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
('201579958', 'S77000172', 'S77000172', 'UT01', 'Advanced Practice Medical Clinic', 'Brand', 'P', 'Reynolds', 'NP', 'Family Practice', '', '', NULL, 'B', 'PO Box 922', 'Tooele', 'Tooele', 'UT', '84074', '4358438881', '4358438802', 'PO Box 922', 'Tooele', 'Tooele', 'UT', '84074', '4358438881', '4358438802', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB|', '1154325991', 0, 'Y', 0, '2014-06-16', NULL, NULL, 0, 0, NULL, NULL),
('201581429', 'S77000173', 'S77000173', 'UT01', 'Maternal Fetal Services of Utah', 'Michael', 'A', 'Belfort', 'MD', 'Maternal Fetal Medicine', 'Obstetrics and Gynecology', 'Perinatology', NULL, 'O', '1140 E 3900 S Ste 390', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434700', '8017436603', '3 Maryland Farms', 'Brentwood', '', 'TN', '37027', '', '', 'Wise+', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2010-08-31', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1184618753', 0, 'N', 0, '2009-06-23', NULL, NULL, 0, 0, NULL, NULL),
('201581429', 'S77000174', 'S77000174', 'UT01', 'Maternal Fetal Services of Utah', 'Steven', 'L', 'Clark', 'MD', 'Maternal Fetal Medicine', 'Perinatology', NULL, NULL, 'O', '5475 S 500 E', 'Ogden', 'Weber', 'UT', '84405', '8014792452', NULL, NULL, NULL, '', NULL, NULL, '', '', 'Wise+', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1255326633', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('201581429', 'S77000175', 'S77000175', 'UT01', 'Maternal Fetal Services of Utah', 'Melissa', 'A', 'Herbst', 'MD', 'Perinatology', '', '', NULL, 'O', '1140 E 3900 S Ste 390', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434700', '8017434705', '3 Maryland Farms', 'Brentwood', 'Salt Lake', 'TN', '37027', '8017434700', '8017434705', 'Wise+', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2010-07-31', NULL, 0, NULL, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1326199571', 0, 'N', 0, '2011-09-28', NULL, NULL, 0, 0, NULL, NULL),
('201581429', 'S77000176', 'S77000176', 'UT01', 'Maternal Fetal Services of Utah', 'Melissa', 'A', 'Herbst', 'MD', 'Perinatology', '', '', NULL, 'O', '3100 Channing Way', 'Idaho Falls', 'Bonneville', 'ID', '83404', '2085296111', NULL, '3 Maryland Farms', 'Brentwood', 'Bonneville', 'TN', '37027', '2085296111', '          ', 'Wise+', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2010-07-31', NULL, 0, NULL, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1326199571', 0, 'N', 0, '2011-09-28', NULL, NULL, 0, 0, NULL, NULL),
('201610002', 'S77000177', 'S77000177', 'UT01', 'Wasatch Anesthesia Inc', NULL, NULL, 'Wasatch Anesthesia Inc', 'GROUP', 'Anesthesiology', NULL, NULL, NULL, 'O', '1954 E Fort Union Blvd Ste 115', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019939501', '8017335618', '1954 E Fort Union Bvld', 'Salt Lake City', '', 'UT', '84121', '', '', '', NULL, NULL, '0.00', '20.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1982616843', 0, 'Y', 0, '2006-12-21', NULL, NULL, 40.6243, -111.836, NULL, NULL),
('201722705', 'S77000179', 'S77000179', 'UT01', 'PM Pediatrics', 'G', 'Greg', 'Haroutunian', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '196 E 2000 N Ste 110', 'Tooele', 'Tooele', 'UT', '84074', '4358825437', '4358438382', '196 E 2000 N Ste 110', 'Tooele', 'Tooele', 'UT', '84074', '4358825437', '4358438382', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356308167', 0, 'y', 0, '2013-08-06', NULL, NULL, 40.5656, -112.294, NULL, NULL),
('202083175', 'S77000180', 'S77000180', 'UT01', '', 'Stephen', 'L', 'Miller', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '5292 College Dr Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012814278', '8012815960', '5292 College Dr Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012814278', '8012815960', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578514477', 0, 'N', 0, '2014-04-15', NULL, NULL, 40.6557, -111.905, NULL, NULL),
('202104365', 'S77000181', 'S77000181', 'UT01', 'All About Health', 'Nance', 'Lee', 'Allen', 'APRN', 'Family Practice', NULL, NULL, NULL, 'O', '3191 Valley St Ste 210', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8014872889', NULL, '3191 W 3300 E', 'Salt Lake City', '', 'UT', '84109', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', '2010-07-06', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1639224934', 0, 'N', 0, '2006-11-09', NULL, NULL, 0, 0, NULL, NULL),
('202104365', 'S77000182', 'S77000182', 'UT01', 'All About Health', 'Nance', 'Lee', 'Allen', 'APRN', 'Family Practice', NULL, NULL, NULL, 'B', '555 E 4500 S Ste C150', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012880747', NULL, '3191 W 3300 E', 'Salt Lake City', '', 'UT', '84109', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', '2010-07-06', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1639224934', 0, 'Y', 0, '2006-11-09', NULL, NULL, 0, 0, NULL, NULL),
('201579958', 'S77000183', 'S77000183', 'UT01', 'Advanced Practice Medical Clinic', 'Brand', 'P', 'Reynolds', 'NP', 'Family Practice', '', '', NULL, 'O', '300 S Main St Ste 3', 'Tooele', 'Tooele', 'UT', '84074', '4358438881', NULL, '300 S Main St Ste 3', 'Tooele', 'Tooele', 'UT', '84074', '4358438881', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', '2011-10-17', 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB|', '1154325991', 0, 'N', 0, '2014-06-16', NULL, NULL, 0, 0, NULL, NULL),
('201581429', 'S77000184', 'S77000184', 'UT01', 'Maternal Fetal Services of Utah', 'Steven', 'L', 'Clark', 'MD', 'Maternal Fetal Medicine', 'Perinatology', NULL, NULL, 'O', '750 W 800 N', 'Orem', 'Utah', 'UT', '84057', '8017146000', NULL, NULL, NULL, '', NULL, NULL, '', '', 'Wise+', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1255326633', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('201581429', 'S77000185', 'S77000185', 'UT01', 'Maternal Fetal Services of Utah', 'Steven', 'L', 'Clark', 'MD', 'Maternal Fetal Medicine', 'Perinatology', NULL, NULL, 'O', '3100 Channing Way', 'Idaho Falls', 'Bonneville', 'ID', '83404', '2085296111', NULL, '3100 Channing Way', 'Idaho Falls', 'Bonneville', 'ID', '83404', '2085296111', '          ', 'Wise+', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2010-03-08', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1255326633', 0, 'N', 0, '2007-02-07', NULL, NULL, 0, 0, NULL, NULL),
('201896120', 'S77000188', 'S77000188', 'UT01', 'Medical Associates of Salt Lake', 'Nancy', 'L', 'McLaughlin', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '508 E S Temple Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015214500', '8013591665', '508 E S Temple Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015214500', '8013591665', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2009-03-18', 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1184633661', 0, 'N', 0, '2013-09-09', NULL, NULL, 0, 0, NULL, NULL),
('201935776', 'S77000189', 'S77000189', 'UT01', 'Elk Ridge Family Practice', 'Dennis', 'M', 'Concoby', 'DO', 'Family Practice', '', '', NULL, 'O', '1172 E 100 N Ste 11', 'Payson', 'Utah', 'UT', '84651', '8014656100', '8014656114', '1172 E 100 N Ste 11', 'Payson', 'Utah', 'UT', '84651', '8014656100', '8014656114', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', '2014-04-16', 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1386605715', 0, 'Y', 0, '2014-04-24', NULL, NULL, 40.0451, -111.713, NULL, NULL),
('202134065', 'S77000191', 'S77000191', 'UT01', 'Oakridge Optometry', 'Chelle', NULL, 'Nickle', 'OD', 'Optometry', NULL, NULL, NULL, 'B', '174 Oakridge Dr', 'Farmington', 'Davis', 'UT', '84025', '8014474393', '8014472211', NULL, NULL, '', NULL, NULL, '', '', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1144303983', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('202134065', 'S77000192', 'S77000192', 'UT01', 'Oakridge Optometry', 'Chelle', '', 'Nickle', 'OD', 'Optometry', '', '', NULL, 'O', '57 N Main St', 'Farmington', 'Davis', 'UT', '84025', '8014474393', '8014472211', '57 N Main St', 'Farmington', 'Davis', 'UT', '84025', '8014474393', '8014472211', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', '2011-01-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144303983', 0, 'N', 0, '2014-02-28', NULL, NULL, 0, 0, NULL, NULL),
('202422775', 'S77000194', 'S77000194', 'UT01', 'Wasatch Endocrinology', 'Robert', 'E', 'Burr', 'MD', 'Endocrinology', 'Diabetes', '', NULL, 'O', '807 E S Temple Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8017460776', '8017460775', '807 E S Temple Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8017460776', '8017460775', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2013-09-30', 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1770533788', 0, 'N', 0, '2013-11-14', NULL, NULL, 0, 0, NULL, NULL),
('202475777', 'S77000195', 'S77000195', 'UT01', 'Mountain View Foot & Ankle Specialists', 'Spencer', 'B', 'Heninger', 'DPM', 'Podiatry', '', '', NULL, 'O', '1930 S Highway 89', 'Perry', 'Box Elder', 'UT', '84302', '4357230825', '4357230845', '1930 S Highway 89', 'Perry', 'Box Elder', 'UT', '84302', '4357230825', '4357230845', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', '2009-05-31', 0, 0, 0, 'Brigham City Community Hospital', 'Logan Regional Hospital', 'Franklin County Medical Center ', '', 'HCFA|UB|', '1790781292', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('202480294', 'S77000196', 'S77000196', 'UT01', 'SMP Family Medicine', 'Nicola', 'I', 'Riley', 'MD', 'Family Practice', '', '', NULL, 'O', '1220 E 3900 S Ste 4A', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017470922', '8017470924', 'PO Box 932', 'Sandy', 'Salt Lake', 'UT', '84091', '8017470922', '8017470924', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', '2011-02-01', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1841261211', 0, 'N', 0, '2011-05-31', NULL, NULL, 0, 0, NULL, NULL),
('202492084', 'S77000197', 'S77000197', 'UT01', 'Generations OBGYN', 'Michael', 'J', 'Healy', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '1492 W Antelope Dr Ste 206', 'Layton', 'Davis', 'UT', '84041', '8017760567', '8017760595', '1492 W Antelope Dr Ste 206', 'Layton', 'Davis', 'UT', '84041', '8017760567', '8017760595', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2012-02-19', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1427093202', 0, 'N', 0, '2012-04-02', NULL, NULL, 0, 0, NULL, NULL),
('202533400', 'S77000198', 'S77000198', 'UT01', '', 'Chad', 'M', 'Gonzales', 'MD', 'Gastroenterology', '', '', NULL, 'O', '4403 Harrison Blvd Ste 2855', 'Ogden', 'Weber', 'UT', '84403', '8013872550', '8013872564', '4403 Harrison Blvd Ste 2855', 'Ogden', 'Weber', 'UT', '84403', '8013872550', '8013872564', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2013-11-30', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1669447801', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('202611812', 'S77000200', 'S77000200', 'UT01', '', 'Scott', '', 'Erickson', 'MD', 'Family Practice', '', '', NULL, 'O', '440 Medical Dr Ste 4', 'Bountiful', 'Davis', 'UT', '84010', '8012948288', '8012948488', '440 Medical Dr Ste 4', 'Bountiful', 'Davis', 'UT', '84010', '8012948288', '8012948488', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB|', '1780681775', 0, 'N', 0, '2014-03-24', NULL, NULL, 40.8873, -111.872, NULL, NULL),
('202717899', 'S77000201', 'S77000201', 'UT01', 'Evolutionary Healthcare', 'Phil', 'S', 'Haggerty', 'DO', 'Family Practice', NULL, NULL, NULL, 'O', '461 E 200 S Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015192461', NULL, '461 E 200 S', 'Salt Lake City', '', 'UT', '84111', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', '2009-12-07', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000937291', 0, 'N', 0, '2007-01-06', NULL, NULL, 0, 0, NULL, NULL),
('202281089', 'S77000205', 'S77000205', 'UT01', 'ABC Pediatrics', 'Peter', 'K', 'Moskowitz', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '12176 S 1000 E Ste G', 'Draper', 'Salt Lake', 'UT', '84020', '8015233030', NULL, '12176 S 1000 E Ste G', 'Draper', 'Salt Lake', 'UT', '84020', '8015233030', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2012-05-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1144229931', 0, 'N', 0, '2012-03-15', NULL, NULL, 0, 0, NULL, NULL),
('202291559', 'S77000206', 'S77000206', 'UT01', 'Dry Creek Family Practice', 'Rebecca', '', 'Johnson', 'NP', 'Family Practice', '', '', NULL, 'O', '3300 N Running Creek Way Bldg B', 'Lehi', 'Utah', 'UT', '84043', '8017664214', NULL, '3300 N Running Creek Wy', 'Lehi', 'Utah', 'UT', '84043', '8017664214', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2011-10-24', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1326107764', 0, 'N', 0, '2011-10-24', NULL, NULL, 0, 0, NULL, NULL),
('202291559', 'S77000207', 'S77000207', 'UT01', 'Dry Creek Family Practice', 'Richard', '', 'Sharp', 'MD', 'Family Practice', '', '', NULL, 'O', '3300 N Running Creek Way Bldg B', 'Lehi', 'Utah', 'UT', '84043', '8017664214', NULL, '3300 N Running Creek Way Bldg B', 'Lehi', 'Utah', 'UT', '84043', '8017664214', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508817453', 0, 'N', 0, '2012-04-30', NULL, NULL, 40.4296, -111.83, NULL, NULL),
('202475777', 'S77000209', 'S77000209', 'UT01', 'Mountain View Foot & Ankle Specialists', 'Spencer', 'B', 'Heninger', 'DPM', 'Podiatry', '', '', NULL, 'O', '2380 N 400 E Ste G', 'Logan', 'Cache', 'UT', '84341', '4357539044', '4357871858', '2380 N 400 E Ste G', 'Logan', 'Cache', 'UT', '84341', '4357539044', '4357871858', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', '2009-05-31', 0, 0, 0, 'Brigham City Community Hospital', 'Logan Regional Hospital', 'Franklin County Medical Center ', '', 'HCFA|UB|', '1790781292', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('202492084', 'S77000210', 'S77000210', 'UT01', 'Generations OBGYN', 'Rebecca', 'M', 'Vance', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1492 W Antelope Dr Ste 206', 'Layton', 'Davis', 'UT', '84041', '8017760567', '8017760595', '1492 W Antelope Dr Ste 206', 'Layton', 'Davis', 'UT', '84041', '8017760567', '8017760595', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2012-05-14', 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1942242458', 0, 'Y', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('202616136', 'S77000211', 'S77000211', 'UT01', 'Wasatch Audiology Inc', NULL, NULL, 'Wasatch Audiology Inc', 'GROUP', NULL, NULL, NULL, NULL, 'O', '2545 N Canyon Rd Ste 100', 'Provo', 'Utah', 'UT', '84604', '8013731108', '8013734008', '2545 N Canyon Rd', 'Provo', '', 'UT', '84604', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000928146', 0, 'Y', 0, '2006-08-31', NULL, NULL, 40.2678, -111.656, NULL, NULL),
('202764886', 'S77000212', 'S77000212', 'UT01', 'My Family Doctor', 'Layne', 'A', 'Hermansen', 'DO', 'Family Practice', '', '', NULL, 'O', '877 E 12300 S Ste 201', 'Draper', 'Salt Lake', 'UT', '84020', '8015427111', '8015427112', '877 E 12300 S', 'Draper', 'Salt Lake', 'UT', '84020', '8015427111', '8015427112', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, NULL, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1245315332', 0, 'N', 0, '2011-04-13', NULL, NULL, 40.5269, -111.867, NULL, NULL),
('202994901', 'S77000214', 'S77000214', 'UT01', 'Warby DPM, David H', 'David', 'H', 'Warby', 'DPM', 'Podiatry', NULL, NULL, NULL, 'O', '934 S Main St', 'Layton', 'Davis', 'UT', '84041', '8015444227', '8015443724', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1912949421', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('202480294', 'S77000217', 'S77000217', 'UT01', 'SMP Family Medicine', 'Nicola', 'I', 'Riley', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 932', 'Sandy', 'Salt Lake', 'UT', '84091', '8017470922', '8017470924', 'PO Box 932', 'Sandy', 'Salt Lake', 'UT', '84091', '8017470922', '8017470924', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', '2011-02-01', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1841261211', 0, 'Y', 0, '2011-05-31', NULL, NULL, 0, 0, NULL, NULL),
('202492084', 'S77000218', 'S77000218', 'UT01', 'Generations OBGYN', 'Dale', 'A', 'Hardy', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1492 W Antelope Dr Ste 206', 'Layton', 'Davis', 'UT', '84041', '8017760567', '8017760595', '1492 W Antelope Dr Ste 206', 'Layton', 'Davis', 'UT', '84041', '8017760567', '8017760595', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2011-03-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639106453', 0, 'N', 0, '2013-07-08', NULL, NULL, 0, 0, NULL, NULL),
('202581752', 'S77000219', 'S77000219', 'UT01', 'Stansbury Pediatrics', 'Heidi', 'S', 'McMillan', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 1228', 'Tooele', 'Tooele', 'UT', '84074', '4358821288', '4358821275', 'PO Box 1228', 'Tooele', 'Tooele', 'UT', '84074', '4358821288', '4358821275', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2011-10-17', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1457371742', 0, 'Y', 0, '2011-10-19', NULL, NULL, 0, 0, NULL, NULL),
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('260043031', 'S77000287', 'S77000287', 'UT01', 'Utah Hematology Oncology', 'Carl', 'R', 'Gray', 'MD', 'Hematology and Oncology', 'Oncology', NULL, NULL, 'O', '5290 S 400 E', 'Ogden', 'Weber', 'UT', '84405', '8014761777', '8013877155', '4403 Harrison Bvld', 'Ogden', '', 'UT', '84403', '', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'Davis Hospital', 'Ogden Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1598873382', 0, 'N', 0, '2006-12-11', NULL, NULL, 41.1688, -111.971, NULL, NULL),
('270003942', 'S77000291', 'S77000291', 'UT01', 'Nebo Vision Clinic', 'James', 'A', 'Cope', 'OD', 'Optometry', '', '', NULL, 'B', 'PO Box 196', 'Nephi', 'Juab', 'UT', '84648', '4356232100', '4356231671', 'PO Box 196', 'Nephi', 'Juab', 'UT', '84648', '4356232100', '4356231671', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', '2009-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780611954', 0, 'Y', 0, '2013-11-15', NULL, NULL, 0, 0, NULL, NULL),
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('421582800', 'S77000304', 'S77000304', 'UT01', NULL, 'Phil', 'R', 'Merrill', 'PA', 'Gastroenterology', 'Family Practice', NULL, NULL, 'B', '4403 Harrison Blvd Ste 2855', 'Ogden', 'Weber', 'UT', '84403', '8013872550', NULL, '4403 Harrison Bvld', 'Ogden', '', 'UT', '84403', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1639144702', 0, 'y', 0, '2006-10-19', NULL, NULL, 0, 0, NULL, NULL),
('431370851', 'S77000307', 'S77000307', 'UT01', NULL, 'David', 'A', 'Nichols', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'B', 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013529500', '8013529502', 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013529500', '8013529502', 'WEUHP', 'WUSTDHCPC5', NULL, '0.00', '20.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'Castleview Hospital', 'Castleview Hospital', NULL, NULL, 'HCFA|UB|', '1902893993', 0, 'Y', 0, '2013-08-13', NULL, NULL, 0, 0, NULL, NULL),
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('270015335', 'S77000312', 'S77000312', 'UT01', 'SouthWest Foot Clinic', 'Craig', 'J', 'Campbell', 'DPM', 'Podiatry', NULL, NULL, NULL, 'O', '4019 W 12600 S Ste 120', 'Riverton', 'Salt Lake', 'UT', '84065', '8019691434', NULL, '5255 S 4015 W', 'Kearns', 'Salt Lake', 'UT', '84118', '8019691434', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, NULL, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1841288651', 0, 'N', 0, '2011-06-07', NULL, NULL, 40.5222, -111.988, NULL, NULL),
('270090439', 'S77000313', 'S77000313', 'UT01', 'Richards General Surgery', 'David', 'T', 'Richards', 'MD', 'General Surgery', '', '', NULL, 'O', '175 N 100 W Ste 202', 'Vernal', 'Uintah', 'UT', '84078', '4357894180', '4357811185', '11 Green Way Plaza', 'Houston', 'Uintah', 'TX', '77046', '4357894180', '4357811185', 'WURURAL10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', '2011-10-21', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1396853206', 0, 'N', 0, '2011-10-24', NULL, NULL, 0, 0, NULL, NULL),
('270090439', 'S77000314', 'S77000314', 'UT01', 'Richards General Surgery', 'David', 'T', 'Richards', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 1759 Dpt 952', 'Houston', 'Harris', 'TX', '77251', '7135545304', '7135545324', '11 Green Way Plaza', 'Houston', 'Harris', 'TX', '77046', '7135545304', '7135545324', 'WURURAL10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', '2009-04-28', NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1396853206', 0, 'Y', 0, '2011-10-24', NULL, NULL, 0, 0, NULL, NULL),
('286646702', 'S77000317', 'S77000317', 'UT01', NULL, 'Francis', 'X', 'Yubero', 'MD', 'Physical Medicine and Rehabilitation', NULL, NULL, NULL, 'O', '4335 Harrison Blvd Ste D', 'Ogden', 'Weber', 'UT', '84403', '8013876645', '8013876644', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1922010925', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('320132373', 'S77000321', 'S77000321', 'UT01', 'Comprehensive Family Clinic', 'Jonathan', 'R', 'Montgomery', 'MS,APRN,FNP', 'Family Practice', '', '', NULL, 'O', '4701 W 2100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019743382', '8019743295', '4701 W 2100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019743382', '8019743295', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000835656', 0, 'N', 0, '2012-10-16', NULL, NULL, 40.7256, -112.003, NULL, NULL),
