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
('830182821', 'W12048564', 'W12048564', 'WY01', 'Gottsche Rehabilitation Center', 'Ryan', '', 'Vincent', 'PT', 'Physical Therapy', '', '', NULL, 'O', '720 Lindsay Ln', 'Cody', 'Park', 'WY', '82414', '3075781970', '3075781973', '720 Lindsay Ln', 'Cody', 'Park', 'WY', '82414', '3075781970', '3075781973', '', '', '', '0.00', '25.00', '0.00', 3, '2014-06-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1831445162', 0, 'N', 1, '2014-06-17', NULL, NULL, 0, 0, NULL, NULL),
('050593169', 'SCNA00024', 'SCNA00024', 'SCNA01', 'Bostwick Laboratories', '', '', 'Bostwick Laboratories', '', 'Laboratory', '', '', NULL, 'O', '4355 Innslake Dr', 'Glen Allen', 'Henrico', 'VA', '23060', '8049679225', '8042886568', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WULABCORP5', NULL, NULL, '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124051644', 0, 'Y', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('050593169', 'SCNA00025', 'SCNA00025', 'SCNA01', 'Bostwick Laboratories', '', '', 'Bostwick Laboratories', '', 'Laboratory', '', '', NULL, 'B', 'PO Box 403751', 'Atlanta', 'Fulton', 'GA', '30384', '8049679225', '8042886568', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WULABCORP5', NULL, NULL, '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124051644', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('330604557', 'SCNA00051', 'SCNA00051', 'SCNA01', 'Cardionet Inc', '', '', 'Cardionet, Inc', 'Group', 'Cardiac Monitoring', '', '', NULL, 'O', '1000 Cedar Hollow Rd Ste 102', 'Malvern', 'Chester', 'PA', '19355', '6107297000', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'CARDIONET', NULL, NULL, '0.00', '50.00', '0.00', 3, '2014-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1790869402', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('330604557', 'SCNA00033', 'SCNA00033', 'SCNA01', 'Cardionet, LLC', '', '', 'Cardionet, LLC', '', 'Cardiac Monitoring', '', '', NULL, 'O', '1285 Corporate Ctr Dr Ste 175', 'Eagan', 'Dakota', 'MN', '55121', '8664264402', '8669242459', '1285 Corporate Ctr Dr Ste 175', 'Eagan', 'Dakota', 'MN', '55121', '8664264402', '8669242459', 'CARDIONET', '', '', '0.00', '50.00', '0.00', 3, '2014-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1427321199', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('330604557', 'SCNA00034', 'SCNA00034', 'SCNA01', 'Cardionet, LLC', '', '', 'Cardionet, LLC', '', 'Cardiac Monitoring', '', '', NULL, 'O', '456 Montgomery St Ste 600', 'San Francisco', 'San Francisco', 'CA', '94104', '8664264402', '8664264403', '456 Montgomery St Ste 600', 'San Francisco', 'San Francisco', 'CA', '94104', '8664264402', '8664264403', 'CARDIONET', '', '', '0.00', '50.00', '0.00', 3, '2014-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1427321199', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('330604557', 'SCNA00035', 'SCNA00035', 'SCNA01', 'Cardionet, LLC', '', '', 'Cardionet, LLC', '', 'Cardiac Monitoring', '', '', NULL, 'B', 'PO Box 417566', 'Boston', 'Suffolk', 'MA', '02241', '8664264402', '8664264403', 'PO Box 417566', 'Boston', 'Suffolk', 'MA', '02241', '8664264402', '8664264403', 'CARDIONET', '', '', '0.00', '50.00', '0.00', 3, '2014-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1427321199', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('541707322', 'SCNA00038', 'SCNA00038', 'SCNA01', 'Care Rehab and Orthopedic Products  (Muscle Stimulators)', '', '', 'Care Rehab and Orthopedic Products  (Muscle Stimulators)', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', 'Phone Number Only', NULL, NULL, NULL, NULL, '8004879644', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WCSTCROP5', NULL, NULL, '0.00', '20.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578562468', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('953382344', 'SCNA00010', 'SCNA00010', 'SCNA01', 'Choice Source Caremark', '', '', 'Choice Source Caremark', 'GROUP', 'Infusion Agency', 'Mail Order Pharmacy', 'Specialty Pharmacy', NULL, 'B', '1127 Bryn Mawr Ave Ste A', 'Redlands', 'San Bernardino', 'CA', '92374', '8002372767', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '1001', '0.00', '0.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013998921', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('953382344', 'SCNA00011', 'SCNA00011', 'SCNA01', 'Choice Source Caremark', '', '', 'Choice Source Caremark', 'GROUP', 'Infusion Agency', 'Mail Order Pharmacy', 'Specialty Pharmacy', NULL, 'B', '19102 N Creek Pkwy', 'Bothell', 'King', 'WA', '98011', '8002372767', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '1001', '0.00', '0.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013998921', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('953382344', 'SCNA00012', 'SCNA00012', 'SCNA01', 'Choice Source Caremark', '', '', 'Choice Source Caremark', 'GROUP', 'Infusion Agency', 'Mail Order Pharmacy', 'Specialty Pharmacy', NULL, 'B', '543 Pylon Dr', 'Raleigh', 'Wake', 'NC', '27606', '8002372767', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '1001', '0.00', '0.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013998921', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('953382344', 'SCNA00013', 'SCNA00013', 'SCNA01', 'Choice Source Caremark', '', '', 'Choice Source Caremark', 'GROUP', 'Infusion Agency', 'Mail Order Pharmacy', 'Specialty Pharmacy', NULL, 'B', '543 W Hermosa Dr', 'San Antonio', 'Bexar', 'TX', '78212', '8002372767', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '1001', '0.00', '0.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013998921', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('953382344', 'SCNA00014', 'SCNA00014', 'SCNA01', 'Choice Source Caremark', '', '', 'Choice Source Caremark', 'GROUP', 'Infusion Agency', 'Mail Order Pharmacy', 'Specialty Pharmacy', NULL, 'O', 'Phone Number Only', NULL, NULL, NULL, NULL, '8002372767', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '1001', '0.00', '0.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013998921', 0, 'Y', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('953382344', 'SCNA00015', 'SCNA00015', 'SCNA01', 'Choice Source Caremark', '', '', 'Choice Source Caremark', 'GROUP', 'Infusion Agency', 'Mail Order Pharmacy', 'Specialty Pharmacy', NULL, 'B', 'Po Box 840688', 'Dallas', 'Dallas', 'TX', '75284', '8002372767', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '1001', '0.00', '0.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013998921', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('870427760', 'SCNA00022', 'SCNA00022', 'SCNA01', 'Depot Drug (CPAP Services and Home Sleep Testing)', '', '', 'Depot Drug', '', 'Durable Medical Equipment', '', '', NULL, 'O', 'Phone Number Only', NULL, NULL, NULL, NULL, '8008770618', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DEPOTDRUG', NULL, NULL, '0.00', '50.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104987312', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('870427760', 'SCNA00023', 'SCNA00023', 'SCNA01', 'Depot Drug (CPAP Services and Home Sleep Testing)', '', '', 'Depot Drug', '', 'Durable Medical Equipment', '', '', NULL, 'B', 'PO Box 161020', 'Salt Lake City', 'Salt Lake', 'UT', '84116', '8008770618', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DEPOTDRUG', NULL, NULL, '0.00', '50.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104987312', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('061128081', 'SCNA00009', 'SCNA00009', 'SCNA01', 'Dianon Systems Inc', '', '', 'Dianon Systems Inc', 'GROUP', 'Laboratory', '', '', NULL, 'B', 'Phone Number Only', NULL, NULL, NULL, NULL, '8003282666', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WDIANON', NULL, NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003819020', 0, 'Y', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('522165554', 'SCNA00016', 'SCNA00016', 'SCNA01', 'DJO (Orthopedic Supplies for Provider Use Only)', '', '', 'DJO (Orthopedic Supplies for Provider Use Only)', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', 'Phone Number Only', NULL, NULL, NULL, NULL, '8003366569', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DME80', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023296035', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('521262870', 'SCNA00032', 'SCNA00032', 'SCNA01', 'Dynasplint Systems Inc  (Custom Braces)', '', '', 'Dynasplint Systems Inc  (Custom Braces)', 'GROUP', 'Durable Medical Equipment', 'Custom Splints', '', NULL, 'O', 'Phone Number Only', NULL, NULL, NULL, NULL, '8006386771', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WCSTDSS5', NULL, NULL, '0.00', '100.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386643856', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('770644336', 'SCNA00017', 'SCNA00017', 'SCNA01', 'eCardio Diagnostics ', '', '', 'eCardio Diagnostics LLC', 'GROUP', 'Cardiac Monitoring', '', '', NULL, 'B', '1717 N Sam Houston Pkwy W Ste 100', 'Houston', 'Harris', 'TX', '77038', '8884003522', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'wisecardio', NULL, NULL, '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063414258', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('770644336', 'SCNA00018', 'SCNA00018', 'SCNA01', 'eCardio Diagnostics ', '', '', 'eCardio Diagnostics LLC', 'GROUP', 'Cardiac Monitoring', '', '', NULL, 'O', 'Phone Number Only', NULL, NULL, NULL, NULL, '8884003522', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'wisecardio', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063414258', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('341650951', 'SCNA00039', 'SCNA00039', 'SCNA01', 'Edgepark', '', '', 'Edgepark', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'B', '1810 Summit Commerce Park', 'Twinsburg', 'Lorain', 'OH', '44039', '8003210591', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'EDGPRK12', NULL, NULL, '0.00', '40.00', '0.00', 3, '2014-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609858729', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('341650951', 'SCNA00040', 'SCNA00040', 'SCNA01', 'Edgepark', '', '', 'Edgepark', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', 'Phone Number Only', NULL, NULL, NULL, NULL, '8003210591', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'EDGPRK12', NULL, NULL, '0.00', '40.00', '0.00', 3, '2014-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609858729', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('411310335', 'SCNA00026', 'SCNA00026', 'SCNA01', 'Empi Inc (Neuromuscular Stimulator)', '', '', 'Empi Inc (Neuromuscular Stimulator)', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', 'Phone Number Only', NULL, NULL, NULL, NULL, '8003282536', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WCSTEMPI5', 'DME90', NULL, '0.00', '15.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1174574032', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('860898663', 'SCNA00036', 'SCNA00036', 'SCNA01', 'Preferred Homecare', '', '', 'Founders Healthcare', '', 'Durable Medical Equipment', '', '', NULL, 'B', 'PO Box 40700', 'Mesa', 'Maricopa', 'AZ', '85274', NULL, '5056618352', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DME7012', NULL, NULL, '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538468574', 0, 'Y', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('860898663', 'SCNA00042', 'SCNA00042', 'SCNA01', 'Preferred Homecare', '', '', 'Founders Healthcare', '', 'Durable Medical Equipment', '', '', NULL, 'B', 'PO Box 40700', 'Mesa', 'Maricopa', 'AZ', '85274', NULL, '5058211699', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DME7012', NULL, NULL, '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619916632', 0, 'Y', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('232582601', 'SCNA00002', 'SCNA00002', 'SCNA01', 'Hanger Clinic', '', '', 'Hanger Prosthetics & Orthotics Inc', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'B', '4155 E LaPalma Ave Ste B400', 'Anaheim', 'Orange', 'CA', '92807', '7149612107', '          ', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DMECURRENT', NULL, NULL, '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006560', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('521486235', 'SCNA00003', 'SCNA00003', 'SCNA01', 'Hanger Clinic', '', '', 'Hanger Prosthetics & Orthotics Inc', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'B', '4155 E LaPalma Ave Ste B400', 'Anaheim', 'Orange', 'CA', '92807', '7149612107', '          ', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DMECURRENT', NULL, NULL, '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006560', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('760524096', 'SCNA00004', 'SCNA00004', 'SCNA01', 'Dynamic Orthotics and Prosthetics', '', '', 'Hanger Prosthetics & Orthotics Inc', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'B', '4155 E LaPalma Ave Ste B400', 'Anaheim', 'Orange', 'CA', '92807', NULL, '          ', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DMECURRENT', NULL, NULL, '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006560', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('952667855', 'SCNA00005', 'SCNA00005', 'SCNA01', 'Hanger Prosthetics and Orthotics West Inc', '', '', 'Hanger Prosthetics & Orthotics Inc', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'B', '4155 E LaPalma Ave Ste B400', 'Anaheim', 'Orange', 'CA', '92807', '7149612107', '          ', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DMECURRENT', NULL, NULL, '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006560', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('742152396', 'SCNA00031', 'SCNA00031', 'SCNA01', 'KCI USA Inc (Wound Vac Only)', '', '', 'KCI USA Inc. ', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', 'Phone Number Only', NULL, NULL, NULL, NULL, '8002754524', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'KCI', NULL, NULL, '0.00', '100.00', '0.00', 3, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366439507', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('840611484', 'SCNA00021', 'SCNA00021', 'SCNA01', 'LabCorp of America Holdings', '', '', 'LabCorp of America Holdings', 'GROUP', 'Laboratory', '', '', NULL, 'O', 'Phone Number Only', NULL, NULL, NULL, NULL, '8885222677', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WULABCORP5', NULL, NULL, '0.00', '35.00', '0.00', 3, '2006-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104829159', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('710948567', 'SCNA00046', 'SCNA00046', 'SCNA01', 'Life Care Solutions', '', '', 'Life Care Solutions', '', 'Durable Medical Equipment', '', '', NULL, 'B', '1220 Research Dr', 'Redlands', 'San Bernardino', 'CA', '92374', '9512714447', '9515475096', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DME7012', NULL, NULL, '0.00', '35.00', '0.00', 3, '2013-10-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1689956575', 0, 'Y', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('710948567', 'SCNA00047', 'SCNA00047', 'SCNA01', 'Life Care Solutions', '', '', 'Life Care Solutions', '', 'Durable Medical Equipment', '', '', NULL, 'O', '1801 N Government Way Ste 3', 'Coeur D Alene', 'Kootenai', 'ID', '83814', '8005840710', '8005840712', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DME7012', NULL, NULL, '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1689956575', 0, 'Y', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('522212112', 'SCNA00029', 'SCNA00029', 'SCNA01', 'LifeWatch', '', '', 'LifeWatch Inc', 'GROUP', 'Cardiac Monitoring', '', '', NULL, 'B', '10255 W Higgins Rd Ste 100', 'Des Plaines', 'Cook', 'IL', '60018', '8777749846', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WCSTLWI5', NULL, NULL, '0.00', '100.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255367843', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('522212112', 'SCNA00030', 'SCNA00030', 'SCNA01', 'LifeWatch', '', '', 'LifeWatch Inc', 'GROUP', 'Cardiac Monitoring', '', '', NULL, 'O', 'Phone Number Only', NULL, NULL, NULL, NULL, '8777749846', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WCSTLWI5', NULL, NULL, '0.00', '100.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255367843', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('562326691', 'W12048556', 'W12048556', 'UT01', 'Jordan Landing Clinic', 'Kolleen', '', 'Marchand', 'PA-C', 'Family Practice', '', '', NULL, 'O', '3895 W 7800 S Ste 100', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012807774', '8017432790', '3895 W 7800 S Ste 100', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012807774', '8017432790', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740206630', 0, 'N', 0, '2014-06-11', NULL, NULL, 0, 0, NULL, NULL),
('562326691', 'W12048557', 'W12048557', 'UT01', 'Jordan Valley Family Health', 'Kolleen', '', 'Marchand', 'PA-C', 'Family Practice', '', '', NULL, 'B', 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8012807774', '          ', 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8012807774', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740206630', 0, 'N', 0, '2014-06-11', NULL, NULL, 0, 0, NULL, NULL),
('223510467', 'SCNA00050', 'SCNA00050', 'SCNA01', 'Medical Diagnostic Laboratories', '', '', 'Medical Diagnostic Laboratories', 'Group', 'Laboratory', '', '', NULL, 'O', '2439 Kuser Rd', 'Trenton', 'Mercer', 'NJ', '08690', '8772690090', '6095701050', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WULABCORP5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2011-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750373908', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'SCNA00006', 'SCNA00006', 'SCNA01', 'Metwest Inc dba Quest Diagnost', '', '', 'Metwest Inc dba Quest Diagnost', 'GROUP', 'Laboratory', '', '', NULL, 'B', 'PO Box 822504', 'Philadelphia', 'Philadelphia', 'PA', '19182', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUQUEST5', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007585', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('330363116', 'SCNA00007', 'SCNA00007', 'SCNA01', 'Metwest Inc dba Quest Diagnostics', '', '', 'Metwest Inc dba Quest Diagnostic', 'GROUP', 'Laboratory', '', '', NULL, 'B', '2032 Collection Ctr Dr', 'CHICAGO', 'Cook', 'IL', '60693', NULL, '          ', '2032 Collection Ctr Dr', 'CHICAGO', 'Cook', 'IL', '60693', '', '          ', 'WUQUEST5', NULL, '', '0.00', '20.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000831976', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('752608036', 'SCNA00028', 'SCNA00028', 'SCNA01', 'Orthofix Inc (Bone Growth Stimulators Physicians Only)', '', '', 'Orthofix Inc (Bone Growth Stimulators Physicians Only)', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', 'Phone Number Only', '', '', '', '', '8005354492', '          ', 'Phone Number Only', '', '', '', '', '8005354492', '          ', 'ORTHOFIX14', '', '', '0.00', '50.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1235136060', 0, 'N', 1, '2014-07-23', NULL, NULL, 0, 0, NULL, NULL),
('752890546', 'SCNA00043', 'SCNA00043', 'SCNA01', 'Preferred Home Care', '', '', 'Park Infusion Care', '', 'Durable Medical Equipment', '', '', NULL, NULL, '8666 Huebner Rd Ste 208', 'San Antonio', 'Bexar', 'TX', '78240', '2106973800', '2106973801', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DME7012', NULL, NULL, '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1649415746', 0, 'Y', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('752890546', 'SCNA00044', 'SCNA00044', 'SCNA01', 'Preferred Homecare', '', '', 'Park Infusion Care', '', 'Durable Medical Equipment', '', '', NULL, 'B', '4319 Medical Dr Ste 250', 'San Antonio', 'Bexar', 'TX', '78229', '2106157475', '2106973801', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DME7012', NULL, NULL, '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1689761462', 0, 'Y', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('752890546', 'SCNA00045', 'SCNA00045', 'SCNA01', 'Preferred Homecare', '', '', 'Park Infusion Care', '', 'Durable Medical Equipment', '', '', NULL, 'B', 'PO Box 40700', 'Mesa', 'Maricopa', 'AZ', '85274', NULL, '2106973801', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DME7012', NULL, NULL, '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1689761462', 0, 'Y', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('112659192', 'SCNA00052', 'SCNA00052', 'SCNA01', 'PerkinElmer Laboratories Inc', '', '', 'PerkinElmer Laboratories Inc', '', 'Laboratory', '', '', NULL, 'O', '80 Ruland Rd Ste 1', 'Melville', 'Suffolk', 'NY', '11747', '6314250800', '6314250811', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'PERKELABS', NULL, NULL, '0.00', '0.00', '0.00', 3, '2012-12-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992779664', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('860898663', 'SCNA00041', 'SCNA00041', 'SCNA01', 'Preferred Home Care', '', '', 'Preferred Home Care', '', 'Durable Medical Equipment', '', '', NULL, 'M', 'PO Box 40700', 'Mesa', 'Maricopa', 'AZ', '85274', '8013164215', '8013164217', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DME7012', NULL, NULL, '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619280286', 0, 'Y', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('061287427', 'SCNA00027', 'SCNA00027', 'SCNA01', 'Raytel Cardiac Services Inc', '', '', 'Raytel Cardiac Services Inc', 'GROUP', 'Cardiac Monitoring', '', '', NULL, 'O', 'Phone Number Only', NULL, NULL, NULL, NULL, '8003670300', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WCSTRCS5', NULL, NULL, '0.00', '100.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194776518', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('411694999', 'SCNA00019', 'SCNA00019', 'SCNA01', 'Roche Insulin Delivery Systems Inc', '', '', 'Roche Insulin Delivery Systems Inc', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', 'Phone Number Only', NULL, NULL, NULL, NULL, '8002807801', '8888100758', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WDISETR', NULL, NULL, '0.00', '30.00', '0.00', 3, '2010-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083880447', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('411694999', 'SCNA00020', 'SCNA00020', 'SCNA01', 'Roche Insulin Delivery Systems Inc', '', '', 'Roche Insulin Delivery Systems Inc', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'B', 'PO Box 86 SDS 12-2207', 'Minneapolis', 'Hennepin', 'MN', '55486', '8002807801', '8888100758', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WDISETR', NULL, NULL, '0.00', '30.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083880447', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('911490213', 'SCNA00053', 'SCNA00053', 'SCNA01', 'RS Medical (Muscle Stimulators)', '', '', 'RS Medical (Muscle Stimulators)', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', 'Phone Number Only', NULL, NULL, NULL, NULL, '8006830353', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WCSTRSMED5', NULL, NULL, '0.00', '25.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992791230', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('861072115', 'SCNA00048', 'SCNA00048', 'SCNA01', 'Signature Genomic Laboratories', '', '', 'Signature Genomic Laboratories', '', 'Laboratory', '', '', NULL, 'O', '2820 N Astor St', 'Spokane', 'Spokane', 'WA', '99207', '5094746840', '5094746839', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'PERKELABS', NULL, NULL, '0.00', '0.00', '0.00', 3, '2012-10-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740248848', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('861072115', 'SCNA00049', 'SCNA00049', 'SCNA01', 'Signature Genomic Laboratories', '', '', 'Signature Genomic Laboratories', '', 'Laboratory', '', '', NULL, 'B', 'PO Box 4474', 'Spokane', 'Spokane', 'WA', '99220', '5094746840', '5094746839', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'PERKELABS', NULL, NULL, '0.00', '0.00', '0.00', 3, '2012-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740248848', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('510123924', 'SCNA00037', 'SCNA00037', 'SCNA01', 'Smith Nephew Inc (Muscle Stimulators)', '', '', 'Smith Nephew Inc (Muscle Stimulators)', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', 'Phone Number Only', NULL, NULL, NULL, NULL, '8008215700', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '1002', '0.00', '30.