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
('830234097', 'W11013162', 'W11013162', 'WYWSBAIT', 'Campbell County Memorial Hospital', 'Dennis', '', 'Ford', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', NULL, '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', '          ', '', '', '5001A', '0.00', '0.00', '0.00', 3, '2008-09-15', '2011-06-30', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000006280', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W11013154', 'W11013154', 'WYWSBAIT', 'Campbell County Memorial Hospital', 'Stanley', '', 'Lawson', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', NULL, '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', '          ', '', '', '5001A', '0.00', '0.00', '0.00', 3, '2008-09-15', '2011-06-30', 0, 0, 1, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '0000007220', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W11013130', 'W11013130', 'WYWSBAIT', 'Oncology-Cancer Care', '', '', 'Oncology-Cancer Care', 'GROUP', 'Oncology', 'Hematology and Oncology', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881900', NULL, '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881900', '          ', '', '', '5001A', '0.00', '0.00', '0.00', 3, '2008-09-15', '2011-06-30', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000007970', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W11013103', 'W11013103', 'WY01', 'Campbell County Memorial Hospital', '', '', 'Campbell County Memorial Hospital', 'GROUP', 'Hospital', '', '', NULL, 'B', 'PO Box 3011', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', NULL, 'PO Box 3011', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', '          ', '', '', '5001', '0.00', '0.00', '0.00', 6, '2007-11-15', '2013-08-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000005551', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W11013102', 'W11013102', 'WY01', 'Campbell County Memorial Hospital', 'Wojciech', '', 'Zolcik', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076885000', NULL, '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076885000', '          ', '', '', '5001', '0.00', '0.00', '0.00', 6, '2008-09-15', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', '', '', '', 'HCFA|UB|', '1417060427', 0, 'N', 0, '2013-09-17', NULL, NULL, 44.2903, -105.52, NULL, NULL),
('830234097', 'W11013152', 'W11013152', 'WY01', 'Campbell County Memorial Hospital', 'Ted', '', 'Lawson', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', NULL, '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', '          ', '', '', '5001', '0.00', '0.00', '0.00', 6, '2008-09-15', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '0000007221', 0, 'Y', 0, '2013-09-17', NULL, NULL, 44.2903, -105.52, NULL, NULL),
('830234097', 'W11013153', 'W11013153', 'WYWSBAIT', 'Campbell County Memorial Hospital', 'Ted', '', 'Lawson', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', NULL, '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', '          ', '', '', '5001A', '0.00', '0.00', '0.00', 3, '2008-09-15', '2011-06-30', 0, 0, 1, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '0000007221', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W11013101', 'W11013101', 'WYWSBAIT', 'Campbell County Memorial Hospital', 'Wojciech', '', 'Zolcik', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076885000', NULL, '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076885000', '          ', '', '', '5001A', '0.00', '0.00', '0.00', 3, '2008-09-15', '2011-06-30', 0, 0, 1, 'Campbell County Memorial Hospital', '', '', '', 'HCFA|UB|', '1417060427', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W11013163', 'W11013163', 'WY01', 'Campbell County Memorial Hospital', 'Dennis', '', 'Ford', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', NULL, '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', '          ', '', '', '5001', '0.00', '0.00', '0.00', 6, '2008-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006280', 0, 'Y', 0, '2013-09-17', NULL, NULL, 44.2903, -105.52, NULL, NULL),
('830234097', 'W11013125', 'W11013125', 'WYWSBAIT', 'Home Health / Hospice', '', '', 'Home Health / Hospice', 'GROUP', 'Home Health Agency', 'Hospice', '', NULL, 'O', '710 W 12th St', 'Gillette', 'Campbell', 'WY', '82717', '3076886230', NULL, '710 W 12th St', 'Gillette', 'Campbell', 'WY', '82717', '3076886230', '          ', '', '', '5001A', '0.00', '0.00', '0.00', 3, '2008-09-15', '2011-06-30', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000006762', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W11013137', 'W11013137', 'WYWSBAIT', 'Campbell County Memorial Hospital', 'Suzanne', '', 'Harris', 'MD', 'Hospitalist', '', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', NULL, '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', '          ', '', '', '5001A', '0.00', '0.00', '0.00', 3, '2008-09-15', '2011-06-30', 0, 0, 1, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '0000006598', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W11013099', 'W11013099', 'WY01', 'Campbell County Memorial Hospital', 'Robin', '', 'Eicher', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076885000', '', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076885000', '', '', '', '5001', '0.00', '0.00', '0.00', 6, '2008-09-15', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', '', '', '', 'HCFA|UB|', '1518074442', 0, 'N', 0, '2014-07-22', NULL, NULL, 44.2903, -105.52, NULL, NULL),
('830234097', 'W11013140', 'W11013140', 'WY01', 'Campbell County Memorial Hospital', 'Steven', '', 'Prince', 'MD', 'Hospitalist', '', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', NULL, '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', '          ', '', '', '5001', '0.00', '0.00', '0.00', 3, '2008-09-15', '2010-09-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008266', 0, 'N', 0, '2010-09-01', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W11013131', 'W11013131', 'WY01', 'Oncology-Cancer Care', '', '', 'Oncology-Cancer Care', 'GROUP', 'Oncology', 'Hematology and Oncology', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881900', NULL, '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881900', '          ', '', '', '5001', '0.00', '0.00', '0.00', 6, '2008-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007970', 0, 'N', 0, '2013-09-17', NULL, NULL, 44.2903, -105.52, NULL, NULL),
('830234097', 'W11013132', 'W11013132', 'WY01', 'Campbell County Memorial Hospital', 'Shailendra', '', 'Singh', 'MD', 'Hospitalist', '', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', NULL, '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', '          ', '', '', '5001', '0.00', '0.00', '0.00', 6, '2008-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008728', 0, 'Y', 0, '2013-09-17', NULL, NULL, 44.2903, -105.52, NULL, NULL),
('830234097', 'W11013133', 'W11013133', 'WYWSBAIT', 'Campbell County Memorial Hospital', 'Shailendra', '', 'Singh', 'MD', 'Hospitalist', '', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', NULL, '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', '          ', '', '', '5001A', '0.00', '0.00', '0.00', 3, '2008-09-15', '2011-06-30', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000008728', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W11013134', 'W11013134', 'WYWSBAIT', 'Campbell County Memorial Hospital', 'Robert', '', 'Neuwirth', 'MD', 'Nephrology', 'Hospitalist', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', NULL, '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', '          ', '', '', '5001A', '0.00', '0.00', '0.00', 3, '2008-09-15', '2011-06-30', 0, 0, 1, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '0000007826', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W11013136', 'W11013136', 'WY01', 'Campbell County Memorial Hospital', 'Suzanne', '', 'Harris', 'MD', 'Hospitalist', '', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', NULL, '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', '          ', '', '', '5001', '0.00', '0.00', '0.00', 6, '2008-09-15', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '0000006598', 0, 'Y', 0, '2013-09-17', NULL, NULL, 44.2903, -105.52, NULL, NULL),
('830234097', 'W11013124', 'W11013124', 'WY01', 'Home Health / Hospice', '', '', 'Home Health / Hospice', 'GROUP', 'Home Health Agency', 'Hospice', '', NULL, 'O', '710 W 12th St', 'Gillette', 'Campbell', 'WY', '82717', '3076886230', NULL, '710 W 12th St', 'Gillette', 'Campbell', 'WY', '82717', '3076886230', '          ', '', '', '5001', '0.00', '0.00', '0.00', 6, '2008-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006762', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W11013138', 'W11013138', 'WYWSBAIT', 'Campbell County Memorial Hospital', 'Landi', '', 'Halloran', 'MD', 'Hospitalist', '', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', NULL, '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', '          ', '', '', '5001A', '0.00', '0.00', '0.00', 3, '2008-09-15', '2011-06-30', 0, 0, 1, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '0000006540', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W11013139', 'W11013139', 'WY01', 'Campbell County Memorial Hospital', 'Landi', '', 'Halloran', 'MD', 'Hospitalist', '', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', NULL, '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', '          ', '', '', '5001', '0.00', '0.00', '0.00', 6, '2008-09-15', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '0000006540', 0, 'Y', 0, '2013-09-17', NULL, NULL, 44.2903, -105.52, NULL, NULL),
('830234097', 'W11013100', 'W11013100', 'WYWSBAIT', 'Campbell County Memorial Hospital', 'Robin', '', 'Eicher', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076885000', '', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076885000', '', '', '', '5001A', '0.00', '0.00', '0.00', 3, '2008-09-15', '2011-06-30', 0, 0, 1, 'Campbell County Memorial Hospital', '', '', '', 'HCFA|UB|', '1518074442', 0, 'N', 0, '2014-07-22', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W11013150', 'W11013150', 'WYWSBAIT', 'Campbell County Memorial Hospital', 'Michael', '', 'Stolpe', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', NULL, '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', '          ', '', '', '5001A', '0.00', '0.00', '0.00', 3, '2008-09-15', '2011-06-30', 0, 0, 1, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '0000008930', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W11013115', 'W11013115', 'WY01', 'Wright Clinic', 'Scott', NULL, 'Johnston', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '500 Latigo Dr', 'Wright', 'Campbell', 'WY', '82732', '3074641413', NULL, '500 Latigo Dr', 'Wright', 'Campbell', 'WY', '82732', NULL, NULL, '', NULL, '5001', '0.00', '0.00', '0.00', 3, '2008-09-15', '2009-11-16', 1, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000006980', 0, 'n', 0, '2008-09-18', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W11013114', 'W11013114', 'WYWSBAIT', 'Wright Clinic', 'Scott', NULL, 'Johnston', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '500 Latigo Dr', 'Wright', 'Campbell', 'WY', '82732', '3074641413', NULL, '500 Latigo Dr', 'Wright', 'Campbell', 'WY', '82732', NULL, NULL, '', NULL, '5001A', '0.00', '0.00', '0.00', 3, '2008-09-15', '2009-11-16', 1, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000006980', 0, 'n', 0, '2008-09-18', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'W11013059', 'W11013059', 'WY01', 'Gem City Bone and Joint', 'Ryan', '', 'Aukerman', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1458 W 5th', 'Sheridan', 'Sheridan', 'WY', '82801', '3076730623', NULL, '1458 W 5th', 'Sheridan', 'Sheridan', 'WY', '82801', '3076730623', '', '', 'WYHCPCS', 'WYORTHO', '0.00', '10.00', '0.00', 6, '2007-08-01', '2009-06-30', 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1417912858', 0, 'n', 0, '2012-04-16', NULL, NULL, 0, 0, NULL, NULL),
('521486235', 'W11013095', 'W11013095', 'WY01', 'Hanger Prosthetics & Orthotics Inc', NULL, NULL, 'Hanger Prosthetics & Orthotics Inc', 'GROUP', 'Durable Medical Equipment', NULL, NULL, NULL, 'B', '557 Broadway', 'Sheridan', 'Sheridan', 'WY', '82801', '3076720497', '3076720480', '4155 E LaPalma Ave', 'Anaheim', 'Sheridan', 'CA', '92807', NULL, NULL, 'WUDME5', NULL, NULL, '0.00', '35.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000006560', 0, 'y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'W11013058', 'W11013058', 'WY01', 'Gem City Bone and Joint', 'Ryan', '', 'Aukerman', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '2950 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073825112', NULL, '2950 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073825112', '', '', 'WYHCPCS', 'WYORTHO', '0.00', '10.00', '0.00', 6, '2007-08-01', '2009-06-30', 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1417912858', 0, 'n', 0, '2012-04-16', NULL, NULL, 0, 0, NULL, NULL),
('205734461', 'W11013229', 'W11013229', 'ID01', 'West Marriage & Family Counseling Inc', 'Allan', 'L', 'West', 'LCSW', 'Mental Health', 'Marriage & Family Therapy', '', NULL, 'O', '1102 Arthur St', 'Caldwell', 'Canyon', 'ID', '83605', '2084548187', NULL, '1102 Arthur St', 'Caldwell', 'Canyon', 'ID', '83605', '2084548187', '          ', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2008-09-19', '2012-08-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568680544', 0, 'N', 0, '2012-08-07', NULL, NULL, 0, 0, NULL, NULL),
('450590270', 'W11013189', 'W11013189', 'ID01', 'Caldwell Psychological Services', 'Phares', 'L', 'Book', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '623 S Kimsall Ave Ste A', 'Caldwell', 'Canyon', 'ID', '83605', '2084074730', NULL, '623 S Kimsall Ave Ste A', 'Caldwell', 'Canyon', 'ID', '83605', '2084074730', '', 'IDPHD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-09-19', '2009-03-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104083724', 0, 'n', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('450590270', 'W11013190', 'W11013190', 'ID01', 'Boise Psychological Services', 'Phares', 'L', 'Book', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '315 Allumbaugh', 'Boise', 'Canyon', 'ID', '83605', '2083763546', NULL, '315 Allumbaugh', 'Boise', 'Canyon', 'ID', '83605', '2083763546', '          ', 'IDPHD', '', '', '0.00', '35.00', '0.00', 3, '2008-09-19', '2011-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104083724', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('450590270', 'W11013191', 'W11013191', 'ID01', 'Boise Psychological Services', 'Phares', 'L', 'Book', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '315 Allumbaugh', 'Boise', 'Canyon', 'ID', '83605', '2083763546', NULL, '315 Allumbaugh', 'Boise', 'Canyon', 'ID', '83605', '2083763546', '', 'IDPHD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-11-01', '2008-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104083724', 0, 'n', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('450590270', 'W11013192', 'W11013192', 'ID01', 'Caldwell Psychological Services', 'Phares', 'L', 'Book', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '623 S Kimsall Ave Ste A', 'Caldwell', 'Canyon', 'ID', '83605', '2084074730', NULL, '623 S Kimsall Ave Ste A', 'Caldwell', 'Canyon', 'ID', '83605', '2084074730', '', 'IDPHD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-11-01', '2008-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104083724', 0, 'n', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('205734461', 'W11013228', 'W11013228', 'ID01', 'West Marriage & Family Counseling Inc', 'Allan', 'L', 'West', 'LCSW', 'Mental Health', 'Marriage & Family Therapy', '', NULL, 'O', '1102 Arthur St', 'Caldwell', 'Canyon', 'ID', '83605', '2084548187', NULL, '1102 Arthur St', 'Caldwell', 'Canyon', 'ID', '83605', '2084548187', '', 'IDMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-11-01', '2008-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568680544', 0, 'N', 0, '2012-08-07', NULL, NULL, 0, 0, NULL, NULL),
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('501523991', 'W11013203', 'W11013203', 'ID01', NULL, 'Rand', 'G', 'Martel', 'LCPC LMFT', 'Mental Health', 'Marriage & Family Therapy', 'Counseling', NULL, 'O', '7745 W Long Dr', 'Boise', 'Ada', 'ID', '83704', '2083273533', NULL, '7745 W Long Dr', 'Boise', 'Ada', 'ID', '83704', '2083273533', '', 'IDMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-11-01', '2008-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619051463', 0, 'n', 0, '2013-11-26', NULL, NULL, 0, 0, NULL, NULL),
