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
('870616107', 'W11001500', 'W11001500', 'UT01', 'University Health Care', 'Arnold', 'B', 'Morrill', 'DO', 'Family Practice', 'Family Practice', NULL, NULL, 'o', '26 S Main St', 'Centerville', 'Davis', 'UT', '84014', '8016937900', NULL, '26 S Main St', 'Centerville', 'Davis', 'UT', '84014', '8016937900', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2007-08-01', '2012-09-16', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1548252950', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11001501', 'W11001501', 'UT01', 'University Health Care', 'Jeffrey', 'S', 'Rasch', 'MD', 'Family Practice', NULL, NULL, NULL, 'o', '1525 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8018872400', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WISESTDU', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 6, '2007-08-01', '2007-08-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1598717662', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11001502', 'W11001502', 'UT01', 'University Health Care', 'Margaret', 'H', 'Solomon', 'MD', 'Pediatrics', 'Pediatrics', NULL, NULL, 'o', '1525 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8018872400', NULL, '1525 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8018872400', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2007-08-01', '2012-09-16', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1881784411', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11001503', 'W11001503', 'UT01', 'University Health Care', 'Walter', NULL, 'Townson', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'o', '7495 S State St', 'Midvale', 'Salt Lake', 'UT', '84047', '8012139400', NULL, '7495 S State St', 'Midvale', 'Salt Lake', 'UT', '84047', '8012139400', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2007-08-01', '2012-09-16', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1548350176', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11001504', 'W11001504', 'UT01', 'University Health Care', 'Gavin', NULL, 'Van Staden', 'MD', 'Family Practice', NULL, NULL, NULL, 'o', '1525 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8018872400', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WISESTDU', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 6, '2007-08-01', '2007-12-15', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11001505', 'W11001505', 'UT01', 'University Health Care', 'Christina', NULL, 'Vokt', 'MD', 'Family Practice', NULL, NULL, NULL, 'o', '1525 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8018872400', NULL, '1525 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8018872400', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2007-08-01', '2012-09-16', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1568480895', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11001506', 'W11001506', 'UT01', 'U of U Hospitals and Clinics', 'Michael', 'R', 'Adams', 'MD', 'Family Practice', '', 'Family Practice', NULL, 'B', 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876600', NULL, 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876600', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2007-08-01', '2012-09-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780781682', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11001507', 'W11001507', 'UT01', 'U of U Hospitals and Clinics', 'Joseph', NULL, 'Bell', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'b', 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876600', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WISESTDU', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 6, '2007-08-01', '2007-07-11', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11001508', 'W11001508', 'UT01', 'U of U Hospitals and Clinics', 'Joseph', 'H', 'Berman', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876600', NULL, 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876600', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2007-08-01', '2012-09-16', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1780772624', 0, 'N', 0, '2012-09-17', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11001509', 'W11001509', 'UT01', 'U of U Hospitals and Clinics', 'Ellie', NULL, 'Brownstein', 'MD', 'Pediatrics', NULL, NULL, NULL, 'B', 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876600', NULL, 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876600', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2007-08-01', '2012-09-16', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1760572341', 0, 'N', 0, '2012-09-17', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11001510', 'W11001510', 'UT01', 'U of U Hospitals and Clinics', 'Brett', NULL, 'Clayson', 'PA', 'Internal Medicine', NULL, NULL, NULL, 'B', 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876600', NULL, 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876600', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2007-08-01', '2012-09-16', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1457441040', 0, 'N', 0, '2012-09-17', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11001511', 'W11001511', 'UT01', 'University Health Care', 'Jeffrey', 'W', 'Cline', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876600', NULL, 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876600', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2007-08-01', '2012-09-16', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1184714776', 0, 'N', 0, '2012-09-17', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11001512', 'W11001512', 'UT01', 'U of U Hospitals and Clinics', 'Richard', 'M', 'Craig', 'MD ', 'Gastroenterology', 'Internal Medicine', '', NULL, 'B', 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876600', NULL, 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876600', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2007-08-01', '2012-09-16', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1174613764', 0, 'N', 0, '2012-09-17', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11001513', 'W11001513', 'UT01', 'U of U Hospitals and Clinics', 'Wiilliam', 'W', 'Crenshaw', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876600', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WISESTDU', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2007-08-01', '2010-03-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000005833', 0, 'y', 0, '2007-08-01', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11001514', 'W11001514', 'UT01', 'U of U Hospitals and Clinics', 'Julie', 'S', 'Day', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876600', NULL, 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876600', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2007-08-01', '2012-09-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831274521', 0, 'N', 0, '2012-09-17', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11001515', 'W11001515', 'UT01', 'U of U Hospitals and Clinics', 'Jared', 'F', 'Esplin', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'B', 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876600', NULL, 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876600', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2007-08-01', '2012-09-16', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1316037914', 0, 'N', 0, '2012-09-17', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11001516', 'W11001516', 'UT01', 'U of U Hospitals and Clinics', 'Lynn', NULL, 'Falkner', 'PA', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876600', NULL, 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876600', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2007-08-01', '2012-09-16', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1225128820', 0, 'N', 0, '2012-09-17', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11001517', 'W11001517', 'UT01', 'U of U Hospitals and Clinics', 'Salvador', NULL, 'Fernandez', 'MD', 'Family Practice', NULL, NULL, NULL, 'b', 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876600', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WISESTDU', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 6, '2007-08-01', '2007-06-09', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11001518', 'W11001518', 'UT01', 'U of U Hospitals and Clinics', 'Michael', 'C', 'Flynn', 'MD', 'Pediatrics', 'Pediatrics', NULL, NULL, 'B', 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876600', NULL, 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876600', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2007-08-01', '2012-09-16', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1306936901', 0, 'N', 0, '2012-09-17', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11001519', 'W11001519', 'UT01', 'U of U Hospitals and Clinics', 'Brant', 'W', 'Fonnesbeck', 'DO', 'Family Practice', 'Urgent Care', NULL, NULL, 'b', 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876600', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WISESTDU', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 6, '2007-08-01', '2007-08-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1033156849', 0, 'y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11001520', 'W11001520', 'UT01', 'U of U Hospitals and Clinics', 'Theresa (Tina)', 'M', 'Fought', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876600', NULL, 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876600', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2007-08-01', '2012-09-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942390547', 0, 'N', 0, '2013-08-01', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11001521', 'W11001521', 'UT01', 'U of U Hospitals and Clinics', 'Peggy', 'H', 'Fujimura', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876600', NULL, 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876600', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2007-08-01', '2012-09-16', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000006332', 0, 'N', 0, '2012-09-17', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11001522', 'W11001522', 'UT01', 'U of U Hospitals and Clinics', 'Amy', NULL, 'Geroso', 'MD', 'Family Practice', NULL, NULL, NULL, 'b', 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876600', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WISESTDU', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 6, '2007-08-01', '2007-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11001523', 'W11001523', 'UT01', 'U of U Hospitals and Clinics', 'KC', NULL, 'Gerpheide', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876600', NULL, 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876600', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2007-08-01', '2012-09-16', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000006404', 0, 'N', 0, '2012-09-17', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11001524', 'W11001524', 'UT01', 'U of U Hospitals and Clinics', 'Jessica', 'L', 'Greenwood', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876600', NULL, 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876600', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2007-08-01', '2012-09-16', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1982638250', 0, 'N', 0, '2012-09-17', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11001525', 'W11001525', 'UT01', 'U of U Hospitals and Clinics', 'Sumati', 'V', 'Gupta', 'MD', 'Internal Medicine', 'Geriatric Medicine', '', NULL, 'B', 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876600', NULL, 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876600', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-08-01', '2012-09-16', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1003906603', 0, 'N', 0, '2012-09-17', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11001526', 'W11001526', 'UT01', 'U of U Hospitals and Clinics', 'Phil', 'S', 'Haggerty', 'DO', 'Family Practice', NULL, NULL, NULL, 'b', 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876600', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WISESTDU', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 6, '2007-08-01', '2007-10-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11001527', 'W11001527', 'UT01', 'U of U Hospitals and Clinics', 'Mary', 'D', 'Joyce', 'NP', 'Pediatrics', NULL, NULL, NULL, 'B', 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876600', NULL, 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876600', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2007-08-01', '2012-09-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114002805', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11001528', 'W11001528', 'UT01', 'U of U Hospitals and Clinics', 'David', 'R', 'Hillam', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876600', NULL, 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876600', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2007-08-01', '2012-09-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275623878', 0, 'N', 0, '2012-09-25', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11001529', 'W11001529', 'UT01', 'U of U Hospitals and Clinics', 'Rina', 'M', 'Hooper', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876600', NULL, 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876600', '', 'WISESTDU', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2007-08-01', '2008-03-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538259130', 0, 'y', 0, '2013-07-29', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11001530', 'W11001530', 'UT01', 'U of U Hospitals and Clinics', 'Thomas', 'A', 'Hyatt', 'DO', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876600', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WISESTDU', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2007-08-01', '2010-02-15', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1346330941', 0, 'y', 0, '2007-08-01', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11001531', 'W11001531', 'UT01', 'U of U Hospitals and Clinics', 'Raquel', NULL, 'Jaatoul', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876600', NULL, 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876600', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2007-08-01', '2012-09-16', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1619056959', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11001532', 'W11001532', 'UT01', 'U of U Hospitals and Clinics', 'Christopher', 'R', 'Johnson', 'DO', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876600', NULL, 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876600', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2007-08-01', '2012-09-16', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000006960', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11001533', 'W11001533', 'UT01', 'U of U Hospitals and Clinics', 'Matthew', 'B', 'Johnson', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876600', NULL, 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876600', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2007-08-01', '2012-09-16', 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1699787770', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
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('870640775', 'W11001593', 'W11001593', 'UT01', 'University Health Care', 'Pamela', 'A', 'Hansen', 'MD', 'Physical Medicine and Rehabilitation', NULL, NULL, NULL, 'o', '7495 S State St', 'Midvale', 'Salt Lake', 'UT', '84047', '8012139400', NULL, '7495 S State St', 'Midvale', 'Salt Lake', 'UT', '84047', '8012139400', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-08-01', '2012-09-18', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1649360249', 0, 'N', 0, '2012-09-19', 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
('870640775', 'W11001594', 'W11001594', 'UT01', 'University Health Care', 'Scott', 'K', 'Kuwada', 'MD', 'Gastroenterology', NULL, NULL, NULL, 'o', '1525 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8018872400', NULL, '1525 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8018872400', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-08-01', '2012-09-18', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000007164', 0, 'N', 0, '2012-09-19', NULL, NULL, 0, 0, NULL, NULL),
('870640775', 'W11001595', 'W11001595', 'UT01', 'University Health Care', 'Kathryn', 'A', 'Peterson', 'MD', 'Gastroenterology', NULL, NULL, NULL, 'o', '1525 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8018872400', NULL, '1525 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8018872400', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-08-01', '2012-09-18', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1225128846', 0, 'N', 0, '2012-09-19', NULL, NULL, 0, 0, NULL, NULL),
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('870640775', 'W11001598', 'W11001598', 'UT01', 'University Health Care', 'Malcolm', 'M', 'Berenson', 'MD', 'Gastroenterology', NULL, NULL, NULL, 'o', '1525 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8018872400', NULL, '1525 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8018872400', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-08-01', '2012-09-18', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1396835922', 0, 'N', 0, '2012-09-19', NULL, NULL, 0, 0, NULL, NULL),
