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
('942854057', 'W11004311', 'W11004311', 'UTIHCPHY', 'IHC Bountiful Health Center', 'Sherlene', 'Tonia', 'Dean', 'APRN', '', '', '', NULL, 'O', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012941000', '          ', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012941000', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-04-01', '2008-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871603860', 0, 'N', 0, '2014-07-10', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004312', 'W11004312', 'UTIHCPHY', 'IHC Bountiful Health Center', 'Heather', 'L', 'LeSieur', 'PA', 'Family Practice', '', '', NULL, 'O', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012941000', NULL, '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012941000', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-04-01', '2013-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1891726972', 0, 'N', 0, '2013-09-05', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004313', 'W11004313', 'UTIHCPHY', 'IHC Bountiful Health Center', 'Cynthia', '0', 'Zumbrennen', 'PA', 'Family Practice', '', '', NULL, 'O', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012941000', NULL, '390 N Main', 'Bountiful', 'Davis', 'UT', '84010', '8012941000', '', 'USTDMULT', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2008-04-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1255362323', 0, 'N', 0, '2010-05-24', NULL, NULL, 40.8935, -111.881, NULL, NULL),
('841432852', 'W11003970', 'W11003970', 'UT01', NULL, 'Todd', 'A', 'Hackney', 'OD', 'Optometry', '', '', NULL, 'O', '471 S Main Ste 7', 'Moab', 'Grand', 'UT', '84532', '4352599441', NULL, '471 S Main Ste 7', 'Moab', 'Grand', 'UT', '84532', '4352599441', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972609972', 0, 'n', 0, '2014-03-05', NULL, NULL, 38.5666, -109.551, NULL, NULL),
('743134267', 'W11004007', 'W11004007', 'UT01', 'University Health Care', 'Tiffany', 'S', 'Glasgow', 'MD', 'Pediatrics', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8016623645', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8016623645', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2008-01-16', '2012-07-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1003838434', 0, 'N', 0, '2013-01-22', NULL, NULL, 0, 0, NULL, NULL),
('743134267', 'W11004006', 'W11004006', 'UT01', 'Pediatric Inpatient Services-Department of University of Uta', 'Tiffany', 'S', 'Glasgow', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2008-01-16', '2012-07-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1003838434', 0, 'N', 0, '2013-01-22', NULL, NULL, 0, 0, NULL, NULL),
('876000525', 'W11004005', 'W11004005', 'UT01', 'University of Utah Hospital', 'Kristina', 'A', 'Dahlgren', 'PT', 'Physical Therapy', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812121', NULL, NULL, NULL, '', NULL, NULL, '', '', '', NULL, '1', '0.00', '0.00', '0.00', 6, '2008-01-18', NULL, 1, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1255480539', 0, 'N', 0, '2008-09-08', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('876000525', 'W11004004', 'W11004004', 'UT01', 'University of Utah Hospital', 'Kristina', 'A', 'Dahlgren', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 510721', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015812121', NULL, NULL, NULL, '', NULL, NULL, '', '', '', NULL, '1', '0.00', '0.00', '0.00', 6, '2008-01-18', '2008-01-18', 1, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1255480539', 0, 'Y', 0, '2008-09-08', NULL, NULL, 0, 0, NULL, NULL),
('870293873', 'W11004003', 'W11004003', 'UT01', 'Tri City Medical Clinic', 'Michael', '', 'Curtis', 'MD', 'Family Practice', '', '', NULL, 'O', '487 E 1000 S Ste A', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017961333', NULL, '487 E 1000 S Ste A', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017961333', '', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-07-01', '2010-07-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336280759', 0, 'N', 0, '2014-07-17', NULL, NULL, 0, 0, NULL, NULL),
('870293873', 'W11004002', 'W11004002', 'UT01', 'Tri City Medical Clinic', 'Michael', '', 'Curtis', 'MD', 'Family Practice', '', '', NULL, 'O', '830 N 2000 W', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017563511', NULL, '830 N 2000 W', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017563511', '', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-03-28', '2010-07-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336280759', 0, 'N', 0, '2014-07-17', NULL, NULL, 0, 0, NULL, NULL),
('262072378', 'W11004000', 'W11004000', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Terry', '', 'Melendez', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '920 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013741801', NULL, '920 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013741801', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-04-01', '2011-01-31', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1316050081', 0, 'N', 0, '2012-03-08', NULL, NULL, 0, 0, NULL, NULL),
('262072378', 'W11003999', 'W11003999', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Brent', '', 'Lind', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '920 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013741801', NULL, '920 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013741801', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-04-01', '2010-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184732018', 0, 'N', 0, '2012-03-15', NULL, NULL, 0, 0, NULL, NULL),
('262072378', 'W11003998', 'W11003998', 'UT01', 'Valley Obstetrics & Gynecology PC', 'James', '', 'Lamoreaux', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '920 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013741801', NULL, '920 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013741801', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-04-01', '2011-01-31', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1932212503', 0, 'N', 0, '2012-03-14', NULL, NULL, 0, 0, NULL, NULL),
('262072378', 'W11003997', 'W11003997', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Ryan', 'C', 'Ollerton', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '920 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013741801', NULL, '920 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013741801', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-04-01', '2011-01-31', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1528275898', 0, 'N', 0, '2012-03-12', NULL, NULL, 0, 0, NULL, NULL),
('262072378', 'W11003996', 'W11003996', 'UT01', 'Valley Obstetrics & Gynecology PC', '', '', 'Valley Obstetrics & Gynecology PC', 'GROUP', 'Obstetrics and Gynecology', '', '', NULL, 'B', '920 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013741801', NULL, '920 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013741801', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-04-01', '2011-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588863377', 0, 'Y', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('262072378', 'W11003995', 'W11003995', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Robert', '', 'Aagard', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '920 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013741801', NULL, '920 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013741801', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-04-01', '2011-01-31', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1477661379', 0, 'N', 0, '2012-03-08', NULL, NULL, 0, 0, NULL, NULL),
('522165554', 'W11003994', 'W11003994', 'UT01', 'DJO (Orthopedic Supplies)', '', '', 'DJO (Orthopedic Supplies for Provider Use Only)', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'B', '3434 Solutions Ctr', 'Chicago', 'Cook', 'IL', '60677', '8003282536', NULL, '3434 Solutions Ctr', 'Chicago', 'Cook', 'IL', '60677', '8003282536', '', 'WISEDJO', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-01-01', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023296035', 0, 'y', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
('870290108', 'W11003993', 'W11003993', 'UT01', 'Medical Associates of St George', 'Jonathan', 'P', 'Hubbard', 'DO', 'Family Practice', '', '', NULL, 'O', '736 S 900 E Ste 203', 'St George', 'Washington', 'UT', '84790', '4356746065', '4356738557', '736 S 900 E Ste 203', 'St George', 'Washington', 'UT', '84790', '4356746065', '4356738557', 'WUSTGEIPA', 'WUSTDHCPC', NULL, '0.00', '25.00', '0.00', 3, '2008-05-01', '2010-02-01', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1609894922', 0, 'N', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('721576784', 'W11003992', 'W11003992', 'TX01', NULL, 'David', 'W', 'Ririe', 'MD', 'Hematology and Oncology', 'Oncology', NULL, NULL, 'O', '8001 Midcrown Dr', 'San Antonio', 'Bexar', 'TX', '78218', '2102239888', NULL, '8001 Midcrown Dr', 'San Antonio', '', 'TX', '78218', '', '', 'TXONCOL', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2008-04-14', '2009-11-06', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1952307605', 0, 'N', 0, '2008-04-04', NULL, NULL, 0, 0, NULL, NULL),
('721576784', 'W11003991', 'W11003991', 'TX01', NULL, 'Kathleen', 'G', 'Halka', 'MD', 'Hematology and Oncology', NULL, NULL, NULL, 'O', '8001 Midcrown Dr', 'San Antonio', 'Bexar', 'TX', '78218', '2102239888', NULL, '8001 Midcrown Dr', 'San Antonio', '', 'TX', '78218', '', '', 'TXONCOL', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2008-04-14', '2009-04-17', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1487650651', 0, 'N', 0, '2008-04-04', NULL, NULL, 0, 0, NULL, NULL),
