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
('830323501', 'W12003930', 'W12003930', 'Sinclair', 'Therapy Solutions', 'Kacey', 'M', 'Hawkins', 'PT', 'Physical Therapy', '', '', NULL, 'O', '6631 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072689904', '3072689907', '6631 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072689904', '3072689907', 'THERAPY', '', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427065069', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('830323501', 'W12003931', 'W12003931', 'WY01', 'Therapy Solutions', 'Kacey', 'M', 'Hawkins', 'PT', 'Physical Therapy', '', '', NULL, 'O', '6631 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072689904', '3072689907', '6631 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072689904', '3072689907', 'THERAPY', '', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427065069', 0, 'N', 0, '2011-06-10', NULL, NULL, 42.8444, -106.244, NULL, NULL),
('204203827', 'W12003932', 'W12003932', 'UTMH1', 'Resilient Solutions Inc', 'Mindy', 'A', 'Huang', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1355 N Main St Ste 1', 'Bountiful', 'Davis', 'UT', '84010', '8012593883', NULL, '1355 N Main St Ste 1', 'Bountiful', 'Davis', 'UT', '84010', '8012593883', '          ', 'MA', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-01', '2012-01-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407177066', 0, 'N', 0, '2012-01-18', NULL, NULL, 0, 0, NULL, NULL),
('830323501', 'W12003936', 'W12003936', 'Sinclair', 'Therapy Solutions', 'Connie', 'J', 'Mcmillan', 'PT', 'Physical Therapy', '', '', NULL, 'O', '6631 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072689904', '3072689907', '6631 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072689904', '3072689907', 'THERAPY', '', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558380774', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('830323501', 'W12003937', 'W12003937', 'WY01', 'Therapy Solutions', 'Connie', 'J', 'Mcmillan', 'PT', 'Physical Therapy', '', '', NULL, 'O', '6631 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072689904', '3072689907', '6631 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072689904', '3072689907', 'THERAPY', '', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558380774', 0, 'N', 0, '2011-06-10', NULL, NULL, 42.8444, -106.244, NULL, NULL),
('205934739', 'W12003938', 'W12003938', 'ID02', 'Family Medicine Residency of Idaho Inc', 'Phillip ', '', 'Mendoza', 'MD', 'Family Practice', '', '', NULL, 'O', '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083811775', NULL, '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083811775', '          ', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2010-08-09', '2012-04-05', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1760681761', 0, 'N', 0, '2012-04-10', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12003939', 'W12003939', 'ID02', 'Family Medicine Residency of Idaho Inc', 'Phillip ', '', 'Mendoza', 'MD', 'Family Practice', '', '', NULL, 'O', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2083676042', NULL, '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2083676042', '          ', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2010-08-09', '2012-04-05', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1760681761', 0, 'N', 0, '2012-04-10', NULL, NULL, 0, 0, NULL, NULL),
('830323501', 'W12003940', 'W12003940', 'Sinclair', 'Therapy Solutions', 'Mark', 'S', 'Plessman', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '6631 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072689904', '3072689907', '6631 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072689904', '3072689907', 'THERAPY', '', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326060658', 0, 'Y', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('830323501', 'W12003941', 'W12003941', 'WY01', 'Therapy Solutions', 'Mark', 'S', 'Plessman', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '6631 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072689904', '3072689907', '6631 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072689904', '3072689907', 'THERAPY', '', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326060658', 0, 'N', 0, '2011-06-10', NULL, NULL, 42.8444, -106.244, NULL, NULL),
('810284764', 'W12003943', 'W12003943', 'WY01', 'Arapahoe Health Center', 'Phillip', 'K', 'Rector', '', 'Mental Health', '', '', NULL, 'O', '17 Great Plains Rd', 'Arapahoe', 'Fremont', 'WY', '82510', '3078569281', '3078577063', '17 Great Plains Rd', 'Arapahoe', 'Fremont', 'WY', '82510', '3078569281', '3078577063', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1952468043', 0, 'N', 0, '2011-06-10', NULL, NULL, 42.9868, -108.487, NULL, NULL),
('810284764', 'W12003942', 'W12003942', 'WY01', 'Fort Washakie Health Center', 'Phillip', 'K', 'Rector', '', 'Mental Health', '', '', NULL, 'O', '29 Black Coal Dr', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', '29 Black Coal Dr', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1952468043', 0, 'N', 0, '2011-06-10', NULL, NULL, 42.9969, -108.861, NULL, NULL),
('810284764', 'W12003944', 'W12003944', 'WY01', 'Fort Washakie Health Center', 'Phillip', 'K', 'Rector', '', 'Mental Health', '', '', NULL, 'B', 'PO Box 128', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', 'PO Box 128', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1952468043', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('810284764', 'W12003945', 'W12003945', 'WY01', 'Arapahoe Health Center', 'Phillip', 'K', 'Rector', '', 'Mental Health', '', '', NULL, 'M', 'PO Box 31001', 'Pasadena', 'Los Angeles', 'CA', '91110', '3078569281', '3078577063', 'PO Box 31001', 'Pasadena', 'Los Angeles', 'CA', '91110', '3078569281', '3078577063', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1952468043', 0, 'Y', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12003947', 'W12003947', 'ID02', 'Family Medicine Health Center', 'Justin', 'M', 'Bailey', 'MD', 'Family Practice', '', '', NULL, 'O', '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083811775', '          ', '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083811775', '          ', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2010-08-09', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1659484509', 0, 'N', 0, '2014-06-05', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12003946', 'W12003946', 'ID02', 'Family Medicine Health Center', 'Justin', 'M', 'Bailey', 'MD', 'Family Practice', '', '', NULL, 'O', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2083676042', '          ', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2083676042', '          ', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2010-08-09', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1659484509', 0, 'N', 0, '2014-06-05', NULL, NULL, 0, 0, NULL, NULL),
('270690153', 'W12003948', 'W12003948', 'UT01', 'Peak Health Care', 'Timothy', 'A', 'Callahan', 'PA-C', 'Family Practice', '', '', NULL, 'O', '894 E 100 N Ste 3', 'Price', 'Carbon', 'UT', '84501', '4356372324', NULL, '894 E 100 N Ste 3', 'Price', 'Carbon', 'UT', '84501', '4356372324', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-01', '2013-02-04', 0, 0, 0, 'Castleview Hospital', 'Castleview Hospital', NULL, NULL, 'HCFA|UB|', '1427064799', 0, 'N', 0, '2013-04-05', NULL, NULL, 0, 0, NULL, NULL),
('870179340', 'W12003950', 'W12003950', 'UT01', 'Standard Optical', 'Randall', 'C', 'Himes', 'OD', 'Optometry', '', '', NULL, 'O', '1901 W Parkway Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019720203', NULL, '1901 W Parkway Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019720203', '          ', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144380478', 0, 'N', 0, '2014-01-08', NULL, NULL, 40.7164, -111.943, NULL, NULL),
('870179340', 'W12003949', 'W12003949', 'UT01', 'Standard Optical', 'Randall', 'C', 'Himes', 'OD', 'Optometry', '', '', NULL, 'O', '5289 S State St', 'Murray', 'Salt Lake', 'UT', '84107', '8015061111', NULL, '5289 S State St', 'Murray', 'Salt Lake', 'UT', '84107', '8015061111', '          ', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144380478', 0, 'N', 0, '2014-01-08', NULL, NULL, 40.6563, -111.888, NULL, NULL),
('271398252', 'W12003951', 'W12003951', 'UT01', 'Utah Valley Urgent Care', 'Kevin', 'A', 'Hough', 'PA', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '127 E Main St Ste E', 'Lehi', 'Utah', 'UT', '84043', '8017669822', '8017669441', '127 E Main St Ste E', 'Lehi', 'Utah', 'UT', '84043', '8017669822', '8017669441', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1174581870', 0, 'N', 0, '2010-12-15', NULL, NULL, 40.3879, -111.847, NULL, NULL),
('271398252', 'W12003953', 'W12003953', 'UT01', 'Utah Valley Urgent Care', 'LuAnn ', '', 'Jacobs-Peterson', 'APRN', 'Family Practice', '', '', NULL, 'O', '127 E Main St Ste E', 'Lehi', 'Utah', 'UT', '84043', '8017669822', '8017669441', '127 E Main St Ste E', 'Lehi', 'Utah', 'UT', '84043', '8017669822', '8017669441', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396918462', 0, 'N', 0, '2014-07-03', NULL, NULL, 40.3879, -111.847, NULL, NULL),
('870179340', 'W12003955', 'W12003955', 'UT01', 'Standard Optical', 'David', 'A', 'Meyer', 'OD', 'Optometry', '', '', NULL, 'O', '1901 W Parkway Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019720203', NULL, '1901 W Parkway Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019720203', '          ', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255562740', 0, 'N', 0, '2013-12-23', NULL, NULL, 40.7164, -111.943, NULL, NULL),
('870179340', 'W12003954', 'W12003954', 'UT01', 'Standard Optical', 'David', 'A', 'Meyer', 'OD', 'Optometry', '', '', NULL, 'O', '2190 S Highland Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014874138', NULL, '2190 S Highland Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014874138', '          ', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255562740', 0, 'N', 0, '2013-12-23', NULL, NULL, 40.7241, -111.86, NULL, NULL),
('061665963', 'W12003956', 'W12003956', 'ID01', 'Eye 2 Eye', 'Jeffrey', 'E', 'Schwers', 'OD', 'Optometry', '', '', NULL, 'O', '440 E State Ste 140', 'Eagle', 'Ada', 'ID', '83616', '2089397000', NULL, '440 E State Ste 140', 'Eagle', 'Ada', 'ID', '83616', '2089397000', '          ', 'IDOPTOMETRY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730272279', 0, 'N', 0, '2014-03-19', NULL, NULL, 43.695, -116.349, NULL, NULL),
('270573539', 'W12003963', 'W12003963', 'UT01', 'Utah Orthopaedics', 'Francis', 'X', 'Yubero', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '5782 Adams Ave Pkwy', 'Ogden', 'Weber', 'UT', '84405', '8019178000', '8019178001', '5782 Adams Ave Pkwy', 'Ogden', 'Weber', 'UT', '84405', '8019178000', '8019178001', 'WiseOgOrtho', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922010925', 0, 'N', 0, '2014-06-11', NULL, NULL, 41.1576, -111.967, NULL, NULL),
('270573539', 'W12003964', 'W12003964', 'UT01', 'Utah Orthopaedics', 'Francis', 'X', 'Yubero', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'B', 'PO Box 14', 'Lewiston', 'Cache', 'UT', '84320', '4357705199', '2088523951', 'PO Box 14', 'Lewiston', 'Cache', 'UT', '84320', '4357705199', '2088523951', 'WiseOgOrtho', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922010925', 0, 'N', 0, '2014-06-11', NULL, NULL, 0, 0, NULL, NULL),
('870639748', 'W12003967', 'W12003967', 'UT01', 'Hoopes Vision Correction Center', 'Weston', 'T', 'Barney', 'OD', 'Optometry', '', '', NULL, 'O', '10011 S Centennial Pkwy Ste 400', 'Sandy', 'Salt Lake', 'UT', '84070', '8015680200', '8015630200', '10011 S Centennial Pkwy Ste 400', 'Sandy', 'Salt Lake', 'UT', '84070', '8015680200', '8015630200', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-01', '2012-11-28', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1427210269', 0, 'N', 0, '2013-01-04', NULL, NULL, 0, 0, NULL, NULL),
('870639098', 'W12003972', 'W12003972', 'UT01', 'After Hours South Jordan Clinic', 'Paula', 'J', 'Cook', 'MD', 'Family Practice', '', '', NULL, 'O', '10433 S Redwood Rd', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015010500', '8012530696', '10433 S Redwood Rd', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015010500', '8012530696', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1922209386', 0, 'Y', 0, '2013-10-23', NULL, NULL, 40.5602, -111.939, NULL, NULL),
('870639098', 'W12003971', 'W12003971', 'UT01', 'After Hours Draper Clinic', 'Paula', 'J', 'Cook', 'MD', 'Family Practice', '', '', NULL, 'O', '1126 Draper Pkwy', 'Draper', 'Salt Lake', 'UT', '84020', '8015450600', '8015450626', '1126 Draper Pkwy', 'Draper', 'Salt Lake', 'UT', '84020', '8015450600', '8015450626', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1922209386', 0, 'Y', 0, '2013-10-23', NULL, NULL, 40.5284, -111.859, NULL, NULL),
('870639098', 'W12003974', 'W12003974', 'UT01', 'After Hours Latyon Clinic', 'Paula', 'J', 'Cook', 'MD', 'Family Practice', '', '', NULL, 'O', '1550 N Main St Ste Ste E', 'Layton', 'Davis', 'UT', '84041', '8016149030', '8016149040', '1550 N Main St Ste Ste E', 'Layton', 'Davis', 'UT', '84041', '8016149030', '8016149040', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-01', '2011-09-09', 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1922209386', 0, 'Y', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('870639098', 'W12003973', 'W12003973', 'UT01', 'After Hours West Valley Clinic', 'Paula', 'J', 'Cook', 'MD', 'Family Practice', '', '', NULL, 'O', '3451 S 5600 W Ste F', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019570900', '8019664384', '3451 S 5600 W Ste F', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019570900', '8019664384', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1922209386', 0, 'Y', 0, '2013-10-23', NULL, NULL, 40.6977, -112.025, NULL, NULL),
('870639098', 'W12003969', 'W12003969', 'UT01', 'After Hours Medical American Fork ', 'Paula', 'J', 'Cook', 'MD', 'Family Practice', '', '', NULL, 'O', '476 N 900 W Ste C', 'American Fork', 'Utah', 'UT', '84003', '8014921611', NULL, '476 N 900 W Ste C', 'American Fork', 'Utah', 'UT', '84003', '8014921611', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1922209386', 0, 'Y', 0, '2013-10-23', NULL, NULL, 40.3961, -111.815, NULL, NULL),
('870639098', 'W12003968', 'W12003968', 'UT01', 'After Hours Clinic Sandy', 'Paula', 'J', 'Cook', 'MD', 'Family Practice', '', '', NULL, 'O', '7998 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8012552000', NULL, '7998 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8012552000', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1922209386', 0, 'Y', 0, '2013-10-23', NULL, NULL, 40.6056, -111.853, NULL, NULL),
('870639098', 'W12003977', 'W12003977', 'UT01', 'After Hours Medical Company', 'Paula', 'J', 'Cook', 'MD', 'Family Practice', '', '', NULL, 'M', 'PO Box 708757', 'Sandy', 'Salt Lake', 'UT', '84070', '8014921611', NULL, 'PO Box 708757', 'Sandy', 'Salt Lake', 'UT', '84070', '8014921611', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1922209386', 0, 'Y', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('870639098', 'W12003970', 'W12003970', 'UT01', 'After Hours Medical Company', 'Paula', 'J', 'Cook', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 8476', 'Belfast', 'Waldo', 'ME', '04915', '8014921611', NULL, 'PO Box 8476', 'Belfast', 'Waldo', 'ME', '04915', '8014921611', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1922209386', 0, 'Y', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('271398252', 'W12003979', 'W12003979', 'UT01', 'Utah Valley Urgent Care', 'Judd', 'D', 'Hunter', 'APRN', 'Family Practice', '', '', NULL, 'O', '127 E Main St Ste E', 'Lehi', 'Utah', 'UT', '84043', '8017669822', '8017669441', '127 E Main St Ste E', 'Lehi', 'Utah', 'UT', '84043', '8017669822', '8017669441', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831428705', 0, 'N', 0, '2012-11-26', NULL, NULL, 40.3879, -111.847, NULL, NULL),
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('542158195', 'W12003983', 'W12003983', 'UT01', 'OBGYN Associates', 'Carrie', 'L', 'Sloan', 'MD', 'Obstetrics and Gynecology', 'Obstetrics and Gynecology', '', NULL, 'O', '74 Kimballs Ln Ste 330', 'Draper', 'Salt Lake', 'UT', '84020', '8015233053', '          ', '74 Kimballs Ln Ste 330', 'Draper', 'Salt Lake', 'UT', '84020', '8015233053', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-08-05', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1124034012', 0, 'N', 0, '2014-04-16', NULL, NULL, 40.537, -111.889, NULL, NULL),
('760843953', 'W12003985', 'W12003985', 'UT01', 'Seraphine Medical', 'Timothy', 'J', 'Schaat', 'MD', 'Family Practice', '', '', NULL, 'O', '6216 S Redwood Rd', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8019669907', NULL, '6216 S Redwood Rd', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8019669907', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2011-06-08', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1912032640', 0, 'N', 0, '2012-06-28', NULL, NULL, 0, 0, NULL, NULL),
('760843953', 'W12003986', 'W12003986', 'UT01', 'Seraphine Medical', 'Timothy', 'J', 'Schaat', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 71218', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019669907', NULL, 'PO Box 71218', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019669907', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2011-06-08', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1912032640', 0, 'N', 0, '2012-06-28', NULL, NULL, 0, 0, NULL, NULL),
('841367175', 'W12003987', 'W12003987', 'UT01', 'Canyon View Womens Care', 'Reed', 'J', 'Skinner', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1120 E 100 N Ste 3', 'Payson', 'Utah', 'UT', '84651', '8014652559', NULL, '1120 E 100 N Ste 3', 'Payson', 'Utah', 'UT', '84651', '8014652559', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2010-11-01', 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1427259415', 0, 'N', 0, '2013-07-31', NULL, NULL, 0, 0, NULL, NULL),
('841367175', 'W12003988', 'W12003988', 'UT01', 'Spanish Fork Clinic', 'Reed', 'J', 'Skinner', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '325 W Ctr St', 'Spanish Fork', 'Utah', 'UT', '84660', '8017987301', NULL, '325 W Ctr St', 'Spanish Fork', 'Utah', 'UT', '84660', '8017987301', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2011-03-08', 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1427259415', 0, 'N', 0, '2013-07-31', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W12003989', 'W12003989', 'UT01', '', 'Ward', '', 'Wagner', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '10 N 400 E', 'St George', 'Washington', 'UT', '84770', '4356564441', '4356565060', '10 N 400 E', 'St George', 'Washington', 'UT', '84770', '4356564441', '4356565060', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '54.46', 3, '2006-04-01', '2010-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477604122', 0, 'N', 0, '2012-04-03', NULL, NULL, 0, 0, NULL, NULL),
('271670329', 'W12003984', 'W12003984', 'UT01', 'Alpine Center Medical Services', 'Sean', 'A', 'Ponce', 'MD', 'Family Practice', '', '', NULL, 'O', '5689 S Redwood Rd Ste 30', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012681715', '8012681783', '5689 S Redwood Rd Ste 30', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012681715', '8012681783', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1376577049', 0, 'N', 0, '2014-04-03', NULL, NULL, 40.6479, -111.939, NULL, NULL),
('271398252', 'W12003990', 'W12003990', 'UT01', 'Utah Valley Urgent Care', 'Kraig', 'L', 'Packer', 'APRN', 'Family Practice', '', '', NULL, 'O', '127 E Main St Ste E', 'Lehi', 'Utah', 'UT', '84043', '8017669822', '8017669441', '127 E Main St Ste E', 'Lehi', 'Utah', 'UT', '84043', '8017669822', '8017669441', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1518959535', 0, 'N', 0, '2010-12-15', NULL, NULL, 40.3879, -111.847, NULL, NULL),
('743210771', 'W12003992', 'W12003992', 'UT01', 'Sumko-Bitner Orthopaedics & Sports Medicine Clinic', 'Daniel ', 'D', 'Higbee', 'DO', 'Orthopedic Surgery', '', '', NULL, 'O', '2850 N 2000 W Ste 105', 'Ogden', 'Weber', 'UT', '84404', '8017321175', '8017321202', '2850 N 2000 W Ste 105', 'Ogden', 'Weber', 'UT', '84404', '8017321175', '8017321202', 'WUBRIGOR5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, 'Brigham City Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1669702429', 0, 'N', 0, '2011-04-26', NULL, NULL, 41.3105, -112.028, NULL, NULL),
('743210771', 'W12003991', 'W12003991', 'UT01', 'Sumko-Bitner Orthopaedics & Sports Medicine Clinic', 'Daniel ', 'D', 'Higbee', 'DO', 'Orthopedic Surgery', '', '', NULL, 'O', '990 S Medical Dr Ste G4', 'Brigham City', 'Box Elder', 'UT', '84302', '4357342151', '4357342192', '990 S Medical Dr Ste G4', 'Brigham City', 'Box Elder', 'UT', '84302', '4357342151', '4357342192', 'WUBRIGOR5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, 'Brigham City Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1669702429', 0, 'N', 0, '2011-04-26', NULL, NULL, 41.4887, -112.027, NULL, NULL),
('870609622', 'W12001265', 'W12001265', 'UT01', 'Snow Canyon Clinic', 'Robert', 'H', 'Lemon', 'MD', 'Oncology', 'Hematology and Oncology', '', NULL, 'O', '272 E Ctr St', 'Ivins', 'Washington', 'UT', '84738', '4359862300', '          ', '272 E Ctr St  ', 'Ivins', 'Washington', 'UT', '84738', '4359862300', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-05-01', '2011-08-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992867147', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('870545614', 'W12004005', 'W12004005', 'UT01', 'Mountain West Anesthesia', '', '', 'Mountain West Anesthesia', 'Group', 'Anesthesiology', '', '', NULL, 'M', '3340 N Center St Ste 800', 'Lehi', 'Utah', 'UT', '84043', '8005014788', NULL, '3340 N Center St Ste 800', 'Lehi', 'Utah', 'UT', '84043', '8005014788', '', '', '', '', '55.12', '25.00', '0.00', 3, '2010-08-15', '2012-01-31', 1, 12, 0, '', '', '', '', 'HCFA|UB|', '1558391763', 0, 'Y', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('870545614', 'W12004003', 'W12004003', 'UT01', 'Mountain West Anesthesia', '', '', 'Mountain West Anesthesia', 'Group', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3570', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8005014788', NULL, 'PO Box 3570', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8005014788', '', '', '', '', '55.12', '25.00', '0.00', 3, '2010-08-15', '2012-01-31', 1, 12, 0, '', '', '', '', 'HCFA|UB|', '1558391763', 0, 'Y', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('870521827', 'W12004006', 'W12004006', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Douglas', 'G', 'Kondo', 'MD', 'Mental Health', 'Pediatric Psychiatry', 'Psychiatry', NULL, 'B', 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', NULL, 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', '2012-09-18', 0, 0, 0, '', '', '', '', 'HCFA|', '1083703284', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('870521827', 'W12004007', 'W12004007', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Sebastian', '', 'Kreitschitz', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'B', 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', NULL, 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', '2012-09-19', 0, 0, 0, '', '', '', '', 'HCFA|', '1598891616', 0, 'N', 0, '2012-09-19', NULL, NULL, 0, 0, NULL, NULL),
('870521827', 'W12004010', 'W12004010', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Janet', 'E', 'Lainhart', 'MD', 'Mental Health', 'Psychiatry', 'Pediatric Psychiatry', NULL, 'O', '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015814636', NULL, '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015814636', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1346348422', 0, 'N', 0, '2014-02-04', NULL, NULL, 40.757, -111.824, NULL, NULL),
('870521827', 'W12004000', 'W12004000', 'UT01', 'University Health Care Neuropsychiatric Institute', 'William', 'M', 'McMahon', 'MD', 'Mental Health', 'Psychiatry', 'Pediatric Psychiatry', NULL, 'O', '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015814636', NULL, '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015814636', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1063553626', 0, 'N', 0, '2014-02-04', NULL, NULL, 40.757, -111.824, NULL, NULL),
('870521827', 'W12003999', 'W12003999', 'UT01', 'University Health Care Neuropsychiatric Institute', 'William', 'M', 'McMahon', 'MD', 'Mental Health', 'Psychiatry', 'Pediatric Psychiatry', NULL, 'B', 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', NULL, 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1063553626', 0, 'N', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('870521827', 'W12004009', 'W12004009', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Janet', 'E', 'Lainhart', 'MD', 'Mental Health', 'Psychiatry', 'Pediatric Psychiatry', NULL, 'B', 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', NULL, 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1346348422', 0, 'N', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('870521827', 'W12004013', 'W12004013', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Anne', 'G', 'Lin', 'MD', 'Mental Health', 'Psychiatry', 'Pediatric Psychiatry', NULL, 'O', '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015814636', NULL, '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015814636', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|', '1790883874', 0, 'N', 0, '2012-01-26', NULL, NULL, 40.757, -111.824, NULL, NULL),
('870521827', 'W12004012', 'W12004012', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Anne', 'G', 'Lin', 'MD', 'Mental Health', 'Psychiatry', 'Pediatric Psychiatry', NULL, 'B', 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', NULL, 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|', '1790883874', 0, 'N', 0, '2012-01-26', NULL, NULL, 0, 0, NULL, NULL),
('870521827', 'W12004016', 'W12004016', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Melissa', 'P', 'Lopez-Larson', 'MD', 'Mental Health', 'Psychiatry', 'Pediatric Psychiatry', NULL, 'O', '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015842130', NULL, '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015842130', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1942268446', 0, 'N', 0, '2012-01-26', NULL, NULL, 40.757, -111.824, NULL, NULL),
('870521827', 'W12004015', 'W12004015', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Melissa', 'P', 'Lopez-Larson', 'MD', 'Mental Health', 'Psychiatry', 'Pediatric Psychiatry', NULL, 'B', 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', NULL, 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1942268446', 0, 'N', 0, '2012-01-26', NULL, NULL, 0, 0, NULL, NULL),
('870521827', 'W12004018', 'W12004018', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Michael', 'R', 'Lowry', 'MD', 'Mental Health', NULL, NULL, NULL, 'O', '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015842130', NULL, '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015842130', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1932116662', 0, 'N', 0, '2012-01-26', NULL, NULL, 40.757, -111.824, NULL, NULL),
('870521827', 'W12004019', 'W12004019', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Michael', 'R', 'Lowry', 'MD', 'Mental Health', NULL, NULL, NULL, 'B', 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', NULL, 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1932116662', 0, 'N', 0, '2012-01-26', NULL, NULL, 0, 0, NULL, NULL),
('752806777', 'W12003441', 'W12003441', 'TX01', 'Toyota Family Health Center', 'Ann-Marie', 'R', 'Mora', 'OD', 'Ophthalmology', '', '', NULL, 'O', '1 Lone Star Pass Bldg 46', 'San Antonio', 'Bexar', 'TX', '78264', '2102635700', '2102635701', '1 Lone Star Pass Bldg 46', 'San Antonio', 'Bexar', 'TX', '78264', '2102635700', '2102635701', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-07-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1568563344', 0, 'N', 0, '2014-07-23', NULL, NULL, 0, 0, NULL, NULL),
('870521827', 'W12004020', 'W12004020', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Gholson', 'J', 'Lyon', 'MD', 'Mental Health', 'Pediatric Psychiatry', '', NULL, 'B', 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', NULL, 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', '          ', '', '', '1', '0.00', '0.00', '0.00', 3, '2009-06-01', '2010-11-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811910508', 0, 'N', 0, '2012-01-26', NULL, NULL, 0, 0, NULL, NULL),
('870521827', 'W12004021', 'W12004021', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Rachele', 'M', 'McCarthey', 'MD', 'Mental Health', 'Pediatric Psychiatry', 'Psychiatry', NULL, 'B', 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', NULL, 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|', '1700933538', 0, 'N', 0, '2012-01-26', NULL, NULL, 0, 0, NULL, NULL),
('870521827', 'W12004023', 'W12004023', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Suzanne', 'I', 'Tyndall', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015842130', NULL, '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015842130', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1932316544', 0, 'N', 0, '2012-01-26', NULL, NULL, 40.757, -111.824, NULL, NULL),
('870521827', 'W12004024', 'W12004024', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Suzanne', 'I', 'Tyndall', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'B', 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', NULL, 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1932316544', 0, 'N', 0, '2012-01-26', NULL, NULL, 0, 0, NULL, NULL),