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568532901', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('262792136', 'W12048679', 'W12048679', 'ID02', 'Advanced Therapy Care', 'Meara', 'A', 'Baker', 'SLP', 'Speech Therapy', '', '', NULL, 'B', '245 N 3rd E', 'Mountain Home', 'Elmore', 'ID', '83647', '2088980988', '2088989022', '245 N 3rd E', 'Mountain Home', 'Elmore', 'ID', '83647', '2088980988', '2088989022', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2014-06-04', NULL, 0, 0, 1, '', '', '', '', 'HCFA', '1518032853', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('262792136', 'W12048681', 'W12048681', 'ID02', 'Advanced Therapy Care', 'Christine', 'R', 'Bartlett', 'SLP', 'Speech Therapy', '', '', NULL, 'B', '245 N 3rd E', 'Mountain Home', 'Elmore', 'ID', '83647', '2088980988', '2088989022', '245 N 3rd E', 'Mountain Home', 'Elmore', 'ID', '83647', '2088980988', '2088989022', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2014-06-04', NULL, 0, 0, 1, '', '', '', '', 'HCFA', '1396808242', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('262792136', 'W12048682', 'W12048682', 'ID02', 'Advanced Therapy Care', 'Amber', '', 'Bethke', 'CCC-SLP', 'Speech Therapy', '', '', NULL, 'O', '1550 N Crestmont Dr', 'Meridian', 'Ada', 'ID', '83642', '2088980988', '2088989022', '1550 N Crestmont Dr', 'Meridian', 'Ada', 'ID', '83642', '2088980988', '2088989022', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2014-06-04', NULL, 0, 0, 1, '', '', '', '', 'HCFA', '1922388644', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('262792136', 'W12048683', 'W12048683', 'ID02', 'Advanced Therapy Care', 'Amber', '', 'Bethke', 'CCC-SLP', 'Speech Therapy', '', '', NULL, 'B', '245 N 3rd E', 'Mountain Home', 'Elmore', 'ID', '83647', '2088980988', '2088989022', '245 N 3rd E', 'Mountain Home', 'Elmore', 'ID', '83647', '2088980988', '2088989022', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2014-06-04', NULL, 0, 0, 1, '', '', '', '', 'HCFA', '1922388644', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('262792136', 'W12048684', 'W12048684', 'ID02', 'Advanced Therapy Care', 'Taunya', '', 'Bos', 'SLP', 'Speech Therapy', '', '', NULL, 'O', '1550 N Crestmont Dr', 'Meridian', 'Ada', 'ID', '83642', '2088980988', '2088989022', '1550 N Crestmont Dr', 'Meridian', 'Ada', 'ID', '83642', '2088980988', '2088989022', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2014-06-04', NULL, 0, 0, 1, '', '', '', '', 'HCFA', '1487929766', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('262792136', 'W12048685', 'W12048685', 'ID02', 'Advanced Therapy Care', 'Taunya', '', 'Bos', 'SLP', 'Speech Therapy', '', '', NULL, 'B', '245 N 3rd E', 'Mountain Home', 'Elmore', 'ID', '83647', '2088980988', '2088989022', '245 N 3rd E', 'Mountain Home', 'Elmore', 'ID', '83647', '2088980988', '2088989022', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2014-06-04', NULL, 0, 0, 1, '', '', '', '', 'HCFA', '1487929766', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('262792136', 'W12048686', 'W12048686', 'ID02', 'Advanced Therapy Care', 'Pamela', '', 'Clausen', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '1550 N Crestmont Dr', 'Meridian', 'Ada', 'ID', '83642', '2088980988', '2088989022', '1550 N Crestmont Dr', 'Meridian', 'Ada', 'ID', '83642', '2088980988', '2088989022', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2014-06-04', NULL, 0, 0, 1, '', '', '', '', 'HCFA', '1942431796', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('262792136', 'W12048687', 'W12048687', 'ID02', 'Advanced Therapy Care', 'Pamela', '', 'Clausen', 'OT', 'Occupational Therapy', '', '', NULL, 'B', '245 N 3rd E', 'Mountain Home', 'Elmore', 'ID', '83647', '2088980988', '2088989022', '245 N 3rd E', 'Mountain Home', 'Elmore', 'ID', '83647', '2088980988', '2088989022', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2014-06-04', NULL, 0, 0, 1, '', '', '', '', 'HCFA', '1942431796', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('262792136', 'W12048688', 'W12048688', 'ID02', 'Advanced Therapy Care', 'Candice', 'F', 'Curtis', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '1550 N Crestmont Dr', 'Meridian', 'Ada', 'ID', '83642', '2088980988', '2088989022', '1550 N Crestmont Dr', 'Meridian', 'Ada', 'ID', '83642', '2088980988', '2088989022', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2014-06-04', NULL, 0, 0, 1, '', '', '', '', 'HCFA', '1033359286', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('262792136', 'W12048689', 'W12048689', 'ID02', 'Advanced Therapy Care', 'Candice', 'F', 'Curtis', 'OT', 'Occupational Therapy', '', '', NULL, 'B', '245 N 3rd E', 'Mountain Home', 'Elmore', 'ID', '83647', '2088980988', '2088989022', '245 N 3rd E', 'Mountain Home', 'Elmore', 'ID', '83647', '2088980988', '2088989022', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2014-06-04', NULL, 0, 0, 1, '', '', '', '', 'HCFA', '1033359286', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('262792136', 'W12048690', 'W12048690', 'ID02', 'Advanced Therapy Care', 'Rebecca', 'L', 'Daniel', 'CCC-SLP', 'Speech Therapy', 'Speech Language Pathology', '', NULL, 'O', '1550 N Crestmont Dr', 'Meridian', 'Ada', 'ID', '83642', '2088980988', '2088989022', '1550 N Crestmont Dr', 'Meridian', 'Ada', 'ID', '83642', '2088980988', '2088989022', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2014-06-04', NULL, 0, 0, 1, '', '', '', '', 'HCFA', '1639218860', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('262792136', 'W12048691', 'W12048691', 'ID02', 'Advanced Therapy Care', 'Rebecca', 'L', 'Daniel', 'CCC-SLP', 'Speech Therapy', 'Speech Language Pathology', '', NULL, 'B', '245 N 3rd E', 'Mountain Home', 'Elmore', 'ID', '83647', '2088980988', '2088989022', '245 N 3rd E', 'Mountain Home', 'Elmore', 'ID', '83647', '2088980988', '2088989022', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2014-06-04', NULL, 0, 0, 1, '', '', '', '', 'HCFA', '1639218860', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('262792136', 'W12048692', 'W12048692', 'ID02', 'Advanced Therapy Care', 'Kendra ', 'R', 'Lenzi', 'OTR', 'Occupational Therapy', '', '', NULL, 'O', '1550 N Crestmont Dr', 'Meridian', 'Ada', 'ID', '83642', '2088980988', '2088989022', '1550 N Crestmont Dr', 'Meridian', 'Ada', 'ID', '83642', '2088980988', '2088989022', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2014-06-04', NULL, 0, 0, 1, '', '', '', '', 'HCFA', '1326335100', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('262792136', 'W12048693', 'W12048693', 'ID02', 'Advanced Therapy Care', 'Kendra ', 'R', 'Lenzi', 'OTR', 'Occupational Therapy', '', '', NULL, 'B', '245 N 3rd E', 'Mountain Home', 'Elmore', 'ID', '83647', '2088980988', '2088989022', '245 N 3rd E', 'Mountain Home', 'Elmore', 'ID', '83647', '2088980988', '2088989022', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2014-06-04', NULL, 0, 0, 1, '', '', '', '', 'HCFA', '1326335100', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('262792136', 'W12048694', 'W12048694', 'ID02', 'Advanced Therapy Care', 'Cebu', '', 'Maybury', 'SLP', 'Speech Therapy', '', '', NULL, 'O', '1550 N Crestmont Dr', 'Meridian', 'Ada', 'ID', '83642', '2088980988', '2088989022', '1550 N Crestmont Dr', 'Meridian', 'Ada', 'ID', '83642', '2088980988', '2088989022', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2014-06-04', NULL, 0, 0, 1, '', '', '', '', 'HCFA', '1184984932', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('262792136', 'W12048695', 'W12048695', 'ID02', 'Advanced Therapy Care', 'Cebu', '', 'Maybury', 'SLP', 'Speech Therapy', '', '', NULL, 'B', '245 N 3rd E', 'Mountain Home', 'Elmore', 'ID', '83647', '2088980988', '2088989022', '245 N 3rd E', 'Mountain Home', 'Elmore', 'ID', '83647', '2088980988', '2088989022', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2014-06-04', NULL, 0, 0, 1, '', '', '', '', 'HCFA', '1184984932', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('262792136', 'W12048696', 'W12048696', 'ID02', 'Advanced Therapy Care', 'Julie', 'H', 'Orozco', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '1550 N Crestmont Dr', 'Meridian', 'Ada', 'ID', '83642', '2088980988', '2088989022', '1550 N Crestmont Dr', 'Meridian', 'Ada', 'ID', '83642', '2088980988', '2088989022', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2014-06-04', NULL, 0, 0, 1, '', '', '', '', 'HCFA', '1033216510', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('262792136', 'W12048697', 'W12048697', 'ID02', 'Advanced Therapy Care', 'Julie', 'H', 'Orozco', 'OT', 'Occupational Therapy', '', '', NULL, 'B', '245 N 3rd E', 'Mountain Home', 'Elmore', 'ID', '83647', '2088980988', '2088989022', '245 N 3rd E', 'Mountain Home', 'Elmore', 'ID', '83647', '2088980988', '2088989022', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2014-06-04', NULL, 0, 0, 1, '', '', '', '', 'HCFA', '1033216510', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('262792136', 'W12048698', 'W12048698', 'ID02', 'Advanced Therapy Care', 'Allyson', '', 'Overton', 'SLP', 'Speech Therapy', '', '', NULL, 'O', '1550 N Crestmont Dr', 'Meridian', 'Ada', 'ID', '83642', '2088980988', '2088989022', '1550 N Crestmont Dr', 'Meridian', 'Ada', 'ID', '83642', '2088980988', '2088989022', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2014-06-04', NULL, 0, 0, 1, '', '', '', '', 'HCFA', '1346474681', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('262792136', 'W12048699', 'W12048699', 'ID02', 'Advanced Therapy Care', 'Allyson', '', 'Overton', 'SLP', 'Speech Therapy', '', '', NULL, 'B', '245 N 3rd E', 'Mountain Home', 'Elmore', 'ID', '83647', '2088980988', '2088989022', '245 N 3rd E', 'Mountain Home', 'Elmore', 'ID', '83647', '2088980988', '2088989022', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2014-06-04', NULL, 0, 0, 1, '', '', '', '', 'HCFA', '1346474681', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('262792136', 'W12048700', 'W12048700', 'ID02', 'Advanced Therapy Care', 'Shannon', 'G', 'Reid', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '1550 N Crestmont Dr', 'Meridian', 'Ada', 'ID', '83642', '2088980988', '2088989022', '1550 N Crestmont Dr', 'Meridian', 'Ada', 'ID', '83642', '2088980988', '2088989022', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2014-06-04', NULL, 0, 0, 1, '', '', '', '', 'HCFA', '1295084465', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('262792136', 'W12048701', 'W12048701', 'ID02', 'Advanced Therapy Care', 'Shannon', 'G', 'Reid', 'OT', 'Occupational Therapy', '', '', NULL, 'B', '245 N 3rd E', 'Mountain Home', 'Elmore', 'ID', '83647', '2088980988', '2088989022', '245 N 3rd E', 'Mountain Home', 'Elmore', 'ID', '83647', '2088980988', '2088989022', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2014-06-04', NULL, 0, 0, 1, '', '', '', '', 'HCFA', '1295084465', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('850424076', 'W12048703', 'W12048703', 'NM01', 'New Mexico Heart Institute', 'Nancy', 'A', 'Duhigg', 'PA', 'Cardiology', '', '', NULL, 'B', 'PO Box 53537', 'Phoenix', 'Maricopa', 'AZ', '85072', '5058432800', '0000000000', 'PO Box 53537', 'Phoenix', 'Maricopa', 'AZ', '85072', '5058432800', '0000000000', 'NMHEART', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841602638', 0, 'N', 1, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('850424076', 'W12048704', 'W12048704', 'NM01', 'New Mexico Heart Institute', 'Nancy', 'A', 'Duhigg', 'PA', 'Cardiology', '', '', NULL, 'M', 'PO Box 8387', 'Albuquerque', 'Bernalillo', 'NM', '87198', '5059848012', '5059882612', 'PO Box 8387', 'Albuquerque', 'Bernalillo', 'NM', '87198', '5059848012', '5059882612', 'NMHEART', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841602638', 0, 'N', 1, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
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('850424076', 'W12048728', 'W12048728', 'NM01', 'New Mexico Heart Institute', 'Erica', 'J', 'Lopez', 'PA-C', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 53537', 'Phoenix', 'Maricopa', 'AZ', '85072', '5058432800', '0000000000', 'PO Box 53537', 'Phoenix', 'Maricopa', 'AZ', '85072', '5058432800', '0000000000', 'NMHEART', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-06-09', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1295762912', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
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('820200895', 'W12048829', 'W12048829', 'IDBOISTD', 'Saint Alphonsus Medical Group General Surgery NHP', 'Lindsey', 'J', 'Carmichael', 'PA-C', 'General Surgery', '', '', NULL, 'O', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2083677090', '2083677092', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2083677090', '2083677092', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2014-06-12', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1285904144', 0, 'N', 0, '2014-06-11', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12048831', 'W12048831', 'IDBOISTD', 'Saint Alphonsus Medical Group General Surgery Nampa', 'Michael', '', 'McComb', 'PA-C', 'General Surgery', '', '', NULL, 'O', '401 E Hawaii Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084656940', '2084656961', '401 E Hawaii Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084656940', '2084656961', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2014-05-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1740216498', 0, 'N', 0, '2014-06-11', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12048833', 'W12048833', 'IDBOISTD', 'Saint Alphonsus Medical Group Trauma Services Boise', 'Tracey', 'C', 'Reeve', 'PA-C', 'General Surgery', '', '', NULL, 'O', '999 N Curtis Rd Ste 407', 'Boise', 'Ada', 'ID', '83706', '2083677676', '2083675595', '999 N Curtis Rd Ste 407', 'Boise', 'Ada', 'ID', '83706', '2083677676', '2083675595', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2014-04-24', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1174789994', 0, 'N', 0, '2014-06-11', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12048835', 'W12048835', 'IDBOISTD', 'Saint Alphonsus Medical Group Orthopedics Emerald', 'Daniel', '', 'Sellers', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '6500 Emerald', 'Boise', 'Ada', 'ID', '83704', '2083770777', '2083771070', '6500 Emerald', 'Boise', 'Ada', 'ID', '83704', '2083770777', '2083771070', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2014-05-08', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1740226414', 0, 'N', 0, '2014-06-11', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'W12048836', 'W12048836', 'IDBOISTD', 'Saint Alphonsus Medical Group Sports Medicine', 'Craig', 'M', 'Smith', 'MD', 'Family Practice', 'Sports Medicine', '', NULL, 'O', '901 N Curtis Rd Ste 501', 'Boise', 'Ada', 'ID', '83706', '2082884700', '0000000000', '901 N Curtis Rd Ste 501', 'Boise', 'Ada', 'ID', '83706', '2082884700', '0000000000', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-04-24', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1881629202', 0, 'N', 0, '2014-06-11', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'W12048837', 'W12048837', 'IDBOISTD', 'Saint Alphonsus Medical Group Sports Medicine MHP', 'Craig', 'M', 'Smith', 'MD', 'Family Practice', 'Sports Medicine', '', NULL, 'O', '3025 W Cherry Ln', 'Meridian', 'Ada', 'ID', '83642', '2082884700', '0000000000', '3025 W Cherry Ln  ', 'Meridian', 'Ada', 'ID', '83642', '2082884700', '0000000000', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-04-24', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1881629202', 0, 'N', 0, '2014-06-11', NULL, NULL, 0, 0, NULL, NULL),
('271790052', 'W12048838', 'W12048838', 'IDBOISTD', 'Saint Alphonsus Medical Group Baker City Express Care', 'Eva', 'L', 'Michels', 'NP', 'Gastroenterology', 'Family Practice', '', NULL, 'O', '1120 Campbell St', 'Baker City', 'Baker', 'OR', '97814', '5415232100', '5415232108', '1120 Campbell St', 'Baker City', 'Baker', 'OR', '97814', '5415232100', '5415232108', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-04-22', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104134089', 0, 'N', 0, '2014-06-11', NULL, NULL, 0, 0, NULL, NULL),
('271790052', 'W12048840', 'W12048840', 'IDBOISTD', 'Saint Alphonsus Medical Group Baker City Express Care', 'Patricia', 'A', 'Sitting-Runge', 'NP', 'Family Practice', '', '', NULL, 'O', '1120 Campbell St', 'Baker City', 'Baker', 'OR', '97814', '5415232100', '5415232108', '1120 Campbell St', 'Baker City', 'Baker', 'OR', '97814', '5415232100', '5415232108', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-04-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639113731', 0, 'Y', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12048841', 'W12048841', 'IDBOISTD', 'Saint Alphonsus Medical Group OBGYN Eagle OB Hospital', 'Kimberly', 'A', 'Allard', 'CNM', 'Certified Nurse Midwife', '', '', NULL, 'O', '1055 N Curtis Rd Entrance N4', 'Boise', 'Ada', 'ID', '83706', '2083674224', '2083677806', '1055 N Curtis Rd Entrance N4', 'Boise', 'Ada', 'ID', '83706', '2083674224', '2083677806', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-05-14', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1295165389', 0, 'N', 0, '2014-06-11', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('743210771', 'W12048842', 'W12048842', 'UT01', 'Sumko-Bitner Orthopaedics & Sports Medicine Clinic', 'Mathew', 'F', 'Bitner', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '2850 N 2000 W Ste 105', 'Ogden', 'Weber', 'UT', '84404', '8017321175', '8017321202', '2850 N 2000 W Ste 105', 'Ogden', 'Weber', 'UT', '84404', '8017321175', '8017321202', 'WUBRIGOR5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, 'Brigham City Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1467563866', 0, 'N', 0, '2014-06-11', NULL, NULL, 0, 0, NULL, NULL),
('743210771', 'W12048843', 'W12048843', 'UT01', 'Sumko-Bitner Orthopaedics & Sports Medicine Clinic', 'Mathew', 'F', 'Bitner', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '935 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '4357342151', '4357235430', '935 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '4357342151', '4357235430', 'WUBRIGOR5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, 'Brigham City Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1467563866', 0, 'N', 0, '2014-06-11', NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'W12048844', 'W12048844', 'UT01', 'Tanner Memorial Clinic', 'Kurt', 'T', 'Flinders', 'DO', 'Family Practice', '', '', NULL, 'O', '3443 W 5600 S', 'Roy', 'Weber', 'UT', '84067', '8017734840', '8017749219', '3443 W 5600 S', 'Roy', 'Weber', 'UT', '84067', '8017734840', '8017749219', 'WUTANNER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780830612', 0, 'N', 1, '2014-07-22', NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'W12048845', 'W12048845', 'UT01', 'Tanner Memorial Clinic', 'Kurt', 'T', 'Flinders', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'WUTANNER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780830612', 0, 'N', 1, '2014-07-22', NULL, NULL, 0, 0, NULL, NULL),
('870618776', 'W12048846', 'W12048846', 'UT01', 'Gamma West Cancer Services', 'James', 'W', 'Clarke', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '1490 E Foremaster Dr Bldg C', 'St George', 'Washington', 'UT', '84790', '4357679104', '4356521216', '1490 E Foremaster Dr Bldg C', 'St George', 'Washington', 'UT', '84790', '4357679104', '4356521216', 'WUSTDRONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-06-04', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295959724', 0, 'Y', 0, '2014-06-11', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12048848', 'W12048848', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Peter', '', 'Novota', 'MD', 'Family Practice', '', '', NULL, 'O', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2014-06-09', NULL, 0, 0, 0, 'Northwest Community Hospital', '', '', '', 'HCFA|UB|', '1124132394', 0, 'N', 0, '2014-06-11', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12048849', 'W12048849', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Peter', '', 'Novota', 'MD', 'Family Practice', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '          ', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '          ', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2014-06-09', NULL, 0, 0, 0, 'Northwest Community Hospital', '', '', '', 'HCFA|UB|', '1124132394', 0, 'N', 0, '2014-06-11', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12048852', 'W12048852', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Chinomso', 'D', 'Mordi', 'MD', 'Hospitalist', '', '', NULL, 'O', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308012589', '6308013132', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308012589', '6308013132', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2014-06-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740501485', 0, 'Y', 0, '2014-06-11', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12048851', 'W12048851', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Chinomso', 'D', 'Mordi', 'MD', 'Hospitalist', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '          ', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '          ', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2014-06-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740501485', 0, 'N', 0, '2014-06-11', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12048853', 'W12048853', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Chinomso', 'D', 'Mordi', 'MD', 'Hospitalist', '', '', NULL, 'O', '2040 Ogden Ave Ste 401', 'Aurora', 'Dupage', 'IL', '60504', '6306924170', '6306924129', '2040 Ogden Ave Ste 401', 'Aurora', 'Dupage', 'IL', '60504', '6306924170', '6306924129', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2014-06-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740501485', 0, 'Y', 0, '2014-06-11', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'W12048855', 'W12048855', 'ILCHIGSTD', 'Presence Healthcare Services', 'Maria', 'S', 'Hernandez', 'MD', 'Hospitalist', '', '', NULL, 'O', '2233 W Division', 'Chicago', 'Cook', 'IL', '60622', '3127702000', '6309142499', '2233 W Division', 'Chicago', 'Cook', 'IL', '60622', '3127702000', '6309142499', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588721419', 0, 'Y', 0, '2014-07-03', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'W12048856', 'W12048856', 'ILCHIGSTD', 'Presence Healthcare Services', 'Maria', 'S', 'Hernandez', 'MD', 'Hospitalist', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8557647687', '6309142469', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8557647687', '6309142469', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588721419', 0, 'N', 0, '2014-07-03', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'W12048859', 'W12048859', 'ILCHIGSTD', 'Presence Service Corporation', 'Muhammad', 'Omer', 'Ansari', 'MD', 'General Surgery', '', '', NULL, 'O', '410 E Lincoln Hwy Ste 251', 'New Lenox', 'Will', 'IL', '60451', '8154852541', '6309142499', '410 E Lincoln Hwy Ste 251', 'New Lenox', 'Will', 'IL', '60451', '8154852541', '6309142499', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770787673', 0, 'N', 0, '2014-06-11', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'W12048858', 'W12048858', 'ILCHIGSTD', 'Presence Service Corporation', 'Muhammad', 'Omer', 'Ansari', 'MD', 'General Surgery', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8557647687', '6309142469', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8557647687', '6309142469', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770787673', 0, 'N', 0, '2014-06-11', NULL, NULL, 0, 0, NULL, NULL),
