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
('820200895', 'SACN00740', 'SACN00740', 'SACN', 'Saint Alphonsus Medical Group Boise Pediatrics', 'Shana', 'L', 'Tubach', 'MD', 'Pediatrics', '', '', NULL, 'O', '999 N Curtis Ste 407', 'Boise', 'Ada', 'ID', '83706', '2083674321', '2083674525', '999 N Curtis Ste 407', 'Boise', 'Ada', 'ID', '83706', '2083674321', '2083674525', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1205879483', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6132, -116.255, NULL, NULL),
('820477852', 'SACN00741', 'SACN00741', 'SACN', 'Saint Alphonsus Medical Group Eagle Health Plaza', 'Shana', 'L', 'Tubach', 'MD', 'Pediatrics', '', '', NULL, 'B', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', 'IDSINCLAIRL', NULL, '', '0.00', '15.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1205879483', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6892, -116.351, NULL, NULL),
('820477852', 'SACN00742', 'SACN00742', 'SACN', 'Saint Alphonsus Medical Group Pediatrics', 'Shana', 'L', 'Tubach', 'MD', 'Pediatrics', '', '', NULL, 'o', '999 N Curtis Ste 407', 'Boise', 'Ada', 'ID', '83706', '2083674321', '2083674525', '999 N Curtis Ste 407', 'Boise', 'Ada', 'ID', '83706', '2083674321', '2083674525', 'IDSINCLAIRL', NULL, '', '0.00', '15.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1205879483', 0, 'n', 0, '2014-06-20', NULL, NULL, 43.6132, -116.255, NULL, NULL),
('820200895', 'SACN01363', 'SACN01363', 'SACN', 'Saint Alphonsus Medical Group OB/GYN Boise Moreau Bldg', 'Mary Ann', '', 'Tuthill', 'PA-C', 'Family Practice', 'Physician Assistant', 'Obstetrics and Gynecology', NULL, 'O', '6140 W Curtisian Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083674224', '2083677806', '6140 W Curtisian Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083674224', '2083677806', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', '2013-08-01', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1720020217', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6151, -116.256, NULL, NULL),
('820200895', 'SACN01364', 'SACN01364', 'SACN', 'Saint Alphonsus Medical Group Emerald Family Medicine', 'Mary Ann', '', 'Tuthill', 'PA-C', 'Family Practice', 'Physician Assistant', 'Obstetrics and Gynecology', NULL, 'O', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1720020217', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6119, -116.268, NULL, NULL),
('820477852', 'SACN01365', 'SACN01365', 'SACN', 'Saint Alphonsus Medical Group Womens Health', 'Mary Ann', '', 'Tuthill', 'PA-C', 'Family Practice', 'Physician Assistant', 'Obstetrics and Gynecology', NULL, 'o', '6140 W Curtisian Ste 100', 'Boise', 'Ada', 'ID', '83706', '2083674224', '2083677806', '6140 W Curtisian Ste 100', 'Boise', 'Ada', 'ID', '83706', '2083674224', '2083677806', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', '2013-08-01', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1720020217', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6151, -116.256, NULL, NULL),
('820477852', 'SACN01366', 'SACN01366', 'SACN', 'Saint Alphonsus Medical Group Emerald', 'Mary Ann', '', 'Tuthill', 'PA-C', 'Family Practice', 'Physician Assistant', 'Obstetrics and Gynecology', NULL, 'o', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083775039', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083775039', 'IDSINCLAIRL', NULL, '', '0.00', '15.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1720020217', 0, 'n', 0, '2014-06-20', NULL, NULL, 43.6119, -116.268, NULL, NULL),
('820482491', 'SACN00938', 'SACN00938', 'SACN', 'Intermountain Eye & Laser Centers PLLC', 'James', 'P', 'Tweeten', 'MD', 'Ophthalmology', '', '', NULL, 'B', '6063 Corporal Ln', 'Boise', 'Ada', 'ID', '83704', '2083758799', '2083758798', '6063 Corporal Ln', 'Boise', 'Ada', 'ID', '83704', '2083758799', '2083758798', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 3, '2011-01-01', '2011-08-14', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1396791513', 0, 'Y', 0, '2011-08-09', NULL, NULL, 0, 0, NULL, NULL),
('820482491', 'SACN00939', 'SACN00939', 'SACN', 'Intermountain Eye & Laser Centers', 'James', 'P', 'Tweeten', 'MD', 'Ophthalmology', '', '', NULL, 'O', '999 N Curtis Ste 205', 'Boise', 'Ada', 'ID', '83706', '2083731200', '2083731216', '999 N Curtis Ste 205', 'Boise', 'Ada', 'ID', '83706', '2083731200', '2083731216', 'IDSINCLAIRL', NULL, NULL, '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1396791513', 0, 'N', 0, '2011-08-09', NULL, NULL, 43.6132, -116.255, NULL, NULL),
('820200895', 'SACN01337', 'SACN01337', 'SACN', 'Saint Alphonsus Regional Medical Center Behavioral Health', 'Damiana', '', 'Uberuaga', 'LCSW', 'Mental Health', 'Counseling', '', NULL, 'o', '131 N Allumbaugh', 'Boise', 'Ada', 'ID', '83704', '2083672175', '2083760285', '131 N Allumbaugh', 'Boise', 'Ada', 'ID', '83704', '2083672175', '2083760285', 'IDSINCLAIRL', NULL, NULL, '0.00', '15.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1689609190', 0, 'n', 0, '2012-11-16', NULL, NULL, 43.6059, -116.267, NULL, NULL),
('820484706', 'SACN00331', 'SACN00331', 'SACN', 'Idaho Nephrology Associates', 'Kristina', '', 'Unterseher', 'NP', 'Nephrology', '', '', NULL, 'O', '5610 Gage St Ste A', 'Boise', 'Ada', 'ID', '83706', '2083673370', NULL, '5610 Gage St Ste A', 'Boise', 'Ada', 'ID', '83706', '2083673370', '', 'IDSINCLAIRL', NULL, NULL, '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1538324389', 0, 'N', 0, '2012-01-31', NULL, NULL, 0, 0, NULL, NULL),
('841394139', 'SACN01218', 'SACN01218', 'SACN', 'Southwest Idaho ENT ', 'Ryan', 'L', 'Van De Graaff', 'MD', 'Ear, Nose and Throat', NULL, NULL, NULL, 'O', '900 N Liberty St Ste 400', 'Boise', 'Ada', 'ID', '83704', '2083673320', '          ', '900 N Liberty St Ste 400', 'Boise', 'Ada', 'ID', '83704', '2083673320', '          ', 'IDSINCLAIRL', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1619067436', 0, 'N', 0, '2014-06-26', NULL, NULL, 43.6133, -116.259, NULL, NULL),
('460500210', 'SACN00976', 'SACN00976', 'SACN', 'Saint Alphonsus Regional Medical Center - Trauma Coverage', 'Reese', 'A', 'Verner', 'MD', 'General Surgery', '', '', NULL, 'B', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '0', '0', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '0', '0', 'IDSINCLAIRL', NULL, '', '0.00', '15.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1427085281', 0, 'Y', 0, '2014-07-09', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('820297206', 'SACN00977', 'SACN00977', 'SACN', 'Boise Surgical Group PA', 'Reese', 'A', 'Verner', 'MD', 'General Surgery', '', '', NULL, 'O', '3399 E Louise Ave Ste 400', 'Meridian', 'Ada', 'ID', '83642', '2083643000', '2083643191', '3399 E Louise Ave Ste 400', 'Meridian', 'Ada', 'ID', '83642', '2083643000', '2083643191', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 3, '2011-01-01', '2012-09-10', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1427085281', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'SACN00677', 'SACN00677', 'SACN', 'Saint Alphonsus Medical Group Garrity', 'Amber', 'M', 'Vickers', 'PA-C', 'Family Practice', 'Physician Assistant', '', NULL, 'O', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', '2011-01-01', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1114964616', 0, 'Y', 0, '2014-04-14', NULL, NULL, 43.587, -116.549, NULL, NULL),
('820200895', 'SACN00678', 'SACN00678', 'SACN', 'Saint Alphonsus Medical Group MHP Family Medicine', 'Amber', 'M', 'Vickers', 'PA-C', 'Family Practice', 'Physician Assistant', '', NULL, 'O', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', NULL, '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', '2011-01-01', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1114964616', 0, 'Y', 0, '2014-04-14', NULL, NULL, 43.6188, -116.431, NULL, NULL),
('820477852', 'SACN00679', 'SACN00679', 'SACN', 'Saint Alphonsus Medical Group Garrity', 'Amber', 'M', 'Vickers', 'PA-C', 'Family Practice', 'Physician Assistant', '', NULL, 'o', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', '2012-04-03', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1114964616', 0, 'N', 0, '2014-04-14', NULL, NULL, 43.587, -116.549, NULL, NULL),
('820477852', 'SACN00680', 'SACN00680', 'SACN', 'Saint Alphonsus Medical Group Cherry Lane', 'Amber', 'M', 'Vickers', 'PA-C', 'Family Practice', 'Physician Assistant', '', NULL, 'O', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', '2012-04-03', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1114964616', 0, 'N', 0, '2014-04-14', NULL, NULL, 43.6188, -116.431, NULL, NULL),
('200324983', 'SACN00622', 'SACN00622', 'SACN', 'Idaho Sports Medicine Institute PA', 'George', 'A', 'Wade', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1188 University Dr', 'Boise', 'Ada', 'ID', '83706', '2083368250', '2083459514', '1188 University Dr', 'Boise', 'Ada', 'ID', '83706', '2083368250', '2083459514', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1063418903', 0, 'Y', 0, '2013-11-11', NULL, NULL, 43.601, -116.196, NULL, NULL),
('201300128', 'SACN00170', 'SACN00170', 'SACN', 'Idaho Urologic Institute', 'Todd', 'M', 'Waldmann', 'MD', 'Urology', 'Pediatric Urology', '', NULL, 'O', '2855 E Magic View Dr', 'Meridian', 'Ada', 'ID', '83642', '2086394900', NULL, '2855 E Magic View Dr', 'Meridian', 'Ada', 'ID', '83642', '2086394900', '', 'IDSINCLAIRL', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1104877299', 0, 'n', 0, '2013-07-31', NULL, NULL, 43.599, -116.36, NULL, NULL),
('201300128', 'SACN00171', 'SACN00171', 'SACN', 'Idaho Urologic Institute', 'Todd', 'M', 'Waldmann', 'MD', 'Urology', 'Pediatric Urology', '', NULL, 'O', '333 N 1st Ste 100', 'Boise', 'Ada', 'ID', '83702', '2086394900', NULL, '333 N 1st Ste 100', 'Boise', 'Ada', 'ID', '83702', '2086394900', '          ', 'IDSINCLAIRL', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2011-01-01', '2012-02-24', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1104877299', 0, 'N', 0, '2013-07-31', NULL, NULL, 43.6135, -116.194, NULL, NULL),
('820425454', 'SACN00136', 'SACN00136', 'SACN', 'Boise Anesthesia, PA', 'James', 'L', 'Ward', 'MD', 'Anesthesiology', '', '', NULL, 'o', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2084594641', NULL, '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2084594641', '0         ', '', '', '', '58.45', '10.00', '0.00', 3, '2011-01-01', NULL, 1, 15, 0, '', '', 'West Valley Medical Center', '', 'HCFA|UB|', '1720133085', 0, 'N', 0, '2013-07-18', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'SACN01657', 'SACN01657', 'SACN', 'Saint Alphonsus Medical Group Eagle Health Plaza ', 'Hilary', 'A', 'Warren', 'MD', 'Pediatrics', '', '', NULL, 'O', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', '2012-04-03', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|', '1972515054', 0, 'Y', 0, '2012-04-03', NULL, NULL, 43.6892, -116.351, NULL, NULL),
('820200895', 'SACN01658', 'SACN01658', 'SACN', 'Saint Alphonsus Medical Group Pediatrics', 'Hilary', 'A', 'Warren', 'MD', 'Pediatrics', '', '', NULL, 'O', '999 N Curtis Ste 407', 'Boise', 'Ada', 'ID', '83706', '2083674321', '2083674525', '999 N Curtis Ste 407', 'Boise', 'Ada', 'ID', '83706', '2083674321', '2083674525', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', '2012-04-03', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|', '1972515054', 0, 'N', 0, '2012-04-03', NULL, NULL, 43.6132, -116.255, NULL, NULL),
('820477852', 'SACN01659', 'SACN01659', 'SACN', 'Saint Alphonsus Medical Group Eagle Health Plaza', 'Hilary', 'A', 'Warren', 'MD', 'Pediatrics', '', '', NULL, 'B', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', '2012-04-03', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1972515054', 0, 'Y', 0, '2012-04-03', NULL, NULL, 43.6892, -116.351, NULL, NULL),
('820477852', 'SACN01660', 'SACN01660', 'SACN', 'Saint Alphonsus Medical Group Pediatrics', 'Hilary', 'A', 'Warren', 'MD', 'Pediatrics', '', '', NULL, 'o', '999 N Curtis Ste 407', 'Boise', 'Ada', 'ID', '83706', '2083674321', '2083674525', '999 N Curtis Ste 407', 'Boise', 'Ada', 'ID', '83706', '2083674321', '2083674525', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', '2012-04-03', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1972515054', 0, 'N', 0, '2012-04-03', NULL, NULL, 43.6132, -116.255, NULL, NULL),
('820312175', 'SACN00304', 'SACN00304', 'SACN', 'Idaho Emergency Physicians PA', 'Jessica', 'N', 'Wasielewski', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '1717 Arlington', 'Caldwell', NULL, 'ID', '83605', '2083221730', '2083221731', '1717 Arlington', 'Caldwell', '', 'ID', '83605', '2083221730', '2083221731', 'IDSINCLAIRL', NULL, NULL, '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1427126127', 0, 'N', 0, '2012-01-31', NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'SACN00305', 'SACN00305', 'SACN', 'Idaho Emergency Physicians PA', 'Jessica', 'N', 'Wasielewski', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', NULL, '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', '          ', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1427126127', 0, 'N', 0, '2012-01-31', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'SACN01170', 'SACN01170', 'SACN', 'Saint Alphonsus Medical Group Overland Family Medicine', 'Karl', 'N', 'Watts', 'MD', 'Family Practice', '', '', NULL, 'O', '10255 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083677205', '2083677204', '10255 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083677205', '2083677204', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1578591053', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.5899, -116.31, NULL, NULL),
('820477852', 'SACN01171', 'SACN01171', 'SACN', 'Saint Alphonsus Medical Group Overland', 'Karl', 'N', 'Watts', 'MD', 'Family Practice', '', '', NULL, 'O', '10255 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083677205', '2083677204', '10255 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083677205', '2083677204', 'IDSINCLAIRL', NULL, '', '0.00', '15.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1578591053', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.5899, -116.31, NULL, NULL),
('820425454', 'SACN00048', 'SACN00048', 'SACN', 'Boise Anesthesia, PA', 'Gary', 'L', 'Weber', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'o', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676416', '2083759530', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676416', '2083759530', '', '', '', '58.45', '10.00', '0.00', 3, '2011-01-01', NULL, 1, 15, 0, '', '', '', '', 'HCFA|UB|', '1578510236', 0, 'N', 0, '2012-11-01', NULL, NULL, 43.6127, -116.254, NULL, NULL),
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('820445140', 'SACN00870', 'SACN00870', 'SACN', 'The Eye Associates', 'Katherine', 'O', 'Whitfield', 'MD', 'Ophthalmology', 'Pediatric Ophthalmology', NULL, NULL, 'O', '901 N Curtis Rd Ste 302', 'Boise', 'Ada', 'ID', '83706', '2083425151', NULL, '901 N Curtis Rd Ste 302', 'Boise', 'Ada', 'ID', '83706', '2083425151', '', 'IDSINCLAIRL', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1336255223', 0, 'n', 0, '2013-07-31', NULL, NULL, 43.6126, -116.255, NULL, NULL),
('820200895', 'SACN00632', 'SACN00632', 'SACN', 'Saint Alphonsus Medical Group MHP Family Medicine ', 'Margaret', 'L', 'Widener', 'CNM', 'Certified Nurse Midwife', '', '', NULL, 'O', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083674224', '2083678555', '3025 W Cherry Lane Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083674224', '2083678555', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', '2011-09-01', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1063454437', 0, 'Y', 0, '2014-03-21', NULL, NULL, 43.6188, -116.431, NULL, NULL),
('820200895', 'SACN00633', 'SACN00633', 'SACN', 'Saint Alphonsus Medical Group Eagle Health Plaza', 'Margaret', 'L', 'Widener', 'CNM', 'Certified Nurse Midwife', '', '', NULL, 'O', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', '2011-12-01', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1063454437', 0, 'Y', 0, '2014-03-21', NULL, NULL, 43.6892, -116.351, NULL, NULL),
('820200895', 'SACN00634', 'SACN00634', 'SACN', 'Saint Alphonsus Medical Group OB/GYN Boise Moreau Bldg', 'Margaret', 'L', 'Widener', 'CNM', 'Certified Nurse Midwife', '', '', NULL, 'O', '6140 W Curtisian Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083674224', '2083677806', '6140 W Curtisian Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083674224', '2083677806', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', '2013-08-01', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1063454437', 0, 'Y', 0, '2014-03-21', NULL, NULL, 43.6151, -116.256, NULL, NULL),
('820200895', 'SACN00635', 'SACN00635', 'SACN', 'Saint Alphonsus Medical Group  OB/GYN Boise Liberty Bldg', 'Margaret', 'L', 'Widener', 'CNM', 'Certified Nurse Midwife', '', '', NULL, 'O', '900 N Liberty Ste 204', 'Boise', 'Ada', 'ID', '83704', '2083674224', '2083674242', '900 N Liberty Ste 204', 'Boise', 'Ada', 'ID', '83704', '2083674224', '2083674242', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1063454437', 0, 'Y', 0, '2014-03-21', NULL, NULL, 43.6133, -116.259, NULL, NULL),
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('820477852', 'SACN00638', 'SACN00638', 'SACN', 'Saint Alphonsus Medical Group Womens Health', 'Margaret', 'L', 'Widener', 'CNM', 'Certified Nurse Midwife', '', '', NULL, 'O', '6140 W Curtisian Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083674224', '2083677806', '6140 W Curtisian Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083674224', '2083677806', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', '2013-08-01', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1063454437', 0, 'N', 0, '2014-03-21', NULL, NULL, 43.6151, -116.256, NULL, NULL),
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('205934739', 'SACN00374', 'SACN00374', 'SACN', 'Family Medicine Health Center', 'Anntara', '', 'Smith', 'PA', 'Family Practice', '', '', NULL, 'O', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'IDSINCLAIRL', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1659309557', 0, 'n', 0, '2013-02-28', 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
('271524083', 'W12019399', 'W12019399', 'WY01', 'Big Horn Health Network', 'Sarah', 'C', 'Smith', 'MD', 'General Surgery', '', '', NULL, 'O', '1333 W 5th St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076753181', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '', '', 'BHHN', '0.00', '0.00', '0.00', 3, '2012-03-01', NULL, NULL, 0, NULL, 'Sheridan Memorial Hospital', NULL, NULL, NULL, 'HCFA|', '1245280148', 0, 'N', 0, '2013-02-28', NULL, NULL, 44.8074, -106.975, NULL, NULL),
('205934739', 'SACN00373', 'SACN00373', 'SACN', 'Family Medicine Health Center', 'Anntara', '', 'Smith', 'PA', 'Family Practice', '', '', NULL, 'O', '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083811775', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'IDSINCLAIRL', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1659309557', 0, 'n', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('820442659', 'SACN00416', 'SACN00416', 'SACN', 'Idaho Foot & Ankle Associates', 'Rebecca', '', 'Smiley-Leis', 'DPM', 'Podiatry', '', '', NULL, 'O', '809 N Liberty', 'Boise', 'Ada', 'ID', '83704', '2083270627', '2083765258', '809 N Liberty', 'Boise', 'Ada', 'ID', '83704', '2083270627', '2083765258', 'IDSINCLAIRL', NULL, NULL, '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1689629024', 0, 'N', 0, '2014-03-26', NULL, NULL, 0, 0, NULL, NULL),
('820442659', 'SACN00415', 'SACN00415', 'SACN', 'Idaho Foot & Ankle Associates', 'Rebecca', '', 'Smiley-Leis', 'DPM', 'Podiatry', '', '', NULL, 'O', '2635 Caldwell Blvd Ste 101', 'Nampa', 'Canyon', 'ID', '83651', '2084550655', '2084550654', '2635 Caldwell Blvd Ste 101', 'Nampa', 'Canyon', 'ID', '83651', '2084550655', '2084550654', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1689629024', 0, 'N', 0, '2014-03-26', NULL, NULL, 0, 0, NULL, NULL),
('850395469', 'W12019619', 'W12019619', 'NM01', 'Fifty n Fit', 'Tracie', 'L', 'Sipple', 'PT', 'Physical Therapy', '', '', NULL, 'B', '11801 Menaul Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87112', '5053458050', '5053438050', '11801 Menaul Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87112', '5053458050', '5053438050', '', '', '', '0.00', '0.00', '75.00', 3, '2012-05-01', '2013-09-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205836707', 0, 'N', 0, '2013-07-15', NULL, NULL, 0, 0, NULL, NULL),
('203129832', 'SACN00673', 'SACN00673', 'SACN', 'Idaho Minor Emergency and Family Practice', 'Mark', 'S', 'Williams', 'DO; Sports Med', 'Family Practice', 'Sports Medicine', '', NULL, 'O', '3041 E Copper Pointe Dr', 'Meridian', 'Ada', 'ID', '83642', '2085144401', NULL, '3041 E Copper Pointe Dr', 'Meridian', 'Ada', 'ID', '83642', '2085144401', '          ', 'IDSINCLAIRL', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2011-01-01', '2012-02-27', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1114961166', 0, 'N', 0, '2014-03-12', NULL, NULL, 43.5837, -116.356, NULL, NULL),
('271145419', 'SACN00674', 'SACN00674', 'SACN', 'Ada Orthopaedic Clinic', 'Mark', 'S', 'Williams', 'DO; Sports Med', 'Family Practice', 'Sports Medicine', '', NULL, 'O', '6500 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083770777', NULL, '6500 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083770777', '          ', 'IDSINCLAIRL', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1114961166', 0, 'N', 0, '2013-07-03', NULL, NULL, 43.612, -116.262, NULL, NULL),
('830234097', 'W12020048', 'W12020048', 'WYT1', 'Powder River Orthopedics and Spine', 'Nathan', 'S', 'Simpson', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '508 Stocktrail Ste A', 'Gillette', 'Campbell', 'WY', '82716', '3076851413', '3076821113', '508 Stocktrail Ste A', 'Gillette', 'Campbell', 'WY', '82716', '3076851413', '3076821113', '', '', '', '0.00', '21.00', '0.00', 6, '2012-06-29', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1427042936', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
