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
('830217795', 'W12046733', 'W12046733', 'WY01', 'Internal Medicine Group', 'Kenneth', '', 'Kranz', 'MD', 'Gastroenterology', '', '', NULL, 'O', '2301 House Ave Ste 300', 'Cheyenne', 'Laramie', 'WY', '82001', '3076354141', '3076356587', '2301 House Ave Ste 300', 'Cheyenne', 'Laramie', 'WY', '82001', '3076354141', '3076356587', 'WY160', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1740222462', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('830217795', 'W12046736', 'W12046736', 'WY01', 'Internal Medicine Group', 'Steven', '', 'Reeb', 'MD', 'Pulmonary', '', '', NULL, 'O', '2301 House Ave Ste 300', 'Cheyenne', 'Laramie', 'WY', '82001', '3076354141', '3076356587', '2301 House Ave Ste 300', 'Cheyenne', 'Laramie', 'WY', '82001', '3076354141', '3076356587', 'WY160', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1154367845', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('830217795', 'W12046737', 'W12046737', 'WYT1', 'Internal Medicine Group', 'Steven', '', 'Reeb', 'MD', 'Pulmonary', '', '', NULL, 'O', '2301 House Ave Ste 300', 'Cheyenne', 'Laramie', 'WY', '82001', '3076354141', '3076356587', '2301 House Ave Ste 300', 'Cheyenne', 'Laramie', 'WY', '82001', '3076354141', '3076356587', 'WY160', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1154367845', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('830217795', 'W12046739', 'W12046739', 'WY01', 'Internal Medicine Group', 'Michael', '', 'Miller', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2301 House Ave Ste 300', 'Cheyenne', 'Laramie', 'WY', '82001', '3076354141', '3076356587', '2301 House Ave Ste 300', 'Cheyenne', 'Laramie', 'WY', '82001', '3076354141', '3076356587', 'WY160', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1518903954', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('830217795', 'W12046740', 'W12046740', 'WYT1', 'Internal Medicine Group', 'Michael', '', 'Miller', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2301 House Ave Ste 300', 'Cheyenne', 'Laramie', 'WY', '82001', '3076354141', '3076356587', '2301 House Ave Ste 300', 'Cheyenne', 'Laramie', 'WY', '82001', '3076354141', '3076356587', 'WY160', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1518903954', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('830217795', 'W12046742', 'W12046742', 'WY01', 'Internal Medicine Group', 'Ting-Hui', '', 'Hsieh', 'MD', 'Gastroenterology', '', '', NULL, 'O', '2301 House Ave Ste 300', 'Cheyenne', 'Laramie', 'WY', '82001', '3076354141', '3076356587', '2301 House Ave Ste 300', 'Cheyenne', 'Laramie', 'WY', '82001', '3076354141', '3076356587', 'WY160', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1326234667', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('830217795', 'W12046743', 'W12046743', 'WYT1', 'Internal Medicine Group', 'Ting-Hui', '', 'Hsieh', 'MD', 'Gastroenterology', '', '', NULL, 'O', '2301 House Ave Ste 300', 'Cheyenne', 'Laramie', 'WY', '82001', '3076354141', '3076356587', '2301 House Ave Ste 300', 'Cheyenne', 'Laramie', 'WY', '82001', '3076354141', '3076356587', 'WY160', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1326234667', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('830217795', 'W12046745', 'W12046745', 'WY01', 'Internal Medicine Group', 'Scott', '', 'McRae', 'MD', 'Gastroenterology', '', '', NULL, 'O', '2301 House Ave Ste 300', 'Cheyenne', 'Laramie', 'WY', '82001', '3076354141', '3076356587', '2301 House Ave Ste 300', 'Cheyenne', 'Laramie', 'WY', '82001', '3076354141', '3076356587', 'WY160', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1144390006', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('830217795', 'W12046746', 'W12046746', 'WYT1', 'Internal Medicine Group', 'Scott', '', 'McRae', 'MD', 'Gastroenterology', '', '', NULL, 'O', '2301 House Ave Ste 300', 'Cheyenne', 'Laramie', 'WY', '82001', '3076354141', '3076356587', '2301 House Ave Ste 300', 'Cheyenne', 'Laramie', 'WY', '82001', '3076354141', '3076356587', 'WY160', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1144390006', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('830217795', 'W12046749', 'W12046749', 'WYT1', 'Internal Medicine Group', 'Jessie', '', 'Hockett', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '2301 House Ave Ste 300', 'Cheyenne', 'Laramie', 'WY', '82001', '3076354141', '3076356587', '2301 House Ave Ste 300', 'Cheyenne', 'Laramie', 'WY', '82001', '3076354141', '3076356587', 'WY160', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1396026225', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('830217795', 'W12046751', 'W12046751', 'WY01', 'Internal Medicine Group', 'Gennady', '', 'Nosovitsky', 'PA-C', 'Internal Medicine', '', '', NULL, 'O', '2301 House Ave Ste 300', 'Cheyenne', 'Laramie', 'WY', '82001', '3076354141', '3076356587', '2301 House Ave Ste 300', 'Cheyenne', 'Laramie', 'WY', '82001', '3076354141', '3076356587', 'WY160', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1780007708', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('830217795', 'W12046752', 'W12046752', 'WYT1', 'Internal Medicine Group', 'Gennady', '', 'Nosovitsky', 'PA-C', 'Internal Medicine', '', '', NULL, 'O', '2301 House Ave Ste 300', 'Cheyenne', 'Laramie', 'WY', '82001', '3076354141', '3076356587', '2301 House Ave Ste 300', 'Cheyenne', 'Laramie', 'WY', '82001', '3076354141', '3076356587', 'WY160', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1780007708', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'W12046754', 'W12046754', 'UT01', 'Heart and Lung Institute', '', '', 'Physician Group of Utah Inc', 'GROUP', '', '', '', NULL, 'O', '3570 W 9000 S Ste 110', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012330140', '          ', '3570 W 9000 S Ste 110', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012330140', '          ', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006645', 0, 'Y', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'W12046755', 'W12046755', 'UT01', 'Heart and Lung Institute', '', '', 'Physician Group of Utah Inc', 'GROUP', '', '', '', NULL, 'O', '5979 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012630140', '          ', '5979 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012630140', '          ', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006645', 0, 'Y', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('870354442', 'W12046756', 'W12046756', 'UT01', 'Rocky Mountain Womens Health Center', '', '', 'Physician Group of Utah Inc', 'GROUP', '', '', '', NULL, 'O', '1580 W Antelope Dr Ste 280', 'Layton', 'Davis', 'UT', '84041', '8017760880', '          ', '1580 W Antelope Dr Ste 280', 'Layton', 'Davis', 'UT', '84041', '8017760880', '          ', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447387519', 0, 'Y', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('371643195', 'W12046757', 'W12046757', 'UT01', 'Mountainstar Intensivist Services ', 'Branden', 'D', 'Rosenhan', '', 'Hospitalist', '', '', NULL, 'O', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687111', '8663153628', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687111', '8663153628', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912160060', 0, 'N', 0, '2014-06-03', NULL, NULL, 0, 0, NULL, NULL),
('371643195', 'W12046758', 'W12046758', 'UT01', 'Mountainstar Intensivist Services ', 'Branden', 'D', 'Rosenhan', '', 'Hospitalist', '', '', NULL, 'B', 'PO Box 741904', 'Atlanta', 'Fulton', 'GA', '30374', '8017146387', '8017146596', 'PO Box 741904', 'Atlanta', 'Fulton', 'GA', '30374', '8017146387', '8017146596', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912160060', 0, 'N', 0, '2014-06-03', NULL, NULL, 0, 0, NULL, NULL),
('870481325', 'W12046759', 'W12046759', 'UT01', 'Westside Medical Clinic', 'Mark ', 'S', 'Jorgensen', 'MD', 'Family Practice', '', '', NULL, 'O', '1477 N 2000 W Ste C', 'Clearfield', 'Davis', 'UT', '84015', '8017748888', '8018258519', '1477 N 2000 W Ste C', 'Clearfield', 'Davis', 'UT', '84015', '8017748888', '8018258519', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-15', NULL, 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB|', '1407083710', 0, 'N', 0, '2014-06-02', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'W12046760', 'W12046760', 'UT01', 'Community Health Centers Inc', 'Marilyn', 'L', 'Curran', 'MD', 'Family Practice', '', '', NULL, 'B', '220 W 7200 S Ste A', 'Midvale', 'Salt Lake', 'UT', '84047', '8018583468', '8018583470', '220 W 7200 S Ste A', 'Midvale', 'Salt Lake', 'UT', '84047', '8018583468', '8018583470', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-21', NULL, 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1285631358', 0, 'N', 0, '2014-04-22', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'W12046762', 'W12046762', 'UT01', 'Community Health Centers Inc', 'Kyle', '', 'Daley', 'PA', 'Physicians Assistant', '', '', NULL, 'B', '220 W 7200 S Ste A', 'Midvale', 'Salt Lake', 'UT', '84047', '8018583468', '8018583470', '220 W 7200 S Ste A', 'Midvale', 'Salt Lake', 'UT', '84047', '8018583468', '8018583470', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912215476', 0, 'N', 1, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'W12046763', 'W12046763', 'UT01', 'Central City Clinic Medical', 'Kyle', '', 'Daley', 'PA', 'Physicians Assistant', '', '', NULL, 'O', '461 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015398634', '8015377238', '461 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015398634', '8015377238', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912215476', 0, 'N', 1, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'W12046764', 'W12046764', 'UT01', 'Community Health Centers Inc', 'Stefani', 'J', 'Day', 'MD', 'Family Practice', '', '', NULL, 'B', '220 W 7200 S Ste A', 'Midvale', 'Salt Lake', 'UT', '84047', '8018583468', '8018583470', '220 W 7200 S Ste A', 'Midvale', 'Salt Lake', 'UT', '84047', '8018583468', '8018583470', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-21', NULL, 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1265439236', 0, 'N', 0, '2014-04-22', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'W12046766', 'W12046766', 'UT01', 'Community Health Centers Inc', 'Jose', '', 'Esparza', 'NP', 'Nurse Practitioner', '', '', NULL, 'B', '220 W 7200 S Ste A', 'Midvale', 'Salt Lake', 'UT', '84047', '8018583468', '8018583470', '220 W 7200 S Ste A', 'Midvale', 'Salt Lake', 'UT', '84047', '8018583468', '8018583470', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720341837', 0, 'N', 1, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'W12046767', 'W12046767', 'UT01', 'Central City Clinic Medical', 'Jose', '', 'Esparza', 'NP', 'Nurse Practitioner', '', '', NULL, 'O', '461 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015398634', '8015377238', '461 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015398634', '8015377238', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720341837', 0, 'N', 1, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'W12046768', 'W12046768', 'UT01', 'Community Health Centers Inc', 'Kenneth', 'P', 'Libre', 'MD', 'Family Practice', '', '', NULL, 'B', '220 W 7200 S Ste A', 'Midvale', 'Salt Lake', 'UT', '84047', '8018583468', '8018583470', '220 W 7200 S Ste A', 'Midvale', 'Salt Lake', 'UT', '84047', '8018583468', '8018583470', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-21', NULL, 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1801873534', 0, 'N', 0, '2014-04-22', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'W12046771', 'W12046771', 'UT01', '72nd Street Clinic', 'Christian', 'P', 'Hyer', 'PA', 'Family Practice', '', '', NULL, 'B', '220 W 7200 S Ste A', 'Midvale', 'Salt Lake', 'UT', '84047', '8018583468', '8018583470', '220 W 7200 S Ste A', 'Midvale', 'Salt Lake', 'UT', '84047', '8018583468', '8018583470', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164672549', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'W12046773', 'W12046773', 'UT01', 'Community Health Centers Inc', 'John', '', 'Lelis', 'PA', 'Physician Assistant', '', '', NULL, 'B', '220 W 7200 S Ste A', 'Midvale', 'Salt Lake', 'UT', '84047', '8018583468', '8018583470', '220 W 7200 S Ste A', 'Midvale', 'Salt Lake', 'UT', '84047', '8018583468', '8018583470', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275812208', 0, 'N', 1, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'W12046774', 'W12046774', 'UT01', '72nd Street Clinic', 'John', '', 'Lelis', 'PA', 'Physician Assistant', '', '', NULL, 'O', '220 W 7200 S Ste A', 'Midvale', 'Salt Lake', 'UT', '84047', '8015665494', '8015619647', '220 W 7200 S Ste A', 'Midvale', 'Salt Lake', 'UT', '84047', '8015665494', '8015619647', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275812208', 0, 'N', 1, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'W12046775', 'W12046775', 'UT01', 'Community Health Centers Inc', 'Martha', 'P', 'Mandujano', 'PA', 'Family Practice', '', '', NULL, 'B', '220 W 7200 S Ste A', 'Midvale', 'Salt Lake', 'UT', '84047', '8018583468', '8018583470', '220 W 7200 S Ste A', 'Midvale', 'Salt Lake', 'UT', '84047', '8018583468', '8018583470', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356446215', 0, 'N', 0, '2014-04-22', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'W12046776', 'W12046776', 'UT01', 'Community Health Centers Inc', 'Jay', 'C', 'Moreland', 'MD', 'Family Practice', '', '', NULL, 'B', '220 W 7200 S Ste A', 'Midvale', 'Salt Lake', 'UT', '84047', '8018583468', '8018583470', '220 W 7200 S Ste A', 'Midvale', 'Salt Lake', 'UT', '84047', '8018583468', '8018583470', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-21', NULL, 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1023095866', 0, 'N', 0, '2014-04-22', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'W12046777', 'W12046777', 'UT01', '72nd Street Clinic', 'Jay', 'C', 'Moreland', 'MD', 'Family Practice', '', '', NULL, 'O', '220 W 7200 S Ste A', 'Midvale', 'Salt Lake', 'UT', '84047', '8015665494', '8015619647', '220 W 7200 S Ste A', 'Midvale', 'Salt Lake', 'UT', '84047', '8015665494', '8015619647', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-22', NULL, 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1023095866', 0, 'N', 0, '2014-04-22', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'W12046778', 'W12046778', 'UT01', 'Community Health Centers Inc', 'Kathryn', 'M', 'Ekstrom', 'MD', 'Internal Medicine', 'Pediatrics', '', NULL, 'B', '220 W 7200 S Ste A', 'Midvale', 'Salt Lake', 'UT', '84047', '8018583468', '8018583470', '220 W 7200 S Ste A', 'Midvale', 'Salt Lake', 'UT', '84047', '8018583468', '8018583470', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-21', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1346493400', 0, 'N', 0, '2014-04-22', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'W12046781', 'W12046781', 'UT01', 'Clinca De Buena Salud Medical', 'LaPriel', '', 'Clark', 'APRN', 'Advanced Practice Registered Nurse', '', '', NULL, 'O', '14 N 100 E Ste 200', 'Brigham City', 'Box Elder', 'UT', '84302', '4357238276', '4357349761', '14 N 100 E Ste 200', 'Brigham City', 'Box Elder', 'UT', '84302', '4357238276', '4357349761', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730309998', 0, 'N', 1, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'W12046782', 'W12046782', 'UT01', 'Clinca De Buena Salud Medical', 'Jeffrey', 'M', 'Coursey', 'PA', 'Family Practice', '', '', NULL, 'O', '14 N 100 E Ste 200', 'Brigham City', 'Box Elder', 'UT', '84302', '4357238276', '4357349761', '14 N 100 E Ste 200', 'Brigham City', 'Box Elder', 'UT', '84302', '4357238276', '4357349761', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477550515', 0, 'N', 0, '2014-04-22', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'W12046783', 'W12046783', 'UT01', 'Community Health Centers Inc', 'Jeffrey', 'M', 'Coursey', 'PA', 'Family Practice', '', '', NULL, 'B', '220 W 7200 S Ste A', 'Midvale', 'Salt Lake', 'UT', '84047', '8018583468', '8018583470', '220 W 7200 S Ste A', 'Midvale', 'Salt Lake', 'UT', '84047', '8018583468', '8018583470', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477550515', 0, 'N', 0, '2014-04-22', NULL, NULL, 0, 0, NULL, NULL),
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('452715973', 'W12046829', 'W12046829', 'Sinclair', 'St Lukes Clinic Wood River LLC', 'Timothy', '', 'Stoddard', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'B', 'PO Box 640', 'Boise', 'Ada', 'ID', '83701', '2087883434', '2087882025', 'PO Box 640', 'Boise', 'Ada', 'ID', '83701', '2087883434', '2087882025', 'IDSINCLAIRD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, 'St Lukes Regional Medical Center', '', '', '', 'HCFA|UB|', '1821212788', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('201937212', 'W12046831', 'W12046831', 'TXDALSTD', 'Pinnacle Home Health Services', '', '', 'Baylor Institute for Rehabilitation- - Pinnacle Home Health Services', '', 'Rehabilitation Hospital', '', '', NULL, 'O', '1241 Cross Timbers Rd', 'Flower Mound', 'Denton', 'TX', '75028', '9726913131', '          ', '1241 Cross Timbers Rd', 'Flower Mound', 'Denton', 'TX', '75028', '9726913131', '          ', '', '', 'BAYHEALTHD', '0.00', '0.00', '0.00', 3, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518041102', 0, 'N', 0, '2014-04-23', NULL, NULL, 0, 0, NULL, NULL),
('262520217', 'W12046834', 'W12046834', 'TXDALSTD', 'Performance Orthopaedics & Sports Medicine', 'Daniel', 'R', 'Maurer', 'DO', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 848383', 'Boston', 'Suffolk', 'MA', '02284', '6174021934', '6144021099', 'PO Box 848383', 'Boston', 'Suffolk', 'MA', '02284', '6174021934', '6144021099', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-15', NULL, 0, 0, 0, 'Baylor Medical Center at McKinney', '', '', '', 'HCFA|UB|', '1497976476', 0, 'N', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('262520217', 'W12046833', 'W12046833', 'TXDALSTD', 'Performance Orthopaedics & Sports Medicine', 'Daniel', 'R', 'Maurer', 'DO', 'Orthopedic Surgery', '', '', NULL, 'O', '4461 Coit Rd Ste 301', 'Frisco', 'Collin', 'TX', '75035', '2147056611', '2146191008', '4461 Coit Rd Ste 301', 'Frisco', 'Collin', 'TX', '75035', '2147056611', '2146191008', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-15', NULL, 0, 0, 0, 'Baylor Medical Center at McKinney', '', '', '', 'HCFA|UB|', '1497976476', 0, 'N', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('262520217', 'W12046836', 'W12046836', 'TXDALSTD', 'Performance Orthopaedics & Sports Medicine', 'Troy', 'C', 'Diehl', 'DO', 'Orthopedic Surgery', '', '', NULL, 'O', '4461 Coit Rd Ste 301', 'Frisco', 'Collin', 'TX', '75035', '2147056611', '2146191008', '4461 Coit Rd Ste 301', 'Frisco', 'Collin', 'TX', '75035', '2147056611', '2146191008', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-15', NULL, 0, 0, 0, 'Baylor Medical Center at McKinney', '', '', '', 'HCFA|UB|', '1457480287', 0, 'N', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('262520217', 'W12046837', 'W12046837', 'TXDALSTD', 'Performance Orthopaedics & Sports Medicine', 'Troy', 'C', 'Diehl', 'DO', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 848383', 'Boston', 'Suffolk', 'MA', '02284', '6174021934', '6144021099', 'PO Box 848383', 'Boston', 'Suffolk', 'MA', '02284', '6174021934', '6144021099', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-15', NULL, 0, 0, 0, 'Baylor Medical Center at McKinney', '', '', '', 'HCFA|UB|', '1457480287', 0, 'N', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12046841', 'W12046841', 'UTIHCPHY', 'Intermountain Pediatric Imaging', 'Constance', 'K', 'Maves', 'MD', 'Pediatrics', '', '', NULL, 'O', '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8014870451', '8014872467', '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8014870451', '8014872467', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063513596', 0, 'N', 0, '2014-04-23', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH180', 'PGUTAH180', 'UT01', 'Comprehensive Orthopedics and Sports Medicine', 'Stephen', 'T', 'Kirk', 'MD', 'Sports Medicine', '', '', NULL, 'O', '9350 S 150 E Ste 460', 'Sandy', 'Salt Lake', 'UT', '84070', '8015332002', '8013239546', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1578737979', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH181', 'PGUTAH181', 'UT01', 'Physician Group of Utah', 'Stephen', 'T', 'Kirk', 'MD', 'Sports Medicine', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1578737979', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH349', 'PGUTAH349', 'UT01', 'Heart and Lung Institute of Utah', 'David', '', 'Klein', 'MD', 'Pulmonary', '', '', NULL, 'O', '3336 S 4155 W Ste 203', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1124075437', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH350', 'PGUTAH350', 'UT01', 'Heart and Lung Institute of Utah', 'David', '', 'Klein', 'MD', 'Pulmonary', '', '', NULL, 'O', '3570 W 9000 S Ste 110', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1124075437', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH351', 'PGUTAH351', 'UT01', 'Heart and Lung Institute of Utah', 'David', '', 'Klein', 'MD', 'Pulmonary', '', '', NULL, 'O', '5979 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1124075437', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH352', 'PGUTAH352', 'UT01', 'Heart and Lung Institute of Utah', 'David', '', 'Klein', 'MD', 'Pulmonary', '', '', NULL, 'O', '5980 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1124075437', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH353', 'PGUTAH353', 'UT01', 'Heart and Lung Institute of Utah', 'David', '', 'Klein', 'MD', 'Pulmonary', '', '', NULL, 'O', '82 S 1100 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1124075437', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH354', 'PGUTAH354', 'UT01', 'Heart and Lung Institute of Utah', 'David', '', 'Klein', 'MD', 'Pulmonary', '', '', NULL, 'B', 'PO Box 847112', 'Dallas', 'Dallas', 'TX', '75284', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1124075437', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH212', 'PGUTAH212', 'UT01', 'Gero - Psych', 'Michael', 'A', 'Kligman', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504111', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1679615918', 0, 'Y', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870354442', 'PGUTAH317', 'PGUTAH317', 'UT01', 'Rocky Mountain Womens Health Center', 'Linda', 'S', 'Koenen', 'NP', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1580 W Antelope Dr Ste 290', 'Layton', 'Davis', 'UT', '84041', '8017760880', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1407949415', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870354442', 'PGUTAH318', 'PGUTAH318', 'UT01', 'Rocky Mountain Womens Health Center', 'Linda', 'S', 'Koenen', 'NP', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 844839', 'Dallas', 'Dallas', 'TX', '75284', '8017760880', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1407949415', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH435', 'PGUTAH435', 'UT01', 'Heart and Lung Institute of Utah Inc', 'Brian', 'C', 'Kolski', 'MD', 'Cardiology', '', '', NULL, 'O', '3336 S 4155 W  Ste 203', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1851449896', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH436', 'PGUTAH436', 'UT01', 'Heart and Lung Institute of Utah Inc', 'Brian', 'C', 'Kolski', 'MD', 'Cardiology', '', '', NULL, 'O', '3570 W 9000 S Ste 110', 'West Jordan', 'Salt Lake', 'UT', '84084', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1851449896', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH437', 'PGUTAH437', 'UT01', 'Heart and Lung Institute of Utah Inc', 'Brian', 'C', 'Kolski', 'MD', 'Cardiology', '', '', NULL, 'O', '5979 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1851449896', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH438', 'PGUTAH438', 'UT01', 'Heart and Lung Institute of Utah Inc', 'Brian', 'C', 'Kolski', 'MD', 'Cardiology', '', '', NULL, 'O', '82 S 1100 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1851449896', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH439', 'PGUTAH439', 'UT01', 'Heart and Lung Institute of Utah Inc', 'Brian', 'C', 'Kolski', 'MD', 'Cardiology', '', '', NULL, 'B', 'PO Box 847112', 'Dallas', 'Dallas', 'TX', '75284', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1851449896', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH024', 'PGUTAH024', 'UT01', 'Internal Medicine Specialist - Hospitalists', 'Pinky', '', 'Kotwal', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '3460 Pioneer Pkwy', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643101', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1083645444', 0, 'y', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH025', 'PGUTAH025', 'UT01', 'Pioneer Valley Hospital Physicians', 'Pinky', '', 'Kotwal', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'B', '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013529500', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1083645444', 0, 'Y', 0, '2014-04-29', 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
