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
('752536818', 'W12042394', 'W12042394', 'TXDALSTD', 'Baylor Family Medicine at Coppell', 'Vijayalakshmi', '', 'Raghu', 'MD', 'Family Practice', '', '', NULL, 'O', '878 S Denton Tap Rd Ste 250', 'Coppell', 'Dallas', 'TX', '75019', '9727456590', '9727456595', '878 S Denton Tap Rd Ste 250', 'Coppell', 'Dallas', 'TX', '75019', '9727456590', '9727456595', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-10-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225220940', 0, 'N', 0, '2013-12-20', NULL, NULL, 32.9492, -96.9934, NULL, NULL),
('752536818', 'W12042395', 'W12042395', 'TXDALSTD', 'Baylor Family Medicine at Coppell', 'Vijayalakshmi', '', 'Raghu', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-10-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225220940', 0, 'N', 0, '2013-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'W12042396', 'W12042396', 'TXDALSTD', 'Cardiac & Thoracic Surgery at Baylor University Medical Center at Dallas', 'Juan', 'C', 'MacHannaford', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '1600 W College St Ste 490', 'Grapevine', 'Tarrant', 'TX', '76051', '2148207100', '2148206863', '1600 W College St Ste 490', 'Grapevine', 'Tarrant', 'TX', '76051', '2148207100', '2148206863', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-10-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1902094246', 0, 'N', 0, '2013-12-20', NULL, NULL, 32.9356, -97.0929, NULL, NULL),
('752512142', 'W12042440', 'W12042440', 'TXDALSTD', 'The Center for Cancer and Blood Disorders', '', '', 'The Center for Cancer and Blood Disorders', 'GROUP', 'Oncology', 'Hematology', '', NULL, 'O', '800 W Magnolia Ave', 'Fort Worth', 'Tarrant', 'TX', '76104', '8173330100', '8178828053', '800 W Magnolia Ave', 'Fort Worth', 'Tarrant', 'TX', '76104', '8173330100', '8178828053', 'CCBD', 'TXHCPC118', '', '0.00', '50.00', '0.00', 3, '2014-01-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1629021159', 0, 'Y', 0, '2014-01-06', NULL, NULL, 32.7306, -97.3325, NULL, NULL),
('752536818', 'W12042399', 'W12042399', 'TXDALSTD', 'Health Texas Provider Network', 'Ajikumar', 'V', 'Aryangat', 'MD', 'Endocrinology', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-10-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1407971856', 0, 'N', 0, '2013-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'W12042443', 'W12042443', 'TXDALSTD', 'Endocrinology Specialists of North Texas', 'Howard', 'J', 'Heller', 'MD', 'Endocrinology', '', '', NULL, 'O', '910 N Central Expwy', 'Dallas', 'Dallas', 'TX', '75204', '2148236435', '2148234675', '910 N Central Expwy', 'Dallas', 'Dallas', 'TX', '75204', '2148236435', '2148234675', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2014-01-10', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1538129424', 0, 'N', 0, '2013-12-20', NULL, NULL, 32.79, -96.7917, NULL, NULL),
('752536818', 'W12042402', 'W12042402', 'TXDALSTD', 'Health Texas Provider Network', 'Howard', 'J', 'Heller', 'MD', 'Endocrinology', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2014-01-10', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1538129424', 0, 'N', 0, '2013-12-20', NULL, NULL, 0, 0, NULL, NULL),
('911947573', 'W12042406', 'W12042406', 'TXDALSTD', 'Health Texas Provider Network', 'Joseph', 'N', 'Khalil', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '2148203000', '2148203022', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '2148203000', '2148203022', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2014-01-10', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1154646511', 0, 'N', 0, '2013-12-20', NULL, NULL, 0, 0, NULL, NULL),
('911947573', 'W12042407', 'W12042407', 'TXDALSTD', 'MedProvider Inpatient Care Unit', 'Joseph', 'N', 'Khalil', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3500 Gaston Ave Roberts Tower 4th Fl', 'Dallas', 'Dallas', 'TX', '75246', '2148203000', '2148203022', '3500 Gaston Ave Roberts Tower 4th Fl', 'Dallas', 'Dallas', 'TX', '75246', '2148203000', '2148203022', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2014-01-10', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1154646511', 0, 'N', 0, '2013-12-20', NULL, NULL, 32.7911, -96.7802, NULL, NULL),
('752536818', 'W12042409', 'W12042409', 'TXDALSTD', 'Advanced Lung Disease Specialists', 'Howard', 'J', 'Huang', 'MD', 'Pulmonary', '', '', NULL, 'O', '3410 Worth St Ste 250', 'Dallas', 'Dallas', 'TX', '75246', '2148206856', '2148201474', '3410 Worth St Ste 250', 'Dallas', 'Dallas', 'TX', '75246', '2148206856', '2148201474', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2014-01-10', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1396896189', 0, 'N', 0, '2013-12-20', NULL, NULL, 32.7886, -96.779, NULL, NULL),
('752536818', 'W12042410', 'W12042410', 'TXDALSTD', 'Health Texas Provider Network', 'Howard', 'J', 'Huang', 'MD', 'Pulmonary', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2014-01-10', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1396896189', 0, 'N', 0, '2013-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'W12042411', 'W12042411', 'TXDALSTD', 'Cardiology Consultants of Texas', 'Robert', '', 'Kowal', 'MD', 'Cardiology', '', '', NULL, 'O', '621 N Hall St Ste 400', 'Dallas', 'Dallas', 'TX', '75226', '2148248721', '2142376529', '621 N Hall St Ste 400', 'Dallas', 'Dallas', 'TX', '75226', '2148248721', '2142376529', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2014-01-10', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1093779258', 0, 'N', 0, '2014-01-13', NULL, NULL, 32.7879, -96.7802, NULL, NULL),
('752536818', 'W12042412', 'W12042412', 'TXDALSTD', 'Health Texas Provider Network', 'Robert', '', 'Kowal', 'MD', 'Cardiology', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2014-01-10', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1093779258', 0, 'N', 0, '2013-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752600832', 'W12042414', 'W12042414', 'TXDALSTD', 'MedProvider', 'Akira', 'S', 'Numajiri', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3434 Swiss Ave Ste 201', 'Dallas', 'Dallas', 'TX', '75204', '2148285006', '2148285080', '3434 Swiss Ave Ste 201', 'Dallas', 'Dallas', 'TX', '75204', '2148285006', '2148285080', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2014-01-10', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1558392506', 0, 'N', 0, '2013-12-20', NULL, NULL, 32.7915, -96.7824, NULL, NULL),
('752600832', 'W12042415', 'W12042415', 'TXDALSTD', 'MedProvider', 'Akira', 'S', 'Numajiri', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3900 Junius St Ste 605', 'Dallas', 'Dallas', 'TX', '75246', '2148285000', '2148202437', '3900 Junius St Ste 605', 'Dallas', 'Dallas', 'TX', '75246', '2148285000', '2148202437', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2014-01-10', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1558392506', 0, 'N', 0, '2013-12-20', NULL, NULL, 32.791, -96.7782, NULL, NULL),
('752600832', 'W12042416', 'W12042416', 'TXDALSTD', 'MedProvider', 'Akira', 'S', 'Numajiri', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3600 Gaston Ave Ste 303', 'Dallas', 'Dallas', 'TX', '75246', '2148285000', '2148202437', '3600 Gaston Ave Ste 303', 'Dallas', 'Dallas', 'TX', '75246', '2148285000', '2148202437', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2014-01-10', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1558392506', 0, 'N', 0, '2013-12-20', NULL, NULL, 32.7913, -96.7799, NULL, NULL),
('752536818', 'W12042417', 'W12042417', 'TXDALSTD', 'Cardiology Consultants of Texas', 'Rohit', '', 'Parmar', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1305 W Jefferson Ste 100', 'Dallas', 'Dallas', 'TX', '78165', '9729237292', '9729238089', '1305 W Jefferson Ste 100', 'Dallas', 'Dallas', 'TX', '78165', '9729237292', '9729238089', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2014-01-14', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1114985405', 0, 'N', 0, '2013-12-20', NULL, NULL, 32.7439, -96.8429, NULL, NULL),
('752536818', 'W12042418', 'W12042418', 'TXDALSTD', 'Health Texas Provider Network', 'Rohit', '', 'Parmar', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2014-01-14', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1114985405', 0, 'N', 0, '2013-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'W12042419', 'W12042419', 'TXDALSTD', 'Cardiology Consultants of Texas', 'Rohit', '', 'Parmar', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '9101 N Central Expwy Ste 300', 'Dallas', 'Dallas', 'TX', '75231', '4698007500', '4698007510', '9101 N Central Expwy Ste 300', 'Dallas', 'Dallas', 'TX', '75231', '4698007500', '4698007510', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2014-01-14', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1114985405', 0, 'N', 0, '2013-12-20', NULL, NULL, 32.873, -96.7706, NULL, NULL),
('752536818', 'W12042421', 'W12042421', 'TXDALSTD', 'Health Texas Provider Network', 'Renika', 'K', 'Thompson', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2014-01-10', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, '', '', 'HCFA|UB', '1154570570', 0, 'N', 0, '2013-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'W12042422', 'W12042422', 'TXDALSTD', 'Irving Interfaith Clinic', 'Renika', 'K', 'Thompson', 'MD', 'Family Practice', '', '', NULL, 'O', '1302 Lane St Ste 100', 'Irving', 'Dallas', 'TX', '75061', '4698001012', '4698001010', '1302 Lane St Ste 100', 'Irving', 'Dallas', 'TX', '75061', '4698001012', '4698001010', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2014-01-10', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, '', '', 'HCFA|UB', '1154570570', 0, 'N', 0, '2013-12-20', NULL, NULL, 32.8337, -96.9622, NULL, NULL),
('911947573', 'W12042424', 'W12042424', 'TXDALSTD', 'MedProvider Inpatient Care Unit', 'Mohammed', 'K', 'Paika', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3500 Gaston Ave Roberts Tower 4th Fl', 'Dallas', 'Dallas', 'TX', '75246', '2148203000', '2148203022', '3500 Gaston Ave Roberts Tower 4th Fl', 'Dallas', 'Dallas', 'TX', '75246', '2148203000', '2148203022', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2014-01-10', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1407015159', 0, 'N', 0, '2013-12-20', NULL, NULL, 32.7911, -96.7802, NULL, NULL),
('911947573', 'W12042425', 'W12042425', 'TXDALSTD', 'Health Texas Provider Network', 'Mohammed', 'K', 'Paika', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '2148203000', '2148203022', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '2148203000', '2148203022', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2014-01-10', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1407015159', 0, 'N', 0, '2013-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'W12042429', 'W12042429', 'TXDALSTD', 'Health Texas Provider Network', 'Robert', 'L', 'Rosenthal', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '6435 S FM 549 Ste 201', 'Rockwall', 'Rockwall', 'TX', '75032', '4698007500', '4698007510', '6435 S FM 549 Ste 201', 'Rockwall', 'Rockwall', 'TX', '75032', '4698007500', '4698007510', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2014-01-11', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1194773085', 0, 'N', 0, '2013-12-20', NULL, NULL, 32.8645, -96.4413, NULL, NULL),
('752536818', 'W12042427', 'W12042427', 'TXDALSTD', 'Health Texas Provider Network', 'Robert', 'L', 'Rosenthal', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2014-01-10', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB', '1194773085', 0, 'N', 0, '2013-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'W12042431', 'W12042431', 'TXDALSTD', 'Health Texas Provider Network', 'Robert', 'L', 'Rosenthal', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '9101 N Central Expwy Ste 300', 'Dallas', 'Dallas', 'TX', '75231', '4698007500', '4698007510', '9101 N Central Expwy Ste 300', 'Dallas', 'Dallas', 'TX', '75231', '4698007500', '4698007510', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2014-01-10', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1194773085', 0, 'N', 0, '2013-12-20', NULL, NULL, 32.873, -96.7706, NULL, NULL),
('752536818', 'W12042444', 'W12042444', 'TXDALSTD', 'Endocrinology Specialists of North Texas', 'Raphaelle', 'D', 'Vallera', 'MD', 'Endocrinology', '', '', NULL, 'O', '910 N Central Expwy', 'Dallas', 'Dallas', 'TX', '75204', '2148236435', '2148234675', '910 N Central Expwy', 'Dallas', 'Dallas', 'TX', '75204', '2148236435', '2148234675', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2014-01-10', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1790777365', 0, 'N', 0, '2013-12-20', NULL, NULL, 32.79, -96.7917, NULL, NULL),
('752536818', 'W12042434', 'W12042434', 'TXDALSTD', 'Health Texas Provider Network', 'Raphaelle', 'D', 'Vallera', 'MD', 'Endocrinology', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2014-01-10', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1790777365', 0, 'N', 0, '2013-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'W12042445', 'W12042445', 'TXDALSTD', 'Endocrinology Specialists of North Texas', 'Brian', 'J', 'Welch', 'MD', 'Endocrinology', '', '', NULL, 'O', '910 N Central Expwy', 'Dallas', 'Dallas', 'TX', '75204', '2148236435', '2148234675', '910 N Central Expwy', 'Dallas', 'Dallas', 'TX', '75204', '2148236435', '2148234675', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2014-01-10', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1386694966', 0, 'N', 0, '2013-12-20', NULL, NULL, 32.79, -96.7917, NULL, NULL),
('752536818', 'W12042437', 'W12042437', 'TXDALSTD', 'Health Texas Provider Network', 'Brian', 'J', 'Welch', 'MD', 'Endocrinology', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2014-01-10', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1386694966', 0, 'N', 0, '2013-12-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'W12042439', 'W12042439', 'TXDALSTD', 'Kevin R Wheelan MD PA', 'Kevin', 'R', 'Wheelan', 'MD', 'Cardiology', '', '', NULL, 'O', '9101 N Central Expwy Ste 300', 'Dallas', 'Dallas', 'TX', '75231', '4698007500', '4698007510', '9101 N Central Expwy Ste 300', 'Dallas', 'Dallas', 'TX', '75231', '4698007500', '4698007510', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2014-01-10', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1023066727', 0, 'N', 0, '2013-12-20', NULL, NULL, 32.873, -96.7706, NULL, NULL),
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('752512142', 'CFC000041', 'CFC000041', 'TXDALSTD', 'The Center for Cancer and Blood Disorders', 'Ray', 'D', 'Page', 'DO', 'Oncology', NULL, NULL, NULL, 'O', '920 Sante Fe Dr', 'Weatherford', 'Parker', 'TX', '76086', '8175960637', '8175965143', '920 Sante Fe Dr', 'Weatherford', 'Parker', 'TX', '76086', '8175960637', '8175965143', 'CCBD', 'TXHCPC118', NULL, '0.00', '50.00', '0.00', 3, '2014-01-20', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1669422143', 0, 'N', 0, '2014-01-06', NULL, NULL, 32.7492, -97.7841, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
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('752512142', 'CFC000045', 'CFC000045', 'TXDALSTD', 'The Center for Cancer and Blood Disorders', 'Vinaya', NULL, 'Potluri', 'MD', 'Oncology', NULL, NULL, NULL, 'O', '11805 S I-35 W Ste 201', 'Burleson', 'Johnson', 'TX', '76028', '8175515312', '8175511389', '11805 S I-35 W Ste 201', 'Burleson', 'Johnson', 'TX', '76028', '8175515312', '8175511389', 'CCBD', 'TXHCPC118', NULL, '0.00', '50.00', '0.00', 3, '2014-01-20', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', NULL, 'HCFA|UB|', '1881647493', 0, 'N', 0, '2014-01-06', NULL, NULL, 32.5409, -97.3169, NULL, NULL),
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('752512142', 'CFC000044', 'CFC000044', 'TXDALSTD', 'The Center for Cancer and Blood Disorders', 'Vinaya', NULL, 'Potluri', 'MD', 'Oncology', NULL, NULL, NULL, 'B', 'PO Box 164009', 'Fort Worth', 'Tarrant', 'TX', '76161', '8173330124', '8178829762', 'PO Box 164009', 'Fort Worth', 'Tarrant', 'TX', '76161', '8173330124', '8178829762', 'CCBD', 'TXHCPC118', NULL, '0.00', '50.00', '0.00', 3, '2014-01-20', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', NULL, 'HCFA|UB|', '1881647493', 0, 'Y', 0, '2014-01-06', NULL, NULL, 0, 0, NULL, NULL),
('752512142', 'CFC000051', 'CFC000051', 'TXDALSTD', 'The Center for Cancer and Blood Disorders', 'Bibas', NULL, 'Reddy', 'DO', 'Oncology', '', '', NULL, 'O', '6100 Harris Pkwy Ste 260', 'Fort Worth', 'Tarrant', 'TX', '76132', '8173333282', '8172945900', '6100 Harris Pkwy Ste 260', 'Fort Worth', 'Tarrant', 'TX', '76132', '8173333282', '8172945900', 'CCBD', 'TXHCPC118', NULL, '0.00', '50.00', '0.00', 3, '2014-01-20', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', NULL, 'HCFA|UB|', '1457577017', 0, 'N', 0, '2014-01-06', NULL, NULL, 32.66, -97.4203, NULL, NULL),
('752512142', 'CFC000050', 'CFC000050', 'TXDALSTD', 'The Center for Cancer and Blood Disorders', 'Bibas', NULL, 'Reddy', 'DO', 'Oncology', '', '', NULL, 'O', '800 W Magnolia Ave', 'Fort Worth', 'Tarrant', 'TX', '76104', '8177597000', '8177597027', '800 W Magnolia Ave', 'Fort Worth', 'Tarrant', 'TX', '76104', '8177597000', '8177597027', 'CCBD', 'TXHCPC118', '', '0.00', '50.00', '0.00', 3, '2014-01-20', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', NULL, 'HCFA|UB|', '1457577017', 0, 'N', 0, '2014-01-06', NULL, NULL, 32.7306, -97.3325, NULL, NULL),
('752512142', 'CFC000049', 'CFC000049', 'TXDALSTD', 'The Center for Cancer and Blood Disorders', 'Bibas', NULL, 'Reddy', 'DO', 'Oncology', '', '', NULL, 'B', 'PO Box 164009', 'Fort Worth', 'Tarrant', 'TX', '76161', '8173330124', '8178829762', 'PO Box 164009', 'Fort Worth', 'Tarrant', 'TX', '76161', '8173330124', '8178829762', 'CCBD', 'TXHCPC118', NULL, '0.00', '50.00', '0.00', 3, '2014-01-20', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', NULL, 'HCFA|UB|', '1457577017', 0, 'Y', 0, '2014-01-06', NULL, NULL, 0, 0, NULL, NULL),
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('820200895', 'W12042471', 'W12042471', 'IDBOISTD', 'Saint Alphonsus Medical Group Hospitalist Boise', 'William ', 'T', 'Edwards', 'MD', 'Family Practice', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676279', '2083675180', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676279', '2083675180', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-11-25', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1679745590', 0, 'N', 0, '2013-12-23', NULL, NULL, 43.6145, -116.254, NULL, NULL),
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('820200895', 'W12042522', 'W12042522', 'IDBOISTD', 'Saint Alphonsus Medical Group Iowa Family Medicine', 'Mary', '', 'Morgan', 'NP-C', 'Family Practice', 'Nurse Practitioner', '', NULL, 'O', '211 W Iowa Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084657377', '2084657397', '211 W Iowa Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084657377', '2084657397', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-01-01', '2014-01-01', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1437381209', 0, 'N', 0, '2014-02-10', NULL, NULL, 43.5539, -116.575, NULL, NULL),
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('820425454', 'W12042530', 'W12042530', 'ID01', 'Boise Anesthesia PA', 'Jessica', 'L', 'Miller', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'O', '1055 N Curtis Rd', 'Portland', 'Multnomah', 'OR', '97208', '2083676416', '2083759530', '1055 N Curtis Rd   ', 'Portland', 'Multnomah', 'OR', '97208', '2083676416', '2083759530', 'IDSAMG3', '', '', '62.80', '10.00', '0.00', 3, '2013-12-09', NULL, 0, 15, 0, '', '', '', '', 'HCFA|UB|', '1386077220', 0, 'N', 0, '2013-12-26', NULL, NULL, 0, 0, NULL, NULL),
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('820528742', 'W12042534', 'W12042534', 'ID02', 'Emmett Medical Center', 'Jennifer', 'L', 'Petrie', 'MD', 'Family Practice', '', '', NULL, 'O', '1102 E Locust St', 'Emmett', 'Gem', 'ID', '83617', '2083656004', '2083653589', '1102 E Locust St', 'Emmett', 'Gem', 'ID', '83617', '2083656004', '2083653589', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-11-25', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1891879094', 0, 'N', 0, '2013-12-26', NULL, NULL, 0, 0, NULL, NULL),
('820528742', 'W12042536', 'W12042536', 'ID02', 'Emmett Medical Center', 'William', 'H', 'Vetter', 'MD', 'Family Practice', '', '', NULL, 'O', '1102 E Locust St', 'Emmett', 'Gem', 'ID', '83617', '2083656004', '2083653589', '1102 E Locust St', 'Emmett', 'Gem', 'ID', '83617', '2083656004', '2083653589', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-11-25', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992775480', 0, 'N', 0, '2014-03-07', 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
