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
('870617263', 'S77009470', 'S77009470', 'UT01', 'St Marks Family Medicine', 'John', 'A', 'Berneike', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '1250 E 3900 S Ste 260', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012652000', '8012652008', '1250 E 3900 S Ste 260', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012652000', '8012652008', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2006-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982688321', 0, 'N', 0, '2012-02-07', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('870617263', 'S77009473', 'S77009473', 'UT01', 'St Marks Family Medicine', 'L Brett', NULL, 'Grandy', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '1250 E 3900 S Ste 260', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012652000', '8012652008', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870617391', 'S77009476', 'S77009476', 'UT01', 'Primary Care Pediatrics', 'Nina', 'G', 'Jorgensen', 'MD', 'Pediatrics', NULL, NULL, NULL, 'B', '2380 N 400 E Ste C', 'Logan', 'Cache', 'UT', '84341', '4357537337', '4357506779', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1013973031', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870617733', 'S77009477', 'S77009477', 'UT01', 'Bountiful Hills Eye Center', 'John', 'D', 'Armstrong', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1551 S Renaissance Towne Dr Ste 340', 'Bountiful', 'Davis', 'UT', '84010', '8016771122', NULL, '1551 S Renaissance Towne Dr Ste 340', 'Bountiful', 'Davis', 'UT', '84010', '8016771122', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-10-01', '2011-11-14', 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1932188133', 0, 'N', 0, '2014-02-26', NULL, NULL, 0, 0, NULL, NULL),
('870617733', 'S77009478', 'S77009478', 'UT01', 'Utah Eye Centers', 'Mark', 'S', 'Ballif', 'MD', 'Ophthalmology', '', '', NULL, 'B', 'PO Box 1529', 'Layton', 'Davis', 'UT', '84041', '8015933223', '8015939626', 'PO Box 1529', 'Layton', 'Davis', 'UT', '84041', '8015933223', '8015939626', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-10-01', NULL, 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB|', '1376522573', 0, 'Y', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('870617733', 'S77009479', 'S77009479', 'UT01', 'Utah Eye Centers', 'Dane', 'F', 'Dansie', 'OD', 'Optometry', '', '', NULL, 'O', '4360 Washington Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014760494', NULL, '4360 Washington Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014760494', '          ', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-10-01', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1770562985', 0, 'N', 0, '2014-01-06', NULL, NULL, 41.1826, -111.971, NULL, NULL),
('870617733', 'S77009481', 'S77009481', 'UT01', 'Utah Eye Centers', 'Keith', 'W', 'Linford', 'OD', 'Optometry', NULL, NULL, NULL, 'O', '4360 Washington Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014760494', NULL, '4360 Washington Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014760494', '          ', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-10-01', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1275512493', 0, 'N', 0, '2013-11-18', NULL, NULL, 41.1826, -111.971, NULL, NULL),
('870617733', 'S77009482', 'S77009482', 'UT01', 'Utah Eye Centers', 'Keith', 'W', 'Linford', 'OD', 'Optometry', NULL, NULL, NULL, 'B', 'PO Box 1529', 'Layton', 'Davis', 'UT', '84041', '8015933223', '8015939626', 'PO Box 1529', 'Layton', 'Davis', 'UT', '84041', '8015933223', '8015939626', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-10-01', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1275512493', 0, 'Y', 0, '2013-11-18', NULL, NULL, 0, 0, NULL, NULL),
('870617733', 'S77009483', 'S77009483', 'UT01', 'Utah Eye Centers', 'Bhupendra', 'C', 'Patel', 'MD', 'Ophthalmology', 'Oculoplastic Surgery', '', NULL, 'O', '4360 Washington Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014760494', NULL, '4360 Washington Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014760494', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-10-01', NULL, 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1366436412', 0, 'N', 0, '2014-06-23', NULL, NULL, 41.1826, -111.971, NULL, NULL),
('870617733', 'S77009484', 'S77009484', 'UT01', 'Utah Eye Centers', 'Michael', 'B', 'Wilcox', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '1551 S Renaissance Towne Dr Ste 340', 'Bountiful', 'Davis', 'UT', '84010', '8016771122', NULL, '1551 S Renaissance Towne Dr Ste 340', 'Bountiful', 'Davis', 'UT', '84010', '8016771122', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-10-01', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053391771', 0, 'N', 0, '2013-08-13', NULL, NULL, 40.8737, -111.888, NULL, NULL),
('870618776', 'S77009486', 'S77009486', 'UT01', 'Gamma West Brachytherapy', 'Roger', 'S', 'Hansen', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '425 E 5350 S Ste 180', 'Ogden', 'Weber', 'UT', '84405', '8014754571', '8014756119', '425 E 5350 S Ste 180', 'Ogden', 'Weber', 'UT', '84405', '8014754571', '8014756119', 'WUSTDRONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1811036478', 0, 'N', 0, '2014-01-17', NULL, NULL, 41.166, -111.97, NULL, NULL),
('870618776', 'S77009487', 'S77009487', 'UT01', 'Gamma West Brachytherapy Orem', 'Roger', 'S', 'Hansen', 'MD', 'Radiation Oncology', NULL, NULL, NULL, 'O', '674 W 800 N Ste B 10', 'Orem', 'Utah', 'UT', '84057', '8018520210', '8018520215', '24 S 1100 E', 'Salt Lake City', '', 'UT', '84102', '', '', 'WUSTDRONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1811036478', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870618776', 'S77009488', 'S77009488', 'UT01', 'Gamma West Brachytherapy Orem', 'Roger', 'S', 'Hansen', 'MD', 'Radiation Oncology', NULL, NULL, NULL, 'B', 'PO Box 25213', 'Salt Lake City', 'Salt Lake', 'UT', '84125', '8014754571', '8014756119', '24 S 1100 E', 'Salt Lake City', '', 'UT', '84102', '', '', 'WUSTDRONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1811036478', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870618776', 'S77009489', 'S77009489', 'UT01', 'Gamma West Brachytherapy', 'Robert', 'A', 'Harris', 'MD', 'Radiation Oncology', NULL, NULL, NULL, 'B', 'PO Box 25213', 'Salt Lake City', 'Salt Lake', 'UT', '84125', '8014754571', '8014756119', 'PO Box 25213', 'Salt Lake City', 'Salt Lake', 'UT', '84125', '8014754571', '8014756119', 'WUSTDRONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1144369752', 0, 'Y', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('870618776', 'S77009490', 'S77009490', 'UT01', 'Gamma West Brachytherapy', 'John', 'K', 'Hayes', 'MD', 'Radiation Oncology', NULL, NULL, NULL, 'O', '425 E 5350 S Ste 180', 'Ogden', 'Weber', 'UT', '84405', '8014754571', '8014756119', '24 S 1100 E', 'Salt Lake City', '', 'UT', '84102', '', '', 'WUSTDRONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, 'Ogden Regional Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1275672933', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870618776', 'S77009492', 'S77009492', 'UT01', 'Gamma West Brachytherapy', 'Charles', 'L', 'Rogers', 'MD', 'Radiation Oncology', NULL, NULL, NULL, 'O', '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013508400', '8013504021', '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013508400', '8013504021', 'WUSTDRONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1609915289', 0, 'N', 0, '2012-06-18', NULL, NULL, 40.7694, -111.861, NULL, NULL),
('870618776', 'S77009493', 'S77009493', 'UT01', 'Gamma West Brachytherapy', 'Charles', 'L', 'Rogers', 'MD', 'Radiation Oncology', NULL, NULL, NULL, 'O', '674 W 800 N Ste B 10', 'Orem', 'Utah', 'UT', '84057', '8018520210', '8018520215', '24 S 1100 E', 'Salt Lake City', '', 'UT', '84102', '', '', 'WUSTDRONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, 'Ogden Regional Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1609915289', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870618776', 'S77009494', 'S77009494', 'UT01', 'Gamma West Brachytherapy Orem', 'Jeremy', 'D', 'Spearman', 'PA', 'Radiation Oncology', NULL, NULL, NULL, 'B', 'PO Box 25213', 'Salt Lake City', 'Salt Lake', 'UT', '84125', '8014754571', '8014756119', '24 S 1100 E', 'Salt Lake City', '', 'UT', '84102', '', '', 'WUSTDRONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832599', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870621939', 'S77009519', 'S77009519', 'UT01', 'Alpine Womens Clinic', 'Deborah', 'H', 'Himes', 'NP', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '48 N 1100 E Ste A', 'American Fork', 'Utah', 'UT', '84003', '8017565826', NULL, '48 N 1100 E', 'American Fork', '', 'UT', '84003', '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', '2010-04-15', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1982890745', 0, 'N', 0, '2006-10-17', NULL, NULL, 0, 0, NULL, NULL),
('870622307', 'S77009520', 'S77009520', 'UT01', '', 'Janet', 'K', 'Harnsberger', 'MD', 'Pediatric Gastroenterology', NULL, NULL, NULL, 'O', '5770 S 250 E Ste 330', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8013144444', NULL, '5770 S 250 E Ste 330', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8013144444', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', '2012-07-06', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811992928', 0, 'N', 0, '2012-09-05', NULL, NULL, 0, 0, NULL, NULL),
('870622307', 'S77009521', 'S77009521', 'UT01', 'Pediatric Gastroenterology & Nutrition', 'Louis', 'L', 'Mizell', 'MD', 'Pediatric Gastroenterology', NULL, NULL, NULL, 'O', '5770 S 250 E Ste 330', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8013144444', NULL, '5770 S 250 E Ste 330', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8013144444', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', '2012-07-08', 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1851396964', 0, 'N', 0, '2013-08-07', NULL, NULL, 0, 0, NULL, NULL),
('870622942', 'S77009524', 'S77009524', 'UT01', 'Utah Imaging Associates', 'Paul', '', 'Asmar', 'MD', 'Radiologist', NULL, NULL, NULL, 'B', 'PO Box 1369', 'Bountiful', 'Davis', 'UT', '84011', '8012962113', '8012961715', 'PO Box 1369', 'Bountiful', 'Davis', 'UT', '84011', '8012962113', '8012961715', 'WUUTIMAGE5', NULL, NULL, '0.00', '35.00', '0.00', 3, '2006-04-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1184626756', 0, 'Y', 0, '2011-03-24', NULL, NULL, 0, 0, NULL, NULL),
('870622942', 'S77009525', 'S77009525', 'UT01', 'Utah Imaging Associates', 'Robert', 'M', 'Bell', 'MD', 'Radiologist', NULL, NULL, NULL, 'B', 'PO Box 1369', 'Bountiful', 'Davis', 'UT', '84011', '8012962113', '8012961715', 'PO Box 1369', 'Bountiful', 'Davis', 'UT', '84011', '8012962113', '8012961715', 'WUUTIMAGE5', NULL, NULL, '0.00', '35.00', '0.00', 3, '2006-04-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1831199918', 0, 'Y', 0, '2012-08-03', NULL, NULL, 0, 0, NULL, NULL),
('870622942', 'S77009526', 'S77009526', 'UT01', 'Utah Imaging Associates', 'John', 'V', 'Catasca', 'MD', 'Radiologist', NULL, NULL, NULL, 'B', 'PO Box 1369', 'Bountiful', 'Davis', 'UT', '84011', '8012962113', '8012961715', 'PO Box 1369', 'Bountiful', 'Davis', 'UT', '84011', '8012962113', '8012961715', 'WUUTIMAGE5', '', '', '0.00', '35.00', '0.00', 3, '2006-04-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1376542548', 0, 'Y', 0, '2013-06-04', NULL, NULL, 0, 0, NULL, NULL),
('870622942', 'S77009527', 'S77009527', 'UT01', 'Utah Imaging Associates', 'Hannah', 'L', 'Chung', 'MD', 'Diagnostic Radiology', 'Radiologist', '', NULL, 'B', 'PO Box 1369', 'Bountiful', 'Davis', 'UT', '84011', '8012962113', '8012961715', 'PO Box 1369', 'Bountiful', '', 'UT', '84011', '', '', 'WUUTIMAGE5', NULL, NULL, '0.00', '35.00', '0.00', 3, '2006-04-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1780683508', 0, 'Y', 0, '2009-04-03', NULL, NULL, 0, 0, NULL, NULL),
('870622942', 'S77009528', 'S77009528', 'UT01', 'Utah Imaging Associates', 'Paul', 'R', 'Jensen', 'MD', 'Radiologist', NULL, NULL, NULL, 'B', 'PO Box 1369', 'Bountiful', 'Davis', 'UT', '84011', '8012962113', '8012961715', 'PO Box 1369', 'Bountiful', 'Davis', 'UT', '84011', '8012962113', '8012961715', 'WUUTIMAGE5', NULL, NULL, '0.00', '35.00', '0.00', 3, '2006-04-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1528049335', 0, 'Y', 0, '2013-04-15', NULL, NULL, 0, 0, NULL, NULL),
('870623071', 'S77009534', 'S77009534', 'UT01', 'City Creek Internal Medicine', 'Nandita', 'C', 'Gupta', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '324 10th Ave Ste 160', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8014085151', NULL, '324 10th Ave', 'Salt Lake City', '', 'UT', '84103', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', '2010-01-01', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1801862255', 0, 'N', 0, '2006-12-11', NULL, NULL, 0, 0, NULL, NULL),
('870623071', 'S77009535', 'S77009535', 'UT01', 'City Creek Internal Medicine', 'Ann', '', 'Jefferds', 'MD', 'Internal Medicine', 'Pulmonary', NULL, NULL, 'O', '324 10th Ave Ste 285', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8014085151', NULL, '324 10th Ave Ste 285', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8014085151', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386691558', 0, 'N', 0, '2013-04-09', NULL, NULL, 40.7808, -111.88, NULL, NULL),
('870626821', 'S77009549', 'S77009549', 'UT01', NULL, 'Scott', 'Brett', 'Humpherys', 'DPM', 'Podiatry', '', '', NULL, 'B', '368 N 780 E', 'Lindon', 'Utah', 'UT', '84042', '8013675183', NULL, '368 N 780 E', 'Lindon', 'Utah', 'UT', '84042', '8013675183', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275647596', 0, 'Y', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('870629690', 'S77009552', 'S77009552', 'UT01', 'Epic', 'James', NULL, 'Antinori', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'B', 'PO Box 96398', 'Oklahoma', 'Oklahoma', 'OK', '73143', NULL, NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834181', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870629690', 'S77009553', 'S77009553', 'UT01', 'Epic', 'Jonathan', NULL, 'Appelbaum', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504111', NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834676', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870629690', 'S77009554', 'S77009554', 'UT01', 'Davis Hospital & Medical Center', 'Jonathan', NULL, 'Appelbaum', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8018259561', NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834676', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870629690', 'S77009555', 'S77009555', 'UT01', 'Ogden Regional Medical Center', 'Jonathan', NULL, 'Appelbaum', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '5475 S 500 E', 'Ogden', 'Weber', 'UT', '84405', '8014792111', NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834676', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870629690', 'S77009556', 'S77009556', 'UT01', 'Epic', 'Jonathan', NULL, 'Appelbaum', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'B', 'PO Box 96398', 'Oklahoma', 'Oklahoma', 'OK', '73143', NULL, NULL, '370 E S Temple', 'Salt Lake City', '', 'UT', '84111', '', '', 'WCSTEPIC', NULL, NULL, '0.00', '30.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834676', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('870634650', 'S77009621', 'S77009621', 'UT01', 'OBGYN Associates', 'Vernon', 'K', 'Yamashiro', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1441 W Ute Blvd Ste 160', 'Park City', 'Summit', 'UT', '84098', '4352145335', NULL, '1441 W Ute Blvd Ste 160', 'Park City', 'Summit', 'UT', '84098', '4352145335', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', '2011-10-04', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1962417741', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('870634650', 'S77009622', 'S77009622', 'UT01', 'OBGYN Associates', 'Vernon', 'K', 'Yamashiro', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1151 E 3900 S Ste B 299', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012686811', '8012688673', '1151 E 3900 S Ste B 299', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012686811', '8012688673', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1962417741', 0, 'N', 0, '2014-07-11', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('870635460', 'S77009625', 'S77009625', 'UT01', 'Comfort Care Pediatrics', 'Rita', 'K', 'Fox', 'MD', 'Pediatrics', '', '', NULL, 'O', '4546 S 815 W Ste 204', 'Taylorsville', 'Salt Lake', 'UT', '84123', '8015958844', '8015951133', '4546 S 815 W Ste 204', 'Taylorsville', 'Salt Lake', 'UT', '84123', '8015958844', '8015951133', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1790969384', 0, 'N', 0, '2014-07-25', NULL, NULL, 40.6597, -111.924, NULL, NULL),
('870635530', 'S77009627', 'S77009627', 'UT01', 'Mount Olympus Obstetrics and Gynecology', 'Clayton', 'S', 'Wilde', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '1220 E 3900 S Ste 3E', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8016857188', NULL, '1220 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8016857188', '          ', 'Wise+', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2011-10-04', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1275586083', 0, 'N', 0, '2011-10-05', NULL, NULL, 0, 0, NULL, NULL),