('621801973', 'PGUTAH010', 'PGUTAH010', 'UT01', 'Salt Lake Regional Physical Therapy', 'Elizabeth', '', 'Kunzer', '', 'Physical Therapy', '', '', NULL, 'O', '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504593', '8013504483', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013142009', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH011', 'PGUTAH011', 'UT01', 'Eccles Health Wellness and Athletic Center', 'Elizabeth', '', 'Kunzer', '', 'Physical Therapy', '', '', NULL, 'O', '1840 S 1300 E', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8018323671', '8013504483', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013142009', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH168', 'PGUTAH168', 'UT01', 'Salt Lake Senior Clinic', 'Keith', 'J', 'Lane', 'MD', 'Internal Medicine', 'Geriatric Medicine', NULL, NULL, 'O', '82 S 1100 E Ste 204', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504602', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1558370361', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH149', 'PGUTAH149', 'UT01', 'Rocky Mountain Womens Health Center at West Valley Campus', 'Stephen', 'D', 'Lash', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '3336 S Pioneer Pkwy Ste 301', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643865', '8019643894', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1447228572', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH150', 'PGUTAH150', 'UT01', 'Rocky Mountain Womens Health Center at West Valley Campus', 'Stephen', 'D', 'Lash', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1447228572', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH259', 'PGUTAH259', 'UT01', 'Jordan Valley Neurology Associates', 'Phuong', '', 'Le', 'LCSW', 'Mental Health', 'Counseling', '', NULL, 'O', '3590 W 9000 S Ste 120', 'West Jordan', 'Salt Lake', 'UT', '84088', '8013528373', '8013528459', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831169341', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH260', 'PGUTAH260', 'UT01', 'Pioneer Valley Hospital Outpatient Behavioral Health Unit', 'Phuong', '', 'Le', 'LCSW', 'Mental Health', 'Counseling', '', NULL, 'O', '4052 W Pioneer Pkwy Ste 105', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643111', '8019643752', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831169341', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH261', 'PGUTAH261', 'UT01', 'Pioneer Valley Hospital Outpatient Behavioral Health Unit', 'Phuong', '', 'Le', 'LCSW', 'Mental Health', 'Counseling', '', NULL, 'M', '406 W South Jordan Pkwy Ste 450', 'South Jordan', 'Salt Lake', 'UT', '84095', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831169341', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH262', 'PGUTAH262', 'UT01', 'Pioneer Valley Hospital Outpatient Behavioral Health Unit', 'Phuong', '', 'Le', 'LCSW', 'Mental Health', 'Counseling', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831169341', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH074', 'PGUTAH074', 'UT01', 'Western Hills Medical Clinic', 'Randal', 'J', 'Lewis', 'MD', 'Family Practice', '', '', NULL, 'O', '5255 S 4015 W Ste 206', 'Salt Lake City', 'Salt Lake', 'UT', '84129', '8019129700', '8019129710', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1215964309', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH075', 'PGUTAH075', 'UT01', 'Physician Group of Utah', 'Randal', 'J', 'Lewis', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1215964309', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH064', 'PGUTAH064', 'UT01', 'Jordan Valley Neurology Associates', 'Nancy', '', 'Lieu', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '3590 W 9000 S Ste 120', 'West Jordan', 'Salt Lake', 'UT', '84088', '8013528373', '8013528459', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205124021', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH065', 'PGUTAH065', 'UT01', 'PVH Outpatient Behavioral Health Unit', 'Nancy', '', 'Lieu', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '4052 W Pioneer Pkwy Ste 105', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643111', '8019643752', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205124021', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH066', 'PGUTAH066', 'UT01', 'Physician Group of Utah', 'Nancy', '', 'Lieu', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'M', '406 W South Jordan Pkwy Ste 450', 'South Jordan', 'Salt Lake', 'UT', '84095', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205124021', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH067', 'PGUTAH067', 'UT01', 'PVH Outpatient Behavioral Health Unit', 'Nancy', '', 'Lieu', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205124021', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH195', 'PGUTAH195', 'UT01', 'Salt Lake Senior Clinic', 'John', 'C', 'Luras', 'MD', 'Internal Medicine', '', '', NULL, 'O', '82 S 1100 E Ste 204', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504602', NULL, '82 S 1100 E Ste 204', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504602', '', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1619084928', 0, 'N', 0, '2014-06-26', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH394', 'PGUTAH394', 'UT01', 'Heart and Lung Institute', 'Bard', 'R', 'Madsen', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3336 S 4155 W Ste 203', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012632370', '8012651200', '3336 S 4155 W Ste 203', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012632370', '8012651200', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-01', '2014-07-01', 0, 0, 0, 'Jordan Valley Medical Center', 'Salt Lake Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1497738074', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH395', 'PGUTAH395', 'UT01', 'Heart and Lung Institute', 'Bard', 'R', 'Madsen', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3570 W 9000 S Ste 110', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012330140', '          ', '3570 W 9000 S Ste 110', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012330140', '          ', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-01', '2014-07-01', 0, 0, 0, 'Jordan Valley Medical Center', 'Salt Lake Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1497738074', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH396', 'PGUTAH396', 'UT01', 'Heart and Lung Institute of Utah Inc', 'Bard', 'R', 'Madsen', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3584 W 9000 S Ste 209', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012632370', '8012651200', '3584 W 9000 S Ste 209', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012632370', '8012651200', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-01', '2014-07-01', 0, 0, 0, 'Jordan Valley Medical Center', 'Salt Lake Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1497738074', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH397', 'PGUTAH397', 'UT01', 'Heart and Lung Institute', 'Bard', 'R', 'Madsen', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '5979 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012632370', '8012651200', '5979 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012632370', '8012651200', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-01', '2014-07-01', 0, 0, 0, 'Jordan Valley Medical Center', 'Salt Lake Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1497738074', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH398', 'PGUTAH398', 'UT01', 'Heart and Lung Institute', 'Bard', 'R', 'Madsen', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '82 S 1100 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8012632370', '8012651200', '82 S 1100 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8012632370', '8012651200', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-01', '2014-07-01', 0, 0, 0, 'Jordan Valley Medical Center', 'Salt Lake Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1497738074', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH399', 'PGUTAH399', 'UT01', 'Heart and Lung Institute', 'Bard', 'R', 'Madsen', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 847112', 'Dallas', 'Dallas', 'TX', '75284', '8012632370', '8012651200', 'PO Box 847112', 'Dallas', 'Dallas', 'TX', '75284', '8012632370', '8012651200', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-01', '2014-07-01', 0, 0, 0, 'Jordan Valley Medical Center', 'Salt Lake Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1497738074', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH014', 'PGUTAH014', 'UT01', 'Salt Lake Regional Medical Center', 'Roger', 'J', 'Martineau', 'MD', 'Psychiatry', '', '', NULL, 'O', '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504111', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063454999', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH015', 'PGUTAH015', 'UT01', 'Davis Hospital & Medical Center', 'Roger', 'J', 'Martineau', 'MD', 'Psychiatry', '', '', NULL, 'O', '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8018203731', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063454999', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH016', 'PGUTAH016', 'UT01', 'Pioneer Valley Hospital', 'Roger', 'J', 'Martineau', 'MD', 'Psychiatry', '', '', NULL, 'O', '3460 S Pioneer Pkwy', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643100', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063454999', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH017', 'PGUTAH017', 'UT01', 'Physician Group of Utah', 'Roger', 'J', 'Martineau', 'MD', 'Psychiatry', '', '', NULL, 'M', '406 W S Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063454999', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH018', 'PGUTAH018', 'UT01', 'Physician Group of Utah', 'Roger', 'J', 'Martineau', 'MD', 'Psychiatry', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063454999', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH378', 'PGUTAH378', 'UT01', 'Heart and Lung Institute', 'David', 'S', 'Massinople', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3336 S 4155 W Ste 203', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012632370', '8012651200', '3336 S 4155 W Ste 203', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012632370', '8012651200', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', 'Salt Lake Regional Medical Center', '', '', 'HCFA|UB|', '1255541785', 0, NULL, 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH379', 'PGUTAH379', 'UT01', 'Heart and Lung Institute', 'David', 'S', 'Massinople', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3570 W 9000 S Ste 110', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012632370', '8012651200', '3570 W 9000 S Ste 110', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012632370', '8012651200', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', 'Salt Lake Regional Medical Center', '', '', 'HCFA|UB|', '1255541785', 0, NULL, 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH380', 'PGUTAH380', 'UT01', 'Heart and Lung Institute of Utah Inc', 'David', 'S', 'Massinople', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3584 W 9000 S Ste 209', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012632370', '8012651200', '3584 W 9000 S Ste 209', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012632370', '8012651200', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', 'Salt Lake Regional Medical Center', '', '', 'HCFA|UB|', '1255541785', 0, NULL, 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH381', 'PGUTAH381', 'UT01', 'Heart and Lung Institute', 'David', 'S', 'Massinople', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '5979 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012632370', '8012651200', '5979 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012632370', '8012651200', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', 'Salt Lake Regional Medical Center', '', '', 'HCFA|UB|', '1255541785', 0, NULL, 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH382', 'PGUTAH382', 'UT01', 'Heart and Lung Institute', 'David', 'S', 'Massinople', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 847112', 'Dallas', 'Dallas', 'TX', '75284', '8012632370', '8012651200', 'PO Box 847112', 'Dallas', 'Dallas', 'TX', '75284', '8012632370', '8012651200', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', 'Salt Lake Regional Medical Center', '', '', 'HCFA|UB|', '1255541785', 0, NULL, 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH021', 'PGUTAH021', 'UT01', 'Specialty Surgery of Utah', 'David', '', 'McCray', 'MD', 'General Surgery', '', '', NULL, 'O', '3336 S 4155 W Ste 306', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643855', '8019643860', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073649836', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH022', 'PGUTAH022', 'UT01', 'Specialty Surgery of Utah', 'David', '', 'McCray', 'MD', 'General Surgery', '', '', NULL, 'M', '406 W S Jordan Pkwy Ste 450', 'South Jordan', 'Salt Lake', 'UT', '84095', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073649836', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH023', 'PGUTAH023', 'UT01', 'Specialty Surgery of Utah', 'David', '', 'McCray', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019643855', '8019643860', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073649836', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH062', 'PGUTAH062', 'UT01', 'Salt Lake Regional Medical Associates', 'Nancy', 'L', 'McLaughlin', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '24 S 1100 E Ste 304', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015214500', '8013591665', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1184633661', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH063', 'PGUTAH063', 'UT01', 'Salt Lake Regional Medical Associates', 'Nancy', 'L', 'McLaughlin', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1184633661', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH296', 'PGUTAH296', 'UT01', 'Salt Lake Regional Medical Center', 'Caroline', '', 'Merveille', 'MD', 'Psychiatry', '', '', NULL, 'O', '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504111', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972512721', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH297', 'PGUTAH297', 'UT01', 'Davis Hospital and Medical Center', 'Caroline', '', 'Merveille', 'MD', 'Psychiatry', '', '', NULL, 'O', '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8018071000', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972512721', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH298', 'PGUTAH298', 'UT01', 'Pioneer Valley Hospital', 'Caroline', '', 'Merveille', 'MD', 'Psychiatry', '', '', NULL, 'O', '3460 S Pioneer Pkwy 5th Floor', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643100', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972512721', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH299', 'PGUTAH299', 'UT01', 'Physician Group of Utah Inc', 'Caroline', '', 'Merveille', 'MD', 'Psychiatry', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972512721', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH361', 'PGUTAH361', 'UT01', 'Heart and Lung Institute', 'James', 'J', 'Milavetz', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '3336 S 4155 W Ste 203', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', 'Salt Lake Regional Medical Center', 'Jordan Valley Medical Center', NULL, 'HCFA|UB|', '1154316206', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH362', 'PGUTAH362', 'UT01', 'Heart and Lung Institute', 'James', 'J', 'Milavetz', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '3570 W 9000 S Ste 110', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', 'Salt Lake Regional Medical Center', 'Jordan Valley Medical Center', NULL, 'HCFA|UB|', '1154316206', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH363', 'PGUTAH363', 'UT01', 'Heart and Lung Institute of Utah Inc', 'James', 'J', 'Milavetz', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '3584 W 9000 S Ste 209', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', 'Salt Lake Regional Medical Center', 'Jordan Valley Medical Center', NULL, 'HCFA|UB|', '1154316206', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH364', 'PGUTAH364', 'UT01', 'Heart and Lung Institute', 'James', 'J', 'Milavetz', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '5979 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', 'Salt Lake Regional Medical Center', 'Jordan Valley Medical Center', NULL, 'HCFA|UB|', '1154316206', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH365', 'PGUTAH365', 'UT01', 'Heart and Lung Institute', 'James', 'J', 'Milavetz', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '82 S 1100 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', 'Salt Lake Regional Medical Center', 'Jordan Valley Medical Center', NULL, 'HCFA|UB|', '1154316206', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH366', 'PGUTAH366', 'UT01', 'Heart and Lung Institute', 'James', 'J', 'Milavetz', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'B', 'PO Box 847112', 'Dallas', 'Dallas', 'TX', '75284', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', 'Salt Lake Regional Medical Center', 'Jordan Valley Medical Center', NULL, 'HCFA|UB|', '1154316206', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH045', 'PGUTAH045', 'UT01', 'West Valley Family Medicine ', 'Charles', 'W', 'Miller', '', 'Family Practice', '', '', NULL, 'O', '4052 W Pioneer Pkwy Ste 109', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019128230', '8012857222', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', NULL, NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144340530', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH046', 'PGUTAH046', 'UT01', 'West Valley Family Medicine ', 'Charles', 'W', 'Miller', '', 'Family Practice', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', NULL, NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144340530', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH047', 'PGUTAH047', 'UT01', 'Center of Orthopedic and Rehabiliation Excellence', 'Traske', 'M', 'Muir', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '3580 W 9000 S Ste 405', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015683480', '8015683482', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1144369935', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH048', 'PGUTAH048', 'UT01', 'Physician Group of Utah Inc', 'Traske', 'M', 'Muir', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1144369935', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH068', 'PGUTAH068', 'UT01', 'Internal Medicine of Salt Lake ', 'Anthony', 'G', 'Musci', '', 'Internal Medicine', '', '', NULL, 'O', '2645 E Parleys Way Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8013844700', '8013844733', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1205853173', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH069', 'PGUTAH069', 'UT01', 'Internal Medicine of Salt Lake ', 'Anthony', 'G', 'Musci', '', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1205853173', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH235', 'PGUTAH235', 'UT01', 'Physician Group of Utah', 'Jeanette', 'C', 'Nelson', 'PA-C', 'Family Practice', '', '', NULL, 'O', '4888 S Highland Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8014245042', '8012938618', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730481912', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH236', 'PGUTAH236', 'UT01', 'Physician Group of Utah', 'Jeanette', 'C', 'Nelson', 'PA-C', 'Family Practice', '', '', NULL, 'O', '9350 S 150 E Ste 460', 'Sandy', 'Salt Lake', 'UT', '84070', '8014245042', '8012938618', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730481912', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH237', 'PGUTAH237', 'UT01', 'Physician Group of Utah', 'Jeanette', 'C', 'Nelson', 'PA-C', 'Family Practice', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730481912', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH086', 'PGUTAH086', 'UT01', 'Physician Group of Utah Inc', 'John', 'S', 'Oglesby', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2295 S Foothill Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8012147650', '8012147651', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1245385962', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH087', 'PGUTAH087', 'UT01', 'Physician Group of Utah Inc', 'John', 'S', 'Oglesby', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '6360 S 3000 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012147650', '8013651033', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1245385962', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH088', 'PGUTAH088', 'UT01', 'Salt Lake Regional Womens Center', 'John', 'S', 'Oglesby', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '82 S 1100 E Ste 305', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8012147650', '8012147651', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1245385962', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH089', 'PGUTAH089', 'UT01', 'Physician Group of Utah Inc', 'John', 'S', 'Oglesby', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '9350 S 150 E Ste 150', 'Sandy', 'Salt Lake', 'UT', '84070', '8012147650', '8012147651', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1245385962', 0, 'Y', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH090', 'PGUTAH090', 'UT01', 'Salt Lake Regional Womens Clinic', 'John', 'S', 'Oglesby', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1245385962', 0, 'y', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH072', 'PGUTAH072', 'UT01', 'Herriman Medical Clinic', 'Karen', '', 'Olson', '', 'Family Practice', '', '', NULL, 'O', '5746 W 13400 S Ste 200', 'Herriman', 'Salt Lake', 'UT', '84096', '8019877500', '8019877539', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1215154232', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH073', 'PGUTAH073', 'UT01', 'Herriman Medical Clinic', 'Karen', '', 'Olson', '', 'Family Practice', '', '', NULL, 'B', 'Po Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1215154232', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH345', 'PGUTAH345', 'UT01', 'Heart And Lung Institute', 'Sunny', '', 'Pandita', 'MD', 'Pulmonary', 'Sleep Medicine', 'Critical Care', NULL, 'B', '5979 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012632370', '8012648407', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023095809', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH302', 'PGUTAH302', 'UT01', 'Lonnie Paulos MD', 'Leon (Lonnie)', 'E', 'Paulos', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '6415 S 3000 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8014662676', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1992700330', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH303', 'PGUTAH303', 'UT01', 'Lonnie Paulos MD', 'Leon (Lonnie)', 'E', 'Paulos', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1992700330', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH383', 'PGUTAH383', 'UT01', 'Heart and Lung Institute of Utah', 'Wei', '', 'Peng', 'MD', 'Cardiovascular Disease', 'Hospitalist', 'Internal Medicine', NULL, 'O', '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1295831865', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH384', 'PGUTAH384', 'UT01', 'Heart and Lung Institute of Utah', 'Wei', '', 'Peng', 'MD', 'Cardiovascular Disease', 'Hospitalist', 'Internal Medicine', NULL, 'O', '3460 S Pioneer Pkwy', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1295831865', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH385', 'PGUTAH385', 'UT01', 'Heart and Lung Institute of Utah', 'Wei', '', 'Peng', 'MD', 'Cardiovascular Disease', 'Hospitalist', 'Internal Medicine', NULL, 'O', '3580 W 9000 S Ste 110', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1295831865', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH386', 'PGUTAH386', 'UT01', 'Heart and Lung Institute of Utah', 'Wei', '', 'Peng', 'MD', 'Cardiovascular Disease', 'Hospitalist', 'Internal Medicine', NULL, 'M', '5979 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012632370', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1295831865', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH387', 'PGUTAH387', 'UT01', 'Heart and Lung Institute of Utah', 'Wei', '', 'Peng', 'MD', 'Cardiovascular Disease', 'Hospitalist', 'Internal Medicine', NULL, 'B', 'PO Box 847112', 'Dallas', 'Dallas', 'TX', '75284', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1295831865', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH139', 'PGUTAH139', 'UT01', 'Rock Run Medical', 'Darlene', '', 'Petersen', 'MD', 'Family Practice', '', '', NULL, 'B', '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8017732838', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1376744433', 0, 'y', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH140', 'PGUTAH140', 'UT01', 'Rock Run Medical', 'Darlene', '', 'Petersen', 'MD', 'Family Practice', '', '', NULL, 'O', '5991 S 3500 W Ste 400', 'Roy', 'Weber', 'UT', '84067', '8017732838', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1376744433', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH143', 'PGUTAH143', 'UT01', 'Davis Medical Group', 'Steven', 'J', 'Potter', 'MD', 'Family Practice', '', '', NULL, 'O', '124 S Fairfield Rd', 'Layton', 'Davis', 'UT', '84041', '8019273080', '8019273088', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1407922446', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH144', 'PGUTAH144', 'UT01', 'Davis Medical Group', 'Steven', 'J', 'Potter', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1407922446', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH076', 'PGUTAH076', 'UT01', 'Salt Lake Senior Clinic - Jordan Commons', 'Tanya', 'K', 'Powel', 'MD', 'Internal Medicine', '', '', NULL, 'O', '9350 S 150 E Ste 150', 'Sandy', 'Salt Lake', 'UT', '84070', '8019843418', '8019848281', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1235265802', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH077', 'PGUTAH077', 'UT01', 'Salt Lake Senior Clinic - Jordan Commons', 'Tanya', 'K', 'Powel', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1235265802', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH219', 'PGUTAH219', 'UT01', 'Salt Lake Senior Clinic - Jordan Commons', 'Robert', '', 'Powell', 'MD', 'Geriatrics', 'Internal Medicine', '', NULL, 'O', '9350 S 150 E Ste 150', 'Sandy', 'Salt Lake', 'UT', '84070', '8019035666', '8019848281', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1700988656', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH220', 'PGUTAH220', 'UT01', 'Salt Lake Senior Clinic - Jordan Commons', 'Robert', '', 'Powell', 'MD', 'Geriatrics', 'Internal Medicine', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1700988656', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH193', 'PGUTAH193', 'UT01', 'Rock Run Medical', 'Kevin', '', 'Rarick', 'PA', 'Family Practice', NULL, NULL, NULL, 'O', '5991 S 3500 W Ste 400', 'Roy', 'Weber', 'UT', '84067', '8017732838', '8017733025', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1609971506', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH194', 'PGUTAH194', 'UT01', 'Physician Group of Utah Inc', 'Kevin', '', 'Rarick', 'PA', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1609971506', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH425', 'PGUTAH425', 'UT01', 'Heart and Lung Institute of Utah', 'James', 'A', 'Rasmussen', 'MD', 'Pulmonary', 'Internal Medicine', 'Critical Care', NULL, 'O', '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1770661712', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH426', 'PGUTAH426', 'UT01', 'Heart and Lung Institute of Utah', 'James', 'A', 'Rasmussen', 'MD', 'Pulmonary', 'Internal Medicine', 'Critical Care', NULL, 'O', '3460 S Pioneer Pkwy', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1770661712', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH427', 'PGUTAH427', 'UT01', 'Heart and Lung Institute of Utah', 'James', 'A', 'Rasmussen', 'MD', 'Pulmonary', 'Internal Medicine', 'Critical Care', NULL, 'O', '3580 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1770661712', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH428', 'PGUTAH428', 'UT01', 'Heart and Lung Institute of Utah', 'James', 'A', 'Rasmussen', 'MD', 'Pulmonary', 'Internal Medicine', 'Critical Care', NULL, 'M', '5979 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1770661712', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH429', 'PGUTAH429', 'UT01', 'Heart and Lung Institute of Utah', 'James', 'A', 'Rasmussen', 'MD', 'Pulmonary', 'Internal Medicine', 'Critical Care', NULL, 'B', 'PO Box 847112', 'Dallas', 'Dallas', 'TX', '75284', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1770661712', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH406', 'PGUTAH406', 'UT01', 'Heart And Lung Institute of Utah', 'Chakravarthy', 'B', 'Reddy', 'MD', 'Pulmonary', 'Critical Care Medicine', '', NULL, 'O', '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1508962176', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH407', 'PGUTAH407', 'UT01', 'Heart And Lung Institute of Utah', 'Chakravarthy', 'B', 'Reddy', 'MD', 'Pulmonary', 'Critical Care Medicine', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1508962176', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH408', 'PGUTAH408', 'UT01', 'Heart and Lung Institute of Utah', 'Chakravarthy', 'B', 'Reddy', 'MD', 'Pulmonary', 'Critical Care Medicine', '', NULL, 'M', '5979 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1508962176', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH409', 'PGUTAH409', 'UT01', 'Heart and Lung Institute of Utah', 'Chakravarthy', 'B', 'Reddy', 'MD', 'Pulmonary', 'Critical Care Medicine', '', NULL, 'B', 'PO Box 847112', 'Dallas', 'Dallas', 'TX', '75284', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1508962176', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH202', 'PGUTAH202', 'UT01', 'Jordan Valley Neurology', 'Rebecca', 'H', 'Reiser', 'MD', 'Neurology', '', '', NULL, 'O', '3590 W 9000 S Ste 240', 'West Jordan', 'Salt Lake', 'UT', '84088', '8013528373', '8013528459', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639336795', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH203', 'PGUTAH203', 'UT01', 'Jordan Valley Neurology Associates', 'Rebecca', 'H', 'Reiser', 'MD', 'Neurology', '', '', NULL, 'O', '3665 S 8400 W Ste 206', 'Magna', 'Salt Lake', 'UT', '84044', '8013528373', '8013528459', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639336795', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH204', 'PGUTAH204', 'UT01', 'Neurology Associates in Assoc with JVMC', 'Rebecca', 'H', 'Reiser', 'MD', 'Neurology', '', '', NULL, 'M', '406 W S Jordan Pkwy Ste 450', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013528373', '8013528459', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639336795', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH205', 'PGUTAH205', 'UT01', 'Neurology Associates in Assoc with JVMC', 'Rebecca', 'H', 'Reiser', 'MD', 'Neurology', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639336795', 0, 'N', 0, '2014-04-29', 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