('820528742', 'W12042538', 'W12042538', 'ID02', 'Emmett Medical Center', 'David', 'M', 'Shuey II', 'PA-C', 'Family Practice', '', '', NULL, 'O', '1102 E Locust St', 'Emmett', 'Gem', 'ID', '83617', '2083656004', '2083653589', '1102 E Locust St', 'Emmett', 'Gem', 'ID', '83617', '2083656004', '2083653589', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-11-25', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730276445', 0, 'N', 0, '2013-12-26', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12045852', 'W12045852', 'WYBILLINGS', 'Billings Clinic - Hospitalist', 'Naomi', 'K', 'Atkins', 'DO', 'Hospitalist', '', '', NULL, 'O', '2800 10th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382572', '2800 10th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382572', '', '', '', '0.00', '17.00', '0.00', 3, '2014-03-12', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225308844', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('820438921', 'W12042539', 'W12042539', 'ID02', 'Treasure Valley Hearing and Balance Clinic', 'Jay', 'B', 'Richman', 'AUD', 'Audiology', '', '', NULL, 'O', '745 S Progress Ave', 'Meridian', 'Ada', 'ID', '83642', '2083770019', '2083770313', '745 S Progress Ave', 'Meridian', 'Ada', 'ID', '83642', '2083770019', '2083770313', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-11-20', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1578991196', 0, 'N', 0, '2013-12-26', NULL, NULL, 0, 0, NULL, NULL),
('453948727', 'W12042541', 'W12042541', 'ID02', 'Emmett Eye Center', 'Trenton', 'G', 'Warner', 'OD', 'Optometry', '', '', NULL, 'O', '1108 S Washington Ave', 'Emmett', 'Gem', 'ID', '83617', '2083652020', '2083653854', '1108 S Washington Ave', 'Emmett', 'Gem', 'ID', '83617', '2083652020', '2083653854', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-12-05', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1184823049', 0, 'N', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('820368134', 'W12042544', 'W12042544', 'ID02', 'Iwasa Eye Center, PA', 'Daniel', 'E', 'Iwasa', 'OD', 'Optometry', '', '', NULL, 'O', '925 NW 12th St', 'Fruitland', 'Payette', 'ID', '83619', '2086422151', '2086427374', '925 NW 12th St', 'Fruitland', 'Payette', 'ID', '83619', '2086422151', '2086427374', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-12-09', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1346383957', 0, 'Y', 0, '2013-12-26', NULL, NULL, 0, 0, NULL, NULL),
('710932918', 'W12042546', 'W12042546', 'ID02', 'Gem State Dermatology, PA', 'Michael', 'J', 'Lane', 'PA-C', 'Dermatology', '', '', NULL, 'O', '388 Parkcenter Blvd', 'Boise', 'Ada', 'ID', '83706', '2084249101', '2084245072', '388 Parkcenter Blvd', 'Boise', 'Ada', 'ID', '83706', '2084249101', '2084245072', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-12-05', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1669415188', 0, 'N', 0, '2013-12-26', NULL, NULL, 0, 0, NULL, NULL),
('820299260', 'W12042548', 'W12042548', 'ID02', 'West Idaho Orthopedic & Sports Medicine', 'Michael', 'T', 'Daines', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '3875 E Overland', 'Meridian', 'Ada', 'ID', '83642', '2088950888', '2088883911', '3875 E Overland', 'Meridian', 'Ada', 'ID', '83642', '2088950888', '2088883911', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-12-09', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1598973992', 0, 'N', 0, '2013-12-26', NULL, NULL, 0, 0, NULL, NULL),
('820299260', 'W12042549', 'W12042549', 'ID02', 'West Idaho Orthopedic & Sports Medicine', 'Michael', 'T', 'Daines', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '206 E Elm St', 'Caldwell', 'Canyon', 'ID', '83605', '2084594511', '2084596602', '206 E Elm St', 'Caldwell', 'Canyon', 'ID', '83605', '2084594511', '2084596602', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-12-09', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1598973992', 0, 'N', 0, '2013-12-26', NULL, NULL, 0, 0, NULL, NULL),
('900426273', 'W12042550', 'W12042550', 'ID02', 'Richard Davis, MD', 'Bradley', '', 'Heninger', 'PA-C', 'General Surgery', '', '', NULL, 'O', '1818 S 10th Ave Ste 250', 'Caldwell', 'Canyon', 'ID', '83605', '5418893111', '5418893999', '1818 S 10th Ave Ste 250', 'Caldwell', 'Canyon', 'ID', '83605', '5418893111', '5418893999', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-12-17', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1205103389', 0, 'N', 0, '2014-06-05', NULL, NULL, 43.6538, -116.693, NULL, NULL),
('900426273', 'W12042551', 'W12042551', 'ID02', 'Richard Davis, MD', 'Kacey', '', 'Andreasen', 'PA-C', 'General Surgery', '', '', NULL, 'O', '1818 S 10th Ave Ste 250', 'Caldwell', 'Canyon', 'ID', '83605', '5418893111', '5418893999', '1818 S 10th Ave Ste 250', 'Caldwell', 'Canyon', 'ID', '83605', '5418893111', '5418893999', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-12-17', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1215160510', 0, 'N', 0, '2014-06-05', NULL, NULL, 43.6538, -116.693, NULL, NULL),
('201312583', 'W12042553', 'W12042553', 'ID01', 'Life Counseling Center', 'Brittany', 'C', 'Kasefang', 'MFT', 'Mental Health', 'Counseling', '', NULL, 'O', '123 N Yale', 'Nampa', 'Canyon', 'ID', '83651', '2084655433', '2084665802', '123 N Yale', 'Nampa', 'Canyon', 'ID', '83651', '2084655433', '2084665802', 'IDMA', '', '', '0.00', '40.00', '0.00', 6, '2014-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992135743', 0, 'N', 0, '2014-01-22', NULL, NULL, 43.5839, -116.574, NULL, NULL),
('464113854', 'W12042542', 'W12042542', 'ID02', 'Exodus Pain Clinic', 'Daniel', 'R', 'Marsh', 'MD', 'Pain Management', NULL, NULL, NULL, 'O', '1906 Fairview Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2089477246', '2089394411', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-12-10', NULL, NULL, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1356377535', 0, 'N', 0, '2013-12-30', NULL, NULL, 43.653, -116.695, NULL, NULL),
('464113854', 'W12042543', 'W12042543', 'ID02', 'Exodus Pain Clinic', 'Daniel', 'R', 'Marsh', 'MD', 'Pain Management', NULL, NULL, NULL, 'O', '4850 N Rosepoint Way Ste 100', 'Boise', 'Ada', 'ID', '83713', '2089477246', '2089394411', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-12-10', NULL, NULL, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1356377535', 0, 'N', 0, '2013-12-30', NULL, NULL, 0, 0, NULL, NULL),
('453201756', 'W12042554', 'W12042554', 'TXSATSTD', 'Olga Joukovski ', 'Olga', '', 'Joukovski', 'MD', 'Internal Medicine', '', '', NULL, 'O', '11212 State Hwy 151 Plaza 1, Ste 370', 'San Antonio', 'Bexar', 'TX', '78251', '2105205040', '2105205041', '11212 State Hwy 151 Plaza 1, Ste 370', 'San Antonio', 'Bexar', 'TX', '78251', '2105205040', '2105205041', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-02-10', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, '', '', 'HCFA|UB|', '1437256179', 0, 'N', 0, '2014-01-10', NULL, NULL, 29.4801, -98.7053, NULL, NULL),
('751602844', 'W12042555', 'W12042555', 'TXSATSTD', 'Dr Thuy Danh DO MD & Associates ', 'Thuy', 'D', 'Do', 'MD DO', 'Family Practice', '', '', NULL, 'O', '1214 S New Braunfels', 'San Antonio', 'Bexar', 'TX', '78210', '2105346225', '2105346106', '1214 S New Braunfels', 'San Antonio', 'Bexar', 'TX', '78210', '2105346225', '2105346106', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-02-10', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1376506196', 0, 'N', 0, '2014-01-10', NULL, NULL, 29.4078, -98.4612, NULL, NULL),
('743045485', 'W12042557', 'W12042557', 'TXSATSTD', '', 'Leticia', 'A', 'Poret', 'MD', 'Internal Medicine', '', '', NULL, 'M', '12627 Stonehenge', 'San Antonio', 'Bexar', 'TX', '78230', '2107333005', '2107333001', '12627 Stonehenge', 'San Antonio', 'Bexar', 'TX', '78230', '2107333005', '2107333001', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-02-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114024478', 0, 'N', 0, '2014-01-10', NULL, NULL, 0, 0, NULL, NULL),
('743045485', 'W12042556', 'W12042556', 'TXSATSTD', '', 'Leticia', 'A', 'Poret', 'MD', 'Internal Medicine', '', '', NULL, 'O', '4522 Fredericksburg Rd Ste A-14', 'San Antonio', 'Bexar', 'TX', '78201', '2107333005', '2107333001', '4522 Fredericksburg Rd Ste A-14', 'San Antonio', 'Bexar', 'TX', '78201', '2107333005', '2107333001', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-02-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114024478', 0, 'N', 0, '2014-01-10', NULL, NULL, 29.4901, -98.5514, NULL, NULL),
('942854057', 'W12042559', 'W12042559', 'UTIHCPHY', 'Payson Clinic', '', '', 'Payson Clinic', '', 'Family Practice', '', '', NULL, 'O', '854 Turf Farm Rd Ste 1', 'Payson', 'Utah', 'UT', '84651', '8014656200', '8014656298', '854 Turf Farm Rd Ste 1', 'Payson', 'Utah', 'UT', '84651', '8014656200', '8014656298', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023449733', 0, 'N', 0, '2013-12-30', NULL, NULL, 0, 0, NULL, NULL),
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('202034762', 'W12042664', 'W12042664', 'TXSATSTD', 'San Antonio A thru Z Pediatrics PA', '', '', 'San Antonio A thru Z Pediatrics', '', 'Pediatrics', '', '', NULL, 'O', '1314 E Sonterra Blvd Ste 5102', 'San Antonio', 'Bexar', 'TX', '78258', '2104908888', '2104966865', '1314 E Sonterra Blvd Ste 5102', 'San Antonio', 'Bexar', 'TX', '78258', '2104908888', '2104966865', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609931088', 0, 'N', 0, '2014-01-20', NULL, NULL, 29.6146, -98.4744, NULL, NULL),
('202034762', 'W12042665', 'W12042665', 'TXSATSTD', 'San Antonio A thru Z Pediatrics PA', '', '', 'San Antonio A thru Z Pediatrics', '', 'Pediatrics', '', '', NULL, 'O', '7922 Ewing Halsell Ste 360', 'San Antonio', 'Bexar', 'TX', '78229', '2106147500', '2106147540', '7922 Ewing Halsell Ste 360', 'San Antonio', 'Bexar', 'TX', '78229', '2106147500', '2106147540', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609931088', 0, 'N', 0, '2014-01-20', NULL, NULL, 29.5126, -98.5738, NULL, NULL),
('870781773', 'W12042666', 'W12042666', 'TXHOUSTD', 'Coastal Gastroenterology Associates', 'Advitya', '', 'Malhotra', 'MD', 'Gastroenterology', '', '', NULL, 'O', '1015 Medical Ctr Blvd Ste 1300', 'Webster', 'Harris', 'TX', '77598', '2815572527', '2815577203', '1015 Medical Ctr Blvd Ste 1300', 'Webster', 'Harris', 'TX', '77598', '2815572527', '2815577203', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-02-10', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, '', '', 'HCFA|UB|', '1609070275', 0, 'N', 0, '2014-01-10', NULL, NULL, 29.5362, -95.1332, NULL, NULL),
('200303478', 'W12042675', 'W12042675', 'TXSATSTD', '', 'Alma ', 'L', 'Aguado', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1445 Somerset Rd Ste 1', 'San Antonio', 'Bexar', 'TX', '78211', '2109246649', '2109240198', '1445 Somerset Rd Ste 1', 'San Antonio', 'Bexar', 'TX', '78211', '2109246649', '2109240198', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-02-10', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1487710091', 0, 'N', 0, '2014-01-10', NULL, NULL, 29.3621, -98.5451, 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
('810231784', 'W12042747', 'W12042747', 'WYBILLINGS', 'Billings Clinic - Hospitalist', 'Lindsey', 'B', 'James', 'MD', 'Hospitalist', '', '', NULL, 'O', '2800 10th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382572', '2800 10th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382572', '', '', '', '0.00', '17.00', '0.00', 3, '2013-12-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205026697', 0, 'N', 0, '2014-01-03', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12042748', 'W12042748', 'WYBILLINGS', 'Billings Clinic', 'Lindsey', 'B', 'James', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2013-12-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205026697', 0, 'N', 0, '2014-01-03', NULL, NULL, 0, 0, NULL, NULL),
('870781773', 'W12042669', 'W12042669', 'TXHOUSTD', 'Coastal Gastroenterology Associates ', 'Kalyanam', '', 'Subramanyam', 'MD', 'Gastroenterology', '', '', NULL, 'O', '1015 Medical Ctr Blvd Ste 1300', 'Webster', 'Harris', 'TX', '77598', '2815572527', '2815577203', '1015 Medical Ctr Blvd Ste 1300', 'Webster', 'Harris', 'TX', '77598', '2815572527', '2815577203', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-02-10', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, '', '', 'HCFA|UB|', '1164493870', 0, 'N', 0, '2014-01-10', NULL, NULL, 29.5362, -95.1332, NULL, NULL),
('261755891', 'W12042901', 'W12042901', 'TXSATSTD', 'Family First Clinic', 'Angela', '', 'Mitchell', 'FNP-C', 'Family Practice', '', '', NULL, 'O', '9135 Schaefer Rd Ste 4', 'Converse', 'Bexar', 'TX', '78109', '2102815507', '2102909791', '9135 Schaefer Rd Ste 4', 'Converse', 'Bexar', 'TX', '78109', '2102815507', '2102909791', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1023174604', 0, 'N', 1, '2014-01-07', NULL, NULL, 0, 0, NULL, NULL),
('261755891', 'W12042900', 'W12042900', 'TXSATSTD', 'Family First Clinic', 'Alanda', '', 'White', 'FNP-C', 'Family Practice', '', '', NULL, 'O', '9135 Schaefer Rd Ste 4', 'Converse', 'Bexar', 'TX', '78109', '2102815507', '2102909791', '9135 Schaefer Rd Ste 4', 'Converse', 'Bexar', 'TX', '78109', '2102815507', '2102909791', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1548523582', 0, 'N', 1, '2014-01-07', NULL, NULL, 0, 0, NULL, NULL),
('760542534', 'W12042676', 'W12042676', 'TXHOUSTD', 'North West Internal Medicine Specialists', 'Muhammad', '', 'Hanief', 'MD', 'Internal Medicine', '', '', NULL, 'O', '13325 Hargrave Rd Ste 180', 'Houston', 'Harris', 'TX', '77070', '2818906800', '2818906865', '13325 Hargrave Rd Ste 180', 'Houston', 'Harris', 'TX', '77070', '2818906800', '2818906865', 'HOUSTON1', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2014-02-10', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1013999036', 0, 'N', 0, '2014-01-10', NULL, NULL, 29.9686, -95.552, NULL, NULL),
('742900029', 'W12042680', 'W12042680', 'TXSATSTD', 'Stockdale Family Medical Center', '', '', 'Stockdale Family Medical Center', '', 'Family Practice', '', '', NULL, 'O', '402 W Chihuahua St', 'La Vernia', 'Wilson', 'TX', '78121', '8307793800', '8307791066', '402 W Chihuahua St', 'La Vernia', 'Wilson', 'TX', '78121', '8307793800', '8307791066', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225066434', 0, 'Y', 0, '2014-01-10', NULL, NULL, 29.3387, -98.1093, NULL, NULL),
('742900029', 'W12042678', 'W12042678', 'TXSATSTD', 'Stockdale Family Medical Center', '', '', 'Stockdale Family Medical Center', '', 'Family Practice', '', '', NULL, 'O', '601 Person St', 'Stockdale', 'Wilson', 'TX', '78160', '8309963701', '8309963749', '601 Person St', 'Stockdale', 'Wilson', 'TX', '78160', '8309963701', '8309963749', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225066434', 0, 'Y', 0, '2014-01-10', NULL, NULL, 29.2393, -97.946, NULL, NULL),
('742900029', 'W12042679', 'W12042679', 'TXSATSTD', 'Stockdale Family Medical Center', '', '', 'Stockdale Family Medical Center', '', 'Family Practice', '', '', NULL, 'O', '921 Tenth St Ste 111', 'Floresville', 'Wilson', 'TX', '78114', '8302167979', '8302165972', '921 Tenth St Ste 111', 'Floresville', 'Wilson', 'TX', '78114', '8302167979', '8302165972', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225066434', 0, 'Y', 0, '2014-01-10', NULL, NULL, 29.1436, -98.1552, NULL, NULL),
('742900029', 'W12042681', 'W12042681', 'TXSATSTD', 'Stockdale Family Medical Center', '', '', 'Stockdale Family Medical Center', '', 'Family Practice', '', '', NULL, 'B', 'PO Box 98', 'Stockdale', 'Wilson', 'TX', '78160', '8309963701', '8309963749', 'PO Box 98', 'Stockdale', 'Wilson', 'TX', '78160', '8309963701', '8309963749', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225066434', 0, 'Y', 0, '2014-01-10', NULL, NULL, 0, 0, NULL, NULL),
('742900029', 'W12042683', 'W12042683', 'TXSATSTD', 'Stockdale Family Medical Center', 'Daryl', 'C', 'Currier', 'MD PA', 'Family Practice', '', '', NULL, 'O', '601 Person St', 'Stockdale', 'Wilson', 'TX', '78160', '8309963701', '8309963749', '601 Person St', 'Stockdale', 'Wilson', 'TX', '78160', '8309963701', '8309963749', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508808700', 0, 'N', 0, '2014-01-10', NULL, NULL, 29.2393, -97.946, NULL, NULL),
('742900029', 'W12042685', 'W12042685', 'TXSATSTD', 'Stockdale Family Medical Center', 'Daryl', 'C', 'Currier', 'MD PA', 'Family Practice', '', '', NULL, 'O', '402 W Chihuahua St', 'La Vernia', 'Wilson', 'TX', '78121', '8307793800', '8307791066', '402 W Chihuahua St', 'La Vernia', 'Wilson', 'TX', '78121', '8307793800', '8307791066', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508808700', 0, 'N', 0, '2014-01-10', NULL, NULL, 29.3387, -98.1093, NULL, NULL),
('742900029', 'W12042684', 'W12042684', 'TXSATSTD', 'Stockdale Family Medical Center', 'Daryl', 'C', 'Currier', 'MD PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 98', 'Stockdale', 'Wilson', 'TX', '78160', '8309963701', '8309963749', 'PO Box 98', 'Stockdale', 'Wilson', 'TX', '78160', '8309963701', '8309963749', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508808700', 0, 'N', 0, '2014-01-10', NULL, NULL, 0, 0, NULL, NULL),
('742900029', 'W12042687', 'W12042687', 'TXSATSTD', 'Stockdale Family Medical Center', 'Toni', '', 'Vargan', 'PA', 'Family Practice', '', '', NULL, 'O', '601 Person St', 'Stockdale', 'Wilson', 'TX', '78160', '8309963701', '8309963749', '601 Person St', 'Stockdale', 'Wilson', 'TX', '78160', '8309963701', '8309963749', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154627487', 0, 'Y', 0, '2014-01-10', NULL, NULL, 29.2393, -97.946, NULL, NULL),
('742900029', 'W12042688', 'W12042688', 'TXSATSTD', 'Stockdale Family Medical Center', 'Toni', '', 'Vargan', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 98', 'Stockdale', 'Wilson', 'TX', '78160', '8309963701', '8309963749', 'PO Box 98', 'Stockdale', 'Wilson', 'TX', '78160', '8309963701', '8309963749', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154627487', 0, 'N', 0, '2014-01-10', NULL, NULL, 0, 0, NULL, NULL),
('741724391', 'W12044487', 'W12044487', 'TXSATSTD', 'CommuniCare Health Centers', 'Kim', 'M', 'Hinojosa', 'NP', 'Family Practice', '', '', NULL, 'O', '8210 Callaghan Rd', 'San Antonio', 'Bexar', 'TX', '78230', '2102337000', '2103489607', '8210 Callaghan Rd', 'San Antonio', 'Bexar', 'TX', '78230', '2102337000', '2103489607', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-03-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366754715', 0, 'Y', 0, '2014-02-28', NULL, NULL, 0, 0, NULL, NULL),
('742900029', 'W12042692', 'W12042692', 'TXSATSTD', 'Stockdale Family Medical Center', 'Amy', '', 'Dugi', 'FNP', 'Family Practice', '', '', NULL, 'O', '601 Person St', 'Stockdale', 'Wilson', 'TX', '78160', '8309963701', '8309963749', '601 Person St', 'Stockdale', 'Wilson', 'TX', '78160', '8309963701', '8309963749', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366876443', 0, 'Y', 0, '2014-01-10', NULL, NULL, 29.2393, -97.946, NULL, NULL),
('742900029', 'W12042694', 'W12042694', 'TXSATSTD', 'Stockdale Family Medical Center', 'Amy', '', 'Dugi', 'FNP', 'Family Practice', '', '', NULL, 'B', 'PO Box 98', 'Stockdale', 'Wilson', 'TX', '78160', '8309963701', '8309963749', 'PO Box 98', 'Stockdale', 'Wilson', 'TX', '78160', '8309963701', '8309963749', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366876443', 0, 'N', 0, '2014-01-10', NULL, NULL, 0, 0, NULL, NULL),
('742900029', 'W12042695', 'W12042695', 'TXSATSTD', 'Stockdale Family Medical Center', 'Alice', 'A', 'Finegan', 'FNP', 'Family Practice', '', '', NULL, 'B', 'PO Box 98', 'Stockdale', 'Wilson', 'TX', '78160', '8309963701', '8309963749', 'PO Box 98', 'Stockdale', 'Wilson', 'TX', '78160', '8309963701', '8309963749', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538120274', 0, 'N', 0, '2014-01-10', NULL, NULL, 0, 0, NULL, NULL),
('742900029', 'W12042696', 'W12042696', 'TXSATSTD', 'Stockdale Family Medical Center', 'Alice', 'A', 'Finegan', 'FNP', 'Family Practice', '', '', NULL, 'O', '601 Person St', 'Stockdale', 'Wilson', 'TX', '78160', '8309963701', '8309963749', '601 Person St', 'Stockdale', 'Wilson', 'TX', '78160', '8309963701', '8309963749', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538120274', 0, 'Y', 0, '2014-01-10', NULL, NULL, 29.2393, -97.946, NULL, NULL),
('742900029', 'W12042697', 'W12042697', 'TXSATSTD', 'Stockdale Family Medical Center', 'Cecelia', 'A', 'Kothmann', 'FNP', 'Family Practice', '', '', NULL, 'B', 'PO Box 98', 'Stockdale', 'Wilson', 'TX', '78160', '8309963701', '8309963749', 'PO Box 98', 'Stockdale', 'Wilson', 'TX', '78160', '8309963701', '8309963749', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942337563', 0, 'N', 0, '2014-01-10', NULL, NULL, 0, 0, NULL, NULL),
