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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('390816848', 'IL0000454', 'IL0000454', 'ILCHIGSTD', 'Mercy Woodstock Medical Center', 'Bibiano', '', 'Ronquillo', 'MD', 'Internal Medicine', '', '', NULL, 'O', '200 Lake Ave', 'Woodstock', 'McHenry', 'IL', '60098', '8153377100', NULL, '200 Lake Ave', 'Woodstock', 'McHenry', 'IL', '60098', '8153377100', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB', '1285791228', 0, 'N', 0, '2013-03-27', NULL, NULL, 0, 0, NULL, NULL),
('390816848', 'IL0000455', 'IL0000455', 'ILCHIGSTD', 'Mercy Woodstock Medical Center', 'Timothy', '', 'Rusthoven', 'DPM', 'Podiatry', '', '', NULL, 'O', '200 Lake Ave', 'Woodstock', 'McHenry', 'IL', '60098', '8153377100', NULL, '200 Lake Ave', 'Woodstock', 'McHenry', 'IL', '60098', '8153377100', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB', '1972668325', 0, 'N', 0, '2013-03-27', NULL, NULL, 0, 0, NULL, NULL),
('390816848', 'IL0000456', 'IL0000456', 'ILCHIGSTD', 'Mercy Woodstock Medical Center', 'Shahariar', '', 'Saikh', 'MD', 'Family Practice', '', '', NULL, 'O', '200 Lake Ave', 'Woodstock', 'McHenry', 'IL', '60098', '8153377100', NULL, '200 Lake Ave', 'Woodstock', 'McHenry', 'IL', '60098', '8153377100', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB', '1841380714', 0, 'N', 0, '2013-03-27', NULL, NULL, 0, 0, NULL, NULL),
('390816848', 'IL0000457', 'IL0000457', 'ILCHIGSTD', 'Mercy McHenry Immediate Care', 'Robert', '', 'Schwaner', 'MD', 'Urgent Care', '', '', NULL, 'O', '3922 Mercy Dr', 'McHenry', 'McHenry', 'IL', '60050', '8153444499', NULL, '3922 Mercy Dr', 'McHenry', 'Mchenry', 'IL', '60050', '8153444499', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1003971144', 0, 'N', 0, '2012-12-06', NULL, NULL, 42.3167, -88.2738, NULL, NULL),
('390816848', 'IL0000458', 'IL0000458', 'ILCHIGSTD', 'Mercy Harvard Hospital', 'Jaymin', '', 'Shah', 'DO', 'Pain Management', '', '', NULL, 'O', '1001 Grant St', 'Harvard', 'McHenry', 'IL', '60033', '8159438090', NULL, '1001 Grant St', 'Harvard', 'Mchenry', 'IL', '60033', '8159438090', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1770670408', 0, 'Y', 0, '2012-12-06', NULL, NULL, 42.4268, -88.6077, NULL, NULL),
('390816848', 'IL0000461', 'IL0000461', 'ILCHIGSTD', 'Mercy McHenry Medical Center', 'Ratna', '', 'Srinivas', 'MD', 'Gynecology', '', '', NULL, 'O', '3922 Mercy Dr', 'McHenry', 'McHenry', 'IL', '60050', '8153444499', NULL, '3922 Mercy Dr', 'McHenry', 'Mchenry', 'IL', '60050', '8153444499', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1841357845', 0, 'N', 0, '2012-12-06', NULL, NULL, 42.3167, -88.2738, NULL, NULL),
('390816848', 'W12026149', 'W12026149', 'ILCHIGSTD', 'Mercy Crystal Lake Medical Center - South', 'Emily', '', 'Shen', 'MD', 'Family Practice', '', '', NULL, 'O', '415 Congress Pkwy', 'Crystal Lake', 'McHenry', 'IL', '60014', '8153567494', NULL, '415 Congress Pkwy', 'Crystal Lake', 'Mchenry', 'IL', '60014', '8153567494', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1871779744', 0, 'N', 0, '2012-12-06', NULL, NULL, 42.2322, -88.3052, NULL, NULL),
('390816848', 'W12026151', 'W12026151', 'ILCHIGSTD', 'Mercy Crystal Lake Medical Center - South', 'Ranjana', '', 'Soorya', 'MD', 'Internal Medicine', '', '', NULL, 'O', '415 Congress Pkwy', 'Crystal Lake', 'McHenry', 'IL', '60014', '8153567494', NULL, '415 Congress Pkwy', 'Crystal Lake', 'McHenry', 'IL', '60014', '8153567494', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1396762084', 0, 'N', 0, '2013-07-26', NULL, NULL, 42.2322, -88.3052, NULL, NULL),
('390816848', 'IL0000462', 'IL0000462', 'ILCHIGSTD', 'Mercy Woodstock Medical Center', 'Dana', '', 'Tarandy', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '200 Lake Ave', 'Woodstock', 'McHenry', 'IL', '60098', '8153377100', NULL, '200 Lake Ave', 'Woodstock', 'McHenry', 'IL', '60098', '8153377100', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB', '1629001623', 0, 'N', 0, '2013-03-27', NULL, NULL, 0, 0, NULL, NULL),
('390816848', 'IL0000463', 'IL0000463', 'ILCHIGSTD', 'Mercy Health Systems Corp', 'Rajeev', '', 'Varma', 'MD', 'Pulmonary', '', '', NULL, 'O', '1001 Grant St', 'Harvard', 'McHenry', 'IL', '60033', '8159438090', NULL, '1001 Grant St', 'Harvard', 'McHenry', 'IL', '60033', '8159438090', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-03-02', 0, 0, 0, '', '', '', '', 'HCFA|UB', '1073525770', 0, 'N', 0, '2013-07-26', NULL, NULL, 42.4268, -88.6073, NULL, NULL),
('390816848', 'IL0000464', 'IL0000464', 'ILCHIGSTD', 'Mercy Crystal Lake Medical Center - East', 'Preeti', '', 'Vemuri', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '390 Congress Pkwy Ste M', 'Crystal Lake', 'McHenry', 'IL', '60014', '8154550850', NULL, '390 Congress Pkwy Ste M', 'Crystal Lake', 'Mchenry', 'IL', '60014', '8154550850', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1548318488', 0, 'N', 0, '2012-12-06', NULL, NULL, 42.2312, -88.3073, NULL, NULL),
('390816848', 'IL0000465', 'IL0000465', 'ILCHIGSTD', 'Mercy Harvard Clinic South', 'Shailesh', '', 'Virani', 'MD', 'Family Practice', '', '', NULL, 'O', '348 S Division St', 'Harvard', 'McHenry', 'IL', '60033', '8159431122', NULL, '348 S Division St', 'Harvard', 'McHenry', 'IL', '60033', '8159431122', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1891842506', 0, 'N', 0, '2013-07-02', NULL, NULL, 42.4121, -88.6134, NULL, NULL),
('390816848', 'IL0000466', 'IL0000466', 'ILCHIGSTD', 'Mercy Crystal Lake OB/GYN', 'Randy', '', 'Wittman', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '750 E Terra Cotta Ste B', 'Crystal Lake', 'McHenry', 'IL', '60014', '8154591212', NULL, '750 E Terra Cotta Ste B', 'Crystal Lake', 'Mchenry', 'IL', '60014', '8154591212', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1023165644', 0, 'N', 0, '2012-12-06', NULL, NULL, 42.2486, -88.2921, NULL, NULL),
('390816848', 'IL0000467', 'IL0000467', 'ILCHIGSTD', 'Mercy Woodstock Medical Center', 'Ricca', '', 'Zaino', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '200 Lake Ave', 'Woodstock', 'McHenry', 'IL', '60098', '8153377100', NULL, '200 Lake Ave', 'Woodstock', 'McHenry', 'IL', '60098', '8153377100', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB', '1558418947', 0, 'N', 0, '2013-03-27', NULL, NULL, 0, 0, NULL, NULL),
('203193817', 'W12026153', 'W12026153', 'ILCHIGSTD', 'Broadway Medical Group', 'Matthew', 'B', 'Ajluni', 'DO', 'Family Practice', '', '', NULL, 'O', '800 Austin St West Tower Ste 201', 'Evanston', 'Cook', 'IL', '60202', '8477337500', '8477331266', '800 Austin St West Tower Ste 201', 'Evanston', 'Cook', 'IL', '60202', '8477337500', '8477331266', 'CHIG11', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-04-03', 0, 0, 0, 'Presence Saint Francis Hospital', '', '', '', 'HCFA|UB|', '1124072400', 0, 'N', 0, '2014-07-17', NULL, NULL, 42.0252, -87.6828, NULL, NULL),
('203193817', 'W12026155', 'W12026155', 'ILCHIGSTD', 'Broadway Medical Group', 'Sean', 'Adam', 'Le', 'MD', 'Internal Medicine', '', '', NULL, 'O', '800 Austin St West Tower Ste 201', 'Evanston', 'Cook', 'IL', '60202', '8477337500', '8477331266', '800 Austin St West Tower Ste 201', 'Evanston', 'Cook', 'IL', '60202', '8477337500', '8477331266', 'CHIG11', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-04-03', 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', '', 'HCFA|UB|', '1578552915', 0, 'N', 0, '2013-04-03', NULL, NULL, 42.0252, -87.6828, NULL, NULL),
('201780406', 'IL0000348', 'IL0000348', 'ILCHIGSTD', 'UroPartners', 'Shivani', 'T', 'Patel', 'PAC', 'Urology', '', '', NULL, 'O', '1555 Barrington Rd Ste 2500', 'Hoffman Estates', 'Cook', 'IL', '60169', '8478233185', '8478233318', '1555 Barrington Rd Ste 2500', 'Hoffman Estates', 'Cook', 'IL', '60169', '8478233185', '8478233318', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023301454', 0, 'Y', 0, '2014-04-24', NULL, NULL, 42.0542, -88.1444, NULL, NULL),
('201780406', 'W12026169', 'W12026169', 'ILCHIGSTD', 'UroPartners', '', '', 'UROPARTNERS LLC', '', 'Urology', '', '', NULL, 'M', '2245 Enterprise Ste 4506', 'Westchester', 'Cook', 'IL', '60154', '          ', NULL, '2245 Enterprise Ste 4506', 'Westchester', 'Cook', 'IL', '60154', '          ', '          ', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000010006', 0, 'N', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'W12026170', 'W12026170', 'ILCHIGSTD', 'UroPartners', '', '', 'UROPARTNERS LLC', '', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000010006', 0, 'Y', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'W12026172', 'W12026172', 'IDBOISTD', 'Saint Alphonsus Medical Group Comprehensive Pain and Spine', 'Vivek', '', 'Kadyan', 'MD', 'Physical Medicine and Rehabilitation', 'Rehabilitation Practitioner', '', NULL, 'O', '1055 N Curtis Rd Floor 6', 'Boise', 'Ada', 'ID', '83706', '2083674343', '2083677667', '1055 N Curtis Rd Floor 6', 'Boise', 'Ada', 'ID', '83706', '2083674343', '2083677667', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-11-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1417950205', 0, 'Y', 0, '2014-07-09', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('820200895', 'W12026173', 'W12026173', 'IDBOISTD', 'Saint Alphonsus Medical Group NHP Urgent Care', 'Kevin', '', 'Chicoine', 'MD', 'Occupational Medicine', 'Family Practice', 'Urgent Care', NULL, 'O', '4400 E Flamingo Ave Ste 301', 'Nampa', 'Canyon', 'ID', '83687', '2084422388', '2084663403', '4400 E Flamingo Ave Ste 301', 'Nampa', 'Canyon', 'ID', '83687', '2084422388', '2084663403', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-11-20', NULL, 0, 0, 0, 'West Valley Medical Center', '', '', '', 'HCFA|', '1730121740', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.5966, -116.519, NULL, NULL),
('820200895', 'W12026174', 'W12026174', 'IDBOISTD', 'Saint Alphonsus Medical Group NHP Urgent Care', 'Seana', 'K', 'Daly', 'MD', 'Family Practice', '', '', NULL, 'O', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084422388', '2084663403', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084422388', '2084663403', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-11-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1558301929', 0, 'Y', 0, '2014-03-20', NULL, NULL, 43.5966, -116.519, NULL, NULL),
('820200895', 'W12026175', 'W12026175', 'IDBOISTD', 'Saint Alphonsus Medical Group NHP Family Medicine  ', 'Charles', '', 'Frost', 'PA-C', 'Occupational Medicine', '', '', NULL, 'O', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084656947', '2084656910', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084656947', '2084656910', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1760425730', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.5966, -116.519, NULL, NULL),
('820200895', 'W12026176', 'W12026176', 'IDBOISTD', 'Saint Alphonsus Medical Group NHP Urgent Care', 'Charles', '', 'Frost', 'PA-C', 'Occupational Medicine', '', '', NULL, 'O', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2082884640', '2084663403', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2082884640', '2084663403', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-11-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1760425730', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.5966, -116.519, NULL, NULL),
('820200895', 'W12026177', 'W12026177', 'IDBOISTD', 'Saint Alphonsus Medical Group Wound & Hyperbaric Nampa', 'Andrea', '', 'Gabica', 'NP', 'Family Practice', '', '', NULL, 'O', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2082884560', '2082884578', '4400 E Flamingo Ave   ', 'Nampa', 'Canyon', 'ID', '83687', '2082884560', '2082884578', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-11-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'Saint Alphonsus Medical Center Nampa', '', '', 'HCFA|', '1750641197', 0, 'Y', 0, '2014-03-27', NULL, NULL, 43.5966, -116.519, NULL, NULL),
('820200895', 'W12026178', 'W12026178', 'IDBOISTD', 'Saint Alphonsus Medical Group NHP Family Medicine  ', 'Calvin', 'M', 'Harrold', 'PA-C', 'Family Practice', 'Physician Assistant', '', NULL, 'O', '4400 E Flamingo', 'Nampa', 'Canyon', 'ID', '83687', '2084656900', '2084656910', '4400 E Flamingo', 'Nampa', 'Canyon', 'ID', '83687', '2084656900', '2084656910', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1598705311', 0, 'Y', 0, '2014-03-27', NULL, NULL, 43.5966, -116.519, NULL, NULL),
('820200895', 'W12026180', 'W12026180', 'IDBOISTD', 'Saint Alphonsus Medical Group NHP Family Medicine  ', 'Sis', 'E', 'Ostolasa', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084656900', '2084656910', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084656900', '2084656910', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|', '1013952761', 0, 'N', 0, '2013-09-05', NULL, NULL, 43.5966, -116.519, NULL, NULL),
('820200895', 'W12026181', 'W12026181', 'IDBOISTD', 'Saint Alphonsus Medical Group NHP Family Medicine', 'Cherese', 'R', 'Severson', 'NPC', 'Family Practice', '', '', NULL, 'O', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084656947', '2084656910', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084656947', '2084656910', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-11-20', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|', '1275631244', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.5966, -116.519, NULL, NULL),
('820200895', 'W12026182', 'W12026182', 'IDBOISTD', 'Saint Alphonsus Medical Group Family Practice Nampa Health Plaza', 'Cherese', 'R', 'Severson', 'NPC', 'Family Practice', '', '', NULL, 'O', '4400 E Flamingo Ave Ste 301', 'Nampa', 'Canyon', 'ID', '83687', '2084656900', '2084656910', '4400 E Flamingo Ave Ste 301', 'Nampa', 'Canyon', 'ID', '83687', '2084656900', '2084656910', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2012-12-25', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|', '1275631244', 0, 'N', 0, '2013-09-05', NULL, NULL, 43.5976, -116.517, NULL, NULL),
('820200895', 'W12026183', 'W12026183', 'IDBOISTD', 'Saint Alphonsus Medical Group NHP Urgent Care', 'Travis', '', 'Smith', 'PA-C', 'Family Practice', '', '', NULL, 'O', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084656947', '2084663403', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084656947', '2084663403', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-11-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1376810689', 0, 'N', 0, '2014-05-20', NULL, NULL, 43.5966, -116.519, NULL, NULL),
('820200895', 'W12026184', 'W12026184', 'IDBOISTD', 'Saint Alphonsus Medical Group NHP Urgent Care', 'Colette', 'D', 'Weber', 'PAC', 'Family Practice', 'Physician Assistant', '', NULL, 'O', '4400  E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084422388', '2084663403', '4400  E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084422388', '2084663403', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-11-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1922042464', 0, 'N', 0, '2013-09-05', NULL, NULL, 43.5966, -116.519, NULL, NULL),
('820200895', 'W12026185', 'W12026185', 'IDBOISTD', 'Saint Alphonsus Medical Group NHP Urgent Care', 'Cherese', 'R', 'Severson', 'NPC', 'Family Practice', '', '', NULL, 'O', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2082884640', '2084663403', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2082884640', '2084663403', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-11-21', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|', '1275631244', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.5966, -116.519, 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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('760550011', 'W12026354', 'W12026354', 'TXHOUSTD', '', 'Aye', '', 'Thida', 'MD', 'Pediatrics', '', '', NULL, 'O', '9110 Bellaire Blvd Ste C', 'Houston', 'Harris', 'TX', '77036', '7132726366', '7132726336', '9110 Bellaire Blvd Ste C', 'Houston', 'Harris', 'TX', '77036', '7132726366', '7132726336', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386628592', 0, 'N', 0, '2012-12-18', NULL, NULL, 29.705, -95.5442, NULL, NULL),
('201032630', 'W12026355', 'W12026355', 'TXHOUSTD', 'Clear Lake Regional Medical Center', 'Beena', 'M', 'Thomas', 'MD', 'Pediatrics', '', '', NULL, 'O', '333 N Texas Ave Ste 4300', 'Webster', 'Harris', 'TX', '77598', '2813385437', '2813389543', '333 N Texas Ave Ste 4300', 'Webster', 'Harris', 'TX', '77598', '2813385437', '2813389543', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1336237387', 0, 'N', 0, '2013-05-24', NULL, NULL, 29.5349, -95.1258, NULL, NULL),
('201032630', 'W12026356', 'W12026356', 'TXHOUSTD', 'The Childrens Clinic of Clear Lake', 'Robert', 'L', 'Quillin', 'MD', 'Pediatrics', '', '', NULL, 'O', '333 N Texas Ave Ste 4300', 'Webster', 'Harris', 'TX', '77598', '2813385437', '2813389543', '333 N Texas Ave Ste 4300', 'Webster', 'Harris', 'TX', '77598', '2813385437', '2813389543', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1144227257', 0, 'N', 0, '2013-05-24', NULL, NULL, 29.5349, -95.1258, NULL, NULL),
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('760609536', 'W12026360', 'W12026360', 'TXHOUSTD', 'Texas Alliance Medical Group', '', '', 'Texas Alliance Medical Group', '', 'Clinics', '', '', NULL, 'O', '14770 Memorial Dr Ste 100', 'Houston', 'Harris', 'TX', '77079', '2814967333', '2814967337', '14770 Memorial Dr Ste 100', 'Houston', 'Harris', 'TX', '77079', '2814967333', '2814967337', 'TAMG12412', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861446304', 0, 'Y', 0, '2013-06-03', NULL, NULL, 29.7718, -95.6118, NULL, NULL),
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('870286381', 'W12026367', 'W12026367', 'UT01', 'Ogden Clinic PC', 'Marylynn', '', 'Cardona', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753500', '8014753414', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753500', '8014753414', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1376703710', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
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('870286381', 'W12026372', 'W12026372', 'UT01', 'Ogden Clinic Womens Center McKay', 'LeAnne', 'P', 'Gundy', 'NP', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '4403 Harrison Blvd Ste 4650', 'Ogden', 'Weber', 'UT', '84403', '8014753240', '8014753241', '4403 Harrison Blvd Ste 4650', 'Ogden', 'Weber', 'UT', '84403', '8014753240', '8014753241', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-01-01', '2014-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB', '1932109261', 0, 'N', 0, '2014-06-04', NULL, NULL, 41.1828, -111.949, NULL, NULL),
('870286381', 'W12026373', 'W12026373', 'UT01', 'Ogden Clinic PC', 'Steven', 'E', 'Kammeyer', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753500', '8014753414', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753500', '8014753414', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1851374920', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'W12026374', 'W12026374', 'UT01', 'Ogden Clinic Womens Center McKay', 'Steven', 'E', 'Kammeyer', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '4403 Harrison Blvd Ste 4650', 'Ogden', 'Weber', 'UT', '84403', '8014753240', '8014753241', '4403 Harrison Blvd Ste 4650', 'Ogden', 'Weber', 'UT', '84403', '8014753240', '8014753241', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB', '1851374920', 0, 'N', 0, '2014-07-21', NULL, NULL, 41.1828, -111.949, NULL, NULL),
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('870286381', 'W12026376', 'W12026376', 'UT01', 'Ogden Clinic Womens Center McKay', 'Kirk', 'A', 'Lammi', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '4403 Harrison Blvd Ste 4650', 'Ogden', 'Weber', 'UT', '84403', '8014753240', '8014753241', '4403 Harrison Blvd Ste 4650', 'Ogden', 'Weber', 'UT', '84403', '8014753240', '8014753241', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB', '1851575344', 0, 'N', 0, '2012-12-06', NULL, NULL, 41.1828, -111.949, NULL, NULL),
('202630141', 'W12026378', 'W12026378', 'ID02', 'Primary Health Medical Group', 'Jennifer', 'R', 'Appel', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 191050', 'Boise', 'Ada', 'ID', '83719', '2088788011', '0000000000', 'PO Box 191050', 'Boise', 'Ada', 'ID', '83719', '2088788011', '0000000000', 'IDSTDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-01-01', '2013-02-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1588918924', 0, 'N', 0, '2014-03-18', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W12026377', 'W12026377', 'ID02', 'Primary Health Medical Group', 'Jennifer', 'R', 'Appel', 'PA', 'Family Practice', '', '', NULL, 'O', '11197 W Fairview Ave', 'Boise', 'Ada', 'ID', '83713', '2088788011', NULL, '11197 W Fairview Ave', 'Boise', 'Ada', 'ID', '83713', '2088788011', '          ', 'IDSTDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-01-01', '2013-02-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1588918924', 0, 'N', 0, '2014-03-18', NULL, NULL, 43.6191, -116.322, NULL, NULL),
('870286381', 'W12026379', 'W12026379', 'UT01', 'Ogden Clinic Womens Center McKay', 'Kolleen', '', 'Marchand', 'PA-C', 'Family Practice', '', '', NULL, 'O', '4403 Harrison Blvd Ste 4650', 'Ogden', 'Weber', 'UT', '84403', '8014753240', '8014753241', '4403 Harrison Blvd Ste 4650', 'Ogden', 'Weber', 'UT', '84403', '8014753240', '8014753241', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-01-01', '2014-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB', '1740206630', 0, 'N', 0, '2014-05-27', NULL, NULL, 41.1828, -111.949, NULL, NULL),
('870373083', 'W12026380', 'W12026380', 'UT01', 'Heart and Lung Institute of Utah', 'James', 'A', 'Rasmussen', 'MD', 'Pulmonary', 'Internal Medicine', 'Critical Care', NULL, 'O', '3460 S Pioneer Pkwy', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012632370', '8012651200', '3460 S Pioneer Pkwy', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012632370', '8012651200', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-01', '2014-04-30', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1770661712', 0, 'N', 0, '2013-01-24', NULL, NULL, 40.6972, -111.99, NULL, NULL),
('870373083', 'W12026381', 'W12026381', 'UT01', 'Heart and Lung Institute of Utah', 'James', 'A', 'Rasmussen', 'MD', 'Pulmonary', 'Internal Medicine', 'Critical Care', NULL, 'O', '3580 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012632370', '8012651200', '3580 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012632370', '8012651200', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-01', '2014-04-30', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1770661712', 0, 'N', 0, '2013-01-24', NULL, NULL, 40.5879, -111.975, NULL, NULL),