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('200112754', 'W11013171', 'W11013171', 'ID02', 'Jenkins Chiropractic', 'Martha', 'M', 'Jenkins', 'DC', 'Chiropractic', '', '', NULL, 'O', '4696 Overland Rd Ste 182', 'Boise', 'Ada', 'ID', '83705', '2083238315', NULL, '4696 Overland Rd Ste 182', 'Boise', 'Ada', 'ID', '83705', '2083238315', '', 'IDCHIRO1', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-09-15', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1447250444', 0, 'n', 0, '2013-01-10', NULL, NULL, 0, 0, NULL, NULL),
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('314924879', 'W11013196', 'W11013196', 'ID01', 'Etnyre & Associates', 'Allison', 'L', 'Etnyre', 'PSYD', 'Mental Health', 'Psychology', '', NULL, 'O', '1070 N Curtis Rd Ste 210', 'Boise', 'Ada', 'ID', '83706', '2088600770', NULL, '1070 N Curtis Rd Ste 210', 'Boise', 'Ada', 'ID', '83706', '2088600770', '', 'IDPHD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-11-01', '2008-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619001005', 0, 'n', 0, '2013-03-18', NULL, NULL, 43.6141, -116.253, NULL, NULL),
('841370759', 'W11013248', 'W11013248', 'ID02', 'Kranz Chiropractic Chartered', 'James', 'W', 'Kranz', 'DC', 'Chiropractic', 'Acupuncture', '', NULL, 'O', '910 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083773777', NULL, '910 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083773777', '', 'IDCHIRO1', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-09-22', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1972614485', 0, 'n', 0, '2012-02-14', NULL, NULL, 0, 0, NULL, NULL),
('314924879', 'W11013195', 'W11013195', 'ID01', 'Etnyre & Associates', 'Allison', 'L', 'Etnyre', 'PSYD', 'Mental Health', 'Psychology', '', NULL, 'O', '1070 N Curtis Rd Ste 210', 'Boise', 'Ada', 'ID', '83706', '2088600770', NULL, '1070 N Curtis Rd Ste 210', 'Boise', 'Ada', 'ID', '83706', '2088600770', '', 'IDPHD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-09-19', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619001005', 0, 'n', 0, '2013-03-18', NULL, NULL, 43.6141, -116.253, NULL, NULL),
('820410990', 'W11013169', 'W11013169', 'ID02', 'Thiry Chiropractic', 'John', 'L', 'Thiry', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '381 W Parkcenter Blvd', 'Boise', 'Ada', 'ID', '83706', '2083440000', NULL, '381 W Parkcenter Blvd', 'Boise', 'Ada', 'ID', '83706', '2083440000', '', 'IDCHIRO1', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-09-15', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1114975612', 0, 'n', 0, '2013-07-09', NULL, NULL, 0, 0, NULL, NULL),
('820475342', 'W11013069', 'W11013069', 'ID01', 'All Together Now Inc', 'Toni', '', 'Sparks', 'ARNP', 'Mental Health', 'Psychiatry', '', NULL, 'B', 'PO Box 7786', 'Boise', 'Ada', 'ID', '83707', '2083364504', NULL, 'PO Box 7786', 'Boise', 'Ada', 'ID', '83707', '2083364504', '', 'IDARNP', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-09-06', '2013-02-14', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1356454839', 0, 'y', 0, '2013-08-16', NULL, NULL, 0, 0, NULL, NULL),
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('820475342', 'W11013067', 'W11013067', 'ID01', 'All Together Now Inc', 'Kathy', '', 'Rodgers', 'LCPC', 'Mental Health', 'Counseling', '', NULL, 'B', 'PO Box 7786', 'Boise', 'Ada', 'ID', '83707', '2083364504', NULL, 'PO Box 7786', 'Boise', 'Ada', 'ID', '83707', '2083364504', '', 'IDMA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-11-01', '2008-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639274327', 0, 'y', 0, '2012-08-03', NULL, NULL, 0, 0, NULL, NULL),
('820475342', 'W11013066', 'W11013066', 'ID01', 'All Together Now Inc', 'Toni', '', 'Sparks', 'ARNP', 'Mental Health', 'Psychiatry', '', NULL, 'B', 'PO Box 7786', 'Boise', 'Ada', 'ID', '83707', '2083364504', NULL, 'PO Box 7786', 'Boise', 'Ada', 'ID', '83707', '2083364504', '', 'IDARNP', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-11-01', '2008-11-01', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1356454839', 0, 'y', 0, '2013-08-16', 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
('261246186', 'W11013175', 'W11013175', 'ID01', 'Treasure Valley Psychological Services', 'Melody', 'L', 'Snider', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '6003 Overland Rd Ste 301', 'Boise', 'Ada', 'ID', '83709', '2086728699', NULL, '6003 Overland Rd Ste 301', 'Boise', 'Ada', 'ID', '83709', '2086728699', '', 'IDPHD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-09-15', '2010-02-09', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982734984', 0, 'n', 0, '2012-08-17', NULL, NULL, 0, 0, NULL, NULL),
('261246186', 'W11013176', 'W11013176', 'ID01', 'Treasure Valley Psychological Services', 'Melody', 'L', 'Snider', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '6003 Overland Rd Ste 301', 'Boise', 'Ada', 'ID', '83709', '2086728699', NULL, '6003 Overland Rd Ste 301', 'Boise', 'Ada', 'ID', '83709', '2086728699', '', 'IDPHD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-11-01', '2008-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982734984', 0, 'n', 0, '2012-08-17', NULL, NULL, 0, 0, NULL, NULL),
('481264511', 'W11013082', 'W11013082', 'ID01', 'A Family Place PA', 'Jeanne', 'L', 'Melton', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '6003 W Overland Rd Ste 101', 'Boise', 'Ada', 'ID', '83709', '2083458861', NULL, '6003 W Overland Rd Ste 101', 'Boise', 'Ada', 'ID', '83709', '2083458861', '', 'IDMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-11-01', '2008-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619986957', 0, 'n', 0, '2011-12-22', NULL, NULL, 0, 0, NULL, NULL),
('481264511', 'W11013081', 'W11013081', 'ID01', 'A Family Place PA', 'Jeanne', 'L', 'Melton', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '6003 W Overland Rd Ste 101', 'Boise', 'Ada', 'ID', '83709', '2083458861', NULL, '6003 W Overland Rd Ste 101', 'Boise', 'Ada', 'ID', '83709', '2083458861', '', 'IDMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-09-18', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619986957', 0, 'n', 0, '2011-12-22', NULL, NULL, 0, 0, NULL, NULL),
('461725214', 'W11013238', 'W11013238', 'ID01', NULL, 'Eric', 'A', 'Simmons', 'DO', 'Mental Health', 'Psychiatry', '', NULL, 'B', 'PO Box 4656', 'Boise', 'Ada', 'ID', '83711', '2083778400', NULL, 'PO Box 4656', 'Boise', 'Ada', 'ID', '83711', '2083778400', '', 'IDMD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-09-19', '2013-02-14', 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1023132420', 0, 'y', 0, '2013-04-17', NULL, NULL, 0, 0, NULL, NULL),
('461725214', 'W11013239', 'W11013239', 'ID01', NULL, 'Eric', 'A', 'Simmons', 'DO', 'Mental Health', 'Psychiatry', '', NULL, 'B', 'PO Box 4656', 'Boise', 'Ada', 'ID', '83711', '2083778400', NULL, 'PO Box 4656', 'Boise', 'Ada', 'ID', '83711', '2083778400', '', 'IDMD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-11-01', '2008-11-01', 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1023132420', 0, 'y', 0, '2013-04-17', NULL, NULL, 0, 0, NULL, NULL),
('205105989', 'W11013178', 'W11013178', 'ID01', NULL, 'Traci', 'L', 'Crabb', 'PSYD', 'Mental Health', 'Psychology', '', NULL, 'O', '3775 N Eagle Rd', 'Boise', 'Ada', 'ID', '83713', '2089389653', NULL, '3775 N Eagle Rd', 'Boise', 'Ada', 'ID', '83713', '2089389653', '', 'IDPHD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-11-01', '2008-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336157452', 0, 'n', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('314924879', 'W11013198', 'W11013198', 'ID01', 'Etnyre & Associates PLLC', 'Allison', 'L', 'Etnyre', 'PSYD', 'Mental Health', 'Psychology', '', NULL, 'B', '11368 W Hickory Bark Dr', 'Boise', 'Ada', 'ID', '83713', '2088600770', NULL, '11368 W Hickory Bark Dr', 'Boise', 'Ada', 'ID', '83713', '2088600770', '', 'IDPHD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-09-19', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619001005', 0, 'y', 0, '2013-03-18', NULL, NULL, 0, 0, NULL, NULL),
('205105989', 'W11013177', 'W11013177', 'ID01', NULL, 'Traci', 'L', 'Crabb', 'PSYD', 'Mental Health', 'Psychology', '', NULL, 'O', '3775 N Eagle Rd', 'Boise', 'Ada', 'ID', '83713', '2089389653', NULL, '3775 N Eagle Rd', 'Boise', 'Ada', 'ID', '83713', '2089389653', '', 'IDPHD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-09-15', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336157452', 0, 'n', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('314924879', 'W11013197', 'W11013197', 'ID01', 'Etnyre & Associates PLLC', 'Allison', 'L', 'Etnyre', 'PSYD', 'Mental Health', 'Psychology', '', NULL, 'B', '11368 W Hickory Bark Dr', 'Boise', 'Ada', 'ID', '83713', '2088600770', NULL, '11368 W Hickory Bark Dr', 'Boise', 'Ada', 'ID', '83713', '2088600770', '', 'IDPHD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-11-01', '2008-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619001005', 0, 'y', 0, '2013-03-18', NULL, NULL, 0, 0, NULL, NULL),
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('452061503', 'W11013056', 'W11013056', 'UTMH1', NULL, 'John', '', 'Burr', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '901 S Orem Blvd', 'Orem', 'Utah', 'UT', '84058', '8012257805', NULL, '901 S Orem Blvd', 'Orem', 'Utah', 'UT', '84058', '8012257805', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-09-10', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1689797078', 0, 'n', 0, '2012-10-25', NULL, NULL, 0, 0, NULL, NULL),
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('452061503', 'W11013057', 'W11013057', 'UTMH1', NULL, 'John', '', 'Burr', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 1238', 'Orem', 'UTAH', 'UT', '84059', '8012257805', NULL, 'PO Box 1238', 'Orem', 'UTAH', 'UT', '84059', '8012257805', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-09-10', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1689797078', 0, 'y', 0, '2012-10-25', NULL, NULL, 0, 0, NULL, NULL),
('870621987', 'W11013179', 'W11013179', 'UTMH1', '', 'Alan', 'F', 'Heap', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '185 N Main Ste 601', 'Tooele', 'Tooele', 'UT', '84074', '4358822207', NULL, '185 N Main Ste 601', 'Tooele', 'Tooele', 'UT', '84074', '4358822207', '          ', 'UTMD-2', '', '', '0.00', '35.00', '0.00', 3, '2008-09-19', '2010-06-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730279605', 0, 'N', 0, '2010-06-01', NULL, NULL, 0, 0, NULL, NULL),
('870621987', 'W11013180', 'W11013180', 'UTMH1', '', 'Alan', 'F', 'Heap', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'B', 'PO Box 633', 'Tooele', 'Tooele', 'UT', '84074', '4358822207', NULL, 'PO Box 633', 'Tooele', 'Tooele', 'UT', '84074', '4358822207', '          ', 'UTMD-2', '', '', '0.00', '35.00', '0.00', 3, '2008-09-19', '2010-06-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730279605', 0, 'N', 0, '2010-06-01', NULL, NULL, 0, 0, NULL, NULL),
('200615033', 'W11013243', 'W11013243', 'UT01', 'Tooele Vision Center', 'Kris', 'A', 'Hill', 'OD', 'Optometry', '', '', NULL, 'O', '300 S Main St', 'Tooele', 'Tooele', 'UT', '84074', '4358823233', '4358821626', '300 S Main St', 'Tooele', 'Tooele', 'UT', '84074', '4358823233', '4358821626', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043228554', 0, 'N', 0, '2013-12-10', NULL, NULL, 40.5249, -112.299, NULL, NULL),
('200615033', 'W11013242', 'W11013242', 'UT01', 'Tooele Vision Center', 'Jed', 'C', 'Winder', 'OD', 'Optometry', '', '', NULL, 'O', '300 S Main St', 'Tooele', 'Tooele', 'UT', '84074', '4358823233', '4358821626', '300 S Main St', 'Tooele', 'Tooele', 'UT', '84074', '4358823233', '4358821626', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457369621', 0, 'N', 0, '2012-03-20', NULL, NULL, 40.5249, -112.299, NULL, NULL),
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('900292646', 'W11013240', 'W11013240', 'UT01', 'Vision Source at Jordan Landing', 'James', 'D', 'Sargent', 'OD', 'Optometry', '', '', NULL, 'O', '7555 Ctr View Ct Ste 101', 'West Jordan', 'Salt Lake', 'UT', '84084', '8015665683', '8012558371', '7555 Ctr View Ct Ste 101', 'West Jordan', 'Salt Lake', 'UT', '84084', '8015665683', '8012558371', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2007-02-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942238670', 0, 'N', 0, '2013-07-25', NULL, NULL, 40.6147, -111.984, NULL, NULL),
('529317347', 'W11013249', 'W11013249', 'UTMH1', NULL, 'Valerie', '', 'Poltoratzsky', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1355 S 1100 E', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8019137394', NULL, '1355 S 1100 E', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8019137394', '', 'UTMA', NULL, '', '0.00', '35.00', '0.00', 3, '2008-09-24', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932293958', 0, 'n', 0, '2014-07-02', NULL, NULL, 0, 0, NULL, NULL),
('870490042', 'W11013246', 'W11013246', 'UT01', NULL, 'Regina', 'E', 'Rosenthal', 'MD', 'General Surgery', '', '', NULL, 'O', '5323 S Woodrow St Ste 102', 'Murray', 'Salt Lake', 'UT', '84107', '8012811533', '8012811374', '5323 S Woodrow St Ste 102', 'Murray', 'Salt Lake', 'UT', '84107', '8012811533', '8012811374', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-09-22', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1801939582', 0, 'N', 0, '2012-08-02', NULL, NULL, 40.6549, -111.895, NULL, NULL),
('870564069', 'W11013223', 'W11013223', 'UT01', 'University Health Care', 'Nadia', 'M', 'Cobb', 'PA', 'Family Practice', '', '', NULL, 'o', '555 Foothill Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015818000', NULL, '555 Foothill Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015818000', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-03-10', '2012-08-20', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1790902179', 0, 'N', 0, '2012-08-21', NULL, NULL, 0, 0, NULL, NULL),
('800147425', 'W11013221', 'W11013221', 'UT01', 'University Health Care', 'Richard', 'D', 'Martini', 'MD', 'Mental Health', 'Pediatric Psychiatry', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2008-02-28', '2012-07-31', 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1104995380', 0, 'N', 0, '2013-08-29', NULL, NULL, 0, 0, NULL, NULL),
('039369669', 'W11013064', 'W11013064', 'UTMH1', NULL, 'Alison', 'P', 'Parsons', 'PSYD', 'Mental Health', 'Psychology', '', NULL, 'O', '4190 S Highland Dr Ste 210', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8018031091', NULL, '4190 S Highland Dr Ste 210', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8018031091', '', 'PHD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-09-10', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841375680', 0, 'n', 0, '2011-10-03', NULL, NULL, 0, 0, NULL, NULL),
('870490866', 'W11013219', 'W11013219', 'UT01', 'University Health Care', 'Charity', 'O', 'Coe', 'PA', 'General Surgery', '', '', NULL, 'o', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015814314', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015814314', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-03-10', '2012-09-16', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1184824005', 0, 'N', 0, '2012-09-17', NULL, NULL, 0, 0, NULL, NULL),
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('870490866', 'W11013218', 'W11013218', 'UT01', 'University Health Care', 'Susanna', NULL, 'Chase', 'PA', 'General Surgery', 'Physician Assistant', '', NULL, 'B', 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8015812121', '8015853655', 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8015812121', '8015853655', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-10-23', '2012-09-16', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1548288129', 0, 'Y', 0, '2012-09-17', NULL, NULL, 0, 0, NULL, NULL),
('870490866', 'W11013220', 'W11013220', 'UT01', 'University Health Care', 'Charity', 'O', 'Coe', 'PA', 'General Surgery', '', '', NULL, 'B', 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8015812121', '8015853655', 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8015812121', '8015853655', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-03-10', '2012-09-16', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1184824005', 0, 'N', 0, '2012-09-17', NULL, NULL, 0, 0, NULL, NULL),