('742900029', 'W12042698', 'W12042698', 'TXSATSTD', 'Stockdale Family Medical Center', 'Cecelia', 'A', 'Kothmann', 'FNP', 'Family Practice', '', '', NULL, 'O', '601 Person St', 'Stockdale', 'Wilson', 'TX', '78160', '8309963701', '8309963749', '601 Person St', 'Stockdale', 'Wilson', 'TX', '78160', '8309963701', '8309963749', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942337563', 0, 'Y', 0, '2014-01-10', NULL, NULL, 29.2393, -97.946, NULL, NULL),
('202034762', 'W12042703', 'W12042703', 'TXSATSTD', 'San Antonio A thru Z Pediatrics PA', 'Meena', '', 'Chintapalli', 'MD', 'Family Practice', '', '', NULL, 'O', '1314 E Sonterra Blvd Ste 5102', 'San Antonio', 'Bexar', 'TX', '78258', '2104908888', '2104966865', '1314 E Sonterra Blvd Ste 5102', 'San Antonio', 'Bexar', 'TX', '78258', '2104908888', '2104966865', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-02-15', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1922163492', 0, 'Y', 0, '2014-01-20', NULL, NULL, 29.6146, -98.4744, NULL, NULL),
('202034762', 'W12042704', 'W12042704', 'TXSATSTD', 'San Antonio A thru Z Pediatrics PA', 'Meena', '', 'Chintapalli', 'MD', 'Family Practice', '', '', NULL, 'O', '7922 Ewing Halsell Ste 360', 'San Antonio', 'Bexar', 'TX', '78229', '2106147500', '2106147540', '7922 Ewing Halsell Ste 360', 'San Antonio', 'Bexar', 'TX', '78229', '2106147500', '2106147540', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-02-15', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1922163492', 0, 'Y', 0, '2014-01-20', NULL, NULL, 29.5126, -98.5738, NULL, NULL),
('202034762', 'W12042705', 'W12042705', 'TXSATSTD', 'San Antonio A thru Z Pediatrics PA', 'Darryl', '', 'Longee', 'MD', 'Pediatrics', '', '', NULL, 'O', '1314 E Sonterra Blvd Ste 5102', 'San Antonio', 'Bexar', 'TX', '78258', '2104908888', '2104966865', '1314 E Sonterra Blvd Ste 5102', 'San Antonio', 'Bexar', 'TX', '78258', '2104908888', '2104966865', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-02-15', NULL, 0, 0, 0, 'Mission Trail Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1912077025', 0, 'Y', 0, '2014-01-20', NULL, NULL, 29.6146, -98.4744, NULL, NULL),
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('201391282', 'W12042843', 'W12042843', 'WY01', 'Thunder Basin Orthopedics and Sports Medicine', 'Terri', '', 'Joy', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '808 Riverbend Dr', 'Douglas', 'Converse', 'WY', '82633', '3076826222', NULL, '808 Riverbend Dr', 'Douglas', 'Converse', 'WY', '82633', '3076826222', '          ', 'WYORTHO10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Memorial Hospital of Converse County', NULL, NULL, NULL, 'HCFA|UB|', '1932271343', 0, 'N', 0, '2014-01-03', NULL, NULL, 0, 0, NULL, NULL),
('201391282', 'W12042844', 'W12042844', 'WYT2', 'Thunder Basin Orthopedics and Sports Medicine', 'Terri', '', 'Joy', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '808 Riverbend Dr', 'Douglas', 'Converse', 'WY', '82633', '3076826222', NULL, '808 Riverbend Dr', 'Douglas', 'Converse', 'WY', '82633', '3076826222', '          ', 'WYORTHO10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Memorial Hospital of Converse County', NULL, NULL, NULL, 'HCFA|UB|', '1932271343', 0, 'N', 0, '2014-01-03', NULL, NULL, 0, 0, NULL, NULL),
('201391282', 'W12042845', 'W12042845', 'WY01', 'Thunder Basin Orthopedics and Sports Medicine', 'Mark', 'G', 'Murphy', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '808 Riverbend Dr', 'Douglas', 'Converse', 'WY', '82633', '3076826222', NULL, '808 Riverbend Dr', 'Douglas', 'Converse', 'WY', '82633', '3076826222', '          ', 'WYORTHO10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Memorial Hospital of Converse County', NULL, NULL, NULL, 'HCFA|UB|', '1134187008', 0, 'N', 0, '2014-01-03', NULL, NULL, 0, 0, NULL, NULL),
('201391282', 'W12042846', 'W12042846', 'WYT2', 'Thunder Basin Orthopedics and Sports Medicine', 'Mark', 'G', 'Murphy', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '808 Riverbend Dr', 'Douglas', 'Converse', 'WY', '82633', '3076826222', NULL, '808 Riverbend Dr', 'Douglas', 'Converse', 'WY', '82633', '3076826222', '          ', 'WYORTHO10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Memorial Hospital of Converse County', NULL, NULL, NULL, 'HCFA|UB|', '1134187008', 0, 'N', 0, '2014-01-03', NULL, NULL, 0, 0, NULL, NULL),
('201391282', 'W12042847', 'W12042847', 'WY01', 'Thunder Basin Orthopedics and Sports Medicine', 'Dan', 'A', 'Nicholls', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '808 Riverbend Dr', 'Douglas', 'Converse', 'WY', '82633', '3076826222', NULL, '808 Riverbend Dr', 'Douglas', 'Converse', 'WY', '82633', '3076826222', '          ', 'WYORTHO10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Memorial Hospital of Converse County', NULL, NULL, NULL, 'HCFA|UB|', '1699050617', 0, 'N', 0, '2014-01-03', NULL, NULL, 0, 0, NULL, NULL),
('201391282', 'W12042848', 'W12042848', 'WYT2', 'Thunder Basin Orthopedics and Sports Medicine', 'Dan', 'A', 'Nicholls', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '808 Riverbend Dr', 'Douglas', 'Converse', 'WY', '82633', '3076826222', NULL, '808 Riverbend Dr', 'Douglas', 'Converse', 'WY', '82633', '3076826222', '          ', 'WYORTHO10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Memorial Hospital of Converse County', NULL, NULL, NULL, 'HCFA|UB|', '1699050617', 0, 'N', 0, '2014-01-03', NULL, NULL, 0, 0, NULL, NULL),
('201391282', 'W12042849', 'W12042849', 'WY01', 'Thunder Basin Orthopedics and Sports Medicine', 'Patrick', 'C', 'Robertson', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '808 Riverbend Dr', 'Douglas', 'Converse', 'WY', '82633', '3076826222', NULL, '808 Riverbend Dr', 'Douglas', 'Converse', 'WY', '82633', '3076826222', '          ', 'WYORTHO10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194715037', 0, 'N', 0, '2014-01-03', NULL, NULL, 0, 0, NULL, NULL),
('201391282', 'W12042850', 'W12042850', 'WYT2', 'Thunder Basin Orthopedics and Sports Medicine', 'Patrick', 'C', 'Robertson', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '808 Riverbend Dr', 'Douglas', 'Converse', 'WY', '82633', '3076826222', NULL, '808 Riverbend Dr', 'Douglas', 'Converse', 'WY', '82633', '3076826222', '          ', 'WYORTHO10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194715037', 0, 'N', 0, '2014-01-03', NULL, NULL, 0, 0, NULL, NULL),
('201391282', 'W12042851', 'W12042851', 'WY01', 'Thunder Basin Orthopedics and Sports Medicine', 'James', 'A', 'Ulibarri', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '808 Riverbend Dr', 'Douglas', 'Converse', 'WY', '82633', '3076826222', NULL, '808 Riverbend Dr', 'Douglas', 'Converse', 'WY', '82633', '3076826222', '          ', 'WYORTHO10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Sheridan Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1578586269', 0, 'N', 0, '2014-01-03', NULL, NULL, 0, 0, NULL, NULL),
('201391282', 'W12042852', 'W12042852', 'WYT2', 'Thunder Basin Orthopedics and Sports Medicine', 'James', 'A', 'Ulibarri', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '808 Riverbend Dr', 'Douglas', 'Converse', 'WY', '82633', '3076826222', NULL, '808 Riverbend Dr', 'Douglas', 'Converse', 'WY', '82633', '3076826222', '          ', 'WYORTHO10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Sheridan Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1578586269', 0, 'N', 0, '2014-01-03', NULL, NULL, 0, 0, NULL, NULL),
('201391282', 'W12042853', 'W12042853', 'WY01', 'Thunder Basin Orthopedics and Sports Medicine', 'Debra', 'L', 'Walker', 'PA', 'Orthopaedic Surgery', '', '', NULL, 'O', '808 Riverbend Dr', 'Douglas', 'Converse', 'WY', '82633', '3076826222', NULL, '808 Riverbend Dr', 'Douglas', 'Converse', 'WY', '82633', '3076826222', '          ', 'WYORTHO10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1912993015', 0, 'N', 0, '2014-01-03', NULL, NULL, 0, 0, NULL, NULL),
('201391282', 'W12042854', 'W12042854', 'WYT2', 'Thunder Basin Orthopedics and Sports Medicine', 'Debra', 'L', 'Walker', 'PA', 'Orthopaedic Surgery', '', '', NULL, 'O', '808 Riverbend Dr', 'Douglas', 'Converse', 'WY', '82633', '3076826222', NULL, '808 Riverbend Dr', 'Douglas', 'Converse', 'WY', '82633', '3076826222', '          ', 'WYORTHO10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1912993015', 0, 'N', 0, '2014-01-03', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W12042855', 'W12042855', 'IDBOISTD', 'Primary Health Medical Group', 'Larry', 'M', 'Oborn', 'PA', 'Family Practice', '', '', NULL, 'O', '11197 W Fairview Ave', 'Boise', 'Ada', 'ID', '83713', '2083788011', '2083228095', '11197 W Fairview Ave', 'Boise', 'Ada', 'ID', '83713', '2083788011', '2083228095', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942219233', 0, 'Y', 0, '2014-07-15', NULL, NULL, 43.6195, -116.322, NULL, NULL),
('202630141', 'W12042856', 'W12042856', 'IDBOISTD', 'Primary Health Medical Group', 'Larry', 'M', 'Oborn', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 191050', 'Boise', 'Ada', 'ID', '83719', '2084553545', NULL, 'PO Box 191050', 'Boise', 'Ada', 'ID', '83719', '2084553545', '          ', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942219233', 0, 'N', 0, '2014-01-22', NULL, NULL, 0, 0, NULL, NULL),
('010894077', 'W12042857', 'W12042857', 'UTMH1', 'Kara Heugly Counseling', 'Kara', 'L', 'Heugly', 'LPC', 'Mental Health', '', '', NULL, 'O', '23 S Carbon Ave Ste 21', 'Price', 'Carbon', 'UT', '84501', '4356370171', '4356371265', '23 S Carbon Ave Ste 21', 'Price', 'Carbon', 'UT', '84501', '4356370171', '4356371265', 'UTMA', '', '', '0.00', '40.00', '0.00', 3, '2013-12-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902953623', 0, 'N', 0, '2014-01-03', NULL, NULL, 39.5992, -110.811, NULL, NULL),
('870560763', 'W12042858', 'W12042858', 'UT01', 'Monument Valley Community Health Center', 'Mahana', 'S', 'Fisher', 'MD', 'Family Practice', '', '', NULL, 'O', '30 W Medical Dr', 'Monument Valley', 'San Juan', 'UT', '84536', '4357273000', NULL, '30 W Medical Dr', 'Monument Valley', 'San Juan', 'UT', '84536', '4357273000', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-12-19', NULL, 0, 0, 0, 'Blue mountain hospital', '', '', '', 'HCFA|UB|', '1700878949', 0, 'N', 0, '2014-01-17', NULL, NULL, 37.0992, -110.619, NULL, NULL),
('870281028', 'W12042859', 'W12042859', 'UT01', 'Central Utah Clinic PC', 'Kent', 'J', 'Gleed', 'MD', 'Cardiac Electrophysiology Cardiology', '', '', NULL, 'O', '1380 E Medical Ctr Dr Ste 4100', 'St George', 'Washington', 'UT', '84790', '4352512900', '4352512901', '1380 E Medical Ctr Dr Ste 4100', 'St George', 'Washington', 'UT', '84790', '4352512900', '4352512901', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-03-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1669449997', 0, 'N', 0, '2014-06-18', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12042861', 'W12042861', 'UT01', 'Central Utah Clinic PC', 'Kent', 'J', 'Gleed', 'MD', 'Cardiac Electrophysiology Cardiology', '', '', NULL, 'M', '1055 N 500 W Ste 101', 'Provo', 'Utah', 'UT', '84604', '8013548225', '8014180941', '1055 N 500 W Ste 101', 'Provo', 'Utah', 'UT', '84604', '8013548225', '8014180941', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-03-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1669449997', 0, 'N', 0, '2014-06-18', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12042860', 'W12042860', 'UT01', 'Central Utah Clinic PC', 'Kent', 'J', 'Gleed', 'MD', 'Cardiac Electrophysiology Cardiology', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014298180', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014298180', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-03-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1669449997', 0, 'N', 0, '2014-06-18', NULL, NULL, 0, 0, NULL, NULL),
('741724391', 'W12044493', 'W12044493', 'TXSATSTD', 'CommuniCare Health Centers', 'John', 'C', 'Sorensen', 'DPM', 'Podiatry', '', '', NULL, 'O', '3066 E Commerce St', 'San Antonio', 'Bexar', 'TX', '78220', '2102337000', '2102776387', '3066 E Commerce St', 'San Antonio', 'Bexar', 'TX', '78220', '2102337000', '2102776387', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-03-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1649267311', 0, 'N', 0, '2014-02-19', NULL, NULL, 0, 0, NULL, NULL),
('463736766', 'W12042866', 'W12042866', 'TXDALSTD', 'Texas Dermatology Associates PA', 'John', 'M', 'Biltz', 'MD', 'Dermatology', '', '', NULL, 'O', '13O5 W Jefferson Ste 115', 'Waxahachie', 'Ellis', 'TX', '75165', '9038750413', '9038724467', '13O5 W Jefferson Ste 115', 'Waxahachie', 'Ellis', 'TX', '75165', '9038750413', '9038724467', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1225001860', 0, 'N', 0, '2014-01-06', NULL, NULL, 0, 0, NULL, NULL),
('463736766', 'W12042867', 'W12042867', 'TXDALSTD', 'Texas Dermatology Associates PA', 'John', 'M', 'Biltz', 'MD', 'Dermatology', '', '', NULL, 'B', 'PO Box 8596', 'Belfast', 'Waldo', 'ME', '04915', '9038750413', '9038728165', 'PO Box 8596', 'Belfast', 'Waldo', 'ME', '04915', '9038750413', '9038728165', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1225001860', 0, 'N', 0, '2014-01-06', NULL, NULL, 0, 0, NULL, NULL),
('203361094', 'W12042869', 'W12042869', 'TXDALSTD', 'Debra A Naylor MD', 'Nikki', 'U', 'Wacker', 'MD PA', 'Pediatrics', '', '', NULL, 'O', '3041 Churchill Dr Ste 300', 'Flower Mound', 'Denton', 'TX', '75022', '9726911240', '9726912073', '3041 Churchill Dr Ste 300', 'Flower Mound', 'Denton', 'TX', '75022', '9726911240', '9726912073', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568460756', 0, 'N', 0, '2014-01-06', NULL, NULL, 33.0339, -97.0746, NULL, NULL),
('800814807', 'W12042871', 'W12042871', 'TXDALSTD', 'MISI Associates', 'Charles', 'E', 'Singleton', 'DPM', 'Podiatry', '', '', NULL, 'O', '10400 N Central Expy', 'Dallas', 'Dallas', 'TX', '75231', '9728844400', '2142534545', '10400 N Central Expy', 'Dallas', 'Dallas', 'TX', '75231', '9728844400', '2142534545', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-02-01', NULL, 0, 0, 0, 'Baylor Surgical Hospital at Fort Worth', NULL, '', '', 'HCFA|UB|', '1285654806', 0, 'N', 0, '2014-01-06', NULL, NULL, 32.8877, -96.7695, NULL, NULL),
('800814807', 'W12042873', 'W12042873', 'TXDALSTD', 'MISI Associates', 'Charles', 'E', 'Singleton', 'DPM', 'Podiatry', '', '', NULL, 'O', '729 W Bedford Euless Rd Ste 106', 'Hurst', 'Tarrant', 'TX', '76053', '8172841111', '8172824040', '729 W Bedford Euless Rd Ste 106', 'Hurst', 'Tarrant', 'TX', '76053', '8172841111', '8172824040', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-02-01', NULL, 0, 0, 0, 'Baylor Surgical Hospital at Fort Worth', NULL, '', '', 'HCFA|UB|', '1285654806', 0, 'N', 0, '2014-01-06', NULL, NULL, 32.834, -97.1847, NULL, NULL),
('800814807', 'W12042872', 'W12042872', 'TXDALSTD', 'MISI Associates', 'Charles', 'E', 'Singleton', 'DPM', 'Podiatry', '', '', NULL, 'B', 'PO Box 674151', 'Dallas', 'Dallas', 'TX', '75267', '9728844400', '9725914605', 'PO Box 674151', 'Dallas', 'Dallas', 'TX', '75267', '9728844400', '9725914605', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-02-01', NULL, 0, 0, 0, 'Baylor Surgical Hospital at Fort Worth', NULL, '', '', 'HCFA|UB|', '1285654806', 0, 'N', 0, '2014-01-06', NULL, NULL, 0, 0, NULL, NULL),
('752945686', 'W12042875', 'W12042875', 'TXDALSTD', 'Casper Trey Webb DO PA', 'Casper', 'C', 'Webb', 'DO', 'General Surgery', '', '', NULL, 'O', '1910 W Henderson St Ste 200', 'Cleburne', 'Johnson', 'TX', '76033', '8177749322', '8177749323', '1910 W Henderson St Ste 200', 'Cleburne', 'Johnson', 'TX', '76033', '8177749322', '8177749323', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-02-01', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', '', 'HCFA|UB|', '1477519247', 0, 'N', 0, '2014-01-06', NULL, NULL, 32.3312, -97.4316, NULL, NULL),
('412264277', 'W12042876', 'W12042876', 'UT01', '+240 = 10 mins unit University of Utah Anesthesiology Perioperative Echo ', '', '', '+240 = 10 mins unit University of Utah Anesthesiology Perioperative Echo +240 = 10 mins unit', 'Group', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 413034', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413034', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMGANES', '', '', '63.11', '25.00', '0.00', 3, '2014-01-01', NULL, 1, 12, 0, '', '', '', '', 'HCFA|UB|', '1841477528', 0, 'N', 0, '2014-01-07', NULL, NULL, 0, 0, NULL, NULL),
('455225142', 'W12042877', 'W12042877', 'ID01', '+240 = 10 mins unit U-U Anesthesiology Department NCC-SICU School of Medicine', '', '', 'U-U Anesthesiology Department NCC-SICU School of Medicine', '', 'Anesthesiology', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015816393', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015816393', '          ', 'WUUUMGANES', '', '', '63.11', '25.00', '0.00', 3, '2014-01-01', NULL, 1, 12, 0, '', '', '', '', 'HCFA|UB|', '1497014781', 0, 'N', 0, '2014-01-06', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('455225142', 'W12042878', 'W12042878', 'ID01', '+240 = 10 mins unit U-U Anesthesiology Department NCC-SICU School of Medicine', '', '', 'U-U Anesthesiology Department NCC-SICU School of Medicine', '', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUUMGANES', '', '', '63.11', '25.00', '0.00', 3, '2014-01-01', NULL, 1, 12, 0, '', '', '', '', 'HCFA|UB|', '1497014781', 0, 'N', 0, '2014-01-06', NULL, NULL, 0, 0, NULL, NULL),
('455225142', 'W12042879', 'W12042879', 'UT01', '+240 = 10 mins unit U-U Anesthesiology Department NCC-SICU School of Medicine', '', '', 'U-U Anesthesiology Department NCC-SICU School of Medicine', '', 'Anesthesiology', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015816393', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015816393', '          ', 'WUUUMGANES', '', '', '63.11', '25.00', '0.00', 3, '2014-01-01', NULL, 1, 12, 0, '', '', '', '', 'HCFA|UB|', '1497014781', 0, 'N', 0, '2014-01-06', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('455225142', 'W12042880', 'W12042880', 'UT01', '+240 = 10 mins unit U-U Anesthesiology Department NCC-SICU School of Medicine', '', '', 'U-U Anesthesiology Department NCC-SICU School of Medicine', '', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUUMGANES', '', '', '63.11', '25.00', '0.00', 3, '2014-01-01', NULL, 1, 12, 0, '', '', '', '', 'HCFA|UB|', '1497014781', 0, 'N', 0, '2014-01-06', NULL, NULL, 0, 0, NULL, NULL),
('412264277', 'W12042881', 'W12042881', 'ID01', '+240 = 10 mins unit University of Utah Anesthesiology Perioperative Echo ', '', '', '+240 = 10 mins unit University of Utah Anesthesiology Perioperative Echo +240 = 10 mins unit', 'Group', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 413034', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413034', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMGANES', '', '1000', '60.09', '25.00', '0.00', 3, '2013-01-01', '2013-12-31', 1, 12, 0, '', '', '', '', 'HCFA|UB|', '1841477528', 0, 'N', 0, '2014-01-06', NULL, NULL, 0, 0, NULL, NULL),
('412264277', 'W12042882', 'W12042882', 'ID01', '+240 = 10 mins unit University of Utah Anesthesiology Perioperative Echo ', '', '', '+240 = 10 mins unit University of Utah Anesthesiology Perioperative Echo +240 = 10 mins unit', 'Group', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 413034', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413034', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMGANES', '', '', '63.11', '25.00', '0.00', 3, '2014-01-01', NULL, 1, 12, 0, '', '', '', '', 'HCFA|UB|', '1841477528', 0, 'N', 0, '2014-01-07', NULL, NULL, 0, 0, NULL, NULL),
('870442129', 'W12042883', 'W12042883', 'UT01', '+240 = 10 mins unit U of U Dept of Anesthesiology', '', '', '+240 = 10 mins unit U of U Dept of Anesthesiology +240 = 10 mins unit', 'GROUP', 'Anesthesiology', '', '', NULL, 'B', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8012133800', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8012133800', '          ', '', '', '1000', '63.11', '25.00', '0.00', 3, '2014-01-01', NULL, 1, 12, 0, '', '', '', '', 'HCFA|UB|', '1134158322', 0, 'N', 0, '2014-01-07', NULL, NULL, 0, 0, NULL, NULL),
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('870442129', 'W12042894', 'W12042894', 'ID01', '+240 = 10 mins unit U of U Dept of Anesthesiology', '', '', '+240 = 10 mins unit U of U Dept of Anesthesiology +240 = 10 mins unit', 'GROUP', 'Anesthesiology', '', '', NULL, 'B', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8012133800', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8012133800', '          ', '', '', '1000', '60.09', '25.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1134158322', 0, 'N', 0, '2014-01-07', NULL, NULL, 0, 0, NULL, NULL),
