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
('204572113', 'W73004110', 'W73004110', 'UT01', 'Dixie Opthalmic Specialists', 'Jason', 'A', 'Ahee', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '1085 S Bluff St ', 'St George', 'Washington', 'UT', '84770', '4356882020', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1457357881', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870565010', 'W73004111', 'W73004111', 'UT01', '', 'Richard', 'E', 'Anderson', 'MD', 'General Surgery', '', '', NULL, 'O', '48 W 1500 N', 'Nephi', 'Juab', 'UT', '84648', '4358439964', '', '48 W 1500 N', 'Nephi', 'Juab', 'UT', '84648', '4358439964', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Central Valley Medical Center', 'Gunnison Valley Hospital', '', '', 'HCFA|UB|', '1710906441', 0, 'N', 0, '2014-07-25', NULL, NULL, 39.7306, -111.839, NULL, NULL),
('870565010', 'W73004112', 'W73004112', 'UT01', NULL, 'Richard', 'Edward', 'Anderson', 'MD', 'General Surgery', NULL, NULL, NULL, 'O', '79 E Ctr St', 'Gunnison', 'Sanpete', 'UT', '84634', '4358439964', NULL, 'PO Box 581', 'Levan', '', 'UT', '84639', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1710906441', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870565010', 'W73004113', 'W73004113', 'UT01', '', 'Richard', 'E', 'Anderson', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 581', 'Levan', 'Juab', 'UT', '84639', '4358439964', '', 'PO Box 581', 'Levan', 'Juab', 'UT', '84639', '4358439964', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Central Valley Medical Center', 'Gunnison Valley Hospital', '', '', 'HCFA|UB|', '1710906441', 0, 'y', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('201581429', 'W73004114', 'W73004114', 'UT01', 'Maternal Fetal Services of Utah', 'Robert', 'H', 'Ball', 'MD', 'Perinatology', '', '', NULL, 'O', '3100 Channing Way', 'Idaho Falls', 'Bonneville', 'ID', '83404', '2085296111', NULL, '3100 Channing Way', 'Idaho Falls', 'Bonneville', 'ID', '83404', '2085296111', '', 'Wise+', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2010-08-31', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1447215751', 0, 'N', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
('201581429', 'W73004115', 'W73004115', 'UT01', 'Maternal Fetal Services of Utah', 'Robert', 'H', 'Ball', 'MD', 'Perinatology', '', '', NULL, 'O', '1140 E 3900 S Ste 390', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434713', '8017434705', '1140 E 3900 S Ste 390', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434713', '8017434705', 'Wise+', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2010-08-31', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1447215751', 0, 'N', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
('870363828', 'W73004116', 'W73004116', 'UT01', 'Bountiful Radiology', 'Gregory', 'G', 'Patch', 'MD', 'Radiology', 'Nuclear Medicine', '', NULL, 'O', '630 Medical Dr', 'Bountiful', 'Davis', 'UT', '84011', '8012923212', NULL, '630 Medical Dr', 'Bountiful', 'Davis', 'UT', '84011', '8012923212', '', 'WUSTDRAD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1215918297', 0, 'Y', 0, '2011-04-25', NULL, NULL, 40.8869, -111.869, NULL, NULL),
('870363828', 'W73004117', 'W73004117', 'UT01', 'Bountiful Radiology', 'Richard', 'N', 'Hartvigsen', 'MD', 'Radiology', 'Nuclear Medicine', '', NULL, 'O', '630 Medical Dr', 'Bountiful', 'Davis', 'UT', '84011', '8012923212', NULL, '630 Medical Dr', 'Bountiful', 'Davis', 'UT', '84011', '8012923212', '', 'WUSTDRAD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144201120', 0, 'Y', 0, '2011-04-22', NULL, NULL, 40.8869, -111.869, NULL, NULL),
('200961076', 'W73004118', 'W73004118', 'UT01', 'Summit Pain Management', 'Alexander', 'L', 'Isani', 'MD', 'Pain Management', NULL, NULL, NULL, 'B', '5250 South 320 West Suite 305', 'Murray', 'Salt Lake', 'UT', '84107', '8015341360', NULL, '5250 S Commerce Dr', 'Murray', '', 'UT', '84107', '', '', 'WUSTDPAIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2008-07-15', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1184658049', 0, 'y', 0, '2007-01-10', NULL, NULL, 0, 0, NULL, NULL),
('200961076', 'W73004119', 'W73004119', 'UT01', 'Summit Pain Management', 'Alexander', 'L', 'Isani', 'MD', 'Pain Management', NULL, NULL, NULL, 'O', '5250 Commerce Dr Ste 305', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012627246', NULL, '5250 S Commerce Dr', 'Murray', '', 'UT', '84107', '', '', 'WUSTDPAIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2008-07-15', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1184658049', 0, 'N', 0, '2007-01-10', NULL, NULL, 0, 0, NULL, NULL),
('200961076', 'W73004120', 'W73004120', 'UT01', 'Summit Pain Management', 'Stacy', ' ', 'Robinson', 'APRN', 'Pain Management', NULL, NULL, NULL, 'B', 'PO Box 27688 ', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8015341360', NULL, '5250 S Commerce Dr', 'Murray', '', 'UT', '84107', '', '', 'WUSTDPAIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-08-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1346271798', 0, 'y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('200961076', 'W73004121', 'W73004121', 'UT01', 'Summit Pain Management', 'Stacy', ' ', 'Robinson', 'APRN', 'Pain Management', NULL, NULL, NULL, 'O', '5250 Commerce Dr Ste 305', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012627246', NULL, '5250 S Commerce Dr', 'Murray', '', 'UT', '84107', '', '', 'WUSTDPAIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-08-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1346271798', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('200961076', 'W73004122', 'W73004122', 'UT01', 'Summit Pain Management', 'Greg', NULL, 'Powell', 'PA', 'Pain Management', NULL, NULL, NULL, 'B', '5250 South 320 West Suite 305', 'Murray', 'Salt Lake', 'UT', '84107', '8015341360', NULL, '5250 S Commerce Dr', 'Murray', '', 'UT', '84107', '', '', 'WUSTDPAIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2008-07-15', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1884623829', 0, 'y', 0, '2007-01-10', NULL, NULL, 0, 0, NULL, NULL),
('200961076', 'W73004123', 'W73004123', 'UT01', 'Summit Pain Management', 'Greg', NULL, 'Powell', 'PA', 'Pain Management', NULL, NULL, NULL, 'O', '5250 Commerce Dr Ste 305', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012627246', NULL, '5250 S Commerce Dr', 'Murray', '', 'UT', '84107', '', '', 'WUSTDPAIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2008-07-15', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1884623829', 0, 'N', 0, '2007-01-10', NULL, NULL, 0, 0, NULL, NULL),
('201113635', 'W73004124', 'W73004124', 'UT01', 'Jensen Do PC, Joseph W', 'Leisha', ' ', 'Sanders', 'MD', 'General Surgery', NULL, NULL, NULL, 'O', '1580 W Antelope Dr Ste 230', 'Layton', 'Davis', 'UT', '84041', '8017289555', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('201113635', 'W73004125', 'W73004125', 'UT01', 'Jensen Do PC, Joseph W', 'Leisha', ' ', 'Sanders', NULL, 'General Surgery', NULL, NULL, NULL, 'B', 'PO Box 95970 ', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013529500', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870409899', 'W73004126', 'W73004126', 'UT01', NULL, 'Louis', '', 'Borgenicht', 'MD', 'Pediatrics', '', '', NULL, 'O', '850 E 300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015318689', NULL, '850 E 300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015318689', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2008-10-24', 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1588748859', 0, 'N', 0, '2013-10-08', NULL, NULL, 0, 0, NULL, NULL),
('870517888', 'W73004127', 'W73004127', 'UT01', 'Basin Anesthesia Associates', 'Michael', 'A', 'Hartman', 'CRNA', 'Anesthesiology', NULL, NULL, NULL, 'B', 'PO Box 90164', 'Vernal', 'Uintah', 'UT', '84079', '4357811519', NULL, 'PO Box 90164', 'Vernal', '', 'UT', '84078', '', '', '', NULL, '1000', '37.41', '0.00', '0.00', 3, '2006-11-01', NULL, 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1417075102', 0, 'Y', 0, '2007-01-10', NULL, NULL, 0, 0, NULL, NULL),
('870517888', 'W73004128', 'W73004128', 'UT01', 'Basin Anesthesia Associates', 'Dee', 'L', 'Bambrough', 'CRNA', 'Anesthesiology', NULL, NULL, NULL, 'B', 'PO Box 90164', 'Vernal', 'Uintah', 'UT', '84079', '4357811519', NULL, 'PO Box 90164', 'Vernal', '', 'UT', '84078', '', '', '', NULL, '1000', '37.41', '0.00', '0.00', 3, '2006-11-01', NULL, 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1700904455', 0, 'Y', 0, '2007-01-10', NULL, NULL, 0, 0, NULL, NULL),
('870517888', 'W73004129', 'W73004129', 'UT01', 'Basin Anesthesia Associates', 'Michael', 'A', 'Hartman', 'CRNA', 'Anesthesiology', NULL, NULL, NULL, 'O', '151 W 200 N', 'Vernal', 'Uintah', 'UT', '84078', '4357811519', NULL, 'PO Box 90164', 'Vernal', '', 'UT', '84078', '', '', '', NULL, '1000', '37.41', '0.00', '0.00', 3, '2006-11-01', NULL, 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1417075102', 0, 'Y', 0, '2007-01-10', NULL, NULL, 40.4585, -109.531, NULL, NULL),
('870517888', 'W73004130', 'W73004130', 'UT01', 'Basin Anesthesia Associates', 'Dee', 'L', 'Bambrough', 'CRNA', 'Anesthesiology', NULL, NULL, NULL, 'O', '151 W 200 N', 'Vernal', 'Uintah', 'UT', '84078', '4357811519', NULL, 'PO Box 90164', 'Vernal', '', 'UT', '84078', '', '', '', NULL, '1000', '37.41', '0.00', '0.00', 3, '2006-11-01', NULL, 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1700904455', 0, 'Y', 0, '2007-01-10', NULL, NULL, 40.4585, -109.531, NULL, NULL),
('621795214', 'W73004131', 'W73004131', 'UT01', 'Salt Lake Senior Clinic', 'Carole', 'A', 'Baraldi', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'B', 'PO Box 95970 ', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013529500', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-01-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '5185', 0, 'y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('621795214', 'W73004132', 'W73004132', 'UT01', 'Salt Lake Senior Clinic', 'Carole', 'A', 'Baraldi', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '24 S 1100 E Ste 209', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504602', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-01-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '5185', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('621795214', 'W73004133', 'W73004133', 'UT01', 'Salt Lake Senior Clinic', 'Frederick', NULL, 'Gottlieb', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '24 S 1100 E Ste 209', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504602', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-01-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '6461', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('621795214', 'W73004134', 'W73004134', 'UT01', 'Salt Lake Senior Clinic', 'Frederick', NULL, 'Gottlieb', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'B', 'PO Box 95970 ', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013529500', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-01-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '6461', 0, 'y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('621795214', 'W73004135', 'W73004135', 'UT01', 'Salt Lake Senior Clinic', 'Gary', 'W', 'Buck', NULL, 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 95970 ', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013529500', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('621795214', 'W73004136', 'W73004136', 'UT01', 'Salt Lake Senior Clinic', 'Gary', 'W', 'Buck', ' PA', 'Family Practice', NULL, NULL, NULL, 'O', '24 S 1100 E Ste 209', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504602', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('621795214', 'W73004137', 'W73004137', 'UT01', 'Salt Lake Senior Clinic', 'Keith', 'J', 'Lane', 'MD', 'Internal Medicine', 'Geriatric Medicine', NULL, NULL, 'B', 'PO Box 95970 ', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013529500', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-01-31', 0, NULL, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1558370361', 0, 'y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('621795214', 'W73004138', 'W73004138', 'UT01', 'Salt Lake Senior Clinic', 'Keith', 'J', 'Lane', 'MD', 'Internal Medicine', 'Geriatric Medicine', NULL, NULL, 'O', '24 S 1100 E Ste 209', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504602', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-01-31', 0, NULL, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1558370361', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('680618703', 'W73004139', 'W73004139', 'UT01', 'Gunnison Valley Hospital', 'Stanton', 'A', 'Bailey', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '79 E Ctr St', 'Gunnison', 'Sanpete', 'UT', '84634', '4356600488', NULL, '79 E Ctr St', 'Gunnison', 'Sanpete', 'UT', '84634', '4356600488', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2010-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407873011', 0, 'Y', 0, '2013-07-08', NULL, NULL, 0, 0, NULL, NULL),
