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
('741880422', 'W12045295', 'W12045295', 'TXSATSTD', 'Colon and Rectal Surgical Associates of San Antonio', 'Michael', 'A', 'Keller', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'B', 'PO Box 1536', 'San Antonio', 'Bexar', 'TX', '78295', '2106143069', '0000000000', 'PO Box 1536', 'San Antonio', 'Bexar', 'TX', '78295', '2106143069', '0000000000', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659572824', 0, 'N', 0, '2014-03-18', NULL, NULL, 0, 0, NULL, NULL),
('362660922', 'CL0303973', 'CL0303973', 'SmartCare', 'Horizon Healthcare Associates', NULL, NULL, 'Horizon Healthcare Associates', NULL, 'Clinic', 'Nephrology', '', NULL, 'O', '19550 Governors Hwy Ste 2000', 'Flossmoor', 'Cook', 'IL', '60422', '7082063860', '7088681168', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00303973', 0, 'N', 0, NULL, NULL, NULL, 41.534, -87.6952, NULL, NULL),
('752254247', 'CL0307655', 'CL0307655', 'SmartCare', 'HeartPlace', NULL, NULL, 'HeartPlace', NULL, 'Clinic', 'Cardiovascular Disease', '', NULL, 'O', '621 N Hall St Ste 500', 'Dallas', 'Dallas', 'TX', '75246', '2148412000', '2148412015', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00307655', 0, 'N', 0, NULL, NULL, NULL, 32.7879, -96.7802, NULL, NULL),
('364115235', 'CL0303955', 'CL0303955', 'SmartCare', 'Heartland Cardiovascular Center', NULL, NULL, 'Heartland Cardiovascular Center', NULL, 'Clinic', 'Cardiology', '', NULL, 'O', '301 N Madison St Ste 207', 'Joliet', 'Will', 'IL', '60435', '8157401900', '8157233912', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00303955', 0, 'N', 0, NULL, NULL, NULL, 41.5273, -88.1346, NULL, NULL),
('751856375', 'CL0307629', 'CL0307629', 'SmartCare', 'Healthcare Clinics', NULL, NULL, 'Healthcare Clinics', NULL, 'Clinic', 'Family Practice', '', NULL, 'O', '5315 Ross Ave ', 'Dallas', 'Dallas', 'TX', '75206', '2148262151', '2148262196', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00307629', 0, 'N', 0, NULL, NULL, NULL, 32.8096, -96.7721, NULL, NULL),
('272559167', 'CL0311785', 'CL0311785', 'SmartCare', 'Heart and Vascular Institute of Texas', NULL, NULL, 'Heart and Vascular Institute of Texas', NULL, 'Clinic', 'Cardiovascular Disease', '', NULL, 'O', '1933 NE Loop 410 ', 'San Antonio', 'Bexar', 'TX', '78217', '2108046000', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00311785', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('272559167', 'CL0311792', 'CL0311792', 'SmartCare', 'Heart and Vascular Institute of Texas', NULL, NULL, 'Heart and Vascular Institute of Texas', NULL, 'Clinic', 'Cardiovascular Disease', '', NULL, 'O', '21 Spurs Ln ', 'San Antonio', 'Bexar', 'TX', '78240', '2108046000', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00311792', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('752674367', 'CL0307622', 'CL0307622', 'SmartCare', 'Healthcare Associates of Irving', NULL, NULL, 'Healthcare Associates of Irving', NULL, 'Clinic', 'Family Practice', '', NULL, 'O', '1110 Cottonwood Ln Ste L100', 'Irving', 'Dallas', 'TX', '75038', '9722587499', '9722558922', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00307622', 0, 'N', 0, NULL, NULL, NULL, 32.8652, -96.9601, NULL, NULL),
('202148889', 'CL0311759', 'CL0311759', 'SmartCare', 'Health Texas Medical Group of San Antonio', NULL, NULL, 'Health Texas Medical Group of San Antonio', NULL, 'Clinic', 'Internal Medicine', '', NULL, 'O', '8542 Wurzbach Rd ', 'San Antonio', 'Bexar', 'TX', '78240', '2106167300', '2106167359', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00311759', 0, 'N', 0, NULL, NULL, NULL, 29.5207, -98.5727, NULL, NULL),
('203768194', 'CL0309549', 'CL0309549', 'SmartCare', 'Healing Hearts Clinic', NULL, NULL, 'Healing Hearts Clinic', NULL, 'Clinic', 'Cardiovascular Disease', '', NULL, 'O', '116 Medical Park Ln Ste A2', 'Huntsville', 'Walker', 'TX', '77340', '9364419680', '9365399685', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00309549', 0, 'N', 0, NULL, NULL, NULL, 30.7099, -95.5613, NULL, NULL),
('203768194', 'CL0309548', 'CL0309548', 'SmartCare', 'Healing Hearts Clinic', NULL, NULL, 'Healing Hearts Clinic', NULL, 'Clinic', 'Cardiovascular Disease', '', NULL, 'O', '100 Medical Ctr Blvd Ste 200', 'Conroe', 'Montgomery', 'TX', '77304', '9364419680', '9365399685', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00309548', 0, 'N', 0, NULL, NULL, NULL, 30.2879, -95.4628, NULL, NULL),
('741850643', 'CL0311728', 'CL0311728', 'SmartCare', 'General Surgical Associates', NULL, NULL, 'General Surgical Associates', NULL, 'Clinic', 'General Surgery', '', NULL, 'O', '8042 Wurzbach Rd Ste 310', 'San Antonio', 'Bexar', 'TX', '78229', '2106145113', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00311728', 0, 'N', 0, NULL, NULL, NULL, 29.514, -98.5778, NULL, NULL),
('741850643', 'CL0311727', 'CL0311727', 'SmartCare', 'General Surgical Associates', NULL, NULL, 'General Surgical Associates', NULL, 'Clinic', 'General Surgery', '', NULL, 'O', '225 E Sonterra Blvd Ste 217', 'San Antonio', 'Bexar', 'TX', '78258', '2106145113', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00311727', 0, 'N', 0, NULL, NULL, NULL, 29.6164, -98.492, NULL, NULL),
('741967809', 'CL0311709', 'CL0311709', 'SmartCare', 'Gastroenterology Consultants of San Antonio', NULL, NULL, 'Gastroenterology Consultants of San Antonio', NULL, 'Clinic', 'Gastroenterology', '', NULL, 'O', '8214 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78229', '2106141234', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00311709', 0, 'N', 0, NULL, NULL, NULL, 29.5161, -98.5763, NULL, NULL),
('741967809', 'CL0311710', 'CL0311710', 'SmartCare', 'Gastroenterology Consultants of San Antonio', NULL, NULL, 'Gastroenterology Consultants of San Antonio', NULL, 'Clinic', 'Gastroenterology', '', NULL, 'O', '855 Proton Rd ', 'San Antonio', 'Bexar', 'TX', '78258', '2106141234', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00311710', 0, 'N', 0, NULL, NULL, NULL, 29.6121, -98.4806, NULL, NULL),
('760194878', 'CL0309520', 'CL0309520', 'SmartCare', 'Gastroenterology Consultants', NULL, NULL, 'Gastroenterology Consultants', NULL, 'Clinic', 'Gastroenterology', '', NULL, 'O', '444 FM 1959 Ste A', 'Houston', 'Harris', 'TX', '77034', '2814819400', '2814818528', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00309520', 0, 'N', 0, NULL, NULL, NULL, 29.5965, -95.1791, NULL, NULL),
('760194878', 'CL0309518', 'CL0309518', 'SmartCare', 'Gastroenterology Consultants', NULL, NULL, 'Gastroenterology Consultants', NULL, 'Clinic', 'Gastroenterology', '', NULL, 'O', '250 Blossom Ste 210', 'Webster', 'Harris', 'TX', '77598', '2814819400', '2814819490', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00309518', 0, 'N', 0, NULL, NULL, NULL, 29.5436, -95.126, NULL, NULL),
('760194878', 'CL0309517', 'CL0309517', 'SmartCare', 'Gastroenterology Consultants', NULL, NULL, 'Gastroenterology Consultants', NULL, 'Clinic', 'Gastroenterology', '', NULL, 'O', '2060 Space Park Dr Ste 409', 'Nassau Bay', 'Harris', 'TX', '77058', '2814819400', '2814819490', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00309517', 0, 'N', 0, NULL, NULL, NULL, 29.5482, -95.0867, NULL, NULL),
('760194878', 'CL0309516', 'CL0309516', 'SmartCare', 'Gastroenterology Consultants', NULL, NULL, 'Gastroenterology Consultants', NULL, 'Clinic', 'Gastroenterology', '', NULL, 'O', '10905 Memorial Hermann Ste 211', 'Pearland', 'Brazoria', 'TX', '77584', '2814819400', '2814819490', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00309516', 0, 'N', 0, NULL, NULL, NULL, 29.5603, -95.3892, NULL, NULL),
('752509430', 'CL0307480', 'CL0307480', 'SmartCare', 'Fort Worth Pediatrics', NULL, NULL, 'Fort Worth Pediatrics', NULL, 'Clinic', 'Pediatrics', '', NULL, 'O', '6401 Harris Pkwy Ste 100', 'Fort Worth', 'Tarrant', 'TX', '76132', '8173462525', '8172941692', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00307480', 0, 'N', 0, NULL, NULL, NULL, 32.6567, -97.4191, NULL, NULL),
('752509430', 'CL0307478', 'CL0307478', 'SmartCare', 'Fort Worth Pediatrics', NULL, NULL, 'Fort Worth Pediatrics', NULL, 'Clinic', 'Pediatrics', '', NULL, 'O', '5708 Edwards Ranch Rd', 'Fort Worth', 'Tarrant', 'TX', '76109', '8173364040', '8173366780', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00307478', 0, 'N', 0, NULL, NULL, NULL, 32.6991, -97.4118, NULL, NULL),
('752509430', 'CL0307477', 'CL0307477', 'SmartCare', 'Fort Worth Pediatrics', NULL, NULL, 'Fort Worth Pediatrics', NULL, 'Clinic', 'Pediatrics', '', NULL, 'O', '1108 S Henderson', 'Fort Worth', 'Tarrant', 'TX', '76104', '8173353255', '8173389563', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00307477', 0, 'N', 0, NULL, NULL, NULL, 32.7329, -97.3377, NULL, NULL),
('760403505', 'CL0309459', 'CL0309459', 'SmartCare', 'Foot and Ankle Center', NULL, NULL, 'Foot and Ankle Center', NULL, 'Clinic', 'Podiatry', '', NULL, 'O', '827 S Magnolia Blvd Ste 4', 'Magnolia', 'Montgomery', 'TX', '77355', '2813563780', '2813564765', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00309459', 0, 'N', 0, NULL, NULL, NULL, 30.211, -95.7538, NULL, NULL),
('760403505', 'CL0309452', 'CL0309452', 'SmartCare', 'Foot and Ankle Center', NULL, NULL, 'Foot and Ankle Center', NULL, 'Clinic', 'Podiatry', '', NULL, 'O', '8901 FM 1960 Bypass Ste 305', 'Humble', 'Harris', 'TX', '77338', '2814467773', '2814462223', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00309452', 0, 'N', 0, NULL, NULL, NULL, 30.005, -95.2895, NULL, NULL),
('751654999', 'CL0307456', 'CL0307456', 'SmartCare', 'Fort Worth Eye Associates', NULL, NULL, 'Fort Worth Eye Associates', NULL, 'Clinic', 'Ophthalmology', '', NULL, 'O', '5000 Collinwood Ave ', 'Fort Worth', 'Tarrant', 'TX', '76164', '8177325593', '8173420388', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00307456', 0, 'N', 0, NULL, NULL, NULL, 32.7377, -97.395, NULL, NULL),
('020667546', 'CL0308039', 'CL0308039', 'SmartCare', 'Forest Medical Care', NULL, NULL, 'Forest Medical Care', NULL, 'Clinic', 'Urology', '', NULL, 'O', '2046 Forest Ln ', 'Garland', 'Dallas', 'TX', '75042', '9724944497', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00308039', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('020667546', 'CL0308045', 'CL0308045', 'SmartCare', 'Forest Medical Care', NULL, NULL, 'Forest Medical Care', NULL, 'Clinic', 'Urology', '', NULL, 'B', 'PO Box 150 ', 'Rowlett', 'Dallas', 'TX', '75030', '9724944494', '9724944450', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00308045', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('760403505', 'CL0309460', 'CL0309460', 'SmartCare', 'Foot and Ankle Center', NULL, NULL, 'Foot and Ankle Center', NULL, 'Clinic', 'Podiatry', '', NULL, 'O', '17450 St Lukes Way Ste 190', 'The Woodlands', 'Montgomery', 'TX', '77384', '9362318500', '0000000000', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00309460', 0, 'N', 0, NULL, NULL, NULL, 30.1997, -95.458, NULL, NULL),
('760403505', 'CL0309458', 'CL0309458', 'SmartCare', 'Foot and Ankle Center', NULL, NULL, 'Foot and Ankle Center', NULL, 'Clinic', 'Podiatry', '', NULL, 'O', '17215 Red Oak Dr Ste 102', 'Houston', 'Harris', 'TX', '77090', '2814444114', '2814447789', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00309458', 0, 'N', 0, NULL, NULL, NULL, 30.0203, -95.4461, NULL, NULL),
('364336908', 'CL0303898', 'CL0303898', 'SmartCare', 'Foot and Ankle Associates', NULL, NULL, 'Foot and Ankle Associates', NULL, 'Clinic', 'Podiatry', '', NULL, 'O', '4650 Southwest Hwy ', 'Oak Lawn', 'Cook', 'IL', '60453', '7084243201', '7084245001', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00303898', 0, 'N', 0, NULL, NULL, NULL, 41.7247, -87.7375, NULL, NULL),
('760363583', 'CL0309437', 'CL0309437', 'SmartCare', 'Fondren Orthopedic Group', NULL, NULL, 'Fondren Orthopedic Group', NULL, 'Clinic', 'Orthopedic Surgery', '', NULL, 'O', '7401 S Main ', 'Houston', 'Harris', 'TX', '77030', '7137992300', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00309437', 0, 'N', 0, NULL, NULL, NULL, 29.7006, -95.4093, NULL, NULL),
('760363583', 'CL0309423', 'CL0309423', 'SmartCare', 'Fondren Orthopedic Group', NULL, NULL, 'Fondren Orthopedic Group', NULL, 'Clinic', 'Orthopedic Surgery', '', NULL, 'O', '601 Rockmead Dr ', 'Kingwood', 'Harris', 'TX', '77339', '2813595115', '0000000000', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00309423', 0, 'N', 0, NULL, NULL, NULL, 30.0533, -95.2449, NULL, NULL),
('911982510', 'CL0307437', 'CL0307437', 'SmartCare', 'Family Medical Center at Terrell', NULL, NULL, 'Family Medical Center at Terrell', NULL, 'Clinic', 'Family Practice', '', NULL, 'O', '200 N Virginia St ', 'Terrell', 'Kaufman', 'TX', '75160', '9725517500', '9725247418', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00307437', 0, 'N', 0, NULL, NULL, NULL, 32.7372, -96.2749, NULL, NULL),
('760363583', 'CL0309422', 'CL0309422', 'SmartCare', 'Fondren Orthopedic Group', NULL, NULL, 'Fondren Orthopedic Group', NULL, 'Clinic', 'Orthopedic Surgery', '', NULL, 'O', '18411 W Lake Houston Pkwy Ste 550', 'Humble', 'Montgomery', 'TX', '77382', '2813123820', '2813592816', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00309422', 0, 'N', 0, NULL, NULL, NULL, 29.985, -95.1616, NULL, NULL),
('760363583', 'CL0309413', 'CL0309413', 'SmartCare', 'Fondren Orthopedic Group', NULL, NULL, 'Fondren Orthopedic Group', NULL, 'Clinic', 'Orthopedic Surgery', '', NULL, 'O', '520 Blossom ', 'Webster', 'Harris', 'TX', '77598', '2813329537', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00309413', 0, 'N', 0, NULL, NULL, NULL, 29.5413, -95.1292, NULL, NULL),
('752536818', 'CL0307424', 'CL0307424', 'SmartCare', 'Family Medical Center at Garland', NULL, NULL, 'Family Medical Center at Garland', NULL, 'Clinic', 'Family Practice', '', NULL, 'O', '601 Clara Barton Blvd Ste 140', 'Garland', 'Dallas', 'TX', '75042', '9722726561', '9722763067', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00307424', 0, 'N', 0, NULL, NULL, NULL, 32.9175, -96.662, NULL, NULL),
('752536818', 'CL0307432', 'CL0307432', 'SmartCare', 'Family Medical Center at North Garland', NULL, NULL, 'Family Medical Center at North Garland', NULL, 'Clinic', 'Family Practice', '', NULL, 'O', '5345 N George Bush Fwy ', 'Garland', 'Dallas', 'TX', '75040', '9724955888', '9724950588', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00307432', 0, 'N', 0, NULL, NULL, NULL, 32.9651, -96.6418, NULL, NULL),
('752536818', 'CL0307418', 'CL0307418', 'SmartCare', 'Family Medical Center at Baylor', NULL, NULL, 'Family Medical Center at Baylor', NULL, 'Clinic', 'Family Practice', '', NULL, 'O', '3600 Gaston Ave Barnett Tower Ste 1109', 'Dallas', 'Dallas', 'TX', '75246', '2148208300', '2148208313', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00307418', 0, 'N', 0, NULL, NULL, NULL, 32.7913, -96.7799, NULL, NULL),
('364346917', 'CL0303886', 'CL0303886', 'SmartCare', 'Family Christian Health Center', NULL, NULL, 'Family Christian Health Center', NULL, 'Clinic', 'Family Practice', '', NULL, 'O', '31 W 155th St ', 'Harvey', 'Cook', 'IL', '60426', '7085965177', '7083393583', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00303886', 0, 'N', 0, NULL, NULL, NULL, 41.6081, -87.6581, NULL, NULL),
('760304308', 'CL0309346', 'CL0309346', 'SmartCare', 'Eye Excellence', NULL, NULL, 'Eye Excellence', NULL, 'Clinic', 'Optometry', '', NULL, 'O', '6624 Fannin Ste 2105', 'Houston', 'Harris', 'TX', '77030', '7137919494', '7137950524', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00309346', 0, 'N', 0, NULL, NULL, NULL, 29.7096, -95.4011, NULL, NULL),
('760549217', 'CL0306519', 'CL0306519', 'SmartCare', 'Eye Centers of Southeast Texas', NULL, NULL, 'Eye Centers of Southeast Texas', NULL, 'Clinic', 'Ophthalmology', '', NULL, 'O', '3345 Plaza 10 Dr Ste B', 'Beaumont', 'Jefferson', 'TX', '77707', '4098330444', '4098339039', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00306519', 0, 'N', 0, NULL, NULL, NULL, 30.0782, -94.1369, NULL, NULL),
('850246856', 'CL0306005', 'CL0306005', 'SmartCare', 'Eye Associates of New Mexico', NULL, NULL, 'Eye Associates of New Mexico', NULL, 'Clinic', 'Ophthalmology', '', NULL, 'O', '5757 Harper Dr NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058885757', '5058893589', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00306005', 0, 'N', 0, NULL, NULL, NULL, 35.1517, -106.584, NULL, NULL),
('850246856', 'CL0306009', 'CL0306009', 'SmartCare', 'Eye Associates of New Mexico', NULL, NULL, 'Eye Associates of New Mexico', NULL, 'Clinic', 'Ophthalmology', '', NULL, 'O', '806 Dr Martin Luther King Jr Ave, NE ', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5058426575', '5052433475', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00306009', 0, 'N', 0, NULL, NULL, NULL, 35.0853, -106.638, NULL, NULL),
('760684453', 'CL0309341', 'CL0309341', 'SmartCare', 'Eye Center of Texas', NULL, NULL, 'Eye Center of Texas', NULL, 'Clinic', 'Optometry', '', NULL, 'O', '6565 W Loop S Ste 650', 'Bellaire', 'Harris', 'TX', '77401', '7137971010', '7133577276', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00309341', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('850246856', 'CL0306007', 'CL0306007', 'SmartCare', 'Eye Associates of New Mexico', NULL, NULL, 'Eye Associates of New Mexico', NULL, 'Clinic', 'Ophthalmology', '', NULL, 'O', '5200 Eubank Blvd NE A4', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052984419', '5052980878', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00306007', 0, 'N', 0, NULL, NULL, NULL, 35.1381, -106.533, NULL, NULL),
('363114403', 'CL0303864', 'CL0303864', 'SmartCare', 'Eye Associates', NULL, NULL, 'Eye Associates', NULL, 'Clinic', 'Ophthalmology', '', NULL, 'O', '7447 W Talcott Ave Ste 300', 'Chicago', 'Cook', 'IL', '60631', '7737750811', '7737750818', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00303864', 0, 'N', 0, NULL, NULL, NULL, 41.9887, -87.8131, NULL, NULL),
('364121175', 'CL0303854', 'CL0303854', 'SmartCare', 'ENT Surgical Consultants  ', NULL, NULL, 'ENT Surgical Consultants  ', NULL, 'Clinic', 'Ear, Nose and Throat', '', NULL, 'O', '2201 Glenwood Ave', 'Joliet', 'Will', 'IL', '60435', '8157251191', '8157252048', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00303854', 0, 'N', 0, NULL, NULL, NULL, 41.5296, -88.1347, NULL, NULL),
('742145952', 'CL0311680', 'CL0311680', 'SmartCare', 'Endocrinology-Nuclear Medicine Associates', NULL, NULL, 'Endocrinology-Nuclear Medicine Associates', NULL, 'Clinic', 'Endocrinology', '', NULL, 'O', '1303 McCullough Ave Ste 374', 'San Antonio', 'Bexar', 'TX', '78212', '2102235483', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00311680', 0, 'N', 0, NULL, NULL, NULL, 29.4407, -98.4918, NULL, NULL),
('752536818', 'CL0307402', 'CL0307402', 'SmartCare', 'Endocrinology Specialists of North Texas', NULL, NULL, 'Endocrinology Specialists of North Texas', NULL, 'Clinic', 'Endocrinology', '', NULL, 'O', '910 N Central Expwy ', 'Dallas', 'Dallas', 'TX', '75204', '2148236435', '2148234675', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00307402', 0, 'N', 0, NULL, NULL, NULL, 32.79, -96.7917, NULL, NULL),
('208369279', 'CL0308873', 'CL0308873', 'SmartCare', 'EMC Your Private ER', NULL, NULL, 'EMC Your Private ER', NULL, 'Clinic', 'Obstetrics and Gynecology', '', NULL, 'O', '8245 Precinct Line Rd Ste 100', 'N Richland Hills', 'Tarrant', 'TX', '76182', '8175038800', '8175038801', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00308873', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('134244739', 'CL0309329', 'CL0309329', 'SmartCare', 'Endocrine and Psychiatry Center', NULL, NULL, 'Endocrine and Psychiatry Center', NULL, 'Clinic', 'Endocrinology', '', NULL, 'O', '9539 Huffmeister Rd ', 'Houston', 'Harris', 'TX', '77095', '8325938100', '8325938105', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00309329', 0, 'N', 0, NULL, NULL, NULL, 29.916, -95.6306, NULL, NULL),
('364037473', 'CL0303820', 'CL0303820', 'SmartCare', 'Elmhurst Memorial Hematology Oncology Services', NULL, NULL, 'Elmhurst Memorial Hematology Oncology Services', NULL, 'Clinic', 'Oncology', '', NULL, 'O', '1200 S York Rd Ste 3280', 'Elmhurst', 'Dupage', 'IL', '60126', '6307588640', '6307588642', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00303820', 0, 'N', 0, NULL, NULL, NULL, 41.865, -87.9322, NULL, NULL),
('364079642', 'CL0303839', 'CL0303839', 'SmartCare', 'Elmhurst Orthopaedics', NULL, NULL, 'Elmhurst Orthopaedics', NULL, 'Clinic', 'Orthopedic Surgery', '', NULL, 'O', '300 W Butterfield Rd ', 'Elmhurst', 'Dupage', 'IL', '60126', '6308340491', '6309097001', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00303839', 0, 'N', 0, NULL, NULL, NULL, 41.8661, -87.9484, NULL, NULL),
('364037473', 'CL0303809', 'CL0303809', 'SmartCare', 'Elmhurst Medical Associates', NULL, NULL, 'Elmhurst Medical Associates', NULL, 'Clinic', 'Internal Medicine', '', NULL, 'O', '183 Addison Ave ', 'Elmhurst', 'Dupage', 'IL', '60126', '3312210000', '3312213991', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00303809', 0, 'N', 0, NULL, NULL, NULL, 41.9029, -87.9416, NULL, NULL),
('364037473', 'CL0303747', 'CL0303747', 'SmartCare', 'Elmhurst Clinic', NULL, NULL, 'Elmhurst Clinic', NULL, 'Clinic', 'Family Practice', '', NULL, 'O', '471 W Army Trail Ste 103', 'Bloomingdale', 'Dupage', 'IL', '60108', '6306718020', '6305100235', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00303747', 0, 'N', 0, NULL, NULL, NULL, 41.9396, -88.1216, NULL, NULL),
('364037473', 'CL0303799', 'CL0303799', 'SmartCare', 'Elmhurst Clinic', NULL, NULL, 'Elmhurst Clinic', NULL, 'Clinic', 'Family Practice', '', NULL, 'O', '303 W Lake St Ste 200', 'Addison', 'Dupage', 'IL', '60101', '3312219002', '6308331690', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00303799', 0, 'N', 0, NULL, NULL, NULL, 41.9356, -87.9965, NULL, NULL),
('364037473', 'CL0303792', 'CL0303792', 'SmartCare', 'Elmhurst Clinic', NULL, NULL, 'Elmhurst Clinic', NULL, 'Clinic', 'Family Practice', '', NULL, 'O', '155 E Brush Hill Rd ', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412600', '6309412632', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00303792', 0, 'N', 0, NULL, NULL, NULL, 41.8595, -87.9514, NULL, NULL),
('364037473', 'CL0303800', 'CL0303800', 'SmartCare', 'Elmhurst Clinic', NULL, NULL, 'Elmhurst Clinic', NULL, 'Clinic', 'Family Practice', '', NULL, 'O', '172 Schiller ', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412638', '6309412642', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00303800', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('364037473', 'CL0303798', 'CL0303798', 'SmartCare', 'Elmhurst Clinic', NULL, NULL, 'Elmhurst Clinic', NULL, 'Clinic', 'Family Practice', '', NULL, 'O', '1200 S York Rd ', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412633', '6307588578', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00303798', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('364037473', 'CL0303797', 'CL0303797', 'SmartCare', 'Elmhurst Clinic', NULL, NULL, 'Elmhurst Clinic', NULL, 'Clinic', 'Family Practice', '', NULL, 'O', '1200 S York Rd Ste 2000', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412609', '6307588574', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00303797', 0, 'N', 0, NULL, NULL, NULL, 41.865, -87.9322, NULL, NULL),
('364037473', 'CL0303794', 'CL0303794', 'SmartCare', 'Elmhurst Clinic', NULL, NULL, 'Elmhurst Clinic', NULL, 'Clinic', 'Family Practice', '', NULL, 'O', '130 S Main St ', 'Lombard', 'Dupage', 'IL', '60148', '6306524200', '6306524222', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00303794', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('364037473', 'CL0303795', 'CL0303795', 'SmartCare', 'Elmhurst Clinic', NULL, NULL, 'Elmhurst Clinic', NULL, 'Clinic', 'Family Practice', '', NULL, 'O', '133 E Brush Hill Rd Ste 310', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412608', '6309412642', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00303795', 0, 'N', 0, NULL, NULL, NULL, 41.8616, -87.9371, NULL, NULL),
('364037473', 'CL0303743', 'CL0303743', 'SmartCare', 'Elmhurst Clinic', NULL, NULL, 'Elmhurst Clinic', NULL, 'Clinic', 'Family Practice', '', NULL, 'O', '1100 Lake St Ste 230', 'Oak Park', 'Cook', 'IL', '60301', '7085241420', '7085241509', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00303743', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('197328116', 'CL0308867', 'CL0308867', 'SmartCare', 'Edward H Gilbert MD', NULL, NULL, 'Edward H Gilbert MD', NULL, 'Clinic', 'Obstetrics and Gynecology', '', NULL, 'B', 'PO Box 26706 Section 91 ', 'Oklahoma City', 'Oklahoma', 'TX', '73126', '4693647888', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00308867', 0, 'N', 0, NULL, NULL, NULL, 32.9333, -97.0916, NULL, NULL),
('197328116', 'CL0308869', 'CL0308869', 'SmartCare', 'Edward H Gilbert MD', NULL, NULL, 'Edward H Gilbert MD', NULL, 'Clinic', 'Obstetrics and Gynecology', '', NULL, 'O', '6957 W Plano Pkwy Ste 1300', 'Plano', 'Collin', 'TX', '75093', '4693647888', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00308869', 0, 'N', 0, NULL, NULL, NULL, 32.9333, -97.0916, NULL, NULL),
('197328116', 'CL0308871', 'CL0308871', 'SmartCare', 'Edward H Gilbert MD', NULL, NULL, 'Edward H Gilbert MD', NULL, 'Clinic', 'Obstetrics and Gynecology', '', NULL, 'O', '12606 Greenville Ave Ste 160', 'Dallas', 'Dallas', 'TX', '75243', '4693647880', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00308871', 0, 'N', 0, NULL, NULL, NULL, 32.9187, -96.7424, NULL, NULL),
('741895428', 'CL0311672', 'CL0311672', 'SmartCare', 'Ear Nose and Throat Clinics of San Antonio', NULL, NULL, 'Ear Nose and Throat Clinics of San Antonio', NULL, 'Clinic', 'Ear, Nose and Throat', '', NULL, 'O', '4775 Hamilton Wolfe Bldg 1', 'San Antonio', 'Bexar', 'TX', '78229', '2106141326', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00311672', 0, 'N', 0, NULL, NULL, NULL, 29.5212, -98.5815, NULL, NULL),
('200830401', 'CL0307381', 'CL0307381', 'SmartCare', 'Ear Nose and Throat Associates of Texas', NULL, NULL, 'Ear Nose and Throat Associates of Texas', NULL, 'Clinic', 'Ear, Nose and Throat', '', NULL, 'O', '6717 W Eldorado Pkwy Ste 140', 'McKinney', 'Collin', 'TX', '75070', '9727317654', '9727316226', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00307381', 0, 'N', 0, NULL, NULL, NULL, 33.1741, -96.7048, NULL, NULL),
('200830401', 'CL0307380', 'CL0307380', 'SmartCare', 'Ear Nose and Throat Associates of Texas', NULL, NULL, 'Ear Nose and Throat Associates of Texas', NULL, 'Clinic', 'Ear, Nose and Throat', '', NULL, 'O', '4716 Alliance Blvd Ste 260', 'Plano', 'Collin', 'TX', '75093', '9727317654', '9727316226', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00307380', 0, 'N', 0, NULL, NULL, NULL, 33.0145, -96.7926, NULL, NULL),
('200830401', 'CL0307379', 'CL0307379', 'SmartCare', 'Ear Nose and Throat Associates of Texas', NULL, NULL, 'Ear Nose and Throat Associates of Texas', NULL, 'Clinic', 'Ear, Nose and Throat', '', NULL, 'O', '4401 Coit Rd Ste 411', 'Frisco', 'Collin', 'TX', '75035', '9727317654', '9727316226', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00307379', 0, 'N', 0, NULL, NULL, NULL, 33.1129, -96.7682, NULL, NULL),
('364088232', 'CL0303632', 'CL0303632', 'SmartCare', 'Dreyer Medical Clinic', NULL, NULL, 'Dreyer Medical Clinic', NULL, 'Clinic', 'Family Practice', '', NULL, 'O', '82 Miller Dr Ste 102', 'North Aurora', 'Kane', 'IL', '60542', '6308976044', '6308970180', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00303632', 0, 'N', 0, NULL, NULL, NULL, 41.805, -88.352, NULL, NULL),
('364088232', 'CL0303617', 'CL0303617', 'SmartCare', 'Dreyer Medical Clinic', NULL, NULL, 'Dreyer Medical Clinic', NULL, 'Clinic', 'Family Practice', '', NULL, 'O', '80 Templeton Dr ', 'Oswego', 'Kendall', 'IL', '60543', '6305543456', '6305512933', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00303617', 0, 'N', 0, NULL, NULL, NULL, 41.6724, -88.3381, NULL, NULL),
('364088232', 'CL0303615', 'CL0303615', 'SmartCare', 'Dreyer Medical Clinic', NULL, NULL, 'Dreyer Medical Clinic', NULL, 'Clinic', 'Family Practice', '', NULL, 'O', '4100 Healthway Dr ', 'Aurora', 'Dupage', 'IL', '60504', '6308513105', '6309786690', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00303615', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'CL0303633', 'CL0303633', 'SmartCare', 'Dreyer Medical Clinic', NULL, NULL, 'Dreyer Medical Clinic', NULL, 'Clinic', 'Family Practice', '', NULL, 'O', '2500 W Fabyan Pkwy ', 'Batavia', 'Kane', 'IL', '60510', '6308792110', '6307624779', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00303633', 0, 'N', 0, NULL, NULL, NULL, 41.8633, -88.269, NULL, NULL),
('364088232', 'CL0303627', 'CL0303627', 'SmartCare', 'Dreyer Medical Clinic', NULL, NULL, 'Dreyer Medical Clinic', NULL, 'Clinic', 'Family Practice', '', NULL, 'O', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00303627', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'CL0303630', 'CL0303630', 'SmartCare', 'Dreyer Medical Clinic', NULL, NULL, 'Dreyer Medical Clinic', NULL, 'Clinic', 'Family Practice', '', NULL, 'O', '2040 Ogden Ave Ste 605', 'Aurora', 'Dupage', 'IL', '60504', '6305857100', '6306924005', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00303630', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'CL0303624', 'CL0303624', 'SmartCare', 'Dreyer Medical Clinic', NULL, NULL, 'Dreyer Medical Clinic', NULL, 'Clinic', 'Family Practice', '', NULL, 'O', '2040 Ogden Ave ', 'Aurora', 'Dupage', 'IL', '60504', '6305857100', '6306924057', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00303624', 0, 'N', 0, NULL, NULL, NULL, 41.7282, -88.2677, NULL, NULL),
('364088232', 'CL0303634', 'CL0303634', 'SmartCare', 'Dreyer Medical Clinic', NULL, NULL, 'Dreyer Medical Clinic', NULL, 'Clinic', 'Family Practice', '', NULL, 'O', '2040 Ogden Ave Ste 401', 'Aurora', 'Dupage', 'IL', '60504', '6305857100', '6306924057', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00303634', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'CL0303631', 'CL0303631', 'SmartCare', 'Dreyer Medical Clinic', NULL, NULL, 'Dreyer Medical Clinic', NULL, 'Clinic', 'Family Practice', '', NULL, 'O', '1870 W Galena Blvd ', 'Aurora', 'Kane', 'IL', '60506', '6308596700', '6308596811', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00303631', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'CL0303629', 'CL0303629', 'SmartCare', 'Dreyer Medical Clinic', NULL, NULL, 'Dreyer Medical Clinic', NULL, 'Clinic', 'Family Practice', '', NULL, 'O', '1221 N Highland Ave ', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648828', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00303629', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'CL0303603', 'CL0303603', 'SmartCare', 'Dreyer Medical Clinic', NULL, NULL, 'Dreyer Medical Clinic', NULL, 'Clinic', 'Family Practice', '', NULL, 'O', '1500 Sycamore Rd ', 'Yorkville', 'Kendall', 'IL', '60560', '6305534470', '6303017616', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00303603', 0, 'N', 0, NULL, NULL, NULL, 41.6572, -88.4372, NULL, NULL),
('561599929', 'CL0303348', 'CL0303348', 'SmartCare', 'Dolton Medical Group', NULL, NULL, 'Dolton Medical Group', NULL, 'Clinic', 'Internal Medicine', '', NULL, 'O', '1851 Sibley Blvd ', 'Calumet City', 'Cook', 'IL', '60409', '7088682300', '7088682304', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00303348', 0, 'N', 0, NULL, NULL, NULL, 41.6225, -87.5702, NULL, NULL),
('752845381', 'CL0307348', 'CL0307348', 'SmartCare', 'Doctors of Internal Medicine', NULL, NULL, 'Doctors of Internal Medicine', NULL, 'Clinic', 'Internal Medicine', '', NULL, 'O', '5941 Dallas Pkwy ', 'Plano', 'Collin', 'TX', '75093', '9727584455', '9727584433', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00307348', 0, 'N', 0, NULL, NULL, NULL, 33.054, -96.8303, NULL, NULL),
('205294327', 'CL0301904', 'CL0301904', 'SmartCare', 'Digestive Health Clinic ', NULL, NULL, 'Digestive Health Clinic ', NULL, 'Clinic', 'Gastroenterology', '', NULL, 'O', '6259 W Emerald St ', 'Boise', 'Ada', 'ID', '83704', '2084891900', '2083755286', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00301904', 0, 'N', 0, NULL, NULL, NULL, 43.6114, -116.259, NULL, NULL),
('010593260', 'CL0309303', 'CL0309303', 'SmartCare', 'Digestive and Liver Specialists of Houston', NULL, NULL, 'Digestive and Liver Specialists of Houston', NULL, 'Clinic', 'Gastroenterology', '', NULL, 'O', '915 Gessner Ste 850', 'Houston', 'Harris', 'TX', '77024', '7134611026', '7134614358', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00309303', 0, 'N', 0, NULL, NULL, NULL, 29.7804, -95.5445, NULL, NULL),
('760403880', 'CL0309296', 'CL0309296', 'SmartCare', 'Digestive and Liver Disease Consultants', NULL, NULL, 'Digestive and Liver Disease Consultants', NULL, 'Clinic', 'Gastroenterology', '', NULL, 'O', '920 Medical Plaza Dr Ste 550', 'The Woodlands', 'Montgomery', 'TX', '77380', '2814400101', '2814400526', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00309296', 0, 'N', 0, NULL, NULL, NULL, 30.1728, -95.452, NULL, NULL),
('760403880', 'CL0309294', 'CL0309294', 'SmartCare', 'Digestive and Liver Disease Consultants', NULL, NULL, 'Digestive and Liver Disease Consultants', NULL, 'Clinic', 'Gastroenterology', '', NULL, 'O', '275 Lantern Bend Dr Ste 200', 'Houston', 'Harris', 'TX', '77090', '2814400101', '2814401153', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00309294', 0, 'N', 0, NULL, NULL, NULL, 30.024, -95.4355, NULL, NULL),
('760403880', 'CL0309295', 'CL0309295', 'SmartCare', 'Digestive and Liver Disease Consultants', NULL, NULL, 'Digestive and Liver Disease Consultants', NULL, 'Clinic', 'Gastroenterology', '', NULL, 'O', '18955 Memorial N Ste 500', 'Humble', 'Harris', 'TX', '77338', '2814400101', '2814400526', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00309295', 0, 'N', 0, NULL, NULL, NULL, 29.9948, -95.2752, NULL, NULL),
('201435671', 'CL0309266', 'CL0309266', 'SmartCare', 'Diabetes America', NULL, NULL, 'Diabetes America', NULL, 'Clinic', 'Endocrinology', '', NULL, 'O', '20330 S Huebner Rd Ste 104', 'San Antonio', 'Bexar', 'TX', '78258', '8322373500', '8882377954', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00309266', 0, 'N', 0, NULL, NULL, NULL, 29.6121, -98.491, NULL, NULL),
('201435671', 'CL0309276', 'CL0309276', 'SmartCare', 'Diabetes America', NULL, NULL, 'Diabetes America', NULL, 'Clinic', 'Endocrinology', '', NULL, 'O', '3333 Bayshore Blvd Ste 240', 'Pasadena', 'Harris', 'TX', '77504', '8322373500', '8882377954', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00309276', 0, 'N', 0, NULL, NULL, NULL, 29.663, -95.1837, NULL, NULL),
('272844570', 'CL0307333', 'CL0307333', 'SmartCare', 'DFW Neuropathy ', NULL, NULL, 'DFW Neuropathy ', NULL, 'Clinic', 'Internal Medicine', '', NULL, 'O', '3750 S University Dr Ste 202', 'Fort Worth', 'Tarrant', 'TX', '76109', '8179241000', '8179241001', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00307333', 0, 'N', 0, NULL, NULL, NULL, 32.6953, -97.3604, NULL, NULL),
('272844570', 'CL0307334', 'CL0307334', 'SmartCare', 'DFW Neuropathy ', NULL, NULL, 'DFW Neuropathy ', NULL, 'Clinic', 'Internal Medicine', '', NULL, 'O', '6210 Campbell Rd Ste 225', 'Dallas', 'Dallas', 'TX', '75248', '9729313131', '9729313132', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00307334', 0, 'N', 0, NULL, NULL, NULL, 32.981, -96.8002, NULL, NULL),
('820496280', 'CL0301894', 'CL0301894', 'SmartCare', 'Dermatology Clinic of ID', NULL, NULL, 'Dermatology Clinic of ID', NULL, 'Clinic', 'Dermatology', '', NULL, 'O', '271 Duffers Ln ', 'Cascade', 'Valley', 'ID', '83611', '2083764777', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00301894', 0, 'N', 0, NULL, NULL, NULL, 44.5085, -116.058, NULL, NULL),
('820496280', 'CL0301893', 'CL0301893', 'SmartCare', 'Dermatology Clinic of ID', NULL, NULL, 'Dermatology Clinic of ID', NULL, 'Clinic', 'Dermatology', '', NULL, 'O', '7733 W Emerald', 'Boise', 'Ada', 'ID', '83704', '2083764776', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00301893', 0, 'N', 0, NULL, NULL, NULL, 43.6127, -116.278, NULL, NULL),
('742699861', 'W12045153', 'W12045153', 'TXSATSTD', '', 'Barrett', 'K', 'Hays', 'MD', 'Family Practice', '', '', NULL, 'O', '7500 Barlite Blvd Ste 209', 'San Antonio', 'Bexar', 'TX', '78224', '2109246556', '2109229200', '7500 Barlite Blvd Ste 209', 'San Antonio', 'Bexar', 'TX', '78224', '2109246556', '2109229200', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, '', '', 'HCFA|UB|', '1124204318', 0, 'N', 0, '2014-03-18', NULL, NULL, 0, 0, NULL, NULL),
('272761438', 'W12045148', 'W12045148', 'TXSATSTD', 'Skin Surgery of San Antonio', '', '', 'Skin Surgery of San Antonio', '', 'Dermatology', '', '', NULL, 'O', '2632 Broadway Ste 401N', 'San Antonio', 'Bexar', 'TX', '78215', '2102260040', '2102260050', '2632 Broadway Ste 401N', 'San Antonio', 'Bexar', 'TX', '78215', '2102260040', '2102260050', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-04-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568774735', 0, 'N', 0, '2014-03-04', NULL, NULL, 0, 0, NULL, NULL),
('272761438', 'W12045150', 'W12045150', 'TXSATSTD', 'Skin Surgery of San Antonio', 'Nicole', '', 'Owens', 'MD', 'Dermatology', '', '', NULL, 'O', '2632 Broadway Ste 401N', 'San Antonio', 'Bexar', 'TX', '78215', '2102260040', '2102260050', '2632 Broadway Ste 401N', 'San Antonio', 'Bexar', 'TX', '78215', '2102260040', '2102260050', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-04-03', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, '', '', 'HCFA|UB|', '1154312080', 0, 'N', 0, '2014-03-04', NULL, NULL, 0, 0, NULL, NULL),
('272761438', 'W12045151', 'W12045151', 'TXSATSTD', 'Skin Surgery of San Antonio', 'Paula', 'S', 'Vogel', 'MD', 'Dermatology', '', '', NULL, 'O', '2632 Broadway Ste 401N', 'San Antonio', 'Bexar', 'TX', '78215', '2102260040', '2102260050', '2632 Broadway Ste 401N', 'San Antonio', 'Bexar', 'TX', '78215', '2102260040', '2102260050', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-04-03', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1881678779', 0, 'N', 0, '2014-03-04', NULL, NULL, 0, 0, NULL, NULL),
('742910790', 'W12045279', 'W12045279', 'TXSATSTD', '', 'Mario', '', 'Bustamante', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '343 W Houston St Ste 406', 'San Antonio', 'Bexar', 'TX', '78205', '2102247800', '2102247501', '343 W Houston St Ste 406', 'San Antonio', 'Bexar', 'TX', '78205', '2102247800', '2102247501', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, '', '', 'HCAFA|UB|', '1972546109', 0, 'N', 0, '2014-03-18', NULL, NULL, 0, 0, NULL, NULL),
('826000422', 'W12045320', 'W12045320', 'ID02', 'Walter Knox Memorial Hospital (Recognized PPO but not contra', 'Jennifer', 'L', 'Petrie', 'MD', 'Family Practice', '', '', NULL, 'O', '1202 E Locust St', 'Emmett', 'Gem', 'ID', '83617', '2083653561', '2083654176', '1202 E Locust St', 'Emmett', 'Gem', 'ID', '83617', '2083653561', '2083654176', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2014-01-03', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1891879094', 0, 'N', 0, '2014-03-07', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('826000422', 'W12045321', 'W12045321', 'ID02', 'Walter Knox Memorial Hospital (Recognized PPO but not contra', 'Roy', 'A', 'Sternes', 'PA-C', 'Family Practice', '', '', NULL, 'O', '1202 E Locust St', 'Emmett', 'Gem', 'ID', '83617', '2083653561', '2083654176', '1202 E Locust St', 'Emmett', 'Gem', 'ID', '83617', '2083653561', '2083654176', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2014-01-03', NULL, 0, 0, 1, 'Saint Alphonsus Regional Medical Center', 'Saint Alphonsus Medical Center Nampa', '', '', 'HCFA|UB|', '1437166550', 0, 'N', 0, '2014-06-13', NULL, NULL, 0, 0, NULL, NULL),
('826000422', 'W12045322', 'W12045322', 'ID02', 'Walter Knox Memorial Hospital (Recognized PPO but not contra', 'James', '', 'Thomson', 'MD', 'Family Practice', '', '', NULL, 'O', '1202 E Locust St', 'Emmett', 'Gem', 'ID', '83617', '2083653561', '2083654176', '1202 E Locust St', 'Emmett', 'Gem', 'ID', '83617', '2083653561', '2083654176', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2014-01-03', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1760453781', 0, 'N', 0, '2014-03-07', NULL, NULL, 0, 0, NULL, NULL),
('826000422', 'W12045323', 'W12045323', 'ID02', 'Walter Knox Memorial Hospital (Recognized PPO but not contra', 'William', 'H', 'Vetter', 'MD', 'Family Practice', '', '', NULL, 'O', '1202 E Locust St', 'Emmett', 'Gem', 'ID', '83617', '2083653561', '2083654176', '1202 E Locust St', 'Emmett', 'Gem', 'ID', '83617', '2083653561', '2083654176', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2014-01-03', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1992775480', 0, 'N', 0, '2014-03-07', NULL, NULL, 0, 0, NULL, NULL),
('826000422', 'W12045324', 'W12045324', 'ID02', 'Walter Knox Memorial Hospital (Recognized PPO but not contra', 'Ryan', 'E', 'White', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'O', '1202 E Locust St', 'Emmett', 'Gem', 'ID', '83617', '2083653561', '2083654176', '1202 E Locust St', 'Emmett', 'Gem', 'ID', '83617', '2083653561', '2083654176', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2014-01-03', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1346449956', 0, 'N', 0, '2014-03-07', NULL, NULL, 0, 0, NULL, NULL),
('753134302', 'W12045326', 'W12045326', 'TXDALSTD', 'Allen Sports and Spine Care ', '', '', 'Allen Sports and Spine Care ', '', 'Physical Therapy', '', '', NULL, 'O', '1101 Raintree Cir Ste 150', 'Allen', 'Collin', 'TX', '75013', '2145090029', NULL, '1101 Raintree Cir Ste 150', 'Allen', 'Collin', 'TX', '75013', '2145090029', '          ', 'DME90TX', '', '', '0.00', '0.00', '82.00', 3, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1790772796', 0, 'N', 0, '2014-03-10', NULL, NULL, 0, 0, NULL, NULL),
('752892911', 'W12045328', 'W12045328', 'TXDALSTD', 'Las Colinas Physical Therapy', '', '', 'Las Colinas Physical Therapy', '', 'Physical Therapy', '', '', NULL, 'O', '323 E Las Colinas Blvd', 'Irving', 'Dallas', 'TX', '75039', '9724010300', NULL, '323 E Las Colinas Blvd', 'Irving', 'Dallas', 'TX', '75039', '9724010300', '          ', 'DME90TX', '', '', '0.00', '0.00', '82.00', 3, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1548257553', 0, 'N', 0, '2014-03-10', NULL, NULL, 0, 0, NULL, NULL),
('142001463', 'W12045330', 'W12045330', 'TXDALSTD', 'Orthopedia Physical Therapy', '', '', 'Orthopedia Physical Therapy', '', 'Physical Therapy', '', '', NULL, 'O', '1121 Flower Mound Rd Ste 540', 'Flower Mound', 'Denton', 'TX', '75028', '9723555200', NULL, '1121 Flower Mound Rd Ste 540', 'Flower Mound', 'Denton', 'TX', '75028', '9723555200', '          ', 'DME90TX', '', '', '0.00', '0.00', '82.00', 3, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1114110723', 0, 'N', 0, '2014-03-10', NULL, NULL, 0, 0, NULL, NULL),
('270073373', 'W12045332', 'W12045332', 'TXDALSTD', 'Pinnacle Physical Therapy', '', '', 'Pinnacle Physical Therapy', '', 'Physical Therapy', '', '', NULL, 'O', '2303 Ira E Woods', 'Grapevine', 'Tarrant', 'TX', '76051', '8173103737', NULL, '2303 Ira E Woods', 'Grapevine', 'Tarrant', 'TX', '76051', '8173103737', '          ', 'DME90TX', '', '', '0.00', '0.00', '82.00', 3, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1073500070', 0, 'N', 0, '2014-03-10', NULL, NULL, 0, 0, NULL, NULL),