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('820486458', 'SACN01356', 'SACN01356', 'SACN', 'Adult Adolescent & Children Counseling Center', 'Christine', '', 'Wilson', 'LCPC LMFT', 'Mental Health', 'Counseling', 'Marriage & Family Therapy', NULL, 'O', '3318 N Cole Rd', 'Boise', 'Ada', 'ID', '83704', '2083752730', NULL, '3318 N Cole Rd', 'Boise', 'Ada', 'ID', '83704', '2083752730', '', 'IDSINCLAIRL', NULL, NULL, '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710002746', 0, 'y', 0, '2011-12-13', NULL, NULL, 0, 0, NULL, NULL),
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('820535217', 'SACN01140', 'SACN01140', 'SACN', NULL, 'James', 'A', 'Wolf', 'MD', 'General Surgery', 'Oncology', '', NULL, 'O', '341 E Bannock', 'Boise', 'Ada', 'ID', '83712', '2083427033', '2083427034', '341 E Bannock', 'Boise', 'Ada', 'ID', '83712', '2083427033', '2083427034', 'IDSINCLAIRL', NULL, NULL, '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1538164272', 0, 'N', 0, '2012-01-31', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'SACN01615', 'SACN01615', 'SACN', 'Saint Alphonsus Regional Medical Center - Reading Panel', 'Michael', 'S', 'Womack', 'MD', 'Pediatric Cardiology', '', '', NULL, 'B', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083673722', NULL, '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083673722', '', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', 'West Valley Medical Center', '', 'Saint Alphonsus Medical Center Nampa', 'HCFA|', '1912950338', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('820200895', 'SACN01616', 'SACN01616', 'SACN', 'Saint Alphonsus Medical Center  Nampa Read Only', 'Michael', 'S', 'Womack', 'MD', 'Pediatric Cardiology', '', '', NULL, 'B', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084671171', '2084635050', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084671171', '2084635050', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', '2011-01-01', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', 'West Valley Medical Center', '', 'Saint Alphonsus Medical Center Nampa', 'HCFA|', '1912950338', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.5537, -116.573, NULL, NULL),
('820527771', 'SACN01617', 'SACN01617', 'SACN', 'Pediatric Cardiology', 'Michael', 'S', 'Womack', 'MD', 'Pediatric Cardiology', '', '', NULL, 'O', '100 E Idaho Ste 204 Ste 200', 'Boise', 'Ada', 'ID', '83712', '2084539962', '2084539963', '100 E Idaho Ste 204 Ste 200', 'Boise', 'Ada', 'ID', '83712', '2084539962', '2084539963', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', 'West Valley Medical Center', '', 'Saint Alphonsus Medical Center Nampa', 'HCFA|UB|', '1912950338', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6123, -116.194, NULL, NULL),
('820527771', 'SACN01618', 'SACN01618', 'SACN', 'Pediatric Cardiology', 'Michael', 'S', 'Womack', 'MD', 'Pediatric Cardiology', '', '', NULL, 'O', '111 Broadway Ave Ste 101-165', 'Boise', 'Ada', 'ID', '83702', '2084539962', '2084539963', '111 Broadway Ave Ste 101-165', 'Boise', 'Ada', 'ID', '83702', '2084539962', '2084539963', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 3, '2011-01-01', '2012-01-01', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', 'West Valley Medical Center', '', 'Saint Alphonsus Medical Center Nampa', 'HCFA|UB|', '1912950338', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'SACN00591', 'SACN00591', 'SACN', 'Saint Alphonsus Medical Group Eagle Health Plaza', 'Noreen', 'A', 'Womack', 'MD', 'Pediatrics', '', '', NULL, 'O', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', '2012-04-03', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1033154828', 0, 'Y', 0, '2012-04-03', NULL, NULL, 43.6892, -116.351, NULL, NULL),
('820200895', 'SACN00592', 'SACN00592', 'SACN', 'Saint Alphonsus Medical Group Pediatrics', 'Noreen', 'A', 'Womack', 'MD', 'Pediatrics', '', '', NULL, 'O', '999 N Curtis Ste 407', 'Boise', 'Ada', 'ID', '83706', '2083674321', '2083674525', '999 N Curtis Ste 407', 'Boise', 'Ada', 'ID', '83706', '2083674321', '2083674525', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', '2012-04-03', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1033154828', 0, 'N', 0, '2012-04-03', NULL, NULL, 43.6132, -116.255, NULL, NULL),
('820477852', 'SACN00593', 'SACN00593', 'SACN', 'Saint Alphonsus Medical Group Eagle Health Plaza', 'Noreen', 'A', 'Womack', 'MD', 'Pediatrics', '', '', NULL, 'B', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', '2012-04-03', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1033154828', 0, 'Y', 0, '2012-04-03', NULL, NULL, 43.6892, -116.351, NULL, NULL),
('820477852', 'SACN00594', 'SACN00594', 'SACN', 'Saint Alphonsus Medical Group Pediatrics', 'Noreen', 'A', 'Womack', 'MD', 'Pediatrics', '', '', NULL, 'o', '999 N Curtis Ste 407', 'Boise', 'Ada', 'ID', '83706', '2083674321', '2083674525', '999 N Curtis Ste 407', 'Boise', 'Ada', 'ID', '83706', '2083674321', '2083674525', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', '2012-04-03', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1033154828', 0, 'N', 0, '2012-04-03', NULL, NULL, 43.6132, -116.255, NULL, NULL),
('820527746', 'SACN01677', 'SACN01677', 'SACN', 'Thomas W Woodward PC', 'Thomas', 'W', 'Woodward', 'OD', 'Optometry', '', '', NULL, 'O', '304 E Main', 'Emmett', 'Gem', 'ID', '83617', '2083654531', '2083653854', '304 E Main', 'Emmett', 'Gem', 'ID', '83617', '2083654531', '2083653854', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 3, '2011-01-01', '2013-11-10', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1982792180', 0, 'N', 0, '2013-12-11', NULL, NULL, 0, 0, NULL, NULL),
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('260553931', 'SACN01498', 'SACN01498', 'SACN', 'Saint Alphonsus Specialty Services, Inc', 'Steven', 'L', 'Writer', 'MD', 'Cardiology', '', '', NULL, 'O', '645 E 5th St', 'Weiser', 'Washington', 'ID', '83672', '2085493152', NULL, '645 E 5th St', 'Weiser', 'Washington', 'ID', '83672', '2085493152', '', 'IDSINCLAIRL', NULL, '', '0.00', '15.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1811942543', 0, 'Y', 0, '2014-07-09', NULL, NULL, 44.2487, -116.962, NULL, NULL),
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('331078261', 'SACN01500', 'SACN01500', 'SACN', 'McCall Memorial Hospital', 'Steven', 'L', 'Writer', 'MD', 'Cardiology', '', '', NULL, 'B', '1000 State St', 'McCall', 'Valley', 'ID', '83638', '2086342221', '0', '1000 State St', 'McCall', 'Valley', 'ID', '83638', '2086342221', '0', 'IDSINCLAIRL', NULL, '', '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1811942543', 0, 'n', 0, '2014-07-09', NULL, NULL, 44.9094, -116.11, NULL, NULL),
('331078261', 'SACN01501', 'SACN01501', 'SACN', 'Family Practice Associates', 'Steven', 'L', 'Writer', 'MD', 'Cardiology', '', '', NULL, 'B', '21 E Maple St Ste  A', 'Hailey', 'Blaine', 'ID', '83333', '2087883200', '0', '21 E Maple St Ste  A', 'Hailey', 'Blaine', 'ID', '83333', '2087883200', '0', 'IDSINCLAIRL', NULL, '', '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1811942543', 0, 'n', 0, '2014-07-09', NULL, NULL, 43.5143, -114.31, NULL, NULL),
('331078261', 'SACN01502', 'SACN01502', 'SACN', 'Saint Alphonsus Physicians PA', 'Steven', 'L', 'Writer', 'MD', 'Cardiology', '', '', NULL, 'O', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2083674278', '2083675200', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2083674278', '2083675200', 'IDSINCLAIRL', NULL, '', '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1811942543', 0, 'y', 0, '2014-07-09', NULL, NULL, 43.6539, -116.695, NULL, NULL),
('331078261', 'SACN01503', 'SACN01503', 'SACN', 'Saint Alphonsus Physicians PA', 'Steven', 'L', 'Writer', 'MD', 'Cardiology', '', '', NULL, 'o', '6140 W Curtisian Ste 200', 'Boise', 'Ada', 'ID', '83704', '2083674278', '2083675200', '6140 W Curtisian Ste 200', 'Boise', 'Ada', 'ID', '83704', '2083674278', '2083675200', 'IDSINCLAIRL', NULL, '', '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1811942543', 0, 'n', 0, '2014-07-09', NULL, NULL, 43.6151, -116.256, NULL, NULL),
('331078261', 'SACN01504', 'SACN01504', 'SACN', 'Weiser Memorial Hospital', 'Steven', 'L', 'Writer', 'MD', 'Cardiology', '', '', NULL, 'B', '645 E 5th St', 'Weiser', 'Washington', 'ID', '83672', '2085493152', '0', '645 E 5th St', 'Weiser', 'Washington', 'ID', '83672', '2085493152', '0', 'IDSINCLAIRL', NULL, '', '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1811942543', 0, 'n', 0, '2014-07-09', NULL, NULL, 44.2487, -116.962, NULL, NULL),
('820200895', 'SACN01505', 'SACN01505', 'SACN', 'Saint Alphonsus Regional Medical Center - Reading Panel', 'Steven', 'L', 'Writer', 'MD', 'Cardiology', '', '', NULL, 'B', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083673722', '0', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083673722', '0', 'IDSINCLAIRL', NULL, '', '0.00', '15.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1811942543', 0, 'n', 0, '2014-07-09', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('820312175', 'SACN01271', 'SACN01271', 'SACN', 'Idaho Emergency Physicians PA', 'Christopher', 'C', 'Wyatt', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83704', '2083221730', '2083221731', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83704', '2083221730', '2083221731', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1649487430', 0, 'N', 0, '2012-01-31', NULL, NULL, 43.6136, -116.256, NULL, NULL),
('820312175', 'SACN01272', 'SACN01272', 'SACN', 'Idaho Emergency Physicians PA', 'Christopher', 'C', 'Wyatt', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '1717 Arlington', 'Caldwell', 'Canyon', 'ID', '83605', '2083221730', '2083221731', '1717 Arlington', 'Caldwell', 'Canyon', 'ID', '83605', '2083221730', '2083221731', 'IDSINCLAIRL', NULL, NULL, '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1649487430', 0, 'N', 0, '2012-01-31', NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'SACN01273', 'SACN01273', 'SACN', 'Idaho Emergency Physicians PA', 'Christopher', 'C', 'Wyatt', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', NULL, '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', '          ', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1649487430', 0, 'Y', 0, '2012-01-31', NULL, NULL, 0, 0, NULL, NULL),
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('260553931', 'SACN00451', 'SACN00451', 'SACN', 'INI Saint Alphonsus Neurosurgery', 'Ann Marie', '', 'Yost', 'MD', 'Neurosurgery', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', '', 'ID', '83706', '2083674000', '2083674052', '1055 N Curtis Rd', 'Boise', '', 'ID', '83706', '2083674000', '2083674052', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', '2012-04-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730217704', 0, 'N', 0, '2012-03-29', NULL, NULL, 43.6127, -116.254, NULL, NULL),
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('942938348', 'W40017440', 'W40017440', 'UTMH1', ' Valley Mental Health Inc', 'Craig', 'B', 'Simpson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'UTVMHMA', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1518045699', 0, 'Y', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
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('830207671', 'W12009784', 'W12009784', 'WY01', 'West Park Hospital Discrict', 'Kelly', 'T', 'Simone', '', 'Family Practice', '', '', NULL, '', 'Change', 'Cody', 'Park', 'WY', '82414', '          ', '3075782937', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '', '', '', '0.00', '0.00', '0.00', 3, '2030-01-01', '2030-01-01', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|DEN|', '1770529703', 0, 'N', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
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('820200895', 'SACN01624', 'SACN01624', 'SACN', 'Saint Alphonsus Express Care, Inc.', 'Stephen', 'J', 'Zeimantz', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'O', '4700 N Eagle Rd', 'Boise', 'Ada', 'ID', '83713', '2089384797', NULL, '4700 N Eagle Rd', 'Boise', 'Ada', 'ID', '83713', '2089384797', '          ', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', '2011-08-28', 0, 0, 0, '', '', '', '', 'HCFA|', '1922001478', 0, 'Y', 0, '2011-09-19', NULL, NULL, 43.6474, -116.352, NULL, NULL),
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('820227163', 'SACN00143', 'SACN00143', 'SACN', 'St Benedicts Family Medical Center', 'Thomas', 'H', 'Zepeda', 'MD', 'Family Practice', 'Obstetrics and Gynecology', 'Emergency Medicine', NULL, 'B', '709 N Lincoln', 'Jerome', 'Jerome', 'ID', '83338', '2083241122', '2083243878', '709 N Lincoln', 'Jerome', 'Jerome', 'ID', '83338', '2083241122', '2083243878', 'IDSINCLAIRL', NULL, NULL, '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000009742', 0, 'Y', 0, '2012-07-19', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'SACN00280', 'SACN00280', 'SACN', 'Saint Alphonsus Specialty Services, Inc', 'Christian', 'G', 'Zimmerman', 'MD', 'Neurosurgery', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083674000', '2083674052', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083674000', '2083674052', 'IDSINCLAIRL', NULL, '', '0.00', '15.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1407874068', 0, 'Y', 0, '2014-07-09', NULL, NULL, 43.6127, -116.254, NULL, NULL),
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('260553931', 'SACN00282', 'SACN00282', 'SACN', 'Saint Alphonsus Medical Group Neurosurgery Fruitland', 'Christian', 'G', 'Zimmerman', 'MD', 'Neurosurgery', '', '', NULL, 'O', '1118 NW 16th St', 'Fruitland', 'Payette', 'ID', '83619', '2083674000', '2083674052', '1118 NW 16th St', 'Fruitland', 'Payette', 'ID', '83619', '2083674000', '2083674052', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1407874068', 0, 'Y', 0, '2014-07-09', NULL, NULL, 44.025, -116.928, NULL, NULL),
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('331078261', 'SACN00286', 'SACN00286', 'SACN', 'Saint Alphonsus Physicians PA', 'Christian', 'G', 'Zimmerman', 'MD', 'Neurosurgery', '', '', NULL, 'B', '6140 W Curtisian Ste 400', 'Boise', 'Ada', 'ID', '83706', '2083673500', NULL, '6140 W Curtisian Ste 400', 'Boise', 'Ada', 'ID', '83706', '2083673500', '', 'IDSINCLAIRL', NULL, '', '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1407874068', 0, 'Y', 0, '2014-07-09', NULL, NULL, 43.6151, -116.256, NULL, NULL),
('820200895', 'SACN00390', 'SACN00390', 'SACN', 'Saint Alphonsus Medical Group Pulmonary & Sleep Boise ', 'Heather', 'A', 'Healy', 'NP-C', 'Obstetrics and Gynecology', 'Nurse Practitioner', 'Internal Medicine', NULL, 'O', '1075 N Curtis Rd Ste 200', 'Boise', 'Ada', 'ID', '83704', '2083678333', '          ', '1075 N Curtis Rd Ste 200', 'Boise', 'Ada', 'ID', '83704', '2083678333', '          ', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', '2014-05-06', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1669493771', 0, 'Y', 0, '2014-05-19', NULL, NULL, 43.6143, -116.258, NULL, NULL),
('820200895', 'SACN00391', 'SACN00391', 'SACN', 'Saint Alphonsus Medical Group Garrity Family Medicine', 'Heather', 'A', 'Healy', 'NP-C', 'Obstetrics and Gynecology', 'Nurse Practitioner', 'Internal Medicine', NULL, 'O', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', '2011-12-01', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1669493771', 0, 'Y', 0, '2014-05-19', NULL, NULL, 43.587, -116.549, NULL, NULL),
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('820200895', 'SACN00393', 'SACN00393', 'SACN', 'Saint Alphonsus Express Care, Inc.', 'Heather', 'A', 'Healy', 'NP-C', 'Obstetrics and Gynecology', 'Nurse Practitioner', 'Internal Medicine', NULL, 'O', '1515 W State St', 'Boise', 'Ada', 'ID', '83702', '2083456768', '          ', '1515 W State St', 'Boise', 'Ada', 'ID', '83702', '2083456768', '          ', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', '2014-05-06', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1669493771', 0, 'Y', 0, '2014-05-19', NULL, NULL, 43.6228, -116.21, NULL, NULL),
('820200895', 'SACN00394', 'SACN00394', 'SACN', 'Saint Alphonsus Medical Group Shoreline Family Medicine', 'Heather', 'A', 'Healy', 'NP-C', 'Obstetrics and Gynecology', 'Nurse Practitioner', 'Internal Medicine', NULL, 'O', '1673 W Shoreline Dr Ste 120', 'Boise', 'Ada', 'ID', '83702', '2084298311', '2084298310', '1673 W Shoreline Dr Ste 120', 'Boise', 'Ada', 'ID', '83702', '2084298311', '2084298310', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', '2014-05-06', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1669493771', 0, 'Y', 0, '2014-05-19', NULL, NULL, 43.6171, -116.222, NULL, NULL),
('820200895', 'SACN00395', 'SACN00395', 'SACN', 'Saint Alphonsus Medical Group Iowa Family Medicine', 'Heather', 'A', 'Healy', 'NP-C', 'Obstetrics and Gynecology', 'Nurse Practitioner', 'Internal Medicine', NULL, 'O', '211 W Iowa Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084657377', '2084657397', '211 W Iowa Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084657377', '2084657397', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', '2011-12-01', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1669493771', 0, 'Y', 0, '2014-05-19', NULL, NULL, 43.5539, -116.575, NULL, NULL),
('820200895', 'SACN00396', 'SACN00396', 'SACN', 'Saint Alphonsus Medical Group MHP Family Medicine', 'Heather', 'A', 'Healy', 'NP-C', 'Obstetrics and Gynecology', 'Nurse Practitioner', 'Internal Medicine', NULL, 'O', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', '2014-05-06', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1669493771', 0, 'Y', 0, '2014-05-19', NULL, NULL, 43.6188, -116.431, NULL, NULL),
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('820200895', 'SACN00398', 'SACN00398', 'SACN', 'Saint Alphonsus Medical Group EHP Family Medicine', 'Heather', 'A', 'Healy', 'NP-C', 'Obstetrics and Gynecology', 'Nurse Practitioner', 'Internal Medicine', NULL, 'O', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', '2014-05-06', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1669493771', 0, 'Y', 0, '2014-05-19', NULL, NULL, 43.6892, -116.351, NULL, NULL),
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('820200895', 'SACN00400', 'SACN00400', 'SACN', 'Saint Alphonsus Medical Group Internal Medicine', 'Heather', 'A', 'Healy', 'NP-C', 'Obstetrics and Gynecology', 'Nurse Practitioner', 'Internal Medicine', NULL, 'O', '6094 Emerald Ste 2', 'Boise', 'Ada', 'ID', '83704', '2083676575', '2083676597', '6094 Emerald Ste 2', 'Boise', 'Ada', 'ID', '83704', '2083676575', '2083676597', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', '2014-05-06', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1669493771', 0, 'Y', 0, '2014-05-19', NULL, NULL, 43.6122, -116.257, NULL, NULL),
('820200895', 'SACN00401', 'SACN00401', 'SACN', 'Saint Alphonsus Medical Group OB/GYN Boise Omreau Bldg', 'Heather', 'A', 'Healy', 'NP-C', 'Obstetrics and Gynecology', 'Nurse Practitioner', 'Internal Medicine', NULL, 'O', '6140 W Curtisian Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083674224', '2083677806', '6140 W Curtisian Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083674224', '2083677806', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', '2011-09-01', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1669493771', 0, 'Y', 0, '2014-05-19', NULL, NULL, 43.6151, -116.256, NULL, NULL),
('820200895', 'SACN00402', 'SACN00402', 'SACN', 'Saint Alphonsus Medical Group Emerald Family Medicine', 'Heather', 'A', 'Healy', 'NP-C', 'Obstetrics and Gynecology', 'Nurse Practitioner', 'Internal Medicine', NULL, 'O', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', '2014-05-06', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1669493771', 0, 'Y', 0, '2014-05-19', NULL, NULL, 43.6119, -116.268, NULL, NULL),
('820200895', 'SACN00403', 'SACN00403', 'SACN', 'Saint Alphonsus Medical Group  OB/GYN Boise Liberty Bldg', 'Heather', 'A', 'Healy', 'NP-C', 'Obstetrics and Gynecology', 'Nurse Practitioner', 'Internal Medicine', NULL, 'O', '900 N Liberty Ste 204', 'Boise', 'Ada', 'ID', '83704', '2083672229', '2083674242', '900 N Liberty Ste 204', 'Boise', 'Ada', 'ID', '83704', '2083672229', '2083674242', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', '2011-09-01', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1669493771', 0, 'Y', 0, '2014-05-19', NULL, NULL, 43.6133, -116.259, NULL, NULL),
('820200895', 'SACN00404', 'SACN00404', 'SACN', 'CARE Maternal/Child Health Program - Do Not Publish', 'Heather', 'A', 'Healy', 'NP-C', 'Obstetrics and Gynecology', 'Nurse Practitioner', 'Internal Medicine', NULL, 'O', '900 N Liberty St Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083672126', '2083674505', '900 N Liberty St Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083672126', '2083674505', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', '2014-05-06', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1669493771', 0, 'Y', 0, '2014-05-19', NULL, NULL, 43.6133, -116.259, NULL, NULL),
('820200895', 'SACN00405', 'SACN00405', 'SACN', 'Saint Alphonsus Medical Group Pediatrics', 'Heather', 'A', 'Healy', 'NP-C', 'Obstetrics and Gynecology', 'Nurse Practitioner', 'Internal Medicine', NULL, 'O', '999 N Curtis Ste 407', 'Boise', 'Ada', 'ID', '83706', '2083674321', '2083674525', '999 N Curtis Ste 407', 'Boise', 'Ada', 'ID', '83706', '2083674321', '2083674525', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', '2014-05-06', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1669493771', 0, 'Y', 0, '2014-05-19', NULL, NULL, 43.6132, -116.255, NULL, NULL),