('680618703', 'W73004140', 'W73004140', 'UT01', 'Gunnison Valley Hospital', 'Stanton', 'A', 'Bailey', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 357', 'Nephi', 'Juab', 'UT', '84648', '4356600488', NULL, 'PO Box 357', 'Nephi', 'Juab', 'UT', '84648', '4356600488', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2010-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407873011', 0, 'Y', 0, '2013-07-08', NULL, NULL, 0, 0, NULL, NULL),
('870619248', 'W73004141', 'W73004141', 'UT01', 'Mountain West Medical Center', '', '', 'Mountain West Medical Center', 'GROUP', 'Physical Therapy', NULL, NULL, NULL, 'B', 'PO Box 60000 FILE 74030', 'San Francisco', 'San Francisco', 'CA', '94160', '4358433600', NULL, '2055 N Main', 'Tooele', '', 'UT', '84074', '', '', '', NULL, NULL, '0.00', '35.00', '0.00', 6, '2006-11-01', '2008-06-17', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000007740', 0, 'y', 0, '2006-10-19', NULL, NULL, 0, 0, NULL, NULL),
('870619248', 'W73004142', 'W73004142', 'UT01', 'Mountain West Medical Center Pro Fees', '', '', 'Mountain West Medical Center', 'GROUP', 'Physical Therapy', NULL, NULL, NULL, 'O', '2055 N Main St', 'Tooele', 'Tooele', 'UT', '84074', '4358433737', NULL, '2055 N Main', 'Tooele', '', 'UT', '84074', '', '', '', NULL, NULL, '0.00', '35.00', '0.00', 6, '2006-11-01', '2008-06-17', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000007740', 0, 'Y', 0, '2006-10-19', NULL, NULL, 0, 0, NULL, NULL),
('870619248', 'W73004143', 'W73004143', 'UT01', 'Mountain West Physical Therapy', NULL, NULL, 'Mountain West Medica', 'GROUP', 'Physical Therapy', NULL, NULL, NULL, 'B', 'PO Box 60000 FILE 74030', 'San Francisco', 'San Francisco', 'CA', '94160', '4358433600', NULL, NULL, NULL, '', NULL, NULL, '', '', NULL, NULL, NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870543111', 'W73004144', 'W73004144', 'UT01', 'Mountain Eye Institute', 'Chad', 'W', 'Anderson', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '1811 W Royal Hunte Dr Ste 1', 'Cedar City', 'Iron', 'UT', '84720', '4355861131', NULL, '1811 W Royal Hunte Dr Ste 1', 'Cedar City', 'Iron', 'UT', '84720', '4355861131', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2006-11-01', NULL, 0, 0, 0, 'Valley View Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1144330648', 0, 'N', 0, '2013-08-19', NULL, NULL, 37.658, -113.086, NULL, NULL),
('870543111', 'W73004145', 'W73004145', 'UT01', 'Mountain Eye Institute', 'Rory', 'J', 'Christian', 'OD', 'Optometry', NULL, NULL, NULL, 'O', '1811 W Royal Hunter Dr Ste 1', 'Cedar City', 'Iron', 'UT', '84720', '4355861131', NULL, '1811 W Royal Hunter Dr Ste 1', 'Cedar City', 'Iron', 'UT', '84720', '4355861131', '', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2006-11-01', NULL, 0, 0, 0, 'Valley View Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1326158551', 0, 'N', 0, '2014-01-02', NULL, NULL, 37.658, -113.086, NULL, NULL),
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INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
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('870519691', 'W73004288', 'W73004288', 'UT01', 'Utah Cancer Specialists', 'Julie', 'D', 'Asch', 'MD', 'Hematology and Oncology', 'Oncology', 'Pediatric Hematology and Oncology', NULL, 'B', '1121 S 3900 E Ste C 240', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012660878', NULL, '1121 S 3900 E Ste C 240', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012660878', '          ', 'WUSTDONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2011-07-14', 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1083740070', 0, 'N', 0, '2011-07-14', NULL, NULL, 0, 0, NULL, NULL),
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('870519691', 'W73004301', 'W73004301', 'UT01', 'Utah Cancer Specialists', 'Julie', 'D', 'Asch', 'MD', 'Hematology and Oncology', 'Oncology', 'Pediatric Hematology and Oncology', NULL, 'O', '5121 S Cottonwood St Ste L-2', 'Murray', 'Salt Lake', 'UT', '84157', '8012633416', NULL, '5121 S Cottonwood St Ste L-2', 'Murray', 'Salt Lake', 'UT', '84157', '8012633416', '          ', 'WUSTDONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2006-11-01', 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1083740070', 0, 'Y', 0, '2011-07-14', NULL, NULL, 0, 0, NULL, NULL),
('870519691', 'W73004302', 'W73004302', 'UT01', 'Utah Cancer Specialists', 'Clyde', 'D', 'Ford', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '333 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015358166', NULL, '333 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015358166', '', 'WUSTDONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568496958', 0, 'N', 0, '2012-01-19', NULL, NULL, 40.7622, -111.865, 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
('870519691', 'W73004303', 'W73004303', 'UT01', 'Utah Cancer Specialists', 'Gregory', 'J', 'Miller', 'MD', 'Hematology and Oncology', 'Oncology', 'Pain Management', NULL, 'O', '3838 S 700 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012690231', NULL, '3838 S 700 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012690231', '', 'WUSTDONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1225089790', 0, 'N', 0, '2012-05-04', NULL, NULL, 40.6874, -111.871, NULL, NULL),
('870519691', 'W73004304', 'W73004304', 'UT01', 'Utah Cancer Specialists', 'Finn', 'B', 'Petersen', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '5121 S Cottonwood St Blgd A Level 2', 'Murray', 'Salt Lake', 'UT', '84157', '8012633416', NULL, '5121 S Cottonwood St Blgd A Level 2', 'Murray', 'Salt Lake', 'UT', '84157', '8012633416', '          ', 'WUSTDONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2011-07-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225164114', 0, 'Y', 0, '2011-07-14', NULL, NULL, 0, 0, NULL, NULL),
('870519691', 'W73004305', 'W73004305', 'UT01', 'Utah Cancer Specialists', 'William', 'T', 'Sause', 'MD', 'Hematology and Oncology', NULL, NULL, NULL, 'O', '3838 S 700 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012816860', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUSTDONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1881612927', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870519691', 'W73004306', 'W73004306', 'UT01', 'Utah Cancer Specialists', 'John', NULL, 'Thompson', 'MD', 'Radiation Oncology', NULL, NULL, NULL, 'B', '3838 S 700 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012816860', NULL, '1121 S 3900 E', 'Salt Lake City', '', 'UT', '84124', '', '', 'WUSTDONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000009073', 0, 'Y', 0, '2006-10-27', NULL, NULL, 0, 0, NULL, NULL),
('870519691', 'W73004307', 'W73004307', 'UT01', 'Utah Cancer Specialists', 'Johnathan', 'R', 'Whisenant', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '3838 S 700 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012816860', NULL, '3838 S 700 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012816860', '', 'WUSTDONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Lakeview Hospital', 'St Marks Hospital', '', '', 'HCFA|UB|', '1861441974', 0, 'N', 0, '2014-06-16', NULL, NULL, 40.6874, -111.871, NULL, NULL),
('870519691', 'W73004308', 'W73004308', 'UT01', 'Utah Cancer Specialists', 'Michael', '', 'Gaffney', 'PA-C', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '5121 S Cottonwood St Bldg A Level 2', 'Murray', 'Salt Lake', 'UT', '84157', '8012633416', NULL, '5121 S Cottonwood St Bldg A Level 2', 'Murray', 'Salt Lake', 'UT', '84157', '8012633416', '', 'WUSTDONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2006-11-01', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1811947229', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('870519691', 'W73004309', 'W73004309', 'UT01', 'Utah Cancer Specialists', 'Richard', 'E', 'Hanson', 'PA-C', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '3838 S 700 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012816860', NULL, '3838 S 700 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012816860', '', 'WUSTDONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1568412963', 0, 'N', 0, '2014-06-04', NULL, NULL, 40.6874, -111.871, NULL, NULL),
('870519691', 'W73004310', 'W73004310', 'UT01', 'Utah Cancer Specialists', 'Rosemary', NULL, 'Mcgee-Conder', 'APRN', 'Hematology and Oncology', 'Oncology', NULL, NULL, 'O', '3838 S 700 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012816860', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUSTDONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1699724500', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('870519691', 'W73004312', 'W73004312', 'UT01', 'Utah Cancer Specialists', 'Tracy', '', 'Anderson', 'APRN', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '1034 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013578200', NULL, '1034 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013578200', '          ', 'WUSTDONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2011-10-03', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962453431', 0, 'N', 0, '2011-10-04', NULL, NULL, 0, 0, NULL, NULL),
('870519691', 'W73004313', 'W73004313', 'UT01', 'Utah Cancer Specialists', 'Jenny', NULL, 'Jones', 'APRN', 'Hematology and Oncology', '', '', NULL, 'O', '1492 W Antelope Dr Ste 125', 'Layton', 'Davis', 'UT', '84041', '8015253022', NULL, '1492 W Antelope Dr Ste 125', 'Layton', 'Davis', 'UT', '84041', '8015253022', '          ', 'WUSTDONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2009-04-10', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1568412179', 0, 'Y', 0, '2006-10-27', NULL, NULL, 0, 0, NULL, NULL),
('870519691', 'W73004314', 'W73004314', 'UT01', 'Utah Cancer Specialists', 'Clyde', 'D', 'Ford', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '5121 S Cottonwood St Bldg A Level 2', 'Murray', 'Salt Lake', 'UT', '84157', '8012633416', NULL, '5121 S Cottonwood St Bldg A Level 2', 'Murray', 'Salt Lake', 'UT', '84157', '8012633416', '          ', 'WUSTDONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2006-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568496958', 0, 'N', 0, '2012-01-19', NULL, NULL, 0, 0, NULL, NULL),
('870519691', 'W73004315', 'W73004315', 'UT01', 'Utah Cancer Specialists', 'Gregory', 'J', 'Miller', 'MD', 'Hematology and Oncology', 'Oncology', 'Pain Management', NULL, 'O', '5770 S 250 E Ste 135', 'Murray', 'Salt Lake', 'UT', '84107', '8012633416', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUSTDONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1225089790', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870519691', 'W73004316', 'W73004316', 'UT01', 'Utah Cancer Specialists', 'Johnathan', 'R', 'Whisenant', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '5121 S Cottonwood St Bldg A Level 2', 'Murray', 'Salt Lake', 'UT', '84157', '8012633416', NULL, '5121 S Cottonwood St Bldg A Level 2', 'Murray', 'Salt Lake', 'UT', '84157', '8012633416', '', 'WUSTDONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2006-11-01', 0, 0, 0, 'Lakeview Hospital', 'St Marks Hospital', '', '', 'HCFA|UB|', '1861441974', 0, 'N', 0, '2014-06-16', NULL, NULL, 0, 0, NULL, NULL),
('870639748', 'W73004317', 'W73004317', 'UT01', 'Hoopes Vision Correction Center', 'Phillip', 'C', 'Hoopes', 'MD', 'Ophthalmology', '', '', NULL, 'O', '10011 Centennial Pkwy Ste 400', 'Sandy', 'Salt Lake', 'UT', '84070', '8015680200', '', '10011 Centennial Pkwy Ste 400', 'Sandy', 'Salt Lake', 'UT', '84070', '8015680200', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2012-11-28', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1629067921', 0, 'N', 0, '2014-07-24', NULL, NULL, 0, 0, NULL, NULL),
('870639748', 'W73004318', 'W73004318', 'UT01', NULL, 'Phillip', 'C', 'Hoopes', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '10011 Centennial Pkwy Ste 400', 'Sandy', 'Salt Lake', 'UT', '84070', '8015680200', NULL, '10011 S Center Pkwy', 'Sandy', '', 'UT', '84070', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1629067921', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('134332141', 'W73004319', 'W73004319', 'UT01', 'MountainStar Cardiovascular Surgery', 'J', 'K', 'Thorne', 'MD', 'Cardiovascular Disease', 'Thoracic Surgery', '', NULL, 'O', '1160 E 3900 S Ste 3500', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434750', NULL, '1160 E 3900 S Ste 3500', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434750', '', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', '2010-08-31', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1356335970', 0, 'N', 0, '2012-06-28', NULL, NULL, 0, 0, NULL, NULL),
('134332141', 'W73004320', 'W73004320', 'UT01', 'MountainStar Cardiovascular Surgery', 'Gilbert', 'R', 'Schorlemmer', 'MD', 'Cardiovascular Disease', 'Thoracic Surgery', '', NULL, 'O', '1160 E 3900 S Ste 3500', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434750', NULL, '1160 E 3900 S Ste 3500', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434750', '', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', '2010-08-31', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1629060553', 0, 'N', 0, '2012-06-28', NULL, NULL, 0, 0, NULL, NULL),
