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
('363330926', 'ELP000062', 'ELP000062', 'ILCHIGSTD', 'Presence Resurrection Medical Center', '', '', 'Presence Resurrection Medical Center', '', 'Dialysis Center', '', '', NULL, 'B', '62415 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8478133600', NULL, '62415 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8478133600', '          ', '', '', 'PresResMC', '0.00', '100.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679660906', 0, 'Y', 0, '2013-10-09', '140117', NULL, 0, 0, NULL, NULL),
('363330926', 'ELP000059', 'ELP000059', 'ILCHIGSTD', 'Presence Resurrection Medical Center', '', '', 'Presence Resurrection Medical Center', '', 'Dialysis Center', '', '', NULL, 'O', '7435 W Talcott Ave', 'Chicago', 'Cook', 'IL', '60631', '7737748000', NULL, '7435 W Talcott Ave', 'Chicago', 'Cook', 'IL', '60631', '7737748000', '          ', '', '', 'PresResMC', '0.00', '100.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679660906', 0, 'Y', 0, '2013-10-09', '140117', NULL, 41.9884, -87.8124, NULL, NULL),
('362439318', 'ELP000041', 'ELP000041', 'ILCHIGSTD', 'Presence Holy Family Medical Center', '', '', 'Presence Holy Family Medical Center', '', 'Hospital', NULL, NULL, NULL, 'O', '100 N River Rd', 'Des Plaines', 'Cook', 'IL', '60016', '8472971800', NULL, '100 N River Rd', 'Des Plaines', 'Cook', 'IL', '60016', '8472971800', '          ', '', '', 'PresHolyFam', '0.00', '100.00', '0.00', 8, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1689775736', 0, 'N', 0, '2013-10-09', '142011', NULL, 42.0545, -87.8881, NULL, NULL),
('362439318', 'ELP000042', 'ELP000042', 'ILCHIGSTD', 'Presence Holy Family Medical Center', '', '', 'Presence Holy Family Medical Center', '', 'Hospital', NULL, NULL, NULL, 'B', '2097 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8478133600', NULL, '2097 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8478133600', '          ', '', '', 'PresHolyFam', '0.00', '100.00', '0.00', 8, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1689775736', 0, 'Y', 0, '2013-10-09', '142011', NULL, 0, 0, NULL, NULL),
('363200170', 'ELP000015', 'ELP000015', 'ILCHIGSTD', 'Presence Saint Joseph Hospital', '', '', 'Presence Saint Joseph Hospital', '', 'Skilled Nursing Facility', '', '', NULL, 'O', '2900 N Lake Shore Dr', 'Chicago', 'Cook', 'IL', '60657', '7736653000', NULL, '2900 N Lake Shore Dr', 'Chicago', 'Cook', 'IL', '60657', '7736653000', '          ', '', '', 'PresStJo', '0.00', '100.00', '0.00', 8, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801975735', 0, 'Y', 0, '2013-10-09', '145568', NULL, 41.9349, -87.6367, NULL, NULL),
('363200170', 'ELP000016', 'ELP000016', 'ILCHIGSTD', 'Presence Saint Joseph Hospital', '', '', 'Presence Saint Joseph Hospital', '', 'Skilled Nursing Facility', '', '', NULL, 'B', '4588 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8478133600', NULL, '4588 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8478133600', '          ', '', '', 'PresStJo', '0.00', '100.00', '0.00', 8, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801975735', 0, 'Y', 0, '2013-10-09', '145568', NULL, 0, 0, NULL, NULL),
('362439318', 'ELP000040', 'ELP000040', 'ILCHIGSTD', 'Presence Our Lady Of The Resurrection Medical Center', '', '', 'Presence Our Lady Of The Resurrection Medical Center', '', 'Skilled Nursing Facility', '', '', NULL, 'B', '6921 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8478133600', NULL, '6921 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8478133600', '          ', '', '', 'PresOurLady', '0.00', '100.00', '0.00', 8, '2013-01-01', '2013-10-08', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942305321', 0, 'Y', 0, '2013-10-09', '140251', NULL, 0, 0, NULL, NULL),
('362644178', 'ELP000038', 'ELP000038', 'ILCHIGSTD', 'Presence Our Lady Of The Resurrection Medical Center', '', '', 'Presence Our Lady Of The Resurrection Medical Center', '', 'Skilled Nursing Facility', '', '', NULL, 'O', '5645 W Addison St', 'Chicago', 'Cook', 'IL', '60634', '7732827000', NULL, '5645 W Addison St', 'Chicago', 'Cook', 'IL', '60634', '7732827000', '          ', '', '', 'PresOurLady', '0.00', '100.00', '0.00', 8, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942305321', 0, 'Y', 0, '2013-10-09', '140251', NULL, 41.9459, -87.7678, NULL, NULL),
('370960170', 'W12030280', 'W12030280', 'ILCHIGSTD', 'Northwestern Memorial Hospital', '', '', 'Northwestern Memorial Hospital', '', 'Hospital', '', '', NULL, 'B', '251 E Huron', 'Chicago', 'Cook', 'IL', '60611', '3129265465', NULL, '251 E Huron', 'Chicago', 'Cook', 'IL', '60611', '3129265465', '          ', '', '', 'NWMEM', '0.00', '100.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000010057', 0, 'Y', 0, '2013-02-15', NULL, NULL, 41.8945, -87.6222, NULL, NULL),
('529605918', 'W12030300', 'W12030300', 'UTMH1', 'Family Institute of Northern Utah', 'Susan', 'S', 'Campbell', 'PHD LMFT', 'Mental Health', 'Psychology', 'Marriage & Family Therapy', NULL, 'O', '190 E Ctr St', 'Logan', 'Cache', 'UT', '84321', '4357556707', '4357521976', '190 E Ctr St', 'Logan', 'Cache', 'UT', '84321', '4357556707', '4357521976', 'PHD', '', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2013-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417061789', 0, 'N', 0, '2014-02-26', NULL, NULL, 0, 0, NULL, NULL),
('370960170', 'W12030282', 'W12030282', 'ILCHIGSTD', 'Northwestern Memorial Hospital', '', '', 'Northwestern Memorial Hospital', '', 'Hospital', '', '', NULL, 'O', '251 E Huron', 'Chicago', 'Cook', 'IL', '60611', '3129265465', NULL, '251 E Huron', 'Chicago', 'Cook', 'IL', '60611', '3129265465', '          ', '', '', 'NWMEM', '0.00', '100.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780833675', 0, 'N', 0, '2013-02-15', NULL, NULL, 41.895, -87.6215, NULL, NULL),
('370960170', 'W12030283', 'W12030283', 'ILCHIGSTD', 'Northwestern Memorial Hospital', '', '', 'Northwestern Memorial Hospital', '', 'Hospital', '', '', NULL, 'O', '676 St Clair', 'Chicago', 'Cook', 'IL', '60611', '3129262650', NULL, '676 St Clair', 'Chicago', 'Cook', 'IL', '60611', '3129262650', '          ', '', '', 'NWMEM', '0.00', '100.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780833675', 0, 'N', 0, '2013-02-15', NULL, NULL, 41.8945, -87.6227, NULL, NULL),