('820477852', 'SACN00406', 'SACN00406', 'SACN', 'Saint Alphonsus Medical Group Womens Health', 'Heather', 'A', 'Healy', 'NP-C', 'Obstetrics and Gynecology', 'Nurse Practitioner', 'Internal Medicine', NULL, 'o', '6140 W Curtisian Ste 100', 'Boise', 'Ada', 'ID', '83706', '2083674224', '2083677806', '6140 W Curtisian Ste 100', 'Boise', 'Ada', 'ID', '83706', '2083674224', '2083677806', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', '2014-05-06', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1669493771', 0, 'Y', 0, '2014-05-19', NULL, NULL, 43.6151, -116.256, NULL, NULL),
('201300128', 'SACN00192', 'SACN00192', 'SACN', 'Idaho Urologic Institute', 'Joseph', 'H', 'Williams', 'MD', 'Urology', '', '', NULL, 'O', '2855 E Magic View Dr', 'Meridian', 'Ada', 'ID', '83642', '2086394900', NULL, '2855 E Magic View Dr', 'Meridian', 'Ada', 'ID', '83642', '2086394900', '', 'IDSINCLAIRL', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1194777060', 0, 'n', 0, '2013-07-29', NULL, NULL, 43.599, -116.36, NULL, NULL),
('201300128', 'SACN00193', 'SACN00193', 'SACN', 'Idaho Urologic Institute', 'Joseph', 'H', 'Williams', 'MD', 'Urology', '', '', NULL, 'O', '333 N 1st Ste 100', 'Boise', 'Ada', 'ID', '83702', '2086394900', NULL, '333 N 1st Ste 100', 'Boise', 'Ada', 'ID', '83702', '2086394900', '          ', 'IDSINCLAIRL', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2011-01-01', '2012-02-24', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1194777060', 0, 'N', 0, '2013-07-29', NULL, NULL, 43.6135, -116.194, NULL, NULL),
('820425454', 'SACN00137', 'SACN00137', 'SACN', 'Boise Anesthesia, PA', 'Brian', '', 'Allen', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'o', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083676416', '2083759530', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083676416', '2083759530', '', '', '', '58.45', '10.00', '0.00', 3, '2011-01-01', NULL, 1, 15, 0, '', '', '', '', 'HCFA|UB|', '1982855482', 0, 'N', 0, '2012-10-29', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('820425454', 'SACN00138', 'SACN00138', 'SACN', 'Boise Anesthesia, PA', 'Brian', '', 'Allen', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'o', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2084594641', NULL, '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2084594641', '0         ', '', '', '', '58.45', '10.00', '0.00', 3, '2011-01-01', NULL, 1, 15, 0, '', '', '', '', 'HCFA|UB|', '1982855482', 0, 'N', 0, '2012-10-29', NULL, NULL, 0, 0, NULL, NULL),
('820425454', 'SACN00020', 'SACN00020', 'SACN', 'Boise Anesthesia, PA', 'Bryant', 'L', 'Peterson', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'o', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676416', '2083759530', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676416', '2083759530', '', '', '', '58.45', '10.00', '0.00', 3, '2011-01-01', NULL, 1, 15, 0, '', '', '', '', 'HCFA|UB|', '1174794127', 0, 'N', 0, '2013-06-24', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('820425454', 'SACN00021', 'SACN00021', 'SACN', 'Boise Anesthesia, PA', 'Bryant', 'L', 'Peterson', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'o', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2084594641', NULL, '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2084594641', '0         ', '', '', '', '58.45', '10.00', '0.00', 3, '2011-01-01', NULL, 1, 15, 0, '', '', '', '', 'HCFA|UB|', '1174794127', 0, 'N', 0, '2013-06-24', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'SACN01413', 'SACN01413', 'SACN', 'Saint Alphonsus Medical Group Family Medicine Dominican ', 'Gayle', 'A', 'Stockslager', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'O', '1118 NW 16th St Ste A', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2083676170', '1118 NW 16th St Ste A', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2083676170', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1740475680', 0, 'N', 0, '2013-02-13', NULL, NULL, 44.025, -116.928, 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
('820200895', 'SACN01414', 'SACN01414', 'SACN', 'Saint Alphonsus Medical Group Garrity Family Medicine', 'Gayle', 'A', 'Stockslager', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'O', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1740475680', 0, 'Y', 0, '2013-02-13', NULL, NULL, 43.587, -116.549, NULL, NULL),
('820200895', 'SACN01415', 'SACN01415', 'SACN', 'Saint Alphonsus Express Care, Inc.', 'Gayle', 'A', 'Stockslager', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'O', '1515 W State St', 'Boise', 'Ada', 'ID', '83702', '2083456768', NULL, '1515 W State St', 'Boise', 'Ada', 'ID', '83702', '2083456768', '', 'IDSINCLAIRL', NULL, NULL, '0.00', '15.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1740475680', 0, 'Y', 0, '2013-02-13', NULL, NULL, 43.6228, -116.21, NULL, NULL),
('820200895', 'SACN01416', 'SACN01416', 'SACN', 'Saint Alphonsus Medical Group Shoreline Family Medicine', 'Gayle', 'A', 'Stockslager', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'O', '1673 W Shoreline Dr Ste 120', 'Boise', 'Ada', 'ID', '83702', '2084298311', '2084298310', '1673 W Shoreline Dr Ste 120', 'Boise', 'Ada', 'ID', '83702', '2084298311', '2084298310', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1740475680', 0, 'N', 0, '2013-02-13', NULL, NULL, 43.6171, -116.222, NULL, NULL),
('820200895', 'SACN01417', 'SACN01417', 'SACN', 'Saint Alphonsus Medical Group MHP Family Medicine', 'Gayle', 'A', 'Stockslager', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'O', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1740475680', 0, 'Y', 0, '2013-02-13', NULL, NULL, 43.6188, -116.431, NULL, NULL),
('820200895', 'SACN01418', 'SACN01418', 'SACN', 'Saint Alphonsus Medical Group Elm Family Medicine', 'Gayle', 'A', 'Stockslager', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'O', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', '315 E Elm Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1740475680', 0, 'Y', 0, '2013-02-13', NULL, NULL, 43.6539, -116.695, NULL, NULL),
('820200895', 'SACN01419', 'SACN01419', 'SACN', 'Saint Alphonsus Express Care, Inc.', 'Gayle', 'A', 'Stockslager', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'O', '4700 N Eagle Rd', 'Boise', 'Ada', 'ID', '83713', '2089384797', NULL, '4700 N Eagle Rd', 'Boise', 'Ada', 'ID', '83713', '2089384797', '', 'IDSINCLAIRL', NULL, NULL, '0.00', '15.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1740475680', 0, 'Y', 0, '2013-02-13', NULL, NULL, 43.6474, -116.352, NULL, NULL),
('820200895', 'SACN01420', 'SACN01420', 'SACN', 'Saint Alphonsus Medical Group Emerald Family Medicine', 'Gayle', 'A', 'Stockslager', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'O', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1740475680', 0, 'Y', 0, '2013-02-13', NULL, NULL, 43.6119, -116.268, NULL, NULL),
('820477852', 'SACN01421', 'SACN01421', 'SACN', 'Saint Alphonsus Medical Group Garrity', 'Gayle', 'A', 'Stockslager', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'B', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', 'IDSINCLAIRL', NULL, NULL, '0.00', '15.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740475680', 0, 'Y', 0, '2013-02-13', NULL, NULL, 43.587, -116.549, NULL, NULL),
('820477852', 'SACN01422', 'SACN01422', 'SACN', 'Saint Alphonsus Express Care', 'Gayle', 'A', 'Stockslager', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'B', '1515 W State St', 'Boise', 'Ada', 'ID', '83702', '2083456798', NULL, '1515 W State St', 'Boise', 'Ada', 'ID', '83702', '2083456798', '', 'IDSINCLAIRL', NULL, NULL, '0.00', '15.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740475680', 0, 'Y', 0, '2013-02-13', NULL, NULL, 43.6228, -116.21, NULL, NULL),
('820477852', 'SACN01423', 'SACN01423', 'SACN', 'Saint Alphonsus Express Care', 'Gayle', 'A', 'Stockslager', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'B', '2809 E Cleveland Blvd', 'Caldwell', 'Canyon', 'ID', '83605', '2084551094', NULL, '2809 E Cleveland Blvd', 'Caldwell', 'Canyon', 'ID', '83605', '2084551094', '', 'IDSINCLAIRL', NULL, NULL, '0.00', '15.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740475680', 0, 'Y', 0, '2013-02-13', NULL, NULL, 0, 0, NULL, NULL),
('820477852', 'SACN01424', 'SACN01424', 'SACN', 'Saint Alphonsus Medical Group Cherry Lane', 'Gayle', 'A', 'Stockslager', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'B', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', 'IDSINCLAIRL', NULL, NULL, '0.00', '15.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740475680', 0, 'Y', 0, '2013-02-13', NULL, NULL, 43.6188, -116.431, NULL, NULL),
('820477852', 'SACN01425', 'SACN01425', 'SACN', 'Saint Alphonsus Medical Group Elm Family Medicine', 'Gayle', 'A', 'Stockslager', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'B', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084545113', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084545113', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740475680', 0, 'Y', 0, '2014-01-23', NULL, NULL, 43.6539, -116.695, NULL, NULL),
('820477852', 'SACN01426', 'SACN01426', 'SACN', 'Saint Alphonsus Express Care', 'Gayle', 'A', 'Stockslager', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'B', '4700 N Eagle Rd', 'Boise', 'Ada', 'ID', '83713', '2089384797', NULL, '4700 N Eagle Rd', 'Boise', 'Ada', 'ID', '83713', '2089384797', '', 'IDSINCLAIRL', NULL, NULL, '0.00', '15.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740475680', 0, 'Y', 0, '2013-02-13', NULL, NULL, 43.6474, -116.352, NULL, NULL),
('820477852', 'SACN01427', 'SACN01427', 'SACN', 'Saint Alphonsus Medical Group Emerald Family Medicine', 'Gayle', 'A', 'Stockslager', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'B', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740475680', 0, 'Y', 0, '2014-01-23', NULL, NULL, 43.6119, -116.268, NULL, NULL),
('820477852', 'SACN01428', 'SACN01428', 'SACN', 'Saint Alphonsus Express Care', 'Gayle', 'A', 'Stockslager', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'B', '660 E Boise Ave', 'Boise', 'Ada', 'ID', '83706', '2083451162', NULL, '660 E Boise Ave', 'Boise', 'Ada', 'ID', '83706', '2083451162', '', 'IDSINCLAIRL', NULL, NULL, '0.00', '15.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740475680', 0, 'Y', 0, '2013-02-13', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'SACN01106', 'SACN01106', 'SACN', 'Saint Alphonsus Medical Group Iowa', 'Matthew', 'S', 'Brown', 'MD', 'Pediatrics', '', '', NULL, 'O', '211 W Iowa', 'Nampa', 'Canyon', 'ID', '83686', '2084657377', '2084657397', '211 W Iowa', 'Nampa', 'Canyon', 'ID', '83686', '2084657377', '2084657397', 'IDSINCLAIRL', NULL, '', '0.00', '15.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, 'West Valley Medical Center', '', '', '', 'HCFA|', '1508809914', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'SACN01107', 'SACN01107', 'SACN', 'Saint Alphonsus Medical Group Elm Family Medicine', 'Matthew', 'S', 'Brown', 'MD', 'Pediatrics', '', '', NULL, 'O', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, 'West Valley Medical Center', '', '', '', 'HCFA|', '1508809914', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6539, -116.695, NULL, NULL),
('820477852', 'SACN01108', 'SACN01108', 'SACN', 'Saint Alphonsus Medical Group Iowa', 'Matthew', 'S', 'Brown', 'MD', 'Pediatrics', '', '', NULL, 'o', '211 W Iowa Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084657377', '2084657397', '211 W Iowa Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084657377', '2084657397', 'IDSINCLAIRL', NULL, '', '0.00', '15.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, 'West Valley Medical Center', '', '', '', 'HCFA|UB|', '1508809914', 0, 'n', 0, '2014-06-20', NULL, NULL, 43.5539, -116.575, NULL, NULL),
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('202299593', 'W12012160', 'W12012160', 'WYT1', 'Red Desert InstaCare', 'Jonathan', '', 'Said', 'PA-C', 'Family Practice', '', '', NULL, 'O', '2761 Commercial Way', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073823064', NULL, '2761 Commercial Way', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073823064', '          ', '', '', '', '0.00', '7.50', '0.00', 3, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008532', 0, 'N', 0, '2011-06-30', NULL, NULL, 0, 0, NULL, NULL),
('202299593', 'W12012161', 'W12012161', 'WYT1', 'Wyoming Range Medical', 'Jonathan', '', 'Said', 'PA-C', 'Family Practice', '', '', NULL, 'B', 'PO Box 130', 'Big Piney', 'Sublette', 'WY', '83113', '3073823064', NULL, 'PO Box 130', 'Big Piney', 'Sublette', 'WY', '83113', '3073823064', '          ', '', '', '', '0.00', '7.50', '0.00', 3, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008532', 0, 'Y', 0, '2011-06-30', NULL, NULL, 0, 0, NULL, NULL),
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('810422536', 'W12012165', 'W12012165', 'WYT1', 'Yellowstone Pathologists PC', 'Hoyle', 'E', 'Setzer', 'MD', 'Pathology', '', '', NULL, 'O', '2900 12th Ave N Ste 295W', 'Billings', 'Yellowstone', 'MT', '59101', '4062386363', NULL, '2900 12th Ave N Ste 295W', 'Billings', 'Yellowstone', 'MT', '59101', '4062386363', '          ', 'WYSTD', 'Wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023010253', 0, 'Y', 0, '2013-06-27', NULL, NULL, 0, 0, NULL, NULL),
('223887117', 'W12012166', 'W12012166', 'WYT1', 'Mountain Valley Eye Institute', 'Stacy', 'R', 'Smith', 'MD', 'Ophthalmology', '', '', NULL, 'O', '196 Arrowhead Dr Ste 5', 'Evanston', 'Uinta', 'WY', '82930', '8774232020', NULL, '196 Arrowhead Dr Ste 5', 'Evanston', 'Uinta', 'WY', '82930', '8774232020', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-06-28', NULL, 0, 0, 0, 'Evanston Regional Hospital', 'Heber Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1639348899', 0, 'N', 0, '2012-10-09', NULL, NULL, 0, 0, NULL, NULL),
('830327251', 'W12012167', 'W12012167', 'WYT1', 'Star Valley Medical Center', '', '', 'Star Valley Medical Center', 'GROUP', 'Hospital', '', '', NULL, 'O', '901 Adams St', 'Afton', 'Lincoln', 'WY', '83110', '3078855800', NULL, '901 Adams St', 'Afton', 'Lincoln', 'WY', '83110', '3078855800', '          ', '', '', '', '0.00', '5.00', '0.00', 6, '2011-06-28', '2011-06-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255376406', 0, 'N', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('202299593', 'W12012168', 'W12012168', 'WYT1', 'Red Desert InstaCare', 'Darcy', '', 'Turner', 'MD', 'Family Practice', '', '', NULL, 'O', '2761 Commercial Way', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073823064', NULL, '2761 Commercial Way', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073823064', '', '', '', '', '0.00', '7.50', '0.00', 3, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487741658', 0, 'N', 0, '2014-06-25', NULL, NULL, 0, 0, NULL, NULL),
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('202299593', 'W12012170', 'W12012170', 'WYT1', 'Wyoming Range Medical', 'Darcy', '', 'Turner', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 130', 'Big Piney', 'Sublette', 'WY', '83113', '3073823064', NULL, 'PO Box 130', 'Big Piney', 'Sublette', 'WY', '83113', '3073823064', '', '', '', '', '0.00', '7.50', '0.00', 3, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487741658', 0, 'Y', 0, '2014-06-25', NULL, NULL, 0, 0, NULL, NULL),
('202299593', 'W12012171', 'W12012171', 'WYT1', 'Wyoming Range Medical', 'Lorri', '', 'Turner', 'FNP', 'Family Practice', '', '', NULL, 'O', '630 Piney Dr', 'Big Piney', 'Sublette', 'WY', '83113', '3072764700', NULL, '630 Piney Dr', 'Big Piney', 'Sublette', 'WY', '83113', '3072764700', '          ', '', '', '', '0.00', '7.50', '0.00', 3, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518054782', 0, 'N', 0, '2011-09-20', NULL, NULL, 0, 0, NULL, NULL),
('202299593', 'W12012172', 'W12012172', 'WYT1', 'Wyoming Range Medical', 'Lorri', '', 'Turner', 'FNP', 'Family Practice', '', '', NULL, 'B', 'PO Box 130', 'Big Piney', 'Sublette', 'WY', '83113', '3073823064', NULL, 'PO Box 130', 'Big Piney', 'Sublette', 'WY', '83113', '3073823064', '          ', '', '', '', '0.00', '7.50', '0.00', 3, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518054782', 0, 'Y', 0, '2011-09-20', NULL, NULL, 0, 0, NULL, NULL),
('810490456', 'W12012173', 'W12012173', 'WYT1', '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', '', '0.00', '35.00', '0.00', 3, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922088509', 0, 'N', 0, '2011-06-29', NULL, NULL, 0, 0, NULL, NULL),
('202299593', 'W12012174', 'W12012174', 'WYT1', 'Wyoming Range Medical', '', '', 'Wyoming Range Medical', 'GROUP', 'Urgent Care', '', '', NULL, 'O', '630 Piney Dr', 'Big Piney', 'Sublette', 'WY', '83113', '3072764700', NULL, '630 Piney Drive', 'Big Piney', 'Sublette', 'WY', '83113', '3072764700', '          ', '', '', '', '0.00', '7.50', '0.00', 3, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009692', 0, 'N', 0, '2012-03-20', NULL, NULL, 0, 0, NULL, NULL),
('830259403', 'W12012176', 'W12012176', 'WYT1', 'High Country Audiology', 'Michael', 'B', 'Alley', 'AUD', 'Audiology', '', '', NULL, 'O', '125 Main St', 'Lander', 'Fremont', 'WY', '82520', '3073325088', NULL, '125 Main St', 'Lander', 'Fremont', 'WY', '82520', '3073325088', '          ', 'WISEWYSTD', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2011-06-28', '2013-04-17', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801999826', 0, 'N', 0, '2013-04-18', NULL, NULL, 0, 0, NULL, NULL),
('830259403', 'W12012177', 'W12012177', 'WYT1', 'High Country Audiology', 'Michael', 'B', 'Alley', 'AUD', 'Audiology', '', '', NULL, 'O', '514 Broadway', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073620055', NULL, '514 Broadway', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073620055', '          ', 'WISEWYSTD', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2011-06-28', '2013-04-17', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801999826', 0, 'N', 0, '2013-04-18', NULL, NULL, 0, 0, NULL, NULL),
('203147173', 'W12012178', 'W12012178', 'WYT1', 'Altitude Analysis Inc', '', '', 'Altitude Analysis Inc', 'GROUP', 'Laboratory', '', '', NULL, 'O', '2328 Foothill Blvd', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073624552', NULL, '2328 Foothill Blvd', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073624552', '          ', 'WISEWYSTD', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558554113', 0, 'N', 0, '2011-06-30', NULL, NULL, 0, 0, NULL, NULL),
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('202299593', 'W12012180', 'W12012180', 'WYT1', 'Red Desert InstaCare', 'Rich', '', 'Anderson', 'PA-C', 'Family Practice', '', '', NULL, 'O', '2761 Commercial Way', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073823064', NULL, '2761 Commercial Way', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073823064', '          ', '', '', '', '0.00', '7.50', '0.00', 3, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811084080', 0, 'N', 0, '2011-10-11', NULL, NULL, 0, 0, NULL, NULL),
('202299593', 'W12012181', 'W12012181', 'WYT1', 'Wyoming Range Medical', 'Rich', '', 'Anderson', 'PA-C', 'Family Practice', '', '', NULL, 'B', 'PO Box 130', 'Big Piney', 'Sublette', 'WY', '83113', '3072764700', NULL, 'PO Box 130', 'Big Piney', 'Sublette', 'WY', '83113', '3072764700', '          ', '', '', '', '0.00', '7.50', '0.00', 3, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811084080', 0, 'Y', 0, '2011-10-11', NULL, NULL, 0, 0, NULL, NULL),
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('205050083', 'W12012183', 'W12012183', 'WYT1', 'Wyoming Vision Center', 'Alison', 'A', 'Arrants', 'OD', 'Optometry', '', '', NULL, 'B', 'PO Box 2250', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073824444', NULL, 'PO Box 2250', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073824444', '', 'WYSTD', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144270091', 0, 'Y', 0, '2014-05-07', NULL, NULL, 0, 0, NULL, NULL),
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('830317319', 'W12012185', 'W12012185', 'WYT1', 'Fremont Pediatrics', 'Richard', '', 'Barnes', 'MD', 'Pediatrics', '', '', NULL, 'O', '115 Wyoming St', 'Riverton', 'Fremont', 'WY', '82501', '3073322185', NULL, '115 Wyoming St', 'Riverton', 'Fremont', 'WY', '82501', '3073322185', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2011-06-28', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1174616122', 0, 'N', 0, '2012-06-04', NULL, NULL, 0, 0, NULL, NULL),
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('830283425', 'W12012187', 'W12012187', 'WYT1', 'North Platte Physical Therapy', 'Jeremy', 'E', 'Bieber', 'PT', 'Physical Therapy', '', '', NULL, 'O', '3831 Denis Dr', 'Casper', 'Natrona', 'WY', '82604', '3072349067', '3072349074', '3831 Denis Dr', 'Casper', 'Natrona', 'WY', '82604', '3072349067', '3072349074', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619931102', 0, 'N', 0, '2011-06-30', NULL, NULL, 0, 0, NULL, NULL),
('830283425', 'W12012188', 'W12012188', 'WYT1', 'North Platte Physical Therapy', 'Jeremy', 'E', 'Bieber', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 1790', 'Douglas', 'Converse', 'WY', '82633', '3072342662', '3072348810', 'PO Box 1790', 'Douglas', 'Converse', 'WY', '82633', '3072342662', '3072348810', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619931102', 0, 'N', 0, '2011-06-30', NULL, NULL, 0, 0, NULL, NULL),
