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
('621742196', 'W12028418', 'W12028418', 'TXHOUSTD', 'Sugar Land Ambulatory Surgery Center', '', '', 'Sugar Land Ambulatory Surgery Center', '', 'Ambulatory Surgery Center', NULL, NULL, NULL, 'O', '15300 Southwest Fwy Ste 100', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2812746670', '2812746610', '15300 Southwest Fwy Ste 100', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2812746670', '2812746610', '', '', 'HCA', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659316917', 0, 'N', 0, '2013-02-15', NULL, NULL, 29.6068, -95.6148, NULL, NULL),
('800444943', 'W12028417', 'W12028417', 'TXHOUSTD', 'Physicians Endoscopy Center', '', '', 'Physicians Endoscopy Center', '', 'Endoscopy Center', NULL, NULL, NULL, 'B', 'PO Box 281671', 'Atlanta', 'Fulton', 'GA', '30384', '7135870909', '7135870912', 'PO Box 281671', 'Atlanta', 'Fulton', 'GA', '30384', '7135870909', '7135870912', '', '', 'HCA', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902036049', 0, 'N', 0, '2013-02-15', NULL, NULL, 0, 0, NULL, NULL),
('800444943', 'W12028416', 'W12028416', 'TXHOUSTD', 'Physicians Endoscopy Center', '', '', 'Physicians Endoscopy Center', '', 'Endoscopy Center', NULL, NULL, NULL, 'O', '3030 S Gessner Ste 150', 'Houston', 'Harris', 'TX', '77063', '7135870909', '7135870912', '3030 S Gessner Ste 150', 'Houston', 'Harris', 'TX', '77063', '7135870909', '7135870912', '', '', 'HCA', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902036049', 0, 'N', 0, '2013-02-15', NULL, NULL, 29.7329, -95.5394, NULL, NULL),
('432016059', 'W12028411', 'W12028411', 'TXHOUSTD', 'Fannin Surgicare', '', '', 'Fannin Surgicare', '', 'Ambulatory Surgery Center', NULL, NULL, NULL, 'O', '7700 Fannin St', 'Houston', 'Harris', 'TX', '77054', '7137963800', '7137963807', '7700 Fannin St', 'Houston', 'Harris', 'TX', '77054', '7137963800', '7137963807', '', '', 'HCA', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225091739', 0, 'N', 0, '2013-02-15', NULL, NULL, 29.6921, -95.4021, NULL, NULL),
('432016059', 'W12028412', 'W12028412', 'TXHOUSTD', 'Fannin Surgicare', '', '', 'Fannin Surgicare', '', 'Ambulatory Surgery Center', NULL, NULL, NULL, 'B', 'PO Box 403646', 'Atlanta', 'Fulton', 'GA', '30384', '7137963800', '7137963807', 'PO Box 403646', 'Atlanta', 'Fulton', 'GA', '30384', '7137963800', '7137963807', '', '', 'HCA', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225091739', 0, 'N', 0, '2013-02-15', NULL, NULL, 0, 0, NULL, NULL),
('621771718', 'W12028410', 'W12028410', 'TXHOUSTD', 'Humble Kingwood Endoscopy Center', '', '', 'Humble Kingwood Endoscopy Center', '', 'Endoscopy Center', NULL, NULL, NULL, 'B', 'PO Box 741693', 'Atlanta', 'Fulton', 'GA', '30374', '2813126900', '2813123242', 'PO Box 741693', 'Atlanta', 'Fulton', 'GA', '30374', '2813126900', '2813123242', '', '', 'HCA', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619265295', 0, 'N', 0, '2013-02-15', NULL, NULL, 0, 0, NULL, NULL),
('621771718', 'W12028409', 'W12028409', 'TXHOUSTD', 'Humble Kingwood Endoscopy Center', '', '', 'Humble Kingwood Endoscopy Center', '', 'Endoscopy Center', NULL, NULL, NULL, 'O', '19505 McKay Dr Ste 101', 'Humble', 'Harris', 'TX', '77338', '2813126900', '2813123242', '19505 McKay Dr Ste 101', 'Humble', 'Harris', 'TX', '77338', '2813126900', '2813123242', '', '', 'HCA', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619265295', 0, 'N', 0, '2013-02-15', NULL, NULL, 30.0012, -95.2764, NULL, NULL),
('362167800', 'ELP000009', 'ELP000009', 'ILCHIGSTD', 'Presence Saint Francis Hospital', '', '', 'Presence Saint Francis Hospital', '', 'Hospital', NULL, NULL, NULL, 'O', '355 Ridge Ave', 'Evanston', 'Cook', 'IL', '60202', '8473164000', NULL, '355 Ridge Ave', 'Evanston', 'Cook', 'IL', '60202', '8473164000', '          ', '', '', 'PresStFran', '0.00', '100.00', '0.00', 8, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033210166', 0, 'N', 0, '2013-10-09', '140080', NULL, 42.024, -87.6852, NULL, NULL),
('752399524', 'W12028408', 'W12028408', 'TXHOUSTD', 'Gramercy Outpatient Surgery Center', '', '', 'Gramercy Outpatient Surgery Center', '', 'Ambulatory Surgery Center', NULL, NULL, NULL, 'B', 'PO Box 409837', 'Atlanta', 'Fulton', 'GA', '30384', '7136606900', '7136600704', 'PO Box 409837', 'Atlanta', 'Fulton', 'GA', '30384', '7136606900', '7136600704', '', '', 'HCA', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225091630', 0, 'N', 0, '2013-02-14', NULL, NULL, 0, 0, NULL, NULL),
('752399524', 'W12028407', 'W12028407', 'TXHOUSTD', 'Gramercy Outpatient Surgery Center', '', '', 'Gramercy Outpatient Surgery Center', '', 'Ambulatory Surgery Center', NULL, NULL, NULL, 'O', '2727 Gramercy', 'Houston', 'Harris', 'TX', '77025', '7136606900', '7136600704', '2727 Gramercy', 'Houston', 'Harris', 'TX', '77025', '7136606900', '7136600704', '', '', 'HCA', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225091630', 0, 'N', 0, '2013-02-15', NULL, NULL, 29.7044, -95.4207, NULL, NULL),
('621600411', 'W12028406', 'W12028406', 'TXHOUSTD', 'Bay Area Surgicare Center', '', '', 'Bay Area Surgicare Center', '', 'Ambulatory Surgery Center', NULL, NULL, NULL, 'B', 'PO Box 409852', 'Atlanta', 'Fulton', 'GA', '30384', '2813322433', '2813320619', 'PO Box 409852', 'Atlanta', 'Fulton', 'GA', '30384', '2813322433', '2813320619', '', '', 'HCA', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982667499', 0, 'N', 0, '2013-02-15', NULL, NULL, 0, 0, NULL, NULL),
('621600411', 'W12028405', 'W12028405', 'TXHOUSTD', 'Bay Area Surgicare Center', '', '', 'Bay Area Surgicare Center', '', 'Ambulatory Surgery Center', NULL, NULL, NULL, 'O', '502 Medical Ctr Blvd', 'Webster', 'Harris', 'TX', '77598', '2813322433', '2813320619', '502 Medical Ctr Blvd', 'Webster', 'Harris', 'TX', '77598', '2813322433', '2813320619', '', '', 'HCA', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982667499', 0, 'N', 0, '2013-02-15', NULL, NULL, 29.541, -95.1263, NULL, NULL),
('320383244', 'W12028404', 'W12028404', 'TXHOUSTD', 'Bay Area Houston Endoscopy Center', '', '', 'Bay Area Houston Endoscopy Center', '', 'Endoscopy Center', '', '', NULL, 'B', 'PO Box 742326', 'Atlanta', 'Fulton', 'GA', '30374', '2815543494', '2815543789', 'PO Box 742326', 'Atlanta', 'Fulton', 'GA', '30374', '2815543494', '2815543789', '', '', 'HCA', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275886319', 0, 'N', 0, '2013-02-15', NULL, NULL, 0, 0, NULL, NULL),
('320383244', 'W12028403', 'W12028403', 'TXHOUSTD', 'Bay Area Houston Endoscopy Center', '', '', 'Bay Area Houston Endoscopy Center', '', 'Endoscopy Center', '', '', NULL, 'O', '1015 Medical Ctr Blvd Ste 1200', 'Webster', 'Harris', 'TX', '77598', '2815543494', '2815543789', '1015 Medical Ctr Blvd Ste 1200', 'Webster', 'Harris', 'TX', '77598', '2815543494', '2815543789', '', '', 'HCA', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275886319', 0, 'N', 0, '2013-02-15', NULL, NULL, 29.5362, -95.1332, NULL, NULL),
('621810381', 'W12028402', 'W12028402', 'TXHOUSTD', 'The Womans Hospital of Texas', '', '', 'The Womans Hospital of Texas', '', 'Hospital', NULL, NULL, NULL, 'B', 'PO Box 406299', 'Atlanta', 'Fulton', 'GA', '30384', '7137901234', '7137900469', 'PO Box 406299', 'Atlanta', 'Fulton', 'GA', '30384', '7137901234', '7137900469', '', '', 'HCA', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023065794', 0, 'N', 0, '2013-02-15', NULL, NULL, 0, 0, NULL, NULL),
('621810381', 'W12028401', 'W12028401', 'TXHOUSTD', 'The Womans Hospital of Texas', '', '', 'The Womans Hospital of Texas', '', 'Hospital', NULL, NULL, NULL, 'O', '7600 Fannin St', 'Houston', 'Harris', 'TX', '77054', '7137901234', '7137900469', '7600 Fannin St', 'Houston', 'Harris', 'TX', '77054', '7137901234', '7137900469', '', '', 'HCA', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023065794', 0, 'N', 0, '2013-02-15', NULL, NULL, 29.6929, -95.4011, NULL, NULL),
('621801363', 'W12028399', 'W12028399', 'TXHOUSTD', 'West Houston Medical Center', '', '', 'West Houston Medical Center', '', 'Hospital', NULL, NULL, NULL, 'O', '12141 Richmond Ave', 'Houston', 'Harris', 'TX', '77082', '2815583444', '2815587619', '12141 Richmond Ave', 'Houston', 'Harris', 'TX', '77082', '2815583444', '2815587619', '', '', 'HCA', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275580938', 0, 'N', 0, '2013-02-21', NULL, NULL, 29.7303, -95.5947, NULL, NULL),
('621801363', 'W12028400', 'W12028400', 'TXHOUSTD', 'West Houston Medical Center', '', '', 'West Houston Medical Center', '', 'Hospital', NULL, NULL, NULL, 'B', 'PO Box 406325', 'Atlanta', 'Fulton', 'GA', '30384', '2815583444', '2815587619', 'PO Box 406325', 'Atlanta', 'Fulton', 'GA', '30384', '2815583444', '2815587619', '', '', 'HCA', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275580938', 0, 'Y', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL),
('760418502', 'W12028395', 'W12028395', 'TXHOUSTD', 'Texas Orthopedic Hospital', '', '', 'Texas Orthopedic Hospital', '', 'Hospital', NULL, NULL, NULL, 'O', '7401 S Main St', 'Houston', 'Harris', 'TX', '77030', '7137998600', '7137943580', '7401 S Main St', 'Houston', 'Harris', 'TX', '77030', '7137998600', '7137943580', '', '', 'HCA', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134166192', 0, 'N', 0, '2013-02-15', NULL, NULL, 29.7004, -95.4096, NULL, NULL),
('760418502', 'W12028398', 'W12028398', 'TXHOUSTD', 'Texas Orthopedic Hospital', '', '', 'Texas Orthopedic Hospital', '', 'Hospital', NULL, NULL, NULL, 'B', 'PO Box 406313', 'Atlanta', 'Fulton', 'GA', '30384', '7137998600', '7137943580', 'PO Box 406313', 'Atlanta', 'Fulton', 'GA', '30384', '7137998600', '7137943580', '', '', 'HCA', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134166192', 0, 'N', 0, '2013-02-15', NULL, NULL, 0, 0, NULL, NULL),
('621619857', 'W12028393', 'W12028393', 'TXHOUSTD', 'Kingwood Medical Center', '', '', 'Kingwood Medical Center', '', 'Hospital', NULL, NULL, NULL, 'O', '22999 Hwy 59 N', 'Kingwood', 'Harris', 'TX', '77339', '2813488000', '2813488001', '22999 Hwy 59 N', 'Kingwood', 'Harris', 'TX', '77339', '2813488000', '2813488001', '', '', 'HCA', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811942238', 0, 'N', 0, '2013-02-21', NULL, NULL, 30.048, -95.2535, NULL, NULL),
('621619857', 'W12028394', 'W12028394', 'TXHOUSTD', 'Kingwood Medical Center', '', '', 'Kingwood Medical Center', '', 'Hospital', NULL, NULL, NULL, 'B', 'PO Box 406320', 'Atlanta', 'Fulton', 'GA', '30384', '2813488000', '2813488001', 'PO Box 406320', 'Atlanta', 'Fulton', 'GA', '30384', '2813488000', '2813488001', '', '', 'HCA', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811942238', 0, 'Y', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL),
('621801361', 'W12028391', 'W12028391', 'TXHOUSTD', 'Conroe Regional Medical Center', '', '', 'Conroe Regional Medical Center', '', 'Hospital', NULL, NULL, NULL, 'O', '504 Medical Ctr Blvd', 'Conroe', 'Montgomery', 'TX', '77304', '9365391111', '9365397452', '504 Medical Ctr Blvd', 'Conroe', 'Montgomery', 'TX', '77304', '9365391111', '9365397452', '', '', 'HCA', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962455816', 0, 'N', 0, '2013-02-15', NULL, NULL, 30.2831, -95.4694, NULL, NULL),
('621801361', 'W12028392', 'W12028392', 'TXHOUSTD', 'Conroe Regional Medical Center', '', '', 'Conroe Regional Medical Center', '', 'Hospital', NULL, NULL, NULL, 'B', 'PO Box 406796', 'Atlanta', 'Fulton', 'GA', '30384', '9365391111', '9365397452', 'PO Box 406796', 'Atlanta', 'Fulton', 'GA', '30384', '9365391111', '9365397452', '', '', 'HCA', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962455816', 0, 'N', 0, '2013-02-15', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12028447', 'W12028447', 'IDBOISTD', '', '', '', 'Saint Alphonsus Health Alliance MHPN', '', '', '', '', NULL, 'O', '901 N Curtis Ste 403', 'Boise', 'Ada', 'ID', '83706', '2083677272', '2083677111', '901 N Curtis Ste 403', 'Boise', 'Ada', 'ID', '83706', '2083677272', '2083677111', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '0000009966', 0, 'N', 0, '2014-06-13', NULL, NULL, 43.6126, -116.255, NULL, NULL),
('820200895', 'W12028448', 'W12028448', 'IDBOISTD', '', '', '', 'Saint Alphonsus Health Alliance MHPN', '', '', '', '', NULL, 'O', '910 NW 16th St Ste 101', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2084522140', '910 NW 16th St Ste 101', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2084522140', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '0000009966', 0, 'N', 0, '2014-06-13', NULL, NULL, 44.0254, -116.925, NULL, NULL),
('460500210', 'W12028449', 'W12028449', 'IDBOISTD', '', '', '', 'Saint Alphonsus Health Alliance MHPN', '', '', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083673627', '2083673174', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083673627', '2083673174', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009966', 0, 'N', 0, '2014-06-13', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('460500210', 'W12048915', 'W12048915', 'IDBOISTD', 'Saint Alphonsus Trauma Physician Services', '', '', 'Saint Alphonsus Trauma Physician Services', 'GROUP', '', '', '', NULL, 'B', 'PO Box 9589', 'Boise', 'Ada', 'ID', '83707', '2084728162', '0000000000', 'PO Box 9589', 'Boise', 'Ada', 'ID', '83707', '2084728162', '0000000000', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2014-06-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008552', 0, 'N', 0, '2014-06-13', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12028457', 'W12028457', 'IDBOISTD', '', '', '', 'Saint Alphonsus Health Alliance MHPN', '', '', '', '', NULL, 'O', '214 S Midland Blvd', 'Nampa', 'Canyon', 'ID', '83686', '2084656900', '2084656911', '214 S Midland Blvd', 'Nampa', 'Canyon', 'ID', '83686', '2084656900', '2084656911', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '0000009966', 0, 'N', 0, '2014-06-13', NULL, NULL, 43.5678, -116.593, NULL, NULL),
('820200895', 'W12028459', 'W12028459', 'IDBOISTD', '', '', '', 'Saint Alphonsus Health Alliance MHPN', '', '', '', '', NULL, 'O', '401 E Hawaii Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084656940', '2084656961', '401 E Hawaii Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084656940', '2084656961', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '0000009966', 0, 'N', 0, '2014-06-13', NULL, NULL, 43.5551, -116.569, NULL, NULL),
('820200895', 'W12028460', 'W12028460', 'IDBOISTD', '', '', '', 'Saint Alphonsus Health Alliance MHPN', '', '', '', '', NULL, 'O', '211 W Iowa Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084657377', '2084657397', '211 W Iowa Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084657377', '2084657397', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '0000009966', 0, 'N', 0, '2014-06-13', NULL, NULL, 43.5539, -116.575, NULL, NULL),
('820200895', 'W12028462', 'W12028462', 'IDBOISTD', '', '', '', 'Saint Alphonsus Health Alliance MHPN', '', '', '', '', NULL, 'O', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2083672968', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2083672968', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '0000009966', 0, 'N', 0, '2014-06-13', NULL, NULL, 43.587, -116.549, NULL, NULL),
('850232628', 'W12048914', 'W12048914', 'NM01', 'Womens Specialists of NM', 'Rebecca', '', 'Okun', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '4640 Jefferson Ln Ne', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058436168', '5053383456', '4640 Jefferson Ln Ne', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058436168', '5053383456', 'NMWOMENS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1881768547', 0, 'N', 0, '2014-06-16', NULL, NULL, 0, 0, NULL, NULL),
('262257669', 'W12028468', 'W12028468', 'UT01', 'Douglas H Jones, MD PC', 'David', 'S', 'Gourley', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '1660 W Antelope Dr Dept 310', 'Layton', 'Davis', 'UT', '84041', '8017759800', '8017759806', '1660 W Antelope Dr Dept 310', 'Layton', 'Davis', 'UT', '84041', '8017759800', '8017759806', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-01-01', '2013-03-31', 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1477555712', 0, 'N', 0, '2014-05-29', NULL, NULL, 0, 0, NULL, NULL),
('262257669', 'W12028469', 'W12028469', 'UT01', 'Douglas H Jones, MD PC', 'David', 'S', 'Gourley', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '620 E Medical Dr Ste 150', 'Bountiful', 'Davis', 'UT', '84010', '8017759800', '8017759806', '620 E Medical Dr Ste 150', 'Bountiful', 'Davis', 'UT', '84010', '8017759800', '8017759806', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-01-01', '2013-03-31', 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1477555712', 0, 'N', 0, '2014-05-29', NULL, NULL, 0, 0, NULL, NULL),
('262257669', 'W12028470', 'W12028470', 'UT01', 'Douglas H Jones, MD PC', 'David', 'S', 'Gourley', 'MD', 'Allergy and Immunology', '', '', NULL, 'B', 'PO Box 30015 Ste 124', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8017759800', '8017759806', 'PO Box 30015 Ste 124', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8017759800', '8017759806', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-01-01', '2013-03-31', 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1477555712', 0, 'N', 0, '2014-05-29', NULL, NULL, 0, 0, NULL, NULL),
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('200552841', 'W12029722', 'W12029722', 'WY01', 'Mountain View Clinic', 'Barry', 'C', 'Beutler', 'MD', 'Anesthesiology', '', '', NULL, 'O', '6600 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072664000', '3072664545', '6600 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072664000', '3072664545', '', '', '', '0.00', '15.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1972718658', 0, 'N', 1, '2013-02-01', NULL, NULL, 0, 0, NULL, NULL),
('200136459', 'W12028476', 'W12028476', 'TXHOUSTD', 'Fort Bend Heart Center', 'Naim', '', 'Al Adli', 'MD', 'Cardiology', '', '', NULL, 'O', '13020 Dairy Ashford Ste 101', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2812658500', '2812658588', '13020 Dairy Ashford Ste 101', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2812658500', '2812658588', 'HOUSTON2', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-22', NULL, 0, 0, 0, 'West Houston Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1730260035', 0, 'N', 0, '2013-01-15', NULL, NULL, 29.6282, -95.6017, NULL, NULL),
('200136459', 'W12028478', 'W12028478', 'TXHOUSTD', 'Fort Bend Heart Center', 'Naim', '', 'Al Adli', 'MD', 'Cardiology', '', '', NULL, 'B', '14019 Southwest Fwy Ste 301-330', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2812658500', '2812658588', '14019 SW Fwy Ste 301-330', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2812658500', '2812658588', 'HOUSTON2', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-22', NULL, 0, 0, 0, 'West Houston Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1730260035', 0, 'N', 0, '2013-01-15', NULL, NULL, 0, 0, NULL, NULL),
('830258707', 'W12028479', 'W12028479', 'WY01', 'Wyoming Surgical Associates', 'Philip', 'N', 'Zaharas', 'PA', 'General Surgery', '', '', NULL, 'O', '419 S Washington St Ste 102', 'Casper', 'Natrona', 'WY', '82601', '3075774220', '3072350931', '419 S Washington St Ste 102', 'Casper', 'Natrona', 'WY', '82601', '3075774220', '3072350931', '', '', '', '0.00', '12.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, 'Wyoming Medical Center', '', '', '', 'HCFA|UB|', '1396094108', 0, 'N', 0, '2013-01-31', NULL, NULL, 42.8464, -106.31, NULL, NULL),
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('760642584', 'W12028481', 'W12028481', 'TXBEAUSTD', 'Tamerla Chavis MD', 'Tamerla', '', 'Chavis', 'MD PA', 'Neurology', '', '', NULL, 'O', '755 N 11th St Ste P5500', 'Beaumont', 'Jefferson', 'TX', '77702', '4099248111', '4099248234', '755 N 11th St Ste P5500', 'Beaumont', 'Jefferson', 'TX', '77702', '4099248111', '4099248234', 'BEAUMONT5', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-22', NULL, 0, 0, 0, 'Baptist Beaumont Hospital', NULL, '', '', 'HCFA|UB|', '1104824671', 0, 'N', 0, '2013-06-04', NULL, NULL, 30.0882, -94.1299, NULL, NULL),
('760642584', 'W12028482', 'W12028482', 'TXBEAUSTD', '', 'Tamerla', '', 'Chavis', 'MD PA', 'Neurology', '', '', NULL, 'B', 'PO Box 22683', 'Beaumont', 'Jefferson', 'TX', '77720', '4099248111', '4099248234', 'PO Box 22683', 'Beaumont', 'Jefferson', 'TX', '77720', '4099248111', '4099248234', 'BEAUMONT5', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-22', NULL, 0, 0, 0, 'Baptist Beaumont Hospital', NULL, '', '', 'HCFA|UB|', '1104824671', 0, 'N', 0, '2013-01-15', NULL, NULL, 0, 0, NULL, NULL),
('311819742', 'W12028483', 'W12028483', 'TXBEAUSTD', 'Suresh B Indupalli MD', 'Suresh', '', 'Indupalli', 'MD', 'Family Practice', '', '', NULL, 'O', '4180 Delaware Ste 102', 'Beaumont', 'Jefferson', 'TX', '77706', '4098354907', '4093470070', '4180 Delaware Ste 102', 'Beaumont', 'Jefferson', 'TX', '77706', '4098354907', '4093470070', 'BEAUMONT1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-22', NULL, 0, 0, 0, NULL, NULL, '', '', 'HCFA|UB|', '1053372359', 0, 'N', 0, '2013-05-31', NULL, NULL, 30.1044, -94.1465, NULL, NULL),
('262792136', 'W12031114', 'W12031114', 'ID02', 'Advanced Therapy Care', 'Amber', '', 'Bethke', 'CCC-SLP', 'Speech Therapy', '', '', NULL, 'O', '1550 N Crestmont Ste E', 'Meridian', 'Ada', 'ID', '83642', '2088980988', '2088989022', '1550 N Crestmont Ste E', 'Meridian', 'Ada', 'ID', '83642', '2088980988', '2088989022', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-06-01', '2014-06-03', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1922388644', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('760586019', 'W12028485', 'W12028485', 'TXBEAUSTD', 'Beaumont Pediatric Center', '', '', 'Beaumont Pediatric Center', '', 'Pediatrics', '', '', NULL, 'O', '3127 College St', 'Beaumont', 'Jefferson', 'TX', '77701', '4098991433', '4099819089', '3127 College St', 'Beaumont', 'Jefferson', 'TX', '77701', '4098991433', '4099819089', 'BEAUMONT1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-22', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326125949', 0, 'Y', 0, '2013-09-27', NULL, NULL, 30.0685, -94.1213, NULL, NULL),
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('760586019', 'W12028491', 'W12028491', 'TXBEAUSTD', 'Beaumont Pediatric Center', 'Kyle', 'E', 'Worley', 'MD', 'Pediatrics', '', '', NULL, 'O', '3127 College St', 'Beaumont', 'Jefferson', 'TX', '77701', '4098991433', '4099819089', '3127 College St', 'Beaumont', 'Jefferson', 'TX', '77701', '4098991433', '4099819089', 'BEAUMONT1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-22', NULL, 0, 0, 0, 'Baptist Beaumont Hospital', NULL, '', '', 'HCFA|UB|', '1861474249', 0, 'N', 0, '2013-01-17', NULL, NULL, 30.0685, -94.1213, NULL, NULL),
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('760586019', 'W12028495', 'W12028495', 'TXBEAUSTD', 'Beaumont Pediatric Center', 'Elias', '', 'Ezike', 'MD', 'Pediatrics', '', '', NULL, 'O', '3127 College St', 'Beaumont', 'Jefferson', 'TX', '77701', '4098991433', '4099819089', '3127 College St', 'Beaumont', 'Jefferson', 'TX', '77701', '4098991433', '4099819089', 'BEAUMONT1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-22', NULL, 0, 0, 0, 'Baptist Beaumont Hospital', NULL, '', '', 'HCFA|UB|', '1811902307', 0, 'N', 0, '2013-01-17', NULL, NULL, 30.0685, -94.1213, NULL, NULL),
('760586019', 'W12028497', 'W12028497', 'TXBEAUSTD', 'Beaumont Pediatric Center', 'Roger', 'A', 'Bartz', 'MD', 'Pediatrics', '', '', NULL, 'O', '3127 College St', 'Beaumont', 'Jefferson', 'TX', '77701', '4098991433', '4099819089', '3127 College St', 'Beaumont', 'Jefferson', 'TX', '77701', '4098991433', '4099819089', 'BEAUMONT1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-22', NULL, 0, 0, 0, 'Baptist Beaumont Hospital', NULL, '', '', 'HCFA|UB|', '1053502237', 0, 'N', 0, '2013-01-17', NULL, NULL, 30.0685, -94.1213, NULL, NULL),
('760586019', 'W12028499', 'W12028499', 'TXBEAUSTD', 'Beaumont Pediatric Center', 'Cassandra', '', 'Navarrete', 'PA', 'Pediatrics', '', '', NULL, 'O', '3127 College St', 'Beaumont', 'Jefferson', 'TX', '77701', '4098991433', '4099819089', '3127 College St', 'Beaumont', 'Jefferson', 'TX', '77701', '4098991433', '4099819089', 'BEAUMONT1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-22', NULL, 0, 0, 0, 'Baptist Beaumont Hospital', NULL, '', '', 'HCFA|UB|', '1023120987', 0, 'N', 0, '2013-01-17', NULL, NULL, 30.0685, -94.1213, NULL, NULL),
('364343066', 'W12028500', 'W12028500', 'ILCHIGSTD', 'Northwest Medical Clinic SC', 'Kamal', 'A', 'Patel', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1614 W Central Rd Ste 209', 'Arlington Heights', 'Cook', 'IL', '60005', '8472598777', '8472599994', '1614 W Central Rd Ste 209', 'Arlington Heights', 'Cook', 'IL', '60005', '8472598777', '8472599994', 'CHIG1', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-03', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, '', '', 'HCFA|UB|', '1700981917', 0, 'N', 0, '2014-04-25', NULL, NULL, 42.0667, -88.0017, NULL, NULL),
('760556120', 'W12028765', 'W12028765', 'TXHOUSTD', '', '', '', 'San Jactino Family Practice  Education Foundation', '', 'Family Practice', '', '', NULL, 'O', '4301 Garth Rd Ste 400', 'Baytown', 'Harris', 'TX', '77521', '2814208400', '2814208445', '4301 Garth Rd Ste 400', 'Baytown', 'Harris', 'TX', '77521', '2814208400', '2814208445', 'TMHPHOPCP', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000010039', 0, 'Y', 0, '2013-05-10', NULL, NULL, 29.7681, -94.9775, NULL, NULL),
('942854057', 'W12028501', 'W12028501', 'UTIHC01', 'Sevier Valley Medical Center', 'Howard', 'K', 'Christianson', 'MD', 'Radiology', '', '', NULL, 'O', '1000 N Main St ', 'Richfield', 'Sevier', 'UT', '84701', '4358934100', NULL, '1000 N Main St ', 'Richfield', 'Sevier', 'UT', '84701', '4358934100', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2013-01-01', NULL, 0, 0, 0, 'Delta Community Medical Center', 'Fillmore Community Medical Center', 'Sanpete Valley Hospital', 'Park City Medical Center', 'HCFA|UB|', '1982870283', 0, 'Y', 0, '2013-01-14', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W12028505', 'W12028505', 'UTIHC01', 'Primary Childrens Medical Center', 'Brian', 'A', 'Fitzgerald', 'LPC', 'Counseling', '', '', 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', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2012-11-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013253400', 0, 'N', 0, '2013-01-14', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W12028508', 'W12028508', 'UTIHC04', 'Primary Childrens Medical Center', 'Brian', 'A', 'Fitzgerald', 'LPC', 'Counseling', '', '', 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', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2012-11-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013253400', 0, 'N', 0, '2013-01-14', NULL, NULL, 40.6462, -111.934, NULL, NULL),
('942854057', 'W12028510', 'W12028510', 'UTIHC01', 'Primary Childrens Medical Center', 'Ariel', 'H', 'Gonzales', 'APRN', 'Family Practice', '', '', 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', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2012-12-06', '2013-07-18', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639409089', 0, 'N', 0, '2013-08-29', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12028511', 'W12028511', 'UTIHC02', 'Primary Childrens Medical Center', 'Ariel', 'H', 'Gonzales', 'APRN', 'Family Practice', '', '', 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', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2012-12-06', '2013-07-18', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639409089', 0, 'N', 0, '2013-08-29', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12028512', 'W12028512', 'UTIHC03', 'Primary Childrens Medical Center', 'Ariel', 'H', 'Gonzales', 'APRN', 'Family Practice', '', '', 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', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2012-12-06', '2013-07-18', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639409089', 0, 'N', 0, '2013-08-29', NULL, NULL, 0, 0, NULL, NULL),
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INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
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('942854057', 'W12028552', 'W12028552', 'UTIHC04', 'Primary Childrens Medical Center', 'Robyn', 'A', 'Urry', 'LCSW', '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', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-11-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295785962', 0, 'N', 0, '2013-01-14', NULL, NULL, 40.6462, -111.934, NULL, NULL),
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('752912332', 'W12028697', 'W12028697', 'TXDALSTD', 'Cornea Associates', 'Gregory', '', 'Nettune', 'MD', 'Ophthalmology', '', '', NULL, 'O', '10740 N Central Expwy Ste 350', 'Dallas', 'Dallas', 'TX', '75231', '2146920146', '2146928617', '10740 N Central Expwy Ste 350', 'Dallas', 'Dallas', 'TX', '75231', '2146920146', '2146928617', 'DALLAS4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-22', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962665612', 0, 'N', 0, '2013-08-15', NULL, NULL, 32.8941, -96.7687, NULL, NULL),