('362179779', 'W12030286', 'W12030286', 'ILCHIGSTD', 'Northwestern Lake Forest Hospital', '', '', 'Northwestern Lake Forest Hospital', '', 'Hospital', '', '', NULL, 'O', '660 N Westmoreland Rd', 'Lake Forest', 'Lake', 'IL', '60045', '8472345600', '          ', '660 N Westmoreland Rd', 'Lake Forest', 'Lake', 'IL', '60045', '8472345600', '          ', '', '', 'NWMEM', '0.00', '100.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1828129566', 0, 'N', 0, '2014-05-07', NULL, NULL, 42.2503, -87.8635, NULL, NULL),
('370960170', 'W12030288', 'W12030288', 'ILCHIGSTD', 'Northwestern Memorial Hospital', '', '', 'Northwestern Memorial Hospital', '', 'Ambulatory Surgery Center', '', '', NULL, 'O', '710 N Fairbanks', 'Chicago', 'Cook', 'IL', '60611', '3129265450', NULL, '710 N Fairbanks', 'Chicago', 'Cook', 'IL', '60611', '3129265450', '          ', '', '', 'NWMEM', '0.00', '100.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000010059', 0, 'N', 0, '2013-09-19', NULL, NULL, 41.8953, -87.6208, NULL, NULL),
('370960170', 'W12030291', 'W12030291', 'ILCHIGSTD', 'Northwestern Memorial Hospital', '', '', 'Northwestern Memorial Hospital', '', 'Mental Health', '', '', NULL, 'O', '446 E Ontario Ste 700', 'Chicago', 'Cook', 'IL', '60611', '3129268100', '          ', '446 E Ontario Ste 700', 'Chicago', 'Cook', 'IL', '60611', '3129268100', '          ', '', '', 'NWMEM', '0.00', '100.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000010060', 0, 'Y', 0, '2014-04-01', NULL, NULL, 41.8935, -87.6162, NULL, NULL),
('370960170', 'W12030299', 'W12030299', 'ILCHIGSTD', 'Prentice Womens Hospital', '', '', 'Prentice Womens Hospital', '', 'Hospital', '', '', NULL, 'O', '250 E Superior', 'Chicago', 'Cook', 'IL', '60611', '3129262000', NULL, '250 E Superior', 'Chicago', 'Cook', 'IL', '60611', '3129262000', '          ', '', '', 'NWMEM', '0.00', '100.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000010061', 0, 'N', 0, '2013-02-15', NULL, NULL, 41.8958, -87.6216, NULL, NULL),
('017543315', 'W12030301', 'W12030301', 'UTMH1', 'Family Institute of Northern Utah', 'Jeannine', 'D', 'Nielson', 'LMFT', 'Mental Health', 'Marriage and Family Therapy', '', NULL, 'O', '190 E Ctr St', 'Logan', 'Cache', 'UT', '84321', '4357556707', '4357521976', '190 E Ctr St', 'Logan', 'Cache', 'UT', '84321', '4357556707', '4357521976', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093881799', 0, 'N', 0, '2013-02-27', NULL, NULL, 41.7313, -111.83, NULL, NULL),
('260762942', 'W12030302', 'W12030302', 'UTMH1', 'Ogden Center for Counseling and Assessment', 'John', 'L', 'Kluthe', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '4590 Harrison Blvd Ste 200A', 'Ogden', 'Weber', 'UT', '84405', '8014798286', '8014798247', '4590 Harrison Blvd Ste 200A', 'Ogden', 'Weber', 'UT', '84405', '8014798286', '8014798247', 'PHD', '', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427192087', 0, 'N', 0, '2013-02-27', NULL, NULL, 41.1799, -111.949, NULL, NULL),
('820161600', 'W12030306', 'W12030306', 'ID02', 'St Lukes Clinic Saltzer Medical Group', 'Erin', '', 'Carver', 'PA-C', 'Family Practice', '', '', NULL, 'O', '8950 W Emerald Ste 168', 'Boise', 'Ada', 'ID', '83704', '2083236273', '2083236277', '8950 W Emerald Ste 168', 'Boise', 'Ada', 'ID', '83704', '2083236273', '2083236277', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902877624', 0, 'N', 0, '2013-11-15', NULL, NULL, 0, 0, NULL, NULL),
('760475626', 'W12030308', 'W12030308', 'TXBEAUSTD', 'Orange Clinical Associates', '', '', 'Orange Clinical Assocs', 'MD', 'Internal Medicine', '', '', NULL, 'O', '610 Strickland Dr Ste 290', 'Orange', 'Orange', 'TX', '77630', '4098833580', '4098833570', '610 Strickland Dr Ste 290', 'Orange', 'Orange', 'TX', '77630', '4098833580', '4098833570', 'BEAUMONT1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205044567', 0, 'Y', 0, '2013-06-04', NULL, NULL, 30.0978, -93.7662, NULL, NULL),
('760454034', 'W12030310', 'W12030310', 'TXBEAUSTD', 'Southeast Texas Ear Nose and Throat', '', '', 'Southeast Texas Ear Nose and Throat LLP', '', 'Ear, Nose and Throat', '', '', NULL, 'O', '740 Hospital Dr Ste 300', 'Beaumont', 'Jefferson', 'TX', '77701', '4092128111', '4099811787', '740 Hospital Dr Ste 300', 'Beaumont', 'Jefferson', 'TX', '77701', '4092128111', '4099811787', 'STENT', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962477406', 0, 'Y', 0, '2013-02-15', NULL, NULL, 30.0703, -94.1191, NULL, NULL),
('760475626', 'W12030314', 'W12030314', 'TXBEAUSTD', 'Orange Clinical Associates', 'Marian', '', 'Chen-Hah', 'MD', 'Internal Medicine', '', '', NULL, 'O', '610 Strickland Dr Ste 290', 'Orange', 'Orange', 'TX', '77630', '4098833580', '4098833570', '610 Strickland Dr Ste 290', 'Orange', 'Orange', 'TX', '77630', '4098833580', '4098833570', 'BEAUMONT1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-15', NULL, 0, 0, 0, 'Baptist Orange Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1407963317', 0, 'N', 0, '2013-06-04', NULL, NULL, 30.0978, -93.7662, NULL, NULL),
('760454034', 'W12030315', 'W12030315', 'TXBEAUSTD', 'Southeast Texas Ear Nose and Throat', '', '', 'Southeast Texas Ear Nose and Throat LLP', '', 'Ear, Nose and Throat', '', '', NULL, 'O', '3920 W Park Ave', 'Orange', 'Orange', 'TX', '77630', '4098830607', '4098833645', '3920 W Park Ave', 'Orange', 'Orange', 'TX', '77630', '4098830607', '4098833645', 'STENT', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962477406', 0, 'Y', 0, '2013-02-15', NULL, NULL, 30.1099, -93.7796, NULL, NULL),
('760454034', 'W12030317', 'W12030317', 'TXBEAUSTD', 'Southeast Texas Ear Nose and Throat', 'Ray', '', 'Fontenot', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '3920 W Park Ave', 'Orange', 'Orange', 'TX', '77630', '4098830607', '4098833645', '3920 W Park Ave', 'Orange', 'Orange', 'TX', '77630', '4098830607', '4098833645', 'STENT', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-15', NULL, 0, 0, 0, 'Baptist Beaumont Hospital', 'Baptist Orange Hospital', NULL, NULL, 'HCFA|UB|', '1003881558', 0, 'N', 0, '2013-03-20', NULL, NULL, 30.1099, -93.7796, NULL, NULL),
('760454034', 'W12030318', 'W12030318', 'TXBEAUSTD', 'Southeast Texas Ear Nose and Throat', 'Ray', '', 'Fontenot', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '740 Hospital Dr Ste 300', 'Beaumont', 'Jefferson', 'TX', '77701', '4092128111', '4099811787', '740 Hospital Dr Ste 300', 'Beaumont', 'Jefferson', 'TX', '77701', '4092128111', '4099811787', 'STENT', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-15', NULL, 0, 0, 0, 'Baptist Beaumont Hospital', 'Baptist Orange Hospital', NULL, NULL, 'HCFA|UB|', '1003881558', 0, 'N', 0, '2013-03-20', NULL, NULL, 30.0703, -94.1191, NULL, NULL),