('870685140', 'W12004026', 'W12004026', 'UT01', 'University Health Care', 'Judith', 'S', 'Miller', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '650 S Komas Dr Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015853828', NULL, '650 S Komas Dr Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015853828', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-08-01', '2012-09-18', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407918881', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('870685140', 'W12004027', 'W12004027', 'UT01', 'UNI-Home Project-Psychiatric', 'Judith', 'S', 'Miller', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'B', 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015873103', NULL, 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015873103', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-08-01', '2012-09-18', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407918881', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('870521827', 'W12004029', 'W12004029', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Judith', 'S', 'Miller', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015814636', NULL, '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015814636', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', '2012-09-18', 0, 0, 0, '', '', '', '', 'HCFA|', '1407918881', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('870521827', 'W12004028', 'W12004028', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Judith', 'S', 'Miller', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'B', 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', NULL, 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', '2012-09-18', 0, 0, 0, '', '', '', '', 'HCFA|', '1407918881', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12004031', 'W12004031', 'UT01', 'Central Utah Clinic', 'Melvin', 'E', 'Carter', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '1305 N Commerce Dr Ste 120', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017537424', '8017537425', '1305 N Commerce Dr Ste 120', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017537424', '8017537425', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-07-15', '2011-02-28', 0, 0, 0, 'Timpanogos Regional Hospital', 'Mountain View Regional Hospital', '', '', 'HCFA|UB|', '1700815834', 0, 'N', 0, '2013-03-30', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12004033', 'W12004033', 'UT01', 'Central Utah Clinic', 'Jessica', 'L', 'Haddy', 'CNM', 'Obstetrics and Gynecology', 'Certified Nurse Midwife', '', NULL, 'O', '1305 N Commerce Dr Ste 120', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017537424', '8017537425', '1305 N Commerce Dr Ste 120', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017537424', '8017537425', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-07-15', '2011-02-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366538894', 0, 'N', 0, '2010-07-06', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12004034', 'W12004034', 'UT01', 'Central Utah Clinic', 'Jennifer', '', 'Wright-Bennion', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1305 N Commerce Dr Ste 120', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017537424', '8017537425', '1305 N Commerce Dr Ste 120', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017537424', '8017537425', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-07-15', '2011-02-28', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1982618559', 0, 'N', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12004035', 'W12004035', 'UT01', 'Central Utah Clinic', 'Aaron ', 'N', 'Weaver', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1305 N Commerce Dr Ste 120', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017537424', '8017537425', '1305 N Commerce Dr Ste 120', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017537424', '8017537425', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-07-15', '2011-02-28', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1750594222', 0, 'N', 0, '2011-04-08', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12004037', 'W12004037', 'UT01', 'Central Utah Clinic', 'Roberta', 'L', 'Ward', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1305 N Commerce Dr Ste 120', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017537424', '8017537425', '1305 N Commerce Dr Ste 120', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017537424', '8017537425', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-07-15', '2011-02-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679686034', 0, 'N', 0, '2012-04-04', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12004038', 'W12004038', 'UT01', 'Central Utah Clinic', 'Abigail', '', 'Rizk', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1305 N Commerce Dr Ste 120', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017537424', '8017537425', '1305 N Commerce Dr Ste 120', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017537424', '8017537425', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-07-15', '2011-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487733986', 0, 'N', 0, '2011-01-13', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12004039', 'W12004039', 'UT01', 'Central Utah Clinic', 'Karl', 'N', 'Weenig', 'MD', 'Family Practice', 'Sports Medicine', '', NULL, 'O', '1305 N Commerce Dr Ste 120', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017537424', '8017537425', '1305 N Commerce Dr Ste 120', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017537424', '8017537425', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-07-15', '2011-02-28', 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1740242973', 0, 'N', 0, '2013-08-28', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12004040', 'W12004040', 'UT01', 'Central Utah Clinic', 'Claudia', '', 'Killebrew', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1305 N Commerce Dr Ste 120', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017537424', '8017537425', '1305 N Commerce Dr Ste 120', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017537424', '8017537425', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-07-15', '2011-02-28', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1497717052', 0, 'N', 0, '2012-05-15', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12004044', 'W12004044', 'UT01', 'Central Utah Clinic', 'Michael', 'E', 'Callahan', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1305 N Commerce Dr Ste 120', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017537424', '8017537425', '1305 N Commerce Dr Ste 120', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017537424', '8017537425', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-07-15', '2011-02-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104864651', 0, 'N', 0, '2011-04-08', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12004045', 'W12004045', 'UT01', 'Central Utah Clinic', 'Jonathan', 'R', 'Faux', 'MD', 'Orthopedic Surgery', 'Foot and Ankle', '', NULL, 'O', '1305 N Commerce Dr Ste 120', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017537424', '8017537425', '1305 N Commerce Dr Ste 120', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017537424', '8017537425', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-07-15', '2011-02-28', 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1538250287', 0, 'N', 0, '2013-10-30', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12004046', 'W12004046', 'UT01', 'Central Utah Clinic', 'Matthew', 'S', 'Frazier', 'DO', 'Orthopedic Surgery', '', '', NULL, 'O', '1305 N Commerce Dr Ste 120', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017537424', '8017537425', '1305 N Commerce Dr Ste 120', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017537424', '8017537425', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-07-15', '2011-02-28', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1598977944', 0, 'N', 0, '2013-04-30', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12004047', 'W12004047', 'UT01', 'Central Utah Clinic', 'Erica', 'C', 'Nelson', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1305 N Commerce Dr Ste 120', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017537424', '8017537425', '1305 N Commerce Dr Ste 120', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017537424', '8017537425', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-07-15', '2011-02-28', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1386974525', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12004048', 'W12004048', 'UT01', 'Central Utah Clinic', 'Ryan', 'A', 'Richards', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1305 N Commerce Dr Ste 120', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017537424', '8017537425', '1305 N Commerce Dr Ste 120', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017537424', '8017537425', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-07-15', '2011-02-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427149178', 0, 'N', 0, '2011-04-08', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12004049', 'W12004049', 'UT01', 'Central Utah Clinic', 'Paul', 'K', 'Ritchie', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1305 N Commerce Dr Ste 120', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017537424', '8017537425', '1305 N Commerce Dr Ste 120', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017537424', '8017537425', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-07-15', '2011-02-28', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1720021678', 0, 'N', 0, '2011-04-13', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12004050', 'W12004050', 'WYBILLINGS', 'Billings Clinic - West End Clinic', 'Kathleen', 'C', 'Davis', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '2675 Central Ave', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382978', '2675 Central Ave', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382978', '', '', '', '0.00', '17.00', '0.00', 3, '2010-08-16', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407959489', 0, 'N', 0, '2010-08-18', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12004051', 'W12004051', 'ID02', 'Family Medicine Health Center', 'Anna', 'F', 'Bender', 'PA', 'Family Practice', '', '', NULL, 'O', '2321 E Gala St Ste 2', 'Meridian', 'Ada', 'ID', '83642', '2083676042', NULL, '2321 E Gala St Ste 2', 'Meridian', 'Ada', 'ID', '83642', '2083676042', '          ', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2010-09-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1841527264', 0, 'N', 0, '2011-06-29', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12004052', 'W12004052', 'ID02', 'Family Medicine Health Center', 'Christopher', 'D', 'Gunderson', 'PA', 'Family Practice', '', '', NULL, 'O', '2321 W Gala St Ste 2', 'Meridian', 'Ada', 'ID', '83642', '2085142500', NULL, '2321 W Gala St Ste 2', 'Meridian', 'Ada', 'ID', '83642', '2085142500', '          ', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2010-09-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1417066143', 0, 'N', 0, '2011-06-29', NULL, NULL, 0, 0, NULL, NULL),
('268400130', 'W12004053', 'W12004053', 'TX01', '', 'Mary', 'J', 'Carr', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '147 W Sunset Rd Ste 101', 'San Antonio', 'Bexar', 'TX', '78209', '2108283624', '2108282873', '147 W Sunset Rd Ste 101', 'San Antonio', 'Bexar', 'TX', '78209', '2108283624', '2108282873', 'TXPHD', '', '', '0.00', '0.00', '0.00', 3, '2010-07-28', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1710172036', 0, 'N', 0, '2010-01-20', NULL, NULL, 29.5072, -98.4675, NULL, NULL),
('870395551', 'W12004054', 'W12004054', 'UT01', 'Smithfield Chiropractic', 'Ira', 'Jeremy', 'Crawford', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '428 E 2600 N Ste 4', 'Ogden', 'Weber', 'UT', '84414', '8017820987', '8017370810', '428 E 2600 N Ste 4', 'Ogden', 'Weber', 'UT', '84414', '8017820987', '8017370810', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-07-01', '2010-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225119837', 0, 'N', 0, '2010-10-29', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W12004055', 'W12004055', 'UT01', 'Smithfield Chiropractic', 'Jeremy', 'D', 'Gibbons', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '1177 S Main St', 'Smithfield', 'Cache', 'UT', '84335', '4355632514', '4355350769', '1177 S Main St', 'Smithfield', 'Cache', 'UT', '84335', '4355632514', '4355350769', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-08-01', '2010-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306927991', 0, 'N', 0, '2012-06-29', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W12004056', 'W12004056', 'UT01', '', 'Tom', NULL, 'Grant', 'DC', 'Chiropractic', '', '', NULL, 'O', '4700 S 900 E Ste 41G', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8017163532', '8014852587', '4700 S 900 E Ste 41G', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8017163532', '8014852587', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-07-01', '2010-10-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000006472', 0, 'N', 0, '2008-07-07', 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
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('876000299', 'W12004058', 'W12004058', 'UTMH1', 'Heber Valley Counseling', 'Gerald', 'M', 'Lazar', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '6925 Union Park Ctr Ste 245', 'Midvale', 'Salt Lake', 'UT', '84047', '8017462297', '8017482554', '6925 Union Park Ctr Ste 245', 'Midvale', 'Salt Lake', 'UT', '84047', '8017462297', '8017482554', 'UTMD', '', '', '0.00', '35.00', '0.00', 8, '2010-08-18', '2011-07-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003883349', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870288909', 'W12004060', 'W12004060', 'UT01', 'Planned Parenthood Association of Utah', NULL, NULL, 'Planned Parenthood Association of Utah', 'GROUP', 'Obstetrics and Gynecology', '', '', NULL, 'O', '654 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013225571', '8013220065', '654 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013225571', '8013220065', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1073549614', 0, 'N', 0, '2007-01-05', NULL, NULL, 40.755, -111.865, NULL, NULL),
('870288909', 'W12004061', 'W12004061', 'UT01', 'Planned Parenthood Association of Utah', NULL, NULL, 'Planned Parenthood Association of Utah', 'GROUP', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1091 W S Jordan Pkwy Ste 100', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012542052', '8012545159', '1091 W S Jordan Pkwy Ste 100', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012542052', '8012545159', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1073549614', 0, 'N', 0, '2007-01-05', NULL, NULL, 40.5608, -111.922, NULL, NULL),
('870288909', 'W12004062', 'W12004062', 'UT01', 'Planned Parenthood Association of Utah', NULL, NULL, 'Planned Parenthood Association of Utah', 'GROUP', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1086 N 1200 W', 'Orem', 'Utah', 'UT', '84057', '8012265246', '8014347030', '1086 N 1200 W', 'Orem', 'Utah', 'UT', '84057', '8012265246', '8014347030', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1073549614', 0, 'N', 0, '2007-01-05', NULL, NULL, 0, 0, NULL, NULL),
('870288909', 'W12004063', 'W12004063', 'UT01', 'Planned Parenthood Association of Utah', NULL, NULL, 'Planned Parenthood Association of Utah', 'GROUP', 'Obstetrics and Gynecology', '', '', NULL, 'O', '160 S 10th E Ste 120', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013225571', '8013220065', '160 S 10th E Ste 120', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013225571', '8013220065', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1073549614', 0, 'N', 0, '2007-01-05', NULL, NULL, 40.7659, -111.862, NULL, NULL),
('271498759', 'W12003588', 'W12003588', 'UTMH1', 'Clarity Counseling and Hypnotherapy ', 'Michele', 'W', 'Ashdown', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '460 2nd St Ste B', 'Ogden', 'Weber', 'UT', '84404', '8016984006', '8017307171', '460 2nd St Ste B', 'Ogden', 'Weber', 'UT', '84404', '8016984006', '8017307171', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497876346', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('271185160', 'W12003952', 'W12003952', 'UT01', 'Cedar Creek Family Health Care', 'LuAnn ', '', 'Jacobs-Peterson', 'APRN', 'Family Practice', '', '', NULL, 'O', '453 N Main St Ste A', 'Tooele', 'Tooele', 'UT', '84074', '4358435700', '4358435711', '453 N Main St Ste A', 'Tooele', 'Tooele', 'UT', '84074', '4358435700', '4358435711', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396918462', 0, 'N', 0, '2014-07-03', NULL, NULL, 40.5396, -112.298, NULL, NULL),
('870281028', 'W12004064', 'W12004064', 'UT01', 'Central Utah Clinic PC Cardiology', 'C Robinson', '', 'Mitchell', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1055 N 500 W Ste 101', 'Provo', 'Utah', 'UT', '84604', '8013734366', '8013742615', '1055 N 500 W Ste 101', 'Provo', 'Utah', 'UT', '84604', '8013734366', '8013742615', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-11-01', '2011-02-28', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1952558116', 0, 'N', 0, '2014-01-15', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12004065', 'W12004065', 'UT01', 'Central Utah Clinic', 'C Robinson', '', 'Mitchell', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013734366', NULL, 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013734366', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-11-01', '2011-02-28', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1952558116', 0, 'N', 0, '2014-01-15', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12004067', 'W12004067', 'ID02', 'Family Medicine Residency of Idaho', 'Robert ', 'Y', 'Amrine', 'MD', 'Family Practice', '', '', NULL, 'O', '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083811775', NULL, '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083811775', '          ', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2010-09-01', '2011-08-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1366640484', 0, 'N', 0, '2010-08-26', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12004066', 'W12004066', 'ID02', 'Family Medicine Residency of Idaho', 'Robert ', 'Y', 'Amrine', 'MD', 'Family Practice', '', '', NULL, 'O', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2083676042', NULL, '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2083676042', '          ', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2010-09-01', '2011-08-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1366640484', 0, 'N', 0, '2010-08-26', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12004068', 'W12004068', 'WYBILLINGS', 'Billings Clinic - ENT', 'Jennifer', 'G', 'Andrus', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062385043', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062385043', '', '', '', '0.00', '17.00', '0.00', 3, '2010-07-08', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265651137', 0, 'N', 0, '2012-06-29', NULL, NULL, 0, 0, NULL, NULL),
('942938348', 'W12004069', 'W12004069', 'UTMH1', 'Valley Mental Health  Inc', 'David', '', 'Berryman', 'LSCW', 'Mental Health', 'Social Worker', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', '          ', 'UTVMHMA', '', '', '0.00', '35.00', '0.00', 6, '2010-08-15', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699912998', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12004070', 'W12004070', 'UT01', 'Institute for Specialty Surgery', 'Hussam', '', 'Bitar', 'MD', 'General Surgery', '', '', NULL, 'O', '3336 S Pioneer Pkwy Ste 306', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643855', NULL, '3336 S Pioneer Pkwy Ste 306', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643855', '          ', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-08-19', '2011-09-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437342987', 0, 'N', 0, '2012-04-10', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12004071', 'W12004071', 'UT01', 'Institute for Specialty Surgery', 'Hussam', '', 'Bitar', 'MD', 'General Surgery', '', '', NULL, 'M', '406 W S Jordan  Ste 405', 'South Jordan', 'Salt Lake', 'UT', '84095', '8019643855', NULL, '406 W S Jordan  Ste 405', 'South Jordan', 'Salt Lake', 'UT', '84095', '8019643855', '          ', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-08-19', '2011-09-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437342987', 0, 'N', 0, '2012-04-10', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12004072', 'W12004072', 'UT01', 'Institute for Specialty Surgery', 'Hussam', '', 'Bitar', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 281416', 'Atlanta', 'Fulton', 'GA', '30384', '8019643855', NULL, 'PO Box 281416', 'Atlanta', 'Fulton', 'GA', '30384', '8019643855', '          ', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-08-19', '2011-09-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437342987', 0, 'N', 0, '2012-04-10', NULL, NULL, 0, 0, NULL, NULL),
('562514687', 'W12004074', 'W12004074', 'UT01', 'Advanced Spine and Pain Solutions', 'Howard', 'A', 'Knudsen', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '3585 N University Ave Ste 100', 'Provo', 'Utah', 'UT', '84604', '8013100851', '8013773697', '3585 N University Ave Ste 100', 'Provo', 'Utah', 'UT', '84604', '8013100851', '8013773697', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2010-09-01', '2011-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992863906', 0, 'N', 0, '2012-05-04', NULL, NULL, 0, 0, NULL, NULL),
('562514687', 'W12004075', 'W12004075', 'UT01', 'Advanced Spine and Pain Solutions', 'Howard', 'A', 'Knudsen', 'DPT', 'Physical Therapy', '', '', NULL, 'B', '86 E 1700 S', 'Orem', 'Utah', 'UT', '84058', '8013100851', '8013773697', '86 E 1700 S', 'Orem', 'Utah', 'UT', '84058', '8013100851', '8013773697', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2010-09-01', '2011-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992863906', 0, 'N', 0, '2012-05-04', NULL, NULL, 0, 0, NULL, NULL),
('942938348', 'W12004077', 'W12004077', 'UTMH1', 'Valley Mental Health  Inc', 'Sylvia', 'J', 'Brunisholz', 'LSCW', 'Mental Health', 'Social Worker', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8015382057', NULL, '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8015382057', '          ', 'UTVMHMA', '', '', '0.00', '35.00', '0.00', 6, '2010-09-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013174739', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('810284764', 'W12004079', 'W12004079', 'WY01', 'Arapahoe Health Center', 'Corey', '', 'Dahl', 'PT', 'Physical Therapy', '', '', NULL, 'O', '17 Great Plains Rd', 'Arapahoe', 'Fremont', 'WY', '82510', '3078569281', '3078547063', '17 Great Plains Rd', 'Arapahoe', 'Fremont', 'WY', '82510', '3078569281', '3078547063', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366578106', 0, 'N', 0, '2011-06-10', NULL, NULL, 42.9868, -108.487, NULL, NULL),
('810284764', 'W12004078', 'W12004078', 'WY01', 'Fort Washakie Health Center', 'Corey', '', 'Dahl', 'PT', 'Physical Therapy', '', '', NULL, 'O', '29 Black Coal Dr', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', '29 Black Coal Dr', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366578106', 0, 'N', 0, '2011-06-10', NULL, NULL, 42.9969, -108.861, NULL, NULL),
('810284764', 'W12004080', 'W12004080', 'WY01', 'Fort Washakie Health Center', 'Corey', '', 'Dahl', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 128', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', 'PO Box 128', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366578106', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('810284764', 'W12004081', 'W12004081', 'WY01', 'Arapahoe Health Center', 'Corey', '', 'Dahl', 'PT', 'Physical Therapy', '', '', NULL, 'M', 'PO Box 31001', 'Pasadena', 'Los Angeles', 'CA', '91110', '3078569281', '3078577063', 'PO Box 31001', 'Pasadena', 'Los Angeles', 'CA', '91110', '3078569281', '3078577063', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366578106', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('562577913', 'W12004082', 'W12004082', 'UT01', 'Utah Pain Specialist', 'Heidi ', 'M', 'Duckworth', 'NP', 'Pain Management', '', '', NULL, 'O', '6321 S Redwood Rd Ste 102', 'Taylorsville', 'Salt Lake', 'UT', '84123', '8016857246', '8017475487', '6321 S Redwood Rd Ste 102', 'Taylorsville', 'Salt Lake', 'UT', '84123', '8016857246', '8017475487', 'WCSTSCC5', '', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043521016', 0, 'N', 0, '2011-10-11', NULL, NULL, 40.6365, -111.939, NULL, NULL),
('331177233', 'W12004091', 'W12004091', 'UT01', 'Ogden Internal Medicine and Urology', 'Leslie', 'A', 'Bean', 'APRN', 'Urology', '', '', NULL, 'M', '3 Maryland Farms Ste 250', 'Brentwood', 'Williamson', 'TN', '37027', '8006613365', '          ', '3 Maryland Farms Ste 250', 'Brentwood', 'Williamson', 'TN', '37027', '8006613365', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1336260447', 0, 'N', 1, NULL, NULL, NULL, 0, 0, NULL, NULL),
('331177233', 'W12004089', 'W12004089', 'UT01', 'Ogden Internal Medicine and Urology', 'Leslie', 'A', 'Bean', 'APRN', 'Urology', '', '', NULL, 'O', '425 E 5350 S Ste 255', 'Ogden', 'Weber', 'UT', '84405', '8014792911', '8014792914', '425 E 5350 S Ste 255', 'Ogden', 'Weber', 'UT', '84405', '8014792911', '8014792914', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336260447', 0, 'N', 1, NULL, NULL, NULL, 0, 0, NULL, NULL),
('331177233', 'W12004090', 'W12004090', 'UT01', 'Ogden Internal Medicine and Urology', 'Leslie', 'A', 'Bean', 'APRN', 'Urology', '', '', NULL, 'B', 'PO Box 100925', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '          ', 'PO Box 100925', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1336260447', 0, 'N', 1, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12004093', 'W12004093', 'UT01', 'Central Utah Clinic', 'N', 'C', 'Busk', 'MD', 'Family Practice', '', '', NULL, 'M', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '4356736131', NULL, '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '4356736131', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-11-01', '2011-02-28', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1134212954', 0, 'N', 0, '2011-10-27', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12004092', 'W12004092', 'UT01', 'Central Utah Clinic', 'N', 'C', 'Busk', 'MD', 'Family Practice', '', '', NULL, 'O', '763 S 900 E Ste 203', 'St George', 'Washington', 'UT', '84790', '4356736131', NULL, '763 S 900 E Ste 203', 'St George', 'Washington', 'UT', '84790', '4356736131', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-11-01', '2011-02-28', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1134212954', 0, 'N', 0, '2011-10-27', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12004094', 'W12004094', 'UT01', 'Central Utah Clinic PC', 'N', 'C', 'Busk', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '4356736131', NULL, 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '4356736131', '          ', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1134212954', 0, 'Y', 0, '2013-03-26', NULL, NULL, 0, 0, NULL, NULL),
('870574059', 'W12004095', 'W12004095', 'UT01', 'Mountain Land North Ogden', 'Nylin', 'J', 'Johnson', 'PT', 'Physical Therapy', '', '', NULL, 'O', '698 E 12th St Ste 300', 'Ogden', 'Weber', 'UT', '84404', '8017820300', '8017820305', '698 E 12th St Ste 300', 'Ogden', 'Weber', 'UT', '84404', '8017820300', '8017820305', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2010-09-01', '2011-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1013010727', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12004096', 'W12004096', 'UTPEHP', 'Utah Valley Sports Medicine - North Valley', 'Matthew', '', 'Evans', 'MD', 'Family Practice', '', 'Sports Medicine', NULL, 'O', '1159 E 200 N Ste 100', 'Fillmore', 'Millard', 'UT', '84631', '4357435591', NULL, '1159 E 200 N Ste 100', 'Fillmore', 'Millard', 'UT', '84631', '4357435591', '          ', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2008-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043486384', 0, 'N', 0, '2013-12-30', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12004097', 'W12004097', 'UTPEHP', 'Pulmonary St George-Cedar City', 'Michael', 'R', 'Kline', 'MD', 'Pulmonary', 'Family Practice', 'Internal Medicine', NULL, 'O', '110 W 1325 N Ste 100', 'Cedar City', 'Iron', 'UT', '84721', '4352512600', NULL, '110 W 1325 N Ste 100', 'Cedar City', 'Iron', 'UT', '84721', '4352512600', '', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2010-06-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1073531331', 0, 'N', 0, '2014-06-17', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12004098', 'W12004098', 'UTPEHP', 'North Sevier Medical Clinic', 'Justin', 'D', 'Abbott', 'DO', 'Family Practice', '', '', NULL, 'O', '530 N 250 W', 'Salina', 'Sevier', 'UT', '84654', '4355297411', NULL, '530 N 250 W', 'Salina', 'Sevier', 'UT', '84654', '4355297411', '          ', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2010-07-22', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184814436', 0, 'N', 0, '2012-12-31', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12004100', 'W12004100', 'UTPEHP', 'Southwest Regional Cancer Clinic', 'Magid', 'H', 'Amer', 'MD', 'Oncology', 'Internal Medicine', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884900', NULL, '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884900', '          ', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2010-05-13', '2010-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316947849', 0, 'N', 0, '2011-09-23', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12004102', 'W12004102', 'UTPEHP', 'Cedar City Clinic', 'Travis', 'J', 'Bilanzich', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1303 N Main Ste 3C', 'Cedar City', 'Iron', 'UT', '84720', '4358685500', NULL, '1303 N Main Ste 3C', 'Cedar City', 'Iron', 'UT', '84720', '4358685500', '          ', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2010-07-12', NULL, 0, 0, 0, 'Valley View Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1336331958', 0, 'N', 0, '2010-10-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12004104', 'W12004104', 'UTPEHP', 'Hillcrest Pediatrics', 'Neal', 'R', 'Davis', 'MD', 'Pediatrics', 'Internal Medicine', '', NULL, 'O', '5063 S Cottonwood St Ste 160', 'Murray', 'Salt Lake', 'UT', '84107', '8015071850', NULL, '5063 S Cottonwood St Ste 160', 'Murray', 'Salt Lake', 'UT', '84107', '8015071850', '          ', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2010-07-12', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760691166', 0, 'N', 0, '2012-01-24', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12004106', 'W12004106', 'UTPEHP', 'Logan Clinic', 'Brad', 'M', 'Goates', 'MD', 'Family Practice', '', '', NULL, 'O', '412 N 200 E', 'Logan', 'Cache', 'UT', '84321', '4357132800', NULL, '412 N 200 E', 'Logan', 'Cache', 'UT', '84321', '4357132800', '          ', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2010-07-14', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1396942785', 0, 'N', 0, '2013-08-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12004112', 'W12004112', 'UTPEHP', 'Rock Canyon Pediatric Specialists', 'Thomas', 'L', 'Sutton', 'MD', 'Gastroenterology', 'Pediatrics', 'Pediatric Gastroenterology', NULL, 'O', '1055 N 300 W Ste 110', 'Provo', 'Utah', 'UT', '84604', '8013571700', '8013571709', '1055 N 300 W Ste 110', 'Provo', 'Utah', 'UT', '84604', '8013571700', '8013571709', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2010-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750319232', 0, 'N', 0, '2012-09-04', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12004110', 'W12004110', 'UTPEHP', 'Valley View Heart Clinic', 'Aarush', '', 'Manchanda', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '1303 N Main Ste D', 'Cedar City', 'Iron', 'UT', '84720', '4358685500', NULL, '1303 N Main Ste D', 'Cedar City', 'Iron', 'UT', '84720', '4358685500', '          ', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2010-07-15', NULL, 0, 0, 0, 'Valley View Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1609027986', 0, 'N', 0, '2011-12-01', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12004114', 'W12004114', 'UTPEHP', 'Utah Valley Sports Medicine', 'M Devin', '', 'Taylor', 'DO', 'Sports Medicine', 'Family Medicine', '', NULL, 'O', '1157 N 300 W Ste 201', 'Provo', 'Utah', 'UT', '84604', '8013571200', NULL, '1157 N 300 W Ste 201', 'Provo', 'Utah', 'UT', '84604', '8013571200', '          ', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2010-07-16', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003092842', 0, 'N', 0, '2010-08-24', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12004116', 'W12004116', 'UTPEHP', 'Park City Specialty Clinic', 'Danielle', '', 'Adams', 'MD', 'General Surgery', '', '', NULL, 'O', '900 Round Valley Dr Ste 200', 'Park City', 'Summit', 'UT', '84060', '4356587400', NULL, '900 Round Valley Dr Ste 200', 'Park City', 'Summit', 'UT', '84060', '4356587400', '', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2010-08-06', NULL, 0, 0, 0, 'Heber Valley Medical Center', 'Park City Medical Center', '', '', 'HCFA|UB|', '1699957886', 0, 'N', 0, '2014-06-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12004118', 'W12004118', 'UTPEHP', 'Cedar City Clinic', 'Nupur', '', 'Aggarwal', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1303 N Main Ste 3C', 'Cedar City', 'Iron', 'UT', '84720', '4358685500', NULL, '1303 N Main Ste 3C', 'Cedar City', 'Iron', 'UT', '84720', '4358685500', '          ', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2010-08-12', NULL, 0, 0, 0, 'Valley View Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1164680336', 0, 'N', 0, '2010-10-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12004120', 'W12004120', 'UTPEHP', 'Southridge Pediatrics', 'Marcus', '', 'Blackburn', 'MD', 'Pediatrics', '', '', NULL, 'O', '3723 W 12600 S Ste 450', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854543', NULL, '3723 W 12600 S Ste 450', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854543', '          ', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2010-10-01', NULL, 0, 0, 0, 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1598919409', 0, 'N', 0, '2013-05-17', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12004122', 'W12004122', 'UTPEHP', 'Noyes Surgical Oncology', 'Tawnya', 'L', 'Bowles', 'MD', 'General Surgery', '', '', NULL, 'O', '5169 S Cottonwood St Ste 440', 'Murray', 'Salt Lake', 'UT', '84107', '8015073915', NULL, '5169 S Cottonwood St Ste 440', 'Murray', 'Salt Lake', 'UT', '84107', '8015073915', '          ', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2010-08-16', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679554141', 0, 'N', 0, '2010-08-24', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12004123', 'W12004123', 'UTPEHP', 'Heber Valley Clinic', 'Brian', 'C', 'Lofgran', 'MD', 'Family Practice', '', '', NULL, 'O', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', NULL, '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', '          ', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2010-08-04', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558518845', 0, 'N', 0, '2010-10-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12004530', 'W12004530', 'UTPEHP', 'Rock Canyon Pediatric Specialists', 'Russell', 'J', 'Osguthorpe', 'MD', 'Pediatric Infectious Diseases', 'Pediatrics', NULL, NULL, 'O', '1034 N 500 W Ste 110', 'Provo', 'Utah', 'UT', '84604', '8013571700', '8013571709', '1034 N 500 W Ste 110', 'Provo', 'Utah', 'UT', '84604', '8013571700', '8013571709', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2010-07-15', NULL, 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1285656322', 0, 'N', 0, '2012-08-06', NULL, NULL, 0, 0, NULL, NULL),