('870635889', 'S77009628', 'S77009628', 'UT01', 'Tooele Clinic Corp', 'Melissa', '', 'Augustyn', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'B', '330 Franklin Rd Ste 135A', 'Brentwood', 'Williamson', 'TN', '37027', '6153457331', NULL, '196 E 2000 N', 'Tooele', 'Williamson', 'UT', '84074', '6153457331', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2008-08-29', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1619940590', 0, 'Y', 0, '2011-09-21', NULL, NULL, 0, 0, NULL, NULL),
('870636424', 'S77009631', 'S77009631', 'UT01', 'Grantsville Medical Clinic', 'Benjamin', 'J', 'Krogh', 'DO', 'Family Practice', NULL, NULL, NULL, 'O', '822 E Main St Ste 7', 'Grantsville', 'Tooele', 'UT', '84029', '4358843578', NULL, 'PO Box 1060', 'Grantsville', '', 'UT', '84029', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, NULL, 0, 0, 'Mountain West Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1013003540', 0, 'N', 0, '2006-11-30', NULL, NULL, 40.5996, -112.426, NULL, NULL),
('870637613', 'S77009632', 'S77009632', 'UT01', 'David C Seegmiller, DPM', 'David', 'C', 'Seegmiller', 'DPM', 'Podiatry', NULL, NULL, NULL, 'O', '3920 S 1100 E Ste 115', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8016857129', NULL, 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|', '1619914751', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870637613', 'S77009633', 'S77009633', 'UT01', NULL, 'David', 'C', 'Seegmiller', 'DPM', 'Podiatry', '', '', NULL, 'O', '508 E S Temple Ste 118', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8016717766', NULL, '3920 S 1100 E', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8016717766', '', '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|', '1619914751', 0, 'N', 0, '2012-01-23', NULL, NULL, 0, 0, NULL, NULL),
('870639098', 'S77009639', 'S77009639', 'UT01', 'After Hours Medical Company', 'Sean', 'P', 'Collins', 'NP', 'Urgent Care', NULL, NULL, NULL, 'B', 'PO Box 1000', 'Draper', 'Salt Lake', 'UT', '84020', '8013529500', '8013529502', 'PO Box 1000', 'Draper', 'Salt Lake', 'UT', '84020', '8013529500', '8013529502', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', '2008-11-01', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1174589105', 0, 'Y', 0, '2013-12-30', NULL, NULL, 0, 0, NULL, NULL),
('870639098', 'S77009640', 'S77009640', 'UT01', 'After Hours Medical Company', 'Eileen', '', 'Hyde', 'NP', 'Urgent Care', NULL, NULL, NULL, 'B', 'PO Box 1000', 'Draper', 'Salt Lake', 'UT', '84020', '8013529500', '8013529502', 'PO Box 1000', 'Draper', 'Salt Lake', 'UT', '84020', '8013529500', '8013529502', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', '2008-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467418483', 0, 'Y', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('870639098', 'S77009641', 'S77009641', 'UT01', 'After Hours Medical Company', 'Renee', 'J', 'Neff', 'NP', 'Urgent Care', NULL, NULL, NULL, 'B', 'PO Box 1000', 'Draper', 'Salt Lake', 'UT', '84020', '8013529500', '8013529502', 'PO Box 1000', 'Draper', 'Salt Lake', 'UT', '84020', '8013529500', '8013529502', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', '2008-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679520811', 0, 'Y', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('870639098', 'S77009642', 'S77009642', 'UT01', 'After Hours Urgent Care Draper', 'Rachot', '', 'Vacharathone', 'MD', 'Urgent Care', '', '', NULL, 'O', '1126 Draper Pkwy', 'Draper', 'Salt Lake', 'UT', '84020', '8015450600', NULL, '1126 Draper Pkwy', 'Draper', 'Salt Lake', 'UT', '84020', '8015450600', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', 'Pioneer Valley Hospital', '', '', 'HCFA|UB|', '1548228497', 0, 'Y', 0, '2014-05-30', NULL, NULL, 40.5284, -111.859, NULL, NULL),
('870641072', 'S77009665', 'S77009665', 'UT01', 'Parkway Pediatrics', 'Jimmy', 'L', 'Ryan', 'MD', 'Pediatrics', NULL, NULL, NULL, 'B', 'PO Box 1010', 'Riverton', 'Salt Lake', 'UT', '84065', '8012533500', '8012535859', 'PO Box 1010', 'Riverton', 'Salt Lake', 'UT', '84065', '8012533500', '8012535859', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1508800145', 0, 'Y', 0, '2012-05-31', NULL, NULL, 0, 0, NULL, NULL),
('870641300', 'S77009668', 'S77009668', 'UT01', 'Utah Hyperbaric Physicians', 'Tommy', NULL, 'Love', 'DO', 'Hyperbaric Medicine ', NULL, NULL, NULL, 'B', 'PO Box 96398', 'Oklahoma', 'Oklahoma', 'OK', '73143', '8002250953', '4056821586', NULL, NULL, '', NULL, NULL, '', '', 'WUEPIC5', 'WUSTDHCPC5', NULL, '0.00', '30.00', NULL, 3, '2007-01-01', '2007-03-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832571', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870642241', 'S77009673', 'S77009673', 'UT01', 'Northern Ut Gastro & Endoscopy Specialists', 'V', 'D', 'Bohman', 'MD', 'Gastroenterology', '', '', NULL, 'O', '630 E 1400 N', 'Logan', 'Cache', 'UT', '84341', '4357870270', '4357870262', '630 E 1400 N', 'Logan', 'Cache', 'UT', '84341', '4357870270', '4357870262', 'WiseSTD20', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2012-06-30', 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1336105360', 0, 'N', 0, '2014-04-14', NULL, NULL, 0, 0, NULL, NULL),
('870642984', 'S77009674', 'S77009674', 'UT01', 'InVision Eye Health', 'Brenden', 'R', 'White', 'OD', 'Optometry', NULL, NULL, NULL, 'O', '227 W 10000 S', 'Sandy', 'Salt Lake', 'UT', '84070', '8014952020', '8014952020', '227 W 10000 S', 'Sandy', 'Salt Lake', 'UT', '84070', '8014952020', '8014952020', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', '2011-10-06', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558357954', 0, 'N', 0, '2013-11-15', NULL, NULL, 0, 0, NULL, NULL),
('870643070', 'S77009675', 'S77009675', 'UT01', 'Circle of Life Womens Center', 'Darren', 'W', 'Housel', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '1525 E 6000 S', 'Ogden', 'Weber', 'UT', '84405', '8013375800', '8013375808', '1525 E 6000 S', 'Ogden', 'Weber', 'UT', '84405', '8013375800', '8013375808', '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|', '1023031507', 0, 'N', 0, '2012-06-20', NULL, NULL, 41.1543, -111.941, NULL, NULL),
('870643070', 'S77009676', 'S77009676', 'UT01', 'Circle of Life Womens Center', 'Jed', 'P', 'Naisbitt', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1525 E 6000 S', 'Ogden', 'Weber', 'UT', '84405', '8013375800', '8013375808', '1525 E 6000 S', 'Ogden', 'Weber', 'UT', '84405', '8013375800', '8013375808', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1487677613', 0, 'N', 0, '2014-03-27', NULL, NULL, 41.1543, -111.941, NULL, NULL),
('870643195', 'S77009677', 'S77009677', 'UT01', 'Cache Valley Womens Center', 'Gary', 'K', 'Fowers', 'MD', 'Obstetrics and Gynecology', 'Obstetrics and Gynecology', NULL, NULL, 'B', '1325 N 600 E Ste 102', 'Logan', 'Cache', 'UT', '84341', '4357539999', '4357532301', NULL, NULL, '', NULL, NULL, '', '', 'Wise+', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1457342818', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870643310', 'S77009678', 'S77009678', 'UT01', 'Allergy Clinics of Utah', 'Allan', 'Curtis', 'Edson', 'DO', 'Allergy and Immunology', 'Family Practice', NULL, NULL, 'O', '1492 S 800 W Ste J', 'Woods Cross', 'Davis', 'UT', '84087', '8012945224', '8012950311', '1492 S 800 W Ste J', 'Woods Cross', 'Davis', 'UT', '84087', '8012945224', '8012950311', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2013-09-30', 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1508811092', 0, 'N', 0, '2013-10-15', NULL, NULL, 0, 0, NULL, NULL),
('870643872', 'S77009686', 'S77009686', 'UT01', 'Intermountain Neurology Clinic', 'Jahan', '', 'Imani', 'MD', 'Neurology', 'Neuromuscular Disease & EMG', '', NULL, 'O', '6112 S 1550 E Ste 200', 'Ogden', 'Weber', 'UT', '84405', '8014757707', NULL, '6112 S 1550 E Ste 200', 'Ogden', 'Weber', 'UT', '84405', '8014757707', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2011-11-10', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1063414969', 0, 'N', 0, '2014-06-03', NULL, NULL, 0, 0, NULL, NULL),
('870644582', 'S77009687', 'S77009687', 'UT01', 'Wasatch Cardiology Consultants', 'David', 'Arthur', 'Rawling', 'MD', 'Cardiovascular Disease', 'Internal Medicine', NULL, NULL, 'B', '6011 S Redwood Rd', 'Murray', 'Salt Lake', 'UT', '84123', '8012937001', '8012939500', '6011 S Redwood Rd', 'Taylorsville', '', 'UT', '84123', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1750362844', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870646870', 'S77009725', 'S77009725', 'UT01', '', 'Douglas', 'C', 'Walker', 'DO', 'Family Practice', '', '', NULL, 'O', '300 W 1400 S', 'Garland', 'Box Elder', 'UT', '84312', '4352573684', '4352577554', '300 W 1400 S', 'Garland', 'Box Elder', 'UT', '84312', '4352573684', '4352577554', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Bear River Valley Hospital', '', '', '', 'HCFA|UB|', '1821095142', 0, 'N', 0, '2014-07-25', NULL, NULL, 41.7264, -112.158, 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
('870647799', 'S77009726', 'S77009726', 'UT01', NULL, 'Wayne', 'E', 'Smith', 'MD', 'Dermatology', NULL, NULL, NULL, 'O', '5333 S Adams Ave Ste C', 'Washington Terrace', 'Weber', 'UT', '84405', '8014796200', NULL, '425 E 5350 S', 'Ogden', '', 'UT', '84405', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1164404497', 0, 'N', 0, '2006-08-31', NULL, NULL, 41.1664, -111.969, NULL, NULL),
('870649259', 'S77009740', 'S77009740', 'UT01', 'Alpine Orthopaedic Specialists', 'Michael', 'L', 'Clegg', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '2310 N 400 E Ste A', 'North Logan', 'Cache', 'UT', '84341', '4357872000', NULL, '2310 N 400 E Ste A', 'North Logan', 'Cache', 'UT', '84341', '4357872000', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Brigham City Community Hospital', 'Logan Regional Hospital', NULL, NULL, 'HCFA|UB|', '1679561708', 0, 'N', 0, '2014-01-21', NULL, NULL, 41.7738, -111.823, NULL, NULL),
('870649259', 'S77009741', 'S77009741', 'UT01', 'Alpine Orthopaedic Specialists', 'David', 'G', 'Edwards', 'DPM', 'Podiatry', '', '', NULL, 'O', '2310 N 400 E Ste A', 'North Logan', 'Cache', 'UT', '84341', '4357872000', NULL, '2310 N 400 E Ste A', 'North Logan', 'Cache', 'UT', '84341', '4357872000', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Brigham City Community Hospital', 'Logan Regional Hospital', NULL, NULL, 'HCFA|UB|', '1235125212', 0, 'N', 0, '2014-02-26', NULL, NULL, 41.7738, -111.823, NULL, NULL),
('870649259', 'S77009743', 'S77009743', 'UT01', 'Alpine Orthopaedic Specialists', 'David', 'G', 'Edwards', 'DPM', 'Podiatry', '', '', NULL, 'B', 'PO Box 6250', 'Logan', 'Cache', 'UT', '84341', '4357872000', NULL, 'PO Box 6250', 'Logan', 'Cache', 'UT', '84341', '4357872000', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Brigham City Community Hospital', 'Logan Regional Hospital', NULL, NULL, 'HCFA|UB|', '1235125212', 0, 'Y', 0, '2014-01-28', NULL, NULL, 0, 0, NULL, NULL),
('870649259', 'S77009744', 'S77009744', 'UT01', 'Alpine Orthopaedic Specialists', 'Terry', 'I', 'Finlayson', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 6250', 'Logan', 'Cache', 'UT', '84341', '4357872000', '', 'PO Box 6250', 'Logan', 'Cache', 'UT', '84341', '4357872000', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1316935539', 0, 'Y', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('870649259', 'S77009747', 'S77009747', 'UT01', 'Alpine Orthopaedic Specialists', 'Brad', 'J', 'Larson', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1930 S Hwy 89', 'Perry', 'Box Elder', 'UT', '84302', '4357872000', NULL, '1930 S Hwy 89', 'Perry', 'Box Elder', 'UT', '84302', '4357872000', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Brigham City Community Hospital', 'Logan Regional Hospital', NULL, NULL, 'HCFA|UB|', '1396733507', 0, 'N', 0, '2014-01-21', NULL, NULL, 41.4751, -112.025, NULL, NULL),
('870649259', 'S77009748', 'S77009748', 'UT01', 'Alpine Orthopaedic Specialists', 'Brad', 'J', 'Larson', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 6250', 'Logan', 'Cache', 'UT', '84341', '4357872000', NULL, 'PO Box 6250', 'Logan', 'Cache', 'UT', '84341', '4357872000', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Brigham City Community Hospital', 'Logan Regional Hospital', NULL, NULL, 'HCFA|UB|', '1396733507', 0, 'Y', 0, '2014-01-21', NULL, NULL, 0, 0, NULL, NULL),
('870649259', 'S77009749', 'S77009749', 'UT01', 'Bear Lake Community Health Center', 'Keith', 'J', 'Nelson', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '325 W Logan Hwy', 'Garden City', 'Rich', 'UT', '84028', '4357872000', NULL, 'PO Box 6250', 'Logan', 'Rich', 'UT', '84341', '4357872000', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, NULL, 0, 0, 'Brigham City Community Hospital', 'Logan Regional Hospital', NULL, NULL, 'HCFA|UB|', '1245229954', 0, 'N', 0, '2011-05-25', NULL, NULL, 41.9363, -111.394, NULL, NULL),
('870649642', 'S77009750', 'S77009750', 'UT01', 'Ear Technology', 'Ear Technology', NULL, NULL, 'GROUP', 'Audiology', NULL, NULL, NULL, 'O', '3955 Harrison Blvd Ste U7', 'Ogden', 'Weber', 'UT', '84403', '8013999955', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-08-01', '2006-08-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834795', 0, 'y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870649642', 'S77009751', 'S77009751', 'UT01', 'Eartech Audiology', 'Kerry', 'S', 'Braunberger', 'AUD', 'Audiology', '', '', NULL, 'O', '3955 Harrison Blvd Ste U7', 'Ogden', 'Weber', 'UT', '84403', '8013999955', '8013993144', '3955 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8013999955', '8013993144', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1710985965', 0, 'N', 0, '2010-11-29', NULL, NULL, 41.191, -111.949, NULL, NULL),
('870651047', 'S77009752', 'S77009752', 'UT01', 'Flegal Clinic', 'Douglas', 'Clark', 'Flegal', 'DPM', 'Podiatry', NULL, NULL, NULL, 'B', '740 E 3900 S Ste 108', 'Murray', 'Salt Lake', 'UT', '84107', '8012663113', NULL, '740 E 3900 S', 'Salt Lake City', '', 'UT', '84107', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1710955745', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870651355', 'S77009753', 'S77009753', 'UT01', 'Utah Valley Obstetrics & Gynecology', 'C Joseph', NULL, 'Glenn', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'B', '1055 N 300 W Ste 303', 'Provo', 'Utah', 'UT', '84604', '8013577377', '8013577378', 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|', '1942302211', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870651355', 'S77009754', 'S77009754', 'UT01', 'Utah Valley Obstetrics & Gynecology', 'Julie', '', 'Grover', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '1055 N 300 W Ste 110', 'Provo', 'Utah', 'UT', '84604', '8013577377', '          ', '1055 N 300 W Ste 110', 'Provo', 'Utah', 'UT', '84604', '8013577377', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1386746659', 0, 'N', 0, '2014-06-11', NULL, NULL, 40.2476, -111.664, NULL, NULL),
('870652734', 'S77009755', 'S77009755', 'UT01', '', 'Layne', 'A', 'Smith', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '9600 S 1300 E Ste 305', 'Sandy', 'Salt Lake', 'UT', '84094', '8015725808', '8015722953', '9600 S 1300 E Ste 305', 'Sandy', 'Salt Lake', 'UT', '84094', '8015725808', '8015722953', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2013-08-31', 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1770693251', 0, 'N', 0, '2013-08-07', NULL, NULL, 0, 0, NULL, NULL),
('870653164', 'S77009756', 'S77009756', 'UT01', 'Utah Digestive Health Institute', 'John', 'E', 'Lowe', 'MD', 'Gastroenterology', NULL, NULL, NULL, 'O', '6028 S Ridgeline Dr Ste 201', 'Ogden', 'Weber', 'UT', '84405', '8014755400', '8014758614', '6028 S Ridgeline Dr Ste 201', 'Ogden', 'Weber', 'UT', '84405', '8014755400', '8014758614', 'WUSTDGAST4', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-05-01', NULL, 0, 0, 0, 'Davis Hospital', 'Ogden Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1851387195', 0, 'N', 0, '2012-06-13', NULL, NULL, 41.1538, -111.942, NULL, NULL),
('870653551', 'S77009757', 'S77009757', 'UT01', 'Park City Healthcare', 'Robert', 'W', 'Barnett', 'MD', 'Family Practice', '', '', NULL, 'O', '1655 Bonanza Dr', 'Park City', 'Summit', 'UT', '84060', '4356497640', '4356491365', '1655 Bonanza Dr', 'Park City', 'Summit', 'UT', '84060', '4356497640', '4356491365', 'WURURAL10', 'wUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-04-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1831146752', 0, 'N', 0, '2012-09-06', NULL, NULL, 0, 0, NULL, NULL),
('870653551', 'S77009758', 'S77009758', 'UT01', 'Park City Healthcare', 'Cress', 'R', 'Bohnn', 'MD', 'Family Practice', 'Sports Medicine', '', NULL, 'O', '1655 Bonanza Dr', 'Park City', 'Summit', 'UT', '84060', '4356497640', '4356491365', '1655 Bonanza Dr', 'Park City', 'Summit', 'UT', '84060', '4356497640', '4356491365', 'WURURAL10', 'wUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-04-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1861423113', 0, 'N', 0, '2012-09-06', NULL, NULL, 0, 0, NULL, NULL),