('621801973', 'PGUTAH097', 'PGUTAH097', 'UT01', 'Rock Run Medical', 'Brannick', 'B', 'Riggs', 'MD', 'Family Practice', '', '', NULL, 'B', '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8016014420', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1255324984', 0, 'Y', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH098', 'PGUTAH098', 'UT01', 'Rock Run Medical', 'Brannick', 'B', 'Riggs', 'MD', 'Family Practice', '', '', NULL, 'O', '5991 S 3500 W Ste 400', 'Roy', 'Weber', 'UT', '84067', '8017732838', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1255324984', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH037', 'PGUTAH037', 'UT01', NULL, 'Zoe', '', 'Robbins', 'APRN', 'Neurology', '', '', NULL, 'O', '3460 S Pioneer Pkwy 5th Fl', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643100', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134321508', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH038', 'PGUTAH038', 'UT01', 'Jordan Valley Neurology Associates', 'Zoe', '', 'Robbins', 'APRN', 'Neurology', '', '', NULL, 'O', '3590 W 9000 S Ste 120', 'West Jordan', 'Salt Lake', 'UT', '84088', '8013528373', '8013528459', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134321508', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH039', 'PGUTAH039', 'UT01', 'Pioneer Valley Hospital Outpatient Behavioral Health Unit', 'Zoe', '', 'Robbins', 'APRN', 'Neurology', '', '', NULL, 'O', '4052 W Pioneer Pkwy Ste 105', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643111', '8019643752', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134321508', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH040', 'PGUTAH040', 'UT01', 'Pioneer Valley Hospital Outpatient Behavioral Health Unit', 'Zoe', '', 'Robbins', 'APRN', 'Neurology', '', '', NULL, 'B', 'PO Box 281201', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134321508', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH128', 'PGUTAH128', 'UT01', 'Physician Group of Utah Inc', 'Scott', '', 'Robins', 'DO', 'Family Practice', '', '', NULL, 'M', '406 W South Jordan Pkwy Ste 450', 'South Jordan', 'Salt Lake', 'UT', '84095', '8019643697', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1346495678', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH129', 'PGUTAH129', 'UT01', 'Western Hills Medical Clinic', 'Scott', '', 'Robins', 'DO', 'Family Practice', '', '', NULL, 'O', '5255 S 4015 W Ste 206', 'Salt Lake City', 'Salt Lake', 'UT', '84129', '8019129700', '8019129710', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1346495678', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH130', 'PGUTAH130', 'UT01', 'Physician Group of Utah Inc', 'Scott', '', 'Robins', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1346495678', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH057', 'PGUTAH057', 'UT01', 'Copper Canyon Womens Center', 'Mindy', '', 'Ruhlman', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3336 S Pioneer Pkwy Ste 301', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643865', '8019643894', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', 'Jordan Valley Medical Center', '', '', 'HCFA|UB|', '1164453536', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH058', 'PGUTAH058', 'UT01', 'Physician Group of Utah Inc', 'Mindy', '', 'Ruhlman', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', 'Jordan Valley Medical Center', '', '', 'HCFA|UB|', '1164453536', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH119', 'PGUTAH119', 'UT01', NULL, 'Merium', 'K', 'Saidi', 'MD', 'Pediatrics', '', '', NULL, 'O', '4052 W Pioneer Pkwy Ste 205', 'West Valley', 'Salt Lake', 'UT', '84120', '8019643492', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336314145', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH120', 'PGUTAH120', 'UT01', NULL, 'Merium', 'K', 'Saidi', 'MD', 'Pediatrics', '', '', NULL, 'B', '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8019643492', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336314145', 0, 'y', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH304', 'PGUTAH304', 'UT01', 'Summit Family Medicine', 'Allen', NULL, 'Salem', 'MD', 'Pulmonary', 'Sleep Medicine', '', NULL, 'O', '1492 W Antelope Dr Ste 203', 'Layton', 'Davis', 'UT', '84041', '8017737500', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1992797088', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH305', 'PGUTAH305', 'UT01', 'Summit Family Medicine', 'Allen', NULL, 'Salem', 'MD', 'Pulmonary', 'Sleep Medicine', '', NULL, 'O', '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8018071000', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1992797088', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH306', 'PGUTAH306', 'UT01', 'Heritage Park Care Center', 'Allen', NULL, 'Salem', 'MD', 'Pulmonary', 'Sleep Medicine', '', NULL, 'O', '2700 W 5600 S', 'Roy', 'Weber', 'UT', '84067', '8018259731', '8011728422', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1992797088', 0, 'Y', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH307', 'PGUTAH307', 'UT01', 'South Davis Community Hospital', 'Allen', NULL, 'Salem', 'MD', 'Pulmonary', 'Sleep Medicine', '', NULL, 'O', '401 S 400 E', 'Bountiful', 'Davis', 'UT', '84010', '8012952361', '8012945877', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1992797088', 0, 'Y', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH308', 'PGUTAH308', 'UT01', 'Summit Family Medicine', 'Allen', NULL, 'Salem', 'MD', 'Pulmonary', 'Sleep Medicine', '', NULL, 'B', 'Po Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1992797088', 0, 'Y', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH169', 'PGUTAH169', 'UT01', 'Physician Group of Utah Inc', 'Jessica', 'Maria ', 'Salinas', '', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2295 S Foothill Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8012147650', '8014872894', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1568662567', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH170', 'PGUTAH170', 'UT01', 'Salt Lake Regional Womens Center ', 'Jessica', 'Maria ', 'Salinas', '', 'Obstetrics and Gynecology', '', '', NULL, 'O', '24 S 1100 E Ste 209', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8012147650', '8012147651', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1568662567', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH171', 'PGUTAH171', 'UT01', 'Physician Group of Utah Inc', 'Jessica', 'Maria ', 'Salinas', '', 'Obstetrics and Gynecology', '', '', NULL, 'O', '6360 S 3000 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012147650', '8013651033', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1568662567', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH172', 'PGUTAH172', 'UT01', 'Physician Group of Utah Inc', 'Jessica', 'Maria ', 'Salinas', '', 'Obstetrics and Gynecology', '', '', NULL, 'O', '9350 S 150 E Ste 150', 'Sandy', 'Salt Lake', 'UT', '84070', '8012147650', '8012147651', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1568662567', 0, 'Y', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH173', 'PGUTAH173', 'UT01', 'Salt Lake Regional Womens Center ', 'Jessica', 'Maria ', 'Salinas', '', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1568662567', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH054', 'PGUTAH054', 'UT01', 'Davis Internal Medicine', 'Emily', 'E', 'Sandberg', 'PA-C', 'Family Practice', '', '', NULL, 'O', '1492 W Antelope Dr Ste 203', 'Layton', 'Davis', 'UT', '84041', '8017737500', '8017737800', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1164440665', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH055', 'PGUTAH055', 'UT01', 'Legacy Point Family Medicine Center', 'Emily', 'E', 'Sandberg', 'PA-C', 'Family Practice', '', '', NULL, 'O', '3110 W 300 N Ste A', 'West Point', 'Davis', 'UT', '84015', '8016145140', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1164440665', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH056', 'PGUTAH056', 'UT01', 'Legacy Point Family Medicine Center', 'Emily', 'E', 'Sandberg', 'PA-C', 'Family Practice', '', '', NULL, 'B', '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8016145140', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1164440665', 0, 'y', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH080', 'PGUTAH080', 'UT01', 'Internal Medicine Specialist - Hospitalists', 'Kenneth', 'L', 'Schaecher', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3460 Pioneer Pkwy', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643101', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1245262492', 0, 'y', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH081', 'PGUTAH081', 'UT01', 'Pioneer Valley Hospital Physicians', 'Kenneth', 'L', 'Schaecher', 'MD', 'Internal Medicine', '', '', NULL, 'B', '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013529500', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1245262492', 0, 'Y', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH102', 'PGUTAH102', 'UT01', 'Salt Lake Senior Clinic', 'Alison', '', 'Schlisman', 'MD', 'Geriatrics', 'Internal Medicine', '', NULL, 'B', '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8019843418', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1265534887', 0, 'Y', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH103', 'PGUTAH103', 'UT01', 'Salt Lake Senior Clinic', 'Alison', '', 'Schlisman', 'MD', 'Geriatrics', 'Internal Medicine', '', NULL, 'O', '82 S 1100 E Ste 204', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504602', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1265534887', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH109', 'PGUTAH109', 'UT01', 'North Pointe Medical Clinic', 'Hilary', 'S', 'Seibert', 'DO', 'Family Practice', NULL, NULL, NULL, 'O', '2376 N 400 E Ste 203', 'Tooele', 'Tooele', 'UT', '84074', '4358330206', '4358330205', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275623894', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH110', 'PGUTAH110', 'UT01', 'North Pointe Medical Clinic', 'Hilary', 'S', 'Seibert', 'DO', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 281415 Ste 203', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275623894', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH111', 'PGUTAH111', 'UT01', 'Davis Urgent Care', 'Ernest', '', 'Severn', 'DO', 'Family Practice', '', '', NULL, 'O', '124 S Fairfield Rd', 'Layton', 'Davis', 'UT', '84041', '8019273099', '8019273088', '124 S Fairfield Rd', 'Layton', 'Davis', 'UT', '84041', '8019273099', '8019273088', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1326080847', 0, 'N', 0, '2014-06-17', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH112', 'PGUTAH112', 'UT01', 'Davis Urgent Care', 'Ernest', '', 'Severn', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1326080847', 0, 'N', 0, '2014-06-17', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH078', 'PGUTAH078', 'UT01', 'Davis Urgent Care ', 'Kimberly', 'Elyce', 'Simpson', 'NP', 'Family Practice', '', '', NULL, 'O', '124 S Fairfield Rd', 'Layton', 'Davis', 'UT', '84041', '8019273099', '8019273088', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235488917', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH079', 'PGUTAH079', 'UT01', 'Physician Group of Utah, Inc', 'Kimberly', 'Elyce', 'Simpson', 'NP', 'Family Practice', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235488917', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH274', 'PGUTAH274', 'UT01', 'Jordan Valley Internal Medicine', 'Lora', '', 'Slabodkina', '', 'Internal Medicine', '', '', NULL, 'O', '3570 W 9000 S Ste 100', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015692384', '8015698643', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1881646149', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH275', 'PGUTAH275', 'UT01', 'Jordan Valley Internal Medicine', 'Lora', '', 'Slabodkina', '', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1881646149', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH254', 'PGUTAH254', 'UT01', 'Physician Group of Utah Inc', 'Andrea', 'N', 'Smith', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2295 S Foothill Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8012147650', '8014872894', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1831155746', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH255', 'PGUTAH255', 'UT01', 'Physicians Group of Utah', 'Andrea', 'N', 'Smith', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '24 S 1100 E Ste 209', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8012147650', '8012147651', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1831155746', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH256', 'PGUTAH256', 'UT01', 'Physician Group of Utah Inc', 'Andrea', 'N', 'Smith', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '6360 S 3000 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012147650', '8013651033', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1831155746', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH257', 'PGUTAH257', 'UT01', 'Physician Group of Utah Inc', 'Andrea', 'N', 'Smith', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '9350 S 150 E Ste 150', 'Sandy', 'Salt Lake', 'UT', '84070', '8012147650', '8012147651', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1831155746', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH258', 'PGUTAH258', 'UT01', 'Physicians Group of Utah', 'Andrea', 'N', 'Smith', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1831155746', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH430', 'PGUTAH430', 'UT01', 'Heart and Lung Institute', 'Stephen', 'A', 'Spurlock', 'PA-C', 'Pulmonary', '', '', NULL, 'O', '3336 S 4155 W Ste 203', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790093201', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH431', 'PGUTAH431', 'UT01', 'Heart And Lung Institute', 'Stephen', 'A', 'Spurlock', 'PA-C', 'Pulmonary', '', '', NULL, 'O', '3570 W 9000 S Ste 110', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790093201', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH432', 'PGUTAH432', 'UT01', 'Heart and Lung Institute', 'Stephen', 'A', 'Spurlock', 'PA-C', 'Pulmonary', '', '', NULL, 'O', '5979 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790093201', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH433', 'PGUTAH433', 'UT01', 'Heart and Lung Institute', 'Stephen', 'A', 'Spurlock', 'PA-C', 'Pulmonary', '', '', NULL, 'O', '82 S 1100 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790093201', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH434', 'PGUTAH434', 'UT01', 'Heart and Lung Institute', 'Stephen', 'A', 'Spurlock', 'PA-C', 'Pulmonary', '', '', NULL, 'B', 'PO Box 847112', 'Dallas', 'Dallas', 'TX', '75284', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790093201', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH221', 'PGUTAH221', 'UT01', NULL, 'Jean', '', 'Stanford', 'PA-C', 'Psychiatry', '', '', NULL, 'O', '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504111', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710037213', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH222', 'PGUTAH222', 'UT01', NULL, 'Jean', '', 'Stanford', 'PA-C', 'Psychiatry', '', '', NULL, 'O', '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8018203731', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710037213', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH223', 'PGUTAH223', 'UT01', NULL, 'Jean', '', 'Stanford', 'PA-C', 'Psychiatry', '', '', NULL, 'O', '3460 S Pioneer Pkwy', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643100', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710037213', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH224', 'PGUTAH224', 'UT01', 'Physician Group of Utah', 'Jean', '', 'Stanford', 'PA-C', 'Psychiatry', '', '', NULL, 'M', '406 W South Jordan Pkwy Ste 450', 'South Jordan', 'Salt Lake', 'UT', '84095', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710037213', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH225', 'PGUTAH225', 'UT01', 'Physician Group of Utah', 'Jean', '', 'Stanford', 'PA-C', 'Psychiatry', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710037213', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH145', 'PGUTAH145', 'UT01', 'Davis Comp Health', 'Robert', '', 'Stauffer', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8018077377', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1427109685', 0, 'Y', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH146', 'PGUTAH146', 'UT01', 'Davis Comp Health', 'Robert', '', 'Stauffer', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8018077377', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1427109685', 0, 'y', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH095', 'PGUTAH095', 'UT01', 'Rocky Mountain Womens Health Center at West Valley Campus', 'Gayle', '', 'Stewart', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3336 S Pioneer Pkwy Ste 301', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643865', '8019643894', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1255300331', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH096', 'PGUTAH096', 'UT01', 'Rocky Mountain Womens Health Center at West Valley Campus', 'Gayle', '', 'Stewart', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1255300331', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH410', 'PGUTAH410', 'UT01', 'Heart and Lung Institute', 'James', 'C', 'Stringham', 'MD', 'Cardiovascular Disease', 'Pulmonary', NULL, NULL, 'O', '3336 S 4155 W  Ste 203', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1538182449', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH411', 'PGUTAH411', 'UT01', 'Heart and Lung Institute', 'James', 'C', 'Stringham', 'MD', 'Cardiovascular Disease', 'Pulmonary', NULL, NULL, 'O', '3570 W 9000 S Ste 110', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1538182449', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH412', 'PGUTAH412', 'UT01', 'Heart and Lung Institute of Utah', 'James', 'C', 'Stringham', 'MD', 'Cardiovascular Disease', 'Pulmonary', NULL, NULL, 'O', '5979 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1538182449', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH413', 'PGUTAH413', 'UT01', 'Heart and Lung Institute of Utah', 'James', 'C', 'Stringham', 'MD', 'Cardiovascular Disease', 'Pulmonary', NULL, NULL, 'O', '82 S 1100 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1538182449', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH414', 'PGUTAH414', 'UT01', 'Heart and Lung Institute', 'James', 'C', 'Stringham', 'MD', 'Cardiovascular Disease', 'Pulmonary', NULL, NULL, 'B', 'PO Box 847112', 'Dallas', 'Dallas', 'TX', '75284', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1538182449', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH265', 'PGUTAH265', 'UT01', 'Davis Hospital & Medical Center', 'Zachary', '', 'Stucki', '', 'Psychiatry', '', '', NULL, 'O', '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8018071000', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831343292', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH266', 'PGUTAH266', 'UT01', 'Pioneer Valley Hospital', 'Zachary', '', 'Stucki', '', 'Psychiatry', '', '', NULL, 'O', '3460 S Pioneer Pkwy', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643100', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831343292', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH267', 'PGUTAH267', 'UT01', 'Physician Group of Utah', 'Zachary', '', 'Stucki', '', 'Psychiatry', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831343292', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH269', 'PGUTAH269', 'UT01', 'Salt Lake Senior Clinic - Jordan Commons', 'Nikki', '', 'Switzer', 'MD', 'Geriatrics', 'Internal Medicine', '', NULL, 'O', '9350 S 150 E Ste 150', 'Sandy', 'Salt Lake', 'UT', '84070', '8013504602', '8013504753', '9350 S 150 E Ste 150', 'Sandy', 'Salt Lake', 'UT', '84070', '8013504602', '8013504753', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1851468367', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH270', 'PGUTAH270', 'UT01', 'Salt Lake Senior Clinic - Jordan Commons', 'Nikki', '', 'Switzer', 'MD', 'Geriatrics', 'Internal Medicine', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1851468367', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH164', 'PGUTAH164', 'UT01', 'Salt Lake Regional Medical Associates', 'Lorraine', 'B', 'Szczesny', 'MD', 'Internal Medicine', '', '', NULL, 'O', '24 S 1100 E Ste 304', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015214500', '8013591665', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518022896', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH165', 'PGUTAH165', 'UT01', 'Salt Lake Regional Medical Associates', 'Lorraine', 'B', 'Szczesny', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518022896', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH400', 'PGUTAH400', 'UT01', 'Heart and Lung Institute', 'Konstantyn', 'Y', 'Szwajkun', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3336 S 4155 W Ste 203', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', 'Salt Lake Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1508849191', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH401', 'PGUTAH401', 'UT01', 'Heart and Lung Institute', 'Konstantyn', 'Y', 'Szwajkun', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3570 W 9000 S Ste 110', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012330140', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', 'Salt Lake Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1508849191', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH402', 'PGUTAH402', 'UT01', 'Heart and Lung Institute of Utah Inc', 'Konstantyn', 'Y', 'Szwajkun', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3584 W 9000 S Ste 209', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', 'Salt Lake Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1508849191', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH403', 'PGUTAH403', 'UT01', 'Heart and Lung Institute', 'Konstantyn', 'Y', 'Szwajkun', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '5979 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', 'Salt Lake Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1508849191', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH404', 'PGUTAH404', 'UT01', 'Heart and Lung Institute', 'Konstantyn', 'Y', 'Szwajkun', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '82 S 1100 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', 'Salt Lake Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1508849191', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH405', 'PGUTAH405', 'UT01', 'Heart and Lung Institute', 'Konstantyn', 'Y', 'Szwajkun', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 847112', 'Dallas', 'Dallas', 'TX', '75284', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', 'Salt Lake Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1508849191', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH196', 'PGUTAH196', 'UT01', 'Jordan Parkway  Medical Clinic ', 'Rebecca', 'P', 'Tanner', '', 'Internal Medicine', '', '', NULL, 'O', '1325 W South Jordan Pkwy Ste 102', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015083111', '8015083105', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1629050067', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH197', 'PGUTAH197', 'UT01', 'Jordan Parkway  Medical Clinic ', 'Rebecca', 'P', 'Tanner', '', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1629050067', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH415', 'PGUTAH415', 'UT01', 'Heart and Lung Institute of Utah', 'Navin', 'S', 'Thakur', 'MD', 'Cardiovascular Disease', 'Thoracic Surgery', 'Vascular Surgery', NULL, 'O', '3336 S 4155 W Ste 203', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639146566', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH416', 'PGUTAH416', 'UT01', 'Heart and Lung Institute of Utah', 'Navin', 'S', 'Thakur', 'MD', 'Cardiovascular Disease', 'Thoracic Surgery', 'Vascular Surgery', NULL, 'O', '3570 W 9000 S Ste 110', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639146566', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH417', 'PGUTAH417', 'UT01', 'Heart and Lung Institute of Utah', 'Navin', 'S', 'Thakur', 'MD', 'Cardiovascular Disease', 'Thoracic Surgery', 'Vascular Surgery', NULL, 'O', '5979 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639146566', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH418', 'PGUTAH418', 'UT01', 'Heart and Lung Institute of Utah', 'Navin', 'S', 'Thakur', 'MD', 'Cardiovascular Disease', 'Thoracic Surgery', 'Vascular Surgery', NULL, 'O', '82 S 1100 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639146566', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH419', 'PGUTAH419', 'UT01', 'Heart and Lung Institute of Utah', 'Navin', 'S', 'Thakur', 'MD', 'Cardiovascular Disease', 'Thoracic Surgery', 'Vascular Surgery', NULL, 'B', 'PO Box 847112', 'Dallas', 'Dallas', 'TX', '75284', '8012632370', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639146566', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH166', 'PGUTAH166', 'UT01', '(Practice emphasis on Sports Medicine)', 'Russell', 'A', 'Toronto', 'MD', 'General Practice', '', '', NULL, 'B', '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8014245042', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1528005618', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH167', 'PGUTAH167', 'UT01', 'Oval Sports Medicine (Practice emphasis on Sports Medicine)', 'Russell', 'A', 'Toronto', 'MD', 'General Practice', '', '', NULL, 'O', '5662 S Cougar Ln Ste 311', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8019128210', '8019128209', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1528005618', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH245', 'PGUTAH245', 'UT01', 'Just Kids Pediatrics & Adolescent Clinic', 'Ericka', 'K', 'Tse', 'PA-C', 'Family Practice', '', '', NULL, 'O', '3336 S 4155 W Ste 204', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643492', '8019643493', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750650586', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH246', 'PGUTAH246', 'UT01', 'Just Kids Pediatrics & Adolescent Clinic', 'Ericka', 'K', 'Tse', 'PA-C', 'Family Practice', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750650586', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH184', 'PGUTAH184', 'UT01', 'Davis Comp Health', 'Bradley', 'A', 'Urie', 'MD', 'Pain Management', '', '', NULL, 'O', '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8017737500', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1588688360', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH185', 'PGUTAH185', 'UT01', 'Davis Comp Health', 'Bradley', 'A', 'Urie', 'MD', 'Pain Management', '', '', NULL, 'B', '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8017737500', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1588688360', 0, 'y', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH186', 'PGUTAH186', 'UT01', 'West Valley Family Medicine', 'Christopher', 