('870640775', 'W11001599', 'W11001599', 'UT01', 'University Health Care', 'Jason', '', 'Biggs', 'PA', 'Cardiovascular Disease', NULL, NULL, NULL, 'o', '1525 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8018872400', NULL, '1525 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8018872400', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-08-01', '2012-09-18', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750471389', 0, 'N', 0, '2012-09-19', NULL, NULL, 0, 0, NULL, NULL),
('870640775', 'W11001600', 'W11001600', 'UT01', 'University Health Care', 'Bruce', 'E', 'Bray', 'MD', 'Cardiovascular Disease', 'Internal Medicine', 'Echocardiography', NULL, 'o', '145 W University Pkwy', 'Orem', 'Utah', 'UT', '84058', '8012348600', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WISESTDU', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-08-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1124118708', 0, 'N', 0, '2007-08-01', NULL, NULL, 40.2735, -111.698, NULL, NULL),
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('870616107', 'W11001684', 'W11001684', 'UT01', 'University Health Care', 'Kenneth', 'A', 'Garcia', 'PAC', 'Family Practice', NULL, NULL, NULL, 'O', '1525 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8012139900', NULL, '1525 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8012139900', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2007-08-01', '2012-09-16', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1154413235', 0, 'N', 0, '2012-09-17', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11001685', 'W11001685', 'UT01', 'U of U Hospitals and Clinics', 'Ali', NULL, 'Salari', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876303', NULL, 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876303', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2007-08-01', '2012-09-16', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1598898579', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('870616107', 'W11001686', 'W11001686', 'UT01', 'University Health Care', 'Ali', NULL, 'Salari', 'DO', 'Family Practice', '', '', NULL, 'O', '1525 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8012139900', NULL, '1525 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8012139900', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2007-08-01', '2012-09-16', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1598898579', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('870640775', 'W11001687', 'W11001687', 'UT01', 'University Health Care', 'Bruce', 'E', 'Bray', 'MD', 'Cardiovascular Disease', 'Internal Medicine', 'Echocardiography', NULL, 'o', '1743 W Redstone Ctr Ste 115', 'Park City', 'Summit', 'UT', '84098', '4356589200', NULL, '1743 W Redstone Ctr Ste 115', 'Park City', 'Summit', 'UT', '84098', '4356589200', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-08-01', '2012-09-18', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1124118708', 0, 'N', 0, '2012-09-19', NULL, NULL, 0, 0, NULL, NULL),
('830319938', 'W11001688', 'W11001688', 'WY01', 'Health Services', 'Shirley', 'L', 'Haley', 'NP', 'Family Practice', '', '', NULL, 'O', '201 W Lakeway Ste 414', 'Gillette', 'Campbell', 'WY', '82716', '3076828110', NULL, '201 W Lakeway Ste 414', 'Gillette', 'Campbell', 'WY', '82716', '3076828110', '', 'WiseWYStd', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962524504', 0, 'n', 0, '2014-06-25', NULL, NULL, 44.269, -105.505, NULL, NULL),
('830319938', 'W11001689', 'W11001689', 'WY01', 'Health Services', 'Shirley', 'L', 'Haley', 'NP', 'Family Practice', '', '', NULL, 'B', 'PO Box 2915', 'Gillette', 'Campbell', 'WY', '82716', '3076828110', NULL, 'PO Box 2915', 'Gillette', 'Campbell', 'WY', '82716', '3076828110', '', 'WiseWYStd', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962524504', 0, 'Y', 0, '2014-06-25', NULL, NULL, 0, 0, NULL, NULL),
('710972884', 'W11001690', 'W11001690', 'WY01', 'Timeless Touch Skin Professionals', 'Lynn', '', 'Perlenfein', 'PA-C', 'Dermatology', '', '', NULL, 'O', '3805 S Douglas Hwy Ste 2', 'Gillette', 'Campbell', 'WY', '82718', '3076858111', NULL, '3805 S Douglas Hwy Ste 2', 'Gillette', 'Campbell', 'WY', '82718', '3076858111', '          ', 'WiseWYSTD', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-08-01', '2011-06-21', 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1881641553', 0, 'N', 0, '2013-10-29', NULL, NULL, 0, 0, NULL, NULL),
('529676822', 'W11001691', 'W11001691', 'UT01', 'Preferred Family Clinic', 'Summer', 'A', 'Morris', 'LPC', 'Mental Health', 'Counseling', NULL, NULL, 'O', '1355 N University Ave Ste 200', 'Provo', 'Utah', 'UT', '84604', '8012210223', NULL, '1355 N University Ave', 'Provo', '', 'UT', '84604', '', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-08-01', '2008-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1578767737', 0, 'n', 0, '2008-06-30', NULL, NULL, 0, 0, NULL, NULL),
('830324450', 'W11001692', 'W11001692', 'WY01', 'Worland Optometric Center', 'Mahlon', 'C', 'Anderson', 'OD', 'Optometry', '', '', NULL, 'O', '820 Coburn Ave', 'Worland', 'Washakie', 'WY', '82401', '3073476141', NULL, '820 Coburn Ave', 'Worland', 'Washakie', 'WY', '82401', '3073476141', '          ', 'WiseWYSTD', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-08-01', '2011-05-23', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000005031', 0, 'N', 0, '2011-05-23', NULL, NULL, 0, 0, NULL, NULL),
('830324450', 'W11001693', 'W11001693', 'WY01', 'Worland Optometric Center', 'Mahlon', 'C', 'Anderson', 'OD', 'Optometry', '', '', NULL, 'B', 'PO Box 926', 'Worland', 'Washakie', 'WY', '82401', '3073476141', NULL, 'PO Box 926', 'Worland', 'Washakie', 'WY', '82401', '3073476141', '          ', 'WiseWYSTD', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-08-01', '2011-05-23', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000005031', 0, 'Y', 0, '2011-05-23', NULL, NULL, 0, 0, NULL, NULL),
('205978580', 'W11001694', 'W11001694', 'TX01', 'Alamo Nephrology Associates', 'Naushad', '', 'Zafar', 'MD', 'Nephrology', NULL, NULL, NULL, 'O', '7940 Floyd Curl Dr Ste 260', 'San Antonio', 'Bexar', 'TX', '78229', '2106147900', NULL, '7940 Floyd Curl Dr Ste 260', 'San Antonio', 'Bexar', 'TX', '78229', '2106147900', '', 'TXSTD', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2007-07-01', '2012-08-19', 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1497813331', 0, 'N', 0, '2013-09-24', NULL, NULL, 29.5117, -98.5756, NULL, NULL),
('870413860', 'W11001695', 'W11001695', 'UT01', 'Now Care Clinic', 'Dixie', '', 'Allen', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '1937 W 5700 S', 'Roy', 'Weber', 'UT', '84067', '8017739380', '8016218811', '1937 W 5700 S', 'Roy', 'Weber', 'UT', '84067', '8017739380', '8016218811', 'WUSTDFAM5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', '2008-08-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013119726', 0, 'N', 0, '2013-12-04', NULL, NULL, 0, 0, NULL, NULL),
('870413860', 'W11001696', 'W11001696', 'UT01', 'Now Care Clinic', 'Dixie', '', 'Allen', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '698 12th St', 'Ogden', 'Weber', 'UT', '84404', '8016213466', '8016218811', '698 12th St', 'Ogden', 'Weber', 'UT', '84404', '8016213466', '8016218811', 'WUSTDFAM5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', '2008-08-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013119726', 0, 'N', 0, '2013-12-04', NULL, NULL, 0, 0, NULL, NULL),
('870413860', 'W11001697', 'W11001697', 'UT01', 'Now Care Clinic', 'Dixie', '', 'Allen', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'B', 'PO Box 241', 'Roy', 'Weber', 'UT', '84067', '8016213466', '8016218811', 'PO Box 241', 'Roy', 'Weber', 'UT', '84067', '8016213466', '8016218811', 'WUSTDFAM5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', '2008-08-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013119726', 0, 'Y', 0, '2013-12-04', NULL, NULL, 0, 0, NULL, NULL),
('113676182', 'W11001698', 'W11001698', 'TX01', 'The Podiatry Group of South Texas', 'Ed', NULL, 'Davis', 'DPM', 'Podiatry', NULL, NULL, NULL, 'O', '2950 Thousand Oaks Ste 25', 'San Antonio', 'Bexar', 'TX', '78247', '2105459100', NULL, '45 N E Loop 410', 'San Antonio', '', 'TX', '78216', '', '', 'TXSTD', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2007-01-01', '2008-08-22', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1609075902', 0, 'N', 0, '2007-01-11', NULL, NULL, 0, 0, NULL, NULL),
('113676182', 'W11001699', 'W11001699', 'TX01', 'The Podiatry Group of South Texas', 'Ed', NULL, 'Davis', 'DPM', 'Podiatry', NULL, NULL, NULL, 'B', 'PO Box 1277', 'San Antonio', 'Bexar', 'TX', '78295', '2105459100', NULL, '45 N E Loop 410', 'San Antonio', '', 'TX', '78216', '', '', 'TXSTD', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2007-01-01', '2008-08-22', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1609075902', 0, 'Y', 0, '2007-01-11', NULL, NULL, 0, 0, NULL, NULL),
('113676182', 'W11001700', 'W11001700', 'TX01', 'The Podiatry Group of South Texas', 'Michael', 'L', 'Dempsey', 'DPM', 'Podiatry', '', '', NULL, 'B', 'PO Box 1277', 'San Antonio', 'Bexar', 'TX', '78295', '2105459100', NULL, 'PO Box 1277', 'San Antonio', 'Bexar', 'TX', '78295', '2105459100', '', 'TXSTD', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2007-01-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1003886789', 0, 'Y', 0, '2013-05-23', NULL, NULL, 0, 0, NULL, NULL),
('113676182', 'W11001701', 'W11001701', 'TX01', 'The Podiatry Group of South Texas', 'Michael', 'L', 'Dempsey', 'DPM', 'Podiatry', '', '', NULL, 'O', '720 Pleasanton Rd', 'San Antonio', 'Bexar', 'TX', '78214', '2109213800', NULL, '720 Pleasanton Rd', 'San Antonio', 'Bexar', 'TX', '78214', '2109213800', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-01-01', '2010-11-30', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1003886789', 0, 'N', 0, '2013-05-23', NULL, NULL, 0, 0, NULL, NULL),
('113676182', 'W11001702', 'W11001702', 'TX01', 'The Podiatry Group of South Texas', 'Michael', 'L', 'Dempsey', 'DPM', 'Podiatry', '', '', NULL, 'O', '1540 Goodwin St', 'Pleasanton', 'Atascosa', 'TX', '78064', '8305696340', NULL, '1540 Goodwin St', 'Pleasanton', 'Atascosa', 'TX', '78064', '8305696340', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-01-01', '2010-11-30', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1003886789', 0, 'N', 0, '2013-05-23', NULL, NULL, 0, 0, NULL, NULL),
('870687383', 'W11001703', 'W11001703', 'UT01', 'Western Neurological Associates', 'Stephen', 'B', 'Carroll', 'MD', 'Radiology', '', '', 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|', '1669532008', 0, 'N', 0, '2013-11-18', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('621762570', 'W11001704', 'W11001704', 'UT01', 'Ashley Valley Physician Practice', 'Ghanshyam', 'P', 'Massand', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013529500', '8013529502', 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013529500', '8013529502', 'WURURAL5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2010-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740245604', 0, 'Y', 0, '2014-06-02', NULL, NULL, 0, 0, NULL, NULL),
('621762570', 'W11001705', 'W11001705', 'UT01', 'Ashley Valley Physician Practice', 'Ghanshyam', 'P', 'Massand', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '150 W 100 N Ste S102', 'Vernal', 'Uintah', 'UT', '84078', '4357891522', NULL, '150 W 100 N Ste S102', 'Vernal', 'Uintah', 'UT', '84078', '4357891522', '', 'WURURAL5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2009-10-05', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740245604', 0, 'N', 0, '2014-06-02', NULL, NULL, 0, 0, NULL, NULL),
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('870639098', 'W11001707', 'W11001707', 'UT01', 'After Hours Medical Company', 'David', 'W', 'Brinton', 'MD', 'Family Practice', 'Sports Medicine', 'Urgent Care', NULL, 'O', '1126 E 12300 S', 'Draper', 'Salt Lake', 'UT', '84020', '8015450600', '8013529502', 'PO Box 1000', 'Draper', '', 'UT', '84020', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', '2008-06-30', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1093820706', 0, 'y', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
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('870480520', 'W11001709', 'W11001709', 'UT01', 'University Health Care', 'Jeffrey', 'C', 'Wagner', 'MD', 'Neurology', '', '', NULL, 'o', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015856387', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015856387', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2012-08-09', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1033321914', 0, 'N', 0, '2012-08-13', NULL, NULL, 0, 0, NULL, NULL),
('870480520', 'W11001710', 'W11001710', 'UT01', 'Dept of Neurology School of Medicine U of U', 'Jeffrey', 'C', 'Wagner', 'MD', 'Neurology', '', '', NULL, 'B', 'PO Box 413027', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413027', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2012-08-09', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1033321914', 0, 'N', 0, '2012-08-13', NULL, NULL, 0, 0, NULL, NULL),
('753031794', 'W11001711', 'W11001711', 'WY01', 'Clear Image Vision Care', 'Kirby', 'T', 'Treat', 'OD', 'Optometry', '', '', NULL, 'B', 'PO Box 846', 'Worland', 'Washakie', 'WY', '82401', '3073474157', NULL, 'PO Box 846', 'Worland', 'Washakie', 'WY', '82401', '3073474157', '          ', 'WISEWYSTD', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386836302', 0, 'Y', 0, '2014-02-06', NULL, NULL, 0, 0, NULL, NULL),
('753031794', 'W11001712', 'W11001712', 'WY01', 'Treat Vision Care', 'Alden', 'L', 'Curtis', 'OD', 'Optometry', '', '', NULL, 'B', 'PO Box 846', 'Worland', 'Washakie', 'WY', '82401', '3073474157', NULL, 'PO Box 846', 'Worland', 'Washakie', 'WY', '82401', '3073474157', '          ', 'WISEWYSTD', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-08-01', '2010-03-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000005860', 0, 'Y', 0, '2007-08-08', NULL, NULL, 0, 0, NULL, NULL),
('753031794', 'W11001713', 'W11001713', 'WY01', 'Treat Vision Care', 'Jody', 'L', 'Fink', 'OD', 'Optometry', '', '', NULL, 'B', 'PO Box 846', 'Worland', 'Washakie', 'WY', '82401', '3073474157', NULL, 'PO Box 846', 'Worland', 'Washakie', 'WY', '82401', '3073474157', '          ', 'WISEWYSTD', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-08-01', '2007-09-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006245', 0, 'Y', 0, '2011-02-17', NULL, NULL, 0, 0, NULL, NULL),
('753031794', 'W11001714', 'W11001714', 'WY01', 'Curtis Optometric Clinic', 'Jody', 'L', 'Fink', 'OD', 'Optometry', '', '', NULL, 'O', '316 N 10th St', 'Worland', 'Washakie', 'WY', '82401', '3073474157', NULL, '316 N 10th St', 'Worland', 'Washakie', 'WY', '82401', '3073474157', '          ', 'WISEWYSTD', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-08-01', '2007-09-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006245', 0, 'N', 0, '2011-02-17', NULL, NULL, 0, 0, NULL, NULL),
('753031794', 'W11001715', 'W11001715', 'WY01', 'Curtis Optometric Clinic', 'Alden', 'L', 'Curtis', 'OD', 'Optometry', '', '', NULL, 'O', '316 N 10th St', 'Worland', 'Washakie', 'WY', '82401', '3073474157', NULL, '316 N 10th St', 'Worland', 'Washakie', 'WY', '82401', '3073474157', '          ', 'WISEWYSTD', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-08-01', '2010-03-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000005860', 0, 'N', 0, '2007-08-08', NULL, NULL, 0, 0, NULL, NULL),
('753031794', 'W11001716', 'W11001716', 'WY01', 'Curtis Optometric Clinic', 'Kirby', 'T', 'Treat', 'OD', 'Optometry', '', '', NULL, 'O', '316 N 10th St', 'Worland', 'Washakie', 'WY', '82401', '3073474157', NULL, '316 N 10th St', 'Worland', 'Washakie', 'WY', '82401', '3073474157', '          ', 'WISEWYSTD', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-08-01', '2010-08-13', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386836302', 0, 'N', 0, '2014-02-21', NULL, NULL, 0, 0, NULL, NULL),
('412071781', 'W11001717', 'W11001717', 'WY01', 'Casper Foot Clinic', 'John', 'H', 'Nelson', 'DPM', 'Podiatry', NULL, NULL, NULL, 'O', '1916 E 1st', 'Casper', 'Natrona', 'WY', '82601', '3072664415', NULL, '1916 E 1st', 'Casper', '', 'WY', '82601', '', '', 'WISEWYSTD', 'wyhcpcs', NULL, '0.00', '35.00', NULL, 3, '2007-08-01', '2007-08-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1184785107', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('412071781', 'W11001718', 'W11001718', 'WY01', 'Gillette Foot Clinic', 'John', 'H', 'Nelson', 'DPM', 'Podiatry', NULL, NULL, NULL, 'O', '1307 W 3rd', 'Gillette', 'Campbell', 'WY', '82716', '3076824954', NULL, '1916 E 1st', 'Casper', '', 'WY', '82601', '', '', 'WISEWYSTD', 'wyhcpcs', NULL, '0.00', '35.00', NULL, 3, '2007-08-01', '2007-08-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1184785107', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('741967809', 'W11001719', 'W11001719', 'TX01', 'Gastroenterology Consultants of San Antonio Ambulatory Surgery', '', '', 'Gastroenterology Consultants of San Antonio Ambulatory Surgery', 'GROUP', 'Ambulatory Surgery Center', '', '', NULL, 'O', '8214 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78229', '2106141234', NULL, '8214 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78229', '2106141234', '          ', '', '', 'OP-1', '0.00', '0.00', '0.00', 6, '2007-08-01', '2012-09-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006384', 0, 'N', 0, '2013-02-06', NULL, NULL, 29.5159, -98.5758, NULL, NULL),