('870653551', 'S77009760', 'S77009760', 'UT01', 'Park City Healthcare', 'Camellia', 'R', 'Koleyni', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '1655 Bonanza Dr', 'Park City', 'Summit', 'UT', '84060', '4356497640', '4356491365', 'PO Box 680670', 'Park City', '', 'UT', '84068', '', '', 'WURURAL10', 'wUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-04-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1356469217', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870653551', 'S77009761', 'S77009761', 'UT01', 'Park City Healthcare', 'Charles', 'R', 'Morrison', 'MD', 'Family Practice', 'Urgent Care', '', NULL, 'B', 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '4356497640', '4356491365', 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '4356497640', '4356491365', 'WURURAL10', 'wUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-04-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1083669204', 0, 'Y', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('870653551', 'S77009762', 'S77009762', 'UT01', 'Park City Healthcare', 'Kathleen', 'W', 'Thomas', 'APRN', 'Family Practice', 'Advanced Practice Registered Nurse', '', NULL, 'O', '1655 Bonanza Dr', 'Park City', 'Summit', 'UT', '84060', '4356497640', '4356491365', '1655 Bonanza Dr', 'Park City', 'Summit', 'UT', '84060', '4356497640', '4356491365', 'WURURAL10', 'wUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-04-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1740235290', 0, 'N', 0, '2012-09-10', NULL, NULL, 0, 0, NULL, NULL),
('870653551', 'S77009763', 'S77009763', 'UT01', 'Park City Healthcare', 'Kathleen', 'W', 'Thomas', 'APRN', 'Family Practice', 'Advanced Practice Registered Nurse', '', NULL, 'B', 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '4356497640', '4356491365', 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '4356497640', '4356491365', 'WURURAL10', 'wUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-04-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1740235290', 0, 'Y', 0, '2012-09-10', NULL, NULL, 0, 0, NULL, NULL),
('870653674', 'S77009764', 'S77009764', 'UT01', NULL, 'John', 'A', 'Carver', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1055 N 300 W Ste 210', 'Provo', 'Utah', 'UT', '84604', '8013577704', '8013577424', '1055 N 300 W Ste 210', 'Provo', 'Utah', 'UT', '84604', '8013577704', '8013577424', 'WiseSTD3', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2008-09-14', 0, 0, 0, 'St Marks Hospital', 'Mountain View Hospital', 'Timpanogos Regional Hospital', '', 'HCFA|UB|', '1669435160', 0, 'N', 0, '2013-08-05', NULL, NULL, 0, 0, NULL, NULL),
('870654162', 'S77009766', 'S77009766', 'UT01', 'Utah Orthopaedic Specialists', 'Peter', 'G', 'Larcom', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '5323 S Woodrow St Ste 200', 'Murray', 'Salt Lake', 'UT', '84107', '8017471020', NULL, '5323 S Woodrow St Ste 200', 'Murray', 'Salt Lake', 'UT', '84107', '8017471020', '', 'WUSLORTH5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1821029869', 0, 'N', 0, '2014-04-14', NULL, NULL, 40.6549, -111.895, NULL, NULL),
('870654617', 'S77009767', 'S77009767', 'UT01', 'Castle Country Family Medicine', 'Shane', 'D', 'Gagon', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '377 N Fairgrounds Rd', 'Price', 'Carbon', 'UT', '84501', '4356132200', NULL, '377 N Fairgrounds Rd', 'Price', '', 'UT', '84501', '', '', '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|', '1508951328', 0, 'N', 0, '2007-01-07', NULL, NULL, 39.607, -110.835, NULL, NULL),
('870654931', 'S77009768', 'S77009768', 'UT01', NULL, 'Kelly', 'W', 'Hubbard', 'MD', 'Dermatology', '', '', NULL, 'O', '2380 N 400 E Ste B', 'North Logan', 'Cache', 'UT', '84341', '4357525741', '4357525746', '2380 N 400 E Ste B', 'North Logan', 'Cache', 'UT', '84341', '4357525741', '4357525746', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1871542308', 0, 'N', 0, '2014-03-20', NULL, NULL, 41.775, -111.823, NULL, NULL),
('870656268', 'S77009774', 'S77009774', 'UT01', 'Utah Bone & Joint Center', 'Lawrence', 'L', 'Baer', 'PT-M', 'Physical Therapy', NULL, NULL, NULL, 'O', '5323 S Woodrow St Ste 204', 'Murray', 'Salt Lake', 'UT', '84107', '8017130610', NULL, '5323 S Woodrow St Ste 204', 'Murray', 'Salt Lake', 'UT', '84107', '8017130610', '          ', '', '', '', '0.00', '0.00', '57.75', 6, '2006-12-01', '2011-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346234010', 0, 'Y', 0, '2014-01-31', NULL, NULL, 0, 0, NULL, NULL),
('870656465', 'S77009775', 'S77009775', 'UT01', 'Cascade Family Medicine', 'Kelly', 'K', 'Wosnik', 'NP', 'Family Practice', '', '', NULL, 'O', '173 N 400 W Ste C11', 'Orem', 'Utah', 'UT', '84057', '8018027373', '8018027733', '173 N 400 W Ste C11', 'Orem', 'Utah', 'UT', '84057', '8018027373', '8018027733', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2014-03-21', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000911513', 0, 'N', 0, '2014-03-26', NULL, NULL, 40.3003, -111.705, NULL, NULL),
('870656683', 'S77009776', 'S77009776', 'UT01', 'Plastic Surgical Center', 'Gary', 'Chad', 'Carson', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'O', '4401 Harrison Blvd Ste 3680', 'Ogden', 'Weber', 'UT', '84403', '8013932249', NULL, '4403 Harrison Blvd', 'Ogden', '', 'UT', '84403', '', '', '', NULL, '1000', '45.00', '0.00', '0.00', 3, '2006-11-01', NULL, 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000833034', 0, 'Y', 0, '2007-01-10', NULL, NULL, 41.1828, -111.949, NULL, NULL),
('870656925', 'S77009779', 'S77009779', 'UT01', 'Utah Vascular Center', 'Robert', 'Paul', 'Smilanich', 'MD', 'Vascular Surgery', NULL, NULL, NULL, 'O', '1055 N 300 W Ste 205', 'Provo', 'Utah', 'UT', '84604', '8013749100', '8013749117', '1055 N 300 W Ste 205', 'Provo', 'Utah', 'UT', '84604', '8013749100', '8013749117', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730187600', 0, 'N', 0, '2012-02-07', NULL, NULL, 40.2476, -111.664, NULL, NULL),
('870657375', 'S77009780', 'S77009780', 'UT01', NULL, 'Paul', 'H', 'Robinson', 'MD', 'General Surgery', NULL, NULL, NULL, 'O', '226 N 1100 E Ste C', 'American Fork', 'Utah', 'UT', '84003', '8017565084', NULL, '226 N 1100 E', 'American Fork', '', 'UT', '84003', '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', '2008-10-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000833162', 0, 'N', 0, '2006-10-17', NULL, NULL, 0, 0, NULL, NULL),
('870658282', 'S77009781', 'S77009781', 'UT01', NULL, 'Brent', 'H', 'Goodsell', 'DO', 'Dermatology', NULL, NULL, NULL, 'O', '379 N 500 W', 'Vernal', 'Uintah', 'UT', '84078', '8775287546', '8017560202', 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|', '1528172863', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870658625', 'S77009782', 'S77009782', 'UT01', 'Wasatch Peak Family Practice', 'Douglas', 'S', 'Linford', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '1492 W Antelope Dr Ste 208', 'Layton', 'Davis', 'UT', '84041', '8017734770', NULL, '1492 W Antelope Dr', 'Layton', '', 'UT', '84041', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-07-12', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1821180134', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870661473', 'S77009800', 'S77009800', 'UT01', 'Park City Urgent Care', 'Robert', 'W', 'Barnett', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 680004', 'Park City', 'Summit', 'UT', '84068', '4356497640', '8012942412', 'PO Box 680004', 'Park City', 'Summit', 'UT', '84068', '4356497640', '8012942412', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1831146752', 0, 'Y', 0, '2012-09-06', NULL, NULL, 0, 0, NULL, NULL),
('870661473', 'S77009801', 'S77009801', 'UT01', 'Park City Urgent Care', 'Robert', 'J', 'Evers', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 680004', 'Park City', 'Summit', 'UT', '84068', '4356497640', '8012942412', 'PO Box 680670', 'Park City', 'Summit', 'UT', '84068', '4356497640', '8012942412', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, NULL, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1720033905', 0, 'y', 0, '2011-04-28', NULL, NULL, 0, 0, NULL, NULL),
('870661473', 'S77009802', 'S77009802', 'UT01', 'Park City Urgent Care', 'Christopher', 'L', 'Hays', 'MD', 'Family Practice', 'Sports Medicine', 'Urgent Care', NULL, 'B', 'PO Box 680004', 'Park City', 'Summit', 'UT', '84068', '4356497640', '8012942412', 'PO Box 680004', 'Park City', 'Summit', 'UT', '84068', '4356497640', '8012942412', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Park City Medical Center', 'Salt Lake Regional Medical Center', '', '', 'HCFA|UB|', '1144274499', 0, 'Y', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('870661952', 'S77009803', 'S77009803', 'UT01', 'Utah Neurological Clinic', 'Joseph', 'R', 'Watkins', 'MD', 'Neurology', '', '', NULL, 'O', '1055 N 300 W Ste 404', 'Provo', 'Utah', 'UT', '84604', '8013577401', NULL, '1055 N 300 W Ste 404', 'Provo', 'Utah', 'UT', '84604', '8013577401', '', 'WUSTDNEUR5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1659396695', 0, 'N', 0, '2014-07-10', NULL, NULL, 40.2476, -111.664, NULL, NULL),
('870662864', 'S77009805', 'S77009805', 'UT01', 'Precision Medical Management', 'Glori', 'M', 'Allen', 'MD', 'Internal Medicine', 'Emergency Medicine', '', NULL, 'B', 'PO Box 1276', 'Salem', 'Utah', 'UT', '84653', '8014264689', NULL, 'PO Box 1276', 'Salem', 'Utah', 'UT', '84653', '8014264689', '          ', 'WRMER', 'WUSTDHCPC5', '', '0.00', '20.00', '0.00', 3, '2007-01-01', '2014-04-23', 0, 0, 0, 'Castleview Hospital', 'Castleview Hospital', NULL, NULL, 'HCFA|UB|', '1801824297', 0, 'Y', 0, '2014-02-05', NULL, NULL, 0, 0, NULL, NULL),
('870662864', 'S77009806', 'S77009806', 'UT01', 'Precision Medical Management - Castleview Hospital', 'Patrick', NULL, 'Scherer', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '300 N Hospital Dr', 'Price', 'Carbon', 'UT', '84501', '4356374800', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WRMER', 'WUSTDHCPC5', NULL, '0.00', '20.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870662864', 'S77009807', 'S77009807', 'UT01', 'Precision Medical Management - Castleview Hospital', 'Bruce', NULL, 'Taylor', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '300 N Hospital Dr', 'Price', 'Carbon', 'UT', '84501', '4356374800', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WRMER', 'WUSTDHCPC5', NULL, '0.00', '20.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870663873', 'S77009808', 'S77009808', 'UT01', NULL, 'Julie', '', 'Jones', 'CNM', 'Obstetrics and Gynecology', 'Nurse Midwife', '', NULL, 'O', '166 E 5900 S  Ste B104', 'Murray', 'Salt Lake', 'UT', '84107', '8012651266', '8012650755', '166 E 5900 S  Ste B104', 'Murray', 'Salt Lake', 'UT', '84107', '8012651266', '8012650755', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2009-06-01', 0, 0, 0, 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1124006457', 0, 'N', 0, '2012-05-17', NULL, NULL, 0, 0, NULL, NULL),
('870666144', 'S77009812', 'S77009812', 'UT01', 'Deseret Peak Anesthesia', 'Kyle', 'H', 'Jones', 'CRNA', 'Anesthesiology', NULL, NULL, NULL, 'B', 'PO Box 210', 'Roy', 'Weber', 'UT', '84067', '8018254700', NULL, 'PO Box 210', 'Roy', '', 'UT', '84067', '', '', '', NULL, '1000', '37.41', '0.00', '0.00', 3, '2006-11-01', NULL, 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1720092752', 0, 'Y', 0, '2007-01-10', NULL, NULL, 0, 0, NULL, NULL),
('870668900', 'S77009815', 'S77009815', 'UT01', 'Mountain Valley Imaging', 'John', 'C', 'Olson', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 470', 'Ogden', 'Weber', 'UT', '84402', 'Weber', NULL, '1850 Sidewinder Dr', 'Park City', 'Weber', 'UT', '84060', 'Weber', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2009-11-15', NULL, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1932169604', 0, 'Y', 0, '2010-12-28', NULL, NULL, 0, 0, NULL, NULL),
('870671798', 'S77009819', 'S77009819', 'UT01', NULL, 'Francis', 'J', 'Clark', 'DPM', 'Podiatry', NULL, NULL, NULL, 'O', '3584 W 9000 S Ste 301', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012558633', '8015693885', '3584 W 9000 S', 'Salt Lake City', 'Salt Lake', 'UT', '84088', '8012558633', '8015693885', '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|', '1477649234', 0, 'N', 0, '2011-06-15', NULL, NULL, 40.5879, -111.976, NULL, NULL),
('870673066', 'S77009822', 'S77009822', 'UT01', 'Northern Utah Pathology', 'Matthew', 'M', 'Kershisnik', 'MD', 'Pathology', NULL, NULL, NULL, 'B', '5935 Rivers Ave Ste 101', 'North Charleston', 'Charleston', 'SC', '29406', '8008325270', NULL, 'PO Box 551', 'Logan', '', 'UT', '84323', '', '', 'WUSTDPATH5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1851363600', 0, 'Y', 0, '2006-12-11', NULL, NULL, 0, 0, NULL, NULL),
('870673881', 'S77009824', 'S77009824', 'UT01', NULL, 'Brian', 'H', 'Richman', 'DPM', 'Podiatry', NULL, NULL, NULL, 'O', '550 E 1400 N Ste N', 'Logan', 'Cache', 'UT', '84341', '4357521038', NULL, '1660 W Antelope Dr', 'Layton', 'Cache', 'UT', '84041', '4357521038', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, NULL, 0, 0, 'Davis Hospital', 'Logan Regional Hospital', NULL, NULL, 'HCFA|UB|', '1831124247', 0, 'N', 0, '2011-08-08', NULL, NULL, 41.7574, -111.82, NULL, NULL),
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('870675632', 'S77009827', 'S77009827', 'UT01', 'Valley Family Clinic', 'Laura', 'L', 'Mahler', 'FNP', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 189', 'Vernal', 'Uintah', 'UT', '84078', '4357890064', '4357890537', 'PO Box 189', 'Vernal', 'Uintah', 'UT', '84078', '4357890064', '4357890537', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740373125', 0, 'Y', 0, '2013-10-30', NULL, NULL, 0, 0, NULL, NULL),
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('870678603', 'S77009831', 'S77009831', 'UT01', 'Northern Utah Nephrology', 'Harry', 'O', 'Senekjian', 'MD', 'Nephrology', NULL, NULL, NULL, 'O', '425 E 5350 S Ste 320', 'Ogden', 'Weber', 'UT', '84405', '8014791117', NULL, '425 E 5350 S', 'Ogden', 'Weber', 'UT', '84405', '8014791117', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, NULL, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1760484596', 0, 'N', 0, '2011-02-10', NULL, NULL, 41.166, -111.97, NULL, NULL),
('870678993', 'S77009832', 'S77009832', 'UT01', 'Families First Pediatrics', 'Matthew', 'N', 'Cox', 'MD', 'Pediatrics', '', '', NULL, 'O', '1268 W S Jordan Pkwy Ste 201', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012549700', NULL, '1268 W S Jordan Pkwy Ste 201', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012549700', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1811081904', 0, 'N', 0, '2014-07-01', NULL, NULL, 40.5622, -111.928, NULL, NULL),
('870678993', 'S77009833', 'S77009833', 'UT01', 'Families First Pediatrics', 'Dallen', 'K', 'Ormond', 'NP', 'Pediatrics', '', '', NULL, 'O', '1268 W S Jordan Pkwy Ste 201', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012549700', NULL, '1268 W S Jordan Pkwy Ste 201', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012549700', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1497850069', 0, 'N', 0, '2014-05-26', NULL, NULL, 40.5622, -111.928, NULL, NULL),
('870678993', 'S77009834', 'S77009834', 'UT01', 'Families First Pediatrics', 'Dallen', 'K', 'Ormond', 'NP', 'Pediatrics', '', '', NULL, 'B', 'PO Box 95868', 'South Jordan', 'Salt Lake', 'UT', '84095', NULL, NULL, 'PO Box 95868', 'South Jordan', 'Salt Lake', 'UT', '84095', '', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1497850069', 0, 'Y', 0, '2014-05-26', NULL, NULL, 0, 0, NULL, NULL),
('870679508', 'S77009837', 'S77009837', 'UT01', 'Art City Foot & Ankle', 'Matthew', 'G', 'Ollerton', 'DPM', 'Podiatry', NULL, NULL, NULL, 'B', 'PO Box 595', 'Springville', 'Utah', 'UT', '84663', '8014913668', 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|', '1518959733', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870680455', 'S77009838', 'S77009838', 'UT01', 'Ogden Ortho & Neurosurgical Specialists', 'Dann', 'C', 'Byck', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'B', '5405 S 500 E Ste 203', 'Ogden', 'Weber', 'UT', '84405', NULL, NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseOGORTHO', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1679565758', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870680455', 'S77009839', 'S77009839', 'UT01', 'Ogden Ortho & Neurosurgical Specialists', 'John', 'W', 'Cory', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '5405 S 500 E Ste 203', 'Ogden', 'Weber', 'UT', '84405', '8014799860', '8014768821', NULL, NULL, '', NULL, NULL, '', '', 'WiseOGORTHO', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '921423', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870680811', 'S77009842', 'S77009842', 'UT01', 'Personal Community Healthcare', 'Linda', NULL, 'Brown-Trudel', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '1959 N Aaron Dr Ste C', 'Tooele', 'Tooele', 'UT', '84074', '4358821644', NULL, '1959 N Aaron Dr', 'Tooele', '', 'UT', '84074', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', '2008-08-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1043262835', 0, 'N', 0, '2006-10-19', NULL, NULL, 0, 0, NULL, NULL),
('870681544', 'S77009845', 'S77009845', 'UT01', NULL, 'Merwin', NULL, 'Rasmussen', 'CRNA', 'Anesthesiology', NULL, NULL, NULL, 'B', '1954 E Fort Union Blvd Ste 101', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019939500', '8017335623', '1954 E Fort Union Blvd', 'Salt Lake City', '', 'UT', '84121', '', '', '', NULL, NULL, '0.00', '20.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1497770978', 0, 'Y', 0, '2009-09-15', NULL, NULL, 0, 0, NULL, NULL),