('134332141', 'W73004321', 'W73004321', 'UT01', 'MountainStar Cardiovascular Surgery', 'David', 'G', 'Affleck', 'MD', 'Cardiovascular Disease', 'Thoracic Surgery', '', NULL, 'O', '1160 E 3900 S Ste 3500', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434750', NULL, '1160 E 3900 S Ste 3500', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434750', '', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', '2010-08-31', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1710979653', 0, 'N', 0, '2012-06-22', NULL, NULL, 0, 0, NULL, NULL),
('870474130', 'W73004322', 'W73004322', 'UT01', 'Northeastern Utah Medical Group', 'Russel', 'N', 'Smith', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '210 W 300 N Ste 75-3', 'Roosevelt', 'Duchesne', 'UT', '84066', '4357226143', NULL, '210 W 300 N Ste 75-3', 'Roosevelt', 'Duchesne', 'UT', '84066', '4357226143', '          ', 'WURURAL5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-11-01', '2009-12-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1184685158', 0, 'N', 0, '2006-11-01', NULL, NULL, 0, 0, NULL, NULL),
('870474130', 'W73004323', 'W73004323', 'UT01', 'Northeastern Utah Medical Group', 'Jason', '', 'Beales', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '210 W 300 N Ste 75-3', 'Roosevelt', 'Duchesne', 'UT', '84066', '4357252000', NULL, '210 W 300 N Ste 75-3', 'Roosevelt', 'Duchesne', 'UT', '84066', '4357252000', '          ', 'WURURAL5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-11-01', NULL, 0, 0, 0, 'Uintah Basin Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1891755872', 0, 'N', 0, '2013-09-25', NULL, NULL, 40.3034, -109.995, 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
('870474130', 'W73004399', 'W73004399', 'UT01', 'Northeastern Utah Medical Group', 'Brad', '', 'Jenkins', 'NP', 'Family Practice', NULL, NULL, NULL, 'O', '582 N 1700 W ', 'Vernal', 'Uintah', 'UT', '84078', '4357812511', NULL, '210 W 300 N 75-3', 'Roosevelt', '', 'UT', '84066', '', '', 'WURURAL5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870474130', 'W73004400', 'W73004400', 'UT01', 'Northeastern Utah Medical Group', 'Lori', '', 'Teem', 'NP', 'Family Practice', '', '', NULL, 'O', '38080 W State Rd 35', 'Tabiona', 'Duchesne', 'UT', '84072', '4358485509', '          ', '38080 W State Rd 35', 'Tabiona', 'Duchesne', 'UT', '84072', '4358485509', '          ', 'WURURAL5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-11-01', '2013-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009029', 0, 'N', 0, '2014-06-04', NULL, NULL, 40.3724, -110.691, NULL, NULL),
('870474130', 'W73004401', 'W73004401', 'UT01', 'Northeastern Utah Medical Group', 'Darwin', NULL, 'McKee', 'PA', 'Family Practice', NULL, NULL, NULL, 'O', '582 N 1700 W ', 'Vernal', 'Uintah', 'UT', '84078', '4357812511', NULL, '210 W 300 N 75-3', 'Roosevelt', '', 'UT', '84066', '', '', 'WURURAL5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '7524', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870474130', 'W73004402', 'W73004402', 'UT01', 'Northeastern Utah Medical Group', 'Bonnie', NULL, 'Crozier', 'PA', 'Family Practice', NULL, NULL, NULL, 'O', '582 N 1700 W ', 'Vernal', 'Uintah', 'UT', '84078', '4357812511', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WURURAL5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '5849', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870474130', 'W73004403', 'W73004403', 'UT01', 'Northeastern Utah Medical Group', 'Russel', 'N', 'Smith', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '175 N 100 W Ste 102', 'Vernal', 'Uintah', 'UT', '84078', '4357812030', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WURURAL5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1184685158', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870474130', 'W73004404', 'W73004404', 'UT01', 'Northeastern Utah Medical Group', 'Jason', NULL, 'Beales', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '175 N 100 W Ste 102', 'Vernal', 'Uintah', 'UT', '84078', '4357812030', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WURURAL5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, 'Uintah Basin Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1891755872', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870474130', 'W73004405', 'W73004405', 'UT01', 'Northeastern Utah Medical Group', 'Keith', 'H', 'Evans', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '175 N 100 W Ste 102', 'Vernal', 'Uintah', 'UT', '84078', '4357812030', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WURURAL5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1033179049', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870474130', 'W73004406', 'W73004406', 'UT01', 'Northeastern Utah Medical Group', 'Hal', 'E', 'Mitchell', 'DO', 'Family Practice', NULL, NULL, NULL, 'B', '175 N 100 W Ste 102', 'Vernal', 'Uintah', 'UT', '84078', '4357226130', NULL, '210 W 300 N 75-3', 'Roosevelt', '', 'UT', '84066', '', '', 'WURURAL5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2006-11-01', '2008-07-15', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1689634479', 0, 'N', 0, '2006-11-01', NULL, NULL, 0, 0, NULL, NULL),
('870474130', 'W73004407', 'W73004407', 'UT01', 'Northeastern Utah Medical Group', 'Mark', 'A', 'Mitchell', 'MD', 'General Practice', NULL, NULL, NULL, 'O', '175 N 100 W Ste 102', 'Vernal', 'Uintah', 'UT', '84078', '4357812030', NULL, '210 W 300 N 75-3', 'Roosevelt', '', 'UT', '84066', '', '', 'WURURAL5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1649230541', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870474130', 'W73004408', 'W73004408', 'UT01', 'Northeastern Utah Medical Group', 'L', 'Lynn', 'Morrill', 'DO', 'Family Practice', NULL, NULL, NULL, 'O', '175 N 100 W Ste 102', 'Vernal', 'Uintah', 'UT', '84078', '4357812030', NULL, '210 W 300 N 75-3', 'Roosevelt', '', 'UT', '84066', '', '', 'WURURAL5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, 'Uintah Basin Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1497715593', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870474130', 'W73004409', 'W73004409', 'UT01', 'Northeastern Utah Medical Group', 'John', NULL, 'Nolte', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '175 N 100 W Ste 102', 'Vernal', 'Uintah', 'UT', '84078', '4357812030', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WURURAL5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-03-01', 0, NULL, 0, 'Uintah Basin Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1194786095', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870474130', 'W73004410', 'W73004410', 'UT01', 'Northeastern Utah Medical Group', 'Rex', 'Fowler', 'Ripplinger', 'MD', 'Internal Medicine', 'Emergency Medicine', NULL, NULL, 'O', '175 N 100 W Ste 102', 'Vernal', 'Uintah', 'UT', '84078', '4357812030', NULL, '210 W 300 N 75-3', 'Roosevelt', '', 'UT', '84066', '', '', 'WURURAL5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1083674972', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870474130', 'W73004411', 'W73004411', 'UT01', 'Northeastern Utah Medical Group', 'Glenn', 'l', 'Robertson', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '38080 W State Rd 35', 'Tabiona', 'Duchesne', 'UT', '84072', '4358485509', NULL, '38080 W State Rd 35', 'Tabiona', 'Duchesne', 'UT', '84072', '4358485509', '          ', 'WURURAL5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-11-01', '2011-09-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144281122', 0, 'N', 0, '2011-09-21', NULL, NULL, 0, 0, NULL, NULL),
('870474130', 'W73004412', 'W73004412', 'UT01', 'Northeastern Utah Medical Group', 'Kent', 'E', 'Smith', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '175 N 100 W Ste 102', 'Vernal', 'Uintah', 'UT', '84078', '4357812030', NULL, '210 W 300 N 75-3', 'Roosevelt', '', 'UT', '84066', '', '', 'WURURAL5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1588625479', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870474130', 'W73004413', 'W73004413', 'UT01', 'Northeastern Utah Medical Group', 'Gary', 'B', 'White', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '175 N 100 W Ste 102', 'Vernal', 'Uintah', 'UT', '84078', '4357812030', NULL, '210 W 300 N 75-3', 'Roosevelt', '', 'UT', '84066', '', '', 'WURURAL5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, 'Uintah Basin Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1205897196', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870474130', 'W73004414', 'W73004414', 'UT01', 'Northeastern Utah Medical Group', 'James', '', 'White', 'MD', 'Physical Medicine and Rehabilitation', NULL, NULL, NULL, 'O', '175 N 100 W Ste 102', 'Vernal', 'Uintah', 'UT', '84078', '4357894489', NULL, '175 N 100 W Ste 102', 'Vernal', 'Uintah', 'UT', '84078', '4357894489', '          ', 'WURURAL5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-09-21', NULL, 0, 0, 0, 'Uintah Basin Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1316908122', 0, 'N', 0, '2013-09-09', NULL, NULL, 40.4582, -109.53, NULL, NULL),
('870474130', 'W73004415', 'W73004415', 'UT01', 'Northeastern Utah Medical Group', 'Mark', NULL, 'Mason', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '175 N 100 W Ste 102', 'Vernal', 'Uintah', 'UT', '84078', '4357812030', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WURURAL5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, 'Uintah Basin Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1811958887', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870474130', 'W73004416', 'W73004416', 'UT01', 'Northeastern Utah Medical Group', 'John', NULL, 'Blake', 'MD', 'Dermatology', NULL, NULL, NULL, 'O', '175 N 100 W Ste 102', 'Vernal', 'Uintah', 'UT', '84078', '4357812030', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WURURAL5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-12-31', 0, NULL, 0, 'Uintah Basin Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1508826587', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870474130', 'W73004417', 'W73004417', 'UT01', 'Northeastern Utah Medical Group', 'Michael', '', 'Catten', 'MD', 'Ear, Nose and Throat', NULL, NULL, NULL, 'O', '175 W 200 Ste 102', 'Vernal', 'Uintah', 'UT', '84078', '4357894009', NULL, '175 W 200 Ste 102', 'Vernal', 'Uintah', 'UT', '84078', '4357894009', '          ', 'WURURAL5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-11-01', '2011-09-13', 0, 0, 0, 'Uintah Basin Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1861452070', 0, 'N', 0, '2011-12-22', NULL, NULL, 0, 0, NULL, NULL),
('870474130', 'W73004418', 'W73004418', 'UT01', 'Northeastern Utah Medical Group', 'Shane', 'K', 'Powell', 'MD', 'Ophthalmology', '', '', NULL, 'O', '175 N 100 W Ste 102', 'Vernal', 'Uintah', 'UT', '84078', '4357812030', NULL, '175 N 100 W Ste 102', 'Vernal', 'Uintah', 'UT', '84078', '4357812030', '          ', 'WURURAL5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-11-01', '2011-09-19', 0, 0, 0, 'Uintah Basin Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1750342655', 0, 'N', 0, '2014-01-17', NULL, NULL, 0, 0, NULL, NULL),
('870474130', 'W73004419', 'W73004419', 'UT01', 'Northeastern Utah Medical Group', 'Gregory', NULL, 'Staker', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '175 N 100 W Ste 102', 'Vernal', 'Uintah', 'UT', '84078', '4357812030', NULL, '210 W 300 N 75-3', 'Roosevelt', '', 'UT', '84066', '', '', 'WURURAL5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, 'Uintah Basin Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1275593717', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870474130', 'W73004420', 'W73004420', 'UT01', 'Northeastern Utah Medical Group', 'Shannon', NULL, 'Staker', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '175 N 100 W Ste 102', 'Vernal', 'Uintah', 'UT', '84078', '4357812030', NULL, '210 W 300 N 75-3', 'Roosevelt', '', 'UT', '84066', '', '', 'WURURAL5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, 'Uintah Basin Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1023078045', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870474130', 'W73004421', 'W73004421', 'UT01', 'Northeastern Utah Medical Group', 'David', 'K', 'Krzymowski', 'MD', 'General Surgery', NULL, NULL, NULL, 'O', '175 N 100 W Ste 102', 'Vernal', 'Uintah', 'UT', '84078', '4357812030', NULL, '210 W 300 N 75-3', 'Roosevelt', '', 'UT', '84066', '', '', 'WURURAL5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, 'Uintah Basin Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1730149634', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870474130', 'W73004422', 'W73004422', 'UT01', 'Northeastern Utah Medical Group', 'Lorenzo', NULL, 'Romney', 'DO', 'Family Practice', NULL, NULL, NULL, 'O', '175 N 100 W Ste 102', 'Vernal', 'Uintah', 'UT', '84078', '4357812030', NULL, '210 W 300 N 75-3', 'Roosevelt', '', 'UT', '84066', '', '', 'WURURAL5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1487563658', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870474130', 'W73004423', 'W73004423', 'UT01', 'Northeastern Utah Medical Group', 'Laura', '', 'Duncan', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '210 W 300 N Ste 75-3', 'Roosevelt', 'Duchesne', 'UT', '84066', '4357226143', NULL, '210 W 300 N Ste 75-3', 'Roosevelt', 'Duchesne', 'UT', '84066', '4357226143', '          ', 'WURURAL5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-11-01', '2010-10-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215011077', 0, 'N', 0, '2010-09-17', NULL, NULL, 0, 0, NULL, NULL),
