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
('061506129', 'W12035030', 'W12035030', 'UT01', 'Wee Care Pediatrics', '', '', 'Wee Care Pediatrics', 'GROUP', 'Pediatrics', '', '', NULL, 'O', '1792 W 1700 S', 'Layton', 'Davis', 'UT', '84077', '8017738644', NULL, '1792 W 1700 S', 'Layton', 'Davis', 'UT', '84077', '8017738644', '          ', 'WUSTDPEDE5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009555', 0, 'N', 0, '2013-06-26', NULL, NULL, 0, 0, NULL, NULL),
('454041098', 'W12035034', 'W12035034', 'ILCHIGSTD', 'Partners in Primary Care', '', '', 'Partners in Primary Care', '', 'Family Practice', '', '', NULL, 'B', 'PO Box 2050', 'Addison', 'Dallas', 'TX', '75001', '9723419555', '9723851759', 'PO Box 2050', 'Addison', 'Dallas', 'TX', '75001', '9723419555', '9723851759', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1811267396', 0, 'N', 0, '2014-01-28', NULL, NULL, 0, 0, NULL, NULL),
('836000097', 'W12035035', 'W12035035', 'WY01', 'Memorial Hospital of Converse County', '', '', 'Memorial Hospital of Converse County', '', 'Clinic', '', '', NULL, 'O', '5000 Blackmore Rd', 'Casper', 'Natrona', 'WY', '82609', '3072373077', '0000000000', '5000 Blackmore Rd', 'Casper', 'Natrona', 'WY', '82609', '3072373077', '0000000000', '', '', '', '0.00', '13.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA', '0000014002', 0, 'Y', 0, '2013-07-08', NULL, NULL, 0, 0, NULL, NULL),
('836000097', 'W12035036', 'W12035036', 'WYT1', 'Memorial Hospital of Converse County', '', '', 'Memorial Hospital of Converse County', '', 'Clinic', '', '', NULL, 'O', '5000 Blackmore Rd', 'Casper', 'Natrona', 'WY', '82609', '3072373077', '0000000000', '5000 Blackmore Rd', 'Casper', 'Natrona', 'WY', '82609', '3072373077', '0000000000', '', '', '', '0.00', '13.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA', '0000014002', 0, 'Y', 0, '2013-07-08', NULL, NULL, 0, 0, NULL, NULL),
('454041098', 'W12035039', 'W12035039', 'ILCHIGSTD', 'Partners in Primary Care', 'Massarat', '', 'Bala', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 2050', 'Addison', 'Dallas', 'TX', '75001', '9723419555', '9723851759', 'PO Box 2050', 'Addison', 'Dallas', 'TX', '75001', '9723419555', '9723851759', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-15', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, '', '', 'HCFA|UB', '1730196833', 0, 'N', 0, '2014-01-28', NULL, NULL, 0, 0, NULL, NULL),
('454041098', 'W12035038', 'W12035038', 'ILCHIGSTD', 'Partners in Primary Care', 'Massarat', '', 'Bala', 'MD', 'Family Practice', '', '', NULL, 'O', '921 N Plum Grove Rd', 'Schaumburg', 'Cook', 'IL', '60173', '8474909393', '8473582770', '921 N Plum Grove Rd', 'Schaumburg', 'Cook', 'IL', '60173', '8474909393', '8473582770', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-15', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, '', '', 'HCFA|UB', '1730196833', 0, 'N', 0, '2014-01-28', NULL, NULL, 42.0457, -88.06, NULL, NULL),
('454041098', 'W12035041', 'W12035041', 'ILCHIGSTD', 'Partners in Primary Care', 'Sinisa', '', 'Boskovic', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 2050', 'Addison', 'Dallas', 'TX', '75001', '9723419555', '9723851759', 'PO Box 2050', 'Addison', 'Dallas', 'TX', '75001', '9723419555', '9723851759', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-15', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, '', '', 'HCFA|UB', '1467462796', 0, 'N', 0, '2014-01-28', NULL, NULL, 0, 0, NULL, NULL),
('454041098', 'W12035042', 'W12035042', 'ILCHIGSTD', 'Partners in Primary Care', 'Sinisa', '', 'Boskovic', 'MD', 'Family Practice', '', '', NULL, 'O', '921 N Plum Grove Rd', 'Schaumburg', 'Cook', 'IL', '60173', '8474909393', '8473582770', '921 N Plum Grove Rd', 'Schaumburg', 'Cook', 'IL', '60173', '8474909393', '8473582770', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-15', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, '', '', 'HCFA|UB', '1467462796', 0, 'N', 0, '2014-01-28', NULL, NULL, 42.0457, -88.06, NULL, NULL),
('454041098', 'W12035044', 'W12035044', 'ILCHIGSTD', 'Partners in Primary Care', 'Gordon', '', 'Lang', 'MD', 'Family Practice', '', '', NULL, 'O', '921 N Plum Grove Rd', 'Schaumburg', 'Cook', 'IL', '60173', '8474909393', '8473582770', '921 N Plum Grove Rd', 'Schaumburg', 'Cook', 'IL', '60173', '8474909393', '8473582770', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-15', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, '', '', 'HCFA|UB', '1912977174', 0, 'N', 0, '2014-01-28', NULL, NULL, 42.0457, -88.06, NULL, NULL),
('454041098', 'W12035045', 'W12035045', 'ILCHIGSTD', 'Partners in Primary Care', 'Gordon', '', 'Lang', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 2050', 'Addison', 'Dallas', 'TX', '75001', '9723419555', '9723851759', 'PO Box 2050', 'Addison', 'Dallas', 'TX', '75001', '9723419555', '9723851759', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-15', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, '', '', 'HCFA|UB', '1912977174', 0, 'N', 0, '2014-01-28', NULL, NULL, 0, 0, NULL, NULL),
('454041098', 'W12035047', 'W12035047', 'ILCHIGSTD', 'Partners in Primary Care', 'Asha', '', 'Vijayakumar', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 2050', 'Addison', 'Dallas', 'TX', '75001', '9723419555', '9723851759', 'PO Box 2050', 'Addison', 'Dallas', 'TX', '75001', '9723419555', '9723851759', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-15', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, '', '', 'HCFA|UB', '1790724540', 0, 'N', 0, '2014-01-28', NULL, NULL, 0, 0, NULL, NULL),
('454041098', 'W12035048', 'W12035048', 'ILCHIGSTD', 'Partners in Primary Care', 'Asha', '', 'Vijayakumar', 'MD', 'Family Practice', '', '', NULL, 'O', '921 N Plum Grove Rd', 'Schaumburg', 'Cook', 'IL', '60173', '8474909393', '8473582770', '921 N Plum Grove Rd', 'Schaumburg', 'Cook', 'IL', '60173', '8474909393', '8473582770', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-15', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, '', '', 'HCFA|UB', '1790724540', 0, 'N', 0, '2014-01-28', NULL, NULL, 42.0457, -88.06, NULL, NULL),
('454041098', 'W12035050', 'W12035050', 'ILCHIGSTD', 'Partners in Primary Care', 'Jabeen', '', 'Aqueel', 'MD', 'Family Practice', '', '', NULL, 'O', '921 N Plum Grove Rd', 'Schaumburg', 'Cook', 'IL', '60173', '8474909393', '8473582770', '921 N Plum Grove Rd', 'Schaumburg', 'Cook', 'IL', '60173', '8474909393', '8473582770', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-15', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, '', '', 'HCFA|UB', '1689883225', 0, 'N', 0, '2014-01-28', NULL, NULL, 42.0457, -88.06, NULL, NULL),
('454041098', 'W12035051', 'W12035051', 'ILCHIGSTD', 'Partners in Primary Care', 'Jabeen', '', 'Aqueel', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 2050', 'Addison', 'Dallas', 'TX', '75001', '9723419555', '9723851759', 'PO Box 2050', 'Addison', 'Dallas', 'TX', '75001', '9723419555', '9723851759', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-15', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, '', '', 'HCFA|UB', '1689883225', 0, 'N', 0, '2014-01-28', NULL, NULL, 0, 0, NULL, NULL),
('454041098', 'W12035052', 'W12035052', 'ILCHIGSTD', 'Partners in Primary Care', 'Priya', '', 'Pillai Indira', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 2050', 'Addison', 'Dallas', 'TX', '75001', '9723419555', '9723851759', 'PO Box 2050', 'Addison', 'Dallas', 'TX', '75001', '9723419555', '9723851759', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-15', '2014-06-12', 0, 0, 0, 'Northwest Community Hospital', NULL, '', '', 'HCFA|UB', '1376844555', 0, 'N', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('454041098', 'W12035053', 'W12035053', 'ILCHIGSTD', 'Partners in Primary Care', 'Priya', '', 'Pillai Indira', 'MD', 'Family Practice', '', '', NULL, 'O', '921 N Plum Grove Rd', 'Schaumburg', 'Cook', 'IL', '60173', '8474909393', '8473582770', '921 N Plum Grove Rd', 'Schaumburg', 'Cook', 'IL', '60173', '8474909393', '8473582770', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-15', '2014-06-12', 0, 0, 0, 'Northwest Community Hospital', NULL, '', '', 'HCFA|UB', '1376844555', 0, 'N', 0, '2014-06-23', NULL, NULL, 42.0457, -88.06, NULL, NULL),
('870649259', 'W12035054', 'W12035054', 'UT01', 'Alpine Orthopaedic Specialists', '', '', 'Alpine Orthopaedic Specialists', 'GROUP', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 30015 Dept 214', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '4357872000', NULL, 'PO Box 30015 Dept 214', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '4357872000', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427184449', 0, 'Y', 0, '2013-06-26', NULL, NULL, 0, 0, NULL, NULL),
('870283576', 'W12008014', 'W12008014', 'UT01', 'Excel Eye Center of Provo', 'Todd', 'B', 'Engen', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '1735 N State St', 'Provo', 'Utah', 'UT', '84604', '8013741818', '8013740163', '1735 N State St', 'Provo', 'Utah', 'UT', '84604', '8013741818', '8013740163', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-02-03', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1295705697', 0, 'N', 0, '2013-08-20', NULL, NULL, 40.2568, -111.673, NULL, NULL),
('870284475', 'W12035057', 'W12035057', 'UT01', 'Granger Medical Clinic', 'Brian', 'K', 'Connolly', 'PA-C', 'Family Practice', '', '', NULL, 'O', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019653600', '0000000000', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019653600', '0000000000', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922024926', 0, 'N', 0, '2013-10-23', NULL, NULL, 40.682, -111.979, NULL, NULL),
('870284475', 'W12035058', 'W12035058', 'UT01', 'Granger Medical Clinic', 'Brian', 'K', 'Connolly', 'PA-C', 'Family Practice', '', '', NULL, 'B', 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '8019653600', '0000000000', 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '8019653600', '0000000000', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922024926', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('270806125', 'W12035059', 'W12035059', 'NM01', 'Breathe America Albuquerque', 'P. James', '', 'Romero', 'NP', 'Family Practice', '', '', NULL, 'O', '4901 Lang Ave NE  Ste 100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058832574', '5052654033', '4901 Lang Ave NE  Ste 100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058832574', '5052654033', 'NMALLERGY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', '2013-10-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396047957', 0, 'N', 0, '2013-10-04', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'W12035061', 'W12035061', 'ILCHIGSTD', 'Presence Service Corporation', 'Bell', 'A', 'Margo', 'MD', 'Pediatrics', '', '', NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', '6309142499', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', '6309142499', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427107812', 0, 'N', 0, '2013-06-26', NULL, NULL, 41.528, -88.1346, NULL, NULL),
('364314354', 'W12035062', 'W12035062', 'ILCHIGSTD', 'Presence Service Corporation', 'Bell', 'A', 'Margo', 'MD', 'Pediatrics', '', '', 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, '2013-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427107812', 0, 'N', 0, '2013-06-26', NULL, NULL, 0, 0, NULL, NULL),
('820492308', 'W12035067', 'W12035067', 'ID02', 'Idaho Gastroenterology Associates', 'Brian', 'T', 'Story', 'MD', 'Gastroenterology', '', '', NULL, 'O', '425 W Bannock St', 'Boise', 'Ada', 'ID', '83702', '2083436458', '2083435031', '425 W Bannock St  ', 'Boise', 'Ada', 'ID', '83702', '2083436458', '2083435031', 'IDPPONONFAC', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1851551089', 0, 'N', 0, '2013-10-10', NULL, NULL, 0, 0, NULL, NULL),
('820492308', 'W12035068', 'W12035068', 'ID02', 'Idaho Gastroenterology Associates', 'Brian', 'T', 'Story', 'MD', 'Gastroenterology', '', '', NULL, 'O', '2235 E Gala St', 'Meridian', 'Ada', 'ID', '83642', '2088873724', '2088871682', '2235 E Gala St  ', 'Meridian', 'Ada', 'ID', '83642', '2088873724', '2088871682', 'IDPPONONFAC', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1851551089', 0, 'N', 0, '2013-10-10', NULL, NULL, 0, 0, NULL, NULL),
('462260758', 'W12035070', 'W12035070', 'UTDT01', 'David V Brown DDS', 'David', '', 'Brown', 'DDS', 'Dentist', '', '', NULL, 'O', '195 W Telegraph', 'Washington', 'Washington', 'UT', '84780', '4356734605', NULL, '195 W Telegraph', 'Washington', 'Washington', 'UT', '84780', '4356734605', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000010129', 0, 'N', 0, '2013-06-27', NULL, NULL, 0, 0, NULL, NULL),
('528806591', 'W12035072', 'W12035072', 'UTDT01', 'Monte Dansie Family Dental', 'Monte', '', 'Dansie', 'DDS', 'Dentist', '', '', NULL, 'O', '111 N 200 E', 'Price', 'Carbon', 'UT', '84501', '4356370430', NULL, '111 N 200 E', 'Price', 'Carbon', 'UT', '84501', '4356370430', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000010130', 0, 'N', 0, '2013-06-27', NULL, NULL, 0, 0, NULL, NULL),
('900049617', 'W12035076', 'W12035076', 'UTDT01', 'R Eric Johansen', 'R Eric', '', 'Johansen', 'DDS', 'Dentist', '', '', NULL, 'O', '7611 S Jordan Landing Blvd Ste 100', 'West Jordan', 'Salt Lake', 'UT', '84084', '8015630699', NULL, '7611 S Jordan Landing Blvd Ste 100', 'West Jordan', 'Salt Lake', 'UT', '84084', '8015630699', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000010132', 0, 'N', 0, '2013-06-27', NULL, NULL, 0, 0, NULL, NULL),
('900941378', 'W12035078', 'W12035078', 'UTDT01', 'Layton Smiles Dentistry and Orthodontics', 'Katie', '', 'McCann', 'DDS', 'Dentist', '', '', NULL, 'O', '820 N Main St Ste B', 'Layton', 'Davis', 'UT', '84041', '8017718000', NULL, '820 N Main St Ste B', 'Layton', 'Davis', 'UT', '84041', '8017718000', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000010133', 0, 'N', 0, '2013-06-27', NULL, NULL, 0, 0, NULL, NULL),
('900941378', 'W12035080', 'W12035080', 'UTDT01', 'Layton Smiles Dentistry and Orthodontics', 'Cordell', '', 'Nebeker', 'DDS', 'Pedodontist', '', '', NULL, 'O', '820 N Main St Ste B', 'Layton', 'Davis', 'UT', '84041', '8017718000', NULL, '820 N Main St Ste B', 'Layton', 'Davis', 'UT', '84041', '8017718000', '          ', 'UTSPA', '', '', '0.00', '20.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000010134', 0, 'N', 0, '2013-06-27', NULL, NULL, 0, 0, NULL, NULL),
('870603681', 'W12035082', 'W12035082', 'UTDT01', 'Fairfield Dental Care', 'Brad', '', 'Salmon', 'DMD', 'Dentist', '', '', NULL, 'O', '1086 N Fairfield Rd', 'Layton', 'Davis', 'UT', '84041', '8015478880', NULL, '1086 N Fairfield Rd', 'Layton', 'Davis', 'UT', '84041', '8015478880', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000010135', 0, 'N', 0, '2013-06-27', NULL, NULL, 0, 0, NULL, NULL),
('462438545', 'W12035083', 'W12035083', 'UTDT01', 'Burg Pediatric Dentistry Orchard', 'Darin', '', 'Knudson', 'DDS', 'Dentist', 'Pedodontist', '', NULL, 'O', '3377 Orchard Dr', 'Bountiful', 'Davis', 'UT', '84010', '8019518038', NULL, '3377 Orchard Dr', 'Bountiful', 'Davis', 'UT', '84010', '8019518038', '          ', 'UT00A', '', '', '0.00', '20.00', '0.00', 8, '2013-05-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000007122', 0, 'N', 0, '2013-06-27', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12035084', 'W12035084', 'UTDT01', 'Monarch Dental', 'Richard A', '', 'Shulze', 'DMD', 'Dentist', '', '', NULL, 'O', '476 N 900 W', 'Ogden', 'Weber', 'UT', '84403', '8017565522', NULL, '476 N 900 W', 'Ogden', 'Weber', 'UT', '84403', '8017565522', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-05-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000008710', 0, 'N', 0, '2013-06-27', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12035085', 'W12035085', 'UTDT01', 'Monarch Dental', 'Richard A', '', 'Shulze', 'DMD', 'Dentist', '', '', NULL, 'O', '10011 S Centennial Pkwy Ste 330', 'Sandy', 'Salt Lake', 'UT', '84070', '8012563700', NULL, '10011 S Centennial Pkwy Ste 330', 'Sandy', 'Salt Lake', 'UT', '84070', '8012563700', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-05-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000008710', 0, 'N', 0, '2013-06-27', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12035086', 'W12035086', 'UTDT01', 'Monarch Dental', 'Richard A', '', 'Shulze', 'DMD', 'Dentist', '', '', NULL, 'O', '575 E University Pkwy Ste A-24', 'Orem', 'Utah', 'UT', '84097', '8012253300', NULL, '575 E University Pkwy Ste A-24', 'Orem', 'Utah', 'UT', '84097', '8012253300', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-05-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000008710', 0, 'N', 0, '2013-06-27', NULL, NULL, 0, 0, NULL, NULL),
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('760574724', 'W12035181', 'W12035181', 'TXDALSTD', 'Highland Village Primary Care', 'Rominder', '', 'Kaur', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2016 FM 407 Ste 370', 'Highland Village', 'Denton', 'TX', '75077', '9729662525', '9729661359', '2016 FM 407 Ste 370', 'Highland Village', 'Denton', 'TX', '75077', '9729662525', '9729661359', 'DALLAS1', 'TXHCPC13', '', '50.00', '0.00', '0.00', 3, '2013-08-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA', '1902899396', 0, 'N', 0, '2013-07-09', NULL, NULL, 33.0716, -97.0519, NULL, NULL),
('760308812', 'W12035183', 'W12035183', 'TXHOUSTD', 'Dr Interiano Office', 'Jose', 'C', 'Interiano', 'MD', 'Pediatrics', '', '', NULL, 'O', '1631 N Loop W Ste 440', 'Houston', 'Harris', 'TX', '77024', '7138618113', '7138616010', '1631 N Loop W Ste 440', 'Houston', 'Harris', 'TX', '77024', '7138618113', '7138616010', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1790778470', 0, 'N', 0, '2013-07-09', NULL, NULL, 29.8123, -95.4307, NULL, NULL),
('830348859', 'W12035184', 'W12035184', 'TXHOUSTD', '', 'Arshad', '', 'Umer', 'MD', 'Internal Medicine', '', '', NULL, 'O', '11211 Hwy 6 S Ste A', 'Sugarland', 'Fort Bend', 'TX', '77498', '2814915500', '2814915505', '11211 Hwy 6 S Ste A', 'Sugarland', 'Fort Bend', 'TX', '77498', '2814915500', '2814915505', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-09', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA', '1477548071', 0, 'N', 0, '2013-07-09', NULL, NULL, 29.6524, -95.6497, NULL, NULL),
('830348859', 'W12035188', 'W12035188', 'TXHOUSTD', '', 'Arshad', '', 'Umer', 'MD', 'Internal Medicine', '', '', NULL, 'O', '6052 N Fry Rd Ste A', 'Katy', 'Harris', 'TX', '77449', '8325936600', '8325936606', '6052 N Fry Rd Ste A', 'Katy', 'Harris', 'TX', '77449', '8325936600', '8325936606', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-09', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA', '1477548071', 0, 'N', 0, '2013-07-09', NULL, NULL, 29.8599, -95.7198, NULL, NULL),
('830348859', 'W12035189', 'W12035189', 'TXHOUSTD', '', 'Arshad', '', 'Umer', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 941178', 'Houston', 'Harris', 'TX', '77094', '0000000000', '0000000000', 'PO Box 941178', 'Houston', 'Harris', 'TX', '77094', '0000000000', '0000000000', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-09', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA', '1477548071', 0, 'N', 0, '2013-07-09', NULL, NULL, 0, 0, NULL, NULL),
('201916933', 'W12035190', 'W12035190', 'TXDALSTD', '', 'Cherry', '', 'Chandi', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2016 FM 407 Ste 360', 'Highland Village', 'Denton', 'TX', '75077', '9729662525', '9729661359', '2016 FM 407 Ste 360', 'Highland Village', 'Denton', 'TX', '75077', '9729662525', '9729661359', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-08-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA', '1265425664', 0, 'N', 0, '2013-07-09', NULL, NULL, 33.0716, -97.0519, NULL, NULL),
('364088232', 'W12035196', 'W12035196', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Stephen', 'J', 'Kim', 'MD', 'Radiology', '', '', NULL, 'O', '1870 W Galena Blvd', 'Aurora', 'Kane', 'IL', '60506', '6308596700', '6309065962', '1870 W Galena Blvd', 'Aurora', 'Kane', 'IL', '60506', '6308596700', '6309065962', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-07-26', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', '', 'HCFA|UB|', '1992967293', 0, 'N', 0, '2014-04-07', NULL, NULL, 41.7642, -88.3626, NULL, NULL),
('364088232', 'W12035194', 'W12035194', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Stephen', 'J', 'Kim', '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, '2013-07-26', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', '', 'HCFA|UB|', '1992967293', 0, 'N', 0, '2014-04-07', NULL, NULL, 41.7821, -88.3293, NULL, NULL),
('364088232', 'W12035195', 'W12035195', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Stephen', 'J', 'Kim', '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, '2013-07-26', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', '', 'HCFA|UB|', '1992967293', 0, 'N', 0, '2014-04-07', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12035198', 'W12035198', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Aman', '', 'Sethi', 'MD', 'Pulmonary', '', '', NULL, 'O', '2040 Ogden Ave Ste 605', 'Aurora', 'Dupage', 'IL', '60504', '6305857100', '6306924005', '2040 Ogden Ave Ste 605', 'Aurora', 'Dupage', 'IL', '60504', '6305857100', '6306924005', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-07-26', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', '', 'HCFA|UB|', '1447446349', 0, 'N', 0, '2013-07-01', NULL, NULL, 41.7282, -88.2677, NULL, NULL),
('364088232', 'W12035199', 'W12035199', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Aman', '', 'Sethi', 'MD', 'Pulmonary', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '          ', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-07-26', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', '', 'HCFA|UB|', '1447446349', 0, 'N', 0, '2013-07-01', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12035202', 'W12035202', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Leonor', 'D', 'Banez', 'NP', 'Nephrology', '', '', NULL, 'O', '1870 W Galena Blvd', 'Aurora', 'Kane', 'IL', '60506', '6308596700', '6309066773', '1870 W Galena Blvd', 'Aurora', 'Kane', 'IL', '60506', '6308596700', '6309066773', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-07-26', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', '', 'HCFA|UB|', '1386987352', 0, 'N', 0, '2013-07-01', NULL, NULL, 41.7642, -88.3626, NULL, NULL),
('364088232', 'W12035203', 'W12035203', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Leonor', 'D', 'Banez', 'NP', 'Nephrology', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '          ', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-07-26', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', '', 'HCFA|UB|', '1386987352', 0, 'N', 0, '2013-07-01', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12035201', 'W12035201', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Leonor', 'D', 'Banez', 'NP', 'Nephrology', '', '', 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, '2013-07-26', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', '', 'HCFA|UB|', '1386987352', 0, 'N', 0, '2013-07-01', NULL, NULL, 41.6724, -88.3381, NULL, NULL),
('621801973', 'W12035205', 'W12035205', 'UT01', '', 'Jean', '', 'Stanford', 'PA-C', 'Psychiatry', '', '', NULL, 'O', '3460 S Pioneer Pkwy', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643100', NULL, '3460 S Pioneer Pkwy', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643100', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-08-01', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710037213', 0, 'N', 0, '2013-07-03', NULL, NULL, 40.6972, -111.99, NULL, NULL),
('731684200', 'W12035206', 'W12035206', 'WY01', 'Rocky Mountain Oncology Center', 'John ', '', 'Purviance', 'MD', 'Radiation Oncology', '', '', NULL, 'B', 'PO Box 306141', 'Nashville', 'Davidson', 'TN', '37230', '3072355433', NULL, 'PO Box 306141', 'Nashville', 'Davidson', 'TN', '37230', '3072355433', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2013-06-25', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1437279692', 0, 'N', 0, '2013-07-01', NULL, NULL, 0, 0, NULL, NULL),
('731684200', 'W12035207', 'W12035207', 'WYT2', 'Rocky Mountain Oncology Center', 'John ', '', 'Purviance', 'MD', 'Radiation Oncology', '', '', NULL, 'B', 'PO Box 306141', 'Nashville', 'Davidson', 'TN', '37230', '3072355433', '          ', 'PO Box 306141', 'Nashville', 'Davidson', 'TN', '37230', '3072355433', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2013-06-25', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1437279692', 0, 'N', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('731684200', 'W12035208', 'W12035208', 'WY01', 'Rocky Mountain Oncology Center', 'Toni', '', 'Patik', 'PA-C', 'Oncology', '', '', NULL, 'B', 'PO Box 306141', 'Nashville', 'Davidson', 'TN', '37230', '3072355433', '          ', 'PO Box 306141', 'Nashville', 'Davidson', 'TN', '37230', '3072355433', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2013-06-25', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1437265006', 0, 'N', 0, '2014-04-22', NULL, NULL, 0, 0, NULL, NULL),