('362171079', 'W12048862', 'W12048862', 'ILCHIGSTD', 'Nazareth Family Practice Center', 'Nancy', 'A', 'Tutor', 'NP', 'Nurse Practitioner', '', '', NULL, 'O', '1127 N Oakley Blvd 2nd Fl', 'Chicago', 'Cook', 'IL', '60622', '3127702040', '6309142499', '1127 N Oakley Blvd 2nd Fl', 'Chicago', 'Cook', 'IL', '60622', '3127702040', '6309142499', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 8, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841511896', 0, 'N', 0, '2014-06-11', NULL, NULL, 0, 0, NULL, NULL),
('362171079', 'W12048861', 'W12048861', 'ILCHIGSTD', 'Presence Saints Mary and Elizabeth Medical Center', 'Nancy', 'A', 'Tutor', 'NP', 'Nurse Practitioner', '', '', NULL, 'B', '62311 Collections Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8557647687', '6309142469', '62311 Collections Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8557647687', '6309142469', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 8, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841511896', 0, 'N', 0, '2014-06-11', NULL, NULL, 0, 0, NULL, NULL),
('870212459', 'W12048863', 'W12048863', 'UT01', 'CNS Community Nursing Services Infusion Pharmacy', '', '', 'CNS Community Nursing Services', 'GROUP', 'Home Health Agency', '', 'Hospice', NULL, 'O', '2830 S Redwood Rd Ste A', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8012336100', '          ', '2830 S Redwood Rd Ste A', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8012336100', '          ', '', '', '3', '0.00', '35.00', '0.00', 3, '2014-06-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000833772', 0, 'N', 0, '2014-06-11', NULL, NULL, 0, 0, NULL, NULL),
('870212459', 'W12048864', 'W12048864', 'UT01', 'CNS Community Nursing Services Home Health & Hospice', '', '', 'CNS Community Nursing Services', 'GROUP', 'Home Health Agency', '', 'Hospice', NULL, 'O', '2820 S Redwood Rd', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8012336100', '          ', '2820 S Redwood Rd', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8012336100', '          ', '', '', '3', '0.00', '35.00', '0.00', 3, '2014-06-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000833772', 0, 'N', 0, '2014-06-11', NULL, NULL, 0, 0, NULL, NULL),
('830182821', 'W12048865', 'W12048865', 'WY01', 'Gottsche Rehabilitation Center', 'Wesley', '', 'Mills', 'OT', 'Occupational 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', '25.00', '0.00', 3, '2014-06-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740480789', 0, 'N', 0, '2014-06-16', NULL, NULL, 0, 0, NULL, NULL),
('830182821', 'W12048866', 'W12048866', 'WYT1', 'Gottsche Rehabilitation Center', 'Wesley', '', 'Mills', 'OT', 'Occupational 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', '25.00', '0.00', 3, '2014-06-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740480789', 0, 'N', 0, '2014-06-16', 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
('752780119', 'CL0307638', 'CL0307638', 'SmartCare', 'Heart Center of North Texas', NULL, NULL, 'Heart Center of North Texas', NULL, 'Clinic', 'Cardiology', '', NULL, 'O', '1017 12th Ave ', 'Fort Worth', 'Tarrant', 'TX', '76104', '8173342800', '8173361954', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00307638', 0, 'N', 0, NULL, NULL, NULL, 32.7341, -97.3475, NULL, NULL),
('204043287', 'W12048895', 'W12048895', 'NM01', 'ABQ Health Partners', 'Susan', '', 'Lewis', 'MD', 'Hospitalist', '', '', NULL, 'O', '500 Walter St NE Ste 401', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5052627451', '5052627870', '500 Walter St NE Ste 401', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5052627451', '5052627870', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-05-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770634982', 0, 'Y', 0, '2014-06-13', NULL, NULL, 0, 0, NULL, NULL),
('202148889', 'W12048897', 'W12048897', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'Christopher', 'J', 'Collins', 'MD', 'Family Practice', '', '', NULL, 'O', '1248 Austin Hwy Ste 214', 'San Antonio', 'Bexar', 'TX', '78209', '2108282531', '2108282532', '1248 Austin Hwy Ste 214', 'San Antonio', 'Bexar', 'TX', '78209', '2108282531', '2108282532', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2014-06-23', NULL, 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1932390960', 0, 'N', 0, '2014-06-13', NULL, NULL, 0, 0, NULL, NULL),
('202148889', 'W12048898', 'W12048898', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'Melba', 'J', 'Beine', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1248 Austin Hwy Ste 214', 'San Antonio', 'Bexar', 'TX', '78209', '2108282531', '2108282532', '1248 Austin Hwy Ste 214', 'San Antonio', 'Bexar', 'TX', '78209', '2108282531', '2108282532', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2014-06-23', NULL, 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1366417495', 0, 'N', 0, '2014-06-13', NULL, NULL, 0, 0, NULL, NULL),
('202148889', 'W12048899', 'W12048899', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'Melba', 'J', 'Beine', 'MD', 'Internal Medicine', '', '', NULL, 'B', '6243 IH 10 W Ste 480', 'San Antonio', 'Bexar', 'TX', '78201', '2103714800', '          ', '6243 IH 10 W Ste 480', 'San Antonio', 'Bexar', 'TX', '78201', '2103714800', '          ', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2014-06-23', NULL, 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1366417495', 0, 'Y', 0, '2014-06-13', NULL, NULL, 0, 0, NULL, NULL),
('202148889', 'W12048900', 'W12048900', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'Melba', 'J', 'Beine', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 100026', 'San Antonio', 'Bexar', 'TX', '78201', '2103714800', '          ', 'PO Box 100026', 'San Antonio', 'Bexar', 'TX', '78201', '2103714800', '          ', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2014-06-23', NULL, 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1366417495', 0, 'N', 0, '2014-06-13', NULL, NULL, 0, 0, NULL, NULL),
('202148889', 'W12048901', 'W12048901', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'April', 'D', 'Hain', 'MD', 'Family Medicine', '', '', NULL, 'O', '1248 Austin Hwy Ste 214', 'San Antonio', 'Bexar', 'TX', '78209', '2108282531', '2108282532', '1248 Austin Hwy Ste 214', 'San Antonio', 'Bexar', 'TX', '78209', '2108282531', '2108282532', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2014-06-23', NULL, 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1366411530', 0, 'N', 0, '2014-06-13', NULL, NULL, 0, 0, NULL, NULL),
('202148889', 'W12048902', 'W12048902', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'April', 'D', 'Hain', 'MD', 'Family Medicine', '', '', NULL, 'M', '6243 IH 10 W Ste 480', 'San Antonio', 'Bexar', 'TX', '78201', '2103714800', '          ', '6243 IH 10 W Ste 480', 'San Antonio', 'Bexar', 'TX', '78201', '2103714800', '          ', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2014-06-23', NULL, 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1366411530', 0, 'N', 0, '2014-06-13', NULL, NULL, 0, 0, NULL, NULL),
('202148889', 'W12048903', 'W12048903', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'April', 'D', 'Hain', 'MD', 'Family Medicine', '', '', NULL, 'B', 'PO Box 100026', 'San Antonio', 'Bexar', 'TX', '78201', '2109242337', '          ', 'PO Box 100026', 'San Antonio', 'Bexar', 'TX', '78201', '2109242337', '          ', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2014-06-23', NULL, 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1366411530', 0, 'N', 0, '2014-06-13', NULL, NULL, 0, 0, NULL, NULL),
('202148889', 'W12048904', 'W12048904', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'April', 'D', 'Hain', 'MD', 'Family Medicine', '', '', NULL, 'O', '8542 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2106167300', '2106167359', '8542 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2106167300', '2106167359', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1366411530', 0, 'N', 0, '2014-06-13', NULL, NULL, 0, 0, NULL, NULL),
('800307419', 'W12048905', 'W12048905', 'WY01', 'Wyoming Health Medical Group', 'Michael', '', 'Fowler', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1020 E 2nd St Ste 200', 'Casper', 'Natrona', 'WY', '82601', '3072662222', '3072330266', '1020 E 2nd St Ste 200', 'Casper', 'Natrona', 'WY', '82601', '3072662222', '3072330266', '', '', '', '0.00', '18.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487083861', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('800307419', 'W12048906', 'W12048906', 'WYT1', 'Wyoming Health Medical Group', 'Michael', '', 'Fowler', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1020 E 2nd St Ste 200', 'Casper', 'Natrona', 'WY', '82601', '3072662222', '3072330266', '1020 E 2nd St Ste 200', 'Casper', 'Natrona', 'WY', '82601', '3072662222', '3072330266', '', '', '', '0.00', '18.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487083861', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W12048907', 'W12048907', 'IDBOISTD', 'Primary Health Medical Group', 'Tyler', 'W', 'Hudon', 'MD', 'Family Practice', '', '', NULL, 'O', '1623 S Wells Ave', 'Meridian', 'Ada', 'ID', '83642', '2084891450', '2084891451', '1623 S Wells Ave', 'Meridian', 'Ada', 'ID', '83642', '2084891450', '2084891451', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295097012', 0, 'N', 1, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W12048908', 'W12048908', 'IDBOISTD', 'Primary Health Medical Group', 'Tyler', 'W', 'Hudon', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 191050', 'Boise', 'Ada', 'ID', '83719', '2089556500', '2089556501', 'PO Box 191050', 'Boise', 'Ada', 'ID', '83719', '2089556500', '2089556501', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295097012', 0, 'N', 1, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('870687510', 'W12048877', 'W12048877', 'UT01', 'Tooele Valley Spine Center', 'Travis ', '', 'Sargent', 'DC', 'Chiropractic', '', '', NULL, 'O', '1244 N Main St Ste 100', 'Tooele', 'Tooele', 'UT', '84074', '4358339200', '4358339223', '1244 N Main St Ste 100', 'Tooele', 'Tooele', 'UT', '84074', '4358339200', '4358339223', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2014-06-05', '2014-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861534356', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('271789847', 'W12048910', 'W12048910', 'IDONTSTD', 'Saint Alphonsus Medical Group Ontario', '', '', 'Saint Alphonsus Health Alliance MHPN', '', '', '', '', NULL, 'O', '1050 SW 3rd Ave Ste 3200', 'Ontario', 'Malheur', 'OR', '97914', '5418817370', '5418817379', '1050 SW 3rd Ave Ste 3200', 'Ontario', 'Malheur', 'OR', '97914', '5418817370', '5418817379', 'IDSAMG1,2,3', '', '', '0.00', '10.00', '0.00', 6, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009966', 0, 'N', 1, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('870179340', 'W12048918', 'W12048918', 'UT01', 'Standard Optical', 'Jonathan', 'J', 'Boster', '', 'Optometry', '', '', NULL, 'O', '1901 W Pkwy Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019720203', '          ', '1901 W Pkwy Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019720203', '          ', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184037285', 0, 'N', 1, '2014-07-10', NULL, NULL, 0, 0, NULL, NULL),
('261996389', 'W12048919', 'W12048919', 'UT01', 'Utah Podiatry Group PC', 'Ryan', 'T', 'Kitterman', 'DPM', 'Podiatry', '', '', NULL, 'O', '82 S 1100 E Ste 301', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015055277', '          ', '82 S 1100 E Ste 301', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015055277', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1174811442', 0, 'N', 1, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('830231437', 'W12048920', 'W12048920', 'WY01', 'Casper Orthopedic Associates', '', '', 'Casper Orthopedic Associates', '', 'Orthopedic Surgery', '', '', NULL, 'O', '4140 Centennial Hills Blvd Ste A', 'Casper', 'Natrona', 'WY', '82609', '3072657205', '3072356262', '4140 Centennial Hills Blvd Ste A', 'Casper', 'Natrona', 'WY', '82609', '3072657205', '3072356262', '', '', '', '0.00', '15.00', '0.00', 3, '2013-11-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962494864', 0, 'N', 0, '2014-06-19', NULL, NULL, 0, 0, NULL, NULL),
('830231437', 'W12048921', 'W12048921', 'WYT1', 'Casper Orthopedic Associates', '', '', 'Casper Orthopedic Associates', '', 'Orthopedic Surgery', '', '', NULL, 'M', '4140 Centennial Hills Blvd Ste A', 'Casper', 'Natrona', 'WY', '82609', '3072657205', '3072356262', '4140 Centennial Hills Blvd Ste A', 'Casper', 'Natrona', 'WY', '82609', '3072657205', '3072356262', '', '', '', '0.00', '15.00', '0.00', 3, '2013-11-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962494864', 0, 'N', 0, '2014-06-19', NULL, NULL, 0, 0, NULL, NULL),
('300367890', 'W12048925', 'W12048925', 'ID01', 'Treasure Valley Mental Health', 'Phillip', 'J', 'Norris', 'PA-C', 'Mental Health', '', '', NULL, 'O', '339 N Allumbaugh St', 'Boise', 'Ada', 'ID', '83704', '2083761611', '2086581753', '339 N Allumbaugh St', 'Boise', 'Ada', 'ID', '83704', '2083761611', '2086581753', 'IDMA', '', '', '0.00', '40.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497790224', 0, 'N', 1, '2014-06-30', NULL, NULL, 0, 0, NULL, NULL),
('300367890', 'W12048926', 'W12048926', 'ID01', 'Treasure Valley Mental Health', 'Phillip', 'J', 'Norris', 'PA-C', 'Mental Health', '', '', NULL, 'M', 'PO Box 4363', 'Boise', 'Ada', 'ID', '83711', '2083761611', '2086581753', 'PO Box 4363', 'Boise', 'Ada', 'ID', '83711', '2083761611', '2086581753', 'IDMA', '', '', '0.00', '40.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497790224', 0, 'N', 1, '2014-06-30', NULL, NULL, 0, 0, NULL, NULL),
('300367890', 'W12048927', 'W12048927', 'ID01', 'Treasure Valley Mental Health', 'Phillip', 'J', 'Norris', 'PA-C', 'Mental Health', '', '', NULL, 'B', 'PO Box 16820', 'Boise', 'Ada', 'ID', '83715', '2083761611', '2086581753', 'PO Box 16820', 'Boise', 'Ada', 'ID', '83715', '2083761611', '2086581753', 'IDMA', '', '', '0.00', '40.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497790224', 0, 'N', 1, '2014-06-30', NULL, NULL, 0, 0, NULL, NULL),
('826001195', 'W12048928', 'W12048928', 'UT01', 'Bear Lake Memorial Hospital Physicians Clinic', 'Joseph ', 'E', 'Podany', 'MD', 'General Surgery', '', '', NULL, 'O', '166 S 5th St', 'Montpelier', 'Bear Lake', 'ID', '83254', '2088471110', '2088470228', '166 S 5th St', 'Montpelier', 'Bear Lake', 'ID', '83254', '2088471110', '2088470228', '', '', '', '0.00', '25.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'Bear Lake County Memorial Hospital', '', '', '', 'HCFA|UB|', '1376613851', 0, 'N', 1, '2014-06-30', NULL, NULL, 0, 0, NULL, NULL),
('208929857', 'W12048929', 'W12048929', 'UT01', 'Utah Center for Oral and Facial Surgery', 'Alvin', 'J', 'Stosich', 'DDS MD', 'Oral Surgeon', 'Oral/Maxillofacial Surgery', '', NULL, 'O', '6268 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8015665117', '          ', '6268 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8015665117', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2014-06-17', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|', '1689795114', 0, 'N', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'W12048930', 'W12048930', 'WY01', 'Community Health Center of Central Wyoming', 'Richard ', 'M', 'Harris', 'PA-C', 'Family Practice', '', '', NULL, 'O', '511 N 12th St E Ste A', 'Riverton', 'Fremont', 'WY', '82501', '3074637160', '3074637159', '511 N 12th St E Ste A', 'Riverton', 'Fremont', 'WY', '82501', '3074637160', '3074637159', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750478525', 0, 'N', 1, '2014-06-17', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'W12048931', 'W12048931', 'WYT1', 'Community Health Center of Central Wyoming', 'Richard ', 'M', 'Harris', 'PA-C', 'Family Practice', '', '', NULL, 'O', '511 N 12th St E Ste A', 'Riverton', 'Fremont', 'WY', '82501', '3074637160', '3074637159', '511 N 12th St E Ste A', 'Riverton', 'Fremont', 'WY', '82501', '3074637160', '3074637159', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750478525', 0, 'N', 1, '2014-06-17', NULL, NULL, 0, 0, NULL, NULL),
('465330843', 'W12048932', 'W12048932', 'UT01', 'Eagle Vision', 'Tyler', 'J', 'Barney', 'OD', 'Optometry', '', '', NULL, 'O', '3535 Ranches Pkwy Ste C', 'Eagle Mountain', 'Utah', 'UT', '84005', '8017893937', '          ', '3535 Ranches Pkwy Ste C', 'Eagle Mountain', 'Utah', 'UT', '84005', '8017893937', '          ', 'WUTALBERT5', '', '', '0.00', '35.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528268398', 0, 'N', 0, '2014-07-02', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12048933', 'W12048933', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Luke', 'M', 'Jacobson', 'PT', 'Physical Therapy', '', '', NULL, 'O', '4100 Healthway Dr', 'Aurora', 'Dupage', 'IL', '60504', '6308513105', '6309786694', '4100 Healthway Dr', 'Aurora', 'Dupage', 'IL', '60504', '6308513105', '6309786694', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2014-06-16', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255755913', 0, 'N', 0, '2014-06-17', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12048934', 'W12048934', 'UTIHCPHY', 'Budge Clinic Surgical Specialists', '', '', 'Budge Surgical Specialists-Preston', 'GROUP', 'Clinic', '', '', NULL, 'O', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357520422', '4357921692', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357520422', '4357921692', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2014-06-12', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255565107', 0, 'N', 0, '2014-06-17', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12048935', 'W12048935', 'UTIHCPHY', 'Utah Valley Heart & Lung Surgical Associates', 'James', 'T', 'Dane', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1134 N 500 W Ste 100', 'Provo', 'Utah', 'UT', '84604', '8013577081', '8013577351', '1134 N 500 W Ste 100', 'Provo', 'Utah', 'UT', '84604', '8013577081', '8013577351', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2014-06-12', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083629828', 0, 'N', 0, '2014-06-17', NULL, NULL, 0, 0, NULL, NULL),
('364037473', 'W12048936', 'W12048936', 'ILCHIGSTD', 'Elmhurst Clinic', 'John', 'A', 'Benages', 'MD', 'Family Practice', '', '', NULL, 'B', 'Dept 4585', 'Carol Stream', 'Dupage', 'IL', '60122', '3312219099', '6309935681', 'Dept 4585', 'Carol Stream', 'Dupage', 'IL', '60122', '3312219099', '6309935681', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1679524722', 0, 'N', 0, '2014-06-17', NULL, NULL, 0, 0, NULL, NULL),
('364037473', 'W12048937', 'W12048937', 'ILCHIGSTD', 'Elmhurst Clinic', 'Phillip', 'J', 'Cozzi', 'MD', 'Pulmonary', '', '', NULL, 'O', '130 S Main St Ste 201', 'Lombard', 'Dupage', 'IL', '60148', '3312219003', '3312213978', '130 S Main St Ste 201', 'Lombard', 'Dupage', 'IL', '60148', '3312219003', '3312213978', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2014-06-16', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1205887353', 0, 'N', 0, '2014-06-17', NULL, NULL, 0, 0, NULL, NULL),
('364037473', 'W12048938', 'W12048938', 'ILCHIGSTD', 'Elmhurst Clinic', 'Phillip', 'J', 'Cozzi', 'MD', 'Pulmonary', '', '', NULL, 'B', 'Dept 4585', 'Carol Stream', 'Dupage', 'IL', '60122', '3312219099', '6309935681', 'Dept 4585', 'Carol Stream', 'Dupage', 'IL', '60122', '3312219099', '6309935681', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2014-06-16', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1205887353', 0, 'N', 0, '2014-06-17', NULL, NULL, 0, 0, NULL, NULL),
('364037473', 'W12048939', 'W12048939', 'ILCHIGSTD', 'Elmhurst Memorial Primary Care Associates', 'Maggie', '', 'Chacko', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3005 Wolf Rd', 'Westchester', 'Cook', 'IL', '60154', '3312214390', '3312213925', '3005 Wolf Rd', 'Westchester', 'Cook', 'IL', '60154', '3312214390', '3312213925', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2014-06-16', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1417993734', 0, 'N', 0, '2014-06-17', NULL, NULL, 0, 0, NULL, NULL),
('364037473', 'W12048940', 'W12048940', 'ILCHIGSTD', 'Elmhurst Clinic', 'Maggie', '', 'Chacko', 'MD', 'Internal Medicine', '', '', NULL, 'M', '172 Schiller', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412600', '6307588480', '172 Schiller', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412600', '6307588480', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2014-06-16', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1417993734', 0, 'N', 0, '2014-06-17', NULL, NULL, 0, 0, NULL, NULL),
