012-08-19', 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB||', '1871690826', 0, 'Y', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('203059260', 'W12003574', 'W12003574', 'TX01', 'BHS Physicians Network', 'Marek ', '', 'Walczak', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', NULL, 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2010-08-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB||', '1083840375', 0, 'Y', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('203059260', 'W12003575', 'W12003575', 'TX01', 'BHS Physicians Network', 'Michael', 'I', 'Zuflacht', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', NULL, 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2010-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB||', '1417938507', 0, 'Y', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('820161600', 'W12003576', 'W12003576', 'ID02', 'Idaho Endocrinology', 'Irinel', '', 'Stanciu', 'MD', 'Endocrinology', '', '', NULL, 'O', '403 S 11th St Ste 100', 'Boise', 'Ada', 'ID', '83702', '2084290300', '2084290305', '403 S 11th St Ste 100', 'Boise', 'Ada', 'ID', '83702', '2084290300', '2084290305', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2010-06-01', '2012-06-11', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1720068760', 0, 'N', 0, '2013-10-16', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'W12003577', 'W12003577', 'UT01', 'Ogden Clinic', 'Traysa', 'S', 'Smith', 'PA-C', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1159 12th St', 'Ogden', 'Weber', 'UT', '84404', '8014753700', '8014762670', '1159 12th St', 'Ogden', 'Weber', 'UT', '84404', '8014753700', '8014762670', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-07-29', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1881755817', 0, 'N', 0, '2014-06-16', NULL, NULL, 41.244, -111.95, NULL, NULL),
('810284761', 'W12003579', 'W12003579', 'WY01', 'Arapahoe Health Center', 'Garth ', 'E', 'Reber', 'DO', 'Family Practice', '', '', NULL, 'O', '17 Great Plains Rd', 'Arapahoe', 'Fremont', 'WY', '82510', '3078569281', '3073320131', '17 Great Plains Rd', 'Arapahoe', 'Fremont', 'WY', '82510', '3078569281', '3073320131', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, 'SageWest Health Care', '', '', '', 'HCFA|UB|', '1417029950', 0, 'N', 0, '2011-06-10', NULL, NULL, 42.9868, -108.487, NULL, NULL),
('810284761', 'W12003578', 'W12003578', 'WY01', 'Wind River Fort Washakie Health Center', 'Garth ', 'E', 'Reber', 'DO', 'Family Practice', '', '', NULL, 'O', '29 Black Coal Dr', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', '29 Black Coal Dr', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, 'SageWest Health Care', '', '', '', 'HCFA|UB|', '1417029950', 0, 'N', 0, '2011-06-10', NULL, NULL, 42.9969, -108.861, NULL, NULL),
('810284761', 'W12003582', 'W12003582', 'WY01', 'Wind River Health Center', 'Garth ', 'E', 'Reber', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 128', 'Fort Washakie', 'Fremont', 'WY', '82514', '3078569281', '3073320131', 'PO Box 128', 'Fort Washakie', 'Fremont', 'WY', '82514', '3078569281', '3073320131', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, 'SageWest Health Care', '', '', '', 'HCFA|UB|', '1417029950', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('810284761', 'W12003580', 'W12003580', 'WY01', 'Wind River Health Center', 'Garth ', 'E', 'Reber', 'DO', 'Family Practice', '', '', NULL, 'M', 'PO Box 31001', 'Pasadena', 'Los Angeles', 'CA', '91110', '3078569281', '3073320131', 'PO Box 31001', 'Pasadena', 'Los Angeles', 'CA', '91110', '3078569281', '3073320131', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, 'SageWest Health Care', '', '', '', 'HCFA|UB|', '1417029950', 0, 'Y', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12003589', 'W12003589', 'UT01', 'Central Utah Clinic', '', '', 'Central Utah Clinic', 'GROUP', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', NULL, 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-07-15', '2011-02-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000005617', 0, 'Y', 0, '2012-11-26', NULL, NULL, 0, 0, NULL, NULL),
('263329351', 'W12003594', 'W12003594', 'TX01', 'San Antonio Internal Medicine Physicians', 'Jennifer', '', 'Wallace', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1303 McCullough Ave Ste 560', 'San Antonio', 'Bexar', 'TX', '78212', '2102239617', '2102236115', '1303 McCullough Ave Ste 560', 'San Antonio', 'Bexar', 'TX', '78212', '2102239617', '2102236115', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-08-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1699760934', 0, 'N', 0, '2013-08-28', NULL, NULL, 29.4412, -98.4924, NULL, NULL),
('263329351', 'W12003595', 'W12003595', 'TX01', 'San Antonio Internal Medicine Physicians', 'Jennifer', '', 'Wallace', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 741181', 'Atlanta', 'Fulton', 'GA', '30374', '2102239617', '2102236115', 'PO Box 741181', 'Atlanta', 'Fulton', 'GA', '30374', '2102239617', '2102236115', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-08-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1699760934', 0, 'N', 0, '2013-08-28', NULL, NULL, 0, 0, NULL, NULL),
('870521827', 'W12003596', 'W12003596', 'UT01', 'University Health Care Neuropsychiatric Institute', '', '', 'University Health Care Neuropsychiatric Institute', 'GROUP', 'Mental Health Facility', '', '', NULL, 'B', 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', NULL, 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', '          ', '', '', '1', '0.00', '0.00', '0.00', 3, '2006-01-01', '2011-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760562052', 0, 'N', 0, '2012-01-26', NULL, NULL, 0, 0, NULL, NULL),