('752879045', 'W12045334', 'W12045334', 'TXDALSTD', 'Southwest Sports and Spine', '', '', 'Southwest Sports and Spine', '', 'Physical Therapy', '', '', NULL, 'O', '11661 Preston Rd Ste 173', 'Dallas', 'Dallas', 'TX', '75230', '2142657200', NULL, '11661 Preston Rd Ste 173', 'Dallas', 'Dallas', 'TX', '75230', '2142657200', '          ', 'DME90TX', '', '', '0.00', '0.00', '82.00', 3, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1760479760', 0, 'N', 0, '2014-03-10', NULL, NULL, 0, 0, NULL, NULL),
('142000364', 'W12045336', 'W12045336', 'TXDALSTD', 'Katy Trail Southwest Sports and Spine', '', '', 'Katy Trail Southwest Sports and Spine', '', 'Physical Therapy', '', '', NULL, 'O', '3535 Travis St Ste 160', 'Dallas', 'Dallas', 'TX', '75204', '2143469105', NULL, '3535 Travis St Ste 160', 'Dallas', 'Dallas', 'TX', '75204', '2143469105', '          ', 'DME90TX', '', '', '0.00', '0.00', '0.00', 3, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1033106984', 0, 'N', 0, '2014-03-10', NULL, NULL, 0, 0, NULL, NULL),
('752879634', 'W12045338', 'W12045338', 'TXDALSTD', 'SportsCare and Rehabilitation', '', '', 'SportsCare and Rehabilitation', '', 'Physical Therapy', '', '', NULL, 'O', '6105 Windcom Ct Ste 300', 'Plano', 'Collin', 'TX', '75093', '9727811111', NULL, '6105 Windcom Ct Ste 300', 'Plano', 'Collin', 'TX', '75093', '9727811111', '          ', 'DME90TX', '', '', '0.00', '0.00', '82.00', 3, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1326035346', 0, 'N', 0, '2014-03-10', NULL, NULL, 0, 0, NULL, NULL),
('412057967', 'W12045340', 'W12045340', 'TXDALSTD', 'Vista Rehab of Mesquite', '', '', 'Vista Rehab of Mesquite', '', 'Physical Therapy', '', '', NULL, 'O', '2758 N Galloway Ave Ste 100', 'Mesquite', 'Dallas', 'TX', '75150', '9726811155', NULL, '2758 N Galloway Ave Ste 100', 'Mesquite', 'Dallas', 'TX', '75150', '9726811155', '          ', 'DME90TX', '', '', '0.00', '0.00', '82.00', 3, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1447247465', 0, 'N', 0, '2014-03-10', NULL, NULL, 0, 0, NULL, NULL),
('752864297', 'W12045342', 'W12045342', 'TXDALSTD', 'Vista Physical Therapy Bedford Euless', '', '', 'Vista Physical Therapy Bedford Euless', '', 'Physical Therapy', '', '', NULL, 'O', '2303 Ira E Woods', 'Grapevine', 'Tarrant', 'TX', '76051', '8174231621', NULL, '2303 Ira E Woods', 'Grapevine', 'Tarrant', 'TX', '76051', '8174231621', '          ', 'DME90TX', '', '', '0.00', '0.00', '82.00', 3, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1588900187', 0, 'N', 0, '2014-03-10', NULL, NULL, 0, 0, NULL, NULL),
('752864297', 'W12045344', 'W12045344', 'TXDALSTD', 'Vista Physical Therapy Fort Worth', '', '', 'Vista Physical Therapy Fort Worth', '', 'Physical Therapy', '', '', NULL, 'O', '420 McCart Ave Ste 116', 'Fort Worth', 'Tarrant', 'TX', '76133', '8174231621', NULL, '420 McCart Ave Ste 116', 'Fort Worth', 'Tarrant', 'TX', '76133', '8174231621', '          ', 'DME90TX', '', '', '0.00', '0.00', '82.00', 3, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1710223318', 0, 'N', 0, '2014-03-10', NULL, NULL, 0, 0, NULL, NULL),
('752864297', 'W12045346', 'W12045346', 'TXDALSTD', 'Vista Physical Therapy Fossil Creek', '', '', 'Vista Physical Therapy Fossil Creek', '', 'Physical Therapy', '', '', NULL, 'O', '5000 Western Ctr Blvd Ste 220', 'Haltom City', 'Tarrant', 'TX', '76137', '8175140519', NULL, '5000 Western Ctr Blvd Ste 220', 'Haltom City', 'Tarrant', 'TX', '76137', '8175140519', '          ', 'DME90TX', '', '', '0.00', '0.00', '82.00', 3, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1831435437', 0, 'N', 0, '2014-03-10', NULL, NULL, 0, 0, NULL, NULL),
('752864297', 'W12045348', 'W12045348', 'TXDALSTD', 'Vista Physical Therapy Dallas', '', '', 'Vista Physical Therapy Dallas', '', 'Physical Therapy', '', '', NULL, 'O', '450 BainBridge Dr Ste 560', 'Dallas', 'Dallas', 'TX', '75247', '9725723001', NULL, '450 BainBridge Dr Ste 560', 'Dallas', 'Dallas', 'TX', '75247', '9725723001', '          ', 'DME90TX', '', '', '0.00', '0.00', '82.00', 3, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1801132410', 0, 'N', 0, '2014-03-10', NULL, NULL, 0, 0, NULL, NULL),
('752864297', 'W12045352', 'W12045352', 'TXDALSTD', 'Vista Physical Therapy Grand Prairie', '', '', 'Vista Physical Therapy Grand Prairie', '', 'Physical Therapy', '', '', NULL, 'O', '3055 W Bardin Rd Ste 220', 'Grand Prairie', 'Dallas', 'TX', '75052', '9725222200', NULL, '3055 W Bardin Rd Ste 220', 'Grand Prairie', 'Dallas', 'TX', '75052', '9725222200', '          ', 'DME90TX', '', '', '0.00', '0.00', '82.00', 3, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1346679263', 0, 'N', 0, '2014-03-10', NULL, NULL, 0, 0, NULL, NULL),
('752864297', 'W12045350', 'W12045350', 'TXDALSTD', 'Vista Physical Therapy Prosper', '', '', 'Vista Physical Therapy Prosper', '', 'Physical Therapy', '', '', NULL, 'O', '821 N Coleman St Ste 160', 'Prosper', 'Collin', 'TX', '75078', '9723471111', NULL, '821 N Coleman St Ste 160', 'Prosper', 'Collin', 'TX', '75078', '9723471111', '          ', 'DME90TX', '', '', '0.00', '0.00', '82.00', 3, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1659716462', 0, 'N', 0, '2014-03-10', NULL, NULL, 0, 0, NULL, NULL),
('262072378', 'W12045358', 'W12045358', 'UT01', 'Valley Obstetrics & Gynecology PC', '', '', 'Valley Obstetrics & Gynecology PC', 'GROUP', 'Obstetrics and Gynecology', '', '', NULL, 'O', '41 E Commerce Dr Ste 2', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017569635', '8012168357', '41 E Commerce Dr Ste 2', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017569635', '8012168357', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-09-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588863377', 0, 'Y', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('262072378', 'W12045359', 'W12045359', 'UT01', 'Valley Obstetrics & Gynecology PC', '', '', 'Valley Obstetrics & Gynecology PC', 'GROUP', 'Obstetrics and Gynecology', '', '', NULL, 'O', '700 W 800 N Ste 200', 'Orem', 'Utah', 'UT', '84057', '8017569635', '8012168357', '700 W 800 N Ste 200', 'Orem', 'Utah', 'UT', '84057', '8017569635', '8012168357', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-03-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588863377', 0, 'Y', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('262072378', 'W12045360', 'W12045360', 'UT01', 'Valley Obstetrics & Gynecology PC', '', '', 'Valley Obstetrics & Gynecology PC', 'GROUP', 'Obstetrics and Gynecology', '', '', NULL, 'O', '585 N 500 W', 'Provo', 'Utah', 'UT', '84601', '8013741801', '8012168357', '585 N 500 W', 'Provo', 'Utah', 'UT', '84601', '8013741801', '8012168357', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-03-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588863377', 0, 'Y', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('262072378', 'W12045361', 'W12045361', 'UT01', 'Valley Obstetrics & Gynecology PC', '', '', 'Valley Obstetrics & Gynecology PC', 'GROUP', 'Obstetrics and Gynecology', '', '', NULL, 'O', '285 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8014890111', '8014898351', '285 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8014890111', '8014898351', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-03-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588863377', 0, 'Y', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('262072378', 'W12045362', 'W12045362', 'UT01', 'Valley Obstetrics & Gynecology PC', '', '', 'Valley Obstetrics & Gynecology PC', 'GROUP', 'Obstetrics and Gynecology', '', '', NULL, 'O', '39 Professional Way Ste 4', 'Payson', 'Utah', 'UT', '84651', '8014653201', '8014652889', '39 Professional Way Ste 4', 'Payson', 'Utah', 'UT', '84651', '8014653201', '8014652889', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-03-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588863377', 0, 'Y', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('262072378', 'W12045363', 'W12045363', 'UT01', 'Valley Obstetrics & Gynecology PC', '', '', 'Valley Obstetrics & Gynecology PC', 'GROUP', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1120 E 100 N Ste 3', 'Payson', 'Utah', 'UT', '84651', '8013741801', '8012168375', '1120 E 100 N Ste 3', 'Payson', 'Utah', 'UT', '84651', '8013741801', '8012168375', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-03-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588863377', 0, 'Y', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('262072378', 'W12045364', 'W12045364', 'UT01', 'Valley Obstetrics & Gynecology PC', '', '', 'Valley Obstetrics & Gynecology PC', 'GROUP', 'Obstetrics and Gynecology', '', '', NULL, 'O', '515 S 300 E Ste 206', 'St George', 'Washington', 'UT', '84770', '4356281662', '4356281722', '515 S 300 E Ste 206', 'St George', 'Washington', 'UT', '84770', '4356281662', '4356281722', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-03-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588863377', 0, 'Y', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('262072378', 'W12045370', 'W12045370', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Tiffany', '', 'Spencer', 'NP', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1248 E 90 N Ste 300', 'American Fork', 'Utah', 'UT', '84003', '8017569635', '8012168357', '1248 E 90 N Ste 300', 'American Fork', 'Utah', 'UT', '84003', '8017569635', '8012168357', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-08-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932430824', 0, 'N', 0, '2014-03-10', NULL, NULL, 0, 0, NULL, NULL),
('262072378', 'W12045368', 'W12045368', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Evan', 'B', 'Jones', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '700 W 800 N Ste 200', 'Orem', 'Utah', 'UT', '84057', '8017569635', '8012168357', '700 W 800 N Ste 200', 'Orem', 'Utah', 'UT', '84057', '8017569635', '8012168357', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336450832', 0, 'N', 0, '2014-03-10', NULL, NULL, 0, 0, NULL, NULL),
('262072378', 'W12045367', 'W12045367', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Evan', 'B', 'Jones', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '41 E Commerce Dr Ste 2', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017569635', '8012168357', '41 E Commerce Dr Ste 2', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017569635', '8012168357', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336450832', 0, 'N', 0, '2014-03-10', NULL, NULL, 0, 0, NULL, NULL),
('262072378', 'W12045371', 'W12045371', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Tiffany', '', 'Spencer', 'NP', 'Obstetrics and Gynecology', '', '', NULL, 'O', '41 E Commerce Dr Ste 2', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017569635', '8012168357', '41 E Commerce Dr Ste 2', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017569635', '8012168357', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-08-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932430824', 0, 'N', 0, '2014-03-10', NULL, NULL, 0, 0, NULL, NULL),
('262072378', 'W12045372', 'W12045372', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Tiffany', '', 'Spencer', 'NP', 'Obstetrics and Gynecology', '', '', NULL, 'O', '700 W 800 N Ste 200', 'Orem', 'Utah', 'UT', '84057', '8017569635', '8012168357', '700 W 800 N Ste 200', 'Orem', 'Utah', 'UT', '84057', '8017569635', '8012168357', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-08-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932430824', 0, 'N', 0, '2014-03-10', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12045377', 'W12045377', 'NM01', 'ABQ Health Partners', 'Robert', '', 'Gardner', 'MD', 'Internal Medicine', '', '', NULL, 'O', '5400 Gibson Blvd SE', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5052627960', '5052321368', '5400 Gibson Blvd SE', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5052627960', '5052321368', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-01-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194717801', 0, 'Y', 0, '2014-03-11', NULL, NULL, 0, 0, NULL, NULL),
('870609622', 'W12045379', 'W12045379', 'UT01', 'Snow Canyon Clinic', 'William', 'F', 'Esplin', 'DO', 'Family Practice', '', '', NULL, 'O', '2313 Santa Clara Dr Ste J1', 'Santa Clara', 'Washington', 'UT', '84765', '4359862300', '4356563850', '2313 Santa Clara Dr Ste J1', 'Santa Clara', 'Washington', 'UT', '84765', '4359862300', '4356563850', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-02-27', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1093923393', 0, 'N', 0, '2014-03-19', NULL, NULL, 0, 0, NULL, NULL),
('870609622', 'W12045380', 'W12045380', 'UT01', 'Snow Canyon Clinic', 'Dana', 'B', 'Hardin', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '2313 Santa Clara Dr Ste J1', 'Santa Clara', 'Washington', 'UT', '84765', '4359862300', '4356563850', '2313 Santa Clara Dr Ste J1', 'Santa Clara', 'Washington', 'UT', '84765', '4359862300', '4356563850', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-02-27', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1053381558', 0, 'N', 0, '2014-03-11', NULL, NULL, 0, 0, NULL, NULL),
('464269271', 'W12045382', 'W12045382', 'TXDALSTD', 'Nabeel M Shabout MD', 'Nabeel', 'M', 'Shabout', 'MD', 'General Surgery', '', '', NULL, 'O', '10840 Texas Health Tr Ste 200', 'Keller', 'Tarrant', 'TX', '76244', '8177536917', '8177536921', '10840 Texas Health Tr Ste 200', 'Keller', 'Tarrant', 'TX', '76244', '8177536917', '8177536921', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', '', 'HCFA|UB|', '1033160858', 0, 'N', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('810587644', 'W12045383', 'W12045383', 'UT01', 'Bear Lake Community Health Center', '', '', 'Cache Valley Community Health Center', '', 'Urgent Care', '', '', NULL, 'O', '325 W Logan Hwy', 'Garden City', 'Rich', 'UT', '84028', '4359463660', NULL, '325 W Logan Hwy', 'Garden City', 'Rich', 'UT', '84028', '4359463660', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-03-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009772', 0, 'N', 0, '2014-03-11', NULL, NULL, 0, 0, NULL, NULL),
('810587644', 'W12045384', 'W12045384', 'WY01', 'Evanston Community Health Center', '', '', 'Cache Valley Community Health Center', '', 'Urgent Care', '', '', NULL, 'O', '75 Yellow Creek Rd Ste 102', 'Evanston', 'Uinta', 'WY', '82930', '3077898290', '3077898975', '75 Yellow Creek Rd Ste 102', 'Evanston', 'Uinta', 'WY', '82930', '3077898290', '3077898975', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-03-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009772', 0, 'N', 0, '2014-03-11', NULL, NULL, 0, 0, NULL, NULL),
('810587644', 'W12045385', 'W12045385', 'WYT1', 'Evanston Community Health Center', '', '', 'Cache Valley Community Health Center', '', 'Urgent Care', '', '', NULL, 'O', '75 Yellow Creek Rd Ste 102', 'Evanston', 'Uinta', 'WY', '82930', '3077898290', '3077898975', '75 Yellow Creek Rd Ste 102', 'Evanston', 'Uinta', 'WY', '82930', '3077898290', '3077898975', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-03-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009772', 0, 'N', 0, '2014-03-11', NULL, NULL, 0, 0, NULL, NULL),
('363729867', 'W12045391', 'W12045391', 'ILCHIGSTD', 'Retina Associates', 'Aaron', 'B', 'Weinberg', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1200 S York Rd Ste 4260', 'Elmhurst', 'Dupage', 'IL', '60126', '6307588707', '6307588749', '1200 S York Rd Ste 4260', 'Elmhurst', 'Dupage', 'IL', '60126', '6307588707', '6307588749', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2014-03-04', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1801834676', 0, 'N', 0, '2014-03-26', NULL, NULL, 0, 0, NULL, NULL),
('363729867', 'W12045393', 'W12045393', 'ILCHIGSTD', 'Retina Associates', 'Aaron', 'B', 'Weinberg', 'MD', 'Ophthalmology', '', '', NULL, 'O', '4700 W 95th St Ste LL8', 'Oak Lawn', 'Cook', 'IL', '60453', '7084994192', '7084995674', '4700 W 95th St Ste LL8', 'Oak Lawn', 'Cook', 'IL', '60453', '7084994192', '7084995674', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2014-03-04', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1801834676', 0, 'N', 0, '2014-03-26', NULL, NULL, 0, 0, NULL, NULL),
('363729867', 'W12045394', 'W12045394', 'ILCHIGSTD', 'Retina Associates', 'Aaron', 'B', 'Weinberg', 'MD', 'Ophthalmology', '', '', NULL, 'O', '800 Austin St Ste 154', 'Evanston', 'Cook', 'IL', '60202', '8478669700', '8478668475', '800 Austin St Ste 154', 'Evanston', 'Cook', 'IL', '60202', '8478669700', '8478668475', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2014-03-04', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1801834676', 0, 'N', 0, '2014-03-26', NULL, NULL, 0, 0, NULL, NULL),
('870527703', 'W12045395', 'W12045395', 'UT01', '', 'Joseph', 'W', 'VickRoy', 'MD', 'Neurology', '', '', NULL, 'O', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012936800', '8012936828', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012936800', '8012936828', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1104818442', 0, 'N', 1, '2014-07-07', NULL, NULL, 0, 0, NULL, NULL),
('460707563', 'W12045404', 'W12045404', 'UT01', 'Maisa Morris Family Practice LLC', 'Maisa', 'N', 'Morris', 'MD', 'Family Practice', '', '', NULL, 'O', '8074 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8015656500', '8015656774', '8074 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8015656500', '8015656774', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-03-05', NULL, 0, 0, 0, 'Health South Rehabilitation Hospital of Utah (inpatient services only)', '', '', '', 'HCFA|UB|', '1497794655', 0, 'Y', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('460707563', 'W12045405', 'W12045405', 'UT01', 'Maisa Morris Family Practice LLC', 'Maisa', 'N', 'Morris', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 307', 'Bountiful', 'Davis', 'UT', '84011', '8015656500', '8015656774', 'PO Box 307', 'Bountiful', 'Davis', 'UT', '84011', '8015656500', '8015656774', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-03-05', NULL, 0, 0, 0, 'Health South Rehabilitation Hospital of Utah (inpatient services only)', '', '', '', 'HCFA|UB|', '1497794655', 0, 'N', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('454759716', 'W12045403', 'W12045403', 'UT01', 'Mark Rada MD LLC', 'Mark', 'A', 'Rada', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 307', 'Bountiful', 'Davis', 'UT', '84011', '8015656500', '8015656774', 'PO Box 307', 'Bountiful', 'Davis', 'UT', '84011', '8015656500', '8015656774', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-03-05', NULL, 0, 0, 0, 'Health South Rehabilitation Hospital of Utah (inpatient services only)', NULL, NULL, NULL, 'HCFA|UB|', '1770515140', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('454759716', 'W12045402', 'W12045402', 'UT01', 'Mark Rada MD LLC', 'Mark', 'A', 'Rada', 'MD', 'Internal Medicine', '', '', NULL, 'O', '8074 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8015656500', '8015656774', '8074 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8015656500', '8015656774', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-03-05', NULL, 0, 0, 0, 'Health South Rehabilitation Hospital of Utah (inpatient services only)', NULL, NULL, NULL, 'HCFA|UB|', '1770515140', 0, 'Y', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('900798831', 'W12045400', 'W12045400', 'UT01', 'Cara Drury Consulting LLC', 'Cara', '', 'Drury', 'PA-C', 'General Surgery', 'Hospitalist', '', NULL, 'O', '8074 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8015656500', '8015656774', '8074 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8015656500', '8015656774', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-03-05', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730482209', 0, 'Y', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('900798831', 'W12045401', 'W12045401', 'UT01', 'Cara Drury Consulting LLC', 'Cara', '', 'Drury', 'PA-C', 'General Surgery', 'Hospitalist', '', NULL, 'B', 'PO Box 307', 'Bountiful', 'Davis', 'UT', '84011', '8015656500', '8015656774', 'PO Box 307', 'Bountiful', 'Davis', 'UT', '84011', '8015656500', '8015656774', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-03-05', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730482209', 0, 'N', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'W12045683', 'W12045683', 'IDBOISTD', 'Saint Alphonsus Medical Group Gynecology/Oncology Baker City', 'Gerard', 'P', 'Connor', 'MD', 'Gynecologic Oncology', '', '', NULL, 'O', '3325 Pocahontas Rd', 'Baker City', 'Baker', 'OR', '97814', '2083675227', '2083675225', '3325 Pocahontas Rd', 'Baker City', 'Baker', 'OR', '97814', '2083675227', '2083675225', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2013-06-21', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1669470274', 0, 'Y', 0, '2014-03-17', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'W12045406', 'W12045406', 'ILCHIGSTD', '', 'Acezr', 'S', 'Leynes', 'MD', 'Family Practice', '', '', NULL, 'O', '3758 W Chicago Ave', 'Chicago', 'Cook', 'IL', '60651', '7732350626', '7732355834', '3758 W Chicago Ave', 'Chicago', 'Cook', 'IL', '60651', '7732350626', '7732355834', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-03-31', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1689672537', 0, 'N', 0, '2014-03-11', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'W12045407', 'W12045407', 'ILCHIGSTD', '', 'Acezr', 'S', 'Leynes', 'MD', 'Family Practice', '', '', NULL, 'O', '3224 W Armitage Ave', 'Chicago', 'Cook', 'IL', '60647', '7736450096', '7736450113', '3224 W Armitage Ave', 'Chicago', 'Cook', 'IL', '60647', '7736450096', '7736450113', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-03-31', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1689672537', 0, 'N', 0, '2014-03-11', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'W12045408', 'W12045408', 'ILCHIGSTD', 'Presence Healthcare Services', 'Acezr', 'S', 'Leynes', 'MD', 'Family Practice', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8557647687', '6309142469', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8557647687', '6309142469', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-03-31', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1689672537', 0, 'N', 0, '2014-03-11', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'W12045409', 'W12045409', 'ILCHIGSTD', '', 'Donna', 'I', 'Vasquez', 'MD', 'Family Practice', '', '', NULL, 'O', '3758 W Chicago Ave', 'Chicago', 'Cook', 'IL', '60651', '7732350626', '7732355834', '3758 W Chicago Ave', 'Chicago', 'Cook', 'IL', '60651', '7732350626', '7732355834', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-03-31', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1154333169', 0, 'N', 0, '2014-03-11', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'W12045416', 'W12045416', 'ILCHIGSTD', '', 'Noel', 'E', 'Lasala', 'MD', 'Family Practice', '', '', NULL, 'O', '3224 W Armitage Ave', 'Chicago', 'Cook', 'IL', '60647', '7736450096', '7736450113', '3224 W Armitage Ave', 'Chicago', 'Cook', 'IL', '60647', '7736450096', '7736450113', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-03-31', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1386646172', 0, 'N', 0, '2014-03-11', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'W12045410', 'W12045410', 'ILCHIGSTD', '', 'Donna', 'I', 'Vasquez', 'MD', 'Family Practice', '', '', NULL, 'O', '3224 W Armitage Ave', 'Chicago', 'Cook', 'IL', '60647', '7736450096', '7736450113', '3224 W Armitage Ave', 'Chicago', 'Cook', 'IL', '60647', '7736450096', '7736450113', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-03-31', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1154333169', 0, 'N', 0, '2014-03-11', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'W12045411', 'W12045411', 'ILCHIGSTD', 'Presence Healthcare Services', 'Donna', 'I', 'Vasquez', 'MD', 'Family Practice', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8557647687', '6309142469', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8557647687', '6309142469', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-03-31', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1154333169', 0, 'N', 0, '2014-03-11', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'W12045412', 'W12045412', 'ILCHIGSTD', '', 'Irma', 'E', 'Maravilla', 'MD', 'Family Practice', '', '', NULL, 'O', '3758 W Chicago Ave', 'Chicago', 'Cook', 'IL', '60651', '7732350626', '7732355834', '3758 W Chicago Ave', 'Chicago', 'Cook', 'IL', '60651', '7732350626', '7732355834', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-03-31', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1881634061', 0, 'N', 0, '2014-03-11', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'W12045413', 'W12045413', 'ILCHIGSTD', '', 'Irma', 'E', 'Maravilla', 'MD', 'Family Practice', '', '', NULL, 'O', '3224 W Armitage Ave', 'Chicago', 'Cook', 'IL', '60647', '7736450096', '7736450113', '3224 W Armitage Ave', 'Chicago', 'Cook', 'IL', '60647', '7736450096', '7736450113', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-03-31', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1881634061', 0, 'N', 0, '2014-03-11', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'W12045414', 'W12045414', 'ILCHIGSTD', 'Presence Healthcare Services', 'Irma', 'E', 'Maravilla', 'MD', 'Family Practice', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8557647687', '6309142469', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8557647687', '6309142469', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-03-31', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1881634061', 0, 'N', 0, '2014-03-11', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'W12045415', 'W12045415', 'ILCHIGSTD', 'Chicago Hamlin Medical Center', 'Noel', 'E', 'Lasala', 'MD', 'Family Practice', '', '', NULL, 'O', '3758 W Chicago Ave', 'Chicago', 'Cook', 'IL', '60651', '7732350626', '7732355834', '3758 W Chicago Ave', 'Chicago', 'Cook', 'IL', '60651', '7732350626', '7732355834', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-03-31', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1386646172', 0, 'N', 0, '2014-03-11', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'W12045417', 'W12045417', 'ILCHIGSTD', 'Presence Healthcare Services', 'Noel', 'E', 'Lasala', 'MD', 'Family Practice', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8557647687', '6309142469', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8557647687', '6309142469', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-03-31', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1386646172', 0, 'N', 0, '2014-03-11', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'W12045419', 'W12045419', 'ILCHIGSTD', '', 'Najib', '', 'Chaljub', 'MD', 'Family Practice', '', '', NULL, 'O', '3758 W Chicago Ave', 'Chicago', 'Cook', 'IL', '60651', '7732350626', '7732355834', '3758 W Chicago Ave', 'Chicago', 'Cook', 'IL', '60651', '7732350626', '7732355834', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-03-31', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, '', '', 'HCFA|UB|', '1508867821', 0, 'N', 0, '2014-03-11', NULL, NULL, 0, 0, NULL, NULL),
('830282780', 'W12045427', 'W12045427', 'WYT1', 'Marbleton Big Piney Clinic', 'Shannon', 'D', 'Evans', 'DO', 'Family Practice', '', '', NULL, 'O', '103 W 3rd St', 'Big Piney', 'Sublette', 'WY', '83113', '3072763306', '3072763024', '103 W 3rd St', 'Big Piney', 'Sublette', 'WY', '83113', '3072763306', '3072763024', 'SCRHCD13', '', '', '0.00', '20.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1003071804', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('830282780', 'W12045429', 'W12045429', 'WYT1', 'Pinedale Medical Clinic', 'Shannon', 'D', 'Evans', 'DO', 'Family Practice', '', '', NULL, 'O', '625 E Hennick', 'Pinedale', 'Sublette', 'WY', '82941', '3073674133', '3073676636', '625 E Hennick', 'Pinedale', 'Sublette', 'WY', '82941', '3073674133', '3073676636', 'SCRHCD13', '', '', '0.00', '20.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1003071804', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('830282780', 'W12045431', 'W12045431', 'WY01', 'Pinedale Medical Clinic', 'Carolyn', 'E', 'Albritton-McDonald', 'MD', 'Family Practice', '', '', NULL, 'O', '625 E Hennick', 'Pinedale', 'Sublette', 'WY', '82941', '3073674133', '3073676636', '625 E Hennick', 'Pinedale', 'Sublette', 'WY', '82941', '3073674133', '3073676636', 'SCRHCD13', '', '', '0.00', '20.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1750371399', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('830282780', 'W12045433', 'W12045433', 'WY01', 'Marbleton Big Piney Clinic', 'Carolyn', 'E', 'Albritton-McDonald', 'MD', 'Family Practice', '', '', NULL, 'O', '103 W 3rd St', 'Big Piney', 'Sublette', 'WY', '83113', '3072763306', '3072763024', '103 W 3rd St', 'Big Piney', 'Sublette', 'WY', '83113', '3072763306', '3072763024', 'SCRHCD13', '', '', '0.00', '20.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1750371399', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('830282780', 'W12045434', 'W12045434', 'WYT1', 'Sublette County Rural Health Care District', 'Carolyn', 'E', 'Albritton-McDonald', 'MD', 'Family Practice', '', '', NULL, 'O', '103 W 3rd St', 'Big Piney', 'Sublette', 'WY', '83113', '3072763306', '3072763024', '103 W 3rd St', 'Big Piney', 'Sublette', 'WY', '83113', '3072763306', '3072763024', 'SCRHCD13', '', '', '0.00', '20.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1750371399', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('830282780', 'W12045439', 'W12045439', 'WY01', 'Sublette County Rural Health Care', 'William', 'D', 'Burnett', 'MD', 'Family Practice', '', '', NULL, 'M', 'PO Box 787', 'Big Piney', 'Sublette', 'WY', '83113', '0000000000', '0000000000', 'PO Box 787', 'Big Piney', 'Sublette', 'WY', '83113', '0000000000', '0000000000', 'SCRHCD13', '', '', '0.00', '20.00', '0.00', 3, '2014-03-05', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1760579023', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830282780', 'W12045440', 'W12045440', 'WYT1', 'Sublette County Rural Health Care', 'William', 'D', 'Burnett', 'MD', 'Family Practice', '', '', NULL, 'M', 'PO Box 787', 'Big Piney', 'Sublette', 'WY', '83113', '0000000000', '0000000000', 'PO Box 787', 'Big Piney', 'Sublette', 'WY', '83113', '0000000000', '0000000000', 'SCRHCD13', '', '', '0.00', '20.00', '0.00', 3, '2014-03-05', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1760579023', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830282780', 'W12045441', 'W12045441', 'WY01', 'Sublette County Rural Health Care', 'William', 'D', 'Burnett', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 627', 'Pinedale', 'Sublette', 'WY', '82941', '3072763306', '3072763024', 'PO Box 627', 'Pinedale', 'Sublette', 'WY', '82941', '3072763306', '3072763024', 'SCRHCD13', '', '', '0.00', '20.00', '0.00', 3, '2014-03-05', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1760579023', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830282780', 'W12045442', 'W12045442', 'WYT1', 'Sublette County Rural Health Care', 'William', 'D', 'Burnett', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 627', 'Pinedale', 'Sublette', 'WY', '82941', '3072763306', '3072763024', 'PO Box 627', 'Pinedale', 'Sublette', 'WY', '82941', '3072763306', '3072763024', 'SCRHCD13', '', '', '0.00', '20.00', '0.00', 3, '2014-03-05', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1760579023', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830282780', 'W12045443', 'W12045443', 'WY01', 'Sublette County Rural Health Care', 'Carolyn', 'E', 'Albritton-McDonald', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 627', 'Pinedale', 'Sublette', 'WY', '82941', '3072763306', '3072763024', 'PO Box 627', 'Pinedale', 'Sublette', 'WY', '82941', '3072763306', '3072763024', 'SCRHCD13', '', '', '0.00', '20.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1750371399', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('830282780', 'W12045444', 'W12045444', 'WYT1', 'Sublette County Rural Health Care', 'Carolyn', 'E', 'Albritton-McDonald', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 627', 'Pinedale', 'Sublette', 'WY', '82941', '3072763306', '3072763024', 'PO Box 627', 'Pinedale', 'Sublette', 'WY', '82941', '3072763306', '3072763024', 'SCRHCD13', '', '', '0.00', '20.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1750371399', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('830282780', 'W12045445', 'W12045445', 'WY01', 'Sublette County Rural Health Care', 'Carolyn', 'E', 'Albritton-McDonald', 'MD', 'Family Practice', '', '', NULL, 'M', 'PO Box 787', 'Big Piney', 'Sublette', 'WY', '83113', '0000000000', '0000000000', 'PO Box 787', 'Big Piney', 'Sublette', 'WY', '83113', '0000000000', '0000000000', 'SCRHCD13', '', '', '0.00', '20.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1750371399', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('830282780', 'W12045446', 'W12045446', 'WYT1', 'Sublette County Rural Health Care', 'Carolyn', 'E', 'Albritton-McDonald', 'MD', 'Family Practice', '', '', NULL, 'M', 'PO Box 787', 'Big Piney', 'Sublette', 'WY', '83113', '0000000000', '0000000000', 'PO Box 787', 'Big Piney', 'Sublette', 'WY', '83113', '0000000000', '0000000000', 'SCRHCD13', '', '', '0.00', '20.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1750371399', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('830282780', 'W12045447', 'W12045447', 'WY01', 'Sublette County Rural Health Care', 'Shannon', 'D', 'Evans', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 627', 'Pinedale', 'Sublette', 'WY', '82941', '3072763306', '3072763024', 'PO Box 627', 'Pinedale', 'Sublette', 'WY', '82941', '3072763306', '3072763024', 'SCRHCD13', '', '', '0.00', '20.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1003071804', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('830282780', 'W12045448', 'W12045448', 'WYT1', 'Sublette County Rural Health Care', 'Shannon', 'D', 'Evans', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 627', 'Pinedale', 'Sublette', 'WY', '82941', '3072763306', '3072763024', 'PO Box 627', 'Pinedale', 'Sublette', 'WY', '82941', '3072763306', '3072763024', 'SCRHCD13', '', '', '0.00', '20.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1003071804', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('830282780', 'W12045449', 'W12045449', 'WY01', 'Sublette County Rural Health Care', 'Shannon', 'D', 'Evans', 'DO', 'Family Practice', '', '', NULL, 'M', 'PO Box 787', 'Big Piney', 'Sublette', 'WY', '83113', '0000000000', '0000000000', 'PO Box 787', 'Big Piney', 'Sublette', 'WY', '83113', '0000000000', '0000000000', 'SCRHCD13', '', '', '0.00', '20.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1003071804', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('830282780', 'W12045450', 'W12045450', 'WYT1', 'Sublette County Rural Health Care', 'Shannon', 'D', 'Evans', 'DO', 'Family Practice', '', '', NULL, 'M', 'PO Box 787', 'Big Piney', 'Sublette', 'WY', '83113', '0000000000', '0000000000', 'PO Box 787', 'Big Piney', 'Sublette', 'WY', '83113', '0000000000', '0000000000', 'SCRHCD13', '', '', '0.00', '20.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1003071804', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('830282780', 'W12045451', 'W12045451', 'WY01', 'Sublette County Rural Health Care', '', '', 'Sublette County Rural Health Care District', '', 'Family Practice', '', '', NULL, 'M', 'PO Box 787', 'Big Piney', 'Sublette', 'WY', '83113', '0000000000', '0000000000', 'PO Box 787', 'Big Piney', 'Sublette', 'WY', '83113', '0000000000', '0000000000', 'SCRHCD13', '', '', '0.00', '20.00', '0.00', 3, '2014-03-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1194776930', 0, 'N', 0, '2014-07-10', NULL, NULL, 0, 0, NULL, NULL),
('830282780', 'W12045452', 'W12045452', 'WYT1', 'Sublette County Rural Health Care', '', '', 'Sublette County Rural Health Care District', '', 'Family Practice', '', '', NULL, 'M', 'PO Box 787', 'Big Piney', 'Sublette', 'WY', '83113', '0000000000', '0000000000', 'PO Box 787', 'Big Piney', 'Sublette', 'WY', '83113', '0000000000', '0000000000', 'SCRHCD13', '', '', '0.00', '20.00', '0.00', 3, '2014-03-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1194776930', 0, 'N', 1, '2014-07-10', NULL, NULL, 0, 0, NULL, NULL),
('830282780', 'W12045453', 'W12045453', 'WY01', 'Sublette County Rural Health Care', '', '', 'Sublette County Rural Health Care District', '', 'Family Practice', '', '', NULL, 'B', 'PO Box 627', 'Pinedale', 'Sublette', 'WY', '82941', '3072763306', '3072763024', 'PO Box 627', 'Pinedale', 'Sublette', 'WY', '82941', '3072763306', '3072763024', 'SCRHCD13', '', '', '0.00', '20.00', '0.00', 3, '2014-03-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1194776930', 0, 'N', 1, '2014-07-10', NULL, NULL, 0, 0, NULL, NULL),
('830282780', 'W12045454', 'W12045454', 'WYT1', 'Sublette County Rural Health Care', '', '', 'Sublette County Rural Health Care District', '', 'Family Practice', '', '', NULL, 'B', 'PO Box 627', 'Pinedale', 'Sublette', 'WY', '82941', '3072763306', '3072763024', 'PO Box 627', 'Pinedale', 'Sublette', 'WY', '82941', '3072763306', '3072763024', 'SCRHCD13', '', '', '0.00', '20.00', '0.00', 3, '2014-03-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1194776930', 0, 'N', 1, '2014-07-10', NULL, NULL, 0, 0, NULL, NULL),
('830282780', 'W12045464', 'W12045464', 'WY01', 'Marbleton Big Piney Clinic', 'Deborah', 'S', 'Brackett', 'MD', 'Family Practice', '', '', NULL, 'O', '103 W 3rd St', 'Big Piney', 'Sublette', 'WY', '83113', '3072763306', '3072763024', '103 W 3rd St', 'Big Piney', 'Sublette', 'WY', '83113', '3072763306', '3072763024', 'SCRHCD13', '', '', '0.00', '20.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|', '1306978580', 0, 'N', 0, '2014-03-17', NULL, NULL, 0, 0, NULL, NULL),
('830282780', 'W12045466', 'W12045466', 'WY01', 'Pinedale Medical Clinic', 'Deborah', 'S', 'Brackett', 'MD', 'Family Practice', '', '', NULL, 'O', '625 E Hennick', 'Pinedale', 'Sublette', 'WY', '82941', '3073674133', '3073676636', '625 E Hennick', 'Pinedale', 'Sublette', 'WY', '82941', '3073674133', '3073676636', 'SCRHCD13', '', '', '0.00', '20.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|', '1306978580', 0, 'N', 0, '2014-03-17', NULL, NULL, 0, 0, NULL, NULL),
('830282780', 'W12045467', 'W12045467', 'WYT1', 'Pinedale Medical Clinic', 'Deborah', 'S', 'Brackett', 'MD', 'Family Practice', '', '', NULL, 'O', '625 E Hennick', 'Pinedale', 'Sublette', 'WY', '82941', '3073674133', '3073676636', '625 E Hennick', 'Pinedale', 'Sublette', 'WY', '82941', '3073674133', '3073676636', 'SCRHCD13', '', '', '0.00', '20.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|', '1306978580', 0, 'N', 0, '2014-03-17', NULL, NULL, 0, 0, NULL, NULL),
('830282780', 'W12045468', 'W12045468', 'WY01', 'Sublette County Rural Health Care', 'Deborah', 'S', 'Brackett', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 627', 'Pinedale', 'Sublette', 'WY', '82941', '3072763306', '3072763024', 'PO Box 627', 'Pinedale', 'Sublette', 'WY', '82941', '3072763306', '3072763024', 'SCRHCD13', '', '', '0.00', '20.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|', '1306978580', 0, 'N', 0, '2014-03-17', NULL, NULL, 0, 0, NULL, NULL),
('830282780', 'W12045469', 'W12045469', 'WY01', 'Sublette County Rural Health Care', 'Deborah', 'S', 'Brackett', 'MD', 'Family Practice', '', '', NULL, 'M', 'PO Box 787', 'Big Piney', 'Sublette', 'WY', '83113', '0000000000', '0000000000', 'PO Box 787', 'Big Piney', 'Sublette', 'WY', '83113', '0000000000', '0000000000', 'SCRHCD13', '', '', '0.00', '20.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|', '1306978580', 0, 'N', 0, '2014-03-17', NULL, NULL, 0, 0, NULL, NULL),
('830282780', 'W12045470', 'W12045470', 'WYT1', 'Sublette County Rural Health Care', 'Deborah', 'S', 'Brackett', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 627', 'Pinedale', 'Sublette', 'WY', '82941', '3072763306', '3072763024', 'PO Box 627', 'Pinedale', 'Sublette', 'WY', '82941', '3072763306', '3072763024', 'SCRHCD13', '', '', '0.00', '20.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|', '1306978580', 0, 'N', 0, '2014-03-17', NULL, NULL, 0, 0, NULL, NULL),
('830282780', 'W12045471', 'W12045471', 'WYT1', 'Sublette County Rural Health Care', 'Deborah', 'S', 'Brackett', 'MD', 'Family Practice', '', '', NULL, 'M', 'PO Box 787', 'Big Piney', 'Sublette', 'WY', '83113', '0000000000', '0000000000', 'PO Box 787', 'Big Piney', 'Sublette', 'WY', '83113', '0000000000', '0000000000', 'SCRHCD13', '', '', '0.00', '20.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|', '1306978580', 0, 'N', 0, '2014-03-17', NULL, NULL, 0, 0, NULL, NULL),
('830282780', 'W12045476', 'W12045476', 'WYT1', 'Sublette County Rural Health Care', 'Rebecca', 'A', 'Stroklund', 'DO', 'Family Practice', '', '', NULL, 'M', 'PO Box 787', 'Big Piney', 'Sublette', 'WY', '83113', '0000000000', '0000000000', 'PO Box 787', 'Big Piney', 'Sublette', 'WY', '83113', '0000000000', '0000000000', 'SCRHCD13', '', '', '0.00', '20.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1700046927', 0, 'N', 0, '2014-03-17', NULL, NULL, 0, 0, NULL, NULL),
('830282780', 'W12045478', 'W12045478', 'WY01', 'Marbleton Big Piney Clinic', 'Rebecca', 'A', 'Stroklund', 'DO', 'Family Practice', '', '', NULL, 'O', '103 W 3rd St', 'Big Piney', 'Sublette', 'WY', '83113', '3072763306', '3072763024', '103 W 3rd St', 'Big Piney', 'Sublette', 'WY', '83113', '3072763306', '3072763024', 'SCRHCD13', '', '', '0.00', '20.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1700046927', 0, 'N', 0, '2014-03-17', NULL, NULL, 0, 0, NULL, NULL),
('830282780', 'W12045490', 'W12045490', 'WYT1', 'Sublette County Rural Health Care', 'Kurt', 'E', 'Frauenpreis', 'MD', 'Family Practice', '', '', NULL, 'M', 'PO Box 787', 'Big Piney', 'Sublette', 'WY', '83113', '0000000000', '0000000000', 'PO Box 787', 'Big Piney', 'Sublette', 'WY', '83113', '0000000000', '0000000000', 'SCRHCD13', '', '', '0.00', '20.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1093722182', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('830282780', 'W12045485', 'W12045485', 'WY01', 'Marbleton Big Piney Clinic', 'Kurt', 'E', 'Frauenpreis', 'MD', 'Family Practice', '', '', NULL, 'O', '103 W 3rd St', 'Big Piney', 'Sublette', 'WY', '83113', '3072763306', '3072763024', '103 W 3rd St', 'Big Piney', 'Sublette', 'WY', '83113', '3072763306', '3072763024', 'SCRHCD13', '', '', '0.00', '20.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1093722182', 0, 'N', 0, '2014-03-17', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('830282780', 'W12045495', 'W12045495', 'WYT1', 'Sublette County Rural Health Care', 'Stephen', 'W', 'Wallace', 'MD', 'Emergency Medicine', 'Family Practice', '', NULL, 'M', 'PO Box 787', 'Big Piney', 'Sublette', 'WY', '83113', '0000000000', '0000000000', 'PO Box 787', 'Big Piney', 'Sublette', 'WY', '83113', '0000000000', '0000000000', 'SCRHCD13', '', '', '0.00', '20.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1851379119', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('830282780', 'W12045496', 'W12045496', 'WY01', 'Marbleton Big Piney Clinic', 'Stephen', 'W', 'Wallace', 'MD', 'Emergency Medicine', 'Family Practice', '', NULL, 'O', '103 W 3rd St', 'Big Piney', 'Sublette', 'WY', '83113', '3072763306', '3072763024', '103 W 3rd St', 'Big Piney', 'Sublette', 'WY', '83113', '3072763306', '3072763024', 'SCRHCD13', '', '', '0.00', '20.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1851379119', 0, 'N', 0, '2014-03-17', NULL, NULL, 0, 0, NULL, NULL),