('760454034', 'W12030320', 'W12030320', 'TXBEAUSTD', 'Southeast Texas Ear Nose and Throat', 'Carl', 'C', 'Jordan', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '740 Hospital Dr Ste 300', 'Beaumont', 'Jefferson', 'TX', '77701', '4092128111', '4099811787', '740 Hospital Dr Ste 300', 'Beaumont', 'Jefferson', 'TX', '77701', '4092128111', '4099811787', 'STENT', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-15', NULL, 0, 0, 0, 'Baptist Beaumont Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1982679452', 0, 'N', 0, '2013-02-15', NULL, NULL, 30.0703, -94.1191, NULL, NULL),
('760454034', 'W12030322', 'W12030322', 'TXBEAUSTD', 'Southeast Texas Ear Nose and Throat', 'William', 'E', 'OMara', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '740 Hospital Dr Ste 300', 'Beaumont', 'Jefferson', 'TX', '77701', '4092128111', '4099811787', '740 Hospital Dr Ste 300', 'Beaumont', 'Jefferson', 'TX', '77701', '4092128111', '4099811787', 'STENT', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-15', NULL, 0, 0, 0, 'Baptist Beaumont Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1902871874', 0, 'N', 0, '2013-02-15', NULL, NULL, 30.0703, -94.1191, NULL, NULL),
('760454034', 'W12030324', 'W12030324', 'TXBEAUSTD', 'Southeast Texas Ear Nose and Throat', 'Harold', 'S', 'Parks', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '740 Hospital Dr Ste 300', 'Beaumont', 'Jefferson', 'TX', '77701', '4092128111', '4099811787', '740 Hospital Dr Ste 300', 'Beaumont', 'Jefferson', 'TX', '77701', '4092128111', '4099811787', 'STENT', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-15', NULL, 0, 0, 0, 'Baptist Beaumont Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1275508764', 0, 'N', 0, '2013-02-15', NULL, NULL, 30.0703, -94.1191, NULL, NULL),
('760454034', 'W12030326', 'W12030326', 'TXBEAUSTD', 'Southeast Texas Ear Nose and Throat', 'Jeremy', 'C', 'Roebuck', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '740 Hospital Dr Ste 300', 'Beaumont', 'Jefferson', 'TX', '77701', '4092128111', '4099811787', '740 Hospital Dr Ste 300', 'Beaumont', 'Jefferson', 'TX', '77701', '4092128111', '4099811787', 'STENT', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-15', NULL, 0, 0, 0, 'Baptist Beaumont Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1538103189', 0, 'N', 0, '2013-02-15', NULL, NULL, 30.0703, -94.1191, NULL, NULL),
('760649775', 'W12030327', 'W12030327', 'TXBEAUSTD', 'Christopher Dowdy MD', 'Christopher', '', 'Dowdy', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3070 College Ste 207', 'Beaumont', 'Jefferson', 'TX', '77701', '4098335790', '4098335899', '3070 College Ste 207', 'Beaumont', 'Jefferson', 'TX', '77701', '4098335790', '4098335899', 'BEAUMONT3', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-15', NULL, 0, 0, 0, 'Baptist Beaumont Hospital', NULL, '', '', 'HCFA|UB|', '1740386317', 0, 'N', 0, '2013-06-04', NULL, NULL, 30.0685, -94.1191, NULL, NULL),
('760475626', 'W12030312', 'W12030312', 'TXBEAUSTD', 'Orange Clinical Associates', 'Wilbur', '', 'Hah', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '610 Strickland Dr Ste 290', 'Orange', 'Orange', 'TX', '77630', '4098833580', '4098833570', '610 Strickland Dr Ste 290', 'Orange', 'Orange', 'TX', '77630', '4098833580', '4098833570', 'BEAUMONT1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-15', NULL, 0, 0, 0, 'Baptist Orange Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1043327943', 0, 'N', 0, '2013-06-04', NULL, NULL, 30.0978, -93.7662, NULL, NULL),
('542094413', 'W12030333', 'W12030333', 'TXSATSTD', 'Jimmy Y Uy MD', 'Jimmy', 'Y', 'UY', 'MD', 'Pulmonary', '', '', NULL, 'O', '4242 E Southcross Blvd Ste 5', 'San Antonio', 'Bexar', 'TX', '78222', '2103599898', NULL, '4242 E Southcross Blvd Ste 5', 'San Antonio', 'Bexar', 'TX', '78222', '2103599898', '', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-03-15', NULL, 0, 0, 0, 'Mission Trail Baptist Hospital', '', '', '', 'HCFA|UB|', '1720196975', 0, 'N', 0, '2014-05-01', NULL, NULL, 29.3749, -98.4113, NULL, NULL),
('870299862', 'W40018774', 'W40018774', 'UTMH1', 'LDS Family Services', 'Michele', 'W', 'Ashdown', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1525 Lincoln Ave', 'Ogden', 'Weber', 'UT', '84404', '8016216510', NULL, '1525 Lincoln Ave', 'Ogden', 'Weber', 'UT', '84404', '8016216510', '          ', 'MA', '', '', '0.00', '40.00', '0.00', 8, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497876346', 0, 'N', 0, '2013-02-27', NULL, NULL, 41.2395, -111.976, NULL, NULL),
('870271413', 'W40005251', 'W40005251', 'UTMH1', 'LDS Family Services', 'Michele', 'W', 'Ashdown', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1525 Lincoln Ave', 'Ogden', 'Weber', 'UT', '84401', '8016216510', NULL, '1525 Lincoln Ave', 'Ogden', 'Weber', 'UT', '84401', '8016216510', '', 'UTMA', NULL, NULL, '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497876346', 0, 'n', 0, '2013-02-27', NULL, NULL, 41.2395, -111.976, NULL, NULL),
('205954281', 'W12030334', 'W12030334', 'TXSATSTD', 'Salazar, David MD', 'David', '', 'Salazar', 'MD', 'Pulmonary', '', '', NULL, 'O', '225 E Sonterra Blvd Ste 217', 'San Antonio', 'Bexar', 'TX', '78258', '2104813119', NULL, '225 E Sonterra Blvd Ste 217', 'San Antonio', 'Bexar', 'TX', '78258', '2104813119', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-03-15', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1104810910', 0, 'N', 0, '2013-12-11', NULL, NULL, 29.6164, -98.492, NULL, NULL),
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('752536818', 'W12030379', 'W12030379', 'TXDALSTD', '', 'Molly', '', 'Szerlip', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-03-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1902849631', 0, 'N', 0, '2013-12-09', NULL, NULL, 0, 0, NULL, NULL),
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('752536818', 'W12030380', 'W12030380', 'TXDALSTD', '', 'Molly', '', 'Szerlip', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '7777 Forest Ln Ste A202', 'Dallas', 'Dallas', 'TX', '75230', '9725667733', '9727205803', '7777 Forest Ln Ste A202', 'Dallas', 'Dallas', 'TX', '75230', '9725667733', '9727205803', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-03-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1902849631', 0, 'N', 0, '2013-12-09', NULL, NULL, 32.9095, -96.7721, NULL, NULL),