('870521827', 'W12003599', 'W12003599', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Julia', '', 'Connelly', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015814636', NULL, '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015814636', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', '2012-09-18', 0, 0, 0, '', '', '', '', 'HCFA|', '1396915609', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('870521827', 'W12003598', 'W12003598', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Julia', '', 'Connelly', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'B', 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', NULL, 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', '2012-09-18', 0, 0, 0, '', '', '', '', 'HCFA|', '1396915609', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('870685140', 'W12003600', 'W12003600', 'UT01', 'University Health Care', 'Julia', '', 'Connelly', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '650 S Komas Dr Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015853828', NULL, '650 S Komas Dr Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015853828', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-06-03', '2012-09-18', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396915609', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('870685140', 'W12003601', 'W12003601', 'UT01', 'UNI-Home Project-Psychiatric', 'Julia', '', 'Connelly', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'B', 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015873103', NULL, 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015873103', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-06-03', '2012-09-18', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396915609', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('870685140', 'W12003603', 'W12003603', 'UT01', 'University Health Care', 'James', 'C', 'Ashworth', 'MD', 'Mental Health', 'Pediatric Psychiatry', '', NULL, 'O', '650 S Komas Dr Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015853828', NULL, '650 S Komas Dr Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015853828', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-08-01', '2012-09-18', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679514988', 0, 'N', 0, '2013-07-09', NULL, NULL, 0, 0, NULL, NULL),
('870685140', 'W12003602', 'W12003602', 'UT01', 'UNI-Home Project-Psychiatric', 'James', 'C', 'Ashworth', 'MD', 'Mental Health', 'Pediatric Psychiatry', '', NULL, 'B', 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015873103', NULL, 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015873103', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-08-01', '2012-09-18', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679514988', 0, 'N', 0, '2013-07-09', NULL, NULL, 0, 0, NULL, NULL),
('870685140', 'W12003604', 'W12003604', 'UT01', 'UNI Home Program', 'Philip', 'L', 'Baese', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '650 S Komas Dr Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015853828', NULL, '650 S Komas Dr Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015853828', '          ', 'WUUUNI', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1184669848', 0, 'N', 0, '2013-12-12', NULL, NULL, 40.7553, -111.83, NULL, NULL),
('870521827', 'W12003607', 'W12003607', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Philip', 'L', 'Baese', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015842130', NULL, '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015842130', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', '2012-09-18', 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|', '1184669848', 0, 'N', 0, '2012-10-02', NULL, NULL, 0, 0, NULL, NULL),
('870521827', 'W12003606', 'W12003606', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Philip', 'L', 'Baese', 'MD', 'Pediatrics', NULL, NULL, NULL, 'B', 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', NULL, 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', '2012-09-18', 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|', '1184669848', 0, 'N', 0, '2012-10-02', NULL, NULL, 0, 0, NULL, NULL),
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('870521827', 'W12003609', 'W12003609', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Carol', 'A', 'Ballou', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'B', 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', NULL, 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1912967647', 0, 'Y', 0, '2014-03-13', NULL, NULL, 0, 0, NULL, NULL),
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('870521827', 'W12003615', 'W12003615', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Roxanne', 'L', 'Bartel', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'B', 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', NULL, 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1104903897', 0, 'Y', 0, '2014-03-13', NULL, NULL, 0, 0, NULL, NULL),
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('870521827', 'W12003619', 'W12003619', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Lorna', 'S', 'Benjamin', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'B', 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', NULL, 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', '2012-07-01', 0, 0, 0, '', '', '', '', 'HCFA|', '1760572390', 0, 'N', 0, '2014-03-13', NULL, NULL, 0, 0, NULL, NULL),
('870685140', 'W12003621', 'W12003621', 'UT01', 'University Health Care', 'Deborah', 'A', 'Bilder', 'MD', 'Mental Health', 'Psychiatry', 'Pediatrics', NULL, 'O', '650 S Komas Dr Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015853828', NULL, '650 S Komas Dr Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015853828', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-08-03', '2012-09-18', 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1427084615', 0, 'N', 0, '2013-05-17', NULL, NULL, 0, 0, NULL, NULL),
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('870521827', 'W12003625', 'W12003625', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Jana', 'D', 'Bingman', 'MD', 'Mental Health', 'Pediatric Psychiatry', 'Psychiatry', NULL, 'B', 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', NULL, 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', '2014-03-13', 0, 0, 0, '', '', '', '', 'HCFA|', '1801073663', 0, 'N', 0, '2014-03-13', NULL, NULL, 0, 0, NULL, NULL),
('870521827', 'W12003627', 'W12003627', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Robert', 'D', 'Birch', 'DO', 'Mental Health', 'Psychiatry', '', NULL, 'O', '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015814636', NULL, '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015814636', '', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|', '1245220805', 0, 'N', 0, '2014-04-14', NULL, NULL, 40.757, -111.824, NULL, NULL),
('870521827', 'W12003626', 'W12003626', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Robert', 'D', 'Birch', 'DO', 'Mental Health', 'Psychiatry', '', NULL, 'B', 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', NULL, 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', '', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|', '1245220805', 0, 'N', 0, '2014-04-14', NULL, NULL, 0, 0, NULL, NULL),