('731684200', 'W12035209', 'W12035209', 'WYT2', 'Rocky Mountain Oncology Center', 'Toni', '', 'Patik', 'PA-C', 'Oncology', '', '', NULL, 'B', 'PO Box 306141', 'Nashville', 'Davidson', 'TN', '37230', '3072625992', NULL, 'PO Box 306141', 'Nashville', 'Davidson', 'TN', '37230', '3072625992', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2013-06-25', NULL, 0, 0, 1, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1437265006', 0, 'N', 0, '2013-07-01', NULL, NULL, 0, 0, NULL, NULL),
('201300128', 'W12035210', 'W12035210', 'IDBOISTD', 'Idaho Urologic Institute', 'Helen', 'J', 'Kuo', 'MD', 'Urology', '', '', NULL, 'O', '222 N 2nd Ste 115', 'Boise', 'Ada', 'ID', '83702', '2086394900', '2086394901', '222 N 2nd Ste 115', 'Boise', 'Ada', 'ID', '83702', '2086394900', '2086394901', 'IDUROLOGY', 'WUSTDHCPC5', '', '0.00', '20.00', '0.00', 3, '2013-06-25', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1346407921', 0, 'N', 0, '2014-04-24', NULL, NULL, 43.613, -116.195, NULL, NULL),
('201300128', 'W12035211', 'W12035211', 'IDBOISTD', 'Idaho Urologic Institute', 'Helen', 'J', 'Kuo', 'MD', 'Urology', '', '', NULL, 'O', '1613 12th Ave Rd Ste B', 'Nampa', 'Canyon', 'ID', '83686', '2086394900', '2086394901', '1613 12th Ave Ste B', 'Nampa', 'Canyon', 'ID', '83686', '2086394900', '2086394901', 'IDUROLOGY', 'WUSTDHCPC5', '', '0.00', '20.00', '0.00', 3, '2013-06-25', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1346407921', 0, 'N', 0, '2013-07-01', NULL, NULL, 43.5528, -116.573, NULL, NULL),
('731684200', 'W12035215', 'W12035215', 'WY01', 'Rocky Mountain Oncology Center', 'Joseph ', '', 'Rosen', 'MD', 'Oncology', '', '', NULL, 'B', 'PO Box 306141', 'Nashville', 'Davidson', 'TN', '37230', '3072355433', '          ', 'PO Box 306141', 'Nashville', 'Davidson', 'TN', '37230', '3072355433', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2013-06-25', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1225002413', 0, 'N', 0, '2014-04-22', NULL, NULL, 0, 0, NULL, NULL),
('731684200', 'W12035216', 'W12035216', 'WYT2', 'Rocky Mountain Oncology Center', 'Joseph ', '', 'Rosen', 'MD', 'Oncology', '', '', NULL, 'B', 'PO Box 306141', 'Nashville', 'Davidson', 'TN', '37230', '3072355433', '          ', 'PO Box 306141', 'Nashville', 'Davidson', 'TN', '37230', '3072355433', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2013-06-25', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1225002413', 0, 'N', 0, '2014-04-22', NULL, NULL, 0, 0, NULL, NULL),
('731684200', 'W12035218', 'W12035218', 'WY01', 'Rocky Mountain Oncology Center', 'Jo', 'A', 'Ramsey', 'PA-C', 'Oncology', '', '', NULL, 'B', 'PO Box 306141', 'Nashville', 'Davidson', 'TN', '37230', '3072355433', '          ', 'PO Box 306141', 'Nashville', 'Davidson', 'TN', '37230', '3072355433', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2013-06-25', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1598792368', 0, 'N', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('731684200', 'W12035219', 'W12035219', 'WYt2', 'Rocky Mountain Oncology Center', 'Jo', 'A', 'Ramsey', 'PA-C', 'Oncology', '', '', NULL, 'B', 'PO Box 306141', 'Nashville', 'Davidson', 'TN', '37230', '3072355433', '          ', 'PO Box 306141', 'Nashville', 'Davidson', 'TN', '37230', '3072355433', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2013-06-25', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1598792368', 0, 'N', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'W12035220', 'W12035220', 'ILCHIGSTD', 'Presence Medical Group', 'Julie', '', 'Schriefer', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '7435 W Talcott Ave', 'Chicago', 'Cook', 'IL', '60631', '7737748000', '7739909635', '7435 W Talcott Ave', 'Chicago', 'Cook', 'IL', '60631', '7737748000', '7739909635', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-07-29', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, '', '', 'HCFA|UB|', '1043445778', 0, 'N', 0, '2013-07-01', NULL, NULL, 41.9884, -87.8124, NULL, NULL),
('363330928', 'W12035221', 'W12035221', 'ILCHIGSTD', 'Presence Medical Group', 'Julie', '', 'Schriefer', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8472511500', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8472511500', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-07-29', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, '', '', 'HCFA|UB|', '1043445778', 0, 'N', 0, '2013-07-01', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'W12035222', 'W12035222', 'ILCHIGSTD', 'Presence Medical Group', 'Alphi', 'P', 'Elackattu ', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8472511500', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8472511500', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-07-29', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1033372750', 0, 'N', 0, '2013-07-01', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'W12035223', 'W12035223', 'ILCHIGSTD', 'Presence Medical Group', 'Alphi', 'P', 'Elackattu ', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '800 Austin St East Tower Ste 363', 'Evanston', 'Cook', 'IL', '60202', '7734278114', '7734278116', '800 Austin St East Tower Ste 363', 'Evanston', 'Cook', 'IL', '60202', '7734278114', '7734278116', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-07-29', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1033372750', 0, 'N', 0, '2013-07-01', NULL, NULL, 42.0255, -87.6819, NULL, NULL),
('363330928', 'W12035224', 'W12035224', 'ILCHIGSTD', 'Presence Medical Group', 'Alphi', 'P', 'Elackattu ', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '7447 W Talcott Ave Ste 507', 'Chicago', 'Cook', 'IL', '60603', '7734278114', '7734278116', '7447 W Talcott Ave Ste 507', 'Chicago', 'Cook', 'IL', '60603', '7734278114', '7734278116', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-07-29', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1033372750', 0, 'N', 0, '2013-07-01', NULL, NULL, 41.9887, -87.8131, NULL, NULL),
('731684200', 'W12035225', 'W12035225', 'WY01', 'Rocky Mountain Oncology Center', 'Robert', '', 'Tobin', 'MD', 'Oncology', '', '', NULL, 'B', 'PO Box 306141', 'Nashville', 'Davidson', 'TN', '37230', '3072355433', '          ', 'PO Box 306141', 'Nashville', 'Davidson', 'TN', '37230', '3072355433', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2013-06-25', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1912967050', 0, 'N', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('731684200', 'W12035226', 'W12035226', 'WYT2', 'Rocky Mountain Oncology Center', 'Robert', '', 'Tobin', 'MD', 'Oncology', '', '', NULL, 'B', 'PO Box 306141', 'Nashville', 'Davidson', 'TN', '37230', '3072355433', '          ', 'PO Box 306141', 'Nashville', 'Davidson', 'TN', '37230', '3072355433', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2013-06-25', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1912967050', 0, 'N', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('462252776', 'W12035229', 'W12035229', 'UT01', 'Premier Family Medical M-F 8am-9pm Sat 9am-9pm', '', '', 'Premier Family Medical', 'GROUP', 'Primary Care with Extended Hours', 'Urgent Care', '', NULL, 'O', '275 W 200 N Ste 100', 'Lindon', 'Utah', 'UT', '84042', '8017961333', '8017960625', '275 W 200 N Ste 100', 'Lindon', 'Utah', 'UT', '84042', '8017961333', '8017960625', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000834776', 0, 'N', 0, '2013-11-04', NULL, NULL, 40.3419, -111.722, NULL, NULL),
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INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
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('311756818', 'W12035288', 'W12035288', 'TXHOUSTD', 'Hope Clinic', 'Annaporani', '', 'Arunachalam', 'MD', 'Pediatrics', '', '', NULL, 'O', '7001 Corporate Dr Ste 120', 'Houston', 'Harris', 'TX', '77036', '7137732901', '7132715422', '7001 Corporate Dr Ste 120', 'Houston', 'Harris', 'TX', '77036', '7137732901', '7132715422', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275674178', 0, 'N', 0, '2013-07-10', NULL, NULL, 29.7037, -95.5515, NULL, NULL),
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('820200896', 'W12031106', 'W12031106', 'IDBOISTD', 'Saint Alphonsus Medical Center Nampa Read Only', 'Eloisa', 'S', 'Walker', '(accepting newborn pediatric patients only)', 'Pediatric Cardiology', '', '', NULL, 'B', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084671171', '2084635050', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084671171', '2084635050', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2013-03-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760433601', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.5537, -116.573, NULL, NULL),
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('201435671', 'W12035342', 'W12035342', 'TXHOUSTD', 'Diabetes America', 'Yin', '', 'Oo', 'MD', 'Endocrinology', '', '', NULL, 'B', '13100 NW Fwy Ste 400', 'Houston', 'Harris', 'TX', '77040', '8666934223', '8882377954', '13100 NW Fwy Ste 400', 'Houston', 'Harris', 'TX', '77040', '8666934223', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760682561', 0, 'N', 0, '2013-07-08', NULL, NULL, 0, 0, NULL, NULL),
('201435671', 'W12035341', 'W12035341', 'TXHOUSTD', 'Diabetes America', 'Yin', '', 'Oo', 'MD', 'Endocrinology', '', '', NULL, 'O', '4519 Matlock Rd Ste 135', 'Arlington', 'Tarrant', 'TX', '76018', '8666934223', '8882377954', '4519 Matlock Rd Ste 135', 'Arlington', 'Tarrant', 'TX', '76018', '8666934223', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760682561', 0, 'N', 0, '2013-07-08', NULL, NULL, 32.6736, -97.1148, NULL, NULL),
('820315557', 'W12035343', 'W12035343', 'ID01', 'Boise Psychological Services', 'Michael', 'J', 'Eisenbeiss', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '315 N Allumbaugh', 'Boise', 'Ada', 'ID', '83704', '2083763546', NULL, '315 N Allumbaugh', 'Boise', 'Ada', 'ID', '83704', '2083763546', '          ', 'IDBPSMH13PHD', '', '', '0.00', '40.00', '0.00', 6, '2013-07-01', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1740343235', 0, 'N', 0, '2013-11-01', NULL, NULL, 43.6081, -116.266, NULL, NULL),
('870284475', 'W12035344', 'W12035344', 'UT01', 'Granger Medical Clinic', '', '', 'Granger Medical Clinic', 'GROUP', 'Primary Care with Extended Hours', 'Urgent Care', '', NULL, 'O', '3181 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015695575', '0000000000', '3181 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015695575', '0000000000', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184657041', 0, 'N', 0, '2014-01-20', NULL, NULL, 40.5877, -111.967, NULL, NULL),
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('364195126', 'W12035359', 'W12035359', 'ILCHIGSTD', 'Neuroscience Institute at Provena', 'Ziad', '', 'Al Aani', 'MD', 'Neurology', '', '', NULL, 'O', '301 N Madison St Ste 300', 'Joliet', 'Will', 'IL', '60435', '8157254367', '8157254863', '301 N Madison St Ste 300', 'Joliet', 'Will', 'IL', '60435', '8157254367', '8157254863', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-06-24', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1730398959', 0, 'N', 0, '2013-07-05', NULL, NULL, 41.5273, -88.1346, NULL, NULL),
('870179340', 'W12035362', 'W12035362', 'UT01', 'Standard Optical', 'Paul', 'E', 'Reed', 'OD', 'Optometry', '', '', NULL, 'O', '460 N 325 E', 'Ogden', 'Weber', 'UT', '84404', '8015460255', '8015460260', '460 N 325 E', 'Ogden', 'Weber', 'UT', '84404', '8015460255', '8015460260', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-07-05', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396792982', 0, 'N', 0, '2013-08-21', NULL, NULL, 41.2734, -111.974, NULL, NULL),
('870179340', 'W12035361', 'W12035361', 'UT01', 'Standard Optical', 'Paul', 'E', 'Reed', 'OD', 'Optometry', '', '', NULL, 'O', '1901 W Parkway Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019720203', NULL, '1901 W Parkway Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019720203', '          ', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-07-05', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396792982', 0, 'N', 0, '2013-08-21', NULL, NULL, 40.7164, -111.943, NULL, NULL),
('830307239', 'W12035363', 'W12035363', 'WY01', 'Big Horn Urology', 'Stephen', 'W', 'Holst', 'MD', 'Urology', '', '', NULL, 'O', '340 W Dow St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076721806', '3076721808', '340 W Dow St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076721806', '3076721808', '', '', '', '0.00', '7.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, 'Sheridan Memorial Hospital', NULL, NULL, NULL, 'HCFA', '1043379472', 0, 'N', 0, '2013-07-29', NULL, NULL, 44.8025, -106.96, NULL, NULL),
('830307239', 'W12035364', 'W12035364', 'WYT1', 'Big Horn Urology', 'Stephen', 'W', 'Holst', 'MD', 'Urology', '', '', NULL, 'O', '340 W Dow St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076721806', '3076721808', '340 W Dow St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076721806', '3076721808', '', '', '', '0.00', '7.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, 'Sheridan Memorial Hospital', NULL, NULL, NULL, 'HCFA', '1043379472', 0, 'N', 0, '2013-07-29', NULL, NULL, 0, 0, NULL, NULL),
('830332945', 'W12035371', 'W12035371', 'WY01', 'Outpatient Radiology', '', '', 'Outpatient Radiology', '', 'Imaging Center', '', '', NULL, 'O', '419 S Washington St Ste 101', 'Casper', 'Natrona', 'WY', '82601', '3072651620', '3072371074', '419 S Washington St Ste 101', 'Casper', 'Natrona', 'WY', '82601', '3072651620', '3072371074', '', '', '', '0.00', '10.00', '0.00', 3, '2013-07-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA', '1396704474', 0, 'N', 0, '2013-07-09', NULL, NULL, 42.8464, -106.31, NULL, NULL),
('830332945', 'W12035372', 'W12035372', 'WYT2', 'Outpatient Radiology', '', '', 'Outpatient Radiology', '', 'Imaging Center', '', '', NULL, 'O', '419 S Washington St Ste 101', 'Casper', 'Natrona', 'WY', '82601', '3072651620', '3072371074', '419 S Washington St Ste 101', 'Casper', 'Natrona', 'WY', '82601', '3072651620', '3072371074', '', '', '', '0.00', '10.00', '0.00', 3, '2013-07-15', NULL, 0, 0, 1, '', '', '', '', 'HCFA', '1396704474', 0, 'N', 0, '2013-07-09', NULL, NULL, 0, 0, NULL, NULL),
('830212463', 'W12035386', 'W12035386', 'WY01', 'Casper Medical Imaging', '', '', 'Casper Medical Imaging', '', 'Radiology', '', '', NULL, 'O', '419 S Washington St Ste 101', 'Casper', 'Natrona', 'WY', '82601', '3072651620', '3072371074', '419 S Washington St Ste 101', 'Casper', 'Natrona', 'WY', '82601', '3072651620', '3072371074', '', '', '', '0.00', '10.00', '0.00', 3, '2013-07-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA', '1316908940', 0, 'Y', 0, '2013-07-09', NULL, NULL, 42.8464, -106.31, NULL, NULL),
('371647965', 'W12035375', 'W12035375', 'TXHOUSTD', 'Shadow Creek Family Physicians', 'Krishali', '', 'Hoffman', 'DO', 'Family Practice', '', '', NULL, 'O', '10970 Shadow Creek Pkwy Ste 360', 'Pearland', 'Brazoria', 'TX', '77584', '7134363697', '2819976532', '10970 Shadow Creek Pkwy Ste 360', 'Pearland', 'Brazoria', 'TX', '77584', '7134363697', '2819976532', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-23', NULL, 0, 0, 0, '', '', '', '', 'HCFA', '1427074335', 0, 'N', 0, '2013-07-23', NULL, NULL, 29.5802, -95.3886, NULL, NULL),
('870574059', 'W12035384', 'W12035384', 'UT01', 'Mountain Land Maple Grove', 'Nate', 'I', 'Allen', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '1435 Maple Grove Rd', 'Boise', 'Ada', 'ID', '83709', '2083226200', '2083226233', '1435 Maple Grove Rd', 'Boise', 'Ada', 'ID', '83709', '2083226200', '2083226233', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2013-07-01', '2013-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003173360', 0, 'N', 0, '2014-02-10', NULL, NULL, 0, 0, NULL, NULL),
('870574059', 'W12035385', 'W12035385', 'UT01', 'Mountain Land Maple Grove', 'Nate', 'I', 'Allen', 'DPT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 711185', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '2083226200', '2083226233', 'PO Box 711185', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '2083226200', '2083226233', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2013-07-01', '2014-01-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003173360', 0, 'N', 0, '2014-02-10', NULL, NULL, 0, 0, NULL, NULL),
('870354442', 'W12035426', 'W12035426', 'UT01', 'Rocky Mountain Womens Health Center', 'Erin', 'K', 'Cassiere', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '124 S Fairfield Rd', 'Layton', 'Davis', 'UT', '84041', '8019273077', NULL, '124 S Fairfield Rd', 'Layton', 'Davis', 'UT', '84041', '8019273077', '          ', 'WRYMTWOM', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-08-01', '2014-04-30', 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1700048980', 0, 'N', 0, '2013-07-22', NULL, NULL, 41.0604, -111.945, NULL, NULL),
('830212463', 'W12035387', 'W12035387', 'WYT2', 'Casper Medical Imaging', '', '', 'Casper Medical Imaging', '', 'Radiology', '', '', NULL, 'O', '419 S Washington St Ste 101', 'Casper', 'Natrona', 'WY', '82601', '3072651620', '3072371074', '419 S Washington St Ste 101', 'Casper', 'Natrona', 'WY', '82601', '3072651620', '3072371074', '', '', '', '0.00', '10.00', '0.00', 3, '2013-07-15', NULL, 0, 0, 1, '', '', '', '', 'HCFA', '1316908940', 0, 'Y', 0, '2013-07-09', NULL, NULL, 0, 0, NULL, NULL),
('273244517', 'W12035396', 'W12035396', 'TXDALSTD', 'Gina Rushing DO', 'Gina ', '', 'Rushing', 'DO', 'Family Practice', '', '', NULL, 'O', '5005 Live Oak St', 'Greenville', 'Hunt', 'TX', '75402', '9034553500', '9034553509', '5005 Live Oak St', 'Greenville', 'Hunt', 'TX', '75402', '9034553500', '9034553509', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-08-23', NULL, 0, 0, 0, '', '', '', '', 'HCFA', '1922056845', 0, 'N', 0, '2013-07-23', NULL, NULL, 33.1206, -96.113, NULL, NULL),
('462253072', 'W12035399', 'W12035399', 'TXDALSTD', 'Charles Downey MD', 'Charles', '', 'Downey', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2821 E President George Bush Hwy Ste 300', 'Richardson', 'Dallas', 'TX', '75082', '9722319144', '9722319174', '2821 E President George Bush Hwy Ste 300', 'Richardson', 'Dallas', 'TX', '75082', '9722319144', '9722319174', 'DALLAS3', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2030-01-01', '2030-01-01', 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, '', '', 'HCFA|UB', '1720037435', 0, 'N', 1, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('462253072', 'W12035400', 'W12035400', 'TXDALSTD', 'Charles Downey MD', 'Charles', '', 'Downey', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'M', '9101 LBJ Fwy Ste 710', 'Dallas', 'Dallas', 'TX', '75243', '9722319144', '9722319174', '9101 LBJ Fwy Ste 710', 'Dallas', 'Dallas', 'TX', '75243', '9722319144', '9722319174', 'DALLAS3', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2030-01-01', '2030-01-01', 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, '', '', 'HCFA|UB', '1720037435', 0, 'N', 1, '2014-04-25', 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
('261348411', 'W12035401', 'W12035401', 'ID01', 'Reagan and Associates', 'Leah', 'F', 'Reagan', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '413 N Allumbaugh St Ste 101', 'Boise', 'Ada', 'ID', '83704', '2083231125', '2083239604', '413 N Allumbaugh St Ste 101', 'Boise', 'Ada', 'ID', '83704', '2083231125', '2083239604', 'IDMD', '', '', '0.00', '40.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1710001938', 0, 'N', 0, '2013-07-29', NULL, NULL, 43.6087, -116.266, NULL, NULL),
('260598432', 'W12035402', 'W12035402', 'ILCHIGSTD', 'Comprehensive Pediatric Care', 'Anna', 'P', 'Sienkiewicz', 'MD', 'Pediatrics', '', '', NULL, 'O', '7447 W Talcott Ave Ste 248', 'Chicago', 'Cook', 'IL', '60631', '7737746547', '7737740019', '7447 W Talcott Ave Ste 248', 'Chicago', 'Cook', 'IL', '60631', '7737746547', '7737740019', 'CHIG11', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-10-15', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB', '1689801185', 0, 'N', 0, '2013-09-16', NULL, NULL, 41.9887, -87.8131, NULL, NULL),
('331050664', 'W12035403', 'W12035403', 'TXDALSTD', 'Keller Family Medical Center ', 'Bill', '', 'Burke', 'DO', 'Family Practice', '', '', NULL, 'O', '808 Keller Pkwy', 'Keller', 'Tarrant', 'TX', '76248', '8174312573', '8173796881', '808 Keller Pkwy', 'Keller', 'Tarrant', 'TX', '76248', '8174312573', '8173796881', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-09-09', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, '', '', 'HCFA|UB', '1497799308', 0, 'N', 0, '2014-02-11', NULL, NULL, 32.9342, -97.236, NULL, NULL),
('331050664', 'W12035404', 'W12035404', 'TXDALSTD', 'Keller Family Medical Center ', 'Bill', '', 'Burke', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 487', 'Keller', 'Tarrant', 'TX', '76244', '8174312573', '8173796881', 'PO Box 487', 'Keller', 'Tarrant', 'TX', '76244', '8174312573', '8173796881', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-09-09', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, '', '', 'HCFA|UB', '1497799308', 0, 'N', 0, '2013-08-09', NULL, NULL, 0, 0, NULL, NULL),
('200324983', 'W12035405', 'W12035405', 'ID01', 'Idaho Sports Medicine Institute', 'Christopher', 'J', 'Hansen', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '1188 University Dr', 'Boise', 'Ada', 'ID', '83706', '2083368250', '2082459514', '1188 University Dr', 'Boise', 'Ada', 'ID', '83706', '2083368250', '2082459514', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA', '1346533478', 0, 'N', 0, '2014-01-15', NULL, NULL, 43.601, -116.196, NULL, NULL),
('453191565', 'W12035406', 'W12035406', 'UT01', 'Express Med Family Care', 'Karl', 'J', 'Barton', 'NP', 'Family Practice', '', '', NULL, 'O', '415 N Main St', 'Spanish Fork', 'Utah', 'UT', '84660', '8017989715', '8017983131', '415 N Main St', 'Spanish Fork', 'Utah', 'UT', '84660', '8017989715', '8017983131', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Castleview Hospital', 'Castleview Hospital', NULL, NULL, 'HCFA|UB|', '1306889522', 0, 'N', 0, '2013-12-23', NULL, NULL, 40.1152, -111.655, NULL, NULL),
('453191565', 'W12035407', 'W12035407', 'UT01', 'Express Med Family Care', 'Karl', 'J', 'Barton', 'NP', 'Family Practice', '', '', NULL, 'B', 'PO Box 540610', 'North Salt Lake', 'Davis', 'UT', '84054', '8017989715', '8017983131', 'PO Box 540610', 'North Salt Lake', 'Davis', 'UT', '84054', '8017989715', '8017983131', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Castleview Hospital', 'Castleview Hospital', NULL, NULL, 'HCFA|UB|', '1306889522', 0, 'N', 0, '2013-12-23', NULL, NULL, 0, 0, NULL, NULL),
('760672149', 'W12035409', 'W12035409', 'TXHOUSTD', 'Moe Zaw MD', 'Moe', 'O', 'Zaw', 'MD', 'Internal Medicine', '', '', NULL, 'O', '7141 SW Fwy', 'Houston', 'Harris', 'TX', '77074', '7137731132', '7137738866', '7141 SW Fwy', 'Houston', 'Harris', 'TX', '77074', '7137731132', '7137738866', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1255330106', 0, 'N', 0, '2013-08-09', NULL, NULL, 29.7057, -95.5111, NULL, NULL),
('760361732', 'W12035410', 'W12035410', 'TXDALSTD', 'Kanubhai Patel MD', 'Kanubhai', 'A', 'Patel', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1441 Redbud Blvd Ste 101', 'Mckinney', 'Collin', 'TX', '75069', '9725488998', '9725489522', '1441 Redbud Blvd Ste 101', 'Mckinney', 'Collin', 'TX', '75069', '9725488998', '9725489522', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-07-23', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1225090848', 0, 'N', 0, '2013-07-23', NULL, NULL, 33.2112, -96.6341, NULL, NULL),
('710922709', 'W12035412', 'W12035412', 'UT01', '', 'Matthew', 'S', 'Ward', 'MD', 'Ophthalmology', '', '', NULL, 'O', '280 W River Park Dr Ste 220', 'Provo', 'Utah', 'UT', '84604', '8012243565', '8012243567', '280 W River Park Dr Ste 220', 'Provo', 'Utah', 'UT', '84604', '8012243565', '8012243567', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Central Valley Medical Center', '', '', '', 'HCFA|UB|', '1023251881', 0, 'N', 0, '2013-12-23', NULL, NULL, 40.3037, -111.662, NULL, NULL),
('870354540', 'W12035416', 'W12035416', 'UT01', 'ENT Specialists', 'Justin', 'D', 'Hill', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '4000 S 700 E Ste 10', 'Murray', 'Salt Lake', 'UT', '84107', '8012684141', '8012618609', '4000 S 700 E Ste 10', 'Murray', 'Salt Lake', 'UT', '84107', '8012684141', '8012618609', 'WUSTDENT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1750590238', 0, 'N', 0, '2014-01-06', NULL, NULL, 40.6857, -111.871, NULL, NULL),