('870474130', 'W73004424', 'W73004424', 'UT01', 'Northeastern Utah Medical Group', 'Matthew', 'S', 'Duncan', 'MD', 'Mental Health', 'Psychology', '', NULL, 'O', '210 W 300 N Ste 75-3', 'Roosevelt', 'Duchesne', 'UT', '84066', '4357226144', NULL, '210 W 300 N Ste 75-3', 'Roosevelt', 'Duchesne', 'UT', '84066', '4357226144', '          ', 'WURURAL5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-11-01', '2009-09-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710061577', 0, 'N', 0, '2012-04-02', NULL, NULL, 0, 0, NULL, NULL),
('870474130', 'W73004425', 'W73004425', 'UT01', 'Northeastern Utah Medical Group', 'H', 'Kim', 'Jones', 'DPM', 'Podiatry', 'Foot and Ankle', '', NULL, 'O', '75 N 200 W Ste 1', 'Vernal', 'Uintah', 'UT', '84078', '4357892060', NULL, '75 N 200 W Ste 1', 'Vernal', 'Uintah', 'UT', '84078', '4357892060', '', 'WURURAL5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-11-01', '2008-09-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518932995', 0, 'y', 0, '2014-07-01', NULL, NULL, 0, 0, NULL, NULL),
('870474130', 'W73004426', 'W73004426', 'UT01', 'Northeastern Utah Medical Group', 'Brad', '', 'Jenkins', 'NP', 'Family Practice', NULL, NULL, NULL, 'O', '175 N 100 W Ste 102', 'Vernal', 'Uintah', 'UT', '84078', '4357812030', NULL, '210 W 300 N 75-3', 'Roosevelt', '', 'UT', '84066', '', '', 'WURURAL5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('870474130', 'W73004428', 'W73004428', 'UT01', 'Northeastern Utah Medical Group', 'Darwin', NULL, 'McKee', 'PA', 'Family Practice', NULL, NULL, NULL, 'O', '175 N 100 W Ste 102', 'Vernal', 'Uintah', 'UT', '84078', '4357812030', NULL, '210 W 300 N 75-3', 'Roosevelt', '', 'UT', '84066', '', '', 'WURURAL5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '7524', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870474130', 'W73004429', 'W73004429', 'UT01', 'Northeastern Utah Medical Group', 'Bonnie', NULL, 'Crozier', 'PA', 'Family Practice', NULL, NULL, NULL, 'O', '175 N 100 W Ste 102', 'Vernal', 'Uintah', 'UT', '84078', '4357812030', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WURURAL5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '5849', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870396036', 'W73004430', 'W73004430', 'UT01', 'Enterprise Valley Medical Clinic', 'Jacqueline', 'L', 'Murray', 'PA-C', 'Family Practice', '', '', NULL, 'O', '223 S 200 E', 'Enterprise', 'Washington', 'UT', '84725', '4358782281', NULL, '223 S 200 E', 'Enterprise', 'Washington', 'UT', '84725', '4358782281', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', '2011-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215908322', 0, 'N', 0, '2011-11-03', NULL, NULL, 0, 0, NULL, NULL),
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('742412898', 'W73004471', 'W73004471', 'UT01', 'Community Health Centers', 'Jennifer', '', 'Coombs', 'MD', 'Family Practice', '', '', NULL, 'B', '1798 S W Temple Ste A 100', 'South Salt Lake', 'Salt Lake', 'UT', '84115', '8014126930', NULL, '1798 S W Temple Ste A 100', 'South Salt Lake', 'Salt Lake', 'UT', '84115', '8014126930', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2011-09-22', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518964659', 0, 'Y', 0, '2012-10-01', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'W73004472', 'W73004472', 'UT01', NULL, 'Leslie', 'F', 'DiMella', 'PHD', 'Mental Health', NULL, NULL, NULL, 'B', '1798 S W Temple Ste A 100', 'Salt Lake City', 'Salt Lake', 'UT', '84115', '8014126929', NULL, '1798 S W Temple', 'Salt Lake City', '', 'UT', '84115', '', '', 'PHD', 'WUSTDHCPC5', NULL, '0.00', '100.00', '0.00', 6, '2006-06-01', '2008-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1346226222', 0, 'Y', 0, '2007-12-05', NULL, NULL, 0, 0, NULL, NULL),
('870539775', 'W73004473', 'W73004473', 'UT01', 'Health South Rehab Center', 'Anina', NULL, 'Merrill', 'MD', 'Physical Medicine and Rehabilitation', NULL, NULL, NULL, 'B', 'PO Box 307 ', 'Bountiful', 'Davis', 'UT', '84011', '8012946907', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, 'Health South Rehabilitation Hospital of Utah (inpatient services only)', NULL, NULL, NULL, 'HCFA|UB|', '1134111545', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870539775', 'W73004474', 'W73004474', 'UT01', 'Health South Rehab Center', 'Anina', NULL, 'Merrill', 'MD', 'Physical Medicine and Rehabilitation', NULL, NULL, NULL, 'O', '8074 S 1300 E ', 'Sandy', 'Salt Lake', 'UT', '84094', '8015656600', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, 'Health South Rehabilitation Hospital of Utah (inpatient services only)', NULL, NULL, NULL, 'HCFA|UB|', '1134111545', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('841401924', 'W73004475', 'W73004475', 'UT01', 'Alpine Medical Group', 'Theresa', 'D', 'Gourde', 'MD', 'Family Practice', 'Internal Medicine', NULL, NULL, 'O', '24 S 1100 E Ste 3 ', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8014780010', NULL, NULL, NULL, '', NULL, NULL, '', '', 'USTDMULT', 'USTDHCPC', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1487688685', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('841401924', 'W73004476', 'W73004476', 'UT01', 'Alpine Medical Group', 'Tiffani', NULL, 'Parker', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '24 S 1100 E Ste 304', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8014780010', NULL, NULL, NULL, '', NULL, NULL, '', '', 'USTDMULT', 'USTDHCPC', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('841401924', 'W73004477', 'W73004477', 'UT01', 'Alpine Medical Group', 'Rita', 'A', 'Gambrel', 'CNM', 'Pediatrics', NULL, NULL, NULL, 'O', '1060 E 100 S Ste 400', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015212640', NULL, NULL, NULL, '', NULL, NULL, '', '', 'USTDMULT', 'USTDHCPC', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('841401924', 'W73004478', 'W73004478', 'UT01', 'Alpine Medical Group', 'Lance', 'O', 'Hewitt', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '70 S 900 E Ste 8', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013641117', NULL, NULL, NULL, '', NULL, NULL, '', '', 'USTDINT', 'USTDHCPC', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('841401924', 'W73004479', 'W73004479', 'UT01', 'Alpine Medical Group', 'Tiffany', 'A', 'Hubbard', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '24 S 1100 E Ste 304', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8014780010', NULL, NULL, NULL, '', NULL, NULL, '', '', 'USTDINT', 'USTDHCPC', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2005-12-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('841401924', 'W73004480', 'W73004480', 'UT01', 'Alpine Medical Group', 'Jeffery', NULL, 'Robinson', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '24 S 1100 E Ste 304', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8014780010', NULL, NULL, NULL, '', NULL, NULL, '', '', 'USTDINT', 'USTDHCPC', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('841401924', 'W73004481', 'W73004481', 'UT01', 'Alpine Medical Group', 'Michael', 'B', 'Strong', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '15 N Medical Dr Ste 4B-1', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013641117', NULL, NULL, NULL, '', NULL, NULL, '', '', 'USTDINT', 'USTDHCPC', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1154359594', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('841401924', 'W73004482', 'W73004482', 'UT01', 'Alpine Medical Group', 'Sandae', 'B', 'Conroy', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '324 10th Ave Ste 163', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013641117', NULL, NULL, NULL, '', NULL, NULL, '', '', 'USTDMULT', 'USTDHCPC', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('841401924', 'W73004483', 'W73004483', 'UT01', 'Alpine Medical Group', 'Clyn', 'A', 'Robinson', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '1954 E Ft Union Blvd Ste 207', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013641117', NULL, NULL, NULL, '', NULL, NULL, '', '', 'USTDMULT', 'USTDHCPC', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1033117114', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('841401924', 'W73004484', 'W73004484', 'UT01', 'Alpine Medical Group', 'Matt', NULL, 'Smith', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '1954 E Ft Union Blvd Ste 207', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013641117', NULL, NULL, NULL, '', NULL, NULL, '', '', 'USTDMULT', 'USTDHCPC', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('680516959', 'W73004485', 'W73004485', 'UT01', 'Vista Eye Center', 'Paul', 'C', 'Bruderer', 'OD', 'Optometry', '', '', NULL, 'O', '339 E 3900 S Ste 150', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012681200', NULL, '339 E 3900 S Ste 150', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012681200', '          ', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', '2012-09-20', 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1316956576', 0, 'N', 0, '2014-01-17', NULL, NULL, 0, 0, NULL, NULL),
('870179340', 'W73004486', 'W73004486', 'UT01', 'Standard Optical', 'Todd', 'E', 'Daynes', 'MD', 'Ophthalmology', '', '', NULL, 'O', '4878 S Highland Dr', 'Holladay', 'Salt Lake', 'UT', '84121', '8012728861', NULL, '4878 S Highland Dr', 'Holladay', 'Salt Lake', 'UT', '84121', '8012728861', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2006-10-01', '2009-07-29', 0, 0, 0, 'Lakeview Hospital', 'St Marks Hospital', '', '', 'HCFA|UB|', '1053412494', 0, 'N', 0, '2011-10-12', NULL, NULL, 0, 0, NULL, NULL),
('870179340', 'W73004487', 'W73004487', 'UT01', 'Standard Optical', 'Todd', 'E', 'Daynes', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1076 Layton Hills Mall Ste 2090', 'Layton', 'Davis', 'UT', '84041', '8015460255', NULL, '1076 Layton Hills Mall Ste 2090', 'Layton', 'Davis', 'UT', '84041', '8015460255', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2006-10-01', '2009-07-29', 0, 0, 0, 'Lakeview Hospital', 'St Marks Hospital', '', '', 'HCFA|UB|', '1053412494', 0, 'N', 0, '2011-10-12', NULL, NULL, 0, 0, NULL, NULL),
('870326048', 'W73004488', 'W73004488', 'UT01', 'Utah Pathology Services', 'Chris', 'F', 'Campana', 'MD', NULL, NULL, NULL, NULL, 'B', 'PO Box 30309', 'Charleston', 'Charleston', 'SC', '29417', '8668017177', NULL, 'PO Box 30309', 'Charleston', '', 'SC', '29417', '', '', 'WUSTDPATH5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1114996675', 0, 'Y', 0, '2006-11-17', NULL, NULL, 0, 0, NULL, NULL),
('870326048', 'W73004489', 'W73004489', 'UT01', 'Utah Pathology Services', 'George', 'H', 'Cannon', 'MD', NULL, NULL, NULL, NULL, 'B', 'PO Box 30309', 'Charleston', 'Charleston', 'SC', '29417', '8668017177', NULL, 'PO Box 30309', 'Charleston', '', 'SC', '29417', '', '', 'WUSTDPATH5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1770542953', 0, 'Y', 0, '2006-11-17', NULL, NULL, 0, 0, NULL, NULL),
('870326048', 'W73004490', 'W73004490', 'UT01', 'Utah Pathology Services', 'Melissa', 'H', 'Cessna', 'MD', NULL, NULL, NULL, NULL, 'B', 'PO Box 30309', 'Charleston', 'Charleston', 'SC', '29417', '8668017177', NULL, 'PO Box 30309', 'Charleston', '', 'SC', '29417', '', '', 'WUSTDPATH5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1033178090', 0, 'Y', 0, '2006-11-17', NULL, NULL, 0, 0, NULL, NULL),
('870326048', 'W73004491', 'W73004491', 'UT01', 'Utah Pathology Services', 'Landon', 'W', 'Coleman', 'MD', '', '', '', NULL, 'B', 'PO Box 30309', 'Charleston', 'Charleston', 'SC', '29417', '8668017177', NULL, 'PO Box 30309', 'Charleston', 'Charleston', 'SC', '29417', '8668017177', '          ', 'WUSTDPATH5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', '2011-10-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275592479', 0, 'Y', 0, '2011-10-05', NULL, NULL, 0, 0, NULL, NULL),
('870326048', 'W73004492', 'W73004492', 'UT01', 'Utah Pathology Services', 'James', 'R', 'Farnsworth', 'MD', 'Pathology', 'Clinical Pathology', '', NULL, 'B', 'PO Box 30309', 'Charleston', 'Charleston', 'SC', '29417', '8668017177', NULL, 'PO Box 30309', 'Charleston', 'Charleston', 'SC', '29417', '8668017177', '          ', 'WUSTDPATH5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548229578', 0, 'Y', 0, '2012-03-06', NULL, NULL, 0, 0, NULL, NULL),
('870326048', 'W73004493', 'W73004493', 'UT01', 'Utah Pathology Services', 'Mary Elizabeth', 'H', 'Hammond', 'MD', NULL, NULL, NULL, NULL, 'B', 'PO Box 30309', 'Charleston', 'Charleston', 'SC', '29417', '8668017177', NULL, 'PO Box 30309', 'Charleston', '', 'SC', '29417', '', '', 'WUSTDPATH5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000006549', 0, 'Y', 0, '2006-11-17', NULL, NULL, 0, 0, NULL, NULL),
('870326048', 'W73004494', 'W73004494', 'UT01', 'Utah Pathology Services', 'Christopher', 'M', 'Herman', 'MD', 'Laboratory', NULL, NULL, NULL, 'B', 'PO Box 30309', 'Charleston', 'Charleston', 'SC', '29417', '8668017177', NULL, 'PO Box 30309', 'Charleston', '', 'SC', '29417', '', '', 'WUSTDPATH5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', '2008-08-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000036683', 0, 'Y', 0, '2006-11-17', NULL, NULL, 0, 0, NULL, NULL),