'Burgon', 'Valentine', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '3336 S 4155 W Ste 202', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019128230', '8012857222', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1598753501', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH187', 'PGUTAH187', 'UT01', 'Sandy Ridge Family Medicine', 'Christopher', 'Burgon', 'Valentine', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '8706 S 700 E Ste 105', 'Sandy', 'Salt Lake', 'UT', '84094', '8015083160', '8015083165', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1598753501', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH188', 'PGUTAH188', 'UT01', 'West Valley Family Medicine', 'Christopher', 'Burgon', 'Valentine', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1598753501', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12017339', 'W12017339', 'UT01', 'Salt Lake Senior Center', 'George', 'J', 'Van Komen', '', 'Internal Medicine', NULL, NULL, NULL, 'O', '82 S 1100 E Ste 204', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504602', '8013504753', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-11-01', '2014-04-30', 0, 0, NULL, '', '', '', '', 'HCFA|UB|', '1346287265', 0, 'N', 1, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH124', 'PGUTAH124', 'UT01', 'Salt Lake Senior Center', 'George', 'J', 'Van Komen', '', 'Internal Medicine', NULL, NULL, NULL, 'O', '82 S 1100 E Ste 204', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504602', '8013504753', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346287265', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12017340', 'W12017340', 'UT01', 'Salt Lake Senior Center', 'George', 'J', 'Van Komen', '', 'Internal Medicine', NULL, NULL, NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-11-01', '2014-04-30', 0, 0, NULL, '', '', '', '', 'HCFA|UB|', '1346287265', 0, 'N', 1, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH125', 'PGUTAH125', 'UT01', 'Salt Lake Senior Center', 'George', 'J', 'Van Komen', '', 'Internal Medicine', NULL, NULL, NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346287265', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870354442', 'PGUTAH338', 'PGUTAH338', 'UT01', 'Rocky Mountain Womens Health Center', 'Rebecca', 'M', 'Vance', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1580 W Antelope Dr Ste 290', 'Layton', 'Davis', 'UT', '84041', '8017760880', '8017737399', '1580 W Antelope Dr Ste 290', 'Layton', 'Davis', 'UT', '84041', '8017760880', '8017737399', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1942242458', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('870354442', 'PGUTAH339', 'PGUTAH339', 'UT01', 'Rocky Mountain Womens Health Center', 'Rebecca', 'M', 'Vance', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 844839', 'Dallas', 'Dallas', 'TX', '75284', '8017737399', '8017738625', 'PO Box 844839', 'Dallas', 'Dallas', 'TX', '75284', '8017737399', '8017738625', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1942242458', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('621801973', 'PGUTAH268', 'PGUTAH268', 'UT01', 'Summit Family Medicine', 'Gavin', 'N', 'Vanstaden', 'MD', 'Family Practice', '', '', NULL, 'B', '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8017737500', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Davis Hospital', 'Ogden Regional Medical Center', '', '', 'HCFA|UB|', '1841380433', 0, 'y', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH034', 'PGUTAH034', 'UT01', NULL, 'Christopher', 'J', 'Vinegra', 'MD', 'Psychiatry', '', '', NULL, 'O', '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8018203730', '8018203731', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1134198633', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH035', 'PGUTAH035', 'UT01', NULL, 'Christopher', 'J', 'Vinegra', 'MD', 'Psychiatry', '', '', NULL, 'B', '406 W South Jordan Pkwy Ste 450', 'South Jordan', 'Salt Lake', 'UT', '84095', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1134198633', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH036', 'PGUTAH036', 'UT01', NULL, 'Christopher', 'J', 'Vinegra', 'MD', 'Psychiatry', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1134198633', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH253', 'PGUTAH253', 'UT01', 'Internal Medicine Specialist - Hospitalists', 'James', 'A', 'Wilcox', 'MD', NULL, NULL, NULL, NULL, 'O', '3460 Pioneer Pkwy', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643101', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1831121078', 0, 'y', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH388', 'PGUTAH388', 'UT01', 'Vein Care Center', 'Craig', 'W', 'Wilkinson', 'MD', 'Vascular Surgery', NULL, NULL, NULL, 'O', '3570 W 9000 S Ste 110', 'West Jordan', 'Salt Lake', 'UT', '84088', '8016852900', '8012651200', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1467562504', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH389', 'PGUTAH389', 'UT01', 'Vein Care Center', 'Craig', 'W', 'Wilkinson', 'MD', 'Vascular Surgery', NULL, NULL, NULL, 'M', '5979 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1467562504', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'PGUTAH390', 'PGUTAH390', 'UT01', 'Vein Care Center', 'Craig', 'W', 'Wilkinson', 'MD', 'Vascular Surgery', NULL, NULL, NULL, 'B', 'PO Box 847112', 'Dallas', 'Dallas', 'TX', '75284', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1467562504', 0, NULL, 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH276', 'PGUTAH276', 'UT01', 'Gero - Psych', 'Bradley', 'D', 'Workman', 'APRN', 'Mental Health', 'Psychiatry', '', NULL, 'O', '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504111', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1881764835', 0, 'Y', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH277', 'PGUTAH277', 'UT01', 'Gero - Psych', 'Bradley', 'D', 'Workman', 'APRN', 'Mental Health', 'Psychiatry', '', NULL, 'B', '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013504111', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1881764835', 0, 'y', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH215', 'PGUTAH215', 'UT01', 'Salt Lake Regional Medical Center', 'Eun', '', 'Young Matineau', 'APRN', 'Psychiatry', '', '', NULL, 'O', '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504111', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699050310', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH216', 'PGUTAH216', 'UT01', 'Davis Hospital & Medical Center', 'Eun', '', 'Young Matineau', 'APRN', 'Psychiatry', '', '', NULL, 'O', '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8018203730', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699050310', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH217', 'PGUTAH217', 'UT01', 'Pioneer Valley Hospital', 'Eun', '', 'Young Matineau', 'APRN', 'Psychiatry', '', '', NULL, 'O', '3460 S Pioneer Pkwy', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643559', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699050310', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH218', 'PGUTAH218', 'UT01', 'Physician Group of Utah', 'Eun', '', 'Young Matineau', 'APRN', 'Psychiatry', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699050310', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH126', 'PGUTAH126', 'UT01', 'Jordan Valley Internal Medicine', 'David', 'R', 'Zackrison', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '3570 W 9000 S Ste 100', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015692384', '8015698643', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1346364775', 0, 'n', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH127', 'PGUTAH127', 'UT01', 'Jordan Valley Internal Medicine', 'David', 'R', 'Zackrison', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'B', '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8019643921', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1346364775', 0, 'Y', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH113', 'PGUTAH113', 'UT01', 'Legacy Point Womens Center', 'Kristine', 'M', 'Zelenkov', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3110 W 300 N Ste B', 'Clearfield', 'Davis', 'UT', '84015', '8016145270', '8016145271', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1326159427', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH114', 'PGUTAH114', 'UT01', 'Legacy Point Womens Center', 'Kristine', 'M', 'Zelenkov', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843477', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1326159427', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('200800593', 'W12047047', 'W12047047', 'ILCHIGSTD', 'BioConcepts Hanger Clinic', '', '', 'BioConcepts Hanger Clinic', '', 'Durable Medical Equipment', '', '', NULL, 'O', '100 Tower Dr', 'Willowbrook', 'Dupage', 'IL', '60527', '6309860007', '          ', '100 Tower Dr', 'Willowbrook', 'Dupage', 'IL', '60527', '6309860007', '          ', 'DMECURRENT', '', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770576902', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('760524096', 'W12047048', 'W12047048', 'TXHOUSTD', 'Dynamic Orthotics and Prosthetics', '', '', 'Dynamic Orthotics and Prosthetics', '', 'Durable Medical Equipment', '', '', NULL, 'O', '1718 Fry Rd Ste 405', 'Houston', 'Harris', 'TX', '77084', '2813983724', '2813984871', '1718 Fry Rd Ste 405', 'Houston', 'Harris', 'TX', '77084', '2813983724', '2813984871', 'DMECURRENT', '', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356655849', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('760524096', 'W12047049', 'W12047049', 'TXHOUSTD', 'Dynamic Orthotics and Prosthetics', '', '', 'Dynamic Orthotics and Prosthetics', '', 'Durable Medical Equipment', '', '', NULL, 'O', '11155 S Main', 'Houston', 'Harris', 'TX', '77025', '7137474171', '7137474249', '11155 S Main', 'Houston', 'Harris', 'TX', '77025', '7137474171', '7137474249', 'DMECURRENT', '', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477558047', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('232582601', 'W12047050', 'W12047050', 'ILCHIGSTD', 'Hanger Clinic', '', '', 'Hanger Clinic', '', 'Durable Medical Equipment', '', '', NULL, 'O', '4525 W Lincoln Hwy', 'Matteson', 'Cook', 'IL', '60443', '7086791006', '          ', '4525 W Lincoln Hwy', 'Matteson', 'Cook', 'IL', '60443', '7086791006', '          ', 'DMECURRENT', '', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033283999', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('232582601', 'W12047051', 'W12047051', 'ILCHIGSTD', 'Hanger Clinic', '', '', 'Hanger Clinic', '', 'Durable Medical Equipment', '', '', NULL, 'O', '4255 Westbrook Dr Ste 215', 'Aurora', 'Dupage', 'IL', '60504', '6308205656', '          ', '4255 Westbrook Dr Ste 215', 'Aurora', 'Dupage', 'IL', '60504', '6308205656', '          ', 'DMECURRENT', '', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124192083', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('521486235', 'W12047052', 'W12047052', 'TXDALSTD', 'Hanger Clinic', '', '', 'Hanger Clinic', '', 'Durable Medical Equipment', '', '', NULL, 'O', '1401 W Magnolia Ave', 'Fort Worth', 'Tarrant', 'TX', '76104', '8179232101', '8179261471', '1401 W Magnolia Ave', 'Fort Worth', 'Tarrant', 'TX', '76104', '8179232101', '8179261471', 'DMECURRENT', '', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1154495034', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('232582601', 'W12047053', 'W12047053', 'ILCHIGSTD', 'Hanger Clinic', '', '', 'Hanger Clinic', '', 'Durable Medical Equipment', '', '', NULL, 'O', '10837 S Cicero Ave Ste 100', 'Oak Lawn', 'Cook', 'IL', '60453', '7083719999', '          ', '10837 S Cicero Ave Ste 100', 'Oak Lawn', 'Cook', 'IL', '60453', '7083719999', '          ', 'DMECURRENT', '', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215001177', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('232582601', 'W12047054', 'W12047054', 'ILCHIGSTD', 'Hanger Clinic', '', '', 'Hanger Clinic', '', 'Durable Medical Equipment', '', '', NULL, 'O', '11231 W Cermak Rd', 'Westchester', 'Cook', 'IL', '60154', '7084479860', '          ', '11231 W Cermak Rd', 'Westchester', 'Cook', 'IL', '60154', '7084479860', '          ', 'DMECURRENT', '', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1306910260', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('232582601', 'W12047055', 'W12047055', 'ILCHIGSTD', 'Hanger Clinic', '', '', 'Hanger Clinic', '', 'Durable Medical Equipment', '', '', NULL, 'O', '4801 W Peterson Ave Ste 618', 'Lucerne', 'Weld', 'CO', '80646', '7737779494', '          ', '4801 W Peterson Ave Ste 618', 'Lucerne', 'Weld', 'CO', '80646', '7737779494', '          ', 'DMECURRENT', '', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497829352', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('232582601', 'W12047056', 'W12047056', 'ILCHIGSTD', 'Hanger Clinic', '', '', 'Hanger Clinic', '', 'Durable Medical Equipment', '', '', NULL, 'O', '215 N Convent St Ste 4', 'Bourbonnais', 'Kankakee', 'IL', '60914', '8159370241', '          ', '215 N Convent St Ste 4', 'Bourbonnais', 'Kankakee', 'IL', '60914', '8159370241', '          ', 'DMECURRENT', '', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518032390', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('232582601', 'W12047057', 'W12047057', 'ILCHIGSTD', 'Hanger Clinic', '', '', 'Hanger Clinic', '', 'Durable Medical Equipment', '', '', NULL, 'O', '300 Village Green Dr Ste 205', 'Lincolnshire', 'Lake', 'IL', '60069', '8474788154', '          ', '300 Village Green Dr Ste 205', 'Lincolnshire', 'Lake', 'IL', '60069', '8474788154', '          ', 'DMECURRENT', '', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1588738439', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('232582601', 'W12047058', 'W12047058', 'ILCHIGSTD', 'Hanger Clinic', '', '', 'Hanger Clinic', '', 'Durable Medical Equipment', '', '', NULL, 'O', '17530 Kedzie Ave', 'Hazel Crest', 'Cook', 'IL', '60429', '7089570240', '          ', '17530 Kedzie Ave', 'Hazel Crest', 'Cook', 'IL', '60429', '7089570240', '          ', 'DMECURRENT', '', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659445518', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('232582601', 'W12047059', 'W12047059', 'ILCHIGSTD', 'Hanger Clinic', '', '', 'Hanger Clinic', '', 'Durable Medical Equipment', '', '', NULL, 'O', '35 Tower Ct Ste C', 'Gurnee', 'Lake', 'IL', '60031', '8476236080', '          ', '35 Tower Ct Ste C', 'Gurnee', 'Lake', 'IL', '60031', '8476236080', '          ', 'DMECURRENT', '', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1679647523', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('232582601', 'W12047060', 'W12047060', 'ILCHIGSTD', 'Hanger Clinic', '', '', 'Hanger Clinic', '', 'Durable Medical Equipment', '', '', NULL, 'O', '75 Market St Ste 12', 'Elgin', 'Kane', 'IL', '60123', '8476956955', '          ', '75 Market St Ste 12', 'Elgin', 'Kane', 'IL', '60123', '8476956955', '          ', 'DMECURRENT', '', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841364981', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('232582601', 'W12047061', 'W12047061', 'ILCHIGSTD', 'Hanger Clinic', '', '', 'Hanger Clinic', '', 'Durable Medical Equipment', '', '', NULL, 'O', '694 Essington Rd', 'Joliet', 'Will', 'IL', '60435', '8157449944', '          ', '694 Essington Rd', 'Joliet', 'Will', 'IL', '60435', '8157449944', '          ', 'DMECURRENT', '', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1851465702', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('232582601', 'W12047062', 'W12047062', 'ILCHIGSTD', 'Hanger Clinic', '', '', 'Hanger Clinic', '', 'Durable Medical Equipment', '', '', NULL, 'O', '620 S State Route 31 Ste 7', 'Mchenry', 'Mchenry', 'IL', '60050', '8153443070', '          ', '620 S State Route 31 Ste 7', 'Mchenry', 'Mchenry', 'IL', '60050', '8153443070', '          ', 'DMECURRENT', '', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1891860664', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('952667855', 'W12047063', 'W12047063', 'NM01', 'Hanger Clinic (Orthotics, Prosthetics & Breast Prosthetics)', '', '', 'Hanger Clinic (Orthotics, Prosthetics & Breast Prosthetics)', '', 'Durable Medical Equipment', '', '', NULL, 'O', '3917 West Rd Ste 150', 'Los Alamos', 'Los Alamos', 'NM', '87544', '5059885526', '5059894464', '3917 West Rd Ste 150', 'Los Alamos', 'Los Alamos', 'NM', '87544', '5059885526', '5059894464', 'DMECURRENT', '', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225102114', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
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('204043287', 'W12047102', 'W12047102', 'NM01', 'ABQ Health Partners', 'Karen', 'A', 'Zimmerman', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 27829           ', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5058968604', '5058968697', 'PO Box 27829           ', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5058968604', '5058968697', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-04-07', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1790746808', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('453330168', 'W12047104', 'W12047104', 'ID02', 'Calico Pediatric Therapy Center', 'Kristin', 'K', 'Negilski', 'SLP', 'Speech Therapy', '', '', NULL, 'O', '1650 N Hilton St', 'Boise', 'Ada', 'ID', '83706', '2083214898', '2083214859', '1650 N Hilton St', 'Boise', 'Ada', 'ID', '83706', '2083214898', '2083214859', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2014-04-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1184886574', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('711048468', 'W12047105', 'W12047105', 'UT01', 'Cutting Edge Physical Therapy ', 'Jacob', 'J', 'McKay', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '1151 E 3900 S Ste B199', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8016859212', '8016859195', '1151 E 3900 S Ste B199', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8016859212', '8016859195', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1619213857', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('262478465', 'W12047106', 'W12047106', 'UT01', 'Fast Track Physical Therapy & Sports Medicine', 'Cherianne', '', 'Mecham', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '6717 S 900 E Ste 201', 'Midvale', 'Salt Lake', 'UT', '84047', '8016494690', '8019844011', '6717 S 900 E Ste 201', 'Midvale', 'Salt Lake', 'UT', '84047', '8016494690', '8019844011', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1548437726', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('020622106', 'W12047108', 'W12047108', 'UT01', 'Physical Therapy & Sports Medicine @ Kimball Junction', 'Lauren', 'J', 'Ziaks', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '6531 N Landmark Dr Ste E', 'Park City', 'Summit', 'UT', '84098', '4356497335', '4356497568', '6531 N Landmark Dr Ste E', 'Park City', 'Summit', 'UT', '84098', '4356497335', '4356497568', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1467680835', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('020622106', 'W12047109', 'W12047109', 'UT01', 'Physical Therapy & Sports Medicine @ Kimball Junction', 'Lauren', 'J', 'Ziaks', 'DPT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 784', 'Midway', 'Wasatch', 'UT', '84049', '4356497335', '4356497568', 'PO Box 784', 'Midway', 'Wasatch', 'UT', '84049', '4356497335', '4356497568', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1467680835', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('201113815', 'W12047111', 'W12047111', 'UT01', 'Rocky Mountain Therapy Services', 'Jamie', 'Lynn', 'Phillips', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '1950 E 7000 S', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019431041', '8019438805', '1950 E 7000 S', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019431041', '8019438805', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1700035847', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('201113815', 'W12047112', 'W12047112', 'UT01', 'Rocky Mountain Therapy Services', 'Jamie', 'Lynn', 'Phillips', 'OT', 'Occupational Therapy', '', '', NULL, 'B', 'PO Box 540640', 'North Salt Lake', 'Davis', 'UT', '84054', '8019431041', '8019438805', 'PO Box 540640', 'North Salt Lake', 'Davis', 'UT', '84054', '8019431041', '8019438805', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1700035847', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('201113815', 'W12047113', 'W12047113', 'UT01', 'Rocky Mountain Therapy Services', 'Jamie', 'Lynn', 'Phillips', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '3497 W 3500 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8014175017', '8014175016', '3497 W 3500 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8014175017', '8014175016', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1700035847', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('261211429', 'W12047115', 'W12047115', 'UT01', 'Utah Physical Therapy Specialists', 'Kyle', 'C', 'Anderson', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '3181 W 9000 S Ste 103', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015611061', '8015611570', '3181 W 9000 S Ste 103', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015611061', '8015611570', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1932523792', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
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('461680470', 'W12047119', 'W12047119', 'ID02', 'Eastern Idaho Physical Therapy', 'Todd', 'R', 'Anderson', 'PT', 'Physical Therapy', '', '', NULL, 'O', '180 N Broadway St', 'Blackfoot', 'Bingham', 'ID', '83221', '2087850628', '2087858667', '180 N Broadway St', 'Blackfoot', 'Bingham', 'ID', '83221', '2087850628', '2087858667', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2014-04-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1942400718', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('461680470', 'W12047120', 'W12047120', 'ID02', 'Eastern Idaho Physical Therapy', 'Todd', 'R', 'Anderson', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 1043', 'Blackfoot', 'Bingham', 'ID', '83221', '2087850628', '2087858667', 'PO Box 1043', 'Blackfoot', 'Bingham', 'ID', '83221', '2087850628', '2087858667', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2014-04-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1942400718', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('450677154', 'W12047122', 'W12047122', 'ID02', 'Sawtooth Physical Therapy', 'Chelsea', 'L', 'Beyers', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '7979 W Rifleman St', 'Boise', 'Ada', 'ID', '83704', '2083773850', '2086581360', '7979 W Rifleman St', 'Boise', 'Ada', 'ID', '83704', '2083773850', '2086581360', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2014-04-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1598190571', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('208172241', 'W12047124', 'W12047124', 'ID02', 'Moscow Mountain Sport & Physical Therapy', 'Brenda', 'L', 'Boyko', 'PT', 'Physical Therapy', '', '', NULL, 'O', '872 Troy Rd Ste 180', 'Moscow', 'Latah', 'ID', '83843', '2088821426', '2088821428', '872 Troy Rd Ste 180', 'Moscow', 'Latah', 'ID', '83843', '2088821426', '2088821428', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2014-04-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1184775124', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('742938437', 'W12047126', 'W12047126', 'TXSATSTD', 'MacGregor Medical Center', 'Mark', 'K', 'Smith', 'MD', 'Family Practice', '', '', NULL, 'O', '9969 Fredericksburg Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2106902273', '          ', '9969 Fredericksburg Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2106902273', '          ', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'St Lukes Baptist Hospital', '', '', '', 'HCFA|UB|', '0000008769', 0, 'N', 1, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('262403449', 'W12047134', 'W12047134', 'ID02', 'Valley Pediatric Feeding ', 'Jennifer', 'A', 'Dahms', 'CCC-SLP', 'Speech Therapy', '', '', NULL, 'O', '2995 N Cole Rd Ste 130', 'Boise', 'Ada', 'ID', '83704', '2085592348', '8885594660', '2995 N Cole Rd Ste 130', 'Boise', 'Ada', 'ID', '83704', '2085592348', '8885594660', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2014-04-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1013178730', 0, 'N', 0, '2014-06-05', NULL, NULL, 0, 0, NULL, NULL),
('820463153', 'W12047139', 'W12047139', 'ID02', 'Ellis Physical Therapy PA', 'Jay', 'T', 'Ellis', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '3100 S Woodruff Ave', 'Idaho Falls', 'Bonneville', 'ID', '83404', '2085238879', '2085230436', '3100 S Woodruff Ave', 'Idaho Falls', 'Bonneville', 'ID', '83404', '2085238879', '2085230436', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2014-04-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1811924012', 0, 'N', 0, '2014-04-30', NULL, NULL, 0, 0, NULL, NULL),
('820463153', 'W12047140', 'W12047140', 'ID02', 'Ellis Physical Therapy PA', 'Jay', 'T', 'Ellis', 'DPT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 1463', 'Idaho Falls', 'Bonneville', 'ID', '83403', '2085238879', '2085230436', 'PO Box 1463', 'Idaho Falls', 'Bonneville', 'ID', '83403', '2085238879', '2085230436', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2014-04-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1811924012', 0, 'N', 0, '2014-04-30', NULL, NULL, 0, 0, NULL, NULL),
('208172241', 'W12047142', 'W12047142', 'ID02', 'Moscow Mountain Sport & Physical Therapy', 'Marie', 'H', 'Eriksson', 'PT', 'Physical Therapy', '', '', NULL, 'O', '872 Troy Rd Ste 180', 'Moscow', 'Latah', 'ID', '83843', '2088821426', '2088821428', '872 Troy Rd Ste 180', 'Moscow', 'Latah', 'ID', '83843', '2088821426', '2088821428', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2014-04-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1720137532', 0, 'N', 0, '2014-04-30', NULL, NULL, 0, 0, NULL, NULL),
('208172241', 'W12047144', 'W12047144', 'ID02', 'Moscow Mountain Sport & Physical Therapy', 'Kimberly', '', 'Fletcher', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '872 Troy Rd Ste 180', 'Moscow', 'Latah', 'ID', '83843', '2088821426', '2088821428', '872 Troy Rd Ste 180', 'Moscow', 'Latah', 'ID', '83843', '2088821426', '2088821428', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2014-04-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1689863367', 0, 'N', 0, '2014-04-30', NULL, NULL, 0, 0, NULL, NULL),
('208172241', 'W12047146', 'W12047146', 'ID02', 'Moscow Mountain Sport & Physical Therapy', 'Rory', 'M', 'Fletcher', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '872 Troy Rd Ste 180', 'Moscow', 'Latah', 'ID', '83843', '2088821426', '2088821428', '872 Troy Rd Ste 180', 'Moscow', 'Latah', 'ID', '83843', '2088821426', '2088821428', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2014-04-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1346473063', 0, 'N', 0, '2014-04-30', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('208172241', 'W12047148', 'W12047148', 'ID02', 'Moscow Mountain Sport & Physical Therapy', 'Kelly', 'P', 'Isakson', 'PT', 'Physical Therapy', '', '', NULL, 'O', '872 Troy Rd Ste 180', 'Moscow', 'Latah', 'ID', '83843', '2088821426', '2088821428', '872 Troy Rd Ste 180', 'Moscow', 'Latah', 'ID', '83843', '2088821426', '2088821428', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2014-04-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1477606119', 0, 'N', 0, '2014-04-30', NULL, NULL, 0, 0, NULL, NULL),
('208172241', 'W12047150', 'W12047150', 'ID02', 'Moscow Mountain Sport & Physical Therapy', 'Hilary', '', 'Snell', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '872 Troy Rd Ste 180', 'Moscow', 'Latah', 'ID', '83843', '2088821426', '2088821428', '872 Troy Rd Ste 180', 'Moscow', 'Latah', 'ID', '83843', '2088821426', '2088821428', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2014-04-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1063772630', 0, 'N', 0, '2014-04-30', NULL, NULL, 0, 0, NULL, NULL),