('870354540', 'W12035417', 'W12035417', 'UT01', 'ENT Specialists', 'Justin', 'D', 'Hill', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '74 E 11800 S Ste 360', 'Draper', 'Salt Lake', 'UT', '84020', '8012603687', '8012618609', '74 E 11800 S Ste 360', 'Draper', 'Salt Lake', 'UT', '84020', '8012603687', '8012618609', 'WUSTDENT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1750590238', 0, 'N', 0, '2014-01-06', NULL, NULL, 40.537, -111.889, NULL, NULL),
('830326307', 'W12035420', 'W12035420', 'WYT1', 'Community Health Center of Central Wyoming', 'Ryan', 'W', 'Black', 'PA', 'Dermatology', '', '', NULL, 'O', '5000 Blackmore Rd', 'Casper', 'Natrona', 'WY', '82609', '3072336000', '3072336089', '5000 Blackmore Rd', 'Casper', 'Natrona', 'WY', '82609', '3072336000', '3072336089', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932452091', 0, 'N', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'W12035419', 'W12035419', 'WY01', 'Community Health Center of Central Wyoming', 'Ryan', 'W', 'Black', 'PA', 'Dermatology', '', '', NULL, 'O', '5000 Blackmore Rd', 'Casper', 'Natrona', 'WY', '82609', '3072336000', '3072336089', '5000 Blackmore Rd', 'Casper', 'Natrona', 'WY', '82609', '3072336000', '3072336089', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932452091', 0, 'N', 0, '2013-11-13', NULL, NULL, 42.8286, -106.293, NULL, NULL),
('270441391', 'W12035421', 'W12035421', 'UTMH1', 'NeuroPsychology of Utah', 'Adam', '', 'Schwebach', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'B', 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', '8006588556', '8013529502', 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', '8006588556', '8013529502', 'PHD', '', '', '0.00', '40.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780837047', 0, 'N', 0, '2013-07-09', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'W12035423', 'W12035423', 'WYT1', 'Community Health Center of Central Wyoming', 'Beverly', 'J', 'North', 'NP', 'Family Practice', '', '', NULL, 'O', '5000 Blackmore Rd', 'Casper', 'Natrona', 'WY', '82609', '3072336000', '3072336089', '5000 Blackmore Rd', 'Casper', 'Natrona', 'WY', '82609', '3072336000', '3072336089', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750727574', 0, 'N', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'W12035422', 'W12035422', 'WY01', 'Community Health Center of Central Wyoming', 'Beverly', 'J', 'North', 'NP', 'Family Practice', '', '', NULL, 'O', '5000 Blackmore Rd', 'Casper', 'Natrona', 'WY', '82609', '3072336000', '3072336089', '5000 Blackmore Rd', 'Casper', 'Natrona', 'WY', '82609', '3072336000', '3072336089', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750727574', 0, 'N', 0, '2013-11-13', NULL, NULL, 42.8286, -106.293, NULL, NULL),
('621801973', 'W12035424', 'W12035424', 'UT01', 'Jordan Parkway Medical Clinic ', 'Michael', 'L', 'Cosgrave', 'DO', 'Family Practice', 'Sports Medicine', '', NULL, 'O', '3570 W 9000 S Ste 100', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015692384', '8015698643', '3570 W 9000 S Ste 100', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015692384', '8015698643', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-08-01', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720252117', 0, 'N', 0, '2013-07-25', NULL, NULL, 40.588, -111.975, NULL, NULL),
('870354442', 'W12035425', 'W12035425', 'UT01', 'Rocky Mountain Womens Health Center', 'Erin', 'K', 'Cassiere', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1580 W Antelope Dr Ste 290', 'Layton', 'Davis', 'UT', '84041', '8017760880', NULL, '1580 W Antelope Dr Ste 290', 'Layton', 'Davis', 'UT', '84041', '8017760880', '          ', 'WRYMTWOM', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-08-01', '2014-04-30', 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1700048980', 0, 'N', 0, '2013-07-22', NULL, NULL, 41.0893, -111.994, NULL, NULL),
('870354442', 'W12035427', 'W12035427', 'UT01', 'Rocky Mountain Womens Health Center', 'Erin', 'K', 'Cassiere', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 844839', 'Dallas', 'Dallas', 'TX', '75284', '0000000000', NULL, 'PO Box 844839', 'Dallas', 'Dallas', 'TX', '75284', '0000000000', '          ', 'WRYMTWOM', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-08-01', '2014-04-30', 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1700048980', 0, 'N', 0, '2013-07-22', NULL, NULL, 0, 0, NULL, NULL),
('850275777', 'W12035429', 'W12035429', 'NM01', 'Southwest Medical Associates', 'Susan', 'L', 'Simon', 'CNM', 'Obstetrics and Gynecology', '', '', 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, '2013-08-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1659446433', 0, 'N', 0, '2013-10-30', NULL, NULL, 35.131, -106.591, NULL, NULL),
('850275777', 'W12035428', 'W12035428', 'NM01', 'Southwest Medical Associates', 'Susan', 'L', 'Simon', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'M', '6100 Pan American Fwy NE Ste 100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', '5057974503', '6100 Pan American Fwy NE Ste 100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', '5057974503', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1659446433', 0, 'N', 0, '2013-10-30', NULL, NULL, 0, 0, NULL, NULL),
('850275777', 'W12035430', 'W12035430', 'NM01', 'Southwest Medical Associates', 'Susan', 'L', 'Simon', 'CNM', 'Obstetrics and Gynecology', '', '', 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, '2013-08-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1659446433', 0, 'N', 0, '2013-10-30', NULL, NULL, 35.1902, -106.665, NULL, NULL),
('364130066', 'W12035432', 'W12035432', 'ILCHIGSTD', 'Advanced Foot and Ankle', 'Daniel', 'J', 'Walters', 'DPM', 'Podiatry', '', '', NULL, 'O', '6545 W Archer Ave', 'Chicago', 'Cook', 'IL', '60638', '7735860050', '7735860533', '6545 W Archer Ave', 'Chicago', 'Cook', 'IL', '60638', '7735860050', '7735860533', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-08-17', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598832552', 0, 'N', 0, '2013-07-10', NULL, NULL, 41.7922, -87.7856, NULL, NULL),
('364130066', 'W12035431', 'W12035431', 'ILCHIGSTD', 'Advanced Foot and Ankle', 'Daniel', 'J', 'Walters', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-08-07', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598832552', 0, 'N', 0, '2014-01-20', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('621801973', 'W12035433', 'W12035433', 'UT01', 'Jordan Valley Internal Medicine', 'Michelle ', 'L', 'Palmer', '', 'Family Practice', '', '', NULL, 'O', '3570 W 9000 S Ste 100', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015692384', '8015698643', '3570 W 9000 S Ste 100', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015692384', '8015698643', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-08-01', '2013-09-06', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194987875', 0, 'N', 0, '2013-08-26', NULL, NULL, 0, 0, NULL, NULL),
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('760617995', 'W12035488', 'W12035488', 'TXHOUSTD', 'Sealy Urgent Care Medical Center', 'Kannappan', '', 'Krishnaswamy', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1036 N Circle Dr', 'Sealy', 'Austin', 'TX', '77474', '9788770022', '9788853810', '1036 N Circle Dr', 'Sealy', 'Austin', 'TX', '77474', '9788770022', '9788853810', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-12', NULL, 0, 0, 0, '', '', '', '', 'HCFA', '1700886900', 0, 'N', 0, '2013-07-12', NULL, NULL, 29.773, -96.1588, NULL, NULL),
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('820200895', 'W12035592', 'W12035592', 'IDBOISTD', 'Saint Alphonsus Medical Group OBGYN Mulvaney', 'Alison', '', 'Shearer', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1072 N Liberty Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083674224', '2083677806', '1072 N Liberty Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083674224', '2083677806', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-07-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'Saint Alphonsus Medical Center Nampa', '', '', 'HCFA|', '1396898482', 0, 'N', 0, '2014-03-18', NULL, NULL, 43.6156, -116.261, NULL, NULL),
('529874358', 'W12035664', 'W12035664', 'UTMH1', '', 'Katherine', 'M', 'Tolsma', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '5801 S Fashion Blvd Ste 230', 'Murray', 'Salt Lake', 'UT', '84107', '8013501599', NULL, '5801 S Fashion Blvd Ste 230', 'Murray', 'Salt Lake', 'UT', '84107', '8013501599', '', 'UTMA', '', '', '0.00', '40.00', '0.00', 6, '2013-07-01', '2014-02-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417155227', 0, 'N', 0, '2014-04-15', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'W12035595', 'W12035595', 'UT01', 'Ogden Clinic', 'Kyle', 'G', 'Dunning', 'MD', 'General Surgery', '', '', NULL, 'O', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753000', '8014753001', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753000', '8014753001', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-10-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1548453582', 0, 'N', 0, '2013-09-10', NULL, NULL, 41.1787, -111.949, NULL, NULL),
('760540476', 'W12035598', 'W12035598', 'TXHOUSTD', 'Oakbend Medical Group', 'Benjamin', '', 'Oei', 'MD', 'Family Practice', '', '', NULL, 'O', '4911 Sand Hill Dr', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2812387870', '2816334985', '4911 Sand Hill Dr', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2812387870', '2816334985', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396845740', 0, 'N', 0, '2013-07-15', NULL, NULL, 29.5995, -95.682, NULL, NULL),
('760540476', 'W12035599', 'W12035599', 'TXHOUSTD', 'Oakbend Medical Group', 'Benjamin', '', 'Oei', 'MD', 'Family Practice', '', '', NULL, 'O', '30525 First St Ste C', 'Rosenberg', 'Fort Bend', 'TX', '77471', '2816334950', '2816334955', '30525 First St Ste C', 'Rosenberg', 'Fort Bend', 'TX', '77471', '2816334950', '2816334955', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396845740', 0, 'N', 0, '2013-07-15', NULL, NULL, 29.5491, -95.8087, NULL, NULL),
('621801973', 'W12035600', 'W12035600', 'UT01', 'Endurance Orthopedics and Sports Medicine', 'Mark', 'D', 'Scholl', 'MD', 'Orthopedic Surgery', 'Sports Medicine', NULL, NULL, 'O', '2645 E Parleys Way Ste 5', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8014245042', '8012938618', '2645 E Parleys Way Ste 5', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8014245042', '8012938618', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-07-10', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1396713020', 0, 'N', 0, '2013-07-25', NULL, NULL, 40.7203, -111.816, NULL, NULL),
('451125559', 'W12035604', 'W12035604', 'TXHOUSTD', 'Cardiac Specialists of Houston ', 'Masroor', '', 'Khan', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '10021 Main Ste B1', 'Houston', 'Harris', 'TX', '77025', '7137976000', '7137979090', '10021 Main Ste B1', 'Houston', 'Harris', 'TX', '77025', '7137976000', '7137979090', 'HOUSTON2', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-23', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, '', '', 'HCFA|UB', '1861482861', 0, 'N', 0, '2013-07-23', NULL, NULL, 29.6764, -95.4284, NULL, NULL),
('451125559', 'W12035605', 'W12035605', 'TXHOUSTD', 'Cardiac Specialists of Houston ', 'Masroor', '', 'Khan', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 540088', 'Houston', 'Harris', 'TX', '772534', '0000000000', '0000000000', 'PO Box 540088', 'Houston', 'Harris', 'TX', '772534', '0000000000', '0000000000', 'HOUSTON2', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-23', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, '', '', 'HCFA|UB', '1861482861', 0, 'N', 0, '2013-07-23', NULL, NULL, 0, 0, NULL, NULL),
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('461482835', 'W12035606', 'W12035606', 'UT01', 'Rocky Mountain Allergy Asthma and Immunology ', 'Rafael', '', 'Firszt', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '380 E 1500 S Ste 201', 'Heber City', 'Wasatch', 'UT', '84032', '8017759800', '8017759806', '380 E 1500 S Ste 201', 'Heber City', 'Wasatch', 'UT', '84032', '8017759800', '8017759806', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', '2030-01-01', 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1659616241', 0, 'N', 1, '2013-09-20', NULL, NULL, 0, 0, NULL, NULL),
('461482835', 'W12035609', 'W12035609', 'UT01', 'Rocky Mountain Allergy Asthma and Immunology ', 'Rafael', '', 'Firszt', 'MD', 'Allergy and Immunology', '', '', NULL, 'B', 'PO Box 410008', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '0000000000', '0000000000', 'PO Box 410008', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '0000000000', '0000000000', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', '2030-01-01', 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1659616241', 0, 'N', 1, '2013-09-20', NULL, NULL, 0, 0, NULL, NULL),
('860735726', 'W12035610', 'W12035610', 'Sinclair', 'Flagstaff Bone and Joint', 'Meredith', 'K', 'Sena', 'PT', 'Physical Therapy', '', '', NULL, 'O', '77 W Forest Ave Ste 301', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287732280', '9287732281', '77 W Forest Ave Ste 301', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287732280', '9287732281', '', '', '', '0.00', '40.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720424997', 0, 'N', 0, '2013-08-27', NULL, NULL, 0, 0, NULL, NULL),
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('202906475', 'W12035615', 'W12035615', 'UT01', 'Dixie Hearing and Balance Center', 'Richard', 'L', 'Luekenga', 'AUD', 'Audiology', NULL, NULL, NULL, 'O', '1251 N Northfield Rd Ste 202', 'Cedar City', 'Iron', 'UT', '84720', '4356888991', '4356882122', '1251 N Northfield Rd Ste 202', 'Cedar City', 'Iron', 'UT', '84720', '4356888991', '4356882122', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609818905', 0, 'N', 0, '2013-07-15', NULL, NULL, 37.6996, -113.068, NULL, NULL),
('202906475', 'W12035616', 'W12035616', 'UT01', 'Dixie Hearing and Balance Center', 'Richard', 'L', 'Luekenga', 'AUD', 'Audiology', NULL, NULL, NULL, 'O', '145 N 100 E', 'Richfield', 'Sevier', 'UT', '84701', '4356888991', '4356882122', '145 N 100 E', 'Richfield', 'Sevier', 'UT', '84701', '4356888991', '4356882122', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609818905', 0, 'N', 0, '2013-07-15', NULL, NULL, 38.7701, -112.083, NULL, NULL),
('611696015', 'W12035620', 'W12035620', 'UT01', 'Lakeview Behavioral Health', 'Joe', 'C', 'Culbertson', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '630 Medical Dr', 'Bountiful', 'Davis', 'UT', '84010', '8012993781', '8012992416', '630 Medical Dr', 'Bountiful', 'Davis', 'UT', '84010', '8012993781', '8012992416', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB', '1548286792', 0, 'N', 0, '2013-09-10', NULL, NULL, 40.8869, -111.869, NULL, NULL),
('870373083', 'W12035621', 'W12035621', 'UT01', 'Heart and Lung Institute of Utah', 'Rasheel', 'A', 'Chowdhary', 'MD', 'Pulmonary', '', '', NULL, 'O', '5980 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012632370', '8012651200', '5980 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012632370', '8012651200', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-01-01', '2014-04-30', 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1467656264', 0, 'N', 0, '2013-12-17', NULL, NULL, 40.6408, -111.883, NULL, NULL),
('870373083', 'W12035623', 'W12035623', 'UT01', 'Heart And Lung Institute', 'Rasheel', 'A', 'Chowdhary', 'MD', 'Pulmonary', '', '', NULL, 'O', '3570 W 9000 S Ste 110', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012622370', '8012661200', '3570 W 9000 S Ste 110', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012622370', '8012661200', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-01-01', '2014-04-30', 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1467656264', 0, 'N', 0, '2013-12-17', NULL, NULL, 40.588, -111.975, NULL, NULL),
('870373083', 'W12035624', 'W12035624', 'UT01', 'Heart and Lung Institute of Utah Inc', 'Rasheel', 'A', 'Chowdhary', 'MD', 'Pulmonary', '', '', NULL, 'B', 'PO Box 847112', 'Dallas', 'Dallas', 'TX', '75284', '8012632370', '8012651200', 'PO Box 847112', 'Dallas', 'Dallas', 'TX', '75284', '8012632370', '8012651200', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-01-01', '2014-04-30', 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1467656264', 0, 'N', 0, '2013-12-17', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W12035625', 'W12035625', 'IDBOISTD', 'Primary Health Medical Group', 'Aaron', 'L', 'Bledsoe', 'PA', 'Family Practice', '', '', NULL, 'O', '8971 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083784288', '2083784297', '8971 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083784288', '2083784297', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366724650', 0, 'N', 0, '2013-08-27', NULL, NULL, 43.5903, -116.294, NULL, NULL),
('202630141', 'W12035626', 'W12035626', 'IDBOISTD', 'Primary Health Medical Group', 'Aaron', 'L', 'Bledsoe', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 191050', 'Boise', 'Ada', 'ID', '83719', '2084666567', NULL, 'PO Box 191050   ', 'Boise', 'Ada', 'ID', '83719', '2084666567', '          ', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366724650', 0, 'N', 0, '2013-08-27', NULL, NULL, 0, 0, NULL, NULL),
('850275777', 'W12035627', 'W12035627', 'NM01', 'Southwest Medical Associates', '', '', 'Southwest Medical Associates', '', '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, '2013-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009787', 0, 'Y', 0, '2013-10-31', NULL, NULL, 35.131, -106.591, NULL, NULL),
('850275777', 'W12035628', 'W12035628', 'NM01', 'Southwest Medical Associates', '', '', 'Southwest Medical Associates', '', '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, '2013-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009787', 0, 'Y', 0, '2013-10-31', NULL, NULL, 35.2073, -106.676, NULL, NULL),
('870680455', 'W12035629', 'W12035629', 'UT01', 'Ogden Ortho & Neurosurgical Specialists', '', '', 'Ogden Ortho & Neurosurgical Specialists', 'GROUP', '', '', '', NULL, 'B', 'PO Box 150356', 'Ogden', 'Weber', 'UT', '84415', '8013872600', NULL, 'PO Box 150356', 'Ogden', 'Weber', 'UT', '84415', '8013872600', '          ', 'WiseOGORTHO', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-08-31', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007936', 0, 'Y', 0, '2013-07-15', NULL, NULL, 0, 0, NULL, NULL),
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('362643663', 'W12035661', 'W12035661', 'ILCHIGSTD', 'Horizon Office Technologies', 'Michelle', 'C', 'OLeary', 'MD', 'Pathology', '', '', NULL, 'B', '2205 Point Blvd Ste 220', 'Elgin', 'Kane', 'IL', '60123', '2242384200', '0000000000', '2205 Point Blvd Ste 220', 'Elgin', 'Kane', 'IL', '60123', '2242384200', '0000000000', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-06-24', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285890863', 0, 'N', 0, '2013-07-17', NULL, NULL, 0, 0, NULL, NULL),
('262388378', 'W12035662', 'W12035662', 'UT01', 'Utah Endocrinology Associates', '', '', 'Utah Endocrinology Associates PLLC', 'MD', 'Endocrinology', '', '', NULL, 'O', '470 E 3900 S Ste 200', 'Murray', 'Salt Lake', 'UT', '84107', '8017472800', '8017475222', '470 E 3900 S Ste 200', 'Murray', 'Salt Lake', 'UT', '84107', '8017472800', '8017475222', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000003001', 0, 'N', 0, '2013-07-17', NULL, NULL, 40.6871, -111.878, 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
('262388378', 'W12035663', 'W12035663', 'UT01', 'Utah Endocrinology Associates', '', '', 'Utah Endocrinology Associates PLLC', 'MD', 'Endocrinology', '', '', NULL, 'B', 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8017477465', '8017477237', 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8017477465', '8017477237', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000003001', 0, 'N', 0, '2013-07-17', NULL, NULL, 0, 0, NULL, NULL),
('529874358', 'W12035665', 'W12035665', 'UTMH1', '', 'Katherine', 'M', 'Tolsma', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 27128', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8013501599', NULL, 'PO Box 27128', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8013501599', '', 'UTMA', '', '', '0.00', '40.00', '0.00', 6, '2013-07-01', '2014-02-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417155227', 0, 'N', 0, '2014-04-15', NULL, NULL, 0, 0, NULL, NULL),
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('261240978', 'W12035670', 'W12035670', 'TXHOUSTD', 'Enayat Rahim MD PA', 'Enayet', '', 'Rahim', 'MD', 'Internal Medicine', '', '', NULL, 'O', '13630 Beamer Rd Ste 114', 'Houston', 'Harris', 'TX', '77089', '2814818500', '2814818520', '13630 Beamer Rd Ste 114', 'Houston', 'Harris', 'TX', '77089', '2814818500', '2814818520', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811999014', 0, 'N', 0, '2013-09-04', NULL, NULL, 29.5777, -95.2047, NULL, NULL),
('760681988', 'W12035672', 'W12035672', 'TXHOUSTD', 'C Funsho Fagbohun MD', 'C Funsho', '', 'Fagbohun', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1601 Main St Ste A', 'Richmond', 'Fort Bend', 'TX', '77469', '2813426962', '2813426963', '1601 Main St Ste A', 'Richmond', 'Fort Bend', 'TX', '77469', '2813426962', '2813426963', 'HOUSTON3', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-23', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, '', '', 'HCFA', '1629016415', 0, 'N', 0, '2013-08-09', NULL, NULL, 29.5772, -95.7691, NULL, NULL),
('760681988', 'W12035673', 'W12035673', 'TXHOUSTD', 'C Funsho Fagbohun MD', 'C Funsho', '', 'Fagbohun', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'M', '324 Dulles Dr', 'Lafayette', 'Lafayette', 'LA', '70506', '0000000000', '0000000000', '324 Dulles Dr', 'Lafayette', 'Lafayette', 'LA', '70506', '0000000000', '0000000000', 'HOUSTON3', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-23', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, '', '', 'HCFA', '1629016415', 0, 'N', 0, '2013-08-09', NULL, NULL, 0, 0, NULL, NULL),
('870710584', 'W12035674', 'W12035674', 'UTMH1', 'Jordan West Family Counseling', 'Gayle', '', 'Wyner', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '9263 Redwood Rd Bldg 8 Ste B', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660749', '8015667108', '9263 Redwood Rd Bldg 8 Ste B', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660749', '8015667108', 'UTMA', '', '', '0.00', '40.00', '0.00', 6, '2013-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497194906', 0, 'N', 0, '2013-09-23', NULL, NULL, 40.583, -111.939, NULL, NULL),
('870710584', 'W12035675', 'W12035675', 'UTMH1', 'Jordan West Family Counseling', 'Noelle', 'K', 'Gardner', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '9263 Redwood Rd Bldg 8 Ste B', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660749', '8015667108', '9263 Redwood Rd Bldg 8 Ste B', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660749', '8015667108', 'UTMA', '', '', '0.00', '40.00', '0.00', 6, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336442227', 0, 'N', 0, '2013-07-23', NULL, NULL, 40.583, -111.939, NULL, NULL),
('870710584', 'W12035676', 'W12035676', 'UTMH1', 'Jordan West Family Counseling', 'Kathleen', '', 'Hofer', 'CMHC', 'Mental Health', 'Counseling', '', NULL, 'O', '9263 Redwood Rd Bldg 8 Ste B', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660749', '8015667108', '9263 Redwood Rd Bldg 8 Ste B', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660749', '8015667108', 'UTMA', '', '', '0.00', '40.00', '0.00', 6, '2013-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326175282', 0, 'N', 0, '2013-09-23', NULL, NULL, 40.583, -111.939, NULL, NULL),
('870710584', 'W12035677', 'W12035677', 'UTMH1', 'Jordan West Family Counseling', 'Keralee', '', 'Vought', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '9263 Redwood Rd Bldg 8 Ste B', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660749', '8015667108', '9263 Redwood Rd Bldg 8 Ste B', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660749', '8015667108', 'UTMA', '', '', '0.00', '40.00', '0.00', 6, '2013-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083925200', 0, 'N', 0, '2013-09-23', NULL, NULL, 40.583, -111.939, NULL, NULL),
('621801973', 'W12035678', 'W12035678', 'UT01', 'South Towne Surgery Center', 'Andrew', 'D', 'Cooper', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '10011 S Centennial Pkwy Ste 100', 'Sandy', 'Salt Lake', 'UT', '84070', '8012339300', '0000000000', '10011 S Centennial Pkwy Ste 100', 'Sandy', 'Salt Lake', 'UT', '84070', '8012339300', '0000000000', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-07-16', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1477547164', 0, 'N', 0, '2013-07-18', NULL, NULL, 40.5696, -111.895, NULL, NULL),