('810608733', 'W12004125', 'W12004125', 'UT01', 'Nexus Pain Care', 'James', 'H', 'Cloyd', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'B', 'PO Box 15109', 'Springfield', 'Hampden', 'MA', '01115', '8013566100', NULL, 'PO Box 15109', 'Springfield', 'Hampden', 'MA', '01115', '8013566100', '', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-25', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750450953', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('810608733', 'W12004126', 'W12004126', 'UT01', 'Nexus Pain Care', 'James', 'H', 'Cloyd', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '3585 N University Ave Ste 150', 'Provo', 'Utah', 'UT', '84604', '8013566100', NULL, '3585 N University Ave Ste 150', 'Provo', 'Utah', 'UT', '84604', '8013566100', '', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-25', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750450953', 0, 'N', 0, '2014-06-04', NULL, NULL, 40.2818, -111.658, NULL, NULL),
('810608733', 'W12004127', 'W12004127', 'UT01', 'Nexus Pain Care', 'James', 'H', 'Cloyd', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '3570 W 9000 S Ste 200', 'West Jordan', 'Salt Lake', 'UT', '84088', '8018336569', NULL, '3570 W 9000 S Ste 200', 'West Jordan', 'Salt Lake', 'UT', '84088', '8018336569', '', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-25', '2011-11-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750450953', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12004129', 'W12004129', 'UTPEHP', 'Dixie Orthopaedics-Hurricane', 'Scott', 'M', 'Smith', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '75 N 2260 W', 'Hurricane', 'Washington', 'UT', '84737', '4356284460', NULL, '75 N 2260 W', 'Hurricane', 'Washington', 'UT', '84737', '4356284460', '          ', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588698997', 0, 'N', 0, '2010-08-25', NULL, NULL, 0, 0, NULL, NULL),
('830212533', 'W12003923', 'W12003923', 'Sinclair', 'Carbon County Counseling', 'Mary Jo', '', 'Greenwood', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '112 E Bridge St', 'Saratoga', 'Carbon', 'WY', '82331', '3073265156', NULL, '112 E Bridge St', 'Saratoga', 'Carbon', 'WY', '82331', '3073265156', '          ', 'WYMA', '', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2012-03-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831181130', 0, 'Y', 0, '2012-04-10', NULL, NULL, 0, 0, NULL, NULL),
('830212533', 'W12003922', 'W12003922', 'Sinclair', 'Carbon County Counseling', 'Mary Jo', '', 'Greenwood', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '721 W Maple', 'Rawlins', 'Carbon', 'WY', '82301', '3073247156', NULL, '721 W Maple', 'Rawlins', 'Carbon', 'WY', '82301', '3073247156', '          ', 'WYMA', '', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2012-03-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831181130', 0, 'Y', 0, '2012-04-10', NULL, NULL, 0, 0, NULL, NULL),
('742152396', 'W12004130', 'W12004130', 'UT01', 'KCI USA Inc (Wound Vac Only)', '', '', 'KCI USA Inc. ', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '1761 S 900 W', 'Salt Lake City', 'Salt Lake', 'UT', '84104', '8002754524', NULL, '1761 S 900 W', 'Salt Lake City', 'Salt Lake', 'UT', '84104', '8002754524', '          ', 'KCI', '', '', '0.00', '100.00', '0.00', 3, '2010-08-01', '2010-08-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366439507', 0, 'N', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('742152396', 'W12004132', 'W12004132', 'UT01', 'KCI USA Inc (Wound Vac Only)', '', '', 'KCI USA Inc. ', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'M', '8023 Vantage Dr', 'San Antonio', 'Bexar', 'TX', '78230', '8002754524', NULL, '8023 Vantage Dr', 'San Antonio', 'Bexar', 'TX', '78230', '8002754524', '          ', 'KCI', '', '', '0.00', '100.00', '0.00', 3, '2011-03-01', '2013-02-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366439507', 0, 'N', 0, '2013-03-15', NULL, NULL, 0, 0, NULL, NULL),
('742152396', 'W12004131', 'W12004131', 'UT01', 'KCI USA Inc (Wound Vac Only)', '', '', 'KCI USA Inc. ', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'B', 'PO Box 203084', 'Houston', 'Harris', 'TX', '77215', '8002754524', NULL, 'PO Box 203084', 'Houston', 'Harris', 'TX', '77215', '8002754524', '          ', 'KCI', '', '', '0.00', '100.00', '0.00', 3, '2011-03-01', '2013-06-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366439507', 0, 'N', 0, '2013-05-16', NULL, NULL, 0, 0, NULL, NULL),
('810284764', 'W12004134', 'W12004134', 'WY01', 'Arapahoe Health Center', 'Jenaneta ', 'S', 'Hampton', 'NP', 'Family Practice', '', '', NULL, 'O', '17 Great Plains Rd', 'Arapahoe', 'Fremont', 'WY', '82510', '3078569281', '3078577063', '17 Great Plains Rd', 'Arapahoe', 'Fremont', 'WY', '82510', '3078569281', '3078577063', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1396817516', 0, 'N', 0, '2011-06-10', NULL, NULL, 42.9868, -108.487, NULL, NULL),
('810284764', 'W12004133', 'W12004133', 'WY01', 'Fort Washakie Health Center', 'Jenaneta ', 'S', 'Hampton', 'NP', 'Family Practice', '', '', NULL, 'O', '29 Black Coal Dr', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', '29 Black Coal Dr', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1396817516', 0, 'N', 0, '2011-06-10', NULL, NULL, 42.9969, -108.861, NULL, NULL),
('810284764', 'W12004135', 'W12004135', 'WY01', 'Fort Washakie Health Center', 'Jenaneta ', 'S', 'Hampton', 'NP', 'Family Practice', '', '', NULL, 'B', 'PO Box 128', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', 'PO Box 128', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1396817516', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('810284764', 'W12004136', 'W12004136', 'WY01', 'Arapahoe Health Center', 'Jenaneta ', 'S', 'Hampton', 'NP', 'Family Practice', '', '', NULL, 'M', 'PO Box 31001', 'Pasadena', 'Los Angeles', 'CA', '91110', '3078569281', '3078577063', 'PO Box 31001', 'Pasadena', 'Los Angeles', 'CA', '91110', '3078569281', '3078577063', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1396817516', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('810284764', 'W12004138', 'W12004138', 'WY01', 'Arapahoe Health Center', 'Jacqueline', '', 'Nelson', 'MD', 'Pediatrics', '', '', NULL, 'O', '17 Great Plains Rd', 'Arapahoe', 'Fremont', 'WY', '82510', '3078569281', '3078577063', '17 Great Plains Rd', 'Arapahoe', 'Fremont', 'WY', '82510', '3078569281', '3078577063', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1548333206', 0, 'N', 0, '2011-06-10', NULL, NULL, 42.9868, -108.487, NULL, NULL),
('810284764', 'W12004137', 'W12004137', 'WY01', 'Fort Washakie Health Center', 'Jacqueline', '', 'Nelson', 'MD', 'Pediatrics', '', '', NULL, 'O', '29 Black Coal Dr', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', '29 Black Coal Dr', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1548333206', 0, 'N', 0, '2011-06-10', NULL, NULL, 42.9969, -108.861, NULL, NULL),
('810284764', 'W12004140', 'W12004140', 'WY01', 'Fort Washakie Health Center', 'Jacqueline', '', 'Nelson', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 128', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', 'PO Box 128', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1548333206', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('810284764', 'W12004139', 'W12004139', 'WY01', 'Arapahoe Health Center', 'Jacqueline', '', 'Nelson', 'MD', 'Pediatrics', '', '', NULL, 'M', 'PO Box 31001', 'Pasadena', 'Los Angeles', 'CA', '91110', '3078569281', '3078577063', 'PO Box 31001', 'Pasadena', 'Los Angeles', 'CA', '91110', '3078569281', '3078577063', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1548333206', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('810284764', 'W12004142', 'W12004142', 'WY01', 'Arapahoe Health Center', 'Marilyn', 'R', 'Scott', 'NP', 'Family Practice', '', '', NULL, 'O', '17 Great Plains Rd', 'Arapahoe', 'Fremont', 'WY', '82510', '3078569281', '3078577063', '17 Great Plains Rd', 'Arapahoe', 'Fremont', 'WY', '82510', '3078569281', '3078577063', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740264993', 0, 'N', 0, '2011-06-10', NULL, NULL, 42.9868, -108.487, NULL, NULL),
('810284764', 'W12004141', 'W12004141', 'WY01', 'Fort Washakie Health Center', 'Marilyn', 'R', 'Scott', 'NP', 'Family Practice', '', '', NULL, 'O', '29 Black Coal Dr', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', '29 Black Coal Dr', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740264993', 0, 'N', 0, '2011-06-10', NULL, NULL, 42.9969, -108.861, NULL, NULL),
('810284764', 'W12004144', 'W12004144', 'WY01', 'Fort Washakie Health Center', 'Marilyn', 'R', 'Scott', 'NP', 'Family Practice', '', '', NULL, 'B', 'PO Box 128', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', 'PO Box 128', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740264993', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('810284764', 'W12004143', 'W12004143', 'WY01', 'Arapahoe Health Center', 'Marilyn', 'R', 'Scott', 'NP', 'Family Practice', '', '', NULL, 'M', 'PO Box 31001', 'Pasadena', 'Los Angeles', 'CA', '91110', '3078569281', '3078577063', 'PO Box 31001', 'Pasadena', 'Los Angeles', 'CA', '91110', '3078569281', '3078577063', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740264993', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('529315937', 'W12004629', 'W12004629', 'UTMH1', '', 'Jay', 'E', 'Jeppson', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '140 N Cedar Hills Dr', 'Price', 'Carbon', 'UT', '84501', '4358202199', NULL, '140 N Cedar Hills Dr', 'Price', 'Carbon', 'UT', '84501', '4358202199', '          ', 'UTPHD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-30', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|UB|', '1346204450', 0, 'N', 1, '2010-10-23', NULL, NULL, 0, 0, NULL, NULL),
('270301506', 'W12004147', 'W12004147', 'UT01', 'Aspen Cosmetic Dermatology', 'John', 'L', 'Peterson', 'MD', 'Dermatology', '', '', NULL, 'O', '425 Medical Dr Ste 220', 'Bountiful', 'Davis', 'UT', '84010', '8012953095', NULL, '425 Medical Dr Ste 220', 'Bountiful', 'Davis', 'UT', '84010', '8012953095', '', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, NULL, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB|', '1891729109', 0, 'N', 0, '2014-07-14', NULL, NULL, 40.8873, -111.872, NULL, NULL),
('742915297', 'W12004149', 'W12004149', 'TX01', 'South Texas Oncology and Hematology', 'Drew', 'W', 'Rasco', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '4383 Medical Dr', 'San Antonio', 'Bexar', 'TX', '78229', '2105935700', NULL, '4383 Medical Dr', 'San Antonio', 'Bexar', 'TX', '78229', '2105935700', '          ', 'TXONCOL', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-08-25', '2012-08-19', 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1558311225', 0, 'N', 0, '2013-04-04', NULL, NULL, 29.5109, -98.5711, NULL, NULL),
('742915297', 'W12004148', 'W12004148', 'TX01', 'South Texas Oncology and Hematology', 'Drew', 'W', 'Rasco', 'MD', 'Hematology and Oncology', '', '', NULL, 'B', 'PO Box 268', 'San Antonio', 'Bexar', 'TX', '78229', '2105935700', NULL, 'PO Box 268', 'San Antonio', 'Bexar', 'TX', '78229', '2105935700', '          ', 'TXONCOL', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-08-25', '2012-08-19', 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1558311225', 0, 'N', 0, '2013-04-04', NULL, NULL, 0, 0, NULL, NULL),
('320189746', 'W12004151', 'W12004151', 'UT01', 'Draper Family Practice', 'Carlie', '', 'Hamilton', 'NP', 'Family Practice', '', '', NULL, 'O', '12272 S 800 E Ste A', 'Draper', 'Salt Lake', 'UT', '84020', '8015231300', NULL, '12272 S 800 E Ste A', 'Draper', 'Salt Lake', 'UT', '84020', '8015231300', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-03-29', '2012-03-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104978873', 0, 'N', 0, '2013-08-21', NULL, NULL, 0, 0, NULL, NULL),
('870521827', 'W12004154', 'W12004154', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Radha', 'C', 'Moldover', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015814636', NULL, '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015814636', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1174699490', 0, 'N', 0, '2014-02-04', NULL, NULL, 40.757, -111.824, NULL, NULL),
('870521827', 'W12004153', 'W12004153', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Radha', 'C', 'Moldover', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', NULL, 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1174699490', 0, 'N', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('870521827', 'W12004158', 'W12004158', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Matthew', 'L', 'Moench', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015814636', NULL, '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015814636', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|', '1376641456', 0, 'N', 0, '2012-01-26', NULL, NULL, 40.757, -111.824, NULL, NULL),
('870521827', 'W12004157', 'W12004157', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Matthew', 'L', 'Moench', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'B', 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', NULL, 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|', '1376641456', 0, 'N', 0, '2012-01-26', NULL, NULL, 0, 0, NULL, NULL),
('870521827', 'W12004161', 'W12004161', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Matthew', 'B', 'Perkins', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015814636', NULL, '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015814636', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1831222538', 0, 'N', 0, '2012-01-26', NULL, NULL, 40.757, -111.824, NULL, NULL),
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('870521827', 'W12004177', 'W12004177', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Cassandra', '', 'Romine', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'B', 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', NULL, 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1497922744', 0, 'N', 0, '2012-01-26', NULL, NULL, 0, 0, NULL, NULL),
('870443046', 'W12004180', 'W12004180', 'UT01', 'University Health Care', 'Scott', '', 'Stiefel', 'MD', 'Mental Health', 'Neonatology', NULL, NULL, 'o', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817951', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817951', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2012-08-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235218801', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('870443046', 'W12004179', 'W12004179', 'UT01', 'U of U Medical Center - Psychiatry', 'Scott', '', 'Stiefel', 'MD', 'Mental Health', 'Neonatology', NULL, NULL, 'B', 'PO Box 413029', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413029', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2012-08-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235218801', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('870521827', 'W12004181', 'W12004181', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Scott', '', 'Stiefel', 'MD', 'Mental Health', 'Neonatology', NULL, NULL, 'O', '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015814636', NULL, '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015814636', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', '2012-09-18', 0, 0, 0, '', '', '', '', 'HCFA|', '1235218801', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('870521827', 'W12004182', 'W12004182', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Scott', '', 'Stiefel', 'MD', 'Mental Health', 'Neonatology', NULL, NULL, 'B', 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', NULL, 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', '2012-09-18', 0, 0, 0, '', '', '', '', 'HCFA|', '1235218801', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('870521827', 'W12004183', 'W12004183', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Paul', 'T', 'Teman', 'MD', 'Mental Health', 'Psychiatry', 'Sleep Medicine', NULL, 'O', '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015814636', NULL, '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015814636', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1700858727', 0, 'N', 0, '2012-01-26', NULL, NULL, 40.757, -111.824, NULL, NULL),
('870521827', 'W12004184', 'W12004184', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Paul', 'T', 'Teman', 'MD', 'Mental Health', 'Psychiatry', 'Sleep Medicine', NULL, 'B', 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', NULL, 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1700858727', 0, 'N', 0, '2012-01-26', NULL, NULL, 0, 0, NULL, NULL),
('870521827', 'W12004185', 'W12004185', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Stephanie', 'L', 'Tonin', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'B', 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', NULL, 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1225200033', 0, 'N', 0, '2012-01-26', NULL, NULL, 0, 0, NULL, NULL),
('870521827', 'W12004188', 'W12004188', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Matthew', 'M', 'Woolley', 'PHD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015814636', NULL, '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015814636', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|', '1871691956', 0, 'N', 0, '2012-01-26', NULL, NULL, 40.757, -111.824, NULL, NULL),
('870521827', 'W12004187', 'W12004187', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Matthew', 'M', 'Woolley', 'PHD', 'Mental Health', 'Psychiatry', '', NULL, 'B', 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', NULL, 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|', '1871691956', 0, 'N', 0, '2012-01-26', NULL, NULL, 0, 0, NULL, NULL),
('870443046', 'W12004190', 'W12004190', 'UT01', 'University Health Care', 'A M', '', 'Redd', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'o', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817951', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817951', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2012-08-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215027834', 0, 'N', 0, '2012-08-21', NULL, NULL, 0, 0, NULL, NULL),
('870521827', 'W12004192', 'W12004192', 'UT01', 'University Health Care Neuropsychiatric Institute', 'A M', '', 'Redd', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015814636', NULL, '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015814636', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1215027834', 0, 'N', 0, '2012-01-26', NULL, NULL, 40.757, -111.824, NULL, NULL),
('870521827', 'W12004191', 'W12004191', 'UT01', 'University Health Care Neuropsychiatric Institute', 'A M', '', 'Redd', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'B', 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', NULL, 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1215027834', 0, 'N', 0, '2012-01-26', NULL, NULL, 0, 0, NULL, NULL),
('870443046', 'W12004189', 'W12004189', 'UT01', 'U of U Medical Center - Psychiatry', 'A M', '', 'Redd', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'B', 'PO Box 413029', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012367790', NULL, 'PO Box 413029', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012367790', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215027834', 0, 'N', 0, '2012-01-26', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12004195', 'W12004195', 'ID01', 'Dominican Health Services', 'Michael', 'B', 'Wells', 'DO', 'Family Practice', '', '', NULL, 'O', '1118 NW 16th St Ste A', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2084522140', '1118 NW 16th St Ste A', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2084522140', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2010-07-26', '2012-04-03', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1114909579', 0, 'Y', 0, '2012-04-03', NULL, NULL, 44.025, -116.928, NULL, NULL),
('820200895', 'W12004196', 'W12004196', 'ID01', 'Saint Alphonsus Medical Group Eagle ', 'Debra', 'A', 'Bogossian', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'o', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-10-01', '2011-11-10', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1437175064', 0, 'N', 0, '2011-12-19', NULL, NULL, 43.6892, -116.351, NULL, NULL),
('263813027', 'W12001127', 'W12001127', 'UTMH1', 'Childrens Neurodevelopmental Sevices Inc', 'Julien', 'T', 'Smith', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '231 E 400 S Ste 340', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015962347', NULL, '231 E 400 S Ste 340', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015962347', '          ', 'UTPHD', '', '', '0.00', '35.00', '0.00', 3, '2010-04-20', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326069022', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12004205', 'W12004205', 'UT01', 'Central Utah Clinic', '', '', 'Central Utah Clinic PC', 'GROUP', '', '', '', NULL, 'O', '1305 N Commerce Dr Ste 120', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017537424', '8017537425', '1305 N Commerce Dr Ste 120', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017537424', '8017537425', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-07-15', '2011-02-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000005619', 0, 'N', 0, '2014-07-22', NULL, NULL, 0, 0, NULL, NULL),
('870271937', 'W12004206', 'W12004206', 'UT01', '', 'Scott', 'A', 'Langford', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1109 N 100 W', 'Beaver', 'Beaver', 'UT', '84713', '4354387183', '4354387142', '1109 N 100 W', 'Beaver', 'Beaver', 'UT', '84713', '4354387183', '4354387142', 'MA', '', '', '0.00', '100.00', '0.00', 6, '2010-08-31', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003802836', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('621762573', 'W12004207', 'W12004207', 'UT01', 'Eastern Utah Family Medicine', 'Matthew', 'F', 'Brady', 'MD', 'Family Practice', 'Obstetrics and Gynecology', '', NULL, 'O', '280 N Hospital Dr Ste 4', 'Price', 'Carbon', 'UT', '84501', '4356373584', NULL, '280 N Hospital Dr Ste 4', 'Price', 'Carbon', 'UT', '84501', '4356373584', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, 'Castleview Hospital', 'Castleview Hospital', NULL, NULL, 'HCFA|UB|', '1245263177', 0, 'N', 0, '2010-11-01', NULL, NULL, 39.6047, -110.831, NULL, NULL),
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('942854057', 'W12004290', 'W12004290', 'UTIHC04', 'Emergency Room', 'Brian', 'C', 'Lofgran', 'MD', 'Family Practice', '', '', NULL, 'O', '1485 S Hwy 40', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', NULL, '1485 S Hwy 40', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2010-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558518845', 0, 'N', 0, '2010-10-28', NULL, NULL, 40.489, -111.409, NULL, NULL),
('942854057', 'W12004291', 'W12004291', 'UTIHC04', 'Anesthesiology', 'Art', NULL, 'Shimata', 'CRNA', 'Anesthesiology', '', '', NULL, 'O', '1100 S Medical Dr', 'Mount Pleasant', 'Sanpete', 'UT', '84647', '8013577475', NULL, '1100 S Medical Dr', 'Mount Pleasant', 'Sanpete', 'UT', '84647', '8013577475', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2010-08-12', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1720099542', 0, 'Y', 0, '2007-02-23', NULL, NULL, 39.5318, -111.461, NULL, NULL),
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('870649259', 'W12004301', 'W12004301', 'UT01', 'Alpine Orthopaedic Specialists', '', '', 'Alpine Orthopaedic Specialists', 'GROUP', 'Orthopedic Surgery', '', '', NULL, 'O', '267 N Spring Creek Pkwy', 'Providence', 'Cache', 'UT', '84332', '4357872000', '4357871913', '267 N Spring Creek Pkwy', 'Providence', 'Cache', 'UT', '84332', '4357872000', '4357871913', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-08-28', '2011-05-23', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427184449', 0, 'Y', 0, '2013-06-24', NULL, NULL, 0, 0, NULL, NULL),
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('870281028', 'W12004306', 'W12004306', 'UT01', 'Central Utah Clinic', 'Abraham', 'R', 'Tomco', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8012218811', NULL, 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8012218811', '', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-01-01', '2011-02-28', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1033320791', 0, 'N', 0, '2014-05-12', NULL, NULL, 0, 0, NULL, NULL),
('201300128', 'W12004309', 'W12004309', 'ID01', 'Idaho Urologic Institute', 'Helen', 'J', 'Kuo', 'MD', 'Urology', '', '', NULL, 'O', '333 N 1st Ste 100', 'Boise', 'Ada', 'ID', '83702', '2086394900', '2086394901', '333 N 1st Ste 100', 'Boise', 'Ada', 'ID', '83702', '2086394900', '2086394901', 'IDUROLOGY', 'WUSTDHCPC5', '', '0.00', '20.00', '0.00', 3, '2010-11-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1346407921', 0, 'N', 0, '2013-06-25', NULL, NULL, 43.6135, -116.194, NULL, NULL),
('061506129', 'W12004313', 'W12004313', 'UT01', 'Wee Care Pediatrics', 'Elenor', '', 'MacGregor', 'DO', 'Pediatrics', '', '', NULL, 'O', '1580 W Antelope Dr Ste 100', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8019271591', '1580 W Antelope Dr Ste 100', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8019271591', 'WUSTDPEDE5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2011-06-30', 0, 0, 0, 'Ogden Regional Medical Center', 'Davis Hospital', '', '', 'HCFA|UB|', '1740509223', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
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('061506129', 'W12004310', 'W12004310', 'UT01', 'Wee Care Pediatrics', 'Elenor', '', 'MacGregor', 'DO', 'Pediatrics', '', '', NULL, 'O', '5991 S 3500 W Ste 100', 'Roy', 'Weber', 'UT', '84067', '8017738644', '8019850486', '5991 S 3500 W Ste 100', 'Roy', 'Weber', 'UT', '84067', '8017738644', '8019850486', 'WUSTDPEDE5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', 'Davis Hospital', '', '', 'HCFA|UB|', '1740509223', 0, 'N', 0, '2014-07-21', NULL, NULL, 41.1545, -112.064, NULL, NULL),
('061506129', 'W12004311', 'W12004311', 'UT01', 'Wee Care Pediatrics', 'Elenor', '', 'MacGregor', 'DO', 'Pediatrics', '', '', NULL, 'O', '934 S Main St Ste 8', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8015936188', '934 S Main St Ste 8', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8015936188', 'WUSTDPEDE5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', 'Davis Hospital', '', '', 'HCFA|UB|', '1740509223', 0, 'N', 0, '2014-07-21', NULL, NULL, 41.0461, -111.953, NULL, NULL),
('061506129', 'W12004314', 'W12004314', 'UT01', 'Wee Care Pediatrics', 'Elenor', '', 'MacGregor', 'DO', 'Pediatrics', '', '', NULL, 'B', 'Dept 1310', 'Denver', 'Denver', 'CO', '80256', '8019271562', '8019271591', 'Dept 1310', 'Denver', 'Denver', 'CO', '80256', '8019271562', '8019271591', 'WUSTDPEDE5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', 'Davis Hospital', '', '', 'HCFA|UB|', '1740509223', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('870342259', 'W12004315', 'W12004315', 'UT01', 'Wayne Community Health Center', 'Matthew', 'J', 'Pettit', 'LMFT', 'Mental Health', '', '', NULL, 'O', '128 S 300 W', 'Bicknell', 'Wayne', 'UT', '84715', '4354253744', '4354253785', '128 S 300 W', 'Bicknell', 'Wayne', 'UT', '84715', '4354253744', '4354253785', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2010-11-01', '2011-11-07', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871745117', 0, 'N', 0, '2011-11-17', NULL, NULL, 0, 0, NULL, NULL),
('870342259', 'W12004317', 'W12004317', 'UT01', 'Wayne Community Health Center', 'Matthew', 'J', 'Pettit', 'LMFT', 'Mental Health', '', '', NULL, 'B', 'PO Box 303', 'Bicknell', 'Wayne', 'UT', '84715', '4354253744', '4354253785', 'PO Box 303', 'Bicknell', 'Wayne', 'UT', '84715', '4354253744', '4354253785', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2010-11-01', '2011-11-07', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871745117', 0, 'N', 0, '2011-11-17', NULL, NULL, 0, 0, NULL, NULL),
('061506129', 'W12004318', 'W12004318', 'UT01', 'Wee Care Pediatrics', 'Carmen', 'M', 'Taveras Espinal', 'MD', 'Pediatrics', '', '', NULL, 'O', '1580 W Antelope Dr Ste 100', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8019271591', '1580 W Antelope Dr Ste 100', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8019271591', 'WUSTDPEDE5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2011-06-30', 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1831400589', 0, 'N', 0, '2012-01-24', NULL, NULL, 0, 0, NULL, NULL),
('061506129', 'W12004321', 'W12004321', 'UT01', 'Wee Care Pediatrics', 'Carmen', 'M', 'Taveras Espinal', 'MD', 'Pediatrics', '', '', NULL, 'O', '1792 W 1700 S Ste 102', 'Syracuse', 'Davis', 'UT', '84075', '8017738644', '8018254161', '1792 W 1700 S Ste 102', 'Syracuse', 'Davis', 'UT', '84075', '8017738644', '8018254161', 'WUSTDPEDE5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2011-09-30', 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1831400589', 0, 'N', 0, '2012-01-24', NULL, NULL, 0, 0, NULL, NULL),
('061506129', 'W12004320', 'W12004320', 'UT01', 'Wee Care Pediatrics', 'Carmen', 'M', 'Taveras Espinal', 'MD', 'Pediatrics', '', '', NULL, 'O', '5991 S 3500 W Ste 100', 'Roy', 'Weber', 'UT', '84067', '8017738644', '8019850486', '5991 S 3500 W Ste 100', 'Roy', 'Weber', 'UT', '84067', '8017738644', '8019850486', 'WUSTDPEDE5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2011-09-30', 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1831400589', 0, 'N', 0, '2012-01-24', NULL, NULL, 0, 0, NULL, NULL),
('061506129', 'W12004319', 'W12004319', 'UT01', 'Wee Care Pediatrics', 'Carmen', 'M', 'Taveras Espinal', 'MD', 'Pediatrics', '', '', NULL, 'O', '934 S Main St Ste 8', 'Layton', 'Davis', 'UT', '84041', '8017388644', '8015936188', '934 S Main St Ste 8', 'Layton', 'Davis', 'UT', '84041', '8017388644', '8015936188', 'WUSTDPEDE5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2011-09-30', 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1831400589', 0, 'N', 0, '2012-01-24', NULL, NULL, 0, 0, NULL, NULL),
('061506129', 'W12004322', 'W12004322', 'UT01', 'Wee Care Pediatrics', 'Carmen', 'M', 'Taveras Espinal', 'MD', 'Pediatrics', '', '', NULL, 'B', 'Dept 1310', 'Denver', 'Denver', 'CO', '80256', '8019271562', '8019271591', 'Dept 1310', 'Denver', 'Denver', 'CO', '80256', '8019271562', '8019271591', 'WUSTDPEDE5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2011-09-30', 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1831400589', 0, 'N', 0, '2012-01-24', NULL, NULL, 0, 0, NULL, NULL),
('271419508', 'W12004323', 'W12004323', 'UT01', 'Utah Pain Relief Institute', 'Jerry ', 'G', 'Hong', 'PT', 'Physical Therapy', '', '', NULL, 'O', '10464 S Redwood Rd', 'South Jordan', 'Salt Lake', 'UT', '84095', '8014667246', '8012857056', '10464 S Redwood Rd', 'South Jordan', 'Salt Lake', 'UT', '84095', '8014667246', '8012857056', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-01', '2011-10-12', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255397287', 0, 'N', 0, '2011-10-12', 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
('263094136', 'W12004324', 'W12004324', 'TX01', 'IMED HealthCare Associates', 'Cassandra', 'C', 'Key', 'MD', 'Internal Medicine', '', '', NULL, 'O', '255 E Sonterra Blvd Ste 100', 'San Antonio', 'Bexar', 'TX', '78258', '2104040000', '2104042813', '255 E Sonterra Blvd Ste 100', 'San Antonio', 'Bexar', 'TX', '78258', '2104040000', '2104042813', 'TXINTB', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-01-01', '2011-07-17', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568645638', 0, 'N', 1, '2013-01-15', NULL, NULL, 29.6171, -98.4906, NULL, NULL),
('263094136', 'W12004325', 'W12004325', 'TX01', 'IMED HealthCare Associates', 'Cassandra', 'C', 'Key', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 405458', 'Atlanta', 'Fulton', 'GA', '30384', '2104040000', NULL, 'PO Box 405458', 'Atlanta', 'Fulton', 'GA', '30384', '2104040000', '          ', 'TXINTB', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-01-01', '2011-07-17', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568645638', 0, 'N', 1, '2013-01-15', NULL, NULL, 0, 0, NULL, NULL),
('271419508', 'W12004326', 'W12004326', 'UT01', 'Utah Pain Relief Institute', 'Shannon (Shawn)', 'D', 'Loree', 'NP', 'Family Practice', 'Pain Management', '', NULL, 'O', '10464 S Redwood Rd', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012857052', '8012857056', '10464 S Redwood Rd', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012857052', '8012857056', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', '2030-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851327886', 0, 'N', 1, '2014-03-05', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12004327', 'W12004327', 'UT01', 'Specialty Surgery of Utah', 'Aaron', '', 'Rabinovich', 'MD', 'General Surgery', '', '', NULL, 'O', '3336 S 4155 W Ste 306', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643855', '8019643860', '3336 S 4155 W Ste 306', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643855', '8019643860', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-08-17', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053364067', 0, 'N', 0, '2012-06-29', NULL, NULL, 40.6991, -111.99, NULL, NULL),