('870682101', 'S77009846', 'S77009846', 'UT01', 'Salt Lake Orthopaedic Clinic', 'Joel', 'T', 'Dall', 'MD', 'Physical Medicine and Rehabilitation', NULL, NULL, NULL, 'O', '1160 E 3900 S Ste 5000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012628486', NULL, '1160 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012628486', '', 'WUSLORTH5', 'wUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-04-01', NULL, NULL, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1992707657', 0, 'N', 0, '2011-07-15', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('870682101', 'S77009847', 'S77009847', 'UT01', 'Salt Lake Orthopaedic Clinic', 'Brent', 'A', 'Felix', 'MD', 'Orthopedic Surgery', 'Spine', '', NULL, 'O', '1160 E 3900 S Ste 5000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012628486', NULL, '1160 E 3900 S Ste 5000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012628486', '', 'WUSLORTH5', 'wUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-04-01', NULL, 0, 0, 0, 'Brigham City Community Hospital', 'St Marks Hospital', 'Logan Regional Hospital', NULL, 'HCFA|UB|', '1851383350', 0, 'N', 0, '2014-01-28', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('870682101', 'S77009848', 'S77009848', 'UT01', 'Salt Lake Orthopaedic Clinic', 'Portia', 'Kam', 'Jones', 'RN', 'Orthopedic Surgery', '', '', NULL, 'O', '1160 E 3900 S Ste 5000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012628486', NULL, '1160 E 3900 S Ste 5000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012628486', '          ', 'WUSLORTH5', 'wUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417990508', 0, 'Y', 0, '2014-01-28', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('870682101', 'S77009849', 'S77009849', 'UT01', 'Salt Lake Orthopaedic Clinic', 'J', 'E', 'Vanderhooft', 'MD', 'Orthopedic Surgery', 'Orthopedic Surgery', NULL, NULL, 'O', '1160 E 3900 S Ste 5000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012628486', NULL, '1160 E 3900 S Ste 5000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012628486', '', 'WUSLORTH5', 'wUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-04-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1821080326', 0, 'N', 0, '2012-05-30', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('870682101', 'S77009850', 'S77009850', 'UT01', 'Salt Lake Orthopaedic Clinic', 'Whitney', 'M', 'Werner', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '1160 E 3900 S Ste 5000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012628486', NULL, '1160 E 3900 S Ste 5000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012628486', '', 'WUSLORTH5', 'wUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-04-01', NULL, 0, 0, 0, 'Brigham City Community Hospital', 'Logan Regional Hospital', 'St Marks Hospital', '', 'HCFA|UB|', '1629011754', 0, 'N', 0, '2014-04-14', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('870682101', 'S77009851', 'S77009851', 'UT01', 'Salt Lake Orthopaedic Clinic', 'Jennifer', NULL, 'Williams', 'PA-C', 'Internal Medicine', 'Podiatry', NULL, NULL, 'O', '1160 E 3900 S Ste 5000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012628486', NULL, '1160 E 3900 S', 'Salt Lake City', '', 'UT', '84121', '', '', 'WUSLORTH5', 'wUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-04-01', '2009-02-01', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1962585844', 0, 'N', 0, '2009-05-04', NULL, NULL, 0, 0, NULL, NULL),
('870683247', 'S77009853', 'S77009853', 'UT01', 'First Med', 'Terry', NULL, 'Brown', 'MD', 'General Practice', NULL, NULL, NULL, 'B', 'PO Box 307', 'Bountiful', 'Davis', 'UT', '84011', '8012946907', '8012946917', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-07-01', '2006-07-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834848', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870683247', 'S77009854', 'S77009854', 'UT01', 'First Med', 'Janet', 'M', 'Williams', 'PA', 'Emergency Medicine', NULL, NULL, NULL, 'B', 'PO Box 307', 'Bountiful', 'Davis', 'UT', '84011', '8012946907', '8012946917', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-07-01', '2006-07-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '835682', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870683394', 'S77009856', 'S77009856', 'UT01', NULL, 'Regina', 'W', 'Drueding', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '415 Medical Dr Ste D201', 'Bountiful', 'Davis', 'UT', '84010', '8012982332', '8012985018', '415 Medical Dr', 'Bountiful', '', 'UT', '840104946', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1396850707', 0, 'N', 0, '2007-03-20', NULL, NULL, 40.8873, -111.872, NULL, NULL),
('870683394', 'S77009857', 'S77009857', 'UT01', NULL, 'Regina', 'W', 'Drueding', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'B', '971 Green Oaks Dr', 'Bountiful', 'Davis', 'UT', '84010', '8012982332', '8012985018', 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|', '1396850707', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870684599', 'S77009862', 'S77009862', 'UT01', 'Bountiful Eye Care', 'Robert', 'M', 'Wilkes', 'OD', 'Optometry', NULL, NULL, NULL, 'O', '140 S Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012952020', NULL, '140 S Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012952020', '', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093788184', 0, 'N', 0, '2013-11-20', NULL, NULL, 40.8879, -111.881, NULL, NULL),
('870684853', 'S77009863', 'S77009863', 'UT01', 'Bountiful Neurology', 'Jozef', 'A', 'Ottowicz', 'MD', 'Neurology', '', '', NULL, 'O', '440 Medical Dr', 'Bountiful', 'Davis', 'UT', '84010', '8016770027', '8016770028', '440 Medical Dr', 'Bountiful', 'Davis', 'UT', '84010', '8016770027', '8016770028', 'WiseSTD6A', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB|', '1861484297', 0, 'N', 0, '2014-07-17', NULL, NULL, 40.8873, -111.872, NULL, NULL),
('870685140', 'S77009864', 'S77009864', 'UT01', 'UNI Home Project', 'Scott', '', 'Stiefel', 'MD', 'Mental Health', 'Neonatology', NULL, NULL, 'O', '546 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015873103', NULL, '546 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015873103', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', '2008-10-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235218801', 0, 'y', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('870685287', 'S77009865', 'S77009865', 'UT01', 'Southwest Childrens Clinic', 'Valerie', 'L', 'Rahaniotis', 'MD', 'Pediatrics', '', '', NULL, 'O', '8822 Redwood Rd Ste C-211', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015631975', NULL, '8822 Redwood Rd Ste C-211', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015631975', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1538382890', 0, 'N', 0, '2014-06-03', NULL, NULL, 40.5916, -111.939, NULL, NULL),
('870686529', 'S77009867', 'S77009867', 'UT01', 'Pioneer Valley Ob/Gyn', 'Spencer', 'N', 'Colby', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'B', '3336 Pioneer Pkwy Ste 301', 'West Valley', 'Salt Lake', 'UT', '84120', '8019642229', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1144287699', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870686529', 'S77009868', 'S77009868', 'UT01', 'Pioneer Valley OBGYN', 'Steven', 'M', 'Thackeray', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3336 Pioneer Pkwy Ste 301', 'West Valley', 'Salt Lake', 'UT', '84120', '8019642229', NULL, '3336 Pioneer Pkwy', 'West Valley', 'Salt Lake', 'UT', '841202000', '8019642229', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2008-10-31', NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1407813959', 0, 'N', 0, '2011-10-05', NULL, NULL, 0, 0, NULL, NULL),
('870687383', 'S77009869', 'S77009869', 'UT01', 'Western Neurological Associates', 'Mary', 'Kathryn', 'Alderson', 'MD', 'Neurology', NULL, NULL, NULL, 'O', '166 E 5900 S Ste B106', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8017436444', '8012699005', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832436', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870687383', 'S77009871', 'S77009871', 'UT01', 'Western Neurological Associates', 'Dennis', 'D', 'Thoen', 'MD', 'Neurology', NULL, NULL, NULL, 'O', '1151 E 3900 S Ste B150', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012623441', NULL, '1151 E 3900 S Ste B150', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012623441', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023014297', 0, 'N', 0, '2013-11-04', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('870687511', 'S77009872', 'S77009872', 'UT01', 'Brigham City Arthritis Clinic', 'Harold', NULL, 'Vonk', 'MD', 'Rheumatology', NULL, NULL, NULL, 'O', '984 Medical Dr Ste 3', 'Brigham City', 'Box Elder', 'UT', '84302', '4357235500', NULL, '984 S Medical Dr', 'Brigham City', '', 'UT', '84302', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1235201526', 0, 'N', 0, '2007-01-06', NULL, NULL, 41.4888, -112.026, NULL, NULL),
('870687579', 'S77009873', 'S77009873', 'UT01', 'Ogden Internal Medicine', 'Seth', 'R', 'Lewis', 'MD', 'Internal Medicine', 'Hospitalist', NULL, NULL, 'B', 'PO Box 71128', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8777992455', NULL, '5405 S 500 E', 'Ogden', 'Salt Lake', 'UT', '84405', '8777992455', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, NULL, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1851409544', 0, 'Y', 0, '2011-11-10', NULL, NULL, 0, 0, NULL, NULL),
('876000309', 'S77009874', 'S77009874', 'UT01', 'Garfield Memorial Hospital - Pro Fees', '', '', 'Garfield Memorial Clinic', 'GROUP', 'Clinic', NULL, NULL, NULL, 'B', 'PO Box 389', 'Panguitch', 'Garfield', 'UT', '84759', '4356768811', NULL, 'PO Box 389', 'Panguitch', '', 'UT', '84759', '', '', NULL, NULL, NULL, '0.00', '15.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000834487', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('876000309', 'S77009875', 'S77009875', 'UT01', 'Garfield Memorial Clinic', 'Richard', '', 'Birch', 'DO', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 389', 'Panguitch', 'Garfield', 'UT', '84759', '4356768811', NULL, 'PO Box 389', 'Panguitch', 'Garfield', 'UT', '84759', '4356768811', '', '', NULL, NULL, '0.00', '15.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'Garfield Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1124135462', 0, 'Y', 0, '2010-08-28', NULL, NULL, 0, 0, NULL, NULL),
('876000309', 'S77009877', 'S77009877', 'UT01', 'Garfield Memorial Clinic', 'Robert', 'K', 'McCullough', 'PA', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 389', 'Panguitch', 'Garfield', 'UT', '84759', '4356768811', NULL, 'PO Box 389', 'Panguitch', '', 'UT', '84759', '', '', NULL, NULL, NULL, '0.00', '15.00', NULL, 3, '2006-09-01', '2007-04-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '908258', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('876000309', 'S77009879', 'S77009879', 'UT01', 'Kazan Memorial Clinic', 'Robert', 'K', 'McCullough', 'PA', 'Family Practice', NULL, NULL, NULL, 'O', '65 N Ctr St', 'Escalante', 'Garfield', 'UT', '84726', '4358264374', NULL, 'PO Box 389', 'Panguitch', '', 'UT', '84759', '', '', NULL, NULL, NULL, '0.00', '15.00', NULL, 3, '2006-09-01', '2007-04-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '908258', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('876000309', 'S77009881', 'S77009881', 'UT01', 'Kazan Memorial Clinic', 'Todd', '', 'Mooney', 'MD', 'Family Practice', '', '', NULL, 'O', '65 N Ctr St', 'Escalante', 'Garfield', 'UT', '84726', '4358264374', NULL, '65 N Ctr St', 'Escalante', 'Garfield', 'UT', '84726', '4358264374', '', '', NULL, NULL, '0.00', '15.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'Garfield Memorial Hospital', '', '', '', 'HCFA|UB|', '1013024330', 0, 'N', 0, '2014-04-07', NULL, NULL, 0, 0, NULL, NULL),
('876000309', 'S77009882', 'S77009882', 'UT01', 'Orderville Clinic', 'Todd', '', 'Mooney', 'MD', 'Family Practice', '', '', NULL, 'O', '425 E State St', 'Orderville', 'Kane', 'UT', '84758', '4356482108', NULL, '425 E State St', 'Orderville', 'Kane', 'UT', '84758', '4356482108', '', '', NULL, NULL, '0.00', '15.00', '0.00', 3, '2006-09-01', '2008-07-31', 0, 0, 0, 'Garfield Memorial Hospital', '', '', '', 'HCFA|UB|', '1013024330', 0, 'N', 0, '2014-04-07', NULL, NULL, 0, 0, NULL, NULL),
('876000309', 'S77009883', 'S77009883', 'UT01', 'Circleville Clinic', 'Becky', 'S', 'Roberts', 'FNP', 'Family Practice', '', '', NULL, 'O', '145 W Main', 'Circleville', 'Piute', 'UT', '84723', '4355772958', NULL, '145 W Main', 'Circleville', 'Piute', 'UT', '84723', '4355772958', '', '', NULL, NULL, '0.00', '15.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'Garfield Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1689779449', 0, 'N', 0, '2014-02-26', NULL, NULL, 38.1717, -112.273, NULL, NULL),
('876000309', 'S77009885', 'S77009885', 'UT01', 'Kazan Memorial Clinic', 'Becky', 'S', 'Roberts', 'FNP', 'Family Practice', '', '', NULL, 'O', '65 N Ctr St', 'Escalante', 'Garfield', 'UT', '84726', '4358264374', NULL, 'PO Box 389', 'Panguitch', '', 'UT', '84759', '', '', '', NULL, NULL, '0.00', '15.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'Garfield Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1689779449', 0, 'N', 0, '2007-03-20', NULL, NULL, 0, 0, NULL, NULL),
('876000309', 'S77009886', 'S77009886', 'UT01', 'Orderville Clinic', 'Randall', 'W', 'Walters', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '425 E State St', 'Orderville', 'Kane', 'UT', '84758', '4356482108', NULL, 'PO Box 389', 'Panguitch', '', 'UT', '84759', '', '', NULL, NULL, NULL, '0.00', '15.00', NULL, 3, '2006-09-01', '2007-04-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '831832', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('876000525', 'S77009887', 'S77009887', 'UT01', 'University Hospital Physicians', NULL, '', 'University Hospital', 'GROUP', 'Physical Therapy', NULL, NULL, NULL, 'O', '590 Wakara Way ', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015877100', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUSTDMULT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('876000545', 'S77009888', 'S77009888', 'UT01', 'Health Clinics Of Utah', 'Dan', 'S', 'Albu-Zaruba', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '2540 Washington Blvd Ste 122', 'Ogden', 'Weber', 'UT', '84401', '8016263670', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-08-01', '2006-08-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1912969270', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('876000545', 'S77009889', 'S77009889', 'UT01', 'Health Clinics Of Utah', 'Heather', 'D', 'Hack', 'NP', 'Family Practice', NULL, NULL, NULL, 'O', '2540 Washington Blvd Ste 122', 'Ogden', 'Weber', 'UT', '84401', '8016263670', NULL, '3195 S Main St', 'Salt Lake City', '', 'UT', '84115', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-08-01', '2006-08-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '831883', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('876000545', 'S77009890', 'S77009890', 'UT01', 'Health Clinics of Utah', 'Thomas', 'L', 'Jones', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '3195 S Main St Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84115', '8014680354', '8014680353', '3195 S Main St', 'Salt Lake City', 'Salt Lake', 'UT', '84115', '8014680354', '8014680353', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-08-01', '2011-11-14', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1588795264', 0, 'N', 0, '2011-11-17', NULL, NULL, 0, 0, NULL, NULL),
('876000545', 'S77009891', 'S77009891', 'UT01', 'Health Clinics of Utah', 'Rebecca', 'J', 'Levine', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', '3195 S Main St Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84115', '8014680354', '8014680353', '3195 S Main St Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84115', '8014680354', '8014680353', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-08-01', '2010-02-22', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1316986136', 0, 'Y', 0, '2013-09-19', NULL, NULL, 0, 0, NULL, NULL),
('876000545', 'S77009892', 'S77009892', 'UT01', 'Health Clinics of Utah', 'Kurt', 'E', 'Rifleman', 'MD', 'Family Practice', '', '', NULL, 'O', '2540 Washington Blvd Ste 122', 'Ogden', 'Weber', 'UT', '84401', '8016263670', NULL, '2540 Washington Blvd Ste 122', 'Ogden', 'Weber', 'UT', '84401', '8016263670', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1780682567', 0, 'N', 0, '2013-09-09', NULL, NULL, 41.2198, -111.971, NULL, NULL),
('876000616', 'S77009894', 'S77009894', 'UT01', 'San Juan Clinic', 'Blen', NULL, 'Freestone', 'PA', 'Family Practice', NULL, NULL, NULL, 'O', '380 W 100 N', 'Monticello', 'San Juan', 'UT', '84535', '4355875054', NULL, 'PO Box 308', 'Monticello', '', 'UT', '84535', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2006-11-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1487646337', 0, 'N', 0, '2006-10-19', NULL, NULL, 37.8741, -109.348, NULL, NULL),
('876000616', 'S77009897', 'S77009897', 'UT01', 'San Juan Clinic', 'Kevin', 'M', 'Matteson', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 1054', 'Monticello', 'San Juan', 'UT', '84535', '4355875054', NULL, 'PO Box 308', 'Monticello', 'San Juan', 'UT', '84535', '4355875054', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2006-11-01', NULL, NULL, 0, 0, 'Southwest Memorial Hospital', NULL, NULL, NULL, 'HCFA|', '1407853013', 0, 'y', 0, '2011-10-19', NULL, NULL, 0, 0, NULL, NULL),
('876000616', 'S77009898', 'S77009898', 'UT01', 'Blanding Medical Clinic', 'Jane', 'B', 'Palmer', 'FNP', 'Family Practice', NULL, NULL, NULL, 'O', '804 N 400 W ', 'Blanding', 'San Juan', 'UT', '84511', '4356782254', NULL, 'PO Box 308', 'Monticello', '', 'UT', '84535', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-04-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1154314169', 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
