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
('870284475', 'S77011839', 'S77011839', 'UT01', 'Granger Medical Clinic', 'David', 'H', 'Oelsner', 'MD', 'Gastroenterology', 'Gastroenterology', 'Internal Medicine', NULL, 'O', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653425', '8019683605', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653425', '8019683605', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', NULL, NULL, 'HCFA|UB|', '1396760765', 0, 'N', 0, '2012-07-13', NULL, NULL, 40.682, -111.979, NULL, NULL),
('870284475', 'S77011840', 'S77011840', 'UT01', 'Granger Medical Clinic', 'Heather', 'L', 'Campbell', 'APRN', 'Family Practice', '', '', NULL, 'B', 'PO Box 70658', 'West Valley', 'Salt Lake', 'UT', '84170', '8019653720', '8019653740', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653720', '8019653740', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', '2008-08-28', NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1427080670', 0, 'Y', 0, '2011-09-19', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'S77011841', 'S77011841', 'UT01', 'Granger Medical Clinic', 'Heather', 'L', 'Campbell', 'APRN', 'Family Practice', '', '', NULL, 'O', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653479', '8019683605', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653479', '8019683605', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', '2008-08-28', NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1427080670', 0, 'N', 0, '2011-09-19', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'S77011842', 'S77011842', 'UT01', 'Granger Medical Clinic', 'Douglas', 'B', 'Jerman', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 70658', 'West Valley', 'Salt Lake', 'UT', '84170', '8019653720', '8019653740', 'PO Box 70658', 'West Valley', 'Salt Lake', 'UT', '84170', '8019653720', '8019653740', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', '', '', 'HCFA|UB|', '1518999762', 0, 'Y', 0, '2014-04-09', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'S77011843', 'S77011843', 'UT01', 'Granger Medical Clinic', 'Douglas', 'B', 'Jerman', 'PA', 'Family Practice', '', '', NULL, 'O', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653479', '8019683605', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653479', '8019683605', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', '', '', 'HCFA|UB|', '1518999762', 0, 'N', 0, '2014-04-09', NULL, NULL, 40.682, -111.979, NULL, NULL),
('870286381', 'S77011844', 'S77011844', 'UT01', 'Ogden Clinic', 'Damon', 'B', 'Marsh', 'PA', 'Family Practice', NULL, NULL, NULL, 'B', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794621', '8014762670', '4650 Harrison Blvd', 'Ogden', '', 'UT', '84403', '', '', 'WUOGDCLIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2006-08-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1467441089', 0, 'y', 0, '2006-07-31', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'S77011845', 'S77011845', 'UT01', 'Ogden Clinic', 'Brent', 'M', 'Baranko', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'b', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794621', '8014762670', '4650 Harrison Blvd', 'Ogden', '', 'UT', '84403', '', '', 'WUOGDCLIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-08-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1306833968', 0, 'y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'S77011847', 'S77011847', 'UT01', 'Ogden Clinic', 'Cheryl', 'L', 'Henley', 'MD', 'Occupational Therapy', 'Urgent Care', '', NULL, 'B', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794621', '8014762670', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794621', '8014762670', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-08-01', '2008-02-29', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1982617809', 0, 'N', 0, '2012-10-11', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'S77011848', 'S77011848', 'UT01', 'Ogden Clinic', 'Cheryl', 'L', 'Henley', 'MD', 'Occupational Therapy', 'Urgent Care', '', NULL, 'O', '5430 S 1900 W Ste G1', 'Roy', 'Weber', 'UT', '84067', '8017799975', NULL, '5430 S 1900 W Ste G1', 'Roy', 'Weber', 'UT', '84067', '8017799975', '          ', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-08-01', '2008-02-29', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1982617809', 0, 'N', 0, '2012-10-11', NULL, NULL, 0, 0, NULL, NULL),
('870288909', 'S77011849', 'S77011849', 'UT01', 'Planned Parenthood Association of Utah', NULL, NULL, 'Planned Parenthood Association of Utah', 'GROUP', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '654 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015321586', '8015325748', '645 S 900 E', 'Salt Lake City', '', 'UT', '84102', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000831176', 0, 'N', 0, '2007-01-05', NULL, NULL, 40.755, -111.865, NULL, NULL),
('870345870', 'S77011850', 'S77011850', 'UT01', 'Eye Clinic & Contact Lens Center of Utah Valley', 'Todd', 'J', 'Lewis', 'OD', 'Optometry', NULL, NULL, NULL, 'O', '2230 N University Pkwy Ste 10A', 'Provo', 'Utah', 'UT', '84604', '8013734550', '8013738634', '2230 N University Pkwy', 'Provo', 'Utah', 'UT', '84604', '8013734550', '8013738634', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1801856976', 0, 'N', 0, '2011-10-13', NULL, NULL, 40.2621, -111.666, NULL, NULL),
('870373083', 'S77011851', 'S77011851', 'UT01', 'Heart and Lung Institute', 'David', 'T', 'Harris', 'MD', 'Pulmonary', NULL, NULL, NULL, 'O', '5979 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012632370', '8012651200', '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),
('870395551', 'S77011852', 'S77011852', 'UT01', 'Chiropractic Health Plan', 'Daniel', 'R', 'Guthrie', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', '8013527270', '8013527024', '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2006-04-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1972722916', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77011853', 'S77011853', 'UT01', 'Guthrie Chiropractic', 'Daniel', 'R', 'Guthrie', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '3856 W 5400 S Ste 120', 'Salt Lake City', 'Salt Lake', 'UT', '84118', '8019579696', '8019579694', '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2006-04-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1972722916', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77011854', 'S77011854', 'UT01', 'Chiropractic Health Plan', 'Tricia', 'A', 'Chepanoske', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', '8013527270', '8013527024', '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2006-04-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1457338279', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77011855', 'S77011855', 'UT01', 'Chiropractic Health Plan', 'Tricia', 'A', 'Chepanoske', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '715 E 3900 S Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8016850588', NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2006-04-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1457338279', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77011856', 'S77011856', 'UT01', 'Chiropractic Health Plan', 'Mark', 'V', 'Vosti', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', '8013527270', '8013527024', '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2006-04-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1669444303', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77011857', 'S77011857', 'UT01', 'South Mountain Chiropractic', 'Mark', 'V', 'Vosti', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '1101 Draper Pkwy', 'Draper', 'Salt Lake', 'UT', '84020', '8016196090', '8015536323', '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2006-04-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1669444303', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77011858', 'S77011858', 'UT01', 'Chiropractic Health Plan', 'Jeremiah', NULL, 'Hoopes', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', '8013527270', '8013527024', '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2006-04-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1881652535', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77011859', 'S77011859', 'UT01', 'Body Needs', 'Jeremiah', NULL, 'Hoopes', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '770 S 200 E Ste 102', 'Brigham City', 'Box Elder', 'UT', '84302', '4357230517', '4357230587', '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2006-04-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1881652535', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77011860', 'S77011860', 'UT01', NULL, 'Joshua', 'A', 'Carr', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', '8013527270', '8013527024', '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1538235221', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77011861', 'S77011861', 'UT01', 'Coral Canyon Chiropractic', 'Joshua', 'A', 'Carr', 'DC', 'Chiropractic', '', '', NULL, 'O', '1141 W State St Ste 12', 'Hurricane', 'Washington', 'UT', '84737', '4356357771', '4356357701', '867 E 9400 S', 'Sandy', 'Washington', 'UT', '84094', '4356357771', '4356357701', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-08-31', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1538235221', 0, 'N', 0, '2010-10-29', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77011862', 'S77011862', 'UT01', NULL, 'Kelly', 'E', 'Murie', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', '8013527270', '8013527024', '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1306912969', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77011863', 'S77011863', 'UT01', 'Coral Canyon Chiropractic', 'Kelly', 'E', 'Murie', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '1141 W State St Ste 12', 'Hurricane', 'Washington', 'UT', '84737', '4356357771', '4356357701', '867 E 9400 S', 'Sandy', 'Washington', 'UT', '84094', '4356357771', '4356357701', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-08-31', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1306912969', 0, 'N', 0, '2012-01-23', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77011864', 'S77011864', 'UT01', NULL, 'Raymond', NULL, 'Hour', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', '8013527270', '8013527024', '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1871670232', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77011865', 'S77011865', 'UT01', NULL, 'Raymond', NULL, 'Hour', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '3534 S Redwood Rd', 'West Valley', 'Salt Lake', 'UT', '84119', '8019722162', '8019723473', '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2006-04-01', '2008-09-04', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1871670232', 0, 'N', 0, '2006-08-31', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77011866', 'S77011866', 'UT01', NULL, 'Bruce', 'R', 'Lowry', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', '8013527270', '8013527024', '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1891832473', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77011867', 'S77011867', 'UT01', NULL, 'Bruce', 'R', 'Lowry', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '420 W Main St', 'American Fork', 'Utah', 'UT', '84003', '8017563888', '8017561588', '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1891832473', 0, 'N', 0, '2006-08-31', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77011868', 'S77011868', 'UT01', NULL, 'Brandon', 'L', 'Neff', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', '8013527270', '8013527024', '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1609839638', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77011869', 'S77011869', 'UT01', '', 'Brandon', 'L', 'Neff', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '10358 S Redwood Rd', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012546697', '8012545739', '867 E 9400 S', 'Sandy', 'Salt Lake', 'UT', '84094', '8012546697', '8012545739', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1609839638', 0, 'N', 0, '2010-10-29', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77011870', 'S77011870', 'UT01', NULL, 'Walter', 'W', 'Wagner', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', '8013527270', '8013527024', '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1396894622', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77011871', 'S77011871', 'UT01', NULL, 'Walter', 'W', 'Wagner', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '6271 Dixie Dr (3655 W) Ste 12', 'West Jordan', 'Salt Lake', 'UT', '84084', '8019666200', '8019666424', '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1396894622', 0, 'N', 0, '2006-12-20', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77011872', 'S77011872', 'UT01', NULL, 'Lance', 'M', 'Tilley', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', '8013527270', '8013527024', '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '973631', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77011873', 'S77011873', 'UT01', NULL, 'Lance', 'M', 'Tilley', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '1150 S Depot Dr Ste 200', 'Ogden', 'Weber', 'UT', '84404', '8016216155', '8016216158', '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2006-04-01', '2008-07-03', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000973631', 0, 'N', 0, '2008-07-11', NULL, NULL, 0, 0, NULL, NULL),
('870413860', 'S77011874', 'S77011874', 'UT01', 'Now Care Clinic', 'Diane', 'E', 'Wilson', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 241', 'Roy', 'Weber', 'UT', '84067', '8016213466', '8016218811', 'PO Box 241', 'Roy', 'Weber', 'UT', '84067', '8016213466', '8016218811', 'WUSTDFAM5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', '2009-12-15', 0, 0, 0, 'Davis Hospital', 'Ogden Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1013932185', 0, 'Y', 0, '2013-12-18', NULL, NULL, 0, 0, NULL, NULL),
('870413860', 'S77011875', 'S77011875', 'UT01', 'Now Care Clinic', 'Diane', 'EH', 'Wilson', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '698 12th St', 'Ogden', 'Weber', 'UT', '84404', '8016213466', '8016218811', NULL, NULL, '', NULL, NULL, '', '', 'WUSTDFAM5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, 'Davis Hospital', 'Ogden Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1013932185', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870423799', 'S77011876', 'S77011876', 'UT01', 'Eyecare Associates', 'Kris', 'A', 'Hill', 'OD', 'Optometry', '', '', NULL, 'O', '7400 Union Park Ave Ste 202', 'Midvale', 'Salt Lake', 'UT', '84047', '8015693698', '8015690578', '7400 Union Park Ave Ste 202', 'Midvale', 'Salt Lake', 'UT', '84047', '8015693698', '8015690578', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043228554', 0, 'N', 0, '2013-12-10', NULL, NULL, 40.6168, -111.859, NULL, NULL),
('870437878', 'S77011878', 'S77011878', 'UT01', 'Beaver/Milford Medical Clinic', 'R Wade', NULL, 'Oakden', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '451 N Main', 'Milford', 'Beaver', 'UT', '84751', '4353872471', '4354382475', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, 'Beaver Valley Hospital', 'Beaver Valley Hospital Pro Fee', NULL, NULL, 'HCFA|UB|', '1346245438', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870452022', 'S77011881', 'S77011881', 'UT01', 'Mt Timpanogos Womens Healthcare', 'Amy', 'A', 'Holtsclaw', 'CNM', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '1886 W 800 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017565288', '8017567589', '1886 W 800 N', 'Pleasant Grove', '', 'UT', '84062', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', '2008-01-15', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1760444335', 0, 'N', 0, '2006-10-19', NULL, NULL, 0, 0, NULL, NULL),
('870482436', 'S77011892', 'S77011892', 'UT01', 'Mountain West Eyecare', 'Shawn', 'D', 'Beagley', 'OD', 'Optometry', NULL, NULL, NULL, 'O', '2727 W 3500 S', 'West Valley', 'Salt Lake', 'UT', '84119', '8019686772', '8019686772', '2727 W 3500 S', 'West Valley', 'Salt Lake', 'UT', '84119', '8019686772', '8019686772', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-01-01', '2011-10-06', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982602231', 0, 'N', 0, '2012-03-12', NULL, NULL, 0, 0, NULL, NULL),
('870482642', 'S77011893', 'S77011893', 'UT01', 'Millcreek Anesthesia', 'Jennifer', '', 'Layman', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'B', '1954 E Fort Union Blvd Ste 104', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019939530', NULL, '1954 E Fort Union Blvd Ste 104', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019939530', '', '', NULL, NULL, '0.00', '20.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1336172840', 0, 'Y', 0, '2012-07-23', NULL, NULL, 0, 0, NULL, NULL),
('870482642', 'S77011894', 'S77011894', 'UT01', 'St Marks Internventional Spine and Pain Clinic', 'Jennifer', '', 'Layman', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'O', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687725', NULL, '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687725', '', '', NULL, NULL, '0.00', '20.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1336172840', 0, 'Y', 0, '2012-07-23', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('870503202', 'S77011899', 'S77011899', 'UT01', 'Mountain West Ear Nose and Throat', 'Kelly', 'E', 'Stoker', 'MD', 'Ear, Nose and Throat', NULL, NULL, NULL, 'O', '1551 Renaissance Towne Dr Ste 310', 'Bountiful', 'Davis', 'UT', '84010', '8012955581', NULL, '1660 W Antelope Dr', 'Layton', '', 'UT', '84041', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2009-12-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1740338136', 0, 'N', 0, '2006-11-01', NULL, NULL, 0, 0, NULL, NULL),
('870503202', 'S77011900', 'S77011900', 'UT01', 'Mountain West Ear Nose and Throat', 'Kelly', 'E', 'Stoker', 'MD', 'Ear, Nose and Throat', NULL, NULL, NULL, 'O', '114 E 12450 S Ste 206', 'Draper', 'Salt Lake', 'UT', '84020', '8015765930', NULL, '1660 W Antelope Dr', 'Layton', '', 'UT', '84041', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2009-12-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1740338136', 0, 'N', 0, '2006-11-01', NULL, NULL, 0, 0, NULL, NULL),
('870503202', 'S77011903', 'S77011903', 'UT01', 'Mountain West Ear Nose and Throat', 'Steven', 'M', 'Kelly', 'MD', 'Pediatric Ear, Nose and Throat', '', '', NULL, 'O', '1551 Renaissance Towne Dr Ste 310', 'Bountiful', 'Davis', 'UT', '84010', '8012955581', '', '1551 Renaissance Towne Dr Ste 310', 'Bountiful', 'Davis', 'UT', '84010', '8012955581', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Lakeview Hospital', 'Primary Childrens Medical Center', 'Davis Hospital', '', 'HCFA|UB|', '1841348240', 0, 'N', 0, '2014-07-25', NULL, NULL, 40.8737, -111.888, NULL, NULL),
('870503202', 'S77011904', 'S77011904', 'UT01', 'Mountain West Ear Nose and Throat', 'Steven', 'M', 'Kelly', 'MD', 'Pediatric Ear, Nose and Throat', '', '', NULL, 'O', '114 E 12450 S Ste 206', 'Draper', 'Salt Lake', 'UT', '84020', '8015765930', '', '114 E 12450 S Ste 206', 'Draper', 'Salt Lake', 'UT', '84020', '8015765930', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Lakeview Hospital', 'Primary Childrens Medical Center', 'Davis Hospital', '', 'HCFA|UB|', '1841348240', 0, 'N', 0, '2014-07-25', NULL, NULL, 40.5249, -111.887, NULL, NULL),
('870507858', 'S77011905', 'S77011905', 'UT01', 'Neurological Associates', 'Christopher', 'Jay', 'Reynolds', 'MD', 'Neurology', NULL, NULL, NULL, 'B', '52 N 1100 E', 'American Fork', 'Utah', 'UT', '84003', '8017630901', NULL, '52 N 1100 E', 'American Fork', '', 'UT', '84003', '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1700843695', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870507858', 'S77011906', 'S77011906', 'UT01', 'Neurological Associates', 'Christopher', 'J', 'Reynolds', 'MD', 'Neurology', 'Sleep Medicine', '', NULL, 'O', '700 W 800 N Ste 330', 'Orem', 'Utah', 'UT', '84057', '8014267748', NULL, '700 W 800 N Ste 330', 'Orem', 'Utah', 'UT', '84057', '8014267748', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2010-07-14', 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1700843695', 0, 'N', 0, '2013-12-10', NULL, NULL, 0, 0, NULL, NULL),