('841367175', 'W11003990', 'W11003990', 'UT01', 'Canyon View Medical Group', 'Roman', 'Y', 'Takasaki', 'MD', 'Family Practice', '', '', NULL, 'O', '94 W Main', 'Santaquin', 'Utah', 'UT', '84655', '8017543122', NULL, '94 W Main', 'Santaquin', 'Utah', 'UT', '84655', '8017543122', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-04-15', '2010-07-14', 0, 0, 0, 'Mountain View Regional Hospital', '', '', '', 'HCFA|UB|', '1669428611', 0, 'N', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('061506129', 'W11003988', 'W11003988', 'UT01', 'Wee Care Pediatrics', 'Laurent', 'C', 'Sigg', 'MD', 'Pediatrics', '', '', NULL, 'O', '1792 W 1700 S', 'Syracuse', 'Davis', 'UT', '84075', '8019271634', NULL, '1792 W 1700 S', 'Syracuse', 'Davis', 'UT', '84075', '8019271634', '', 'WUSTDPEDE5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-06-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1750389805', 0, 'N', 0, '2014-03-27', NULL, NULL, 41.0891, -112.061, NULL, NULL),
('061506129', 'W11003986', 'W11003986', 'UT01', 'Wee Care Pediatrics', 'Michael', 'P', 'Husseman', 'MD', 'Pediatrics', '', '', NULL, 'O', '1792 W 1700 S', 'Syracuse', 'Davis', 'UT', '84075', '8019271634', NULL, '1792 W 1700 S', 'Syracuse', 'Davis', 'UT', '84075', '8019271634', '', 'WUSTDPEDE5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-06-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1053319186', 0, 'N', 0, '2014-04-16', NULL, NULL, 41.0891, -112.061, NULL, NULL),
('061506129', 'W11003984', 'W11003984', 'UT01', 'Wee Care Pediatrics', 'Jennifer', 'M', 'Gilsoul', 'MD', 'Pediatrics', '', '', NULL, 'O', '1792 W 1700 S', 'Syracuse', 'Davis', 'UT', '84075', '8019271634', '8019271591', '1792 W 1700 S', 'Syracuse', 'Davis', 'UT', '84075', '8019271634', '8019271591', 'WUSTDPEDE5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-06-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1164402202', 0, 'N', 0, '2014-02-10', NULL, NULL, 41.0891, -112.061, NULL, NULL),
('061506129', 'W11003980', 'W11003980', 'UT01', 'Wee Care Pediatrics', 'Priscilla', 'Aye', 'Chen', 'MD', 'Pediatrics', '', '', NULL, 'O', '1792 W 1700 S', 'Syracuse', 'Davis', 'UT', '84075', '8019271634', '8019271591', '1792 W 1700 S', 'Syracuse', 'Davis', 'UT', '84075', '8019271634', '8019271591', 'WUSTDPEDE5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-06-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1750346599', 0, 'N', 0, '2012-01-04', NULL, NULL, 41.0891, -112.061, NULL, NULL),
('204296622', 'W11003979', 'W11003979', 'UT01', 'Arches Audiology', 'David', 'R', 'Ward', 'AUD', 'Audiology', '', '', NULL, 'O', '804 North 400 West', 'Blanding', 'San Juan', 'UT', '84511', '4352592508', '4352592513', '804 North 400 West', 'Blanding', 'San Juan', 'UT', '84511', '4352592508', '4352592513', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', '2011-05-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336111418', 0, 'N', 0, '2011-03-02', NULL, NULL, 0, 0, NULL, NULL),
('204296622', 'W11003978', 'W11003978', 'UT01', 'Arches Audiology', 'David', 'R', 'Ward', 'AUD', 'Audiology', '', '', NULL, 'O', '16 E 300 S', 'Monticello', 'San Juan', 'UT', '84535', '4352592508', '4352592513', '16 E 300 S', 'Monticello', 'San Juan', 'UT', '84535', '4352592508', '4352592513', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', '2011-05-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336111418', 0, 'N', 0, '2011-03-02', NULL, NULL, 0, 0, NULL, NULL),
('061506129', 'W11003977', 'W11003977', 'UT01', 'Wee Care Pediatrics', 'James', 'A', 'Fennell', 'MD', 'Pediatrics', '', '', NULL, 'O', '1792 W 1700 S', 'Syracuse', 'Davis', 'UT', '84075', '8019271634', '8019271591', '1792 W 1700 S', 'Syracuse', 'Davis', 'UT', '84075', '8019271634', '8019271591', 'WUSTDPEDE5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-06-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1912905035', 0, 'N', 0, '2013-04-11', NULL, NULL, 41.0891, -112.061, NULL, NULL),
('870371792', 'W11003976', 'W11003976', 'UT01', 'Valley View Medical Center', 'Ronald', 'G', 'Duerksen', 'MD', 'Physical Medicine and Rehabilitation', 'Electrodiagnosis', NULL, NULL, 'O', '1303 N Main St', 'Cedar City', 'Iron', 'UT', '84720', '4358685000', NULL, '1055 N 300 W', 'Provo', '', 'UT', '84604', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1164503900', 0, 'N', 0, '2008-04-04', NULL, NULL, 37.7003, -113.064, NULL, NULL),
('870371792', 'W11003975', 'W11003975', 'UT01', 'Dr. Mark Greenwoods Office', 'Ronald', 'G', 'Duerksen', 'MD', 'Physical Medicine and Rehabilitation', 'Electrodiagnosis', NULL, NULL, 'O', '460 N Main St', 'Richfield', 'Sevier', 'UT', '84701', '4358965496', NULL, '1055 N 300 W', 'Provo', '', 'UT', '84604', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1164503900', 0, 'N', 0, '2008-04-04', NULL, NULL, 38.7745, -112.085, NULL, NULL),
('870371792', 'W11003974', 'W11003974', 'UT01', 'Castleview Hospital, Phys Therapy & Sports Med', 'Ronald', 'G', 'Duerksen', 'MD', 'Physical Medicine and Rehabilitation', 'Electrodiagnosis', NULL, NULL, 'O', '284 N Hospital Dr', 'Price', 'Carbon', 'UT', '84501', '4356364841', NULL, '1055 N 300 W', 'Provo', '', 'UT', '84604', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1164503900', 0, 'N', 0, '2008-04-04', NULL, NULL, 39.6048, -110.831, NULL, NULL),
('870371792', 'W11003973', 'W11003973', 'UT01', 'Dr Steven Andersons Office', 'Ronald', 'G', 'Duerksen', 'MD', 'Physical Medicine and Rehabilitation', 'Electrodiagnosis', NULL, NULL, 'O', '1151 E 3900 S Ste B275', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012622452', NULL, '1055 N 300 W', 'Provo', '', 'UT', '84604', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1164503900', 0, 'N', 0, '2008-04-04', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('208487468', 'W11003972', 'W11003972', 'UT01', 'Advanced Pulmonary, Sleep Disorders and Internal Medicine', 'Zahabia', 'T', 'Gandhi', 'MD', 'Internal Medicine', '', '', NULL, 'O', '640 E 700 S Ste 105', 'St George', 'Washington', 'UT', '84770', '4356887770', NULL, '640 E 700 S Ste 105', 'St George', 'Washington', 'UT', '84770', '4356887770', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-03-05', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1538125240', 0, 'n', 0, '2014-03-24', NULL, NULL, 37.0963, -113.57, NULL, NULL),
('208487468', 'W11003971', 'W11003971', 'UT01', 'Advanced Pulmonary, Sleep Disorders and Internal Medicine', 'Mustufa', 'T', 'Saifee', 'MD', 'Pulmonary', 'Sleep Disorders', 'Critical Care Medicine', NULL, 'O', '640 E 700 S Ste 105', 'St George', 'Washington', 'UT', '84770', '4356887770', NULL, '640 E 700 S Ste 105', 'St George', 'Washington', 'UT', '84770', '4356887770', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-03-05', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1568428357', 0, 'n', 0, '2012-03-26', NULL, NULL, 37.0963, -113.57, NULL, NULL),
('870550275', 'W11004314', 'W11004314', 'UT01', 'Willow Creek Pediatrics', 'Rachel', 'J', 'Woods', 'MD', 'Pediatrics', '', '', NULL, 'O', '114 E 12450 S Ste 100', 'Draper', 'Salt Lake', 'UT', '84020', '8015233001', NULL, '114 E 12450 S Ste 100', 'Draper', 'Salt Lake', 'UT', '84020', '8015233001', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-08-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1326174616', 0, 'N', 0, '2014-07-10', NULL, NULL, 40.5249, -111.887, NULL, NULL),
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('870395551', 'W11004043', 'W11004043', 'UT01', NULL, 'Brandon', 'J', 'Trujillo', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '466 N Main St Ste 104', 'Clearfield', 'Davis', 'UT', '84015', '8012598737', '8013527024', '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2008-04-04', '2010-10-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1619166063', 0, 'N', 0, '2008-06-01', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11004044', 'W11004044', 'UT01', NULL, 'John', 'M', 'Ratliff', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '613 E 7200 S Ste 101', 'Midvale', 'Salt Lake', 'UT', '84047', '8015622400', NULL, '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2008-05-01', '2010-10-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1265551030', 0, 'N', 0, '2008-04-16', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11004045', 'W11004045', 'UT01', NULL, 'Robb', 'L', 'Leishman', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '12176 S 1000 E Ste 1', 'Draper', 'Salt Lake', 'UT', '84020', '8015233040', '8015681534', '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2008-05-01', '2008-05-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1033151576', 0, 'N', 0, '2008-04-16', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11004046', 'W11004046', 'ID03', 'West Chiropractic Clinic', 'Grant', 'D', 'Finn', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '134 W Chubbuck Rd', 'Chubbuck', 'Bannock', 'ID', '83202', '2082372377', NULL, '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2008-04-01', '2010-10-31', 0, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1174544688', 0, 'N', 0, '2008-04-16', NULL, NULL, 0, 0, NULL, NULL),
('870636552', 'W11004315', 'W11004315', 'UT01', 'Wasatch Orthotics & Pedorthics', '', '', 'Wasatch Orthotics & Pedorthics', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '887 East Vine', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012938777', '8012930231', '887 East Vine', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012938777', '8012930231', 'WUDME5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-05-05', '2012-09-25', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164418505', 0, 'N', 0, '2012-10-15', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11004316', 'W11004316', 'UT01', NULL, 'Jeff', 'C', 'Olavsen', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '1355 State St', 'Rigby', 'Jefferson', 'ID', '83442', '2087451109', '2085235005', '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2008-04-11', '2010-10-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1174794457', 0, 'N', 0, '2008-04-22', NULL, NULL, 0, 0, NULL, NULL),