('836000025', 'W12035679', 'W12035679', 'WY01', 'Wagon Circle Family Practice', 'James', 'A', 'Trent', 'MD', 'Family Practice', '', '', NULL, 'O', '2012 W Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3073245346', '0000000000', '2012 W Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3073245346', '0000000000', 'WISEWYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 6, '2013-07-15', NULL, 0, 0, 0, 'Memorial Hospital of Carbon County', '', '', '', 'HCFA|', '1285756007', 0, 'N', 0, '2013-09-12', NULL, NULL, 41.7872, -107.259, NULL, NULL),
('272118774', 'W12035680', 'W12035680', 'UT01', 'Advanced Spine Pain Specialists', 'Vikas', '', 'Garg', 'MD', 'Pain Management', NULL, NULL, NULL, 'O', '11800 S State Ste 350', 'Draper', 'Salt Lake', 'UT', '84020', '8012611391', '0000000000', '11800 S State Ste 350', 'Draper', 'Salt Lake', 'UT', '84020', '8012611391', '0000000000', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-07-01', '2013-10-31', 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1104852599', 0, 'N', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('363323927', 'W12035681', 'W12035681', 'ILCHIGSTD', 'Robert H Geller MD', 'Robert', '', 'Geller', 'MD', 'General Surgery', '', '', NULL, 'O', '1200 S York Rd Ste 4280', 'Elmhurst', 'Dupage', 'IL', '60126', '7084500462', '7084501591', '1200 S York Rd Ste 4280', 'Elmhurst', 'Dupage', 'IL', '60126', '7084500462', '7084501591', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1326068677', 0, 'N', 0, '2013-10-24', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('820200895', 'W12035682', 'W12035682', 'IDBOISTD', 'Saint Alphonsus Medical Group Diabetic Education', 'Cindy', 'K', 'Horrocks', 'RD, LD, CDE', 'Diabetic Education', '', '', NULL, 'O', '3250 W Cherry Ln', 'Meridian', 'Ada', 'ID', '83642', '2083676130', '2083677316', '3250 W Cherry Ln', 'Meridian', 'Ada', 'ID', '83642', '2083676130', '2083677316', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-07-08', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1992059125', 0, 'N', 0, '2014-01-23', NULL, NULL, 43.6193, -116.434, NULL, NULL),
('820200895', 'W12035683', 'W12035683', 'IDBOISTD', 'Saint Alphonsus Medical Group Diabetic Education', 'Marjorie', '', 'Rich', 'RD, LD, CDE', 'Diabetic Education', '', '', NULL, 'O', '3250 W Cherry Ln', 'Meridian', 'Ada', 'ID', '83642', '2083676130', '2083677316', '3250 W Cherry Ln', 'Meridian', 'Ada', 'ID', '83642', '2083676130', '2083677316', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-07-08', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1558664755', 0, 'N', 0, '2014-01-23', NULL, NULL, 43.6193, -116.434, NULL, NULL),
('820200895', 'W12035684', 'W12035684', 'IDBOISTD', 'Saint Alphonsus Medical Group Diabetic Education', 'Barbara', '', 'Irish', 'NPC', 'Nurse Practitioner', '', '', NULL, 'O', '3250 W Cherry Ln', 'Meridian', 'Ada', 'ID', '83642', '2083676130', '2083677316', '3250 W Cherry Ln', 'Meridian', 'Ada', 'ID', '83642', '2083676130', '2083677316', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-07-08', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1598774275', 0, 'N', 0, '2014-01-23', NULL, NULL, 43.6193, -116.434, NULL, NULL),
('820200895', 'W12035685', 'W12035685', 'IDBOISTD', 'Saint Alphonsus Medical Group Diabetic Education', 'D Nicole', '', 'Livingston', 'NP-C', 'Family Practice', '', '', NULL, 'O', '3250 W Cherry Ln', 'Meridian', 'Ada', 'ID', '83642', '2083676130', '2083677316', '3250 W Cherry Ln  ', 'Meridian', 'Ada', 'ID', '83642', '2083676130', '2083677316', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-07-08', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1508133679', 0, 'N', 0, '2014-01-23', NULL, NULL, 43.6193, -116.434, NULL, NULL),
('820200895', 'W12035686', 'W12035686', 'IDBOISTD', 'Saint Alphonsus Medical Group Diabetic Education', 'Jared', 'T', 'Rye', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'O', '3250 W Cherry Ln', 'Meridian', 'Ada', 'ID', '83642', '2083676130', '2083677316', '3250 W Cherry Ln', 'Meridian', 'Ada', 'ID', '83642', '2083676130', '2083677316', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-07-08', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1457596413', 0, 'N', 0, '2014-01-24', NULL, NULL, 43.6193, -116.434, NULL, NULL),
('820200895', 'W12035687', 'W12035687', 'IDBOISTD', 'Saint Alphonsus Medical Group Diabetic Education', 'Martha', 'G', 'Shelver', 'NPC', 'Diabetic Education', '', '', NULL, 'O', '3250 W Cherry Ln', 'Meridian', 'Ada', 'ID', '83642', '2083676130', '2083677316', '3250 W Cherry Ln', 'Meridian', 'Ada', 'ID', '83642', '2083676130', '2083677316', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2013-07-08', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1528218625', 0, 'N', 0, '2014-06-13', NULL, NULL, 43.6193, -116.434, NULL, NULL),
('820200895', 'W12035688', 'W12035688', 'IDBOISTD', 'Saint Alphonsus Medical Group Diabetic Education', 'Catherine', '', 'Prinzing', 'CNS', 'Nurse SpecialistCertified', '', '', NULL, 'O', '3250 W Cherry Ln', 'Meridian', 'Ada', 'ID', '83642', '2083676130', '2083677316', '3250 W Cherry Ln', 'Meridian', 'Ada', 'ID', '83642', '2083676130', '2083677316', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-07-08', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1932331626', 0, 'Y', 0, '2014-01-23', NULL, NULL, 43.6193, -116.434, NULL, NULL),
('820425454', 'W12035689', 'W12035689', 'ID01', 'Boise Anesthesia PA', 'James', 'L', 'Ward', 'MD', 'Anesthesiology', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676416', '2083759530', '1055 N Curtis Rd    ', 'Boise', 'Ada', 'ID', '83706', '2083676416', '2083759530', 'IDSAMG3', '', '', '62.80', '10.00', '0.00', 3, '2013-07-11', NULL, 1, 15, 0, '', '', 'West Valley Medical Center', '', 'HCFA|UB|', '1720133085', 0, 'N', 0, '2013-07-18', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('820425454', 'W12035690', 'W12035690', 'ID01', 'Boise Anesthesia PA', 'James', 'L', 'Ward', 'MD', 'Anesthesiology', '', '', NULL, 'O', '3025 W Cherry Ln', 'Meridian', 'Ada', 'ID', '83642', '2083678500', '2083759530', '3025 W Cherry Ln    ', 'Meridian', 'Ada', 'ID', '83642', '2083678500', '2083759530', 'IDSAMG3', '', '', '62.80', '10.00', '0.00', 3, '2013-07-11', NULL, 1, 15, 0, '', '', 'West Valley Medical Center', '', 'HCFA|UB|', '1720133085', 0, 'N', 0, '2013-07-18', NULL, NULL, 43.6193, -116.431, NULL, NULL),
('820425454', 'W12035691', 'W12035691', 'ID01', 'Boise Anesthesia PA', 'James', 'L', 'Ward', 'MD', 'Anesthesiology', '', '', NULL, 'O', '900 N Liberty St Ste 450', 'Meridian', 'Ada', 'ID', '83642', '2083677431', '2083759530', '900 N Liberty St Ste 450', 'Meridian', 'Ada', 'ID', '83642', '2083677431', '2083759530', 'IDSAMG3', '', '', '62.80', '10.00', '0.00', 3, '2013-07-11', NULL, 1, 15, 0, '', '', 'West Valley Medical Center', '', 'HCFA|UB|', '1720133085', 0, 'N', 0, '2013-07-18', NULL, NULL, 0, 0, NULL, NULL),
('820161600', 'W12035692', 'W12035692', 'ID02', 'St Lukes Clinic Saltzer Medical Group', 'Nicholas', '', 'Lewis', 'MD', 'Internal Medicine', '', '', NULL, 'O', '215 E Hawaii Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084633000', '2084654825', '215 E Hawaii Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084633000', '2084654825', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2013-06-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1134372386', 0, 'N', 0, '2013-07-18', NULL, NULL, 0, 0, NULL, NULL),
('452716222', 'W12035693', 'W12035693', 'ID02', 'St Lukes Clinic Family Medicine', 'Elizabeth', 'A', 'Rulon', 'MD', 'Family Practice', '', '', NULL, 'O', '130 E Boise Ave', 'Boise', 'Ada', 'ID', '83712', '2083454066', '2083454196', '130 E Boise Ave', 'Boise', 'Ada', 'ID', '83712', '2083454066', '2083454196', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1558300475', 0, 'N', 0, '2013-07-18', NULL, NULL, 0, 0, NULL, NULL),
('452716222', 'W12035694', 'W12035694', 'ID02', 'St Lukes Idaho Family Physicians', 'Elizabeth', 'A', 'Rulon', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 640', 'Boise', 'Ada', 'ID', '83701', '2087065000', '0000000000', 'PO Box 640', 'Boise', 'Ada', 'ID', '83701', '2087065000', '0000000000', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1558300475', 0, 'N', 0, '2013-10-16', NULL, NULL, 0, 0, NULL, NULL),
('870520042', 'W12032090', 'W12032090', 'UT01', 'Nephrology Associates', 'Minerva', '', 'Dantis Tan', 'NP', 'Family Practice', '', '', NULL, 'O', '650 E 4500 S Ste 210', 'Murray', 'Salt Lake', 'UT', '84107', '8012882634', '8012881186', '650 E 4500 S Ste 210', 'Murray', 'Salt Lake', 'UT', '84107', '8012882634', '8012881186', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164715124', 0, 'N', 0, '2013-07-19', NULL, NULL, 40.6743, -111.874, NULL, NULL),
('452716222', 'W12035696', 'W12035696', 'ID02', 'St Lukes Clinic Pediatric Cystic Fibrosis', 'Elizabeth', 'A', 'Rulon', 'MD', 'Family Practice', '', '', NULL, 'O', '100 E Idaho St Ste 316', 'Boise', 'Ada', 'ID', '83706', '2083817092', '2083817071', '100 E Idaho St Ste 316', 'Boise', 'Ada', 'ID', '83706', '2083817092', '2083817071', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1558300475', 0, 'N', 0, '2013-07-18', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12035726', 'W12035726', 'WYT1', 'Campbell County Clinics OB/GYN Specialists', 'Jeffery', 'J', 'Anderson', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1414 W 4th St', 'Gillette', 'Campbell', 'WY', '82716', '3076863855', '3076868190', '1414 W 4th St', 'Gillette', 'Campbell', 'WY', '82716', '3076863855', '3076868190', '', '', '', '0.00', '21.00', '0.00', 6, '2013-09-01', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1043223696', 0, 'N', 0, '2013-10-18', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12035713', 'W12035713', 'UT01', 'Davis Hospital & Medical Center', 'Eun', '', 'Young Matineau', 'APRN', 'Psychiatry', '', '', NULL, 'O', '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8018203730', '0000000000', '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8018203730', '0000000000', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-08-01', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699050310', 0, 'N', 0, '2013-07-22', NULL, NULL, 41.0893, -111.995, NULL, NULL),
('273995478', 'W12035704', 'W12035704', 'UT01', 'Southwest Spine and Pain Care', 'Alan', 'P', 'Hillstead', 'MD', 'Pain Management', 'Anesthesiology', '', NULL, 'O', '1303 N Main St', 'Cedar City', 'Iron', 'UT', '84720', '4355862229', '4355862022', '1303 N Main St', 'Cedar City', 'Iron', 'UT', '84720', '4355862229', '4355862022', 'WISESTD', '', '', '0.00', '35.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1144431958', 0, 'N', 0, '2013-09-23', NULL, NULL, 37.7003, -113.064, NULL, NULL),
('273995478', 'W12035705', 'W12035705', 'UT01', 'Southwest Spine and Pain Care Specialists', 'Alan', 'P', 'Hillstead', 'MD', 'Pain Management', 'Anesthesiology', '', NULL, 'O', '652 S Medical Ctr Dr Ste 110', 'St George', 'Washington', 'UT', '84790', '4356562424', '4356562828', '652 S Medical Ctr Dr Ste 110', 'St George', 'Washington', 'UT', '84790', '4356562424', '4356562828', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1144431958', 0, 'N', 0, '2013-09-23', NULL, NULL, 37.0498, -113.574, NULL, NULL),
('273995478', 'W12035706', 'W12035706', 'UT01', 'Southwest Spine and Pain Care', 'Alan', 'P', 'Hillstead', 'MD', 'Pain Management', 'Anesthesiology', '', NULL, 'O', '70 E 1000 N', 'Richfield', 'Sevier', 'UT', '84701', '4358930580', '4358968420', '70 E 1000 N', 'Richfield', 'Sevier', 'UT', '84701', '4358930580', '4358968420', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1144431958', 0, 'N', 0, '2013-09-23', NULL, NULL, 38.8608, -111.967, NULL, NULL),
('870574059', 'W12035707', 'W12035707', 'UT01', 'Mountain Land Movement Specialists Murray', 'Michael', 'Adam', 'King', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '5872 S 900 E Ste 150', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8017473889', '8017475218', '5872 S 900 E Ste 150', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8017473889', '8017475218', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1063675304', 0, 'N', 0, '2013-07-22', NULL, NULL, 40.6432, -111.866, NULL, NULL),
('836000025', 'W12035708', 'W12035708', 'WYT1', 'Wagon Circle Family Practice', 'James', 'A', 'Trent', 'MD', 'Family Practice', '', '', NULL, 'O', '2012 W Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3073245346', '0000000000', '2012 W Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3073245346', '0000000000', 'WISEWYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 6, '2013-07-15', NULL, 0, 0, 0, 'Memorial Hospital of Carbon County', '', '', '', 'HCFA|', '1285756007', 0, 'N', 0, '2013-09-12', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12035709', 'W12035709', 'UT01', 'Lonnie Paulos MD', 'Leon (Lonnie)', 'E', 'Paulos', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '6415 S 3000 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8014662676', '0000000000', '6415 S 3000 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8014662676', '0000000000', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-07-08', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1992700330', 0, 'N', 0, '2013-07-25', NULL, NULL, 40.6345, -111.806, NULL, NULL),
('364314354', 'W12035710', 'W12035710', 'ILCHIGSTD', 'Presence Medical Group', 'Sonal', 'R', 'Patel', 'MD', 'Pediatrics', '', '', NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', '6309142499', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', '6309142499', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-07-15', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1740508514', 0, 'N', 0, '2013-07-22', NULL, NULL, 41.528, -88.1346, NULL, NULL),
('364314354', 'W12035711', 'W12035711', 'ILCHIGSTD', 'Presence Medical Group', 'Sonal', 'R', 'Patel', 'MD', 'Pediatrics', '', '', 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, '2013-07-15', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1740508514', 0, 'N', 0, '2013-07-22', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12035712', 'W12035712', 'UT01', 'Pioneer Valley Hospital', 'Eun', '', 'Young Matineau', 'APRN', 'Psychiatry', '', '', NULL, 'O', '3460 S Pioneer Pkwy', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643559', NULL, '3460 S Pioneer Pkwy', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643559', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-08-01', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699050310', 0, 'N', 0, '2013-07-22', NULL, NULL, 40.6972, -111.99, NULL, NULL),
('621801973', 'W12035714', 'W12035714', 'UT01', 'Salt Lake Regional Medical Center', 'Eun', '', 'Young Matineau', 'APRN', 'Psychiatry', '', '', NULL, 'O', '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504111', NULL, '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504111', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-08-01', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699050310', 0, 'N', 0, '2013-07-22', NULL, NULL, 40.7694, -111.861, NULL, NULL),
('621801973', 'W12035715', 'W12035715', 'UT01', 'Physician Group of Utah', 'Eun', '', 'Young Matineau', 'APRN', 'Psychiatry', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-08-01', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699050310', 0, 'N', 0, '2013-07-22', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12035722', 'W12035722', 'WYT1', 'Campbell County Clinics Orthopaedic Specialists', 'Vanessa', 'J', 'Gunn', 'PA', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 3046', 'Gillette', 'Campbell', 'WY', '82717', '0000000000', '0000000000', 'PO Box 3046', 'Gillette', 'Campbell', 'WY', '82717', '0000000000', '0000000000', '', '', '5001', '0.00', '21.00', '0.00', 6, '2013-11-01', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', '', '', '', 'HCFA|UB|', '1588996110', 0, 'N', 0, '2013-10-18', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12035721', 'W12035721', 'WY01', 'Campbell County Clinics Orthopaedic Specialists', 'Vanessa', 'J', 'Gunn', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82716', '3076883500', '3076883510', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82716', '3076883500', '3076883510', '', '', '5001', '0.00', '21.00', '0.00', 6, '2013-11-01', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', '', '', '', 'HCFA|UB|', '1588996110', 0, 'N', 0, '2013-10-18', NULL, NULL, 44.2903, -105.52, NULL, NULL),
('830234097', 'W12035723', 'W12035723', 'WY01', 'Campbell County Clinics Orthopaedic Specialists', 'Vanessa', 'J', 'Gunn', 'PA', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 3046', 'Gillette', 'Campbell', 'WY', '82717', '0000000000', '0000000000', 'PO Box 3046', 'Gillette', 'Campbell', 'WY', '82717', '0000000000', '0000000000', '', '', '5001', '0.00', '21.00', '0.00', 6, '2013-11-01', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', '', '', '', 'HCFA|UB|', '1588996110', 0, 'N', 0, '2013-10-18', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12035720', 'W12035720', 'WYT1', 'Campbell County Clinics Orthopaedic Specialists', 'Vanessa', 'J', 'Gunn', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82716', '3076883500', '3076883510', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82716', '3076883500', '3076883510', '', '', '5001', '0.00', '21.00', '0.00', 6, '2013-11-01', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', '', '', '', 'HCFA|UB|', '1588996110', 0, 'N', 0, '2013-10-18', NULL, NULL, 0, 0, NULL, NULL),
('870520042', 'W12035724', 'W12035724', 'UT01', 'Nephrology Associates', 'Reiad', 'Y', 'Najjar', 'MD', 'Nephrology', '', '', NULL, 'O', '650 E 4500 S Ste 210', 'Murray', 'Salt Lake', 'UT', '84107', '8012882634', '8017470932', '650 E 4500 S Ste 210', 'Murray', 'Salt Lake', 'UT', '84107', '8012882634', '8017470932', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', 'St Marks Hospital', '', '', 'HCFA|UB|', '1043498397', 0, 'N', 0, '2013-09-10', NULL, NULL, 40.6743, -111.874, NULL, NULL),
('830234097', 'W12035728', 'W12035728', 'WY01', 'OB/GYN Specialists', 'Jeffery', 'J', 'Anderson', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1405 W 4th St', 'Gillette', 'Campbell', 'WY', '82716', '0000000000', '0000000000', '1405 W 4th St', 'Gillette', 'Campbell', 'WY', '82716', '0000000000', '0000000000', '', '', '5001', '0.00', '0.00', '0.00', 6, '2013-09-01', '2013-09-01', 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1043223696', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12035725', 'W12035725', 'WY01', 'Campbell County Clinics OB/GYN Specialists', 'Jeffery', 'J', 'Anderson', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1414 W 4th St', 'Gillette', 'Campbell', 'WY', '82716', '3076863855', '3076868190', '1414 W 4th St', 'Gillette', 'Campbell', 'WY', '82716', '3076863855', '3076868190', '', '', '5001', '0.00', '0.00', '0.00', 6, '2013-09-01', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1043223696', 0, 'N', 0, '2013-10-18', NULL, NULL, 44.291, -105.523, NULL, NULL),
('830234097', 'W12035727', 'W12035727', 'WYT1', 'OB/GYN Specialists', 'Jeffery', 'J', 'Anderson', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1405 W 4th St', 'Gillette', 'Campbell', 'WY', '82716', '0000000000', '0000000000', '1405 W 4th St', 'Gillette', 'Campbell', 'WY', '82716', '0000000000', '0000000000', '', '', '', '0.00', '21.00', '0.00', 6, '2013-09-01', '2013-09-01', 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1043223696', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('362340313', 'W12035729', 'W12035729', 'ILCHIGSTD', 'Northwest Community Hospital', '', '', 'Northwest Community Hospital', '', 'Hospital', NULL, NULL, NULL, 'B', 'PO Box 95865', 'Chicago', 'Cook', 'IL', '60694', '8476181000', NULL, 'PO Box 95865', 'Chicago', 'Cook', 'IL', '60694', '8476181000', '          ', 'NWPROFFS', '', '', '0.00', '50.00', '0.00', 3, '2013-01-02', '2013-10-24', 0, 0, 0, '', '', '', '', 'HCFA', '1770531600', 0, 'Y', 0, '2013-11-20', NULL, NULL, 0, 0, NULL, NULL),
('362340313', 'W12035730', 'W12035730', 'ILCHIGSTD', 'Northwest Community Hospital', '', '', 'Northwest Community Hospital', '', 'Hospital', NULL, NULL, NULL, 'O', '800 W Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8476181000', NULL, '800 W Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8476181000', '          ', 'NWPROFFS', '', '', '0.00', '50.00', '0.00', 3, '2013-01-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA', '1770531600', 0, 'N', 0, '2013-09-05', NULL, NULL, 42.0666, -87.993, NULL, NULL),
('363330928', 'W12035992', 'W12035992', 'ILCHIGSTD', 'Presence Healthcare Services', 'Rebecca', '', 'Nishimoto', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '2233 W Division St', 'Chicago', 'Cook', 'IL', '60622', '3127702000', '3127703264', '2233 W Division St', 'Chicago', 'Cook', 'IL', '60622', '3127702000', '3127703264', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073624664', 0, 'N', 0, '2013-07-30', NULL, NULL, 41.9031, -87.6829, NULL, NULL),
('751382781', 'SPA100004', 'SPA100004', 'TXDALSTD', 'Family Practice Association', 'Richard', NULL, 'Redington', 'MD', 'Family Practice', '', '', NULL, 'O', '1410 W Jefferson', 'Waxahachie', 'Ellis', 'TX', '75165', '9729371210', '9729370243', '1410 W Jefferson', 'Waxahachie', 'Ellis', 'TX', '75165', '9729371210', '9729370243', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1003911959', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.3968, -96.865, NULL, NULL),
('751382781', 'SPA100006', 'SPA100006', 'TXDALSTD', 'Family Practice Association', 'Richard', NULL, 'Redington', 'MD', 'Family Practice', '', '', NULL, 'B', '17610 Preston Rd', 'Dallas', 'Collin', 'TX', '75252', '9729310400', '9729370243', '17610 Preston Rd', 'Dallas', 'Collin', 'TX', '75252', '9729310400', '9729370243', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1003911959', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.9922, -96.8002, NULL, NULL),
('752675062', 'SPA100011', 'SPA100011', 'TXDALSTD', 'Daniel Witheiler MD', 'Daniel', '', 'Witheiler', 'MD', 'Dermatology', '', '', NULL, 'B', '1305 W Jefferson Ste 115', 'Waxahachie', 'Ellis', 'TX', '75165', '2149417546', '2149412442', '1305 W Jefferson Ste 115', 'Waxahachie', 'Ellis', 'TX', '75165', '2149417546', '2149412442', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023083482', 0, 'Y', 0, '2014-04-10', NULL, NULL, 32.3953, -96.8626, NULL, NULL),
('752675062', 'SPA100012', 'SPA100012', 'TXDALSTD', 'Daniel Witheiler MD', 'Daniel', '', 'Witheiler', 'MD', 'Dermatology', '', '', NULL, 'O', '1411 N Beckley Ave Ste 470', 'Dallas', 'Dallas', 'TX', '75203', '2149417546', '2149412442', '1411 N Beckley Ave Ste 470', 'Dallas', 'Dallas', 'TX', '75203', '2149417546', '2149412442', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023083482', 0, 'N', 0, '2014-04-10', NULL, NULL, 32.761, -96.823, NULL, NULL),
('830207671', 'W12046484', 'W12046484', 'WY01', 'West Park Hospital District', 'Randy', 'J', 'Folker', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075227501', '3075782492', '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075227501', '3075782492', '', '', '', '0.00', '12.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1649296914', 0, 'N', 1, '2014-04-23', NULL, NULL, 0, 0, NULL, NULL),
('640951013', 'SPA100024', 'SPA100024', 'TXDALSTD', 'Dr Bradley Friedman MD', 'Bradley', 'R', 'Friedman', 'MD', 'Family Practice', '', '', NULL, 'B', '10670 N Central Expy Ste 170', 'Dallas', 'Dallas', 'TX', '75231', '2143681884', '9726680885', '10670 N Central Expy Ste 170', 'Dallas', 'Dallas', 'TX', '75231', '2143681884', '9726680885', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Frisco', NULL, '', '', 'HCFA|UB|', '1033135066', 0, 'Y', 0, '2014-03-27', NULL, NULL, 32.8921, -96.7685, NULL, NULL),
('640951013', 'SPA100022', 'SPA100022', 'TXDALSTD', 'Dr Bradley Friedman MD', 'Bradley', 'R', 'Friedman', 'MD', 'Family Practice', '', '', NULL, 'O', '11560 Teel Pkwy Ste 100', 'Frisco', 'Denton', 'TX', '75034', '9726680821', '9726680885', '11560 Teel Pkwy Ste 100', 'Frisco', 'Denton', 'TX', '75034', '9726680821', '9726680885', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Frisco', NULL, '', '', 'HCFA|UB|', '1033135066', 0, 'N', 0, '2014-03-27', NULL, NULL, 33.1731, -96.8633, NULL, NULL),
('455480260', 'SPA100025', 'SPA100025', 'TXDALSTD', 'Frisco ENT for Children', 'Amy', 'C', 'Brenski', 'MD', 'Pediatric Ear, Nose and Throat', '', '', NULL, 'O', '11445 Dallas Pkwy Ste 240', 'Frisco', 'Denton', 'TX', '75033', '9727458400', '9723159011', '11445 Dallas Pkwy Ste 240', 'Frisco', 'Denton', 'TX', '75033', '9727458400', '9723159011', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043270630', 0, 'Y', 0, '2014-04-10', NULL, NULL, 33.1529, -96.8367, NULL, NULL),