('870518863', 'S77011909', 'S77011909', 'UT01', 'Jordan Meadows Medical Center', 'Frederic', 'M', 'Civish', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', '3534 S 6000 W', 'West Valley', 'Salt Lake', 'UT', '84128', '8019696264', '8019696333', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1124137278', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870519084', 'S77011910', 'S77011910', 'UT01', NULL, 'David', 'A', 'Debenham', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'B', 'PO Box 911928', 'St George', 'Washington', 'UT', '84791', '4356282866', NULL, 'PO Box 911928', 'St George', 'Washington', 'UT', '84791', '4356282866', '', 'WUSTDPAIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, NULL, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1053491183', 0, 'Y', 0, '2011-09-20', NULL, NULL, 0, 0, NULL, NULL),
('870519084', 'S77011912', 'S77011912', 'UT01', '', 'David', 'A', 'Debenham', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356885555', NULL, 'PO Box 911928', 'St George', 'Washington', 'UT', '84791', '4356885555', '          ', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-01-01', '2011-09-19', NULL, 0, NULL, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1053491183', 0, 'Y', 0, '2011-09-20', NULL, NULL, 0, 0, NULL, NULL),
('870519084', 'S77011913', 'S77011913', 'UT01', NULL, 'David', 'A', 'Debenham', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'O', '676 S Bluff St', 'St George', 'Washington', 'UT', '84770', '4356738080', NULL, 'PO Box 911928', 'St George', '', 'UT', '84791', '', '', 'WUSTDPAIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1053491183', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870520042', 'S77011914', 'S77011914', 'UT01', 'Nephrology Associates', 'Josephine', 'D', 'Abraham', 'MD', 'Nephrology', NULL, NULL, NULL, 'B', '650 E 4500 S Ste 210', 'Murray', 'Salt Lake', 'UT', '84107', '8012882634', 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|', '1942260229', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870520042', 'S77011915', 'S77011915', 'UT01', 'Nephrology Associates', 'Josephine', 'D', 'Abraham', 'MD', 'Nephrology', NULL, NULL, NULL, 'O', '650 E 4500 S Ste 210', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012882634', NULL, '650 E 4500 S Ste 210', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012882634', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2013-08-07', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1942260229', 0, 'N', 0, '2013-08-14', NULL, NULL, 0, 0, NULL, NULL),
('870532396', 'S77011917', 'S77011917', 'UT01', 'Pioneer Anesthesia Group', 'Robert', 'L', 'Langston', 'CRNA', 'Anesthesiology', NULL, NULL, NULL, 'O', '3715 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019643100', NULL, '1954 E Fort Union Blvd', 'Salt Lake City', '', 'UT', '84121', '', '', NULL, NULL, NULL, '0.00', '20.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1366557407', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870537951', 'S77011918', 'S77011918', 'UT01', 'Hardy OD PC, Dale F', 'Scott', 'R', 'Lewis', 'OD', 'Optometry', NULL, NULL, NULL, 'B', 'PO Box 95110', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012531374', '8012531672', NULL, NULL, '', NULL, NULL, '', '', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '25.00', NULL, 3, '2006-08-01', '2007-01-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '956784', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870537951', 'S77011919', 'S77011919', 'UT01', 'Dale F Hardy OD', 'Scott', 'R', 'Lewis', 'OD', 'Optometry', NULL, NULL, NULL, 'O', '10372 S Redwood Rd', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012531374', '8012531672', NULL, NULL, '', NULL, NULL, '', '', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '25.00', NULL, 3, '2006-08-01', '2007-01-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '956784', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77011922', 'S77011922', 'UT01', 'Wasatch Pediatrics', 'Maggie', 'S', 'Hull', 'MD', 'Pediatrics', '', '', NULL, 'B', '7138 Highland Dr Ste 102', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019470830', '8019470864', '7138 Highland Dr Ste 102', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019470830', '8019470864', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2008-11-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013999622', 0, 'Y', 0, '2014-07-02', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77011923', 'S77011923', 'UT01', 'Wasatch Pediatrics', 'Maggie', 'S', 'Hull', 'MD', 'Pediatrics', '', '', NULL, 'O', '380 E 1500 S Ste 210', 'Heber City', 'Wasatch', 'UT', '84032', '4356570101', NULL, '380 E 1500 S Ste 210', 'Heber City', 'Wasatch', 'UT', '84032', '4356570101', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2008-11-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013999622', 0, 'N', 0, '2014-07-02', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77011924', 'S77011924', 'UT01', 'Wasatch Pediatrics', 'David', 'P', 'Jubelirer', 'MD', 'Pediatrics', NULL, NULL, NULL, 'B', '7138 Highland Dr Ste 102', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019470830', '8019470864', '7138 S 2000 E', 'Salt Lake City', '', 'UT', '84121', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '937665', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77011925', 'S77011925', 'UT01', 'Summit Pediatrics', 'David', 'P', 'Jubelirer', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '1790 Sun Peak Dr Ste A101', 'Park City', 'Summit', 'UT', '84098', '4356550926', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '937665', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77011926', 'S77011926', 'UT01', 'Cottonwood Pediatrics', 'Daniel', 'B', 'Clayton', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', '7138 S 2000 E', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019470830', '8019470864', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, NULL, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1811979214', 0, 'Y', 0, '2011-06-07', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77011927', 'S77011927', 'UT01', 'Willow Creek Pediatrics', 'Daniel', 'B', 'Clayton', 'MD', 'Pediatrics', '', '', NULL, 'O', '114 E 12450 S Ste 100', 'Draper', 'Salt Lake', 'UT', '84020', '8015233001', NULL, '114 E 12450 S Ste 100', 'Draper', 'Salt Lake', 'UT', '84020', '8015233001', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1811979214', 0, 'N', 0, '2014-03-11', NULL, NULL, 40.5249, -111.887, NULL, NULL),
('870550275', 'S77011928', 'S77011928', 'UT01', 'Cottonwood Pediatrics', 'Monica', 'M', 'Schaffer', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1093798407', 0, 'Y', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77011929', 'S77011929', 'UT01', 'Summit Pediatrics', 'Monica', 'M', 'Schaffer', 'MD', 'Pediatrics', '', '', NULL, 'O', '1790 W Sun Peak Dr Ste A101', 'Park City', 'Summit', 'UT', '84098', '4356550926', '4356493748', '1790 W Sun Peak Dr Ste A101', 'Park City', 'Summit', 'UT', '84098', '4356550926', '4356493748', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2011-10-17', 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1093798407', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77011930', 'S77011930', 'UT01', 'Cottonwood Pediatrics', 'Michelle', 'A', 'Chamberlain', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1992787741', 0, 'Y', 0, '2014-01-06', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77011931', 'S77011931', 'UT01', 'Willow Creek Pediatrics', 'Michelle', 'A', 'Chamberlain', 'MD', 'Pediatrics', '', '', NULL, 'O', '7138 S 2000 E Ste 106', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019421800', NULL, '7138 S 2000 E Ste 106', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019421800', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1992787741', 0, 'N', 0, '2014-03-05', NULL, NULL, 40.6215, -111.834, NULL, NULL),
('870550275', 'S77011932', 'S77011932', 'UT01', 'Cottonwood Pediatrics', 'Earl', 'R', 'Judd', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1679555387', 0, 'Y', 0, '2013-12-27', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77011933', 'S77011933', 'UT01', 'Grow Up Great', 'Earl', 'R', 'Judd', 'MD', 'Pediatrics', '', '', NULL, 'O', '620 Medical Dr Ste 100', 'Bountiful', 'Davis', 'UT', '84010', '8012952888', '8012950311', '620 Medical Dr Ste 100', 'Bountiful', 'Davis', 'UT', '84010', '8012952888', '8012950311', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2006-06-01', 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1679555387', 0, 'N', 0, '2013-12-27', NULL, NULL, 0, 0, NULL, NULL),
('870575413', 'S77011935', 'S77011935', 'UT01', 'SouthWest Vision', 'Paul', 'R', 'Gooch', 'OD', 'Optometry', NULL, NULL, 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|', '1457498305', 0, 'N', 0, '2013-12-16', NULL, NULL, 37.0962, -113.563, NULL, NULL),
('870579573', 'S77011936', 'S77011936', 'UT01', NULL, 'Lynn', 'D', 'Stromness', 'OD', 'Optometry', NULL, NULL, NULL, 'O', '1434 E 9400 S Ste 104', 'Sandy', 'Salt Lake', 'UT', '84093', '8015761145', '8015768316', '1434 E 9400 S Ste 104', 'Sandy', 'Salt Lake', 'UT', '84093', '8015761145', '8015768316', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073694212', 0, 'N', 0, '2012-07-31', NULL, NULL, 40.5804, -111.849, NULL, NULL),
('870609622', 'S77011937', 'S77011937', 'UT01', 'Snow Canyon Clinic', 'John', 'G', 'Schmidt', 'MD', 'Neurology', NULL, NULL, NULL, 'B', '272 E Ctr St Ste 101', 'Ivins', 'Washington', 'UT', '84738', '4356564477', '4356563850', '272 E Center St', 'Ivins', '', 'UT', '84738', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1295786507', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870609622', 'S77011938', 'S77011938', 'UT01', 'Snow Canyon Clinic', 'John', 'G', 'Schmidt', 'MD', 'Neurology', NULL, NULL, NULL, 'O', '272 E Ctr St', 'Ivins', 'Washington', 'UT', '84738', '4359862300', '4356563850', '272 E Ctr St', 'Ivins', 'Washington', 'UT', '84738', '4359862300', '4356563850', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', '2014-03-31', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1295786507', 0, 'N', 0, '2014-05-21', NULL, NULL, 37.1684, -113.673, NULL, NULL),
('870618776', 'S77011945', 'S77011945', 'UT01', 'Gamma West Brachytherapy', 'Ray', 'S', 'Richards', 'MD', 'Radiation Oncology', '', '', NULL, 'B', 'PO Box 27301', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8014756532', '8014756182', 'PO Box 27301', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8014756532', '8014756182', 'WUSTDRONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1063551695', 0, 'Y', 0, '2014-07-17', NULL, NULL, 0, 0, NULL, NULL),
('870618776', 'S77011946', 'S77011946', 'UT01', 'Gamma West Brachytherapy Orem', 'Ray', 'S', 'Richards', 'MD', 'Radiation Oncology', NULL, NULL, NULL, 'B', 'PO Box 271098', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8013598956', '8014756119', '24 S 1100 E', 'Salt Lake City', '', 'UT', '84102', '', '', 'WUSTDRONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1063551695', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870618776', 'S77011947', 'S77011947', 'UT01', 'Gamma West Brachytherapy', 'Ray', 'S', 'Richards', 'MD', 'Radiation Oncology', NULL, NULL, NULL, 'B', 'PO Box 71309', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8013598956', '8013504021', '24 S 1100 E', 'Salt Lake City', '', 'UT', '84102', '', '', 'WUSTDRONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1063551695', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870618776', 'S77011948', 'S77011948', 'UT01', 'Gamma West Brachytherapy', 'Ray', 'S', 'Richards', 'MD', 'Radiation Oncology', NULL, NULL, NULL, 'B', 'PO Box 25213', 'Salt Lake City', 'Salt Lake', 'UT', '84125', '8014756532', '8014756119', '24 S 1100 E', 'Salt Lake City', '', 'UT', '84102', '', '', 'WUSTDRONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1063551695', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870618776', 'S77011949', 'S77011949', 'UT01', 'Gamma West Brachytherapy', 'Ray', 'S', 'Richards', 'MD', 'Radiation Oncology', NULL, NULL, NULL, 'O', '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013508400', '8013504021', '24 S 1100 E', 'Salt Lake City', '', 'UT', '84102', '', '', 'WUSTDRONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1063551695', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870618776', 'S77011950', 'S77011950', 'UT01', 'Gamma West Brachytherapy Orem', 'Ray', 'S', 'Richards', 'MD', 'Radiation Oncology', NULL, NULL, NULL, 'O', '674 W 800 N Ste B 10', 'Orem', 'Utah', 'UT', '84057', '8018520210', '8018520215', '24 S 1100 E', 'Salt Lake City', '', 'UT', '84102', '', '', 'WUSTDRONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1063551695', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870618776', 'S77011951', 'S77011951', 'UT01', 'Gamma West Brachytherapy', 'Ray', 'S', 'Richards', 'MD', 'Radiation Oncology', NULL, NULL, NULL, 'O', '425 E 5350 S Ste 180', 'Ogden', 'Weber', 'UT', '84405', '8014754571', '8014756119', '24 S 1100 E', 'Salt Lake City', '', 'UT', '84102', '', '', 'WUSTDRONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1063551695', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870618776', 'S77011952', 'S77011952', 'UT01', 'Gamma West Brachytherapy', 'Ray', 'S', 'Richards', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84790', '4356884175', NULL, '544 S 400 E', 'St George', 'Washington', 'UT', '84790', '4356884175', '', 'WUSTDRONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1063551695', 0, 'N', 0, '2014-07-17', NULL, NULL, 37.0989, -113.575, NULL, NULL),
('870620808', 'S77011953', 'S77011953', 'UT01', NULL, 'Eric', 'A', 'Evans', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 911928', 'St George', 'Washington', 'UT', '84791', NULL, NULL, 'PO Box 911928', 'St George', 'Washington', 'UT', '84791', '', '', 'WUSTDPAIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1285724989', 0, 'Y', 0, '2012-04-18', NULL, NULL, 0, 0, NULL, NULL),
('870620808', 'S77011954', 'S77011954', 'UT01', '', 'Eric', 'A', 'Evans', 'MD', 'Anesthesiology', '', '', NULL, 'O', '354 E 600 S', 'St George', 'Washington', 'UT', '84770', '4356885555', NULL, '354 E 600 S', 'St George', 'Washington', 'UT', '84770', '4356885555', '          ', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-01-01', '2011-11-13', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1285724989', 0, 'N', 0, '2012-04-18', NULL, NULL, 0, 0, NULL, NULL),
('870629690', 'S77011955', 'S77011955', 'UT01', 'EPIC', 'EPIC', NULL, NULL, 'GROUP', 'Emergency Medicine', NULL, NULL, NULL, 'O', 'PO Box 96398', 'Oklahoma', 'Oklahoma', 'OK', '73143', NULL, NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '836032', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870635889', 'S77011956', 'S77011956', 'UT01', 'Tooele Clinic Corp', 'An', 'T', 'Dinh', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', '330 Franklin Rd Ste 135A', 'Brentwood', 'Williamson', 'TN', '37027', '4358821697', '4358826304', '330 Franklin Rd Ste 135A', 'Brentwood', 'Williamson', 'TN', '37027', '4358821697', '4358826304', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB|', '1144319997', 0, 'Y', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
('870635889', 'S77011958', 'S77011958', 'UT01', 'Stansbury Family Medicine', 'An', 'Tuong', 'Dinh', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '196 E 2000 N Ste 105', 'Tooele', 'Tooele', 'UT', '84074', '4358433647', '4358825766', 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|', '1144319997', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870635889', 'S77011959', 'S77011959', 'UT01', NULL, 'An', 'T', 'Dinh', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '210 Millpond', 'Stansbury Park', 'Tooele', 'UT', '84074', '4358433647', '4358821275', '210 Millpond', 'Stansbury Park', 'Tooele', 'UT', '84074', '4358433647', '4358821275', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB|', '1144319997', 0, 'N', 0, '2012-06-25', NULL, NULL, 40.6329, -112.311, NULL, NULL),
('870639098', 'S77011962', 'S77011962', 'UT01', 'After Hours Medical Company', 'Karl', 'J', 'Barton', 'NP', 'Family Practice', '', '', NULL, 'B', 'PO Box 1000', 'Draper', 'Salt Lake', 'UT', '84020', '8013529500', '8013529502', 'PO Box 1000', 'Draper', 'Salt Lake', 'UT', '84020', '8013529500', '8013529502', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', '2008-11-01', 0, 0, 0, 'Castleview Hospital', 'Castleview Hospital', NULL, NULL, 'HCFA|UB|', '1306889522', 0, 'Y', 0, '2013-12-23', NULL, NULL, 0, 0, NULL, NULL),
('870639098', 'S77011963', 'S77011963', 'UT01', 'After Hours Urgent Care American Fork', 'Renee', 'J', 'Neff', 'NP', 'Urgent Care', NULL, NULL, NULL, 'O', '476 N 900 W Ste C', 'American Fork', 'Utah', 'UT', '84003', '8014921611', NULL, '476 N 900 W Ste C', 'American Fork', 'Utah', 'UT', '84003', '8014921611', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679520811', 0, 'Y', 0, '2013-10-23', NULL, NULL, 40.3961, -111.815, NULL, NULL),
('870639098', 'S77011965', 'S77011965', 'UT01', 'After Hours Medical Family Medicine', 'Rachot', '', 'Vacharathone', 'MD', 'General Practice', NULL, NULL, NULL, 'B', 'PO Box 1000', 'Draper', 'Salt Lake', 'UT', '84020', '8013529500', '8013529502', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, 'Jordan Valley Medical Center', 'Pioneer Valley Hospital', NULL, NULL, 'HCFA|UB|', '1548228497', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870639098', 'S77011966', 'S77011966', 'UT01', 'After Hours Urgent Care WVC', 'Rachot', '', 'Vacharathone', 'MD', 'Urgent Care', '', '', NULL, 'O', '3451 S 5600 W Ste F', 'West Valley', 'Salt Lake', 'UT', '84121', '8019570900', NULL, '3451 S 5600 W Ste F', 'West Valley', 'Salt Lake', 'UT', '84121', '8019570900', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', 'Pioneer Valley Hospital', '', '', 'HCFA|UB|', '1548228497', 0, 'Y', 0, '2014-05-30', NULL, NULL, 40.6977, -112.025, NULL, NULL),
('870639098', 'S77011967', 'S77011967', 'UT01', 'After Hours Urgent Care South Jordan', 'Rachot', '', 'Vacharathone', 'MD', 'Urgent Care', '', '', NULL, 'O', '10433 S Redwood Rd', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015010500', '8012560696', '10433 S Redwood Rd', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015010500', '8012560696', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', 'Pioneer Valley Hospital', '', '', 'HCFA|UB|', '1548228497', 0, 'Y', 0, '2014-05-30', NULL, NULL, 40.5602, -111.939, NULL, NULL),
('870639098', 'S77011968', 'S77011968', 'UT01', 'After Hours Medical Company', 'Bradley', 'K', 'Lewis', 'MD', 'Urgent Care', '', '', NULL, 'B', 'PO Box 1000', 'Draper', 'Salt Lake', 'UT', '84020', '8013529500', '8013529502', 'PO Box 1000', 'Draper', 'Salt Lake', 'UT', '84020', '8013529500', '8013529502', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', '2008-11-01', 0, 0, 0, 'Pioneer Valley Hospital', '', '', '', 'HCFA|UB|', '1871609222', 0, 'Y', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('870639098', 'S77011969', 'S77011969', 'UT01', 'After Hours Urgent Care American Fork', 'Bradley', 'K', 'Lewis', 'MD', 'Urgent Care', NULL, NULL, NULL, 'O', '476 N 900 W Ste C', 'American Fork', 'Utah', 'UT', '84003', '8014921611', '8014901480', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1871609222', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870639098', 'S77011970', 'S77011970', 'UT01', 'After Hours Medical Company', 'Elmer', 'G', 'Sisneros', 'PA', 'Urgent Care', NULL, NULL, NULL, 'B', 'PO Box 1000', 'Draper', 'Salt Lake', 'UT', '84020', '8013529500', '8013529502', 'PO Box 1000', 'Draper', 'Salt Lake', 'UT', '84020', '8013529500', '8013529502', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', '2008-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912963117', 0, 'Y', 0, '2013-10-23', 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
('870639098', 'S77011971', 'S77011971', 'UT01', 'After Hours Urgent Care American Fork', 'Elmer', 'G', 'Sisneros', 'PA', 'Urgent Care', NULL, NULL, NULL, 'O', '476 N 900 W Ste C', 'American Fork', 'Utah', 'UT', '84003', '8014921611', '8014901480', '476 N 900 W Ste C', 'American Fork', 'Utah', 'UT', '84003', '8014921611', '8014901480', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912963117', 0, 'Y', 0, '2013-10-23', NULL, NULL, 40.3961, -111.815, NULL, NULL),
('870649259', 'S77011973', 'S77011973', 'UT01', 'Alpine Orthopaedic Specialists', 'Brad', 'J', 'Larson', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '451 W 600 N', 'Tremonton', 'Box Elder', 'UT', '84337', '4352573809', NULL, '451 W 600 N', 'Tremonton', 'Box Elder', 'UT', '84337', '4352573809', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Brigham City Community Hospital', 'Logan Regional Hospital', NULL, NULL, 'HCFA|UB|', '1396733507', 0, 'N', 0, '2014-01-21', NULL, NULL, 41.7188, -112.174, NULL, NULL),