('262719583', 'W11013225', 'W11013225', 'UT01', 'Northern Utah Eye Center', 'Christian', 'D', 'Nilson', 'MD', 'Ophthalmology', '', '', NULL, 'O', '550 E 1400 N Ste T', 'Logan', 'Cache', 'UT', '84341', '4357522020', NULL, '550 E 1400 N Ste T', 'Logan', 'Cache', 'UT', '84341', '4357522020', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-09-10', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1932321460', 0, 'n', 0, '2011-11-16', NULL, NULL, 41.7574, -111.82, NULL, NULL),
('571174725', 'W11013212', 'W11013212', 'UT01', NULL, 'Julie', 'A', 'Maughan', 'MD', 'Dermatology', '', '', NULL, 'O', '6028 S Ridgeline Dr Ste 200', 'South Ogden', 'Weber', 'UT', '84405', '8014755210', NULL, '6028 S Ridgeline Dr Ste 200', 'South Ogden', 'Weber', 'UT', '84405', '8014755210', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-09-15', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1114098357', 0, 'N', 0, '2014-04-16', NULL, NULL, 41.1538, -111.942, NULL, NULL),
('261104077', 'W11013174', 'W11013174', 'UT01', NULL, 'Brent', 'H', 'Goodsell', 'DO', 'Dermatology', '', '', NULL, 'O', '250 N Fairgrounds Rd', 'Price', 'Carbon', 'UT', '84501', '4356374048', '8017560202', '250 N Fairgrounds Rd', 'Price', 'Carbon', 'UT', '84501', '4356374048', '8017560202', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-05-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1528172863', 0, 'N', 0, '2014-06-04', NULL, NULL, 39.6058, -110.835, NULL, NULL),
('876000312', 'W11013167', 'W11013167', 'UT01', 'Utah County Health Department', '', '', 'Utah County Health Department', 'GROUP', 'Health Department', '', '', NULL, 'O', '151 S University Ave Ste 1900', 'Provo', 'Utah', 'UT', '84601', '8018517042', NULL, '151 S University Ave Ste 1900', 'Provo', 'Utah', 'UT', '84601', '8018517042', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-09-15', '2010-09-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1891865010', 0, 'Y', 0, '2012-03-10', NULL, NULL, 0, 0, NULL, NULL),
('900213133', 'W11013244', 'W11013244', 'UT01', 'Rocky Mountain Foot and Ankle', 'Kelly', 'A', 'Gomez', 'DPM', 'Podiatry', '', '', NULL, 'O', '777 N 500 W Ste 105', 'Provo', 'Utah', 'UT', '84604', '8013756677', NULL, '777 N 500 W Ste 105', 'Provo', 'Utah', 'UT', '84604', '8013756677', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-01-01', '2010-07-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821021957', 0, 'N', 0, '2013-10-28', NULL, NULL, 0, 0, NULL, NULL),
('820468943', 'W11013172', 'W11013172', 'ID02', 'Stutzman Chiropractic', 'Brian', 'W', 'Stutzman', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '1580 W 4th Ste 103', 'Meridian', 'Ada', 'ID', '83642', '2088889292', NULL, '1580 W 4th', 'Meridian', 'Sanpete', 'UT', '83642', NULL, NULL, 'IDCHIRO1', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-09-15', NULL, 0, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1033268545', 0, 'n', 0, '2008-10-01', NULL, NULL, 0, 0, NULL, NULL),
('900213133', 'W11013245', 'W11013245', 'UT01', 'Rocky Mountain Foot And Ankle', 'Kelly', 'A', 'Gomez', 'DPM', 'Podiatry', '', '', NULL, 'B', 'PO Box 98', 'Springville', 'Utah', 'UT', '84663', '8013750346', NULL, 'PO Box 98', 'Springville', 'Utah', 'UT', '84663', '8013750346', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-01-01', '2010-07-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821021957', 0, 'Y', 0, '2013-10-28', NULL, NULL, 0, 0, NULL, NULL),
('260425225', 'W11013247', 'W11013247', 'UT01', 'Coral Desert Orthopedics', 'Edward', 'J', 'Prince', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1490 E Foremaster Dr Ste 150', 'St George', 'Washington', 'UT', '84790', '4356289393', NULL, '1490 E Foremaster Dr Ste 150', 'St George', 'Washington', 'UT', '84790', '4356289393', '', 'WUSTDORTH5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1659306975', 0, 'N', 0, '2013-01-24', NULL, NULL, 37.0959, -113.551, NULL, NULL),
('911490213', 'W11013093', 'W11013093', 'ID01', 'RS Medical', '', '', 'RS Medical (Muscle Stimulators', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'B', 'PO Box 872650', 'Vancouver', 'Clark', 'WA', '98687', '8006830353', '8009291930', 'PO Box 872650', 'Vancouver', 'Clark', 'WA', '98687', '8006830353', '8009291930', 'WCSTRSMED5', NULL, NULL, '0.00', '25.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000833766', 0, 'Y', 0, '2011-08-25', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11013339', 'W11013339', 'WY01', 'Billings Clinic - Cancer Center', 'Jennifer', 'K', 'Finn', 'LCSW', 'Mental Health', 'Social Worker', 'Oncology', NULL, 'O', '2825 8th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382469', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2008-07-30', '2009-04-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1649436601', 0, 'N', 0, '2010-01-15', NULL, NULL, 0, 0, NULL, NULL),
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('911394965', 'W11013323', 'W11013323', 'ID01', 'Pacific Cataract & Laser', 'Reid', 'I', 'Mamiya', 'OD', 'Optometry', NULL, NULL, NULL, 'B', '250 Bobwhite Ct Ste 100', 'Boise', 'Ada', 'ID', '83706', '2083857576', NULL, NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDSTD', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 6, '2008-10-01', '2010-01-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1407963770', 0, 'Y', 0, '2010-01-14', NULL, NULL, 0, 0, NULL, NULL),
('911394965', 'W11013322', 'W11013322', 'ID01', 'Pacific Cataract & Laser', 'Brian', 'S', 'Johnson', 'OD', 'Optometry', NULL, NULL, NULL, 'B', '250 Bobwhite Ct Ste 100', 'Boise', 'Ada', 'ID', '83706', '2083857576', NULL, NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDSTD', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 6, '2008-10-01', '2010-01-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1487761748', 0, 'Y', 0, '2010-01-14', NULL, NULL, 0, 0, NULL, NULL),
('911394965', 'W11013321', 'W11013321', 'ID01', 'Pacific Cataract & Laser', 'Donald', 'K', 'James', 'OD', 'Optometry', NULL, NULL, NULL, 'B', '250 Bobwhite Ct Ste 100', 'Boise', 'Ada', 'ID', '83706', '2083857576', NULL, NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDSTD', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 6, '2008-10-01', '2010-01-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1972610236', 0, 'Y', 0, '2010-01-14', NULL, NULL, 0, 0, NULL, NULL),
('911394965', 'W11013320', 'W11013320', 'ID01', 'Pacific Cataract & Laser', 'Robert', 'D', 'Gibbs', 'OD', 'Optometry', NULL, NULL, NULL, 'B', '250 Bobwhite Ct Ste 100', 'Boise', 'Ada', 'ID', '83706', '2083857576', NULL, NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDSTD', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 6, '2008-10-01', '2010-01-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1972610210', 0, 'Y', 0, '2010-01-14', NULL, NULL, 0, 0, NULL, NULL),
('911394965', 'W11013319', 'W11013319', 'ID01', 'Pacific Cataract & Laser', 'Bruce', 'G', 'Flint', 'OD', 'Optometry', NULL, NULL, NULL, 'B', '250 Bobwhite Ct Ste 100', 'Boise', 'Ada', 'ID', '83706', '2083857576', NULL, NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDSTD', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 6, '2008-10-01', '2010-01-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1154438471', 0, 'Y', 0, '2010-01-14', NULL, NULL, 0, 0, NULL, NULL),
('911394965', 'W11013318', 'W11013318', 'ID01', 'Pacific Cataract & Laser', 'Mark', 'G', 'Everett', 'OD', 'Optometry', NULL, NULL, NULL, 'B', '250 Bobwhite Ct Ste 100', 'Boise', 'Ada', 'ID', '83706', '2083857576', NULL, NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDSTD', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 6, '2008-10-01', '2010-01-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1225060296', 0, 'Y', 0, '2010-01-14', NULL, NULL, 0, 0, NULL, NULL),
('911394965', 'W11013317', 'W11013317', 'ID01', 'Pacific Cataract & Laser', 'Rick', 'R', 'Burk', 'OD', 'Optometry', NULL, NULL, NULL, 'B', '250 Bobwhite Ct Ste 100', 'Boise', 'Ada', 'ID', '83706', '2083857576', NULL, NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDSTD', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 6, '2008-10-01', '2010-01-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1245255686', 0, 'Y', 0, '2010-01-14', NULL, NULL, 0, 0, NULL, NULL),
('911394965', 'W11013315', 'W11013315', 'ID01', 'Pacific Cataract & Laser', 'Frank', 'J', 'Barnhart', 'OD', 'Optometry', '', '', NULL, 'B', '250 Bobwhite Ct Ste 100', 'Boise', 'Ada', 'ID', '83706', '2083857576', NULL, '250 Bobwhite Ct Ste 100', 'Boise', 'Ada', 'ID', '83706', '2083857576', '', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 6, '2008-10-01', '2010-01-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457386260', 0, 'Y', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('911394965', 'W11013327', 'W11013327', 'ID01', 'Pacific Cataract & Laser', 'Robert', 'O', 'Ford', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '250 Bobwhite Ct Ste 100', 'Boise', 'Ada', 'ID', '83706', '2083857576', NULL, NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDSTD', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 6, '2008-10-01', '2010-01-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1295842524', 0, 'n', 0, '2010-01-14', NULL, NULL, 0, 0, NULL, NULL),
('870526396', 'W11013295', 'W11013295', 'UTMH1', '', 'Joan', 'B', 'Anderson', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'B', 'PO Box 1176', 'Bountiful', 'Davis', 'UT', '84011', '8012966166', NULL, 'PO Box 1176', 'Bountiful', 'Davis', 'UT', '84011', '8012966166', '          ', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2008-09-22', '2012-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730278631', 0, 'N', 0, '2012-08-07', NULL, NULL, 0, 0, NULL, NULL),
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('800147447', 'W11013258', 'W11013258', 'UT01', 'University Health Care', 'Marlene', '', 'Peng', 'MD', 'Pediatrics', 'Pediatric Allergy and Immunology', '', NULL, 'O', '7495 S State St', 'Midvale', 'Salt Lake', 'UT', '84047', '8012139400', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WUUPEDS', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2008-03-16', '2009-06-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1770697112', 0, 'n', 0, '2008-10-30', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11013267', 'W11013267', 'UT01', 'UUHC - Greenwood Health Center', 'Melissa', 'S', 'Briley', 'PA', 'Physician Assistant', '', '', NULL, 'O', '7495 S State St', 'Midvale', 'Salt Lake', 'UT', '84047', '8012139400', '8012139443', '7495 S State St', 'Midvale', 'Salt Lake', 'UT', '84047', '8012139400', '8012139443', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-08-01', '2012-09-16', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1265439376', 0, 'N', 0, '2012-09-17', NULL, NULL, 0, 0, NULL, NULL),
('870564069', 'W11013254', 'W11013254', 'UT01', 'Univ Health Care Park City Mtn Resort - Urgent Care', 'Theodore', 'S', 'Paisley', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', '1493 Lowell Ave', 'Park City', 'Summit', 'UT', '84060', '4356557970', NULL, '1493 Lowell Ave', 'Park City', 'Summit', 'UT', '84060', '4356557970', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2012-08-20', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1952415556', 0, 'N', 0, '2012-08-21', NULL, NULL, 0, 0, NULL, NULL),
('205805198', 'W11013292', 'W11013292', 'UT01', 'Concentra Urgent Care M-F 8am-5pm', '', '', 'Concentra Urgent Care', 'GROUP', 'Urgent Care', '', '', NULL, 'O', '385 W 9000 S', 'Sandy', 'Salt Lake', 'UT', '84070', '8015624382', NULL, '385 W 9000 S', 'Sandy', 'Salt Lake', 'UT', '84070', '8015624382', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-09-24', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265615397', 0, 'N', 0, '2013-12-06', 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
('870640775', 'W11013250', 'W11013250', 'UT01', 'UUHC Anesthesiology Dept School of Medicine', 'Daniel', 'P', 'Vezina', 'MD', 'Echocardiography', 'Anesthesiology', 'Cardiovascular Disease', NULL, 'o', '1091 W South Jordan Pkwy', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012139800', NULL, '1091 W South Jordan Pkwy', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012139800', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-03-13', '2012-09-18', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1487744074', 0, 'N', 0, '2012-09-19', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11013251', 'W11013251', 'UT01', 'UUHC - Redstone Center', 'Daniel', 'P', 'Vezina', 'MD', 'Echocardiography', 'Anesthesiology', 'Cardiovascular Disease', NULL, 'o', '1743 W Redstone Ctr Ste 115', 'Park City', 'Summit', 'UT', '84098', '4356589200', NULL, NULL, NULL, 'Summit', NULL, NULL, NULL, NULL, 'WISESTDU', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2008-03-13', '2008-03-13', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1487744074', 0, 'N', 0, '2008-09-23', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11013266', 'W11013266', 'UT01', 'UUHC - Redstone Center', 'Melissa', 'S', 'Briley', 'PA', 'Physician Assistant', '', '', NULL, 'O', '1743 W Redstone Ctr Ste 115', 'Park City', 'Summit', 'UT', '84098', '4356589200', NULL, '1743 W Redstone Ctr Ste 115', 'Park City', 'Summit', 'UT', '84098', '4356589200', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-08-01', '2012-09-16', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1265439376', 0, 'N', 0, '2012-09-17', NULL, NULL, 0, 0, NULL, NULL),
('870640775', 'W11013297', 'W11013297', 'UT01', 'University Health Care', 'Wayne', 'L', 'Stokes', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '1743 W Redstone Ctr Ste 115', 'Park City', 'Summit', 'UT', '84098', '4356589200', NULL, '1743 W Redstone Ctr Ste 115', 'Park City', 'Summit', 'UT', '84098', '4356589200', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-08-01', '2010-07-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1871622985', 0, 'N', 0, '2009-09-30', NULL, NULL, 0, 0, NULL, NULL),
('205805198', 'W11013291', 'W11013291', 'UT01', 'Concentra Urgent Care M-F 7:30am-5:30pm', '', '', 'Concentra Urgent Care', 'GROUP', 'Urgent Care', '', '', NULL, 'O', '1735 S Redwood Rd', 'Salt Lake City', 'SALT LAKE', 'UT', '84104', '8019734434', NULL, '1735 S Redwood Rd', 'Salt Lake City', 'SALT LAKE', 'UT', '84104', '8019734434', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-09-24', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639352768', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('412144134', 'W11013300', 'W11013300', 'UT01', 'ARUP Pathology Associates', 'Anneli', 'R', 'Bowen', 'MD', 'Dermatology', '', '', NULL, 'B', 'PO Box 413037', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015853655', 'PO Box 413037', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015853655', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-03-28', '2011-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437175825', 0, 'N', 0, '2012-03-06', NULL, NULL, 0, 0, NULL, NULL),
('830458867', 'W11013255', 'W11013255', 'UT01', 'University Health Care', 'Theodore', 'S', 'Paisley', 'MD', 'Family Practice', NULL, NULL, NULL, 'o', '1138 E Wilmington Ave', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8015812000', NULL, '1138 E Wilmington Ave', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8015812000', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2007-01-01', '2012-08-20', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1952415556', 0, 'N', 0, '2012-08-21', NULL, NULL, 0, 0, NULL, NULL),
('412144134', 'W11013299', 'W11013299', 'UT01', 'University Health Care', 'Anneli', 'R', 'Bowen', 'MD', 'Dermatology', '', '', NULL, 'O', '500 S Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015812507', '8015857376', '500 S Chipeta Wy', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015812507', '8015857376', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-03-28', '2011-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437175825', 0, 'N', 0, '2012-03-06', NULL, NULL, 0, 0, NULL, NULL),
('870564069', 'W11013263', 'W11013263', 'UT01', 'University Health Care', 'Melissa', 'S', 'Briley', 'PA', 'Physician Assistant', '', '', NULL, 'o', '555 Foothill Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015818000', NULL, '555 Foothill Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015818000', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2012-08-20', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1265439376', 0, 'N', 0, '2012-08-21', NULL, NULL, 0, 0, NULL, NULL),