('870521827', 'W12003630', 'W12003630', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Jonathan', 'D', 'Bone', 'PSYD', 'Mental Health', 'Psychology', '', NULL, 'O', '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015814636', NULL, '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015814636', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1649436916', 0, 'N', 0, '2012-01-26', NULL, NULL, 40.757, -111.824, NULL, NULL),
('870521827', 'W12003629', 'W12003629', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Jonathan', 'D', 'Bone', 'PSYD', 'Mental Health', 'Psychology', '', NULL, 'B', 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', NULL, 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1649436916', 0, 'N', 0, '2012-01-26', NULL, NULL, 0, 0, NULL, NULL),
('870521827', 'W12003633', 'W12003633', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Julie', 'M', 'Bowen', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015814636', NULL, '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015814636', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1780802066', 0, 'N', 0, '2012-11-27', NULL, NULL, 40.757, -111.824, NULL, NULL),
('870521827', 'W12003632', 'W12003632', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Julie', 'M', 'Bowen', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'B', 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', NULL, 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1780802066', 0, 'N', 0, '2012-11-27', NULL, NULL, 0, 0, NULL, NULL),
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('870521827', 'W12003651', 'W12003651', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Susan', '', 'Connor', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015814636', NULL, '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015814636', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1588606503', 0, 'N', 0, '2012-01-26', NULL, NULL, 40.757, -111.824, NULL, NULL),
('870521827', 'W12003652', 'W12003652', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Susan', '', 'Connor', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'B', 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', NULL, 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1588606503', 0, 'N', 0, '2012-01-26', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('870521827', 'W12003653', 'W12003653', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Thomas', 'G', 'Conover', 'MD', 'Mental Health', 'Pediatric Psychiatry', 'Pediatric Psychiatry', NULL, 'O', '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015842130', NULL, '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015842130', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1093805228', 0, 'N', 0, '2012-01-26', NULL, NULL, 40.757, -111.824, NULL, NULL),
('870521827', 'W12003654', 'W12003654', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Thomas', 'G', 'Conover', 'MD', 'Mental Health', 'Pediatric Psychiatry', 'Pediatric Psychiatry', NULL, 'B', 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', NULL, 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1093805228', 0, 'N', 0, '2012-01-26', NULL, NULL, 0, 0, NULL, NULL),
('870521827', 'W12003656', 'W12003656', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Larua', 'J', 'Cover', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015842130', NULL, '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015842130', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1821147299', 0, 'N', 0, '2012-01-26', NULL, NULL, 40.757, -111.824, NULL, NULL),
('870521827', 'W12003657', 'W12003657', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Larua', 'J', 'Cover', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', NULL, 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1821147299', 0, 'N', 0, '2012-01-26', NULL, NULL, 0, 0, NULL, NULL),
('870521827', 'W12003658', 'W12003658', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Jonathan', 'C', 'Cox', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'B', 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', NULL, 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1467614966', 0, 'N', 0, '2012-09-05', NULL, NULL, 0, 0, NULL, NULL),
('870521827', 'W12003661', 'W12003661', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Kenneth', 'L', 'Critchfield', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015842130', NULL, '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015842130', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1235344763', 0, 'N', 0, '2014-02-04', NULL, NULL, 40.757, -111.824, NULL, NULL),
('870521827', 'W12003660', 'W12003660', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Kenneth', 'L', 'Critchfield', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'B', 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', NULL, 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1235344763', 0, 'N', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('870521827', 'W12003663', 'W12003663', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Joe', 'C', 'Culbertson', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015842130', NULL, '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015842130', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|', '1548286792', 0, 'N', 0, '2013-09-10', NULL, NULL, 40.757, -111.824, NULL, NULL),
('870521827', 'W12003662', 'W12003662', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Joe', 'C', 'Culbertson', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'B', 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', NULL, 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|', '1548286792', 0, 'N', 0, '2013-09-10', NULL, NULL, 0, 0, NULL, NULL),
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('870521827', 'W12003666', 'W12003666', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Traci', 'L', 'David', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'B', 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', NULL, 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', '2012-09-18', 0, 0, 0, '', '', '', '', 'HCFA|', '1437297272', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('870685140', 'W12003668', 'W12003668', 'UT01', 'UNI-Home Project-Psychiatric', 'Traci', 'L', 'David', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'B', 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015873103', NULL, 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015873103', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-08-01', '2012-09-18', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437297272', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('870521827', 'W12003671', 'W12003671', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Spencer', 'C', 'DeBry', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015842130', NULL, '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015842130', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|', '1194797738', 0, 'N', 0, '2014-02-04', NULL, NULL, 40.757, -111.824, NULL, NULL),