('202616091', 'W11004317', 'W11004317', 'UT01', 'Sleepwell Partners', '', '', 'Sleepwell Partners', 'GROUP', 'Sleep Disorders', '', '', NULL, 'O', '613 E Fort Union Blvd Ste A 102', 'Midvale', 'Salt Lake', 'UT', '84047', '8015237533', NULL, '613 E Fort Union Blvd Ste A 102', 'Midvale', 'Salt Lake', 'UT', '84047', '8015237533', '          ', 'WCSTSWP5', '', '', '0.00', '100.00', '0.00', 3, '2006-11-01', '2012-02-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942206370', 0, 'N', 0, '2013-06-27', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11004318', 'W11004318', 'WY01', 'Billings Clinic - Same Day Care', 'John', 'L', 'Swanson', 'PA-C', 'Family Practice', NULL, NULL, NULL, 'O', '2825 8th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382868', 'PO Box 37000', 'Billings', '', 'MT', '59107', '', '', '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2008-05-01', '2009-04-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1487646949', 0, 'N', 0, '2010-01-15', NULL, NULL, 0, 0, NULL, NULL),
('870470946', 'W11004319', 'W11004319', 'UT01', 'Hurricane Family Practice', 'Melvin', 'E', 'Carter', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '1175 E 50 S', 'American Fork', 'Washington', 'UT', '84003', '8014922815', '8014920191', '1175 E 50 S', 'American Fork', 'Washington', 'UT', '84003', '8014922815', '8014920191', 'WUSTGEIPA', 'WUSTDHCPC', '', '0.00', '25.00', '0.00', 3, '2008-03-26', '2008-03-26', 0, 0, 0, 'Timpanogos Regional Hospital', 'Mountain View Regional Hospital', '', '', 'HCFA|UB|', '1700815834', 0, 'N', 0, '2013-03-30', NULL, NULL, 0, 0, NULL, NULL),
('260707688', 'W11004320', 'W11004320', 'UT01', '', 'Callie', 'A', 'Murray', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '2721 N 400 E Ste 8', 'North Ogden', 'Weber', 'UT', '84414', '8015288169', NULL, '2721 N 400 E Ste 8', 'North Ogden', 'Weber', 'UT', '84414', '8015288169', '          ', 'MA', '', '', '0.00', '100.00', '0.00', 3, '2007-12-01', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114933033', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('522165554', 'W11004321', 'W11004321', 'UT01', 'DJO (Orthopedic Supplies)', '', '', 'DJO (Orthopedic Supplies for Provider Use Only)', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '1430 Decision St', 'Vista', 'San Diego', 'CA', '92081', '8008638010', NULL, '1430 Decision St', 'Vista', 'San Diego', 'CA', '92081', '8008638010', '', 'WISEDJO', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-01-01', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023296035', 0, 'Y', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
('522165554', 'W11004322', 'W11004322', 'UT01', 'DJO (Orthopedic Supplies)', '', '', 'DJO (Orthopedic Supplies for Provider Use Only)', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'B', 'PO Box 515471', 'Los Angeles', 'Los Angeles', 'CA', '90051', '8008638010', NULL, 'PO Box 515471', 'Los Angeles', 'Los Angeles', 'CA', '90051', '8008638010', '', 'WISEDJO', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-01-01', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023296035', 0, 'y', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
('522165554', 'W11004323', 'W11004323', 'WY01', 'DJO (Orthopedic Supplies)', '', '', 'DJO (Orthopedic Supplies for Provider Use Only)', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'B', 'PO Box 515471', 'Los Angeles', 'Los Angeles', 'CA', '90051', '8008638010', NULL, 'PO Box 515471', 'Los Angeles', 'Los Angeles', 'CA', '90051', '8008638010', '', 'WISEDJO', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-01-01', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023296035', 0, 'y', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11002998', 'W11002998', 'WY01', 'Billings Clinic - Derm', 'Samuel', 'J', 'Reck', 'MD', 'Dermatology', NULL, NULL, NULL, 'o', '2825 8th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382437', 'PO Box 37000', 'Billings', '', 'MT', '59107', '', '', '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2008-02-01', '2009-04-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1790832756', 0, 'n', 0, '2010-03-16', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11004324', 'W11004324', 'WY01', 'Billings Clinic - Peds', 'J', 'Patrick', 'Sauer', 'MD', 'Pediatrics', NULL, NULL, NULL, 'B', 'PO Box 35100', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', NULL, 'PO Box 37000', 'BILLINGS', '', 'MT', '59107', '', '', '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2008-02-01', '2008-02-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1295818953', 0, 'Y', 0, '2009-05-04', NULL, NULL, 0, 0, NULL, NULL),
('870640775', 'W11004325', 'W11004325', 'UT01', 'Uiversity Health Care', 'Naomi', 'R', 'Laird', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '1525 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8012139900', NULL, '1525 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8012139900', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-04-28', '2012-09-18', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1053303420', 0, 'N', 0, '2012-09-19', NULL, NULL, 0, 0, NULL, NULL),
('870640775', 'W11004326', 'W11004326', 'UT01', 'Uiversity Health Care', 'Naomi', 'R', 'Laird', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '7495 S State St', 'Salt Lake City', 'Salt Lake', 'UT', '84047', '8012139400', NULL, '7495 S State St', 'Salt Lake City', 'Salt Lake', 'UT', '84047', '8012139400', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-04-28', '2012-09-18', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1053303420', 0, 'N', 0, '2012-09-19', NULL, NULL, 0, 0, NULL, NULL),
('870640775', 'W11004327', 'W11004327', 'UT01', 'Uiversity Health Care', 'Naomi', 'R', 'Laird', 'PA', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876303', NULL, 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876303', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-04-28', '2012-09-18', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1053303420', 0, 'N', 0, '2012-09-19', NULL, NULL, 0, 0, NULL, NULL),
('870483582', 'W11004328', 'W11004328', 'UT01', 'Uiversity Health Care', 'Naomi', 'R', 'Laird', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '590 Wakara Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015877100', NULL, '590 Wakara Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015877100', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2012-08-22', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1053303420', 0, 'N', 0, '2012-08-23', NULL, NULL, 0, 0, NULL, NULL),
('870483582', 'W11004329', 'W11004329', 'UT01', 'Uiversity Health Care', 'Naomi', 'R', 'Laird', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '555 Foothill Blvd Ste 3', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015817790', NULL, '555 Foothill Blvd Ste 3', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015817790', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2012-08-22', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1053303420', 0, 'N', 0, '2012-08-23', NULL, NULL, 0, 0, NULL, NULL),
('870478993', 'W11004330', 'W11004330', 'UT01', 'Uiversity Health Care', 'Naomi', 'R', 'Laird', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '555 Foothill Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015817790', NULL, '555 Foothill Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015817790', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2012-08-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1053303420', 0, 'N', 0, '2012-08-31', NULL, NULL, 0, 0, NULL, NULL),
('870478993', 'W11004331', 'W11004331', 'UT01', 'Uiversity Health Care', 'Naomi', 'R', 'Laird', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817818', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817818', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2012-08-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1053303420', 0, 'N', 0, '2012-08-31', NULL, NULL, 0, 0, NULL, NULL),
('870478993', 'W11004332', 'W11004332', 'UT01', 'U-U General Medicine Division', 'Naomi', 'R', 'Laird', 'PA', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8012133800', NULL, 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2012-08-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1053303420', 0, 'Y', 0, '2012-08-31', NULL, NULL, 0, 0, NULL, NULL),
('876000525', 'W11004333', 'W11004333', 'UT01', 'University of Utah Hospital', 'Kristen', 'V', 'Nielsen-Jones', 'OT', 'Occupational Therapy', NULL, NULL, NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015812121', NULL, NULL, NULL, '', NULL, NULL, '', '', '', NULL, '1', '0.00', '0.00', '0.00', 6, '2007-11-15', NULL, 1, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '0000007877', 0, 'Y', 0, '2008-05-06', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('876000525', 'W11004334', 'W11004334', 'UT01', 'University of Utah Hospital', 'Meghan', 'L', 'Howell', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'B', 'PO Box 510721 ', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015812121', NULL, NULL, NULL, '', NULL, NULL, '', '', NULL, NULL, '1', '0.00', NULL, NULL, 6, '2008-03-21', '2006-01-01', 1, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'W11004335', 'W11004335', 'UT01', 'Tanner Memorial Clinic', 'Mark', 'R', 'Lenthe', 'DO', 'Family Practice', '', '', NULL, 'O', '2121 Robins Dr', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', '2121 Robins Dr', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'WUTANNER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-07-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1831188358', 0, 'N', 0, '2014-07-21', NULL, NULL, 41.0893, -111.997, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('876000525', 'W11004336', 'W11004336', 'UT01', 'University of Utah Hospital', 'Meghan', 'L', 'Howell', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812121', NULL, NULL, NULL, '', NULL, NULL, '', '', '', NULL, '1', '0.00', '0.00', '0.00', 6, '2008-03-21', NULL, 1, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '0000006787', 0, 'N', 0, '2008-05-07', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('870616107', 'W11004337', 'W11004337', 'UT01', 'University Health Care', 'Adam', 'R', 'Frederick', 'MD', 'Family Practice', '', '', NULL, 'O', '1525 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8012139900', NULL, '1525 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8012139900', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-08-01', '2012-09-16', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1184809949', 0, 'N', 0, '2012-09-17', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11004338', 'W11004338', 'UT01', 'University Health Care', 'Adam', 'R', 'Frederick', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876303', NULL, 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876303', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-08-01', '2012-09-16', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1184809949', 0, 'Y', 0, '2012-09-17', NULL, NULL, 0, 0, NULL, NULL),