('830283425', 'W12012189', 'W12012189', 'WYT1', 'North Platte Physical Therapy', 'Michael', 'R', 'Boulter', 'PT', 'Physical Therapy', '', '', NULL, 'O', '311 Thelma Dr', 'Casper', 'Natrona', 'WY', '82609', '3072342662', '3072348810', '311 Thelma Dr', 'Casper', 'Natrona', 'WY', '82609', '3072342662', '3072348810', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265663587', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('830283425', 'W12012190', 'W12012190', 'WYT1', 'North Platte Physical Therapy', 'Michael', 'R', 'Boulter', 'PT', 'Physical Therapy', '', '', NULL, 'O', '3831 Denis Dr', 'Casper', 'Natrona', 'WY', '82604', '3072342662', '3072349074', '3831 Denis Dr', 'Casper', 'Natrona', 'WY', '82604', '3072342662', '3072349074', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265663587', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('830283425', 'W12012191', 'W12012191', 'WYT1', 'North Platte Physical Therapy', 'Michael', 'R', 'Boulter', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 1790', 'Douglas', 'Converse', 'WY', '82633', '3072342662', '3072348810', 'PO Box 1790', 'Douglas', 'Converse', 'WY', '82633', '3072342662', '3072348810', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265663587', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('830336991', 'W12012192', 'W12012192', 'WYT1', 'Optique 20/20 of Evanston', 'William', 'B', 'Bourland', 'OD', 'Optometry', '', '', NULL, 'O', '701 Front St', 'Evanston', 'Uinta', 'WY', '82930', '3077898820', NULL, '701 Front St', 'Evanston', 'Uinta', 'WY', '82930', '3077898820', '', 'wystd', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063413318', 0, 'N', 0, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
('810490456', 'W12012193', 'W12012193', 'WYT1', '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', '', '0.00', '35.00', '0.00', 3, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033189261', 0, 'N', 0, '2011-06-30', NULL, NULL, 0, 0, NULL, NULL),
('830310603', 'W12012194', 'W12012194', 'WYT1', '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', '', '0.00', '35.00', '0.00', 3, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215997382', 0, 'N', 0, '2011-06-30', NULL, NULL, 0, 0, NULL, NULL),
('830310603', 'W12012195', 'W12012195', 'WYT1', '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', '', '0.00', '35.00', '0.00', 3, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225098585', 0, 'N', 0, '2011-06-30', NULL, NULL, 0, 0, NULL, NULL),
('830310603', 'W12012196', 'W12012196', 'WYT1', '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', '', '0.00', '35.00', '0.00', 3, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356300602', 0, 'N', 0, '2011-06-30', NULL, NULL, 0, 0, NULL, NULL),
('810490456', 'W12012197', 'W12012197', 'WYT1', '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', '', '0.00', '35.00', '0.00', 3, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376523050', 0, 'N', 0, '2011-06-30', NULL, NULL, 0, 0, NULL, NULL),
('830310603', 'W12012198', 'W12012198', 'WYT1', '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', '', '0.00', '35.00', '0.00', 3, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1881653145', 0, 'N', 0, '2011-06-30', NULL, NULL, 0, 0, NULL, NULL),
('830310603', 'W12012199', 'W12012199', 'WYT1', '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', '', '0.00', '35.00', '0.00', 3, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922068287', 0, 'N', 0, '2011-06-30', NULL, NULL, 0, 0, NULL, NULL),
('830310603', 'W12012200', 'W12012200', 'WYT1', 'Community Home Oxygen', '', '', 'Community Home Oxygen', 'Group', 'Durable Medical Equipment', '', '', NULL, 'O', '604 9th St', 'Wheatland', 'Platte', 'WY', '82201', '307 322471', NULL, '604 9th St', 'Wheatland', 'Platte', 'WY', '82201', '307 322471', '307 322311', 'ROTECH', 'DME80', '', '0.00', '35.00', '0.00', 3, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962462218', 0, 'N', 0, '2011-06-30', NULL, NULL, 0, 0, NULL, NULL),
('830283425', 'W12012201', 'W12012201', 'WYT1', 'North Platte Physical Therapy', 'Deidra', 'N', 'Cottenoir', 'PT', 'Physical Therapy', '', '', NULL, 'O', '311 Thelma Dr', 'Casper', 'Natrona', 'WY', '82609', '3072342662', '3072348810', '311 Thelma Dr', 'Casper', 'Natrona', 'WY', '82609', '3072342662', '3072348810', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225215635', 0, 'N', 0, '2014-07-24', NULL, NULL, 0, 0, NULL, NULL),
('830283425', 'W12012202', 'W12012202', 'WYT1', 'North Platte Physical Therapy', 'Deidra', 'N', 'Cottenoir', 'PT', 'Physical Therapy', '', '', NULL, 'O', '3831 Denis Dr', 'Casper', 'Natrona', 'WY', '82604', '3072349067', '3072349074', '3831 Denis Dr', 'Casper', 'Natrona', 'WY', '82604', '3072349067', '3072349074', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225215635', 0, 'N', 0, '2014-07-24', NULL, NULL, 0, 0, NULL, NULL),
('830283425', 'W12012203', 'W12012203', 'WYT1', 'North Platte Physical Therapy', 'Deidra', 'N', 'Cottenoir', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 1790', 'Douglas', 'Converse', 'WY', '82633', '3072342662', '3072348810', 'PO Box 1790', 'Douglas', 'Converse', 'WY', '82633', '3072342662', '3072348810', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225215635', 0, 'N', 0, '2014-07-24', NULL, NULL, 0, 0, NULL, NULL),
('830306207', 'W12012204', 'W12012204', 'WYT1', 'Big Horn Pediatrics', 'David', 'R', 'Fall', 'MD', 'Pediatrics', '', '', NULL, 'O', '1308 W Fourth St', 'Gillette', 'Campbell', 'WY', '82716', '3076871300', NULL, '1308 W Fourth St', 'Gillette', 'Campbell', 'WY', '82716', '3076871300', '          ', '', '', '', '0.00', '12.00', '0.00', 3, '2011-06-28', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1578676490', 0, 'N', 0, '2012-04-12', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('830306207', 'W12012205', 'W12012205', 'WYT1', 'Big Horn Pediatrics', 'Julie', 'S', 'Fall', 'MD', 'Pediatrics', '', '', NULL, 'O', '1308 W Fourth St', 'Gillette', 'Campbell', 'WY', '82716', '3076871300', NULL, '1308 W Fourth St', 'Gillette', 'Campbell', 'WY', '82716', '3076871300', '          ', '', '', '', '0.00', '12.00', '0.00', 3, '2011-06-28', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1306959267', 0, 'N', 0, '2012-04-12', NULL, NULL, 0, 0, NULL, NULL),
('830317319', 'W12012206', 'W12012206', 'WYT1', 'Fremont Pediatrics', 'Cheryl', '', 'Fallin', 'MD', 'Pediatrics', '', '', NULL, 'O', '115 Wyoming St', 'Riverton', 'Fremont', 'WY', '82501', '3073322185', NULL, '115 Wyoming St', 'Riverton', 'Fremont', 'WY', '82501', '3073322185', '', '', '', '', '0.00', '10.00', '0.00', 3, '2011-06-28', NULL, 0, 0, 0, 'SageWest Health Care', '', '', '', 'HCFA|UB|', '1720189368', 0, 'N', 0, '2014-06-17', NULL, NULL, 0, 0, NULL, NULL),
('830317319', 'W12012208', 'W12012208', 'WYT1', 'Fremont County Pediatrics', 'Ryan', '', 'Firth', 'MD', 'Pediatrics', '', '', NULL, 'O', '115 Wyoming St', 'Riverton', 'Fremont', 'WY', '82501', '3073322185', '          ', '115 Wyoming St', 'Riverton', 'Fremont', 'WY', '82501', '3073322185', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2011-06-28', '2014-02-13', 0, 0, 0, 'SageWest Health Care', '', '', '', 'HCFA|UB|', '1689847485', 0, 'N', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('272904966', 'W12012209', 'W12012209', 'WYT1', 'The Eye Institute of Utah', 'Randy', 'L', 'Fuja', 'OD', 'Optometry', '', '', NULL, 'O', '2631 Foothill Blvd Ste A', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073624202', NULL, '2631 Foothill Blvd Ste A', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073624202', '          ', 'WYSTD', '', '', '0.00', '35.00', '0.00', 6, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215979976', 0, 'N', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('870450251', 'W12012210', 'W12012210', 'WYT1', 'The Eye Institute of Utah', 'Randy', 'L', 'Fuja', 'OD', 'Optometry', '', '', NULL, 'O', '2631 Foothill Blvd Ste A', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073624202', NULL, '2631 Foothill Blvd Ste A', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073624202', '          ', 'WYSTD', '', '', '0.00', '35.00', '0.00', 6, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215979976', 0, 'N', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('870450251', 'W12012211', 'W12012211', 'WYT1', 'The Eye Institute of Utah', 'Randy', 'L', 'Fuja', 'OD', 'Optometry', '', '', NULL, 'B', '755 E 3900 S', 'Murray', 'Salt Lake', 'UT', '84107', '3073624202', NULL, '755 E 3900 S', 'Murray', 'Salt Lake', 'UT', '84107', '3073624202', '          ', 'WYSTD', '', '', '0.00', '35.00', '0.00', 6, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215979976', 0, 'Y', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('010624198', 'W12012212', 'W12012212', 'TX01', 'Alamo Mental Health Group', 'James', 'R', 'Furlin', 'LMFT', 'Mental Health', 'Counseling', '', NULL, 'O', '4242 Medical Dr Ste 6300', 'San Antonio', 'Bexar', 'TX', '78229', '2106148400', NULL, '4242 Medical Dr Ste 6300', 'San Antonio', 'Bexar', 'TX', '78229', '2106148400', '', 'TXALAMOMA', '', '', '0.00', '35.00', '0.00', 6, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619987633', 0, 'N', 0, '2014-05-08', NULL, NULL, 29.5146, -98.5673, NULL, NULL),
('830332771', 'W12012213', 'W12012213', 'WYT1', 'ABC Pediatrics ', 'Deborah', 'Kim', 'Gardner', 'FNP', 'Pediatrics', 'Infectious Disease', '', NULL, 'O', '1300 W 4th St', 'Gillette', 'Campbell', 'WY', '82716', '3076864900', NULL, '1300 W 4th St', 'Gillette', 'Campbell', 'WY', '82716', '3076864900', '          ', '', '', '', '0.00', '6.50', '0.00', 3, '2011-06-28', '2013-09-18', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568669489', 0, 'N', 0, '2013-09-25', NULL, NULL, 0, 0, NULL, NULL),
('521486235', 'W12012214', 'W12012214', 'WYT1', 'Hanger Prosthetics & Orthotics Inc', '', '', 'Hanger Prosthetics & Orthotics Inc', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'o', '148 E Arapaho', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078645530', '3078643281', '148 E Arapaho', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078645530', '3078643281', 'WUDME5', '', '', '0.00', '35.00', '0.00', 3, '2011-06-28', '2012-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006560', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('521486235', 'W12012215', 'W12012215', 'WYT1', 'Hanger Prosthetics & Orthotics Inc', '', '', 'Hanger Prosthetics & Orthotics Inc', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'o', '557 Broadway', 'Sheridan', 'Sheridan', 'WY', '82801', '3076720497', '3076720480', '557 Broadway', 'Sheridan', 'Sheridan', 'WY', '82801', '3076720497', '3076720480', 'WUDME5', '', '', '0.00', '35.00', '0.00', 3, '2011-06-28', '2012-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006560', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('841271328', 'W12012216', 'W12012216', 'WYT1', '', 'Robert', 'S', 'Hanna', 'MD', 'Ophthalmology', '', '', NULL, 'O', '340 W Dow', 'Sheridan', 'Sheridan', 'WY', '82801', '3076731704', '          ', '340 W Dow', 'Sheridan', 'Sheridan', 'WY', '82801', '3076731704', '          ', 'WiseWYSTD', 'Wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2011-06-28', '2014-05-12', 0, 0, 0, 'Sheridan Memorial Hospital', '', '', '', 'HCFA|UB|', '1508908799', 0, 'N', 0, '2014-05-12', NULL, NULL, 0, 0, NULL, NULL),
('200070263', 'W12012217', 'W12012217', 'WYT1', 'Wind River OB/GYN ', 'Maryanne', 'A', 'Hannaney', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1005 College View Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078575217', NULL, '1005 College View Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078575217', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2011-06-28', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1497797260', 0, 'N', 0, '2012-01-17', NULL, NULL, 0, 0, NULL, NULL),
('273723626', 'W12012218', 'W12012218', 'WYT1', 'Family Circle Counseling', 'Janae', 'B', 'Harman', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'M', '1508 Coburn Ave', 'Worland', 'Washakie', 'WY', '82401', '3079212360', NULL, '1508 Coburn Ave', 'Worland', 'Washakie', 'WY', '82401', '3079212360', '          ', 'WYMA', '', '', '0.00', '35.00', '0.00', 3, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851627210', 0, 'N', 0, '2014-02-03', NULL, NULL, 0, 0, NULL, NULL),
('870393111', 'W12012219', 'W12012219', 'WYT1', 'Sweetwater Audiology', 'Stephen', 'B', 'Harward', 'AUD', 'Audiology', '', '', NULL, 'B', '425 E 5350 S Ste 120', 'Ogden', 'Weber', 'UT', '84405', '8014793346', NULL, '425 E 5350 S Ste 120', 'Ogden', 'Weber', 'UT', '84405', '8014793346', '', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609899459', 0, 'Y', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('870393111', 'W12012220', 'W12012220', 'WYT1', 'Sweetwater Audiology', 'Stephen', 'B', 'Harward', 'AUD', 'Audiology', '', '', NULL, 'O', '430 Broadway St Floor 2', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073628221', NULL, '430 Broadway St Floor 2', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073628221', '', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609899459', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('830283425', 'W12012221', 'W12012221', 'WYT1', 'North Platte Physical Therapy', 'Abby', 'L', 'Holwegner', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '311 Thelma Dr', 'Casper', 'Natrona', 'WY', '82609', '3072342662', '3072348810', '311 Thelma Dr', 'Casper', 'Natrona', 'WY', '82609', '3072342662', '3072348810', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720216294', 0, 'N', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('830283425', 'W12012222', 'W12012222', 'WYT1', 'North Platte Physical Therapy', 'Abby', 'L', 'Holwegner', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '3831 Denis Dr', 'Casper', 'Natrona', 'WY', '82604', '3072349067', '3072349074', '3831 Denis Dr', 'Casper', 'Natrona', 'WY', '82604', '3072349067', '3072349074', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720216294', 0, 'N', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('830283425', 'W12012223', 'W12012223', 'WYT1', 'North Platte Physical Therapy', 'Abby', 'L', 'Holwegner', 'OT', 'Occupational Therapy', '', '', NULL, 'B', 'PO Box 1790', 'Douglas', 'Converse', 'WY', '82633', '3072342662', '3072348810', 'PO Box 1790', 'Douglas', 'Converse', 'WY', '82633', '3072342662', '3072348810', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720216294', 0, 'N', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('830245718', 'W12012224', 'W12012224', 'WYT1', 'Northeast Wyoming Pediatric Associates', 'Marilyn', 'K', 'Horsley', 'PA-C', 'Pediatrics', '', '', NULL, 'O', '916 Jackson Ave', 'Sheridan', 'Sheridan', 'WY', '82801', '3076726451', NULL, '916 Jackson Ave', 'Sheridan', 'Sheridan', 'WY', '82801', '3076726451', '          ', '', '', '', '0.00', '15.00', '0.00', 3, '2011-06-28', NULL, 0, 0, 0, 'Sheridan Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1992782619', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('836000025', 'W12012226', 'W12012226', 'WYT1', 'Kinbrook Clinic of Interal Medicine and Pediatrics', 'Michelle', '', 'Kinbrook', 'MD', 'Pediatrics', '', '', NULL, 'O', '2221 W Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3073248255', '3073248236', '2221 W Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3073248255', '3073248236', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-07-01', NULL, 0, 0, 0, 'Memorial Hospital of Carbon County', '', '', '', 'HCFA|', '1801983523', 0, 'N', 0, '2011-12-22', NULL, NULL, 0, 0, NULL, NULL),
('830307192', 'W12012227', 'W12012227', 'WYT1', 'Powell Vision Clinic', 'Kim', 'A', 'Mcdowell', 'OD', 'Optometry', '', '', NULL, 'O', '106 S Absaroka', 'Powell', 'Park', 'WY', '82435', '3077542020', NULL, '106 S Absaroka', 'Powell', 'Park', 'WY', '82435', '3077542020', '          ', 'WiseWYSTD', 'Wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043385594', 0, 'N', 0, '2011-09-19', NULL, NULL, 0, 0, NULL, NULL),
('836000025', 'W12012228', 'W12012228', 'WYT1', 'Memorial Hospital of Carbon County', '', '', 'Memorial Hospital of Carbon County', 'GROUP', 'Hospital', '', '', NULL, 'O', '2221 W Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3073248252', NULL, '2221 W Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3073248252', '          ', '', '', '', '0.00', '27.00', '0.00', 6, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417031311', 0, 'N', 0, '2013-04-26', NULL, NULL, 0, 0, NULL, NULL),
('201523220', 'W12012229', 'W12012229', 'WYT1', 'Rawlins Eye Care', 'Scott', 'C', 'Neuman', 'OD', 'Optometry', '', '', NULL, 'O', '819 W Maple', 'Rawlins', 'Carbon', 'WY', '82301', '3073242219', NULL, '819 W Maple', 'Rawlins', 'Carbon', 'WY', '82301', '3073242219', '', 'WISEWYSTD', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780776369', 0, 'N', 0, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
('201523220', 'W12012230', 'W12012230', 'WYT1', 'Rawlins Eye Care', 'Scott', 'C', 'Neuman', 'OD', 'Optometry', '', '', NULL, 'B', 'PO Box 1001', 'Rawlins', 'Carbon', 'WY', '82301', '3073242219', NULL, 'PO Box 1001', 'Rawlins', 'Carbon', 'WY', '82301', '3073242219', '', 'WISEWYSTD', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780776369', 0, 'Y', 0, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
('205050083', 'W12012231', 'W12012231', 'WYT1', 'Wyoming Vision Center', 'F', 'John', 'Pembroke', 'OD', 'Optometry', '', '', NULL, 'O', '2820 Foothill Blvd', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073824444', NULL, '2820 Foothill Blvd', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073824444', '          ', 'WYSTD', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578582573', 0, 'N', 0, '2014-01-08', NULL, NULL, 0, 0, NULL, NULL),
('205050083', 'W12012232', 'W12012232', 'WYT1', 'Wyoming Vision Center', 'F', 'John', 'Pembroke', 'OD', 'Optometry', '', '', NULL, 'B', 'PO Box 2250', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073824444', NULL, 'PO Box 2250', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073824444', '          ', 'WYSTD', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578582573', 0, 'Y', 0, '2014-01-08', NULL, NULL, 0, 0, NULL, NULL),
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('820299231', 'W12012316', 'W12012316', 'ID02', 'Saltzer Medical Group Rehab', 'Kristyn', 'A', 'Schelhaas', 'DO', 'Family Practice', '', '', NULL, 'O', '290 W Georgia Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084633000', '2084633044', '290 W Georgia Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084633000', '2084633044', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-06-23', '2012-12-31', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1366453524', 0, 'N', 0, '2013-02-21', 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
('820299231', 'W12012317', 'W12012317', 'ID02', 'Saltzer Medical Group-Hearing & Balance', 'Kristyn', 'A', 'Schelhaas', 'DO', 'Family Practice', '', '', NULL, 'O', '210 W Georgia Ave Ste 100', 'Nampa', 'Canyon', 'ID', '83686', '2084633000', '2084633044', '210 W Georgia Ave Ste 100', 'Nampa', 'Canyon', 'ID', '83686', '2084633000', '2084633044', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-06-23', '2012-12-31', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1366453524', 0, 'N', 0, '2013-02-21', NULL, NULL, 43.5564, -116.575, NULL, NULL),
('820299231', 'W12012318', 'W12012318', 'ID02', 'Saltzer Medical Group-Sleep', 'Kristyn', 'A', 'Schelhaas', 'DO', 'Family Practice', '', '', NULL, 'O', '7272 W Potomac Dr', 'Boise', 'Ada', 'ID', '83704', '2084633000', '2082884987', '7272 W Potomac Dr', 'Boise', 'Ada', 'ID', '83704', '2084633000', '2082884987', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-06-23', '2012-12-31', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1366453524', 0, 'N', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12012319', 'W12012319', 'ID02', 'Saltzer Medical Group-Portico', 'Kristyn', 'A', 'Schelhaas', 'DO', 'Family Practice', '', '', NULL, 'O', '3277 E Louise Dr Ste 200', 'Meridian', 'Ada', 'ID', '83642', '2084633000', '2084633044', '3277 E Louise Dr Ste 200', 'Meridian', 'Ada', 'ID', '83642', '2084633000', '2084633044', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-06-23', '2012-12-31', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1366453524', 0, 'N', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12012320', 'W12012320', 'ID02', 'Saltzer Medical Group North', 'Kristyn', 'A', 'Schelhaas', 'DO', 'Family Practice', '', '', NULL, 'O', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084633000', '2084633044', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084633000', '2084633044', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-06-23', '2012-12-31', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1366453524', 0, 'N', 0, '2013-02-21', NULL, NULL, 43.5976, -116.517, NULL, NULL),
('942854057', 'W12012321', 'W12012321', 'UTPEHP', 'Bountiful Clinic', 'Kerry', 'S', 'Fisher', 'MD', 'General Surgery', '', '', NULL, 'O', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012941000', NULL, '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012941000', '          ', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932156346', 0, 'N', 0, '2011-07-12', NULL, NULL, 0, 0, NULL, NULL),
('870293873', 'W12012323', 'W12012323', 'UT01', 'Tri City Medical Clinic', 'Thad', 'J', 'Barkdull', 'MD', 'Family Practice', '', '', NULL, 'O', '275 W 200 N', 'Lindon', 'Utah', 'UT', '84042', '8017961333', '8017960625', '275 W 200 N', 'Lindon', 'Utah', 'UT', '84042', '8017961333', '8017960625', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-15', '2013-06-30', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1871524421', 0, 'N', 0, '2013-10-14', NULL, NULL, 0, 0, NULL, NULL),
('870293873', 'W12012322', 'W12012322', 'UT01', 'Tri City Medical Clinic', 'Thad', 'J', 'Barkdull', 'MD', 'Family Practice', '', '', NULL, 'O', '830 N 2000 W', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017563511', '8017561705', '830 N 2000 W', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017563511', '8017561705', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-15', '2013-06-30', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1871524421', 0, 'N', 0, '2013-10-14', NULL, NULL, 0, 0, NULL, NULL),