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('870521827', 'W12003673', 'W12003673', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Paula', 'K', 'Gibbs', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015842130', NULL, '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015842130', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|', '1396754495', 0, 'N', 0, '2012-01-26', NULL, NULL, 40.757, -111.824, NULL, NULL),
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('870521827', 'W12003675', 'W12003675', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Douglas', 'D', 'Gray', 'MD', 'Mental Health', 'Pediatric Psychiatry', 'Psychiatry', NULL, 'B', 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', NULL, 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|', '1154429223', 0, 'N', 0, '2012-01-26', NULL, NULL, 0, 0, NULL, NULL),
('800530793', 'W12003690', 'W12003690', 'UTDT01', 'Logan Peak Dental Care', 'David', 'R', 'Gordon', 'DDS', 'Dentist', '', '', NULL, 'O', '981 S Main St Ste 260', 'Logan', 'Cache', 'UT', '84321', '4357870222', NULL, '981 S Main St Ste 260', 'Logan', 'Cache', 'UT', '84321', '4357870222', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009762', 0, 'N', 0, '2010-11-05', NULL, NULL, 0, 0, NULL, NULL),
('529327833', 'W12003692', 'W12003692', 'UTDT01', '', 'Kenneth R', '', 'Anderson', 'DDS', 'Dentist', '', '', NULL, 'O', '2290 E 4500 S', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012784131', NULL, '2290 E 4500 S', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012784131', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-04-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000005030', 0, 'N', 0, '2012-04-24', NULL, NULL, 0, 0, NULL, NULL),
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('711034954', 'W12003699', 'W12003699', 'UTDT01', '', 'Mark', '', 'Redd', 'DDS', 'Dentist', 'Pediatrics', '', NULL, 'O', '1792 W 1700 S Ste 101', 'Syracuse', 'Davis', 'UT', '84075', '8016140099', NULL, '1792 W 1700 S Ste 101', 'Syracuse', 'Davis', 'UT', '84075', '8016140099', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-05-01', '2011-03-01', 0, 0, 0, '', '', '', '', 'DEN|', '0000008344', 0, 'N', 0, '2011-05-16', NULL, NULL, 0, 0, NULL, NULL),
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('621801973', 'W12003440', 'W12003440', 'UT01', 'Jordan Valley Surgical Specialists', 'Dinhkim', '', 'Le', 'MD', 'General Surgery', '', '', NULL, 'M', '406 W S Jordan Pkwy', 'South Jordan', 'Salt Lake', 'UT', '84095', '8019843418', '8019843479', '406 W S Jordan Pkwy', 'South Jordan', 'Salt Lake', 'UT', '84095', '8019843418', '8019843479', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-08-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1588845101', 0, 'Y', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12003438', 'W12003438', 'UT01', 'Jordan Valley Surgical Specialists', 'Dinhkim', '', 'Le', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-08-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1588845101', 0, 'N', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('820513775', 'W12003702', 'W12003702', 'ID01', '', 'Bryan', 'J', 'Anderson', 'MD', 'General Surgery', '', '', NULL, 'O', '1072 N Liberty St Ste 201', 'Boise', 'Ada', 'ID', '83704', '2083772273', NULL, '1072 N Liberty St Ste 201', 'Boise', 'Ada', 'ID', '83704', '2083772273', '', 'IDGENSURG', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2010-07-12', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1811059264', 0, 'N', 0, '2014-06-11', NULL, NULL, 43.6139, -116.261, NULL, NULL),
('870281028', 'W12003703', 'W12003703', 'UT01', '', 'Jason', '', 'Hendrix', 'MD', 'Ophthalmology', '', '', NULL, 'O', '66 W Harding Ave Ste B', 'Cedar City', 'Iron', 'UT', '84720', '4356738080', '4356283748', '66 W Harding Ave Ste B', 'Cedar City', 'Iron', 'UT', '84720', '4356738080', '4356283748', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-07-30', '2011-02-28', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1831117167', 0, 'N', 0, '2013-12-12', NULL, NULL, 0, 0, NULL, NULL),
('870280408', 'W12003704', 'W12003704', 'UT01', 'Pediatric Anesthesiologists', 'McKay', 'H', 'Bateman', '', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3870', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8014322639', '8014322670', 'PO Box 3870', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8014322639', '8014322670', '', '', '', '0.00', '12.00', '0.00', 3, '2010-09-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1518014315', 0, 'N', 0, '2012-06-29', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12003705', 'W12003705', 'WYBILLINGS', 'Billings Clinic Oncology', 'Jennifer', 'L', 'Hill', 'LCPC', 'Mental Health', '', '', NULL, 'O', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382394', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382394', '', '', '', '0.00', '17.00', '0.00', 3, '2010-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992018865', 0, 'N', 0, '2010-09-30', NULL, NULL, 0, 0, NULL, NULL),
('621095750', 'W12003706', 'W12003706', 'UT01', 'The Neurology Group', 'Richard', 'T', 'Hoos', 'MD', 'Neurology', '', '', NULL, 'O', '302 Old Stone Bridge Rd', 'Goodlettsville', 'Davidson', 'TN', '37072', '6158551374', '6158551352', '302 Old Stone Bridge Rd', 'Goodlettsville', 'Davidson', 'TN', '37072', '6158551374', '6158551352', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356385645', 0, 'Y', 0, '2012-06-29', NULL, NULL, 36.3342, -86.7132, NULL, NULL),
('205934739', 'W12003708', 'W12003708', 'ID02', 'Family Medicine Health Center', 'Michelle', 'L', 'Minikel', 'MD', '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, '2010-08-03', '2012-04-05', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1093913113', 0, 'N', 0, '2012-04-10', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12003707', 'W12003707', 'ID02', 'Family Medicine Health Center', 'Michelle', 'L', 'Minikel', 'MD', 'Family Practice', '', '', NULL, 'O', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', NULL, '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '          ', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2010-08-03', '2012-04-05', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1093913113', 0, 'N', 0, '2012-04-10', NULL, NULL, 0, 0, NULL, NULL),