('911947573', 'W12030382', 'W12030382', 'TXDALSTD', '', 'Sunil', 'J', 'Modi', 'MD', 'Family Practice', '', '', NULL, 'O', '1405 W Jefferson St', 'Waxahachie', 'Ellis', 'TX', '75165', '9729237144', '9729237145', '1405 W Jefferson St', 'Waxahachie', 'Ellis', 'TX', '75165', '9729237144', '9729237145', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-03-15', '2013-03-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811195365', 0, 'N', 0, '2013-05-08', NULL, NULL, 32.3961, -96.864, NULL, NULL),
('911947573', 'W12030383', 'W12030383', 'TXDALSTD', '', 'Sunil', 'J', 'Modi', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '9729237144', '9729239145', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '9729237144', '9729239145', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-03-15', '2013-03-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811195365', 0, 'N', 0, '2013-05-08', NULL, NULL, 0, 0, NULL, NULL),
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('870687383', 'W12030491', 'W12030491', 'UT01', 'Western Neurological', 'Lia Ana', '', 'Chebeleu', 'MD', 'Neurology', '', '', NULL, 'O', '1151 E 3900 S Ste B150', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012623441', '8012699005', '1151 E 3900 S Ste B150', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012623441', '8012699005', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1174727739', 0, 'N', 0, '2013-12-23', NULL, NULL, 40.6871, -111.858, NULL, NULL),
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('455507864', 'W12030499', 'W12030499', 'ID02', '', 'Arthur', 'G', 'Hamblin', 'PSYD', 'Mental Health', 'Psychology', '', NULL, 'O', '575 E Parkcenter Blvd Ste 110', 'Boise', 'Ada', 'ID', '83706', '2083871854', '2083364408', '575 E Parkcenter Blvd Ste 110', 'Boise', 'Ada', 'ID', '83706', '2083871854', '2083364408', 'PHD', '', '', '0.00', '35.00', '0.00', 3, '2012-09-01', '2014-07-15', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1366488132', 0, 'N', 0, '2014-07-22', NULL, NULL, 0, 0, NULL, NULL),
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('562627040', 'W12030502', 'W12030502', 'UT01', 'University of Utah Dept of OBGYN Maternal Fetal Medicine', '', '', 'University of Utah Dept of OBGYN Maternal Fetal Medicine', 'GROUP', 'Maternal Fetal Medicine', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817647', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817647', '          ', 'WUUGYN', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2013-02-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009288', 0, 'Y', 0, '2013-12-12', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('562627040', 'W12030503', 'W12030503', 'UT01', 'University of Utah Dept of OBGYN Maternal Fetal Medicine', '', '', 'University of Utah Dept of OBGYN Maternal Fetal Medicine', 'GROUP', 'Maternal Fetal Medicine', '', '', NULL, 'B', 'PO Box 413028', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413028', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUGYN', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009288', 0, 'Y', 0, '2013-12-12', NULL, NULL, 0, 0, NULL, NULL),
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('870450500', 'W12030508', 'W12030508', 'UT01', 'University Urology Associates', '', '', 'University Urology Associates', 'GROUP', 'Urology', '', '', NULL, 'B', 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413035   ', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2013-02-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009334', 0, 'N', 0, '2013-12-12', NULL, NULL, 0, 0, NULL, NULL),
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('362167784', 'W12030512', 'W12030512', 'ILCHIGSTD', 'Elmhurst Memorial Hospital Reference Laboratory', '', '', 'Elmhurst Memorial Hospital Reference Laboratory', '', 'Laboratory', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312211000', NULL, '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312211000', '          ', '', '', 'ELMHURST', '0.00', '0.00', '0.00', 6, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '0000010069', 0, 'N', 0, '2013-05-28', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('362167784', 'W12030514', 'W12030514', 'ILCHIGSTD', 'Elmhurst Memorial Lombard Health Center', '', '', 'Elmhurst Memorial Lombard Health Center', '', 'Urgent Care', '', '', NULL, 'O', '130 S Main St', 'Lombard', 'Dupage', 'IL', '60148', '6306521700', NULL, '130 S Main St', 'Lombard', 'Dupage', 'IL', '60148', '6306521700', '          ', '', '', 'ELMHURST', '0.00', '0.00', '0.00', 6, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '0000010070', 0, 'N', 0, '2013-05-28', NULL, NULL, 41.8856, -88.0184, NULL, NULL),
('362167784', 'W12030516', 'W12030516', 'ILCHIGSTD', 'Elmhurst Memorial Addison Health Center', '', '', 'Elmhurst Memorial Addison Health Center', '', 'Urgent Care', '', '', NULL, 'O', '303 W Lake St', 'Addison', 'Dupage', 'IL', '60101', '6307827832', NULL, '303 W Lake St', 'Addison', 'Dupage', 'IL', '60101', '6307827832', '          ', '', '', 'ELMHURST', '0.00', '0.00', '0.00', 6, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '0000010071', 0, 'N', 0, '2013-05-28', NULL, NULL, 41.9356, -87.9965, NULL, NULL),
('362167784', 'W12030518', 'W12030518', 'ILCHIGSTD', 'Elmhurst Memorial Hospital', '', '', 'Elmhurst Memorial Hospital Reference Laboratory', '', 'Laboratory', '', '', NULL, 'B', 'Dept 4592 Attn Patient Accounts', 'Carol Stream', 'Dupage', 'IL', '60122', '3312211000', NULL, 'Dept 4592 Attn Patient Accounts', 'Carol Stream', 'Dupage', 'IL', '60122', '3312211000', '          ', '', '', 'ELMHURST', '0.00', '0.00', '0.00', 6, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '0000010069', 0, 'N', 0, '2013-05-28', NULL, NULL, 0, 0, NULL, NULL),