('364037473', 'W12048941', 'W12048941', 'ILCHIGSTD', 'Elmhurst Clinic', 'Christine', 'R', 'Jankowski', 'MD', 'Hospitalist', '', '', NULL, 'M', '172 Schiller', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412600', '6307588480', '172 Schiller', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412600', '6307588480', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2014-06-14', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', NULL, NULL, 'HCFA|UB|', '1891867156', 0, 'Y', 0, '2014-06-17', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12048943', 'W12048943', 'UTSLCPCH', 'Primary Childrens Medical Center', '', '', 'Primary Childrens Medical Center', 'Group (Recognized PPO but not contracted pre-', 'Hospital', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', '          ', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', '          ', '', '', '', '0.00', '0.00', '0.00', 8, '2014-06-17', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1235148594', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12048944', 'W12048944', 'UTSLCPCH', 'Primary Childrens Medical Center', '', '', 'Primary Childrens Medical Center', 'Group (Recognized PPO but not contracted pre-', 'Hospital', '', '', NULL, 'B', 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8016621000', '          ', 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8016621000', '          ', '', '', '', '0.00', '0.00', '0.00', 8, '2014-06-17', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1235148594', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12048946', 'W12048946', 'UTIHC04', 'Residential Treatment', 'Renae', '', 'Decker-Cahoon', 'APRN', 'Mental Health', 'Advanced Practice Registered Nurse', '', NULL, 'O', '5770 S 1500 W', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8013137770', '          ', '5770 S 1500 W', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8013137770', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2010-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699785824', 0, 'N', 0, '2014-06-18', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12048947', 'W12048947', 'ID01', 'PCMC Wasatch Canyons Counseling Center', 'Renae', '', 'Decker-Cahoon', 'APRN', 'Mental Health', 'Advanced Practice Registered Nurse', '', NULL, 'O', '5770 S 1500 W Bldg A', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8013137800', '          ', '5770 S 1500 W Bldg A', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8013137800', '          ', '', '', '', '0.00', '0.00', '0.00', 8, '2008-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699785824', 0, 'Y', 0, '2014-06-18', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12048948', 'W12048948', 'ID01', 'Center for Counseling', 'Nancy', 'L', 'Cantor', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '675 E 500 S Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8016626755', '          ', '675 E 500 S Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8016626755', '          ', '', '', '', '0.00', '0.00', '0.00', 8, '2010-02-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144243312', 0, 'N', 0, '2014-06-18', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12048949', 'W12048949', 'ID01', 'Spina Bifida Clinic', 'Nancy', 'L', 'Cantor', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', '          ', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', '          ', '', '', '', '0.00', '0.00', '0.00', 8, '2010-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144243312', 0, 'N', 0, '2014-06-18', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12048951', 'W12048951', 'UTIHC04', '', 'Michael', 'R', 'Charlton', 'MD', 'Gastroenterology', '', '', NULL, 'O', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '8015073380', '          ', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '8015073380', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2014-05-27', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1821064692', 0, 'N', 0, '2014-06-18', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12048953', 'W12048953', 'UTIHC04', '', 'Kent', 'J', 'Gleed', 'MD', 'Cardiac Electrophysiology Cardiology', '', '', NULL, 'O', '1380 E Medical Ctr Dr Ste 4100', 'St George', 'Washington', 'UT', '84790', '4352512900', '          ', '1380 E Medical Ctr Dr Ste 4100', 'St George', 'Washington', 'UT', '84790', '4352512900', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2014-01-09', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1669449997', 0, 'N', 0, '2014-06-18', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12048955', 'W12048955', 'UTIHC04', 'Primary Childrens Medical Center', 'Ali', '', 'Lunt', 'AUD', 'Audiology', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', '          ', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2014-05-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1336494368', 0, 'N', 0, '2014-06-18', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12048957', 'W12048957', 'UTIHC04', 'Primary Childrens Medical Center', 'Meredith', 'L', 'Seamon', 'MD', 'Pediatric Nephrology', '', '', NULL, 'o', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016626801', '          ', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016626801', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2014-05-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1053357251', 0, 'N', 0, '2014-06-18', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12048959', 'W12048959', 'UTIHC04', 'Primary Childrens Rehab Taylorsville', 'Rachel', 'K', 'West', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '3845 W 4700 S', 'Salt Lake City', 'Salt Lake', 'UT', '84129', '8018404360', '          ', '3845 W 4700 S', 'Salt Lake City', 'Salt Lake', 'UT', '84129', '8018404360', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2014-03-17', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1891112447', 0, 'N', 0, '2014-06-18', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12048962', 'W12048962', 'WYBILLINGS', 'Billings Clinic', 'Benjamin', 'G', 'Plank', 'MD', 'Cardiology', '', '', NULL, 'M', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-05-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053462200', 0, 'N', 0, '2014-06-18', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12048961', 'W12048961', 'WYBILLINGS', 'Billings Clinic', 'Benjamin', 'G', 'Plank', 'MD', 'Cardiology', '', '', NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-05-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053462200', 0, 'N', 0, '2014-06-18', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12048963', 'W12048963', 'WYBILLINGS', 'Billings Clinic - Cardiology', 'Benjamin', 'G', 'Plank', 'MD', 'Cardiology', '', '', NULL, 'O', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382000', '4062382066', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382000', '4062382066', '', '', '', '0.00', '17.00', '0.00', 3, '2014-05-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053462200', 0, 'N', 0, '2014-06-18', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12048965', 'W12048965', 'WYBILLINGS', 'Billings Clinic - Internal Medicine', 'Beata', '', 'Kis', 'MD', 'Internal Medicine', '', '', NULL, 'O', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382413', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382413', '', '', '', '0.00', '17.00', '0.00', 3, '2014-05-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770895344', 0, 'N', 0, '2014-06-18', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12048966', 'W12048966', 'WYBILLINGS', 'Billings Clinic', 'Beata', '', 'Kis', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-05-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770895344', 0, 'N', 0, '2014-06-18', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12048967', 'W12048967', 'WYBILLINGS', 'Billings Clinic', 'Beata', '', 'Kis', 'MD', 'Internal Medicine', '', '', NULL, 'M', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-05-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770895344', 0, 'N', 0, '2014-06-18', NULL, NULL, 0, 0, NULL, NULL),
('454713491', 'W12048980', 'W12048980', 'UTDT01', 'Genesis Dental Of Saint George', 'Susan', '', 'Baker', 'DDS', 'Dentist', '', '', NULL, 'O', '1449 N 1400 W Ste A-1', 'St George', 'Washington', 'UT', '84770', '4356562800', '          ', '1449 N 1400 W Ste A-1', 'St George', 'Washington', 'UT', '84770', '4356562800', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1003817271', 0, 'N', 0, '2014-06-19', NULL, NULL, 0, 0, NULL, NULL),
('464240247', 'W12048981', 'W12048981', 'UTDT01', 'Southwest Oral & Facial Surgery', 'Jared', 'M', 'Brown', 'MD DDS', 'Oral Surgeon', '', '', NULL, 'O', '11748 S 3600 W', 'South Jordan', 'Salt Lake', 'UT', '84095', '8014557593', '0000000000', '11748 S 3600 W', 'South Jordan', 'Salt Lake', 'UT', '84095', '8014557593', '0000000000', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2014-05-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'DEN|', '1326167354', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('260501814', 'W12048983', 'W12048983', 'UTDT01', 'Woodland Dental', 'David', '', 'Hansen', 'DMD', 'Dentist', '', '', NULL, 'O', '204 E 400 N Ste A', 'Salem', 'Utah', 'UT', '84653', '8014230905', '          ', '204 E 400 N Ste A', 'Salem', 'Utah', 'UT', '84653', '8014230905', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1780884247', 0, 'N', 0, '2014-06-19', NULL, NULL, 0, 0, NULL, NULL),
('205099898', 'W12048984', 'W12048984', 'UTDT01', 'Haws Family Dentistry', 'Jayson', '', 'Haws', 'DDS', 'Dentist', '', '', NULL, 'O', '140 E 1000 S Ste 1', 'Brigham City', 'Box Elder', 'UT', '84302', '4357349144', '          ', '140 E 1000 S Ste 1', 'Brigham City', 'Box Elder', 'UT', '84302', '4357349144', '          ', 'UT000C', '', '', '0.00', '100.00', '0.00', 8, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1083747927', 0, 'N', 0, '2014-06-19', NULL, NULL, 0, 0, NULL, NULL),
('465029817', 'W12048985', 'W12048985', 'UTDT01', 'Clark B Hicken', 'Clark', '', 'Hicken', 'DDS', 'Dentist', '', '', NULL, 'O', '312 N Main', 'Spanish Fork', 'Utah', 'UT', '84660', '8017949684', '          ', '312 N Main', 'Spanish Fork', 'Utah', 'UT', '84660', '8017949684', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1407925308', 0, 'N', 0, '2014-06-19', NULL, NULL, 0, 0, NULL, NULL),
('463221080', 'W12048988', 'W12048988', 'UTDT01', 'Jeffrey B Roberson DDS', 'Jeffrey', '', 'Roberson', 'DDS', 'Dentist', '', '', NULL, 'O', '2854 W 4700 S Ste C', 'Salt Lake City', 'Salt Lake', 'UT', '84129', '8019681142', '          ', '2854 W 4700 S Ste C', 'Salt Lake City', 'Salt Lake', 'UT', '84129', '8019681142', '          ', 'UT000B', '', '', '0.00', '20.00', '0.00', 8, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1710116041', 0, 'N', 0, '2014-06-19', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12048990', 'W12048990', 'UTSLCPCH', 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', '', '', 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', 'Group', 'Hospital', '', '', NULL, 'O', '3741 W 12600 S Floor 4', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854000', '          ', '3741 W 12600 S Floor 4', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854000', '          ', '', '', '', '0.00', '0.00', '0.00', 8, '2014-06-17', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000004000', 0, 'N', 0, '2014-06-19', NULL, NULL, 0, 0, NULL, NULL),
('311504075', 'W12048991', 'W12048991', 'SCNA01', 'Management and Network Services', '', '', 'Management and Network Services', '', 'Skilled Nursing Facility', '', '', NULL, 'B', '4892 Blazer Pkwy', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '          ', '4892 Blazer Pkwy', 'Dublin', 'Franklin', 'OH', '43017', '8009492159', '          ', '', '', 'MNS2014', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', '|UB|', '0000010161', 0, 'Y', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('465305461', 'W12048992', 'W12048992', 'UT01', 'Alta View Sports Medicine Center ', 'James', 'R', 'Meadows', 'MD', 'Orthopedic Surgery', 'Sports Medicine', '', NULL, 'O', '9844 S 1300 E Ste 100', 'Sandy', 'Salt Lake', 'UT', '84094', '8015719433', '8015725607', '9844 S 1300 E Ste 100', 'Sandy', 'Salt Lake', 'UT', '84094', '8015719433', '8015725607', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'Lone Peak Hospital', '', '', '', 'HCFA|UB|', '1285892968', 0, 'N', 1, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('810608733', 'W12048993', 'W12048993', 'UT01', 'Nexus Pain Care', 'Laney', 'W', 'Nelson', 'DC', 'Chiropractic', '', '', NULL, 'O', '3585 N University Ave Ste 150', 'Provo', 'Utah', 'UT', '84604', '8013566100', '8013562113', '3585 N University Ave Ste 150', 'Provo', 'Utah', 'UT', '84604', '8013566100', '8013562113', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255368965', 0, 'N', 1, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('810608733', 'W12048994', 'W12048994', 'UT01', 'Nexus Pain Care', 'Laney', 'W', 'Nelson', 'DC', 'Chiropractic', '', '', NULL, 'B', 'PO Box 521593', 'Salt Lake City', 'Salt Lake', 'UT', '84152', '8015341360', '8013669883', 'PO Box 521593', 'Salt Lake City', 'Salt Lake', 'UT', '84152', '8015341360', '8013669883', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255368965', 0, 'N', 1, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('870685287', 'W12048995', 'W12048995', 'UT01', 'Southwest Childrens Clinic', 'Molly', 'L', 'Montes', 'MD', 'Pediatrics', '', '', NULL, 'O', '8822 Redwood Rd Ste C-211', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015631975', '          ', '8822 Redwood Rd Ste C-211', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015631975', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801186838', 0, 'N', 1, '2014-07-10', NULL, NULL, 0, 0, NULL, NULL),
('030527214', 'W12048996', 'W12048996', 'UT01', 'Pamela L Vincent MD PC', 'Joseph', 'R', 'Watkins', 'MD', 'Neurology', '', '', NULL, 'O', '3152 N University Ave Ste 220', 'Provo', 'Utah', 'UT', '84604', '8012291014', '8012291067', '3152 N University Ave Ste 220', 'Provo', 'Utah', 'UT', '84604', '8012291014', '8012291067', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1659396695', 0, 'N', 0, '2014-07-10', NULL, NULL, 0, 0, NULL, NULL),
('030527214', 'W12048997', 'W12048997', 'UT01', 'Pamela L Vincent MD PC', 'Joseph', 'R', 'Watkins', 'MD', 'Neurology', '', '', NULL, 'B', 'PO Box 11957', 'Belfast', 'Waldo', 'ME', '04915', '8012291014', '8012291067', 'PO Box 11957', 'Belfast', 'Waldo', 'ME', '04915', '8012291014', '8012291067', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1659396695', 0, 'N', 0, '2014-07-10', NULL, NULL, 0, 0, NULL, NULL),
('464197992', 'W12048998', 'W12048998', 'UT01', 'Utah Autism Academy', 'Sherlene', 'Tonia', 'Dean', 'APRN', '', '', '', NULL, 'O', '7434 S State St', 'Midvale', 'Salt Lake', 'UT', '84047', '8014569955', '8014569954', '7434 S State St', 'Midvale', 'Salt Lake', 'UT', '84047', '8014569955', '8014569954', 'UTARNP', '', '', '40.00', '40.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871603860', 0, 'N', 1, '2014-07-10', NULL, NULL, 0, 0, NULL, NULL),
('752608036', 'W12048999', 'W12048999', 'SCNA01', 'Orthofix Inc (Bone Growth Stimulators Physicians Only)', '', '', 'Orthofix Inc (Bone Growth Stimulators Physicians Only)', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'B', 'PO Box 849806', 'Dallas', 'Dallas', 'TX', '75284', '8005354492', '          ', 'PO Box 849806', 'Dallas', 'Dallas', 'TX', '75284', '8005354492', '          ', 'ORTHOFIX14', '', '', '0.00', '50.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1235136060', 0, 'N', 1, '2014-07-23', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12049001', 'W12049001', 'NM01', 'ABQ Health Partners', 'Dorothy', '', 'Beach', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052546500', '5052546532', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052546500', '5052546532', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-07-09', NULL, 0, 0, 0, 'Lovelace Womens Hospital', '', '', '', 'HCFA|UB|', '1639192826', 0, 'N', 0, '2014-06-19', NULL, NULL, 0, 0, NULL, NULL),
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('752608036', 'W12049015', 'W12049015', 'NA01', 'Orthofix Inc (Bone Growth Stimulators Physicians Only)', '', '', 'Orthofix Inc (Bone Growth Stimulators Physicians Only)', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', 'Phone Number Only', '', '', '', '', '8005354492', '          ', 'Phone Number Only', '', '', '', '', '8005354492', '          ', 'ORTHOFIX14', '', '', '0.00', '50.00', '0.00', 3, '2014-06-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '0000647859', 0, 'N', 0, '2014-07-02', NULL, NULL, 0, 0, NULL, NULL),
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('870643778', 'W12049029', 'W12049029', 'UTMH1', 'Counseling Center of Park City ', 'Leah', 'M', 'Harter', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'B', 'PO Box 683480', 'Park City', 'Summit', 'UT', '84068', '3039819685', '4356492268', 'PO Box 683480', 'Park City', 'Summit', 'UT', '84068', '3039819685', '4356492268', '', '', '', '0.00', '35.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760511455', 0, 'N', 0, '2014-06-19', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12049030', 'W12049030', 'UT01', 'Central Utah Clinic PC', 'Matthew', 'B', 'Clark', 'MD', 'Family Practice', '', '', NULL, 'O', '1886 W 800 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017565288', '8017565289', '1886 W 800 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017565288', '8017565289', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2030-01-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1851619076', 0, 'N', 1, '2014-06-19', 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
('870281028', 'W12049032', 'W12049032', 'UT01', 'Central Utah Clinic PC', 'Matthew', 'B', 'Clark', 'MD', 'Family Practice', '', '', NULL, 'M', '1055 N 500 W Attn: Credentialing', 'Provo', 'Utah', 'UT', '84604', '8013548225', '8014180941', '1055 N 500 W Attn: Credentialing', 'Provo', 'Utah', 'UT', '84604', '8013548225', '8014180941', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2030-01-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1851619076', 0, 'N', 1, '2014-06-19', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12049034', 'W12049034', 'UT01', 'Central Utah Clinic PC', 'Matthew', 'B', 'Clark', 'MD', 'Family Practice', '', '', NULL, 'O', '1055 N 500 W Ste 212', 'Provo', 'Utah', 'UT', '84604', '8017565288', '8017565289', '1055 N 500 W Ste 212', 'Provo', 'Utah', 'UT', '84604', '8017565288', '8017565289', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2030-01-02', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1851619076', 0, 'N', 1, '2014-06-19', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12049031', 'W12049031', 'UT01', 'Central Utah Clinic PC', 'Matthew', 'B', 'Clark', 'MD', 'Family Practice', '', '', NULL, 'O', '1305 N Commerce Dr Ste 120', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017565288', '8017565289', '1305 N Commerce Dr Ste 120', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017565288', '8017565289', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2030-01-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1851619076', 0, 'N', 1, '2014-06-19', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12049033', 'W12049033', 'UT01', 'Central Utah Clinic PC', 'Matthew', 'B', 'Clark', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014298180', 'PO Box 30079', 'Salt Lake City', 'Utah', 'UT', '84130', '8013758858', '8014298180', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2030-01-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1851619076', 0, 'N', 1, '2014-06-19', NULL, NULL, 0, 0, NULL, NULL),
('464452233', 'W12048989', 'W12048989', 'UTDT01', 'South Valley Periodontics', 'Steven', '', 'Skanchy', 'DDS', 'Periodontist', '', '', NULL, 'O', '8938 S State St', 'Sandy', 'Salt Lake', 'UT', '84070', '8015720333', '          ', '8938 S State St', 'Sandy', 'Salt Lake', 'UT', '84070', '8015720333', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1700911294', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('453836973', 'W12049038', 'W12049038', 'UT01', 'Creekside Oral and Facial Surgery', 'Jared', 'M', 'Brown', 'MD DDS', 'Oral Surgeon', '', '', NULL, 'O', '7390 S Creek Rd Ste 101', 'Sandy', 'Salt Lake', 'UT', '84093', '8012552422', '8012553013', '7390 S Creek Rd Ste 101', 'Sandy', 'Salt Lake', 'UT', '84093', '8012552422', '8012553013', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2014-06-01', '2014-06-01', 0, 0, 0, 'St Marks Hospital', '', '', '', '|DEN|', '1326167354', 0, 'N', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('559230204', 'W12049039', 'W12049039', 'IDBOISTD', 'Idaho Center For Regenerative Medicine', 'Tara', 'C', 'Rothwell', 'PA', 'Family Practice', '', '', NULL, 'O', '500 E Shore Dr Ste 100', 'Eagle', 'Ada', 'ID', '83616', '2089943677', '          ', '500 E Shore Dr Ste 100', 'Eagle', 'Ada', 'ID', '83616', '2089943677', '          ', 'IDSTDCRM', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-07-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912087438', 0, 'N', 0, '2014-07-08', NULL, NULL, 0, 0, NULL, NULL),
('850424076', 'W12049322', 'W12049322', 'NM01', 'New Mexico Heart Institute', 'Michael', 'T', 'Bestawros', 'MD', 'Cardiac Electrophysiology Cardiology', '', '', NULL, 'B', 'PO Box 53537', 'Phoenix', 'Maricopa', 'AZ', '85072', '5058432800', '0000000000', 'PO Box 53537', 'Phoenix', 'Maricopa', 'AZ', '85072', '5058432800', '0000000000', 'NMHEART', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699909879', 0, 'N', 1, '2014-06-30', NULL, NULL, 0, 0, NULL, NULL),
('262072378', 'W12049319', 'W12049319', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Michelle', '', 'Grubb', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1248 E 90 N Ste 300', 'American Fork', 'Utah', 'UT', '84003', '8017561577', '8012168357', '1248 E 90 N Ste 300', 'American Fork', 'Utah', 'UT', '84003', '8017561577', '8012168357', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1467708487', 0, 'N', 0, '2014-06-30', NULL, NULL, 0, 0, NULL, NULL),
('559230204', 'W12049041', 'W12049041', 'IDBOISTD', 'Idaho Center For Regenerative Medicine', 'Tara', 'C', 'Rothwell', 'PA', 'Family Practice', '', '', NULL, 'M', '10 Spring Creek Dr', 'Horseshoe Bend', 'Boise', 'ID', '83629', '2086852484', '          ', '10 Spring Creek Dr', 'Horseshoe Bend', 'Boise', 'ID', '83629', '2086852484', '          ', 'IDSTDCRM', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-07-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912087438', 0, 'N', 0, '2014-07-08', NULL, NULL, 0, 0, NULL, NULL),
('826001195', 'W12049042', 'W12049042', 'UT01', 'Bear Lake Memorial Hospital Physicians Clinic', 'Jack', 'O', 'Clark', 'MD', 'Internal Medicine', '', '', NULL, 'O', '166 S 5th St', 'Montpelier', 'Bear Lake', 'ID', '83254', '2088471110', '2088470228', '166 S 5th St', 'Montpelier', 'Bear Lake', 'ID', '83254', '2088471110', '2088470228', '', '', '', '0.00', '25.00', '0.00', 3, '2014-07-15', NULL, 0, 0, 0, 'Bear Lake County Memorial Hospital', '', '', '', 'HCFA|UB|', '1902992837', 0, 'N', 1, '2014-07-08', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12049043', 'W12049043', 'IDBOISTD', '', 'Kevin', 'A', 'Clifford', 'MD', 'Emergency Medicine', 'Hospice', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083672121', '          ', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083672121', '          ', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 6, '2014-06-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1568500700', 0, 'Y', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12049044', 'W12049044', 'IDBOISTD', '', 'Kevin', 'A', 'Clifford', 'MD', 'Emergency Medicine', 'Hospice', '', NULL, 'B', 'PO Box 190930', 'Boise', 'Ada', 'ID', '83719', '2083672396', '          ', 'PO Box 190930', 'Boise', 'Ada', 'ID', '83719', '2083672396', '          ', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 6, '2014-06-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1568500700', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12049046', 'W12049046', 'WYBILLINGS', 'Billings Clinic - Internal Medicine', 'Daniel', 'G', 'Tobias', 'MD', 'Internal Medicine', '', '', NULL, 'O', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382771', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382771', '', '', '', '0.00', '17.00', '0.00', 3, '2014-06-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932496239', 0, 'N', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12049047', 'W12049047', 'WYBILLINGS', 'Billings Clinic', 'Daniel', 'G', 'Tobias', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-06-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932496239', 0, 'N', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12049048', 'W12049048', 'WYBILLINGS', 'Billings Clinic', 'Daniel', 'G', 'Tobias', 'MD', 'Internal Medicine', '', '', NULL, 'M', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-06-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932496239', 0, 'N', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12049050', 'W12049050', 'WYBILLINGS', 'Billings Clinic', 'Harvey', 'B', 'Wilds', 'MD', 'Radiation Oncology', '', '', NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-06-16', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1891769378', 0, 'N', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12049052', 'W12049052', 'WYBILLINGS', 'Billings Clinic - Radiation Oncology', 'Harvey', 'B', 'Wilds', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382572', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382572', '', '', '', '0.00', '17.00', '0.00', 3, '2014-06-16', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1891769378', 0, 'N', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12049051', 'W12049051', 'WYBILLINGS', 'Billings Clinic', 'Harvey', 'B', 'Wilds', 'MD', 'Radiation Oncology', '', '', NULL, 'M', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-06-16', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1891769378', 0, 'N', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12049054', 'W12049054', 'WYBILLINGS', 'Billings Clinic - Internal Medicine', 'Terry', 'D', 'Dennis', 'MD', 'Internal Medicine', '', '', NULL, 'O', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382771', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382771', '', '', '', '0.00', '17.00', '0.00', 3, '2014-06-17', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639244767', 0, 'N', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12049055', 'W12049055', 'WYBILLINGS', 'Billings Clinic', 'Terry', 'D', 'Dennis', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-06-17', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639244767', 0, 'N', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12049056', 'W12049056', 'WYBILLINGS', 'Billings Clinic', 'Terry', 'D', 'Dennis', 'MD', 'Internal Medicine', '', '', NULL, 'M', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-06-17', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639244767', 0, 'N', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12049058', 'W12049058', 'WYBILLINGS', 'Billings Clinic', 'Kathleen', '', 'Maxfield', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-06-16', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386783371', 0, 'N', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12049060', 'W12049060', 'WYBILLINGS', 'Billings Clinic - Cardiovascular Surgery', 'Kathleen', '', 'Maxfield', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382848', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382848', '', '', '', '0.00', '17.00', '0.00', 3, '2014-06-16', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386783371', 0, 'N', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12049059', 'W12049059', 'WYBILLINGS', 'Billings Clinic', 'Kathleen', '', 'Maxfield', 'MD', 'Cardiovascular Disease', '', '', NULL, 'M', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-06-16', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386783371', 0, 'N', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('262072378', 'W12049062', 'W12049062', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Jennifer', 'J', 'Krebs', 'CNM', 'Certified Nurse Midwife', '', '', NULL, 'O', '41 E Commerce Dr Ste 2', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017561577', '8012168357', '41 E Commerce Dr Ste 2', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017561577', '8012168357', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1952615205', 0, 'N', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('262072378', 'W12049061', 'W12049061', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Jennifer', 'J', 'Krebs', 'CNM', 'Certified Nurse Midwife', '', '', NULL, 'O', '1248 E 90 N Ste 300', 'American Fork', 'Utah', 'UT', '84003', '8017561577', '8012168357', '1248 E 90 N Ste 300', 'American Fork', 'Utah', 'UT', '84003', '8017561577', '8012168357', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1952615205', 0, 'N', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('800307419', 'W12049063', 'W12049063', 'WY01', 'Wyoming Health Medical Group', 'Joelle', '', 'Anthony', 'OTR', 'Occupational Therapy', '', '', NULL, 'O', '1020 E 2nd St Ste 201', 'Casper', 'Natrona', 'WY', '82601', '3072330235', '0000000000', '1020 E 2nd St Ste 201', 'Casper', 'Natrona', 'WY', '82601', '3072330235', '0000000000', '', '', '', '0.00', '18.