('460703284', 'W12029077', 'W12029077', 'ID01', 'JC Hospitalists', 'Carolyn', '', 'Matzinger', 'MD', 'Hospitalist', '', '', NULL, 'O', '2131 S Bonito Way', 'Meridian', 'Ada', 'ID', '83642', '2084899500', '2084899599', '2131 S Bonito Way', 'Meridian', 'Ada', 'ID', '83642', '2084899500', '2084899599', 'IDSAMG1', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-03-01', '2012-09-01', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1447252911', 0, 'N', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('760324613', 'W12028602', 'W12028602', 'TXHOUSTD', '', '', '', 'Texas Cardiology Associates of Houston', '', 'Cardiovascular Disease', '', '', NULL, 'O', '2627 Chestnut Ridge Rd Ste 100', 'Kingwood', 'Harris', 'TX', '77339', '2813581950', '2813581923', '2627 Chestnut Ridge Rd Ste 100', 'Kingwood', 'Harris', 'TX', '77339', '2813581950', '2813581923', 'HOUSTON2', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-22', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487669248', 0, 'Y', 0, '2013-10-24', NULL, NULL, 30.0499, -95.2405, NULL, NULL),
('760324613', 'W12028604', 'W12028604', 'TXHOUSTD', '', 'Charles', 'H', 'Moore', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '2627 Chestnut Ridge Rd Ste 100', 'Kingwood', 'Harris', 'TX', '77339', '2813581950', '2813581923', '2627 Chestnut Ridge Rd Ste 100', 'Kingwood', 'Harris', 'TX', '77339', '2813581950', '2813581923', 'HOUSTON2', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-22', NULL, 0, 0, 0, 'Kingwood Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1275533044', 0, 'N', 0, '2013-01-18', NULL, NULL, 30.0499, -95.2405, NULL, NULL),
('760324613', 'W12028606', 'W12028606', 'TXHOUSTD', '', 'Shakeel', '', 'Uddin', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '2627 Chestnut Ridge Rd Ste 100', 'Kingwood', 'Harris', 'TX', '77339', '2813581950', '2813581923', '2627 Chestnut Ridge Rd Ste 100', 'Kingwood', 'Harris', 'TX', '77339', '2813581950', '2813581923', 'HOUSTON2', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-22', NULL, 0, 0, 0, 'Kingwood Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1548260029', 0, 'N', 0, '2013-01-18', NULL, NULL, 30.0499, -95.2405, NULL, NULL),
('760324613', 'W12028608', 'W12028608', 'TXHOUSTD', 'Texas Cardiology Associates of Houston', 'Ira', 'H', 'Lieber', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '2627 Chestnut Ridge Rd Ste 100', 'Kingwood', 'Harris', 'TX', '77339', '2813581950', '2813581923', '2627 Chestnut Ridge Rd Ste 100', 'Kingwood', 'Harris', 'TX', '77339', '2813581950', '2813581923', 'HOUSTON2', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-22', NULL, 0, 0, 0, 'Kingwood Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1619977477', 0, 'N', 0, '2013-01-18', NULL, NULL, 30.0499, -95.2405, NULL, NULL),
('263981143', 'W12028609', 'W12028609', 'UT01', 'Thyroid Institute of Utah', 'Sharla', 'E', 'Morgan', 'NP', 'Endocrinology', '', '', NULL, 'O', '1055 N 300 W Ste 212', 'Provo', 'Utah', 'UT', '84604', '8013561300', NULL, '1055 N 300 W Ste 212', 'Provo', 'Utah', 'UT', '84604', '8013561300', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003151853', 0, 'N', 0, '2013-02-06', NULL, NULL, 40.2476, -111.664, NULL, NULL),
('461572664', 'W12028425', 'W12028425', 'UTMH1', 'Heber Valley Community Counseling', 'Jennifer', '', 'Pinter', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '150 N Main St Ste 206', 'Heber City', 'Wasatch', 'UT', '84032', '4356713074', NULL, '150 N Main St Ste 206', 'Heber City', 'Wasatch', 'UT', '84032', '4356713074', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2013-01-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB', '1801012190', 0, 'N', 0, '2013-01-21', NULL, NULL, 0, 0, NULL, NULL),
('461572664', 'W12028426', 'W12028426', 'UTMH1', 'Heber Valley Community Counseling', 'Jennifer', '', 'Pinter', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'B', '571 Lindsay Springs Rd', 'Heber City', 'Wasatch', 'UT', '84032', '4356713074', NULL, '571 Lindsay Springs Rd', 'Heber City', 'Wasatch', 'UT', '84032', '4356713074', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2013-01-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB', '1801012190', 0, 'N', 0, '2013-01-21', NULL, NULL, 0, 0, NULL, NULL),
('000001005', 'W12028612', 'W12028612', 'ILCHIGSTD', '', '', '', 'Provena St Joseph Medical Center', '', 'Hospital', '', '', NULL, '', 'Change', '', '', '', '00000', '          ', NULL, 'Change', '', '', '', '00000', '          ', '          ', 'PRE150ASPDME', 'PRES150', '', '0.00', '30.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000010036', 0, 'Y', 0, '2013-08-06', NULL, NULL, 0, 0, NULL, NULL),
('364195126', 'W12029165', 'W12029165', 'ILCHIGSTD', 'Provena Immediate Care Plainfield Imaging', '', '', 'Provena Convenient Care Center-Carpentersville', '', 'Urgent Care', '', '', NULL, 'O', '7000 Caton Farm Rd', 'Plainfield', 'Will', 'IL', '60586', '8156095501', NULL, '7000 Caton Farm Rd', 'Plainfield', 'Will', 'IL', '60586', '8156095501', '          ', 'PRE150ASPDME', 'PRES150', '', '0.00', '30.00', '0.00', 6, '2013-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000010049', 0, 'N', 0, '2013-05-24', NULL, NULL, 41.5651, -88.2088, NULL, NULL),
('364195126', 'W12029164', 'W12029164', 'ILCHIGSTD', 'Provena St Joseph Medical Center- Express Care', '', '', 'Provena Convenient Care Center-Carpentersville', '', 'Urgent Care', '', '', NULL, 'B', '2668 Momentum Pl', 'Chicago', 'Cook', 'IL', '60689', '8887404111', NULL, '2668 Momentum Pl', 'Chicago', 'Cook', 'IL', '60689', '8887404111', '          ', 'PRE150ASPDME', 'PRES150', '', '0.00', '30.00', '0.00', 6, '2013-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000010049', 0, 'N', 0, '2013-05-24', NULL, NULL, 0, 0, NULL, NULL),
('364195126', 'W12029167', 'W12029167', 'ILCHIGSTD', 'Presence Saint Joseph Medical Center', '', '', 'Presence Saint Joseph Medical Center', '', 'Hospital', NULL, NULL, NULL, 'B', '2668 Momentum Pl', 'Chicago', 'Cook', 'IL', '60689', '8887404111', NULL, '2668 Momentum Pl', 'Chicago', 'Cook', 'IL', '60689', '8887404111', '          ', '', '', 'PresProvStJo', '0.00', '0.00', '0.00', 6, '2013-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487715645', 0, 'Y', 0, '2013-10-15', '140007', NULL, 0, 0, NULL, NULL),
('870281028', 'W12029176', 'W12029176', 'UT01', 'Central Utah Clinic PC', 'Scott', 'A', 'Parry', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '180 W 300 N', 'Kanab', 'Kane', 'UT', '84741', '8002399393', NULL, '180 W 300 N', 'Kanab', 'Kane', 'UT', '84741', '8002399393', '          ', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1548292485', 0, 'N', 0, '2013-04-10', NULL, NULL, 37.0533, -112.532, NULL, NULL),
('454041098', 'ELCI00004', 'ELCI00004', 'ILCHIGSTD', 'Concentra Primary Care of Illinois PC', 'Shahrair', '', 'Dadkhah', 'DO', 'Cardiology', '', '', NULL, 'O', '7126 N Lincoln Ave', 'Lincolnwood', 'Cook', 'IL', '60712', '8475839189', '8475839196', '7126 N Lincoln Ave', 'Lincolnwood', 'Cook', 'IL', '60712', '8475839189', '8475839196', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1063469641', 0, 'N', 0, '2013-03-26', NULL, NULL, 42.0109, -87.7383, NULL, NULL),
('454041098', 'ELCI00003', 'ELCI00003', 'ILCHIGSTD', 'Concentra Primary Care of Illinois PC', 'Shahrair', '', 'Dadkhah', 'DO', 'Cardiology', '', '', NULL, 'B', 'PO Box 2050', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '8664414306', 'PO Box 2050', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '8664414306', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1063469641', 0, 'Y', 0, '2013-03-26', NULL, NULL, 0, 0, NULL, NULL),
('454041098', 'ELCI00008', 'ELCI00008', 'ILCHIGSTD', 'Concentra Primary Care of Illinois PC', 'Carl', '', 'Moshovitis', 'MD', 'Cardiology', '', '', NULL, 'O', '7126 N Lincoln Ave', 'Lincolnwood', 'Cook', 'IL', '60712', '8475839189', '8475839196', '7126 N Lincoln Ave', 'Lincolnwood', 'Cook', 'IL', '60712', '8475839189', '8475839196', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1598702912', 0, 'N', 0, '2013-03-26', NULL, NULL, 42.0109, -87.7383, NULL, NULL),
('454041098', 'ELCI00007', 'ELCI00007', 'ILCHIGSTD', 'Concentra Primary Care of Illinois PC', 'Carl', '', 'Moshovitis', 'MD', 'Cardiology', '', '', NULL, 'B', 'PO Box 2050', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '8664414306', 'PO Box 2050', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '8664414306', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1598702912', 0, 'Y', 0, '2013-03-26', NULL, NULL, 0, 0, NULL, NULL),
('454041098', 'ELCI00020', 'ELCI00020', 'ILCHIGSTD', 'Concentra Primary Care of Illinois PC', 'Jeanne', 'C', 'Zimmerman', 'MD', 'Family Practice', '', '', NULL, 'O', '7126 N Lincoln Ave', 'Lincolnwood', 'Cook', 'IL', '60712', '8475839189', '8475839196', '7126 N Lincoln Ave', 'Lincolnwood', 'Cook', 'IL', '60712', '8475839189', '8475839196', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023056066', 0, 'N', 0, '2013-04-09', NULL, NULL, 42.0109, -87.7383, NULL, NULL),
('454041098', 'ELCI00019', 'ELCI00019', 'ILCHIGSTD', 'Concentra Primary Care of Illinois PC', 'Jeanne', 'C', 'Zimmerman', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 2050', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '8664414306', 'PO Box 2050', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '8664414306', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023056066', 0, 'Y', 0, '2013-04-09', NULL, NULL, 0, 0, NULL, NULL),
('454041098', 'ELCI00012', 'ELCI00012', 'ILCHIGSTD', 'Concentra Primary Care of Illinois PC', 'Sharon', 'B', 'Rosenberg', 'MD', 'Internal Medicine', '', '', NULL, 'O', '7126 N Lincoln Ave', 'Lincolnwood', 'Cook', 'IL', '60712', '8475839189', '8475839196', '7126 N Lincoln Ave', 'Lincolnwood', 'Cook', 'IL', '60712', '8475839189', '8475839196', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', '', 'HCFA|UB|', '1205876893', 0, 'N', 0, '2013-08-01', NULL, NULL, 42.0109, -87.7383, NULL, NULL),
('454041098', 'ELCI00011', 'ELCI00011', 'ILCHIGSTD', 'Concentra Primary Care of Illinois PC', 'Sharon', 'B', 'Rosenberg', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 2050', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '8664414306', 'PO Box 2050', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '8664414306', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', '', 'HCFA|UB|', '1205876893', 0, 'Y', 0, '2013-08-01', NULL, NULL, 0, 0, NULL, NULL),
('454041098', 'ELCI00018', 'ELCI00018', 'ILCHIGSTD', 'Concentra Primary Care of Illinois PC', 'Solomon', NULL, 'Yigazu', 'MD', 'Family Practice', '', '', NULL, 'O', '7126 N Lincoln Ave', 'Lincolnwood', 'Cook', 'IL', '60712', '8475839189', '8475839196', '7126 N Lincoln Ave', 'Lincolnwood', 'Cook', 'IL', '60712', '8475839189', '8475839196', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', NULL, 'HCFA|UB|', '1376539221', 0, 'N', 0, '2013-03-26', NULL, NULL, 42.0109, -87.7383, NULL, NULL),
('454041098', 'ELCI00017', 'ELCI00017', 'ILCHIGSTD', 'Concentra Primary Care of Illinois PC', 'Solomon', NULL, 'Yigazu', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 2050', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '8664414306', 'PO Box 2050', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '8664414306', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', NULL, 'HCFA|UB|', '1376539221', 0, 'Y', 0, '2013-03-26', NULL, NULL, 0, 0, NULL, NULL),
('454041098', 'ELCI00009', 'ELCI00009', 'ILCHIGSTD', '', 'Saji', NULL, 'Oommen', 'MD', 'Family Practice', '', '', NULL, 'O', '800 Austin St East Tower Ste 269', 'Evanston', 'Cook', 'IL', '60202', '8473285550', '8473285606', '800 Austin St East Tower Ste 269', 'Evanston', 'Cook', 'IL', '60202', '8473285550', '8473285606', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2013-03-31', 0, 0, 0, 'Presence Saint Francis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1497856330', 0, 'N', 0, '2013-03-26', NULL, NULL, 42.0252, -87.6828, NULL, NULL),
('454041098', 'ELCI00014', 'ELCI00014', 'ILCHIGSTD', 'Concentra Primary Care of Illinois PC', 'Brenda', 'J', 'Sikorski', 'DO', 'Family Practice', '', '', NULL, 'O', '7126 N Lincoln Ave', 'Lincolnwood', 'Cook', 'IL', '60712', '8475839189', '8475839196', '7126 N Lincoln Ave', 'Lincolnwood', 'Cook', 'IL', '60712', '8475839189', '8475839196', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', '', 'HCFA|UB|', '1649310905', 0, 'N', 0, '2013-08-01', NULL, NULL, 42.0109, -87.7383, NULL, NULL),
('454041098', 'ELCI00013', 'ELCI00013', 'ILCHIGSTD', 'Concentra Primary Care of Illinois PC', 'Brenda', 'J', 'Sikorski', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 2050', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '8664414306', 'PO Box 2050', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '8664414306', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', '', 'HCFA|UB|', '1649310905', 0, 'Y', 0, '2013-08-01', NULL, NULL, 0, 0, NULL, NULL),
('454041098', 'ELCI00001', 'ELCI00001', 'ILCHIGSTD', '', 'Parisa', '', 'Amleshi', 'MD', 'Family Practice', '', '', NULL, 'O', '800 Austin St East Tower Ste 269', 'Evanston', 'Cook', 'IL', '60202', '8473285550', '8473285606', '800 Austin St East Tower Ste 269', 'Evanston', 'Cook', 'IL', '60202', '8473285550', '8473285606', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2013-03-31', 0, 0, 0, 'Presence Saint Francis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1689619314', 0, 'N', 0, '2013-03-19', NULL, NULL, 42.0252, -87.6828, NULL, NULL),
('454041098', 'ELCI00015', 'ELCI00015', 'ILCHIGSTD', '', 'Satish', 'K', 'Vij', 'MD', 'Family Practice', '', '', NULL, 'O', '800 Austin St East Tower Ste 269', 'Evanston', 'Cook', 'IL', '60202', '8473285550', '8473285606', '800 Austin St East Tower Ste 269', 'Evanston', 'Cook', 'IL', '60202', '8473285550', '8473285606', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2013-03-31', 0, 0, 0, 'Presence Saint Francis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1881621043', 0, 'N', 0, '2013-03-26', NULL, NULL, 42.0252, -87.6828, NULL, NULL),
('454041098', 'ELCI00006', 'ELCI00006', 'ILCHIGSTD', 'Concentra Primary Care of Illinois PC', 'Celia', 'M', 'Lipinski', 'DO', 'Family Practice', '', '', NULL, 'O', '7126 N Lincoln Ave', 'Lincolnwood', 'Cook', 'IL', '60712', '8475839189', '8475839196', '7126 N Lincoln Ave', 'Lincolnwood', 'Cook', 'IL', '60712', '8475839189', '8475839196', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', '', 'HCFA|UB|', '1982808523', 0, 'N', 0, '2013-04-02', NULL, NULL, 42.0109, -87.7383, NULL, NULL),
('454041098', 'ELCI00005', 'ELCI00005', 'ILCHIGSTD', 'Concentra Primary Care of Illinois PC', 'Celia', 'M', 'Lipinski', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 2050', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '8664414306', 'PO Box 2050', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '8664414306', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', '', 'HCFA|UB|', '1982808523', 0, 'Y', 0, '2013-04-02', NULL, NULL, 0, 0, NULL, NULL),
('320346082', 'ELCI00134', 'ELCI00134', 'TXDALSTD', 'Concentra Primary Care', 'Crisanto', '', 'Dimafelix', 'MD', 'Family Practice', '', '', NULL, 'O', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003853722', 0, 'N', 0, '2013-09-24', NULL, NULL, 32.9653, -96.839, NULL, NULL),
('320346082', 'ELCI00141', 'ELCI00141', 'TXDALSTD', 'Concentra Primary Care', 'Crisanto', '', 'Dimafelix', 'MD', 'Family Practice', '', '', NULL, 'O', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003853722', 0, 'N', 0, '2013-09-24', NULL, NULL, 33.1512, -96.8641, NULL, NULL),
('320346082', 'ELCI00131', 'ELCI00131', 'TXSATSTD', 'Allied Institute of Medicine', 'Crisanto', '', 'Dimafelix', 'MD', 'Family Practice', '', '', NULL, 'O', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003853722', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.0273, -98.0989, NULL, NULL),
('320346082', 'ELCI00132', 'ELCI00132', 'TXSATSTD', 'Allied Institute of Medicine', 'Crisanto', '', 'Dimafelix', 'MD', 'Family Practice', '', '', NULL, 'O', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003853722', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.5513, -98.3486, NULL, NULL),
('320346082', 'ELCI00133', 'ELCI00133', 'TXSATSTD', 'Allied Institute of Medicine', 'Crisanto', '', 'Dimafelix', 'MD', 'Family Practice', '', '', NULL, 'O', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003853722', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.572, -97.9461, NULL, NULL),
('320346082', 'ELCI00135', 'ELCI00135', 'TXSATSTD', 'Allied Institute of Medicine', 'Crisanto', '', 'Dimafelix', 'MD', 'Family Practice', '', '', NULL, 'O', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003853722', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.6798, -98.1066, NULL, NULL),
('320346082', 'ELCI00136', 'ELCI00136', 'TXSATSTD', 'Allied Institute of Medicine', 'Crisanto', '', 'Dimafelix', 'MD', 'Family Practice', '', '', NULL, 'O', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003853722', 0, 'Y', 0, '2013-09-24', NULL, NULL, 28.9591, -98.4855, NULL, NULL),
('320346082', 'ELCI00137', 'ELCI00137', 'TXSATSTD', 'Allied Institute of Medicine', 'Crisanto', '', 'Dimafelix', 'MD', 'Family Practice', '', '', NULL, 'O', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003853722', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.1534, -98.1662, NULL, NULL),
('320346082', 'ELCI00138', 'ELCI00138', 'TXSATSTD', 'Concentra Primary Care', 'Crisanto', '', 'Dimafelix', 'MD', 'Family Practice', '', '', NULL, 'O', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003853722', 0, 'Y', 0, '2013-09-24', NULL, NULL, 31.5262, -97.1643, NULL, NULL),
('320346082', 'ELCI00139', 'ELCI00139', 'TXSATSTD', 'Allied Institute of Medicine', 'Crisanto', '', 'Dimafelix', 'MD', 'Family Practice', '', '', NULL, 'O', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003853722', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.3804, -98.4088, NULL, NULL),
('320346082', 'ELCI00140', 'ELCI00140', 'TXSATSTD', 'Allied Institute of Medicine', 'Crisanto', '', 'Dimafelix', 'MD', 'Family Practice', '', '', NULL, 'B', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003853722', 0, 'N', 0, '2013-09-24', NULL, NULL, 0, 0, NULL, NULL),
('320346082', 'ELCI00090', 'ELCI00090', 'TXDALSTD', 'Concentra Primary Care', 'Raynell', NULL, 'Odem', 'FNP', 'Family Practice', '', '', NULL, 'O', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1013071448', 0, 'Y', 0, '2013-01-16', NULL, NULL, 32.9653, -96.839, NULL, NULL),
('320346082', 'ELCI00097', 'ELCI00097', 'TXDALSTD', 'Concentra Primary Care', 'Raynell', NULL, 'Odem', 'FNP', 'Family Practice', '', '', NULL, 'O', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1013071448', 0, 'Y', 0, '2013-01-16', NULL, NULL, 33.1512, -96.8641, NULL, NULL),
('320346082', 'ELCI00087', 'ELCI00087', 'TXSATSTD', 'Allied Institute of Medicine', 'Raynell', NULL, 'Odem', 'FNP', 'Family Practice', '', '', NULL, 'O', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1013071448', 0, 'Y', 0, '2013-01-16', NULL, NULL, 29.0273, -98.0989, NULL, NULL),
('320346082', 'ELCI00088', 'ELCI00088', 'TXSATSTD', 'Allied Institute of Medicine', 'Raynell', NULL, 'Odem', 'FNP', 'Family Practice', '', '', NULL, 'O', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1013071448', 0, 'Y', 0, '2013-01-16', NULL, NULL, 29.5513, -98.3486, NULL, NULL),
('320346082', 'ELCI00089', 'ELCI00089', 'TXSATSTD', 'Allied Institute of Medicine', 'Raynell', NULL, 'Odem', 'FNP', 'Family Practice', '', '', NULL, 'O', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1013071448', 0, 'Y', 0, '2013-01-16', NULL, NULL, 29.572, -97.9461, NULL, NULL),
('320346082', 'ELCI00091', 'ELCI00091', 'TXSATSTD', 'Allied Institute of Medicine', 'Raynell', NULL, 'Odem', 'FNP', 'Family Practice', '', '', NULL, 'O', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1013071448', 0, 'Y', 0, '2013-01-16', NULL, NULL, 29.6798, -98.1066, NULL, NULL),
('320346082', 'ELCI00092', 'ELCI00092', 'TXSATSTD', 'Allied Institute of Medicine', 'Raynell', NULL, 'Odem', 'FNP', 'Family Practice', '', '', NULL, 'O', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1013071448', 0, 'Y', 0, '2013-01-16', NULL, NULL, 28.9591, -98.4855, NULL, NULL),
('320346082', 'ELCI00093', 'ELCI00093', 'TXSATSTD', 'Allied Institute of Medicine', 'Raynell', NULL, 'Odem', 'FNP', 'Family Practice', '', '', NULL, 'O', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1013071448', 0, 'Y', 0, '2013-01-16', NULL, NULL, 29.1534, -98.1662, NULL, NULL),
('320346082', 'ELCI00094', 'ELCI00094', 'TXSATSTD', 'Concentra Primary Care', 'Raynell', NULL, 'Odem', 'FNP', 'Family Practice', '', '', NULL, 'O', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1013071448', 0, 'Y', 0, '2013-01-16', NULL, NULL, 31.5262, -97.1643, NULL, NULL),
('320346082', 'ELCI00095', 'ELCI00095', 'TXSATSTD', 'Allied Institute of Medicine', 'Raynell', NULL, 'Odem', 'FNP', 'Family Practice', '', '', NULL, 'O', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1013071448', 0, 'Y', 0, '2013-01-16', NULL, NULL, 29.3804, -98.4088, NULL, NULL),
('320346082', 'ELCI00096', 'ELCI00096', 'TXSATSTD', 'Allied Institute of Medicine', 'Raynell', NULL, 'Odem', 'FNP', 'Family Practice', '', '', NULL, 'B', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', '8647 Wurzbach', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1013071448', 0, 'Y', 0, '2013-01-16', NULL, NULL, 0, 0, NULL, NULL),
('320346082', 'ELCI00343', 'ELCI00343', 'TXDALSTD', 'Concentra Primary Care', 'Roxanne', '', 'Rodriguez', 'PA C', 'Family Practice', '', '', NULL, 'O', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093989352', 0, 'Y', 0, '2013-10-07', NULL, NULL, 32.9653, -96.839, NULL, NULL),
('320346082', 'ELCI00350', 'ELCI00350', 'TXDALSTD', 'Concentra Primary Care', 'Roxanne', '', 'Rodriguez', 'PA C', 'Family Practice', '', '', NULL, 'O', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093989352', 0, 'Y', 0, '2013-10-07', NULL, NULL, 33.1512, -96.8641, 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
('320346082', 'ELCI00340', 'ELCI00340', 'TXSATSTD', 'Allied Institute of Medicine', 'Roxanne', '', 'Rodriguez', 'PA C', 'Family Practice', '', '', NULL, 'O', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093989352', 0, 'Y', 0, '2013-10-07', NULL, NULL, 29.0273, -98.0989, NULL, NULL),
('320346082', 'ELCI00341', 'ELCI00341', 'TXSATSTD', 'Allied Institute of Medicine', 'Roxanne', '', 'Rodriguez', 'PA C', 'Family Practice', '', '', NULL, 'O', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093989352', 0, 'Y', 0, '2013-10-07', NULL, NULL, 29.5513, -98.3486, NULL, NULL),
('320346082', 'ELCI00342', 'ELCI00342', 'TXSATSTD', 'Allied Institute of Medicine', 'Roxanne', '', 'Rodriguez', 'PA C', 'Family Practice', '', '', NULL, 'O', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093989352', 0, 'Y', 0, '2013-10-07', NULL, NULL, 29.572, -97.9461, NULL, NULL),
('320346082', 'ELCI00344', 'ELCI00344', 'TXSATSTD', 'Allied Institute of Medicine', 'Roxanne', '', 'Rodriguez', 'PA C', 'Family Practice', '', '', NULL, 'O', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093989352', 0, 'Y', 0, '2013-10-07', NULL, NULL, 29.6798, -98.1066, NULL, NULL),
('320346082', 'ELCI00345', 'ELCI00345', 'TXSATSTD', 'Allied Institute of Medicine', 'Roxanne', '', 'Rodriguez', 'PA C', 'Family Practice', '', '', NULL, 'O', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093989352', 0, 'Y', 0, '2013-10-07', NULL, NULL, 28.9591, -98.4855, NULL, NULL),
('320346082', 'ELCI00346', 'ELCI00346', 'TXSATSTD', 'Allied Institute of Medicine', 'Roxanne', '', 'Rodriguez', 'PA C', 'Family Practice', '', '', NULL, 'O', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093989352', 0, 'Y', 0, '2013-10-07', NULL, NULL, 29.1534, -98.1662, NULL, NULL),
('320346082', 'ELCI00347', 'ELCI00347', 'TXSATSTD', 'Concentra Primary Care', 'Roxanne', '', 'Rodriguez', 'PA C', 'Family Practice', '', '', NULL, 'O', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093989352', 0, 'Y', 0, '2013-10-07', NULL, NULL, 31.5262, -97.1643, NULL, NULL),
('320346082', 'ELCI00348', 'ELCI00348', 'TXSATSTD', 'Allied Institute of Medicine', 'Roxanne', '', 'Rodriguez', 'PA C', 'Family Practice', '', '', NULL, 'O', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093989352', 0, 'Y', 0, '2013-10-07', NULL, NULL, 29.3804, -98.4088, NULL, NULL),
('320346082', 'ELCI00349', 'ELCI00349', 'TXSATSTD', 'Allied Institute of Medicine', 'Roxanne', '', 'Rodriguez', 'PA C', 'Family Practice', '', '', NULL, 'B', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093989352', 0, 'N', 0, '2013-10-07', NULL, NULL, 0, 0, NULL, NULL),
('320346082', 'ELCI00354', 'ELCI00354', 'TXDALSTD', 'Concentra Primary Care', 'Stephanie', '', 'Sekula', 'PA C', 'Family Practice', '', '', NULL, 'O', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215169727', 0, 'Y', 0, '2013-10-07', NULL, NULL, 32.9653, -96.839, NULL, NULL),
('320346082', 'ELCI00361', 'ELCI00361', 'TXDALSTD', 'Concentra Primary Care', 'Stephanie', '', 'Sekula', 'PA C', 'Family Practice', '', '', NULL, 'O', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215169727', 0, 'Y', 0, '2013-10-07', NULL, NULL, 33.1512, -96.8641, NULL, NULL),
('320346082', 'ELCI00351', 'ELCI00351', 'TXSATSTD', 'Allied Institute of Medicine', 'Stephanie', '', 'Sekula', 'PA C', 'Family Practice', '', '', NULL, 'O', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215169727', 0, 'Y', 0, '2013-10-07', NULL, NULL, 29.0273, -98.0989, NULL, NULL),
('320346082', 'ELCI00352', 'ELCI00352', 'TXSATSTD', 'Allied Institute of Medicine', 'Stephanie', '', 'Sekula', 'PA C', 'Family Practice', '', '', NULL, 'O', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215169727', 0, 'Y', 0, '2013-10-07', NULL, NULL, 29.5513, -98.3486, NULL, NULL),
('320346082', 'ELCI00353', 'ELCI00353', 'TXSATSTD', 'Allied Institute of Medicine', 'Stephanie', '', 'Sekula', 'PA C', 'Family Practice', '', '', NULL, 'O', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215169727', 0, 'Y', 0, '2013-10-07', NULL, NULL, 29.572, -97.9461, NULL, NULL),
('320346082', 'ELCI00355', 'ELCI00355', 'TXSATSTD', 'Allied Institute of Medicine', 'Stephanie', '', 'Sekula', 'PA C', 'Family Practice', '', '', NULL, 'O', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215169727', 0, 'Y', 0, '2013-10-07', NULL, NULL, 29.6798, -98.1066, NULL, NULL),
('320346082', 'ELCI00356', 'ELCI00356', 'TXSATSTD', 'Allied Institute of Medicine', 'Stephanie', '', 'Sekula', 'PA C', 'Family Practice', '', '', NULL, 'O', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215169727', 0, 'Y', 0, '2013-10-07', NULL, NULL, 28.9591, -98.4855, NULL, NULL),
('320346082', 'ELCI00357', 'ELCI00357', 'TXSATSTD', 'Allied Institute of Medicine', 'Stephanie', '', 'Sekula', 'PA C', 'Family Practice', '', '', NULL, 'O', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215169727', 0, 'Y', 0, '2013-10-07', NULL, NULL, 29.1534, -98.1662, NULL, NULL),
('320346082', 'ELCI00358', 'ELCI00358', 'TXSATSTD', 'Concentra Primary Care', 'Stephanie', '', 'Sekula', 'PA C', 'Family Practice', '', '', NULL, 'O', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215169727', 0, 'Y', 0, '2013-10-07', NULL, NULL, 31.5262, -97.1643, NULL, NULL),
('320346082', 'ELCI00359', 'ELCI00359', 'TXSATSTD', 'Allied Institute of Medicine', 'Stephanie', '', 'Sekula', 'PA C', 'Family Practice', '', '', NULL, 'O', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215169727', 0, 'Y', 0, '2013-10-07', NULL, NULL, 29.3804, -98.4088, NULL, NULL),
('320346082', 'ELCI00360', 'ELCI00360', 'TXSATSTD', 'Concentra Primary Care', 'Stephanie', '', 'Sekula', 'PA C', 'Family Practice', '', '', NULL, 'B', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215169727', 0, 'N', 0, '2013-10-07', NULL, NULL, 0, 0, NULL, NULL),
('320346082', 'ELCI00277', 'ELCI00277', 'TXDALSTD', 'Concentra Primary Care', 'Sharla', 'R', 'Clark', 'PA C', 'Family Practice', '', '', NULL, 'O', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225292386', 0, 'Y', 0, '2013-09-30', NULL, NULL, 32.9653, -96.839, NULL, NULL),
('320346082', 'ELCI00284', 'ELCI00284', 'TXDALSTD', 'Concentra Primary Care', 'Sharla', 'R', 'Clark', 'PA C', 'Family Practice', '', '', NULL, 'O', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225292386', 0, 'Y', 0, '2013-09-30', NULL, NULL, 33.1512, -96.8641, NULL, NULL),
('320346082', 'ELCI00274', 'ELCI00274', 'TXSATSTD', 'Allied Institute of Medicine', 'Sharla', 'R', 'Clark', 'PA C', 'Family Practice', '', '', NULL, 'O', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225292386', 0, 'Y', 0, '2013-09-30', NULL, NULL, 29.0273, -98.0989, NULL, NULL),
('320346082', 'ELCI00275', 'ELCI00275', 'TXSATSTD', 'Allied Institute of Medicine', 'Sharla', 'R', 'Clark', 'PA C', 'Family Practice', '', '', NULL, 'O', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225292386', 0, 'Y', 0, '2013-09-30', NULL, NULL, 29.5513, -98.3486, NULL, NULL),
('320346082', 'ELCI00276', 'ELCI00276', 'TXSATSTD', 'Allied Institute of Medicine', 'Sharla', 'R', 'Clark', 'PA C', 'Family Practice', '', '', NULL, 'O', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225292386', 0, 'Y', 0, '2013-09-30', NULL, NULL, 29.572, -97.9461, NULL, NULL),
('320346082', 'ELCI00278', 'ELCI00278', 'TXSATSTD', 'Allied Institute of Medicine', 'Sharla', 'R', 'Clark', 'PA C', 'Family Practice', '', '', NULL, 'O', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225292386', 0, 'Y', 0, '2013-09-30', NULL, NULL, 29.6798, -98.1066, NULL, NULL),
('320346082', 'ELCI00279', 'ELCI00279', 'TXSATSTD', 'Allied Institute of Medicine', 'Sharla', 'R', 'Clark', 'PA C', 'Family Practice', '', '', NULL, 'O', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225292386', 0, 'Y', 0, '2013-09-30', NULL, NULL, 28.9591, -98.4855, NULL, NULL),
