INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(29771, 1006, 23241, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent f/u email @ ZASHBAUGH@centene.com & ProspectiveProviderTX@wellcare.com:  Sub: Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  \"Hello,   I wanted to get an update regarding the enrollment status for the following group:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Address: 4042 River Hill Corpus Christi , TX 78410 Quaternary Address: 3817 South Padre Island Drive Corpus Christi , TX 78415  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-08-24 13:15:20', '2021-08-24 13:15:20'),
(29772, 1006, 23241, NULL, '2021-09-08 00:00:00.000', 'In Process', 'We received the following email from Zujey.Ashbaugh@superiorhealthplan.com:  \"Good afternoon,  We are still pending your completed credentialing documents. The contract was sign.  I have attached them for you. Once completed please forward them to SHP.NetworkDevelopment@superiorhealthplan.com  Thank you, Zujey Ashbaugh (Zuzy) Contract Coordinator Network Participation Request related info Phone Number 866-615-9399  “Never stop learning, because life never stops teaching”\"  Facility credentialing application was filled out and sent out to SHP.NetworkDevelopment@superiorhealthplan.com, attached in main group task for reference. ', NULL, NULL, '2021-09-01 15:41:21', '2021-09-01 15:41:21'),
(29773, 11056, 23241, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning!  Hope this email finds you well. Please provide me with the latest updates regarding the enrollment process and with facility Ancillary application of which we have submitted in the starting of Sep,2021 of the Facility mentioned below:  Group Name                	Statcare Minor Emergency Clinic Tax ID	                            46-0575924 Group NPI	                    1689924904 Primary Location	             500 E CAESAR, KINGSVILLE , TX 78363 Secondary Location	     6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Location	             4042 River Hill, Corpus Christi , TX 78410 Quarternary Location	     3817 South Padre Island Drive, Corpus Christi , TX 78415   If you have any concerns or questions or require documents please let me know.   Thank you! Have a blessed week ahead!', NULL, NULL, '2021-09-22 10:46:03', '2021-09-22 10:46:03'),
(29774, 11056, 23241, NULL, '2021-10-07 00:00:00.000', 'In Process', 'Email received from : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning,   We received your completed application on 9/7/21. Your projected effective date is 10/01/21.  The enrollment record is currently in the process of being loaded into our system. Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.  Phone: 866-615-9399  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com', NULL, NULL, '2021-09-30 17:01:49', '2021-09-30 17:01:49'),
(29775, 11056, 23241, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good evening Zujey!  Hope this email finds you well. It is just a follow up email regarding the agreement and welcome packet. I am still waiting for that, please provide that soon.  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-12 16:09:17', '2021-10-12 16:09:17'),
(29776, 11056, 23241, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email received from : SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Hello,   Your record has not been complete, but the effective date is still showing 10/1/121.    Once they complete your record. You will received a welcome packet.   Thank you,', NULL, NULL, '2021-10-20 14:13:29', '2021-10-20 14:13:29'),
(29777, 11056, 23241, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email sent to: 	SHP Network Development NPR Contracting  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good afternoon!  Hope this email finds you well. Has my record been completed yet or not? Please expedite, it has been a long time for the credentialing processing.  Take Care!  Thank you! Have a blessed day!', NULL, NULL, '2021-11-10 17:45:05', '2021-11-10 17:45:05'),
(29778, 11056, 23241, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email sent to: SHP Network Development NPR Contracting  Sub: Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning!  Hope this email finds you well. Please respond to my query at your earliest opportunity.  Eagerly, waiting for your reply.  Thank you! Have a wonderful day!', NULL, NULL, '2021-11-19 17:49:40', '2021-11-19 17:49:40'),
(29779, 11056, 23241, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email received from:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com   Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Hello,     Your record has not been complete, but the effective date is still showing 10/1/121.     Thank you,', NULL, NULL, '2021-12-01 13:14:35', '2021-12-01 13:14:35'),
(29780, 11056, 23241, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION  Good afternoon!  Hope you are having a productive day. I am unable to add the location through the link. Kindly add the highlighted locations to the agreement and as well as to the directory too.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382   Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-16 16:43:43', '2021-12-16 16:43:43'),
(29781, 11056, 23241, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   The NPI and Tax ID is the same as the main and billing location for all locations. Please see below.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382', NULL, NULL, '2021-12-23 15:38:57', '2021-12-23 15:38:57'),
(29782, 19067, 23241, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Greetings!   Any updates on the previously mentioned request?   Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 17:20:27', '2022-01-10 17:20:27'),
(29783, 19067, 23241, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Greetings!  This is my THIRD REMINDER on the request below. Kindly respond in a timely manner.  Regards, Hammad Ahmed.', NULL, NULL, '2022-01-26 17:59:38', '2022-01-26 17:59:38'),
(29784, 19067, 23241, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Hello!  I haven\'t heard from you and it\'s been a while now. Kindly look into my requests and update me.  Waiting to hear from you soon!  Thanks, Hammad Ahmed.', NULL, NULL, '2022-02-11 17:09:23', '2022-02-11 17:09:23'),
(29785, 19067, 23241, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Hello!  Hope this email finds you well.  I haven\'t heard from you for 1 month. Kindly respond at your earliest convenience.   Regards, Hammad Ahmed.', NULL, NULL, '2022-02-21 17:48:58', '2022-02-21 17:48:58'),
(29786, 19067, 23241, NULL, '2022-03-02 00:00:00.000', 'In Process', 'Email received from: Zujey.Ashbaugh@superiorhealthplan.com  Subject: RE: Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare    Hello,     Your request was forward to the correct dep to get you the welcome packet and welcome letter.', NULL, NULL, '2022-02-23 10:35:00', '2022-02-23 10:35:00'),
(29787, 19067, 23241, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Fwd: Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare    Hi Zuzi,  I haven\'t received the welcome kit as far, can you request that department one more time to send us the approval letter?  Thanks,', NULL, NULL, '2022-03-15 18:03:06', '2022-03-15 18:03:06'),
(29788, 3046, 23244, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 16:18:38', '2021-03-18 16:18:38'),
(29789, 1006, 23244, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Sent following enrollment request email @ CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,   I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?   Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.   Thank you. \" ', NULL, NULL, '2021-04-08 18:48:03', '2021-04-08 18:48:03'),
(29790, 9057, 23244, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent following email to CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Status - RHC - Christus Spohn  \"Hello, We want to know the current status of the request we sent to you last month about the enrollment for the following group and its providers:  Group Name: Statcare Minor Emergency Clinic NPI#  1689924904  TIN#  46-0575924  Please get back to us as soon as possible.  Thank you\"', NULL, NULL, '2021-05-25 10:16:39', '2021-05-25 10:16:39'),
(29791, 1006, 23244, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent a VM to Vicki Gera @ (800) 419-3461 as we haven\'t been receiving any replies on emails. ', NULL, NULL, '2021-06-11 14:12:56', '2021-06-11 14:12:56'),
(29792, 1006, 23244, NULL, '2021-07-08 00:00:00.000', 'In Process', 'We received the following update from vicki.guerra@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hi Adil,  Happy Wednesday!  Thank you for reaching out. We would like for Statcare Minor Emergency Clinic to come back on board. The last time we spoke it was to my understanding that Ms. Rabagos did not have a sponsoring physician with hospital privileges for a Christus facility. This is one of the requirements to bring this provider group back on board with a new contract.  Is there a sponsor/supervising physician who has hospital affiliations at a Christus Facility that Ms. Rabagos will be utilizing?  Vicki Ann Guerra  Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  Sent following reply:  \"Hello Vicki,   I appreciate the update, would you be able to check again if David Gray (NPI# 1902814874) now has hospital privileges with a Christus facility?   Thank you. \" ', NULL, NULL, '2021-07-01 13:46:20', '2021-07-01 13:46:20'),
(29793, 1006, 23244, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Sent following email to Vicki @ Guerra, Vicki A. vicki.guerra@christushealth.org:  Sub: Hospital Privileges - Gray  \"Hello Vicki,   I apologize for the incorrect information, the correct supervising physician for Katherine is Luis Leyton Gonzalez (NPI# 1013911601), please look into this provider instead.   Thank you. \"', NULL, NULL, '2021-07-12 13:36:31', '2021-07-12 13:36:31'),
(29794, 1006, 23244, NULL, '2021-08-09 00:00:00.000', 'In Process', 'We received the following reply from vicki.guerra@christushealth.org:  Sub: vicki.guerra@christushealth.org  \"Hi Brad,  Happy Tuesday!  Can I have the last 4 of Dr. Leyton Gonzalez SS? This is the only way for me to verify in the portal along with NPI.  Thanks,  Vicki Ann Guerra Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  I replied with the requested information to her.', NULL, NULL, '2021-08-02 17:05:21', '2021-08-02 17:05:21'),
(29795, 1006, 23244, NULL, '2021-08-12 00:00:00.000', 'Not Eligible', 'Received the following denial notification:  Sub: Denial Letter CSHN: STATCARE Contract  \"August 3, 2021  STATCARE Administrator/Owner Rabagos C/O – Office Manager  Dear Administrator and Owner Rabagos (OM), Thank you for your continuous efforts to participate in the Christus Spohn Health Network. Currently to contract with CSHN, Ms. Rabagos will need to have a sponsoring physician to participate in the network. The requirement for a sponsoring physician is to have and maintain  hospital affiliations/memberships with a Christus facility as per Article 5.5 in CSHNs contract agreement and Section I, Article III, Section(s) 3.2-1 and 3.6. CSHN would love to see STACARE back on the Spohn Network directory. Until this criterion for a sponsoring physician is met with hospital affiliations/memberships with a Christus facility CSHN cannot extend a contract.  Locations: STATCARE Kingsville 500 E Caesar Ave, Kingsville Texas 78363 STATCARE Calallen 4042 River Hill Drive Corpus Christi Texas 78410 STATCARE Corpus Christi Southside 6646 S Staples St #122 Corpus Christi Texas 78413 STATCARE Corpus Christi SPID 3817 S. Padre Island Dr. Corpus Christi Texas 78415 STATCARE Rockport 2102 FM 2165 Rockport Texas 78382  Have a blessed and wonderful day. Sincerely,  Vicki Ann Guerra Provider Relations Representative\"', NULL, NULL, '2021-08-05 09:41:42', '2021-08-05 09:41:42'),
(29796, 11056, 23244, NULL, '2021-10-07 00:00:00.000', 'Approved', 'Email received from : michal.simms@christushealth.org  Sub : Fwd: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Hello,  The additional service locations were loaded in our system on 8/23/21.  Facility contracting is completed.  Eff date is : 09/1/2021   Confirmed with rep.  Rep. : Jackie P  Ref code : JackieP  Please see the attachment.', NULL, NULL, '2021-09-30 13:30:06', '2021-09-30 13:30:06'),
(29797, 3046, 23253, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 16:23:55', '2021-03-18 16:23:55'),
(29798, 3040, 23253, NULL, '2021-04-07 00:00:00.000', 'Initiated', 'Your form was submitted successfully. Thank you for contacting us. A representative will be in contact to discuss your interest in becoming a participating Provider.', NULL, NULL, '2021-03-31 15:38:14', '2021-03-31 15:38:14'),
(29799, 9057, 23253, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Request isn\'t showing up on wellcare\'s end, talked to representative and he has forwarded our request to provider relations to call us back. ', NULL, NULL, '2021-05-26 14:31:25', '2021-05-26 14:31:25'),
(29800, 3040, 23253, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com   Subject: Enroll Group || Statcare Minor Emergency Clinic || Group || Wellcare ||  Greetings,   Hope all is well. I wanted to know the enrollment status for the below mentioned group in Wellcare under the below locations. We already sent the request for enrollment on 03/31/2021.   Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Address: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Secondary Address: 4042 River Hill Corpus Christi , TX 78410 Tertiary Address: 3817 South Padre Island Drive Corpus Christi , TX 78415  Please get back to me as soon as you can get a chance. Waiting for your reply.   Thank you ', NULL, NULL, '2021-06-15 16:43:08', '2021-06-15 16:43:08'),
(29801, 11056, 23253, NULL, '2021-07-09 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com   Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare ||  Greetings,  Kindly respond soon. Hope all is well. I wanted to know the enrollment status for the below mentioned group in Wellcare under the below locations. We already sent the request for enrollment on 03/31/2021.  Practice: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Address: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Secondary Address: 4042 River Hill Corpus Christi , TX 78410 Tertiary Address: 3817 South Padre Island Drive Corpus Christi , TX 78415  Please get back to me as soon as you can get a chance. Waiting for your reply.  Thank you !', NULL, NULL, '2021-07-01 17:04:50', '2021-07-01 17:04:50'),
(29802, 1006, 23253, NULL, '2021-07-22 00:00:00.000', 'In Process', 'Contract received from Zujey Ashbaugh ZASHBAUGH@centene.com:  Sub: Signature requested on \"RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032\"  \"You finished signing “RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032”.  Next, SHP Provider Validation will approve.  We will email the final agreement to all parties. You can alsodownload a copyof what you just signed.\"  Copy of contract is attached in main Superior task for reference. ', NULL, NULL, '2021-07-15 11:03:40', '2021-07-15 11:03:40'),