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1881004257', 0, 'N', 1, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('800307419', 'W12049064', 'W12049064', 'WYT1', 'Wyoming Health Medical Group', 'Joelle', '', 'Anthony', 'OTR', 'Occupational Therapy', '', '', NULL, 'O', '1020 E 2nd St Ste 201', 'Casper', 'Natrona', 'WY', '82601', '3072330235', '0000000000', '1020 E 2nd St Ste 201', 'Casper', 'Natrona', 'WY', '82601', '3072330235', '0000000000', '', '', '', '0.00', '18.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1881004257', 0, 'N', 1, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('850275777', 'W12049065', 'W12049065', 'NM01', 'Southwest Medical Associates', 'Maude', '', 'Nielsen', 'MD', 'Family Practice', '', '', NULL, 'O', '8401 Constitution NE Ste 150', 'Albuquerque', 'Bernalillo', 'NM', '87110', '5058231010', '5057974503', '8401 Constitution NE Ste 150', 'Albuquerque', 'Bernalillo', 'NM', '87110', '5058231010', '5057974503', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679572283', 0, 'N', 1, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('850275777', 'W12049067', 'W12049067', 'NM01', 'Southwest Medical Associates', 'Maude', '', 'Nielsen', 'MD', 'Family Practice', '', '', NULL, 'O', '10511 Golf Course Rd Ste 205', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5058231010', '5057974503', '10511 Golf Course Rd Ste 205', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5058231010', '5057974503', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679572283', 0, 'N', 1, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('850275777', 'W12049068', 'W12049068', 'NM01', 'Southwest Medical Associates', 'Maude', '', 'Nielsen', 'MD', 'Family Practice', '', '', NULL, 'O', '4420 Irving Blvd NW', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5058231010', '5057974503', '4420 Irving Blvd NW', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5058231010', '5057974503', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679572283', 0, 'N', 1, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('850275777', 'W12049069', 'W12049069', 'NM01', 'Southwest Medical Associates', 'Maude', '', 'Nielsen', 'MD', 'Family Practice', '', '', NULL, 'O', '4705 Montgomery Blvd NE Ste 301-302', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', '5057974503', '4705 Montgomery Blvd NE Ste 301-302', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', '5057974503', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679572283', 0, 'N', 1, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('850275777', 'W12049070', 'W12049070', 'NM01', 'Southwest Medical Associates', 'Maude', '', 'Nielsen', 'MD', 'Family Practice', '', '', NULL, 'O', '4801 McMahon Blvd Ste 110', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5057274025', '5057274030', '4801 McMahon Blvd Ste 110', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5057274025', '5057274030', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679572283', 0, 'N', 1, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('850275777', 'W12049066', 'W12049066', 'NM01', 'Southwest Medical Associates', 'Maude', '', 'Nielsen', 'MD', 'Family Practice', '', '', NULL, 'B', '6100 Pan American Fwy, NE Ste 100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', '          ', '6100 Pan American Fwy, NE Ste 100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', '          ', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679572283', 0, 'N', 1, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('850275777', 'W12049071', 'W12049071', 'NM01', 'Southwest Medical Associates', 'Maude', '', 'Nielsen', 'MD', 'Family Practice', '', '', NULL, 'O', '9501 Paseo del Norte Ste C & D', 'Albuquerque', 'Bernalillo', 'NM', '87122', '5057274000', '5057274014', '9501 Paseo del Norte Ste C & D', 'Albuquerque', 'Bernalillo', 'NM', '87122', '5057274000', '5057274014', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679572283', 0, 'N', 1, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('850232628', 'W12049072', 'W12049072', 'NM01', 'Womens Specialists of NM', 'Carl', 'J', 'Connors', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '4640 Jefferson Ln NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058436168', '5052479743', '4640 Jefferson Ln NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058436168', '5052479743', 'NMWOMENS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1629175838', 0, 'N', 1, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('870545614', 'W12049073', 'W12049073', 'UT01', 'Mountain West Anesthesia', '', '', 'Mountain West Anesthesia', 'Group', 'Anesthesiology', '', '', NULL, 'M', '3340 N Ctr St Ste 800', 'Lehi', 'Utah', 'UT', '84043', '8005014788', '          ', '3340 N Ctr St Ste 800', 'Lehi', 'Utah', 'UT', '84043', '8005014788', '          ', '', '', '', '60.00', '25.00', '0.00', 3, '2014-07-01', NULL, 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1558391763', 0, 'N', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('870545614', 'W12049074', 'W12049074', 'UT01', 'Mountain West Anesthesia', '', '', 'Mountain West Anesthesia', 'Group', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3570', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8005014788', '          ', 'PO Box 3570', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8005014788', '          ', '', '', '', '60.00', '25.00', '0.00', 3, '2014-07-01', NULL, 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1558391763', 0, 'N', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('841421665', 'W12049075', 'W12049075', 'Sinclair', 'St Lukes Woodriver Anesthesia', 'John', 'S', 'Carmichael', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'B', 'PO Box 587', 'Twin Falls', 'Twin Falls', 'ID', '83303', '2083266866', '2083266866', 'PO Box 587', 'Twin Falls', 'Twin Falls', 'ID', '83303', '2083266866', '2083266866', '', '', '', '0.00', '14.00', '0.00', 3, '2014-06-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972682060', 0, 'N', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('841421665', 'W12049076', 'W12049076', 'Sinclair', 'St Lukes Woodriver Anesthesia', 'Nathan', 'G', 'Seedall', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'B', 'PO Box 587', 'Twin Falls', 'Twin Falls', 'ID', '83303', '2083266866', '2083266866', 'PO Box 587', 'Twin Falls', 'Twin Falls', 'ID', '83303', '2083266866', '2083266866', '', '', '', '0.00', '14.00', '0.00', 3, '2014-06-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992740716', 0, 'N', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('841421665', 'W12049077', 'W12049077', 'Sinclair', 'St Lukes Woodriver Anesthesia', 'Jeffrey', 'L', 'Taylor', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'B', 'PO Box 587', 'Twin Falls', 'Twin Falls', 'ID', '83303', '2083266866', '2083266866', 'PO Box 587', 'Twin Falls', 'Twin Falls', 'ID', '83303', '2083266866', '2083266866', '', '', '', '0.00', '14.00', '0.00', 3, '2014-06-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306870498', 0, 'N', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('841421665', 'W12049078', 'W12049078', 'Sinclair', 'St Lukes Woodriver Anesthesia', 'Walter', 'J', 'Trudo', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'B', 'PO Box 587', 'Twin Falls', 'Twin Falls', 'ID', '83303', '2083266866', '2083266866', 'PO Box 587', 'Twin Falls', 'Twin Falls', 'ID', '83303', '2083266866', '2083266866', '', '', '', '0.00', '14.00', '0.00', 3, '2014-06-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841243474', 0, 'N', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('841421665', 'W12049079', 'W12049079', 'Sinclair', 'St Lukes Woodriver Anesthesia', 'James', 'H', 'Cleveland', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'B', 'PO Box 587', 'Twin Falls', 'Twin Falls', 'ID', '83303', '2083266866', '2083266866', 'PO Box 587', 'Twin Falls', 'Twin Falls', 'ID', '83303', '2083266866', '2083266866', '', '', '', '0.00', '14.00', '0.00', 3, '2014-06-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265624290', 0, 'N', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('841421665', 'W12049080', 'W12049080', 'Sinclair', 'St Lukes Woodriver Anesthesia', 'John', 'J', 'Driscoll', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'B', 'PO Box 587', 'Twin Falls', 'Twin Falls', 'ID', '83303', '2083266866', '2083266866', 'PO Box 587', 'Twin Falls', 'Twin Falls', 'ID', '83303', '2083266866', '2083266866', '', '', '', '0.00', '14.00', '0.00', 3, '2014-06-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437341468', 0, 'N', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('841421665', 'W12049081', 'W12049081', 'Sinclair', 'St Lukes Woodriver Anesthesia', 'Steven', 'C', 'Funk', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 587', 'Twin Falls', 'Twin Falls', 'ID', '83303', '2083266866', '2083266866', 'PO Box 587', 'Twin Falls', 'Twin Falls', 'ID', '83303', '2083266866', '2083266866', '', '', '', '0.00', '14.00', '0.00', 3, '2014-06-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245259894', 0, 'N', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('841421665', 'W12049082', 'W12049082', 'Sinclair', 'St Lukes Woodriver Anesthesia', 'Albert', '', 'Trearse', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 587', 'Twin Falls', 'Twin Falls', 'ID', '83303', '2083266866', '2083266866', 'PO Box 587', 'Twin Falls', 'Twin Falls', 'ID', '83303', '2083266866', '2083266866', '', '', '', '0.00', '14.00', '0.00', 3, '2014-06-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508864851', 0, 'Y', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('752646217', 'W12049085', 'W12049085', 'TXDALSTD', 'J W Eye Associates', 'Ronald', '', 'Barke', 'MD', 'Ophthalmology', '', '', NULL, 'B', '2801 Lemmon Ave Ste 400', 'Dallas', 'Dallas', 'TX', '75204', '2147540000', '2143791849', '2801 Lemmon Ave Ste 400', 'Dallas', 'Dallas', 'TX', '75204', '2147540000', '2143791849', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447255476', 0, 'N', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('752646217', 'W12049084', 'W12049084', 'TXDALSTD', 'J W Eye Associates', 'Ronald', '', 'Barke', 'MD', 'Ophthalmology', '', '', NULL, 'O', '400 W Arbrook Blvd Ste 121', 'Arlington', 'Tarrant', 'TX', '76014', '2147540000', '2143791849', '400 W Arbrook Blvd Ste 121', 'Arlington', 'Tarrant', 'TX', '76014', '2147540000', '2143791849', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447255476', 0, 'N', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('752646217', 'W12049083', 'W12049083', 'TXDALSTD', 'J W Eye Associates', 'Ronald', '', 'Barke', 'MD', 'Ophthalmology', '', '', NULL, 'O', '910 N Davis Ste 400', 'Arlington', 'Tarrant', 'TX', '76012', '2147540000', '2143791849', '910 N Davis Ste 400', 'Arlington', 'Tarrant', 'TX', '76012', '2147540000', '2143791849', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447255476', 0, 'N', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('841433620', 'W12049087', 'W12049087', 'UT01', 'Jordan Oaks Chiropractic', 'Alan', 'John', 'Adams', 'DC', 'Chiropractic', '', '', NULL, 'O', '7555 S Ctr View Ct Ste 102', 'West Jordan', 'Salt Lake', 'UT', '84084', '8015689222', '8015689559', '7555 S Ctr View Ct Ste 102', 'West Jordan', 'Salt Lake', 'UT', '84084', '8015689222', '8015689559', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '58.83', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598894685', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('454838898', 'W12049089', 'W12049089', 'UT01', 'Salt Lake Sports Chiropractic', 'Bradley', 'A', 'Anderson', 'DC', 'Chiropractic', '', '', NULL, 'O', '3980 S 700 E Ste 22', 'Murray', 'Salt Lake', 'UT', '84107', '8014560350', '8014560351', '3980 S 700 E Ste 22', 'Murray', 'Salt Lake', 'UT', '84107', '8014560350', '8014560351', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '58.83', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790022382', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('260296649', 'W12049090', 'W12049090', 'UT01', 'Integrated Wellness Group ', 'Scott', '', 'Asay', 'DC', 'Chiropractic', '', '', NULL, 'O', '458 N 500 W', 'Bountiful', 'Davis', 'UT', '84010', '8012929355', '8012968050', '458 N 500 W', 'Bountiful', 'Davis', 'UT', '84010', '8012929355', '8012968050', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '58.83', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366748790', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('463819765', 'W12049091', 'W12049091', 'UT01', 'Synergy Soft Tissue Center', 'Timothy', 'J', 'Bailey', 'DC', 'Chiropractic', '', '', NULL, 'O', '30 E Main St', 'Hyrum', 'Cache', 'UT', '84319', '4352457555', '4352457607', '30 E Main St', 'Hyrum', 'Cache', 'UT', '84319', '4352457555', '4352457607', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '58.83', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1891063731', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('810392990', 'W12049092', 'W12049092', 'UT01', '', 'Scott', 'W', 'Bentley', 'DC', 'Chiropractic', '', '', NULL, 'O', '1611 S Buckskin Dr', 'Kanab', 'Kane', 'UT', '84741', '4356442837', '4356442837', '1611 S Buckskin Dr', 'Kanab', 'Kane', 'UT', '84741', '4356442837', '4356442837', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '58.83', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558448647', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('870623385', 'W12049093', 'W12049093', 'UT01', 'Berlin Chiropractic Inc', 'Daniel', '', 'Berlin', 'DC', 'Chiropractic', '', '', NULL, 'O', '4360 S Redwood Rd Ste 3', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8019638750', '8019672494', '4360 S Redwood Rd Ste 3', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8019638750', '8019672494', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '58.83', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487862843', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('010891863', 'W12049094', 'W12049094', 'UT01', 'San Juan Chiropractic & Wellness Center', 'Sterling', 'P', 'Black', 'DC', 'Chiropractic', '', '', NULL, 'O', '792 S Main St', 'Blanding', 'San Juan', 'UT', '84511', '4356782795', '8885102690', '792 S Main St', 'Blanding', 'San Juan', 'UT', '84511', '4356782795', '8885102690', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '58.83', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699725747', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('261686506', 'W12049095', 'W12049095', 'UT01', 'Advanced Spinal Rehabilitation', 'Corey', '', 'Bowden', 'DC', 'Chiropractic', '', '', NULL, 'O', '67 S Main Ste 150', 'Layton', 'Davis', 'UT', '84041', '8014441230', '8014441228', '67 S Main Ste 150', 'Layton', 'Davis', 'UT', '84041', '8014441230', '8014441228', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '58.83', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063639359', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('450295980', 'W12049096', 'W12049096', 'UT01', '', 'Ron', 'Dell', 'Boyer', 'DC', 'Chiropractic', '', '', NULL, 'O', '47 N 100 E', 'St George', 'Washington', 'UT', '84770', '4352754015', '4356568400', '47 N 100 E', 'St George', 'Washington', 'UT', '84770', '4352754015', '4356568400', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '58.83', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609092030', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('870424894', 'W12049097', 'W12049097', 'UT01', 'Campbell Chiropractic', 'Craig', 'D', 'Campbell', 'DC', 'Chiropractic', '', '', NULL, 'O', '115 E 7200 S', 'Midvale', 'Salt Lake', 'UT', '84047', '8015664357', '8015664476', '115 E 7200 S', 'Midvale', 'Salt Lake', 'UT', '84047', '8015664357', '8015664476', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '58.83', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013023282', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('800879941', 'W12049098', 'W12049098', 'UT01', 'Roosevelt Chiropractic PC', 'Michael', 'M', 'Campbell', 'DC', 'Chiropractic', '', '', NULL, 'O', '383 E Lagoon St', 'Roosevelt', 'Duchesne', 'UT', '84066', '4357223370', '4357223384', '383 E Lagoon St', 'Roosevelt', 'Duchesne', 'UT', '84066', '4357223370', '4357223384', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '58.83', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1700989746', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('870526252', 'W12049099', 'W12049099', 'UT01', 'Courtney Chiropractic Clinic', 'David', '', 'Courtney', 'DC', 'Chiropractic', '', '', NULL, 'O', '800 N 100 E', 'Spanish Fork', 'Utah', 'UT', '84660', '8017982482', '8017986607', '800 N 100 E', 'Spanish Fork', 'Utah', 'UT', '84660', '8017982482', '8017986607', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '58.83', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356358758', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('870576626', 'W12049100', 'W12049100', 'UT01', 'Spinal Care Center of Utah', 'Daniel', 'B', 'Davenport', 'DC', 'Chiropractic', '', '', NULL, 'O', '1186 E 4600 S Ste 220', 'Ogden', 'Weber', 'UT', '84403', '8014751800', '8014750071', '1186 E 4600 S Ste 220', 'Ogden', 'Weber', 'UT', '84403', '8014751800', '8014750071', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '58.83', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073625869', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('870576626', 'W12049101', 'W12049101', 'UT01', 'Spinal Care Center of Utah', 'Daniel', 'B', 'Davenport', 'DC', 'Chiropractic', '', '', NULL, 'B', 'PO Box 150342', 'Ogden', 'Weber', 'UT', '84415', '8014751800', '8014750071', 'PO Box 150342', 'Ogden', 'Weber', 'UT', '84415', '8014751800', '8014750071', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '58.83', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073625869', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('204348971', 'W12049102', 'W12049102', 'UT01', 'Utah Spinal Health and Rehabilitation', 'Steven', 'E', 'Davis', 'DC', 'Chiropractic', '', '', NULL, 'O', '750 N Main St', 'Spanish Fork', 'Utah', 'UT', '84660', '8017982515', '8017982510', '750 N Main St', 'Spanish Fork', 'Utah', 'UT', '84660', '8017982515', '8017982510', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '58.83', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770735284', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('870661331', 'W12049103', 'W12049103', 'UT01', 'Syracuse Chiropractic and Health Center', 'Tyler', 'R', 'Elmore', 'DC', 'Chiropractic', '', '', NULL, 'O', '1842 S 2000 W Ste 2', 'Syracuse', 'Davis', 'UT', '84075', '8017747540', '8017747542', '1842 S 2000 W Ste 2', 'Syracuse', 'Davis', 'UT', '84075', '8017747540', '8017747542', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '58.83', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811081771', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('538081436', 'W12049104', 'W12049104', 'UT01', 'Panah Chiropractic', 'Ryan', 'Lee', 'Emmett', 'DC', 'Chiropractic', '', '', NULL, 'O', '2002 N Main St Ste 7', 'Cedar City', 'Iron', 'UT', '84721', '4358674505', '          ', '2002 N Main St Ste 7', 'Cedar City', 'Iron', 'UT', '84721', '4358674505', '          ', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '58.83', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083837934', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('870653332', 'W12049105', 'W12049105', 'UT01', '', 'Brian', 'H', 'Ewell', 'DC', 'Chiropractic', '', '', NULL, 'O', '2964 W 4700 S Ste 102', 'Salt Lake City', 'Salt Lake', 'UT', '84129', '8019669100', '8019660094', '2964 W 4700 S Ste 102', 'Salt Lake City', 'Salt Lake', 'UT', '84129', '8019669100', '8019660094', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '58.83', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760459135', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('452483380', 'W12049106', 'W12049106', 'UT01', 'Advanced Spinal Authority of Northern Utah', 'Jace', 'H', 'Ferguson', 'DC', 'Chiropractic', '', '', NULL, 'O', '3935 N 75 W', 'Hyde Park', 'Cache', 'UT', '84318', '4355636363', '4355630160', '3935 N 75 W', 'Hyde Park', 'Cache', 'UT', '84318', '4355636363', '4355630160', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '58.83', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427269166', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('454788597', 'W12049107', 'W12049107', 'UT01', 'Genesis Chiropractic', 'Tiffani', '', 'Fries', 'DC', 'Chiropractic', '', '', NULL, 'O', '1548 E 4500 S Ste 1', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8016760243', '8016760245', '1548 