('870326048', 'W73004495', 'W73004495', 'UT01', 'Utah Pathology Services', 'Sarah', 'J', 'Istrup', 'MD', 'Laboratory', NULL, NULL, NULL, 'B', 'PO Box 30309', 'Charleston', 'Charleston', 'SC', '29417', '8668017177', NULL, 'PO Box 30309', 'Charleston', '', 'SC', '29417', '', '', 'WUSTDPATH5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000006882', 0, 'Y', 0, '2006-11-17', 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
('870326048', 'W73004496', 'W73004496', 'UT01', 'Utah Pathology Services', 'Todd', 'L', 'Randolph', 'MD', 'Pathology', 'Anatomic Pathology', 'Laboratory', NULL, 'B', 'PO Box 30309', 'Charleston', 'Charleston', 'SC', '29417', '8668017177', NULL, 'PO Box 30309', 'Charleston', 'Charleston', 'SC', '29417', '8668017177', '', 'WUSTDPATH5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740249192', 0, 'Y', 0, '2012-03-06', NULL, NULL, 0, 0, NULL, NULL),
('870326048', 'W73004497', 'W73004497', 'UT01', 'Utah Pathology Services', 'James', 'P', 'Seaman', 'MD', 'Pathology', 'Anatomic Pathology', 'Laboratory', NULL, 'B', 'PO Box 30309', 'Charleston', 'Charleston', 'SC', '29417', '8668017177', NULL, 'PO Box 30309', 'Charleston', 'Charleston', 'SC', '29417', '8668017177', '', 'WUSTDPATH5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548229487', 0, 'Y', 0, '2012-03-06', NULL, NULL, 0, 0, NULL, NULL),
('870326048', 'W73004498', 'W73004498', 'UT01', 'Utah Pathology Services', 'Ann', NULL, 'Taylor', 'MD', 'Laboratory', NULL, NULL, NULL, 'B', 'PO Box 30309', 'Charleston', 'Charleston', 'SC', '29417', '8668017177', NULL, 'PO Box 30309', 'Charleston', '', 'SC', '29417', '', '', 'WUSTDPATH5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1548220809', 0, 'Y', 0, '2006-11-17', NULL, NULL, 0, 0, NULL, NULL),
('870326048', 'W73004499', 'W73004499', 'UT01', 'Utah Pathology Services', 'Michael', 'T', 'Wright', 'MD', 'Laboratory', NULL, NULL, NULL, 'B', 'PO Box 30309', 'Charleston', 'Charleston', 'SC', '29417', '8668017177', NULL, 'PO Box 30309', 'Charleston', '', 'SC', '29417', '', '', 'WUSTDPATH5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1376502666', 0, 'Y', 0, '2006-11-17', NULL, NULL, 0, 0, NULL, NULL),
('870326048', 'W73004500', 'W73004500', 'UT01', 'Utah Pathology Services', 'Jorge', NULL, 'Isaac', 'MD', 'Laboratory', NULL, NULL, NULL, 'B', 'PO Box 30309', 'Charleston', 'Charleston', 'SC', '29417', '8668017177', NULL, 'PO Box 30309', 'Charleston', '', 'SC', '29417', '', '', 'WUSTDPATH5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1659476463', 0, 'Y', 0, '2006-11-17', NULL, NULL, 0, 0, NULL, NULL),
('870662713', 'W73004501', 'W73004501', 'UT01', 'Alpine Medical Group', 'Christine', NULL, 'Kapsa', 'NP', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '1002 E S Temple ', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013641117', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUSTDMULT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1265400568', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870450466', 'W73004502', 'W73004502', 'UT01', 'Pulmonary Internal Medicine', 'David', '', 'Klein', 'MD', 'Pulmonary', '', '', NULL, 'O', '1220 E 3900 S Ste 2 C', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012632482', NULL, '1220 E 3900 S Ste 2 C', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012632482', '          ', 'WiseStd10A', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2013-12-24', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1124075437', 0, 'N', 0, '2014-02-18', NULL, NULL, 0, 0, NULL, NULL),
('870533883', 'W73004503', 'W73004503', 'UT01', 'Brigham Orthopedic Clinic', 'Matthew', 'F', 'Bitner', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '990 Medical Dr ', 'Brigham City', 'Wasatch', 'UT', '84032', '4357342151', NULL, '990 S Medical Dr', 'Brigham City', '', 'UT', '84302', '', '', 'WUBRIGOR5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2007-05-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('270041325', 'W73004693', 'W73004693', 'UT01', 'Pinnacle Anesthesia Associates', 'Shaun', 'S', 'Evans', 'CRNA', 'Certified Nurse Anesthetist', 'Anesthesiology', NULL, NULL, 'O', '300 N Hospital Dr', 'Price', 'Carbon', 'UT', '84501', '8007484868', NULL, '1954 E Fort Union Blvd', 'Salt Lake City', '', 'UT', '84121', '', '', '', NULL, NULL, '0.00', '20.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1649292897', 0, 'Y', 0, '2009-09-10', NULL, NULL, 39.6051, -110.832, NULL, NULL),
('270041325', 'W73004694', 'W73004694', 'UT01', 'Pinnacle Anesthesia Associates', 'Todd', 'W', 'Johnson', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'B', '1954 E Fort Union Blvd Ste 105', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8007484868', NULL, '1954 E Fort Union Blvd', 'Salt Lake City', '', 'UT', '84121', '', '', '', NULL, NULL, '0.00', '20.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1932204807', 0, 'Y', 0, '2007-01-11', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
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('270041325', 'W73004696', 'W73004696', 'UT01', 'Pinnacle Anesthesia Associates', 'Ray', 'W', 'Hobbs', 'CRNA', 'Anesthesiology', NULL, NULL, NULL, 'B', '1954 E Fort Union Blvd Ste 105', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8007484868', NULL, '1954 E Fort Union Blvd', 'Salt Lake City', '', 'UT', '84121', '', '', '', NULL, NULL, '0.00', '20.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1194770644', 0, 'Y', 0, '2007-01-11', NULL, NULL, 0, 0, NULL, NULL),
('270041325', 'W73004697', 'W73004697', 'UT01', 'Pinnacle Anesthesia Associates', 'Laurence', NULL, 'Van Atta', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'B', '1954 E Fort Union Blvd Ste 105', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8007484868', NULL, '1954 E Fort Union Blvd', 'Salt Lake City', '', 'UT', '84121', '', '', '', NULL, NULL, '0.00', '20.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000009410', 0, 'Y', 0, '2007-01-11', NULL, NULL, 0, 0, NULL, NULL),
('270041325', 'W73004698', 'W73004698', 'UT01', 'Pinnacle Anesthesia Associates', 'Jay', 'H', 'Gassman', 'MD', 'Anesthesiology', 'Nurse Anesthetist', '', NULL, 'B', '1954 E Fort Union Blvd Ste 105', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8007484868', NULL, '1954 E Fort Union Blvd Ste 105', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8007484868', '', '', NULL, NULL, '0.00', '20.00', '0.00', 3, '2007-01-01', '2008-08-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720193956', 0, 'Y', 0, '2013-10-24', NULL, NULL, 0, 0, NULL, NULL),
('270041325', 'W73004699', 'W73004699', 'UT01', 'Pinnacle Anesthesia Associates', 'Shaun', 'S', 'Evans', 'CRNA', 'Certified Nurse Anesthetist', 'Anesthesiology', NULL, NULL, 'B', '1954 E Fort Union Blvd Ste 105', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8007484868', NULL, '1954 E Fort Union Blvd', 'Salt Lake City', '', 'UT', '84121', '', '', '', NULL, NULL, '0.00', '20.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1649292897', 0, 'Y', 0, '2009-09-10', NULL, NULL, 0, 0, NULL, NULL),
('870517888', 'W73004700', 'W73004700', 'UT01', 'Basin Anesthesia Associates', 'Michael', 'S', 'Berg', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'O', '151 W 200 N', 'Vernal', 'Uintah', 'UT', '84078', '4357811519', NULL, 'PO Box 90164', 'Vernal', '', 'UT', '84078', '', '', '', NULL, '1000', '37.41', '0.00', '0.00', 3, '2007-01-01', '2008-08-31', 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000005269', 0, 'Y', 0, '2007-01-11', NULL, NULL, 0, 0, NULL, NULL),
('870517888', 'W73004701', 'W73004701', 'UT01', 'Basin Anesthesia Associates', 'Michael', 'S', 'Berg', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'B', 'PO Box 90164', 'Vernal', 'Uintah', 'UT', '84079', '4357811519', NULL, 'PO Box 90164', 'Vernal', '', 'UT', '84078', '', '', '', NULL, '1000', '37.41', '0.00', '0.00', 3, '2007-01-01', '2008-08-31', 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000005269', 0, 'Y', 0, '2007-01-11', NULL, NULL, 0, 0, NULL, NULL),
('450470087', 'W73004702', 'W73004702', 'UT01', 'Wasatch Neurosurgery', 'James', 'C', 'Pingree', 'MD', 'Neurosurgery', 'Oncology', '', NULL, 'O', '1220 E 3900 S Ste 4E', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012618507', '', '1220 E 3900 S Ste 4E', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012618507', '', 'WUOGDEN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-01-01', '2008-04-28', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1730249582', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('870656683', 'W73004703', 'W73004703', 'UT01', 'Plastic Surgical Center', 'Gary', 'Chad', 'Carson', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'B', '4403 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8013932249', NULL, '4403 Harrison Blvd', 'Ogden', '', 'UT', '84403', '', '', '', NULL, '1000', '45.00', '0.00', '0.00', 3, '2006-11-01', NULL, 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000005589', 0, 'Y', 0, '2007-01-11', NULL, NULL, 0, 0, NULL, NULL),
('731652742', 'W73004704', 'W73004704', 'UT01', 'Alpine Spine, Sports And Rehabilitation', 'Brian', 'H', 'Morgan', 'MD', 'Physical Medicine and Rehabilitation', NULL, NULL, NULL, 'O', '2084 N 1700 W Ste 4', 'Layton', 'Davis', 'UT', '84041', '8014790312', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1598873283', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('731652742', 'W73004705', 'W73004705', 'UT01', 'Alpine Spine  Sports and Rehabilitation', 'Brian', 'H', 'Morgan', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '1551 Renaissance Towne Dr Ste 420', 'Bountiful', 'Davis', 'UT', '84010', '8014790312', NULL, '1551 Renaissance Towne Dr Ste 420', 'Bountiful', 'Davis', 'UT', '84010', '8014790312', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1598873283', 0, 'N', 0, '2014-03-20', NULL, NULL, 40.8737, -111.888, NULL, NULL),
('731652742', 'W73004706', 'W73004706', 'UT01', 'Alpine Spine  Sports and Rehabilitation', 'Matthew', 'J', 'Pingree', 'MD', 'Physical Medicine and Rehabilitation', NULL, NULL, NULL, 'O', '2084 N 1700 W Ste 4', 'Layton', 'Davis', 'UT', '84041', '8014790312', NULL, '5405 S 500 E', 'Ogden', '', 'UT', '84405', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2010-03-04', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1225149883', 0, 'N', 0, '2007-01-11', NULL, NULL, 0, 0, NULL, NULL),
('731652742', 'W73004707', 'W73004707', 'UT01', 'Alpine Spine  Sports and Rehabilitation', 'William', 'F', 'Brandt', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '2084 N 1700 W Ste 4', 'Layton', 'Davis', 'UT', '84041', '8014790312', NULL, '2084 N 1700 W Ste 4', 'Layton', 'Davis', 'UT', '84041', '8014790312', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2011-09-13', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1760593313', 0, 'N', 0, '2013-08-19', NULL, NULL, 0, 0, NULL, NULL),
('731652742', 'W73004708', 'W73004708', 'UT01', 'Alpine Spine  Sports And Rehabilitation', '', '', 'Alpine Spine  Sports And Rehabilitation', 'GROUP', '', '', '', NULL, 'O', '2084 N 1700 W Ste 4', 'Layton', 'Davis', 'UT', '84041', '8014790312', NULL, '2084 N 1700 W Ste 4', 'Layton', 'Davis', 'UT', '84041', '8014790312', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000004990', 0, 'Y', 0, '2011-03-24', NULL, NULL, 41.0897, -111.997, NULL, NULL),
('731652742', 'W73004709', 'W73004709', 'UT01', 'Alpine Spine  Sports and Rehabilitation', 'Douglas', 'T', 'Shepherd', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '1551 Renaissance Towne Dr Ste 420', 'Bountiful', 'Davis', 'UT', '84010', '8014790312', NULL, '1551 Renaissance Towne Dr Ste 420', 'Bountiful', 'Davis', 'UT', '84010', '8014790312', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1659482289', 0, 'N', 0, '2014-03-13', NULL, NULL, 40.8737, -111.888, NULL, NULL),
('731652742', 'W73004710', 'W73004710', 'UT01', 'Alpine Spine  Sports And Rehabilitation', '', '', 'Alpine Spine  Sports And Rehabilitation', 'GROUP', '', '', '', NULL, 'O', '1551 Renaissance Towne Dr Ste 420', 'Bountiful', 'Davis', 'UT', '84010', '8014790312', NULL, '1551 Renaissance Towne Dr Ste 420', 'Bountiful', 'Davis', 'UT', '84010', '8014790312', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000004990', 0, 'Y', 0, '2011-03-24', NULL, NULL, 40.8737, -111.888, NULL, NULL),
('870560763', 'W73004711', 'W73004711', 'UT01', 'Montezuma Creek Community Health Center', 'Brooks', '', 'Thompson', 'MD', 'Family Practice', '', '', NULL, 'O', 'East Hwy 262', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356513291', NULL, 'East Hwy 262', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356513291', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-12-01', NULL, 0, 0, 0, 'Sanpete Valley Hospital', '', '', '', 'HCFA|UB|', '1487657763', 0, 'N', 0, '2014-06-04', NULL, NULL, 37.2619, -109.306, NULL, NULL),
('870560763', 'W73004712', 'W73004712', 'UT01', 'Montezuma Creek', 'Brooks', '', 'Thompson', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 130', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356513291', NULL, 'PO Box 130', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356513291', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-12-01', NULL, 0, 0, 0, 'Sanpete Valley Hospital', '', '', '', 'HCFA|UB|', '1487657763', 0, 'Y', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