('830282780', 'W12045505', 'W12045505', 'WY01', 'Sublette County Rural Health Care', 'David', 'P', 'Kappenman', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 627', 'Pinedale', 'Sublette', 'WY', '82941', '3072763306', '3072763024', 'PO Box 627', 'Pinedale', 'Sublette', 'WY', '82941', '3072763306', '3072763024', 'SCRHCD13', '', '', '0.00', '20.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1134149958', 0, 'N', 0, '2014-03-17', NULL, NULL, 0, 0, NULL, NULL),
('830282780', 'W12045503', 'W12045503', 'WY01', 'Marbleton Big Piney Clinic', 'David', 'P', 'Kappenman', 'MD', 'Family Practice', '', '', NULL, 'O', '103 W 3rd St', 'Big Piney', 'Sublette', 'WY', '83113', '3072763306', '3072763024', '103 W 3rd St', 'Big Piney', 'Sublette', 'WY', '83113', '3072763306', '3072763024', 'SCRHCD13', '', '', '0.00', '20.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1134149958', 0, 'N', 0, '2014-03-17', NULL, NULL, 0, 0, NULL, NULL),
('870516264', 'W12045509', 'W12045509', 'UT01', 'Utah Surgical Associates', 'Ivo', 'K', 'Hanza', 'NP', 'General Surgery', '', '', NULL, 'O', '1490 E Foremaster Dr Ste 200', 'St George', 'Washington', 'UT', '84790', '4356281641', '4356281660', '1490 E Foremaster Dr Ste 200', 'St George', 'Washington', 'UT', '84790', '4356281641', '4356281660', 'WUSTGEIPA', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 6, '2014-06-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1740605963', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'W12045511', 'W12045511', 'UT01', 'Granger Medical Clinic', 'Jennifer', '', 'DenBleyker', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '11724 S State St', 'Draper', 'Salt Lake', 'UT', '84020', '8015762000', '8015762001', '11724 S State St', 'Draper', 'Salt Lake', 'UT', '84020', '8015762000', '8015762001', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1033141270', 0, 'N', 0, '2014-03-12', NULL, NULL, 0, 0, NULL, NULL),
('364037473', 'W12045512', 'W12045512', 'ILCHIGSTD', 'Elmhurst Clinic', 'Douglas', 'L', 'Cotsamire', 'MD', 'Rheumatology', '', '', NULL, 'O', '1100 Lake St Ste 230', 'Oak Park', 'Cook', 'IL', '60301', '3312219001', '3312213957', '1100 Lake St Ste 230', 'Oak Park', 'Cook', 'IL', '60301', '3312219001', '3312213957', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2014-02-26', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1164487658', 0, 'N', 0, '2014-03-12', NULL, NULL, 0, 0, NULL, NULL),
('364037473', 'W12045513', 'W12045513', 'ILCHIGSTD', 'Elmhurst Clinic', 'Douglas', 'L', 'Cotsamire', 'MD', 'Rheumatology', '', '', NULL, 'B', 'Dept 4585', 'Carol Stream', 'Dupage', 'IL', '60122', '3312219001', '3312213957', 'Dept 4585', 'Carol Stream', 'Dupage', 'IL', '60122', '3312219001', '3312213957', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2014-02-26', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1164487658', 0, 'N', 0, '2014-03-17', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W12045514', 'W12045514', 'IDBOISTD', 'Primary Health Medical Group', 'Amber', 'M', 'Vickers', 'PA-C', 'Family Practice', 'Physician Assistant', '', NULL, 'O', '3115 E Florence', 'Meridian', 'Ada', 'ID', '83642', '2088958670', '2089550494', '3115 E Florence', 'Meridian', 'Ada', 'ID', '83642', '2088958670', '2089550494', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1114964616', 0, 'N', 0, '2014-04-18', NULL, NULL, 0, 0, NULL, NULL),
('800405814', 'W12045516', 'W12045516', 'ID01', 'Boise Spine Center', 'Noah', 'B', 'Edvalson', 'DC', 'Chiropractic', '', '', NULL, 'O', '3271 N Milwaukee', 'Boise', 'Ada', 'ID', '83704', '2086295374', '2086295394', '3271 N Milwaukee', 'Boise', 'Ada', 'ID', '83704', '2086295374', '2086295394', 'IDCHIRO1', '', '', '0.00', '35.00', '0.00', 3, '2014-03-07', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275767519', 0, 'N', 0, '2014-03-12', NULL, NULL, 0, 0, NULL, NULL),
('836000891', 'W12045518', 'W12045518', 'WYT1', 'North Big Horn Hospital Clinic', 'Brendan', 'H', 'Fitzsimmons', 'MD', 'Family Practice', '', '', NULL, 'O', '1115 Ln 12', 'Lovell', 'Big Horn', 'WY', '82431', '3075485201', NULL, '1115 Ln 12', 'Lovell', 'Big Horn', 'WY', '82431', '3075485201', '          ', '', '', '', '0.00', '12.00', '0.00', 3, '2014-02-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1912102989', 0, 'N', 0, '2014-03-12', NULL, NULL, 0, 0, NULL, NULL),
('836000891', 'W12045519', 'W12045519', 'WY01', 'North Big Horn Hospital Clinic', 'Brendan', 'H', 'Fitzsimmons', 'MD', 'Family Practice', '', '', NULL, 'O', '1115 Ln 12', 'Lovell', 'Big Horn', 'WY', '82431', '3075485201', NULL, '1115 Ln 12', 'Lovell', 'Big Horn', 'WY', '82431', '3075485201', '          ', '', '', '', '0.00', '12.00', '0.00', 3, '2014-02-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1912102989', 0, 'N', 0, '2014-03-12', NULL, NULL, 0, 0, NULL, NULL),
('362169147', 'W12045520', 'W12045520', 'ILCHIGSTD', 'Advocate Medical Group Midwest Heart Specialists', 'Steven', 'P', 'Chough', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3825 Highland Ave Ste 400', 'Downers Grove', 'Dupage', 'IL', '60515', '6307194799', '0000000000', '3825 Highland Ave Ste 400', 'Downers Grove', 'Dupage', 'IL', '60515', '6307194799', '0000000000', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 8, '2014-02-27', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1831145051', 0, 'N', 0, '2014-03-12', NULL, NULL, 0, 0, NULL, NULL),
('362169147', 'W12045521', 'W12045521', 'ILCHIGSTD', 'Advocate Medical Group Midwest Heart Specialists', 'Steven', 'P', 'Chough', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', '75 Remittance Dr Ste 1787', 'Chicago', 'Cook', 'IL', '60675', '6307194799', '0000000000', '75 Remittance Dr Ste 1787', 'Chicago', 'Cook', 'IL', '60675', '6307194799', '0000000000', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 8, '2014-02-27', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1831145051', 0, 'N', 0, '2014-03-17', NULL, NULL, 0, 0, NULL, NULL),
('800701770', 'W12045522', 'W12045522', 'UT01', 'Lone Peak General Surgery', 'Robert', '', 'Hurst', 'APRN', 'Cardiovascular Disease', '', '', NULL, 'O', '74 Kimballs Ln Ste 210', 'Draper', 'Salt Lake', 'UT', '84020', '8015663062', '8015018219', '74 Kimballs Ln Ste 210', 'Draper', 'Salt Lake', 'UT', '84020', '8015663062', '8015018219', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB', '1639488950', 0, 'N', 0, '2014-03-12', NULL, NULL, 0, 0, NULL, NULL),
('830335677', 'W12047408', 'W12047408', 'WY01', 'Big Country Rehab', 'Jessica', '', 'Mangus', 'PT', 'Physical Therapy', '', '', NULL, 'O', '525 E Birch', 'Glenrock', 'Converse', 'WY', '82637', '3073589464', '3073589330', '525 E Birch', 'Glenrock', 'Converse', 'WY', '82637', '3073589464', '3073589330', '', '', '', '0.00', '0.00', '120.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1093060204', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('830335677', 'W12047407', 'W12047407', 'WY01', 'Big Country Rehab', 'Jessica', '', 'Mangus', 'PT', 'Physical Therapy', '', '', NULL, 'O', '521 E 10th St', 'Lusk', 'Niobrara', 'WY', '82225', '3073589464', '3073589330', '521 E 10th St', 'Lusk', 'Niobrara', 'WY', '82225', '3073589464', '3073589330', '', '', '', '0.00', '0.00', '120.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1093060204', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('830335677', 'W12047404', 'W12047404', 'WYT1', 'Big Country Rehab', 'Charles', '', 'Mangus', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 1790', 'Douglas', 'Converse', 'WY', '82633', '3073589464', '3073589330', 'PO Box 1790', 'Douglas', 'Converse', 'WY', '82633', '3073589464', '3073589330', '', '', '', '0.00', '0.00', '120.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1942264122', 0, 'N', 0, '2014-05-29', NULL, NULL, 0, 0, NULL, NULL),
('830335677', 'W12047402', 'W12047402', 'WYT1', 'Big Country Rehab', 'Charles', '', 'Mangus', 'PT', 'Physical Therapy', '', '', NULL, 'O', '525 E Birch', 'Glenrock', 'Converse', 'WY', '82637', '3073589464', '3073589330', '525 E Birch', 'Glenrock', 'Converse', 'WY', '82637', '3073589464', '3073589330', '', '', '', '0.00', '0.00', '120.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1942264122', 0, 'N', 0, '2014-05-29', NULL, NULL, 0, 0, NULL, NULL),
('830335677', 'W12047395', 'W12047395', 'WYT1', 'Big Country Rehab', '', '', 'Big Country Rehab', '', 'Physical Therapy', 'Occupational Therapy', '', NULL, 'O', '521 E 10th St', 'Lusk', 'Niobrara', 'WY', '82225', '3073589464', '3073589330', '521 E 10th St', 'Lusk', 'Niobrara', 'WY', '82225', '3073589464', '3073589330', '', '', '', '0.00', '0.00', '120.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1366493264', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('830335677', 'W12047394', 'W12047394', 'WY01', 'Big Country Rehab', '', '', 'Big Country Rehab', '', 'Physical Therapy', 'Occupational Therapy', '', NULL, 'O', '521 E 10th St', 'Lusk', 'Niobrara', 'WY', '82225', '3073589464', '3073589330', '521 E 10th St', 'Lusk', 'Niobrara', 'WY', '82225', '3073589464', '3073589330', '', '', '', '0.00', '0.00', '120.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1366493264', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('830335677', 'W12047393', 'W12047393', 'WYT1', 'Big Country Rehab', '', '', 'Big Country Rehab', '', 'Physical Therapy', 'Occupational Therapy', '', NULL, 'M', 'PO Box 1790', 'Douglas', 'Converse', 'WY', '82633', '3073589464', '3073589330', 'PO Box 1790', 'Douglas', 'Converse', 'WY', '82633', '3073589464', '3073589330', '', '', '', '0.00', '0.00', '120.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1366493264', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('621762468', 'W12047185', 'W12047185', 'WY01', 'SageWest Health Care', '', '', 'Riverton Memorial Hospital, LLC', 'GROUP', 'Rehabilitation Hospital', '', '', NULL, 'B', 'PO Box 742744', 'Atlanta', 'Fulton', 'GA', '30374', '3078564161', '          ', 'PO Box 742744', 'Atlanta', 'Fulton', 'GA', '30374', '3078564161', '          ', '', '', '', '0.00', '5.00', '0.00', 6, '2014-04-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295153591', 0, 'N', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
('830335677', 'W12047392', 'W12047392', 'WY01', 'Big Country Rehab', '', '', 'Big Country Rehab', '', 'Physical Therapy', 'Occupational Therapy', '', NULL, 'B', 'PO Box 1790', 'Douglas', 'Converse', 'WY', '82633', '3073589464', '3073589330', 'PO Box 1790', 'Douglas', 'Converse', 'WY', '82633', '3073589464', '3073589330', '', '', '', '0.00', '0.00', '120.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1366493264', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('830335677', 'W12047390', 'W12047390', 'WY01', 'Big Country Rehab', '', '', 'Big Country Rehab', '', 'Physical Therapy', 'Occupational Therapy', '', NULL, 'O', '525 E Birch', 'Glenrock', 'Converse', 'WY', '82637', '3073589464', '3073589330', '525 E Birch', 'Glenrock', 'Converse', 'WY', '82637', '3073589464', '3073589330', '', '', '', '0.00', '0.00', '120.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1366493264', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('820466781', 'W12046611', 'W12046611', 'ID02', 'Mountain States Counseling & Psychological Services', 'Robert', 'F', 'Calhoun', 'PHD', 'Psychology', '', '', NULL, 'O', '311 N Allumbaugh St', 'Boise', 'Ada', 'ID', '83704', '2083756402', '2083231850', '311 N Allumbaugh St', 'Boise', 'Ada', 'ID', '83704', '2083756402', '2083231850', 'IDPHD', '', '', '0.00', '40.00', '0.00', 8, '2014-01-24', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1376697946', 0, 'N', 0, '2014-05-23', NULL, NULL, 0, 0, NULL, NULL),
('830335677', 'W12047389', 'W12047389', 'WYT1', 'Big Country Rehab', '', '', 'Big Country Rehab', '', 'Physical Therapy', 'Occupational Therapy', '', NULL, 'O', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073589464', '3073589330', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073589464', '3073589330', '', '', '', '0.00', '0.00', '120.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1366493264', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('830217795', 'W12046748', 'W12046748', 'WY01', 'Internal Medicine Group', 'Jessie', '', 'Hockett', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '2301 House Ave Ste 300', 'Cheyenne', 'Laramie', 'WY', '82001', '3076354141', '3076356587', '2301 House Ave Ste 300', 'Cheyenne', 'Laramie', 'WY', '82001', '3076354141', '3076356587', 'WY160', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1396026225', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('300176561', 'W12046847', 'W12046847', 'ILCHIGSTD', 'Midwest Orthopedics at Rush LLC', 'David', '', 'Garras', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1611 W Harrison Ste 400', 'Chicago', 'Cook', 'IL', '60612', '3122434244', '3129421517', '1611 W Harrison Ste 400', 'Chicago', 'Cook', 'IL', '60612', '3122434244', '3129421517', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2014-02-19', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1386847283', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('752943993', 'W12046219', 'W12046219', 'TXDALSTD', 'North Texas Kidney Disease Associates', 'Zhi', '', 'Mao', 'MD', 'Nephrology', '', '', NULL, 'M', '1600 Waters Ridge Ste A', 'Lewisville', 'Denton', 'TX', '75057', '9722190558', '9724369273', '1600 Waters Ridge Ste A', 'Lewisville', 'Denton', 'TX', '75057', '9722190558', '9724369273', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609087600', 0, 'N', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('830327251', 'W12046170', 'W12046170', 'WY01', 'Star Valley Medical Center', 'Niki', '', 'Milleson', 'DO', 'Family Practice', '', '', NULL, 'O', '122 Peterson Pkwy', 'Thayne', 'Lincoln', 'WY', '83127', '3078855817', '          ', '122 Peterson Pkwy', 'Thayne', 'Lincoln', 'WY', '83127', '3078855817', '          ', 'WSTARV', 'wyhcpcs', '', '0.00', '10.00', '0.00', 6, '2014-03-24', NULL, 0, 0, 0, 'Star Valley Medical Center', '', '', '', 'HCFA|UB|', '1225155997', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046588', 'W12046588', 'IDBOISTD', 'Saint Alphonsus Medical Group Occupational Med Emerald ', 'Amanda', 'R', 'Schwartz', 'PA-C', 'Family Practice', '', '', NULL, 'O', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674179', '2083678136', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674179', '2083678136', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-03-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1619112216', 0, 'Y', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('202500191', 'W12046567', 'W12046567', 'UTMH1', 'Draper Pyschological Services', 'Richard', 'J', 'Hydo', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1980 S 600 E', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8016193569', '8015767540', '1980 S 600 E', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8016193569', '8015767540', 'UTMA', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184046633', 0, 'N', 0, '2014-06-25', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046071', 'W12046071', 'IDBOISTD', 'Saint Alphonsus Medical Group MHP Family Medicine', 'Anthony', '', 'Millward', 'PA', 'Family Practice', '', '', NULL, 'O', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-01-23', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1609889252', 0, 'Y', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('841367175', 'W12046870', 'W12046870', 'UT01', 'Mapleton Medical Clinic', 'Michael', '', 'McLay', 'MD', 'Family Practice', '', '', NULL, 'O', '724 S 1600 W Ste 203', 'Mapleton', 'Utah', 'UT', '84664', '8014898464', '8014896378', '724 S 1600 W Ste 203', 'Mapleton', 'Utah', 'UT', '84664', '8014898464', '8014896378', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-21', NULL, 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1063605475', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('841367175', 'W12046868', 'W12046868', 'UT01', 'Mapleton Medical Clinic', 'John', 'S', 'Taylor', 'MD', 'Family Practice', '', '', NULL, 'O', '724 S 1600 W Ste 203', 'Mapleton', 'Utah', 'UT', '84664', '8014898464', '8014896378', '724 S 1600 W Ste 203', 'Mapleton', 'Utah', 'UT', '84664', '8014898464', '8014896378', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-21', NULL, 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1740228055', 0, 'N', 0, '2014-06-16', NULL, NULL, 0, 0, NULL, NULL),
('841367175', 'W12046869', 'W12046869', 'UT01', 'Mapleton Medical Clinic', 'Brayden', 'T', 'McBride', 'MD', 'Family Practice', '', '', NULL, 'O', '724 S 1600 W Ste 203', 'Mapleton', 'Utah', 'UT', '84664', '8014898464', '8014896378', '724 S 1600 W Ste 203', 'Mapleton', 'Utah', 'UT', '84664', '8014898464', '8014896378', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-21', NULL, 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1831363225', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046109', 'W12046109', 'IDBOISTD', 'Saint Alphonsus Medical Group Wound Emmett', 'Cory', '', 'Huffine', 'NP-C', 'Wound Care', '', '', NULL, 'O', '1024 E Locust St', 'Emmett', 'Gem', 'ID', '83617', '2083676038', '2083676022', '1024 E Locust St  ', 'Emmett', 'Gem', 'ID', '83617', '2083676038', '2083676022', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-03-03', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1700879459', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'W12046677', 'W12046677', 'UT01', '72nd Street Clinic', '', '', 'Community Health Centers', 'GROUP', 'Primary Care with Extended Hours', '', '', NULL, 'O', '220 W 7200 S Ste A', 'Midvale', 'Salt Lake', 'UT', '84047', '8015665494', '8015619647', '220 W 7200 S Ste A', 'Midvale', 'Salt Lake', 'UT', '84047', '8015665494', '8015619647', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-17', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000005779', 0, 'N', 0, '2014-04-22', NULL, NULL, 0, 0, NULL, NULL),
('452715973', 'W12046653', 'W12046653', 'Sinclair', 'St Lukes Clinic Wood River', 'Steven', 'M', 'Greenberg', 'MD', 'Family Practice', '', '', NULL, 'M', '190 E Bannock St', 'Boise', 'Ada', 'ID', '83712', '2087883434', '2087889238', '190 E Bannock St', 'Boise', 'Ada', 'ID', '83712', '2087883434', '2087889238', 'IDSINCLAIRD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1407817364', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('363553664', 'LCOMSP061', 'LCOMSP061', 'ILCHIGSTD', '', 'Todd', 'S', 'Kirk', 'MD', 'Ophthalmology', '', '', NULL, 'O', '13303 S Ridgeland Ave', 'Palos Heights', 'Cook', 'IL', '60463', '7088577990', '7088577998', '13303 S Ridgeland Ave', 'Palos Heights', 'Cook', 'IL', '60463', '7088577990', '7088577998', 'CHIG1', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', '', '', '', 'HCFA|UB|DEN|', '1811955560', 0, 'N', 0, '2014-04-18', NULL, NULL, 0, 0, NULL, NULL),
('752943993', 'W12046239', 'W12046239', 'TXDALSTD', 'North Texas Kidney Disease Associates', 'Raghuveer', '', 'Vanguru', 'MD', 'Nephrology', '', '', NULL, 'O', '6331 Blvd 26 Ste 220', 'North Richland Hills', 'Tarrant', 'TX', '76180', '8176280284', '8176280288', '6331 Blvd 26 Ste 220', 'North Richland Hills', 'Tarrant', 'TX', '76180', '8176280284', '8176280288', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700891579', 0, 'N', 0, '2014-04-07', NULL, NULL, 0, 0, NULL, NULL),
('800864010', 'W12046846', 'W12046846', 'UT01', 'St Marks Interventional Pain Center', 'David', 'D', 'Byrd', 'MD', 'Pain Management', '', '', NULL, 'O', '74 Kimballs Ln Ste 230', 'Draper', 'Salt Lake', 'UT', '84020', '8012687248', '8663461644', '74 Kimballs Ln Ste 230', 'Draper', 'Salt Lake', 'UT', '84020', '8012687248', '8663461644', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-01-31', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB', '1720173164', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('830335677', 'W12047445', 'W12047445', 'WY01', 'Big Country Rehab', 'Kelsey', '', 'Nelson', 'OT', 'Occupational Therapy', '', '', NULL, 'B', 'PO Box 1790', 'Douglas', 'Converse', 'WY', '82633', '3073589464', '3073589330', 'PO Box 1790', 'Douglas', 'Converse', 'WY', '82633', '3073589464', '3073589330', '', '', '', '0.00', '0.00', '120.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1417282070', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'W12046790', 'W12046790', 'UT01', 'Community Health Centers Inc', 'Saskia', '', 'Spiess', 'MD', 'Family Practice', '', '', NULL, 'B', '220 W 7200 S Ste A', 'Midvale', 'Salt Lake', 'UT', '84047', '8018583468', '8018583470', '220 W 7200 S Ste A', 'Midvale', 'Salt Lake', 'UT', '84047', '8018583468', '8018583470', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1689966004', 0, 'N', 1, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W12046665', 'W12046665', 'IDBOISTD', 'Primary Health Medical Group', 'Amber', 'M', 'Vickers', 'PA-C', 'Family Practice', 'Physician Assistant', '', NULL, 'O', '1623 S Wells Ave', 'Meridian', 'Ada', 'ID', '83642', '2084891450', '2084891451', '1623 S Wells Ave', 'Meridian', 'Ada', 'ID', '83642', '2084891450', '2084891451', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1114964616', 0, 'N', 0, '2014-04-18', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12046423', 'W12046423', 'UTIHCPHY', 'American Fork Wound Care', 'Marc', 'S', 'Robins', 'DO', 'Family Practice', '', '', NULL, 'O', '98 N 1100 E Ste 302', 'American Fork', 'Utah', 'UT', '84003', '8014922260', '8014922267', '98 N 1100 E Ste 302', 'American Fork', 'Utah', 'UT', '84003', '8014922260', '8014922267', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780671453', 0, 'N', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('870481325', 'W12046408', 'W12046408', 'UT01', 'Westside Medical Clinic', 'Dustin', 'C', 'Jasmer', 'APRN', 'Family Practice', '', '', NULL, 'O', '1477 N 2000 W Ste C', 'Clearfield', 'Davis', 'UT', '84015', '8017748888', '8018258519', '1477 N 2000 W Ste C', 'Clearfield', 'Davis', 'UT', '84015', '8017748888', '8018258519', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275979841', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('820471268', 'W12046676', 'W12046676', 'ID01', 'Sage Health Care', 'Michael', 'B', 'Loegering', 'NP', 'Mental Health', 'Counseling', '', NULL, 'O', '413 N Allumbaugh St Ste 101', 'Boise', 'Ada', 'ID', '83704', '2083231125', '          ', '413 N Allumbaugh St Ste 101', 'Boise', 'Ada', 'ID', '83704', '2083231125', '          ', 'IDARNP', '', '', '0.00', '40.00', '0.00', 6, '2014-04-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1821038704', 0, 'N', 0, '2014-06-05', NULL, NULL, 0, 0, NULL, NULL),
('753143209', 'W12047461', 'W12047461', 'WYT1', 'Big Horn Basin Bone and Joint', 'Glen', 'J', 'Poffenbarger', 'MD', 'Neurosurgery', '', '', NULL, 'O', '720 Lindsay Ln Ste C', 'Cody', 'Park', 'WY', '82414', '3075781955', '3075781979', '720 Lindsay Ln Ste C', 'Cody', 'Park', 'WY', '82414', '3075781955', '3075781979', '', '', '', '0.00', '25.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669469227', 0, 'N', 1, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('752988036', 'W12047459', 'W12047459', 'TXSATSTD', '', 'Khanh', 'G', 'Do', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1439 SW Military Dr', 'San Antonio', 'Bexar', 'TX', '78221', '2109246565', '2109244835', '1439 SW Military Dr', 'San Antonio', 'Bexar', 'TX', '78221', '2109246565', '2109244835', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-06-21', NULL, 0, 0, 0, 'Baptist Medical Center', 'North Central Baptist Hospital', 'North East Baptist Hospital', 'Mission Trail Baptist Hospital', 'HCFA|UB|', '1174672927', 0, 'N', 0, '2014-05-21', NULL, NULL, 0, 0, NULL, NULL),
('830335677', 'W12047429', 'W12047429', 'WYT1', 'Big Country Rehab', 'Emily', '', 'Cook', 'PT', 'Physical Therapy', '', '', NULL, 'O', '521 E 10th St', 'Lusk', 'Niobrara', 'WY', '82225', '3073589464', '3073589330', '521 E 10th St', 'Lusk', 'Niobrara', 'WY', '82225', '3073589464', '3073589330', '', '', '', '0.00', '0.00', '120.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1437113552', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('830335677', 'W12047418', 'W12047418', 'WY01', 'Big Country Rehab', 'Meghann', '', 'Boggs', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 1790', 'Douglas', 'Converse', 'WY', '82633', '3073589464', '3073589330', 'PO Box 1790', 'Douglas', 'Converse', 'WY', '82633', '3073589464', '3073589330', '', '', '', '0.00', '0.00', '120.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1265669287', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('830335677', 'W12047403', 'W12047403', 'WY01', 'Big Country Rehab', 'Charles', '', 'Mangus', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 1790', 'Douglas', 'Converse', 'WY', '82633', '3073589464', '3073589330', 'PO Box 1790', 'Douglas', 'Converse', 'WY', '82633', '3073589464', '3073589330', '', '', '', '0.00', '0.00', '120.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1942264122', 0, 'N', 0, '2014-05-29', NULL, NULL, 0, 0, NULL, NULL),
('830335677', 'W12047401', 'W12047401', 'WY01', 'Big Country Rehab', 'Charles', '', 'Mangus', 'PT', 'Physical Therapy', '', '', NULL, 'O', '525 E Birch', 'Glenrock', 'Converse', 'WY', '82637', '3073589464', '3073589330', '525 E Birch', 'Glenrock', 'Converse', 'WY', '82637', '3073589464', '3073589330', '', '', '', '0.00', '0.00', '120.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1942264122', 0, 'N', 0, '2014-05-29', NULL, NULL, 0, 0, NULL, NULL),
('830335677', 'W12047388', 'W12047388', 'WY01', 'Big Country Rehab', '', '', 'Big Country Rehab', '', 'Physical Therapy', 'Occupational Therapy', '', NULL, 'O', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073589464', '3073589330', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073589464', '3073589330', '', '', '', '0.00', '0.00', '120.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1366493264', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12046154', 'W12046154', 'UTIHCPHY', 'American Fork Surgical Associates', '', '', 'American Fork Surgical Associates', 'GROUP', 'Clinic', '', '', NULL, 'O', '98 N 1100 E Ste 202', 'American Fork', 'Utah', 'UT', '84003', '8014922510', '8014923537', '98 N 1100 E Ste 202', 'American Fork', 'Utah', 'UT', '84003', '8014922510', '8014923537', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2014-03-26', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710136742', 0, 'N', 0, '2014-03-31', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'W12046780', 'W12046780', 'UT01', 'Community Health Centers Inc', 'LaPriel', '', 'Clark', 'APRN', 'Advanced Practice Registered Nurse', '', '', NULL, 'B', '220 W 7200 S Ste A', 'Midvale', 'Salt Lake', 'UT', '84047', '8018583468', '8018583470', '220 W 7200 S Ste A', 'Midvale', 'Salt Lake', 'UT', '84047', '8018583468', '8018583470', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730309998', 0, 'N', 1, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'W12046769', 'W12046769', 'UT01', 'Community Health Centers Inc', 'David', 'K', 'Turok', 'MD', 'Obstetrics and Gynecology', 'Family Practice', '', NULL, 'B', '220 W 7200 S Ste A', 'Midvale', 'Salt Lake', 'UT', '84047', '8018583468', '8018583470', '220 W 7200 S Ste A', 'Midvale', 'Salt Lake', 'UT', '84047', '8018583468', '8018583470', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-21', NULL, 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1568449379', 0, 'N', 0, '2014-04-22', NULL, NULL, 0, 0, NULL, NULL),
('830335677', 'W12047454', 'W12047454', 'WY01', 'Big Country Rehab', 'Jessica', '', 'McWilliams', 'OT', 'Occupational Therapy', '', '', NULL, 'B', 'PO Box 1790', 'Douglas', 'Converse', 'WY', '82633', '3073589464', '3073589330', 'PO Box 1790', 'Douglas', 'Converse', 'WY', '82633', '3073589464', '3073589330', '', '', '', '0.00', '0.00', '120.00', 3, '2030-01-01', '2030-01-01', 0, 0, 0, '', '', '', '', 'HCFA|', '1609107259', 0, 'N', 1, '2014-06-03', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'W12046770', 'W12046770', 'UT01', 'Community Health Centers Inc', 'Thomas', 'C', 'Whittaker', 'MD', 'Family Practice', '', '', NULL, 'B', '220 W 7200 S Ste A', 'Midvale', 'Salt Lake', 'UT', '84047', '8018583468', '8018583470', '220 W 7200 S Ste A', 'Midvale', 'Salt Lake', 'UT', '84047', '8018583468', '8018583470', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770600918', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('830335677', 'W12047435', 'W12047435', 'WY01', 'Big Country Rehab', 'Bonnie', '', 'Richards', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '525 E Birch', 'Glenrock', 'Converse', 'WY', '82637', '3073589464', '3073589330', '525 E Birch', 'Glenrock', 'Converse', 'WY', '82637', '3073589464', '3073589330', '', '', '', '0.00', '0.00', '120.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1558325068', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12048191', 'W12048191', 'IDBOISTD', 'Saint Alphonsus Medical Group Medical Oncology Caldwell', 'Jessica', '', 'Butterfield', 'NP', 'Oncology', '', '', NULL, 'O', '3123 Medical Dr', 'Caldwell', 'Canyon', 'ID', '83605', '2083674810', '2083674817', '3123 Medical Dr', 'Caldwell', 'Canyon', 'ID', '83605', '2083674810', '2083674817', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2013-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1730432352', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12046470', 'W12046470', 'WYBILLINGS', 'Billings Clinic - Electrophysiology', 'Alan', '', 'Thometz', 'MD', 'Cardiovascular Disease', 'Electrophysiology', '', NULL, 'O', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382000', '4062382066', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382000', '4062382066', '', '', '', '0.00', '17.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104925098', 0, 'N', 0, '2014-04-09', NULL, NULL, 0, 0, NULL, NULL),
('830335677', 'W12047424', 'W12047424', 'WY01', 'Big Country Rehab', 'Emily', '', 'Cook', 'PT', 'Physical Therapy', '', '', NULL, 'O', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073589464', '3073589330', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073589464', '3073589330', '', '', '', '0.00', '0.00', '120.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1437113552', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'W12046786', 'W12046786', 'UT01', 'Clinca De Buena Salud Medical', 'Edward', 'H', 'Redd', 'MD', 'Internal Medicine', '', '', NULL, 'O', '14 N 100 E Ste 200', 'Brigham City', 'Box Elder', 'UT', '84302', '4357238276', '4357349761', '14 N 100 E Ste 200', 'Brigham City', 'Box Elder', 'UT', '84302', '4357238276', '4357349761', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1578597647', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('830335677', 'W12047406', 'W12047406', 'WY01', 'Big Country Rehab', 'Jessica', '', 'Mangus', 'PT', 'Physical Therapy', '', '', NULL, 'O', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073589464', '3073589330', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073589464', '3073589330', '', '', '', '0.00', '0.00', '120.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1093060204', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('830335677', 'W12047400', 'W12047400', 'WYT1', 'Big Country Rehab', 'Charles', '', 'Mangus', 'PT', 'Physical Therapy', '', '', NULL, 'O', '521 E 10th St', 'Lusk', 'Niobrara', 'WY', '82225', '3073589464', '3073589330', '521 E 10th St', 'Lusk', 'Niobrara', 'WY', '82225', '3073589464', '3073589330', '', '', '', '0.00', '0.00', '120.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1942264122', 0, 'N', 0, '2014-05-29', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12048112', 'W12048112', 'ID01', 'Saint Alphonsus Employee Assistance Program', 'Susan', '', 'Murphy', 'CADC', 'Mental Health', 'Counseling', '', NULL, 'O', '6140 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083673300', '2083673308', '6140 Emerald St  ', 'Boise', 'Ada', 'ID', '83704', '2083673300', '2083673308', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1457406209', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('870609622', 'W12047969', 'W12047969', 'UT01', 'Snow Canyon Clinic', 'Carl', 'P', 'Hallenborg', 'MD', 'Pulmonary', 'Sleep Medicine', '', NULL, 'O', '2313 Santa Clara Dr Ste J1', 'Santa Clara', 'Washington', 'UT', '84765', '4359862300', '4356563850', '2313 Santa Clara Dr Ste J1', 'Santa Clara', 'Washington', 'UT', '84765', '4359862300', '4356563850', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-03-31', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1508978651', 0, 'N', 0, '2014-05-21', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'W12047484', 'W12047484', 'TXDALSTD', 'Physiatric Medicine Associates', 'Brite', 'J', 'Chalunkal', 'DO', 'Physical Medicine and Rehabilitation', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', 'Baylor University Medical Center', '', '', 'HCFA|UB|', '1790917797', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('680624385', 'W12046127', 'W12046127', 'ID02', 'Eagle Creek Family Medicine', 'Kristina', 'M', 'Huffaker', 'PA', 'Family Practice', '', '', NULL, 'O', '1281 E Iron Eagle Dr', 'Eagle', 'Ada', 'ID', '83616', '2089395535', '2089395536', '1281 E Iron Eagle Dr', 'Eagle', 'Ada', 'ID', '83616', '2089395535', '2089395536', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2014-02-24', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1508142613', 0, 'N', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('462903406', 'W12039347', 'W12039347', 'ID02', 'Peavey Medical PC', 'Elisa', 'A', 'Peavey', 'DO', 'Family Practice', '', '', NULL, 'O', '1219 SW 4th Ave Ste 2', 'Ontario', 'Malheur', 'OR', '97914', '5418892229', '5418894378', '1219 SW 4th Ave Ste 2', 'Ontario', 'Malheur', 'OR', '97914', '5418892229', '5418894378', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-09-23', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1740508480', 0, 'N', 0, '2014-03-28', NULL, NULL, 0, 0, NULL, NULL),
('836000331', 'W12046534', 'W12046534', 'WYT1', 'UW Family Medicine Residency Casper', 'Douglas', '', 'Phipps', 'MD', 'Family Practice', '', '', NULL, 'O', '1522 E A St', 'Casper', 'Natrona', 'WY', '82601', '3072346161', '3072347033', '1522 E A St', 'Casper', 'Natrona', 'WY', '82601', '3072346161', '3072347033', 'WYWISESTD130', 'WUSTDHCPC5', '', '0.00', '0.00', '0.00', 3, '2014-05-01', NULL, 0, 35, 0, 'SageWest Health Care', '', '', '', 'HCFA', '1508952276', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'W12046678', 'W12046678', 'UT01', 'Bear River Community Health Center', '', '', 'Community Health Centers', 'GROUP', 'Primary Care with Extended Hours', '', '', NULL, 'O', '440 W 600 N', 'Tremonton', 'Box Elder', 'UT', '84337', '4357238276', '4357349761', '440 W 600 N', 'Tremonton', 'Box Elder', 'UT', '84337', '4357238276', '4357349761', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-17', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000005779', 0, 'N', 0, '2014-04-22', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12048009', 'W12048009', 'UTIHC04', '', 'Tracie', '', 'Penunuri', 'LCSW', 'Social Worker', '', '', NULL, 'O', '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016623600', '          ', '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016623600', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245666106', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('201773062', 'W12046880', 'W12046880', 'ID01', 'Access Behavioral Health Services Inc', 'Carolyn', '', 'Corbett', 'PMHNP', 'Psychiatry', '', '', NULL, 'O', '1276 River St Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083384699', '2083384699', '1276 River St Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083384699', '2083384699', 'IDARNP', '', '', '0.00', '40.00', '0.00', 6, '2014-06-24', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841529310', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'W12046053', 'W12046053', 'IDBOISTD', 'Saint Alphonsus Medical Group General Surgery Nampa', 'Matthew', 'J', 'McHale', 'DO', 'General Surgery', '', '', NULL, 'O', '401 E Hawaii Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084656940', '2084656961', '401 E Hawaii Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084656940', '2084656961', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2014-03-14', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245431220', 0, 'Y', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'W12046050', 'W12046050', 'IDBOISTD', 'Saint Alphonsus Medical Group Orthopedics Emerald', 'William', 'C', 'Lindner', 'MD; Shoulder, General', 'Orthopedic Surgery', '', '', NULL, 'O', '6500 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083770777', '2083771070', '6500 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083770777', '2083771070', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2014-03-03', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1982649927', 0, 'N', 0, '2014-07-07', NULL, NULL, 0, 0, NULL, NULL),
('931141856', 'W12047207', 'W12047207', 'IDONTSTD', 'Treasure Valley Pediatric Clinic', 'Patricia', '', 'Barfield', 'NP-C', 'Mental Health', 'Counseling', '', NULL, 'O', '1219 SW 4th Ave Ste 1', 'Ontario', 'Malheur', 'OR', '97914', '5418892668', '5418892997', '1219 SW 4th Ave Ste 1', 'Ontario', 'Malheur', 'OR', '97914', '5418892668', '5418892997', 'IDSAMG2', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-05-04', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386860930', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('830335677', 'W12047439', 'W12047439', 'WYT1', 'Big Country Rehab', 'Bonnie', '', 'Richards', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '525 E Birch', 'Glenrock', 'Converse', 'WY', '82637', '3073589464', '3073589330', '525 E Birch', 'Glenrock', 'Converse', 'WY', '82637', '3073589464', '3073589330', '', '', '', '0.00', '0.00', '120.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1558325068', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'W12046554', 'W12046554', 'TXSATSTD', 'Institute for Womens Health', 'Joe', 'R', 'Childress', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '999 E Basse Rd Ste 100', 'San Antonio', 'Bexar', 'TX', '78209', '2106563040', '2106566419', '999 E Basse Rd Ste 100', 'San Antonio', 'Bexar', 'TX', '78209', '2106563040', '2106566419', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2014-04-14', NULL, 0, 0, 0, 'North East Baptist Hospital', '', '', '', 'HCFA|UB|', '1063401271', 0, 'N', 0, '2014-04-11', NULL, NULL, 0, 0, NULL, NULL),
('830335677', 'W12047449', 'W12047449', 'WYT1', 'Big Country Rehab', 'Kelsey', '', 'Nelson', 'OT', 'Occupational Therapy', '', '', NULL, 'B', 'PO Box 1790', 'Douglas', 'Converse', 'WY', '82633', '3073589464', '3073589330', 'PO Box 1790', 'Douglas', 'Converse', 'WY', '82633', '3073589464', '3073589330', '', '', '', '0.00', '0.00', '120.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1417282070', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('870212455', 'W12047472', 'W12047472', 'UTMH1', 'Family Counseling Center', '', '', 'Family Counseling Center', '', 'Mental Health', '', '', NULL, 'O', '5250 S Commerce Dr Ste 250', 'Murray', 'Salt Lake', 'UT', '84107', '8012613500', '8012612111', '5250 S Commerce Dr Ste 250', 'Murray', 'Salt Lake', 'UT', '84107', '8012613500', '8012612111', 'UTMA', '', '', '0.00', '40.00', '0.00', 6, '2030-01-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912343351', 0, 'N', 0, '2014-07-22', NULL, NULL, 0, 0, NULL, NULL),
('870212455', 'W12047474', 'W12047474', 'UTMH1', 'Family Counseling Center', 'LeAnn', '', 'Casto', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '5250 S Commerce Dr Ste 250', 'Murray', 'Salt Lake', 'UT', '84107', '8012613500', '8012612111', '5250 S Commerce Dr Ste 250', 'Murray', 'Salt Lake', 'UT', '84107', '8012613500', '8012612111', 'UTMA', '', '', '0.00', '40.00', '0.00', 6, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639204126', 0, 'N', 0, '2014-07-22', NULL, NULL, 0, 0, NULL, NULL),
('742719352', 'W12046539', 'W12046539', 'TXSATSTD', 'Urology of San Antonio', 'Luis', 'R', 'Rivera', 'MD', 'Urology', '', '', NULL, 'O', '3327 Research Plaza Ste 403', 'San Antonio', 'Bexar', 'TX', '78235', '2103376228', '          ', '3327 Research Plaza Ste 403', 'San Antonio', 'Bexar', 'TX', '78235', '2103376228', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2014-04-08', NULL, 0, 0, 0, 'Mission Trail Baptist Hospital', '', '', '', 'HCFA|UB|', '1780664177', 0, 'N', 0, '2014-04-11', NULL, NULL, 0, 0, NULL, NULL),