('800147425', 'W11013268', 'W11013268', 'UT01', 'University Health Care', 'Lisa', 'E', 'Giles', 'MD', 'Mental Health', 'Pediatric Psychiatry', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', '', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2008-07-01', '2012-07-31', 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1841408309', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11013260', 'W11013260', 'UT01', 'University Health Care', 'Leslie', 'W', 'Cooper', 'MD', 'Family Practice', 'Sports Medicine', '', NULL, 'o', '1525 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8012139900', NULL, '1525 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8012139900', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-08-01', '2012-09-16', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1023122611', 0, 'N', 0, '2012-09-17', NULL, NULL, 0, 0, NULL, NULL),
('870640775', 'W11013298', 'W11013298', 'UT01', 'University Health Care', 'Wayne', 'L', 'Stokes', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '1525 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8012139900', NULL, '1525 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8012139900', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-08-01', '2010-07-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1871622985', 0, 'N', 0, '2009-09-30', NULL, NULL, 0, 0, NULL, NULL),
('364598541', 'W11013306', 'W11013306', 'UT01', 'University Health Care', 'Timothy', 'J', 'Gayowski', 'MD', 'General Surgery', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812121', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812121', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2007-09-10', '2010-09-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154515765', 0, 'N', 0, '2012-04-24', NULL, NULL, 0, 0, NULL, NULL),
('870490866', 'W11013303', 'W11013303', 'UT01', 'University Health Care', 'Timothy', 'J', 'Gayowski', 'MD', 'General Surgery', '', '', NULL, 'o', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015814314', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015814314', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2007-09-10', '2010-09-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154515765', 0, 'N', 0, '2012-04-24', NULL, NULL, 0, 0, NULL, NULL),
('412264277', 'W11013252', 'W11013252', 'UT01', 'University Health Care', 'Daniel', 'P', 'Vezina', 'MD', 'Echocardiography', 'Anesthesiology', 'Cardiovascular Disease', NULL, 'B', '30 N 1900 E Ste 3C 444', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015850777', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, '', NULL, '1000', '47.52', '0.00', '0.00', 3, '2008-03-13', '2008-12-31', 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1487744074', 0, 'y', 0, '2008-09-23', NULL, NULL, 0, 0, NULL, NULL),
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('820482491', 'W11013362', 'W11013362', 'ID02', 'Intermountain Eye & Laser Centers', 'Mark', 'D', 'Borup', 'MD', 'Ophthalmology', '', '', NULL, 'O', '323 E Riverside Dr Ste 122', 'Eagle', 'Ada', 'ID', '83616', '2089384749', '2089384902', '323 E Riverside Dr Ste 122', 'Eagle', 'Ada', 'ID', '83616', '2089384749', '2089384902', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2008-10-01', '2011-11-21', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1386739928', 0, 'N', 0, '2012-03-01', NULL, NULL, 43.6892, -116.351, NULL, NULL),
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('820534476', 'W11013380', 'W11013380', 'ID02', 'ClarifEye Family Eyecare', 'Robert', 'S', 'Grigg', 'OD', 'Optometry', '', '', NULL, 'O', '943 N Linder Ave Ste 102', 'Kuna', 'Ada', 'ID', '83634', '2089223060', '2089221228', '943 N Linder Ave Ste 102', 'Kuna', 'Ada', 'ID', '83634', '2089223060', '2089221228', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1780698522', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
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('202630141', 'W11013480', 'W11013480', 'ID02', 'Primary Health Medical Group', 'James', '', 'Weiss', 'MD', 'Family Practice', '', '', NULL, 'O', '1130 E Fairview', 'Meridian', 'Ada', 'ID', '83642', '2088889393', '2088889525', '1130 E Fairview', 'Meridian', 'Ada', 'ID', '83642', '2088889393', '2088889525', 'IDSTDPPO', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-10-01', '2013-02-28', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1598701757', 0, 'n', 0, '2013-02-28', NULL, NULL, 43.6199, -116.379, NULL, NULL),
('202630141', 'W11013461', 'W11013461', 'ID02', 'Primary Health Medical Group', 'Timothy', '', 'Loewenstein', 'PA', 'Family Practice', '', '', NULL, 'B', '3115 E Florence', 'Meridian', 'Ada', 'ID', '83642', '2088958670', '2089550494', '3115 E Florence', 'Meridian', 'Ada', 'ID', '83642', '2088958670', '2089550494', 'IDSTDPPO', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-10-01', '2013-02-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1376597377', 0, 'Y', 0, '2013-07-11', NULL, NULL, 43.6163, -116.355, NULL, NULL),
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('202630141', 'W11013448', 'W11013448', 'ID02', 'Primary Health Medical Group', 'Darryl', '', 'Barnes', 'PA', 'Family Practice', '', '', NULL, 'B', '3115 E Florence', 'Meridian', 'Ada', 'ID', '83642', '2088958670', '2089550494', '3115 E Florence', 'Meridian', 'Ada', 'ID', '83642', '2088958670', '2089550494', 'IDSTDPPO', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-10-01', '2013-02-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1891733663', 0, 'Y', 0, '2013-06-10', NULL, NULL, 43.6163, -116.355, NULL, NULL),
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('820447063', 'W11013388', 'W11013388', 'ID02', 'Mountain Home Eye Center', 'Terrence', 'J', 'Reynolds', 'OD', 'Optometry', '', '', NULL, 'O', '395 N 3rd East', 'Mountain Home', 'Elmore', 'ID', '83647', '2085878415', '2085878416', '395 N 3rd East', 'Mountain Home', 'Elmore', 'ID', '83647', '2085878415', '2085878416', 'IDACN', NULL, NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1386628162', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('820447063', 'W11013433', 'W11013433', 'ID02', 'Mountain Home Eye Center', 'Terrence', 'J', 'Reynolds', 'OD', 'Optometry', '', '', NULL, 'B', '395 N 3rd St East', 'Mountain Home', 'Elmore', 'ID', '83647', '2085878415', '2085878416', '395 N 3rd St East', 'Mountain Home', 'Elmore', 'ID', '83647', '2085878415', '2085878416', 'IDACN', NULL, NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1386628162', 0, 'Y', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('820440995', 'W11013435', 'W11013435', 'ID02', 'Advanced Eyecare', 'Rodney', NULL, 'White', 'OD', 'Optometry', NULL, NULL, NULL, 'B', '901 12th Ave Rd S', 'Nampa', 'Canyon', 'ID', '83651', '2084669251', '2084631714', NULL, NULL, 'Canyon', NULL, NULL, NULL, NULL, 'IDACN', NULL, NULL, '0.00', '15.00', NULL, 3, '2000-01-01', '2000-01-01', NULL, NULL, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1487647509', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('820440995', 'W11013390', 'W11013390', 'ID02', 'Advanced Eyecare', 'Rodney', '', 'White', 'OD', 'Optometry', NULL, NULL, NULL, 'O', '901 12th Ave Rd S', 'Nampa', 'Canyon', 'ID', '83651', '2084669251', '2084631714', '901 12th Ave Rd S', 'Nampa', 'Canyon', 'ID', '83651', '2084669251', '2084631714', 'IDACN', NULL, NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1487647509', 0, 'N', 0, '2011-06-29', NULL, NULL, 0, 0, NULL, NULL),
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('820368134', 'W11013428', 'W11013428', 'ID02', 'Iwasa Eye Center, PA', 'Daniel', 'E', 'Iwasa', 'OD', 'Optometry', '', '', NULL, 'B', '915 3rd Ave N', 'Payette', 'Payette', 'ID', '83661', '2086422151', '2086427374', '915 3rd Ave N', 'Payette', 'Payette', 'ID', '83661', '2086422151', '2086427374', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1346383957', 0, 'Y', 0, '2013-12-26', NULL, NULL, 0, 0, NULL, NULL),
('820368134', 'W11013383', 'W11013383', 'id03', 'Payette Vision Clinic PA', 'Daniel', 'E', 'Iwasa', 'OD', 'Optometry', '', '', NULL, 'O', '915 3rd Ave N', 'Payette', 'Payette', 'ID', '83661', '2086422151', '2086427374', '915 3rd Ave N', 'Payette', 'Payette', 'ID', '83661', '2086422151', '2086427374', 'IDACN', NULL, NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', '2008-12-12', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1346383957', 0, 'N', 0, '2013-12-26', NULL, NULL, 0, 0, NULL, NULL);
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('820316249', 'W11013398', 'W11013398', 'ID02', 'Nampa Radiologists PA', 'James', 'A', 'Engelhart', 'MD', 'Radiologist', '', '', NULL, 'O', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084635431', '2084635051', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084635431', '2084635051', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2008-10-01', '2010-07-01', 0, 0, 1, NULL, NULL, NULL, 'Saint Alphonsus Medical Center Nampa', 'HCFA|UB|', '1649222480', 0, 'Y', 0, '2009-01-21', NULL, NULL, 43.5537, -116.573, NULL, NULL),
('820316249', 'W11013402', 'W11013402', 'ID02', 'Nampa Radiologists PA', 'Daniel', 'J', 'Wegner', 'MD', 'Radiologist', '', '', NULL, 'O', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084635431', '2084635051', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084635431', '2084635051', 'IDACN', NULL, NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 1, '', '', '', 'Saint Alphonsus Medical Center Nampa', 'HCFA|UB|', '1275584997', 0, 'Y', 0, '2011-06-29', NULL, NULL, 43.5537, -116.573, NULL, NULL),
('820316249', 'W11013400', 'W11013400', 'ID02', 'Nampa Radiologists PA', 'David', 'J', 'Giles', 'MD', 'Radiologist', '', '', NULL, 'O', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084635431', '2084635051', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084635431', '2084635051', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2008-10-01', '2010-08-01', 0, 0, 1, '', '', '', 'Saint Alphonsus Medical Center Nampa', 'HCFA|UB|', '1295787935', 0, 'Y', 0, '2011-06-29', NULL, NULL, 43.5537, -116.573, NULL, NULL),
('820316249', 'W11013396', 'W11013396', 'ID02', 'Nampa Radiologists PA', 'Dirk', 'E', 'Bigler', 'DO', 'Radiologist', '', '', NULL, 'O', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084635431', '2084635051', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084635431', '2084635051', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2008-10-01', '2010-08-01', 0, 0, 1, NULL, NULL, NULL, 'Saint Alphonsus Medical Center Nampa', 'HCFA|UB|', '1457304776', 0, 'Y', 0, '2009-01-21', NULL, NULL, 43.5537, -116.573, NULL, NULL),
('820316249', 'W11013393', 'W11013393', 'ID02', 'Nampa Radiologists PA', 'Mark', 'J', 'Baldeck', 'MD', 'Radiologist', '', '', NULL, 'O', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084635431', '2084635051', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084635431', '2084635051', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2008-10-01', '2010-08-01', 0, 0, 1, NULL, NULL, NULL, 'Saint Alphonsus Medical Center Nampa', 'HCFA|UB|', '1295788669', 0, 'Y', 0, '2009-01-21', NULL, NULL, 43.5537, -116.573, NULL, NULL),
('820316249', 'W11013403', 'W11013403', 'ID02', 'Nampa Radiologists PA', 'Daniel', 'J', 'Wegner', 'MD', 'Radiologist', '', '', NULL, 'O', '4403 E Flamingo', 'Nampa', 'Canyon', 'ID', '83687', '2084633000', '2082884961', '4403 E Flamingo', 'Nampa', 'Canyon', 'ID', '83687', '2084633000', '2082884961', 'IDACN', NULL, NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 1, '', '', '', 'Saint Alphonsus Medical Center Nampa', 'HCFA|UB|', '1275584997', 0, 'Y', 0, '2011-06-29', NULL, NULL, 0, 0, NULL, NULL),
('820316249', 'W11013394', 'W11013394', 'ID02', 'Nampa Radiologists PA', 'Mark', 'J', 'Baldeck', 'MD', 'Radiologist', '', '', NULL, 'O', '4403 E Flamingo', 'Nampa', 'Canyon', 'ID', '83687', '2084633000', '2082884961', '4403 E Flamingo', 'Nampa', 'Canyon', 'ID', '83687', '2084633000', '2082884961', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2008-10-01', '2010-08-01', 0, 0, 1, NULL, NULL, NULL, 'Saint Alphonsus Medical Center Nampa', 'HCFA|UB|', '1295788669', 0, 'Y', 0, '2009-01-21', NULL, NULL, 0, 0, NULL, NULL),
('204565057', 'W11013395', 'W11013395', 'ID02', 'Idaho Vascular Institute', 'Mark', 'J', 'Baldeck', 'MD', 'Radiologist', '', '', NULL, 'O', '4400 E Flamingo', 'Nampa', 'Canyon', 'ID', '83687', '2082884620', '2082884629', '4400 E Flamingo', 'Nampa', 'Canyon', 'ID', '83687', '2082884620', '2082884629', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2008-10-01', '2010-08-01', 0, 0, 1, NULL, NULL, NULL, 'Saint Alphonsus Medical Center Nampa', 'HCFA|UB|', '1295788669', 0, 'Y', 0, '2009-01-21', NULL, NULL, 43.5976, -116.517, NULL, NULL),
('820482491', 'W11013366', 'W11013366', 'ID02', 'Intermountain Eye & Laser Centers', 'Leo', 'S', 'Harf', 'MD', 'Ophthalmology', '', '', NULL, 'O', '4400 E Flamingo Rd', 'Nampa', 'Canyon', 'ID', '83687', '2084662222', '2084653441', '4400 E Flamingo Rd', 'Nampa', 'Canyon', 'ID', '83687', '2084662222', '2084653441', 'IDACN', NULL, NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1417041849', 0, 'N', 0, '2011-08-11', NULL, NULL, 0, 0, NULL, NULL),
('820316249', 'W11013397', 'W11013397', 'ID02', 'Nampa Radiologists PA', 'Dirk', 'E', 'Bigler', 'DO', 'Radiologist', '', '', NULL, 'O', '4403 E Flamingo', 'Nampa', 'Canyon', 'ID', '83687', '2084633000', '2082884961', '4403 E Flamingo', 'Nampa', 'Canyon', 'ID', '83687', '2084633000', '2082884961', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2008-10-01', '2010-08-01', 0, 0, 1, NULL, NULL, NULL, 'Saint Alphonsus Medical Center Nampa', 'HCFA|UB|', '1457304776', 0, 'Y', 0, '2009-01-21', NULL, NULL, 0, 0, NULL, NULL),
('820482491', 'W11013373', 'W11013373', 'ID02', 'Intermountain Eye & Laser Centers', 'Adam', 'C', 'Reynolds', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '4400 E Flamingo Rd', 'Nampa', 'Canyon', 'ID', '83687', '2084662222', '2084653441', '4400 E Flamingo Rd', 'Nampa', 'Canyon', 'ID', '83687', '2084662222', '2084653441', 'IDACN', NULL, NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1417916586', 0, 'N', 0, '2011-08-09', NULL, NULL, 0, 0, NULL, NULL),
('820316249', 'W11013401', 'W11013401', 'ID02', 'Nampa Radiologists PA', 'David', 'J', 'Giles', 'MD', 'Radiologist', '', '', NULL, 'O', '4403 E Flamingo', 'Nampa', 'Canyon', 'ID', '83687', '2084633000', '2082884961', '4403 E Flamingo', 'Nampa', 'Canyon', 'ID', '83687', '2084633000', '2082884961', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2008-10-01', '2010-08-01', 0, 0, 1, '', '', '', 'Saint Alphonsus Medical Center Nampa', 'HCFA|UB|', '1295787935', 0, 'Y', 0, '2011-06-29', NULL, NULL, 0, 0, NULL, NULL),
('204565057', 'W11013404', 'W11013404', 'ID02', 'Idaho Vascular Institute', 'Daniel', 'J', 'Wegner', 'MD', 'Radiologist', '', '', NULL, 'O', '4400 E Flamingo', 'Nampa', 'Canyon', 'ID', '83687', '2082884620', '2082884629', '4400 E Flamingo', 'Nampa', 'Canyon', 'ID', '83687', '2082884620', '2082884629', 'IDACN', NULL, NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 1, '', '', '', 'Saint Alphonsus Medical Center Nampa', 'HCFA|UB|', '1275584997', 0, 'Y', 0, '2011-06-29', NULL, NULL, 43.5976, -116.517, NULL, NULL),
('820316249', 'W11013399', 'W11013399', 'ID02', 'Nampa Radiologists PA', 'James', 'A', 'Engelhart', 'MD', 'Radiologist', '', '', NULL, 'O', '4403 E Flamingo', 'Nampa', 'Canyon', 'ID', '83687', '2084633000', '2082884961', '4403 E Flamingo', 'Nampa', 'Canyon', 'ID', '83687', '2084633000', '2082884961', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2008-10-01', '2010-07-01', 0, 0, 1, NULL, NULL, NULL, 'Saint Alphonsus Medical Center Nampa', 'HCFA|UB|', '1649222480', 0, 'Y', 0, '2009-01-21', NULL, NULL, 0, 0, NULL, NULL),
('820482491', 'W11013369', 'W11013369', 'ID02', 'Pediatric Ophthalmology & Adult Strabismus', 'Katherine', 'A', 'Lee', 'MD', 'Ophthalmology', 'Pediatric Ophthalmology', '', NULL, 'O', '222 N 2nd Ste 215', 'Boise', 'Ada', 'ID', '83702', '2083422706', '2083362278', '222 N 2nd Ste 215', 'Boise', 'Ada', 'ID', '83702', '2083422706', '2083362278', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2008-10-01', '2011-02-18', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1386738839', 0, 'Y', 0, '2011-02-18', NULL, NULL, 43.6131, -116.195, NULL, NULL),