('830317012', 'W12012326', 'W12012326', 'WY01', 'Fremont Therapy Group ', 'Tammy', '', 'Bowers', 'PT', 'Physical Therapy', '', '', NULL, 'O', '2002 W Sunset Dr Ste 1', 'Riverton', 'Fremont', 'WY', '82501', '3078567021', '3078565546', '2002 W Sunset Dr Ste 1', 'Riverton', 'Fremont', 'WY', '82501', '3078567021', '3078565546', 'WYFREEM', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2011-11-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932415205', 0, 'N', 0, '2014-05-13', NULL, NULL, 43.0337, -108.417, NULL, NULL),
('830317012', 'W12012325', 'W12012325', 'WY01', 'Fremont Therapy Group', 'Tammy', '', 'Bowers', 'PT', 'Physical Therapy', '', '', NULL, 'O', '8168 Hwy 789', 'Lander', 'Fremont', 'WY', '82520', '3073325240', '3073325241', '8168 Hwy 789', 'Lander', 'Fremont', 'WY', '82520', '3073325240', '3073325241', 'WYFREEM', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2011-11-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932415205', 0, 'N', 0, '2014-05-13', NULL, NULL, 42.8352, -108.721, NULL, NULL),
('830317012', 'W12012327', 'W12012327', 'WYT1', 'Fremont Therapy Group ', 'Tammy', '', 'Bowers', 'PT', 'Physical Therapy', '', '', NULL, 'O', '2002 W Sunset Dr Ste 1', 'Riverton', 'Fremont', 'WY', '82501', '3078567021', '3078565546', '2002 W Sunset Dr Ste 1', 'Riverton', 'Fremont', 'WY', '82501', '3078567021', '3078565546', 'WYFREEM', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2011-11-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932415205', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('830317012', 'W12012324', 'W12012324', 'WYT1', 'Fremont Therapy Group', 'Tammy', '', 'Bowers', 'PT', 'Physical Therapy', '', '', NULL, 'O', '8168 Hwy 789', 'Lander', 'Fremont', 'WY', '82520', '3073325240', '3073325241', '8168 Hwy 789', 'Lander', 'Fremont', 'WY', '82520', '3073325240', '3073325241', 'WYFREEM', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2011-11-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932415205', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('371624924', 'W12012331', 'W12012331', 'UT01', 'Internal Med- Hematology- Hematologic Department of University of Utah', '', '', 'Internal Med- Hematology- Hematologic Department of University of Utah', 'Group', 'Clinics', '', '', NULL, 'O', '1950 E Cirlce of Hope Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015853229', NULL, '1950 E Cirlce of Hope Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015853229', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225325145', 0, 'N', 0, '2012-05-14', NULL, NULL, 40.7732, -111.837, NULL, NULL),
('371624924', 'W12012332', 'W12012332', 'UT01', 'Internal Med- Hematology- Hematologic Department of University of Utah', '', '', 'Internal Med- Hematology- Hematologic Department of University of Utah', 'Group', 'Clinics', '', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225325145', 0, 'N', 0, '2011-07-12', NULL, NULL, 0, 0, NULL, NULL),
('364692502', 'W12012336', 'W12012336', 'UT01', 'University Health Care', '', '', 'Internal Med- Cardiology- EP-  Department of University of Utah', 'Group', 'Clinics', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015853229', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015853229', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356637599', 0, 'N', 0, '2011-07-12', NULL, NULL, 0, 0, NULL, NULL),
('364692502', 'W12012334', 'W12012334', 'UT01', 'Internal Med- Cardiology- EP-  Department of University of Utah', '', '', 'Internal Med- Cardiology- EP-  Department of University of Utah', 'Group', 'Clinics', '', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356637599', 0, 'N', 0, '2011-07-12', NULL, NULL, 0, 0, NULL, NULL),
('870271413', 'W12012337', 'W12012337', 'UTMH1', 'Family Counseling Service', 'Sally', 'M', 'Anderson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '3518 Washington Blvd', 'Ogden', 'Weber', 'UT', '84403', '8013991600', '8013991640', '3518 Washington Blvd', 'Ogden', 'Weber', 'UT', '84403', '8013991600', '8013991640', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2011-11-15', '2013-02-14', 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1396966594', 0, 'N', 0, '2014-07-22', NULL, NULL, 0, 0, NULL, NULL),
('320340482', 'W12012338', 'W12012338', 'UT01', 'Perry Family Medicine', 'Cynthia', 'L', 'Duncan', 'NP', 'Family Practice', '', '', NULL, 'O', '1930 S Nighway 89', 'Brigham City', 'Box Elder', 'UT', '84302', '4357234500', '4357234504', '1930 S Nighway 89', 'Brigham City', 'Box Elder', 'UT', '84302', '4357234500', '4357234504', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-09-01', '2013-08-08', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922242262', 0, 'N', 0, '2013-08-20', NULL, NULL, 0, 0, NULL, NULL),
('830207671', 'W12012342', 'W12012342', 'WY01', 'West Park Hospital Surgical Clinic', 'William', 'S', 'Evans', 'MD', 'General Surgery', '', '', NULL, 'O', '424 Yellowstone Ave Ste 250', 'Cody', 'Park', 'WY', '82414', '3075782947', '3075782968', '424 Yellowstone Ave Ste 250', 'Cody', 'Park', 'WY', '82414', '3075782947', '3075782968', '', '', '', '0.00', '12.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1306819974', 0, 'N', 0, '2011-07-19', NULL, NULL, 44.517, -109.083, NULL, NULL),
('830207671', 'W12012339', 'W12012339', 'WY01', 'West Park Hospital District', 'William', 'S', 'Evans', 'MD', 'General Surgery', '', '', NULL, 'O', '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075782480', '3075782492', '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075782480', '3075782492', '', '', '', '0.00', '12.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1306819974', 0, 'N', 0, '2011-07-19', NULL, NULL, 44.526, -109.074, NULL, NULL),
('830207671', 'W12012340', 'W12012340', 'WYT2', 'West Park Hospital Surgical Clinic', 'William', 'S', 'Evans', 'MD', 'General Surgery', '', '', NULL, 'O', '424 Yellowstone Ave Ste 250', 'Cody', 'Park', 'WY', '82414', '3075782947', '3075782968', '424 Yellowstone Ave Ste 250', 'Cody', 'Park', 'WY', '82414', '3075782947', '3075782968', '', '', '', '0.00', '10.00', '0.00', 3, '2011-08-01', '2011-07-01', 0, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1306819974', 0, 'N', 0, '2011-07-19', NULL, NULL, 0, 0, NULL, NULL),
('830207671', 'W12012341', 'W12012341', 'WYT2', 'West Park Hospital District', 'William', 'S', 'Evans', 'MD', 'General Surgery', '', '', NULL, 'O', '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075782480', '3075782492', '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075782480', '3075782492', '', '', '', '0.00', '10.00', '0.00', 3, '2011-08-01', '2011-07-01', 0, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1306819974', 0, 'N', 0, '2011-07-19', NULL, NULL, 0, 0, NULL, NULL),
('202492084', 'W12012343', 'W12012343', 'UT01', 'Generations OBGYN', 'Randy', 'S', 'Heninger', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1492 W Antelope Dr Ste 206', 'Layton', 'Davis', 'UT', '84041', '8017760567', '8017760595', '1492 W Antelope Dr Ste 206', 'Layton', 'Davis', 'UT', '84041', '8017760567', '8017760595', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', '2011-07-30', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1164497988', 0, 'N', 1, '2012-12-11', NULL, NULL, 0, 0, NULL, NULL),
('954893928', 'W12012344', 'W12012344', 'UT01', 'Exodus Healthcare Network', 'Pragati', '', 'Hooda', 'MD', 'Family Practice', '', '', NULL, 'O', '3336 Pioneer Pkwy Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012509638', '8012503204', '3336 Pioneer Pkwy Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012509638', '8012503204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-10', '2014-05-30', 0, 0, 0, 'Pioneer Valley Hospital', '', '', '', 'HCFA|UB|', '1962735670', 0, 'N', 0, '2014-05-30', NULL, NULL, 40.6991, -111.99, NULL, NULL),
('954893928', 'W12012345', 'W12012345', 'UT01', 'Exodus Healthcare Network', 'Pragati', '', 'Hooda', 'MD', 'Family Practice', '', '', NULL, 'O', '3665 S 8400 W Ste 110', 'Magna', 'Salt Lake', 'UT', '84044', '8012509638', '8012503204', '3665 S 8400 W Ste 110', 'Magna', 'Salt Lake', 'UT', '84044', '8012509638', '8012503204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-10', NULL, 0, 0, 0, 'Pioneer Valley Hospital', '', '', '', 'HCFA|UB|', '1962735670', 0, 'N', 0, '2014-04-16', NULL, NULL, 40.6928, -112.092, NULL, NULL),
('272888596', 'W12012346', 'W12012346', 'ID01', 'Living Balance', 'Cathy', 'S', 'Kotter', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '1910 N Lakes Place', 'Meridian', 'Ada', 'ID', '83646', '2083422273', '2088985484', '1910 N Lakes Place', 'Meridian', 'Ada', 'ID', '83646', '2083422273', '2088985484', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2011-09-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124184114', 0, 'N', 0, '2014-05-06', NULL, NULL, 0, 0, NULL, NULL),
('870525882', 'W12012347', 'W12012347', 'UT01', 'Mountain View Anesthesia', 'Robert ', 'B', 'Monson', 'CRNA', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3750', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8014322648', '8014322668', 'PO Box 3750', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8014322648', '8014322668', '', '', '', '0.00', '23.00', '0.00', 3, '2011-11-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467598375', 0, 'N', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('870542403', 'W12013309', 'W12013309', 'UT01', 'Intermountain Anesthesia', 'Robert ', 'B', 'Monson', 'CRNA', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3930', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8017272086', '8014322668', 'PO Box 3930', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8017272086', '8014322668', '', '', '1000', '41.23', '0.00', '0.00', 6, '2011-11-10', NULL, 1, 12, 0, '', '', '', '', 'HCFA|UB|', '1467598375', 0, 'N', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('270852226', 'W12012351', 'W12012351', 'UT01', 'Silverton Group', 'Roopika', 'M', 'Reddy', 'MD', 'Hospitalist', '', '', NULL, 'O', '1050 E S Temple Floor 3', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504110', '8012961715', '1050 E S Temple Floor 3', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504110', '8012961715', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-10-01', '2011-10-01', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1760618516', 0, 'N', 0, '2013-03-06', NULL, NULL, 0, 0, NULL, NULL),
('270852226', 'W12012350', 'W12012350', 'UT01', 'Silverton Group', 'Roopika', 'M', 'Reddy', 'MD', 'Hospitalist', '', '', NULL, 'O', '401 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8012952361', '8012961715', '401 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8012952361', '8012961715', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-10-01', '2012-06-15', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1760618516', 0, 'N', 0, '2013-04-15', NULL, NULL, 0, 0, NULL, NULL),
('270852226', 'W12012349', 'W12012349', 'UT01', 'Silverton Group', 'Roopika', 'M', 'Reddy', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 1249', 'Bountiful', 'Davis', 'UT', '84011', '8012952361', '8012961715', 'PO Box 1249', 'Bountiful', 'Davis', 'UT', '84011', '8012952361', '8012961715', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-10-01', '2012-06-15', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1760618516', 0, 'N', 0, '2013-04-15', NULL, NULL, 0, 0, NULL, NULL),
('528536165', 'W12012352', 'W12012352', 'UTMH1', 'St. George Children and Family Psychiatric Center', 'Jacob', 'S', 'Roberts', 'NP', 'Mental Health', '', '', NULL, 'O', '437 S Bluff Ste 202', 'St George', 'Washington', 'UT', '84770', '4356521897', '4356749380', '437 S Bluff Ste 202', 'St George', 'Washington', 'UT', '84770', '4356521897', '4356749380', 'ARNP', '', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952696270', 0, 'N', 1, '2013-12-03', NULL, NULL, 0, 0, NULL, NULL),
('870484695', 'W12012353', 'W12012353', 'UT01', 'Delta Family Medicine', 'Matthew', 'W', 'Told', 'DO', 'Family Practice', '', '', NULL, 'O', '140 S White Sage Ave', 'Delta', 'Millard', 'UT', '84624', '4358643333', '4358642790', '140 S White Sage Ave', 'Delta', 'Millard', 'UT', '84624', '4358643333', '4358642790', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-10', NULL, 0, 0, 0, 'Delta Community Medical Center', '', '', '', 'HCFA|UB|', '1477718716', 0, 'N', 0, '2014-05-22', NULL, NULL, 39.3504, -112.56, NULL, NULL),
('870286381', 'W12012354', 'W12012354', 'UT01', 'Ogden Clinic', 'Carolyn', '', 'Belfry', 'MD', 'Family Practice', '', '', NULL, 'O', '1100 W 2700 N', 'Ogden', 'Weber', 'UT', '84414', '8014753600', '8014753601', '1100 W 2700 N', 'Ogden', 'Weber', 'UT', '84414', '8014753600', '8014753601', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-06-09', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1417944083', 0, 'N', 0, '2014-04-09', NULL, NULL, 41.3068, -112.007, NULL, NULL),
('621801973', 'W12012355', 'W12012355', 'UT01', 'Urology Specialists of Utah', 'Justin', 'P', 'Parkinson', 'MD', 'Urology', '', '', NULL, 'O', '3665 S 8400 W Ste 200', 'Magna', 'Salt Lake', 'UT', '84044', '8019551685', '8019630981', '3665 S 8400 W Ste 200', 'Magna', 'Salt Lake', 'UT', '84044', '8019551685', '8019630981', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-07-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', 'Salt Lake Regional Medical Center', 'Pioneer Valley Hospital', '', 'HCFA|UB|', '1851314066', 0, 'N', 0, '2014-06-17', NULL, NULL, 40.6928, -112.092, NULL, NULL),
('300473168', 'W12012356', 'W12012356', 'UTMH1', 'North Star Counseling', 'Holly', 'H', 'Lineback', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '1555 W Stratford Ave Ste 400', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014669469', '8014669469', '1555 W Stratford Ave Ste 400', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014669469', '8014669469', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2011-05-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982663597', 0, 'N', 0, '2013-04-12', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12012358', 'W12012358', 'WY01', '', 'Sherri', '', 'Blanchard', 'MD', 'Family Practice', '', '', NULL, 'B', '1405 W 4th St', 'Gillette', 'Campbell', 'WY', '82716', '3076882665', NULL, '1405 W 4th St', 'Gillette', 'Campbell', 'WY', '82716', '3076882665', '', '', '', '5001', '0.00', '0.00', '0.00', 6, '2011-08-01', '2013-08-31', 0, 0, 0, 'Campbell County Memorial Hospital', '', '', '', 'HCFA|UB|', '1730275835', 0, 'N', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12012357', 'W12012357', 'WY01', 'Cottonwood Clinic', 'Sherri', '', 'Blanchard', 'MD', 'Family Practice', '', '', NULL, 'O', '407 S Medical Arts Ct Ste F', 'Gillette', 'Campbell', 'WY', '82716', '3076821441', NULL, '407 S Medical Arts Ct Ste F', 'Gillette', 'Campbell', 'WY', '82716', '3076821441', '', '', '', '5001', '0.00', '0.00', '0.00', 6, '2011-08-01', '2013-06-27', 0, 0, 0, 'Campbell County Memorial Hospital', '', '', '', 'HCFA|UB|', '1730275835', 0, 'N', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12012359', 'W12012359', 'WYT2', '', 'Sherri', '', 'Blanchard', 'MD', 'Family Practice', '', '', NULL, 'B', '1405 W 4th St', 'Gillette', 'Campbell', 'WY', '82716', '3076882665', NULL, '1405 W 4th St', 'Gillette', 'Campbell', 'WY', '82716', '3076882665', '', '', '', '5001', '0.00', '0.00', '0.00', 6, '2011-08-01', '2011-08-01', 0, 0, 0, 'Campbell County Memorial Hospital', '', '', '', 'HCFA|UB|', '1730275835', 0, 'N', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12012360', 'W12012360', 'WYT2', '', 'Sherri', '', 'Blanchard', 'MD', 'Family Practice', '', '', NULL, 'O', '407 S Medical Arts Ct Ste F', 'Gillette', 'Campbell', 'WY', '82716', '3076882665', NULL, '407 S Medical Arts Ct Ste F', 'Gillette', 'Campbell', 'WY', '82716', '3076882665', '', '', '', '5001', '0.00', '0.00', '0.00', 6, '2011-08-01', '2011-08-01', 0, 0, 0, 'Campbell County Memorial Hospital', '', '', '', 'HCFA|UB|', '1730275835', 0, 'N', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12012362', 'W12012362', 'UT01', 'Associates in Orthopaedic Surgery', 'J', 'Douglas', 'Burrows', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-07-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1477506913', 0, 'N', 0, '2013-11-14', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12012361', 'W12012361', 'UT01', 'Associates in Orthopaedic Surgery', 'J', 'Douglas', 'Burrows', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '3665 S 8400 W Ste 200', 'Magna', 'Salt Lake', 'UT', '84044', '8019643925', '8019643928', '3665 S 8400 W Ste 200', 'Magna', 'Salt Lake', 'UT', '84044', '8019643925', '8019643928', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-07-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1477506913', 0, 'N', 0, '2013-11-14', NULL, NULL, 40.6928, -112.092, NULL, NULL),
('870635889', 'W12012363', 'W12012363', 'UT01', 'Tooele Clinic Corp', 'Marlee', 'K', 'Dalton', 'CNM', 'Obstetrics and Gynecology', 'Family Practice', '', NULL, 'M', 'PO Box 689022', 'Franklin', 'Williamson', 'TN', '37068', '4358821697', '4358826304', 'PO Box 689022', 'Franklin', 'Williamson', 'TN', '37068', '4358821697', '4358826304', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-07-13', NULL, 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB|', '1730175761', 0, 'Y', 0, '2014-03-28', NULL, NULL, 0, 0, NULL, NULL),
('870635889', 'W12012364', 'W12012364', 'UT01', 'Tooele Clinic Corp', 'Marlee', 'K', 'Dalton', 'CNM', 'Obstetrics and Gynecology', 'Family Practice', '', NULL, 'B', 'PO Box 848416', 'Boston', 'Suffolk', 'MA', '02284', '4358821697', '4358826304', 'PO Box 848416', 'Boston', 'Suffolk', 'MA', '02284', '4358821697', '4358826304', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-07-13', NULL, 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB|', '1730175761', 0, 'Y', 0, '2014-03-28', NULL, NULL, 0, 0, NULL, NULL),
('270285894', 'W12012365', 'W12012365', 'TX01', 'Mind Works', 'Mary', 'A', 'Dom', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '8207 Callaghan Rd Ste 240', 'San Antonio', 'Bexar', 'TX', '78230', '2103663700', '2103663700', '8207 Callaghan Rd Ste 240', 'San Antonio', 'Bexar', 'TX', '78230', '2103663700', '2103663700', 'MINDWORKSMA', '', '', '0.00', '100.00', '0.00', 6, '2011-07-01', '2012-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356507586', 0, 'N', 0, '2013-10-15', NULL, NULL, 0, 0, NULL, NULL),
('270285894', 'W12012366', 'W12012366', 'TX01', '', 'Anne', 'M', 'Esquivel', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '8207 Callaghan Rd Ste 240', 'San Antonio', 'Bexar', 'TX', '78230', '2103663700', NULL, '8207 Callaghan Rd Ste 240', 'San Antonio', 'Bexar', 'TX', '78230', '2103663700', '          ', 'MINDWORKSPHD', '', '', '0.00', '100.00', '0.00', 6, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285822379', 0, 'N', 0, '2011-07-13', NULL, NULL, 29.5141, -98.5496, NULL, NULL),
('201581429', 'W12012367', 'W12012367', 'UT01', 'Maternal Fetal Services of Utah', 'Melissa', 'A', 'Herbst', 'MD', 'Perinatology', '', '', NULL, 'O', '1140 E 3900 S Ste 390', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434700', '8017434705', '1140 E 3900 S Ste 390', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434700', '8017434705', 'Wise+', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1326199571', 0, 'N', 0, '2012-04-18', NULL, NULL, 40.6871, -111.859, NULL, NULL),
('201581429', 'W12012368', 'W12012368', 'UT01', 'Maternal Fetal Services of Utah', 'Melissa', 'A', 'Herbst', 'MD', 'Perinatology', '', '', NULL, 'B', 'PO Box 404496', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '8017434705', 'PO Box 404496', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '8017434705', 'Wise+', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1326199571', 0, 'N', 0, '2012-04-18', NULL, NULL, 0, 0, NULL, NULL),
('270285894', 'W12012370', 'W12012370', 'TX01', 'Mind Works', 'Tammy ', 'F', 'Hicks', 'LPC', 'Mental Health', '', '', NULL, 'O', '8207 Callaghan Rd Ste 240', 'San Antonio', 'Bexar', 'TX', '78230', '2103663700', '2103663700', '8207 Callaghan Rd Ste 240', 'San Antonio', 'Bexar', 'TX', '78230', '2103663700', '2103663700', 'MINDWORKSMA', '', '', '0.00', '100.00', '0.00', 6, '2011-07-01', '2012-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306172317', 0, 'N', 0, '2013-10-15', NULL, NULL, 0, 0, NULL, NULL),
('270285894', 'W12012371', 'W12012371', 'TX01', 'Mind Works', 'Erin', 'R', 'Porche', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '8207 Callaghan Rd Ste 240', 'San Antonio', 'Bexar', 'TX', '78230', '2103663700', '2103663700', '8207 Callaghan Rd Ste 240', 'San Antonio', 'Bexar', 'TX', '78230', '2103663700', '2103663700', 'MINDWORKSMA', '', '', '0.00', '100.00', '0.00', 6, '2011-07-01', '2012-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912210428', 0, 'N', 0, '2014-04-23', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12012373', 'W12012373', 'ID02', 'Family Medicine Health Center', 'Jennifer', 'L', 'Holliday', 'MD', 'Family Practice', '', '', NULL, 'O', '2321 E Gala St Ste 2', 'Meridian', 'Ada', 'ID', '83642', '2085142520', '2085142521', '2321 E Gala St Ste 2', 'Meridian', 'Ada', 'ID', '83642', '2085142520', '2085142521', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2011-07-13', '2012-12-25', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1538320676', 0, 'N', 0, '2013-01-18', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12012372', 'W12012372', 'ID02', 'Family Medicine Health Center', 'Jennifer', 'L', 'Holliday', 'MD', 'Family Practice', '', '', NULL, 'O', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '2083676123', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '2083676123', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2011-07-13', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1538320676', 0, 'N', 0, '2012-07-23', NULL, NULL, 0, 0, NULL, NULL),