('611696015', 'W12045958', 'W12045958', 'UT01', 'MountainStar Behavioral Health', 'Michael', '', 'Roundy', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '630 Medical Dr', 'Bountiful', 'Davis', 'UT', '84010', '8012992186', '8012992416', '630 Medical Dr', 'Bountiful', 'Davis', 'UT', '84010', '8012992186', '8012992416', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB', '1255366696', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('611696015', 'W12045959', 'W12045959', 'UT01', 'MountainStar Behavioral Health', 'Michael', '', 'Roundy', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'B', 'PO Box 742353', 'Atlanta', 'Fulton', 'GA', '30384', '6153737490', '0000000000', 'PO Box 742353', 'Atlanta', 'Fulton', 'GA', '30384', '6153737490', '0000000000', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB', '1255366696', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('364410036', 'W12045962', 'W12045962', 'ILCHIGSTD', 'Laura E Loya Frank MD', 'Laura', '', 'Loya Frank', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '133 E Brush Hill Rd Ste 205', 'Elmhurst', 'Dupage', 'IL', '60126', '7083438512', '7083438529', '133 E Brush Hill Rd Ste 205', 'Elmhurst', 'Dupage', 'IL', '60126', '7083438512', '7083438529', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2014-03-24', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1205895380', 0, 'N', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12045964', 'W12045964', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Reggie', 'M', 'Augusthy', 'DO', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648444', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648444', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2014-03-21', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', '', 'HCFA|UB|', '1760579361', 0, 'N', 0, '2014-03-26', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12045965', 'W12045965', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Reggie', 'M', 'Augusthy', 'DO', 'Physical Medicine and Rehabilitation', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '          ', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2014-03-21', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', '', 'HCFA|UB|', '1760579361', 0, 'N', 0, '2014-03-26', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12045968', 'W12045968', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Sara', 'V', 'Smith', 'MD', 'Pathology', '', '', NULL, 'O', '1870 W Galena Blvd', 'Aurora', 'Kane', 'IL', '60506', '6308596700', '6308597299', '1870 W Galena Blvd', 'Aurora', 'Kane', 'IL', '60506', '6308596700', '6308597299', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2014-03-21', '2014-06-27', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578728168', 0, 'N', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12045969', 'W12045969', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Sara', 'V', 'Smith', 'MD', 'Pathology', '', '', NULL, 'O', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648478', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648478', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2014-03-21', '2014-06-27', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578728168', 0, 'N', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12045967', 'W12045967', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Sara', 'V', 'Smith', 'MD', 'Pathology', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '          ', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '          ', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2014-03-21', '2014-06-27', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578728168', 0, 'N', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12045970', 'W12045970', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'David', 'L', 'Gibson', 'MD', 'Diagnostic Radiology', '', '', NULL, 'O', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2014-03-03', NULL, 0, 0, 0, 'Presence Mercy Medical Center', '', '', '', 'HCFA|UB|', '1225030927', 0, 'Y', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('364088232', 'W12045971', 'W12045971', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Brent', 'T', 'Fonner', 'MD', 'Diagnostic Radiology', '', '', NULL, 'O', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2014-03-03', NULL, 0, 0, 0, 'Presence Mercy Medical Center', '', '', '', 'HCFA|UB|', '1477555308', 0, 'Y', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12045972', 'W12045972', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Edwin', 'H', 'Dolin', 'MD', 'Diagnostic Radiology', '', '', NULL, 'O', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2014-03-03', NULL, 0, 0, 0, 'Presence Mercy Medical Center', '', '', '', 'HCFA|UB|', '1295737195', 0, 'Y', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12045973', 'W12045973', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'David', 'B', 'Wallace', 'MD', 'Diagnostic Radiology', '', '', NULL, 'O', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2014-03-03', NULL, 0, 0, 0, 'Presence Mercy Medical Center', '', '', '', 'HCFA|UB|', '1295736809', 0, 'Y', 0, '2014-04-07', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12045974', 'W12045974', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Aparna', '', 'Vootkur', 'MD', 'Diagnostic Radiology', '', '', NULL, 'O', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2014-03-03', NULL, 0, 0, 0, 'Presence Mercy Medical Center', '', '', '', 'HCFA|UB|', '1477593325', 0, 'Y', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12045975', 'W12045975', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'John', 'R', 'Tauscher', 'MD', 'Diagnostic Radiology', '', '', NULL, 'O', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2014-03-03', NULL, 0, 0, 0, 'Presence Mercy Medical Center', '', '', '', 'HCFA|UB|', '1902894231', 0, 'Y', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12045976', 'W12045976', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Suveer', 'B', 'Tatineni', 'MD', 'Diagnostic Radiology', '', '', NULL, 'O', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2014-03-03', NULL, 0, 0, 0, 'Presence Mercy Medical Center', '', '', '', 'HCFA|UB|', '1275579401', 0, 'Y', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12045981', 'W12045981', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'James', 'D', 'Studio', 'MD', 'Diagnostic Radiology', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '          ', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '          ', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2014-03-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407857015', 0, 'Y', 0, '2014-04-07', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12045979', 'W12045979', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'James', 'D', 'Studio', 'MD', 'Diagnostic Radiology', '', '', NULL, 'O', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648522', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648522', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2014-03-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407857015', 0, 'Y', 0, '2014-04-07', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12045980', 'W12045980', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'James', 'D', 'Studio', 'MD', 'Diagnostic Radiology', '', '', NULL, 'O', '1870 W Galena Blvd', 'Aurora', 'Kane', 'IL', '60506', '6308596700', '6308596811', '1870 W Galena Blvd', 'Aurora', 'Kane', 'IL', '60506', '6308596700', '6308596811', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2014-03-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407857015', 0, 'Y', 0, '2014-04-07', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12045978', 'W12045978', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'James', 'D', 'Studio', 'MD', 'Diagnostic Radiology', '', '', NULL, 'O', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308970180', '6308976044', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308970180', '6308976044', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2014-03-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407857015', 0, 'Y', 0, '2014-04-07', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12045982', 'W12045982', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Bernard', 'G', 'Schupbach', 'MD', 'Diagnostic Radiology', '', '', NULL, 'O', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2014-03-03', NULL, 0, 0, 0, 'Presence Mercy Medical Center', '', '', '', 'HCFA|UB|', '1407857287', 0, 'Y', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12045983', 'W12045983', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'John', 'M', 'Plotke', 'MD', 'Diagnostic Radiology', '', '', NULL, 'O', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2014-03-03', NULL, 0, 0, 0, 'Presence Mercy Medical Center', '', '', '', 'HCFA|UB|', '1154322857', 0, 'Y', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12045984', 'W12045984', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Gregory', 'G', 'Neri', 'MD', 'Radiology', '', '', NULL, 'O', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2014-03-03', NULL, 0, 0, 0, 'Presence Mercy Medical Center', '', '', '', 'HCFA|UB|', '1679607485', 0, 'Y', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12045985', 'W12045985', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'James', '', 'Lee', 'MD', 'Diagnostic Radiology', '', '', NULL, 'O', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2014-03-03', NULL, 0, 0, 0, 'Presence Mercy Medical Center', '', '', '', 'HCFA|UB|', '1598767295', 0, 'Y', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12045986', 'W12045986', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Sandy', 'M', 'Kwak', 'MD', 'Diagnostic Radiology', '', '', NULL, 'O', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2014-03-03', NULL, 0, 0, 0, 'Presence Mercy Medical Center', '', '', '', 'HCFA|UB|', '1033148291', 0, 'Y', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12045987', 'W12045987', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Joseph', 'A', 'Kmiecik', 'MD', 'Radiology', '', '', NULL, 'O', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2014-03-03', NULL, 0, 0, 0, 'Presence Mercy Medical Center', '', '', '', 'HCFA|UB|', '1942317839', 0, 'Y', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12045988', 'W12045988', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Stephen', 'J', 'Kim', 'MD', 'Radiology', '', '', NULL, 'O', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2014-03-03', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', '', 'HCFA|UB|', '1992967293', 0, 'N', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12045989', 'W12045989', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Nicholas', 'D', 'Kennedy', 'MD', 'Diagnostic Radiology', '', '', NULL, 'O', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2014-03-03', NULL, 0, 0, 0, 'Presence Mercy Medical Center', '', '', '', 'HCFA|UB|', '1447416235', 0, 'Y', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12045990', 'W12045990', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Helen', 'M', 'Kellett', 'MD', 'Diagnostic Radiology', '', '', NULL, 'O', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2014-03-03', NULL, 0, 0, 0, 'Presence Mercy Medical Center', '', '', '', 'HCFA|UB|', '1659373587', 0, 'Y', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12045991', 'W12045991', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Michael', 'J', 'Hutchinson', 'MD', 'Diagnostic Radiology', '', '', NULL, 'O', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2014-03-03', NULL, 0, 0, 0, 'Presence Mercy Medical Center', '', '', '', 'HCFA|UB|', '1376707513', 0, 'Y', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('900944023', 'W12045992', 'W12045992', 'TXDALSTD', 'Baylor Emergency Medical Center', '', '', 'Baylor Emergency Medical Center', '', 'Hospital', '', '', NULL, 'O', '1975 Alpha Rd Ste 100', 'Rockwall', 'Rockwall', 'TX', '75087', '2142946200', NULL, '1975 Alpha Rd Ste 100', 'Rockwall', 'Rockwall', 'TX', '75087', '2142946200', '          ', '', '', 'BAYHEALTHD', '0.00', '0.00', '0.00', 3, '2014-03-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952732653', 0, 'N', 0, '2014-03-26', NULL, NULL, 0, 0, NULL, NULL),
('900944023', 'W12045993', 'W12045993', 'TXDALSTD', 'Baylor Emergency Medical Center', '', '', 'Baylor Emergency Medical Center', '', 'Hospital', '', '', NULL, 'B', 'PO Box 46023', 'Houston', 'Harris', 'TX', '77210', '2142946200', NULL, 'PO Box 46023', 'Houston', 'Harris', 'TX', '77210', '2142946200', '          ', '', '', 'BAYHEALTHD', '0.00', '0.00', '0.00', 3, '2014-03-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952732653', 0, 'N', 0, '2014-03-26', NULL, NULL, 0, 0, NULL, NULL),
('300038860', 'W12045995', 'W12045995', 'TXHOUSTD', 'Lone Star Family Health Center', 'Christina', '', 'Ho', 'DO', 'Family Practice', '', '', NULL, 'O', 'PO Box 3180', 'Houston', 'Harris', 'TX', '77253', '9365394004', '0000000000', 'PO Box 3180', 'Houston', 'Harris', 'TX', '77253', '9365394004', '0000000000', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-11-03', NULL, 0, 0, 0, NULL, NULL, '', '', 'HCFA|UB', '1508136227', 0, 'N', 0, '2014-04-04', NULL, NULL, 0, 0, NULL, NULL),
('201831246', 'W12045997', 'W12045997', 'TXDALSTD', 'Family Health Services', 'Alexandra', 'E', 'Akra', 'PA-C', 'Family Practice', '', '', NULL, 'O', '4305 S Hulen St', 'Fort Worth', 'Tarrant', 'TX', '76109', '8179274600', '8179274604', '4305 S Hulen St', 'Fort Worth', 'Tarrant', 'TX', '76109', '8179274600', '8179274604', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245667559', 0, 'N', 0, '2014-03-26', NULL, NULL, 0, 0, NULL, NULL),
('262345602', 'W12045999', 'W12045999', 'TXDALSTD', 'Wise Family Practice Urgent Care', 'Natashia', 'T', 'Jones-Dobbins', 'DO', 'Family Practice', '', '', NULL, 'O', '2351 S FM 51 Ste 100', 'Decatur', 'Wise', 'TX', '76234', '9406262110', '9406262113', '2351 S FM 51 Ste 100', 'Decatur', 'Wise', 'TX', '76234', '9406262110', '9406262113', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487804910', 0, 'N', 0, '2014-03-26', NULL, NULL, 0, 0, NULL, NULL),
('043767348', 'W12046002', 'W12046002', 'TXDALSTD', 'Metroplex Pediatrics PA', 'Raymona', 'N', 'Wilburn', 'ANP', 'Pediatrics', '', '', NULL, 'O', '900 Jerome St Ste 102', 'Fort Worth', 'Tarrant', 'TX', '76104', '8173869900', '8173869910', '900 Jerome St Ste 102', 'Fort Worth', 'Tarrant', 'TX', '76104', '8173869900', '8173869910', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902232754', 0, 'N', 0, '2014-03-26', NULL, NULL, 0, 0, NULL, NULL),
('043767348', 'W12046001', 'W12046001', 'TXDALSTD', 'Metroplex Pediatrics PA', 'Raymona', 'N', 'Wilburn', 'ANP', 'Pediatrics', '', '', NULL, 'O', '6010 Curzon Ave Ste B', 'Fort Worth', 'Tarrant', 'TX', '76116', '8173869900', '8173869910', '6010 Curzon Ave Ste B', 'Fort Worth', 'Tarrant', 'TX', '76116', '8173869900', '8173869910', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902232754', 0, 'N', 0, '2014-03-26', NULL, NULL, 0, 0, NULL, NULL),
('141903853', 'W12046006', 'W12046006', 'TXDALSTD', 'JRC Healthcare', 'Cecilier', 'Hua', 'Chen', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2828 W Parker Rd Ste 102B', 'Plano', 'Collin', 'TX', '75075', '9723518907', '9729437770', '2828 W Parker Rd Ste 102B', 'Plano', 'Collin', 'TX', '75075', '9723518907', '9729437770', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053348847', 0, 'N', 0, '2014-03-26', NULL, NULL, 0, 0, NULL, NULL),
('141903853', 'W12046007', 'W12046007', 'TXDALSTD', 'JRC Healthcare', 'Cecilier', 'Hua', 'Chen', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 911294', 'Dallas', 'Dallas', 'TX', '75391', '8178528445', '0000000000', 'PO Box 911294', 'Dallas', 'Dallas', 'TX', '75391', '8178528445', '0000000000', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053348847', 0, 'N', 0, '2014-03-26', NULL, NULL, 0, 0, NULL, NULL),
('161676686', 'W12046004', 'W12046004', 'TXDALSTD', 'JPS Family Health Center', 'Cecilier', 'Hua', 'Chen', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1500 S Main St', 'Fort Worth', 'Tarrant', 'TX', '76104', '8179271398', '8179273603', '1500 S Main St', 'Fort Worth', 'Tarrant', 'TX', '76104', '8179271398', '8179273603', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053348847', 0, 'N', 0, '2014-03-26', NULL, NULL, 0, 0, NULL, NULL),
('161676686', 'W12046005', 'W12046005', 'TXDALSTD', 'JPS Family Health Center', 'Cecilier', 'Hua', 'Chen', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 911294', 'Dallas', 'Dallas', 'TX', '75391', '8178528450', '8178528445', 'PO Box 911294', 'Dallas', 'Dallas', 'TX', '75391', '8178528450', '8178528445', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053348847', 0, 'N', 0, '2014-04-10', NULL, NULL, 0, 0, NULL, NULL),
('820161600', 'W12046008', 'W12046008', 'IDREC', 'St Lukes Pediatrics Endocrinology (Recognized PPO but not contracted pre-auth required)', 'Daniel', '', 'Flynn', '', 'Pediatric Endocrinology', '', '', NULL, 'O', '222 N 2nd St Ste 215', 'Boise', 'Ada', 'ID', '83702', '2083817340', NULL, '222 N 2nd St Ste 215', 'Boise', 'Ada', 'ID', '83702', '2083817340', '          ', '', '', '', '0.00', '0.00', '0.00', 8, '2014-03-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1447449574', 0, 'N', 0, '2014-03-26', NULL, NULL, 0, 0, NULL, NULL),
('841421665', 'W12046010', 'W12046010', 'Sinclair', '(Sinclair Health Services \rProvider) St Lukes Wood River Medical Center ', 'James', 'H', 'Cleveland', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'O', '100 Hospital Dr Anesthesia Dept', 'Ketchum', 'Blaine', 'ID', '83340', '2087278638', '2087278684', '100 Hospital Dr Anesthesia Dept', 'Ketchum', 'Blaine', 'ID', '83340', '2087278638', '2087278684', '', '', '', '0.00', '14.00', '0.00', 3, '2014-03-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265624290', 0, 'N', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('841421665', 'W12046011', 'W12046011', 'Sinclair', '(Sinclair Health Services \rProvider) St Lukes Wood River Medical Center ', 'James', 'H', 'Cleveland', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'B', 'PO Box 100', 'Ketchum', 'Blaine', 'ID', '83340', '2087278638', '2087278684', 'PO Box 100', 'Ketchum', 'Blaine', 'ID', '83340', '2087278638', '2087278684', '', '', '', '0.00', '14.00', '0.00', 3, '2014-03-03', '2014-06-11', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265624290', 0, 'N', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('841421665', 'W12046013', 'W12046013', 'Sinclair', '(Sinclair Health Services \rProvider) St Lukes Wood River Medical Center ', 'John', 'J', 'Driscoll', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'O', '100 Hospital Dr Anesthesia Dept', 'Ketchum', 'Blaine', 'ID', '83340', '2087278638', '2087278684', '100 Hospital Dr Anesthesia Dept', 'Ketchum', 'Blaine', 'ID', '83340', '2087278638', '2087278684', '', '', '', '0.00', '14.00', '0.00', 3, '2014-03-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437341468', 0, 'N', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('841421665', 'W12046014', 'W12046014', 'Sinclair', '(Sinclair Health Services \rProvider) St Lukes Wood River Medical Center ', 'John', 'J', 'Driscoll', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'B', 'PO Box 100', 'Ketchum', 'Blaine', 'ID', '83340', '2087278638', '2087278684', 'PO Box 100', 'Ketchum', 'Blaine', 'ID', '83340', '2087278638', '2087278684', '', '', '', '0.00', '14.00', '0.00', 3, '2014-03-03', '2014-06-09', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437341468', 0, 'N', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('841421665', 'W12046015', 'W12046015', 'Sinclair', '(Sinclair Health Services \rProvider) St Lukes Wood River Medical Center ', 'Steven', 'C', 'Funk', 'MD', 'Anesthesiology', '', '', NULL, 'O', '100 Hospital Dr', 'Ketchum', 'Blaine', 'ID', '83340', '2087278638', '2087278684', '100 Hospital Dr', 'Ketchum', 'Blaine', 'ID', '83340', '2087278638', '2087278684', '', '', '', '0.00', '14.00', '0.00', 3, '2014-03-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245259894', 0, 'Y', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('841421665', 'W12046016', 'W12046016', 'Sinclair', '(Sinclair Health Services \rProvider) St Lukes Wood River Medical Center ', 'Steven', 'C', 'Funk', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 100', 'Ketchum', 'Blaine', 'ID', '83340', '2087278638', '2087278684', 'PO Box 100', 'Ketchum', 'Blaine', 'ID', '83340', '2087278638', '2087278684', '', '', '', '0.00', '14.00', '0.00', 3, '2014-03-03', '2014-06-09', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245259894', 0, 'Y', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('841421665', 'W12046018', 'W12046018', 'Sinclair', '(Sinclair Health Services \rProvider) St Lukes Wood River Medical Center ', 'Nathan', 'G', 'Seedall', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'O', '3100 Channing Wy', 'Idaho Falls', 'Bonneville', 'ID', '83401', '2085296775', '2085297056', '3100 Channing Wy', 'Idaho Falls', 'Bonneville', 'ID', '83401', '2085296775', '2085297056', '', '', '', '0.00', '14.00', '0.00', 3, '2014-03-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992740716', 0, 'N', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('841421665', 'W12046020', 'W12046020', 'Sinclair', '(Sinclair Health Services \rProvider) St Lukes Wood River Medical Center ', 'Jeffrey', 'L', 'Taylor', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'B', '4688 Majestiic View Dr', 'Idaho Falls', 'Bonneville', 'ID', '83406', '0000000000', '0000000000', '4688 Majestiic View Dr', 'Idaho Falls', 'Bonneville', 'ID', '83406', '0000000000', '0000000000', '', '', '', '0.00', '14.00', '0.00', 3, '2014-03-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306870498', 0, 'N', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('841421665', 'W12046022', 'W12046022', 'Sinclair', '(Sinclair Health Services \rProvider) St Lukes Wood River Medical Center ', 'Albert', '', 'Trearse', 'MD', 'Anesthesiology', '', '', NULL, 'O', '100 Hospital Dr Anesthesia Dept', 'Ketchum', 'Blaine', 'ID', '83340', '2087278638', '2087278684', '100 Hospital Dr Anesthesia Dept', 'Ketchum', 'Blaine', 'ID', '83340', '2087278638', '2087278684', '', '', '', '0.00', '14.00', '0.00', 3, '2014-03-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508864851', 0, 'Y', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('841421665', 'W12046021', 'W12046021', 'Sinclair', '(Sinclair Health Services \rProvider) St Lukes Wood River Medical Center ', 'Albert', '', 'Trearse', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 100', 'Ketchum', 'Blaine', 'ID', '83340', '2087278638', '2087278684', 'PO Box 100', 'Ketchum', 'Blaine', 'ID', '83340', '2087278638', '2087278684', '', '', '', '0.00', '14.00', '0.00', 3, '2014-03-03', '2014-06-09', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508864851', 0, 'Y', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('841421665', 'W12046025', 'W12046025', 'Sinclair', '(Sinclair Health Services \rProvider) St Lukes Wood River Medical Center ', 'Walter', 'J', 'Trudo', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'B', '5258 Treyden Dr', 'Idaho Falls', 'Bonneville', 'ID', '83406', '0000000000', '0000000000', '5258 Treyden Dr', 'Idaho Falls', 'Bonneville', 'ID', '83406', '0000000000', '0000000000', '', '', '', '0.00', '14.00', '0.00', 3, '2014-03-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841243474', 0, 'N', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('460906063', 'W12046026', 'W12046026', 'UTMH1', 'The Counseling Center', 'Karen', '', 'Redd', 'CMHC', 'Mental Health', 'Counseling', '', NULL, 'O', '535 E 500 S Ste 7', 'Bountiful', 'Davis', 'UT', '84010', '8012982000', '8019511490', '535 E 500 S Ste 7', 'Bountiful', 'Davis', 'UT', '84010', '8012982000', '8019511490', 'UTMA', '', '', '0.00', '40.00', '0.00', 3, '2014-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114266988', 0, 'N', 0, '2014-03-26', NULL, NULL, 0, 0, NULL, NULL),
('870179340', 'W12046027', 'W12046027', 'UT01', 'Standard Optical', 'Brent', 'L', 'Hadlock', 'OD', 'Optometry', '', '', NULL, 'O', '5289 S State St', 'Murray', 'Salt Lake', 'UT', '84107', '8015061111', '8015062021', '5289 S State St', 'Murray', 'Salt Lake', 'UT', '84107', '8015061111', '8015062021', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1100799934', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('870179340', 'W12046028', 'W12046028', 'UT01', 'Standard Optical', 'Brent', 'L', 'Hadlock', 'OD', 'Optometry', '', '', NULL, 'O', '1901 W Pkwy Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019720203', '          ', '1901 W Pkwy Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019720203', '          ', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1100799934', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('870557015', 'W12046029', 'W12046029', 'UTMH1', 'UIPT', 'Penny', 'B', 'Jameson', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '1801 S 2600 E', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8013500118', NULL, '1801 S 2600 E', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8013500118', '          ', 'PHD', '', '', '0.00', '40.00', '0.00', 3, '2014-03-24', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1334125776', 0, 'N', 0, '2014-03-26', NULL, NULL, 0, 0, NULL, NULL),
('364600437', 'W12046030', 'W12046030', 'ILCHIGSTD', 'Advanced Renal Care', 'Anis', 'A', 'Rauf', 'DO', 'Nephrology', '', '', NULL, 'O', '911 Elm St Ste 102', 'Hinsdale', 'Dupage', 'IL', '60521', '6304959356', '6304959357', '911 Elm St Ste 102', 'Hinsdale', 'Dupage', 'IL', '60521', '6304959356', '6304959357', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2014-03-25', NULL, 0, 0, 0, 'Edward Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1639259740', 0, 'N', 0, '2014-03-26', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'W12046031', 'W12046031', 'UT01', 'Ogden Clinic', 'Amanda', '', 'Sumrall', 'SLP', 'Speech Therapy', '', '', NULL, 'O', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753000', '8014753076', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753000', '8014753076', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861839805', 0, 'N', 0, '2014-04-18', NULL, NULL, 0, 0, NULL, NULL),
('061506129', 'W12046032', 'W12046032', 'UT01', 'Wee Care Pediatrics', 'Kurtis', 'R', 'Smith', 'APRN', 'Family Practice', '', '', NULL, 'O', '2084 N 1700 W Ste A', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8019271591', '2084 N 1700 W Ste A', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8019271591', 'WUSTDPEDE5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326475476', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('061506129', 'W12046033', 'W12046033', 'UT01', 'Wee Care Pediatrics', 'Kurtis', 'R', 'Smith', 'APRN', 'Family Practice', '', '', NULL, 'O', '934 S Main St Ste 8', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8015936188', '934 S Main St Ste 8', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8015936188', 'WUSTDPEDE5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326475476', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('061506129', 'W12046034', 'W12046034', 'UT01', 'Wee Care Pediatrics', 'Kurtis', 'R', 'Smith', 'APRN', 'Family Practice', '', '', NULL, 'M', '2086 N 1700 W Ste C', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8019271591', '2086 N 1700 W Ste C', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8019271591', 'WUSTDPEDE5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326475476', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('061506129', 'W12046035', 'W12046035', 'UT01', 'Wee Care Pediatrics', 'Kurtis', 'R', 'Smith', 'APRN', 'Family Practice', '', '', NULL, 'B', 'Dept 1310', 'Denver', 'Denver', 'CO', '80256', '8019271562', '8019271591', 'Dept 1310', 'Denver', 'Denver', 'CO', '80256', '8019271562', '8019271591', 'WUSTDPEDE5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326475476', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12046038', 'W12046038', 'UT01', 'Central Utah Clinic PC', 'Bryce', 'D', 'Haslem', 'MD', 'Gastroenterology', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014298180', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014298180', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2030-01-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', 'Mountain View Hospital', '', '', 'HCFA|UB|', '1124286133', 0, 'N', 1, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12046036', 'W12046036', 'UT01', 'Central Utah Clinic PC', 'Bryce', 'D', 'Haslem', 'MD', 'Gastroenterology', '', '', NULL, 'O', '1055 N 500 W Ste 100 Bldg B', 'Provo', 'Utah', 'UT', '84604', '8013741268', '8014298041', '1055 N 500 W Ste 100 Bldg B', 'Provo', 'Utah', 'UT', '84604', '8013741268', '8014298041', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2030-01-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', 'Mountain View Hospital', '', '', 'HCFA|UB|', '1124286133', 0, 'N', 1, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12046037', 'W12046037', 'UT01', 'Central Utah Clinic PC', 'Bryce', 'D', 'Haslem', 'MD', 'Gastroenterology', '', '', NULL, 'B', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013548225', '8014180941', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013548225', '8014180941', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2030-01-02', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', 'Mountain View Hospital', '', '', 'HCFA|UB|', '1124286133', 0, 'N', 1, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('621762570', 'W12046040', 'W12046040', 'UT01', 'Ashley Valley Physician Practices', 'Shaun', 'C', 'Shurtliff', 'DO', 'Family Practice', '', '', NULL, 'B', '175 N 100 W Ste 204', 'Vernal', 'Uintah', 'UT', '84078', '4357253327', '4357253331', '175 N 100 W Ste 204', 'Vernal', 'Uintah', 'UT', '84078', '4357253327', '4357253331', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-04-15', NULL, 0, 0, 0, 'Ashley Valley Regional Medical', '', '', '', 'HCFA|UB|', '1285719294', 0, 'N', 0, '2014-06-27', NULL, NULL, 0, 0, NULL, NULL),
('621762570', 'W12046039', 'W12046039', 'UT01', 'Ashley Valley Physician Practices', 'Shaun', 'C', 'Shurtliff', 'DO', 'Family Practice', '', '', NULL, 'O', '409 S 200 E', 'Roosevelt', 'Duchesne', 'UT', '84066', '4357253327', '4357253331', '409 S 200 E', 'Roosevelt', 'Duchesne', 'UT', '84066', '4357253327', '4357253331', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-04-15', NULL, 0, 0, 0, 'Ashley Valley Regional Medical', '', '', '', 'HCFA|UB|', '1285719294', 0, 'N', 0, '2014-06-27', NULL, NULL, 0, 0, NULL, NULL),
('460792228', 'W12046399', 'W12046399', 'TXSATSTD', 'Mission Trails Family Health', 'Jane', 'E', 'Lee', 'DO', 'Family Practice', '', '', NULL, 'M', '11212 Hwy 151 Ste 240', 'San Antonio', 'Bexar', 'TX', '78251', '2105708500', '2102760493', '11212 Hwy 151 Ste 240', 'San Antonio', 'Bexar', 'TX', '78251', '2105708500', '2102760493', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730400854', 0, 'N', 0, '2014-04-18', NULL, NULL, 0, 0, NULL, NULL),
('464073830', 'W12046044', 'W12046044', 'TXSATSTD', 'Alamo Eye Care', 'Melanie', 'J', 'Frogozo', 'OD', 'Optometry', '', '', NULL, 'O', '1742 N Loop 1604 E Ste 118', 'San Antonio', 'Bexar', 'TX', '78232', '2104039050', '2104039939', '1742 N Loop 1604 E Ste 118', 'San Antonio', 'Bexar', 'TX', '78232', '2104039050', '2104039939', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1992961874', 0, 'N', 0, '2014-04-15', NULL, NULL, 0, 0, NULL, NULL),
('460792228', 'W12046398', 'W12046398', 'TXSATSTD', 'Mission Trails Family Health', 'Jane', 'E', 'Lee', 'DO', 'Family Practice', '', '', NULL, 'O', '3327 Research Plaza Ste 103', 'San Antonio', 'Bexar', 'TX', '78235', '2105708500', '2102760493', '3327 Research Plaza Ste 103', 'San Antonio', 'Bexar', 'TX', '78235', '2105708500', '2102760493', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730400854', 0, 'N', 0, '2014-04-18', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'W12046051', 'W12046051', 'IDBOISTD', 'Saint Alphonsus Medical Group Heart Care', 'J Antonio', 'G', 'Lopez', 'MD', 'Cardiology', '', '', NULL, 'O', '1024 E Locust', 'Emmett', 'Gem', 'ID', '83617', '2083678484', '2083678456', '1024 E Locust', 'Emmett', 'Gem', 'ID', '83617', '2083678484', '2083678456', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2014-03-03', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1326011503', 0, 'Y', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'W12046054', 'W12046054', 'IDBOISTD', 'Saint Alphonsus Medical Group Heart Care', 'Charles', 'M', 'Rasmussen', 'MD', 'Cardiology', '', '', NULL, 'O', '1024 E Locust', 'Emmett', 'Gem', 'ID', '83617', '2083678484', '2083678456', '1024 E Locust', 'Emmett', 'Gem', 'ID', '83617', '2083678484', '2083678456', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2014-03-03', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1881611424', 0, 'N', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'W12046055', 'W12046055', 'IDBOISTD', 'Saint Alphonsus Medical Group Orthopedics Emerald', 'Katherine', 'R', 'Reed', 'NP', 'Orthopedic Surgery', 'Family Practice', '', NULL, 'O', '6500 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083770777', '2083771070', '6500 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083770777', '2083771070', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2014-03-03', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1588807838', 0, 'N', 0, '2014-07-07', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'W12046056', 'W12046056', 'IDBOISTD', 'Saint Alphonsus Medical Group Heart Care', 'Donald', 'K', 'Stott', 'MD', 'Cardiology', '', '', NULL, 'O', '1024 E Locust', 'Emmett', 'Gem', 'ID', '83617', '2083678484', '2083678456', '1024 E Locust', 'Emmett', 'Gem', 'ID', '83617', '2083678484', '2083678456', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2014-03-03', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1649264003', 0, 'Y', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'W12046060', 'W12046060', 'ID01', 'Idaho Emergency Physicians PA', 'Charles', '', 'Reynolds', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '1717 Arlington', 'Caldwell', 'Canyon', 'ID', '83605', '2083221730', '2083221731', '1717 Arlington', 'Caldwell', 'Canyon', 'ID', '83605', '2083221730', '2083221731', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2014-03-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073770400', 0, 'N', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'W12046058', 'W12046058', 'ID01', 'Idaho Emergency Physicians PA', 'Charles', '', 'Reynolds', 'MD', 'Emergency Medicine', '', '', NULL, 'o', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83704', '2083221730', '2083221731', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83704', '2083221730', '2083221731', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2014-03-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073770400', 0, 'N', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'W12046059', 'W12046059', 'ID01', 'Idaho Emergency Physicians PA', 'Charles', '', 'Reynolds', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2083221730', '2083221731', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2083221730', '2083221731', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2014-03-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073770400', 0, 'N', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'W12046061', 'W12046061', 'ID01', 'Idaho Emergency Physicians PA', 'Charles', '', 'Reynolds', 'MD', 'Emergency Medicine', '', '', NULL, 'o', '323 E Riverside Dr', 'Eagle', 'Ada', 'ID', '83616', '2083221730', '2083221731', '323 E Riverside Dr', 'Eagle', 'Ada', 'ID', '83616', '2083221730', '2083221731', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2014-03-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073770400', 0, 'N', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'W12046062', 'W12046062', 'ID01', 'Idaho Emergency Physicians PA', 'Charles', '', 'Reynolds', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2083221730', '2083221731', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2083221730', '2083221731', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2014-03-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073770400', 0, 'N', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046063', 'W12046063', 'IDBOISTD', 'Saint Alphonsus Medical Group Overland Family Medicine', 'Anthony', '', 'Millward', 'PA', 'Family Practice', '', '', NULL, 'O', '10255 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083677205', '2083677204', '10255 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083677205', '2083677204', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-01-23', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1609889252', 0, 'Y', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046064', 'W12046064', 'IDBOISTD', 'Saint Alphonsus Medical Group Boise Pediatrics Mulvaney', 'Anthony', '', 'Millward', 'PA', 'Family Practice', '', '', NULL, 'O', '1072 N Liberty Ste 203', 'Boise', 'Ada', 'ID', '83704', '2083674321', '2083674525', '1072 N Liberty Ste 203', 'Boise', 'Ada', 'ID', '83704', '2083674321', '2083674525', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-01-23', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1609889252', 0, 'Y', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046065', 'W12046065', 'IDBOISTD', 'Saint Alphonsus Medical Group Express Care Carrington', 'Anthony', '', 'Millward', 'PA', 'Family Practice', '', '', NULL, 'O', '1122 N Liberty Rd', 'Boise', 'Ada', 'ID', '83704', '2083672032', '2083672033', '1122 N Liberty Rd', 'Boise', 'Ada', 'ID', '83704', '2083672032', '2083672033', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-01-23', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1609889252', 0, 'Y', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046066', 'W12046066', 'IDBOISTD', 'Saint Alphonsus Medical Group McMillan Family Medicine', 'Anthony', '', 'Millward', 'PA', 'Family Practice', '', '', NULL, 'O', '12273 W McMillan Rd', 'Boise', 'Ada', 'ID', '83713', '2083676330', '2083674765', '12273 W McMillan Rd', 'Boise', 'Ada', 'ID', '83713', '2083676330', '2083674765', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-01-23', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1609889252', 0, 'Y', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046067', 'W12046067', 'IDBOISTD', 'Saint Alphonsus Medical Group Express Clinics', 'Anthony', '', 'Millward', 'PA', 'Family Practice', '', '', NULL, 'O', '1515 W State St', 'Boise', 'Ada', 'ID', '83702', '2083456768', '          ', '1515 W State St', 'Boise', 'Ada', 'ID', '83702', '2083456768', '          ', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-01-23', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1609889252', 0, 'Y', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046068', 'W12046068', 'IDBOISTD', 'Saint Alphonsus Medical Group Shoreline Family Medicine', 'Anthony', '', 'Millward', 'PA', 'Family Practice', '', '', NULL, 'O', '1673 W Shoreline Dr Ste 120', 'Boise', 'Ada', 'ID', '83702', '2083678383', '2083677171', '1673 W Shoreline Dr Ste 120', 'Boise', 'Ada', 'ID', '83702', '2083678383', '2083677171', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-01-23', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1609889252', 0, 'Y', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046069', 'W12046069', 'IDBOISTD', 'Saint Alphonsus Medical Group Kuna Family Medicine', 'Anthony', '', 'Millward', 'PA', 'Family Practice', '', '', NULL, 'O', '757 E Wythe Creek Ct', 'Kuna', 'Ada', 'ID', '83634', '2083673366', '2083672070', '757 E Wythe Creek Ct', 'Kuna', 'Ada', 'ID', '83634', '2083673366', '2083672070', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-01-23', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1609889252', 0, 'Y', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046070', 'W12046070', 'IDBOISTD', 'Saint Alphonsus Medical Group Federal Way Family Medicine', 'Anthony', '', 'Millward', 'PA', 'Family Practice', '', '', NULL, 'O', '1880 W Judith Ln', 'Boise', 'Ada', 'ID', '83705', '2083676910', '2083676170', '1880 W Judith Ln', 'Boise', 'Ada', 'ID', '83705', '2083676910', '2083676170', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-01-23', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1609889252', 0, 'Y', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046072', 'W12046072', 'IDBOISTD', 'Saint Alphonsus Medical Group EHP Family Medicine', 'Anthony', '', 'Millward', 'PA', 'Family Practice', '', '', NULL, 'O', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-01-23', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1609889252', 0, 'Y', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046073', 'W12046073', 'IDBOISTD', 'Saint Alphonsus Medical Group Occupational Med EHP', 'Anthony', '', 'Millward', 'PA', 'Family Practice', '', '', NULL, 'O', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-01-24', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1609889252', 0, 'Y', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046074', 'W12046074', 'IDBOISTD', 'Saint Alphonsus Medical Group Express Care Clinics', 'Anthony', '', 'Millward', 'PA', 'Family Practice', '', '', NULL, 'O', '4700 N Eagle Rd', 'Boise', 'Ada', 'ID', '83713', '2089384797', '0000000000', '4700 N Eagle Rd', 'Boise', 'Ada', 'ID', '83713', '2089384797', '0000000000', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-01-23', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1609889252', 0, 'Y', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046075', 'W12046075', 'IDBOISTD', 'Saint Alphonsus Medical Group Curtisian Internal Medicine', 'Anthony', '', 'Millward', 'PA', 'Family Practice', '', '', NULL, 'O', '6140 W Curtisian Ave Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083676575', '2083676597', '6140 W Curtisian Ave Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083676575', '2083676597', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-01-23', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1609889252', 0, 'Y', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046076', 'W12046076', 'IDBOISTD', 'Saint Alphonsus Medical Group Emerald Family Medicine', 'Anthony', '', 'Millward', 'PA', 'Family Practice', '', '', NULL, 'O', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-01-23', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1609889252', 0, 'Y', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046077', 'W12046077', 'IDBOISTD', 'Saint Alphonsus Medical Group Occupational Med Emerald', 'Anthony', '', 'Millward', 'PA', 'Family Practice', '', '', NULL, 'O', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674179', '2083678136', '6533 Emerald St  ', 'Boise', 'Ada', 'ID', '83704', '2083674179', '2083678136', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-01-24', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1609889252', 0, 'Y', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046079', 'W12046079', 'IDBOISTD', 'Saint Alphonsus Medical Group Overland Family Medicine', 'Joseph', 'S', 'Robinson', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '10255 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083677205', '2083677204', '10255 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083677205', '2083677204', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-03-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1710315577', 0, 'Y', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046080', 'W12046080', 'IDBOISTD', 'Saint Alphonsus Medical Group Boise Pediatrics Mulvaney', 'Joseph', 'S', 'Robinson', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '1072 N Liberty Ste 203', 'Boise', 'Ada', 'ID', '83704', '2083674321', '2083674525', '1072 N Liberty Ste 203', 'Boise', 'Ada', 'ID', '83704', '2083674321', '2083674525', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-03-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1710315577', 0, 'Y', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046081', 'W12046081', 'IDBOISTD', 'Saint Alphonsus Medical Group Express Care Carrington', 'Joseph', 'S', 'Robinson', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '1122 N Liberty Rd', 'Boise', 'Ada', 'ID', '83704', '2083672032', '2083672033', '1122 N Liberty Rd', 'Boise', 'Ada', 'ID', '83704', '2083672032', '2083672033', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-03-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1710315577', 0, 'Y', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046082', 'W12046082', 'IDBOISTD', 'Saint Alphonsus Medical Group Garrity Family Medicine', 'Joseph', 'S', 'Robinson', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-03-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1710315577', 0, 'Y', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046083', 'W12046083', 'IDBOISTD', 'Saint Alphonsus Medical Group McMillan Family Medicine', 'Joseph', 'S', 'Robinson', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '12273 W McMillan Rd', 'Boise', 'Ada', 'ID', '83713', '2083676330', '2083674765', '12273 W McMillan Rd', 'Boise', 'Ada', 'ID', '83713', '2083676330', '2083674765', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-03-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1710315577', 0, 'Y', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046084', 'W12046084', 'IDBOISTD', 'Saint Alphonsus Medical Group Express Clinics', 'Joseph', 'S', 'Robinson', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '1515 W State St', 'Boise', 'Ada', 'ID', '83702', '2083456768', '          ', '1515 W State St', 'Boise', 'Ada', 'ID', '83702', '2083456768', '          ', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-03-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1710315577', 0, 'Y', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046085', 'W12046085', 'IDBOISTD', 'Saint Alphonsus Medical Group Shoreline Family Medicine', 'Joseph', 'S', 'Robinson', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '1673 W Shoreline Dr Ste 120', 'Boise', 'Ada', 'ID', '83702', '2083678383', '2083677171', '1673 W Shoreline Dr Ste 120', 'Boise', 'Ada', 'ID', '83702', '2083678383', '2083677171', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-03-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1710315577', 0, 'Y', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046086', 'W12046086', 'IDBOISTD', 'Saint Alphonsus Medical Group Federal Way Family Medicine', 'Joseph', 'S', 'Robinson', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '1880 W Judith Ln', 'Boise', 'Ada', 'ID', '83705', '2083676910', '2083676170', '1880 W Judith Ln', 'Boise', 'Ada', 'ID', '83705', '2083676910', '2083676170', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-03-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1710315577', 0, 