('320346082', 'ELCI00280', 'ELCI00280', 'TXSATSTD', 'Allied Institute of Medicine', 'Sharla', 'R', 'Clark', 'PA C', 'Family Practice', '', '', NULL, 'O', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225292386', 0, 'Y', 0, '2013-09-30', NULL, NULL, 29.1534, -98.1662, NULL, NULL),
('320346082', 'ELCI00281', 'ELCI00281', 'TXSATSTD', 'Concentra Primary Care', 'Sharla', 'R', 'Clark', 'PA C', 'Family Practice', '', '', NULL, 'O', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225292386', 0, 'Y', 0, '2013-09-30', NULL, NULL, 31.5262, -97.1643, NULL, NULL),
('320346082', 'ELCI00282', 'ELCI00282', 'TXSATSTD', 'Allied Institute of Medicine', 'Sharla', 'R', 'Clark', 'PA C', 'Family Practice', '', '', NULL, 'O', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225292386', 0, 'Y', 0, '2013-09-30', NULL, NULL, 29.3804, -98.4088, NULL, NULL),
('320346082', 'ELCI00283', 'ELCI00283', 'TXSATSTD', 'Concentra Primary Care', 'Sharla', 'R', 'Clark', 'PA C', 'Family Practice', '', '', NULL, 'B', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225292386', 0, 'N', 0, '2013-09-30', NULL, NULL, 0, 0, NULL, NULL),
('320346082', 'ELCI00200', 'ELCI00200', 'TXDALSTD', 'Concentra Primary Care', 'David', 'A', 'Rodriguez', 'MD', 'Family Practice', '', '', NULL, 'O', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2014-07-09', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285727206', 0, 'N', 0, '2014-07-09', NULL, NULL, 32.9653, -96.839, NULL, NULL),
('320346082', 'ELCI00207', 'ELCI00207', 'TXDALSTD', 'Concentra Primary Care', 'David', 'A', 'Rodriguez', 'MD', 'Family Practice', '', '', NULL, 'O', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2014-07-09', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285727206', 0, 'N', 0, '2014-07-09', NULL, NULL, 33.1512, -96.8641, NULL, NULL),
('320346082', 'ELCI00197', 'ELCI00197', 'TXSATSTD', 'Allied Institute of Medicine', 'David', 'A', 'Rodriguez', 'MD', 'Family Practice', '', '', NULL, 'O', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2014-07-09', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285727206', 0, 'Y', 0, '2014-07-09', NULL, NULL, 29.0273, -98.0989, NULL, NULL),
('320346082', 'ELCI00198', 'ELCI00198', 'TXSATSTD', 'Allied Institute of Medicine', 'David', 'A', 'Rodriguez', 'MD', 'Family Practice', '', '', NULL, 'O', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2013-04-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285727206', 0, 'N', 0, '2014-07-09', NULL, NULL, 29.5511, -98.3477, NULL, NULL),
('320346082', 'ELCI00199', 'ELCI00199', 'TXSATSTD', 'Allied Institute of Medicine', 'David', 'A', 'Rodriguez', 'MD', 'Family Practice', '', '', NULL, 'O', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2013-04-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285727206', 0, 'N', 0, '2014-07-09', NULL, NULL, 29.5723, -97.9446, NULL, NULL),
('320346082', 'ELCI00201', 'ELCI00201', 'TXSATSTD', 'Allied Institute of Medicine', 'David', 'A', 'Rodriguez', 'MD', 'Family Practice', '', '', NULL, 'O', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2013-04-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285727206', 0, 'N', 0, '2014-07-09', NULL, NULL, 29.6803, -98.1077, NULL, NULL),
('320346082', 'ELCI00202', 'ELCI00202', 'TXSATSTD', 'Allied Institute of Medicine', 'David', 'A', 'Rodriguez', 'MD', 'Family Practice', '', '', NULL, 'O', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2014-07-09', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285727206', 0, 'Y', 0, '2014-07-09', NULL, NULL, 28.9591, -98.4855, NULL, NULL),
('320346082', 'ELCI00203', 'ELCI00203', 'TXSATSTD', 'Allied Institute of Medicine', 'David', 'A', 'Rodriguez', 'MD', 'Family Practice', '', '', NULL, 'O', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2013-04-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285727206', 0, 'N', 0, '2014-07-09', NULL, NULL, 29.1588, -98.1706, NULL, NULL),
('320346082', 'ELCI00204', 'ELCI00204', 'TXSATSTD', 'Concentra Primary Care', 'David', 'A', 'Rodriguez', 'MD', 'Family Practice', '', '', NULL, 'O', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2014-07-09', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285727206', 0, 'Y', 0, '2014-07-09', NULL, NULL, 31.5262, -97.1643, NULL, NULL),
('320346082', 'ELCI00205', 'ELCI00205', 'TXSATSTD', 'Allied Institute of Medicine', 'David', 'A', 'Rodriguez', 'MD', 'Family Practice', '', '', NULL, 'O', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2013-04-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285727206', 0, 'N', 0, '2014-07-09', NULL, NULL, 29.3804, -98.4079, NULL, NULL),
('320346082', 'ELCI00206', 'ELCI00206', 'TXSATSTD', 'Allied Institute of Medicine', 'David', 'A', 'Rodriguez', 'MD', 'Family Practice', '', '', NULL, 'B', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2014-07-09', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285727206', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('320346082', 'ELCI00266', 'ELCI00266', 'TXDALSTD', 'Concentra Primary Care', 'Elizabeth', '', 'Clancy Hrna', 'PA', 'Family Practice', '', '', NULL, 'O', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285866772', 0, 'Y', 0, '2013-09-30', NULL, NULL, 32.9653, -96.839, NULL, NULL),
('320346082', 'ELCI00273', 'ELCI00273', 'TXDALSTD', 'Concentra Primary Care', 'Elizabeth', '', 'Clancy Hrna', 'PA', 'Family Practice', '', '', NULL, 'O', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285866772', 0, 'Y', 0, '2013-09-30', NULL, NULL, 33.1512, -96.8641, NULL, NULL),
('320346082', 'ELCI00263', 'ELCI00263', 'TXSATSTD', 'Allied Institute of Medicine', 'Elizabeth', '', 'Clancy Hrna', 'PA', 'Family Practice', '', '', NULL, 'O', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285866772', 0, 'Y', 0, '2013-09-30', NULL, NULL, 29.0273, -98.0989, NULL, NULL),
('320346082', 'ELCI00264', 'ELCI00264', 'TXSATSTD', 'Allied Institute of Medicine', 'Elizabeth', '', 'Clancy Hrna', 'PA', 'Family Practice', '', '', NULL, 'O', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285866772', 0, 'Y', 0, '2013-09-30', NULL, NULL, 29.5513, -98.3486, NULL, NULL),
('320346082', 'ELCI00265', 'ELCI00265', 'TXSATSTD', 'Allied Institute of Medicine', 'Elizabeth', '', 'Clancy Hrna', 'PA', 'Family Practice', '', '', NULL, 'O', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285866772', 0, 'Y', 0, '2013-09-30', NULL, NULL, 29.572, -97.9461, NULL, NULL),
('320346082', 'ELCI00267', 'ELCI00267', 'TXSATSTD', 'Allied Institute of Medicine', 'Elizabeth', '', 'Clancy Hrna', 'PA', 'Family Practice', '', '', NULL, 'O', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285866772', 0, 'Y', 0, '2013-09-30', NULL, NULL, 29.6798, -98.1066, NULL, NULL),
('320346082', 'ELCI00268', 'ELCI00268', 'TXSATSTD', 'Allied Institute of Medicine', 'Elizabeth', '', 'Clancy Hrna', 'PA', 'Family Practice', '', '', NULL, 'O', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285866772', 0, 'Y', 0, '2013-09-30', NULL, NULL, 28.9591, -98.4855, NULL, NULL),
('320346082', 'ELCI00269', 'ELCI00269', 'TXSATSTD', 'Allied Institute of Medicine', 'Elizabeth', '', 'Clancy Hrna', 'PA', 'Family Practice', '', '', NULL, 'O', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285866772', 0, 'Y', 0, '2013-09-30', NULL, NULL, 29.1534, -98.1662, NULL, NULL),
('320346082', 'ELCI00270', 'ELCI00270', 'TXSATSTD', 'Concentra Primary Care', 'Elizabeth', '', 'Clancy Hrna', 'PA', 'Family Practice', '', '', NULL, 'O', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285866772', 0, 'Y', 0, '2013-09-30', NULL, NULL, 31.5262, -97.1643, NULL, NULL),
('320346082', 'ELCI00271', 'ELCI00271', 'TXSATSTD', 'Allied Institute of Medicine', 'Elizabeth', '', 'Clancy Hrna', 'PA', 'Family Practice', '', '', NULL, 'O', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285866772', 0, 'Y', 0, '2013-09-30', NULL, NULL, 29.3804, -98.4088, NULL, NULL),
('320346082', 'ELCI00272', 'ELCI00272', 'TXSATSTD', 'Allied Institute of Medicine', 'Elizabeth', '', 'Clancy Hrna', 'PA', 'Family Practice', '', '', NULL, 'B', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285866772', 0, 'N', 0, '2013-09-30', NULL, NULL, 0, 0, NULL, NULL),
('320346082', 'ELCI00310', 'ELCI00310', 'TXDALSTD', 'Concentra Primary Care', 'Kimberly', '', 'Lasswell', 'PA C', 'Family Practice', '', '', NULL, 'O', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Mission Trail Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1306078886', 0, 'Y', 0, '2013-10-07', NULL, NULL, 32.9653, -96.839, NULL, NULL),
('320346082', 'ELCI00317', 'ELCI00317', 'TXDALSTD', 'Concentra Primary Care', 'Kimberly', '', 'Lasswell', 'PA C', 'Family Practice', '', '', NULL, 'O', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Mission Trail Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1306078886', 0, 'Y', 0, '2013-10-07', NULL, NULL, 33.1512, -96.8641, NULL, NULL),
('320346082', 'ELCI00307', 'ELCI00307', 'TXSATSTD', 'Allied Institute of Medicine', 'Kimberly', '', 'Lasswell', 'PA C', 'Family Practice', '', '', NULL, 'O', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Mission Trail Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1306078886', 0, 'Y', 0, '2013-10-07', NULL, NULL, 29.0273, -98.0989, NULL, NULL),
('320346082', 'ELCI00308', 'ELCI00308', 'TXSATSTD', 'Allied Institute of Medicine', 'Kimberly', '', 'Lasswell', 'PA C', 'Family Practice', '', '', NULL, 'O', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Mission Trail Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1306078886', 0, 'Y', 0, '2013-10-07', NULL, NULL, 29.5513, -98.3486, NULL, NULL),
('320346082', 'ELCI00309', 'ELCI00309', 'TXSATSTD', 'Allied Institute of Medicine', 'Kimberly', '', 'Lasswell', 'PA C', 'Family Practice', '', '', NULL, 'O', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Mission Trail Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1306078886', 0, 'Y', 0, '2013-10-07', NULL, NULL, 29.572, -97.9461, NULL, NULL),
('320346082', 'ELCI00311', 'ELCI00311', 'TXSATSTD', 'Allied Institute of Medicine', 'Kimberly', '', 'Lasswell', 'PA C', 'Family Practice', '', '', NULL, 'O', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Mission Trail Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1306078886', 0, 'Y', 0, '2013-10-07', NULL, NULL, 29.6798, -98.1066, NULL, NULL),
('320346082', 'ELCI00312', 'ELCI00312', 'TXSATSTD', 'Allied Institute of Medicine', 'Kimberly', '', 'Lasswell', 'PA C', 'Family Practice', '', '', NULL, 'O', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Mission Trail Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1306078886', 0, 'Y', 0, '2013-10-07', NULL, NULL, 28.9591, -98.4855, NULL, NULL),
('320346082', 'ELCI00313', 'ELCI00313', 'TXSATSTD', 'Allied Institute of Medicine', 'Kimberly', '', 'Lasswell', 'PA C', 'Family Practice', '', '', NULL, 'O', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Mission Trail Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1306078886', 0, 'Y', 0, '2013-10-07', NULL, NULL, 29.1534, -98.1662, NULL, NULL),
('320346082', 'ELCI00314', 'ELCI00314', 'TXSATSTD', 'Concentra Primary Care', 'Kimberly', '', 'Lasswell', 'PA C', 'Family Practice', '', '', NULL, 'O', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Mission Trail Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1306078886', 0, 'Y', 0, '2013-10-07', NULL, NULL, 31.5262, -97.1643, NULL, NULL),
('320346082', 'ELCI00315', 'ELCI00315', 'TXSATSTD', 'Allied Institute of Medicine', 'Kimberly', '', 'Lasswell', 'PA C', 'Family Practice', '', '', NULL, 'O', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Mission Trail Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1306078886', 0, 'Y', 0, '2013-10-07', NULL, NULL, 29.3804, -98.4088, NULL, NULL),
('320346082', 'ELCI00316', 'ELCI00316', 'TXSATSTD', 'Allied Institute of Medicine', 'Kimberly', '', 'Lasswell', 'PA C', 'Family Practice', '', '', NULL, 'B', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Mission Trail Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1306078886', 0, 'N', 0, '2013-10-07', NULL, NULL, 0, 0, NULL, NULL),
('320346082', 'ELCI00112', 'ELCI00112', 'TXDALSTD', 'Concentra Primary Care', 'Nicolle', '', 'Block', 'MD', 'Family Practice', '', '', NULL, 'O', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336369370', 0, 'N', 0, '2013-09-24', NULL, NULL, 32.9653, -96.839, NULL, NULL),
('320346082', 'ELCI00119', 'ELCI00119', 'TXDALSTD', 'Concentra Primary Care', 'Nicolle', '', 'Block', 'MD', 'Family Practice', '', '', NULL, 'O', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336369370', 0, 'N', 0, '2013-09-24', NULL, NULL, 33.1512, -96.8641, NULL, NULL),
('320346082', 'ELCI00109', 'ELCI00109', 'TXSATSTD', 'Allied Institute of Medicine', 'Nicolle', '', 'Block', 'MD', 'Family Practice', '', '', NULL, 'O', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336369370', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.0273, -98.0989, NULL, NULL),
('320346082', 'ELCI00110', 'ELCI00110', 'TXSATSTD', 'Allied Institute of Medicine', 'Nicolle', '', 'Block', 'MD', 'Family Practice', '', '', NULL, 'O', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336369370', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.5513, -98.3486, NULL, NULL),
('320346082', 'ELCI00111', 'ELCI00111', 'TXSATSTD', 'Allied Institute of Medicine', 'Nicolle', '', 'Block', 'MD', 'Family Practice', '', '', NULL, 'O', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336369370', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.572, -97.9461, NULL, NULL),
('320346082', 'ELCI00113', 'ELCI00113', 'TXSATSTD', 'Allied Institute of Medicine', 'Nicolle', '', 'Block', 'MD', 'Family Practice', '', '', NULL, 'O', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336369370', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.6798, -98.1066, NULL, NULL),
('320346082', 'ELCI00114', 'ELCI00114', 'TXSATSTD', 'Allied Institute of Medicine', 'Nicolle', '', 'Block', 'MD', 'Family Practice', '', '', NULL, 'O', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336369370', 0, 'Y', 0, '2013-09-24', NULL, NULL, 28.9591, -98.4855, NULL, NULL),
('320346082', 'ELCI00115', 'ELCI00115', 'TXSATSTD', 'Allied Institute of Medicine', 'Nicolle', '', 'Block', 'MD', 'Family Practice', '', '', NULL, 'O', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336369370', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.1534, -98.1662, NULL, NULL),
('320346082', 'ELCI00116', 'ELCI00116', 'TXSATSTD', 'Concentra Primary Care', 'Nicolle', '', 'Block', 'MD', 'Family Practice', '', '', NULL, 'O', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336369370', 0, 'Y', 0, '2013-09-24', NULL, NULL, 31.5262, -97.1643, NULL, NULL),
('320346082', 'ELCI00117', 'ELCI00117', 'TXSATSTD', 'Allied Institute of Medicine', 'Nicolle', '', 'Block', 'MD', 'Family Practice', '', '', NULL, 'O', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336369370', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.3804, -98.4088, NULL, NULL),
('320346082', 'ELCI00118', 'ELCI00118', 'TXSATSTD', 'Allied Institute of Medicine', 'Nicolle', '', 'Block', 'MD', 'Family Practice', '', '', NULL, 'B', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336369370', 0, 'N', 0, '2013-09-24', NULL, NULL, 0, 0, NULL, NULL),
('320346082', 'ELCI00079', 'ELCI00079', 'TXDALSTD', 'Concentra Primary Care', 'Victor', 'G', 'Rosales', 'DO', 'Family Practice', '', '', NULL, 'O', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2014-07-09', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346488905', 0, 'N', 0, '2014-07-09', NULL, NULL, 32.9653, -96.839, NULL, NULL),
('320346082', 'ELCI00086', 'ELCI00086', 'TXDALSTD', 'Concentra Primary Care', 'Victor', 'G', 'Rosales', 'DO', 'Family Practice', '', '', NULL, 'O', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2014-07-09', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346488905', 0, 'N', 0, '2014-07-09', NULL, NULL, 33.1512, -96.8641, NULL, NULL),
('320346082', 'ELCI00076', 'ELCI00076', 'TXSATSTD', 'Allied Institute of Medicine', 'Victor', 'G', 'Rosales', 'DO', 'Family Practice', '', '', NULL, 'O', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2014-07-09', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346488905', 0, 'Y', 0, '2014-07-09', NULL, NULL, 29.0273, -98.0989, NULL, NULL),
('320346082', 'ELCI00077', 'ELCI00077', 'TXSATSTD', 'Allied Institute of Medicine', 'Victor', 'G', 'Rosales', 'DO', 'Family Practice', '', '', NULL, 'O', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2013-04-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346488905', 0, 'N', 0, '2014-07-09', NULL, NULL, 29.5511, -98.3477, NULL, NULL),
('320346082', 'ELCI00078', 'ELCI00078', 'TXSATSTD', 'Allied Institute of Medicine', 'Victor', 'G', 'Rosales', 'DO', 'Family Practice', '', '', NULL, 'O', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2014-07-09', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346488905', 0, 'Y', 0, '2014-07-09', NULL, NULL, 29.572, -97.9461, NULL, NULL),
('320346082', 'ELCI00080', 'ELCI00080', 'TXSATSTD', 'Allied Institute of Medicine', 'Victor', 'G', 'Rosales', 'DO', 'Family Practice', '', '', NULL, 'O', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2014-07-09', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346488905', 0, 'Y', 0, '2014-07-09', NULL, NULL, 29.6798, -98.1066, NULL, NULL),
('320346082', 'ELCI00081', 'ELCI00081', 'TXSATSTD', 'Allied Institute of Medicine', 'Victor', 'G', 'Rosales', 'DO', 'Family Practice', '', '', NULL, 'O', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2014-07-09', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346488905', 0, 'Y', 0, '2014-07-09', NULL, NULL, 28.9591, -98.4855, NULL, NULL),
('320346082', 'ELCI00082', 'ELCI00082', 'TXSATSTD', 'Allied Institute of Medicine', 'Victor', 'G', 'Rosales', 'DO', 'Family Practice', '', '', NULL, 'O', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2014-07-09', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346488905', 0, 'Y', 0, '2014-07-09', NULL, NULL, 29.1534, -98.1662, NULL, NULL),
('320346082', 'ELCI00083', 'ELCI00083', 'TXSATSTD', 'Concentra Primary Care', 'Victor', 'G', 'Rosales', 'DO', 'Family Practice', '', '', NULL, 'O', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2014-07-09', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346488905', 0, 'Y', 0, '2014-07-09', NULL, NULL, 31.5262, -97.1643, NULL, NULL),
('320346082', 'ELCI00084', 'ELCI00084', 'TXSATSTD', 'Allied Institute of Medicine', 'Victor', 'G', 'Rosales', 'DO', 'Family Practice', '', '', NULL, 'O', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2014-07-09', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346488905', 0, 'Y', 0, '2014-07-09', NULL, NULL, 29.3804, -98.4088, NULL, NULL),
('320346082', 'ELCI00085', 'ELCI00085', 'TXSATSTD', 'Concentra Primary Care', 'Victor', 'G', 'Rosales', 'DO', 'Family Practice', '', '', NULL, 'B', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346488905', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('320346082', 'ELCI00167', 'ELCI00167', 'TXDALSTD', 'Concentra Primary Care', 'Filomeno', 'P', 'Gonzalez', 'MD', 'Family Practice', '', '', NULL, 'O', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376549204', 0, 'N', 0, '2013-09-24', NULL, NULL, 32.9653, -96.839, NULL, NULL),
('320346082', 'ELCI00174', 'ELCI00174', 'TXDALSTD', 'Concentra Primary Care', 'Filomeno', 'P', 'Gonzalez', 'MD', 'Family Practice', '', '', NULL, 'O', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376549204', 0, 'N', 0, '2013-09-24', NULL, NULL, 33.1512, -96.8641, NULL, NULL),
('320346082', 'ELCI00164', 'ELCI00164', 'TXSATSTD', 'Allied Institute of Medicine', 'Filomeno', 'P', 'Gonzalez', 'MD', 'Family Practice', '', '', NULL, 'O', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376549204', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.0273, -98.0989, NULL, NULL),
('320346082', 'ELCI00165', 'ELCI00165', 'TXSATSTD', 'Allied Institute of Medicine', 'Filomeno', 'P', 'Gonzalez', 'MD', 'Family Practice', '', '', NULL, 'O', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376549204', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.5513, -98.3486, NULL, NULL),
('320346082', 'ELCI00166', 'ELCI00166', 'TXSATSTD', 'Allied Institute of Medicine', 'Filomeno', 'P', 'Gonzalez', 'MD', 'Family Practice', '', '', NULL, 'O', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376549204', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.572, -97.9461, NULL, NULL),
('320346082', 'ELCI00168', 'ELCI00168', 'TXSATSTD', 'Allied Institute of Medicine', 'Filomeno', 'P', 'Gonzalez', 'MD', 'Family Practice', '', '', NULL, 'O', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2013-04-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376549204', 0, 'N', 0, '2013-09-24', NULL, NULL, 29.6803, -98.1077, 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
('320346082', 'ELCI00169', 'ELCI00169', 'TXSATSTD', 'Allied Institute of Medicine', 'Filomeno', 'P', 'Gonzalez', 'MD', 'Family Practice', '', '', NULL, 'O', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376549204', 0, 'Y', 0, '2013-09-24', NULL, NULL, 28.9591, -98.4855, NULL, NULL),
('320346082', 'ELCI00170', 'ELCI00170', 'TXSATSTD', 'Allied Institute of Medicine', 'Filomeno', 'P', 'Gonzalez', 'MD', 'Family Practice', '', '', NULL, 'O', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376549204', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.1534, -98.1662, NULL, NULL),
('320346082', 'ELCI00171', 'ELCI00171', 'TXSATSTD', 'Concentra Primary Care', 'Filomeno', 'P', 'Gonzalez', 'MD', 'Family Practice', '', '', NULL, 'O', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376549204', 0, 'Y', 0, '2013-09-24', NULL, NULL, 31.5262, -97.1643, NULL, NULL),
('320346082', 'ELCI00172', 'ELCI00172', 'TXSATSTD', 'Allied Institute of Medicine', 'Filomeno', 'P', 'Gonzalez', 'MD', 'Family Practice', '', '', NULL, 'O', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376549204', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.3804, -98.4088, NULL, NULL),
('320346082', 'ELCI00173', 'ELCI00173', 'TXSATSTD', 'Concentra Primary Care', 'Filomeno', 'P', 'Gonzalez', 'MD', 'Family Practice', '', '', NULL, 'B', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376549204', 0, 'N', 0, '2013-09-24', NULL, NULL, 0, 0, NULL, NULL),
('320346082', 'ELCI00068', 'ELCI00068', 'TXDALSTD', 'Concentra Primary Care', 'Yolanda', '', 'Rios Alonzo', 'DO', 'Family Practice', '', '', NULL, 'O', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2013-11-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396734711', 0, 'N', 0, '2013-11-20', NULL, NULL, 32.9655, -96.8391, NULL, NULL),
('320346082', 'ELCI00075', 'ELCI00075', 'TXDALSTD', 'Concentra Primary Care', 'Yolanda', '', 'Rios Alonzo', 'DO', 'Family Practice', '', '', NULL, 'O', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2013-11-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396734711', 0, 'N', 0, '2013-11-20', NULL, NULL, 33.1506, -96.8633, NULL, NULL),
('320346082', 'ELCI00065', 'ELCI00065', 'TXSATSTD', 'Allied Institute of Medicine', 'Yolanda', '', 'Rios Alonzo', 'DO', 'Family Practice', '', '', NULL, 'O', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2013-11-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396734711', 0, 'Y', 0, '2013-11-20', NULL, NULL, 29.0715, -98.0831, NULL, NULL),
('320346082', 'ELCI00066', 'ELCI00066', 'TXSATSTD', 'Allied Institute of Medicine', 'Yolanda', '', 'Rios Alonzo', 'DO', 'Family Practice', '', '', NULL, 'O', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2013-04-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396734711', 0, 'N', 0, '2013-09-24', NULL, NULL, 29.5511, -98.3477, NULL, NULL),
('320346082', 'ELCI00067', 'ELCI00067', 'TXSATSTD', 'Allied Institute of Medicine', 'Yolanda', '', 'Rios Alonzo', 'DO', 'Family Practice', '', '', NULL, 'O', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2013-11-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396734711', 0, 'Y', 0, '2013-11-20', NULL, NULL, 29.5723, -97.9446, NULL, NULL),
('320346082', 'ELCI00069', 'ELCI00069', 'TXSATSTD', 'Allied Institute of Medicine', 'Yolanda', '', 'Rios Alonzo', 'DO', 'Family Practice', '', '', NULL, 'O', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2013-11-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396734711', 0, 'Y', 0, '2013-11-20', NULL, NULL, 29.6803, -98.1077, NULL, NULL),
('320346082', 'ELCI00070', 'ELCI00070', 'TXSATSTD', 'Allied Institute of Medicine', 'Yolanda', '', 'Rios Alonzo', 'DO', 'Family Practice', '', '', NULL, 'O', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2013-11-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396734711', 0, 'Y', 0, '2013-11-20', NULL, NULL, 28.9591, -98.4855, NULL, NULL),
('320346082', 'ELCI00071', 'ELCI00071', 'TXSATSTD', 'Allied Institute of Medicine', 'Yolanda', '', 'Rios Alonzo', 'DO', 'Family Practice', '', '', NULL, 'O', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2013-11-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396734711', 0, 'Y', 0, '2013-11-20', NULL, NULL, 29.1588, -98.1706, NULL, NULL),
('320346082', 'ELCI00072', 'ELCI00072', 'TXSATSTD', 'Concentra Primary Care', 'Yolanda', '', 'Rios Alonzo', 'DO', 'Family Practice', '', '', NULL, 'O', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2013-11-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396734711', 0, 'Y', 0, '2013-11-20', NULL, NULL, 31.5264, -97.1651, NULL, NULL),
('320346082', 'ELCI00073', 'ELCI00073', 'TXSATSTD', 'Allied Institute of Medicine', 'Yolanda', '', 'Rios Alonzo', 'DO', 'Family Practice', '', '', NULL, 'O', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2013-11-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396734711', 0, 'Y', 0, '2013-11-20', NULL, NULL, 29.3804, -98.4079, NULL, NULL),
('320346082', 'ELCI00074', 'ELCI00074', 'TXSATSTD', 'Allied Institute of Medicine', 'Yolanda', '', 'Rios Alonzo', 'DO', 'Family Practice', '', '', NULL, 'B', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2013-11-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396734711', 0, 'N', 0, '2013-11-20', NULL, NULL, 0, 0, NULL, NULL),
('320346082', 'ELCI00222', 'ELCI00222', 'TXDALSTD', 'Concentra Primary Care', 'John', 'J', 'Ryan', 'MD', 'Family Practice', '', '', NULL, 'O', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396791562', 0, 'N', 0, '2013-09-30', NULL, NULL, 32.9653, -96.839, NULL, NULL),
('320346082', 'ELCI00229', 'ELCI00229', 'TXDALSTD', 'Concentra Primary Care', 'John', 'J', 'Ryan', 'MD', 'Family Practice', '', '', NULL, 'O', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396791562', 0, 'N', 0, '2013-09-30', NULL, NULL, 33.1512, -96.8641, NULL, NULL),
('320346082', 'ELCI00219', 'ELCI00219', 'TXSATSTD', 'Allied Institute of Medicine', 'John', 'J', 'Ryan', 'MD', 'Family Practice', '', '', NULL, 'O', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396791562', 0, 'Y', 0, '2013-09-30', NULL, NULL, 29.0273, -98.0989, NULL, NULL),
('320346082', 'ELCI00220', 'ELCI00220', 'TXSATSTD', 'Allied Institute of Medicine', 'John', 'J', 'Ryan', 'MD', 'Family Practice', '', '', NULL, 'O', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396791562', 0, 'Y', 0, '2013-09-30', NULL, NULL, 29.5513, -98.3486, NULL, NULL),
('320346082', 'ELCI00221', 'ELCI00221', 'TXSATSTD', 'Allied Institute of Medicine', 'John', 'J', 'Ryan', 'MD', 'Family Practice', '', '', NULL, 'O', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396791562', 0, 'Y', 0, '2013-09-30', NULL, NULL, 29.572, -97.9461, NULL, NULL),
('320346082', 'ELCI00223', 'ELCI00223', 'TXSATSTD', 'Allied Institute of Medicine', 'John', 'J', 'Ryan', 'MD', 'Family Practice', '', '', NULL, 'O', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396791562', 0, 'Y', 0, '2013-09-30', NULL, NULL, 29.6798, -98.1066, NULL, NULL),
('320346082', 'ELCI00224', 'ELCI00224', 'TXSATSTD', 'Allied Institute of Medicine', 'John', 'J', 'Ryan', 'MD', 'Family Practice', '', '', NULL, 'O', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396791562', 0, 'Y', 0, '2013-09-30', NULL, NULL, 28.9591, -98.4855, NULL, NULL),
('320346082', 'ELCI00225', 'ELCI00225', 'TXSATSTD', 'Allied Institute of Medicine', 'John', 'J', 'Ryan', 'MD', 'Family Practice', '', '', NULL, 'O', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2013-04-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396791562', 0, 'N', 0, '2013-09-30', NULL, NULL, 29.1588, -98.1706, NULL, NULL),
('320346082', 'ELCI00226', 'ELCI00226', 'TXSATSTD', 'Concentra Primary Care', 'John', 'J', 'Ryan', 'MD', 'Family Practice', '', '', NULL, 'O', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396791562', 0, 'Y', 0, '2013-09-30', NULL, NULL, 31.5262, -97.1643, NULL, NULL),
('320346082', 'ELCI00227', 'ELCI00227', 'TXSATSTD', 'Allied Institute of Medicine', 'John', 'J', 'Ryan', 'MD', 'Family Practice', '', '', NULL, 'O', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396791562', 0, 'Y', 0, '2013-09-30', NULL, NULL, 29.3804, -98.4088, NULL, NULL),
('320346082', 'ELCI00228', 'ELCI00228', 'TXSATSTD', 'Allied Institute of Medicine', 'John', 'J', 'Ryan', 'MD', 'Family Practice', '', '', NULL, 'B', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396791562', 0, 'N', 0, '2013-09-30', NULL, NULL, 0, 0, NULL, NULL),
('320346082', 'ELCI00101', 'ELCI00101', 'TXDALSTD', 'Concentra Primary Care', 'Peggy', '', 'Wood', 'FNP', 'Family Practice', '', '', NULL, 'O', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437453800', 0, 'Y', 0, '2013-10-07', NULL, NULL, 32.9653, -96.839, NULL, NULL),