(29803, 1006, 23253, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent f/u email @ ZASHBAUGH@centene.com & ProspectiveProviderTX@wellcare.com:  Sub: Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  \"Hello,   I wanted to get an update regarding the enrollment status for the following group:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Address: 4042 River Hill Corpus Christi , TX 78410 Quaternary Address: 3817 South Padre Island Drive Corpus Christi , TX 78415  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-08-24 13:15:13', '2021-08-24 13:15:13'),
(29804, 1006, 23253, NULL, '2021-09-08 00:00:00.000', 'In Process', 'We received the following email from Zujey.Ashbaugh@superiorhealthplan.com:  \"Good afternoon,  We are still pending your completed credentialing documents. The contract was sign.  I have attached them for you. Once completed please forward them to SHP.NetworkDevelopment@superiorhealthplan.com  Thank you, Zujey Ashbaugh (Zuzy) Contract Coordinator Network Participation Request related info Phone Number 866-615-9399  “Never stop learning, because life never stops teaching”\"  Facility credentialing application was filled out and sent out to SHP.NetworkDevelopment@superiorhealthplan.com, attached in main group task for reference. ', NULL, NULL, '2021-09-01 15:41:13', '2021-09-01 15:41:13'),
(29805, 11056, 23253, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning!  Hope this email finds you well. Please provide me with the latest updates regarding the enrollment process and with facility Ancillary application of which we have submitted in the starting of Sep,2021 of the Facility mentioned below:  Group Name                	Statcare Minor Emergency Clinic Tax ID	                            46-0575924 Group NPI	                    1689924904 Primary Location	             500 E CAESAR, KINGSVILLE , TX 78363 Secondary Location	     6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Location	             4042 River Hill, Corpus Christi , TX 78410 Quarternary Location	     3817 South Padre Island Drive, Corpus Christi , TX 78415   If you have any concerns or questions or require documents please let me know.   Thank you! Have a blessed week ahead!', NULL, NULL, '2021-09-22 10:45:58', '2021-09-22 10:45:58'),
(29806, 11056, 23253, NULL, '2021-10-07 00:00:00.000', 'In Process', 'Email received from : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning,   We received your completed application on 9/7/21. Your projected effective date is 10/01/21.  The enrollment record is currently in the process of being loaded into our system. Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.  Phone: 866-615-9399  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com', NULL, NULL, '2021-09-30 17:01:43', '2021-09-30 17:01:43'),
(29807, 11056, 23253, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good evening Zujey!  Hope this email finds you well. It is just a follow up email regarding the agreement and welcome packet. I am still waiting for that, please provide that soon.  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-12 16:09:10', '2021-10-12 16:09:10'),
(29808, 11056, 23253, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email received from : SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Hello,   Your record has not been complete, but the effective date is still showing 10/1/121.    Once they complete your record. You will received a welcome packet.   Thank you,', NULL, NULL, '2021-10-20 14:13:23', '2021-10-20 14:13:23'),
(29809, 11056, 23253, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email sent to: 	SHP Network Development NPR Contracting  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good afternoon!  Hope this email finds you well. Has my record been completed yet or not? Please expedite, it has been a long time for the credentialing processing.  Take Care!  Thank you! Have a blessed day!', NULL, NULL, '2021-11-10 17:45:00', '2021-11-10 17:45:00'),
(29810, 11056, 23253, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email sent to: SHP Network Development NPR Contracting  Sub: Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning!  Hope this email finds you well. Please respond to my query at your earliest opportunity.  Eagerly, waiting for your reply.  Thank you! Have a wonderful day!', NULL, NULL, '2021-11-19 17:48:00', '2021-11-19 17:48:00'),
(29811, 11056, 23253, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email sent to: SHP Network Development NPR Contracting  Sub: Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good afternoon!  Hope this email finds you well. Has my record been completed yet or not? Please expedite, it has been a long time for the credentialing processing.  Take Care!  Thank you! Have a blessed day!', NULL, NULL, '2021-11-19 17:49:15', '2021-11-19 17:49:15'),
(29812, 11056, 23253, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email received from:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com   Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Hello,     Your record has not been complete, but the effective date is still showing 10/1/121.     Thank you,', NULL, NULL, '2021-12-01 13:14:07', '2021-12-01 13:14:07'),
(29813, 11056, 23253, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION  Good afternoon!  Hope you are having a productive day. I am unable to add the location through the link. Kindly add the highlighted locations to the agreement and as well as to the directory too.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382   Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-16 16:43:37', '2021-12-16 16:43:37'),
(29814, 11056, 23253, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   The NPI and Tax ID is the same as the main and billing location for all locations. Please see below.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382', NULL, NULL, '2021-12-23 15:38:52', '2021-12-23 15:38:52'),
(29815, 19067, 23253, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Greetings!   Any updates on the previously mentioned request?   Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 17:20:22', '2022-01-10 17:20:22'),
(29816, 19067, 23253, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Greetings!  This is my THIRD REMINDER on the request below. Kindly respond in a timely manner.  Regards, Hammad Ahmed.', NULL, NULL, '2022-01-26 17:59:43', '2022-01-26 17:59:43'),
(29817, 19067, 23253, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Hello!  I haven\'t heard from you and it\'s been a while now. Kindly look into my requests and update me.  Waiting to hear from you soon!  Thanks, Hammad Ahmed.', NULL, NULL, '2022-02-11 17:09:18', '2022-02-11 17:09:18'),
(29818, 19067, 23253, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Hello!  Hope this email finds you well.  I haven\'t heard from you for 1 month. Kindly respond at your earliest convenience.   Regards, Hammad Ahmed.', NULL, NULL, '2022-02-21 17:48:53', '2022-02-21 17:48:53'),
(29819, 19067, 23253, NULL, '2022-03-02 00:00:00.000', 'In Process', 'Email received from: Zujey.Ashbaugh@superiorhealthplan.com  Subject: RE: Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare    Hello,     Your request was forward to the correct dep to get you the welcome packet and welcome letter.', NULL, NULL, '2022-02-23 10:35:06', '2022-02-23 10:35:06'),
(29820, 19067, 23253, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Fwd: Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare    Hi Zuzi,  I haven\'t received the welcome kit as far, can you request that department one more time to send us the approval letter?  Thanks,', NULL, NULL, '2022-03-15 18:03:11', '2022-03-15 18:03:11'),
(29821, 3046, 23256, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 16:23:59', '2021-03-18 16:23:59'),
(29822, 1006, 23256, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Sent following enrollment request email @ CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,   I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?   Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.   Thank you. \" ', NULL, NULL, '2021-04-08 18:48:07', '2021-04-08 18:48:07'),
(29823, 9057, 23256, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent following email to CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Status - RHC - Christus Spohn  \"Hello, We want to know the current status of the request we sent to you last month about the enrollment for the following group and its providers:  Group Name: Statcare Minor Emergency Clinic NPI#  1689924904  TIN#  46-0575924  Please get back to us as soon as possible.  Thank you\"', NULL, NULL, '2021-05-25 10:07:13', '2021-05-25 10:07:13'),
(29824, 1006, 23256, NULL, '2021-06-11 00:00:00.000', 'In Process', 'Sent f/u email @ CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,   I want to check in on the status of this request for enrollment, as we still haven\'t heard anything back as of yet?   Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-06-04 14:20:47', '2021-06-04 14:20:47'),
(29825, 1006, 23256, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent a VM to Vicki Gera @ (800) 419-3461 as we haven\'t been receiving any replies on emails. ', NULL, NULL, '2021-06-11 14:14:08', '2021-06-11 14:14:08'),
(29826, 3040, 23256, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email sent to: vicki.guerra@christushealth.org  Subject:  Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,  I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?  Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-30 15:21:17', '2021-06-30 15:21:17'),
(29827, 1006, 23256, NULL, '2021-07-08 00:00:00.000', 'In Process', 'We received the following update from vicki.guerra@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hi Adil,  Happy Wednesday!  Thank you for reaching out. We would like for Statcare Minor Emergency Clinic to come back on board. The last time we spoke it was to my understanding that Ms. Rabagos did not have a sponsoring physician with hospital privileges for a Christus facility. This is one of the requirements to bring this provider group back on board with a new contract.  Is there a sponsor/supervising physician who has hospital affiliations at a Christus Facility that Ms. Rabagos will be utilizing?  Vicki Ann Guerra  Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  Sent following reply:  \"Hello Vicki,   I appreciate the update, would you be able to check again if David Gray (NPI# 1902814874) now has hospital privileges with a Christus facility?   Thank you. \" ', NULL, NULL, '2021-07-01 14:11:41', '2021-07-01 14:11:41'),
(29828, 1006, 23256, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Sent following email to Vicki @ Guerra, Vicki A. vicki.guerra@christushealth.org:  Sub: Hospital Privileges - Gray  \"Hello Vicki,   I apologize for the incorrect information, the correct supervising physician for Katherine is Luis Leyton Gonzalez (NPI# 1013911601), please look into this provider instead.   Thank you. \" ', NULL, NULL, '2021-07-12 13:42:10', '2021-07-12 13:42:10'),
(29829, 1006, 23256, NULL, '2021-08-09 00:00:00.000', 'In Process', 'We received the following reply from vicki.guerra@christushealth.org:  Sub: vicki.guerra@christushealth.org  \"Hi Brad,  Happy Tuesday!  Can I have the last 4 of Dr. Leyton Gonzalez SS? This is the only way for me to verify in the portal along with NPI.  Thanks,  Vicki Ann Guerra Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  I replied with the requested information to her.', NULL, NULL, '2021-08-02 17:07:49', '2021-08-02 17:07:49'),
(29830, 1006, 23256, NULL, '2021-08-12 00:00:00.000', 'Not Eligible', 'Received the following denial notification:  Sub: Denial Letter CSHN: STATCARE Contract  \"August 3, 2021  STATCARE Administrator/Owner Rabagos C/O – Office Manager  Dear Administrator and Owner Rabagos (OM), Thank you for your continuous efforts to participate in the Christus Spohn Health Network. Currently to contract with CSHN, Ms. Rabagos will need to have a sponsoring physician to participate in the network. The requirement for a sponsoring physician is to have and maintain  hospital affiliations/memberships with a Christus facility as per Article 5.5 in CSHNs contract agreement and Section I, Article III, Section(s) 3.2-1 and 3.6. CSHN would love to see STACARE back on the Spohn Network directory. Until this criterion for a sponsoring physician is met with hospital affiliations/memberships with a Christus facility CSHN cannot extend a contract.  Locations: STATCARE Kingsville 500 E Caesar Ave, Kingsville Texas 78363 STATCARE Calallen 4042 River Hill Drive Corpus Christi Texas 78410 STATCARE Corpus Christi Southside 6646 S Staples St #122 Corpus Christi Texas 78413 STATCARE Corpus Christi SPID 3817 S. Padre Island Dr. Corpus Christi Texas 78415 STATCARE Rockport 2102 FM 2165 Rockport Texas 78382  Have a blessed and wonderful day. Sincerely,  Vicki Ann Guerra Provider Relations Representative\"', NULL, NULL, '2021-08-05 09:48:42', '2021-08-05 09:48:42'),
(29831, 11056, 23256, NULL, '2021-10-07 00:00:00.000', 'Approved', 'Email received from : michal.simms@christushealth.org  Sub : Fwd: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Hello,  The additional service locations were loaded in our system on 8/23/21.  Facility contracting is completed.  Eff date is : 09/1/2021   Confirmed with rep.  Rep. : Jackie P  Ref code : JackieP  Please see the attachment.', NULL, NULL, '2021-09-30 13:30:22', '2021-09-30 13:30:22'),
(29832, 3040, 23260, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-22 12:08:04', '2021-03-22 12:08:04'),
(29833, 3040, 23260, NULL, '2021-05-05 00:00:00.000', 'In Process', 'View Summary Thank you for completing the BCBSTX enrollment. We will notify you once your application has been processed. If you requested to be contracted, please note that your claims may pay out of network for services rendered until your contracts have been accepted, the credentialing process has been completed, and you receive an effective date. Application ID: 300738', NULL, NULL, '2021-04-28 12:24:55', '2021-04-28 12:24:55'),
(29834, 3040, 23260, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com, Provider_Relations_Houston@bcbstx.com  Subject: Application ID: 300738 || Valley Med Urgent Care PLLC || Wert, Jeniece K || BCBS ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542  Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address:101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name: Wert, Jeniece K Provider NPI# 1659919702  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you', NULL, NULL, '2021-05-27 10:26:19', '2021-05-27 10:26:19'),
(29835, 3040, 23260, NULL, '2021-06-23 00:00:00.000', 'In Process', 'View Summary Thank you for completing the BCBSTX enrollment. We will notify you once your application has been processed. If you requested to be contracted, please note that your claims may pay out of network for services rendered until your contracts have been accepted, the credentialing process has been completed, and you receive an effective date. Application ID: 312903', NULL, NULL, '2021-06-16 10:50:17', '2021-06-16 10:50:17'),