('830330554', 'W12003709', 'W12003709', 'WY01', 'Mountain View Medical Clinic', 'Amanda', 'M', 'Barnes', 'PA', 'General Surgery', '', '', NULL, 'O', '831 Parkway Dr', 'Mountain View', 'Uinta', 'WY', '82939', '3077891390', '          ', '831 Parkway Dr', 'Mountain View', 'Uinta', 'WY', '82939', '3077891390', '          ', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2009-08-01', '2014-04-23', 0, 0, 0, 'Evanston Regional Hospital', '', '', '', 'HCFA|UB|', '1841435385', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('830330554', 'W12003710', 'W12003710', 'WY01', 'Mountain View Medical Clinic', 'Gary', '', 'Noe', 'MD', 'Family Practice', '', '', NULL, 'O', '831 Parkway Dr', 'Mountain View', 'Uinta', 'WY', '82939', '3077891390', NULL, '831 Parkway Dr', 'Mountain View', 'Uinta', 'WY', '82939', '3077891390', '', 'wystd', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', '', '', '', 'HCFA|UB|', '1417952391', 0, 'N', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('820497538', 'W12003711', 'W12003711', 'ID01', 'All Seasons Mental Health', 'Terry', 'E', 'Sprague', 'LPC', 'Mental Health', '', '', NULL, 'O', '8050 W Rifleman Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083210634', NULL, '8050 W Rifleman Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083210634', '          ', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2010-10-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255503926', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870521827', 'W12003714', 'W12003714', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Najmeh', '', 'Hourmanesh', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015842130', NULL, '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015842130', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1093955502', 0, 'N', 0, '2013-02-27', NULL, NULL, 40.757, -111.824, NULL, NULL),
('870521827', 'W12003713', 'W12003713', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Najmeh', '', 'Hourmanesh', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'B', 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', NULL, 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1093955502', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870521827', 'W12003718', 'W12003718', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Elizabeth', 'F', 'Howell', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015842130', NULL, '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015842130', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|', '1326052440', 0, 'N', 0, '2014-02-04', NULL, NULL, 40.757, -111.824, NULL, NULL),
('870521827', 'W12003717', 'W12003717', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Elizabeth', 'F', 'Howell', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'B', 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', NULL, 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|', '1326052440', 0, 'N', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('870521827', 'W12003720', 'W12003720', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Jason', '', 'Hunziker', 'MD', 'Mental Health', '', '', NULL, 'O', '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015842130', NULL, '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015842130', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1619067212', 0, 'N', 0, '2012-01-26', NULL, NULL, 40.757, -111.824, NULL, NULL),
('870521827', 'W12003719', 'W12003719', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Jason', '', 'Hunziker', 'MD', 'Mental Health', '', '', NULL, 'B', 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', NULL, 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1619067212', 0, 'N', 0, '2012-01-26', NULL, NULL, 0, 0, NULL, NULL),
('364100874', 'W12003732', 'W12003732', 'TX01', 'Walgreens Home Care Inc.', '', '', 'Walgreens Home Care Inc', 'GROUP', 'Infusion Agency', 'Infusion Agency', NULL, NULL, 'B', '16358 Collections Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '2104049259', NULL, '16358 Collections Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '2104049259', '          ', 'DME80', '', 'TX2', '0.00', '50.00', '0.00', 8, '2009-05-01', '2012-06-30', 1, 0, 0, '', '', '', '', 'HCFA|UB|', '1124033196', 0, 'N', 0, '2012-07-03', NULL, NULL, 0, 0, NULL, NULL),
('270458690', 'W12002849', 'W12002849', 'UT01', 'Family First Care', 'David', 'T', 'Roberts', 'MD', 'Neurology', NULL, NULL, NULL, 'O', '1718 N University Pkwy Ste A', 'Provo', 'Utah', 'UT', '84604', '8014656969', '8014656999', '1718 N University Pkwy Ste A', 'Provo', 'Utah', 'UT', '84604', '8014656969', '8014656999', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-05-26', '2011-07-06', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326031782', 0, 'N', 0, '2011-07-06', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12003733', 'W12003733', 'UTIHC01', 'Pediatrics', 'Daniel', 'J', 'Allen', 'DO', 'Family Practice', 'Sports Medicine', '', NULL, 'O', '1303 N Main', 'Cedar City', 'Iron', 'UT', '84721', '4355867676', NULL, '1303 N Main', 'Cedar City', 'Iron', 'UT', '84721', '4355867676', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2010-08-01', '2012-12-31', 0, 0, 0, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1720017247', 0, 'N', 0, '2013-10-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12003734', 'W12003734', 'UTIHC03', 'Pediatrics', 'Daniel', 'J', 'Allen', 'DO', 'Family Practice', 'Sports Medicine', '', NULL, 'O', '1303 N Main', 'Cedar City', 'Iron', 'UT', '84721', '4355867676', NULL, '1303 N Main', 'Cedar City', 'Iron', 'UT', '84721', '4355867676', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2010-08-01', '2012-12-31', 0, 0, 0, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1720017247', 0, 'N', 0, '2013-10-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12003735', 'W12003735', 'UTIHC04', 'Pediatrics', 'Daniel', 'J', 'Allen', 'DO', 'Family Practice', 'Sports Medicine', '', NULL, 'O', '1303 N Main', 'Cedar City', 'Iron', 'UT', '84721', '4355867676', NULL, '1303 N Main', 'Cedar City', 'Iron', 'UT', '84721', '4355867676', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2010-08-01', '2012-12-31', 0, 0, 0, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1720017247', 0, 'N', 0, '2013-10-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12003736', 'W12003736', 'UTIHC04', 'EKG', 'Cammon', 'Bart', 'Arrington', 'MD', 'Pediatric Cardiology', 'Pediatrics', NULL, NULL, 'O', '1501 Hiland Ave', 'Burley', 'Cassia', 'ID', '83318', '2086784444', NULL, '1501 Hiland Ave', 'Burley', 'Cassia', 'ID', '83318', '2086784444', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2010-03-01', '2011-10-17', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700910114', 0, 'Y', 0, '2011-11-03', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12003763', 'W12003763', 'UTIHC04', 'Radiology', 'Seth', 'Y', 'Cardall', 'MD', 'Radiology', '', '', NULL, 'O', '1000 N Main St', 'Richfield', 'Sevier', 'UT', '84701', '4358934100', NULL, '1000 N Main St', 'Richfield', 'Sevier', 'UT', '84701', '4358934100', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2010-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831298900', 0, 'N', 0, '2010-08-05', NULL, NULL, 38.7833, -112.085, NULL, NULL),