('870666061', 'S77011984', 'S77011984', 'UT01', 'Copperview Medical Center', 'Mary', 'D', 'Tipton', 'MD', 'Internal Medicine', 'Pediatrics', NULL, NULL, 'O', '3556 W 9800 S Ste 101', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015679780', '8015679826', '3556 W 9800 S', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015679780', '8015679826', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, NULL, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1922065598', 0, 'N', 0, '2011-10-14', NULL, NULL, 40.5732, -111.975, NULL, NULL),
('870680102', 'S77011985', 'S77011985', 'UT01', 'Red Cliffs Administrative Services', 'Robert', 'W', 'Welker', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', '162 E 300 S', 'St George', 'Washington', 'UT', '84770', '4356733521', '4356733522', '162 E 300 S', 'St George', '', 'UT', '84770', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1740278183', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870680102', 'S77011986', 'S77011986', 'UT01', 'Red Cliffs Administrative Services', 'Robert', 'W', 'Welker', 'MD', 'Family Practice', '', '', NULL, 'O', '162 E 300 S', 'St George', 'Washington', 'UT', '84770', '4356733521', '4356733522', '162 E 300 S', 'St George', 'Washington', 'UT', '84770', '4356733521', '4356733522', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2008-12-23', 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1740278183', 0, 'N', 0, '2012-04-18', NULL, NULL, 0, 0, NULL, NULL),
('870687383', 'S77011987', 'S77011987', 'UT01', 'Western Neurological Associates', 'Gary', 'A', 'Podolny', 'MD', 'Diagnostic Radiology', NULL, NULL, NULL, 'O', '1151 E 3900 S Ste B150', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012623441', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832134', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('876000616', 'S77011988', 'S77011988', 'UT01', 'Blanding Medical Clinic', 'Kevin', 'M', 'Matteson', 'MD', 'General Surgery', '', '', NULL, 'O', '804 N 400 W', 'Blanding', 'San Juan', 'UT', '84511', '4356782254', NULL, 'PO Box 308', 'Monticello', 'San Juan', 'UT', '84535', '4356782254', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-11-01', '2011-10-17', NULL, 0, NULL, 'Southwest Memorial Hospital', NULL, NULL, NULL, 'HCFA|', '1407853013', 0, 'N', 0, '2011-10-19', NULL, NULL, 0, 0, NULL, NULL),
('876000616', 'S77011989', 'S77011989', 'UT01', 'Blanding Medical Clinic', 'Blen', NULL, 'Freestone', 'PA', 'Family Practice', NULL, NULL, NULL, 'O', '804 N 400 W ', 'Blanding', 'San Juan', 'UT', '84511', '4356782254', NULL, 'PO Box 308', 'Monticello', '', 'UT', '84535', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1487646337', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'S77011994', 'S77011994', 'UT02', 'Intermountain Health Care', 'Jamile', 'S', 'Woods', 'MD', 'Pulmonary', NULL, NULL, NULL, 'B', 'PO Box 27128', 'Salt Lake City', 'Salt Lake', 'UT', '84127', NULL, NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2006-06-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1114931540', 0, 'Y', 0, '2009-03-24', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'S77011995', 'S77011995', 'UT02', 'IHC Pulmonary Clinic', 'Jamile', 'S', 'Woods', 'MD', 'Pulmonary', NULL, NULL, NULL, 'O', '1055 N 300 W Ste 500', 'Provo', 'Utah', 'UT', '84604', '8013577291', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2006-06-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1114931540', 0, 'Y', 0, '2009-03-24', NULL, NULL, 0, 0, NULL, NULL),
('010814102', 'S77011996', 'S77011996', 'UT01', NULL, 'Paul', 'E', 'Reed', 'OD', 'Optometry', '', '', NULL, 'O', '1761 N 2000 W Ste 4', 'Ogden', 'Weber', 'UT', '84404', '8017315558', '8017313143', '1761 N 2000 W Ste 4', 'Ogden', 'Weber', 'UT', '84404', '8017315558', '8017313143', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396792982', 0, 'N', 0, '2013-08-21', NULL, NULL, 41.2888, -112.028, NULL, NULL),
('010858024', 'S77011997', 'S77011997', 'UT01', '', 'Vikas', '', 'Garg', 'MD', 'Pain Management', NULL, NULL, NULL, 'B', '274 N Main St', 'Logan', 'Cache', 'UT', '84321', '4357531600', NULL, '274 N Main St', 'Logan', 'Cache', 'UT', '84321', '4357531600', '          ', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2007-01-01', '2012-12-31', 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1104852599', 0, 'Y', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('010858024', 'S77011998', 'S77011998', 'UT01', '', 'Vikas', '', 'Garg', 'MD', 'Pain Management', NULL, NULL, NULL, 'O', '2380 N 400 E Ste A', 'Logan', 'Cache', 'UT', '84341', '4357139681', NULL, '2380 N 400 E Ste A', 'Logan', 'Cache', 'UT', '84341', '4357139681', '          ', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-01-01', '2012-03-31', 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1104852599', 0, 'N', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('201730782', 'S77012001', 'S77012001', 'UT01', '', 'Laura', 'C', 'Maw', 'APRN', 'Family Practice', '', '', NULL, 'O', '1495 N 200 W', 'Orem', 'Utah', 'UT', '84057', '8013616038', '8014893492', '1495 N 200 W', 'Orem', 'Utah', 'UT', '84057', '8013616038', '8014893492', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2014-01-27', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982661039', 0, 'N', 0, '2014-04-14', NULL, NULL, 0, 0, NULL, NULL),
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('204780557', 'S77012008', 'S77012008', 'UT01', '', 'David', 'H', 'Warby', 'DPM', 'Podiatry', NULL, NULL, NULL, 'O', '934 S Main St', 'Layton', 'Davis', 'UT', '84041', '8015444227', '8015443724', '934 S Main St', 'Layton', 'Davis', 'UT', '84041', '8015444227', '8015443724', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-08-01', '2011-11-30', 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1912949421', 0, 'N', 0, '2013-03-14', NULL, NULL, 0, 0, NULL, NULL),
('371450599', 'S77012011', 'S77012011', 'UT01', 'Mountain Family Health', 'Brian', 'J', 'Rush', 'MD', 'Family Practice', '', '', NULL, 'B', '348 E 4500 S Ste 220', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8002708917', NULL, '348 E 4500 S Ste 220', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8002708917', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Park City Medical Center', '', '', '', 'HCFA|UB|', '1184672511', 0, 'Y', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('371450599', 'S77012012', 'S77012012', 'UT01', 'Mountain Family Health', 'Brian', 'J', 'Rush', 'MD', 'Family Practice', '', '', NULL, 'O', '1600 Snow Creek Dr', 'Park City', 'Summit', 'UT', '84060', '4359409400', '4356558979', '1600 Snow Creek Dr', 'Park City', 'Summit', 'UT', '84060', '4359409400', '4356558979', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', '2011-11-14', 0, 0, 0, 'Park City Medical Center', '', '', '', 'HCFA|UB|', '1184672511', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('371450599', 'S77012013', 'S77012013', 'UT01', 'Mountain Family Health', 'Julie', 'A', 'Dolan', 'MD', 'Family Practice', '', '', NULL, 'B', '348 E 4500 S Ste 220', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8002708917', NULL, '348 E 4500 S Ste 220', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8002708917', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1477501252', 0, 'Y', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('371450599', 'S77012014', 'S77012014', 'UT01', 'Mountain Family Health', 'Julie', 'A', 'Dolan', 'MD', 'Family Practice', '', '', NULL, 'O', '1600 Snow Creek Dr', 'Park City', 'Summit', 'UT', '84060', '4359409400', '4356558979', '1600 Snow Creek Dr', 'Park City', 'Summit', 'UT', '84060', '4359409400', '4356558979', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', '2011-11-13', 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1477501252', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('421630048', 'S77012015', 'S77012015', 'UT01', 'Vein Institute of Utah', 'Ehsan', '', 'Hadjbian', 'MD', 'Family Practice', '', '', NULL, 'O', '1275 Fort Union Blvd Ste 118', 'Midvale', 'Salt Lake', 'UT', '84047', '8017480580', '8017482274', '1275 Fort Union Blvd Ste 118', 'Midvale', 'Salt Lake', 'UT', '84047', '8017480580', '8017482274', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', '2012-07-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275535742', 0, 'N', 0, '2013-06-19', NULL, NULL, 0, 0, NULL, NULL),
('543909946', 'S77012016', 'S77012016', 'UT01', NULL, 'Anina', '', 'Merrill', 'MD', 'Physical Medicine and Rehabilitation', NULL, NULL, NULL, 'B', 'PO Box 307', 'Bountiful', 'Davis', 'UT', '84011', '8015656500', NULL, 'PO Box 307', 'Bountiful', 'Davis', 'UT', '84011', '8015656500', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'Health South Rehabilitation Hospital of Utah (inpatient services only)', NULL, NULL, NULL, 'HCFA|UB|', '1134111545', 0, 'Y', 0, '2013-01-03', NULL, NULL, 0, 0, NULL, NULL),
('571188761', 'S77012017', 'S77012017', 'UT01', 'Westview Womens Center', 'Gregory', 'C', 'Tanner', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'B', 'PO Box 1569', 'Bountiful', 'Davis', 'UT', '84011', '8019631880', '8019631886', 'PO Box 1569', 'Bountiful', 'Davis', 'UT', '84011', '8019631880', '8019631886', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', '2011-05-01', 0, 0, 0, 'Jordan Valley Medical Center', 'Pioneer Valley Hospital', '', '', 'HCFA|UB|', '1598875973', 0, 'Y', 0, '2012-07-13', NULL, NULL, 0, 0, NULL, NULL),
('571188761', 'S77012018', 'S77012018', 'UT01', 'Westview Womens Center', 'Gregory', 'C', 'Tanner', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '3451 S 5600 W Ste E', 'West Valley', 'Salt Lake', 'UT', '84120', '8019631880', '8019631886', '3451 S 5600 W Ste E', 'West Valley', 'Salt Lake', 'UT', '84120', '8019631880', '8019631886', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', '2011-05-01', 0, 0, 0, 'Jordan Valley Medical Center', 'Pioneer Valley Hospital', '', '', 'HCFA|UB|', '1598875973', 0, 'Y', 0, '2012-07-13', NULL, NULL, 0, 0, NULL, NULL),
('571188761', 'S77012019', 'S77012019', 'UT01', 'Westview Womens Center', 'Gordon', 'T', 'Oremland', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 1569', 'Bountiful', 'Davis', 'UT', '84011', '8019631880', '8019631886', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1013061688', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('571188761', 'S77012020', 'S77012020', 'UT01', 'Westview Womens Center', 'Gordon', 'T', 'Oremland', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '3451 S 5600 W Ste E', 'West Valley', 'Salt Lake', 'UT', '84120', '8019631880', '8019631886', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1013061688', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'S77012022', 'S77012022', 'UT01', 'Community Health Centers', 'Christine', 'H', 'Broken Leg', 'PA', 'Family Practice', NULL, NULL, NULL, 'B', '1798 S W Temple Ste A 100', 'South Salt Lake', 'Salt Lake', 'UT', '84115', '8014126930', '8014126950', '1798 S W Temple', 'Salt Lake City', '', 'UT', '84115', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-03-30', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1740287861', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'S77012023', 'S77012023', 'UT01', 'Community Health Centers', 'Christine', 'H', 'Broken Leg', 'PA', 'Family Practice', NULL, NULL, NULL, 'O', '8446 Harrison St', 'Midvale', 'Salt Lake', 'UT', '84047', '8015665494', NULL, '1798 S W Temple', 'Salt Lake City', '', 'UT', '84115', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-03-30', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1740287861', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('841411398', 'S77012030', 'S77012030', 'UT01', 'Foothill Family Clinic', 'George', 'K', 'Wong', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '2295 Foothill Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8014863021', '8014856339', NULL, NULL, '', 'UT', '84109', '', '', 'WUFOOTHIL5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '932595', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870345378', 'S77012032', 'S77012032', 'UT01', NULL, 'Larry', NULL, 'Noble', 'MD, MPH', 'Ophthalmology', NULL, NULL, NULL, 'O', '3200 N Canyon Rd Ste A', 'Provo', 'Utah', 'UT', '84604', '8013752020', '8012253595', '3200 N Canyon Rd', 'Provo', '', 'UT', '84604', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1588734537', 0, 'N', 0, '2006-10-27', NULL, NULL, 40.276, -111.651, NULL, NULL),
('870364983', 'S77012034', 'S77012034', 'UT01', NULL, 'R Ralph', '', 'Bradley', 'MD', 'Dermatology', '', '', NULL, 'O', '166 E 5900 S Ste B 111', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012689672', '8012689672', '166 E 5900 S Ste B 111', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012689672', '8012689672', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386681005', 0, 'N', 0, '2014-04-16', NULL, NULL, 40.6428, -111.886, NULL, NULL),
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('870395551', 'S77012037', 'S77012037', 'UT01', 'Thomson Chiropractic', 'David', 'B', 'Thomson', 'DC', 'Chiropractic', '', '', NULL, 'O', '40 Gallivan Ave', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8019611300', NULL, '867 E 9400 S', 'Sandy', 'Salt Lake', 'UT', '84094', '8019611300', '          ', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2006-04-01', '2008-06-01', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1902898927', 0, 'N', 0, '2011-08-05', NULL, NULL, 0, 0, NULL, NULL),
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('870395551', 'S77012039', 'S77012039', 'UT01', NULL, 'Jeffrey', NULL, 'Wheeler', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '993 W 3800 N', 'Pleasant View', 'Weber', 'UT', '84404', '8013922612', '8013931377', '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2006-04-01', '2009-05-01', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1912012360', 0, 'N', 0, '2006-08-31', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77012040', 'S77012040', 'UT01', NULL, 'Brian', 'N', 'Hardy', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', '8013527270', '8013527024', '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1831255033', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('870395551', 'S77012044', 'S77012044', 'UT01', NULL, 'Jeremy', 'D', 'Gibbons', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', '8013527270', '8013527024', '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1306927991', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77012045', 'S77012045', 'UT01', 'Smithfield Chiropractic', 'Jeremy', 'D', 'Gibbons', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '892 S Main St', 'Smithfield', 'Cache', 'UT', '84335', '4355632514', '4355350769', '892 S Main St', 'Smithfield', 'Cache', 'UT', '84335', '4355632514', '4355350769', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306927991', 0, 'N', 0, '2012-06-29', NULL, NULL, 0, 0, NULL, NULL),
('870413860', 'S77012050', 'S77012050', 'UT01', 'Now Care Clinic', 'Joelle', NULL, 'Creager', 'NP', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 241', 'Roy', 'Weber', 'UT', '84067', '8016213466', '8016218811', NULL, NULL, '', NULL, NULL, '', '', 'WUSTDFAM5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1558394692', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870413860', 'S77012051', 'S77012051', 'UT01', 'Now Care Clinic', 'Joelle', NULL, 'Creager', 'NP', 'Family Practice', NULL, NULL, NULL, 'O', '1937 W 5700 S', 'Roy', 'Weber', 'UT', '84067', '8017739380', '8016218811', NULL, NULL, '', NULL, NULL, '', '', 'WUSTDFAM5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1558394692', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870479370', 'S77012061', 'S77012061', 'UT01', 'Mountain West Cardiovascular Associates', 'Michael', '', 'Adjei-Poku', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '3584 W 9000 S Ste 209', 'West Jordan', 'Salt Lake', 'UT', '84088', '8016763776', '8016763776', '3584 W 9000 S Ste 209', 'West Jordan', 'Salt Lake', 'UT', '84088', '8016763776', '8016763776', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1528050465', 0, 'N', 0, '2012-11-28', NULL, NULL, 40.5879, -111.976, NULL, NULL),
('870479370', 'S77012062', 'S77012062', 'UT01', 'Mountain West Cardiovascular Associates', 'Michael', '', 'Adjei-Poku', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019681818', NULL, '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019681818', '', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1528050465', 0, 'N', 0, '2012-11-28', NULL, NULL, 40.682, -111.979, NULL, NULL),
('870484695', 'S77012063', 'S77012063', 'UT01', 'Delta Family Medicine', 'Easton', 'D', 'Jackson', 'MD', 'Urgent Care', '', '', NULL, 'O', '140 White Sage Ave', 'Delta', 'Millard', 'UT', '84624', '4358643333', NULL, '140 White Sage Ave', 'Delta', 'Millard', 'UT', '84624', '4358643333', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', '2011-09-20', 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1316049828', 0, 'N', 0, '2014-01-17', NULL, NULL, 0, 0, NULL, NULL),
('870507858', 'S77012067', 'S77012067', 'UT01', 'Neurological Associates', 'Mohammad', 'E', 'Taher', 'MD', 'Neurology', NULL, NULL, NULL, 'O', '700 W 800 N Ste 330', 'Orem', 'Utah', 'UT', '84057', '8014267748', NULL, '52 N 1100 E', 'American Fork', 'Utah', 'UT', '84003', '8014267748', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2010-07-14', NULL, 0, NULL, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1992762918', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('870519691', 'S77012070', 'S77012070', 'UT01', 'Utah Cancer Specialists', 'Gregory', 'J', 'Litton', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '5121 S Cottonwood St Blvd A Level 2', 'Murray', 'Salt Lake', 'UT', '84157', '8012633416', '8012633428', '1121 S 3900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012633416', '8012633428', 'WUSTDONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2006-11-01', NULL, 0, NULL, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1487603916', 0, 'N', 0, '2011-09-09', NULL, NULL, 0, 0, NULL, NULL),
('870519691', 'S77012071', 'S77012071', 'UT01', 'Utah Cancer Specialists', 'Gregory', 'J', 'Litton', 'MD', 'Hematology and Oncology', NULL, NULL, NULL, 'O', '9720 S 1300 E Ste W120', 'Sandy', 'Salt Lake', 'UT', '84094', '8012625679', 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|', '1487603916', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870529491', 'S77012072', 'S77012072', 'UT01', NULL, 'Jeffery', 'D', 'Graf', 'OD', 'Optometry', '', '', NULL, 'O', '754 S Main St Ste 6', 'St George', 'Washington', 'UT', '84770', '4356340420', '4356345409', '754 S Main St Ste 6', 'St George', 'Washington', 'UT', '84770', '4356340420', '4356345409', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184628091', 0, 'N', 0, '2014-01-13', NULL, NULL, 37.0954, -113.583, NULL, NULL),
('870534017', 'S77012074', 'S77012074', 'UT01', 'Mt View Foot Clinic', 'Steven', 'P', 'Royall', 'DPM', 'Podiatry', '', '', NULL, 'O', '8074 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8013646444', NULL, '8074 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8013646444', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2008-12-16', 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1962442822', 0, 'N', 0, '2013-07-03', NULL, NULL, 0, 0, NULL, NULL),
('870543318', 'S77012075', 'S77012075', 'UT01', 'Mountain West Gastroenterology', 'Oscar', 'A', 'Batista', 'MD', 'Gastroenterology', '', '', NULL, 'B', '6360 S 3000 E Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019443188', '8019443180', '6360 S 3000 E Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019443188', '8019443180', 'WCSTMTWEST5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2013-12-31', 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1962443465', 0, 'Y', 0, '2014-01-17', NULL, NULL, 0, 0, NULL, NULL),