('870373083', 'W12026382', 'W12026382', 'UT01', 'Heart and Lung Institute of Utah', 'James', 'A', 'Rasmussen', 'MD', 'Pulmonary', 'Internal Medicine', 'Critical Care', NULL, 'M', '5979 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012632370', '8012651200', '5979 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012632370', '8012651200', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-01', '2014-04-30', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1770661712', 0, 'N', 0, '2013-01-24', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'W12026383', 'W12026383', 'UT01', 'Heart and Lung Institute of Utah', 'James', 'A', 'Rasmussen', 'MD', 'Pulmonary', 'Internal Medicine', 'Critical Care', NULL, 'B', 'PO Box 847112', 'Dallas', 'Dallas', 'TX', '75284', '8012632370', '8012651200', 'PO Box 847112', 'Dallas', 'Dallas', 'TX', '75284', '8012632370', '8012651200', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-01', '2014-04-30', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1770661712', 0, 'N', 0, '2013-01-24', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'W12026384', 'W12026384', 'UT01', 'Heart and Lung Institute of Utah', 'James', 'A', 'Rasmussen', 'MD', 'Pulmonary', 'Internal Medicine', 'Critical Care', NULL, 'O', '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8012632370', '8012651200', '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8012632370', '8012651200', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-01', '2014-04-30', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1770661712', 0, 'N', 0, '2013-01-24', NULL, NULL, 40.7694, -111.861, NULL, NULL),
('455225142', 'W12026385', 'W12026385', 'UT01', '+240 = 10 mins unit U-U Anesthesiology Department NCC-SICU School of Medicine', '', '', 'U-U Anesthesiology Department NCC-SICU School of Medicine', '', 'Anesthesiology', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015816393', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015816393', '          ', 'WUUUMGANES', '', '', '60.10', '25.00', '0.00', 3, '2013-01-01', '2013-12-31', 1, 12, 0, '', '', '', '', 'HCFA|UB|', '1497014781', 0, 'N', 0, '2014-01-06', NULL, NULL, 0, 0, NULL, NULL),
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('870442129', 'W12026387', 'W12026387', 'UT01', '+240 = 10 mins unit U of U Dept of Anesthesiology', '', '', '+240 = 10 mins unit U of U Dept of Anesthesiology +240 = 10 mins unit', 'GROUP', 'Anesthesiology', '', '', NULL, 'B', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8012133800', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8012133800', '          ', '', '', '1000', '60.10', '25.00', '0.00', 3, '2013-01-01', '2013-12-31', 1, 12, 0, '', '', '', '', 'HCFA|UB|', '1134158322', 0, 'N', 0, '2014-01-07', NULL, NULL, 0, 0, NULL, NULL),
('870442129', 'W12026388', 'W12026388', 'UT01', '+240 = 10 mins unit U of U Dept of Anesthesiology', '', '', '+240 = 10 mins unit U of U Dept of Anesthesiology +240 = 10 mins unit', 'GROUP', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 413034', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413034', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', '', '', '1000', '60.10', '25.00', '0.00', 3, '2013-01-01', '2013-12-31', 1, 12, 0, '', '', '', '', 'HCFA|UB|', '1134158322', 0, 'N', 0, '2014-01-07', NULL, NULL, 0, 0, NULL, NULL),
('412264277', 'W12026389', 'W12026389', 'UT01', '+240 = 10 mins unit University of Utah Anesthesiology Perioperative Echo ', '', '', '+240 = 10 mins unit University of Utah Anesthesiology Perioperative Echo +240 = 10 mins unit', 'Group', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 413034', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413034', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMGANES', '', '1000', '60.10', '25.00', '0.00', 3, '2013-01-01', '2013-12-31', 1, 12, 0, '', '', '', '', 'HCFA|UB|', '1841477528', 0, 'N', 0, '2014-01-06', NULL, NULL, 0, 0, NULL, NULL),
('760609536', 'W12026392', 'W12026392', 'TXHOUSTD', 'Texas Alliance Medical Group', '', '', 'Texas Alliance Medical Group', '', 'Clinics', '', '', NULL, 'O', '14755 N Fwy Ste 400', 'Houston', 'Harris', 'TX', '77090', '2818762500', '2818762574', '14755 N Fwy Ste 400', 'Houston', 'Harris', 'TX', '77090', '2818762500', '2818762574', 'TAMG12412', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861446304', 0, 'Y', 0, '2013-06-03', NULL, NULL, 30.0118, -95.4279, NULL, NULL),
('760609536', 'W12026393', 'W12026393', 'TXHOUSTD', 'Texas Alliance Medical Group', '', '', 'Texas Alliance Medical Group', '', 'Clinics', '', '', NULL, 'O', '13259 E Fwy', 'Houston', 'Harris', 'TX', '77015', '7133301530', '7133301535', '13259 E Fwy', 'Houston', 'Harris', 'TX', '77015', '7133301530', '7133301535', 'TAMG12412', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861446304', 0, 'Y', 0, '2013-06-03', NULL, NULL, 29.7712, -95.1897, NULL, NULL),
('760609536', 'W12026394', 'W12026394', 'TXHOUSTD', 'Texas Alliance Medical Group', '', '', 'Texas Alliance Medical Group', '', 'Clinics', '', '', NULL, 'O', '6969 Gulf Fwy Ste 370', 'Houston', 'Harris', 'TX', '77087', '7136430600', '7136414229', '6969 Gulf Fwy Ste 370', 'Houston', 'Harris', 'TX', '77087', '7136430600', '7136414229', 'TAMG12412', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861446304', 0, 'Y', 0, '2013-06-03', NULL, NULL, 29.7027, -95.2959, NULL, NULL),
('201780406', 'IL0000179', 'IL0000179', 'ILCHIGSTD', 'UroPartners', 'Nejd', 'F', 'Alsikafi', 'MD', 'Urology', '', '', NULL, 'O', '151 W Golf Rd', 'Libertyville', 'Lake', 'IL', '60048', '8476803803', '8476803811', '151 W Golf Rd', 'Libertyville', 'Lake', 'IL', '60048', '8476803803', '8476803811', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1649271123', 0, 'N', 0, '2012-12-06', NULL, NULL, 42.2696, -87.9527, NULL, NULL),
('201780406', 'IL0000178', 'IL0000178', 'ILCHIGSTD', 'UroPartners', 'Nejd', 'F', 'Alsikafi', 'MD', 'Urology', '', '', NULL, 'O', '3 S Greenleaf Ave Ste J', 'Gurnee', 'Lake', 'IL', '60031', '8475991111', '8475991148', '3 S Greenleaf Ave Ste J', 'Gurnee', 'Lake', 'IL', '60031', '8475991111', '8475991148', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1649271123', 0, 'N', 0, '2012-12-06', NULL, NULL, 42.3596, -87.9019, NULL, NULL),
('201780406', 'IL0000182', 'IL0000182', 'ILCHIGSTD', 'UroPartners', 'Kristopher', 'N', 'Atzeff', 'MD', 'Urology', '', '', NULL, 'O', '1475 E Belvidere Rd Ste 312', 'Grayslake', 'Lake', 'IL', '60030', '8479863030', '8479863035', '1475 E Belvidere Rd Ste 312', 'Grayslake', 'Lake', 'IL', '60030', '8479863030', '8479863035', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1073577045', 0, 'N', 0, '2014-07-18', NULL, NULL, 42.3366, -88.0293, NULL, NULL),
('201780406', 'W12026397', 'W12026397', 'ILCHIGSTD', 'UroPartners', 'Nejd', 'F', 'Alsikafi', 'MD', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1649271123', 0, 'Y', 0, '2012-12-06', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'W12026398', 'W12026398', 'ILCHIGSTD', 'UroPartners', 'Kristopher', 'N', 'Atzeff', 'MD', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1073577045', 0, 'Y', 0, '2012-12-06', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'IL0000181', 'IL0000181', 'ILCHIGSTD', 'UroPartners', 'Kristopher', 'N', 'Atzeff', 'MD', 'Urology', '', '', NULL, 'O', '900 N Westmoreland Rd Ste 125', 'Lake Forest', 'Lake', 'IL', '60045', '8472950010', '8472955433', '900 N Westmoreland Rd Ste 125', 'Lake Forest', 'Lake', 'IL', '60045', '8472950010', '8472955433', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1073577045', 0, 'N', 0, '2012-12-06', NULL, NULL, 42.2574, -87.8634, NULL, NULL),
('201780406', 'IL0000184', 'IL0000184', 'ILCHIGSTD', 'UroPartners', 'Kenneth', 'R', 'Beck', 'MD', 'Pathology', '', '', NULL, 'O', '2225 Enterprise Dr Ste 2511', 'Westchester', 'Cook', 'IL', '60154', '7084860076', '7084920203', '2225 Enterprise Dr Ste 2511', 'Westchester', 'Cook', 'IL', '60154', '7084860076', '7084920203', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326017484', 0, 'Y', 0, '2012-12-06', NULL, NULL, 41.8474, -87.9096, NULL, NULL),
('201780406', 'W12026399', 'W12026399', 'ILCHIGSTD', 'UroPartners', 'Kenneth', 'R', 'Beck', 'MD', 'Pathology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326017484', 0, 'Y', 0, '2012-12-06', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'IL0000187', 'IL0000187', 'ILCHIGSTD', 'UroPartners', 'Ronald', 'J', 'Bonaguro', 'MD', 'Urology', '', '', NULL, 'O', '12701 W 143rd St Ste 280', 'Homer Glen', 'Will', 'IL', '60491', '7083492350', '7084252785', '12701 W 143rd St Ste 280', 'Homer Glen', 'Will', 'IL', '60491', '7083492350', '7084252785', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1851309041', 0, 'N', 0, '2012-12-06', NULL, NULL, 41.6291, -87.9278, NULL, NULL),
('201780406', 'W12026400', 'W12026400', 'ILCHIGSTD', 'UroPartners', 'Ronald', 'J', 'Bonaguro', 'MD', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1851309041', 0, 'Y', 0, '2012-12-06', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'IL0000186', 'IL0000186', 'ILCHIGSTD', 'UroPartners', 'Ronald', 'J', 'Bonaguro', 'MD', 'Urology', '', '', NULL, 'O', '9760 Kedzie Ave Ste 6', 'Evergreen Park', 'Cook', 'IL', '60805', '7084250112', '7084252785', '9760 Kedzie Ave Ste 6', 'Evergreen Park', 'Cook', 'IL', '60805', '7084250112', '7084252785', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1851309041', 0, 'N', 0, '2012-12-06', NULL, NULL, 41.716, -87.7017, NULL, NULL),
('201780406', 'IL0000190', 'IL0000190', 'ILCHIGSTD', 'UroPartners', 'Mark', 'T', 'Brandt', 'MD', 'Urology', '', '', NULL, 'O', '1875 Dempster St Ste 506', 'Park Ridge', 'Cook', 'IL', '60068', '8478234700', '8474701550', '1875 Dempster St Ste 506', 'Park Ridge', 'Cook', 'IL', '60068', '8478234700', '8474701550', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2014-08-01', 0, 0, 0, 'Presence Resurrection Medical Center', '', '', '', 'HCFA|UB|', '1942248794', 0, 'N', 0, '2014-06-19', NULL, NULL, 42.0397, -87.8491, NULL, NULL),
('201780406', 'W12026401', 'W12026401', 'ILCHIGSTD', 'UroPartners', 'Mark', 'T', 'Brandt', 'MD', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', '', '', '', 'HCFA|UB|', '1942248794', 0, 'Y', 0, '2014-06-19', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'IL0000191', 'IL0000191', 'ILCHIGSTD', 'UroPartners', 'Mark', 'T', 'Brandt', 'MD', 'Urology', '', '', NULL, 'O', '7447 W Talcott Ave Ste 509', 'Chicago', 'Cook', 'IL', '60631', '7737750800', '8474701550', '7447 W Talcott Ave Ste 509', 'Chicago', 'Cook', 'IL', '60631', '7737750800', '8474701550', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', '', '', '', 'HCFA|UB|', '1942248794', 0, 'N', 0, '2014-06-19', NULL, NULL, 41.9887, -87.8131, NULL, NULL),
('201780406', 'IL0000189', 'IL0000189', 'ILCHIGSTD', 'UroPartners', 'Mark', 'T', 'Brandt', 'MD', '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, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', '', '', '', 'HCFA|UB|', '1942248794', 0, 'N', 0, '2014-06-19', NULL, NULL, 42.0244, -87.8126, NULL, NULL),
('201780406', 'IL0000193', 'IL0000193', 'ILCHIGSTD', 'UroPartners', 'Heather', 'M', 'Brown', 'MD', 'Pathology', '', '', NULL, 'O', '2225 Enterprise Dr Ste 2511', 'Westchester', 'Cook', 'IL', '60154', '7084860076', '7084920203', '2225 Enterprise Dr Ste 2511', 'Westchester', 'Cook', 'IL', '60154', '7084860076', '7084920203', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750382560', 0, 'Y', 0, '2012-12-06', NULL, NULL, 41.8474, -87.9096, NULL, NULL),
('201780406', 'W12026402', 'W12026402', 'ILCHIGSTD', 'UroPartners', 'Heather', 'M', 'Brown', 'MD', 'Pathology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750382560', 0, 'Y', 0, '2012-12-06', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'IL0000198', 'IL0000198', 'ILCHIGSTD', 'UroPartners', 'Robert', 'J', 'Challenger', 'MD', 'Urology', '', '', NULL, 'O', '302 Randall Rd Ste 306', 'Geneva', 'Kane', 'IL', '60134', '6303771368', '6303777514', '302 Randall Rd Ste 306', 'Geneva', 'Kane', 'IL', '60134', '6303771368', '6303777514', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710996962', 0, 'Y', 0, '2012-12-06', NULL, NULL, 41.8887, -88.3404, NULL, NULL),
('201780406', 'IL0000195', 'IL0000195', 'ILCHIGSTD', 'UroPartners', 'Courtney', 'R', 'Carlson', 'PAC', 'Urology', '', '', NULL, 'O', '676 N St Clair St Ste 1835', 'Chicago', 'Cook', 'IL', '60611', '3129263535', '3129263585', '676 N St Clair St Ste 1835', 'Chicago', 'Cook', 'IL', '60611', '3129263535', '3129263585', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1942516224', 0, 'Y', 0, '2012-12-06', NULL, NULL, 41.8945, -87.6227, NULL, NULL),
('201780406', 'W12026403', 'W12026403', 'ILCHIGSTD', 'UroPartners', 'Courtney', 'R', 'Carlson', 'PAC', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1942516224', 0, 'Y', 0, '2014-03-11', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'IL0000201', 'IL0000201', 'ILCHIGSTD', 'UroPartners', 'Justin', 'J', 'Cohen', 'MD', 'Urology', '', '', NULL, 'O', '1475 E Belvidere Rd Ste 312', 'Grayslake', 'Lake', 'IL', '60030', '8479863030', '8479863035', '1475 E Belvidere Rd Ste 312', 'Grayslake', 'Lake', 'IL', '60030', '8479863030', '8479863035', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1700060704', 0, 'N', 0, '2014-07-18', NULL, NULL, 42.3366, -88.0293, NULL, NULL),
('201780406', 'IL0000197', 'IL0000197', 'ILCHIGSTD', 'UroPartners', 'Robert', 'J', 'Challenger', 'MD', 'Urology', '', '', NULL, 'O', '610 E Roosevelt Rd Ste 203', 'Wheaton', 'Dupage', 'IL', '60187', '6306535550', '6306535561', '610 E Roosevelt Rd Ste 203', 'Wheaton', 'Dupage', 'IL', '60187', '6306535550', '6306535561', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710996962', 0, 'Y', 0, '2012-12-06', NULL, NULL, 41.8588, -88.0984, NULL, NULL),
('201780406', 'W12026404', 'W12026404', 'ILCHIGSTD', 'UroPartners', 'Robert', 'J', 'Challenger', 'MD', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710996962', 0, 'Y', 0, '2012-12-06', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'W12026405', 'W12026405', 'ILCHIGSTD', 'UroPartners', 'Justin', 'J', 'Cohen', 'MD', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1700060704', 0, 'Y', 0, '2012-12-06', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'IL0000200', 'IL0000200', 'ILCHIGSTD', 'UroPartners', 'Justin', 'J', 'Cohen', 'MD', 'Urology', '', '', NULL, 'O', '900 N Westmoreland Rd Ste 125', 'Lake Forest', 'Lake', 'IL', '60045', '8472950010', '8472955433', '900 N Westmoreland Rd Ste 125', 'Lake Forest', 'Lake', 'IL', '60045', '8472950010', '8472955433', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1700060704', 0, 'N', 0, '2012-12-06', NULL, NULL, 42.2574, -87.8634, NULL, NULL),
('201780406', 'IL0000203', 'IL0000203', 'ILCHIGSTD', 'UroPartners', 'Christopher', 'L', 'Coogan', 'MD', 'Urology', '', '', NULL, 'O', '1725 W Harrison St Ste 758', 'Chicago', 'Cook', 'IL', '60612', '3129428484', '3129428494', '1725 W Harrison St Ste 758', 'Chicago', 'Cook', 'IL', '60612', '3129428484', '3129428494', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568412716', 0, 'Y', 0, '2012-12-06', NULL, NULL, 41.8741, -87.6698, NULL, NULL),
('201780406', 'W12026407', 'W12026407', 'ILCHIGSTD', 'UroPartners', 'Joel', 'Z', 'Cornfield', 'MD', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376543249', 0, 'Y', 0, '2012-12-06', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'W12026406', 'W12026406', 'ILCHIGSTD', 'UroPartners', 'Christopher', 'L', 'Coogan', 'MD', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568412716', 0, 'Y', 0, '2012-12-06', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'IL0000205', 'IL0000205', 'ILCHIGSTD', 'UroPartners', 'Joel', 'Z', 'Cornfield', 'MD', 'Urology', '', '', NULL, 'O', '950 N York Rd Ste 208', 'Hinsdale', 'Dupage', 'IL', '60521', '6308870580', '6308870618', '950 N York Rd Ste 208', 'Hinsdale', 'Dupage', 'IL', '60521', '6308870580', '6308870618', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376543249', 0, 'Y', 0, '2012-12-06', NULL, NULL, 41.8178, -87.9266, NULL, NULL),
('201780406', 'W12026409', 'W12026409', 'ILCHIGSTD', 'UroPartners', 'Karen', 'L', 'Cox', 'PAC', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-08-06', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730104746', 0, 'Y', 0, '2013-08-14', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'IL0000208', 'IL0000208', 'ILCHIGSTD', 'UroPartners', 'Karen', 'L', 'Cox', 'PAC', 'Urology', '', '', NULL, 'O', '1555 Barrington Rd Ste 2500', 'Hoffman Estates', 'Cook', 'IL', '60169', '8478233185', '8478233318', '1555 Barrington Rd Ste 2500', 'Hoffman Estates', 'Cook', 'IL', '60169', '8478233185', '8478233318', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-08-06', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730104746', 0, 'Y', 0, '2013-08-14', NULL, NULL, 42.0526, -88.1415, NULL, NULL),
('201780406', 'IL0000211', 'IL0000211', 'ILCHIGSTD', 'UroPartners', 'John', 'J', 'Cudecki', 'MD', 'Urology', '', '', NULL, 'O', '2850 S Wabash Ave Ste 106', 'Chicago', 'Cook', 'IL', '60616', '3128424400', '3128424595', '2850 S Wabash Ave Ste 106', 'Chicago', 'Cook', 'IL', '60616', '3128424400', '3128424595', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053397851', 0, 'Y', 0, '2014-04-25', NULL, NULL, 41.8423, -87.6253, NULL, NULL),
('201780406', 'IL0000207', 'IL0000207', 'ILCHIGSTD', 'UroPartners', 'Karen', 'L', 'Cox', 'PAC', 'Urology', '', '', NULL, 'O', '900 Rand Rd Ste 120', 'Des Plaines', 'Cook', 'IL', '60016', '8478233185', '8478233318', '900 Rand Rd Ste 120', 'Des Plaines', 'Cook', 'IL', '60016', '8478233185', '8478233318', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-08-06', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730104746', 0, 'Y', 0, '2013-08-14', NULL, NULL, 42.0568, -87.9018, NULL, NULL),
('201780406', 'W12026408', 'W12026408', 'ILCHIGSTD', 'UroPartners', 'Karen', 'L', 'Cox', 'PAC', 'Urology', '', '', NULL, 'O', '1450 Busch Pkwy Ste 135', 'Buffalo Grove', 'Lake', 'IL', '60089', '8478233185', '8478233318', '1450 Busch Pkwy Ste 135', 'Buffalo Grove', 'Lake', 'IL', '60089', '8478233185', '8478233318', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-08-06', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730104746', 0, 'Y', 0, '2013-08-14', NULL, NULL, 42.1726, -87.926, NULL, NULL),
('201780406', 'IL0000213', 'IL0000213', 'ILCHIGSTD', 'UroPartners', 'Daniel', 'P', 'Dalton', 'MD', 'Urology', '', '', NULL, 'O', '676 N St Clair St Ste 1835', 'Chicago', 'Cook', 'IL', '60611', '3129263535', '3129263585', '676 N St Clair St Ste 1835', 'Chicago', 'Cook', 'IL', '60611', '3129263535', '3129263585', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1669403432', 0, 'N', 0, '2012-12-06', NULL, NULL, 41.8945, -87.6227, NULL, NULL),
('201780406', 'W12026410', 'W12026410', 'ILCHIGSTD', 'UroPartners', 'John', 'J', 'Cudecki', 'MD', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053397851', 0, 'Y', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'W12026411', 'W12026411', 'ILCHIGSTD', 'UroPartners', 'Daniel', 'P', 'Dalton', 'MD', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1669403432', 0, 'Y', 0, '2012-12-06', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'IL0000217', 'IL0000217', 'ILCHIGSTD', 'UroPartners', 'Steven', 'B', 'Dritz', 'MD', 'Urology', '', '', NULL, 'O', '1200 S York St Ste 4190', 'Elmhurst', 'Dupage', 'IL', '60126', '6308345701', '7083382474', '1200 S York St Ste 4190', 'Elmhurst', 'Dupage', 'IL', '60126', '6308345701', '7083382474', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1629027016', 0, 'N', 0, '2012-12-06', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('201780406', 'W12026412', 'W12026412', 'ILCHIGSTD', 'UroPartners', 'Steven', 'B', 'Dritz', 'MD', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1629027016', 0, 'Y', 0, '2012-12-06', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'IL0000216', 'IL0000216', 'ILCHIGSTD', 'UroPartners', 'Steven', 'B', 'Dritz', 'MD', 'Urology', '', '', NULL, 'O', '610 S Maple Ave Ste 2800', 'Oak Park', 'Cook', 'IL', '60304', '7083831810', '7083831829', '610 S Maple Ave Ste 2800', 'Oak Park', 'Cook', 'IL', '60304', '7083831810', '7083831829', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1629027016', 0, 'N', 0, '2012-12-06', NULL, NULL, 41.878, -87.8038, NULL, NULL),
('201780406', 'IL0000215', 'IL0000215', 'ILCHIGSTD', 'UroPartners', 'Steven', 'B', 'Dritz', 'MD', 'Urology', '', '', NULL, 'O', '675 W North Ave Ste 605', 'Melrose Park', 'Cook', 'IL', '60160', '7084505055', '7083382474', '675 W North Ave Ste 605', 'Melrose Park', 'Cook', 'IL', '60160', '7084505055', '7083382474', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1629027016', 0, 'N', 0, '2012-12-06', NULL, NULL, 41.9083, -87.8421, NULL, NULL),
('201780406', 'IL0000219', 'IL0000219', 'ILCHIGSTD', 'UroPartners', 'George', '', 'Engel', 'MD', 'Pathology', '', '', NULL, 'O', '2225 Enterprise Dr Ste 2511', 'Westchester', 'Cook', 'IL', '60154', '7084860076', '7084920203', '2225 Enterprise Dr Ste 2511', 'Westchester', 'Cook', 'IL', '60154', '7084860076', '7084920203', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912908690', 0, 'Y', 0, '2012-12-06', NULL, NULL, 41.8474, -87.9096, NULL, NULL),
('201780406', 'W12026413', 'W12026413', 'ILCHIGSTD', 'UroPartners', 'George', '', 'Engel', 'MD', 'Pathology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912908690', 0, 'Y', 0, '2012-12-06', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'IL0000222', 'IL0000222', 'ILCHIGSTD', 'UroPartners', 'Walter', 'S', 'Falkowski', 'MD', 'Urology', '', '', NULL, 'O', '1875 Dempster St Ste 506', 'Park Ridge', 'Cook', 'IL', '60068', '8478234700', '8474701550', '1875 Dempster St Ste 506', 'Park Ridge', 'Cook', 'IL', '60068', '8478234700', '8474701550', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-10-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124067335', 0, 'N', 0, '2013-08-29', NULL, NULL, 42.0386, -87.8487, NULL, NULL),
('201780406', 'W12026414', 'W12026414', 'ILCHIGSTD', 'UroPartners', 'Walter', 'S', 'Falkowski', 'MD', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-10-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124067335', 0, 'Y', 0, '2013-08-29', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'IL0000223', 'IL0000223', 'ILCHIGSTD', 'UroPartners', 'Walter', 'S', 'Falkowski', 'MD', 'Urology', '', '', NULL, 'O', '7447 W Talcott Ave Ste 509', 'Chicago', 'Cook', 'IL', '60631', '7737750800', '8474701550', '7447 W Talcott Ave Ste 509', 'Chicago', 'Cook', 'IL', '60631', '7737750800', '8474701550', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-10-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124067335', 0, 'N', 0, '2013-08-29', NULL, NULL, 41.9902, -87.8159, NULL, NULL),
('201780406', 'IL0000221', 'IL0000221', 'ILCHIGSTD', 'UroPartners', 'Walter', 'S', 'Falkowski', 'MD', '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, '2013-01-01', '2013-10-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124067335', 0, 'N', 0, '2013-08-29', NULL, NULL, 42.0249, -87.8141, NULL, NULL),