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('870442129', 'W12042895', 'W12042895', 'ID01', '+240 = 10 mins unit U of U Dept of Anesthesiology', '', '', '+240 = 10 mins unit U of U Dept of Anesthesiology +240 = 10 mins unit', 'GROUP', 'Anesthesiology', '', '', NULL, 'B', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8012133800', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8012133800', '          ', '', '', '1000', '63.11', '25.00', '0.00', 3, '2014-01-01', NULL, 1, 12, 0, '', '', '', '', 'HCFA|UB|', '1134158322', 0, 'N', 0, '2014-01-07', NULL, NULL, 0, 0, NULL, NULL),
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('710885968', 'W12042906', 'W12042906', 'UT01', 'U of U Pain Management Physicians Group', '', '', 'U of U Pain Management Physicians Group', 'GROUP', 'Pain Management', 'Anesthesiology', '', NULL, 'B', 'PO Box 413034', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413034', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '63.11', '25.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009243', 0, 'N', 0, '2014-01-07', NULL, NULL, 0, 0, NULL, NULL),
('519806230', 'W12042907', 'W12042907', 'ID01', '', 'Wendy', 'E', 'Barth', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '512 W Idaho St Ste 102', 'Boise', 'Ada', 'ID', '83702', '2083227699', '3608247699', '512 W Idaho St Ste 102', 'Boise', 'Ada', 'ID', '83702', '2083227699', '3608247699', 'IDMA', '', '', '0.00', '40.00', '0.00', 3, '2013-09-26', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609885953', 1, 'N', 0, '2014-02-04', NULL, NULL, 43.6147, -116.199, NULL, NULL),
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('363330928', 'W12042914', 'W12042914', 'ILCHIGSTD', 'Presence Healthcare Services', 'Mohin', '', 'Samaraweera', 'MD', 'General Practice', '', '', NULL, 'O', '24016 W Main St', 'Plainfield', 'Will', 'IL', '60544', '8154367303', '8156097980', '24016 W Main St', 'Plainfield', 'Will', 'IL', '60544', '8154367303', '8156097980', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-02-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1295896173', 0, 'N', 0, '2014-01-08', NULL, NULL, 41.6121, -88.2032, NULL, NULL),
('363330928', 'W12042913', 'W12042913', 'ILCHIGSTD', 'Presence Healthcare Services', 'Mohin', '', 'Samaraweera', 'MD', 'General Practice', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8557647687', '6309142469', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8557647687', '6309142469', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-02-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1295896173', 0, 'N', 0, '2014-01-08', NULL, NULL, 0, 0, NULL, NULL),
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('830321534', 'W12042790', 'W12042790', 'WY01', 'Wind City Physical Therapy ', 'Kathy', '', 'Blair', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1347 S Wisconsin Ave', 'Casper', 'Natrona', 'WY', '82609', '3072353910', '3072662891', '1347 S Wisconsin Ave', 'Casper', 'Natrona', 'WY', '82609', '3072353910', '3072662891', '', '', '', '0.00', '0.00', '125.00', 3, '2014-01-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1649323460', 0, 'N', 0, '2014-04-04', NULL, NULL, 42.8376, -106.297, NULL, NULL),
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('830321534', 'W12042792', 'W12042792', 'WY01', 'Wind City Physical Therapy ', 'Josh', '', 'Henderson', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1347 S Wisconsin Ave', 'Casper', 'Natrona', 'WY', '82609', '3072353910', '3072662891', '1347 S Wisconsin Ave', 'Casper', 'Natrona', 'WY', '82609', '3072353910', '3072662891', '', '', '', '0.00', '0.00', '125.00', 3, '2014-01-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1710327804', 0, 'N', 0, '2014-04-04', NULL, NULL, 42.8376, -106.297, NULL, NULL),
('830321534', 'W12042793', 'W12042793', 'WYT1', 'Wind City Physical Therapy ', 'Josh', '', 'Henderson', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1347 S Wisconsin Ave', 'Casper', 'Natrona', 'WY', '82609', '3072353910', '3072662891', '1347 S Wisconsin Ave', 'Casper', 'Natrona', 'WY', '82609', '3072353910', '3072662891', '', '', '', '0.00', '0.00', '125.00', 3, '2014-01-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1710327804', 0, 'N', 0, '2014-04-04', NULL, NULL, 0, 0, NULL, NULL),
('830321534', 'W12042788', 'W12042788', 'WY01', 'Wind City Physical Therapy ', 'Dustin', '', 'Davidson', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1347 S Wisconsin Ave', 'Casper', 'Natrona', 'WY', '82609', '3072353910', '3072662891', '1347 S Wisconsin Ave', 'Casper', 'Natrona', 'WY', '82609', '3072353910', '3072662891', '', '', '', '0.00', '0.00', '125.00', 3, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1356638167', 0, 'N', 0, '2014-04-04', NULL, NULL, 0, 0, NULL, NULL),
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('830321534', 'W12042787', 'W12042787', 'WYT1', 'Wind City Physical Therapy ', 'Julie', '', 'Maiers', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1347 S Wisconsin Ave', 'Casper', 'Natrona', 'WY', '82609', '3072353910', '3072662891', '1347 S Wisconsin Ave', 'Casper', 'Natrona', 'WY', '82609', '3072353910', '3072662891', '', '', '', '0.00', '0.00', '125.00', 3, '2014-03-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1245437599', 0, 'N', 0, '2014-04-04', NULL, NULL, 0, 0, NULL, NULL),
('262072378', 'W12045366', 'W12045366', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Evan', 'B', 'Jones', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1248 E 90 N Ste 300', 'American Fork', 'Utah', 'UT', '84003', '8017569635', '8012168357', '1248 E 90 N Ste 300', 'American Fork', 'Utah', 'UT', '84003', '8017569635', '8012168357', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336450832', 0, 'N', 0, '2014-03-10', NULL, NULL, 0, 0, NULL, NULL),
('830321534', 'W12042795', 'W12042795', 'WY01', 'Wind City Physical Therapy ', 'Jessica', '', 'Schlagenhaufer', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1347 S Wisconsin Ave', 'Casper', 'Natrona', 'WY', '82609', '3072353910', '3072662891', '1347 S Wisconsin Ave', 'Casper', 'Natrona', 'WY', '82609', '3072353910', '3072662891', '', '', '', '0.00', '0.00', '125.00', 3, '2014-03-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1528346343', 0, 'N', 0, '2014-04-04', NULL, NULL, 0, 0, NULL, NULL),
('830321534', 'W12042794', 'W12042794', 'WYT1', 'Wind City Physical Therapy ', 'Jessica', '', 'Schlagenhaufer', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1347 S Wisconsin Ave', 'Casper', 'Natrona', 'WY', '82609', '3072353910', '3072662891', '1347 S Wisconsin Ave', 'Casper', 'Natrona', 'WY', '82609', '3072353910', '3072662891', '', '', '', '0.00', '0.00', '125.00', 3, '2014-03-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1528346343', 0, 'N', 0, '2014-04-04', NULL, NULL, 0, 0, NULL, NULL),
('203125761', 'W12042798', 'W12042798', 'WY01', 'Blair Investments', 'Ken', '', 'Abbott', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1331 Prairie Ave Ste 6', 'Cheyenne', 'Laramie', 'WY', '82001', '3076374617', '3076373568', '1331 Prairie Ave Ste 6', 'Cheyenne', 'Laramie', 'WY', '82001', '3076374617', '3076373568', '', '', 'WCPTEXD', '0.00', '0.00', '0.00', 3, '2014-01-15', '2014-05-14', 0, 0, 0, '', '', '', '', 'HCFA|', '1609028844', 0, 'N', 0, '2014-05-22', NULL, NULL, 41.164, -104.808, NULL, NULL),
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('203125761', 'W12042797', 'W12042797', 'WYT1', 'Blair Investments', 'Ken', '', 'Abbott', 'PT', 'Physical Therapy', '', '', NULL, 'O', '4016 Laramie St', 'Cheyenne', 'Laramie', 'WY', '82009', '3076374617', '3076373568', '4016 Laramie St', 'Cheyenne', 'Laramie', 'WY', '82009', '3076374617', '3076373568', '', '', 'WCPTEXD', '0.00', '0.00', '0.00', 3, '2014-01-15', '2014-05-14', 0, 0, 0, '', '', '', '', 'HCFA|', '1609028844', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('203125761', 'W12042803', 'W12042803', 'WY01', 'Blair Investments', 'Lewis', '', 'Benedict', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1331 Prairie Ave Ste 6', 'Cheyenne', 'Laramie', 'WY', '82001', '3076374617', '3076373568', '1331 Prairie Ave Ste 6', 'Cheyenne', 'Laramie', 'WY', '82001', '3076374617', '3076373568', '', '', 'WCPTEXD', '0.00', '0.00', '0.00', 3, '2014-01-15', '2014-05-14', 0, 0, 0, '', '', '', '', 'HCFA|', '1417269457', 0, 'N', 0, '2014-05-22', NULL, NULL, 41.164, -104.808, NULL, NULL),
('203125761', 'W12042801', 'W12042801', 'WY01', 'Blair Investments', 'Lewis', '', 'Benedict', 'PT', 'Physical Therapy', '', '', NULL, 'O', '4016 Laramie St', 'Cheyenne', 'Laramie', 'WY', '82009', '3076374617', '3076373568', '4016 Laramie St', 'Cheyenne', 'Laramie', 'WY', '82009', '3076374617', '3076373568', '', '', 'WCPTEXD', '0.00', '0.00', '0.00', 3, '2014-01-15', '2014-05-14', 0, 0, 0, '', '', '', '', 'HCFA|', '1417269457', 0, 'N', 0, '2014-05-22', NULL, NULL, 41.1511, -104.761, 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
('203125761', 'W12042802', 'W12042802', 'WYT1', 'Blair Investments', 'Lewis', '', 'Benedict', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1331 Prairie Ave Ste 6', 'Cheyenne', 'Laramie', 'WY', '82001', '3076374617', '3076373568', '1331 Prairie Ave Ste 6', 'Cheyenne', 'Laramie', 'WY', '82001', '3076374617', '3076373568', '', '', 'WCPTEXD', '0.00', '0.00', '0.00', 3, '2014-01-15', '2014-05-14', 0, 0, 0, '', '', '', '', 'HCFA|', '1417269457', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('203125761', 'W12042800', 'W12042800', 'WYT1', 'Blair Investments', 'Lewis', '', 'Benedict', 'PT', 'Physical Therapy', '', '', NULL, 'O', '4016 Laramie St', 'Cheyenne', 'Laramie', 'WY', '82009', '3076374617', '3076373568', '4016 Laramie St', 'Cheyenne', 'Laramie', 'WY', '82009', '3076374617', '3076373568', '', '', 'WCPTEXD', '0.00', '0.00', '0.00', 3, '2014-01-15', '2014-05-14', 0, 0, 0, '', '', '', '', 'HCFA|', '1417269457', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('203125761', 'W12042806', 'W12042806', 'WY01', 'Blair Investments', 'Barry', '', 'Burton', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1331 Prairie Ave Ste 6', 'Cheyenne', 'Laramie', 'WY', '82001', '3076374617', '3076373568', '1331 Prairie Ave Ste 6', 'Cheyenne', 'Laramie', 'WY', '82001', '3076374617', '3076373568', '', '', 'WCPTEXD', '0.00', '0.00', '0.00', 3, '2014-04-01', '2014-05-14', 0, 0, 0, '', '', '', '', 'HCFA|', '1578809547', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('203125761', 'W12042805', 'W12042805', 'WY01', 'Blair Investments', 'Barry', '', 'Burton', 'PT', 'Physical Therapy', '', '', NULL, 'O', '4016 Laramie St', 'Cheyenne', 'Laramie', 'WY', '82009', '3076374617', '3076373568', '4016 Laramie St', 'Cheyenne', 'Laramie', 'WY', '82009', '3076374617', '3076373568', '', '', 'WCPTEXD', '0.00', '0.00', '0.00', 3, '2014-04-01', '2014-05-14', 0, 0, 0, '', '', '', '', 'HCFA|', '1578809547', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('203125761', 'W12042807', 'W12042807', 'WYT1', 'Blair Investments', 'Barry', '', 'Burton', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1331 Prairie Ave Ste 6', 'Cheyenne', 'Laramie', 'WY', '82001', '3076374617', '3076373568', '1331 Prairie Ave Ste 6', 'Cheyenne', 'Laramie', 'WY', '82001', '3076374617', '3076373568', '', '', 'WCPTEXD', '0.00', '0.00', '0.00', 3, '2014-04-01', '2014-05-14', 0, 0, 0, '', '', '', '', 'HCFA|', '1578809547', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('203125761', 'W12042804', 'W12042804', 'WYT1', 'Blair Investments', 'Barry', '', 'Burton', 'PT', 'Physical Therapy', '', '', NULL, 'O', '4016 Laramie St', 'Cheyenne', 'Laramie', 'WY', '82009', '3076374617', '3076373568', '4016 Laramie St', 'Cheyenne', 'Laramie', 'WY', '82009', '3076374617', '3076373568', '', '', 'WCPTEXD', '0.00', '0.00', '0.00', 3, '2014-04-01', '2014-05-14', 0, 0, 0, '', '', '', '', 'HCFA|', '1578809547', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('203125761', 'W12042810', 'W12042810', 'WY01', 'Blair Investments', 'Gretchen', '', 'Claude', 'PT', 'Physical Therapy', '', '', NULL, 'M', '1347 S Wisconsin Ave', 'Casper', 'Natrona', 'WY', '82609', '3077423110', '3077214785', '1347 S Wisconsin Ave', 'Casper', 'Natrona', 'WY', '82609', '3077423110', '3077214785', '', '', 'WCPTEXD', '0.00', '0.00', '0.00', 3, '2014-01-15', '2014-05-14', 0, 0, 0, '', '', '', '', 'HCFA|', '1760680821', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('203125761', 'W12042808', 'W12042808', 'WY01', 'Blair Investments', 'Gretchen', '', 'Claude', 'PT', 'Physical Therapy', '', '', NULL, 'O', '3125 E Grand Ave', 'Laramie', 'Albany', 'WY', '82070', '3077423110', '3077214785', '3125 E Grand Ave', 'Laramie', 'Albany', 'WY', '82070', '3077423110', '3077214785', '', '', 'WCPTEXD', '0.00', '0.00', '0.00', 3, '2014-01-15', '2014-05-14', 0, 0, 0, '', '', '', '', 'HCFA|', '1760680821', 0, 'N', 0, '2014-05-22', NULL, NULL, 41.309, -105.557, NULL, NULL),
('203125761', 'W12042811', 'W12042811', 'WYT1', 'Blair Investments', 'Gretchen', '', 'Claude', 'PT', 'Physical Therapy', '', '', NULL, 'M', '1347 S Wisconsin Ave', 'Casper', 'Natrona', 'WY', '82609', '0000000000', '0000000000', '1347 S Wisconsin Ave', 'Casper', 'Natrona', 'WY', '82609', '0000000000', '0000000000', '', '', 'WCPTEXD', '0.00', '0.00', '0.00', 3, '2014-01-15', '2014-05-14', 0, 0, 0, '', '', '', '', 'HCFA|', '1760680821', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
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('363317058', 'W12042981', 'W12042981', 'ILCHIGSTD', 'Access Blue Island Family Health Center', 'Susana', 'C', 'Alvarez', 'MD', 'Pediatrics', '', '', NULL, 'O', '13000 S Maple Ave ', 'Blue Island', 'Cook', 'IL', '60406', '7083856100', NULL, '13000 S Maple Ave ', 'Blue Island', 'Cook', 'IL', '60406', '7083856100', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386897700', 0, 'Y', 0, '2014-01-13', NULL, NULL, 41.6571, -87.6849, NULL, NULL),
('363317058', 'W12042982', 'W12042982', 'ILCHIGSTD', 'Access Grand Boulevard Family and Specialty Health Center  ', 'Krishnaswamy ', '', 'Anand', 'MD', 'Internal Medicine', 'Gastroenterology', '', NULL, 'O', '5401 S Wentworth', 'Chicago', 'Cook', 'IL', '60609', '7732886900', NULL, '5401 S Wentworth', 'Chicago', 'Cook', 'IL', '60609', '7732886900', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720080732', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.7964, -87.6305, NULL, NULL),
('363317058', 'W12042983', 'W12042983', 'ILCHIGSTD', 'Access Genesis Family Health Center ', 'Sandra', '', 'Anderson', 'MD', 'Pediatrics', '', '', NULL, 'O', '1 N Broadway', 'Des Plaines', 'Cook', 'IL', '60016', '8472983150', NULL, '1 N Broadway', 'Des Plaines', 'Cook', 'IL', '60016', '8472983150', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', '', 'HCFA|UB|', '1669541868', 0, 'N', 0, '2014-01-10', NULL, NULL, 42.0513, -87.9094, NULL, NULL),
('363317058', 'W12042984', 'W12042984', 'ILCHIGSTD', 'Access Des Plaines Valley Health Center', 'Nasreen', '', 'Ansari', 'MD', 'Family Practice', '', '', NULL, 'O', '7450 W 63rd St', 'Summit Argo', 'Cook', 'IL', '60501', '7084580757', NULL, '7450 W 63rd St', 'Summit Argo', 'Cook', 'IL', '60501', '7084580757', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992886717', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.7772, -87.8069, NULL, NULL),
('363317058', 'W12042985', 'W12042985', 'ILCHIGSTD', 'Access Brandon Family Health Center ', 'Andi', '', 'Arnautovic', 'MD', 'Family Practice', '', '', NULL, 'O', '8300 S Brandon ', 'Chicago', 'Cook', 'IL', '60617', '7737217600', NULL, '8300 S Brandon ', 'Chicago', 'Cook', 'IL', '60617', '7737217600', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487795118', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.7447, -87.5467, NULL, NULL),
('363317058', 'W12042986', 'W12042986', 'ILCHIGSTD', 'Access Madison Family Health Center ', 'Ihab', '', 'Aziz', 'MD', 'Family Practice', '', '', NULL, 'O', '3800 W Madison', 'Chicago', 'Cook', 'IL', '60624', '7738266600', NULL, '3800 W Madison', 'Chicago', 'Cook', 'IL', '60624', '7738266600', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508968652', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8808, -87.7223, NULL, NULL),
('363317058', 'W12042987', 'W12042987', 'ILCHIGSTD', 'Access Ashland Health Center', 'Myesha Janell', '', 'Banks', 'MD', 'Pediatrics', '', '', NULL, 'O', '5159 S Ashland Ave', 'Chicago', 'Cook', 'IL', '60609', '7734349216', NULL, '5159 S Ashland Ave', 'Chicago', 'Cook', 'IL', '60609', '7734349216', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821258724', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8003, -87.6646, NULL, NULL),
('363317058', 'W12042988', 'W12042988', 'ILCHIGSTD', 'Access Southwest Family Health Ctr ', 'Charles', '', 'Barron', 'MD', 'Family Practice', '', '', NULL, 'O', '4839 W 47th St', 'Chicago', 'Cook', 'IL', '60638', '7737352345', NULL, '4839 W 47th St', 'Chicago', 'Cook', 'IL', '60638', '7737352345', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457433039', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8076, -87.7445, NULL, NULL),
('363317058', 'W12042989', 'W12042989', 'ILCHIGSTD', 'Access Centro Medico', 'Syed', '', 'Baseer', 'MD', 'Pediatrics', '', '', NULL, 'O', '3700 W 26th St', 'Chicago', 'Cook', 'IL', '60623', '7735425203', NULL, '3700 W 26th St', 'Chicago', 'Cook', 'IL', '60623', '7735425203', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316988710', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8444, -87.7172, NULL, NULL),
('363317058', 'W12042990', 'W12042990', 'ILCHIGSTD', 'Access Centro Medico', 'Cesar', '', 'Bastos', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3700 W 26th St', 'Chicago', 'Cook', 'IL', '60623', '7735425203', NULL, '3700 W 26th St', 'Chicago', 'Cook', 'IL', '60623', '7735425203', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912080581', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8444, -87.7172, NULL, NULL),
('363317058', 'W12042991', 'W12042991', 'ILCHIGSTD', 'Access Holy Cross', 'Sterling', '', 'Baumwell', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2701 W 68th St', 'Chicago', 'Cook', 'IL', '60629', '7734344040', NULL, '2701 W 68th St', 'Chicago', 'Cook', 'IL', '60629', '7734344040', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205807658', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.7699, -87.6907, NULL, NULL),
('363317058', 'W12042992', 'W12042992', 'ILCHIGSTD', 'Access Humboldt Park Family Health Center', 'Nydia', '', 'Beard Rogers', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3202 W North Ave ', 'Chicago', 'Cook', 'IL', '60647', '7732781880', NULL, '3202 W North Ave ', 'Chicago', 'Cook', 'IL', '60647', '7732781880', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922234921', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.9102, -87.7071, NULL, NULL),
('363317058', 'W12042993', 'W12042993', 'ILCHIGSTD', 'Access Servicios Medicos La Villita', 'Jose Daniel', '', 'Benatar', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3303 W 26th St', 'Chicago', 'Cook', 'IL', '60623', '7732776589', NULL, '3303 W 26th St', 'Chicago', 'Cook', 'IL', '60623', '7732776589', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063413094', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.8445, -87.7075, NULL, NULL),
('363317058', 'W12042994', 'W12042994', 'ILCHIGSTD', 'Access Grand Boulevard Family and Specialty Health Center  ', 'Patricia', '', 'Benitez', 'MD', 'Family Practice', '', '', NULL, 'O', '5401 S Wentworth ', 'Chicago', 'Cook', 'IL', '60609', '7732886900', NULL, '5401 S Wentworth ', 'Chicago', 'Cook', 'IL', '60609', '7732886900', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417039009', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.7964, -87.6305, NULL, NULL),
('363317058', 'W12042995', 'W12042995', 'ILCHIGSTD', 'Access Grand Boulevard Family and Specialty Health Center  ', 'Jean Luc', '', 'Benoit', 'MD', 'Internal Medicine', '', '', NULL, 'O', '5401 S Wentworth', 'Chicago', 'Cook', 'IL', '60609', '7732886900', NULL, '5401 S Wentworth', 'Chicago', 'Cook', 'IL', '60609', '7732886900', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710049267', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.7964, -87.6305, NULL, NULL),
('363317058', 'W12042996', 'W12042996', 'ILCHIGSTD', 'Access Plaza Family Health Center', 'Bernadine', '', 'Berridge', 'MD', 'Pediatrics', '', '', NULL, 'O', '2533 W Cermak Rd ', 'Chicago', 'Cook', 'IL', '60608', '7735230900', NULL, '2533 W Cermak Rd ', 'Chicago', 'Cook', 'IL', '60608', '7735230900', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437322195', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.852, -87.6888, 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
('363317058', 'W12042997', 'W12042997', 'ILCHIGSTD', 'Access Kling Professional Building', 'Bharathi', '', 'Bhoopathi', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2720 W 15th St 3rd Fl', 'Chicago', 'Cook', 'IL', '60608', '7732576676', NULL, '2720 W 15th St 3rd Fl', 'Chicago', 'Cook', 'IL', '60608', '7732576676', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164480976', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8611, -87.6934, NULL, NULL),