('621801973', 'W12004328', 'W12004328', 'UT01', 'Specialty Surgery of Utah', 'Aaron', '', 'Rabinovich', 'MD', 'General Surgery', '', '', NULL, 'O', '3584 W 9000 S Ste 304', 'West Jordan', 'Salt Lake', 'UT', '84088', '8016014423', '8016014422', '3584 W 9000 S Ste 304', 'West Jordan', 'Salt Lake', 'UT', '84088', '8016014423', '8016014422', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-08-17', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053364067', 0, 'N', 0, '2012-06-29', NULL, NULL, 40.5879, -111.976, NULL, NULL),
('621801973', 'W12004329', 'W12004329', 'UT01', 'Specialty Surgery of Utah', 'Aaron', '', 'Rabinovich', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-08-17', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053364067', 0, 'N', 0, '2012-06-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12004330', 'W12004330', 'UT01', 'Specialty Surgery of Utah', 'Aaron', '', 'Rabinovich', 'MD', 'General Surgery', '', '', NULL, 'M', '406 W S J Plwy Ste 450', 'South Jordan', 'Salt Lake', 'UT', '84095', '8019843418', '8019843479', '406 W S J Plwy Ste 450', 'South Jordan', 'Salt Lake', 'UT', '84095', '8019843418', '8019843479', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-08-17', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053364067', 0, 'N', 0, '2012-06-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12004332', 'W12004332', 'UT01', 'Associates in Orthopaedic Surgery', 'Peter', '', 'Silvero', '', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019643925', '8019643928', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019643925', '8019643928', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-10-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1699844001', 0, 'N', 0, '2013-11-14', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12004331', 'W12004331', 'UT01', 'Associates in Orthopaedic Surgery', 'Peter', '', 'Silvero', '', 'Orthopedic Surgery', '', '', NULL, 'O', '3336 Pioneer Pkwy Ste 102', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643925', '8019643928', '3336 Pioneer Pkwy Ste 102', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643925', '8019643928', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-10-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1699844001', 0, 'N', 0, '2013-11-14', NULL, NULL, 40.6991, -111.99, NULL, NULL),
('621801973', 'W12004333', 'W12004333', 'UT01', 'Associates in Orthopaedic Surgery', 'Peter', '', 'Silvero', '', 'Orthopedic Surgery', '', '', NULL, 'M', '406 W S Jordan Pkwy 102 Ste 102', 'South Jordan', 'Salt Lake', 'UT', '84095', '8019643925', '8019643928', '406 W S Jordan Pkwy 102 Ste 102', 'South Jordan', 'Salt Lake', 'UT', '84095', '8019643925', '8019643928', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-10-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1699844001', 0, 'N', 0, '2013-11-14', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12004335', 'W12004335', 'UT01', 'Alta Internal Medicine', 'Richard', 'W', 'Bennett', 'MD', 'Internal Medicine', '', '', NULL, 'O', '10965 S State St Ste 100', 'Sandy', 'Salt Lake', 'UT', '84070', '8015720311', '8015711369', '10965 S State St Ste 100', 'Sandy', 'Salt Lake', 'UT', '84070', '8015720311', '8015711369', 'wise+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-10-01', '2011-09-22', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1407871510', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12004337', 'W12004337', 'UT01', 'Lone Peak Family Medicine', 'Richard', 'W', 'Bennett', 'MD', 'Internal Medicine', '', '', NULL, 'O', '11760 S 700 E Ste 111', 'Draper', 'Salt Lake', 'UT', '84020', '8019964384', '8015769800', '11760 S 700 E Ste 111', 'Draper', 'Salt Lake', 'UT', '84020', '8019964384', '8015769800', 'wise+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-10-01', '2011-09-21', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1407871510', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12004336', 'W12004336', 'UT01', 'St Marks Millcreek Primary Care', 'Richard', 'W', 'Bennett', 'MD', 'Internal Medicine', '', '', NULL, 'O', '4465 S 900 E Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012662777', '8012661377', '4465 S 900 E Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012662777', '8012661377', 'wise+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-10-01', '2011-09-29', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1407871510', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12004334', 'W12004334', 'UT01', 'Alta Internal Medicine', 'Richard', 'W', 'Bennett', 'MD', 'Internal Medicine', '', '', NULL, 'O', '74 Kimballs Ln Ste 300', 'Draper', 'Salt Lake', 'UT', '84020', '8015720311', '8015711363', '74 Kimballs Ln Ste 300', 'Draper', 'Salt Lake', 'UT', '84020', '8015720311', '8015711363', 'wise+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-10-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1407871510', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12004338', 'W12004338', 'UT01', 'Alta Internal Medicine', 'Richard', 'W', 'Bennett', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '8015711369', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '8015711369', 'wise+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-10-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1407871510', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12004339', 'W12004339', 'UTIHCPHY', 'Utah Valley ENT', 'Glen', 'T', 'Porter', '', 'Ear, Nose and Throat', 'Sleep Medicine', '', NULL, 'O', '1159 E 200 N Ste 375', 'American Fork', 'Utah', 'UT', '84003', '8014928900', NULL, '1159 E 200 N Ste 375', 'American Fork', 'Utah', 'UT', '84003', '8014928900', '', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2010-07-12', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205825973', 0, 'N', 0, '2014-06-27', NULL, NULL, 40.3805, -111.769, NULL, NULL),
('271790052', 'W12023868', 'W12023868', 'IDBOISTD', 'Saint Alphonsus Medical Group Baker City', 'Gerard', 'P', 'Connor', 'MD', 'Gynecologic Oncology', '', '', NULL, 'O', '3325 Pocahontas Rd', 'Baker City', 'Baker', 'OR', '97814', '5415236461', '0000000000', '3325 Pocahontas Rd', 'Baker City', 'Baker', 'OR', '97814', '5415236461', '0000000000', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-09-01', '2012-09-01', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1669470274', 0, 'N', 0, '2014-03-17', NULL, NULL, 44.7949, -117.847, NULL, NULL),
('204969546', 'W12004341', 'W12004341', 'ID01', 'Meridian Pediatrics', 'Heather', 'N', 'Owens', 'MD', 'Pediatrics', '', '', NULL, 'O', '3653 N Locust Grove Rd', 'Meridian', 'Ada', 'ID', '83646', '2083385437', '2089399811', '3653 N Locust Grove Rd', 'Meridian', 'Ada', 'ID', '83646', '2083385437', '2089399811', 'IDSTD10', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2011-01-01', '2012-08-19', 0, NULL, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1588688477', 0, 'N', 0, '2014-07-17', NULL, NULL, 43.6379, -116.376, NULL, NULL),
('770701557', 'W12004343', 'W12004343', 'UT01', 'Alta Internal Medicine', 'Philip', 'L', 'Roberts', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '10965 S State St Ste 100', 'Sandy', 'Salt Lake', 'UT', '84070', '8015720311', '8015711369', '10965 S State St Ste 100', 'Sandy', 'Salt Lake', 'UT', '84070', '8015720311', '8015711369', 'wise+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-10-01', '2011-09-28', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1013012418', 0, 'N', 0, '2012-06-28', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12004345', 'W12004345', 'UT01', 'Lone Peak Family Medicine', 'Philip', 'L', 'Roberts', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '11760 S 700 E Ste 111', 'Draper', 'Salt Lake', 'UT', '84020', '8019961384', '8015769800', '11760 S 700 E Ste 111', 'Draper', 'Salt Lake', 'UT', '84020', '8019961384', '8015769800', 'wise+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-10-01', '2011-09-21', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1013012418', 0, 'N', 0, '2012-06-28', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12004344', 'W12004344', 'UT01', 'St Marks Millcreek Primary Care', 'Philip', 'L', 'Roberts', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '4465 S 900 E Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012662777', '8012661377', '4465 S 900 E Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012662777', '8012661377', 'wise+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-10-01', '2011-09-29', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1013012418', 0, 'N', 0, '2012-06-28', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12004342', 'W12004342', 'UT01', 'Alta Internal Medicine', 'Philip', 'L', 'Roberts', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '74 Kimballs Ln Ste 300', 'Draper', 'Salt Lake', 'UT', '84020', '8015720311', '8015711369', '74 Kimballs Ln Ste 300', 'Draper', 'Salt Lake', 'UT', '84020', '8015720311', '8015711369', 'wise+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-10-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1013012418', 0, 'N', 0, '2012-06-28', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12004346', 'W12004346', 'UT01', 'Alta Internal Medicine', 'Philip', 'L', 'Roberts', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'B', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '8015711369', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '8015711369', 'wise+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-10-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1013012418', 0, 'N', 0, '2012-06-28', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12004348', 'W12004348', 'UT01', 'Alta Internal Medicine', 'Kevin', 'W', 'Tschetter', 'MD', 'Internal Medicine', '', '', NULL, 'O', '10965 S State St Ste 100', 'Sandy', 'Salt Lake', 'UT', '84070', '8015720311', '8015711369', '10965 S State St Ste 100', 'Sandy', 'Salt Lake', 'UT', '84070', '8015720311', '8015711369', 'wise+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-10-01', '2011-09-23', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1912922923', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12004350', 'W12004350', 'UT01', 'Lone Peak Family Medicine', 'Kevin', 'W', 'Tschetter', 'MD', 'Internal Medicine', '', '', NULL, 'O', '11760 S 700 E Ste 111', 'Draper', 'Salt Lake', 'UT', '84020', '8019964384', '8015769800', '11760 S 700 E Ste 111', 'Draper', 'Salt Lake', 'UT', '84020', '8019964384', '8015769800', 'wise+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-10-01', '2011-09-23', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1912922923', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12004349', 'W12004349', 'UT01', 'St Marks Millcreek Primary Care', 'Kevin', 'W', 'Tschetter', 'MD', 'Internal Medicine', '', '', NULL, 'O', '4465 S 900 E Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012662777', '8012661377', '4465 S 900 E Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012662777', '8012661377', 'wise+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-10-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1912922923', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12004347', 'W12004347', 'UT01', 'Alta Internal Medicine', 'Kevin', 'W', 'Tschetter', 'MD', 'Internal Medicine', '', '', NULL, 'O', '74 Kimballs Ln Ste 300', 'Draper', 'Salt Lake', 'UT', '84020', '8015720311', '8015711369', '74 Kimballs Ln Ste 300', 'Draper', 'Salt Lake', 'UT', '84020', '8015720311', '8015711369', 'wise+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-10-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1912922923', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12004351', 'W12004351', 'UT01', 'Alta Internal Medicine', 'Kevin', 'W', 'Tschetter', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 198560 Ste ', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '8015711369', 'PO Box 198560 Ste ', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '8015711369', 'wise+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-10-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1912922923', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('830327251', 'W12004352', 'W12004352', 'WY01', 'Star Valley Medical Center', 'Roger', '', 'Brecheen', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '901 Adams St', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', '          ', '901 Adams St', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', '          ', 'WSTARV', 'wyhcpcs', '', '0.00', '10.00', '0.00', 6, '2010-09-08', '2014-03-24', 0, 0, 0, 'SageWest Health Care', '', '', '', 'HCFA|UB|', '1720039357', 0, 'N', 0, '2014-03-31', NULL, NULL, 42.719, -110.931, NULL, NULL),
('830327251', 'W12004353', 'W12004353', 'WY01', 'Star Valley Medical Center', 'Roger', '', 'Brecheen', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 579', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', '          ', 'PO Box 579', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', '          ', 'WSTARV', 'wyhcpcs', '', '0.00', '10.00', '0.00', 6, '2010-09-08', '2014-03-24', 0, 0, 0, 'SageWest Health Care', '', '', '', 'HCFA|UB|', '1720039357', 0, 'N', 0, '2014-03-31', NULL, NULL, 0, 0, NULL, NULL),
('830327251', 'W12004354', 'W12004354', 'WY01', 'Star Valley Medical Center', 'Jacob ', '', 'Crosby', 'CRNA', 'Anesthesia', '', '', NULL, 'O', '901 Adams St', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', NULL, '901 Adams St', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', '          ', 'WSTARV', 'wyhcpcs', '', '0.00', '10.00', '0.00', 6, '2010-09-08', NULL, 0, 0, 0, 'Star Valley Medical Center', '', '', '', 'HCFA|UB|', '1578721544', 0, 'Y', 0, '2011-06-10', NULL, NULL, 42.719, -110.931, NULL, NULL),
('830327251', 'W12004355', 'W12004355', 'WY01', 'Star Valley Medical Center', 'Jacob ', '', 'Crosby', 'CRNA', 'Anesthesia', '', '', NULL, 'B', 'PO Box 579', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', NULL, 'PO Box 579', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', '          ', 'WSTARV', 'wyhcpcs', '', '0.00', '10.00', '0.00', 6, '2010-09-08', NULL, 0, 0, 0, 'Star Valley Medical Center', '', '', '', 'HCFA|UB|', '1578721544', 0, 'Y', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('830327251', 'W12004357', 'W12004357', 'WY01', 'Star Valley Medical Center', 'E Marlowe', '', 'Goble', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '901 Adams St', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', NULL, '901 Adams St', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', '', 'WSTARV', 'wyhcpcs', '', '0.00', '10.00', '0.00', 6, '2010-09-08', NULL, 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1235232646', 0, 'N', 0, '2014-05-08', NULL, NULL, 42.719, -110.931, NULL, NULL),
('830327251', 'W12004358', 'W12004358', 'WY01', 'Star Valley Medical Center', 'E Marlowe', '', 'Goble', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 579', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', NULL, 'PO Box 579', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', '', 'WSTARV', 'wyhcpcs', '', '0.00', '10.00', '0.00', 6, '2010-09-08', NULL, 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1235232646', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
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('830327251', 'W12004362', 'W12004362', 'WY01', 'Star Valley Medical Center', 'Gary ', '', 'Hess', 'APRN', 'Anesthesia', '', '', NULL, 'B', 'PO Box 579', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', NULL, 'PO Box 579', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', '          ', 'WSTARV', 'wyhcpcs', '', '0.00', '10.00', '0.00', 6, '2010-09-08', NULL, 0, 0, 0, 'Star Valley Medical Center', '', '', '', 'HCFA|UB|', '1558396911', 0, 'Y', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('830327251', 'W12004363', 'W12004363', 'WY01', 'Star Valley Medical Center', 'Kyle', '', 'Hirschi', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '901 Adams St', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', NULL, '901 Adams St', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', '', 'WSTARV', 'wyhcpcs', '', '0.00', '10.00', '0.00', 6, '2010-09-08', NULL, 0, 0, 0, 'Star Valley Medical Center', '', '', '', 'HCFA|UB|', '1881841898', 0, 'N', 0, '2014-07-21', NULL, NULL, 42.719, -110.931, NULL, NULL),
('830327251', 'W12004364', 'W12004364', 'WY01', 'Star Valley Medical Center', 'Kyle', '', 'Hirschi', 'PA', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 579', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', NULL, 'PO Box 579', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', '', 'WSTARV', 'wyhcpcs', '', '0.00', '10.00', '0.00', 6, '2010-09-08', NULL, 0, 0, 0, 'Star Valley Medical Center', '', '', '', 'HCFA|UB|', '1881841898', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
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('830327251', 'W12004370', 'W12004370', 'WY01', 'Star Valley Medical Center', 'Lance', '', 'Petersen', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 579', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', '', 'PO Box 579', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', '', 'WSTARV', 'wyhcpcs', '', '0.00', '10.00', '0.00', 6, '2010-09-08', NULL, 0, 0, 0, 'Star Valley Medical Center', '', '', '', 'HCFA|UB|', '1245303429', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
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('830327251', 'W12004372', 'W12004372', 'WY01', 'Star Valley Medical Center', 'Michael ', 'Ross', 'Pieper', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 579', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', '', 'PO Box 579', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', '', 'WSTARV', 'wyhcpcs', '', '0.00', '10.00', '0.00', 6, '2010-09-08', NULL, 0, 0, 0, 'Star Valley Medical Center', '', '', '', 'HCFA|UB|', '1174717128', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
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('830327251', 'W12004373', 'W12004373', 'WY01', 'Star Valley Medical Center', 'David ', '', 'Shrader', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 579', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', NULL, 'PO Box 579', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', '', 'WSTARV', 'wyhcpcs', '', '0.00', '10.00', '0.00', 6, '2010-09-08', '2013-12-31', 0, 0, 0, 'Star Valley Medical Center', '', '', '', 'HCFA|UB|', '1275615494', 0, 'N', 0, '2014-04-03', NULL, NULL, 0, 0, NULL, NULL),
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('830327251', 'W12004376', 'W12004376', 'WY01', 'Star Valley Medical Center', 'Ruthanne ', '', 'Taylor', 'APRN', 'Family Practice', '', '', NULL, 'B', 'PO Box 579', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', '          ', 'PO Box 579', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', '          ', 'WSTARV', 'wyhcpcs', '', '0.00', '10.00', '0.00', 6, '2010-09-08', '2014-03-24', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538278171', 0, 'N', 0, '2014-03-31', NULL, NULL, 0, 0, NULL, NULL),
('830212533', 'W12004377', 'W12004377', 'Sinclair', 'Carbon County Counseling', 'Mary Jo', '', 'Greenwood', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 1056', 'Rawlins', 'Carbon', 'WY', '82301', '3073265156', NULL, 'PO Box 1056', 'Rawlins', 'Carbon', 'WY', '82301', '3073265156', '          ', 'WYMA', '', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2012-03-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831181130', 0, 'Y', 0, '2012-04-10', NULL, NULL, 0, 0, NULL, NULL),
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('870284475', 'W12004379', 'W12004379', 'UT01', 'Granger Medical Clinic', 'Orrenzo', 'B', 'Snyder', 'MD', 'Urology', '', '', NULL, 'B', 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '8019653600', '', 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '8019653600', '', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-08', NULL, 0, 0, 0, 'Pioneer Valley Hospital', '', '', '', 'HCFA|UB|', '1720171259', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('263538695', 'W12004380', 'W12004380', 'UT01', 'Steps Recovery Center', '', '', 'Steps Recovery Center', 'GROUP', 'Mental Health Facility', '', '', NULL, 'O', '984 S 930 W', 'Payson', 'Utah', 'UT', '84651', '8014655111', '8014657702', '984 S 930 W', 'Payson', 'Utah', 'UT', '84651', '8014655111', '8014657702', '', '', '8', '0.00', '40.00', '0.00', 3, '2011-01-11', '2011-01-11', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598087702', 0, 'N', 0, '2012-06-29', NULL, NULL, 0, 0, NULL, NULL),
('870618776', 'W12004381', 'W12004381', 'UT01', 'Gamma West Cancer Services', 'James', 'W', 'Clarke', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '425 E 5350 S Ste 180', 'Ogden', 'Weber', 'UT', '84405', '8014754571', '          ', '425 E 5350 S Ste 180', 'Ogden', 'Weber', 'UT', '84405', '8014754571', '          ', 'WUSTDRONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-04-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295959724', 0, 'Y', 0, '2014-06-05', NULL, NULL, 41.166, -111.97, NULL, NULL),
('870618776', 'W12004382', 'W12004382', 'UT01', 'Gamma West Cancer Services', 'James', 'W', 'Clarke', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '674 W 800 N Ste B10', 'Orem', 'Utah', 'UT', '84057', '8018520210', '          ', '674 W 800 N Ste B10', 'Orem', 'Utah', 'UT', '84057', '8018520210', '          ', 'WUSTDRONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-04-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295959724', 0, 'Y', 0, '2014-06-05', NULL, NULL, 40.3121, -111.712, NULL, NULL),
('870618776', 'W12004383', 'W12004383', 'UT01', 'Gamma West Cancer Services', 'James', 'W', 'Clarke', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356275327', NULL, '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356275327', '', 'WUSTDRONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-04-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295959724', 0, 'N', 0, '2014-06-05', NULL, NULL, 37.0989, -113.575, NULL, NULL),
('870618776', 'W12004384', 'W12004384', 'UT01', 'Gamma West Cancer Services', 'James', 'W', 'Clarke', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '2132 N 1700 W Ste B101', 'Layton', 'Davis', 'UT', '84041', '8018077777', '          ', '2132 N 1700 W Ste B101', 'Layton', 'Davis', 'UT', '84041', '8018077777', '          ', 'WUSTDRONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-04-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295959724', 0, 'Y', 0, '2014-06-05', NULL, NULL, 41.0892, -111.997, NULL, NULL),
('870618776', 'W12004385', 'W12004385', 'UT01', 'Gamma West Cancer Services', 'James', 'W', 'Clarke', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '5475 S 500 E', 'Ogden', 'Weber', 'UT', '84405', '8014792570', '          ', '5475 S 500 E', 'Ogden', 'Weber', 'UT', '84405', '8014792570', '          ', 'WUSTDRONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-04-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295959724', 0, 'Y', 0, '2014-06-05', NULL, NULL, 41.1635, -111.969, NULL, NULL),
('870618776', 'W12004386', 'W12004386', 'UT01', 'Gamma West Cancer Services', 'James', 'W', 'Clarke', 'MD', 'Radiation Oncology', '', '', NULL, 'B', 'PO Box 30015 Ste Dept 16', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8014756532', NULL, 'PO Box 30015 Ste Dept 16', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8014756532', '', 'WUSTDRONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-04-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295959724', 0, 'Y', 0, '2014-06-05', NULL, NULL, 0, 0, NULL, NULL),
('870618776', 'W12004387', 'W12004387', 'UT01', 'Gamma West Cancer Services', 'James', 'W', 'Clarke', 'MD', 'Radiation Oncology', '', '', NULL, 'B', 'PO Box 25213', 'Salt Lake City', 'Salt Lake', 'UT', '84125', '8014756532', NULL, 'PO Box 25213', 'Salt Lake City', 'Salt Lake', 'UT', '84125', '8014756532', '', 'WUSTDRONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-04-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295959724', 0, 'Y', 0, '2014-06-05', NULL, NULL, 0, 0, NULL, NULL),
('870618776', 'W12004388', 'W12004388', 'UT01', 'Gamma West Cancer Services', 'James', 'W', 'Clarke', 'MD', 'Radiation Oncology', '', '', NULL, 'B', 'PO Box 271098', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8014756532', NULL, 'PO Box 271098', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8014756532', '', 'WUSTDRONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-04-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295959724', 0, 'Y', 0, '2014-06-05', NULL, NULL, 0, 0, NULL, NULL),
('263883041', 'W12004389', 'W12004389', 'UTMH1', '', 'Herta', 'A', 'Crawford', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '313 E 1200 St Ste 101', 'Orem', 'Utah', 'UT', '84058', '8013100849', NULL, '313 E 1200 St Ste 101', 'Orem', 'Utah', 'UT', '84058', '8013100849', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2010-01-25', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952425043', 0, 'N', 0, '2011-09-29', NULL, NULL, 0, 0, NULL, NULL),
('261752159', 'W12004680', 'W12004680', 'UTMH1', 'Hope Haven Counseling', 'Ryan', 'W', 'Hamilton', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '9140 S State St Ste 101', 'Sandy', 'Salt Lake', 'UT', '84070', '8016768796', NULL, '9140 S State St Ste 101', 'Sandy', 'Salt Lake', 'UT', '84070', '8016768796', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2010-03-09', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295065712', 0, 'N', 0, '2013-09-11', NULL, NULL, 0, 0, NULL, NULL),
('271817962', 'W12004396', 'W12004396', 'UT01', 'Cottonwood Eye & Laser Clinic', 'David', 'T', 'Brockbank', 'MD', 'Ophthalmology', '', '', NULL, 'O', '201 E 5900 S Ste 101', 'Murray', 'Salt Lake', 'UT', '84107', '8012686600', NULL, '201 E 5900 S Ste 101', 'Murray', 'Salt Lake', 'UT', '84107', '8012686600', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-01', '2011-02-14', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1093822561', 0, 'N', 0, '2011-12-15', NULL, NULL, 0, 0, NULL, NULL),
('800481035', 'W12004399', 'W12004399', 'UT01', 'Mountainstar Canyon Surgical Clinic LLC', 'Lance', 'R', 'Bryce', 'MD', 'General Surgery', '', '', NULL, 'O', '2850 N 2000 W Ste 101', 'Farr West', 'Weber', 'UT', '84404', '8017311222', '8017311666', '2850 N 2000 W Ste 101', 'Farr West', 'Weber', 'UT', '84404', '8017311222', '8017311666', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-11-01', '2012-06-30', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639372840', 0, 'N', 0, '2013-10-15', NULL, NULL, 0, 0, NULL, NULL),
('800481035', 'W12004401', 'W12004401', 'UT01', 'Mountainstar Canyon Surgical Clinic LLC', 'Lance', 'R', 'Bryce', 'MD', 'General Surgery', '', '', NULL, 'M', '3 Marlyand Farms Ste 250', 'Brentwood', 'Williamson', 'TN', '37027', '8006613365', '8017311666', '3 Marlyand Farms Ste 250', 'Brentwood', 'Williamson', 'TN', '37027', '8006613365', '8017311666', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-11-01', '2012-06-30', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639372840', 0, 'N', 0, '2013-10-15', NULL, NULL, 0, 0, NULL, NULL),
('800481035', 'W12004398', 'W12004398', 'UT01', 'Mountainstar Canyon Surgical Clinic LLC', 'Lance', 'R', 'Bryce', 'MD', 'General Surgery', '', '', NULL, 'O', '984 S Medical Dr Ste 2', 'Brigham City', 'Box Elder', 'UT', '84302', '4357230329', '4357230429', '984 S Medical Dr Ste 2', 'Brigham City', 'Box Elder', 'UT', '84302', '4357230329', '4357230429', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-11-01', '2012-06-30', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639372840', 0, 'N', 0, '2013-10-15', NULL, NULL, 0, 0, NULL, NULL),
('800481035', 'W12004400', 'W12004400', 'UT01', 'Mountainstar Canyon Surgical Clinic LLC', 'Lance', 'R', 'Bryce', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 402302', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '8017311666', 'PO Box 402302', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '8017311666', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-11-01', '2012-06-30', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639372840', 0, 'N', 0, '2013-10-15', NULL, NULL, 0, 0, NULL, NULL),
('870573947', 'W12004402', 'W12004402', 'UT01', 'Holladay Family Practice', 'Carol', 'A', 'Cheney', 'NP', 'Family Practice', NULL, NULL, NULL, 'O', '999 Murray Holladay Rd 207', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012682584', '8012621168', '999 Murray Holladay Rd 207', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012682584', '8012621168', 'HOLLADAYFP', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1710952791', 0, 'N', 0, '2006-12-21', NULL, NULL, 40.6657, -111.862, NULL, NULL),
('870573947', 'W12004403', 'W12004403', 'UT01', 'Holladay Family Practice', 'Randall', 'P', 'Daynes', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '999 Murray Holladay Rd 207', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012682584', '8012621168', '999 Murray Holladay Rd 207', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012682584', '8012621168', 'HOLLADAYFP', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1811962939', 0, 'N', 0, '2012-06-19', NULL, NULL, 40.6657, -111.862, NULL, NULL),
('870573947', 'W12004404', 'W12004404', 'UT01', 'Holladay Family Practice', 'Gene', 'R', 'Fuller', 'MD', 'Family Practice', '', '', NULL, 'O', '999 Murray Holladay Rd 207', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012682584', '8012621168', '999 Murray Holladay Rd 207', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012682584', '8012621168', 'HOLLADAYFP', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1396710281', 0, 'N', 0, '2014-04-16', NULL, NULL, 40.6657, -111.862, NULL, NULL),
('870573947', 'W12004405', 'W12004405', 'UT01', 'Holladay Family Practice', '', '', 'Holladay Family Practice', 'Group', 'Primary Care with Extended Hours', '', '', NULL, 'O', '999 Murray Holladay Rd 207', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012682584', '8012621168', '999 Murray Holladay Rd 207', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012682584', '8012621168', 'HOLLADAYFP', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437255866', 0, 'N', 0, '2010-09-17', NULL, NULL, 40.6657, -111.862, NULL, NULL),
('870573947', 'W12004406', 'W12004406', 'UT01', 'Holladay Family Practice', 'Taylor', 'A', 'Jeppson', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '999 Murray Holladay Rd 207', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012682584', '8012621168', '999 Murray Holladay Rd 207', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012682584', '8012621168', 'HOLLADAYFP', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2014-04-01', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1932174919', 0, 'N', 0, '2014-03-21', NULL, NULL, 40.6657, -111.862, NULL, NULL),
('870573947', 'W12004407', 'W12004407', 'UT01', 'Holladay Family Practice', 'David', 'C', 'Larsen', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '999 Murray Holladay Rd 207', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012682584', '8012621168', '999 Murray Holladay Rd 207', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012682584', '8012621168', 'HOLLADAYFP', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1679548564', 0, 'N', 0, '2006-12-21', NULL, NULL, 40.6657, -111.862, NULL, NULL),
('870573947', 'W12004408', 'W12004408', 'UT01', 'Holladay Family Practice', 'Eric', 'C', 'McDougall', 'MD', 'Family Practice', '', '', NULL, 'O', '999 Murray Holladay Rd 207', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012682584', '8012621168', '999 Murray Holladay Rd 207', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012682584', '8012621168', 'HOLLADAYFP', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2014-02-06', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285609313', 0, 'N', 0, '2014-02-10', NULL, NULL, 0, 0, NULL, NULL),
('870573947', 'W12004409', 'W12004409', 'UT01', 'Holladay Family Practice', 'Brian', 'C', 'Rasmussen', 'MD', 'Family Practice', '', '', NULL, 'O', '999 Murray Holladay Rd 207', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012682584', '8012621168', '999 Murray Holladay Rd 207', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012682584', '8012621168', 'HOLLADAYFP', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1316058670', 0, 'N', 0, '2011-11-03', NULL, NULL, 40.6657, -111.862, NULL, NULL),