('876000616', 'S77009899', 'S77009899', 'UT01', 'Blanding Medical Clinic', 'James', 'D', 'Redd', 'MD', 'General Practice', NULL, NULL, NULL, 'O', '804 N 400 W ', 'Blanding', 'San Juan', 'UT', '84511', '4356782254', NULL, 'PO Box 308', 'Monticello', '', 'UT', '84535', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1417949132', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('900098068', 'S77009941', 'S77009941', 'UT01', '', 'Richard', 'G', 'Seegmiller', 'DPM', 'Podiatry', '', '', NULL, 'O', '508 E S Temple Ste 118', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013221466', '', '508 E S Temple Ste 118', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013221466', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', '2008-11-17', 0, 0, 0, 'Davis Hospital', 'Lakeview Hospital', 'St Marks Hospital', '', 'HCFA|UB|', '1174539449', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('900200313', 'S77009942', 'S77009942', 'UT01', NULL, 'Luz', 'E', 'Boyer', 'NP', 'Neurology', NULL, NULL, NULL, 'O', '2545 N Canyon Rd Ste 100', 'Provo', 'Utah', 'UT', '84604', '8016232073', NULL, '2545 N Canyon Rd', 'Provo', '', 'UT', '84604', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', '2008-08-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1700923455', 0, 'N', 0, '2006-11-09', NULL, NULL, 0, 0, NULL, NULL),
('931239371', 'S77009943', 'S77009943', 'UT01', 'Peak Otolaryngology', 'Seth', 'A', 'Riddle', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '1055 N 300 W Ste 401', 'Provo', 'Utah', 'UT', '84604', '8013577499', '8013566326', '1055 N 300 W', 'Provo', 'Utah', 'UT', '84604', '8013577499', '8013566326', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2009-03-31', NULL, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1598701955', 0, 'N', 0, '2011-12-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'S77009955', 'S77009955', 'UT02', 'Intermountain Health Care', 'William', 'T', 'Alward', 'MD', 'Critical Care', '', '', NULL, 'B', 'PO Box 27128', 'Salt Lake City', 'Salt Lake', 'UT', '84127', NULL, NULL, NULL, NULL, 'Salt Lake', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2006-06-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1609880939', 0, 'Y', 0, '2011-07-26', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'S77009958', 'S77009958', 'UT02', 'IHC Pulmonary Clinic', 'Clark', 'T', 'Bishop', 'MD', 'Pulmonary', NULL, NULL, NULL, 'O', '1055 N 300 W Ste 500', 'Provo', 'Utah', 'UT', '84604', '8013577291', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2006-06-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1841206844', 0, 'Y', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'S77009959', 'S77009959', 'UT02', 'Intermountain Health Care', 'Clark', 'T', 'Bishop', 'MD', 'Pulmonary', NULL, NULL, NULL, 'B', 'PO Box 27128', 'Salt Lake City', 'Salt Lake', 'UT', '84127', NULL, NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2006-06-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1841206844', 0, 'Y', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'S77009983', 'S77009983', 'UT02', 'Ihc Pulmonary Clinic', 'Tracy', 'Arnold', 'Hill', 'MD', 'Pulmonary', NULL, NULL, NULL, 'O', '1055 N 300 W Ste 500', 'Provo', 'Utah', 'UT', '84604', '8013577291', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2006-06-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1992711253', 0, 'Y', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'S77009985', 'S77009985', 'UT02', 'Ihc Pulmonary Clinic', 'John', 'W', 'Manwaring', 'PA', 'Pulmonary', NULL, NULL, NULL, 'O', '1055 N 300 W Ste 500', 'Provo', 'Utah', 'UT', '84604', '8013577291', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2006-06-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000834116', 0, 'Y', 0, '2006-10-17', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'S77009986', 'S77009986', 'UT02', 'Intermountain Health Care', 'John', 'W', 'Manwaring', 'PA', 'Pulmonary', NULL, NULL, NULL, 'B', 'PO Box 27128', 'Salt Lake City', 'Salt Lake', 'UT', '84127', NULL, NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2006-06-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000834116', 0, 'Y', 0, '2006-10-17', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'S77009996', 'S77009996', 'UT02', 'Intermountain Health Care', 'Andrea', 'N', 'Smith', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 27128', 'Salt Lake City', 'Salt Lake', 'UT', '84127', NULL, NULL, 'PO Box 27128', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2006-06-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1831155746', 0, 'Y', 0, '2012-07-05', NULL, NULL, 0, 0, NULL, NULL),
('953750714', 'S77010003', 'S77010003', 'UT01', '', 'E Stanley', '', 'Rodier', 'MD', 'Dermatology', NULL, NULL, NULL, 'O', '1441 W Ute Blvd Ste 160', 'Park City', 'Summit', 'UT', '84098', '4356494145', NULL, '1441 W Ute Blvd Ste 160', 'Park City', 'Summit', 'UT', '84098', '4356494145', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134201312', 0, 'N', 0, '2013-04-30', NULL, NULL, 0, 0, NULL, NULL),
('954893928', 'S77010004', 'S77010004', 'UT01', 'Exodus Healthcare Network', 'Janee', '', 'Gillette', 'PA', 'Family Practice', NULL, NULL, NULL, 'O', '8211 W 3500 S', 'Magna', 'Salt Lake', 'UT', '84044', '8012509638', '8012503204', '8211 W 3500 S', 'Magna', 'Salt Lake', 'UT', '84044', '8012509638', '8012503204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-08-01', '2011-09-01', NULL, 0, NULL, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1669407979', 0, 'N', 0, '2011-09-29', NULL, NULL, 0, 0, NULL, NULL),
('954893928', 'S77010005', 'S77010005', 'UT01', 'Exodus Healthcare Network', 'Douglas', 'A', 'Greene', 'PA', 'Family Practice', NULL, NULL, NULL, 'O', '8211 W 3500 S', 'Magna', 'Salt Lake', 'UT', '84044', '8012509638', '8012503204', '8211 W 3500 S', 'Magna', '', 'UT', '84044', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', '2008-08-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000831690', 0, 'N', 0, '2006-10-19', NULL, NULL, 0, 0, NULL, NULL),
('954893928', 'S77010007', 'S77010007', 'UT01', 'Exodus Healthcare Network', 'Brian', 'K', 'Zehnder', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '3336 Pioneer Pkwy Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012509638', '8014170063', '3336 Pioneer Pkwy Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012509638', '8014170063', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-08-01', '2014-05-30', 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1447278023', 0, 'N', 0, '2014-05-30', NULL, NULL, 40.6991, -111.99, NULL, NULL),
('200262965', 'S77010538', 'S77010538', 'UT01', 'Kinross Crna PC Shawn', 'Shawn', '', 'Kinross', 'CRNA', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 1727', 'Provo', 'Utah', 'UT', '84603', '4355866587', NULL, NULL, NULL, '', NULL, NULL, '', '', '', NULL, '1000', '40.90', '0.00', '0.00', 3, '2007-01-01', NULL, 1, 12, 0, '', '', '', '', 'HCFA|UB|', '1679687396', 0, 'Y', 0, '2007-01-10', NULL, NULL, 0, 0, NULL, NULL),
('200262965', 'S77010539', 'S77010539', 'UT01', NULL, 'Shawn', '', 'Kinross', 'CRNA', 'Anesthesiology', '', '', NULL, 'O', '1811 W Royal Hunte Dr', 'Cedar City', 'Iron', 'UT', '84720', '4355863402', NULL, NULL, NULL, '', NULL, NULL, '', '', '', NULL, '1000', '40.90', '0.00', '0.00', 3, '2007-01-01', NULL, 1, 12, 0, '', '', '', '', 'HCFA|UB|', '1679687396', 0, 'N', 0, '2007-01-10', NULL, NULL, 37.658, -113.086, NULL, NULL),
('200262965', 'S77010540', 'S77010540', 'UT01', 'Kinross Crna PC Shawn', NULL, NULL, 'Kinross Crna PC Shawn', 'GROUP', 'Anesthesiology', NULL, NULL, NULL, 'O', '1303 N Main St', 'Cedar City', 'Iron', 'UT', '84720', '4355866587', NULL, NULL, NULL, '', NULL, NULL, '', '', '', NULL, '1000', '40.90', '0.00', '0.00', 3, '2007-01-01', NULL, 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000833040', 0, 'Y', 0, '2007-01-10', NULL, NULL, 0, 0, NULL, NULL),
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('870395551', 'S77010656', 'S77010656', 'UT01', 'Brewer Chiropractic', 'Ryan', 'C', 'Brewer', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '946 W Sunset Blvd Ste M', 'St George', 'Washington', 'UT', '84770', '4359868287', '4359866895', '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-04-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '929573', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870376618', 'S77010657', 'S77010657', 'UT01', NULL, 'William', 'T', 'Graff', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '630 S 400 E Ste 101', 'St George', 'Washington', 'UT', '84770', '4356739653', NULL, '630 S 400 E', 'St George', '', 'UT', '847703765', '', '', 'WUSTGEIPA', 'WUSTDHCPC5', NULL, '0.00', '25.00', NULL, 3, '2007-01-01', '2007-06-30', 0, NULL, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1487667473', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77010658', 'S77010658', 'UT01', NULL, 'Richard', 'Mark', 'Albright', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', NULL, NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1013050707', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77010659', 'S77010659', 'UT01', 'Chiropractic Health Plan', 'Ryan', 'C', 'Brewer', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', '8013527270', '8013527024', '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-04-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '929573', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77010661', 'S77010661', 'UT01', 'Labrum Chiropractic', 'I Clark', NULL, 'Labrum', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '415 W Tabernacle St', 'St George', 'Washington', 'UT', '84770', '4356732700', '4356732714', '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000833543', 0, 'N', 0, '2006-12-20', 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
('870396036', 'S77010662', 'S77010662', 'UT01', 'Enterprise Valley Medical Clinic', 'William', 'T', 'Graff', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 370', 'Enterprise', 'Washington', 'UT', '84725', '4358782281', '4358782434', 'PO Box 370', 'Enterprise', 'Washington', 'UT', '84725', '4358782281', '4358782434', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', '2014-07-25', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1487667473', 0, 'Y', 0, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
('870396036', 'S77010663', 'S77010663', 'UT01', 'Enterprise Valley Medical Clinic', 'Lisa', 'A', 'Griffin', 'PA', 'Family Practice', NULL, NULL, NULL, 'O', '223 S 200 E', 'Enterprise', 'Washington', 'UT', '84725', '4358782281', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '831901', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77010664', 'S77010664', 'UT01', NULL, 'Robert', 'S', 'McKnight', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', NULL, NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1508876533', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77010665', 'S77010665', 'UT01', NULL, 'David', 'R', 'Middleton', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', NULL, NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834372', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870398281', 'S77010666', 'S77010666', 'UT01', 'Canyonland Pediatrics', 'Christian', 'Y', 'Herrera', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '1490 E Foremaster Dr Ste 130', 'St George', 'Washington', 'UT', '84790', '4356340055', NULL, '1490 E Foremaster', 'St George', '', 'UT', '84790', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-06-30', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '831282', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870398281', 'S77010667', 'S77010667', 'UT01', 'Canyonland Pediatrics', 'Wendell', 'T', 'Nilson', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '1490 E Foremaster Dr Ste 130', 'St George', 'Washington', 'UT', '84790', '4356340055', NULL, '1490 E Foremaster', 'St George', '', 'UT', '84790', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-06-30', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1205883576', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77010668', 'S77010668', 'UT01', 'Zion Chiropractic Neurology Assoc', 'Justin', 'W', 'Salmon', 'DC', 'Chiropractic', '', '', NULL, 'O', '301 N 200 E Ste 1B', 'St George', 'Washington', 'UT', '84770', '4356742626', '4356285999', '867 E 9400 S', 'Sandy', 'Washington', 'UT', '84094', '4356742626', '4356285999', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-04-15', NULL, 0, NULL, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1013993815', 0, 'N', 0, '2006-12-20', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77010669', 'S77010669', 'UT01', NULL, 'Michael', NULL, 'Hobson', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', NULL, NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1417047507', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77010670', 'S77010670', 'UT01', NULL, 'Victor', 'L', 'Tebbs', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '15 N 200 W', 'Hurricane', 'Washington', 'UT', '84737', '4356354688', '4356354689', '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1164559266', 0, 'N', 0, '2006-12-20', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77010671', 'S77010671', 'UT01', NULL, 'Walter', 'W', 'Wagner', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '10 N 400 E', 'St George', 'Washington', 'UT', '84790', '4356564441', '4356565060', '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1396894622', 0, 'N', 0, '2006-12-20', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77010672', 'S77010672', 'UT01', NULL, 'Ward', 'W', 'Wagner', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', NULL, NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1710996418', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77010673', 'S77010673', 'UT01', NULL, 'Nathan', 'R', 'Neeley', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', '8013527270', '8013527024', '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1932185717', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870396036', 'S77010674', 'S77010674', 'UT01', 'Enterprise Valley Medical Clinic', 'William', 'T', 'Graff', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '223 S 200 E', 'Enterprise', 'Washington', 'UT', '84725', '4358782281', '          ', '223 S 200 E', 'Enterprise', 'Washington', 'UT', '84725', '4358782281', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', '2014-07-25', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1487667473', 0, 'N', 0, '2014-07-15', NULL, NULL, 37.5736, -113.719, NULL, NULL),
('870395551', 'S77010675', 'S77010675', 'UT01', '', 'Brian', 'T', 'Richey', 'DC', 'Chiropractic', '', '', NULL, 'O', '301 N 200 E Ste 1B', 'St George', 'Washington', 'UT', '84770', '4356742626', '4356285999', '867 E 9400 S', 'Sandy', 'Washington', 'UT', '84094', '4356742626', '4356285999', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-04-15', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1043296221', 0, 'N', 0, '2010-07-16', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77010676', 'S77010676', 'UT01', '', 'John', 'C', 'Romney', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '965 S Main St Ste A', 'Cedar City', 'Iron', 'UT', '84720', '4355869904', '4355869648', '867 E 9400 S', 'Sandy', 'Iron', 'UT', '84094', '4355869904', '4355869648', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1982640454', 0, 'N', 0, '2011-06-29', NULL, NULL, 0, 0, NULL, NULL),
('870414618', 'S77010677', 'S77010677', 'UT01', 'Foot and Ankle Institute', 'Andrew', 'B', 'Powell', 'DPM', 'Podiatry', NULL, NULL, NULL, 'O', '340 Falconridge Pkwy Ste 300 A', 'Mesquite', 'Clark', 'NV', '89027', '7023467678', NULL, '340 Falconridge Pkwy Ste 300 A', 'Mesquite', 'Clark', 'NV', '89027', '7023467678', '', 'WURURAL10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1861499568', 0, 'N', 0, '2013-12-18', NULL, NULL, 36.8077, -114.113, NULL, NULL),
('870395551', 'S77010678', 'S77010678', 'UT01', 'Zion Chiropractic Neurology Assoc', 'Carl', 'Kirk', 'Salmon', 'DC', 'Chiropractic', '', '', NULL, 'O', '301 N 200 E Ste 1B', 'St George', 'Washington', 'UT', '84770', '4356742626', '4356285999', '301 N 200 E Ste 1B', 'St George', 'Washington', 'UT', '84770', '4356742626', '4356285999', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730165606', 0, 'N', 0, '2013-09-25', NULL, NULL, 0, 0, NULL, NULL),
('870396036', 'S77010679', 'S77010679', 'UT01', 'Enterprise Valley Medical Clinic', 'James', 'R', 'Martin', 'PA', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 370', 'Enterprise', 'Washington', 'UT', '84725', '4358782281', '4358782434', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '831902', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870414618', 'S77010680', 'S77010680', 'UT01', 'Foot and Ankle Institute', 'Andrew', 'B', 'Powell', 'DPM', 'Podiatry', NULL, NULL, NULL, 'O', '754 S Main St Ste 3', 'St George', 'Washington', 'UT', '84770', '4356282671', NULL, '754 S Main St Ste 3', 'St George', 'Washington', 'UT', '84770', '4356282671', '', 'WURURAL10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1861499568', 0, 'N', 0, '2013-12-18', NULL, NULL, 37.0954, -113.583, NULL, NULL),
('870414618', 'S77010681', 'S77010681', 'UT01', 'Foot And Ankle Institute', 'Keith', 'R', 'Reber', 'DPM', 'Podiatry', NULL, NULL, NULL, 'B', '754 S Main St Ste 3', 'St George', 'Washington', 'UT', '84770', '4356282671', NULL, '754 S Main St', 'St George', '', 'UT', '84770', '', '', 'WURURAL10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-01-01', '2007-03-01', 0, NULL, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1669479358', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870414618', 'S77010682', 'S77010682', 'UT01', 'Foot and Ankle Institute', 'Lary', 'J', 'Smith', 'DPM', 'Podiatry', NULL, NULL, NULL, 'O', '340 Falconridge Pkwy Ste 300 A', 'Mesquite', 'Clark', 'NV', '89027', '7023467678', NULL, '340 Falconridge Pkwy Ste 300 A', 'Mesquite', 'Clark', 'NV', '89027', '7023467678', '          ', 'WURURAL10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1093713539', 0, 'N', 0, '2013-12-18', NULL, NULL, 36.8077, -114.113, NULL, NULL),