('820519838', 'W11013360', 'W11013360', 'ID02', 'Northwest Eye & Laser Center', 'Mark', 'J', 'Boerner', 'MD', 'Ophthalmology', '', '', NULL, 'O', '111 Main St Ste 200', 'Boise', 'Ada', 'ID', '83702', '2083443220', '2083440461', '111 Main St Ste 200', 'Boise', 'Ada', 'ID', '83702', '2083443220', '2083440461', 'IDACN', NULL, NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1003819459', 0, 'N', 0, '2012-07-19', NULL, NULL, 0, 0, NULL, NULL),
('820482491', 'W11013374', 'W11013374', 'ID02', 'Intermountain Eye & Laser Centers', 'James', 'R', 'Swartley', 'MD', 'Ophthalmology', '', '', NULL, 'O', '222 N 2nd Ste 215', 'Boise', 'Ada', 'ID', '83702', '2083422706', '2083362278', '222 N 2nd Ste 215', 'Boise', 'Ada', 'ID', '83702', '2083422706', '2083362278', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2008-10-01', '2013-08-07', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1003861253', 0, 'N', 0, '2013-08-23', NULL, NULL, 43.6131, -116.195, NULL, NULL),
('202630141', 'W11013474', 'W11013474', 'ID02', 'Primary Health Medical Group', 'Kathleen', 'M', 'Romito', 'MD', 'Family Practice', '', '', NULL, 'O', '801 N Stilson Rd', 'Boise', 'Ada', 'ID', '83703', '2083447799', '2083447152', '801 N Stilson Rd', 'Boise', 'Ada', 'ID', '83703', '2083447799', '2083447152', 'IDSTDPPO', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-10-01', '2009-01-01', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1619919933', 0, 'n', 0, '2013-10-16', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W11013482', 'W11013482', 'ID02', 'Primary Health Medical Group', 'Sharon', 'E', 'Westbrook', 'MD', 'Family Practice', '', '', NULL, 'O', '801 N Stilson Rd', 'Boise', 'Ada', 'ID', '83703', '2083447799', '2083447152', '801 N Stilson Rd', 'Boise', 'Ada', 'ID', '83703', '2083447799', '2083447152', 'IDSTDPPO', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-10-01', '2009-06-15', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1184669889', 0, 'n', 0, '2013-03-06', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W11013451', 'W11013451', 'ID02', 'Primary Health Medical Group', 'Bruce', '', 'Belzer', 'MD', 'Family Practice', '', '', NULL, 'O', '801 N Stilson Rd', 'Boise', 'Ada', 'ID', '83703', '2083447799', '2083447152', '801 N Stilson Rd', 'Boise', 'Ada', 'ID', '83703', '2083447799', '2083447152', 'IDSTDPPO', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-10-01', '2009-06-15', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1083666382', 0, 'n', 0, '2013-03-06', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W11013481', 'W11013481', 'ID02', 'Primary Health Medical Group', 'Katie', '', 'Weller', 'CFNP', 'Family Practice', '', '', NULL, 'B', '801 N Stilson Rd', 'Boise', 'Ada', 'ID', '83703', '2083447799', '2083447152', '801 N Stilson Rd', 'Boise', 'Ada', 'ID', '83703', '2083447799', '2083447152', 'IDSTDPPO', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-10-01', '2009-06-15', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1275584534', 0, 'Y', 0, '2014-01-31', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W11013484', 'W11013484', 'ID02', 'Primary Health Medical Group', 'Tracy', '', 'Yun', 'CFNP', 'Urgent Care', '', '', NULL, 'B', '801 N Stilson Rd', 'Boise', 'Ada', 'ID', '83703', '2083447799', '2083447152', '801 N Stilson Rd', 'Boise', 'Ada', 'ID', '83703', '2083447799', '2083447152', 'IDSTDPPO', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-10-01', '2009-06-15', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1346422235', 0, 'Y', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('820447063', 'W11013387', 'W11013387', 'ID02', 'Capital Eye Care', 'Terrence', 'J', 'Reynolds', 'OD', 'Optometry', '', '', NULL, 'O', '6700 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083367100', '2083212710', '6700 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083367100', '2083212710', 'IDACN', NULL, NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1386628162', 0, 'N', 0, '2012-10-26', NULL, NULL, 0, 0, NULL, NULL),
('820482491', 'W11013418', 'W11013418', 'ID02', 'Intermountain Eye & Laser Centers PLLC', 'Adam', 'C', 'Reynolds', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'B', '6063 Corporal Ln', 'Boise', 'Ada', 'ID', '83704', '2083758799', '2088989924', '6063 Corporal Ln', 'Boise', 'Ada', 'ID', '83704', '2083758799', '2088989924', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2008-10-01', '2011-08-14', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1417916586', 0, 'Y', 0, '2011-08-09', NULL, NULL, 0, 0, NULL, NULL),
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('331078261', 'W11013493', 'W11013493', 'ID01', 'Saint Alphonsus Physicians PA', 'Carolyn', '', 'Kolb', 'NP-C', 'Cardiovascular Disease', 'Nurse Practitioner', '', NULL, 'B', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2083674278', NULL, '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2083674278', '          ', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 3, '2008-09-29', '2012-12-13', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1649297532', 0, 'N', 0, '2012-12-14', NULL, NULL, 43.587, -116.549, NULL, NULL),
('820507577', 'W11013501', 'W11013501', 'ID02', 'Boise Heart Clinic PLLC', 'Robert', 'S', 'Lee', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 800', 'Boise', 'Ada', 'ID', '83701', '2083437940', NULL, 'PO Box 800', 'Boise', 'Ada', 'ID', '83701', '2083437940', '          ', 'IDSTDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-10-01', '2013-11-01', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1205871258', 0, 'N', 0, '2013-12-19', NULL, NULL, 0, 0, NULL, NULL),
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('820521864', 'W11013499', 'W11013499', 'ID02', 'Eagle Eye Surgery & Laser Center', NULL, NULL, 'Eagle Eye Surgery & Laser Center', 'GROUP', 'Ambulatory Surgery Center', NULL, NULL, NULL, 'O', '6063 Corporal Ln', 'Boise', 'ADA', 'ID', '83704', '2083758799', NULL, NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '10.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000006072', 0, 'n', 0, '2008-09-30', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W11013496', 'W11013496', 'ID01', 'Saint Alphonsus Regional Medical Center Behavioral Health', 'Joseph', 'A', 'Whitfield', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'o', '131 N Allumbaugh', 'Boise', 'Ada', 'ID', '83704', '2083676500', '2083760285', '131 N Allumbaugh', 'Boise', 'Ada', 'ID', '83704', '2083676500', '2083760285', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2008-07-01', '2011-04-01', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1477750453', 0, 'N', 0, '2011-08-05', NULL, NULL, 43.6059, -116.267, NULL, NULL),
('820200895', 'W11013495', 'W11013495', 'ID01', 'Saint Alphonsus Regional Medical Center Behavioral Health', 'David', 'A', 'Kent', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'o', '131 N Allumbaugh', 'Boise', 'Ada', 'ID', '83704', '2083676500', '2083760285', '131 N Allumbaugh', 'Boise', 'Ada', 'ID', '83704', '2083676500', '2083760285', 'IDSAMG1', NULL, '', '0.00', '10.00', '0.00', 6, '2008-07-01', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1215965199', 0, 'n', 0, '2014-06-10', NULL, NULL, 43.6062, -116.266, NULL, NULL),
('331078261', 'W11013490', 'W11013490', 'ID01', 'Saint Alphonsus Physicians PA', 'Carolyn', '', 'Kolb', 'NP-C', 'Cardiovascular Disease', 'Nurse Practitioner', '', NULL, 'o', '6140 W Curtisian Ste 200', 'Boise', 'Ada', 'ID', '83704', '2083674278', NULL, '6140 W Curtisian Ste 200', 'Boise', 'Ada', 'ID', '83704', '2083674278', '          ', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 3, '2008-09-29', '2012-12-13', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1649297532', 0, 'N', 0, '2012-12-14', NULL, NULL, 43.6151, -116.256, NULL, NULL),
('203942050', 'W11013509', 'W11013509', 'ID02', 'Four Rivers Hospice', '', '', 'Four Rivers Hospice', 'GROUP (Amedisys, Inc)', 'Hospice', '', '', NULL, 'B', 'Dept 115034 PO Box 150473', 'Hartford', 'HARTFORD', 'CT', '06115', '2083677305', NULL, 'Dept 115034 PO Box 150473', 'Hartford', 'HARTFORD', 'CT', '06115', '2083677305', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2008-10-01', '2012-06-30', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000006290', 0, 'N', 0, '2012-10-10', NULL, NULL, 0, 0, NULL, NULL),
('203942050', 'W11013508', 'W11013508', 'ID02', 'Saint Alphonsus Home Health', '', '', 'Saint Alphonsus Home Health and Hospice, an Amedisys Partner', 'GROUP (Amedisys, Inc)', 'Hospice', '', '', NULL, 'B', 'Dept 115034 PO Box 150473', 'Hartford', 'HARTFORD', 'CT', '06115', '2083677305', NULL, 'Dept 115034 PO Box 150473', 'Hartford', 'HARTFORD', 'CT', '06115', '2083677305', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2008-10-01', '2013-09-24', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1518911890', 0, 'N', 0, '2013-10-15', NULL, NULL, 0, 0, NULL, NULL),
('820507577', 'W11013504', 'W11013504', 'ID02', 'Boise Heart Clinic PLLC', 'James', 'W', 'Smith', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 800', 'Boise', 'Ada', 'ID', '83701', '2083437940', NULL, 'PO Box 800', 'Boise', 'Ada', 'ID', '83701', '2083437940', '          ', 'IDSTDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-10-01', '2013-11-01', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1700814787', 0, 'N', 0, '2013-12-19', NULL, NULL, 0, 0, NULL, NULL),
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('820507577', 'W11013505', 'W11013505', 'ID02', 'Boise Heart Clinic', 'James', 'W', 'Smith', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '287 W Jefferson St', 'Boise', 'Ada', 'ID', '83702', '2083437940', NULL, '287 W Jefferson St', 'Boise', 'Ada', 'ID', '83702', '2083437940', '          ', 'IDSTDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-10-01', '2013-11-01', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1700814787', 0, 'N', 0, '2013-12-19', NULL, NULL, 0, 0, NULL, NULL),
('820507577', 'W11013503', 'W11013503', 'ID02', 'Boise Heart Clinic', 'Renee', 'L', 'Manring', 'ACNP', 'Cardiovascular Disease', '', '', NULL, 'O', '287 W Jefferson St', 'Boise', 'Ada', 'ID', '83702', '2083437940', NULL, '287 W Jefferson St', 'Boise', 'Ada', 'ID', '83702', '2083437940', '          ', 'IDSTDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-10-01', '2013-11-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1578578043', 0, 'N', 0, '2013-12-19', NULL, NULL, 0, 0, NULL, NULL),
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('205934739', 'W11013512', 'W11013512', 'ID02', 'Family Medicine Health Center', 'Ted', 'D', 'Epperly', 'MD', 'Family Practice', '', '', NULL, 'O', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', NULL, '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '', 'IDPPO', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1134176548', 0, 'n', 0, '2012-04-11', NULL, NULL, 0, 0, NULL, NULL),
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('205934739', 'W11013561', 'W11013561', 'ID02', 'Family Medicine Health Center', 'Phoebe', 'S', 'Gray', 'NP', 'Family Practice', '', '', NULL, 'O', '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083811775', NULL, '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083811775', '', 'IDPPO', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1659480754', 0, 'n', 0, '2011-06-29', NULL, NULL, 0, 0, NULL, NULL),
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('205934739', 'W11013565', 'W11013565', 'ID02', 'Family Medicine Health Center', 'Susan', 'C', 'Kim', 'MD', 'Family Practice', 'Pediatrics', '', NULL, 'O', '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083811775', NULL, '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083811775', '          ', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-11-01', '2012-04-05', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1265478531', 0, 'N', 0, '2012-04-05', NULL, NULL, 0, 0, NULL, NULL),
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('820511819', 'W11013574', 'W11013574', 'ID02', 'Treasure Valley Laboratory', '', '', 'Treasure Valley Laboratory', 'GROUP', 'Laboratory', '', '', NULL, 'O', '1520 W State St Ste 100', 'Boise', 'Ada', 'ID', '83702', '2089477708', NULL, '1520 W State St Ste 100', 'Boise', 'Ada', 'ID', '83702', '2089477708', '          ', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2008-10-01', '2010-10-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1730165838', 0, 'N', 0, '2011-05-23', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W11013579', 'W11013579', 'UTPEHP', 'IHC Home Medical Equipment  - Logan', NULL, NULL, 'IHC Home Medical Equipment  - Logan', 'GROUP', 'Durable Medical Equipment', NULL, NULL, NULL, 'O', '101 E 1400 N', 'Logan', 'Cache', 'UT', '84341', '4357165477', NULL, NULL, NULL, 'Cache', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '10.00', '0.00', 8, '2008-07-01', '2008-12-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000006839', 0, 'N', 0, '2009-07-01', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W11013581', 'W11013581', 'UTPEHP', 'IHC Home Medical Equipment  - St George', NULL, NULL, 'IHC Home Medical Equipment  - St George', 'GROUP', 'Durable Medical Equipment', NULL, NULL, NULL, 'O', '1240 E 100 S Ste 119', 'St George', 'Washington', 'UT', '84790', '4356884554', NULL, NULL, NULL, 'Washington', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '10.00', '0.00', 8, '2008-07-01', '2008-12-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000006842', 0, 'N', 0, '2009-07-01', NULL, NULL, 0, 0, NULL, NULL),
('820511819', 'W11013571', 'W11013571', 'ID02', 'Treasure Valley Laboratory', '', '', 'Treasure Valley Laboratory', 'GROUP', 'Laboratory', '', '', NULL, 'B', 'PO Box 2693', 'Spokane', 'Spokane', 'WA', '99220', '8004331583', NULL, 'PO Box 2693', 'Spokane', 'Spokane', 'WA', '99220', '8004331583', '          ', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2008-10-01', '2010-10-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1730165838', 0, 'N', 0, '2011-05-23', NULL, NULL, 0, 0, NULL, NULL),
('820483425', 'W11012399', 'W11012399', 'ID01', 'Idaho Surgical Partners', 'Matthew', 'R', 'Macha', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 2045', 'Eagle', 'Ada', 'ID', '83616', '2083435600', NULL, 'PO Box 2045', 'Eagle', 'Ada', 'ID', '83616', '2083435600', '', 'IDSTD', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-09-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1730190836', 0, 'y', 0, '2013-07-31', NULL, NULL, 0, 0, NULL, NULL),
('820483425', 'W11012398', 'W11012398', 'ID01', 'Idaho Surgical Partners', 'Matthew', 'R', 'Macha', 'MD', 'General Surgery', '', '', NULL, 'o', '323 E Riverside Dr Ste 220', 'Eagle', 'Ada', 'ID', '83616', '2083435600', NULL, '323 E Riverside Dr Ste 220', 'Eagle', 'Ada', 'ID', '83616', '2083435600', '', 'IDSTD', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-09-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1730190836', 0, 'n', 0, '2014-02-21', NULL, NULL, 43.6892, -116.351, NULL, NULL),
('870621824', 'W11005342', 'W11005342', 'UTMH1', 'Intermountain Center for Cognitive Therapy', 'Randy', 'S', 'Linnell', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '560 S State Ste G1', 'Orem', 'Utah', 'UT', '84058', '8018028608', NULL, '560 S State Ste G1', 'Orem', 'Utah', 'UT', '84058', '8018028608', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-07-01', '2008-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457480204', 0, 'N', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
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('870442845', 'W11012940', 'W11012940', 'UT01', 'U-U Hematology / Oncology Division', 'David', 'B', 'Brown', 'PA-C', 'Mental Health', 'Physician Assistant', NULL, NULL, 'B', 'PO Box 581700', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8012133800', '8015853655', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2008-02-05', '2008-03-13', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1003990573', 0, 'y', 0, '2010-01-14', NULL, NULL, 0, 0, NULL, NULL),
('870656553', 'W11013582', 'W11013582', 'UT01', 'Lehi Vision Care', 'Roger', 'M', 'Pickering', 'OD', 'Optometry', '', '', NULL, 'O', '159 E Main St Ste F', 'Lehi', 'Utah', 'UT', '84043', '8017661696', NULL, '159 E Main St Ste F', 'Lehi', 'Utah', 'UT', '84043', '8017661696', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770577058', 0, 'n', 0, '2011-10-04', NULL, NULL, 40.388, -111.846, 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