('455480260', 'SPA100026', 'SPA100026', 'TXDALSTD', 'Frisco ENT for Children', 'Amy', 'C', 'Brenski', 'MD', 'Pediatric Ear, Nose and Throat', '', '', NULL, 'B', '2698 N Galloway Ste 106', 'Mesquite', 'Dallas', 'TX', '75150', '9722707320', '9723159011', '2698 N Galloway Ste 106', 'Mesquite', 'Dallas', 'TX', '75150', '9722707320', '9723159011', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043270630', 0, 'Y', 0, '2014-04-10', NULL, NULL, 32.8013, -96.6102, NULL, NULL),
('455480260', 'SPA100027', 'SPA100027', 'TXDALSTD', 'Frisco ENT for Children', 'Amy', 'C', 'Brenski', 'MD', 'Pediatric Ear, Nose and Throat', '', '', NULL, 'M', '783 N Denton Tap Rd Ste 200', 'Coppell', 'Dallas', 'TX', '75019', '9727458400', '9723159011', '783 N Denton Tap Rd Ste 200', 'Coppell', 'Dallas', 'TX', '75019', '9727458400', '9723159011', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043270630', 0, 'Y', 0, '2014-04-10', NULL, NULL, 32.9894, -96.9934, NULL, NULL),
('752652430', 'SPA100028', 'SPA100028', 'TXDALSTD', 'Obstetrics and Gynecology of North Texas', 'Michael', 'N', 'Sims', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1301 E Debbie Ln Ste 102', 'Mansfield', 'Tarrant', 'TX', '76063', '8178875924', '8173298561', '1301 E Debbie Ln Ste 102', 'Mansfield', 'Tarrant', 'TX', '76063', '8178875924', '8173298561', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, NULL, NULL, 'HCFA|UB|', '1043275027', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('752652430', 'SPA100029', 'SPA100029', 'TXDALSTD', 'Obstetrics and Gynecology of North Texas', 'Michael', 'N', 'Sims', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1600 W College St Ste 540', 'Grapevine', 'Tarrant', 'TX', '76051', '8174815863', '8173298561', '1600 W College St Ste 540', 'Grapevine', 'Tarrant', 'TX', '76051', '8174815863', '8173298561', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, NULL, NULL, 'HCFA|UB|', '1043275027', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.9356, -97.0929, NULL, NULL),
('752696283', 'SPA100031', 'SPA100031', 'TXDALSTD', 'Fort Worth Vascular and Surgical Associates', 'Joseph', 'E', 'Guinn', 'MD', 'Vascular Surgery', '', '', NULL, 'B', '1425 8th Ave', 'Fort Worth', 'Tarrant', 'TX', '76104', '8179264362', '8179277568', '1425 8th Ave', 'Fort Worth', 'Tarrant', 'TX', '76104', '8179264362', '8179277568', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', NULL, 'HCFA|UB|', '1073532958', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.7285, -97.3433, NULL, NULL),
('752696283', 'SPA100032', 'SPA100032', 'TXDALSTD', 'Fort Worth Vascular and Surgical Associates', 'Joseph', 'E', 'Guinn', 'MD', 'Vascular Surgery', '', '', NULL, 'M', '2737 S Hulen St', 'Fort Worth', 'Tarrant', 'TX', '76109', '8179275627', '8179277568', '2737 S Hulen St', 'Fort Worth', 'Tarrant', 'TX', '76109', '8179275627', '8179277568', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', NULL, 'HCFA|UB|', '1073532958', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.7116, -97.3859, NULL, NULL),
('752696283', 'SPA100033', 'SPA100033', 'TXDALSTD', 'Fort Worth Vascular and Surgical Associates', 'Joseph', 'E', 'Guinn', 'MD', 'Vascular Surgery', '', '', NULL, 'O', '787 East FM 1187', 'Crowley', 'Tarrant', 'TX', '76036', '8179275627', '8179277568', '787 East FM 1187', 'Crowley', 'Tarrant', 'TX', '76036', '8179275627', '8179277568', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', NULL, 'HCFA|UB|', '1073532958', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.5685, -97.3476, NULL, NULL),
('752696283', 'SPA100034', 'SPA100034', 'TXDALSTD', 'Fort Worth Vascular and Surgical Associates', 'Joseph', 'E', 'Guinn', 'MD', 'Vascular Surgery', '', '', NULL, 'O', '909 9th Ave Ste 201', 'Fort Worth', 'Tarrant', 'TX', '76104', '8179275627', '8179277568', '909 9th Ave Ste 201', 'Fort Worth', 'Tarrant', 'TX', '76104', '8179275627', '8179277568', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', NULL, 'HCFA|UB|', '1073532958', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7349, -97.3458, NULL, NULL),
('383751560', 'SPA100035', 'SPA100035', 'TXDALSTD', 'OB Hospitalists of Texas', 'Christina', 'P', 'Littrell', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '126 International Rd Ste B', 'Garland', 'Dallas', 'TX', '75042', '9722765560', '2143619379', '126 International Rd Ste B', 'Garland', 'Dallas', 'TX', '75042', '9722765560', '2143619379', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1083607980', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.9138, -96.6727, NULL, NULL),
('383751560', 'SPA100036', 'SPA100036', 'TXDALSTD', 'OB Hospitalists of Texas', 'Christina', 'P', 'Littrell', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3500 Gaston Ave', 'Dallas', 'Dallas', 'TX', '75246', '2143612152', '2143619379', '3500 Gaston Ave', 'Dallas', 'Dallas', 'TX', '75246', '2143612152', '2143619379', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1083607980', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7911, -96.7802, NULL, NULL),
('383751560', 'SPA100037', 'SPA100037', 'TXDALSTD', 'OB Hospitalists of Texas', 'Christina', 'P', 'Littrell', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'M', '8409 Pickwick Ln Ste 329', 'Dallas', 'Dallas', 'TX', '75225', '9726200382', '2143619379', '8409 Pickwick Ln Ste 329', 'Dallas', 'Dallas', 'TX', '75225', '9726200382', '2143619379', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1083607980', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('205743711', 'SPA100038', 'SPA100038', 'TXDALSTD', 'Allergy and Asthma Center at NorthPark', 'Scot', NULL, 'Laurie', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '1305 W Jefferson Ste 115', 'Waxahachie', 'Ellis', 'TX', '75165', '9722179564', '9729380508', '1305 W Jefferson Ste 115', 'Waxahachie', 'Ellis', 'TX', '75165', '9722179564', '9729380508', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, '', NULL, 'HCFA|UB|', '1093882110', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.3961, -96.8638, NULL, NULL),
('205743711', 'SPA100040', 'SPA100040', 'TXDALSTD', 'Allergy and Asthma Center at NorthPark', 'Scot', NULL, 'Laurie', 'MD', 'Allergy and Immunology', '', '', NULL, 'B', '1420 N MacArthur Blvd', 'Irving', 'Dallas', 'TX', '75061', '2145969231', '9729380508', '1420 N MacArthur Blvd', 'Irving', 'Dallas', 'TX', '75061', '2145969231', '9729380508', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, '', NULL, 'HCFA|UB|', '1093882110', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.8288, -96.9585, NULL, NULL),
('383751560', 'SPA100041', 'SPA100041', 'TXDALSTD', 'OB Hospitalists of Texas', 'Paul', 'B', 'Payne', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1015 N Carroll Ave', 'Dallas', 'Dallas', 'TX', '75246', '2148247755', '2143619379', '1015 N Carroll Ave', 'Dallas', 'Dallas', 'TX', '75246', '2148247755', '2143619379', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1104819986', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.7972, -96.7741, NULL, NULL),
('383751560', 'SPA100042', 'SPA100042', 'TXDALSTD', 'OB Hospitalists of Texas', 'Paul', 'B', 'Payne', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3500 Gaston Ave', 'Dallas', 'Dallas', 'TX', '75246', '2143612152', '2143619379', '3500 Gaston Ave', 'Dallas', 'Dallas', 'TX', '75246', '2143612152', '2143619379', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1104819986', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7911, -96.7802, NULL, NULL),
('383751560', 'SPA100043', 'SPA100043', 'TXDALSTD', 'OB Hospitalists of Texas', 'Paul', 'B', 'Payne', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'M', '8409 Pickwick Ln Ste 329', 'Dallas', 'Dallas', 'TX', '75225', '9726200382', '2143619379', '8409 Pickwick Ln Ste 329', 'Dallas', 'Dallas', 'TX', '75225', '9726200382', '2143619379', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1104819986', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('752469741', 'SPA100044', 'SPA100044', 'TXDALSTD', 'Jonathan M Kletz DPM', 'Jonathan', 'M', 'Kletz', 'DPM', 'Podiatry', '', '', NULL, 'O', '514 B East Corsicana', 'Athens', 'Henderson', 'TX', '75751', '2143408885', '2143404046', '514 B East Corsicana', 'Athens', 'Henderson', 'TX', '75751', '2143408885', '2143404046', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', '2014-05-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104879998', 0, 'N', 0, '2014-05-12', NULL, NULL, 32.2043, -95.8498, NULL, NULL),
('752469741', 'SPA100045', 'SPA100045', 'TXDALSTD', 'Jonathan M Kletz DPM', 'Jonathan', 'M', 'Kletz', 'DPM', 'Podiatry', '', '', NULL, 'O', '6760 Abrams Ste 203', 'Dallas', 'Dallas', 'TX', '75231', '2143408885', '2143404046', '6760 Abrams Ste 203', 'Dallas', 'Dallas', 'TX', '75231', '2143408885', '2143404046', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', '2014-05-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104879998', 0, 'N', 0, '2014-05-12', NULL, NULL, 32.8671, -96.7429, NULL, NULL),
('752469741', 'SPA100047', 'SPA100047', 'TXDALSTD', 'Jonathan M Kletz DPM', 'Jonathan', 'M', 'Kletz', 'DPM', 'Podiatry', '', '', NULL, 'B', 'PO Box 660046', 'Dallas', 'Dallas', 'TX', '75266', '2143408885', '2143404046', 'PO Box 660046', 'Dallas', 'Dallas', 'TX', '75266', '2143408885', '2143404046', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', '2014-05-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104879998', 0, 'Y', 0, '2014-05-12', NULL, NULL, 0, 0, NULL, NULL),
('751432313', 'SPA100048', 'SPA100048', 'TXDALSTD', 'Dallas Anesthesiology Group', 'Catalina', NULL, 'Garcia', 'MD', 'Anesthesiology', '', '', NULL, 'B', '1411 N Beckley Ave Ste 470', 'Dallas', 'Dallas', 'TX', '75203', '2149412442', '2147392550', '1411 N Beckley Ave Ste 470', 'Dallas', 'Dallas', 'TX', '75203', '2149412442', '2147392550', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Mary Shiels Hospital', 'Baylor University Medical Center', '', NULL, 'HCFA|UB|', '1104924604', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.7604, -96.8258, NULL, NULL),
('751432313', 'SPA100049', 'SPA100049', 'TXDALSTD', 'Dallas Anesthesiology Group', 'Catalina', NULL, 'Garcia', 'MD', 'Anesthesiology', '', '', NULL, 'O', '7622 Royal Ln', 'Dallas', 'Dallas', 'TX', '75230', '2143615680', '2147392550', '7622 Royal Ln', 'Dallas', 'Dallas', 'TX', '75230', '2143615680', '2147392550', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Mary Shiels Hospital', 'Baylor University Medical Center', '', NULL, 'HCFA|UB|', '1104924604', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.8963, -96.775, NULL, NULL),
('751432313', 'SPA100050', 'SPA100050', 'TXDALSTD', 'Dallas Anesthesiology Group', 'Catalina', NULL, 'Garcia', 'MD', 'Anesthesiology', '', '', NULL, 'M', 'PO Box 821388 314', 'Dallas', 'Dallas', 'TX', '75382', '2143615680', '2147392550', 'PO Box 821388 314', 'Dallas', 'Dallas', 'TX', '75382', '2143615680', '2147392550', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Mary Shiels Hospital', 'Baylor University Medical Center', '', NULL, 'HCFA|UB|', '1104924604', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('272710082', 'SPA100051', 'SPA100051', 'TXDALSTD', 'First Step Pediatric Associates', 'Ayman', 'M', 'Arouse', 'MD', 'Pediatrics', '', '', NULL, 'O', '201 Walls Dr Ste 503', 'Cleburne', 'Johnson', 'TX', '76033', '8176418800', '8176418807', '201 Walls Dr Ste 503', 'Cleburne', 'Johnson', 'TX', '76033', '8176418800', '8176418807', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, '', NULL, 'HCFA|UB|', '1114019304', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.3302, -97.4455, NULL, NULL),
('272710082', 'SPA100053', 'SPA100053', 'TXDALSTD', 'First Step Pediatric Associates', 'Ayman', 'M', 'Arouse', 'MD', 'Pediatrics', '', '', NULL, 'B', '6750 N MacArthur Blvd Ste 206', 'Irving', 'Dallas', 'TX', '75039', '9724069930', '8176418807', '6750 N MacArthur Blvd Ste 206', 'Irving', 'Dallas', 'TX', '75039', '9724069930', '8176418807', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, '', NULL, 'HCFA|UB|', '1114019304', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.9008, -96.9574, NULL, NULL),
('751725278', 'SPA100054', 'SPA100054', 'TXDALSTD', 'R D Dignan MD', 'RD', NULL, 'Dignan', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'O', '3600 Gaston Ave Ste 1209', 'Dallas', 'Dallas', 'TX', '75246', '2148242573', '2148242575', '3600 Gaston Ave Ste 1209', 'Dallas', 'Dallas', 'TX', '75246', '2148242573', '2148242575', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1114110145', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7913, -96.7799, NULL, NULL),
('751725278', 'SPA100056', 'SPA100056', 'TXDALSTD', 'R D Dignan MD', 'RD', NULL, 'Dignan', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'B', 'PO Box 630345', 'Irving', 'Dallas', 'TX', '75063', '2148242573', '2148242575', 'PO Box 630345', 'Irving', 'Dallas', 'TX', '75063', '2148242573', '2148242575', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1114110145', 0, 'Y', 0, '2013-11-11', 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
('751774410', 'SPA100057', 'SPA100057', 'TXDALSTD', 'Adolescent Health Associates', 'John', 'C', 'Edlin', 'MD', 'Pediatrics', '', '', NULL, 'B', '12800 Hillcrest Rd Ste 216', 'Dallas', 'Dallas', 'TX', '75230', '9722399252', '9724049609', '12800 Hillcrest Rd Ste 216', 'Dallas', 'Dallas', 'TX', '75230', '9722399252', '9724049609', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114936614', 0, 'N', 0, '2014-03-31', NULL, NULL, 32.9234, -96.7841, NULL, NULL),
('751774410', 'SPA100059', 'SPA100059', 'TXDALSTD', 'Adolescent Health Associates', 'John', 'C', 'Edlin', 'MD', 'Pediatrics', '', '', NULL, 'B', '1505 W Jefferson Ste 120', 'Waxahachie', 'Ellis', 'TX', '75165', '9729375608', '9724049609', '1505 W Jefferson Ste 120', 'Waxahachie', 'Ellis', 'TX', '75165', '9729375608', '9724049609', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114936614', 0, 'Y', 0, '2014-03-31', NULL, NULL, 32.3968, -96.865, NULL, NULL),
('752310286', 'SPA100060', 'SPA100060', 'TXDALSTD', 'Whitcomb Clinic', 'Donald', 'Craig', 'Whitcomb', 'MD', 'Family Practice', '', '', NULL, 'B', '1806 W Pleasant Ridge', 'Arlington', 'Tarrant', 'TX', '76015', '2145752245', '9726061637', '1806 W Pleasant Ridge', 'Arlington', 'Tarrant', 'TX', '76015', '2145752245', '9726061637', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, '', NULL, 'HCFA|UB|', '1124036884', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.6792, -97.1361, NULL, NULL),
('752310286', 'SPA100061', 'SPA100061', 'TXDALSTD', 'Whitcomb Clinic', 'Donald', 'Craig', 'Whitcomb', 'MD', 'Family Practice', '', '', NULL, 'M', '2461 Robinson Rd Bldg A', 'Grand Prairie', 'Dallas', 'TX', '75051', '9726061334', '9726061334', '2461 Robinson Rd Bldg A', 'Grand Prairie', 'Dallas', 'TX', '75051', '9726061334', '9726061334', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, '', NULL, 'HCFA|UB|', '1124036884', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('383751560', 'SPA100063', 'SPA100063', 'TXDALSTD', 'OB Hospitalists of Texas', 'Sandra', 'Z', 'Brothers', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3500 Gaston Ave', 'Dallas', 'Dallas', 'TX', '75246', '2143612152', '2143619379', '3500 Gaston Ave', 'Dallas', 'Dallas', 'TX', '75246', '2143612152', '2143619379', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1124052121', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7911, -96.7802, NULL, NULL),
('383751560', 'SPA100064', 'SPA100064', 'TXDALSTD', 'OB Hospitalists of Texas', 'Sandra', 'Z', 'Brothers', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '8 Medical Pkwy Plaza 2 Ste 304', 'Dallas', 'Dallas', 'TX', '75234', '9726200382', '2143619379', '8 Medical Pkwy Plaza 2 Ste 304', 'Dallas', 'Dallas', 'TX', '75234', '9726200382', '2143619379', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1124052121', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('383751560', 'SPA100065', 'SPA100065', 'TXDALSTD', 'OB Hospitalists of Texas', 'Sandra', 'Z', 'Brothers', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'M', '8409 Pickwick Ln Ste 329', 'Dallas', 'Dallas', 'TX', '75225', '9726200382', '2143619379', '8409 Pickwick Ln Ste 329', 'Dallas', 'Dallas', 'TX', '75225', '9726200382', '2143619379', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1124052121', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('455031185', 'SPA100066', 'SPA100066', 'TXDALSTD', 'Dallas Plastic Surgery Institute', 'Bradley', 'A', 'Hubbard', 'MD', 'Plastic Surgery', '', '', NULL, 'B', '2737 S Hulen St', 'Fort Worth', 'Tarrant', 'TX', '76109', '8179277568', '4693753844', '2737 S Hulen St', 'Fort Worth', 'Tarrant', 'TX', '76109', '8179277568', '4693753844', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', NULL, 'HCFA|UB|', '1124119854', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.7116, -97.3859, NULL, NULL),
('455031185', 'SPA100067', 'SPA100067', 'TXDALSTD', 'Dallas Plastic Surgery Institute', 'Bradley', 'A', 'Hubbard', 'MD', 'Plastic Surgery', '', '', NULL, 'O', '9101 N Central Expy Ste 600', 'Dallas', 'Dallas', 'TX', '75231', '2143704813', '4693753844', '9101 N Central Expy Ste 600', 'Dallas', 'Dallas', 'TX', '75231', '2143704813', '4693753844', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', NULL, 'HCFA|UB|', '1124119854', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.873, -96.7706, NULL, NULL),
('270647022', 'SPA100069', 'SPA100069', 'TXDALSTD', 'Advanced Gastroenterology Associates', 'Muhammad', 'A', 'Asim', 'MD', 'Gastroenterology', '', '', NULL, 'B', '375 Municipal Dr Ste 102', 'Richardson', 'Dallas', 'TX', '75080', '9722315357', '9406261865', '375 Municipal Dr Ste 102', 'Richardson', 'Dallas', 'TX', '75080', '9722315357', '9406261865', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, NULL, NULL, 'HCFA|UB|', '1134130628', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.973, -96.7255, NULL, NULL),
('270647022', 'SPA100070', 'SPA100070', 'TXDALSTD', 'Advanced Gastroenterology Associates', 'Muhammad', 'A', 'Asim', 'MD', 'Gastroenterology', '', '', NULL, 'O', '609 Medical Ctr Dr Ste 2600', 'Decatur', 'Wise', 'TX', '76234', '9406261864', '9406261865', '609 Medical Ctr Dr Ste 2600', 'Decatur', 'Wise', 'TX', '76234', '9406261864', '9406261865', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, NULL, NULL, 'HCFA|UB|', '1134130628', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.2198, -97.5939, NULL, NULL),
('752652430', 'SPA100072', 'SPA100072', 'TXDALSTD', 'Obstetrics and Gynecology of North Texas', 'Robert', 'B', 'Wai', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1600 W College St Ste 540', 'Grapevine', 'Tarrant', 'TX', '76051', '8174815863', '8173298561', '1600 W College St Ste 540', 'Grapevine', 'Tarrant', 'TX', '76051', '8174815863', '8173298561', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, NULL, NULL, 'HCFA|UB|', '1134181308', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.9356, -97.0929, NULL, NULL),
('752652430', 'SPA100074', 'SPA100074', 'TXDALSTD', 'Obstetrics and Gynecology of North Texas', 'Robert', 'B', 'Wai', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '5013 Heritage Ave', 'Colleyville', 'Tarrant', 'TX', '76034', '8178681617', '8173298561', '5013 Heritage Ave', 'Colleyville', 'Tarrant', 'TX', '76034', '8178681617', '8173298561', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, NULL, NULL, 'HCFA|UB|', '1134181308', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.8822, -97.1041, NULL, NULL),
('30572405', 'SPA100075', 'SPA100075', 'TXDALSTD', 'Archana Chandra MD', 'Archana', NULL, 'Chandra', 'MD', 'Family Practice', '', '', NULL, 'B', '3600 Gaston Ave Ste 1209', 'Dallas', 'Dallas', 'TX', '75246', '2148242575', '9723535352', '3600 Gaston Ave Ste 1209', 'Dallas', 'Dallas', 'TX', '75246', '2148242575', '9723535352', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, '', NULL, 'HCFA|UB|', '1134198013', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.791, -96.7798, NULL, NULL),
('30572405', 'SPA100076', 'SPA100076', 'TXDALSTD', 'Archana Chandra MD', 'Archana', NULL, 'Chandra', 'MD', 'Family Practice', '', '', NULL, 'O', '502 N Valley Pkwy Ste 1', 'Lewisville', 'Denton', 'TX', '75067', '9723538616', '9723535352', '502 N Valley Pkwy Ste 1', 'Lewisville', 'Denton', 'TX', '75067', '9723538616', '9723535352', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, '', NULL, 'HCFA|UB|', '1134198013', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.0478, -97.0207, NULL, NULL),
('742367230', 'SPA100078', 'SPA100078', 'TXDALSTD', 'J D Bell MD', 'John', NULL, 'Bell', 'MD', 'Nephrology', '', '', NULL, 'O', '1809 Forest Ridge Dr', 'Bedford', 'Tarrant', 'TX', '76022', '8172680830', '8172686247', '1809 Forest Ridge Dr', 'Bedford', 'Tarrant', 'TX', '76022', '8172680830', '8172686247', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, 'Baylor Regional Medical Center at Grapevine', '', NULL, 'HCFA|UB|', '1144213927', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8355, -97.1419, NULL, NULL),
('742367230', 'SPA100079', 'SPA100079', 'TXDALSTD', 'J D Bell MD', 'John', NULL, 'Bell', 'MD', 'Nephrology', '', '', NULL, 'B', '8144 Walnut Hill Ln Ste 448', 'Dallas', 'Dallas', 'TX', '75231', '2143615601', '8172686247', '8144 Walnut Hill Ln Ste 448', 'Dallas', 'Dallas', 'TX', '75231', '2143615601', '8172686247', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', '2013-08-26', 0, 0, 0, NULL, 'Baylor Regional Medical Center at Grapevine', '', NULL, 'HCFA|UB|', '1144213927', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.8809, -96.766, NULL, NULL),
('742367230', 'SPA100080', 'SPA100080', 'TXDALSTD', 'J D Bell MD', 'John', NULL, 'Bell', 'MD', 'Nephrology', '', '', NULL, 'B', 'PO Box 210608', 'Bedford', 'Tarrant', 'TX', '76095', '8172680830', '8172686247', 'PO Box 210608', 'Bedford', 'Tarrant', 'TX', '76095', '8172680830', '8172686247', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, 'Baylor Regional Medical Center at Grapevine', '', NULL, 'HCFA|UB|', '1144213927', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('751892943', 'SPA100081', 'SPA100081', 'TXDALSTD', 'Burleson Family Medical Center', 'B', 'Craig', 'Nelon', 'DO', 'Family Practice', '', '', NULL, 'O', '434 SW Wilshire Blvd', 'Burleson', 'Johnson', 'TX', '76028', '8174471208', '8174471106', '434 SW Wilshire Blvd', 'Burleson', 'Johnson', 'TX', '76028', '8174471208', '8174471106', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184600397', 0, 'N', 0, '2014-04-10', NULL, NULL, 32.5394, -97.3324, NULL, NULL),
('751892943', 'SPA100083', 'SPA100083', 'TXDALSTD', 'Burleson Family Medical Center', 'B', 'Craig', 'Nelon', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 821388 314', 'Dallas', 'Dallas', 'TX', '75382', '8174471208', '8174471106', 'PO Box 821388 314', 'Dallas', 'Dallas', 'TX', '75382', '8174471208', '8174471106', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184600397', 0, 'Y', 0, '2014-04-10', NULL, NULL, 0, 0, NULL, NULL),
('272269378', 'SPA100087', 'SPA100087', 'TXDALSTD', 'Texas Skin Surgery Center', 'Paul', 'T', 'Martinelli', 'MD', 'Dermatology', '', '', NULL, 'B', '1015 N Carroll Ave Ste 2000', 'Dallas', 'Dallas', 'TX', '75204', '2148247755', '4694676648', '1015 N Carroll Ave Ste 2000', 'Dallas', 'Dallas', 'TX', '75204', '2148247755', '4694676648', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1194813543', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.7969, -96.7745, NULL, NULL),
('272269378', 'SPA100088', 'SPA100088', 'TXDALSTD', 'Texas Skin Surgery Center', 'Paul', 'T', 'Martinelli', 'MD', 'Dermatology', '', '', NULL, 'O', '4716 Alliance Blvd Ste 150', 'Plano', 'Collin', 'TX', '75093', '4694676647', '4694676648', '4716 Alliance Blvd Ste 150', 'Plano', 'Collin', 'TX', '75093', '4694676647', '4694676648', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1194813543', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.0145, -96.7926, NULL, NULL),
('272269378', 'SPA100090', 'SPA100090', 'TXDALSTD', 'Texas Skin Surgery Center', 'Paul', 'T', 'Martinelli', 'MD', 'Dermatology', '', '', NULL, 'O', '75 Main St Ste 150', 'Colleyville', 'Tarrant', 'TX', '76034', '2148247755', '4694676648', '75 Main St Ste 150', 'Colleyville', 'Tarrant', 'TX', '76034', '2148247755', '4694676648', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1194813543', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8851, -97.1557, NULL, NULL),
('751774410', 'SPA100091', 'SPA100091', 'TXDALSTD', 'Adolescent Health Associates', 'Drew', 'W', 'Alexander', 'MD', 'Pediatrics', '', '', NULL, 'O', '12800 Hillcrest Rd Ste 216', 'Dallas', 'Dallas', 'TX', '75230', '9722399252', '9724049609', '12800 Hillcrest Rd Ste 216', 'Dallas', 'Dallas', 'TX', '75230', '9722399252', '9724049609', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1194819763', 0, 'N', 0, '2014-03-31', NULL, NULL, 32.9228, -96.7862, NULL, NULL),