('870424089', 'S77010683', 'S77010683', 'UT01', NULL, 'Richard', 'W', 'Wintch', 'MD', 'General Surgery', NULL, NULL, NULL, 'O', '515 S 300 E Ste 203', 'St George', 'Washington', 'UT', '84770', '4356284489', NULL, '515 S 300 E', 'St George', '', 'UT', '847703900', '', '', 'WUSTGEIPA', 'WUSTDHCPC5', NULL, '0.00', '25.00', NULL, 3, '2007-01-01', '2007-06-30', 0, NULL, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1619992807', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870414618', 'S77010686', 'S77010686', 'UT01', 'Foot And Ankle Institute', 'S Kent', NULL, 'Burton', 'DPM', 'Podiatry', NULL, NULL, NULL, 'B', '754 S Main St Ste 3', 'St George', 'Washington', 'UT', '84770', '4356282671', NULL, '754 S Main St', 'St George', '', 'UT', '84770', '', '', 'WURURAL10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-01-01', '2007-03-01', 0, NULL, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1306843099', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870414618', 'S77010687', 'S77010687', 'UT01', 'Foot and Ankle Institute', 'S', 'K', 'Burton', 'DPM', 'Podiatry', NULL, NULL, NULL, 'O', '754 S Main St Ste 3', 'St George', 'Washington', 'UT', '84770', '4356282671', NULL, '754 S Main St Ste 3', 'St George', 'Washington', 'UT', '84770', '4356282671', '', 'WURURAL10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1306843099', 0, 'N', 0, '2013-08-21', NULL, NULL, 37.0954, -113.583, NULL, NULL),
('870414618', 'S77010688', 'S77010688', 'UT01', 'Foot and Ankle Institute', 'Keith', 'R', 'Reber', 'DPM', 'Podiatry', '', '', NULL, 'O', '754 S Main St Ste 3', 'St George', 'Washington', 'UT', '84770', '4356282671', NULL, '754 S Main St', 'St George', 'Washington', 'UT', '84770', '4356282671', '', 'WURURAL10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, NULL, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1669479358', 0, 'N', 0, '2011-12-15', NULL, NULL, 37.0954, -113.583, NULL, NULL),
('870414618', 'S77010689', 'S77010689', 'UT01', 'Foot And Ankle Institute', 'Carl', 'C', 'VanGils', 'DPM', 'Podiatry', NULL, NULL, NULL, 'B', '754 S Main St Ste 3', 'St George', 'Washington', 'UT', '84770', '4356282671', NULL, '754 S Main St', 'St George', '', 'UT', '84770', '', '', 'WURURAL10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-01-01', '2007-03-01', 0, NULL, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1518964212', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870452360', 'S77010690', 'S77010690', 'UT01', '', 'David', 'P', 'Henrie', 'MD', 'Family Practice', '', '', NULL, 'O', '130 White Sage Ave', 'Delta', 'Millard', 'UT', '84624', '4358642708', '4358642855', '130 White Sage Ave', 'Delta', 'Millard', 'UT', '84624', '4358642708', '4358642855', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', '2010-11-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427016815', 0, 'Y', 0, '2014-03-03', NULL, NULL, 0, 0, NULL, NULL),
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('870675814', 'S77010900', 'S77010900', 'UT01', 'Richens Eye Center', 'Sharon', '', 'Richens', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '619 S Bluff St Ste 1B', 'St George', 'Washington', 'UT', '84770', '4356524040', '4356524041', '619 S Bluff St', 'St George', 'Washington', 'UT', '84770', '4356524040', '4356524041', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2011-08-16', NULL, 0, NULL, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1497769368', 0, 'N', 0, '2011-11-14', NULL, NULL, 0, 0, NULL, NULL),
('870671766', 'S77010909', 'S77010909', 'UT01', 'Heart Of Dixie Cardiovascular Diagnostics', 'Gregory', NULL, 'Price', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'B', '736 S 900 E Ste 108', 'St George', 'Washington', 'UT', '84790', '4356344283', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '833325', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('870673378', 'S77010911', 'S77010911', 'UT01', 'Collins-Kronmiller Urologic', 'Dean', 'L', 'Bristow', 'MD', 'Urology', NULL, NULL, NULL, 'O', '140 White Sage Ave', 'Delta', 'Millard', 'UT', '84624', '8014652511', NULL, '140 White Sage Ave', 'Delta', 'Millard', 'UT', '84624', '8014652511', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2010-01-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255442976', 0, 'N', 0, '2010-06-08', NULL, NULL, 0, 0, NULL, NULL),
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('870675605', 'S77010917', 'S77010917', 'UT01', NULL, 'David', 'C', 'Boorman', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '736 S 900 E Ste 107', 'St George', 'Washington', 'UT', '84790', '4356348383', NULL, '736 S 900 E Ste 107', 'St George', 'Washington', 'UT', '84790', '4356348383', '', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', '2008-07-01', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1659344471', 0, 'N', 0, '2013-10-31', NULL, NULL, 0, 0, NULL, NULL),
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('870484695', 'S77010977', 'S77010977', 'UT01', 'Delta Family Medicine', 'Alan', 'Ross', 'Smith', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '140 White Sage Ave', 'Delta', 'Millard', 'UT', '84624', '4358643333', NULL, '140 S White Sage Ave', 'Delta', '', 'UT', '84624', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'Delta Community Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1518069020', 0, 'N', 0, '2006-12-20', NULL, NULL, 39.3504, -112.56, NULL, NULL),
('870499792', 'S77010995', 'S77010995', 'UT01', 'Southwest Surgical Associates', 'J Jared', '', 'Speakman', 'MD', 'General Surgery', '', '', NULL, 'O', '1490 E Foremaster Dr Ste 200', 'St George', 'Washington', 'UT', '84790', '4356281641', '4356281660', '1490 E Foremaster Dr Ste 200', 'St George', 'Washington', 'UT', '84790', '4356281641', '4356281660', 'WUSTGEIPA', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2007-01-01', '2013-06-30', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639279573', 0, 'N', 0, '2014-01-30', NULL, NULL, 0, 0, NULL, NULL),
('870499792', 'S77010996', 'S77010996', 'UT01', 'Southwest Surgical Associates', 'Bruce', 'C', 'Williams', 'MD', 'General Surgery', NULL, NULL, NULL, 'O', '1490 E Foremaster Dr Ste 200', 'St George', 'Washington', 'UT', '84790', '4356281641', '4356281660', '1490 E Foremaster Dr Ste 200', 'St George', 'Washington', 'UT', '84790', '4356281641', '4356281660', 'WUSTGEIPA', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2007-01-01', '2013-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306946231', 0, 'N', 0, '2013-10-25', NULL, NULL, 0, 0, NULL, NULL),
('870532769', 'S77010997', 'S77010997', 'UT01', NULL, 'Kent', 'B', 'McDonald', 'MD', 'Hospitalist', '', '', NULL, 'O', '515 S 300 E Ste 105', 'St George', 'Washington', 'UT', '84770', '4356282814', NULL, '515 S 300 E Ste 105', 'St George', 'Washington', 'UT', '84770', '4356282814', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1093794554', 0, 'N', 0, '2012-05-29', NULL, NULL, 37.0994, -113.577, NULL, NULL),
('870543318', 'S77010998', 'S77010998', 'UT01', 'Mountain West Gastroenterology', 'Lee', 'J', 'Hixson', 'MD', 'Gastroenterology', NULL, NULL, NULL, 'B', '6360 S 3000 E Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019443188', '8019443180', '6360 S 3000 E Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019443188', '8019443180', 'WCSTMTWEST5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2013-12-31', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1952314593', 0, 'Y', 0, '2013-12-18', NULL, NULL, 0, 0, NULL, NULL),
('870544237', 'S77010999', 'S77010999', 'UT01', NULL, 'Michael', 'R', 'Green', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'B', '1490 E Foremaster Dr Ste 260', 'St George', 'Washington', 'UT', '84790', '4356880156', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1356384226', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870545030', 'S77011000', 'S77011000', 'UT01', 'Advanced Foot & Ankle', 'Russell', 'G', 'Olsen', 'DPM', 'Podiatry', NULL, NULL, NULL, 'O', '1490 E Foremaster Dr Ste 250', 'St George', 'Washington', 'UT', '84770', '4356349225', '4358671909', '1811 W Royal Hunte Dr', 'Cedar City', '', 'UT', '84720', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2008-07-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1639178882', 0, 'N', 0, '2006-12-20', NULL, NULL, 0, 0, NULL, NULL),
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('870547628', 'S77011003', 'S77011003', 'UT01', NULL, 'Lynn', 'R', 'Nimer', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1380 E Medical Ctr Dr Ste 3500', 'St George', 'Washington', 'UT', '84790', '4352512150', '4352512151', '1380 E Medical Ctr Dr Ste 3500', 'St George', 'Washington', 'UT', '84790', '4352512150', '4352512151', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1689635922', 0, 'N', 0, '2012-04-10', NULL, NULL, 37.0998, -113.554, NULL, NULL),
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('870560452', 'S77011006', 'S77011006', 'UT01', NULL, 'Gary', 'V', 'Petersen', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'B', '736 S 900 E Ste 108', 'St George', 'Washington', 'UT', '84790', '4356344283', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1295775971', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870560452', 'S77011007', 'S77011007', 'UT01', NULL, 'Julie', 'Lynn', 'Porter', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'B', '736 S 900 E Ste 108', 'St George', 'Washington', 'UT', '84790', '4356344283', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '835658', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870562879', 'S77011008', 'S77011008', 'UT01', 'Urology Associates', 'Ronald', 'H', 'Crouch', 'MD', 'Urology', '', '', NULL, 'O', '1303 N Main St Ste D', 'Cedar City', 'Iron', 'UT', '84721', '4358670325', '4355868202', '1303 N Main St Ste D', 'Cedar City', 'Iron', 'UT', '84721', '4358670325', '4355868202', 'WiseSTD10A', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Valley View Medical Center', 'Dixie Regional Medical Center', '', '', 'HCFA|UB|', '1952342248', 0, 'N', 0, '2013-10-03', NULL, NULL, 37.7003, -113.064, NULL, NULL),
('870562879', 'S77011009', 'S77011009', 'UT01', 'Urology Associates', 'J', 'B', 'Ellsworth', 'MD', 'Urology', NULL, NULL, NULL, 'O', '391 E 500 S', 'St George', 'Washington', 'UT', '84770', '4356283606', NULL, '391 E 500 S', 'St George', 'Washington', 'UT', '84770', '4356283606', '          ', 'WiseSTD10A', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2012-02-29', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1083619043', 0, 'N', 0, '2012-07-06', 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
('870570100', 'S77011010', 'S77011010', 'UT01', NULL, 'Raymond', 'K', 'Hinton', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '195 W Telegraph St', 'Washington', 'Washington', 'UT', '84780', '4356284444', NULL, '195 W Telegraph St', 'Washington', '', 'UT', '847801675', '', '', 'WUSTGEIPA', 'WUSTDHCPC5', NULL, '0.00', '25.00', NULL, 3, '2007-01-01', '2007-06-30', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1609978345', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870609622', 'S77011014', 'S77011014', 'UT01', 'Snow Canyon Clinic', 'Barry', 'R', 'Fleischer', 'DO', 'Neurology', NULL, NULL, NULL, 'O', '272 E Ctr St', 'Ivins', 'Washington', 'UT', '84738', '4359862300', '4356563850', '272 E Center St', 'Ivins', 'Washington', 'UT', '84738', '4359862300', '4356563850', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', '2009-05-12', NULL, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1578520409', 0, 'N', 0, '2010-10-28', NULL, NULL, 0, 0, NULL, NULL),
('870609622', 'S77011015', 'S77011015', 'UT01', 'Snow Canyon Clinic', 'Michael', 'S', 'Harlan', 'PA', 'Cardiovascular Disease', NULL, NULL, NULL, 'B', '272 E Ctr St Ste 101', 'Ivins', 'Washington', 'UT', '84738', '4356564477', '4356563850', '272 E Center St', 'Ivins', '', 'UT', '84738', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '920848', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870609622', 'S77011016', 'S77011016', 'UT01', 'Snow Canyon Clinic', 'Steven', 'B', 'Davis', 'MD', 'Radiologist', '', '', NULL, 'O', '272 E Ctr St', 'Ivins', 'Washington', 'UT', '84738', '4359862300', '4356563850', '272 E Ctr St', 'Ivins', 'Washington', 'UT', '84738', '4359862300', '4356563850', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', '2014-03-31', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1467471284', 0, 'Y', 0, '2014-05-21', NULL, NULL, 37.1684, -113.673, NULL, NULL),
('870609622', 'S77011017', 'S77011017', 'UT01', 'Snow Canyon Clinic', 'Gary', 'L', 'Jones', 'MD', 'Neurology', '', '', NULL, 'O', '272 E Ctr St', 'Ivins', 'Washington', 'UT', '84738', '4359862300', '4356563850', '272 E Ctr St', 'Ivins', 'Washington', 'UT', '84738', '4359862300', '4356563850', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', '2014-03-31', 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1770540619', 0, 'N', 0, '2014-05-21', NULL, NULL, 37.1684, -113.673, NULL, NULL),
('870609622', 'S77011018', 'S77011018', 'UT01', 'Snow Canyon Clinic', 'Raymond', NULL, 'Middleton', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '272 E Ctr St', 'Ivins', 'Washington', 'UT', '84738', '4359862300', '4356563850', '272 E Ctr St', 'Ivins', 'Washington', 'UT', '84738', '4359862300', '4356563850', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', '2013-07-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1083670459', 0, 'N', 0, '2013-08-19', NULL, NULL, 0, 0, NULL, NULL),
('870628665', 'S77011019', 'S77011019', 'UT01', 'Southern Utah Ear Nose & Throat', 'Steven', 'P', 'Chase', 'MD', 'Ear, Nose and Throat', NULL, NULL, NULL, 'O', '1490 E Foremaster Dr Ste 350', 'St George', 'Washington', 'UT', '84790', '4356283334', '4356283375', '1490 E Foremaster', 'St George', '', 'UT', '84790', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2007-06-30', 0, NULL, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1831108042', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870629019', 'S77011020', 'S77011020', 'UT01', '', 'Robert', 'D', 'Pearson', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '1870 N Main St Ste 104', 'Cedar City', 'Iron', 'UT', '84720', '4358678719', NULL, '1870 N Main St Ste 104', 'Cedar City', 'Iron', 'UT', '84720', '4358678719', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2011-05-23', 0, 0, 0, 'Valley View Medical Center', '', '', '', 'HCFA|UB|', '1295793834', 0, 'N', 0, '2014-06-17', NULL, NULL, 0, 0, NULL, NULL),
('870631032', 'S77011021', 'S77011021', 'UT01', NULL, 'G', 'Paul', 'Doxey', 'MD', 'Ear, Nose and Throat', NULL, NULL, NULL, 'B', '736 S 900 E Ste 201', 'St George', 'Washington', 'UT', '84790', '4356283342', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1245298959', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870637137', 'S77011022', 'S77011022', 'UT01', 'Hunt Vision Center', 'Mark', 'T', 'Hunt', 'OD', 'Optometry', NULL, NULL, NULL, 'O', '223 S 200 E', 'Enterprise', 'Washington', 'UT', '84725', '4356283019', '4356283562', NULL, NULL, '', NULL, NULL, '', '', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1457334740', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870639304', 'S77011023', 'S77011023', 'UT01', NULL, 'Kathleen', 'M', 'Daly', 'MD', 'Pain Management', NULL, NULL, NULL, 'O', '301 N 200 E Ste 2A', 'St George', 'Washington', 'UT', '84770', '4356887246', '4356881363', NULL, NULL, '', NULL, NULL, '', '', 'WUSTDPAIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-01-01', '2007-02-28', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1063403723', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('528085375', 'S77011108', 'S77011108', 'UT01', NULL, 'Robert', 'W', 'Keller', 'OD', 'Optometry', 'Optometry', NULL, NULL, 'O', '2535 S State St', 'Salt Lake City', 'Salt Lake', 'UT', '84115', '8014665611', '8014665638', '2535 S State St', 'Salt Lake City', 'Salt Lake', 'UT', '841153109', '8014665611', '8014665638', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1376503730', 0, 'N', 0, '2011-11-08', NULL, NULL, 40.7155, -111.888, NULL, NULL),
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('621801973', 'S77011113', 'S77011113', 'UT01', 'Associates in Orthopedic Surgery', 'J Lynn', NULL, 'Smith', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '3336 Pioneer Pkwy Ste 203', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643925', '8019643928', 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|', '1548293400', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('731698522', 'S77011114', 'S77011114', 'UT01', 'Tooele Orthopaedics & Sports Medicine Specialists', 'Scott', 'E', 'Bruderer', 'PA', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '2356 N 400 E Ste 102', 'Tooele', 'Tooele', 'UT', '84074', '4358339180', '4358339177', '2356 N 400 E', 'Tooele', 'Tooele', 'UT', '84074', '4358339180', '4358339177', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, NULL, 0, 0, 'Mountain West Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1003988205', 0, 'N', 0, '2010-09-20', NULL, NULL, 40.5621, -112.293, NULL, NULL),