E 4500 S Ste 1', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8016760243', '8016760245', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '58.83', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114977105', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('271277601', 'W12049108', 'W12049108', 'UT01', 'Wasatch Back Wellness', 'Mark', 'H', 'Frogley', 'DC', 'Chiropractic', '', '', NULL, 'O', '906 S Main St', 'Heber City', 'Wasatch', 'UT', '84032', '4356543032', '4356543035', '906 S Main St', 'Heber City', 'Wasatch', 'UT', '84032', '4356543032', '4356543035', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '58.83', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316291966', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('800543080', 'W12049109', 'W12049109', 'UT01', 'Advanced Spine & Health Center of Cache Valley', 'Thomas', 'Owen', 'Fullmer', 'DC', 'Chiropractic', '', '', NULL, 'O', '1652 S Hwy 165 Ste B', 'Providence', 'Cache', 'UT', '84332', '4357525522', '4357523075', '1652 S Hwy 165 Ste B', 'Providence', 'Cache', 'UT', '84332', '4357525522', '4357523075', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '58.83', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134451529', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('870522152', 'W12049110', 'W12049110', 'UT01', 'Green Chiropractic Clinic', 'Ralph', 'K', 'Green', 'DC', 'Chiropractic', '', '', NULL, 'O', '2048 W 5400 S', 'Salt Lake City', 'Salt Lake', 'UT', '84129', '8019685400', '8019685405', '2048 W 5400 S', 'Salt Lake City', 'Salt Lake', 'UT', '84129', '8019685400', '8019685405', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '58.83', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053409235', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('870333664', 'W12049111', 'W12049111', 'UT01', '', 'Nathan', 'E', 'Hales', 'DC', 'Chiropractic', '', '', NULL, 'O', '360 S State St Ste A', 'Clearfield', 'Davis', 'UT', '84015', '8017731821', '8018255276', '360 S State St Ste A', 'Clearfield', 'Davis', 'UT', '84015', '8017731821', '8018255276', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '58.83', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336398189', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('841378055', 'W12049112', 'W12049112', 'UT01', 'Elite Chiropractic and Performance Center', 'Chris', 'Jared', 'Harbrecht', 'DC', 'Chiropractic', '', '', NULL, 'O', '6717 S 900 E Ste 101', 'Midvale', 'Salt Lake', 'UT', '84047', '8014327511', '8014327516', '6717 S 900 E Ste 101', 'Midvale', 'Salt Lake', 'UT', '84047', '8014327511', '8014327516', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '58.83', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336351444', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('461688738', 'W12049113', 'W12049113', 'UT01', 'Brian N Hardy PLLC', 'Brian', 'N', 'Hardy', 'DC', 'Chiropractic', '', '', NULL, 'O', '75 S 100 E Ste 1A', 'St George', 'Washington', 'UT', '84770', '4356888830', '4356882240', '75 S 100 E Ste 1A', 'St George', 'Washington', 'UT', '84770', '4356888830', '4356882240', 'Hardy', 'WUSTDHCPC5', '', '0.00', '0.00', '58.83', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831255033', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('263003358', 'W12049114', 'W12049114', 'UT01', 'Aspen Falls Spinal Care Center', 'Dustin', 'James', 'Hedstrom', 'DC', 'Chiropractic', '', '', NULL, 'O', '370 E S Temple Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8013630060', '8013633926', '370 E S Temple Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8013630060', '8013633926', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '58.83', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831383298', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('870517949', 'W12049115', 'W12049115', 'UT01', 'Layton Chiropractic Clinic', 'Daniel', 'Lee', 'Hendricks', 'DC', 'Chiropractic', '', '', NULL, 'O', '1025 N Main St', 'Layton', 'Davis', 'UT', '84041', '8015444333', '8015440063', '1025 N Main St', 'Layton', 'Davis', 'UT', '84041', '8015444333', '8015440063', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '58.83', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437123122', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('204890438', 'W12049116', 'W12049116', 'UT01', 'Horsley Chiropractic', 'Erik', 'Spence', 'Horsley', 'DC', 'Chiropractic', '', '', NULL, 'O', '3855 W 7800 S Ste 125', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012807777', '8012807797', '3855 W 7800 S Ste 125', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012807777', '8012807797', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '58.83', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952341802', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('273945978', 'W12049117', 'W12049117', 'UT01', 'Zion Health Management Services', 'Richard', 'S', 'Jensen', 'DC', 'Chiropractic', '', '', NULL, 'O', '237 N Bluff St Ste A', 'St George', 'Washington', 'UT', '84770', '4356742626', '4356285999', '237 N Bluff St Ste A', 'St George', 'Washington', 'UT', '84770', '4356742626', '4356285999', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '58.83', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801104740', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('273132189', 'W12049118', 'W12049118', 'UT01', 'Corner Canyon Chiropractic', 'Carl', 'G', 'LeSueur', 'DC', 'Chiropractic', '', '', NULL, 'O', '1178 E Draper Pkwy', 'Draper', 'Salt Lake', 'UT', '84020', '8015539691', '8015714288', '1178 E Draper Pkwy', 'Draper', 'Salt Lake', 'UT', '84020', '8015539691', '8015714288', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '58.83', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770715831', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
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('870395634', 'W12049123', 'W12049123', 'UT01', 'Dr Loral G Linton DC PC', 'Loral', 'G', 'Linton', 'DC', 'Chiropractic', '', '', NULL, 'O', '662 S Hwy 89 Ste A', 'Kanab', 'Kane', 'UT', '84741', '4356445296', '4356445296', '662 S Hwy 89 Ste A', 'Kanab', 'Kane', 'UT', '84741', '4356445296', '4356445296', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '58.83', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194894501', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('271898282', 'W12049124', 'W12049124', 'UT01', 'Integrated Wellness South Jordan', 'Caleb', 'J', 'Lorenc', 'DC', 'Chiropractic', '', '', NULL, 'O', '10684 S River Front Pkwy', 'South Jordan', 'Salt Lake', 'UT', '84095', '8018160332', '8018160331', '10684 S River Front Pkwy', 'South Jordan', 'Salt Lake', 'UT', '84095', '8018160332', '8018160331', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '58.83', 8, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801140900', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('330995596', 'W12049125', 'W12049125', 'UT01', '', 'Kevin', '', 'Lundell', 'DC', 'Chiropractic', '', '', NULL, 'O', '3500 Harrison Blvd Ste 200', 'Ogden', 'Weber', 'UT', '84403', '8016272225', '8016272228', '3500 Harrison Blvd Ste 200', 'Ogden', 'Weber', 'UT', '84403', '8016272225', '8016272228', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '58.83', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992036180', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('200721283', 'W12049126', 'W12049126', 'UT01', 'McClean Clinic', 'Gordon', 'M Jr', 'McClean', 'DC', 'Chiropractic', '', '', NULL, 'O', '385 N 500 W', 'Provo', 'Utah', 'UT', '84601', '8013731035', '8013731038', '385 N 500 W', 'Provo', 'Utah', 'UT', '84601', '8013731035', '8013731038', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '58.83', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053408955', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('000009771', 'W12049127', 'W12049127', 'UT01', 'Network Management Group', '', '', 'Network Management Group', '', 'Chiropractic', '', '', NULL, '', 'Change', 'Salt Lake City', 'Salt Lake', 'UT', '84126', '          ', '          ', 'Change', 'Salt Lake City', 'Salt Lake', 'UT', '84126', '          ', '          ', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '58.83', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009771', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('270616354', 'W12049128', 'W12049128', 'UT01', 'Optimum Health and Spinal Care', 'John', 'Kurt', 'Olsen', 'DC', 'Chiropractic', '', '', NULL, 'O', '7840 S 700 E', 'Sandy', 'Salt Lake', 'UT', '84070', '8012560006', '8012560005', '7840 S 700 E', 'Sandy', 'Salt Lake', 'UT', '84070', '8012560006', '8012560005', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '58.83', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982836631', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('460803374', 'W12049129', 'W12049129', 'UT01', 'South Jordan Health and Wellness', 'Matthew', 'W', 'Peterson', 'DC', 'Chiropractic', '', '', NULL, 'O', '352 N Main St', 'Tooele', 'Tooele', 'UT', '84074', '4358821621', '8014328072', '352 N Main St', 'Tooele', 'Tooele', 'UT', '84074', '4358821621', '8014328072', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '58.83', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326011891', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('870559629', 'W12049130', 'W12049130', 'UT01', '', 'Bryon', '', 'Rosquist', 'DC', 'Chiropractic', '', '', NULL, 'O', '405 S 100 E Ste 104', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017859411', '8884312763', '405 S 100 E Ste 104', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017859411', '8884312763', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '58.83', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730221706', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('201030213', 'W12049131', 'W12049131', 'UT01', 'Sanders Chiropractic and Wellness', 'Ronald', 'Eric', 'Sanders', '', 'Chiropractic', '', '', NULL, 'O', '180 W Gordon Ave', 'Layton', 'Davis', 'UT', '84041', '8015464500', '8012560005', '180 W Gordon Ave', 'Layton', 'Davis', 'UT', '84041', '8015464500', '8012560005', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '58.83', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619044179', 0, 'N', 0, '2014-06-30', NULL, NULL, 0, 0, NULL, NULL),
('870687510', 'W12049132', 'W12049132', 'UT01', 'Tooele Valley Spine Center', 'Travis ', '', 'Sargent', 'DC', 'Chiropractic', '', '', NULL, 'O', '1244 N Main St Ste 100', 'Tooele', 'Tooele', 'UT', '84074', '4358339200', '4358339223', '1244 N Main St Ste 100', 'Tooele', 'Tooele', 'UT', '84074', '4358339200', '4358339223', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '58.83', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861534356', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('462999933', 'W12049133', 'W12049133', 'UT01', '', 'Dean', 'Foster', 'Sheldon', 'DC', 'Chiropractic', '', '', NULL, 'O', '96 N Main St Ste 103', 'Cedar City', 'Iron', 'UT', '84720', '4358678986', '4358676233', '96 N Main St Ste 103', 'Cedar City', 'Iron', 'UT', '84720', '4358678986', '4358676233', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '58.83', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659608032', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('870657473', 'W12049134', 'W12049134', 'UT01', 'Skaggs Chiropractic', 'Daniel', 'S', 'Skaggs', 'DC', 'Chiropractic', '', '', NULL, 'O', '2721 N Hwy 89 Ste 100', 'Ogden', 'Weber', 'UT', '84404', '8017824454', '8017824455', '2721 N Hwy 89 Ste 100', 'Ogden', 'Weber', 'UT', '84404', '8017824454', '8017824455', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '58.83', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477684884', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('870627188', 'W12049135', 'W12049135', 'UT01', 'Canyon Ridge Chiropractic Inc', 'Jason', 'L', 'Smith', 'DC', 'Chiropractic', '', '', NULL, 'O', '425 S Medical Dr Ste 216', 'Bountiful', 'Davis', 'UT', '84010', '8012924400', '8013353209', '425 S Medical Dr Ste 216', 'Bountiful', 'Davis', 'UT', '84010', '8012924400', '8013353209', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '58.83', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558391169', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('262128007', 'W12049136', 'W12049136', 'UT01', 'Sorenson Chiropractic ', 'John', 'Robert', 'Sorenson', 'DC', 'Chiropractic', '', '', NULL, 'O', '1495 S Blackridge Dr Ste A210', 'St George', 'Washington', 'UT', '84770', '4356881415', '4356881204', '1495 S Blackridge Dr Ste A210', 'St George', 'Washington', 'UT', '84770', '4356881415', '4356881204', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '58.83', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396918686', 0, 'N', 0, '2014-06-24', 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
('262128007', 'W12049137', 'W12049137', 'UT01', 'Sorenson Chiropractic ', 'John', 'Robert', 'Sorenson', 'DC', 'Chiropractic', '', '', NULL, 'O', '47 N 100 E', 'St George', 'Washington', 'UT', '84770', '4352754015', '4356568400', '47 N 100 E', 'St George', 'Washington', 'UT', '84770', '4352754015', '4356568400', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '58.83', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396918686', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('870637498', 'W12049138', 'W12049138', 'UT01', 'Dr. Jon L. Stucky, DC', 'Jon', 'LaShay', 'Stucky', 'DC CCEP CCST', 'Chiropractic', '', '', NULL, 'O', '130 N 800 E', 'Hyrum', 'Cache', 'UT', '84319', '4352453500', '4357552913', '130 N 800 E', 'Hyrum', 'Cache', 'UT', '84319', '4352453500', '4357552913', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '58.83', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578611273', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('870664764', 'W12049139', 'W12049139', 'UT01', 'First Physicians ', 'Stephen', 'Cope', 'Taylor', 'DC', 'Chiropractic', '', '', NULL, 'O', '298 24th St Ste 435C', 'Ogden', 'Weber', 'UT', '84401', '8017823060', '8016058031', '298 24th St Ste 435C', 'Ogden', 'Weber', 'UT', '84401', '8017823060', '8016058031', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '58.83', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750478723', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('870304778', 'W12049140', 'W12049140', 'UT01', 'Carbon Chiropractic Center', 'Milton', 'K', 'Thayn', 'DC', 'Chiropractic', '', '', NULL, 'O', '39 N 600 E', 'Price', 'Carbon', 'UT', '84501', '4356370450', '4356376341', '39 N 600 E', 'Price', 'Carbon', 'UT', '84501', '4356370450', '4356376341', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '58.83', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720112980', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('870488222', 'W12049141', 'W12049141', 'UT01', 'Willow Creek Chiropractic', 'Brian', '', 'Thomas', 'DC', 'Chiropractic', '', '', NULL, 'O', '8170 S Highland Dr Ste E2', 'Sandy', 'Salt Lake', 'UT', '84093', '8019424999', '8019428816', '8170 S Highland Dr Ste E2', 'Sandy', 'Salt Lake', 'UT', '84093', '8019424999', '8019428816', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '58.83', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235269366', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('464760729', 'W12049142', 'W12049142', 'UT01', 'Salt City Chiropractic Wellness Center', 'Jason', 'R', 'Vance', 'DC', 'Chiropractic', '', '', NULL, 'O', '11762 S State St Ste 320', 'Draper', 'Salt Lake', 'UT', '84020', '8013129991', '8013129979', '11762 S State St Ste 320', 'Draper', 'Salt Lake', 'UT', '84020', '8013129991', '8013129979', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '58.83', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124369988', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12049145', 'W12049145', 'NM01', 'ABQ Health Partners', 'Brian', '', 'Davis', 'MD', 'Pathology', '', '', NULL, 'O', '601 Dr Martin Luther King Jr Ave NE', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5057276450', '5057278391', '601 Dr Martin Luther King Jr Ave NE', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5057276450', '5057278391', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-07-14', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164677944', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12049148', 'W12049148', 'NM01', 'ABQ Health Partners', 'Brian', '', 'Davis', 'MD', 'Pathology', '', '', NULL, 'O', '4701 Montgomery Blvd', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5057276450', '5057278391', '4701 Montgomery Blvd', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5057276450', '5057278391', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-07-14', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164677944', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12049147', 'W12049147', 'NM01', 'ABQ Health Partners', 'Brian', '', 'Davis', 'MD', 'Pathology', '', '', NULL, 'M', '5400 Gibson Blvd SE', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5052623937', '5052627147', '5400 Gibson Blvd SE', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5052623937', '5052627147', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-07-14', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164677944', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12049146', 'W12049146', 'NM01', 'ABQ Health Partners', 'Brian', '', 'Davis', 'MD', 'Pathology', '', '', NULL, 'B', 'PO Box 27829           ', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052627600', '5052627147', 'PO Box 27829           ', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052627600', '5052627147', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-07-14', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164677944', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12049149', 'W12049149', 'NM01', 'ABQ Health Partners', 'Danielle', '', 'Hoelter', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052546500', '5052546532', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052546500', '5052546532', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-07-09', NULL, 0, 0, 0, 'Lovelace Womens Hospital', 'Lovelace Westside Hospital', NULL, NULL, 'HCFA|UB|', '1780848648', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12049150', 'W12049150', 'NM01', 'ABQ Health Partners', 'Danielle', '', 'Hoelter', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '13701 Encantado Rd NE', 'Albuquerque', 'Bernalillo', 'NM', '87123', '5052546500', '5052546532', '13701 Encantado Rd NE', 'Albuquerque', 'Bernalillo', 'NM', '87123', '5052546500', '5052546532', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-07-09', NULL, 0, 0, 0, 'Lovelace Womens Hospital', 'Lovelace Westside Hospital', NULL, NULL, 'HCFA|UB|', '1780848648', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12049151', 'W12049151', 'NM01', 'ABQ Health Partners', 'Danielle', '', 'Hoelter', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2929 Coors Blvd NW Ste 200', 'Albuquerque', 'Bernalillo', 'NM', '87120', '5058392300', '5058392303', '2929 Coors Blvd NW Ste 200', 'Albuquerque', 'Bernalillo', 'NM', '87120', '5058392300', '5058392303', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-06-18', NULL, 0, 0, 0, 'Lovelace Womens Hospital', 'Lovelace Westside Hospital', NULL, NULL, 'HCFA|UB|', '1780848648', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12049153', 'W12049153', 'NM01', 'ABQ Health Partners', 'Tambra', '', 'Bensch', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '9101 Montgomery Blvd Ne', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052754259', '5052754223', '9101 Montgomery Blvd Ne', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052754259', '5052754223', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-07-09', NULL, 0, 0, 0, 'Lovelace Womens Hospital', 'Lovelace Westside Hospital', '', '', 'HCFA|UB|', '1528091014', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12049154', 'W12049154', 'NM01', 'ABQ Health Partners', 'Tambra', '', 'Bensch', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '13701 Encantado Rd NE', 'Albuquerque', 'Bernalillo', 'NM', '87123', '5052378700', '5052378703', '13701 Encantado Rd NE', 'Albuquerque', 'Bernalillo', 'NM', '87123', '5052378700', '5052378703', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'Lovelace Womens Hospital', 'Lovelace Westside Hospital', '', '', 'HCFA|UB|', '1528091014', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12049155', 'W12049155', 'NM01', 'ABQ Health Partners', 'Terri', '', 'Caspary-Schmidt', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '13701 Encantado Rd NE', 'Albuquerque', 'Bernalillo', 'NM', '87123', '5052378700', '5052378703', '13701 Encantado Rd NE', 'Albuquerque', 'Bernalillo', 'NM', '87123', '5052378700', '5052378703', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'Lovelace Womens Hospital', 'Lovelace Westside Hospital', '', '', 'HCFA|UB|', '1396778981', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12049156', 'W12049156', 'NM01', 'ABQ Health Partners', 'Terri', '', 'Caspary-Schmidt', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052754288', '5052754203', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052754288', '5052754203', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-07-09', NULL, 0, 0, 0, 'Lovelace Womens Hospital', 'Lovelace Westside Hospital', '', '', 'HCFA|UB|', '1396778981', 0, 'N', 0, '2014-06-30', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12049157', 'W12049157', 'NM01', 'ABQ Health Partners', 'Yvonne', '', 'Castillo', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052754259', '5052754223', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052754259', '5052754223', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-07-09', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1396778809', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12049158', 'W12049158', 'NM01', 'ABQ Health Partners', 'Yvonne', '', 'Castillo', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '13701 Encantado Rd NE', 'Albuquerque', 'Bernalillo', 'NM', '87123', '5052378700', '5052378703', '13701 Encantado Rd NE', 'Albuquerque', 'Bernalillo', 'NM', '87123', '5052378700', '5052378703', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1396778809', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12049159', 'W12049159', 'NM01', 'ABQ Health Partners', 'Susan', '', 'Daniels', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '13701 Encantado Rd NE', 'Albuquerque', 'Bernalillo', 'NM', '87123', '5052378700', '5052378703', '13701 Encantado Rd NE', 'Albuquerque', 'Bernalillo', 'NM', '87123', '5052378700', '5052378703', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'Lovelace Womens Hospital', 'Lovelace Westside Hospital', '', '', 'HCFA|UB|', '1245265222', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12049160', 'W12049160', 'NM01', 'ABQ Health Partners', 'Susan', '', 'Daniels', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052754259', '5052754223', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052754259', '5052754223', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-07-09', NULL, 0, 0, 0, 'Lovelace Womens Hospital', 'Lovelace Westside Hospital', '', '', 'HCFA|UB|', '1245265222', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12049161', 'W12049161', 'NM01', 'ABQ Health Partners', 'Elizabeth', '', 'Heath-West', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052754259', '5052754223', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052754259', '5052754223', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-07-09', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1134152721', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12049162', 'W12049162', 'NM01', 'ABQ Health Partners', 'Elizabeth', '', 