('751774410', 'SPA100093', 'SPA100093', 'TXDALSTD', 'Adolescent Health Associates', 'Drew', 'W', 'Alexander', 'MD', 'Pediatrics', '', '', NULL, 'B', '1505 W Jefferson Ste 120', 'Waxahachie', 'Ellis', 'TX', '75165', '9729375608', '9724049609', '1505 W Jefferson Ste 120', 'Waxahachie', 'Ellis', 'TX', '75165', '9729375608', '9724049609', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1194819763', 0, 'Y', 0, '2014-03-31', NULL, NULL, 32.3968, -96.865, NULL, NULL),
('205714560', 'SPA100094', 'SPA100094', 'TXDALSTD', 'Alliance Family Medicine', 'Hania', NULL, 'Alaidroos', 'MD', 'Family Practice', '', '', NULL, 'B', '1600 W College St Ste 510', 'Grapevine', 'Tarrant', 'TX', '76051', '8173298561', '9729310400', '1600 W College St Ste 510', 'Grapevine', 'Tarrant', 'TX', '76051', '8173298561', '9729310400', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1205826112', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.9345, -97.0946, NULL, NULL),
('205714560', 'SPA100095', 'SPA100095', 'TXDALSTD', 'Alliance Family Medicine', 'Hania', NULL, 'Alaidroos', 'MD', 'Family Practice', '', '', NULL, 'O', '17610 Preston Rd', 'Dallas', 'Collin', 'TX', '75252', '9729310100', '9729310400', '17610 Preston Rd', 'Dallas', 'Collin', 'TX', '75252', '9729310100', '9729310400', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1205826112', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.9917, -96.8008, NULL, NULL),
('202600100', 'SPA100097', 'SPA100097', 'TXDALSTD', 'ENT for Children', 'Alan', 'D', 'Murray', 'MD', 'Pediatric Ear, Nose and Throat', '', '', NULL, 'B', '3808 Swiss Ave', 'Dallas', 'Dallas', 'TX', '75204', '2148242404', '9723159011', '3808 Swiss Ave', 'Dallas', 'Dallas', 'TX', '75204', '2148242404', '9723159011', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, '', NULL, 'HCFA|UB|', '1205891553', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.7933, -96.7803, NULL, NULL),
('202600100', 'SPA100098', 'SPA100098', 'TXDALSTD', 'ENT for Children', 'Alan', 'D', 'Murray', 'MD', 'Pediatric Ear, Nose and Throat', '', '', NULL, 'O', '783 N Denton Tap Rd Ste 200', 'Coppell', 'Dallas', 'TX', '75019', '9727458400', '9723159011', '783 N Denton Tap Rd Ste 200', 'Coppell', 'Dallas', 'TX', '75019', '9727458400', '9723159011', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, '', NULL, 'HCFA|UB|', '1205891553', 0, 'Y', 0, '2014-04-01', NULL, NULL, 32.9741, -96.989, NULL, NULL),
('751848653', 'SPA100100', 'SPA100100', 'TXDALSTD', 'Craig A Bolton MD', 'Craig', 'A', 'Bolton', 'MD', 'Ophthalmology', '', '', NULL, 'O', '10670 N Central Expy Ste 170', 'Dallas', 'Dallas', 'TX', '75231', '2143680000', '2143681884', '10670 N Central Expy Ste 170', 'Dallas', 'Dallas', 'TX', '75231', '2143680000', '2143681884', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1215042775', 0, 'N', 0, '2014-04-25', NULL, NULL, 32.8915, -96.7689, NULL, NULL),
('751848653', 'SPA100102', 'SPA100102', 'TXDALSTD', 'Craig A Bolton MD', 'Craig', 'A', 'Bolton', 'MD', 'Ophthalmology', '', '', NULL, 'B', '6701 Heritage Pkwy Ste 110', 'Rockwall', 'Rockwall', 'TX', '75087', '9724129700', '2143681884', '6701 Heritage Pkwy Ste 110', 'Rockwall', 'Rockwall', 'TX', '75087', '9724129700', '2143681884', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1215042775', 0, 'Y', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('752541871', 'SPA100103', 'SPA100103', 'TXDALSTD', 'Daniel T Myint MD', 'Daniel', 'T', 'Myint', 'MD', 'Pediatrics', '', '', NULL, 'O', '2097 N Collins Blvd Ste 198', 'Richardson', 'Dallas', 'TX', '75080', '9726809983', '9726809163', '2097 N Collins Blvd Ste 198', 'Richardson', 'Dallas', 'TX', '75080', '9726809983', '9726809163', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, '', NULL, 'HCFA|UB|', '1215936695', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.9789, -96.7175, NULL, NULL),
('752541871', 'SPA100105', 'SPA100105', 'TXDALSTD', 'Daniel T Myint MD', 'Daniel', 'T', 'Myint', 'MD', 'Pediatrics', '', '', NULL, 'B', '4716 Alliance Blvd Ste 150', 'Plano', 'Collin', 'TX', '75093', '4694676648', '9726809163', '4716 Alliance Blvd Ste 150', 'Plano', 'Collin', 'TX', '75093', '4694676648', '9726809163', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, '', NULL, 'HCFA|UB|', '1215936695', 0, 'Y', 0, '2013-11-11', NULL, NULL, 33.0143, -96.7929, NULL, NULL),
('752840613', 'SPA100106', 'SPA100106', 'TXDALSTD', 'Kevin Q Nguyen Khoa DPM', 'Kevin', 'Q', 'Nguyen Khoa', 'DPM', 'Podiatry', '', '', NULL, 'B', '1220 N Alma Dr', 'Allen', 'Collin', 'TX', '75013', '8172651595', '8172007991', '1220 N Alma Dr', 'Allen', 'Collin', 'TX', '75013', '8172651595', '8172007991', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, '', NULL, 'HCFA|UB|', '1215959556', 0, 'Y', 0, '2013-11-11', NULL, NULL, 33.1168, -96.6978, NULL, NULL),
('752840613', 'SPA100107', 'SPA100107', 'TXDALSTD', 'Kevin Q Nguyen Khoa DPM', 'Kevin', 'Q', 'Nguyen Khoa', 'DPM', 'Podiatry', '', '', NULL, 'O', '1327 E Pioneer Pkwy', 'Arlington', 'Tarrant', 'TX', '76010', '8172651595', '8172007991', '1327 E Pioneer Pkwy', 'Arlington', 'Tarrant', 'TX', '76010', '8172651595', '8172007991', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, '', NULL, 'HCFA|UB|', '1215959556', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7081, -97.0906, NULL, NULL),
('752840613', 'SPA100109', 'SPA100109', 'TXDALSTD', 'Kevin Q Nguyen Khoa DPM', 'Kevin', 'Q', 'Nguyen Khoa', 'DPM', 'Podiatry', '', '', NULL, 'O', '2157 W Buckingham', 'Richardson', 'Dallas', 'TX', '75081', '8172651595', '8172007991', '2157 W Buckingham', 'Richardson', 'Dallas', 'TX', '75081', '8172651595', '8172007991', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, '', NULL, 'HCFA|UB|', '1215959556', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.9313, -96.6856, NULL, NULL),
('752912056', 'SPA100110', 'SPA100110', 'TXDALSTD', 'Hitesh Yagnik MD', 'Hitesh', NULL, 'Yagnik', 'MD', 'Internal Medicine', '', '', NULL, 'B', '3500 Oaklawn Ste 600', 'Dallas', 'Dallas', 'TX', '75219', '2145202956', '9727810450', '3500 Oaklawn Ste 600', 'Dallas', 'Dallas', 'TX', '75219', '2145202956', '9727810450', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, '', NULL, 'HCFA|UB|', '1225058589', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.812, -96.8054, NULL, NULL),
('752912056', 'SPA100111', 'SPA100111', 'TXDALSTD', 'Hitesh Yagnik MD', 'Hitesh', NULL, 'Yagnik', 'MD', 'Internal Medicine', '', '', NULL, 'O', '4001 W 15th St Ste 480', 'Plano', 'Collin', 'TX', '75093', '9724031122', '9727810450', '4001 W 15th St Ste 480', 'Plano', 'Collin', 'TX', '75093', '9724031122', '9727810450', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, '', NULL, 'HCFA|UB|', '1225058589', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.0191, -96.7671, NULL, NULL),
('752912056', 'SPA100112', 'SPA100112', 'TXDALSTD', 'Hitesh Yagnik MD', 'Hitesh', NULL, 'Yagnik', 'MD', 'Internal Medicine', '', '', NULL, 'O', '5930 Parker Rd Ste 900', 'Plano', 'Collin', 'TX', '75093', '9724031122', '9727810450', '5930 Parker Rd Ste 900', 'Plano', 'Collin', 'TX', '75093', '9724031122', '9727810450', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, '', NULL, 'HCFA|UB|', '1225058589', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.0451, -96.8244, NULL, NULL),
('454931169', 'SPA100114', 'SPA100114', 'TXDALSTD', 'PSMD Medical Associates', 'Durga', 'P', 'Mekala', 'MD', 'Family Practice', '', '', NULL, 'O', '3132 Matlock Rd Ste 311', 'Arlington', 'Tarrant', 'TX', '76015', '8179871414', '8179871425', '3132 Matlock Rd Ste 311', 'Arlington', 'Tarrant', 'TX', '76015', '8179871414', '8179871425', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, '', NULL, 'HCFA|UB|', '1235340290', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.6937, -97.115, NULL, NULL),
('454931169', 'SPA100116', 'SPA100116', 'TXDALSTD', 'PSMD Medical Associates', 'Durga', 'P', 'Mekala', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 650409', 'Dallas', 'Dallas', 'TX', '75265', '9724630864', '8179871425', 'PO Box 650409', 'Dallas', 'Dallas', 'TX', '75265', '9724630864', '8179871425', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, '', NULL, 'HCFA|UB|', '1235340290', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('752575257', 'SPA100001', 'SPA100001', 'TXDALSTD', 'Steven M Pounders MD', 'Steven', 'M', 'Pounders', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3500 Oaklawn Ste 600', 'Dallas', 'Dallas', 'TX', '75219', '2145208833', '2145202956', '3500 Oaklawn Ste 600', 'Dallas', 'Dallas', 'TX', '75219', '2145208833', '2145202956', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1124073614', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8119, -96.8055, NULL, NULL),
('752575257', 'SPA100003', 'SPA100003', 'TXDALSTD', 'Steven M Pounders MD', 'Steven', 'M', 'Pounders', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 227174', 'Dallas', 'Dallas', 'TX', '75222', '2145208833', '2145202956', 'PO Box 227174', 'Dallas', 'Dallas', 'TX', '75222', '2145208833', '2145202956', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1124073614', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('112423479', 'SPA100117', 'SPA100117', 'TXDALSTD', 'Kutsi Onur MD', 'Kutsi', NULL, 'Onur', 'MD', 'Pediatrics', '', '', NULL, 'O', '3310 Live Oak Ste 250', 'Dallas', 'Dallas', 'TX', '75204', '2148231152', '2148235974', '3310 Live Oak Ste 250', 'Dallas', 'Dallas', 'TX', '75204', '2148231152', '2148235974', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', NULL, 'HCFA|UB|', '1255396644', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7922, -96.7851, NULL, NULL),
('112423479', 'SPA100119', 'SPA100119', 'TXDALSTD', 'Kutsi Onur MD', 'Kutsi', NULL, 'Onur', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 227174', 'Dallas', 'Dallas', 'TX', '75222', '2148231152', '2148235974', 'PO Box 227174', 'Dallas', 'Dallas', 'TX', '75222', '2148231152', '2148235974', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', NULL, 'HCFA|UB|', '1255396644', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('270290451', 'SPA100120', 'SPA100120', 'TXDALSTD', 'Carrie Phelps Morris MD', 'Carrie Phelps', NULL, 'Morris', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1600 W College St Ste 540', 'Grapevine', 'Tarrant', 'TX', '76051', '8174815863', '8173298561', '1600 W College St Ste 540', 'Grapevine', 'Tarrant', 'TX', '76051', '8174815863', '8173298561', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, NULL, NULL, 'HCFA|UB|', '1255534335', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.9356, -97.0929, NULL, NULL),
('270290451', 'SPA100122', 'SPA100122', 'TXDALSTD', 'Carrie Phelps Morris MD', 'Carrie Phelps', NULL, 'Morris', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '2203 W Lampasas Ste 101', 'Ennis', 'Ellis', 'TX', '75119', '8174815863', '8173298561', '2203 W Lampasas Ste 101', 'Ennis', 'Ellis', 'TX', '75119', '8174815863', '8173298561', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, NULL, NULL, 'HCFA|UB|', '1255534335', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.3058, -96.6419, NULL, NULL),
('460886875', 'SPA100124', 'SPA100124', 'TXDALSTD', 'Tanveer Ahmed MD', 'Tanveer', NULL, 'Ahmed', 'MD', 'Pulmonary', '', '', NULL, 'O', '3600 Gaston Ave Ste 1055', 'Dallas', 'Dallas', 'TX', '75246', '2148270330', '2148272860', '3600 Gaston Ave Ste 1055', 'Dallas', 'Dallas', 'TX', '75246', '2148270330', '2148272860', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', NULL, 'HCFA|UB|', '1265491724', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7913, -96.7799, NULL, NULL),
('460886875', 'SPA100123', 'SPA100123', 'TXDALSTD', 'Tanveer Ahmed MD', 'Tanveer', NULL, 'Ahmed', 'MD', 'Pulmonary', '', '', NULL, 'O', '3604 Preston Rd Ste 300 A', 'Plano', 'Collin', 'TX', '75093', '2148270330', '2148272860', '3604 Preston Rd Ste 300 A', 'Plano', 'Collin', 'TX', '75093', '2148270330', '2148272860', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', NULL, 'HCFA|UB|', '1265491724', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.0465, -96.7943, NULL, NULL),
('460886875', 'SPA100126', 'SPA100126', 'TXDALSTD', 'Tanveer Ahmed MD', 'Tanveer', NULL, 'Ahmed', 'MD', 'Pulmonary', '', '', NULL, 'B', '905 N Jupiter Rd Ste 160', 'Richardson', 'Dallas', 'TX', '75081', '2148270330', '2148272860', '905 N Jupiter Rd Ste 160', 'Richardson', 'Dallas', 'TX', '75081', '2148270330', '2148272860', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', NULL, 'HCFA|UB|', '1265491724', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.9594, -96.6831, NULL, NULL),
('752368139', 'SPA100127', 'SPA100127', 'TXDALSTD', 'Timothy J Rost MD', 'Timothy', 'J', 'Rost', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'M', '1600 W College St Ste 340', 'Grapevine', 'Tarrant', 'TX', '76051', '8173290389', '8174211416', '1600 W College St Ste 340', 'Grapevine', 'Tarrant', 'TX', '76051', '8173290389', '8174211416', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, NULL, NULL, 'HCFA|UB|', '1275539439', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.9345, -97.0946, NULL, NULL),
('752368139', 'SPA100129', 'SPA100129', 'TXDALSTD', 'Timothy J Rost MD', 'Timothy', 'J', 'Rost', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '2140 FM 157 N', 'Mansfield', 'Tarrant', 'TX', '76063', '8174637703', '8174211416', '2140 FM 157 N', 'Mansfield', 'Tarrant', 'TX', '76063', '8174637703', '8174211416', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, NULL, NULL, 'HCFA|UB|', '1275539439', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.607, -97.1433, NULL, NULL),
('752336130', 'SPA100130', 'SPA100130', 'TXDALSTD', 'R Greg Maul D O', 'R Greg', '', 'Maul', 'DO', 'Family Practice', '', '', NULL, 'O', '440 State Hwy 78 Ste 220', 'Lavon', 'Collin', 'TX', '75166', '9724633100', '8668011503', '440 State Hwy 78 Ste 220', 'Lavon', 'Collin', 'TX', '75166', '9724633100', '8668011503', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, '', '', 'HCFA|UB|', '1285671891', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.0224, -96.4446, NULL, NULL),
('752336130', 'SPA100131', 'SPA100131', 'TXDALSTD', 'R Greg Maul D O', 'R Greg', '', 'Maul', 'DO', 'Family Practice', '', '', NULL, 'O', '7501 Lakeview Pkwy Ste 130', 'Rowlett', 'Dallas', 'TX', '75088', '9724633100', '8668011503', '7501 Lakeview Pkwy Ste 130', 'Rowlett', 'Dallas', 'TX', '75088', '9724633100', '8668011503', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, '', '', 'HCFA|UB|', '1285671891', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.911, -96.5309, NULL, NULL),
('752336130', 'SPA100133', 'SPA100133', 'TXDALSTD', 'R Greg Maul D O', 'R Greg', '', 'Maul', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 848259', 'Boston', 'Suffolk', 'TX', '02284', '9724633100', '8668011503', 'PO Box 848259', 'Boston', 'Suffolk', 'TX', '02284', '9724633100', '8668011503', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, '', '', 'HCFA|UB|', '1285671891', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('611566045', 'SPA100134', 'SPA100134', 'TXDALSTD', 'Ruth R Wiley DO', 'Ruth', 'Reposa', 'Wiley', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1425 8th Ave', 'Fort Worth', 'Tarrant', 'TX', '76104', '8179264118', '8179264362', '1425 8th Ave', 'Fort Worth', 'Tarrant', 'TX', '76104', '8179264118', '8179264362', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1285810291', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7291, -97.3437, NULL, NULL),
('611566045', 'SPA100136', 'SPA100136', 'TXDALSTD', 'Ruth R Wiley DO', 'Ruth', 'Reposa', 'Wiley', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'B', '3501 N MacArthur Blvd Ste 500', 'Irving', 'Dallas', 'TX', '75062', '9722589887', '8179264362', '3501 N MacArthur Blvd Ste 500', 'Irving', 'Dallas', 'TX', '75062', '9722589887', '8179264362', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1285810291', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.8525, -96.9592, NULL, NULL),
('202904746', 'SPA100137', 'SPA100137', 'TXDALSTD', 'Womens Health Specialists of North Texas', 'David', 'B', 'Morehead', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1505 W Jefferson Ste 120', 'Waxahachie', 'Ellis', 'TX', '75165', '9729383493', '9729375608', '1505 W Jefferson Ste 120', 'Waxahachie', 'Ellis', 'TX', '75165', '9729383493', '9729375608', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1295744035', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.3972, -96.8656, NULL, NULL),
('202904746', 'SPA100139', 'SPA100139', 'TXDALSTD', 'Womens Health Specialists of North Texas', 'David', 'B', 'Morehead', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1670 E Broad St Ste 101', 'Mansfield', 'Tarrant', 'TX', '76063', '9729383493', '9729375608', '1670 E Broad St Ste 101', 'Mansfield', 'Tarrant', 'TX', '76063', '9729383493', '9729375608', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1295744035', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.5687, -97.1156, NULL, NULL),
('202904746', 'SPA100140', 'SPA100140', 'TXDALSTD', 'Womens Health Specialists of North Texas', 'David', 'B', 'Morehead', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'B', '3501 N MacArthur Blvd Ste 500', 'Irving', 'Dallas', 'TX', '75062', '9722589887', '9729375608', '3501 N MacArthur Blvd Ste 500', 'Irving', 'Dallas', 'TX', '75062', '9722589887', '9729375608', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1295744035', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.8525, -96.9592, NULL, NULL),
('202904746', 'SPA100152', 'SPA100152', 'TXDALSTD', 'Womens Health Specialists of North Texas', 'Kristin', 'N', 'Williams', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1505 W Jefferson Ste 120', 'Waxahachie', 'Ellis', 'TX', '75165', '9729383493', '9729375608', '1505 W Jefferson Ste 120', 'Waxahachie', 'Ellis', 'TX', '75165', '9729383493', '9729375608', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1316950108', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.3972, -96.8656, NULL, NULL),
('202904746', 'SPA100154', 'SPA100154', 'TXDALSTD', 'Womens Health Specialists of North Texas', 'Kristin', 'N', 'Williams', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1670 E Broad St Ste 101', 'Mansfield', 'Tarrant', 'TX', '76063', '9729383493', '9729375608', '1670 E Broad St Ste 101', 'Mansfield', 'Tarrant', 'TX', '76063', '9729383493', '9729375608', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1316950108', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.5687, -97.1156, NULL, NULL),
('202904746', 'SPA100155', 'SPA100155', 'TXDALSTD', 'Womens Health Specialists of North Texas', 'Kristin', 'N', 'Williams', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '6780 Abrams Rd Ste 103', 'Dallas', 'Dallas', 'TX', '75231', '2143987200', '9729375608', '6780 Abrams Rd Ste 103', 'Dallas', 'Dallas', 'TX', '75231', '2143987200', '9729375608', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1316950108', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('364712381', 'SPA100157', 'SPA100157', 'TXDALSTD', 'Lakeside Surgery', 'Jeffrey', 'S', 'Stephens', 'MD', 'General Surgery', '', '', NULL, 'O', '200 N Arch St', 'Royse', 'Rockwall', 'TX', '75189', '9727223290', '9727723815', '200 N Arch St', 'Royse', 'Rockwall', 'TX', '75189', '9727223290', '9727723815', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', '', '', '', 'HCFA|UB|', '1326097676', 0, 'N', 0, '2014-05-09', NULL, NULL, 32.976, -96.3315, NULL, NULL),
('364712381', 'SPA100156', 'SPA100156', 'TXDALSTD', 'Lakeside Surgery', 'Jeffrey', 'S', 'Stephens', 'MD', 'General Surgery', '', '', NULL, 'M', '2850 Shoreline Trl PMB 154', 'Rockwall', 'Rockwall', 'TX', '75032', '9727223290', '9727723815', '2850 Shoreline Trl PMB 154', 'Rockwall', 'Rockwall', 'TX', '75032', '9727223290', '9727723815', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', '2014-05-01', 0, 0, 0, 'Baylor University Medical Center', '', '', '', 'HCFA|UB|', '1326097676', 0, 'Y', 0, '2014-05-09', NULL, NULL, 0, 0, NULL, NULL),
('364712381', 'SPA100158', 'SPA100158', 'TXDALSTD', 'Lakeside Surgery', 'Jeffrey', 'S', 'Stephens', 'MD', 'General Surgery', '', '', NULL, 'O', '3142 Horizon Rd Ste 206', 'Rockwall', 'Rockwall', 'TX', '75032', '9727223290', '9727723815', '3142 Horizon Rd Ste 206', 'Rockwall', 'Rockwall', 'TX', '75032', '9727223290', '9727723815', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', '2014-05-01', 0, 0, 0, 'Baylor University Medical Center', '', '', '', 'HCFA|UB|', '1326097676', 0, 'N', 0, '2014-05-09', NULL, NULL, 32.8897, -96.469, NULL, NULL),
('364712381', 'SPA100159', 'SPA100159', 'TXDALSTD', 'Lakeside Surgery', 'Jeffrey', 'S', 'Stephens', 'MD', 'General Surgery', '', '', NULL, 'B', '3600 Gaston Ave Ste 508', 'Dallas', 'Dallas', 'TX', '75246', '2143705480', '9727723815', '3600 Gaston Ave Ste 508', 'Dallas', 'Dallas', 'TX', '75246', '2143705480', '9727723815', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', '2014-05-01', 0, 0, 0, 'Baylor University Medical Center', '', '', '', 'HCFA|UB|', '1326097676', 0, 'Y', 0, '2014-05-09', NULL, NULL, 32.791, -96.7798, NULL, NULL),
('751778101', 'SPA100164', 'SPA100164', 'TXDALSTD', 'Philip L Kelton Jr MD', 'Philip', 'L', 'Kelton', 'MD', 'Plastic Surgery', '', '', NULL, 'M', '3600 Gaston Ave Ste 1054', 'Dallas', 'Dallas', 'TX', '75246', '2148268950', '2148263434', '3600 Gaston Ave Ste 1054', 'Dallas', 'Dallas', 'TX', '75246', '2148268950', '2148263434', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1336335223', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.791, -96.7798, NULL, NULL),
('751778101', 'SPA100163', 'SPA100163', 'TXDALSTD', 'Philip L Kelton Jr MD', 'Philip', 'L', 'Kelton', 'MD', 'Plastic Surgery', '', '', NULL, 'O', '3600 Gaston Ave LB 78 Ste 1054', 'Dallas', 'Dallas', 'TX', '75246', '2148268950', '2148263434', '3600 Gaston Ave LB 78 Ste 1054', 'Dallas', 'Dallas', 'TX', '75246', '2148268950', '2148263434', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1336335223', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7913, -96.7799, NULL, NULL),
('751778101', 'SPA100165', 'SPA100165', 'TXDALSTD', 'Philip L Kelton Jr MD', 'Philip', 'L', 'Kelton', 'MD', 'Plastic Surgery', '', '', NULL, 'B', 'PO Box 7824', 'Belfast', 'Waldo', 'TX', '04915', '9723885971', '2148263434', 'PO Box 7824', 'Belfast', 'Waldo', 'TX', '04915', '9723885971', '2148263434', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1336335223', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('274024724', 'SPA100169', 'SPA100169', 'TXDALSTD', 'Internal Medicine and Urgent Care Clinic of Frisco', 'Latha', NULL, 'Yedlapalli', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3520 Preston Rd Ste 108', 'Frisco', 'Denton', 'TX', '75034', '2144364949', '2144365792', '3520 Preston Rd Ste 108', 'Frisco', 'Denton', 'TX', '75034', '2144364949', '2144365792', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, '', NULL, 'HCFA|UB|', '1356368898', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.1083, -96.8056, NULL, NULL),
('274024724', 'SPA100171', 'SPA100171', 'TXDALSTD', 'Internal Medicine and Urgent Care Clinic of Frisco', 'Latha', NULL, 'Yedlapalli', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 130', 'Midlothian', 'Ellis', 'TX', '76065', '9724239694', '2144365792', 'PO Box 130', 'Midlothian', 'Ellis', 'TX', '76065', '9724239694', '2144365792', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, '', NULL, 'HCFA|UB|', '1356368898', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('205702320', 'SPA100172', 'SPA100172', 'TXDALSTD', 'J Todd Carruthers MD', 'Jeffrey', 'Todd', 'Carruthers', 'MD', 'Family Practice', '', '', NULL, 'O', '1220 N Alma Dr', 'Allen', 'Collin', 'TX', '75013', '9728521534', '9723599160', '1220 N Alma Dr', 'Allen', 'Collin', 'TX', '75013', '9728521534', '9723599160', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, '', NULL, 'HCFA|UB|', '1386645562', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.116, -96.6983, NULL, NULL),
('205702320', 'SPA100174', 'SPA100174', 'TXDALSTD', 'J Todd Carruthers MD', 'Jeffrey', 'Todd', 'Carruthers', 'MD', 'Family Practice', '', '', NULL, 'B', '783 N Denton Tap Rd Ste 200', 'Coppell', 'Dallas', 'TX', '75019', '9728521534', '9723599160', '783 N Denton Tap Rd Ste 200', 'Coppell', 'Dallas', 'TX', '75019', '9728521534', '9723599160', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, '', NULL, 'HCFA|UB|', '1386645562', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.9894, -96.9934, NULL, NULL),
('202904746', 'SPA100175', 'SPA100175', 'TXDALSTD', 'Womens Health Specialists of North Texas', 'Jason', 'P', 'Brown', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1505 W Jefferson Ste 120', 'Waxahachie', 'Ellis', 'TX', '75165', '9729383493', '9729375608', '1505 W Jefferson Ste 120', 'Waxahachie', 'Ellis', 'TX', '75165', '9729383493', '9729375608', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1386752699', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.3972, -96.8656, NULL, NULL),