('363317058', 'W12042998', 'W12042998', 'ILCHIGSTD', 'Access Genesis Family Health Center ', 'Julie', '', 'Blankemeier', 'MD', 'Family Practice', '', '', NULL, 'O', '1 N Broadway ', 'Des Plaines', 'Cook', 'IL', '60016', '8472983150', NULL, '1 N Broadway ', 'Des Plaines', 'Cook', 'IL', '60016', '8472983150', '', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801101555', 0, 'N', 0, '2014-06-02', NULL, NULL, 42.0513, -87.9094, NULL, NULL),
('363317058', 'W12042999', 'W12042999', 'ILCHIGSTD', 'Access Kling Professional Building', 'Josef', '', 'Blankstein', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2720 W 15th St 3rd Fl', 'Chicago', 'Cook', 'IL', '60608', '7732576676', NULL, '2720 W 15th St 3rd Fl', 'Chicago', 'Cook', 'IL', '60608', '7732576676', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972596914', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.8611, -87.6934, NULL, NULL),
('363317058', 'W12043000', 'W12043000', 'ILCHIGSTD', 'Access Madison Family Health Center ', 'Kumar', '', 'Bobba', 'MD', 'Family Practice', '', '', NULL, 'O', '3800 W Madison ', 'Chicago', 'Cook', 'IL', '60624', '7738266600', NULL, '3800 W Madison ', 'Chicago', 'Cook', 'IL', '60624', '7738266600', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023223161', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8808, -87.7223, NULL, NULL),
('363317058', 'W12043001', 'W12043001', 'ILCHIGSTD', 'Access Madison Family Health Center ', 'Leo', '', 'Boler', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3800 W Madison ', 'Chicago', 'Cook', 'IL', '60624', '7738266600', NULL, '3800 W Madison ', 'Chicago', 'Cook', 'IL', '60624', '7738266600', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629151352', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.8808, -87.7223, NULL, NULL),
('363317058', 'W12043002', 'W12043002', 'ILCHIGSTD', 'Access Servicios Medicos La Villita', 'Kenneth ', '', 'Bretts', 'DO', 'Family Practice', '', '', NULL, 'O', '3303 W 26th St', 'Chicago', 'Cook', 'IL', '60623', '7732776589', NULL, '3303 W 26th St', 'Chicago', 'Cook', 'IL', '60623', '7732776589', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285717678', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8445, -87.7075, NULL, NULL),
('363317058', 'W12043003', 'W12043003', 'ILCHIGSTD', 'Access St Francis Health Center ', 'Michele', 'A', 'Bucciero', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '7464 N Clark St', 'Chicago', 'Cook', 'IL', '60626', '7733818700', NULL, '7464 N Clark St', 'Chicago', 'Cook', 'IL', '60626', '7733818700', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', '', 'HCFA|UB|', '1255441275', 0, 'N', 0, '2014-01-10', NULL, NULL, 42.0173, -87.6755, NULL, NULL),
('363317058', 'W12043004', 'W12043004', 'ILCHIGSTD', 'Access Kling Professional Building', 'Juan', '', 'Campbell', 'MD', 'Pediatrics', '', '', NULL, 'O', '2720 W 15th St 3rd Fl', 'Chicago', 'Cook', 'IL', '60608', '7732571700', NULL, '2720 W 15th St 3rd Fl', 'Chicago', 'Cook', 'IL', '60608', '7732571700', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205940582', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8611, -87.6934, NULL, NULL),
('363317058', 'W12043005', 'W12043005', 'ILCHIGSTD', 'Access Kedzie Family Health Center', 'Paula', '', 'Cavens', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3229 W 47th Pl', 'Chicago', 'Cook', 'IL', '60632', '7732546044', NULL, '3229 W 47th Pl', 'Chicago', 'Cook', 'IL', '60632', '7732546044', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528084779', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8068, -87.7048, NULL, NULL),
('363317058', 'W12043006', 'W12043006', 'ILCHIGSTD', 'Access Madison Family Health Center ', 'Mohammad', '', 'Chaudhary', 'MD', 'Pediatrics', '', '', NULL, 'O', '3800 W Madison ', 'Chicago', 'Cook', 'IL', '60624', '7738266600', NULL, '3800 W Madison ', 'Chicago', 'Cook', 'IL', '60624', '7738266600', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619080850', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8808, -87.7223, NULL, NULL),
('363317058', 'W12043007', 'W12043007', 'ILCHIGSTD', 'Access Kling Professional Building', 'Quimbo', '', 'Ching', 'MD', 'Pediatrics', '', '', NULL, 'O', '2720 W 15th St 3rd Fl', 'Chicago', 'Cook', 'IL', '60608', '7732571700', NULL, '2720 W 15th St 3rd Fl', 'Chicago', 'Cook', 'IL', '60608', '7732571700', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1083667646', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8611, -87.6934, NULL, NULL),
('363317058', 'W12043008', 'W12043008', 'ILCHIGSTD', 'Access St Francis Health Center ', 'Magdalena', '', 'Chlebowicz', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '7464 N Clark St', 'Chicago', 'Cook', 'IL', '60626', '7733818700', NULL, '7464 N Clark St', 'Chicago', 'Cook', 'IL', '60626', '7733818700', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1538460084', 0, 'N', 0, '2014-01-10', NULL, NULL, 42.0173, -87.6755, NULL, NULL),
('363317058', 'W12043009', 'W12043009', 'ILCHIGSTD', 'Access Grand Boulevard Family and Specialty Health Center  ', 'Saima', '', 'Chohan', 'MD', 'Internal Medicine', 'Rheumatology', '', NULL, 'O', '5401 S Wentworth ', 'Chicago', 'Cook', 'IL', '60609', '7732886900', NULL, '5401 S Wentworth ', 'Chicago', 'Cook', 'IL', '60609', '7732886900', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073675526', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.7964, -87.6305, NULL, NULL),
('363317058', 'W12043010', 'W12043010', 'ILCHIGSTD', 'Access Kling Professional Building', 'Caroline', '', 'Cinquegrani', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2720 W 15th St 3rd Fl', 'Chicago', 'Cook', 'IL', '60608', '7732576676', NULL, '2720 W 15th St 3rd Fl', 'Chicago', 'Cook', 'IL', '60608', '7732576676', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1649353251', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.8611, -87.6934, NULL, NULL),
('363317058', 'W12043011', 'W12043011', 'ILCHIGSTD', 'Access Genesis Family Health Center ', 'Diana', '', 'Climaco Smith', 'MD', 'Family Practice', '', '', NULL, 'O', '1 N Broadway ', 'Des Plaines', 'Cook', 'IL', '60016', '8472983150', NULL, '1 N Broadway ', 'Des Plaines', 'Cook', 'IL', '60016', '8472983150', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356579023', 0, 'N', 0, '2014-01-10', NULL, NULL, 42.0513, -87.9094, NULL, NULL),
('363317058', 'W12043012', 'W12043012', 'ILCHIGSTD', 'Access Martin Russo Family Health Center', 'David', '', 'Cooke', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '245 S Gary Ave', 'Bloomingdale', 'Dupage', 'IL', '60108', '6308935230', NULL, '245 S Gary Ave', 'Bloomingdale', 'Dupage', 'IL', '60108', '6308935230', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942234430', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.9434, -88.1196, NULL, NULL),
('363317058', 'W12043013', 'W12043013', 'ILCHIGSTD', 'Access Addison Family Health Center', 'Maribel', '', 'Corral', 'PA', 'Family Practice', '', '', NULL, 'O', '1111 Lake St', 'Addison', 'Dupage', 'IL', '60101', '6306281811', NULL, '1111 Lake St', 'Addison', 'Dupage', 'IL', '60101', '6306281811', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467631978', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.9438, -88.016, NULL, NULL),
('363317058', 'W12043014', 'W12043014', 'ILCHIGSTD', 'Access St Francis Health Center ', 'Migdalia', '', 'Cortina', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '7464 N Clark St', 'Chicago', 'Cook', 'IL', '60626', '7733818700', NULL, '7464 N Clark St', 'Chicago', 'Cook', 'IL', '60626', '7733818700', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1306090089', 0, 'N', 0, '2014-01-10', NULL, NULL, 42.0173, -87.6755, NULL, NULL),
('363317058', 'W12043015', 'W12043015', 'ILCHIGSTD', 'Access Kling Professional Building', 'Michael', '', 'Cristofano', 'PA', 'Family Practice', '', '', NULL, 'O', '2720 W 15th St 3rd Fl', 'Chicago', 'Cook', 'IL', '60608', '7732576730', NULL, '2720 W 15th St 3rd Fl', 'Chicago', 'Cook', 'IL', '60608', '7732576730', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407826472', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.8611, -87.6934, NULL, NULL),
('363317058', 'W12043016', 'W12043016', 'ILCHIGSTD', 'Access Martin Russo Family Health Center', 'Francisco', '', 'Cruz', 'MD', 'Psychiatry', '', '', NULL, 'O', '245 S Gary Ave', 'Bloomingdale', 'Dupage', 'IL', '60108', '6308935230', NULL, '245 S Gary Ave', 'Bloomingdale', 'Dupage', 'IL', '60108', '6308935230', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871533935', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.9434, -88.1196, NULL, NULL),
('363317058', 'W12043017', 'W12043017', 'ILCHIGSTD', 'Access Northwest Community', 'Kimberly', '', 'Curnyn', 'MD', 'Pediatrics', 'Pediatric Ophthalmology', '', NULL, 'O', '675 W Central Rd Ste 101', 'Arlington Heights', 'Cook', 'IL', '60005', '8473421554', NULL, '675 W Central Rd Ste 101', 'Arlington Heights', 'Cook', 'IL', '60005', '8473421554', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1669575296', 0, 'N', 0, '2014-01-10', NULL, NULL, 42.0665, -87.9909, NULL, NULL),
('363317058', 'W12043018', 'W12043018', 'ILCHIGSTD', 'Access Madison Family Health Center ', 'Teresa', '', 'Cvengros', 'MD', 'Family Practice', '', '', NULL, 'O', '3800 W Madison', 'Chicago', 'Cook', 'IL', '60624', '7738266600', NULL, '3800 W Madison', 'Chicago', 'Cook', 'IL', '60624', '7738266600', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1558366591', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8808, -87.7223, NULL, NULL),
('363317058', 'W12043019', 'W12043019', 'ILCHIGSTD', 'Access Madison Family Health Center ', 'Nkeiruka ', '', 'Dara', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3800 W Madison ', 'Chicago', 'Cook', 'IL', '60624', '7738266600', NULL, '3800 W Madison ', 'Chicago', 'Cook', 'IL', '60624', '7738266600', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679801476', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.8808, -87.7223, NULL, NULL),
('363317058', 'W12043020', 'W12043020', 'ILCHIGSTD', 'Access Kedzie Family Health Center', 'Tara', '', 'De Jesus', 'MD', 'Pediatrics', '', '', NULL, 'O', '3229 W 47th Pl', 'Chicago', 'Cook', 'IL', '60632', '7732546044', NULL, '3229 W 47th Pl', 'Chicago', 'Cook', 'IL', '60632', '7732546044', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477590651', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8068, -87.7048, NULL, NULL),
('363317058', 'W12043021', 'W12043021', 'ILCHIGSTD', 'Access Near West Family Health Center', 'Lilia', '', 'De Leon', 'MD', 'Family Practice', '', '', NULL, 'O', '1158 W Taylor ', 'Chicago', 'Cook', 'IL', '60607', '3124558640', NULL, '1158 W Taylor ', 'Chicago', 'Cook', 'IL', '60607', '3124558640', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164503975', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.8695, -87.6559, NULL, NULL),
('363317058', 'W12043022', 'W12043022', 'ILCHIGSTD', 'Access Martin Russo Family Health Center', 'Joy', '', 'De Leoz', 'MD', 'Family Practice', '', '', NULL, 'O', '245 S Gary Ave', 'Bloomingdale', 'Dupage', 'IL', '60108', '6308935230', NULL, '245 S Gary Ave', 'Bloomingdale', 'Dupage', 'IL', '60108', '6308935230', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083697171', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.9434, -88.1196, NULL, NULL),
('363317058', 'W12043023', 'W12043023', 'ILCHIGSTD', 'Access Addison Family Health Center', 'Maria Carmen', '', 'Del Cid', 'NP', 'Family Practice', '', '', NULL, 'O', '1111 Lake St', 'Addison', 'Dupage', 'IL', '60101', '6306281811', NULL, '1111 Lake St', 'Addison', 'Dupage', 'IL', '60101', '6306281811', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396047668', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.9438, -88.016, NULL, NULL),
('363317058', 'W12043024', 'W12043024', 'ILCHIGSTD', 'Access Blue Island Family Health Center', 'Alfonso', 'F', 'Del Granado', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '13000 S Maple Ave ', 'Blue Island', 'Cook', 'IL', '60406', '7083856100', NULL, '13000 S Maple Ave ', 'Blue Island', 'Cook', 'IL', '60406', '7083856100', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1720157977', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.6571, -87.6849, NULL, NULL),
('363317058', 'W12043025', 'W12043025', 'ILCHIGSTD', 'Access Centro Medico San Rafael', 'Arnulfo', '', 'Delgado', 'MD', 'Pediatrics', '', '', NULL, 'O', '3204 W 26th St', 'Chicago', 'Cook', 'IL', '60623', '7739273100', NULL, '3204 W 26th St', 'Chicago', 'Cook', 'IL', '60623', '7739273100', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538172887', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8445, -87.7052, NULL, NULL),
('363317058', 'W12043026', 'W12043026', 'ILCHIGSTD', 'Access West Chicago Family Health Center ', 'Sarah', '', 'Dennison', 'MD', 'Pediatrics', '', '', NULL, 'O', '245 W Roosevelt Rd Bldg 14', 'West Chicago', 'Dupage', 'IL', '60185', '6302934124', NULL, '245 W Roosevelt Rd Bldg 14', 'West Chicago', 'Dupage', 'IL', '60185', '6302934124', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861576407', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.8663, -88.2075, NULL, NULL),
('363317058', 'W12043027', 'W12043027', 'ILCHIGSTD', 'Access Servicios Medicos La Villita', 'Oscar', '', 'Diaz', 'MD', 'Pediatrics', '', '', NULL, 'O', '3303 W 26th St', 'Chicago', 'Cook', 'IL', '60623', '7732776589', NULL, '3303 W 26th St', 'Chicago', 'Cook', 'IL', '60623', '7732776589', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1174618383', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8445, -87.7075, NULL, NULL),
('363317058', 'W12043028', 'W12043028', 'ILCHIGSTD', 'Access Madison Family Health Center ', 'Mara', '', 'Divis', 'DO', 'Family Practice', '', '', NULL, 'O', '3800 W Madison', 'Chicago', 'Cook', 'IL', '60624', '7738266600', NULL, '3800 W Madison', 'Chicago', 'Cook', 'IL', '60624', '7738266600', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780824037', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8808, -87.7223, NULL, NULL),
('363317058', 'W12043029', 'W12043029', 'ILCHIGSTD', 'Access Madison Family Health Center ', 'Grettel', '', 'Donahue', 'MD', 'Pediatrics', '', '', NULL, 'O', '1111 Lake St', 'Addison', 'Dupage', 'IL', '60101', '6306281811', NULL, '1111 Lake St', 'Addison', 'Dupage', 'IL', '60101', '6306281811', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477605913', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.9438, -88.016, NULL, NULL),
('363317058', 'W12043030', 'W12043030', 'ILCHIGSTD', 'Access Kedzie Family Health Center', 'Barbara Alif', '', 'Doran', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3229 W 47th Pl', 'Chicago', 'Cook', 'IL', '60632', '7732546044', NULL, '3229 W 47th Pl', 'Chicago', 'Cook', 'IL', '60632', '7732546044', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669541371', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.8068, -87.7048, NULL, NULL),
('363317058', 'W12043031', 'W12043031', 'ILCHIGSTD', 'Access Addison Family Health Center', 'Amy', '', 'Drescher Crumpley', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1111 Lake St', 'Addison', 'Dupage', 'IL', '60101', '6306281811', NULL, '1111 Lake St', 'Addison', 'Dupage', 'IL', '60101', '6306281811', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801907589', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.9438, -88.016, NULL, NULL),
('363317058', 'W12043032', 'W12043032', 'ILCHIGSTD', 'Access Kling Professional Building', 'David', '', 'Ebert', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2720 W 15th St 4th Fl', 'Chicago', 'Cook', 'IL', '60608', '7732576730', NULL, '2720 W 15th St 4th Fl', 'Chicago', 'Cook', 'IL', '60608', '7732576730', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902987753', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8611, -87.6934, NULL, NULL),
('363317058', 'W12043033', 'W12043033', 'ILCHIGSTD', 'Access Plaza Family Health Center', 'Bernadette', '', 'Espiritu', 'MD', 'Pediatrics', '', '', NULL, 'O', '2533 W Cermak Rd', 'Chicago', 'Cook', 'IL', '60608', '7735230900', NULL, '2533 W Cermak Rd', 'Chicago', 'Cook', 'IL', '60608', '7735230900', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912089756', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.852, -87.6888, NULL, NULL),
('363317058', 'W12043034', 'W12043034', 'ILCHIGSTD', 'Access Kling Professional Building', 'Leonard', '', 'Feinkind', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2720 W 15th St 3rd Fl', 'Chicago', 'Cook', 'IL', '60608', '7732576676', NULL, '2720 W 15th St 3rd Fl', 'Chicago', 'Cook', 'IL', '60608', '7732576676', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, '', '', 'HCFA|UB|', '1962403659', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8611, -87.6934, NULL, NULL),
('363317058', 'W12043035', 'W12043035', 'ILCHIGSTD', 'Access Family Health Society', 'Melinda', '', 'Fitzgerald', 'NP', 'Pediatrics', '', '', NULL, 'O', '152 W Lincoln Hwy', 'Chicago Heights', 'Cook', 'IL', '60411', '7087549687', NULL, '152 W Lincoln Hwy', 'Chicago Heights', 'Cook', 'IL', '60411', '7087549687', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053600932', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.506, -87.6475, NULL, NULL),
('363317058', 'W12043036', 'W12043036', 'ILCHIGSTD', 'Access Illinois Eye Institute', 'Kwame', '', 'Foucher', 'MD', 'Family Practice', '', '', NULL, 'O', '3241 S Michigan Ave', 'Chicago', 'Cook', 'IL', '60616', '3129497770', NULL, '3241 S Michigan Ave', 'Chicago', 'Cook', 'IL', '60616', '3129497770', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336209527', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8357, -87.6234, NULL, NULL),
('363317058', 'W12043037', 'W12043037', 'ILCHIGSTD', 'Access Hawthorn Family Health Center', 'Hazel', '', 'Galicia', 'DO', 'Pediatrics', '', '', NULL, 'O', '230709 S Cicero', 'Cicero', 'Cook', 'IL', '60804', '7087809777', NULL, '230709 S Cicero', 'Cicero', 'Cook', 'IL', '60804', '7087809777', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114183738', 0, 'N', 0, '2014-01-10', NULL, NULL, 0, 0, NULL, NULL),
('363317058', 'W12043038', 'W12043038', 'ILCHIGSTD', 'Access Kedzie Family Health Center', 'Nancy', '', 'Gamarra', 'MD', 'Internal Medicine', 'Endocrinology', '', NULL, 'O', '3229 W 47th Pl', 'Chicago', 'Cook', 'IL', '60632', '7732546044', NULL, '3229 W 47th Pl', 'Chicago', 'Cook', 'IL', '60632', '7732546044', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710094685', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8068, -87.7048, NULL, NULL),
('363317058', 'W12043039', 'W12043039', 'ILCHIGSTD', 'Access Blue Island Family Health Center', 'Julianne', '', 'Gatlin', 'DO', 'Family Practice', '', '', NULL, 'O', '13000 S Maple Ave', 'Blue Island', 'Cook', 'IL', '60406', '7083856100', NULL, '13000 S Maple Ave', 'Blue Island', 'Cook', 'IL', '60406', '7083856100', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386806354', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.6571, -87.6849, NULL, NULL),
('363317058', 'W12043040', 'W12043040', 'ILCHIGSTD', 'Access Madison Family Health Center ', 'Yacob', '', 'Gawo', 'MD', 'Family Practice', '', '', NULL, 'O', '3800 W Madison', 'Chicago', 'Cook', 'IL', '60624', '7738266600', NULL, '3800 W Madison', 'Chicago', 'Cook', 'IL', '60624', '7738266600', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831296540', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8808, -87.7223, NULL, NULL),
('363317058', 'W12043041', 'W12043041', 'ILCHIGSTD', 'Access Hawthorn Family Health Center ', 'Anne', '', 'Gearhart', 'MD', 'Pediatrics', '', '', NULL, 'O', '230709 S Cicero', 'Cicero', 'Cook', 'IL', '60804', '7087809777', NULL, '230709 S Cicero', 'Cicero', 'Cook', 'IL', '60804', '7087809777', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699949263', 0, 'N', 0, '2014-01-10', NULL, NULL, 0, 0, NULL, NULL),
('363317058', 'W12043042', 'W12043042', 'ILCHIGSTD', 'Access Genesis Family Health Center ', 'Davida', '', 'Gerena', 'MD', 'Pediatrics', '', '', NULL, 'O', '1 N Broadway', 'Des Plaines', 'Cook', 'IL', '60016', '8472983150', NULL, '1 N Broadway', 'Des Plaines', 'Cook', 'IL', '60016', '8472983150', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538325113', 0, 'N', 0, '2014-01-10', NULL, NULL, 42.0513, -87.9094, NULL, NULL),
('363317058', 'W12043043', 'W12043043', 'ILCHIGSTD', 'Access Holy Cross', 'Melinda', '', 'Gibson', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2701 W 68th St', 'Chicago', 'Cook', 'IL', '60629', '7734344040', NULL, '2701 W 68th St', 'Chicago', 'Cook', 'IL', '60629', '7734344040', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427046705', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.7699, -87.6907, NULL, NULL),