(29836, 3040, 23260, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: noemi_diaz@bcbstx.com  Subject: Application ID: 312903 || Valley Med Urgent Care PLLC || Wert, Jeniece K || BCBS || : Case Number - 02504790  Hello Noemi,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider.    Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542  Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address:101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248   Provider 1: Provider Name: Wert, Jeniece K Provider NPI# 1659919702   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-05 14:19:13', '2021-07-05 14:19:13'),
(29837, 3040, 23260, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Noemi_Diaz@bcbstx.com  Subject: Application ID: 312903 || Valley Med Urgent Care PLLC || Wert, Jeniece K || BCBS || : Case Number - 02504790 Good morning,  The onboarding case for Jeniece K. Wert, PA was submitted on 6.16.21 and is still in process.  A provider record ID number has been assigned to her (#8PS725).  These cases can take at least 2-3 months to be processed.  At this time the case is moving along as it should be.  Thanks,     All the Best,  Noemi Diaz Network Management Consultant | Network Management Blue Cross and Blue Shield of Texas phone (210) 558-5149 | fax (361) 852-0624 email Noemi_Diaz@bcbstx.com  ', NULL, NULL, '2021-07-26 13:51:12', '2021-07-26 13:51:12'),
(29838, 3040, 23260, NULL, '2021-09-16 00:00:00.000', 'Approved', 'Email rcvd from: txintaketeampiermailbox@bcbstx.com  Subject: BCBSTX New Provider Information  Group Name : VALLEY MED URGENT CARE PLLC Group Record Id : H000Q9Z701  Provider Name : JENIECE K WERT Provider Record Number : H08PS72501 Specialty : Physician Assistant  Networks : Network Name	Network Effective Date BAV - Blue Advantage HMO	09/10/2021 HMO - Blue Essentials	09/10/2021 BCA - BlueChoice PPO	09/10/2021 CHP - CHIP (Medicaid)	09/10/2021 HME - Health Select	09/10/2021 PMC - Medicare Advantage PPO	09/10/2021 STR - STAR (Medicaid)	09/10/2021 STK - STAR Kids (Medicaid)	09/10/2021 ', NULL, NULL, '2021-09-09 15:02:06', '2021-09-09 15:02:06'),
(29839, 3040, 23261, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-22 12:08:10', '2021-03-22 12:08:10'),
(29840, 3040, 23261, NULL, '2021-05-05 00:00:00.000', 'In Process', 'View Summary Thank you for completing the BCBSTX enrollment. We will notify you once your application has been processed. If you requested to be contracted, please note that your claims may pay out of network for services rendered until your contracts have been accepted, the credentialing process has been completed, and you receive an effective date. Application ID: 300738', NULL, NULL, '2021-04-28 12:25:05', '2021-04-28 12:25:05'),
(29841, 3040, 23261, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com, Provider_Relations_Houston@bcbstx.com  Subject: Application ID: 300738 || Valley Med Urgent Care PLLC || Wert, Jeniece K || BCBS ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542  Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address:101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name: Wert, Jeniece K Provider NPI# 1659919702  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you', NULL, NULL, '2021-05-27 10:26:27', '2021-05-27 10:26:27'),
(29842, 3040, 23261, NULL, '2021-06-23 00:00:00.000', 'In Process', 'View Summary Thank you for completing the BCBSTX enrollment. We will notify you once your application has been processed. If you requested to be contracted, please note that your claims may pay out of network for services rendered until your contracts have been accepted, the credentialing process has been completed, and you receive an effective date. Application ID: 312903', NULL, NULL, '2021-06-16 10:50:08', '2021-06-16 10:50:08'),
(29843, 3040, 23261, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: noemi_diaz@bcbstx.com  Subject: Application ID: 312903 || Valley Med Urgent Care PLLC || Wert, Jeniece K || BCBS || : Case Number - 02504790  Hello Noemi,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider.    Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542  Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address:101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248   Provider 1: Provider Name: Wert, Jeniece K Provider NPI# 1659919702   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-05 14:19:08', '2021-07-05 14:19:08'),
(29844, 3040, 23261, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Noemi_Diaz@bcbstx.com  Subject: Application ID: 312903 || Valley Med Urgent Care PLLC || Wert, Jeniece K || BCBS || : Case Number - 02504790 Good morning,  The onboarding case for Jeniece K. Wert, PA was submitted on 6.16.21 and is still in process.  A provider record ID number has been assigned to her (#8PS725).  These cases can take at least 2-3 months to be processed.  At this time the case is moving along as it should be.  Thanks,     All the Best,  Noemi Diaz Network Management Consultant | Network Management Blue Cross and Blue Shield of Texas phone (210) 558-5149 | fax (361) 852-0624 email Noemi_Diaz@bcbstx.com  ', NULL, NULL, '2021-07-26 13:51:13', '2021-07-26 13:51:13'),
(29845, 3040, 23261, NULL, '2021-09-17 00:00:00.000', 'In Process', 'Email sent to: Noemi_Diaz@bcbstx.com  Subject: Wert, Jeniece K || BCBS || : Case Number - 02552862  Good afternoon,     The onboarding case (02552862) for Jeniece K. Wert, PA is still in process.  There are no updates to share at this time.        All the Best,   Noemi Diaz Network Management Consultant | Network Management  Blue Cross and Blue Shield of Texas phone (210) 558-5149 | fax (361) 852-0624  email Noemi_Diaz@bcbstx.com', NULL, NULL, '2021-09-10 15:29:21', '2021-09-10 15:29:21'),
(29846, 10057, 23261, NULL, '2021-10-12 00:00:00.000', 'In Process', 'Email Sent To : Noemi_Diaz@bcbstx.com  Sub : BCBS - Enrollment Query  Good Afternoon,  Hope you are doing well. I am writing this email to get the latest update on the credentialing applications of below mentioned providers.  Group Name	Valley Med Urgent Care PLLC (Two locations) Tax ID	81-3237149 Group NPI	1821542432 Primary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Provider Name	NPI Wert, Jeniece K	1659919702 - Case # 02552862 Luyando, Mariana	1518404631 - Application # 334796  Please feel free to call or email me. Waiting to hear from you soon  Thanks & Regards,', NULL, NULL, '2021-10-05 14:50:56', '2021-10-05 14:50:56'),
(29847, 10057, 23261, NULL, '2021-10-28 00:00:00.000', 'Approved', 'Email Received From : NoemiDiaz@bcbstx.com  Sub: BCBS - Enrollment Query  Good afternoon,  The tax ID and NPI number in your email belong to a different group.  If you’re needing status for that TIN/NPI, the rep is Marina Machuca.  Please reach out to her directly at  MarinaMachuca@bcbstx.com, or 713.354.7421.  The following information is for Valley Med Urgent Care.  The onboarding case 02829164 for Luyando, Mariana is still in process.  The case was submitted on 9.3.21 and can take at least 2-3 months for processing.  A provider record ID number has been assigned to her which is 8QD630.  A welcome email will also be sent out once she is in network.  Jeniece K Wert is in network for the plans listed below with an effective date of 9.10.21.  The two locations are listed as satellite locations:  101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166;  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Thank you, All the Best,  Noemi Diaz', NULL, NULL, '2021-10-21 14:23:48', '2021-10-21 14:23:48'),
(29848, 3040, 23262, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-22 12:08:15', '2021-03-22 12:08:15');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(29849, 3040, 23262, NULL, '2021-05-05 00:00:00.000', 'In Process', 'View Summary Thank you for completing the BCBSTX enrollment. We will notify you once your application has been processed. If you requested to be contracted, please note that your claims may pay out of network for services rendered until your contracts have been accepted, the credentialing process has been completed, and you receive an effective date. Application ID: 300738', NULL, NULL, '2021-04-28 12:25:13', '2021-04-28 12:25:13'),
(29850, 3040, 23262, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com, Provider_Relations_Houston@bcbstx.com  Subject: Application ID: 300738 || Valley Med Urgent Care PLLC || Wert, Jeniece K || BCBS ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542  Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address:101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name: Wert, Jeniece K Provider NPI# 1659919702  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you', NULL, NULL, '2021-05-27 10:26:23', '2021-05-27 10:26:23'),
(29851, 3040, 23262, NULL, '2021-06-23 00:00:00.000', 'In Process', 'View Summary Thank you for completing the BCBSTX enrollment. We will notify you once your application has been processed. If you requested to be contracted, please note that your claims may pay out of network for services rendered until your contracts have been accepted, the credentialing process has been completed, and you receive an effective date. Application ID: 312903', NULL, NULL, '2021-06-16 10:50:03', '2021-06-16 10:50:03'),
(29852, 3040, 23262, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: noemi_diaz@bcbstx.com  Subject: Application ID: 312903 || Valley Med Urgent Care PLLC || Wert, Jeniece K || BCBS || : Case Number - 02504790  Hello Noemi,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider.    Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542  Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address:101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248   Provider 1: Provider Name: Wert, Jeniece K Provider NPI# 1659919702   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-05 14:19:04', '2021-07-05 14:19:04'),
(29853, 3040, 23262, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Noemi_Diaz@bcbstx.com  Subject: Application ID: 312903 || Valley Med Urgent Care PLLC || Wert, Jeniece K || BCBS || : Case Number - 02504790 Good morning,  The onboarding case for Jeniece K. Wert, PA was submitted on 6.16.21 and is still in process.  A provider record ID number has been assigned to her (#8PS725).  These cases can take at least 2-3 months to be processed.  At this time the case is moving along as it should be.  Thanks,     All the Best,  Noemi Diaz Network Management Consultant | Network Management Blue Cross and Blue Shield of Texas phone (210) 558-5149 | fax (361) 852-0624 email Noemi_Diaz@bcbstx.com  ', NULL, NULL, '2021-07-26 13:51:14', '2021-07-26 13:51:14'),
(29854, 3040, 23262, NULL, '2021-09-17 00:00:00.000', 'In Process', 'Email sent to: Noemi_Diaz@bcbstx.com  Subject: Wert, Jeniece K || BCBS || : Case Number - 02552862  Good afternoon,     The onboarding case (02552862) for Jeniece K. Wert, PA is still in process.  There are no updates to share at this time.        All the Best,   Noemi Diaz Network Management Consultant | Network Management  Blue Cross and Blue Shield of Texas phone (210) 558-5149 | fax (361) 852-0624  email Noemi_Diaz@bcbstx.com', NULL, NULL, '2021-09-10 15:29:24', '2021-09-10 15:29:24'),
(29855, 10057, 23262, NULL, '2021-10-12 00:00:00.000', 'In Process', 'Email Sent To : Noemi_Diaz@bcbstx.com  Sub : BCBS - Enrollment Query  Good Afternoon,  Hope you are doing well. I am writing this email to get the latest update on the credentialing applications of below mentioned providers.  Group Name	Valley Med Urgent Care PLLC (Two locations) Tax ID	81-3237149 Group NPI	1821542432 Primary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Provider Name	NPI Wert, Jeniece K	1659919702 - Case # 02552862 Luyando, Mariana	1518404631 - Application # 334796  Please feel free to call or email me. Waiting to hear from you soon  Thanks & Regards,', NULL, NULL, '2021-10-05 14:49:15', '2021-10-05 14:49:15'),
(29856, 10057, 23262, NULL, '2021-10-28 00:00:00.000', 'Approved', 'Email Received From : NoemiDiaz@bcbstx.com  Sub: BCBS - Enrollment Query  Good afternoon,  The tax ID and NPI number in your email belong to a different group.  If you’re needing status for that TIN/NPI, the rep is Marina Machuca.  Please reach out to her directly at  MarinaMachuca@bcbstx.com, or 713.354.7421.  The following information is for Valley Med Urgent Care.  The onboarding case 02829164 for Luyando, Mariana is still in process.  The case was submitted on 9.3.21 and can take at least 2-3 months for processing.  A provider record ID number has been assigned to her which is 8QD630.  A welcome email will also be sent out once she is in network.  Jeniece K Wert is in network for the plans listed below with an effective date of 9.10.21.  The two locations are listed as satellite locations:  101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166;  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Thank you, All the Best,  Noemi Diaz', NULL, NULL, '2021-10-21 14:21:39', '2021-10-21 14:21:39'),
(29857, 3040, 23266, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-22 12:09:49', '2021-03-22 12:09:49'),
(29858, 3040, 23266, NULL, '2021-05-04 00:00:00.000', 'Approved', 'Ancillary Contract No need to add individual providers. Contract attached in group task. ', NULL, NULL, '2021-04-27 15:51:04', '2021-04-27 15:51:04'),
(29859, 3040, 23267, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-22 12:09:55', '2021-03-22 12:09:55'),
(29860, 3040, 23267, NULL, '2021-05-04 00:00:00.000', 'Approved', 'Ancillary Contract No need to add individual providers. Contract attached in group task. ', NULL, NULL, '2021-04-27 15:50:59', '2021-04-27 15:50:59'),
(29861, 3040, 23268, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-22 12:10:04', '2021-03-22 12:10:04'),
(29862, 3040, 23268, NULL, '2021-05-04 00:00:00.000', 'Approved', 'Ancillary Contract No need to add individual providers. Contract attached in group task. ', NULL, NULL, '2021-04-27 15:50:54', '2021-04-27 15:50:54'),
(29863, 3040, 23269, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-22 12:10:49', '2021-03-22 12:10:49'),
(29864, 3040, 23269, NULL, '2021-03-31 00:00:00.000', 'Approved', 'Ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-03-24 09:25:44', '2021-03-24 09:25:44'),
(29865, 3040, 23270, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-22 12:10:52', '2021-03-22 12:10:52'),
(29866, 3040, 23270, NULL, '2021-03-31 00:00:00.000', 'Initiated', 'Email sent to: pr.south@healthsmart.com  Subject:  Add Locations || Tax ID# 81-5123542 || Valley Med Urgent Care PLLC || AnciCare ||  Greetings,   Hope you are doing well. I wanted to add the locations in Anci-Care for our group Valley Med Urgent Care PLLC under below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Effective Date: 03/15/2018 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-03-24 09:25:58', '2021-03-24 09:25:58'),
(29867, 3040, 23270, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: vipproviders@anci-care.com  Subject: Add Locations || Tax ID# 81-5123542 || Valley Med Urgent Care PLLC || AnciCare ||  Greetings,   Hope you are doing well. I wanted to add the locations in Anci-Care for our group Valley Med Urgent Care PLLC under the below locations. Can you please send me the copt of contract.  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Effective Date: 03/15/2018 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-01 15:03:39', '2021-06-01 15:03:39'),
(29868, 3040, 23270, NULL, '2021-06-09 00:00:00.000', 'Approved', 'No need to add the providers because our group has an ancillary contract.  ', NULL, NULL, '2021-06-02 16:50:55', '2021-06-02 16:50:55'),