('320132373', 'S77000322', 'S77000322', 'UT01', 'Comprehensive Family Clinic', 'Jonathan', 'R', 'Montgomery', 'MS,APRN,FNP', 'Family Practice', NULL, NULL, NULL, 'B', '4701 W 2100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019743382', NULL, '4701 W 2100 S', 'West Valley', '', 'UT', '84120', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000835656', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('411536255', 'S77000330', 'S77000330', 'UT01', 'Davis Valley Foot Clinic', 'Gary', NULL, 'Green', 'DPM', 'Podiatry', NULL, NULL, NULL, 'O', '75 N 200 W', 'Vernal', 'Uintah', 'UT', '84078', '4357895500', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1801896816', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('470897660', 'S77000332', 'S77000332', 'UT01', 'South Valley Ear Nose and Throat Associates', 'Janis', 'K', 'Cline', 'PA-C', 'Ear, Nose and Throat', '', '', NULL, 'O', '3584 W 9000 S Ste 311', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015668304', NULL, '3584 W 9000 S Ste 311', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015668304', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2012-07-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1053327312', 0, 'N', 0, '2013-09-11', NULL, NULL, 0, 0, NULL, NULL),
('470905811', 'S77000333', 'S77000333', 'UT01', 'Asthma & Allergy Clinic of Utah', 'Cathy', 'J', 'Gonzales', 'APRN', 'Allergy and Immunology', '', '', NULL, 'O', '1121 E 3900 S Ste C 130', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012811300', '8012815973', '1121 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012811300', '8012815973', 'WiseSTD8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, NULL, 0, NULL, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '0000945526', 0, 'Y', 0, '2010-11-05', NULL, NULL, 40.6871, -111.859, NULL, NULL),
('481297403', 'S77000337', 'S77000337', 'UT01', 'Mountain West Family Practice', 'Sergio', 'O', 'Abarca', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '1929 N Aaron Dr Ste I', 'Tooele', 'Tooele', 'UT', '84074', '4358822350', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2007-03-01', 0, NULL, 0, 'Mountain West Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1245238617', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('481297403', 'S77000338', 'S77000338', 'UT01', 'Mountain West Family Practice', 'Chad', 'S', 'Jarvis', 'PA', 'Family Practice', NULL, NULL, NULL, 'O', '2356 N 400 E Ste 201', 'Tooele', 'Tooele', 'UT', '84074', '4358822350', NULL, '1929 N Aaron Dr', 'Tooele', '', 'UT', '84074', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Mountain West Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1619974664', 0, 'N', 0, '2007-01-06', NULL, NULL, 40.5621, -112.293, NULL, NULL),
('481297430', 'S77000339', 'S77000339', 'UT01', 'Mountain West Family Practice', 'Blake', 'R', 'Beazer', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '1929 N Aaron Dr Ste I', 'Tooele', 'Tooele', 'UT', '84074', '4358822350', '4358822309', '1929 N Aaron Dr Ste I', 'Tooele', 'Tooele', 'UT', '84074', '4358822350', '4358822309', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Mountain West Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1073510012', 0, 'y', 0, '2013-08-14', NULL, NULL, 40.5651, -112.298, NULL, NULL),
('501506566', 'S77000340', 'S77000340', 'UT01', 'Pioneer Valley Hospital', 'David', 'D', 'Miller', 'CRNA', 'Anesthesiology', 'Nurse Anesthetist', NULL, NULL, 'B', 'PO Box 1512', 'Layton', 'Davis', 'UT', '84041', '8015939223', NULL, 'PO Box 9', 'Sandy', '', 'UT', '84091', '', '', '', NULL, '1000', '38.25', '0.00', '0.00', 3, '2007-01-01', NULL, 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1205838745', 0, 'Y', 0, '2007-01-10', NULL, NULL, 0, 0, NULL, NULL),
('510456153', 'S77000342', 'S77000342', 'UT01', 'Daynes MD, Gregory S', 'Gregory', 'S', 'Daynes', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', '5746 W 13400 S', 'Riverton', 'Salt Lake', 'UT', '84096', '8012534001', '8012534003', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1972559557', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('331016055', 'S77000345', 'S77000345', 'UT01', 'Complete Care Clinic', 'Paul', 'Anthony', 'Satter', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '15 N 100 E', 'Tooele', 'Tooele', 'UT', '84074', '4358826618', '4358433774', '15 N 100 E', 'Tooele', '', 'UT', '84074', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Mountain West Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1528092475', 0, 'N', 0, '2006-10-19', NULL, NULL, 40.531, -112.296, NULL, NULL),
('331064921', 'S77000347', 'S77000347', 'UT01', '', 'Ryan', 'K', 'Anderson', 'DPM', 'Podiatry', '', '', NULL, 'O', '425 Medical Dr Ste 209', 'Bountiful', 'Davis', 'UT', '84010', '8012924425', '8013971938', '425 Medical Dr Ste 209', 'Bountiful', 'Davis', 'UT', '84010', '8012924425', '8013971938', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2011-09-14', 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053334730', 0, 'N', 0, '2014-02-03', NULL, NULL, 0, 0, NULL, NULL),
('382605313', 'S77000350', 'S77000350', 'UT01', '', 'Ada', 'X', 'Van Vloten', 'MD', 'Pediatrics', '', '', NULL, 'O', '280 N Hospital Dr Ste 2', 'Price', 'Carbon', 'UT', '84501', '4356377100', '4356377101', '280 N Hospital Dr', 'Price', 'Carbon', 'UT', '84501', '4356377100', '4356377101', 'WEUHP', 'WUSTDHCPC5', '', '0.00', '20.00', '0.00', 3, '2006-11-01', '2011-05-31', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1861525164', 0, 'N', 0, '2011-12-05', NULL, NULL, 0, 0, NULL, NULL),
('382605313', 'S77000351', 'S77000351', 'UT01', '', 'Ada', 'X', 'Van Vloten', 'MD', 'Pediatrics', '', '', NULL, 'B', '620 S 400 E Ste 108', 'St George', 'Washington', 'UT', '84770', '4356280966', NULL, '280 N Hospital Dr', 'Price', 'Washington', 'UT', '84501', '4356280966', '          ', 'WEUHP', 'WUSTDHCPC5', '', '0.00', '20.00', '0.00', 3, '2006-11-01', '2011-05-31', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1861525164', 0, 'Y', 0, '2011-12-05', NULL, NULL, 0, 0, NULL, NULL),
('412060533', 'S77000353', 'S77000353', 'UT01', '', 'Gordon', 'S', 'Olsen', 'DO', 'Orthopedic Surgery', '', '', NULL, 'O', '1485 S Hwy 40 Ste D', 'Heber City', 'Wasatch', 'UT', '84032', '4356546360', NULL, '1485 S Hwy 40 Ste D', 'Heber City', 'Wasatch', 'UT', '84032', '4356546360', '          ', 'WUSTDORTH5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', 'Heber Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1235237744', 0, 'N', 0, '2014-02-26', NULL, NULL, 40.489, -111.409, NULL, NULL),
('412060533', 'S77000355', 'S77000355', 'UT01', NULL, 'Gordon', 'S', 'Olsen', 'DO', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 796', 'Heber City', 'Wasatch', 'UT', '84032', '4356546360', NULL, 'PO Box 796', 'Heber City', 'Wasatch', 'UT', '84032', '4356546360', '', 'WUSTDORTH5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', 'Heber Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1235237744', 0, 'Y', 0, '2014-01-21', NULL, NULL, 0, 0, NULL, NULL),
('412174608', 'S77000358', 'S77000358', 'UT01', 'Comprehensive Orthopedics and Sports Medicine', 'Andrew', 'D', 'Cooper', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '82 S 1100 E Ste 303', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015332002', '8013239546', '24 S 1100 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015332002', '8013239546', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2011-02-28', NULL, 0, NULL, 'Salt Lake Regional Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1477547164', 0, 'N', 0, '2011-03-16', NULL, NULL, 0, 0, NULL, NULL),
('421545104', 'S77000359', 'S77000359', 'UT01', '', 'Chad', 'L', 'McCance', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 723', 'Price', 'Carbon', 'UT', '84501', '4356371268', NULL, 'PO Box 723', 'Price', 'Carbon', 'UT', '84501', '4356371268', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2011-06-30', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1093770083', 0, 'Y', 0, '2010-08-13', NULL, NULL, 0, 0, NULL, NULL),
('421552627', 'S77000360', 'S77000360', 'UT01', 'Tooele Pediatrics', 'G', 'Greg', 'Haroutunian', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '196 E 2000 N Ste 100', 'Tooele', 'Tooele', 'UT', '84074', '4358827644', '4358822284', '196 E 2000 N Ste 100', 'Tooele', 'Tooele', 'UT', '84074', '4358827644', '4358822284', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356308167', 0, 'N', 0, '2013-08-06', NULL, NULL, 40.5656, -112.294, NULL, NULL),
('421582800', 'S77000362', 'S77000362', 'UT01', '', 'Steven', 'A', 'Porter', 'MD', 'Gastroenterology', '', '', NULL, 'O', '4403 Harrison Blvd Ste 2855', 'Ogden', 'Weber', 'UT', '84403', '8013872550', '', '4403 Harrison Blvd Ste 2855', 'Ogden', 'Weber', 'UT', '84403', '8013872550', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2013-11-30', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1740255819', 0, 'N', 0, '2014-07-24', NULL, NULL, 0, 0, NULL, NULL),
('421594945', 'S77000363', 'S77000363', 'UT01', 'Timpangoes Hearing and Balance ', 'Layne', '', 'Garrett', 'AUD', 'Audiology', '', '', NULL, 'O', '321 E 300 N', 'American Fork', 'Utah', 'UT', '84003', '8017630724', NULL, '321 E 300 N', 'American Fork', 'Utah', 'UT', '84003', '8017630724', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1417918087', 0, 'N', 0, '2011-10-21', NULL, NULL, 40.383, -111.79, 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
('450470087', 'S77000365', 'S77000365', 'UT01', 'Wasatch Neurosurgery', 'Christopher', 'C', 'Lindsey', 'PA', 'Neurology', NULL, NULL, NULL, 'O', '1220 E 3900 S Ste 4E', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012618507', NULL, '1220 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012618507', '          ', 'WUOGDEN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', '2011-10-04', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1689671737', 0, 'N', 0, '2011-10-05', NULL, NULL, 0, 0, NULL, NULL),
('450470087', 'S77000366', 'S77000366', 'UT01', 'Wasatch Neurosurgery', 'Richard', 'H', 'Schwartz', 'MD', 'Neurosurgery', NULL, NULL, NULL, 'B', '1220 E 3900 S Ste 4-E', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012618507', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUOGDEN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1336148063', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'S77000371', 'S77000371', 'UT01', 'Community Heatlh Centers', 'Michael', 'C', 'Flowers', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1104 E Ashton St Ste 111', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8015588650', NULL, '1104 E Ashton St Ste 111', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8015588650', '', 'ma', NULL, NULL, '0.00', '100.00', '0.00', 6, '2006-06-01', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043297716', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('527255248', 'S77000372', 'S77000372', 'UT01', '', 'Rebecca', 'J', 'Levine', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '1575 W 7000 S', 'West Jordan', 'Salt Lake', 'UT', '84084', '8015699133', '8015699103', '1575 W 7000 S', 'West Jordan', 'Salt Lake', 'UT', '84084', '8015699133', '8015699103', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-07-01', '2013-09-12', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1316986136', 0, 'N', 0, '2013-09-23', NULL, NULL, 0, 0, NULL, NULL),
('529645179', 'S77000377', 'S77000377', 'UT01', NULL, 'Jayne', 'E', 'Clark', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '2180 E 4500 S Ste 185', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012726972', NULL, '2180 E 4500 S Ste 185', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012726972', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2010-03-08', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295735728', 0, 'N', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('421545104', 'S77000378', 'S77000378', 'UT01', '', 'Chad', 'L', 'McCance', 'MD', 'General Surgery', '', '', NULL, 'O', '280 N Hospital Dr Ste 5', 'Price', 'Carbon', 'UT', '84501', '4356371268', NULL, 'PO Box 723', 'Price', 'Carbon', 'UT', '84501', '4356371268', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2010-08-13', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1093770083', 0, 'N', 0, '2010-08-13', NULL, NULL, 0, 0, NULL, NULL),
('421594945', 'S77000379', 'S77000379', 'UT01', 'Timpanogos Audiology', 'Timpanogos Audiology', NULL, NULL, 'GROUP', 'Audiology', NULL, NULL, NULL, 'O', '321 E 300 N', 'American Fork', 'Utah', 'UT', '84003', '8017630724', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834835', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('432012389', 'S77000382', 'S77000382', 'UT01', 'Salt Lake Eye Associates', 'Maureen', 'K', 'Lundergan', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '1025 E 3300 S Ste B', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012812020', NULL, '1025 E 3300 S', 'Salt Lake City', '', 'UT', '84106', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', '2008-07-14', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000832833', 0, 'N', 0, '2006-12-15', NULL, NULL, 0, 0, NULL, NULL),
('432084602', 'S77000383', 'S77000383', 'UT01', '', 'Angelo', 'G', 'Chachas', 'MD', 'General Surgery', '', '', NULL, 'O', '24 S 1100 E Ste 302', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8014780010', '8013631847', '24 S 1100 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8014780010', '8013631847', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, NULL, 0, NULL, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1194726232', 0, 'N', 0, '2011-10-12', NULL, NULL, 40.7689, -111.86, NULL, NULL),
('450470087', 'S77000384', 'S77000384', 'UT01', 'Wasatch Neurosurgery', 'Christopher', 'C', 'Lindsey', 'PA', 'Neurology', NULL, NULL, NULL, 'B', '1220 E 3900 S Ste 4-E', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012618507', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUOGDEN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1689671737', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('450486684', 'S77000393', 'S77000393', 'UT01', '', 'Ali', '', 'Ben-Jacob', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '550 E 1400 N Ste W', 'Logan', 'Cache', 'UT', '84341', '4357525999', NULL, '550 E 1400 N', 'Logan', 'Cache', 'UT', '84341', '4357525999', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2011-11-30', NULL, 0, NULL, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1083611669', 0, 'N', 0, '2011-12-20', NULL, NULL, 0, 0, NULL, NULL),
('456061357', 'S77000394', 'S77000394', 'UT01', NULL, 'Jana', '', 'Kolc', 'MD', 'General Surgery', '', '', NULL, 'O', '1220 E 3900 S Ste 3F', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012682531', NULL, '1220 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '841241327', '8012682531', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, NULL, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1093787673', 0, 'N', 0, '2010-11-10', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('501506566', 'S77000397', 'S77000397', 'UT01', 'Pioneer Valley Hospital', 'David', 'D', 'Miller', 'CRNA', 'Anesthesiology', 'Nurse Anesthetist', NULL, NULL, 'O', '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504700', NULL, NULL, NULL, '', NULL, NULL, '', '', NULL, NULL, '1000', '38.25', NULL, NULL, 3, '2007-01-01', '2007-01-01', 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1205838745', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('510529950', 'S77000399', 'S77000399', 'UT01', 'Ogden Nurse Midwives', 'Guy', 'T', 'Cox', 'CNM', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '5495 S 500 E Ste 320', 'Ogden', 'Weber', 'UT', '84405', '8014767300', NULL, '5495 S 500 E', 'Ogden', 'Weber', 'UT', '84405', '8014767300', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', '2011-11-10', NULL, 0, NULL, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1649205154', 0, 'N', 0, '2011-11-17', NULL, NULL, 0, 0, NULL, NULL),
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('529824757', 'S77000404', 'S77000404', 'UT01', NULL, 'Douglas', 'C', 'Bankhead', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'O', '4695 S 1900 W', 'Roy', 'Weber', 'UT', '84067', '8018254700', NULL, 'PO Box 210', 'Roy', '', 'UT', '840672766', '', '', NULL, NULL, '1000', '45.00', NULL, NULL, 3, '2007-01-01', '2007-01-01', 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1700896347', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('542161691', 'S77000407', 'S77000407', 'UT01', 'OBGYN Associates', 'Danielle', 'M', 'Demeter', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1441 W Ute Blvd Ste 160', 'Park City', 'Summit', 'UT', '84098', '4352145335', '4357434516', '1441 W Ute Blvd Ste 160', 'Park City', 'Summit', 'UT', '84098', '4352145335', '4357434516', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', '2009-09-10', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265447940', 0, 'N', 0, '2012-05-04', NULL, NULL, 0, 0, NULL, NULL),
('543909946', 'S77000408', 'S77000408', 'UT01', 'HealthSouth Rehabilitation Hospital', 'Anina', '', 'Merrill', 'MD', 'Physical Medicine and Rehabilitation', NULL, NULL, NULL, 'O', '8074 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8015656500', NULL, '8074 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8015656500', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'Health South Rehabilitation Hospital of Utah (inpatient services only)', NULL, NULL, NULL, 'HCFA|UB|', '1134111545', 0, 'N', 0, '2013-01-03', NULL, NULL, 40.6046, -111.853, NULL, NULL),
('545708680', 'S77000409', 'S77000409', 'UT01', NULL, 'Margaret', 'A', 'Kluthe', 'MD', 'Pediatrics', '', '', NULL, 'O', '425 E 5350 S Ste 355', 'Ogden', 'Weber', 'UT', '84405', '8014757007', '8014750703', '425 E 5350 S Ste 355', 'Ogden', 'Weber', 'UT', '84405', '8014757007', '8014750703', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1558327361', 0, 'N', 0, '2013-12-20', NULL, NULL, 41.166, -111.97, NULL, NULL),
('562302331', 'S77000410', 'S77000410', 'UT01', 'Central Utah Anesthesia', NULL, NULL, 'Central Utah Anesthesia', 'GROUP', 'Anesthesiology', NULL, NULL, NULL, 'B', '274 N Main St', 'Logan', 'Cache', 'UT', '84321', '4357531600', NULL, '274 N Main St', 'Logan', '', 'UT', '84321', '', '', NULL, NULL, '1000', '0.00', NULL, NULL, 6, '2006-01-01', '2006-01-01', 1, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1578765533', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('562485184', 'S77000416', 'S77000416', 'UT01', 'Hyperbaric Medicine Physicians', 'Deanne', NULL, 'Long', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'B', 'PO Box 96398', 'Oklahoma City', 'Oklahoma', 'OK', '73143', '8009623303', '8015824269', 'PO Box 96398', 'Oklahoma City', '', 'OK', '731436398', '', '', 'WUEPIC5', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1023087434', 0, 'Y', 0, '2007-01-05', NULL, NULL, 0, 0, NULL, NULL),
('510456153', 'S77000420', 'S77000420', 'UT01', '', 'Gregory', 'Sharp', 'Daynes', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '5746 W 13400 S', 'Herriman', 'Salt Lake', 'UT', '84096', '8012534001', '8012534003', '5746 W 13400 S', 'Herriman', 'Salt Lake', 'UT', '84096', '8012534001', '8012534003', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', '2012-08-27', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1972559557', 0, 'Y', 0, '2013-01-31', NULL, NULL, 0, 0, NULL, NULL),
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('527255248', 'S77000424', 'S77000424', 'UT01', 'Southwest Family Medicine', 'Rebecca', 'J', 'Levine', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 71128', 'Cottonwood', 'Salt Lake', 'UT', '84171', '8015699133', '8015699103', 'PO Box 71128', 'Cottonwood', 'Salt Lake', 'UT', '84171', '8015699133', '8015699103', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-07-01', '2013-09-12', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1316986136', 0, 'Y', 0, '2013-09-23', NULL, NULL, 0, 0, NULL, NULL),
('528067942', 'S77000425', 'S77000425', 'UT01', '', 'Rodney', 'S', 'Merrill', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '425 E 5350 S Ste 125', 'Ogden', 'Weber', 'UT', '84405', '8014791641', '8014768538', '425 E 5350 S Ste 125', 'Ogden', 'Weber', 'UT', '84405', '8014791641', '8014768538', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', '2013-02-06', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1265591697', 0, 'N', 0, '2014-01-16', NULL, NULL, 0, 0, NULL, NULL),