('621795215', 'W11004339', 'W11004339', 'UT01', 'Center of Orthopedic and Rehab', 'Patrick', 'A', 'Barnes', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 150', 'West Jordan', 'Salt Lake', 'UT', '84084', '8013529500', NULL, 'PO Box 150', 'West Jordan', 'Salt Lake', 'UT', '84084', '8013529500', '', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2007-10-25', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1447329164', 0, 'Y', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('621795215', 'W11004340', 'W11004340', 'UT01', 'Center of Orthopedic and Rehab', 'Patrick', 'A', 'Barnes', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '3584 W 9000 S Ste 405', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015683480', NULL, '3584 W 9000 S Ste 405', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015683480', '', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2007-10-25', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1447329164', 0, 'N', 0, '2014-06-23', NULL, NULL, 40.5879, -111.976, NULL, NULL),
('528969825', 'W11004341', 'W11004341', 'UTMH1', 'Price Neuropsychological Clinic', 'Heath', 'D', 'Earl', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '590 E 100 N Ste 1', 'Price', 'Carbon', 'UT', '84501', '4356301499', NULL, '590 E 100 N Ste 1', 'Price', 'Carbon', 'UT', '84501', '4356301499', '', 'UTPHD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-02-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093992232', 0, 'n', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11004342', 'W11004342', 'WY01', 'Billings Clinic - Geriatrics', 'Diane', NULL, 'Kersten', 'LCSW', 'Geriatrics', NULL, NULL, NULL, 'O', '2825 8th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382413', 'PO Box 37000', 'Billings', '', 'MT', '59107', '', '', '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2008-05-06', '2009-04-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1093801847', 0, 'N', 0, '2010-01-15', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11004343', 'W11004343', 'WY01', 'Billings Clinic - Geriatrics', 'Valerie', '', 'Caton', 'APRN', 'Family Practice', '', '', NULL, 'O', '2825 8th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382413', '2825 8th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382413', '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2008-05-07', '2009-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104846658', 0, 'N', 0, '2013-12-26', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11004344', 'W11004344', 'WY01', 'Billings Clinic - Rehab', 'Ryan', 'J', 'Strecker', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'O', '2825 8th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382978', 'PO Box 37000', 'Billings', '', 'MT', '59107', '', '', '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2008-05-06', '2009-04-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1720254139', 0, 'N', 0, '2010-01-15', NULL, NULL, 0, 0, NULL, NULL),
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('870395551', 'W11004417', 'W11004417', 'UT01', NULL, 'Walter', NULL, 'Robertson', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', 'PO Box 2817 1 Kayenta Dr', 'Kayenta', 'Navajo', 'AZ', '86033', '9286972547', '9286972549', '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2008-01-01', '2008-01-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1639250137', 0, 'Y', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11004418', 'W11004418', 'UT01', NULL, 'Brian', NULL, 'Robinson', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '1880 E 17th St', 'Idaho Falls', 'Bonneville', 'ID', '83404', '2085230121', '2085290001', '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2008-01-01', '2010-10-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1346282100', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11004419', 'W11004419', 'UT01', NULL, 'Jeff', NULL, 'Roderick', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '1096 Erikson Dr', 'Rexburg', 'Madison', 'ID', '83440', '2086563205', '2086563206', '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2008-01-01', '2010-10-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1740289248', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
('820391200', 'W11004420', 'W11004420', 'ID01', 'Neurological Associates', '', '', 'Neurological Associates', 'GROUP', 'Neurology', '', '', NULL, 'B', '3875 E Overland Rd Ste 203', 'Meridian', 'Ada', 'ID', '83642', '2083433976', NULL, '3875 E Overland Rd Ste 203', 'Meridian', 'Ada', 'ID', '83642', '2083433976', '', 'IDSTD', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912963372', 0, 'n', 0, '2014-04-15', NULL, NULL, 43.5898, -116.346, NULL, NULL),
('820391200', 'W11004421', 'W11004421', 'ID01', 'Neurological Associates', 'Martha', 'A', 'Cline', 'MD', 'Neurology', '', '', NULL, 'O', '3875 E Overland Rd Ste 203', 'Meridian', 'Ada', 'ID', '83642', '2083433976', NULL, '3875 E Overland Rd Ste 203', 'Meridian', 'Ada', 'ID', '83642', '2083433976', '', 'IDSTD', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1043249964', 0, 'n', 0, '2014-04-25', NULL, NULL, 43.5898, -116.346, NULL, NULL),
('820391200', 'W11004422', 'W11004422', 'ID01', 'Neurological Associates', 'Stephen', 'W', 'Asher', 'MD', 'Neurology', '', '', NULL, 'O', '3875 E Overland Rd Ste 203', 'Meridian', 'Ada', 'ID', '83642', '2083433976', NULL, '3875 E Overland Rd Ste 203', 'Meridian', 'Ada', 'ID', '83642', '2083433976', '', 'IDSTD', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1871523373', 0, 'n', 0, '2014-04-25', NULL, NULL, 43.5898, -116.346, NULL, NULL),
('820391200', 'W11004423', 'W11004423', 'ID01', 'Neurological Associates', 'Allen', 'C', 'Han', 'MD', 'Neurology', '', '', NULL, 'O', '3875 E Overland Rd Ste 203', 'Meridian', 'Ada', 'ID', '83642', '2083433976', NULL, '3875 E Overland Rd Ste 203', 'Meridian', 'Ada', 'ID', '83642', '2083433976', '', 'IDSTD', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1801825724', 0, 'n', 0, '2014-04-25', NULL, NULL, 43.5898, -116.346, NULL, NULL),
('203129832', 'W11004424', 'W11004424', 'ID01', 'Idaho Minor Emergency and Family Practice', 'Raymond', 'P', 'Hooft', 'MD', 'Family Practice', '', '', NULL, 'O', '3041 E Copper Pointe Dr', 'Meridian', 'Ada', 'ID', '83642', '2085144400', NULL, '3041 E Copper Pointe Dr', 'Meridian', 'Ada', 'ID', '83642', '2085144400', '', 'IDSTD', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114974326', 0, 'n', 0, '2011-12-15', NULL, NULL, 43.5837, -116.356, NULL, NULL),
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('820424691', 'W11004426', 'W11004426', 'ID01', 'Boise Family Medicine Center', 'Eric', 'S', 'Jacobsen', 'MD', 'Family Practice', '', '', NULL, 'O', '10798 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083773368', '2083224691', '10798 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083773368', '2083224691', 'IDSTD', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2009-12-10', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1053405969', 0, 'n', 0, '2011-11-09', NULL, NULL, 0, 0, NULL, NULL),
('820424691', 'W11004427', 'W11004427', 'ID01', 'Boise Family Medicine Center', 'Dale', 'L', 'Mock', 'MD', 'Family Practice', '', '', NULL, 'O', '10798 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083773368', NULL, '10798 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083773368', '', 'IDSTD', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2009-12-10', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1215948351', 0, 'n', 0, '2011-06-29', NULL, NULL, 0, 0, NULL, NULL),
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('721545000', 'W11004431', 'W11004431', 'UT01', 'Dinosaurland Pediatrics', 'Vanessa', '', 'LaQuinte', 'MD', 'Pediatrics', '', '', NULL, 'O', '175 N 100 W Ste 106', 'Vernal', 'Uintah', 'UT', '84078', '4357899060', '4357897754', '175 N 100 W Ste 106', 'Vernal', 'Uintah', 'UT', '84078', '4357899060', '4357897754', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-04-28', '2009-08-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396945770', 0, 'N', 0, '2011-12-06', NULL, NULL, 0, 0, NULL, NULL),
('870635889', 'W11004432', 'W11004432', 'UT01', 'Tooele Clinic Corp', 'Blaine', 'J', 'Cashmore', 'MD', 'General Surgery', '', '', NULL, 'B', '330 Franklin Rd Ste 135A', 'Brentwood', 'Williamson', 'TN', '37027', '6153457331', NULL, '330 Franklin Rd Ste 135A', 'Brentwood', 'Williamson', 'TN', '37027', '6153457331', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-07-02', NULL, 0, 0, 0, 'Mountain West Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1174576144', 0, 'Y', 0, '2011-10-19', NULL, NULL, 0, 0, NULL, NULL),