(29869, 3040, 23271, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-22 12:10:54', '2021-03-22 12:10:54'),
(29870, 3040, 23271, NULL, '2021-03-31 00:00:00.000', 'Initiated', 'Email sent to: pr.south@healthsmart.com  Subject:  Add Locations || Tax ID# 81-5123542 || Valley Med Urgent Care PLLC || AnciCare ||  Greetings,   Hope you are doing well. I wanted to add the locations in Anci-Care for our group Valley Med Urgent Care PLLC under below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Effective Date: 03/15/2018 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-03-24 09:26:03', '2021-03-24 09:26:03'),
(29871, 3040, 23271, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: vipproviders@anci-care.com  Subject: Add Locations || Tax ID# 81-5123542 || Valley Med Urgent Care PLLC || AnciCare ||  Greetings,   Hope you are doing well. I wanted to add the locations in Anci-Care for our group Valley Med Urgent Care PLLC under the below locations. Can you please send me the copt of contract.  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Effective Date: 03/15/2018 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-01 15:02:51', '2021-06-01 15:02:51'),
(29872, 3040, 23271, NULL, '2021-06-09 00:00:00.000', 'Approved', 'No need to add the providers because our group has an ancillary contract. ', NULL, NULL, '2021-06-02 16:48:15', '2021-06-02 16:48:15'),
(29873, 3040, 23272, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-22 12:11:56', '2021-03-22 12:11:56'),
(29874, 3040, 23272, NULL, '2021-05-05 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Subject: Enroll Provider || Valley Med Urgent Care PLLC || Wert, Jeniece K || UHC ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned provider with United Health Care for our group Valley Med Urgent Care PLLC under all three locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-28 10:31:21', '2021-04-28 10:31:21'),
(29875, 3040, 23272, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Subject: Enroll Provider || Valley Med Urgent Care PLLC || Naranjo, Diego|| UHC ||  Hello,   Hope you are doing well. I wanted to follow up regarding the enrollment status for the below mentioned providers.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Naranjo, Diego Provider NPI#  1568929800  Provider 2: Provider Name: Wert, Jeniece K Provider NPI#  1659919702  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-06-01 10:56:21', '2021-06-01 10:56:21'),
(29876, 3040, 23272, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Subject:   Enroll Provider || Valley Med Urgent Care PLLC || Wert, Jeniece K || UHC ||  Hello,  Hope you are doing well. I wanted to follow up regarding the enrollment status for the below mentioned provider.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Wert, Jeniece K Provider NPI#  1659919702  If you need any additional information please let me know. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-21 15:27:27', '2021-06-21 15:27:27'),
(29877, 3040, 23272, NULL, '2021-07-16 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Subject: Re: Enroll Provider || Valley Med Urgent Care PLLC || Wert, Jeniece K || UHC ||  Greetings,  Please advise the enrollment status for the below mentioned provider in UHC in our group for Valley Med Urgent Care PLLC under the below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Wert, Jeniece K Provider NPI#  1659919702  If you need any additional information please let me know. Waiting to hear from you soon.  Thank you', NULL, NULL, '2021-07-09 11:40:45', '2021-07-09 11:40:45'),
(29878, 3040, 23272, NULL, '2021-07-16 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Subject: Re: Enroll Provider || Valley Med Urgent Care PLLC || Wert, Jeniece K || UHC ||  Greetings,  Please advise the enrollment status for the below mentioned provider in UHC in our group for Valley Med Urgent Care PLLC under the below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Wert, Jeniece K Provider NPI#  1659919702  If you need any additional information please let me know. Waiting to hear from you soon.  Thank you', NULL, NULL, '2021-07-09 11:40:46', '2021-07-09 11:40:46'),
(29879, 3040, 23272, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Subject: Re: Enroll Provider || Valley Med Urgent Care PLLC || Wert, Jeniece K || UHC ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in UHC in our group for Valley Med Urgent Care PLLC under the below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Wert, Jeniece K Provider NPI#  1659919702  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-08-30 11:51:20', '2021-08-30 11:51:20'),
(29880, 3040, 23272, NULL, '2021-09-10 00:00:00.000', 'In Process', 'Email rcvd from: networkhelp@uhc.com  Subject: Secure Message from david.c.cliff@optum.com  Good Afternoon,  The provider recently completed credentialing (provider was approved at credentialing committee 8/11/2021).  A request is in process to add this provider to the group contract under PR-6113062.  Please allow more time for the contract load to complete.  David Cliff UnitedHealthcare Network Management Resource Team (NMRT)', NULL, NULL, '2021-09-03 10:22:39', '2021-09-03 10:22:39'),
(29881, 10057, 23272, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : networkhelp@uhc.com  Sub : Enroll Provider || Valley Med Urgent Care PLLC || Wert, Jeniece K || UHC ||  Good Afternoon,  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned provider in UHC in our group for Valley Med Urgent Care PLLC under the below locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631  Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Wert, Jeniece K	1659919702  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-18 11:29:54', '2021-10-18 11:29:54'),
(29882, 10057, 23272, NULL, '2021-11-04 00:00:00.000', 'In Process', 'Email Received From : networkhelp@uhc.com  Sub : Secure Message from jennifer_r_bready@uhc.com  Good afternoon,  Thank you for contacting the UnitedHealthcare Network Management Resource Team. Attached is a report that shows the demographic, credentialing and contracting status for the provider you requested. Also included is the product roster showing demographic information, lines of business and effective dates for the provider requested. Here’s how to read the roster:  Please see attachments.', NULL, NULL, '2021-10-28 13:17:17', '2021-10-28 13:17:17'),
(29883, 10057, 23272, NULL, '2021-11-23 00:00:00.000', 'In Process', 'Email Sent To : networkhelp@uhc.com  Sub : RE: Secure Message from jennifer_r_bready@uhc.com  Hello,  Hope this email finds you well. Could you please help me out to get the  latest updates on credentialing request for below mentioned providers  under TIN for all three locations.  Group Name	Valley Med Urgent Care PLLC (All three locations)	 Tax ID	81-5123542	  Group NPI	1518404631	 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496	 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248	 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX  78501-1166	  Provider Name		NPI Edna Michi		1992293906 Nubia Benavides		1801371935 Wert, Jeniece K		1659919702  Your earliest response will be highly appreciated.  Thanks & Regards Steve Albert', NULL, NULL, '2021-11-16 11:09:19', '2021-11-16 11:09:19'),
(29884, 10057, 23272, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : networkhelp@uhc.com  Sub : RE: Secure Message from jennifer_r_bready@uhc.com  Hello,  Hope this email finds you well. Could you please help me out to get the  latest updates on credentialing request for below mentioned providers  under TIN for all three locations.  Group Name	Valley Med Urgent Care PLLC (All three locations)	 Tax ID	81-5123542	  Group NPI	1518404631	 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496	 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248	 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX  78501-1166	  Provider Name		NPI Edna Michi		1992293906 Nubia Benavides		1801371935 Wert, Jeniece K		1659919702  Your earliest response will be highly appreciated.  Thanks & Regards Steve Albert', NULL, NULL, '2021-11-30 16:02:12', '2021-11-30 16:02:12'),
(29885, 10057, 23272, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Email Received From : jennifer_r_bready@uhc.com  Sub : Secure Message from jennifer_r_bready@uhc.com  Good morning,   Thank you for contacting the UnitedHealthcare Network Management Resource Team.   Credentialing for Edna Michi is showing as current and active, however, provider is not linked to TIN 815123542.  There are two ways you can submit your request regarding adding a practitioner to an existing Medical Group Participation Agreement: 	a. For faster processing, submit a change request using our Link App called My Practice Profile (https://www.uhcprovider.com/en/demographics-profiles-attestation/link- my-practice-profile.html).  This process will enable you to check your status online. If you have further questions regarding this system, please feel free to contact the LINK help desk (866-842-3278, option 1).   If you don\'t have access to My Practice Profile, then complete the attached form for each practitioner and send via email to  hpdemo@uhc.com.   You should receive a reference number (starts with PR)  for your request within an hour. If you have not received a PR number within 24 business hours (please double check spam/junk folder), please resubmit due to technical error. Please do not CC anyone on your request. This can cause an error and it may not be received.  Nubia Benavides is currently not credentialed.  You can find complete information on our process and requirements on our Credentialing page:  https://www.uhcprovider.com/content/provider/en/resource-library/Join- Our-Network.html?CID=none For assistance with credentialing and contracting for facilities and other specialty providers, refer to these contacts:  https://www.uhcprovider.com/en/resource-library/Join-Our-Network/join- get-started.html  · Update CAQH application: Make sure the health care professional\'s Council for Affordable Quality Healthcare (CAQH) application is up-to-date and attested   Submit your request through the RFP portal at https://ncc-optum.secure.force.com/rfp  Jeniece Wert is currently credentialed and linked to TIN 815123542 with contracts loaded.  Sincerely, UnitedHealthcare Network Management Resource Team  Jennifer Bready UnitedHealthcare Network Management Resource Team (NMRT)', NULL, NULL, '2021-12-07 15:21:26', '2021-12-07 15:21:26'),
(29886, 10057, 23272, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email Received From : networkhelp@uhc.com  Sub : Secure Message from jennifer_r_bready@uhc.com  Good afternoon,  Thank you for contacting the Network Management Resource Team. We will be glad to assist regarding your inquiry.  We have verified that credentialing for Edna Michi is showing as current and active.  Linkage to TIN 815123542/contract loading is currently in process under reference number PR-6356670, initiated 12/08/2021. Turnaround time for contract loading is 30-45 days.  Additionally, once contracts have been loaded for Edna Michi, this information is now in your LINK/My Practice Profile (https://www.uhcprovider.com/en/demographics-profiles-attestation/link-my-practice-profile.html). If you have further questions regarding this system, please feel free to contact the LINK help desk (866-842-3278, option 1). Please see the attached handout for more information.  Sincerely,  UnitedHealthcare Network Management Resource Team  Jennifer Bready UnitedHealthcare  Network Management Resource Team (NMRT)', NULL, NULL, '2021-12-14 13:54:42', '2021-12-14 13:54:42'),
(29887, 10057, 23272, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Received From : networkhelp@uhc.com  Sub : Secure Message from jennifer_r_bready@uhc.com   Good morning,   Jeniece Wert is currently credentialed and linked to TIN 815123542 with contracts loaded, effective date is 07/13/2021.  Nubia Benavides is currently not credentialed.  A provider must first meet criteria for credentialing before contracting can begin.  You can find complete information on our process and requirements on our Credentialing page:  https://www.uhcprovider.com/content/provider/en/resource-library/Join-Our-Network.html?CID=none For assistance with credentialing and contracting for facilities and other specialty providers, refer to these contacts: https://www.uhcprovider.com/en/resource-library/Join-Our-Network/join-get-started.html  · Update CAQH application: Make sure the health care professional’s Council for Affordable Quality Healthcare (CAQH) application is up-to-date and attested   Submit your request through the RFP portal at  https://ncc-optum.secure.force.com/rfp   Jennifer Bready UnitedHealthcare Network Management Resource Team (NMRT)', NULL, NULL, '2021-12-21 13:59:26', '2021-12-21 13:59:26'),
(29888, 10057, 23272, NULL, '2022-01-04 00:00:00.000', 'Approved', 'Call Details: (877) 842-3210  Rep: Darry  Ref # 5437  Effective Date: 07/13/2021  Please see locations attachment.', NULL, NULL, '2021-12-28 11:00:21', '2021-12-28 11:00:21'),
(29889, 3040, 23273, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-22 12:11:57', '2021-03-22 12:11:57'),
(29890, 3040, 23273, NULL, '2021-05-05 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Subject: Enroll Provider || Valley Med Urgent Care PLLC || Wert, Jeniece K || UHC ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned provider with United Health Care for our group Valley Med Urgent Care PLLC under all three locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-28 10:31:25', '2021-04-28 10:31:25'),
(29891, 3040, 23273, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Subject: Enroll Provider || Valley Med Urgent Care PLLC || Naranjo, Diego|| UHC ||  Hello,   Hope you are doing well. I wanted to follow up regarding the enrollment status for the below mentioned providers.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Naranjo, Diego Provider NPI#  1568929800  Provider 2: Provider Name: Wert, Jeniece K Provider NPI#  1659919702  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-06-01 10:56:41', '2021-06-01 10:56:41'),
(29892, 3040, 23273, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Subject:   Enroll Provider || Valley Med Urgent Care PLLC || Wert, Jeniece K || UHC ||  Hello,  Hope you are doing well. I wanted to follow up regarding the enrollment status for the below mentioned provider.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Wert, Jeniece K Provider NPI#  1659919702  If you need any additional information please let me know. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-21 15:27:23', '2021-06-21 15:27:23'),
(29893, 3040, 23273, NULL, '2021-07-16 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Subject: Re: Enroll Provider || Valley Med Urgent Care PLLC || Wert, Jeniece K || UHC ||  Greetings,  Please advise the enrollment status for the below mentioned provider in UHC in our group for Valley Med Urgent Care PLLC under the below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Wert, Jeniece K Provider NPI#  1659919702  If you need any additional information please let me know. Waiting to hear from you soon.  Thank you', NULL, NULL, '2021-07-09 11:40:36', '2021-07-09 11:40:36'),