('870543318', 'S77012076', 'S77012076', 'UT01', 'Mountain West Gastroenterology', 'Oscar', 'A', 'Batista', 'MD', 'Gastroenterology', '', '', NULL, 'O', '620 Medical Dr Ste 205', 'Bountiful', 'Davis', 'UT', '84010', '8012980057', '8019443186', '620 Medical Dr Ste 205', 'Bountiful', 'Davis', 'UT', '84010', '8012980057', '8019443186', 'WCSTMTWEST5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2013-12-31', 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1962443465', 0, 'N', 0, '2014-01-17', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77012077', 'S77012077', 'UT01', 'Wasatch Pediatrics', 'Pamela', 'M', 'Rubner', 'MD', 'Pediatrics', NULL, NULL, NULL, 'B', '7138 Highland Dr Ste 102', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019470830', '8019470864', '7138 S 2000 E', 'Salt Lake City', '', 'UT', '84121', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '977244', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77012078', 'S77012078', 'UT01', 'Southpoint Pediatrics', 'Pamela', 'M', 'Rubner', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '9071 S 1300 W Ste 301', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015651162', NULL, '7138 S 2000 E', 'Salt Lake City', '', 'UT', '84121', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '977244', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870649259', 'S77012116', 'S77012116', 'UT01', 'Alpine Orthopaedic Specialists', 'Randy', 'L', 'Chadwell', 'FNP, PA-C', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 6250', 'Logan', 'Cache', 'UT', '84341', '4357872000', NULL, 'PO Box 6250', 'Logan', 'Cache', 'UT', '84341', '4357872000', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, NULL, 0, 0, 'Brigham City Community Hospital', 'Logan Regional Hospital', NULL, NULL, 'HCFA|UB|', '1295838605', 0, 'Y', 0, '2011-08-16', NULL, NULL, 0, 0, NULL, NULL),
('870649259', 'S77012117', 'S77012117', 'UT01', 'Alpine Orthopaedic Specialists', 'Randy', 'L', 'Chadwell', 'FNP, PA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '2310 N 400 E Ste A', 'North Logan', 'Cache', 'UT', '84341', '4357872000', NULL, 'PO Box 6250', 'Logan', 'Cache', 'UT', '84341', '4357872000', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, NULL, 0, 0, 'Brigham City Community Hospital', 'Logan Regional Hospital', NULL, NULL, 'HCFA|UB|', '1295838605', 0, 'N', 0, '2011-08-16', NULL, NULL, 41.7738, -111.823, NULL, NULL),
('870653164', 'S77012119', 'S77012119', 'UT01', 'Utah Digestive Health Institute', 'John', 'E', 'Lowe', 'MD', 'Gastroenterology', NULL, NULL, NULL, 'O', '1660 W Antelope Dr Ste 320', 'Layton', 'Davis', 'UT', '84041', '8017732268', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUSTDGAST4', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-05-01', '2007-05-01', 0, NULL, 0, 'Davis Hospital', 'Ogden Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1851387195', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870677196', 'S77012122', 'S77012122', 'UT01', 'Hidden Valley Eye Care', 'Dallin', 'W', 'Rice', 'OD', 'Optometry', '', '', NULL, 'O', '1147 E Draper Pkwy', 'Draper', 'Salt Lake', 'UT', '84020', '8016199555', '8014060444', '1147 E Draper Pkwy', 'Draper', 'Salt Lake', 'UT', '84020', '8016199555', '8014060444', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467444273', 0, 'N', 0, '2014-03-05', NULL, NULL, 40.5284, -111.858, NULL, NULL),
('870677196', 'S77012123', 'S77012123', 'UT01', 'Hidden Valley Eye Care', 'R', 'B', 'Rice', 'OD', 'Optometry', '', '', NULL, 'O', '1147 E Draper Pkwy', 'Draper', 'Salt Lake', 'UT', '84020', '8016199555', '8014060444', '1147 E Draper Pkwy', 'Draper', 'Salt Lake', 'UT', '84020', '8016199555', '8014060444', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740272319', 0, 'N', 0, '2014-03-05', NULL, NULL, 40.5284, -111.858, NULL, NULL),
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('870682564', 'S77012126', 'S77012126', 'UT01', NULL, 'Jeffrey', 'P', 'Tipton', 'OD', 'Optometry', NULL, NULL, NULL, 'O', '1055 W Hill Field Rd', 'Layton', 'Davis', 'UT', '84041', '8014447160', '8014447183', '1055 W Hill Field Rd', 'Layton', 'Davis', 'UT', '84041', '8014447160', '8014447183', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366443079', 0, 'N', 0, '2013-04-29', NULL, NULL, 41.0719, -111.985, NULL, NULL),
('876000545', 'S77012127', 'S77012127', 'UT01', 'Health Clinics of Utah', 'Judith', 'A', 'Berry', 'NP', 'Gynecology', NULL, NULL, NULL, 'O', '150 E Ctr St Ste 1100', 'Provo', 'Utah', 'UT', '84606', '8013747011', NULL, '3195 S Main St', 'Salt Lake City', 'Utah', 'UT', '84115', '8013747011', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1104884253', 0, 'N', 0, '2010-05-18', NULL, NULL, 40.2337, -111.656, NULL, NULL),
('880432423', 'S77012128', 'S77012128', 'UT01', 'Retina Consultants of Southern Utah', 'R', 'Jeffrey', 'Parker', 'MD', 'Ophthalmology', '', '', NULL, 'B', '653 N Town Ctr Dr Ste 518', 'Las Vegas', 'Clark', 'NV', '89144', '7023690200', '7022438383', '653 N Town Ctr Dr', 'Las Vegas', '', 'NV', '891440514', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386685311', 0, 'Y', 0, '2007-04-09', NULL, NULL, 0, 0, NULL, NULL),
('880432423', 'S77012129', 'S77012129', 'UT01', 'Retina Consultants of Southern Utah', 'R', 'Jeffrey', 'Parker', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1791 E 280 N', 'St George', 'Washington', 'UT', '84790', '7023690200', '7022438383', '1791 E 280 N', 'St George', 'Washington', 'UT', '84790', '7023690200', '7022438383', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386685311', 0, 'Y', 0, '2014-04-15', NULL, NULL, 37.1131, -113.545, NULL, NULL),
('203219862', 'S77012143', 'S77012143', 'UT01', 'Cardiovascular Consultants of Utah', 'Thomas', 'Robert', 'Calame', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '24 S 1100 E Ste 304', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8017464440', '8017464455', '24 S 1100 E', 'Salt Lake City', '', 'UT', '84102', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', '2008-07-14', 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1801888748', 0, 'N', 0, '2009-06-08', NULL, NULL, 0, 0, NULL, NULL),
('204166249', 'S77012144', 'S77012144', 'UT01', 'Deseret Medical Clinic', 'Heath', 'M', 'Scott', 'PA', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 307', 'Bountiful', 'Davis', 'UT', '84011', '8012946907', '8012946917', '3856 W 5400 S', 'Taylorsville', 'Davis', 'UT', '84118', '8012946907', '8012946917', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1437176229', 0, 'Y', 0, '2011-09-29', NULL, NULL, 0, 0, NULL, NULL),
('204166249', 'S77012145', 'S77012145', 'UT01', 'Deseret Medical Clinic', 'Heath', 'M', 'Scott', 'PA', 'Family Practice', NULL, NULL, NULL, 'O', '3865 W 5400 S', 'Salt Lake City', 'Salt Lake', 'UT', '84118', '8019664600', NULL, '3856 W 5400 S', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8019664600', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2006-11-01', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1437176229', 0, 'N', 0, '2011-09-29', NULL, NULL, 0, 0, NULL, NULL),
('204187908', 'S77012146', 'S77012146', 'UT01', 'Belnap & Vander Werf Surgical Associates', 'Willem', '', 'Vanderwerf', 'MD', 'General Surgery', '', '', NULL, 'O', '1250 E 3900 S Ste 220', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012629782', NULL, '1250 E 3900 S Ste 220', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012629782', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2010-12-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275563397', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('204240941', 'S77012147', 'S77012147', 'UT01', 'CCU Diagnostics LC', 'Imran', '', 'Zubair', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '24 S 1100 E Ste 304', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8017464440', '8017464455', '24 S 1100 E Ste 304', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8017464440', '8017464455', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1992798243', 0, 'y', 0, '2012-03-20', NULL, NULL, 40.7689, -111.86, NULL, NULL),
('204240941', 'S77012148', 'S77012148', 'UT01', 'CCU Diagnostics', 'Thomas', 'Robert', 'Calame', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '24 S 1100 E Ste 304', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8017464440', '8017464455', '24 S 1100 E', 'Salt Lake City', '', 'UT', '84102', '', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', '2008-07-14', 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1801888748', 0, 'y', 0, '2009-06-08', NULL, NULL, 0, 0, NULL, NULL),
('204296622', 'S77012149', 'S77012149', 'UT01', 'Arches Audiology', 'David', 'R', 'Ward', 'AUD', 'Audiology', '', '', NULL, 'O', '16 S 100 E', 'Moab', 'Grand', 'UT', '84532', '4352592508', '4352592513', '16 S 100 E', 'Moab', 'Grand', 'UT', '84532', '4352592508', '4352592513', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', '2011-05-31', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1336111418', 0, 'N', 0, '2011-03-02', NULL, NULL, 0, 0, NULL, NULL),
('245710270', 'S77012154', 'S77012154', 'UT01', 'Epic Associates For Inpatient Medicine', 'Alina', 'D', 'Borchardt', 'MD', 'Hospitalist', NULL, NULL, NULL, 'B', 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013529500', '8013529502', '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WUSTDINT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832810', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('245710270', 'S77012155', 'S77012155', 'UT01', 'Epic Associates For Inpatient Medicine', 'Alina', 'D', 'Borchardt', 'MD', 'Hospitalist', NULL, NULL, NULL, 'O', '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8012962113', '8012961716', '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WUSTDINT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832810', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('303540236', 'S77012156', 'S77012156', 'UT01', 'Vision Source at Jordan Landing', 'James', 'D', 'Sargent', 'OD', 'Optometry', NULL, NULL, NULL, 'O', '7555 Ctr View Ct Ste 101', 'West Jordan', 'Salt Lake', 'UT', '84084', '8015665683', '8012558371', '7555 S Ctr View Ct', 'West Jordan', '', 'UT', '84084', '', '', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2007-02-09', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1942238670', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('371522099', 'S77012159', 'S77012159', 'UT01', NULL, 'Charles', 'T', 'Ivester', 'MD', 'Pulmonary', 'Internal Medicine', '', NULL, 'O', '4403 Harrison Blvd Ste 3815', 'Ogden', 'Weber', 'UT', '84403', '8013872575', NULL, '4403 Harrison Blvd Ste 3815', 'Ogden', 'Weber', 'UT', '84403', '8013872575', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', '2009-01-01', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1376585372', 0, 'N', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('529645179', 'S77012160', 'S77012160', 'UT01', NULL, 'Jayne', 'Elizabeth', 'Clark', 'MD', 'Physical Medicine and Rehabilitation', NULL, NULL, NULL, 'B', '555 E 4500 S Ste C150', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012880747', 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|', '835058', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('621795211', 'S77012161', 'S77012161', 'UT01', 'Salt Lake Regional Physicians', 'Alex', 'H', 'Tessnow', '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, '2006-09-01', '2007-01-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1740255801', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('621795211', 'S77012163', 'S77012163', 'UT01', 'Salt Lake Regional Physicians', 'Shauna', 'A', 'Leonard', 'PA', 'Cardiovascular Disease', 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, '2006-09-01', '2007-01-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832540', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('621795211', 'S77012164', 'S77012164', 'UT01', 'Multispecialty Partners', 'Shauna', 'A', 'Leonard', 'PA', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '24 S 1100 E Ste 304', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8017464440', '8017464455', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-09-01', '2007-01-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832540', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('680624157', 'S77012165', 'S77012165', 'UT01', NULL, 'Mark', 'D', 'Johnson', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '6321 S Redwood Rd', 'Taylorsville', 'Salt Lake', 'UT', '84123', '8012652212', NULL, '6321 S Redwood Rd', 'Taylorsville', '', 'UT', '84123', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1184668659', 0, 'N', 0, '2006-10-19', NULL, NULL, 40.6365, -111.939, NULL, NULL),
('753059009', 'S77012166', 'S77012166', 'UT01', 'Coral Desert Orthopedics', 'Todd', 'R', 'Parry', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'B', '1490 E Foremaster Dr Ste 150', 'St George', 'Washington', 'UT', '84790', '4356289393', '4356289382', NULL, NULL, '', NULL, NULL, '', '', 'WUSTDORTH5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1114905932', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('841411398', 'S77012168', 'S77012168', 'UT01', 'Foothill Family Clinic', 'Thomas', 'K', 'Conner', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '2295 Foothill Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8014863021', '8014856339', NULL, NULL, '', NULL, NULL, '', '', '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|', '1780619023', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77012169', 'S77012169', 'UT01', 'Central Utah Clinic', 'Douglas', 'R', 'Debenham', 'MD', 'Radiation Oncology', NULL, NULL, NULL, 'B', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013742362', '8013742615', '1055 N 500 W', 'Provo', '', 'UT', '84604', '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1821056425', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77012170', 'S77012170', 'UT01', 'Central Utah Clinic', 'Douglas', 'R', 'Debenham', 'MD', 'Radiation Oncology', NULL, NULL, NULL, 'O', '1055 N 500 W Bldg C Ste 102', 'Provo', 'Utah', 'UT', '84604', '8013742367', '8014290600', '1055 N 500 W', 'Provo', '', 'UT', '84604', '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-07-06', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1821056425', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('870479370', 'S77012177', 'S77012177', 'UT01', 'Mountain West Cardiovascular Assoc', 'Eugen', NULL, 'Ivan', 'MD', 'Cardiovascular Disease', 'Interventional Cadiology', 'Internal Medicine', NULL, 'O', '1160 E 3900 S Ste 2000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012663418', '8012664174', '1160 E 3900 S', 'Salt Lake City', '', 'UT', '84124', '', '', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', '2009-01-15', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1790735389', 0, 'N', 0, '2008-12-17', NULL, NULL, 0, 0, NULL, NULL),
('870479370', 'S77012178', 'S77012178', 'UT01', 'Mountain West Cardiovascular Assoc', 'Eugen', NULL, 'Ivan', 'MD', 'Cardiovascular Disease', 'Interventional Cadiology', 'Internal Medicine', NULL, 'O', '24 S 1100 E Ste 105', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8012663418', NULL, '1160 E 3900 S', 'Salt Lake City', '', 'UT', '84124', '', '', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', '2009-01-15', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1790735389', 0, 'N', 0, '2008-12-17', NULL, NULL, 0, 0, NULL, NULL),
('870492272', 'S77012179', 'S77012179', 'UT01', 'Utah Cardiology', 'Richard', 'S', 'White', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'B', '520 Medical Dr Ste 310', 'Bountiful', 'Davis', 'UT', '84010', '8013973000', '8013970455', '520 E Medical Dr', 'Bountiful', '', 'UT', '84010', '', '', 'WUUTCARD5', 'WUSTDHCPC5', NULL, '0.00', '23.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '833322', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870492272', 'S77012180', 'S77012180', 'UT01', 'Utah Cardiology', 'Richard', 'S', 'White', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '4403 Harrison Blvd Ste 3400', 'Ogden', 'Weber', 'UT', '84403', '8013873400', NULL, '520 E Medical Dr', 'Bountiful', '', 'UT', '84010', '', '', 'WUUTCARD5', 'WUSTDHCPC5', NULL, '0.00', '23.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '833322', 0, 'N', 0, NULL, 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
('870498345', 'S77012181', 'S77012181', 'UT01', '', 'Douglas', 'M', 'Woseth', 'MD', 'Dermatology', NULL, NULL, NULL, 'O', '3920 S 1100 E Ste 310', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012668841', '8012660449', '3920 S 1100 E Ste 310', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012668841', '8012660449', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', '2011-01-02', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1619978970', 0, 'N', 0, '2013-12-04', NULL, NULL, 0, 0, NULL, NULL),
('870550276', 'S77012184', 'S77012184', 'UT01', 'City Creek Pediatrics', 'Meri', 'T', 'Harper', 'MD', 'Pediatrics', '', '', NULL, 'O', '77 S 700 E Ste 220', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015758080', '8015951133', '77 S 700 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015758080', '8015951133', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', '2008-02-29', NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1780796961', 0, 'N', 0, '2011-07-27', NULL, NULL, 0, 0, NULL, NULL),
('870570160', 'S77012185', 'S77012185', 'UT01', 'Wasatch Vision Clinic', 'Denmark', 'R', 'Jensen', 'OD', 'Optometry', '', '', NULL, 'O', '849 E 400 S', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013282020', '8013632201', '849 E 400 S', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013282020', '8013632201', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-01-01', '2011-10-05', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538127170', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('870642933', 'S77012194', 'S77012194', 'UT01', NULL, 'Joseph', 'Dean', 'Jensen', 'MD', 'Dermatology', NULL, NULL, NULL, 'O', '7396 S Union Park Ave Ste 201', 'Midvale', 'Salt Lake', 'UT', '84047', '8015671400', '8015671777', '7396 S Union Park Ave', 'Midvale', '', 'UT', '84047', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1740281500', 0, 'N', 0, '2006-08-31', NULL, NULL, 40.6168, -111.859, NULL, NULL),
('870669383', 'S77012197', 'S77012197', 'UT01', 'Andrus Vision Center', 'Ryan', 'E', 'Robison', 'OD', 'Optometry', NULL, NULL, NULL, 'B', '803 S Bluff St', 'St George', 'Washington', 'UT', '84770', '4356284464', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '951172', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870669383', 'S77012198', 'S77012198', 'UT01', 'Andrus Vision Center', 'Ryan', 'E', 'Robison', 'OD', 'Optometry', NULL, NULL, NULL, 'O', '803 S Bluff St', 'St George', 'Washington', 'UT', '84770', '4356284464', '4356736616', NULL, NULL, '', NULL, NULL, '', '', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '951172', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('912160693', 'S77012199', 'S77012199', 'UT01', 'Nephrology Medical Assoc', 'Nazia', '', 'Junejo', 'MD', 'Internal Medicine', 'Nephrology', '', NULL, 'O', '724 W 500 S Ste 300', 'Bountiful', 'Davis', 'UT', '84010', '8012969091', NULL, '724 W 500 S Ste 300', 'Bountiful', 'Davis', 'UT', '84010', '8012969091', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', '2008-08-31', 0, 0, 0, 'Jordan Valley Medical Center', 'St Marks Hospital', 'Pioneer Valley Hospital', '', 'HCFA|UB|', '1346218047', 0, 'N', 0, '2013-04-26', NULL, NULL, 0, 0, NULL, NULL),
('912160693', 'S77012200', 'S77012200', 'UT01', 'Nephrology Medical Assoc', 'Nazia', '', 'Junejo', 'MD', 'Internal Medicine', 'Nephrology', '', NULL, 'O', '620 Medical Dr Ste 150', 'Bountiful', 'Davis', 'UT', '84010', '8012681296', '8013236420', '620 Medical Dr Ste 150', 'Bountiful', 'Davis', 'UT', '84010', '8012681296', '8013236420', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', '2008-08-31', 0, 0, 0, 'Jordan Valley Medical Center', 'St Marks Hospital', 'Pioneer Valley Hospital', '', 'HCFA|UB|', '1346218047', 0, 'N', 0, '2013-04-26', NULL, NULL, 0, 0, NULL, NULL),
('954893928', 'S77012205', 'S77012205', 'UT01', 'Magna Center For Family Medicine', 'Twana', 'M', 'Rigney', 'PA', 'Family Practice', NULL, NULL, NULL, 'O', '8211 W 3500 S', 'Magna', 'Salt Lake', 'UT', '84044', '8012509638', '8012503204', '8211 W 3500 S', 'Magna', '', 'UT', '84044', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-08-01', '2006-08-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '908286', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('113771953', 'S77012206', 'S77012206', 'UT01', NULL, 'Steven', 'B', 'Sargent', 'OD', 'Optometry', NULL, NULL, NULL, 'B', 'PO Box 238', 'Oakley', 'Summit', 'UT', '84055', '4357834114', '4357834119', 'PO Box 238', 'Oakley', 'Summit', 'UT', '84055', '4357834114', '4357834119', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1508839770', 0, 'Y', 0, '2011-11-21', NULL, NULL, 0, 0, NULL, NULL),