('208172241', 'W12047152', 'W12047152', 'ID02', 'Moscow Mountain Sport & Physical Therapy', 'Glenda', 'D', 'Thie', 'PT', 'Physical Therapy', '', '', NULL, 'O', '872 Troy Rd Ste 180', 'Moscow', 'Latah', 'ID', '83843', '2088821426', '2088821428', '872 Troy Rd Ste 180', 'Moscow', 'Latah', 'ID', '83843', '2088821426', '2088821428', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2014-04-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1134456809', 0, 'N', 0, '2014-04-30', NULL, NULL, 0, 0, NULL, NULL),
('141892738', 'W12047155', 'W12047155', 'ID02', 'Joshua Tree Physical Therapy', 'Kevin', 'J', 'Sgroi', 'PT', 'Physical Therapy', '', '', NULL, 'O', '8475 N Government Way Ste 102', 'Hayden', 'Kootenai', 'ID', '83835', '2087729774', '2087729564', '8475 N Government Way Ste 102', 'Hayden', 'Kootenai', 'ID', '83835', '2087729774', '2087729564', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2014-04-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1770678484', 0, 'N', 0, '2014-04-30', NULL, NULL, 0, 0, NULL, NULL),
('200834009', 'W12047157', 'W12047157', 'ID02', 'Northstar Physical Therapy', 'Brian', 'D', 'Nichols', 'MPT', 'Physical Therapy', '', '', NULL, 'O', '9652 W State St', 'Star', 'Ada', 'ID', '83669', '2082860766', '2082860768', '9652 W State St', 'Star', 'Ada', 'ID', '83669', '2082860766', '2082860768', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2014-04-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1679679088', 0, 'N', 0, '2014-04-30', NULL, NULL, 0, 0, NULL, NULL),
('200834009', 'W12047159', 'W12047159', 'ID02', 'Northstar Physical Therapy', 'Judianne', 'K', 'Nichols', 'MPT', 'Physical Therapy', '', '', NULL, 'O', '9652 W State St', 'Star', 'Ada', 'ID', '83669', '2082860766', '2082860768', '9652 W State St', 'Star', 'Ada', 'ID', '83669', '2082860766', '2082860768', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2014-04-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1184794810', 0, 'N', 0, '2014-04-30', NULL, NULL, 0, 0, NULL, NULL),
('201349599', 'W12047161', 'W12047161', 'ID02', 'Mayes Physical Therapy', 'Daryl', 'D', 'Mayes', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '1976 S Lincoln Ave', 'Jerome', 'Jerome', 'ID', '83338', '2086441433', '2086441434', '1976 S Lincoln Ave', 'Jerome', 'Jerome', 'ID', '83338', '2086441433', '2086441434', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2014-04-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1033262183', 0, 'N', 0, '2014-04-30', NULL, NULL, 0, 0, NULL, NULL),
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('931141856', 'W12047219', 'W12047219', 'IDONTSTD', 'Treasure Valley Pediatric Clinic', 'Marisue', '', 'Susman', 'NP', 'Pediatrics', '', '', NULL, 'O', '1219 SW 4th Ave Ste 1', 'Ontario', 'Malheur', 'OR', '97914', '5418892668', '5418892997', '1219 SW 4th Ave Ste 1', 'Ontario', 'Malheur', 'OR', '97914', '5418892668', '5418892997', 'IDSAMG2', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-05-04', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205124377', 0, 'N', 0, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
('931141856', 'W12047221', 'W12047221', 'IDONTSTD', 'Treasure Valley Pediatric Clinic', 'Rachel', '', 'Robb', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '1219 SW 4th Ave Ste 1', 'Ontario', 'Malheur', 'OR', '97914', '5418892668', '5418892997', '1219 SW 4th Ave Ste 1', 'Ontario', 'Malheur', 'OR', '97914', '5418892668', '5418892997', 'IDSAMG2', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-05-04', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1881015774', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('760653932', 'W12047224', 'W12047224', 'TXHOUSTD', 'Metropolitan Infectious Disease', 'Shahe', '', 'Vartivarian', 'MD', 'Infectious Disease', '', '', NULL, 'O', '7777 SW Fwy Ste 610', 'Houston', 'Harris', 'TX', '77074', '7133399949', '7133399888', '7777 SW Fwy Ste 610', 'Houston', 'Harris', 'TX', '77074', '7133399949', '7133399888', 'HOUSTON2', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-06-05', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235233651', 0, 'N', 0, '2014-06-03', NULL, NULL, 0, 0, NULL, NULL),
('760653932', 'W12047226', 'W12047226', 'TXHOUSTD', 'Metropolitan Infectious Disease', 'Souad', '', 'Youssef', 'MD', 'Infectious Disease', '', '', NULL, 'O', '7777 SW Fwy Ste 610', 'Houston', 'Harris', 'TX', '77074', '7133399949', '7133399888', '7777 SW Fwy Ste 610', 'Houston', 'Harris', 'TX', '77074', '7133399949', '7133399888', 'HOUSTON2', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-06-05', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922202563', 0, 'N', 0, '2014-06-03', NULL, NULL, 0, 0, NULL, NULL),
('760653932', 'W12047228', 'W12047228', 'TXHOUSTD', 'Metropolitan Infectious Disease', 'Nicolas', '', 'Daoura', 'MD', 'Infectious Disease', '', '', NULL, 'O', '7777 SW Fwy Ste 610', 'Houston', 'Harris', 'TX', '77074', '7133399949', '7133399888', '7777 SW Fwy Ste 610', 'Houston', 'Harris', 'TX', '77074', '7133399949', '7133399888', 'HOUSTON2', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-06-05', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639273956', 0, 'N', 0, '2014-06-03', NULL, NULL, 0, 0, NULL, NULL),
('200093120', 'W12047230', 'W12047230', 'ID02', 'Specialty Clinics of Idaho Inc', '', '', 'Specialty Clinics of Idaho Inc', '', 'Ear, Nose and Throat', '', '', NULL, 'O', '1001 Caldwell Bvld', 'Nampa', 'Canyon', 'ID', '83651', '2084339300', '2084339854', '1001 Caldwell Bvld', 'Nampa', 'Canyon', 'ID', '83651', '2084339300', '2084339854', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000010165', 0, 'Y', 0, '2014-05-02', NULL, NULL, 0, 0, NULL, NULL),
('200093120', 'W12047231', 'W12047231', 'ID02', 'Specialty Clinics of Idaho Inc', '', '', 'Specialty Clinics of Idaho Inc', '', 'Ear, Nose and Throat', '', '', NULL, 'O', '1210 NW 16th St', 'Emmett', 'Gem', 'ID', '83617', '2084339300', '2084339854', '1210 NW 16th St', 'Emmett', 'Gem', 'ID', '83617', '2084339300', '2084339854', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000010165', 0, 'Y', 0, '2014-05-02', NULL, NULL, 0, 0, NULL, NULL),
('200093120', 'W12047229', 'W12047229', 'ID02', 'Specialty Clinics of Idaho Inc', '', '', 'Specialty Clinics of Idaho Inc', '', 'Ear, Nose and Throat', '', '', NULL, 'O', '727 E River Park Ln Ste 200', 'Boise', 'Ada', 'ID', '83706', '2084339300', '2084339854', '727 E River Park Ln Ste 200', 'Boise', 'Ada', 'ID', '83706', '2084339300', '2084339854', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000010165', 0, 'Y', 0, '2014-05-02', NULL, NULL, 0, 0, NULL, NULL),
('200093120', 'W12047233', 'W12047233', 'ID02', 'Specialty Clinics of Idaho Inc', 'John', 'A', 'Boyajian', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '727 E River Park Ln Ste 200', 'Boise', 'Ada', 'ID', '83706', '2084339300', '2084339854', '727 E River Park Ln Ste 200', 'Boise', 'Ada', 'ID', '83706', '2084339300', '2084339854', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'St Lukes Regional Medical Center', '', '', '', 'HCFA|UB|', '1942205604', 0, 'N', 1, '2014-07-22', NULL, NULL, 0, 0, NULL, NULL),
('200093120', 'W12047235', 'W12047235', 'ID02', 'Specialty Clinics of Idaho Inc', 'John', 'A', 'Boyajian', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '1001 Caldwell Bvld', 'Nampa', 'Canyon', 'ID', '83651', '2084339300', '2084339854', '1001 Caldwell Bvld', 'Nampa', 'Canyon', 'ID', '83651', '2084339300', '2084339854', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'St Lukes Regional Medical Center', '', '', '', 'HCFA|UB|', '1942205604', 0, 'N', 1, '2014-07-22', NULL, NULL, 0, 0, NULL, NULL),
('200093120', 'W12047234', 'W12047234', 'ID02', 'Specialty Clinics of Idaho Inc', 'John', 'A', 'Boyajian', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '1210 NW 16th St', 'Emmett', 'Gem', 'ID', '83617', '2084339300', '2084339854', '1210 NW 16th St', 'Emmett', 'Gem', 'ID', '83617', '2084339300', '2084339854', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'St Lukes Regional Medical Center', '', '', '', 'HCFA|UB|', '1942205604', 0, 'N', 1, '2014-07-22', NULL, NULL, 0, 0, NULL, NULL),
('200093120', 'W12047236', 'W12047236', 'ID02', 'Specialty Clinics of Idaho Inc', 'Rick', 'L', 'Steinburg', 'PA', 'Ear, Nose and Throat', '', '', NULL, 'O', '727 E River Park Ln Ste 200', 'Boise', 'Ada', 'ID', '83706', '2084339300', '2084339854', '727 E River Park Ln Ste 200', 'Boise', 'Ada', 'ID', '83706', '2084339300', '2084339854', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548265218', 0, 'N', 0, '2014-06-06', NULL, NULL, 0, 0, NULL, NULL),
('200093120', 'W12047237', 'W12047237', 'ID02', 'Specialty Clinics of Idaho Inc', 'Rick', 'L', 'Steinburg', 'PA', 'Ear, Nose and Throat', '', '', NULL, 'O', '1001 Caldwell Bvld', 'Nampa', 'Canyon', 'ID', '83651', '2084339300', '2084339854', '1001 Caldwell Bvld', 'Nampa', 'Canyon', 'ID', '83651', '2084339300', '2084339854', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548265218', 0, 'N', 0, '2014-06-06', NULL, NULL, 0, 0, NULL, NULL),
('200093120', 'W12047238', 'W12047238', 'ID02', 'Specialty Clinics of Idaho Inc', 'Rick', 'L', 'Steinburg', 'PA', 'Ear, Nose and Throat', '', '', NULL, 'O', '1210 NW 16th St', 'Emmett', 'Gem', 'ID', '83617', '2084339300', '2084339854', '1210 NW 16th St', 'Emmett', 'Gem', 'ID', '83617', '2084339300', '2084339854', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548265218', 0, 'N', 0, '2014-06-06', NULL, NULL, 0, 0, NULL, NULL),
('826000952', 'W12047290', 'W12047290', 'UT01', 'Southeastern Idaho Public Health', '', '', 'Southeastern Idaho Public Health', '', 'Health Department', '', '', NULL, 'O', '175 S 300 E', 'Malad City', 'Oneida', 'ID', '83252', '2087664764', '2087662528', '175 S 300 E', 'Malad City', 'Oneida', 'ID', '83252', '2087664764', '2087662528', 'WISEA2013', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063576445', 0, 'N', 0, '2014-06-18', NULL, NULL, 0, 0, NULL, NULL),
('870507600', 'W12047241', 'W12047241', 'UT01', 'Love Air Healthcare', '', '', 'Love Air Healthcare', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '2550 S Decker Lake Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019730900', '          ', '2550 S Decker Lake Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019730900', '          ', 'DMECURRENT', '', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639105125', 0, 'N', 0, '2014-05-02', NULL, NULL, 0, 0, NULL, NULL),
('870507600', 'W12047242', 'W12047242', 'UT01', 'Love Air Healthcare', '', '', 'Love Air Healthcare', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '383 W Vine St Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8019730900', '          ', '383 W Vine St Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8019730900', '          ', 'DMECURRENT', '', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639105125', 0, 'N', 0, '2014-05-02', NULL, NULL, 0, 0, NULL, NULL),
('245710825', 'W12047243', 'W12047243', 'UT01', 'Precision Health Services ', '', '', 'Precision Health Services', 'GROUP', 'Sleep Disorders', 'Durable Medical Equipment', '', NULL, 'O', '2307 N Hill Field Rd Ste 102', 'Layton', 'Davis', 'UT', '84041', '8012660399', '8012660421', '2307 N Hill Field Rd Ste 102', 'Layton', 'Davis', 'UT', '84041', '8012660399', '8012660421', 'WCSTPHS5', 'DMECURRENT', '', '0.00', '65.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000834822', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('245710825', 'W12047244', 'W12047244', 'UT01', 'Precision Health Services', '', '', 'Precision Health Services', 'GROUP', 'Sleep Disorders', 'Durable Medical Equipment', '', NULL, 'O', '4885 S 900 E Ste 107', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012660399', '8012660421', '4885 S 900 E Ste 107', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012660399', '8012660421', 'WCSTPHS5', 'DMECURRENT', '', '0.00', '65.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000834822', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('820277763', 'W12047245', 'W12047245', 'ID01', 'Norco', '', '', 'Norco', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '2150 E Fairview Ave', 'Meridian', 'Ada', 'ID', '83642', '2088980202', '2088882266', '2150 E Fairview Ave', 'Meridian', 'Ada', 'ID', '83642', '2088980202', '2088882266', 'DMECURRENT', '', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821158692', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('820277763', 'W12047246', 'W12047246', 'ID01', 'Norco', '', '', 'Norco', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'B', 'PO Box 15299', 'Boise', 'Ada', 'ID', '83715', '2088980202', '          ', 'PO Box 15299', 'Boise', 'Ada', 'ID', '83715', '2088980202', '          ', 'DMECURRENT', '', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821158692', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('870477339', 'W12047247', 'W12047247', 'UT01', 'Service Drug', '', '', 'Service Drug', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '215 W Main St', 'Delta', 'Millard', 'UT', '84624', '4358642545', '          ', '215 W Main St', 'Delta', 'Millard', 'UT', '84624', '4358642545', '          ', 'DMECURRENT', '', '', '0.00', '40.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528089570', 0, 'N', 0, '2014-05-02', NULL, NULL, 0, 0, NULL, NULL),
('200079821', 'W12047248', 'W12047248', 'ID01', 'CPAP Now Inc', '', '', 'CPAP Now Inc', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '2423 S Georgia', 'Caldwell', 'Canyon', 'ID', '83605', '2084558801', '          ', '2423 S Georgia', 'Caldwell', 'Canyon', 'ID', '83605', '2084558801', '          ', 'DMECURRENT', '', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518066414', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('200079821', 'W12047249', 'W12047249', 'ID01', 'CPAP Now Inc', '', '', 'CPAP Now Inc', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '526-C Shoup Ave W', 'Twin Falls', 'Twin Falls', 'ID', '83301', '2084552400', '          ', '526-C Shoup Ave W', 'Twin Falls', 'Twin Falls', 'ID', '83301', '2084552400', '          ', 'DMECURRENT', '', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518066414', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('200079821', 'W12047250', 'W12047250', 'ID01', 'CPAP Now Inc', '', '', 'CPAP Now Inc', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '6128 Fairview Ste 1A', 'Boise', 'Ada', 'ID', '83704', '2082871733', '          ', '6128 Fairview Ste 1A', 'Boise', 'Ada', 'ID', '83704', '2082871733', '          ', 'DMECURRENT', '', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518066414', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('412045308', 'W12047251', 'W12047251', 'UT01', 'Insight Orthotics & Prosthetics ', '', '', 'Insight Orthotics & Prosthetics LLC', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '457 W 4800 S', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012691030', '          ', '457 W 4800 S', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012691030', '          ', 'DMECURRENT', '', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437217890', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('200046179', 'W12047252', 'W12047252', 'UT01', 'Western Medical Supplies', '', '', 'Western Medical Supplies', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '3293 Harrison Blvd Ste 210', 'Ogden', 'Weber', 'UT', '84403', '8779378342', '8668083418', '3293 Harrison Blvd Ste 210', 'Ogden', 'Weber', 'UT', '84403', '8779378342', '8668083418', 'DMEWMED', 'DMECURRENT', '', '0.00', '100.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427015718', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('800522450', 'W12047254', 'W12047254', 'UT01', 'Omega Interventional Pain', 'Jeremy', 'J', 'Joyal', 'MD', 'Pain Management', '', '', NULL, 'O', '3838 S 700 E Ste 300A', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012614988', '8012699425', '3838 S 700 E Ste 300A', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012614988', '8012699425', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-07-01', NULL, 0, 0, 0, 'University of Utah Hospital', '', '', '', 'HCFA|UB|', '1861622219', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('800522450', 'W12047256', 'W12047256', 'UT01', 'Omega Interventional Pain', 'Tracy', 'L', 'Holley', 'PA', 'Physician Assistant', '', '', NULL, 'O', '3838 S 700 E Ste 300A', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012614988', '8012699425', '3838 S 700 E Ste 300A', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012614988', '8012699425', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801194097', 0, 'N', 1, '2014-06-17', NULL, NULL, 0, 0, NULL, NULL),
('311651314', 'W12047257', 'W12047257', 'ID02', 'EBI LLC (Bone Stimulators)', '', '', 'EBI LLC (Bone Stimulators)', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'B', '100 Interpace Pkwy', 'Parsippany', 'Morris', 'NJ', '07054', '9732999300', '          ', '100 Interpace Pkwy', 'Parsippany', 'Morris', 'NJ', '07054', '9732999300', '          ', 'DMECURRENT', '', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1366423220', 0, 'Y', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('311651314', 'W12047258', 'W12047258', 'ID02', 'EBI LLC (Bone Stimulators)', '', '', 'EBI LLC (Bone Stimulators)', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', 'Phone Number Only', '', '', '', '', '8005262579', '          ', 'Phone Number Only', '', '', '', '', '8005262579', '          ', 'DMECURRENT', '', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1366423220', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('311651314', 'W12047259', 'W12047259', 'TX01', 'EBI LLC (Bone Stimulators)', '', '', 'EBI LLC (Bone Stimulators)', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'B', '100 Interpace Pkwy', 'Parsippany', 'Morris', 'NJ', '07054', '9732999300', '          ', '100 Interpace Pkwy', 'Parsippany', 'Morris', 'NJ', '07054', '9732999300', '          ', 'DMECURRENT', '', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366423220', 0, 'Y', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('311651314', 'W12047260', 'W12047260', 'TX01', 'EBI LLC (Bone Stimulators)', '', '', 'EBI LLC (Bone Stimulators)', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', 'Phone Number Only', '', '', '', '', '8005262579', '          ', 'Phone Number Only', '', '', '', '', '8005262579', '          ', 'DMECURRENT', '', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366423220', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('311651314', 'W12047261', 'W12047261', 'UT01', 'EBI LLC (Bone Stimulators)', '', '', 'EBI LLC (Bone Stimulators)', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'B', '100 Interpace Pkwy', 'Parsippany', 'Morris', 'NJ', '07054', '9732999300', '          ', '100 Interpace Pkwy', 'Parsippany', 'Morris', 'NJ', '07054', '9732999300', '          ', 'DMECURRENT', '', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366423220', 0, 'Y', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('311651314', 'W12047262', 'W12047262', 'UT01', 'EBI LLC (Bone Stimulators)', '', '', 'EBI LLC (Bone Stimulators)', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', 'Phone Number Only', '', '', '', '', '8005262579', '          ', 'Phone Number Only', '', '', '', '', '8005262579', '          ', 'DMECURRENT', '', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366423220', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('311651314', 'W12047263', 'W12047263', 'WY01', 'EBI LLC (Bone Stimulators)', '', '', 'EBI LLC (Bone Stimulators)', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'B', '100 Interpace Pkwy', 'Parsippany', 'Morris', 'NJ', '07054', '9732999300', '          ', '100 Interpace Pkwy', 'Parsippany', 'Morris', 'NJ', '07054', '9732999300', '          ', 'DMECURRENT', '', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366423220', 0, 'Y', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('311651314', 'W12047264', 'W12047264', 'WY01', 'EBI LLC (Bone Stimulators)', '', '', 'EBI LLC (Bone Stimulators)', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', 'Phone Number Only', '', '', '', '', '8005262579', '          ', 'Phone Number Only', '', '', '', '', '8005262579', '          ', 'DMECURRENT', '', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366423220', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('311651314', 'W12047265', 'W12047265', 'WYT2', 'EBI LLC (Bone Stimulators)', '', '', 'EBI LLC (Bone Stimulators)', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'B', '100 Interpace Pkwy', 'Parsippany', 'Morris', 'NJ', '07054', '9732999300', '          ', '100 Interpace Pkwy', 'Parsippany', 'Morris', 'NJ', '07054', '9732999300', '          ', 'DMECURRENT', '', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366423220', 0, 'Y', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('311651314', 'W12047266', 'W12047266', 'WYT2', 'EBI LLC (Bone Stimulators)', '', '', 'EBI LLC (Bone Stimulators)', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', 'Phone Number Only', '', '', '', '', '8005262579', '          ', 'Phone Number Only', '', '', '', '', '8005262579', '          ', 'DMECURRENT', '', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366423220', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('943170060', 'W12047267', 'W12047267', 'ID01', 'Pacific Medical Inc', '', '', 'Pacific Medical Inc', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'B', 'File 31026 PO Box 60000', 'San Francisco', 'San Francisco', 'CA', '94160', '8007269180', '          ', 'File 31026 PO Box 60000', 'San Francisco', 'San Francisco', 'CA', '94160', '8007269180', '          ', 'DMECURRENT', '', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326048893', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('943170060', 'W12047268', 'W12047268', 'ID01', 'Pacific Medical Inc', '', '', 'Pacific Medical Inc', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', 'Phone Number Only', '', '', 'ID', '', '2088715151', '          ', 'Phone Number Only', '', '', 'ID', '', '2088715151', '          ', 'DMECURRENT', '', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326048893', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('943170060', 'W12047269', 'W12047269', 'ID01', 'Pacific Medical Inc', '', '', 'Pacific Medical Inc', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', 'Phone Number Only 8007269180', '', '', 'ID', '', '8007269180', '          ', 'Phone Number Only 8007269180', '', '', 'ID', '', '8007269180', '          ', 'DMECURRENT', '', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326048893', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('201909749', 'W12047270', 'W12047270', 'UT01', 'Mesquite Medical Equipment', '', '', 'Mesquite Medical Equipment', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '1301 Bertha Howe Ave Ste 7', 'Mesquite', 'Clark', 'NV', '89027', '7023454625', '          ', '1301 Bertha Howe Ave Ste 7', 'Mesquite', 'Clark', 'NV', '89027', '7023454625', '          ', 'DMECURRENT', '', '', '0.00', '40.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316010432', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('201909749', 'W12047271', 'W12047271', 'UT01', 'Mesquite Medical Equipment', '', '', 'Mesquite Medical Equipment', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'B', 'PO Box 2885', 'Mesquite', 'Clark', 'NV', '89024', '7023454625', '          ', 'PO Box 2885', 'Mesquite', 'Clark', 'NV', '89024', '7023454625', '          ', 'DMECURRENT', '', '', '0.00', '40.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316010432', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('461698467', 'W12047272', 'W12047272', 'WY01', 'Bellkins Paps', '', '', 'Bellkins Paps LLC', '', 'Durable Medical Equipment', '', '', NULL, 'O', '724 Front St Ste 510', 'Evanston', 'Uinta', 'WY', '82930', '3077892082', '3077892029', '724 Front St Ste 510', 'Evanston', 'Uinta', 'WY', '82930', '3077892082', '3077892029', 'DMECURRENT', '', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245577410', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('461698467', 'W12047273', 'W12047273', 'WYT1', 'Bellkins Paps', '', '', 'Bellkins Paps LLC', '', 'Durable Medical Equipment', '', '', NULL, 'O', '724 Front St Ste 510', 'Evanston', 'Uinta', 'WY', '82930', '3077892082', '3077892029', '724 Front St Ste 510', 'Evanston', 'Uinta', 'WY', '82930', '3077892082', '3077892029', 'DMECURRENT', '', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245577410', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('204941789', 'W12047274', 'W12047274', 'UT01', 'Medway Medical', '', '', 'Medway Medical', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '1837 S 4130 W Unit B', 'Salt Lake City', 'Salt Lake', 'UT', '84104', '4357559600', '          ', '1837 S 4130 W Unit B', 'Salt Lake City', 'Salt Lake', 'UT', '84104', '4357559600', '          ', 'DMECURRENT', '', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962438358', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('331177233', 'W12047276', 'W12047276', 'UT01', 'Ogden Internal Medicine and Urology', 'Melissa', 'J', 'Bentley', 'MD', 'Internal Medicine', '', '', NULL, 'O', '425 E 5350 S Ste 255', 'Ogden', 'Weber', 'UT', '84405', '8014792911', '0000000000', '425 E 5350 S Ste 255', 'Ogden', 'Weber', 'UT', '84405', '8014792911', '0000000000', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-01-01', '2014-01-01', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639354897', 0, 'N', 0, '2014-06-11', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'W12047278', 'W12047278', 'UT01', 'Ogden Clinic- Grand View', 'Kayleen ', '', 'Wilson', 'NP', 'Family Practice', '', '', NULL, 'O', '3485 W 5200 S', 'Roy', 'Weber', 'UT', '84067', '8014753900', '8014753901', '3485 W 5200 S', 'Roy', 'Weber', 'UT', '84067', '8014753900', '8014753901', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790088797', 0, 'N', 0, '2014-05-02', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'W12047280', 'W12047280', 'UT01', 'Ogden Cinic Adams Ave', 'Kayleen ', '', 'Wilson', 'NP', 'Family Practice', '', '', NULL, 'O', '5275 S Adams Ave Ste A', 'Ogden', 'Weber', 'UT', '84405', '8014755335', '8014755558', '5275 S Adams Ave Ste A', 'Ogden', 'Weber', 'UT', '84405', '8014755335', '8014755558', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790088797', 0, 'N', 0, '2014-05-02', NULL, NULL, 0, 0, NULL, NULL),
('261891316', 'W12047281', 'W12047281', 'TXHOUSTD', 'Houston Pediatric Pulmonary and Sleep Associates', 'Joseph', 'B', 'Rosen', 'MD', 'Pediatric Pulmonology', '', '', NULL, 'O', '7400 Fannin St Ste 1130', 'Houston', 'Harris', 'TX', '77054', '7137940200', '7137940203', '7400 Fannin St Ste 1130', 'Houston', 'Harris', 'TX', '77054', '7137940200', '7137940203', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144547423', 0, 'N', 0, '2014-05-02', 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
('261891316', 'W12047283', 'W12047283', 'TXHOUSTD', 'Houston Pediatric Pulmonary and Sleep Associates', 'Joseph', 'B', 'Rosen', 'MD', 'Pediatric Pulmonology', '', '', NULL, 'B', 'PO Box 281009', 'Atlanta', 'Fulton', 'GA', '30384', '7137940200', '7137940203', 'PO Box 281009', 'Atlanta', 'Fulton', 'GA', '30384', '7137940200', '7137940203', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144547423', 0, 'N', 0, '2014-05-02', NULL, NULL, 0, 0, NULL, NULL),
('826000952', 'W12047288', 'W12047288', 'UT01', 'Southeastern Idaho Public Health', '', '', 'Southeastern Idaho Public Health', '', 'Health Department', '', '', NULL, 'O', '178 Sunset', 'Arco', 'Butte', 'ID', '83213', '2085273463', '2085273972', '178 Sunset', 'Arco', 'Butte', 'ID', '83213', '2085273463', '2085273972', 'WISEA2013', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063576445', 0, 'Y', 0, '2014-06-18', NULL, NULL, 0, 0, NULL, NULL),