('202904746', 'SPA100177', 'SPA100177', 'TXDALSTD', 'Womens Health Specialists of North Texas', 'Jason', 'P', 'Brown', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1670 E Broad St Ste 101', 'Mansfield', 'Tarrant', 'TX', '76063', '9729383493', '9729375608', '1670 E Broad St Ste 101', 'Mansfield', 'Tarrant', 'TX', '76063', '9729383493', '9729375608', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1386752699', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.5687, -97.1156, NULL, NULL),
('202904746', 'SPA100178', 'SPA100178', 'TXDALSTD', 'Womens Health Specialists of North Texas', 'Jason', 'P', 'Brown', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '3501 N MacArthur Blvd Ste 500', 'Irving', 'Dallas', 'TX', '75062', '9722589887', '9729375608', '3501 N MacArthur Blvd Ste 500', 'Irving', 'Dallas', 'TX', '75062', '9722589887', '9729375608', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1386752699', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.8525, -96.9592, NULL, NULL),
('383751560', 'SPA100179', 'SPA100179', 'TXDALSTD', 'OB Hospitalists of Texas', 'Robert', 'J', 'Mathews', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3500 Gaston Ave', 'Dallas', 'Dallas', 'TX', '75246', '2143612152', '2143619379', '3500 Gaston Ave', 'Dallas', 'Dallas', 'TX', '75246', '2143612152', '2143619379', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', '2014-03-31', 0, 0, 0, 'Baylor Specialty Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1396773495', 0, 'N', 0, '2014-04-21', NULL, NULL, 32.7911, -96.7802, NULL, NULL),
('383751560', 'SPA100180', 'SPA100180', 'TXDALSTD', 'OB Hospitalists of Texas', 'Robert', 'J', 'Mathews', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'M', '8409 Pickwick Ln Ste 329', 'Dallas', 'Dallas', 'TX', '75225', '9726200382', '2143619379', '8409 Pickwick Ln Ste 329', 'Dallas', 'Dallas', 'TX', '75225', '9726200382', '2143619379', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', '2014-03-31', 0, 0, 0, 'Baylor Specialty Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1396773495', 0, 'Y', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('383751560', 'SPA100181', 'SPA100181', 'TXDALSTD', 'OB Hospitalists of Texas', 'Robert', 'J', 'Mathews', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '9205 Skillman St Ste 104', 'Dallas', 'Dallas', 'TX', '75243', '2142211285', '2143619379', '9205 Skillman St Ste 104', 'Dallas', 'Dallas', 'TX', '75243', '2142211285', '2143619379', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', '2014-03-31', 0, 0, 0, 'Baylor Specialty Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1396773495', 0, 'Y', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('260478705', 'SPA100182', 'SPA100182', 'TXDALSTD', 'Blair Family Medicine', 'Raymond', 'W', 'Blair', 'MD', 'Family Practice', '', '', NULL, 'O', '2203 W Lampasas Ste 101', 'Ennis', 'Ellis', 'TX', '75119', '9728757799', '9728783031', '2203 W Lampasas Ste 101', 'Ennis', 'Ellis', 'TX', '75119', '9728757799', '9728783031', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417077207', 0, 'N', 0, '2014-04-01', NULL, NULL, 32.3136, -96.6341, NULL, NULL),
('260478705', 'SPA100184', 'SPA100184', 'TXDALSTD', 'Blair Family Medicine', 'Raymond', 'W', 'Blair', 'MD', 'Family Practice', '', '', NULL, 'B', '4004 Medical Pkwy', 'Greenville', 'Hunt', 'TX', '75401', '9728757799', '9728783031', '4004 Medical Pkwy', 'Greenville', 'Hunt', 'TX', '75401', '9728757799', '9728783031', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417077207', 0, 'Y', 0, '2014-04-01', NULL, NULL, 33.1268, -96.1239, NULL, NULL),
('751664269', 'SPA100188', 'SPA100188', 'TXDALSTD', 'Howard A Moore MD', 'Howard', 'A', 'Moore', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1015 N Carroll Ave Ste 2000', 'Dallas', 'Dallas', 'TX', '75204', '2148247744', '2148247755', '1015 N Carroll Ave Ste 2000', 'Dallas', 'Dallas', 'TX', '75204', '2148247744', '2148247755', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1427161694', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7974, -96.7743, NULL, NULL),
('751664269', 'SPA100190', 'SPA100190', 'TXDALSTD', 'Howard A Moore MD', 'Howard', 'A', 'Moore', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '502 N Valley Pkwy Ste 1', 'Lewisville', 'Denton', 'TX', '75067', '9723535352', '2148247755', '502 N Valley Pkwy Ste 1', 'Lewisville', 'Denton', 'TX', '75067', '9723535352', '2148247755', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1427161694', 0, 'Y', 0, '2013-11-11', NULL, NULL, 33.0481, -97.0213, NULL, NULL),
('593821403', 'SPA100193', 'SPA100193', 'TXDALSTD', 'Southwestern Digestive Health Physicians', 'John', '', 'Abdulian', 'MD', 'Gastroenterology', '', '', NULL, 'B', '201 Walls Dr Ste 503', 'Cleburne', 'Johnson', 'TX', '76033', '9728751800', '9728751490', '201 Walls Dr Ste 503', 'Cleburne', 'Johnson', 'TX', '76033', '9728751800', '9728751490', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', '', '', '', 'HCFA|UB|', '1437114113', 0, 'Y', 0, '2014-07-10', NULL, NULL, 32.3333, -97.4381, NULL, NULL),
('593821403', 'SPA100191', 'SPA100191', 'TXDALSTD', 'Southwestern Digestive Health Physicians', 'John', '', 'Abdulian', 'MD', 'Gastroenterology', '', '', NULL, 'O', '2200 Physicians Blvd Ste C', 'Ennis', 'Ellis', 'TX', '75119', '9728751800', '9728751490', '2200 Physicians Blvd Ste C', 'Ennis', 'Ellis', 'TX', '75119', '9728751800', '9728751490', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', '', '', '', 'HCFA|UB|', '1437114113', 0, 'N', 0, '2014-07-10', NULL, NULL, 32.3032, -96.6352, NULL, NULL),
('383751560', 'SPA100194', 'SPA100194', 'TXDALSTD', 'OB Hospitalists of Texas', 'Patricia', 'N', 'Harris', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '126 International Rd Ste B', 'Garland', 'Dallas', 'TX', '75042', '9722765560', '2143619379', '126 International Rd Ste B', 'Garland', 'Dallas', 'TX', '75042', '9722765560', '2143619379', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', NULL, 'HCFA|UB|', '1437368743', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.9138, -96.6727, NULL, NULL),
('383751560', 'SPA100195', 'SPA100195', 'TXDALSTD', 'OB Hospitalists of Texas', 'Patricia', 'N', 'Harris', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3500 Gaston Ave', 'Dallas', 'Dallas', 'TX', '75246', '2143612152', '2143619379', '3500 Gaston Ave', 'Dallas', 'Dallas', 'TX', '75246', '2143612152', '2143619379', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', NULL, 'HCFA|UB|', '1437368743', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7911, -96.7802, 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
('383751560', 'SPA100196', 'SPA100196', 'TXDALSTD', 'OB Hospitalists of Texas', 'Patricia', 'N', 'Harris', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'M', '8409 Pickwick Ln Ste 329', 'Dallas', 'Dallas', 'TX', '75225', '9726200382', '2143619379', '8409 Pickwick Ln Ste 329', 'Dallas', 'Dallas', 'TX', '75225', '9726200382', '2143619379', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', NULL, 'HCFA|UB|', '1437368743', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('752336130', 'SPA100204', 'SPA100204', 'TXDALSTD', 'R Greg Maul D O', 'Paulo', NULL, 'Calderon', 'MD', 'Family Practice', '', '', NULL, 'O', '7501 Lakeview Pkwy Ste 130', 'Rowlett', 'Dallas', 'TX', '75088', '9724633100', '8668011503', '7501 Lakeview Pkwy Ste 130', 'Rowlett', 'Dallas', 'TX', '75088', '9724633100', '8668011503', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, '', NULL, 'HCFA|UB|', '1467637819', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.911, -96.5309, NULL, NULL),
('752336130', 'SPA100206', 'SPA100206', 'TXDALSTD', 'R Greg Maul D O', 'Paulo', NULL, 'Calderon', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 450789', 'Garland', 'Dallas', 'TX', '75045', '9724633100', '8668011503', 'PO Box 450789', 'Garland', 'Dallas', 'TX', '75045', '9724633100', '8668011503', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, '', NULL, 'HCFA|UB|', '1467637819', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('412135442', 'SPA100207', 'SPA100207', 'TXDALSTD', 'Midlothian Family Medicine Clinic', 'Bob', 'K', 'Felty', 'MD', 'Family Practice', '', '', NULL, 'B', '1919 S Shiloh Rd Ste 210 LB34', 'Garland', 'Dallas', 'TX', '75042', '9727231185', '9727234003', '1919 S Shiloh Rd Ste 210 LB34', 'Garland', 'Dallas', 'TX', '75042', '9727231185', '9727234003', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1487762365', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.8952, -96.6666, NULL, NULL),
('412135442', 'SPA100208', 'SPA100208', 'TXDALSTD', 'Midlothian Family Medicine Clinic', 'Bob', 'K', 'Felty', 'MD', 'Family Practice', '', '', NULL, 'O', '200 Silken Crossing Ste 201', 'Midlothian', 'Ellis', 'TX', '76065', '9727231185', '9727234003', '200 Silken Crossing Ste 201', 'Midlothian', 'Ellis', 'TX', '76065', '9727231185', '9727234003', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1487762365', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.4774, -96.9831, NULL, NULL),
('205873288', 'SPA100212', 'SPA100212', 'TXDALSTD', 'MacArthur OB GYN Management', 'Jeff', 'M', 'Livingston', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '307 W Park Way', 'Euless', 'Tarrant', 'TX', '76040', '8175102930', '9722589887', '307 W Park Way', 'Euless', 'Tarrant', 'TX', '76040', '8175102930', '9722589887', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, NULL, NULL, 'HCFA|UB|', '1487769642', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8344, -97.1199, NULL, NULL),
('205873288', 'SPA100210', 'SPA100210', 'TXDALSTD', 'MacArthur OB GYN Management', 'Jeff', 'M', 'Livingston', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3501 N MacArthur Blvd Ste 500', 'Irving', 'Dallas', 'TX', '75062', '9722563700', '9722589887', '3501 N MacArthur Blvd Ste 500', 'Irving', 'Dallas', 'TX', '75062', '9722563700', '9722589887', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, NULL, NULL, 'HCFA|UB|', '1487769642', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8525, -96.9591, NULL, NULL),
('205873288', 'SPA100213', 'SPA100213', 'TXDALSTD', 'MacArthur OB GYN Management', 'Jeff', 'M', 'Livingston', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 227174', 'Dallas', 'Dallas', 'TX', '75222', '9722563700', '9722589887', 'PO Box 227174', 'Dallas', 'Dallas', 'TX', '75222', '9722563700', '9722589887', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, NULL, NULL, 'HCFA|UB|', '1487769642', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('383751560', 'SPA100217', 'SPA100217', 'TXDALSTD', 'OB Hospitalists of Texas', 'Robert', 'W', 'Inzer', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3500 Gaston Ave', 'Dallas', 'Dallas', 'TX', '75246', '2143612152', '2143619379', '3500 Gaston Ave', 'Dallas', 'Dallas', 'TX', '75246', '2143612152', '2143619379', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Specialty Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1497780118', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7911, -96.7802, NULL, NULL),
('383751560', 'SPA100218', 'SPA100218', 'TXDALSTD', 'OB Hospitalists of Texas', 'Robert', 'W', 'Inzer', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'M', '8409 Pickwick Ln Ste 329', 'Dallas', 'Dallas', 'TX', '75225', '9726200382', '2143619379', '8409 Pickwick Ln Ste 329', 'Dallas', 'Dallas', 'TX', '75225', '9726200382', '2143619379', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Specialty Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1497780118', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('383751560', 'SPA100219', 'SPA100219', 'TXDALSTD', 'OB Hospitalists of Texas', 'Robert', 'W', 'Inzer', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '9101 LBJ Fwy Ste 710', 'Dallas', 'Dallas', 'TX', '75243', '2145752245', '2143619379', '9101 LBJ Fwy Ste 710', 'Dallas', 'Dallas', 'TX', '75243', '2145752245', '2143619379', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Specialty Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1497780118', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('752845933', 'SPA100220', 'SPA100220', 'TXDALSTD', 'Procare Medical Clinic', 'Rifat', '', 'Naghmi', 'MD', 'Internal Medicine', '', '', NULL, 'O', '126 International Rd Ste B', 'Garland', 'Dallas', 'TX', '75042', '9722761779', '9722765560', '126 International Rd Ste B', 'Garland', 'Dallas', 'TX', '75042', '9722761779', '9722765560', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1508822537', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.914, -96.6727, NULL, NULL),
('752845933', 'SPA100222', 'SPA100222', 'TXDALSTD', 'Procare Medical Clinic', 'Rifat', '', 'Naghmi', 'MD', 'Internal Medicine', '', '', NULL, 'B', '783 N Denton Tap Rd Ste 200', 'Coppell', 'Dallas', 'TX', '75019', '8178602704', '9722765560', '783 N Denton Tap Rd Ste 200', 'Coppell', 'Dallas', 'TX', '75019', '8178602704', '9722765560', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1508822537', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.9894, -96.9934, NULL, NULL),
('752284981', 'SPA100223', 'SPA100223', 'TXDALSTD', 'Robert E White MD', 'Robert', 'E', 'White', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '2821 E Pres George Bush Hwy Ste 308', 'Richardson', 'Dallas', 'TX', '75082', '2143201691', '2148215473', '2821 E Pres George Bush Hwy Ste 308', 'Richardson', 'Dallas', 'TX', '75082', '2143201691', '2148215473', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', NULL, 'HCFA|UB|', '1508862582', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.9958, -96.667, NULL, NULL),
('752284981', 'SPA100224', 'SPA100224', 'TXDALSTD', 'Robert E White MD', 'Robert', 'E', 'White', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3801 Gaston Ave Ste 308', 'Dallas', 'Dallas', 'TX', '75246', '2148243730', '2148215473', '3801 Gaston Ave Ste 308', 'Dallas', 'Dallas', 'TX', '75246', '2148243730', '2148215473', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', NULL, 'HCFA|UB|', '1508862582', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7919, -96.7792, NULL, NULL),
('271385779', 'SPA100230', 'SPA100230', 'TXDALSTD', 'Colleen I Kennedy MD', 'Colleen', 'I', 'Kennedy', 'MD', 'General Surgery', '', '', NULL, 'M', '1309 Ridge Rd Ste 109', 'Rockwall', 'Rockwall', 'TX', '75087', '2147751356', '2146132231', '1309 Ridge Rd Ste 109', 'Rockwall', 'Rockwall', 'TX', '75087', '2147751356', '2146132231', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', NULL, 'HCFA|UB|', '1508897810', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('271385779', 'SPA100231', 'SPA100231', 'TXDALSTD', 'Colleen I Kennedy MD', 'Colleen', 'I', 'Kennedy', 'MD', 'General Surgery', '', '', NULL, 'O', '3142 Horizon Rd Ste 202', 'Rockwall', 'Rockwall', 'TX', '75032', '2147751356', '2146132231', '3142 Horizon Rd Ste 202', 'Rockwall', 'Rockwall', 'TX', '75032', '2147751356', '2146132231', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', NULL, 'HCFA|UB|', '1508897810', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8897, -96.469, NULL, NULL),
('271385779', 'SPA100232', 'SPA100232', 'TXDALSTD', 'Colleen I Kennedy MD', 'Colleen', 'I', 'Kennedy', 'MD', 'General Surgery', '', '', NULL, 'O', '3808 Swiss Ave', 'Dallas', 'Dallas', 'TX', '75204', '2147751356', '2146132231', '3808 Swiss Ave', 'Dallas', 'Dallas', 'TX', '75204', '2147751356', '2146132231', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', NULL, 'HCFA|UB|', '1508897810', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7931, -96.7805, NULL, NULL),
('271385779', 'SPA100233', 'SPA100233', 'TXDALSTD', 'Colleen I Kennedy MD', 'Colleen', 'I', 'Kennedy', 'MD', 'General Surgery', '', '', NULL, 'B', '3900 W 15th St Ste 503', 'Plano', 'Collin', 'TX', '75075', '2147751356', '2146132231', '3900 W 15th St Ste 503', 'Plano', 'Collin', 'TX', '75075', '2147751356', '2146132231', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', NULL, 'HCFA|UB|', '1508897810', 0, 'Y', 0, '2013-11-11', NULL, NULL, 33.0192, -96.7653, NULL, NULL),
('264833556', 'SPA100234', 'SPA100234', 'TXDALSTD', 'Shelton Family Health Care', 'Kevin', 'J', 'Shelton', 'MD', 'Family Practice', '', '', NULL, 'B', '1300 Plaza Rd', 'Desoto', 'Dallas', 'TX', '75115', '9722244242', '9723821167', '1300 Plaza Rd', 'Desoto', 'Dallas', 'TX', '75115', '9722244242', '9723821167', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528019452', 0, 'Y', 0, '2014-04-02', NULL, NULL, 32.6092, -96.8247, NULL, NULL),
('264833556', 'SPA100235', 'SPA100235', 'TXDALSTD', 'Shelton Family Health Care', 'Kevin', 'J', 'Shelton', 'MD', 'Family Practice', '', '', NULL, 'O', '701 N Preston Rd Ste 100', 'Celina', 'Collin', 'TX', '75009', '9723821000', '9723821167', '701 N Preston Rd Ste 100', 'Celina', 'Collin', 'TX', '75009', '9723821000', '9723821167', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528019452', 0, 'N', 0, '2014-04-02', NULL, NULL, 33.3302, -96.7731, NULL, NULL),
('202654717', 'SPA100240', 'SPA100240', 'TXDALSTD', 'Transcend Medical Group', 'Todd', 'T', 'Nguyen', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1119 W Randol Mill Rd Ste 100', 'Arlington', 'Tarrant', 'TX', '76012', '8178602700', '8178602704', '1119 W Randol Mill Rd Ste 100', 'Arlington', 'Tarrant', 'TX', '76012', '8178602700', '8178602704', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, '', NULL, 'HCFA|UB|', '1548249030', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7502, -97.1216, NULL, NULL),
('202654717', 'SPA100242', 'SPA100242', 'TXDALSTD', 'Transcend Medical Group', 'Todd', 'T', 'Nguyen', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 660046', 'Dallas', 'Dallas', 'TX', '75266', '8178602700', '8178602704', 'PO Box 660046', 'Dallas', 'Dallas', 'TX', '75266', '8178602700', '8178602704', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, '', NULL, 'HCFA|UB|', '1548249030', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('752961148', 'SPA100243', 'SPA100243', 'TXDALSTD', 'Carrollton Pediatrics', 'Muhammad', '', 'Mirza', 'MD', 'Pediatrics', '', '', NULL, 'B', '10246 Midway Ste A', 'Dallas', 'Dallas', 'TX', '75229', '2143578435', '2144833286', '10246 Midway Ste A', 'Dallas', 'Dallas', 'TX', '75229', '2143578435', '2144833286', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, NULL, NULL, 'HCFA|UB|', '1548269822', 0, 'Y', 0, '2014-02-12', NULL, NULL, 32.8866, -96.8379, NULL, NULL),
('752961148', 'SPA100244', 'SPA100244', 'TXDALSTD', 'Carrollton Pediatrics', 'Muhammad', '', 'Mirza', 'MD', 'Pediatrics', '', '', NULL, 'O', '4300 N Josey Ln Ste 110', 'Carrollton', 'Denton', 'TX', '75010', '2144833292', '2144833286', '4300 N Josey Ln Ste 110', 'Carrollton', 'Denton', 'TX', '75010', '2144833292', '2144833286', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, NULL, NULL, 'HCFA|UB|', '1548269822', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.0272, -96.8847, NULL, NULL),
('205714560', 'SPA100246', 'SPA100246', 'TXDALSTD', 'Alliance Family Medicine', 'Risha', NULL, 'Kopel', 'MD', 'Internal Medicine', '', '', NULL, 'O', '17610 Preston Rd', 'Dallas', 'Collin', 'TX', '75252', '9729310100', '9729310400', '17610 Preston Rd', 'Dallas', 'Collin', 'TX', '75252', '9729310100', '9729310400', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1548311160', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.9917, -96.8008, NULL, NULL),
('205714560', 'SPA100248', 'SPA100248', 'TXDALSTD', 'Alliance Family Medicine', 'Risha', NULL, 'Kopel', 'MD', 'Internal Medicine', '', '', NULL, 'B', '800 W Magnolia Ave', 'Fort Worth', 'Tarrant', 'TX', '76104', '8173330173', '9729310400', '800 W Magnolia Ave', 'Fort Worth', 'Tarrant', 'TX', '76104', '8173330173', '9729310400', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1548311160', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.7311, -97.3328, NULL, NULL),
('752952407', 'SPA100256', 'SPA100256', 'TXDALSTD', 'Berry Milner and Uhr', 'William', 'L', 'Berry', 'MD', 'Ophthalmology', '', '', NULL, 'O', '3600 Gaston Ave Ste 609', 'Dallas', 'Dallas', 'TX', '75246', '2148268201', '2148278515', '3600 Gaston Ave Ste 609', 'Dallas', 'Dallas', 'TX', '75246', '2148268201', '2148278515', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1588612741', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7913, -96.7799, NULL, NULL),
('752952407', 'SPA100257', 'SPA100257', 'TXDALSTD', 'Berry Milner and Uhr', 'William', 'L', 'Berry', 'MD', 'Ophthalmology', '', '', NULL, 'M', '3600 Gaston Ave LB120 Ste 609', 'Dallas', 'Dallas', 'TX', '75246', '2148268201', '2148278515', '3600 Gaston Ave LB120 Ste 609', 'Dallas', 'Dallas', 'TX', '75246', '2148268201', '2148278515', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1588612741', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('752952407', 'SPA100258', 'SPA100258', 'TXDALSTD', 'Berry Milner and Uhr', 'William', 'L', 'Berry', 'MD', 'Ophthalmology', '', '', NULL, 'B', 'PO Box 7824', 'Belfast', 'Waldo', 'TX', '04915', '9723885971', '2148278515', 'PO Box 7824', 'Belfast', 'Waldo', 'TX', '04915', '9723885971', '2148278515', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1588612741', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('752333069', 'SPA100259', 'SPA100259', 'TXDALSTD', 'Drs Vanderpool and Westmoreland', 'David', NULL, 'Vanderpool', 'MD', 'General Surgery', '', '', NULL, 'O', '3808 Swiss Ave', 'Dallas', 'Dallas', 'TX', '75204', '2148232650', '2148242404', '3808 Swiss Ave', 'Dallas', 'Dallas', 'TX', '75204', '2148232650', '2148242404', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1598735979', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7931, -96.7805, NULL, NULL),
('752333069', 'SPA100261', 'SPA100261', 'TXDALSTD', 'Drs Vanderpool and Westmoreland', 'David', NULL, 'Vanderpool', 'MD', 'General Surgery', '', '', NULL, 'B', '707 N Zang Blvd', 'Dallas', 'Dallas', 'TX', '75208', '2149435130', '2148242404', '707 N Zang Blvd', 'Dallas', 'Dallas', 'TX', '75208', '2149435130', '2148242404', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1598735979', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.7511, -96.8245, NULL, NULL),
('43822175', 'SPA100269', 'SPA100269', 'TXDALSTD', 'Jennifer Hudman MD', 'Jennifer', 'M', 'Hudman', 'MD', 'Pediatrics', '', '', NULL, 'B', '3600 Gaston Ave Ste 1209', 'Dallas', 'Dallas', 'TX', '75246', '2148263434', '8172702450', '3600 Gaston Ave Ste 1209', 'Dallas', 'Dallas', 'TX', '75246', '2148263434', '8172702450', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619955432', 0, 'Y', 0, '2014-04-01', NULL, NULL, 32.791, -96.7798, NULL, NULL),
('43822175', 'SPA100270', 'SPA100270', 'TXDALSTD', 'Jennifer Hudman MD', 'Jennifer', 'M', 'Hudman', 'MD', 'Pediatrics', '', '', NULL, 'O', '604 Southeast Pkwy', 'Azle', 'Tarrant', 'TX', '76020', '8172702320', '8172702450', '604 Southeast Pkwy', 'Azle', 'Tarrant', 'TX', '76020', '8172702320', '8172702450', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619955432', 0, 'N', 0, '2014-04-01', NULL, NULL, 32.883, -97.5379, NULL, NULL),
('752603970', 'SPA100275', 'SPA100275', 'TXDALSTD', 'Josephine T Win MD', 'Josephine', 'T', 'Win', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2097 N Collins Blvd Ste 198', 'Richardson', 'Dallas', 'TX', '75080', '9726809983', '9726809163', '2097 N Collins Blvd Ste 198', 'Richardson', 'Dallas', 'TX', '75080', '9726809983', '9726809163', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, '', NULL, 'HCFA|UB|', '1629078779', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.9789, -96.7175, NULL, NULL),
('752603970', 'SPA100277', 'SPA100277', 'TXDALSTD', 'Josephine T Win MD', 'Josephine', 'T', 'Win', 'MD', 'Internal Medicine', '', '', NULL, 'B', '6750 N MacArthur Blvd Ste 206', 'Irving', 'Dallas', 'TX', '75039', '9724069930', '9726809163', '6750 N MacArthur Blvd Ste 206', 'Irving', 'Dallas', 'TX', '75039', '9724069930', '9726809163', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, '', NULL, 'HCFA|UB|', '1629078779', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.9008, -96.9574, NULL, NULL),
('261210901', 'SPA100278', 'SPA100278', 'TXDALSTD', 'Buckner Elam Medical Group', 'Setal', NULL, 'Rana', 'MD', 'Family Practice', '', '', NULL, 'B', '1600 W College St Ste 340', 'Grapevine', 'Tarrant', 'TX', '76051', '8174211416', '2143980102', '1600 W College St Ste 340', 'Grapevine', 'Tarrant', 'TX', '76051', '8174211416', '2143980102', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, '', NULL, 'HCFA|UB|', '1629274295', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.9345, -97.0946, NULL, NULL),
('261210901', 'SPA100279', 'SPA100279', 'TXDALSTD', 'Buckner Elam Medical Group', 'Setal', NULL, 'Rana', 'MD', 'Family Practice', '', '', NULL, 'O', '8202 Elam Rd', 'Dallas', 'Dallas', 'TX', '75217', '2143980678', '2143980102', '8202 Elam Rd', 'Dallas', 'Dallas', 'TX', '75217', '2143980678', '2143980102', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, '', NULL, 'HCFA|UB|', '1629274295', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7196, -96.681, NULL, NULL),