('113771953', 'S77012207', 'S77012207', 'UT01', '', 'Steven', 'B', 'Sargent', 'OD', 'Optometry', NULL, NULL, NULL, 'O', '568 Foothill Dr Ste 5', 'Kamas', 'Summit', 'UT', '84036', '4357834114', '4357834119', 'PO Box 238', 'Oakley', 'Summit', 'UT', '84055', '4357834114', '4357834119', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2006-11-01', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1508839770', 0, 'N', 0, '2011-11-21', NULL, NULL, 0, 0, NULL, NULL),
('204187908', 'S77012208', 'S77012208', 'UT01', 'Belnap & Vander Werf Surgical Associates', 'LeGrand', 'P', 'Belnap', 'MD', 'General Surgery', '', '', NULL, 'O', '1250 E 3900 S Ste 220', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012629782', '8012629782', '1250 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012629782', '8012629782', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2011-07-26', NULL, 0, NULL, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1225060676', 0, 'N', 0, '2011-09-28', NULL, NULL, 0, 0, NULL, NULL),
('204457261', 'S77012209', 'S77012209', 'UT01', NULL, 'Brad', 'S', 'Webb', 'DPM', 'Podiatry', '', '', NULL, 'O', '230 N 1680 E Ste I-2', 'St George', 'Washington', 'UT', '84790', '4352519112', NULL, '230 N 1680 E Ste I-2', 'St George', 'Washington', 'UT', '84790', '4352519112', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2008-08-30', 0, 0, 0, 'Dixie Regional Medical Center', 'Valley View Medical Center', NULL, NULL, 'HCFA|UB|', '1518900562', 0, 'N', 0, '2013-01-09', NULL, NULL, 0, 0, NULL, NULL),
('204673147', 'S77012211', 'S77012211', 'UT01', 'The Foot and Ankle Health Center', 'John', 'T', 'Cloninger', 'DPM', 'Podiatry', NULL, NULL, NULL, 'O', '6028 S Ridgeline Dr Ste 205', 'Ogden', 'Weber', 'UT', '84405', '8014092100', '8014758614', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-01-01', '2006-04-07', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1457304180', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('204872226', 'S77012212', 'S77012212', 'UT01', '', 'Richard', 'T', 'Stevens', 'MD', 'Family Practice', '', '', NULL, 'O', '169 Springcreek Pkwy Ste 100', 'Providence', 'Cache', 'UT', '84332', '4357520330', '4357550922', '169 Springcreek Pkwy Ste 100', 'Providence', 'Cache', 'UT', '84332', '4357520330', '4357550922', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2011-06-30', 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1790739449', 0, 'N', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('205297628', 'S77012213', 'S77012213', 'UT01', 'Parzych Family Practice', 'Stacey', '', 'Bank', 'MD', 'Family Practice', 'Emergency Medicine', '', NULL, 'O', '1151 E 3900 S Ste B299', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8018920135', '8012662362', '1151 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8018920135', '8012662362', 'WUSTDFAM5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', '2008-03-03', NULL, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1790797959', 0, 'N', 0, '2011-09-26', NULL, NULL, 0, 0, NULL, NULL),
('223887117', 'S77012214', 'S77012214', 'UT01', 'Mountain Valley Eye Institute', 'Sandra', 'J', 'Lehman', 'OD', 'Optometry', '', '', NULL, 'B', 'PO Box 27688', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8015341360', '8013669883', 'PO Box 27688', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8015341360', '8013669883', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-11-01', '2011-10-05', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598708182', 0, 'Y', 0, '2014-01-27', NULL, NULL, 0, 0, NULL, NULL),
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('830458867', 'S77012267', 'S77012267', 'UT01', '', 'Leslie', 'W', 'Cooper', 'MD', 'Family Practice', 'Sports Medicine', '', NULL, 'O', '1138 Wilmington Ave', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8015812000', NULL, '1138 Wilmington Ave', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8015812000', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2007-01-01', '2012-08-20', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1023122611', 0, 'N', 0, '2012-08-21', NULL, NULL, 0, 0, NULL, NULL),
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('870218917', 'S77012271', 'S77012271', 'UT01', 'Tanner Memorial Clinic', 'Ryan', 'L', 'Stewart', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8015258151', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8015258151', 'WUTANNER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1649207606', 0, 'Y', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
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('870281028', 'S77012275', 'S77012275', 'UT01', 'Central Utah Clinic', 'Mazen', '', 'Sires', 'MD', 'Internal Medicine', '', '', NULL, 'B', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013742362', '8013742615', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013742362', '8013742615', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-06-01', '2010-07-14', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1154370765', 0, 'Y', 0, '2011-04-13', NULL, NULL, 0, 0, NULL, NULL),
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('870395551', 'S77012315', 'S77012315', 'UT01', NULL, 'Lori', 'L', 'Bosley', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', '8013527270', '8013527024', '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1164638300', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77012316', 'S77012316', 'UT01', 'Chiropractic Health Center', 'Lori', 'L', 'Bosley', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '3500 Harrison Blvd Ste 200', 'Ogden', 'Weber', 'UT', '84403', '8016272225', '8016272228', '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2006-04-01', '2009-05-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1164638300', 0, 'N', 0, '2006-08-31', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77012317', 'S77012317', 'UT01', NULL, 'Ryan', 'B', 'Bosley', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', '8013527270', '8013527024', '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1013020213', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77012318', 'S77012318', 'UT01', 'Chiropractic Health Center', 'Ryan', 'Benson', 'Bosley', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '3500 Harrison Blvd Ste 200', 'Ogden', 'Weber', 'UT', '84403', '8016272225', '8016272228', '867 E 9400 S', 'Sandy', 'Weber', 'UT', '84094', '8016272225', '8016272228', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1013020213', 0, 'N', 0, '2011-02-11', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77012319', 'S77012319', 'UT01', NULL, 'Richard', 'P', 'Amon', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', '8013527270', '8013527024', '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1265407282', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77012320', 'S77012320', 'UT01', 'Amon Chiropractic Center', 'Richard', 'P', 'Amon', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '3996 S 1900 W', 'Roy', 'Weber', 'UT', '84067', '8017312200', '8017312228', '3996 S 1900 W', 'Roy', 'Weber', 'UT', '84067', '8017312200', '8017312228', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265407282', 0, 'N', 0, '2012-10-15', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77012321', 'S77012321', 'UT01', NULL, 'Gailen', 'E', 'Lundell', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', '8013527270', '8013527024', '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1093765364', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77012322', 'S77012322', 'UT01', 'Chiropractic Health Center', 'Gailen', 'E', 'Lundell', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '3500 Harrison Blvd Ste 200', 'Ogden', 'Weber', 'UT', '84403', '8016272225', '8016272228', '3500 Harrison Blvd Ste 200', 'Ogden', 'Weber', 'UT', '84403', '8016272225', '8016272228', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093765364', 0, 'N', 0, '2012-02-15', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77012323', 'S77012323', 'UT01', NULL, 'Brian', 'J', 'Lundell', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', '8013527270', '8013527024', '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1992756365', 0, 'Y', 0, NULL, 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
('870395551', 'S77012324', 'S77012324', 'UT01', 'Chiropractic Health Center', 'Brian', 'J', 'Lundell', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '3500 Harrison Blvd Ste 200', 'Ogden', 'Weber', 'UT', '84403', '8016272225', '8016272228', '867 E 9400 S', 'Sandy', 'Weber', 'UT', '84094', '8016272225', '8016272228', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-06-30', NULL, 0, NULL, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1992756365', 0, 'N', 0, '2006-08-31', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77012325', 'S77012325', 'UT01', NULL, 'J Dean', NULL, 'Fitzgerald', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', '8013527270', '8013527024', '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1427129105', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77012326', 'S77012326', 'UT01', NULL, 'J', 'Dean', 'Fitzgerald', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '375 E Lagoon St', 'Roosevelt', 'Duchesne', 'UT', '84066', '4357221461', '4357221444', '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1427129105', 0, 'N', 0, '2006-08-31', NULL, NULL, 0, 0, NULL, NULL),
('870414618', 'S77012333', 'S77012333', 'UT01', 'Foot And Ankle Institute', 'Leon', 'K', 'Reber', 'DPM', 'Podiatry', '', '', NULL, 'O', '754 S Main St Ste 3', 'St George', 'Washington', 'UT', '84770', '4356282671', NULL, '754 S Main St', 'St George', 'Washington', 'UT', '84770', '4356282671', '', 'WURURAL10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, NULL, 0, 0, 'Dixie Regional Medical Center', 'Valley View Medical Center', NULL, NULL, 'HCFA|UB|', '1336179886', 0, 'N', 0, '2011-12-16', NULL, NULL, 37.0954, -113.583, NULL, NULL),
('870414618', 'S77012334', 'S77012334', 'UT01', 'Foot and Ankle Institute', 'Leon', 'K', 'Reber', 'DPM', 'Podiatry', NULL, NULL, NULL, 'O', '754 S Main St Ste 3', 'St George', 'Washington', 'UT', '84770', '4356282671', NULL, '754 S Main St', 'St George', '', 'UT', '84770', '', '', 'WURURAL10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 0, 'Dixie Regional Medical Center', 'Valley View Medical Center', NULL, NULL, 'HCFA|UB|', '1336179886', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870471677', 'S77012343', 'S77012343', 'UT01', 'Lone Peak Family Medicine', 'Edward', 'R', 'Schultz', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '9829 S 1300 E Ste 101', 'Sandy', 'Salt Lake', 'UT', '84094', '8015768855', '8015769800', '9829 S 1300 E', 'Sandy', '', 'UT', '84094', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2007-04-03', 0, NULL, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1942287719', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870486209', 'S77012364', 'S77012364', 'UT01', 'Berner Eye Clinic', 'Karri', 'A', 'Buresh', 'OD', 'Optometry', '', '', NULL, 'B', '250 E 300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8013220467', '8013636053', '250 E 300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8013220467', '8013636053', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124009824', 0, 'Y', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('870486209', 'S77012365', 'S77012365', 'UT01', 'Berner Eye Clinic', 'Karri', 'A', 'Buresh', 'OD', 'Optometry', '', '', NULL, 'O', '250 E Broadway', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8013220467', '8013636053', '250 E Broadway', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8013220467', '8013636053', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124009824', 0, 'N', 0, '2014-05-08', NULL, NULL, 40.7628, -111.884, NULL, NULL),
('870503375', 'S77012368', 'S77012368', 'UT01', 'Snow Canyon Eye Center', 'Kyle', 'D', 'Andrus', 'OD', 'Optometry', NULL, NULL, NULL, 'O', '1930 W Sunset Blvd Ste 106', 'St George', 'Washington', 'UT', '84770', '4356281112', '4356285653', '1930 W Sunset Blvd Ste 106', 'St George', 'Washington', 'UT', '84770', '4356281112', '4356285653', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316982028', 0, 'N', 0, '2013-11-04', NULL, NULL, 37.1228, -113.624, NULL, NULL),
('870543318', 'S77012377', 'S77012377', 'UT01', 'Mountain West Gastroenterology', 'Robert', 'G', 'Jones', 'MD', 'Gastroenterology', NULL, NULL, NULL, 'B', '6360 S 3000 E Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019443188', '8019443180', '6360 S 3000 E', 'Salt Lake City', '', 'UT', '84120', '', '', 'WCSTMTWEST5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1164465647', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870543318', 'S77012379', 'S77012379', 'UT01', 'Mountain West Gastroenterology', 'Robert', 'G', 'Jones', 'MD', 'Gastroenterology', '', '', NULL, 'O', '620 Medical Dr Ste 205', 'Bountiful', 'Davis', 'UT', '84010', '8012980057', '8019443186', '620 Medical Dr Ste 205', 'Bountiful', 'Davis', 'UT', '84010', '8012980057', '8019443186', 'WCSTMTWEST5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2013-12-31', 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB|', '1164465647', 0, 'N', 0, '2013-12-18', NULL, NULL, 0, 0, NULL, NULL),
('870543318', 'S77012380', 'S77012380', 'UT01', 'Mountain West Gastroenterology', 'Robert', 'G', 'Jones', 'MD', 'Gastroenterology', '', '', NULL, 'O', '6360 S 3000 E Ste 310', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019443144', '8019443186', '6360 S 3000 E Ste 310', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019443144', '8019443186', 'WCSTMTWEST5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2013-12-31', 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB|', '1164465647', 0, 'N', 0, '2013-12-18', NULL, NULL, 0, 0, NULL, NULL),
('870550021', 'S77012381', 'S77012381', 'UT01', 'Utah Physicians Care Center', 'David', '', 'Kuo', 'MD', 'Internal Medicine', '', '', NULL, 'B', '5630 Waterbury Way Ste B102', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012742000', NULL, '5630 Waterbury Way Ste B102', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012742000', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1508881640', 0, 'Y', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('870550021', 'S77012382', 'S77012382', 'UT01', 'Utah Physicians Care Center', 'David', '', 'Kuo', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1160 E 3900 S Ste 1200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012619651', '8012619656', '1160 E 3900 S Ste 1200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012619651', '8012619656', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1508881640', 0, 'N', 0, '2014-02-20', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('870566422', 'S77012386', 'S77012386', 'UT01', NULL, 'Christine', 'S', 'Osborne', 'AUD', 'Audiology', NULL, NULL, NULL, 'B', 'PO Box 971', 'Kaysville', 'Davis', 'UT', '84037', '8015478719', NULL, '8017 Royal Ln', 'Sandy', '', 'UT', '84093', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2007-07-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1093880312', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870635410', 'S77012403', 'S77012403', 'UT01', 'Timpanogos Vision Center', 'Kevin', 'J', 'Fromm', 'OD', 'Optometry', NULL, NULL, NULL, 'O', '238 E State Rd Ste 4', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017961054', '8017961084', '238 E State Rd Ste 4', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017961054', '8017961084', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659347144', 0, 'N', 0, '2013-11-18', NULL, NULL, 40.3566, -111.737, NULL, NULL),
('870635410', 'S77012404', 'S77012404', 'UT01', 'Timpanogos Vision Center', 'Bruce', 'T', 'Potts', 'OD', 'Optometry', NULL, NULL, NULL, 'O', '238 E State Rd Ste 4', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017961054', '8017961084', '238 E State Rd Ste 4', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017961054', '8017961084', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598794281', 0, 'N', 0, '2013-11-21', NULL, NULL, 40.3566, -111.737, NULL, NULL),
('870639098', 'S77012405', 'S77012405', 'UT01', 'After Hours Medical Family Medicine', 'L', 'B', 'Grandy', 'MD', 'Urgent Care', '', '', NULL, 'B', 'PO Box 1000', 'Draper', 'Salt Lake', 'UT', '84020', '8013529500', '8013529502', 'PO Box 1000', 'Draper', 'Salt Lake', 'UT', '84020', '8013529500', '8013529502', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', '2008-11-01', 0, 0, 0, 'Pioneer Valley Hospital', '', '', '', 'HCFA|UB|', '1306829056', 0, 'Y', 0, '2014-06-02', NULL, NULL, 0, 0, NULL, NULL),
('870639098', 'S77012406', 'S77012406', 'UT01', 'After Hours Urgent Care WVC', 'L', 'B', 'Grandy', 'MD', 'Urgent Care', '', '', NULL, 'O', '3451 S 5600 W Ste F', 'West Valley', 'Salt Lake', 'UT', '84121', '8019570900', NULL, '3451 S 5600 W Ste F', 'West Valley', 'Salt Lake', 'UT', '84121', '8019570900', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', '', '', '', 'HCFA|UB|', '1306829056', 0, 'Y', 0, '2014-06-02', NULL, NULL, 40.6977, -112.025, NULL, NULL),
('870653551', 'S77012417', 'S77012417', 'UT01', 'Park City Healthcare', 'William', 'Bryant', 'Pidwell', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '4356497640', '4356491365', 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '4356497640', '4356491365', 'WURURAL10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-04-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1548208028', 0, 'Y', 0, '2012-09-10', NULL, NULL, 0, 0, NULL, NULL),
('870653551', 'S77012418', 'S77012418', 'UT01', 'Park City Healthcare', 'William', 'Bryant', 'Pidwell', 'MD', 'Family Practice', '', '', NULL, 'O', '1655 Bonanza Dr', 'Park City', 'Summit', 'UT', '84060', '4356497640', '4356491365', '1655 Bonanza Dr', 'Park City', 'Summit', 'UT', '84060', '4356497640', '4356491365', 'WURURAL10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-04-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1548208028', 0, 'N', 0, '2012-09-10', NULL, NULL, 0, 0, NULL, NULL),
('870682101', 'S77012419', 'S77012419', 'UT01', 'Salt Lake Orthopaedic Clinic', 'Laura', 'J', 'Aberton', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1160 E 3900 S Ste 5000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012628486', NULL, '1160 E 3900 S Ste 5000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012628486', '', 'WUSLORTH5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144208562', 0, 'N', 0, '2014-01-09', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('870682547', 'S77012420', 'S77012420', 'UT01', NULL, 'Roy', 'R', 'Gibson', 'OD', 'Optometry', NULL, NULL, NULL, 'B', '5690 S 3750 W', 'Roy', 'Weber', 'UT', '84067', '8019854141', NULL, '5690 S 3750 W', 'Roy', 'Weber', 'UT', '84067', '8019854141', '', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104816743', 0, 'y', 0, '2013-10-24', NULL, NULL, 0, 0, NULL, NULL),
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('810608733', 'S77012494', 'S77012494', 'UT01', 'Nexus Pain Care', 'William', 'C', 'Scott', 'DO', 'Physical Medicine and Rehabilitation', NULL, NULL, NULL, 'B', 'PO Box 27688', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8015341360', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUSTDPAIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1487674784', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('810608733', 'S77012495', 'S77012495', 'UT01', 'Nexus Pain Care', 'William', 'C', 'Scott', 'DO', 'Physical Medicine and Rehabilitation', NULL, NULL, NULL, 'O', '3585 N University Ave Ste 150', 'Provo', 'Utah', 'UT', '84604', '8013566100', NULL, '3585 N University Ave', 'Provo', '', 'UT', '84604', '', '', 'WUSTDPAIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2008-08-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1487674784', 0, 'N', 0, '2006-10-19', NULL, NULL, 0, 0, NULL, NULL),