('870635889', 'W11004433', 'W11004433', 'UT01', 'Oquirrh Surgical Services', 'Blaine', 'J', 'Cashmore', 'MD', 'General Surgery', '', '', NULL, 'O', '196 E 2000 N Ste 110', 'Tooele', 'Tooele', 'UT', '84074', '4352280061', NULL, '196 E 2000 N Ste 110', 'Tooele', 'Tooele', 'UT', '84074', '4352280061', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-07-02', NULL, 0, 0, 0, 'Mountain West Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1174576144', 0, 'N', 0, '2014-02-26', NULL, NULL, 40.5656, -112.294, NULL, NULL),
('870635889', 'W11004434', 'W11004434', 'UT01', 'Mountain View Health Care', 'Ermita', '', 'Bort', 'MD', 'Internal Medicine', 'Pediatrics', 'Hospitalist', NULL, 'O', '1959 N Aaron Dr Ste C', 'Tooele', 'Tooele', 'UT', '84074', '4358821644', NULL, '1959 N Aaron Dr Ste C', 'Tooele', 'Tooele', 'UT', '84074', '4358821644', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-08-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1649475120', 0, 'N', 0, '2011-09-19', NULL, NULL, 40.5653, -112.298, NULL, NULL),
('870635889', 'W11004435', 'W11004435', 'UT01', NULL, 'Ermita', '', 'Bort', 'MD', 'Internal Medicine', 'Pediatrics', 'Hospitalist', NULL, 'B', '330 Franklin Rd Ste 135A', 'Brentwood', 'Williamson', 'TN', '37027', '6153457331', NULL, '330 Franklin Rd Ste 135A', 'Brentwood', 'Williamson', 'TN', '37027', '6153457331', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-07-02', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1649475120', 0, 'Y', 0, '2011-09-19', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('450317368', 'W11004436', 'W11004436', 'TX01', 'Country Breeze Counseling Center', 'Donna', '', 'Granato', 'LPC', 'Mental Health', '', '', NULL, 'B', '3160  FM 3175', 'Lytle', 'Atascosa', 'TX', '78052', '8307090711', NULL, '3160  FM 3175', 'Lytle', 'Atascosa', 'TX', '78052', '8307090711', '', 'TXMA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2008-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154468296', 0, 'Y', 0, '2011-01-19', NULL, NULL, 0, 0, NULL, NULL),
('741899144', 'W11004437', 'W11004437', 'TX01', NULL, 'Efren', 'S', 'Olea', 'MD', 'Mental Health', '', '', NULL, 'O', '343 W Houston St Ste 408', 'San Antonio', 'Bexar', 'TX', '78205', '2102262238', NULL, '343 W Houston St Ste 408', 'San Antonio', 'Bexar', 'TX', '78205', '2102262238', '', 'TXMD', NULL, NULL, '0.00', '100.00', '0.00', 3, '2008-06-01', '2009-07-24', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740285386', 0, 'N', 0, '2011-04-12', NULL, NULL, 29.4267, -98.4973, NULL, NULL),
('870635889', 'W11004454', 'W11004454', 'UT01', 'Tooele Clinic Corp', 'Heidi', 'S', 'McMillan', 'MD', 'Pediatrics', '', '', NULL, 'B', '330 Franklin Rd Ste 135A-304', 'Brentwood', 'Williamson', 'TN', '37027', '8778481463', '4358821275', '330 Franklin Rd Ste 135A-304', 'Brentwood', 'Williamson', 'TN', '37027', '8778481463', '4358821275', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-05-27', '2011-10-17', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457371742', 0, 'Y', 0, '2011-10-19', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11004455', 'W11004455', 'WY01', 'Billings Clinic - Occupational Health & Wellness', 'Tina', NULL, 'Garcia', 'OT', 'Occupational Therapy', NULL, NULL, NULL, 'O', '2825 8th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382066', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2008-02-01', '2009-03-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1730346297', 0, 'N', 0, '2009-05-04', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11004451', 'W11004451', 'WY01', 'Billings Clinic - Miles City Clinic', 'William', NULL, 'Smith', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '620 S Haynes', 'Miles City', 'Custer', 'MT', '59301', '4062337000', '4062337070', 'PO Box 37000', 'Billings', 'Custer', 'MT', '59107', NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2008-05-15', '2009-04-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1396739561', 0, 'N', 0, '2009-05-04', NULL, NULL, 0, 0, NULL, NULL),
('231705363', 'W11004460', 'W11004460', 'TX01', NULL, 'Sydney', 'E', 'Slye', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '120 E Colorado', 'Pearsall', 'Frio', 'TX', '78061', '2104946340', NULL, '120 E Colorado', 'Pearsall', 'Frio', 'TX', '78061', '2104946340', '', 'TXMA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2008-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821001413', 0, 'Y', 0, '2014-02-05', NULL, NULL, 0, 0, NULL, NULL),
('742794469', 'W11004956', 'W11004956', 'TX01', 'Alamo Psychiatric Care PA', 'Damaso', 'A', 'Oliva', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'B', 'PO Box 13396', 'San Antonio', 'Bexar', 'TX', '78213', '2102253764', NULL, 'PO Box 13396', 'San Antonio', 'Bexar', 'TX', '78213', '2102253764', '', 'TXMD', NULL, NULL, '0.00', '100.00', '0.00', 3, '2008-06-01', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1659304350', 0, 'Y', 0, '2011-11-14', NULL, NULL, 0, 0, NULL, NULL),
('742794469', 'W11004955', 'W11004955', 'TX01', 'Alamo Psychiatric Care', 'Damaso', 'A', 'Oliva', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '343 W Houston St Ste 301', 'San Antonio', 'Bexar', 'TX', '78205', '2102253764', NULL, '343 W Houston St Ste 301', 'San Antonio', 'Bexar', 'TX', '78205', '2102253764', '          ', 'TXMD', '', '', '0.00', '100.00', '0.00', 3, '2008-06-01', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1659304350', 0, 'N', 0, '2011-11-14', NULL, NULL, 29.4264, -98.4967, NULL, NULL),
('331001443', 'W11004457', 'W11004457', 'TX01', 'Tree of Life Counseling', 'Antonio', 'M', 'Navarro', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1931 NW Military Hwy Ste 222', 'San Antonio', 'Bexar', 'TX', '78213', '2103497404', NULL, '1931 NW Military Hwy Ste 222', 'San Antonio', 'Bexar', 'TX', '78213', '2103497404', '', 'TXMA', NULL, '', '0.00', '100.00', '0.00', 3, '2008-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518180934', 0, 'n', 0, '2014-07-21', NULL, NULL, 29.5284, -98.5193, NULL, NULL),
('030606179', 'W11004947', 'W11004947', 'TX01', NULL, 'Lou', '', 'Valdez', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '6609 Blanco Ste 157', 'San Antonio', 'Bexar', 'TX', '78216', '2105250202', NULL, '6609 Blanco Ste 157', 'San Antonio', 'Bexar', 'TX', '78216', '2105250202', '', 'TXMA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2008-06-01', '2008-11-21', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366523466', 0, 'n', 0, '2014-02-21', NULL, NULL, 0, 0, NULL, NULL),
('502469443', 'W11004456', 'W11004456', 'TX01', NULL, 'Arlis', 'F', 'Schmidt', 'LCSW', 'Mental Health', 'Social Worker', NULL, NULL, 'O', '1635 N E Loop 410 Ste 901', 'San Antonio', 'Bexar', 'TX', '78209', '2103267447', '2104946494', '1635 N E Loop 410', 'San Antonio', 'Bexar', 'TX', '78209', NULL, NULL, 'TXMA', NULL, NULL, '0.00', '100.00', '0.00', 3, '2008-06-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1497844971', 0, 'Y', 0, '2008-05-22', NULL, NULL, 29.5164, -98.4386, NULL, NULL),
('237847064', 'W11004945', 'W11004945', 'TX01', 'Adult - Parent - Family - Child', 'Marianne', 'M', 'Ross', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '10615 Perrin-Beitel Ste 402', 'San Antonio', 'Bexar', 'TX', '78217', '2103647609', NULL, '10615 Perrin-Beitel Ste 402', 'San Antonio', 'Bexar', 'TX', '78217', '2103647609', '', 'TXMA', NULL, '', '0.00', '100.00', '0.00', 3, '2008-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407912249', 0, 'n', 0, '2014-05-08', NULL, NULL, 29.5367, -98.4111, NULL, NULL),
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('820477852', 'W11004652', 'W11004652', 'ID01', 'Saint Alphonsus Medical Group Eagle Health Plaza', 'Leck', '', 'Read', 'MD', 'Family Practice', '', '', NULL, 'B', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675180', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675180', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2008-07-01', '2012-04-03', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316965239', 0, 'Y', 0, '2012-04-03', NULL, NULL, 43.6892, -116.351, NULL, NULL),
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('820418861', 'W11004474', 'W11004474', 'ID01', 'The Walking Center', 'William', 'S', 'Stano', 'DPM', 'Podiatry', NULL, NULL, NULL, 'O', '220 W Jefferson St', 'Boise', 'Ada', 'ID', '83702', '2083438907', '2083439161', '220 W Jefferson St', 'Boise', 'Ada', 'ID', '83702', '2083438907', '2083439161', 'IDMED', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', 'Saint Alphonsus Medical Center Nampa', NULL, '', 'HCFA|UB|', '1063426948', 0, 'N', 0, '2013-07-31', NULL, NULL, 43.615, -116.195, NULL, NULL),
('820418861', 'W11004475', 'W11004475', 'ID01', 'Jefferson Day Surgery Center', 'William', 'S', 'Stano', 'DPM', 'Podiatry', NULL, NULL, NULL, 'O', '220 W Jefferson St', 'Boise', 'Ada', 'ID', '83702', '2083438914', NULL, '220 W Jefferson St', 'Boise', 'Ada', 'ID', '83702', NULL, NULL, 'IDMED', 'WUSTDHCPC5', NULL, '0.00', '30.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, 'St Lukes', NULL, 'Mercy', 'HCFA|UB|', '1063426948', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('820484875', 'W11004939', 'W11004939', 'ID01', 'Boise Family Practice', 'David', NULL, 'Deroin', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '610 W Hays St', 'Boise', 'Ada', 'ID', '83702', '2083427722', NULL, '610 W Hays St', 'Boise', 'Ada', 'ID', '83702', NULL, NULL, 'IDSTD', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2008-09-29', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1609815158', 0, 'n', 0, '2008-05-28', NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'W11004610', 'W11004610', 'ID01', 'Idaho Emergency Physicians PA', 'Michael', 'R', 'Mercy', 'MD', 'Emergency Medicine', '', '', NULL, 'o', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83704', '2083221730', '2083221731', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83704', '2083221730', '2083221731', 'IDSAMG3', NULL, NULL, '0.00', '10.00', '0.00', 3, '2008-07-01', '2010-01-30', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1689602336', 0, 'n', 0, '2013-04-02', NULL, NULL, 43.6136, -116.256, NULL, NULL),