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('870560763', 'W73004714', 'W73004714', 'UT01', 'Montezuma Creek Community Health Center', 'Kimberly', '', 'Fairley', 'MD', 'Family Practice', '', '', NULL, 'O', 'E Hwy 262', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356513291', NULL, 'E Hwy 262', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356513291', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235214289', 0, 'N', 0, '2014-06-04', NULL, NULL, 37.2619, -109.306, NULL, NULL),
('870560763', 'W73004715', 'W73004715', 'UT01', 'Montezuma Creek Community Health Center', 'Martin', '', 'Neubert', 'PA', 'Family Practice', NULL, NULL, NULL, 'O', 'East Hwy 262', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356513291', NULL, 'East Hwy 262', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356513291', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2006-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1649273921', 0, 'N', 0, '2013-11-05', NULL, NULL, 37.2619, -109.306, NULL, NULL),
('870560763', 'W73004716', 'W73004716', 'UT01', 'Montezuma Creek', 'Martin', '', 'Neubert', 'PA', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 130', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356513291', NULL, 'PO Box 130', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356513291', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2006-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1649273921', 0, 'Y', 0, '2013-11-05', NULL, NULL, 0, 0, NULL, NULL),
('870560763', 'W73004717', 'W73004717', 'UT01', 'Montezuma Creek Community Health Center', 'Peggy', NULL, 'Towles', 'PA', 'Family Practice', NULL, NULL, NULL, 'O', 'East Hwy 262', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356513291', NULL, 'PO Box 130', 'Montezuma Creek', '', 'UT', '84534', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2006-12-01', '2008-08-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1598768871', 0, 'N', 0, '2007-01-11', NULL, NULL, 0, 0, NULL, NULL),
('870560763', 'W73004718', 'W73004718', 'UT01', 'Montezuma Creek', 'Peggy', NULL, 'Towles', 'PA', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 130', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356513291', NULL, 'PO Box 130', 'Montezuma Creek', '', 'UT', '84534', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2006-12-01', '2008-08-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1598768871', 0, 'Y', 0, '2007-01-11', NULL, NULL, 0, 0, NULL, NULL),
('870560763', 'W73004719', 'W73004719', 'UT01', 'Montezuma Creek Community Health Center', 'Freddie', '', 'Riggs', 'PA', 'Family Practice', '', '', NULL, 'O', 'East Hwy 262', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356513291', NULL, 'East Hwy 262', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356513291', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2006-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1881697365', 0, 'N', 0, '2014-01-17', NULL, NULL, 37.2619, -109.306, NULL, NULL),
('870560763', 'W73004720', 'W73004720', 'UT01', 'Montezuma Creek', 'Freddie', '', 'Riggs', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 130', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356513291', NULL, 'PO Box 130', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356513291', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2006-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1881697365', 0, 'Y', 0, '2014-01-17', NULL, NULL, 0, 0, NULL, NULL),
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('870479370', 'W73004757', 'W73004757', 'UT01', 'Mountain West Cardiovascular Associates', 'Ronald', NULL, 'Brown', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '24 S 1100 E Ste 105', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012663418', NULL, '1160 E 3900 S', 'Salt Lake City', '', 'UT', '84124', '', '', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-09-01', '2007-07-01', 0, NULL, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1447242060', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('870491749', 'W73004766', 'W73004766', 'UT01', 'Utah Sleep Specialists', 'Kathleen', 'D', 'Pfeffer', 'MD', 'Pediatric Pulmonology', '', '', NULL, 'O', '11075 S State St Ste 20', 'Sandy', 'Salt Lake', 'UT', '84070', '8019673155', NULL, '11075 S State St Ste 20', 'Sandy', 'Salt Lake', 'UT', '84070', '8019673155', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-01-01', '2010-01-07', 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1700986346', 0, 'N', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('870491749', 'W73004767', 'W73004767', 'UT01', 'Utah Sleep Specialists', 'Gregory', 'P', 'Dupont', 'MD', 'Pulmonary', 'Sleep Medicine', '', NULL, 'O', '11075 S State St Ste 20', 'Sandy', 'Salt Lake', 'UT', '84070', '8019673155', NULL, '11075 S State St Ste 20', 'Sandy', 'Salt Lake', 'UT', '84070', '8019673155', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-01-01', '2010-01-07', 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1306943121', 0, 'N', 0, '2012-11-01', NULL, NULL, 0, 0, NULL, NULL),
('870583479', 'W73004768', 'W73004768', 'UT01', 'Phase II Center for Womens Health', 'Rebecca', NULL, 'Gatesman', 'FNP', 'Gynecology', NULL, NULL, NULL, 'O', '348 E 4500 S Ste 200', 'Murray', 'Salt Lake', 'UT', '84107', '8012629800', NULL, '348 E 4500 S', 'Murray', '', 'UT', '84107', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-01-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('870583479', 'W73004770', 'W73004770', 'UT01', 'Phase II Center for Womens Health', 'Shirley', NULL, 'Bleak', 'FNP', 'Gynecology', NULL, NULL, NULL, 'O', '348 E 4500 S Ste 200', 'Murray', 'Salt Lake', 'UT', '84107', '8012629800', NULL, '348 E 4500 S', 'Murray', '', 'UT', '84107', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', '2008-12-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000005332', 0, 'N', 0, '2007-01-19', NULL, NULL, 0, 0, NULL, NULL),
('870306646', 'W73004771', 'W73004771', 'UT01', 'Emergency Physicians Group', 'Stacey', '', 'Bank', 'MD', 'Family Practice', 'Emergency Medicine', '', NULL, 'O', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687975', NULL, '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687975', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1790797959', 0, 'Y', 0, '2011-09-26', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('870306646', 'W73004772', 'W73004772', 'UT01', 'Emergency Physicians Group', 'Stacey', '', 'Bank', 'MD', 'Family Practice', 'Emergency Medicine', '', NULL, 'B', 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013529500', NULL, 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013529500', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1790797959', 0, 'Y', 0, '2011-09-26', NULL, NULL, 0, 0, NULL, NULL),
('870622942', 'W73004773', 'W73004773', 'UT01', 'Utah Imaging Associates ', '', '', 'Utah Imaging Associates LLC', 'GROUP', 'Imaging Center', 'Mammography', '', NULL, 'O', '5740 Crestwood Dr Ste 150', 'Ogden', 'Weber', 'UT', '84405', '8014797771', NULL, '5740 Crestwood Dr Ste 150', 'Ogden', 'Weber', 'UT', '84405', '8014797771', '', 'WUUTIMAGE5', NULL, NULL, '0.00', '35.00', '0.00', 3, '2006-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629076229', 0, 'Y', 0, '2013-04-15', NULL, NULL, 41.1583, -111.947, NULL, NULL),
('270015335', 'W73004774', 'W73004774', 'UT01', 'Southwest Foot Clinic', 'Craig', 'James', 'Campbell', 'DPM', 'Podiatry', NULL, NULL, NULL, 'O', '4019 W 12600 S Ste 120', 'Riverton', 'Salt Lake', 'UT', '84065', '8019691434', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-08-01', '2006-08-01', 0, NULL, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1841288651', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('200390399', 'W73004775', 'W73004775', 'UT01', 'Solo Clinical Services', 'Bennett', '', 'Navarro', 'NP', 'Family Practice', '', '', NULL, 'O', '12285 S 2240 W', 'Riverton', 'Salt Lake', 'UT', '84065', '8019795330', NULL, '12285 S 2240 W', 'Riverton', 'Salt Lake', 'UT', '84065', '8019795330', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2011-11-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841267309', 0, 'N', 0, '2011-11-21', NULL, NULL, 0, 0, NULL, NULL),
('870548726', 'W73004776', 'W73004776', 'UT01', 'Snow Creek Emergency Center', 'Lisa', 'M', 'Anderson', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '1600 Snow Creek Dr', 'Park City', 'Summit', 'UT', '84060', '4356550055', NULL, 'PO Box 95970', 'South Jordan', '', 'UT', '84095', '', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1083679989', 0, 'Y', 0, '2007-01-26', NULL, NULL, 40.662, -111.511, NULL, NULL),
('870548726', 'W73004777', 'W73004777', 'UT01', 'Snow Creek Emergency Center', 'Kathy', 'Jo', 'Atkinson', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '1600 Snow Creek Dr', 'Park City', 'Summit', 'UT', '84060', '4356550055', NULL, 'PO Box 95970', 'South Jordan', '', 'UT', '84095', '', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, 0, 0, 0, 'Mountain West Medical Center', 'Salt Lake Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1497715577', 0, 'Y', 0, '2007-01-26', NULL, NULL, 40.662, -111.511, NULL, NULL),
('870548726', 'W73004778', 'W73004778', 'UT01', 'Snow Creek Emergency Center', 'Arnold', '', 'Finkleman', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '1600 Snow Creek Dr', 'Park City', 'Summit', 'UT', '84060', '4356550055', NULL, '1600 Snow Creek Dr', 'Park City', 'Summit', 'UT', '84060', '4356550055', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-07-01', '2012-06-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053371542', 0, 'Y', 0, '2012-09-19', NULL, NULL, 0, 0, NULL, NULL),
('870548726', 'W73004779', 'W73004779', 'UT01', 'Snow Creek Emergency Center', 'Robert', 'D', 'Gannon', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '1600 Snow Creek Dr', 'Park City', 'Summit', 'UT', '84060', '4356550055', NULL, 'PO Box 95970', 'South Jordan', '', 'UT', '84095', '', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1629039649', 0, 'Y', 0, '2007-03-20', NULL, NULL, 40.662, -111.511, NULL, NULL),
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('870548726', 'W73004781', 'W73004781', 'UT01', 'Snow Creek Emergency Center', 'Larry', '', 'Orosz', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '1600 Snow Creek Dr', 'Park City', 'Summit', 'UT', '84060', '4356550055', NULL, '1600 Snow Creek Dr', 'Park City', 'Summit', 'UT', '84060', '4356550055', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1922030998', 0, 'Y', 0, '2011-07-19', NULL, NULL, 40.662, -111.511, NULL, NULL),
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('870400650', 'W73004783', 'W73004783', 'UT01', 'Smoot Center', 'David', 'J', 'Smoot', 'DDS DMS', 'Oral Surgeon', 'Oral/Maxillofacial Surgery', '', NULL, 'O', '2651 W South Jordan Pkwy Ste 102', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012534352', NULL, '2651 W South Jordan Pkwy Ste 102', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012534352', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2006-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1508874090', 0, 'N', 0, '2013-07-25', NULL, NULL, 40.5623, -111.957, NULL, NULL),
('870326048', 'W73004784', 'W73004784', 'UT01', 'Utah Pathology Services', 'James', 'Edward', 'Albro', 'MD', 'Laboratory', NULL, NULL, NULL, 'B', 'PO Box 30309', 'Charlston', 'Charleston', 'SC', '29417', '8668017177', NULL, 'PO Box 30309', 'Charleston', '', 'SC', '29417', '', '', 'WUSTDPATH5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1144299645', 0, 'Y', 0, '2007-01-26', NULL, NULL, 0, 0, NULL, NULL),
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('870482642', 'W73004788', 'W73004788', 'UT01', 'Millcreek Anesthesia', 'Rajiv', 'R', 'Shah', 'MD', 'Pain Management', NULL, NULL, NULL, 'B', '1954 E Fort Union Blvd Ste 104', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019939530', NULL, '1954 E Fort Union', 'Salt Lake City', '', 'UT', '84124', '', '', 'WUSTDPAIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1285664185', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870766965', 'W73004789', 'W73004789', 'UT01', 'Lone Peak Primary Care', 'Justin', 'Carl', 'Wilcox', 'PA', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 708578', 'Sandy', 'Salt Lake', 'UT', '84070', '8015458480', NULL, 'PO Box 708578', 'Sandy', '', 'UT', '84070', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', '2008-01-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000009617', 0, 'Y', 0, '2007-01-26', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('870766965', 'W73004790', 'W73004790', 'UT01', 'Lone Peak Primary Care', 'Justin', 'Carl', 'Wilcox', 'PA', 'Family Practice', NULL, NULL, NULL, 'O', '10011 So Centennial Pkwy Ste 150', 'Sandy', 'Salt Lake', 'UT', '84094', '8015458480', NULL, 'PO Box 708578', 'Sandy', '', 'UT', '84070', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', '2008-01-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000009617', 0, 'N', 0, '2007-01-26', NULL, NULL, 0, 0, NULL, NULL),