('528151384', 'S77000426', 'S77000426', 'UT01', 'Clark, Scott A', 'Scott', 'A', 'Clark', 'DPM', 'Podiatry', NULL, NULL, NULL, 'B', '2178 S 900 E Ste 1', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014668206', '8014666601', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1700865748', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('528649348', 'S77000429', 'S77000429', 'UT01', 'SJC Anesthesia', NULL, NULL, 'SJC Anesthesia LLC', 'GROUP', 'Anesthesiology', NULL, NULL, NULL, 'O', '4364 Washington Blvd', 'Ogden', 'Weber', 'UT', '84403', '8018254700', NULL, '4364 Washington Blvd', 'Ogden', '', 'UT', '844031866', '', '', NULL, NULL, '1000', '30.00', NULL, NULL, 3, '2007-01-01', '2007-01-01', 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834832', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('542158195', 'S77000439', 'S77000439', 'UT01', 'OB/GYN Associates', 'Carrie', 'L', 'Sloan', 'MD', 'Obstetrics and Gynecology', 'Obstetrics and Gynecology', '', NULL, 'B', '1151 E 3900 S Ste B-299', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012686811', '          ', '1151 E 3900 S Ste B-299', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012686811', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1124034012', 0, 'Y', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('571174725', 'S77000440', 'S77000440', 'UT01', NULL, 'Willard', 'Z', 'Maughan', 'MD', 'Dermatology', '', '', NULL, 'O', '6028 S Ridgeline Dr Ste 200', 'South Ogden', 'Weber', 'UT', '84405', '8014755210', NULL, '6028 S Ridgeline Dr', 'South Ogden', 'Weber', 'UT', '84405', '8014755210', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, NULL, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1235125063', 0, 'N', 0, '2011-04-18', NULL, NULL, 41.1538, -111.942, NULL, NULL),
('571188761', 'S77000442', 'S77000442', 'UT01', 'Westview Womens Center', 'Larry', 'D', 'Smith', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'B', 'PO Box 1569', 'Bountiful', 'Davis', 'UT', '84011', '8019631880', '8019631886', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '831621', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('571188761', 'S77000443', 'S77000443', 'UT01', 'Westview Womens Center', 'Larry', 'D', 'Smith', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '3451 S 5600 W Ste E', 'West Valley', 'Salt Lake', 'UT', '84120', '8019631880', '8019631886', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '831621', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('571190130', 'S77000444', 'S77000444', 'UT01', 'Utah Valley Optometric Physicians', 'Rick', 'W', 'Winward', 'OD', 'Optometry', NULL, NULL, NULL, 'B', '1355 N University Ave Ste 100', 'Provo', 'Utah', 'UT', '84604', '8013774333', '8013703951', NULL, NULL, '', NULL, NULL, '', '', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1750373411', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('528151384', 'S77000455', 'S77000455', 'UT01', NULL, 'Scott', 'A', 'Clark', 'DPM', 'Podiatry', '', '', NULL, 'O', '2178 S 900 E Ste 1', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014668206', '8014666601', '2178 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014668206', '8014666601', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', '2008-11-17', NULL, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1700865748', 0, 'N', 0, '2012-01-05', NULL, NULL, 0, 0, NULL, NULL),
('528154740', 'S77000456', 'S77000456', 'UT01', NULL, 'Polly', 'W', 'Sheffield', 'MD', 'General Surgery', 'Pediatrics', '', NULL, 'O', '1159 E 200 N Ste 350', 'American Fork', 'Utah', 'UT', '84003', '8017564781', NULL, '1159 E 200 N Ste 350', 'American Fork', 'Utah', 'UT', '84003', '8017564781', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', '2008-05-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215980974', 0, 'N', 0, '2013-05-06', NULL, NULL, 0, 0, NULL, NULL),
('528647654', 'S77000461', 'S77000461', 'UT01', '', 'Richard', '', 'Herold', 'MD', 'Internal Medicine', '', '', NULL, 'O', '6028 S Ridgeline Dr Ste 204', 'Ogden', 'Weber', 'UT', '84405', '8014758100', '          ', '6028 S Ridgeline Dr Ste 204', 'Ogden', 'Weber', 'UT', '84405', '8014758100', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1891799318', 0, 'N', 0, '2014-07-14', NULL, NULL, 41.1538, -111.942, NULL, NULL),
('528681578', 'S77000462', 'S77000462', 'UT01', '', 'Robert', 'Merrill', 'Christiansen', 'MD', 'Ophthalmology', '', '', NULL, 'O', '324 10th Ave Ste 260', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8014083937', NULL, '324 10th Ave', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8014083937', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1114991841', 0, 'N', 0, '2011-10-05', NULL, NULL, 40.7808, -111.88, NULL, NULL),
('528723936', 'S77000463', 'S77000463', 'UT01', 'Nance, Steven G', 'Steven', 'G', 'Nance', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '285 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8014890111', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1376645887', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('529069313', 'S77000465', 'S77000465', 'UT01', 'Moab Family Medicine', 'Katherine', 'K', 'Williams', 'MD', 'Family Practice', '', '', NULL, 'O', '38 W 300 S', 'Moab', 'Grand', 'UT', '84532', '4352597121', '4352593112', '38 W 300 S', 'Moab', 'Grand', 'UT', '84532', '4352597121', '4352593112', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2011-09-01', 0, 0, 0, 'Moab Regional Hospital', '', '', '', 'HCFA|UB|', '1669455580', 0, 'N', 0, '2014-06-17', NULL, NULL, 0, 0, NULL, NULL),
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('621795217', 'S77000569', 'S77000569', 'UT01', 'Rock Run Medical', 'Brannick', 'B', 'Riggs', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '2102 Robins Dr Ste 103B', 'Layton', 'Davis', 'UT', '84041', '8017732838', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-01-01', '2007-01-31', 0, NULL, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1255324984', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'S77000570', 'S77000570', 'UT01', 'Internal Medicine Specialists', 'Mandi', 'J', 'McKay', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '2530 W 4700 S Ste B8', 'Salt Lake City', 'Salt Lake', 'UT', '84118', '8019675866', '8019699028', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2007-01-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1699716373', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('680562677', 'S77000573', 'S77000573', 'UT01', 'Intermountain Ear Nose and Throat Specialists', 'John', 'R', 'Bennett', 'MD', 'Ear, Nose and Throat', 'Plastic Surgery', '', NULL, 'O', '1777 Sun Peak Dr Ste 150', 'Park City', 'Summit', 'UT', '84098', '4356450800', '4356473003', '22 S 900 E', 'Salt Lake City', 'Summit', 'UT', '84102', '4356450800', '4356473003', 'WiseOrtho', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, NULL, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1699800227', 0, 'N', 0, '2011-02-02', NULL, NULL, 40.6924, -111.545, NULL, NULL),
('680562677', 'S77000574', 'S77000574', 'UT01', 'Intermountain Ear Nose and Throat Specialists', 'John', 'R', 'Bennett', 'MD', 'Ear, Nose and Throat', 'Plastic Surgery', '', NULL, 'O', '22 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013282522', NULL, '22 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013282522', '', 'WiseOrtho', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, NULL, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1699800227', 0, 'N', 0, '2011-02-02', NULL, NULL, 40.7689, -111.865, NULL, NULL),
('680562677', 'S77000576', 'S77000576', 'UT01', 'Intermountain Ear Nose and Throat Specialists', 'John', 'R', 'Bennett', 'MD', 'Ear, Nose and Throat', 'Plastic Surgery', '', NULL, 'O', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '8005438964', NULL, '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '8005438964', '', 'WiseOrtho', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1699800227', 0, 'N', 0, '2014-02-20', NULL, NULL, 40.4893, -111.409, NULL, NULL),
('621560557', 'S77000589', 'S77000589', 'UT01', 'South Ogden Center for Family Medicine', 'Alan', 'N', 'Bybee', 'PA', 'Family Practice', NULL, NULL, NULL, 'O', '5740 Crestwood Dr', 'Ogden', 'Weber', 'UT', '84405', '8014797771', '8014797795', '5740 Crestwood Dr', 'Ogden', 'Weber', 'UT', '84405', '8014797771', '8014797795', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', '2010-08-31', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1033184940', 0, 'N', 0, '2012-04-16', NULL, NULL, 0, 0, NULL, NULL),
('621560557', 'S77000590', 'S77000590', 'UT01', 'Morgan Health Center', 'Norman', 'L', 'Challburg', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '166 N State St', 'Morgan', 'Morgan', 'UT', '84050', '8018293426', NULL, 'PO Box 1007', 'Morgan', 'Morgan', 'UT', '84405', '8018293426', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-07-01', '2011-01-01', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1336178409', 0, 'N', 0, '2011-02-17', NULL, NULL, 0, 0, NULL, NULL),
('621560557', 'S77000591', 'S77000591', 'UT01', 'South Ogden Center for Family Medicine', 'John', 'M', 'Hemmersmeier', 'MD', 'Family Practice', '', '', NULL, 'O', '5740 Crestwood Dr', 'Ogden', 'Weber', 'UT', '84405', '8014797771', '8014797795', '5740 Crestwood Dr', 'Ogden', 'Weber', 'UT', '84405', '8014797771', '8014797795', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-07-01', '2010-08-31', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1073582995', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('621560557', 'S77000593', 'S77000593', 'UT01', 'South Ogden Center For Family Medicine', 'Anne', 'M', 'Hutchinson', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '5740 Crestwood Dr', 'Ogden', 'Weber', 'UT', '84405', '8014797771', '8014797795', '5740 Crestwood Dr', 'Ogden', '', 'UT', '84405', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-07-01', '2007-04-14', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1861461824', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('621650578', 'S77000594', 'S77000594', 'UT01', 'Ogden Regional Medical Center Pro Fees', NULL, NULL, 'Ogden Regional Medic', 'GROUP', 'Multi Specialty (Clinic)', 'Occupational Therapy', 'Speech Therapy', NULL, 'O', '5475 S 500 E', 'Ogden', 'Weber', 'UT', '84405', '8014792131', NULL, NULL, NULL, '', NULL, NULL, '', '', NULL, NULL, '1', '0.00', '36.00', NULL, 3, '2006-10-01', '2006-10-01', 1, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834819', 0, 'y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('621762357', 'S77000596', 'S77000596', 'UT01', 'Castleview Hospital Pro Fees', NULL, NULL, 'Castleview Hospital', 'GROUP', 'Multi Specialty (Clinic)', NULL, NULL, NULL, 'O', '300 N Hospital Dr', 'Price', 'Carbon', 'UT', '84501', NULL, NULL, NULL, NULL, '', NULL, NULL, '', '', NULL, NULL, NULL, '0.00', '12.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1417064205', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('621762357', 'S77000597', 'S77000597', 'UT01', 'Castleview Hospital Physicians Practice', 'Allan', 'P', 'Jeffery', 'DO', 'Internal Medicine', NULL, NULL, NULL, 'O', '300 N Hospital Dr', 'Price', 'Carbon', 'UT', '84501', '4356374800', '4356364895', NULL, NULL, '', NULL, NULL, '', '', 'WURURAL5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '920840', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('621762532', 'S77000598', 'S77000598', 'UT01', 'Ashley Valley Medical Center', 'Orlando', '', 'Heaton', 'PT', 'Physical Therapy', '', '', NULL, 'O', '151 W 200 N', 'Vernal', 'Uintah', 'UT', '84078', '4357896757', NULL, '151 W 200 N', 'Vernal', 'Uintah', 'UT', '84078', '4357896757', '          ', '', '', '', '0.00', '7.00', '0.00', 3, '2006-11-01', '2011-06-27', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000834753', 0, 'N', 0, '2012-07-30', NULL, NULL, 0, 0, NULL, NULL),
('621795211', 'S77000599', 'S77000599', 'UT01', 'Family Health Partners', 'Jonathan', 'W', 'Blanch', 'MD', 'Internal Medicine', 'Hospitalist', NULL, NULL, 'B', 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013529500', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1295757573', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('621795211', 'S77000600', 'S77000600', 'UT01', 'Multispecialty Partners', 'James', 'Anthony', 'Rasmussen', 'MD', 'Pulmonary', 'Internal Medicine', NULL, NULL, 'O', '24 S 1100 E Ste 304', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8017464440', '8017464455', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-09-01', '2007-01-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1770661712', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('621795211', 'S77000601', 'S77000601', 'UT01', 'Family Health Partners', 'Elizabeth', 'L', 'Remillong', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013529500', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '940043', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('710871556', 'S77000604', 'S77000604', 'UT01', '', 'Kevin', 'R', 'Duke', 'DO', 'Family Practice', NULL, NULL, NULL, 'O', '169 Springcreek Pkwy Ste 100', 'Providence', 'Cache', 'UT', '84332', '4357520330', '4357550922', 'PO Box 609', 'Providence', 'Cache', 'UT', '84332', '4357520330', '4357550922', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', '2011-06-30', NULL, 0, NULL, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1003882713', 0, 'N', 0, '2011-09-20', NULL, NULL, 0, 0, NULL, NULL),
('721598378', 'S77000615', 'S77000615', 'UT01', 'Southridge Foot & Ankle Clinic', 'Mark', 'R', 'Elkins', 'DPM', 'Podiatry', NULL, NULL, NULL, 'B', '4019 W 12600 S Ste 120', 'Riverton', 'Salt Lake', 'UT', '84096', '8012536886', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1124027453', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('721598378', 'S77000616', 'S77000616', 'UT01', 'Southridge Foot & Ankle Clinic', 'Mark', 'R', 'Elkins', 'DPM', 'Podiatry', NULL, NULL, NULL, 'B', '4019 W 12600 S Ste 120', 'Riverton', 'Salt Lake', 'UT', '84096', '8012536886', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1124027453', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('731642150', 'S77000617', 'S77000617', 'UT01', '', 'M', 'S', 'Major', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '5896 S Ridgeline Dr Ste B', 'South Ogden', 'Weber', 'UT', '84405', '8018660170', '8016210357', '5896 S Ridgeline Dr Ste B', 'South Ogden', 'Weber', 'UT', '84405', '8018660170', '8016210357', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Brigham City Community Hospital', 'Ogden Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1558394783', 0, 'N', 0, '2014-03-21', NULL, NULL, 41.157, -111.951, NULL, NULL),
('621560557', 'S77000619', 'S77000619', 'UT01', 'Morgan Health Center', 'Anne', 'M', 'Hutchinson', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '166 N State St', 'Morgan', 'Morgan', 'UT', '84050', '8018293426', NULL, '5740 Crestwood Dr', 'Ogden', '', 'UT', '84405', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-07-01', '2007-04-14', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1861461824', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('621560557', 'S77000621', 'S77000621', 'UT01', 'South Ogden Center for Family Medicine', 'Michael', 'E', 'Severance', 'PA', 'Family Practice', '', '', NULL, 'O', '5740 Crestwood Dr', 'Ogden', 'Weber', 'UT', '84405', '8014797771', '8014797795', '5740 Crestwood Dr', 'Ogden', 'Weber', 'UT', '84405', '8014797771', '8014797795', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', '2010-08-31', NULL, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1942273149', 0, 'N', 0, '2011-02-10', NULL, NULL, 0, 0, NULL, NULL),
('621560557', 'S77000622', 'S77000622', 'UT01', 'South Ogden Center for Family Medicine', 'Parker', 'J', 'Ward', 'PA', 'Family Practice', '', '', NULL, 'O', '5740 Crestwood Dr', 'Ogden', 'Weber', 'UT', '84405', '8014797771', '8014797795', '5740 Crestwood Dr', 'Ogden', 'Weber', 'UT', '84405', '8014797771', '8014797795', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', '2008-09-15', NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1790750107', 0, 'N', 0, '2010-10-18', NULL, NULL, 0, 0, NULL, NULL),
('621560557', 'S77000623', 'S77000623', 'UT01', 'South Ogden Center for Family Medicine', 'Michael', 'D', 'Woolman', 'MD', 'Family Practice', '', '', NULL, 'O', '5740 Crestwood Dr', 'Ogden', 'Weber', 'UT', '84405', '8014797771', '8014797795', '5740 Crestwood Dr', 'Ogden', 'Weber', 'UT', '84405', '8014797771', '8014797795', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', '2010-08-31', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1508833450', 0, 'N', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('621650578', 'S77000624', 'S77000624', 'UT01', 'Ogden Senior Health Center', 'Nancy', 'J', 'Zega', 'DO', 'Urology', '', '', NULL, 'O', '425 E 5350 S Ste 255', 'Ogden', 'Weber', 'UT', '84405', '8014754379', NULL, '425 E 5350 S', 'Ogden', 'Weber', 'UT', '84405', '8014754379', '          ', 'WUSTDFAM5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-10-01', '2010-03-31', NULL, 0, NULL, '', '', '', '', 'HCFA|', '1689746786', 0, 'N', 0, '2011-11-15', NULL, NULL, 0, 0, NULL, NULL),
('621762532', 'S77000625', 'S77000625', 'UT01', 'Ashley Valley Medical Center Pro Fees', NULL, NULL, 'Ashley Valley Medical Center Pro Fees', 'GROUP', NULL, NULL, NULL, NULL, 'O', '151 W 200 N', 'Vernal', 'Uintah', 'UT', '84078', '4357896757', NULL, '151 W 200 N', 'Vernal', '', 'UT', '84078', '', '', NULL, NULL, NULL, '0.00', '7.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000906687', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('621762570', 'S77000626', 'S77000626', 'UT01', 'Ashley Valley Physician Practice', 'Richard', 'V', 'Thomas', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'B', 'PO Box 876', 'Price', 'Carbon', 'UT', '84501', '8013529500', NULL, 'PO Box 876', 'Price', '', 'UT', '84501', '', '', 'WURURAL5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', '2009-01-21', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1932165461', 0, 'Y', 0, '2006-10-19', NULL, NULL, 0, 0, NULL, NULL),
('621762570', 'S77000627', 'S77000627', 'UT01', 'Ashley Valley Physician Practice', 'Richard', 'V', 'Thomas', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '175 N 100 W Ste 105', 'Vernal', 'Uintah', 'UT', '84078', '4357898627', '4357891314', 'PO Box 876', 'Price', '', 'UT', '84501', '', '', 'WURURAL5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', '2009-01-21', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1932165461', 0, 'N', 0, '2006-10-19', NULL, NULL, 0, 0, NULL, NULL),