('942854057', 'W12003762', 'W12003762', 'UTIHC01', 'Radiology', 'Seth', 'Y', 'Cardall', 'MD', 'Radiology', '', '', NULL, 'O', '1000 N Main St', 'Richfield', 'Sevier', 'UT', '84701', '4358934100', NULL, '1000 N Main St', 'Richfield', 'Sevier', 'UT', '84701', '4358934100', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2010-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831298900', 0, 'N', 0, '2010-08-05', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12003752', 'W12003752', 'UTIHC04', 'Radiology', 'Paul', '', 'Asmar', 'MD', 'Radiologist', NULL, NULL, NULL, 'O', '1485 S Hwy 40', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', '8012961715', '1485 S Hwy 40', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', '8012961715', '', '', '', '0.00', '15.00', '0.00', 8, '2010-07-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184626756', 0, 'N', 0, '2011-03-24', NULL, NULL, 40.489, -111.409, NULL, NULL),
('942854057', 'W12003753', 'W12003753', 'UTIHC04', 'Radiology', 'Paul', '', 'Asmar', 'MD', 'Radiologist', NULL, NULL, NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '8012961715', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '8012961715', '', '', '', '0.00', '15.00', '0.00', 8, '2010-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184626756', 0, 'N', 0, '2011-03-24', NULL, NULL, 40.6876, -111.468, NULL, NULL),
('942854057', 'W12003755', 'W12003755', 'UTIHC04', 'Radiology', 'Robert', '', 'Brinton', 'MD', 'Radiologist', '', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '8012961715', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '8012961715', '', '', '', '0.00', '15.00', '0.00', 8, '2010-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275530289', 0, 'N', 0, '2011-03-24', NULL, NULL, 40.6876, -111.468, NULL, NULL),
('942854057', 'W12003754', 'W12003754', 'UTIHC04', 'Radiology', 'Robert', '', 'Brinton', 'MD', 'Radiologist', '', '', NULL, 'O', '1485 S Hwy 40', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', '8012961715', '1485 S Hwy 40', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', '8012961715', '', '', '', '0.00', '15.00', '0.00', 8, '2010-07-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275530289', 0, 'N', 0, '2011-03-24', NULL, NULL, 40.489, -111.409, NULL, NULL),
('942854057', 'W12003744', 'W12003744', 'UTIHC04', 'Radiology', 'Robert', 'M', 'Bell', 'MD', 'Radiologist', NULL, NULL, NULL, 'O', '1485 S Hwy 40', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', '8012961715', '1485 S Hwy 40', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', '8012961715', '', '', '', '0.00', '15.00', '0.00', 8, '2010-07-29', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1831199918', 0, 'Y', 0, '2012-08-03', NULL, NULL, 40.489, -111.409, NULL, NULL),
('942854057', 'W12003745', 'W12003745', 'UTIHC04', 'Radiology', 'Robert', 'M', 'Bell', 'MD', 'Radiologist', NULL, NULL, NULL, 'O', '900 Round Valley Dr', 'Heber City', 'Wasatch', 'UT', '84032', '4356587000', '8012961715', '900 Round Valley Dr', 'Heber City', 'Wasatch', 'UT', '84032', '4356587000', '8012961715', '', '', '', '0.00', '15.00', '0.00', 8, '2010-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1831199918', 0, 'Y', 0, '2012-08-03', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12003746', 'W12003746', 'UTIHC04', 'Cardiology', 'Ronald', 'W', 'Asay', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1000 N Main St', 'Richfield', 'Sevier', 'UT', '84701', '4358934100', NULL, '1000 N Main St', 'Richfield', 'Sevier', 'UT', '84701', '4358934100', '', '', '', '', '0.00', '15.00', '0.00', 8, '2010-07-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1578521308', 0, 'N', 0, '2014-06-04', NULL, NULL, 38.7833, -112.085, NULL, NULL),
('942854057', 'W12003747', 'W12003747', 'UTIHC01', 'Cardiology', 'Ronald', 'W', 'Asay', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1000 N Main St', 'Richfield', 'Sevier', 'UT', '84701', '4358934100', NULL, '1000 N Main St', 'Richfield', 'Sevier', 'UT', '84701', '4358934100', '', '', '', '', '0.00', '15.00', '0.00', 8, '2010-07-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1578521308', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12003748', 'W12003748', 'UTIHC04', 'Cardiology', 'Ronald', 'W', 'Asay', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1100 S Medical Dr', 'Mount Pleasant', 'Sanpete', 'UT', '84647', '4354622441', NULL, '1100 S Medical Dr', 'Mount Pleasant', 'Sanpete', 'UT', '84647', '4354622441', '', '', '', '', '0.00', '15.00', '0.00', 8, '2010-07-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1578521308', 0, 'N', 0, '2014-06-04', NULL, NULL, 39.5318, -111.461, NULL, NULL),
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('942854057', 'W12003790', 'W12003790', 'UTIHC04', 'Radiology', 'Maryellyn', '', 'Gilfeather', 'MD', 'Radiologist', NULL, NULL, NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '8012961715', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '8012961715', '', '', '', '0.00', '15.00', '0.00', 8, '2010-07-01', NULL, 0, 0, 0, 'Lakeview Hospital', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1598764847', 0, 'N', 0, '2013-04-15', NULL, NULL, 40.6876, -111.468, NULL, NULL),
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('942854057', 'W12003814', 'W12003814', 'UTIHC04', 'Radiology', 'Steven', 'Brent', 'Lee', 'MD', 'Radiologist', NULL, NULL, NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '8012961715', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '8012961715', '', '', '', '0.00', '15.00', '0.00', 8, '2010-07-01', NULL, 0, 0, 0, 'Lakeview Hospital', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1629075684', 0, 'N', 0, '2013-04-15', NULL, NULL, 40.6876, -111.468, NULL, NULL),