('270285894', 'W12012374', 'W12012374', 'TX01', 'Mind Works', 'Jacqueline', 'L', 'Kappelman', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '8207 Callaghan Rd Ste 240', 'San Antonio', 'Bexar', 'TX', '78230', '2103663700', '2103663700', '8207 Callaghan Rd Ste 240', 'San Antonio', 'Bexar', 'TX', '78230', '2103663700', '2103663700', 'MINDWORKSMA', '', '', '0.00', '100.00', '0.00', 6, '2011-09-01', '2012-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962791228', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('836000182', 'W12012375', 'W12012375', 'WYT1', 'Hot Springs County Memorial Hospital', '', '', 'Hot Springs County Memorial Hospital', 'GROUP', 'Hospital', '', '', NULL, 'O', '150 E Arapahoe', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078643121', NULL, '150 E Arapahoe', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078643121', '          ', '', '', '', '0.00', '12.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006783', 0, 'N', 0, '2012-04-04', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12012377', 'W12012377', 'ID02', 'Family Medicine Residency of Idaho ', 'Derek', 'D', 'Jackson', '', 'Family Practice', '', '', NULL, 'O', '6094 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '2083752217', '6094 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '2083752217', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2011-08-01', '2012-04-05', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1225299357', 0, 'N', 0, '2012-04-05', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12012376', 'W12012376', 'ID02', 'Family Medicine Residency of Idaho ', 'Derek', 'D', 'Jackson', '', 'Family Practice', '', '', NULL, 'O', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '2083752217', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '2083752217', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2011-08-01', '2012-04-05', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1225299357', 0, 'N', 0, '2012-04-05', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12012379', 'W12012379', 'UT01', 'Central Utah Clinic PC', 'Richard', 'T', 'Jackson II', 'MD', 'Diagnostic Radiology', '', '', NULL, 'O', '1055 N 500 W Ste 112 Bldg C', 'Provo', 'Utah', 'UT', '84604', '8018124624', '8014290629', '1055 N 500 W Ste 112 Bldg C', 'Provo', 'Utah', 'UT', '84604', '8018124624', '8014290629', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-07-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922248202', 0, 'N', 0, '2013-04-09', NULL, NULL, 40.248, -111.667, NULL, NULL),
('870281028', 'W12012378', 'W12012378', 'UT01', 'Central Utah Clinic PC', 'Richard', 'T', 'Jackson II', 'MD', 'Diagnostic Radiology', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8018124624', '8014290629', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8018124624', '8014290629', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-07-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922248202', 0, 'N', 0, '2013-04-09', NULL, NULL, 0, 0, NULL, NULL),
('870443687', 'W12012381', 'W12012381', 'UT01', 'University Health Care', 'Tawni', 'L', 'Jetter', 'APRN', 'Cardiovascular Disease', '', '', NULL, 'o', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015857676', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015857676', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2010-04-13', '2012-08-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346579687', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('870443687', 'W12012380', 'W12012380', 'UT01', 'U-U Cardiology Division', 'Tawni', 'L', 'Jetter', 'APRN', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2010-04-13', '2012-08-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346579687', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('270285894', 'W12012382', 'W12012382', 'TX01', '', 'Randall', '', 'McGibeny', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '8207 Callaghan Rd Ste 240', 'San Antonio', 'Bexar', 'TX', '78230', '2103663700', NULL, '8207 Callaghan Rd Ste 240', 'San Antonio', 'Bexar', 'TX', '78230', '2103663700', '          ', 'MINDWORKSMA', '', '', '0.00', '100.00', '0.00', 6, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477729705', 0, 'N', 0, '2013-11-19', NULL, NULL, 29.5141, -98.5496, NULL, NULL),
('870333048', 'W12012383', 'W12012383', 'SIMPWISE', 'Mountain View Hospital', '', '', 'Mountain View Hospital', 'GROUP', 'Hospital', '', '', NULL, 'O', '1000 E 100 N', 'Payson', 'Utah', 'UT', '84651', '8014657000', NULL, '1000 E 100 N', 'Payson', 'Utah', 'UT', '84651', '8014657000', '          ', '', '', '', '0.00', '36.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487607669', 0, 'N', 0, '2011-07-13', NULL, NULL, 0, 0, NULL, NULL),
('870333048', 'W12012384', 'W12012384', 'SIMPWISE', 'Mountain View Hospital', '', '', 'Mountain View Hospital', 'GROUP', 'Hospital', '', '', NULL, 'B', 'PO Box 409636', 'Atlanta', 'Fulton', 'GA', '30384', '8014659201', NULL, 'PO Box 409636', 'Atlanta', 'Fulton', 'GA', '30384', '8014659201', '          ', '', '', '', '0.00', '36.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487607669', 0, 'N', 0, '2011-07-13', NULL, NULL, 0, 0, NULL, NULL),
('621650578', 'W12012385', 'W12012385', 'SIMPWISE', 'Ogden Regional Medical Center', '', '', 'Ogden Regional Medical Center', 'GROUP', 'Hospital', '', '', NULL, 'O', '5475 S 500 E', 'Ogden', 'Weber', 'UT', '84405', '8014792111', NULL, '5475 S 500 E', 'Ogden', 'Weber', 'UT', '84405', '8014792111', '          ', '', '', '', '0.00', '36.00', '0.00', 6, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'UB|', '1720031636', 0, 'N', 0, '2011-07-13', NULL, NULL, 0, 0, NULL, NULL),
('621650578', 'W12012386', 'W12012386', 'SIMPWISE', 'Ogden Regional Medical Center', '', '', 'Ogden Regional Medical Center', 'GROUP', 'Hospital', '', '', NULL, 'B', 'PO Box 409654', 'Atlanta', 'Fulton', 'GA', '30384', '8014792922', NULL, 'PO Box 409654', 'Atlanta', 'Fulton', 'GA', '30384', '8014792922', '          ', '', '', '', '0.00', '36.00', '0.00', 6, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'UB|', '1720031636', 0, 'N', 0, '2011-07-13', NULL, NULL, 0, 0, NULL, NULL),
('621831495', 'W12012387', 'W12012387', 'SIMPWISE', 'Timpanogos Regional Hospital', '', '', 'Timpanogos Regional Hospital', 'GROUP', 'Hospital', '', '', NULL, 'O', '750 W 800 N', 'Orem', 'Utah', 'UT', '84057', '8017146000', NULL, '750 W 800 N', 'Orem', 'Utah', 'UT', '84057', '8017146000', '          ', '', '', '', '0.00', '36.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497702195', 0, 'N', 0, '2011-07-13', NULL, NULL, 0, 0, NULL, NULL),
('621831495', 'W12012388', 'W12012388', 'SIMPWISE', 'Timpanogos Regional Hospital', '', '', 'Timpanogos Regional Hospital', 'GROUP', 'Hospital', '', '', NULL, 'B', 'PO Box 31172', 'Tampa', 'Hillsborough', 'FL', '33631', '8002604905', NULL, 'PO Box 31172', 'Tampa', 'Hillsborough', 'FL', '33631', '8002604905', '          ', '', '', '', '0.00', '36.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497702195', 0, 'N', 0, '2011-07-13', NULL, NULL, 0, 0, NULL, NULL),
('352262646', 'W12012389', 'W12012389', 'SIMPWISE', 'Synergies Surgery Center LP dba Mt Olympus Surgery Center', '', '', 'Synergies Surgery Center LP dba Mt Olympus Surgery Center', 'GROUP', 'Ambulatory Surgery Center', '', '', NULL, 'O', '348 E 4500 S', 'Salt Lake City', 'Salt Lake', 'UT', '84115', '8016856400', NULL, '348 E 4500 S', 'Salt Lake City', 'Salt Lake', 'UT', '84115', '8016856400', '          ', '', '', '', '0.00', '31.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008978', 0, 'N', 0, '2011-07-13', NULL, NULL, 0, 0, NULL, NULL),
('621449273', 'W12012390', 'W12012390', 'SIMPWISE', 'St Marks Outpatient Surgery Center', '', '', 'St Marks Outpatient Surgery Center', 'GROUP', 'Ambulatory Surgery Center', '', '', NULL, 'O', '1250 E 3900 S Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012620358', NULL, '1250 E 3900 S Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012620358', '          ', '', '', '', '0.00', '31.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000830868', 0, 'N', 0, '2011-07-13', NULL, NULL, 0, 0, NULL, NULL),
('621600427', 'W12012391', 'W12012391', 'SIMPWISE', 'Wasatch Endoscopy Center', '', '', 'Wasatch Endoscopy Center', 'GROUP', 'Endoscopy Center', '', '', NULL, 'O', '1220 E 3900 S Ste 1B', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012813657', NULL, '1220 E 3900 S Ste 1B', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012813657', '          ', '', '', '', '0.00', '31.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1881701290', 0, 'N', 0, '2011-07-13', NULL, NULL, 0, 0, NULL, NULL),
('621600427', 'W12012392', 'W12012392', 'SIMPWISE', 'Wasatch Endoscopy Center', '', '', 'Wasatch Endoscopy Center', 'GROUP', 'Endoscopy Center', '', '', NULL, 'B', 'PO Box 402311', 'Atlanta', 'Fulton', 'GA', '30384', '8012813657', NULL, 'PO Box 402311', 'Atlanta', 'Fulton', 'GA', '30384', '8012813657', '          ', '', '', '', '0.00', '31.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1881701290', 0, 'N', 0, '2011-07-13', NULL, NULL, 0, 0, NULL, NULL),
('562601697', 'W12012393', 'W12012393', 'SIMPWISE', 'South Towne Surgery Center', '', '', 'South Towne Surgery Center', 'GROUP', 'Ambulatory Surgery Center', '', '', NULL, 'O', '10011 S Centennial Pkwy Ste 100', 'Sandy', 'Salt Lake', 'UT', '84094', '8012339300', NULL, '10011 S Centennial Pkwy Ste 100', 'Sandy', 'Salt Lake', 'UT', '84094', '8012339300', '          ', '', '', '', '0.00', '31.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598772634', 0, 'N', 0, '2011-07-13', NULL, NULL, 0, 0, NULL, NULL),
('621650573', 'W12012394', 'W12012394', 'SIMPWISE', 'St Marks Hospital', '', '', 'St Marks Hospital', 'GROUP', 'Hospital', '', '', NULL, 'O', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687111', NULL, '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687111', '          ', '', '', '', '0.00', '36.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000830877', 0, 'N', 0, '2011-07-13', NULL, NULL, 0, 0, NULL, NULL),
('621650573', 'W12012395', 'W12012395', 'SIMPWISE', 'St Marks Hospital Lone Peak Emergencey Center', '', '', 'St Marks Hospital', 'GROUP', 'Hospital', '', '', NULL, 'O', '74 E Kimballs Ln Ste 100', 'Draper', 'Salt Lake', 'UT', '84020', '8012687111', NULL, '74 E Kimballs Ln Ste 100', 'Draper', 'Salt Lake', 'UT', '84020', '8012687111', '          ', '', '', '', '0.00', '36.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000830877', 0, 'Y', 0, '2011-07-13', NULL, NULL, 0, 0, NULL, NULL),
('621650573', 'W12012396', 'W12012396', 'SIMPWISE', 'St Marks Hospital', '', '', 'St Marks Hospital', 'GROUP', 'Hospital', '', '', NULL, 'B', 'PO Box 409655', 'Atlanta', 'Fulton', 'GA', '30384', '7028551012', '7028551013', 'PO Box 409655', 'Atlanta', 'Fulton', 'GA', '30384', '7028551012', '7028551013', '', '', '', '0.00', '36.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000830877', 0, 'N', 0, '2011-07-13', NULL, NULL, 0, 0, NULL, NULL),
('721537787', 'W12012397', 'W12012397', 'WY01', 'Lander Family Medicine', 'Susan', 'M', 'Pearson', 'MD', 'Family Practice', '', '', NULL, 'O', '8185 S Hwy 789', 'Lander', 'Fremont', 'WY', '82520', '3073321551', NULL, '8185 S Hwy 789', 'Lander', 'Fremont', 'WY', '82520', '3073321551', '          ', 'WY130', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1245289511', 0, 'N', 0, '2012-05-07', NULL, NULL, 42.8352, -108.721, NULL, NULL),
('721537787', 'W12012398', 'W12012398', 'WYT1', 'Lander Family Medicine', 'Susan', 'M', 'Pearson', 'MD', 'Family Practice', '', '', NULL, 'O', '8185 S Hwy 789', 'Lander', 'Fremont', 'WY', '82520', '3073321551', NULL, '8185 S Hwy 789', 'Lander', 'Fremont', 'WY', '82520', '3073321551', '          ', 'WY130', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1245289511', 0, 'N', 0, '2012-05-07', NULL, NULL, 0, 0, NULL, NULL),
('721537787', 'W12012399', 'W12012399', 'WY01', 'Lander Family Medicine', 'Steve', '', 'Platz', 'PA', 'Family Practice', '', '', NULL, 'O', '8160 S Hwy 789', 'Lander', 'Fremont', 'WY', '82520', '3073321551', NULL, '8160 S Hwy 789', 'Lander', 'Fremont', 'WY', '82520', '3073321551', '          ', 'WY130', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1376638338', 0, 'N', 0, '2011-07-13', NULL, NULL, 42.835, -108.721, NULL, NULL),
('721537787', 'W12012400', 'W12012400', 'WYT1', 'Lander Family Medicine', 'Steve', '', 'Platz', 'PA', 'Family Practice', '', '', NULL, 'O', '8160 S Hwy 789', 'Lander', 'Fremont', 'WY', '82520', '3073321551', NULL, '8160 S Hwy 789', 'Lander', 'Fremont', 'WY', '82520', '3073321551', '          ', 'WY130', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1376638338', 0, 'N', 0, '2011-07-13', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12012401', 'W12012401', 'UT01', 'Specialty Surgery of Utah', 'Aaron', '', 'Rabinovich', 'MD', 'General Surgery', '', '', NULL, 'O', '3665 S 8400 W Ste 200', 'Magna', 'Salt Lake', 'UT', '84044', '8019643855', '8019643860', '3665 S 8400 W Ste 200', 'Magna', 'Salt Lake', 'UT', '84044', '8019643855', '8019643860', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053364067', 0, 'N', 0, '2012-06-29', NULL, NULL, 40.6928, -112.092, NULL, NULL),
('621795214', 'W12012402', 'W12012402', 'SIMPWISE', 'Salt Lake Regional Medical Center', '', '', 'Salt Lake Regional Medical Center', 'GROUP', 'Hospital', '', '', NULL, 'O', '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504111', NULL, '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504111', '          ', '', '', '', '0.00', '52.00', '0.00', 6, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417988833', 0, 'N', 0, '2011-07-13', NULL, NULL, 0, 0, NULL, NULL),
('621795214', 'W12012403', 'W12012403', 'SIMPWISE', 'Salt Lake Regional Medical Center', '', '', 'Salt Lake Regional Medical Center', 'GROUP', 'Hospital', '', '', NULL, 'B', 'PO Box 26935', 'Salt Lake City', 'Salt Lake', 'UT', '84126', '8013508141', NULL, 'PO Box 26935', 'Salt Lake City', 'Salt Lake', 'UT', '84126', '8013508141', '          ', '', '', '', '0.00', '52.00', '0.00', 6, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417988833', 0, 'Y', 0, '2011-07-13', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12012404', 'W12012404', 'UT01', 'Associates in Orthopaedic Surgery', 'Peter', '', 'Silvero', '', 'Orthopedic Surgery', '', '', NULL, 'O', '3665 S 8400 W Ste 200', 'Magna', 'Salt Lake', 'UT', '84044', '8019643925', '8019643928', '3665 S 8400 W Ste 200', 'Magna', 'Salt Lake', 'UT', '84044', '8019643925', '8019643928', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-07-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1699844001', 0, 'N', 0, '2013-11-14', NULL, NULL, 40.6928, -112.092, NULL, NULL),
('830128950', 'W12012405', 'W12012405', 'WYT1', 'South Lincoln Nursing Center', '', '', 'South Lincoln Nursing Center', 'GROUP', '', '', '', NULL, 'O', '711 Onyx St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078774401', NULL, '711 Onyx St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078774401', '          ', '', '', '1', '0.00', '12.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008834', 0, 'N', 0, '2011-07-20', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12012407', 'W12012407', 'UT01', 'Rock Run Medical', 'Micheal ', 'S', 'Dawson', '', 'Family Practice', '', '', NULL, 'O', '5991 S 3500 W Ste 400', 'Roy', 'Weber', 'UT', '84067', '8017732838', '8017733025', '5991 S 3500 W Ste 400', 'Roy', 'Weber', 'UT', '84067', '8017732838', '8017733025', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-05-17', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376853036', 0, 'N', 0, '2011-07-28', NULL, NULL, 41.1545, -112.064, NULL, NULL),
('621801973', 'W12012408', 'W12012408', 'UT01', 'Rock Run Medical', 'Micheal ', 'S', 'Dawson', '', 'Family Practice', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-05-17', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376853036', 0, 'N', 0, '2011-07-28', NULL, NULL, 0, 0, NULL, NULL),
('830207671', 'W12012409', 'W12012409', 'WYT1', 'West Park Hospital District', 'William', 'S', 'Evans', 'MD', 'General Surgery', '', '', NULL, 'O', '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075782480', '3075782492', '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075782480', '3075782492', '', '', '', '0.00', '12.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1306819974', 0, 'N', 0, '2011-07-19', NULL, NULL, 0, 0, NULL, NULL),
('830207671', 'W12012410', 'W12012410', 'WYT1', 'West Park Hospital Surgical Clinic', 'William', 'S', 'Evans', 'MD', 'General Surgery', '', '', NULL, 'O', '424 Yellowstone Ave Ste 250', 'Cody', 'Park', 'WY', '82414', '3075782947', '3075782968', '424 Yellowstone Ave Ste 250', 'Cody', 'Park', 'WY', '82414', '3075782947', '3075782968', '', '', '', '0.00', '12.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1306819974', 0, 'N', 0, '2011-07-19', NULL, NULL, 0, 0, NULL, NULL),
('270288410', 'W12012540', 'W12012540', 'UT01', '', 'Clark', 'J', 'Staheli', 'MD', 'Family Practice', '', '', NULL, 'O', '8555 N Hwy 18', 'Dammeron Valley', 'Washington', 'UT', '84783', '4355742546', '4355742619', '8555 N Hwy 18', 'Dammeron Valley', 'Washington', 'UT', '84783', '4355742546', '4355742619', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568505691', 0, 'N', 0, '2013-10-30', NULL, NULL, 37.3114, -113.675, NULL, NULL),
('830207671', 'W12012411', 'W12012411', 'WYT1', 'West Park Hospital District ', 'Lisa', 'E', 'Harvey', 'MD', 'Family Practice', '', '', NULL, 'O', '424 Yellowstone Ave Ste 120', 'Cody', 'Park', 'WY', '82414', '3075787207', '3075782937', '424 Yellowstone Ave Ste 120', 'Cody', 'Park', 'WY', '82414', '3075787207', '3075782937', '', '', '', '0.00', '12.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1477527299', 0, 'N', 0, '2014-04-10', NULL, NULL, 0, 0, NULL, NULL),
('830207671', 'W12012412', 'W12012412', 'WYT1', 'West Park Hospital Disctrict ', 'Lisa', 'E', 'Harvey', 'MD', 'Family Practice', '', '', NULL, 'B', '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075787207', '3075782937', '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075787207', '3075782937', '', '', '', '0.00', '12.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1477527299', 0, 'N', 0, '2014-04-10', NULL, NULL, 0, 0, NULL, NULL),
('830207671', 'W12012413', 'W12012413', 'WYT1', 'West Park Hospital District', 'Matthew', '', 'Hopkins', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075277501', NULL, '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075277501', '          ', '', '', '', '0.00', '12.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1194816439', 0, 'N', 0, '2011-07-20', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12012414', 'W12012414', 'UT01', 'Pioneer Valley Multi Specialty Clinic', 'Lori', 'R', 'Swenson', 'MD', 'General Surgery', '', '', NULL, 'O', '3665 S 8400 W Ste 260', 'Magna', 'Salt Lake', 'UT', '84044', '8019643855', '8019643860', '3665 S 8400 W Ste 260', 'Magna', 'Salt Lake', 'UT', '84044', '8019643855', '8019643860', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-07-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1972534279', 0, 'N', 0, '2011-09-29', NULL, NULL, 40.6928, -112.092, NULL, NULL),
('830207671', 'W12012415', 'W12012415', 'WYT1', 'West Park Hospital District', 'Kyle', '', 'Tilden', 'MD', 'Urgent Care', '', '', NULL, 'O', '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075277501', NULL, '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075277501', '          ', '', '', '', '0.00', '12.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009101', 0, 'Y', 0, '2011-07-21', NULL, NULL, 0, 0, NULL, NULL),
('870443687', 'W12012417', 'W12012417', 'UT01', 'University Health Care', 'Theresa', 'A', 'Ularich', 'APRN', 'Cardiovascular Disease', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015857676', '8015877290', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015857676', '8015877290', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-10-10', '2012-08-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134208606', 0, 'N', 0, '2012-08-30', 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
('870443687', 'W12012416', 'W12012416', 'UT01', 'U-U Cardiology Division', 'Theresa', 'A', 'Ularich', 'APRN', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-10-10', '2012-08-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134208606', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12012418', 'W12012418', 'ID02', 'Family Medicine Health Center', 'Hilary', 'A', 'Warren', 'MD', 'Pediatrics', '', '', NULL, 'O', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '2083752217', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '2083752217', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1972515054', 0, 'N', 0, '2014-06-05', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12012419', 'W12012419', 'ID02', 'Family Medicine Health Center', 'Hilary', 'A', 'Warren', 'MD', 'Pediatrics', '', '', NULL, 'O', '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083816102', '2083811776', '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083816102', '2083811776', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1972515054', 0, 'N', 0, '2014-06-05', NULL, NULL, 0, 0, NULL, NULL),
('830207671', 'W12012420', 'W12012420', 'WYT1', 'West Park Hospital District', '', '', 'West Park Hospital District', 'GROUP', 'Hospital', '', '', NULL, 'O', '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075277501', NULL, '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075277501', '          ', '', '', '', '0.00', '12.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009575', 0, 'Y', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12012421', 'W12012421', 'UT01', 'Associates in Orthopedic Surgery', 'Bret', '', 'Winter', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '3665 S 8400 W Ste 200', 'Magna', 'Salt Lake', 'UT', '84044', '8019643925', '8019643928', '3665 S 8400 W Ste 200', 'Magna', 'Salt Lake', 'UT', '84044', '8019643925', '8019643928', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-07-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1427252865', 0, 'N', 0, '2012-01-30', NULL, NULL, 40.6928, -112.092, NULL, NULL),