('621795214', 'S77000629', 'S77000629', 'UT01', 'Salt Lake Regional Medical Ctr - Pro Fees', NULL, '', 'Salt Lake Reg Med Ct', 'GROUP', 'Multi Specialty (Clinic)', NULL, NULL, NULL, 'B', 'PO Box 26935 ', 'Salt Lake City', 'Salt Lake', 'UT', '84126', NULL, NULL, NULL, NULL, '', NULL, NULL, '', '', NULL, NULL, '1', '0.00', '0.00', '42.00', 3, '2006-02-01', '2006-02-01', 1, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('621795215', 'S77000633', 'S77000633', 'UT01', 'Jordan Valley Surgical Specialists', 'Robert', 'B', 'McFaul', 'DO', 'General Surgery', 'Vascular Surgery', NULL, NULL, 'O', '3590 W 9000 S Ste 105', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015623150', '8015683149', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD3', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2007-01-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '947590', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('621795215', 'S77000635', 'S77000635', 'UT01', 'Jordan Valley Surgical Specialists', 'E Douglas', NULL, 'Slawson', 'MD', 'General Surgery', NULL, NULL, NULL, 'O', '3590 W 9000 S Ste 105', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015623150', '8015683149', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD3', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2007-01-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834002', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('621795216', 'S77000636', 'S77000636', 'UT01', NULL, 'Joseph', 'A', 'Conrad', 'MD', 'Geriatrics', NULL, NULL, NULL, 'O', '3336 S 4155 W Ste 204', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019647363', NULL, 'PO Box 95970', 'South Jordan', '', 'UT', '84095', '', '', 'WUSTDINT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-02-01', '2007-06-30', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1164502662', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('621795217', 'S77000637', 'S77000637', 'UT01', 'Davis Internal Medicine', 'Adam', 'C', 'Craner', 'FNP-C', 'Internal Medicine', 'Family Practice', NULL, NULL, 'B', 'PO Box 95970 ', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013529500', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-01-01', '2007-01-31', 0, NULL, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1952326357', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('621795217', 'S77000638', 'S77000638', 'UT01', 'Davis Internal Medicine', 'Frank', '', 'Haglund', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '1492 W Antelope Dr Ste 203', 'Layton', 'Davis', 'UT', '84041', '8017737500', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-01-01', '2007-01-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('621795217', 'S77000639', 'S77000639', 'UT01', 'Davis Internal Medicine', 'Marian', 'H', 'Pham', 'MD', 'Internal Medicine', 'Pediatrics', NULL, NULL, 'O', '1492 W Antelope Dr Ste 203', 'Layton', 'Davis', 'UT', '84041', '8017737500', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-01-01', '2007-01-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1285667980', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('621795217', 'S77000640', 'S77000640', 'UT01', 'Davis Internal Medicine', 'John', 'K', 'Reis', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'B', 'PO Box 95970 ', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013529500', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-01-01', '2007-01-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1588689095', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('621831495', 'S77000641', 'S77000641', 'UT01', 'Timpanogos Regional Hospital Pro Fees', NULL, NULL, 'Timpanogos Regional', 'GROUP', 'Multi Specialty (Clinic)', NULL, NULL, NULL, 'B', 'PO Box 409650', 'Atlanta', 'Fulton', 'GA', '30384', '8017146000', NULL, NULL, NULL, '', NULL, NULL, '', '', NULL, NULL, '2358', '0.00', '36.00', NULL, 3, '2006-10-01', '2006-10-01', 1, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832015', 0, 'y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('742412898', 'S77000829', 'S77000829', 'UT01', 'Community Health Centers', 'Steven', 'E', 'Nickman', 'PA', 'Family Practice', NULL, NULL, NULL, 'B', '1798 S W Temple Ste A 100', 'South Salt Lake', 'Salt Lake', 'UT', '84115', '8014126930', '8014126950', '1798 S W Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84115', '8014126930', '8014126950', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2007-06-18', NULL, 0, NULL, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1669459301', 0, 'Y', 0, '2006-10-17', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'S77000856', 'S77000856', 'UT01', 'Community Health Centers', 'Steven', 'E', 'Nickman', 'PA', 'Family Practice', NULL, NULL, NULL, 'O', '4745 S 3200 W', 'Salt Lake City', 'Salt Lake', 'UT', '84118', '8019646214', '8014126950', '1798 S W Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84115', '8019646214', '8014126950', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2007-06-18', NULL, 0, NULL, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1669459301', 0, 'N', 0, '2006-10-17', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('742412898', 'S77000857', 'S77000857', 'UT01', 'Community Health Centers', 'Kathy', 'J', 'Pedersen', 'PA', 'Family Practice', '', '', NULL, 'B', '1798 S W Temple Ste A 100', 'South Salt Lake', 'Salt Lake', 'UT', '84115', '8014126930', '8014126950', '1798 S W Temple Ste A 100', 'South Salt Lake', 'Salt Lake', 'UT', '84115', '8014126930', '8014126950', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2012-06-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265419022', 0, 'Y', 0, '2014-04-11', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'S77000858', 'S77000858', 'UT01', 'Community Health Centers', 'Miranda', 'M', 'Raiche', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '1365 W 1000 N', 'Salt Lake City', 'Salt Lake', 'UT', '84116', '8013285750', NULL, '1798 S W Temple', 'Salt Lake City', '', 'UT', '84115', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 6, '2006-06-01', '2007-02-21', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '932024', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'S77000859', 'S77000859', 'UT01', 'Stephen D Ratcliffe Medical', 'David', 'E', 'Robinson', 'MD', 'Family Practice', '', '', NULL, 'O', '1365 W 1000 N', 'Salt Lake City', 'Salt Lake', 'UT', '84116', '8013285750', '8015217463', '1365 W 1000 N', 'Salt Lake City', 'Salt Lake', 'UT', '84116', '8013285750', '8015217463', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1780661421', 0, 'N', 0, '2014-04-22', NULL, NULL, 40.791, -111.931, NULL, NULL),
('742412898', 'S77000860', 'S77000860', 'UT01', 'Oquirrhview Clinic Medical', 'Katherine', 'A', 'Shen', 'MD', 'Family Practice', '', '', NULL, 'O', '4745 S 3200 W', 'Salt Lake City', 'Salt Lake', 'UT', '84118', '8019646214', '8019829232', '4745 S 3200 W', 'Salt Lake City', 'Salt Lake', 'UT', '84118', '8019646214', '8019829232', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1578540357', 0, 'N', 0, '2014-04-22', NULL, NULL, 40.6664, -111.967, NULL, NULL),
('742412898', 'S77000861', 'S77000861', 'UT01', 'Community Health Centers', 'Susan', 'J', 'Sittler', 'NP', 'Family Practice', '', '', NULL, 'B', '1798 S W Temple Ste A 100', 'South Salt Lake', 'Salt Lake', 'UT', '84115', '8014126930', '8014126950', '1798 S W Temple Ste A 100', 'South Salt Lake', 'Salt Lake', 'UT', '84115', '8014126930', '8014126950', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2014-04-21', 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1972580769', 0, 'Y', 0, '2014-04-22', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'S77000862', 'S77000862', 'UT01', 'Community Health Centers', 'Carole', 'H', 'Stipelman', 'MD', 'Pediatrics', 'Family Practice', '', NULL, 'B', '1798 S W Temple Ste A 100', 'South Salt Lake', 'Salt Lake', 'UT', '84115', '8014126930', '8014126950', '1798 S W Temple Ste A 100', 'South Salt Lake', 'Salt Lake', 'UT', '84115', '8014126930', '8014126950', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2011-08-30', 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1851496616', 0, 'N', 0, '2014-04-11', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'S77000863', 'S77000863', 'UT01', 'Central City Clinic Medical', 'David', 'K', 'Turok', 'MD', 'Obstetrics and Gynecology', 'Family Practice', '', 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, '2006-06-01', NULL, 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1568449379', 0, 'N', 0, '2014-04-22', NULL, NULL, 40.7593, -111.88, NULL, NULL),
('742481087', 'S77000864', 'S77000864', 'UT01', NULL, 'Jeffrey', 'A', 'Abel', 'MD', 'Pulmonary', 'Emergency Medicine', 'Sleep Medicine', NULL, 'O', '4403 Harrison Blvd Ste 2455', 'Ogden', 'Weber', 'UT', '84403', '8013872575', NULL, '4403 Harrison Blvd Ste 2455', 'Ogden', 'Weber', 'UT', '84403', '8013872575', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2009-01-01', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1730129941', 0, 'N', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('742883725', 'S77000865', 'S77000865', 'UT01', '', 'Brian', 'R', 'Peterson', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '3584 W 9000 S Ste 311', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015668304', '4356139709', '3584 W 9000 S Ste 311', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015668304', '4356139709', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-01-01', '2013-10-02', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1316978687', 0, 'N', 0, '2013-10-02', NULL, NULL, 0, 0, NULL, NULL),
('743096310', 'S77000868', 'S77000868', 'UT01', 'St Marks Professional Services', NULL, NULL, 'St Marks Professional Services', 'GROUP', NULL, NULL, NULL, NULL, 'O', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687700', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000832716', 0, 'Y', 0, '2006-11-07', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('743102924', 'S77000895', 'S77000895', 'UT01', 'Ogden Internal Medicine', 'Elena', 'L', 'Goncharova', 'MD', 'Internal Medicine', 'Pain Management', '', NULL, 'B', 'PO Box 71128', 'Cottonwood', 'Salt Lake', 'UT', '84171', '8014755100', '8014758580', 'PO Box 71128', 'Cottonwood', 'Salt Lake', 'UT', '84171', '8014755100', '8014758580', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1619085339', 0, 'Y', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('752992232', 'S77000911', 'S77000911', 'UT01', 'Canyons Medical Center', 'Michael', 'Edward', 'Cobble', 'MD', 'Family Practice', '', '', NULL, 'O', '9355 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8015721616', NULL, '9355 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8015721616', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1992927834', 0, 'N', 0, '2012-06-08', NULL, NULL, 40.5809, -111.853, NULL, NULL),
('752992232', 'S77000912', 'S77000912', 'UT01', 'Canyons Medical Center', 'Michael', 'Edward', 'Cobble', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 980700', 'Park City', 'Summit', 'UT', '84098', '8015721616', NULL, 'PO Box 980700', 'Park City', 'Summit', 'UT', '84098', '8015721616', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1992927834', 0, 'Y', 0, '2012-06-08', NULL, NULL, 0, 0, NULL, NULL),
('752992731', 'S77000913', 'S77000913', 'UT01', 'Mountain West Radiology', 'James', 'T', 'Webber', 'MD', 'Diagnostic Radiology', 'Radiologist', '', NULL, 'O', '1244 N Main St Ste 201', 'Tooele', 'Tooele', 'UT', '84074', '4358433600', NULL, '1244 N Main St Ste 201', 'Tooele', 'Tooele', 'UT', '84074', '4358433600', '', 'WUSTDRAD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'Mountain West Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1467459479', 0, 'N', 0, '2012-04-24', NULL, NULL, 40.5556, -112.297, NULL, NULL),
('752992731', 'S77000914', 'S77000914', 'UT01', 'Mountain West Radiology', 'James', 'T', 'Webber', 'MD', 'Diagnostic Radiology', 'Radiologist', '', NULL, 'B', 'PO Box 1210', 'Tooele', 'Tooele', 'UT', '84074', '4358433645', NULL, 'PO Box 1210', 'Tooele', 'Tooele', 'UT', '84074', '4358433645', '', 'WUSTDRAD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'Mountain West Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1467459479', 0, 'Y', 0, '2012-04-24', NULL, NULL, 0, 0, NULL, NULL),
('753026770', 'S77000917', 'S77000917', 'UT01', 'Cascade Foot and Ankle Clinic', 'Jared', 'T', 'Clegg', 'DPM', 'Podiatry', '', '', NULL, 'O', '1937 N 1120 W', 'Provo', 'Utah', 'UT', '84604', '8013732499', '8013739200', '1937 N 1120 W', 'Provo', 'Utah', 'UT', '84604', '8013732499', '8013739200', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, 0, 0, 0, 'Central Valley Medical Center', '', '', '', 'HCFA|UB|', '1588664759', 0, 'N', 0, '2013-07-26', NULL, NULL, 40.2597, -111.676, NULL, NULL),
('753090765', 'S77000919', 'S77000919', 'UT01', NULL, 'Kathleen', 'K', 'Boynton', 'MD', 'Gastroenterology', 'Internal Medicine', '', NULL, 'O', '3584 W 9000 S Ste 300', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015635121', '8015653663', '3590 W 9000 S', 'West Jordan', '', 'UT', '84088', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2010-03-17', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1174666739', 0, 'N', 0, '2008-09-17', NULL, NULL, 0, 0, NULL, NULL),
('752985103', 'S77000924', 'S77000924', 'UT01', NULL, 'Stanley', 'J', 'Phillips', 'DPM', 'Podiatry', '', '', NULL, 'O', '9690 S 1300 E Ste 120', 'Sandy', 'Salt Lake', 'UT', '84094', '8015014335', '8015014338', '9690 S 1300 E Ste 120', 'Sandy', 'Salt Lake', 'UT', '84094', '8015014335', '8015014338', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', NULL, '', '', 'HCFA|UB|', '1841202397', 0, 'N', 0, '2013-12-10', NULL, NULL, 40.5743, -111.853, NULL, NULL),
('752992731', 'S77000925', 'S77000925', 'UT01', 'Mountain West Radiology', 'James', 'T', 'Webber', 'MD', 'Diagnostic Radiology', 'Radiologist', '', NULL, 'O', '2055 N Main St', 'Tooele', 'Tooele', 'UT', '84074', '4358433600', '4358432590', '2055 N Main St', 'Tooele', 'Tooele', 'UT', '84074', '4358433600', '4358432590', 'WUSTDRAD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'Mountain West Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1467459479', 0, 'Y', 0, '2012-04-24', NULL, NULL, 40.5716, -112.295, NULL, NULL),
('753096764', 'S77000928', 'S77000928', 'UT01', NULL, 'Joseph', 'D', 'Hollingsworth', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '945 W Hospital Dr Ste 4', 'Price', 'Carbon', 'UT', '84501', '4356370675', '4356370677', '945 W Hospital Dr', 'Price', '', 'UT', '84501', '', '', 'WEUHP', 'WUSTDHCPC5', NULL, '0.00', '20.00', '0.00', 3, '2007-01-01', '2008-05-16', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1003920729', 0, 'N', 0, '2007-01-07', NULL, NULL, 0, 0, NULL, NULL),
('800028188', 'S77000931', 'S77000931', 'UT01', 'West Valley Eye Care', 'Robert', 'E', 'Smith', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'B', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653786', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, 'Pioneer Valley Hospital', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1578675633', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('800013869', 'S77000949', 'S77000949', 'UT01', 'Wasatch Medical Clinic', 'Stanton', 'B', 'McDonald', 'MD', 'Family Practice', '', '', NULL, 'O', '35 S 500 E', 'Heber City', 'Wasatch', 'UT', '84032', '4356541501', NULL, '35 S 500 E', 'Heber City', 'Wasatch', 'UT', '84032', '4356541501', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Heber Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1982636890', 0, 'N', 0, '2013-01-17', NULL, NULL, 40.5071, -111.405, NULL, NULL),
('810587644', 'S77000951', 'S77000951', 'UT01', 'Bear Lake Community Health Center', 'Douglas', 'R', 'Hyldahl', 'MD', 'Family Practice', '', '', NULL, 'O', '325 W Logan Hwy Ste 3', 'Garden City', 'Rich', 'UT', '84028', '4359463660', '4359468215', '325 W Logan Hwy Ste 3', 'Garden City', 'Rich', 'UT', '84028', '4359463660', '4359468215', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1083624555', 0, 'N', 0, '2014-06-30', NULL, NULL, 41.9363, -111.394, NULL, NULL),
('810587644', 'S77000952', 'S77000952', 'UT01', 'Cache Valley Community Health Ctr', 'Douglas', 'R', 'Hyldahl', 'MD', 'Family Practice', '', '', NULL, 'O', '550 E 1400 N Ste K', 'Logan', 'Cache', 'UT', '84341', '4357556061', NULL, '550 E 1400 N Ste K', 'Logan', 'Cache', 'UT', '84341', '4357556061', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1083624555', 0, 'N', 0, '2014-06-30', NULL, NULL, 41.7574, -111.82, NULL, NULL),
('810608733', 'S77000953', 'S77000953', 'UT01', 'Nexus Pain Care', 'Cynthia', 'C', 'Sullivan', 'PA', 'Pain Management', NULL, NULL, NULL, 'B', 'PO Box 27688', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8015341360', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUSTDPAIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-01-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '911510', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('810633879', 'S77000954', 'S77000954', 'UT01', NULL, 'Kenneth', 'H', 'Wadsworth', 'MD', 'Urology', NULL, NULL, NULL, 'O', '4403 Harrison Blvd Ste 4400', 'Ogden', 'Weber', 'UT', '84403', '8013874550', NULL, '4403 Harrison Bvld', 'Ogden', '', 'UT', '84403', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', '2008-03-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1962500264', 0, 'N', 0, '2006-11-30', NULL, NULL, 0, 0, NULL, NULL),
('820330853', 'S77000955', 'S77000955', 'UT01', NULL, 'Daniel', 'A', 'Johnson', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '1675 N Freedom Blvd Ste 9C', 'Provo', 'Utah', 'UT', '84604', '8013774800', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-04-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '831291', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('820330853', 'S77000956', 'S77000956', 'UT01', NULL, 'Joseph', 'M', 'Johnson', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '1675 N Freedom Blvd Ste 9C', 'Provo', 'Utah', 'UT', '84604', '8013774800', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-07-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1427126192', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('810587644', 'S77000959', 'S77000959', 'UT01', 'Bear Lake Community Health Center', 'William', 'B', 'Evans', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '325 W Logan Hwy Ste 3', 'Garden City', 'Rich', 'UT', '84028', '4359463660', '4359468215', '325 W Logan Hwy Ste 3', 'Garden City', 'Rich', 'UT', '84028', '4359463660', '4359468215', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2011-11-15', 0, 0, 0, 'Brigham City Community Hospital', 'Logan Regional Hospital', NULL, NULL, 'HCFA|UB|', '1811942964', 0, 'N', 0, '2014-03-11', NULL, NULL, 41.9363, -111.394, NULL, NULL),
('810608733', 'S77000960', 'S77000960', 'UT01', 'Nexus Pain Care', 'Timothy', 'A', 'Dennis', 'PA', NULL, NULL, NULL, NULL, 'B', 'PO Box 27688', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8015341360', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUSTDPAIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-01-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '908254', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('841367175', 'S77001069', 'S77001069', 'UT01', 'Canyon View Medical Group', 'John', 'S', 'Taylor', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', '325 W Ctr St', 'Spanish Fork', 'Utah', 'UT', '84660', '8014898464', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1740228055', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('841367175', 'S77001070', 'S77001070', 'UT01', 'Canyon View Medical Group', 'John', 'S', 'Taylor', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '5 E 400 N', 'Springville', 'Utah', 'UT', '84663', '8014898464', '8014896378', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1740228055', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('841372856', 'S77001071', 'S77001071', 'UT01', NULL, 'Keith', 'P', 'Ramsey', 'DO', 'Pediatrics', '', '', NULL, 'O', '8822 Redwood Rd Ste S103', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012532273', NULL, '8822 Redwood Rd Ste S103', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012532273', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1245294586', 0, 'N', 0, '2014-04-02', NULL, NULL, 40.5916, -111.939, NULL, NULL),
('841410513', 'S77001080', 'S77001080', 'UT01', NULL, 'Barclay', 'Fiske', 'Bigelow', 'MD', 'Internal Medicine', '', '', NULL, 'O', '880 E 9400 S Ste 105', 'Sandy', 'Salt Lake', 'UT', '84094', '8015717494', NULL, '880 E 9400 S Ste 105', 'Sandy', 'Salt Lake', 'UT', '84094', '8015717494', '', 'WUSTDINT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588617542', 0, 'N', 0, '2014-04-16', NULL, NULL, 40.5806, -111.866, NULL, NULL),
('841411398', 'S77001081', 'S77001081', 'UT01', 'Foothill Family Clinic', 'Jon', 'R', 'Aoki', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'B', '6360 S 3000 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8013651032', '8013651033', '6360 S 3000 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8013651032', '8013651033', 'WUFOOTHIL5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', '2008-04-30', 0, 0, 0, 'Pioneer Valley Hospital', '', '', '', 'HCFA|UB|', '1295805265', 0, 'Y', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('841411398', 'S77001082', 'S77001082', 'UT01', 'Foothill Family Clinic', 'Richard', 'W', 'Chapa', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'B', '6360 S 3000 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8013651032', '8013651033', '6360 S 3000 E', 'Salt Lake City', '', 'UT', '84121', '', '', 'WUFOOTHIL5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', '2009-06-23', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1568556298', 0, 'Y', 0, '2006-12-21', NULL, NULL, 0, 0, NULL, NULL),
('841411398', 'S77001084', 'S77001084', 'UT01', 'Foothill Family Clinic', 'Thomas', 'K', 'Conner', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '6360 S 3000 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8013651032', '8013651033', '6360 S 3000 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8013651032', '8013651033', 'WUFOOTHIL5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1780619023', 0, 'N', 0, '2013-02-19', NULL, NULL, 40.6339, -111.806, NULL, NULL),
('841411398', 'S77001085', 'S77001085', 'UT01', 'Foothill Family Clinic', 'Shana', 'K', 'Eborn', 'MD', 'Family Practice', 'Obstetrics and Gynecology', '', NULL, 'B', '6360 S 3000 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8013651032', '8013651033', '6360 S 3000 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8013651032', '8013651033', 'WUFOOTHIL5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1780615658', 0, 'Y', 0, '2013-01-30', NULL, NULL, 0, 0, NULL, NULL),
('841411398', 'S77001087', 'S77001087', 'UT01', 'Foothill Family Clinic', 'Susan', '', 'Edwards', 'MD', 'Family Practice', '', '', NULL, 'B', '2295 Foothill Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8014863021', '8014856339', '2295 Foothill Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8014863021', '8014856339', 'WUFOOTHIL5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1992730139', 0, 'Y', 0, '2013-01-17', NULL, NULL, 0, 0, NULL, NULL),
('841401924', 'S77001089', 'S77001089', 'UT01', 'Alpine Medical Group OBGYN & Pediatrics', 'Natalie', 'K', 'Loewen', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '1060 E 100 S Ste 400', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015212640', NULL, '1060 E 100 S', 'Salt Lake City', '', 'UT', '84102', '', '', 'WUSTDMULT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2006-12-01', '2008-02-29', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1891763199', 0, 'N', 0, '2006-11-09', NULL, NULL, 0, 0, NULL, NULL),