(29894, 3040, 23273, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Subject: Re: Enroll Provider || Valley Med Urgent Care PLLC || Wert, Jeniece K || UHC ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in UHC in our group for Valley Med Urgent Care PLLC under the below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Wert, Jeniece K Provider NPI#  1659919702  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-08-30 11:51:21', '2021-08-30 11:51:21'),
(29895, 3040, 23273, NULL, '2021-09-10 00:00:00.000', 'In Process', 'Email rcvd from: networkhelp@uhc.com  Subject: Secure Message from david.c.cliff@optum.com  Good Afternoon,  The provider recently completed credentialing (provider was approved at credentialing committee 8/11/2021).  A request is in process to add this provider to the group contract under PR-6113062.  Please allow more time for the contract load to complete.  David Cliff UnitedHealthcare Network Management Resource Team (NMRT)', NULL, NULL, '2021-09-03 10:22:40', '2021-09-03 10:22:40'),
(29896, 10057, 23273, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : networkhelp@uhc.com  Sub : Enroll Provider || Valley Med Urgent Care PLLC || Wert, Jeniece K || UHC ||  Good Afternoon,  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned provider in UHC in our group for Valley Med Urgent Care PLLC under the below locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631  Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Wert, Jeniece K	1659919702  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-18 11:29:43', '2021-10-18 11:29:43'),
(29897, 10057, 23273, NULL, '2021-11-04 00:00:00.000', 'In Process', 'Email Received From : networkhelp@uhc.com  Sub : Secure Message from jennifer_r_bready@uhc.com  Good afternoon,  Thank you for contacting the UnitedHealthcare Network Management Resource Team. Attached is a report that shows the demographic, credentialing and contracting status for the provider you requested. Also included is the product roster showing demographic information, lines of business and effective dates for the provider requested. Here’s how to read the roster:  Please see attachments.', NULL, NULL, '2021-10-28 13:17:07', '2021-10-28 13:17:07'),
(29898, 10057, 23273, NULL, '2021-11-23 00:00:00.000', 'In Process', 'Email Sent To : networkhelp@uhc.com  Sub : RE: Secure Message from jennifer_r_bready@uhc.com  Hello,  Hope this email finds you well. Could you please help me out to get the  latest updates on credentialing request for below mentioned providers  under TIN for all three locations.  Group Name	Valley Med Urgent Care PLLC (All three locations)	 Tax ID	81-5123542	  Group NPI	1518404631	 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496	 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248	 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX  78501-1166	  Provider Name		NPI Edna Michi		1992293906 Nubia Benavides		1801371935 Wert, Jeniece K		1659919702  Your earliest response will be highly appreciated.  Thanks & Regards Steve Albert', NULL, NULL, '2021-11-16 11:09:12', '2021-11-16 11:09:12'),
(29899, 10057, 23273, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : networkhelp@uhc.com  Sub : RE: Secure Message from jennifer_r_bready@uhc.com  Hello,  Hope this email finds you well. Could you please help me out to get the  latest updates on credentialing request for below mentioned providers  under TIN for all three locations.  Group Name	Valley Med Urgent Care PLLC (All three locations)	 Tax ID	81-5123542	  Group NPI	1518404631	 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496	 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248	 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX  78501-1166	  Provider Name		NPI Edna Michi		1992293906 Nubia Benavides		1801371935 Wert, Jeniece K		1659919702  Your earliest response will be highly appreciated.  Thanks & Regards Steve Albert', NULL, NULL, '2021-11-30 16:02:06', '2021-11-30 16:02:06'),
(29900, 10057, 23273, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Email Received From : jennifer_r_bready@uhc.com  Sub : Secure Message from jennifer_r_bready@uhc.com  Good morning,   Thank you for contacting the UnitedHealthcare Network Management Resource Team.   Credentialing for Edna Michi is showing as current and active, however, provider is not linked to TIN 815123542.  There are two ways you can submit your request regarding adding a practitioner to an existing Medical Group Participation Agreement: 	a. For faster processing, submit a change request using our Link App called My Practice Profile (https://www.uhcprovider.com/en/demographics-profiles-attestation/link- my-practice-profile.html).  This process will enable you to check your status online. If you have further questions regarding this system, please feel free to contact the LINK help desk (866-842-3278, option 1).   If you don\'t have access to My Practice Profile, then complete the attached form for each practitioner and send via email to  hpdemo@uhc.com.   You should receive a reference number (starts with PR)  for your request within an hour. If you have not received a PR number within 24 business hours (please double check spam/junk folder), please resubmit due to technical error. Please do not CC anyone on your request. This can cause an error and it may not be received.  Nubia Benavides is currently not credentialed.  You can find complete information on our process and requirements on our Credentialing page:  https://www.uhcprovider.com/content/provider/en/resource-library/Join- Our-Network.html?CID=none For assistance with credentialing and contracting for facilities and other specialty providers, refer to these contacts:  https://www.uhcprovider.com/en/resource-library/Join-Our-Network/join- get-started.html  · Update CAQH application: Make sure the health care professional\'s Council for Affordable Quality Healthcare (CAQH) application is up-to-date and attested   Submit your request through the RFP portal at https://ncc-optum.secure.force.com/rfp  Jeniece Wert is currently credentialed and linked to TIN 815123542 with contracts loaded.  Sincerely, UnitedHealthcare Network Management Resource Team  Jennifer Bready UnitedHealthcare Network Management Resource Team (NMRT)', NULL, NULL, '2021-12-07 15:21:18', '2021-12-07 15:21:18'),
(29901, 10057, 23273, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email Received From : networkhelp@uhc.com  Sub : Secure Message from jennifer_r_bready@uhc.com  Good afternoon,  Thank you for contacting the Network Management Resource Team. We will be glad to assist regarding your inquiry.  We have verified that credentialing for Edna Michi is showing as current and active.  Linkage to TIN 815123542/contract loading is currently in process under reference number PR-6356670, initiated 12/08/2021. Turnaround time for contract loading is 30-45 days.  Additionally, once contracts have been loaded for Edna Michi, this information is now in your LINK/My Practice Profile (https://www.uhcprovider.com/en/demographics-profiles-attestation/link-my-practice-profile.html). If you have further questions regarding this system, please feel free to contact the LINK help desk (866-842-3278, option 1). Please see the attached handout for more information.  Sincerely,  UnitedHealthcare Network Management Resource Team  Jennifer Bready UnitedHealthcare  Network Management Resource Team (NMRT)', NULL, NULL, '2021-12-14 13:54:35', '2021-12-14 13:54:35'),
(29902, 10057, 23273, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Received From : networkhelp@uhc.com  Sub : Secure Message from jennifer_r_bready@uhc.com   Good morning,   Jeniece Wert is currently credentialed and linked to TIN 815123542 with contracts loaded, effective date is 07/13/2021.  Nubia Benavides is currently not credentialed.  A provider must first meet criteria for credentialing before contracting can begin.  You can find complete information on our process and requirements on our Credentialing page:  https://www.uhcprovider.com/content/provider/en/resource-library/Join-Our-Network.html?CID=none For assistance with credentialing and contracting for facilities and other specialty providers, refer to these contacts: https://www.uhcprovider.com/en/resource-library/Join-Our-Network/join-get-started.html  · Update CAQH application: Make sure the health care professional’s Council for Affordable Quality Healthcare (CAQH) application is up-to-date and attested   Submit your request through the RFP portal at  https://ncc-optum.secure.force.com/rfp   Jennifer Bready UnitedHealthcare Network Management Resource Team (NMRT)', NULL, NULL, '2021-12-21 13:59:20', '2021-12-21 13:59:20'),
(29903, 10057, 23273, NULL, '2022-01-04 00:00:00.000', 'Approved', 'Call Details: (877) 842-3210  Rep: Darry  Ref # 5437  Effective Date: 07/13/2021  Please see locations attachment.', NULL, NULL, '2021-12-28 10:59:52', '2021-12-28 10:59:52'),
(29904, 3040, 23274, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-22 12:11:59', '2021-03-22 12:11:59'),
(29905, 3040, 23274, NULL, '2021-05-05 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Subject: Enroll Provider || Valley Med Urgent Care PLLC || Wert, Jeniece K || UHC ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned provider with United Health Care for our group Valley Med Urgent Care PLLC under all three locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-28 10:31:30', '2021-04-28 10:31:30'),
(29906, 3040, 23274, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Subject: Enroll Provider || Valley Med Urgent Care PLLC || Naranjo, Diego|| UHC ||  Hello,   Hope you are doing well. I wanted to follow up regarding the enrollment status for the below mentioned providers.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Naranjo, Diego Provider NPI#  1568929800  Provider 2: Provider Name: Wert, Jeniece K Provider NPI#  1659919702  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-06-01 10:56:32', '2021-06-01 10:56:32'),
(29907, 3040, 23274, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Subject:   Enroll Provider || Valley Med Urgent Care PLLC || Wert, Jeniece K || UHC ||  Hello,  Hope you are doing well. I wanted to follow up regarding the enrollment status for the below mentioned provider.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Wert, Jeniece K Provider NPI#  1659919702  If you need any additional information please let me know. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-21 15:27:18', '2021-06-21 15:27:18'),
(29908, 3040, 23274, NULL, '2021-07-16 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Subject: Re: Enroll Provider || Valley Med Urgent Care PLLC || Wert, Jeniece K || UHC ||  Greetings,  Please advise the enrollment status for the below mentioned provider in UHC in our group for Valley Med Urgent Care PLLC under the below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Wert, Jeniece K Provider NPI#  1659919702  If you need any additional information please let me know. Waiting to hear from you soon.  Thank you', NULL, NULL, '2021-07-09 11:40:33', '2021-07-09 11:40:33'),
(29909, 3040, 23274, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Subject: Re: Enroll Provider || Valley Med Urgent Care PLLC || Wert, Jeniece K || UHC ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in UHC in our group for Valley Med Urgent Care PLLC under the below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Wert, Jeniece K Provider NPI#  1659919702  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-08-30 11:51:22', '2021-08-30 11:51:22'),
(29910, 3040, 23274, NULL, '2021-09-10 00:00:00.000', 'In Process', 'Email rcvd from: networkhelp@uhc.com  Subject: Secure Message from david.c.cliff@optum.com  Good Afternoon,  The provider recently completed credentialing (provider was approved at credentialing committee 8/11/2021).  A request is in process to add this provider to the group contract under PR-6113062.  Please allow more time for the contract load to complete.  David Cliff UnitedHealthcare Network Management Resource Team (NMRT)', NULL, NULL, '2021-09-03 10:22:40', '2021-09-03 10:22:40'),
(29911, 10057, 23274, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : networkhelp@uhc.com  Sub : Enroll Provider || Valley Med Urgent Care PLLC || Wert, Jeniece K || UHC ||  Good Afternoon,  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned provider in UHC in our group for Valley Med Urgent Care PLLC under the below locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631  Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Wert, Jeniece K	1659919702  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-18 11:29:34', '2021-10-18 11:29:34'),
(29912, 10057, 23274, NULL, '2021-11-04 00:00:00.000', 'In Process', 'Email Received From : networkhelp@uhc.com  Sub : Secure Message from jennifer_r_bready@uhc.com  Good afternoon,  Thank you for contacting the UnitedHealthcare Network Management Resource Team. Attached is a report that shows the demographic, credentialing and contracting status for the provider you requested. Also included is the product roster showing demographic information, lines of business and effective dates for the provider requested. Here’s how to read the roster:  Please see attachments.', NULL, NULL, '2021-10-28 13:16:55', '2021-10-28 13:16:55'),
(29913, 10057, 23274, NULL, '2021-11-23 00:00:00.000', 'In Process', 'Email Sent To : networkhelp@uhc.com  Sub : RE: Secure Message from jennifer_r_bready@uhc.com  Hello,  Hope this email finds you well. Could you please help me out to get the  latest updates on credentialing request for below mentioned providers  under TIN for all three locations.  Group Name	Valley Med Urgent Care PLLC (All three locations)	 Tax ID	81-5123542	  Group NPI	1518404631	 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496	 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248	 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX  78501-1166	  Provider Name		NPI Edna Michi		1992293906 Nubia Benavides		1801371935 Wert, Jeniece K		1659919702  Your earliest response will be highly appreciated.  Thanks & Regards Steve Albert', NULL, NULL, '2021-11-16 11:09:06', '2021-11-16 11:09:06'),