('528692286', 'W12004410', 'W12004410', 'UT01', 'Holladay Family Practice', 'Timothy', 'P', 'Young', 'MD', 'Family Practice', '', '', NULL, 'O', '999 Murray Holladay Rd Ste 207', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012682584', '8012621168', '999 Murray Holladay Rd Ste 207', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012682584', '8012621168', 'WUSTDMULT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1558520189', 0, 'N', 0, '2013-11-25', NULL, NULL, 40.6657, -111.862, NULL, NULL),
('271637237', 'W12004411', 'W12004411', 'UT01', 'Davis Vision Center Associates PLLC', 'Brian', 'R', 'Davis', 'MD', 'Ophthalmology', '', '', NULL, 'O', '3741 W 12600 S Ste 480', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854000', '8012854871', '3741 W 12600 S Ste 480', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854000', '8012854871', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-04-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1679583470', 0, 'N', 0, '2014-01-17', NULL, NULL, 40.5222, -111.98, NULL, NULL),
('271637237', 'W12004412', 'W12004412', 'UT01', 'Davis Vision Center Associates PLLC', 'Kurt', 'P', 'Hepworth', 'OD', 'Optometry', '', '', NULL, 'O', '3741 W 12600 S Ste 480', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854000', '8012854871', '3741 W 12600 S Ste 480', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854000', '8012854871', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-04-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1457531428', 0, 'N', 0, '2012-07-31', NULL, NULL, 40.5222, -111.98, NULL, NULL),
('271817962', 'W12004413', 'W12004413', 'UT01', 'Cottonwood Eye & Laser Clinic', 'Steven', 'T', 'Jackson', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '201 E 5900 S Ste 101', 'Murray', 'Salt Lake', 'UT', '84107', '8012686600', NULL, '201 E 5900 S Ste 101', 'Murray', 'Salt Lake', 'UT', '84107', '8012686600', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-01', '2011-10-05', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447215173', 0, 'N', 0, '2011-10-05', NULL, NULL, 0, 0, NULL, NULL),
('271817962', 'W12004414', 'W12004414', 'UT01', 'Cottonwood Eye & Laser Clinic', 'Alan', 'E', 'Jackson', 'MD', 'Ophthalmology', '', '', NULL, 'O', '201 E 5900 S Ste 101', 'Murray', 'Salt Lake', 'UT', '84107', '8012686600', NULL, '201 E 5900 S Ste 101', 'Murray', 'Salt Lake', 'UT', '84107', '8012686600', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1467411223', 0, 'N', 0, '2011-11-16', NULL, NULL, 40.6426, -111.885, NULL, NULL),
('271817962', 'W12004415', 'W12004415', 'UT01', 'Cottonwood Eye & Laser Clinic', 'Michael', 'M', 'Judkins', 'OD', 'Optometry', '', '', NULL, 'O', '201 E 5900 S Ste 101', 'Murray', 'Salt Lake', 'UT', '84107', '8012686600', NULL, '201 E 5900 S Ste 101', 'Murray', 'Salt Lake', 'UT', '84107', '8012686600', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-01', '2011-10-05', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699774026', 0, 'N', 0, '2011-10-05', NULL, NULL, 0, 0, NULL, NULL),
('271817962', 'W12004416', 'W12004416', 'UT01', 'Cottonwood Eye & Laser Clinic', 'Mike', 'K', 'Mitchell', 'OD', 'Optometry', '', '', NULL, 'O', '201 E 5900 S Ste 101', 'Murray', 'Salt Lake', 'UT', '84107', '8012686600', NULL, '201 E 5900 S Ste 101', 'Murray', 'Salt Lake', 'UT', '84107', '8012686600', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851362339', 0, 'N', 0, '2012-05-22', NULL, NULL, 40.6426, -111.885, NULL, NULL),
('331177233', 'W12004417', 'W12004417', 'UT01', 'Ogden Adult and Senior Medicine', 'Leslie', 'A', 'Bean', 'APRN', 'Internal Medicine', '', '', NULL, 'O', '425 E 5350 S Ste 255', 'Ogden', 'Weber', 'UT', '84405', '8014792911', '8014792914', '425 E 5350 S Ste 255', 'Ogden', 'Weber', 'UT', '84405', '8014792911', '8014792914', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2010-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336260447', 0, 'N', 0, '2012-08-03', NULL, NULL, 0, 0, NULL, NULL),
('331177233', 'W12004418', 'W12004418', 'UT01', 'Ogden Adult and Senior Medicine', 'Leslie', 'A', 'Bean', 'APRN', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 100925', 'Atlanta', 'Fulton', 'GA', '30384', '8014792911', '8014792914', 'PO Box 100925', 'Atlanta', 'Fulton', 'GA', '30384', '8014792911', '8014792914', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336260447', 0, 'N', 0, '2012-08-03', NULL, NULL, 0, 0, NULL, NULL),
('331177233', 'W12004419', 'W12004419', 'UT01', 'Ogden Adult and Senior Medicine', 'Leslie', 'A', 'Bean', 'APRN', 'Internal Medicine', '', '', NULL, 'M', '3 Maryland Farms Ste 250', 'Brentwood', 'Williamson', 'TN', '37027', '8014792911', '8014792914', '3 Maryland Farms Ste 250', 'Brentwood', 'Williamson', 'TN', '37027', '8014792911', '8014792914', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336260447', 0, 'N', 0, '2012-08-03', NULL, NULL, 0, 0, NULL, NULL),
('262296552', 'W12004420', 'W12004420', 'UT01', '', 'Steven', 'E', 'Call', 'MD', 'Rheumatology', '', '', NULL, 'O', '3651 N 100 E Ste 150', 'Provo', 'Utah', 'UT', '84604', '8012260737', '8012660832', '3651 N 100 E Ste 150', 'Provo', 'Utah', 'UT', '84604', '8012260737', '8012660832', 'SCALL', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1790957454', 0, 'N', 0, '2012-06-26', NULL, NULL, 40.2824, -111.657, NULL, NULL),
('205905417', 'W12004421', 'W12004421', 'UT01', 'Nephrology of Northern Utah', 'Ruth', 'M', 'Indahyung', 'MD', 'Nephrology', '', '', NULL, 'O', '425 E 5350 S Ste 320', 'Ogden', 'Weber', 'UT', '84405', '8014791117', NULL, '425 E 5350 S Ste 320', 'Ogden', 'Weber', 'UT', '84405', '8014791117', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-10', '2012-08-31', 0, 0, 0, 'Lakeview Hospital', 'St Marks Hospital', '', '', 'HCFA|UB|', '1649452772', 0, 'N', 0, '2013-03-15', NULL, NULL, 0, 0, NULL, NULL),
('205905417', 'W12004422', 'W12004422', 'UT01', 'Nephrology of Northern Utah', 'Ruth', 'M', 'Indahyung', 'MD', 'Nephrology', '', '', NULL, 'O', '942 S Main', 'Layton', 'Davis', 'UT', '84041', '8014791117', NULL, '942 S Main', 'Layton', 'Davis', 'UT', '84041', '8014791117', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-10', '2012-08-31', 0, 0, 0, 'Lakeview Hospital', 'St Marks Hospital', '', '', 'HCFA|UB|', '1649452772', 0, 'N', 0, '2013-03-15', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
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('870767026', 'W11025353', 'W11025353', 'ID01', 'Caldwell Internal Medicine Group', 'Steven', 'T', 'Koga', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 277976', 'Atlanta', 'Fulton', 'GA', '30384', '2084594667', NULL, 'PO Box 277976', 'Atlanta', 'Fulton', 'GA', '30384', '2084594667', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1144275512', 0, 'N', 0, '2013-08-16', NULL, NULL, 0, 0, NULL, NULL),
('331177233', 'W11025435', 'W11025435', 'UT01', 'Ogden Internal Medicine & Urology', 'Samuel', 'J', 'Otto', 'MD', 'Urology', '', '', NULL, 'O', '5405 S 500 E Ste 203', 'Ogden', 'Weber', 'UT', '84405', '8014758600', NULL, '5405 S 500 E Ste 203', 'Ogden', 'Weber', 'UT', '84405', '8014758600', '', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1154565273', 0, 'N', 0, '2014-04-09', NULL, NULL, 0, 0, NULL, NULL),
('331177233', 'W11025450', 'W11025450', 'UT01', 'Ogden Internal Medicine and Urology LLC', 'Samuel', 'J', 'Otto', 'MD', 'Urology', '', '', NULL, 'O', '620 E Medical Dr Ste 300', 'Bountiful', 'Davis', 'UT', '84010', '8012983247', '8012989675', '620 E Medical Dr Ste 300', 'Bountiful', 'Davis', 'UT', '84010', '8012983247', '8012989675', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1154565273', 0, 'N', 0, '2014-04-09', NULL, NULL, 0, 0, NULL, NULL),
('331177233', 'W11025436', 'W11025436', 'UT01', 'Ogden Internal Medicine & Urology', 'Samuel', 'J', 'Otto', 'MD', 'Urology', '', '', NULL, 'B', 'PO Box 100925', 'Atlanta', 'Fulton', 'GA', '30384', '8014758600', NULL, 'PO Box 100925', 'Atlanta', 'Fulton', 'GA', '30384', '8014758600', '', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1154565273', 0, 'N', 0, '2014-04-09', NULL, NULL, 0, 0, NULL, NULL),
('331177233', 'W11025379', 'W11025379', 'UT01', 'Ogden Internal Medicine & Urology', 'Joseph', 'A', 'Conrad', 'MD', 'Geriatrics', 'Pulmonary', '', NULL, 'O', '5405 S 500 E Ste 100A', 'Ogden', 'Weber', 'UT', '84405', '8014754617', '8014758686', '5405 S 500 E Ste 100A', 'Ogden', 'Weber', 'UT', '84405', '8014754617', '8014758686', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2010-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164502662', 0, 'N', 0, '2010-11-19', NULL, NULL, 0, 0, NULL, NULL),
('331177233', 'W11025357', 'W11025357', 'UT01', 'Ogden Internal Medicine & Urology', 'Joseph', 'A', 'Conrad', 'MD', 'Geriatrics', 'Pulmonary', '', NULL, 'B', 'PO Box 100925', 'Atlanta', 'Fulton', 'GA', '30384', '8014758600', NULL, 'PO Box 100925', 'Atlanta', 'Fulton', 'GA', '30384', '8014758600', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2010-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164502662', 0, 'N', 0, '2010-11-19', NULL, NULL, 0, 0, NULL, NULL),
('201581429', 'W11025319', 'W11025319', 'UT01', 'St Marks Maternal Fetal of Utah', 'Michael', 'A', 'Belfort', 'MD', 'Maternal Fetal Medicine', 'Obstetrics and Gynecology', 'Perinatology', NULL, 'O', '1140 E 3900 S Ste 390', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434713', '8017434705', '1140 E 3900 S Ste 390', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434713', '8017434705', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2010-12-28', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1184618753', 0, 'N', 0, '2009-06-23', NULL, NULL, 0, 0, NULL, NULL),
('201581429', 'W11025316', 'W11025316', 'UT01', 'St Marks Maternal Fetal of Utah', 'Michael', 'A', 'Belfort', 'MD', 'Maternal Fetal Medicine', 'Obstetrics and Gynecology', 'Perinatology', NULL, 'O', '3100 Channing Way', 'Idaho Falls', 'Bonneville', 'ID', '83404', '2085296111', NULL, '3100 Channing Way', 'Idaho Falls', 'Bonneville', 'ID', '83404', '2085296111', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2010-12-28', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1184618753', 0, 'N', 0, '2009-06-23', NULL, NULL, 0, 0, NULL, NULL),
('061787631', 'W11025404', 'W11025404', 'UT01', 'Lone Peak General Surgery', 'Ian', 'R', 'Cavin', 'DO', 'General Surgery', '', '', NULL, 'O', '4000 S 700 E Ste 9', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012623564', '8012623613', '4000 S 700 E Ste 9', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012623564', '8012623613', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1184647315', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
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('061787631', 'W11025401', 'W11025401', 'UT01', 'Jordan Family Health', 'Ian', 'R', 'Cavin', 'DO', 'General Surgery', '', '', NULL, 'O', '8846 S Redwood Rd Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', NULL, '8846 S Redwood Rd Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1184647315', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('061787631', 'W11025342', 'W11025342', 'UT01', 'Lone Peak General Surgery', 'Ian', 'R', 'Cavin', 'DO', 'General Surgery', '', '', NULL, 'B', 'PO Box 100253', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', NULL, 'PO Box 100253', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1184647315', 0, 'Y', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('800223062', 'W11025366', 'W11025366', 'UT01', 'Brigham Center for Womens Health', 'Daniel', 'R', 'Ferguson', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '984 S Medical Dr Ste 4', 'Brigham City', 'Box Elder', 'UT', '84302', '4356952273', NULL, '984 S Medical Dr Ste 4', 'Brigham City', 'Box Elder', 'UT', '84302', '4356952273', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, 'Brigham City Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1194802991', 0, 'N', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
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('352329743', 'W11025364', 'W11025364', 'UT01', 'Mountain Star Pediatrics', 'Kenneth', 'E', 'Stevenson', 'MD', 'Pediatrics', '', '', NULL, 'O', '5495 S 500 E Ste 120', 'Ogden', 'Weber', 'UT', '84405', '8014790174', NULL, '5495 S 500 E Ste 120', 'Ogden', 'Weber', 'UT', '84405', '8014790174', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1245326065', 0, 'N', 0, '2012-06-28', NULL, NULL, 0, 0, NULL, NULL),
('800239738', 'W11025371', 'W11025371', 'UT01', 'Jordan Family Health ', 'Judith', 'L', 'Kirstein', 'MD', 'Family Practice', '', '', NULL, 'O', '8846 S Redwood Rd Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84084', '8015691999', NULL, '8846 S Redwood Rd Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84084', '8015691999', '', 'WISE+5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2010-09-01', NULL, 0, 0, 0, 'St Marks Hospital', 'Jordan Valley Medical Center', 'Pioneer Valley Hospital', '', 'HCFA|UB|', '1275576027', 0, 'N', 0, '2014-04-09', NULL, NULL, 40.5911, -111.939, NULL, NULL),
('800239738', 'W11025370', 'W11025370', 'UT01', 'Jordan Family Health ', 'Judith', 'L', 'Kirstein', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 405483', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', NULL, 'PO Box 405483', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', '', 'WISE+5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2010-09-01', NULL, 0, 0, 0, 'St Marks Hospital', 'Jordan Valley Medical Center', 'Pioneer Valley Hospital', '', 'HCFA|UB|', '1275576027', 0, 'y', 0, '2014-04-09', NULL, NULL, 0, 0, NULL, NULL),
('450579015', 'W11025412', 'W11025412', 'UT01', 'South Jordan Family Practice', 'David', 'D', 'Poor', 'MD', 'Family Practice', '', '', NULL, 'O', '10623 S Redwood Rd Ste 101', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013020899', NULL, '10623 S Redwood Rd Ste 101', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013020899', '', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2011-12-31', 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1275589699', 0, 'N', 0, '2014-04-09', NULL, NULL, 0, 0, NULL, NULL),
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('450579015', 'W11025385', 'W11025385', 'UT01', 'St Marks South Jordan Family Practice', 'Anne', 'M', 'Dubosky', 'DO', 'Family Practice', '', '', NULL, 'O', '10623 S Redwood Rd Ste 100', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013020899', '8013020892', '10623 S Redwood Rd Ste 100', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013020899', '8013020892', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2011-09-29', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1295769446', 0, 'N', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
('450579015', 'W11025449', 'W11025449', 'UT01', 'St Marks South Jordan Family Practice', 'Anne', 'M', 'Dubosky', 'DO', 'Family Practice', '', '', NULL, 'O', '74 E Kimballs Ln Ste 260', 'South Jordan', 'Salt Lake', 'UT', '84020', '8015458480', '8015458495', '74 E Kimballs Ln Ste 260', 'South Jordan', 'Salt Lake', 'UT', '84020', '8015458480', '8015458495', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2011-12-31', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1295769446', 0, 'N', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
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('900448097', 'W11025429', 'W11025429', 'UT01', 'Lakeview Urology & General Surgery ', 'Jon', 'C', 'Oberg', 'MD', 'General Surgery', 'Vascular Surgery', '', NULL, 'B', 'PO Box 405831', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '          ', 'PO Box 405831', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2014-04-04', 0, 0, 0, 'Davis Hospital', 'Lakeview Hospital', '', '', 'HCFA|UB|', '1316035942', 0, 'N', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('061787631', 'W11025405', 'W11025405', 'UT01', 'Lone Peak General Surgery', 'Charles', 'R', 'Davis', 'MD', 'General Surgery', '', '', NULL, 'O', '4000 S 700 E Ste 9', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012623564', '8012623613', '4000 S 700 E Ste 9', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012623564', '8012623613', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1326136565', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('061787631', 'W11025448', 'W11025448', 'UT01', 'Lone Peak General Surgery', 'Charles', 'R', 'Davis', 'MD', 'General Surgery', '', '', NULL, 'O', '74 Kimballs Ln', 'Salt Lake City', 'Salt Lake', 'UT', '84020', '8015663062', '8015018219', '74 Kimballs Ln', 'Salt Lake City', 'Salt Lake', 'UT', '84020', '8015663062', '8015018219', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1326136565', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('061787631', 'W11025402', 'W11025402', 'UT01', 'Jordan Family Health', 'Charles', 'R', 'Davis', 'MD', 'General Surgery', '', '', NULL, 'O', '8846 S Redwood Rd Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', NULL, '8846 S Redwood Rd Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1326136565', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('061787631', 'W11025343', 'W11025343', 'UT01', 'Lone Peak General Surgery', 'Charles', 'R', 'Davis', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 100253', 'Atlanta', 'Fulton', 'GA', '30384', '8015663062', NULL, 'PO Box 100253', 'Atlanta', 'Fulton', 'GA', '30384', '8015663062', '', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1326136565', 0, 'Y', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('870618816', 'W12047860', 'W12047860', 'UT01', 'Petersen Medical', '', '', 'Orem Branch Location', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'B', '1268 S 1380 W', 'Orem', 'Utah', 'UT', '84058', '8013731010', '          ', '1268 S 1380 W', 'Orem', 'Utah', 'UT', '84058', '8013731010', '          ', 'DME75CURR', '', '', '0.00', '40.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164519856', 0, 'N', 0, '2014-05-16', NULL, NULL, 0, 0, NULL, NULL),
('061787631', 'W11025396', 'W11025396', 'UT01', 'Lone Peak General Surgery', 'Hugh', 'D', 'Voorhees', 'MD', 'General Surgery', '', '', NULL, 'O', '4000 S 700 E Ste 9', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012623564', '8012623613', '4000 S 700 E Ste 9', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012623564', '8012623613', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1346354537', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('061787631', 'W11025403', 'W11025403', 'UT01', 'Jordan Family Health', 'Hugh', 'D', 'Voorhees', 'MD', 'General Surgery', '', '', NULL, 'O', '8846 S Redwood Rd Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', NULL, '8846 S Redwood Rd Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1346354537', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('061787631', 'W11025395', 'W11025395', 'UT01', 'Lone Peak General Surgery', 'Hugh', 'D', 'Voorhees', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 100253', 'Atlanta', 'Fulton', 'GA', '30384', '8015663062', NULL, 'PO Box 100253', 'Atlanta', 'Fulton', 'GA', '30384', '8015663062', '', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1346354537', 0, 'Y', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
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('134332141', 'W11025382', 'W11025382', 'UT01', 'MountainStar Cardiovascular Surgery', 'Wendy', 'S', 'Douglas', 'APRN', 'Cardiovascular Disease', '', '', NULL, 'O', '1160 E 3900 S Ste 3500', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434750', NULL, '1160 E 3900 S Ste 3500', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434750', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1427297084', 0, 'N', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
('134332141', 'W11025406', 'W11025406', 'UT01', 'MountainStar Cardiovascular Surgery', 'Wendy', 'S', 'Douglas', 'APRN', 'Cardiovascular Disease', '', '', NULL, 'O', '5405 S 500 E Ste 200', 'Ogden', 'Weber', 'UT', '84405', '8014766900', NULL, '5405 S 500 E Ste 200', 'Ogden', 'Weber', 'UT', '84405', '8014766900', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1427297084', 0, 'N', 0, '2012-06-25', 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
('134332141', 'W11025383', 'W11025383', 'UT01', 'MountainStar Cardiovascular Surgery', 'Wendy', 'S', 'Douglas', 'APRN', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 281490', 'Atlanta', 'Fulton', 'GA', '30384', '8017434750', NULL, 'PO Box 281490', 'Atlanta', 'Fulton', 'GA', '30384', '8017434750', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1427297084', 0, 'N', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
('331177233', 'W11025431', 'W11025431', 'UT01', 'Ogden Internal Medicine, LLC', 'Kathleen', 'R', 'DeRemer', 'MD', 'Internal Medicine', '', '', NULL, 'O', '5405 S 500 E Ste 203', 'Ogden', 'Weber', 'UT', '84405', '8014754617', '8014758686', '5405 S 500 E Ste 203', 'Ogden', 'Weber', 'UT', '84405', '8014754617', '8014758686', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1437267192', 0, 'N', 0, '2013-08-21', NULL, NULL, 0, 0, NULL, NULL),
('331177233', 'W11025432', 'W11025432', 'UT01', 'Ogden Internal Medicine, LLC', 'Kathleen', 'R', 'DeRemer', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 100925', 'Atlanta', 'Fulton', 'GA', '30384', '8014758600', NULL, 'PO Box 100925', 'Atlanta', 'Fulton', 'GA', '30384', '8014758600', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1437267192', 0, 'N', 0, '2013-08-21', NULL, NULL, 0, 0, NULL, NULL),
('201581429', 'W11025452', 'W11025452', 'UT01', 'Maternal Fetal Services of Utah', 'Robert', 'H', 'Ball', 'MD', 'Perinatology', '', '', NULL, 'O', '1140 E 3900 S Ste 390', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434700', NULL, '1140 E 3900 S Ste 390', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434700', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2011-10-01', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1447215751', 0, 'N', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
('201581429', 'W11025451', 'W11025451', 'UT01', 'Maternal Fetal Services of Utah', 'Robert', 'H', 'Ball', 'MD', 'Perinatology', '', '', NULL, 'O', '3100 Channing Way', 'Idaho Falls', 'Bonneville', 'ID', '83404', '2085296111', NULL, '3100 Channing Way', 'Idaho Falls', 'Bonneville', 'ID', '83404', '2085296111', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2011-10-01', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1447215751', 0, 'N', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
('161767581', 'W11025438', 'W11025438', 'UT01', 'Layton Family Practice', 'Mont', 'C', 'Robins', 'PA', 'Family Practice', '', '', NULL, 'O', '124 S Fairfield Rd', 'Layton', 'Davis', 'UT', '84041', '8015469441', NULL, '124 S Fairfield Rd', 'Layton', 'Davis', 'UT', '84041', '8015469441', '', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2011-09-30', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1467440701', 0, 'N', 0, '2014-04-09', NULL, NULL, 0, 0, NULL, NULL),
('161767581', 'W11025437', 'W11025437', 'UT01', 'Layton Family Practice', 'Mont', 'C', 'Robins', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 281221', 'Atlanta', 'Fulton', 'GA', '30384', '8015469441', NULL, 'PO Box 281221', 'Atlanta', 'Fulton', 'GA', '30384', '8015469441', '', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1467440701', 0, 'N', 0, '2014-04-09', NULL, NULL, 0, 0, NULL, NULL),
('450579015', 'W11025384', 'W11025384', 'UT01', 'St Marks South Jordan Family Practice', 'Theresa', 'D', 'Gourde', 'MD', 'Family Practice', 'Internal Medicine', '', NULL, 'O', '10623 S Redwood Rd Ste 101', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013020899', '8013020892', '10623 S Redwood Rd Ste 101', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013020899', '8013020892', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2011-12-31', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1487688685', 0, 'N', 0, '2013-09-19', NULL, NULL, 0, 0, NULL, NULL),
('450579015', 'W11025386', 'W11025386', 'UT01', 'St Marks South Jordan Family Practice', 'Theresa', 'D', 'Gourde', 'MD', 'Family Practice', 'Internal Medicine', '', NULL, 'B', 'PO Box 281148', 'Atlanta', 'Fulton', 'GA', '30384', '8013020899', '8013020892', 'PO Box 281148', 'Atlanta', 'Fulton', 'GA', '30384', '8013020899', '8013020892', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2011-12-31', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1487688685', 0, 'N', 0, '2013-09-19', NULL, NULL, 0, 0, NULL, NULL),
('450579013', 'W11025376', 'W11025376', 'UT01', 'St Marks Gynocology Oncology Care', 'Denise', '', 'Gitlin', 'APRN', 'Gynecologic Oncology', '', '', NULL, 'O', '1140 E 3900 S Ste 340', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434730', NULL, '1140 E 3900 S Ste 340', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434730', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1487744082', 0, 'N', 0, '2013-01-10', NULL, NULL, 0, 0, NULL, NULL),
('450579013', 'W11025377', 'W11025377', 'UT01', 'Monarch Womens Cancer Center', 'Denise', '', 'Gitlin', 'APRN', 'Gynecologic Oncology', '', '', NULL, 'O', '3100 Channing Way', 'Idaho Falls', 'Bonneville', 'ID', '83404', '2085296111', NULL, '3100 Channing Way', 'Idaho Falls', 'Bonneville', 'ID', '83404', '2085296111', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1487744082', 0, 'N', 0, '2013-01-10', NULL, NULL, 0, 0, NULL, NULL),
('450579013', 'W11025378', 'W11025378', 'UT01', 'Monarch Womens Cancer Center', 'Denise', '', 'Gitlin', 'APRN', 'Gynecologic Oncology', '', '', NULL, 'B', 'PO Box 198546', 'Atlanta', 'Fulton', 'GA', '30384', '2085296111', NULL, 'PO Box 198546', 'Atlanta', 'Fulton', 'GA', '30384', '2085296111', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1487744082', 0, 'N', 0, '2013-01-10', NULL, NULL, 0, 0, NULL, NULL),
('743096310', 'W11025340', 'W11025340', 'UT01', 'St Marks Senior Center', 'Danesh', '', 'Rahimi', 'MD', 'Geriatrics', 'Internal Medicine', '', NULL, 'O', '1160 E 3900 S Ste G200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687766', NULL, '1160 E 3900 S Ste G200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687766', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1487744553', 0, 'N', 0, '2014-02-06', NULL, NULL, 0, 0, NULL, NULL),
('743096310', 'W11025331', 'W11025331', 'UT01', 'St Marks Senior Center', 'Danesh', '', 'Rahimi', 'MD', 'Geriatrics', 'Internal Medicine', '', NULL, 'B', 'PO Box 271220', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '6153737629', NULL, 'PO Box 271220', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '6153737629', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1487744553', 0, 'Y', 0, '2014-02-06', NULL, NULL, 0, 0, NULL, NULL),
('800239738', 'W11025360', 'W11025360', 'UT01', 'Jordan Family Health LLC', 'Joni', 'W', 'Hougaard', 'MD', 'Family Practice', '', '', NULL, 'O', '8846 S Redwood Rd Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84084', '8015691999', '', '8846 S Redwood Rd Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84084', '8015691999', '', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2011-12-31', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1508801606', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('800239738', 'W11025361', 'W11025361', 'UT01', 'Jordan Family Health LLC', 'Joni', 'W', 'Hougaard', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 405483', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', '', 'PO Box 405483', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', '', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2011-12-31', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1508801606', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('621560557', 'W11025323', 'W11025323', 'UT01', 'South Ogden Center for Family Medicine', 'Michael', 'D', 'Woolman', 'MD', 'Family Practice', '', '', NULL, 'O', '5740 Crestwood Dr', 'Ogden', 'Weber', 'UT', '84405', '8014797771', '8014797795', '5740 Crestwood Dr', 'Ogden', 'Weber', 'UT', '84405', '8014797771', '8014797795', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1508833450', 0, 'N', 0, '2014-04-04', NULL, NULL, 41.1583, -111.947, NULL, NULL),
('134332141', 'W11025391', 'W11025391', 'UT01', 'MountainStar Cardiovascular Surgery', 'Joseph', 'E', 'Graham', 'MD', 'Cardiovascular Disease', 'Thoracic Surgery', 'Vascular Surgery', NULL, 'O', '1160 E 3900 S Ste 3500', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434750', NULL, '1160 E 3900 S Ste 3500', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434750', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1578638383', 0, 'N', 0, '2014-03-24', NULL, NULL, 0, 0, NULL, NULL),
('134332141', 'W11025392', 'W11025392', 'UT01', 'MountainStar Cardiovascular Surgery', 'Joseph', 'E', 'Graham', 'MD', 'Cardiovascular Disease', 'Thoracic Surgery', 'Vascular Surgery', NULL, 'O', '5405 S 500 E Ste 200', 'Ogden', 'Weber', 'UT', '84405', '8014766900', NULL, '5405 S 500 E Ste 200', 'Ogden', 'Weber', 'UT', '84405', '8014766900', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1578638383', 0, 'N', 0, '2014-03-24', NULL, NULL, 0, 0, NULL, NULL),
('200133012', 'W11025374', 'W11025374', 'UT01', 'Lakeview OB/GYN Clinic', 'Laura', 'M', 'Zaugg', 'CNM', 'Family Practice', '', '', NULL, 'O', '620 E Medical Dr Ste 340', 'Bountiful', 'Davis', 'UT', '84010', '8012992229', NULL, '620 E Medical Dr Ste 340', 'Bountiful', 'Davis', 'UT', '84010', '8012992229', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1598831604', 0, 'N', 0, '2012-06-28', NULL, NULL, 0, 0, NULL, NULL),
('200133012', 'W11025375', 'W11025375', 'UT01', 'Lakeview OB/GYN Clinic', 'Laura', 'M', 'Zaugg', 'CNM', 'Family Practice', '', '', NULL, 'B', 'PO Box 281721', 'Atlanta', 'Fulton', 'GA', '30384', '8012992229', NULL, 'PO Box 281721', 'Atlanta', 'Fulton', 'GA', '30384', '8012992229', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1598831604', 0, 'N', 0, '2012-06-28', NULL, NULL, 0, 0, NULL, NULL),
('134332141', 'W11025454', 'W11025454', 'UT01', 'MountainStar Cardiovascular Surgery', 'Gilbert', 'R', 'Schorlemmer', 'MD', 'Cardiovascular Disease', 'Thoracic Surgery', '', NULL, 'O', '1160 E 3900 S Ste 3500', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434750', NULL, '1160 E 3900 S Ste 3500', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434750', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1629060553', 0, 'N', 0, '2012-06-28', NULL, NULL, 0, 0, NULL, NULL),
('134332141', 'W11025394', 'W11025394', 'UT01', 'MountainStar Cardiovascular Surgery', 'Gilbert', 'R', 'Schorlemmer', 'MD', 'Cardiovascular Disease', 'Thoracic Surgery', '', NULL, 'O', '698 W 800 N Ste 210', 'Orem', 'Utah', 'UT', '84057', '8017146412', NULL, '698 W 800 N Ste 210', 'Orem', 'Utah', 'UT', '84057', '8017146412', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1629060553', 0, 'N', 0, '2012-06-28', NULL, NULL, 0, 0, NULL, NULL),
('743096310', 'W11025338', 'W11025338', 'UT01', 'St Marks Senior Center', 'Laurene', '', 'Joseph', 'MD', 'Geriatrics', 'Internal Medicine', '', NULL, 'O', '1160 E 3900 S Ste G200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687766', NULL, '1160 E 3900 S Ste G200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687766', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1629145123', 0, 'N', 0, '2014-02-06', NULL, NULL, 0, 0, NULL, NULL),
('743096310', 'W11025333', 'W11025333', 'UT01', 'St Marks Senior Center', 'Laurene', '', 'Joseph', 'MD', 'Geriatrics', 'Internal Medicine', '', NULL, 'B', 'PO Box 271220', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '6153737629', NULL, 'PO Box 271220', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '6153737629', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1629145123', 0, 'Y', 0, '2014-02-06', NULL, NULL, 0, 0, NULL, NULL),
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('260686204', 'W11025363', 'W11025363', 'UT01', 'Canyon Surgical Clinic', 'Lance', 'R', 'Bryce', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 268', 'Bountiful', 'Davis', 'UT', '84011', '4357230329', NULL, 'PO Box 268', 'Bountiful', 'Davis', 'UT', '84011', '4357230329', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2012-12-31', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639372840', 0, 'N', 0, '2013-10-15', NULL, NULL, 0, 0, NULL, NULL),
('161767581', 'W11025327', 'W11025327', 'UT01', 'Layton Family Practice', 'Jonathan', 'A', 'Weeks', 'MD', 'Family Practice', '', '', NULL, 'O', '124 S Fairfield Rd', 'Layton', 'Davis', 'UT', '84041', '8015469441', NULL, '124 S Fairfield Rd', 'Layton', 'Davis', 'UT', '84041', '8015469441', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2011-09-30', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1649364803', 0, 'N', 0, '2013-10-30', NULL, NULL, 0, 0, NULL, NULL),
('743096310', 'W11025339', 'W11025339', 'UT01', 'St Marks Senior Center', 'Florentino', '', 'Abueg', 'MD', 'Geriatrics', 'Internal Medicine', '', NULL, 'O', '1160 E 3900 S Ste G200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687766', NULL, '1160 E 3900 S Ste G200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687766', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1649372558', 0, 'N', 0, '2014-02-06', NULL, NULL, 0, 0, NULL, NULL),