('841401924', 'S77001091', 'S77001091', 'UT01', 'Alpine Internal Medicine', 'Kristin', 'Kaye', 'McElwain', 'FNP', 'Internal Medicine', NULL, NULL, NULL, 'O', '1060 E 100 S Ste L10', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013281260', NULL, '1060 E 100 S', 'Salt Lake City', '', 'UT', '84102', '', '', 'USTDMULT', 'USTDHCPC', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1700851854', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('841401924', 'S77001095', 'S77001095', 'UT01', 'Alpine Medical Group Surgery', 'Christina', 'G', 'Richards', 'MD', 'General Surgery', 'Bariatric Surgery', '', NULL, 'O', '24 S 1100 E Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8014780010', NULL, '24 S 1100 E Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8014780010', '', 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2006-12-01', '2009-03-11', 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1922123694', 0, 'N', 0, '2014-04-14', NULL, NULL, 0, 0, NULL, NULL),
('841401924', 'S77001102', 'S77001102', 'UT01', 'Alpine Medical Group OBGYN & Pediatrics', 'Margaret', 'Margaret', 'Batson', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1060 E 100 S Ste 400', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015212640', NULL, '1060 E 100 S Ste 400', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015212640', '          ', 'WUSTDMULT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-12-01', '2013-01-01', 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1437127735', 0, 'N', 0, '2013-03-08', NULL, NULL, 0, 0, NULL, NULL),
('841401924', 'S77001111', 'S77001111', 'UT01', 'Alpine Internal Medicine', 'Joyce', 'Dunn', 'Johnson', 'MD', 'Dermatology', 'Internal Medicine', NULL, NULL, 'O', '1060 E 100 S Ste L10', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013281260', NULL, '1060 E 100 S', 'Salt Lake City', '', 'UT', '84102', '', '', 'USTDMULT', 'USTDHCPC', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1649245705', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('841411398', 'S77001113', 'S77001113', 'UT01', 'Foothill Family Clinic', 'Susan', '', 'Edwards', 'MD', 'Family Practice', '', '', NULL, 'o', '6360 S 3000 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8013651032', '8013651033', '6360 S 3000 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8013651032', '8013651033', 'WUFOOTHIL5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1992730139', 0, 'N', 0, '2013-01-17', NULL, NULL, 40.6339, -111.806, NULL, NULL),
('841411398', 'S77001114', 'S77001114', 'UT01', 'Foothill Family Clinic', 'John', 'A', 'Griffin', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'O', '6360 S 3000 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8013651032', '8013651033', '6360 S 3000 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8013651032', '8013651033', 'WUFOOTHIL5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-01-01', '2011-09-28', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1821014903', 0, 'N', 0, '2014-07-17', NULL, NULL, 0, 0, NULL, NULL),
('841411398', 'S77001115', 'S77001115', 'UT01', 'Foothill Family Clinic', 'David', 'J', 'Howe', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '2295 Foothill Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8014863021', '8014856339', '6360 S 3000 E', 'Salt Lake City', '', 'UT', '84121', '', '', 'WUFOOTHIL5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-01-01', '2007-05-01', 0, NULL, 0, 'Salt Lake Regional Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1578667226', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('841411398', 'S77001116', 'S77001116', 'UT01', 'Foothill Family Clinic', 'Steven', 'K', 'Miller', 'MD', 'Ear, Nose and Throat', NULL, NULL, NULL, 'O', '6360 S 3000 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8013651032', '8013651033', '6360 S 3000 E', 'Salt Lake City', '', 'UT', '84121', '', '', 'WUFOOTHIL5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-01-01', '2007-04-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1942313796', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('841411398', 'S77001117', 'S77001117', 'UT01', 'Foothill Family Clinic', 'Robert', 'F', 'Sprung', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'B', '6360 S 3000 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8013651032', '8013651033', '6360 S 3000 E', 'Salt Lake City', '', 'UT', '84121', '', '', 'WUFOOTHIL5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', '2008-07-03', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1255314837', 0, 'Y', 0, '2007-11-06', NULL, NULL, 0, 0, NULL, NULL),
('841411398', 'S77001118', 'S77001118', 'UT01', 'Foothill Family Clinic', 'Bryan', 'C', 'Tagge', 'MD', 'Ear, Nose and Throat', NULL, NULL, NULL, 'O', '6360 S 3000 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8013651032', '8013651033', NULL, NULL, '', 'UT', '84109', '', '', 'WUFOOTHIL5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1164557583', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('841411398', 'S77001119', 'S77001119', 'UT01', 'Foothill Family Clinic', 'Stephen', '', 'Wood', 'MD', 'Family Practice', '', '', NULL, 'O', '6360 S 3000 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8013651032', '8013651033', '6360 S 3000 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8013651032', '8013651033', 'WUFOOTHIL5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1508881657', 0, 'N', 0, '2013-01-22', NULL, NULL, 40.6339, -111.806, NULL, NULL),
('841424470', 'S77001120', 'S77001120', 'UT01', '', 'Kieuanh', '', 'Pham', 'MD', 'Internal Medicine', '', '', NULL, 'O', '4568 Highland Dr Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012772323', NULL, '4568 S Highland Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012772323', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2011-10-10', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1538234299', 0, 'N', 0, '2011-10-11', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('841424994', 'S77001121', 'S77001121', 'UT01', 'Peterson, Warren A', 'Michael', 'P', 'Eyre', 'DO', 'Dermatology', 'Dermatology', NULL, NULL, 'O', '78 E 900 N', 'Spanish Fork', 'Utah', 'UT', '84660', '8017941490', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2007-02-28', 0, NULL, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1063481646', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('841424994', 'S77001122', 'S77001122', 'UT01', 'Peterson, Warren A', 'Warren', 'A', 'Peterson', 'DO', 'Dermatology', NULL, NULL, NULL, 'O', '48 W 1500 N', 'Nephi', 'Juab', 'UT', '84648', '4356232023', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2007-02-28', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1134198807', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('841429813', 'S77001125', 'S77001125', 'UT01', 'Intermountain Pain Specialists', 'Gordon', 'P', 'George', 'MD', 'Pain Management', NULL, NULL, NULL, 'B', '700 W 800 N Ste 340A', 'American Fork', 'Utah', 'UT', '84003', '8014310100', '8017639740', NULL, NULL, '', NULL, NULL, '', '', 'WUSTDPAIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1730109158', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('841409599', 'S77001127', 'S77001127', 'UT01', 'Bear Care Pediatrics', 'Kathie', 'Ellen', 'Coopersmith', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '5495 S 500 E Ste 120', 'Ogden', 'Weber', 'UT', '84405', '8014790174', NULL, '5495 S 500 E', 'Ogden', '', 'UT', '84405', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2009-08-01', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1447359039', 0, 'N', 0, '2009-01-12', NULL, NULL, 0, 0, NULL, NULL),
('841409599', 'S77001128', 'S77001128', 'UT01', 'Bear Care Pediatrics', 'Kenneth', 'E', 'Stevenson', 'MD', 'Pediatrics', '', '', NULL, 'O', '5495 S 500 E Ste 120', 'Ogden', 'Weber', 'UT', '84405', '8014790174', NULL, '5495 S 500 E Ste 120', 'Ogden', 'Weber', 'UT', '84405', '8014790174', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2008-12-18', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1245326065', 0, 'N', 0, '2012-06-28', NULL, NULL, 0, 0, NULL, NULL),
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('870218917', 'S77001245', 'S77001245', 'UT01', 'Tanner Memorial Clinic', 'Norman', 'C', 'Bos', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '2121 Robins Dr', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'WUTANNER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-07-01', '2011-04-15', NULL, 0, NULL, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1104805118', 0, 'N', 0, '2011-04-19', NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'S77001246', 'S77001246', 'UT01', 'Tanner Memorial Clinic', 'Ted', 'H', 'Burningham', 'MD', 'Family Practice', '', '', NULL, 'O', '2121 Robins Dr', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', '2121 Robins Dr', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1174509129', 0, 'N', 0, '2014-02-26', NULL, NULL, 41.0893, -111.997, NULL, NULL),
('870218917', 'S77001247', 'S77001247', 'UT01', 'Tanner Memorial Clinic', 'Bruce', 'F', 'Burtenshaw', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'B', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'PO Box 337', 'Layton', '', 'UT', '84041', '', '', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1609852656', 0, 'Y', 0, '2006-12-15', NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'S77001248', 'S77001248', 'UT01', 'Tanner Memorial Clinic', 'Darin', 'D', 'Checketts', 'DO', 'Internal Medicine', NULL, NULL, 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, '2006-07-01', '2011-08-15', NULL, 0, NULL, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1639158512', 0, 'Y', 0, '2011-06-20', NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'S77001249', 'S77001249', 'UT01', 'Tanner Memorial Clinic', 'Brent', '', 'Eberhard', 'MD', 'Pediatrics', '', '', 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, '2006-07-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1679559629', 0, 'Y', 0, '2014-05-29', NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'S77001250', 'S77001250', 'UT01', 'Tanner Memorial Clinic', 'Ryan', 'N', 'Evans', 'MD', 'Pediatrics', '', '', NULL, 'O', '380 N 400 W', 'Kaysville', 'Davis', 'UT', '84037', '8017734840', NULL, '380 N 400 W', 'Kaysville', 'Davis', 'UT', '84037', '8017734840', '', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1659357606', 0, 'N', 0, '2014-01-24', NULL, NULL, 41.0412, -111.946, NULL, NULL),
('870218917', 'S77001251', 'S77001251', 'UT01', 'Tanner Memorial Clinic', 'Duane', 'E', 'Farley', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '2121 Robins Dr', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', '2121 Robins Dr', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1538145586', 0, 'N', 0, '2012-03-20', NULL, NULL, 41.0893, -111.997, NULL, NULL),
('870218917', 'S77001252', 'S77001252', 'UT01', 'Tanner Memorial Clinic', 'Sharon', 'L', 'Fillerup', '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', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, NULL, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1225014251', 0, 'Y', 0, '2012-01-23', NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'S77001253', 'S77001253', 'UT01', 'Tanner Memorial Clinic', 'E Dean', '', 'Flanders', 'MD', 'General Surgery', '', '', NULL, 'O', '2121 Robins Dr', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', '2121 Robins Dr', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'WUTANNER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-07-01', '2013-11-25', 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1457337305', 0, 'N', 0, '2013-11-25', NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'S77001254', 'S77001254', 'UT01', 'Tanner Memorial Clinic', 'E Dean', '', 'Flanders', 'MD', 'General Surgery', '', '', 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, '2006-07-01', '2013-11-25', 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1457337305', 0, 'Y', 0, '2013-11-25', NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'S77001255', 'S77001255', 'UT01', 'Tanner Memorial Clinic', 'Stephen', 'M', 'Foote', 'DO', 'Family Practice', NULL, NULL, NULL, 'O', '2038 W 1900 S', 'Syracuse', 'Davis', 'UT', '84075', '8017734840', NULL, 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, NULL, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1689650632', 0, 'N', 0, '2011-11-11', NULL, NULL, 41.0863, -112.065, NULL, NULL),
('870218917', 'S77001256', 'S77001256', 'UT01', 'Tanner Memorial Clinic', 'Glenn', 'S', 'Gold', 'DPM', 'Podiatry', '', '', NULL, 'B', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1437137817', 0, 'Y', 0, '2011-04-21', NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'S77001257', 'S77001257', 'UT01', 'Tanner Memorial Clinic', 'Craig', 'R', 'Hall', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2121 Robins Dr', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, NULL, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1508842378', 0, 'N', 0, '2011-04-19', NULL, NULL, 41.0893, -111.997, NULL, NULL),
('870218917', 'S77001258', 'S77001258', 'UT01', 'Tanner Memorial Clinic', 'Craig', 'R', 'Hall', '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', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, NULL, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1508842378', 0, 'Y', 0, '2011-04-19', NULL, NULL, 0, 0, NULL, NULL),
('841411398', 'S77001259', 'S77001259', 'UT01', 'Foothill Family Clinic', 'Teddy', '', 'Witbeck', 'MD', 'Family Practice', '', '', NULL, 'O', '6360 S 3000 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8013651032', '8013651033', '6360 S 3000 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8013651032', '8013651033', 'WUFOOTHIL5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1972522316', 0, 'N', 0, '2013-01-30', NULL, NULL, 40.6339, -111.806, NULL, NULL),
('841424766', 'S77001261', 'S77001261', 'UT01', '', 'Carolyn', '', 'Forbes', 'MD', 'Family Practice', '', '', NULL, 'O', '1959 Aaron Dr Ste F', 'Tooele', 'Tooele', 'UT', '84074', '4358431225', '4358431228', '1959 Aaron Dr Ste F', 'Tooele', 'Tooele', 'UT', '84074', '4358431225', '4358431228', 'WUSTDFAM5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-01-01', '2011-10-17', 0, 0, 0, 'Mountain West Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1144251711', 0, 'N', 0, '2013-08-14', NULL, NULL, 0, 0, NULL, NULL),
('841424994', 'S77001262', 'S77001262', 'UT01', 'Peterson, Warren A', 'Warren', 'A', 'Peterson', 'DO', 'Dermatology', NULL, NULL, NULL, 'O', '35 E Ctr St', 'Gunnison', 'Sanpete', 'UT', '84634', '8017941495', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2007-02-28', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1134198807', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('841424994', 'S77001263', 'S77001263', 'UT01', 'Peterson, Warren A', 'Warren', 'A', 'Peterson', 'DO', 'Dermatology', NULL, NULL, NULL, 'B', '78 E 900 N', 'Spanish Fork', 'Utah', 'UT', '84660', '8017941490', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2007-02-28', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1134198807', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL);
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
('841429813', 'S77001264', 'S77001264', 'UT01', 'Intermountain Pain Specialists', 'Gordon', 'P', 'George', 'MD', 'Pain Management', NULL, NULL, NULL, 'B', '700 W 800 N Ste 340A', 'Orem', 'Utah', 'UT', '84057', '8014310100', '8017639740', NULL, NULL, '', NULL, NULL, '', '', 'WUSTDPAIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1730109158', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('841431764', 'S77001266', 'S77001266', 'UT01', 'Eastern Utah Eye Physicians', 'Jeffrey', 'E', 'Hansen', 'MD', 'Ophthalmology', '', '', NULL, 'O', '200 N Fairgrounds Rd Ste 2', 'Price', 'Carbon', 'UT', '84501', '4356378689', '4356371123', '200 N Fairgrounds Rd Ste 2', 'Price', 'Carbon', 'UT', '84501', '4356378689', '4356371123', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Castleview Hospital', '', '', '', 'HCFA|UB|', '1386751634', 0, 'N', 0, '2014-06-04', NULL, NULL, 39.6051, -110.835, NULL, NULL),
('841448378', 'S77001269', 'S77001269', 'UT01', NULL, 'Douglas', 'R', 'Coombs', 'MD', 'Pediatrics', '', '', NULL, 'O', '520 E Medical Dr Ste 301', 'Bountiful', 'Davis', 'UT', '84010', '8012921464', NULL, '520 E Medical Dr Ste 301', 'Bountiful', 'Davis', 'UT', '84010', '8012921464', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1487655668', 0, 'N', 0, '2014-04-16', NULL, NULL, 40.8873, -111.87, NULL, NULL),
('870265581', 'S77001279', 'S77001279', 'UT01', NULL, 'Leon', 'H', 'White', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '5756 S 2000 W', 'Roy', 'Weber', 'UT', '84067', '8017737133', NULL, '5756 S 2000 W', 'Roy', '', 'UT', '84067', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2010-04-19', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1730260076', 0, 'N', 0, '2006-10-19', NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'S77001282', 'S77001282', 'UT01', 'Tanner Memorial Clinic', 'Charles', 'C', 'Harpe', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '2121 Robins Dr', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8015258151', 'PO Box 337', 'Layton', '', 'UT', '84041', '', '', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', '2008-01-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1063498004', 0, 'N', 0, '2006-12-15', NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'S77001283', 'S77001283', 'UT01', 'Tanner Memorial Clinic', 'Rachel', 'B', 'Hobbs', 'MD', 'Family Practice', '', '', NULL, 'O', '2121 Robins Dr', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', '2121 Robins Dr', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1275519126', 0, 'N', 0, '2014-01-24', NULL, NULL, 41.0893, -111.997, NULL, NULL),
('870218917', 'S77001284', 'S77001284', 'UT01', 'Tanner Memorial Clinic', 'Rachel', 'B', 'Hobbs', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1275519126', 0, 'Y', 0, '2014-01-24', NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'S77001285', 'S77001285', 'UT01', 'Tanner Memorial Clinic', 'Jennifer', NULL, 'Hogge', 'AUD', 'Audiology', NULL, NULL, NULL, 'O', '2121 Robins Dr', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', NULL, NULL, '', NULL, NULL, '', '', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-07-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '833033', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'S77001286', 'S77001286', 'UT01', 'Tanner Memorial Clinic', 'Jennifer', NULL, 'Hogge', 'AUD', 'Audiology', NULL, NULL, NULL, 'B', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', NULL, NULL, '', NULL, NULL, '', '', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-07-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '833033', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'S77001288', 'S77001288', 'UT01', 'Tanner Memorial Clinic', 'Wade', 'B', 'Larsen', 'MD', 'General Surgery', '', '', NULL, 'O', '2121 Robins Dr', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, NULL, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1326024191', 0, 'N', 0, '2011-11-10', NULL, NULL, 41.0893, -111.997, NULL, NULL),
('870218917', 'S77001289', 'S77001289', 'UT01', 'Tanner Memorial Clinic', 'Wade', 'B', 'Larsen', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, NULL, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1326024191', 0, 'Y', 0, '2011-11-10', NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'S77001290', 'S77001290', 'UT01', 'Tanner Memorial Clinic', 'Robert', 'L', 'Mellor', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '2121 Robins Dr', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', '2121 Robins Dr', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'WUTANNER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1023094992', 0, 'N', 0, '2014-06-03', NULL, NULL, 41.0893, -111.997, NULL, NULL),
('870218917', 'S77001291', 'S77001291', 'UT01', 'Tanner Memorial Clinic', 'Stephen', 'L', 'Morrell', 'MD', 'Family Practice', '', '', NULL, 'O', '380 N 400 W', 'Kaysville', 'Davis', 'UT', '84037', '8017734840', NULL, '380 N 400 W', 'Kaysville', 'Davis', 'UT', '84037', '8017734840', '', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1801872601', 0, 'N', 0, '2014-02-12', NULL, NULL, 41.0412, -111.946, NULL, NULL),
('870218917', 'S77001292', 'S77001292', 'UT01', 'Tanner Memorial Clinic', 'Noel', 'C', 'Nye', 'DO', 'Pediatrics', NULL, NULL, NULL, 'B', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, NULL, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1437135399', 0, 'Y', 0, '2011-10-04', NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'S77001293', 'S77001293', 'UT01', 'Tanner Memorial Clinic', 'Bryan', 'L', 'Richards', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '2121 Robins Dr', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, NULL, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1780660548', 0, 'N', 0, '2011-04-18', NULL, NULL, 41.0893, -111.997, NULL, NULL),
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('870218917', 'S77001306', 'S77001306', 'UT01', 'Tanner Memorial Clinic', 'Michael', 'G', 'Allred', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1811973829', 0, 'Y', 0, '2014-01-24', NULL, NULL, 0, 0, NULL, NULL),
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('870218917', 'S77001310', 'S77001310', 'UT01', 'Tanner Memorial Clinic', 'Warren', 'L', 'Butler', 'MD', 'Family Practice', '', '', NULL, 'O', '2038 W 1900 S', 'Syracuse', 'Davis', 'UT', '84075', '8017734840', NULL, '2038 W 1900 S', 'Syracuse', 'Davis', 'UT', '84075', '8017734840', '', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1679559694', 0, 'N', 0, '2014-01-24', NULL, NULL, 41.0863, -112.065, NULL, NULL),