(29914, 10057, 23274, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : networkhelp@uhc.com  Sub : RE: Secure Message from jennifer_r_bready@uhc.com  Hello,  Hope this email finds you well. Could you please help me out to get the  latest updates on credentialing request for below mentioned providers  under TIN for all three locations.  Group Name	Valley Med Urgent Care PLLC (All three locations)	 Tax ID	81-5123542	  Group NPI	1518404631	 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496	 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248	 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX  78501-1166	  Provider Name		NPI Edna Michi		1992293906 Nubia Benavides		1801371935 Wert, Jeniece K		1659919702  Your earliest response will be highly appreciated.  Thanks & Regards Steve Albert', NULL, NULL, '2021-11-30 16:01:59', '2021-11-30 16:01:59');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(29915, 10057, 23274, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Email Received From : jennifer_r_bready@uhc.com  Sub : Secure Message from jennifer_r_bready@uhc.com  Good morning,   Thank you for contacting the UnitedHealthcare Network Management Resource Team.   Credentialing for Edna Michi is showing as current and active, however, provider is not linked to TIN 815123542.  There are two ways you can submit your request regarding adding a practitioner to an existing Medical Group Participation Agreement: 	a. For faster processing, submit a change request using our Link App called My Practice Profile (https://www.uhcprovider.com/en/demographics-profiles-attestation/link- my-practice-profile.html).  This process will enable you to check your status online. If you have further questions regarding this system, please feel free to contact the LINK help desk (866-842-3278, option 1).   If you don\'t have access to My Practice Profile, then complete the attached form for each practitioner and send via email to  hpdemo@uhc.com.   You should receive a reference number (starts with PR)  for your request within an hour. If you have not received a PR number within 24 business hours (please double check spam/junk folder), please resubmit due to technical error. Please do not CC anyone on your request. This can cause an error and it may not be received.  Nubia Benavides is currently not credentialed.  You can find complete information on our process and requirements on our Credentialing page:  https://www.uhcprovider.com/content/provider/en/resource-library/Join- Our-Network.html?CID=none For assistance with credentialing and contracting for facilities and other specialty providers, refer to these contacts:  https://www.uhcprovider.com/en/resource-library/Join-Our-Network/join- get-started.html  · Update CAQH application: Make sure the health care professional\'s Council for Affordable Quality Healthcare (CAQH) application is up-to-date and attested   Submit your request through the RFP portal at https://ncc-optum.secure.force.com/rfp  Jeniece Wert is currently credentialed and linked to TIN 815123542 with contracts loaded.  Sincerely, UnitedHealthcare Network Management Resource Team  Jennifer Bready UnitedHealthcare Network Management Resource Team (NMRT)', NULL, NULL, '2021-12-07 15:21:09', '2021-12-07 15:21:09'),
(29916, 10057, 23274, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email Received From : networkhelp@uhc.com  Sub : Secure Message from jennifer_r_bready@uhc.com  Good afternoon,  Thank you for contacting the Network Management Resource Team. We will be glad to assist regarding your inquiry.  We have verified that credentialing for Edna Michi is showing as current and active.  Linkage to TIN 815123542/contract loading is currently in process under reference number PR-6356670, initiated 12/08/2021. Turnaround time for contract loading is 30-45 days.  Additionally, once contracts have been loaded for Edna Michi, this information is now in your LINK/My Practice Profile (https://www.uhcprovider.com/en/demographics-profiles-attestation/link-my-practice-profile.html). If you have further questions regarding this system, please feel free to contact the LINK help desk (866-842-3278, option 1). Please see the attached handout for more information.  Sincerely,  UnitedHealthcare Network Management Resource Team  Jennifer Bready UnitedHealthcare  Network Management Resource Team (NMRT)', NULL, NULL, '2021-12-14 13:54:30', '2021-12-14 13:54:30'),
(29917, 10057, 23274, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Received From : networkhelp@uhc.com  Sub : Secure Message from jennifer_r_bready@uhc.com   Good morning,   Jeniece Wert is currently credentialed and linked to TIN 815123542 with contracts loaded, effective date is 07/13/2021.  Nubia Benavides is currently not credentialed.  A provider must first meet criteria for credentialing before contracting can begin.  You can find complete information on our process and requirements on our Credentialing page:  https://www.uhcprovider.com/content/provider/en/resource-library/Join-Our-Network.html?CID=none For assistance with credentialing and contracting for facilities and other specialty providers, refer to these contacts: https://www.uhcprovider.com/en/resource-library/Join-Our-Network/join-get-started.html  · Update CAQH application: Make sure the health care professional’s Council for Affordable Quality Healthcare (CAQH) application is up-to-date and attested   Submit your request through the RFP portal at  https://ncc-optum.secure.force.com/rfp   Jennifer Bready UnitedHealthcare Network Management Resource Team (NMRT)', NULL, NULL, '2021-12-21 13:59:15', '2021-12-21 13:59:15'),
(29918, 10057, 23274, NULL, '2022-01-04 00:00:00.000', 'Approved', 'Call Details: (877) 842-3210  Rep: Darry  Ref # 5437  Effective Date: 07/13/2021  Please see locations attachment.', NULL, NULL, '2021-12-28 10:59:39', '2021-12-28 10:59:39'),
(29919, 3040, 23275, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-22 12:12:31', '2021-03-22 12:12:31'),
(29920, 3040, 23275, NULL, '2021-05-04 00:00:00.000', 'In Process', 'Request submitted online through PECOS.   Applicant Name: JENIECE WERT Tracking ID: T042720210003071 Submitted Date: TUE - APRIL 27 2021 04:11:39 PM EST Submitted By: Jeniece Wert Contact Email(s): VMUC@CLAIMSMEDINC.COM JENIECE.WERT@YALE.EDU', NULL, NULL, '2021-04-27 15:13:42', '2021-04-27 15:13:42'),
(29921, 3040, 23275, NULL, '2021-05-11 00:00:00.000', 'Approved', 'Email rcvd from: medenroll via Valley Med Urgent Care  Subject: Medicare Provider Enrollment Notification JENIECE WERT  Medicare Enrollment Information  Individual Name: JENIECE WERT Individual Specialty: PHYSICIAN ASSISTANT Individual National Provider Identifier (NPI): 1659919702 Individual Provider Transaction Access Number (PTAN): 1O6853 Individual PTAN Effective Date: MARCH 01, 2021 Employer Legal Business Name (LBN): VALLEY MED URGENT CARE PLLC Employer National Provider Identifier (NPI): 1518404631 Employer Provider Transaction Access Number (PTAN): 578343', NULL, NULL, '2021-05-04 14:44:15', '2021-05-04 14:44:15'),
(29922, 3040, 23276, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-22 12:12:38', '2021-03-22 12:12:38'),
(29923, 3040, 23276, NULL, '2021-05-04 00:00:00.000', 'In Process', 'Request submitted online through PECOS.   Applicant Name: JENIECE WERT Tracking ID: T042720210003071 Submitted Date: TUE - APRIL 27 2021 04:11:39 PM EST Submitted By: Jeniece Wert Contact Email(s): VMUC@CLAIMSMEDINC.COM JENIECE.WERT@YALE.EDU', NULL, NULL, '2021-04-27 15:13:47', '2021-04-27 15:13:47'),
(29924, 3040, 23276, NULL, '2021-05-11 00:00:00.000', 'Approved', 'Email rcvd from: medenroll via Valley Med Urgent Care  Subject: Medicare Provider Enrollment Notification JENIECE WERT  Medicare Enrollment Information  Individual Name: JENIECE WERT Individual Specialty: PHYSICIAN ASSISTANT Individual National Provider Identifier (NPI): 1659919702 Individual Provider Transaction Access Number (PTAN): 1O6853 Individual PTAN Effective Date: MARCH 01, 2021 Employer Legal Business Name (LBN): VALLEY MED URGENT CARE PLLC Employer National Provider Identifier (NPI): 1518404631 Employer Provider Transaction Access Number (PTAN): 578343', NULL, NULL, '2021-05-04 14:44:20', '2021-05-04 14:44:20'),
(29925, 3040, 23277, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-22 12:12:46', '2021-03-22 12:12:46'),
(29926, 3040, 23277, NULL, '2021-05-04 00:00:00.000', 'In Process', 'Request submitted online through PECOS.   Applicant Name: JENIECE WERT Tracking ID: T042720210003071 Submitted Date: TUE - APRIL 27 2021 04:11:39 PM EST Submitted By: Jeniece Wert Contact Email(s): VMUC@CLAIMSMEDINC.COM JENIECE.WERT@YALE.EDU', NULL, NULL, '2021-04-27 15:13:51', '2021-04-27 15:13:51'),
(29927, 3040, 23277, NULL, '2021-05-11 00:00:00.000', 'Approved', 'Email rcvd from: medenroll via Valley Med Urgent Care  Subject: Medicare Provider Enrollment Notification JENIECE WERT  Medicare Enrollment Information  Individual Name: JENIECE WERT Individual Specialty: PHYSICIAN ASSISTANT Individual National Provider Identifier (NPI): 1659919702 Individual Provider Transaction Access Number (PTAN): 1O6853 Individual PTAN Effective Date: MARCH 01, 2021 Employer Legal Business Name (LBN): VALLEY MED URGENT CARE PLLC Employer National Provider Identifier (NPI): 1518404631 Employer Provider Transaction Access Number (PTAN): 578343', NULL, NULL, '2021-05-04 14:44:16', '2021-05-04 14:44:16'),
(29928, 3040, 23278, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-22 12:13:00', '2021-03-22 12:13:00'),
(29929, 3040, 23278, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Your new Railroad Medicare PTAN has been assigned and is shown here :  PROVIDER NAME	JENIECE K WERT PA PROVIDER PTAN	Q00077800 PROVIDER NPI	1659919702 EFFECTIVE DATE	03/01/2021 END DATE	', NULL, NULL, '2021-05-27 09:06:50', '2021-05-27 09:06:50'),
(29930, 3040, 23278, NULL, '2021-06-10 00:00:00.000', 'Approved', 'Provider enrolled in Medicare Railroad.   Your active Railroad Medicare PTAN has been located and is shown here :  PROVIDER NAME	JENIECE K WERT PA PROVIDER PTAN	Q00077800 PROVIDER NPI	1659919702 EFFECTIVE DATE	03/01/2021  Reference Number :	21124001040', NULL, NULL, '2021-06-03 16:39:19', '2021-06-03 16:39:19'),
(29931, 3040, 23279, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-22 12:13:08', '2021-03-22 12:13:08'),
(29932, 3040, 23279, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Your new Railroad Medicare PTAN has been assigned and is shown here :  PROVIDER NAME	JENIECE K WERT PA PROVIDER PTAN	Q00077800 PROVIDER NPI	1659919702 EFFECTIVE DATE	03/01/2021 END DATE	', NULL, NULL, '2021-05-27 09:07:00', '2021-05-27 09:07:00'),
(29933, 3040, 23279, NULL, '2021-06-10 00:00:00.000', 'Approved', 'Provider enrolled in Medicare Railroad.   Your active Railroad Medicare PTAN has been located and is shown here :  PROVIDER NAME	JENIECE K WERT PA PROVIDER PTAN	Q00077800 PROVIDER NPI	1659919702 EFFECTIVE DATE	03/01/2021  Reference Number :	21124001040', NULL, NULL, '2021-06-03 16:39:22', '2021-06-03 16:39:22'),
(29934, 3040, 23280, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-22 12:13:14', '2021-03-22 12:13:14'),
(29935, 3040, 23280, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Your new Railroad Medicare PTAN has been assigned and is shown here :  PROVIDER NAME	JENIECE K WERT PA PROVIDER PTAN	Q00077800 PROVIDER NPI	1659919702 EFFECTIVE DATE	03/01/2021 END DATE	', NULL, NULL, '2021-05-27 09:06:55', '2021-05-27 09:06:55'),
(29936, 3040, 23280, NULL, '2021-06-10 00:00:00.000', 'Approved', 'Provider enrolled in Medicare Railroad.   Your active Railroad Medicare PTAN has been located and is shown here :  PROVIDER NAME	JENIECE K WERT PA PROVIDER PTAN	Q00077800 PROVIDER NPI	1659919702 EFFECTIVE DATE	03/01/2021  Reference Number :	21124001040', NULL, NULL, '2021-06-03 16:39:21', '2021-06-03 16:39:21'),
(29937, 3040, 23281, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-22 12:13:31', '2021-03-22 12:13:31'),
(29938, 3040, 23281, NULL, '2021-05-10 00:00:00.000', 'On Hold', 'Waiting for Superior enrollment. ', NULL, NULL, '2021-05-03 10:42:24', '2021-05-03 10:42:24'),
(29939, 3040, 23281, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Email sent to: shp.networkdevelopment@superiorhealthplan.com  Subject: Enroll Provider || Valley Med Urgent Care PLLC || Wert, Jeniece || Ambetter ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned provider in Ambetter in our group Valley Med Urgent Care PLLC under the below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Wert, Jeniece Provider NPI# 1659919702  If you need any additional information please let me know. Waiting for your response.  Thank you  ', NULL, NULL, '2021-07-12 09:54:00', '2021-07-12 09:54:00'),
(29940, 10057, 23281, NULL, '2021-10-12 00:00:00.000', 'In Process', 'Email sent to : AM.Hidalgo@superiorhealthplan.com  Sub : Status Request - Enrollment Status || Best Health Urgent Care & Clinic || Superior Health ||  Good Morning,  Hope this email finds you well. I want to get the latest update on my credentialing application of below mentioned providers under the facility tax I.D.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Provider Name	NPI Hernandez, Juan	1225617558 Wert, Jeniece K	1659919702  If you have any questions please let us know, we will be happy to help.  Thanks & Regards,', NULL, NULL, '2021-10-05 10:53:57', '2021-10-05 10:53:57'),
(29941, 10057, 23281, NULL, '2021-11-15 00:00:00.000', 'In Process', 'Email Sent To : SHP.NetworkDevelopment@superiorhealthplan.com, AM.Houston@superiorhealthplan.com  Sub : Enroll Provider || Valley Med Urgent Care PLLC || Jeniece Wert & Juan Hernandez || Ambetter ||  Good Afternoon,  Hope this email finds you well. I want to get the latest update on my credentialing application for below mentioned providers under the facility tax I.D.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Hernandez, Juan	1225617558 Wert, Jeniece K	1659919702  Looking forward to hearing from you soon. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-08 15:23:13', '2021-11-08 15:23:13'),
(29942, 10057, 23281, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Email Received From : Daniel.Velez@superiorhealthplan.com,   Sub : Enroll Provider || Valley Med Urgent Care PLLC || Jeniece Wert & Juan Hernandez || Ambetter ||  Hello Region 4,  Provider is requesting assistance with contract status. Location is in Brownsville, Tx  Can someone please assist?  Thank you, Patricia Torres', NULL, NULL, '2021-11-09 11:46:31', '2021-11-09 11:46:31'),
(29943, 10057, 23281, NULL, '2021-11-18 00:00:00.000', 'Approved', 'Email Received From : Daniel.Velez@superiorhealthplan.com  Sub : Enroll Provider || Valley Med Urgent Care PLLC || Jeniece Wert & Juan Hernandez || Ambetter ||  Good Evening,  Please view the following provider Credentialing status:  Hernandez, Juan NPI: 1225617558 TIN: 815123542 is under Credentialing, please allow additional time to process.  Wert, Jeniece K NPI: 1659919702 TIN: 815123542 Effective Date: 12/1/2021  Respectfully,  Daniel Velez Provider Account Manager, Region 4 - Provider Relations Hidalgo SDA', NULL, NULL, '2021-11-11 13:37:32', '2021-11-11 13:37:32'),
(29944, 3040, 23282, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-22 12:13:38', '2021-03-22 12:13:38'),
(29945, 3040, 23282, NULL, '2021-05-10 00:00:00.000', 'On Hold', 'Waiting for Superior enrollment. ', NULL, NULL, '2021-05-03 10:42:30', '2021-05-03 10:42:30'),
(29946, 3040, 23282, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Email sent to: shp.networkdevelopment@superiorhealthplan.com  Subject: Enroll Provider || Valley Med Urgent Care PLLC || Wert, Jeniece || Ambetter ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned provider in Ambetter in our group Valley Med Urgent Care PLLC under the below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Wert, Jeniece Provider NPI# 1659919702  If you need any additional information please let me know. Waiting for your response.  Thank you  ', NULL, NULL, '2021-07-12 09:54:03', '2021-07-12 09:54:03'),
(29947, 10057, 23282, NULL, '2021-10-12 00:00:00.000', 'In Process', 'Email sent to : AM.Hidalgo@superiorhealthplan.com  Sub : Status Request - Enrollment Status || Best Health Urgent Care & Clinic || Superior Health ||  Good Morning,  Hope this email finds you well. I want to get the latest update on my credentialing application of below mentioned providers under the facility tax I.D.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Provider Name	NPI Hernandez, Juan	1225617558 Wert, Jeniece K	1659919702  If you have any questions please let us know, we will be happy to help.  Thanks & Regards,', NULL, NULL, '2021-10-05 10:53:47', '2021-10-05 10:53:47'),