('870766965', 'W73004791', 'W73004791', 'UT01', 'Lone Peak Primary Care', 'Robin', 'S', 'Poppen', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 708578', 'Sandy', 'Salt Lake', 'UT', '84070', '8015458480', NULL, 'PO Box 708578', 'Sandy', 'Salt Lake', 'UT', '84070', '8015458480', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', '2009-07-01', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1588698831', 0, 'Y', 0, '2014-04-09', NULL, NULL, 0, 0, NULL, NULL),
('870766965', 'W73004792', 'W73004792', 'UT01', 'Lone Peak Primary Care', 'Robin', 'S', 'Poppen', 'MD', 'Internal Medicine', '', '', NULL, 'O', '10011 So Centennial Pkwy Ste 150', 'Sandy', 'Salt Lake', 'UT', '84094', '8015458480', NULL, '10011 So Centennial Pkwy Ste 150', 'Sandy', 'Salt Lake', 'UT', '84094', '8015458480', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', '2009-07-01', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1588698831', 0, 'N', 0, '2014-04-09', NULL, NULL, 0, 0, NULL, NULL),
('870293534', 'W73004793', 'W73004793', 'UT01', 'Neurosurgical Clinic of Utah', 'David', 'J', 'Nathan', 'MD', 'Neurosurgery', '', '', NULL, 'O', '24 S 1100 E Ste 302', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015317806', NULL, '24 S 1100 E Ste 302', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015317806', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2011-10-03', 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1194731240', 0, 'N', 0, '2014-01-27', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'W73004794', 'W73004794', 'UT01', 'Heart and Lung Institute', 'Robert', 'F', 'Sprung', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '5979 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012632370', NULL, '5979 S Fashion Blvd', 'Murray', '', 'UT', '84107', '', '', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', '2008-01-25', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1255314837', 0, 'N', 0, '2007-11-06', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'W73004795', 'W73004795', 'UT01', 'Heart and Lung Institute', 'Robert', 'F', 'Sprung', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '3570 W 9000 S Ste 110', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012330140', NULL, '5979 S Fashion Blvd', 'Murray', '', 'UT', '84107', '', '', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', '2008-01-25', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1255314837', 0, 'N', 0, '2007-11-06', NULL, NULL, 0, 0, NULL, NULL),
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('870373083', 'W73004797', 'W73004797', 'UT01', 'Heart and Lung Institute', 'Bard', 'R', 'Madsen', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3570 W 9000 S Ste 110', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012330140', NULL, '3570 W 9000 S Ste 110', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012330140', '', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', 'Salt Lake Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1497738074', 0, 'N', 0, '2014-02-10', NULL, NULL, 40.588, -111.975, NULL, NULL),
('870373083', 'W73004798', 'W73004798', 'UT01', 'Heart And Lung Institute', 'Mark', 'H', 'Keep', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '3570 W 9000 S Ste 110', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012330140', NULL, '5979 S Fashion Blvd', 'Murray', '', 'UT', '84107', '', '', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1609859297', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'W73004799', 'W73004799', 'UT01', 'Heart and Lung Institute', 'Konstantyn', 'Y', 'Szwajkun', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3570 W 9000 S Ste 110', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012330140', NULL, '3570 W 9000 S Ste 110', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012330140', '', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', 'Salt Lake Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1508849191', 0, 'N', 0, '2012-06-26', NULL, NULL, 40.588, -111.975, NULL, NULL),
('870373083', 'W73004800', 'W73004800', 'UT01', 'Heart and Lung Institute', 'David', 'G', 'Dienhart', 'MD', 'Pulmonary', 'Sleep Medicine', 'Critical Care', NULL, 'O', '3570 W 9000 S Ste 110', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012330140', NULL, '3570 W 9000 S Ste 110', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012330140', '          ', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2011-04-01', 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1184601940', 0, 'N', 0, '2013-12-10', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'W73004801', 'W73004801', 'UT01', 'Heart and Lung Institute', 'Patricia', 'L', 'Nelson', 'MD', 'Pulmonary', '', '', NULL, 'O', '3570 W 9000 S Ste 110', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012330140', NULL, '3570 W 9000 S Ste 110', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012330140', '          ', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2011-04-01', 0, 0, 0, 'Lone Peak Hospital', '', '', '', 'HCFA|UB|', '1629051206', 0, 'N', 0, '2011-05-11', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'W73004802', 'W73004802', 'UT01', 'Heart and Lung Institute', 'David', 'T', 'Harris', 'MD', 'Pulmonary', NULL, NULL, NULL, 'O', '3570 W 9000 S Ste 110', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012330140', NULL, '5979 S Fashion Blvd', 'Murray', '', 'UT', '84107', '', '', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', '2008-03-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1992783559', 0, 'N', 0, '2007-01-26', NULL, NULL, 0, 0, NULL, NULL),
('870467635', 'W73004803', 'W73004803', 'UT01', 'Highland Family Practice', 'Malinda', '', 'Christensen', 'PA', 'Family Practice', '', '', NULL, 'O', '4460 Highland Dr Ste 400', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012724111', NULL, '4460 Highland Dr Ste 400', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012724111', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', '2008-06-01', 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285812586', 0, 'N', 0, '2012-10-01', NULL, NULL, 0, 0, NULL, NULL),
('870545723', 'W73004804', 'W73004804', 'UT01', 'Lihai Medical Clinic', 'Kingi', 'M', 'Langi', 'PA, MT', 'Family Practice', '', '', NULL, 'O', '6095 S Fashion Blvd Ste 130', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012652608', NULL, '6095 S Fashion Blvd Ste 130', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012652608', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942257795', 0, 'Y', 0, '2012-04-17', NULL, NULL, 40.6386, -111.883, NULL, NULL),
('870637304', 'W73004805', 'W73004805', 'UT01', 'Zion Pain Management', 'Dale G Stott MD PC', NULL, NULL, NULL, 'Pain Management', NULL, NULL, NULL, 'O', '301 N 200 E', 'St George', 'Washington', 'UT', '84770', '4356887246', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUSTDPAIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-03-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870637304', 'W73004806', 'W73004806', 'UT01', 'Zion Pain Management', 'Kathleen', 'M', 'Daly', 'MD', 'Pain Management', NULL, NULL, NULL, 'O', '301 N 200 E Ste 2A', 'St George', 'Washington', 'UT', '84770', '4356887246', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUSTDPAIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-03-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1063403723', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870637304', 'W73004807', 'W73004807', 'UT01', 'Zion Pain Management', 'Derek', 'L', 'Frieden', 'MD', 'Pain Management', 'Anesthesiology', '', NULL, 'O', '301 N 200 E Ste 2A', 'St George', 'Washington', 'UT', '84770', '4356887246', NULL, '301 N 200 E Ste 2A', 'St George', 'Washington', 'UT', '84770', '4356887246', '', 'WUSTDPAIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-03-01', '2010-08-15', 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1528059201', 0, 'N', 0, '2013-05-23', NULL, NULL, 0, 0, NULL, NULL),
('870637304', 'W73004808', 'W73004808', 'UT01', 'Zion Pain Management', 'Brook', 'J', 'Mickelson', 'FNP', 'Pain Management', '', '', NULL, 'O', '301 N 200 E Ste 2A', 'St George', 'Washington', 'UT', '84770', '4356887246', NULL, '301 N 200 E Ste 2A', 'St George', 'Washington', 'UT', '84770', '4356887246', '', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013916915', 0, 'N', 0, '2014-05-08', NULL, NULL, 37.1081, -113.566, NULL, NULL),
('870637304', 'W73004809', 'W73004809', 'UT01', 'Zion Pain Management', 'Dale', 'G', 'Stott', 'MD', 'Pain Management', NULL, NULL, NULL, 'O', '301 N 200 E Ste 2A', 'St George', 'Washington', 'UT', '84770', '4356887246', NULL, '301 N 200 E Ste 2A', 'St George', 'Washington', 'UT', '84770', '4356887246', '', 'WUSTDPAIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-03-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1164421053', 0, 'N', 0, '2013-10-15', NULL, NULL, 37.1081, -113.566, NULL, NULL),
('870523626', 'W73004810', 'W73004810', 'UT01', 'Blake O Zobell DPM', 'Blake', 'O', 'Zobell', 'DPM', 'Podiatry', NULL, NULL, NULL, 'O', '525 N Main St', 'Ephraim', 'Sevier', 'UT', '84701', '4358966497', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, 'Sanpete Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1720026560', 0, 'y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870419153', 'W73004811', 'W73004811', 'UT01', NULL, 'Robert', 'William', 'Wing', 'MD', 'Ophthalmology', '', '', NULL, 'O', '415 Medical Dr Ste C201', 'Bountiful', 'Davis', 'UT', '84010', '8012989277', NULL, '415 Medical Dr Ste C201', 'Bountiful', 'Davis', 'UT', '84010', '8012989277', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', '2008-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508899949', 0, 'N', 0, '2011-01-19', NULL, NULL, 0, 0, NULL, NULL),
('870555591', 'W73004812', 'W73004812', 'UT01', 'Womens Health Services', 'Jacqueline', 'M', 'Smithers', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '391 N Ana Blvd Ste A', 'Wendover', 'Tooele', 'UT', '84083', '8017330555', NULL, '391 N Ana Blvd Ste A', 'Wendover', 'Tooele', 'UT', '84083', '8017330555', '', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', '2006-09-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356302624', 0, 'N', 0, '2014-06-17', NULL, NULL, 0, 0, NULL, NULL),
('870589881', 'W73004813', 'W73004813', 'UT01', '', 'Spence', 'D', 'Harper', 'DPM', 'Podiatry', '', '', NULL, 'O', '1471 S Hwy 40', 'Heber City', 'Wasatch', 'UT', '84032', '8012749062', NULL, '1471 S Hwy 40', 'Heber City', 'Wasatch', 'UT', '84032', '8012749062', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2008-11-17', 0, 0, 0, 'Heber Valley Medical Center', 'St Marks Hospital', 'Park City Medical Center', NULL, 'HCFA|UB|', '1851394803', 1, 'N', 0, '2012-01-05', NULL, NULL, 0, 0, NULL, NULL),
('870575413', 'W73004814', 'W73004814', 'UT01', 'SouthWest Vision', 'Ryan', 'E', 'Robison', 'OD', 'Optometry', '', '', NULL, 'O', '965 E 700 S Ste 100', 'St George', 'Washington', 'UT', '84790', '4356735577', '4356880381', '965 E 700 S Ste 100', 'St George', 'Washington', 'UT', '84790', '4356735577', '4356880381', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679686547', 0, 'N', 0, '2014-01-17', NULL, NULL, 37.0962, -113.563, NULL, NULL),
('870560763', 'W73004815', 'W73004815', 'UT01', 'Montezuma Creek Community Heatlh Center', 'Alton', '', 'Pugh', 'CRNA', 'Anesthesiology', '', '', NULL, 'O', 'East Hwy 262', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356513291', NULL, 'East Hwy 262', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356513291', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008281', 0, 'Y', 0, '2011-12-14', NULL, NULL, 37.2619, -109.306, NULL, NULL),
('870560763', 'W73004816', 'W73004816', 'UT01', 'Montezuma Creek Community Health Center', 'Deirdre', '', 'Piotrowski', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', 'E Hwy 262', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356513291', NULL, 'E Hwy 262', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356513291', '', 'ma', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-12-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609879998', 0, 'N', 0, '2014-05-12', NULL, NULL, 0, 0, NULL, NULL),
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('870560763', 'W73004818', 'W73004818', 'UT01', 'Montezuma Creek Community Health Center', 'Roselyn', '', 'Maryboy', 'LCSW', 'Mental Health', '', '', NULL, 'O', 'E Hwy 262', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356513291', NULL, 'E Hwy 262', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356513291', '', 'MA', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2006-12-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053324665', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870560763', 'W73004819', 'W73004819', 'UT01', 'Montezuma Creek Community Health Center', 'Terry', 'R', 'Cook', 'DPM', 'Podiatry', '', '', NULL, 'O', 'E Hwy 262', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356513291', NULL, 'E Hwy 262', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356513291', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2006-12-01', NULL, 0, 0, 0, 'Southwest Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285636449', 0, 'N', 0, '2011-10-14', NULL, NULL, 37.2619, -109.306, NULL, NULL),