('942854057', 'W12003815', 'W12003815', 'UTIHC04', 'EKG', 'Gordon', 'K', 'Mack', 'MD', 'Pediatric Cardiology', '', '', NULL, 'O', '1501 Hiland Ave', 'Burley', 'Cassia', 'ID', '83318', '2086784444', NULL, '1501 Hiland Ave', 'Burley', 'Cassia', 'ID', '83318', '2086784444', '', '', '', '', '0.00', '15.00', '0.00', 8, '2010-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982937058', 0, 'Y', 0, '2014-04-04', NULL, NULL, 42.5342, -113.783, NULL, NULL),
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('942854057', 'W12003889', 'W12003889', 'UTIHC04', 'EKG', 'Martin', 'J', 'Tristani-Firouzi', 'MD', 'Pediatric Cardiology', 'Pediatrics', '', NULL, 'O', '1501 Hiland Ave', 'Burley', 'Cassia', 'ID', '83318', '2086784444', NULL, '1501 Hiland Ave', 'Burley', 'Cassia', 'ID', '83318', '2086784444', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2010-03-01', '2011-10-17', 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1669551230', 0, 'Y', 0, '2011-11-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12003890', 'W12003890', 'UTIHC04', 'Radiology', 'Paul', 'N', 'Weiss', 'MD', 'Radiologist', NULL, NULL, NULL, 'O', '1485 S Hwy 40', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', '8012961715', '1485 S Hwy 40', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', '8012961715', '', '', '', '0.00', '15.00', '0.00', 8, '2010-07-29', NULL, 0, 0, 0, 'Lakeview Hospital', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1982604666', 0, 'Y', 0, '2013-04-15', NULL, NULL, 40.489, -111.409, NULL, NULL),
('942854057', 'W12003891', 'W12003891', 'UTIHC04', 'Radiology', 'Paul', 'N', 'Weiss', 'MD', 'Radiologist', NULL, NULL, NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '8012961715', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '8012961715', '', '', '', '0.00', '15.00', '0.00', 8, '2010-07-01', NULL, 0, 0, 0, 'Lakeview Hospital', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1982604666', 0, 'Y', 0, '2013-04-15', NULL, NULL, 40.6876, -111.468, NULL, NULL),
('942854057', 'W12003892', 'W12003892', 'UTIHC04', 'EKG', 'Richard', 'Vincent', 'Williams', 'MD', 'Pediatric Cardiology', 'Pediatrics', '', NULL, 'O', '1501 Hiland Ave', 'Burley', 'Cassia', 'ID', '83318', '2086784444', NULL, '1501 Hiland Ave', 'Burley', 'Cassia', 'ID', '83318', '2086784444', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2010-03-01', '2011-10-17', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578642047', 0, 'Y', 0, '2012-05-03', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12003893', 'W12003893', 'UTIHC04', 'EKG', 'Angela', 'T', 'Yetman', 'MD', 'Pediatric Cardiology', 'Pediatrics', '', NULL, 'O', '1501 Hiland Ave', 'Burley', 'Cassia', 'ID', '83318', '2086784444', NULL, '1501 Hiland Ave', 'Burley', 'Cassia', 'ID', '83318', '2086784444', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2010-03-01', '2011-10-17', 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1891885471', 0, 'Y', 0, '2012-10-05', NULL, NULL, 0, 0, NULL, NULL),
('300051569', 'W12003894', 'W12003894', 'WY01', 'Wyoming Specialized Physical Therapy', 'Michael', 'G', 'Jacketta', 'PT', 'Physical Therapy', '', '', NULL, 'O', '620 W Cheyenne Dr', 'Evanston', 'Uinta', 'WY', '82930', '3077864460', NULL, '620 W Cheyenne Dr', 'Evanston', 'Uinta', 'WY', '82930', '3077864460', '          ', 'wystd', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134131055', 0, 'N', 0, '2011-12-19', NULL, NULL, 41.2598, -110.98, NULL, NULL),
('412060533', 'W12003896', 'W12003896', 'WY01', '', 'Derek', '', 'Hoopes', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '170 Arrowhead Dr Ste 3', 'Evanston', 'Uinta', 'WY', '82930', '3077890098', NULL, '170 Arrowhead Dr Ste 3', 'Evanston', 'Uinta', 'WY', '82930', '3077890098', '', 'WUSTDORTH5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', 'Heber Valley Medical Center', '', '', 'HCFA|UB|', '0000009763', 0, 'N', 0, '2014-06-23', NULL, NULL, 41.2426, -110.996, NULL, NULL),
('412060533', 'W12003898', 'W12003898', 'WY01', '', 'Derek', '', 'Hoopes', 'PA', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 796', 'Heber City', 'Wasatch', 'UT', '84032', '4356546360', NULL, 'PO Box 796', 'Heber City', 'Wasatch', 'UT', '84032', '4356546360', '', 'WUSTDORTH5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', 'Heber Valley Medical Center', '', '', 'HCFA|UB|', '0000009763', 0, 'N', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('331177233', 'W12003902', 'W12003902', 'UT01', 'Ogden Adult and Senior Medicine', 'Nancy', 'J', 'Zega', 'DO', 'Urology', '', '', NULL, 'O', '425 E 5350 S Ste 255', 'Ogden', 'Weber', 'UT', '84405', '8014792911', '8014792914', '425 E 5350 S Ste 255', 'Ogden', 'Weber', 'UT', '84405', '8014792911', '8014792914', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-04-01', '2010-08-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1689746786', 0, 'N', 0, '2011-11-15', NULL, NULL, 0, 0, NULL, NULL),
('331177233', 'W12003903', 'W12003903', 'UT01', 'Ogden Adult and Senior Medicine', 'Nancy', 'J', 'Zega', 'DO', 'Urology', '', '', NULL, 'B', 'PO Box 100925', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', NULL, 'PO Box 100925', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-04-01', '2010-08-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1689746786', 0, 'N', 0, '2011-11-15', NULL, NULL, 0, 0, NULL, NULL),
('271398252', 'W12003907', 'W12003907', 'UT01', 'Utah Valley Urgent Care', 'Troy ', 'J', 'Badger', 'MD', 'Internal Medicine', '', '', NULL, 'O', '127 E Main St Ste E', 'Lehi', 'Utah', 'UT', '84043', '8017669822', '8017669441', '127 E Main St Ste E', 'Lehi', 'Utah', 'UT', '84043', '8017669822', '8017669441', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', '2030-01-01', 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1831335660', 0, 'N', 0, '2012-01-26', NULL, NULL, 0, 0, NULL, NULL),
('830323501', 'W12003910', 'W12003910', 'Sinclair', 'Therapy Solutions', 'Michael ', 'J', 'Bernd', 'PT', 'Physical Therapy', '', '', NULL, 'O', '6631 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072689904', '3072689907', '6631 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072689904', '3072689907', 'THERAPY', '', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568484897', 0, 'N', 0, '2011-06-29', NULL, NULL, 0, 0, NULL, NULL),
('830323501', 'W12003909', 'W12003909', 'WY01', 'Therapy Solutions', 'Michael ', 'J', 'Bernd', 'PT', 'Physical Therapy', '', '', NULL, 'O', '6631 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072689904', '3072689907', '6631 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072689904', '3072689907', 'THERAPY', '', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568484897', 0, 'N', 0, '2011-06-29', NULL, NULL, 42.8444, -106.244, NULL, NULL),