(29948, 10057, 23282, NULL, '2021-11-15 00:00:00.000', 'In Process', 'Email Sent To : SHP.NetworkDevelopment@superiorhealthplan.com, AM.Houston@superiorhealthplan.com  Sub : Enroll Provider || Valley Med Urgent Care PLLC || Jeniece Wert & Juan Hernandez || Ambetter ||  Good Afternoon,  Hope this email finds you well. I want to get the latest update on my credentialing application for below mentioned providers under the facility tax I.D.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Hernandez, Juan	1225617558 Wert, Jeniece K	1659919702  Looking forward to hearing from you soon. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-08 15:23:05', '2021-11-08 15:23:05'),
(29949, 10057, 23282, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Email Received From : Daniel.Velez@superiorhealthplan.com,   Sub : Enroll Provider || Valley Med Urgent Care PLLC || Jeniece Wert & Juan Hernandez || Ambetter ||  Hello Region 4,  Provider is requesting assistance with contract status. Location is in Brownsville, Tx  Can someone please assist?  Thank you, Patricia Torres', NULL, NULL, '2021-11-09 11:46:24', '2021-11-09 11:46:24'),
(29950, 10057, 23282, NULL, '2021-11-18 00:00:00.000', 'Approved', 'Email Received From : Daniel.Velez@superiorhealthplan.com  Sub : Enroll Provider || Valley Med Urgent Care PLLC || Jeniece Wert & Juan Hernandez || Ambetter ||  Good Evening,  Please view the following provider Credentialing status:  Hernandez, Juan NPI: 1225617558 TIN: 815123542 is under Credentialing, please allow additional time to process.  Wert, Jeniece K NPI: 1659919702 TIN: 815123542 Effective Date: 12/1/2021  Respectfully,  Daniel Velez Provider Account Manager, Region 4 - Provider Relations Hidalgo SDA', NULL, NULL, '2021-11-11 13:37:21', '2021-11-11 13:37:21'),
(29951, 3040, 23283, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-22 12:13:47', '2021-03-22 12:13:47'),
(29952, 3040, 23283, NULL, '2021-05-10 00:00:00.000', 'On Hold', 'Waiting for Superior enrollment. ', NULL, NULL, '2021-05-03 10:42:35', '2021-05-03 10:42:35'),
(29953, 3040, 23283, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Email sent to: shp.networkdevelopment@superiorhealthplan.com  Subject: Enroll Provider || Valley Med Urgent Care PLLC || Wert, Jeniece || Ambetter ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned provider in Ambetter in our group Valley Med Urgent Care PLLC under the below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Wert, Jeniece Provider NPI# 1659919702  If you need any additional information please let me know. Waiting for your response.  Thank you  ', NULL, NULL, '2021-07-12 09:54:06', '2021-07-12 09:54:06'),
(29954, 10057, 23283, NULL, '2021-10-12 00:00:00.000', 'In Process', 'Email sent to : AM.Hidalgo@superiorhealthplan.com  Sub : Status Request - Enrollment Status || Best Health Urgent Care & Clinic || Superior Health ||  Good Morning,  Hope this email finds you well. I want to get the latest update on my credentialing application of below mentioned providers under the facility tax I.D.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Provider Name	NPI Hernandez, Juan	1225617558 Wert, Jeniece K	1659919702  If you have any questions please let us know, we will be happy to help.  Thanks & Regards,', NULL, NULL, '2021-10-05 10:53:35', '2021-10-05 10:53:35'),
(29955, 10057, 23283, NULL, '2021-11-15 00:00:00.000', 'In Process', 'Email Sent To : SHP.NetworkDevelopment@superiorhealthplan.com, AM.Houston@superiorhealthplan.com  Sub : Enroll Provider || Valley Med Urgent Care PLLC || Jeniece Wert & Juan Hernandez || Ambetter ||  Good Afternoon,  Hope this email finds you well. I want to get the latest update on my credentialing application for below mentioned providers under the facility tax I.D.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Hernandez, Juan	1225617558 Wert, Jeniece K	1659919702  Looking forward to hearing from you soon. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-08 15:22:58', '2021-11-08 15:22:58'),
(29956, 10057, 23283, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Email Received From : Daniel.Velez@superiorhealthplan.com,   Sub : Enroll Provider || Valley Med Urgent Care PLLC || Jeniece Wert & Juan Hernandez || Ambetter ||  Hello Region 4,  Provider is requesting assistance with contract status. Location is in Brownsville, Tx  Can someone please assist?  Thank you, Patricia Torres', NULL, NULL, '2021-11-09 11:46:18', '2021-11-09 11:46:18'),
(29957, 10057, 23283, NULL, '2021-11-18 00:00:00.000', 'Approved', 'Email Received From : Daniel.Velez@superiorhealthplan.com  Sub : Enroll Provider || Valley Med Urgent Care PLLC || Jeniece Wert & Juan Hernandez || Ambetter ||  Good Evening,  Please view the following provider Credentialing status:  Hernandez, Juan NPI: 1225617558 TIN: 815123542 is under Credentialing, please allow additional time to process.  Wert, Jeniece K NPI: 1659919702 TIN: 815123542 Effective Date: 12/1/2021  Respectfully,  Daniel Velez Provider Account Manager, Region 4 - Provider Relations Hidalgo SDA', NULL, NULL, '2021-11-11 13:36:47', '2021-11-11 13:36:47'),
(29958, 3040, 23284, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-22 12:14:23', '2021-03-22 12:14:23'),
(29959, 3040, 23284, NULL, '2021-05-10 00:00:00.000', 'On Hold', 'Waiting for Medicaid approval.', NULL, NULL, '2021-05-03 10:51:20', '2021-05-03 10:51:20'),
(29960, 3040, 23284, NULL, '2021-06-21 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com, SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Subject: Need To Enroll || Valley Med Urgent Care PLLC || Wert, Jeniece || Superior Health Plan ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned provider in our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Wert, Jeniece Provider NPI# 1659919702  If you need any additional information please let me know. Waiting for your response.   Thank you ', NULL, NULL, '2021-06-14 15:51:41', '2021-06-14 15:51:41'),
(29961, 3040, 23284, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Thank You For Your Request! Important to Note:  Prior to a new provider’s provision of services and receipt of claims reimbursement, program enrollment must be confirmed on requests for Superior Medicaid (STAR, STAR Health, STAR Kids and STAR+PLUS), CHIP and/or Long-Term Services and Supports (LTSS) programs.  Superior will notify you of acceptance or non-acceptance to our network no later than 90 days from receipt of a complete application for participation.  If additional information is required to process your request, a Superior representative will contact you soon.', NULL, NULL, '2021-06-15 08:29:54', '2021-06-15 08:29:54'),
(29962, 3040, 23284, NULL, '2021-06-30 00:00:00.000', 'In Process', 'Email sent to: shp.networkdevelopment@superiorhealthplan.com  Subject: VALLEY MED URGENT CARE PLLC  Greetings,   Hope you are doing well. Please find the attached Provider Contracting Form for Jeniece K Wert in Superior Healthplan for our group under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address:  2534 Boca Chica Blvd. Brownsville, TX 78521-3496   Secondary Address:  101 E. Expy 83 Ste. 170 McAllen, TX 78501-1166 Tertiary Address:  800 E. Alton Gloor Ave. Brownsville, TX 78521-3496  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-23 16:41:03', '2021-06-23 16:41:03'),
(29963, 3040, 23284, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Email sent to: AM.Hidalgo@superiorhealthplan.com  Subject; Re: [SECURE] - VALLEY MED URGENT CARE PLLC  Hello,   Hope you are doing well. I wanted to follow up regarding the enrollment status for the below mentioned provider in Superior Healthplan in our group under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address:  2534 Boca Chica Blvd. Brownsville, TX 78521-3496   Secondary Address:  101 E. Expy 83 Ste. 170 McAllen, TX 78501-1166 Tertiary Address:  800 E. Alton Gloor Ave. Brownsville, TX 78521-3496  Provider 1: Provider Name: Wert, Jeniece K Provider NPI#  1659919702  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-12 14:50:00', '2021-07-12 14:50:00'),
(29964, 3040, 23284, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to: Daniel.Velez@superiorhealthplan.com  Subject: Re: [SECURE] - VALLEY MED URGENT CARE PLLC  Hello,   Hope you are doing well. I wanted to follow up regarding the enrollment status for the below mentioned provider in Superior Healthplan in our group under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address:  2534 Boca Chica Blvd. Brownsville, TX 78521-3496   Secondary Address:  101 E. Expy 83 Ste. 170 McAllen, TX 78501-1166 Tertiary Address:  800 E. Alton Gloor Ave. Brownsville, TX 78521-3496  Provider 1: Provider Name: Wert, Jeniece K Provider NPI#  1659919702  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-27 13:21:48', '2021-08-27 13:21:48'),
(29965, 3040, 23284, NULL, '2021-09-08 00:00:00.000', 'In Process', 'Email rcvd from: Daniel.Velez@superiorhealthplan.com  Subject: RE: [SECURE] - VALLEY MED URGENT CARE PLLC  Good Afternoon Adil,  JENIECE K WERT NPI: 1659919702 TIN: 815123542  is currently within the credentialing status.  Please allow additional time to process and feel free to proceed requesting status updates.  Respectfully,  Daniel Velez Provider Account Manager, Region 4 - Provider Relations Hidalgo SDA', NULL, NULL, '2021-09-01 10:01:18', '2021-09-01 10:01:18'),
(29966, 10057, 23284, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : Daniel.Velez@superiorhealthplan.com  Sub : [SECURE] - VALLEY MED URGENT CARE PLLC  Good Afternoon,  Hope this email finds you well. I wanted to follow up regarding the enrollment status for the below mentioned provider in Superior Healthplan in our group under the below locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Wert, Jeniece K	1659919702  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-18 11:16:43', '2021-10-18 11:16:43'),
(29967, 10057, 23284, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email Received From : Daniel.Velez@superiorhealthplan.com  Sub : [SECURE] - VALLEY MED URGENT CARE PLLC  Good Morning,  I sent an email to our contracting team for additional review of JENIECE K WERT NPI 1659919702 TIN 815123542, which is in the credentialing process.  I will inform you of the outcome as soon as I receive notification, please allow additional time to process.  Respectfully, Daniel Velez  Provider Account Manager,', NULL, NULL, '2021-10-22 09:17:19', '2021-10-22 09:17:19'),
(29968, 10057, 23284, NULL, '2021-11-23 00:00:00.000', 'In Process', 'Email Sent To : SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com Daniel.Velez@superiorhealthplan.com  Sub : Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Good Morning,  Hope this email finds you in good health. Could you please help me out to get the latest enrollment status for below mentioned providers under TIN including all given locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Juan Hernandez	1225617558 Wert, Jeniece K	1659919702  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-11-16 09:33:28', '2021-11-16 09:33:28'),
(29969, 10057, 23284, NULL, '2021-11-23 00:00:00.000', 'In Process', 'Email Received From : SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Daniel.Velez@superiorhealthplan.com  Sub : Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Good morning,  Here are the statuses below-  Juan Hernandez- We received your completed application on 09/13/21.  It is currently in credentialing.  Please note that we will notify you of acceptance and/or participation status within 90 days of receipt of completed application.  Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.  Jeniece Wert- We received your completed application on 06/24/2021.  Your effective date is 12/01/2021 and you will be receiving a welcome packet shortly.  Thank you,  Samantha Cazares  Contracts Coordinator', NULL, NULL, '2021-11-16 13:50:51', '2021-11-16 13:50:51'),
(29970, 10057, 23284, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub : Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Greetings!  Thank you for your prompt response. Have a great day!  Regards,', NULL, NULL, '2021-11-30 15:09:02', '2021-11-30 15:09:02'),
(29971, 10057, 23284, NULL, '2021-12-09 00:00:00.000', 'Approved', 'Email Received From : ECMExecutionTeam@superiorhealthplan.com  Sub : JENIECE K WERT WELCOME LETTER  JENIECE K WERT  VALLEY MED URGENT CARE PLLC  VMUC@CLAIMSMEDINC.COM  Welcome to the Superior HealthPlan network. We are excited to have you as a partner of our growing network of high quality health care professionals. You play a key role as we pursue our commitment to improve the health and well-being of the members we serve.Your records were reviewed and approved by our credentialing committee. You are now able to provide covered services to Superior members.  Your effective date is:   12/01/2021', NULL, NULL, '2021-12-02 15:30:06', '2021-12-02 15:30:06'),
(29972, 3040, 23285, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-22 12:14:34', '2021-03-22 12:14:34'),
(29973, 3040, 23285, NULL, '2021-05-10 00:00:00.000', 'On Hold', 'Waiting for Medicaid approval.', NULL, NULL, '2021-05-03 10:51:37', '2021-05-03 10:51:37'),
(29974, 3040, 23285, NULL, '2021-06-21 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com, SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Subject: Need To Enroll || Valley Med Urgent Care PLLC || Wert, Jeniece || Superior Health Plan ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned provider in our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Wert, Jeniece Provider NPI# 1659919702  If you need any additional information please let me know. Waiting for your response.   Thank you ', NULL, NULL, '2021-06-14 15:51:32', '2021-06-14 15:51:32'),
(29975, 3040, 23285, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Thank You For Your Request! Important to Note:  Prior to a new provider’s provision of services and receipt of claims reimbursement, program enrollment must be confirmed on requests for Superior Medicaid (STAR, STAR Health, STAR Kids and STAR+PLUS), CHIP and/or Long-Term Services and Supports (LTSS) programs.  Superior will notify you of acceptance or non-acceptance to our network no later than 90 days from receipt of a complete application for participation.  If additional information is required to process your request, a Superior representative will contact you soon.', NULL, NULL, '2021-06-15 08:29:49', '2021-06-15 08:29:49'),
(29976, 3040, 23285, NULL, '2021-06-30 00:00:00.000', 'In Process', 'Email sent to: shp.networkdevelopment@superiorhealthplan.com  Subject: VALLEY MED URGENT CARE PLLC  Greetings,   Hope you are doing well. Please find the attached Provider Contracting Form for Jeniece K Wert in Superior Healthplan for our group under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address:  2534 Boca Chica Blvd. Brownsville, TX 78521-3496   Secondary Address:  101 E. Expy 83 Ste. 170 McAllen, TX 78501-1166 Tertiary Address:  800 E. Alton Gloor Ave. Brownsville, TX 78521-3496  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-23 16:40:58', '2021-06-23 16:40:58'),