('201780406', 'IL0000224', 'IL0000224', 'ILCHIGSTD', 'UroPartners', 'Walter', 'S', 'Falkowski', 'MD', 'Urology', '', '', NULL, 'O', '800 Austin Ave East Tower Ste 266', ' Evanston', 'Cook', 'IL', '60202', '8474911756', '8474701550', '800 Austin Ave East Tower Ste 266', ' Evanston', 'Cook', 'IL', '60202', '8474911756', '8474701550', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-10-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124067335', 0, 'Y', 0, '2013-08-29', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'W12026415', 'W12026415', 'ILCHIGSTD', 'UroPartners', 'Risha', 'M', 'Foster', 'MD', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376706630', 0, 'Y', 0, '2012-12-06', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'IL0000226', 'IL0000226', 'ILCHIGSTD', 'UroPartners', 'Risha', 'M', 'Foster', 'MD', 'Urology', '', '', NULL, 'O', '5201 S Willow Springs Rd Ste 380', 'LaGrange', 'Cook', 'IL', '60525', '7083542550', '7083544552', '5201 S Willow Springs Rd Ste 380', 'LaGrange', 'Cook', 'IL', '60525', '7083542550', '7083544552', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376706630', 0, 'Y', 0, '2012-12-06', NULL, NULL, 41.7974, -87.8884, NULL, NULL),
('201780406', 'W12026416', 'W12026416', 'ILCHIGSTD', 'UroPartners', 'John', 'E', 'Garnett', 'MD', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2014-03-08', 0, 0, 0, 'Northwestern Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1134150048', 0, 'Y', 0, '2013-12-12', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'IL0000228', 'IL0000228', 'ILCHIGSTD', 'UroPartners', 'John', 'E', 'Garnett', 'MD', 'Urology', '', '', NULL, 'O', '676 N St Clair St Ste 1835', 'Chicago', 'Cook', 'IL', '60611', '3129263535', '3129263585', '676 N St Clair St Ste 1835', 'Chicago', 'Cook', 'IL', '60611', '3129263535', '3129263585', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2014-03-08', 0, 0, 0, 'Northwestern Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1134150048', 0, 'N', 0, '2013-12-12', NULL, NULL, 41.8945, -87.6227, 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
('201780406', 'IL0000231', 'IL0000231', 'ILCHIGSTD', 'UroPartners', 'James', 'G', 'Giblin', 'MD', 'Urology', '', '', NULL, 'O', '302 Randall Rd Ste 306', 'Geneva', 'Kane', 'IL', '60134', '6303771368', '6303777514', '302 Randall Rd Ste 306', 'Geneva', 'Kane', 'IL', '60134', '6303771368', '6303777514', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457360695', 0, 'Y', 0, '2013-04-05', NULL, NULL, 41.8848, -88.3434, NULL, NULL),
('201780406', 'W12026417', 'W12026417', 'ILCHIGSTD', 'UroPartners', 'James', 'G', 'Giblin', 'MD', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457360695', 0, 'Y', 0, '2013-04-05', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'IL0000230', 'IL0000230', 'ILCHIGSTD', 'UroPartners', 'James', 'G', 'Giblin', 'MD', 'Urology', '', '', NULL, 'O', '610 E Roosevelt Rd Ste 203', 'Wheaton', 'Dupage', 'IL', '60187', '6306535550', '6306535561', '610 E Roosevelt Rd Ste 203', 'Wheaton', 'Dupage', 'IL', '60187', '6306535550', '6306535561', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457360695', 0, 'Y', 0, '2013-04-05', NULL, NULL, 41.8584, -88.0972, NULL, NULL),
('201780406', 'IL0000236', 'IL0000236', 'ILCHIGSTD', 'UroPartners', 'Gordon', 'R', 'Gluckman', 'MD', 'Urology', '', '', NULL, 'O', '1450 Busch Pkwy Ste 135', 'Buffalo Grove', 'Lake', '', '60089', '8478233185', '8478233318', '1450 Busch Pkwy Ste 135', 'Buffalo Grove', 'Lake', '', '60089', '8478233185', '8478233318', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, '', '', 'HCFA|UB|', '1366480170', 0, 'Y', 0, '2014-04-24', NULL, NULL, 42.1717, -87.9275, NULL, NULL),
('201780406', 'IL0000234', 'IL0000234', 'ILCHIGSTD', 'UroPartners', 'Gordon', 'R', 'Gluckman', 'MD', 'Urology', '', '', NULL, 'O', '1555 Barrington Rd Ste 2500', 'Hoffman Estates', 'Cook', 'IL', '60169', '8478233185', '8478233318', '1555 Barrington Rd Ste 2500', 'Hoffman Estates', 'Cook', 'IL', '60169', '8478233185', '8478233318', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, '', '', 'HCFA|UB|', '1366480170', 0, 'N', 0, '2014-04-24', NULL, NULL, 42.0542, -88.1444, NULL, NULL),
('201780406', 'W12026418', 'W12026418', 'ILCHIGSTD', 'UroPartners', 'Gordon', 'R', 'Gluckman', 'MD', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, '', '', 'HCFA|UB|', '1366480170', 0, 'Y', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'IL0000235', 'IL0000235', 'ILCHIGSTD', 'UroPartners', 'Gordon', 'R', 'Gluckman', 'MD', 'Urology', '', '', NULL, 'O', '431 Lakeview Ct Ste D', 'Mount Prospect', 'Cook', 'IL', '60056', '8478233185', '8478233318', '431 Lakeview Ct Ste D', 'Mount Prospect', 'Cook', 'IL', '60056', '8478233185', '8478233318', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2014-04-11', 0, 0, 0, 'Northwest Community Hospital', NULL, '', '', 'HCFA|UB|', '1366480170', 0, 'N', 0, '2014-04-24', NULL, NULL, 42.0751, -87.9115, NULL, NULL),
('201780406', 'IL0000233', 'IL0000233', 'ILCHIGSTD', 'UroPartners', 'Gordon', 'R', 'Gluckman', 'MD', 'Urology', '', '', NULL, 'O', '900 Rand Rd Ste 120', 'Des Plaines', 'Cook', 'IL', '60016', '8478233185', '8478233318', '900 Rand Rd Ste 120', 'Des Plaines', 'Cook', 'IL', '60016', '8478233185', '8478233318', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, '', '', 'HCFA|UB|', '1366480170', 0, 'N', 0, '2014-04-24', NULL, NULL, 42.0564, -87.9023, NULL, NULL),
('201780406', 'IL0000238', 'IL0000238', 'ILCHIGSTD', 'UroPartners', 'Michael', 'S', 'Gomez', 'MD', 'Urology', '', '', NULL, 'O', '2850 S Wabash Ave Ste 106', 'Chicago', 'Cook', 'IL', '60616', '3128424400', '3128424595', '2850 S Wabash Ave Ste 106', 'Chicago', 'Cook', 'IL', '60616', '3128424400', '3128424595', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922277268', 0, 'Y', 0, '2014-04-25', NULL, NULL, 41.8423, -87.6253, NULL, NULL),
('201780406', 'W12026419', 'W12026419', 'ILCHIGSTD', 'UroPartners', 'Michael', 'S', 'Gomez', 'MD', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922277268', 0, 'Y', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'IL0000241', 'IL0000241', 'ILCHIGSTD', 'UroPartners', 'Lara', '', 'Hammond', 'MD', 'Urology', '', '', NULL, 'O', '1875 Dempster St Ste 506', 'Park Ridge', 'Cook', 'IL', '60068', '8478234700', '8474701550', '1875 Dempster St Ste 506', 'Park Ridge', 'Cook', 'IL', '60068', '8478234700', '8474701550', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2014-08-01', 0, 0, 0, 'Presence Resurrection Medical Center', '', '', '', 'HCFA|UB|', '1235167149', 0, 'N', 0, '2014-06-19', NULL, NULL, 42.0397, -87.8491, NULL, NULL),
('201780406', 'W12026420', 'W12026420', 'ILCHIGSTD', 'UroPartners', 'Lara', '', 'Hammond', 'MD', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', '', '', '', 'HCFA|UB|', '1235167149', 0, 'Y', 0, '2014-06-19', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'IL0000242', 'IL0000242', 'ILCHIGSTD', 'UroPartners', 'Lara', '', 'Hammond', 'MD', 'Urology', '', '', NULL, 'O', '7447 W Talcott Ave Ste 509', 'Chicago', 'Cook', 'IL', '60631', '7737750800', '8474701550', '7447 W Talcott Ave Ste 509', 'Chicago', 'Cook', 'IL', '60631', '7737750800', '8474701550', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', '', '', '', 'HCFA|UB|', '1235167149', 0, 'N', 0, '2014-06-19', NULL, NULL, 41.9887, -87.8131, NULL, NULL),
('201780406', 'IL0000240', 'IL0000240', 'ILCHIGSTD', 'UroPartners', 'Lara', '', 'Hammond', 'MD', '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, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', '', '', '', 'HCFA|UB|', '1235167149', 0, 'N', 0, '2014-06-19', NULL, NULL, 42.0244, -87.8126, NULL, NULL),
('201780406', 'IL0000246', 'IL0000246', 'ILCHIGSTD', 'UroPartners', 'Richard', 'G', 'Harris', 'MD', 'Urology', '', '', NULL, 'O', '1200 S York St Ste 4190', 'Elmhurst', 'Dupage', 'IL', '60126', '6308345701', '7083382474', '1200 S York St Ste 4190', 'Elmhurst', 'Dupage', 'IL', '60126', '6308345701', '7083382474', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1346290673', 0, 'N', 0, '2012-12-06', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('201780406', 'W12026421', 'W12026421', 'ILCHIGSTD', 'UroPartners', 'Richard', 'G', 'Harris', 'MD', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1346290673', 0, 'Y', 0, '2012-12-06', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'IL0000245', 'IL0000245', 'ILCHIGSTD', 'UroPartners', 'Richard', 'G', 'Harris', 'MD', 'Urology', '', '', NULL, 'O', '610 S Maple Ave Ste 2800', 'Oak Park', 'Cook', 'IL', '60304', '7083831810', '7083831829', '610 S Maple Ave Ste 2800', 'Oak Park', 'Cook', 'IL', '60304', '7083831810', '7083831829', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1346290673', 0, 'N', 0, '2012-12-06', NULL, NULL, 41.878, -87.8038, NULL, NULL),
('201780406', 'IL0000244', 'IL0000244', 'ILCHIGSTD', 'UroPartners', 'Richard', 'G', 'Harris', 'MD', 'Urology', '', '', NULL, 'O', '675 W North Ave Ste 605', 'Melrose Park', 'Cook', 'IL', '60160', '7084505055', '7083382474', '675 W North Ave Ste 605', 'Melrose Park', 'Cook', 'IL', '60160', '7084505055', '7083382474', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1346290673', 0, 'N', 0, '2012-12-06', NULL, NULL, 41.9083, -87.8421, NULL, NULL),
('201780406', 'IL0000249', 'IL0000249', 'ILCHIGSTD', 'UroPartners', 'Brian', 'C', 'Hennig', 'PAC', 'Urology', '', '', NULL, 'O', '1875 Dempster St Ste 506', 'Park Ridge', 'Cook', 'IL', '60068', '8478234700', '8474701550', '1875 Dempster St Ste 506', 'Park Ridge', 'Cook', 'IL', '60068', '8478234700', '8474701550', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2014-08-01', 0, 0, 0, 'Presence Resurrection Medical Center', '', '', '', 'HCFA|UB|', '1457439408', 0, 'Y', 0, '2014-06-19', NULL, NULL, 42.0397, -87.8491, NULL, NULL),
('201780406', 'IL0000252', 'IL0000252', 'ILCHIGSTD', 'UroPartners', 'Jerome', '', 'Hoeksema', 'MD', 'Urology', '', '', NULL, 'O', '1725 W Harrison St Ste 352', 'Chicago', 'Cook', 'IL', '60612', '3125635000', '3125635007', '1725 W Harrison St Ste 352', 'Chicago', 'Cook', 'IL', '60612', '3125635000', '3125635007', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235102328', 0, 'Y', 0, '2014-04-25', NULL, NULL, 41.8741, -87.6698, NULL, NULL),
('201780406', 'IL0000250', 'IL0000250', 'ILCHIGSTD', 'UroPartners', 'Brian', 'C', 'Hennig', 'PAC', 'Urology', '', '', NULL, 'O', '7447 W Talcott Ave Ste 509', 'Chicago', 'Cook', 'IL', '60631', '7737750800', '8474701550', '7447 W Talcott Ave Ste 509', 'Chicago', 'Cook', 'IL', '60631', '7737750800', '8474701550', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', '', '', '', 'HCFA|UB|', '1457439408', 0, 'Y', 0, '2014-06-19', NULL, NULL, 41.9887, -87.8131, NULL, NULL),
('201780406', 'IL0000248', 'IL0000248', 'ILCHIGSTD', 'UroPartners', 'Brian', 'C', 'Hennig', 'PAC', '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, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', '', '', '', 'HCFA|UB|', '1457439408', 0, 'Y', 0, '2014-06-19', NULL, NULL, 42.0244, -87.8126, NULL, NULL),
('201780406', 'W12026422', 'W12026422', 'ILCHIGSTD', 'UroPartners', 'Brian', 'C', 'Hennig', 'PAC', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', '', '', '', 'HCFA|UB|', '1457439408', 0, 'Y', 0, '2014-06-19', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'IL0000254', 'IL0000254', 'ILCHIGSTD', 'UroPartners', 'Rakesh', '', 'Jagetia', '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, '2013-01-01', '2013-03-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164464129', 0, 'N', 0, '2013-03-01', NULL, NULL, 42.101, -87.8241, NULL, NULL),
('201780406', 'W12026423', 'W12026423', 'ILCHIGSTD', 'UroPartners', 'Jerome', '', 'Hoeksema', 'MD', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235102328', 0, 'Y', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'W12026424', 'W12026424', 'ILCHIGSTD', 'UroPartners', 'Rakesh', '', 'Jagetia', 'MD', 'Radiation Oncology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-03-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164464129', 0, 'Y', 0, '2013-03-01', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'IL0000257', 'IL0000257', 'ILCHIGSTD', 'UroPartners', 'Leah', 'D', 'Kampas', 'PAC', 'Urology', '', '', NULL, 'O', '1875 Dempster St Ste 506', 'Park Ridge', 'Cook', 'IL', '60068', '8478234700', '8474701550', '1875 Dempster St Ste 506', 'Park Ridge', 'Cook', 'IL', '60068', '8478234700', '8474701550', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2014-08-01', 0, 0, 0, 'Presence Resurrection Medical Center', '', '', '', 'HCFA|UB|', '1588778906', 0, 'Y', 0, '2014-06-19', NULL, NULL, 42.0397, -87.8491, NULL, NULL),
('201780406', 'IL0000261', 'IL0000261', 'ILCHIGSTD', 'UroPartners', 'Robert', 'S', 'Kaplinsky', 'MD', 'Urology', '', '', NULL, 'O', '1875 Dempster St Ste 506', 'Park Ridge', 'Cook', 'IL', '60068', '8478234700', '8474701550', '1875 Dempster St Ste 506', 'Park Ridge', 'Cook', 'IL', '60068', '8478234700', '8474701550', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2014-08-01', 0, 0, 0, 'Presence Resurrection Medical Center', '', '', '', 'HCFA|UB|', '1982643235', 0, 'N', 0, '2014-06-19', NULL, NULL, 42.0397, -87.8491, NULL, NULL),
('201780406', 'IL0000258', 'IL0000258', 'ILCHIGSTD', 'UroPartners', 'Leah', 'D', 'Kampas', 'PAC', 'Urology', '', '', NULL, 'O', '7447 W Talcott Ave Ste 509', 'Chicago', 'Cook', 'IL', '60631', '7737750800', '8474701550', '7447 W Talcott Ave Ste 509', 'Chicago', 'Cook', 'IL', '60631', '7737750800', '8474701550', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', '', '', '', 'HCFA|UB|', '1588778906', 0, 'Y', 0, '2014-06-19', NULL, NULL, 41.9887, -87.8131, NULL, NULL),
('201780406', 'IL0000256', 'IL0000256', 'ILCHIGSTD', 'UroPartners', 'Leah', 'D', 'Kampas', 'PAC', '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, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', '', '', '', 'HCFA|UB|', '1588778906', 0, 'Y', 0, '2014-06-19', NULL, NULL, 42.0244, -87.8126, NULL, NULL),
('201780406', 'W12026425', 'W12026425', 'ILCHIGSTD', 'UroPartners', 'Leah', 'D', 'Kampas', 'PAC', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', '', '', '', 'HCFA|UB|', '1588778906', 0, 'Y', 0, '2014-06-19', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'W12026426', 'W12026426', 'ILCHIGSTD', 'UroPartners', 'Robert', 'S', 'Kaplinsky', 'MD', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', '', '', '', 'HCFA|UB|', '1982643235', 0, 'Y', 0, '2014-06-19', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'IL0000262', 'IL0000262', 'ILCHIGSTD', 'UroPartners', 'Robert', 'S', 'Kaplinsky', 'MD', 'Urology', '', '', NULL, 'O', '7447 W Talcott Ave Ste 509', 'Chicago', 'Cook', 'IL', '60631', '7737750800', '8474701550', '7447 W Talcott Ave Ste 509', 'Chicago', 'Cook', 'IL', '60631', '7737750800', '8474701550', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', '', '', '', 'HCFA|UB|', '1982643235', 0, 'N', 0, '2014-06-19', NULL, NULL, 41.9887, -87.8131, NULL, NULL),
('201780406', 'IL0000260', 'IL0000260', 'ILCHIGSTD', 'UroPartners', 'Robert', 'S', 'Kaplinsky', 'MD', '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, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', '', '', '', 'HCFA|UB|', '1982643235', 0, 'N', 0, '2014-06-19', NULL, NULL, 42.0244, -87.8126, NULL, NULL),
('201780406', 'IL0000265', 'IL0000265', 'ILCHIGSTD', 'UroPartners', 'Raza', 'M', 'Khan', 'MD', 'Urology', '', '', NULL, 'O', '151 W Golf Rd', 'Libertyville', 'Lake', 'IL', '60048', '8476803803', '8476803811', '151 W Golf Rd', 'Libertyville', 'Lake', 'IL', '60048', '8476803803', '8476803811', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1568455327', 0, 'N', 0, '2012-12-06', NULL, NULL, 42.2696, -87.9527, NULL, NULL),
('201780406', 'IL0000264', 'IL0000264', 'ILCHIGSTD', 'UroPartners', 'Raza', 'M', 'Khan', 'MD', 'Urology', '', '', NULL, 'O', '3 S Greenleaf Ave Ste J', 'Gurnee', 'Lake', 'IL', '60031', '8475991111', '8475991148', '3 S Greenleaf Ave Ste J', 'Gurnee', 'Lake', 'IL', '60031', '8475991111', '8475991148', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1568455327', 0, 'N', 0, '2012-12-06', NULL, NULL, 42.3596, -87.9019, NULL, NULL),
('201780406', 'W12026427', 'W12026427', 'ILCHIGSTD', 'UroPartners', 'Raza', 'M', 'Khan', 'MD', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1568455327', 0, 'Y', 0, '2012-12-06', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'IL0000268', 'IL0000268', 'ILCHIGSTD', 'UroPartners', 'Ronald', 'J', 'Kim', 'MD', 'Urology', '', '', NULL, 'O', '1475 E Belvidere Rd Ste 312', 'Grayslake', 'Lake', 'IL', '60030', '8479863030', '8479863035', '1475 E Belvidere Rd Ste 312', 'Grayslake', 'Lake', 'IL', '60030', '8479863030', '8479863035', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', NULL, '', '', 'HCFA|UB|', '1447451554', 0, 'N', 0, '2014-07-18', NULL, NULL, 42.3366, -88.0293, NULL, NULL),
('201780406', 'W12026428', 'W12026428', 'ILCHIGSTD', 'UroPartners', 'Ronald', 'J', 'Kim', 'MD', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', NULL, '', '', 'HCFA|UB|', '1447451554', 0, 'Y', 0, '2012-12-06', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'IL0000267', 'IL0000267', 'ILCHIGSTD', 'UroPartners', 'Ronald', 'J', 'Kim', 'MD', 'Urology', '', '', NULL, 'O', '900 N Westmoreland Rd Ste 125', 'Lake Forest', 'Lake', 'IL', '60045', '8472950010', '8472955433', '900 N Westmoreland Rd Ste 125', 'Lake Forest', 'Lake', 'IL', '60045', '8472950010', '8472955433', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', NULL, '', '', 'HCFA|UB|', '1447451554', 0, 'N', 0, '2012-12-06', NULL, NULL, 42.2574, -87.8634, NULL, NULL),
('201780406', 'W12026429', 'W12026429', 'ILCHIGSTD', 'UroPartners', 'Samuel', 'S', 'Krengel', 'MD', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497755375', 0, 'Y', 0, '2012-12-06', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'IL0000270', 'IL0000270', 'ILCHIGSTD', 'UroPartners', 'Samuel', 'S', 'Krengel', 'MD', 'Urology', '', '', NULL, 'O', '950 N York Rd Ste 208', 'Hinsdale', 'Dupage', 'IL', '60521', '6308870580', '6308870618', '950 N York Rd Ste 208', 'Hinsdale', 'Dupage', 'IL', '60521', '6308870580', '6308870618', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497755375', 0, 'Y', 0, '2012-12-06', NULL, NULL, 41.8178, -87.9266, NULL, NULL),
('201780406', 'IL0000276', 'IL0000276', 'ILCHIGSTD', 'UroPartners', 'Robert', 'S', 'Lai', 'MD', 'Urology', '', '', NULL, 'O', '1200 S York St Ste 4190', 'Elmhurst', 'Dupage', 'IL', '60126', '6308345701', '7083382474', '1200 S York St Ste 4190', 'Elmhurst', 'Dupage', 'IL', '60126', '6308345701', '7083382474', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2014-03-24', 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1730193459', 0, 'N', 0, '2014-03-26', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('201780406', 'IL0000272', 'IL0000272', 'ILCHIGSTD', 'UroPartners', 'John', 'J', 'Kritsas', 'MD', 'Urology', '', '', NULL, 'O', '950 N York Rd Ste 208', 'Hinsdale', 'Dupage', 'IL', '60521', '6308870580', '6308870618', '950 N York Rd Ste 208', 'Hinsdale', 'Dupage', 'IL', '60521', '6308870580', '6308870618', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134129018', 0, 'Y', 0, '2012-12-06', NULL, NULL, 41.8178, -87.9266, NULL, NULL),
('201780406', 'W12026430', 'W12026430', 'ILCHIGSTD', 'UroPartners', 'John', 'J', 'Kritsas', 'MD', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134129018', 0, 'Y', 0, '2012-12-06', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'W12026431', 'W12026431', 'ILCHIGSTD', 'UroPartners', 'Robert', 'S', 'Lai', 'MD', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2014-03-24', 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1730193459', 0, 'Y', 0, '2014-03-26', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'IL0000275', 'IL0000275', 'ILCHIGSTD', 'UroPartners', 'Robert', 'S', 'Lai', 'MD', 'Urology', '', '', NULL, 'O', '610 S Maple Ave Ste 2800', 'Oak Park', 'Cook', 'IL', '60304', '7083831810', '7083831829', '610 S Maple Ave Ste 2800', 'Oak Park', 'Cook', 'IL', '60304', '7083831810', '7083831829', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2014-03-24', 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1730193459', 0, 'N', 0, '2014-03-26', NULL, NULL, 41.878, -87.8038, NULL, NULL),
('201780406', 'IL0000274', 'IL0000274', 'ILCHIGSTD', 'UroPartners', 'Robert', 'S', 'Lai', 'MD', 'Urology', '', '', NULL, 'O', '675 W North Ave Ste 605', 'Melrose Park', 'Cook', 'IL', '60160', '7084505055', '7083382474', '675 W North Ave Ste 605', 'Melrose Park', 'Cook', 'IL', '60160', '7084505055', '7083382474', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2014-03-24', 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1730193459', 0, 'N', 0, '2014-03-26', NULL, NULL, 41.9083, -87.8421, NULL, NULL),
('201780406', 'IL0000280', 'IL0000280', 'ILCHIGSTD', 'UroPartners', 'Spencer', 'A', 'Land', 'MD', 'Urology', '', '', NULL, 'O', '1200 S York St Ste 4190', 'Elmhurst', 'Dupage', 'IL', '60126', '6308345701', '7083382474', '1200 S York St Ste 4190', 'Elmhurst', 'Dupage', 'IL', '60126', '6308345701', '7083382474', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2014-08-01', 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', '', '', '', 'HCFA|UB|', '1407820491', 0, 'N', 0, '2014-06-11', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('201780406', 'W12026432', 'W12026432', 'ILCHIGSTD', 'UroPartners', 'Spencer', 'A', 'Land', 'MD', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2014-08-01', 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', '', '', '', 'HCFA|UB|', '1407820491', 0, 'Y', 0, '2014-06-11', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'IL0000279', 'IL0000279', 'ILCHIGSTD', 'UroPartners', 'Spencer', 'A', 'Land', 'MD', 'Urology', '', '', NULL, 'O', '610 S Maple Ave Ste 2800', 'Oak Park', 'Cook', 'IL', '60304', '7083831810', '7083831829', '610 S Maple Ave Ste 2800', 'Oak Park', 'Cook', 'IL', '60304', '7083831810', '7083831829', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2014-08-01', 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', '', '', '', 'HCFA|UB|', '1407820491', 0, 'N', 0, '2014-06-11', NULL, NULL, 41.878, -87.8038, NULL, NULL),
('201780406', 'IL0000278', 'IL0000278', 'ILCHIGSTD', 'UroPartners', 'Spencer', 'A', 'Land', 'MD', 'Urology', '', '', NULL, 'O', '675 W North Ave Ste 605', 'Melrose Park', 'Cook', 'IL', '60160', '7084505055', '7083382474', '675 W North Ave Ste 605', 'Melrose Park', 'Cook', 'IL', '60160', '7084505055', '7083382474', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2014-08-01', 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', '', '', '', 'HCFA|UB|', '1407820491', 0, 'N', 0, '2014-06-11', NULL, NULL, 41.9083, -87.8421, NULL, NULL),
('201780406', 'IL0000282', 'IL0000282', 'ILCHIGSTD', 'UroPartners', 'Kalyan', 'C', 'Latchamsetty', 'MD', 'Urology', '', '', NULL, 'O', '1725 W Harrison St Ste 758', 'Chicago', 'Cook', 'IL', '60612', '3129428484', '3129428494', '1725 W Harrison St Ste 758', 'Chicago', 'Cook', 'IL', '60612', '3129428484', '3129428494', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699724138', 0, 'Y', 0, '2014-04-25', NULL, NULL, 41.8741, -87.6698, NULL, NULL),