('870629869', 'W11013583', 'W11013583', 'UT01', 'Central Utah Public Health', NULL, NULL, 'Central Utah Public Health', 'GROUP', 'Health Department', NULL, NULL, NULL, 'O', '70 Westview Dr', 'Richfield', 'Sevier', 'UT', '84701', '4358965451', NULL, '70 Westview Dr', 'Richfield', 'Sevier', 'UT', '84701', NULL, NULL, 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1073626412', 0, 'n', 0, '2008-10-02', NULL, NULL, 0, 0, NULL, NULL),
('820464330', 'W11013589', 'W11013589', 'ID01', 'Pediatric Cardiology of Idaho', 'Eloisa', 'S', 'Walker', '(accepting newborn pediatric patients only)', 'Pediatric Cardiology', '', '', NULL, 'B', '315 E Elm St', 'Caldwell', 'Canyon', 'ID', '83605', '2083369188', NULL, '315 E Elm St', 'Caldwell', 'Canyon', 'ID', '83605', '2083369188', '', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-10-01', '2011-10-02', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760433601', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6539, -116.695, NULL, NULL),
('820464330', 'W11013587', 'W11013587', 'ID01', 'Pediatric Cardiology of Idaho', 'Eloisa', 'S', 'Walker', '(accepting newborn pediatric patients only)', 'Pediatric Cardiology', '', '', NULL, 'B', '1118 NW 16th St Ste A', 'Fruitland', 'Payette', 'ID', '83619', '2083369188', NULL, '1118 NW 16th St Ste A', 'Fruitland', 'Payette', 'ID', '83619', '2083369188', '', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-10-01', '2011-10-02', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760433601', 0, 'Y', 0, '2014-06-20', NULL, NULL, 44.025, -116.928, NULL, NULL),
('820464330', 'W11013592', 'W11013592', 'ID01', 'Pediatric Cardiology of Idaho', 'Eloisa', 'S', 'Walker', '(accepting newborn pediatric patients only)', 'Pediatric Cardiology', '', '', NULL, 'B', 'Po Box 1026', 'Homedale', 'Owyhee', 'ID', '83628', '2083369188', NULL, 'Po Box 1026', 'Homedale', 'Owyhee', 'ID', '83628', '2083369188', '', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-10-01', '2011-10-02', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760433601', 0, 'Y', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('820464330', 'W11013590', 'W11013590', 'ID01', 'Pediatric Cardiology of Idaho', 'Eloisa', 'S', 'Walker', '(accepting newborn pediatric patients only)', 'Pediatric Cardiology', '', '', NULL, 'B', '520 S Eagle Rd Ste 3213', 'Meridian', 'Ada', 'ID', '83642', '2083369188', NULL, '520 S Eagle Rd Ste 3213', 'Meridian', 'Ada', 'ID', '83642', '2083369188', '', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-10-01', '2011-10-02', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760433601', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.5995, -116.352, NULL, NULL),
('820464330', 'W11013588', 'W11013588', 'ID01', 'Pediatric Cardiology of Idaho', 'Eloisa', 'S', 'Walker', '(accepting newborn pediatric patients only)', 'Pediatric Cardiology', '', '', NULL, 'B', '890 N 6th E', 'Mountain Home', 'Elmore', 'ID', '83647', '2083369188', NULL, '890 N 6th E', 'Mountain Home', 'Elmore', 'ID', '83647', '2083369188', '', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-10-01', '2011-10-02', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760433601', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.1392, -115.692, NULL, NULL),
('200578784', 'W11013585', 'W11013585', 'ID02', 'Kormylo Orthopedic Inc', '', '', 'Kormylo Orthopedic Inc', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '220 3rd Ave S', 'Nampa', 'Canyon', 'ID', '83651', '2084664360', NULL, '220 3rd Ave S', 'Nampa', 'Canyon', 'ID', '83651', '2084664360', '', 'IDDME100', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1306043369', 0, 'n', 0, '2012-02-13', NULL, NULL, 0, 0, NULL, NULL),
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('200578784', 'W11013584', 'W11013584', 'ID02', 'Kormylo Orthopedic Inc', NULL, NULL, 'Kormylo Orthopedic Inc', 'GROUP', 'Durable Medical Equipment', NULL, NULL, NULL, 'O', '175 N Benjamin Ln', 'Boise', 'Ada', 'ID', '83704', '2083774024', NULL, '175 N Benjamin Ln', 'Boise', 'Ada', 'ID', '83704', NULL, NULL, 'IDDME100', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1902811433', 0, 'n', 0, '2008-10-02', NULL, NULL, 0, 0, NULL, NULL),
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('593250414', 'W11013678', 'W11013678', 'TX01', 'Taylor Home Health Supply', NULL, NULL, 'Taylor Home Health Supply', 'Group', 'Durable Medical Equipment', NULL, NULL, NULL, 'B', '701 S Beckham Ave', 'Tyler', 'Smith', 'TX', '75701', '9035358245', '9035359566', NULL, NULL, 'Smith', NULL, NULL, NULL, NULL, 'ROTECH', 'DME80', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1447230073', 0, 'Y', 0, '2008-10-02', NULL, NULL, 0, 0, NULL, NULL),
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('593339037', 'W11013680', 'W11013680', 'TX01', 'Rhema Medical', NULL, NULL, 'Rhema Medical', 'Group', 'Durable Medical Equipment', NULL, NULL, NULL, 'B', '2400 Chambers St', 'Venus', 'Johnson', 'TX', '76084', '8174534387', '8174538063', NULL, NULL, 'Johnson', NULL, NULL, NULL, NULL, 'ROTECH', 'DME80', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1841360278', 0, 'Y', 0, '2008-10-02', NULL, NULL, 0, 0, NULL, NULL),
('752622932', 'W11013652', 'W11013652', 'TX01', 'Rhema Medical', NULL, NULL, 'Rhema Medical', 'Group', 'Durable Medical Equipment', NULL, NULL, NULL, 'B', '9665 Camp Bowie W', 'Fort Worth', 'Tarrant', 'TX', '76116', '8172447052', '8175604975', NULL, NULL, 'Tarrant', NULL, NULL, NULL, NULL, 'ROTECH', 'DME80', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1649231267', 0, 'Y', 0, '2008-10-02', NULL, NULL, 0, 0, NULL, NULL),
('752622932', 'W11013650', 'W11013650', 'TX01', 'Rhema Medical', NULL, NULL, 'Rhema Medical', 'Group', 'Durable Medical Equipment', NULL, NULL, NULL, 'B', '1108 Dallas Dr Ste 333', 'Denton', 'Denton', 'TX', '76205', '9402439009', '9403815227', NULL, NULL, 'Denton', NULL, NULL, NULL, NULL, 'ROTECH', 'DME80', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1609837202', 0, 'Y', 0, '2008-10-02', NULL, NULL, 0, 0, NULL, NULL),
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('752622932', 'W11013682', 'W11013682', 'TX01', 'Rhema Medical', NULL, NULL, 'Rhema Medical', 'Group', 'Durable Medical Equipment', NULL, NULL, NULL, 'B', '100 E Nasa Rd One Ste 85', 'Webster', 'Harris', 'TX', '77598', '2813325183', '2813324482', NULL, NULL, 'Harris', NULL, NULL, NULL, NULL, 'ROTECH', 'DME80', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1134180755', 0, 'Y', 0, '2008-10-02', NULL, NULL, 0, 0, NULL, NULL),
('593250414', 'W11013643', 'W11013643', 'TX01', 'Taylor Home Health Supply  ', NULL, NULL, 'Taylor Home Health Supply  ', 'Group', 'Durable Medical Equipment', NULL, NULL, NULL, 'B', '2688 Calder Ave', 'Beaumont', 'Jefferson', 'TX', '77702', '4098389173', '4098384702', NULL, NULL, 'Jefferson', NULL, NULL, NULL, NULL, 'ROTECH', 'DME80', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1184694796', 0, 'Y', 0, '2008-10-13', NULL, NULL, 0, 0, NULL, NULL),
('592973784', 'W11013674', 'W11013674', 'TX01', 'Aaa Medical & Oxygen Supply', '', '', 'Aaa Medical & Oxygen Supply', 'Group', 'Durable Medical Equipment', '', '', NULL, 'O', '11913 Starcrest Dr', 'San Antonio', 'Bexar', 'TX', '78247', '2104969770', '2104961405', '11913 Starcrest Dr', 'San Antonio', 'Bexar', 'TX', '78247', '2104969770', '2104961405', 'ROTECH', 'DME80', '', '0.00', '35.00', '0.00', 3, '2008-10-01', '2014-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073583159', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('593344111', 'W11013646', 'W11013646', 'TX01', 'Aaa Oxygen & Medical Supply', '', '', 'Aaa Oxygen & Medical Supply', 'Group', 'Durable Medical Equipment', '', '', NULL, 'B', '2209 N Padre Island Dr Ste D', 'Corpus Christi', 'Nueces', 'TX', '78408', '3612992293', '3612891127', '2209 N Padre Island Dr Ste D', 'Corpus Christi', 'Nueces', 'TX', '78408', '3612992293', '3612891127', 'ROTECH', 'DME80', '', '0.00', '35.00', '0.00', 3, '2008-10-01', '2014-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376513820', 0, 'Y', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('593344111', 'W11013664', 'W11013664', 'TX01', 'Aaa Medical & Oxygen Supply', '', '', 'Aaa Medical & Oxygen Supply ', 'Group', 'Durable Medical Equipment', '', '', NULL, 'B', '1800 S Main St Ste 105 & 115', 'Mcallen', 'Hidalgo', 'TX', '78503', '9566311153', '9566312091', '1800 S Main St Ste 105 & 115', 'Mcallen', 'Hidalgo', 'TX', '78503', '9566311153', '9566312091', 'ROTECH', 'DME80', '', '0.00', '35.00', '0.00', 3, '2008-10-01', '2014-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932179926', 0, 'Y', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
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('593344111', 'W11013675', 'W11013675', 'TX01', 'Aaa Medical & Oxygen Supply', '', '', 'Aaa Medical & Oxygen Supply', 'Group', 'Durable Medical Equipment', '', '', NULL, 'B', '1218 Hwy 123', 'San Marcos', 'Hays', 'TX', '78666', '5123963372', '5123963479', '1218 Hwy 123', 'San Marcos', 'Hays', 'TX', '78666', '5123963372', '5123963479', 'ROTECH', 'DME80', '', '0.00', '35.00', '0.00', 3, '2008-10-01', '2014-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508836404', 0, 'Y', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('593344111', 'W11013642', 'W11013642', 'TX01', 'Aaa Medical & Oxygen Supply', '', '', 'Aaa Medical & Oxygen Supply  ', 'Group', 'Durable Medical Equipment', '', '', NULL, 'B', '5210 N Lamar', 'Austin', 'Travis', 'TX', '78751', '5124519999', '5124515413', '5210 N Lamar', 'Austin', 'Travis', 'TX', '78751', '5124519999', '5124515413', 'ROTECH', 'DME80', '', '0.00', '35.00', '0.00', 3, '2008-10-01', '2014-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992775829', 0, 'Y', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('752461923', 'W11013679', 'W11013679', 'TX01', 'Oxygen Therapy Associates', NULL, NULL, 'Oxygen Therapy Associates', 'Group', 'Durable Medical Equipment', NULL, NULL, NULL, 'B', '115 W Main St', 'Uvalde', 'Uvalde', 'TX', '78801', '8302788101', '8302788163', NULL, NULL, 'Uvalde', NULL, NULL, NULL, NULL, 'ROTECH', 'DME80', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1003875097', 0, 'Y', 0, '2008-10-02', NULL, NULL, 0, 0, NULL, NULL),
('751583420', 'W11013649', 'W11013649', 'TX01', 'Major Medical Supply', NULL, NULL, 'Major Medical Supply', 'Group', 'Durable Medical Equipment', NULL, NULL, NULL, 'B', '612 Bedell Ave Ste F', 'Del Rio', 'Val Verde', 'TX', '78840', '8307750442', '8307740533', NULL, NULL, 'Val Verde', NULL, NULL, NULL, NULL, 'ROTECH', 'DME80', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1700855376', 0, 'Y', 0, '2008-10-02', NULL, NULL, 0, 0, NULL, NULL),
('593366769', 'W11013668', 'W11013668', 'TX01', 'Caremor Health Services', NULL, NULL, 'Caremor Health Services', 'Group', 'Durable Medical Equipment', NULL, NULL, NULL, 'B', '1708 N Hobart St', 'Pampa', 'Gray', 'TX', '79065', '8066655571', '8066658986', NULL, NULL, 'Gray', NULL, NULL, NULL, NULL, 'ROTECH', 'DME80', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1265402077', 0, 'Y', 0, '2008-10-02', NULL, NULL, 0, 0, NULL, NULL),
('752461923', 'W11013670', 'W11013670', 'TX01', 'Rhema Medical', NULL, NULL, 'Rhema Medical', 'Group', 'Durable Medical Equipment', NULL, NULL, NULL, 'B', '4436 Olton Rd', 'Plainview', 'Hale', 'TX', '79072', '8062967665', '8062967886', NULL, NULL, 'Hale', NULL, NULL, NULL, NULL, 'ROTECH', 'DME80', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1063471902', 0, 'Y', 0, '2008-10-02', NULL, NULL, 0, 0, NULL, NULL),
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('752461923', 'W11013663', 'W11013663', 'TX01', 'Major Medical', NULL, NULL, 'Major Medical', 'Group', 'Durable Medical Equipment', NULL, NULL, NULL, 'B', '6102 45Th St Ste D', 'Lubbock', 'Lubbock', 'TX', '79407', '8067971977', '8067971999', NULL, NULL, 'Lubbock', NULL, NULL, NULL, NULL, 'ROTECH', 'DME80', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1255390282', 0, 'Y', 0, '2008-10-02', NULL, NULL, 0, 0, NULL, NULL),
('751583420', 'W11013665', 'W11013665', 'TX01', 'Major Medical', NULL, NULL, 'Major Medical', 'Group', 'Durable Medical Equipment', NULL, NULL, NULL, 'B', '4310 W Illinois Ste 140', 'Midland', 'Midland', 'TX', '79703', '4326990214', '4326860681', NULL, NULL, 'Midland', NULL, NULL, NULL, NULL, 'ROTECH', 'DME80', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1396714952', 0, 'Y', 0, '2008-10-02', NULL, NULL, 0, 0, NULL, NULL),
('593339037', 'W11013644', 'W11013644', 'TX01', 'Family Medical Equipment', NULL, NULL, 'Family Medical Equipment', 'Group', 'Durable Medical Equipment', NULL, NULL, NULL, 'B', '912 E 4Th St', 'Big Spring', 'Howard', 'TX', '79720', '4322636652', '4322646290', NULL, NULL, 'Howard', NULL, NULL, NULL, NULL, 'ROTECH', 'DME80', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1477514214', 0, 'Y', 0, '2008-10-02', NULL, NULL, 0, 0, NULL, NULL),
('751583420', 'W11013667', 'W11013667', 'TX01', 'Major Medical', NULL, NULL, 'Major Medical', 'Group', 'Durable Medical Equipment', NULL, NULL, NULL, 'B', '618 N Golder Ave', 'Odessa', 'Ector', 'TX', '79761', '4323323621', '4323325946', NULL, NULL, 'Ector', NULL, NULL, NULL, NULL, 'ROTECH', 'DME80', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1427027085', 0, 'Y', 0, '2008-10-02', NULL, NULL, 0, 0, NULL, NULL),
('752323364', 'W11013651', 'W11013651', 'TX01', 'Major Medical Supply  ', NULL, NULL, 'Major Medical Supply  ', 'Group', 'Durable Medical Equipment', NULL, NULL, NULL, 'B', '12025 Rojas St Ste C&D', 'El Paso', 'El Paso', 'TX', '79936', '9157720767', '9158571834', NULL, NULL, 'El Paso', NULL, NULL, NULL, NULL, 'ROTECH', 'DME80', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1669442471', 0, 'Y', 0, '2008-10-02', NULL, NULL, 0, 0, NULL, NULL),
('841117477', 'W11013619', 'W11013619', 'UT01', 'Roth Medical', NULL, NULL, 'Roth Medical', 'Group', 'Durable Medical Equipment', NULL, NULL, NULL, 'O', '1380 Overlook Dr Ste 105B', 'Lafayette', 'Boulder', 'CO', '80026', '3036657009', '3036657945', NULL, NULL, 'Boulder', NULL, NULL, NULL, NULL, 'ROTECH', 'DME80', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1396706933', 0, 'N', 0, '2008-10-02', NULL, NULL, 0, 0, NULL, NULL),
('841143534', 'W11013625', 'W11013625', 'UT01', 'Summit Respiratory ', NULL, NULL, 'Summit Respiratory ', 'Group', 'Durable Medical Equipment', NULL, NULL, NULL, 'O', '5161 Ward Rd Ste 6', 'Wheatridge', 'Jefferson', 'CO', '80033', '3034313758', '3034311112', NULL, NULL, 'Jefferson', NULL, NULL, NULL, NULL, 'ROTECH', 'DME80', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1801947635', 0, 'N', 0, '2008-10-02', NULL, NULL, 0, 0, NULL, NULL),
('841117477', 'W11013608', 'W11013608', 'UT01', 'Roth Medical', NULL, NULL, 'Roth Medical', 'Group', 'Durable Medical Equipment', NULL, NULL, NULL, 'O', '7045 S Fulton St Ste 200', 'Centennial', 'Arapahoe', 'CO', '80112', '3032327878', '3032379034', NULL, NULL, 'Arapahoe', NULL, NULL, NULL, NULL, 'ROTECH', 'DME80', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1881655421', 0, 'N', 0, '2008-10-02', NULL, NULL, 0, 0, NULL, NULL),
('841143534', 'W11013621', 'W11013621', 'UT01', 'Summit Respiratory ', NULL, NULL, 'Summit Respiratory ', 'Group', 'Durable Medical Equipment', NULL, NULL, NULL, 'O', '3265 S Wadsworth Blvd Bldg 2 Ste J', 'Lakewood', 'Jefferson', 'CO', '80227', '3037306777', '3037383657', NULL, NULL, 'Jefferson', NULL, NULL, NULL, NULL, 'ROTECH', 'DME80', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1841270154', 0, 'N', 0, '2008-10-02', NULL, NULL, 0, 0, NULL, NULL),
('841117477', 'W11013615', 'W11013615', 'UT01', 'Roth Medical', NULL, NULL, 'Roth Medical', 'Group', 'Durable Medical Equipment', NULL, NULL, NULL, 'O', '225 N Lemay Ave Ste 3', 'Ft Collins', 'Larimer', 'CO', '80524', '9702242828', '9702242517', NULL, NULL, 'Larimer', NULL, NULL, NULL, NULL, 'ROTECH', 'DME80', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1841251485', 0, 'N', 0, '2008-10-02', NULL, NULL, 0, 0, NULL, NULL),
('841177602', 'W11013607', 'W11013607', 'UT01', 'Brighton Oxygen & Home Medical', '', '', 'Brighton Oxygen & Home Medical  ', 'Group', 'Durable Medical Equipment', '', '', NULL, 'O', '975 Platte River Blvd bldg 2 Ste A', 'Brighton', 'Adams', 'CO', '80601', '3036551515', '3036370195', '975 Platte River Blvd bldg 2 Ste A', 'Brighton', 'Adams', 'CO', '80601', '3036551515', '3036370195', 'ROTECH', 'DME80', '', '0.00', '35.00', '0.00', 3, '2008-10-01', '2014-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184604886', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('841177602', 'W11013618', 'W11013618', 'UT01', 'Don Paul Respiratory Services', NULL, NULL, 'Don Paul Respiratory Services', 'Group', 'Durable Medical Equipment', NULL, NULL, NULL, 'O', '965 59Th Ave Ste C', 'Greeley', 'Weld', 'CO', '80634', '9703560210', '9703469081', NULL, NULL, 'Weld', NULL, NULL, NULL, NULL, 'ROTECH', 'DME80', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1306826011', 0, 'N', 0, '2008-10-02', NULL, NULL, 0, 0, NULL, NULL),