('753187000', 'S77011119', 'S77011119', 'UT01', NULL, 'Jory', 'T', 'Kimball', 'OD', 'Optometry', NULL, NULL, NULL, 'O', '8806 S Redwood Rd Ste 101', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015782020', '8017484892', '8806 S Redwood Rd Ste 101', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015782020', '8017484892', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962592782', 0, 'N', 0, '2013-03-11', NULL, NULL, 40.592, -111.939, NULL, NULL),
('870462018', 'S77011120', 'S77011120', 'UT01', 'Healthy Eyes for Life', 'Todd', 'E', 'Kimball', 'OD', 'Optometry', NULL, NULL, NULL, 'O', '8806 S Redwood Rd Ste 101', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015782020', '8017484892', '2178 S 900 E', 'Salt Lake City', '', 'UT', '84106', '', '', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1932292281', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('810608733', 'S77011121', 'S77011121', 'UT01', 'Nexus Pain Care', 'Jay', 'E', 'Rosenfeld', 'MD', 'Pain Management', 'Physical Medicine and Rehabilitation', NULL, NULL, 'B', 'PO Box 27688', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8015341360', NULL, '3585 N University Ave', 'Provo', '', 'UT', '84604', '', '', 'WUSTDPAIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '952514', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('810608733', 'S77011122', 'S77011122', 'UT01', 'Nexus Pain Care', 'Jay', 'E', 'Rosenfeld', 'MD', 'Pain Management', 'Physical Medicine and Rehabilitation', NULL, NULL, 'O', '3585 N University Ave Ste 150', 'Provo', 'Utah', 'UT', '84604', '8013566100', NULL, '3585 N University Ave', 'Provo', '', 'UT', '84604', '', '', 'WUSTDPAIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '952514', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('870286381', 'S77011134', 'S77011134', 'UT01', 'Ogden Clinic', 'Edward', 'A', 'Jordan', 'MD', 'General Surgery', NULL, NULL, NULL, 'O', '6112 S 1550 E Ste 101', 'Ogden', 'Weber', 'UT', '84405', '8014768688', NULL, '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014768688', '', 'WUOGDCLIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2006-08-01', NULL, NULL, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1740277599', 0, 'N', 0, '2012-01-04', NULL, NULL, 41.1523, -111.94, NULL, NULL),
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('870345870', 'S77011143', 'S77011143', 'UT01', 'Eye Clinic & Contact Lens Center of Utah Valley', 'Roland', 'K', 'Monson', 'OD', 'Optometry', NULL, NULL, NULL, 'O', '2230 N University Pkwy Ste 10A', 'Provo', 'Utah', 'UT', '84604', '8013734550', '8013738634', '2230 N University Pkwy Ste 10A', 'Provo', 'Utah', 'UT', '84604', '8013734550', '8013738634', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811952799', 0, 'N', 0, '2012-10-17', NULL, NULL, 40.2621, -111.666, NULL, NULL),
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('870378810', 'S77011145', 'S77011145', 'UT01', NULL, 'Spencer', 'D', 'Mortensen', 'OD', 'Optometry', NULL, NULL, NULL, 'O', '462 E 100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015325176', '8015325179', '462 E 100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015325176', '8015325179', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548321078', 0, 'N', 0, '2013-04-29', NULL, NULL, 40.7672, -111.878, NULL, NULL),
('870382132', 'S77011147', 'S77011147', 'UT01', 'Sandy Vision Care Center', 'Howard', 'A', 'Katzman', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '9035 S 1300 E Ste 100', 'Sandy', 'Salt Lake', 'UT', '84094', '8015664119', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1760492912', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77011148', 'S77011148', 'UT01', NULL, 'Theodore', 'Allan', 'Kyle', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', '8013527270', '8013527024', '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '833502', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77011149', 'S77011149', 'UT01', NULL, 'Theodore (Ted)', 'Allan', 'Kyle', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '2618 W 7800 S Ste 200', 'West Jordan', 'Salt Lake', 'UT', '84088', '8019671400', '8015621534', '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2006-04-01', '2009-05-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000833502', 0, 'N', 0, '2006-08-31', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77011150', 'S77011150', 'UT01', NULL, 'Loral', 'G', 'Linton', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', '8013527270', '8013527024', '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1194894501', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77011151', 'S77011151', 'UT01', '', 'Loral', 'G', 'Linton', 'DC', 'Chiropractic', '', '', NULL, 'O', '662 S Hwy 89 Ste A', 'Kanab', 'Kane', 'UT', '84741', '4356445296', NULL, '662 S Hwy 89 Ste A', 'Kanab', 'Kane', 'UT', '84741', '4356445296', '', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194894501', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77011152', 'S77011152', 'UT01', NULL, 'Rett', 'W', 'Roberts', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', '8013527270', '8013527024', '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1407838139', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77011153', 'S77011153', 'UT01', 'Tooele Valley Spine Center', 'Rett', 'W', 'Roberts', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '1244 N Main St Ste 100', 'Tooele', 'Tooele', 'UT', '84074', '4358339200', '4358339223', '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1407838139', 0, 'N', 0, '2006-08-31', NULL, NULL, 0, 0, NULL, NULL),
('870423799', 'S77011156', 'S77011156', 'UT01', 'Eyecare Associates', 'Angela', 'D', 'Hill', 'OD', 'Optometry', '', '', NULL, 'O', '7400 Union Park Ave Ste 202', 'Midvale', 'Salt Lake', 'UT', '84047', '8015693698', '8015690578', '7400 Union Park Ave Ste 202', 'Midvale', 'Salt Lake', 'UT', '84047', '8015693698', '8015690578', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982613865', 0, 'N', 0, '2014-07-21', NULL, NULL, 40.6168, -111.859, NULL, NULL),
('870459414', 'S77011171', 'S77011171', 'UT01', 'Allergy Associates of Utah', 'Charles', 'M', 'Rogers', 'MD', 'Allergy and Immunology', NULL, NULL, NULL, 'B', '6095 Fashion Blvd Ste 100', 'Murray', 'Salt Lake', 'UT', '84107', '8012638700', '8012638693', '6095 Fashion Blvd', 'Murray', '', 'UT', '84107', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 0, 'Jordan Valley Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1912906330', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870459414', 'S77011172', 'S77011172', 'UT01', 'Allergy Associates of Utah', 'Charles', 'M', 'Rogers', 'MD', 'Allergy and Immunology', NULL, NULL, NULL, 'O', '3855 W 7800 S Ste 225', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012828700', NULL, '3855 W 7800 S Ste 225', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012828700', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1912906330', 0, 'N', 0, '2012-05-30', NULL, NULL, 40.6094, -111.983, NULL, NULL),
('870462018', 'S77011173', 'S77011173', 'UT01', 'Sugarhouse Vision Clinic', 'Jory', 'T', 'Kimball', 'OD', 'Optometry', NULL, NULL, NULL, 'O', '2178 S 900 E Ste 4', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014842020', '8014662865', '2178 S 900 E Ste 4', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014842020', '8014662865', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962592782', 0, 'N', 0, '2013-03-11', NULL, NULL, 40.7237, -111.865, NULL, NULL),
('870462018', 'S77011174', 'S77011174', 'UT01', 'Sugarhouse Vision Clinic', 'Todd', 'E', 'Kimball', 'OD', 'Optometry', NULL, NULL, NULL, 'O', '2178 S 900 E Ste 4', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014842020', '8014662865', '2178 S 900 E Ste 4', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014842020', '8014662865', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932292281', 0, 'N', 0, '2013-07-11', NULL, NULL, 40.7237, -111.865, NULL, NULL),
('870465532', 'S77011175', 'S77011175', 'UT01', NULL, 'Ronald', 'M', 'Pugh', 'OD', 'Optometry', NULL, NULL, NULL, 'B', '2696 N University Ave Ste 100A', 'Provo', 'Utah', 'UT', '84604', '8013730440', '8013732144', '2696 N University Ave', 'Provo', '', 'UT', '84064', '', '', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1013012715', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870465532', 'S77011176', 'S77011176', 'UT01', NULL, 'Ronald', 'M', 'Pugh', 'OD', 'Optometry', NULL, NULL, NULL, 'O', '2696 N University Ave Ste 100A', 'Provo', 'Utah', 'UT', '84604', '8013730440', '8013732144', '2696 N University Ave Ste 100A', 'Provo', 'Utah', 'UT', '84604', '8013730440', '8013732144', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013012715', 0, 'N', 0, '2012-06-25', NULL, NULL, 40.2743, -111.657, NULL, NULL),
('870465532', 'S77011177', 'S77011177', 'UT01', '', 'Ronald', 'M', 'Pugh', 'OD', 'Optometry', NULL, NULL, NULL, 'O', '325 W Ctr St', 'Spanish Fork', 'Utah', 'UT', '84660', '8017987496', '8013732144', '325 W Ctr St', 'Spanish Fork', 'Utah', 'UT', '84660', '8017987496', '8013732144', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', '2011-10-27', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013012715', 0, 'N', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
('870469325', 'S77011181', 'S77011181', 'UT01', NULL, 'Bradley', 'V', 'Fellows', 'OD', 'Optometry', '', '', NULL, 'O', '9035 S 1300 E Ste 100', 'Sandy', 'Salt Lake', 'UT', '84094', '8015664119', '8015683844', '9035 S 1300 E Ste 100', 'Sandy', 'Salt Lake', 'UT', '84094', '8015664119', '8015683844', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', '2008-09-25', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841473295', 0, 'N', 0, '2013-09-30', NULL, NULL, 0, 0, NULL, NULL),
('870469325', 'S77011182', 'S77011182', 'UT01', NULL, 'Bradley', 'V', 'Fellows', 'OD', 'Optometry', '', '', NULL, 'O', '12256 S 900 E Ste 401', 'Draper', 'Salt Lake', 'UT', '84020', '8016199494', '8015683844', '12256 S 900 E Ste 401', 'Draper', 'Salt Lake', 'UT', '84020', '8016199494', '8015683844', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', '2008-09-25', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841473295', 0, 'N', 0, '2013-09-30', NULL, NULL, 0, 0, NULL, NULL),
('870471766', 'S77011183', 'S77011183', 'UT01', 'Wasatch Vision Center', 'Bradley', 'B', 'Rounds', 'OD', 'Optometry', NULL, NULL, NULL, 'O', '454 N Main St', 'Heber City', 'Wasatch', 'UT', '84032', '4356541863', '4356570739', '454 N Main St', 'Heber City', '', 'UT', '840321440', '', '', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1265514988', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870479370', 'S77011196', 'S77011196', 'UT01', 'Mountain West Cardiovascular Associates', 'Pawan', 'K', 'Sharma', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '24 S 1100 E Ste 105', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8012663418', '8012664174', '1160 E 3900 S', 'Salt Lake City', '', 'UT', '84124', '', '', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-09-01', '2007-07-01', 0, NULL, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1114919073', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870479370', 'S77011198', 'S77011198', 'UT01', 'Mountain West Cardiovascular Associates', 'Cynthia', 'L', 'Bauman', 'FNP', 'Cardiovascular Disease', 'Family Practice', NULL, NULL, 'O', '1160 E 3900 S Ste 2000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012663418', '8012664174', '1160 E 3900 S', 'Salt Lake City', '', 'UT', '84124', '', '', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-09-01', '2006-12-08', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1770530495', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870479370', 'S77011199', 'S77011199', 'UT01', 'The Heart Center', 'Cynthia', 'L', 'Bauman', 'FNP', 'Cardiovascular Disease', 'Family Practice', NULL, NULL, 'O', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019681818', NULL, '1160 E 3900 S', 'Salt Lake City', '', 'UT', '84124', '', '', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1770530495', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870482436', 'S77011200', 'S77011200', 'UT01', 'Mountain West Eyecare', 'Michael', 'D', 'Brown', 'OD', 'Optometry', NULL, NULL, NULL, 'O', '2727 W 3500 S', 'West Valley', 'Salt Lake', 'UT', '84119', '8019686772', '8019686772', '2727 W 3500 S', 'West Valley', 'Salt Lake', 'UT', '84119', '8019686772', '8019686772', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1861541419', 0, 'N', 0, '2011-09-19', NULL, NULL, 40.6966, -111.959, NULL, NULL),
('870483958', 'S77011201', 'S77011201', 'UT01', 'Eye Foundation of Utah', 'Robert', 'P', 'Wooldridge', 'OD', 'Optometry', NULL, NULL, NULL, 'O', '201 E 5900 S Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012686408', '8012629216', '201 E 5900 S Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012686408', '8012629216', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013962828', 0, 'N', 0, '2013-11-26', NULL, NULL, 40.6426, -111.885, NULL, NULL),
('870485512', 'S77011202', 'S77011202', 'UT01', NULL, 'Michael', 'L', 'West', 'OD', 'Optometry', NULL, NULL, NULL, 'O', '650 Union Sq', 'Sandy', 'Salt Lake', 'UT', '84070', '8015723937', '8015729849', '650 Union Sq', 'Sandy', 'Salt Lake', 'UT', '84070', '8015723937', '8015729849', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730225608', 0, 'N', 0, '2013-04-30', NULL, NULL, 40.5793, -111.873, NULL, NULL),
('870507790', 'S77011205', 'S77011205', 'UT01', 'Advantage Eye Care', 'James', 'M', 'Abraham', 'OD', 'Optometry', '', '', NULL, 'O', '4995 S Atwood Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012880882', '8012880977', '4995 S Atwood Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012880882', '8012880977', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2013-11-05', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063597342', 0, 'N', 0, '2013-11-14', NULL, NULL, 0, 0, NULL, NULL),
('870513901', 'S77011206', 'S77011206', 'UT01', 'Redwood Vision Center', 'Kerry', 'A', 'Okelberry', 'OD', 'Optometry', '', '', NULL, 'O', '6705 Redwood Rd', 'West Jordan', 'Salt Lake', 'UT', '84084', '8012680866', '8012682092', '6705 Redwood Rd', 'West Jordan', 'Salt Lake', 'UT', '84084', '8012680866', '8012682092', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639264427', 0, 'N', 0, '2014-04-23', NULL, NULL, 40.6295, -111.939, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('870519691', 'S77011209', 'S77011209', 'UT01', 'Utah Cancer Specialists', 'Bruce', 'A', 'Bolonesi', 'PA', 'Hematology and Oncology', 'Oncology', '', NULL, 'B', '1121 E 3900 S Bldg C Ste 240', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012660878', '8012662074', '1121 E 3900 S Bldg C Ste 240', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012660878', '8012662074', 'WUSTDONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1619928199', 0, 'Y', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('870519691', 'S77011211', 'S77011211', 'UT01', 'Utah Cancer Specialists', 'Bruce', 'A', 'Bolonesi', 'PA', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '1034 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013578200', NULL, '1034 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013578200', '', 'WUSTDONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2010-07-02', 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1619928199', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('870519691', 'S77011212', 'S77011212', 'UT01', 'Utah Cancer Specialists', 'Bruce', 'A', 'Bolonesi', 'PA', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '5121 S Cottonwood St Bldg A Level 2', 'Murray', 'Salt Lake', 'UT', '84157', '8012633416', '8012633428', '5121 S Cottonwood St Bldg A Level 2', 'Murray', 'Salt Lake', 'UT', '84157', '8012633416', '8012633428', 'WUSTDONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2006-11-01', 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1619928199', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('870524027', 'S77011213', 'S77011213', 'UT01', '', 'Alan', 'T', 'Rees', 'OD', 'Optometry', '', '', NULL, 'O', '1706 N Heritage Park Blvd Ste 5', 'Layton', 'Davis', 'UT', '84041', '8017762020', '8017764321', '1706 N Heritage Park Blvd Ste 5', 'Layton', 'Davis', 'UT', '84041', '8017762020', '8017764321', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194854265', 0, 'N', 0, '2014-01-17', NULL, NULL, 41.0846, -111.988, NULL, NULL),
('870536032', 'S77011214', 'S77011214', 'UT01', 'Jordan Valley Family Health', 'Caryn', 'M', 'Slack', 'MD', 'Family Practice', '', '', NULL, 'O', '3570 W 9000 S Ste 100', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', '3570 W 9000 S Ste 100', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2011-09-28', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1689619124', 0, 'N', 0, '2014-04-10', NULL, NULL, 0, 0, NULL, NULL),
('870537951', 'S77011215', 'S77011215', 'UT01', NULL, 'Dale', 'F', 'Hardy', 'OD', 'Optometry', '', '', NULL, 'B', 'PO Box 95110', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012531374', '8012531672', 'PO Box 95110', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012531374', '8012531672', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356343487', 0, 'Y', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('870537951', 'S77011216', 'S77011216', 'UT01', NULL, 'Dale', 'F', 'Hardy', 'OD', 'Optometry', '', '', NULL, 'O', '10372 S Redwood Rd', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012531374', '8012531672', '10372 S Redwood Rd', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012531374', '8012531672', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356343487', 0, 'N', 0, '2014-04-24', NULL, NULL, 40.5641, -111.939, NULL, NULL),