('201780406', 'W12026433', 'W12026433', 'ILCHIGSTD', 'UroPartners', 'Kalyan', 'C', 'Latchamsetty', 'MD', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699724138', 0, 'Y', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'W12026435', 'W12026435', 'ILCHIGSTD', 'UroPartners', 'Ronald', 'D', 'Lee', 'MD', 'Urology', '', '', NULL, 'O', '1450 Busch Pkwy Ste 135', 'Buffalo Grove', 'Lake', 'IL', '60089', '8478233185', '8478233318', '1450 Busch Pkwy Ste 135', 'Buffalo Grove', 'Lake', 'IL', '60089', '8478233185', '8478233318', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', 'Northwest Community Hospital', '', '', 'HCFA|UB|', '1023091667', 0, 'N', 0, '2014-04-25', NULL, NULL, 42.1717, -87.9275, NULL, NULL),
('201780406', 'IL0000286', 'IL0000286', 'ILCHIGSTD', 'UroPartners', 'Ronald', 'D', 'Lee', 'MD', 'Urology', '', '', NULL, 'O', '431 Lakeview Ct Ste D', 'Mount Prospect', 'Cook', 'IL', '60056', '8478233185', '8478233318', '431 Lakeview Ct Ste D', 'Mount Prospect', 'Cook', 'IL', '60056', '8478233185', '8478233318', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2014-04-11', 0, 0, 0, 'Presence Resurrection Medical Center', 'Northwest Community Hospital', '', '', 'HCFA|UB|', '1023091667', 0, 'N', 0, '2014-04-25', NULL, NULL, 42.0751, -87.9115, NULL, NULL),
('201780406', 'IL0000284', 'IL0000284', 'ILCHIGSTD', 'UroPartners', 'Ronald', 'D', 'Lee', 'MD', 'Urology', '', '', NULL, 'O', '900 Rand Rd Ste 120', 'Des Plaines', 'Cook', 'IL', '60016', '8478233185', '8478233318', '900 Rand Rd Ste 120', 'Des Plaines', 'Cook', 'IL', '60016', '8478233185', '8478233318', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', 'Northwest Community Hospital', '', '', 'HCFA|UB|', '1023091667', 0, 'N', 0, '2014-04-25', NULL, NULL, 42.0564, -87.9023, NULL, NULL),
('201780406', 'IL0000289', 'IL0000289', 'ILCHIGSTD', 'UroPartners', 'Laurence', 'A', 'Levine', 'MD', 'Urology', '', '', NULL, 'O', '1725 W Harrison St Ste 352', 'Chicago', 'Cook', 'IL', '60612', '3125635000', '3125635007', '1725 W Harrison St Ste 352', 'Chicago', 'Cook', 'IL', '60612', '3125635000', '3125635007', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922072131', 0, 'Y', 0, '2014-04-25', NULL, NULL, 41.8741, -87.6698, NULL, NULL),
('201780406', 'W12026438', 'W12026438', 'ILCHIGSTD', 'UroPartners', 'William', 'W', 'Lin', 'MD', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1396776209', 0, 'Y', 0, '2012-12-06', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'W12026437', 'W12026437', 'ILCHIGSTD', 'UroPartners', 'Laurence', 'A', 'Levine', 'MD', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922072131', 0, 'Y', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'IL0000291', 'IL0000291', 'ILCHIGSTD', 'UroPartners', 'William', 'W', 'Lin', 'MD', 'Urology', '', '', NULL, 'O', '676 N St Clair St Ste 1835', 'Chicago', 'Cook', 'IL', '60611', '3129263535', '3129263585', '676 N St Clair St Ste 1835', 'Chicago', 'Cook', 'IL', '60611', '3129263535', '3129263585', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1396776209', 0, 'N', 0, '2012-12-06', NULL, NULL, 41.8945, -87.6227, NULL, NULL),
('201780406', 'IL0000294', 'IL0000294', 'ILCHIGSTD', 'UroPartners', 'H Merrill', '', 'Matschke', 'MD', 'Urology', '', '', NULL, 'O', '1475 E Belvidere Rd Ste 312', 'Grayslake', 'Lake', 'IL', '60030', '8479863030', '8479863035', '1475 E Belvidere Rd Ste 312', 'Grayslake', 'Lake', 'IL', '60030', '8479863030', '8479863035', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1629032115', 0, 'N', 0, '2014-07-18', NULL, NULL, 42.3366, -88.0293, NULL, NULL),
('201780406', 'W12026439', 'W12026439', 'ILCHIGSTD', 'UroPartners', 'H Merrill', '', 'Matschke', 'MD', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1629032115', 0, 'Y', 0, '2012-12-06', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'IL0000293', 'IL0000293', 'ILCHIGSTD', 'UroPartners', 'H Merrill', '', 'Matschke', 'MD', 'Urology', '', '', NULL, 'O', '900 N Westmoreland Rd Ste 125', 'Lake Forest', 'Lake', 'IL', '60045', '8472950010', '8472955433', '900 N Westmoreland Rd Ste 125', 'Lake Forest', 'Lake', 'IL', '60045', '8472950010', '8472955433', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1629032115', 0, 'N', 0, '2012-12-06', NULL, NULL, 42.2574, -87.8634, NULL, NULL),
('201780406', 'W12026440', 'W12026440', 'ILCHIGSTD', 'UroPartners', 'Kelly', 'M', 'Maxwell', 'MD', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1528216108', 0, 'Y', 0, '2012-12-06', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'IL0000296', 'IL0000296', 'ILCHIGSTD', 'UroPartners', 'Kelly', 'M', 'Maxwell', 'MD', 'Urology', '', '', NULL, 'O', '676 N St Clair St Ste 1835', 'Chicago', 'Cook', 'IL', '60611', '3129263535', '3129263585', '676 N St Clair St Ste 1835', 'Chicago', 'Cook', 'IL', '60611', '3129263535', '3129263585', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1528216108', 0, 'N', 0, '2012-12-06', NULL, NULL, 41.8945, -87.6227, NULL, NULL),
('201780406', 'W12026441', 'W12026441', 'ILCHIGSTD', 'UroPartners', 'Matthew', 'A', 'Meadows', 'MD', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', 'Presence Saint Joseph Hospital Chicago', '', '', 'HCFA|UB|', '1275599219', 0, 'Y', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'IL0000299', 'IL0000299', 'ILCHIGSTD', 'UroPartners', 'Matthew', 'A', 'Meadows', 'MD', 'Urology', '', '', NULL, 'O', '9669 N Kenton Ave Ste 309', 'Skokie', 'Cook', 'IL', '60076', '8476741899', '8476741936', '9669 N Kenton Ave Ste 309', 'Skokie', 'Cook', 'IL', '60076', '8476741899', '8476741936', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', 'Presence Saint Joseph Hospital Chicago', '', '', 'HCFA|UB|', '1275599219', 0, 'N', 0, '2014-04-25', NULL, NULL, 42.0563, -87.742, NULL, NULL),
('201780406', 'W12026442', 'W12026442', 'ILCHIGSTD', 'UroPartners', 'Daniel', 'S', 'Merrick', 'MD', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', 'Presence Saint Joseph Hospital Chicago', '', '', 'HCFA|UB|', '1184680654', 0, 'Y', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'IL0000302', 'IL0000302', 'ILCHIGSTD', 'UroPartners', 'Daniel', 'S', 'Merrick', 'MD', 'Urology', '', '', NULL, 'O', '9669 N Kenton Ave Ste 309', 'Skokie', 'Cook', 'IL', '60076', '8476741899', '8476741936', '9669 N Kenton Ave Ste 309', 'Skokie', 'Cook', 'IL', '60076', '8476741899', '8476741936', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', 'Presence Saint Joseph Hospital Chicago', '', '', 'HCFA|UB|', '1184680654', 0, 'N', 0, '2014-04-25', NULL, NULL, 42.0563, -87.742, NULL, NULL),
('201780406', 'W12026443', 'W12026443', 'ILCHIGSTD', 'UroPartners', 'Michael', 'H', 'Milani', 'DO', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982617056', 0, 'Y', 0, '2012-12-06', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'IL0000304', 'IL0000304', 'ILCHIGSTD', 'UroPartners', 'Michael', 'H', 'Milani', 'DO', 'Urology', '', '', NULL, 'O', '5201 S Willow Springs Rd Ste 380', 'LaGrange', 'Cook', 'IL', '60525', '7083542550', '7083544552', '5201 S Willow Springs Rd Ste 380', 'LaGrange', 'Cook', 'IL', '60525', '7083542550', '7083544552', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982617056', 0, 'Y', 0, '2012-12-06', NULL, NULL, 41.7974, -87.8884, NULL, NULL),
('201780406', 'W12026444', 'W12026444', 'ILCHIGSTD', 'UroPartners', 'George', 'G', 'Moran', 'MD', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417960758', 0, 'Y', 0, '2012-12-06', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'IL0000306', 'IL0000306', 'ILCHIGSTD', 'UroPartners', 'George', 'G', 'Moran', 'MD', 'Urology', '', '', NULL, 'O', '5201 S Willow Springs Rd Ste 380', 'LaGrange', 'Cook', 'IL', '60525', '7083542550', '7083544552', '5201 S Willow Springs Rd Ste 380', 'LaGrange', 'Cook', 'IL', '60525', '7083542550', '7083544552', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417960758', 0, 'Y', 0, '2012-12-06', NULL, NULL, 41.7974, -87.8884, NULL, NULL),
('201780406', 'IL0000309', 'IL0000309', 'ILCHIGSTD', 'UroPartners', 'Donna', 'M', 'Mullahy', 'PAC', 'Urology', '', '', NULL, 'O', '1875 Dempster St Ste 506', 'Park Ridge', 'Cook', 'IL', '60068', '8478234700', '8474701550', '1875 Dempster St Ste 506', 'Park Ridge', 'Cook', 'IL', '60068', '8478234700', '8474701550', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2014-08-01', 0, 0, 0, 'Presence Resurrection Medical Center', '', '', '', 'HCFA|UB|', '1386722783', 0, 'Y', 0, '2014-06-19', NULL, NULL, 42.0397, -87.8491, NULL, NULL),
('201780406', 'IL0000310', 'IL0000310', 'ILCHIGSTD', 'UroPartners', 'Donna', 'M', 'Mullahy', 'PAC', 'Urology', '', '', NULL, 'O', '7447 W Talcott Ave Ste 509', 'Chicago', 'Cook', 'IL', '60631', '7737750800', '8474701550', '7447 W Talcott Ave Ste 509', 'Chicago', 'Cook', 'IL', '60631', '7737750800', '8474701550', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', '', '', '', 'HCFA|UB|', '1386722783', 0, 'Y', 0, '2014-06-19', NULL, NULL, 41.9887, -87.8131, NULL, NULL),
('201780406', 'IL0000308', 'IL0000308', 'ILCHIGSTD', 'UroPartners', 'Donna', 'M', 'Mullahy', 'PAC', '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, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', '', '', '', 'HCFA|UB|', '1386722783', 0, 'Y', 0, '2014-06-19', NULL, NULL, 42.0244, -87.8126, NULL, NULL),
('201780406', 'W12026445', 'W12026445', 'ILCHIGSTD', 'UroPartners', 'Donna', 'M', 'Mullahy', 'PAC', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', '', '', '', 'HCFA|UB|', '1386722783', 0, 'Y', 0, '2014-06-19', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'W12026447', 'W12026447', 'ILCHIGSTD', 'UroPartners', 'Sarah', 'B', 'Murfey', 'NP', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558663344', 0, 'Y', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'IL0000313', 'IL0000313', 'ILCHIGSTD', 'UroPartners', 'Sarah', 'B', 'Murfey', 'NP', 'Urology', '', '', NULL, 'O', '1555 Barrington Rd Ste 2500', 'Hoffman Estates', 'Cook', 'IL', '60169', '8478233185', '8478233318', '1555 Barrington Rd Ste 2500', 'Hoffman Estates', 'Cook', 'IL', '60169', '8478233185', '8478233318', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558663344', 0, 'Y', 0, '2014-04-24', NULL, NULL, 42.0542, -88.1444, NULL, NULL),
('201780406', 'W12026448', 'W12026448', 'ILCHIGSTD', 'UroPartners', 'David', 'L', 'Mutchnik', 'MD', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', '', '', '', 'HCFA|UB|', '1417917006', 0, 'Y', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'IL0000314', 'IL0000314', 'ILCHIGSTD', 'UroPartners', 'Sarah', 'B', 'Murfey', 'NP', 'Urology', '', '', NULL, 'O', '431 Lakeview Ct Ste D', 'Mount Prospect', 'Cook', 'IL', '60056', '8478233185', '8478233318', '431 Lakeview Ct Ste D', 'Mount Prospect', 'Cook', 'IL', '60056', '8478233185', '8478233318', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2014-04-11', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558663344', 0, 'Y', 0, '2014-04-24', NULL, NULL, 42.0751, -87.9115, NULL, NULL),
('201780406', 'IL0000312', 'IL0000312', 'ILCHIGSTD', 'UroPartners', 'Sarah', 'B', 'Murfey', 'NP', 'Urology', '', '', NULL, 'O', '900 Rand Rd Ste 120', 'Des Plaines', 'Cook', 'IL', '60016', '8478233185', '8478233318', '900 Rand Rd Ste 120', 'Des Plaines', 'Cook', 'IL', '60016', '8478233185', '8478233318', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558663344', 0, 'Y', 0, '2014-04-24', NULL, NULL, 42.0564, -87.9023, NULL, NULL),
('201780406', 'W12026446', 'W12026446', 'ILCHIGSTD', 'UroPartners', 'Sarah', 'B', 'Murfey', 'NP', 'Urology', '', '', NULL, 'O', '1450 Busch Pkwy Ste 135', 'Buffalo Grove', 'Lake', 'IL', '60089', '8478233185', '8478233318', '1450 Busch Pkwy Ste 135', 'Buffalo Grove', 'Lake', 'IL', '60089', '8478233185', '8478233318', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558663344', 0, 'Y', 0, '2014-04-24', NULL, NULL, 42.1717, -87.9275, NULL, NULL),
('201780406', 'W12026449', 'W12026449', 'ILCHIGSTD', 'UroPartners', 'David', 'L', 'Mutchnik', 'MD', 'Urology', '', '', NULL, 'O', '757 Park Ave W Ste 3800', 'Highland Park', 'Lake', 'IL', '60035', '8474803993', '8474803936', '757 Park Ave W Ste 3800', 'Highland Park', 'Lake', 'IL', '60035', '8474803993', '8474803936', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', '', '', '', 'HCFA|UB|', '1417917006', 0, 'N', 0, '2014-04-25', NULL, NULL, 42.1888, -87.8075, NULL, NULL),
('201780406', 'IL0000319', 'IL0000319', 'ILCHIGSTD', 'UroPartners', 'David', 'L', 'Mutchnik', 'MD', 'Urology', '', '', NULL, 'O', '836 W Wellington Ave Ste 4th Fl', 'Chicago', 'Cook', 'IL', '60657', '7732967159', '8476773343', '836 W Wellington Ave Ste 4th Fl', 'Chicago', 'Cook', 'IL', '60657', '7732967159', '8476773343', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', '', '', '', 'HCFA|UB|', '1417917006', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.9364, -87.6508, NULL, NULL),
('201780406', 'IL0000317', 'IL0000317', 'ILCHIGSTD', 'UroPartners', 'David', 'L', 'Mutchnik', 'MD', 'Urology', '', '', NULL, 'O', '9669 N Kenton Ave Ste 608', 'Skokie', 'Cook', 'IL', '60076', '8476774111', '8476773343', '9669 N Kenton Ave Ste 608', 'Skokie', 'Cook', 'IL', '60076', '8476774111', '8476773343', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', '', '', '', 'HCFA|UB|', '1417917006', 0, 'N', 0, '2014-04-25', NULL, NULL, 42.0563, -87.742, NULL, NULL),
('201780406', 'W12026450', 'W12026450', 'ILCHIGSTD', 'UroPartners', 'Steven', 'E', 'Mutchnik', 'MD', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', '', '', '', 'HCFA|UB|', '1427019611', 0, 'Y', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'W12026451', 'W12026451', 'ILCHIGSTD', 'UroPartners', 'Steven', 'E', 'Mutchnik', 'MD', 'Urology', '', '', NULL, 'O', '757 Park Ave W Ste 3800', 'Highland Park', 'Lake', 'IL', '60035', '8474803993', '8474803936', '757 Park Ave W Ste 3800', 'Highland Park', 'Lake', 'IL', '60035', '8474803993', '8474803936', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', '', '', '', 'HCFA|UB|', '1427019611', 0, 'N', 0, '2014-04-25', NULL, NULL, 42.1888, -87.8075, NULL, NULL),
('201780406', 'IL0000321', 'IL0000321', 'ILCHIGSTD', 'UroPartners', 'Steven', 'E', 'Mutchnik', 'MD', 'Urology', '', '', NULL, 'O', '9669 N Kenton Ave Ste 608', 'Skokie', 'Cook', 'IL', '60076', '8476774111', '8476773343', '9669 N Kenton Ave Ste 608', 'Skokie', 'Cook', 'IL', '60076', '8476774111', '8476773343', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', '', '', '', 'HCFA|UB|', '1427019611', 0, 'N', 0, '2014-04-25', NULL, NULL, 42.0563, -87.742, NULL, NULL),
('201780406', 'W12026452', 'W12026452', 'ILCHIGSTD', 'UroPartners', 'Narendra', '', 'Narepalem', 'MD', 'Urology', '', '', NULL, 'O', '1450 Busch Pkwy Ste 135', 'Buffalo Grove', 'Lake', 'IL', '60089', '8478233185', '8478233318', '1450 Busch Pkwy Ste 135', 'Buffalo Grove', 'Lake', 'IL', '60089', '8478233185', '8478233318', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', '', '', '', 'HCFA|UB|', '1063495851', 0, 'N', 0, '2014-04-24', NULL, NULL, 42.1717, -87.9275, NULL, NULL),
('201780406', 'IL0000328', 'IL0000328', 'ILCHIGSTD', 'UroPartners', 'Narendra', '', 'Narepalem', 'MD', 'Urology', '', '', NULL, 'O', '1460 Market St Ste 300', 'Des Plaines', 'Cook', 'IL', '60016', '8478233185', '8478233318', '1460 Market St Ste 300', 'Des Plaines', 'Cook', 'IL', '60016', '8478233185', '8478233318', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2014-07-01', 0, 0, 0, 'Northwest Community Hospital', '', '', '', 'HCFA|UB|', '1063495851', 0, 'N', 0, '2014-05-05', NULL, NULL, 42.0425, -87.8858, 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
('201780406', 'IL0000325', 'IL0000325', 'ILCHIGSTD', 'UroPartners', 'Narendra', '', 'Narepalem', 'MD', 'Urology', '', '', NULL, 'O', '1555 Barrington Rd Ste 2500', 'Hoffman Estates', 'Cook', 'IL', '60169', '8478233185', '8478233318', '1555 Barrington Rd Ste 2500', 'Hoffman Estates', 'Cook', 'IL', '60169', '8478233185', '8478233318', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', '', '', '', 'HCFA|UB|', '1063495851', 0, 'N', 0, '2014-04-24', NULL, NULL, 42.0542, -88.1444, NULL, NULL),
('201780406', 'W12026453', 'W12026453', 'ILCHIGSTD', 'UroPartners', 'Narendra', '', 'Narepalem', 'MD', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', '', '', '', 'HCFA|UB|', '1063495851', 0, 'Y', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'IL0000326', 'IL0000326', 'ILCHIGSTD', 'UroPartners', 'Narendra', '', 'Narepalem', 'MD', 'Urology', '', '', NULL, 'O', '431 Lakeview Ct Ste D', 'Mount Prospect', 'Cook', 'IL', '60056', '8478233185', '8478233318', '431 Lakeview Ct Ste D', 'Mount Prospect', 'Cook', 'IL', '60056', '8478233185', '8478233318', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2014-04-11', 0, 0, 0, 'Northwest Community Hospital', '', '', '', 'HCFA|UB|', '1063495851', 0, 'N', 0, '2014-04-24', NULL, NULL, 42.0751, -87.9115, NULL, NULL),
('201780406', 'IL0000324', 'IL0000324', 'ILCHIGSTD', 'UroPartners', 'Narendra', '', 'Narepalem', 'MD', 'Urology', '', '', NULL, 'O', '900 Rand Rd Ste 120', 'Des Plaines', 'Cook', 'IL', '60016', '8478233185', '8478233318', '900 Rand Rd Ste 120', 'Des Plaines', 'Cook', 'IL', '60016', '8478233185', '8478233318', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', '', '', '', 'HCFA|UB|', '1063495851', 0, 'N', 0, '2014-04-24', NULL, NULL, 42.0564, -87.9023, NULL, NULL),
('201780406', 'IL0000331', 'IL0000331', 'ILCHIGSTD', 'UroPartners', 'Kristin', 'E', 'Nimbley', 'PAC', 'Urology', '', '', NULL, 'O', '1875 Dempster St Ste 506', 'Park Ridge', 'Cook', 'IL', '60068', '8478234700', '8474701550', '1875 Dempster St Ste 506', 'Park Ridge', 'Cook', 'IL', '60068', '8478234700', '8474701550', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-11-11', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588845366', 0, 'Y', 0, '2013-11-14', NULL, NULL, 42.0386, -87.8487, NULL, NULL),
('201780406', 'W12026455', 'W12026455', 'ILCHIGSTD', 'UroPartners', 'Donald', 'M', 'Norris', 'MD', 'Urology', '', '', NULL, 'O', '1450 Busch Pkwy Ste 135', 'Buffalo Grove', 'Lake', 'IL', '60089', '8478233185', '8478233318', '1450 Busch Pkwy Ste 135', 'Buffalo Grove', 'Lake', 'IL', '60089', '8478233185', '8478233318', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', '', '', '', 'HCFA|UB|', '1164405700', 0, 'N', 0, '2014-04-25', NULL, NULL, 42.1717, -87.9275, NULL, NULL),
('201780406', 'IL0000332', 'IL0000332', 'ILCHIGSTD', 'UroPartners', 'Kristin', 'E', 'Nimbley', 'PAC', 'Urology', '', '', NULL, 'O', '7447 W Talcott Ave Ste 509', 'Chicago', 'Cook', 'IL', '60631', '7737750800', '8474701550', '7447 W Talcott Ave Ste 509', 'Chicago', 'Cook', 'IL', '60631', '7737750800', '8474701550', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-11-11', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588845366', 0, 'Y', 0, '2013-11-14', NULL, NULL, 41.9902, -87.8159, NULL, NULL),
('201780406', 'IL0000330', 'IL0000330', 'ILCHIGSTD', 'UroPartners', 'Kristin', 'E', 'Nimbley', 'PAC', '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, '2013-01-01', '2013-11-11', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588845366', 0, 'Y', 0, '2013-11-14', NULL, NULL, 42.0249, -87.8141, NULL, NULL),
('201780406', 'W12026454', 'W12026454', 'ILCHIGSTD', 'UroPartners', 'Kristin', 'E', 'Nimbley', 'PAC', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-11-11', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588845366', 0, 'Y', 0, '2013-11-14', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'IL0000335', 'IL0000335', 'ILCHIGSTD', 'UroPartners', 'Donald', 'M', 'Norris', 'MD', 'Urology', '', '', NULL, 'O', '1555 Barrington Rd Ste 2500', 'Hoffman Estates', 'Cook', 'IL', '60169', '8478233185', '8478233318', '1555 Barrington Rd Ste 2500', 'Hoffman Estates', 'Cook', 'IL', '60169', '8478233185', '8478233318', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', '', '', '', 'HCFA|UB|', '1164405700', 0, 'N', 0, '2014-04-25', NULL, NULL, 42.0542, -88.1444, NULL, NULL),
('201780406', 'W12026456', 'W12026456', 'ILCHIGSTD', 'UroPartners', 'Donald', 'M', 'Norris', 'MD', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', '', '', '', 'HCFA|UB|', '1164405700', 0, 'Y', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'IL0000336', 'IL0000336', 'ILCHIGSTD', 'UroPartners', 'Donald', 'M', 'Norris', 'MD', 'Urology', '', '', NULL, 'O', '431 Lakeview Ct Ste D', 'Mount Prospect', 'Cook', 'IL', '60056', '8478233185', '8478233318', '431 Lakeview Ct Ste D', 'Mount Prospect', 'Cook', 'IL', '60056', '8478233185', '8478233318', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2014-04-11', 0, 0, 0, 'Presence Resurrection Medical Center', '', '', '', 'HCFA|UB|', '1164405700', 0, 'N', 0, '2014-04-25', NULL, NULL, 42.0751, -87.9115, NULL, NULL),
('201780406', 'IL0000334', 'IL0000334', 'ILCHIGSTD', 'UroPartners', 'Donald', 'M', 'Norris', 'MD', 'Urology', '', '', NULL, 'O', '900 Rand Rd Ste 120', 'Des Plaines', 'Cook', 'IL', '60016', '8478233185', '8478233318', '900 Rand Rd Ste 120', 'Des Plaines', 'Cook', 'IL', '60016', '8478233185', '8478233318', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', '', '', '', 'HCFA|UB|', '1164405700', 0, 'N', 0, '2014-04-25', NULL, NULL, 42.0564, -87.9023, NULL, NULL),
('201780406', 'W12026457', 'W12026457', 'ILCHIGSTD', 'UroPartners', 'Jeffrey', 'P', 'Norris', 'MD', 'Urology', '', '', NULL, 'O', '1450 Busch Pkwy Ste 135', 'Buffalo Grove', 'Lake', 'IL', '60089', '8478233185', '8478233318', '1450 Busch Pkwy Ste 135', 'Buffalo Grove', 'Lake', 'IL', '60089', '8478233185', '8478233318', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', 'Northwest Community Hospital', '', '', 'HCFA|UB|', '1508849142', 0, 'N', 0, '2014-04-25', NULL, NULL, 42.1717, -87.9275, NULL, NULL),
('201780406', 'IL0000340', 'IL0000340', 'ILCHIGSTD', 'UroPartners', 'Jeffrey', 'P', 'Norris', 'MD', 'Urology', '', '', NULL, 'O', '1555 Barrington Rd Ste 2500', 'Hoffman Estates', 'Cook', 'IL', '60169', '8478233185', '8478233318', '1555 Barrington Rd Ste 2500', 'Hoffman Estates', 'Cook', 'IL', '60169', '8478233185', '8478233318', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', 'Northwest Community Hospital', '', '', 'HCFA|UB|', '1508849142', 0, 'N', 0, '2014-04-25', NULL, NULL, 42.0542, -88.1444, NULL, NULL),
('201780406', 'W12026458', 'W12026458', 'ILCHIGSTD', 'UroPartners', 'Jeffrey', 'P', 'Norris', 'MD', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', 'Northwest Community Hospital', '', '', 'HCFA|UB|', '1508849142', 0, 'Y', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'IL0000341', 'IL0000341', 'ILCHIGSTD', 'UroPartners', 'Jeffrey', 'P', 'Norris', 'MD', 'Urology', '', '', NULL, 'O', '431 Lakeview Ct Ste D', 'Mount Prospect', 'Cook', 'IL', '60056', '8478233185', '8478233318', '431 Lakeview Ct Ste D', 'Mount Prospect', 'Cook', 'IL', '60056', '8478233185', '8478233318', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2014-04-11', 0, 0, 0, 'Presence Resurrection Medical Center', 'Northwest Community Hospital', '', '', 'HCFA|UB|', '1508849142', 0, 'N', 0, '2014-04-25', NULL, NULL, 42.0751, -87.9115, NULL, NULL),