('830210617', 'W11001720', 'W11001720', 'WY01', 'Crook County Medical Services District', 'Patricia', '', 'Voll', 'FNP', 'Family Practice', '', '', NULL, 'B', 'PO Box 517', 'Sundance', 'Crook', 'WY', '82729', '3072832476', NULL, 'PO Box 517', 'Sundance', 'Crook', 'WY', '82729', '3072832476', '', 'WISEWYSTD', 'Wyhcpcs', NULL, '0.00', '35.00', '0.00', 6, '2007-09-01', NULL, 0, 0, 0, 'Crook County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1457467607', 0, 'Y', 0, '2013-09-25', NULL, NULL, 0, 0, NULL, NULL),
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('830210617', 'W11001722', 'W11001722', 'WY01', 'Crook County Medical Services District', 'Erin', 'L', 'Rogers', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 517', 'Sundance', 'Crook', 'WY', '82729', '3072832476', '          ', 'PO Box 517', 'Sundance', 'Crook', 'WY', '82729', '3072832476', '          ', 'WISEWYSTD', 'Wyhcpcs', '', '0.00', '35.00', '0.00', 6, '2007-09-01', '2014-05-13', 0, 0, 0, 'Crook County Memorial Hospital', '', '', '', 'HCFA|UB|', '1104932359', 0, 'Y', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
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('830210617', 'W11001726', 'W11001726', 'WY01', 'Moorcroft Clinic', 'Patricia', '', 'Voll', 'FNP', 'Family Practice', '', '', NULL, 'O', '107 W Crook', 'Moorcroft', 'Crook', 'WY', '82721', '3077563414', NULL, '107 W Crook', 'Moorcroft', 'Crook', 'WY', '82721', '3077563414', '', 'WISEWYSTD', 'Wyhcpcs', NULL, '0.00', '35.00', '0.00', 6, '2007-09-01', NULL, 0, 0, 0, 'Crook County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1457467607', 0, 'N', 0, '2013-09-25', NULL, NULL, 0, 0, NULL, NULL),
('830210617', 'W11001727', 'W11001727', 'WY01', 'Moorcroft Clinic', 'Keith', 'A', 'Noback', 'MD', 'Family Practice', '', '', NULL, 'O', '107 W Crook', 'Moorcroft', 'Crook', 'WY', '82721', '3077563414', NULL, '107 W Crook', 'Moorcroft', 'Crook', 'WY', '82721', '3077563414', '', 'WISEWYSTD', 'Wyhcpcs', NULL, '0.00', '35.00', '0.00', 6, '2007-09-01', NULL, 0, 0, 0, 'Crook County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1154437317', 0, 'N', 0, '2013-09-25', NULL, NULL, 0, 0, NULL, NULL),
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('830210617', 'W11001729', 'W11001729', 'WY01', 'Moorcroft Clinic', 'Jeremi', '', 'Villano', 'MD', 'Family Practice', '', '', NULL, 'O', '107 W Crook', 'Moorcroft', 'Crook', 'WY', '82721', '3077563414', NULL, '107 W Crook', 'Moorcroft', 'Crook', 'WY', '82721', '3077563414', '', 'WISEWYSTD', 'Wyhcpcs', NULL, '0.00', '35.00', '0.00', 6, '2007-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265548424', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('830210617', 'W11001730', 'W11001730', 'WY01', 'Moorcroft Clinic', 'Robert', '', 'Cummings', 'PAC', 'Family Practice', '', '', NULL, 'O', '107 W Crook', 'Moorcroft', 'Crook', 'WY', '82721', '3077563414', NULL, '107 W Crook', 'Moorcroft', 'Crook', 'WY', '82721', '3077563414', '', 'WISEWYSTD', 'Wyhcpcs', NULL, '0.00', '35.00', '0.00', 6, '2007-09-01', NULL, 0, 0, 0, 'Crook County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1831205095', 0, 'N', 0, '2013-09-04', NULL, NULL, 0, 0, NULL, NULL),
('830210617', 'W11001731', 'W11001731', 'WY01', 'Moorcroft Clinic', 'Cynthia', 'M', 'Casey', 'MD', 'Family Practice', '', '', NULL, 'O', '107 W Crook', 'Moorcroft', 'Crook', 'WY', '82721', '3077563414', NULL, '107 W Crook', 'Moorcroft', 'Crook', 'WY', '82721', '3077563414', '', 'WISEWYSTD', 'Wyhcpcs', '', '0.00', '35.00', '0.00', 6, '2007-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497861652', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('830210617', 'W11001732', 'W11001732', 'WY01', 'Halett Clinic', 'Patricia', '', 'Voll', 'FNP', 'Family Practice', '', '', NULL, 'O', '122 Main St', 'Hulett', 'Crook', 'WY', '82720', '3074675281', NULL, '122 Main St', 'Hulett', 'Crook', 'WY', '82720', '3074675281', '', 'WISEWYSTD', 'Wyhcpcs', NULL, '0.00', '35.00', '0.00', 6, '2007-09-01', NULL, 0, 0, 0, 'Crook County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1457467607', 0, 'N', 0, '2013-09-25', NULL, NULL, 44.6825, -104.6, NULL, NULL),
('830210617', 'W11001733', 'W11001733', 'WY01', 'Halett Clinic', 'Keith', 'A', 'Noback', 'MD', 'Family Practice', '', '', NULL, 'O', '122 Main St', 'Hulett', 'Crook', 'WY', '82720', '3074675281', NULL, '122 Main St', 'Hulett', 'Crook', 'WY', '82720', '3074675281', '', 'WISEWYSTD', 'Wyhcpcs', NULL, '0.00', '35.00', '0.00', 6, '2007-09-01', NULL, 0, 0, 0, 'Crook County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1154437317', 0, 'N', 0, '2013-09-25', NULL, NULL, 44.6825, -104.6, NULL, NULL),
('830210617', 'W11001734', 'W11001734', 'WY01', 'Halett Clinic', 'Erin', 'L', 'Rogers', 'MD', 'Family Practice', '', '', NULL, 'O', '122 Main St', 'Hulett', 'Crook', 'WY', '82720', '3074675281', '          ', '122 Main St', 'Hulett', 'Crook', 'WY', '82720', '3074675281', '          ', 'WISEWYSTD', 'Wyhcpcs', '', '0.00', '35.00', '0.00', 6, '2007-09-01', '2014-05-13', 0, 0, 0, 'Crook County Memorial Hospital', '', '', '', 'HCFA|UB|', '1104932359', 0, 'N', 0, '2014-05-13', NULL, NULL, 44.6825, -104.6, NULL, NULL),
('830210617', 'W11001735', 'W11001735', 'WY01', 'Halett Clinic', 'Jeremi', '', 'Villano', 'MD', 'Family Practice', '', '', NULL, 'O', '122 Main St', 'Hulett', 'Crook', 'WY', '82720', '3074675281', NULL, '122 Main St', 'Hulett', 'Crook', 'WY', '82720', '3074675281', '', 'WISEWYSTD', 'Wyhcpcs', NULL, '0.00', '35.00', '0.00', 6, '2007-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265548424', 0, 'N', 0, '2011-06-10', NULL, NULL, 44.6825, -104.6, NULL, NULL),
('830210617', 'W11001736', 'W11001736', 'WY01', 'Halett Clinic', 'Robert', '', 'Cummings', 'PAC', 'Family Practice', '', '', NULL, 'O', '122 Main St', 'Hulett', 'Crook', 'WY', '82720', '3074675281', NULL, '122 Main St', 'Hulett', 'Crook', 'WY', '82720', '3074675281', '', 'WISEWYSTD', 'Wyhcpcs', NULL, '0.00', '35.00', '0.00', 6, '2007-09-01', NULL, 0, 0, 0, 'Crook County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1831205095', 0, 'N', 0, '2013-09-04', NULL, NULL, 44.6825, -104.6, NULL, NULL),
('830210617', 'W11001737', 'W11001737', 'WY01', 'Halett Clinic', 'Cynthia', 'M', 'Casey', 'MD', 'Family Practice', '', '', NULL, 'O', '122 Main St', 'Hulett', 'Crook', 'WY', '82720', '3074675281', NULL, '122 Main St', 'Hulett', 'Crook', 'WY', '82720', '3074675281', '', 'WISEWYSTD', 'Wyhcpcs', '', '0.00', '35.00', '0.00', 6, '2007-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497861652', 0, 'N', 0, '2014-06-20', NULL, NULL, 44.6825, -104.6, NULL, NULL),
('830210617', 'W11001738', 'W11001738', 'WY01', 'Sundance Clinic', 'Patricia', '', 'Voll', 'FNP', 'Family Practice', '', '', NULL, 'O', '713 Oak St', 'Sundance', 'Crook', 'WY', '82729', '3072832476', NULL, '713 Oak St', 'Sundance', 'Crook', 'WY', '82729', '3072832476', '', 'WISEWYSTD', 'Wyhcpcs', NULL, '0.00', '35.00', '0.00', 6, '2007-09-01', NULL, 0, 0, 0, 'Crook County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1457467607', 0, 'N', 0, '2013-09-25', NULL, NULL, 44.405, -104.382, NULL, NULL),
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('830219655', 'W11001801', 'W11001801', 'WY01', 'Gem City Bone and Joint', 'Ryan', '', 'Aukerman', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '620 4-J Rd', 'Gillette', 'Campbell', 'WY', '82716', '3076828899', NULL, '620 4-J Rd', 'Gillette', 'Campbell', 'WY', '82716', '3076828899', '', '', 'WYHCPCS', 'WYORTHO', '0.00', '10.00', '0.00', 6, '2007-08-01', '2009-06-30', 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1417912858', 0, 'n', 0, '2012-04-16', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'W11001802', 'W11001802', 'WY01', 'Gem City Bone and Joint', '', '', 'Premier Bone and Joint Centers', 'GROUP', 'Ambulatory Surgery Center', '', '', NULL, 'B', '1400 Uinta Dr', 'Green River', 'Sweetwater', 'WY', '82935', '8004465684', NULL, '1400 Uinta Dr', 'Green River', 'Sweetwater', 'WY', '82935', '8004465684', '          ', '', 'WYHCPCS', 'WYORTHO', '0.00', '10.00', '0.00', 6, '2007-08-01', '2009-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518947589', 0, 'Y', 0, '2013-03-07', NULL, NULL, 0, 0, NULL, NULL),
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('830219655', 'W11001804', 'W11001804', 'WY01', 'Gem City Bone and Joint', 'Lawrence', '', 'Jenkins', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1400 Uinta Dr', 'Green River', 'Sweetwater', 'WY', '82935', '3078757576', NULL, '1400 Uinta Dr', 'Green River', 'Sweetwater', 'WY', '82935', '3078757576', '', '', 'WYHCPCS', 'WYORTHO', '0.00', '10.00', '0.00', 6, '2007-08-01', '2009-06-30', 0, 0, 0, 'Ivinson Memorial Hospital', '', '', '', 'HCFA|UB|', '1093795056', 0, 'n', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'W11001805', 'W11001805', 'WY01', 'Gem City Bone and Joint', 'Thomas', '', 'Bienz', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1400 Uinta Dr', 'Green River', 'Sweetwater', 'WY', '82935', '3078757576', NULL, '1400 Uinta Dr', 'Green River', 'Sweetwater', 'WY', '82935', '3078757576', '', '', 'WYHCPCS', 'WYORTHO', '0.00', '10.00', '0.00', 6, '2007-08-01', '2009-06-30', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1992785976', 0, 'n', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
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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
('870483582', 'W11001876', 'W11001876', 'UT01', 'University Health Care', 'Judd', 'E', 'Cummings', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'o', '590 Wakara Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015877100', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2006-08-01', '2008-07-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1043437965', 0, 'N', 0, '2007-02-07', NULL, NULL, 0, 0, NULL, NULL),
('870483582', 'W11001877', 'W11001877', 'UT01', 'University Health Care', 'Judd', 'E', 'Cummings', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'B', 'PO Box 58108', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8015813998', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2006-08-01', '2008-07-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1043437965', 0, 'Y', 0, '2007-02-07', NULL, NULL, 0, 0, NULL, NULL),
('870483582', 'W11001878', 'W11001878', 'UT01', 'University Health Care', 'Corey', 'E', 'Ponder', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'B', 'PO Box 58108', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8015813998', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2006-08-01', '2008-07-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1982743787', 0, 'Y', 0, '2007-02-07', NULL, NULL, 0, 0, NULL, NULL),
('870483582', 'W11001879', 'W11001879', 'UT01', 'University Health Care', 'Bryce', 'C', 'Allen', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'B', 'PO Box 58108', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8015813998', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2006-08-01', '2008-07-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1518182831', 0, 'Y', 0, '2007-02-07', NULL, NULL, 0, 0, NULL, NULL),
('870483582', 'W11001880', 'W11001880', 'UT01', 'University Health Care', 'Bryce', 'C', 'Allen', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '590 Wakara Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015877100', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2006-08-01', '2008-07-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1518182831', 0, 'N', 0, '2007-02-07', NULL, NULL, 0, 0, NULL, NULL),
('870483582', 'W11001881', 'W11001881', 'UT01', 'University Health Care', 'Corey', 'E', 'Ponder', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '590 Wakara Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015877100', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2006-08-01', '2008-07-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1982743787', 0, 'N', 0, '2007-02-07', NULL, NULL, 0, 0, NULL, NULL),
('870443687', 'W11001882', 'W11001882', 'UT01', 'U-U Cardiology Division', 'Karen', 'E', 'Segerson', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'B', 'PO Box 581700', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8012133800', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2007-01-01', '2008-05-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1003995572', 0, 'y', 0, '2007-08-01', NULL, NULL, 0, 0, NULL, NULL),
('870443687', 'W11001883', 'W11001883', 'UT01', 'University Health Care', 'Karen', 'E', 'Segerson', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817715', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2007-01-01', '2008-05-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1003995572', 0, 'N', 0, '2007-08-01', NULL, NULL, 0, 0, NULL, NULL),
('870640775', 'W11001884', 'W11001884', 'UT01', 'University Health Care', 'Karen', 'E', 'Segerson', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'o', '1525 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8018872400', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WISESTDU', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-08-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1003995572', 0, 'N', 0, '2007-08-01', NULL, NULL, 40.7259, -111.934, NULL, NULL),
('870640775', 'W11001885', 'W11001885', 'UT01', 'University Health Care', 'Karen', 'E', 'Segerson', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'B', 'PO Box 581700', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8012133800', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WISESTDU', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-08-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1003995572', 0, 'Y', 0, '2007-08-01', NULL, NULL, 0, 0, NULL, NULL),
('870478993', 'W11001886', 'W11001886', 'UT01', 'University Health Care', 'Karen', 'E', 'Segerson', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'o', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817818', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2006-08-01', '2008-05-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1003995572', 0, 'N', 0, '2007-08-01', NULL, NULL, 0, 0, NULL, NULL),
('870478993', 'W11001887', 'W11001887', 'UT01', 'University Health Care', 'Karen', 'E', 'Segerson', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'B', 'PO Box 581700', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8012133800', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2006-08-01', '2008-05-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1003995572', 0, 'Y', 0, '2007-08-01', NULL, NULL, 0, 0, NULL, NULL),
('876151902', 'W11001888', 'W11001888', 'UT01', 'University Health Care', 'Mehdi', NULL, 'Ghajarnia', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'o', '65 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812352', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 6, '2007-01-01', '2008-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1417077983', 0, 'N', 0, '2007-02-07', NULL, NULL, 0, 0, NULL, NULL),
('876151902', 'W11001889', 'W11001889', 'UT01', 'University Health Care', 'Mehdi', NULL, 'Ghajarnia', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'B', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812352', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 6, '2007-01-01', '2008-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1417077983', 0, 'Y', 0, '2007-02-07', NULL, NULL, 0, 0, NULL, NULL),
('870567427', 'W11001890', 'W11001890', 'UT01', 'U of U Emergency Physicians', 'Scott', 'T', 'Youngquist', 'MD', 'Emergency Medicine', '', '', NULL, 'B', 'PO Box 510726', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876600', NULL, 'PO Box 510726', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876600', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2012-09-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134168701', 0, 'Y', 0, '2012-09-19', NULL, NULL, 0, 0, NULL, NULL),
('870567427', 'W11001891', 'W11001891', 'UT01', 'U of U Emergency Physicians', 'Scott', 'T', 'Youngquist', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812292', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812292', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2012-09-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134168701', 0, 'N', 0, '2012-09-19', NULL, NULL, 0, 0, NULL, NULL),
('205977241', 'W11001892', 'W11001892', 'TX01', 'Toyota Family Health Center', 'Julie', 'A', 'Bingham', 'MD', 'Family Practice', '', '', NULL, 'O', '1 Lone Star Pass Bldg 46', 'San Antonio', 'Bexar', 'TX', '78264', '2102635700', NULL, '1 Lone Star Pass Bldg 46', 'San Antonio', 'Bexar', 'TX', '78264', '2102635700', '', 'TXSTD', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2007-07-01', '2008-08-21', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548375272', 0, 'N', 0, '2011-02-03', NULL, NULL, 0, 0, NULL, NULL),