('820312175', 'W11004608', 'W11004608', 'ID01', 'Idaho Emergency Physicians PA', 'Christopher', 'T', 'Lawler', 'MD This Provider will terminate on July 1st', 'Sports Medicine', 'Emergency Medicine', '', NULL, 'o', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83704', '2083221730', '2083221731', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83704', '2083221730', '2083221731', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2008-07-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1801801576', 0, 'N', 0, '2012-10-01', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('820477852', 'W11004661', 'W11004661', 'ID01', 'Saint Alphonsus Medical Group Emerald', 'Scott', 'N', 'Schwendiman', 'MD', 'Family Practice', '', '', NULL, 'o', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', 'IDSAMG2', NULL, '', '0.00', '10.00', '0.00', 6, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1538110234', 0, 'n', 0, '2014-06-20', NULL, NULL, 43.6119, -116.268, NULL, NULL),
('820312175', 'W11004606', 'W11004606', 'ID01', 'Idaho Emergency Physicians PA', 'Michael', 'J', 'Lamers', 'MD', 'Emergency Medicine', '', '', NULL, 'o', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83704', '2083221730', '2083221731', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83704', '2083221730', '2083221731', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2008-07-01', '2011-09-15', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1629091491', 0, 'N', 0, '2012-01-30', NULL, NULL, 43.6136, -116.256, NULL, NULL),
('820312175', 'W11004620', 'W11004620', 'ID01', 'Idaho Emergency Physicians PA', 'Christopher', 'E', 'Tobe', 'MD', 'Emergency Medicine', '', '', NULL, 'o', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83704', '2083221730', '2083221731', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83704', '2083221730', '2083221731', 'IDSAMG3', NULL, NULL, '0.00', '10.00', '0.00', 3, '2008-07-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1205889136', 0, 'n', 0, '2012-01-31', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('820312175', 'W11004614', 'W11004614', 'ID01', 'Idaho Emergency Physicians PA', 'Jason', 'M', 'Quinn', 'MD', 'Emergency Medicine', '', '', NULL, 'o', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83704', '2083221730', '2083221731', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83704', '2083221730', '2083221731', 'IDSAMG3', NULL, NULL, '0.00', '10.00', '0.00', 3, '2008-07-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1710978036', 0, 'n', 0, '2012-01-31', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('820312175', 'W11004616', 'W11004616', 'ID01', 'Idaho Emergency Physicians PA', 'Janet', 'A', 'Rosenquist', 'MD', 'Emergency Medicine', '', '', NULL, 'o', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83704', '2083221730', '2083221731', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83704', '2083221730', '2083221731', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2008-07-01', '2012-03-15', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1265468144', 0, 'N', 0, '2013-04-02', NULL, NULL, 43.6136, -116.256, NULL, NULL),
('820312175', 'W11004618', 'W11004618', 'ID01', 'Idaho Emergency Physicians PA', 'Kristen', 'H', 'Saak', 'MD', 'Emergency Medicine', '', '', NULL, 'o', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83704', '2083221730', '2083221731', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83704', '2083221730', '2083221731', 'IDSAMG3', NULL, NULL, '0.00', '10.00', '0.00', 3, '2008-07-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1821128018', 0, 'n', 0, '2012-01-31', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('820312175', 'W11004612', 'W11004612', 'ID01', 'Idaho Emergency Physicians PA', 'Mike', 'W', 'Pool', 'MD', 'Emergency Medicine', '', '', NULL, 'o', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83704', '2083221730', '2083221731', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83704', '2083221730', '2083221731', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2008-07-01', '2011-12-31', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', 'West Valley Medical Center', '', '', 'HCFA|UB|', '1154368918', 0, 'N', 0, '2012-02-23', NULL, NULL, 43.6136, -116.256, NULL, NULL),
('820487790', 'W11004441', 'W11004441', 'ID01', 'Selah Medical Center', 'Renee', 'M', 'Wilson', 'PA-C', 'Family Practice', '', '', NULL, 'O', '6565 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083775055', NULL, '6565 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083775055', '', 'IDPCPSELAH', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215019534', 0, 'n', 0, '2013-09-11', NULL, NULL, 43.6119, -116.268, NULL, NULL),
('820312175', 'W11004624', 'W11004624', 'ID01', 'Idaho Emergency Physicians PA', 'Brandon', 'J', 'Wilding', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83704', '2083221730', '2083221731', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83704', '2083221730', '2083221731', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2008-07-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1851307367', 0, 'N', 0, '2014-04-15', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('820487790', 'W11004446', 'W11004446', 'ID01', 'Selah Medical Center', 'Donald', 'D', 'Hartman', 'MD', 'Family Practice', '', '', NULL, 'O', '6565 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083775055', NULL, '6565 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083775055', '', 'IDPCPSELAH', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1588669410', 0, 'n', 0, '2013-07-12', NULL, NULL, 43.6119, -116.268, NULL, NULL),
('820477852', 'W11004659', 'W11004659', 'ID01', 'Saint Alphonsus Medical Group Womens Health', 'Leck', '', 'Read', 'MD', 'Family Practice', '', '', NULL, 'B', '6140 W Curtisian Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083674224', '2083677806', '6140 W Curtisian Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083674224', '2083677806', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2008-07-01', '2012-04-03', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316965239', 0, 'Y', 0, '2012-04-03', NULL, NULL, 43.6151, -116.256, NULL, NULL),
('820487790', 'W11004440', 'W11004440', 'ID01', 'Selah Medical Center', 'Stephen', '', 'Spencer', 'MD', 'Internal Medicine', '', '', NULL, 'O', '6565 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083775055', NULL, '6565 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083775055', '', 'IDPCPSELAH', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1376548230', 0, 'n', 0, '2011-11-14', NULL, NULL, 43.6119, -116.268, NULL, NULL),
('820477852', 'W11004629', 'W11004629', 'ID01', 'Saint Alphonsus Medical Group Emerald', 'Charles', 'M', 'Davis', 'DO', 'Family Practice', '', '', NULL, 'o', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', 'IDSAMG2', NULL, '', '0.00', '10.00', '0.00', 6, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1104877364', 0, 'n', 0, '2014-06-20', NULL, NULL, 43.6119, -116.268, NULL, NULL),
('820477852', 'W11004655', 'W11004655', 'ID01', 'Saint Alphonsus Medical Group Internal Medicine', 'Leck', '', 'Read', 'MD', 'Family Practice', '', '', NULL, 'B', '6094 Emerald Ste 2', 'Boise', 'Ada', 'ID', '83704', '2083676575', '2083676597', '6094 Emerald Ste 2', 'Boise', 'Ada', 'ID', '83704', '2083676575', '2083676597', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2008-07-01', '2012-04-03', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316965239', 0, 'Y', 0, '2012-04-03', NULL, NULL, 43.6122, -116.257, NULL, NULL),
('820487790', 'W11004444', 'W11004444', 'ID01', 'Selah Medical Center', 'Bryan', 'C', 'Pogue', 'MD', 'Family Practice', '', '', NULL, 'O', '6565 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083775055', NULL, '6565 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083775055', '', 'IDPCPSELAH', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1740286723', 0, 'n', 0, '2012-01-04', NULL, NULL, 43.6119, -116.268, NULL, NULL),
('820477852', 'W11004653', 'W11004653', 'ID01', 'Saint Alphonsus Medical Group Emerald Family Medicine', 'Leck', '', 'Read', 'MD', 'Family Practice', '', '', NULL, 'B', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2008-07-01', '2012-04-03', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316965239', 0, 'Y', 0, '2014-01-24', NULL, NULL, 43.6119, -116.268, NULL, NULL),
('820312175', 'W11004580', 'W11004580', 'ID01', 'Idaho Emergency Physicians PA', 'Peter', 'J', 'Angleton', 'MD', 'Emergency Medicine', '', '', NULL, 'o', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83704', '2083221730', '2083221731', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83704', '2083221730', '2083221731', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2008-07-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1821042334', 0, 'N', 0, '2012-01-06', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('820487790', 'W11004443', 'W11004443', 'ID01', 'Selah Medical Center', 'Lawrence', 'E', 'Brown', 'MD', 'Family Practice', '', '', NULL, 'O', '6565 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083775055', NULL, '6565 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083775055', '', 'IDPCPSELAH', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1922040021', 0, 'n', 0, '2012-01-25', NULL, NULL, 43.6119, -116.268, NULL, NULL),