('870280366', 'S77001311', 'S77001311', 'UT01', 'Obstetrics and Gynecology Clinic', 'Jason', 'L', 'Johnson', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '850 E 300 S Ste 1', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013221214', NULL, '850 E 300 S Ste 1', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013221214', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1376638718', 0, 'N', 0, '2014-05-15', NULL, NULL, 40.7628, -111.867, NULL, NULL),
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('870280459', 'S77001320', 'S77001320', 'UT01', 'Western Gyn & Ob Clinic', 'Suphithaya', NULL, 'Anders', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'B', '5770 S 250 E Ste G-50', 'Murray', 'Salt Lake', 'UT', '84107', '8013144440', '8013144437', '5770 S 250 E', 'Murray', '', 'UT', '84107', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1558401919', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870280459', 'S77001321', 'S77001321', 'UT01', 'Western Gyn & Ob Clinic', 'Joylyn', NULL, 'Cluny', 'MSNP', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'B', '5770 S 250 E Ste G-50', 'Murray', 'Salt Lake', 'UT', '84107', '8013144440', NULL, '5770 S 250 E', 'Murray', '', 'UT', '84107', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1578603932', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('870280459', 'S77001323', 'S77001323', 'UT01', 'Western GYN & OB Clinic', 'Robert', 'D', 'Merrill', 'DO', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '12600 S 3723 W Ste 350', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854900', '8012854901', '5770 S 250 E', 'Murray', '', 'UT', '84107', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1669491031', 0, 'N', 0, '2006-10-19', NULL, NULL, 40.5104, -111.952, NULL, NULL),
('870281028', 'S77001324', 'S77001324', 'UT01', 'Central Utah Clinic PC-PT', NULL, NULL, 'Central Utah Clinic', 'GROUP', 'Physical Therapy', NULL, NULL, NULL, 'O', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8014290610', '8014290629', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834797', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'S77001326', 'S77001326', 'UT01', 'Tanner Memorial Clinic', 'Richard', 'K', 'Wallin', 'MD', 'Family Practice', '', '', 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, '2006-07-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1518943471', 0, 'Y', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'S77001327', 'S77001327', 'UT01', 'Tanner Memorial Clinic', 'Jean', NULL, 'Weiner', 'MD', 'Dietician', NULL, NULL, NULL, 'B', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', NULL, NULL, '', NULL, NULL, '', '', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '0000834151', 0, 'Y', 0, '2006-10-17', NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'S77001328', 'S77001328', 'UT01', 'Tanner Memorial Clinic', 'Jay', 'R', 'Yates', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '2121 Robins Dr', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'PO Box 337', 'Layton', '', 'UT', '84041', '', '', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1427034297', 0, 'N', 0, '2006-10-17', NULL, NULL, 41.0893, -111.997, NULL, NULL),
('870218917', 'S77001329', 'S77001329', 'UT01', 'Tanner Memorial Clinic', 'Jay', 'R', 'Yates', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'PO Box 337', 'Layton', '', 'UT', '84041', '', '', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1427034297', 0, 'Y', 0, '2006-10-17', NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'S77001336', 'S77001336', 'UT01', 'Tanner Memorial Clinic', 'Warren', 'L', 'Butler', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', NULL, NULL, 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '', '', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1679559694', 0, 'Y', 0, '2014-01-24', NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'S77001337', 'S77001337', 'UT01', 'Tanner Memorial Clinic', 'David', 'A', 'Cook', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '2121 Robins Dr', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', '2121 Robins Dr', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285610048', 0, 'N', 0, '2014-02-26', NULL, NULL, 41.0893, -111.997, NULL, NULL),
('870218917', 'S77001338', 'S77001338', 'UT01', 'Tanner Memorial Clinic', 'David', 'A', 'Cook', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, NULL, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285610048', 0, 'Y', 0, '2011-01-27', NULL, NULL, 0, 0, NULL, NULL),
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('870281028', 'S77001350', 'S77001350', 'UT01', 'Central Utah Clinic', 'Marvin', 'R', 'Allen', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013734366', '8014290629', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1831154566', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('870280408', 'S77001372', 'S77001372', 'UT01', 'Pediatric Anesthesiologists', 'David', 'L', 'Tanner', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'O', '1954 E Fort Union Blvd Ste 111', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019939551', '8017335872', '1954 E Ft Union Blvd', 'Salt Lake City', '', 'UT', '84121', '', '', '', NULL, NULL, '0.00', '12.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1912016023', 0, 'Y', 0, '2007-03-20', NULL, NULL, 40.6243, -111.836, NULL, NULL),
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('870280459', 'S77001374', 'S77001374', 'UT01', 'Western GYN & OB Clinic', 'Suphithaya', '', 'Anders', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '12600 S 3723 W Ste 350', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854900', '8012854901', '12600 S 3723 W Ste 350', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854900', '8012854901', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1558401919', 0, 'N', 0, '2013-04-11', NULL, NULL, 40.5104, -111.952, NULL, NULL),
('870280459', 'S77001375', 'S77001375', 'UT01', 'Western Gyn & Ob Clinic', 'Elizabeth', NULL, 'Bergquist', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'B', '5770 S 250 E Ste G-50', 'Murray', 'Salt Lake', 'UT', '84107', '8013144440', NULL, '5770 S 250 E', 'Murray', '', 'UT', '84107', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834053', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870280459', 'S77001376', 'S77001376', 'UT01', 'Western Gyn & Ob Clinic', 'Elizabeth', NULL, 'Bergquist', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '5770 S 250 E Ste G50', 'Murray', 'Salt Lake', 'UT', '84107', '8013144440', NULL, '5770 S 250 E', 'Murray', '', 'UT', '84107', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834053', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'S77001378', 'S77001378', 'UT01', 'Tanner Memorial Clinic', 'Kenneth', 'W', 'Jee', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1679559538', 0, 'Y', 0, '2014-01-24', NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'S77001379', 'S77001379', 'UT01', 'Tanner Memorial Clinic', 'Rodney', 'M', 'Jex', 'DPM', 'Podiatry', '', '', NULL, 'O', '2121 Robins Dr', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', '2121 Robins Dr', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'WUTANNER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-07-01', '2014-04-22', 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1912986662', 0, 'N', 0, '2014-07-23', NULL, NULL, 41.0893, -111.997, NULL, NULL),
('870218917', 'S77001380', 'S77001380', 'UT01', 'Tanner Memorial Clinic', 'Michael', 'D', 'Kirkham', 'MD', 'Family Practice', '', '', NULL, 'O', '380 N 400 W', 'Kaysville', 'Davis', 'UT', '84037', '8017734840', '', '380 N 400 W', 'Kaysville', 'Davis', 'UT', '84037', '8017734840', '', 'WUTANNER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1861478638', 0, 'N', 0, '2014-07-21', NULL, NULL, 41.0412, -111.946, NULL, NULL),
('870218917', 'S77001381', 'S77001381', 'UT01', 'Tanner Memorial Clinic', 'Robert', 'L', 'Mellor', 'MD', 'Ear, Nose and Throat', '', '', 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, '2006-07-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1023094992', 0, 'Y', 0, '2014-06-03', NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'S77001382', 'S77001382', 'UT01', 'Tanner Memorial Clinic', 'Stephen', 'L', 'Morrell', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', NULL, NULL, 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '', '', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1801872601', 0, 'Y', 0, '2014-02-06', NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'S77001384', 'S77001384', 'UT01', 'Tanner Memorial Clinic', 'Noel', 'C', 'Nye', 'DO', 'Pediatrics', NULL, NULL, NULL, 'O', '2038 W 1900 S', 'Syracuse', 'Davis', 'UT', '84075', '8017734840', NULL, 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, NULL, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1437135399', 0, 'N', 0, '2011-10-04', NULL, NULL, 41.0863, -112.065, NULL, NULL),
('870218917', 'S77001385', 'S77001385', 'UT01', 'Tanner Memorial Clinic', 'Noel', 'C', 'Nye', 'DO', 'Pediatrics', NULL, NULL, NULL, 'O', '2121 Robins Dr', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'PO Box 337', 'Layton', '', 'UT', '84041', '', '', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-07-01', '2007-03-01', 0, NULL, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1437135399', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'S77001386', 'S77001386', 'UT01', 'Tanner Memorial Clinic', 'Bryan', 'L', 'Richards', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'B', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, NULL, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1780660548', 0, 'Y', 0, '2011-04-18', NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'S77001387', 'S77001387', 'UT01', 'Tanner Memorial Clinic', 'Teela', 'S', 'Sorensen', '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, '2006-07-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1871579920', 0, 'Y', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'S77001388', 'S77001388', 'UT01', 'Tanner Memorial Clinic', 'Kevin', 'S', 'Sumsion', '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', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, NULL, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1255317053', 0, 'Y', 0, '2011-12-20', NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'S77001389', 'S77001389', 'UT01', 'Tanner Memorial Clinic', 'Bohus', '', 'Svagr', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, NULL, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1164408118', 0, 'Y', 0, '2011-11-22', NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'S77001390', 'S77001390', 'UT01', 'Tanner Memorial Clinic', 'Robert', 'R', 'Taylor', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '2121 Robins Dr', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'PO Box 337', 'Layton', '', 'UT', '84041', '', '', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285610063', 0, 'N', 0, '2006-12-15', NULL, NULL, 41.0893, -111.997, NULL, NULL),
('870218917', 'S77001391', 'S77001391', 'UT01', 'Tanner Memorial Clinic', 'York', 'J', 'Yates', 'MD', 'Plastic Surgery', '', '', NULL, 'O', '2121 Robins Dr', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', '2121 Robins Dr', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'WUTANNER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-07-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1851377725', 0, 'N', 0, '2012-05-03', NULL, NULL, 41.0893, -111.997, NULL, NULL),
('870281028', 'S77001393', 'S77001393', 'UT01', 'Central Utah Clinic', 'Thomas', 'A', 'Dickinson', 'MD', 'Gastroenterology', NULL, NULL, NULL, 'O', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013741268', '8014290629', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1376591354', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('870281028', 'S77001394', 'S77001394', 'UT01', 'Central Utah Clinic', 'Jonathan', 'R', 'Faux', 'MD', 'Orthopedic Surgery', 'Foot and Ankle', '', NULL, 'O', '700 W 800 N Ste 100', 'Orem', 'Utah', 'UT', '84057', '8012245373', NULL, '700 W 800 N Ste 100', 'Orem', 'Utah', 'UT', '84057', '8012245373', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-06-01', '2010-07-14', 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1538250287', 0, 'N', 0, '2013-10-30', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001396', 'S77001396', 'UT01', 'Wasatch Otolaryngology Group', 'Randal', 'B', 'Gibb', 'MD', 'Ear, Nose and Throat', NULL, NULL, NULL, 'O', '39 Professional Way Ste 1', 'Payson', 'Utah', 'UT', '84651', '8014654805', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1679675383', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001397', 'S77001397', 'UT01', 'Central Utah Clinic', 'Kent', 'M', 'Gledhill', 'MD', 'Radiologist', '', '', NULL, 'B', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013742362', '8013742615', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013742362', '8013742615', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-06-01', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1871539833', 0, 'Y', 0, '2014-07-16', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001398', 'S77001398', 'UT01', 'Central Utah Clinic PC-Radiology', 'Izabella', NULL, 'Gurau', 'MD', 'Nephrology', NULL, NULL, NULL, 'O', '1055 N 500 W Ste 222', 'Provo', 'Utah', 'UT', '84604', '8013774623', '8018124699', '1055 N 500 W', 'Provo', '', 'UT', '84604', '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2006-06-01', '2008-06-02', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1821034885', 0, 'N', 0, '2006-10-19', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001399', 'S77001399', 'UT01', 'Central Utah Clinic', 'Wynn', 'H', 'Hemmert', 'MD', 'Gastroenterology', NULL, NULL, NULL, 'B', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013742362', '8013742615', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1003874736', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001400', 'S77001400', 'UT01', 'Central Utah Clinic', 'Chun', NULL, 'Hwang', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013734366', '8014290629', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1649238080', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001402', 'S77001402', 'UT01', 'Central Utah Clinic', 'Robert', 'T', 'Jackson', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '700 W 800 N Ste 100', 'Orem', 'Utah', 'UT', '84057', '8012245373', NULL, '700 W 800 N Ste 100', 'Orem', 'Utah', 'UT', '84057', '8012245373', '', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-06-01', '2010-07-14', 0, 0, 0, 'Mountain View Hospital', 'Timpanogos Regional Hospital', '', '', 'HCFA|UB|', '1407959695', 0, 'N', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001403', 'S77001403', 'UT01', 'Central Utah Clinic', 'Scott', 'T', 'Jackson', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '50 S Medical Dr', 'Payson', 'Utah', 'UT', '84651', '8014652527', NULL, '50 S Medical Dr', 'Payson', 'Utah', 'UT', '84651', '8014652527', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-06-01', '2010-07-14', 0, 0, 0, 'Mountain View Hospital', 'Timpanogos Regional Hospital', '', '', 'HCFA|UB|', '1578666533', 0, 'N', 0, '2013-11-21', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001404', 'S77001404', 'UT01', 'Central Utah Clinic', 'Curtis', NULL, 'Johnson', 'MD', 'Hand Surgery', 'Orthopedic Surgery', NULL, NULL, 'B', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013742362', '8013742615', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1205939089', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001405', 'S77001405', 'UT01', 'Central Utah Clinic', 'Jeffrey', 'W', 'Johnson', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013742362', '8014290629', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1285692400', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870280459', 'S77001408', 'S77001408', 'UT01', 'Western GYN & OB Clinic', 'Mark', 'K', 'Curtis', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '12600 S 3723 W Ste 350', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854900', '8012854901', '5770 S 250 E', 'Murray', '', 'UT', '84107', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1942340658', 0, 'N', 0, '2006-10-19', NULL, NULL, 40.5104, -111.952, NULL, NULL),
('870280459', 'S77001409', 'S77001409', 'UT01', 'Western GYN & OB Clinic', 'Jeffrey', 'D', 'Quinn', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '12600 S 3723 W Ste 350', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854900', '8012854901', '12600 S 3723 W Ste 350', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854900', '8012854901', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1992845366', 0, 'N', 0, '2014-03-18', NULL, NULL, 40.5104, -111.952, NULL, NULL),
('870281028', 'S77001410', 'S77001410', 'UT01', 'Central Utah Clinic PC-PT', NULL, NULL, 'Central Utah Clinic', 'GROUP', 'Physical Therapy', NULL, NULL, NULL, 'B', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8014290610', '8017130613', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834797', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001411', 'S77001411', 'UT01', 'Central Utah Clinic PC-Radiology', '', '', 'Central Utah Clinic PC-Radiology', 'GROUP', 'Imaging Center', 'Radiology', '', NULL, 'O', '852 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8018124624', '8018124699', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8018124624', '8018124699', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-06-01', '2010-07-14', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '0000834774', 0, 'N', 0, '2011-04-13', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001412', 'S77001412', 'UT01', 'Central Utah Clinic', 'Nancy', NULL, 'Ahlstrom', 'MD', 'Nephrology', NULL, NULL, NULL, 'B', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013742362', '8013742615', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1962431122', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001413', 'S77001413', 'UT01', 'Central Utah Clinic', 'C', 'William', 'Bacon', 'MD', 'Orthopedic', NULL, NULL, NULL, 'B', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013742362', '8013742615', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1962505750', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001414', 'S77001414', 'UT01', 'Central Utah Clinic', 'C', 'W', 'Bacon', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '50 S Medical Dr', 'Payson', 'Utah', 'UT', '84651', '8014652527', NULL, '50 S Medical Dr', 'Payson', 'Utah', 'UT', '84651', '8014652527', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-06-01', '2010-07-15', 0, 0, 0, 'Timpanogos Regional Hospital', 'Mountain View Hospital', '', '', 'HCFA|UB|', '1962505750', 0, 'N', 0, '2013-12-09', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001416', 'S77001416', 'UT01', 'Central Utah Clinic', 'Alan', 'M', 'Banks', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'B', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013742362', '8013742615', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832855', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001417', 'S77001417', 'UT01', 'Central Utah Clinic', 'Tarlton', 'J', 'Blair', 'MD', 'Radiation Oncology', NULL, NULL, NULL, 'O', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013742367', '8014290629', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1477655181', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001418', 'S77001418', 'UT01', 'Central Utah Clinic', 'J', 'Cordell', 'Bott', 'MD', 'Hematology and Oncology', NULL, NULL, NULL, 'O', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013742367', '8014290629', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '833249', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001419', 'S77001419', 'UT01', 'Central Utah Clinic', 'Brian', NULL, 'Bradshaw', 'MD', 'Dermatology', NULL, NULL, NULL, 'O', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013742362', '8014290629', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1811955800', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001421', 'S77001421', 'UT01', 'Central Utah Clinic', 'Alan', 'L', 'Colledge', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '680 W 800 N', 'Orem', 'Utah', 'UT', '84057', '8012245373', NULL, '680 W 800 N', 'Orem', 'Utah', 'UT', '84057', '8012245373', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-06-01', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1629169370', 0, 'N', 0, '2013-12-10', NULL, NULL, 0, 0, NULL, NULL),
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('050569704', 'S77001483', 'S77001483', 'UT01', 'Pinnacle Family Care', 'Nameer', 'T', 'Qader', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '5495 S 500 E Ste 100', 'Ogden', 'Weber', 'UT', '84405', '8014757100', NULL, '5495 S 500 E Ste 100', 'Ogden', 'Weber', 'UT', '84405', '8014757100', '          ', 'WUSTDFAM5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-08-01', '2011-10-18', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1336289610', 0, 'N', 0, '2013-09-09', NULL, NULL, 0, 0, NULL, NULL),