('621801973', 'W12012422', 'W12012422', 'UT01', 'Associates in Orthopedic Surgery', 'Bret', '', 'Winter', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-07-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1427252865', 0, 'N', 0, '2012-01-30', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W12012532', 'W12012532', 'UTIHC04', '', 'Jared', '', 'Pikus', 'MD', 'Family Practice', '', '', NULL, 'O', '674 S Hwy 99', 'Fillmore', 'Millard', 'UT', '84631', '4357435591', NULL, '674 S Hwy 99', 'Fillmore', 'Millard', 'UT', '84631', '4357435591', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2011-07-01', '2013-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164650289', 0, 'N', 0, '2013-06-13', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12012533', 'W12012533', 'UTIHC04', '', 'Mark', 'W', 'Corry', 'MD', 'Urgent Care', 'Family Practice', '', NULL, 'O', '126 S White Sage Ave', 'Delta', 'Millard', 'UT', '84624', '4358645591', NULL, '126 S White Sage Ave', 'Delta', 'Millard', 'UT', '84624', '4358645591', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2011-07-01', NULL, 0, 0, 0, 'Valley View Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1033347158', 0, 'Y', 0, '2012-05-29', NULL, NULL, 39.3506, -112.56, NULL, NULL),
('942854057', 'W12012534', 'W12012534', 'UTIHC04', '', 'Mark', 'W', 'Corry', 'MD', 'Urgent Care', 'Family Practice', '', NULL, 'O', '674 S Hwy 99', 'Hooper', 'Weber', 'UT', '84315', '4357435591', NULL, '674 S Hwy 99', 'Hooper', 'Weber', 'UT', '84315', '4357435591', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2011-07-01', NULL, 0, 0, 0, 'Valley View Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1033347158', 0, 'N', 0, '2012-05-29', NULL, NULL, 0, 0, NULL, NULL),
('870550968', 'W12012537', 'W12012537', 'UT01', '', 'April', 'M', 'Greener', 'NP', 'Family Practice', '', '', NULL, 'O', '1551 S Renaissance Town Dr', 'Bountiful', 'Davis', 'UT', '84010', '8013872090', '8013876606', '1551 S Renaissance Town Dr', 'Bountiful', 'Davis', 'UT', '84010', '8013872090', '8013876606', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952608028', 0, 'N', 0, '2011-11-11', NULL, NULL, 40.8737, -111.888, NULL, NULL),
('870550968', 'W12012535', 'W12012535', 'UT01', '', 'April', 'M', 'Greener', 'NP', 'Family Practice', '', '', NULL, 'O', '4403 Harrison Blvd Ste 1875', 'Ogden', 'Weber', 'UT', '84403', '8013872090', '8013876606', '4403 Harrison Blvd Ste 1875', 'Ogden', 'Weber', 'UT', '84403', '8013872090', '8013876606', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952608028', 0, 'N', 0, '2011-11-11', NULL, NULL, 41.1828, -111.949, NULL, NULL),
('870550968', 'W12012536', 'W12012536', 'UT01', '', 'April', 'M', 'Greener', 'NP', 'Family Practice', '', '', NULL, 'B', 'PO Box 27688', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8015341360', NULL, 'PO Box 27688', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8015341360', '          ', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952608028', 0, 'N', 0, '2011-11-11', NULL, NULL, 0, 0, NULL, NULL),
('621762573', 'W12012538', 'W12012538', 'UT01', 'Eastern Utah Ear, Nose, and Throat', 'Erik ', 'M', 'Lyman', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '945 W Hospital Dr Ste 1', 'Price', 'Carbon', 'UT', '84501', '4356374327', '4356139709', '945 W Hospital Dr Ste 1', 'Price', 'Carbon', 'UT', '84501', '4356374327', '4356139709', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-10', NULL, 0, 0, 0, 'Castleview Hospital', 'Castleview Hospital', NULL, NULL, 'HCFA|UB|', '1568680122', 0, 'N', 0, '2011-11-11', NULL, NULL, 39.6064, -110.834, NULL, NULL),
('742962755', 'W12012545', 'W12012545', 'Group', '', '', '', 'Stone Oaks Peds', '', 'Pediatrics', '', '', NULL, '', 'Change', 'San Antonio', 'Bexar', 'TX', '78258', '          ', NULL, 'Change', 'San Antonio', 'Bexar', 'TX', '78258', '          ', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '0000000148', 0, 'Y', 0, '2012-06-29', NULL, NULL, 0, 0, NULL, NULL),
('830182821', 'W12012546', 'W12012546', 'WY01', 'Gottsche Rehabilitation Center', 'William', '', 'Lemke', 'PT', 'Physical Therapy', '', '', NULL, 'O', '148 E Arapahoe', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078642146', '3078642857', '148 E Arapahoe', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078642146', '3078642857', '', '', '', '0.00', '10.00', '0.00', 3, '2011-11-10', '2012-12-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912145376', 0, 'N', 0, '2014-05-01', NULL, NULL, 43.6474, -108.2, NULL, NULL),
('830182821', 'W12012547', 'W12012547', 'WYT2', 'Gottsche Rehabilitation Center', 'William', '', 'Lemke', 'PT', 'Physical Therapy', '', '', NULL, 'O', '148 E Arapahoe', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078642146', '3078642857', '148 E Arapahoe', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078642146', '3078642857', '', '', '', '0.00', '10.00', '0.00', 3, '2011-11-10', '2012-12-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912145376', 0, 'N', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
('830128950', 'W12012548', 'W12012548', 'WY01', 'South Lincoln Medical Center', '', '', 'South Lincoln Medical Center', 'GROUP', 'Hospital', '', '', NULL, 'O', '711 Onyx St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078774401', NULL, '711 Onyx St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078774401', '          ', '', '', '1', '0.00', '12.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008830', 0, 'N', 0, '2011-07-20', NULL, NULL, 41.7896, -110.54, NULL, NULL),
('830128950', 'W12012549', 'W12012549', 'WY01', 'South Lincoln Medical Center Home Oxygen/Swing Bed', '', '', 'South Lincoln Medical Center Home Oxygen/Swing Bed', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '711 Onyx St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078774401', NULL, '711 Onyx St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078774401', '          ', '', '', '1', '0.00', '12.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008831', 0, 'Y', 0, '2011-07-20', NULL, NULL, 41.7896, -110.54, NULL, NULL),
('830128950', 'W12012550', 'W12012550', 'WYT1', 'South Lincoln Medical Center Swing Bed', '', '', 'South Lincoln Medical Center Swing Bed', 'GROUP', '', '', '', NULL, 'O', '711 Onyx St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078774401', NULL, '711 Onyx St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078774401', '          ', '', '', '1', '0.00', '12.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008832', 0, 'Y', 0, '2011-07-20', NULL, NULL, 0, 0, NULL, NULL),
('830128950', 'W12012551', 'W12012551', 'WY01', 'South Lincoln Medical Center Swing Bed', '', '', 'South Lincoln Medical Center Swing Bed', 'GROUP', '', '', '', NULL, 'O', '711 Onyx St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078774401', NULL, '711 Onyx St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078774401', '          ', '', '', '1', '0.00', '12.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008832', 0, 'Y', 0, '2011-07-20', NULL, NULL, 41.7896, -110.54, NULL, NULL),
('830128950', 'W12012552', 'W12012552', 'WY01', 'South Lincoln Nursing Center', '', '', 'South Lincoln Nursing Center', 'GROUP', '', '', '', NULL, 'O', '711 Onyx St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078774401', NULL, '711 Onyx St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078774401', '          ', '', '', '1', '0.00', '12.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008834', 0, 'N', 0, '2012-01-26', NULL, NULL, 41.7896, -110.54, NULL, NULL),
('830207671', 'W12012553', 'W12012553', 'WY01', 'West Park Hospital District', '', '', 'West Park Hospital District', 'GROUP', 'Hospital', '', '', NULL, 'O', '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075277501', NULL, '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075277501', '          ', '', '', '', '0.00', '12.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009575', 0, 'Y', 0, '2013-06-28', NULL, NULL, 44.526, -109.074, NULL, NULL),
('836000182', 'W12012554', 'W12012554', 'WY01', 'Hot Springs County Memorial Hospital', '', '', 'Hot Springs County Memorial Hospital', 'GROUP', 'Hospital', '', '', NULL, 'O', '150 E Arapahoe', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078643121', NULL, '150 E Arapahoe', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078643121', '          ', '', '', '', '0.00', '12.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006783', 0, 'N', 0, '2012-04-04', NULL, NULL, 43.6474, -108.2, 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
('836000891', 'W12012555', 'W12012555', 'WY01', 'North Big Horn Hospital', '', '', 'North Big Horn Hospital', 'GROUP', 'Hospital', '', '', NULL, 'O', '1115 Ln 12', 'Lovell', 'Big Horn', 'WY', '82431', '3075485201', NULL, '1115 Ln 12', 'Lovell', 'Big Horn', 'WY', '82431', '3075485201', '          ', '', '', '', '0.00', '12.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007899', 0, 'Y', 0, '2013-08-07', NULL, NULL, 44.8258, -108.39, NULL, NULL),
('870618431', 'W12012556', 'W12012556', 'UT01', 'Providence Family Medicine', 'Lars', '', 'Bergeson', 'MD', 'Family Practice', '', '', NULL, 'O', '382 W 280 N', 'Providence', 'Cache', 'UT', '84332', '4357520330', '4357550922', '382 W 280 N', 'Providence', 'Cache', 'UT', '84332', '4357520330', '4357550922', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1497721195', 0, 'N', 0, '2014-01-22', NULL, NULL, 41.7134, -111.827, NULL, NULL),
('870284475', 'W12011377', 'W12011377', 'UT01', 'Granger Medical Clinic', 'Gerald ', '', 'Berrett', 'PA', 'Pain Management', '', '', NULL, 'O', '3181 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8013525900', '8013525914', '3181 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8013525900', '8013525914', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245367630', 0, 'N', 0, '2011-07-20', NULL, NULL, 40.5877, -111.967, NULL, NULL),
('870284475', 'W12011378', 'W12011378', 'UT01', 'Granger Medical Clinic', 'Gerald ', '', 'Berrett', 'PA', 'Pain Management', '', '', NULL, 'O', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019653600', '8013525914', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019653600', '8013525914', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245367630', 0, 'N', 0, '2011-07-20', NULL, NULL, 40.682, -111.979, NULL, NULL),
('870284475', 'W12011379', 'W12011379', 'UT01', 'Granger Medical Clinic', 'Gerald ', '', 'Berrett', 'PA', 'Pain Management', '', '', NULL, 'B', 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '8013525900', '8013525914', 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '8013525900', '8013525914', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245367630', 0, 'N', 0, '2011-07-20', NULL, NULL, 0, 0, NULL, NULL),
('830182821', 'W12012557', 'W12012557', 'WYT2', 'Gottsche Rehabilitation Center', 'Jeri', '', 'Black-Farber', 'PT', 'Physical Therapy', '', '', NULL, 'O', '148 E Arapahoe', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078642146', '3078642857', '148 E Arapahoe', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078642146', '3078642857', '', '', '', '0.00', '10.00', '0.00', 3, '2011-08-01', '2014-06-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083694483', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('830182821', 'W12012558', 'W12012558', 'WYT2', 'Gottsche Rehabilitation Center', 'Jeri', '', 'Black-Farber', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 790', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078642146', '3078642857', 'PO Box 790', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078642146', '3078642857', '', '', '', '0.00', '10.00', '0.00', 3, '2011-08-01', '2014-06-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083694483', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'W12012005', 'W12012005', 'UT01', 'Granger Medical Clinic', 'Malinda', '', 'Christensen', 'PA', 'Family Practice', '', '', NULL, 'O', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019653608', '8019653740', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019653608', '8019653740', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285812586', 0, 'N', 0, '2012-10-01', NULL, NULL, 40.682, -111.979, NULL, NULL),
('870284475', 'W12012006', 'W12012006', 'UT01', 'Granger Medical Clinic', 'Malinda', '', 'Christensen', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '8019653720', '8019653740', 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '8019653720', '8019653740', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285812586', 0, 'N', 0, '2012-10-01', NULL, NULL, 0, 0, NULL, NULL),
('710871556', 'W12012561', 'W12012561', 'UT01', 'Providence Family Medicine', 'Kevin', 'R', 'Duke', 'DO', 'Family Practice', NULL, NULL, NULL, 'O', '382 W 280 N', 'Providence', 'Cache', 'UT', '84332', '4357520330', '4357550922', '382 W 280 N', 'Providence', 'Cache', 'UT', '84332', '4357520330', '4357550922', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1003882713', 0, 'N', 0, '2013-10-28', NULL, NULL, 41.7134, -111.827, NULL, NULL),
('870284475', 'W12012008', 'W12012008', 'UT01', 'Granger Medical Clinic', 'Natalie', '', 'Evans-Dahle', 'PA-C', 'Family Practice', '', '', NULL, 'O', '12391 S 4000 W', 'Riverton', 'Salt Lake', 'UT', '84065', '8013021700', '8013021714', '12391 S 4000 W', 'Riverton', 'Salt Lake', 'UT', '84065', '8013021700', '8013021714', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053627737', 0, 'N', 0, '2011-10-26', NULL, NULL, 40.5226, -111.987, NULL, NULL),
('870284475', 'W12012007', 'W12012007', 'UT01', 'Granger Medical Clinic', 'Natalie', '', 'Evans-Dahle', 'PA-C', 'Family Practice', '', '', NULL, 'O', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019653424', '8019653740', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019653424', '8019653740', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053627737', 0, 'N', 0, '2011-10-26', NULL, NULL, 40.682, -111.979, NULL, NULL),
('870284475', 'W12012009', 'W12012009', 'UT01', 'Granger Medical Clinic', 'Natalie', '', 'Evans-Dahle', 'PA-C', 'Family Practice', '', '', NULL, 'B', 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '8019653720', '8019653740', 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '8019653720', '8019653740', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053627737', 0, 'N', 0, '2011-10-26', NULL, NULL, 0, 0, NULL, NULL),
('741849254', 'W12012562', 'W12012562', 'TX01', 'Southeast Surgical Associates', 'Oluwamayowa', 'F', 'Familua', 'MD', 'General Surgery', '', '', NULL, 'O', '4242 E Southcross Blvd Ste 1', 'San Antonio', 'Bexar', 'TX', '78222', '2103337510', '2103331912', '4242 E Southcross Blvd Ste 1', 'San Antonio', 'Bexar', 'TX', '78222', '2103337510', '2103331912', 'TXSURGB', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2011-09-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1063714970', 0, 'N', 0, '2013-05-22', NULL, NULL, 29.374, -98.4109, NULL, NULL),
('741849254', 'W12012563', 'W12012563', 'TX01', 'Southeast Surgical Associates', 'Oluwamayowa', 'F', 'Familua', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 23409', 'San Antonio', 'Bexar', 'TX', '78223', '2103337510', NULL, 'PO Box 23409', 'San Antonio', 'Bexar', 'TX', '78223', '2103337510', '          ', 'TXSURGB', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2011-09-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1063714970', 0, 'N', 0, '2013-05-22', NULL, NULL, 0, 0, NULL, NULL),
('223887117', 'W12012564', 'W12012564', 'WYT1', 'Mountain Valley Eye Institute', 'John', 'B', 'Fassio', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '196 Arrowhead Dr Ste 5', 'Evanston', 'Uinta', 'WY', '82930', '8774232020', NULL, '196 Arrowhead Dr Ste 5', 'Evanston', 'Uinta', 'WY', '82930', '8774232020', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-06-28', NULL, 0, 0, 0, 'Evanston Regional Hospital', 'Heber Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1689671638', 0, 'N', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('836000891', 'W12012566', 'W12012566', 'WY01', 'North Big Horn Hospital Clinic', 'Mary', '', 'Freund', 'NP', 'Family Practice', '', '', NULL, 'O', '1115 Ln 12', 'Lovell', 'Big Horn', 'WY', '82431', '3075485201', NULL, '1115 Ln 12', 'Lovell', 'Big Horn', 'WY', '82431', '3075485201', '          ', '', '', '', '0.00', '12.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1134231558', 0, 'N', 0, '2013-12-04', NULL, NULL, 44.8258, -108.39, NULL, NULL),
('203276415', 'W12012567', 'W12012567', 'ID01', 'Ada West Dermatology', 'Alisa', 'A', 'Funke', 'MD', 'Dermatology', '', '', NULL, 'O', '1618 S Millennium Way Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2088843376', '2088840858', '1618 S Millennium Way Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2088843376', '2088840858', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-07-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831229871', 0, 'N', 0, '2014-04-16', NULL, NULL, 43.5903, -116.368, NULL, NULL),
('836000891', 'W12012568', 'W12012568', 'WY01', 'North Big Horn Hospital Clinic', 'Derek', '', 'Gilbert', 'MD', 'Family Practice', '', '', NULL, 'O', '1115 Ln 12', 'Lovell', 'Big Horn', 'WY', '82431', '3075485201', NULL, '1115 Ln 12', 'Lovell', 'Big Horn', 'WY', '82431', '3075485201', '          ', '', '', '', '0.00', '12.00', '0.00', 3, '2011-07-01', '2012-03-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477665925', 0, 'N', 0, '2012-04-27', NULL, NULL, 0, 0, NULL, NULL),
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('836000891', 'W12012577', 'W12012577', 'WY01', 'North Big Horn Hospital Clinic', 'David', '', 'Hoffman', 'MD', 'Family Practice', 'General Surgery', '', NULL, 'O', '1115 Lane 12', 'Lovell', 'Big Horn', 'WY', '82431', '3075485201', NULL, '1115 Lane 12', 'Lovell', 'Big Horn', 'WY', '82431', '3075485201', '          ', '', '', '', '0.00', '12.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1144332552', 0, 'N', 0, '2013-06-18', NULL, NULL, 44.8258, -108.39, NULL, NULL),
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('621801973', 'W12012582', 'W12012582', 'UT01', 'Physician Group of Utah', 'Kimberly', 'S', 'Larson', '', 'Orthopedic Surgery', '', '', NULL, 'O', '82 S 1100 E Ste 303', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015332002', '8013239546', '82 S 1100 E Ste 303', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015332002', '8013239546', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-07-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1982614723', 0, 'N', 0, '2013-07-10', NULL, NULL, 40.7676, -111.86, NULL, NULL),
('621801973', 'W12012583', 'W12012583', 'UT01', 'Physician Group of Utah', 'Kimberly', 'S', 'Larson', '', 'Orthopedic Surgery', '', '', NULL, 'O', '9350 S 150 E Ste 460', 'Sandy', 'Salt Lake', 'UT', '84070', '8015332002', '8013239546', '9350 S 150 E Ste 460', 'Sandy', 'Salt Lake', 'UT', '84070', '8015332002', '8013239546', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-07-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1982614723', 0, 'N', 0, '2013-07-10', NULL, NULL, 40.5814, -111.887, NULL, NULL),
('621801973', 'W12012584', 'W12012584', 'UT01', 'Physician Group of Utah', 'Kimberly', 'S', 'Larson', '', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-07-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1982614723', 0, 'N', 0, '2013-07-10', NULL, NULL, 0, 0, NULL, NULL),
('070348665', 'W12012585', 'W12012585', 'UTMH1', '', 'Gerald', 'M', 'Lazar', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '6925 Union Park Ctr Ste 245', 'Midvale', 'Salt Lake', 'UT', '84047', '8017462297', '8017482554', '6925 Union Park Ctr Ste 245', 'Midvale', 'Salt Lake', 'UT', '84047', '8017462297', '8017482554', 'UTMD', '', '', '0.00', '35.00', '0.00', 8, '2011-05-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003883349', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870635889', 'W12012586', 'W12012586', 'UT01', 'Tooele Clinic Corp', 'Jeffrey ', 'D', 'Lee', 'MD', 'Family Practice', '', '', NULL, 'O', '210 Millpond Rd', 'Tooele', 'Tooele', 'UT', '84074', '4358433647', '4357759272', '210 Millpond Rd', 'Tooele', 'Tooele', 'UT', '84074', '4358433647', '4357759272', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-07-01', '2011-10-18', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639221526', 0, 'N', 0, '2011-10-19', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12012588', 'W12012588', 'WY01', 'OB/GYN Specialists', 'Amber', 'R', 'Cohn', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1414 W 4th St', 'Gillette', 'Campbell', 'WY', '82716', '3076886658', '3076868190', '1414 W 4th St', 'Gillette', 'Campbell', 'WY', '82716', '3076886658', '3076868190', '', '', '5001', '0.00', '0.00', '0.00', 6, '2011-09-01', NULL, 1, 0, 0, 'Campbell County Memorial Hospital', '', '', '', 'HCFA|UB|', '1265475420', 0, 'N', 0, '2014-04-17', NULL, NULL, 44.291, -105.523, NULL, NULL),
('830234097', 'W12012589', 'W12012589', 'WY01', 'OB/GYN Specialists', 'Amber', 'R', 'Cohn', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1405 W 4th St', 'Gillette', 'Campbell', 'WY', '82716', '3076886658', '3076868190', '1405 W 4th St', 'Gillette', 'Campbell', 'WY', '82716', '3076886658', '3076868190', '', '', '5001', '0.00', '0.00', '0.00', 6, '2011-09-01', '2013-08-31', 0, 0, 0, 'Campbell County Memorial Hospital', '', '', '', 'HCFA|UB|', '1265475420', 0, 'N', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
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('204872226', 'W12012598', 'W12012598', 'UT01', 'Providence Family Medicine', 'Richard', 'T', 'Stevens', 'MD', 'Family Practice', '', '', NULL, 'O', '382 W 280 N', 'Providence', 'Cache', 'UT', '84332', '4357520330', '4357550922', '382 W 280 N', 'Providence', 'Cache', 'UT', '84332', '4357520330', '4357550922', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1790739449', 0, 'N', 0, '2014-04-16', NULL, NULL, 41.7134, -111.827, NULL, NULL),