('320346082', 'ELCI00108', 'ELCI00108', 'TXDALSTD', 'Concentra Primary Care', 'Peggy', '', 'Wood', 'FNP', 'Family Practice', '', '', NULL, 'O', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437453800', 0, 'Y', 0, '2013-10-07', NULL, NULL, 33.1512, -96.8641, NULL, NULL),
('320346082', 'ELCI00098', 'ELCI00098', 'TXSATSTD', 'Allied Institute of Medicine', 'Peggy', '', 'Wood', 'FNP', 'Family Practice', '', '', NULL, 'O', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437453800', 0, 'Y', 0, '2013-10-07', NULL, NULL, 29.0273, -98.0989, NULL, NULL),
('320346082', 'ELCI00099', 'ELCI00099', 'TXSATSTD', 'Allied Institute of Medicine', 'Peggy', '', 'Wood', 'FNP', 'Family Practice', '', '', NULL, 'O', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437453800', 0, 'Y', 0, '2013-10-07', NULL, NULL, 29.5513, -98.3486, NULL, NULL),
('320346082', 'ELCI00100', 'ELCI00100', 'TXSATSTD', 'Allied Institute of Medicine', 'Peggy', '', 'Wood', 'FNP', 'Family Practice', '', '', NULL, 'O', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437453800', 0, 'Y', 0, '2013-10-07', NULL, NULL, 29.572, -97.9461, NULL, NULL),
('320346082', 'ELCI00102', 'ELCI00102', 'TXSATSTD', 'Allied Institute of Medicine', 'Peggy', '', 'Wood', 'FNP', 'Family Practice', '', '', NULL, 'O', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437453800', 0, 'Y', 0, '2013-10-07', NULL, NULL, 29.6798, -98.1066, NULL, NULL),
('320346082', 'ELCI00103', 'ELCI00103', 'TXSATSTD', 'Allied Institute of Medicine', 'Peggy', '', 'Wood', 'FNP', 'Family Practice', '', '', NULL, 'O', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437453800', 0, 'Y', 0, '2013-10-07', NULL, NULL, 28.9591, -98.4855, NULL, NULL),
('320346082', 'ELCI00104', 'ELCI00104', 'TXSATSTD', 'Allied Institute of Medicine', 'Peggy', '', 'Wood', 'FNP', 'Family Practice', '', '', NULL, 'O', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437453800', 0, 'Y', 0, '2013-10-07', NULL, NULL, 29.1534, -98.1662, NULL, NULL),
('320346082', 'ELCI00105', 'ELCI00105', 'TXSATSTD', 'Concentra Primary Care', 'Peggy', '', 'Wood', 'FNP', 'Family Practice', '', '', NULL, 'O', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437453800', 0, 'Y', 0, '2013-10-07', NULL, NULL, 31.5262, -97.1643, NULL, NULL),
('320346082', 'ELCI00106', 'ELCI00106', 'TXSATSTD', 'Allied Institute of Medicine', 'Peggy', '', 'Wood', 'FNP', 'Family Practice', '', '', NULL, 'O', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437453800', 0, 'Y', 0, '2013-10-07', NULL, NULL, 29.3804, -98.4088, NULL, NULL),
('320346082', 'ELCI00107', 'ELCI00107', 'TXSATSTD', 'Concentra Primary Care', 'Peggy', '', 'Wood', 'FNP', 'Family Practice', '', '', NULL, 'B', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437453800', 0, 'N', 0, '2013-10-07', NULL, NULL, 0, 0, NULL, NULL),
('320346082', 'ELCI00211', 'ELCI00211', 'TXDALSTD', 'Concentra Primary Care', 'Joseph', '', 'Rosiles', 'MD', 'Family Practice', '', '', NULL, 'O', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487662078', 0, 'N', 0, '2013-09-24', NULL, NULL, 32.9653, -96.839, NULL, NULL),
('320346082', 'ELCI00218', 'ELCI00218', 'TXDALSTD', 'Concentra Primary Care', 'Joseph', '', 'Rosiles', 'MD', 'Family Practice', '', '', NULL, 'O', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487662078', 0, 'N', 0, '2013-09-24', NULL, NULL, 33.1512, -96.8641, NULL, NULL),
('320346082', 'ELCI00208', 'ELCI00208', 'TXSATSTD', 'Allied Institute of Medicine', 'Joseph', '', 'Rosiles', 'MD', 'Family Practice', '', '', NULL, 'O', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487662078', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.0273, -98.0989, NULL, NULL),
('320346082', 'ELCI00209', 'ELCI00209', 'TXSATSTD', 'Allied Institute of Medicine', 'Joseph', '', 'Rosiles', 'MD', 'Family Practice', '', '', NULL, 'O', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487662078', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.5513, -98.3486, NULL, NULL),
('320346082', 'ELCI00210', 'ELCI00210', 'TXSATSTD', 'Allied Institute of Medicine', 'Joseph', '', 'Rosiles', 'MD', 'Family Practice', '', '', NULL, 'O', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487662078', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.572, -97.9461, NULL, NULL),
('320346082', 'ELCI00212', 'ELCI00212', 'TXSATSTD', 'Allied Institute of Medicine', 'Joseph', '', 'Rosiles', 'MD', 'Family Practice', '', '', NULL, 'O', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487662078', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.6798, -98.1066, NULL, NULL),
('320346082', 'ELCI00213', 'ELCI00213', 'TXSATSTD', 'Allied Institute of Medicine', 'Joseph', '', 'Rosiles', 'MD', 'Family Practice', '', '', NULL, 'O', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487662078', 0, 'Y', 0, '2013-09-24', NULL, NULL, 28.9591, -98.4855, NULL, NULL),
('320346082', 'ELCI00214', 'ELCI00214', 'TXSATSTD', 'Allied Institute of Medicine', 'Joseph', '', 'Rosiles', 'MD', 'Family Practice', '', '', NULL, 'O', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487662078', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.1534, -98.1662, NULL, NULL),
('320346082', 'ELCI00215', 'ELCI00215', 'TXSATSTD', 'Concentra Primary Care', 'Joseph', '', 'Rosiles', 'MD', 'Family Practice', '', '', NULL, 'O', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487662078', 0, 'Y', 0, '2013-09-24', NULL, NULL, 31.5262, -97.1643, NULL, NULL),
('320346082', 'ELCI00216', 'ELCI00216', 'TXSATSTD', 'Allied Institute of Medicine', 'Joseph', '', 'Rosiles', 'MD', 'Family Practice', '', '', NULL, 'O', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487662078', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.3804, -98.4088, NULL, NULL),
('320346082', 'ELCI00217', 'ELCI00217', 'TXSATSTD', 'Concentra Primary Care', 'Joseph', '', 'Rosiles', 'MD', 'Family Practice', '', '', NULL, 'B', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487662078', 0, 'N', 0, '2013-09-24', NULL, NULL, 0, 0, NULL, NULL),
('320346082', 'ELCI00046', 'ELCI00046', 'TXDALSTD', 'Concentra Primary Care', 'Vernon', 'C', 'Haverlah', 'DO', 'Family Practice', '', '', NULL, 'O', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497865448', 0, 'N', 0, '2013-09-30', NULL, NULL, 32.9653, -96.839, NULL, NULL),
('320346082', 'ELCI00053', 'ELCI00053', 'TXDALSTD', 'Concentra Primary Care', 'Vernon', 'C', 'Haverlah', 'DO', 'Family Practice', '', '', NULL, 'O', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497865448', 0, 'N', 0, '2013-09-30', NULL, NULL, 33.1512, -96.8641, NULL, NULL),
('320346082', 'ELCI00043', 'ELCI00043', 'TXSATSTD', 'Allied Institute of Medicine', 'Vernon', 'C', 'Haverlah', 'DO', 'Family Practice', '', '', NULL, 'O', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497865448', 0, 'Y', 0, '2013-09-30', NULL, NULL, 29.0273, -98.0989, NULL, NULL),
('320346082', 'ELCI00044', 'ELCI00044', 'TXSATSTD', 'Allied Institute of Medicine', 'Vernon', 'C', 'Haverlah', 'DO', 'Family Practice', '', '', NULL, 'O', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497865448', 0, 'Y', 0, '2013-09-30', NULL, NULL, 29.5513, -98.3486, NULL, NULL),
('320346082', 'ELCI00045', 'ELCI00045', 'TXSATSTD', 'Allied Institute of Medicine', 'Vernon', 'C', 'Haverlah', 'DO', 'Family Practice', '', '', NULL, 'O', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497865448', 0, 'Y', 0, '2013-09-30', NULL, NULL, 29.572, -97.9461, NULL, NULL),
('320346082', 'ELCI00047', 'ELCI00047', 'TXSATSTD', 'Allied Institute of Medicine', 'Vernon', 'C', 'Haverlah', 'DO', 'Family Practice', '', '', NULL, 'O', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497865448', 0, 'Y', 0, '2013-09-30', NULL, NULL, 29.6798, -98.1066, NULL, NULL),
('320346082', 'ELCI00048', 'ELCI00048', 'TXSATSTD', 'Allied Institute of Medicine', 'Vernon', 'C', 'Haverlah', 'DO', 'Family Practice', '', '', NULL, 'O', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497865448', 0, 'Y', 0, '2013-09-30', NULL, NULL, 28.9591, -98.4855, NULL, NULL),
('320346082', 'ELCI00049', 'ELCI00049', 'TXSATSTD', 'Allied Institute of Medicine', 'Vernon', 'C', 'Haverlah', 'DO', 'Family Practice', '', '', NULL, 'O', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497865448', 0, 'Y', 0, '2013-09-30', NULL, NULL, 29.1534, -98.1662, NULL, NULL),
('320346082', 'ELCI00050', 'ELCI00050', 'TXSATSTD', 'Concentra Primary Care', 'Vernon', 'C', 'Haverlah', 'DO', 'Family Practice', '', '', NULL, 'O', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497865448', 0, 'Y', 0, '2013-09-30', NULL, NULL, 31.5262, -97.1643, NULL, NULL),
('320346082', 'ELCI00051', 'ELCI00051', 'TXSATSTD', 'Allied Institute of Medicine', 'Vernon', 'C', 'Haverlah', 'DO', 'Family Practice', '', '', NULL, 'O', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2013-04-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497865448', 0, 'N', 0, '2013-09-30', NULL, NULL, 29.3804, -98.4079, NULL, NULL),
('320346082', 'ELCI00052', 'ELCI00052', 'TXSATSTD', 'Allied Institute of Medicine', 'Vernon', 'C', 'Haverlah', 'DO', 'Family Practice', '', '', NULL, 'B', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497865448', 0, 'N', 0, '2013-09-30', NULL, NULL, 0, 0, NULL, NULL),
('320346082', 'ELCI00178', 'ELCI00178', 'TXDALSTD', 'Concentra Primary Care', 'Jonathan', '', 'Piga', 'MD', 'Family Practice', '', '', NULL, 'O', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518008366', 0, 'N', 0, '2013-09-24', NULL, NULL, 32.9653, -96.839, NULL, NULL),
('320346082', 'ELCI00185', 'ELCI00185', 'TXDALSTD', 'Concentra Primary Care', 'Jonathan', '', 'Piga', 'MD', 'Family Practice', '', '', NULL, 'O', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518008366', 0, 'N', 0, '2013-09-24', NULL, NULL, 33.1512, -96.8641, NULL, NULL),
('320346082', 'ELCI00175', 'ELCI00175', 'TXSATSTD', 'Allied Institute of Medicine', 'Jonathan', '', 'Piga', 'MD', 'Family Practice', '', '', NULL, 'O', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518008366', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.0273, -98.0989, NULL, NULL),
('320346082', 'ELCI00176', 'ELCI00176', 'TXSATSTD', 'Allied Institute of Medicine', 'Jonathan', '', 'Piga', 'MD', 'Family Practice', '', '', NULL, 'O', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518008366', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.5513, -98.3486, NULL, NULL),
('320346082', 'ELCI00177', 'ELCI00177', 'TXSATSTD', 'Allied Institute of Medicine', 'Jonathan', '', 'Piga', 'MD', 'Family Practice', '', '', NULL, 'O', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518008366', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.572, -97.9461, NULL, NULL),
('320346082', 'ELCI00179', 'ELCI00179', 'TXSATSTD', 'Allied Institute of Medicine', 'Jonathan', '', 'Piga', 'MD', 'Family Practice', '', '', NULL, 'O', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518008366', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.6798, -98.1066, NULL, NULL),
('320346082', 'ELCI00180', 'ELCI00180', 'TXSATSTD', 'Allied Institute of Medicine', 'Jonathan', '', 'Piga', 'MD', 'Family Practice', '', '', NULL, 'O', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518008366', 0, 'Y', 0, '2013-09-24', NULL, NULL, 28.9591, -98.4855, NULL, NULL),
('320346082', 'ELCI00181', 'ELCI00181', 'TXSATSTD', 'Allied Institute of Medicine', 'Jonathan', '', 'Piga', 'MD', 'Family Practice', '', '', NULL, 'O', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518008366', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.1534, -98.1662, NULL, NULL),
('320346082', 'ELCI00182', 'ELCI00182', 'TXSATSTD', 'Concentra Primary Care', 'Jonathan', '', 'Piga', 'MD', 'Family Practice', '', '', NULL, 'O', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518008366', 0, 'Y', 0, '2013-09-24', NULL, NULL, 31.5262, -97.1643, NULL, NULL),
('320346082', 'ELCI00183', 'ELCI00183', 'TXSATSTD', 'Allied Institute of Medicine', 'Jonathan', '', 'Piga', 'MD', 'Family Practice', '', '', NULL, 'O', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518008366', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.3804, -98.4088, NULL, NULL),
('320346082', 'ELCI00184', 'ELCI00184', 'TXSATSTD', 'Allied Institute of Medicine', 'Jonathan', '', 'Piga', 'MD', 'Family Practice', '', '', NULL, 'B', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518008366', 0, 'N', 0, '2013-09-24', NULL, NULL, 0, 0, NULL, NULL),
('320346082', 'ELCI00057', 'ELCI00057', 'TXDALSTD', 'Concentra Primary Care', 'David', 'H', 'Pak', 'DO', 'Family Practice', '', '', NULL, 'O', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2013-06-11', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518025766', 0, 'N', 0, '2013-06-27', NULL, NULL, 32.9655, -96.8391, NULL, NULL),
('320346082', 'ELCI00064', 'ELCI00064', 'TXDALSTD', 'Concentra Primary Care', 'David', 'H', 'Pak', 'DO', 'Family Practice', '', '', NULL, 'O', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2013-06-11', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518025766', 0, 'N', 0, '2013-06-27', NULL, NULL, 33.1506, -96.8633, NULL, NULL),
('320346082', 'ELCI00054', 'ELCI00054', 'TXSATSTD', 'Allied Institute of Medicine', 'David', 'H', 'Pak', 'DO', 'Family Practice', '', '', NULL, 'O', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2013-04-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518025766', 0, 'N', 0, '2013-04-04', NULL, NULL, 29.0715, -98.0831, NULL, NULL),
('320346082', 'ELCI00055', 'ELCI00055', 'TXSATSTD', 'Allied Institute of Medicine', 'David', 'H', 'Pak', 'DO', 'Family Practice', '', '', NULL, 'O', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2013-04-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518025766', 0, 'N', 0, '2013-04-04', NULL, NULL, 29.5511, -98.3477, NULL, NULL),
('320346082', 'ELCI00056', 'ELCI00056', 'TXSATSTD', 'Allied Institute of Medicine', 'David', 'H', 'Pak', 'DO', 'Family Practice', '', '', NULL, 'O', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2013-04-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518025766', 0, 'N', 0, '2013-04-04', NULL, NULL, 29.5723, -97.9446, NULL, NULL),
('320346082', 'ELCI00058', 'ELCI00058', 'TXSATSTD', 'Allied Institute of Medicine', 'David', 'H', 'Pak', 'DO', 'Family Practice', '', '', NULL, 'O', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2013-04-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518025766', 0, 'N', 0, '2013-04-04', NULL, NULL, 29.6803, -98.1077, NULL, NULL),
('320346082', 'ELCI00059', 'ELCI00059', 'TXSATSTD', 'Allied Institute of Medicine', 'David', 'H', 'Pak', 'DO', 'Family Practice', '', '', NULL, 'O', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2013-06-11', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518025766', 0, 'N', 0, '2013-06-27', NULL, NULL, 28.9591, -98.4855, NULL, NULL),
('320346082', 'ELCI00060', 'ELCI00060', 'TXSATSTD', 'Allied Institute of Medicine', 'David', 'H', 'Pak', 'DO', 'Family Practice', '', '', NULL, 'O', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2013-06-11', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518025766', 0, 'N', 0, '2013-06-27', NULL, NULL, 29.1588, -98.1706, NULL, NULL),
('320346082', 'ELCI00061', 'ELCI00061', 'TXSATSTD', 'Concentra Primary Care', 'David', 'H', 'Pak', 'DO', 'Family Practice', '', '', NULL, 'O', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2013-06-11', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518025766', 0, 'Y', 0, '2013-06-27', NULL, NULL, 31.5264, -97.1651, NULL, NULL),
('320346082', 'ELCI00062', 'ELCI00062', 'TXSATSTD', 'Allied Institute of Medicine', 'David', 'H', 'Pak', 'DO', 'Family Practice', '', '', NULL, 'O', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2013-04-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518025766', 0, 'N', 0, '2013-04-04', NULL, NULL, 29.3804, -98.4079, NULL, NULL),
('320346082', 'ELCI00063', 'ELCI00063', 'TXSATSTD', 'Allied Institute of Medicine', 'David', 'H', 'Pak', 'DO', 'Family Practice', '', '', NULL, 'B', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2013-06-11', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518025766', 0, 'Y', 0, '2013-06-27', NULL, NULL, 0, 0, NULL, NULL),
('320346082', 'ELCI00156', 'ELCI00156', 'TXDALSTD', 'Concentra Primary Care', 'Majdouleen', '', 'Georgeos', 'MD', 'Family Practice', '', '', NULL, 'O', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518277144', 0, 'N', 0, '2013-09-24', NULL, NULL, 32.9653, -96.839, NULL, NULL),
('320346082', 'ELCI00163', 'ELCI00163', 'TXDALSTD', 'Concentra Primary Care', 'Majdouleen', '', 'Georgeos', 'MD', 'Family Practice', '', '', NULL, 'O', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518277144', 0, 'N', 0, '2013-09-24', NULL, NULL, 33.1512, -96.8641, NULL, NULL),
('320346082', 'ELCI00153', 'ELCI00153', 'TXSATSTD', 'Allied Institute of Medicine', 'Majdouleen', '', 'Georgeos', 'MD', 'Family Practice', '', '', NULL, 'O', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518277144', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.0273, -98.0989, NULL, NULL),
('320346082', 'ELCI00154', 'ELCI00154', 'TXSATSTD', 'Allied Institute of Medicine', 'Majdouleen', '', 'Georgeos', 'MD', 'Family Practice', '', '', NULL, 'O', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518277144', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.5513, -98.3486, NULL, NULL),
('320346082', 'ELCI00155', 'ELCI00155', 'TXSATSTD', 'Allied Institute of Medicine', 'Majdouleen', '', 'Georgeos', 'MD', 'Family Practice', '', '', NULL, 'O', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518277144', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.572, -97.9461, NULL, NULL),
('320346082', 'ELCI00157', 'ELCI00157', 'TXSATSTD', 'Allied Institute of Medicine', 'Majdouleen', '', 'Georgeos', 'MD', 'Family Practice', '', '', NULL, 'O', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518277144', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.6798, -98.1066, NULL, NULL),
('320346082', 'ELCI00158', 'ELCI00158', 'TXSATSTD', 'Allied Institute of Medicine', 'Majdouleen', '', 'Georgeos', 'MD', 'Family Practice', '', '', NULL, 'O', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518277144', 0, 'Y', 0, '2013-09-24', NULL, NULL, 28.9591, -98.4855, NULL, NULL),
('320346082', 'ELCI00159', 'ELCI00159', 'TXSATSTD', 'Allied Institute of Medicine', 'Majdouleen', '', 'Georgeos', 'MD', 'Family Practice', '', '', NULL, 'O', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518277144', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.1534, -98.1662, NULL, NULL),
('320346082', 'ELCI00160', 'ELCI00160', 'TXSATSTD', 'Concentra Primary Care', 'Majdouleen', '', 'Georgeos', 'MD', 'Family Practice', '', '', NULL, 'O', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518277144', 0, 'Y', 0, '2013-09-24', NULL, NULL, 31.5262, -97.1643, NULL, NULL),
('320346082', 'ELCI00161', 'ELCI00161', 'TXSATSTD', 'Allied Institute of Medicine', 'Majdouleen', '', 'Georgeos', 'MD', 'Family Practice', '', '', NULL, 'O', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518277144', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.3804, -98.4088, NULL, NULL),
('320346082', 'ELCI00162', 'ELCI00162', 'TXSATSTD', 'Allied Institute of Medicine', 'Majdouleen', '', 'Georgeos', 'MD', 'Family Practice', '', '', NULL, 'B', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518277144', 0, 'N', 0, '2013-09-24', NULL, NULL, 0, 0, NULL, NULL),
('320346082', 'ELCI00332', 'ELCI00332', 'TXDALSTD', 'Concentra Primary Care', 'Thanh', NULL, 'Phan', 'PA C', 'Family Practice', '', '', NULL, 'O', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1528250701', 0, 'Y', 0, '2013-01-16', NULL, NULL, 32.9653, -96.839, 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
('320346082', 'ELCI00339', 'ELCI00339', 'TXDALSTD', 'Concentra Primary Care', 'Thanh', NULL, 'Phan', 'PA C', 'Family Practice', '', '', NULL, 'O', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1528250701', 0, 'Y', 0, '2013-01-16', NULL, NULL, 33.1512, -96.8641, NULL, NULL),
('320346082', 'ELCI00329', 'ELCI00329', 'TXSATSTD', 'Allied Institute of Medicine', 'Thanh', NULL, 'Phan', 'PA C', 'Family Practice', '', '', NULL, 'O', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1528250701', 0, 'Y', 0, '2013-01-16', NULL, NULL, 29.0273, -98.0989, NULL, NULL),
('320346082', 'ELCI00330', 'ELCI00330', 'TXSATSTD', 'Allied Institute of Medicine', 'Thanh', NULL, 'Phan', 'PA C', 'Family Practice', '', '', NULL, 'O', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1528250701', 0, 'Y', 0, '2013-01-16', NULL, NULL, 29.5513, -98.3486, NULL, NULL),
('320346082', 'ELCI00331', 'ELCI00331', 'TXSATSTD', 'Allied Institute of Medicine', 'Thanh', NULL, 'Phan', 'PA C', 'Family Practice', '', '', NULL, 'O', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1528250701', 0, 'Y', 0, '2013-01-16', NULL, NULL, 29.572, -97.9461, NULL, NULL),
('320346082', 'ELCI00333', 'ELCI00333', 'TXSATSTD', 'Allied Institute of Medicine', 'Thanh', NULL, 'Phan', 'PA C', 'Family Practice', '', '', NULL, 'O', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1528250701', 0, 'Y', 0, '2013-01-16', NULL, NULL, 29.6798, -98.1066, NULL, NULL),
('320346082', 'ELCI00334', 'ELCI00334', 'TXSATSTD', 'Allied Institute of Medicine', 'Thanh', NULL, 'Phan', 'PA C', 'Family Practice', '', '', NULL, 'O', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1528250701', 0, 'Y', 0, '2013-01-16', NULL, NULL, 28.9591, -98.4855, NULL, NULL),
('320346082', 'ELCI00335', 'ELCI00335', 'TXSATSTD', 'Allied Institute of Medicine', 'Thanh', NULL, 'Phan', 'PA C', 'Family Practice', '', '', NULL, 'O', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1528250701', 0, 'Y', 0, '2013-01-16', NULL, NULL, 29.1534, -98.1662, NULL, NULL),
('320346082', 'ELCI00336', 'ELCI00336', 'TXSATSTD', 'Concentra Primary Care', 'Thanh', NULL, 'Phan', 'PA C', 'Family Practice', '', '', NULL, 'O', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1528250701', 0, 'Y', 0, '2013-01-16', NULL, NULL, 31.5262, -97.1643, NULL, NULL),
('320346082', 'ELCI00337', 'ELCI00337', 'TXSATSTD', 'Allied Institute of Medicine', 'Thanh', NULL, 'Phan', 'PA C', 'Family Practice', '', '', NULL, 'O', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1528250701', 0, 'Y', 0, '2013-01-16', NULL, NULL, 29.3804, -98.4088, NULL, NULL),
('320346082', 'ELCI00338', 'ELCI00338', 'TXSATSTD', 'Concentra Primary Care', 'Thanh', NULL, 'Phan', 'PA C', 'Family Practice', '', '', NULL, 'B', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1528250701', 0, 'N', 0, '2013-09-24', NULL, NULL, 0, 0, NULL, NULL),
('320346082', 'ELCI00123', 'ELCI00123', 'TXDALSTD', 'Concentra Primary Care', 'Robert', '', 'Contreras', 'MD', 'Family Practice', '', '', NULL, 'O', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538168364', 0, 'N', 0, '2013-09-24', NULL, NULL, 32.9653, -96.839, NULL, NULL),
('320346082', 'ELCI00130', 'ELCI00130', 'TXDALSTD', 'Concentra Primary Care', 'Robert', '', 'Contreras', 'MD', 'Family Practice', '', '', NULL, 'O', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538168364', 0, 'N', 0, '2013-09-24', NULL, NULL, 33.1512, -96.8641, NULL, NULL),
('320346082', 'ELCI00120', 'ELCI00120', 'TXSATSTD', 'Allied Institute of Medicine', 'Robert', '', 'Contreras', 'MD', 'Family Practice', '', '', NULL, 'O', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538168364', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.0273, -98.0989, NULL, NULL),
('320346082', 'ELCI00121', 'ELCI00121', 'TXSATSTD', 'Allied Institute of Medicine', 'Robert', '', 'Contreras', 'MD', 'Family Practice', '', '', NULL, 'O', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538168364', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.5513, -98.3486, NULL, NULL),
('320346082', 'ELCI00122', 'ELCI00122', 'TXSATSTD', 'Allied Institute of Medicine', 'Robert', '', 'Contreras', 'MD', 'Family Practice', '', '', NULL, 'O', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538168364', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.572, -97.9461, NULL, NULL),
('320346082', 'ELCI00124', 'ELCI00124', 'TXSATSTD', 'Allied Institute of Medicine', 'Robert', '', 'Contreras', 'MD', 'Family Practice', '', '', NULL, 'O', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538168364', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.6798, -98.1066, NULL, NULL),
('320346082', 'ELCI00125', 'ELCI00125', 'TXSATSTD', 'Allied Institute of Medicine', 'Robert', '', 'Contreras', 'MD', 'Family Practice', '', '', NULL, 'O', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538168364', 0, 'Y', 0, '2013-09-24', NULL, NULL, 28.9591, -98.4855, NULL, NULL),
('320346082', 'ELCI00126', 'ELCI00126', 'TXSATSTD', 'Allied Institute of Medicine', 'Robert', '', 'Contreras', 'MD', 'Family Practice', '', '', NULL, 'O', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538168364', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.1534, -98.1662, NULL, NULL),
('320346082', 'ELCI00127', 'ELCI00127', 'TXSATSTD', 'Concentra Primary Care', 'Robert', '', 'Contreras', 'MD', 'Family Practice', '', '', NULL, 'O', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538168364', 0, 'Y', 0, '2013-09-24', NULL, NULL, 31.5262, -97.1643, NULL, NULL),
('320346082', 'ELCI00128', 'ELCI00128', 'TXSATSTD', 'Allied Institute of Medicine', 'Robert', '', 'Contreras', 'MD', 'Family Practice', '', '', NULL, 'O', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538168364', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.3804, -98.4088, NULL, NULL),
('320346082', 'ELCI00129', 'ELCI00129', 'TXSATSTD', 'Concentra Primary Care', 'Robert', '', 'Contreras', 'MD', 'Family Practice', '', '', NULL, 'B', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538168364', 0, 'N', 0, '2013-09-24', NULL, NULL, 0, 0, NULL, NULL),
('320346082', 'ELCI00321', 'ELCI00321', 'TXDALSTD', 'Concentra Primary Care', 'Shannon', '', 'Lawson', 'PA C', 'Family Practice', '', '', NULL, 'O', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538467519', 0, 'Y', 0, '2013-10-07', NULL, NULL, 32.9653, -96.839, NULL, NULL),
('320346082', 'ELCI00327', 'ELCI00327', 'TXDALSTD', 'Concentra Primary Care', 'Shannon', '', 'Lawson', 'PA C', 'Family Practice', '', '', NULL, 'B', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538467519', 0, 'Y', 0, '2013-10-07', NULL, NULL, 0, 0, NULL, NULL),
('320346082', 'ELCI00328', 'ELCI00328', 'TXDALSTD', 'Concentra Primary Care', 'Shannon', '', 'Lawson', 'PA C', 'Family Practice', '', '', NULL, 'O', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538467519', 0, 'Y', 0, '2013-10-07', NULL, NULL, 33.1512, -96.8641, NULL, NULL),
('320346082', 'ELCI00318', 'ELCI00318', 'TXSATSTD', 'Allied Institute of Medicine', 'Shannon', '', 'Lawson', 'PA C', 'Family Practice', '', '', NULL, 'O', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538467519', 0, 'Y', 0, '2013-10-07', NULL, NULL, 29.0273, -98.0989, NULL, NULL),
('320346082', 'ELCI00319', 'ELCI00319', 'TXSATSTD', 'Allied Institute of Medicine', 'Shannon', '', 'Lawson', 'PA C', 'Family Practice', '', '', NULL, 'O', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538467519', 0, 'Y', 0, '2013-10-07', NULL, NULL, 29.5513, -98.3486, NULL, NULL),
('320346082', 'ELCI00320', 'ELCI00320', 'TXSATSTD', 'Allied Institute of Medicine', 'Shannon', '', 'Lawson', 'PA C', 'Family Practice', '', '', NULL, 'O', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538467519', 0, 'Y', 0, '2013-10-07', NULL, NULL, 29.572, -97.9461, NULL, NULL),
('320346082', 'ELCI00322', 'ELCI00322', 'TXSATSTD', 'Allied Institute of Medicine', 'Shannon', '', 'Lawson', 'PA C', 'Family Practice', '', '', NULL, 'O', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538467519', 0, 'Y', 0, '2013-10-07', NULL, NULL, 29.6798, -98.1066, NULL, NULL),
('320346082', 'ELCI00323', 'ELCI00323', 'TXSATSTD', 'Allied Institute of Medicine', 'Shannon', '', 'Lawson', 'PA C', 'Family Practice', '', '', NULL, 'O', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538467519', 0, 'Y', 0, '2013-10-07', NULL, NULL, 28.9591, -98.4855, NULL, NULL),
('320346082', 'ELCI00324', 'ELCI00324', 'TXSATSTD', 'Allied Institute of Medicine', 'Shannon', '', 'Lawson', 'PA C', 'Family Practice', '', '', NULL, 'O', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538467519', 0, 'Y', 0, '2013-10-07', NULL, NULL, 29.1534, -98.1662, NULL, NULL),
('320346082', 'ELCI00325', 'ELCI00325', 'TXSATSTD', 'Concentra Primary Care', 'Shannon', '', 'Lawson', 'PA C', 'Family Practice', '', '', NULL, 'O', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538467519', 0, 'Y', 0, '2013-10-07', NULL, NULL, 31.5262, -97.1643, NULL, NULL),
('320346082', 'ELCI00326', 'ELCI00326', 'TXSATSTD', 'Allied Institute of Medicine', 'Shannon', '', 'Lawson', 'PA C', 'Family Practice', '', '', NULL, 'O', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538467519', 0, 'Y', 0, '2013-10-07', NULL, NULL, 29.3804, -98.4088, NULL, NULL),
('320346082', 'ELCI00365', 'ELCI00365', 'TXDALSTD', 'Concentra Primary Care', 'Miranda', NULL, 'Willette', 'PA C', 'Family Practice', '', '', NULL, 'O', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1578839593', 0, 'Y', 0, '2013-01-16', NULL, NULL, 32.9653, -96.839, NULL, NULL),
('320346082', 'ELCI00372', 'ELCI00372', 'TXDALSTD', 'Concentra Primary Care', 'Miranda', NULL, 'Willette', 'PA C', 'Family Practice', '', '', NULL, 'O', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1578839593', 0, 'Y', 0, '2013-01-16', NULL, NULL, 33.1512, -96.8641, NULL, NULL),