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('000001010', 'W12030521', 'W12030521', 'ILCHIGSTD', 'Elmhurst PHO', '', '', 'Elmhurst PHO', '', 'Multiple Specialty', '', '', NULL, 'B', '62025 Collections Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8153062888', '8153062889', '62025 Collections Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8153062888', '8153062889', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '0000010058', 0, 'N', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('820500162', 'W12030572', 'W12030572', 'ID01', 'Anesthesiology Consultants of ID', '', '', 'Saint Alphonsus Health Alliance PPO', '', 'Master', '', '', NULL, 'O', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084635029', '2084635081', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084635029', '2084635081', '', '', '', '59.62', '0.00', '0.00', 3, '2013-01-01', '2013-01-01', 1, 15, 0, '', '', '', '', 'HCFA|UB|', '0000009765', 0, 'Y', 0, '2014-01-15', NULL, NULL, 43.5537, -116.573, NULL, NULL),
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('455369159', 'W12030529', 'W12030529', 'TXHOUSTD', 'Doucet', 'Timothy', 'W', 'Doucet', 'MD', 'Ophthalmology', '', '', NULL, 'B', 'PO Box 4248 Dept 289', 'Houston', 'Harris', 'TX', '77210', '9367608570', '9365218208', 'PO Box 4248 Dept 289', 'Houston', 'Harris', 'TX', '77210', '9367608570', '9365218208', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, '', '', 'HCFA|UB|', '1366538654', 0, 'N', 0, '2013-03-01', NULL, NULL, 0, 0, NULL, NULL),
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('876114073', 'W12030532', 'W12030532', 'UTMH1', 'The Childrens Center', 'Alexandra', '', 'Starr', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '350 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8619664251', '8619664289', '350 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8619664251', '8619664289', 'UTMA', '', '', '0.00', '40.00', '0.00', 6, '2013-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295012078', 0, 'N', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('263553949', 'W12030533', 'W12030533', 'TXDALSTD', 'Podiatric Medical Partners of Texas', 'Joseph', '', 'Morgan', 'DPT', 'Podiatry', '', '', NULL, 'B', 'PO Box 975517', 'Dallas', 'Dallas', 'TX', '75397', '3212072839', '3212562966', 'PO Box 975517', 'Dallas', 'Dallas', 'TX', '75397', '3212072839', '3212562966', 'DALLAS4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700175775', 0, 'Y', 0, '2014-03-18', 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
('263553949', 'W12030534', 'W12030534', 'TXDALSTD', 'Rowlett Foot and Ankle Specialist div of PMPT', '', '', 'Podiatric Medical Partners of Texas PA', '', 'Podiatry', '', '', NULL, 'O', '7801 Lakeview Pkwy Ste 110', 'Rowlett', 'Dallas', 'TX', '75088', '9722889034', '9722858025', '7801 Lakeview Pkwy Ste 110', 'Rowlett', 'Dallas', 'TX', '75088', '9722889034', '9722858025', 'DALLAS4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831323302', 0, 'Y', 0, '2013-02-21', NULL, NULL, 32.9146, -96.5237, NULL, NULL),
('263553949', 'W12030535', 'W12030535', 'TXDALSTD', 'Permian Basin Foot and Ankle Specialist div of PMPT', '', '', 'Podiatric Medical Partners of Texas PA', '', 'Podiatry', '', '', NULL, 'O', '420 E 6th St Ste 104', 'Odessa', 'Ector', 'TX', '79761', '4326141799', '4322422918', '420 E 6th St Ste 104', 'Odessa', 'Ector', 'TX', '79761', '4326141799', '4322422918', 'DALLAS4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831323302', 0, 'Y', 0, '2013-02-21', NULL, NULL, 31.851, -102.367, NULL, NULL),
('841411398', 'W12030536', 'W12030536', 'UT01', 'Foothill Family Clinic', 'Jose', '', 'Azarcon', 'DO', 'Family Practice', '', '', NULL, 'O', '6360 S 3000 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8013651032', '8013651036', '6360 S 3000 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8013651032', '8013651036', 'WUFOOTHIL5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1285627455', 0, 'N', 0, '2013-03-14', NULL, NULL, 40.6339, -111.806, NULL, NULL),
('841411398', 'W12030537', 'W12030537', 'UT01', 'Foothill Family Clinic', 'Jose', '', 'Azarcon', 'DO', 'Family Practice', '', '', NULL, 'O', '2295 Foothill Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8014863021', '8014856339', '2295 Foothill Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8014863021', '8014856339', 'WUFOOTHIL5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1285627455', 0, 'N', 0, '2013-03-14', NULL, NULL, 40.7206, -111.811, NULL, NULL),
('820200895', 'W12030538', 'W12030538', 'IDBOISTD', 'Saint Alphonsus Medical Group Pulmonary and Sleep Boise ', 'Beverlee', 'K', 'Furner', 'NPC', 'Family Practice', '', '', NULL, 'O', '1075 N Curtis Ste 200', 'Boise', 'Ada', 'ID', '83704', '2083678333', '2083672003', '1075 N Curtis Ste 200', 'Boise', 'Ada', 'ID', '83704', '2083678333', '2083672003', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-02-18', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1487816500', 0, 'N', 0, '2013-12-10', NULL, NULL, 43.6148, -116.254, NULL, NULL),
('820200895', 'W12030539', 'W12030539', 'IDBOISTD', 'Saint Alphonsus Medical Group Hospitalist Boise', 'Jennifer', '', 'Nordquist', 'NP-C', 'Family Practice', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676279', '2083675180', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676279', '2083675180', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-02-04', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1437489895', 0, 'N', 0, '2013-12-11', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('820200895', 'W12030541', 'W12030541', 'IDBOISTD', 'Saint Alphonsus Medical Group Family Medicine Fruitland Health Plaza', 'Roy', 'A', 'Sternes', 'PA-C', 'Family Practice', '', '', NULL, 'O', '910 NW 16th St Ste 101', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2084522140', '910 NW 16th St Ste 101', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2084522140', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-02-18', '2013-03-31', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'Saint Alphonsus Medical Center Nampa', '', '', 'HCFA|', '1437166550', 0, 'N', 0, '2014-06-13', NULL, NULL, 44.0254, -116.925, NULL, NULL),
('363525049', 'W12030542', 'W12030542', 'ID02', 'West Valley Clinic at Middleton', 'Christy', '', 'Bayes', 'NP', 'Family Practice', '', '', NULL, 'O', '381 B S Middleton Rd', 'Middleton', 'Canyon', 'ID', '83644', '2085856311', '2085856221', '381 B S Middleton Rd', 'Middleton', 'Canyon', 'ID', '83644', '2085856311', '2085856221', 'IDACN', '', '', '0.00', '15.00', '0.00', 6, '2012-06-18', '2013-03-04', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1760796296', 0, 'N', 0, '2013-11-12', NULL, NULL, 0, 0, NULL, NULL),