('870280366', 'S77001494', 'S77001494', 'UT01', 'Obstetrics and Gynecology Clinic', 'Richard', 'W', 'Chapa', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '850 E 300 S Ste 1', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013221214', NULL, '850 E 300 S', 'Salt Lake City', '', 'UT', '84102', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', '2009-06-30', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1568556298', 0, 'N', 0, '2006-12-21', NULL, NULL, 0, 0, NULL, NULL),
('870280408', 'S77001495', 'S77001495', 'UT01', 'Pediatric Anesthesiologists', 'Barry', 'J', 'Anderton', 'MD', 'Anesthesiology', '', '', NULL, 'O', '1954 E Fort Union Blvd Ste 111', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019939551', '8017335872', '1954 E Ft Union Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019939551', '8017335872', '', '', '', '0.00', '12.00', '0.00', 3, '2006-09-01', NULL, NULL, 0, NULL, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1962517961', 0, 'Y', 0, '2012-01-03', NULL, NULL, 40.6243, -111.836, NULL, NULL),
('870281028', 'S77001497', 'S77001497', 'UT01', 'Central Utah Clinic', 'Richard', 'K', 'Olsen', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013742362', '8014290629', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1932157138', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001502', 'S77001502', 'UT01', 'Central Utah Clinic', 'Brian', 'P', 'Tudor', 'MD', 'Hematology and Oncology', NULL, NULL, NULL, 'O', '64 E 100 N', 'Gunnison', 'Sanpete', 'UT', '84634', '8013734366', NULL, '1055 N 500 W', 'Provo', '', 'UT', '84604', '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, 'Dixie Regional Medical Center', 'Valley View Medical Center', NULL, NULL, 'HCFA|UB|', '1699877308', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001503', 'S77001503', 'UT01', 'Central Utah Clinic PC-Radiology', 'David', 'H', 'Watters', 'MD', 'Radiologist', '', '', NULL, 'O', '852 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8018124624', '8018124699', '852 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8018124624', '8018124699', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-06-01', '2010-07-14', 0, 0, 0, 'Mountain View Hospital', 'Timpanogos Regional Hospital', NULL, NULL, 'HCFA|UB|', '1558397570', 0, 'Y', 0, '2014-01-17', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001505', 'S77001505', 'UT01', 'Central Utah Clinic', 'Dalton', 'H', 'Wright', 'MD', 'Radiologist', NULL, NULL, NULL, 'B', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013742362', '8013742615', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, 'Mountain View Hospital', 'Timpanogos Regional Hospital', NULL, NULL, 'HCFA|UB|', '1174569131', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001506', 'S77001506', 'UT01', 'Central Utah Clinic', 'Karl', 'N', 'Weenig', 'MD', 'Family Practice', 'Sports Medicine', '', NULL, 'O', '700 W 800 N Ste 100', 'Orem', 'Utah', 'UT', '84057', '8012245373', '8018124699', '700 W 800 N Ste 100', 'Orem', 'Utah', 'UT', '84057', '8012245373', '8018124699', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-06-01', '2010-07-14', 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1740242973', 0, 'N', 0, '2013-08-28', NULL, NULL, 0, 0, NULL, NULL),
('870281299', 'S77001507', 'S77001507', 'UT01', 'American Fork Clinic', 'David', 'K', 'Hafen', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '226 N 1100 E Ste A', 'American Fork', 'Utah', 'UT', '84003', '8018553841', '8018553847', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1134238207', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281299', 'S77001508', 'S77001508', 'UT01', 'American Fork Clinic', 'Cheryl', 'A', 'Johnson', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '226 N 1100 E Ste A', 'American Fork', 'Utah', 'UT', '84003', '8018553841', '8018553847', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1417066671', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281299', 'S77001509', 'S77001509', 'UT01', 'American Fork Clinic', 'G', 'Brent', 'Johnson', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '226 N 1100 E Ste A', 'American Fork', 'Utah', 'UT', '84003', '8018553841', '8018553847', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1902914427', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001511', 'S77001511', 'UT01', 'Central Utah Clinic', 'Robert', 'E', 'Corniea', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013742362', '8014290629', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1447218664', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001512', 'S77001512', 'UT01', 'Central Utah Clinic', 'Sean', 'R', 'Curzon', 'DO', 'Internal Medicine', NULL, NULL, NULL, 'O', '700 W 800 N Ste 220', 'Orem', 'Utah', 'UT', '84057', '8012218811', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1780600247', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001513', 'S77001513', 'UT01', 'Central Utah Clinic', 'Jonathan', 'R', 'Faux', 'MD', 'Orthopedic Surgery', 'Foot and Ankle', '', NULL, 'O', '1055 N 500 W Ste 121', 'Provo', 'Utah', 'UT', '84604', '8013577350', NULL, '1055 N 500 W Ste 121', 'Provo', 'Utah', 'UT', '84604', '8013577350', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-06-01', '2010-07-14', 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1538250287', 0, 'N', 0, '2013-10-30', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001515', 'S77001515', 'UT01', 'Central Utah Clinic', 'Walstir', NULL, 'Fonseca', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'B', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013742362', '8013742615', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1013933506', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001516', 'S77001516', 'UT01', 'Central Utah Clinic', 'John', 'Kay', 'Frischknecht', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013734366', '8014290629', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1235197674', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001517', 'S77001517', 'UT01', 'Wasatch Otolaryngology Group', 'Randal', 'B', 'Gibb', 'MD', 'Ear, Nose and Throat', NULL, NULL, NULL, 'O', '700 W 800 N Ste 230', 'Orem', 'Utah', 'UT', '84057', '8014290620', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-03-01', 0, NULL, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1679675383', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001518', 'S77001518', 'UT01', 'Central Utah Clinic', 'Kent', 'M', 'Gledhill', 'MD', 'Radiologist', '', '', NULL, 'O', '852 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8018124624', '8018124699', '852 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8018124624', '8018124699', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-06-01', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1871539833', 0, 'Y', 0, '2014-07-16', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001519', 'S77001519', 'UT01', 'Central Utah Clinic', 'Heidi', 'Ann', 'Heras', 'MD', 'Ear, Nose and Throat', NULL, NULL, NULL, 'B', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013742362', '8013742615', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1619910684', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001521', 'S77001521', 'UT01', 'Central Utah Clinic', 'Richard', 'T', 'Jackson', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '700 W 800 N Ste 100', 'Orem', 'Utah', 'UT', '84057', '8012245373', NULL, '700 W 800 N Ste 100', 'Orem', 'Utah', 'UT', '84057', '8012245373', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-06-01', '2010-07-14', 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1144323163', 0, 'N', 0, '2013-11-07', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001522', 'S77001522', 'UT01', 'Central Utah Clinic', 'Scott', 'T', 'Jackson', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013742362', '8013742615', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013742362', '8013742615', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-06-01', '2010-07-14', 0, 0, 0, 'Mountain View Hospital', 'Timpanogos Regional Hospital', '', '', 'HCFA|UB|', '1578666533', 0, 'Y', 0, '2013-11-21', NULL, NULL, 0, 0, NULL, NULL),
('870280408', 'S77001524', 'S77001524', 'UT01', 'Pediatric Anesthesiologists', 'Sheldon', 'R', 'Furst', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'O', '1954 E Fort Union Blvd Ste 111', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019939551', '8017335872', '1954 E Ft Union Blvd', 'Salt Lake City', '', 'UT', '84121', '', '', '', NULL, NULL, '0.00', '12.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639286669', 0, 'Y', 0, '2007-03-20', NULL, NULL, 40.6243, -111.836, NULL, NULL),
('870280408', 'S77001525', 'S77001525', 'UT01', 'Pediatric Anesthesiologists', 'Christopher', 'R', 'Miller', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'O', '1954 E Fort Union Blvd Ste 111', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019939551', '8017335872', '1954 E Ft Union Blvd', 'Salt Lake City', '', 'UT', '84121', '', '', '', NULL, NULL, '0.00', '12.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1619084415', 0, 'Y', 0, '2007-03-20', NULL, NULL, 40.6243, -111.836, NULL, NULL),
('870280408', 'S77001526', 'S77001526', 'UT01', 'Pediatric Anesthesiologists', 'John', 'J', 'Mulroy', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'O', '1954 E Fort Union Blvd Ste 111', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019939551', '8017335872', '1954 E Ft Union Blvd', 'Salt Lake City', '', 'UT', '84121', '', '', '', NULL, NULL, '0.00', '12.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1083721880', 0, 'Y', 0, '2007-03-20', NULL, NULL, 40.6243, -111.836, NULL, NULL),
('870280408', 'S77001527', 'S77001527', 'UT01', 'Pediatric Anesthesiologists', 'Robert', 'L', 'Rayburn', 'MD', 'Anesthesiology', '', '', NULL, 'O', '1954 E Fort Union Blvd Ste 111', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019939551', '8017335872', '1954 E Fort Union Blvd Ste 111', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019939551', '8017335872', '', '', '', '0.00', '12.00', '0.00', 3, '2006-09-01', '2012-10-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1851400956', 0, 'Y', 0, '2012-12-06', NULL, NULL, 0, 0, NULL, NULL),
('870280408', 'S77001528', 'S77001528', 'UT01', 'Pediatric Anesthesiologists', 'James', NULL, 'Viney', 'NP', 'Anesthesiology', NULL, NULL, NULL, 'O', '1954 E Fort Union Blvd Ste 111', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019939551', '8017335872', '1954 E Ft Union Blvd', 'Salt Lake City', '', 'UT', '84121', '', '', '', NULL, NULL, '0.00', '12.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1144339292', 0, 'Y', 0, '2007-03-20', NULL, NULL, 40.6243, -111.836, NULL, NULL),
('870280408', 'S77001529', 'S77001529', 'UT01', 'Pediatric Anesthesiologists', 'Kenneth', 'Duff', 'Yauney', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'O', '1954 E Fort Union Blvd Ste 111', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019939551', '8017335872', '1954 E Ft Union Blvd', 'Salt Lake City', '', 'UT', '84121', '', '', '', NULL, NULL, '0.00', '12.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '0000905771', 0, 'Y', 0, '2007-03-20', NULL, NULL, 40.6243, -111.836, NULL, NULL),
('870280459', 'S77001531', 'S77001531', 'UT01', 'Western Gyn & Ob Clinic', 'Mark', 'K', 'Curtis', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'B', '5770 S 250 E Ste G-50', 'Murray', 'Salt Lake', 'UT', '84107', '8013144440', NULL, '5770 S 250 E', 'Murray', '', 'UT', '84107', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1942340658', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870280459', 'S77001532', 'S77001532', 'UT01', 'Western Gyn & Ob Clinic', 'Kristina', NULL, 'Hedin-Goldsmith', 'MSNP', 'Gynecology', NULL, NULL, NULL, 'B', '5770 S 250 E Ste G-50', 'Murray', 'Salt Lake', 'UT', '84107', '8013144440', NULL, '5770 S 250 E', 'Murray', '', 'UT', '84107', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1235279944', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870280459', 'S77001533', 'S77001533', 'UT01', 'Western Gyn & Ob Clinic', 'Robert', 'D', 'Merrill', 'DO', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'B', '5770 S 250 E Ste G-50', 'Murray', 'Salt Lake', 'UT', '84107', '8013144440', NULL, '5770 S 250 E', 'Murray', '', 'UT', '84107', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1669491031', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870280459', 'S77001534', 'S77001534', 'UT01', 'Western Gyn & Ob Clinic', 'Jeffrey', 'D', 'Quinn', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'B', '5770 S 250 E Ste G-50', 'Murray', 'Salt Lake', 'UT', '84107', '8013144440', NULL, '5770 S 250 E', 'Murray', '', 'UT', '84107', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1492845366', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001535', 'S77001535', 'UT01', 'Central Utah Clinic', 'Igor', NULL, 'Abolnik', 'MD', 'Infectious Disease', NULL, NULL, NULL, 'O', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8014298166', '8014290629', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1194783829', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001536', 'S77001536', 'UT01', 'Central Utah Clinic Nephrology', 'Nancy', NULL, 'Ahlstrom', 'MD', 'Nephrology', NULL, NULL, NULL, 'O', '1055 N 500 W Ste 222', 'Provo', 'Utah', 'UT', '84604', '8013774623', '8013776832', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1962431122', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281299', 'S77001537', 'S77001537', 'UT01', 'American Fork Clinic', 'David', 'C', 'McClain', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '226 N 1100 E Ste A', 'American Fork', 'Utah', 'UT', '84003', '8018553841', '8018553847', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-03-01', 0, NULL, 0, 'Cassia Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1851329767', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281299', 'S77001538', 'S77001538', 'UT01', 'American Fork Clinic', 'Peter', 'V', 'Sundwall', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '680 E Main St Ste 100', 'Lehi', 'Utah', 'UT', '84043', '8017681699', '8017684526', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1558470641', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281337', 'S77001540', 'S77001540', 'UT01', '', 'L', 'Craig', 'Larsen', 'DPM', 'Podiatry', '', '', NULL, 'O', '2180 E 4500 S Ste 105', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012784448', '8012787756', '2180 E 4500 S Ste 105', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012784448', '8012787756', 'WiseSTD6A', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2011-10-12', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1366411753', 0, 'N', 0, '2013-08-22', NULL, NULL, 0, 0, NULL, NULL),
('870281337', 'S77001541', 'S77001541', 'UT01', 'Larsen, L Craig', 'L Craig', NULL, 'Larsen', 'DPM', 'Podiatry', NULL, NULL, NULL, 'B', '2180 E 4500 S', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012784448', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD6A', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1366411753', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('870281707', 'S77001542', 'S77001542', 'UT01', 'Cache Valley Eye Associates', 'David', 'G', 'Waterman', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1300 N 500 E Ste 350', 'Logan', 'Cache', 'UT', '84341', '4357527445', '4357533059', '1300 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357527445', '4357533059', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', '2009-01-19', NULL, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1689603284', 0, 'N', 0, '2011-03-18', NULL, NULL, 0, 0, NULL, NULL),
('870281942', 'S77001543', 'S77001543', 'UT01', 'Brigham Medical Clinic', 'Bruce', 'W', 'Keller', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 719', 'Brigham City', 'Box Elder', 'UT', '84302', '4357342041', '4357238028', 'PO Box 719', 'Brigham City', 'Box Elder', 'UT', '84302', '4357342041', '4357238028', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Brigham City Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1427169036', 0, 'Y', 0, '2013-12-10', NULL, NULL, 0, 0, NULL, NULL),
('870281942', 'S77001544', 'S77001544', 'UT01', 'Brigham Medical Clinic', 'David', 'G', 'Wilding', 'MD', 'Internal Medicine', '', '', NULL, 'O', '600 W Hospital Rd', 'Brigham City', 'Box Elder', 'UT', '84302', '4357342041', '4357238028', '600 W Hospital Rd', 'Brigham City', 'Box Elder', 'UT', '84302', '4357342041', '4357238028', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Brigham City Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1740391226', 0, 'N', 0, '2013-12-02', NULL, NULL, 41.4905, -112.025, NULL, NULL),
('870282100', 'S77001545', 'S77001545', 'UT01', 'Medical Arts Center Clinic', 'Michael', 'C', 'Shaw', 'MD', 'Family Practice', '', '', NULL, 'O', '984 Medical Dr Ste 1', 'Brigham City', 'Box Elder', 'UT', '84302', '4357235248', NULL, '984 Medical Dr Ste 1', 'Brigham City', 'Box Elder', 'UT', '84302', '4357235248', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'Brigham City Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1235161936', 0, 'N', 0, '2014-02-20', NULL, NULL, 41.4888, -112.026, NULL, NULL),
('870282100', 'S77001546', 'S77001546', 'UT01', 'Medical Arts Center Clinic', 'Tawna', 'B', 'Thornton', 'FNP', 'Family Practice', '', '', NULL, 'O', '984 Medical Dr Ste 1', 'Brigham City', 'Box Elder', 'UT', '84302', '4357235248', NULL, '984 S Medical Dr', 'Brigham City', 'Box Elder', 'UT', '84302', '4357235248', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, NULL, 0, 0, 'Brigham City Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1962539452', 0, 'N', 0, '2011-03-10', NULL, NULL, 41.4888, -112.026, NULL, NULL),
('870283576', 'S77001547', 'S77001547', 'UT01', 'Excel Eye Center of American Fork', 'Jesse', 'N', 'Hunsaker', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '12 N 1100 E', 'American Fork', 'Utah', 'UT', '84003', '8017569627', NULL, '12 N 1100 E', 'American Fork', 'Utah', 'UT', '84003', '8017569627', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-06-01', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1104895507', 0, 'N', 0, '2013-07-03', NULL, NULL, 0, 0, NULL, NULL),
('870283576', 'S77001548', 'S77001548', 'UT01', 'Excel Eye Center of Delta', 'W', 'Scott', 'Lohner', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '140 S White Sage Ave', 'Delta', 'Millard', 'UT', '84624', '4358643333', NULL, '140 S White Sage Ave', 'Delta', 'Millard', 'UT', '84624', '4358643333', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-06-01', '2010-07-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992764187', 0, 'N', 0, '2013-07-03', NULL, NULL, 0, 0, NULL, NULL),
('870283576', 'S77001549', 'S77001549', 'UT01', 'Excel Eye Center of Mount Pleasant', 'Matthew', 'R', 'Parsons', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1100 S Medical Dr', 'Mount Pleasant', 'Sanpete', 'UT', '84647', '4354622441', NULL, '1100 S Medical Dr', 'Mount Pleasant', 'Sanpete', 'UT', '84647', '4354622441', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-06-01', '2010-07-14', 0, 0, 0, 'Central Valley Medical Center', '', '', '', 'HCFA|UB|', '1063483071', 0, 'N', 0, '2013-08-16', NULL, NULL, 0, 0, NULL, NULL),