('320346082', 'ELCI00362', 'ELCI00362', 'TXSATSTD', 'Allied Institute of Medicine', 'Miranda', NULL, 'Willette', 'PA C', 'Family Practice', '', '', NULL, 'O', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1578839593', 0, 'Y', 0, '2013-01-16', NULL, NULL, 29.0273, -98.0989, NULL, NULL),
('320346082', 'ELCI00363', 'ELCI00363', 'TXSATSTD', 'Allied Institute of Medicine', 'Miranda', NULL, 'Willette', 'PA C', 'Family Practice', '', '', NULL, 'O', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1578839593', 0, 'Y', 0, '2013-01-16', NULL, NULL, 29.5513, -98.3486, NULL, NULL),
('320346082', 'ELCI00364', 'ELCI00364', 'TXSATSTD', 'Allied Institute of Medicine', 'Miranda', NULL, 'Willette', 'PA C', 'Family Practice', '', '', NULL, 'O', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1578839593', 0, 'Y', 0, '2013-01-16', NULL, NULL, 29.572, -97.9461, NULL, NULL),
('320346082', 'ELCI00366', 'ELCI00366', 'TXSATSTD', 'Allied Institute of Medicine', 'Miranda', NULL, 'Willette', 'PA C', 'Family Practice', '', '', NULL, 'O', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1578839593', 0, 'Y', 0, '2013-01-16', NULL, NULL, 29.6798, -98.1066, NULL, NULL),
('320346082', 'ELCI00367', 'ELCI00367', 'TXSATSTD', 'Allied Institute of Medicine', 'Miranda', NULL, 'Willette', 'PA C', 'Family Practice', '', '', NULL, 'O', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1578839593', 0, 'Y', 0, '2013-01-16', NULL, NULL, 28.9591, -98.4855, NULL, NULL),
('320346082', 'ELCI00368', 'ELCI00368', 'TXSATSTD', 'Allied Institute of Medicine', 'Miranda', NULL, 'Willette', 'PA C', 'Family Practice', '', '', NULL, 'O', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1578839593', 0, 'Y', 0, '2013-01-16', NULL, NULL, 29.1534, -98.1662, NULL, NULL),
('320346082', 'ELCI00369', 'ELCI00369', 'TXSATSTD', 'Concentra Primary Care', 'Miranda', NULL, 'Willette', 'PA C', 'Family Practice', '', '', NULL, 'O', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1578839593', 0, 'Y', 0, '2013-01-16', NULL, NULL, 31.5262, -97.1643, NULL, NULL),
('320346082', 'ELCI00370', 'ELCI00370', 'TXSATSTD', 'Allied Institute of Medicine', 'Miranda', NULL, 'Willette', 'PA C', 'Family Practice', '', '', NULL, 'O', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1578839593', 0, 'Y', 0, '2013-01-16', NULL, NULL, 29.3804, -98.4088, NULL, NULL),
('320346082', 'ELCI00371', 'ELCI00371', 'TXSATSTD', 'Allied Institute of Medicine', 'Miranda', NULL, 'Willette', 'PA C', 'Family Practice', '', '', NULL, 'B', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1578839593', 0, 'N', 0, '2013-09-24', NULL, NULL, 0, 0, NULL, NULL),
('320346082', 'ELCI00255', 'ELCI00255', 'TXDALSTD', 'Concentra Primary Care', 'Patrick', 'G', 'Vinyard', 'MD', 'Family Practice', '', '', NULL, 'O', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Mission Trail Baptist Hospital', '', '', '', 'HCFA|UB|', '1598831281', 0, 'N', 0, '2014-07-09', NULL, NULL, 32.9653, -96.839, NULL, NULL),
('320346082', 'ELCI00262', 'ELCI00262', 'TXDALSTD', 'Concentra Primary Care', 'Patrick', 'G', 'Vinyard', 'MD', 'Family Practice', '', '', NULL, 'O', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Mission Trail Baptist Hospital', '', '', '', 'HCFA|UB|', '1598831281', 0, 'N', 0, '2014-07-09', NULL, NULL, 33.1512, -96.8641, NULL, NULL),
('320346082', 'ELCI00252', 'ELCI00252', 'TXSATSTD', 'Allied Institute of Medicine', 'Patrick', 'G', 'Vinyard', 'MD', 'Family Practice', '', '', NULL, 'O', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Mission Trail Baptist Hospital', '', '', '', 'HCFA|UB|', '1598831281', 0, 'Y', 0, '2014-07-09', NULL, NULL, 29.0273, -98.0989, NULL, NULL),
('320346082', 'ELCI00253', 'ELCI00253', 'TXSATSTD', 'Allied Institute of Medicine', 'Patrick', 'G', 'Vinyard', 'MD', 'Family Practice', '', '', NULL, 'O', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Mission Trail Baptist Hospital', '', '', '', 'HCFA|UB|', '1598831281', 0, 'Y', 0, '2014-07-09', NULL, NULL, 29.5513, -98.3486, NULL, NULL),
('320346082', 'ELCI00254', 'ELCI00254', 'TXSATSTD', 'Allied Institute of Medicine', 'Patrick', 'G', 'Vinyard', 'MD', 'Family Practice', '', '', NULL, 'O', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Mission Trail Baptist Hospital', '', '', '', 'HCFA|UB|', '1598831281', 0, 'Y', 0, '2014-07-09', NULL, NULL, 29.572, -97.9461, NULL, NULL),
('320346082', 'ELCI00256', 'ELCI00256', 'TXSATSTD', 'Allied Institute of Medicine', 'Patrick', 'G', 'Vinyard', 'MD', 'Family Practice', '', '', NULL, 'O', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Mission Trail Baptist Hospital', '', '', '', 'HCFA|UB|', '1598831281', 0, 'Y', 0, '2014-07-09', NULL, NULL, 29.6798, -98.1066, NULL, NULL),
('320346082', 'ELCI00257', 'ELCI00257', 'TXSATSTD', 'Allied Institute of Medicine', 'Patrick', 'G', 'Vinyard', 'MD', 'Family Practice', '', '', NULL, 'O', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Mission Trail Baptist Hospital', '', '', '', 'HCFA|UB|', '1598831281', 0, 'Y', 0, '2014-07-09', NULL, NULL, 28.9591, -98.4855, NULL, NULL),
('320346082', 'ELCI00258', 'ELCI00258', 'TXSATSTD', 'Allied Institute of Medicine', 'Patrick', 'G', 'Vinyard', 'MD', 'Family Practice', '', '', NULL, 'O', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Mission Trail Baptist Hospital', '', '', '', 'HCFA|UB|', '1598831281', 0, 'Y', 0, '2014-07-09', NULL, NULL, 29.1534, -98.1662, NULL, NULL),
('320346082', 'ELCI00259', 'ELCI00259', 'TXSATSTD', 'Concentra Primary Care', 'Patrick', 'G', 'Vinyard', 'MD', 'Family Practice', '', '', NULL, 'O', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Mission Trail Baptist Hospital', '', '', '', 'HCFA|UB|', '1598831281', 0, 'Y', 0, '2014-07-09', NULL, NULL, 31.5262, -97.1643, NULL, NULL),
('320346082', 'ELCI00260', 'ELCI00260', 'TXSATSTD', 'Allied Institute of Medicine', 'Patrick', 'G', 'Vinyard', 'MD', 'Family Practice', '', '', NULL, 'O', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2013-04-04', 0, 0, 0, 'Mission Trail Baptist Hospital', '', '', '', 'HCFA|UB|', '1598831281', 0, 'N', 0, '2014-07-09', NULL, NULL, 29.3804, -98.4079, NULL, NULL),
('320346082', 'ELCI00261', 'ELCI00261', 'TXSATSTD', 'Concentra Primary Care', 'Patrick', 'G', 'Vinyard', 'MD', 'Family Practice', '', '', NULL, 'B', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Mission Trail Baptist Hospital', '', '', '', 'HCFA|UB|', '1598831281', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('320346082', 'ELCI00244', 'ELCI00244', 'TXDALSTD', 'Concentra Primary Care', 'Kim', '', 'Tran', 'MD', 'Family Practice', '', '', NULL, 'O', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, NULL, NULL, 'HCFA|UB|', '1609877208', 0, 'N', 0, '2013-12-17', NULL, NULL, 32.9653, -96.839, NULL, NULL),
('320346082', 'ELCI00251', 'ELCI00251', 'TXDALSTD', 'Concentra Primary Care', 'Kim', '', 'Tran', 'MD', 'Family Practice', '', '', NULL, 'O', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, NULL, NULL, 'HCFA|UB|', '1609877208', 0, 'N', 0, '2013-12-17', NULL, NULL, 33.1512, -96.8641, NULL, NULL),
('320346082', 'ELCI00241', 'ELCI00241', 'TXSATSTD', 'Allied Institute of Medicine', 'Kim', '', 'Tran', 'MD', 'Family Practice', '', '', NULL, 'O', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, NULL, NULL, 'HCFA|UB|', '1609877208', 0, 'Y', 0, '2013-12-17', NULL, NULL, 29.0273, -98.0989, NULL, NULL),
('320346082', 'ELCI00242', 'ELCI00242', 'TXSATSTD', 'Allied Institute of Medicine', 'Kim', '', 'Tran', 'MD', 'Family Practice', '', '', NULL, 'O', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, NULL, NULL, 'HCFA|UB|', '1609877208', 0, 'Y', 0, '2013-12-17', NULL, NULL, 29.5513, -98.3486, NULL, NULL),
('320346082', 'ELCI00243', 'ELCI00243', 'TXSATSTD', 'Allied Institute of Medicine', 'Kim', '', 'Tran', 'MD', 'Family Practice', '', '', NULL, 'O', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, NULL, NULL, 'HCFA|UB|', '1609877208', 0, 'Y', 0, '2013-12-17', NULL, NULL, 29.572, -97.9461, NULL, NULL),
('320346082', 'ELCI00245', 'ELCI00245', 'TXSATSTD', 'Allied Institute of Medicine', 'Kim', '', 'Tran', 'MD', 'Family Practice', '', '', NULL, 'O', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, NULL, NULL, 'HCFA|UB|', '1609877208', 0, 'Y', 0, '2013-12-17', NULL, NULL, 29.6798, -98.1066, NULL, NULL),
('320346082', 'ELCI00246', 'ELCI00246', 'TXSATSTD', 'Allied Institute of Medicine', 'Kim', '', 'Tran', 'MD', 'Family Practice', '', '', NULL, 'O', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, NULL, NULL, 'HCFA|UB|', '1609877208', 0, 'Y', 0, '2013-12-17', NULL, NULL, 28.9591, -98.4855, NULL, NULL),
('320346082', 'ELCI00247', 'ELCI00247', 'TXSATSTD', 'Allied Institute of Medicine', 'Kim', '', 'Tran', 'MD', 'Family Practice', '', '', NULL, 'O', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, NULL, NULL, 'HCFA|UB|', '1609877208', 0, 'Y', 0, '2013-12-17', NULL, NULL, 29.1534, -98.1662, NULL, NULL),
('320346082', 'ELCI00248', 'ELCI00248', 'TXSATSTD', 'Concentra Primary Care', 'Kim', '', 'Tran', 'MD', 'Family Practice', '', '', NULL, 'O', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, NULL, NULL, 'HCFA|UB|', '1609877208', 0, 'Y', 0, '2013-12-17', NULL, NULL, 31.5262, -97.1643, NULL, NULL),
('320346082', 'ELCI00249', 'ELCI00249', 'TXSATSTD', 'Allied Institute of Medicine', 'Kim', '', 'Tran', 'MD', 'Family Practice', '', '', NULL, 'O', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, NULL, NULL, 'HCFA|UB|', '1609877208', 0, 'Y', 0, '2013-12-17', NULL, NULL, 29.3804, -98.4088, NULL, NULL),
('320346082', 'ELCI00250', 'ELCI00250', 'TXSATSTD', 'Allied Institute of Medicine', 'Kim', '', 'Tran', 'MD', 'Family Practice', '', '', NULL, 'B', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, NULL, NULL, 'HCFA|UB|', '1609877208', 0, 'N', 0, '2013-12-17', NULL, NULL, 0, 0, NULL, NULL),
('320346082', 'ELCI00376', 'ELCI00376', 'TXDALSTD', 'Concentra Primary Care', 'Sarah', '', 'Becker', 'RD ', 'Dietician', '', '', NULL, 'O', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639458292', 0, 'Y', 0, '2014-04-01', NULL, NULL, 32.9653, -96.839, NULL, NULL),
('320346082', 'ELCI00383', 'ELCI00383', 'TXDALSTD', 'Concentra Primary Care', 'Sarah', '', 'Becker', 'RD ', 'Dietician', '', '', NULL, 'O', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639458292', 0, 'Y', 0, '2014-04-01', NULL, NULL, 33.1512, -96.8641, NULL, NULL),
('320346082', 'ELCI00373', 'ELCI00373', 'TXSATSTD', 'Allied Institute of Medicine', 'Sarah', '', 'Becker', 'RD ', 'Dietician', '', '', NULL, 'O', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639458292', 0, 'Y', 0, '2013-09-30', NULL, NULL, 29.0273, -98.0989, NULL, NULL),
('320346082', 'ELCI00374', 'ELCI00374', 'TXSATSTD', 'Allied Institute of Medicine', 'Sarah', '', 'Becker', 'RD ', 'Dietician', '', '', NULL, 'O', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639458292', 0, 'Y', 0, '2013-09-30', NULL, NULL, 29.5513, -98.3486, NULL, NULL),
('320346082', 'ELCI00375', 'ELCI00375', 'TXSATSTD', 'Allied Institute of Medicine', 'Sarah', '', 'Becker', 'RD ', 'Dietician', '', '', NULL, 'O', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639458292', 0, 'Y', 0, '2013-09-30', NULL, NULL, 29.572, -97.9461, NULL, NULL),
('320346082', 'ELCI00377', 'ELCI00377', 'TXSATSTD', 'Allied Institute of Medicine', 'Sarah', '', 'Becker', 'RD ', 'Dietician', '', '', NULL, 'O', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639458292', 0, 'Y', 0, '2013-09-30', NULL, NULL, 29.6798, -98.1066, NULL, NULL),
('320346082', 'ELCI00378', 'ELCI00378', 'TXSATSTD', 'Allied Institute of Medicine', 'Sarah', '', 'Becker', 'RD ', 'Dietician', '', '', NULL, 'O', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639458292', 0, 'Y', 0, '2013-09-30', NULL, NULL, 28.9591, -98.4855, NULL, NULL),
('320346082', 'ELCI00379', 'ELCI00379', 'TXSATSTD', 'Allied Institute of Medicine', 'Sarah', '', 'Becker', 'RD ', 'Dietician', '', '', NULL, 'O', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639458292', 0, 'Y', 0, '2013-09-30', NULL, NULL, 29.1534, -98.1662, NULL, NULL),
('320346082', 'ELCI00380', 'ELCI00380', 'TXSATSTD', 'Concentra Primary Care', 'Sarah', '', 'Becker', 'RD ', 'Dietician', '', '', NULL, 'O', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639458292', 0, 'Y', 0, '2013-09-30', NULL, NULL, 31.5262, -97.1643, NULL, NULL),
('320346082', 'ELCI00381', 'ELCI00381', 'TXSATSTD', 'Allied Institute of Medicine', 'Sarah', '', 'Becker', 'RD ', 'Dietician', '', '', NULL, 'O', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639458292', 0, 'Y', 0, '2013-09-30', NULL, NULL, 29.3804, -98.4088, NULL, NULL),
('320346082', 'ELCI00382', 'ELCI00382', 'TXSATSTD', 'Concentra Primary Care', 'Sarah', '', 'Becker', 'RD ', 'Dietician', '', '', NULL, 'B', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639458292', 0, 'Y', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('320346082', 'ELCI00024', 'ELCI00024', 'TXDALSTD', 'Concentra Primary Care', 'Gregory', '', 'Brogden', 'ACNP ', 'Family Practice', '', '', NULL, 'O', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659674760', 0, 'Y', 0, '2013-09-24', NULL, NULL, 32.9653, -96.839, NULL, NULL),
('320346082', 'ELCI00031', 'ELCI00031', 'TXDALSTD', 'Concentra Primary Care', 'Gregory', '', 'Brogden', 'ACNP ', 'Family Practice', '', '', NULL, 'O', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659674760', 0, 'Y', 0, '2013-09-24', NULL, NULL, 33.1512, -96.8641, NULL, NULL),
('320346082', 'ELCI00021', 'ELCI00021', 'TXSATSTD', 'Allied Institute of Medicine', 'Gregory', '', 'Brogden', 'ACNP ', 'Family Practice', '', '', NULL, 'O', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659674760', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.0273, -98.0989, NULL, NULL),
('320346082', 'ELCI00022', 'ELCI00022', 'TXSATSTD', 'Allied Institute of Medicine', 'Gregory', '', 'Brogden', 'ACNP ', 'Family Practice', '', '', NULL, 'O', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659674760', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.5513, -98.3486, NULL, NULL),
('320346082', 'ELCI00023', 'ELCI00023', 'TXSATSTD', 'Allied Institute of Medicine', 'Gregory', '', 'Brogden', 'ACNP ', 'Family Practice', '', '', NULL, 'O', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659674760', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.572, -97.9461, NULL, NULL),
('320346082', 'ELCI00025', 'ELCI00025', 'TXSATSTD', 'Allied Institute of Medicine', 'Gregory', '', 'Brogden', 'ACNP ', 'Family Practice', '', '', NULL, 'O', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659674760', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.6798, -98.1066, NULL, NULL),
('320346082', 'ELCI00026', 'ELCI00026', 'TXSATSTD', 'Allied Institute of Medicine', 'Gregory', '', 'Brogden', 'ACNP ', 'Family Practice', '', '', NULL, 'O', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659674760', 0, 'Y', 0, '2013-09-24', NULL, NULL, 28.9591, -98.4855, NULL, NULL),
('320346082', 'ELCI00027', 'ELCI00027', 'TXSATSTD', 'Allied Institute of Medicine', 'Gregory', '', 'Brogden', 'ACNP ', 'Family Practice', '', '', NULL, 'O', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659674760', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.1534, -98.1662, NULL, NULL),
('320346082', 'ELCI00028', 'ELCI00028', 'TXSATSTD', 'Concentra Primary Care', 'Gregory', '', 'Brogden', 'ACNP ', 'Family Practice', '', '', NULL, 'O', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659674760', 0, 'Y', 0, '2013-09-24', NULL, NULL, 31.5262, -97.1643, NULL, NULL),
('320346082', 'ELCI00029', 'ELCI00029', 'TXSATSTD', 'Allied Institute of Medicine', 'Gregory', '', 'Brogden', 'ACNP ', 'Family Practice', '', '', NULL, 'O', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659674760', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.3804, -98.4088, NULL, NULL),
('320346082', 'ELCI00030', 'ELCI00030', 'TXSATSTD', 'Allied Institute of Medicine', 'Gregory', '', 'Brogden', 'ACNP ', 'Family Practice', '', '', NULL, 'B', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659674760', 0, 'N', 0, '2013-09-24', NULL, NULL, 0, 0, NULL, NULL),
('320346082', 'ELCI00145', 'ELCI00145', 'TXDALSTD', 'Concentra Primary Care', 'Jose', '', 'Garza', 'MD', 'Family Practice', '', '', NULL, 'O', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Mission Trail Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1750577995', 0, 'N', 0, '2013-09-24', NULL, NULL, 32.9653, -96.839, NULL, NULL),
('320346082', 'ELCI00152', 'ELCI00152', 'TXDALSTD', 'Concentra Primary Care', 'Jose', '', 'Garza', 'MD', 'Family Practice', '', '', NULL, 'O', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Mission Trail Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1750577995', 0, 'N', 0, '2013-09-24', NULL, NULL, 33.1512, -96.8641, NULL, NULL),
('320346082', 'ELCI00142', 'ELCI00142', 'TXSATSTD', 'Allied Institute of Medicine', 'Jose', '', 'Garza', 'MD', 'Family Practice', '', '', NULL, 'O', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Mission Trail Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1750577995', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.0273, -98.0989, NULL, NULL),
('320346082', 'ELCI00143', 'ELCI00143', 'TXSATSTD', 'Allied Institute of Medicine', 'Jose', '', 'Garza', 'MD', 'Family Practice', '', '', NULL, 'O', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Mission Trail Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1750577995', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.5513, -98.3486, NULL, NULL),
('320346082', 'ELCI00144', 'ELCI00144', 'TXSATSTD', 'Allied Institute of Medicine', 'Jose', '', 'Garza', 'MD', 'Family Practice', '', '', NULL, 'O', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Mission Trail Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1750577995', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.572, -97.9461, 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
('320346082', 'ELCI00146', 'ELCI00146', 'TXSATSTD', 'Allied Institute of Medicine', 'Jose', '', 'Garza', 'MD', 'Family Practice', '', '', NULL, 'O', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Mission Trail Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1750577995', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.6798, -98.1066, NULL, NULL),
('320346082', 'ELCI00147', 'ELCI00147', 'TXSATSTD', 'Allied Institute of Medicine', 'Jose', '', 'Garza', 'MD', 'Family Practice', '', '', NULL, 'O', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Mission Trail Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1750577995', 0, 'Y', 0, '2013-09-24', NULL, NULL, 28.9591, -98.4855, NULL, NULL),
('320346082', 'ELCI00148', 'ELCI00148', 'TXSATSTD', 'Allied Institute of Medicine', 'Jose', '', 'Garza', 'MD', 'Family Practice', '', '', NULL, 'O', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Mission Trail Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1750577995', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.1534, -98.1662, NULL, NULL),
('320346082', 'ELCI00149', 'ELCI00149', 'TXSATSTD', 'Concentra Primary Care', 'Jose', '', 'Garza', 'MD', 'Family Practice', '', '', NULL, 'O', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Mission Trail Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1750577995', 0, 'Y', 0, '2013-09-24', NULL, NULL, 31.5262, -97.1643, NULL, NULL),
('320346082', 'ELCI00150', 'ELCI00150', 'TXSATSTD', 'Allied Institute of Medicine', 'Jose', '', 'Garza', 'MD', 'Family Practice', '', '', NULL, 'O', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2013-04-04', 0, 0, 0, 'Mission Trail Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1750577995', 0, 'N', 0, '2013-09-24', NULL, NULL, 29.3804, -98.4079, NULL, NULL),
('320346082', 'ELCI00151', 'ELCI00151', 'TXSATSTD', 'Concentra Primary Care', 'Jose', '', 'Garza', 'MD', 'Family Practice', '', '', NULL, 'B', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Mission Trail Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1750577995', 0, 'N', 0, '2013-09-24', NULL, NULL, 0, 0, NULL, NULL),
('320346082', 'ELCI00288', 'ELCI00288', 'TXDALSTD', 'Concentra Primary Care', 'Anny', '', 'Hickman', 'PA C', 'Family Practice', '', '', NULL, 'O', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770864134', 0, 'Y', 0, '2013-09-24', NULL, NULL, 32.9653, -96.839, NULL, NULL),
('320346082', 'ELCI00295', 'ELCI00295', 'TXDALSTD', 'Concentra Primary Care', 'Anny', '', 'Hickman', 'PA C', 'Family Practice', '', '', NULL, 'O', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770864134', 0, 'Y', 0, '2013-09-24', NULL, NULL, 33.1512, -96.8641, NULL, NULL),
('320346082', 'ELCI00285', 'ELCI00285', 'TXSATSTD', 'Allied Institute of Medicine', 'Anny', '', 'Hickman', 'PA C', 'Family Practice', '', '', NULL, 'O', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770864134', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.0273, -98.0989, NULL, NULL),
('320346082', 'ELCI00286', 'ELCI00286', 'TXSATSTD', 'Allied Institute of Medicine', 'Anny', '', 'Hickman', 'PA C', 'Family Practice', '', '', NULL, 'O', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770864134', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.5513, -98.3486, NULL, NULL),
('320346082', 'ELCI00287', 'ELCI00287', 'TXSATSTD', 'Allied Institute of Medicine', 'Anny', '', 'Hickman', 'PA C', 'Family Practice', '', '', NULL, 'O', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770864134', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.572, -97.9461, NULL, NULL),
('320346082', 'ELCI00289', 'ELCI00289', 'TXSATSTD', 'Allied Institute of Medicine', 'Anny', '', 'Hickman', 'PA C', 'Family Practice', '', '', NULL, 'O', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770864134', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.6798, -98.1066, NULL, NULL),
('320346082', 'ELCI00290', 'ELCI00290', 'TXSATSTD', 'Allied Institute of Medicine', 'Anny', '', 'Hickman', 'PA C', 'Family Practice', '', '', NULL, 'O', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770864134', 0, 'Y', 0, '2013-09-24', NULL, NULL, 28.9591, -98.4855, NULL, NULL),
('320346082', 'ELCI00291', 'ELCI00291', 'TXSATSTD', 'Allied Institute of Medicine', 'Anny', '', 'Hickman', 'PA C', 'Family Practice', '', '', NULL, 'O', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770864134', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.1534, -98.1662, NULL, NULL),
('320346082', 'ELCI00292', 'ELCI00292', 'TXSATSTD', 'Concentra Primary Care', 'Anny', '', 'Hickman', 'PA C', 'Family Practice', '', '', NULL, 'O', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770864134', 0, 'Y', 0, '2013-09-24', NULL, NULL, 31.5262, -97.1643, NULL, NULL),
('320346082', 'ELCI00293', 'ELCI00293', 'TXSATSTD', 'Allied Institute of Medicine', 'Anny', '', 'Hickman', 'PA C', 'Family Practice', '', '', NULL, 'O', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770864134', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.3804, -98.4088, NULL, NULL),
('320346082', 'ELCI00294', 'ELCI00294', 'TXSATSTD', 'Allied Institute of Medicine', 'Anny', '', 'Hickman', 'PA C', 'Family Practice', '', '', NULL, 'B', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770864134', 0, 'N', 0, '2013-09-24', NULL, NULL, 0, 0, NULL, NULL),
('320346082', 'ELCI00233', 'ELCI00233', 'TXDALSTD', 'Concentra Primary Care', 'Teresa', '', 'Smith Knuppel', 'MD', 'Family Practice', '', '', NULL, 'O', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841512019', 0, 'N', 0, '2013-09-24', NULL, NULL, 32.9653, -96.839, NULL, NULL),
('320346082', 'ELCI00240', 'ELCI00240', 'TXDALSTD', 'Concentra Primary Care', 'Teresa', '', 'Smith Knuppel', 'MD', 'Family Practice', '', '', NULL, 'O', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841512019', 0, 'N', 0, '2013-09-24', NULL, NULL, 33.1512, -96.8641, NULL, NULL),
('320346082', 'ELCI00230', 'ELCI00230', 'TXSATSTD', 'Allied Institute of Medicine', 'Teresa', '', 'Smith Knuppel', 'MD', 'Family Practice', '', '', NULL, 'O', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841512019', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.0273, -98.0989, NULL, NULL),
('320346082', 'ELCI00231', 'ELCI00231', 'TXSATSTD', 'Allied Institute of Medicine', 'Teresa', '', 'Smith Knuppel', 'MD', 'Family Practice', '', '', NULL, 'O', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841512019', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.5513, -98.3486, NULL, NULL),
('320346082', 'ELCI00232', 'ELCI00232', 'TXSATSTD', 'Allied Institute of Medicine', 'Teresa', '', 'Smith Knuppel', 'MD', 'Family Practice', '', '', NULL, 'O', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841512019', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.572, -97.9461, NULL, NULL),
('320346082', 'ELCI00234', 'ELCI00234', 'TXSATSTD', 'Allied Institute of Medicine', 'Teresa', '', 'Smith Knuppel', 'MD', 'Family Practice', '', '', NULL, 'O', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2013-04-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841512019', 0, 'N', 0, '2013-09-24', NULL, NULL, 29.6803, -98.1077, NULL, NULL),
('320346082', 'ELCI00235', 'ELCI00235', 'TXSATSTD', 'Allied Institute of Medicine', 'Teresa', '', 'Smith Knuppel', 'MD', 'Family Practice', '', '', NULL, 'O', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841512019', 0, 'Y', 0, '2013-09-24', NULL, NULL, 28.9591, -98.4855, NULL, NULL),
('320346082', 'ELCI00236', 'ELCI00236', 'TXSATSTD', 'Allied Institute of Medicine', 'Teresa', '', 'Smith Knuppel', 'MD', 'Family Practice', '', '', NULL, 'O', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841512019', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.1534, -98.1662, NULL, NULL),
('320346082', 'ELCI00237', 'ELCI00237', 'TXSATSTD', 'Concentra Primary Care', 'Teresa', '', 'Smith Knuppel', 'MD', 'Family Practice', '', '', NULL, 'O', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841512019', 0, 'Y', 0, '2013-09-24', NULL, NULL, 31.5262, -97.1643, NULL, NULL),
('320346082', 'ELCI00238', 'ELCI00238', 'TXSATSTD', 'Allied Institute of Medicine', 'Teresa', '', 'Smith Knuppel', 'MD', 'Family Practice', '', '', NULL, 'O', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2013-04-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841512019', 0, 'N', 0, '2013-09-24', NULL, NULL, 29.3804, -98.4079, NULL, NULL),
('320346082', 'ELCI00239', 'ELCI00239', 'TXSATSTD', 'Concentra Primary Care', 'Teresa', '', 'Smith Knuppel', 'MD', 'Family Practice', '', '', NULL, 'B', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841512019', 0, 'N', 0, '2013-09-24', NULL, NULL, 0, 0, NULL, NULL),
('320346082', 'ELCI00299', 'ELCI00299', 'TXDALSTD', 'Concentra Primary Care', 'Shelly', '', 'Lambdin', 'PA C', 'Family Practice', '', '', NULL, 'O', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871886374', 0, 'Y', 0, '2013-09-24', NULL, NULL, 32.9653, -96.839, NULL, NULL),
('320346082', 'ELCI00306', 'ELCI00306', 'TXDALSTD', 'Concentra Primary Care', 'Shelly', '', 'Lambdin', 'PA C', 'Family Practice', '', '', NULL, 'O', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871886374', 0, 'Y', 0, '2013-09-24', NULL, NULL, 33.1512, -96.8641, NULL, NULL),
('320346082', 'ELCI00296', 'ELCI00296', 'TXSATSTD', 'Allied Institute of Medicine', 'Shelly', '', 'Lambdin', 'PA C', 'Family Practice', '', '', NULL, 'O', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871886374', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.0273, -98.0989, NULL, NULL),
('320346082', 'ELCI00297', 'ELCI00297', 'TXSATSTD', 'Allied Institute of Medicine', 'Shelly', '', 'Lambdin', 'PA C', 'Family Practice', '', '', NULL, 'O', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871886374', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.5513, -98.3486, NULL, NULL),
('320346082', 'ELCI00298', 'ELCI00298', 'TXSATSTD', 'Allied Institute of Medicine', 'Shelly', '', 'Lambdin', 'PA C', 'Family Practice', '', '', NULL, 'O', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871886374', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.572, -97.9461, NULL, NULL),
('320346082', 'ELCI00300', 'ELCI00300', 'TXSATSTD', 'Allied Institute of Medicine', 'Shelly', '', 'Lambdin', 'PA C', 'Family Practice', '', '', NULL, 'O', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871886374', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.6798, -98.1066, NULL, NULL),
('320346082', 'ELCI00301', 'ELCI00301', 'TXSATSTD', 'Allied Institute of Medicine', 'Shelly', '', 'Lambdin', 'PA C', 'Family Practice', '', '', NULL, 'O', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871886374', 0, 'Y', 0, '2013-09-24', NULL, NULL, 28.9591, -98.4855, NULL, NULL),
('320346082', 'ELCI00302', 'ELCI00302', 'TXSATSTD', 'Allied Institute of Medicine', 'Shelly', '', 'Lambdin', 'PA C', 'Family Practice', '', '', NULL, 'O', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871886374', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.1534, -98.1662, NULL, NULL),
('320346082', 'ELCI00303', 'ELCI00303', 'TXSATSTD', 'Concentra Primary Care', 'Shelly', '', 'Lambdin', 'PA C', 'Family Practice', '', '', NULL, 'O', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871886374', 0, 'Y', 0, '2013-09-24', NULL, NULL, 31.5262, -97.1643, NULL, NULL),
('320346082', 'ELCI00304', 'ELCI00304', 'TXSATSTD', 'Allied Institute of Medicine', 'Shelly', '', 'Lambdin', 'PA C', 'Family Practice', '', '', NULL, 'O', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871886374', 0, 'Y', 0, '2013-09-24', NULL, NULL, 29.3804, -98.4088, NULL, NULL),