('870550275', 'S77011218', 'S77011218', 'UT01', 'Cottonwood Pediatrics', 'Jenifer', 'L', 'Sandvig', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1689657082', 0, 'Y', 0, '2014-01-06', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77011219', 'S77011219', 'UT01', 'Wasatch Pediatrics at St Marks', 'Jenifer', 'L', 'Sandvig', 'MD', 'Pediatrics', '', '', NULL, 'O', '1140 E 3900 S Ste 360', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012648686', '8012648962', '1140 E 3900 S Ste 360', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012648686', '8012648962', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1689657082', 0, 'N', 0, '2014-01-06', NULL, NULL, 40.6871, -111.859, NULL, NULL),
('870550275', 'S77011221', 'S77011221', 'UT01', 'Wasatch Pediatrics', 'Kimberly', 'A', 'Balog', 'MD', 'Pediatrics', NULL, NULL, NULL, 'B', '7138 Highland Dr Ste 102', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019470830', '8019470864', '7138 S 2000 E', 'Salt Lake City', '', 'UT', '84121', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1891775871', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'S77011222', 'S77011222', 'UT01', 'Southpoint Pediatrics', 'Kimberly', 'A', 'Balog', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '9071 S 1300 W Ste 301', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015651162', NULL, '7138 S 2000 E', 'Salt Lake City', '', 'UT', '84121', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1891775871', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870552429', 'S77011223', 'S77011223', 'UT01', NULL, 'Mitchell', 'D', 'Peterson', 'OD', 'Optometry', '', '', NULL, 'O', '90 E Ctr St', 'Richfield', 'Sevier', 'UT', '84701', '4358965671', '4358960120', '90 E Ctr St', 'Richfield', 'Sevier', 'UT', '84701', '4358965671', '4358960120', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104993690', 0, 'N', 0, '2014-02-20', NULL, NULL, 38.7681, -112.083, NULL, NULL),
('870570160', 'S77011240', 'S77011240', 'UT01', 'Wasatch Vision Clinic', 'Craig', 'J', 'Cutler', 'OD', 'Optometry', NULL, NULL, NULL, 'O', '849 E 400 S', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013282020', '8013632201', '849 E 400 S', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013282020', '8013632201', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720056161', 0, 'N', 0, '2012-03-14', NULL, NULL, 40.7608, -111.867, NULL, NULL),
('870570160', 'S77011241', 'S77011241', 'UT01', 'Wasatch Vision Clinic', 'Cheryl', 'A', 'Torghele', 'OD', 'Optometry', '', '', NULL, 'O', '849 E 400 S', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013282020', '8013632201', '849 E 400 S', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013282020', '8013632201', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962416727', 0, 'N', 0, '2014-01-02', NULL, NULL, 40.7608, -111.867, NULL, NULL),
('870622942', 'S77011260', 'S77011260', 'UT01', 'Utah Imaging Associates', 'Mark', 'E', 'Fruin', 'MD', 'Radiologist', NULL, NULL, NULL, 'B', 'PO Box 1369', 'Bountiful', 'Davis', 'UT', '84011', '8012962113', '8012961715', 'PO Box 1369', 'Bountiful', 'Davis', 'UT', '84011', '8012962113', '8012961715', 'WUUTIMAGE5', NULL, NULL, '0.00', '35.00', '0.00', 3, '2006-04-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1578544797', 0, 'Y', 0, '2011-03-24', NULL, NULL, 0, 0, NULL, NULL),
('870635410', 'S77011261', 'S77011261', 'UT01', 'Timpanogos Vision Center', 'Kevin', 'J', 'Fromm', 'OD', 'Optometry', NULL, NULL, NULL, 'O', '5455 W 11000 N Ste 101', 'Highland', 'Utah', 'UT', '84003', '8017569357', '8017569358', '5455 W 11000 N Ste 101', 'Highland', 'Utah', 'UT', '84003', '8017569357', '8017569358', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659347144', 0, 'N', 0, '2013-11-18', NULL, NULL, 40.4319, -111.789, NULL, NULL),
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('870639098', 'S77011264', 'S77011264', 'UT01', 'After Hours Urgent Care American Fork', 'Rachot', '', 'Vacharathone', 'MD', 'Urgent Care', '', '', NULL, 'O', '476 N 900 W Ste C', 'American Fork', 'Utah', 'UT', '84003', '8014921611', '8014901480', '476 N 900 W Ste C', 'American Fork', 'Utah', 'UT', '84003', '8014921611', '8014901480', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', 'Pioneer Valley Hospital', '', '', 'HCFA|UB|', '1548228497', 0, 'Y', 0, '2014-05-30', NULL, NULL, 40.3961, -111.815, NULL, NULL),
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('550905164', 'S77011315', 'S77011315', 'UT01', '', 'G Stedman', '', 'Huard', 'MD', 'Vascular Surgery', '', '', NULL, 'O', '1490 E Foremaster Dr Ste 310', 'St George', 'Washington', 'UT', '84790', '4356881922', '4356881901', '1490 E Foremaster Dr Ste 310', 'St George', 'Washington', 'UT', '84790', '4356881922', '4356881901', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1124084587', 0, 'N', 0, '2014-07-25', NULL, NULL, 37.0959, -113.551, NULL, NULL),
('870395551', 'S77011316', 'S77011316', 'UT01', NULL, 'David', 'W', 'Muir', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', '8013527270', '8013527024', '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1477762466', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77011317', 'S77011317', 'UT01', NULL, 'David', 'W', 'Muir', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '285 W Tabernacle St', 'St George', 'Washington', 'UT', '84770', '4356349584', '4356349566', '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1477762466', 0, 'N', 0, '2006-12-20', NULL, NULL, 0, 0, NULL, NULL),
('870414618', 'S77011319', 'S77011319', 'UT01', 'Foot And Ankle Institute', 'Keith', 'R', 'Reber', 'DPM', 'Podiatry', NULL, NULL, NULL, 'O', '415 N Main St Ste 204', 'Cedar City', 'Iron', 'UT', '84720', '4355861112', NULL, '754 S Main St', 'St George', '', 'UT', '84770', '', '', 'WURURAL10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-01-01', '2007-03-01', 0, NULL, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1669479358', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('870516264', 'S77011411', 'S77011411', 'UT01', 'Utah County Surgical Associates', 'Bruce', 'B', 'Hill', 'MD', 'General Surgery', NULL, NULL, NULL, 'O', '1120 E 100 N Ste 1', 'Payson', 'Utah', 'UT', '84651', '8013749625', '8013737506', '1120 E 100 N Ste 1', 'Payson', 'Utah', 'UT', '84651', '8013749625', '8013737506', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-06-01', '2011-01-10', 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1699715664', 0, 'N', 0, '2013-05-06', NULL, NULL, 0, 0, NULL, NULL),
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('870617444', 'S77011423', 'S77011423', 'UT01', NULL, 'Robert', 'E', 'Nakken', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '166 W 1325 N Ste 150', 'Cedar City', 'Iron', 'UT', '84720', '4355866962', '4358671663', '166 W 1325 N Ste 150', 'Cedar City', 'Iron', 'UT', '84720', '4355866962', '4358671663', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Valley View Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1033244207', 0, 'N', 0, '2014-02-10', NULL, NULL, 37.7011, -113.065, NULL, NULL),
('870617733', 'S77011424', 'S77011424', 'UT01', 'Mt Ogden Eye Center', 'John', 'D', 'McCann', 'MD', 'Ophthalmology', 'Oculoplastic Surgery', NULL, NULL, 'B', 'PO Box 1529', 'Layton', 'Davis', 'UT', '84041', '8015933223', '8015939626', '4360 Washington Bvld', 'Ogden', '', 'UT', '84403', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, 'Salt Lake Regional Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1326006917', 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
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('870617733', 'S77011427', 'S77011427', 'UT01', 'Bountiful Hills Eye Center', 'John', 'D', 'McCann', 'MD', 'Ophthalmology', 'Oculoplastic Surgery', NULL, NULL, 'O', '1551 S Renaissance Towne Dr Ste 340', 'Bountiful', 'Davis', 'UT', '84010', '8016771122', NULL, '4360 Washington Bvld', 'Ogden', '', 'UT', '84403', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, 'Salt Lake Regional Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1326006917', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870621466', 'S77011429', 'S77011429', 'UT01', 'Sellers, Daniel S', 'Daniel', 'S', 'Sellers', 'MD', 'Plastic Surgery', 'Hand Surgery', NULL, NULL, 'O', '440 D St Ste 202', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8014082511', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUSTDPLAS5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1194750711', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('990243454', 'S77011440', 'S77011440', 'UT01', 'St George Regional Neurology', 'Taj', 'N', 'Becker', 'MD', 'Neurology', '', '', NULL, 'B', '620 S 400 E Ste 108', 'St George', 'Washington', 'UT', '84770', '4356280966', NULL, '620 S 400 E Ste 108', 'St George', 'Washington', 'UT', '84770', '4356280966', '', 'WUSTDNEUR5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1497976864', 0, 'Y', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('990243454', 'S77011441', 'S77011441', 'UT01', 'St George Regional Neurology', 'Taj', 'N', 'Becker', 'MD', 'Neurology', '', '', NULL, 'O', '736 S 900 E Ste 202', 'St George', 'Washington', 'UT', '84790', '4356887800', NULL, '736 S 900 E Ste 202', 'St George', 'Washington', 'UT', '84790', '4356887800', '', 'WUSTDNEUR5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1497976864', 0, 'N', 0, '2014-02-04', NULL, NULL, 37.0956, -113.564, NULL, NULL),
('870395551', 'S77011499', 'S77011499', 'UT01', NULL, 'Daniel', 'R', 'Guthrie', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', '8013527270', '8013527024', '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1972722916', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77011500', 'S77011500', 'UT01', NULL, 'Daniel', 'R', 'Guthrie', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '3856 W 5400 S Ste 120', 'Salt Lake City', 'Salt Lake', 'UT', '84118', '8019579696', '8019579694', '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1972722916', 0, 'N', 0, '2006-08-31', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77011501', 'S77011501', 'UT01', NULL, 'Tricia', 'A', 'Chepanoske', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', '8013527270', '8013527024', '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1457338279', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77011502', 'S77011502', 'UT01', NULL, 'Tricia', 'A', 'Chepanoske', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '715 E 3900 S Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8016850588', '8016856195', '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1457338279', 0, 'N', 0, '2006-08-31', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77011503', 'S77011503', 'UT01', NULL, 'Mark', 'V', 'Vosti', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', '8013527270', '8013527024', '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1669444303', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77011504', 'S77011504', 'UT01', NULL, 'Mark', 'V', 'Vosti', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '1101 Draper Pkwy', 'Draper', 'Salt Lake', 'UT', '84020', '8016196090', '8017480604', '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1669444303', 0, 'N', 0, '2006-08-31', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77011505', 'S77011505', 'UT01', NULL, 'Jeremiah', NULL, 'Hoopes', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', '8013527270', '8013527024', '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1881652535', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77011506', 'S77011506', 'UT01', '', 'Jeremiah', '', 'Hoopes', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '770 S 200 E Ste 102', 'Brigham City', 'Box Elder', 'UT', '84302', '4357230517', '4357230587', '867 E 9400 S', 'Sandy', 'Box Elder', 'UT', '84094', '4357230517', '4357230587', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1881652535', 0, 'N', 0, '2010-10-29', NULL, NULL, 0, 0, NULL, NULL),
('010800109', 'S77011719', 'S77011719', 'UT01', NULL, 'Phillip', 'A', 'Plothow', 'OD', 'Optometry', '', '', NULL, 'O', '3651 N 100 E Ste 250', 'Provo', 'Utah', 'UT', '84604', '8013733337', '8013733339', '3651 N 100 E Ste 250', 'Provo', 'Utah', 'UT', '84604', '8013733337', '8013733339', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235110149', 0, 'N', 0, '2014-01-07', NULL, NULL, 40.2824, -111.657, NULL, NULL),
('043814907', 'S77011720', 'S77011720', 'UT01', 'East Layton Internal Medicine', 'Anne', 'M', 'Hutchinson', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 403944', 'Atlanta', 'Fulton', 'GA', '30384', '8017711331', '8017711330', 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|', '1861461824', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('043814907', 'S77011721', 'S77011721', 'UT01', 'East Layton Internal Medicine', 'Anne', 'M', 'Hutchinson', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '1240 E Highway 193 Ste G1', 'Layton', 'Davis', 'UT', '84040', '8017711331', '8017711330', 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|', '1861461824', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('061506129', 'S77011723', 'S77011723', 'UT01', 'Wee Care Pediatrics', 'Jennifer', 'M', 'Gilsoul', 'MD', 'Pediatrics', '', '', NULL, 'O', '1580 W Antelope Dr Ste 100', 'Layton', 'Davis', 'UT', '84041', '8017738644', NULL, '1580 W Antelope Dr Ste 100', 'Layton', 'Davis', 'UT', '84041', '8017738644', '          ', 'WUSTDPEDE5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2011-06-30', 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1164402202', 0, 'N', 0, '2014-02-10', NULL, NULL, 0, 0, NULL, NULL),
('113772883', 'S77011724', 'S77011724', 'UT01', 'Comprehensive Orthopedics and Sports Medicine', 'Mark', 'D', 'Scholl', 'MD', 'Orthopedic Surgery', 'Sports Medicine', NULL, NULL, 'O', '82 S 1100 E Ste 303', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015332002', '8012329546', '82 S 1100 E Ste 303', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015332002', '8012329546', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2011-09-28', 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1396713020', 0, 'N', 0, '2012-11-07', NULL, NULL, 0, 0, NULL, NULL),
('200154272', 'S77011725', 'S77011725', 'UT01', 'House Call Doctors', 'Edward', 'R', 'Schultz', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '1556 Emerson Ave', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8018659590', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2007-03-23', 0, NULL, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1942287719', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('200377803', 'S77011726', 'S77011726', 'UT01', 'Alta Vision', 'W Carlan', NULL, 'Reese', 'OD', 'Optometry', NULL, NULL, NULL, 'O', '6095 Fashion Blvd Ste 110', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012622020', '8012629664', NULL, NULL, '', NULL, NULL, '', '', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1790757110', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('202719425', 'S77011731', 'S77011731', 'UT01', '', 'Spencer', 'D', 'Johnson', 'OD', 'Optometry', '', '', NULL, 'O', '12357 S 450 E Ste 2', 'Draper', 'Salt Lake', 'UT', '84020', '8015729804', '8015729805', '12357 S 450 E', 'Draper', 'Salt Lake', 'Ut', '84020', '8015729804', '8015729805', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2011-10-01', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1487747408', 0, 'N', 0, '2011-09-23', NULL, NULL, 0, 0, NULL, NULL),
('202962026', 'S77011732', 'S77011732', 'UT01', NULL, 'Mark', 'L', 'Newey', 'DDS', 'Oral/Maxillofacial Surgery', 'Oral Surgeon', '', NULL, 'O', '938 S University Park Blvd Ste 100', 'Clearfield', 'Davis', 'UT', '84015', '8018251116', '8018251310', '938 S University Park Blvd Ste 100', 'Clearfield', 'Davis', 'UT', '84015', '8018251116', '8018251310', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2006-10-01', '2008-11-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1619074259', 0, 'N', 0, '2012-04-13', NULL, NULL, 0, 0, NULL, NULL),
('202963126', 'S77011733', 'S77011733', 'UT01', 'Alpine Vision Center', 'W Carlan', NULL, 'Reese', 'OD', 'Optometry', NULL, NULL, NULL, 'O', '144 S Main St Ste 100', 'Alpine', 'Utah', 'UT', '84004', '8017567150', '8017567206', NULL, NULL, '', NULL, NULL, '', '', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1790757110', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('870283830', 'S77011837', 'S77011837', 'UT01', 'Intermountain Allergy', 'Duane', 'J', 'Harris', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '12422 S 450 E Ste C', 'Draper', 'Salt Lake', 'UT', '84020', '8015331900', NULL, '12422 S 450 E Ste C', 'Draper', 'Salt Lake', 'UT', '84020', '8015331900', '          ', 'WiseSTD6A', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 1, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1275535411', 0, 'N', 0, '2013-05-06', NULL, NULL, 40.5256, -111.878, NULL, NULL),
('870284475', 'S77011838', 'S77011838', 'UT01', 'Granger Medical Clinic', 'David', 'H', 'Oelsner', 'MD', 'Gastroenterology', 'Gastroenterology', 'Internal Medicine', NULL, 'B', 'PO Box 70658', 'West Valley', 'Salt Lake', 'UT', '84170', '8019653720', '8019653740', 'PO Box 70658', 'West Valley', 'Salt Lake', 'UT', '84170', '8019653720', '8019653740', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', NULL, NULL, 'HCFA|UB|', '1396760765', 0, 'Y', 0, '2012-07-13', NULL, NULL, 0, 0, NULL, NULL);