'Y', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('820200895', 'W12046087', 'W12046087', 'IDBOISTD', 'Saint Alphonsus Medical Group Iowa Family Medicine', 'Joseph', 'S', 'Robinson', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '211 W Iowa Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084657377', '2084657397', '211 W Iowa Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084657377', '2084657397', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-03-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1710315577', 0, 'Y', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046088', 'W12046088', 'IDBOISTD', 'Saint Alphonsus Medical Group Kuna Family Medicine', 'Joseph', 'S', 'Robinson', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '757 E Wythe Creek Ct', 'Kuna', 'Ada', 'ID', '83634', '2083673366', '2083672070', '757 E Wythe Creek Ct', 'Kuna', 'Ada', 'ID', '83634', '2083673366', '2083672070', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-03-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1710315577', 0, 'Y', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046089', 'W12046089', 'IDBOISTD', 'Saint Alphonsus Medical Group Dallan Woods Family Medicine', 'Joseph', 'S', 'Robinson', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '214 S Midland Blvd', 'Nampa', 'Canyon', 'ID', '83686', '2084656900', '2084656911', '214 S Midland Blvd', 'Nampa', 'Canyon', 'ID', '83686', '2084656900', '2084656911', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-03-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1710315577', 0, 'Y', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046090', 'W12046090', 'IDBOISTD', 'Saint Alphonsus Medical Group MHP Family Medicine', 'Joseph', 'S', 'Robinson', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-03-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1710315577', 0, 'Y', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046091', 'W12046091', 'IDBOISTD', 'Saint Alphonsus Medical Group Elm Family Medicine', 'Joseph', 'S', 'Robinson', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-03-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1710315577', 0, 'Y', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046092', 'W12046092', 'IDBOISTD', 'Saint Alphonsus Medical Group Oasis Medical Clinic', 'Joseph', 'S', 'Robinson', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '3217 W Bavaria St', 'Eagle', 'Ada', 'ID', '83616', '2082866676', '2089473419', '3217 W Bavaria St', 'Eagle', 'Ada', 'ID', '83616', '2082866676', '2089473419', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-03-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1710315577', 0, 'Y', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046093', 'W12046093', 'IDBOISTD', 'Saint Alphonsus Medical Group EHP Family Medicine', 'Joseph', 'S', 'Robinson', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-03-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1710315577', 0, 'Y', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046094', 'W12046094', 'IDBOISTD', 'Saint Alphonsus Medical Group Occupational Med EHP', 'Joseph', 'S', 'Robinson', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-03-07', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1710315577', 0, 'Y', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046095', 'W12046095', 'IDBOISTD', 'Saint Alphonsus Medical Group Occupational Med NHP', 'Joseph', 'S', 'Robinson', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084668912', '2084663403', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084668912', '2084663403', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-03-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1710315577', 0, 'Y', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046096', 'W12046096', 'IDBOISTD', 'Saint Alphonsus Medical Group NHP Family Medicine  ', 'Joseph', 'S', 'Robinson', '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, '2014-03-07', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1710315577', 0, 'Y', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046097', 'W12046097', 'IDBOISTD', 'Saint Alphonsus Medical Group Express Care Clinics', 'Joseph', 'S', 'Robinson', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '4700 N Eagle Rd', 'Boise', 'Ada', 'ID', '83713', '2089384797', '0000000000', '4700 N Eagle Rd', 'Boise', 'Ada', 'ID', '83713', '2089384797', '0000000000', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-03-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1710315577', 0, 'Y', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046098', 'W12046098', 'IDBOISTD', 'Saint Alphonsus Medical Group Internal Medicine', 'Joseph', 'S', 'Robinson', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '6140 W Curtisian Ave Ste 300', 'Boise', 'Ada', 'ID', '83704', '2083676575', '2083676597', '6140 W Curtisian Ave Ste 300', 'Boise', 'Ada', 'ID', '83704', '2083676575', '2083676597', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-03-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1710315577', 0, 'Y', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046099', 'W12046099', 'IDBOISTD', 'Saint Alphonsus Medical Group Emerald Family Medicine', 'Joseph', 'S', 'Robinson', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-03-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1710315577', 0, 'Y', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046100', 'W12046100', 'IDBOISTD', 'Saint Alphonsus Medical Group Occupational Med Emerald ', 'Joseph', 'S', 'Robinson', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674179', '2083678136', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674179', '2083678136', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-03-07', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1710315577', 0, 'Y', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046102', 'W12046102', 'IDBOISTD', 'Saint Alphonsus Medical Group Neurology', 'Heather', 'A', 'Wilcke', 'NP', 'Neurology', '', '', NULL, 'O', '901 N Curtis Rd Ste 401', 'Boise', 'Ada', 'ID', '83706', '2083672800', '2083672876', '901 N Curtis Rd Ste 401', 'Boise', 'Ada', 'ID', '83706', '2083672800', '2083672876', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-04-01', '2014-05-27', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1215362785', 0, 'Y', 0, '2014-05-20', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046104', 'W12046104', 'IDBOISTD', 'Saint Alphonsus Medical Group Pulmonary & Sleep', 'Peter', 'L', 'Zamfirescu-Alexander', 'MD', 'Pulmonary', '', '', NULL, 'O', '1075 N Curtis Rd Ste 200', 'Boise', 'Ada', 'ID', '83704', '2083678333', '2083672003', '1075 N Curtis Rd Ste 200', 'Boise', 'Ada', 'ID', '83704', '2083678333', '2083672003', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-03-14', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1548245830', 0, 'N', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046105', 'W12046105', 'IDBOISTD', 'Saint Alphonsus Medical Group Wound Emmett', 'Andrea', '', 'Gabica', 'NP', 'Family Practice', '', '', NULL, 'O', '1024 E Locust St', 'Emmett', 'Gem', 'ID', '83617', '2083676038', '2083676022', '1024 E Locust St  ', 'Emmett', 'Gem', 'ID', '83617', '2083676038', '2083676022', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-03-03', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'Saint Alphonsus Medical Center Nampa', '', '', 'HCFA|', '1750641197', 0, 'N', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046107', 'W12046107', 'ID01', 'Saint Alphonsus Behavioral Health', 'Jeremy', 'A', 'Handy', 'MD', 'Psychiatry', '', '', NULL, 'O', '131 N Allumbaugh', 'Boise', 'Ada', 'ID', '83704', '2083672175', '2083760285', '131 N Allumbaugh', 'Boise', 'Ada', 'ID', '83704', '2083672175', '2083760285', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2014-03-11', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1437371671', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046108', 'W12046108', 'IDBOISTD', 'Saint Alphonsus Medical Group Dallan Woods Family Medicine', 'Calvin', 'M', 'Harrold', 'PA-C', 'Family Practice', 'Physician Assistant', '', NULL, 'O', '214 S Midland Blvd', 'Nampa', 'Canyon', 'ID', '83686', '2084656900', '2084656911', '214 S Midland Blvd', 'Nampa', 'Canyon', 'ID', '83686', '2084656900', '2084656911', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-03-10', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1598705311', 0, 'Y', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046111', 'W12046111', 'IDBOISTD', 'Saint Alphonsus Medical Group Wound Emmett', 'Scott', 'D', 'Lossmann', 'MD', 'Family Practice', '', '', NULL, 'O', '1024 E Locust St', 'Emmett', 'Gem', 'ID', '83617', '2083676038', '2083676022', '1024 E Locust St  ', 'Emmett', 'Gem', 'ID', '83617', '2083676038', '2083676022', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-03-03', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1720032725', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('202320132', 'W12046113', 'W12046113', 'IDBOISTD', 'Lifestages OB/GYN', 'Janine', '', 'Franco', 'PA-C', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3908 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084428035', '2084428038', '3908 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084428035', '2084428038', 'IDSAMG2', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 6, '2014-02-24', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578524559', 0, 'N', 0, '2014-04-15', NULL, NULL, 0, 0, NULL, NULL),
('202320132', 'W12046114', 'W12046114', 'IDBOISTD', 'Lifestages OB/GYN', 'Dustan', 'T', 'Hughes', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3908 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084428035', '2084428038', '3908 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084428035', '2084428038', 'IDSAMG2', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 6, '2014-02-24', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1770513228', 0, 'N', 0, '2014-04-14', NULL, NULL, 0, 0, NULL, NULL),
('418135095', 'W12046116', 'W12046116', 'ID02', 'Beacon Pain Clinic', 'Rebekah', 'E', 'Guy', 'MD', 'Pain Management', '', '', NULL, 'O', '1906 Fairview Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2083422104', '2083424710', '1906 Fairview Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2083422104', '2083424710', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2014-02-19', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1154542355', 0, 'N', 0, '2014-04-14', NULL, NULL, 0, 0, NULL, NULL),
('463815168', 'W12046118', 'W12046118', 'ID02', 'Justin Rowe, OD', 'Justin', 'M', 'Rowe', 'OD', 'Optometry', '', '', NULL, 'O', '204 Lenora St', 'Mccall', 'Valley', 'ID', '83638', '2086344161', '2086341716', '204 Lenora St', 'Mccall', 'Valley', 'ID', '83638', '2086344161', '2086341716', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2014-02-27', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1598954638', 0, 'N', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('464445030', 'W12046120', 'W12046120', 'ID02', 'Gibb Anesthesia', 'Justin', '', 'Gibb', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'O', '6144 Birch Ln', 'Nampa', 'Canyon', 'ID', '83687', '2089367111', '          ', '6144 Birch Ln', 'Nampa', 'Canyon', 'ID', '83687', '2089367111', '          ', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2014-02-27', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1023263894', 0, 'Y', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('464445030', 'W12046121', 'W12046121', 'ID02', 'Gibb Anesthesia', 'Justin', '', 'Gibb', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'O', '115 N Plymouth Ave', 'New Plymouth', 'Payette', 'ID', '83655', '2082789900', '2085232025', '115 N Plymouth Ave', 'New Plymouth', 'Payette', 'ID', '83655', '2082789900', '2085232025', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2014-02-27', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1023263894', 0, 'Y', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('464445030', 'W12046122', 'W12046122', 'ID02', 'Gibb Anesthesia', 'Justin', '', 'Gibb', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'O', '3235 N Tower Bridge Way', 'Meridian', 'Ada', 'ID', '83646', '2088956611', '0000000000', '3235 N Tower Bridge Way', 'Meridian', 'Ada', 'ID', '83646', '2088956611', '0000000000', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2014-02-27', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1023263894', 0, 'Y', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('464445030', 'W12046123', 'W12046123', 'ID02', 'Gibb Anesthesia', 'Justin', '', 'Gibb', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'O', '347 W Idaho Ave', 'Ontario', 'Malheur', 'OR', '97914', '5418898837', '0000000000', '347 W Idaho Ave', 'Ontario', 'Malheur', 'OR', '97914', '5418898837', '0000000000', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2014-02-27', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1023263894', 0, 'Y', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('464445030', 'W12046124', 'W12046124', 'ID02', 'Gibb Anesthesia', 'Justin', '', 'Gibb', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'O', '478 SW 12th St', 'Weiser', 'Washington', 'ID', '83672', '5418811794', '0000000000', '478 SW 12th St', 'Weiser', 'Washington', 'ID', '83672', '5418811794', '0000000000', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2014-02-27', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1023263894', 0, 'Y', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('464445030', 'W12046125', 'W12046125', 'ID02', 'Gibb Anesthesia', 'Justin', '', 'Gibb', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'O', '513 E Main St', 'Weiser', 'Washington', 'ID', '83672', '2085491732', '0000000000', '513 E Main St', 'Weiser', 'Washington', 'ID', '83672', '2085491732', '0000000000', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2014-02-27', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1023263894', 0, 'Y', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('752943993', 'W12046264', 'W12046264', 'TXDALSTD', 'North Texas Kidney Disease Associates', 'Jun', '', 'Chen', 'MD', 'Nephrology', '', '', NULL, 'B', 'PO Box 650097', 'Dallas', 'Dallas', 'TX', '75265', '9722190558', '9724369273', 'PO Box 650097', 'Dallas', 'Dallas', 'TX', '75265', '9722190558', '9724369273', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477583763', 0, 'N', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('752943993', 'W12046271', 'W12046271', 'TXDALSTD', 'North Texas Kidney Disease Associates', 'Ira', 'M', 'Epstein', 'DO', 'Nephrology', '', '', NULL, 'O', '1409 Clifton St', 'Fort Worth', 'Tarrant', 'TX', '76107', '8178709941', '8178700044', '1409 Clifton St', 'Fort Worth', 'Tarrant', 'TX', '76107', '8178709941', '8178700044', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205886207', 0, 'N', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('752943993', 'W12046267', 'W12046267', 'TXDALSTD', 'North Texas Kidney Disease Associates', 'Ira', 'M', 'Epstein', 'DO', 'Nephrology', '', '', NULL, 'M', '1600 Waters Ridge Ste A', 'Lewisville', 'Denton', 'TX', '75057', '9722190558', '9724369273', '1600 Waters Ridge Ste A', 'Lewisville', 'Denton', 'TX', '75057', '9722190558', '9724369273', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205886207', 0, 'N', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('752943993', 'W12046270', 'W12046270', 'TXDALSTD', 'North Texas Kidney Disease Associates', 'Ira', 'M', 'Epstein', 'DO', 'Nephrology', '', '', NULL, 'O', '6331 Blvd 26 Ste 220', 'North Richland Hills', 'Tarrant', 'TX', '76180', '8176280284', '8176280288', '6331 Blvd 26 Ste 220', 'North Richland Hills', 'Tarrant', 'TX', '76180', '8176280284', '8176280288', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205886207', 0, 'N', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('752943993', 'W12046269', 'W12046269', 'TXDALSTD', 'North Texas Kidney Disease Associates', 'Ira', 'M', 'Epstein', 'DO', 'Nephrology', '', '', NULL, 'B', 'PO Box 650097', 'Dallas', 'Dallas', 'TX', '75265', '9722190558', '9724369273', 'PO Box 650097', 'Dallas', 'Dallas', 'TX', '75265', '9722190558', '9724369273', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205886207', 0, 'N', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('752943993', 'W12046273', 'W12046273', 'TXDALSTD', 'North Texas Kidney Disease Associates', 'Mohammad', 'F', 'Hussain', 'MD', 'Nephrology', '', '', NULL, 'O', '3315 Colorado Blvd Ste 102', 'Denton', 'Denton', 'TX', '76210', '9403201708', '9405655457', '3315 Colorado Blvd Ste 102', 'Denton', 'Denton', 'TX', '76210', '9403201708', '9405655457', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376737932', 0, 'N', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('752943993', 'W12046275', 'W12046275', 'TXDALSTD', 'North Texas Kidney Disease Associates', 'Mohammad', 'F', 'Hussain', 'MD', 'Nephrology', '', '', NULL, 'M', '1600 Waters Ridge Ste A', 'Lewisville', 'Denton', 'TX', '75057', '9722190558', '9724369273', '1600 Waters Ridge Ste A', 'Lewisville', 'Denton', 'TX', '75057', '9722190558', '9724369273', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376737932', 0, 'N', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('752943993', 'W12046274', 'W12046274', 'TXDALSTD', 'North Texas Kidney Disease Associates', 'Mohammad', 'F', 'Hussain', 'MD', 'Nephrology', '', '', NULL, 'B', 'PO Box 650097', 'Dallas', 'Dallas', 'TX', '75265', '9722190558', '9724369273', 'PO Box 650097', 'Dallas', 'Dallas', 'TX', '75265', '9722190558', '9724369273', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376737932', 0, 'N', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('454710555', 'W12046276', 'W12046276', 'ID01', 'Gail Robison', 'Gail', '', 'Robison', 'NP', 'Mental Health', 'Counseling', '', NULL, 'O', '413 N Allumbaugh St Ste 101', 'Boise', 'Ada', 'ID', '83704', '2083231125', '2083239604', '413 N Allumbaugh St Ste 101', 'Boise', 'Ada', 'ID', '83704', '2083231125', '2083239604', 'IDARNP', '', '', '0.00', '40.00', '0.00', 6, '2014-04-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972876639', 0, 'N', 0, '2014-04-18', NULL, NULL, 0, 0, NULL, NULL),
('364470011', 'W12046277', 'W12046277', 'ILCHIGSTD', 'Dina Kaner MD SC', '', '', 'Dina Kaner MD SC', '', 'Pediatrics', '', '', NULL, 'O', '3385 N Arlington Heights Rd Ste A', 'Arlington Heights', 'Cook', 'IL', '60004', '8476320600', '8476320604', '3385 N Arlington Heights Rd Ste A', 'Arlington Heights', 'Cook', 'IL', '60004', '8476320600', '8476320604', 'CHIG1', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346491941', 0, 'Y', 0, '2014-04-03', NULL, NULL, 0, 0, NULL, NULL),
('364470011', 'W12046279', 'W12046279', 'ILCHIGSTD', 'Dina Kaner MD SC', 'Dina', '', 'Kaner', 'MD', 'Pediatrics', '', '', NULL, 'O', '3385 N Arlington Heights Rd Ste A', 'Arlington Heights', 'Cook', 'IL', '60004', '8476320600', '8476320604', '3385 N Arlington Heights Rd Ste A', 'Arlington Heights', 'Cook', 'IL', '60004', '8476320600', '8476320604', 'CHIG1', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710943097', 0, 'N', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('364470011', 'W12046281', 'W12046281', 'ILCHIGSTD', 'Dina Kaner MD SC', 'Suman', '', 'Sharma', 'MD', 'Pediatrics', '', '', NULL, 'O', '3385 N Arlington Heights Rd Ste A', 'Arlington Heights', 'Cook', 'IL', '60004', '8476320600', '8476320604', '3385 N Arlington Heights Rd Ste A', 'Arlington Heights', 'Cook', 'IL', '60004', '8476320600', '8476320604', 'CHIG1', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356340822', 0, 'N', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('742807579', 'W12046282', 'W12046282', 'TXSATSTD', 'Allergy & Asthma Clinic of San Antonio', 'Miguel', 'J', 'Martinez', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '2829 Babcock Rd Ste 115', 'San Antonio', 'Bexar', 'TX', '78229', '2606929558', '2606929486', '2829 Babcock Rd Ste 115', 'San Antonio', 'Bexar', 'TX', '78229', '2606929558', '2606929486', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1013091586', 0, 'N', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'W12046285', 'W12046285', 'UT01', 'Ogden Clinic', 'Kayleen ', '', 'Wilson', 'NP', 'Family Practice', '', '', NULL, 'B', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753000', '8014753031', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753000', '8014753031', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790088797', 0, 'N', 0, '2014-05-02', NULL, NULL, 0, 0, NULL, NULL),
('261891316', 'W12047282', 'W12047282', 'TXHOUSTD', 'Southern Texas Physicians Network Inc-501A', 'Joseph', 'B', 'Rosen', 'MD', 'Pediatric Pulmonology', '', '', NULL, 'M', 'Three Maryland Farms Ste 250', 'Kingwood', 'Harris', 'TX', '77339', '0000000000', '0000000000', 'Three Maryland Farms Ste 250', 'Kingwood', 'Harris', 'TX', '77339', '0000000000', '0000000000', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144547423', 0, 'N', 0, '2014-05-02', NULL, NULL, 0, 0, NULL, NULL),
('753143209', 'W12046286', 'W12046286', 'WY01', 'Big Horn Basin Bone and Joint', 'Craig ', 'J', 'Edwards', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '720 Lindsay Ln Ste C', 'Cody', 'Park', 'WY', '82414', '3075781955', '3075781996', '720 Lindsay Ln Ste C', 'Cody', 'Park', 'WY', '82414', '3075781955', '3075781996', '', '', '', '0.00', '25.00', '0.00', 3, '2014-04-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477859015', 0, 'N', 0, '2014-04-18', NULL, NULL, 0, 0, NULL, NULL),
('753143209', 'W12046287', 'W12046287', 'WYT1', 'Big Horn Basin Bone and Joint', 'Craig ', 'J', 'Edwards', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '720 Lindsay Ln Ste C', 'Cody', 'Park', 'WY', '82414', '3075781955', '3075781996', '720 Lindsay Ln Ste C', 'Cody', 'Park', 'WY', '82414', '3075781955', '3075781996', '', '', '', '0.00', '25.00', '0.00', 3, '2014-04-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477859015', 0, 'N', 0, '2014-04-18', NULL, NULL, 0, 0, NULL, NULL),
('453191565', 'W12046288', 'W12046288', 'UT01', 'Express Med Family Care', 'Carol', 'S', 'Tanner', 'PAC', 'Family Practice', '', '', NULL, 'O', '415 N Main St', 'Spanish Fork', 'Utah', 'UT', '84660', '8017989715', '8017983131', '415 N Main St', 'Spanish Fork', 'Utah', 'UT', '84660', '8017989715', '8017983131', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-15', NULL, 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1386857829', 0, 'N', 0, '2014-04-18', NULL, NULL, 0, 0, NULL, NULL),
('453191565', 'W12046289', 'W12046289', 'UT01', 'Express Med Family Care', 'Carol', 'S', 'Tanner', 'PAC', 'Family Practice', '', '', NULL, 'B', 'PO Box 540610', 'North Salt Lake', 'Davis', 'UT', '84054', '8017989715', '8017983131', 'PO Box 540610', 'North Salt Lake', 'Davis', 'UT', '84054', '8017989715', '8017983131', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-15', NULL, 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1386857829', 0, 'N', 0, '2014-04-18', NULL, NULL, 0, 0, NULL, NULL),
('760684453', 'W12046290', 'W12046290', 'TXHOUSTD', 'Eye Center of Texas', '', '', 'Eye Center of Texas', '', 'Ophthalmology', '', '', NULL, 'O', '6565 W Loop S Ste 650', 'Bellaire', 'Harris', 'TX', '77401', '7137971010', '7133577276', '6565 W Loop S Ste 650', 'Bellaire', 'Harris', 'TX', '77401', '7137971010', '7133577276', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1720174485', 0, 'N', 0, '2014-04-15', NULL, NULL, 0, 0, NULL, NULL),
('760684453', 'W12046292', 'W12046292', 'TXHOUSTD', 'Eye Center of Texas', 'Edward', '', 'Wade', 'MD', 'Ophthalmology', '', '', NULL, 'O', '6565 W Loop S Ste 650', 'Bellaire', 'Harris', 'TX', '77401', '7137971010', '7133577276', '6565 W Loop S Ste 650', 'Bellaire', 'Harris', 'TX', '77401', '7137971010', '7133577276', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1366445645', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('760684453', 'W12046294', 'W12046294', 'TXHOUSTD', 'Eye Center of Texas', 'Mark', '', 'Mayo', 'MD', 'Ophthalmology', '', '', NULL, 'O', '6565 W Loop S Ste 650', 'Bellaire', 'Harris', 'TX', '77401', '7137971010', '7133577276', '6565 W Loop S Ste 650', 'Bellaire', 'Harris', 'TX', '77401', '7137971010', '7133577276', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1538144423', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('760684453', 'W12046296', 'W12046296', 'TXHOUSTD', 'Eye Center of Texas', 'Ting', '', 'Fang-Suarez', 'MD', 'Ophthalmology', '', '', NULL, 'O', '6565 W Loop S Ste 650', 'Bellaire', 'Harris', 'TX', '77401', '7137971010', '7133577276', '6565 W Loop S Ste 650', 'Bellaire', 'Harris', 'TX', '77401', '7137971010', '7133577276', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1124021498', 0, 'N', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('760684453', 'W12046298', 'W12046298', 'TXHOUSTD', 'Eye Center of Texas', 'Paul', '', 'Stewart', 'MD', 'Ophthalmology', '', '', NULL, 'O', '6565 W Loop S Ste 650', 'Bellaire', 'Harris', 'TX', '77401', '7137971010', '7133577276', '6565 W Loop S Ste 650', 'Bellaire', 'Harris', 'TX', '77401', '7137971010', '7133577276', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1508028523', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('760684453', 'W12046300', 'W12046300', 'TXHOUSTD', 'Eye Center of Texas', 'Christopher', '', 'Allee', 'OD', 'Optometry', '', '', NULL, 'O', '6565 W Loop S Ste 650', 'Bellaire', 'Harris', 'TX', '77401', '7137971010', '7133577276', '6565 W Loop S Ste 650', 'Bellaire', 'Harris', 'TX', '77401', '7137971010', '7133577276', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1154324408', 0, 'N', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('760684453', 'W12046302', 'W12046302', 'TXHOUSTD', 'Eye Center of Texas', 'Jill', '', 'Autry', 'OD', 'Optometry', '', '', NULL, 'O', '6565 W Loop S Ste 650', 'Bellaire', 'Harris', 'TX', '77401', '7137971010', '7133577276', '6565 W Loop S Ste 650', 'Bellaire', 'Harris', 'TX', '77401', '7137971010', '7133577276', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1922001270', 0, 'N', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('760684453', 'W12046304', 'W12046304', 'TXHOUSTD', 'Eye Center of Texas', 'Randall', '', 'Reichle', 'OD', 'Optometry', '', '', NULL, 'O', '6565 W Loop S Ste 650', 'Bellaire', 'Harris', 'TX', '77401', '7137971010', '7133577276', '6565 W Loop S Ste 650', 'Bellaire', 'Harris', 'TX', '77401', '7137971010', '7133577276', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1477556736', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('760684453', 'W12046306', 'W12046306', 'TXHOUSTD', 'Eye Center of Texas', 'Amanda', '', 'Bachman', 'OD', 'Optometry', '', '', NULL, 'O', '6565 W Loop S Ste 650', 'Bellaire', 'Harris', 'TX', '77401', '7137971010', '7133577276', '6565 W Loop S Ste 650', 'Bellaire', 'Harris', 'TX', '77401', '7137971010', '7133577276', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1396950788', 0, 'N', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('760684453', 'W12046308', 'W12046308', 'TXHOUSTD', 'Eye Center of Texas', 'Dung', '', 'Ngo', 'OD', 'Optometry', '', '', NULL, 'O', '6565 W Loop S Ste 650', 'Bellaire', 'Harris', 'TX', '77401', '7137971010', '7133577276', '6565 W Loop S Ste 650', 'Bellaire', 'Harris', 'TX', '77401', '7137971010', '7133577276', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1851541189', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('760684453', 'W12046310', 'W12046310', 'TXHOUSTD', 'Eye Center of Texas', 'James', '', 'Holt', 'OD', 'Optometry', '', '', NULL, 'O', '6565 W Loop S Ste 650', 'Bellaire', 'Harris', 'TX', '77401', '7137971010', '7133577276', '6565 W Loop S Ste 650', 'Bellaire', 'Harris', 'TX', '77401', '7137971010', '7133577276', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1780962167', 0, 'N', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('760684453', 'W12046312', 'W12046312', 'TXHOUSTD', 'Eye Center of Texas', 'Darcy', '', 'Sczepanik', 'OD', 'Optometry', '', '', NULL, 'O', '6565 W Loop S Ste 650', 'Bellaire', 'Harris', 'TX', '77401', '7137971010', '7133577276', '6565 W Loop S Ste 650', 'Bellaire', 'Harris', 'TX', '77401', '7137971010', '7133577276', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1366786543', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12046314', 'W12046314', 'WYBILLINGS', 'Billings Clinic', 'Justin', 'N', 'Bottsford-Miller', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-03-31', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598986200', 0, 'N', 0, '2014-04-03', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12046316', 'W12046316', 'WYBILLINGS', 'Billings Clinic - OB/GYN', 'Justin', 'N', 'Bottsford-Miller', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382806', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382806', '', '', '', '0.00', '17.00', '0.00', 3, '2014-03-31', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598986200', 0, 'N', 0, '2014-04-03', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12046315', 'W12046315', 'WYBILLINGS', 'Billings Clinic', 'Justin', 'N', 'Bottsford-Miller', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'M', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-03-31', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598986200', 0, 'N', 0, '2014-04-03', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12046318', 'W12046318', 'WYBILLINGS', 'Billings Clinic - West End Clinic', 'Leslie', 'D', 'Taylor', 'PT', 'Physical Therapy', '', '', NULL, 'O', '2675 Central Ave', 'Billings', 'Yellowstone', 'MT', '59102', '4062382501', '4062382978', '2675 Central Ave', 'Billings', 'Yellowstone', 'MT', '59102', '4062382501', '4062382978', '', '', '', '0.00', '17.00', '0.00', 3, '2014-03-26', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720405996', 0, 'N', 0, '2014-04-03', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12046319', 'W12046319', 'WYBILLINGS', 'Billings Clinic', 'Leslie', 'D', 'Taylor', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-03-26', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720405996', 0, 'N', 0, '2014-04-03', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12046320', 'W12046320', 'WYBILLINGS', 'Billings Clinic', 'Leslie', 'D', 'Taylor', 'PT', 'Physical Therapy', '', '', NULL, 'M', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-03-26', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720405996', 0, 'N', 0, '2014-04-03', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12046322', 'W12046322', 'WYBILLINGS', 'Billings Clinic', 'Gordon', '', 'Riha', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-03-25', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801002340', 0, 'N', 0, '2014-04-03', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12046324', 'W12046324', 'WYBILLINGS', 'Billings Clinic - General Surgery', 'Gordon', '', 'Riha', 'MD', 'General Surgery', '', '', NULL, 'O', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382868', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382868', '', '', '', '0.00', '17.00', '0.00', 3, '2014-03-25', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801002340', 0, 'N', 0, '2014-04-03', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12046323', 'W12046323', 'WYBILLINGS', 'Billings Clinic', 'Gordon', '', 'Riha', 'MD', 'General Surgery', '', '', NULL, 'M', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-03-25', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801002340', 0, 'N', 0, '2014-04-03', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12046326', 'W12046326', 'WYBILLINGS', 'Billings Clinic - Pulmonary', 'Jamie', '', 'Riha', 'MD', 'Pulmonary', '', '', NULL, 'O', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382813', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382813', '', '', '', '0.00', '17.00', '0.00', 3, '2014-03-25', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821207689', 0, 'N', 0, '2014-04-03', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12046327', 'W12046327', 'WYBILLINGS', 'Billings Clinic', 'Jamie', '', 'Riha', 'MD', 'Pulmonary', '', '', NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-03-25', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821207689', 0, 'N', 0, '2014-04-03', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12046328', 'W12046328', 'WYBILLINGS', 'Billings Clinic', 'Jamie', '', 'Riha', 'MD', 'Pulmonary', '', '', NULL, 'M', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-03-25', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821207689', 0, 'N', 0, '2014-04-03', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12046330', 'W12046330', 'WYBILLINGS', 'Billings Clinic', 'Alyssa', '', 'Burkhart', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-03-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740571991', 0, 'N', 0, '2014-04-03', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12046332', 'W12046332', 'WYBILLINGS', 'Billings Clinic - Hospitalist', 'Alyssa', '', 'Burkhart', 'MD', 'Hospitalist', '', '', NULL, 'O', '2800 10th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382572', '2800 10th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382572', '', '', '', '0.00', '17.00', '0.00', 3, '2014-03-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740571991', 0, 'N', 0, '2014-04-03', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12046331', 'W12046331', 'WYBILLINGS', 'Billings Clinic', 'Alyssa', '', 'Burkhart', 'MD', 'Hospitalist', '', '', NULL, 'M', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-03-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740571991', 0, 'N', 0, '2014-04-03', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12046334', 'W12046334', 'WYBILLINGS', 'Billings Clinic - Pulmonary', 'Fernando', '', 'Caceres', 'MD', 'Pulmonary', '', '', NULL, 'O', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382813', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382813', '', '', '', '0.00', '17.00', '0.00', 3, '2014-03-24', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225281033', 0, 'N', 0, '2014-04-03', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12046335', 'W12046335', 'WYBILLINGS', 'Billings Clinic', 'Fernando', '', 'Caceres', 'MD', 'Pulmonary', '', '', NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-03-24', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225281033', 0, 'N', 0, '2014-04-03', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12046336', 'W12046336', 'WYBILLINGS', 'Billings Clinic', 'Fernando', '', 'Caceres', 'MD', 'Pulmonary', '', '', NULL, 'M', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-03-24', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225281033', 0, 'N', 0, '2014-04-03', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12046337', 'W12046337', 'UT01', 'Central Utah Clinic PC', 'Terry', 'C', 'Hammond', 'MD', 'Nephrology', '', '', NULL, 'O', '1000 N Main St Ste C, 2nd Flr', 'Richfield', 'Sevier', 'UT', '84701', '8013774623', '8018013776', '1000 N Main St Ste C, 2nd Flr', 'Richfield', 'Sevier', 'UT', '84701', '8013774623', '8018013776', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-02-19', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1124064845', 0, 'N', 0, '2014-04-03', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12046338', 'W12046338', 'UT01', 'Central Utah Clinic PC', 'Mariusz', '', 'Kielar', 'MD', 'Nephrology', '', '', NULL, 'O', '1000 N Main St Ste C, 2nd Flr', 'Richfield', 'Sevier', 'UT', '84701', '8013774623', '8018013776', '1000 N Main St Ste C, 2nd Flr', 'Richfield', 'Sevier', 'UT', '84701', '8013774623', '8018013776', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-02-19', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1548588114', 0, 'N', 0, '2014-04-03', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12046339', 'W12046339', 'UT01', 'Central Utah Clinic PC', 'Molly', 'M', 'Brotherson', 'PA', 'Family Practice', '', '', NULL, 'O', '1000 N Main St Ste C, 2nd Flr', 'Richfield', 'Sevier', 'UT', '84701', '8013774623', '8018013776', '1000 N Main St Ste C, 2nd Flr', 'Richfield', 'Sevier', 'UT', '84701', '8013774623', '8018013776', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578598132', 0, 'N', 1, '2014-07-16', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12046341', 'W12046341', 'UT01', 'Central Utah Clinic PC', 'Mark', '', 'Boyack', 'NP', 'Nephrology', '', '', NULL, 'O', '1000 N Main St Ste C, 2nd Flr', 'Richfield', 'Sevier', 'UT', '84701', '8013774623', '8018013776', '1000 N Main St Ste C, 2nd Flr', 'Richfield', 'Sevier', 'UT', '84701', '8013774623', '8018013776', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750323986', 0, 'N', 1, '2014-07-16', NULL, NULL, 0, 0, NULL, NULL),
('742592013', 'CL0311658', 'CL0311658', 'SmartCare', 'Dermatology Associates of San Antonio', NULL, NULL, 'Dermatology Associates of San Antonio', NULL, 'Clinic', 'Dermatology', '', NULL, 'O', '18540 Sigma Rd', 'San Antonio', 'Bexar', 'TX', '78258', '2104904661', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00311658', 0, 'N', 0, NULL, NULL, NULL, 29.6121, -98.4831, NULL, NULL),
('742592013', 'CL0311659', 'CL0311659', 'SmartCare', 'Dermatology Associates of San Antonio', NULL, NULL, 'Dermatology Associates of San Antonio', NULL, 'Clinic', 'Dermatology', '', NULL, 'O', '7832 Pat Booker Rd', 'San Antonio', 'Bexar', 'TX', '78233', '2106579338', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00311659', 0, 'N', 0, NULL, NULL, NULL, 29.5623, -98.3334, NULL, NULL),
('752582845', 'CL0307282', 'CL0307282', 'SmartCare', 'Dallas Diagnostic Association Plano', NULL, NULL, 'Dallas Diagnostic Association Plano', NULL, 'Clinic', 'Internal Medicine', '', NULL, 'O', '4708 Alliance Blvd Ste 200', 'Plano', 'Collin', 'TX', '75093', '4698006020', '4698006001', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00307282', 0, 'N', 0, NULL, NULL, NULL, 33.0145, -96.7925, NULL, NULL),
('752582845', 'CL0307245', 'CL0307245', 'SmartCare', 'Dallas Diagnostic Association Garland', NULL, NULL, 'Dallas Diagnostic Association Garland', NULL, 'Clinic', 'Gastroenterology', '', NULL, 'O', '601 Clara Barton Blvd Ste 300', 'Garland', 'Dallas', 'TX', '75042', '4698002010', '9722722073', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00307245', 0, 'N', 0, NULL, NULL, NULL, 32.9175, -96.662, NULL, NULL),
('752582845', 'CL0307285', 'CL0307285', 'SmartCare', 'Dallas Diagnostic Association Plano', NULL, NULL, 'Dallas Diagnostic Association Plano', NULL, 'Clinic', 'Internal Medicine', '', NULL, 'O', '4708 Alliance Blvd Baylor Med Pl 1', 'Plano', 'Collin', 'TX', '75093', '4698006000', '4698006001', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00307285', 0, 'N', 0, NULL, NULL, NULL, 33.0145, -96.7925, NULL, NULL),
('262836114', 'CL0307207', 'CL0307207', 'SmartCare', 'Crowley Saade Clinic PA', NULL, NULL, 'Crowley Saade Clinic PA', NULL, 'Clinic', 'Family Practice', '', NULL, 'O', '1005 S Crowley Rd ', 'Crowley', 'Tarrant', 'TX', '76036', '8172974455', '8172953022', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00307207', 0, 'N', 0, NULL, NULL, NULL, 32.5638, -97.352, NULL, NULL),
('752286998', 'CL0307232', 'CL0307232', 'SmartCare', 'Dallas Associated Dermatologists', NULL, NULL, 'Dallas Associated Dermatologists', NULL, 'Clinic', 'Dermatology', '', NULL, 'O', '3900 Junius St Ste 710', 'Dallas', 'Dallas', 'TX', '75246', '2149873376', '2148241900', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00307232', 0, 'N', 0, NULL, NULL, NULL, 32.791, -96.7782, NULL, NULL),
('752286998', 'CL0307231', 'CL0307231', 'SmartCare', 'Dallas Associated Dermatologists', NULL, NULL, 'Dallas Associated Dermatologists', NULL, 'Clinic', 'Dermatology', '', NULL, 'O', '5924 Royal Ln Ste 104', 'Dallas', 'Dallas', 'TX', '75230', '2149873376', '2146926567', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00307231', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('752891223', 'CL0307202', 'CL0307202', 'SmartCare', 'Craig Ranch OBGYN', NULL, NULL, 'Craig Ranch OBGYN', NULL, 'Clinic', 'Obstetrics and Gynecology', '', NULL, 'O', '7900 Henneman Way Ste 100', 'Mckinney', 'Collin', 'TX', '75070', '2145446600', '2145447770', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00307202', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12046347', 'W12046347', 'UTIHC04', 'Park City Medical Center', 'Casey', 'Jane', 'Brady', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587350', '          ', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587350', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336284637', 0, 'N', 0, '2014-04-04', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12046349', 'W12046349', 'UTIHC04', 'Primary Childrens Medical Center', 'Barbu', 'R', 'Gociman', 'MD', 'Plastic Surgery', '', '', NULL, 'O', '100 N Mario Capecchi Dr Ste 3600', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621700', '          ', '100 N Mario Capecchi Dr Ste 3600', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621700', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396900841', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'PGUTAH179', 'PGUTAH179', 'UT01', 'Comprehensive Orthopedics and Sports Medicine', 'Stephen', 'T', 'Kirk', 'MD', 'Sports Medicine', '', '', NULL, 'O', '82 S 1100 E Ste 303', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015332002', '8013239546', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1578737979', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'CL0307190', 'CL0307190', 'SmartCare', 'Cottonwood Cardiology', NULL, NULL, 'Cottonwood Cardiology', NULL, 'Clinic', 'Cardiovascular Disease', '', NULL, 'O', '1110 Cottonwood Ln Ste 105', 'Irving', 'Dallas', 'TX', '75038', '9726072525', '9722528837', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00307190', 0, 'N', 0, NULL, NULL, NULL, 32.8652, -96.9601, 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
('752912332', 'CL0307181', 'CL0307181', 'SmartCare', 'Cornea Associates', NULL, NULL, 'Cornea Associates', NULL, 'Clinic', 'Ophthalmology', '', NULL, 'O', '900 W Magnolia Ave Ste 203', 'Fort Worth', 'Tarrant', 'TX', '76104', '8178509282', '8172619218', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00307181', 0, 'N', 0, NULL, NULL, NULL, 32.7306, -97.3342, NULL, NULL),
('611684739', 'CL0309216', 'CL0309216', 'SmartCare', 'Conroe Physician Associates', NULL, NULL, 'Conroe Physician Associates', NULL, 'Clinic', 'Cardiology', 'Family Practice', NULL, 'O', '508 Medical Ctr Blvd Ste 200', 'Conroe', 'Montgomery', 'TX', '77304', '9367604600', '9367604601', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00309216', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('752912332', 'CL0307182', 'CL0307182', 'SmartCare', 'Cornea Associates', NULL, NULL, 'Cornea Associates', NULL, 'Clinic', 'Ophthalmology', '', NULL, 'O', '10740 N Central Expwy Ste 350', 'Dallas', 'Dallas', 'TX', '75231', '2146920146', '2146928617', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00307182', 0, 'N', 0, NULL, NULL, NULL, 32.8941, -96.7687, NULL, NULL),
('454041098', 'CL0303301', 'CL0303301', 'SmartCare', 'Concentra Primary Care of Illinois PC', NULL, NULL, 'Concentra Primary Care of Illinois PC', NULL, 'Clinic', 'Family Practice', '', NULL, 'O', '7126 N Lincoln Ave ', 'Lincolnwood', 'Cook', 'IL', '60712', '8475839189', '8475839196', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00303301', 0, 'N', 0, NULL, NULL, NULL, 42.0108, -87.7386, NULL, NULL),