('841177602', 'W11013616', 'W11013616', 'UT01', 'Don Paul Respiratory Services', NULL, NULL, 'Don Paul Respiratory Services', 'Group', 'Durable Medical Equipment', NULL, NULL, NULL, 'O', '412 E Burlington Ave', 'Ft Morgan', 'Morgan', 'CO', '80701', '9708671137', '9708671139', NULL, NULL, 'Morgan', NULL, NULL, NULL, NULL, 'ROTECH', 'DME80', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1063492767', 0, 'N', 0, '2008-10-02', NULL, NULL, 0, 0, NULL, NULL),
('841143534', 'W11013609', 'W11013609', 'UT01', 'Summit Respiratory ', NULL, NULL, 'Summit Respiratory ', 'Group', 'Durable Medical Equipment', NULL, NULL, NULL, 'O', '4740 Forge Rd Ste 100 & 102', 'Colorado Springs', 'El Paso', 'CO', '80907', '7195938476', '7195221752', NULL, NULL, 'El Paso', NULL, NULL, NULL, NULL, 'ROTECH', 'DME80', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1255311072', 0, 'N', 0, '2008-10-02', NULL, NULL, 0, 0, NULL, NULL),
('841117477', 'W11013610', 'W11013610', 'UT01', 'Roth Medical', NULL, NULL, 'Roth Medical', 'Group', 'Durable Medical Equipment', NULL, NULL, NULL, 'O', '4715 Town Ctr Dr Ste A & B', 'Colorado Springs', 'El Paso', 'CO', '80916', '7195201414', '7196344002', NULL, NULL, 'El Paso', NULL, NULL, NULL, NULL, 'ROTECH', 'DME80', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1568423002', 0, 'N', 0, '2008-10-02', NULL, NULL, 0, 0, NULL, NULL),
('841117477', 'W11013622', 'W11013622', 'UT01', 'Roth Medical', NULL, NULL, 'Roth Medical', 'Group', 'Durable Medical Equipment', NULL, NULL, NULL, 'O', '729-C Fortino Blvd', 'Pueblo', 'Pueblo', 'CO', '81008', '7195441414', '7195431414', NULL, NULL, 'Pueblo', NULL, NULL, NULL, NULL, 'ROTECH', 'DME80', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1457312993', 0, 'N', 0, '2008-10-02', NULL, NULL, 0, 0, NULL, NULL),
('841117477', 'W11013620', 'W11013620', 'UT01', 'Roth Medical ', NULL, NULL, 'Roth Medical ', 'Group', 'Durable Medical Equipment', NULL, NULL, NULL, 'O', '109 W Lee Ave Ste 8', 'Lamar', 'Prowers', 'CO', '81052', '7193364779', '7193365328', NULL, NULL, 'Prowers', NULL, NULL, NULL, NULL, 'ROTECH', 'DME80', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1891756334', 0, 'N', 0, '2008-10-02', NULL, NULL, 0, 0, NULL, NULL),
('841188104', 'W11013623', 'W11013623', 'UT01', 'Medco Professional Services, Corp.', NULL, NULL, 'Medco Professional Services, Corp.', 'Group', 'Durable Medical Equipment', NULL, NULL, NULL, 'O', '300 Pine St', 'Trinidad', 'Las Animas', 'CO', '81082', '7198468328', '7198468278', NULL, NULL, 'Las Animas', NULL, NULL, NULL, NULL, 'ROTECH', 'DME80', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1710967690', 0, 'N', 0, '2008-10-02', NULL, NULL, 0, 0, NULL, NULL),
('841188104', 'W11013624', 'W11013624', 'UT01', 'Medco Professional Services, Corp.', NULL, NULL, 'Medco Professional Services, Corp.', 'Group', 'Durable Medical Equipment', NULL, NULL, NULL, 'O', '915 W 7Th St', 'Walsenburg', 'Huerfano', 'CO', '81089', '7197383525', '7197386675', NULL, NULL, 'Huerfano', NULL, NULL, NULL, NULL, 'ROTECH', 'DME80', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1508835000', 0, 'N', 0, '2008-10-02', NULL, NULL, 0, 0, NULL, NULL),
('841117477', 'W11013606', 'W11013606', 'UT01', 'Roth Medical', NULL, NULL, 'Roth Medical', 'Group', 'Durable Medical Equipment', NULL, NULL, NULL, 'O', '215 Carson Ave', 'Alamosa', 'Alamosa', 'CO', '81101', '7195893889', '7195893905', NULL, NULL, 'Alamosa', NULL, NULL, NULL, NULL, 'ROTECH', 'DME80', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1427019066', 0, 'N', 0, '2008-10-02', NULL, NULL, 0, 0, NULL, NULL),
('841033419', 'W11013614', 'W11013614', 'UT01', 'A-Med Supply   ', NULL, NULL, 'A-Med Supply   ', 'Group', 'Durable Medical Equipment', NULL, NULL, NULL, 'O', '799 Tech Ctr Dr Ste B1', 'Durango', 'La Plata', 'CO', '81301', '9702595333', '9702597628', NULL, NULL, 'La Plata', NULL, NULL, NULL, NULL, 'ROTECH', 'DME80', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1174503486', 0, 'N', 0, '2008-10-02', NULL, NULL, 0, 0, NULL, NULL),
('841033419', 'W11013611', 'W11013611', 'UT01', 'A-Med Supply', '', '', 'A-Med Supply', 'Group', 'Durable Medical Equipment', '', '', NULL, 'O', '27 N Harrison', 'Cortez', 'Montezuma', 'CO', '81321', '9705657699', '9705657861', '27 N Harrison', 'Cortez', 'Montezuma', 'CO', '81321', '9705657699', '9705657861', 'ROTECH', 'DME80', '', '0.00', '35.00', '0.00', 3, '2008-10-01', '2014-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144200957', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('841143534', 'W11013613', 'W11013613', 'UT01', 'Oxygen Plus', NULL, NULL, 'Oxygen Plus', 'Group', 'Durable Medical Equipment', NULL, NULL, NULL, 'O', '1410 Valley View Dr Ste 306', 'Delta', 'Delta', 'CO', '81416', '9708744324', '9708744377', NULL, NULL, 'Delta', NULL, NULL, NULL, NULL, 'ROTECH', 'DME80', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1033199864', 0, 'N', 0, '2008-10-02', NULL, NULL, 0, 0, NULL, NULL),
('841033419', 'W11013617', 'W11013617', 'UT01', 'G&G Medical', NULL, NULL, 'G&G Medical', 'Group', 'Durable Medical Equipment', NULL, NULL, NULL, 'O', '622 W Gunnison Ave', 'Grand Junction', 'Mesa', 'CO', '81501', '9702459054', '9702439028', NULL, NULL, 'Mesa', NULL, NULL, NULL, NULL, 'ROTECH', 'DME80', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1588644322', 0, 'N', 0, '2008-10-02', NULL, NULL, 0, 0, NULL, NULL),
('841033419', 'W11013612', 'W11013612', 'UT01', 'G&G Medical', NULL, NULL, 'G&G Medical', 'Group', 'Durable Medical Equipment', NULL, NULL, NULL, 'O', '551 Russell St', 'Craig', 'Moffat', 'CO', '81625', '9708248347', '9708242703', NULL, NULL, 'Moffat', NULL, NULL, NULL, NULL, 'ROTECH', 'DME80', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1730169558', 0, 'N', 0, '2008-10-02', NULL, NULL, 0, 0, NULL, NULL),
('830310603', 'W11013691', 'W11013691', 'WY01', 'Community Home Oxygen', '', '', 'Community Home Oxygen', 'Group', 'Durable Medical Equipment', '', '', NULL, 'O', '6002 Us Hwy 30 Bldg 1', 'Cheyenne', 'Laramie', 'WY', '82001', '3076358866', '3076355685', '6002 Us Hwy 30 Bldg 1', 'Cheyenne', 'Laramie', 'WY', '82001', '3076358866', '3076355685', 'ROTECH', 'DME80', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1881653145', 0, 'N', 0, '2011-06-30', NULL, NULL, 0, 0, NULL, NULL),
('830310603', 'W11013694', 'W11013694', 'WY01', 'Community Home Oxygen', '', '', 'Community Home Oxygen', 'Group', 'Durable Medical Equipment', '', '', NULL, 'O', '2900 Grand Ave Ste 106', 'Laramie', 'Albany', 'WY', '82070', '3077455716', '3077457859', '2900 Grand Ave Ste 106', 'Laramie', 'Albany', 'WY', '82070', '3077455716', '3077457859', 'ROTECH', 'DME80', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225098585', 0, 'N', 0, '2011-06-30', NULL, NULL, 0, 0, NULL, NULL),
('830310603', 'W11013701', 'W11013701', 'WY01', 'Community Home Oxygen', '', '', 'Community Home Oxygen', 'Group', 'Durable Medical Equipment', '', '', NULL, 'O', '604 9Th St', 'Wheatland', 'Platte', 'WY', '82201', '307 3224719', NULL, '604 9Th St', 'Wheatland', 'Platte', 'WY', '82201', '307 3224719', '307 3223118', 'ROTECH', 'DME80', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962462218', 0, 'N', 0, '2011-06-30', NULL, NULL, 0, 0, NULL, NULL),
('830310603', 'W11013700', 'W11013700', 'WY01', 'Community Home Oxygen', '', '', 'Community Home Oxygen', 'Group', 'Durable Medical Equipment', '', '', NULL, 'O', '115 W 22Nd Ave', 'Torrington', 'Goshen', 'WY', '82240', '3075328907', '3075328905', '115 W 22Nd Ave', 'Torrington', 'Goshen', 'WY', '82240', '3075328907', '3075328905', 'ROTECH', 'DME80', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922068287', 0, 'N', 0, '2011-06-30', NULL, NULL, 0, 0, NULL, NULL),
('830310603', 'W11013698', 'W11013698', 'WY01', 'Community Home Oxygen', '', '', 'Community Home Oxygen ', 'Group', 'Durable Medical Equipment', '', '', NULL, 'O', '1012 W Bridge St Ste B', 'Saratoga', 'Carbon', 'WY', '82331', '3073265592', '3073265114', '1012 W Bridge St Ste B', 'Saratoga', 'Carbon', 'WY', '82331', '3073265592', '3073265114', 'ROTECH', 'DME80', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215997382', 0, 'N', 0, '2011-06-30', 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
('810490456', 'W11013702', 'W11013702', 'WY01', 'Vital Air Medical', '', '', 'Vital Air Medical', 'Group', 'Durable Medical Equipment', '', '', NULL, 'O', '460 W Big Horn Ave', 'Worland', 'Washakie', 'WY', '82401', '3073476475', '3073472126', '460 W Big Horn Ave', 'Worland', 'Washakie', 'WY', '82401', '3073476475', '3073472126', 'ROTECH', 'DME80', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336129006', 0, 'N', 0, '2011-06-30', NULL, NULL, 0, 0, NULL, NULL),
('810490456', 'W11013692', 'W11013692', 'WY01', 'Vital Air Medical', '', '', 'Vital Air Medical', 'Group', 'Durable Medical Equipment', '', '', NULL, 'O', '538 Yellowstone Ave', 'Cody', 'Park', 'WY', '82414', '3075874953', '3075277841', '538 Yellowstone Ave', 'Cody', 'Park', 'WY', '82414', '3075874953', '3075277841', 'ROTECH', 'DME80', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922088509', 0, 'N', 0, '2011-06-29', NULL, NULL, 0, 0, NULL, NULL),
('810490456', 'W11013695', 'W11013695', 'WY01', 'Vital Air Medical', '', '', 'Vital Air Medical', 'Group', 'Durable Medical Equipment', '', '', NULL, 'O', '233 E 2Nd St', 'Powell', 'Park', 'WY', '82435', '3077544524', '3077544536', '233 E 2Nd St', 'Powell', 'Park', 'WY', '82435', '3077544524', '3077544536', 'ROTECH', 'DME80', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1881674562', 0, 'N', 0, '2011-06-30', NULL, NULL, 0, 0, NULL, NULL),
('810490456', 'W11013696', 'W11013696', 'WY01', 'Community Home Oxygen', '', '', 'Community Home Oxygen', 'Group', 'Durable Medical Equipment', '', '', NULL, 'O', '810 S Federal Blvd', 'Riverton', 'Fremont', 'WY', '82501', '3078569415', '3078568616', '810 S Federal Blvd', 'Riverton', 'Fremont', 'WY', '82501', '3078569415', '3078568616', 'ROTECH', 'DME80', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376523050', 0, 'N', 0, '2011-06-30', NULL, NULL, 0, 0, NULL, NULL),
('830310603', 'W11013690', 'W11013690', 'WY01', 'Community Home Oxygen', '', '', 'Community Home Oxygen', 'Group', 'Durable Medical Equipment', '', '', NULL, 'O', '240 N Elk St', 'Casper', 'Natrona', 'WY', '82601', '3072377350', '3074723977', '240 N Elk St', 'Casper', 'Natrona', 'WY', '82601', '3072377350', '3074723977', 'ROTECH', 'DME80', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508825845', 0, 'N', 0, '2011-06-29', NULL, NULL, 0, 0, NULL, NULL),
('460360287', 'W11013693', 'W11013693', 'WY01', 'Psi Health Care', '', '', 'Psi Health Care', 'Group', 'Durable Medical Equipment', '', '', NULL, 'O', '609 4-J Ct Ste B', 'Gillette', 'Campbell', 'WY', '82718', '3076861102', '3076862789', '609 4-J Ct Ste B', 'Gillette', 'Campbell', 'WY', '82718', '3076861102', '3076862789', 'ROTECH', 'DME80', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205816980', 0, 'N', 0, '2011-06-30', NULL, NULL, 0, 0, NULL, NULL),
('810490456', 'W11013699', 'W11013699', 'WY01', 'Community Home Oxygen', '', '', 'Community Home Oxygen', 'Group', 'Durable Medical Equipment', '', '', NULL, 'O', '2240 Coffeen Ave Ste F', 'Sheridan', 'Sheridan', 'WY', '82801', '3076729021', '3076728367', '2240 Coffeen Ave Ste F', 'Sheridan', 'Sheridan', 'WY', '82801', '3076729021', '3076728367', 'ROTECH', 'DME80', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033189261', 0, 'N', 0, '2011-06-30', NULL, NULL, 0, 0, NULL, NULL),
('830310603', 'W11013697', 'W11013697', 'WY01', 'Community Home Oxygen', '', '', 'Community Home Oxygen', 'Group', 'Durable Medical Equipment', '', '', NULL, 'O', '1993 Dewar Dr Ste 4', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073621419', '3073627439', '1993 Dewar Dr Ste 4', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073621419', '3073627439', 'ROTECH', 'DME80', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356300602', 0, 'N', 0, '2011-06-30', NULL, NULL, 0, 0, NULL, NULL),
('820361262', 'W11013626', 'W11013626', 'ID03', 'Homecare Medical Equipment', NULL, NULL, 'Homecare Medical Equipment', 'Group', 'Durable Medical Equipment', NULL, NULL, NULL, 'O', '44 N Pine St', 'Blackfoot', 'Bingham', 'ID', '83221', '2087850511', '2087851064', NULL, NULL, 'Bingham', NULL, NULL, NULL, NULL, 'ROTECH', 'DME80', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', '2008-12-12', 0, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1841270725', 0, 'N', 0, '2008-12-12', NULL, NULL, 0, 0, NULL, NULL),
('820361262', 'W11013629', 'W11013629', 'ID03', 'Homecare Medical Equipment', NULL, NULL, 'Homecare Medical Equipment', 'Group', 'Durable Medical Equipment', NULL, NULL, NULL, 'O', '386 Washington', 'Montpelier', 'Bear Lake', 'ID', '83254', '2088473300', '2088472612', NULL, NULL, 'Bear Lake', NULL, NULL, NULL, NULL, 'ROTECH', 'DME80', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', '2008-12-12', 0, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1033199922', 0, 'N', 0, '2008-12-12', NULL, NULL, 0, 0, NULL, NULL),
('820361262', 'W11013628', 'W11013628', 'ID03', 'Homecare Medical Equipment', NULL, NULL, 'Homecare Medical Equipment', 'Group', 'Durable Medical Equipment', NULL, NULL, NULL, 'O', '2275 Channing Way', 'Idaho Falls', 'Bonneville', 'ID', '83404', '2085232700', '2085232720', NULL, NULL, 'Bonneville', NULL, NULL, NULL, NULL, 'ROTECH', 'DME80', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', '2008-12-12', 0, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1285614172', 0, 'N', 0, '2008-12-12', NULL, NULL, 0, 0, NULL, NULL),
('611529959', 'W11013594', 'W11013594', 'ID02', 'Advantage Walkin Chiropractic', 'JD', 'Tucker', 'Rohm', 'DC', 'Chiropractic', '', '', NULL, 'O', '3211 N Milwaukee St', 'Boise', 'Ada', 'ID', '83704', '2083752225', NULL, '3211 N Milwaukee St', 'Boise', 'Ada', 'ID', '83704', '2083752225', '          ', 'IDCHIRO1', '', '', '0.00', '35.00', '0.00', 3, '2008-10-01', '2012-02-29', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1356504443', 0, 'N', 0, '2012-03-01', NULL, NULL, 0, 0, NULL, NULL),
('611529959', 'W11013735', 'W11013735', 'ID02', 'Advantage Walkin Chiropractic', 'Andrew', '', 'Kidder', 'DC', 'Chiropractic', '', '', NULL, 'O', '3211 N Milwaukee St', 'Boise', 'Ada', 'ID', '83704', '2083752225', NULL, '3211 N Milwaukee St', 'Boise', 'Ada', 'ID', '83704', '2083752225', '', 'IDCHIRO1', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1710048681', 0, 'n', 0, '2010-11-08', NULL, NULL, 0, 0, NULL, NULL),
('468543064', 'W11013593', 'W11013593', 'ID01', NULL, 'Mydell', 'L', 'Yeager', 'LCPC', 'Mental Health', 'Counseling', '', NULL, 'O', '3218 Overland', 'Boise', 'Ada', 'ID', '83705', '2083313999', NULL, '3218 Overland', 'Boise', 'Ada', 'ID', '83705', '2083313999', '', 'IDMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', '2013-02-14', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1346328564', 0, 'n', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('820388664', 'W11013627', 'W11013627', 'ID03', 'Ironwood Medical Supply & Oxygen', NULL, NULL, 'Ironwood Medical Supply & Oxygen', 'Group', 'Durable Medical Equipment', NULL, NULL, NULL, 'O', '2120 Ironwood Center Dr', 'Coeur D'' Alene', 'Kootenai', 'ID', '83814', '2087650930', '2087655255', NULL, NULL, 'Kootenai', NULL, NULL, NULL, NULL, 'ROTECH', 'DME80', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', '2008-12-12', 0, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1093774044', 0, 'N', 0, '2008-12-12', NULL, NULL, 0, 0, NULL, NULL),
('820388664', 'W11013630', 'W11013630', 'ID03', 'Selkirk Medical Services', NULL, NULL, 'Selkirk Medical Services', 'Group', 'Durable Medical Equipment', NULL, NULL, NULL, 'O', '525 Cedar St', 'Sandpoint', 'Bonner', 'ID', '83864', '2082630117', '2082638842', NULL, NULL, 'Bonner', NULL, NULL, NULL, NULL, 'ROTECH', 'DME80', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', '2008-12-12', 0, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1891754842', 0, 'N', 0, '2008-12-12', NULL, NULL, 0, 0, NULL, NULL),