'Heath-West', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '13701 Encantado Rd NE', 'Albuquerque', 'Bernalillo', 'NM', '87123', '5052378700', '5052378703', '13701 Encantado Rd NE', 'Albuquerque', 'Bernalillo', 'NM', '87123', '5052378700', '5052378703', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1134152721', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12049163', 'W12049163', 'NM01', 'ABQ Health Partners', 'Amelia', '', 'Maestas', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '13701 Encantado Rd NE', 'Albuquerque', 'Bernalillo', 'NM', '87123', '5052378700', '5052378703', '13701 Encantado Rd NE', 'Albuquerque', 'Bernalillo', 'NM', '87123', '5052378700', '5052378703', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'Lovelace Womens Hospital', '', '', '', 'HCFA|UB|', '1487687075', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12049165', 'W12049165', 'NM01', 'ABQ Health Partners', 'Amelia', '', 'Maestas', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052754259', '5052754223', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052754259', '5052754223', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-07-09', NULL, 0, 0, 0, 'Lovelace Womens Hospital', '', '', '', 'HCFA|UB|', '1487687075', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12049166', 'W12049166', 'NM01', 'ABQ Health Partners', 'Kathie', '', 'Maxwell', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052754259', '5052754223', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052754259', '5052754223', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-07-09', NULL, 0, 0, 0, 'Lovelace Womens Hospital', 'Lovelace Westside Hospital', '', '', 'HCFA|UB|', '1609897388', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12049167', 'W12049167', 'NM01', 'ABQ Health Partners', 'Kathie', '', 'Maxwell', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '13701 Encantado Rd NE', 'Albuquerque', 'Bernalillo', 'NM', '87123', '5052378700', '5052378703', '13701 Encantado Rd NE', 'Albuquerque', 'Bernalillo', 'NM', '87123', '5052378700', '5052378703', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'Lovelace Womens Hospital', 'Lovelace Westside Hospital', '', '', 'HCFA|UB|', '1609897388', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12049168', 'W12049168', 'NM01', 'ABQ Health Partners', 'Candace', '', 'Reid', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '13701 Encantado Rd NE', 'Albuquerque', 'Bernalillo', 'NM', '87123', '5052378700', '5052378703', '13701 Encantado Rd NE', 'Albuquerque', 'Bernalillo', 'NM', '87123', '5052378700', '5052378703', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'Lovelace Womens Hospital', 'Lovelace Westside Hospital', '', '', 'HCFA|UB|', '1700193216', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12049169', 'W12049169', 'NM01', 'ABQ Health Partners', 'Candace', '', 'Reid', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052754259', '5052754223', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052754259', '5052754223', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-07-09', NULL, 0, 0, 0, 'Lovelace Womens Hospital', 'Lovelace Westside Hospital', '', '', 'HCFA|UB|', '1700193216', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12049171', 'W12049171', 'NM01', 'ABQ Health Partners', 'Ryan', '', 'Dympna', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052754259', '5052754223', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052754259', '5052754223', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-07-09', NULL, 0, 0, 0, 'Lovelace Medical Center ', 'Lovelace Womens Hospital', 'Lovelace Womens Hospital', '', 'HCFA|UB|', '1508871062', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12049172', 'W12049172', 'NM01', 'ABQ Health Partners', 'Ryan', '', 'Dympna', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '13701 Encantado Rd NE', 'Albuquerque', 'Bernalillo', 'NM', '87123', '5052378700', '5052378703', '13701 Encantado Rd NE', 'Albuquerque', 'Bernalillo', 'NM', '87123', '5052378700', '5052378703', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'Lovelace Medical Center ', 'Lovelace Womens Hospital', 'Lovelace Womens Hospital', '', 'HCFA|UB|', '1508871062', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12049173', 'W12049173', 'NM01', 'ABQ Health Partners', 'Nina', '', 'Simon', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '13701 Encantado Rd NE', 'Albuquerque', 'Bernalillo', 'NM', '87123', '5052378700', '5052378703', '13701 Encantado Rd NE', 'Albuquerque', 'Bernalillo', 'NM', '87123', '5052378700', '5052378703', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'Lovelace Womens Hospital', 'Lovelace Westside Hospital', '', '', 'HCFA|UB|', '1811185036', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12049174', 'W12049174', 'NM01', 'ABQ Health Partners', 'Nina', '', 'Simon', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052754259', '5052754223', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052754259', '5052754223', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-07-09', NULL, 0, 0, 0, 'Lovelace Womens Hospital', 'Lovelace Westside Hospital', '', '', 'HCFA|UB|', '1811185036', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12049175', 'W12049175', 'NM01', 'ABQ Health Partners', 'Victoria', '', 'Stetson', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052754259', '5052754223', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052754259', '5052754223', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-07-09', NULL, 0, 0, 0, 'Lovelace Womens Hospital', '', '', '', 'HCFA|UB|', '1215950191', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12049176', 'W12049176', 'NM01', 'ABQ Health Partners', 'Victoria', '', 'Stetson', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '13701 Encantado Rd NE', 'Albuquerque', 'Bernalillo', 'NM', '87123', '5052378700', '5052378703', '13701 Encantado Rd NE', 'Albuquerque', 'Bernalillo', 'NM', '87123', '5052378700', '5052378703', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'Lovelace Womens Hospital', '', '', '', 'HCFA|UB|', '1215950191', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12049177', 'W12049177', 'NM01', 'ABQ Health Partners', 'Martha', '', 'Tiryaki', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '13701 Encantado Rd NE', 'Albuquerque', 'Bernalillo', 'NM', '87123', '5052378700', '5052378703', '13701 Encantado Rd NE', 'Albuquerque', 'Bernalillo', 'NM', '87123', '5052378700', '5052378703', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'Lovelace Womens Hospital', 'Lovelace Westside Hospital', '', '', 'HCFA|UB|', '1609899806', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12049179', 'W12049179', 'NM01', 'ABQ Health Partners', 'Martha', '', 'Tiryaki', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052754259', '5052754223', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052754259', '5052754223', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-07-09', NULL, 0, 0, 0, 'Lovelace Womens Hospital', 'Lovelace Westside Hospital', '', '', 'HCFA|UB|', '1609899806', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12049180', 'W12049180', 'NM01', 'ABQ Health Partners', 'Jennifer', '', 'Williams', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052754259', '5052754223', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052754259', '5052754223', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-07-09', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1043245020', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12049181', 'W12049181', 'NM01', 'ABQ Health Partners', 'Jennifer', '', 'Williams', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '13701 Encantado Rd NE', 'Albuquerque', 'Bernalillo', 'NM', '87123', '5052378700', '5052378703', '13701 Encantado Rd NE', 'Albuquerque', 'Bernalillo', 'NM', '87123', '5052378700', '5052378703', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1043245020', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12049182', 'W12049182', 'NM01', 'ABQ Health Partners', 'Yeni', '', 'Yim', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '13701 Encantado Rd NE', 'Albuquerque', 'Bernalillo', 'NM', '87123', '5052378700', '5052378703', '13701 Encantado Rd NE', 'Albuquerque', 'Bernalillo', 'NM', '87123', '5052378700', '5052378703', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'Lovelace Medical Center', 'Lovelace Womens Hospital', '', '', 'HCFA|UB|', '1215960711', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12049183', 'W12049183', 'NM01', 'ABQ Health Partners', 'Yeni', '', 'Yim', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052754259', '5052754223', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052754259', '5052754223', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-07-09', NULL, 0, 0, 0, 'Lovelace Medical Center', 'Lovelace Womens Hospital', '', '', 'HCFA|UB|', '1215960711', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('830330554', 'W12049184', 'W12049184', 'WYT1', 'Evanston Clinic', 'Eric', 'N', 'Swensen', 'DO', 'Family Practice', '', '', NULL, 'O', '531 Parkway Dr', 'Mountain View', 'Uinta', 'WY', '82939', '3077827560', '3077827584', '531 Parkway Dr', 'Mountain View', 'Uinta', 'WY', '82939', '3077827560', '3077827584', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1700013661', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('830330554', 'W12049185', 'W12049185', 'WY01', 'Evanston Clinic', 'Eric', 'N', 'Swensen', 'DO', 'Family Practice', '', '', NULL, 'O', '531 Parkway Dr', 'Mountain View', 'Uinta', 'WY', '82939', '3077827560', '3077827584', '531 Parkway Dr', 'Mountain View', 'Uinta', 'WY', '82939', '3077827560', '3077827584', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1700013661', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('870518391', 'W12049186', 'W12049186', 'UT01', '', 'Amanda', 'S', 'Montiel', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '24 S 1100 E Ste 209', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8019080930', '8015310930', '24 S 1100 E Ste 209', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8019080930', '8015310930', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-06-24', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1689716888', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('830216782', 'W12049187', 'W12049187', 'Sinclair', 'Laramie Physicians for Women and Children', 'Kim', 'N', 'Westbrook', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2710 E Harney St', 'Laramie', 'Albany', 'WY', '82072', '3077429116', '3077458167', '2710 E Harney St', 'Laramie', 'Albany', 'WY', '82072', '3077429116', '3077458167', '', '', '', '0.00', '10.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'Ivinson Memorial Hospital (Sinclair Health Services Provider)  (Recognized But Not Contracted)', '', '', '', 'HCFA|UB|', '1518279678', 0, 'N', 1, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12049188', 'W12049188', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Brendan', 'M', 'Thomas', 'MD', 'Dermatology', '', '', NULL, 'O', '80 Templeton Dr', 'Oswego', 'Kendall', 'IL', '60543', '6305543456', '6305512933', '80 Templeton Dr', 'Oswego', 'Kendall', 'IL', '60543', '6305543456', '6305512933', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', NULL, 'HCFA|UB|', '1497989644', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'W12049191', 'W12049191', 'ILCHIGSTD', 'Presence Healthcare Services', 'Jason', '', 'Satz', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '2233 W Division St', 'Chicago', 'Cook', 'IL', '60622', '3127702000', '6309142499', '2233 W Division St', 'Chicago', 'Cook', 'IL', '60622', '3127702000', '6309142499', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center', '', '', '', 'HCFA|UB|', '1154617199', 0, 'N', 0, '2014-07-03', NULL, NULL, 0, 0, NULL, NULL),
('529882908', 'W12049193', 'W12049193', 'UTMH1', '', 'David', 'B', 'Tate', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '437 S Bluff Ste 202', 'St George', 'Washington', 'UT', '84770', '4356560506', '          ', '437 S Bluff Ste 202', 'St George', 'Washington', 'UT', '84770', '4356560506', '          ', 'PHD', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', '2014-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093992711', 0, 'N', 0, '2014-06-25', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'W12049194', 'W12049194', 'UT01', 'Granger Medical Clinic', 'Jennifer', '', 'DenBleyker', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '12391 S 4000 W', 'Riverton', 'Salt Lake', 'UT', '84065', '8013021700', '8013021712', '12391 S 4000 W', 'Riverton', 'Salt Lake', 'UT', '84065', '8013021700', '8013021712', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1033141270', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'W12049195', 'W12049195', 'UT01', 'Granger Medical Clinic', 'Susan', 'J', 'Maturlo', 'MD', 'Endocrinology', '', '', NULL, 'O', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019653720', '8019653740', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019653720', '8019653740', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-08-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1023076460', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'W12049196', 'W12049196', 'UT01', 'Granger Medical Clinic', 'Susan', 'J', 'Maturlo', 'MD', 'Endocrinology', '', '', NULL, 'O', '12391 S 4000 W', 'Riverton', 'Salt Lake', 'UT', '84065', '8013021700', '8019683605', '12391 S 4000 W', 'Riverton', 'Salt Lake', 'UT', '84065', '8013021700', '8019683605', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-08-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1023076460', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'W12049197', 'W12049197', 'UT01', 'Granger Medical Clinic', 'Susan', 'J', 'Maturlo', 'MD', 'Endocrinology', '', '', NULL, 'B', 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '8019653720', '          ', 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '8019653720', '          ', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-08-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1023076460', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'W12049198', 'W12049198', 'UT01', 'Granger Medical Clinic', 'Susan', 'J', 'Maturlo', 'MD', 'Endocrinology', '', '', NULL, 'O', '3181 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8013525900', '8013525914', '3181 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8013525900', '8013525914', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-08-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1023076460', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'W12049199', 'W12049199', 'UT01', 'Granger Medical Clinic', 'Susan', 'J', 'Maturlo', 'MD', 'Endocrinology', '', '', NULL, 'O', '11724 S State St', 'Draper', 'Salt Lake', 'UT', '84020', '8015762000', '8015762001', '11724 S State St', 'Draper', 'Salt Lake', 'UT', '84020', '8015762000', '8015762001', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-08-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1023076460', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('830244879', 'W12049200', 'W12049200', 'WY01', 'Richard D Green MD', 'Richard', '', 'Green', 'MD', 'Pediatrics', '', '', NULL, 'O', '940 E 3rd St Ste 102', 'Casper', 'Natrona', 'WY', '82601', '3075774280', '3075774283', '940 E 3rd St Ste 102', 'Casper', 'Natrona', 'WY', '82601', '3075774280', '3075774283', 'WY140PED1', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|', '1669438412', 0, 'N', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('830244879', 'W12049202', 'W12049202', 'WYT1', 'Richard D Green MD', 'Richard', '', 'Green', 'MD', 'Pediatrics', '', '', NULL, 'O', '940 E 3rd St Ste 102', 'Casper', 'Natrona', 'WY', '82601', '3075774280', '3075774283', '940 E 3rd St Ste 102', 'Casper', 'Natrona', 'WY', '82601', '3075774280', '3075774283', 'WY140PED1', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|', '1669438412', 0, 'N', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('529882908', 'W12049206', 'W12049206', 'UTMH1', '', 'David', 'B', 'Tate', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '437 S Bluff St Ste 202', 'St George', 'Washington', 'UT', '84770', '4356560506', '          ', '437 S Bluff St Ste 202', 'St George', 'Washington', 'UT', '84770', '4356560506', '          ', 'PHD', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093992711', 0, 'N', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('205131219', 'W12049227', 'W12049227', 'WY01', 'Wyoming Neurologic Associates', 'Alana', '', 'Cozier', 'MD', 'Neurology', '', '', NULL, 'O', '1020 E 2nd St Ste 100', 'Casper', 'Natrona', 'WY', '82601', '3072654343', '3072346339', '1020 E 2nd St Ste 100', 'Casper', 'Natrona', 'WY', '82601', '3072654343', '3072346339', '', '', '', '0.00', '12.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821387721', 0, 'N', 1, '2014-06-30', NULL, NULL, 0, 0, NULL, NULL),
('205131219', 'W12049229', 'W12049229', 'WY01', 'Wyoming Neurologic Associates', 'Alana', '', 'Cozier', 'MD', 'Neurology', '', '', NULL, 'B', 'PO Box 848389', 'Boston', 'Suffolk', 'MA', '02284', '3072654343', '3072346339', 'PO Box 848389', 'Boston', 'Suffolk', 'MA', '02284', '3072654343', '3072346339', '', '', '', '0.00', '12.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821387721', 0, 'N', 1, '2014-06-30', NULL, NULL, 0, 0, NULL, NULL),
('202500191', 'W12049207', 'W12049207', 'UTMH1', 'Draper Pyschological Services', 'Jenivee', '', 'Akalis', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '668 E 12225 S Ste 202', 'Draper', 'Salt Lake', 'UT', '84020', '8016193596', '8015767540', '668 E 12225 S Ste 202', 'Draper', 'Salt Lake', 'UT', '84020', '8016193596', '8015767540', 'UTMA', '', '', '0.00', '40.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821382417', 0, 'N', 1, '2014-07-02', NULL, NULL, 0, 0, NULL, NULL),
('262786698', 'W12049208', 'W12049208', 'WY01', 'High Mountain Fitness Physical Therapy', 'Beth', 'A', 'Johnsey', 'PT', 'Physical Therapy', '', '', NULL, 'O', '669 Main St', 'Lander', 'Fremont', 'WY', '82520', '3073357678', '3073330600', '669 Main St', 'Lander', 'Fremont', 'WY', '82520', '3073357678', '3073330600', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497734248', 0, 'N', 1, '2014-06-25', NULL, NULL, 0, 0, NULL, NULL),
('262786698', 'W12049209', 'W12049209', 'WYT1', 'High Mountain Fitness Physical Therapy', 'Beth', 'A', 'Johnsey', 'PT', 'Physical Therapy', '', '', NULL, 'O', '669 Main St', 'Lander', 'Fremont', 'WY', '82520', '3073357678', '3073330600', '669 Main St', 'Lander', 'Fremont', 'WY', '82520', '3073357678', '3073330600', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497734248', 0, 'N', 1, '2014-06-25', NULL, NULL, 0, 0, NULL, NULL),
('752608036', 'W12049210', 'W12049210', 'TXDALSTD', 'Orthofix Inc (Bone Growth Stimulators Physicians Only)', '', '', 'Orthofix Inc (Bone Growth Stimulators Physicians Only)', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'B', 'Po Box 849806', 'Dallas', 'Dallas', 'TX', '75284', '8005354492', '          ', 'Po Box 849806', 'Dallas', 'Dallas', 'TX', '75284', '8005354492', '          ', 'ORTHOFIX14', '', '', '0.00', '50.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1235136060', 0, 'N', 1, '2014-07-23', NULL, NULL, 0, 0, NULL, NULL),
('836000103', 'W12049218', 'W12049218', 'WY01', 'Campbell County Public Health', '', '', 'Campbell County Public Health', '', 'Public Health', '', '', NULL, 'O', '2301 S 4J Rd', 'Gillette', 'Campbell', 'WY', '82718', '3076827275', '3076820374', '2301 S 4J Rd', 'Gillette', 'Campbell', 'WY', '82718', '3076827275', '3076820374', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1861607566', 0, 'N', 1, '2014-07-07', NULL, NULL, 0, 0, NULL, NULL),
('836000103', 'W12049219', 'W12049219', 'WY01', 'Campbell County Public Health', '', '', 'Campbell County Public Health', '', 'Public Health', '', '', NULL, 'M', 'PO Box 3420', 'Gillette', 'Campbell', 'WY', '82717', '3076827275', '3076820374', 'PO Box 3420', 'Gillette', 'Campbell', 'WY', '82717', '3076827275', '3076820374', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1861607566', 0, 'N', 1, '2014-07-07', NULL, NULL, 0, 0, NULL, NULL),
('836000103', 'W12049220', 'W12049220', 'WYT1', 'Campbell County Public Health', '', '', 'Campbell County Public Health', '', 'Public Health', '', '', NULL, 'O', '2301 S 4J Rd', 'Gillette', 'Campbell', 'WY', '82718', '3076827275', '3076820374', '2301 S 4J Rd', 'Gillette', 'Campbell', 'WY', '82718', '3076827275', '3076820374', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1861607566', 0, 'N', 1, '2014-07-07', NULL, NULL, 0, 0, NULL, NULL),
('836000103', 'W12049221', 'W12049221', 'WYT1', 'Campbell County Public Health', '', '', 'Campbell County Public Health', '', 'Public Health', '', '', NULL, 'M', 'PO Box 3420', 'Gillette', 'Campbell', 'WY', '82717', '3076827275', '3076820374', 'PO Box 3420', 'Gillette', 'Campbell', 'WY', '82717', '3076827275', '3076820374', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1861607566', 0, 'N', 1, '2014-07-07', NULL, NULL, 0, 0, NULL, NULL),
('621400785', 'W12049222', 'W12049222', 'NA01', 'National Seating and Mobility', '', '', 'National Seating and Mobility', '', 'Durable Medical Equipment', '', '', NULL, 'B', '5959 Shallowford Rd Ste 443', 'Chattanooga', 'Hamilton', 'TN', '37421', '4237562268', '4232669699', '5959 Shallowford Rd Ste 443', 'Chattanooga', 'Hamilton', 'TN', '37421', '4237562268', '4232669699', '', '', 'NSM_2014', '0.00', '50.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '0000010171', 0, 'N', 1, '2014-07-24', NULL, NULL, 0, 0, NULL, NULL),
('621400785', 'W12049223', 'W12049223', 'SCNA01', 'National Seating and Mobility', '', '', 'National Seating and Mobility', '', 'Durable Medical Equipment', '', '', NULL, 'B', '5959 Shallowford Rd Ste 443', 'Chattanooga', 'Hamilton', 'TN', '37421', '4237562268', '4232669699', '5959 Shallowford Rd Ste 443', 'Chattanooga', 'Hamilton', 'TN', '37421', '4237562268', '4232669699', '', '', 'NSM_2014', '0.00', '50.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '0000010171', 0, 'N', 1, '2014-07-24', NULL, NULL, 0, 0, NULL, NULL),
('000010172', 'W12049225', 'W12049225', 'NA01', 'Guardian Healthcare Holding', '', '', 'Guardian Healthcare Holding', '', 'Home Health Agency', '', '', NULL, 'O', '13737 Noel Rd Ste 1200', 'Dallas', 'Dallas', 'TX', '75240', '0000000000', '2147122444', '13737 Noel Rd Ste 1200', 'Dallas', 'Dallas', 'TX', '75240', '0000000000', '2147122444', 'GHH', '', 'Guardian Healthcare', '0.00', '55.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '0000010172', 0, 'N', 1, '2014-07-24', NULL, NULL, 0, 0, NULL, NULL),
('000010172', 'W12049224', 'W12049224', 'SCNA01', 'Guardian Healthcare Holding', '', '', 'Guardian Healthcare Holding', '', 'Home Health Agency', '', '', NULL, 'O', '13737 Noel Rd Ste 1200', 'Dallas', 'Dallas', 'TX', '75240', '2147122772', '2147122444', '13737 Noel Rd Ste 1200', 'Dallas', 'Dallas', 'TX', '75240', '2147122772', '2147122444', 'GHH', '', 'Guardian Healthcare', '0.00', '55.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '0000010172', 0, 'N', 1, '2014-07-24', NULL, NULL, 0, 0, NULL, NULL),
('205131219', 'W12049228', 'W12049228', 'WYT1', 'Wyoming Neurologic Associates', 'Alana', '', 'Cozier', 'MD', 'Neurology', '', '', NULL, 'O', '1020 E 2nd St Ste 100', 'Casper', 'Natrona', 'WY', '82601', '3072654343', '3072346339', '1020 E 2nd St Ste 100', 'Casper', 'Natrona', 'WY', '82601', '3072654343', '3072346339', '', '', '', '0.00', '12.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821387721', 0, 'N', 1, '2014-06-30', NULL, NULL, 0, 0, NULL, NULL),