('760670938', 'CL0309194', 'CL0309194', 'SmartCare', 'Conroe Family Medicine', NULL, NULL, 'Conroe Family Medicine', NULL, 'Clinic', 'Family Practice', '', NULL, 'O', '690 S Loop 336 W Ste 222', 'Conroe', 'Montgomery', 'TX', '77304', '9367566661', '9367566661', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00309194', 0, 'N', 0, NULL, NULL, NULL, 30.3082, -95.5079, NULL, NULL),
('263091124', 'CL0309184', 'CL0309184', 'SmartCare', 'Complete Womens Care Center', NULL, NULL, 'Complete Womens Care Center', NULL, 'Clinic', 'Obstetrics and Gynecology', '', NULL, 'O', '7900 Fannin St Ste 3000', 'Houston', 'Harris', 'TX', '77030', '7137919100', '7137911016', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00309184', 0, 'N', 0, NULL, NULL, NULL, 29.6896, -95.4034, NULL, NULL),
('320346082', 'CL0307170', 'CL0307170', 'SmartCare', 'Concentra Primary Care', NULL, NULL, 'Concentra Primary Care', NULL, 'Clinic', 'Family Practice', '', NULL, 'O', '15810 Midway Rd ', 'Addison', 'Dallas', 'TX', '75001', '9724588111', '9724587776', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00307170', 0, 'N', 0, NULL, NULL, NULL, 32.9653, -96.839, NULL, NULL),
('462252776', 'W12046973', 'W12046973', 'UT01', 'Premier Family Medical', 'Michael', 'D', 'Lehnardt', 'MD', 'Urgent Care', '', '', NULL, 'O', '275 W 200 N', 'Lindon', 'Utah', 'UT', '84042', '8017961333', '8017561705', '275 W 200 N', 'Lindon', 'Utah', 'UT', '84042', '8017961333', '8017561705', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497044911', 0, 'N', 1, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('320346082', 'CL0307171', 'CL0307171', 'SmartCare', 'Concentra Primary Care', NULL, NULL, 'Concentra Primary Care', NULL, 'Clinic', 'Family Practice', '', NULL, 'O', '8756 Teel Pkwy Ste 350', 'Frisco', 'Denton', 'TX', '75034', '9727125454', '9727125442', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 0, '2014-06-10', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'NONE', 'CL00307171', 0, 'N', 0, NULL, NULL, NULL, 33.1512, -96.8641, NULL, NULL),
('752943993', 'W12046242', 'W12046242', 'TXDALSTD', 'North Texas Kidney Disease Associates', 'Raghuveer', '', 'Vanguru', 'MD', 'Nephrology', '', '', NULL, 'M', '1600 Waters Ridge Ste A', 'Lewisville', 'Denton', 'TX', '75057', '9722190558', '9724369273', '1600 Waters Ridge Ste A', 'Lewisville', 'Denton', 'TX', '75057', '9722190558', '9724369273', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700891579', 0, 'N', 0, '2014-04-07', NULL, NULL, 0, 0, NULL, NULL),
('752943993', 'W12046241', 'W12046241', 'TXDALSTD', 'North Texas Kidney Disease Associates', 'Raghuveer', '', 'Vanguru', 'MD', 'Nephrology', '', '', NULL, 'O', '909 9th Ave Ste 205', 'Fort Worth', 'Tarrant', 'TX', '76104', '8178709941', '8178405881', '909 9th Ave Ste 205', 'Fort Worth', 'Tarrant', 'TX', '76104', '8178709941', '8178405881', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700891579', 0, 'N', 0, '2014-04-07', NULL, NULL, 0, 0, NULL, NULL),
('752943993', 'W12046240', 'W12046240', 'TXDALSTD', 'North Texas Kidney Disease Associates', 'Raghuveer', '', 'Vanguru', 'MD', 'Nephrology', '', '', NULL, 'B', 'PO Box 650097', 'Dallas', 'Dallas', 'TX', '75265', '9722190558', '9724369273', 'PO Box 650097', 'Dallas', 'Dallas', 'TX', '75265', '9722190558', '9724369273', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700891579', 0, 'N', 0, '2014-04-07', NULL, NULL, 0, 0, NULL, NULL),
('273321637', 'W12046358', 'W12046358', 'UTMH1', 'Utah Behavior Services Inc', 'Jennifer', 'M', 'Smith', 'LMFT', 'Mental Health', 'Counseling', '', NULL, 'O', '189 S State St Ste 245', 'Clearfield', 'Davis', 'UT', '84015', '8012555131', '8012555131', '189 S State St Ste 245', 'Clearfield', 'Davis', 'UT', '84015', '8012555131', '8012555131', 'UTMA', '', '', '0.00', '40.00', '0.00', 6, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912941527', 0, 'N', 1, '2014-07-22', NULL, NULL, 0, 0, NULL, NULL),
('273321637', 'W12046357', 'W12046357', 'UTMH1', 'Utah Behavior Services Inc', 'Jennifer', 'M', 'Smith', 'LMFT', 'Mental Health', 'Counseling', '', NULL, 'O', '6013 S Redwood Rd', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012555131', '8012555131', '6013 S Redwood Rd', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012555131', '8012555131', 'UTMA', '', '', '0.00', '40.00', '0.00', 6, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912941527', 0, 'N', 1, '2014-07-22', NULL, NULL, 0, 0, NULL, NULL),
('273321637', 'W12046360', 'W12046360', 'UTMH1', 'Utah Behavior Services Inc', 'Megan', '', 'Rasmussen', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '189 S State St Ste 245', 'Clearfield', 'Davis', 'UT', '84015', '8012555131', '8012555131', '189 S State St Ste 245', 'Clearfield', 'Davis', 'UT', '84015', '8012555131', '8012555131', 'UTMA', '', '', '0.00', '40.00', '0.00', 6, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154760783', 0, 'N', 0, '2014-06-25', NULL, NULL, 0, 0, NULL, NULL),
('273321637', 'W12046359', 'W12046359', 'UTMH1', 'Utah Behavior Services Inc', 'Megan', '', 'Rasmussen', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '6013 S Redwood Rd', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012555131', '8012555131', '6013 S Redwood Rd', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012555131', '8012555131', 'UTMA', '', '', '0.00', '40.00', '0.00', 6, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154760783', 0, 'N', 0, '2014-06-25', NULL, NULL, 0, 0, NULL, NULL),
('273321637', 'W12046361', 'W12046361', 'UTMH1', 'Utah Behavior Services Inc', 'Frederick', '', 'Brewer', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '189 S State St Ste 245', 'Clearfield', 'Davis', 'UT', '84015', '8012555131', '8012555131', '189 S State St Ste 245', 'Clearfield', 'Davis', 'UT', '84015', '8012555131', '8012555131', 'UTMA', '', '', '0.00', '40.00', '0.00', 6, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023312683', 0, 'N', 1, '2014-04-09', NULL, NULL, 0, 0, NULL, NULL),
('273321637', 'W12046362', 'W12046362', 'UTMH1', 'Utah Behavior Services Inc', 'Frederick', '', 'Brewer', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '6013 S Redwood Rd', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012555131', '          ', '6013 S Redwood Rd', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012555131', '          ', 'UTMA', '', '', '0.00', '40.00', '0.00', 6, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023312683', 0, 'N', 1, '2014-04-09', NULL, NULL, 0, 0, NULL, NULL),
('850424076', 'W12046365', 'W12046365', 'NM01', 'New Mexico Heart Institute', 'Michele', 'L', 'Head', 'CNP', 'Nephrology', '', '', NULL, 'O', '502 Elm St NE', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5058411000', '5058432593', '502 Elm St NE', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5058411000', '5058432593', 'NMHEART', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386881076', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('264193798', 'W12046364', 'W12046364', 'TXDALSTD', 'Jyothi Rereddy', 'Jyothi', '', 'Rereddy', 'MD', 'Internal Medicine', '', '', NULL, 'O', '5702 Rowlett Rd Ste 210', 'Rowlett', 'Dallas', 'TX', '75089', '9724127900', '9724127955', '5702 Rowlett Rd Ste 210', 'Rowlett', 'Dallas', 'TX', '75089', '9724127900', '9724127955', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1891934295', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('850424076', 'W12046367', 'W12046367', 'NM01', 'New Mexico Heart Institute', 'Michele', 'L', 'Head', 'CNP', 'Nephrology', '', '', NULL, 'B', 'PO Box 53537', 'Phoenix', 'Maricopa', 'AZ', '85072', '5058411000', '5058432819', 'PO Box 53537', 'Phoenix', 'Maricopa', 'AZ', '85072', '5058411000', '5058432819', 'NMHEART', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386881076', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('850424076', 'W12046366', 'W12046366', 'NM01', 'New Mexico Heart Institute', 'Michele', 'L', 'Head', 'CNP', 'Nephrology', '', '', NULL, 'M', 'PO Box 8387', 'Albuquerque', 'Bernalillo', 'NM', '87198', '5059848012', '5059882612', 'PO Box 8387', 'Albuquerque', 'Bernalillo', 'NM', '87198', '5059848012', '5059882612', 'NMHEART', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386881076', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('263624373', 'W12046368', 'W12046368', 'UT01', 'Color Country Pediatrics', 'Scott', 'B', 'Parker', 'APRN', 'Pediatrics', '', '', NULL, 'O', '2002 N Main St Ste 3', 'Cedar City', 'Iron', 'UT', '84721', '4358650218', '          ', '2002 N Main St Ste 3', 'Cedar City', 'Iron', 'UT', '84721', '4358650218', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386626018', 0, 'N', 0, '2014-04-07', NULL, NULL, 0, 0, NULL, NULL),
('820200896', 'W12046369', 'W12046369', 'IDBOISTD', 'Saint Alphonsus Medical Center - Nampa', '', '', 'Saint Alphonsus Medical Center - Nampa', '', 'Hospital', '', '', NULL, 'O', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084635000', '          ', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084635000', '          ', '', '', '', '0.00', '27.00', '0.00', 6, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659371870', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'W12046371', 'W12046371', 'UT01', 'Tanner Memorial Clinic', 'Cassie ', 'L', 'Whittier', 'MD', 'Family Practice', '', '', NULL, 'O', '2121 N 1700 W', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8015258151', '2121 N 1700 W', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8015258151', 'WUTANNER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1992084768', 0, 'N', 1, '2014-06-19', NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'W12046372', 'W12046372', 'UT01', 'Tanner Memorial Clinic', 'Cassie ', 'L', 'Whittier', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'WUTANNER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1992084768', 0, 'N', 1, '2014-06-19', NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'W12046374', 'W12046374', 'UT01', 'Tanner Memorial Clinic', 'Patrick', 'J', 'Kendell', 'MD', 'Mental Health', '', '', NULL, 'O', '2121 N 1700 W', 'Layton', 'Davis', 'UT', '84041', '8017734840', '          ', '2121 N 1700 W', 'Layton', 'Davis', 'UT', '84041', '8017734840', '          ', 'WUTANNER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225324973', 0, 'N', 1, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'W12046373', 'W12046373', 'UT01', 'Tanner Memorial Clinic', 'Patrick', 'J', 'Kendell', 'MD', 'Mental Health', '', '', NULL, 'B', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '8017749219', 'WUTANNER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225324973', 0, 'N', 1, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('841636078', 'W12046375', 'W12046375', 'IDBOISTD', 'River Medical Family Practice', 'Michael', 'R', 'Minas', 'MD', 'Family Practice', '', '', NULL, 'O', '1025 S Bridgeway Pl Ste 100', 'Eagle', 'Ada', 'ID', '83616', '2089393314', '          ', '1025 S Bridgeway Pl Ste 100', 'Eagle', 'Ada', 'ID', '83616', '2089393314', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-04-04', '2014-07-09', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528178977', 0, 'Y', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12046377', 'W12046377', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Nancy', 'E', 'Rifenburg', 'MD', 'Radiology', '', '', NULL, 'O', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2014-03-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407049778', 0, 'Y', 0, '2014-04-07', NULL, NULL, 0, 0, NULL, NULL),
('271398252', 'W12046378', 'W12046378', 'UT01', 'Utah Valley Urgent Care', 'Russell', 'S', 'Anderson', 'DO', 'Family Practice', '', '', NULL, 'O', '127 E Main St Ste E', 'Lehi', 'Utah', 'UT', '84043', '8016192175', '8015539562', '127 E Main St Ste E', 'Lehi', 'Utah', 'UT', '84043', '8016192175', '8015539562', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-01', '2014-04-21', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1548407513', 0, 'N', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('271398252', 'W12046379', 'W12046379', 'UT01', 'Utah Valley Urgent Care', 'Russell', 'S', 'Anderson', 'DO', 'Family Practice', '', '', NULL, 'O', '960 W 800 N', 'Orem', 'Utah', 'UT', '84057', '8016192175', '8015539562', '960 W 800 N', 'Orem', 'Utah', 'UT', '84057', '8016192175', '8015539562', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-01', '2014-04-21', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1548407513', 0, 'N', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('900730991', 'W12046380', 'W12046380', 'UT01', 'Mount Olympus OB/GYN', 'Christopher', 'D', 'Barton', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1220 E 3900 S Ste 3E', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8016857188', '8016858116', '1220 E 3900 S Ste 3E', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8016857188', '8016858116', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1699001073', 0, 'N', 0, '2014-04-07', NULL, NULL, 0, 0, NULL, NULL),
('452715973', 'W12046382', 'W12046382', 'Sinclair', 'St Lukes Clinic Wood River', 'David ', '', 'McClusky', 'MD', 'General Surgery', '', '', NULL, 'M', 'PO Box 100', 'Ketchum', 'Blaine', 'ID', '83340', '2087261765', '2087262863', 'PO Box 100', 'Ketchum', 'Blaine', 'ID', '83340', '2087261765', '2087262863', 'IDSINCLAIRD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, 'St. Lukes Jerome', '', '', '', 'HCFA|UB|', '1902005598', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('452715973', 'W12046381', 'W12046381', 'Sinclair', 'St Lukes Clinic Wood River', 'David ', '', 'McClusky', 'MD', 'General Surgery', '', '', NULL, 'O', '100 Hospital Dr Ste 109', 'Ketchum', 'Blaine', 'ID', '83340', '2087261765', '2087262863', '100 Hospital Dr Ste 109', 'Ketchum', 'Blaine', 'ID', '83340', '2087261765', '2087262863', 'IDSINCLAIRD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, 'St. Lukes Jerome', '', '', '', 'HCFA|UB|', '1902005598', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('452715973', 'W12046383', 'W12046383', 'Sinclair', 'St Lukes Clinic Wood River', 'David ', '', 'McClusky', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 640', 'Boise', 'Ada', 'ID', '83701', '2087261765', '2087262863', 'PO Box 640', 'Boise', 'Ada', 'ID', '83701', '2087261765', '2087262863', 'IDSINCLAIRD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, 'St. Lukes Jerome', '', '', '', 'HCFA|UB|', '1902005598', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('850275777', 'W12046386', 'W12046386', 'NM01', 'Southwest Medical Associates', 'Starla ', '', 'Willis', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '10511 Golf Course Rd Ste 205', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5058231010', '5057974503', '10511 Golf Course Rd Ste 205', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5058231010', '5057974503', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1972575793', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('850275777', 'W12046388', 'W12046388', 'NM01', 'Southwest Medical Associates', 'Starla ', '', 'Willis', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '4420 Irving Blvd NW', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5058231010', '5057974503', '4420 Irving Blvd NW', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5058231010', '5057974503', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1972575793', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('850275777', 'W12046384', 'W12046384', 'NM01', 'Southwest Medical Associates', 'Starla ', '', 'Willis', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '4705 Montgomery Blvd NE Ste 301', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5057274500', '5057274505', '4705 Montgomery Blvd NE Ste 301', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5057274500', '5057274505', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1972575793', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('850275777', 'W12046389', 'W12046389', 'NM01', 'Southwest Medical Associates', 'Starla ', '', 'Willis', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '4801 McMahon Blvd Ste 110', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5057274025', '5057274030', '4801 McMahon Blvd Ste 110', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5057274025', '5057274030', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1972575793', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('850275777', 'W12046385', 'W12046385', 'NM01', 'Southwest Medical Associates', 'Starla ', '', 'Willis', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '6100 Pan American Fwy, NE Ste 100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', '          ', '6100 Pan American Fwy, NE Ste 100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', '          ', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1972575793', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('850275777', 'W12046390', 'W12046390', 'NM01', 'Southwest Medical Associates', 'Starla ', '', 'Willis', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '8401 Constitution NE Ste 150', 'Albuquerque', 'Bernalillo', 'NM', '87110', '5058231010', '5057974503', '8401 Constitution NE Ste 150', 'Albuquerque', 'Bernalillo', 'NM', '87110', '5058231010', '5057974503', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1972575793', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('850275777', 'W12046391', 'W12046391', 'NM01', 'Southwest Medical Associates', 'Starla ', '', 'Willis', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '9501 Paseo del Norte Ste C & D', 'Albuquerque', 'Bernalillo', 'NM', '87122', '5057274000', '5057274014', '9501 Paseo del Norte Ste C & D', 'Albuquerque', 'Bernalillo', 'NM', '87122', '5057274000', '5057274014', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1972575793', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('463537229', 'W12046392', 'W12046392', 'UT01', 'Kimberly Jo Davis', 'Kimberly', 'J', 'Davis', 'DO', 'Family Practice', '', '', NULL, 'O', '999 Murray Holladay Rd Ste 207', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012682584', '8012621168', '999 Murray Holladay Rd Ste 207', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012682584', '8012621168', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-06-09', NULL, 0, 0, 0, 'Pioneer Valley Hospital', '', '', '', 'HCFA|UB|', '1487820320', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('460792228', 'W12046400', 'W12046400', 'TXSATSTD', 'Mission Trails Family Health', 'Jane', 'E', 'Lee', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 11852', 'Belfast', 'Waldo', 'ME', '04915', '2105708500', '2102760493', 'PO Box 11852', 'Belfast', 'Waldo', 'ME', '04915', '2105708500', '2102760493', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730400854', 0, 'N', 0, '2014-04-18', NULL, NULL, 0, 0, NULL, NULL),
('020752585', 'W12046401', 'W12046401', 'TXSATSTD', 'Leonard Deal MD PA', 'Leonard', 'E', 'Deal', 'MD', 'Pulmonary', '', '', NULL, 'O', '8715 Village Dr Ste 514', 'San Antonio', 'Bexar', 'TX', '78217', '2106563603', '2106563603', '8715 Village Dr Ste 514', 'San Antonio', 'Bexar', 'TX', '78217', '2106563603', '2106563603', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1467443986', 0, 'N', 0, '2014-04-15', NULL, NULL, 0, 0, NULL, NULL),
('020752585', 'W12046402', 'W12046402', 'TXSATSTD', 'Leonard Deal', 'Leonard', 'E', 'Deal', 'MD', 'Pulmonary', '', '', NULL, 'M', 'PO Box 65140', 'San Antonio', 'Bexar', 'TX', '78265', '2106563603', '2106563603', 'PO Box 65140', 'San Antonio', 'Bexar', 'TX', '78265', '2106563603', '2106563603', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1467443986', 0, 'N', 0, '2014-04-15', NULL, NULL, 0, 0, NULL, NULL),
('201773062', 'W12046403', 'W12046403', 'ID01', 'Access Behavioral Health Services Inc', 'David', '', 'Horras', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '1276 River St Ste 100', 'Boise', 'Ada', 'ID', '83702', '2083384699', '2083224722', '1276 River St Ste 100', 'Boise', 'Ada', 'ID', '83702', '2083384699', '2083224722', 'IDSTD', '', '', '0.00', '30.00', '0.00', 3, '2014-04-15', '2014-06-23', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295093573', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('201773062', 'W12046404', 'W12046404', 'ID01', 'Access Behavioral Health Services Inc', 'David', '', 'Horras', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '3307 Caldwell Blvd Ste 104', 'Nampa', 'Canyon', 'ID', '83651', '2084654833', '2084672654', '3307 Caldwell Blvd Ste 104', 'Nampa', 'Canyon', 'ID', '83651', '2084654833', '2084672654', 'IDSTD', '', '', '0.00', '30.00', '0.00', 3, '2014-04-15', '2014-06-23', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295093573', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('320340482', 'W12046405', 'W12046405', 'UT01', 'Perry Family Medicine', 'Ronald', 'B', 'Simmons', 'DO', 'Family Practice', '', '', NULL, 'O', '1030 S Medical Dr Ste A', 'Brigham City', 'Box Elder', 'UT', '84302', '4357234500', '4357234504', '1030 S Medical Dr Ste A', 'Brigham City', 'Box Elder', 'UT', '84302', '4357234500', '4357234504', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083607469', 0, 'N', 0, '2014-05-16', NULL, NULL, 0, 0, NULL, NULL),
('320340482', 'W12046406', 'W12046406', 'UT01', 'Perry Family Medicine', 'Ronald', 'B', 'Simmons', 'DO', 'Family Practice', '', '', NULL, 'M', '3263 S Hwy 89 Ste 400', 'Bountiful', 'Davis', 'UT', '84010', '8015050821', '8015050803', '3263 S Hwy 89 Ste 400', 'Bountiful', 'Davis', 'UT', '84010', '8015050821', '8015050803', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083607469', 0, 'N', 0, '2014-05-16', NULL, NULL, 0, 0, NULL, NULL),
('320340482', 'W12046407', 'W12046407', 'UT01', 'Perry Family Medicine', 'Ronald', 'B', 'Simmons', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 540610', 'North Salt Lake', 'Davis', 'UT', '84054', '8014516060', '8012960218', 'PO Box 540610', 'North Salt Lake', 'Davis', 'UT', '84054', '8014516060', '8012960218', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083607469', 0, 'N', 0, '2014-05-16', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12046409', 'W12046409', 'UTIHCPHY', 'Sunset Family Practice', 'Amber', 'M', 'Anderson', 'LCSW', 'Behavioral Health', '', '', NULL, 'O', '1739 W Sunset Blvd', 'St George', 'Washington', 'UT', '84770', '4356346000', '4356346033', '1739 W Sunset Blvd', 'St George', 'Washington', 'UT', '84770', '4356346000', '4356346033', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932412947', 0, 'N', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12033556', 'W12033556', 'UTIHCPHY', 'Southern Utah Behavioral Health', 'Amber', 'M', 'Anderson', 'LCSW', 'Behavioral Health', '', '', NULL, 'O', '1054 E Riverside Dr Ste 202', 'St George', 'Washington', 'UT', '84790', '4356346100', '4356346129', '1054 E Riverside Dr Ste 202', 'St George', 'Washington', 'UT', '84790', '4356346100', '4356346129', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1932412947', 0, 'N', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12046411', 'W12046411', 'UTIHCPHY', 'Holladay Pediatrics North', 'Cynthia', 'L', 'Coor', 'MD', 'Pediatrics', '', '', NULL, 'O', '2160 E 4500 S', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012784693', '8012784850', '2160 E 4500 S', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012784693', '8012784850', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114038015', 0, 'Y', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12046412', 'W12046412', 'UTIHCPHY', 'Southwest Regional Cancer Cedar City', 'David', 'T', 'Cowley', 'NP', 'Pain Management', '', '', NULL, 'O', '1303 N Main St', 'Cedar City', 'Iron', 'UT', '84720', '4358685690', '4356349852', '1303 N Main St', 'Cedar City', 'Iron', 'UT', '84720', '4358685690', '4356349852', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2014-02-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720429491', 0, 'Y', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12046413', 'W12046413', 'UTIHCPHY', 'Budge Clinic Radiology', 'Michael', 'R', 'Francis', 'DO', 'Internal Medicine', NULL, NULL, NULL, 'O', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357520422', '4357530401', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357520422', '4357530401', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2014-01-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1104093996', 0, 'N', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12046414', 'W12046414', 'UTIHCPHY', 'Sunset InstaCare', 'Mark', 'Robert', 'Greenwood', 'MD', 'Family Practice', 'Urgent Care', '', NULL, 'O', '1739 W Sunset Blvd', 'St George', 'Washington', 'UT', '84770', '4356346050', '4356346033', '1739 W Sunset Blvd', 'St George', 'Washington', 'UT', '84770', '4356346050', '4356346033', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083620298', 0, 'Y', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12046415', 'W12046415', 'UTIHCPHY', 'Hurricane Valley InstaCare', 'Mark', 'Robert', 'Greenwood', 'MD', 'Family Practice', 'Urgent Care', '', NULL, 'O', '75 N 2260 W', 'Hurricane', 'Washington', 'UT', '84737', '4356356550', '4356356549', '75 N 2260 W', 'Hurricane', 'Washington', 'UT', '84737', '4356356550', '4356356549', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083620298', 0, 'Y', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12046417', 'W12046417', 'UTIHCPHY', 'Park City Specialty Clinic', 'Marnae', '', 'Harward', 'CNM', 'Certified Nurse Midwife', '', '', NULL, 'O', '900 Round Valley Dr Ste 200', 'Park City', 'Summit', 'UT', '84060', '4356587400', '4536587401', '900 Round Valley Dr Ste 200', 'Park City', 'Summit', 'UT', '84060', '4356587400', '4536587401', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2014-03-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295166809', 0, 'Y', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12046419', 'W12046419', 'UTIHCPHY', 'Hillcrest Pediatrics', 'Teresa', '', 'Steele', 'APRN', 'Pediatrics', '', '', NULL, 'O', '5063 S Cottonwood St #160', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8015071850', '8015871875', '5063 S Cottonwood St #160', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8015071850', '8015871875', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2014-02-26', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982025961', 0, 'Y', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12046420', 'W12046420', 'UTIHCPHY', 'Park City Specialty Clinic', 'Jewel', 'E', 'Maeda', 'CNM', 'Certified Nurse Midwife', '', '', NULL, 'O', '900 Round Valley Dr Ste 200', 'Park City', 'Summit', 'UT', '84060', '4356587400', '4536587401', '900 Round Valley Dr Ste 200', 'Park City', 'Summit', 'UT', '84060', '4356587400', '4536587401', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679669022', 0, 'Y', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12046421', 'W12046421', 'UTIHCPHY', 'North Cache Valley Instacare', 'John', 'J', 'Murdock', 'MD', 'Urgent Care', '', '', NULL, 'O', '4088 N Hwy 91', 'Hyde Park', 'Cache', 'UT', '84318', '4355634888', '4355634832', '4088 N Hwy 91', 'Hyde Park', 'Cache', 'UT', '84318', '4355634888', '4355634832', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2014-01-01', NULL, 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1891786968', 0, 'Y', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12046422', 'W12046422', 'UTIHCPHY', 'Logan InstaCare', 'John', 'J', 'Murdock', 'MD', 'Urgent Care', '', '', NULL, 'O', '412 N 200 E', 'Logan', 'Cache', 'UT', '84321', '4357132710', '4357132746', '412 N 200 E', 'Logan', 'Cache', 'UT', '84321', '4357132710', '4357132746', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2014-01-01', NULL, 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1891786968', 0, 'Y', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12046424', 'W12046424', 'UTIHCPHY', 'American Fork Wound Care', 'James', 'R', 'Stewart', 'DO', 'Family Practice', '', '', NULL, 'O', '98 N 1100 E Ste 302', 'American Fork', 'Utah', 'UT', '84003', '8014922260', '8014922267', '98 N 1100 E Ste 302', 'American Fork', 'Utah', 'UT', '84003', '8014922260', '8014922267', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457338220', 0, 'Y', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12046425', 'W12046425', 'UTIHCPHY', 'Hurricane Valley InstaCare', 'Laura', 'L', 'Thomas', 'APRN', 'Family Practice', 'Urgent Care', '', NULL, 'O', '75 N 2260 W', 'Hurricane', 'Washington', 'UT', '84737', '4356356550', '4356356549', '75 N 2260 W', 'Hurricane', 'Washington', 'UT', '84737', '4356356550', '4356356549', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2014-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1568779783', 0, 'Y', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('850424076', 'W12046430', 'W12046430', 'NM01', 'New Mexico Heart Institute', '', '', 'New Mexico Heart Institute', '', 'Cardiovascular Disease', '', '', NULL, 'O', '2240 Grande Blvd SE Ste 102', 'Rio Rancho', 'Sandoval', 'NM', '87124', '5058411000', '5058432592', '2240 Grande Blvd SE Ste 102', 'Rio Rancho', 'Sandoval', 'NM', '87124', '5058411000', '5058432592', 'NMHEART', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-09-05', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346242575', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('752473418', 'W12046436', 'W12046436', 'TXDALSTD', 'CareNow Carrollton', '', '', 'CareNow', '', 'Urgent Care', '', '', NULL, 'O', '1017 W Hebron Pkwy', 'Carrollton', 'Denton', 'TX', '75010', '9729399495', '9729390230', '1017 W Hebron Pkwy', 'Carrollton', 'Denton', 'TX', '75010', '9729399495', '9729390230', '', '', '', '0.00', '0.00', '141.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609802719', 0, 'N', 0, '2014-06-02', NULL, NULL, 0, 0, NULL, NULL),
('752473418', 'W12046432', 'W12046432', 'TXDALSTD', 'CareNow Allen', '', '', 'CareNow', '', 'Urgent Care', '', '', NULL, 'O', '1218 W McDermott', 'Allen', 'Collin', 'TX', '75013', '9723909000', '9723965173', '1218 W McDermott', 'Allen', 'Collin', 'TX', '75013', '9723909000', '9723965173', '', '', '', '0.00', '0.00', '141.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609802719', 0, 'N', 0, '2014-06-02', NULL, NULL, 0, 0, NULL, NULL),
('752473418', 'W12046453', 'W12046453', 'TXDALSTD', 'CareNow North Dallas', '', '', 'CareNow', '', 'Urgent Care', '', '', NULL, 'O', '14856 Preston Rd Ste 100', 'Dallas', 'Dallas', 'TX', '75254', '9723878900', '9726619868', '14856 Preston Rd Ste 100', 'Dallas', 'Dallas', 'TX', '75254', '9723878900', '9726619868', '', '', '', '0.00', '0.00', '141.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609802719', 0, 'N', 0, '2014-06-02', NULL, NULL, 0, 0, NULL, NULL),
('752473418', 'W12046435', 'W12046435', 'TXDALSTD', 'CareNow Burleson', '', '', 'CareNow', '', 'Urgent Care', '', '', NULL, 'O', '1501 SW Wilshire Blvd', 'Burleson', 'Johnson', 'TX', '76028', '8172959400', '8172959408', '1501 SW Wilshire Blvd', 'Burleson', 'Johnson', 'TX', '76028', '8172959400', '8172959408', '', '', '', '0.00', '0.00', '141.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609802719', 0, 'N', 0, '2014-06-02', NULL, NULL, 0, 0, NULL, NULL),
('752473418', 'W12046439', 'W12046439', 'TXDALSTD', 'CareNow East Chase', '', '', 'CareNow', '', 'Urgent Care', '', '', NULL, 'O', '1661 E Chase Pkwy', 'Fort Worth', 'Tarrant', 'TX', '76120', '8174592005', '8174593797', '1661 E Chase Pkwy', 'Fort Worth', 'Tarrant', 'TX', '76120', '8174592005', '8174593797', '', '', '', '0.00', '0.00', '141.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609802719', 0, 'N', 0, '2014-06-02', NULL, NULL, 0, 0, NULL, NULL),
('752473418', 'W12046445', 'W12046445', 'TXDALSTD', 'CareNow Grapevine', '', '', 'CareNow', '', 'Urgent Care', '', '', NULL, 'O', '2355 Grapevine Mills Cir E', 'Grapevine', 'Tarrant', 'TX', '76051', '9725396330', '9725393077', '2355 Grapevine Mills Cir E', 'Grapevine', 'Tarrant', 'TX', '76051', '9725396330', '9725393077', '', '', '', '0.00', '0.00', '141.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609802719', 0, 'N', 0, '2014-06-02', NULL, NULL, 0, 0, NULL, NULL),
('752473418', 'W12046443', 'W12046443', 'TXDALSTD', 'CareNow Frisco West', '', '', 'CareNow', '', 'Urgent Care', '', '', NULL, 'O', '301 Main St', 'Frisco', 'Denton', 'TX', '75034', '9723350030', '9723353660', '301 Main St', 'Frisco', 'Denton', 'TX', '75034', '9723350030', '9723353660', '', '', '', '0.00', '0.00', '141.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609802719', 0, 'N', 0, '2014-06-02', NULL, NULL, 0, 0, NULL, NULL),
('752473418', 'W12046437', 'W12046437', 'TXDALSTD', 'CareNow Cedar Hill', '', '', 'CareNow', '', 'Urgent Care', '', '', NULL, 'O', '345 N Hwy 67', 'Cedar Hill', 'Dallas', 'TX', '75104', '9729565300', '9729565393', '345 N Hwy 67', 'Cedar Hill', 'Dallas', 'TX', '75104', '9729565300', '9729565393', '', '', '', '0.00', '0.00', '141.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609802719', 0, 'N', 0, '2014-06-02', NULL, NULL, 0, 0, NULL, NULL),
('752473418', 'W12046451', 'W12046451', 'TXDALSTD', 'CareNow Lake Worth', '', '', 'CareNow', '', 'Urgent Care', '', '', NULL, 'O', '3520 NW Centre Dr', 'Fort Worth', 'Tarrant', 'TX', '76135', '8173752100', '8172370022', '3520 NW Centre Dr', 'Fort Worth', 'Tarrant', 'TX', '76135', '8173752100', '8172370022', '', '', '', '0.00', '0.00', '141.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609802719', 0, 'N', 0, '2014-06-02', NULL, NULL, 0, 0, NULL, NULL),
('752473418', 'W12046438', 'W12046438', 'TXDALSTD', 'CareNow Denton', '', '', 'CareNow', '', 'Urgent Care', '', '', NULL, 'O', '3751 S I-35 E', 'Burleson', 'Johnson', 'TX', '76028', '9403832700', '9403837640', '3751 S I-35 E', 'Burleson', 'Johnson', 'TX', '76028', '9403832700', '9403837640', '', '', '', '0.00', '0.00', '141.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609802719', 0, 'N', 0, '2014-06-02', NULL, NULL, 0, 0, NULL, NULL),
('752473418', 'W12046454', 'W12046454', 'TXDALSTD', 'CareNow Plano', '', '', 'CareNow', '', 'Urgent Care', '', '', NULL, 'O', '3821 W Spring Creek Pkwy', 'Plano', 'Collin', 'TX', '75023', '9725990077', '9725990030', '3821 W Spring Creek Pkwy', 'Plano', 'Collin', 'TX', '75023', '9725990077', '9725990030', '', '', '', '0.00', '0.00', '141.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609802719', 0, 'N', 0, '2014-06-02', NULL, NULL, 0, 0, NULL, NULL),
('752473418', 'W12046444', 'W12046444', 'TXDALSTD', 'CareNow Grand Prairie', '', '', 'CareNow', '', 'Urgent Care', '', '', NULL, 'O', '3950 S Carrier Pkwy Ste 110', 'Grand Prairie', 'Dallas', 'TX', '75052', '9722645858', '9722648800', '3950 S Carrier Pkwy Ste 110', 'Grand Prairie', 'Dallas', 'TX', '75052', '9722645858', '9722648800', '', '', '', '0.00', '0.00', '141.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609802719', 0, 'N', 0, '2014-06-02', NULL, NULL, 0, 0, NULL, NULL),
('752473418', 'W12046449', 'W12046449', 'TXDALSTD', 'CareNow I20 & Wheatland', '', '', 'CareNow', '', 'Urgent Care', '', '', NULL, 'O', '39769 LBJ Fwy', 'Dallas', 'Dallas', 'TX', '75237', '9727800802', '9727807134', '39769 LBJ Fwy', 'Dallas', 'Dallas', 'TX', '75237', '9727800802', '9727807134', '', '', '', '0.00', '0.00', '141.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609802719', 0, 'N', 0, '2014-06-02', NULL, NULL, 0, 0, NULL, NULL),
('752473418', 'W12046448', 'W12046448', 'TXDALSTD', 'CareNow Hurst', '', '', 'CareNow', '', 'Urgent Care', '', '', NULL, 'O', '400 Mid Cities Blvd', 'Hurst', 'Tarrant', 'TX', '76054', '8174287300', '8174281085', '400 Mid Cities Blvd', 'Hurst', 'Tarrant', 'TX', '76054', '8174287300', '8174281085', '', '', '', '0.00', '0.00', '141.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609802719', 0, 'N', 0, '2014-06-02', NULL, NULL, 0, 0, NULL, NULL),
('752473418', 'W12046434', 'W12046434', 'TXDALSTD', 'CareNow Bedford-Eules', '', '', 'CareNow', '', 'Urgent Care', '', '', NULL, 'O', '5301 William D Tate Ave', 'Grapevine', 'Tarrant', 'TX', '76051', '8172512101', '8174215041', '5301 William D Tate Ave', 'Grapevine', 'Tarrant', 'TX', '76051', '8172512101', '8174215041', '', '', '', '0.00', '0.00', '141.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609802719', 0, 'N', 0, '2014-06-02', NULL, NULL, 0, 0, NULL, NULL),
('752473418', 'W12046433', 'W12046433', 'TXDALSTD', 'CareNow Arlington', '', '', 'CareNow', '', 'Urgent Care', '', '', NULL, 'O', '5405 S Cooper St', 'Arlington', 'Tarrant', 'TX', '76017', '8174654928', '8174720758', '5405 S Cooper St', 'Arlington', 'Tarrant', 'TX', '76017', '8174654928', '8174720758', '', '', '', '0.00', '0.00', '141.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609802719', 0, 'N', 0, '2014-06-02', NULL, NULL, 0, 0, NULL, NULL),
('752473418', 'W12046442', 'W12046442', 'TXDALSTD', 'CareNow Frisco Preston Road', '', '', 'CareNow', '', 'Urgent Care', '', '', NULL, 'O', '5644 Preston Rd', 'Frisco', 'Denton', 'TX', '75034', '9725294545', '2148724323', '5644 Preston Rd', 'Frisco', 'Denton', 'TX', '75034', '9725294545', '2148724323', '', '', '', '0.00', '0.00', '141.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609802719', 0, 'N', 0, '2014-06-02', NULL, NULL, 0, 0, NULL, NULL),
('752473418', 'W12046446', 'W12046446', 'TXDALSTD', 'CareNow Garland South (Mesquite)', '', '', 'CareNow', '', 'Urgent Care', '', '', NULL, 'O', '565 W I-30', 'Garland', 'Dallas', 'TX', '75043', '9723033030', '9722401223', '565 W I-30', 'Garland', 'Dallas', 'TX', '75043', '9723033030', '9722401223', '', '', '', '0.00', '0.00', '141.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609802719', 0, 'N', 0, '2014-06-02', NULL, NULL, 0, 0, NULL, NULL),
('752473418', 'W12046447', 'W12046447', 'TXDALSTD', 'CareNow Garland North', '', '', 'CareNow', '', 'Urgent Care', '', '', NULL, 'O', '7145 N George Bush Fwy', 'Garland', 'Dallas', 'TX', '75044', '9725301900', '9725307400', '7145 N George Bush Fwy', 'Garland', 'Dallas', 'TX', '75044', '9725301900', '9725307400', '', '', '', '0.00', '0.00', '141.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609802719', 0, 'N', 0, '2014-06-02', NULL, NULL, 0, 0, NULL, NULL),
('752473418', 'W12046456', 'W12046456', 'TXDALSTD', 'CareNow Keller', '', '', 'CareNow', '', 'Urgent Care', '', '', NULL, 'O', '720 S Main St', 'Keller', 'Tarrant', 'TX', '76248', '8174312800', '8174310371', '720 S Main St', 'Keller', 'Tarrant', 'TX', '76248', '8174312800', '8174310371', '', '', '', '0.00', '0.00', '141.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609802719', 0, 'N', 0, '2014-06-02', NULL, NULL, 0, 0, NULL, NULL),
('752473418', 'W12046441', 'W12046441', 'TXDALSTD', 'CareNow Fossil Creek', '', '', 'CareNow', '', 'Urgent Care', '', '', NULL, 'O', '7232 N Fwy', 'Fort Worth', 'Tarrant', 'TX', '76137', '8174398100', '8174398103', '7232 N Fwy', 'Fort Worth', 'Tarrant', 'TX', '76137', '8174398100', '8174398103', '', '', '', '0.00', '0.00', '141.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609802719', 0, 'N', 0, '2014-06-02', NULL, NULL, 0, 0, NULL, NULL),
('752473418', 'W12046440', 'W12046440', 'TXDALSTD', 'CareNow Fort Worth', '', '', 'CareNow', '', 'Urgent Care', '', '', NULL, 'O', '7400 McCart Ave', 'Fort Worth', 'Tarrant', 'TX', '76133', '8172941651', '8172941048', '7400 McCart Ave', 'Fort Worth', 'Tarrant', 'TX', '76133', '8172941651', '8172941048', '', '', '', '0.00', '0.00', '141.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609802719', 0, 'N', 0, '2014-06-02', NULL, NULL, 0, 0, NULL, NULL),
('752473418', 'W12046455', 'W12046455', 'TXDALSTD', 'CareNow McKinney', '', '', 'CareNow', '', 'Urgent Care', '', '', NULL, 'O', '809 N Central Expy', 'Mckinney', 'Collin', 'TX', '75070', '9725294500', '9725294505', '809 N Central Expy', 'Mckinney', 'Collin', 'TX', '75070', '9725294500', '9725294505', '', '', '', '0.00', '0.00', '141.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609802719', 0, 'N', 0, '2014-06-02', NULL, NULL, 0, 0, NULL, NULL),
('752473418', 'W12046431', 'W12046431', 'TXDALSTD', 'CareNow', '', '', 'CareNow', '', 'Urgent Care', '', '', NULL, 'B', 'PO Box 9101', 'Coppell', 'Dallas', 'TX', '75019', '9727457500', '9724710700', 'PO Box 9101', 'Coppell', 'Dallas', 'TX', '75019', '9727457500', '9724710700', '', '', '', '0.00', '0.00', '141.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609802719', 0, 'Y', 0, '2014-06-02', NULL, NULL, 0, 0, NULL, NULL),
('850424076', 'W12046457', 'W12046457', 'NM01', 'New Mexico Heart Institute', 'Mark', 'C', 'Bieniarz', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '2240 Grande Blvd SE Ste 102', 'Rio Rancho', 'Sandoval', 'NM', '87124', '5058411000', '5058432592', '2240 Grande Blvd SE Ste 102', 'Rio Rancho', 'Sandoval', 'NM', '87124', '5058411000', '5058432592', 'NMHEART', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-09-05', NULL, 0, 0, 0, 'Heart Hospital of New Mexico', '', '', '', 'HCFA|UB|', '1174776868', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('850424076', 'W12046459', 'W12046459', 'NM01', 'New Mexico Heart Institute', 'Mihaela', 'B', 'Bujoi', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '2240 Grande Blvd SE Ste 102', 'Rio Rancho', 'Sandoval', 'NM', '87124', '5058411000', '5058432592', '2240 Grande Blvd SE Ste 102', 'Rio Rancho', 'Sandoval', 'NM', '87124', '5058411000', '5058432592', 'NMHEART', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-09-05', NULL, 0, 0, 0, 'Heart Hospital of New Mexico', '', '', '', 'HCFA|UB|', '1164424214', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('850424076', 'W12046460', 'W12046460', 'NM01', 'New Mexico Heart Institute', 'Brendan', 'J', 'Cavanaugh', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '2240 Grande Blvd SE Ste 102', 'Rio Rancho', 'Sandoval', 'NM', '87124', '5058411000', '5058432592', '2240 Grande Blvd SE Ste 102', 'Rio Rancho', 'Sandoval', 'NM', '87124', '5058411000', '5058432592', 'NMHEART', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-09-05', NULL, 0, 0, 0, 'Heart Hospital of New Mexico', '', '', '', 'HCFA|UB|', '1013947639', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('850424076', 'W12046461', 'W12046461', 'NM01', 'New Mexico Heart Institute', 'Richard', 'L', 'Gerety', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '2240 Grande Blvd SE Ste 102', 'Rio Rancho', 'Sandoval', 'NM', '87124', '5058411000', '5058432592', '2240 Grande Blvd SE Ste 102', 'Rio Rancho', 'Sandoval', 'NM', '87124', '5058411000', '5058432592', 'NMHEART', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-09-05', NULL, 0, 0, 0, 'Heart Hospital of New Mexico', '', '', '', 'HCFA|UB|', '1942204292', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('850424076', 'W12046462', 'W12046462', 'NM01', 'New Mexico Heart Institute', 'Esteban', 'A', 'Henao', 'MD', 'Vascular Surgery', '', '', NULL, 'O', '2240 Grande Blvd SE Ste 102', 'Rio Rancho', 'Sandoval', 'NM', '87124', '5058411000', '5058432592', '2240 Grande Blvd SE Ste 102', 'Rio Rancho', 'Sandoval', 'NM', '87124', '5058411000', '5058432592', 'NMHEART', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-09-05', NULL, 0, 0, 0, 'Heart Hospital of New Mexico', '', '', '', 'HCFA|UB|', '1881653277', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('850424076', 'W12046463', 'W12046463', 'NM01', 'New Mexico Heart Institute', 'Robert', 'C', 'Orchard', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '2240 Grande Blvd SE Ste 102', 'Rio Rancho', 'Sandoval', 'NM', '87124', '5058411000', '5058432592', '2240 Grande Blvd SE Ste 102', 'Rio Rancho', 'Sandoval', 'NM', '87124', '5058411000', '5058432592', 'NMHEART', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-09-05', NULL, 0, 0, 0, 'Heart Hospital of New Mexico', '', '', '', 'HCFA|UB|', '1659375558', 0, 'N', 0, '2014-04-09', NULL, NULL, 0, 0, NULL, NULL),