('205977241', 'W11001893', 'W11001893', 'TX01', 'Toyota Family Health Center', 'Stephen', 'Anthony', 'Carter', 'MD', 'Family Practice', '', '', NULL, 'O', '1 Lone Star Pass Bldg 46', 'San Antonio', 'Bexar', 'TX', '78264', '2102635700', NULL, '1 Lone Star Pass Bldg 46', 'San Antonio', 'Bexar', 'TX', '78264', '2102635700', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-07-01', '2010-04-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1518083062', 0, 'N', 0, '2007-09-03', NULL, NULL, 0, 0, NULL, NULL),
('205977241', 'W11001894', 'W11001894', 'TX01', 'Toyota Family Health Center', 'Jeb', '', 'Johnson', 'MD', 'Family Practice', '', '', NULL, 'O', '1 Lone Star Pass Bldg 46', 'San Antonio', 'Bexar', 'TX', '78264', '2102635700', NULL, '1 Lone Star Pass Bldg 46', 'San Antonio', 'Bexar', 'TX', '78264', '2102635700', '', 'TXSTD', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2007-07-01', '2009-12-07', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006970', 0, 'N', 0, '2010-06-29', NULL, NULL, 0, 0, NULL, NULL),
('205977241', 'W11001895', 'W11001895', 'TX01', 'Toyota Family Health Center', 'Steven', 'Thomas', 'Elliott', 'PTA', 'Physical Therapy', '', '', NULL, 'O', '1 Lone Star Pass Bldg 46', 'San Antonio', 'Bexar', 'TX', '78264', '2102635700', NULL, '1 Lone Star Pass Bldg 46', 'San Antonio', '', 'TX', '78264', '', '', 'TXSTD', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2007-07-01', '2008-08-21', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1851421424', 0, 'N', 0, '2007-09-03', NULL, NULL, 0, 0, NULL, NULL),
('205977241', 'W11001896', 'W11001896', 'TX01', 'Toyota Family Health Center', 'Stuart', 'Alfred', 'Saunders', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1 Lone Star Pass Bldg 46', 'San Antonio', 'Bexar', 'TX', '78264', '2102635700', NULL, '1 Lone Star Pass Bldg 46', 'San Antonio', 'Bexar', 'TX', '78264', '2102635700', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-07-01', '2010-04-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1245359793', 0, 'N', 0, '2007-09-03', NULL, NULL, 0, 0, NULL, NULL),
('205977241', 'W11001897', 'W11001897', 'TX01', 'Toyota Family Health Center', NULL, NULL, 'Toyota Family Health Center', 'GROUP', NULL, NULL, NULL, NULL, 'O', '1 Lone Star Pass Bldg 46', 'San Antonio', 'Bexar', 'TX', '78264', '2102635700', NULL, '1 Lone Star Pass Bldg 46', 'San Antonio', '', 'TX', '78264', '', '', 'TXSTD', 'TXHCPCS', NULL, '0.00', '50.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '0000009153', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('205977241', 'W11001898', 'W11001898', 'TX01', 'Toyota Family Health Center', '', '', 'Toyota Family Health Center', 'GROUP', '', '', '', NULL, 'O', '1 Lone Star Pass Bldg 46', 'San Antonio', 'Bexar', 'TX', '78264', '2102635700', NULL, '1 Lone Star Pass Bldg 46', 'San Antonio', 'Bexar', 'TX', '78264', '2102635700', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-07-01', '2010-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009153', 0, 'N', 0, '2010-11-05', NULL, NULL, 0, 0, NULL, NULL),
('205977241', 'W11001899', 'W11001899', 'TX01', 'Toyota Family Health Center', NULL, NULL, 'Toyota Family Health Center', 'GROUP', NULL, NULL, NULL, NULL, 'O', '1 Lone Star Pass Bldg 46', 'San Antonio', 'Bexar', 'TX', '78264', '2102635700', NULL, '1 Lone Star Pass Bldg 46', 'San Antonio', '', 'TX', '78264', '', '', 'TXSTD', 'TXHCPCS', NULL, '0.00', '50.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '0000009153', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('205977241', 'W11001900', 'W11001900', 'TX01', 'Toyota Family Health Center', NULL, NULL, 'Toyota Family Health Center', 'GROUP', NULL, NULL, NULL, NULL, 'O', '1 Lone Star Pass Bldg 46', 'San Antonio', 'Bexar', 'TX', '78264', '2102635700', NULL, '1 Lone Star Pass Bldg 46', 'San Antonio', '', 'TX', '78264', '', '', 'TXSTD', 'TXHCPCS', NULL, '0.00', '50.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '0000009153', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('205977241', 'W11001901', 'W11001901', 'TX01', 'Toyota Family Health Center', NULL, NULL, 'Toyota Family Health Center', 'GROUP', NULL, NULL, NULL, NULL, 'O', '1 Lone Star Pass Bldg 46', 'San Antonio', 'Bexar', 'TX', '78264', '2102635700', NULL, '1 Lone Star Pass Bldg 46', 'San Antonio', '', 'TX', '78264', '', '', 'TXSTD', 'TXHCPCS', NULL, '0.00', '50.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '0000009153', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('205977241', 'W11001902', 'W11001902', 'TX01', 'Toyota Family Health Center', 'Shayesteh', 'M', 'Izaddoost', 'OD', 'Optometry', '', '', NULL, 'O', '1 Lone Star Pass Bldg 46', 'San Antonio', 'Bexar', 'TX', '78264', '2102635700', NULL, '1 Lone Star Pass Bldg 46', 'San Antonio', 'Bexar', 'TX', '78264', '2102635700', '', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-07-01', '2012-08-22', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396875910', 0, 'N', 0, '2014-04-22', NULL, NULL, 0, 0, NULL, NULL),
('205977241', 'W11001903', 'W11001903', 'TX01', 'Toyota Family Health Center', 'James', NULL, 'Ramos', 'PA-C', 'Family Practice', NULL, NULL, NULL, 'O', '1 Lone Star Pass Bldg 46', 'San Antonio', 'Bexar', 'TX', '78264', '2102635700', NULL, '1 Lone Star Pass Bldg 46', 'San Antonio', '', 'TX', '78264', '', '', 'TXSTD', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2007-07-01', '2008-08-21', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000008314', 0, 'N', 0, '2007-09-03', NULL, NULL, 0, 0, NULL, NULL),
('205977241', 'W11001904', 'W11001904', 'TX01', 'Toyota Family Health Center', 'James', 'E', 'Calhoun', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1 Lone Star Pass Bldg 46', 'San Antonio', 'Bexar', 'TX', '78264', '2102635700', NULL, '1 Lone Star Pass Bldg 46', 'San Antonio', 'Bexar', 'TX', '78264', '2102635700', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-07-01', '2010-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437292497', 0, 'N', 0, '2011-02-03', NULL, NULL, 0, 0, NULL, NULL),
('870474993', 'W11001905', 'W11001905', 'UT01', 'Lifetree Pain Clinic', 'Andrew', 'P', 'Talbott', 'MD', 'Anesthesiology', 'Pain Management', NULL, NULL, 'O', '3838 S 700 E Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012614988', NULL, '3838 S 700 E', 'Salt Lake City', '', 'UT', '84127', '', '', 'WUSTDPAIN5', 'WUSTDHCPC5', '1000', '45.00', '35.00', '0.00', 6, '2006-11-01', NULL, 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000003004', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870474993', 'W11001906', 'W11001906', 'UT01', 'Lifetree Medical Group', 'Andrew', 'P', 'Talbott', 'MD', 'Anesthesiology', 'Pain Management', NULL, NULL, 'o', '617 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012618272', NULL, '3838 S 700 E', 'Salt Lake City', '', 'UT', '84127', '', '', 'WUSTDPAIN5', 'WUSTDHCPC5', '1000', '45.00', '35.00', '0.00', 6, '2006-11-01', NULL, 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000003004', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870640775', 'W11001907', 'W11001907', 'UT01', 'U of U Hospitals and Clinics - FPO', 'David', 'Arthur', 'Rawling', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'B', 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876600', NULL, 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876600', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-08-01', '2012-09-18', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750362844', 0, 'N', 0, '2012-09-19', NULL, NULL, 0, 0, NULL, NULL),
('870640775', 'W11001908', 'W11001908', 'UT01', 'University Health Care', 'David', 'Arthur', 'Rawling', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876303', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876303', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-08-01', '2012-09-18', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750362844', 0, 'N', 0, '2012-09-19', NULL, NULL, 0, 0, NULL, NULL),
('870640775', 'W11001909', 'W11001909', 'UT01', 'University Health Care', 'Gerald', 'Ira', 'Polukoff', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876303', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876303', '', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-08-01', '2008-02-02', 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1215020045', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('870640775', 'W11001910', 'W11001910', 'UT01', 'University Health Care', 'Gerald', 'Ira', 'Polukoff', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876303', NULL, 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876303', '', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-08-01', '2008-02-02', 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1215020045', 0, 'Y', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
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('836000129', 'W11001947', 'W11001947', 'WY01', 'Family Planning Sercices', 'Lori', 'L', 'Schaal', 'APRN', 'Family Practice', 'Obstetrics and Gynecology', NULL, NULL, 'O', '1007 Robertson', 'Worland', 'Washakie', 'WY', '82401', '3073473278', NULL, '1007 Robertson', 'Worland', '', 'WY', '82401', '', '', 'WisewyStd', 'wyhcpcs', NULL, '0.00', '35.00', '0.00', 3, '2007-08-01', '2008-07-15', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000003040', 0, 'N', 0, '2007-07-23', NULL, NULL, 0, 0, NULL, NULL),
('870490866', 'W11001948', 'W11001948', 'UT01', 'University Health Care', 'Heather', 'M', 'Acord', 'APRN', 'General Surgery', NULL, NULL, NULL, 'o', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817738', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', NULL, 3, '2006-08-01', '2007-12-15', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1326230129', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870490866', 'W11001949', 'W11001949', 'UT01', 'University Health Care', 'Heather', 'M', 'Acord', 'APRN', 'General Surgery', NULL, NULL, NULL, 'B', 'PO Box 58681', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8012133800', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', NULL, 3, '2006-08-01', '2007-12-15', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1326230129', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('743134252', 'W11001950', 'W11001950', 'UT01', 'Pediatric Genetics-Department of University of Utah', 'Lorenzo', 'D', 'Botto', 'MD', 'Pediatrics', 'Pediatric Genetics', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2006-08-01', '2012-07-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982819645', 0, 'N', 0, '2012-07-31', NULL, NULL, 0, 0, NULL, NULL),
('743134252', 'W11001951', 'W11001951', 'UT01', 'University Health Care', 'Lorenzo', 'D', 'Botto', 'MD', 'Pediatrics', 'Pediatric Genetics', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015818943', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015818943', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2006-08-01', '2012-07-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982819645', 0, 'N', 0, '2012-07-31', NULL, NULL, 0, 0, NULL, NULL),
('876151902', 'W11001952', 'W11001952', 'UT01', 'University of Utah Dept of Ophthalmology', 'Parisa', NULL, 'Farhi', 'MD', 'Ophthalmology', '', '', NULL, 'B', '65 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015813195', NULL, '65 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015813195', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 6, '2007-01-01', '2012-08-09', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1376672717', 0, 'N', 0, '2012-08-10', NULL, NULL, 0, 0, NULL, NULL),
('876151902', 'W11001953', 'W11001953', 'UT01', 'University Health Care', 'Parisa', NULL, 'Farhi', 'MD', 'Ophthalmology', '', '', NULL, 'O', '65 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015813195', NULL, '65 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015813195', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 6, '2007-01-01', '2012-08-09', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1376672717', 0, 'N', 0, '2012-08-10', NULL, NULL, 0, 0, NULL, NULL),
('942764098', 'W11001954', 'W11001954', 'UT01', 'University Neurosurgery Associates', 'Edgar', 'C', 'Goldston', 'MD', 'Pain Management', 'Physical Medicine and Rehabilitation', 'Neurosurgery', NULL, 'B', 'PO Box 58417', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8012133800', NULL, 'PO Box 58417', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8012133800', '', 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2006-08-01', '2008-02-01', 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1942492079', 0, 'y', 0, '2011-10-24', NULL, NULL, 0, 0, NULL, NULL),
('942764098', 'W11001955', 'W11001955', 'UT01', 'University Health Care', 'Edgar', 'C', 'Goldston', 'MD', 'Pain Management', 'Physical Medicine and Rehabilitation', 'Neurosurgery', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015816909', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015816909', '', 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2006-08-01', '2008-02-01', 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1942492079', 0, 'N', 0, '2011-10-24', NULL, NULL, 0, 0, NULL, NULL),
('201513999', 'W11001956', 'W11001956', 'UT01', 'Timpanogos Emergency Physicians', 'Susan', 'S', 'Watson', 'DO', 'Emergency Medicine', NULL, NULL, NULL, 'B', 'PO Box 1747', 'Orem', 'Utah', 'UT', '84059', '8003733055', '          ', 'PO Box 1747', 'Orem', 'Utah', 'UT', '84059', '8003733055', '          ', 'WRMER', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-08-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1629176433', 0, 'Y', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('201513999', 'W11001957', 'W11001957', 'UT01', 'Timpanogos Emergency Physicians', 'Micah', 'J', 'Smith', 'DO', 'Emergency Medicine', NULL, NULL, NULL, 'B', 'PO Box 1747', 'Orem', 'Utah', 'UT', '84059', '8003733055', '          ', 'PO Box 1747', 'Orem', 'Utah', 'UT', '84059', '8003733055', '          ', 'WRMER', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-08-15', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1750316188', 0, 'Y', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('201513999', 'W11001958', 'W11001958', 'UT01', 'Timpanogos Emergency Physicians', 'Craig', 'P', 'Patten', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'B', 'PO Box 1747', 'Orem', 'Utah', 'UT', '84059', '8003733055', '          ', 'PO Box 1747', 'Orem', 'Utah', 'UT', '84059', '8003733055', '          ', 'WRMER', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-08-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1114967163', 0, 'Y', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('201513999', 'W11001959', 'W11001959', 'UT01', 'Timpanogos Emergency Physicians', 'Koneen', '', 'Willis', 'PA-C', 'Neurology', 'Emergency Medicine', '', NULL, 'B', 'PO Box 1747', 'Orem', 'Utah', 'UT', '84059', '8003733055', '          ', 'PO Box 1747', 'Orem', 'Utah', 'UT', '84059', '8003733055', '          ', 'WRMER', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861510240', 0, 'Y', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('201513999', 'W11001960', 'W11001960', 'UT01', 'Timpanogos Emergency Physicians', 'James', 'B', 'Meeks', 'PA', 'Urology', 'Emergency Medicine', '', NULL, 'B', 'PO Box 1747', 'Orem', 'Utah', 'UT', '84059', '8003733055', '          ', 'PO Box 1747', 'Orem', 'Utah', 'UT', '84059', '8003733055', '          ', 'WRMER', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-08-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1023057460', 0, 'Y', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('201513999', 'W11001961', 'W11001961', 'UT01', 'Timpanogos Emergency Physicians', 'Shari', 'L', 'Rowley', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'B', 'PO Box 1747', 'Orem', 'Utah', 'UT', '84059', '8003733055', '          ', 'PO Box 1747', 'Orem', 'Utah', 'UT', '84059', '8003733055', '          ', 'WRMER', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-08-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1043218464', 0, 'Y', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('201513999', 'W11001962', 'W11001962', 'UT01', 'Timpanogos Emergency Physicians', 'Jeffrey', 'W', 'Madsen', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'B', 'PO Box 1747', 'Orem', 'Utah', 'UT', '84059', '8003733055', '          ', 'PO Box 1747', 'Orem', 'Utah', 'UT', '84059', '8003733055', '          ', 'WRMER', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-08-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1063627859', 0, 'Y', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('870659348', 'W11001963', 'W11001963', 'UT01', 'University Pathology Associates', 'Albert', '', 'Ho', 'MD', 'Pathology', 'Anatomic Pathology', 'Clinical Pathology', NULL, 'o', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812507', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812507', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2011-05-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902003965', 0, 'Y', 0, '2011-07-15', NULL, NULL, 0, 0, NULL, NULL),