('870547456', 'W11013685', 'W11013685', 'UT01', 'Valley Home Medical ', NULL, NULL, 'Valley Home Medical ', 'Group', 'Durable Medical Equipment', NULL, NULL, NULL, 'O', '731 N Mccormick Way Ste 1', 'Layton', 'Davis', 'UT', '84041', '8015448866', '8015448859', NULL, NULL, 'Davis', NULL, NULL, NULL, NULL, 'ROTECH', 'DME80', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1760443204', 0, 'N', 0, '2008-10-02', NULL, NULL, 0, 0, NULL, NULL),
('870547456', 'W11013686', 'W11013686', 'UT01', 'Valley Home Medical', NULL, NULL, 'Valley Home Medical', 'Group', 'Durable Medical Equipment', NULL, NULL, NULL, 'O', '6973 S 300 W', 'Midvale', 'Salt Lake', 'UT', '84047', '8015630202', '8015635188', NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'ROTECH', 'DME80', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1275594020', 0, 'N', 0, '2008-10-02', NULL, NULL, 0, 0, NULL, NULL),
('870547456', 'W11013687', 'W11013687', 'UT01', 'Valley Home Medical', NULL, NULL, 'Valley Home Medical', 'Group', 'Durable Medical Equipment', NULL, NULL, NULL, 'O', '538 S Commerce St', 'Orem', 'Utah', 'UT', '84058', '8012259979', '8012256221', NULL, NULL, 'Utah', NULL, NULL, NULL, NULL, 'ROTECH', 'DME80', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1194786202', 0, 'N', 0, '2008-10-02', NULL, NULL, 0, 0, NULL, NULL),
('870547456', 'W11013689', 'W11013689', 'UT01', 'Valley Home Medical', NULL, NULL, 'Valley Home Medical', 'Group', 'Durable Medical Equipment', NULL, NULL, NULL, 'O', '395 S Vernal Ave', 'Vernal', 'Uintah', 'UT', '84078', '4357813011', '4357811981', NULL, NULL, 'Uintah', NULL, NULL, NULL, NULL, 'ROTECH', 'DME80', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1588625024', 0, 'N', 0, '2008-10-02', NULL, NULL, 0, 0, NULL, NULL),
('820361262', 'W11013723', 'W11013723', 'ID03', 'Homecare Medical Equipment', NULL, NULL, 'Homecare Medical Equipment', 'Group', 'Durable Medical Equipment', NULL, NULL, NULL, 'B', 'PO Box 9901', 'Clearfield', 'Davis', 'UT', '84089', '8008451378', '8019261335', NULL, NULL, 'Davis', NULL, NULL, NULL, NULL, 'ROTECH', 'DME80', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1033199922', 0, 'Y', 0, '2008-12-12', NULL, NULL, 0, 0, NULL, NULL),
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('522229954', 'W11014134', 'W11014134', 'UT01', 'Mountain Land Kuna', 'Leslie', NULL, 'Sparkuhl', 'SLP', 'Physical Therapy', NULL, NULL, NULL, 'O', '172 W Main St', 'Kuna', 'Ada', 'ID', '83634', '2089229828', NULL, 'PO Box 74125', 'Salt Lake City', 'Ada', 'UT', '84171', NULL, NULL, 'WestRehab', 'WUSTDHCPC5', NULL, '0.00', '0.00', '65.00', 3, '2008-10-01', '2008-09-04', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1851575716', 0, 'N', 0, '2008-10-03', NULL, NULL, 0, 0, NULL, NULL),
('092782607', 'W11013755', 'W11013755', 'ID01', 'IMRS', 'Camilla', '', 'Cafferty', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'B', '1940 S Benito Way Ste 170', 'Meridian', 'Ada', 'ID', '83642', '2088666227', NULL, '1940 S Benito Way Ste 170', 'Meridian', 'Ada', 'ID', '83642', '2088666227', '', 'IDMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-10-03', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063569796', 0, 'y', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11014129', 'W11014129', 'ID02', 'MLR of Meridian', 'Michael', '', 'Schow', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1450 W Fairview Ste 201', 'Meridian', 'Ada', 'ID', '83642', '2088876757', NULL, '1450 W Fairview Ste 201', 'Meridian', 'Ada', 'ID', '83642', '2088876757', '          ', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '65.00', 3, '2008-10-01', '2009-10-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1154424752', 0, 'N', 0, '2013-07-02', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11014514', 'W11014514', 'ID02', 'MLR of Meridian', 'Ryan', '', 'Myhre', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '1450 E Fairview Ste 201', 'Meridian', 'Ada', 'ID', '83642', '2088876757', NULL, '1450 E Fairview Ste 201', 'Meridian', 'Ada', 'ID', '83642', '2088876757', '          ', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2009-11-01', '2009-11-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1851494637', 0, 'N', 0, '2011-04-20', NULL, NULL, 0, 0, NULL, NULL),
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('820478504', 'W11013752', 'W11013752', 'ID01', 'Personal Solutions', 'Phyllis', 'R', 'Nodler', 'LCPC', 'Mental Health', 'Counseling', '', NULL, 'O', '2596 N Stokesberry Pl Ste 100', 'Meridian', 'Ada', 'ID', '83646', '2089383837', NULL, '2596 N Stokesberry Pl Ste 100', 'Meridian', 'Ada', 'ID', '83646', '2089383837', '          ', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2008-10-03', '2010-10-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295983443', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
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('518139637', 'W11013751', 'W11013751', 'ID01', NULL, 'Kristen', 'G', 'Ware', 'LCPC', 'Mental Health', 'Counseling', '', NULL, 'B', '5175 W Tournament', 'Meridian', 'Ada', 'ID', '83646', '2088841705', NULL, '5175 W Tournament', 'Meridian', 'Ada', 'ID', '83646', '2088841705', '', 'IDMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-10-03', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639355977', 0, 'Y', 0, '2011-12-22', NULL, NULL, 0, 0, NULL, NULL),
('092782607', 'W11013754', 'W11013754', 'ID01', 'Cafferty Counseling Services', 'Camilla', '', 'Cafferty', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '890 S 6th E', 'Mountain Home', 'Elmore', 'ID', '83647', '2088666227', NULL, '890 S 6th E', 'Mountain Home', 'Elmore', 'ID', '83647', '2088666227', '', 'IDMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-10-03', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063569796', 0, 'n', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11014097', 'W11014097', 'ID02', 'MLR of Boise', 'Monica', '', 'Gerhart', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1907 S Broadway Ste 203', 'Boise', 'Ada', 'ID', '83706', '2084229826', '2084229855', '1907 S Broadway Ste 203', 'Boise', 'Ada', 'ID', '83706', '2084229826', '2084229855', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '65.00', 3, '2008-10-01', '2009-10-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1326140468', 0, 'N', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11014524', 'W11014524', 'UT01', 'Mountain Land Boise', 'Leslie', NULL, 'Sparkuhl', 'SLP', 'Physical Therapy', NULL, NULL, NULL, 'O', '230 W Mallard Ste A', 'Boise', 'Ada', 'ID', '83706', '2084229826', NULL, 'PO Box 74125', 'Salt Lake City', 'Ada', 'UT', '84171', NULL, NULL, 'WestRehab', 'WUSTDHCPC5', NULL, '0.00', '0.00', '68.00', 3, '2009-11-01', '2008-09-04', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1851575716', 0, 'N', 0, '2008-10-03', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11014132', 'W11014132', 'UT01', 'Mountain Land Boise', 'Leslie', NULL, 'Sparkuhl', 'SLP', 'Physical Therapy', NULL, NULL, NULL, 'O', '230 W Mallard Ste A', 'Boise', 'Ada', 'ID', '83706', '2084229826', NULL, 'PO Box 74125', 'Salt Lake City', 'Ada', 'UT', '84171', NULL, NULL, 'WestRehab', 'WUSTDHCPC5', NULL, '0.00', '0.00', '65.00', 3, '2008-10-01', '2008-09-04', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1851575716', 0, 'N', 0, '2008-10-03', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11014489', 'W11014489', 'ID02', 'MLR of Boise', 'Monica', '', 'Gerhart', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1907 S Broadway Ste 203', 'Boise', 'Ada', 'ID', '83706', '2084229826', '2084229855', '1907 S Broadway Ste 203', 'Boise', 'Ada', 'ID', '83706', '2084229826', '2084229855', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2009-11-01', '2009-11-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1326140468', 0, 'N', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11014527', 'W11014527', 'UT01', 'Mountain Land Maple Grove', 'Leslie', NULL, 'Sparkuhl', 'SLP', 'Physical Therapy', NULL, NULL, NULL, 'O', '1435 Maple Grove', 'Boise', 'Ada', 'ID', '83709', '2083226200', NULL, 'PO Box 74125', 'Salt Lake City', 'Ada', 'UT', '84171', NULL, NULL, 'WestRehab', 'WUSTDHCPC5', NULL, '0.00', '0.00', '68.00', 3, '2009-11-01', '2008-09-04', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1851575716', 0, 'N', 0, '2008-10-03', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11014474', 'W11014474', 'ID02', 'MLR of Maple Grove', 'Jeffrey', '', 'Box', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1435 Maple Grove', 'Boise', 'Ada', 'ID', '83709', '2083226200', NULL, '1435 Maple Grove', 'Boise', 'Ada', 'ID', '83709', '2083226200', '          ', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2009-11-01', '2009-12-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1104928258', 0, 'N', 0, '2011-04-20', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11014135', 'W11014135', 'UT01', 'Mountain Land Maple Grove', 'Leslie', NULL, 'Sparkuhl', 'SLP', 'Physical Therapy', NULL, NULL, NULL, 'O', '1435 Maple Grove', 'Boise', 'Ada', 'ID', '83709', '2083226200', NULL, 'PO Box 74125', 'Salt Lake City', 'Ada', 'UT', '84171', NULL, NULL, 'WestRehab', 'WUSTDHCPC5', NULL, '0.00', '0.00', '65.00', 3, '2008-10-01', '2008-09-04', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1851575716', 0, 'N', 0, '2008-10-03', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11014082', 'W11014082', 'ID02', 'MLR of Maple Grove', 'Jeffrey', '', 'Box', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1435 Maple Grove', 'Boise', 'Ada', 'ID', '83709', '2083226200', NULL, '1435 Maple Grove', 'Boise', 'Ada', 'ID', '83709', '2083226200', '          ', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '65.00', 3, '2008-10-01', '2009-10-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1104928258', 0, 'N', 0, '2011-04-20', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11014196', 'W11014196', 'UT01', 'Human Performance Institute', 'Russell', 'Jack', 'Gatenby', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1184 E 80 N', 'American Fork', 'Utah', 'UT', '84003', '8017567777', NULL, '1184 E 80 N', 'American Fork', 'Utah', 'UT', '84003', '8017567777', '          ', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2009-11-01', '2009-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134241904', 0, 'N', 0, '2011-04-20', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11014197', 'W11014197', 'UT01', 'Human Performance Institute', 'John', 'Robert', 'Sumsion', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'O', '1184 E 80 N', 'American Fork', 'Utah', 'UT', '84003', '8017567777', NULL, '1184 E 80 N', 'American Fork', 'Utah', 'UT', '84003', '8017567777', '          ', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2009-11-01', '2009-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598887069', 0, 'N', 0, '2011-04-20', NULL, NULL, 0, 0, NULL, NULL),
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('522229954', 'W11013804', 'W11013804', 'UT01', 'Human Performance Institute', 'Russell', 'Jack', 'Gatenby', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1184 E 80 N', 'American Fork', 'Utah', 'UT', '84003', '8017567777', NULL, '1184 E 80 N', 'American Fork', 'Utah', 'UT', '84003', '8017567777', '          ', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '65.00', 3, '2008-10-01', '2009-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134241904', 0, 'N', 0, '2011-04-20', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11014019', 'W11014019', 'UT01', 'Professional Physical Therapy & Sports Medicine', 'Wendell', 'Buck', 'Mendenhall', 'PT', 'Physical Therapy', '', '', NULL, 'O', '155 W Canyon Crest Rd Ste 1', 'Alpine', 'Utah', 'UT', '84004', '8017567061', '8017567043', '155 W Canyon Crest Rd Ste 1', 'Alpine', 'Utah', 'UT', '84004', '8017567061', '8017567043', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '65.00', 3, '2008-10-01', '2009-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275682262', 0, 'N', 0, '2011-12-19', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11014411', 'W11014411', 'UT01', 'Professional Physical Therapy & Sports Medicine', 'Wendell', 'Buck', 'Mendenhall', 'PT', 'Physical Therapy', '', '', NULL, 'O', '155 W Canyon Crest Rd Ste 1', 'Alpine', 'Utah', 'UT', '84004', '8017567061', '8017567043', '155 W Canyon Crest Rd Ste 1', 'Alpine', 'Utah', 'UT', '84004', '8017567061', '8017567043', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2009-11-01', '2009-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275682262', 0, 'N', 0, '2011-12-19', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11014548', 'W11014548', 'UT01', 'Performance West Physical Therapy', 'Deven', 'M', 'Bawden', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '1511 S Renaissance Towne Dr Ste 300', 'Bountiful', 'Davis', 'UT', '84010', '8012953553', '8012953599', '1511 S Renaissance Towne Dr Ste 300', 'Bountiful', 'Davis', 'UT', '84010', '8012953553', '8012953599', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2009-11-01', '2009-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316019037', 0, 'N', 0, '2011-04-19', NULL, NULL, 0, 0, NULL, NULL),
('870543318', 'W11014556', 'W11014556', 'UT01', 'Lakeview Hospital', 'Christopher', 'C', 'Canale', 'MD', 'Gastroenterology', '', '', NULL, 'O', '630 E Medical Dr', 'Bountiful', 'Davis', 'UT', '84010', '8012990057', '8019443186', '630 E Medical Dr', 'Bountiful', 'Davis', 'UT', '84010', '8012990057', '8019443186', 'WCSTMTWEST5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-10-03', '2013-12-31', 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1598952145', 0, 'N', 0, '2013-12-18', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11014156', 'W11014156', 'UT01', 'Performance West Physical Therapy', 'Deven', 'M', 'Bawden', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '1511 S Renaissance Towne Dr Ste 300', 'Bountiful', 'Davis', 'UT', '84010', '8012953553', '8012953599', '1511 S Renaissance Towne Dr Ste 300', 'Bountiful', 'Davis', 'UT', '84010', '8012953553', '8012953599', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '65.00', 3, '2008-10-01', '2009-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316019037', 0, 'N', 0, '2011-04-19', NULL, NULL, 0, 0, NULL, NULL),
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('522229954', 'W11014181', 'W11014181', 'UT01', 'Hand & Orthopedic Rehabilitation Specialists', 'Margo', 'Jones', 'Brady', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'O', '535 E 500 S Ste 7', 'Bountiful', 'Davis', 'UT', '84010', '8013288535', NULL, '535 E 500 S Ste 7', 'Bountiful', 'Davis', 'UT', '84010', '8013288535', '          ', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2009-11-01', '2009-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104827849', 0, 'N', 0, '2011-04-20', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11013996', 'W11013996', 'UT01', 'Performance West Physical Therapy', 'Klementina', '', 'Buchheister', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1551 Renaissance Town Dr Ste 350', 'Bountiful', 'Davis', 'UT', '84010', '8012953553', NULL, '1551 Renaissance Town Dr Ste 350', 'Bountiful', 'Davis', 'UT', '84010', '8012953553', '          ', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '65.00', 3, '2008-10-01', '2009-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447242847', 0, 'N', 0, '2012-11-01', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11014388', 'W11014388', 'UT01', 'Performance West Physical Therapy', 'Klementina', '', 'Buchheister', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1551 Renaissance Town Dr Ste 350', 'Bountiful', 'Davis', 'UT', '84010', '8012953553', NULL, '1551 Renaissance Town Dr Ste 350', 'Bountiful', 'Davis', 'UT', '84010', '8012953553', '          ', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2009-11-01', '2009-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447242847', 0, 'N', 0, '2012-11-01', NULL, NULL, 0, 0, NULL, NULL),
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('522229954', 'W11013844', 'W11013844', 'UT01', 'Performance West Physical Therapy', 'Curtis', 'B', 'Jolley', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1551 Renaissance Town Dr Ste 350', 'Bountiful', 'Davis', 'UT', '84010', '8012953553', NULL, '1551 Renaissance Town Dr Ste 350', 'Bountiful', 'Davis', 'UT', '84010', '8012953553', '          ', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '65.00', 3, '2008-10-01', '2009-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548261431', 0, 'N', 0, '2011-11-01', NULL, NULL, 0, 0, NULL, NULL),
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