('363525049', 'W12030543', 'W12030543', 'ID02', 'West Valley Clinic at Middleton', 'Christy', '', 'Bayes', 'NP', 'Family Practice', '', '', NULL, 'B', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2087955070', '2085856221', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2087955070', '2085856221', 'IDACN', '', '', '0.00', '15.00', '0.00', 6, '2012-06-18', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1760796296', 0, 'N', 0, '2013-12-05', NULL, NULL, 0, 0, NULL, NULL),
('826001139', 'W12030545', 'W12030545', 'ID02', 'Weiser Memorial Specialty Clinic', 'Randolph', 'E', 'Peterson', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '645 E 5th St', 'Weiser', 'Washington', 'ID', '83672', '2085493152', '2085493153', '645 E 5th St', 'Weiser', 'Washington', 'ID', '83672', '2085493152', '2085493153', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2013-03-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA', '1669461364', 0, 'N', 0, '2013-07-05', NULL, NULL, 44.2487, -116.962, NULL, NULL),
('820500162', 'W12030547', 'W12030547', 'ID01', 'Anesthesiology Consultants of ID', 'Andrew', '', 'Allen', 'DO', 'Anesthesiology', '', '', NULL, 'O', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084635029', '2084635081', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084635029', '2084635081', '', '', '', '59.62', '0.00', '0.00', 3, '2012-12-01', NULL, 1, 15, 0, '', '', '', '', 'HCFA|UB|', '1063692028', 0, 'N', 0, '2014-06-10', NULL, NULL, 43.5537, -116.573, NULL, NULL),
('820500162', 'W12030548', 'W12030548', 'ID01', 'Anesthesiology Consultants of ID', 'Andrew', '', 'Allen', 'DO', 'Anesthesiology', '', '', NULL, 'B', '104 W 5th Ave Ste 250E', 'Spokane', 'Spokane', 'WA', '99204', '8662631223', NULL, '104 W 5th Ave Ste 250E', 'Spokane', 'Spokane', 'WA', '99204', '8662631223', '', '', '', '', '59.62', '0.00', '0.00', 3, '2012-12-01', NULL, 1, 15, 0, '', '', '', '', 'HCFA|UB|', '1063692028', 0, 'N', 0, '2014-06-10', NULL, NULL, 0, 0, NULL, NULL),
('820161600', 'W12030549', 'W12030549', 'ID02', 'St Lukes Clinic Saltzer Medical Group', 'Shane', 'A', 'Maxwell', 'DO', 'Neurology', '', '', NULL, 'O', '8950 W Emerald Ste 168', 'Boise', 'Ada', 'ID', '83704', '2083236273', '2083236277', '8950 W Emerald Ste 168', 'Boise', 'Ada', 'ID', '83704', '2083236273', '2083236277', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2013-01-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1508825456', 0, 'N', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL),
('820161600', 'W12030551', 'W12030551', 'ID02', 'St Lukes Clinic Saltzer Medical Group', 'Erik', '', 'Richardson', 'DO', 'Family Practice', '', '', NULL, 'O', '1818 S 10th Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2084685959', '2084685958', '1818 S 10th Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2084685959', '2084685958', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2013-01-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1942307640', 0, 'N', 0, '2013-02-21', NULL, NULL, 43.6538, -116.693, NULL, NULL),
('460621930', 'W12030553', 'W12030553', 'ID02', 'John Sigurdson MD', 'John', 'D', 'Sigudson', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1509 N Whitley Dr Ste 10', 'Fruitland', 'Payette', 'ID', '83619', '2084522446', '2084527183', '1509 N Whitley Dr Ste 10', 'Fruitland', 'Payette', 'ID', '83619', '2084522446', '2084527183', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-02-18', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1861773806', 0, 'N', 0, '2014-05-09', NULL, NULL, 0, 0, NULL, NULL),
('460621930', 'W12030554', 'W12030554', 'ID02', 'John Sigurdson MD', 'John', 'D', 'Sigudson', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '2965 E Tarpon Dr Ste 150', 'Meridian', 'Ada', 'ID', '83642', '2082879420', '0000000000', '2965 E Tarpon Dr Ste 150', 'Meridian', 'Ada', 'ID', '83642', '2082879420', '0000000000', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-02-18', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1861773806', 0, 'N', 0, '2014-05-09', NULL, NULL, 0, 0, NULL, NULL),
('452716222', 'W12030562', 'W12030562', 'ID02', 'St Lukes Clinic Endocrinology', '', '', 'Saint Alphonsus Health Alliance PPO', '', 'Master', '', '', NULL, 'O', '520 S Eagle Rd Ste 1234', 'Meridian', 'Ada', 'ID', '83642', '2084290300', '2084290305', '520 S Eagle Rd Ste 1234', 'Meridian', 'Ada', 'ID', '83642', '2084290300', '2084290305', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2013-01-01', '2013-09-24', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000009765', 0, 'Y', 0, '2014-01-15', NULL, NULL, 43.5995, -116.352, NULL, NULL),
('452716222', 'W12030563', 'W12030563', 'ID02', 'St Lukes Clinic Endocrinology', '', '', 'Saint Alphonsus Health Alliance PPO', '', 'Master', '', '', NULL, 'O', '403 S 11th St Ste 100', 'Boise', 'Ada', 'ID', '83702', '2084290300', '2084290305', '403 S 11th St Ste 100', 'Boise', 'Ada', 'ID', '83702', '2084290300', '2084290305', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2013-01-01', '2013-09-24', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000009765', 0, 'Y', 0, '2014-01-15', NULL, NULL, 0, 0, NULL, NULL),
('452716222', 'W12030564', 'W12030564', 'ID02', 'St Lukes Clinic Urology', '', '', 'Saint Alphonsus Health Alliance PPO', '', 'Master', '', '', NULL, 'O', '1202 E Locust', 'Emmett', 'Gem', 'ID', '83617', '2084549181', '2084546338', '1202 E Locust', 'Emmett', 'Gem', 'ID', '83617', '2084549181', '2084546338', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2013-01-01', '2013-09-24', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000009765', 0, 'Y', 0, '2014-01-15', NULL, NULL, 43.8791, -116.485, NULL, NULL),
('452716222', 'W12030565', 'W12030565', 'ID02', 'St Lukes Clinic Urology', '', '', 'Saint Alphonsus Health Alliance PPO', '', 'Master', '', '', NULL, 'O', '1620 S Kimball Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2084549181', '2084546338', '1620 S Kimball Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2084549181', '2084546338', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2013-01-01', '2013-09-24', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000009765', 0, 'Y', 0, '2014-01-15', NULL, NULL, 0, 0, NULL, NULL),