('870659348', 'W11001964', 'W11001964', 'UT01', 'University Pathology Associates', 'Albert', '', 'Ho', 'MD', 'Pathology', 'Anatomic Pathology', 'Clinical Pathology', NULL, 'B', 'PO Box 413037', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413037', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2011-05-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902003965', 0, 'Y', 0, '2011-07-15', NULL, NULL, 0, 0, NULL, NULL),
('412144134', 'W11001965', 'W11001965', 'UT01', 'ARUP Pathology Associates', 'Albert', '', 'Ho', 'MD', 'Pathology', 'Anatomic Pathology', 'Clinical Pathology', NULL, 'o', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812507', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812507', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2011-05-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902003965', 0, 'Y', 0, '2011-07-15', NULL, NULL, 0, 0, NULL, NULL),
('412144134', 'W11001966', 'W11001966', 'UT01', 'ARUP Pathology Associates', 'Albert', '', 'Ho', 'MD', 'Pathology', 'Anatomic Pathology', 'Clinical Pathology', NULL, 'B', 'PO Box 413037', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413037', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2011-05-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902003965', 0, 'Y', 0, '2011-07-15', NULL, NULL, 0, 0, NULL, NULL),
('870483582', 'W11001967', 'W11001967', 'UT01', 'University Health Care', 'Bret', 'T', 'Kean', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '590 Wakara Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015877100', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2006-08-01', '2008-07-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1871797654', 0, 'N', 0, '2007-02-07', NULL, NULL, 0, 0, NULL, NULL),
('870483582', 'W11001968', 'W11001968', 'UT01', 'University Health Care', 'Bret', 'T', 'Kean', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'B', 'PO Box 58108', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8015813998', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2006-08-01', '2008-07-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1871797654', 0, 'Y', 0, '2007-02-07', NULL, NULL, 0, 0, NULL, NULL),
('870483582', 'W11001969', 'W11001969', 'UT01', 'University Health Care', 'William', 'E', 'MacLeod', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'B', 'PO Box 58108', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8015813998', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2006-08-01', '2008-07-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1902021041', 0, 'Y', 0, '2007-02-07', NULL, NULL, 0, 0, NULL, NULL),
('870483582', 'W11001970', 'W11001970', 'UT01', 'University Health Care', 'William', 'E', 'MacLeod', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '590 Wakara Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015877100', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2006-08-01', '2008-07-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1902021041', 0, 'N', 0, '2007-02-07', 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
('876000525', 'W11001971', 'W11001971', 'UT01', 'University of Utah Hospital', 'Cheryl', 'S', 'Nickisch', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 510721', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8012382663', NULL, 'PO Box 510721', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8012382663', '          ', '', '', '1', '0.00', '0.00', '0.00', 6, '2006-01-01', '2011-10-01', 0, 0, 0, '', '', '', '', 'HCFA|', '1386628733', 0, 'Y', 0, '2011-10-12', NULL, NULL, 0, 0, NULL, NULL),
('876000525', 'W11001972', 'W11001972', 'UT01', 'University of Utah Hospital', 'Cheryl', 'S', 'Nickisch', 'PT', 'Physical Therapy', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812121', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812121', '          ', '', '', '1', '0.00', '0.00', '0.00', 6, '2006-01-01', '2011-10-01', 0, 0, 0, '', '', '', '', 'HCFA|', '1386628733', 0, 'N', 0, '2011-10-12', NULL, NULL, 0, 0, NULL, NULL),
('870642019', 'W11001973', 'W11001973', 'UT01', 'Pediatric Urology Associates', 'Siam', NULL, 'Oottamasathien', 'MD', 'Urology', '', '', NULL, 'B', 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2006-08-01', '2012-09-17', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1215084017', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('870642019', 'W11001974', 'W11001974', 'UT01', 'Pediatric Urology Associates', 'Siam', NULL, 'Oottamasathien', 'MD', 'Urology', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015883300', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015883300', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2006-08-01', '2012-09-17', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1215084017', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('870483582', 'W11001975', 'W11001975', 'UT01', 'University Health Care', 'Kevin', 'L', 'Stucki', 'DO', 'Orthopedic Surgery', '', '', NULL, 'B', '590 Wakara Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015877100', NULL, '590 Wakara Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015877100', '', 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2006-08-01', '2008-07-31', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1306975701', 0, 'N', 0, '2012-01-17', NULL, NULL, 0, 0, NULL, NULL),
('870483582', 'W11001976', 'W11001976', 'UT01', 'University Health Care', 'Kevin', 'L', 'Stucki', 'DO', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 58108', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8015813998', NULL, 'PO Box 58108', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8015813998', '', 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2006-08-01', '2008-07-31', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1306975701', 0, 'Y', 0, '2012-01-17', NULL, NULL, 0, 0, NULL, NULL),
('870659348', 'W11001977', 'W11001977', 'UT01', 'University Pathology Associates', 'Annika', 'B', 'Svensson', 'MD', 'Pathology', 'Anatomic Pathology', 'Clinical Pathology', NULL, 'o', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812507', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812507', '', 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2006-08-01', '2009-03-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467643122', 0, 'Y', 0, '2012-03-06', NULL, NULL, 0, 0, NULL, NULL),
('870659348', 'W11001978', 'W11001978', 'UT01', 'University Pathology Associates', 'Annika', 'B', 'Svensson', 'MD', 'Pathology', 'Anatomic Pathology', 'Clinical Pathology', NULL, 'B', 'PO Box 581054', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8012133800', NULL, 'PO Box 581054', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8012133800', '', 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2006-08-01', '2009-03-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467643122', 0, 'Y', 0, '2012-03-06', NULL, NULL, 0, 0, NULL, NULL),
('412144134', 'W11001979', 'W11001979', 'UT01', 'ARUP Pathology Associates', 'Annika', 'B', 'Svensson', 'MD', 'Pathology', 'Anatomic Pathology', 'Clinical Pathology', NULL, 'o', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812507', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812507', '', 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2006-08-01', '2009-03-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467643122', 0, 'Y', 0, '2012-03-06', NULL, NULL, 0, 0, NULL, NULL),
('412144134', 'W11001980', 'W11001980', 'UT01', 'ARUP Pathology Associates', 'Annika', 'B', 'Svensson', 'MD', 'Pathology', 'Anatomic Pathology', 'Clinical Pathology', NULL, 'B', 'PO Box 581054', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8012133800', NULL, 'PO Box 581054', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8012133800', '', 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2006-08-01', '2009-03-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467643122', 0, 'Y', 0, '2012-03-06', NULL, NULL, 0, 0, NULL, NULL),
('743134257', 'W11001981', 'W11001981', 'UT01', 'Pediatric Infectious Disease-Dept of University of Utah', 'Emily', 'A', 'Thorell', 'MD', 'Pediatric Infectious Diseases', 'Pediatrics', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2006-08-01', '2012-07-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1891751384', 0, 'N', 0, '2013-01-22', NULL, NULL, 0, 0, NULL, NULL),
('743134257', 'W11001982', 'W11001982', 'UT01', 'Pediatric Infectious Disease-Dept of University of Utah', 'Emily', 'A', 'Thorell', 'MD', 'Pediatric Infectious Diseases', 'Pediatrics', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015816791', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015816791', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2006-08-01', '2012-07-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1891751384', 0, 'N', 0, '2013-01-22', NULL, NULL, 0, 0, NULL, NULL),
('743134267', 'W11001983', 'W11001983', 'UT01', 'University Health Care', 'Emily', 'A', 'Thorell', 'MD', 'Pediatric Infectious Diseases', 'Pediatrics', '', NULL, 'o', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882000', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882000', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2006-08-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1891751384', 0, 'N', 0, '2013-01-22', NULL, NULL, 0, 0, NULL, NULL),
('743134267', 'W11001984', 'W11001984', 'UT01', 'University Health Care', 'Emily', 'A', 'Thorell', 'MD', 'Pediatric Infectious Diseases', 'Pediatrics', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2006-08-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1891751384', 0, 'Y', 0, '2013-01-22', NULL, NULL, 0, 0, NULL, NULL),
('870442845', 'W11001985', 'W11001985', 'UT01', 'University Health Care', 'Guido', 'J', 'Tricot', 'MD', 'Hematology and Oncology', 'Magnetic Resonance Imaging', 'Oncology', NULL, 'o', '1950 Circle of Hope', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015850100', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2007-07-01', '2009-08-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1063502540', 0, 'N', 0, '2009-11-30', NULL, NULL, 0, 0, NULL, NULL),
('870442845', 'W11001986', 'W11001986', 'UT01', 'University Health Care', 'Guido', 'J', 'Tricot', 'MD', 'Hematology and Oncology', 'Magnetic Resonance Imaging', 'Oncology', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2007-07-01', '2009-08-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1063502540', 0, 'Y', 0, '2009-11-30', NULL, NULL, 0, 0, NULL, NULL),
('743134266', 'UT0055', 'W11001987', 'UT01', 'Pediatric Emergency Medicine-Dept of University of Utah', 'Kelly', 'E', 'Wood', 'MD', 'Pediatrics', 'Pediatric Emergency Medicine', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015853655', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015853655', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2008-08-01', '2012-07-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407901283', 0, 'N', 0, '2013-01-22', NULL, NULL, 0, 0, NULL, NULL),
('743134266', 'UT0056', 'W11001988', 'UT01', 'University Health Care', 'Kelly', 'E', 'Wood', 'MD', 'Pediatrics', 'Pediatric Emergency Medicine', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621234', '', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621234', '', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2008-08-01', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407901283', 0, 'N', 0, '2013-01-22', NULL, NULL, 0, 0, NULL, NULL),
('364586972', 'UT0057', 'W11001989', 'UT01', 'University of Utah Pediatric Rapid Treatment Unit', 'Kelly', 'E', 'Wood', 'MD', 'Pediatrics', 'Pediatric Emergency Medicine', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015853655', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015853655', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2008-08-01', '2012-07-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407901283', 0, 'N', 0, '2013-01-22', NULL, NULL, 0, 0, NULL, NULL),
('364586972', 'UT0058', 'W11001990', 'UT01', 'University Healthcare', 'Kelly', 'E', 'Wood', 'MD', 'Pediatrics', 'Pediatric Emergency Medicine', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621234', '8015877455', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621234', '8015877455', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2008-08-01', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407901283', 0, 'N', 0, '2013-01-22', NULL, NULL, 0, 0, NULL, NULL),
('204528561', 'W11001991', 'W11001991', 'WY01', 'Family Vision Clinic', 'Mike', 'E', 'Harris', 'OD', 'Optometry', '', '', NULL, 'O', '2510 E 15th St Ste 1', 'Casper', 'Natrona', 'WY', '82609', '3072378713', NULL, '2510 E 15th St Ste 1', 'Casper', 'Natrona', 'WY', '82609', '3072378713', '', 'WISEWYSTD', 'wyhcpcs', NULL, '0.00', '35.00', '0.00', 3, '2007-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104819333', 0, 'n', 0, '2011-06-29', NULL, NULL, 42.8353, -106.294, NULL, NULL),
('870654617', 'W11001992', 'W11001992', 'UT01', 'Castle Country Family Medicine', 'Shane', 'D', 'Gagon', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 1437', '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, 'Y', 0, '2007-01-07', NULL, NULL, 0, 0, NULL, NULL),
('870654617', 'W11001993', 'W11001993', 'UT01', 'Castle Country Family Medicine', 'Jeannee', 'L', 'Hunt', 'PAC', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 1437', 'Price', 'Carbon', 'UT', '84501', '4356132200', NULL, 'PO Box 1437', 'Price', 'Carbon', 'UT', '84501', '4356132200', '', '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|', '1194810937', 0, 'Y', 0, '2010-09-20', NULL, NULL, 0, 0, NULL, NULL),
('621795215', 'W11001994', 'W11001994', 'UT01', 'Pioneer Valley Hospital Physicians', 'Justin', 'P', 'Parkinson', 'MD', 'Urology', '', '', NULL, 'B', 'PO Box 150', 'West Jordan', 'Salt Lake', 'UT', '84084', '8013529500', NULL, 'PO Box 150', 'West Jordan', 'Salt Lake', 'UT', '84084', '8013529500', '', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2007-08-01', '2010-06-16', 0, 0, 0, 'Jordan Valley Medical Center', 'Salt Lake Regional Medical Center', 'Pioneer Valley Hospital', '', 'HCFA|UB|', '1851314066', 0, 'Y', 0, '2014-06-17', NULL, NULL, 0, 0, NULL, NULL),
('621795215', 'W11001995', 'W11001995', 'UT01', 'Pioneer Valley Hospital Physicians', 'Justin', 'P', 'Parkinson', 'MD', 'Urology', '', '', NULL, 'O', '4052 W Pioneer Pkwy Ste 202', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019554685', NULL, '4052 W Pioneer Pkwy Ste 202', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019554685', '', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2007-08-01', '2010-06-16', 0, 0, 0, 'Jordan Valley Medical Center', 'Salt Lake Regional Medical Center', 'Pioneer Valley Hospital', '', 'HCFA|UB|', '1851314066', 0, 'N', 0, '2014-06-17', NULL, NULL, 0, 0, NULL, NULL),
('870401574', 'W11001996', 'W11001996', 'UT01', 'Highland Ridge Hospital', '', '', 'Highland Ridge Hospital', 'GROUP', 'Mental Health Facility', 'Substance Abuse Facility', '', NULL, 'O', '7309 S 180 W', 'Midvale', 'Salt Lake', 'UT', '84106', '8015692153', NULL, '7309 S 180 W', 'Midvale', 'Salt Lake', 'UT', '84106', '8015692153', '          ', '', '', '8', '0.00', '100.00', '0.00', 3, '2007-09-01', '2008-09-30', 1, 0, 0, '', '', '', '', 'HCFA|UB|', '1871504159', 0, 'N', 0, '2014-02-24', NULL, NULL, 0, 0, NULL, NULL),
('870474993', 'W11001997', 'W11001997', 'UT01', 'Lifetree Medical Group', 'Andrew', 'P', 'Talbott', 'MD', 'Pain Management', 'Anesthesiology', '', NULL, 'B', 'PO Box 27688', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8015341360', NULL, 'PO Box 27688', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8015341360', '', 'WUSTDPAIN5', 'WUSTDHCPC5', '1000', '45.00', '35.00', '0.00', 6, '2006-11-01', '2012-04-01', 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1619932761', 0, 'Y', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('870474993', 'W11001998', 'W11001998', 'UT01', 'Lifetree Medical Group', 'Andrew', 'P', 'Talbott', 'MD', 'Pain Management', 'Anesthesiology', '', NULL, 'O', '617 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012618272', NULL, '617 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012618272', '', 'WUSTDPAIN5', 'WUSTDHCPC5', '1000', '45.00', '35.00', '0.00', 6, '2006-11-01', '2011-10-10', 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1619932761', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('870474993', 'W11001999', 'W11001999', 'UT01', 'Lifetree Pain Clinic', 'Andrew', 'P', 'Talbott', 'MD', 'Pain Management', 'Anesthesiology', '', NULL, 'o', '3838 S 700 E', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012614988', NULL, '3838 S 700 E', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012614988', '', 'WUSTDPAIN5', 'WUSTDHCPC5', '1000', '45.00', '35.00', '0.00', 6, '2006-11-01', '2012-04-01', 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1619932761', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('742478680', 'W11002000', 'W11002000', 'TX01', 'Night and Day Pediatrics', 'Carolina', NULL, 'Pillion', 'MD', 'Pediatrics', NULL, NULL, NULL, 'B', '4499 Medical Dr Ste 280', 'San Antonio', 'Bexar', 'TX', '78229', '2106144499', NULL, '4499 Medical Dr', 'San Antonio', '', 'TX', '78229', '', '', 'TXPED', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2007-01-01', '2009-07-21', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1831399195', 0, 'Y', 0, '2007-01-11', NULL, NULL, 29.5105, -98.5737, NULL, NULL),