('201780406', 'IL0000339', 'IL0000339', 'ILCHIGSTD', 'UroPartners', 'Jeffrey', 'P', 'Norris', 'MD', 'Urology', '', '', NULL, 'O', '900 Rand Rd Ste 120', 'Des Plaines', 'Cook', 'IL', '60016', '8478233185', '8478233318', '900 Rand Rd Ste 120', 'Des Plaines', 'Cook', 'IL', '60016', '8478233185', '8478233318', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', 'Northwest Community Hospital', '', '', 'HCFA|UB|', '1508849142', 0, 'N', 0, '2014-04-25', NULL, NULL, 42.0564, -87.9023, NULL, NULL),
('201780406', 'IL0000345', 'IL0000345', 'ILCHIGSTD', 'UroPartners', 'Joseph', '', 'Nuzzarello', 'MD', 'Urology', '', '', NULL, 'O', '302 Randall Rd Ste 306', 'Geneva', 'Kane', 'IL', '60134', '6303771368', '6303777514', '302 Randall Rd Ste 306', 'Geneva', 'Kane', 'IL', '60134', '6303771368', '6303777514', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134143613', 0, 'Y', 0, '2012-12-06', NULL, NULL, 41.8887, -88.3404, NULL, NULL),
('201780406', 'W12026460', 'W12026460', 'ILCHIGSTD', 'UroPartners', 'Shivani', 'T', 'Patel', 'PAC', 'Urology', '', '', NULL, 'O', '1450 Busch Pkwy Ste 135', 'Buffalo Grove', 'Lake', 'IL', '60089', '8478233185', '8478233318', '1450 Busch Pkwy Ste 135', 'Buffalo Grove', 'Lake', 'IL', '60089', '8478233185', '8478233318', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023301454', 0, 'Y', 0, '2014-04-24', NULL, NULL, 42.1717, -87.9275, NULL, NULL),
('201780406', 'IL0000344', 'IL0000344', 'ILCHIGSTD', 'UroPartners', 'Joseph', '', 'Nuzzarello', 'MD', 'Urology', '', '', NULL, 'O', '610 E Roosevelt Rd Ste 203', 'Wheaton', 'Dupage', 'IL', '60187', '6306535550', '6306535561', '610 E Roosevelt Rd Ste 203', 'Wheaton', 'Dupage', 'IL', '60187', '6306535550', '6306535561', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134143613', 0, 'Y', 0, '2012-12-06', NULL, NULL, 41.8588, -88.0984, NULL, NULL),
('201780406', 'W12026459', 'W12026459', 'ILCHIGSTD', 'UroPartners', 'Joseph', '', 'Nuzzarello', 'MD', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134143613', 0, 'Y', 0, '2012-12-06', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'IL0000353', 'IL0000353', 'ILCHIGSTD', 'UroPartners', 'Sutchin', 'R', 'Patel', 'MD', 'Urology', '', '', NULL, 'O', '151 W Golf Rd', 'Libertyville', 'Lake', 'IL', '60048', '8476803803', '8476803811', '151 W Golf Rd', 'Libertyville', 'Lake', 'IL', '60048', '8476803803', '8476803811', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1679792394', 0, 'N', 0, '2012-12-06', NULL, NULL, 42.2696, -87.9527, NULL, NULL),
('201780406', 'IL0000349', 'IL0000349', 'ILCHIGSTD', 'UroPartners', 'Shivani', 'T', 'Patel', 'PAC', 'Urology', '', '', NULL, 'O', '431 Lakeview Ct Ste D', ' Mount Prospect', 'Cook', 'IL', '60056', '8478233185', '8478233318', '431 Lakeview Ct Ste D', ' Mount Prospect', 'Cook', 'IL', '60056', '8478233185', '8478233318', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2014-04-11', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023301454', 0, 'Y', 0, '2014-04-24', NULL, NULL, 42.0751, -87.9115, NULL, NULL),
('201780406', 'IL0000347', 'IL0000347', 'ILCHIGSTD', 'UroPartners', 'Shivani', 'T', 'Patel', 'PAC', 'Urology', '', '', NULL, 'O', '900 Rand Rd Ste 120', 'Des Plaines', 'Cook', 'IL', '60016', '8478233185', '8478233318', '900 Rand Rd Ste 120', 'Des Plaines', 'Cook', 'IL', '60016', '8478233185', '8478233318', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023301454', 0, 'Y', 0, '2014-04-24', NULL, NULL, 42.0564, -87.9023, NULL, NULL),
('201780406', 'IL0000352', 'IL0000352', 'ILCHIGSTD', 'UroPartners', 'Sutchin', 'R', 'Patel', 'MD', 'Urology', '', '', NULL, 'O', '3 S Greenleaf Ave Ste J', 'Gurnee', 'Lake', 'IL', '60031', '8475991111', '8475991148', '3 S Greenleaf Ave Ste J', 'Gurnee', 'Lake', 'IL', '60031', '8475991111', '8475991148', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1679792394', 0, 'N', 0, '2012-12-06', NULL, NULL, 42.3596, -87.9019, NULL, NULL),
('201780406', 'W12026462', 'W12026462', 'ILCHIGSTD', 'UroPartners', 'Sutchin', 'R', 'Patel', 'MD', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1679792394', 0, 'Y', 0, '2012-12-06', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'IL0000355', 'IL0000355', 'ILCHIGSTD', 'UroPartners', 'Lester', 'J', 'Raff', 'MD', 'Pathology', '', '', NULL, 'O', '2225 Enterprise Dr Ste 2511', 'Westchester', 'Cook', 'IL', '60154', '7084860076', '7084920203', '2225 Enterprise Dr Ste 2511', 'Westchester', 'Cook', 'IL', '60154', '7084860076', '7084920203', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710943220', 0, 'Y', 0, '2012-12-06', NULL, NULL, 41.8474, -87.9096, NULL, NULL),
('201780406', 'W12026463', 'W12026463', 'ILCHIGSTD', 'UroPartners', 'Lester', 'J', 'Raff', 'MD', 'Pathology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710943220', 0, 'Y', 0, '2012-12-06', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'W12026464', 'W12026464', 'ILCHIGSTD', 'UroPartners', 'Alan', 'M', 'Rogin', 'MD', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063479202', 0, 'Y', 0, '2013-03-01', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'IL0000360', 'IL0000360', 'ILCHIGSTD', 'UroPartners', 'Robert', 'S', 'Saffrin', 'MD', 'Urology', '', '', NULL, 'O', '3 S Greenleaf Ave Ste J', 'Gurnee', 'Lake', 'IL', '60031', '8475991111', '8475991148', '3 S Greenleaf Ave Ste J', 'Gurnee', 'Lake', 'IL', '60031', '8475991111', '8475991148', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1366435034', 0, 'N', 0, '2012-12-06', NULL, NULL, 42.3596, -87.9019, NULL, NULL),
('201780406', 'W12026465', 'W12026465', 'ILCHIGSTD', 'UroPartners', 'Robert', 'S', 'Saffrin', 'MD', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1366435034', 0, 'Y', 0, '2012-12-06', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'IL0000362', 'IL0000362', 'ILCHIGSTD', 'UroPartners', 'Brian', 'J', 'Schuster', 'PAC', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Circle', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114236882', 0, 'Y', 0, '2012-12-06', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'IL0000363', 'IL0000363', 'ILCHIGSTD', 'UroPartners', 'Brian', 'J', 'Schuster', 'PAC', 'Urology', '', '', NULL, 'O', '950 N York Rd Ste 208', 'Hinsdale', 'Dupage', 'IL', '60521', '6308870580', '6308870618', '950 N York Rd Ste 208', 'Hinsdale', 'Dupage', 'IL', '60521', '6308870580', '6308870618', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114236882', 0, 'Y', 0, '2012-12-06', NULL, NULL, 41.8178, -87.9266, NULL, NULL),
('201780406', 'IL0000365', 'IL0000365', 'ILCHIGSTD', 'UroPartners', 'David', 'M', 'Shore', 'MD', 'Urology', '', '', NULL, 'O', '1011 W Wellington Ave Ste 200', 'Chicago', 'Cook', 'IL', '60657', '7732811011', '7732811029', '1011 W Wellington Ave Ste 200', 'Chicago', 'Cook', 'IL', '60657', '7732811011', '7732811029', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1184823163', 0, 'N', 0, '2012-12-06', NULL, NULL, 41.9363, -87.6544, NULL, NULL),
('201780406', 'W12026466', 'W12026466', 'ILCHIGSTD', 'UroPartners', 'David', 'M', 'Shore', 'MD', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1184823163', 0, 'Y', 0, '2012-12-06', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'IL0000366', 'IL0000366', 'ILCHIGSTD', 'UroPartners', 'David', 'M', 'Shore', 'MD', 'Urology', '', '', NULL, 'O', '836 W Wellington Ave 4th Fl', 'Chicago', 'Cook', 'IL', '60657', '7732811011', '7732811029', '836 W Wellington Ave 4th Floor', 'Chicago', 'Cook', 'IL', '60657', '7732811011', '7732811029', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1184823163', 0, 'N', 0, '2012-12-06', NULL, NULL, 41.9364, -87.6508, NULL, NULL),
('201780406', 'W12026467', 'W12026467', 'ILCHIGSTD', 'UroPartners', 'Jaimee', 'K', 'Smith', 'NP', 'Nurse Practitioner', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992766786', 0, 'Y', 0, '2012-12-06', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'W12026468', 'W12026468', 'ILCHIGSTD', 'UroPartners', 'Jaimee', 'K', 'Smith', 'NP', 'Nurse Practitioner', '', '', NULL, 'O', '757 Park Ave W Ste 3800', 'Highland Park', 'Lake', 'IL', '60035', '8474803993', '8474803936', '757 Park Ave W Ste 3800', 'Highland Park', 'Lake', 'IL', '60035', '8474803993', '8474803936', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992766786', 0, 'Y', 0, '2012-12-06', NULL, NULL, 42.1888, -87.8075, NULL, NULL),
('201780406', 'IL0000368', 'IL0000368', 'ILCHIGSTD', 'UroPartners', 'Jaimee', 'K', 'Smith', 'NP', 'Nurse Practitioner', '', '', NULL, 'O', '9669 N Kenton Ave Ste 608', 'Skokie', 'Cook', 'IL', '60076', '8476774111', '8476773343', '9669 N Kenton Ave Ste 608', 'Skokie', 'Cook', 'IL', '60076', '8476774111', '8476773343', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992766786', 0, 'Y', 0, '2012-12-06', NULL, NULL, 42.0563, -87.742, NULL, NULL),
('201780406', 'IL0000372', 'IL0000372', 'ILCHIGSTD', 'UroPartners', 'Marek', 'Z', 'Stobnicki', 'MD', 'Urology', '', '', NULL, 'O', '1875 Dempster St Ste 506', 'Park Ridge', 'Cook', 'IL', '60068', '8478234700', '8474701550', '1875 Dempster St Ste 506', 'Park Ridge', 'Cook', 'IL', '60068', '8478234700', '8474701550', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2014-08-01', 0, 0, 0, 'Presence Resurrection Medical Center', '', '', '', 'HCFA|UB|', '1811942600', 0, 'N', 0, '2014-06-19', NULL, NULL, 42.0397, -87.8491, NULL, NULL),
('201780406', 'W12026469', 'W12026469', 'ILCHIGSTD', 'UroPartners', 'Marek', 'Z', 'Stobnicki', 'MD', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', '', '', '', 'HCFA|UB|', '1811942600', 0, 'Y', 0, '2014-06-19', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'IL0000373', 'IL0000373', 'ILCHIGSTD', 'UroPartners', 'Marek', 'Z', 'Stobnicki', 'MD', 'Urology', '', '', NULL, 'O', '7447 W Talcott Ave Ste 509', 'Chicago', 'Cook', 'IL', '60631', '7737750800', '8474701550', '7447 W Talcott Ave Ste 509', 'Chicago', 'Cook', 'IL', '60631', '7737750800', '8474701550', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', '', '', '', 'HCFA|UB|', '1811942600', 0, 'N', 0, '2014-06-19', NULL, NULL, 41.9887, -87.8131, NULL, NULL),
('201780406', 'IL0000371', 'IL0000371', 'ILCHIGSTD', 'UroPartners', 'Marek', 'Z', 'Stobnicki', 'MD', '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, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', '', '', '', 'HCFA|UB|', '1811942600', 0, 'N', 0, '2014-06-19', NULL, NULL, 42.0244, -87.8126, NULL, NULL),
('201780406', 'W12026470', 'W12026470', 'ILCHIGSTD', 'UroPartners', 'Scott', 'I', 'Tiplitsky', 'MD', 'Urology', '', '', NULL, 'O', '1450 Busch Pkwy Ste 135', 'Buffalo Grove', 'Lake', 'IL', '60089', '8478233185', '8478233318', '1450 Busch Pkwy Ste 135', 'Buffalo Grove', 'Lake', 'IL', '60089', '8478233185', '8478233318', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', 'Northwest Community Hospital', '', '', 'HCFA|UB|', '1619117298', 0, 'N', 0, '2014-04-25', NULL, NULL, 42.1717, -87.9275, NULL, NULL),
('201780406', 'IL0000376', 'IL0000376', 'ILCHIGSTD', 'UroPartners', 'Scott', 'I', 'Tiplitsky', 'MD', 'Urology', '', '', NULL, 'O', '1555 Barrington Rd Ste 2500', 'Hoffman Estates', 'Cook', 'IL', '60169', '8478233185', '8478233318', '1555 Barrington Rd Ste 2500', 'Hoffman Estates', 'Cook', 'IL', '60169', '8478233185', '8478233318', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', 'Northwest Community Hospital', '', '', 'HCFA|UB|', '1619117298', 0, 'N', 0, '2014-04-25', NULL, NULL, 42.0542, -88.1444, NULL, NULL),
('201780406', 'W12026471', 'W12026471', 'ILCHIGSTD', 'UroPartners', 'Scott', 'I', 'Tiplitsky', 'MD', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', 'Northwest Community Hospital', '', '', 'HCFA|UB|', '1619117298', 0, 'Y', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'IL0000377', 'IL0000377', 'ILCHIGSTD', 'UroPartners', 'Scott', 'I', 'Tiplitsky', 'MD', 'Urology', '', '', NULL, 'O', '431 Lakeview Ct Ste D', 'Mount Prospect', 'Cook', 'IL', '60056', '8478233185', '8478233318', '431 Lakeview Ct Ste D', 'Mount Prospect', 'Cook', 'IL', '60056', '8478233185', '8478233318', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2014-04-11', 0, 0, 0, 'Presence Resurrection Medical Center', 'Northwest Community Hospital', '', '', 'HCFA|UB|', '1619117298', 0, 'N', 0, '2014-04-25', NULL, NULL, 42.0751, -87.9115, NULL, NULL),
('201780406', 'IL0000375', 'IL0000375', 'ILCHIGSTD', 'UroPartners', 'Scott', 'I', 'Tiplitsky', 'MD', 'Urology', '', '', NULL, 'O', '900 Rand Rd Ste 120', 'Des Plaines', 'Cook', 'IL', '60016', '8478233185', '8478233318', '900 Rand Rd Ste 120', 'Des Plaines', 'Cook', 'IL', '60016', '8478233185', '8478233318', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', 'Northwest Community Hospital', '', '', 'HCFA|UB|', '1619117298', 0, 'N', 0, '2014-04-25', NULL, NULL, 42.0564, -87.9023, NULL, NULL),
('201780406', 'IL0000381', 'IL0000381', 'ILCHIGSTD', 'UroPartners', 'Brett', 'A', 'Trockman', 'MD', 'Urology', '', '', NULL, 'O', '302 Randall Rd Ste 306', 'Geneva', 'Kane', 'IL', '60134', '6303771368', '6303777514', '302 Randall Rd Ste 306', 'Geneva', 'Kane', 'IL', '60134', '6303771368', '6303777514', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548279797', 0, 'Y', 0, '2012-12-06', NULL, NULL, 41.8887, -88.3404, NULL, NULL),
('201780406', 'IL0000383', 'IL0000383', 'ILCHIGSTD', 'UroPartners', 'Gina', 'J', 'Ugo', 'PAC', 'Urology', '', '', NULL, 'O', '1725 W Harrison St Ste 352', 'Chicago', 'Cook', 'IL', '60612', '3125635000', '3125635007', '1725 W Harrison St Ste 352', 'Chicago', 'Cook', 'IL', '60612', '3125635000', '3125635007', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1174511851', 0, 'Y', 0, '2012-12-06', NULL, NULL, 41.8741, -87.6698, NULL, NULL),
('201780406', 'IL0000380', 'IL0000380', 'ILCHIGSTD', 'UroPartners', 'Brett', 'A', 'Trockman', 'MD', 'Urology', '', '', NULL, 'O', '610 E Roosevelt Rd Ste 203', 'Wheaton', 'Dupage', 'IL', '60187', '6306535550', '6306535561', '610 E Roosevelt Rd Ste 203', 'Wheaton', 'Dupage', 'IL', '60187', '6306535550', '6306535561', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548279797', 0, 'Y', 0, '2012-12-06', NULL, NULL, 41.8588, -88.0984, NULL, NULL),
('201780406', 'W12026472', 'W12026472', 'ILCHIGSTD', 'UroPartners', 'Brett', 'A', 'Trockman', 'MD', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548279797', 0, 'Y', 0, '2012-12-06', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'W12026474', 'W12026474', 'ILCHIGSTD', 'UroPartners', 'Thomas', 'A', 'Will', 'MD', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1891955233', 0, 'Y', 0, '2012-12-06', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'W12026473', 'W12026473', 'ILCHIGSTD', 'UroPartners', 'Gina', 'J', 'Ugo', 'PAC', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', '3183 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7084920502', '7084920565', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1174511851', 0, 'Y', 0, '2012-12-06', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'IL0000385', 'IL0000385', 'ILCHIGSTD', 'UroPartners', 'Thomas', 'A', 'Will', 'MD', 'Urology', '', '', NULL, 'O', '5201 S Willow Springs Rd Ste 380', 'LaGrange', 'Cook', 'IL', '60525', '7083542550', '7083544552', '5201 S Willow Springs Rd Ste 380', 'LaGrange', 'Cook', 'IL', '60525', '7083542550', '7083544552', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1891955233', 0, 'Y', 0, '2012-12-06', NULL, NULL, 41.7974, -87.8884, 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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('363317058', 'EDM000035', 'EDM000035', 'ILCHIGSTD', 'Access Grand Boulevard Family and Specialty Health Center  ', 'Saima', '', 'Chohan', 'MD', 'Internal Medicine', 'Rheumatology', '', NULL, 'O', '5401 S Wentworth ', 'Chicago ', 'Cook', 'IL', '60609', '7732886900', NULL, '5401 S Wentworth ', 'Chicago ', 'Cook', 'IL', '60609', '7732886900', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073675526', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.7952, -87.6291, NULL, NULL),
('363317058', 'EDM000184', 'EDM000184', 'ILCHIGSTD', 'Access Ashland Health Center', 'Kalpana', '', 'Singh', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '5159 S Ashland Ave', 'Chicago', 'Cook', 'IL', '60609', '7734349216', NULL, '5159 S Ashland Ave', 'Chicago', 'Cook', 'IL', '60609', '7734349216', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073697934', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.7996, -87.6646, NULL, NULL),
('363317058', 'EDM000072', 'EDM000072', 'ILCHIGSTD', 'Access Grand Boulevard Family and Specialty Health Center  ', 'Nancy', '', 'Glick', 'MD', 'Internal Medicine', '', '', NULL, 'O', '5401 S Wentworth ', 'Chicago ', 'Cook', 'IL', '60609', '7732886900', NULL, '5401 S Wentworth ', 'Chicago ', 'Cook', 'IL', '60609', '7732886900', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083607881', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.7952, -87.6291, NULL, NULL),
('363317058', 'EDM000033', 'EDM000033', 'ILCHIGSTD', 'Access Kling Professional Building', 'Quimbo', '', 'Ching', 'MD', 'Pediatrics', '', '', NULL, 'O', '2720 W 15th St 3rd Fl', 'Chicago ', 'Cook', 'IL', '60608', '7732571700', NULL, '2720 W 15th St 3rd Fl', 'Chicago ', 'Cook', 'IL', '60608', '7732571700', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1083667646', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8612, -87.6941, NULL, NULL),
('363317058', 'EDM000048', 'EDM000048', 'ILCHIGSTD', 'Access Martin Russo Family Health Center', 'Joy', '', 'De Leoz', 'MD', 'Family Practice', '', '', NULL, 'O', '245 S Gary Ave', 'Bloomingdale', 'Dupage', 'IL', '60108', '6308935230', NULL, '245 S Gary Ave', 'Bloomingdale', 'Dupage', 'IL', '60108', '6308935230', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083697171', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.9432, -88.1195, NULL, NULL),
('363317058', 'EDM000088', 'EDM000088', 'ILCHIGSTD', 'Access Ashland Health Center', 'Jessica', '', 'Holmes', 'MD', 'Family Practice', '', '', NULL, 'O', '5159 S Ashland Ave', 'Chicago', 'Cook', 'IL', '60609', '7734349216', NULL, '5159 S Ashland Ave', 'Chicago', 'Cook', 'IL', '60609', '7734349216', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093038242', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.7996, -87.6646, NULL, NULL),
('363317058', 'EDM000150', 'EDM000150', 'ILCHIGSTD', 'Access Holy Cross', 'Osaretin', '', 'Oronsaye', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2701 W 68th St', 'Chicago ', 'Cook', 'IL', '60629', '7734344040', NULL, '2701 W 68th St', 'Chicago ', 'Cook', 'IL', '60629', '7734344040', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-03-06', 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1093701575', 0, 'N', 0, '2013-03-07', NULL, NULL, 41.7695, -87.6924, NULL, NULL),
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('363317058', 'EDM000179', 'EDM000179', 'ILCHIGSTD', 'Access Martin Russo Family Health Center', 'Emily', '', 'Shaw', 'PA', 'Family Practice', '', '', NULL, 'O', '245 S Gary Ave', 'Bloomingdale', 'Dupage', 'IL', '60108', '6308935230', NULL, '245 S Gary Ave', 'Bloomingdale', 'Dupage', 'IL', '60108', '6308935230', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124169222', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.9432, -88.1195, NULL, NULL),
('363317058', 'EDM000166', 'EDM000166', 'ILCHIGSTD', 'Access St Francis Health Center ', 'Susana', '', 'Salcedo', 'MD', 'Internal Medicine', '', '', NULL, 'O', '7464 N Clark St', 'Chicago ', 'Cook', 'IL', '60626', '7733818700', NULL, '7464 N Clark St', 'Chicago ', 'Cook', 'IL', '60626', '7733818700', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134305402', 0, 'N', 0, '2014-01-10', NULL, NULL, 42.0177, -87.676, NULL, NULL),
('363317058', 'EDM000181', 'EDM000181', 'ILCHIGSTD', 'Access St Francis Health Center ', 'Silvana', '', 'Shliapochnik', 'MD', 'Family Practice', '', '', NULL, 'O', '7464 N Clark St', 'Chicago ', 'Cook', 'IL', '60626', '7733818700', NULL, '7464 N Clark St', 'Chicago ', 'Cook', 'IL', '60626', '7733818700', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, 'Presence Saint Francis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1144275546', 0, 'N', 0, '2014-01-10', NULL, NULL, 42.0177, -87.676, NULL, NULL),
('363317058', 'EDM000143', 'EDM000143', 'ILCHIGSTD', 'Access Genesis Family Health Center ', 'Gabriela', '', 'Novota', 'MD', 'Pediatrics', '', '', NULL, 'O', '1 N Broadway ', 'Des Plaines', 'Cook', 'IL', '60016', '8472983150', NULL, '1 N Broadway ', 'Des Plaines', 'Cook', 'IL', '60016', '8472983150', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, 'Northwest Community Hospital', NULL, '', '', 'HCFA|UB|', '1154520096', 0, 'N', 0, '2014-01-10', NULL, NULL, 42.0519, -87.909, NULL, NULL),
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('363317058', 'EDM000047', 'EDM000047', 'ILCHIGSTD', 'Access Near West Family Health Center', 'Lilia', '', 'De Leon', 'MD', 'Family Practice', '', '', NULL, 'O', '1158 W Taylor ', 'Chicago ', 'Cook', 'IL', '60607', '3124558640', NULL, '1158 W Taylor ', 'Chicago ', 'Cook', 'IL', '60607', '3124558640', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164503975', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.8695, -87.6565, NULL, NULL),
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('363317058', 'EDM000053', 'EDM000053', 'ILCHIGSTD', 'Access Servicios Medicos La Villita', 'Oscar', '', 'Diaz', 'MD', 'Pediatrics', '', '', NULL, 'O', '3303 W 26th St', 'Chicago ', 'Cook', 'IL', '60623', '7732776589', NULL, '3303 W 26th St', 'Chicago ', 'Cook', 'IL', '60623', '7732776589', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1174618383', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8445, -87.7076, NULL, NULL),
('363317058', 'EDM000208', 'EDM000208', 'ILCHIGSTD', 'Access Servicios Medicos La Villita', 'Sukhveer', '', 'Wahi', 'MD', 'Family Practice', '', '', NULL, 'O', '3303 W 26th St', 'Chicago ', 'Cook', 'IL', '60623', '7732776589', NULL, '3303 W 26th St', 'Chicago ', 'Cook', 'IL', '60623', '7732776589', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184707358', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8445, -87.7076, NULL, NULL),
('363317058', 'EDM000092', 'EDM000092', 'ILCHIGSTD', 'Access St Francis Health Center ', 'Rajesh', '', 'Jindal', 'MD', 'Internal Medicine', '', '', NULL, 'O', '7464 N Clark St', 'Chicago ', 'Cook', 'IL', '60626', '7733818700', NULL, '7464 N Clark St', 'Chicago ', 'Cook', 'IL', '60626', '7733818700', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, 'Presence Holy Family Medical Center', 'Presence Saint Francis Hospital', '', '', 'HCFA|UB|', '1184818791', 0, 'N', 0, '2014-01-10', NULL, NULL, 42.0177, -87.676, NULL, NULL),