('363317058', 'W12043044', 'W12043044', 'ILCHIGSTD', 'Access Madison Family Health Center ', 'Raja', '', 'Gill', 'MD', 'Psychiatry', '', '', NULL, 'O', '3800 W Madison', 'Chicago', 'Cook', 'IL', '60624', '7738266600', NULL, '3800 W Madison', 'Chicago', 'Cook', 'IL', '60624', '7738266600', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851540165', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.8808, -87.7223, NULL, NULL),
('363317058', 'W12043045', 'W12043045', 'ILCHIGSTD', 'Access Westside Family Health Center', 'William', '', 'Gillard', 'MD', 'Family Practice', '', '', NULL, 'O', '3752 W 16th St', 'Chicago', 'Cook', 'IL', '60623', '7737622435', NULL, '3752 W 16th St', 'Chicago', 'Cook', 'IL', '60623', '7737622435', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457369662', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8589, -87.7193, NULL, NULL),
('363317058', 'W12043046', 'W12043046', 'ILCHIGSTD', 'Access Grand Boulevard Family and Specialty Health Center  ', 'Nancy', '', 'Glick', 'MD', 'Internal Medicine', '', '', NULL, 'O', '5401 S Wentworth', 'Chicago', 'Cook', 'IL', '60609', '7732886900', NULL, '5401 S Wentworth', 'Chicago', 'Cook', 'IL', '60609', '7732886900', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083607881', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.7964, -87.6305, NULL, NULL),
('363317058', 'W12043047', 'W12043047', 'ILCHIGSTD', 'Access Melrose Park Family  Health Center', 'James', '', 'Gomez', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '8321 W N Ave', 'Melrose Park', 'Cook', 'IL', '60160', '7086812298', NULL, '8321 W N Ave', 'Melrose Park', 'Cook', 'IL', '60160', '7086812298', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376654103', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.9085, -87.8267, NULL, NULL),
('363317058', 'W12043048', 'W12043048', 'ILCHIGSTD', 'Access Centro Medico', 'Aileen', '', 'Gomez Torres', 'MD', 'Pediatrics', '', '', NULL, 'O', '3700 W 26th St', 'Chicago', 'Cook', 'IL', '60623', '7735425203', NULL, '3700 W 26th St', 'Chicago', 'Cook', 'IL', '60623', '7735425203', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922119957', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8444, -87.7172, NULL, NULL),
('363317058', 'W12043049', 'W12043049', 'ILCHIGSTD', 'Access Kling Professional Building', 'Marlene', '', 'Green', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2720 W 15th St 3rd Fl', 'Chicago', 'Cook', 'IL', '60608', '7732576676', NULL, '2720 W 15th St 3rd Fl', 'Chicago', 'Cook', 'IL', '60608', '7732576676', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447333166', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.8611, -87.6934, NULL, NULL),
('363317058', 'W12043050', 'W12043050', 'ILCHIGSTD', 'Access Northwest Community', 'Penny', '', 'Grillos', 'PA', 'Obstetrics and Gynecology', '', '', NULL, 'O', '675 W Central Rd Ste 101', 'Arlington Heights', 'Cook', 'IL', '60005', '8473421554', NULL, '675 W Central Rd Ste 101', 'Arlington Heights', 'Cook', 'IL', '60005', '8473421554', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1407807548', 0, 'Y', 0, '2014-01-10', NULL, NULL, 42.0665, -87.9909, NULL, NULL),
('363317058', 'W12043051', 'W12043051', 'ILCHIGSTD', 'Access St Francis Health Center ', 'Kenneth ', '', 'Grumet', 'MD', 'Internal Medicine', '', '', NULL, 'O', '7464 N Clark St', 'Chicago', 'Cook', 'IL', '60626', '7733818700', NULL, '7464 N Clark St', 'Chicago', 'Cook', 'IL', '60626', '7733818700', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1275564940', 0, 'N', 0, '2014-01-10', NULL, NULL, 42.0173, -87.6755, NULL, NULL),
('363317058', 'W12043052', 'W12043052', 'ILCHIGSTD', 'Access Kling Professional Building', 'Howard', '', 'Grundy', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2720 W 15th St 3rd Fl', 'Chicago', 'Cook', 'IL', '60608', '7732576676', NULL, '2720 W 15th St 3rd Fl', 'Chicago', 'Cook', 'IL', '60608', '7732576676', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871587493', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.8611, -87.6934, NULL, NULL),
('363317058', 'W12043053', 'W12043053', 'ILCHIGSTD', 'Access Northwest Community', 'Rosalina', '', 'Guerrero Guzman', 'MD', 'Internal Medicine', '', '', NULL, 'O', '675 W Central Rd Ste 101', 'Arlington Heights', 'Cook', 'IL', '60005', '8473421554', NULL, '675 W Central Rd Ste 101', 'Arlington Heights', 'Cook', 'IL', '60005', '8473421554', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1013010628', 0, 'N', 0, '2014-01-10', NULL, NULL, 42.0665, -87.9909, NULL, NULL),
('363317058', 'W12043054', 'W12043054', 'ILCHIGSTD', 'Access St Francis Health Center ', 'Anshu', '', 'Gupta', 'MD', 'Internal Medicine', '', '', NULL, 'O', '7464 N Clark St', 'Chicago', 'Cook', 'IL', '60626', '7733818700', NULL, '7464 N Clark St', 'Chicago', 'Cook', 'IL', '60626', '7733818700', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', '', 'HCFA|UB|', '1063466738', 0, 'N', 0, '2014-01-10', NULL, NULL, 42.0173, -87.6755, NULL, NULL),
('363317058', 'W12043055', 'W12043055', 'ILCHIGSTD', 'Access Blue Island Family Health Center', 'Mahmoud', '', 'Halloway', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '13000 S Maple Ave', 'Blue Island', 'Cook', 'IL', '60406', '7083856100', NULL, '13000 S Maple Ave', 'Blue Island', 'Cook', 'IL', '60406', '7083856100', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114009891', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.6571, -87.6849, NULL, NULL),
('363317058', 'W12043056', 'W12043056', 'ILCHIGSTD', 'Access Auburn Gresham Family Health Center', 'Kathryn', '', 'Hawley', 'PA', 'Family Practice', '', '', NULL, 'O', '8234 S Ashland Ave', 'Chicago', 'Cook', 'IL', '60620', '7738741400', NULL, '8234 S Ashland Ave', 'Chicago', 'Cook', 'IL', '60620', '7738741400', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285876599', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.7442, -87.6634, NULL, NULL),
('363317058', 'W12043057', 'W12043057', 'ILCHIGSTD', 'Access Melrose Park Family  Health Center', 'Estella', '', 'Hernandez', 'MD', 'Family Practice', '', '', NULL, 'O', '8321 W N Ave', 'Melrose Park', 'Cook', 'IL', '60160', '7086812298', NULL, '8321 W N Ave', 'Melrose Park', 'Cook', 'IL', '60160', '7086812298', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326173618', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.9085, -87.8267, NULL, NULL),
('363317058', 'W12043058', 'W12043058', 'ILCHIGSTD', 'Access St Francis Health Center ', 'Thomas', '', 'Herriges', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '7464 N Clark St', 'Chicago', 'Cook', 'IL', '60626', '7733818700', NULL, '7464 N Clark St', 'Chicago', 'Cook', 'IL', '60626', '7733818700', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1407962079', 0, 'Y', 0, '2014-01-10', NULL, NULL, 42.0173, -87.6755, NULL, NULL),
('363317058', 'W12043059', 'W12043059', 'ILCHIGSTD', 'Access Martin Russo Family Health Center', 'Tally', '', 'Hollin', 'NP', 'Family Practice', '', '', NULL, 'O', '245 S Gary Ave', 'Bloomingdale', 'Dupage', 'IL', '60108', '6308935230', NULL, '245 S Gary Ave', 'Bloomingdale', 'Dupage', 'IL', '60108', '6308935230', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518251149', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.9434, -88.1196, NULL, NULL),
('363317058', 'W12043060', 'W12043060', 'ILCHIGSTD', 'Access Ashland Health Center', 'Jessica', '', 'Holmes', 'MD', 'Family Practice', '', '', NULL, 'O', '5159 S Ashland Ave', 'Chicago', 'Cook', 'IL', '60609', '7734349216', NULL, '5159 S Ashland Ave', 'Chicago', 'Cook', 'IL', '60609', '7734349216', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093038242', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8003, -87.6646, NULL, NULL),
('363317058', 'W12043061', 'W12043061', 'ILCHIGSTD', 'Access Brandon Family Health Center ', 'Sarah', '', 'Houck', 'PA', 'Pediatrics', '', '', NULL, 'O', '8300 S Brandon', 'Chicago', 'Cook', 'IL', '60617', '7737217600', NULL, '8300 S Brandon', 'Chicago', 'Cook', 'IL', '60617', '7737217600', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932386737', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.7447, -87.5467, NULL, NULL),
('363317058', 'W12043062', 'W12043062', 'ILCHIGSTD', 'Access St Francis Health Center ', 'Marko', '', 'Jachtorowycz', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '7464 N Clark St', 'Chicago', 'Cook', 'IL', '60626', '7733818700', NULL, '7464 N Clark St', 'Chicago', 'Cook', 'IL', '60626', '7733818700', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', '', '', '', 'HCFA|UB|', '1073597894', 0, 'N', 0, '2014-01-10', NULL, NULL, 42.0173, -87.6755, NULL, NULL),
('363317058', 'W12043063', 'W12043063', 'ILCHIGSTD', 'Access Genesis Family Health Center ', 'Ian', '', 'Jasenof', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1 N Broadway', 'Des Plaines', 'Cook', 'IL', '60016', '8472983150', NULL, '1 N Broadway', 'Des Plaines', 'Cook', 'IL', '60016', '8472983150', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578509428', 0, 'Y', 0, '2014-01-10', NULL, NULL, 42.0513, -87.9094, NULL, NULL),
('363317058', 'W12043064', 'W12043064', 'ILCHIGSTD', 'Access St Francis Health Center ', 'Rajesh', '', 'Jindal', 'MD', 'Internal Medicine', '', '', NULL, 'O', '7464 N Clark St', 'Chicago', 'Cook', 'IL', '60626', '7733818700', NULL, '7464 N Clark St', 'Chicago', 'Cook', 'IL', '60626', '7733818700', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Presence Holy Family Medical Center', 'Presence Saint Francis Hospital', '', '', 'HCFA|UB|', '1184818791', 0, 'N', 0, '2014-01-10', NULL, NULL, 42.0173, -87.6755, NULL, NULL),
('363317058', 'W12043065', 'W12043065', 'ILCHIGSTD', 'Access Holy Cross', 'Ketan', '', 'Jobanputra', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2701 W 68th St', 'Chicago', 'Cook', 'IL', '60629', '7734344040', NULL, '2701 W 68th St', 'Chicago', 'Cook', 'IL', '60629', '7734344040', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992818827', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.7699, -87.6907, NULL, NULL),
('363317058', 'W12043066', 'W12043066', 'ILCHIGSTD', 'Access Family Health Society', 'Smita', '', 'Jobanputra', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '152 W Lincoln Hwy', 'Chicago Heights', 'Cook', 'IL', '60411', '7087549687', NULL, '152 W Lincoln Hwy', 'Chicago Heights', 'Cook', 'IL', '60411', '7087549687', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427242452', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.506, -87.6475, NULL, NULL),
('363317058', 'W12043067', 'W12043067', 'ILCHIGSTD', 'Access St Francis Health Center ', 'Janice', '', 'Johnson', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '7464 N Clark St', 'Chicago', 'Cook', 'IL', '60626', '7733818700', NULL, '7464 N Clark St', 'Chicago', 'Cook', 'IL', '60626', '7733818700', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285640425', 0, 'N', 0, '2014-01-10', NULL, NULL, 42.0173, -87.6755, NULL, NULL),
('363317058', 'W12043068', 'W12043068', 'ILCHIGSTD', 'Access Holy Cross', 'Andrea', 'D', 'Jones', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2701 W 68th St', 'Chicago', 'Cook', 'IL', '60629', '7734344040', NULL, '2701 W 68th St', 'Chicago', 'Cook', 'IL', '60629', '7734344040', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1861487423', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.7699, -87.6907, NULL, NULL),
('363317058', 'W12043069', 'W12043069', 'ILCHIGSTD', 'Access Grand Boulevard Family and Specialty Health Center  ', 'Stacy', '', 'Kahn', 'MD', 'Pediatrics', '', '', NULL, 'O', '5401 S Wentworth', 'Chicago', 'Cook', 'IL', '60609', '7732886900', NULL, '5401 S Wentworth', 'Chicago', 'Cook', 'IL', '60609', '7732886900', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912123340', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.7964, -87.6305, NULL, NULL),
('363317058', 'W12043070', 'W12043070', 'ILCHIGSTD', 'Access St Francis Health Center ', 'Shaista', '', 'Kamal', 'MD', 'Pediatrics', '', '', NULL, 'O', '7464 N Clark St', 'Chicago', 'Cook', 'IL', '60626', '7733818700', NULL, '7464 N Clark St', 'Chicago', 'Cook', 'IL', '60626', '7733818700', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', '', 'HCFA|UB|', '1215023916', 0, 'N', 0, '2014-01-10', NULL, NULL, 42.0173, -87.6755, NULL, NULL),
('363317058', 'W12043071', 'W12043071', 'ILCHIGSTD', 'Access Holy Cross', 'Alina', '', 'Karpinski', 'DO', 'Pediatrics', '', '', NULL, 'O', '2701 W 68th St', 'Chicago', 'Cook', 'IL', '60629', '7738847932', NULL, '2701 W 68th St', 'Chicago', 'Cook', 'IL', '60629', '7738847932', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750352142', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.7699, -87.6907, NULL, NULL),
('264696078', 'W12047479', 'W12047479', 'UT01', 'Mountain Springs Family Medicine PLLC', 'Jana', 'R', 'Boehler', 'PA-C', 'Family Practice', '', '', NULL, 'O', '468 S Main St', 'Spanish Fork', 'Utah', 'UT', '84660', '8015046117', '8015046328', '468 S Main St', 'Spanish Fork', 'Utah', 'UT', '84660', '8015046117', '8015046328', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104197524', 0, 'N', 0, '2014-06-25', NULL, NULL, 0, 0, NULL, NULL),
('363317058', 'W12043072', 'W12043072', 'ILCHIGSTD', 'Access Kling Professional Building', 'Gary', '', 'Kaufman', 'MD', 'Internal Medicine', 'Pediatrics', '', NULL, 'O', '2720 W 15th St 4th Fl', 'Chicago', 'Cook', 'IL', '60608', '7732576730', NULL, '2720 W 15th St 4th Fl', 'Chicago', 'Cook', 'IL', '60608', '7732576730', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447252457', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8611, -87.6934, NULL, NULL),
('363317058', 'W12043073', 'W12043073', 'ILCHIGSTD', 'Access Kedzie Family Health Center', 'Salman', '', 'Khan', 'MD', 'Pediatrics', '', '', NULL, 'O', '3229 W 47th Pl', 'Chicago', 'Cook', 'IL', '60632', '7732546044', NULL, '3229 W 47th Pl', 'Chicago', 'Cook', 'IL', '60632', '7732546044', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710098777', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8068, -87.7048, NULL, NULL),
('363317058', 'W12043074', 'W12043074', 'ILCHIGSTD', 'Access Kling Professional Building', 'Stuart', '', 'Kiken', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2720 W 15th St 4th Fl', 'Chicago', 'Cook', 'IL', '60608', '7732576730', NULL, '2720 W 15th St 4th Fl', 'Chicago', 'Cook', 'IL', '60608', '7732576730', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790868008', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8611, -87.6934, NULL, NULL),
('363317058', 'W12043075', 'W12043075', 'ILCHIGSTD', 'Access Grand Boulevard Family and Specialty Health Center  ', 'Gene', '', 'Kim', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '5401 S Wentworth', 'Chicago', 'Cook', 'IL', '60609', '7732886900', NULL, '5401 S Wentworth', 'Chicago', 'Cook', 'IL', '60609', '7732886900', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598923005', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.7964, -87.6305, NULL, NULL),
('363317058', 'W12043076', 'W12043076', 'ILCHIGSTD', 'Access Humboldt Park Family Health Center', 'Min Soo', '', 'Kim', 'MD', 'Family Practice', '', '', NULL, 'O', '3202 W N Ave', 'Chicago', 'Cook', 'IL', '60647', '7732781880', NULL, '3202 W N Ave', 'Chicago', 'Cook', 'IL', '60647', '7732781880', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, '', '', 'HCFA|UB|', '1831204379', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.9102, -87.7071, NULL, NULL),
('363317058', 'W12043077', 'W12043077', 'ILCHIGSTD', 'Access Madison Family Health Center ', 'Daniela', '', 'Kovacs', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3800 W Madison', 'Chicago', 'Cook', 'IL', '60624', '7738266600', NULL, '3800 W Madison', 'Chicago', 'Cook', 'IL', '60624', '7738266600', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659573624', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8808, -87.7223, NULL, NULL),
('363317058', 'W12043078', 'W12043078', 'ILCHIGSTD', 'Access Kling Professional Building', 'Girija', '', 'Kumar', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2720 W 15th St 4th Fl', 'Chicago', 'Cook', 'IL', '60608', '7732576730', NULL, '2720 W 15th St 4th Fl', 'Chicago', 'Cook', 'IL', '60608', '7732576730', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861486250', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8611, -87.6934, NULL, NULL),
('363317058', 'W12043079', 'W12043079', 'ILCHIGSTD', 'Access Martin Russo Family Health Center', 'Kenneth', '', 'Kwiatkowski', 'DO', 'Pediatrics', '', '', NULL, 'O', '245 S Gary Ave', 'Bloomingdale', 'Dupage', 'IL', '60108', '6308935230', NULL, '245 S Gary Ave', 'Bloomingdale', 'Dupage', 'IL', '60108', '6308935230', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538179361', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.9434, -88.1196, NULL, NULL),
('363317058', 'W12043080', 'W12043080', 'ILCHIGSTD', 'Access Kling Professional Building', 'Edward', 'Charles', 'Lampley', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2720 W 15th St 3rd Fl', 'Chicago', 'Cook', 'IL', '60608', '7732576676', NULL, '2720 W 15th St 3rd Fl', 'Chicago', 'Cook', 'IL', '60608', '7732576676', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699776385', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8611, -87.6934, NULL, NULL),
('363317058', 'W12043081', 'W12043081', 'ILCHIGSTD', 'Access Plaza Family Health Center', 'Silvia', '', 'Lara', 'NP', 'Family Practice', '', '', NULL, 'O', '2533 W Cermak Rd', 'Chicago', 'Cook', 'IL', '60608', '7735230900', NULL, '2533 W Cermak Rd', 'Chicago', 'Cook', 'IL', '60608', '7735230900', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356644272', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.852, -87.6888, NULL, NULL),
('363317058', 'W12043082', 'W12043082', 'ILCHIGSTD', 'Access Pilsen Family Health Center ', 'Concepta', '', 'Lasquite', 'MD', 'General Practice', '', '', NULL, 'O', '1817 S Loomis', 'Chicago', 'Cook', 'IL', '60608', '3126666511', NULL, '1817 S Loomis', 'Chicago', 'Cook', 'IL', '60608', '3126666511', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700922648', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8573, -87.6613, NULL, NULL),
('363317058', 'W12043083', 'W12043083', 'ILCHIGSTD', 'Access Auburn Gresham Family Health Center', 'Clyde', '', 'Lawson', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '8234 S Ashland Ave', 'Chicago', 'Cook', 'IL', '60620', '7738741400', NULL, '8234 S Ashland Ave', 'Chicago', 'Cook', 'IL', '60620', '7738741400', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013098920', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.7442, -87.6634, NULL, NULL),
('363317058', 'W12043084', 'W12043084', 'ILCHIGSTD', 'Access Grand Boulevard Family and Specialty Health Center  ', 'Doan', '', 'Le', 'MD', 'Pediatrics', '', '', NULL, 'O', '5401 S Wentworth', 'Chicago', 'Cook', 'IL', '60609', '7732886900', NULL, '5401 S Wentworth', 'Chicago', 'Cook', 'IL', '60609', '7732886900', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942444617', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.7964, -87.6305, NULL, NULL),
('363317058', 'W12043085', 'W12043085', 'ILCHIGSTD', 'Access Northwest Community', 'Mireya', '', 'Ledesma', 'PA', 'Obstetrics and Gynecology', '', '', NULL, 'O', '675 W Central Rd Ste 101', 'Arlington Heights', 'Cook', 'IL', '60005', '8473421554', NULL, '675 W Central Rd Ste 101', 'Arlington Heights', 'Cook', 'IL', '60005', '8473421554', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1063530368', 0, 'Y', 0, '2014-01-10', NULL, NULL, 42.0665, -87.9909, NULL, NULL),
('363317058', 'W12043086', 'W12043086', 'ILCHIGSTD', 'Access Servicios Medicos La Villita', 'Meredith', '', 'Lembke Vanputten', 'PA', 'Family Practice', '', '', NULL, 'O', '3303 W 26th St', 'Chicago', 'Cook', 'IL', '60623', '7732776589', NULL, '3303 W 26th St', 'Chicago', 'Cook', 'IL', '60623', '7732776589', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811179195', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.8445, -87.7075, NULL, NULL),
('363317058', 'W12043087', 'W12043087', 'ILCHIGSTD', 'Access Melrose Park Family  Health Center', 'Roberto', '', 'Levi Dancona', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '8321 W N Ave', 'Melrose Park', 'Cook', 'IL', '60160', '7086812298', NULL, '8321 W N Ave', 'Melrose Park', 'Cook', 'IL', '60160', '7086812298', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053394155', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.9085, -87.8267, 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