('810608733', 'S77012496', 'S77012496', 'UT01', 'Nexus Pain Care', 'William', 'C', 'Scott', 'DO', 'Physical Medicine and Rehabilitation', NULL, NULL, NULL, 'O', '2332 W 12600 S Ste 2B', 'Riverton', 'Salt Lake', 'UT', '84065', '8013020856', '8014467373', '3585 N University Ave', 'Provo', '', 'UT', '84604', '', '', 'WUSTDPAIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1487674784', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('841401924', 'S77012497', 'S77012497', 'UT01', 'Alpine Medical Group', 'Heidi', 'E', 'Standteiner', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'B', '1060 E 100 S Ste 400', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015212640', NULL, '1060 E 100 S', 'Salt Lake City', '', 'UT', '84102', '', '', 'USTDINT', 'USTDHCPC', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1982633830', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('841401924', 'S77012498', 'S77012498', 'UT01', 'Alpine Internal Medicine', 'Heidi', 'E', 'Standteiner', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '1060 E 100 S Ste L10', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013281260', NULL, '1060 E 100 S', 'Salt Lake City', '', 'UT', '84102', '', '', 'USTDINT', 'USTDHCPC', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1982633830', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'S77012501', 'S77012501', 'UT01', 'Tanner Memorial Clinic', 'Duane', 'E', 'Farley', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'B', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8015258151', NULL, NULL, '', NULL, NULL, '', '', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-07-01', '2006-07-01', 0, NULL, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1538145586', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'S77012502', 'S77012502', 'UT01', 'Tanner Memorial Clinic', 'Duane', 'E', 'Farley', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '380 N 400 W', 'Kaysville', 'Davis', 'UT', '84037', '8017734840', NULL, 'PO Box 337', 'Layton', '', 'UT', '84041', '', '', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-07-01', '2007-03-01', 0, NULL, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1538145586', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'S77012503', 'S77012503', 'UT01', 'Tanner Memorial Clinic', 'Nathan', '', 'Forbush', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8015258151', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8015258151', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1962439851', 0, 'Y', 0, '2014-02-07', NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'S77012504', 'S77012504', 'UT01', 'Tanner Memorial Clinic', 'Nathan', '', 'Forbush', 'MD', 'Pediatrics', '', '', NULL, 'O', '2121 Robins Dr', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8015258151', '2121 Robins Dr', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8015258151', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1962439851', 0, 'N', 0, '2014-02-12', NULL, NULL, 41.0893, -111.997, NULL, NULL),
('870218917', 'S77012505', 'S77012505', 'UT01', 'Tanner Memorial Clinic', 'Chadd', 'D', 'Nelson', 'DO', 'Internal Medicine', NULL, NULL, NULL, 'B', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8015258151', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8015258151', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, NULL, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1619904679', 0, 'Y', 0, '2011-10-03', NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'S77012506', 'S77012506', 'UT01', 'Tanner Memorial Clinic', 'Chadd', 'D', 'Nelson', 'DO', 'Internal Medicine', NULL, NULL, NULL, 'O', '2121 Robins Dr', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8015258151', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8015258151', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, NULL, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1619904679', 0, 'N', 0, '2011-10-03', NULL, NULL, 41.0893, -111.997, NULL, NULL),
('870281028', 'S77012507', 'S77012507', 'UT01', 'Central Utah Clinic', 'Terry', 'A', 'Hammond', 'MD', 'Nephrology', NULL, NULL, NULL, 'B', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013742362', '8013742615', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1124064845', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77012508', 'S77012508', 'UT01', 'Central Utah Clinic', 'Terry', 'C', 'Hammond', 'MD', 'Nephrology', '', '', NULL, 'O', '852 N 500 W Ste B', 'Provo', 'Utah', 'UT', '84604', '8013774623', '8018155500', '852 N 500 W Ste B', 'Provo', 'Utah', 'UT', '84604', '8013774623', '8018155500', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-06-01', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1124064845', 0, 'N', 0, '2013-12-02', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77012509', 'S77012509', 'UT01', 'Central Utah Clinic', 'Ronald', 'W', 'Asay', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'B', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013742362', '8013742615', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1578521308', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77012510', 'S77012510', 'UT01', 'Wasatch Otolaryngology Group', 'Ronald', 'W', 'Asay', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '700 W 800 N Ste 230', 'Orem', 'Utah', 'UT', '84057', '8014290620', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1578521308', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77012511', 'S77012511', 'UT01', 'Central Utah Clinic', 'Alan', 'L', 'Colledge', 'MD', 'Physical Medicine and Rehabilitation', NULL, NULL, NULL, 'O', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013742362', '8014298191', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1629169370', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77012512', 'S77012512', 'UT01', 'Central Utah Clinic', 'M', 'Eric', 'Carter', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'B', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013742362', '8013742615', '1055 N 500 W', 'Provo', '', 'UT', '84604', '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '913281', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77012513', 'S77012513', 'UT01', 'Central Utah Clinic', 'M Eric', NULL, 'Carter', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'B', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013742362', '8013742615', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '913281', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77012514', 'S77012514', 'UT01', 'Central Utah Clinic', 'Melvin', 'E', 'Carter', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '1175 E 50 S Ste 251', 'American Fork', 'Utah', 'UT', '84003', '8014922815', '8018155500', '1175 E 50 S Ste 251', 'American Fork', 'Utah', 'UT', '84003', '8014922815', '8018155500', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-06-01', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', 'Mountain View Regional Hospital', '', '', 'HCFA|UB|', '1700815834', 0, 'N', 0, '2013-03-30', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77012515', 'S77012515', 'UT01', 'Central Utah Clinic', 'Melvin', 'E', 'Carter', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'B', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013734366', '8013758858', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013734366', '8013758858', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-06-01', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', 'Mountain View Regional Hospital', '', '', 'HCFA|UB|', '1700815834', 0, 'N', 0, '2013-03-30', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77012516', 'S77012516', 'UT01', 'Central Utah Clinic', 'Bruce', 'C', 'McAllister', 'MD', 'Radiation Oncology', NULL, NULL, NULL, 'B', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013742362', '8013742615', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1144223835', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77012517', 'S77012517', 'UT01', 'Central Utah Clinic', 'Bruce', 'C', 'McAllister', 'MD', 'Radiation Oncology', NULL, NULL, NULL, 'O', ' ', 'Provo', 'Utah', 'UT', '84604', '8013742367', '8014290600', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1144223835', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77012518', 'S77012518', 'UT01', 'Central Utah Clinic', 'Nancy', '', 'Ahlstrom', 'MD', 'Nephrology', '', '', NULL, 'o', '852 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8018124624', '8013742615', '852 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8018124624', '8013742615', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-06-01', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1962431122', 0, 'N', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77012519', 'S77012519', 'UT01', 'Central Utah Clinic', 'Tala at', '', 'Al Shuquirat', 'MD', 'Pulmonary', 'Emergency Medicine', '', NULL, 'O', '1120 E 100 N Ste 1', 'Payson', 'Utah', 'UT', '84651', '8014654813', NULL, '1120 E 100 N Ste 1', 'Payson', 'Utah', 'UT', '84651', '8014654813', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-06-01', '2010-07-14', 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1104875574', 0, 'N', 0, '2013-08-19', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77012520', 'S77012520', 'UT01', 'Central Utah Clinic', 'Karl', 'N', 'Weenig', 'MD', 'Family Practice', 'Sports Medicine', '', NULL, 'o', '50 S Medical Dr Ste 6', 'Payson', 'Utah', 'UT', '84651', '8014652527', '8013742615', '50 S Medical Dr Ste 6', 'Payson', 'Utah', 'UT', '84651', '8014652527', '8013742615', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-06-01', '2010-07-14', 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1740242973', 0, 'N', 0, '2013-08-28', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77012521', 'S77012521', 'UT01', 'Central Utah Clinic', 'Karl', 'N', 'Weenig', 'MD', 'Family Practice', 'Sports Medicine', '', NULL, 'O', '1055 N 500 W Ste 121', 'Provo', 'Utah', 'UT', '84604', '8013577350', NULL, '1055 N 500 W Ste 121', 'Provo', 'Utah', 'UT', '84604', '8013577350', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-06-01', '2010-07-14', 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1740242973', 0, 'N', 0, '2013-08-28', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77012522', 'S77012522', 'UT01', 'Central Utah Clinic', 'Scott', 'D', 'Valadez', 'MD', 'Radiology', '', '', NULL, 'O', '1055 N 500 W Ste 112', 'Provo', 'Utah', 'UT', '84604', '8018124624', '8014298191', '1055 N 500 W Ste 112', 'Provo', 'Utah', 'UT', '84604', '8018124624', '8014298191', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-06-01', '2010-07-14', 0, 0, 0, 'Mountain View Hospital', 'Timpanogos Regional Hospital', NULL, NULL, 'HCFA|UB|', '1114900206', 0, 'Y', 0, '2013-09-11', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'S77012523', 'S77012523', 'UT01', 'Granger Medical Clinic', 'David', 'M', 'Witter', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'B', 'PO Box 70658', 'West Valley', 'Salt Lake', 'UT', '84170', '8019653720', '8019653740', 'PO Box 70658', 'West Valley', 'Salt Lake', 'UT', '84170', '8019653720', '8019653740', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-08-01', '2011-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518992510', 0, 'Y', 0, '2012-03-29', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'S77012524', 'S77012524', 'UT01', 'Granger Medical Clinic', 'David', 'M', 'Witter', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653419', '8019683605', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653419', '8019683605', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-08-01', '2011-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518992510', 0, 'N', 0, '2012-03-29', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'S77012525', 'S77012525', 'UT01', 'Ogden Clinic', 'Richard', 'C', 'Hammond', 'DO', 'Neurology', 'Sleep Medicine', '', NULL, 'O', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794621', '8014762670', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794621', '8014762670', 'WUOGDCLIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2006-08-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1174541742', 0, 'N', 0, '2013-01-30', NULL, NULL, 41.1787, -111.949, NULL, NULL),
('870342259', 'S77012526', 'S77012526', 'UT01', 'Wayne Community Health Centers', 'Bret', 'D', 'Hilton', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 303', 'Bicknell', 'Wayne', 'UT', '84715', '4354253744', '4354253785', 'PO Box 303', 'Bicknell', 'Wayne', 'UT', '84715', '4354253744', '4354253785', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2006-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467451609', 0, 'Y', 0, '2014-07-23', NULL, NULL, 0, 0, NULL, NULL),
('870342259', 'S77012527', 'S77012527', 'UT01', 'Wayne Community Health Centers', 'Bret', 'D', 'Hilton', 'PA', 'Family Practice', '', '', NULL, 'O', '128 S 300 W', 'Bicknell', 'Wayne', 'UT', '84715', '4354253744', '4354253785', '128 S 300 W', 'Bicknell', 'Wayne', 'UT', '84715', '4354253744', '4354253785', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2006-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467451609', 0, 'N', 0, '2014-07-23', NULL, NULL, 38.2989, -111.421, NULL, NULL),
('870358327', 'S77012528', 'S77012528', 'UT01', 'Olympus Clinic', 'Maisa', 'N', 'Morris', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', '4624 Holladay Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012772682', '8012772980', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-03-01', 0, NULL, 0, 'Health South Rehabilitation Hospital of Utah (inpatient services only)', NULL, NULL, NULL, 'HCFA|UB|', '1497794655', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870358327', 'S77012529', 'S77012529', 'UT01', 'Olympus Clinic', 'Maisa', 'N', 'Morris', 'MD', 'Family Practice', '', '', NULL, 'O', '4624 Holladay Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012772682', '8012772980', '4624 Holladay Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012772682', '8012772980', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'Health South Rehabilitation Hospital of Utah (inpatient services only)', '', '', '', 'HCFA|UB|', '1497794655', 0, 'N', 0, '2014-04-08', NULL, NULL, 40.6703, -111.826, NULL, NULL),
('870382132', 'S77012530', 'S77012530', 'UT01', 'Katzman, Howard A', 'Howard', 'A', 'Katzman', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'B', '1485 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8019719066', 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|', '1760492912', 0, 'Y', 0, NULL, 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
('870395551', 'S77012531', 'S77012531', 'UT01', NULL, 'Jeffrey', 'T', 'Owens', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', '8013527270', '8013527024', '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1033277025', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77012532', 'S77012532', 'UT01', 'Owens Chiropractic', 'Jeffrey', 'T', 'Owens', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '9035 S 1300 E Ste 1', 'Sandy', 'Salt Lake', 'UT', '84094', '8015698787', NULL, '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2006-04-01', '2008-05-01', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1033277025', 0, 'N', 0, '2006-11-07', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77012533', 'S77012533', 'UT01', NULL, 'Sean', 'T', 'Smith', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', '8013527270', '8013527024', '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1821048208', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77012534', 'S77012534', 'UT01', NULL, 'Sean', 'T', 'Smith', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '1220 N Main St Ste 12', 'Springville', 'Utah', 'UT', '84663', '8014899230', NULL, '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2006-04-01', '2009-05-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1821048208', 0, 'N', 0, '2006-10-19', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77012535', 'S77012535', 'UT01', NULL, 'David', 'M', 'Hammond', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', '8013527270', '8013527024', '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1457372005', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77012536', 'S77012536', 'UT01', '', 'David', 'M', 'Hammond', 'DC', 'Chiropractic', '', '', NULL, 'O', '1745 W 7800 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015651155', '8015651157', '867 E 9400 S', 'Sandy', 'Salt Lake', 'UT', '84094', '8015651155', '8015651157', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1457372005', 0, 'N', 0, '2011-02-11', NULL, NULL, 0, 0, NULL, NULL),
('870406457', 'S77012537', 'S77012537', 'UT01', 'Tooele Foot Clinic', 'Kim', 'A', 'Halladay', 'DPM', 'Podiatry', NULL, NULL, NULL, 'B', '300 S Main St Ste 2', 'Tooele', 'Tooele', 'UT', '84074', '4358820711', '4358821778', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, 'Mountain West Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1902809528', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870437878', 'S77012540', 'S77012540', 'UT01', 'Beaver Medical Clinic', 'Kenneth', 'L', 'Hussey', 'PA', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 1690', 'Beaver', 'Beaver', 'UT', '84713', '4354387280', '4354387210', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, 'Beaver Valley Hospital', 'Beaver Valley Hospital Pro Fee', NULL, NULL, 'HCFA|UB|', '1841295938', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870437878', 'S77012541', 'S77012541', 'UT01', 'Beaver Medical Clinic', 'Kenneth', 'L', 'Hussey', 'PA', 'Family Practice', NULL, NULL, NULL, 'O', '451 N Main', 'Milford', 'Beaver', 'UT', '84751', '4353872471', '4354382475', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, 'Beaver Valley Hospital', 'Beaver Valley Hospital Pro Fee', NULL, NULL, 'HCFA|UB|', '1841295938', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870479370', 'S77012557', 'S77012557', 'UT01', 'Mountain West Cardiovascular Assoc', 'Charles', 'S', 'King', 'PA', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '1160 E 3900 S Ste 2000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012663418', '8012664174', '1160 E 3900 S', 'Salt Lake City', '', 'UT', '84124', '', '', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', '2009-01-15', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000990593', 0, 'N', 0, '2006-10-19', NULL, NULL, 0, 0, NULL, NULL),
('870479370', 'S77012558', 'S77012558', 'UT01', 'The Heart Center', 'Charles', 'S', 'King', 'PA', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019681818', NULL, '1160 E 3900 S', 'Salt Lake City', '', 'UT', '84124', '', '', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '990593', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870484924', 'S77012569', 'S77012569', 'UT01', 'Oculoplastic Surgery', 'M', 'Reza', 'Vagefi', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'B', '1002 E S Temple Ste 308', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013633355', '8015339613', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '989661', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870484924', 'S77012570', 'S77012570', 'UT01', 'Oculoplastic Surgery', 'M', 'Ross', 'Vagefi', 'MD', 'Oculoplastic Surgery', NULL, NULL, NULL, 'O', '1002 E S Temple Ste 308', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013633355', NULL, '1002 E South Temple', 'Salt Lake City', '', 'UT', '84102', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', '2010-02-22', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1760432801', 0, 'N', 0, '2006-10-19', NULL, NULL, 0, 0, NULL, NULL),
('870489979', 'S77012571', 'S77012571', 'UT01', 'Millcreek Womens Center', 'Linda', 'P', 'Alexander', 'CNM', 'Nurse Midwife', NULL, NULL, NULL, 'O', '1140 E 3900 S Ste 410', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012628666', '8012638821', '1140 E 3900 S', 'Salt Lake City', '', 'UT', '84124', '', '', 'Wise+', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '831210', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870503202', 'S77012573', 'S77012573', 'UT01', 'Mountain West Ear Nose and Throat', 'Scott', 'K', 'Thompson', 'MD', 'Ear, Nose and Throat', 'Plastic Surgery', NULL, NULL, 'O', '1660 W Antelope Dr Ste 315', 'Layton', 'Davis', 'UT', '84041', '8017762220', '8017762534', '1660 W Antelope Dr Ste 315', 'Layton', 'Davis', 'UT', '84041', '8017762220', '8017762534', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2010-01-19', 0, 0, 0, 'Davis Hospital', 'Primary Childrens Medical Center', 'Lakeview Hospital', NULL, 'HCFA|UB|', '1356378095', 0, 'N', 0, '2013-08-19', NULL, NULL, 0, 0, NULL, NULL),
('870503202', 'S77012574', 'S77012574', 'UT01', 'Mountain West Ear Nose and Throat', 'Scott', 'K', 'Thompson', 'MD', 'Ear, Nose and Throat', 'Plastic Surgery', NULL, NULL, 'O', '1551 Renaissance Towne Dr Ste 310', 'Bountiful', 'Davis', 'UT', '84010', '8012955581', NULL, '1551 Renaissance Towne Dr Ste 310', 'Bountiful', 'Davis', 'UT', '84010', '8012955581', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Davis Hospital', 'Primary Childrens Medical Center', 'Lakeview Hospital', NULL, 'HCFA|UB|', '1356378095', 0, 'N', 0, '2013-08-19', NULL, NULL, 40.8737, -111.888, NULL, NULL),