('870308023', 'W12012599', 'W12012599', 'UT01', 'Middleton Urological Associates', 'Lisa', '', 'Stout', 'MD', 'Urology', NULL, NULL, NULL, 'O', '181 E 5600 S Ste 130', 'Murray', 'Salt Lake', 'UT', '84107', '8012668664', '8012649031', '181 E 5600 S Ste 130', 'Murray', 'Salt Lake', 'UT', '84107', '8012668664', '8012649031', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1548263213', 0, 'N', 0, '2011-08-23', NULL, NULL, 40.6492, -111.886, NULL, NULL),
('830207671', 'W12012600', 'W12012600', 'WY01', 'West Park Hospital District', 'Kyle', '', 'Tilden', 'MD', 'Urgent Care', '', '', NULL, 'O', '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075277501', NULL, '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075277501', '          ', '', '', '', '0.00', '12.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009101', 0, 'Y', 0, '2011-07-21', NULL, NULL, 44.526, -109.074, NULL, NULL),
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('621801973', 'W12012602', 'W12012602', 'UT01', 'Associates in Orthopedic Surgery', 'David', 'M', 'Witter', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8013843479', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8013843479', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-07-01', '2013-05-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518992510', 0, 'N', 0, '2013-05-23', NULL, NULL, 0, 0, NULL, NULL),
('271285997', 'W12012603', 'W12012603', 'UT01', 'University OB/GYN', 'Thomas', 'E', 'Judd', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1355 N University Ave Ste 110', 'Provo', 'Utah', 'UT', '84604', '8013745000', '8013740077', '1355 N University Ave Ste 110', 'Provo', 'Utah', 'UT', '84604', '8013745000', '8013740077', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1740210756', 0, 'N', 0, '2013-10-22', NULL, NULL, 40.2519, -111.659, NULL, NULL),
('421566166', 'W12012604', 'W12012604', 'ID01', 'Eagle Pediatrics', 'Alan', 'P', 'Miller', 'MD', 'Pediatrics', '', '', NULL, 'O', '125 N Sterman Way Ste A', 'Eagle', 'Ada', 'ID', '83616', '2089394880', '2089395003', '125 N Sterman Way Ste A', 'Eagle', 'Ada', 'ID', '83616', '2089394880', '2089395003', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2011-08-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659329928', 0, 'N', 0, '2014-06-25', NULL, NULL, 0, 0, NULL, NULL),
('518170623', 'W12012605', 'W12012605', 'ID02', 'Advanced Therapy Care', 'Allyson', '', 'Overton', 'SLP', 'Speech Therapy', '', '', NULL, 'O', '1550 N Crestmont Ste E', 'Meridian', 'Ada', 'ID', '83642', '2088980988', '2088989022', '1550 N Crestmont Ste E', 'Meridian', 'Ada', 'ID', '83642', '2088980988', '2088989022', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2011-09-01', '2011-09-15', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1346474681', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('518170623', 'W12012606', 'W12012606', 'ID02', 'Advanced Therapy Care', 'Allyson', '', 'Overton', 'SLP', 'Speech Therapy', '', '', NULL, 'O', '245 N Thrid E', 'Mountain Home', 'Elmore', 'ID', '83647', '2085878255', '2085874475', '245 N Thrid E', 'Mountain Home', 'Elmore', 'ID', '83647', '2085878255', '2085874475', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2011-09-01', '2011-09-15', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1346474681', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('651229319', 'W12012607', 'W12012607', 'UT01', 'Spinal Interventions PLLC', 'J ', 'R', 'Stringham', 'MD', 'Pain Management', 'Anesthesia', '', NULL, 'O', '280 W  River Park Dr Ste 200', 'Provo', 'Utah', 'UT', '84604', '8012234860', '8013718993', '280 W  River Park Dr Ste 200', 'Provo', 'Utah', 'UT', '84604', '8012234860', '8013718993', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-11-10', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1588872691', 0, 'N', 0, '2014-04-17', NULL, NULL, 40.3037, -111.662, NULL, NULL),
('651229319', 'W12012608', 'W12012608', 'UT01', 'Spinal Interventions PLLC', 'J ', 'R', 'Stringham', 'MD', 'Pain Management', 'Anesthesia', '', NULL, 'O', '39 S Professional Way Ste 2', 'Payson', 'Utah', 'UT', '84651', '8012234860', '8013718993', '39 S Professional Way Ste 2', 'Payson', 'Utah', 'UT', '84651', '8012234860', '8013718993', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-11-10', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1588872691', 0, 'N', 0, '2014-04-17', NULL, NULL, 40.0442, -111.712, NULL, NULL),
('870271413', 'W12012609', 'W12012609', 'UTMH1', 'Family Counseling Services', 'Curtis', 'W', 'Watson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '3518 Washington Blvd', 'Ogden', 'Weber', 'UT', '84403', '8013991600', '8013991640', '3518 Washington Blvd', 'Ogden', 'Weber', 'UT', '84403', '8013991600', '8013991640', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2011-11-10', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477681245', 0, 'N', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12012612', 'W12012612', 'ID02', 'Saltzer Medical Group Rehab', 'Patricia', 'M', 'Buersmeyer', 'MD', 'Internal Medicine', '', '', NULL, 'O', '290 W Georgia Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084633000', '2084633044', '290 W Georgia Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084633000', '2084633044', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-06-23', '2012-12-31', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1104816198', 0, 'N', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12012613', 'W12012613', 'ID02', 'Saltzer Medical Group- Caldwell', 'Patricia', 'M', 'Buersmeyer', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1818 S 10th Ave Ste 120 or Ste 220', 'Caldwell', 'Canyon', 'ID', '83605', '2084633000', '2084633044', '1818 S 10th Ave Ste 120 or Ste 220', 'Caldwell', 'Canyon', 'ID', '83605', '2084633000', '2084633044', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-06-23', '2012-12-31', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1104816198', 0, 'N', 0, '2013-02-21', NULL, NULL, 43.6538, -116.693, NULL, NULL),
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('820476912', 'W12012611', 'W12012611', 'ID02', 'Two Rivers Medical Clinic', 'Lore', '', 'Wootton', 'MD', 'Family Practice', '', '', NULL, 'O', '683 E 3rd St', 'Weiser', 'Washington', 'ID', '83672', '2085490211', '2085490104', '683 E 3rd St', 'Weiser', 'Washington', 'ID', '83672', '2085490211', '2085490104', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-05-26', NULL, 0, 0, 1, NULL, '', '', '', 'HCFA|UB|', '1649365404', 0, 'N', 0, '2011-07-21', NULL, NULL, 0, 0, NULL, NULL),
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INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('820299231', 'W12012658', 'W12012658', 'ID02', 'Saltzer Medical Group- Caldwell', 'Andrew', 'R', 'Curran', 'DO', 'Orthopedic Surgery', '', '', NULL, 'O', '1818 S 10th Ave Ste 120 or Ste 220', 'Caldwell', 'Canyon', 'ID', '83605', '2084633000', '2084633044', '1818 S 10th Ave Ste 120 or Ste 220', 'Caldwell', 'Canyon', 'ID', '83605', '2084633000', '2084633044', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-06-23', '2012-11-11', 0, 0, 1, 'Saint Alphonsus Regional Medical Center', 'Saint Alphonsus Medical Center Nampa', '', '', 'HCFA|UB|', '1093705071', 0, 'N', 0, '2014-03-20', NULL, NULL, 43.6538, -116.693, NULL, NULL),
('820299231', 'W12012659', 'W12012659', 'ID02', 'Saltzer Medical Group North', 'Andrew', 'R', 'Curran', 'DO', 'Orthopedic Surgery', '', '', NULL, 'O', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084633000', '2084633044', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084633000', '2084633044', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-06-23', '2012-11-11', 0, 0, 1, 'Saint Alphonsus Regional Medical Center', 'Saint Alphonsus Medical Center Nampa', '', '', 'HCFA|UB|', '1093705071', 0, 'Y', 0, '2014-03-20', NULL, NULL, 43.5976, -116.517, NULL, NULL),
('820299231', 'W12012660', 'W12012660', 'ID02', 'Saltzer Medical Group-Sleep', 'Andrew', 'R', 'Curran', 'DO', 'Orthopedic Surgery', '', '', NULL, 'O', '7272 W Potomac Dr', 'Boise', 'Ada', 'ID', '83704', '2084633000', '2084633044', '7272 W Potomac Dr', 'Boise', 'Ada', 'ID', '83704', '2084633000', '2084633044', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-06-23', '2012-11-11', 0, 0, 1, 'Saint Alphonsus Regional Medical Center', 'Saint Alphonsus Medical Center Nampa', '', '', 'HCFA|UB|', '1093705071', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12012661', 'W12012661', 'ID02', 'Saltzer Medical Group Portico ', 'Andrew', 'R', 'Curran', 'DO', 'Orthopedic Surgery', '', '', NULL, 'O', '3277 E Louise Dr Ste 200', 'Meridian', 'Ada', 'ID', '83642', '2088842920', '2088842979', '3277 E Louise Dr Ste 200', 'Meridian', 'Ada', 'ID', '83642', '2088842920', '2088842979', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-06-23', '2012-11-11', 0, 0, 1, 'Saint Alphonsus Regional Medical Center', 'Saint Alphonsus Medical Center Nampa', '', '', 'HCFA|UB|', '1093705071', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('202809445', 'W12012662', 'W12012662', 'ID02', '', 'Mark', 'A', 'Spelich', 'MD; Jnt Replc/Recon, Genrl, Foot/Ankle, Peds', 'Orthopedic Surgery', '', '', NULL, 'O', '7979 W Rifleman Dr', 'Boise', 'Ada', 'ID', '83704', '2088552410', '2088550157', '7979 W Rifleman Dr', 'Boise', 'Ada', 'ID', '83704', '2088552410', '2088550157', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2008-10-01', '2014-02-04', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1972513083', 0, 'N', 0, '2014-02-26', NULL, NULL, 0, 0, NULL, NULL),
('202809445', 'W12012663', 'W12012663', 'SACN', '', 'Mark', 'A', 'Spelich', 'MD; Jnt Replc/Recon, Genrl, Foot/Ankle, Peds', 'Orthopedic Surgery', '', '', NULL, 'O', '7979 W Rifleman Dr', 'Boise', 'Ada', 'ID', '83704', '2088552410', '2088550157', '7979 W Rifleman Dr', 'Boise', 'Ada', 'ID', '83704', '2088552410', '2088550157', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-01-01', '2014-02-04', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1972513083', 0, 'N', 0, '2014-02-26', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12012664', 'W12012664', 'ID02', 'Saltzer Medical Group Rehab', 'Michael', 'B', 'Aldous', 'MD', 'Pediatrics', '', '', NULL, 'O', '290 W Georgia Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084633000', '2084633044', '290 W Georgia Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084633000', '2084633044', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-06-23', '2012-12-31', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1386616431', 0, 'N', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12012665', 'W12012665', 'ID02', 'Saltzer Medical Group- Caldwell', 'Michael', 'B', 'Aldous', 'MD', 'Pediatrics', '', '', NULL, 'O', '1818 S 10th Ave Ste 120 or Ste 220', 'Caldwell', 'Canyon', 'ID', '83605', '2084633000', '2084633044', '1818 S 10th Ave Ste 120 or Ste 220', 'Caldwell', 'Canyon', 'ID', '83605', '2084633000', '2084633044', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-06-23', '2012-12-31', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1386616431', 0, 'N', 0, '2013-02-21', NULL, NULL, 43.6538, -116.693, NULL, NULL),
('820299231', 'W12012666', 'W12012666', 'ID02', 'Saltzer Medical Group North', 'Michael', 'B', 'Aldous', 'MD', 'Pediatrics', '', '', NULL, 'O', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084633000', '2084633044', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084633000', '2084633044', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-06-23', '2012-12-31', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1386616431', 0, 'N', 0, '2013-02-21', NULL, NULL, 43.5976, -116.517, NULL, NULL),
('820299231', 'W12012667', 'W12012667', 'ID02', 'Saltzer Medical Group-Portico', 'Michael', 'B', 'Aldous', 'MD', 'Pediatrics', '', '', NULL, 'O', '3277 E Louise Dr Ste 200', 'Meridian', 'Ada', 'ID', '83642', '2084633000', '2084633044', '3277 E Louise Dr Ste 200', 'Meridian', 'Ada', 'ID', '83642', '2084633000', '2084633044', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-06-23', '2012-12-31', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1386616431', 0, 'N', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12012668', 'W12012668', 'ID02', 'Saltzer Medical Group-Sleep', 'Michael', 'B', 'Aldous', 'MD', 'Pediatrics', '', '', NULL, 'O', '7272 W Potomac Dr', 'Boise', 'Ada', 'ID', '83704', '2084633000', '2084633044', '7272 W Potomac Dr', 'Boise', 'Ada', 'ID', '83704', '2084633000', '2084633044', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-06-23', '2012-12-31', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1386616431', 0, 'N', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL),
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('820299231', 'W12012674', 'W12012674', 'ID02', 'Saltzer Medical Group- Caldwell', 'Brandy', 'N', 'Welch', 'MD', 'Pediatrics', '', '', NULL, 'O', '1818 S 10th Ave Ste 120 or Ste 220', 'Caldwell', 'Canyon', 'ID', '83605', '2084633000', '2084633044', '1818 S 10th Ave Ste 120 or Ste 220', 'Caldwell', 'Canyon', 'ID', '83605', '2084633000', '2084633044', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-06-23', '2012-12-31', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1528057544', 0, 'N', 0, '2013-09-04', NULL, NULL, 43.6538, -116.693, NULL, NULL),
('820299231', 'W12012677', 'W12012677', 'ID02', 'Saltzer Medical Group-Hearing & Balance', 'Brandy', 'N', 'Welch', 'MD', 'Pediatrics', '', '', NULL, 'O', '210 W Georgia Ave Ste 100', 'Nampa', 'Canyon', 'ID', '83686', '2084633000', '2084633044', '210 W Georgia Ave Ste 100', 'Nampa', 'Canyon', 'ID', '83686', '2084633000', '2084633044', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-06-23', '2012-12-31', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1528057544', 0, 'N', 0, '2013-09-04', NULL, NULL, 43.5564, -116.575, NULL, NULL),
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('820299231', 'W12012676', 'W12012676', 'ID02', 'Saltzer Medical Group-Sleep', 'Brandy', 'N', 'Welch', 'MD', 'Pediatrics', '', '', NULL, 'O', '7272 W Potomac Dr', 'Boise', 'Ada', 'ID', '83704', '2084633000', '2084633044', '7272 W Potomac Dr', 'Boise', 'Ada', 'ID', '83704', '2084633000', '2084633044', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-06-23', '2012-12-31', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1528057544', 0, 'N', 0, '2013-09-04', NULL, NULL, 0, 0, NULL, NULL),
('820444934', 'W12012679', 'W12012679', 'ID02', 'Boise Physical Medicine and Rehabilitation', 'Arden', '', 'Mahaffey', 'DO', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '1000 N Curtis Ste 202', 'Boise', 'Ada', 'ID', '83706', '2083773435', '2083773147', '1000 N Curtis Ste 202', 'Boise', 'Ada', 'ID', '83706', '2083773435', '2083773147', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-06-23', '2013-10-01', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1891017190', 0, 'N', 0, '2013-11-15', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12012680', 'W12012680', 'ID02', 'Saltzer Medical Group- Caldwell', 'Sarah', 'C', 'Maddux', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '1818 S 10th Ave Ste 120 or Ste 220', 'Caldwell', 'Canyon', 'ID', '83605', '2084633000', '2084633044', '1818 S 10th Ave Ste 120 or Ste 220', 'Caldwell', 'Canyon', 'ID', '83605', '2084633000', '2084633044', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-05-26', '2012-12-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1518155662', 0, 'N', 0, '2013-02-21', NULL, NULL, 43.6538, -116.693, NULL, NULL),
('820299231', 'W12012681', 'W12012681', 'ID02', 'Saltzer Medical Group North', 'Sarah', 'C', 'Maddux', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084633000', '2084633044', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084633000', '2084633044', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-05-26', '2012-12-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1518155662', 0, 'N', 0, '2013-02-21', NULL, NULL, 43.5976, -116.517, NULL, NULL),
('820299231', 'W12012682', 'W12012682', 'ID02', 'Saltzer Medical Group-Portico', 'Sarah', 'C', 'Maddux', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '3277 E Louise Dr Ste 200', 'Meridian', 'Ada', 'ID', '83642', '2084633000', '2084633044', '3277 E Louise Dr Ste 200', 'Meridian', 'Ada', 'ID', '83642', '2084633000', '2084633044', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-05-26', '2012-12-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1518155662', 0, 'N', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W12012741', 'W12012741', 'UTIHCPHY', 'Park City Specialty East', 'G David', '', 'Munday', 'MD', 'Urology', '', '', NULL, 'O', '750 Round Valley Dr Ste 101', 'Park City', 'Summit', 'UT', '84060', '4356587246', '4356587456', '750 Round Valley Dr Ste 101', 'Park City', 'Summit', 'UT', '84060', '4356587246', '4356587456', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235108432', 0, 'N', 0, '2014-07-09', NULL, NULL, 40.6855, -111.466, NULL, NULL),
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('320202382', 'W12012778', 'W12012778', 'UTDT01', 'Childrens Dental', 'Bren', '', 'Dixon', 'DMD', 'Pedodontist', '', '', NULL, 'O', '2746 E 850 N', 'St George', 'Washington', 'UT', '84790', '4356737776', NULL, '2746 E 850 N', 'St George', 'Washington', 'UT', '84790', '4356737776', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004209', 0, 'N', 0, '2011-07-28', NULL, NULL, 0, 0, NULL, NULL),
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('205103691', 'W12012791', 'W12012791', 'UTDT01', 'Main Plaza Dental', 'John', '', 'Peterson', 'DDS', 'Dentist', '', '', NULL, 'O', '312 N Main St', 'Spanish Fork', 'Utah', 'UT', '84660', '8017949684', NULL, '312 N Main St', 'Spanish Fork', 'Utah', 'UT', '84660', '8017949684', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000008161', 0, 'N', 0, '2011-07-28', NULL, NULL, 0, 0, NULL, NULL),
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('275027918', 'W12012795', 'W12012795', 'UTDT01', 'Murdock & Searle Family Dentistry', 'Bruce T', '', 'Murdock', 'DDS', 'Dentist', '', '', NULL, 'O', '356 E 20 S', 'American Fork', 'Utah', 'UT', '84003', '8017564595', NULL, '356 E 20 S', 'American Fork', 'Utah', 'UT', '84003', '8017564595', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000007766', 0, 'N', 0, '2012-01-20', NULL, NULL, 0, 0, NULL, NULL),
('275027918', 'W12012797', 'W12012797', 'UTDT01', 'Murdock & Searle Family Dentistry', 'Bryce', '', 'Searle', 'DDS', 'Dentist', '', '', NULL, 'O', '356 E 20 S', 'American Fork', 'Utah', 'UT', '84003', '8017564595', NULL, '356 E 20 S', 'American Fork', 'Utah', 'UT', '84003', '8017564595', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004215', 0, 'N', 0, '2011-07-28', NULL, NULL, 0, 0, NULL, NULL),
('452455459', 'W12012799', 'W12012799', 'UTDT01', 'Cannon Family Dental', 'Hyrum', '', 'Cannon', 'DDS', 'Dentist', '', '', NULL, 'O', '55 E 2200 S', 'Bountiful', 'Davis', 'UT', '84010', '8012955115', NULL, '55 E 2200 S', 'Bountiful', 'Davis', 'UT', '84010', '8012955115', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0001000016', 0, 'N', 0, '2012-01-20', NULL, NULL, 0, 0, NULL, NULL),
('452455459', 'W12012800', 'W12012800', 'UTDT01', 'Cannon Family Dental', 'John', '', 'Peterson', 'DDS', 'Dentist', '', '', NULL, 'O', '55 E 2200 S', 'Bountiful', 'Davis', 'UT', '84010', '8012955115', NULL, '55 E 2200 S', 'Bountiful', 'Davis', 'UT', '84010', '8012955115', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000008161', 0, 'N', 0, '2011-07-28', NULL, NULL, 0, 0, NULL, NULL),
('202965326', 'W12012805', 'W12012805', 'UT01', 'Wasatch Neonatal', 'Dolla', 'J', 'Allison', 'NP', 'Neonatology', '', '', NULL, 'O', '730 W 800 N Ste 340B', 'Orem', 'Utah', 'UT', '84057', '8016555425', '8016555426', '730 W 800 N Ste 340B', 'Orem', 'Utah', 'UT', '84057', '8016555425', '8016555426', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609050608', 0, 'N', 0, '2011-11-01', NULL, NULL, 40.3121, -111.713, NULL, NULL),
('830335735', 'W12012806', 'W12012806', 'WY01', 'Physical Therapy of Star Valley', 'Clancy', 'C', 'Brown', 'PT', 'Physical Therapy', '', '', NULL, 'O', '124 Petersen Pkwy Ste 1', 'Thayne', 'Lincoln', 'WY', '83127', '3078837878', '3078837877', '124 Petersen Pkwy Ste 1', 'Thayne', 'Lincoln', 'WY', '83127', '3078837878', '3078837877', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710271630', 0, 'N', 0, '2014-05-13', NULL, NULL, 42.944, -111.008, NULL, NULL),
('830335735', 'W12012807', 'W12012807', 'WY01', 'Physical Therapy of Star Valley', 'Clancy', 'C', 'Brown', 'PT', 'Physical Therapy', '', '', NULL, 'B', '161 Lafayette St', 'Winona', 'Winona', 'MN', '55987', '3078837878', '3078837877', '161 Lafayette St', 'Winona', 'Winona', 'MN', '55987', '3078837878', '3078837877', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710271630', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('830335735', 'W12012808', 'W12012808', 'WYT1', 'Physical Therapy of Star Valley', 'Clancy', 'C', 'Brown', 'PT', 'Physical Therapy', '', '', NULL, 'O', '124 Petersen Pkwy Ste 1', 'Thayne', 'Lincoln', 'WY', '83127', '3078837878', '3078837877', '124 Petersen Pkwy Ste 1', 'Thayne', 'Lincoln', 'WY', '83127', '3078837878', '3078837877', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710271630', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('830335735', 'W12012809', 'W12012809', 'WYT1', 'Physical Therapy of Star Valley', 'Clancy', 'C', 'Brown', 'PT', 'Physical Therapy', '', '', NULL, 'B', '161 Lafayette St', 'Winona', 'Winona', 'MN', '55987', '3078837878', '3078837877', '161 Lafayette St', 'Winona', 'Winona', 'MN', '55987', '3078837878', '3078837877', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710271630', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL);