('363317058', 'W12043088', 'W12043088', 'ILCHIGSTD', 'Access Martin Russo Family Health Center', 'Chong Hsiang', '', 'Liang', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '245 S Gary Ave', 'Bloomingdale', 'Dupage', 'IL', '60108', '6308935230', NULL, '245 S Gary Ave', 'Bloomingdale', 'Dupage', 'IL', '60108', '6308935230', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407086143', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.9434, -88.1196, NULL, NULL),
('363317058', 'W12043089', 'W12043089', 'ILCHIGSTD', 'Access St Francis Health Center ', 'Riley', '', 'Lloyd', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '7464 N Clark St', 'Chicago', 'Cook', 'IL', '60626', '7733818700', NULL, '7464 N Clark St', 'Chicago', 'Cook', 'IL', '60626', '7733818700', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1073628285', 0, 'N', 0, '2014-01-10', NULL, NULL, 42.0173, -87.6755, NULL, NULL),
('363317058', 'W12043090', 'W12043090', 'ILCHIGSTD', 'Access Genesis Family Health Center ', 'Brian', '', 'Locker', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1 N Broadway', 'Des Plaines', 'Cook', 'IL', '60016', '8472983150', NULL, '1 N Broadway', 'Des Plaines', 'Cook', 'IL', '60016', '8472983150', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679540868', 0, 'Y', 0, '2014-01-10', NULL, NULL, 42.0513, -87.9094, NULL, NULL),
('363317058', 'W12043091', 'W12043091', 'ILCHIGSTD', 'Access Northwest Community', 'Cereesa', '', 'Longest', 'MD', 'Ophthalmology', '', '', NULL, 'O', '675 W Central Rd Ste 101', 'Arlington Heights', 'Cook', 'IL', '60005', '8473421554', NULL, '675 W Central Rd Ste 101', 'Arlington Heights', 'Cook', 'IL', '60005', '8473421554', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1467438341', 0, 'N', 0, '2014-01-10', NULL, NULL, 42.0665, -87.9909, NULL, NULL),
('363317058', 'W12043092', 'W12043092', 'ILCHIGSTD', 'Access Cabrini Family Health Center', 'Sonia', '', 'Lott', 'MD', 'Family Practice', '', '', NULL, 'O', '3450 S Archer Ave', 'Chicago', 'Cook', 'IL', '60608', '7735231000', NULL, '3450 S Archer Ave', 'Chicago', 'Cook', 'IL', '60608', '7735231000', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801918545', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8313, -87.6762, NULL, NULL),
('363317058', 'W12043093', 'W12043093', 'ILCHIGSTD', 'Access Grand Boulevard Family and Specialty Health Center  ', 'Carol', '', 'Macmillan', 'MD', 'Pediatrics', 'Neurology', '', NULL, 'O', '5401 S Wentworth', 'Chicago', 'Cook', 'IL', '60609', '7732886900', NULL, '5401 S Wentworth', 'Chicago', 'Cook', 'IL', '60609', '7732886900', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306949615', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.7964, -87.6305, NULL, NULL),
('363317058', 'W12043094', 'W12043094', 'ILCHIGSTD', 'Access Hawthorn Family Health Center ', 'Andres', '', 'Mafla', 'MD', 'Internal Medicine', '', '', NULL, 'O', '230709 S Cicero', 'Cicero', 'Cook', 'IL', '60804', '7087809777', NULL, '230709 S Cicero', 'Cicero', 'Cook', 'IL', '60804', '7087809777', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326249285', 0, 'N', 0, '2014-01-10', NULL, NULL, 0, 0, NULL, NULL),
('363317058', 'W12043095', 'W12043095', 'ILCHIGSTD', 'Access Melrose Park Family  Health Center', 'Eileen', '', 'Magill', 'NP', 'Family Practice', '', '', NULL, 'O', '8321 W N Ave', 'Melrose Park', 'Cook', 'IL', '60160', '7086812298', NULL, '8321 W N Ave', 'Melrose Park', 'Cook', 'IL', '60160', '7086812298', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447411483', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.9085, -87.8267, NULL, NULL),
('363317058', 'W12043096', 'W12043096', 'ILCHIGSTD', 'Access Hawthorn Family Health Center ', 'Nirupama', '', 'Mahidhara', 'MD', 'Pediatrics', '', '', NULL, 'O', '230709 S Cicero', 'Cicero', 'Cook', 'IL', '60804', '7087809777', NULL, '230709 S Cicero', 'Cicero', 'Cook', 'IL', '60804', '7087809777', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205862422', 0, 'N', 0, '2014-01-10', NULL, NULL, 0, 0, NULL, NULL),
('363317058', 'W12043097', 'W12043097', 'ILCHIGSTD', 'Access Northwest Community', 'Liseth', '', 'Manjarrez', 'MD', 'Pediatrics', '', '', NULL, 'O', '675 W Central Rd Ste 101', 'Arlington Heights', 'Cook', 'IL', '60005', '8473421554', NULL, '675 W Central Rd Ste 101', 'Arlington Heights', 'Cook', 'IL', '60005', '8473421554', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1831320621', 0, 'N', 0, '2014-01-10', NULL, NULL, 42.0665, -87.9909, NULL, NULL),
('363317058', 'W12043098', 'W12043098', 'ILCHIGSTD', 'Access Near West Family Health Center', 'Annamma', '', 'Mathew', 'MD', 'Pediatrics', '', '', NULL, 'O', '1158 W Taylor', 'Chicago', 'Cook', 'IL', '60607', '3124558640', NULL, '1158 W Taylor', 'Chicago', 'Cook', 'IL', '60607', '3124558640', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780766535', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8695, -87.6559, NULL, NULL),
('363317058', 'W12043099', 'W12043099', 'ILCHIGSTD', 'Access Plaza Family Health Center', 'Jairo', '', 'Mejia', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2533 W Cermak Rd', 'Chicago', 'Cook', 'IL', '60608', '7735230900', NULL, '2533 W Cermak Rd', 'Chicago', 'Cook', 'IL', '60608', '7735230900', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952361164', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.852, -87.6888, NULL, NULL),
('363317058', 'W12043100', 'W12043100', 'ILCHIGSTD', 'Access Genesis Family Health Center ', 'Mary Jean', '', 'Mendizabal', 'PA', 'Family Practice', '', '', NULL, 'O', '1 N Broadway', 'Des Plaines', 'Cook', 'IL', '60016', '8472983150', NULL, '1 N Broadway', 'Des Plaines', 'Cook', 'IL', '60016', '8472983150', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902989908', 0, 'Y', 0, '2014-03-03', NULL, NULL, 42.0513, -87.9094, NULL, NULL),
('363317058', 'W12043101', 'W12043101', 'ILCHIGSTD', 'Access Centro Medico', 'Sloan', '', 'Metz', 'DPM', 'Podiatry', '', '', NULL, 'O', '3700 W 26th St', 'Chicago', 'Cook', 'IL', '60623', '7735425203', NULL, '3700 W 26th St', 'Chicago', 'Cook', 'IL', '60623', '7735425203', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1851385553', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8444, -87.7172, NULL, NULL),
('363317058', 'W12043102', 'W12043102', 'ILCHIGSTD', 'Access Doctors Medical Center', 'George Y', '', 'Michael', 'MD', 'Family Practice', '', '', NULL, 'O', '6240 W 55th St', 'Chicago', 'Cook', 'IL', '60638', '7732842200', NULL, '6240 W 55th St', 'Chicago', 'Cook', 'IL', '60638', '7732842200', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831272137', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.7924, -87.7794, NULL, NULL),
('363317058', 'W12043103', 'W12043103', 'ILCHIGSTD', 'Access Cabrini Family Health Center', 'Michael', '', 'Miller', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3450 S Archer Ave', 'Chicago', 'Cook', 'IL', '60608', '7735231000', NULL, '3450 S Archer Ave', 'Chicago', 'Cook', 'IL', '60608', '7735231000', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861576043', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8313, -87.6762, NULL, NULL),
('363317058', 'W12043104', 'W12043104', 'ILCHIGSTD', 'Access Melrose Park Family  Health Center', 'Tina', '', 'Mingo', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '8321 W N Ave', 'Melrose Park', 'Cook', 'IL', '60160', '7086812298', NULL, '8321 W N Ave', 'Melrose Park', 'Cook', 'IL', '60160', '7086812298', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114978822', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.9085, -87.8267, NULL, NULL),
('363317058', 'W12043105', 'W12043105', 'ILCHIGSTD', 'Access Madison Family Health Center ', 'Sunita', '', 'Mohapatra', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3800 W Madison', 'Chicago', 'Cook', 'IL', '60624', '7738266600', NULL, '3800 W Madison', 'Chicago', 'Cook', 'IL', '60624', '7738266600', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629062328', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8808, -87.7223, NULL, NULL),
('363317058', 'W12043106', 'W12043106', 'ILCHIGSTD', 'Access Des Plaines Valley Health Center', 'Jesika', '', 'Moore', 'NP', 'Family Practice', '', '', NULL, 'O', '7450 W 63rd St', 'Summit Argo', 'Cook', 'IL', '60501', '7084580757', NULL, '7450 W 63rd St', 'Summit Argo', 'Cook', 'IL', '60501', '7084580757', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801129895', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.7772, -87.8069, NULL, NULL),
('363317058', 'W12043107', 'W12043107', 'ILCHIGSTD', 'Access Warren Family Health Center ', 'Ramalingappa', '', 'Nagaraju', 'MD', 'General Practice', '', '', NULL, 'O', '2409 W Warren Blvd', 'Chicago', 'Cook', 'IL', '60612', '3127334475', NULL, '2409 W Warren Blvd', 'Chicago', 'Cook', 'IL', '60612', '3127334475', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1437175015', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.8821, -87.6867, NULL, NULL),
('363317058', 'W12043108', 'W12043108', 'ILCHIGSTD', 'Access Booker Family Health Center ', 'Vasantha', 'A', 'Naidu', 'MD', 'Family Practice', 'Pediatrics', '', NULL, 'O', '654 E 47th St', 'Chicago', 'Cook', 'IL', '60653', '7736244800', NULL, '654 E 47th St', 'Chicago', 'Cook', 'IL', '60653', '7736244800', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760546329', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8095, -87.6097, NULL, NULL),
('363317058', 'W12043109', 'W12043109', 'ILCHIGSTD', 'Access Humboldt Park Family Health Center', 'Mukund', '', 'Narayan', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3202 W N Ave', 'Chicago', 'Cook', 'IL', '60647', '7732781880', NULL, '3202 W N Ave', 'Chicago', 'Cook', 'IL', '60647', '7732781880', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467535740', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.9102, -87.7071, NULL, NULL),
('363317058', 'W12043110', 'W12043110', 'ILCHIGSTD', 'Access Genesis Family Health Center ', 'Matthew', '', 'Nash', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1 N Broadway', 'Des Plaines', 'Cook', 'IL', '60016', '8472983150', NULL, '1 N Broadway', 'Des Plaines', 'Cook', 'IL', '60016', '8472983150', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740257930', 0, 'Y', 0, '2014-01-10', NULL, NULL, 42.0513, -87.9094, NULL, NULL),
('363317058', 'W12043111', 'W12043111', 'ILCHIGSTD', 'Access West Chicago Family Health Center ', 'Laura ', '', 'Neilsen', 'PA', 'Family Practice', '', '', NULL, 'O', '245 W Roosevelt Rd Bldg 14', 'West Chicago', 'Dupage', 'IL', '60185', '6302934124', NULL, '245 W Roosevelt Rd Bldg 14', 'West Chicago', 'Dupage', 'IL', '60185', '6302934124', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285886721', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.8663, -88.2075, NULL, NULL),
('363317058', 'W12043112', 'W12043112', 'ILCHIGSTD', 'Access Genesis Family Health Center ', 'Gabriela', '', 'Novota', 'MD', 'Pediatrics', '', '', NULL, 'O', '1 N Broadway', 'Des Plaines', 'Cook', 'IL', '60016', '8472983150', NULL, '1 N Broadway', 'Des Plaines', 'Cook', 'IL', '60016', '8472983150', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, '', '', 'HCFA|UB|', '1154520096', 0, 'N', 0, '2014-03-03', NULL, NULL, 42.0513, -87.9094, NULL, NULL),
('363317058', 'W12043113', 'W12043113', 'ILCHIGSTD', 'Access Northwest Community', 'Peter', '', 'Novota', 'MD', 'Family Practice', '', '', NULL, 'O', '675 W Central Rd Ste 101', 'Arlington Heights', 'Cook', 'IL', '60005', '8473421554', NULL, '675 W Central Rd Ste 101', 'Arlington Heights', 'Cook', 'IL', '60005', '8473421554', '', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', '', '', '', 'HCFA|UB|', '1124132394', 0, 'N', 0, '2014-06-11', NULL, NULL, 42.0665, -87.9909, NULL, NULL),
('363317058', 'W12043114', 'W12043114', 'ILCHIGSTD', 'Access Kling Professional Building', 'Emmanuel', '', 'Nwaokocha', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2720 W 15th St 4th Fl', 'Chicago', 'Cook', 'IL', '60608', '7732576730', NULL, '2720 W 15th St 4th Fl', 'Chicago', 'Cook', 'IL', '60608', '7732576730', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003999376', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8611, -87.6934, NULL, NULL),
('363317058', 'W12043115', 'W12043115', 'ILCHIGSTD', 'Access Servicios Medicos La Villita', 'Felix', '', 'Obregon', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3303 W 26th St', 'Chicago', 'Cook', 'IL', '60623', '7732776589', NULL, '3303 W 26th St', 'Chicago', 'Cook', 'IL', '60623', '7732776589', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831271709', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8445, -87.7075, NULL, NULL),
('363317058', 'W12043116', 'W12043116', 'ILCHIGSTD', 'Access Genesis Family Health Center ', 'Therese', '', 'Oconnor', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1 N Broadway', 'Des Plaines', 'Cook', 'IL', '60016', '8472983150', NULL, '1 N Broadway', 'Des Plaines', 'Cook', 'IL', '60016', '8472983150', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114995800', 0, 'N', 0, '2014-01-10', NULL, NULL, 42.0513, -87.9094, NULL, NULL),
('363317058', 'W12043117', 'W12043117', 'ILCHIGSTD', 'Access Madison Family Health Center ', 'Solomon', '', 'Okai', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3800 W Madison', 'Chicago', 'Cook', 'IL', '60624', '7738266600', NULL, '3800 W Madison', 'Chicago', 'Cook', 'IL', '60624', '7738266600', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992815088', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8808, -87.7223, NULL, NULL),
('363317058', 'W12043118', 'W12043118', 'ILCHIGSTD', 'Access Holy Cross', 'Nizar', '', 'Olabi', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2701 W 68th St', 'Chicago', 'Cook', 'IL', '60629', '7734344040', NULL, '2701 W 68th St', 'Chicago', 'Cook', 'IL', '60629', '7734344040', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023004504', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.7699, -87.6907, NULL, NULL),
('363317058', 'W12043119', 'W12043119', 'ILCHIGSTD', 'Access Genesis Family Health Center ', 'Angela', '', 'Papassavas', 'MD', 'Family Practice', '', '', NULL, 'O', '1 N Broadway', 'Des Plaines', 'Cook', 'IL', '60016', '8472983150', NULL, '1 N Broadway', 'Des Plaines', 'Cook', 'IL', '60016', '8472983150', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, '', '', 'HCFA|UB|', '1376731448', 0, 'N', 0, '2014-01-10', NULL, NULL, 42.0513, -87.9094, NULL, NULL),
('363317058', 'W12043120', 'W12043120', 'ILCHIGSTD', 'Access Genesis Family Health Center ', 'Nigam', '', 'Patel', 'MD', 'Family Practice', '', '', NULL, 'O', '1 N Broadway', 'Des Plaines', 'Cook', 'IL', '60016', '8472983150', NULL, '1 N Broadway', 'Des Plaines', 'Cook', 'IL', '60016', '8472983150', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, '', '', 'HCFA|UB|', '1477656684', 0, 'N', 0, '2014-01-10', NULL, NULL, 42.0513, -87.9094, NULL, NULL),
('363317058', 'W12043121', 'W12043121', 'ILCHIGSTD', 'Access Melrose Park Family  Health Center', 'Scott', '', 'Pierce', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '8321 W N Ave', 'Melrose Park', 'Cook', 'IL', '60160', '7086812298', NULL, '8321 W N Ave', 'Melrose Park', 'Cook', 'IL', '60160', '7086812298', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467459305', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.9085, -87.8267, NULL, NULL),
('363317058', 'W12043122', 'W12043122', 'ILCHIGSTD', 'Access Holy Cross', 'Priya', '', 'Pillai Indira', 'MD', 'Family Practice', '', '', NULL, 'O', '2701 W 68th St', 'Chicago', 'Cook', 'IL', '60629', '7734344040', NULL, '2701 W 68th St', 'Chicago', 'Cook', 'IL', '60629', '7734344040', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, '', '', 'HCFA|UB|', '1376844555', 0, 'N', 0, '2014-01-28', NULL, NULL, 41.7699, -87.6907, NULL, NULL),
('363317058', 'W12043123', 'W12043123', 'ILCHIGSTD', 'Access Grand Boulevard Family and Specialty Health Center  ', 'David', '', 'Pitrak', 'MD', 'Internal Medicine', '', '', NULL, 'O', '5401 S Wentworth', 'Chicago', 'Cook', 'IL', '60609', '7732886900', NULL, '5401 S Wentworth', 'Chicago', 'Cook', 'IL', '60609', '7732886900', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902968456', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.7964, -87.6305, NULL, NULL),
('363317058', 'W12043124', 'W12043124', 'ILCHIGSTD', 'Access Grand Boulevard Family and Specialty Health Center  ', 'Renee', '', 'Poole', 'MD', 'Family Practice', '', '', NULL, 'O', '5401 S Wentworth', 'Chicago', 'Cook', 'IL', '60609', '7732886900', NULL, '5401 S Wentworth', 'Chicago', 'Cook', 'IL', '60609', '7732886900', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821268434', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.7964, -87.6305, NULL, NULL),
('363317058', 'W12043125', 'W12043125', 'ILCHIGSTD', 'Access Auburn Gresham Family Health Center', 'Narayan', '', 'Prabhakar', 'MD', 'Family Practice', '', '', NULL, 'O', '8234 S Ashland Ave', 'Chicago', 'Cook', 'IL', '60620', '7738741400', NULL, '8234 S Ashland Ave', 'Chicago', 'Cook', 'IL', '60620', '7738741400', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275616955', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.7442, -87.6634, NULL, NULL),
('363317058', 'W12043126', 'W12043126', 'ILCHIGSTD', 'Access St Francis Health Center ', 'Anshu', '', 'Raj', 'MD', 'Internal Medicine', '', '', NULL, 'O', '7464 N Clark St', 'Chicago', 'Cook', 'IL', '60626', '7733818700', NULL, '7464 N Clark St', 'Chicago', 'Cook', 'IL', '60626', '7733818700', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1972771848', 0, 'N', 0, '2014-01-10', NULL, NULL, 42.0173, -87.6755, NULL, NULL),
('363317058', 'W12043127', 'W12043127', 'ILCHIGSTD', 'Access Centro Medico', 'Jhansi', 'R', 'Raju', 'MD', 'Ophthalmology', '', '', NULL, 'O', '3700 W 26th St', 'Chicago', 'Cook', 'IL', '60623', '7735425203', NULL, '3700 W 26th St', 'Chicago', 'Cook', 'IL', '60623', '7735425203', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013091032', 0, 'Y', 0, '2014-03-24', NULL, NULL, 41.8444, -87.7172, NULL, NULL),
('363317058', 'W12043128', 'W12043128', 'ILCHIGSTD', 'Access Melrose Park Family  Health Center', 'Christy', 'G', 'Reinhard', 'MD', 'Pediatrics', '', '', NULL, 'O', '8321 W N Ave', 'Melrose Park', 'Cook', 'IL', '60160', '7086812298', NULL, '8321 W N Ave', 'Melrose Park', 'Cook', 'IL', '60160', '7086812298', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467523647', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.9085, -87.8267, NULL, NULL),
('363317058', 'W12043129', 'W12043129', 'ILCHIGSTD', 'Access Martin Russo Family Health Center', 'Audrey', '', 'Richardson', 'MD', 'Family Practice', '', '', NULL, 'O', '245 S Gary Ave', 'Bloomingdale', 'Dupage', 'IL', '60108', '6308935230', NULL, '245 S Gary Ave', 'Bloomingdale', 'Dupage', 'IL', '60108', '6308935230', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326031196', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.9434, -88.1196, NULL, NULL),
('363317058', 'W12043130', 'W12043130', 'ILCHIGSTD', 'Access Doctors Medical Center', 'Jose', '', 'Rodriguez', 'MD', 'Family Practice', '', '', NULL, 'O', '6240 W 55th St', 'Chicago', 'Cook', 'IL', '60638', '7732842200', NULL, '6240 W 55th St', 'Chicago', 'Cook', 'IL', '60638', '7732842200', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164477113', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.7924, -87.7794, NULL, NULL),
('363317058', 'W12043131', 'W12043131', 'ILCHIGSTD', 'Access Southwest Family Health Ctr ', 'Pamela', '', 'Roper', 'MD', 'Pediatrics', '', '', NULL, 'O', '4839 W 47th St', 'Chicago', 'Cook', 'IL', '60638', '7737352345', NULL, '4839 W 47th St', 'Chicago', 'Cook', 'IL', '60638', '7737352345', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457433237', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8076, -87.7445, NULL, NULL),
('363317058', 'W12043132', 'W12043132', 'ILCHIGSTD', 'Access Cabrini Family Health Center', 'Mary Theresa', '', 'Rosales', 'MD', 'Pediatrics', '', '', NULL, 'O', '3450 S Archer Ave', 'Chicago', 'Cook', 'IL', '60608', '7735231000', NULL, '3450 S Archer Ave', 'Chicago', 'Cook', 'IL', '60608', '7735231000', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831109172', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8313, -87.6762, NULL, NULL),
('363317058', 'W12043133', 'W12043133', 'ILCHIGSTD', 'Access Rogers Park Family Health Center', 'Frances', '', 'Rosenberg', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1555 W Howard St', 'Chicago', 'Cook', 'IL', '60626', '7737647146', NULL, '1555 W Howard St', 'Chicago', 'Cook', 'IL', '60626', '7737647146', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1588614218', 0, 'Y', 0, '2014-01-10', NULL, NULL, 42.0194, -87.6702, NULL, NULL),