('870560763', 'W73004820', 'W73004820', 'UT01', 'Blanding Family Practice', 'Alton', '', 'Pugh', 'CRNA', 'Anesthesiology', '', '', NULL, 'O', '799 S 200 W', 'Blanding', 'San Juan', 'UT', '84511', '4356783601', NULL, '799 S 200 W', 'Blanding', 'San Juan', 'UT', '84511', '4356783601', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-12-01', '2011-10-13', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008281', 0, 'N', 0, '2011-12-14', NULL, NULL, 0, 0, NULL, NULL),
('870560763', 'W73004821', 'W73004821', 'UT01', 'Blanding Family Practice', 'Deirdre', '', 'Piotrowski', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '799 S 200 W', 'Blanding', 'San Juan', 'UT', '84511', '4356783601', NULL, '799 S 200 W', 'Blanding', 'San Juan', 'UT', '84511', '4356783601', '', 'ma', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-12-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609879998', 0, 'N', 0, '2014-05-12', NULL, NULL, 0, 0, NULL, NULL),
('870560763', 'W73004822', 'W73004822', 'UT01', 'Montezuma Creek', 'Richard', 'T', 'Ward', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 130', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356783601', NULL, 'PO Box 130', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356783601', '', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144223413', 0, 'Y', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('870560763', 'W73004823', 'W73004823', 'UT01', 'Blanding Family Practice', 'Roselyn', '', 'Maryboy', 'LCSW', 'Mental Health', '', '', NULL, 'O', '799 S 200W', 'Blanding', 'San Juan', 'UT', '84511', '4356783601', NULL, '799 S 200W', 'Blanding', 'San Juan', 'UT', '84511', '4356783601', '', 'MA', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2006-12-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053324665', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870560763', 'W73004824', 'W73004824', 'UT01', 'Blanding Family Practice', 'Terry', 'R', 'Cook', 'DPM', 'Podiatry', '', '', NULL, 'O', '799 S 200 W', 'Blanding', 'San Juan', 'UT', '84511', '4356783601', NULL, '799 S 200 W', 'Blanding', 'San Juan', 'UT', '84511', '4356783601', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-12-01', '2011-10-13', 0, 0, 0, 'Southwest Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285636449', 0, 'N', 0, '2011-10-14', NULL, NULL, 0, 0, NULL, NULL),
('870560763', 'W73004825', 'W73004825', 'UT01', 'Monument Valley Community Health Center', 'Brooks', NULL, 'Thompson', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', 'Four Rock Door Canyon Rd', 'Monument Valley', 'San Juan', 'UT', '84536', '4357273000', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2007-03-01', 0, NULL, 0, 'Sanpete Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1487657763', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870560763', 'W73004826', 'W73004826', 'UT01', 'Monument Valley Community Health Center', 'Deirdre', '', 'Piotrowski', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', 'Four Rock Door Canyon Rd', 'Monument Valley', 'San Juan', 'UT', '84536', '4357273000', NULL, 'Four Rock Door Canyon Rd', 'Monument Valley', 'San Juan', 'UT', '84536', '4357273000', '', 'ma', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-12-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609879998', 0, 'N', 0, '2014-05-12', NULL, NULL, 0, 0, NULL, NULL),
('870560763', 'W73004827', 'W73004827', 'UT01', 'Monument Valley Community Health Center', 'Terry', 'R', 'Cook', 'DPM', 'Podiatry', '', '', NULL, 'O', 'Four Rock Door Canyon Rd', 'Monument Valley', 'San Juan', 'UT', '84536', '4357273000', NULL, 'Four Rock Door Canyon Rd', 'Monument Valley', 'San Juan', 'UT', '84536', '4357273000', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2006-12-01', NULL, 0, 0, 0, 'Southwest Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285636449', 0, 'N', 0, '2011-10-14', NULL, NULL, 37.0992, -110.619, NULL, NULL),
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('870682101', 'W73004866', 'W73004866', 'UT01', 'Salt Lake Orthopaedic Clinic', 'J Eric', NULL, 'Vanderhooft', 'MD', 'Hand Surgery', NULL, NULL, NULL, 'O', '1160 E 3900 S Ste 5000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012628486', NULL, '1160 E 3900 S', 'Salt Lake City', '', 'UT', '84121', '', '', 'WUSLORTH5', 'wUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-04-01', '2006-04-01', 0, NULL, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1821080326', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870621466', 'W73004867', 'W73004867', 'UT01', '', 'Daniel', 'S', 'Sellers', 'MD', 'Plastic Surgery', 'Hand Surgery', '', NULL, 'O', '440 D St Ste 202', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8014082511', NULL, '440 D St Ste 202', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8014082511', '          ', 'WUSTDPLAS5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', '2011-09-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194750711', 0, 'N', 0, '2014-03-13', NULL, NULL, 0, 0, NULL, NULL),
('870621466', 'W73004868', 'W73004868', 'UT01', 'Sellers, Daniel S', 'Daniel', 'S', 'Sellers', 'MD', 'Hand Surgery', NULL, NULL, NULL, 'O', '620 Medical Dr Ste 310', 'Bountiful', 'Davis', 'UT', '84010', '8012956554', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUSTDPLAS5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1194750711', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('200685493', 'W73004869', 'W73004869', 'UT01', NULL, 'Larry', 'G', 'Leonard', 'MD', 'Hand Surgery', NULL, NULL, NULL, 'O', '1795 Sidewinder Dr Ste 200', 'Park City', 'Summit', 'UT', '84060', '4356470074', NULL, '1795 Sidewinder Dr', 'Park City', '', 'UT', '84060', '', '', 'WiseSTD10A', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1972523942', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('200685493', 'W73004870', 'W73004870', 'UT01', NULL, 'Larry', 'G', 'Leonard', 'MD', 'Hand Surgery', NULL, NULL, NULL, 'O', '440 D St Ste 202', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8014082508', NULL, '1795 Sidewinder Dr', 'Park City', '', 'UT', '84060', '', '', 'WiseSTD10A', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1972523942', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870623071', 'W73004873', 'W73004873', 'UT01', 'City Creek Internal Medicine', 'Mary', 'G', 'Mooers', 'MD', 'Internal Medicine', 'Infectious Disease', NULL, NULL, 'O', '324 10th Ave Ste 160', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8014085151', NULL, '324 10th Ave', 'Salt Lake City', '', 'UT', '84103', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1609823889', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870550021', 'W73004874', 'W73004874', 'UT01', 'Utah Physicians Care Center', 'Thomas', 'Anton', 'Kurrus', 'MD', 'Infectious Disease', NULL, NULL, NULL, 'O', '1160 E 3900 S Ste 1200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012619651', NULL, '1160 E 3900 S', 'Salt Lake City', '', 'UT', '84124', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1831120567', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870323929', 'W73004875', 'W73004875', 'UT01', '', 'G', 'S', 'Jessen', 'DDS', 'Oral/Maxillofacial Surgery', 'Oral Surgeon', '', NULL, 'O', '1448 N 2000 W Ste 12', 'Clinton', 'Davis', 'UT', '84015', '8014798201', NULL, '1448 N 2000 W Ste 12', 'Clinton', 'Davis', 'UT', '84015', '8014798201', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-11-01', '2011-12-31', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|DEN|', '1548349251', 0, 'N', 0, '2012-08-23', NULL, NULL, 0, 0, NULL, NULL),
('841411398', 'W73004876', 'W73004876', 'UT01', 'Foothill Family Clinic', 'Bryan', NULL, 'Nelson', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '6360 S 3000 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8013651032', NULL, NULL, NULL, '', 'UT', '84109', '', '', 'WUFOOTHIL5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1346265477', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W73004877', 'W73004877', 'UT01', '', 'Blake', 'O', 'Zobell', 'DPM', 'Podiatry', '', '', NULL, 'B', 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013577482', NULL, 'PO Box 30180', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013577482', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2006-09-01', '2013-11-22', 0, 0, 0, 'Sanpete Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1720026560', 0, 'Y', 0, '2014-03-03', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W73004878', 'W73004878', 'UT01', '', 'Blake', 'O', 'Zobell', 'DPM', 'Podiatry', '', '', NULL, 'O', '1000 N Main St', 'Richfield', 'Sevier', 'UT', '84701', '4358966497', NULL, '1000 N Main St', 'Richfield', 'Sevier', 'UT', '84701', '4358966497', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2006-09-01', '2013-11-22', 0, 0, 0, 'Sanpete Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1720026560', 0, 'Y', 0, '2014-03-03', NULL, NULL, 38.7833, -112.085, NULL, NULL),
('942854057', 'W73004879', 'W73004879', 'UT01', 'Ephraim Clinic', 'Blake', 'O', 'Zobell', 'DPM', 'Podiatry', '', '', NULL, 'O', '525 N Main St', 'Ephraim', 'Sanpete', 'UT', '84627', '4352834076', NULL, '525 N Main St', 'Ephraim', 'Sanpete', 'UT', '84627', '4352834076', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2006-09-01', '2013-11-22', 0, 0, 0, 'Sanpete Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1720026560', 0, 'Y', 0, '2014-03-03', NULL, NULL, 39.371, -111.587, NULL, NULL),
('841424994', 'W73004880', 'W73004880', 'UT01', 'Peterson, Warren A', 'Warren', 'A', 'Peterson', 'MD', 'Dermatology', NULL, NULL, NULL, 'O', '114 E 800 N', 'Spanish Fork', 'Utah', 'UT', '84660', '8017941490', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2007-02-28', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1134198807', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('205297795', 'W73004881', 'W73004881', 'UT01', 'Kaysville Family Medicine', 'Steven', 'J', 'Potter', 'MD', 'Family Practice', '', '', NULL, 'O', '307 N 300 W Ste 301', 'Kaysville', 'Davis', 'UT', '84037', '8015432221', NULL, '307 N 300 W Ste 301', 'Kaysville', 'Davis', 'UT', '84037', '8015432221', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-03-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1407922446', 0, 'N', 0, '2013-10-18', NULL, NULL, 41.0399, -111.944, NULL, NULL),
('205297795', 'W73004882', 'W73004882', 'UT01', 'Kaysville Family Medicine', 'Steven', 'J', 'Potter', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8015432221', NULL, 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8015432221', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-03-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1407922446', 0, 'Y', 0, '2013-10-18', NULL, NULL, 0, 0, NULL, NULL),
('200407874', 'W73004883', 'W73004883', 'UT01', 'Treehouse Pediatrics And Family Care', 'Bruce', 'A', 'O''Very', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '1325 N 600 E Ste 101', 'Logan', 'Cache', 'UT', '84341', '4357505599', NULL, '1325 N 600 E', 'Logan', '', 'UT', '84341', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1225047996', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870666061', 'W73004884', 'W73004884', 'UT01', 'Copperview Medical Center', 'Mary', 'D', 'Tipton', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '3556 W 9800 S Ste 101', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015679780', NULL, '3556 W 9800 S', 'South Jordan', '', 'UT', '84095', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1922065598', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('200494346', 'W73004885', 'W73004885', 'UT01', 'Park City Internal Medicine, Pediatrics', 'Viet-Dung', 'N', 'Nguyen', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '1612 Ute Blvd Ste 112', 'Park City', 'Summit', 'UT', '84098', '4356553309', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1063470136', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('680562677', 'W73004886', 'W73004886', 'UT01', 'Intermountain Ear Nose and Throat Specialists', 'Jon', 'Richard', 'Aoki', 'MD', 'Ear, Nose and Throat', NULL, NULL, NULL, 'O', '4052 W Pioneer Pkwy Ste 210 ', 'West Valley', 'Salt Lake', 'UT', '84120', '8019668534', NULL, '22 S 900 E', 'Salt Lake City', '', 'UT', '84102', '', '', 'WiseOrtho', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-09-01', '2007-12-31', 0, NULL, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1295805265', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('680562677', 'W73004887', 'W73004887', 'UT01', 'Intermountain Ear Nose And Throat Specialists', 'Jon', 'Richard', 'Aoki', 'MD', 'Ear, Nose and Throat', NULL, NULL, NULL, 'B', '22 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013282522', NULL, '22 S 900 E', 'Salt Lake City', '', 'UT', '84102', '', '', 'WiseOrtho', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-09-01', '2007-12-31', 0, NULL, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1295805265', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL);