('743096310', 'W11025332', 'W11025332', 'UT01', 'St Marks Senior Center', 'Florentino', '', 'Abueg', 'MD', 'Geriatrics', 'Internal Medicine', '', NULL, 'B', 'PO Box 271220', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '6153737629', NULL, 'PO Box 271220', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '6153737629', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1649372558', 0, 'Y', 0, '2014-02-06', NULL, NULL, 0, 0, NULL, NULL),
('800239738', 'W11025369', 'W11025369', 'UT01', 'Jordan Family Health LLC', 'Caryn', 'M', 'Slack', 'MD', 'Family Practice', '', '', NULL, 'O', '8846 S Redwood Rd Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84084', '8015691999', NULL, '8846 S Redwood Rd Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84084', '8015691999', '', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2011-12-31', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1689619124', 0, 'N', 0, '2014-04-10', NULL, NULL, 0, 0, NULL, NULL),
('800239738', 'W11025368', 'W11025368', 'UT01', 'Jordan Family Health LLC', 'Caryn', 'M', 'Slack', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 405483', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', NULL, 'PO Box 405483', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', '', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2011-12-31', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1689619124', 0, 'N', 0, '2014-04-10', NULL, NULL, 0, 0, NULL, NULL),
('134332141', 'W11025389', 'W11025389', 'UT01', 'MountainStar Cardiovascular Surgery', 'Analee', '', 'Creer', 'APRN', 'Cardiovascular Disease', '', '', NULL, 'O', '1160 E 3900 S Ste 3500', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434750', NULL, '1160 E 3900 S Ste 3500', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434750', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, 'Timpanogos Regional Hospital', 'St Marks Hospital', '', '', 'HCFA|UB|', '1689856320', 0, 'N', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
('134332141', 'W11025390', 'W11025390', 'UT01', 'MountainStar Cardiovascular Surgery', 'Analee', '', 'Creer', 'APRN', 'Cardiovascular Disease', '', '', NULL, 'O', '698 W 800 N Ste 210', 'Orem', 'Utah', 'UT', '84057', '8017146412', NULL, '698 W 800 N Ste 210', 'Orem', 'Utah', 'UT', '84057', '8017146412', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, 'Timpanogos Regional Hospital', 'St Marks Hospital', '', '', 'HCFA|UB|', '1689856320', 0, 'N', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
('743096310', 'W11025337', 'W11025337', 'UT01', 'St Marks Senior Center', 'Robert', '', 'Powell', 'MD', 'Geriatrics', 'Internal Medicine', '', NULL, 'O', '1160 E 3900 S Ste G200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687766', NULL, '1160 E 3900 S Ste G200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687766', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2013-07-10', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1700988656', 0, 'N', 0, '2014-01-28', NULL, NULL, 0, 0, NULL, NULL),
('743096310', 'W11025334', 'W11025334', 'UT01', 'St Marks Senior Center', 'Robert', '', 'Powell', 'MD', 'Geriatrics', 'Internal Medicine', '', NULL, 'B', 'PO Box 271220', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '6153737629', NULL, 'PO Box 271220', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '6153737629', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2013-07-10', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1700988656', 0, 'Y', 0, '2014-01-28', NULL, NULL, 0, 0, NULL, NULL),
('134332141', 'W11025455', 'W11025455', 'UT01', 'MountainStar Cardiovascular Surgery', 'David', 'G', 'Affleck', 'MD', 'Cardiovascular Disease', 'Thoracic Surgery', '', NULL, 'O', '1160 E 3900 S Ste 3500', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434750', NULL, '1160 E 3900 S Ste 3500', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434750', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1710979653', 0, 'N', 0, '2012-06-22', NULL, NULL, 0, 0, NULL, NULL),
('134332141', 'W11025388', 'W11025388', 'UT01', 'MountainStar Cardiovascular Surgery', 'David', 'G', 'Affleck', 'MD', 'Cardiovascular Disease', 'Thoracic Surgery', '', NULL, 'O', '698 W 800 N Ste 210', 'Orem', 'Utah', 'UT', '84057', '8017146412', NULL, '698 W 800 N Ste 210', 'Orem', 'Utah', 'UT', '84057', '8017146412', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1710979653', 0, 'N', 0, '2012-06-22', NULL, NULL, 0, 0, NULL, NULL),
('743096310', 'W11025359', 'W11025359', 'UT01', 'St Marks Pain Center', 'David', 'D', 'Byrd', 'MD', 'Pain Management', '', '', NULL, 'O', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687729', NULL, '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687729', '', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1720173164', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('743096310', 'W11025358', 'W11025358', 'UT01', 'St Marks Pain Center', 'David', 'D', 'Byrd', 'MD', 'Pain Management', '', '', NULL, 'B', 'PO Box 271220', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '6153737629', NULL, 'PO Box 271220', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '6153737629', '', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1720173164', 0, 'Y', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('870767026', 'W11025350', 'W11025350', 'ID01', 'Caldwell Internal Medicine Group', 'Cheryl', 'K', 'Sobba', 'NP', 'Family Practice', '', '', NULL, 'O', '211 E Logan St Ste 303', 'Caldwell', 'Canyon', 'ID', '83605', '2084594667', NULL, '211 E Logan St Ste 303', 'Caldwell', 'Canyon', 'ID', '83605', '2084594667', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1740235712', 0, 'N', 0, '2013-08-16', NULL, NULL, 43.6554, -116.697, NULL, NULL),
('870767026', 'W11025355', 'W11025355', 'ID01', 'Caldwell Internal Medicine Group', 'Cheryl', 'K', 'Sobba', 'NP', 'Family Practice', '', '', NULL, 'B', 'PO Box 277976', 'Atlanta', 'Fulton', 'GA', '30384', '2084594667', NULL, 'PO Box 277976', 'Atlanta', 'Fulton', 'GA', '30384', '2084594667', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1740235712', 0, 'N', 0, '2013-08-16', NULL, NULL, 0, 0, NULL, NULL),
('611572907', 'W11025426', 'W11025426', 'UT01', 'Mountain Star Medical Group', 'Robert', 'R', 'Mohr', 'MD', 'Internal Medicine', '', '', NULL, 'O', '5405 S 500 E Ste 100', 'Ogden', 'Weber', 'UT', '84405', '8014757966', NULL, '5405 S 500 E Ste 100', 'Ogden', 'Weber', 'UT', '84405', '8014757966', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1750314480', 0, 'N', 0, '2012-06-27', NULL, NULL, 0, 0, NULL, NULL),
('611572907', 'W11025425', 'W11025425', 'UT01', 'MountainStar Medical Group', 'Robert', 'R', 'Mohr', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 405714', 'Atlanta', 'Fulton', 'GA', '30384', '8014757966', NULL, 'PO Box 405714', 'Atlanta', 'Fulton', 'GA', '30384', '8014757966', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1750314480', 0, 'N', 0, '2012-06-27', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W11025345', 'W11025345', 'UT01', 'Millcreek Primary Care', 'Stacey', '', 'Bank', 'MD', 'Family Practice', 'Emergency Medicine', '', NULL, 'O', '4465 S 900 E Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012662777', '8012662362', '4465 S 900 E Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012662777', '8012662362', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1790797959', 0, 'N', 0, '2013-07-25', NULL, NULL, 40.6753, -111.866, NULL, NULL),
('770701557', 'W11025346', 'W11025346', 'UT01', '', 'Stacey', '', 'Bank', 'MD', 'Family Practice', 'Emergency Medicine', '', NULL, 'B', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8012662777', '8012662362', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8012662777', '8012662362', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1790797959', 0, 'Y', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
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('621560557', 'W11025325', 'W11025325', 'UT01', 'South Ogden Center for Family Medicine', 'Stephen', 'J', 'Bruce', 'MD', 'Family Practice', '', '', NULL, 'O', '5740 Crestwood Dr', 'Ogden', 'Weber', 'UT', '84405', '8014797771', '8014797795', '5740 Crestwood Dr', 'Ogden', 'Weber', 'UT', '84405', '8014797771', '8014797795', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1841269321', 0, 'N', 0, '2014-04-04', NULL, NULL, 41.1583, -111.947, NULL, NULL),
('743096310', 'W11025336', 'W11025336', 'UT01', 'St Marks Senior Center', 'Nikki', '', 'Switzer', 'MD', 'Geriatrics', 'Internal Medicine', '', NULL, 'O', '1160 E 3900 S Ste G200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687766', '          ', '1160 E 3900 S Ste G200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687766', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1851468367', 0, 'N', 0, '2014-06-04', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('743096310', 'W11025335', 'W11025335', 'UT01', 'St Marks Senior Center', 'Nikki', '', 'Switzer', 'MD', 'Geriatrics', 'Internal Medicine', '', NULL, 'B', 'PO Box 271220', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '6153737629', '          ', 'PO Box 271220', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '6153737629', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1851468367', 0, 'Y', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
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('743096310', 'W11025330', 'W11025330', 'UT01', 'St Marks Senior Center', 'Alexander', '', 'Del Castillo', 'MD', 'Geriatrics', 'Internal Medicine', '', NULL, 'B', 'PO Box 271220', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '6153737629', NULL, 'PO Box 271220', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '6153737629', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1881705168', 0, 'Y', 0, '2014-02-06', NULL, NULL, 0, 0, NULL, NULL),
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('800239738', 'W11025421', 'W11025421', 'UT01', 'Jordan Family Health LLC', 'LeeAnn', '', 'Johnson', 'FNP', 'Family Practice', '', '', NULL, 'O', '8846 S Redwood Rd Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', NULL, '8846 S Redwood Rd Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2011-12-31', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1942462825', 0, 'N', 0, '2012-06-27', NULL, NULL, 0, 0, NULL, NULL),
('800239738', 'W11025414', 'W11025414', 'UT01', 'Jordan Family Health LLC', 'LeeAnn', '', 'Johnson', 'FNP', 'Family Practice', '', '', NULL, 'B', 'PO Box 405483', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', NULL, 'PO Box 405483', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2011-12-31', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1942462825', 0, 'N', 0, '2012-06-27', NULL, NULL, 0, 0, NULL, NULL),
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('611572907', 'W11025427', 'W11025427', 'UT01', 'Mountain Star Medical Group', 'Adam', 'C', 'Craner', 'FNP-C', 'Internal Medicine', 'Family Practice', '', NULL, 'B', 'PO Box 405714', 'Atlanta', 'Fulton', 'GA', '30384', '8014757966', NULL, 'PO Box 405714', 'Atlanta', 'Fulton', 'GA', '30384', '8014757966', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1952326357', 0, 'N', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
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('800239738', 'W11025413', 'W11025413', 'UT01', 'Jordan Family Health LLC', 'Joanne', '', 'Haeffele', 'FNP', 'Family Practice', '', '', NULL, 'B', 'PO Box 405483', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', NULL, 'PO Box 405483', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2010-09-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952326795', 0, 'N', 0, '2011-09-28', NULL, NULL, 0, 0, NULL, NULL),
('205450896', 'W11025458', 'W11025458', 'UT01', '', 'Scott', '', 'Southworth', 'MD', 'Internal Medicine', '', '', NULL, 'O', '520 E Medical Dr Ste 200', 'Bountiful', 'Davis', 'UT', '84010', '8012949333', '          ', '520 E Medical Dr Ste 200', 'Bountiful', 'Davis', 'UT', '84010', '8012949333', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1972602910', 0, 'N', 0, '2014-04-03', NULL, NULL, 40.8873, -111.87, NULL, NULL),
('205450896', 'W11025459', 'W11025459', 'UT01', '', 'Scott', '', 'Southworth', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 1468', 'Bountiful', 'Davis', 'UT', '84011', '8012949333', '          ', 'PO Box 1468', 'Bountiful', 'Davis', 'UT', '84011', '8012949333', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1972602910', 0, 'N', 0, '2014-04-03', NULL, NULL, 0, 0, NULL, NULL),
('134332141', 'W11025356', 'W11025356', 'UT01', 'MountainStar Cardiovascular Surgery', 'Shreekanth', '', 'Karwande', 'MD', 'Cardiovascular Disease', 'Cardiothorac Vascular Surgery', '', NULL, 'O', '1160 E 3900 S Ste 3500', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434750', NULL, '1160 E 3900 S Ste 3500', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434750', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1972693570', 0, 'N', 0, '2012-06-27', NULL, NULL, 0, 0, NULL, NULL),
('450579013', 'W11025398', 'W11025398', 'UT01', 'St Marks Gynocology Oncology Care', 'Jennifer', 'M', 'Rhode', 'MD', 'Gynecologic Oncology', '', '', NULL, 'O', '1140 E 3900 S Ste 340', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434730', NULL, '1140 E 3900 S Ste 340', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434730', '', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', 'Ogden Regional Medical Center', 'Timpanogos Regional Hospital', '', 'HCFA|UB|', '1992735534', 0, 'N', 0, '2014-03-28', NULL, NULL, 0, 0, NULL, NULL),
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('450579013', 'W11025399', 'W11025399', 'UT01', 'Monarch Womens Cancer Center', 'Jennifer', 'M', 'Rhode', 'MD', 'Gynecologic Oncology', '', '', NULL, 'B', 'PO Box 198546', 'Atlanta', 'Fulton', 'GA', '30384', '8017434730', NULL, 'PO Box 198546', 'Atlanta', 'Fulton', 'GA', '30384', '8017434730', '', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', 'Ogden Regional Medical Center', 'Timpanogos Regional Hospital', '', 'HCFA|UB|', '1992735534', 0, 'N', 0, '2014-03-28', NULL, NULL, 0, 0, NULL, NULL),
('161767581', 'W11025400', 'W11025400', 'UT01', 'Layton Family Practice', 'Jody', 'L', 'Fowers', 'APRN', 'Family Practice', '', '', NULL, 'O', '124 S Fairfield Rd', 'Layton', 'Davis', 'UT', '84041', '8015469441', NULL, '124 S Fairfield Rd', 'Layton', 'Davis', 'UT', '84041', '8015469441', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2011-09-30', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1992915052', 0, 'N', 0, '2013-10-24', NULL, NULL, 0, 0, NULL, NULL),
('820509579', 'W12001186', 'W12001186', 'ID02', 'Counseling Services of Mountain Home', 'Glenda', 'K', 'Breslin', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'B', 'PO Box 375', 'Mountain Home', 'Elmore', 'ID', '83647', '2085874444', NULL, 'PO Box 375', 'Mountain Home', 'Elmore', 'ID', '83647', '2085874444', '          ', '', '', '', '0.00', '35.00', '0.00', 3, '2010-04-02', '2010-04-02', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1851414809', 0, 'N', 0, '2014-02-20', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12001427', 'W12001427', 'UTPEHP', 'Psychology', 'Kimberlee', 'M', 'Roy', 'PhD', 'Mental Health', 'Psychology', '', NULL, 'O', '675 E 500 S Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8016625592', NULL, '675 E 500 S Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8016625592', '          ', 'PEHPPHD', '', '', '0.00', '30.00', '0.00', 8, '2009-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386877397', 0, 'N', 0, '2011-05-03', NULL, NULL, 0, 0, NULL, NULL),
('272033824', 'W12001575', 'W12001575', 'WY01', 'Clear Creek Counseling', 'Virginia', 'K', 'Oedekoven', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '801 E 4th St Ste 24', 'Gillette', 'Campbell', 'WY', '82716', '3076869422', NULL, '801 E 4th St Ste 24', 'Gillette', 'Campbell', 'WY', '82716', '3076869422', '          ', 'WYMA', '', '', '0.00', '35.00', '0.00', 3, '2010-03-17', '2011-07-05', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700988854', 0, 'N', 0, '2011-05-18', NULL, NULL, 0, 0, NULL, NULL),
('870464264', 'W12002030', 'W12002030', 'UT01', ' Fit Stop Physical Therapy Health Club', 'Tobin', '', 'Bluth', '', 'Physical Therapy', '', '', NULL, 'O', '345 W 600 S Ste 200', 'Heber City', 'Wasatch', 'UT', '84032', '4356545607', '4356542602', '345 W 600 S Ste 200', 'Heber City', 'Wasatch', 'UT', '84032', '4356545607', '4356542602', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2010-05-01', '2011-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1326374331', 0, 'N', 0, '2011-04-19', NULL, NULL, 0, 0, NULL, NULL),
('870540010', 'W12002101', 'W12002101', 'UTDT01', '', 'Bradley', '', 'Hair', 'DDS', 'Dentist', '', '', NULL, 'O', '702 E S Temple Ste 109', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015321122', NULL, '702 E S Temple Ste 109', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015321122', '          ', 'UT000B', '', '', '0.00', '100.00', '0.00', 8, '2010-04-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0001000020', 0, 'N', 0, '2011-03-09', NULL, NULL, 0, 0, NULL, NULL),
('272083389', 'W12002109', 'W12002109', 'UTDT01', '', 'Adrian', '', 'Huang', 'DMD', 'Dentist', '', '', NULL, 'O', '1234 N 900 E', 'Provo', 'Utah', 'UT', '84604', '8018549140', NULL, '1234 N 900 E', 'Provo', 'Utah', 'UT', '84604', '8018549140', '          ', '', '', '', '0.00', '0.00', '0.00', 8, '2010-05-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0001000022', 0, 'N', 0, '2010-11-05', NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'W12002432', 'W12002432', 'UT01', 'Tanner Memorial Clinic', 'Jared', 'A', 'Morris', 'DO', 'Family Practice', '', '', NULL, 'O', '380 N 400 W', 'Kaysville', 'Davis', 'UT', '84037', '8017734840', NULL, '380 N 400 W', 'Kaysville', 'Davis', 'UT', '84037', '8017734840', '          ', 'WUTANNER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1992952287', 0, 'N', 0, '2013-07-29', NULL, NULL, 41.0412, -111.946, NULL, NULL),
('870218917', 'W12002431', 'W12002431', 'UT01', 'Tanner Memorial Clinic', 'Jared', 'A', 'Morris', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'WUTANNER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1992952287', 0, 'Y', 0, '2013-07-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12003143', 'W12003143', 'UT01', 'Jordan Valley Hospital', 'Donna', 'M', 'Thompson', 'APRN', 'Family Practice', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019643100', NULL, 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019643100', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-06-07', '2010-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467615476', 0, 'N', 0, '2011-10-06', NULL, NULL, 0, 0, NULL, NULL),
('204421181', 'W12004821', 'W12004821', 'UT01', 'Elevate Sports Medicine', 'Henry', 'D', 'Hunt', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '147 W 400 N', 'Orem', 'Utah', 'UT', '84057', '8012219060', '8012219071', '147 W 400 N', 'Orem', 'Utah', 'UT', '84057', '8012219060', '8012219071', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2010-10-01', '2010-10-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598701773', 0, 'N', 0, '2011-07-18', NULL, NULL, 0, 0, NULL, NULL),
('529628952', 'W12001373', 'W12001373', 'UTMH1', '', 'Paul', '', 'Stratton', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'B', '266 4th Ave Ste 402', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8014501128', NULL, '266 4th Ave Ste 402', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8014501128', '          ', 'UTPHD', '', '', '0.00', '35.00', '0.00', 3, '2010-05-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730122318', 0, 'N', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('529628952', 'W12001372', 'W12001372', 'UTMH1', '', 'Paul', '', 'Stratton', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '525 E 100 S Ste 120', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8014501128', NULL, '525 E 100 S Ste 120', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8014501128', '          ', 'UTPHD', '', '', '0.00', '35.00', '0.00', 3, '2010-05-01', '2010-06-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730122318', 0, 'N', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('263471225', 'W12004466', 'W12004466', 'WYWSBAIT', 'The Coalition Family Health Center', 'Scott', 'L', 'Johnston', 'MD', 'Family Practice', '', '', NULL, 'B', '205 Miller Spring Ct', 'Franklin', 'Williamson', 'TN', '37064', '3076856500', NULL, '205 Miller Spring Ct', 'Franklin', 'Williamson', 'TN', '37064', '3076856500', '          ', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-11-15', '2011-07-06', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1912290458', 0, 'N', 0, '2010-09-16', NULL, NULL, 0, 0, NULL, NULL),
('263471225', 'W12004467', 'W12004467', 'WYWSBAIT', 'The Coalition Family Health Center', 'Scott', 'L', 'Johnston', 'MD', 'Family Practice', '', '', NULL, 'O', '430 Medical Arts Ct', 'Gillette', 'Campbell', 'WY', '82716', '3076856500', NULL, '430 Medical Arts Ct', 'Gillette', 'Campbell', 'WY', '82716', '3076856500', '          ', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-11-15', '2011-07-06', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1912290458', 0, 'N', 0, '2010-09-16', NULL, NULL, 0, 0, NULL, NULL),
('263471225', 'W12004468', 'W12004468', 'WYWSBAIT', 'The Coalition Family Health Center', 'Thomas', 'A', 'Losey', 'MD', 'Family Practice', '', '', NULL, 'B', '205 Miller Spring Ct', 'Franklin', 'Williamson', 'TN', '37064', '3076856500', NULL, '205 Miller Spring Ct', 'Franklin', 'Williamson', 'TN', '37064', '3076856500', '          ', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-11-15', '2011-07-06', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1073595757', 0, 'N', 0, '2011-04-21', NULL, NULL, 0, 0, NULL, NULL),
('263471225', 'W12004469', 'W12004469', 'WYWSBAIT', 'The Coalition Family Health Center', 'Thomas', 'A', 'Losey', 'MD', 'Family Practice', '', '', NULL, 'O', '430 Medical Arts Ct', 'Gillette', 'Campbell', 'WY', '82716', '3076856500', NULL, '430 Medical Arts Ct', 'Gillette', 'Campbell', 'WY', '82716', '3076856500', '          ', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-11-15', '2011-07-06', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1073595757', 0, 'N', 0, '2011-04-21', NULL, NULL, 0, 0, NULL, NULL),
('870621575', 'W12004470', 'W12004470', 'UTDTSheet', '', 'Samuel', '', 'Knight', 'DDS', 'Dentist', '', '', NULL, 'O', '1761 N 2000 W', 'Ogden', 'Weber', 'UT', '84404', '8017313200', NULL, '1761 N 2000 W', 'Ogden', 'Weber', 'UT', '84404', '8017313200', '          ', 'UT000B', '', '', '0.00', '100.00', '0.00', 8, '2009-01-01', '2013-05-31', 0, 0, 0, '', '', '', '', 'DEN|', '1083705149', 0, 'N', 0, '2013-09-25', NULL, NULL, 0, 0, NULL, NULL),
('330203775', 'W12005245', 'W12005245', 'Sinclair', '(Sinclair Health Services\rProvider) ', 'Thomas ', 'E', 'Acomb', 'MD', 'Ear, Nose and Throat', 'Pediatric Ear, Nose & Throat', '', NULL, 'O', '191 5th St W', 'Ketchum', 'Blaine', 'ID', '83340', '2086228701', NULL, '191 5th St W', 'Ketchum', 'Blaine', 'ID', '83340', '2086228701', '          ', 'IDSINCLAIRB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-27', '2012-12-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396851200', 0, 'Y', 0, '2012-12-11', NULL, NULL, 0, 0, NULL, NULL),
('271460201', 'W12004497', 'W12004497', 'UT01', 'Quest Family Services', 'Keith', '', 'Hooker', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '564 N Main St', 'Monticello', 'San Juan', 'UT', '84535', '4355872801', '4355873164', '564 N Main St', 'Monticello', 'San Juan', 'UT', '84535', '4355872801', '4355873164', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134127558', 0, 'N', 0, '2010-10-18', NULL, NULL, 37.8795, -109.343, NULL, NULL),
('271460201', 'W12004498', 'W12004498', 'UT01', 'Quest Family Services', 'Keith', '', 'Hooker', 'MD', 'Emergency Medicine', '', '', NULL, 'M', 'PO Box 12', 'Monticello', 'San Juan', 'UT', '84535', '4355872801', '4355873164', 'PO Box 12', 'Monticello', 'San Juan', 'UT', '84535', '4355872801', '4355873164', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134127558', 0, 'N', 0, '2010-10-18', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('271460201', 'W12004499', 'W12004499', 'UT01', 'Quest Family Services', 'Keith', '', 'Hooker', 'MD', 'Emergency Medicine', '', '', NULL, 'B', 'PO Box 288', 'Bountiful', 'Davis', 'UT', '84010', '4355872801', '4355873164', 'PO Box 288', 'Bountiful', 'Davis', 'UT', '84010', '4355872801', '4355873164', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134127558', 0, 'N', 0, '2010-10-18', NULL, NULL, 0, 0, NULL, NULL),
('741967809', 'W12004500', 'W12004500', 'TX01', 'Gastroenterology Consultants of San Antonio', 'Hays', 'L', 'Arnold', 'MD', 'Gastroenterology', '', '', NULL, 'B', 'PO Box 2778', 'San Antonio', 'Bexar', 'TX', '78229', '2106141234', NULL, 'PO Box 2778', 'San Antonio', 'Bexar', 'TX', '78229', '2106141234', '          ', 'TXSURGA', 'TXHCPCS', '', '0.00', '50.00', '0.00', 6, '2010-09-21', '2012-08-19', 0, 0, 0, 'North East Baptist Hospital', NULL, '', '', 'HCFA|UB|', '1699765461', 0, 'N', 0, '2010-09-28', NULL, NULL, 0, 0, NULL, NULL),
('741967809', 'W12004502', 'W12004502', 'TX01', 'Gastroenterology Consultants of San Antonio', 'Hays', 'L', 'Arnold', 'MD', 'Gastroenterology', '', '', NULL, 'O', '11485 Topperwein Ste 2', 'San Antonio', 'Bexar', 'TX', '78233', '2106141234', NULL, '11485 Topperwein Ste 2', 'San Antonio', 'Bexar', 'TX', '78233', '2106141234', '          ', 'TXSURGA', 'TXHCPCS', '', '0.00', '50.00', '0.00', 6, '2010-09-21', '2012-08-19', 0, 0, 0, 'North East Baptist Hospital', NULL, '', '', 'HCFA|UB|', '1699765461', 0, 'N', 0, '2010-09-28', NULL, NULL, 29.5423, -98.3402, NULL, NULL),
('741967809', 'W12004501', 'W12004501', 'TX01', 'Gastroenterology Consultants of San Antonio', 'Hays', 'L', 'Arnold', 'MD', 'Gastroenterology', '', '', NULL, 'M', '8415 Datapoint Dr Ste 1000', 'San Antonio', 'Bexar', 'TX', '78229', '2106141234', NULL, '8415 Datapoint Dr Ste 1000', 'San Antonio', 'Bexar', 'TX', '78229', '2106141234', '          ', 'TXSURGA', 'TXHCPCS', '', '0.00', '50.00', '0.00', 6, '2010-09-21', '2012-08-19', 0, 0, 0, 'North East Baptist Hospital', NULL, '', '', 'HCFA|UB|', '1699765461', 0, 'N', 0, '2010-09-28', NULL, NULL, 0, 0, NULL, NULL),
('272558096', 'W12004503', 'W12004503', 'ID01', 'Promising Horizons', 'Gregory', 'M', 'Deitchler', 'LMFT LPC', 'Mental Health', 'Marriage and Family Therapy', 'Counseling', NULL, 'O', '1552 N Crestmont Ste C', 'Meridian', 'Ada', 'ID', '83642', '2088871911', NULL, '1552 N Crestmont Ste C', 'Meridian', 'Ada', 'ID', '83642', '2088871911', '          ', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2010-07-19', '2012-02-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013196716', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12004504', 'W12004504', 'UT01', 'Center of Orthopedic and Rehabilitation Excellence', 'Richard', 'B', 'Mackey', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '3584 W 9000 S Ste 405', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015683480', '8015683482', '3584 W 9000 S Ste 405', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015683480', '8015683482', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-08-30', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1992923874', 0, 'N', 0, '2011-12-20', NULL, NULL, 40.5879, -111.976, NULL, NULL),
('621801973', 'W12004505', 'W12004505', 'UT01', 'Center of Orthopedic and Rehabilitation Excellence', 'Richard', 'B', 'Mackey', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-08-30', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1992923874', 0, 'N', 0, '2011-12-20', NULL, NULL, 0, 0, NULL, NULL),
('870354442', 'W12004509', 'W12004509', 'UT01', 'Rocky Mountain Womens Health Center', 'Maria', 'D', 'Hernandez', 'MD', 'Urogynecology', 'Gynecology', '', NULL, 'O', '1580 W Antelope Dr Ste 290', 'Layton', 'Davis', 'UT', '84041', '8017760880', NULL, '1580 W Antelope Dr Ste 290', 'Layton', 'Davis', 'UT', '84041', '8017760880', '', 'WRYMTWOM', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2014-04-30', 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1891960738', 0, 'N', 0, '2014-07-14', NULL, NULL, 41.0893, -111.994, NULL, NULL),
('621801973', 'W12004510', 'W12004510', 'UT01', 'Davis Orthopedics', 'Matthew', 'H', 'Lyman', 'DO', 'Orthopedic Surgery', '', '', NULL, 'O', '2132 N 1700 W Ste 230', 'Layton', 'Davis', 'UT', '84041', '8017733900', '8017733902', '2132 N 1700 W Ste 230', 'Layton', 'Davis', 'UT', '84041', '8017733900', '8017733902', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-08-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1851307706', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.0892, -111.997, NULL, NULL),
('830216112', 'W12004514', 'W12004514', 'WY01', 'Lander Medical Clinic', 'Michael', 'C', 'McManus', 'MD', 'Urology', '', '', NULL, 'O', '745 Buena Vista Dr', 'Lander', 'Fremont', 'WY', '82520', '3073322941', '3073321920', '745 Buena Vista Dr', 'Lander', 'Fremont', 'WY', '82520', '3073322941', '3073321920', '', '', '', '0.00', '10.00', '0.00', 3, '2011-02-01', '2012-05-01', 0, 0, 0, 'SageWest Health Care', '', '', '', 'HCFA|UB|', '1609085612', 0, 'N', 0, '2012-04-30', NULL, NULL, 0, 0, NULL, NULL),
('830216112', 'W12004515', 'W12004515', 'WY01', 'Lander Medical Clinic', 'Michael', 'C', 'McManus', 'MD', 'Urology', '', '', NULL, 'B', 'PO Box 9432', 'Belfast', 'Waldo', 'ME', '04915', '3073322941', '3073321920', 'PO Box 9432', 'Belfast', 'Waldo', 'ME', '04915', '3073322941', '3073321920', '', '', '', '0.00', '10.00', '0.00', 3, '2011-02-01', '2012-05-01', 0, 0, 0, 'SageWest Health Care', '', '', '', 'HCFA|UB|', '1609085612', 0, 'N', 0, '2012-04-30', NULL, NULL, 0, 0, NULL, NULL),
('870577952', 'W12004516', 'W12004516', 'UT01', 'Western Newborn Specialists', 'Evelyn', 'C', 'Peterson', 'MD', 'Neonatology', '', '', NULL, 'O', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687111', '', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687111', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, 'St Marks Hospital', 'Jordan Valley Medical Center', 'Lone Peak Hospital', '', 'HCFA|UB|', '1306809520', 0, 'N', 0, '2014-07-25', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('870577952', 'W12004517', 'W12004517', 'UT01', 'Western Newborn Specialists', 'Evelyn', 'C', 'Peterson', 'MD', 'Neonatology', '', '', NULL, 'O', '3580 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015618888', '', '3580 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015618888', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, 'St Marks Hospital', 'Jordan Valley Medical Center', 'Lone Peak Hospital', '', 'HCFA|UB|', '1306809520', 0, 'N', 0, '2014-07-25', NULL, NULL, 40.5879, -111.975, NULL, NULL),
('870577952', 'W12004518', 'W12004518', 'UT01', 'Western Newborn Specialists', 'Evelyn', 'C', 'Peterson', 'MD', 'Neonatology', '', '', NULL, 'B', 'PO Box 520691', 'Salt Lake City', 'Salt Lake', 'UT', '84152', '8012687111', '', 'PO Box 520691', 'Salt Lake City', 'Salt Lake', 'UT', '84152', '8012687111', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, 'St Marks Hospital', 'Jordan Valley Medical Center', 'Lone Peak Hospital', '', 'HCFA|UB|', '1306809520', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('870299862', 'W12004519', 'W12004519', 'UTMH1', 'LDS Family Services', 'Louise', 'B', 'Jorgensen', 'LPC', 'Mental Health', '', '', NULL, 'O', '94 E Pages Ln Ste A', 'Centerville', 'Davis', 'UT', '84014', '8012940578', NULL, '94 E Pages Ln Ste A', 'Centerville', 'Davis', 'UT', '84014', '8012940578', '          ', 'MA', '', '', '0.00', '35.00', '0.00', 8, '2010-11-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821280280', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('830182821', 'W12004520', 'W12004520', 'WY01', 'Gottsche Rehabilitation Center', 'Susan', '', 'Abbott', 'PT', 'Physical Therapy', '', '', NULL, 'O', '148 E Arapahoe', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078642146', '3078642857', '148 E Arapahoe', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078642146', '3078642857', 'WISEWYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2010-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629274303', 0, 'N', 0, '2014-07-22', NULL, NULL, 0, 0, NULL, NULL),