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('942938348', 'W40018229', 'W40018229', 'UTMH1', 'Valley Mental Health  Inc', 'Dianna', '', 'Hales', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8015656856', NULL, '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8015656856', '          ', 'UTVMHMA', '', '', '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043531908', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
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('870560763', 'W40000323', 'W40000323', 'UT01', 'Montezuma Creek', 'Roselyn', '', 'Maryboy', 'LCSW', 'Mental Health', '', '', NULL, 'B', 'PO Box 130', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4357273241', NULL, 'PO Box 130', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4357273241', '', 'MA', 'WUSTDHCPC5', NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053324665', 0, 'Y', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
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('942938348', 'W40006923', 'W40006923', 'UTMH1', 'Valley Mental Health  Inc', 'T Michael', '', 'Reid', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', '          ', 'UTMD-2', '', '', '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, 0, 0, 0, 'Mountain West Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1053381194', 0, 'Y', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('942938348', 'W40006750', 'W40006750', 'UTMH1', 'Valley Mental Health  Inc', 'CONNIE', NULL, 'STRONG', 'APRN', 'Mental Health', '', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', '', 'UTVMHARNP', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1053398610', 0, 'Y', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
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('528824817', 'W40018221', 'W40018221', 'UTMH1', '', 'R', 'L', 'Richards', 'PHD', 'Mental Health', '', '', NULL, 'O', '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015873215', '8015851084', '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015873215', '8015851084', 'UTPHD', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053408682', 0, 'N', 0, '2013-02-27', NULL, NULL, 40.757, -111.824, NULL, NULL),
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('396742374', 'W40019131', 'W40019131', 'WY01', '', 'Denise', 'M', 'Marcz', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '901 12st Main Floor', 'Cody', 'Park', 'WY', '82414', '3072508191', NULL, '901 12st Main Floor', 'Cody', 'Park', 'WY', '82414', '3072508191', '          ', 'WYMA', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053496539', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('273291370', 'W40022258', 'W40022258', 'ID02', 'Northwest Neurobehavioral Health', 'Jeffery ', 'D', 'Hall', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '2076 S Eagle Rd', 'Meridian', 'Ada', 'ID', '83642', '2089557333', '2089557330', '2076 S Eagle Rd', 'Meridian', 'Ada', 'ID', '83642', '2089557333', '2089557330', 'IDPHD', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1053568816', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('273291370', 'W40022259', 'W40022259', 'ID02', 'Northwest Neurobehavioral Health', 'Jeffery ', 'D', 'Hall', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'B', 'PO Box 16820', 'Boise', 'Ada', 'ID', '83715', '2089557333', '2089557330', 'PO Box 16820', 'Boise', 'Ada', 'ID', '83715', '2089557333', '2089557330', 'IDPHD', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1053568816', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
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('261703236', 'W40002427', 'W40002427', 'UTMH1', 'Clinical Consultants ', 'Wayne', 'R', 'Sears', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '7601 Redwood Rd Bldg E', 'West Jordan', 'Salt Lake', 'UT', '84084', '8012338670', '8012338682', '7601 Redwood Rd Bldg E', 'West Jordan', 'Salt Lake', 'UT', '84084', '8012338670', '8012338682', 'UTMD', '', '', '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063686160', 0, 'N', 0, '2014-06-02', NULL, NULL, 40.6131, -111.939, NULL, NULL),
('030578114', 'W40019569', 'W40019569', 'UTMH1', '', 'Timothy', 'R', 'Kockler', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '1224 S River Rd Ste B-221', 'St George', 'Washington', 'UT', '84790', '4356321445', '4356881091', '1224 S River Rd Ste B-221', 'St George', 'Washington', 'UT', '84790', '4356321445', '4356881091', 'PHD', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063422202', 0, 'N', 0, '2013-02-27', NULL, NULL, 37.0876, -113.557, NULL, NULL),
('030578114', 'W40019570', 'W40019570', 'UTMH1', '', 'Timothy', 'R', 'Kockler', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'B', 'PO Box 153', 'St George', 'Washington', 'UT', '84771', '4356321445', '4356881091', 'PO Box 153', 'St George', 'Washington', 'UT', '84771', '4356321445', '4356881091', 'PHD', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063422202', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('942938348', 'W40006848', 'W40006848', 'UTMH1', 'Valley Mental Health  Inc', 'NATALIE', '', 'PUGMIRE', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', '', 'UTVMHMA', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063464600', 0, 'Y', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL);
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('529682676', 'W40005547', 'W40005547', 'UTMH1', 'West Counseling', 'Jean', 'N', 'Soderquist', 'LMFT', 'Mental Health', 'Marriage and Family Therapy', '', NULL, 'O', '2880 W 4700 S Ste A', 'Salt Lake City', 'Salt Lake', 'UT', '84118', '8019642465', NULL, '2880 W 4700 S Ste A', 'Salt Lake City', 'Salt Lake', 'UT', '84118', '8019642465', '', 'UTPHD', NULL, NULL, '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063480580', 0, 'n', 0, '2013-02-27', NULL, NULL, 40.6676, -111.961, NULL, NULL),
('529560317', 'W40005713', 'W40005713', 'UTMH1', 'Affiliated Psychotherapists', 'Rick', 'G', 'Lambert', 'LCSW, LMFT', 'Mental Health', 'Social Worker', 'Marriage and Family Therapy', NULL, 'O', '3098 S Highland Dr Ste 305', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014676255', NULL, '3098 S Highland Dr Ste 305', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014676255', '', 'UTMA', NULL, NULL, '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063528248', 0, 'n', 0, '2013-02-27', NULL, NULL, 40.7036, -111.852, NULL, NULL),