('826000952', 'W12047284', 'W12047284', 'UT01', 'Southeastern Idaho Public Health', '', '', 'Southeastern Idaho Public Health', '', 'Health Department', '', '', NULL, 'O', '1901 Alvin Ricken Dr', 'Athol', 'Kootenai', 'ID', '83801', '2082339080', '2082347169', '1901 Alvin Ricken Dr', 'Athol', 'Kootenai', 'ID', '83801', '2082339080', '2082347169', 'WISEA2013', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063576445', 0, 'Y', 0, '2014-06-18', NULL, NULL, 0, 0, NULL, NULL),
('826000952', 'W12047286', 'W12047286', 'UT01', 'Southeastern Idaho Public Health', '', '', 'Southeastern Idaho Public Health', '', 'Health Department', '', '', NULL, 'O', '326 Poplar', 'Blackfoot', 'Bingham', 'ID', '83221', '2087852160', '2087856372', '326 Poplar', 'Blackfoot', 'Bingham', 'ID', '83221', '2087852160', '2087856372', 'WISEA2013', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063576445', 0, 'Y', 0, '2014-06-18', NULL, NULL, 0, 0, NULL, NULL),
('826000952', 'W12047289', 'W12047289', 'UT01', 'Southeastern Idaho Public Health', '', '', 'Southeastern Idaho Public Health', '', 'Health Department', '', '', NULL, 'O', '42 W 1st S', 'Preston', 'Franklin', 'ID', '83263', '2088520478', '2088522346', '42 W 1st S', 'Preston', 'Franklin', 'ID', '83263', '2088520478', '2088522346', 'WISEA2013', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063576445', 0, 'N', 0, '2014-06-18', NULL, NULL, 0, 0, NULL, NULL),
('826000952', 'W12047285', 'W12047285', 'UT01', 'Southeastern Idaho Public Health', '', '', 'Southeastern Idaho Public Health', '', 'Health Department', '', '', NULL, 'O', '455 Washington Ste 2', 'Montpelier', 'Bear Lake', 'ID', '83254', '2088473000', '2088472538', '455 Washington Ste 2', 'Montpelier', 'Bear Lake', 'ID', '83254', '2088473000', '2088472538', 'WISEA2013', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063576445', 0, 'Y', 0, '2014-06-18', NULL, NULL, 0, 0, NULL, NULL),
('826000952', 'W12047287', 'W12047287', 'UT01', 'Southeastern Idaho Public Health', '', '', 'Southeastern Idaho Public Health', '', 'Health Department', '', '', NULL, 'O', '55 E 1st S', 'Soda Springs', 'Caribou', 'ID', '83276', '2085474375', '2085474398', '55 E 1st S', 'Soda Springs', 'Caribou', 'ID', '83276', '2085474375', '2085474398', 'WISEA2013', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063576445', 0, 'Y', 0, '2014-06-18', NULL, NULL, 0, 0, NULL, NULL),
('826000952', 'W12047291', 'W12047291', 'UT01', 'Southeastern Idaho Public Health', '', '', 'Southeastern Idaho Public Health', '', 'Health Department', '', '', NULL, 'O', '590 1/2 Gifford', 'American Falls', 'Power', 'ID', '83211', '2082265096', '2082267145', '590 1/2 Gifford', 'American Falls', 'Power', 'ID', '83211', '2082265096', '2082267145', 'WISEA2013', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063576445', 0, 'Y', 0, '2014-06-18', NULL, NULL, 0, 0, NULL, NULL),
('204432779', 'W12047293', 'W12047293', 'TXDALSTD', 'Dr Mark Lindemann DO', 'Mark', 'A', 'Lindemann', 'DO', 'Internal Medicine', '', '', NULL, 'O', '4545 Bellaire Dr S Ste 9', 'Fort Worth', 'Tarrant', 'TX', '76109', '8178894932', '8173779486', '4545 Bellaire Dr S Ste 9', 'Fort Worth', 'Tarrant', 'TX', '76109', '8178894932', '8173779486', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', '', '', '', 'HCFA|UB|', '1295776391', 0, 'N', 0, '2014-05-05', NULL, NULL, 0, 0, NULL, NULL),
('204432779', 'W12047294', 'W12047294', 'TXDALSTD', 'Dr Mark Lindemann DO', 'Mark', 'A', 'Lindemann', 'DO', 'Internal Medicine', '', '', NULL, 'B', '9715 Burnet Rd Ste 201', 'Austin', 'Travis', 'TX', '78758', '8884198176', '5123432598', '9715 Burnet Rd Ste 201', 'Austin', 'Travis', 'TX', '78758', '8884198176', '5123432598', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', '', '', '', 'HCFA|UB|', '1295776391', 0, 'N', 0, '2014-05-05', NULL, NULL, 0, 0, NULL, NULL),
('752947630', 'W12047297', 'W12047297', 'TXDALSTD', 'Kid Care Pediatrics', 'Michelle', 'M', 'McKane', 'MD', 'Pediatrics', '', '', NULL, 'O', '230 N Rufe Snow', 'Keller', 'Tarrant', 'TX', '76248', '8173375503', '8173370110', '230 N Rufe Snow', 'Keller', 'Tarrant', 'TX', '76248', '8173375503', '8173370110', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255363099', 0, 'N', 0, '2014-05-05', NULL, NULL, 0, 0, NULL, NULL),
('752947630', 'W12047298', 'W12047298', 'TXDALSTD', 'Kid Care Pediatrics', 'Michelle', 'M', 'McKane', 'MD', 'Pediatrics', '', '', NULL, 'O', '500 FM 156 S Ste 100', 'Haslet', 'Tarrant', 'TX', '76052', '8174390303', '8178471353', '500 FM 156 S Ste 100', 'Haslet', 'Tarrant', 'TX', '76052', '8174390303', '8178471353', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255363099', 0, 'N', 0, '2014-05-05', NULL, NULL, 0, 0, NULL, NULL),
('752286998', 'W12047300', 'W12047300', 'TXDALSTD', 'Dallas Associated Dermatologists', 'Amy', 'W', 'Moldrem', 'MD', 'General Surgery', '', '', NULL, 'O', '5924 Royal Ln Ste 104', 'Dallas', 'Dallas', 'TX', '75230', '2149873376', '2146926567', '5924 Royal Ln Ste 104', 'Dallas', 'Dallas', 'TX', '75230', '2149873376', '2146926567', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, 'Baylor University Medical Center', '', '', '', 'HCFA|UB|', '1700958253', 0, 'N', 0, '2014-05-05', NULL, NULL, 0, 0, NULL, NULL),
('752286998', 'W12047301', 'W12047301', 'TXDALSTD', 'Dallas Associated Dermatologists', 'Amy', 'W', 'Moldrem', 'MD', 'General Surgery', '', '', NULL, 'O', '6750 N MacArthur Blvd Ste 260', 'Irving', 'Dallas', 'TX', '75039', '2149873376', '2146926567', '6750 N MacArthur Blvd Ste 260', 'Irving', 'Dallas', 'TX', '75039', '2149873376', '2146926567', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, 'Baylor University Medical Center', '', '', '', 'HCFA|UB|', '1700958253', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('464860928', 'W12047303', 'W12047303', 'TXDALSTD', 'Heriberto Salinas MD', 'Heriberto', '', 'Salinas', 'MD', 'Family Practice', '', '', NULL, 'O', '1900 E Henderson St', 'Cleburne', 'Johnson', 'TX', '76031', '8176450409', '8176450408', '1900 E Henderson St', 'Cleburne', 'Johnson', 'TX', '76031', '8176450409', '8176450408', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609808500', 0, 'N', 0, '2014-05-12', NULL, NULL, 0, 0, NULL, NULL),
('463862676', 'W12047306', 'W12047306', 'TXDALSTD', 'Pediatric Endocrinology of North Texas', 'Amy', '', 'Burton', 'MD', 'Pediatric Endocrinology', '', '', NULL, 'B', '9601 White Rock Tr Ste 310', 'Dallas', 'Dallas', 'TX', '75238', '9406004861', '9406004866', '9601 White Rock Tr Ste 310', 'Dallas', 'Dallas', 'TX', '75238', '9406004861', '9406004866', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154544054', 0, 'N', 0, '2014-05-05', NULL, NULL, 0, 0, NULL, NULL),
('463862676', 'W12047305', 'W12047305', 'TXDALSTD', 'Pediatric Endocrinology of North Texas', 'Amy', '', 'Burton', 'MD', 'Pediatric Endocrinology', '', '', NULL, 'O', '209 Bonnie Brae St Bldg 3 Ste 301', 'Denton', 'Denton', 'TX', '76201', '9406004861', '9406004866', '209 Bonnie Brae St Bldg 3 Ste 301', 'Denton', 'Denton', 'TX', '76201', '9406004861', '9406004866', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154544054', 0, 'N', 0, '2014-05-05', NULL, NULL, 0, 0, NULL, NULL),
('463862676', 'W12047307', 'W12047307', 'TXDALSTD', 'Pediatric Endocrinology of North Texas', 'Amy', '', 'Burton', 'MD', 'Pediatric Endocrinology', '', '', NULL, 'M', '2221 Shakespeare St', 'Carrollton', 'Denton', 'TX', '75010', '0000000000', '0000000000', '2221 Shakespeare St', 'Carrollton', 'Denton', 'TX', '75010', '0000000000', '0000000000', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154544054', 0, 'N', 0, '2014-05-05', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'W12047309', 'W12047309', 'TXSATSTD', 'Consultants in Womens Health', 'Anna', 'L', 'Chavana', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '250 E Basse Ste 205', 'San Antonio', 'Bexar', 'TX', '78209', '2106535501', '          ', '250 E Basse Ste 205', 'San Antonio', 'Bexar', 'TX', '78209', '2106535501', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, 'North Central Baptist Hospital', '', '', '', 'HCFA|UB|', '1689683039', 0, 'Y', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'W12047310', 'W12047310', 'UT01', 'Tanner Memorial Clinic', 'David', 'A', 'Pennington', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3443 W 5600 S', 'Roy', 'Weber', 'UT', '84067', '8017734840', '8017749219', '3443 W 5600 S', 'Roy', 'Weber', 'UT', '84067', '8017734840', '8017749219', 'WUTANNER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1609941582', 0, 'N', 1, '2014-06-19', NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'W12047311', 'W12047311', 'UT01', 'Tanner Memorial Clinic', 'David', 'A', 'Pennington', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'WUTANNER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1609941582', 0, 'N', 1, '2014-06-19', NULL, NULL, 0, 0, NULL, NULL),
('870658280', 'W12047312', 'W12047312', 'UT01', 'Audiology and Hearing Care of Southern Utah', 'Lance', 'F', 'Greer', 'AUD', 'Audiology', NULL, NULL, NULL, 'O', '1490 E Foremaster Dr Ste A-360', 'St George', 'Washington', 'UT', '84790', '4356888866', '          ', '1490 E Foremaster Dr Ste A-360', 'St George', 'Washington', 'UT', '84790', '4356888866', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992799688', 0, 'N', 0, '2014-05-05', NULL, NULL, 0, 0, NULL, NULL),
('830333437', 'W12047315', 'W12047315', 'WY01', 'Teton Therapy', 'John', 'P', 'Schutt', 'PT', 'Physical Therapy', '', '', NULL, 'O', '425 Lincoln', 'Lander', 'Fremont', 'WY', '82520', '3073322230', '3073320463', '425 Lincoln', 'Lander', 'Fremont', 'WY', '82520', '3073322230', '3073320463', 'WISEWYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225463656', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('830333437', 'W12047313', 'W12047313', 'WY01', 'Teton Therapy', 'John', 'P', 'Schutt', 'PT', 'Physical Therapy', '', '', NULL, 'O', '820 W Main', 'Riverton', 'Fremont', 'WY', '82501', '3078577044', '3078566459', '820 W Main', 'Riverton', 'Fremont', 'WY', '82501', '3078577044', '3078566459', 'WISEWYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225463656', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('830333437', 'W12047316', 'W12047316', 'WYT1', 'Teton Therapy', 'John', 'P', 'Schutt', 'PT', 'Physical Therapy', '', '', NULL, 'O', '425 Lincoln', 'Lander', 'Fremont', 'WY', '82520', '3073322230', '3073320463', '425 Lincoln', 'Lander', 'Fremont', 'WY', '82520', '3073322230', '3073320463', 'WISEWYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225463656', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('830333437', 'W12047314', 'W12047314', 'WYT1', 'Teton Therapy', 'John', 'P', 'Schutt', 'PT', 'Physical Therapy', '', '', NULL, 'O', '820 W Main', 'Riverton', 'Fremont', 'WY', '82501', '3078577074', '3078566459', '820 W Main', 'Riverton', 'Fremont', 'WY', '82501', '3078577074', '3078566459', 'WISEWYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225463656', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'W12047317', 'W12047317', 'UT01', 'Granger Medical Clinic', 'Ronak', '', 'Iqbal', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019653600', '8019653740', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019653600', '8019653740', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', 'Pioneer Valley Hospital', '', '', 'HCFA|UB|', '1679746085', 0, 'N', 1, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'W12047318', 'W12047318', 'UT01', 'Granger Medical Clinic', 'Ronak', '', 'Iqbal', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '8019653720', '8019653740', 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '8019653720', '8019653740', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', 'Pioneer Valley Hospital', '', '', 'HCFA|UB|', '1679746085', 0, 'N', 1, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12047321', 'W12047321', 'WY01', 'Memorial Hospital of Sweetwater County', 'Preetpal', '', 'Grewal', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1180 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528471', '3073528477', '1180 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528471', '3073528477', '', '', '', '0.00', '5.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1437346822', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12047320', 'W12047320', 'WY01', 'Memorial Hospital of Sweetwater County', 'Preetpal', '', 'Grewal', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 1359', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073623711', '          ', 'PO Box 1359', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073623711', '          ', '', '', '', '0.00', '5.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1437346822', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12047322', 'W12047322', 'WYT2', 'Memorial Hospital of Sweetwater County', 'Preetpal', '', 'Grewal', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1180 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528471', '3073528477', '1180 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528471', '3073528477', '', '', '', '0.00', '5.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1437346822', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12047319', 'W12047319', 'WYT2', 'Memorial Hospital of Sweetwater County', 'Preetpal', '', 'Grewal', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 1359', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073623711', '          ', 'PO Box 1359', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073623711', '          ', '', '', '', '0.00', '5.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1437346822', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('271789847', 'W12047370', 'W12047370', 'IDONTSTD', 'Saint Alphonsus Medical Group - Ontario Surgical Services', 'Pamela', '', 'Bruce', 'MD', 'General Surgery', '', '', NULL, 'O', '1050 SW 3rd Ave Ste 2600', 'Ontario', 'Malheur', 'OR', '97914', '5418811601', '5418811244', '1050 SW 3rd Ave Ste 2600', 'Ontario', 'Malheur', 'OR', '97914', '5418811601', '5418811244', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 8, '2013-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508083635', 0, 'N', 0, '2014-06-10', NULL, NULL, 0, 0, NULL, NULL),
('820200896', 'W12047759', 'W12047759', 'IDBOISTD', 'Saint Alphonsus Medical Center - Nampa', '', '', 'Saint Alphonsus Medical Center - Nampa', '', 'Hospital', '', '', NULL, 'B', 'PO Box 31001-1274', 'Pasadena', 'Los Angeles', 'CA', '91110', '2083673514', '          ', 'PO Box 31001-1274', 'Pasadena', 'Los Angeles', 'CA', '91110', '2083673514', '          ', '', '', '', '0.00', '27.00', '0.00', 6, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659371870', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('330363116', 'W12047328', 'W12047328', 'UT01', 'Quest Diagnostics', '', '', 'Metwest Inc dba Quest Diagnostic', 'GROUP', 'Laboratory', '', '', NULL, 'O', '377 N Fairgrounds Rd', 'Price', 'Carbon', 'UT', '84501', '4356375936', '4356370164', '377 N Fairgrounds Rd', 'Price', 'Carbon', 'UT', '84501', '4356375936', '4356370164', 'WUQUEST5', '', '', '0.00', '20.00', '0.00', 3, '2014-05-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000831976', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('330363116', 'W12047336', 'W12047336', 'UT01', 'Ogden Clinic McKay Womans', '', '', 'Metwest Inc dba Quest Diagnostic', 'GROUP', 'Laboratory', '', '', NULL, 'O', '4403 Harrison Blvd Ste 4650', 'Ogden', 'Weber', 'UT', '84403', '8014753240', '0000000000', '4403 Harrison Blvd Ste 4650', 'Ogden', 'Weber', 'UT', '84403', '8014753240', '0000000000', 'WUQUEST5', '', '', '0.00', '20.00', '0.00', 3, '2014-05-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000831976', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('330363116', 'W12047330', 'W12047330', 'UT01', 'Quest Diagnostics', '', '', 'Metwest Inc dba Quest Diagnostic', 'GROUP', 'Laboratory', '', '', NULL, 'O', '348 E 4500 S Ste 210', 'Murray', 'Salt Lake', 'UT', '84107', '8012625222', '8012625644', '348 E 4500 S Ste 210', 'Murray', 'Salt Lake', 'UT', '84107', '8012625222', '8012625644', 'WUQUEST5', '', '', '0.00', '20.00', '0.00', 3, '2014-05-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000831976', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('330363116', 'W12047331', 'W12047331', 'UT01', 'Quest Diagnostics', '', '', 'Metwest Inc dba Quest Diagnostic', 'GROUP', 'Laboratory', '', '', NULL, 'O', '1160 E 3900 S Ste 1200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012663555', '8012664556', '1160 E 3900 S Ste 1200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012663555', '8012664556', 'WUQUEST5', '', '', '0.00', '20.00', '0.00', 3, '2014-05-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000831976', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('330363116', 'W12047333', 'W12047333', 'UT01', 'Quest Diagnostics Exam One', '', '', 'Metwest Inc dba Quest Diagnostic', 'GROUP', 'Laboratory', '', '', NULL, 'O', '420 E S Temple Ste 405A', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015214707', '8015756960', '420 E S Temple Ste 405A', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015214707', '8015756960', 'WUQUEST5', '', '', '0.00', '20.00', '0.00', 3, '2014-05-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000831976', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('330363116', 'W12047334', 'W12047334', 'UT01', 'Mountain West Medical Center', '', '', 'Metwest Inc dba Quest Diagnostic', 'GROUP', 'Laboratory', '', '', NULL, 'O', '2055 N Main St', 'Tooele', 'Tooele', 'UT', '84074', '4358432500', '0000000000', '2055 N Main St', 'Tooele', 'Tooele', 'UT', '84074', '4358432500', '0000000000', 'WUQUEST5', '', '', '0.00', '20.00', '0.00', 3, '2014-05-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000831976', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('330363116', 'W12047335', 'W12047335', 'UT01', 'Ogden Clinic Canyon View', '', '', 'Metwest Inc dba Quest Diagnostic', 'GROUP', 'Laboratory', '', '', NULL, 'O', '1159 12th St', 'Ogden', 'Weber', 'UT', '84404', '8014753700', '0000000000', '1159 12th St', 'Ogden', 'Weber', 'UT', '84404', '8014753700', '0000000000', 'WUQUEST5', '', '', '0.00', '20.00', '0.00', 3, '2014-05-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000831976', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('330363116', 'W12047337', 'W12047337', 'UT01', 'Ogden Clinic Main', '', '', 'Metwest Inc dba Quest Diagnostic', 'GROUP', 'Laboratory', '', '', NULL, 'O', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753000', '0000000000', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753000', '0000000000', 'WUQUEST5', '', '', '0.00', '20.00', '0.00', 3, '2014-05-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000831976', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('330363116', 'W12047338', 'W12047338', 'UT01', 'Ogden Clinic ORMC Womens', '', '', 'Metwest Inc dba Quest Diagnostic', 'GROUP', 'Laboratory', '', '', NULL, 'O', '5495 S 500 E Ste 310', 'Ogden', 'Weber', 'UT', '84405', '8014753100', '0000000000', '5495 S 500 E Ste 310', 'Ogden', 'Weber', 'UT', '84405', '8014753100', '0000000000', 'WUQUEST5', '', '', '0.00', '20.00', '0.00', 3, '2014-05-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000831976', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('330363116', 'W12047339', 'W12047339', 'UT01', 'Ogden Clinic Mountain View', '', '', 'Metwest Inc dba Quest Diagnostic', 'GROUP', 'Laboratory', '', '', NULL, 'O', '1100 W 2700 N', 'Ogden', 'Weber', 'UT', '84404', '8014753600', '0000000000', '1100 W 2700 N', 'Ogden', 'Weber', 'UT', '84404', '8014753600', '0000000000', 'WUQUEST5', '', '', '0.00', '20.00', '0.00', 3, '2014-05-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000831976', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('330363116', 'W12047340', 'W12047340', 'UT01', 'Ogden Clinic Grand View', '', '', 'Metwest Inc dba Quest Diagnostic', 'GROUP', 'Laboratory', '', '', NULL, 'O', '3485 W 5200 S', 'Roy', 'Weber', 'UT', '84067', '8014753900', '0000000000', '3485 W 5200 S', 'Roy', 'Weber', 'UT', '84067', '8014753900', '0000000000', 'WUQUEST5', '', '', '0.00', '20.00', '0.00', 3, '2014-05-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000831976', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('330363116', 'W12047341', 'W12047341', 'UT01', 'Ogden Clinic Skyline', '', '', 'Metwest Inc dba Quest Diagnostic', 'GROUP', 'Laboratory', '', '', NULL, 'O', '6112 S 1550 E', 'Ogden', 'Weber', 'UT', '84405', '8014753800', '0000000000', '6112 S 1550 E', 'Ogden', 'Weber', 'UT', '84405', '8014753800', '0000000000', 'WUQUEST5', '', '', '0.00', '20.00', '0.00', 3, '2014-05-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000831976', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('330363116', 'W12047342', 'W12047342', 'WY01', 'Wellness Screening LLC', '', '', 'Metwest Inc dba Quest Diagnostic', 'GROUP', 'Laboratory', '', '', NULL, 'O', '1988 E 1st St Ste A', 'Casper', 'Natrona', 'WY', '82601', '3072356004', '0000000000', '1988 E 1st St Ste A', 'Casper', 'Natrona', 'WY', '82601', '3072356004', '0000000000', 'WUQUEST5', '', '', '0.00', '20.00', '0.00', 3, '2014-05-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000831976', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('330363116', 'W12047343', 'W12047343', 'WYT1', 'Wellness Screening LLC', '', '', 'Metwest Inc dba Quest Diagnostic', 'GROUP', 'Laboratory', '', '', NULL, 'O', '1988 E 1st St Ste A', 'Casper', 'Natrona', 'WY', '82601', '3072356004', '0000000000', '1988 E 1st St Ste A', 'Casper', 'Natrona', 'WY', '82601', '3072356004', '0000000000', 'WUQUEST5', '', '', '0.00', '20.00', '0.00', 3, '2014-05-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000831976', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'W12047344', 'W12047344', 'ID01', 'Quest Diagnostics', '', '', 'Metwest Inc dba Quest Diagnostic', 'GROUP', 'Laboratory', '', '', NULL, 'O', '1151 D Hospital Way Ste 200', 'Pocatello', 'Bannock', 'ID', '83201', '2082334804', '2082334814', '1151 D Hospital Way Ste 200', 'Pocatello', 'Bannock', 'ID', '83201', '2082334804', '2082334814', 'WUQUEST5', '', '', '0.00', '20.00', '0.00', 3, '2014-05-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000831976', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'W12047345', 'W12047345', 'ID01', 'Quest Diagnostics', '', '', 'Metwest Inc dba Quest Diagnostic', 'GROUP', 'Laboratory', '', '', NULL, 'O', '2001 S Woodruff Ave Ste 7', 'Idaho Falls', 'Bonneville', 'ID', '83404', '2085524826', '2085520352', '2001 S Woodruff Ave Ste 7', 'Idaho Falls', 'Bonneville', 'ID', '83404', '2085524826', '2085520352', 'WUQUEST5', '', '', '0.00', '20.00', '0.00', 3, '2014-05-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000831976', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'W12047346', 'W12047346', 'ID01', 'Quest Diagnostics', '', '', 'Metwest Inc dba Quest Diagnostic', 'GROUP', 'Laboratory', '', '', NULL, 'O', '1118 W Ironwood Dr', 'Coeur D Alene', 'Kootenai', 'ID', '83814', '2087653601', '2087653608', '1118 W Ironwood Dr', 'Coeur D Alene', 'Kootenai', 'ID', '83814', '2087653601', '2087653608', 'WUQUEST5', '', '', '0.00', '20.00', '0.00', 3, '2014-05-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000831976', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('382084239', 'W12047347', 'W12047347', 'NM01', 'Mesa Medical Services', '', '', 'Metwest Inc dba Quest Diagnostic', 'GROUP', 'Laboratory', '', '', NULL, 'O', '906 W Pierce', 'Carlsbad', 'Eddy', 'NM', '88220', '5758870080', '0000000000', '906 W Pierce', 'Carlsbad', 'Eddy', 'NM', '88220', '5758870080', '0000000000', 'WUQUEST5', '', '', '0.00', '20.00', '0.00', 3, '2014-05-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000831976', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
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('752536818', 'W12047504', 'W12047504', 'TXDALSTD', 'Physiatric Medicine Associates', 'James', 'J', 'Lewis', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, 'Baylor University Medical Center', '', '', '', 'HCFA|UB|', '1649590944', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'W12047506', 'W12047506', 'TXDALSTD', 'Dallas Intensivists', 'Kimber', 'L', 'Foust', 'MD', 'Pulmonary', '', '', NULL, 'O', '3600 Gaston Ave Ste 550', 'Dallas', 'Dallas', 'TX', '75246', '9724510219', '2148221193', '3600 Gaston Ave Ste 550', 'Dallas', 'Dallas', 'TX', '75246', '9724510219', '2148221193', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, 'Baylor University Medical Center', '', '', '', 'HCFA|UB|', '1013176718', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'W12047507', 'W12047507', 'TXDALSTD', 'Dallas Intensivists', 'Kimber', 'L', 'Foust', 'MD', 'Pulmonary', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, 'Baylor University Medical Center', '', '', '', 'HCFA|UB|', '1013176718', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('911947573', 'W12047508', 'W12047508', 'TXDALSTD', 'MedProvider Inpatient Care Unit', 'Danielle', 'R', 'Ford', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3500 Gaston Ave Roberts Tower 4th Fl', 'Dallas', 'Dallas', 'TX', '75246', '2148203000', '2148203022', '3500 Gaston Ave Roberts Tower 4th Fl', 'Dallas', 'Dallas', 'TX', '75246', '2148203000', '2148203022', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568601516', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('911947573', 'W12047509', 'W12047509', 'TXDALSTD', 'MedProvider Inpatient Care Unit', 'Danielle', 'R', 'Ford', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '2148203000', '2148203022', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '2148203000', '2148203022', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568601516', 0, 'N', 0, '2014-05-08', 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