('830182821', 'W12004521', 'W12004521', 'WY01', 'Gottsche Rehabilitation Center', 'Susan', '', 'Abbott', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 790', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078642146', '3078642857', 'PO Box 790', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078642146', '3078642857', 'WISEWYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2010-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629274303', 0, 'N', 0, '2014-07-22', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'W12004522', 'W12004522', 'UT01', 'Granger Medical Clinic', 'Steve ', 'A', 'Oliver', 'MD', 'Urgent Care', '', '', NULL, 'O', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019653608', '8019653407', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019653608', '8019653407', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-22', NULL, 0, 0, 0, 'Pioneer Valley Hospital', '', '', '', 'HCFA|UB|', '1396720058', 0, 'N', 0, '2014-07-25', NULL, NULL, 40.682, -111.979, NULL, NULL),
('870284475', 'W12004523', 'W12004523', 'UT01', 'Granger Medical Clinic', 'Steve ', 'A', 'Oliver', 'MD', 'Urgent Care', '', '', NULL, 'B', 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '8019653608', '8019653407', 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '8019653608', '8019653407', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-22', NULL, 0, 0, 0, 'Pioneer Valley Hospital', '', '', '', 'HCFA|UB|', '1396720058', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W12004524', 'W12004524', 'ID02', 'Primary Health Medical Group', 'Shelley', 'R', 'Ringo', 'MD', 'Family Practice', 'Sports Medicine', '', NULL, 'O', '6052 W State St', 'Boise', 'Ada', 'ID', '83703', '2083447799', '2089471945', '6052 W State St', 'Boise', 'Ada', 'ID', '83703', '2083447799', '2089471945', 'IDSTDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2010-09-22', '2013-02-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1316143886', 0, 'N', 0, '2014-07-21', NULL, NULL, 43.6597, -116.264, NULL, NULL),
('202630141', 'W12004525', 'W12004525', 'ID02', 'Primary Health Medical Group', 'Shelley', 'R', 'Ringo', 'MD', 'Family Practice', 'Sports Medicine', '', NULL, 'B', 'PO Box 191050', 'Boise', 'Ada', 'ID', '83719', '2084553545', '', 'PO Box 191050', 'Boise', 'Ada', 'ID', '83719', '2084553545', '', 'IDSTDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2010-09-22', '2013-02-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1316143886', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12004526', 'W12004526', 'UTPEHP', 'Heber Valley Clinic', 'Jill', 'B', 'Faatz', 'MD', 'Family Practice', 'Urgent Care', '', NULL, 'O', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', NULL, '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', '          ', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2010-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417981002', 0, 'Y', 0, '2010-09-23', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12004532', 'W12004532', 'UTPEHP', '', 'Peter', '', 'Danzig', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '5770 S 1500 W', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8013137770', NULL, '5770 S 1500 W', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8013137770', '          ', 'PEHPLCSW', '', '', '0.00', '30.00', '0.00', 8, '2010-06-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467521112', 0, 'N', 0, '2010-09-23', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12004534', 'W12004534', 'UTPEHP', 'Southwest Regional Cancer Clinic', 'Karim', '', 'Anwar', 'MD', 'Oncology', '', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884900', NULL, '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884900', '          ', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2010-09-13', '2012-05-25', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053350140', 0, 'N', 0, '2012-06-01', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12004536', 'W12004536', 'UTPEHP', 'Northern Utah Surgeons', 'Joseph', 'E', 'Hansler', 'MD', 'General Surgery', '', '', NULL, 'O', '4403 Harrison Blvd Ste 1635', 'Ogden', 'Weber', 'UT', '84403', '8013877450', NULL, '4403 Harrison Blvd Ste 1635', 'Ogden', 'Weber', 'UT', '84403', '8013877450', '          ', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2010-08-26', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1093979601', 0, 'N', 0, '2010-10-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12004538', 'W12004538', 'UTPEHP', 'Southwest Cardiology - St. George', 'Jaime', 'J', 'Molden', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '1380 E Medical Ctr Dr Ste 1500', 'St George', 'Washington', 'UT', '84790', '4352512500', NULL, '1380 E Medical Ctr Dr Ste 1500', 'St George', 'Washington', 'UT', '84790', '4352512500', '          ', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2010-09-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356540272', 0, 'N', 0, '2013-11-18', NULL, NULL, 0, 0, NULL, NULL),
('205537931', 'W12004193', 'W12004193', 'UT01', '', 'Nameer', 'T', 'Qader', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '5495 S 500 E Ste 100', 'Ogden', 'Weber', 'UT', '84405', '8014757100', NULL, '5495 S 500 E Ste 100', 'Ogden', 'Weber', 'UT', '84405', '8014757100', '          ', 'WUSTDFAM5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-08-01', '2011-11-07', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1336289610', 0, 'N', 0, '2013-09-09', NULL, NULL, 0, 0, NULL, NULL),
('205537931', 'W12004194', 'W12004194', 'UT01', '', 'Nameer', 'T', 'Qader', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 1468', 'Bountiful', 'Davis', 'UT', '84011', '8014757100', NULL, 'PO Box 1468', 'Bountiful', 'Davis', 'UT', '84011', '8014757100', '          ', 'WUSTDFAM5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-08-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1336289610', 0, 'N', 0, '2013-09-09', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12004548', 'W12004548', 'ID01', 'Saint Alphonsus Regional Medical Center - Reading Only', 'Alex', 'C', 'Johnson', 'MD', 'Cardiology', '', '', NULL, 'O', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083673722', '2083675200', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083673722', '2083675200', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-08-17', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1417081399', 0, 'Y', 0, '2014-07-09', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('260553931', 'W12004544', 'W12004544', 'ID01', 'Saint Alphonsus Medical Group Heart Care Garrity', 'Alex', 'C', 'Johnson', 'MD', 'Cardiology', '', '', NULL, 'O', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2083674278', '2083675200', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2083674278', '2083675200', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-08-17', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1417081399', 0, 'N', 0, '2014-07-09', NULL, NULL, 43.587, -116.549, NULL, NULL),
('260553931', 'W12004547', 'W12004547', 'ID01', 'Saint Alphonsus Medical Group Heart Care Caldwell', 'Alex', 'C', 'Johnson', 'MD', 'Cardiology', '', '', NULL, 'O', '1818 S 10th Ave Ste 200', 'Caldwell', 'Canyon', 'ID', '83605', '2083675734', '2083675744', '1818 S 10th Ave Ste 200', 'Caldwell', 'Canyon', 'ID', '83605', '2083675734', '2083675744', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-08-17', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1417081399', 0, 'N', 0, '2014-07-09', NULL, NULL, 43.6538, -116.693, NULL, NULL),
('260553931', 'W12004545', 'W12004545', 'ID01', 'Saint Alphonsus Medical Group Heart Care Meridian', 'Alex', 'C', 'Johnson', 'MD', 'Cardiology', '', '', NULL, 'O', '3025 W Cherry Ln Ste 205', 'Meridian', 'Ada', 'ID', '83642', '2083678484', '2083678456', '3025 W Cherry Ln Ste 205', 'Meridian', 'Ada', 'ID', '83642', '2083678484', '2083678456', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-08-17', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1417081399', 0, 'N', 0, '2014-07-09', NULL, NULL, 43.6188, -116.431, NULL, NULL),
('260553931', 'W12004546', 'W12004546', 'ID01', 'Saint Alphonsus Medical Group Heart Care Elm', 'Alex', 'C', 'Johnson', 'MD', 'Cardiology', '', '', NULL, 'O', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2083674278', '2083675200', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2083674278', '2083675200', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-08-17', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1417081399', 0, 'N', 0, '2014-07-09', NULL, NULL, 43.6539, -116.695, NULL, NULL),
('260553931', 'W12004542', 'W12004542', 'ID01', 'Saint Alphonsus Medical Group Heart Care Eagle', 'Alex', 'C', 'Johnson', 'MD', 'Cardiology', '', '', NULL, 'O', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083674278', '2083675200', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083674278', '2083675200', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-08-17', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1417081399', 0, 'N', 0, '2014-07-09', NULL, NULL, 43.6892, -116.351, NULL, NULL),
('260553931', 'W12004543', 'W12004543', 'ID01', 'Idaho Heart Care', 'Alex', 'C', 'Johnson', 'MD', 'Cardiology', '', '', NULL, 'B', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2083675200', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2083675200', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-08-17', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1417081399', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'W12004541', 'W12004541', 'ID01', 'Saint Alphonsus Medical Group Heart Care Boise', 'Alex', 'C', 'Johnson', 'MD', 'Cardiology', '', '', NULL, 'O', '6140 W Curtisian Ste 200', 'Boise', 'Ada', 'ID', '83704', '2083674278', '2083675200', '6140 W Curtisian Ste 200', 'Boise', 'Ada', 'ID', '83704', '2083674278', '2083675200', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-08-17', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1417081399', 0, 'N', 0, '2014-07-09', NULL, NULL, 43.6151, -116.256, NULL, NULL),
('820200895', 'W12004549', 'W12004549', 'ID01', 'Saint Alphonsus Regional Medical Center - Reading Only', 'Alex', 'C', 'Johnson', 'MD', 'Cardiology', '', '', NULL, 'B', 'PO Box 190930', 'Boise', 'Ada', 'ID', '83719', '2083672130', '2083675200', 'PO Box 190930', 'Boise', 'Ada', 'ID', '83719', '2083672130', '2083675200', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-08-17', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1417081399', 0, 'Y', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12004551', 'W12004551', 'ID01', 'Saint Alphonsus Regional Medical Center', 'John ', 'R', 'Reusser', 'LCSW', 'Mental Health', 'Counseling', '', NULL, 'O', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083676238', '2083670285', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083676238', '2083670285', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-08-17', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1477864411', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('820200895', 'W12004552', 'W12004552', 'ID01', 'Saint Alphonsus Regional Medical Center', 'John ', 'R', 'Reusser', 'LCSW', 'Mental Health', 'Counseling', '', NULL, 'B', 'PO Box 190930', 'Boise', 'Ada', 'ID', '83719', '2083672396', '2083670285', 'PO Box 190930', 'Boise', 'Ada', 'ID', '83719', '2083672396', '2083670285', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-08-17', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1477864411', 0, 'Y', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'W12004554', 'W12004554', 'ID01', 'Idaho Emergency Physicians PA', 'Matthew', 'T', 'Judd', 'DO', 'Emergency Medicine', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83704', '2083221730', '2083221731', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83704', '2083221730', '2083221731', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2010-08-17', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1003934100', 0, 'N', 0, '2012-01-31', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('820312175', 'W12004556', 'W12004556', 'ID01', 'Idaho Emergency Physicians PA', 'Matthew', 'T', 'Judd', 'DO', 'Emergency Medicine', '', '', NULL, 'O', '1717 Arlington', 'Caldwell', 'Canyon', 'ID', '83605', '2083221730', '2083221731', '1717 Arlington', 'Caldwell', 'Canyon', 'ID', '83605', '2083221730', '2083221731', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2010-08-17', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1003934100', 0, 'N', 0, '2012-01-31', NULL, NULL, 43.6542, -116.696, NULL, NULL),
('820312175', 'W12004557', 'W12004557', 'ID01', 'Idaho Emergency Physicians PA', 'Matthew', 'T', 'Judd', 'DO', 'Emergency Medicine', '', '', NULL, 'B', '2312 N Cole Ste B', 'Boise', 'Ada', 'ID', '83704', '2083221730', '2083221731', '2312 N Cole Ste B', 'Boise', 'Ada', 'ID', '83704', '2083221730', '2083221731', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2010-08-17', '2011-02-21', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1003934100', 0, 'N', 0, '2012-01-31', NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'W12004555', 'W12004555', 'ID01', 'Idaho Emergency Physicians PA', 'Matthew', 'T', 'Judd', 'DO', 'Emergency Medicine', '', '', NULL, 'O', '323 E Riverside Dr', 'Eagle', 'Ada', 'ID', '83616', '2083221730', '2083221731', '323 E Riverside Dr', 'Eagle', 'Ada', 'ID', '83616', '2083221730', '2083221731', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2010-08-17', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1003934100', 0, 'N', 0, '2012-01-31', NULL, NULL, 43.6896, -116.35, NULL, NULL),
('820200895', 'W12004562', 'W12004562', 'ID01', 'Saint Alphonsus Boise OB-Gyn', 'Rebecca', 'L', 'McCaffrey', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2083778163', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2083778163', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2010-08-17', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1215193263', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12004559', 'W12004559', 'ID01', 'Saint Alphonsus Medical Group OB/GYN Boise BOGA Bldg', 'Rebecca', 'L', 'McCaffrey', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '5966 Curtisian', 'Boise', 'Ada', 'ID', '83704', '2083758100', '2083778163', '5966 Curtisian', 'Boise', 'Ada', 'ID', '83704', '2083758100', '2083778163', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2010-08-17', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1215193263', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6149, -116.256, NULL, NULL),
('820200895', 'W12004560', 'W12004560', 'ID01', 'Saint Alphonsus Medical Group OB/GYN Boise Moreau Bldg', 'Rebecca', 'L', 'McCaffrey', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '6140 W Curtisian Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083674224', '2083677806', '6140 W Curtisian Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083674224', '2083677806', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2010-08-17', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1215193263', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6151, -116.256, NULL, NULL),
('820200895', 'W12004561', 'W12004561', 'ID01', 'Saint Alphonsus Medical Group  OB/GYN Liberty Bldg', 'Rebecca', 'L', 'McCaffrey', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '900 N Liberty Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083672229', '2083674242', '900 N Liberty Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083672229', '2083674242', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2010-08-17', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1215193263', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6133, -116.259, NULL, NULL),
('820200895', 'W12004564', 'W12004564', 'ID01', 'Saint Alphonsus Medical Group Pulmonary & Sleep Boise ', 'Marian', 'M', 'Marsh', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '1075 N Curtis Ste 200 Bldg 6', 'Boise', 'Ada', 'ID', '83706', '2083678333', '2083672003', '1075 N Curtis Ste 200 Bldg 6', 'Boise', 'Ada', 'ID', '83706', '2083678333', '2083672003', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2010-08-17', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1770733560', 0, 'N', 0, '2011-09-19', NULL, NULL, 43.6148, -116.254, NULL, NULL),
('800010265', 'W12004565', 'W12004565', 'ID02', 'Cherry Lane Family Clinic', 'Timothy', 'E', 'McHugh', 'MD', 'Family Practice', '', '', NULL, 'O', '1001 N Meridian Rd', 'Meridian', 'Ada', 'ID', '83642', '2088844800', '2088844802', '1001 N Meridian Rd', 'Meridian', 'Ada', 'ID', '83642', '2088844800', '2088844802', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2010-04-01', '2013-10-01', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', 'Saint Alphonsus Medical Center Nampa', 'HCFA|UB|', '1831143692', 0, 'N', 0, '2013-09-12', NULL, NULL, 0, 0, NULL, NULL),
('800010265', 'W12004566', 'W12004566', 'ID02', 'Cherry Lane Family Clinic', 'Heidi', 'S', 'Dyer', 'PA-C', 'Family Practice', '', '', NULL, 'O', '1001 N Meridian Rd', 'Meridian', 'Ada', 'ID', '83642', '2088844800', '2088844802', '1001 N Meridian Rd', 'Meridian', 'Ada', 'ID', '83642', '2088844800', '2088844802', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2010-04-01', '2012-03-29', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1922150580', 0, 'N', 0, '2012-03-29', NULL, NULL, 0, 0, NULL, NULL),
('270338220', 'W12004571', 'W12004571', 'UT01', 'Advanced Family Vision Center', 'Shaune', 'K', 'Wallace', 'OD', 'Optometry', '', '', NULL, 'O', '1760 N Main St Ste 103', 'Cedar City', 'Iron', 'UT', '84721', '4358670644', '4358670645', '1760 N Main St Ste 103', 'Cedar City', 'Iron', 'UT', '84721', '4358670644', '4358670645', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467550335', 0, 'N', 0, '2014-01-17', NULL, NULL, 37.7088, -113.062, NULL, NULL),
('205686709', 'W12004575', 'W12004575', 'UT01', 'Care Medical', '', '', 'Care Medical', 'GROUP', 'Internal Medicine', '', '', NULL, 'O', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8665007071', '8665007081', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8665007071', '8665007081', 'WUT147', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861534307', 0, 'Y', 0, '2010-10-28', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('205686709', 'W12004576', 'W12004576', 'UT01', 'Care Medical', '', '', 'Care Medical', 'GROUP', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 9677', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8665007071', '8665007081', 'PO Box 9677', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8665007071', '8665007081', 'WUT147', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861534307', 0, 'N', 0, '2010-10-28', NULL, NULL, 0, 0, NULL, NULL),
('810284764', 'W12004578', 'W12004578', 'WY01', 'Arapahoe Health Center', 'Kimberly', 'R', 'Donohue', 'MD', 'Family Practice', '', '', NULL, 'O', '14 Great Plains Rd', 'Arapahoe', 'Fremont', 'WY', '82510', '3078569281', '3078577063', '14 Great Plains Rd', 'Arapahoe', 'Fremont', 'WY', '82510', '3078569281', '3078577063', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1457548760', 0, 'N', 0, '2011-06-10', NULL, NULL, 42.9869, -108.487, NULL, NULL),
('810284764', 'W12004577', 'W12004577', 'WY01', 'Fort Washakie Health Center', 'Kimberly', 'R', 'Donohue', 'MD', 'Family Practice', '', '', NULL, 'O', '29 Black Coal Dr', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', '29 Black Coal Dr', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1457548760', 0, 'N', 0, '2011-06-10', NULL, NULL, 42.9969, -108.861, NULL, NULL),
('810284764', 'W12004579', 'W12004579', 'WY01', 'Fort Washakie Health Center', 'Kimberly', 'R', 'Donohue', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 128', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', 'PO Box 128', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1457548760', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'W12004583', 'W12004583', 'UT01', 'Tanner Memorial Clinic', 'Dustin', 'B', 'Harker', 'MD', 'Neurosurgery', '', '', NULL, 'O', '2038 W 1900 S', 'Syracuse', 'Davis', 'UT', '84075', '8017734840', '8015258151', '2038 W 1900 S', 'Syracuse', 'Davis', 'UT', '84075', '8017734840', '8015258151', 'WUTANNER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1225216096', 0, 'N', 0, '2010-11-01', NULL, NULL, 41.0863, -112.065, NULL, NULL),
('870218917', 'W12004580', 'W12004580', 'UT01', 'Tanner Memorial Clinic', 'Dustin', 'B', 'Harker', 'MD', 'Neurosurgery', '', '', NULL, 'O', '2121 N 1700 W', 'Layton', 'Davis', 'UT', '84041', '8017734840', NULL, '2121 N 1700 W', 'Layton', 'Davis', 'UT', '84041', '8017734840', '          ', 'WUTANNER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1225216096', 0, 'N', 0, '2010-11-01', NULL, NULL, 41.0893, -111.997, NULL, NULL),
('870218917', 'W12004582', 'W12004582', 'UT01', 'Tanner Memorial Clinic', 'Dustin', 'B', 'Harker', 'MD', 'Neurosurgery', '', '', NULL, 'O', '380 N 400 W', 'Kaysville', 'Davis', 'UT', '84037', '8017734840', NULL, '380 N 400 W', 'Kaysville', 'Davis', 'UT', '84037', '8017734840', '          ', 'WUTANNER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1225216096', 0, 'N', 0, '2010-11-01', NULL, NULL, 41.0412, -111.946, NULL, NULL),
('272752875', 'W12004584', 'W12004584', 'UT01', 'Hofmann Arthritis Institute', 'Aaron', 'A', 'Hofmann', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '24 S 1100 E Ste 101', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013556468', '8013553450', '24 S 1100 E Ste 101', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013556468', '8013553450', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-12-01', NULL, 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1801986401', 0, 'N', 0, '2014-05-27', NULL, NULL, 40.7689, -111.86, NULL, NULL),
('272752875', 'W12004585', 'W12004585', 'UT01', 'Hoffman Arthritis Institute', 'Aaron', 'A', 'Hofmann', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'B', 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8013556468', '8013553450', 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8013556468', '8013553450', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-12-01', '2013-08-30', 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1801986401', 0, 'N', 0, '2013-12-03', NULL, NULL, 0, 0, NULL, NULL),
('272752875', 'W12004586', 'W12004586', 'UT01', 'Hofmann Arthritis Institute', 'Jeremy', 'B', 'McCandless', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '24 S 1100 E 101', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013556468', '8013553450', '24 S 1100 E 101', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013556468', '8013553450', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-02-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1700074127', 0, 'N', 0, '2014-05-27', NULL, NULL, 40.7689, -111.86, NULL, NULL),
('272752875', 'W12004587', 'W12004587', 'UT01', 'Hofmann Arthritis Institute', 'Jeremy', 'B', 'McCandless', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 413062', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8017477265', '8017477237', 'PO Box 413062', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8017477265', '8017477237', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-02-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1700074127', 0, 'N', 0, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
('860735726', 'W12004588', 'W12004588', 'Sinclair', 'Flagstaff Bone and Joint', 'Brent', 'G', 'Morrow', 'PT', 'Physical Therapy', '', '', NULL, 'O', '77 W Forest Ave Ste 301', 'Flagstaff', 'Coconino', 'AZ', '86001', '9282142836', NULL, '77 W Forest Ave Ste 301', 'Flagstaff', 'Coconino', 'AZ', '86001', '9282142836', '          ', '', '', '', '0.00', '40.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1881909315', 0, 'N', 0, '2012-07-31', NULL, NULL, 0, 0, NULL, NULL),
('810284764', 'W12004590', 'W12004590', 'WY01', 'Arapahoe Health Center', 'Joni', 'D', 'Renbarger', 'PSYD', 'Mental Health', 'Psychology', '', NULL, 'O', '17 Great Plains Rd', 'Arapahoe', 'Fremont', 'WY', '82510', '3078569281', '3078577063', '17 Great Plains Rd', 'Arapahoe', 'Fremont', 'WY', '82510', '3078569281', '3078577063', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, 'SageWest Health Care', '', '', '', 'HCFA|UB|', '1629238365', 0, 'N', 0, '2014-07-21', NULL, NULL, 42.9868, -108.487, NULL, NULL),
('810284764', 'W12004589', 'W12004589', 'WY01', 'Fort Washakie Health Center', 'Joni', 'D', 'Renbarger', 'PSYD', 'Mental Health', 'Psychology', '', NULL, 'O', '29 Black Coal Dr', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', '29 Black Coal Dr', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, 'SageWest Health Care', '', '', '', 'HCFA|UB|', '1629238365', 0, 'N', 0, '2014-07-21', NULL, NULL, 42.9969, -108.861, NULL, NULL),
('810284764', 'W12004591', 'W12004591', 'WY01', 'Fort Washakie Health Center', 'Joni', 'D', 'Renbarger', 'PSYD', 'Mental Health', 'Psychology', '', NULL, 'B', 'PO Box 128', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', 'PO Box 128', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, 'SageWest Health Care', '', '', '', 'HCFA|UB|', '1629238365', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('810284764', 'W12004592', 'W12004592', 'WY01', 'Arapahoe Health Center', 'Joni', 'D', 'Renbarger', 'PSYD', 'Mental Health', 'Psychology', '', NULL, 'M', 'PO Box 31001', 'Pasadena', 'Los Angeles', 'CA', '91110', '3078569281', '3078577063', 'PO Box 31001', 'Pasadena', 'Los Angeles', 'CA', '91110', '3078569281', '3078577063', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, 'SageWest Health Care', '', '', '', 'HCFA|UB|', '1629238365', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('870489979', 'W12002442', 'W12002442', 'UT01', 'Millcreek Womens Center', 'Andrea', 'N', 'Smith', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1140 E 3900 S Ste 410', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012628666', NULL, '1140 E 3900 S Ste 410', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012628666', '          ', 'Wise+', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1831155746', 0, 'Y', 0, '2012-07-05', NULL, NULL, 40.6871, -111.859, NULL, NULL),
('870280408', 'W12004593', 'W12004593', 'UT01', 'Pediatric Anesthesiologists', 'Stephen', 'P', 'Spanos', '', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3870', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8014322639', '8014322670', 'PO Box 3870', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8014322639', '8014322670', '', '', '', '0.00', '12.00', '0.00', 3, '2010-12-01', NULL, 0, NULL, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1598982043', 0, 'Y', 0, '2012-06-29', NULL, NULL, 0, 0, NULL, NULL),
('836000025', 'W12004594', 'W12004594', 'WY01', 'Wagon Circle Family Practice', 'James', 'A', 'Trent', 'MD', 'Family Practice', '', '', NULL, 'B', '2221 W Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3073242221', '3073248232', '2221 W Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3073242221', '3073248232', 'WISEWYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 6, '2010-09-30', NULL, 0, 0, 0, 'Memorial Hospital of Carbon County', '', '', '', 'HCFA|', '1285756007', 0, 'N', 0, '2013-09-12', NULL, NULL, 0, 0, NULL, NULL),
('836000025', 'W12004595', 'W12004595', 'WY01', 'Memorial Hospital of Carbon County', 'James', 'A', 'Trent', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 460', 'Rawlins', 'Carbon', 'WY', '82301', '3073242221', '3073248232', 'PO Box 460', 'Rawlins', 'Carbon', 'WY', '82301', '3073242221', '3073248232', 'WISEWYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 6, '2010-09-30', '2013-07-15', 0, 0, 0, 'Memorial Hospital of Carbon County', '', '', '', 'HCFA|', '1285756007', 0, 'N', 0, '2013-09-12', NULL, NULL, 0, 0, NULL, NULL),
('830182821', 'W12004597', 'W12004597', 'WY01', 'Gottsche Rehabilitation Center', 'James', '', 'Wyssmann', 'PHD', 'Mental Health', '', '', NULL, 'O', '148 E Arapahoe', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078642146', '3078642857', '148 E Arapahoe', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078642146', '3078642857', 'WISEWYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2010-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063695419', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('830182821', 'W12004596', 'W12004596', 'WY01', 'Gottsche Rehabilitation Center', 'James', '', 'Wyssmann', 'PHD', 'Mental Health', '', '', NULL, 'B', 'PO Box 790', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078642146', '3078642857', 'PO Box 790', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078642146', '3078642857', 'WISEWYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2010-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063695419', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('870354540', 'W12004598', 'W12004598', 'UT01', 'ENT Specialists', 'Joshua', 'G', 'Yorgason', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '4000 S 700 E Ste 10', 'Murray', 'Salt Lake', 'UT', '84107', '8012684141', NULL, '4000 S 700 E Ste 10', 'Murray', 'Salt Lake', 'UT', '84107', '8012684141', '          ', 'WUSTDENT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1275707572', 0, 'N', 0, '2010-11-02', NULL, NULL, 40.6857, -111.871, NULL, NULL),
('204969546', 'W12004599', 'W12004599', 'ID01', 'Meridian Pediatrics', 'Velma', '', 'Bradford', 'MD', 'Pediatrics', '', '', NULL, 'O', '3653 N Locust Grove Rd', 'Meridian', 'Ada', 'ID', '83646', '2083385437', '2089399811', '3653 N Locust Grove Rd', 'Meridian', 'Ada', 'ID', '83646', '2083385437', '2089399811', 'IDSTD10', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2010-11-01', '2012-08-19', 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1629070636', 0, 'N', 0, '2014-06-05', NULL, NULL, 43.6379, -116.376, NULL, NULL),
('741619182', 'W12004600', 'W12004600', 'TX01', 'Clinical Pathology Associates', '', '', 'Clinical Pathology Associates', 'GROUP', 'Pathology', '', '', NULL, 'O', '111 Dallas St', 'San Antonio', 'Bexar', 'TX', '78205', '2102977830', NULL, '111 Dallas St', 'San Antonio', 'Bexar', 'TX', '78205', '2102977830', '          ', '', '', '', '0.00', '25.00', '0.00', 3, '2010-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255395810', 0, 'Y', 0, '2010-12-16', NULL, NULL, 29.4329, -98.4928, NULL, NULL),
('470905811', 'W12004601', 'W12004601', 'UT01', 'Asthma & Allergy Clinic of Utah', 'Amit', 'J', 'Shah', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '1121 E 3900 S Ste C 130', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012811300', '8012865973', '1121 E 3900 S Ste C 130', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012811300', '8012865973', 'WiseSTD8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-12-01', NULL, 0, NULL, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1134246770', 0, 'N', 0, '2011-10-10', NULL, NULL, 40.6871, -111.859, NULL, NULL),
('810284764', 'W12004603', 'W12004603', 'WY01', 'Arapahoe Health Center', 'Raymond', 'P', 'Adams', 'MD', 'Family Practice', '', '', NULL, 'O', '17 Great Plains Rd', 'Arapahoe', 'Fremont', 'WY', '82510', '3078569281', '3078577063', '17 Great Plains Rd', 'Arapahoe', 'Fremont', 'WY', '82510', '3078569281', '3078577063', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, 'SageWest Health Care', '', '', '', 'HCFA|UB|', '1265577134', 0, 'N', 0, '2011-06-08', NULL, NULL, 42.9868, -108.487, NULL, NULL),
('810284764', 'W12004602', 'W12004602', 'WY01', 'Fort Washakie Health Center', 'Raymond', 'P', 'Adams', 'MD', 'Family Practice', '', '', NULL, 'O', '29 Black Coal Dr', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', '29 Black Coal Dr', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, 'SageWest Health Care', '', '', '', 'HCFA|UB|', '1265577134', 0, 'N', 0, '2011-06-08', NULL, NULL, 42.9969, -108.861, NULL, NULL),
('810284764', 'W12004604', 'W12004604', 'WY01', 'Fort Washakie Health Center', 'Raymond', 'P', 'Adams', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 128', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', 'PO Box 128', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, 'SageWest Health Care', '', '', '', 'HCFA|UB|', '1265577134', 0, 'N', 0, '2011-06-08', NULL, NULL, 0, 0, NULL, NULL),
('810284764', 'W12004605', 'W12004605', 'WY01', 'Arapahoe Health Center', 'Raymond', 'P', 'Adams', 'MD', 'Family Practice', '', '', NULL, 'M', 'PO Box 31001', 'Pasadena', 'Los Angeles', 'CA', '91110', '3078569281', '3078577063', 'PO Box 31001', 'Pasadena', 'Los Angeles', 'CA', '91110', '3078569281', '3078577063', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, 'SageWest Health Care', '', '', '', 'HCFA|UB|', '1265577134', 0, 'N', 0, '2011-06-08', NULL, NULL, 0, 0, NULL, NULL),
('810284764', 'W12004607', 'W12004607', 'WY01', 'Arapahoe Health Center', 'Shelly ', '', 'Cadman', 'OD', 'Optometry', '', '', NULL, 'O', '17 Great Plains Rd', 'Arapahoe', 'Fremont', 'WY', '82510', '3078569281', '3078577063', '17 Great Plains Rd', 'Arapahoe', 'Fremont', 'WY', '82510', '3078569281', '3078577063', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417969718', 0, 'N', 0, '2014-07-21', NULL, NULL, 42.9868, -108.487, NULL, NULL),