('820312175', 'W11004622', 'W11004622', 'ID01', 'Idaho Emergency Physicians PA', 'Guerin', 'M', 'Walsh', 'MD', 'Emergency Medicine', '', '', NULL, 'o', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83704', '2083221730', '2083221731', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83704', '2083221730', '2083221731', 'IDSAMG3', NULL, NULL, '0.00', '10.00', '0.00', 3, '2008-07-01', '2008-11-13', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1871530824', 0, 'n', 0, '2013-02-28', NULL, NULL, 43.6136, -116.256, 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
('331078261', 'W11004541', 'W11004541', 'ID01', 'Saint Alphonsus Physicians PA', 'Walter', 'L', 'Seale', 'MD', 'Cardiology', '', '', NULL, 'o', '6140 W Curtisian Ste 200', 'Boise', 'Ada', 'ID', '83704', '2083674278', '2083675200', '6140 W Curtisian Ste 200', 'Boise', 'Ada', 'ID', '83704', '2083674278', '2083675200', 'IDSAMG1', NULL, NULL, '0.00', '10.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1720033459', 0, 'n', 0, '2014-01-24', NULL, NULL, 43.6151, -116.256, NULL, NULL),
('820200895', 'W11004564', 'W11004564', 'ID01', 'Saint Alphonsus Addiction Recovery Center', 'Gary', NULL, 'Edson', '0', 'Mental Health', 'Counseling', '', NULL, 'o', '6138 Emerald Ste  B', 'Boise', 'Ada', 'ID', '83704', '2083673553', '2083760285', '6138 Emerald Ste  B', 'Boise', 'Ada', 'ID', '83704', '2083673553', '2083760285', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2008-07-01', '2010-06-04', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1275688012', 0, 'N', 0, '2008-05-22', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W11004563', 'W11004563', 'ID01', 'Saint Alphonsus Regional Medical Center Behavioral Health', 'Maria', 'C', 'DiMattina', 'LCSW', 'Mental Health', 'Counseling', '', NULL, 'o', '131 N Allumbaugh', 'Boise', 'Ada', 'ID', '83704', '2083672175', '2083760285', '131 N Allumbaugh', 'Boise', 'Ada', 'ID', '83704', '2083672175', '2083760285', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2008-07-01', '2011-04-21', 0, 0, 0, '', '', '', '', 'HCFA|', '1326069808', 0, 'N', 0, '2011-08-05', NULL, NULL, 43.6059, -116.267, NULL, NULL),
('820200895', 'W11004562', 'W11004562', 'ID01', 'Saint Alphonsus Addiction Recovery Center', 'Ted', '', 'Burgess', 'LCSW', 'Mental Health', 'Counseling', '', NULL, 'o', '6138 Emerald Ste  B', 'Boise', 'Ada', 'ID', '83704', '2083673553', '2083760285', '6138 Emerald Ste  B', 'Boise', 'Ada', 'ID', '83704', '2083673553', '2083760285', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2008-07-01', '2010-06-04', 0, 0, 0, '', '', '', '', 'HCFA|', '1770618712', 0, 'N', 0, '2013-12-23', NULL, NULL, 0, 0, NULL, NULL),
('820477852', 'W11004902', 'W11004902', 'ID01', 'Saint Alphonsus Billing', '', '', 'Saint Alphonsus Billing', 'Group', '', '', '', NULL, 'B', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '          ', '', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '          ', '', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2008-07-01', '2013-01-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008537', 0, 'Y', 0, '2014-07-25', NULL, NULL, 43.6119, -116.268, NULL, NULL),
('841394139', 'W11004997', 'W11004997', 'ID01', 'Southwest Idaho ENT ', 'Todd', 'J', 'Rustad', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '900 N Liberty St Ste 400', 'Boise', 'Ada', 'ID', '83704', '2083673320', NULL, '900 N Liberty St Ste 400', 'Boise', 'Ada', 'ID', '83704', '2083673320', '          ', 'IDSWIENT', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1306829973', 0, 'N', 0, '2014-01-24', NULL, NULL, 43.6133, -116.259, NULL, NULL),
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('841433992', 'W11004986', 'W11004986', 'UTPEHP', 'Rosenberg Cooley Metcalf', 'Michael', 'H', 'Metcalf', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '5848 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8017434500', NULL, '5848 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8017434500', '', 'WMETCALF', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', NULL, 0, 0, 0, 'Heber Valley Medical Center', '', '', '', 'HCFA|UB|', '1750333092', 0, 'n', 0, '2014-02-06', NULL, NULL, 0, 0, NULL, NULL),
('841433992', 'W11004980', 'W11004980', 'UTPEHP', 'Rosenberg Cooley Metcalf', 'Thomas', 'D', 'Rosenberg', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '5848 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8017434500', NULL, '5848 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8017434500', '', 'WMETCALF', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', NULL, 0, 0, 0, 'Park City Medical Center', '', '', '', 'HCFA|UB|', '1144273905', 0, 'n', 0, '2011-10-05', NULL, NULL, 0, 0, NULL, NULL),
('841433992', 'W11004983', 'W11004983', 'UTPEHP', 'Rosenberg Cooley Metcalf', 'Vernon', 'J', 'Cooley', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '5848 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8017434500', NULL, '5848 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8017434500', '', 'WMETCALF', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', NULL, 0, 0, 0, 'Park City Medical Center', 'Heber Valley Medical Center', '', '', 'HCFA|UB|', '1891747291', 0, 'n', 0, '2011-11-21', NULL, NULL, 0, 0, NULL, NULL),
('202422775', 'W11004477', 'W11004477', 'UT01', 'Wasatch Endocrinology Inc', 'Robert', 'E', 'Burr', 'MD', 'Endocrinology', 'Diabetes', '', NULL, 'O', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8017460776', NULL, '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8017460776', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-04-01', '2011-09-20', 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1770533788', 0, 'N', 0, '2011-09-21', NULL, NULL, 0, 0, NULL, NULL),
('920185134', 'W11004892', 'W11004892', 'UT01', 'Highland Family Practice', 'Amanda', 'J', 'Wirth', 'MD', 'Family Practice', '', '', NULL, 'O', '4460 Highland Dr Ste 400', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012724111', '8012725989', '4460 Highland Dr Ste 400', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012724111', '8012725989', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-01-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1376612150', 0, 'N', 0, '2012-05-01', NULL, NULL, 40.6754, -111.842, NULL, NULL),
('920185134', 'W11004893', 'W11004893', 'UT01', 'Highland Family Practice', 'Brian', 'G', 'Drage', 'MD', 'Family Practice', '', '', NULL, 'O', '4460 Highland Dr Ste 400', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012724111', '8012725989', '4460 Highland Dr Ste 400', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012724111', '8012725989', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-01-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1932278785', 0, 'N', 0, '2011-05-03', NULL, NULL, 40.6754, -111.842, NULL, NULL),
('920185134', 'W11004894', 'W11004894', 'UT01', 'Highland Family Practice', 'Derek', 'D', 'Muse', 'MD', 'Family Practice', '', '', NULL, 'O', '4460 Highland Dr Ste 400', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012724111', '8012725989', '4460 Highland Dr Ste 400', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012724111', '8012725989', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-01-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1720157555', 0, 'N', 0, '2012-07-02', NULL, NULL, 40.6754, -111.842, NULL, NULL),
('942854057', 'W11004914', 'W11004914', 'UTPEHP', 'Logan InstaCare', '', '', 'Logan InstaCare', 'group', 'Urgent Care', '', '', NULL, 'O', '235 E 400 N', 'Logan', 'Cache', 'UT', '84321', '4357132710', NULL, '235 E 400 N', 'Logan', 'Cache', 'UT', '84321', '4357132710', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245374313', 0, 'N', 0, '2012-03-20', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004909', 'W11004909', 'UTIHCPHY', 'Logan InstaCare M-Sun 8am-8pm', '', '', 'Logan InstaCare', 'group', 'Urgent Care', '', '', NULL, 'o', '235 E 400 N', 'Logan', 'Cache', 'UT', '84321', '4357132710', NULL, '235 E 400 N', 'Logan', 'Cache', 'UT', '84321', '4357132710', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245374313', 0, 'N', 0, '2013-06-12', NULL, NULL, 41.7389, -111.828, NULL, NULL),
('870557437', 'W11004929', 'W11004929', 'UT01', NULL, 'Steven', 'S', 'Salisbury', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1300 N 500 E Ste 370', 'Logan', 'Cache', 'UT', '84341', '4357552100', NULL, '1300 N 500 E Ste 370', 'Logan', 'Cache', 'UT', '84341', '4357552100', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-05-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1235191495', 0, 'n', 0, '2011-07-12', NULL, NULL, 41.7563, -111.821, NULL, NULL),
('870335428', 'W11004471', 'W11004471', 'UT01', 'Optical Associates', 'James', 'L', 'Frost', 'OD', 'Optometry', '', '', NULL, 'O', '1196 30th St', 'Ogden', 'Weber', 'UT', '84403', '8013999873', NULL, '1196 30th St', 'Ogden', 'Weber', 'UT', '84403', '8013999873', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740372846', 0, 'n', 0, '2011-03-10', NULL, NULL, 41.2099, -111.949, NULL, NULL),
('870335428', 'W11004472', 'W11004472', 'UT01', 'Optical Associates', 'Greg', 'M', 'Pickett', 'OD', 'Optometry', '', '', NULL, 'O', '1196 30th St', 'Ogden', 'Weber', 'UT', '84403', '8013999873', '', '1196 30th St', 'Ogden', 'Weber', 'UT', '84403', '8013999873', '', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639155617', 0, 'n', 0, '2014-07-24', NULL, NULL, 41.2099, -111.949, NULL, NULL),
('743098318', 'W11004906', 'W11004906', 'UT01', 'Castle Valley Eyecare', 'Steven', 'O', 'Tuttle', 'OD', 'Optometry', '', '', NULL, 'O', '190 E Main St', 'Castle Dale', 'Emery', 'UT', '84513', '4353812040', NULL, '190 E Main St', 'Castle Dale', 'Emery', 'UT', '84513', '4353812040', '', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912981036', 0, 'N', 0, '2011-10-11', NULL, NULL, 39.2109, -111.02, NULL, NULL),