('911947573', 'W12047510', 'W12047510', 'TXDALSTD', 'Waxahachie Inpatient Care Unit', 'Danielle', 'R', 'Ford', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1405 W Jefferson St', 'Waxahachie', 'Ellis', 'TX', '75165', '9729237144', '9729237145', '1405 W Jefferson St', 'Waxahachie', 'Ellis', 'TX', '75165', '9729237144', '9729237145', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568601516', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12047512', 'W12047512', 'WYBILLINGS', 'Billings Clinic', 'Clinton', 'E', 'Preston', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-04-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467441048', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12047514', 'W12047514', 'WYBILLINGS', 'Billings Clinic - Family Medicine', 'Clinton', 'E', 'Preston', 'MD', 'Family Practice', '', '', NULL, 'O', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382413', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382413', '', '', '', '0.00', '17.00', '0.00', 3, '2014-04-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467441048', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12047513', 'W12047513', 'WYBILLINGS', 'Billings Clinic', 'Clinton', 'E', 'Preston', 'MD', 'Family Practice', '', '', NULL, 'M', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-04-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467441048', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12047516', 'W12047516', 'WYBILLINGS', 'Billings Clinic - Family Medicine', 'Jane', 'L', 'LaRoche', 'MD', 'Family Practice', '', '', NULL, 'O', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382413', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382413', '', '', '', '0.00', '17.00', '0.00', 3, '2014-04-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902820079', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12047517', 'W12047517', 'WYBILLINGS', 'Billings Clinic', 'Jane', 'L', 'LaRoche', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-04-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902820079', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12047518', 'W12047518', 'WYBILLINGS', 'Billings Clinic', 'Jane', 'L', 'LaRoche', 'MD', 'Family Practice', '', '', NULL, 'M', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-04-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902820079', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('911394965', 'W12047519', 'W12047519', 'IDBOISTD', 'Pacific Cataract & Laser', '', '', 'Pacific Cataract & Laser', 'GROUP', 'Ambulatory Surgery Center', '', '', NULL, 'O', '2822 S Vista Ave MD', 'Boise', 'Ada', 'ID', '83705', '2083857576', '          ', '2822 S Vista Ave MD', 'Boise', 'Ada', 'ID', '83705', '2083857576', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 6, '2014-04-30', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275700957', 0, 'Y', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('911394965', 'W12047520', 'W12047520', 'ID01', 'Pacific Cataract & Laser', '', '', 'Pacific Cataract & Laser', 'GROUP', 'Ambulatory Surgery Center', '', '', NULL, 'O', '2822 S Vista Ave OD', 'Boise', 'Ada', 'ID', '83705', '2083857576', '          ', '2822 S Vista Ave OD', 'Boise', 'Ada', 'ID', '83705', '2083857576', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 6, '2014-04-30', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275700957', 0, 'Y', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('911394965', 'W12047521', 'W12047521', 'IDBOISTD', 'Pacific Cataract & Laser', '', '', 'Pacific Cataract & Laser', 'GROUP', 'Ambulatory Surgery Center', '', '', NULL, 'O', '2822 S Vista Ave CRNA', 'Boise', 'Ada', 'ID', '83705', '2083857576', '          ', '2822 S Vista Ave CRNA', 'Boise', 'Ada', 'ID', '83705', '2083857576', '          ', '', '', '1000', '44.65', '100.00', '0.00', 6, '2014-04-30', '2014-04-30', 0, 15, 0, '', '', '', '', 'HCFA|UB|', '1275700957', 0, 'Y', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('911394965', 'W12047548', 'W12047548', 'ID01', 'Pacific Cataract & Laser', 'Brooks', 'R', 'Alldredge', 'OD', 'Optometry', '', '', NULL, 'O', '2822 S Vista Ave', 'Boise', 'Ada', 'ID', '83705', '2083857576', '          ', '2822 S Vista Ave', 'Boise', 'Ada', 'ID', '83705', '2083857576', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 6, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154463099', 0, 'N', 1, '2014-05-09', NULL, NULL, 0, 0, NULL, NULL),
('911394965', 'W12047544', 'W12047544', 'IDBOISTD', 'Pacific Cataract & Laser', 'Donald', 'A', 'Zinke', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'O', '2822 S Vista Ave', 'Boise', 'Ada', 'ID', '83705', '2083857576', '          ', '2822 S Vista Ave', 'Boise', 'Ada', 'ID', '83705', '2083857576', '          ', '', '', '1000', '44.65', '100.00', '0.00', 6, '2014-04-30', NULL, 0, 15, 0, '', '', '', '', 'HCFA|UB|', '1992874069', 0, 'Y', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('911394965', 'W12047541', 'W12047541', 'IDBOISTD', 'Pacific Cataract & Laser', 'Karl', 'W', 'Hare', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'O', '2822 S Vista Ave', 'Boise', 'Ada', 'ID', '83705', '2083857576', '          ', '2822 S Vista Ave', 'Boise', 'Ada', 'ID', '83705', '2083857576', '          ', '', '', '1000', '44.65', '100.00', '0.00', 6, '2014-04-30', NULL, 0, 15, 0, '', '', '', '', 'HCFA|UB|', '1184659666', 0, 'Y', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('911394965', 'W12047538', 'W12047538', 'IDBOISTD', 'Pacific Cataract & Laser', 'Kevin', '', 'Burman', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'O', '2822 S Vista Ave', 'Boise', 'Ada', 'ID', '83705', '2083857576', '          ', '2822 S Vista Ave', 'Boise', 'Ada', 'ID', '83705', '2083857576', '          ', '', '', '1000', '44.65', '100.00', '0.00', 6, '2014-01-02', NULL, 0, 15, 0, '', '', '', '', 'HCFA|UB|', '1457674640', 0, 'Y', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('911394965', 'W12047526', 'W12047526', 'IDBOISTD', 'Pacific Cataract & Laser', 'Brian', 'J', 'Carey', 'MD', 'Ophthalmology', '', '', NULL, 'O', '2822 S Vista Ave', 'Boise', 'Ada', 'ID', '83705', '2083857576', '          ', '2822 S Vista Ave', 'Boise', 'Ada', 'ID', '83705', '2083857576', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 6, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942377502', 0, 'N', 1, '2014-05-09', NULL, NULL, 0, 0, NULL, NULL),
('911394965', 'W12047529', 'W12047529', 'IDBOISTD', 'Pacific Cataract & Laser', 'Joyce', 'E', 'Choe', 'MD', 'Ophthalmology', '', '', NULL, 'O', '2822 S Vista Ave', 'Boise', 'Ada', 'ID', '83705', '2083857576', '          ', '2822 S Vista Ave', 'Boise', 'Ada', 'ID', '83705', '2083857576', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 6, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467437509', 0, 'N', 1, '2014-05-09', NULL, NULL, 0, 0, NULL, NULL),
('911394965', 'W12047532', 'W12047532', 'IDBOISTD', 'Pacific Cataract & Laser', 'Robert', 'M', 'Ford', 'MD', 'Ophthalmology', '', '', NULL, 'O', '2822 S Vista Ave', 'Boise', 'Ada', 'ID', '83705', '2083857576', '          ', '2822 S Vista Ave', 'Boise', 'Ada', 'ID', '83705', '2083857576', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 6, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598959108', 0, 'N', 1, '2014-05-09', NULL, NULL, 0, 0, NULL, NULL),
('911394965', 'W12047550', 'W12047550', 'ID01', 'Pacific Cataract & Laser', 'Brian', 'A', 'Arvidson', 'OD', 'Optometry', '', '', NULL, 'O', '2822 S Vista Ave', 'Boise', 'Ada', 'ID', '83705', '2083857576', '          ', '2822 S Vista Ave', 'Boise', 'Ada', 'ID', '83705', '2083857576', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 6, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508050337', 0, 'N', 1, '2014-05-09', NULL, NULL, 0, 0, NULL, NULL),
('911394965', 'W12047545', 'W12047545', 'IDBOISTD', 'Pacific Cataract & Laser', 'William ', '', 'Taylor', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'O', '2822 S Vista Ave', 'Boise', 'Ada', 'ID', '83705', '2083857576', '          ', '2822 S Vista Ave', 'Boise', 'Ada', 'ID', '83705', '2083857576', '          ', '', '', '1000', '44.65', '100.00', '0.00', 6, '2014-03-31', NULL, 0, 15, 0, '', '', '', '', 'HCFA|UB|', '1598792186', 0, 'Y', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('911394965', 'W12047536', 'W12047536', 'IDBOISTD', 'Pacific Cataract & Laser', 'Jason', 'W', 'Leng', 'MD', 'Ophthalmology', '', '', NULL, 'O', '2822 S Vista Ave', 'Boise', 'Ada', 'ID', '83705', '2083857576', '          ', '2822 S Vista Ave', 'Boise', 'Ada', 'ID', '83705', '2083857576', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 6, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730396326', 0, 'N', 1, '2014-05-09', NULL, NULL, 0, 0, NULL, NULL),
('911394965', 'W12047557', 'W12047557', 'ID01', 'Pacific Cataract & Laser', 'Aaron', 'W', 'Bronner', 'OD', 'Optometry', '', '', NULL, 'O', '2822 S Vista Ave', 'Boise', 'Ada', 'ID', '83705', '2083857576', '          ', '2822 S Vista Ave', 'Boise', 'Ada', 'ID', '83705', '2083857576', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 6, '2014-04-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275730723', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('911394965', 'W12047554', 'W12047554', 'ID01', 'Pacific Cataract & Laser', 'Kimberly', 'J', 'Calnan-Holt', 'OD', 'Optometry', '', '', NULL, 'O', '2822 S Vista Ave', 'Boise', 'Ada', 'ID', '83705', '2083857576', '          ', '2822 S Vista Ave', 'Boise', 'Ada', 'ID', '83705', '2083857576', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 6, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790881514', 0, 'N', 1, '2014-05-09', NULL, NULL, 0, 0, NULL, NULL),
('911394965', 'W12047556', 'W12047556', 'ID01', 'Pacific Cataract & Laser', 'Mark', 'A', 'Maraman', 'OD', 'Optometry', '', '', NULL, 'O', '2822 S Vista Ave', 'Boise', 'Ada', 'ID', '83705', '2083857576', '          ', '2822 S Vista Ave', 'Boise', 'Ada', 'ID', '83705', '2083857576', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 6, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457559072', 0, 'N', 1, '2014-05-09', NULL, NULL, 0, 0, NULL, NULL),
('201435671', 'W12047558', 'W12047558', 'TXHOUSTD', 'Diabetes America', 'Anand', '', 'Balasubramanian', 'MD', 'Endocrinology', '', '', NULL, 'O', '11301 Fallbrook Dr Ste 304', 'Houston', 'Harris', 'TX', '77065', '8322373500', '8882377954', '11301 Fallbrook Dr Ste 304', 'Houston', 'Harris', 'TX', '77065', '8322373500', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811939606', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('201435671', 'W12047559', 'W12047559', 'TXHOUSTD', 'Diabetes America', 'Anand', '', 'Balasubramanian', 'MD', 'Endocrinology', '', '', NULL, 'B', '13100 NW Fwy Ste 400', 'Houston', 'Harris', 'TX', '77040', '8666934223', '8882377954', '13100 NW Fwy Ste 400', 'Houston', 'Harris', 'TX', '77040', '8666934223', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811939606', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('465036373', 'W12047561', 'W12047561', 'UT01', 'UPRI East', 'Teri', 'A', 'Clubb', 'NP', 'Pain Management', '', '', NULL, 'O', '2180 E 4500 S Ste 210', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8014667246', '8012810444', '2180 E 4500 S Ste 210', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8014667246', '8012810444', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801227715', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('455244568', 'W12047560', 'W12047560', 'UT01', 'UPRI Taylorsville', 'Teri', 'A', 'Clubb', 'NP', 'Pain Management', '', '', NULL, 'O', '1972 W 5400 S Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84129', '8018787880', '8012810444', '1972 W 5400 S Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84129', '8018787880', '8012810444', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801227715', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('364037473', 'W12047562', 'W12047562', 'ILCHIGSTD', 'Elmhurst Clinic', 'Shirley', '', 'Moore', 'CNM', 'Certified Nurse Midwife', '', '', NULL, 'O', '130 S Main', 'Lombard', 'Dupage', 'IL', '60148', '3312219004', '3312213977', '130 S Main', 'Lombard', 'Dupage', 'IL', '60148', '3312219004', '3312213977', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2014-05-02', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1780719104', 0, 'N', 0, '2014-06-10', NULL, NULL, 0, 0, NULL, NULL),
('263553949', 'W12047578', 'W12047578', 'TXDALSTD', 'Beltline Foot and Ankle Specialist div of PMPT', 'Matthew', 'T', 'Britt', 'DPM', 'Podiatry', '', '', NULL, 'O', '1601 Beltline Rd Ste A', 'Mesquite', 'Dallas', 'TX', '75149', '9722887441', '9722898025', '1601 Beltline Rd Ste A', 'Mesquite', 'Dallas', 'TX', '75149', '9722887441', '9722898025', 'DALLAS4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104164896', 0, 'N', 0, '2014-05-09', NULL, NULL, 0, 0, NULL, NULL),
('465472084', 'W12047564', 'W12047564', 'ID01', 'Sage Health Care', 'Laura', 'S', 'Shockley', 'LCPC', 'Mental Health', 'Counseling', '', NULL, 'O', '413 N Allumbaugh St Ste 101', 'Boise', 'Ada', 'ID', '83704', '2083231125', '          ', '413 N Allumbaugh St Ste 101', 'Boise', 'Ada', 'ID', '83704', '2083231125', '          ', 'IDMA', '', '', '0.00', '40.00', '0.00', 6, '2014-06-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750447173', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('465472084', 'W12047565', 'W12047565', 'SACN', 'Sage Health Care', 'Laura', 'S', 'Shockley', 'LCPC', 'Mental Health', 'Counseling', '', NULL, 'O', '413 N Allumbaugh St Ste 101', 'Boise', 'Ada', 'ID', '83704', '2083231125', '          ', '413 N Allumbaugh St Ste 101', 'Boise', 'Ada', 'ID', '83704', '2083231125', '          ', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2014-06-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750447173', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('262577896', 'W12047566', 'W12047566', 'TXDALSTD', 'Colleyville Dermatology', 'Gabriela', 'M', 'Blanco', 'MD', 'Dermatology', '', '', NULL, 'O', '5013 Heritage Ave', 'Colleyville', 'Tarrant', 'TX', '76034', '8178681616', '8178681617', '5013 Heritage Ave', 'Colleyville', 'Tarrant', 'TX', '76034', '8178681616', '8178681617', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, '', NULL, '', '', 'HCFA|UB|', '1710186960', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('611684739', 'W12047567', 'W12047567', 'TXHOUSTD', 'Conroe Physician Associates', 'Gerald', 'L', 'Bullock', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '508 Medical Ctr Blvd Ste 200', 'Conroe', 'Montgomery', 'TX', '77304', '9367604600', '9367604601', '508 Medical Ctr Blvd Ste 200', 'Conroe', 'Montgomery', 'TX', '77304', '9367604600', '9367604601', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-04-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437255411', 0, 'N', 0, '2014-05-09', NULL, NULL, 0, 0, NULL, NULL),
('611684739', 'W12047568', 'W12047568', 'TXHOUSTD', 'Conroe Physician Associates', 'Gerald', 'L', 'Bullock', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 742183', 'Atlanta', 'Fulton', 'GA', '30374', '9367604600', '9367604601', 'PO Box 742183', 'Atlanta', 'Fulton', 'GA', '30374', '9367604600', '9367604601', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-04-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437255411', 0, 'N', 0, '2014-05-09', NULL, NULL, 0, 0, NULL, NULL),
('611684739', 'W12047569', 'W12047569', 'TXHOUSTD', 'Conroe Physician Associates', 'Gerald', 'L', 'Bullock', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'M', 'Three Maryland Farms Ste 250', 'Brentwood', 'Williamson', 'TN', '37027', '9367604600', '9367604601', 'Three Maryland Farms Ste 250', 'Brentwood', 'Williamson', 'TN', '37027', '9367604600', '9367604601', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-04-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437255411', 0, 'N', 0, '2014-05-09', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'W12047570', 'W12047570', 'ILCHIGSTD', 'UroPartners', 'Amy', '', 'Hedstrom', 'PAC', 'Urology', '', '', NULL, 'O', '7900 N Milwaukee Ave Ste 17', 'Niles', 'Cook', 'IL', '60714', '8474701500', '8474701550', '7900 N Milwaukee Ave Ste 17', 'Niles', 'Cook', 'IL', '60714', '8474701500', '8474701550', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396070801', 0, 'N', 0, '2014-06-19', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'W12047571', 'W12047571', 'ILCHIGSTD', 'UroPartners', 'Amy', '', 'Hedstrom', 'PAC', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cr', 'Chicago', 'Cook', 'IL', '60674', '2242603100', '8479988112', '3183 Paysphere Cr', 'Chicago', 'Cook', 'IL', '60674', '2242603100', '8479988112', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-05-01', '2014-08-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396070801', 0, 'N', 0, '2014-06-19', NULL, NULL, 0, 0, NULL, NULL),
('364475941', 'W12047572', 'W12047572', 'ILCHIGSTD', 'Srinivas Kota MD', 'Srinivas', '', 'Kota', 'MD', 'Internal Medicine', '', '', NULL, 'O', '726 S Weber Rd', 'Bolingbrook', 'Will', 'IL', '60490', '6303789785', '6303789836', '726 S Weber Rd', 'Bolingbrook', 'Will', 'IL', '60490', '6303789785', '6303789836', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-05-06', NULL, 0, 0, 0, 'Edward Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1659481562', 0, 'N', 0, '2014-05-09', NULL, NULL, 0, 0, NULL, NULL),
('830300467', 'W12047573', 'W12047573', 'WYT1', 'Powell Valley Healthcare', 'Andrea', '', 'Whitaker', 'CCC-SLP', 'Speech Therapy', '', '', NULL, 'O', '777 Ave H', 'Powell', 'Park', 'WY', '82435', '3077547257', '          ', '777 Ave H', 'Powell', 'Park', 'WY', '82435', '3077547257', '          ', '', '', '', '0.00', '12.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033453444', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('830300467', 'W12047574', 'W12047574', 'WY01', 'Powell Valley Healthcare', 'Andrea', '', 'Whitaker', 'CCC-SLP', 'Speech Therapy', '', '', NULL, 'O', '777 Ave H', 'Powell', 'Park', 'WY', '82435', '3077547257', '          ', '777 Ave H', 'Powell', 'Park', 'WY', '82435', '3077547257', '          ', '', '', '', '0.00', '12.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033453444', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12047575', 'W12047575', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Bienvenido', 'V', 'Castillo', 'MD', 'Ophthalmology', '', '', NULL, 'O', '2040 Ogden Ave Ste 401', 'Aurora', 'Dupage', 'IL', '60504', '6305857100', '6306924057', '2040 Ogden Ave Ste 401', 'Aurora', 'Dupage', 'IL', '60504', '6305857100', '6306924057', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2014-04-29', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1891710257', 0, 'N', 0, '2014-05-09', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12047576', 'W12047576', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Yasmin', 'K', 'Bhathena', 'MD', 'Pediatrics', '', '', NULL, 'O', '2040 Ogden Ave Ste 401', 'Aurora', 'Dupage', 'IL', '60504', '6305857100', '6306924057', '2040 Ogden Ave Ste 401', 'Aurora', 'Dupage', 'IL', '60504', '6305857100', '6306924057', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2014-04-29', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1114953825', 0, 'N', 0, '2014-05-09', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12047577', 'W12047577', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Neena', 'S', 'Szuch', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '2040 Ogden Ave Ste 401', 'Aurora', 'Dupage', 'IL', '60504', '6305857100', '6306924057', '2040 Ogden Ave Ste 401', 'Aurora', 'Dupage', 'IL', '60504', '6305857100', '6306924057', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2014-04-30', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1992842116', 0, 'N', 0, '2014-05-09', NULL, NULL, 0, 0, NULL, NULL),
('263553949', 'W12047579', 'W12047579', 'TXDALSTD', 'Beltline Foot and Ankle Specialist div of PMPT', 'Matthew', 'T', 'Britt', 'DPM', 'Podiatry', '', '', NULL, 'O', '763 E US Hwy 80 Ste 280', 'Forney', 'Kaufman', 'TX', '75126', '9722887441', '9722898025', '763 E US Hwy 80 Ste 280', 'Forney', 'Kaufman', 'TX', '75126', '9722887441', '9722898025', 'DALLAS4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104164896', 0, 'N', 0, '2014-05-09', NULL, NULL, 0, 0, NULL, NULL),
('263553949', 'W12047580', 'W12047580', 'TXDALSTD', 'Podiatric Medical Partners of Texas', 'Matthew', 'T', 'Britt', 'DPM', 'Podiatry', '', '', NULL, 'B', 'PO Box 975517', 'Dallas', 'Dallas', 'TX', '75397', '3212072839', '3212562966', 'PO Box 975517', 'Dallas', 'Dallas', 'TX', '75397', '3212072839', '3212562966', 'DALLAS4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104164896', 0, 'N', 0, '2014-05-09', NULL, NULL, 0, 0, NULL, NULL),
('043692740', 'W12047581', 'W12047581', 'TXDALSTD', 'Surgical Group of North Texas', 'Sina', '', 'Matin', 'MD', 'General Surgery', '', '', NULL, 'O', '1600 W College', 'Grapevine', 'Tarrant', 'TX', '76051', '8172510070', '8172592040', '1600 W College', 'Grapevine', 'Tarrant', 'TX', '76051', '8172510070', '8172592040', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', '', '', '', 'HCFA|UB|', '1366481228', 0, 'N', 0, '2014-05-09', NULL, NULL, 0, 0, NULL, NULL),
('043692740', 'W12047582', 'W12047582', 'TXDALSTD', 'Surgical Group of North Texas', 'Sina', '', 'Matin', 'MD', 'General Surgery', '', '', NULL, 'O', '2001 N MacArthur Blvd Ste 530', 'Irving', 'Dallas', 'TX', '75061', '9722549399', '9722592040', '2001 N MacArthur Blvd Ste 530', 'Irving', 'Dallas', 'TX', '75061', '9722549399', '9722592040', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', '', '', '', 'HCFA|UB|', '1366481228', 0, 'N', 0, '2014-05-09', NULL, NULL, 0, 0, NULL, NULL),
('043692740', 'W12047583', 'W12047583', 'TXDALSTD', 'Surgical Group of North Texas', 'Sina', '', 'Matin', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 670824 Ste 255', 'Dallas', 'Dallas', 'TX', '75367', '9722549399', '9722592040', 'PO Box 670824 Ste 255', 'Dallas', 'Dallas', 'TX', '75367', '9722549399', '9722592040', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', '2014-05-29', 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', '', '', '', 'HCFA|UB|', '1366481228', 0, 'N', 0, '2014-05-09', NULL, NULL, 0, 0, NULL, NULL),
('043692740', 'W12047584', 'W12047584', 'TXDALSTD', 'Surgical Group of North Texas', 'Sina', '', 'Matin', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 204803', 'Dallas', 'Dallas', 'TX', '75230', '9722549399', '9722592040', 'PO Box 204803', 'Dallas', 'Dallas', 'TX', '75230', '9722549399', '9722592040', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-30', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', '', '', '', 'HCFA|UB|', '1366481228', 0, 'N', 0, '2014-05-09', NULL, NULL, 0, 0, NULL, NULL),
('043692740', 'W12047585', 'W12047585', 'TXDALSTD', 'Surgical Group of North Texas', 'Julio', 'R', 'Rivera', 'MD', 'General Surgery', '', '', NULL, 'O', '1600 W College', 'Grapevine', 'Tarrant', 'TX', '76051', '8172510070', '8172592040', '1600 W College', 'Grapevine', 'Tarrant', 'TX', '76051', '8172510070', '8172592040', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', '', '', '', 'HCFA|UB|', '1316980410', 0, 'N', 0, '2014-05-09', NULL, NULL, 0, 0, NULL, NULL),
('043692740', 'W12047586', 'W12047586', 'TXDALSTD', 'Surgical Group of North Texas', 'Julio', 'R', 'Rivera', 'MD', 'General Surgery', '', '', NULL, 'O', '2001 N MacArthur Blvd Ste 530', 'Irving', 'Dallas', 'TX', '75061', '9722549399', '9722592040', '2001 N MacArthur Blvd Ste 530', 'Irving', 'Dallas', 'TX', '75061', '9722549399', '9722592040', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', '', '', '', 'HCFA|UB|', '1316980410', 0, 'N', 0, '2014-05-09', NULL, NULL, 0, 0, NULL, NULL),
('043692740', 'W12047587', 'W12047587', 'TXDALSTD', 'Surgical Group of North Texas', 'Julio', 'R', 'Rivera', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 670824 Ste 255', 'Dallas', 'Dallas', 'TX', '75367', '9722549399', '9722592040', 'PO Box 670824 Ste 255', 'Dallas', 'Dallas', 'TX', '75367', '9722549399', '9722592040', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', '2013-05-29', 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', '', '', '', 'HCFA|UB|', '1316980410', 0, 'Y', 0, '2014-05-09', NULL, NULL, 0, 0, NULL, NULL),
('043692740', 'W12047588', 'W12047588', 'TXDALSTD', 'Surgical Group of North Texas', 'Julio', 'R', 'Rivera', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 204803', 'Dallas', 'Dallas', 'TX', '75230', '9722549399', '9722592040', 'PO Box 204803', 'Dallas', 'Dallas', 'TX', '75230', '9722549399', '9722592040', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-30', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', '', '', '', 'HCFA|UB|', '1316980410', 0, 'N', 0, '2014-05-09', NULL, NULL, 0, 0, NULL, NULL),
('043692740', 'W12047589', 'W12047589', 'TXDALSTD', 'Surgical Group of North Texas', 'Edward', 'J', 'Clifford', 'MD', 'General Surgery', '', '', NULL, 'O', '1600 W College', 'Grapevine', 'Tarrant', 'TX', '76051', '8172510070', '8172592040', '1600 W College', 'Grapevine', 'Tarrant', 'TX', '76051', '8172510070', '8172592040', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', '', '', '', 'HCFA|UB|', '1730122763', 0, 'N', 0, '2014-05-09', NULL, NULL, 0, 0, NULL, NULL),
('043692740', 'W12047590', 'W12047590', 'TXDALSTD', 'Surgical Group of North Texas', 'Edward', 'J', 'Clifford', 'MD', 'General Surgery', '', '', NULL, 'O', '2001 N MacArthur Blvd Ste 530', 'Irving', 'Dallas', 'TX', '75061', '9722549399', '9722592040', '2001 N MacArthur Blvd Ste 530', 'Irving', 'Dallas', 'TX', '75061', '9722549399', '9722592040', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', '', '', '', 'HCFA|UB|', '1730122763', 0, 'N', 0, '2014-05-09', NULL, NULL, 0, 0, NULL, NULL),
('043692740', 'W12047591', 'W12047591', 'TXDALSTD', 'Surgical Group of North Texas', 'Edward', 'J', 'Clifford', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 670824', 'Dallas', 'Dallas', 'TX', '75367', '9722549399', '9722592040', 'PO Box 670824', 'Dallas', 'Dallas', 'TX', '75367', '9722549399', '9722592040', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', '2014-05-29', 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', '', '', '', 'HCFA|UB|', '1730122763', 0, 'N', 0, '2014-05-09', NULL, NULL, 0, 0, NULL, NULL),
('043692740', 'W12047592', 'W12047592', 'TXDALSTD', 'Surgical Group of North Texas', 'Edward', 'J', 'Clifford', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 204803', 'Dallas', 'Dallas', 'TX', '75230', '9722549399', '9722592040', 'PO Box 204803', 'Dallas', 'Dallas', 'TX', '75230', '9722549399', '9722592040', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-30', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', '', '', '', 'HCFA|UB|', '1730122763', 0, 'N', 0, '2014-05-09', NULL, NULL, 0, 0, NULL, NULL),
('364712381', 'W12047593', 'W12047593', 'TXDALSTD', 'Lakeside Surgery', 'Caraleigh', 'N', 'Buxie', 'MD', 'General Surgery', '', '', NULL, 'O', '4450 Tubbs Rd', 'Rockwall', 'Rockwall', 'TX', '75032', '9727223290', '9727723815', '4450 Tubbs Rd', 'Rockwall', 'Rockwall', 'TX', '75032', '9727223290', '9727723815', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', '', '', '', 'HCFA|UB|', '1952577546', 0, 'N', 0, '2014-05-09', NULL, NULL, 0, 0, NULL, NULL),
('364712381', 'W12047594', 'W12047594', 'TXDALSTD', 'Lakeside Surgery', 'Katherine', 'R', 'Makohon', 'MD', 'General Surgery', '', '', NULL, 'O', '4450 Tubbs Rd', 'Rockwall', 'Rockwall', 'TX', '75032', '9727223290', '9727723815', '4450 Tubbs Rd', 'Rockwall', 'Rockwall', 'TX', '75032', '9727223290', '9727723815', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', '', '', '', 'HCFA|UB|', '1952393415', 0, 'N', 0, '2014-05-09', NULL, NULL, 0, 0, NULL, NULL),
('364712381', 'W12047595', 'W12047595', 'TXDALSTD', 'Lakeside Surgery', 'Jeffrey', 'S', 'Stephens', 'MD', 'General Surgery', '', '', NULL, 'O', '4450 Tubbs Rd', 'Rockwall', 'Rockwall', 'TX', '75032', '9727223290', '9727723815', '4450 Tubbs Rd', 'Rockwall', 'Rockwall', 'TX', '75032', '9727223290', '9727723815', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Baylor University Medical Center', '', '', '', 'HCFA|UB|', '1326097676', 0, 'N', 0, '2014-05-09', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12047597', 'W12047597', 'WYBILLINGS', 'Billings Clinic', 'Illias', '', 'Oikonomopoulos', 'MD', 'Rheumatology', '', '', NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-05-07', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639334832', 0, 'N', 0, '2014-05-09', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12047599', 'W12047599', 'WYBILLINGS', 'Billings Clinic - Rheumatology', 'Illias', '', 'Oikonomopoulos', 'MD', 'Rheumatology', '', '', NULL, 'O', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382806', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382806', '', '', '', '0.00', '17.00', '0.00', 3, '2014-05-07', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639334832', 0, 'N', 0, '2014-05-09', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12047598', 'W12047598', 'WYBILLINGS', 'Billings Clinic', 'Illias', '', 'Oikonomopoulos', 'MD', 'Rheumatology', '', '', NULL, 'M', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-05-07', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639334832', 0, 'N', 0, '2014-05-09', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12047600', 'W12047600', 'WYBILLINGS', 'Billings Clinic - Miles City Clinic', 'Elizabeth', '', 'Reid', 'PT', 'Physical Therapy', '', '', NULL, 'O', '620 S Haynes', 'Miles City', 'Custer', 'MT', '59301', '4062337000', '4062337070', '620 S Haynes', 'Miles City', 'Custer', 'MT', '59301', '4062337000', '4062337070', '', '', '', '0.00', '17.00', '0.00', 3, '2014-05-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265621452', 0, 'N', 0, '2014-05-09', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12047601', 'W12047601', 'WYBILLINGS', 'Billings Clinic', 'Elizabeth', '', 'Reid', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-05-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265621452', 0, 'N', 0, '2014-05-09', NULL, NULL, 0, 0, NULL, NULL),