('271398252', 'W12003912', 'W12003912', 'UT01', 'Utah Valley Urgent Care', 'Jennifer', 'L', 'Butcher', 'APRN', 'Family Practice', '', '', NULL, 'O', '127 E Main St Ste E', 'Lehi', 'Utah', 'UT', '84043', '8017669822', '8017669441', '127 E Main St Ste E', 'Lehi', 'Utah', 'UT', '84043', '8017669822', '8017669441', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013230598', 0, 'N', 0, '2010-09-20', NULL, NULL, 40.3879, -111.847, NULL, NULL),
('742412898', 'W12003914', 'W12003914', 'UT01', 'Oquirrh View Community Health Centers', 'Eric Hong-Wen', '', 'Chen', 'MD', 'Family Practice', '', '', NULL, 'B', '1798 S W Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84115', '8019646214', NULL, '1798 S W Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84115', '8019646214', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-04-01', '2011-07-22', 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1912192220', 0, 'N', 0, '2011-09-21', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'W12003913', 'W12003913', 'UT01', 'Oquirrh View Community Health Centers', 'Eric Hong-Wen', '', 'Chen', 'MD', 'Family Practice', '', '', NULL, 'O', '4745 S 3200 W', 'Salt Lake City', 'Salt Lake', 'UT', '84118', '8019646214', '8019829232', '4745 S 3200 W', 'Salt Lake City', 'Salt Lake', 'UT', '84118', '8019646214', '8019829232', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-04-01', '2011-07-22', 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1912192220', 0, 'N', 0, '2011-09-21', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12003916', 'W12003916', 'ID02', 'Family Medicine Health Center', 'Ryan', 'J', 'Gilles', 'MD', '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, '2010-08-15', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1053519553', 0, 'N', 0, '2012-06-29', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12003915', 'W12003915', 'ID02', 'Family Medicine Health Center', 'Ryan', 'J', 'Gilles', 'MD', 'Family Practice', '', '', NULL, 'O', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2083676042', NULL, '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2083676042', '          ', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2010-08-15', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1053519553', 0, 'N', 0, '2012-06-29', NULL, NULL, 0, 0, NULL, NULL),
('810284764', 'W12003918', 'W12003918', 'WY01', 'Arapahoe Health Center', 'Mary', 'A', 'Gookin', 'FNP', 'Family Practice', '', '', NULL, 'O', '17 Great Plains Rd', 'Arapahoe', 'Fremont', 'WY', '82510', '3078569281', '3078577063', '17 Great Plains Rd', 'Arapahoe', 'Fremont', 'WY', '82510', '3078569281', '3078577063', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1104000827', 0, 'N', 0, '2011-06-10', NULL, NULL, 42.9868, -108.487, NULL, NULL),
('810284764', 'W12003917', 'W12003917', 'WY01', 'Fort Washakie Health Center', 'Mary', 'A', 'Gookin', 'FNP', 'Family Practice', '', '', NULL, 'O', '29 Black Coal Dr', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', '29 Black Coal Dr', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1104000827', 0, 'N', 0, '2011-06-10', NULL, NULL, 42.9969, -108.861, NULL, NULL),
('810284764', 'W12003919', 'W12003919', 'WY01', 'Fort Washakie Health Center', 'Mary', 'A', 'Gookin', 'FNP', 'Family Practice', '', '', NULL, 'B', 'PO Box 128', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', 'PO Box 128', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1104000827', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('810284764', 'W12003920', 'W12003920', 'WY01', 'Arapahoe Health Center', 'Mary', 'A', 'Gookin', 'FNP', 'Family Practice', '', '', NULL, 'M', 'PO Box 31001', 'Pasadena', 'Los Angeles', 'CA', '91110', '3078569281', '3078577063', 'PO Box 31001', 'Pasadena', 'Los Angeles', 'CA', '91110', '3078569281', '3078577063', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1104000827', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('830323501', 'W12003924', 'W12003924', 'Sinclair', 'Therapy Solutions', 'Heather', 'A', 'Grigg', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '6631 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072689904', '3072689907', '6631 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072689904', '3072689907', 'THERAPY', '', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841447232', 0, 'Y', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('830323501', 'W12003925', 'W12003925', 'WY01', 'Therapy Solutions', 'Heather', 'A', 'Grigg', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '6631 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072689904', '3072689907', '6631 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072689904', '3072689907', 'THERAPY', '', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841447232', 0, 'N', 0, '2011-06-10', NULL, NULL, 42.8444, -106.244, NULL, NULL),
('870635889', 'W12003927', 'W12003927', 'UT01', 'Oquirrh Surgical Services', 'T', 'Randy', 'Hansen', 'MD', 'General Surgery', '', '', NULL, 'O', '196 E 2000 N Ste 110', 'Tooele', 'Tooele', 'UT', '84074', '4352280061', '          ', '196 E 2000 N Ste 110', 'Tooele', 'Tooele', 'UT', '84074', '4352280061', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2013-12-31', 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB|', '1861433443', 0, 'N', 0, '2014-05-30', NULL, NULL, 40.5656, -112.294, NULL, NULL),
('870635889', 'W12003929', 'W12003929', 'UT01', 'Tooele Clinic Corp', 'T', 'Randy', 'Hansen', 'MD', 'General Surgery', '', '', NULL, 'M', '7100 Commerce Way Ste 180', 'Brentwood', 'Williamson', 'TN', '37027', '4352280661', '4358821275', '7100 Commerce Way Ste 180', 'Brentwood', 'Williamson', 'TN', '37027', '4352280661', '4358821275', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2013-12-31', 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB|', '1861433443', 0, 'Y', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('870635889', 'W12003928', 'W12003928', 'UT01', 'Oquirrh Surgical Services', 'T', 'Randy', 'Hansen', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 848416', 'Boston', 'Suffolk', 'MA', '02284', '4352280661', '          ', 'PO Box 848416', 'Boston', 'Suffolk', 'MA', '02284', '4352280661', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2013-12-31', 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB|', '1861433443', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL);