('320346082', 'ELCI00305', 'ELCI00305', 'TXSATSTD', 'Concentra Primary Care', 'Shelly', '', 'Lambdin', 'PA C', 'Family Practice', '', '', NULL, 'B', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871886374', 0, 'N', 0, '2013-09-24', NULL, NULL, 0, 0, NULL, NULL),
('320346082', 'ELCI00035', 'ELCI00035', 'TXDALSTD', 'Concentra Primary Care', 'Barbara', '', 'Hair', 'DO', 'Family Practice', '', '', NULL, 'O', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912027483', 0, 'N', 0, '2014-03-25', NULL, NULL, 32.9653, -96.839, NULL, NULL),
('320346082', 'ELCI00042', 'ELCI00042', 'TXDALSTD', 'Concentra Primary Care', 'Barbara', '', 'Hair', 'DO', 'Family Practice', '', '', NULL, 'O', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912027483', 0, 'N', 0, '2014-03-25', NULL, NULL, 33.1512, -96.8641, NULL, NULL),
('320346082', 'ELCI00032', 'ELCI00032', 'TXSATSTD', 'Allied Institute of Medicine', 'Barbara', '', 'Hair', 'DO', 'Family Practice', '', '', NULL, 'O', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912027483', 0, 'Y', 0, '2014-03-25', NULL, NULL, 29.0273, -98.0989, NULL, NULL),
('320346082', 'ELCI00033', 'ELCI00033', 'TXSATSTD', 'Allied Institute of Medicine', 'Barbara', '', 'Hair', 'DO', 'Family Practice', '', '', NULL, 'O', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912027483', 0, 'Y', 0, '2014-03-25', NULL, NULL, 29.5513, -98.3486, NULL, NULL),
('320346082', 'ELCI00034', 'ELCI00034', 'TXSATSTD', 'Allied Institute of Medicine', 'Barbara', '', 'Hair', 'DO', 'Family Practice', '', '', NULL, 'O', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912027483', 0, 'Y', 0, '2014-03-25', NULL, NULL, 29.572, -97.9461, NULL, NULL),
('320346082', 'ELCI00036', 'ELCI00036', 'TXSATSTD', 'Allied Institute of Medicine', 'Barbara', '', 'Hair', 'DO', 'Family Practice', '', '', NULL, 'O', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912027483', 0, 'Y', 0, '2014-03-25', NULL, NULL, 29.6798, -98.1066, NULL, NULL),
('320346082', 'ELCI00037', 'ELCI00037', 'TXSATSTD', 'Allied Institute of Medicine', 'Barbara', '', 'Hair', 'DO', 'Family Practice', '', '', NULL, 'O', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912027483', 0, 'Y', 0, '2014-03-25', NULL, NULL, 28.9591, -98.4855, NULL, NULL),
('320346082', 'ELCI00038', 'ELCI00038', 'TXSATSTD', 'Allied Institute of Medicine', 'Barbara', '', 'Hair', 'DO', 'Family Practice', '', '', NULL, 'O', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912027483', 0, 'Y', 0, '2014-03-25', NULL, NULL, 29.1534, -98.1662, NULL, NULL),
('320346082', 'ELCI00039', 'ELCI00039', 'TXSATSTD', 'Concentra Primary Care', 'Barbara', '', 'Hair', 'DO', 'Family Practice', '', '', NULL, 'O', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912027483', 0, 'Y', 0, '2014-03-25', NULL, NULL, 31.5262, -97.1643, NULL, NULL),
('320346082', 'ELCI00040', 'ELCI00040', 'TXSATSTD', 'Allied Institute of Medicine', 'Barbara', '', 'Hair', 'DO', 'Family Practice', '', '', NULL, 'O', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912027483', 0, 'Y', 0, '2014-03-25', NULL, NULL, 29.3804, -98.4088, NULL, NULL),
('320346082', 'ELCI00041', 'ELCI00041', 'TXSATSTD', 'Allied Institute of Medicine', 'Barbara', '', 'Hair', 'DO', 'Family Practice', '', '', NULL, 'B', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912027483', 0, 'N', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('320346082', 'ELCI00189', 'ELCI00189', 'TXDALSTD', 'Concentra Primary Care', 'Charles', '', 'Reynolds', 'MD', 'Family Practice', '', '', NULL, 'O', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2014-05-10', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982668059', 0, 'N', 0, '2014-05-12', NULL, NULL, 32.9653, -96.839, NULL, NULL),
('320346082', 'ELCI00196', 'ELCI00196', 'TXDALSTD', 'Concentra Primary Care', 'Charles', '', 'Reynolds', 'MD', 'Family Practice', '', '', NULL, 'O', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2014-05-10', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982668059', 0, 'N', 0, '2014-05-12', NULL, NULL, 33.1512, -96.8641, NULL, NULL),
('320346082', 'ELCI00186', 'ELCI00186', 'TXSATSTD', 'Allied Institute of Medicine', 'Charles', '', 'Reynolds', 'MD', 'Family Practice', '', '', NULL, 'O', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', '117 Dilworth Plz', 'Poth', 'Wilson', 'TX', '78147', '8304843530', '8304843639', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2014-05-10', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982668059', 0, 'Y', 0, '2014-05-12', NULL, NULL, 29.0273, -98.0989, NULL, NULL),
('320346082', 'ELCI00187', 'ELCI00187', 'TXSATSTD', 'Allied Institute of Medicine', 'Charles', '', 'Reynolds', 'MD', 'Family Practice', '', '', NULL, 'O', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', '12413 Judson Rd', 'Live Oak', 'Bexar', 'TX', '78233', '2106540030', '2106540029', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2014-05-10', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982668059', 0, 'Y', 0, '2014-05-12', NULL, NULL, 29.5513, -98.3486, NULL, NULL),
('320346082', 'ELCI00188', 'ELCI00188', 'TXSATSTD', 'Allied Institute of Medicine', 'Charles', '', 'Reynolds', 'MD', 'Family Practice', '', '', NULL, 'O', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', '1354 E Walnut St', 'Seguin', 'Guadalupe', 'TX', '78155', '8304010025', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2014-05-10', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982668059', 0, 'Y', 0, '2014-05-12', NULL, NULL, 29.572, -97.9461, NULL, NULL),
('320346082', 'ELCI00190', 'ELCI00190', 'TXSATSTD', 'Allied Institute of Medicine', 'Charles', '', 'Reynolds', 'MD', 'Family Practice', '', '', NULL, 'O', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', '1860 S Seguin Ave', 'New Braunfels', 'Comal', 'TX', '78130', '8306267770', '8306242678', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2014-05-10', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982668059', 0, 'Y', 0, '2014-05-12', NULL, NULL, 29.6798, -98.1066, NULL, NULL),
('320346082', 'ELCI00191', 'ELCI00191', 'TXSATSTD', 'Allied Institute of Medicine', 'Charles', '', 'Reynolds', 'MD', 'Family Practice', '', '', NULL, 'O', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', '220 W Goodwin', 'Pleasanton', 'Atascosa', 'TX', '78064', '8302818232', '8302815958', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2014-05-10', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982668059', 0, 'Y', 0, '2014-05-12', NULL, NULL, 28.9591, -98.4855, NULL, NULL),
('320346082', 'ELCI00192', 'ELCI00192', 'TXSATSTD', 'Allied Institute of Medicine', 'Charles', '', 'Reynolds', 'MD', 'Family Practice', '', '', NULL, 'O', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', '260 US Hwy 181 N', 'Floresville', 'Wilson', 'TX', '78114', '8303938222', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2014-05-10', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982668059', 0, 'Y', 0, '2014-05-12', NULL, NULL, 29.1534, -98.1662, NULL, NULL),
('320346082', 'ELCI00193', 'ELCI00193', 'TXSATSTD', 'Concentra Primary Care', 'Charles', '', 'Reynolds', 'MD', 'Family Practice', '', '', NULL, 'O', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', '4205 Franklin Ave', 'Waco', 'Mclennan', 'TX', '76710', '2547722777', '2547722770', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2014-05-10', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982668059', 0, 'Y', 0, '2014-05-12', NULL, NULL, 31.5262, -97.1643, NULL, NULL),
('320346082', 'ELCI00194', 'ELCI00194', 'TXSATSTD', 'Allied Institute of Medicine', 'Charles', '', 'Reynolds', 'MD', 'Family Practice', '', '', NULL, 'O', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', '4360 Greco Dr', 'San Antonio', 'Bexar', 'TX', '78222', '2106488200', '2106488204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2014-05-10', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982668059', 0, 'Y', 0, '2014-05-12', NULL, NULL, 29.3804, -98.4088, NULL, NULL),
('320346082', 'ELCI00195', 'ELCI00195', 'TXSATSTD', 'Concentra Primary Care', 'Charles', '', 'Reynolds', 'MD', 'Family Practice', '', '', NULL, 'B', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', '8647 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2104487700', '2104487703', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2014-05-10', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982668059', 0, 'N', 0, '2014-05-12', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'TX0113600', 'TX0113600', 'TXSATSTD', 'Northeast OB/GYN Associates', 'Marianna', 'G', 'Law', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2105906195', '2105810050', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, NULL, 0, NULL, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1457542649', 0, 'N', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W40013466', 'W40013466', 'IDBOISTD', 'Primary Health Medical Group', 'Mark', 'J', 'Michaud', 'MD', 'Family Practice', '', '', NULL, 'O', '1907 S Broadway Ave Ste 101', 'Boise', 'Ada', 'ID', '83706', '2083451222', '2083451261', '1907 S Broadway Ave Ste 101', 'Boise', 'Ada', 'ID', '83706', '2083451222', '2083451261', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1780621128', 0, 'N', 0, '2013-03-01', NULL, NULL, 43.5897, -116.194, NULL, NULL),
('870281028', 'W12029178', 'W12029178', 'UT01', 'Central Utah Clinic PC', 'Scott', 'A', 'Parry', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '700 N Spring St', 'Caliente', 'Lincoln', 'NV', '89008', '8002399393', NULL, '700 N Spring St', 'Caliente', 'Lincoln', 'NV', '89008', '8002399393', '          ', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1548292485', 0, 'N', 0, '2013-04-10', NULL, NULL, 37.6227, -114.512, NULL, NULL),
('870281028', 'W12029179', 'W12029179', 'UT01', 'Central Utah Clinic PC', 'Scott', 'A', 'Parry', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1301 Bertha Howe Ave Ste 1', 'Mesquite', 'Clark', 'NV', '89024', '8002399393', NULL, '1301 Bertha Howe Ave Ste 1', 'Mesquite', 'Clark', 'NV', '89024', '8002399393', '          ', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1548292485', 0, 'N', 0, '2013-04-10', NULL, NULL, 36.8087, -114.115, NULL, NULL),
('371127787', 'W12028638', 'W12028638', 'ILCHIGSTD', 'Presence Cor Mariae Center', '', '', 'Presence Cor Mariae Center', '', 'Skilled Nursing Facility', '', '', NULL, 'O', '3330 Maria Linden Dr', 'Rockford', 'Winnebago', 'IL', '61114', '8158777416', NULL, '3330 Maria Linden Dr', 'Rockford', 'Winnebago', 'IL', '61114', '8158777416', '          ', 'PRE150ASPDME', 'PRES150', '', '0.00', '30.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124013255', 0, 'Y', 0, '2013-10-15', NULL, NULL, 42.309, -89.0135, NULL, NULL),
('371127787', 'W12028639', 'W12028639', 'ILCHIGSTD', 'Presence Cor Mariae Center', '', '', 'Presence Cor Mariae Center', '', 'Skilled Nursing Facility', '', '', NULL, 'B', '2864 Momentum Pl', 'Chicago', 'Cook', 'IL', '60689', '8887404111', NULL, '2864 Momentum Pl', 'Chicago', 'Cook', 'IL', '60689', '8887404111', '          ', 'PRE150ASPDME', 'PRES150', '', '0.00', '30.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124013255', 0, 'Y', 0, '2013-10-15', NULL, NULL, 0, 0, NULL, NULL),
('371127787', 'W12028641', 'W12028641', 'ILCHIGSTD', 'Presence McAuley Manor', '', '', 'Presence McAuley Manor', '', 'Skilled Nursing Facility', NULL, NULL, NULL, 'O', '400 W Sullivan Rd', 'Aurora', 'Kane', 'IL', '60506', '6308593700', NULL, '400 W Sullivan Rd', 'Aurora', 'Kane', 'IL', '60506', '6308593700', '          ', 'PRE150ASPDME', 'PRES150', '', '0.00', '30.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205822335', 0, 'N', 0, '2013-10-15', NULL, NULL, 41.7888, -88.325, NULL, NULL),
('371127787', 'W12028642', 'W12028642', 'ILCHIGSTD', 'Presence McAuley Manor', '', '', 'Presence McAuley Manor', '', 'Skilled Nursing Facility', NULL, NULL, NULL, 'B', '2859 Momentum Pl', 'Chicago', 'Cook', 'IL', '60689', '8887404111', NULL, '2859 Momentum Pl', 'Chicago', 'Cook', 'IL', '60689', '8887404111', '          ', 'PRE150ASPDME', 'PRES150', '', '0.00', '30.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205822335', 0, 'Y', 0, '2013-10-15', NULL, NULL, 0, 0, NULL, NULL),
('371127787', 'W12028644', 'W12028644', 'ILCHIGSTD', 'Presence Pine View Care Center', '', '', 'Presence Pine View Care Center', '', 'Skilled Nursing Facility', NULL, NULL, NULL, 'O', '611 Allen Ln', 'St Charles', 'Kane', 'IL', '60174', '6303774352', NULL, '611 Allen Ln', 'St Charles', 'Kane', 'IL', '60174', '6303774352', '          ', 'PRE150ASPDME', 'PRES150', '', '0.00', '30.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396731428', 0, 'N', 0, '2013-10-15', NULL, NULL, 41.9237, -88.3076, NULL, NULL),
('371127787', 'W12028645', 'W12028645', 'ILCHIGSTD', 'Presence Pine View Care Center', '', '', 'Presence Pine View Care Center', '', 'Skilled Nursing Facility', NULL, NULL, NULL, 'B', '2857 Momentum Pl', 'Chicago', 'Cook', 'IL', '60689', '8887404111', NULL, '2857 Momentum Pl', 'Chicago', 'Cook', 'IL', '60689', '8887404111', '          ', 'PRE150ASPDME', 'PRES150', '', '0.00', '30.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396731428', 0, 'Y', 0, '2013-10-15', NULL, NULL, 0, 0, NULL, NULL),
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('741985832', 'W12028705', 'W12028705', 'TXBEAUSTD', 'Mary Manuel MD', 'Mary ', '', 'Manuel', 'MD', 'Pediatrics', '', '', NULL, 'O', '710 S 8th St', 'Beaumont', 'Jefferson', 'TX', '77701', '4098389944', '4098389086', '710 S 8th St', 'Beaumont', 'Jefferson', 'TX', '77701', '4098389944', '4098389086', 'BEAUMONT1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-18', NULL, 0, 0, 0, 'Baptist Beaumont Hospital', NULL, '', '', 'HCFA|UB|', '1518962364', 0, 'N', 0, '2013-05-24', NULL, NULL, 30.071, -94.1247, NULL, NULL);
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('752912332', 'W12028720', 'W12028720', 'TXDALSTD', 'Cornea Associates', 'Henry', '', 'Gelender', 'MD', 'Ophthalmology', '', '', NULL, 'B', 'PO Box 730486', 'Dallas', 'Dallas', 'TX', '75373', '2146920146', '0000000000', 'PO Box 730486', 'Dallas', 'Dallas', 'TX', '75373', '2146920146', '0000000000', 'DALLAS4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-04-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619919008', 0, 'N', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
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('751008430', 'W12028723', 'W12028723', 'TXDALSTD', 'Baylor All Saints Medical Center', '', '', 'Baylor All Saints Medical Center', '', 'Hospital', NULL, NULL, NULL, 'B', 'PO Box 848108', 'Dallas', 'Dallas', 'TX', '75284', '8179262544', NULL, 'PO Box 848108', 'Dallas', 'Dallas', 'TX', '75284', '8179262544', '          ', '', '', 'BAYHEALTHD', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669472387', 0, 'N', 0, '2013-02-08', NULL, NULL, 0, 0, NULL, NULL),
('752834135', 'W12028725', 'W12028725', 'TXDALSTD', 'Baylor Heart and Vascular Hospital', '', '', 'Baylor Heart & Vascular Hospital', '', 'Hospital', NULL, NULL, NULL, 'O', '621 Hall St', 'Dallas', 'Dallas', 'TX', '75246', '2148200600', NULL, '621 Hall St', 'Dallas', 'Dallas', 'TX', '75246', '2148200600', '          ', '', '', 'BAYHEALTHD', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609855139', 0, 'N', 0, '2013-02-08', NULL, NULL, 32.7879, -96.7802, NULL, NULL),
('752834135', 'W12028726', 'W12028726', 'TXDALSTD', 'Baylor Heart & Vascular Hospital', '', '', 'Baylor Heart & Vascular Hospital', '', 'Hospital', NULL, NULL, NULL, 'B', 'PO Box 848076', 'Dallas', 'Dallas', 'TX', '75246', '2148200600', NULL, 'PO Box 848076', 'Dallas', 'Dallas', 'TX', '75246', '2148200600', '          ', '', '', 'BAYHEALTHD', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609855139', 0, 'N', 0, '2013-02-08', NULL, NULL, 0, 0, NULL, NULL),
('751037591', 'W12028728', 'W12028728', 'TXDALSTD', 'Baylor Medical Center at Garland', '', '', 'Baylor Medical Center at Garland', '', 'Hospital', NULL, NULL, NULL, 'O', '2300 Marie Curie Blvd', 'Garland', 'Dallas', 'TX', '75046', '9724875000', NULL, '2300 Marie Curie Blvd', 'Garland', 'Dallas', 'TX', '75046', '9724875000', '          ', '', '', 'BAYHEALTHD', '0.00', '0.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134127749', 0, 'N', 0, '2013-05-30', NULL, NULL, 32.9186, -96.6619, NULL, NULL),
('751037591', 'W12028729', 'W12028729', 'TXDALSTD', 'Baylor Medical Center at Garland', '', '', 'Baylor Medical Center at Garland', '', 'Hospital', NULL, NULL, NULL, 'B', 'PO Box 841540', 'Dallas', 'Dallas', 'TX', '75284', '9724875000', NULL, 'PO Box 841540', 'Dallas', 'Dallas', 'TX', '75284', '9724875000', '          ', '', '', 'BAYHEALTHD', '0.00', '0.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134127749', 0, 'N', 0, '2013-06-06', NULL, NULL, 0, 0, NULL, NULL),
('752586857', 'W12028731', 'W12028731', 'TXDALSTD', 'Baylor Medical Center at Irving', '', '', 'Baylor Medical Center at Irving', '', 'Hospital', NULL, NULL, NULL, 'O', '1901 N MacArthur Blvd', 'Irving', 'Dallas', 'TX', '75061', '9729237000', NULL, '1901 N MacArthur Blvd', 'Irving', 'Dallas', 'TX', '75061', '9729237000', '          ', '', '', 'BAYHEALTHD', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992700983', 0, 'N', 0, '2013-02-08', NULL, NULL, 32.8341, -96.9592, NULL, NULL),
('752586857', 'W12028732', 'W12028732', 'TXDALSTD', 'Baylor Medical Center at Irving', '', '', 'Baylor Medical Center at Irving', '', 'Hospital', NULL, NULL, NULL, 'B', 'PO Box 841590', 'Dallas', 'Dallas', 'TX', '75284', '9729237000', NULL, 'PO Box 841590', 'Dallas', 'Dallas', 'TX', '75284', '9729237000', '          ', '', '', 'BAYHEALTHD', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992700983', 0, 'N', 0, '2013-02-08', NULL, NULL, 0, 0, NULL, NULL),
('751844139', 'W12028734', 'W12028734', 'TXDALSTD', 'Baylor Medical Center at Waxahachie', '', '', 'Baylor Medical Center at Waxahachie', '', 'Hospital', NULL, NULL, NULL, 'O', '1405 W Jefferson', 'Waxahachie', 'Ellis', 'TX', '75165', '9729237000', NULL, '1405 W Jefferson', 'Waxahachie', 'Ellis', 'TX', '75165', '9729237000', '          ', '', '', 'BAYHEALTHD', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265430177', 0, 'N', 0, '2013-02-08', NULL, NULL, 32.3968, -96.865, NULL, NULL),
('751844139', 'W12028735', 'W12028735', 'TXDALSTD', 'Baylor Medical Center at Waxahachie', '', '', 'Baylor Medical Center at Waxahachie', '', 'Hospital', NULL, NULL, NULL, 'B', 'PO Box 844597', 'Dallas', 'Dallas', 'TX', '75284', '9729237000', NULL, 'PO Box 844597', 'Dallas', 'Dallas', 'TX', '75284', '9729237000', '          ', '', '', 'BAYHEALTHD', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265430177', 0, 'N', 0, '2013-02-08', NULL, NULL, 0, 0, NULL, NULL),
('751777119', 'W12028737', 'W12028737', 'TXDALSTD', 'Baylor Regional Medical Center at Grapevine', '', '', 'Baylor Regional Medical Center at Grapevine', '', 'Hospital', NULL, NULL, NULL, 'O', '1650 W College', 'Grapevine', 'Tarrant', 'TX', '76051', '8174887546', NULL, '1650 W College', 'Grapevine', 'Tarrant', 'TX', '76051', '8174887546', '          ', '', '', 'BAYHEALTHD', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073511762', 0, 'N', 0, '2013-02-08', NULL, NULL, 32.9356, -97.0942, NULL, NULL),
('751777119', 'W12028738', 'W12028738', 'TXDALSTD', 'Baylor Regional Medical Center at Grapevine', '', '', 'Baylor Regional Medical Center at Grapevine', '', 'Hospital', NULL, NULL, NULL, 'B', 'PO Box 847229', 'Dallas', 'Dallas', 'TX', '75284', '8174887546', NULL, 'PO Box 847229', 'Dallas', 'Dallas', 'TX', '75284', '8174887546', '          ', '', '', 'BAYHEALTHD', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073511762', 0, 'N', 0, '2013-02-08', NULL, NULL, 0, 0, NULL, NULL),
('751765385', 'W12028743', 'W12028743', 'TXDALSTD', 'Baylor Specialty Hospital', '', '', 'Baylor Specialty Hospital', '', 'Hospital', NULL, NULL, NULL, 'O', '3504 Swiss Ave', 'Dallas', 'Dallas', 'TX', '75204', '2148209700', NULL, '3504 Swiss Ave', 'Dallas', 'Dallas', 'TX', '75204', '2148209700', '          ', '', '', 'BAYHEALTHD', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851399406', 0, 'N', 0, '2013-02-08', NULL, NULL, 32.7918, -96.7821, NULL, NULL),
('751765385', 'W12028744', 'W12028744', 'TXDALSTD', 'Baylor Specialty Hospital', '', '', 'Baylor Specialty Hospital', '', 'Hospital', NULL, NULL, NULL, 'B', 'PO Box 847137', 'Dallas', 'Dallas', 'TX', '75284', '2148209700', NULL, 'PO Box 847137', 'Dallas', 'Dallas', 'TX', '75284', '2148209700', '          ', '', '', 'BAYHEALTHD', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851399406', 0, 'N', 0, '2013-02-08', NULL, NULL, 0, 0, NULL, NULL),
('751837454', 'W12028747', 'W12028747', 'TXDALSTD', 'Baylor University Medical Center', '', '', 'Baylor University Medical Center', '', 'Hospital', NULL, NULL, NULL, 'O', '3500 Gaston Ave', 'Dallas', 'Dallas', 'TX', '75246', '2148200111', NULL, '3500 Gaston Ave', 'Dallas', 'Dallas', 'TX', '75246', '2148200111', '          ', '', '', 'BAYHEALTHD', '0.00', '0.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447250253', 0, 'N', 0, '2013-03-20', NULL, NULL, 32.7911, -96.7802, NULL, NULL),
('751837454', 'W12028748', 'W12028748', 'TXDALSTD', 'Baylor University Medical Center', '', '', 'Baylor University Medical Center', '', 'Hospital', NULL, NULL, NULL, 'B', 'PO Box 842022', 'Dallas', 'Dallas', 'TX', '75284', '2148200111', NULL, 'PO Box 842022', 'Dallas', 'Dallas', 'TX', '75284', '2148200111', '          ', '', '', 'BAYHEALTHD', '0.00', '0.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447250253', 0, 'N', 0, '2013-03-20', NULL, NULL, 0, 0, NULL, NULL),
('751765385', 'W12028750', 'W12028750', 'TXDALSTD', 'Our Childrens House at Baylor', '', '', 'Our Children’s House at Baylor', '', 'Hospital', NULL, NULL, NULL, 'O', '1208 N Hall St', 'Dallas', 'Dallas', 'TX', '75204', '2148209850', NULL, '1208 N Hall St', 'Dallas', 'Dallas', 'TX', '75204', '2148209850', '          ', '', '', 'BAYHEALTHD', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053319798', 0, 'Y', 0, '2013-02-21', NULL, NULL, 32.7946, -96.7882, NULL, NULL),
('751765385', 'W12028751', 'W12028751', 'TXDALSTD', 'Our Children’s House at Baylor', '', '', 'Our Children’s House at Baylor', '', 'Hospital', NULL, NULL, NULL, 'B', 'PO Box 847137', 'Dallas', 'Dallas', 'TX', '75284', '2148209850', NULL, 'PO Box 847137', 'Dallas', 'Dallas', 'TX', '75284', '2148209850', '          ', '', '', 'BAYHEALTHD', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053319798', 0, 'N', 0, '2013-02-08', NULL, NULL, 0, 0, NULL, NULL),
('412101361', 'W12028753', 'W12028753', 'TXDALSTD', 'The Heart Hospital Baylor Plano', '', '', 'The Heart Hospital Baylor Plano', '', 'Hospital', NULL, NULL, NULL, 'O', '1100 Allied Dr', 'Carrollton', 'Denton', 'TX', '75010', '4698143278', NULL, '1100 Allied Dr', 'Carrollton', 'Denton', 'TX', '75010', '4698143278', '          ', '', '', 'BAYHEALTHD', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962504340', 0, 'N', 0, '2013-02-08', NULL, NULL, 0, 0, NULL, NULL),
('412101361', 'W12028754', 'W12028754', 'TXDALSTD', 'The Heart Hospital Baylor Plano', '', '', 'The Heart Hospital Baylor Plano', '', 'Hospital', NULL, NULL, NULL, 'B', 'PO Box 849900', 'Dallas', 'Dallas', 'TX', '75284', '4698143278', NULL, 'PO Box 849900', 'Dallas', 'Dallas', 'TX', '75284', '4698143278', '          ', '', '', 'BAYHEALTHD', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962504340', 0, 'N', 0, '2013-02-08', NULL, NULL, 0, 0, NULL, NULL),
('208889358', 'W12028758', 'W12028758', 'TXDALSTD', 'Baylor Medical Center at Carrollton', '', '', 'Baylor Medical Center at Carrollton ', '', 'Hospital', '', '', NULL, 'B', 'PO Box 951948', 'Dallas', 'Dallas', 'TX', '75395', '9724921010', NULL, 'PO Box 951948', 'Dallas', 'Dallas', 'TX', '75395', '9724921010', '          ', '', '', 'BAYHEALTHD', '0.00', '0.00', '0.00', 3, '2013-01-01', '2014-04-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952509465', 0, 'N', 0, '2014-03-14', NULL, NULL, 0, 0, NULL, NULL),
('208889358', 'W12028757', 'W12028757', 'TXDALSTD', 'Baylor Medical Center at Carrollton', '', '', 'Baylor Medical Center at Carrollton ', '', 'Hospital', '', '', NULL, 'O', '4343 N Josey Ln', 'Carrollton', 'Denton', 'TX', '75010', '9724921010', NULL, '4343 N Josey Ln', 'Carrollton', 'Denton', 'TX', '75010', '9724921010', '          ', '', '', 'BAYHEALTHD', '0.00', '0.00', '0.00', 3, '2013-01-01', '2014-04-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952509465', 0, 'N', 0, '2014-03-14', NULL, NULL, 33.028, -96.8845, NULL, NULL),
('751037591', 'W12028760', 'W12028760', 'TXDALSTD', 'Baylor Medical Center at McKinney', '', '', 'Baylor Medical Center at McKinney', '', 'Hospital', NULL, NULL, NULL, 'O', '5252 W University Dr', 'Mckinney', 'Collin', 'TX', '75071', '4697641000', NULL, '5252 W University Dr', 'Mckinney', 'Collin', 'TX', '75071', '4697641000', '          ', '', '', 'BAYHEALTHD', '0.00', '0.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124305065', 0, 'N', 0, '2013-05-30', NULL, NULL, 33.2183, -96.6841, NULL, NULL),
('751037591', 'W12028761', 'W12028761', 'TXDALSTD', 'Baylor Medical Center at McKinney', '', '', 'Baylor Medical Center at McKinney', '', 'Hospital', NULL, NULL, NULL, 'B', 'PO Box 847051', 'Dallas', 'Dallas', 'TX', '75284', '4697641000', NULL, 'PO Box 847051', 'Dallas', 'Dallas', 'TX', '75284', '4697641000', '          ', '', '', 'BAYHEALTHD', '0.00', '0.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124305065', 0, 'N', 0, '2013-05-30', NULL, NULL, 0, 0, NULL, NULL),
('262978009', 'W12028764', 'W12028764', 'TXDALSTD', 'Baylor Emergency Medical Center at Aubrey', '', '', 'Baylor Emergency Medical Center at Aubrey', '', 'Hospital', '', '', NULL, 'B', 'PO Box 650823 DPT 41367', 'Dallas', 'Dallas', 'TX', '75267', '9723472525', NULL, 'PO Box 650823 DPT 41367', 'Dallas', 'Dallas', 'TX', '75267', '9723472525', '          ', '', '', 'BAYHEALTHD', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1407010622', 0, 'N', 0, '2013-05-01', NULL, NULL, 0, 0, NULL, NULL),
('262978009', 'W12028763', 'W12028763', 'TXDALSTD', 'Baylor Emergency Medical Center at Aubrey', '', '', 'Baylor Emergency Medical Center at Aubrey', '', 'Hospital', '', '', NULL, 'O', '26791 Hwy 380', 'Aubrey', 'Denton', 'TX', '76227', '9723472525', NULL, '26791 Hwy 380', 'Aubrey', 'Denton', 'TX', '76227', '9723472525', '          ', '', '', 'BAYHEALTHD', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1407010622', 0, 'N', 0, '2013-05-01', NULL, NULL, 33.2206, -96.9135, NULL, NULL),
('201780406', 'W12028770', 'W12028770', 'ILCHIGSTD', 'UroPartners', 'Parthiv', 'S', 'Mehta', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '2600 Patriot Blvd Ste J', 'Glenview', 'Cook', 'IL', '60026', '2242603100', '8479988112', '2600 Patriot Blvd Ste J', 'Glenview', 'Cook', 'IL', '60026', '2242603100', '8479988112', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962539759', 0, 'N', 0, '2013-01-17', NULL, NULL, 42.0979, -87.8246, NULL, NULL),
('201780406', 'W12028771', 'W12028771', 'ILCHIGSTD', 'UroPartners', 'Parthiv', 'S', 'Mehta', 'MD', 'Radiation Oncology', '', '', NULL, 'M', '2245 Enterprise Dr Ste 4506', 'Westchester', 'Cook', 'IL', '60154', '2242603100', '8479988112', '2245 Enterprise Dr Ste 4506', 'Westchester', 'Cook', 'IL', '60154', '2242603100', '8479988112', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962539759', 0, 'N', 0, '2013-01-17', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'W12028772', 'W12028772', 'ILCHIGSTD', 'UroPartners', 'Parthiv', 'S', 'Mehta', 'MD', 'Radiation Oncology', '', '', NULL, 'B', '3183 Paysphere Cr', 'Chicago', 'Cook', 'IL', '60674', '2242603100', '8479988112', '3183 Paysphere Cr', 'Chicago', 'Cook', 'IL', '60674', '2242603100', '8479988112', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962539759', 0, 'N', 0, '2013-01-17', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'W12028774', 'W12028774', 'ILCHIGSTD', 'UroPartners', 'Margaret', '', 'Ostrowski', 'PA-C', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8474701500', '8474701550', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8474701500', '8474701550', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134464704', 0, 'N', 0, '2013-05-06', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'W12028773', 'W12028773', 'ILCHIGSTD', 'UroPartners', 'Margaret', '', 'Ostrowski', 'PA-C', 'Urology', '', '', NULL, 'O', '7900 N Milwaukee Ave Ste 17', 'Niles', 'Cook', 'IL', '60714', '8474701500', '8474701550', '7900 N Milwaukee Ave Ste 17', 'Niles', 'Cook', 'IL', '60714', '8474701500', '8474701550', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134464704', 0, 'N', 0, '2013-05-06', NULL, NULL, 42.0244, -87.8126, NULL, NULL),
('201780406', 'W12028775', 'W12028775', 'ILCHIGSTD', 'UroPartners', 'Margaret', '', 'Ostrowski', 'PA-C', 'Urology', '', '', NULL, 'M', '2245 Enterprise Dr Ste 4506', 'Westchester', 'Cook', 'IL', '60154', '8474701500', '8474701550', '2245 Enterprise Dr Ste 4506', 'Westchester', 'Cook', 'IL', '60154', '8474701500', '8474701550', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134464704', 0, 'N', 0, '2013-05-06', NULL, NULL, 0, 0, NULL, NULL),
('020571980', 'ELBQA2003', 'ELBQA2003', 'TXDALSTD', 'Dallas Cancer Specialists', 'Zhiyong', '', 'Li', 'MD', 'Oncology', '', '', NULL, 'O', '315 N Shiloh Rd Ste 101', 'Garland', 'Dallas', 'TX', '75042', '9724878866', NULL, '315 N Shiloh Rd Ste 101', 'Garland', 'Dallas', 'TX', '75042', '9724878866', '', 'BQA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1033226006', 0, 'N', 0, '2013-03-07', NULL, NULL, 32.9146, -96.6654, NULL, NULL),