('810284764', 'W12004606', 'W12004606', 'WY01', 'Fort Washakie Health Center', 'Shelly ', '', 'Cadman', 'OD', 'Optometry', '', '', NULL, 'O', '29 Black Coal Dr', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', '29 Black Coal Dr', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417969718', 0, 'N', 0, '2014-07-21', NULL, NULL, 42.9969, -108.861, NULL, NULL),
('810284764', 'W12004609', 'W12004609', 'WY01', 'Fort Washakie Health Center', 'Shelly ', '', 'Cadman', 'OD', 'Optometry', '', '', NULL, 'B', 'PO Box 128', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', 'PO Box 128', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417969718', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('810284764', 'W12004608', 'W12004608', 'WY01', 'Arapahoe Health Center', 'Shelly ', '', 'Cadman', 'OD', 'Optometry', '', '', NULL, 'M', 'PO Box 31001', 'Pasadena', 'Los Angeles', 'CA', '91110', '3078569281', '3078577063', 'PO Box 31001', 'Pasadena', 'Los Angeles', 'CA', '91110', '3078569281', '3078577063', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417969718', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('263981143', 'W12004610', 'W12004610', 'UT01', 'Peak ENT Associates LLC', 'Joseph ', 'E', 'Dansie', 'AUD', 'Audiology', '', '', NULL, 'O', '1055 N 300 W Ste 401', 'Provo', 'Utah', 'UT', '84604', '8013577499', '', '1055 N 300 W Ste 401', 'Provo', 'Utah', 'UT', '84604', '8013577499', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2011-11-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972818185', 0, 'N', 0, '2014-07-24', NULL, NULL, 0, 0, NULL, NULL),
('263981143', 'W12004611', 'W12004611', 'UT01', 'Peak ENT Associates LLC', 'Joseph ', 'E', 'Dansie', 'AUD', 'Audiology', '', '', NULL, 'O', '900 Round Valley Dr Ste 200', 'Park City', 'Summit', 'UT', '84060', '4356157500', '', '900 Round Valley Dr Ste 200', 'Park City', 'Summit', 'UT', '84060', '4356157500', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2011-11-21', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972818185', 0, 'N', 0, '2014-07-24', NULL, NULL, 0, 0, NULL, NULL),
('272789328', 'W12004612', 'W12004612', 'UTMH1', 'All Ages & LIfe Stages Counseling', 'Dwight', 'D', 'Hurst', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '845 S Main St Ste B-8', 'Bountiful', 'Davis', 'UT', '84010', '8014253628', NULL, '845 S Main St Ste B-8', 'Bountiful', 'Davis', 'UT', '84010', '8014253628', '          ', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043474620', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870299862', 'W12004614', 'W12004614', 'UTMH1', 'LDS Family Services', 'Debra', 'E', 'Smith', 'CMHC', 'Mental Health', 'Counseling', '', NULL, 'O', '94 E Pages Ln Ste A', 'Centerville', 'Davis', 'UT', '84014', '8012940578', NULL, '94 E Pages Ln Ste A', 'Centerville', 'Davis', 'UT', '84014', '8012940578', '', 'MA', '', '', '0.00', '35.00', '0.00', 8, '2010-12-01', '2013-02-14', 0, NULL, 0, '', '', '', '', 'HCFA|UB|', '1689865974', 0, 'N', 0, '2014-07-16', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12004615', 'W12004615', 'UT01', 'Davis Hospital', 'James', 'M', 'Stewart', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8018077219', NULL, '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8018077219', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-09-24', '2010-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104022557', 0, 'N', 0, '2011-09-21', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('621801973', 'W12004617', 'W12004617', 'UT01', 'Davis Hospital', 'James', 'M', 'Stewart', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8018077219', NULL, 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8018077219', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-09-24', '2010-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104022557', 0, 'N', 0, '2011-09-21', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12004616', 'W12004616', 'UT01', 'Davis Hospital', 'James', 'M', 'Stewart', 'MD', 'Internal Medicine', '', '', NULL, 'M', '406 S Jordan Pkwy Ste 450', 'South Jordan', 'Salt Lake', 'UT', '84095', '8018077219', NULL, '406 S Jordan Pkwy Ste 450', 'South Jordan', 'Salt Lake', 'UT', '84095', '8018077219', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-09-24', '2010-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104022557', 0, 'N', 0, '2011-09-21', NULL, NULL, 0, 0, NULL, NULL),
('444700112', 'W12004618', 'W12004618', 'UTMH1', '', 'Romeo', '', 'Kistler', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '11075 S State St Ste 28', 'Sandy', 'Salt Lake', 'UT', '84070', '8017177176', '8015017317', '11075 S State St Ste 28', 'Sandy', 'Salt Lake', 'UT', '84070', '8017177176', '8015017317', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023172269', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('444700112', 'W12004619', 'W12004619', 'UTMH1', '', 'Romeo', '', 'Kistler', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'B', 'PO Box 900245', 'Sandy', 'Salt Lake', 'UT', '84090', '8017177176', '8015017317', 'PO Box 900245', 'Sandy', 'Salt Lake', 'UT', '84090', '8017177176', '8015017317', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023172269', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870342259', 'W12004621', 'W12004621', 'UT01', 'Wayne Community Health Center', 'Sherree', 'C', 'Rechtsteiner', 'NP', 'Family Practice', '', '', NULL, 'M', 'PO Box 303', 'Bicknell', 'Wayne', 'UT', '84715', '4354253744', '4354253785', 'PO Box 303', 'Bicknell', 'Wayne', 'UT', '84715', '4354253744', '4354253785', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831387679', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('870342259', 'W12004620', 'W12004620', 'UT01', 'Wayne Community Health Center', 'Sherree', 'C', 'Rechtsteiner', 'NP', 'Family Practice', '', '', NULL, 'O', '128 S 300 W', 'Bicknell', 'Wayne', 'UT', '84715', '4354253744', '4354253785', '128 S 300 W', 'Bicknell', 'Wayne', 'UT', '84715', '4354253744', '4354253785', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831387679', 0, 'N', 0, '2014-07-21', NULL, NULL, 38.2989, -111.421, NULL, NULL),
('200022831', 'W12004623', 'W12004623', 'ID02', 'Foothills Physical Therapy', 'Bret', 'A', 'Bastian', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '1618 S Millennium Way Ste 210', 'Meridian', 'Ada', 'ID', '83642', '2088844647', '2088848984', '1618 S Millennium Way Ste 210', 'Meridian', 'Ada', 'ID', '83642', '2088844647', '2088848984', 'WestRehab', '', '', '0.00', '0.00', '65.00', 3, '2010-12-01', '2012-06-30', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1760798375', 0, 'N', 0, '2013-12-30', NULL, NULL, 43.5903, -116.368, NULL, NULL),
('200022831', 'W12004622', 'W12004622', 'ID02', 'Foothills Physical Therapy', 'Bret', 'A', 'Bastian', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '1673 W Shoreline Dr Ste 230', 'Boise', 'Ada', 'ID', '83702', '2083434700', '2083434706', '1673 W Shoreline Dr Ste 230', 'Boise', 'Ada', 'ID', '83702', '2083434700', '2083434706', 'WestRehab', '', '', '0.00', '0.00', '65.00', 3, '2010-12-01', '2012-06-30', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1760798375', 0, 'N', 0, '2013-12-30', NULL, NULL, 43.6171, -116.222, NULL, NULL),
('272768083', 'W12004624', 'W12004624', 'UT01', '', 'Caroline', 'R', 'Tadros', 'MD', 'Gastroenterology', 'Internal Medicine', '', NULL, 'O', '4403 Harrison Blvd Ste 2855', 'Ogden', 'Weber', 'UT', '84403', '8013872550', '8013872564', '4403 Harrison Blvd Ste 2855', 'Ogden', 'Weber', 'UT', '84403', '8013872550', '8013872564', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-10', '2013-11-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427107770', 0, 'N', 0, '2013-12-02', NULL, NULL, 0, 0, NULL, NULL),
('200022831', 'W12004627', 'W12004627', 'ID02', 'Foothills Physical Therapy', 'Kathy', 'M', 'Berg', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '1618 S Millennium Way Ste 210', 'Meridian', 'Ada', 'ID', '83642', '2088844647', '2088848984', '1618 S Millennium Way Ste 210', 'Meridian', 'Ada', 'ID', '83642', '2088844647', '2088848984', 'WestRehab', '', '', '0.00', '0.00', '65.00', 3, '2010-11-01', '2012-06-30', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1598071557', 0, 'N', 0, '2012-07-10', NULL, NULL, 43.5903, -116.368, NULL, NULL),
('200022831', 'W12004625', 'W12004625', 'ID02', 'Foothills Physical Therapy', 'Kathy', 'M', 'Berg', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '1673 W Shoreline Dr Ste 230', 'Boise', 'Ada', 'ID', '83702', '2083434700', '2083434706', '1673 W Shoreline Dr Ste 230', 'Boise', 'Ada', 'ID', '83702', '2083434700', '2083434706', 'WestRehab', '', '', '0.00', '0.00', '65.00', 3, '2010-11-01', '2012-06-30', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1598071557', 0, 'N', 0, '2012-07-10', NULL, NULL, 43.6171, -116.222, NULL, NULL),
('201300128', 'W12004630', 'W12004630', 'ID01', 'Idaho Urologic Institute', 'Helen', 'J', 'Kuo', 'MD', 'Urology', '', '', NULL, 'O', '2855 E Magic View Dr', 'Meridian', 'Ada', 'ID', '83642', '2086394900', '2086394901', '2855 E Magic View Dr', 'Meridian', 'Ada', 'ID', '83642', '2086394900', '2086394901', 'IDUROLOGY', 'WUSTDHCPC5', '', '0.00', '20.00', '0.00', 3, '2010-11-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1346407921', 0, 'N', 0, '2013-06-25', NULL, NULL, 43.599, -116.36, NULL, NULL),
('200022831', 'W12004632', 'W12004632', 'ID02', 'Foothills Physical Therapy', 'Linda', 'M', 'Owen', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1618 S Millennium Way Ste 210', 'Meridian', 'Ada', 'ID', '83642', '2088844647', '2088848984', '1618 S Millennium Way Ste 210', 'Meridian', 'Ada', 'ID', '83642', '2088844647', '2088848984', 'WestRehab', '', '', '0.00', '0.00', '65.00', 3, '2010-11-01', '2012-06-30', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1558677021', 0, 'N', 0, '2013-09-10', NULL, NULL, 43.5903, -116.368, NULL, NULL),
('200022831', 'W12004631', 'W12004631', 'ID02', 'Foothills Physical Therapy', 'Linda', 'M', 'Owen', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1673 W Shoreline Dr Ste 230', 'Boise', 'Ada', 'ID', '83702', '2083434700', '2083434706', '1673 W Shoreline Dr Ste 230', 'Boise', 'Ada', 'ID', '83702', '2083434700', '2083434706', 'WestRehab', '', '', '0.00', '0.00', '65.00', 3, '2010-11-01', '2012-06-30', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1558677021', 0, 'N', 0, '2013-09-10', NULL, NULL, 43.6171, -116.222, NULL, NULL),
('900512734', 'W12004635', 'W12004635', 'UT01', 'Lakeview Intermal Medicine & Surgery', 'Cynthia', '', 'Canga-Siao', 'MD', 'Internal Medicine', '', '', NULL, 'M', '3 Maryland Farms Ste 250', 'Brentwood', 'Williamson', 'TN', '37027', '8012949333', NULL, '3 Maryland Farms Ste 250', 'Brentwood', 'Williamson', 'TN', '37027', '8012949333', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-01', '2011-04-03', 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB|', '1669497558', 0, 'N', 0, '2014-01-21', NULL, NULL, 0, 0, NULL, NULL),
('900512734', 'W12004633', 'W12004633', 'UT01', 'Lakeview Intermal Medicine & Surgery', 'Cynthia', '', 'Canga-Siao', 'MD', 'Internal Medicine', '', '', NULL, 'O', '520 E Medical Dr Ste 200', 'Bountiful', 'Davis', 'UT', '84010', '8012949333', NULL, '520 E Medical Dr Ste 200', 'Bountiful', 'Davis', 'UT', '84010', '8012949333', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-01', '2011-04-03', 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB|', '1669497558', 0, 'N', 0, '2014-01-21', NULL, NULL, 0, 0, NULL, NULL),
('900512734', 'W12004634', 'W12004634', 'UT01', 'Lakeview Intermal Medicine & Surgery', 'Cynthia', '', 'Canga-Siao', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 402381', 'Atlanta', 'Fulton', 'GA', '30384', '8012949333', NULL, 'PO Box 402381', 'Atlanta', 'Fulton', 'GA', '30384', '8012949333', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-01', '2011-04-03', 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB|', '1669497558', 0, 'N', 0, '2014-01-21', NULL, NULL, 0, 0, NULL, NULL),
('271398252', 'W12004636', 'W12004636', 'UT01', 'Utah Valley Urgent Care', 'Bryan', 'K', 'Adams', 'APRN', 'Family Practice', '', '', NULL, 'B', 'PO Box 932', 'Sandy', 'Salt Lake', 'UT', '84091', '8016192175', '8015539562', 'PO Box 932', 'Sandy', 'Salt Lake', 'UT', '84091', '8016192175', '8015539562', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1578654224', 0, 'N', 0, '2010-11-01', NULL, NULL, 0, 0, NULL, NULL),
('271398252', 'W12004640', 'W12004640', 'UT01', 'Utah Valley Urgent Care', 'Troy ', 'J', 'Badger', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 932', 'Sandy', 'Salt Lake', 'UT', '84091', '8016192175', '8015539562', 'PO Box 932', 'Sandy', 'Salt Lake', 'UT', '84091', '8016192175', '8015539562', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', '2030-01-01', 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1831335660', 0, 'N', 0, '2012-01-26', NULL, NULL, 0, 0, NULL, NULL),
('800239738', 'W12004641', 'W12004641', 'UT01', 'Jordan Specialty Services', 'Spencer', 'P', 'Barney', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '8846 S Redwood Rd Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015692001', '8015692001', '8846 S Redwood Rd Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015692001', '8015692001', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1982839130', 0, 'N', 0, '2013-06-17', NULL, NULL, 40.5911, -111.939, NULL, NULL),
('271398252', 'W12004644', 'W12004644', 'UT01', 'Utah Valley Urgent Care', 'Jennifer', 'L', 'Butcher', 'APRN', 'Family Practice', '', '', NULL, 'B', 'PO Box 932', 'Sandy', 'Salt Lake', 'UT', '84091', '8016192175', '8015539562', 'PO Box 932', 'Sandy', 'Salt Lake', 'UT', '84091', '8016192175', '8015539562', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013230598', 0, 'N', 0, '2010-09-20', NULL, NULL, 0, 0, NULL, NULL),
('621560557', 'W12004646', 'W12004646', 'UT01', 'Morgan Health Center', 'Alan', 'N', 'Bybee', 'PA', 'Family Practice', NULL, NULL, NULL, 'O', '166 N State St', 'Morgan', 'Morgan', 'UT', '84050', '8018293426', '8018293135', '166 N State St', 'Morgan', 'Morgan', 'UT', '84050', '8018293426', '8018293135', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1033184940', 0, 'N', 0, '2014-04-04', NULL, NULL, 41.039, -111.679, NULL, NULL),
('870573947', 'W12004647', 'W12004647', 'UT01', 'Holladay Family Practice', 'Carol', 'A', 'Cheney', 'NP', 'Family Practice', NULL, NULL, NULL, 'O', '3920 S 1100 E Ste 220', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012682584', '8012621168', '3920 S 1100 E Ste 220', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012682584', '8012621168', 'HOLLADAYFP', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-15', '2010-11-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1710952791', 0, 'N', 0, '2006-12-21', NULL, NULL, 0, 0, NULL, NULL),
('870573947', 'W12004648', 'W12004648', 'UT01', 'Holladay Family Practice', 'Randall', 'P', 'Daynes', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '3920 S 1100 E Ste Ste 220', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012682584', '8012621168', '3920 S 1100 E Ste Ste 220', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012682584', '8012621168', 'HOLLADAYFP', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-15', '2010-11-01', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1811962939', 0, 'N', 0, '2012-06-19', NULL, NULL, 0, 0, NULL, NULL),
('800239738', 'W12004649', 'W12004649', 'UT01', 'Jordan Specialty Services', 'Erica', 'A', 'Faircloth', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '8846 S Redwood Rd Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', '8846 S Redwood Rd Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2011-12-31', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1700011954', 0, 'N', 0, '2014-04-09', NULL, NULL, 0, 0, NULL, NULL),
('261916023', 'W12004650', 'W12004650', 'ID01', '', 'Trina', 'C', 'Fisher', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '815 S Bridgeway PL Ste 110', 'Eagle', 'Ada', 'ID', '83616', '2088507958', NULL, '815 S Bridgeway PL Ste 110', 'Eagle', 'Ada', 'ID', '83616', '2088507958', '          ', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2010-08-30', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740306695', 0, 'N', 0, '2012-04-24', NULL, NULL, 0, 0, NULL, NULL),
('161767581', 'W12004651', 'W12004651', 'UT01', 'Farr West Family Medicine', 'Jody', 'L', 'Fowers', 'APRN', 'Family Practice', '', '', NULL, 'O', '2850 N 2000 W Ste 101', 'Ogden', 'Weber', 'UT', '84404', '8017311222', '8017311666', '2850 N 2000 W Ste 101', 'Ogden', 'Weber', 'UT', '84404', '8017311222', '8017311666', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1992915052', 0, 'N', 0, '2013-10-24', NULL, NULL, 0, 0, NULL, NULL),
('161767581', 'W12004652', 'W12004652', 'UT01', 'Farr West Family Medicine', 'Jody', 'L', 'Fowers', 'APRN', 'Family Practice', '', '', NULL, 'B', 'PO Box 281221', 'Atlanta', 'Fulton', 'GA', '30384', '8017311222', '8017311666', 'PO Box 281221', 'Atlanta', 'Fulton', 'GA', '30384', '8017311222', '8017311666', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1992915052', 0, 'N', 0, '2013-10-24', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W12004653', 'W12004653', 'UT01', '', 'Jed', 'L', 'Frazier', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '568 S Foothill Dr Ste 5B', 'Kamas', 'Summit', 'UT', '84036', '4357832838', '7357832840', '568 S Foothill Dr Ste 5B', 'Kamas', 'Summit', 'UT', '84036', '4357832838', '7357832840', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-07-01', '2010-10-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1417938184', 0, 'N', 0, '2006-08-31', NULL, NULL, 0, 0, NULL, NULL),
('870573947', 'W12004654', 'W12004654', 'UT01', 'Holladay Family Practice', 'Gene', 'R', 'Fuller', 'MD', 'Family Practice', '', '', NULL, 'O', '3920 S 1100 E', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012682584', '8012621168', '3920 S 1100 E', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012682584', '8012621168', 'HOLLADAYFP', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-15', '2010-11-01', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1396710281', 0, 'N', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
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('870618776', 'W12004702', 'W12004702', 'UT01', 'Gamma West Cancer Services', 'John', 'K', 'Hayes', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '1490 E Foremaster Dr Ste C', 'St George', 'Washington', 'UT', '84790', '4356275327', NULL, '1490 E Foremaster Dr Ste C', 'St George', 'Washington', 'UT', '84790', '4356275327', '', 'WUSTDRONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2011-11-07', 0, 0, 0, 'Ogden Regional Medical Center', 'St Marks Hospital', '', '', 'HCFA|UB|', '1275672933', 0, 'N', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('870618776', 'W12004703', 'W12004703', 'UT01', 'Gamma West Cancer Services', 'John', 'K', 'Hayes', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356275327', NULL, '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356275327', '', 'WUSTDRONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', 'St Marks Hospital', '', '', 'HCFA|UB|', '1275672933', 0, 'N', 0, '2014-04-17', NULL, NULL, 37.0989, -113.575, NULL, NULL),
('870618776', 'W12004704', 'W12004704', 'UT01', 'Gamma West Cancer Services', 'John', 'K', 'Hayes', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '2132 N 1700 W Ste B101', 'Layton', 'Davis', 'UT', '84041', '8018077777', NULL, '2132 N 1700 W Ste B101', 'Layton', 'Davis', 'UT', '84041', '8018077777', '', 'WUSTDRONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', 'St Marks Hospital', '', '', 'HCFA|UB|', '1275672933', 0, 'N', 0, '2014-04-17', NULL, NULL, 41.0892, -111.997, NULL, NULL),
('870618776', 'W12004705', 'W12004705', 'UT01', 'Gamma West Cancer Services', 'John', 'K', 'Hayes', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '5475 S 500 E', 'Ogden', 'Weber', 'UT', '84405', '8014792570', NULL, '5475 S 500 E', 'Ogden', 'Weber', 'UT', '84405', '8014792570', '', 'WUSTDRONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', 'St Marks Hospital', '', '', 'HCFA|UB|', '1275672933', 0, 'N', 0, '2014-04-17', NULL, NULL, 41.1635, -111.969, NULL, NULL),
('870618776', 'W12004706', 'W12004706', 'UT01', 'Gamma West Cancer Services', 'John', 'K', 'Hayes', 'MD', 'Radiation Oncology', '', '', NULL, 'B', 'PO Box 30015 Ste Dept 16', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8014756532', NULL, 'PO Box 30015 Ste Dept 16', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8014756532', '', 'WUSTDRONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', 'St Marks Hospital', '', '', 'HCFA|UB|', '1275672933', 0, 'Y', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('870618776', 'W12004707', 'W12004707', 'UT01', 'Gamma West Cancer Services', 'John', 'K', 'Hayes', 'MD', 'Radiation Oncology', '', '', NULL, 'B', 'PO Box 271098', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8014756532', NULL, 'PO Box 271098', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8014756532', '', 'WUSTDRONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', 'St Marks Hospital', '', '', 'HCFA|UB|', '1275672933', 0, 'Y', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('870618776', 'W12004708', 'W12004708', 'UT01', 'Gamma West Cancer Services', 'John', 'K', 'Hayes', 'MD', 'Radiation Oncology', '', '', NULL, 'B', 'PO Box 27301', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8014756532', NULL, 'PO Box 27301', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8014756532', '', 'WUSTDRONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', 'St Marks Hospital', '', '', 'HCFA|UB|', '1275672933', 0, 'N', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('900512734', 'W12004642', 'W12004642', 'UT01', 'Lakeview Intermal Medicine & Surgery', 'Bryan', '', 'Bartholomew', 'DO', 'Internal Medicine', '', '', NULL, 'O', '520 E Medical Dr Ste 200', 'Bountiful', 'Davis', 'UT', '84010', '8012949338', '8012947558', '520 E Medical Dr Ste 200', 'Bountiful', 'Davis', 'UT', '84010', '8012949338', '8012947558', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407956121', 0, 'N', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('900512734', 'W12004681', 'W12004681', 'UT01', 'Lakeview Intermal Medicine & Surgery', 'Gregory', 'D', 'Hammond', 'MD', 'Pulmonary', 'Sleep Medicine', '', NULL, 'O', '520 E Medical Dr Ste 200', 'Bountiful', 'Davis', 'UT', '84010', '8012949338', '8012947558', '520 E Medical Dr Ste 200', 'Bountiful', 'Davis', 'UT', '84010', '8012949338', '8012947558', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1942374020', 0, 'N', 0, '2012-06-27', NULL, NULL, 0, 0, NULL, NULL),
('900512734', 'W12004710', 'W12004710', 'UT01', 'Lakeview Intermal Medicine & Surgery', 'Scott', '', 'Southworth', 'MD', 'Internal Medicine', '', '', NULL, 'O', '520 E Medical Dr Ste 200', 'Bountiful', 'Davis', 'UT', '84010', '8012949338', '8012947558', '520 E Medical Dr Ste 200', 'Bountiful', 'Davis', 'UT', '84010', '8012949338', '8012947558', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1972602910', 0, 'N', 0, '2013-09-18', NULL, NULL, 0, 0, NULL, NULL),
('870573947', 'W12004711', 'W12004711', 'UT01', 'Holladay Family Practice', '', '', 'Holladay Family Practice', 'Group', 'Primary Care with Extended Hours', '', '', NULL, 'O', '3920 S 1100 E Ste 220', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012682584', '8012621168', '3920 S 1100 E Ste 220', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012682584', '8012621168', 'HOLLADAYFP', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-15', '2010-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437255866', 0, 'N', 0, '2010-09-17', NULL, NULL, 0, 0, NULL, NULL),
('271398252', 'W12004712', 'W12004712', 'UT01', 'Utah Valley Urgent Care', 'Kevin', 'A', 'Hough', 'PA', 'Cardiovascular Disease', NULL, NULL, NULL, 'B', 'PO Box 932', 'Sandy', 'Salt Lake', 'UT', '84091', '8016192175', '8015539562', 'PO Box 932', 'Sandy', 'Salt Lake', 'UT', '84091', '8016192175', '8015539562', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1174581870', 0, 'N', 0, '2010-12-15', NULL, NULL, 0, 0, NULL, NULL),
('271398252', 'W12004713', 'W12004713', 'UT01', 'Utah Valley Urgent Care', 'William', 'E', 'Hough', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 932', 'Sandy', 'Salt Lake', 'UT', '84091', '8016192175', '8015539562', 'PO Box 932', 'Sandy', 'Salt Lake', 'UT', '84091', '8016192175', '8015539562', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-15', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1386737633', 0, 'N', 0, '2014-05-21', NULL, NULL, 0, 0, NULL, NULL),
('271398252', 'W12004714', 'W12004714', 'UT01', 'Utah Valley Urgent Care', 'Judd', 'D', 'Hunter', 'APRN', 'Family Practice', '', '', NULL, 'B', 'PO Box 932', 'Sandy', 'Salt Lake', 'UT', '84091', '8016192175', '8015539562', 'PO Box 932', 'Sandy', 'Salt Lake', 'UT', '84091', '8016192175', '8015539562', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831428705', 0, 'N', 0, '2010-12-15', NULL, NULL, 0, 0, NULL, NULL),
('271398252', 'W12004715', 'W12004715', 'UT01', 'Utah Valley Urgent Care', 'Kraig', 'L', 'Packer', 'APRN', 'Family Practice', '', '', NULL, 'B', 'PO Box 932', 'Sandy', 'Salt Lake', 'UT', '84091', '8016192175', '8015539562', 'PO Box 932', 'Sandy', 'Salt Lake', 'UT', '84091', '8016192175', '8015539562', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1518959535', 0, 'N', 0, '2010-12-15', NULL, NULL, 0, 0, NULL, NULL),
('271398252', 'W12004716', 'W12004716', 'UT01', 'Utah Valley Urgent Care', 'LuAnn ', '', 'Jacobs-Peterson', 'APRN', 'Family Practice', '', '', NULL, 'B', 'PO Box 932', 'Sandy', 'Salt Lake', 'UT', '84091', '8016192175', '8015539562', 'PO Box 932', 'Sandy', 'Salt Lake', 'UT', '84091', '8016192175', '8015539562', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396918462', 0, 'N', 0, '2014-07-03', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12003192', 'W12003192', 'UT01', 'Lone Peak Family Medicine', 'David', 'B', 'Jack', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '11760 S 700 E Ste 111', 'Draper', 'Salt Lake', 'UT', '84020', '8019964384', '8015769800', '11760 S 700 E Ste 111', 'Draper', 'Salt Lake', 'UT', '84020', '8019964384', '8015769800', 'WUSTDFAM5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-01', '2010-08-31', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1255434296', 0, 'N', 0, '2013-10-21', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12003193', 'W12003193', 'UT01', 'Lone Peak Family Medicine', 'David', 'B', 'Jack', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '8015769800', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '8015769800', 'WUSTDFAM5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-01', '2010-08-31', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1255434296', 0, 'N', 0, '2013-10-21', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12004717', 'W12004717', 'UT01', 'Lone Peak Family Medicine', 'David', 'B', 'Jack', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '11760 S 700 E Ste 111', 'Draper', 'Salt Lake', 'UT', '84020', '8019964384', '8015769800', '11760 S 700 E Ste 111', 'Draper', 'Salt Lake', 'UT', '84020', '8019964384', '8015769800', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1255434296', 0, 'N', 0, '2013-10-21', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12004718', 'W12004718', 'UT01', 'Lone Peak Family Medicine', 'David', 'B', 'Jack', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '8015769800', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '8015769800', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1255434296', 0, 'N', 0, '2013-10-21', NULL, NULL, 0, 0, NULL, NULL),
('870573947', 'W12004719', 'W12004719', 'UT01', 'Holladay Family Practice', 'Taylor', 'A', 'Jeppson', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '3920 S 1100 E', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012682584', '8012621168', '3920 S 1100 E', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012682584', '8012621168', 'HOLLADAYFP', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-15', '2010-11-01', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1932174919', 0, 'N', 0, '2011-08-01', NULL, NULL, 0, 0, NULL, NULL),
('870573947', 'W12004720', 'W12004720', 'UT01', 'Holladay Family Practice', 'David', 'C', 'Larsen', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '3920 S 1100 E Ste 220', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012682584', '8012621168', '3920 S 1100 E Ste 220', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012682584', '8012621168', 'HOLLADAYFP', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-15', '2010-11-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1679548564', 0, 'N', 0, '2006-12-21', NULL, NULL, 0, 0, NULL, NULL),
('870573947', 'W12004721', 'W12004721', 'UT01', 'Holladay Family Practice', 'Eric', 'C', 'McDougall', 'MD', 'Family Practice', '', '', NULL, 'O', '3920 S 1100 E Ste 220', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012682584', '8012621168', '3920 S 1100 E Ste 220', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012682584', '8012621168', 'HOLLADAYFP', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-15', '2010-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285609313', 0, 'N', 0, '2014-01-28', NULL, NULL, 0, 0, NULL, NULL),
('870573947', 'W12004722', 'W12004722', 'UT01', 'Holladay Family Practice', 'Brian', 'C', 'Rasmussen', 'MD', 'Family Practice', '', '', NULL, 'O', '3920 S 1100 E Ste 220', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012682584', NULL, '3920 S 1100 E Ste 220', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012682584', '          ', 'HOLLADAYFP', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-15', '2010-11-01', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1316058670', 0, 'N', 0, '2011-11-03', NULL, NULL, 0, 0, NULL, NULL),
('528470920', 'W12004723', 'W12004723', 'UT01', 'Holladay Family Practice', 'Brian', 'C', 'Rasmussen', 'MD', 'Family Practice', '', '', NULL, 'O', '3920 S 1100 E Ste 220', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012682584', NULL, '3920 S 1100 E Ste 220', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012682584', '          ', 'HOLLADAYFP', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-15', '2011-02-23', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1316058670', 0, 'N', 0, '2011-11-03', NULL, NULL, 0, 0, NULL, NULL),
('261752159', 'W12004724', 'W12004724', 'UTMH1', 'Hope Haven Counseling Inc', 'Miriam', 'R', 'Harper', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '9140 S State St Ste 101', 'Sandy', 'Salt Lake', 'UT', '84070', '8016768796', NULL, '9140 S State St Ste 101', 'Sandy', 'Salt Lake', 'UT', '84070', '8016768796', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780647123', 0, 'N', 0, '2013-09-11', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12004725', 'W12004725', 'UT01', 'St. Marks Millcreek Primary Care', 'Douglas', 'B', 'Jerman', 'PA', 'Family Practice', '', '', NULL, 'O', '7798 S 900 E Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012662777', '8012661377', '7798 S 900 E Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012662777', '8012661377', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2014-04-04', 0, 0, 0, 'Pioneer Valley Hospital', 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', '', '', 'HCFA|UB|', '1518999762', 0, 'N', 0, '2014-04-09', NULL, NULL, 0, 0, NULL, NULL),
('271477039', 'W12004726', 'W12004726', 'ID02', 'Advantage Walkin Chiropractic', 'Andrew', '', 'Kidder', 'DC', 'Chiropractic', '', '', NULL, 'O', '3211 N Milwaukee St', 'Boise', 'Ada', 'ID', '83704', '2083752225', NULL, '3211 N Milwaukee St', 'Boise', 'Ada', 'ID', '83704', '2083752225', '          ', 'IDCHIRO1', '', '', '0.00', '35.00', '0.00', 3, '2010-01-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1710048681', 0, 'N', 0, '2010-11-08', NULL, NULL, 0, 0, NULL, NULL),
('870635889', 'W12004729', 'W12004729', 'UT01', 'Grantsville Medical Center', 'Benjamin', 'J', 'Krogh', 'DO', 'Family Practice', NULL, NULL, NULL, 'M', '7100 Commerce Way Ste 180', 'Brentwood', 'Williamson', 'TN', '37027', '4358843578', '4358821275', '7100 Commerce Way Ste 180', 'Brentwood', 'Williamson', 'TN', '37027', '4358843578', '4358821275', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-08-01', NULL, 0, 0, 0, 'Mountain West Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1013003540', 0, 'N', 0, '2006-11-30', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W12004730', 'W12004730', 'ID02', 'Primary Health Medical Group', 'Julia', 'R', 'Middleton', 'PA', 'Family Practice', '', '', NULL, 'O', '3115 E Florence', 'Meridian', 'Ada', 'ID', '83642', '2088958670', '2089550494', '3115 E Florence', 'Meridian', 'Ada', 'ID', '83642', '2088958670', '2089550494', 'IDSTDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2010-07-19', '2012-09-25', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1215113741', 0, 'N', 0, '2013-02-28', NULL, NULL, 43.6163, -116.355, NULL, NULL);