('452093595', 'W40011662', 'W40011662', 'UTMH1', 'Peak Relational Counseling', 'Keith', '', 'Louw', 'LMFT', 'Mental Health', '', '', NULL, 'B', '1055 E 850 N', 'Orem', 'Utah', 'UT', '84097', '8014728442', NULL, '1055 E 850 N', 'Orem', 'Utah', 'UT', '84097', '8014728442', '', 'MA', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063545648', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('452093595', 'W40011660', 'W40011660', 'UTMH1', 'Peak Relational Counseling', 'Keith', '', 'Louw', 'LMFT', 'Mental Health', '', '', NULL, 'O', '170 S Interstate Plaza', 'Lehi', 'Utah', 'UT', '84043', '8014728442', NULL, '170 S Interstate Plaza', 'Lehi', 'Utah', 'UT', '84043', '8014728442', '', 'MA', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063545648', 0, 'N', 0, '2014-06-04', NULL, NULL, 40.387, -111.831, NULL, NULL),
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('271124756', 'W40001166', 'W40001166', 'WY01', '', 'Rose', 'M', 'Harriet', 'MFT', 'Mental Health', 'Counseling', '', NULL, 'O', ' 140 S Main St', 'Buffalo', 'Johnson', 'WY', '82834', '3072172161', NULL, ' 140 S Main St', 'Buffalo', 'Johnson', 'WY', '82834', '3072172161', '          ', 'WYMA', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124268354', 0, 'N', 0, '2013-12-13', NULL, NULL, 44.3442, -106.698, NULL, NULL),
('271124756', 'W40001167', 'W40001167', 'WY01', '', 'Rose', 'M', 'Harriet', 'MFT', 'Mental Health', 'Counseling', '', NULL, 'B', '781 Klondike Dr Ste 2', 'Buffalo', 'Johnson', 'WY', '82834', '3072172161', NULL, '781 Klondike Dr Ste 2', 'Buffalo', 'Johnson', 'WY', '82834', '3072172161', '          ', 'WYMA', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124268354', 0, 'N', 0, '2013-12-13', 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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('201773062', 'W40017569', 'W40017569', 'ID01', 'Access Behavioral Health Services Inc', 'Amy', 'K', 'Curtis-Schaeffer', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '3307 Caldwell Blvd Ste 104', 'Nampa', 'Canyon', 'ID', '83651', '2084654833', '2083384699', '3307 Caldwell Blvd Ste 104', 'Nampa', 'Canyon', 'ID', '83651', '2084654833', '2083384699', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-02-15', '2014-06-23', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124308820', 0, 'N', 0, '2014-04-24', NULL, NULL, 43.6156, -116.618, NULL, NULL),
('260379382', 'W40016101', 'W40016101', 'UTMH1', 'Alliance Behavioral Psychiatry ', 'Lisa', 'J', 'Olsen', 'APRN', 'Mental Health', 'Psychiatry', '', NULL, 'O', '361 E 1200 S Ste 201', 'Orem', 'Utah', 'UT', '84058', '8012243014', NULL, '361 E 1200 S Ste 201', 'Orem', 'Utah', 'UT', '84058', '8012243014', '', 'ARNP-2', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134105364', 0, 'n', 0, '2013-02-27', NULL, NULL, 40.2751, -111.686, NULL, NULL),
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('942938348', 'W40006937', 'W40006937', 'UTMH1', 'Valley Mental Health  Inc', 'C', 'B', 'Hallett', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', '', 'UTVMHPHD', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134107881', 0, 'Y', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
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('870486136', 'W40012860', 'W40012860', 'UTMH1', 'Positive Connections Inc', 'Lewis', 'L', 'Boone', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '9035 S 700 E Ste 207', 'Sandy', 'Salt Lake', 'UT', '84070', '8017465567', '8017461139', '9035 S 700 E Ste 207', 'Sandy', 'Salt Lake', 'UT', '84070', '8017465567', '8017461139', 'MA', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134208051', 0, 'N', 0, '2014-05-08', NULL, NULL, 40.5874, -111.872, NULL, NULL),
('870486136', 'W40005561', 'W40005561', 'UTMH1', 'Positive Connections Inc', 'Lewis', 'L', 'Boone', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '954 E North Union Ave', 'Midvale', 'Salt Lake', 'UT', '84070', '8017481442', NULL, '954 E North Union Ave', 'Midvale', 'Salt Lake', 'UT', '84070', '8017481442', '', 'MA', NULL, '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134208051', 0, 'N', 0, '2014-05-08', NULL, NULL, 40.6209, -111.864, NULL, NULL),
('263045510', 'W40023876', 'W40023876', 'ID01', NULL, 'Sheila', 'E', 'Sturgeon Freitas', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '3709 N Locust Grove Rd Ste 150', 'Meridian', 'Ada', 'ID', '83646', '2084754690', NULL, '3709 N Locust Grove Rd Ste 150', 'Meridian', 'Ada', 'ID', '83646', '2084754690', '', 'IDPHD', NULL, NULL, '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134248750', 0, 'n', 0, '2013-02-27', NULL, NULL, 43.6385, -116.375, NULL, NULL),
('870557015', 'W40005317', 'W40005317', 'UTMH1', 'UIPT', 'Penny', 'B', 'Jameson', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '505 E 200 S Ste 303', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013500118', NULL, '505 E 200 S Ste 303', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013500118', '          ', 'PHD', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', '2014-03-24', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1334125776', 0, 'N', 0, '2014-03-26', NULL, NULL, 40.765, -111.877, NULL, NULL),
('942938348', 'W40006643', 'W40006643', 'UTMH1', 'Valley Mental Health  Inc', 'Kristine', '', 'Kokol', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', '          ', 'UTVMHMA', '', '', '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134370067', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('275063981', 'W40010666', 'W40010666', 'UTMH1', '', 'M Lisa', '', 'Jackson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1780 W 500 S', 'Salt Lake City', 'Salt Lake', 'UT', '84104', '8017254140', NULL, '1780 W 500 S', 'Salt Lake City', 'Salt Lake', 'UT', '84104', '8017254140', '          ', 'MA', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134377211', 0, 'N', 0, '2013-02-27', NULL, NULL, 40.7584, -111.941, NULL, NULL),
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('480901727', 'W40012235', 'W40012235', 'ID01', NULL, 'Chantel', '', 'Jones', 'LCPC', 'Mental Health', 'Counseling', '', NULL, 'O', '1414 W Franklin St', 'Boise', 'Ada', 'ID', '83702', '2083750167', NULL, '1414 W Franklin St', 'Boise', 'Ada', 'ID', '83702', '2083750167', '', 'IDMA', NULL, NULL, '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215096474', 0, 'n', 0, '2013-02-27', NULL, NULL, 43.6239, -116.206, NULL, NULL),
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