('522229954', 'W11004449', 'W11004449', 'UT01', 'ProRehab Physical Therapy', 'Brody', 'Jack', 'Leroy', 'OT', 'Physical Therapy', 'Occupational Therapy', '', NULL, 'O', '150 E Main St', 'Castle Dale', 'Emery', 'UT', '84513', '4353815100', NULL, '150 E Main St', 'Castle Dale', 'Emery', 'UT', '84513', '4353815100', '          ', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '58.00', 3, '2008-05-01', '2008-08-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386801363', 0, 'N', 0, '2011-11-29', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11004962', 'W11004962', 'UT01', NULL, 'Rodger', NULL, 'Scoville', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '58 E Main Ste 1', 'Delta', 'Millard', 'UT', '84624', '4358645121', '4358645168', '867 E 9400 S', 'Sandy', 'Millard', 'UT', '84094', NULL, NULL, 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2008-01-01', '2008-04-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000008641', 0, 'N', 0, '2008-05-29', NULL, NULL, 0, 0, NULL, NULL),
('562674710', 'W11004473', 'W11004473', 'UT01', 'Pace Clinic', 'Aaron', 'C', 'Hartle', 'FNP', 'Family Practice', '', '', NULL, 'O', '405 S Main St', 'Springville', 'Utah', 'UT', '84663', '8014912238', NULL, '405 S Main St', 'Springville', 'Utah', 'UT', '84663', '8014912238', '', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578626727', 0, 'n', 0, '2014-07-16', NULL, NULL, 40.161, -111.611, NULL, NULL),
('942854057', 'W11004912', 'W11004912', 'UTPEHP', 'Cedar City InstaCare', '', '', 'IHC Instacare Cedar City', 'group', 'Urgent Care', '', '', NULL, 'O', '962 S Sage Dr', 'Cedar City', 'Iron', 'UT', '84720', '4358653440', NULL, '962 S Sage Dr', 'Cedar City', 'Iron', 'UT', '84720', '4358653440', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225168610', 0, 'N', 0, '2012-03-20', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004907', 'W11004907', 'UTIHCPHY', 'Cedar City InstaCare M-F 9am-5pm', '', '', 'IHC Instacare Cedar City', 'group', 'Urgent Care', '', '', NULL, 'o', '962 S Sage Dr', 'Cedar City', 'Iron', 'UT', '84720', '4358653440', NULL, '962 S Sage Dr', 'Cedar City', 'Iron', 'UT', '84720', '4358653440', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225168610', 0, 'N', 0, '2013-06-12', NULL, NULL, 37.6608, -113.081, NULL, NULL),
('942854057', 'W11004908', 'W11004908', 'UTIHCPHY', 'Hurricane Valley InstaCare M-Sat 9am-9pm', '', '', 'Hurricane Valley InstaCare', 'group', 'Urgent Care', '', '', NULL, 'o', '75 N 2260 W', 'Hurricane', 'Washington', 'UT', '84737', '4356356550', NULL, '75 N 2260 W', 'Hurricane', 'Washington', 'UT', '84737', '4356356550', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700921343', 0, 'N', 0, '2013-06-12', NULL, NULL, 37.1771, -113.33, NULL, NULL),
('942854057', 'W11004913', 'W11004913', 'UTPEHP', 'Hurricane Valley InstaCare', '', '', 'Hurricane Valley InstaCare', 'group', 'Urgent Care', '', '', NULL, 'O', '75 N 2260 W', 'Hurricane', 'Washington', 'UT', '84737', '4356356550', NULL, '75 N 2260 W', 'Hurricane', 'Washington', 'UT', '84737', '4356356550', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700921343', 0, 'N', 0, '2012-03-20', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004911', 'W11004911', 'UTIHCPHY', 'Sunset InstaCare M-Sat 9am-9pm', '', '', 'Sunset InstaCare', 'group', 'Urgent Care', '', '', NULL, 'o', '1739 W Sunset Blvd', 'St George', 'Washington', 'UT', '84770', '4356346000', NULL, '1739 W Sunset Blvd', 'St George', 'Washington', 'UT', '84770', '4356346000', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851599336', 0, 'N', 0, '2013-06-12', NULL, NULL, 37.1227, -113.62, NULL, NULL),
('942854057', 'W11004916', 'W11004916', 'UTPEHP', 'Sunset InstaCare', '', '', 'Sunset InstaCare', 'group', 'Urgent Care', '', '', NULL, 'O', '1739 W Sunset Blvd', 'St George', 'Washington', 'UT', '84770', '4356346000', NULL, '1739 W Sunset Blvd', 'St George', 'Washington', 'UT', '84770', '4356346000', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851599336', 0, 'N', 0, '2012-03-20', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11004910', 'W11004910', 'UTIHCPHY', 'River Road InstaCare M-Sun 9am-9pm', '', '', 'River Road InstaCare', 'group', 'Urgent Care', '', '', NULL, 'o', '577 S River Road', 'St George', 'Washington', 'UT', '84790', '4356886300', NULL, '577 S River Road', 'St George', 'Washington', 'UT', '84790', '4356886300', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437289808', 0, 'N', 0, '2013-06-12', NULL, NULL, 37.0986, -113.557, NULL, NULL),
('942854057', 'W11004915', 'W11004915', 'UTPEHP', 'River Road InstaCare', '', '', 'River Road InstaCare', 'group', 'Urgent Care', '', '', NULL, 'O', '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886300', NULL, '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886300', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437289808', 0, 'N', 0, '2012-10-09', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11004963', 'W11004963', 'UT01', NULL, 'John', NULL, 'Sherwood', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '524 Walnut St', 'Reno', 'Elko', 'NV', '89801', '7757382225', '7757386886', '867 E 9400 S', 'Sandy', 'Elko', 'UT', '84094', NULL, NULL, 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2008-01-01', '2010-10-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000008698', 0, 'N', 0, '2008-05-29', NULL, NULL, 0, 0, NULL, NULL),
('820425454', 'W11004904', 'W11004904', 'ID01', 'Saint Alphonsus Billing', '', '', 'Saint Alphonsus Billing', 'Group', '', '', '', NULL, 'B', 'PO Box 4008', 'Portland', 'Multnomah', 'OR', '97208', '8002758752', '5033722754', 'PO Box 4008', 'Portland', 'Multnomah', 'OR', '97208', '8002758752', '5033722754', 'IDSAMG3', '', '', '55.81', '10.00', '0.00', 3, '2008-07-01', '2010-01-30', 0, 15, 0, '', '', '', '', 'HCFA|UB|', '0000008537', 0, 'Y', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11005004', 'W11005004', 'UT01', NULL, 'Eric', 'J', 'Tessereau', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '430 Goddard Ave', 'Ignacio', 'La Plata', 'CO', '81137', '9705630330', '9705657325', '867 E 9400 S', 'Sandy', 'La Plata', 'UT', '84094', NULL, NULL, 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2008-01-01', '2010-10-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1295750131', 0, 'N', 0, '2008-06-01', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11005002', 'W11005002', 'UT01', NULL, 'Lawrence', NULL, 'Svendsen', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '501 E 2nd', 'Cortez', 'Montezuma', 'CO', '81321', '9705657315', '9705657325', '867 E 9400 S', 'Sandy', 'Montezuma', 'UT', '84094', NULL, NULL, 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2008-01-01', '2010-10-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1760599914', 0, 'N', 0, '2008-06-01', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11005007', 'W11005007', 'UT01', NULL, 'Michael', NULL, 'Trienen', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '1933 E Main St', 'Cortez', 'Montezuma', 'CO', '81321', '9705654800', '9705650821', '867 E 9400 S', 'Sandy', 'Montezuma', 'UT', '84094', NULL, NULL, 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2008-01-01', '2010-10-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000009181', 0, 'N', 0, '2008-06-01', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11005014', 'W11005014', 'UT01', NULL, 'Thomas', NULL, 'West', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '128 Saddle Rd', 'Ketchum', 'Blaine', 'ID', '83340', '2087264555', '2087264515', '867 E 9400 S', 'Sandy', 'Blaine', 'UT', '84094', NULL, NULL, 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2008-01-01', '2010-10-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1417171745', 0, 'N', 0, '2008-06-01', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11005015', 'W11005015', 'UT01', NULL, 'Scott', 'C', 'White', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '1096 Erickson Dr', 'Rexburg', 'Madison', 'ID', '83440', '2086563205', '2083224115', '867 E 9400 S', 'Sandy', 'Madison', 'UT', '84094', NULL, NULL, 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2008-01-01', '2010-10-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1205840832', 0, 'N', 0, '2008-06-01', NULL, NULL, 0, 0, NULL, NULL),
('204157017', 'W11005020', 'W11005020', 'ID01', 'Jensen Eye Associates', 'Johanna', 'M', 'Jensen', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1615 12th Ave Rd Ste A', 'Nampa', 'Canyon', 'ID', '83686', '2084673271', NULL, '1615 12th Ave Rd Ste A', 'Nampa', 'Canyon', 'ID', '83686', '2084673271', '', 'IDSTD', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1770552846', 0, 'n', 0, '2011-09-21', NULL, NULL, 43.5533, -116.573, NULL, NULL),
('204157017', 'W11005021', 'W11005021', 'ID01', 'Jensen Eye Associates', 'Peter', 'E', 'Jensen', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1615 12th Ave Rd Ste A', 'Nampa', 'Canyon', 'ID', '83686', '2084673271', NULL, '1615 12th Ave Rd Ste A', 'Nampa', 'Canyon', 'ID', '83686', '2084673271', '', 'IDSTD', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1285602581', 0, 'n', 0, '2014-03-20', NULL, NULL, 43.5533, -116.573, NULL, NULL),
('870395551', 'W11005010', 'W11005010', 'ID02', NULL, 'Jeff', NULL, 'Walker', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '10451 Garverdale Ste 201', 'Boise', 'Ada', 'ID', '83704', '2083224115', '2083224115', '867 E 9400 S', 'Sandy', 'Ada', 'UT', '84094', NULL, NULL, 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2008-01-01', '2010-10-31', 0, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000009487', 0, 'N', 0, '2008-06-01', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11005013', 'W11005013', 'UT01', NULL, 'Ryan', 'F', 'Webster', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '476653 Hwy 95 Ste 2', 'Ponderay', 'Bonner', 'ID', '83852', '2082659400', '2082637521', '867 E 9400 S', 'Sandy', 'Bonner', 'UT', '84094', NULL, NULL, 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2008-01-01', '2010-10-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1740247881', 0, 'N', 0, '2008-06-01', NULL, NULL, 0, 0, NULL, NULL);