('742478680', 'W11002001', 'W11002001', 'TX01', 'Night and Day Pediatrics', 'Carolina', NULL, 'Pillion', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '502 Madison Oak Dr Ste 340', 'San Antonio', 'Bexar', 'TX', '78258', '2104955552', NULL, '4499 Medical Dr', 'San Antonio', '', 'TX', '78229', '', '', 'TXPED', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2007-01-01', '2009-07-21', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1831399195', 0, 'N', 0, '2007-01-11', NULL, NULL, 29.6202, -98.49, NULL, NULL),
('836000295', 'W11002002', 'W11002002', 'WY01', 'Memorial Hospital of Sweetwater County', 'Alan', NULL, 'Richardson', 'MD', 'Family Practice', '', '', NULL, 'O', '1204 Hilltop Dr Ste 107', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528125', NULL, '1204 Hilltop Dr Ste 107', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528125', '          ', '', '', '', '0.00', '5.00', '0.00', 3, '2006-12-01', '2010-07-07', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1215085642', 0, 'N', 0, '2007-01-11', NULL, NULL, 0, 0, NULL, NULL),
('562627028', 'W11002003', 'W11002003', 'UT01', 'University of Utah Dept of Obgyn Gynecologic Oncology', NULL, NULL, 'University of Utah Dept of Obgyn Gynecologic Oncology', 'GROUP', 'Gynecologic Oncology', 'Obstetrics and Gynecology', '', NULL, 'B', 'PO Box 413028', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8015813195', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2007-07-01', '2008-12-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000009287', 0, 'Y', 0, '2009-11-30', NULL, NULL, 0, 0, NULL, NULL),
('562627028', 'W11002004', 'W11002004', 'UT01', 'University of Utah Dept of Obgyn Gynecologic Oncology', NULL, NULL, 'University of Utah Dept of Obgyn Gynecologic Oncology', 'GROUP', 'Gynecologic Oncology', 'Obstetrics and Gynecology', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812719', NULL, 'PO Box 58859', 'Salt Lake City', '', 'UT', '84132', '', '', 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2007-07-01', '2008-12-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000009287', 0, 'Y', 0, '2009-11-30', NULL, NULL, 0, 0, NULL, NULL),
('562627035', 'W11002005', 'W11002005', 'UT01', 'University of utah Dept of OBGYN Reproductive Endocrinology', '', '', 'University of Utah Dept of OBGYN Reproductive Endocrinology', 'GROUP', 'Reproductive Endocrinology', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817647', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817647', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2007-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009289', 0, 'Y', 0, '2013-02-11', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('562627035', 'W11002006', 'W11002006', 'UT01', 'University of utah Dept of OBGYN Reproductive Endocrinology', '', '', 'University of Utah Dept of OBGYN Reproductive Endocrinology', 'GROUP', 'Reproductive Endocrinology', '', '', NULL, 'B', 'PO Box 413028', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413028', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2007-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009289', 0, 'Y', 0, '2013-02-11', NULL, NULL, 0, 0, NULL, NULL),
('562627037', 'W11002007', 'W11002007', 'UT01', 'University of Utah Dept of OBGYN Urogynecology', '', '', 'University of Utah Dept of OBGYN Urogynecology', 'GROUP', 'Urogynecology', '', '', NULL, 'B', 'PO Box 413028', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413028', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '', 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2007-07-01', '2008-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009290', 0, 'Y', 0, '2012-08-20', NULL, NULL, 0, 0, NULL, NULL),
('562627037', 'W11002008', 'W11002008', 'UT01', 'University of Utah Dept of OBGYN Urogynecology', '', '', 'University of Utah Dept of OBGYN Urogynecology', 'GROUP', 'Urogynecology', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812719', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812719', '', 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2007-07-01', '2008-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009290', 0, 'Y', 0, '2012-08-20', NULL, NULL, 0, 0, NULL, NULL),
('562627040', 'W11002009', 'W11002009', 'UT01', 'University of Utah Dept of OBGYN Maternal Fetal Medicine', '', '', 'University of Utah Dept of OBGYN Maternal Fetal Medicine', 'GROUP', 'Maternal Fetal Medicine', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817647', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817647', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2007-07-01', '2013-02-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009288', 0, 'Y', 0, '2013-12-12', NULL, NULL, 0, 0, NULL, NULL),
('562627040', 'W11002010', 'W11002010', 'UT01', 'University of Utah Dept of OBGYN Maternal Fetal Medicine', '', '', 'University of Utah Dept of OBGYN Maternal Fetal Medicine', 'GROUP', 'Maternal Fetal Medicine', '', '', NULL, 'B', 'PO Box 413028', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413028', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2007-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009288', 0, 'Y', 0, '2013-12-12', NULL, NULL, 0, 0, NULL, NULL),
('742478680', 'W11002011', 'W11002011', 'TX01', 'Night and Day Pediatrics', 'Deepali', 'J', 'Dubal', 'MD', 'Pediatrics', '', '', NULL, 'O', '502 Madison Oak Dr Ste 340', 'San Antonio', 'Bexar', 'TX', '78258', '2104955552', NULL, '502 Madison Oak Dr Ste 340', 'San Antonio', 'Bexar', 'TX', '78258', '2104955552', '', 'TXPED', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2007-01-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598959447', 0, 'N', 0, '2013-08-28', NULL, NULL, 29.6202, -98.49, NULL, NULL),
('742478680', 'W11002012', 'W11002012', 'TX01', 'Ostrower Nieheisel & Davis MD', 'Deepali', 'J', 'Dubal', 'MD', 'Pediatrics', '', '', NULL, 'B', '4499 Medical Dr Ste 280', 'San Antonio', 'Bexar', 'TX', '78229', '2104955552', NULL, '4499 Medical Dr Ste 280', 'San Antonio', 'Bexar', 'TX', '78229', '2104955552', '', 'TXPED', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2007-01-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598959447', 0, 'Y', 0, '2013-08-28', NULL, NULL, 29.5105, -98.5737, NULL, NULL),
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('562627037', 'W11002050', 'W11002050', 'UT01', 'University Health Care', 'Ingrid', 'E', 'Nygaard', 'MD', 'Urogynecology', '', '', NULL, 'B', 'PO Box 413028', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 58859', 'Salt Lake City', '', 'UT', '84132', '', '', 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2007-07-01', '2008-12-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1790737831', 0, 'Y', 0, '2009-11-30', NULL, NULL, 0, 0, NULL, NULL),
('870529461', 'W11002051', 'W11002051', 'UT01', 'University Health Care', NULL, NULL, 'University of Utah Dept of OBGYN Fertility', 'GROUP', 'Fertiliy', NULL, NULL, NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817260', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', NULL, 3, '2007-08-01', '2007-08-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870529461', 'W11002052', 'W11002052', 'UT01', 'University Health Care', NULL, NULL, 'University of Utah Dept of OBGYN Fertility', 'GROUP', 'Fertiliy', NULL, NULL, NULL, 'B', 'PO Box 58859', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8012133800', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', NULL, 3, '2007-08-01', '2007-08-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11002053', 'W11002053', 'UT01', 'University Health Care', 'Barbara', 'M', 'Fisher', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'o', '7495 S State St', 'Midvale', 'Salt Lake', 'UT', '84047', '8012139400', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WISESTDU', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2007-08-01', '2009-06-22', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1679695050', 0, 'N', 0, '2009-07-14', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11002054', 'W11002054', 'UT01', 'University Health Care', 'Barbara', 'M', 'Fisher', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'o', '1091 W S Jordan Pkwy', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012139800', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WISESTDU', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2007-08-01', '2009-06-22', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1679695050', 0, 'N', 0, '2009-07-14', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11002055', 'W11002055', 'UT01', 'University Health Care', 'Barbara', 'M', 'Fisher', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'B', 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876303', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WISESTDU', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2007-08-01', '2009-06-22', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1679695050', 0, 'Y', 0, '2009-07-14', NULL, NULL, 0, 0, NULL, NULL),
('743134253', 'W11002056', 'W11002056', 'UT01', 'University Health Care', 'Mark', 'N', 'Fluchel', 'MD', 'Pediatric Hematology and Oncolocy', '', '', NULL, 'o', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882000', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882000', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2006-08-01', '2012-07-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972723286', 0, 'N', 0, '2012-07-31', NULL, NULL, 0, 0, NULL, NULL),
('743134253', 'W11002057', 'W11002057', 'UT01', 'University Health Care', 'Mark', 'N', 'Fluchel', 'MD', 'Pediatric Hematology and Oncolocy', '', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2006-08-01', '2012-07-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972723286', 0, 'Y', 0, '2012-07-31', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11002058', 'W11002058', 'UT01', 'University Health Care', 'Andrew', 'W', 'Garrison', 'MD', 'Family Practice', '', '', NULL, 'O', '1525 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8012139900', NULL, '1525 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8012139900', '', 'WISESTDU', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2007-08-01', '2008-08-01', 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1821219379', 0, 'N', 0, '2013-11-26', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11002059', 'W11002059', 'UT01', 'University Health Care', 'Andrew', 'W', 'Garrison', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876303', NULL, 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876303', '', 'WISESTDU', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2007-08-01', '2008-08-01', 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1821219379', 0, 'Y', 0, '2013-11-26', NULL, NULL, 0, 0, NULL, NULL),
('743134260', 'W11002060', 'W11002060', 'UT01', 'University Health Care', 'Matthew', 'M', 'Grinsell', 'MD', 'Pediatric Nephrology', '', '', NULL, 'o', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882000', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882000', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2006-08-01', '2012-07-30', 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1346364429', 0, 'N', 0, '2012-07-31', NULL, NULL, 0, 0, NULL, NULL),
('743134260', 'W11002061', 'W11002061', 'UT01', 'University Health Care', 'Matthew', 'M', 'Grinsell', 'MD', 'Pediatric Nephrology', '', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2006-08-01', '2012-07-30', 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1346364429', 0, 'Y', 0, '2012-07-31', NULL, NULL, 0, 0, NULL, NULL),
('870446925', 'W11002062', 'W11002062', 'UT01', 'University Health Care', 'Curt', 'H', 'Hagedorn', 'MD', 'Gastroenterology', '', '', NULL, 'o', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817802', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817802', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2012-08-29', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1487757399', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('870446925', 'W11002063', 'W11002063', 'UT01', 'University Health Care', 'Curt', 'H', 'Hagedorn', 'MD', 'Gastroenterology', '', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012386615', NULL, 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012386615', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2012-08-29', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1487757399', 0, 'Y', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('870645559', 'W11002064', 'W11002064', 'UT01', 'University Health Care', 'Joni', 'A', 'Hemond', 'MD', 'Pediatrics', 'Child Protection and Family Health', '', NULL, 'o', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015813501', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015813501', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2006-08-01', '2012-08-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1699883496', 0, 'N', 0, '2012-08-02', NULL, NULL, 0, 0, NULL, NULL),
('870645559', 'W11002065', 'W11002065', 'UT01', 'University Health Care', 'Joni', 'A', 'Hemond', 'MD', 'Pediatrics', 'Child Protection and Family Health', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8015813501', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8015813501', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2006-08-01', '2012-08-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1699883496', 0, 'Y', 0, '2012-08-02', NULL, NULL, 0, 0, NULL, NULL),
('870476269', 'W11002066', 'W11002066', 'UT01', 'University Health Care', 'Joni', 'A', 'Hemond', 'MD', 'Pediatrics', 'Child Protection and Family Health', '', NULL, 'o', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015813501', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015813501', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2006-08-01', '2012-08-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1699883496', 0, 'N', 0, '2012-08-02', NULL, NULL, 0, 0, NULL, NULL),
('870476269', 'W11002067', 'W11002067', 'UT01', 'University Health Care', 'Joni', 'A', 'Hemond', 'MD', 'Pediatrics', 'Child Protection and Family Health', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2006-08-01', '2012-08-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1699883496', 0, 'Y', 0, '2012-08-02', NULL, NULL, 0, 0, NULL, NULL),
('743134267', 'W11002068', 'W11002068', 'UT01', 'University Health Care', 'Benjamin', 'A', 'Kalm', 'MD', 'Pediatrics', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882000', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882000', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2007-01-01', '2012-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427130285', 0, 'N', 0, '2013-01-22', NULL, NULL, 0, 0, NULL, NULL),
('743134267', 'W11002069', 'W11002069', 'UT01', 'University Health Care', 'Benjamin', 'A', 'Kalm', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2007-01-01', '2012-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427130285', 0, 'Y', 0, '2013-01-22', NULL, NULL, 0, 0, NULL, NULL),
('743134267', 'W11002070', 'W11002070', 'UT01', 'University Health Care', 'Marta', 'A', 'Kamburowski', 'MD', 'Pediatrics', '', '', NULL, 'o', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882000', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882000', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2006-08-01', '2012-07-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1134135379', 0, 'N', 0, '2013-01-22', NULL, NULL, 0, 0, NULL, NULL),
('743134267', 'W11002071', 'W11002071', 'UT01', 'University Health Care', 'Marta', 'A', 'Kamburowski', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2006-08-01', '2012-07-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1134135379', 0, 'Y', 0, '2013-01-22', NULL, NULL, 0, 0, NULL, NULL),
('870483582', 'W11002072', 'W11002072', 'UT01', 'University Health Care', 'Erik', 'N', 'Kubiak', 'MD', 'Orthopedic Surgery', 'Pediatric Orthopedic Surgery', NULL, NULL, 'B', 'PO Box 58108', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8015813998', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2006-08-01', '2008-07-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1003825753', 0, 'Y', 0, '2008-01-07', NULL, NULL, 0, 0, NULL, NULL),
('870483582', 'W11002073', 'W11002073', 'UT01', 'University Health Care', 'Erik', 'N', 'Kubiak', 'MD', 'Orthopedic Surgery', 'Pediatric Orthopedic Surgery', NULL, NULL, 'O', '590 Wakara Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015877100', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2006-08-01', '2008-07-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1003825753', 0, 'N', 0, '2008-01-07', NULL, NULL, 0, 0, NULL, NULL),
('743134271', 'W11002074', 'W11002074', 'UT01', 'University Health Care', 'Nelangi', 'M', 'Pinto', 'MD', 'Pediatric Cardiology', 'Pediatrics', '', NULL, 'o', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882000', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882000', '', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2006-08-01', '2012-05-01', 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1871616227', 0, 'N', 0, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