('205131219', 'W12049230', 'W12049230', 'WYT1', 'Wyoming Neurologic Associates', 'Alana', '', 'Cozier', 'MD', 'Neurology', '', '', NULL, 'B', 'PO Box 848389', 'Boston', 'Suffolk', 'MA', '02284', '3072654343', '3072346339', 'PO Box 848389', 'Boston', 'Suffolk', 'MA', '02284', '3072654343', '3072346339', '', '', '', '0.00', '12.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821387721', 0, 'N', 1, '2014-06-30', NULL, NULL, 0, 0, NULL, NULL),
('205131219', 'W12049236', 'W12049236', 'WY01', 'Wyoming Neurologic Associates', 'Dixie', '', 'Woolston', 'PHD', 'Neurology', '', '', NULL, 'O', '702 Platinum', 'Cody', 'Park', 'WY', '82414', '3075781985', '3075781938', '702 Platinum', 'Cody', 'Park', 'WY', '82414', '3075781985', '3075781938', '', '', '', '0.00', '12.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578889929', 0, 'N', 1, '2014-06-25', NULL, NULL, 0, 0, NULL, NULL),
('205131219', 'W12049234', 'W12049234', 'WY01', 'Wyoming Neurologic Associates', 'Dixie', '', 'Woolston', 'PHD', 'Neurology', '', '', NULL, 'O', '1020 E 2nd St Ste 100', 'Casper', 'Natrona', 'WY', '82601', '3072654343', '3072346339', '1020 E 2nd St Ste 100', 'Casper', 'Natrona', 'WY', '82601', '3072654343', '3072346339', '', '', '', '0.00', '12.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578889929', 0, 'N', 1, '2014-06-25', NULL, NULL, 0, 0, NULL, NULL),
('205131219', 'W12049232', 'W12049232', 'WY01', 'Wyoming Neurologic Associates', 'Dixie', '', 'Woolston', 'PHD', 'Neurology', '', '', NULL, 'B', 'PO Box 848389', 'Boston', 'Suffolk', 'MA', '02284', '3072654343', '3072346339', 'PO Box 848389', 'Boston', 'Suffolk', 'MA', '02284', '3072654343', '3072346339', '', '', '', '0.00', '12.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578889929', 0, 'N', 1, '2014-06-25', NULL, NULL, 0, 0, NULL, NULL),
('205131219', 'W12049235', 'W12049235', 'WYT1', 'Wyoming Neurologic Associates', 'Dixie', '', 'Woolston', 'PHD', 'Neurology', '', '', NULL, 'O', '1020 E 2nd St Ste 100', 'Casper', 'Natrona', 'WY', '82601', '3072654343', '3072346339', '1020 E 2nd St Ste 100', 'Casper', 'Natrona', 'WY', '82601', '3072654343', '3072346339', '', '', '', '0.00', '12.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578889929', 0, 'N', 1, '2014-06-25', NULL, NULL, 0, 0, NULL, NULL),
('205131219', 'W12049237', 'W12049237', 'WYT1', 'Wyoming Neurologic Associates', 'Dixie', '', 'Woolston', 'PHD', 'Neurology', '', '', NULL, 'O', '702 Platinum', 'Cody', 'Park', 'WY', '82414', '3075781985', '3075781938', '702 Platinum', 'Cody', 'Park', 'WY', '82414', '3075781985', '3075781938', '', '', '', '0.00', '12.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578889929', 0, 'N', 1, '2014-06-25', NULL, NULL, 0, 0, NULL, NULL),
('205131219', 'W12049233', 'W12049233', 'WYT1', 'Wyoming Neurologic Associates', 'Dixie', '', 'Woolston', 'PHD', 'Neurology', '', '', NULL, 'B', 'PO Box 848389', 'Boston', 'Suffolk', 'MA', '02284', '3072654343', '3072346339', 'PO Box 848389', 'Boston', 'Suffolk', 'MA', '02284', '3072654343', '3072346339', '', '', '', '0.00', '12.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578889929', 0, 'N', 1, '2014-06-25', NULL, NULL, 0, 0, NULL, NULL),
('800307419', 'W12049239', 'W12049239', 'WYT1', 'Wyoming Health Medical Group', 'Stacy', 'A', 'Huston', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1020 E 2nd St Ste 200', 'Casper', 'Natrona', 'WY', '82601', '3072330246', '3072375421', '1020 E 2nd St Ste 200', 'Casper', 'Natrona', 'WY', '82601', '3072330246', '3072375421', '', '', '', '0.00', '18.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316376676', 0, 'N', 0, '2014-06-25', NULL, NULL, 0, 0, NULL, NULL),
('800307419', 'W12049238', 'W12049238', 'WY01', 'Wyoming Health Medical Group', 'Stacy', 'A', 'Huston', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1020 E 2nd St Ste 200', 'Casper', 'Natrona', 'WY', '82601', '3072330246', '3072375421', '1020 E 2nd St Ste 200', 'Casper', 'Natrona', 'WY', '82601', '3072330246', '3072375421', '', '', '', '0.00', '18.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316376676', 0, 'N', 0, '2014-06-25', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12049244', 'W12049244', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Laura', 'Ann', 'Freeman', 'MD', 'Radiology', '', '', NULL, 'O', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6302648522', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6302648522', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750544862', 0, 'N', 0, '2014-06-25', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12049241', 'W12049241', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Laura', 'Ann', 'Freeman', 'MD', 'Radiology', '', '', NULL, 'O', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648522', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648522', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750544862', 0, 'N', 0, '2014-06-25', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12049243', 'W12049243', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Laura', 'Ann', 'Freeman', 'MD', 'Radiology', '', '', NULL, 'O', '1870 W Galena Blvd', 'Aurora', 'Kane', 'IL', '60506', '6308596700', '8302648522', '1870 W Galena Blvd', 'Aurora', 'Kane', 'IL', '60506', '6308596700', '8302648522', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750544862', 0, 'N', 0, '2014-06-25', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12049242', 'W12049242', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Laura', 'Ann', 'Freeman', 'MD', 'Radiology', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '          ', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '          ', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750544862', 0, 'N', 0, '2014-06-25', NULL, NULL, 0, 0, NULL, NULL),
('362757374', 'W12049245', 'W12049245', 'ILCHIGSTD', 'Century Ear, Nose and Throat', '', '', 'Century Ear, Nose and Throat', '', 'Ear, Nose and Throat', '', '', NULL, 'O', '16001 S 108th Ave', 'Orland Park', 'Cook', 'IL', '60467', '7084600007', '7084600005', '16001 S 108th Ave', 'Orland Park', 'Cook', 'IL', '60467', '7084600007', '7084600005', 'CHIG1', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1629174834', 0, 'N', 1, '2014-07-08', NULL, NULL, 0, 0, NULL, NULL),
('362757374', 'W12049246', 'W12049246', 'ILCHIGSTD', 'Century Ear, Nose and Throat', '', '', 'Century Ear, Nose and Throat', '', 'Ear, Nose and Throat', '', '', NULL, 'O', '2850 W 95th St Rm 403', 'Evergreen Park', 'Cook', 'IL', '60805', '7082295254', '7084227264', '2850 W 95th St Rm 403', 'Evergreen Park', 'Cook', 'IL', '60805', '7082295254', '7084227264', 'CHIG1', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1629174834', 0, 'N', 1, '2014-07-08', NULL, NULL, 0, 0, NULL, NULL),
('362757374', 'W12049248', 'W12049248', 'ILCHIGSTD', 'Century Ear, Nose and Throat', 'Nirav', 'N', 'Thakkar', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '16001 S 108th Ave', 'Orland Park', 'Cook', 'IL', '60467', '7084600007', '7084600005', '16001 S 108th Ave', 'Orland Park', 'Cook', 'IL', '60467', '7084600007', '7084600005', 'CHIG1', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', '', '', '', 'HCFA|', '1770750804', 0, 'N', 1, '2014-06-25', NULL, NULL, 0, 0, NULL, NULL),
('362757374', 'W12049249', 'W12049249', 'ILCHIGSTD', 'Century Ear, Nose and Throat', 'Nirav', 'N', 'Thakkar', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '2850 W 95th St Rm 403', 'Evergreen Park', 'Cook', 'IL', '60805', '7082295254', '7084227264', '2850 W 95th St Rm 403', 'Evergreen Park', 'Cook', 'IL', '60805', '7082295254', '7084227264', 'CHIG1', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', '', '', '', 'HCFA|', '1770750804', 0, 'N', 1, '2014-06-25', NULL, NULL, 0, 0, NULL, NULL),
('362757374', 'W12049250', 'W12049250', 'ILCHIGSTD', 'Century Ear, Nose and Throat', '', '', 'Century Ear, Nose and Throat', '', 'Ear, Nose and Throat', '', '', NULL, 'B', '10660 W 143rd St', 'Orland Park', 'Cook', 'IL', '60462', '7084600007', '7084600005', '10660 W 143rd St', 'Orland Park', 'Cook', 'IL', '60462', '7084600007', '7084600005', 'CHIG1', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1629174834', 0, 'N', 1, '2014-07-08', NULL, NULL, 0, 0, NULL, NULL),
('362757374', 'W12049251', 'W12049251', 'ILCHIGSTD', 'Century Ear, Nose and Throat', 'Nirav', 'N', 'Thakkar', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'B', '10660 W 143rd St', 'Orland Park', 'Cook', 'IL', '60462', '7084600007', '7084600005', '10660 W 143rd St', 'Orland Park', 'Cook', 'IL', '60462', '7084600007', '7084600005', 'CHIG1', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', '', '', '', 'HCFA|', '1770750804', 0, 'N', 1, '2014-06-25', 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
('362757374', 'W12049253', 'W12049253', 'ILCHIGSTD', 'Century Ear, Nose and Throat', 'Brian', 'P', 'Farrell', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '16001 S 108th Ave', 'Orland Park', 'Cook', 'IL', '60467', '7084600007', '7084600005', '16001 S 108th Ave', 'Orland Park', 'Cook', 'IL', '60467', '7084600007', '7084600005', 'CHIG1', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', 'Palos Community Hospital', 'Advocate Christ Hospital & Medical Center', 'Loyola University Medical Center', 'HCFA|', '1558320747', 0, 'N', 1, '2014-06-25', NULL, NULL, 0, 0, NULL, NULL),
('362757374', 'W12049252', 'W12049252', 'ILCHIGSTD', 'Century Ear, Nose and Throat', 'Brian', 'P', 'Farrell', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '2850 W 95th St Rm 403', 'Evergreen Park', 'Cook', 'IL', '60805', '7082295254', '7084227264', '2850 W 95th St Rm 403', 'Evergreen Park', 'Cook', 'IL', '60805', '7082295254', '7084227264', 'CHIG1', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', 'Palos Community Hospital', 'Advocate Christ Hospital & Medical Center', 'Loyola University Medical Center', 'HCFA|', '1558320747', 0, 'N', 1, '2014-06-25', NULL, NULL, 0, 0, NULL, NULL),
('362757374', 'W12049254', 'W12049254', 'ILCHIGSTD', 'Century Ear, Nose and Throat', 'Brian', 'P', 'Farrell', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'B', '10660 W 143rd St', 'Orland Park', 'Cook', 'IL', '60462', '7084600007', '7084600005', '10660 W 143rd St', 'Orland Park', 'Cook', 'IL', '60462', '7084600007', '7084600005', 'CHIG1', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', 'Palos Community Hospital', 'Advocate Christ Hospital & Medical Center', 'Loyola University Medical Center', 'HCFA|', '1558320747', 0, 'N', 1, '2014-06-25', NULL, NULL, 0, 0, NULL, NULL),
('362757374', 'W12049256', 'W12049256', 'ILCHIGSTD', 'Century Ear, Nose and Throat', 'Philip', 'D', 'Koolker', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '16001 S 108th Ave', 'Orland Park', 'Cook', 'IL', '60467', '7084600007', '7084600005', '16001 S 108th Ave', 'Orland Park', 'Cook', 'IL', '60467', '7084600007', '7084600005', 'CHIG1', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', '', '', '', 'HCFA|', '1770552192', 0, 'N', 1, '2014-06-25', NULL, NULL, 0, 0, NULL, NULL),
('362757374', 'W12049257', 'W12049257', 'ILCHIGSTD', 'Century Ear, Nose and Throat', 'Philip', 'D', 'Koolker', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'B', '10660 W 143rd St', 'Orland Park', 'Cook', 'IL', '60462', '7084600007', '7084600005', '10660 W 143rd St', 'Orland Park', 'Cook', 'IL', '60462', '7084600007', '7084600005', 'CHIG1', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', '', '', '', 'HCFA|', '1770552192', 0, 'N', 1, '2014-06-25', NULL, NULL, 0, 0, NULL, NULL),
('362757374', 'W12049258', 'W12049258', 'ILCHIGSTD', 'Century Ear, Nose and Throat', 'Curtis', 'G', 'Walsh', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'B', '10660 W 143rd St', 'Orland Park', 'Cook', 'IL', '60462', '7084600007', '7084600005', '10660 W 143rd St', 'Orland Park', 'Cook', 'IL', '60462', '7084600007', '7084600005', 'CHIG1', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'Palos Community Hospital', 'Little Company of Mary Hospital', 'Advocate Christ Hospital & Medical Center', 'Loyola University Medical Center', 'HCFA|', '1730148834', 0, 'N', 1, '2014-06-25', NULL, NULL, 0, 0, NULL, NULL),
('362757374', 'W12049259', 'W12049259', 'ILCHIGSTD', 'Century Ear, Nose and Throat', 'Curtis', 'G', 'Walsh', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '16001 S 108th Ave', 'Orland Park', 'Cook', 'IL', '60467', '7084600007', '7084600005', '16001 S 108th Ave', 'Orland Park', 'Cook', 'IL', '60467', '7084600007', '7084600005', 'CHIG1', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'Palos Community Hospital', 'Little Company of Mary Hospital', 'Advocate Christ Hospital & Medical Center', 'Loyola University Medical Center', 'HCFA|', '1730148834', 0, 'N', 1, '2014-06-25', NULL, NULL, 0, 0, NULL, NULL),
('362757374', 'W12049260', 'W12049260', 'ILCHIGSTD', 'Century Ear, Nose and Throat', 'Curtis', 'G', 'Walsh', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '2850 W 95th St Rm 403', 'Evergreen Park', 'Cook', 'IL', '60805', '7082295254', '7084227264', '2850 W 95th St Rm 403', 'Evergreen Park', 'Cook', 'IL', '60805', '7082295254', '7084227264', 'CHIG1', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'Palos Community Hospital', 'Little Company of Mary Hospital', 'Advocate Christ Hospital & Medical Center', 'Loyola University Medical Center', 'HCFA|', '1730148834', 0, 'N', 1, '2014-06-25', NULL, NULL, 0, 0, NULL, NULL),
('362757374', 'W12049261', 'W12049261', 'ILCHIGSTD', 'Century Ear, Nose and Throat', 'Silvio', '', 'Marra', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'B', '10660 W 143rd St', 'Orland Park', 'Cook', 'IL', '60462', '7084600007', '7084600005', '10660 W 143rd St', 'Orland Park', 'Cook', 'IL', '60462', '7084600007', '7084600005', 'CHIG1', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'Advocate Christ Hospital & Medical Center', 'Little Company of Mary Hospital', 'Palos Community Hospital', 'Loyola University Medical Center', 'HCFA|', '1235198383', 0, 'N', 1, '2014-06-25', NULL, NULL, 0, 0, NULL, NULL),
('362757374', 'W12049262', 'W12049262', 'ILCHIGSTD', 'Century Ear, Nose and Throat', 'Silvio', '', 'Marra', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '16001 S 108th Ave', 'Orland Park', 'Cook', 'IL', '60467', '7084600007', '7084600005', '16001 S 108th Ave', 'Orland Park', 'Cook', 'IL', '60467', '7084600007', '7084600005', 'CHIG1', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'Advocate Christ Hospital & Medical Center', 'Little Company of Mary Hospital', 'Palos Community Hospital', 'Loyola University Medical Center', 'HCFA|', '1235198383', 0, 'N', 1, '2014-06-25', NULL, NULL, 0, 0, NULL, NULL),
('362757374', 'W12049263', 'W12049263', 'ILCHIGSTD', 'Century Ear, Nose and Throat', 'Silvio', '', 'Marra', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '2850 W 95th St Rm 403', 'Evergreen Park', 'Cook', 'IL', '60805', '7082295254', '7084227264', '2850 W 95th St Rm 403', 'Evergreen Park', 'Cook', 'IL', '60805', '7082295254', '7084227264', 'CHIG1', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'Advocate Christ Hospital & Medical Center', 'Little Company of Mary Hospital', 'Palos Community Hospital', 'Loyola University Medical Center', 'HCFA|', '1235198383', 0, 'N', 1, '2014-06-25', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12049272', 'W12049272', 'UTIHCPHY', 'Logan Clinic', 'Tyler', 'J', 'Christensen', 'PHD', 'Psychology', '', '', NULL, 'O', '412 N 200 E', 'Logan', 'Cache', 'UT', '84321', '4357132800', '4357132834', '412 N 200 E', 'Logan', 'Cache', 'UT', '84321', '4357132800', '4357132834', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2014-04-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598180838', 0, 'Y', 0, '2014-06-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12049273', 'W12049273', 'UTIHCPHY', 'Logan Psychiatry', 'Tyler', 'J', 'Christensen', 'PHD', 'Psychology', '', '', NULL, 'O', '1300 N 500 E Ste 250', 'Logan', 'Cache', 'UT', '84341', '4357165790', '4357162921', '1300 N 500 E Ste 250', 'Logan', 'Cache', 'UT', '84341', '4357165790', '4357162921', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2014-04-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598180838', 0, 'N', 0, '2014-06-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12049274', 'W12049274', 'UTIHCPHY', 'Budge Clinic Obstetrics & Gynecology', 'Tyler', 'J', 'Christensen', 'PHD', 'Psychology', '', '', NULL, 'O', '1400 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357161920', '4357921677', '1400 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357161920', '4357921677', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2014-04-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598180838', 0, 'Y', 0, '2014-06-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12049275', 'W12049275', 'UTIHCPHY', 'Budge Clinic Internal Medicine', 'Tyler', 'J', 'Christensen', 'PHD', 'Psychology', '', '', NULL, 'O', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921980', '4357921615', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921980', '4357921615', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2014-04-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598180838', 0, 'Y', 0, '2014-06-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12049276', 'W12049276', 'UTIHCPHY', 'South Cache Valley Clinic', 'Tyler', 'J', 'Christensen', 'PHD', 'Psychology', '', '', NULL, 'O', '190 S Hwy 165', 'Providence', 'Cache', 'UT', '84332', '4357553300', '4357553330', '190 S Hwy 165', 'Providence', 'Cache', 'UT', '84332', '4357553300', '4357553330', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2014-04-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598180838', 0, 'Y', 0, '2014-06-27', NULL, NULL, 0, 0, NULL, NULL),
('841394139', 'W12020419', 'W12020419', 'ID01', 'Southwest Idaho ENT PA', 'Shalise', '', 'Adams', 'AUD', 'Audiology', '', '', NULL, 'O', '4400 E Flamingo Ave Ste 220', 'Nampa', 'Canyon', 'ID', '83687', '2083673320', NULL, '4400 E Flamingo Ave Ste 220', 'Nampa', 'Canyon', 'ID', '83687', '2083673320', '', 'IDAUDIO2', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 6, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477725158', 0, 'N', 0, '2014-07-08', NULL, NULL, 0, 0, NULL, NULL),
('841394139', 'W12007060', 'W12007060', 'ID01', 'Southwest Idaho ENT PA', 'Shalise', '', 'Adams', 'AUD', 'Audiology', '', '', NULL, 'O', '900 N Liberty St Ste 400', 'Boise', 'Ada', 'ID', '83704', '2083673320', NULL, '900 N Liberty St Ste 400', 'Boise', 'Ada', 'ID', '83704', '2083673320', '', 'IDAUDIO2', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477725158', 0, 'N', 0, '2014-07-08', NULL, NULL, 0, 0, NULL, NULL),
('841394139', 'W12020420', 'W12020420', 'SACN', 'Southwest Idaho ENT PA', 'Shalise', '', 'Adams', 'AUD', 'Audiology', '', '', NULL, 'O', '4400 E Flamingo Ave Ste 220', 'Nampa', 'Canyon', 'ID', '83687', '2083673320', NULL, '4400 E Flamingo Ave Ste 220', 'Nampa', 'Canyon', 'ID', '83687', '2083673320', '', 'IDSINCLAIRL', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 6, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477725158', 0, 'N', 0, '2014-07-08', NULL, NULL, 0, 0, NULL, NULL),
('841394139', 'SACN01050', 'SACN01050', 'SACN', 'Southwest Idaho ENT PA', 'Shalise', '', 'Adams', 'AUD', 'Audiology', '', '', NULL, 'O', '900 N Liberty St Ste 400', 'Boise', 'Ada', 'ID', '83704', '2083673320', NULL, '900 N Liberty St Ste 400', 'Boise', 'Ada', 'ID', '83704', '2083673320', '', 'IDSINCLAIRL', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477725158', 0, 'N', 0, '2014-07-08', NULL, NULL, 0, 0, NULL, NULL),
('841394139', 'W12006288', 'W12006288', 'Sinclair', 'Southwest Idaho ENT PA', 'Shalise', '', 'Adams', 'AUD', 'Audiology', '', '', NULL, 'O', '900 N Liberty Ste 400', 'Boise', 'Ada', 'ID', '83704', '2083673320', '2083677474', '900 N Liberty Ste 400', 'Boise', 'Ada', 'ID', '83704', '2083673320', '2083677474', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 3, '2010-11-01', '2010-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477725158', 0, 'N', 0, '2014-07-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12049279', 'W12049279', 'UTIHCPHY', 'Utah Valley Womens Center', 'Erica', 'R', 'Hensman', 'PA', 'Occupational Therapy', '', '', NULL, 'O', '1157 N 300 W Ste 301', 'Provo', 'Utah', 'UT', '84604', '8013577009', '8013578132', '1157 N 300 W Ste 301', 'Provo', 'Utah', 'UT', '84604', '8013577009', '8013578132', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2014-05-08', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1649287905', 0, 'Y', 0, '2014-06-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12049280', 'W12049280', 'UTIHCPHY', 'Southwest Cardiology-Cedar City', 'Ralph', 'E', 'Jensen', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '110 W 1325 N Ste 100', 'Cedar City', 'Iron', 'UT', '84721', '4352512500', '4352512525', '110 W 1325 N Ste 100', 'Cedar City', 'Iron', 'UT', '84721', '4352512500', '4352512525', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2014-05-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', 'Valley View Medical Center', '', '', 'HCFA|UB|', '1750351029', 0, 'N', 0, '2014-06-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12049281', 'W12049281', 'UTIHCPHY', 'Southwest Cardiology - St George', 'Ralph', 'E', 'Jensen', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1380 E Medical Ctr Dr Ste 1500', 'St George', 'Washington', 'UT', '84790', '4352512500', '4356564907', '1380 E Medical Ctr Dr Ste 1500', 'St George', 'Washington', 'UT', '84790', '4352512500', '4356564907', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2014-05-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', 'Valley View Medical Center', '', '', 'HCFA|UB|', '1750351029', 0, 'N', 0, '2014-06-27', NULL, NULL, 0, 0, NULL, NULL),
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('260468941', 'W12049289', 'W12049289', 'UTMH1', 'Premier Psychological Counseling & Consulting', 'William', 'S', 'Young', '', 'Mental Health', 'Psychology', '', NULL, 'O', '747 S Paradise Canyon Rd Ste 2', 'Cedar City', 'Iron', 'UT', '84720', '4358659119', '          ', '747 S Paradise Canyon Rd Ste 2', 'Cedar City', 'Iron', 'UT', '84720', '4358659119', '          ', 'UTPHD', '', '', '0.00', '40.00', '0.00', 3, '2014-06-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669602884', 0, 'N', 0, '2014-06-27', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W12049292', 'W12049292', 'UTIHCPHY', 'Medical Center Radiation Oncology', 'Brandon', 'M', 'Barney', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '5121 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073888', '8014423263', '5121 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073888', '8014423263', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194961789', 0, 'N', 0, '2014-06-27', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W12049301', 'W12049301', 'UTIHCPHY', 'Int Heart Cardiology-LDSH', 'Shane', 'M', 'Kjar', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '8th Ave and C St 7th Floor', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8015073500', '8015073505', '8th Ave and C St 7th Floor', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8015073500', '8015073505', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2014-05-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013932342', 0, 'Y', 0, '2014-06-27', NULL, NULL, 0, 0, NULL, NULL),
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('464231778', 'W12049314', 'W12049314', 'NM01', 'MD for Men', 'Wayne', 'W', 'Kuang', 'MD', 'Urology', '', '', NULL, 'O', '8300 Carmel Ave NE Ste 303', 'Albuquerque', 'Bernalillo', 'NM', '87122', '5055101674', '8889729218', '8300 Carmel Ave NE Ste 303', 'Albuquerque', 'Bernalillo', 'NM', '87122', '5055101674', '8889729218', 'NMUROLOGY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1720043151', 0, 'N', 0, '2014-06-27', NULL, NULL, 0, 0, NULL, NULL),
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