('850424076', 'W12046464', 'W12046464', 'NM01', 'New Mexico Heart Institute', 'Mel', 'A', 'Peralta', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '2240 Grande Blvd SE Ste 102', 'Rio Rancho', 'Sandoval', 'NM', '87124', '5058411000', '5058432592', '2240 Grande Blvd SE Ste 102', 'Rio Rancho', 'Sandoval', 'NM', '87124', '5058411000', '5058432592', 'NMHEART', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-09-05', NULL, 0, 0, 0, 'Heart Hospital of New Mexico', '', '', '', 'HCFA|UB|', '1598804593', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('850424076', 'W12046465', 'W12046465', 'NM01', 'New Mexico Heart Institute', 'Barry', 'W', 'Ramo', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '2240 Grande Blvd SE Ste 102', 'Rio Rancho', 'Sandoval', 'NM', '87124', '5058411000', '5058432592', '2240 Grande Blvd SE Ste 102', 'Rio Rancho', 'Sandoval', 'NM', '87124', '5058411000', '5058432592', 'NMHEART', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-09-05', NULL, 0, 0, 0, 'Heart Hospital of New Mexico', '', '', '', 'HCFA|UB|', '1598769499', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('850424076', 'W12046466', 'W12046466', 'NM01', 'New Mexico Heart Institute', 'Karen ', 'S', 'Sopko', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '2240 Grande Blvd SE Ste 102', 'Rio Rancho', 'Sandoval', 'NM', '87124', '5058411000', '5058432592', '2240 Grande Blvd SE Ste 102', 'Rio Rancho', 'Sandoval', 'NM', '87124', '5058411000', '5058432592', 'NMHEART', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-09-05', NULL, 0, 0, 0, 'Heart Hospital of New Mexico', '', '', '', 'HCFA|UB|', '1063551075', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('850424076', 'W12046467', 'W12046467', 'NM01', 'New Mexico Heart Institute', 'Howard', 'S', 'Zeman', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '2240 Grande Blvd SE Ste 102', 'Rio Rancho', 'Sandoval', 'NM', '87124', '5058411000', '5058432592', '2240 Grande Blvd SE Ste 102', 'Rio Rancho', 'Sandoval', 'NM', '87124', '5058411000', '5058432592', 'NMHEART', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-09-05', '2014-04-11', 0, 0, 0, 'Heart Hospital of New Mexico', '', '', '', 'HCFA|UB|', '1104820919', 0, 'N', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('830207671', 'W12046482', 'W12046482', 'WY01', 'West Park Hospital ENT Clinic', 'Randy', 'J', 'Folker', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '424 Yellowstone Ave Ste 220', 'Cody', 'Park', 'WY', '82414', '3075782283', '3075782979', '424 Yellowstone Ave Ste 220', 'Cody', 'Park', 'WY', '82414', '3075782283', '3075782979', '', '', '', '0.00', '12.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1649296914', 0, 'N', 1, '2014-04-23', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12046471', 'W12046471', 'WYBILLINGS', 'Billings Clinic', 'Alan', '', 'Thometz', 'MD', 'Cardiovascular Disease', 'Electrophysiology', '', NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104925098', 0, 'N', 0, '2014-04-09', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12046472', 'W12046472', 'WYBILLINGS', 'Billings Clinic', 'Alan', '', 'Thometz', 'MD', 'Cardiovascular Disease', 'Electrophysiology', '', NULL, 'M', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104925098', 0, 'N', 0, '2014-04-09', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12046474', 'W12046474', 'WYBILLINGS', 'Billings Clinic', 'Donald', '', 'Green', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-03-07', '2014-03-07', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518980671', 0, 'N', 0, '2014-05-09', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12046476', 'W12046476', 'WYBILLINGS', 'Billings Clinic - General Surgery', 'Donald', '', 'Green', 'MD', 'General Surgery', '', '', NULL, 'O', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382848', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382848', '', '', '', '0.00', '17.00', '0.00', 3, '2014-03-07', '2014-03-07', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518980671', 0, 'N', 0, '2014-05-09', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12046475', 'W12046475', 'WYBILLINGS', 'Billings Clinic', 'Donald', '', 'Green', 'MD', 'General Surgery', '', '', NULL, 'M', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-03-07', '2014-03-07', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518980671', 0, 'N', 0, '2014-05-09', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12046477', 'W12046477', 'WYBILLINGS', 'Billings Clinic - Pulmonary', 'Lisa', 'E', 'Harvey', 'MD', 'Family Practice', '', '', NULL, 'O', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382813', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382813', '', '', '', '0.00', '17.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1477527299', 0, 'N', 0, '2014-04-10', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12046478', 'W12046478', 'WYBILLINGS', 'Billings Clinic', 'Lisa', 'E', 'Harvey', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1477527299', 0, 'N', 0, '2014-04-10', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12046479', 'W12046479', 'WYBILLINGS', 'Billings Clinic', 'Lisa', 'E', 'Harvey', 'MD', 'Family Practice', '', '', NULL, 'M', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1477527299', 0, 'N', 0, '2014-04-10', NULL, NULL, 0, 0, NULL, NULL),
('830287251', 'W12046480', 'W12046480', 'WY01', 'Quality Care IV Care', '', '', 'Quality Care IV Care MANUALLY PRICE ', '', 'Infusion Agency', '', '', NULL, 'O', '3131 E Grand Ave Ste B', 'Laramie', 'Albany', 'WY', '82070', '3077425048', '3077450432', '3131 E Grand Ave Ste B', 'Laramie', 'Albany', 'WY', '82070', '3077425048', '3077450432', '', '', 'Q|T|VCARE', '0.00', '50.00', '0.00', 3, '2014-06-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '0000010162', 0, 'N', 0, '2014-06-11', NULL, NULL, 0, 0, NULL, NULL),
('830287251', 'W12046481', 'W12046481', 'WYT1', 'Quality Care IV Care', '', '', 'Quality Care IV Care MANUALLY PRICE ', '', 'Infusion Agency', '', '', NULL, 'O', '3131 E Grand Ave Ste B', 'Laramie', 'Albany', 'WY', '82070', '3077425048', '3077450432', '3131 E Grand Ave Ste B', 'Laramie', 'Albany', 'WY', '82070', '3077425048', '3077450432', '', '', 'Q|T|VCARE', '0.00', '50.00', '0.00', 3, '2014-06-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '0000010162', 0, 'N', 0, '2014-06-11', NULL, NULL, 0, 0, NULL, NULL),
('830207671', 'W12046483', 'W12046483', 'WYT1', 'West Park Hospital ENT Clinic', 'Randy', 'J', 'Folker', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '424 Yellowstone Ave Ste 220', 'Cody', 'Park', 'WY', '82414', '3075782283', '3075782979', '424 Yellowstone Ave Ste 220', 'Cody', 'Park', 'WY', '82414', '3075782283', '3075782979', '', '', '', '0.00', '12.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1649296914', 0, 'N', 1, '2014-04-23', NULL, NULL, 0, 0, NULL, NULL),
('830207671', 'W12046485', 'W12046485', 'WYT1', 'West Park Hospital District', 'Randy', 'J', 'Folker', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075227501', '3075782492', '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075227501', '3075782492', '', '', '', '0.00', '12.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1649296914', 0, 'N', 1, '2014-04-23', NULL, NULL, 0, 0, NULL, NULL),
('870288988', 'W12046486', 'W12046486', 'UT01', 'Layton Visual Center', 'James', 'R', 'David', 'OD', 'Optometry', '', '', NULL, 'O', '180 W Gordon Ave Ste E1', 'Layton', 'Davis', 'UT', '84041', '8015462481', '8015462483', '180 W Gordon Ave Ste E1', 'Layton', 'Davis', 'UT', '84041', '8015462481', '8015462483', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932289691', 0, 'N', 0, '2014-05-16', NULL, NULL, 0, 0, NULL, NULL),
('841433992', 'W12046487', 'W12046487', 'UTIHCPHY', 'Rosenberg Cooley Metcalf', 'Andrew', 'H', 'Avery', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '900 Round Valley Dr Ste 100', 'Park City', 'Summit', 'UT', '84060', '4356556600', '4356552388', '900 Round Valley Dr Ste 100', 'Park City', 'Summit', 'UT', '84060', '4356556600', '4356552388', 'WMETCALF', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'Park City Medical Center', '', '', '', 'HCFA|UB|', '1609203660', 0, 'N', 0, '2014-06-25', NULL, NULL, 0, 0, NULL, NULL),
('464198300', 'W12046489', 'W12046489', 'ID01', 'Saint Alphonsus Behavioral Health', 'Jeremy', 'A', 'Handy', 'MD', 'Psychiatry', '', '', NULL, 'O', '131 N Allumbaugh', 'Boise', 'Ada', 'ID', '83704', '2083672175', '2083760285', '131 N Allumbaugh', 'Boise', 'Ada', 'ID', '83704', '2083672175', '2083760285', 'IDMD', '', '', '0.00', '40.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|UB|', '1437371671', 0, 'N', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('464198300', 'W12046488', 'W12046488', 'ID01', '', 'Jeremy', 'A', 'Handy', 'MD', 'Psychiatry', '', '', NULL, 'O', '413 N Allumbaugh Ste 101', 'Boise', 'Ada', 'ID', '83704', '2083231125', '2083239604', '413 N Allumbaugh Ste 101', 'Boise', 'Ada', 'ID', '83704', '2083231125', '2083239604', 'IDMD', '', '', '0.00', '40.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|UB|', '1437371671', 0, 'N', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('742630478', 'W12046490', 'W12046490', 'TXSATSTD', 'Walter M Bain MD', 'Walter', 'M', 'Bain', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '18518 Hardy Oak Blvd', 'San Antonio', 'Bexar', 'TX', '78258', '2102268982', '          ', '18518 Hardy Oak Blvd', 'San Antonio', 'Bexar', 'TX', '78258', '2102268982', '          ', 'TXSURGB', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2014-04-07', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1194890863', 0, 'N', 0, '2014-04-10', NULL, NULL, 0, 0, NULL, NULL),
('870710584', 'W12046491', 'W12046491', 'UTMH1', 'Jordan West Family Counseling', 'Jessica ', 'B', 'Jones', 'LCPC', 'Mental Health', 'Counseling', '', NULL, 'O', '9263 Redwood Rd Bldg 8 Ste B', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660749', '8015667108', '9263 Redwood Rd Bldg 8 Ste B', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660749', '8015667108', 'UTMA', '', '', '0.00', '40.00', '0.00', 6, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912205824', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12046494', 'W12046494', 'WYBILLINGS', 'Billings Clinic', 'Karen', '', 'Davis', 'PHD', 'Psychology', '', '', NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-04-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144263096', 0, 'N', 0, '2014-04-10', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12046493', 'W12046493', 'WYBILLINGS', 'Behavioral Health Clinic', 'Karen', '', 'Davis', 'PHD', 'Psychology', '', '', NULL, 'O', '1020 N 27th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062525430', '1020 N 27th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062525430', '', '', '', '0.00', '17.00', '0.00', 3, '2014-04-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144263096', 0, 'N', 0, '2014-04-10', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12046495', 'W12046495', 'WYBILLINGS', 'Billings Clinic', 'Karen', '', 'Davis', 'PHD', 'Psychology', '', '', NULL, 'M', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-04-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144263096', 0, 'N', 0, '2014-04-10', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12046497', 'W12046497', 'WYBILLINGS', 'Billings Clinic', 'John', 'R', 'Craig', 'MD', 'Vascular Surgery', '', '', NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013957695', 0, 'N', 0, '2014-04-10', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12046498', 'W12046498', 'WYBILLINGS', 'Billings Clinic', 'John', 'R', 'Craig', 'MD', 'Vascular Surgery', '', '', NULL, 'M', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013957695', 0, 'N', 0, '2014-04-10', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12046499', 'W12046499', 'WYBILLINGS', 'Billings Clinic - Vascular Surgery', 'John', 'R', 'Craig', 'MD', 'Vascular Surgery', '', '', NULL, 'O', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382413', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382413', '', '', '', '0.00', '17.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013957695', 0, 'N', 0, '2014-04-10', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12046500', 'W12046500', 'WYBILLINGS', 'Billings Clinic - Cody Clinic', 'Lisa', 'E', 'Harvey', 'MD', 'Family Practice', '', '', NULL, 'O', '201 Yellowstone Ave', 'Cody', 'Park', 'WY', '82414', '3075277561', '3075277539', '201 Yellowstone Ave', 'Cody', 'Park', 'WY', '82414', '3075277561', '3075277539', '', '', '', '0.00', '17.00', '0.00', 3, '2014-03-31', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1477527299', 0, 'N', 0, '2014-04-10', NULL, NULL, 0, 0, NULL, NULL),
('742974353', 'W12046501', 'W12046501', 'TXSATSTD', 'Robert G Nobles MD', 'Robert', 'G', 'Nobles', 'MD', 'Internal Medicine', '', '', NULL, 'O', '5282 Medical Dr Ste 110', 'San Antonio', 'Bexar', 'TX', '78229', '2106905511', '          ', '5282 Medical Dr Ste 110', 'San Antonio', 'Bexar', 'TX', '78229', '2106905511', '          ', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2014-04-07', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1467457937', 0, 'N', 0, '2014-04-10', NULL, NULL, 0, 0, NULL, NULL),
('742743906', 'W12046502', 'W12046502', 'TXSATSTD', 'San Antonio Kidney Disease Center', 'John', 'E', 'Kobert', 'DO', 'Nephrology', '', '', NULL, 'O', '495 10th St Ste 102', 'Floresville', 'Wilson', 'TX', '78114', '8302162606', '          ', '495 10th St Ste 102', 'Floresville', 'Wilson', 'TX', '78114', '8302162606', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2014-04-07', NULL, 0, 0, 0, 'Mission Trail Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1376528810', 0, 'N', 0, '2014-04-10', NULL, NULL, 0, 0, NULL, NULL),
('274112739', 'W12046503', 'W12046503', 'UT01', 'Young Hearing', 'Jared', 'R', 'Young', 'AUD', 'Audiology', '', '', NULL, 'O', '528 N Main St', 'Springville', 'Utah', 'UT', '84663', '8014897948', '8014910530', '528 N Main St', 'Springville', 'Utah', 'UT', '84663', '8014897948', '8014910530', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-07', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346230745', 0, 'N', 0, '2014-06-03', NULL, NULL, 0, 0, NULL, NULL),
('752943993', 'W12046504', 'W12046504', 'TXDALSTD', 'North Texas Kidney Disease Associates', 'Srivasa', 'B', 'Chebrolu', 'MD', 'Nephrology', '', '', NULL, 'O', '4401 Coit Rd Ste 301', 'Frisco', 'Denton', 'TX', '75034', '4695740464', '4695740471', '4401 Coit Rd Ste 301', 'Frisco', 'Denton', 'TX', '75034', '4695740464', '4695740471', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124019450', 0, 'N', 0, '2014-04-10', NULL, NULL, 0, 0, NULL, NULL),
('954893928', 'W12046509', 'W12046509', 'UT01', 'Exodus Healthcare Network', 'Jean', 'D', 'Zehnder', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '3665 S 8400 W Ste 110', 'Magna', 'Salt Lake', 'UT', '84044', '8012509638', '8012503204', '3665 S 8400 W Ste 110', 'Magna', 'Salt Lake', 'UT', '84044', '8012509638', '8012503204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-08', NULL, 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1770562621', 0, 'N', 0, '2014-04-11', NULL, NULL, 0, 0, NULL, NULL),
('954893928', 'W12046510', 'W12046510', 'UT01', 'Exodus Healthcare Network', 'Jean', 'D', 'Zehnder', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '3336 S Pioneer Pkwy Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012509638', '8012503204', '3336 S Pioneer Pkwy Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012509638', '8012503204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-08', NULL, 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1770562621', 0, 'N', 0, '2014-04-11', NULL, NULL, 0, 0, NULL, NULL),
('463819765', 'W12046511', 'W12046511', 'UT01', 'Synergy Soft Tissue Center', 'Timothy', 'J', 'Bailey', 'DC', 'Chiropractic', '', '', NULL, 'O', '30 E Main St', 'Hyrum', 'Cache', 'UT', '84319', '4352457555', '4352457607', '30 E Main St', 'Hyrum', 'Cache', 'UT', '84319', '4352457555', '4352457607', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2013-11-01', '2014-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1891063731', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('836000331', 'W12046513', 'W12046513', 'WY01', 'UW Family Medicine Residency Casper', 'Michael', 'V', 'Miller', 'DO', 'Family Practice', '', '', NULL, 'O', '1522 E A St', 'Casper', 'Natrona', 'WY', '82601', '3072346161', '3072347033', '1522 E A St', 'Casper', 'Natrona', 'WY', '82601', '3072346161', '3072347033', 'WYWISESTD130', 'WUSTDHCPC5', '', '0.00', '0.00', '0.00', 3, '2014-06-01', NULL, 0, 35, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA', '1548201213', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('836000331', 'W12046514', 'W12046514', 'WYT1', 'UW Family Medicine Residency Casper', 'Michael', 'V', 'Miller', 'DO', 'Family Practice', '', '', NULL, 'O', '1522 E A St', 'Casper', 'Natrona', 'WY', '82601', '3072346161', '3072347033', '1522 E A St', 'Casper', 'Natrona', 'WY', '82601', '3072346161', '3072347033', 'WYWISESTD130', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-06-01', NULL, 0, 35, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA', '1548201213', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('836000331', 'W12046516', 'W12046516', 'WY01', 'UW Family Medicine Residency Casper', 'Valerie', 'K', 'Goen', 'PA-C', 'Family Practice', '', '', NULL, 'O', '1522 E A St', 'Casper', 'Natrona', 'WY', '82601', '3072346161', '3072347033', '1522 E A St', 'Casper', 'Natrona', 'WY', '82601', '3072346161', '3072347033', 'WYWISESTD130', 'WUSTDHCPC5', '', '0.00', '0.00', '0.00', 3, '2014-06-01', NULL, 0, 35, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA', '1851336598', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('836000331', 'W12046517', 'W12046517', 'WYT1', 'UW Family Medicine Residency Casper', 'Valerie', 'K', 'Goen', 'PA-C', 'Family Practice', '', '', NULL, 'O', '1522 E A St', 'Casper', 'Natrona', 'WY', '82601', '3072346161', '3072347033', '1522 E A St', 'Casper', 'Natrona', 'WY', '82601', '3072346161', '3072347033', 'WYWISESTD130', 'WUSTDHCPC5', '', '0.00', '0.00', '0.00', 3, '2014-06-01', NULL, 0, 35, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA', '1851336598', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('836000331', 'W12046520', 'W12046520', 'WY01', 'UW Family Medicine Residency Casper', 'John', 'L', 'Noffsinger', 'PA-C', 'Family Practice', '', '', NULL, 'O', '1522 E A St', 'Casper', 'Natrona', 'WY', '82601', '3072346161', '3072347033', '1522 E A St', 'Casper', 'Natrona', 'WY', '82601', '3072346161', '3072347033', 'WYWISESTD130', 'WUSTDHCPC5', '', '0.00', '0.00', '0.00', 3, '2014-06-01', NULL, 0, 35, 0, '', '', '', '', 'HCFA', '1750318754', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('836000331', 'W12046521', 'W12046521', 'WYT1', 'UW Family Medicine Residency Casper', 'John', 'L', 'Noffsinger', 'PA-C', 'Family Practice', '', '', NULL, 'O', '1522 E A St', 'Casper', 'Natrona', 'WY', '82601', '3072346161', '3072347033', '1522 E A St', 'Casper', 'Natrona', 'WY', '82601', '3072346161', '3072347033', 'WYWISESTD130', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-06-01', NULL, 0, 35, 0, '', '', '', '', 'HCFA', '1750318754', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('836000331', 'W12046523', 'W12046523', 'WY01', 'UW Family Medicine Residency Casper', 'Lillian', 'D', 'Cannon', 'PA-C', 'Family Practice', '', '', NULL, 'O', '1522 E A St', 'Casper', 'Natrona', 'WY', '82601', '3072346161', '3072347033', '1522 E A St', 'Casper', 'Natrona', 'WY', '82601', '3072346161', '3072347033', 'WYWISESTD130', 'WUSTDHCPC5', '', '0.00', '0.00', '0.00', 3, '2014-06-01', NULL, 0, 35, 0, '', '', '', '', 'HCFA', '1174875991', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('836000331', 'W12046524', 'W12046524', 'WYT1', 'UW Family Medicine Residency Casper', 'Lillian', 'D', 'Cannon', 'PA-C', 'Family Practice', '', '', NULL, 'O', '1522 E A St', 'Casper', 'Natrona', 'WY', '82601', '3072346161', '3072347033', '1522 E A St', 'Casper', 'Natrona', 'WY', '82601', '3072346161', '3072347033', 'WYWISESTD130', 'WUSTDHCPC5', '', '0.00', '0.00', '0.00', 3, '2014-06-01', NULL, 0, 35, 0, '', '', '', '', 'HCFA', '1174875991', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('836000331', 'W12046526', 'W12046526', 'WY01', 'UW Family Medicine Residency Casper', 'Jerry', '', 'McLain', 'MD', 'Family Practice', '', '', NULL, 'O', '1522 E A St', 'Casper', 'Natrona', 'WY', '82601', '3072346161', '3072347033', '1522 E A St', 'Casper', 'Natrona', 'WY', '82601', '3072346161', '3072347033', 'WYWISESTD130', 'WUSTDHCPC5', '', '0.00', '0.00', '0.00', 3, '2014-06-01', NULL, 0, 35, 0, '', '', '', '', 'HCFA', '1912980327', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('836000331', 'W12046527', 'W12046527', 'WYT1', 'UW Family Medicine Residency Casper', 'Jerry', '', 'McLain', 'MD', 'Family Practice', '', '', NULL, 'O', '1522 E A St', 'Casper', 'Natrona', 'WY', '82601', '3072346161', '3072347033', '1522 E A St', 'Casper', 'Natrona', 'WY', '82601', '3072346161', '3072347033', 'WYWISESTD130', 'WUSTDHCPC5', '', '0.00', '0.00', '0.00', 3, '2014-06-01', NULL, 0, 35, 0, '', '', '', '', 'HCFA', '1912980327', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('836000331', 'W12046529', 'W12046529', 'WY01', 'UW Family Medicine Residency Casper', 'Michael', 'A', 'Jording', 'MD', 'Family Practice', '', '', NULL, 'O', '1522 E A St', 'Casper', 'Natrona', 'WY', '82601', '3072346161', '3072347033', '1522 E A St', 'Casper', 'Natrona', 'WY', '82601', '3072346161', '3072347033', 'WYWISESTD130', 'WUSTDHCPC5', '', '0.00', '0.00', '0.00', 3, '2014-06-01', NULL, 0, 35, 0, '', '', '', '', 'HCFA', '1982681383', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('836000331', 'W12046530', 'W12046530', 'WYT1', 'UW Family Medicine Residency Casper', 'Michael', 'A', 'Jording', 'MD', 'Family Practice', '', '', NULL, 'O', '1522 E A St', 'Casper', 'Natrona', 'WY', '82601', '3072346161', '3072347033', '1522 E A St', 'Casper', 'Natrona', 'WY', '82601', '3072346161', '3072347033', 'WYWISESTD130', 'WUSTDHCPC5', '', '0.00', '0.00', '0.00', 3, '2014-06-01', NULL, 0, 35, 0, '', '', '', '', 'HCFA', '1982681383', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('836000331', 'W12046532', 'W12046532', 'WYT1', 'UW Family Medicine Residency Casper', 'Eric', 'J', 'Lawrence', 'DO', 'Family Practice', '', '', NULL, 'O', '1522 E A St', 'Casper', 'Natrona', 'WY', '82601', '3072346161', '3072347033', '1522 E A St', 'Casper', 'Natrona', 'WY', '82601', '3072346161', '3072347033', 'WYWISESTD130', 'WUSTDHCPC5', '', '0.00', '0.00', '0.00', 3, '2014-05-01', NULL, 0, 35, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA', '1326223751', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('836000331', 'W12046531', 'W12046531', 'WY01', 'UW Family Medicine Residency Casper', 'Eric', 'J', 'Lawrence', 'DO', 'Family Practice', '', '', NULL, 'O', '1522 E A St', 'Casper', 'Natrona', 'WY', '82601', '3072346161', '3072347033', '1522 E A St', 'Casper', 'Natrona', 'WY', '82601', '3072346161', '3072347033', 'WYWISESTD130', 'WUSTDHCPC5', '', '0.00', '0.00', '0.00', 3, '2014-05-01', NULL, 0, 35, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA', '1326223751', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('836000331', 'W12046533', 'W12046533', 'WY01', 'UW Family Medicine Residency Casper', 'Douglas', '', 'Phipps', 'MD', 'Family Practice', '', '', NULL, 'O', '1522 E A St', 'Casper', 'Natrona', 'WY', '82601', '3072346161', '3072347033', '1522 E A St', 'Casper', 'Natrona', 'WY', '82601', '3072346161', '3072347033', 'WYWISESTD130', 'WUSTDHCPC5', '', '0.00', '0.00', '0.00', 3, '2014-05-01', NULL, 0, 35, 0, 'SageWest Health Care', '', '', '', 'HCFA', '1508952276', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('836000331', 'W12046536', 'W12046536', 'WY01', 'UW Family Medicine Residency Casper', 'Mesha', 'L', 'Dunn', 'MD', 'Family Practice', '', '', NULL, 'O', '1522 E A St', 'Casper', 'Natrona', 'WY', '82601', '3072346161', '3072347033', '1522 E A St', 'Casper', 'Natrona', 'WY', '82601', '3072346161', '3072347033', 'WYWISESTD130', 'WUSTDHCPC5', '', '0.00', '0.00', '0.00', 3, '2014-06-01', NULL, 0, 35, 0, '', '', '', '', 'HCFA', '1235491341', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('836000331', 'W12046537', 'W12046537', 'WYT1', 'UW Family Medicine Residency Casper', 'Mesha', 'L', 'Dunn', 'MD', 'Family Practice', '', '', NULL, 'O', '1522 E A St', 'Casper', 'Natrona', 'WY', '82601', '3072346161', '3072347033', '1522 E A St', 'Casper', 'Natrona', 'WY', '82601', '3072346161', '3072347033', 'WYWISESTD130', 'WUSTDHCPC5', '', '0.00', '0.00', '0.00', 3, '2014-06-01', NULL, 0, 35, 0, '', '', '', '', 'HCFA', '1235491341', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('742719352', 'W12046538', 'W12046538', 'TXSATSTD', 'Urology of San Antonio', '', '', 'Urology of San Antonio', '', 'Urology', '', '', NULL, 'O', '3327 Research Plaza Ste 403', 'San Antonio', 'Bexar', 'TX', '78235', '2103376228', '          ', '3327 Research Plaza Ste 403', 'San Antonio', 'Bexar', 'TX', '78235', '2103376228', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2014-04-08', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000001143', 0, 'Y', 0, '2014-04-11', NULL, NULL, 0, 0, NULL, NULL),
('742719352', 'W12046540', 'W12046540', 'TXSATSTD', 'Urology of San Antonio', 'Christopher', 'H', 'Cantrill', 'MD', 'Urology', '', '', NULL, 'O', '3327 Research Plaza Ste 403', 'San Antonio', 'Bexar', 'TX', '78235', '2103376228', '          ', '3327 Research Plaza Ste 403', 'San Antonio', 'Bexar', 'TX', '78235', '2103376228', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2014-04-08', NULL, 0, 0, 0, 'St Lukes Baptist Hospital', '', '', '', 'HCFA|UB|', '1568642296', 0, 'N', 0, '2014-04-11', NULL, NULL, 0, 0, NULL, NULL),
('742719352', 'W12046541', 'W12046541', 'TX01', 'Urology of San Antonio', '', '', 'Urology of San Antonio', '', 'Urology', '', '', NULL, 'O', '134 Menger Springs', 'San Antonio', 'Bexar', 'TX', '78229', '          ', '          ', '134 Menger Springs', 'San Antonio', 'Bexar', 'TX', '78229', '          ', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-01-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000001143', 0, 'Y', 0, '2014-04-11', NULL, NULL, 0, 0, NULL, NULL),
('364037473', 'W12046543', 'W12046543', 'ILCHIGSTD', 'Elmhurst Memorial Primary Care Associates', 'Maggie', '', 'Chacko', 'MD', 'Internal Medicine', '', '', NULL, 'O', '675 W North Ave Ste 505', 'Melrose Park', 'Cook', 'IL', '60160', '6308340400', '7083442629', '675 W North Ave Ste 505', 'Melrose Park', 'Cook', 'IL', '60160', '6308340400', '7083442629', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2014-04-09', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1417993734', 0, 'N', 0, '2014-04-11', NULL, NULL, 0, 0, NULL, NULL),
('364037473', 'W12046544', 'W12046544', 'ILCHIGSTD', 'Elmhurst Clinic', 'Maggie', '', 'Chacko', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'Dept 4585', 'Carol Stream', 'Dupage', 'IL', '60122', '3312219099', '6309935681', 'Dept 4585', 'Carol Stream', 'Dupage', 'IL', '60122', '3312219099', '6309935681', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1417993734', 0, 'N', 0, '2014-06-17', NULL, NULL, 0, 0, NULL, NULL),
('742743906', 'W12046546', 'W12046546', 'TXSATSTD', 'San Antonio Kidney Disease Center', 'Caridad', 'M', 'Rebollar', 'MD', 'Nephrology', '', '', NULL, 'O', '2902 Goliad Rd Ste 103', 'San Antonio', 'Bexar', 'TX', '78223', '2103374911', '          ', '2902 Goliad Rd Ste 103', 'San Antonio', 'Bexar', 'TX', '78223', '2103374911', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2014-04-08', NULL, 0, 0, 0, 'Mission Trail Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1073598520', 0, 'N', 0, '2014-04-11', NULL, NULL, 0, 0, NULL, NULL),
('954893928', 'W12046548', 'W12046548', 'UT01', 'Exodus Healthcare Network', 'Jocelyn', 'J', 'Decker', 'NP', 'Family Practice', '', '', NULL, 'O', '3655 S 8400 W Ste 110', 'Magna', 'Salt Lake', 'UT', '84044', '8012509638', '8012503204', '3655 S 8400 W Ste 110', 'Magna', 'Salt Lake', 'UT', '84044', '8012509638', '8012503204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003245689', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('954893928', 'W12046547', 'W12046547', 'UT01', 'Exodus Healthcare Network', 'Jocelyn', 'J', 'Decker', 'NP', 'Family Practice', '', '', NULL, 'O', '3336 S Pioneer Pkwy Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012509638', '8014170063', '3336 S Pioneer Pkwy Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012509638', '8014170063', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003245689', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'W12046552', 'W12046552', 'TXSATSTD', 'Institute for Womens Health', 'Sara', '', 'Mornar', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '999 E Basse Rd Ste 100', 'San Antonio', 'Bexar', 'TX', '78209', '2106563040', '2106566419', '999 E Basse Rd Ste 100', 'San Antonio', 'Bexar', 'TX', '78209', '2106563040', '2106566419', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2014-04-14', NULL, 0, 0, 0, 'North East Baptist Hospital', '', '', '', 'HCFA|UB|', '1376710863', 0, 'N', 0, '2014-04-11', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'W12046551', 'W12046551', 'TXSATSTD', 'Institute for Womens Health', 'Henry', '', 'Garza', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '999 E Basse Rd Ste 100', 'San Antonio', 'Bexar', 'TX', '78209', '2106563040', '2106566419', '999 E Basse Rd Ste 100', 'San Antonio', 'Bexar', 'TX', '78209', '2106563040', '2106566419', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2014-04-14', NULL, 0, 0, 0, 'North East Baptist Hospital', '', '', '', 'HCFA|UB|', '1962491175', 0, 'N', 0, '2014-04-11', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'W12046553', 'W12046553', 'TXSATSTD', 'Institute for Womens Health', 'Eduardo', '', 'Raez', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '999 E Basse Rd Ste 100', 'San Antonio', 'Bexar', 'TX', '78209', '2106563040', '2106566419', '999 E Basse Rd Ste 100', 'San Antonio', 'Bexar', 'TX', '78209', '2106563040', '2106566419', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2014-04-14', NULL, 0, 0, 0, 'North East Baptist Hospital', '', '', '', 'HCFA|UB|', '1255320404', 0, 'N', 0, '2014-04-11', NULL, NULL, 0, 0, NULL, NULL),
('364037473', 'W12046555', 'W12046555', 'ILCHIGSTD', 'Elmhurst Memorial Primary Care Associates', 'Agron', '', 'Elezi', 'MD', 'Internal Medicine', '', '', NULL, 'O', '305 N York Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312214350', '3312213934', '305 N York Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312214350', '3312213934', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2014-04-11', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1679886121', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('364037473', 'W12046556', 'W12046556', 'ILCHIGSTD', 'Elmhurst Memorial Primary Care Associates', 'Agron', '', 'Elezi', 'MD', 'Internal Medicine', '', '', NULL, 'O', '675 W North Ave Ste 505', 'Melrose Park', 'Cook', 'IL', '60160', '6308340400', '7083442629', '675 W North Ave Ste 505', 'Melrose Park', 'Cook', 'IL', '60160', '6308340400', '7083442629', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2014-04-11', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1679886121', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'W12046557', 'W12046557', 'UT01', '72nd Street Clinic', 'Christian', 'P', 'Hyer', 'PA', 'Family Practice', '', '', NULL, 'O', '220 W 7200 S Ste A', 'Midvale', 'Salt Lake', 'UT', '84047', '8015665494', '8015619647', '220 W 7200 S Ste A', 'Midvale', 'Salt Lake', 'UT', '84047', '8015665494', '8015619647', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-11', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164672549', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'W12046558', 'W12046558', 'UT01', '72nd Street Clinic', 'Martha', 'P', 'Mandujano', 'PA', 'Family Practice', '', '', NULL, 'O', '220 W 7200 S Ste A', 'Midvale', 'Salt Lake', 'UT', '84047', '8015665494', '          ', '220 W 7200 S Ste A', 'Midvale', 'Salt Lake', 'UT', '84047', '8015665494', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-11', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356446215', 0, 'N', 0, '2014-04-22', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'W12046559', 'W12046559', 'UT01', 'Oquirrhview Clinic Medical', 'Frank', 'J', 'Powers', 'MD', 'Family Practice', '', '', NULL, 'O', '4745 S 3200 W', 'Salt Lake City', 'Salt Lake', 'UT', '84129', '8019646214', '8019829232', '4745 S 3200 W', 'Salt Lake City', 'Salt Lake', 'UT', '84129', '8019646214', '8019829232', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-11', NULL, 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1447412135', 0, 'N', 0, '2014-04-22', NULL, NULL, 0, 0, NULL, NULL),
('870574059', 'W12046562', 'W12046562', 'UT01', 'Mountain Land Stansbury', 'Bret', 'Lloyd', 'Maiers', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '220 Millpond Ste 109', 'Tooele', 'Tooele', 'UT', '84074', '4358824144', '4358824151', '220 Millpond Ste 109', 'Tooele', 'Tooele', 'UT', '84074', '4358824144', '4358824151', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1497061782', 0, 'N', 0, '2014-04-14', NULL, NULL, 0, 0, NULL, NULL),
('870574059', 'W12046563', 'W12046563', 'UT01', 'Mountain Land Rehabilitation Inc', 'Bret', 'Lloyd', 'Maiers', 'DPT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 711185', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8015471155', '8015471173', 'PO Box 711185', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8015471155', '8015471173', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1497061782', 0, 'N', 0, '2014-04-14', NULL, NULL, 0, 0, NULL, NULL),
('462647661', 'W12046396', 'W12046396', 'UT01', 'Pierre Zabel DO', 'Pierre', 'D', 'Zabel', 'DO', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012936800', '8012936828', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012936800', '8012936828', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-15', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1760717805', 0, 'Y', 0, '2014-04-18', NULL, NULL, 0, 0, NULL, NULL),
('462647661', 'W12046397', 'W12046397', 'UT01', 'Pierre Zabel DO', 'Pierre', 'D', 'Zabel', 'DO', 'Physical Medicine and Rehabilitation', '', '', NULL, 'B', 'PO Box 307', 'Bountiful', 'Davis', 'UT', '84011', '8012936800', '8012936828', 'PO Box 307', 'Bountiful', 'Davis', 'UT', '84011', '8012936800', '8012936828', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-15', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1760717805', 0, 'N', 0, '2014-04-18', NULL, NULL, 0, 0, NULL, NULL),
('202500191', 'W12046566', 'W12046566', 'UTMH1', 'H & H Wellnes Group', 'Richard', 'J', 'Hydo', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '2180 E 4500 S Ste 185', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8013088155', '8013088742', '2180 E 4500 S Ste 185', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8013088155', '8013088742', 'UTMA', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184046633', 0, 'N', 0, '2014-06-25', NULL, NULL, 0, 0, NULL, NULL),
('202500191', 'W12046565', 'W12046565', 'UTMH1', 'Draper Pyschological Services', 'Richard', 'J', 'Hydo', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '668 E 12225 S Ste 202', 'Draper', 'Salt Lake', 'UT', '84020', '8016193569', '8015767540', '668 E 12225 S Ste 202', 'Draper', 'Salt Lake', 'UT', '84020', '8016193569', '8015767540', 'UTMA', '', '', '0.00', '40.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184046633', 0, 'N', 0, '2014-06-25', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046569', 'W12046569', 'IDBOISTD', 'Saint Alphonsus Medical Group Overland Family Medicine', 'Amanda', 'R', 'Schwartz', 'PA-C', 'Family Practice', '', '', NULL, 'O', '10255 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083677205', '2083677204', '10255 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083677205', '2083677204', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-03-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1619112216', 0, 'Y', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046570', 'W12046570', 'IDBOISTD', 'Saint Alphonsus Medical Group Boise Pediatrics Mulvaney', 'Amanda', 'R', 'Schwartz', 'PA-C', 'Family Practice', '', '', NULL, 'O', '1072 N Liberty Ste 203', 'Boise', 'Ada', 'ID', '83704', '2083674321', '2083674525', '1072 N Liberty Ste 203', 'Boise', 'Ada', 'ID', '83704', '2083674321', '2083674525', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-03-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1619112216', 0, 'Y', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046571', 'W12046571', 'IDBOISTD', 'Saint Alphonsus Medical Group Express Care Carrington', 'Amanda', 'R', 'Schwartz', 'PA-C', 'Family Practice', '', '', NULL, 'O', '1122 N Liberty Rd', 'Boise', 'Ada', 'ID', '83704', '2083672032', '2083672033', '1122 N Liberty Rd', 'Boise', 'Ada', 'ID', '83704', '2083672032', '2083672033', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-03-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1619112216', 0, 'Y', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046572', 'W12046572', 'IDBOISTD', 'Saint Alphonsus Medical Group Garrity Family Medicine', 'Amanda', 'R', 'Schwartz', 'PA-C', 'Family Practice', '', '', NULL, 'O', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-03-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1619112216', 0, 'Y', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046573', 'W12046573', 'IDBOISTD', 'Saint Alphonsus Medical Group McMillan Family Medicine', 'Amanda', 'R', 'Schwartz', 'PA-C', 'Family Practice', '', '', NULL, 'O', '12273 W McMillan Rd', 'Boise', 'Ada', 'ID', '83713', '2083676330', '2083674765', '12273 W McMillan Rd', 'Boise', 'Ada', 'ID', '83713', '2083676330', '2083674765', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-03-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1619112216', 0, 'Y', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046574', 'W12046574', 'IDBOISTD', 'Saint Alphonsus Medical Group Express Clinics', 'Amanda', 'R', 'Schwartz', 'PA-C', 'Family Practice', '', '', NULL, 'O', '1515 W State St', 'Boise', 'Ada', 'ID', '83702', '2083456768', '          ', '1515 W State St', 'Boise', 'Ada', 'ID', '83702', '2083456768', '          ', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-03-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1619112216', 0, 'Y', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046575', 'W12046575', 'IDBOISTD', 'Saint Alphonsus Medical Group Federal Way Family Medicine', 'Amanda', 'R', 'Schwartz', 'PA-C', 'Family Practice', '', '', NULL, 'O', '1880 W Judith Ln', 'Boise', 'Ada', 'ID', '83705', '2083676910', '2083676170', '1880 W Judith Ln', 'Boise', 'Ada', 'ID', '83705', '2083676910', '2083676170', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-03-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1619112216', 0, 'Y', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046576', 'W12046576', 'IDBOISTD', 'Saint Alphonsus Medical Group Iowa Family Medicine', 'Amanda', 'R', 'Schwartz', 'PA-C', 'Family Practice', '', '', NULL, 'O', '211 W Iowa Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084657377', '2084657397', '211 W Iowa Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084657377', '2084657397', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-03-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1619112216', 0, 'Y', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046577', 'W12046577', 'IDBOISTD', 'Saint Alphonsus Medical Group Dallan Woods Family Medicine', 'Amanda', 'R', 'Schwartz', 'PA-C', 'Family Practice', '', '', NULL, 'O', '214 S Midland Blvd', 'Nampa', 'Canyon', 'ID', '83686', '2084656900', '2084656911', '214 S Midland Blvd', 'Nampa', 'Canyon', 'ID', '83686', '2084656900', '2084656911', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-03-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1619112216', 0, 'Y', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046578', 'W12046578', 'IDBOISTD', 'Saint Alphonsus Medical Group MHP Family Medicine', 'Amanda', 'R', 'Schwartz', 'PA-C', 'Family Practice', '', '', NULL, 'O', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-03-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1619112216', 0, 'Y', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046579', 'W12046579', 'IDBOISTD', 'Saint Alphonsus Medical Group Elm Family Medicine', 'Amanda', 'R', 'Schwartz', 'PA-C', 'Family Practice', '', '', NULL, 'O', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-03-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1619112216', 0, 'Y', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046580', 'W12046580', 'IDBOISTD', 'Saint Alphonsus Medical Group Oasis Medical Clinic', 'Amanda', 'R', 'Schwartz', 'PA-C', 'Family Practice', '', '', NULL, 'O', '3217 W Bavaria St', 'Eagle', 'Ada', 'ID', '83616', '2082866676', '2089473419', '3217 W Bavaria St', 'Eagle', 'Ada', 'ID', '83616', '2082866676', '2089473419', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-03-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1619112216', 0, 'Y', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046581', 'W12046581', 'IDBOISTD', 'Saint Alphonsus Medical Group EHP Family Medicine', 'Amanda', 'R', 'Schwartz', 'PA-C', 'Family Practice', '', '', NULL, 'O', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-03-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1619112216', 0, 'Y', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046582', 'W12046582', 'IDBOISTD', 'Saint Alphonsus Medical Group Occupational Med EHP', 'Amanda', 'R', 'Schwartz', 'PA-C', 'Family Practice', '', '', NULL, 'O', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-03-19', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1619112216', 0, 'Y', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046583', 'W12046583', 'IDBOISTD', 'Saint Alphonsus Medical Group Occupational Med NHP', 'Amanda', 'R', 'Schwartz', 'PA-C', 'Family Practice', '', '', NULL, 'O', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084668912', '2084663403', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084668912', '2084663403', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-03-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1619112216', 0, 'Y', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046584', 'W12046584', 'IDBOISTD', 'Saint Alphonsus Medical Group NHP Family Medicine  ', 'Amanda', 'R', 'Schwartz', 'PA-C', 'Family Practice', '', '', 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, '2014-03-19', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1619112216', 0, 'Y', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046585', 'W12046585', 'IDBOISTD', 'Saint Alphonsus Express Care Inc', 'Amanda', 'R', 'Schwartz', 'PA-C', 'Family Practice', '', '', NULL, 'O', '4700 N Eagle Rd', 'Boise', 'Ada', 'ID', '83713', '2089384797', '2083672968', '4700 N Eagle Rd', 'Boise', 'Ada', 'ID', '83713', '2089384797', '2083672968', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-03-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1619112216', 0, 'Y', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('820200895', 'W12046586', 'W12046586', 'IDBOISTD', 'Saint Alphonsus Medical Group Internal Medicine', 'Amanda', 'R', 'Schwartz', 'PA-C', 'Family Practice', '', '', NULL, 'O', '6140 W Curtisian Ste 300', 'Boise', 'Ada', 'ID', '83704', '2083676575', '2083676597', '6140 W Curtisian Ste 300', 'Boise', 'Ada', 'ID', '83704', '2083676575', '2083676597', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-03-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1619112216', 0, 'Y', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046590', 'W12046590', 'IDBOISTD', 'Saint Alphonsus Medical Group Emerald Family Medicine', 'Amanda', 'R', 'Schwartz', 'PA-C', 'Family Practice', '', '', NULL, 'O', '6533 Emerald', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', '6533 Emerald', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-03-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1619112216', 0, 'Y', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046587', 'W12046587', 'IDBOISTD', 'Saint Alphonsus Medical Group Kuna Family Medicine', 'Amanda', 'R', 'Schwartz', 'PA-C', 'Family Practice', '', '', NULL, 'O', '757 E Wythe Creek Ct', 'Kuna', 'Ada', 'ID', '83634', '2083673366', '2083672070', '757 E Wythe Creek Ct', 'Kuna', 'Ada', 'ID', '83634', '2083673366', '2083672070', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-03-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1619112216', 0, 'Y', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046591', 'W12046591', 'IDBOISTD', 'Saint Alphonsus Medical Group Acute Pain', 'Holly', '', 'Swensen', 'NP', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083677246', '2083674051', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083677246', '2083674051', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1386672012', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'W12046593', 'W12046593', 'IDBOISTD', 'Saint Alphonsus Medical Group Coughlin Clinic Boise ', 'Robert', 'A', 'Swensen', 'DPM', 'Podiatry', '', '', NULL, 'O', '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083673330', '2083673331', '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083673330', '2083673331', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2014-03-18', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1225354244', 0, 'N', 0, '2014-07-10', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'W12046594', 'W12046594', 'IDBOISTD', 'Saint Alphonsus Medical Group Vascular Services Nampa', 'Jeffrey', 'B', 'Symmonds', 'MD', 'Cardiovascular Disease', 'Vascular Surgery', '', NULL, 'O', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2083677787', '2083677798', '4400 E Flamingo Ave   ', 'Nampa', 'Canyon', 'ID', '83687', '2083677787', '2083677798', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2014-04-07', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1154370328', 0, 'Y', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046596', 'W12046596', 'IDBOISTD', 'Saint Alphonsus Medical Group Acute Pain', 'Benjamin', 'N', 'Bish', 'NP', 'Pain Management', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083677246', '2083674051', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083677246', '2083674051', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1770514051', 0, 'N', 0, '2014-04-14', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046597', 'W12046597', 'ID01', 'Saint Alphonsus Behavioral Health', 'Laura', 'E', 'Root', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '131 N Allumbaugh', 'Boise', 'Ada', 'ID', '83704', '2083672175', '2083760285', '131 N Allumbaugh', 'Boise', 'Ada', 'ID', '83704', '2083672175', '2083760285', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1023171428', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046599', 'W12046599', 'IDBOISTD', 'Saint Alphonsus Medical Group Federal Way Family Medicine', 'Katherine', 'L', 'Devlin', 'NP', 'Family Practice', '', '', NULL, 'O', '1880 W Judith Ln', 'Boise', 'Ada', 'ID', '83705', '2083676910', '2083676170', '1880 W Judith Ln', 'Boise', 'Ada', 'ID', '83705', '2083676910', '2083676170', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-03-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1366620825', 0, 'N', 0, '2014-04-14', NULL, NULL, 0, 0, NULL, NULL),