('383751560', 'SPA100281', 'SPA100281', 'TXDALSTD', 'OB Hospitalists of Texas', 'Sharon', 'M', 'Bakos', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3500 Gaston Ave', 'Dallas', 'Dallas', 'TX', '75246', '2143612152', '2143619379', '3500 Gaston Ave', 'Dallas', 'Dallas', 'TX', '75246', '2143612152', '2143619379', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', NULL, 'HCFA|UB|', '1639175847', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7911, -96.7802, NULL, NULL),
('383751560', 'SPA100282', 'SPA100282', 'TXDALSTD', 'OB Hospitalists of Texas', 'Sharon', 'M', 'Bakos', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'M', '8409 Pickwick Ln Ste 329', 'Dallas', 'Dallas', 'TX', '75225', '9724630864', '2143619379', '8409 Pickwick Ln Ste 329', 'Dallas', 'Dallas', 'TX', '75225', '9724630864', '2143619379', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', NULL, 'HCFA|UB|', '1639175847', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('383751560', 'SPA100283', 'SPA100283', 'TXDALSTD', 'OB Hospitalists of Texas', 'Sharon', 'M', 'Bakos', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 650409', 'Dallas', 'Dallas', 'TX', '75265', '9724630864', '2143619379', 'PO Box 650409', 'Dallas', 'Dallas', 'TX', '75265', '9724630864', '2143619379', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', NULL, 'HCFA|UB|', '1639175847', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('383751560', 'SPA100284', 'SPA100284', 'TXDALSTD', 'OB Hospitalists of Texas', 'Adrianne', 'C', 'Browning', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1631 Lancaster Dr Ste 220', 'Grapevine', 'Tarrant', 'TX', '76051', '2143612152', '2143619379', '1631 Lancaster Dr Ste 220', 'Grapevine', 'Tarrant', 'TX', '76051', '2143612152', '2143619379', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', NULL, 'HCFA|UB|', '1639387889', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.9323, -97.0916, NULL, NULL),
('383751560', 'SPA100285', 'SPA100285', 'TXDALSTD', 'OB Hospitalists of Texas', 'Adrianne', 'C', 'Browning', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3500 Gaston Ave', 'Dallas', 'Dallas', 'TX', '75246', '2143612152', '2143619379', '3500 Gaston Ave', 'Dallas', 'Dallas', 'TX', '75246', '2143612152', '2143619379', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', NULL, 'HCFA|UB|', '1639387889', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7911, -96.7802, NULL, NULL),
('383751560', 'SPA100286', 'SPA100286', 'TXDALSTD', 'OB Hospitalists of Texas', 'Adrianne', 'C', 'Browning', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'M', '8409 Pickwick Ln Ste 329', 'Dallas', 'Dallas', 'TX', '75225', '9726200382', '2143619379', '8409 Pickwick Ln Ste 329', 'Dallas', 'Dallas', 'TX', '75225', '9726200382', '2143619379', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', NULL, 'HCFA|UB|', '1639387889', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('751780220', 'SPA100287', 'SPA100287', 'TXDALSTD', 'Texas Cardiothoracic Surgery Associates', 'William', 'G', 'Jones', 'MD', 'Thoracic Surgery', '', '', NULL, 'M', '221 W Colorado Blvd Ste 825', 'Dallas', 'Dallas', 'TX', '75208', '2149425222', '2149429366', '221 W Colorado Blvd Ste 825', 'Dallas', 'Dallas', 'TX', '75208', '2149425222', '2149429366', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', NULL, 'HCFA|UB|', '1649231705', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.7592, -96.8253, NULL, NULL),
('751780220', 'SPA100289', 'SPA100289', 'TXDALSTD', 'Texas Cardiothoracic Surgery Associates', 'William', 'G', 'Jones', 'MD', 'Thoracic Surgery', '', '', NULL, 'B', '7501 Lakeview Pkwy Ste 130', 'Rowlett', 'Dallas', 'TX', '75088', '8668011503', '2149429366', '7501 Lakeview Pkwy Ste 130', 'Rowlett', 'Dallas', 'TX', '75088', '8668011503', '2149429366', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', NULL, 'HCFA|UB|', '1649231705', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.9125, -96.5293, NULL, NULL),
('751780220', 'SPA100290', 'SPA100290', 'TXDALSTD', 'Texas Cardiothoracic Surgery Associates', 'William', 'G', 'Jones', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '929 N Galloway Ste 180', 'Mesquite', 'Dallas', 'TX', '75149', '2149425222', '2149429366', '929 N Galloway Ste 180', 'Mesquite', 'Dallas', 'TX', '75149', '2149425222', '2149429366', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', NULL, 'HCFA|UB|', '1649231705', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.776, -96.5993, NULL, NULL),
('352340017', 'SPA100291', 'SPA100291', 'TXDALSTD', 'Pattyann A Hardt MD', 'Pattyann', 'A', 'Hardt', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1425 8th Ave', 'Fort Worth', 'Tarrant', 'TX', '76104', '8179264118', '8179264362', '1425 8th Ave', 'Fort Worth', 'Tarrant', 'TX', '76104', '8179264118', '8179264362', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1649443201', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7291, -97.3437, NULL, NULL),
('352340017', 'SPA100293', 'SPA100293', 'TXDALSTD', 'Pattyann A Hardt MD', 'Pattyann', 'A', 'Hardt', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '3501 N MacArthur Blvd Ste 500', 'Irving', 'Dallas', 'TX', '75062', '9722589887', '8179264362', '3501 N MacArthur Blvd Ste 500', 'Irving', 'Dallas', 'TX', '75062', '9722589887', '8179264362', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1649443201', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.8525, -96.9592, NULL, NULL),
('262577896', 'SPA100296', 'SPA100296', 'TXDALSTD', 'Colleyville Dermatology', 'Sreedevi', NULL, 'Kodali', 'MD', 'Dermatology', '', '', NULL, 'O', '5013 Heritage Ave', 'Colleyville', 'Tarrant', 'TX', '76034', '8178681616', '8178681617', '5013 Heritage Ave', 'Colleyville', 'Tarrant', 'TX', '76034', '8178681616', '8178681617', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, '', NULL, 'HCFA|UB|', '1649498544', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8817, -97.1056, NULL, NULL),
('262577896', 'SPA100294', 'SPA100294', 'TXDALSTD', 'Colleyville Dermatology', 'Sreedevi', NULL, 'Kodali', 'MD', 'Dermatology', '', '', NULL, 'B', '517 W I-30 Ste C', 'Garland', 'Dallas', 'TX', '75043', '9722404222', '8178681617', '517 W Interstate 30 Ste C', 'Garland', 'Dallas', 'TX', '75043', '9722404222', '8178681617', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, '', NULL, 'HCFA|UB|', '1649498544', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.837, -96.6017, NULL, NULL),
('262577896', 'SPA100295', 'SPA100295', 'TXDALSTD', 'Colleyville Dermatology', 'Sreedevi', NULL, 'Kodali', 'MD', 'Dermatology', '', '', NULL, 'O', '5209 Heritage Ave Ste 220', 'Colleyville', 'Tarrant', 'TX', '76034', '8178681616', '8178681617', '5209 Heritage Ave Ste 220', 'Colleyville', 'Tarrant', 'TX', '76034', '8178681616', '8178681617', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, '', NULL, 'HCFA|UB|', '1649498544', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8849, -97.1054, NULL, NULL),
('752772963', 'SPA100302', 'SPA100302', 'TXDALSTD', 'Rebecca M Robert MD', 'Rebecca', 'M', 'Robert', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1631 Lancaster Dr Ste 220', 'Grapevine', 'Tarrant', 'TX', '76051', '8178655300', '8174429841', '1631 Lancaster Dr Ste 220', 'Grapevine', 'Tarrant', 'TX', '76051', '8178655300', '8174429841', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, '', NULL, 'HCFA|UB|', '1659319424', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.9329, -97.0918, NULL, NULL),
('752772963', 'SPA100304', 'SPA100304', 'TXDALSTD', 'Rebecca M Robert MD', 'Rebecca', 'M', 'Robert', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '2760 Virginia Pkwy Ste 200', 'McKinney', 'Collin', 'TX', '75070', '2145446737', '8174429841', '2760 Virginia Pkwy Ste 200', 'McKinney', 'Collin', 'TX', '75070', '2145446737', '8174429841', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, '', NULL, 'HCFA|UB|', '1659319424', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('752652430', 'SPA100305', 'SPA100305', 'TXDALSTD', 'Obstetrics and Gynecology of North Texas', 'Julia', 'C', 'Flowers', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1600 W College St Ste 540', 'Grapevine', 'Tarrant', 'TX', '76051', '8174815863', '8173298561', '1600 W College St Ste 540', 'Grapevine', 'Tarrant', 'TX', '76051', '8174815863', '8173298561', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, NULL, NULL, 'HCFA|UB|', '1669433140', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.9356, -97.0929, NULL, NULL),
('752652430', 'SPA100307', 'SPA100307', 'TXDALSTD', 'Obstetrics and Gynecology of North Texas', 'Julia', 'C', 'Flowers', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '8202 Elam Rd', 'Dallas', 'Dallas', 'TX', '75217', '8174815863', '8173298561', '8202 Elam Rd', 'Dallas', 'Dallas', 'TX', '75217', '8174815863', '8173298561', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, NULL, NULL, 'HCFA|UB|', '1669433140', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.7192, -96.6812, NULL, NULL),
('752935588', 'SPA100308', 'SPA100308', 'TXDALSTD', 'Rowlett Cardiology Consultants', 'Scott', 'K', 'Stephenson', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3142 Horizon Rd Ste 200', 'Rockwall', 'Rockwall', 'TX', '75032', '9724757500', '9724756131', '3142 Horizon Rd Ste 200', 'Rockwall', 'Rockwall', 'TX', '75032', '9724757500', '9724756131', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', 'Baylor Medical Center at Garland', '', NULL, 'HCFA|UB|', '1669459095', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8897, -96.469, NULL, NULL),
('752935588', 'SPA100309', 'SPA100309', 'TXDALSTD', 'Rowlett Cardiology Consultants', 'Scott', 'K', 'Stephenson', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', '3501 N MacArthur Blvd Ste 500', 'Irving', 'Dallas', 'TX', '75062', '9722589887', '9724756131', '3501 N MacArthur Blvd Ste 500', 'Irving', 'Dallas', 'TX', '75062', '9722589887', '9724756131', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', 'Baylor Medical Center at Garland', '', NULL, 'HCFA|UB|', '1669459095', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.8525, -96.9592, NULL, NULL),
('752935588', 'SPA100310', 'SPA100310', 'TXDALSTD', 'Rowlett Cardiology Consultants', 'Scott', 'K', 'Stephenson', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '7801 Lakeview Pkwy Ste 100', 'Rowlett', 'Dallas', 'TX', '75088', '9724757500', '9724756131', '7801 Lakeview Pkwy Ste 100', 'Rowlett', 'Dallas', 'TX', '75088', '9724757500', '9724756131', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', 'Baylor Medical Center at Garland', '', NULL, 'HCFA|UB|', '1669459095', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.9146, -96.5237, NULL, NULL),
('751856419', 'SPA100312', 'SPA100312', 'TXDALSTD', 'Dennis B Kay MD', 'Dennis', 'B', 'Kay', 'MD', 'Ophthalmology', '', '', NULL, 'O', '8345 Walnut Hill Ln Ste 140', 'Dallas', 'Dallas', 'TX', '75231', '2143688600', '2143688604', '8345 Walnut Hill Ln Ste 140', 'Dallas', 'Dallas', 'TX', '75231', '2143688600', '2143688604', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1669536629', 0, 'N', 0, '2014-04-25', NULL, NULL, 32.8834, -96.7607, NULL, NULL),
('751856419', 'SPA100314', 'SPA100314', 'TXDALSTD', 'Dennis B Kay MD', 'Dennis', 'B', 'Kay', 'MD', 'Ophthalmology', '', '', NULL, 'B', '8668 Skillman', 'Dallas', 'Dallas', 'TX', '75243', '2143688600', '2143688604', '8668 Skillman', 'Dallas', 'Dallas', 'TX', '75243', '2143688600', '2143688604', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1669536629', 0, 'Y', 0, '2014-04-25', NULL, NULL, 32.8965, -96.722, NULL, NULL),
('752869959', 'SPA100318', 'SPA100318', 'TXDALSTD', 'Xuecheng Wang MD', 'Xuecheng', NULL, 'Wang', 'MD', 'Internal Medicine', '', '', NULL, 'B', '2097 N Collins Blvd Ste 198', 'Richardson', 'Dallas', 'TX', '75080', '9726809163', '9724811888', '2097 N Collins Blvd Ste 198', 'Richardson', 'Dallas', 'TX', '75080', '9726809163', '9724811888', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, '', NULL, 'HCFA|UB|', '1679531594', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.9786, -96.718, NULL, NULL),
('752869959', 'SPA100319', 'SPA100319', 'TXDALSTD', 'Xuecheng Wang MD', 'Xuecheng', NULL, 'Wang', 'MD', 'Internal Medicine', '', '', NULL, 'O', '8 Medical Pkwy Ste 204', 'Farmers Branch', 'Dallas', 'TX', '75234', '9724811881', '9724811888', '8 Medical Pkwy Ste 204', 'Farmers Branch', 'Dallas', 'TX', '75234', '9724811881', '9724811888', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, '', NULL, 'HCFA|UB|', '1679531594', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.9161, -96.8698, NULL, NULL),
('752869959', 'SPA100320', 'SPA100320', 'TXDALSTD', 'Xuecheng Wang MD', 'Xuecheng', NULL, 'Wang', 'MD', 'Internal Medicine', '', '', NULL, 'M', '8 Medical Pwy Ste 20', 'Farmers Branch', 'Dallas', 'TX', '75234', '9724811881', '9724811888', '8 Medical Pwy Ste 20', 'Farmers Branch', 'Dallas', 'TX', '75234', '9724811881', '9724811888', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, '', NULL, 'HCFA|UB|', '1679531594', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('203865122', 'SPA100328', 'SPA100328', 'TXDALSTD', 'Casey Nguyen MD', 'Casey', NULL, 'Nguyen', 'MD', 'Family Practice', '', '', NULL, 'O', '1420 N MacArthur Blvd', 'Irving', 'Dallas', 'TX', '75061', '2145969229', '2145969231', '1420 N MacArthur Blvd', 'Irving', 'Dallas', 'TX', '75061', '2145969229', '2145969231', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, NULL, NULL, 'HCFA|UB|', '1700832524', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8285, -96.9591, NULL, NULL),
('203865122', 'SPA100330', 'SPA100330', 'TXDALSTD', 'Casey Nguyen MD', 'Casey', NULL, 'Nguyen', 'MD', 'Family Practice', '', '', NULL, 'B', '3501 N MacArthur Blvd Ste 500', 'Irving', 'Dallas', 'TX', '75062', '9722589887', '2145969231', '3501 N MacArthur Blvd Ste 500', 'Irving', 'Dallas', 'TX', '75062', '9722589887', '2145969231', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, NULL, NULL, 'HCFA|UB|', '1700832524', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.8525, -96.9592, NULL, NULL),
('273208558', 'SPA100331', 'SPA100331', 'TXDALSTD', 'Theresa D Stretch MD', 'Theresa', 'D', 'Stretch', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1806 W Pleasant Ridge', 'Arlington', 'Tarrant', 'TX', '76015', '8176356363', '8176356362', '1806 W Pleasant Ridge', 'Arlington', 'Tarrant', 'TX', '76015', '8176356363', '8176356362', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, '', NULL, 'HCFA|UB|', '1710218169', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.6788, -97.1374, NULL, NULL),
('273208558', 'SPA100333', 'SPA100333', 'TXDALSTD', 'Theresa D Stretch MD', 'Theresa', 'D', 'Stretch', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 93477', 'Southlake', 'Tarrant', 'TX', '76092', '8176356363', '8176356362', 'PO Box 93477', 'Southlake', 'Tarrant', 'TX', '76092', '8176356363', '8176356362', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, '', NULL, 'HCFA|UB|', '1710218169', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('752955654', 'SPA100337', 'SPA100337', 'TXDALSTD', 'Frisco Pediatrics', 'Kathleen', 'D', 'Stokes', 'MD', 'Pediatrics', '', '', NULL, 'B', '1121 W Jefferson Blvd', 'Dallas', 'Dallas', 'TX', '75208', '2149483944', '9723350880', '1121 W Jefferson Blvd', 'Dallas', 'Dallas', 'TX', '75208', '2149483944', '9723350880', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, '', NULL, 'HCFA|UB|', '1710985205', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.7437, -96.8413, NULL, NULL),
('752955654', 'SPA100338', 'SPA100338', 'TXDALSTD', 'Frisco Pediatrics', 'Kathleen', 'D', 'Stokes', 'MD', 'Pediatrics', '', '', NULL, 'O', '6930 Parkwood Blvd', 'Frisco', 'Denton', 'TX', '75034', '9723354444', '9723350880', '6930 Parkwood Blvd', 'Frisco', 'Denton', 'TX', '75034', '9723354444', '9723350880', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, '', NULL, 'HCFA|UB|', '1710985205', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.1258, -96.8055, NULL, NULL),
('752169593', 'SPA100343', 'SPA100343', 'TXDALSTD', 'Alfonso Ramirez MD', 'Alfonso', '', 'Ramirez', 'MD', 'Family Practice', '', '', NULL, 'O', '1121 W Jefferson Blvd', 'Dallas', 'Dallas', 'TX', '75208', '2149435773', '2149483944', '1121 W Jefferson Blvd', 'Dallas', 'Dallas', 'TX', '75208', '2149435773', '2149483944', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730158718', 0, 'N', 0, '2014-03-31', NULL, NULL, 32.7433, -96.8411, NULL, NULL),
('752169593', 'SPA100345', 'SPA100345', 'TXDALSTD', 'Alfonso Ramirez MD', 'Alfonso', '', 'Ramirez', 'MD', 'Family Practice', '', '', NULL, 'B', '901 N Galloway Ste 149', 'Mesquite', 'Dallas', 'TX', '75149', '9722164903', '2149483944', '901 N Galloway Ste 149', 'Mesquite', 'Dallas', 'TX', '75149', '9722164903', '2149483944', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730158718', 0, 'Y', 0, '2014-03-31', NULL, NULL, 32.7765, -96.6001, NULL, NULL),
('201428211', 'SPA100346', 'SPA100346', 'TXDALSTD', 'Edward DeAllen Clark MD', 'Edward', 'D', 'Clark', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1600 W College St Ste 510', 'Grapevine', 'Tarrant', 'TX', '76051', '8174107982', '8174107986', '1600 W College St Ste 510', 'Grapevine', 'Tarrant', 'TX', '76051', '8174107982', '8174107986', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, NULL, NULL, 'HCFA|UB|', '1730294232', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.9356, -97.0929, NULL, NULL),
('201428211', 'SPA100348', 'SPA100348', 'TXDALSTD', 'Edward DeAllen Clark MD', 'Edward', 'D', 'Clark', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '3501 N MacArthur Blvd Ste 500', 'Irving', 'Dallas', 'TX', '75062', '9722589887', '8174107986', '3501 N MacArthur Blvd Ste 500', 'Irving', 'Dallas', 'TX', '75062', '9722589887', '8174107986', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, NULL, NULL, 'HCFA|UB|', '1730294232', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.8525, -96.9592, NULL, NULL),
('751189650', 'SPA100352', 'SPA100352', 'TXDALSTD', 'David Young MD', 'David', 'W', 'Young', 'MD', 'General Surgery', '', '', NULL, 'O', '10246 Midway Ste A', 'Dallas', 'Dallas', 'TX', '75229', '2143578254', '2143578435', '10246 Midway Ste A', 'Dallas', 'Dallas', 'TX', '75229', '2143578254', '2143578435', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', NULL, 'HCFA|UB|', '1760492813', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8864, -96.8383, NULL, NULL),
('751189650', 'SPA100354', 'SPA100354', 'TXDALSTD', 'David Young MD', 'David', 'W', 'Young', 'MD', 'General Surgery', '', '', NULL, 'B', '3310 Live Oak Ste 250', 'Dallas', 'Dallas', 'TX', '75204', '2148235974', '2143578435', '3310 Live Oak Ste 250', 'Dallas', 'Dallas', 'TX', '75204', '2148235974', '2143578435', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', NULL, 'HCFA|UB|', '1760492813', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.7922, -96.7846, NULL, NULL),
('752190750', 'SPA100355', 'SPA100355', 'TXDALSTD', 'Cheryl A Snyder MD', 'Cheryl', 'A', 'Snyder', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1300 Plaza Rd', 'DeSoto', 'Dallas', 'TX', '75115', '9722249000', '9722244242', '1300 Plaza Rd', 'DeSoto', 'Dallas', 'TX', '75115', '9722249000', '9722244242', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1760573893', 0, 'N', 0, '2014-04-02', NULL, NULL, 32.6092, -96.825, NULL, NULL),
('752190750', 'SPA100357', 'SPA100357', 'TXDALSTD', 'Cheryl A Snyder MD', 'Cheryl', 'A', 'Snyder', 'MD', 'Ophthalmology', '', '', NULL, 'B', '1505 W Jefferson Ste 120', 'Waxahachie', 'Ellis', 'TX', '75165', '9729375608', '9722244242', '1505 W Jefferson Ste 120', 'Waxahachie', 'Ellis', 'TX', '75165', '9729375608', '9722244242', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1760573893', 0, 'Y', 0, '2014-04-02', NULL, NULL, 32.3968, -96.865, NULL, NULL),
('202904746', 'SPA100358', 'SPA100358', 'TXDALSTD', 'Womens Health Specialists of North Texas', 'Paul', 'A', 'Lansdowne', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1130 Beachview Rd Ste 100', 'Dallas', 'Dallas', 'TX', '75218', '2143987200', '9729375608', '1130 Beachview Rd Ste 100', 'Dallas', 'Dallas', 'TX', '75218', '2143987200', '9729375608', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1760574115', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('202904746', 'SPA100359', 'SPA100359', 'TXDALSTD', 'Womens Health Specialists of North Texas', 'Paul', 'A', 'Lansdowne', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1505 W Jefferson Ste 120', 'Waxahachie', 'Ellis', 'TX', '75165', '9729383493', '9729375608', '1505 W Jefferson Ste 120', 'Waxahachie', 'Ellis', 'TX', '75165', '9729383493', '9729375608', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1760574115', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.3972, -96.8656, NULL, NULL),
('202904746', 'SPA100361', 'SPA100361', 'TXDALSTD', 'Womens Health Specialists of North Texas', 'Paul', 'A', 'Lansdowne', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1670 E Broad St Ste 101', 'Mansfield', 'Tarrant', 'TX', '76063', '9729383493', '9729375608', '1670 E Broad St Ste 101', 'Mansfield', 'Tarrant', 'TX', '76063', '9729383493', '9729375608', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1760574115', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.5687, -97.1156, NULL, NULL),
('752602616', 'SPA100365', 'SPA100365', 'TXDALSTD', 'Matthew D Lippas MD', 'Matthew', 'D', 'Lippas', 'MD', 'Ophthalmology', '', '', NULL, 'O', '8144 Walnut Hill Ln Ste 448', 'Dallas', 'Dallas', 'TX', '75231', '2143693433', '2143690636', '8144 Walnut Hill Ln Ste 448', 'Dallas', 'Dallas', 'TX', '75231', '2143693433', '2143690636', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', NULL, 'HCFA|UB|', '1790770717', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8825, -96.765, NULL, NULL),
('752602616', 'SPA100367', 'SPA100367', 'TXDALSTD', 'Matthew D Lippas MD', 'Matthew', 'D', 'Lippas', 'MD', 'Ophthalmology', '', '', NULL, 'B', 'PO Box 381329', 'Duncanville', 'Dallas', 'TX', '75138', '2143304609', '2143690636', 'PO Box 381329', 'Duncanville', 'Dallas', 'TX', '75138', '2143304609', '2143690636', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', NULL, 'HCFA|UB|', '1790770717', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('205873288', 'SPA100368', 'SPA100368', 'TXDALSTD', 'MacArthur OB GYN Management', 'Reshma', 'N', 'Patel', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'M', '1130 Beachview Rd Ste 100', 'Dallas', 'Dallas', 'TX', '75218', '9722563700', '9722589887', '1130 Beachview Rd Ste 100', 'Dallas', 'Dallas', 'TX', '75218', '9722563700', '9722589887', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801058342', 0, 'Y', 0, '2014-03-31', NULL, NULL, 0, 0, NULL, NULL),
('205873288', 'SPA100369', 'SPA100369', 'TXDALSTD', 'MacArthur OB GYN Management', 'Reshma', 'N', 'Patel', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1600 W College St Ste 510', 'Grapevine', 'Tarrant', 'TX', '76051', '8174107986', '9722589887', '1600 W College St Ste 510', 'Grapevine', 'Tarrant', 'TX', '76051', '8174107986', '9722589887', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801058342', 0, 'Y', 0, '2014-03-31', NULL, NULL, 32.9345, -97.0946, NULL, NULL),
('205873288', 'SPA100371', 'SPA100371', 'TXDALSTD', 'MacArthur OB GYN Management', 'Reshma', 'N', 'Patel', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '307 W Park Way', 'Euless', 'Tarrant', 'TX', '76040', '8175102930', '9722589887', '307 W Park Way', 'Euless', 'Tarrant', 'TX', '76040', '8175102930', '9722589887', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801058342', 0, 'N', 0, '2014-03-31', NULL, NULL, 32.8344, -97.1199, NULL, NULL),
('205873288', 'SPA100370', 'SPA100370', 'TXDALSTD', 'MacArthur OB GYN Management', 'Reshma', 'N', 'Patel', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3501 N MacArthur Blvd Ste 500', 'Irving', 'Dallas', 'TX', '75062', '9722563700', '9722589887', '3501 N MacArthur Blvd Ste 500', 'Irving', 'Dallas', 'TX', '75062', '9722563700', '9722589887', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801058342', 0, 'N', 0, '2014-03-31', NULL, NULL, 32.8525, -96.9591, NULL, NULL),
('264288765', 'SPA100372', 'SPA100372', 'TXDALSTD', 'Gretchen Prater MD', 'Gretchen', '', 'Prater', 'MD', 'Pediatrics', '', '', NULL, 'B', '1404 W Jefferson', 'Waxahachie', 'Ellis', 'TX', '75165', '9729239488', '8174537703', '1404 W Jefferson', 'Waxahachie', 'Ellis', 'TX', '75165', '9729239488', '8174537703', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, '', NULL, '', '', 'HCFA|UB|', '1811096696', 0, 'Y', 0, '2014-04-02', NULL, NULL, 32.3966, -96.864, NULL, NULL);