('363317058', 'W12043134', 'W12043134', 'ILCHIGSTD', 'Access Madison Family Health Center ', 'Suresh', '', 'Talathi', 'MD', 'Pediatrics', '', '', NULL, 'O', '3800 W Madison', 'Chicago', 'Cook', 'IL', '60624', '7738266600', NULL, '3800 W Madison', 'Chicago', 'Cook', 'IL', '60624', '7738266600', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982788741', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8808, -87.7223, NULL, NULL),
('363317058', 'W12043135', 'W12043135', 'ILCHIGSTD', 'Access Alma Family Health Center', 'Osama', '', 'Thalji', 'MD', 'Internal Medicine', '', '', NULL, 'O', '318 W Madsion', 'Maywood', 'Cook', 'IL', '60153', '7083445300', NULL, '318 W Madsion', 'Maywood', 'Cook', 'IL', '60153', '7083445300', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386747574', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.879, -87.8366, NULL, NULL),
('363317058', 'W12043136', 'W12043136', 'ILCHIGSTD', 'Access Doctors Medical Center', 'Stephanie', '', 'Tillman', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '6240 W 55th St', 'Chicago', 'Cook', 'IL', '60638', '7732842200', NULL, '6240 W 55th St', 'Chicago', 'Cook', 'IL', '60638', '7732842200', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760738769', 0, 'Y', 0, '2014-01-13', NULL, NULL, 41.7924, -87.7794, NULL, NULL),
('363317058', 'W12043137', 'W12043137', 'ILCHIGSTD', 'Access Illinois Eye Institute', 'Linda', '', 'Tinson', 'NP', 'Family Practice', '', '', NULL, 'O', '3241 S Michigan Ave', 'Chicago', 'Cook', 'IL', '60616', '3129497770', NULL, '3241 S Michigan Ave', 'Chicago', 'Cook', 'IL', '60616', '3129497770', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952358103', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.8357, -87.6234, NULL, NULL),
('363317058', 'W12043138', 'W12043138', 'ILCHIGSTD', 'Access Pilsen Family Health Center ', 'Alicia', '', 'Tobler', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1817 S Loomis', 'Chicago', 'Cook', 'IL', '60608', '3126666511', NULL, '1817 S Loomis', 'Chicago', 'Cook', 'IL', '60608', '3126666511', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427280478', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.8573, -87.6613, NULL, NULL),
('363317058', 'W12043139', 'W12043139', 'ILCHIGSTD', 'Access West Chicago Family Health Center ', 'Arnaldo', '', 'Torres', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '245 W Roosevelt Rd Bldg 14', 'West Chicago', 'Dupage', 'IL', '60185', '6302934124', NULL, '245 W Roosevelt Rd Bldg 14', 'West Chicago', 'Dupage', 'IL', '60185', '6302934124', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548221740', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.8663, -88.2075, NULL, NULL),
('363317058', 'W12043140', 'W12043140', 'ILCHIGSTD', 'Access Kedzie Family Health Center', 'Briana', '', 'Trainor', 'MD', 'Pediatrics', '', '', NULL, 'O', '3229 W 47th Pl', 'Chicago', 'Cook', 'IL', '60632', '7732546044', NULL, '3229 W 47th Pl', 'Chicago', 'Cook', 'IL', '60632', '7732546044', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407083652', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8068, -87.7048, NULL, NULL),
('363317058', 'W12043141', 'W12043141', 'ILCHIGSTD', 'Access Servicios Medicos La Villita', 'Richard', '', 'Trester', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3303 W 26th St', 'Chicago', 'Cook', 'IL', '60623', '7732776589', NULL, '3303 W 26th St', 'Chicago', 'Cook', 'IL', '60623', '7732776589', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669554531', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8445, -87.7075, NULL, NULL),
('363317058', 'W12043142', 'W12043142', 'ILCHIGSTD', 'Access West Chicago Family Health Center ', 'Maria', '', 'Tuason', 'MD', 'Family Practice', '', '', NULL, 'O', '245 W Roosevelt Rd Bldg 14', 'West Chicago', 'Dupage', 'IL', '60185', '6302934124', NULL, '245 W Roosevelt Rd Bldg 14', 'West Chicago', 'Dupage', 'IL', '60185', '6302934124', '', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', '', '', '', 'HCFA|UB|', '1013919893', 0, 'N', 0, '2014-05-30', NULL, NULL, 41.8663, -88.2075, NULL, NULL),
('363317058', 'W12043143', 'W12043143', 'ILCHIGSTD', 'Access Family Health Society', 'Luis', '', 'Ugarte', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '152 W Lincoln Hwy', 'Chicago Heights', 'Cook', 'IL', '60411', '7087549687', NULL, '152 W Lincoln Hwy', 'Chicago Heights', 'Cook', 'IL', '60411', '7087549687', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629076781', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.506, -87.6475, NULL, NULL),
('363317058', 'W12043144', 'W12043144', 'ILCHIGSTD', 'Access Martin Russo Family Health Center', 'Radha Krishna', '', 'Upputuri', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '245 S Gary Ave', 'Bloomingdale', 'Dupage', 'IL', '60108', '6308935230', NULL, '245 S Gary Ave', 'Bloomingdale', 'Dupage', 'IL', '60108', '6308935230', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871514315', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.9434, -88.1196, NULL, NULL),
('363317058', 'W12043145', 'W12043145', 'ILCHIGSTD', 'Access Grand Boulevard Family and Specialty Health Center  ', 'Peter', '', 'Varga', 'MD', 'Pediatrics', 'Cardiovascular Disease', '', NULL, 'O', '5401 S Wentworth', 'Chicago', 'Cook', 'IL', '60609', '7732886900', NULL, '5401 S Wentworth', 'Chicago', 'Cook', 'IL', '60609', '7732886900', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', 'Presence Saint Joseph Hospital Chicago', '', '', 'HCFA|UB|', '1487668224', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.7964, -87.6305, NULL, NULL),
('363317058', 'W12043146', 'W12043146', 'ILCHIGSTD', 'Access Doctors Medical Center', 'Christine', '', 'Veres', 'MD', 'Internal Medicine', '', '', NULL, 'O', '6240 W 55th St', 'Chicago', 'Cook', 'IL', '60638', '7732842200', NULL, '6240 W 55th St', 'Chicago', 'Cook', 'IL', '60638', '7732842200', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073615159', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.7924, -87.7794, NULL, NULL),
('363317058', 'W12043147', 'W12043147', 'ILCHIGSTD', 'Access Rogers Park Family Health Center', 'Nirmla', '', 'Verma', 'MD', 'Pediatrics', '', '', NULL, 'O', '1555 W Howard St', 'Chicago', 'Cook', 'IL', '60626', '7737647146', NULL, '1555 W Howard St', 'Chicago', 'Cook', 'IL', '60626', '7737647146', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710931621', 0, 'N', 0, '2014-01-10', NULL, NULL, 42.0194, -87.6702, NULL, NULL),
('363317058', 'W12043148', 'W12043148', 'ILCHIGSTD', 'Access Servicios Medicos La Villita', 'Sukhveer', '', 'Wahi', 'MD', 'Family Practice', '', '', NULL, 'O', '3303 W 26th St', 'Chicago', 'Cook', 'IL', '60623', '7732776589', NULL, '3303 W 26th St', 'Chicago', 'Cook', 'IL', '60623', '7732776589', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184707358', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8445, -87.7075, NULL, NULL),
('363317058', 'W12043149', 'W12043149', 'ILCHIGSTD', 'Access Kling Professional Building', 'Syed', '', 'Wajid', 'MD', 'Pediatrics', '', '', NULL, 'O', '2720 W 15th St 1st Fl', 'Chicago', 'Cook', 'IL', '60608', '7732576730', NULL, '2720 W 15th St 1st Fl', 'Chicago', 'Cook', 'IL', '60608', '7732576730', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275615080', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8611, -87.6934, NULL, NULL),
('363317058', 'W12043150', 'W12043150', 'ILCHIGSTD', 'Access Blue Island Family Health Center', 'Carol', '', 'Wardlaw', 'NP', 'Family Practice', '', '', NULL, 'O', '13000 S Maple Ave', 'Blue Island', 'Cook', 'IL', '60406', '7083856100', NULL, '13000 S Maple Ave', 'Blue Island', 'Cook', 'IL', '60406', '7083856100', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194942029', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.6571, -87.6849, NULL, NULL),
('363317058', 'W12043151', 'W12043151', 'ILCHIGSTD', 'Access St Francis Health Center ', 'Gina', '', 'Wehrmann', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '7464 N Clark St', 'Chicago', 'Cook', 'IL', '60626', '7733818700', NULL, '7464 N Clark St', 'Chicago', 'Cook', 'IL', '60626', '7733818700', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', 'Presence Saint Francis Hospital', NULL, NULL, 'HCFA|UB|', '1992729263', 0, 'N', 0, '2014-01-10', NULL, NULL, 42.0173, -87.6755, NULL, NULL),
('363317058', 'W12043152', 'W12043152', 'ILCHIGSTD', 'Access Servicios Medicos La Villita', 'Marni', '', 'Wichman', 'PA', 'Family Practice', '', '', NULL, 'O', '3303 W 26th St', 'Chicago', 'Cook', 'IL', '60623', '7732776589', NULL, '3303 W 26th St', 'Chicago', 'Cook', 'IL', '60623', '7732776589', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851450100', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.8445, -87.7075, NULL, NULL),
('363317058', 'W12043153', 'W12043153', 'ILCHIGSTD', 'Access Cabrini Family Health Center', 'Mohanlal', '', 'Wickramasinghe', 'MD', 'Pediatrics', '', '', NULL, 'O', '3450 S Archer Ave', 'Chicago', 'Cook', 'IL', '60608', '7735231000', NULL, '3450 S Archer Ave', 'Chicago', 'Cook', 'IL', '60608', '7735231000', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699715979', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8313, -87.6762, NULL, NULL),
('363317058', 'W12043154', 'W12043154', 'ILCHIGSTD', 'Access Westside Family Health Center', 'Kimberly', '', 'Williams', 'MD', 'Family Practice', '', '', NULL, 'O', '3752 W 16th St', 'Chicago', 'Cook', 'IL', '60623', '7737622435', NULL, '3752 W 16th St', 'Chicago', 'Cook', 'IL', '60623', '7737622435', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790736601', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8589, -87.7193, NULL, NULL),
('363317058', 'W12043155', 'W12043155', 'ILCHIGSTD', 'Access Kling Professional Building', 'Brenda', '', 'Wolfe', 'NP', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2720 W 15th St 3rd Fl', 'Chicago', 'Cook', 'IL', '60608', '7732576676', NULL, '2720 W 15th St 3rd Fl', 'Chicago', 'Cook', 'IL', '60608', '7732576676', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538106398', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.8611, -87.6934, NULL, NULL),
('363317058', 'W12043156', 'W12043156', 'ILCHIGSTD', 'Access West Division Family Health Center ', 'Daneen', '', 'Woodard', 'MD', 'Pediatrics', 'Internal Medicine', '', NULL, 'O', '4401 W Division St', 'Chicago', 'Cook', 'IL', '60651', '7732523122', NULL, '4401 W Division St', 'Chicago', 'Cook', 'IL', '60651', '7732523122', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295829646', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.9025, -87.7361, NULL, NULL),
('363317058', 'W12043157', 'W12043157', 'ILCHIGSTD', 'Access Ashland Health Center', 'Daneen', '', 'Woodard', 'MD', 'Pediatrics', 'Internal Medicine', '', NULL, 'O', '5159 S Ashland Ave', 'Chicago', 'Cook', 'IL', '60609', '7734349216', NULL, '5159 S Ashland Ave', 'Chicago', 'Cook', 'IL', '60609', '7734349216', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295829646', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8003, -87.6646, NULL, NULL),
('363317058', 'W12043158', 'W12043158', 'ILCHIGSTD', 'Access Grand Boulevard Family and Specialty Health Center  ', 'Christine', '', 'Yu', 'MD', 'Pediatrics', '', '', NULL, 'O', '5401 S Wentworth', 'Chicago', 'Cook', 'IL', '60609', '7732886900', NULL, '5401 S Wentworth', 'Chicago', 'Cook', 'IL', '60609', '7732886900', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538109582', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.7964, -87.6305, NULL, NULL),
('363317058', 'W12043159', 'W12043159', 'ILCHIGSTD', 'Access West Chicago Family Health Center ', 'W Patrick', '', 'Zeller', 'MD', 'Pediatrics', 'Endocrinology', '', NULL, 'O', '245 W Roosevelt Rd Bldg 14', 'West Chicago', 'Dupage', 'IL', '60185', '6302934124', NULL, '245 W Roosevelt Rd Bldg 14', 'West Chicago', 'Dupage', 'IL', '60185', '6302934124', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Edward Hospital', NULL, '', '', 'HCFA|UB|', '1699738922', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8663, -88.2075, NULL, NULL),
('363317058', 'W12043160', 'W12043160', 'ILCHIGSTD', 'Access St Francis Health Center ', 'Susana', '', 'Salcedo', 'MD', 'Internal Medicine', '', '', NULL, 'O', '7464 N Clark St', 'Chicago', 'Cook', 'IL', '60626', '7733818700', NULL, '7464 N Clark St', 'Chicago', 'Cook', 'IL', '60626', '7733818700', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134305402', 0, 'N', 0, '2014-01-10', NULL, NULL, 42.0173, -87.6755, NULL, NULL),
('363317058', 'W12043161', 'W12043161', 'ILCHIGSTD', 'Access Cabrini Family Health Center', 'Carlos', '', 'Sandoval Herrera', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3450 S Archer Ave', 'Chicago', 'Cook', 'IL', '60608', '7735231000', NULL, '3450 S Archer Ave', 'Chicago', 'Cook', 'IL', '60608', '7735231000', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316244817', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.8313, -87.6762, NULL, NULL),
('363317058', 'W12043162', 'W12043162', 'ILCHIGSTD', 'Access Des Plaines Valley Health Center', 'Ann', '', 'Sarpy', 'MD', 'Psychiatry', '', '', NULL, 'O', '7450 W 63rd St', 'Summit Argo', 'Cook', 'IL', '60501', '7084580757', NULL, '7450 W 63rd St', 'Summit Argo', 'Cook', 'IL', '60501', '7084580757', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Northwestern Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1750426656', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.7772, -87.8069, NULL, NULL),
('363317058', 'W12043163', 'W12043163', 'ILCHIGSTD', 'Access Alma Family Health Center', 'Illur', '', 'Sathy', 'MD', 'Pediatrics', '', '', NULL, 'O', '318 W Madsion', 'Maywood', 'Cook', 'IL', '60153', '7083445300', NULL, '318 W Madsion', 'Maywood', 'Cook', 'IL', '60153', '7083445300', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1164504965', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.879, -87.8366, NULL, NULL),
('363317058', 'W12043164', 'W12043164', 'ILCHIGSTD', 'Access Grand Boulevard Family and Specialty Health Center  ', 'John', '', 'Schneider', 'MD', 'Internal Medicine', '', '', NULL, 'O', '5401 S Wentworth', 'Chicago', 'Cook', 'IL', '60609', '7732886900', NULL, '5401 S Wentworth', 'Chicago', 'Cook', 'IL', '60609', '7732886900', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396868147', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.7964, -87.6305, NULL, NULL),
('363317058', 'W12043165', 'W12043165', 'ILCHIGSTD', 'Access Hawthorn Family Health Center ', 'Christine', '', 'Schofield', 'PA', 'Internal Medicine', '', '', NULL, 'O', '230709 S Cicero', 'Cicero', 'Cook', 'IL', '60804', '7087809777', NULL, '230709 S Cicero', 'Cicero', 'Cook', 'IL', '60804', '7087809777', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902101611', 0, 'Y', 0, '2014-03-24', NULL, NULL, 0, 0, NULL, NULL),
('363317058', 'W12043166', 'W12043166', 'ILCHIGSTD', 'Access West Chicago Family Health Center ', 'Kathryn', '', 'Schutt Kinnear', 'MD', 'Family Practice', '', '', NULL, 'O', '245 W Roosevelt Rd Bldg 14', 'West Chicago', 'Dupage', 'IL', '60185', '6302934124', NULL, '245 W Roosevelt Rd Bldg 14', 'West Chicago', 'Dupage', 'IL', '60185', '6302934124', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942311303', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8663, -88.2075, NULL, NULL),
('363317058', 'W12043167', 'W12043167', 'ILCHIGSTD', 'Access Grand Boulevard Family and Specialty Health Center  ', 'Timothy', '', 'Sentongo', 'MD', 'Pediatrics', '', '', NULL, 'O', '5401 S Wentworth', 'Chicago', 'Cook', 'IL', '60609', '7732886900', NULL, '5401 S Wentworth', 'Chicago', 'Cook', 'IL', '60609', '7732886900', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598726432', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.7964, -87.6305, NULL, NULL),
('363317058', 'W12043168', 'W12043168', 'ILCHIGSTD', 'Access Hawthorn Family Health Center ', 'Lemuel', '', 'Shaffer', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '230709 S Cicero', 'Cicero', 'Cook', 'IL', '60804', '7087809777', NULL, '230709 S Cicero', 'Cicero', 'Cook', 'IL', '60804', '7087809777', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124042338', 0, 'Y', 0, '2014-01-10', NULL, NULL, 0, 0, NULL, NULL),
('363317058', 'W12043169', 'W12043169', 'ILCHIGSTD', 'Access Family Health Society', 'Kumudchandra', '', 'Shah', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '152 W Lincoln Hwy', 'Chicago Heights', 'Cook', 'IL', '60411', '7087549687', NULL, '152 W Lincoln Hwy', 'Chicago Heights', 'Cook', 'IL', '60411', '7087549687', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1891862959', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.506, -87.6475, NULL, NULL),
('363317058', 'W12043170', 'W12043170', 'ILCHIGSTD', 'Access Kling Professional Building', 'Nasreen', '', 'Shah', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2720 W 15th St 4th Fl', 'Chicago', 'Cook', 'IL', '60608', '7732576730', NULL, '2720 W 15th St 4th Fl', 'Chicago', 'Cook', 'IL', '60608', '7732576730', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', '', 'HCFA|UB|', '1225119035', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8611, -87.6934, NULL, NULL),
('363317058', 'W12043171', 'W12043171', 'ILCHIGSTD', 'Access Kling Professional Building', 'Sameer', '', 'Sharma', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2720 W 15th St 3rd Fl', 'Chicago', 'Cook', 'IL', '60608', '7732576676', NULL, '2720 W 15th St 3rd Fl', 'Chicago', 'Cook', 'IL', '60608', '7732576676', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033278056', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.8611, -87.6934, NULL, NULL),
('363317058', 'W12043172', 'W12043172', 'ILCHIGSTD', 'Access Martin Russo Family Health Center', 'Emily', '', 'Shaw', 'PA', 'Family Practice', '', '', NULL, 'O', '245 S Gary Ave', 'Bloomingdale', 'Dupage', 'IL', '60108', '6308935230', NULL, '245 S Gary Ave', 'Bloomingdale', 'Dupage', 'IL', '60108', '6308935230', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124169222', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.9434, -88.1196, NULL, NULL),
('363317058', 'W12043173', 'W12043173', 'ILCHIGSTD', 'Access Booker Family Health Center ', 'Leon', '', 'Sherrell', 'PA', 'Family Practice', '', '', NULL, 'O', '654 E 47th St', 'Chicago', 'Cook', 'IL', '60653', '7736244800', NULL, '654 E 47th St', 'Chicago', 'Cook', 'IL', '60653', '7736244800', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1649395930', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.8095, -87.6097, NULL, NULL),
('363317058', 'W12043174', 'W12043174', 'ILCHIGSTD', 'Access St Francis Health Center ', 'Silvana', '', 'Shliapochnik', 'MD', 'Family Practice', '', '', NULL, 'O', '7464 N Clark St', 'Chicago', 'Cook', 'IL', '60626', '7733818700', NULL, '7464 N Clark St', 'Chicago', 'Cook', 'IL', '60626', '7733818700', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1144275546', 0, 'N', 0, '2014-01-10', NULL, NULL, 42.0173, -87.6755, NULL, NULL),
('363317058', 'W12043175', 'W12043175', 'ILCHIGSTD', 'Access Genesis Family Health Center ', 'Heider', '', 'Shuber', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1 N Broadway', 'Des Plaines', 'Cook', 'IL', '60016', '8472983150', NULL, '1 N Broadway', 'Des Plaines', 'Cook', 'IL', '60016', '8472983150', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1780658823', 0, 'N', 0, '2014-01-10', NULL, NULL, 42.0513, -87.9094, NULL, NULL),
('363317058', 'W12043176', 'W12043176', 'ILCHIGSTD', 'Access Grand Boulevard Family and Specialty Health Center  ', 'Kenneth', '', 'Silver', 'MD', 'Pediatrics', '', '', NULL, 'O', '5401 S Wentworth', 'Chicago', 'Cook', 'IL', '60609', '7732886900', NULL, '5401 S Wentworth', 'Chicago', 'Cook', 'IL', '60609', '7732886900', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871661686', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.7964, -87.6305, NULL, NULL),
('363317058', 'W12043177', 'W12043177', 'ILCHIGSTD', 'Access St Francis Health Center ', 'Bhupinder', '', 'Singh', 'MD', 'Internal Medicine', '', '', NULL, 'O', '7464 N Clark St', 'Chicago', 'Cook', 'IL', '60626', '7733818700', NULL, '7464 N Clark St', 'Chicago', 'Cook', 'IL', '60626', '7733818700', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Presence Holy Family Medical Center', 'Presence Saint Francis Hospital', '', '', 'HCFA|UB|', '1932250446', 0, 'N', 0, '2014-01-10', NULL, NULL, 42.0173, -87.6755, NULL, NULL),
('363317058', 'W12043178', 'W12043178', 'ILCHIGSTD', 'Access Ashland Health Center', 'Kalpana', '', 'Singh', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '5159 S Ashland Ave', 'Chicago', 'Cook', 'IL', '60609', '7734349216', NULL, '5159 S Ashland Ave', 'Chicago', 'Cook', 'IL', '60609', '7734349216', '          ', 'CHIG514', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073697934', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8003, -87.6646, NULL, NULL);