('363317058', 'EDM000210', 'EDM000210', 'ILCHIGSTD', 'Access Blue Island Family Health Center', 'Carol', '', 'Wardlaw', 'NP', 'Family Practice', '', '', NULL, 'O', '13000 S Maple Ave ', 'Blue Island ', 'Cook', 'IL', '60406', '7083856100', NULL, '13000 S Maple Ave ', 'Blue Island ', 'Cook', 'IL', '60406', '7083856100', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194942029', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.6566, -87.6853, NULL, NULL),
('363317058', 'EDM000191', 'EDM000191', 'ILCHIGSTD', 'Access Ashland Health Center', 'Alethia', '', 'Swanson', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '5159 S Ashland Ave', 'Chicago', 'Cook', 'IL', '60609', '7734349216', NULL, '5159 S Ashland Ave', 'Chicago', 'Cook', 'IL', '60609', '7734349216', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205140019', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.7996, -87.6646, NULL, NULL),
('363317058', 'EDM000017', 'EDM000017', 'ILCHIGSTD', 'Access Holy Cross', 'Sterling', '', 'Baumwell', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2701 W 68th St', 'Chicago ', 'Cook', 'IL', '60629', '7734344040', NULL, '2701 W 68th St', 'Chicago ', 'Cook', 'IL', '60629', '7734344040', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205807658', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.7695, -87.6924, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
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('363317058', 'EDM000030', 'EDM000030', 'ILCHIGSTD', 'Access Kling Professional Building', 'Juan', '', 'Campbell', 'MD', 'Pediatrics', '', '', NULL, 'O', '2720 W 15th St 3rd Fl', 'Chicago ', 'Cook', 'IL', '60608', '7732571700', NULL, '2720 W 15th St 3rd Fl', 'Chicago ', 'Cook', 'IL', '60608', '7732571700', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205940582', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8612, -87.6941, NULL, NULL),
('363317058', 'EDM000099', 'EDM000099', 'ILCHIGSTD', 'Access St Francis Health Center ', 'Shaista', '', 'Kamal', 'MD', 'Pediatrics', '', '', NULL, 'O', '7464 N Clark St', 'Chicago ', 'Cook', 'IL', '60626', '7733818700', NULL, '7464 N Clark St', 'Chicago ', 'Cook', 'IL', '60626', '7733818700', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', '', 'HCFA|UB|', '1215023916', 0, 'N', 0, '2014-01-10', NULL, NULL, 42.0177, -87.676, NULL, NULL),
('363317058', 'EDM000177', 'EDM000177', 'ILCHIGSTD', 'Access Kling Professional Building', 'Nasreen', '', 'Shah', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2720 W 15th St 4th Fl', 'Chicago ', 'Cook', 'IL', '60608', '7732576730', NULL, '2720 W 15th St 4th Fl', 'Chicago ', 'Cook', 'IL', '60608', '7732576730', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', '', 'HCFA|UB|', '1225119035', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8612, -87.6941, NULL, NULL),
('363317058', 'EDM000188', 'EDM000188', 'ILCHIGSTD', 'Access Grand Boulevard Family and Specialty Health Center  ', 'Shirley', '', 'Stephenson', 'NP', 'Family Practice', '', '', NULL, 'O', '5401 S Wentworth ', 'Chicago ', 'Cook', 'IL', '60609', '7732886900', NULL, '5401 S Wentworth ', 'Chicago ', 'Cook', 'IL', '60609', '7732886900', '', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225330061', 0, 'Y', 0, '2014-04-08', NULL, NULL, 41.7952, -87.6291, NULL, NULL),
('363317058', 'EDM000029', 'EDM000029', 'ILCHIGSTD', 'Access St Francis Health Center ', 'Michele', 'A', 'Bucciero', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '7464 N Clark St', 'Chicago ', 'Cook', 'IL', '60626', '7733818700', NULL, '7464 N Clark St', 'Chicago ', 'Cook', 'IL', '60626', '7733818700', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', '', 'HCFA|UB|', '1255441275', 0, 'N', 0, '2014-01-10', NULL, NULL, 42.0177, -87.676, NULL, NULL),
('363317058', 'EDM000187', 'EDM000187', 'ILCHIGSTD', 'Access Grand Boulevard Family and Specialty Health Center  ', 'Barbara', '', 'Spoerry', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '5401 S Wentworth ', 'Chicago ', 'Cook', 'IL', '60609', '7732886900', NULL, '5401 S Wentworth ', 'Chicago ', 'Cook', 'IL', '60609', '7732886900', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275511925', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.7952, -87.6291, NULL, NULL),
('363317058', 'EDM000105', 'EDM000105', 'ILCHIGSTD', 'Access Holy Cross', 'James', '', 'Kim', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2701 W 68th St', 'Chicago ', 'Cook', 'IL', '60629', '7734344040', NULL, '2701 W 68th St', 'Chicago ', 'Cook', 'IL', '60629', '7734344040', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-08-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275520132', 0, 'Y', 0, '2013-08-01', NULL, NULL, 41.7695, -87.6924, NULL, NULL),
('363317058', 'EDM000078', 'EDM000078', 'ILCHIGSTD', 'Access St Francis Health Center ', 'Kenneth ', '', 'Grumet', 'MD', 'Internal Medicine', '', '', NULL, 'O', '7464 N Clark St', 'Chicago ', 'Cook', 'IL', '60626', '7733818700', NULL, '7464 N Clark St', 'Chicago ', 'Cook', 'IL', '60626', '7733818700', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, 'Presence Saint Francis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1275564940', 0, 'N', 0, '2014-01-10', NULL, NULL, 42.0177, -87.676, NULL, NULL),
('363317058', 'EDM000209', 'EDM000209', 'ILCHIGSTD', 'Access Kling Professional Building', 'Syed', '', 'Wajid', 'MD', 'Pediatrics', '', '', NULL, 'O', '2720 W 15th St 1st Fl', 'Chicago ', 'Cook', 'IL', '60608', '7732576730', NULL, '2720 W 15th St 1st Fl', 'Chicago ', 'Cook', 'IL', '60608', '7732576730', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275615080', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8612, -87.6941, NULL, NULL),
('363317058', 'EDM000157', 'EDM000157', 'ILCHIGSTD', 'Access Auburn Gresham Family Health Center', 'Narayan', '', 'Prabhakar', 'MD', 'Family Practice', '', '', NULL, 'O', '8234 S Ashland Ave', 'Chicago', 'Cook', 'IL', '60620', '7738741400', NULL, '8234 S Ashland Ave', 'Chicago', 'Cook', 'IL', '60620', '7738741400', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275616955', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.7438, -87.6637, NULL, NULL),
('363317058', 'EDM000004', 'EDM000004', 'ILCHIGSTD', 'Access West Division Family Health Center ', 'Sharif', '', 'Alhamed', 'PA', 'Family Practice', '', '', NULL, 'O', '4401 W Division St', 'Chicago ', 'Cook', 'IL', '60651', '7732523122', NULL, '4401 W Division St', 'Chicago ', 'Cook', 'IL', '60651', '7732523122', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275683500', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.9022, -87.7363, NULL, NULL),
('363317058', 'EDM000095', 'EDM000095', 'ILCHIGSTD', 'Access St Francis Health Center ', 'Janice', '', 'Johnson', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '7464 N Clark St', 'Chicago ', 'Cook', 'IL', '60626', '7733818700', NULL, '7464 N Clark St', 'Chicago ', 'Cook', 'IL', '60626', '7733818700', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, 'Presence Saint Francis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285640425', 0, 'N', 0, '2014-01-10', NULL, NULL, 42.0177, -87.676, NULL, NULL),
('363317058', 'EDM000028', 'EDM000028', 'ILCHIGSTD', 'Access Servicios Medicos La Villita', 'Kenneth ', '', 'Bretts', 'DO', 'Family Practice', '', '', NULL, 'O', '3303 W 26th St', 'Chicago ', 'Cook', 'IL', '60623', '7732776589', NULL, '3303 W 26th St', 'Chicago ', 'Cook', 'IL', '60623', '7732776589', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285717678', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8445, -87.7076, NULL, NULL),
('363317058', 'EDM000084', 'EDM000084', 'ILCHIGSTD', 'Access Auburn Gresham Family Health Center', 'Kathryn', '', 'Hawley', 'PA', 'Family Practice', '', '', NULL, 'O', '8234 S Ashland Ave', 'Chicago', 'Cook', 'IL', '60620', '7738741400', NULL, '8234 S Ashland Ave', 'Chicago', 'Cook', 'IL', '60620', '7738741400', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285876599', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.7438, -87.6637, NULL, NULL),
('363317058', 'EDM000142', 'EDM000142', 'ILCHIGSTD', 'Access West Chicago Family Health Center ', 'Laura ', '', 'Neilsen', 'PA', 'Family Practice', '', '', NULL, 'O', '245 W Roosevelt Rd Bldg 14', 'West Chicago ', 'Dupage', 'IL', '60185', '6302934124', NULL, '245 W Roosevelt Rd Bldg 14', 'West Chicago ', 'Dupage', 'IL', '60185', '6302934124', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285886721', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.8683, -88.2084, NULL, NULL),
('363317058', 'EDM000217', 'EDM000217', 'ILCHIGSTD', 'Access West Division Family Health Center ', 'Daneen', '', 'Woodard', 'MD', 'Pediatrics', 'Internal Medicine', '', NULL, 'O', '4401 W Division St', 'Chicago ', 'Cook', 'IL', '60651', '7732523122', NULL, '4401 W Division St', 'Chicago ', 'Cook', 'IL', '60651', '7732523122', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295829646', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.9022, -87.7363, NULL, NULL),
('363317058', 'EDM000216', 'EDM000216', 'ILCHIGSTD', 'Access Ashland Health Center', 'Daneen', '', 'Woodard', 'MD', 'Pediatrics', 'Internal Medicine', '', NULL, 'O', '5159 S Ashland Ave', 'Chicago ', 'Cook', 'IL', '60609', '7734349216', NULL, '5159 S Ashland Ave', 'Chicago ', 'Cook', 'IL', '60609', '7734349216', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295829646', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.7996, -87.6646, NULL, NULL),
('363317058', 'EDM000040', 'EDM000040', 'ILCHIGSTD', 'Access St Francis Health Center ', 'Migdalia', '', 'Cortina', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '7464 N Clark St', 'Chicago ', 'Cook', 'IL', '60626', '7733818700', NULL, '7464 N Clark St', 'Chicago ', 'Cook', 'IL', '60626', '7733818700', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, 'Presence Saint Francis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1306090089', 0, 'N', 0, '2014-01-10', NULL, NULL, 42.0177, -87.676, NULL, NULL),
('363317058', 'EDM000124', 'EDM000124', 'ILCHIGSTD', 'Access Grand Boulevard Family and Specialty Health Center  ', 'Carol', '', 'Macmillan', 'MD', 'Pediatrics', 'Neurology', '', NULL, 'O', '5401 S Wentworth ', 'Chicago ', 'Cook', 'IL', '60609', '7732886900', NULL, '5401 S Wentworth ', 'Chicago ', 'Cook', 'IL', '60609', '7732886900', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306949615', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.7952, -87.6291, NULL, NULL),
('363317058', 'EDM000167', 'EDM000167', 'ILCHIGSTD', 'Access Cabrini Family Health Center', 'Carlos', '', 'Sandoval Herrera', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3450 S Archer Ave ', 'Chicago ', 'Cook', 'IL', '60608', '7735231000', NULL, '3450 S Archer Ave ', 'Chicago ', 'Cook', 'IL', '60608', '7735231000', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316244817', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.8313, -87.6766, NULL, NULL),
('363317058', 'EDM000015', 'EDM000015', 'ILCHIGSTD', 'Access Centro Medico', 'Syed', '', 'Baseer', 'MD', 'Pediatrics', '', '', NULL, 'O', '3700 W 26th St', 'Chicago ', 'Cook', 'IL', '60623', '7735425203', NULL, '3700 W 26th St', 'Chicago ', 'Cook', 'IL', '60623', '7735425203', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316988710', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8445, -87.7176, NULL, NULL),
('363317058', 'EDM000161', 'EDM000161', 'ILCHIGSTD', 'Access Martin Russo Family Health Center', 'Audrey', '', 'Richardson', 'MD', 'Family Practice', '', '', NULL, 'O', '245 S Gary Ave', 'Bloomingdale', 'Dupage', 'IL', '60108', '6308935230', NULL, '245 S Gary Ave', 'Bloomingdale', 'Dupage', 'IL', '60108', '6308935230', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326031196', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.9432, -88.1196, NULL, NULL),
('363317058', 'EDM000085', 'EDM000085', 'ILCHIGSTD', 'Access Melrose Park Family  Health Center', 'Estella', '', 'Hernandez', 'MD', 'Family Practice', '', '', NULL, 'O', '8321 W North Ave', 'Melrose Park', 'Cook', 'IL', '60160', '7086812298', NULL, '8321 W North Ave', 'Melrose Park', 'Cook', 'IL', '60160', '7086812298', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326173618', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.9083, -87.834, NULL, NULL),
('363317058', 'EDM000125', 'EDM000125', 'ILCHIGSTD', 'Access Hawthorn Family Health Center ', 'Andres', '', 'Mafla', 'MD', 'Internal Medicine', '', '', NULL, 'O', '230709 S Cicero', 'Cicero', 'Cook', 'IL', '60804', '7087809777', NULL, '230709 S Cicero', 'Cicero', 'Cook', 'IL', '60804', '7087809777', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326249285', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8413, -87.7439, NULL, NULL),
('363317058', 'EDM000062', 'EDM000062', 'ILCHIGSTD', 'Access Illinois Eye Institute', 'Kwame', '', 'Foucher', 'MD', 'Family Practice', '', '', NULL, 'O', '3241 S Michigan Ave ', 'Chicago ', 'Cook', 'IL', '60616', '3129497770', NULL, '3241 S Michigan Ave ', 'Chicago ', 'Cook', 'IL', '60616', '3129497770', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336209527', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8353, -87.6223, NULL, NULL),
('363317058', 'EDM000097', 'EDM000097', 'ILCHIGSTD', 'Access St Francis Health Center ', 'Judy', '', 'Joseph', 'MD', 'Internal Medicine', '', '', NULL, 'O', '7464 N Clark St', 'Chicago ', 'Cook', 'IL', '60626', '7733818700', NULL, '7464 N Clark St', 'Chicago ', 'Cook', 'IL', '60626', '7733818700', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346294642', 0, 'N', 0, '2014-01-10', NULL, NULL, 42.0177, -87.676, NULL, NULL),
('363317058', 'EDM000001', 'EDM000001', 'ILCHIGSTD', 'Access Booker Family Health Center ', 'Zainab', '', 'Abdullah', 'MD', 'Pediatrics', '', '', NULL, 'O', '654 E 47th St', 'Chicago ', 'Cook', 'IL', '60653', '7736244800', NULL, '654 E 47th St', 'Chicago ', 'Cook', 'IL', '60653', '7736244800', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356579650', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8098, -87.6092, NULL, NULL),
('363317058', 'EDM000111', 'EDM000111', 'ILCHIGSTD', 'Access Plaza Family Health Center', 'Silvia', '', 'Lara', 'NP', 'Family Practice', '', '', NULL, 'O', '2533 W Cermak Rd ', 'Chicago', 'Cook', 'IL', '60608', '7735230900', NULL, '2533 W Cermak Rd ', 'Chicago', 'Cook', 'IL', '60608', '7735230900', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356644272', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.8511, -87.6887, NULL, NULL),
('363317058', 'EDM000003', 'EDM000003', 'ILCHIGSTD', 'Access Alma Family Health Center', 'Mohammed', '', 'Alam', 'MD', 'Family Practice', '', '', NULL, 'O', '318 W Madsion ', 'Maywood ', 'Cook', 'IL', '60153', '7083445300', NULL, '318 W Madsion ', 'Maywood ', 'Cook', 'IL', '60153', '7083445300', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-07-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366524050', 0, 'N', 0, '2013-08-29', NULL, NULL, 41.8788, -87.8372, NULL, NULL),
('363317058', 'EDM000073', 'EDM000073', 'ILCHIGSTD', 'Access Melrose Park Family  Health Center', 'James', '', 'Gomez', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '8321 W North Ave', 'Melrose Park', 'Cook', 'IL', '60160', '7086812298', NULL, '8321 W North Ave', 'Melrose Park', 'Cook', 'IL', '60160', '7086812298', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376654103', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.9083, -87.834, NULL, NULL),
('363317058', 'EDM000151', 'EDM000151', 'ILCHIGSTD', 'Access Genesis Family Health Center ', 'Angela', '', 'Papassavas', 'MD', 'Family Practice', '', '', NULL, 'O', '1 N Broadway ', 'Des Plaines', 'Cook', 'IL', '60016', '8472983150', NULL, '1 N Broadway ', 'Des Plaines', 'Cook', 'IL', '60016', '8472983150', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, 'Northwest Community Hospital', NULL, '', '', 'HCFA|UB|', '1376731448', 0, 'N', 0, '2014-01-10', NULL, NULL, 42.0519, -87.909, NULL, NULL),
('363317058', 'EDM000154', 'EDM000154', 'ILCHIGSTD', 'Access Holy Cross', 'Priya', '', 'Pillai Indira', 'MD', 'Family Practice', '', '', NULL, 'O', '2701 W 68th St', 'Chicago ', 'Cook', 'IL', '60629', '7734344040', NULL, '2701 W 68th St', 'Chicago ', 'Cook', 'IL', '60629', '7734344040', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, 'Northwest Community Hospital', NULL, '', '', 'HCFA|UB|', '1376844555', 0, 'N', 0, '2014-01-28', NULL, NULL, 41.7695, -87.6924, NULL, NULL),
('363317058', 'EDM000195', 'EDM000195', 'ILCHIGSTD', 'Access Alma Family Health Center', 'Osama', '', 'Thalji', 'MD', 'Internal Medicine', '', '', NULL, 'O', '318 W Madsion ', 'Maywood ', 'Cook', 'IL', '60153', '7083445300', NULL, '318 W Madsion ', 'Maywood ', 'Cook', 'IL', '60153', '7083445300', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386747574', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8788, -87.8372, NULL, NULL),
('363317058', 'EDM000065', 'EDM000065', 'ILCHIGSTD', 'Access Blue Island Family Health Center', 'Julianne', '', 'Gatlin', 'DO', 'Family Practice', '', '', NULL, 'O', '13000 S Maple Ave ', 'Blue Island ', 'Cook', 'IL', '60406', '7083856100', NULL, '13000 S Maple Ave ', 'Blue Island ', 'Cook', 'IL', '60406', '7083856100', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386806354', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.6566, -87.6853, NULL, NULL),
('363317058', 'EDM000007', 'EDM000007', 'ILCHIGSTD', 'Access Blue Island Family Health Center', 'Susana', 'C', 'Alvarez', 'MD', 'Pediatrics', '', '', NULL, 'O', '13000 S Maple Ave ', 'Blue Island ', 'Cook', 'IL', '60406', '7083856100', NULL, '13000 S Maple Ave ', 'Blue Island ', 'Cook', 'IL', '60406', '7083856100', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386897700', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.6566, -87.6853, NULL, NULL),
('363317058', 'EDM000049', 'EDM000049', 'ILCHIGSTD', 'Access Addison Family Health Center', 'Maria Carmen', '', 'Del Cid', 'NP', 'Family Practice', '', '', NULL, 'O', '1111 Lake St', 'Addison ', 'Dupage', 'IL', '60101', '6306281811', NULL, '1111 Lake St', 'Addison ', 'Dupage', 'IL', '60101', '6306281811', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396047668', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.9439, -88.0163, NULL, NULL),
('363317058', 'EDM000171', 'EDM000171', 'ILCHIGSTD', 'Access Grand Boulevard Family and Specialty Health Center  ', 'John', '', 'Schneider', 'MD', 'Internal Medicine', '', '', NULL, 'O', '5401 S Wentworth ', 'Chicago ', 'Cook', 'IL', '60609', '7732886900', NULL, '5401 S Wentworth ', 'Chicago ', 'Cook', 'IL', '60609', '7732886900', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396868147', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.7952, -87.6291, NULL, NULL),
('363317058', 'EDM000200', 'EDM000200', 'ILCHIGSTD', 'Access Kedzie Family Health Center', 'Briana', '', 'Trainor', 'MD', 'Pediatrics', '', '', NULL, 'O', '3229 W 47th Pl', 'Chicago ', 'Cook', 'IL', '60632', '7732546044', NULL, '3229 W 47th Pl', 'Chicago ', 'Cook', 'IL', '60632', '7732546044', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407083652', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8068, -87.7048, NULL, NULL),
('363317058', 'EDM000118', 'EDM000118', 'ILCHIGSTD', 'Access Martin Russo Family Health Center', 'Chong Hsiang', '', 'Liang', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '245 S Gary Ave', 'Bloomingdale', 'Dupage', 'IL', '60108', '6308935230', NULL, '245 S Gary Ave', 'Bloomingdale', 'Dupage', 'IL', '60108', '6308935230', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407086143', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.9432, -88.1196, NULL, NULL),
('363317058', 'EDM000077', 'EDM000077', 'ILCHIGSTD', 'Access Northwest Community', 'Penny', '', 'Grillos', 'PA', 'Obstetrics and Gynecology', '', '', NULL, 'O', '675 W Central Rd  Ste 101', 'Arlington Heights ', 'Cook', 'IL', '60005', '8473421554', NULL, '675 W Central Rd  Ste 101', 'Arlington Heights ', 'Cook', 'IL', '60005', '8473421554', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1407807548', 0, 'Y', 0, '2014-01-10', NULL, NULL, 42.0662, -87.9908, NULL, NULL),
('363317058', 'EDM000041', 'EDM000041', 'ILCHIGSTD', 'Access Kling Professional Building', 'Michael', '', 'Cristofano', 'PA', 'Family Practice', '', '', NULL, 'O', '2720 W 15th St 3rd Fl', 'Chicago ', 'Cook', 'IL', '60608', '7732576730', NULL, '2720 W 15th St 3rd Fl', 'Chicago ', 'Cook', 'IL', '60608', '7732576730', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407826472', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.8612, -87.6941, NULL, NULL),
('363317058', 'EDM000086', 'EDM000086', 'ILCHIGSTD', 'Access St Francis Health Center ', 'Thomas', '', 'Herriges', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '7464 N Clark St', 'Chicago ', 'Cook', 'IL', '60626', '7733818700', NULL, '7464 N Clark St', 'Chicago ', 'Cook', 'IL', '60626', '7733818700', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1407962079', 0, 'Y', 0, '2014-01-10', NULL, NULL, 42.0177, -87.676, NULL, NULL),
('363317058', 'EDM000020', 'EDM000020', 'ILCHIGSTD', 'Access Grand Boulevard Family and Specialty Health Center  ', 'Patricia', '', 'Benitez', 'MD', 'Family Practice', '', '', NULL, 'O', '5401 S Wentworth ', 'Chicago ', 'Cook', 'IL', '60609', '7732886900', NULL, '5401 S Wentworth ', 'Chicago ', 'Cook', 'IL', '60609', '7732886900', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417039009', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.7952, -87.6291, NULL, NULL),
('363317058', 'EDM000069', 'EDM000069', 'ILCHIGSTD', 'Access Holy Cross', 'Melinda', '', 'Gibson', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2701 W 68th St', 'Chicago ', 'Cook', 'IL', '60629', '7734344040', NULL, '2701 W 68th St', 'Chicago ', 'Cook', 'IL', '60629', '7734344040', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427046705', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.7695, -87.6924, NULL, NULL),
('363317058', 'EDM000093', 'EDM000093', 'ILCHIGSTD', 'Access Family Health Society', 'Smita', '', 'Jobanputra', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '152 W Lincoln Hwy', 'Chicago Heights ', 'Cook', 'IL', '60411', '7087549687', NULL, '152 W Lincoln Hwy', 'Chicago Heights ', 'Cook', 'IL', '60411', '7087549687', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427242452', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.5058, -87.6471, NULL, NULL),
('363317058', 'EDM000198', 'EDM000198', 'ILCHIGSTD', 'Access Pilsen Family Health Center ', 'Alicia', '', 'Tobler', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1817 S Loomis ', 'Chicago', 'Cook', 'IL', '60608', '3126666511', NULL, '1817 S Loomis ', 'Chicago', 'Cook', 'IL', '60608', '3126666511', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427280478', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.8573, -87.6609, NULL, NULL),