('870516264', 'S77012575', 'S77012575', 'UT01', 'Utah County Surgical Associates', 'Jennifer', 'J', 'Tittensor', 'MD', 'General Surgery', NULL, NULL, NULL, 'O', '3550 N University Ave Ste 250', 'Provo', 'Utah', 'UT', '84604', '8013749625', NULL, '3550 N University Ave Ste 250', 'Provo', 'Utah', 'UT', '84604', '8013749625', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-06-01', '2010-12-31', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1568497634', 0, 'N', 0, '2013-05-06', NULL, NULL, 0, 0, NULL, NULL),
('870516264', 'S77012576', 'S77012576', 'UT01', 'Utah County Surgical Associates', 'Jory', 'Q', 'Sorensen', 'FNP', 'General Surgery', NULL, NULL, NULL, 'O', '3550 N University Ave Ste 250', 'Provo', 'Utah', 'UT', '84604', '8013749625', NULL, '3550 N University Ave Ste 250', 'Provo', 'Utah', 'UT', '84604', '8013749625', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-06-01', '2010-12-31', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1376689877', 0, 'N', 0, '2013-05-06', NULL, NULL, 0, 0, NULL, NULL),
('870519691', 'S77012579', 'S77012579', 'UT01', 'Utah Cancer Specialists', 'Nathan', 'T', 'Rich', 'MD', 'Hematology and Oncology', NULL, NULL, NULL, 'B', '1121 E 3900 S Bldg C Ste 240', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012660878', '8012662074', '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|', '1396778148', 0, 'Y', 0, '2006-10-27', NULL, NULL, 0, 0, NULL, NULL),
('870519691', 'S77012581', 'S77012581', 'UT01', 'Utah Cancer Specialists', 'Nathan', 'T', 'Rich', 'MD', 'Hematology and Oncology', NULL, NULL, NULL, 'O', '3838 S 700 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012690231', '8012690304', '1121 S 3900 E', 'Salt Lake City', '', 'UT', '84124', '', '', 'WUSTDONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1396778148', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870519691', 'S77012582', 'S77012582', 'UT01', 'Utah Cancer Specialists', 'Nathan', 'T', 'Rich', 'MD', 'Hematology and Oncology', NULL, NULL, NULL, 'O', '1034 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013578200', 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|', '1396778148', 0, 'N', 0, '2006-10-27', NULL, NULL, 40.2469, -111.667, NULL, NULL),
('870525882', 'S77012583', 'S77012583', 'UT01', 'Mountain View Anesthesia', 'Robert', 'G', 'Krum', 'CRNA', 'Nurse Anesthetist', NULL, NULL, NULL, 'O', '1954 E Fort Union Blvd Ste 105', 'Salt Lake City', 'Salt Lake', 'UT', '84121', NULL, NULL, '1954 E Fort Union Blvd', 'Salt Lake City', '', 'UT', '84121', '', '', '', NULL, NULL, '0.00', '23.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1215966080', 0, 'Y', 0, '2006-12-21', NULL, NULL, 40.6243, -111.836, NULL, NULL),
('870525882', 'S77012584', 'S77012584', 'UT01', 'Mountain View Anesthesia', 'Robert', 'G', 'Krum', 'CRNA', 'Nurse Anesthetist', NULL, NULL, NULL, 'O', '1000 E 100 N', 'Payson', 'Utah', 'UT', '84651', '8007484868', NULL, '1954 E Fort Union Blvd', 'Salt Lake City', '', 'UT', '84121', '', '', NULL, NULL, NULL, '0.00', '23.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1215966080', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870543318', 'S77012587', 'S77012587', 'UT01', 'Mountain West Gastroenterology', 'Peter', 'C', 'Fenton', 'MD', 'Gastroenterology', '', '', NULL, 'O', '6360 S 3000 E Ste 310', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019443144', '8019443186', '6360 S 3000 E Ste 310', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019443144', '8019443186', 'WCSTMTWEST5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2013-12-31', 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB|', '1952311797', 0, 'N', 0, '2013-12-18', NULL, NULL, 0, 0, NULL, NULL),
('870543318', 'S77012588', 'S77012588', 'UT01', 'Mountain West Gastroenterology', 'Peter', 'C', 'Fenton', 'MD', 'Gastroenterology', NULL, NULL, NULL, 'O', '6360 S 3000 E Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019443144', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WCSTMTWEST5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1952311797', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870546501', 'S77012590', 'S77012590', 'UT01', 'Alpine Pediatrics', 'Weston', 'E', 'Spencer', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '1912 W 930 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8014921999', '8014921991', '1912 W 930 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8014921999', '8014921991', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1649295809', 0, 'N', 0, '2013-08-20', NULL, NULL, 0, 0, NULL, NULL),
('870546501', 'S77012591', 'S77012591', 'UT01', 'Alpine Pediatrics', 'Weston', 'E', 'Spencer', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '1307 Commerce St Ste 120', 'Saratoga Springs', 'Utah', 'UT', '84043', '8019229222', NULL, '1912 W 930 N', 'Pleasant Grove', '', 'UT', '84062', '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1649295809', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870617263', 'S77012598', 'S77012598', 'UT01', 'St Marks Family Medicine', 'Sean', 'A', 'Ponce', 'MD', 'Family Practice', '', '', NULL, 'O', '1250 E 3900 S Ste 260', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012652000', '8012652008', '1250 E 3900 S Ste 260', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012652000', '8012652008', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2006-06-01', '2008-06-01', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1376577049', 0, 'N', 0, '2013-11-25', NULL, NULL, 0, 0, NULL, NULL),
('870617263', 'S77012599', 'S77012599', 'UT01', 'St Marks Family Medicine', 'Susan', 'B', 'Greger', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '1250 E 3900 S Ste 260', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012652000', '8012652008', '1250 E 3900 S', 'Salt Lake City', '', 'UT', '84124', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2006-06-01', '2008-11-19', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1760447389', 0, 'N', 0, '2006-10-19', NULL, NULL, 0, 0, NULL, NULL),
('870643070', 'S77012608', 'S77012608', 'UT01', 'Circle of Life Womens Center', 'David', 'R', 'Bierer', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'B', 'PO Box 6971', 'Licoln', 'Lancaster', 'NE', '68506', '4024867000', NULL, '1525 E 6000 S', 'South Ogden', 'Lancaster', 'UT', '84405', '4024867000', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2009-04-01', NULL, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1447273024', 0, 'Y', 0, '2011-04-25', NULL, NULL, 0, 0, NULL, NULL),
('870643070', 'S77012609', 'S77012609', 'UT01', 'Circle of Life Womens Center', 'Jed', 'P', 'Naisbitt', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 6971', 'Licoln', 'Lancaster', 'NE', '68506', '4024867000', NULL, 'PO Box 6971', 'Licoln', 'Lancaster', 'NE', '68506', '4024867000', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2009-04-01', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1487677613', 0, 'Y', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('870643070', 'S77012610', 'S77012610', 'UT01', 'Circle of Life Womens Center', 'Byron', 'H', 'Naisbitt', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'B', 'PO Box 6971', 'Licoln', 'Lancaster', 'NE', '68506', '4024867000', NULL, 'PO Box 6971', 'Licoln', 'Lancaster', 'NE', '68506', '4024867000', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2009-04-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336163443', 0, 'Y', 0, '2012-04-25', NULL, NULL, 0, 0, NULL, NULL),
('870643070', 'S77012611', 'S77012611', 'UT01', 'Circle of Life Womens Center', 'Kathleen', 'C', 'Mark', 'CNM', 'Obstetrics and Gynecology', 'Certified Nurse Midwife', '', NULL, 'B', 'PO Box 6971', 'Licoln', 'Lancaster', 'NE', '68506', '4024867000', NULL, 'PO Box 6971', 'Licoln', 'Lancaster', 'NE', '68506', '4024867000', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2009-04-01', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1851314389', 0, 'Y', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
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('742857926', 'TX0000013', 'TX0000013', 'TX01', 'NorthEast Baptist Surgery Center', '', '', 'NorthEast Baptist Surgery Center', '', 'Ambulatory Surgery Center', '', '', NULL, 'O', '8715 Village Dr Ste 200', 'San Antonio', 'Bexar', 'TX', '78217', '2104771775', NULL, '8715 Village Dr Ste 200', 'San Antonio', 'Bexar', 'TX', '78217', '2104771775', '          ', '', '', 'OP-1', '0.00', '100.00', '0.00', 3, '2007-09-15', '2012-09-19', 1, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007905', 0, 'Y', 0, '2012-10-04', NULL, NULL, 29.5187, -98.4281, NULL, NULL),
('861111197', 'TX0000014', 'TX0000014', 'TX01', 'St Lukes Baptist Surgery Center', NULL, NULL, 'St Lukes Baptist Surgery Center', NULL, 'Ambulatory Surgery Center', NULL, NULL, NULL, 'O', '7902 Ewing Halsell', 'San Antonio', 'Bexar', 'TX', '78229', '2109496000', NULL, '615 Soledad ', 'San Antonio', '', 'TX', '78205', '', '', NULL, NULL, NULL, '0.00', '50.00', NULL, 3, '2007-01-01', '2007-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('743020306', 'TX0000015', 'TX0000015', 'TX01', NULL, 'Margaret', 'M', 'Ontiveros', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '311 Camden Ste 102', 'San Antonio', 'Bexar', 'TX', '78215', '2102819800', NULL, '311 Camden Ste 102', 'San Antonio', 'Bexar', 'TX', '78215', '2102819800', '', 'TXSTD', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2007-01-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1346310968', 0, 'N', 0, '2012-05-15', NULL, NULL, 29.4347, -98.4923, NULL, NULL),
('743020306', 'TX0000016', 'TX0000016', 'TX01', NULL, 'Margaret', 'M', 'Ontiveros', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 690264', 'San Antonio', 'Bexar', 'TX', '78269', '2102819800', NULL, 'PO Box 690264', 'San Antonio', 'Bexar', 'TX', '78269', '2102819800', '', 'TXSTD', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2007-01-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1346310968', 0, 'y', 0, '2012-05-15', NULL, NULL, 0, 0, NULL, NULL),
('742688457', 'TX0000017', 'TX0000017', 'TX01', 'Heart and Vascular Institute of Texas', 'Gregory', 'A', 'Buser', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', NULL, 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-01-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1548250407', 0, 'N', 0, '2014-01-15', NULL, NULL, 0, 0, NULL, NULL),
('742688457', 'TX0000018', 'TX0000018', 'TX01', 'Heart and Vascular Institute of Texas', 'Stephen', 'C', 'Carey', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', NULL, 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-01-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1235159195', 0, 'N', 0, '2014-01-17', NULL, NULL, 0, 0, NULL, NULL),
('742688457', 'TX0000019', 'TX0000019', 'TX01', 'Heart and Vascular Institute of Texas', 'Christopher', 'W', 'Casey', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', NULL, 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-01-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1932129806', 0, 'N', 0, '2014-01-15', NULL, NULL, 0, 0, NULL, NULL),
('742688457', 'TX0000020', 'TX0000020', 'TX01', 'Heart and Vascular Institute of Texas', 'Juan', 'L', 'Garza', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', NULL, 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-01-01', '2012-08-19', 0, 0, 0, 'Mission Trail Baptist Hospital', 'North Central Baptist Hospital', NULL, NULL, 'HCFA|UB|', '1891715769', 0, 'N', 0, '2014-01-15', NULL, NULL, 0, 0, NULL, NULL),
('742688457', 'TX0000021', 'TX0000021', 'TX01', 'Heart and Vascular Institute of Texas', 'Kevin', 'F', 'James', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', NULL, 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-01-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1063432938', 0, 'N', 0, '2014-01-15', NULL, NULL, 0, 0, NULL, NULL),
('742688457', 'TX0000022', 'TX0000022', 'TX01', 'Heart and Vascular Institute of Texas', 'Kalife', '', 'Kuri', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', NULL, 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-01-01', '2012-08-19', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1033008283', 0, 'N', 0, '2014-01-15', NULL, NULL, 0, 0, NULL, NULL),
('742688457', 'TX0000023', 'TX0000023', 'TX01', 'Heart and Vascular Institute of Texas', 'Edmond', 'J', 'Leroux', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', NULL, 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-01-01', '2012-08-19', 0, 0, 0, 'Mission Trail Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1922199199', 0, 'N', 0, '2014-01-15', NULL, NULL, 0, 0, NULL, NULL),
('742688457', 'TX0000024', 'TX0000024', 'TX01', 'Heart & Vascular Institute of Texas', 'Rene', 'A', 'Oliveros', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'B', 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', NULL, NULL, NULL, '', NULL, NULL, '', '', 'TXSTD', 'TXHCPCS', NULL, '0.00', '50.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1831280007', 0, 'y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('742688457', 'TX0000025', 'TX0000025', 'TX01', 'Heart and Vascular Institute of Texas', 'John', 'F', 'Seaworth', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', NULL, 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-01-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1740371913', 0, 'N', 0, '2014-01-15', NULL, NULL, 0, 0, NULL, NULL),
('742688457', 'TX0000026', 'TX0000026', 'TX01', 'Heart and Vascular Institute of Texas', 'Stephen', 'M', 'Sokolyk', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', NULL, 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-01-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1659462826', 0, 'N', 0, '2014-01-15', NULL, NULL, 0, 0, NULL, NULL),
('742688457', 'TX0000027', 'TX0000027', 'TX01', 'Heart and Vascular Institute of Texas', 'Armistead', 'Landon', 'Wellford', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', NULL, 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-01-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1568553733', 0, 'N', 0, '2014-01-15', NULL, NULL, 0, 0, NULL, NULL),
('742688457', 'TX0000028', 'TX0000028', 'TX01', 'Heart and Vascular Institute of Texas', 'Andrew', 'J', 'West', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', NULL, 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-01-01', '2012-08-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477644649', 0, 'N', 0, '2014-01-15', NULL, NULL, 0, 0, NULL, NULL),
('742688457', 'TX0000029', 'TX0000029', 'TX01', 'Heart and Vascular Institute of Texas', 'Edwin', 'J', 'Whitney', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', NULL, 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-01-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1669563656', 0, 'N', 0, '2014-01-15', NULL, NULL, 0, 0, NULL, NULL),
('742688457', 'TX0000030', 'TX0000030', 'TX01', 'Heart and Vascular Institute of Texas', 'Richard', 'F', 'Wilks', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', NULL, 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-01-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1023109295', 0, 'N', 0, '2014-01-15', NULL, NULL, 0, 0, NULL, NULL),
('742688457', 'TX0000031', 'TX0000031', 'TX01', 'Heart and Vascular Institute of Texas', '', '', 'Heart & Vascular Institute of Texas', '', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', NULL, 'PO Box 690', 'San Antonio', 'Bexar', 'TX', '78293', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-01-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831492651', 0, 'N', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('742688457', 'TX0000032', 'TX0000032', 'TX01', 'Heart and Vascular Institute of Texas', '', '', 'Heart & Vascular Institute of Texas', '', 'Cardiovascular Disease', '', '', NULL, 'O', '1933 NE Loop 410', 'San Antonio', 'Bexar', 'TX', '78217', '2108046000', NULL, '1933 NE Loop 410', 'San Antonio', 'Bexar', 'TX', '78217', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-01-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831492651', 0, 'N', 0, '2014-03-25', NULL, NULL, 29.5177, -98.432, NULL, NULL),
('742688457', 'TX0000033', 'TX0000033', 'TX01', 'Heart and Vascular Institute of Texas', '', '', 'Heart & Vascular Institute of Texas', '', 'Cardiovascular Disease', '', '', NULL, 'O', '7922 Ewing Halsell Ste 100', 'San Antonio', 'Bexar', 'TX', '78229', '2106146111', NULL, '7922 Ewing Halsell Ste 100', 'San Antonio', 'Bexar', 'TX', '78229', '2106146111', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-01-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831492651', 0, 'N', 0, '2014-03-25', NULL, NULL, 29.5129, -98.5728, NULL, NULL),
('742688457', 'TX0000034', 'TX0000034', 'TX01', 'Heart and Vascular Institute of Texas', '', '', 'Heart & Vascular Institute of Texas', '', 'Cardiovascular Disease', '', '', NULL, 'O', '225 Sonterra Blvd Ste 200', 'San Antonio', 'Bexar', 'TX', '78258', '2104032926', NULL, '225 Sonterra Blvd Ste 200', 'San Antonio', 'Bexar', 'TX', '78258', '2104032926', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-01-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831492651', 0, 'N', 0, '2014-03-25', NULL, NULL, 29.6171, -98.4917, NULL, NULL),
('742688457', 'TX0000035', 'TX0000035', 'TX01', 'Heart and  Vascular Institute of Texas', '', '', 'Heart & Vascular Institute of Texas', '', 'Cardiovascular Disease', '', '', NULL, 'O', '12709 Toepperwein Ste 308', 'San Antonio', 'Bexar', 'TX', '78233', '2105992020', NULL, '12709 Toepperwein Ste 308', 'San Antonio', 'Bexar', 'TX', '78233', '2105992020', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-01-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831492651', 0, 'N', 0, '2014-03-25', NULL, NULL, 29.5532, -98.3483, NULL, NULL),
('742688457', 'TX0000036', 'TX0000036', 'TX01', 'Heart and Vascular Institute of Texas', '', '', 'Heart & Vascular Institute of Texas', '', 'Cardiovascular Disease', '', '', NULL, 'O', '1583 E Common Ste 105', 'New Braunfels', 'Comal', 'TX', '78130', '8306099058', NULL, '1583 E Common Ste 105', 'New Braunfels', 'Comal', 'TX', '78130', '8306099058', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-01-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831492651', 0, 'N', 0, '2014-03-25', NULL, NULL, 29.7245, -98.097, NULL, NULL),
('742688457', 'TX0000037', 'TX0000037', 'TX01', 'Heart and Vascular Institute of Texas', '', '', 'Heart & Vascular Institute of Texas', '', 'Cardiovascular Disease', '', '', NULL, 'O', '128 S Moss St Ste 100', 'Seguin', 'Guadalupe', 'TX', '78155', '8303039221', NULL, '128 S Moss St Ste 100', 'Seguin', 'Guadalupe', 'TX', '78155', '8303039221', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-01-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831492651', 0, 'N', 0, '2014-03-25', NULL, NULL, 29.5682, -97.9489, NULL, NULL),
('742688457', 'TX0000038', 'TX0000038', 'TX01', 'Heart and Vascular Institute of Texas', '', '', 'Heart & Vascular Institute of Texas', '', 'Cardiovascular Disease', '', '', NULL, 'O', '1395 Sattler Rd Ste 6', 'Canyon Lake', 'Comal', 'TX', '78133', '8309643340', NULL, '1395 Sattler Rd Ste 6', 'Canyon Lake', 'Comal', 'TX', '78133', '8309643340', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-01-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831492651', 0, 'N', 0, '2014-03-25', NULL, NULL, 29.8484, -98.1712, NULL, NULL),
('742688457', 'TX0000039', 'TX0000039', 'TX01', 'Heart and Vascular Institute of Texas', '', '', 'Heart & Vascular Institute of Texas', '', 'Cardiovascular Disease', '', '', NULL, 'O', '21 Spurs Ln', 'San Antonio', 'Bexar', 'TX', '78240', '2108046000', NULL, '21 Spurs Ln', 'San Antonio', 'Bexar', 'TX', '78240', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-01-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831492651', 0, 'N', 0, '2014-03-25', NULL, NULL, 29.5271, -98.5917, NULL, NULL),
('742688457', 'TX0000040', 'TX0000040', 'TX01', 'Heart and Vascular Institute of Texas', '', '', 'Heart & Vascular Institute of Texas', '', 'Cardiovascular Disease', '', '', NULL, 'O', '825 4th St', 'New Braunfels', 'Comal', 'TX', '78130', '8308335581', NULL, '825 4th St', 'New Braunfels', 'Comal', 'TX', '78130', '8308335581', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-01-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831492651', 0, 'N', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('742688457', 'TX0000041', 'TX0000041', 'TX01', 'Heart and Vascular Institute of Texas', '', '', 'Heart & Vascular Institute of Texas', '', 'Cardiovascular Disease', '', '', NULL, 'O', '1051 E Hwy 90', 'Castroville', 'Medina', 'TX', '78009', '8309313336', NULL, '1051 E Hwy 90', 'Castroville', 'Medina', 'TX', '78009', '8309313336', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-01-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831492651', 0, 'N', 0, '2014-03-25', NULL, NULL, 29.355, -98.8616, NULL, NULL),