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('820300537', 'W12047635', 'W12047635', 'ID02', 'Terry Reilly Health Services', 'Jonathan', '', 'Bowman', 'MD', 'Family Practice', '', '', NULL, 'O', '201 S 1st Ave E', 'Middleton', 'Canyon', 'ID', '83644', '2085850048', '2085856242', '201 S 1st Ave E', 'Middleton', 'Canyon', 'ID', '83644', '2085850048', '2085856242', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2014-02-14', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1497703169', 0, 'Y', 0, '2014-05-09', NULL, NULL, 0, 0, NULL, NULL),
('820300537', 'W12047636', 'W12047636', 'ID02', 'Terry Reilly Health Services', 'Jonathan', '', 'Bowman', 'MD', 'Family Practice', '', '', NULL, 'O', '300 S 23rd St', 'Boise', 'Ada', 'ID', '83702', '2083443512', '2083444898', '300 S 23rd St', 'Boise', 'Ada', 'ID', '83702', '2083443512', '2083444898', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2014-02-14', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1497703169', 0, 'Y', 0, '2014-05-09', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
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('942854057', 'W12047685', 'W12047685', 'UTIHCPHY', 'Manti Family Clinic', 'Kent', 'S', 'Chapman', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '159 N Main St', 'Manti', 'Sanpete', 'UT', '84642', '4358353344', '4358353081', '159 N Main St', 'Manti', 'Sanpete', 'UT', '84642', '4358353344', '4358353081', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366480162', 0, 'Y', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12047687', 'W12047687', 'UTIHCPHY', 'Moroni Clinic', 'Kent', 'S', 'Chapman', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '51 E Main St', 'Moroni', 'Sanpete', 'UT', '84646', '4354365250', '4354365265', '51 E Main St', 'Moroni', 'Sanpete', 'UT', '84646', '4354365250', '4354365265', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366480162', 0, 'Y', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12047689', 'W12047689', 'UTIHCPHY', 'Park City Allergy Clinic', 'Michael', '', 'Engelbert-Fenton', 'PA', 'Family Practice', '', '', NULL, 'O', '750 Round Valley Dr Ste 101 A', 'Park City', 'Summit', 'UT', '84060', '4356586622', '8013553746', '750 Round Valley Dr Ste 101 A', 'Park City', 'Summit', 'UT', '84060', '4356586622', '8013553746', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194701920', 0, 'Y', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12047692', 'W12047692', 'UTIHCPHY', 'Sunset InstaCare', 'Erik', 'E', 'Gulbrandsen', 'DO', 'Urgent Care', '', '', NULL, 'O', '1739 W Sunset Blvd', 'St George', 'Washington', 'UT', '84770', '4356346050', '4356346033', '1739 W Sunset Blvd', 'St George', 'Washington', 'UT', '84770', '4356346050', '4356346033', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2014-04-01', NULL, 0, 0, 0, 'Valley View Medical Center', '', '', '', 'HCFA|UB|', '1477822955', 0, 'Y', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12047693', 'W12047693', 'UTIHCPHY', 'River Road InstaCare', 'Erik', 'E', 'Gulbrandsen', 'DO', 'Urgent Care', '', '', NULL, 'O', '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886300', '4356886333', '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886300', '4356886333', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2014-04-01', NULL, 0, 0, 0, 'Valley View Medical Center', '', '', '', 'HCFA|UB|', '1477822955', 0, 'Y', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12047694', 'W12047694', 'UTIHCPHY', 'Hurricane Valley InstaCare', 'Erik', 'E', 'Gulbrandsen', 'DO', 'Urgent Care', '', '', NULL, 'O', '75 N 2260 W', 'Hurricane', 'Washington', 'UT', '84737', '4356356550', '4356356549', '75 N 2260 W', 'Hurricane', 'Washington', 'UT', '84737', '4356356550', '4356356549', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2014-04-01', NULL, 0, 0, 0, 'Valley View Medical Center', '', '', '', 'HCFA|UB|', '1477822955', 0, 'Y', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12047697', 'W12047697', 'UTIHCPHY', 'Sevier Valley Specialty Clinic', 'Edgar', 'N', 'Kemp', 'DO', 'Ear, Nose and Throat', '', '', NULL, 'O', '1000 N Main St Ste B', 'Richfield', 'Sevier', 'UT', '84701', '4358930800', '4358930805', '1000 N Main St Ste B', 'Richfield', 'Sevier', 'UT', '84701', '4358930800', '4358930805', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2014-04-07', NULL, 0, 0, 0, 'Delta Community Medical Center', 'Fillmore Community Medical Center', 'Sanpete Valley Hospital', 'Sevier Valley Hospital', 'HCFA|UB|', '1194876805', 0, 'N', 0, '2014-06-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12047698', 'W12047698', 'UTIHCPHY', 'Bear River Specialists', 'Jeffrey', 'S', 'Keyser', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '935 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '4352074800', '4352074808', '935 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '4352074800', '4352074808', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2014-05-01', NULL, 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1588674055', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12047702', 'W12047702', 'UTIHCPHY', 'Sevier Valley Specialty Clinic', 'Scott', 'A', 'Lange', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '1000 N Main St Ste B', 'Richfield', 'Sevier', 'UT', '84701', '4358930800', '4358930805', '1000 N Main St Ste B', 'Richfield', 'Sevier', 'UT', '84701', '4358930800', '4358930805', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104801315', 0, 'Y', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12047700', 'W12047700', 'UTIHCPHY', 'Int Heart Cardiology', 'Shane', 'M', 'Kjar', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '5169 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', '8015073505', '5169 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', '8015073505', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2014-05-24', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013932342', 0, 'Y', 0, '2014-06-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12047703', 'W12047703', 'UTIHCPHY', 'Dixie Acute Rehab', 'Diane', 'M', 'Vroenen', 'DO', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884700', '4356884326', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884700', '4356884326', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2014-03-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1093899924', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12047704', 'W12047704', 'UT01', 'Central Utah Clinic PC', 'Chad', 'B', 'Kawa', 'MD', 'Gastroenterology', '', '', NULL, 'O', '3300 N Running Creek Way Bldg B Ste 100', 'Lehi', 'Utah', 'UT', '84043', '8017720775', '8017711941', '3300 N Running Creek Way Bldg B Ste 100', 'Lehi', 'Utah', 'UT', '84043', '8017720775', '8017711941', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962654681', 0, 'N', 1, '2014-06-30', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'W12047705', 'W12047705', 'TXDALSTD', 'Health Texas Provider Network', 'Christopher', 'C', 'Breuder', 'MD', 'Family Practice', '', '', NULL, 'O', '610 Byron Nelson Blvd Ste 101', 'Roanoke', 'Denton', 'TX', '76262', '8179128200', '8179128210', '610 Byron Nelson Blvd Ste 101', 'Roanoke', 'Denton', 'TX', '76262', '8179128200', '8179128210', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2014-05-08', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', '', '', '', 'HCFA|UB|', '1730361437', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('743219124', 'W12047706', 'W12047706', 'TXDALSTD', 'Medical and Surgical Associates of Corsicana', 'David', 'S', 'Stevener', 'MD', 'Internal Medicine', '', '', NULL, 'O', '301 Hospital Dr Ste 195', 'Corsicana', 'Navarro', 'TX', '75110', '9038723005', '9038757229', '301 Hospital Dr Ste 195', 'Corsicana', 'Navarro', 'TX', '75110', '9038723005', '9038757229', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-08', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609193721', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('204531243', 'W12047707', 'W12047707', 'UT01', 'Serendipity', 'Diana', 'S', 'Ayotte', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '720 S River Rd A215 Ste G', 'St George', 'Washington', 'UT', '84790', '4357342923', '          ', '720 S River Rd A215 Ste G', 'St George', 'Washington', 'UT', '84790', '4357342923', '          ', 'UTMA', '', '', '0.00', '40.00', '0.00', 3, '2014-05-08', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326110412', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('202320132', 'W12047708', 'W12047708', 'IDBOISTD', 'Lifestages OB/GYN', 'Juliette', 'E', 'Hughes', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3908 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084428035', '2084428038', '3908 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084428035', '2084428038', 'IDSAMG2', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 6, '2014-05-07', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1154344190', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('850424076', 'W12047709', 'W12047709', 'NM01', 'New Mexico Heart Institute', 'Karen ', 'S', 'Sopko', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '2240 College Dr', 'Gallup', 'Mckinley', 'NM', '87301', '5058411000', '5058432592', '2240 College Dr', 'Gallup', 'Mckinley', 'NM', '87301', '5058411000', '5058432592', 'NMHEART', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, 'Heart Hospital of New Mexico', '', '', '', 'HCFA|UB|', '1063551075', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('850424076', 'W12047711', 'W12047711', 'NM01', 'New Mexico Heart Institute', 'Mel', 'A', 'Peralta', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '2240 College Dr', 'Gallup', 'Mckinley', 'NM', '87301', '5058411000', '5058432592', '2240 College Dr', 'Gallup', 'Mckinley', 'NM', '87301', '5058411000', '5058432592', 'NMHEART', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, 'Heart Hospital of New Mexico', '', '', '', 'HCFA|UB|', '1598804593', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('870635460', 'W12047712', 'W12047712', 'UT01', 'Comfort Care Pediatrics', 'Sara', 'E', 'Johnson', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '4546 S Atherton Dr Ste 204', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8015958844', '0000000000', '4546 S Atherton Dr Ste 204', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8015958844', '0000000000', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1891856266', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'W12047713', 'W12047713', 'ILCHIGSTD', 'UroPartners', 'Spencer', 'A', 'Land', 'MD', 'Urology', '', '', NULL, 'O', '680 N Lake Shore Dr Ste 1428', 'Chicago', 'Cook', 'IL', '60611', '7734895124', '7734895125', '680 N Lake Shore Dr Ste 1428', 'Chicago', 'Cook', 'IL', '60611', '7734895124', '7734895125', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-05-09', '2014-08-01', 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', '', '', '', 'HCFA|UB|', '1407820491', 0, 'N', 0, '2014-06-11', NULL, NULL, 0, 0, NULL, NULL),
('161767581', 'W12047715', 'W12047715', 'UT01', 'Layton Family Medicine LLC', 'Brad', 'R', 'Larsen', 'PA', 'Family Practice', '', '', NULL, 'O', '2950 N Church St Ste 200', 'Layton', 'Davis', 'UT', '84040', '8015469441', '8015462422', '2950 N Church St Ste 200', 'Layton', 'Davis', 'UT', '84040', '8015469441', '8015462422', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063430890', 0, 'N', 1, '2014-07-22', NULL, NULL, 0, 0, NULL, NULL),
('161767581', 'W12047716', 'W12047716', 'UT01', 'Layton Family Medicine LLC', 'Brad', 'R', 'Larsen', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 281221', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', '0000000000', 'PO Box 281221', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', '0000000000', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063430890', 0, 'N', 1, '2014-07-22', NULL, NULL, 0, 0, NULL, NULL),
('043673591', 'W12047717', 'W12047717', 'ID01', 'Eagle River Psychiatry and Counseling', 'Jill', '', 'Mitchell', 'PHD', 'Mental Health', 'Marriage and Family Therapy', '', NULL, 'O', '1032 S Bridgeway Pl Ste 100', 'Eagle', 'Ada', 'ID', '83616', '2082460123', '          ', '1032 S Bridgeway Pl Ste 100', 'Eagle', 'Ada', 'ID', '83616', '2082460123', '          ', 'IDPHD', '', '', '0.00', '40.00', '0.00', 6, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033395876', 0, 'N', 1, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('463684117', 'W12047718', 'W12047718', 'TXDALSTD', 'Christopher Drennan Fetner MD', 'Christopher', 'D', 'Fetner', 'MD', 'Urology', '', '', NULL, 'O', '7777 Forest Ln Ste A234', 'Dallas', 'Dallas', 'TX', '75230', '9725667772', '9725667703', '7777 Forest Ln Ste A234', 'Dallas', 'Dallas', 'TX', '75230', '9725667772', '9725667703', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-06-21', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', '', '', '', 'HCFA|UB|', '1801859285', 0, 'N', 0, '2014-05-21', NULL, NULL, 0, 0, NULL, NULL),
('820438921', 'W12047721', 'W12047721', 'ID02', 'Treasure Valley Hearing and Balance Clinic', 'Paul', 'C', 'Raymond', 'AUD', 'Audiology', '', '', NULL, 'O', '745 S Progress Ave', 'Meridian', 'Ada', 'ID', '83642', '2083770019', '2083770313', '745 S Progress Ave', 'Meridian', 'Ada', 'ID', '83642', '2083770019', '2083770313', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2014-01-29', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1144527185', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('820300537', 'W12047723', 'W12047723', 'ID02', 'Terry Reilly Health Services', 'Joseph', 'E', 'Toms', 'LCPC', 'Counseling', '', '', NULL, 'O', '1224 S 1st St Ste 302', 'Nampa', 'Canyon', 'ID', '83687', '2084632314', '2084634390', '1224 S 1st St Ste 302', 'Nampa', 'Canyon', 'ID', '83687', '2084632314', '2084634390', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2014-04-11', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1700093069', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('820300537', 'W12047724', 'W12047724', 'ID02', 'Terry Reilly Health Services', 'Joseph', 'E', 'Toms', 'LCPC', 'Counseling', '', '', NULL, 'B', 'PO Box 9', 'Nampa', 'Canyon', 'ID', '83653', '2084617149', '0000000000', 'PO Box 9', 'Nampa', 'Canyon', 'ID', '83653', '2084617149', '0000000000', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2014-04-11', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1700093069', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('820300537', 'W12047725', 'W12047725', 'ID02', 'Terry Reilly Health Services', 'Joseph', 'E', 'Toms', 'LCPC', 'Counseling', '', '', NULL, 'O', '300 S 23rd St', 'Boise', 'Ada', 'ID', '83702', '2083451170', '2083453502', '300 S 23rd St', 'Boise', 'Ada', 'ID', '83702', '2083451170', '2083453502', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2014-04-11', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1700093069', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('826000422', 'W12047728', 'W12047728', 'ID02', 'Walter Knox Memorial Hospital (Recognized PPO but not contra', 'Alan', 'R', 'Benson', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'O', '1202 E Locust St', 'Emmett', 'Gem', 'ID', '83617', '2083653561', '2083654176', '1202 E Locust St', 'Emmett', 'Gem', 'ID', '83617', '2083653561', '2083654176', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2014-04-11', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1013019181', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('820466781', 'W12047730', 'W12047730', 'ID02', 'Mountain States Counseling & Psychological Services', 'Michael', 'D', 'Johnston', 'PHD', 'Psychology', '', '', NULL, 'O', '311 N Allumbaugh St', 'Boise', 'Ada', 'ID', '83704', '2083756402', '2083231850', '311 N Allumbaugh St', 'Boise', 'Ada', 'ID', '83704', '2083756402', '2083231850', 'IDPHD', '', '', '0.00', '40.00', '0.00', 8, '2014-04-15', NULL, 0, 0, 1, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1346394913', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('820300537', 'W12047733', 'W12047733', 'ID02', 'Terry Reilly Health Services', 'Angela', '', 'Hernandez-Henry', 'LPC', 'Counseling', '', '', NULL, 'O', '207 N 16th Ave', 'Nampa', 'Canyon', 'ID', '83653', '2084677654', '2083181391', '207 N 16th Ave', 'Nampa', 'Canyon', 'ID', '83653', '2084677654', '2083181391', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2014-04-02', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1326395146', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('820300537', 'W12047732', 'W12047732', 'ID02', 'Terry Reilly Health Services', 'Angela', '', 'Hernandez-Henry', 'LPC', 'Counseling', '', '', NULL, 'B', 'PO Box 9', 'Nampa', 'Canyon', 'ID', '83653', '2084617149', '0000000000', 'PO Box 9', 'Nampa', 'Canyon', 'ID', '83653', '2084617149', '0000000000', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2014-04-02', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1326395146', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('820300537', 'W12047735', 'W12047735', 'ID02', 'Terry Reilly Health Services', 'Melissa', '', 'Mezo', 'LCSW', 'Counseling', '', '', NULL, 'B', 'PO Box 9', 'Nampa', 'Canyon', 'ID', '83653', '2084617149', '0000000000', 'PO Box 9', 'Nampa', 'Canyon', 'ID', '83653', '2084617149', '0000000000', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2014-04-02', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1154380715', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('820300537', 'W12047736', 'W12047736', 'ID02', 'Terry Reilly Health Services', 'Melissa', '', 'Mezo', 'LCSW', 'Counseling', '', '', NULL, 'O', '300 S 23rd St', 'Boise', 'Ada', 'ID', '83702', '2083443512', '2083444898', '300 S 23rd St', 'Boise', 'Ada', 'ID', '83702', '2083443512', '2083444898', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2014-04-02', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1154380715', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('820300537', 'W12047739', 'W12047739', 'ID02', 'Terry Reilly Health Services', 'Ricardo', '', 'Ramirez-Hernandez', 'LMSW', 'Counseling', '', '', NULL, 'O', '207 N 16th Ave', 'Nampa', 'Canyon', 'ID', '83653', '2084677654', '2083181391', '207 N 16th Ave', 'Nampa', 'Canyon', 'ID', '83653', '2084677654', '2083181391', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2014-04-09', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1093057739', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('820300537', 'W12047740', 'W12047740', 'ID02', 'Terry Reilly Health Services', 'Ricardo', '', 'Ramirez-Hernandez', 'LMSW', 'Counseling', '', '', NULL, 'B', 'PO Box 9', 'Nampa', 'Canyon', 'ID', '83653', '2084617149', '0000000000', 'PO Box 9', 'Nampa', 'Canyon', 'ID', '83653', '2084617149', '0000000000', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2014-04-09', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1093057739', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
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('820300537', 'W12047745', 'W12047745', 'ID02', 'Terry Reilly Health Services', 'Sarah', 'R', 'Staller', 'MD', 'Family Practice', '', '', NULL, 'O', '201 S 1st Ave E', 'Middleton', 'Canyon', 'ID', '83644', '2085850048', '2085856242', '201 S 1st Ave E', 'Middleton', 'Canyon', 'ID', '83644', '2085850048', '2085856242', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2014-02-14', NULL, 0, 0, 1, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1336450402', 0, 'Y', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
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('820300537', 'W12047747', 'W12047747', 'ID02', 'Terry Reilly Health Services', 'Ralene', '', 'Wiberg', 'MD', 'Family Practice', '', '', NULL, 'O', '108 E Idaho', 'Homedale', 'Owyhee', 'ID', '83628', '2083373189', '2083374623', '108 E Idaho', 'Homedale', 'Owyhee', 'ID', '83628', '2083373189', '2083374623', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2014-02-13', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1912956806', 0, 'Y', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('820300537', 'W12047748', 'W12047748', 'ID02', 'Terry Reilly Health Services', 'Ralene', '', 'Wiberg', 'MD', 'Family Practice', '', '', NULL, 'O', '150 2nd St', 'Melba', 'Canyon', 'ID', '83641', '2084951011', '2084951012', '150 2nd St', 'Melba', 'Canyon', 'ID', '83641', '2084951011', '2084951012', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2014-02-13', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1912956806', 0, 'Y', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('820300537', 'W12047749', 'W12047749', 'ID02', 'Terry Reilly Health Services', 'Ralene', '', 'Wiberg', 'MD', 'Family Practice', '', '', NULL, 'O', '201 Main', 'Marsing', 'Owyhee', 'ID', '83639', '2088964159', '2084964917', '201 Main', 'Marsing', 'Owyhee', 'ID', '83639', '2088964159', '2084964917', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2014-02-13', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1912956806', 0, 'Y', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('820300537', 'W12047750', 'W12047750', 'ID02', 'Terry Reilly Health Services', 'Ralene', '', 'Wiberg', 'MD', 'Family Practice', '', '', NULL, 'O', '201 S 1st Ave E', 'Middleton', 'Canyon', 'ID', '83644', '2085850048', '2085856242', '201 S 1st Ave E', 'Middleton', 'Canyon', 'ID', '83644', '2085850048', '2085856242', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2014-02-13', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1912956806', 0, 'Y', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('820300537', 'W12047751', 'W12047751', 'ID02', 'Terry Reilly Health Services', 'Ralene', '', 'Wiberg', 'MD', 'Family Practice', '', '', NULL, 'O', '223 16th Ave N', 'Nampa', 'Canyon', 'ID', '83653', '2084667869', '2084665359', '223 16th Ave N', 'Nampa', 'Canyon', 'ID', '83653', '2084667869', '2084665359', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2014-02-13', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1912956806', 0, 'Y', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('820300537', 'W12047752', 'W12047752', 'ID02', 'Terry Reilly Health Services', 'Ralene', '', 'Wiberg', 'MD', 'Family Practice', '', '', NULL, 'O', '300 S 23rd St', 'Boise', 'Ada', 'ID', '83702', '2083443512', '2083444898', '300 S 23rd St', 'Boise', 'Ada', 'ID', '83702', '2083443512', '2083444898', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2014-02-13', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1912956806', 0, 'Y', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('271789847', 'W12047753', 'W12047753', 'IDONTSTD', 'Saint Alphonsus Medical Center - Ontario', '', '', 'Saint Alphonsus Medical Center - Ontario', '', 'Hospital', '', '', NULL, 'O', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '5418817000', '          ', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '5418817000', '          ', '', '', '', '0.00', '32.00', '0.00', 8, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', '|UB|', '1891891792', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('271789847', 'W12047754', 'W12047754', 'IDONTSTD', 'Saint Alphonsus Medical Center - Ontario', '', '', 'Saint Alphonsus Medical Center - Ontario', '', 'Hospital', '', '', NULL, 'B', 'PO Box 31001', 'Pasadena', 'Los Angeles', 'CA', '91110', '8666267272', '          ', 'PO Box 31001', 'Pasadena', 'Los Angeles', 'CA', '91110', '8666267272', '          ', '', '', '', '0.00', '32.00', '0.00', 8, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', '|UB|', '1891891792', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'W12047755', 'W12047755', 'IDBOISTD', 'Saint Alphonsus Medical Group Neurosurgery Mulvaney', 'Bruce', 'J', 'Andersen', 'MD', 'Neurosurgery', '', '', NULL, 'O', '1072 N Liberty St Ste 303', 'Boise', 'Ada', 'ID', '83706', '2083674035', '2083677111', '1072 N Liberty St Ste 303', 'Boise', 'Ada', 'ID', '83706', '2083674035', '2083677111', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2014-05-27', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1063420792', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12047756', 'W12047756', 'IDBOISTD', 'Saint Alphonsus Medical Group Neurology Mulvaney', 'Lukas', 'T', 'Clark', 'MD', 'Neurology', '', '', NULL, 'O', '1072 N Liberty St Ste 303', 'Boise', 'Ada', 'ID', '83706', '2083672800', '2083677111', '1072 N Liberty St Ste 303', 'Boise', 'Ada', 'ID', '83706', '2083672800', '2083677111', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-05-27', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1659519593', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('465062444', 'W12047757', 'W12047757', 'UT01', 'West Valley OBGYN', 'Michael', '', 'Robinson', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '315 Elm St Ste 310', 'Caldwell', 'Canyon', 'ID', '83605', '2085452035', '2084541065', '315 Elm St Ste 310', 'Caldwell', 'Canyon', 'ID', '83605', '2085452035', '2084541065', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'West Valley Medical Center', '', '', '', 'HCFA|UB|', '1275533184', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('860735726', 'W12047758', 'W12047758', 'Sinclair', 'Flagstaff Bone and Joint', 'Jarem', 'B', 'Lloyd', 'MD', 'Sports Medicine', '', '', NULL, 'O', '1841 Morrow Ave', 'Kingman', 'Mohave', 'AZ', '86401', '9287732280', '9287732281', '1841 Morrow Ave', 'Kingman', 'Mohave', 'AZ', '86401', '9287732280', '9287732281', '', '', '', '0.00', '40.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285953166', 0, 'N', 1, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('464447665', 'W12047762', 'W12047762', 'UT01', 'Weekend Vasectomy Clinic', 'Justin', 'P', 'Parkinson', 'MD', 'Urology', '', '', NULL, 'O', '3584 W 9000 S Ste 401', 'West Jordan', 'Salt Lake', 'UT', '84088', '8447647733', '          ', '3584 W 9000 S Ste 401', 'West Jordan', 'Salt Lake', 'UT', '84088', '8447647733', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-06-15', NULL, 0, 0, 0, 'Jordan Valley Medical Center', 'Salt Lake Regional Medical Center', 'Pioneer Valley Hospital', '', 'HCFA|UB|', '1851314066', 0, 'N', 0, '2014-06-17', NULL, NULL, 0, 0, NULL, NULL),
('464447665', 'W12047763', 'W12047763', 'UT01', 'Weekend Vasectomy Clinic', 'Justin', 'P', 'Parkinson', 'MD', 'Urology', '', '', NULL, 'O', '1060 E 100 S Ste 110', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8447647733', '          ', '1060 E 100 S Ste 110', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8447647733', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-06-15', NULL, 0, 0, 0, 'Jordan Valley Medical Center', 'Salt Lake Regional Medical Center', 'Pioneer Valley Hospital', '', 'HCFA|UB|', '1851314066', 0, 'N', 0, '2014-06-17', NULL, NULL, 0, 0, NULL, NULL),
('464447665', 'W12047764', 'W12047764', 'UT01', 'Weekend Vasectomy Clinic', 'Justin', 'P', 'Parkinson', 'MD', 'Urology', '', '', NULL, 'B', 'PO Box 432', 'Kaysville', 'Davis', 'UT', '84037', '8447647733', '          ', 'PO Box 432', 'Kaysville', 'Davis', 'UT', '84037', '8447647733', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-06-15', NULL, 0, 0, 0, 'Jordan Valley Medical Center', 'Salt Lake Regional Medical Center', 'Pioneer Valley Hospital', '', 'HCFA|UB|', '1851314066', 0, 'N', 0, '2014-06-17', NULL, NULL, 0, 0, NULL, NULL),
('270852226', 'W12047765', 'W12047765', 'UT01', 'Silverton Group', 'Jedediah', 'S', 'Briscoe', '', 'Hospitalist', '', '', NULL, 'O', '8th Ave C St', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014087100', '8012961715', '8th Ave C St', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014087100', '8012961715', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962650184', 0, 'N', 0, '2014-06-25', NULL, NULL, 0, 0, NULL, NULL),
('270852226', 'W12047766', 'W12047766', 'UT01', 'Silverton Group', 'Jedediah', 'S', 'Briscoe', '', 'Hospitalist', '', '', NULL, 'B', 'PO Box 1249', 'Bountiful', 'Davis', 'UT', '84011', '8012962113', '8012961715', 'PO Box 1249', 'Bountiful', 'Davis', 'UT', '84011', '8012962113', '8012961715', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962650184', 0, 'N', 0, '2014-06-25', NULL, NULL, 0, 0, NULL, NULL);