('363317058', 'EDM000138', 'EDM000138', 'ILCHIGSTD', 'Access Warren Family Health Center ', 'Ramalingappa', '', 'Nagaraju', 'MD', 'General Practice', '', '', NULL, 'O', '2409 W Warren Blvd ', 'Chicago ', 'Cook', 'IL', '60612', '3127334475', NULL, '2409 W Warren Blvd ', 'Chicago ', 'Cook', 'IL', '60612', '3127334475', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1437175015', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.8818, -87.6868, NULL, NULL),
('363317058', 'EDM000022', 'EDM000022', 'ILCHIGSTD', 'Access Plaza Family Health Center', 'Bernadine', '', 'Berridge', 'MD', 'Pediatrics', '', '', NULL, 'O', '2533 W Cermak Rd ', 'Chicago', 'Cook', 'IL', '60608', '7735230900', NULL, '2533 W Cermak Rd ', 'Chicago', 'Cook', 'IL', '60608', '7735230900', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437322195', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8511, -87.6887, NULL, NULL),
('363317058', 'EDM000101', 'EDM000101', 'ILCHIGSTD', 'Access Kling Professional Building', 'Gary', '', 'Kaufman', 'MD', 'Internal Medicine', 'Pediatrics', '', NULL, 'O', '2720 W 15th St 4th Fl', 'Chicago ', 'Cook', 'IL', '60608', '7732576730', NULL, '2720 W 15th St 4th Fl', 'Chicago ', 'Cook', 'IL', '60608', '7732576730', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447252457', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8612, -87.6941, NULL, NULL),
('363317058', 'EDM000076', 'EDM000076', 'ILCHIGSTD', 'Access Kling Professional Building', 'Marlene', '', 'Green', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2720 W 15th St 3rd Fl', 'Chicago ', 'Cook', 'IL', '60608', '7732576676', NULL, '2720 W 15th St 3rd Fl', 'Chicago ', 'Cook', 'IL', '60608', '7732576676', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447333166', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.8612, -87.6941, NULL, NULL),
('363317058', 'EDM000126', 'EDM000126', 'ILCHIGSTD', 'Access Melrose Park Family  Health Center', 'Eileen', '', 'Magill', 'NP', 'Family Practice', '', '', NULL, 'O', '8321 W North Ave', 'Melrose Park', 'Cook', 'IL', '60160', '7086812298', NULL, '8321 W North Ave', 'Melrose Park', 'Cook', 'IL', '60160', '7086812298', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447411483', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.9083, -87.834, NULL, NULL),
('363317058', 'EDM000071', 'EDM000071', 'ILCHIGSTD', 'Access Westside Family Health Center', 'William', '', 'Gillard', 'MD', 'Family Practice', '', '', NULL, 'O', '3752 W 16th St', 'Chicago ', 'Cook', 'IL', '60623', '7737622435', NULL, '3752 W 16th St', 'Chicago ', 'Cook', 'IL', '60623', '7737622435', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457369662', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8591, -87.7197, NULL, NULL),
('363317058', 'EDM000014', 'EDM000014', 'ILCHIGSTD', 'Access Southwest Family Health Ctr ', 'Charles', '', 'Barron', 'MD', 'Family Practice', '', '', NULL, 'O', '4839 W 47th St', 'Chicago ', 'Cook', 'IL', '60638', '7737352345', NULL, '4839 W 47th St', 'Chicago ', 'Cook', 'IL', '60638', '7737352345', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457433039', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8073, -87.7447, NULL, NULL),
('363317058', 'EDM000163', 'EDM000163', 'ILCHIGSTD', 'Access Southwest Family Health Ctr ', 'Pamela', '', 'Roper', 'MD', 'Pediatrics', '', '', NULL, 'O', '4839 W 47th St', 'Chicago ', 'Cook', 'IL', '60638', '7737352345', NULL, '4839 W 47th St', 'Chicago ', 'Cook', 'IL', '60638', '7737352345', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457433237', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8073, -87.7447, NULL, NULL),
('363317058', 'EDM000121', 'EDM000121', 'ILCHIGSTD', 'Access Northwest Community', 'Cereesa', '', 'Longest', 'MD', 'Ophthalmology', '', '', NULL, 'O', '675 W Central Rd  Ste 101', 'Arlington Heights ', 'Cook', 'IL', '60005', '8473421554', NULL, '675 W Central Rd  Ste 101', 'Arlington Heights ', 'Cook', 'IL', '60005', '8473421554', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1467438341', 0, 'N', 0, '2014-01-10', NULL, NULL, 42.0662, -87.9908, NULL, NULL),
('363317058', 'EDM000153', 'EDM000153', 'ILCHIGSTD', 'Access Melrose Park Family  Health Center', 'Scott', '', 'Pierce', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '8321 W North Ave', 'Melrose Park', 'Cook', 'IL', '60160', '7086812298', NULL, '8321 W North Ave', 'Melrose Park', 'Cook', 'IL', '60160', '7086812298', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467459305', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.9083, -87.834, NULL, NULL),
('363317058', 'EDM000160', 'EDM000160', 'ILCHIGSTD', 'Access Melrose Park Family  Health Center', 'Christy', 'G', 'Reinhard', 'MD', 'Pediatrics', '', '', NULL, 'O', '8321 W North Ave', 'Melrose Park', 'Cook', 'IL', '60160', '7086812298', NULL, '8321 W North Ave', 'Melrose Park', 'Cook', 'IL', '60160', '7086812298', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467523647', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.9083, -87.834, NULL, NULL),
('363317058', 'EDM000140', 'EDM000140', 'ILCHIGSTD', 'Access Humboldt Park Family Health Center', 'Mukund', '', 'Narayan', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3202 W North Ave', 'Chicago ', 'Cook', 'IL', '60647', '7732781880', NULL, '3202 W North Ave', 'Chicago ', 'Cook', 'IL', '60647', '7732781880', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467535740', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.9103, -87.7072, NULL, NULL),
('363317058', 'EDM000039', 'EDM000039', 'ILCHIGSTD', 'Access Addison Family Health Center', 'Maribel', '', 'Corral', 'PA', 'Family Practice', '', '', NULL, 'O', '1111 Lake St', 'Addison ', 'Dupage', 'IL', '60101', '6306281811', NULL, '1111 Lake St', 'Addison ', 'Dupage', 'IL', '60101', '6306281811', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467631978', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.9439, -88.0163, NULL, NULL),
('363317058', 'EDM000046', 'EDM000046', 'ILCHIGSTD', 'Access Kedzie Family Health Center', 'Tara', '', 'De Jesus', 'MD', 'Pediatrics', '', '', NULL, 'O', '3229 W 47th Pl', 'Chicago ', 'Cook', 'IL', '60632', '7732546044', NULL, '3229 W 47th Pl', 'Chicago ', 'Cook', 'IL', '60632', '7732546044', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477590651', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8068, -87.7048, NULL, NULL),
('363317058', 'EDM000055', 'EDM000055', 'ILCHIGSTD', 'Access Madison Family Health Center ', 'Grettel', '', 'Donahue', 'MD', 'Pediatrics', '', '', NULL, 'O', '1111 Lake St', 'Addison ', 'Dupage', 'IL', '60101', '6306281811', NULL, '1111 Lake St', 'Addison ', 'Dupage', 'IL', '60101', '6306281811', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477605913', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.9439, -88.0163, NULL, NULL),
('363317058', 'EDM000152', 'EDM000152', 'ILCHIGSTD', 'Access Genesis Family Health Center ', 'Nigam', '', 'Patel', 'MD', 'Family Practice', '', '', NULL, 'O', '1 N Broadway ', 'Des Plaines', 'Cook', 'IL', '60016', '8472983150', NULL, '1 N Broadway ', 'Des Plaines', 'Cook', 'IL', '60016', '8472983150', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, 'Northwest Community Hospital', NULL, '', '', 'HCFA|UB|', '1477656684', 0, 'N', 0, '2014-01-10', NULL, NULL, 42.0519, -87.909, NULL, NULL),
('363317058', 'EDM000205', 'EDM000205', 'ILCHIGSTD', 'Access Grand Boulevard Family and Specialty Health Center  ', 'Peter', '', 'Varga', 'MD', 'Pediatrics', 'Cardiovascular Disease', '', NULL, 'O', '5401 S Wentworth ', 'Chicago ', 'Cook', 'IL', '60609', '7732886900', NULL, '5401 S Wentworth ', 'Chicago ', 'Cook', 'IL', '60609', '7732886900', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, 'Presence Resurrection Medical Center', 'Presence Saint Joseph Hospital Chicago', '', '', 'HCFA|UB|', '1487668224', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.7952, -87.6291, NULL, NULL),
('363317058', 'EDM000011', 'EDM000011', 'ILCHIGSTD', 'Access Brandon Family Health Center ', 'Andi', '', 'Arnautovic', 'MD', 'Family Practice', '', '', NULL, 'O', '8300 S Brandon ', 'Chicago ', 'Cook', 'IL', '60617', '7737217600', NULL, '8300 S Brandon ', 'Chicago ', 'Cook', 'IL', '60617', '7737217600', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487795118', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.7446, -87.547, NULL, NULL),
('363317058', 'EDM000012', 'EDM000012', 'ILCHIGSTD', 'Access Madison Family Health Center ', 'Ihab', '', 'Aziz', 'MD', 'Family Practice', '', '', NULL, 'O', '3800 W Madison ', 'Chicago ', 'Cook', 'IL', '60624', '7738266600', NULL, '3800 W Madison ', 'Chicago ', 'Cook', 'IL', '60624', '7738266600', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508968652', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8811, -87.7211, NULL, NULL),
('363317058', 'EDM000087', 'EDM000087', 'ILCHIGSTD', 'Access Martin Russo Family Health Center', 'Tally', '', 'Hollin', 'NP', 'Family Practice', '', '', NULL, 'O', '245 S Gary Ave', 'Bloomingdale', 'Dupage', 'IL', '60108', '6308935230', NULL, '245 S Gary Ave', 'Bloomingdale', 'Dupage', 'IL', '60108', '6308935230', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518251149', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.9432, -88.1196, NULL, NULL),
('363317058', 'EDM000031', 'EDM000031', 'ILCHIGSTD', 'Access Kedzie Family Health Center', 'Paula', '', 'Cavens', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3229 W 47th Pl', 'Chicago ', 'Cook', 'IL', '60632', '7732546044', NULL, '3229 W 47th Pl', 'Chicago ', 'Cook', 'IL', '60632', '7732546044', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528084779', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8068, -87.7048, NULL, NULL),
('363317058', 'EDM000215', 'EDM000215', 'ILCHIGSTD', 'Access Kling Professional Building', 'Brenda', '', 'Wolfe', 'NP', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2720 W 15th St 3rd Fl', 'Chicago ', 'Cook', 'IL', '60608', '7732576676', NULL, '2720 W 15th St 3rd Fl', 'Chicago ', 'Cook', 'IL', '60608', '7732576676', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538106398', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.8612, -87.6941, NULL, NULL),
('363317058', 'EDM000218', 'EDM000218', 'ILCHIGSTD', 'Access Grand Boulevard Family and Specialty Health Center  ', 'Christine', '', 'Yu', 'MD', 'Pediatrics', '', '', NULL, 'O', '5401 S Wentworth ', 'Chicago ', 'Cook', 'IL', '60609', '7732886900', NULL, '5401 S Wentworth ', 'Chicago ', 'Cook', 'IL', '60609', '7732886900', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538109582', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.7952, -87.6291, NULL, NULL),
('363317058', 'EDM000050', 'EDM000050', 'ILCHIGSTD', 'Access Centro Medico San Rafael', 'Arnulfo', '', 'Delgado', 'MD', 'Pediatrics', '', '', NULL, 'O', '3204 W 26th St', 'Chicago', 'Cook', 'IL', '60623', '7739273100', NULL, '3204 W 26th St', 'Chicago', 'Cook', 'IL', '60623', '7739273100', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538172887', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8445, -87.7053, NULL, NULL),
('363317058', 'EDM000109', 'EDM000109', 'ILCHIGSTD', 'Access Martin Russo Family Health Center', 'Kenneth', '', 'Kwiatkowski', 'DO', 'Pediatrics', '', '', NULL, 'O', '245 S Gary Ave', 'Bloomingdale', 'Dupage', 'IL', '60108', '6308935230', NULL, '245 S Gary Ave', 'Bloomingdale', 'Dupage', 'IL', '60108', '6308935230', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538179361', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.9432, -88.1196, NULL, NULL),
('363317058', 'EDM000068', 'EDM000068', 'ILCHIGSTD', 'Access Genesis Family Health Center ', 'Davida', '', 'Gerena', 'MD', 'Pediatrics', '', '', NULL, 'O', '1 N Broadway ', 'Des Plaines', 'Cook', 'IL', '60016', '8472983150', NULL, '1 N Broadway ', 'Des Plaines', 'Cook', 'IL', '60016', '8472983150', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538325113', 0, 'N', 0, '2014-01-10', NULL, NULL, 42.0519, -87.909, NULL, NULL),
('363317058', 'EDM000034', 'EDM000034', 'ILCHIGSTD', 'Access St Francis Health Center ', 'Magdalena', '', 'Chlebowicz', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '7464 N Clark St', 'Chicago ', 'Cook', 'IL', '60626', '7733818700', NULL, '7464 N Clark St', 'Chicago ', 'Cook', 'IL', '60626', '7733818700', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1538460084', 0, 'N', 0, '2014-01-10', NULL, NULL, 42.0177, -87.676, NULL, NULL),
('363317058', 'EDM000199', 'EDM000199', 'ILCHIGSTD', 'Access West Chicago Family Health Center ', 'Arnaldo', '', 'Torres', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '245 W Roosevelt Rd Bldg 14', 'West Chicago ', 'Dupage', 'IL', '60185', '6302934124', NULL, '245 W Roosevelt Rd Bldg 14', 'West Chicago ', 'Dupage', 'IL', '60185', '6302934124', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548221740', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.8683, -88.2084, NULL, NULL),
('363317058', 'EDM000044', 'EDM000044', 'ILCHIGSTD', 'Access Madison Family Health Center ', 'Teresa', '', 'Cvengros', 'MD', 'Family Practice', '', '', NULL, 'O', '3800 W Madison ', 'Chicago ', 'Cook', 'IL', '60624', '7738266600', NULL, '3800 W Madison ', 'Chicago ', 'Cook', 'IL', '60624', '7738266600', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1558366591', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8811, -87.7211, NULL, NULL),
('363317058', 'EDM000091', 'EDM000091', 'ILCHIGSTD', 'Access Genesis Family Health Center ', 'Ian', '', 'Jasenof', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1 N Broadway ', 'Des Plaines', 'Cook', 'IL', '60016', '8472983150', NULL, '1 N Broadway ', 'Des Plaines', 'Cook', 'IL', '60016', '8472983150', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578509428', 0, 'Y', 0, '2014-01-10', NULL, NULL, 42.0519, -87.909, NULL, NULL),
('363317058', 'EDM000165', 'EDM000165', 'ILCHIGSTD', 'Access Rogers Park Family Health Center', 'Frances', '', 'Rosenberg', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1555 W Howard St', 'Chicago ', 'Cook', 'IL', '60626', '7737647146', NULL, '1555 W Howard St', 'Chicago ', 'Cook', 'IL', '60626', '7737647146', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, 'Presence Saint Francis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1588614218', 0, 'Y', 0, '2014-01-10', NULL, NULL, 42.0191, -87.6702, NULL, NULL),
('363317058', 'EDM000174', 'EDM000174', 'ILCHIGSTD', 'Access Grand Boulevard Family and Specialty Health Center  ', 'Timothy', '', 'Sentongo', 'MD', 'Pediatrics', '', '', NULL, 'O', '5401 S Wentworth ', 'Chicago ', 'Cook', 'IL', '60609', '7732886900', NULL, '5401 S Wentworth ', 'Chicago ', 'Cook', 'IL', '60609', '7732886900', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598726432', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.7952, -87.6291, NULL, NULL),
('363317058', 'EDM000104', 'EDM000104', 'ILCHIGSTD', 'Access Grand Boulevard Family and Specialty Health Center  ', 'Gene', '', 'Kim', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '5401 S Wentworth ', 'Chicago ', 'Cook', 'IL', '60609', '7732886900', NULL, '5401 S Wentworth ', 'Chicago ', 'Cook', 'IL', '60609', '7732886900', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598923005', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.7952, -87.6291, NULL, NULL),
('363317058', 'EDM000032', 'EDM000032', 'ILCHIGSTD', 'Access Madison Family Health Center ', 'Mohammad', '', 'Chaudhary', 'MD', 'Pediatrics', '', '', NULL, 'O', '3800 W Madison ', 'Chicago ', 'Cook', 'IL', '60624', '7738266600', NULL, '3800 W Madison ', 'Chicago ', 'Cook', 'IL', '60624', '7738266600', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619080850', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8811, -87.7211, NULL, NULL),
('363317058', 'EDM000136', 'EDM000136', 'ILCHIGSTD', 'Access Madison Family Health Center ', 'Sunita', '', 'Mohapatra', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3800 W Madison ', 'Chicago ', 'Cook', 'IL', '60624', '7738266600', NULL, '3800 W Madison ', 'Chicago ', 'Cook', 'IL', '60624', '7738266600', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629062328', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8811, -87.7211, NULL, NULL),
('363317058', 'EDM000203', 'EDM000203', 'ILCHIGSTD', 'Access Family Health Society', 'Luis', '', 'Ugarte', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '152 W Lincoln Hwy', 'Chicago Heights ', 'Cook', 'IL', '60411', '7087549687', NULL, '152 W Lincoln Hwy', 'Chicago Heights ', 'Cook', 'IL', '60411', '7087549687', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629076781', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.5058, -87.6471, NULL, NULL),
('363317058', 'EDM000027', 'EDM000027', 'ILCHIGSTD', 'Access Madison Family Health Center ', 'Leo', '', 'Boler', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3800 W Madison ', 'Chicago ', 'Cook', 'IL', '60624', '7738266600', NULL, '3800 W Madison ', 'Chicago ', 'Cook', 'IL', '60624', '7738266600', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629151352', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.8811, -87.7211, NULL, NULL),
('363317058', 'EDM000036', 'EDM000036', 'ILCHIGSTD', 'Access Kling Professional Building', 'Caroline', '', 'Cinquegrani', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2720 W 15th St 3rd Fl', 'Chicago ', 'Cook', 'IL', '60608', '7732576676', NULL, '2720 W 15th St 3rd Fl', 'Chicago ', 'Cook', 'IL', '60608', '7732576676', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1649353251', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.8612, -87.6941, NULL, NULL),
('363317058', 'EDM000180', 'EDM000180', 'ILCHIGSTD', 'Access Booker Family Health Center ', 'Leon', '', 'Sherrell', 'PA', 'Family Practice', '', '', NULL, 'O', '654 E 47th St', 'Chicago ', 'Cook', 'IL', '60653', '7736244800', NULL, '654 E 47th St', 'Chicago ', 'Cook', 'IL', '60653', '7736244800', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1649395930', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.8098, -87.6092, NULL, NULL),
('363317058', 'EDM000107', 'EDM000107', 'ILCHIGSTD', 'Access Madison Family Health Center ', 'Daniela', '', 'Kovacs', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3800 W Madison ', 'Chicago ', 'Cook', 'IL', '60624', '7738266600', NULL, '3800 W Madison ', 'Chicago ', 'Cook', 'IL', '60624', '7738266600', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659573624', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8811, -87.7211, NULL, NULL),
('363317058', 'EDM000056', 'EDM000056', 'ILCHIGSTD', 'Access Kedzie Family Health Center', 'Barbara Alif', '', 'Doran', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3229 W 47th Pl', 'Chicago ', 'Cook', 'IL', '60632', '7732546044', NULL, '3229 W 47th Pl', 'Chicago ', 'Cook', 'IL', '60632', '7732546044', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669541371', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.8068, -87.7048, NULL, NULL),
('363317058', 'EDM000009', 'EDM000009', 'ILCHIGSTD', 'Access Genesis Family Health Center ', 'Sandra', '', 'Anderson', 'MD', 'Pediatrics', '', '', NULL, 'O', '1 N Broadway ', 'Des Plaines', 'Cook', 'IL', '60016', '8472983150', NULL, '1 N Broadway ', 'Des Plaines', 'Cook', 'IL', '60016', '8472983150', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', '', 'HCFA|UB|', '1669541868', 0, 'N', 0, '2014-01-10', NULL, NULL, 42.0519, -87.909, NULL, NULL),
('363317058', 'EDM000201', 'EDM000201', 'ILCHIGSTD', 'Access Servicios Medicos La Villita', 'Richard', '', 'Trester', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3303 W 26th St', 'Chicago ', 'Cook', 'IL', '60623', '7732776589', NULL, '3303 W 26th St', 'Chicago ', 'Cook', 'IL', '60623', '7732776589', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669554531', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8445, -87.7076, NULL, NULL),
('363317058', 'EDM000043', 'EDM000043', 'ILCHIGSTD', 'Access Northwest Community', 'Kimberly', '', 'Curnyn', 'MD', 'Pediatrics', 'Pediatric Ophthalmology', '', NULL, 'O', '675 W Central Rd Ste 101', 'Arlington Heights ', 'Cook', 'IL', '60005', '8473421554', NULL, '675 W Central Rd Ste 101', 'Arlington Heights ', 'Cook', 'IL', '60005', '8473421554', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1669575296', 0, 'N', 0, '2014-01-10', NULL, NULL, 42.0662, -87.9908, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('363317058', 'EDM000120', 'EDM000120', 'ILCHIGSTD', 'Access Genesis Family Health Center ', 'Brian', '', 'Locker', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1 N Broadway ', 'Des Plaines', 'Cook', 'IL', '60016', '8472983150', NULL, '1 N Broadway ', 'Des Plaines', 'Cook', 'IL', '60016', '8472983150', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679540868', 0, 'Y', 0, '2014-01-10', NULL, NULL, 42.0519, -87.909, NULL, NULL),
('363317058', 'EDM000045', 'EDM000045', 'ILCHIGSTD', 'Access Madison Family Health Center ', 'Nkeiruka ', '', 'Dara', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3800 W Madison ', 'Chicago ', 'Cook', 'IL', '60624', '7738266600', NULL, '3800 W Madison ', 'Chicago ', 'Cook', 'IL', '60624', '7738266600', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679801476', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.8811, -87.7211, NULL, NULL),
('363317058', 'EDM000213', 'EDM000213', 'ILCHIGSTD', 'Access Cabrini Family Health Center', 'Mohanlal', '', 'Wickramasinghe', 'MD', 'Pediatrics', '', '', NULL, 'O', '3450 S Archer Ave ', 'Chicago ', 'Cook', 'IL', '60608', '7735231000', NULL, '3450 S Archer Ave ', 'Chicago ', 'Cook', 'IL', '60608', '7735231000', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699715979', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8313, -87.6766, NULL, NULL),
('363317058', 'EDM000219', 'EDM000219', 'ILCHIGSTD', 'Access West Chicago Family Health Center ', 'W Patrick', '', 'Zeller', 'MD', 'Pediatrics', 'Endocrinology', '', NULL, 'O', '245 W Roosevelt Rd Bldg 14', 'West Chicago ', 'Dupage', 'IL', '60185', '6302934124', NULL, '245 W Roosevelt Rd Bldg 14', 'West Chicago ', 'Dupage', 'IL', '60185', '6302934124', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, 'Edward Hospital', NULL, '', '', 'HCFA|UB|', '1699738922', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8683, -88.2084, NULL, NULL),
('363317058', 'EDM000110', 'EDM000110', 'ILCHIGSTD', 'Access Kling Professional Building', 'Edward', 'Charles', 'Lampley', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2720 W 15th St 3rd Fl', 'Chicago ', 'Cook', 'IL', '60608', '7732576676', NULL, '2720 W 15th St 3rd Fl', 'Chicago ', 'Cook', 'IL', '60608', '7732576676', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699776385', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8612, -87.6941, NULL, NULL),