('870283576', 'S77001550', 'S77001550', 'UT01', 'Excel Eye Center of Payson', 'James', 'G', 'Theurer', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1172 E 100 N Ste 4', 'Payson', 'Utah', 'UT', '84651', '8014652575', NULL, '1172 E 100 N Ste 4', 'Payson', 'Utah', 'UT', '84651', '8014652575', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-06-01', '2010-07-14', 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1083685101', 0, 'N', 0, '2013-08-26', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001553', 'S77001553', 'UT01', 'Central Utah Clinic', 'Curtis', 'C', 'Johnson', 'MD', 'Hand Surgery', 'Orthopedic Surgery', '', NULL, 'O', '700 W 800 N Ste 100', 'Orem', 'Utah', 'UT', '84057', '8012245373', NULL, '700 W 800 N Ste 100', 'Orem', 'Utah', 'UT', '84057', '8012245373', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-06-01', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', 'Mountain View Hospital', '', '', 'HCFA|UB|', '1205939089', 0, 'N', 0, '2013-12-10', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001554', 'S77001554', 'UT01', 'Central Utah Clinic', 'Kirt', 'M', 'Kimball', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '700 W 800 N Ste 100', 'Orem', 'Utah', 'UT', '84057', '8012245373', NULL, '700 W 800 N Ste 100', 'Orem', 'Utah', 'UT', '84057', '8012245373', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-06-01', '2010-07-14', 0, 0, 0, 'Mountain View Hospital', 'Timpanogos Regional Hospital', '', '', 'HCFA|UB|', '1548363419', 0, 'N', 0, '2014-01-24', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001555', 'S77001555', 'UT01', 'Central Utah Clinic', 'Mitchell', 'W', 'Larsen', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1055 N 500 W Ste 121', 'Provo', 'Utah', 'UT', '84604', '8013577350', NULL, '1055 N 500 W Ste 121', 'Provo', 'Utah', 'UT', '84604', '8013577350', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-06-01', '2010-07-14', 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1205928546', 0, 'N', 0, '2014-01-28', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001556', 'S77001556', 'UT01', 'Central Utah Clinic', 'Mitchell', 'W', 'Larsen', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '50 S Medical Dr Ste 6', 'Payson', 'Utah', 'UT', '84651', '8014652527', NULL, '50 S Medical Dr Ste 6', 'Payson', 'Utah', 'UT', '84651', '8014652527', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-06-01', '2010-07-14', 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1205928546', 0, 'N', 0, '2014-01-28', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001557', 'S77001557', 'UT01', 'Central Utah Clinic PC-Radiology', 'Brent', 'T', 'Layton', 'MD', 'Radiologist', NULL, NULL, NULL, 'O', '852 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8018124624', '8018124699', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-03-01', 0, NULL, 0, 'Mountain View Hospital', 'Timpanogos Regional Hospital', NULL, NULL, 'HCFA|UB|', '1346286317', 0, 'y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001558', 'S77001558', 'UT01', 'Central Utah Clinic', 'Devon', 'A', 'Nelson', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '1055 N 500 W Ste 121', 'Provo', 'Utah', 'UT', '84604', '8013577350', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1235232307', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001559', 'S77001559', 'UT01', 'Central Utah Clinic', 'Devon', 'A', 'Nelson', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'B', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013742362', '8013742615', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1235232307', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001561', 'S77001561', 'UT01', 'Central Utah Clinic', 'Devon', 'A', 'Nelson', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '50 S Medical Dr', 'Payson', 'Utah', 'UT', '84651', '8014652527', NULL, '50 S Medical Dr', 'Payson', 'Utah', 'UT', '84651', '8014652527', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-06-01', '2010-07-14', 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1235232307', 0, 'N', 0, '2013-11-04', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001563', 'S77001563', 'UT01', 'Central Utah Clinic', 'McKay', 'L', 'Platt', 'MD', 'Urology', NULL, NULL, NULL, 'B', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013742362', '8013742615', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1336230085', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001565', 'S77001565', 'UT01', 'Central Utah Clinic', 'Ryan', 'A', 'Richards', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1055 N 500 W Ste 121', 'Provo', 'Utah', 'UT', '84604', '8013577350', NULL, '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013577350', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-06-01', '2010-07-14', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1427149178', 0, 'N', 0, '2011-04-08', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001566', 'S77001566', 'UT01', 'Central Utah Clinic', 'Mohammad', 'M', 'Alsolaiman', 'MD', 'Gastroenterology', '', '', NULL, 'O', '1055 N 500 W Bldg B Ste 100', 'Provo', 'Utah', 'UT', '84604', '8013742362', '8014290629', '1055 N 500 W Bldg B Ste 100', 'Provo', 'Utah', 'UT', '84604', '8013742362', '8014290629', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-06-01', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1215986484', 0, 'N', 0, '2013-08-27', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001567', 'S77001567', 'UT01', 'Central Utah Clinic', 'Ronald', 'W', 'Asay', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013734366', '8014290629', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1578521308', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001568', 'S77001568', 'UT01', 'Central Utah Clinic', 'C William', NULL, 'Bacon', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '1055 N 500 W Ste 121', 'Provo', 'Utah', 'UT', '84604', '8013577350', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1962505750', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001571', 'S77001571', 'UT01', 'Central Utah Clinic', 'David', 'F', 'Bennion', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'B', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013742362', '8013742615', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1255435244', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001572', 'S77001572', 'UT01', 'Central Utah Clinic', 'Scott', 'Eugene', 'Bingham', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013734366', '8014290629', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, 'Timpanogos Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1487612214', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12002567', 'W12002567', 'UT01', 'Central Utah Clinic', 'Alan', 'L', 'Colledge', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '680 W 800 N', 'Orem', 'Utah', 'UT', '84057', '8012245373', NULL, '680 W 800 N', 'Orem', 'Utah', 'UT', '84057', '8012245373', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-07-15', '2011-02-28', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1629169370', 0, 'N', 0, '2013-12-10', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001575', 'S77001575', 'UT01', 'Central Utah Clinic', 'Gregory', 'E', 'Craner', 'MD', 'Gastroenterology', NULL, NULL, NULL, 'O', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013741268', '8014290629', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832422', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001576', 'S77001576', 'UT01', 'Central Utah Clinic', 'Peter', NULL, 'Duros', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '702 W 800 N', 'Orem', 'Utah', 'UT', '84057', '8012218811', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1669498119', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001577', 'S77001577', 'UT01', 'Wasatch Otolaryngology Group', 'Bradford', 'Kelly', 'Ence', 'MD', 'Ear, Nose and Throat', NULL, NULL, NULL, 'O', '700 W 800 N Ste 230', 'Orem', 'Utah', 'UT', '84057', '8014290620', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-03-01', 0, NULL, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1588766299', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001578', 'S77001578', 'UT01', 'Central Utah Clinic', 'Jonathan', 'R', 'Faux', 'MD', 'Orthopedic Surgery', 'Foot and Ankle', NULL, NULL, 'B', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013742362', '8013742615', '1055 N 500 W', 'Provo', '', 'UT', '84604', '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 6, '2000-01-01', '2000-01-01', 0, NULL, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1538250287', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001580', 'S77001580', 'UT01', 'Central Utah Clinic', 'Stanley', 'W', 'Green', 'MD', 'Radiologist', NULL, NULL, NULL, 'O', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8018124624', '8014290629', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, 'Timpanogos Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1184610065', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870283830', 'S77001581', 'S77001581', 'UT01', 'Intermountain Allergy', 'Brent', 'R', 'Burdett', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '1682 E 5600 S', 'Ogden', 'Weber', 'UT', '84403', '8014760052', NULL, '1682 E 5600 S', 'Ogden', 'Weber', 'UT', '844034374', '8014760052', '          ', 'WiseSTD6A', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', '2010-08-31', NULL, 0, NULL, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1750383097', 0, 'N', 0, '2010-11-16', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'S77001586', 'S77001586', 'UT01', 'Granger Medical Clinic', 'Brandon', 'R', 'Allen', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '2751 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8013525900', NULL, '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8013525900', '', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, NULL, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1952333106', 0, 'N', 0, '2011-07-06', NULL, NULL, 40.5878, -111.959, NULL, NULL),
('870284475', 'S77001587', 'S77001587', 'UT01', 'Granger Medical Clinic', 'Dana', 'A', 'Andersen', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 70658', 'West Valley', 'Salt Lake', 'UT', '84170', NULL, NULL, '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '', '', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, NULL, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1578595724', 0, 'Y', 0, '2011-07-01', NULL, NULL, 0, 0, NULL, NULL),
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('870284475', 'S77001631', 'S77001631', 'UT01', 'Granger Medical Clinic', 'Kristin', 'A', 'Lynch', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653600', '8019683605', NULL, NULL, '', NULL, NULL, '', '', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-08-01', '2007-02-22', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1588602320', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'S77001632', 'S77001632', 'UT01', 'Granger Medical Clinic', 'Kristin', 'A', 'Lynch', 'MD', 'Pediatrics', NULL, NULL, NULL, 'B', 'PO Box 70658', 'West Valley', 'Salt Lake', 'UT', '84170', NULL, NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-08-01', '2007-02-22', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1588602320', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'S77001633', 'S77001633', 'UT01', 'Granger Medical Clinic', 'Karen', 'A', 'Nash', 'NP', 'Pediatrics', '', '', NULL, 'O', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653448', '8019683605', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653448', '8019683605', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, NULL, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1770514127', 0, 'N', 0, '2011-06-29', NULL, NULL, 40.682, -111.979, NULL, NULL),
('870284475', 'S77001634', 'S77001634', 'UT01', 'Granger Medical Clinic', 'Karen', 'A', 'Nash', 'NP', 'Pediatrics', '', '', NULL, 'B', 'PO Box 70658', 'West Valley', 'Salt Lake', 'UT', '84170', '8019653720', '8019653740', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653720', '8019653740', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, NULL, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1770514127', 0, 'Y', 0, '2011-06-29', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'S77001635', 'S77001635', 'UT01', 'Granger Medical Clinic', 'Deborah', '', 'Plasman-Coles', 'PA', 'Gastroenterology', NULL, NULL, NULL, 'O', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653425', '8019683605', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653425', '8019683605', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, NULL, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1083645469', 0, 'N', 0, '2011-06-29', NULL, NULL, 40.682, -111.979, NULL, NULL),
('870284475', 'S77001636', 'S77001636', 'UT01', 'Granger Medical Clinic', 'Mindy', '', 'Ruhlman', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 70658', 'West Valley', 'Salt Lake', 'UT', '84170', '          ', NULL, 'PO Box 70658', 'West Valley', 'Salt Lake', 'UT', '84170', '          ', '          ', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-08-01', '2012-07-31', 0, 0, 0, 'Pioneer Valley Hospital', 'Jordan Valley Medical Center', '', '', 'HCFA|UB|', '1164453536', 0, 'Y', 0, '2014-01-27', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'S77001637', 'S77001637', 'UT01', 'Granger Medical Clinic', 'Kenneth', 'L', 'Schaecher', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653419', '8019683605', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653419', '8019683605', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, NULL, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1245262492', 0, 'N', 0, '2011-07-21', NULL, NULL, 40.682, -111.979, NULL, NULL),
('870281299', 'S77001638', 'S77001638', 'UT01', 'Lehi Clinic', 'Daniel', 'W', 'Egan', 'MD', 'Family Practice', '', '', NULL, 'O', '680 E Main St Ste 100', 'Lehi', 'Utah', 'UT', '84043', '8017681699', '8017684526', '680 E Main St Ste 100', 'Lehi', 'Utah', 'UT', '84043', '8017681699', '8017684526', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', '2008-06-30', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1417066564', 0, 'N', 0, '2013-08-13', NULL, NULL, 0, 0, NULL, NULL),
('870281299', 'S77001641', 'S77001641', 'UT01', 'American Fork Clinic', 'K Joe', NULL, 'Murdock', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '226 N 1100 E Ste A', 'American Fork', 'Utah', 'UT', '84003', '8018553841', '8018553847', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1053429563', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281942', 'S77001643', 'S77001643', 'UT01', 'Brigham Medical Clinic', 'Thomas', 'M', 'Matthews', 'MD', 'Family Practice', '', '', NULL, 'O', '600 W Hospital Rd', 'Brigham City', 'Box Elder', 'UT', '84302', '4357342041', '4357238028', '600 W Hospital Rd', 'Brigham City', 'Box Elder', 'UT', '84302', '4357342041', '4357238028', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Brigham City Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1144331711', 0, 'N', 0, '2013-11-21', NULL, NULL, 41.4905, -112.025, NULL, NULL),
('870281942', 'S77001644', 'S77001644', 'UT01', 'Brigham Medical Clinic', 'James', 'R', 'Taylor', 'MD', 'Family Practice', '', '', NULL, 'O', '600 W Hospital Rd', 'Brigham City', 'Box Elder', 'UT', '84302', '4357342041', '4357238028', '600 W Hospital Rd', 'Brigham City', 'Box Elder', 'UT', '84302', '4357342041', '4357238028', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Brigham City Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1215048335', 0, 'N', 0, '2013-11-06', NULL, NULL, 41.4905, -112.025, NULL, NULL),
('870281942', 'S77001645', 'S77001645', 'UT01', 'Brigham Medical Clinic', 'David', 'G', 'Wilding', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 719', 'Brigham City', 'Box Elder', 'UT', '84302', '4357342041', '4357238028', 'PO Box 719', 'Brigham City', 'Box Elder', 'UT', '84302', '4357342041', '4357238028', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Brigham City Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1740391226', 0, 'Y', 0, '2013-12-02', NULL, NULL, 0, 0, NULL, NULL),
('870281942', 'S77001646', 'S77001646', 'UT01', 'Brigham Medical Clinic', 'Gregg', 'H', 'Wilding', 'MD', 'Family Practice', '', '', NULL, 'O', '600 W Hospital Rd', 'Brigham City', 'Box Elder', 'UT', '84302', '4357342041', '4357238028', '600 W Hospital Rd', 'Brigham City', 'Box Elder', 'UT', '84302', '4357342041', '4357238028', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Brigham City Community Hospital', '', '', '', 'HCFA|UB|', '1881705424', 0, 'N', 0, '2014-05-01', NULL, NULL, 41.4905, -112.025, NULL, NULL),
('870283576', 'S77001648', 'S77001648', 'UT01', 'Excel Eye Center', 'Michael', 'S', 'Abrams', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '700 W 800 N Ste 160', 'Orem', 'Utah', 'UT', '84057', '8014269800', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1750325635', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870283576', 'S77001649', 'S77001649', 'UT01', 'Excel Eye Center of Mount Pleasant', 'W', 'Scott', 'Lohner', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '1100 S Medical Dr', 'Mount Pleasant', 'Sanpete', 'UT', '84647', '4354622441', NULL, '1100 S Medical Dr', 'Mount Pleasant', 'Sanpete', 'UT', '84647', '4354622441', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-06-01', '2010-07-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992764187', 0, 'N', 0, '2013-07-03', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001652', 'S77001652', 'UT01', 'Central Utah Clinic', 'Martin', 'M', 'Lee', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013742362', '8014290629', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013742362', '8014290629', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-06-01', '2010-07-14', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1013937663', 0, 'N', 0, '2011-04-13', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001654', 'S77001654', 'UT01', 'Central Utah Clinic', 'Kent', 'G', 'Marshall', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'B', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013742362', '8013742615', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1962422543', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001655', 'S77001655', 'UT01', 'Central Utah Clinic', 'Susan', NULL, 'Maturlo', 'MD', 'Endocrinology', NULL, NULL, NULL, 'O', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013742362', '8014290629', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1023076460', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001656', 'S77001656', 'UT01', 'Central Utah Clinic', 'Bartley', 'B', 'Mortensen', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1055 N 500 W Ste 102', 'Provo', 'Utah', 'UT', '84604', '8014290610', '8014290629', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8014290610', '8014290629', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-06-01', '2010-07-14', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1659473361', 0, 'N', 0, '2011-04-08', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001660', 'S77001660', 'UT01', 'Central Utah Clinic', 'Devon', 'A', 'Nelson', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '700 W 800 N Ste 100', 'Orem', 'Utah', 'UT', '84057', '8012245373', NULL, '700 W 800 N Ste 100', 'Orem', 'Utah', 'UT', '84057', '8012245373', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-06-01', '2010-07-14', 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1235232307', 0, 'N', 0, '2013-11-04', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001661', 'S77001661', 'UT01', 'Central Utah Clinic', 'Lawrence', 'K', 'Nobuhara', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013742362', '8014290629', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013742362', '8014290629', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-06-01', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1740399385', 0, 'N', 0, '2014-04-07', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001663', 'S77001663', 'UT01', 'Central Utah Clinic', 'Paul', 'K', 'Ritchie', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1184 E 80 N', 'American Fork', 'Utah', 'UT', '84003', '8017633885', NULL, '1184 E 80 N', 'American Fork', 'Utah', 'UT', '84003', '8017633885', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-06-01', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1720021678', 0, 'N', 0, '2014-02-25', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001664', 'S77001664', 'UT01', 'Central Utah Clinic', 'Mark', NULL, 'Sanderson', 'MD', 'Plastic Surgery', NULL, NULL, NULL, 'B', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013742362', '8013742615', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1073604609', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'S77001666', 'S77001666', 'UT01', 'Granger Medical Clinic', 'Jennifer', 'L', 'Scheid', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'B', 'PO Box 70658', 'West Valley', 'Salt Lake', 'UT', '84170', '8019653720', '8019653740', NULL, NULL, '', NULL, NULL, '', '', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-08-01', '2007-02-22', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '929935', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'S77001667', 'S77001667', 'UT01', 'Granger Medical Clinic', 'Lori', 'R', 'Swenson', 'MD', 'General Surgery', '', '', NULL, 'O', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653425', '8019683605', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653425', '8019683605', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', '2008-02-18', NULL, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1972534279', 0, 'N', 0, '2011-09-29', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'S77001668', 'S77001668', 'UT01', 'Granger Medical Clinic', 'Paula', 'G', 'Thacker', 'CNM', 'Obstetrics and Gynecology', 'Nurse Midwife', '', NULL, 'B', 'PO Box 70658', 'West Valley', 'Salt Lake', 'UT', '84170', '          ', NULL, 'PO Box 70658', 'West Valley', 'Salt Lake', 'UT', '84170', '          ', '          ', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-08-01', '2012-08-13', 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1205867553', 0, 'Y', 0, '2012-08-20', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'S77001669', 'S77001669', 'UT01', 'Granger Medical Clinic', 'Virginia', '', 'Vierra', 'MD', 'Pediatrics', '', '', NULL, 'O', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653448', '8019683605', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653448', '8019683605', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', '2008-08-28', NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1437181682', 0, 'N', 0, '2012-01-25', NULL, NULL, 0, 0, NULL, NULL);