('742688457', 'TX0000042', 'TX0000042', 'TX01', 'Heart and Vascular Institute of Texas', '', '', 'Heart & Vascular Institute of Texas', '', 'Cardiovascular Disease', '', '', NULL, 'O', '1901 Ave I', 'Hondo', 'Medina', 'TX', '78861', '8307414331', NULL, '1901 Ave I', 'Hondo', 'Medina', 'TX', '78861', '8307414331', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-01-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831492651', 0, 'N', 0, '2014-03-25', NULL, NULL, 29.3477, -99.1383, NULL, NULL),
('742688457', 'TX0000043', 'TX0000043', 'TX01', 'Heart and Vascular Institute of Texas', '', '', 'Heart & Vascular Institute of Texas', '', 'Cardiovascular Disease', '', '', NULL, 'O', '1300 Cedar', 'Bandera', 'Bandera', 'TX', '78003', '8304607715', NULL, '1300 Cedar', 'Bandera', 'Bandera', 'TX', '78003', '8304607715', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-01-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831492651', 0, 'N', 0, '2014-03-25', NULL, NULL, 29.7259, -99.0703, NULL, NULL),
('742688457', 'TX0000044', 'TX0000044', 'TX01', 'Heart and Vascular Institute of Texas', '', '', 'Heart & Vascular Institute of Texas', '', 'Cardiovascular Disease', '', '', NULL, 'O', '3349 S Hwy 181', 'Kenedy', 'Karnes', 'TX', '78119', '8305833401', NULL, '3349 S Hwy 181', 'Kenedy', 'Karnes', 'TX', '78119', '8305833401', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-01-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831492651', 0, 'N', 0, '2014-03-25', NULL, NULL, 28.7952, -97.8507, NULL, NULL),
('742688457', 'TX0000045', 'TX0000045', 'TX01', 'Heart and Vascular Institute of Texas', '', '', 'Heart & Vascular Institute of Texas', '', 'Cardiovascular Disease', '', '', NULL, 'O', '559 10th St Ste 1', 'Floresville', 'Bexar', 'TX', '78293', '2108046000', NULL, '559 10th St Ste 1', 'Floresville', 'Bexar', 'TX', '78293', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-01-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831492651', 0, 'N', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('742688457', 'TX0000046', 'TX0000046', 'TX01', 'Heart and Vascular Institute of Texas', '', '', 'Heart & Vascular Institute of Texas', '', 'Cardiovascular Disease', '', '', NULL, 'O', '32665 Hwy 281 N Ste 206', 'Bulverde', 'Comal', 'TX', '78163', '2108046000', NULL, '32665 Hwy 281 N Ste 206', 'Bulverde', 'Comal', 'TX', '78163', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-01-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831492651', 0, 'N', 0, '2014-03-25', NULL, NULL, 29.6588, -98.4527, NULL, NULL),
('742688457', 'TX0000047', 'TX0000047', 'TX01', 'Heart and Vascular Institute of Texas', 'Gregory', 'A', 'Buser', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1933 NE Loop 410', 'San Antonio', 'Bexar', 'TX', '78217', '2108046000', NULL, '1933 NE Loop 410', 'San Antonio', 'Bexar', 'TX', '78217', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-01-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1548250407', 0, 'N', 0, '2014-01-15', NULL, NULL, 29.5177, -98.432, NULL, NULL),
('742688457', 'TX0000048', 'TX0000048', 'TX01', 'Heart and Vascular Institute of Texas', 'Christopher', 'W', 'Casey', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1933 NE Loop 410', 'San Antonio', 'Bexar', 'TX', '78217', '2108046000', NULL, '1933 NE Loop 410', 'San Antonio', 'Bexar', 'TX', '78217', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-01-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1932129806', 0, 'N', 0, '2014-01-15', NULL, NULL, 29.5177, -98.432, NULL, NULL),
('742688457', 'TX0000049', 'TX0000049', 'TX01', 'Heart and Vascular Institute of Texas', 'Edmond', 'J', 'Leroux', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1933 NE Loop 410', 'San Antonio', 'Bexar', 'TX', '78217', '2108046000', NULL, '1933 NE Loop 410', 'San Antonio', 'Bexar', 'TX', '78217', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-01-01', '2012-08-19', 0, 0, 0, 'Mission Trail Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1922199199', 0, 'N', 0, '2014-01-15', NULL, NULL, 29.5177, -98.432, NULL, NULL),
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('742688457', 'TX0000055', 'TX0000055', 'TX01', 'Heart and Vascular Institute of Texas', 'Gregory', 'A', 'Buser', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '7922 Ewing Halsell Ste 100', 'San Antonio', 'Bexar', 'TX', '78229', '2106146111', NULL, '7922 Ewing Halsell Ste 100', 'San Antonio', 'Bexar', 'TX', '78229', '2106146111', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-01-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1548250407', 0, 'N', 0, '2014-01-15', NULL, NULL, 29.5129, -98.5728, NULL, NULL),
('742688457', 'TX0000056', 'TX0000056', 'TX01', 'Heart and Vascular Institute of Texas', 'Juan', 'L', 'Garza', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '7922 Ewing Halsell Ste 100', 'San Antonio', 'Bexar', 'TX', '78229', '2106146111', NULL, '7922 Ewing Halsell Ste 100', 'San Antonio', 'Bexar', 'TX', '78229', '2106146111', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-01-01', '2012-08-19', 0, 0, 0, 'Mission Trail Baptist Hospital', 'North Central Baptist Hospital', NULL, NULL, 'HCFA|UB|', '1891715769', 0, 'N', 0, '2014-01-15', NULL, NULL, 29.5129, -98.5728, NULL, NULL),
('742688457', 'TX0000057', 'TX0000057', 'TX01', 'Heart and Vascular Institute of Texas', 'Kalife', '', 'Kuri', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '7922 Ewing Halsell Ste 100', 'San Antonio', 'Bexar', 'TX', '78229', '2106146111', NULL, '7922 Ewing Halsell Ste 100', 'San Antonio', 'Bexar', 'TX', '78229', '2106146111', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-01-01', '2012-08-19', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1033008283', 0, 'N', 0, '2014-01-15', NULL, NULL, 29.5129, -98.5728, NULL, NULL),
('742688457', 'TX0000058', 'TX0000058', 'TX01', 'Heart and Vascular Institute of Texas', 'Edmond', 'J', 'Leroux', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '7922 Ewing Halsell Ste 100', 'San Antonio', 'Bexar', 'TX', '78229', '2106146111', NULL, '7922 Ewing Halsell Ste 100', 'San Antonio', 'Bexar', 'TX', '78229', '2106146111', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-01-01', '2012-08-19', 0, 0, 0, 'Mission Trail Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1922199199', 0, 'N', 0, '2014-01-15', NULL, NULL, 29.5129, -98.5728, NULL, NULL),
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('742688457', 'TX0000064', 'TX0000064', 'TX01', 'Heart and Vascular Institute of Texas', 'Kevin', 'F', 'James', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '12709 Toepperwein Ste 308', 'San Antonio', 'Bexar', 'TX', '78233', '2105992020', NULL, '12709 Toepperwein Ste 308', 'San Antonio', 'Bexar', 'TX', '78233', '2105992020', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-01-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1063432938', 0, 'N', 0, '2014-01-15', NULL, NULL, 29.5532, -98.3483, NULL, NULL),
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('742688457', 'TX0000068', 'TX0000068', 'TX01', 'Heart and Vascular Institute of Texas', 'Stephen', 'C', 'Carey', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1395 Sattler Rd Ste 6', 'Canyon Lake', 'Comal', 'TX', '78133', '8309643340', NULL, '1395 Sattler Rd Ste 6', 'Canyon Lake', 'Comal', 'TX', '78133', '8309643340', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-01-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1235159195', 0, 'N', 0, '2014-01-17', NULL, NULL, 29.8484, -98.1712, NULL, NULL),
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('742688457', 'TX0000071', 'TX0000071', 'TX01', 'Heart and Vascular Institute of Texas', 'Kalife', '', 'Kuri', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '21 Spurs Ln', 'San Antonio', 'Bexar', 'TX', '78240', '2108046000', NULL, '21 Spurs Ln', 'San Antonio', 'Bexar', 'TX', '78240', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-01-01', '2012-08-19', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1033008283', 0, 'N', 0, '2014-01-15', NULL, NULL, 29.5271, -98.5917, NULL, NULL),
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('742688457', 'TX0000075', 'TX0000075', 'TX01', 'Heart and Vascular Institute of Texas', 'Kalife', '', 'Kuri', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1051 E Hwy 90', 'Castroville', 'Medina', 'TX', '78009', '8309313336', NULL, '1051 E Hwy 90', 'Castroville', 'Medina', 'TX', '78009', '8309313336', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-01-01', '2012-08-19', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1033008283', 0, 'N', 0, '2014-01-15', NULL, NULL, 29.355, -98.8616, NULL, NULL),
('742688457', 'TX0000076', 'TX0000076', 'TX01', 'Heart and Vascular Institute of Texas', 'Kalife', '', 'Kuri', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1901 Ave I', 'Hondo', 'Medina', 'TX', '78861', '8307414331', NULL, '1901 Ave I', 'Hondo', 'Medina', 'TX', '78861', '8307414331', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-01-01', '2012-08-19', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1033008283', 0, 'N', 0, '2014-01-15', NULL, NULL, 29.3477, -99.1383, NULL, NULL),
('742688457', 'TX0000077', 'TX0000077', 'TX01', 'Heart and Vascular Institute of Texas', 'Edwin', 'J', 'Whitney', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1901 Ave I', 'Hondo', 'Medina', 'TX', '78861', '8307414331', NULL, '1901 Ave I', 'Hondo', 'Medina', 'TX', '78861', '8307414331', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-01-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1669563656', 0, 'N', 0, '2014-01-15', NULL, NULL, 29.3477, -99.1383, NULL, NULL),
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('742688457', 'TX0000080', 'TX0000080', 'TX01', 'Heart and Vascular Institute of Texas', 'John', 'F', 'Seaworth', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3349 S Hwy 181', 'Kenedy', 'Karnes', 'TX', '78119', '8305833401', NULL, '3349 S Hwy 181', 'Kenedy', 'Karnes', 'TX', '78119', '8305833401', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-01-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1740371913', 0, 'N', 0, '2014-01-15', NULL, NULL, 28.7952, -97.8507, NULL, NULL),
('742688457', 'TX0000081', 'TX0000081', 'TX01', 'Heart and Vascular Institute of Texas', 'Stephen', 'M', 'Sokolyk', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '559 10th St Ste 1', 'Floresville', 'Bexar', 'TX', '78293', '2108046000', NULL, '559 10th St Ste 1', 'Floresville', 'Bexar', 'TX', '78293', '2108046000', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-01-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1659462826', 0, 'N', 0, '2014-01-15', NULL, NULL, 0, 0, NULL, NULL),
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('742915297', 'TX0000256', 'TX0000256', 'TX01', 'South Texas Oncology & Hematology PA', 'Joaquin', 'G', 'Mira', 'MD', 'Radiation Oncology', NULL, NULL, NULL, 'O', '155 E Sonterra Blvd Ste 200', 'San Antonio', 'Bexar', 'TX', '78258', '2104040606', NULL, '7979 Wurzbach Rd', 'San Antonio', '', 'TX', '78229', '', '', 'TXONCOL', 'TXHCPCS', NULL, '0.00', '50.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '7636', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('742915297', 'TX0000258', 'TX0000258', 'TX01', 'South Texas Oncology and Hematology', 'Nena', '', 'Mirkovic', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '7979 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78229', '2106165700', NULL, '7979 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78229', '2106165700', '          ', 'TXONCOL', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-01-01', '2012-09-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007641', 0, 'N', 0, '2013-01-23', NULL, NULL, 29.5135, -98.579, NULL, NULL),
('742915297', 'TX0000259', 'TX0000259', 'TX01', 'South Texas Oncology & Hematology PA', 'Jayasree', NULL, 'Rao', 'MD', 'Hematology and Oncology', NULL, NULL, NULL, 'O', '155 E Sonterra Blvd Ste 200', 'San Antonio', 'Bexar', 'TX', '78258', '2104040606', NULL, '7979 Wurzbach Rd', 'San Antonio', '', 'TX', '78229', '', '', 'TXONCOL', 'TXHCPCS', NULL, '0.00', '50.00', NULL, 3, '2007-01-01', '2006-12-13', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('742915297', 'TX0000260', 'TX0000260', 'TX01', 'South Texas Oncology & Hematology PA', 'Gladys', 'I', 'Rodriguez', 'MD', NULL, 'Oncology', NULL, NULL, 'O', '315 N San Saba Ste 1160', 'San Antonio', 'Bexar', 'TX', '78207', '2103543838', NULL, '7979 Wurzbach Rd', 'San Antonio', '', 'TX', '78229', '', '', 'TXONCOL', 'TXHCPCS', NULL, '0.00', '50.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '8453', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('742915297', 'TX0000261', 'TX0000261', 'TX01', 'South Texas Oncology and Hematology', 'Gladys', 'I', 'Rodriguez', 'MD', 'Oncology', '', '', NULL, 'O', '7979 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78229', '2106165700', NULL, '7979 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78229', '2106165700', '', 'TXONCOL', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'North East Baptist Hospital', '', '', '', 'HCFA|UB|', '0000008453', 0, 'N', 0, '2014-04-02', NULL, NULL, 29.5129, -98.5788, NULL, NULL),
('742915297', 'TX0000262', 'TX0000262', 'TX01', 'South Texas Oncology & Hematology PA', 'Luis', 'C', 'Rodriguez', 'MD', 'Hematology and Oncology', 'Oncology', NULL, NULL, 'O', '315 N San Saba Ste 1160', 'San Antonio', 'Bexar', 'TX', '78207', '2103543838', NULL, '7979 Wurzbach Rd', 'San Antonio', '', 'TX', '78229', '', '', 'TXONCOL', 'TXHCPCS', NULL, '0.00', '50.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '8456', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('742915297', 'TX0000263', 'TX0000263', 'TX01', 'South Texas Oncology and Hematology', 'Lon', 'S', 'Smith', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '7979 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78229', '2106165700', NULL, '7979 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78229', '2106165700', '', 'TXONCOL', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '0000008767', 0, 'N', 0, '2013-01-23', NULL, NULL, 29.5129, -98.5788, NULL, NULL),
('742915297', 'TX0000264', 'TX0000264', 'TX01', 'South Texas Oncology & Hematology PA', 'Lon', 'S', 'Smith', 'MD', NULL, 'Oncology', NULL, NULL, 'O', '155 E Sonterra Blvd Ste 200', 'San Antonio', 'Bexar', 'TX', '78258', '2104040606', NULL, '7979 Wurzbach Rd', 'San Antonio', '', 'TX', '78229', '', '', 'TXONCOL', 'TXHCPCS', NULL, '0.00', '50.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '8767', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('742915297', 'TX0000265', 'TX0000265', 'TX01', 'South Texas Oncology & Hematology PA', 'Maria', 'A', 'Sosa', 'MD', 'Hematology and Oncology', NULL, NULL, NULL, 'O', '7979 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78229', '2106165700', NULL, '7979 Wurzbach Rd', 'San Antonio', '', 'TX', '78229', '', '', 'TXONCOL', 'TXHCPCS', NULL, '0.00', '50.00', NULL, 3, '2007-01-01', '2007-08-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('742915297', 'TX0000266', 'TX0000266', 'TX01', 'South Texas Oncology & Hematology PA', 'Scott', 'C', 'Ulmer', 'MD', 'Hematology and Oncology', 'Oncology', NULL, NULL, 'O', '155 E Sonterra Blvd Ste 200', 'San Antonio', 'Bexar', 'TX', '78258', '2104040606', NULL, '7979 Wurzbach Rd', 'San Antonio', '', 'TX', '78229', '', '', 'TXONCOL', 'TXHCPCS', NULL, '0.00', '50.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '9268', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('742915297', 'TX0000267', 'TX0000267', 'TX01', 'South Texas Oncology and Hematology', 'Allan', 'J', 'White', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '7979 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78229', '2106165700', NULL, '7979 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78229', '2106165700', '', 'TXONCOL', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-01-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1497782114', 0, 'Y', 0, '2014-07-17', NULL, NULL, 29.5135, -98.579, NULL, NULL),
('721576784', 'TX0000268', 'TX0000268', 'TX01', NULL, 'Kathleen', 'G', 'Halka', 'MD', 'Hematology and Oncology', NULL, NULL, NULL, 'O', '315 N San Saba Ste 960', 'San Antonio', 'Bexar', 'TX', '78202', '2102239888', NULL, '315 N San Saba', 'San Antonio', '', 'TX', '78202', '', '', 'TXONCOL', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2007-01-01', '2008-04-11', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1487560651', 0, 'N', 0, '2007-01-11', NULL, NULL, 0, 0, NULL, NULL),
('721576784', 'TX0000269', 'TX0000269', 'TX01', NULL, 'David', 'W', 'Ririe', 'MD', 'Hematology and Oncology', 'Oncology', NULL, NULL, 'O', '315 N San Saba Ste 960', 'San Antonio', 'Bexar', 'TX', '78202', '2102239888', NULL, '315 N San Saba', 'San Antonio', '', 'TX', '78202', '', '', 'TXONCOL', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2007-01-01', '2008-04-11', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1952307605', 0, 'N', 0, '2008-04-04', NULL, NULL, 0, 0, NULL, NULL),
('721576784', 'TX0000270', 'TX0000270', 'TX01', NULL, 'Brenda', 'L', 'Frye', 'PA', 'Hematology and Oncology', NULL, NULL, NULL, 'O', '315 N San Saba Ste 960', 'San Antonio', 'Bexar', 'TX', '78202', '2102239888', NULL, '315 N San Saba', 'San Antonio', '', 'TX', '78202', '', '', 'TXONCOL', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2007-01-01', '2008-04-11', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000006327', 0, 'N', 0, '2007-01-11', NULL, NULL, 0, 0, NULL, NULL),
('760714523', 'TX0000271', 'TX0000271', 'TX01', 'Baptist Medical Center', '', '', 'Baptist Medical Center', '', 'Hospital', '', '', NULL, 'O', '111 Dallas St', 'San Antonio', 'Bexar', 'TX', '78205', '2102977000', NULL, '111 Dallas St', 'San Antonio', 'Bexar', 'TX', '78205', '2102977000', '          ', '', '', 'Baptist', '0.00', '100.00', '0.00', 3, '2007-01-01', '2012-08-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000005181', 0, 'N', 0, '2013-07-26', NULL, NULL, 29.4336, -98.4927, NULL, NULL),
('760714523', 'TX0000272', 'TX0000272', 'TX01', 'North Central Baptist Hospital', '', '', 'North Central Baptist Hospital', '', 'Hospital', '', '', NULL, 'O', '520 Madison Oak Dr', 'San Antonio', 'Bexar', 'TX', '78258', '2102974000', NULL, '520 Madision', 'San Antonio', 'Bexar', 'TX', '78258', '2102974000', '          ', '', '', 'Baptist', '0.00', '100.00', '0.00', 3, '2007-01-01', '2012-08-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007900', 0, 'N', 0, '2012-08-30', NULL, NULL, 29.6205, -98.4915, NULL, NULL),
('760714523', 'TX0000273', 'TX0000273', 'TX01', 'North East Baptist Hospital', '', '', 'North East Baptist Hospital', '', 'Hospital', '', '', NULL, 'O', '8811 Village Dr', 'San Antonio', 'Bexar', 'TX', '78217', '2102972000', NULL, '8811 Village Dr', 'San Antonio', 'Bexar', 'TX', '78217', '2102972000', '          ', '', '', 'Baptist', '0.00', '100.00', '0.00', 3, '2007-01-01', '2012-08-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007903', 0, 'N', 0, '2012-08-30', NULL, NULL, 29.5191, -98.4295, NULL, NULL),
('760714523', 'TX0000274', 'TX0000274', 'TX01', 'South East Baptist Hospital', '', '', 'South East Baptist Hospital', '', 'Hospital', '', '', NULL, 'O', '4214 E Southcross Blvd', 'San Antonio', 'Bexar', 'TX', '78222', '2102973000', NULL, '4214 E Southcross Blvd', 'San Antonio', 'Bexar', 'TX', '78222', '2102973000', '          ', '', '', 'Baptist', '0.00', '100.00', '0.00', 3, '2007-01-01', '2011-06-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008828', 0, 'N', 0, '2012-11-05', NULL, NULL, 29.3737, -98.4123, NULL, NULL),
('760714523', 'TX0000275', 'TX0000275', 'TX01', 'St Lukes Baptist Hospital', '', '', 'St Lukes Baptist Hospital', '', 'Hospital', '', '', NULL, 'O', '7930 Floyd Curl Dr', 'San Antonio', 'Bexar', 'TX', '78229', '2102975000', NULL, '7930 Floyd Curl Dr', 'San Antonio', 'Bexar', 'TX', '78229', '2102975000', '          ', '', '', 'Baptist', '0.00', '100.00', '0.00', 3, '2007-01-01', '2012-08-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008874', 0, 'N', 0, '2012-08-30', NULL, NULL, 29.5123, -98.5747, NULL, NULL);