('743134271', 'W11002075', 'W11002075', 'UT01', 'University Health Care', 'Nelangi', 'M', 'Pinto', 'MD', 'Pediatric Cardiology', 'Pediatrics', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2006-08-01', '2012-05-01', 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1871616227', 0, 'Y', 0, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
('320186101', 'W11002076', 'W11002076', 'UT01', 'University Health Care', 'Nelangi', 'M', 'Pinto', 'MD', 'Pediatric Cardiology', 'Pediatrics', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016625400', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016625400', '', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2006-12-01', '2012-05-01', 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1871616227', 0, 'N', 0, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
('320186101', 'W11002077', 'W11002077', 'UT01', 'University Health Care', 'Nelangi', 'M', 'Pinto', 'MD', 'Pediatric Cardiology', 'Pediatrics', NULL, NULL, 'B', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016625400', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUPEDS', 'WUSTDHCPC5', NULL, '0.00', '15.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1871616227', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870442845', 'W11002078', 'W11002078', 'UT01', 'University Health Care', 'Mary', 'T', 'Towns', 'APRN', 'Hematology and Oncology', 'Oncology', '', NULL, 'o', '1950 Circle of Hope', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015850100', NULL, '1950 Circle of Hope', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015850100', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2007-07-01', '2012-08-27', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1174713788', 0, 'N', 0, '2012-08-28', NULL, NULL, 0, 0, NULL, NULL),
('870442845', 'W11002079', 'W11002079', 'UT01', 'University Health Care', 'Mary', 'T', 'Towns', 'APRN', 'Hematology and Oncology', 'Oncology', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2007-07-01', '2012-08-27', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1174713788', 0, 'Y', 0, '2012-08-28', NULL, NULL, 0, 0, NULL, NULL),
('870480520', 'W11002080', 'W11002080', 'UT01', 'University Health Care', 'Meghan', 'S', 'Zorn', 'PA', 'Neurology', 'Neurosurgery', '', NULL, 'o', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812719', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812719', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2007-01-01', '2012-08-09', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1972528784', 0, 'N', 0, '2012-08-13', NULL, NULL, 0, 0, NULL, NULL),
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('870410144', 'W11002082', 'W11002082', 'UT01', 'University Health Care', 'Susan', 'M', 'Rose', 'MD', 'Maternal Fetal Medicine', 'Obstetrics and Gynecology', '', NULL, 'o', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817746', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817746', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2010-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1518088087', 0, 'N', 0, '2007-02-07', NULL, NULL, 0, 0, NULL, NULL),
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('870288620', 'W11002117', 'W11002117', 'UT01', 'Utah Orthopaedic Associates', 'Richard', '', 'Zipnick', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1250 E 3900 S Ste 440', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012612232', NULL, '1250 E 3900 S Ste 440', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012612232', '', 'WUSTDORTH5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-10-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1215917240', 0, 'N', 0, '2014-07-08', NULL, NULL, 40.6871, -111.856, NULL, NULL),
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('870634586', 'W11002143', 'W11002143', 'UTMH1', 'Recovery Bridge', '', '', 'Recovery Bridge', 'GROUP', 'Mental Health Facility', '', '', NULL, 'O', '7679 S Main St', 'Midvale', 'Salt Lake', 'UT', '84047', '8012555999', NULL, '7679 S Main St', 'Midvale', 'Salt Lake', 'UT', '84047', '8012555999', '          ', '', '', '8', '0.00', '100.00', '0.00', 3, '2007-09-01', '2008-09-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871637009', 0, 'Y', 0, '2013-04-22', NULL, NULL, 0, 0, NULL, NULL),
('711001763', 'W11002144', 'W11002144', 'WY01', 'Desert View Eyecare', 'Jeffery', 'A', 'Wilson', 'OD', 'Optometry', '', '', NULL, 'O', '520 Wilkes Dr Ste 12', 'Green River', 'Sweetwater', 'WY', '82935', '3078753399', NULL, '520 Wilkes Dr Ste 12', 'Green River', 'Sweetwater', 'WY', '82935', '3078753399', '', 'WISEWYSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134163272', 0, 'n', 0, '2011-12-20', NULL, NULL, 41.5172, -109.474, NULL, NULL),
('743003947', 'W11002145', 'W11002145', 'TX01', 'The San Antonio Orthopaedic Group', 'Erika', '', 'Jullis', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 2516', 'San Antonio', 'Bexar', 'TX', '78258', '8004454263', '          ', 'PO Box 2516', 'San Antonio', 'Bexar', 'TX', '78258', '8004454263', '          ', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-01-01', '2014-07-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007016', 0, 'Y', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
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('743003947', 'W11002152', 'W11002152', 'TX01', 'The San Antonio Orthopaedic Group', 'Rory', 'H', 'Lewis', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '2829 Babcock Rd Ste 700', 'San Antonio', 'Bexar', 'TX', '78229', '2103965270', NULL, '400 Concord Plaza Dr', 'San Antonio', '', 'TX', '78216', '', '', 'TXORTHO', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2007-01-01', '2009-08-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1548213267', 0, 'N', 0, '2007-10-03', NULL, NULL, 29.5138, -98.5907, NULL, NULL),
('743003947', 'W11002153', 'W11002153', 'TX01', 'The San Antonio Orthopaedic Group', 'Rory', 'H', 'Lewis', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '150 E Sonterra Blvd Ste 300', 'San Antonio', 'Bexar', 'TX', '78258', '2104897270', NULL, '400 Concord Plaza Dr', 'San Antonio', '', 'TX', '78216', '', '', 'TXORTHO', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2007-01-01', '2009-08-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1548213267', 0, 'N', 0, '2007-10-03', NULL, NULL, 29.6152, -98.4924, NULL, NULL),
('870395551', 'W11002154', 'W11002154', 'UT01', NULL, 'Mark', NULL, 'Bentley', '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, '2007-04-09', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1366656241', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11002155', 'W11002155', 'UT01', NULL, 'Cameron', 'J', 'Bateman', '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, '2007-04-09', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1447443452', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11002156', 'W11002156', 'UT01', NULL, 'Jeffrey', 'G', 'Norman', '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, '2007-04-09', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1548362783', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('870395551', 'W11002157', 'W11002157', 'UT01', NULL, 'Bryn', 'W', 'Bradley', '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, '2007-04-09', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1447447982', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11002158', 'W11002158', 'UT01', NULL, 'Matthew', 'B', 'Hull', '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, '2007-04-09', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1457542904', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11002159', 'W11002159', 'UT01', NULL, 'Stephanie', 'A', 'Hoglund', 'DC', 'Chiropractic', '', '', 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', '0.00', '55.46', 3, '2007-04-09', '2008-01-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1912118225', 0, 'Y', 0, '2010-03-24', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11002160', 'W11002160', 'UT01', NULL, 'Mark', NULL, 'Bentley', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '523 E Sunland Dr Ste C', 'St George', 'Washington', 'UT', '84770', '4356287040', '4356742646', '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2007-04-09', '2010-10-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1366656241', 0, 'N', 0, '2007-10-04', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11002161', 'W11002161', 'UT01', NULL, 'Cameron', 'J', 'Bateman', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '715 E 3900 S Ste 107', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012688051', '8012683030', '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2007-04-09', '2010-10-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1447443452', 0, 'N', 0, '2009-05-11', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11002162', 'W11002162', 'UT01', NULL, 'Jeffrey', 'G', 'Norman', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '1266 S Legend Hills Ste B2', 'Clearfield', 'Davis', 'UT', '84015', '8017746602', '8016141210', '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2007-04-09', '2010-10-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1548362783', 0, 'N', 0, '2007-10-04', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11002163', 'W11002163', 'UT01', NULL, 'Bryn', 'W', 'Bradley', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '1781 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015625600', '8012557104', '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2007-04-09', '2010-10-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000013002', 0, 'N', 0, '2007-10-04', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11002164', 'W11002164', 'UT01', NULL, 'Matthew', 'B', 'Hull', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '1424 S Legend Hills Dr Ste 100', 'Clearfield', 'Davis', 'UT', '84015', '8017746602', '8016141210', '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2007-04-09', '2009-05-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1457542904', 0, 'N', 0, '2007-10-04', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11002165', 'W11002165', 'UT01', NULL, 'Stephanie', 'A', 'Hoglund', 'DC', 'Chiropractic', '', '', NULL, 'O', '1300 N 200 E', 'Logan', 'Cache', 'UT', '84341', '4357557654', '8013527024', '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2007-04-09', '2008-01-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1912118225', 0, 'N', 0, '2010-03-24', NULL, NULL, 0, 0, NULL, NULL),
('870442845', 'W11002166', 'W11002166', 'UT01', 'University Health Care', 'Julia', 'A', 'Batten', 'APRN', 'Hematology and Oncology', NULL, NULL, NULL, 'o', '1950 Circle of Hope', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015850100', NULL, '1950 Circle of Hope', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015850100', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2007-07-01', '2012-08-27', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1770673303', 0, 'N', 0, '2012-08-28', NULL, NULL, 0, 0, NULL, NULL),
('870442845', 'W11002167', 'W11002167', 'UT01', 'University Health Care', 'Julia', 'A', 'Batten', 'APRN', 'Hematology and Oncology', NULL, NULL, NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2007-07-01', '2012-08-27', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1770673303', 0, 'Y', 0, '2012-08-28', NULL, NULL, 0, 0, NULL, NULL),
('876000525', 'W11002168', 'W11002168', 'UT01', 'University of Utah Hospital', 'Doug', 'W', 'Benson', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812121', NULL, '50 N Medical Dr', 'Salt Lake City', '', 'UT', '84132', '', '', '', NULL, '1', '0.00', '0.00', '0.00', 6, '2006-01-01', NULL, 1, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '0000005264', 0, 'N', 0, '2007-10-04', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('876000525', 'W11002169', 'W11002169', 'UT01', 'University of Utah Hospital', 'Doug', 'W', 'Benson', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'B', 'PO Box 510721 ', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015812121', NULL, '50 N Medical Dr', 'Salt Lake City', '', 'UT', '84132', '', '', NULL, NULL, '1', '0.00', NULL, NULL, 6, '2006-01-01', '2006-01-01', 1, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '5264', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('876000525', 'W11002170', 'W11002170', 'UT01', 'University of Utah Hospital', 'Jennifer', 'L', 'Bowen', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'B', 'PO Box 510721 ', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015812121', NULL, '50 N Medical Dr', 'Salt Lake City', '', 'UT', '84132', '', '', NULL, NULL, '1', '0.00', NULL, NULL, 6, '2006-01-01', '2006-01-01', 1, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1821264144', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870659348', 'W11002171', 'W11002171', 'UT01', 'University Pathology Associates', 'Brian', 'T', 'Collins', 'MD', 'Pathology', 'Clinical Pathology', 'Anatomic Pathology', NULL, 'o', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812507', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812507', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2011-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427070044', 0, 'Y', 0, '2012-03-06', NULL, NULL, 0, 0, NULL, NULL),
('870659348', 'W11002172', 'W11002172', 'UT01', 'University Pathology Associates', 'Brian', 'T', 'Collins', 'MD', 'Pathology', 'Clinical Pathology', 'Anatomic Pathology', NULL, 'B', 'PO Box 413037', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413037', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2011-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427070044', 0, 'Y', 0, '2012-03-06', NULL, NULL, 0, 0, NULL, NULL),
('412144134', 'W11002173', 'W11002173', 'UT01', 'ARUP Pathology Associates', 'Brian', 'T', 'Collins', 'MD', 'Pathology', 'Clinical Pathology', 'Anatomic Pathology', NULL, 'o', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812507', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812507', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2011-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427070044', 0, 'Y', 0, '2012-03-06', NULL, NULL, 0, 0, NULL, NULL),
('412144134', 'W11002174', 'W11002174', 'UT01', 'ARUP Pathology Associates', 'Brian', 'T', 'Collins', 'MD', 'Pathology', 'Clinical Pathology', 'Anatomic Pathology', NULL, 'B', 'PO Box 413037', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413037', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2011-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427070044', 0, 'Y', 0, '2012-03-06', NULL, NULL, 0, 0, NULL, NULL),
('870442845', 'W11002175', 'W11002175', 'UT01', 'University Health Care', 'Michael', 'J', 'Glantz', 'MD', 'Hematology and Oncology', NULL, NULL, NULL, 'o', '1950 Circle of Hope', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015850100', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2007-07-01', '2009-04-03', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1568457695', 0, 'N', 0, '2007-10-04', NULL, NULL, 0, 0, NULL, NULL),
('870442845', 'W11002176', 'W11002176', 'UT01', 'University Health Care', 'Michael', 'J', 'Glantz', 'MD', 'Hematology and Oncology', NULL, NULL, NULL, 'B', 'PO Box 581700', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8012133800', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2007-07-01', '2009-04-03', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1568457695', 0, 'Y', 0, '2007-10-04', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11002177', 'W11002177', 'UT01', 'University Health Care', 'Johanna', 'E', 'Greenberg', 'PA', 'Family Practice', '', '', NULL, 'o', '220 Millpond Rd Ste 100', 'Stansbury Park', 'Tooele', 'UT', '84074', '8012139400', NULL, '220 Millpond Rd Ste 100', 'Stansbury Park', 'Tooele', 'UT', '84074', '8012139400', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2007-08-01', '2012-09-16', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1013102979', 0, 'N', 0, '2012-09-17', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11002178', 'W11002178', 'UT01', 'University Health Care', 'Johanna', 'E', 'Greenberg', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876303', NULL, 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876303', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2007-08-01', '2012-09-16', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1013102979', 0, 'Y', 0, '2012-09-17', NULL, NULL, 0, 0, NULL, NULL),