('020571980', 'ELBQA2041', 'ELBQA2041', 'TXDALSTD', '', 'Zhiyong', '', 'Li', 'MD', 'Oncology', '', '', NULL, 'B', 'PO Box 451326', 'Garland', 'Dallas', 'TX', '75045', '9724878866', NULL, 'PO Box 451326', 'Garland', 'Dallas', 'TX', '75045', '9724878866', '', 'BQA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1033226006', 0, 'Y', 0, '2013-03-07', NULL, NULL, 0, 0, NULL, NULL),
('752919330', 'ELBQA2017', 'ELBQA2017', 'TXDALSTD', 'Neurology Specialists of Dallas', 'Elmyra', 'V', 'Encarnacion', 'MD', 'Neurology', '', '', NULL, 'O', '9102 N Central Expwy Ste 450', 'Dallas', 'Dallas', 'TX', '75231', '9725640353', NULL, '9102 N Central Expwy Ste 450', 'Dallas', 'Dallas', 'TX', '75231', '9725640353', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-01', '2013-02-01', 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1093762270', 0, 'N', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('751608686', 'ELBQA2029', 'ELBQA2029', 'TXDALSTD', 'Southwest Cardiac Associates', 'Srinivas', '', 'Gunukula', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '5308 N Galloway Ave Ste 100', 'Mesquite', 'Dallas', 'TX', '75150', '9722260505', '9722899645', '5308 N Galloway Ave Ste 100', 'Mesquite', 'Dallas', 'TX', '75150', '9722260505', '9722899645', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, 'The Heart Hospital Baylor Plano', NULL, '', '', 'HCFA|UB|', '1104896844', 0, 'N', 0, '2013-04-05', NULL, NULL, 32.8354, -96.6356, NULL, NULL),
('454180391', 'ELBQA2030', 'ELBQA2030', 'TXDALSTD', 'Steven M Pounders MD', 'Steven', 'M', 'Pounders', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3500 Oak Lawn Ave Ste 600', 'Dallas', 'Dallas', 'TX', '75219', '2145208833', NULL, '3500 Oak Lawn Ave Ste 600', 'Dallas', 'Dallas', 'TX', '75219', '2145208833', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-01', '2013-08-31', 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1124073614', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.812, -96.8054, NULL, NULL),
('200419809', 'ELBQA2009', 'ELBQA2009', 'TXDALSTD', 'Family Orthopedics and Rehabilitation', 'Christopher', 'J', 'Wong', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '611 Matlock Centre Cir', 'Arlington', 'Tarrant', 'TX', '76015', '8176769048', NULL, '611 Matlock Centre Cir', 'Arlington', 'Tarrant', 'TX', '76015', '8176769048', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-01', '2013-05-31', 0, 0, 0, 'Baylor Orthopedic and Spine Hospital at Arlington', NULL, '', '', 'HCFA|UB|', '1144236183', 0, 'N', 0, '2013-06-13', NULL, NULL, 0, 0, NULL, NULL),
('752919333', 'ELBQA2020', 'ELBQA2020', 'TXDALSTD', 'Neurology Specialists of Dallas', 'Robert', 'F', 'Ulrich', 'MD', 'Neurology', '', '', NULL, 'O', '9105 N Central Expwy Ste 450', 'Dallas', 'Dallas', 'TX', '75231', '9725640356', NULL, '9105 N Central Expwy Ste 450', 'Dallas', 'Dallas', 'TX', '75231', '9725640356', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-01', '2013-02-01', 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1215982699', 0, 'N', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('200419809', 'ELBQA2010', 'ELBQA2010', 'TXDALSTD', 'Family Orthopedics and Rehabilitation', 'Paul', '', 'Chong', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '609 Matlock Centre Cir', 'Arlington', 'Tarrant', 'TX', '76015', '8176769046', NULL, '609 Matlock Centre Cir', 'Arlington', 'Tarrant', 'TX', '76015', '8176769046', '', 'BQA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, 'Baylor Orthopedic and Spine Hospital at Arlington', NULL, '', '', 'HCFA|UB|', '1306993274', 0, 'N', 0, '2013-03-12', NULL, NULL, 32.7014, -97.1136, NULL, NULL),
('201796939', 'ELBQA2022', 'ELBQA2022', 'TXDALSTD', 'North Texas Allergy and Asthma', 'Sandeep', '', 'Gupta', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '8220 Walnut Hill Ln Ste 101', 'Dallas', 'Dallas', 'TX', '75231', '2143691901', NULL, '8220 Walnut Hill Ln Ste 101', 'Dallas', 'Dallas', 'TX', '75231', '2143691901', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-01', '2013-08-14', 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1336193069', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8832, -96.7604, NULL, NULL),
('752919332', 'ELBQA2019', 'ELBQA2019', 'TXDALSTD', 'Neurology Specialists of Dallas', 'Nicole', '', 'Simpkins', 'MD', 'Neurology', '', '', NULL, 'O', '9104 N Central Expwy Ste 450', 'Dallas', 'Dallas', 'TX', '75231', '9725640355', NULL, '9104 N Central Expwy Ste 450', 'Dallas', 'Dallas', 'TX', '75231', '9725640355', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-01', '2013-02-01', 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1396940532', 0, 'N', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('751942565', 'ELBQA2032', 'ELBQA2032', 'TXDALSTD', 'Surgical Associates of the Mid-Cities', 'Melvin', 'J', 'Elieson', 'MD', 'General Surgery', '', '', NULL, 'O', '1607 Hospital Pkwy Ste 508', 'Bedford', 'Tarrant', 'TX', '76022', '8172672681', NULL, '1607 Hospital Pkwy Ste 508', 'Bedford', 'Tarrant', 'TX', '76022', '8172672681', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-01', '2013-02-01', 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, NULL, NULL, 'HCFA|UB|', '1427000637', 0, 'N', 0, '2013-04-05', NULL, NULL, 0, 0, NULL, NULL),
('205599452', 'ELBQA2025', 'ELBQA2025', 'TXDALSTD', 'Personalized Womens Healthcare', 'Eric', 'B', 'Jacoby', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3108 Midway Rd Ste 201', 'Plano', 'Collin', 'TX', '75093', '9724732020', NULL, '3108 Midway Rd Ste 201', 'Plano', 'Collin', 'TX', '75093', '9724732020', '', 'BQA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, '', '', 'HCFA|UB|', '1437158441', 0, 'N', 0, '2013-03-12', NULL, NULL, 33.0417, -96.8392, NULL, NULL),
('201052350', 'ELBQA2012', 'ELBQA2012', 'TXDALSTD', 'Plano Neurology', 'Geeta', '', 'Rajan', 'MD', 'Neurology', '', '', NULL, 'O', '4601 Old Shepard Plaza Ste 406', 'Plano', 'Collin', 'TX', '75093', '9728673535', NULL, '4601 Old Shepard Plaza Ste 406', 'Plano', 'Collin', 'TX', '75093', '9728673535', '', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', '', '', '', 'HCFA|UB|', '1477502235', 0, 'N', 0, '2014-07-01', NULL, NULL, 33.0214, -96.7867, NULL, NULL),
('201547087', 'ELBQA2011', 'ELBQA2011', 'TXDALSTD', 'Frisco Heart and Vascular Institute', 'Vishnu', 'Varma', 'Kalidindi', 'MD', 'Cardiology', '', '', NULL, 'O', '8000 Warren Pkwy Ste 104', 'Frisco', 'Denton', 'TX', '75034', '9722766191', NULL, '8000 Warren Pkwy Ste 104', 'Frisco', 'Denton', 'TX', '75034', '9722766191', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-01', '2013-08-14', 0, 0, 0, 'Baylor Medical Center at Frisco', NULL, '', '', 'HCFA|UB|', '1487611273', 0, 'N', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('752919329', 'ELBQA2016', 'ELBQA2016', 'TXDALSTD', 'Neurology Specialists of Dallas', 'Anwarul', '', 'Haq', 'MD', 'Neurology', '', '', NULL, 'O', '9101 N Central Expwy Ste 450', 'Dallas', 'Dallas', 'TX', '75231', '2143791100', '2143791101', '9101 N Central Expwy Ste 450', 'Dallas', 'Dallas', 'TX', '75231', '2143791100', '2143791101', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-01', '2013-08-14', 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1568480689', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8724, -96.7711, NULL, NULL),
('752664856', 'ELBQA2004', 'ELBQA2004', 'TXDALSTD', 'Michael Benavides DO', 'Michael', 'A', 'Benavides', 'DO', 'Family Practice', '', '', NULL, 'O', '1350 N Buckner Rd Ste 101', 'Dallas', 'Dallas', 'TX', '75218', '9726825757', NULL, '1350 N Buckner Rd Ste 101', 'Dallas', 'Dallas', 'TX', '75218', '9726825757', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568497899', 0, 'N', 0, '2013-05-28', NULL, NULL, 32.8319, -96.7, NULL, NULL),
('752664856', 'ELBQA2042', 'ELBQA2042', 'TXDALSTD', 'Michael Benavides DO', 'Michael', 'A', 'Benavides', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 570543', 'Dallas', 'Dallas', 'TX', '75357', '9726825757', NULL, 'PO Box 570543', 'Dallas', 'Dallas', 'TX', '75357', '9726825757', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568497899', 0, 'Y', 0, '2013-06-04', NULL, NULL, 0, 0, NULL, NULL),
('452479098', 'ELBQA2034', 'ELBQA2034', 'TXDALSTD', 'Texas Plastic Surgery Associates', 'Matthew', 'Howard', 'Steele', 'MD', 'Plastic Surgery', '', '', NULL, 'O', '800 12th Ave Ste 100', 'Fort Worth', 'Tarrant', 'TX', '76104', '8178100770', NULL, '800 12th Ave Ste 100', 'Fort Worth', 'Tarrant', 'TX', '76104', '8178100770', '', 'BQA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, 'Baylor Surgical Hospital at Fort Worth', NULL, NULL, NULL, 'HCFA|UB|', '1629010772', 0, 'N', 0, '2013-03-08', NULL, NULL, 32.7365, -97.3482, NULL, NULL),
('752842177', 'ELBQA2005', 'ELBQA2005', 'TXDALSTD', 'Texas Vascular Associates', 'Dennis', 'R', 'Gable', 'MD', 'Vascular Surgery', '', '', NULL, 'O', '621 N Hall St Ste 100', 'Dallas', 'Dallas', 'TX', '75226', '2148219600', '2148235290', '621 N Hall St Ste 100', 'Dallas', 'Dallas', 'TX', '75226', '2148219600', '2148235290', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1649233768', 0, 'N', 0, '2013-04-08', NULL, NULL, 32.7879, -96.7802, NULL, NULL),
('752842177', 'ELBQA2043', 'ELBQA2043', 'TXDALSTD', 'Texas Vascular Associates', 'Dennis', 'R', 'Gable', 'MD', 'Vascular Surgery', '', '', NULL, 'B', 'PO Box 847289', 'Dallas', 'Dallas', 'TX', '75284', '2148219600', NULL, 'PO Box 847289', 'Dallas', 'Dallas', 'TX', '75284', '2148219600', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1649233768', 0, 'Y', 0, '2013-05-28', NULL, NULL, 0, 0, NULL, NULL),
('751942563', 'ELBQA2033', 'ELBQA2033', 'TXDALSTD', 'Surgical Associates of the Mid-Cities', 'Michael', 'W', 'Bryan', 'MD', 'General Surgery', '', '', NULL, 'O', '1605 Hospital Pkwy Ste 506', 'Bedford', 'Wise', 'TX', '76023', '8172672679', NULL, '1605 Hospital Pkwy Ste 506', 'Bedford', 'Wise', 'TX', '76023', '8172672679', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-01', '2013-02-01', 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, NULL, NULL, 'HCFA|UB|', '1659410660', 0, 'N', 0, '2013-04-05', NULL, NULL, 0, 0, NULL, NULL),
('272378173', 'ELBQA2038', 'ELBQA2038', 'TXDALSTD', 'Waxahachie Orthopedics and Sports Medicine', 'Marcus', 'Anderson', 'Roux', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1404 W Jefferson St', 'Waxahachie', 'Ellis', 'TX', '75165', '9729239999', NULL, '1404 W Jefferson St', 'Waxahachie', 'Ellis', 'TX', '75165', '9729239999', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-01', '2013-08-14', 0, 0, 0, 'Baylor Medical Center at Garland', 'Baylor Medical Center at Waxahachie', NULL, NULL, 'HCFA|UB|', '1700820743', 0, 'N', 0, '2014-01-08', NULL, NULL, 0, 0, NULL, NULL),
('752842177', 'ELBQA2035', 'ELBQA2035', 'TXDALSTD', 'Texas Vascular Associates', 'Gregory', 'John', 'Pearl', 'MD', 'Vascular Surgery', '', '', NULL, 'O', '622 N Hall St Ste 100', 'Dallas', 'Dallas', 'TX', '75226', '2148219600', NULL, '622 N Hall St Ste 100', 'Dallas', 'Dallas', 'TX', '75226', '2148219600', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-01', '2013-02-01', 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1720041783', 0, 'N', 0, '2013-04-05', NULL, NULL, 0, 0, NULL, NULL),
('200419809', 'ELBQA2008', 'ELBQA2008', 'TXDALSTD', 'Family Orthopedics and Rehabilitation', 'Christine', '', 'Huynh', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '610 Matlock Centre Cir', 'Arlington', 'Tarrant', 'TX', '76015', '8176769047', NULL, '610 Matlock Centre Cir', 'Arlington', 'Tarrant', 'TX', '76015', '8176769047', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-01', '2013-05-31', 0, 0, 0, 'Baylor Orthopedic and Spine Hospital at Arlington', NULL, '', '', 'HCFA|UB|', '1730195777', 0, 'N', 0, '2013-06-13', NULL, NULL, 0, 0, NULL, NULL),
('270923278', 'ELBQA2039', 'ELBQA2039', 'TXDALSTD', 'Sterling Pain Medicine', 'Radhika', '', 'Ravula', 'MD', 'Pain Management', '', '', NULL, 'O', '11700 Preston Rd Ste 660 PMB 529', 'Dallas', 'Dallas', 'TX', '75230', '9722311591', NULL, '11700 Preston Rd Ste 660 PMB 529', 'Dallas', 'Dallas', 'TX', '75230', '9722311591', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-01', '2013-08-14', 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1750368445', 0, 'N', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('270923278', 'ELBQA2001', 'ELBQA2001', 'TXDALSTD', 'Sterling Pain Medicine', 'Radhika', '', 'Ravula', 'MD', 'Pain Management', '', '', NULL, 'O', '2520 N Central Expwy Ste 400', 'Richardson', 'Dallas', 'TX', '75080', '9722311591', NULL, '2520 N Central Expwy Ste 400', 'Richardson', 'Dallas', 'TX', '75080', '9722311591', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-01', '2013-08-14', 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1750368445', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.9916, -96.7088, NULL, NULL),
('752919331', 'ELBQA2018', 'ELBQA2018', 'TXDALSTD', 'Neurology Specialists of Dallas', 'Maureen', 'P', 'Wooten Watts', 'MD', 'Neurology', '', '', NULL, 'O', '9103 N Central Expwy Ste 450', 'Dallas', 'Dallas', 'TX', '75231', '9725640354', NULL, '9103 N Central Expwy Ste 450', 'Dallas', 'Dallas', 'TX', '75231', '9725640354', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-01', '2013-02-01', 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1750497434', 0, 'N', 0, '2013-04-05', NULL, NULL, 0, 0, NULL, NULL),
('752657742', 'ELBQA2002', 'ELBQA2002', 'TXDALSTD', 'George Wooming MD', 'George', 'Andrew', 'Wooming', 'MD', 'Dermatology', '', '', NULL, 'O', '12200 Park Central Ste 220', 'Dallas', 'Dallas', 'TX', '75251', '9726615476', NULL, '12200 Park Central Ste 220', 'Dallas', 'Dallas', 'TX', '75251', '9726615476', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1760457733', 0, 'N', 0, '2013-05-28', NULL, NULL, 32.9142, -96.7757, NULL, NULL),
('752657742', 'ELBQA2040', 'ELBQA2040', 'TXDALSTD', 'George Wooming MD', 'George', 'Andrew', 'Wooming', 'MD', 'Dermatology', '', '', NULL, 'B', '12200 Park Central Dr Ste 220', 'Dallas', 'Dallas', 'TX', '75251', '9726615476', NULL, '12200 Park Central Dr Ste 220', 'Dallas', 'Dallas', 'TX', '75251', '9726615476', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1760457733', 0, 'Y', 0, '2013-06-05', NULL, NULL, 32.9143, -96.7751, NULL, NULL),
('205599452', 'ELBQA2024', 'ELBQA2024', 'TXDALSTD', 'Personalized Womens Healthcare', 'Berry', 'A', 'Fleming', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3108 Midway Rd Ste 201', 'Plano', 'Collin', 'TX', '75093', '9724732020', NULL, '3108 Midway Rd Ste 201', 'Plano', 'Collin', 'TX', '75093', '9724732020', '', 'BQA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, '', '', 'HCFA|UB|', '1760554604', 0, 'N', 0, '2013-03-12', NULL, NULL, 33.0417, -96.8392, NULL, NULL),
('203774683', 'ELBQA2015', 'ELBQA2015', 'TXDALSTD', '', 'Muhammad', 'A', 'Memon', 'MD', 'Gastroenterology', '', '', NULL, 'O', '2800 E Broad St Ste 500', 'Mansfield', 'Tarrant', 'TX', '76063', '8174775500', NULL, '2800 E Broad St Ste 500', 'Mansfield', 'Tarrant', 'TX', '76063', '8174775500', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-01', '2013-02-01', 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', '', 'HCFA|UB|', '1780691923', 0, 'N', 0, '2013-04-10', NULL, NULL, 32.5684, -97.0945, NULL, NULL),
('201260137', 'ELBQA2023', 'ELBQA2023', 'TXDALSTD', 'Our Family Doctor', 'Jeffrey', 'Barrington', 'Taylor', 'MD', 'Family Practice', '', '', NULL, 'O', '1919 S Shiloh Ste 210', 'Garland', 'Dallas', 'TX', '75042', '9728642050', NULL, '1919 S Shiloh Ste 210', 'Garland', 'Dallas', 'TX', '75042', '9728642050', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-01', '2013-08-14', 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1780695031', 0, 'N', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('752496229', 'ELBQA2006', 'ELBQA2006', 'TXDALSTD', 'Colon and Rectal Associates of Texas', 'Todd', 'A', 'Odom', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'O', '1705 Ohio Dr Ste 100', 'Plano', 'Collin', 'TX', '75093', '9726120430', NULL, '1705 Ohio Dr Ste 100', 'Plano', 'Collin', 'TX', '75093', '9726120430', '', 'BQA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1801860952', 0, 'N', 0, '2013-03-11', NULL, NULL, 33.0224, -96.7867, NULL, NULL),
('752497923', 'ELBQA2014', 'ELBQA2014', 'TXDALSTD', 'Lauren Monti MD', 'Lauren', 'B', 'Monti', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3600 Gaston Ave Ste 560', 'Dallas', 'Dallas', 'TX', '75246', '2148289495', NULL, '3600 Gaston Ave Ste 560', 'Dallas', 'Dallas', 'TX', '75246', '2148289495', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-01', '2013-08-14', 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1841398088', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.791, -96.7798, NULL, NULL),
('751575580', 'ELBQA2026', 'ELBQA2026', 'TXDALSTD', 'Robert T Gunby MD', 'Robert', 'Tau', 'Gunby', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '4224 Swiss Ave', 'Dallas', 'Dallas', 'TX', '75204', '2148219938', NULL, '4224 Swiss Ave', 'Dallas', 'Dallas', 'TX', '75204', '2148219938', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1891788790', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7959, -96.7771, NULL, NULL),
('752333069', 'ELBQA2037', 'ELBQA2037', 'TXDALSTD', 'Vanderpool Westmoreland and Arnold', 'Matthew', 'Van', 'Westmoreland', 'MD', 'General Surgery', '', '', NULL, 'O', '3808 Swiss Ave', 'Dallas', 'Dallas', 'TX', '75204', '2148232650', NULL, '3808 Swiss Ave', 'Dallas', 'Dallas', 'TX', '75204', '2148232650', '', 'BQA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1902877486', 0, 'N', 0, '2013-12-23', NULL, NULL, 32.7931, -96.7805, NULL, NULL),
('752919334', 'ELBQA2021', 'ELBQA2021', 'TXDALSTD', 'Neurology Specialists of Dallas', 'Ziad', '', 'Blaik', 'MD', 'Neurology', '', '', NULL, 'O', '9106 N Central Expwy Ste 450', 'Dallas', 'Dallas', 'TX', '75231', '9725640357', NULL, '9106 N Central Expwy Ste 450', 'Dallas', 'Dallas', 'TX', '75231', '9725640357', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-01', '2013-02-01', 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1912013756', 0, 'N', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('270918982', 'ELBQA2031', 'ELBQA2031', 'TXDALSTD', 'Stoll Neurodiagnostics', 'Scott', 'Thomas', 'Stoll', 'DO', 'Orthopedic Surgery', '', '', NULL, 'O', '2551 River Park Dr Ste 220', 'Fort Worth', 'Tarrant', 'TX', '76116', '8172943195', '          ', '2551 River Park Dr Ste 220', 'Fort Worth', 'Tarrant', 'TX', '76116', '8172943195', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-01', '2014-04-30', 0, 0, 0, NULL, NULL, '', '', 'HCFA|UB|', '1912231408', 0, 'N', 0, '2014-05-05', NULL, NULL, 32.7022, -97.4187, NULL, NULL),
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('000001004', 'W12028779', 'W12028779', 'ILCHIGSTD', 'Concentra Urgent Care', '', '', 'Concentra Urgent Care', '', 'Urgent Care', '', '', NULL, 'O', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '8669446046', '9724587776', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '8669446046', '9724587776', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', '2012-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB', '0000010034', 0, 'Y', 0, '2014-07-15', NULL, NULL, 32.9655, -96.8391, NULL, NULL),
('000001004', 'W12028780', 'W12028780', 'TXDALSTD', 'Concentra Urgent Care', '', '', 'Concentra Urgent Care', '', 'Urgent Care', '', '', NULL, 'O', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '8669446046', '9724587776', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '8669446046', '9724587776', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', '2012-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB', '0000010034', 0, 'Y', 0, '2014-07-15', NULL, NULL, 32.9655, -96.8391, 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
('000001004', 'W12028781', 'W12028781', 'TXSATSTD', 'Concentra Urgent Care', '', '', 'Concentra Urgent Care', '', 'Urgent Care', '', '', NULL, 'O', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '8669446046', '9724587776', '15810 Midway Rd', 'Addison', 'Dallas', 'TX', '75001', '8669446046', '9724587776', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', '2012-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB', '0000010034', 0, 'Y', 0, '2014-07-15', NULL, NULL, 32.9655, -96.8391, NULL, NULL),
('760556120', 'W12028767', 'W12028767', 'TXHOUSTD', '', '', '', 'San Jactino Family Practice  Education Foundation', '', 'Family Practice', '', '', NULL, 'O', '4301 Garth Rd Ste 400', 'Baytown', 'Harris', 'TX', '77521', '2814208400', '2814208445', '4301 Garth Rd Ste 400', 'Baytown', 'Harris', 'TX', '77521', '2814208400', '2814208445', 'TMHPHOHSP', '', '', '0.00', '0.00', '0.00', 6, '2030-01-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000010039', 0, 'Y', 0, '2013-05-10', NULL, NULL, 29.7677, -94.9796, NULL, NULL),
('760556120', 'W12028768', 'W12028768', 'TXHOUSTD', '', '', '', 'San Jactino Family Practice  Education Foundation', '', 'Family Practice', '', '', NULL, 'O', '4301 Garth Rd Ste 400', 'Baytown', 'Harris', 'TX', '77521', '2814208400', '2814208445', '4301 Garth Rd Ste 400', 'Baytown', 'Harris', 'TX', '77521', '2814208400', '2814208445', 'TMHPHOSPC', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2030-01-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000010039', 0, 'Y', 0, '2013-05-10', NULL, NULL, 29.7677, -94.9796, NULL, NULL),
('760556120', 'W12028766', 'W12028766', 'TXHOUSTD', '', '', '', 'San Jactino Family Practice  Education Foundation', '', 'Family Practice', '', '', NULL, 'B', 'PO Box 3133', 'Houston', 'Harris', 'TX', '77253', '2814208400', '2814208445', 'PO Box 3133', 'Houston', 'Harris', 'TX', '77253', '2814208400', '2814208445', 'TMHPHOPCP', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000010039', 0, 'N', 0, '2013-05-10', NULL, NULL, 0, 0, NULL, NULL),
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('760556120', 'W12028783', 'W12028783', 'TXHOUSTD', '', '', '', 'San Jactino Family Practice  Education Foundation', '', 'Family Practice', '', '', NULL, 'B', 'PO Box 3133', 'Houston', 'Harris', 'TX', '77253', '2814208400', '2814208445', 'PO Box 3133', 'Houston', 'Harris', 'TX', '77253', '2814208400', '2814208445', 'TMHPHOHSP', '', '', '0.00', '0.00', '0.00', 6, '2030-01-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000010039', 0, 'N', 0, '2013-05-10', NULL, NULL, 0, 0, NULL, NULL),
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('760556120', 'W12028792', 'W12028792', 'TXHOUSTD', 'San Jacinto Family Practice', 'Lindsay', '', 'Botsford', 'MD', 'Family Practice', '', '', NULL, 'O', '4301 Garth Rd Ste 400', 'Baytown', 'Harris', 'TX', '77521', '2814208400', '2814208445', '4301 Garth Rd Ste 400', 'Baytown', 'Harris', 'TX', '77521', '2814208400', '2814208445', 'TMHPHOPCP', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2013-03-01', '2013-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780849737', 0, 'N', 0, '2013-08-28', NULL, NULL, 29.7677, -94.9796, NULL, NULL),
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('760556120', 'W12028799', 'W12028799', 'TXHOUSTD', 'San Jacinto Family Practice', 'Kelly', '', 'Gabler', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 3133', 'Houston', 'Harris', 'TX', '77253', '2814208400', '2814208445', 'PO Box 3133', 'Houston', 'Harris', 'TX', '77253', '2814208400', '2814208445', 'TMHPHOPCP', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2013-03-01', '2013-07-01', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1083897672', 0, 'N', 0, '2013-08-30', NULL, NULL, 0, 0, NULL, NULL),
('952667855', 'W12029213', 'W12029213', 'NM01', 'Hanger Clinic (Orthotics, Prosthetics & Breast Prosthetics)', '', '', 'Hanger Prosthetics & Orthotics Inc', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '3900 Georgia St NE', 'Albuquerque', 'Bernalillo', 'NM', '87110', '5058818245', '5058836243', '3900 Georgia St NE', 'Albuquerque', 'Bernalillo', 'NM', '87110', '5058818245', '5058836243', 'DME8012', '', '', '0.00', '25.00', '0.00', 3, '2012-10-17', '2012-10-17', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006560', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('742484538', 'W12033166', 'W12033166', 'TXSATSTD', 'Northeast Endocrinology Associates', 'Laura', 'S', 'Akright', 'MD', 'Endocrinology', '', '', NULL, 'O', '5000 Schertz Pkwy Ste 200', 'Schertz', 'Guadalupe', 'TX', '78154', '2106503360', NULL, '5000 Schertz Pkwy Ste 200', 'Schertz', 'Guadalupe', 'TX', '78154', '2106503360', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-05-10', '2013-05-24', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1568548204', 0, 'N', 0, '2013-05-24', NULL, NULL, 29.5891, -98.2887, NULL, NULL),
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('760556120', 'W12028802', 'W12028802', 'TXHOUSTD', 'San Jacinto Family Practice', 'Isaac', '', 'Goldberg', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 3133', 'Houston', 'Harris', 'TX', '77253', '2814208400', '2814208445', 'PO Box 3133', 'Houston', 'Harris', 'TX', '77253', '2814208400', '2814208445', 'TMHPHOPCP', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2013-03-01', '2013-07-01', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1386683548', 0, 'N', 0, '2013-08-30', NULL, NULL, 0, 0, NULL, NULL),
('760556120', 'W12028804', 'W12028804', 'TXHOUSTD', 'San Jacinto Family Practice', 'Rebecca', '', 'Hart', 'MD', 'Family Practice', '', '', NULL, 'O', '4301 Garth Rd Ste 400', 'Baytown', 'Harris', 'TX', '77521', '2814208400', '2814208445', '4301 Garth Rd Ste 400', 'Baytown', 'Harris', 'TX', '77521', '2814208400', '2814208445', 'TMHPHOPCP', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2013-03-01', '2013-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205818861', 0, 'N', 0, '2013-08-30', NULL, NULL, 29.7677, -94.9796, NULL, NULL),
('760556120', 'W12028805', 'W12028805', 'TXHOUSTD', 'San Jacinto Family Practice', 'Rebecca', '', 'Hart', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 3133', 'Houston', 'Harris', 'TX', '77253', '2814208400', '2814208445', 'PO Box 3133', 'Houston', 'Harris', 'TX', '77253', '2814208400', '2814208445', 'TMHPHOPCP', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2013-03-01', '2013-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205818861', 0, 'N', 0, '2013-08-30', NULL, NULL, 0, 0, NULL, NULL),
('331082073', 'W12028809', 'W12028809', 'TXSATSTD', 'Baptist M & S Imaging  Mission Trail', '', '', 'VHS San Antonio Imaging', 'Group', 'Imaging Center', 'Radiology', '', NULL, 'O', '3327 Research Plaza Ste 108', 'San Antonio', 'Bexar', 'TX', '78240', '2108249311', NULL, '3327 Research Plaza Ste 108', 'San Antonio', 'Bexar', 'TX', '78240', '2108249311', '          ', 'TXIMAG', '', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457350993', 0, 'Y', 0, '2013-10-07', NULL, NULL, 29.3447, -98.4359, NULL, NULL),
('331082073', 'W12028810', 'W12028810', 'TXSATSTD', 'Baptist M & S Imaging  Oakwell Farms', '', '', 'VHS San Antonio Imaging', 'Group', 'Imaging Center', 'Radiology', '', NULL, 'O', '3338 Oakwell Ct Ste 106', 'San Antonio', 'Bexar', 'TX', '78218', '2108249311', NULL, '3338 Oakwell Ct Ste 106', 'San Antonio', 'Bexar', 'TX', '78218', '2108249311', '          ', 'TXIMAG', '', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457350993', 0, 'Y', 0, '2013-10-07', NULL, NULL, 29.507, -98.4311, NULL, NULL),
('331082073', 'W12028811', 'W12028811', 'TXSATSTD', 'Baptist M & S Imaging Westover Hills', '', '', 'VHS San Antonio Imaging', 'Group', 'Imaging Center', 'Radiology', '', NULL, 'O', '3903 Wiseman Blvd Ste 101', 'San Antonio', 'Bexar', 'TX', '78251', '2106816474', NULL, '3903 Wiseman Blvd Ste 101', 'San Antonio', 'Bexar', 'TX', '78251', '2106816474', '          ', 'TXIMAG', '', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457350993', 0, 'Y', 0, '2013-10-07', NULL, NULL, 29.4763, -98.6953, NULL, NULL),
('331082073', 'W12028812', 'W12028812', 'TXSATSTD', 'VHS San Antonio Imaging', '', '', 'VHS San Antonio Imaging', 'Group', 'Imaging Center', 'Radiology', '', NULL, 'O', '4440 Piedras St Ste 100', 'San Antonio', 'Bexar', 'TX', '78228', '2107852500', NULL, '4440 Piedras St Ste 100', 'San Antonio', 'Bexar', 'TX', '78228', '2107852500', '          ', 'TXIMAG', '', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457350993', 0, 'Y', 0, '2013-10-07', NULL, NULL, 29.4844, -98.5678, NULL, NULL),
('331082073', 'W12028813', 'W12028813', 'TXSATSTD', 'Baptist Breast Center', '', '', 'VHS San Antonio Imaging', 'Group', 'Imaging Center', 'Radiology', '', NULL, 'O', '502 Madison Oak Dr Ste 450', 'San Antonio', 'Bexar', 'TX', '78258', '2108249311', NULL, '502 Madison Oak Dr Ste 450', 'San Antonio', 'Bexar', 'TX', '78258', '2108249311', '          ', 'TXIMAG', '', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457350993', 0, 'Y', 0, '2013-10-07', NULL, NULL, 29.6212, -98.4905, NULL, NULL),
('331082073', 'W12028814', 'W12028814', 'TXSATSTD', 'VHS San Antonio Imaging', '', '', 'VHS San Antonio Imaging', 'Group', 'Imaging Center', 'Radiology', '', NULL, 'B', 'PO Box 849553', 'Dallas', 'Dallas', 'TX', '75284', '2103510784', NULL, 'PO Box 849553', 'Dallas', 'Dallas', 'TX', '75284', '2103510784', '          ', 'TXIMAG', '', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457350993', 0, 'Y', 0, '2013-10-07', NULL, NULL, 0, 0, NULL, NULL),