('363317058', 'EDM000067', 'EDM000067', 'ILCHIGSTD', 'Access Hawthorn Family Health Center ', 'Anne', '', 'Gearhart', 'MD', 'Pediatrics', '', '', NULL, 'O', '230709 S Cicero', 'Cicero', 'Cook', 'IL', '60804', '7087809777', NULL, '230709 S Cicero', 'Cicero', 'Cook', 'IL', '60804', '7087809777', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699949263', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8575, -87.7556, NULL, NULL),
('363317058', 'EDM000112', 'EDM000112', 'ILCHIGSTD', 'Access Pilsen Family Health Center ', 'Concepta', '', 'Lasquite', 'MD', 'General Practice', '', '', NULL, 'O', '1817 S Loomis ', 'Chicago', 'Cook', 'IL', '60608', '3126666511', NULL, '1817 S Loomis ', 'Chicago', 'Cook', 'IL', '60608', '3126666511', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700922648', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8573, -87.6609, NULL, NULL),
('363317058', 'EDM000021', 'EDM000021', 'ILCHIGSTD', 'Access Grand Boulevard Family and Specialty Health Center  ', 'Jean Luc', '', 'Benoit', 'MD', 'Internal Medicine', '', '', NULL, 'O', '5401 S Wentworth ', 'Chicago ', 'Cook', 'IL', '60609', '7732886900', NULL, '5401 S Wentworth ', 'Chicago ', 'Cook', 'IL', '60609', '7732886900', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710049267', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.7952, -87.6291, NULL, NULL),
('363317058', 'EDM000064', 'EDM000064', 'ILCHIGSTD', 'Access Kedzie Family Health Center', 'Nancy', '', 'Gamarra', 'MD', 'Internal Medicine', 'Endocrinology', '', NULL, 'O', '3229 W 47th Pl', 'Chicago ', 'Cook', 'IL', '60632', '7732546044', NULL, '3229 W 47th Pl', 'Chicago ', 'Cook', 'IL', '60632', '7732546044', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710094685', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8068, -87.7048, NULL, NULL),
('363317058', 'EDM000102', 'EDM000102', 'ILCHIGSTD', 'Access Kedzie Family Health Center', 'Salman', '', 'Khan', 'MD', 'Pediatrics', '', '', NULL, 'O', '3229 W 47th Pl', 'Chicago ', 'Cook', 'IL', '60632', '7732546044', NULL, '3229 W 47th Pl', 'Chicago ', 'Cook', 'IL', '60632', '7732546044', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710098777', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8068, -87.7048, NULL, NULL),
('363317058', 'EDM000207', 'EDM000207', 'ILCHIGSTD', 'Access Rogers Park Family Health Center', 'Nirmla', '', 'Verma', 'MD', 'Pediatrics', '', '', NULL, 'O', '1555 W Howard St', 'Chicago ', 'Cook', 'IL', '60626', '7737647146', NULL, '1555 W Howard St', 'Chicago ', 'Cook', 'IL', '60626', '7737647146', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710931621', 0, 'N', 0, '2014-01-10', NULL, NULL, 42.0191, -87.6702, NULL, NULL),
('363317058', 'EDM000008', 'EDM000008', 'ILCHIGSTD', 'Access Grand Boulevard Family and Specialty Health Center  ', 'Krishnaswamy ', '', 'Anand', 'MD', 'Internal Medicine', 'Gastroenterology', '', NULL, 'O', '5401 S Wentworth ', 'Chicago ', 'Cook', 'IL', '60609', '7732886900', NULL, '5401 S Wentworth ', 'Chicago ', 'Cook', 'IL', '60609', '7732886900', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720080732', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.7952, -87.6291, NULL, NULL),
('363317058', 'EDM000051', 'EDM000051', 'ILCHIGSTD', 'Access Blue Island Family Health Center', 'Alfonso', 'F', 'Del Granado', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '13000 S Maple Ave ', 'Blue Island ', 'Cook', 'IL', '60406', '7083856100', NULL, '13000 S Maple Ave ', 'Blue Island ', 'Cook', 'IL', '60406', '7083856100', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1720157977', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.6566, -87.6853, NULL, NULL),
('363317058', 'EDM000141', 'EDM000141', 'ILCHIGSTD', 'Access Genesis Family Health Center ', 'Matthew', '', 'Nash', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1 N Broadway ', 'Des Plaines', 'Cook', 'IL', '60016', '8472983150', NULL, '1 N Broadway ', 'Des Plaines', 'Cook', 'IL', '60016', '8472983150', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740257930', 0, 'Y', 0, '2014-01-10', NULL, NULL, 42.0519, -87.909, NULL, NULL),
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('363317058', 'EDM000169', 'EDM000169', 'ILCHIGSTD', 'Access Des Plaines Valley Health Center', 'Ann', '', 'Sarpy', 'MD', 'Psychiatry', '', '', NULL, 'O', '7450 W 63rd St', 'Summit ', 'Cook', 'IL', '60501', '7084580757', NULL, '7450 W 63rd St', 'Summit ', 'Cook', 'IL', '60501', '7084580757', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, 'Northwestern Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1750426656', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.7774, -87.8078, NULL, NULL),
('363317058', 'EDM000139', 'EDM000139', 'ILCHIGSTD', 'Access Booker Family Health Center ', 'Vasantha', 'A', 'Naidu', 'MD', 'Family Practice', 'Pediatrics', '', NULL, 'O', '654 E 47th St', 'Chicago ', 'Cook', 'IL', '60653', '7736244800', NULL, '654 E 47th St', 'Chicago ', 'Cook', 'IL', '60653', '7736244800', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760546329', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8098, -87.6092, NULL, NULL),
('363317058', 'EDM000196', 'EDM000196', 'ILCHIGSTD', 'Access Doctors Medical Center', 'Stephanie', '', 'Tillman', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '6240 W 55th St', 'Chicago ', 'Cook', 'IL', '60638', '7732842200', NULL, '6240 W 55th St', 'Chicago ', 'Cook', 'IL', '60638', '7732842200', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760738769', 0, 'Y', 0, '2014-01-13', NULL, NULL, 41.7926, -87.7786, NULL, NULL),
('363317058', 'EDM000190', 'EDM000190', 'ILCHIGSTD', 'Access Genesis Family Health Center ', 'Beth', '', 'Sum', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1 N Broadway ', 'Des Plaines', 'Cook', 'IL', '60016', '8472983150', NULL, '1 N Broadway ', 'Des Plaines', 'Cook', 'IL', '60016', '8472983150', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780643734', 0, 'Y', 0, '2014-01-10', NULL, NULL, 42.0519, -87.909, NULL, NULL),
('363317058', 'EDM000182', 'EDM000182', 'ILCHIGSTD', 'Access Genesis Family Health Center ', 'Heider', '', 'Shuber', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1 N Broadway ', 'Des Plaines', 'Cook', 'IL', '60016', '8472983150', NULL, '1 N Broadway ', 'Des Plaines', 'Cook', 'IL', '60016', '8472983150', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1780658823', 0, 'N', 0, '2014-01-10', NULL, NULL, 42.0519, -87.909, NULL, NULL),
('363317058', 'EDM000129', 'EDM000129', 'ILCHIGSTD', 'Access Near West Family Health Center', 'Annamma', '', 'Mathew', 'MD', 'Pediatrics', '', '', NULL, 'O', '1158 W Taylor ', 'Chicago ', 'Cook', 'IL', '60607', '3124558640', NULL, '1158 W Taylor ', 'Chicago ', 'Cook', 'IL', '60607', '3124558640', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780766535', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8695, -87.6565, NULL, NULL),
('363317058', 'EDM000054', 'EDM000054', 'ILCHIGSTD', 'Access Madison Family Health Center ', 'Mara', '', 'Divis', 'DO', 'Family Practice', '', '', NULL, 'O', '3800 W Madison ', 'Chicago ', 'Cook', 'IL', '60624', '7738266600', NULL, '3800 W Madison ', 'Chicago ', 'Cook', 'IL', '60624', '7738266600', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780824037', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8811, -87.7211, NULL, NULL),
('363317058', 'EDM000214', 'EDM000214', 'ILCHIGSTD', 'Access Westside Family Health Center', 'Kimberly', '', 'Williams', 'MD', 'Family Practice', '', '', NULL, 'O', '3752 W 16th St', 'Chicago ', 'Cook', 'IL', '60623', '7737622435', NULL, '3752 W 16th St', 'Chicago ', 'Cook', 'IL', '60623', '7737622435', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790736601', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8591, -87.7197, NULL, NULL),
('363317058', 'EDM000103', 'EDM000103', 'ILCHIGSTD', 'Access Kling Professional Building', 'Stuart', '', 'Kiken', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2720 W 15th St 4th Fl', 'Chicago ', 'Cook', 'IL', '60608', '7732576730', NULL, '2720 W 15th St 4th Fl', 'Chicago ', 'Cook', 'IL', '60608', '7732576730', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790868008', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8612, -87.6941, NULL, NULL),
('363317058', 'EDM000024', 'EDM000024', 'ILCHIGSTD', 'Access Genesis Family Health Center ', 'Julie', '', 'Blankemeier', 'MD', 'Family Practice', '', '', NULL, 'O', '1 N Broadway ', 'Des Plaines', 'Cook', 'IL', '60016', '8472983150', NULL, '1 N Broadway ', 'Des Plaines', 'Cook', 'IL', '60016', '8472983150', '', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801101555', 0, 'N', 0, '2014-06-02', NULL, NULL, 42.0519, -87.909, NULL, NULL),
('363317058', 'EDM000137', 'EDM000137', 'ILCHIGSTD', 'Access Des Plaines Valley Health Center', 'Jesika', '', 'Moore', 'NP', 'Family Practice', '', '', NULL, 'O', '7450 W 63rd St', 'Summit ', 'Cook', 'IL', '60501', '7084580757', NULL, '7450 W 63rd St', 'Summit ', 'Cook', 'IL', '60501', '7084580757', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801129895', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.7774, -87.8078, NULL, NULL),
('363317058', 'EDM000057', 'EDM000057', 'ILCHIGSTD', 'Access Addison Family Health Center', 'Amy', '', 'Drescher Crumpley', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1111 Lake St', 'Addison ', 'Dupage', 'IL', '60101', '6306281811', NULL, '1111 Lake St', 'Addison ', 'Dupage', 'IL', '60101', '6306281811', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801907589', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.9439, -88.0163, NULL, NULL),
('363317058', 'EDM000122', 'EDM000122', 'ILCHIGSTD', 'Access Cabrini Family Health Center', 'Sonia', '', 'Lott', 'MD', 'Family Practice', '', '', NULL, 'O', '3450 S Archer Ave ', 'Chicago ', 'Cook', 'IL', '60608', '7735231000', NULL, '3450 S Archer Ave ', 'Chicago ', 'Cook', 'IL', '60608', '7735231000', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801918545', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8313, -87.6766, NULL, NULL),
('363317058', 'EDM000075', 'EDM000075', 'ILCHIGSTD', 'Access Family Health Society', 'Kevin', '', 'Gordon', 'DO', 'Family Practice', '', '', NULL, 'O', '152 W Lincoln Hwy', 'Chicago Heights ', 'Cook', 'IL', '60411', '7087549687', NULL, '152 W Lincoln Hwy', 'Chicago Heights ', 'Cook', 'IL', '60411', '7087549687', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-11-16', 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1811082431', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.5058, -87.6471, NULL, NULL),
('363317058', 'EDM000116', 'EDM000116', 'ILCHIGSTD', 'Access Servicios Medicos La Villita', 'Meredith', '', 'Lembke Vanputten', 'PA', 'Family Practice', '', '', NULL, 'O', '3303 W 26th St', 'Chicago ', 'Cook', 'IL', '60623', '7732776589', NULL, '3303 W 26th St', 'Chicago ', 'Cook', 'IL', '60623', '7732776589', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811179195', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.8445, -87.7076, NULL, NULL),
('363317058', 'EDM000013', 'EDM000013', 'ILCHIGSTD', 'Access Ashland Health Center', 'Myesha Janell', '', 'Banks', 'MD', 'Pediatrics', '', '', NULL, 'O', '5159 S Ashland Ave', 'Chicago', 'Cook', 'IL', '60609', '7734349216', NULL, '5159 S Ashland Ave', 'Chicago', 'Cook', 'IL', '60609', '7734349216', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821258724', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.7996, -87.6646, NULL, NULL),
('363317058', 'EDM000156', 'EDM000156', 'ILCHIGSTD', 'Access Grand Boulevard Family and Specialty Health Center  ', 'Renee', '', 'Poole', 'MD', 'Family Practice', '', '', NULL, 'O', '5401 S Wentworth ', 'Chicago ', 'Cook', 'IL', '60609', '7732886900', NULL, '5401 S Wentworth ', 'Chicago ', 'Cook', 'IL', '60609', '7732886900', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821268434', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.7952, -87.6291, NULL, NULL),
('363317058', 'EDM000164', 'EDM000164', 'ILCHIGSTD', 'Access Cabrini Family Health Center', 'Mary Theresa', '', 'Rosales', 'MD', 'Pediatrics', '', '', NULL, 'O', '3450 S Archer Ave ', 'Chicago ', 'Cook', 'IL', '60608', '7735231000', NULL, '3450 S Archer Ave ', 'Chicago ', 'Cook', 'IL', '60608', '7735231000', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831109172', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8313, -87.6766, NULL, NULL),
('363317058', 'EDM000106', 'EDM000106', 'ILCHIGSTD', 'Access Humboldt Park Family Health Center', 'Min Soo', '', 'Kim', 'MD', 'Family Practice', '', '', NULL, 'O', '3202 W North Ave ', 'Chicago ', 'Cook', 'IL', '60647', '7732781880', NULL, '3202 W North Ave ', 'Chicago ', 'Cook', 'IL', '60647', '7732781880', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, '', '', 'HCFA|UB|', '1831204379', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.9103, -87.7072, NULL, NULL),
('363317058', 'EDM000146', 'EDM000146', 'ILCHIGSTD', 'Access Servicios Medicos La Villita', 'Felix', '', 'Obregon', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3303 W 26th St', 'Chicago ', 'Cook', 'IL', '60623', '7732776589', NULL, '3303 W 26th St', 'Chicago ', 'Cook', 'IL', '60623', '7732776589', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831271709', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8445, -87.7076, NULL, NULL),
('363317058', 'EDM000133', 'EDM000133', 'ILCHIGSTD', 'Access Doctors Medical Center', 'George Y', '', 'Michael', 'MD', 'Family Practice', '', '', NULL, 'O', '6240 W 55th St', 'Chicago ', 'Cook', 'IL', '60638', '7732842200', NULL, '6240 W 55th St', 'Chicago ', 'Cook', 'IL', '60638', '7732842200', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831272137', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.7926, -87.7786, NULL, NULL),
('363317058', 'EDM000066', 'EDM000066', 'ILCHIGSTD', 'Access Madison Family Health Center ', 'Yacob', '', 'Gawo', 'MD', 'Family Practice', '', '', NULL, 'O', '3800 W Madison ', 'Chicago ', 'Cook', 'IL', '60624', '7738266600', NULL, '3800 W Madison ', 'Chicago ', 'Cook', 'IL', '60624', '7738266600', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831296540', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8811, -87.7211, NULL, NULL),
('363317058', 'EDM000128', 'EDM000128', 'ILCHIGSTD', 'Access Northwest Community', 'Liseth', '', 'Manjarrez', 'MD', 'Pediatrics', '', '', NULL, 'O', '675 W Central Rd  Ste 101', 'Arlington Heights ', 'Cook', 'IL', '60005', '8473421554', NULL, '675 W Central Rd  Ste 101', 'Arlington Heights ', 'Cook', 'IL', '60005', '8473421554', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1831320621', 0, 'N', 0, '2014-01-10', NULL, NULL, 42.0662, -87.9908, NULL, NULL),
('363317058', 'EDM000132', 'EDM000132', 'ILCHIGSTD', 'Access Centro Medico', 'Sloan', '', 'Metz', 'DPM', 'Podiatry', '', '', NULL, 'O', '3700 W 26th St', 'Chicago ', 'Cook', 'IL', '60623', '7735425203', NULL, '3700 W 26th St', 'Chicago ', 'Cook', 'IL', '60623', '7735425203', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1851385553', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8445, -87.7176, NULL, NULL),
('363317058', 'EDM000212', 'EDM000212', 'ILCHIGSTD', 'Access Servicios Medicos La Villita', 'Marni', '', 'Wichman', 'PA', 'Family Practice', '', '', NULL, 'O', '3303 W 26th St', 'Chicago ', 'Cook', 'IL', '60623', '7732776589', NULL, '3303 W 26th St', 'Chicago ', 'Cook', 'IL', '60623', '7732776589', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851450100', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.8445, -87.7076, NULL, NULL),
('363317058', 'EDM000070', 'EDM000070', 'ILCHIGSTD', 'Access Madison Family Health Center ', 'Raja', '', 'Gill', 'MD', 'Psychiatry', '', '', NULL, 'O', '3800 W Madison ', 'Chicago ', 'Cook', 'IL', '60624', '7738266600', NULL, '3800 W Madison ', 'Chicago ', 'Cook', 'IL', '60624', '7738266600', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851540165', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.8811, -87.7211, NULL, NULL),
('363317058', 'EDM000108', 'EDM000108', 'ILCHIGSTD', 'Access Kling Professional Building', 'Girija', '', 'Kumar', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2720 W 15th St 4th Fl', 'Chicago ', 'Cook', 'IL', '60608', '7732576730', NULL, '2720 W 15th St 4th Fl', 'Chicago ', 'Cook', 'IL', '60608', '7732576730', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861486250', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8612, -87.6941, NULL, NULL),
('363317058', 'EDM000096', 'EDM000096', 'ILCHIGSTD', 'Access Holy Cross', 'Andrea', 'D', 'Jones', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2701 W 68th St', 'Chicago ', 'Cook', 'IL', '60629', '7734344040', NULL, '2701 W 68th St', 'Chicago ', 'Cook', 'IL', '60629', '7734344040', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1861487423', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.7695, -87.6924, NULL, NULL),
('363317058', 'EDM000134', 'EDM000134', 'ILCHIGSTD', 'Access Cabrini Family Health Center', 'Michael', '', 'Miller', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3450 S Archer Ave ', 'Chicago ', 'Cook', 'IL', '60608', '7735231000', NULL, '3450 S Archer Ave ', 'Chicago ', 'Cook', 'IL', '60608', '7735231000', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861576043', 0, 'N', 0, '2014-01-10', NULL, NULL, 41.8313, -87.6766, NULL, NULL),
('363317058', 'EDM000052', 'EDM000052', 'ILCHIGSTD', 'Access West Chicago Family Health Center ', 'Sarah', '', 'Dennison', 'MD', 'Pediatrics', '', '', NULL, 'O', '245 W Roosevelt Rd Bldg 14', 'West Chicago ', 'Dupage', 'IL', '60185', '6302934124', NULL, '245 W Roosevelt Rd Bldg 14', 'West Chicago ', 'Dupage', 'IL', '60185', '6302934124', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861576407', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.8683, -88.2084, NULL, NULL),
('363317058', 'EDM000204', 'EDM000204', 'ILCHIGSTD', 'Access Martin Russo Family Health Center', 'Radha Krishna', '', 'Upputuri', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '245 S Gary Ave', 'Bloomingdale', 'Dupage', 'IL', '60108', '6308935230', NULL, '245 S Gary Ave', 'Bloomingdale', 'Dupage', 'IL', '60108', '6308935230', '          ', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871514315', 0, 'Y', 0, '2014-01-10', NULL, NULL, 41.9432, -88.1196, NULL, NULL),
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('201435671', 'W12026771', 'W12026771', 'TXHOUSTD', 'Diabetes America', '', '', 'Diabetes America', '', 'Endocrinology', '', '', NULL, 'O', '6420 N MacArthur Blvd Ste 130 ', 'Irving', 'Dallas', 'TX', '75039', '8666934223', '8882377954', '6420 N MacArthur Blvd Ste 130 ', 'Irving', 'Dallas', 'TX', '75039', '8666934223', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457396905', 0, 'Y', 0, '2013-06-13', NULL, NULL, 32.8961, -96.9587, NULL, NULL),
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('201435671', 'W12026775', 'W12026775', 'TXHOUSTD', 'Diabetes America', '', '', 'Diabetes America', '', 'Endocrinology', '', '', NULL, 'O', '9473 FM 1960 Bypass Ste 300', 'Humble', 'Harris', 'TX', '77338', '8322373500', '8882377954', '9473 FM 1960 Bypass Ste 300', 'Humble', 'Harris', 'TX', '77338', '8322373500', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457396905', 0, 'Y', 0, '2013-06-13', NULL, NULL, 30.005, -95.2823, NULL, NULL),
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('201435671', 'W12026782', 'W12026782', 'TXHOUSTD', 'Diabetes America', 'Cheryl', '', 'Winter', 'FNP', 'Endocrinology', '', '', NULL, 'O', '17937 I-45 Ste 115', 'Shenandoah', 'Montgomery', 'TX', '77385', '8322373500', '8882377954', '17937 I-45 Ste 115', 'Shenandoah', 'Montgomery', 'TX', '77385', '8322373500', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215075825', 0, 'N', 0, '2012-12-14', NULL, NULL, 30.1963, -95.4539, NULL, NULL),
('201435671', 'W12026786', 'W12026786', 'TXHOUSTD', 'Diabetes America', 'Lloyd', '', 'Weddington', 'MD', 'Endocrinology', '', '', NULL, 'B', '13171 Misty Willow Dr', 'Houston', 'Harris', 'TX', '77070', '8322373500', '8882377954', '13171 Misty Willow Dr', 'Houston', 'Harris', 'TX', '77070', '8322373500', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-05-05', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043288418', 0, 'N', 0, '2013-04-18', NULL, NULL, 0, 0, NULL, NULL),
('201435671', 'W12026785', 'W12026785', 'TXHOUSTD', 'Diabetes America', 'Lloyd', '', 'Weddington', 'MD', 'Endocrinology', '', '', NULL, 'O', '9473 FM 1960 Bypass Ste 300', 'Humble', 'Harris', 'TX', '77338', '8322373500', '8882377954', '9473 FM 1960 Bypass Ste 300', 'Humble', 'Harris', 'TX', '77338', '8322373500', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2014-02-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043288418', 0, 'N', 0, '2014-02-14', NULL, NULL, 30.0016, -95.2799, NULL, NULL),
('201435671', 'W12026788', 'W12026788', 'TXHOUSTD', 'Diabetes America', 'Shivani', '', 'Toma', 'MD', 'Endocrinology', '', '', NULL, 'B', '13171 Misty Willow Dr', 'Houston', 'Harris', 'TX', '77070', '8322373500', '8882377954', '13171 Misty Willow Dr', 'Houston', 'Harris', 'TX', '77070', '8322373500', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-05-05', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063621175', 0, 'N', 0, '2013-07-29', NULL, NULL, 0, 0, NULL, NULL),
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('201435671', 'W12026792', 'W12026792', 'TXHOUSTD', 'Diabetes America', 'Susan', '', 'Sanders', 'MD', 'Endocrinology', '', '', NULL, 'B', '13171 Misty Willow Dr', 'Houston', 'Harris', 'TX', '77070', '8322373500', '8882377954', '13171 Misty Willow Dr', 'Houston', 'Harris', 'TX', '77070', '8322373500', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-02-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124219316', 0, 'N', 0, '2013-04-16', NULL, NULL, 0, 0, NULL, NULL),
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('201435671', 'W12026795', 'W12026795', 'TXHOUSTD', 'Diabetes America', 'Charles', '', 'Reasner II', 'MD', 'Endocrinology', '', '', NULL, 'B', '13171 Misty Willow Dr', 'Houston', 'Harris', 'TX', '77070', '8322373500', '8882377954', '13171 Misty Willow Dr', 'Houston', 'Harris', 'TX', '77070', '8322373500', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-05-05', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275543886', 0, 'N', 0, '2013-05-10', NULL, NULL, 0, 0, NULL, NULL),
('201435671', 'W12026794', 'W12026794', 'TXHOUSTD', 'Diabetes America', 'Charles', '', 'Reasner II', 'MD', 'Endocrinology', '', '', NULL, 'O', '20330 S Huebner Rd Ste 104', 'San Antonio', 'Bexar', 'TX', '78258', '8322373500', '8882377954', '20330 S Huebner Rd Ste 104', 'San Antonio', 'Bexar', 'TX', '78258', '8322373500', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275543886', 0, 'N', 0, '2013-05-10', NULL, NULL, 29.6121, -98.491, NULL, NULL);