('820435241', 'W12046600', 'W12046600', 'ID02', 'Idaho Physical Medicine and Rehabilitation', '', '', 'Idaho Physical Medicine and Rehabilitation', '', 'Ambulatory Surgery Center', '', '', NULL, 'O', '3551 E Overland Rd', 'Meridian', 'Ada', 'ID', '83642', '2088841333', '0000000000', '3551 E Overland Rd', 'Meridian', 'Ada', 'ID', '83642', '2088841333', '0000000000', '', '', '', '0.00', '20.00', '0.00', 3, '2014-01-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497949705', 0, 'N', 0, '2014-04-14', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046601', 'W12046601', 'ID01', 'Saint Alphonsus Medical Group Acute Pain', 'Thomas', '', 'Rambow', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083677246', '2083674051', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083677246', '2083674051', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1679534184', 0, 'N', 0, '2014-04-15', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12046602', 'W12046602', 'IDBOISTD', 'Saint Alphonsus Medical Group Acute Pain', 'Susan', '', 'McMullen', 'NPC', 'Family Practice', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083677246', '2083674051', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083677246', '2083674051', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-05-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1932160447', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('452716222', 'W12046612', 'W12046612', 'ID02', 'St Lukes Clinic - General Surgery', 'Nicolas', '', 'Allen', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '3399 E Louise Dr', 'Meridian', 'Ada', 'ID', '83642', '2083643000', '2083678266', '3399 E Louise Dr', 'Meridian', 'Ada', 'ID', '83642', '2083643000', '2083678266', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2014-03-10', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1205910551', 0, 'N', 0, '2014-04-15', NULL, NULL, 0, 0, NULL, NULL),
('820300537', 'W12046620', 'W12046620', 'ID02', 'Terry Reilly Health Services', 'Claudia', '', 'Currie-Mills', 'LCSW', 'Counseling', '', '', NULL, 'B', 'PO Box 9', 'Nampa', 'Canyon', 'ID', '83653', '2084617149', '0000000000', 'PO Box 9', 'Nampa', 'Canyon', 'ID', '83653', '2084617149', '0000000000', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2014-03-26', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1619936176', 0, 'N', 0, '2014-04-15', NULL, NULL, 0, 0, NULL, NULL),
('452716222', 'W12046613', 'W12046613', 'ID02', 'St Lukes Physician Billing', 'Nicolas', '', 'Allen', 'PA-C', 'Physician Assistant', '', '', NULL, 'B', 'PO Box 640', 'Boise', 'Ada', 'ID', '83701', '2087065000', '0000000000', 'PO Box 640', 'Boise', 'Ada', 'ID', '83701', '2087065000', '0000000000', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2014-03-10', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1205910551', 0, 'N', 0, '2014-04-15', NULL, NULL, 0, 0, NULL, NULL),
('820300537', 'W12046615', 'W12046615', 'ID02', 'Terry Reilly Health Services', 'Andrew', 'R', 'Baron', 'MD', 'Family Practice', '', '', NULL, 'O', '223 16th Ave N', 'Nampa', 'Canyon', 'ID', '83653', '2084667869', '2084665359', '223 16th Ave N', 'Nampa', 'Canyon', 'ID', '83653', '2084667869', '2084665359', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2014-03-31', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1750567731', 0, 'N', 0, '2014-05-09', NULL, NULL, 0, 0, NULL, NULL),
('820300537', 'W12046616', 'W12046616', 'ID02', 'Terry Reilly Health Services', 'Andrew', 'R', 'Baron', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 9', 'Nampa', 'Canyon', 'ID', '83653', '2084617149', '0000000000', 'PO Box 9', 'Nampa', 'Canyon', 'ID', '83653', '2084617149', '0000000000', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2014-03-31', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1750567731', 0, 'N', 0, '2014-05-09', NULL, NULL, 0, 0, NULL, NULL),
('820300537', 'W12046621', 'W12046621', 'ID02', 'Terry Reilly Health Services', 'Claudia', '', 'Currie-Mills', 'LCSW', 'Counseling', '', '', NULL, 'O', '408 Allumbaugh', 'Boise', 'Ada', 'ID', '83704', '2083239600', '2083239606', '408 Allumbaugh', 'Boise', 'Ada', 'ID', '83704', '2083239600', '2083239606', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2014-03-26', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1619936176', 0, 'N', 0, '2014-04-15', NULL, NULL, 0, 0, NULL, NULL),
('202320132', 'W12046628', 'W12046628', 'IDBOISTD', 'Lifestages OB/GYN', 'Olivia', 'A', 'Galvez', 'MD', 'Family Practice', '', '', NULL, 'O', '3908 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084428035', '2084428038', '3908 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084428035', '2084428038', 'IDSAMG2', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 6, '2014-04-01', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1215975677', 0, 'N', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('820496865', 'W12046630', 'W12046630', 'ID02', 'Eyecare Associates of Nampa', 'Landon', 'K', 'Hagberg', 'OD', 'Optometry', '', '', NULL, 'O', '310 2nd St S', 'Nampa', 'Canyon', 'ID', '83651', '2084671361', '          ', '310 2nd St S', 'Nampa', 'Canyon', 'ID', '83651', '2084671361', '          ', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2014-03-26', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1699087437', 0, 'N', 0, '2014-07-03', NULL, NULL, 0, 0, NULL, NULL),
('820300537', 'W12046632', 'W12046632', 'ID02', 'Terry Reilly Health Services', 'Britney', '', 'Journee', 'LCPC', 'Counseling', '', '', NULL, 'O', '408 Allumbaugh', 'Boise', 'Ada', 'ID', '83704', '2083239600', '2083239606', '408 Allumbaugh', 'Boise', 'Ada', 'ID', '83704', '2083239600', '2083239606', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2014-03-26', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1912966730', 0, 'N', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('820300537', 'W12046633', 'W12046633', 'ID02', 'Terry Reilly Health Services', 'Britney', '', 'Journee', 'LCPC', 'Counseling', '', '', NULL, 'B', 'PO Box 9', 'Nampa', 'Canyon', 'ID', '83653', '2084617149', '0000000000', 'PO Box 9', 'Nampa', 'Canyon', 'ID', '83653', '2084617149', '0000000000', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2014-03-26', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1912966730', 0, 'N', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('464841010', 'W12046635', 'W12046635', 'ID02', 'West Idaho Anesthesia', 'John', '', 'Kerfoot', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'O', '3115 Medical Dr', 'Caldwell', 'Canyon', 'ID', '83605', '2085528572', '2085232025', '3115 Medical Dr', 'Caldwell', 'Canyon', 'ID', '83605', '2085528572', '2085232025', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2014-03-14', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1598810863', 0, 'Y', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('464841010', 'W12046636', 'W12046636', 'ID02', 'West Idaho Anesthesia', 'John', '', 'Kerfoot', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'B', 'PO Box 3816', 'Idaho Falls', 'Bonneville', 'ID', '83403', '2085528572', '2085232025', 'PO Box 3816', 'Idaho Falls', 'Bonneville', 'ID', '83403', '2085528572', '2085232025', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2014-03-14', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1598810863', 0, 'N', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('204969546', 'W12046638', 'W12046638', 'IDBOISTD', 'Meridian Pediatrics', 'Vanessa', 'I', 'McCrory', 'NP', 'Pediatrics', '', '', NULL, 'O', '3653 N Locust Grove Rd', 'Meridian', 'Ada', 'ID', '83646', '2083385437', '2089399811', '3653 N Locust Grove Rd', 'Meridian', 'Ada', 'ID', '83646', '2083385437', '2089399811', 'IDSTD10', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-03-31', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801008305', 0, 'N', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('760762803', 'W12046639', 'W12046639', 'ID02', 'Center for Lifetime Health', 'Laura', '', 'Poly', 'PA-C', 'Family Practice', '', '', NULL, 'O', '300 E Bannock St', 'Boise', 'Ada', 'ID', '83712', '2083427400', '2083421879', '300 E Bannock St', 'Boise', 'Ada', 'ID', '83712', '2083427400', '2083421879', 'IDSTDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-04-10', NULL, 0, 0, 1, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1386933513', 0, 'N', 0, '2014-06-10', NULL, NULL, 0, 0, NULL, NULL),
('826000422', 'W12046641', 'W12046641', 'ID02', 'Walter Knox Memorial Hospital (Recognized PPO but not contra', 'Austin', 'H', 'Rasmussen', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '1202 E Locust St', 'Emmett', 'Gem', 'ID', '83617', '2083653561', '2083654176', '1202 E Locust St', 'Emmett', 'Gem', 'ID', '83617', '2083653561', '2083654176', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2014-03-18', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1124306295', 0, 'N', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('931262964', 'W12046643', 'W12046643', 'ID02', 'Ontario Pathology Group', 'Eric', '', 'Rysenga', 'MD', 'Pathology', '', '', NULL, 'O', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '5418817287', '5418817211', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '5418817287', '5418817211', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1659319549', 0, 'N', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('931262964', 'W12046644', 'W12046644', 'ID02', 'Ontario Pathology Group', 'Eric', '', 'Rysenga', 'MD', 'Pathology', '', '', NULL, 'B', 'PO Box 9589', 'Boise', 'Ada', 'ID', '83707', '2083850044', '0000000000', 'PO Box 9589', 'Boise', 'Ada', 'ID', '83707', '2083850044', '0000000000', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1659319549', 0, 'N', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('272481635', 'W12046645', 'W12046645', 'ID02', 'Saint Alphonsus Medical Center Nampa (Sound)', 'Sarah', 'R', 'Staller', 'MD', 'Family Practice', '', '', NULL, 'O', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084635000', '2532841881', '1512 12th Ave Rd   ', 'Nampa', 'Canyon', 'ID', '83686', '2084635000', '2532841881', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2014-04-16', NULL, 0, 0, 1, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1336450402', 0, 'Y', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('272481635', 'W12046646', 'W12046646', 'ID02', 'Saint Alphonsus Medical Center Nampa (Sound)', 'Sarah', 'R', 'Staller', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 742128', 'Los Angeles', 'Los Angeles', 'CA', '90074', '2536826050', '0000000000', 'PO Box 742128   ', 'Los Angeles', 'Los Angeles', 'CA', '90074', '2536826050', '0000000000', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2014-04-16', NULL, 0, 0, 1, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1336450402', 0, 'Y', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('931262964', 'W12046648', 'W12046648', 'ID02', 'Ontario Pathology Group', 'William', 'C', 'Thompson', 'MD', 'Pathology', '', '', NULL, 'B', 'PO Box 9589', 'Boise', 'Ada', 'ID', '83707', '2083850044', '0000000000', 'PO Box 9589', 'Boise', 'Ada', 'ID', '83707', '2083850044', '0000000000', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1376586941', 0, 'N', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('931262964', 'W12046649', 'W12046649', 'ID02', 'Ontario Pathology Group', 'William', 'C', 'Thompson', 'MD', 'Pathology', '', '', NULL, 'O', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '5418817287', '5418817211', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '5418817287', '5418817211', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1376586941', 0, 'N', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('463756705', 'W12046651', 'W12046651', 'ID01', 'Western Pacemaker Clinic', 'Karl', 'P', 'Undesser', 'MD', 'Cardiology', '', '', NULL, 'O', '745 S Progress Ave', 'Meridian', 'Ada', 'ID', '83642', '2088884600', '2082880800', '745 S Progress Ave', 'Meridian', 'Ada', 'ID', '83642', '2088884600', '2082880800', 'IDSTDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-03-21', '2014-05-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013961242', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('452715973', 'W12046652', 'W12046652', 'Sinclair', 'St Lukes Clinic Wood River', 'Steven', 'M', 'Greenberg', 'MD', 'Family Practice', '', '', NULL, 'O', '1450 Aviation Dr Ste 100', 'Hailey', 'Blaine', 'ID', '83333', '2087883434', '2087889238', '1450 Aviation Dr Ste 100', 'Hailey', 'Blaine', 'ID', '83333', '2087883434', '2087889238', 'IDSINCLAIRD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1407817364', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('742603269', 'W12046654', 'W12046654', 'TXSATSTD', '', 'Raul', 'E', 'Gaona', 'MD', 'Internal Medicine', '', '', NULL, 'O', '98 Briggs Ste 900-B', 'San Antonio', 'Bexar', 'TX', '78224', '2109271472', '2109211212', '98 Briggs Ste 900-B', 'San Antonio', 'Bexar', 'TX', '78224', '2109271472', '2109211212', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356384259', 0, 'N', 0, '2014-04-18', NULL, NULL, 0, 0, NULL, NULL),
('742748295', 'W12046658', 'W12046658', 'TXSATSTD', 'New Beginning Cardiology', 'John', 'M', 'Frierson', 'MD', 'Cardiology', '', '', NULL, 'O', '107 N Smith St', 'Pleasanton', 'Atascosa', 'TX', '78064', '2102717266', '2102268411', '107 N Smith St', 'Pleasanton', 'Atascosa', 'TX', '78064', '2102717266', '2102268411', 'TXORTHO', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326021015', 0, 'N', 0, '2014-04-18', NULL, NULL, 0, 0, NULL, NULL),
('742748295', 'W12046656', 'W12046656', 'TXSATSTD', 'New Beginning Cardiology', 'John', 'M', 'Frierson', 'MD', 'Cardiology', '', '', NULL, 'O', '1303 Hospital Blvd', 'Floresville', 'Wilson', 'TX', '78114', '2102717266', '2102268411', '1303 Hospital Blvd', 'Floresville', 'Wilson', 'TX', '78114', '2102717266', '2102268411', 'TXORTHO', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326021015', 0, 'N', 0, '2014-04-18', NULL, NULL, 0, 0, NULL, NULL),
('742748295', 'W12046657', 'W12046657', 'TXSATSTD', 'New Beginning Cardiology', 'John', 'M', 'Frierson', 'MD', 'Cardiology', '', '', NULL, 'O', '205 Hackberry', 'Pearsall', 'Frio', 'TX', '78061', '2102717266', '2102268411', '205 Hackberry', 'Pearsall', 'Frio', 'TX', '78061', '2102717266', '2102268411', 'TXORTHO', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326021015', 0, 'N', 0, '2014-04-18', NULL, NULL, 0, 0, NULL, NULL),
('742748295', 'W12046655', 'W12046655', 'TXSATSTD', 'New Beginning Cardiology', 'John', 'M', 'Frierson', 'MD', 'Cardiology', '', '', NULL, 'O', '4125 McCullough', 'San Antonio', 'Bexar', 'TX', '78212', '2102717266', '2102268411', '4125 McCullough', 'San Antonio', 'Bexar', 'TX', '78212', '2102717266', '2102268411', 'TXORTHO', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326021015', 0, 'N', 0, '2014-04-18', NULL, NULL, 0, 0, NULL, NULL),
('621762570', 'W12046662', 'W12046662', 'UT01', 'Ashley Valley Physician Practices', 'Lori', '', 'Teem', 'NP', 'Family Practice', '', '', NULL, 'B', '175 N 100 W Ste 204', 'Vernal', 'Uintah', 'UT', '84078', '4357253327', '4357253331', '175 N 100 W Ste 204', 'Vernal', 'Uintah', 'UT', '84078', '4357253327', '4357253331', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083675649', 0, 'N', 0, '2014-06-27', NULL, NULL, 0, 0, NULL, NULL),
('742998357', 'W12046660', 'W12046660', 'TXSATSTD', '', 'Jesus', 'A', 'Lopez', 'MD', 'Family Practice', '', '', NULL, 'O', '601 Labor St', 'San Antonio', 'Bexar', 'TX', '78210', '2105348895', '2105348873', '601 Labor St', 'San Antonio', 'Bexar', 'TX', '78210', '2105348895', '2105348873', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861543332', 0, 'N', 0, '2014-04-18', NULL, NULL, 0, 0, NULL, NULL),
('621762570', 'W12046661', 'W12046661', 'UT01', 'Ashley Valley Physician Practices', 'Lori', '', 'Teem', 'NP', 'Family Practice', '', '', NULL, 'O', '409 S 200 E', 'Roosevelt', 'Duchesne', 'UT', '84066', '4357253327', '4357253331', '409 S 200 E', 'Roosevelt', 'Duchesne', 'UT', '84066', '4357253327', '4357253331', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083675649', 0, 'N', 0, '2014-06-27', NULL, NULL, 0, 0, NULL, NULL),
('820471268', 'W12046663', 'W12046663', 'ID01', 'Sage Health Care', 'Janet', '', 'Graf', 'NP', 'Mental Health', 'Counseling', '', NULL, 'O', '413 N Allumbaugh St Ste 101', 'Boise', 'Ada', 'ID', '83704', '2083231125', '          ', '413 N Allumbaugh St Ste 101', 'Boise', 'Ada', 'ID', '83704', '2083231125', '          ', 'IDARNP', '', '', '0.00', '40.00', '0.00', 6, '2014-04-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1467556688', 0, 'N', 0, '2014-05-26', NULL, NULL, 0, 0, NULL, NULL),
('820471268', 'W12046664', 'W12046664', 'ID01', 'Sage Health Care', 'Brady', 'G', 'Hamilton', 'PA', 'Mental Health', '', '', NULL, 'O', '413 N Allumbaugh St Ste 101', 'Boise', 'Ada', 'ID', '83704', '2083231125', '2083239604', '413 N Allumbaugh St Ste 101', 'Boise', 'Ada', 'ID', '83704', '2083231125', '2083239604', 'IDMA', '', '', '0.00', '40.00', '0.00', 6, '2014-04-01', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1245221258', 0, 'N', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('850275777', 'W12046666', 'W12046666', 'NM01', 'Southwest Medical Associates', 'Kader', '', 'AbdeleRahman', 'MD', 'Neurology', '', '', NULL, 'O', '6100 Pan American Fwy, NE Ste 100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', '5057974503', '6100 Pan American Fwy, NE Ste 100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', '5057974503', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1003058157', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('850275777', 'W12046667', 'W12046667', 'NM01', 'Southwest Medical Associates', 'Kader', '', 'AbdeleRahman', 'MD', 'Neurology', '', '', NULL, 'O', '10511 Golf Course Rd Ste 205', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5058231010', '5057974503', '10511 Golf Course Rd Ste 205', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5058231010', '5057974503', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1003058157', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('850275777', 'W12046668', 'W12046668', 'NM01', 'Southwest Medical Associates', 'Kader', '', 'AbdeleRahman', 'MD', 'Neurology', '', '', NULL, 'O', '4420 Irving Blvd NW', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5058231010', '5057974503', '4420 Irving Blvd NW', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5058231010', '5057974503', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1003058157', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('850275777', 'W12046669', 'W12046669', 'NM01', 'Southwest Medical Associates', 'Kader', '', 'AbdeleRahman', 'MD', 'Neurology', '', '', NULL, 'O', '4705 Montgomery Blvd NE Ste 301-302', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', '5057974503', '4705 Montgomery Blvd NE Ste 301-302', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', '5057974503', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1003058157', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('850275777', 'W12046670', 'W12046670', 'NM01', 'Southwest Medical Associates', 'Kader', '', 'AbdeleRahman', 'MD', 'Neurology', '', '', NULL, 'O', '4801 McMahon Blvd Ste 110', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5057274025', '5057274030', '4801 McMahon Blvd Ste 110', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5057274025', '5057274030', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1003058157', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('850275777', 'W12046671', 'W12046671', 'NM01', 'Southwest Medical Associates', 'Kader', '', 'AbdeleRahman', 'MD', 'Neurology', '', '', NULL, 'O', '8401 Constitution NE Ste 150', 'Albuquerque', 'Bernalillo', 'NM', '87110', '5058231010', '5057974503', '8401 Constitution NE Ste 150', 'Albuquerque', 'Bernalillo', 'NM', '87110', '5058231010', '5057974503', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1003058157', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('850275777', 'W12046672', 'W12046672', 'NM01', 'Southwest Medical Associates', 'Kader', '', 'AbdeleRahman', 'MD', 'Neurology', '', '', NULL, 'O', '9501 Paseo del Norte Ste C & D', 'Albuquerque', 'Bernalillo', 'NM', '87122', '5057274000', '5057274014', '9501 Paseo del Norte Ste C & D', 'Albuquerque', 'Bernalillo', 'NM', '87122', '5057274000', '5057274014', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1003058157', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'W12046675', 'W12046675', 'ILCHIGSTD', 'Presence Healthcare Services', 'Richard', 'B', 'Warshell', 'MD', 'Internal Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8557647687', '6309142469', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8557647687', '6309142469', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336119163', 0, 'N', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'W12046674', 'W12046674', 'ILCHIGSTD', 'Presence Healthcare Services', 'Richard', 'B', 'Warshell', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2233 W Division St', 'Chicago', 'Cook', 'IL', '60622', '3127702000', '6309142499', '2233 W Division St', 'Chicago', 'Cook', 'IL', '60622', '3127702000', '6309142499', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336119163', 0, 'N', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'W12046673', 'W12046673', 'ILCHIGSTD', 'Presence Healthcare Services', 'Richard', 'B', 'Warshell', 'MD', 'Internal Medicine', '', '', NULL, 'O', '5645 W Addison St', 'Chicago', 'Cook', 'IL', '60634', '7732827000', '6309142499', '5645 W Addison St', 'Chicago', 'Cook', 'IL', '60634', '7732827000', '6309142499', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336119163', 0, 'N', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'W12046679', 'W12046679', 'UT01', 'Clinca De Buena Salud Medical', '', '', 'Community Health Centers', 'GROUP', 'Primary Care with Extended Hours', '', '', NULL, 'O', '14 N 100 E Ste 200', 'Brigham City', 'Box Elder', 'UT', '84302', '4357238276', '4357349761', '14 N 100 E Ste 200', 'Brigham City', 'Box Elder', 'UT', '84302', '4357238276', '4357349761', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-17', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000005779', 0, 'N', 0, '2014-04-22', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'W12046680', 'W12046680', 'UT01', 'Mountain View Clinic', '', '', 'Community Health Centers', 'GROUP', 'Primary Care with Extended Hours', '', '', NULL, 'O', '1388 S Navajo', 'Salt Lake City', 'Salt Lake', 'UT', '84104', '8014126920', '0000000000', '1388 S Navajo', 'Salt Lake City', 'Salt Lake', 'UT', '84104', '8014126920', '0000000000', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-17', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000005779', 0, 'N', 0, '2014-04-22', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'W12046681', 'W12046681', 'UT01', '72nd Street Clinic', '', '', 'Community Health Centers', 'GROUP', 'Primary Care with Extended Hours', '', '', NULL, 'B', '220 W 7200 S Ste A', 'Midvale', 'Salt Lake', 'UT', '84047', '8018583468', '8018583470', '220 W 7200 S Ste A', 'Midvale', 'Salt Lake', 'UT', '84047', '8018583468', '8018583470', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000005779', 0, 'N', 0, '2014-04-22', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'W12046682', 'W12046682', 'UT01', 'Central City Clinic Medical', '', '', 'Community Health Centers', 'GROUP', 'Primary Care with Extended Hours', '', '', NULL, 'O', '461 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015398634', '8015377238', '461 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015398634', '8015377238', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-17', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000005779', 0, 'N', 0, '2014-04-22', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'W12046683', 'W12046683', 'UT01', 'Central City Clinic Medical', 'Phung (Karen)', 'K', 'Do', 'PA', 'Family Practice', '', '', NULL, 'O', '461 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015398634', '8015377238', '461 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015398634', '8015377238', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-17', '2014-04-21', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902901838', 0, 'N', 0, '2014-04-22', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'W12046684', 'W12046684', 'UT01', 'Central City Clinic Medical', 'David', 'M', 'Gontrum', 'MD', 'Family Practice', '', '', NULL, 'O', '461 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015398634', '8015377238', '461 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015398634', '8015377238', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-17', '2014-04-21', 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1922084813', 0, 'N', 0, '2014-04-22', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'W12046685', 'W12046685', 'UT01', 'Central City Clinic Medical', 'Keith', '', 'Horwood', 'MD', 'Family Practice', '', '', NULL, 'O', '461 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015398634', '8015377238', '461 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015398634', '8015377238', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-17', '2014-04-21', 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1316923113', 0, 'N', 0, '2014-04-22', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'W12046686', 'W12046686', 'UT01', 'Central City Clinic Medical', 'Christian', 'P', 'Hyer', 'PA', 'Family Practice', '', '', NULL, 'O', '461 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015398634', '8015377238', '461 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015398634', '8015377238', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-17', '2014-04-21', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164672549', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'W12046687', 'W12046687', 'UT01', 'Central City Clinic Medical', 'Martha', 'P', 'Mandujano', 'PA', 'Family Practice', '', '', NULL, 'O', '461 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015398634', '8015377238', '461 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015398634', '8015377238', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-17', '2014-04-21', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356446215', 0, 'N', 0, '2014-04-22', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'W12046688', 'W12046688', 'UT01', 'Central City Clinic Medical', 'Jay', 'C', 'Moreland', 'MD', 'Family Practice', '', '', NULL, 'O', '461 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015398634', '8015377238', '461 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015398634', '8015377238', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-17', '2014-04-21', 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1023095866', 0, 'N', 0, '2014-04-22', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'W12046689', 'W12046689', 'UT01', 'Central City Clinic Medical', 'Kathryn', 'M', 'Ekstrom', 'MD', 'Internal Medicine', 'Pediatrics', '', NULL, 'O', '461 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015398634', '8015377238', '461 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015398634', '8015377238', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-17', '2014-04-21', 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1346493400', 0, 'N', 0, '2014-04-22', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'W12046690', 'W12046690', 'UT01', 'Central City Clinic Medical', 'Frank', 'J', 'Powers', 'MD', 'Family Practice', '', '', NULL, 'O', '461 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015398634', '8015377238', '461 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015398634', '8015377238', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-17', '2014-04-21', 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1447412135', 0, 'N', 0, '2014-04-22', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'W12046691', 'W12046691', 'UT01', 'Central City Clinic Medical', 'David', 'E', 'Robinson', 'MD', 'Family Practice', '', '', NULL, 'O', '461 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015398634', '8015377238', '461 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015398634', '8015377238', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-17', '2014-04-21', 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1780661421', 0, 'N', 0, '2014-04-22', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'W12046692', 'W12046692', 'UT01', 'Central City Clinic Medical', 'Edward', 'R', 'Schultz', 'MD', 'Family Practice', '', '', NULL, 'O', '461 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015398634', '8015377238', '461 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015398634', '8015377238', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-17', '2014-04-21', 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1942287719', 0, 'N', 0, '2014-04-22', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'W12046693', 'W12046693', 'UT01', 'Central City Clinic Medical', 'Katherine', 'A', 'Shen', 'MD', 'Family Practice', '', '', NULL, 'O', '461 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015398634', '8015377238', '461 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015398634', '8015377238', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-17', '2014-04-21', 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1578540357', 0, 'N', 0, '2014-04-22', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'W12046694', 'W12046694', 'UT01', 'Central City Clinic Medical', 'Susan', 'J', 'Sittler', 'NP', 'Family Practice', '', '', NULL, 'O', '461 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015398634', '8015377238', '461 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015398634', '8015377238', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-17', '2014-04-21', 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1972580769', 0, 'N', 0, '2014-04-22', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'W12046695', 'W12046695', 'UT01', 'Central City Clinic Medical', 'Gillian', 'G', 'Tufts', 'FNP', 'Family Practice', '', '', NULL, 'O', '461 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015398634', '8015377238', '461 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015398634', '8015377238', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-17', '2014-04-21', 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1083691737', 0, 'N', 0, '2014-04-22', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'W12046696', 'W12046696', 'UT01', 'Central City Clinic Medical', 'Sarah', 'L', 'Woolsey', 'MD', 'Family Practice', '', '', NULL, 'O', '461 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015398634', '8015377238', '461 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015398634', '8015377238', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-17', '2014-04-21', 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1427035187', 0, 'N', 0, '2014-04-22', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12046700', 'W12046700', 'WYBILLINGS', 'Billings Clinic - Neurology', 'Ann', 'Marie', 'Collier', 'MD', 'Neurology', '', '', NULL, 'O', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382805', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382805', '', '', '', '0.00', '17.00', '0.00', 3, '2014-04-14', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487898458', 0, 'N', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12046698', 'W12046698', 'WYBILLINGS', 'Billings Clinic', 'Ann', 'Marie', 'Collier', 'MD', 'Neurology', '', '', NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-04-14', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487898458', 0, 'N', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12046699', 'W12046699', 'WYBILLINGS', 'Billings Clinic', 'Ann', 'Marie', 'Collier', 'MD', 'Neurology', '', '', NULL, 'M', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-04-14', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487898458', 0, 'N', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12046702', 'W12046702', 'WYBILLINGS', 'Billings Clinic - Pulmonary', 'Manfred', '', 'Baumgartner', 'MD', 'Pulmonary', '', '', NULL, 'O', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382813', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382813', '', '', '', '0.00', '17.00', '0.00', 3, '2014-04-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467618645', 0, 'N', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12046703', 'W12046703', 'WYBILLINGS', 'Billings Clinic', 'Manfred', '', 'Baumgartner', 'MD', 'Pulmonary', '', '', NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-04-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467618645', 0, 'N', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12046704', 'W12046704', 'WYBILLINGS', 'Billings Clinic', 'Manfred', '', 'Baumgartner', 'MD', 'Pulmonary', '', '', NULL, 'M', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-04-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467618645', 0, 'N', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12046706', 'W12046706', 'WYBILLINGS', 'Billings Clinic - Family Practice', 'Linda', 'J', 'Starr', 'MD', 'Family Practice', '', '', NULL, 'O', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382469', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382469', '', '', '', '0.00', '17.00', '0.00', 3, '2014-04-08', NULL, 0, 0, 0, 'Billings Clinic Hospital', '', '', '', 'HCFA|UB|', '1477864155', 0, 'N', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12046707', 'W12046707', 'WYBILLINGS', 'Billings Clinic', 'Linda', 'J', 'Starr', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-04-08', NULL, 0, 0, 0, 'Billings Clinic Hospital', '', '', '', 'HCFA|UB|', '1477864155', 0, 'N', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12046708', 'W12046708', 'WYBILLINGS', 'Billings Clinic', 'Linda', 'J', 'Starr', 'MD', 'Family Practice', '', '', NULL, 'M', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-04-08', NULL, 0, 0, 0, 'Billings Clinic Hospital', '', '', '', 'HCFA|UB|', '1477864155', 0, 'N', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12046712', 'W12046712', 'WYBILLINGS', 'Billings Clinic - Radiation  Oncology', 'Breanne', '', 'Terakedis', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382572', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382572', '', '', '', '0.00', '17.00', '0.00', 3, '2014-04-08', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609010578', 0, 'N', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12046710', 'W12046710', 'WYBILLINGS', 'Billings Clinic', 'Breanne', '', 'Terakedis', 'MD', 'Radiation Oncology', '', '', NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-04-08', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609010578', 0, 'N', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12046711', 'W12046711', 'WYBILLINGS', 'Billings Clinic', 'Breanne', '', 'Terakedis', 'MD', 'Radiation Oncology', '', '', NULL, 'M', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-04-08', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609010578', 0, 'N', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'W12046714', 'W12046714', 'TXDALSTD', 'Health Texas Provider Network', 'Jennifer', 'D', 'Heffernan', 'MD', 'Geriatrics', '', '', NULL, 'O', '4009 Worth St', 'Dallas', 'Dallas', 'TX', '75246', '2148209115', '2148209135', '4009 Worth St', 'Dallas', 'Dallas', 'TX', '75246', '2148209115', '2148209135', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2014-03-05', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1992781256', 0, 'N', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'W12046715', 'W12046715', 'TXDALSTD', 'Health Texas Provider Network', 'Neeta', 'G', 'Nayak', 'MD', 'Geriatrics', '', '', NULL, 'O', '4009 Worth St', 'Dallas', 'Dallas', 'TX', '75246', '2148209115', '2148209135', '4009 Worth St', 'Dallas', 'Dallas', 'TX', '75246', '2148209115', '2148209135', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2014-03-05', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', '', '', '', 'HCFA|UB', '1407887425', 0, 'N', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'W12046718', 'W12046718', 'TXDALSTD', 'Health Texas Provider Network', 'Jill', 'L', 'Studley', 'MD', 'Geriatrics', '', '', NULL, 'O', '4009 Worth St', 'Dallas', 'Dallas', 'TX', '75246', '2148209115', '2148209135', '4009 Worth St', 'Dallas', 'Dallas', 'TX', '75246', '2148209115', '2148209135', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2014-03-05', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor Regional Medical Center at Plano', '', '', 'HCFA|UB', '1023049053', 0, 'Y', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'W12046720', 'W12046720', 'TXDALSTD', 'Health Texas Provider Network', 'Joyce', 'M', 'Thompson', 'MD', 'Geriatrics', '', '', NULL, 'O', '4009 Worth St', 'Dallas', 'Dallas', 'TX', '75246', '2148209115', '2148209135', '4009 Worth St', 'Dallas', 'Dallas', 'TX', '75246', '2148209115', '2148209135', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2014-03-05', NULL, 0, 0, 0, 'Baylor University Medical Center', '', '', '', 'HCFA|UB', '1306861448', 0, 'Y', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('362684132', 'W12046724', 'W12046724', 'ILCHIGSTD', 'Mercado Foot and Ankle Clinic', 'O', 'Kent', 'Mercado', 'DPM', 'Podiatry', '', '', NULL, 'O', '6545 W North Ave', 'Oak Park', 'Cook', 'IL', '60302', '7083836800', '7083836827', '6545 W North Ave', 'Oak Park', 'Cook', 'IL', '60302', '7083836800', '7083836827', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2014-04-11', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1447360896', 0, 'N', 0, '2014-04-18', NULL, NULL, 0, 0, NULL, NULL),
('830217795', 'W12046726', 'W12046726', 'WY01', 'Internal Medicine Group', '', '', 'Internal Medicine Group', '', 'Internal Medicine', '', '', NULL, 'O', '2301 House Ave Ste 300', 'Cheyenne', 'Laramie', 'WY', '82001', '3076354141', '3076356587', '2301 House Ave Ste 300', 'Cheyenne', 'Laramie', 'WY', '82001', '3076354141', '3076356587', 'WY160', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '0000000093', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('830217795', 'W12046727', 'W12046727', 'WYT1', 'Internal Medicine Group', '', '', 'Internal Medicine Group', '', 'Internal Medicine', '', '', NULL, 'O', '2301 House Ave Ste 300', 'Cheyenne', 'Laramie', 'WY', '82001', '3076354141', '3076356587', '2301 House Ave Ste 300', 'Cheyenne', 'Laramie', 'WY', '82001', '3076354141', '3076356587', 'WY160', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '0000000093', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('830217795', 'W12046729', 'W12046729', 'WY01', 'Internal Medicine Group', 'Kleanthis', '', 'Dendrinos', 'MD', 'Gastroenterology', '', '', NULL, 'O', '2301 House Ave Ste 300', 'Cheyenne', 'Laramie', 'WY', '82001', '3076354141', '3076356587', '2301 House Ave Ste 300', 'Cheyenne', 'Laramie', 'WY', '82001', '3076354141', '3076356587', 'WY160', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1861528457', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('830217795', 'W12046730', 'W12046730', 'WYT1', 'Internal Medicine Group', 'Kleanthis', '', 'Dendrinos', 'MD', 'Gastroenterology', '', '', NULL, 'O', '2301 House Ave Ste 300', 'Cheyenne', 'Laramie', 'WY', '82001', '3076354141', '3076356587', '2301 House Ave Ste 300', 'Cheyenne', 'Laramie', 'WY', '82001', '3076354141', '3076356587', 'WY160', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1861528457', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL);