('760714523', 'W12028816', 'W12028816', 'TXSATSTD', 'South East Baptist Hospital Laboratory', '', '', 'South East Baptist Hospital Laboratory', '', 'Laboratory', '', '', NULL, 'O', '4214 E Southcross Blvd', 'San Antonio', 'Bexar', 'TX', '78222', '2102973700', NULL, '4214 E Southcross Blvd', 'San Antonio', 'Bexar', 'TX', '78222', '2102973700', '          ', '', '', 'Baptist', '0.00', '100.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008829', 0, 'N', 0, '2013-01-18', NULL, NULL, 29.3748, -98.412, NULL, NULL),
('760714523', 'W12028825', 'W12028825', 'TXSATSTD', 'South East Baptist Hospital Laboratory', '', '', 'South East Baptist Hospital Laboratory', '', 'Laboratory', '', '', NULL, 'B', 'PO Box 848333', 'Dallas', 'Dallas', 'TX', '75284', '2102977000', NULL, 'PO Box 848333', 'Dallas', 'Dallas', 'TX', '75284', '2102977000', '          ', '', '', 'Baptist', '0.00', '100.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008829', 0, 'Y', 0, '2013-01-18', NULL, NULL, 0, 0, NULL, NULL),
('331082073', 'W12028818', 'W12028818', 'TXSATSTD', 'Northeast Baptist Imaging Center', '', '', 'Northeast Baptist Imaging Center', 'Group', 'Imaging Center', 'Radiology', '', NULL, 'O', '8815 Village Dr', 'San Antonio', 'Bexar', 'TX', '78217', '2105905822', NULL, '8815 Village Dr', 'San Antonio', 'Bexar', 'TX', '78217', '2105905822', '          ', 'TXIMAG', '', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007904', 0, 'N', 0, '2013-01-18', NULL, NULL, 29.5197, -98.4276, NULL, NULL),
('331082073', 'W12028819', 'W12028819', 'TXSATSTD', 'North Central Baptist Imaging Center', '', '', 'North Central Baptist Imaging Center', 'Group', 'Imaging Center', 'Radiology', '', NULL, 'O', '540 Madison Oak Dr Ste 160', 'San Antonio', 'Bexar', 'TX', '78258', '2104031600', NULL, '540 Madison Oak Dr Ste 160', 'San Antonio', 'Bexar', 'TX', '78258', '2104031600', '          ', 'TXIMAG', '', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007902', 0, 'N', 0, '2013-01-18', NULL, NULL, 29.6212, -98.4921, NULL, NULL),
('760714523', 'W12028820', 'W12028820', 'TXSATSTD', 'North Central Baptist Hospital Laboratory', '', '', 'North Central Baptist Hospital Laboratory', '', 'Laboratory', '', '', NULL, 'O', '540 Madison Oak Dr', 'San Antonio', 'Bexar', 'TX', '78217', '2102974700', NULL, '520 Madison Oak', 'San Antonio', 'Bexar', 'TX', '78217', '2102974700', '          ', '', '', 'Baptist', '0.00', '100.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007901', 0, 'N', 0, '2013-01-18', NULL, NULL, 29.6212, -98.4921, NULL, NULL),
('760714523', 'W12028821', 'W12028821', 'TXSATSTD', 'North Central Baptist Hospital Laboratory', '', '', 'North Central Baptist Hospital Laboratory', '', 'Laboratory', '', '', NULL, 'B', 'PO Box 848333', 'Dallas', 'Dallas', 'TX', '75284', '2102977000', NULL, 'PO Box 848333', 'Dallas', 'Dallas', 'TX', '75284', '2102977000', '          ', '', '', 'Baptist', '0.00', '100.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007901', 0, 'Y', 0, '2013-01-18', NULL, NULL, 0, 0, NULL, NULL),
('760714523', 'W12028822', 'W12028822', 'TXSATSTD', 'Baptist Medical Center Laboratory', '', '', 'Baptist Medical Center Laboratory', '', 'Laboratory', '', '', NULL, 'O', '111 Dallas St', 'San Antonio', 'Bexar', 'TX', '78205', '2102977700', NULL, '111 Dallas St', 'San Antonio', 'Bexar', 'TX', '78205', '2102977700', '          ', '', '', 'Baptist', '0.00', '100.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000005182', 0, 'N', 0, '2013-01-18', NULL, NULL, 29.4329, -98.4928, NULL, NULL),
('760714523', 'W12028823', 'W12028823', 'TXSATSTD', 'Baptist Medical Center Laboratory', '', '', 'Baptist Medical Center Laboratory', '', 'Laboratory', '', '', NULL, 'B', 'PO Box 848333', 'Dallas', 'Dallas', 'TX', '75284', '2102977000', NULL, 'PO Box 848333', 'Dallas', 'Dallas', 'TX', '75284', '2102977000', '          ', '', '', 'Baptist', '0.00', '100.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000005182', 0, 'Y', 0, '2013-01-18', NULL, NULL, 0, 0, NULL, NULL),
('331082073', 'W12028824', 'W12028824', 'TXSATSTD', 'Baptist Imaging Center', '', '', 'Baptist Imaging Center', 'Group', 'Imaging Center', 'Radiology', '', NULL, 'O', '215 E Quincy Ste 155', 'San Antonio', 'Bexar', 'TX', '78215', '2103510784', NULL, '215 E Quincy Ste 155', 'San Antonio', 'Bexar', 'TX', '78215', '2103510784', '          ', 'TXIMAG', '', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000005180', 0, 'N', 0, '2013-05-02', NULL, NULL, 29.4354, -98.493, NULL, NULL),
('760556120', 'W12028807', 'W12028807', 'TXHOUSTD', 'San Jacinto Family Practice', 'Clare', '', 'Hawkins', 'MD', 'Family Practice', '', '', NULL, 'O', '4301 Garth Rd Ste 400', 'Baytown', 'Harris', 'TX', '77521', '2814208400', '2814208445', '4301 Garth Rd Ste 400', 'Baytown', 'Harris', 'TX', '77521', '2814208400', '2814208445', 'TMHPHOPCP', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2013-03-01', '2013-07-01', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1831171495', 0, 'N', 0, '2013-08-30', NULL, NULL, 29.7677, -94.9796, NULL, NULL),
('760556120', 'W12028808', 'W12028808', 'TXHOUSTD', 'San Jacinto Family Practice', 'Clare', '', 'Hawkins', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 3133', 'Houston', 'Harris', 'TX', '77253', '2814208400', '2814208445', 'PO Box 3133', 'Houston', 'Harris', 'TX', '77253', '2814208400', '2814208445', 'TMHPHOPCP', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2013-03-01', '2013-07-01', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1831171495', 0, 'N', 0, '2013-08-30', NULL, NULL, 0, 0, NULL, NULL),
('760556120', 'W12028827', 'W12028827', 'TXHOUSTD', 'San Jacinto Family Practice', 'Louis', 'B', 'Hughes', 'MD', 'Family Practice', '', '', NULL, 'O', '4301 Garth Rd Ste 400', 'Baytown', 'Harris', 'TX', '77521', '2814208400', '2814208445', '4301 Garth Rd Ste 400', 'Baytown', 'Harris', 'TX', '77521', '2814208400', '2814208445', 'TMHPHOPCP', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2013-03-01', '2013-07-01', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1699758805', 0, 'N', 0, '2013-08-30', NULL, NULL, 29.7677, -94.9796, NULL, NULL),
('760556120', 'W12028828', 'W12028828', 'TXHOUSTD', 'San Jacinto Family Practice', 'Louis', 'B', 'Hughes', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 3133', 'Houston', 'Harris', 'TX', '77253', '2814208400', '2814208445', 'PO Box 3133', 'Houston', 'Harris', 'TX', '77253', '2814208400', '2814208445', 'TMHPHOPCP', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2013-03-01', '2013-07-01', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1699758805', 0, 'N', 0, '2013-08-30', NULL, NULL, 0, 0, NULL, NULL),
('760556120', 'W12028830', 'W12028830', 'TXHOUSTD', 'San Jacinto Family Practice', 'James', '', 'King', 'MD', 'Family Practice', '', '', NULL, 'O', '4301 Garth Rd Ste 400', 'Baytown', 'Harris', 'TX', '77521', '2814208400', '2814208445', '4301 Garth Rd Ste 400', 'Baytown', 'Harris', 'TX', '77521', '2814208400', '2814208445', 'TMHPHOPCP', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2013-03-01', NULL, 0, 0, 0, 'Houston Methodist San Jacinto Hospital', NULL, '', '', 'HCFA|UB|', '1235207713', 0, 'N', 0, '2013-01-23', NULL, NULL, 29.7681, -94.9775, NULL, NULL),
('760556120', 'W12028831', 'W12028831', 'TXHOUSTD', 'San Jacinto Family Practice', 'James', '', 'King', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 3133', 'Houston', 'Harris', 'TX', '77253', '2814208400', '2814208445', 'PO Box 3133', 'Houston', 'Harris', 'TX', '77253', '2814208400', '2814208445', 'TMHPHOPCP', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2013-03-01', NULL, 0, 0, 0, 'Houston Methodist San Jacinto Hospital', NULL, '', '', 'HCFA|UB|', '1235207713', 0, 'N', 0, '2013-01-23', NULL, NULL, 0, 0, NULL, NULL),
('760556120', 'W12028833', 'W12028833', 'TXHOUSTD', 'San Jacinto Family Practice', 'Frank', 'M', 'Lopez Godoy', 'MD', 'Family Practice', '', '', NULL, 'O', '4301 Garth Rd Ste 400', 'Baytown', 'Harris', 'TX', '77521', '2814208400', '2814208445', '4301 Garth Rd Ste 400', 'Baytown', 'Harris', 'TX', '77521', '2814208400', '2814208445', 'TMHPHOPCP', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2013-03-01', '2013-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598990772', 0, 'N', 0, '2013-08-28', NULL, NULL, 29.7677, -94.9796, NULL, NULL),
('760556120', 'W12028834', 'W12028834', 'TXHOUSTD', 'San Jacinto Family Practice', 'Frank', 'M', 'Lopez Godoy', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 3133', 'Houston', 'Harris', 'TX', '77253', '2814208400', '2814208445', 'PO Box 3133', 'Houston', 'Harris', 'TX', '77253', '2814208400', '2814208445', 'TMHPHOPCP', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2013-03-01', '2013-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598990772', 0, 'N', 0, '2013-08-28', NULL, NULL, 0, 0, NULL, NULL),
('205805198', 'ELCUC0070', 'ELCUC0070', 'TXDALSTD', 'Concentra Urgent Care', '', '', 'Concentra Urgent Care', '', 'Urgent Care', '', '', NULL, 'B', 'PO Box 1149', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', 'PO Box 1149', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013196658', 0, 'N', 0, '2013-11-27', NULL, NULL, 0, 0, NULL, NULL),
('205805198', 'ELCUC0027', 'ELCUC0027', 'TXSATSTD', 'Concentra Urgent Care', '', '', 'Concentra Urgent Care', '', 'Urgent Care', '', '', NULL, 'O', '12702 Toepperwein Ste 104', 'San Antonio', 'Bexar', 'TX', '78233', '8669446046', '2106533183', '12702 Toepperwein Ste 104', 'San Antonio', 'Bexar', 'TX', '78233', '8669446046', '2106533183', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013196658', 0, 'N', 0, '2013-11-27', NULL, NULL, 29.5535, -98.3471, NULL, NULL),
('205805198', 'ELCUC0062', 'ELCUC0062', 'TXDALSTD', 'Concentra Urgent Care', '', '', 'Concentra Urgent Care', '', 'Urgent Care', '', '', NULL, 'B', 'PO Box 1149', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', 'PO Box 1149', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043409717', 0, 'N', 0, '2013-11-27', NULL, NULL, 0, 0, NULL, NULL),
('205805198', 'ELCUC0019', 'ELCUC0019', 'TXHOUSTD', 'Concentra Urgent Care', '', '', 'Concentra Urgent Care', '', 'Urgent Care', '', '', NULL, 'O', '6545 SW Fwy', 'Houston', 'Harris', 'TX', '77074', '8669446046', '7139956580', '6545 SW Fwy', 'Houston', 'Harris', 'TX', '77074', '8669446046', '7139956580', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043409717', 0, 'N', 0, '2013-11-27', NULL, NULL, 29.8091, -95.3041, NULL, NULL),
('205805198', 'ELCUC0010', 'ELCUC0010', 'TXDALSTD', 'Concentra Urgent Care', '', '', 'Concentra Urgent Care', '', 'Urgent Care', '', '', NULL, 'O', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '8669446046', '9727125442', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '8669446046', '9727125442', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043598600', 0, 'N', 0, '2013-11-27', NULL, NULL, 33.1512, -96.8641, NULL, NULL),
('205805198', 'ELCUC0053', 'ELCUC0053', 'TXDALSTD', 'Concentra Urgent Care', '', '', 'Concentra Urgent Care', '', 'Urgent Care', '', '', NULL, 'B', 'PO Box 1149', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', 'PO Box 1149', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043598600', 0, 'N', 0, '2013-11-27', NULL, NULL, 0, 0, NULL, NULL),
('205805198', 'ELCUC0088', 'ELCUC0088', 'TXDALSTD', 'Concentra Urgent Care', '', '', 'Concentra Urgent Care', '', 'Urgent Care', '', '', NULL, 'O', '2100 E Randoll Mill Rd', 'Arlington', 'Tarrant', 'TX', '76011', '8669446046', '8172755432', '2100 E Randoll Mill Rd', 'Arlington', 'Tarrant', 'TX', '76011', '8669446046', '8172755432', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073702858', 0, 'N', 0, '2013-11-27', NULL, NULL, 32.7474, -97.0761, NULL, NULL),
('205805198', 'ELCUC0045', 'ELCUC0045', 'TXDALSTD', 'Concentra Urgent Care', '', '', 'Concentra Urgent Care', '', 'Urgent Care', '', '', NULL, 'B', 'PO Box 1149', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', 'PO Box 1149', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073702858', 0, 'N', 0, '2013-11-27', NULL, NULL, 0, 0, NULL, NULL),
('205805198', 'ELCUC0087', 'ELCUC0087', 'TXDALSTD', 'Concentra Urgent Care', '', '', 'Concentra Urgent Care', '', 'Urgent Care', '', '', NULL, 'O', '15810 Midway Rd ', 'Addison', 'Dallas', 'TX', '75001', '8669446046', '9724587776', '15810 Midway Rd ', 'Addison', 'Dallas', 'TX', '75001', '8669446046', '9724587776', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083806822', 0, 'N', 0, '2013-11-27', NULL, NULL, 32.9653, -96.839, NULL, NULL),
('205805198', 'ELCUC0044', 'ELCUC0044', 'TXDALSTD', 'Concentra Urgent Care', '', '', 'Concentra Urgent Care', '', 'Urgent Care', '', '', NULL, 'B', 'PO Box 1149', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', 'PO Box 1149', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083806822', 0, 'N', 0, '2013-11-27', NULL, NULL, 0, 0, NULL, NULL),
('205805198', 'ELCUC0031', 'ELCUC0031', 'ILCHIGSTD', 'Concentra Immediate Care', '', '', 'Concentra Immediate Care', '', 'Urgent Care', '', '', NULL, 'O', '501 S Grace St ', 'Addison', 'Dupage', 'IL', '60101', '8669446046', '6305431050', '501 S Grace St ', 'Addison', 'Dupage', 'IL', '60101', '8669446046', '6305431050', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093833139', 0, 'N', 0, '2013-11-27', NULL, NULL, 41.9164, -88.0076, NULL, NULL),
('205805198', 'ELCUC0074', 'ELCUC0074', 'ILCHIGSTD', 'Concentra Immediate Care', '', '', 'Concentra Immediate Care', '', 'Urgent Care', '', '', NULL, 'B', 'PO Box 2547', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', 'PO Box 2547', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2013-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093833139', 0, 'Y', 0, '2013-11-27', NULL, NULL, 0, 0, NULL, NULL),
('205805198', 'ELCUC0039', 'ELCUC0039', 'ILCHIGSTD', 'Concentra Immediate Care', '', '', 'Concentra Immediate Care', '', 'Urgent Care', '', '', NULL, 'O', '1830 Jarvis Ave', 'Elk Grove Village', 'Cook', 'IL', '60007', '8669446046', '8479521183', '1830 Jarvis Ave', 'Elk Grove Village', 'Cook', 'IL', '60007', '8669446046', '8479521183', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093996480', 0, 'N', 0, '2013-11-27', NULL, NULL, 42.0142, -87.9582, NULL, NULL),
('205805198', 'ELCUC0082', 'ELCUC0082', 'ILCHIGSTD', 'Concentra Immediate Care', '', '', 'Concentra Immediate Care', '', 'Urgent Care', '', '', NULL, 'B', 'PO Box 2547', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', 'PO Box 2547', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2013-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093996480', 0, 'Y', 0, '2013-11-27', NULL, NULL, 0, 0, NULL, NULL),
('205805198', 'ELCUC0040', 'ELCUC0040', 'ILCHIGSTD', 'Concentra Immediate Care', '', '', 'Concentra Immediate Care', '', 'Urgent Care', '', '', NULL, 'O', '10137 W Grand Ave', 'Franklin Park', 'Cook', 'IL', '60131', '8669446046', '8474517608', '10137 W Grand Ave', 'Franklin Park', 'Cook', 'IL', '60131', '8669446046', '8474517608', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104015726', 0, 'N', 0, '2013-11-27', NULL, NULL, 41.9301, -87.8787, NULL, NULL),
('205805198', 'ELCUC0083', 'ELCUC0083', 'ILCHIGSTD', 'Concentra Immediate Care', '', '', 'Concentra Immediate Care', '', 'Urgent Care', '', '', NULL, 'B', 'PO Box 2547', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', 'PO Box 2547', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2013-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104015726', 0, 'Y', 0, '2013-11-27', NULL, NULL, 0, 0, NULL, NULL),
('205805198', 'ELCUC0065', 'ELCUC0065', 'TXDALSTD', 'Concentra Urgent Care', '', '', 'Concentra Urgent Care', '', 'Urgent Care', '', '', NULL, 'B', 'PO Box 1149', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', 'PO Box 1149', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104015783', 0, 'N', 0, '2013-11-27', NULL, NULL, 0, 0, NULL, NULL),
('205805198', 'ELCUC0022', 'ELCUC0022', 'TXHOUSTD', 'Concentra Urgent Care', '', '', 'Concentra Urgent Care', '', 'Urgent Care', '', '', NULL, 'O', '9321 Kirby', 'Houston', 'Harris', 'TX', '77054', '8669446046', '7137976431', '9321 Kirby', 'Houston', 'Harris', 'TX', '77054', '8669446046', '7137976431', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104015783', 0, 'N', 0, '2013-11-27', NULL, NULL, 29.669, -95.4129, NULL, NULL),
('205805198', 'ELCUC0011', 'ELCUC0011', 'TXDALSTD', 'Concentra Urgent Care', '', '', 'Concentra Urgent Care', '', 'Urgent Care', '', '', NULL, 'O', '1621 S Jupiter Ste 101', 'Garland', 'Dallas', 'TX', '75042', '8669446046', '2143403980', '1621 S Jupiter Ste 101', 'Garland', 'Dallas', 'TX', '75042', '8669446046', '2143403980', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114116852', 0, 'N', 0, '2013-11-27', NULL, NULL, 32.8978, -96.6837, NULL, NULL),
('205805198', 'ELCUC0054', 'ELCUC0054', 'TXDALSTD', 'Concentra Urgent Care', '', '', 'Concentra Urgent Care', '', 'Urgent Care', '', '', NULL, 'B', 'PO Box 1149', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', 'PO Box 1149', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114116852', 0, 'N', 0, '2013-11-27', NULL, NULL, 0, 0, NULL, NULL),
('205805198', 'ELCUC0041', 'ELCUC0041', 'ILCHIGSTD', 'Concentra Immediate Care', '', '', 'Concentra Immediate Care', '', 'Urgent Care', '', '', NULL, 'O', '8125 River Dr Ste 102', 'Morton Grove', 'Cook', 'IL', '60053', '8669446046', '8474701723', '8125 River Dr Ste 102', 'Morton Grove', 'Cook', 'IL', '60053', '8669446046', '8474701723', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205015781', 0, 'N', 0, '2013-11-27', NULL, NULL, 42.0291, -87.7845, NULL, NULL),
('205805198', 'ELCUC0084', 'ELCUC0084', 'ILCHIGSTD', 'Concentra Immediate Care', '', '', 'Concentra Immediate Care', '', 'Urgent Care', '', '', NULL, 'B', 'PO Box 2547', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', 'PO Box 2547', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2013-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205015781', 0, 'Y', 0, '2013-11-27', NULL, NULL, 0, 0, NULL, NULL),
('205805198', 'ELCUC0033', 'ELCUC0033', 'ILCHIGSTD', 'Concentra Immediate Care', '', '', 'Concentra Immediate Care', '', 'Urgent Care', '', '', NULL, 'O', '211 E Army Trail Rd', 'Bloomingdale', 'Dupage', 'IL', '60108', '8669446046', '6305820969', '211 E Army Trail Rd', 'Bloomingdale', 'Dupage', 'IL', '60108', '8669446046', '6305820969', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215126842', 0, 'N', 0, '2013-11-27', NULL, NULL, 41.9362, -88.0696, NULL, NULL),
('205805198', 'ELCUC0076', 'ELCUC0076', 'ILCHIGSTD', 'Concentra Immediate Care', '', '', 'Concentra Immediate Care', '', 'Urgent Care', '', '', NULL, 'B', 'PO Box 2547', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', 'PO Box 2547', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2013-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215126842', 0, 'Y', 0, '2013-11-27', NULL, NULL, 0, 0, NULL, NULL),
('205805198', 'ELCUC0006', 'ELCUC0006', 'TXDALSTD', 'Concentra Urgent Care', '', '', 'Concentra Urgent Care', '', 'Urgent Care', '', '', NULL, 'O', '5601 Greenville Ave ', 'Dallas', 'Dallas', 'TX', '75206', '8669446046', '2148216149', '5601 Greenville Ave ', 'Dallas', 'Dallas', 'TX', '75206', '8669446046', '2148216149', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225380405', 0, 'N', 0, '2013-11-27', NULL, NULL, 32.8537, -96.7694, NULL, NULL),
('205805198', 'ELCUC0049', 'ELCUC0049', 'TXDALSTD', 'Concentra Urgent Care', '', '', 'Concentra Urgent Care', '', 'Urgent Care', '', '', NULL, 'B', 'PO Box 1149', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', 'PO Box 1149', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225380405', 0, 'N', 0, '2013-11-27', NULL, NULL, 0, 0, NULL, NULL),
('205805198', 'ELCUC0009', 'ELCUC0009', 'TXDALSTD', 'Concentra Urgent Care', '', '', 'Concentra Urgent Care', '', 'Urgent Care', '', '', NULL, 'O', '4060 Sandshell Dr', 'Fort Worth', 'Tarrant', 'TX', '76137', '8669446046', '8173069780', '4060 Sandshell Dr', 'Fort Worth', 'Tarrant', 'TX', '76137', '8669446046', '8173069780', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255520995', 0, 'N', 0, '2013-11-27', NULL, NULL, 32.8405, -97.2987, NULL, NULL),
('205805198', 'ELCUC0052', 'ELCUC0052', 'TXDALSTD', 'Concentra Urgent Care', '', '', 'Concentra Urgent Care', '', 'Urgent Care', '', '', NULL, 'B', 'PO Box 1149', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', 'PO Box 1149', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255520995', 0, 'N', 0, '2013-11-27', NULL, NULL, 0, 0, NULL, NULL),
('205805198', 'ELCUC0012', 'ELCUC0012', 'TXDALSTD', 'Concentra Urgent Care', NULL, NULL, 'Concentra Urgent Care', NULL, 'Urgent Care', '', '', NULL, 'O', '2100 N Hwy 360 Ste 2201', 'Grand Prairie', 'Dallas', 'TX', '75050', '8669446046', '9726410054', '2100 N Hwy 360 Ste 2201', 'Grand Prairie', 'Dallas', 'TX', '75050', '8669446046', '9726410054', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2013-03-25', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1285823922', 0, 'N', 0, '2013-04-23', NULL, NULL, 0, 0, NULL, NULL),
('205805198', 'ELCUC0055', 'ELCUC0055', 'TXDALSTD', 'Concentra Urgent Care', NULL, NULL, 'Concentra Urgent Care', NULL, 'Urgent Care', '', '', NULL, 'B', 'PO Box 1149', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', 'PO Box 1149', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2013-03-25', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1285823922', 0, 'Y', 0, '2013-04-23', NULL, NULL, 0, 0, NULL, NULL),
('205805198', 'ELCUC0063', 'ELCUC0063', 'TXDALSTD', 'Concentra Urgent Care', '', '', 'Concentra Urgent Care', '', 'Urgent Care', '', '', NULL, 'B', 'PO Box 1149', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', 'PO Box 1149', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295924967', 0, 'N', 0, '2013-11-27', NULL, NULL, 0, 0, NULL, NULL),
('205805198', 'ELCUC0020', 'ELCUC0020', 'TXHOUSTD', 'Concentra Urgent Care', '', '', 'Concentra Urgent Care', '', 'Urgent Care', '', '', NULL, 'O', '8505 Gulf Fwy Ste F', 'Houston', 'Harris', 'TX', '77017', '8669446046', '7139444582', '8505 Gulf Fwy Ste F', 'Houston', 'Harris', 'TX', '77017', '8669446046', '7139444582', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295924967', 0, 'N', 0, '2013-11-27', NULL, NULL, 29.6703, -95.2622, NULL, NULL),
('205805198', 'ELCUC0036', 'ELCUC0036', 'ILCHIGSTD', 'Concentra Immediate Care', '', '', 'Concentra Immediate Care', '', 'Urgent Care', '', '', NULL, 'O', '1230 W Lake St', 'Chicago', 'Cook', 'IL', '60607', '8669446046', '3126665214', '1230 W Lake St', 'Chicago', 'Cook', 'IL', '60607', '8669446046', '3126665214', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316136955', 0, 'N', 0, '2013-11-27', NULL, NULL, 41.8855, -87.658, NULL, NULL),
('205805198', 'ELCUC0079', 'ELCUC0079', 'ILCHIGSTD', 'Concentra Immediate Care', '', '', 'Concentra Immediate Care', '', 'Urgent Care', '', '', NULL, 'B', 'PO Box 2547', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', 'PO Box 2547', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2013-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316136955', 0, 'Y', 0, '2013-11-27', NULL, NULL, 0, 0, NULL, NULL),
('205805198', 'ELCUC0064', 'ELCUC0064', 'TXDALSTD', 'Concentra Urgent Care', '', '', 'Concentra Urgent Care', '', 'Urgent Care', '', '', NULL, 'B', 'PO Box 1149', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', 'PO Box 1149', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346439023', 0, 'N', 0, '2013-11-27', NULL, NULL, 0, 0, NULL, NULL),
('205805198', 'ELCUC0021', 'ELCUC0021', 'TXHOUSTD', 'Concentra Urgent Care', '', '', 'Concentra Urgent Care', '', 'Urgent Care', '', '', NULL, 'O', '8799 N Loop East Ste 110', 'Houston', 'Harris', 'TX', '77029', '8669446046', '7136745169', '8799 N Loop East Ste 110', 'Houston', 'Harris', 'TX', '77029', '8669446046', '7136745169', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346439023', 0, 'N', 0, '2013-11-27', NULL, NULL, 29.7995, -95.2737, NULL, NULL),
('205805198', 'ELCUC0059', 'ELCUC0059', 'TXDALSTD', 'Concentra Urgent Care', '', '', 'Concentra Urgent Care', '', 'Urgent Care', '', '', NULL, 'B', 'PO Box 1149', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', 'PO Box 1149', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376732040', 0, 'N', 0, '2013-11-27', NULL, NULL, 0, 0, NULL, NULL),
('205805198', 'ELCUC0016', 'ELCUC0016', 'TXHOUSTD', 'Concentra Urgent Care', '', '', 'Concentra Urgent Care', '', 'Urgent Care', '', '', NULL, 'O', '2004 Leeland', 'Houston', 'Harris', 'TX', '77003', '8669446046', '7132231310', '2004 Leeland', 'Houston', 'Harris', 'TX', '77003', '8669446046', '7132231310', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376732040', 0, 'N', 0, '2013-11-27', NULL, NULL, 29.747, -95.3599, NULL, NULL),
('205805198', 'ELCUC0069', 'ELCUC0069', 'TXDALSTD', 'Concentra Urgent Care', '', '', 'Concentra Urgent Care', '', 'Urgent Care', '', '', NULL, 'B', 'PO Box 1149', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', 'PO Box 1149', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407045081', 0, 'N', 0, '2013-11-27', NULL, NULL, 0, 0, NULL, NULL),
('205805198', 'ELCUC0026', 'ELCUC0026', 'TXSATSTD', 'Concentra Urgent Care', '', '', 'Concentra Urgent Care', '', 'Urgent Care', '', '', NULL, 'O', '10200 N Broadway Ste 200', 'San Antonio', 'Bexar', 'TX', '78217', '8669446046', '2106543008', '10200 N Broadway Ste 200', 'San Antonio', 'Bexar', 'TX', '78217', '8669446046', '2106543008', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407045081', 0, 'N', 0, '2013-11-27', NULL, NULL, 29.5329, -98.4477, NULL, NULL),
('205805198', 'ELCUC0057', 'ELCUC0057', 'TXDALSTD', 'Concentra Urgent Care', '', '', 'Concentra Urgent Care', '', 'Urgent Care', '', '', NULL, 'B', 'PO Box 1149', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', 'PO Box 1149', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417136979', 0, 'N', 0, '2013-11-27', NULL, NULL, 0, 0, NULL, NULL),
('205805198', 'ELCUC0014', 'ELCUC0014', 'TXHOUSTD', 'Concentra Urgent Care', '', '', 'Concentra Urgent Care', '', 'Urgent Care', '', '', NULL, 'O', '10909 I 10 East Fwy', 'Houston', 'Harris', 'TX', '77029', '8669446046', '7139737947', '10909 I 10 East Fwy', 'Houston', 'Harris', 'TX', '77029', '8669446046', '7139737947', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417136979', 0, 'N', 0, '2013-11-27', NULL, NULL, 29.7749, -95.2364, NULL, NULL),
('205805198', 'ELCUC0071', 'ELCUC0071', 'TXDALSTD', 'Concentra Urgent Care', '', '', 'Concentra Urgent Care', '', 'Urgent Care', '', '', NULL, 'B', 'PO Box 1149', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', 'PO Box 1149', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427247030', 0, 'N', 0, '2013-11-27', NULL, NULL, 0, 0, NULL, NULL),
('205805198', 'ELCUC0028', 'ELCUC0028', 'TXSATSTD', 'Concentra Urgent Care', '', '', 'Concentra Urgent Care', '', 'Urgent Care', '', '', NULL, 'O', '1904 Grandstand Dr Ste 104', 'San Antonio', 'Bexar', 'TX', '78238', '8669446046', '2105217688', '1904 Grandstand Dr Ste 104', 'San Antonio', 'Bexar', 'TX', '78238', '8669446046', '2105217688', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427247030', 0, 'N', 0, '2013-11-27', NULL, NULL, 29.4581, -98.6205, NULL, NULL),
('205805198', 'ELCUC0005', 'ELCUC0005', 'TXDALSTD', 'Concentra Urgent Care', '', '', 'Concentra Urgent Care', '', 'Urgent Care', '', '', NULL, 'O', '2920 N Stemmons Fwy', 'Dallas', 'Dallas', 'TX', '75247', '8669446046', '2149051323', '2920 N Stemmons Fwy', 'Dallas', 'Dallas', 'TX', '75247', '8669446046', '2149051323', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457655540', 0, 'N', 0, '2013-11-27', NULL, NULL, 32.8123, -96.8513, NULL, NULL),
('205805198', 'ELCUC0048', 'ELCUC0048', 'TXDALSTD', 'Concentra Urgent Care', '', '', 'Concentra Urgent Care', '', 'Urgent Care', '', '', NULL, 'B', 'PO Box 1149', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', 'PO Box 1149', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457655540', 0, 'N', 0, '2013-11-27', NULL, NULL, 0, 0, NULL, NULL),
('205805198', 'ELCUC0089', 'ELCUC0089', 'TXDALSTD', 'Concentra Urgent Care', '', '', 'Concentra Urgent Care', '', 'Urgent Care', '', '', NULL, 'O', '811 NE Alsbury Blvd Ste 800', 'Burleson', 'Johnson', 'TX', '76028', '8669446046', '8175511066', '811 NE Alsbury Blvd Ste 800', 'Burleson', 'Johnson', 'TX', '76028', '8669446046', '8175511066', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477847093', 0, 'N', 0, '2013-11-27', NULL, NULL, 32.563, -97.3227, NULL, NULL),
('205805198', 'ELCUC0046', 'ELCUC0046', 'TXDALSTD', 'Concentra Urgent Care', '', '', 'Concentra Urgent Care', '', 'Urgent Care', '', '', NULL, 'B', 'PO Box 1149', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', 'PO Box 1149', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477847093', 0, 'N', 0, '2013-11-27', NULL, NULL, 0, 0, NULL, NULL),
('205805198', 'ELCUC0073', 'ELCUC0073', 'TXDALSTD', 'Concentra Urgent Care', '', '', 'Concentra Urgent Care', '', 'Urgent Care', '', '', NULL, 'B', 'PO Box 1149', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', 'PO Box 1149', 'Addison', 'Dallas', 'TX', '75001', '8774278801', '9723851759', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497944011', 0, 'N', 0, '2013-11-27', NULL, NULL, 0, 0, NULL, NULL),
('205805198', 'ELCUC0030', 'ELCUC0030', 'TXSATSTD', 'Concentra Urgent Care', '', '', 'Concentra Urgent Care', '', 'Urgent Care', '', '', NULL, 'O', '400 E Quincy', 'San Antonio', 'Bexar', 'TX', '78215', '8669446046', '2104720214', '400 E Quincy', 'San Antonio', 'Bexar', 'TX', '78215', '8669446046', '2104720214', '', '', '', '0.00', '0.00', '110.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497944011', 0, 'N', 0, '2013-11-27', NULL, NULL, 29.4365, -98.4911, NULL, NULL);