('876000525', 'W11002179', 'W11002179', 'UT01', 'University of Utah Hospital', 'Erin', NULL, 'Mendenhall', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812121', NULL, '50 N Medical Dr', 'Salt Lake City', '', 'UT', '84132', '', '', '', NULL, '1', '0.00', '0.00', '0.00', 6, '2006-01-01', NULL, 1, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1528247947', 0, 'N', 0, '2007-10-04', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('876000525', 'W11002180', 'W11002180', 'UT01', 'University of Utah Hospital', 'Erin', NULL, 'Mendenhall', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'B', 'PO Box 510721 ', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015812121', NULL, '50 N Medical Dr', 'Salt Lake City', '', 'UT', '84132', '', '', NULL, NULL, '1', '0.00', NULL, NULL, 6, '2006-01-01', '2006-01-01', 1, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1528247947', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('876000525', 'W11002181', 'W11002181', 'UT01', 'University of Utah Hospital', 'Jennifer', 'R', 'Sinclair', 'OT', 'Physical Therapy', NULL, NULL, NULL, 'B', 'PO Box 510721 ', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015812121', NULL, '50 N Medical Dr', 'Salt Lake City', '', 'UT', '84132', '', '', NULL, NULL, '1', '0.00', NULL, NULL, 6, '2006-01-01', '2006-01-01', 1, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1376749481', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('876000525', 'W11002182', 'W11002182', 'UT01', 'University of Utah Hospital', 'Jennifer', 'R', 'Sinclair', 'OT', 'Physical Therapy', NULL, NULL, NULL, 'B', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812121', NULL, '50 N Medical Dr', 'Salt Lake City', '', 'UT', '84132', '', '', '', NULL, '1', '0.00', '0.00', '0.00', 6, '2006-01-01', NULL, 1, 0, 0, '', '', '', '', 'HCFA|', '1376749481', 0, 'Y', 0, '2007-10-04', NULL, NULL, 0, 0, NULL, NULL),
('876000525', 'W11002183', 'W11002183', 'UT01', 'University of Utah Hospital', 'Rebecca', 'L', 'Taylor', 'OT', 'Physical Therapy', NULL, NULL, NULL, 'B', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812121', NULL, '50 N Medical Dr', 'Salt Lake City', '', 'UT', '84132', '', '', '', NULL, '1', '0.00', '0.00', '0.00', 6, '2006-01-01', NULL, 1, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1992992622', 0, 'Y', 0, '2007-10-04', NULL, NULL, 0, 0, NULL, NULL),
('876000525', 'W11002184', 'W11002184', 'UT01', 'University of Utah Hospital', 'Rebecca', 'L', 'Taylor', 'OT', 'Physical Therapy', NULL, NULL, NULL, 'B', 'PO Box 510721 ', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015812121', NULL, '50 N Medical Dr', 'Salt Lake City', '', 'UT', '84132', '', '', NULL, NULL, '1', '0.00', NULL, NULL, 6, '2006-01-01', '2006-01-01', 1, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1992992622', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('830282641', 'W11002220', 'W11002220', 'WY01', 'Big Horn Basin Orthopaedic Clinic', 'Jason', NULL, 'Lawn', 'PA', 'Orthopedic Surgery', NULL, NULL, NULL, 'B', 'PO Box 457', 'Cody', 'Park', 'WY', '82414', '3075781992', NULL, '720 Lindsay Ln', 'Cody', '', 'WY', '82414', '', '', '', NULL, NULL, '0.00', '25.00', '0.00', 3, '2007-10-01', '2008-09-12', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1316908825', 0, 'Y', 0, '2007-10-18', NULL, NULL, 0, 0, NULL, NULL),
('830282641', 'W11002221', 'W11002221', 'WY01', 'Big Horn Basin Orthopaedic Clinic', 'Kevin', '', 'Bell', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 457', 'Cody', 'Park', 'WY', '82414', '3075781992', NULL, 'PO Box 457', 'Cody', 'Park', 'WY', '82414', '3075781992', '', '', NULL, NULL, '0.00', '25.00', '0.00', 3, '2007-10-01', '2009-02-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033146402', 0, 'Y', 0, '2011-09-16', NULL, NULL, 0, 0, NULL, NULL),
('841423431', 'W11002222', 'W11002222', 'UT01', 'Physical Medicine ', 'Max', NULL, 'Root', 'MD', 'Physical Medicine and Rehabilitation', NULL, NULL, NULL, 'O', '1424 E Foremaster Dr Ste 120', 'St George', 'Washington', 'UT', '84790', '4356568800', NULL, '1424 E Foremaster Dr', 'St George', '', 'UT', '84790', '', '', 'WISESTD', 'WUSTDHCPC', NULL, '0.00', '35.00', '0.00', 3, '2007-09-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1295725380', 0, 'n', 0, '2007-10-19', NULL, NULL, 37.0962, -113.553, NULL, NULL),
('841423431', 'W11002223', 'W11002223', 'UT01', 'Physical Medicine ', 'Bradley', NULL, 'Root', 'DO', 'Physical Medicine and Rehabilitation', NULL, NULL, NULL, 'O', '1424 E Foremaster Dr Ste 120', 'St George', 'Washington', 'UT', '84790', '4356568800', NULL, '1424 E Foremaster Dr', 'St George', '', 'UT', '84790', '', '', 'WISESTD', 'WUSTDHCPC', NULL, '0.00', '35.00', '0.00', 3, '2007-09-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1154312197', 0, 'n', 0, '2007-10-19', NULL, NULL, 37.0962, -113.553, NULL, NULL),
('841423431', 'W11002224', 'W11002224', 'UT01', 'Physical Medicine', 'Daniel', '', 'Stagg', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1424 E Foremaster Dr Ste 120', 'St George', 'Washington', 'UT', '84790', '4356568800', NULL, '1424 E Foremaster Dr Ste 120', 'St George', 'Washington', 'UT', '84790', '4356568800', '          ', 'WISESTD', 'WUSTDHCPC', '', '0.00', '35.00', '0.00', 3, '2007-09-01', '2010-11-12', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008879', 0, 'N', 0, '2010-11-12', NULL, NULL, 0, 0, NULL, NULL),
('841423431', 'W11002225', 'W11002225', 'UT01', 'Physical Medicine ', 'Lonnie', NULL, 'Truman', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'O', '1424 E Foremaster Dr Ste 120', 'St George', 'Washington', 'UT', '84790', '4356568800', NULL, '1424 E Foremaster Dr', 'St George', '', 'UT', '84790', '', '', 'WISESTD', 'WUSTDHCPC', NULL, '0.00', '35.00', '0.00', 3, '2007-09-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '0000009189', 0, 'n', 0, '2007-10-19', NULL, NULL, 37.0962, -113.553, NULL, NULL),
('841423431', 'W11002226', 'W11002226', 'UT01', 'Physical Medicine ', 'Sean', 'J', 'Stucki', 'PA', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '1424 E Foremaster Dr Ste 120', 'St George', 'Washington', 'UT', '84790', '4356568800', NULL, '1424 E Foremaster Dr Ste 120', 'St George', 'Washington', 'UT', '84790', '4356568800', '          ', 'WISESTD', 'WUSTDHCPC', '', '0.00', '35.00', '0.00', 3, '2007-09-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1245296383', 0, 'Y', 0, '2010-11-12', NULL, NULL, 37.0962, -113.553, NULL, NULL),
('830320408', 'W11002227', 'W11002227', 'WY01', 'The Family Clinic', 'Dana', 'R', 'Ideen', 'MD', 'Family Practice', '', '', NULL, 'O', '1315 East A St', 'Casper', 'Natrona', 'WY', '82601', '3072358552', '3072354656', '1315 East A Street', 'Casper', 'Natrona', 'WY', '82601', '3072358552', '3072354656', '', '', '', '0.00', '10.00', '0.00', 3, '2007-10-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1558375477', 0, 'N', 0, '2012-06-01', NULL, NULL, 42.8514, -106.308, NULL, NULL),
('830320408', 'W11002228', 'W11002228', 'WY01', 'The Family Clinic', 'Marjorie', 'L', 'Wells', 'MD', 'Family Practice', '', '', NULL, 'O', '1315 East A Street', 'Casper', 'Natrona', 'WY', '82601', '3072358552', '3072354656', '1315 East A Street', 'Casper', 'Natrona', 'WY', '82601', '3072358552', '3072354656', '', '', '', '0.00', '10.00', '0.00', 3, '2007-10-15', '2010-12-31', 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1780698431', 0, 'N', 0, '2013-06-27', NULL, NULL, 0, 0, NULL, NULL),
('830320408', 'W11002229', 'W11002229', 'WY01', 'The Family Clinic', 'Dorothy', 'E', 'Mosher', 'CFNP', 'Family Practice', '', '', NULL, 'O', '1315 East A Street', 'Casper', 'Natrona', 'WY', '82601', '3072358552', '3072354656', '1315 East A Street', 'Casper', 'Natrona', 'WY', '82601', '3072358552', '3072354656', '', '', '', '0.00', '10.00', '0.00', 3, '2007-10-15', '2012-05-29', 0, 0, 0, 'Wyoming Medical Center', '', '', '', 'HCFA|UB|', '1669486502', 0, 'N', 0, '2013-02-13', NULL, NULL, 0, 0, NULL, NULL),
('205550845', 'W11002230', 'W11002230', 'UT01', 'Park City Imaging Inc', NULL, NULL, 'Park City Imaging Inc', 'GROUP', 'Imaging Center', 'Radiology', NULL, NULL, 'B', '1850 Sidewinder Dr Ste 410', 'Park City', 'Summit', 'UT', '84060', '4356150250', NULL, '1850 Sidewinder Dr', 'Park City', '', 'UT', '84060', '', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000008058', 0, 'Y', 0, '2008-01-22', NULL, NULL, 0, 0, NULL, NULL),
('205550845', 'W11002231', 'W11002231', 'UT01', 'Park City Imaging Inc', 'John', 'C', 'Olson', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 470 Ogden', 'Ogden', 'Weber', 'UT', '84402', '4356150250', NULL, 'PO Box 470 Ogden', 'Ogden', 'Weber', 'UT', '84402', '4356150250', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-01-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1932169604', 0, 'Y', 0, '2010-12-28', NULL, NULL, 0, 0, NULL, NULL),
('205550845', 'W11002232', 'W11002232', 'UT01', 'Park City Imaging Inc', 'Barry', 'M', 'Birkin', 'MD', 'Radiologist', '', '', NULL, 'B', 'PO Box 470 Ogden', 'Ogden', 'Weber', 'UT', '84402', '4356150250', NULL, 'PO Box 470 Ogden', 'Ogden', 'Weber', 'UT', '84402', '4356150250', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-01-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1144289521', 0, 'Y', 0, '2010-12-28', NULL, NULL, 0, 0, NULL, NULL),
('205550845', 'W11002233', 'W11002233', 'UT01', 'Park City Imaging Inc', 'William', 'B', 'Hale', 'MD', 'Radiologist', '', '', NULL, 'B', 'PO Box 470 Ogden', 'Ogden', 'Weber', 'UT', '84402', '4356150250', NULL, 'PO Box 470 Ogden', 'Ogden', 'Weber', 'UT', '84402', '4356150250', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-01-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1689625097', 0, 'Y', 0, '2012-08-21', NULL, NULL, 0, 0, NULL, NULL),
('870481325', 'W11002234', 'W11002234', 'UT01', 'Westside Medical Clinic', 'Samantha', 'P', 'Bostrom', 'MD', 'Family Practice', '', '', NULL, 'O', '1477 N 2000 W Ste C', 'Clinton', 'Davis', 'UT', '84015', '8017748888', '8018258519', '1477 N 2000 W Ste C', 'Clinton', 'Davis', 'UT', '84015', '8017748888', '8018258519', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1881801579', 0, 'N', 0, '2014-04-08', NULL, NULL, 41.1353, -112.064, NULL, NULL),
('810587644', 'W11002235', 'W11002235', 'UT01', 'Cache Valley Community Health Ctr', 'Brant', 'W', 'Fonnesbeck', 'DO', 'Family Practice', '', '', NULL, 'O', '550 E 1400 N Ste K', 'Logan', 'Cache', 'UT', '84341', '4357556061', NULL, '550 E 1400 N Ste K', 'Logan', 'Cache', 'UT', '84341', '4357556061', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2011-05-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033156849', 0, 'N', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('810587644', 'W11002236', 'W11002236', 'UT01', 'Cache Valley Community Health Ctr', 'David', 'J', 'Ballingham', 'PA', 'Family Practice', '', '', NULL, 'O', '550 E 1400 N Ste K', 'Logan', 'Cache', 'UT', '84341', '4357556061', NULL, '550 E 1400 N Ste K', 'Logan', 'Cache', 'UT', '84341', '4357556061', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2011-09-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821216722', 0, 'N', 0, '2013-06-17', NULL, NULL, 0, 0, NULL, NULL),
('810587644', 'W11002237', 'W11002237', 'UT01', 'Cache Valley Community Health Ctr', 'Fred', 'H', 'Denison', 'LCSW', 'Mental Health', '', '', NULL, 'O', '550 E 1400 N Ste K', 'Logan', 'Cache', 'UT', '84341', '4357556061', NULL, '550 E 1400 N Ste K', 'Logan', 'Cache', 'UT', '84341', '4357556061', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2013-01-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518187798', 0, 'N', 0, '2013-02-01', NULL, NULL, 0, 0, NULL, NULL),
('810587644', 'W11002238', 'W11002238', 'UT01', 'Bear Lake Community Health Center', 'Fred', 'H', 'Denison', 'LCSW', 'Mental Health', '', '', NULL, 'O', '325 W Logan Hwy Ste 3', 'Garden City', 'Rich', 'UT', '84028', '4359463660', '4359468215', '325 W Logan Hwy Ste 3', 'Garden City', 'Rich', 'UT', '84028', '4359463660', '4359468215', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2013-01-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518187798', 0, 'N', 0, '2013-02-01', NULL, NULL, 0, 0, NULL, NULL),
('810587644', 'W11002239', 'W11002239', 'UT01', 'Bear Lake Community Health Center', 'Brant', 'W', 'Fonnesbeck', 'DO', 'Family Practice', '', '', NULL, 'O', '325 W Logan Hwy Ste 3', 'Garden City', 'Rich', 'UT', '84028', '4359463660', '4359468215', '325 W Logan Hwy Ste 3', 'Garden City', 'Rich', 'UT', '84028', '4359463660', '4359468215', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033156849', 0, 'N', 0, '2014-04-02', NULL, NULL, 41.9363, -111.394, NULL, NULL),
('810587644', 'W11002240', 'W11002240', 'UT01', 'Bear Lake Community Health Center', 'David', 'J', 'Ballingham', 'PA', 'Family Practice', '', '', NULL, 'O', '325 W Logan Hwy Ste 3', 'Garden City', 'Rich', 'UT', '84028', '4359463660', '4359468215', '325 W Logan Hwy Ste 3', 'Garden City', 'Rich', 'UT', '84028', '4359463660', '4359468215', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821216722', 0, 'N', 0, '2013-06-17', NULL, NULL, 41.9363, -111.394, NULL, NULL),
('810587644', 'W11002241', 'W11002241', 'UT01', 'Bear Lake Community Health Center', 'Mary', 'E', 'Orians', 'FNP', 'Family Practice', '', '', NULL, 'O', '325 W Logan Hwy Ste 3', 'Garden City', 'Rich', 'UT', '84028', '4359463660', '4359468215', '325 W Logan Hwy Ste 3', 'Garden City', 'Rich', 'UT', '84028', '4359463660', '4359468215', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', '2009-11-01', 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1093741449', 0, 'N', 0, '2013-02-06', NULL, NULL, 0, 0, NULL, NULL),
('810587644', 'W11002242', 'W11002242', 'UT01', 'Cache Valley Community Health Ctr', 'Mary', 'E', 'Orians', 'FNP', 'Family Practice', '', '', NULL, 'O', '550 E 1400 N Ste K', 'Logan', 'Cache', 'UT', '84341', '4357556061', NULL, '550 E 1400 N Ste K', 'Logan', 'Cache', 'UT', '84341', '4357556061', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', '2009-11-01', 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1093741449', 0, 'N', 0, '2013-02-06', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11002243', 'W11002243', 'UT01', 'Central Utah Clinic', 'John', 'A', 'Griffin', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'O', '1220 E 3900 S Ste 4D', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012659139', NULL, '1220 E 3900 S Ste 4D', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012659139', '', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-01-01', '2010-07-14', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1821014903', 0, 'N', 0, '2014-07-17', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11002244', 'W11002244', 'UT01', 'Central Utah Clinic', 'John', 'A', 'Griffin', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', NULL, 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-01-01', '2010-07-14', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1821014903', 0, 'N', 0, '2014-07-17', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11002245', 'W11002245', 'UT01', 'Central Utah Clinic', 'John', 'K', 'Staheli', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3650 N University Ave Ste 125', 'Provo', 'Utah', 'UT', '84604', '8012277378', NULL, '3650 N University Ave Ste 125', 'Provo', 'Utah', 'UT', '84604', '8012277378', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-01-01', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1275591620', 0, 'N', 0, '2013-08-27', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11002246', 'W11002246', 'UT01', 'Central Utah Clinic', 'John', 'K', 'Staheli', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3300 N Running Creek Way Ste 200', 'Lehi', 'Utah', 'UT', '84043', '8017537400', NULL, '3300 N Running Creek Way Ste 200', 'Lehi', 'Utah', 'UT', '84043', '8017537400', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-01-01', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1275591620', 0, 'N', 0, '2013-08-27', NULL, NULL, 0, 0, NULL, NULL),
('204240264', 'W11002247', 'W11002247', 'UT01', 'Southwest Skin and Cancer', 'Rand', 'L', 'Colbert', 'MD', 'Dermatology', 'Pathology', '', NULL, 'O', '166 W 1325 N Ste 250', 'Cedar City', 'Iron', 'UT', '84720', '4355866440', NULL, '166 W 1325 N Ste 250', 'Cedar City', 'Iron', 'UT', '84720', '4355866440', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', '2009-04-07', 0, 0, 0, 'Valley View Medical Center', '', '', '', 'HCFA|UB|', '1073692380', 0, 'N', 0, '2011-09-20', NULL, NULL, 0, 0, NULL, NULL),
('201192861', 'W11002248', 'W11002248', 'WY01', 'Cesko Family Medicine', 'David', 'R', 'Cesko', 'MD', 'Family Practice', 'Obstetrics and Gynecology', '', NULL, 'O', '819 W Maple', 'Rawlins', 'Carbon', 'WY', '82301', '3073243667', '3073245591', '819 W Maple', 'Rawlins', 'Carbon', 'WY', '82301', '3073243667', '3073245591', 'WY125', 'wyhcpcs', NULL, '0.00', '35.00', '0.00', 3, '2007-09-01', NULL, 0, 0, 0, 'Memorial Hospital of Carbon County', NULL, NULL, NULL, 'HCFA|UB|', '1497756118', 0, 'n', 0, '2011-06-10', NULL, NULL, 41.7905, -107.245, NULL, NULL),
('201192861', 'W11002249', 'W11002249', 'WY01', 'Cesko Family Medicine', 'David', 'R', 'Cesko', 'MD', 'Family Practice', 'Obstetrics and Gynecology', '', NULL, 'B', 'PO Box 40', 'Rawlins', 'Carbon', 'WY', '82301', '3073243667', '3073245591', 'PO Box 40', 'Rawlins', 'Carbon', 'WY', '82301', '3073243667', '3073245591', 'WY125', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-09-01', '2014-02-04', 0, 0, 0, 'Memorial Hospital of Carbon County', NULL, NULL, NULL, 'HCFA|UB|', '1497756118', 0, 'Y', 0, '2014-02-13', NULL, NULL, 0, 0, NULL, NULL),
('742799731', 'W11002250', 'W11002250', 'TX01', 'Ortho Plus, Inc.', NULL, NULL, 'Ortho Plus, Inc.', 'GROUP', 'Durable Medical Equipment', NULL, NULL, NULL, 'O', '7823 Fortune Dr', 'San Antonio', 'Bexar', 'TX', '78250', '2105418568', NULL, 'PO Box 690633', 'San Antonio', '', 'TX', '78269', '', '', 'TXDME', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2007-09-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1366407132', 0, 'n', 0, '2007-10-29', NULL, NULL, 0, 0, NULL, NULL);