(29977, 3040, 23285, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Email sent to: AM.Hidalgo@superiorhealthplan.com  Subject; Re: [SECURE] - VALLEY MED URGENT CARE PLLC  Hello,   Hope you are doing well. I wanted to follow up regarding the enrollment status for the below mentioned provider in Superior Healthplan in our group under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address:  2534 Boca Chica Blvd. Brownsville, TX 78521-3496   Secondary Address:  101 E. Expy 83 Ste. 170 McAllen, TX 78501-1166 Tertiary Address:  800 E. Alton Gloor Ave. Brownsville, TX 78521-3496  Provider 1: Provider Name: Wert, Jeniece K Provider NPI#  1659919702  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-12 14:49:58', '2021-07-12 14:49:58'),
(29978, 3040, 23285, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to: Daniel.Velez@superiorhealthplan.com  Subject: Re: [SECURE] - VALLEY MED URGENT CARE PLLC  Hello,   Hope you are doing well. I wanted to follow up regarding the enrollment status for the below mentioned provider in Superior Healthplan in our group under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address:  2534 Boca Chica Blvd. Brownsville, TX 78521-3496   Secondary Address:  101 E. Expy 83 Ste. 170 McAllen, TX 78501-1166 Tertiary Address:  800 E. Alton Gloor Ave. Brownsville, TX 78521-3496  Provider 1: Provider Name: Wert, Jeniece K Provider NPI#  1659919702  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-27 13:21:49', '2021-08-27 13:21:49'),
(29979, 3040, 23285, NULL, '2021-09-08 00:00:00.000', 'In Process', 'Email rcvd from: Daniel.Velez@superiorhealthplan.com  Subject: RE: [SECURE] - VALLEY MED URGENT CARE PLLC  Good Afternoon Adil,  JENIECE K WERT NPI: 1659919702 TIN: 815123542  is currently within the credentialing status.  Please allow additional time to process and feel free to proceed requesting status updates.  Respectfully,  Daniel Velez Provider Account Manager, Region 4 - Provider Relations Hidalgo SDA', NULL, NULL, '2021-09-01 10:01:17', '2021-09-01 10:01:17'),
(29980, 10057, 23285, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : Daniel.Velez@superiorhealthplan.com  Sub : [SECURE] - VALLEY MED URGENT CARE PLLC  Good Afternoon,  Hope this email finds you well. I wanted to follow up regarding the enrollment status for the below mentioned provider in Superior Healthplan in our group under the below locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Wert, Jeniece K	1659919702  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-18 11:14:54', '2021-10-18 11:14:54'),
(29981, 10057, 23285, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email Received From : Daniel.Velez@superiorhealthplan.com  Sub : [SECURE] - VALLEY MED URGENT CARE PLLC  Good Morning,  I sent an email to our contracting team for additional review of JENIECE K WERT NPI 1659919702 TIN 815123542, which is in the credentialing process.  I will inform you of the outcome as soon as I receive notification, please allow additional time to process.  Respectfully, Daniel Velez  Provider Account Manager,', NULL, NULL, '2021-10-22 09:17:11', '2021-10-22 09:17:11'),
(29982, 10057, 23285, NULL, '2021-11-23 00:00:00.000', 'In Process', 'Email Sent To : SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com Daniel.Velez@superiorhealthplan.com  Sub : Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Good Morning,  Hope this email finds you in good health. Could you please help me out to get the latest enrollment status for below mentioned providers under TIN including all given locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Juan Hernandez	1225617558 Wert, Jeniece K	1659919702  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-11-16 09:33:22', '2021-11-16 09:33:22'),
(29983, 10057, 23285, NULL, '2021-11-23 00:00:00.000', 'In Process', 'Email Received From : SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Daniel.Velez@superiorhealthplan.com  Sub : Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Good morning,  Here are the statuses below-  Juan Hernandez- We received your completed application on 09/13/21.  It is currently in credentialing.  Please note that we will notify you of acceptance and/or participation status within 90 days of receipt of completed application.  Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.  Jeniece Wert- We received your completed application on 06/24/2021.  Your effective date is 12/01/2021 and you will be receiving a welcome packet shortly.  Thank you,  Samantha Cazares  Contracts Coordinator', NULL, NULL, '2021-11-16 13:50:45', '2021-11-16 13:50:45'),
(29984, 10057, 23285, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub : Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Greetings!  Thank you for your prompt response. Have a great day!  Regards,', NULL, NULL, '2021-11-30 15:08:53', '2021-11-30 15:08:53'),
(29985, 10057, 23285, NULL, '2021-12-14 00:00:00.000', 'In Process', 'Email Sent To : SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com Daniel.Velez@superiorhealthplan.com  Sub : Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Good Afternoon,  Hope this email finds you well. I\'m writing this email to get the welcome packets. Your earliest response will be highly appreciated.   Thanks & Regards,', NULL, NULL, '2021-12-07 14:11:51', '2021-12-07 14:11:51'),
(29986, 10057, 23285, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email Received From : SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub : Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Good afternoon,  I have requested the welcome packet for Jeniece Wert and you should be receiving it shortly.  JUAN ALONSO HERNANDEZ- is currently still in credentialing. We appreciate your patience as credentialing can take up to 90 days.', NULL, NULL, '2021-12-14 13:31:45', '2021-12-14 13:31:45'),
(29987, 10057, 23285, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Received From : ECMExecutionTeam@superiorhealthplan.com  Sub : Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Good morning Steve,  Here is the Welcome Packet for Jeniece Wert is attached.  Thank you,  Richard Salas', NULL, NULL, '2021-12-21 13:23:11', '2021-12-21 13:23:11'),
(29988, 10057, 23285, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email Sent To : ECMExecutionTeam@superiorhealthplan.com & SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub : Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Thank you for your response. Is there any update on JUAN ALONSO HERNANDEZ request. Please let me know.  Have a great day ahead!  Regards,', NULL, NULL, '2021-12-28 15:23:08', '2021-12-28 15:23:08'),
(29989, 20067, 23285, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: ECMExecutionTeam@superiorhealthplan.com, SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Subject: Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health   Good Afternoon,  Hope you are doing well. I would like to know the enrollment status of the below-mentioned providers, and if any provider is enrolled kindly send me their welcome letter.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Edna Michi	1992293906 Nubia Olivama Benavides	1801371935  Thanks and Regards, Syed Ahad. ', NULL, NULL, '2022-01-05 16:34:30', '2022-01-05 16:34:30'),
(29990, 20067, 23285, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to: ECMExecutionTeam@superiorhealthplan.com  Sub: Re: Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Good afternoon, Hope you are doing well. I would like to know the enrollment status of the below-mentioned providers and if any of them is enrolled kindly send me their welcome kit.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Juan hernandez	1225617558 jeniece Wert	1659919702  Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-11 12:44:50', '2022-01-11 12:44:50'),
(29991, 20067, 23285, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email received from: ECMExecutionTeam@superiorhealthplan.com  Sub: FW: JENIECE K WERT WELCOME LETTER  Welcome to the Superior HealthPlan network. We are excited to have you as a partner of our growing network of high quality health care professionals. You play a key role as we pursue our commitment to improve the health and well-being of the members we serve.Your records were reviewed and approved by our credentialing committee. You are now able to provide covered services to Superior members.     Your effective date is:   12/01/2021                                                  C/ 53007   ', NULL, NULL, '2022-01-12 17:57:44', '2022-01-12 17:57:44'),
(29992, 20067, 23285, NULL, '2022-02-07 00:00:00.000', 'In Process', 'Email sent to: ECMExecutionTeam@superiorhealthplan.com  Sub: Re: Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Good Morning!  I would like to know the enrollment status of Juan Hernandez 1225617558 and also I would like to add the secondary and tertiary locations for provider Jeniece Wert 1659919702, Locations are listed below:  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166  Thanks & Regards, Syed Ahad. ', NULL, NULL, '2022-01-31 11:42:03', '2022-01-31 11:42:03'),
(29993, 20067, 23285, NULL, '2022-02-24 00:00:00.000', 'In Process', 'Email received from: Daniel.Velez@superiorhealthplan.com  Sub: Re: Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health   Hello Syed,     Provider Juan Alonso Hernandez NPI 1225617558 TIN: 815123542 displays an effective date of 3/1/2022.     Respectfully,', NULL, NULL, '2022-02-17 13:03:03', '2022-02-17 13:03:03'),
(29994, 20067, 23285, NULL, '2022-03-03 00:00:00.000', 'In Process', 'Email sent to: Daniel.Velez@superiorhealthplan.com  Sub: Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Good Afternoon Daniel!  Hope you are doing well. Kindly send me the welcome letter for Juan Hernandez. And what about Jeniece K Wert? Kindly update me.  Thank you,', NULL, NULL, '2022-02-24 10:19:06', '2022-02-24 10:19:06'),
(29995, 20067, 23285, NULL, '2022-03-03 00:00:00.000', 'In Process', 'Email received from: Daniel.Velez@superiorhealthplan.com  Sub: Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Hello Syed,     Provider: JENIECE K WERT NPI: 1659919702 TIN: 815123542 displays an effective date 12/1/2021.     A request was sent to our contracting department to send the Welcome Letters.     Please allow time to process and be sent.', NULL, NULL, '2022-02-24 10:19:40', '2022-02-24 10:19:40'),
(29996, 20067, 23285, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Call superior Health for Credentialing status check.  Provider Jeniece Wert: Secondary and Tertiary Locations added over the call. Location will be update 30 days Ref# I73428875', NULL, NULL, '2022-03-15 18:06:43', '2022-03-15 18:06:43');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(29997, 22077, 23285, NULL, '2022-04-15 00:00:00.000', 'In Process', 'Email sent to: ECMExecutionTeam@superiorhealthplan.com  Subject: Re: Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Hi,  I would like to know the enrollment process of the following provider  Group Name: Valley Med Urgent Care PLLC Tax ID: 81-5123542 Group NPI: 1518404631 Primary Location: 2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location: 800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location: 101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Jeniece Wert	1659919702  Looking forward to your kind response. Have a great day!  Thanks & Regards,', NULL, NULL, '2022-04-08 10:18:04', '2022-04-08 10:18:04'),
(29998, 19067, 23285, NULL, '2022-04-19 00:00:00.000', 'Approved', 'Spoke with Vanessa @ 877-391-5921. Got the eff date as of 12/01/2021. Ref# I752633305', NULL, NULL, '2022-04-12 11:12:00', '2022-04-12 11:12:00'),
(29999, 3040, 23286, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-22 12:14:44', '2021-03-22 12:14:44'),
(30000, 3040, 23286, NULL, '2021-05-10 00:00:00.000', 'On Hold', 'Waiting for Medicaid approval.', NULL, NULL, '2021-05-03 10:51:43', '2021-05-03 10:51:43'),
(30001, 3040, 23286, NULL, '2021-06-21 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com, SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Subject: Need To Enroll || Valley Med Urgent Care PLLC || Wert, Jeniece || Superior Health Plan ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned provider in our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Wert, Jeniece Provider NPI# 1659919702  If you need any additional information please let me know. Waiting for your response.   Thank you ', NULL, NULL, '2021-06-14 15:51:25', '2021-06-14 15:51:25'),
(30002, 3040, 23286, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Thank You For Your Request! Important to Note:  Prior to a new provider’s provision of services and receipt of claims reimbursement, program enrollment must be confirmed on requests for Superior Medicaid (STAR, STAR Health, STAR Kids and STAR+PLUS), CHIP and/or Long-Term Services and Supports (LTSS) programs.  Superior will notify you of acceptance or non-acceptance to our network no later than 90 days from receipt of a complete application for participation.  If additional information is required to process your request, a Superior representative will contact you soon.', NULL, NULL, '2021-06-15 08:29:43', '2021-06-15 08:29:43'),
(30003, 3040, 23286, NULL, '2021-06-30 00:00:00.000', 'In Process', 'Email sent to: shp.networkdevelopment@superiorhealthplan.com  Subject: VALLEY MED URGENT CARE PLLC  Greetings,   Hope you are doing well. Please find the attached Provider Contracting Form for Jeniece K Wert in Superior Healthplan for our group under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address:  2534 Boca Chica Blvd. Brownsville, TX 78521-3496   Secondary Address:  101 E. Expy 83 Ste. 170 McAllen, TX 78501-1166 Tertiary Address:  800 E. Alton Gloor Ave. Brownsville, TX 78521-3496  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-23 16:40:52', '2021-06-23 16:40:52'),
(30004, 3040, 23286, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Email sent to: AM.Hidalgo@superiorhealthplan.com  Subject; Re: [SECURE] - VALLEY MED URGENT CARE PLLC  Hello,   Hope you are doing well. I wanted to follow up regarding the enrollment status for the below mentioned provider in Superior Healthplan in our group under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address:  2534 Boca Chica Blvd. Brownsville, TX 78521-3496   Secondary Address:  101 E. Expy 83 Ste. 170 McAllen, TX 78501-1166 Tertiary Address:  800 E. Alton Gloor Ave. Brownsville, TX 78521-3496  Provider 1: Provider Name: Wert, Jeniece K Provider NPI#  1659919702  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-12 14:49:56', '2021-07-12 14:49:56'),
(30005, 3040, 23286, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to: Daniel.Velez@superiorhealthplan.com  Subject: Re: [SECURE] - VALLEY MED URGENT CARE PLLC  Hello,   Hope you are doing well. I wanted to follow up regarding the enrollment status for the below mentioned provider in Superior Healthplan in our group under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address:  2534 Boca Chica Blvd. Brownsville, TX 78521-3496   Secondary Address:  101 E. Expy 83 Ste. 170 McAllen, TX 78501-1166 Tertiary Address:  800 E. Alton Gloor Ave. Brownsville, TX 78521-3496  Provider 1: Provider Name: Wert, Jeniece K Provider NPI#  1659919702  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-27 13:21:50', '2021-08-27 13:21:50'),
(30006, 3040, 23286, NULL, '2021-09-08 00:00:00.000', 'In Process', 'Email rcvd from: Daniel.Velez@superiorhealthplan.com  Subject: RE: [SECURE] - VALLEY MED URGENT CARE PLLC  Good Afternoon Adil,  JENIECE K WERT NPI: 1659919702 TIN: 815123542  is currently within the credentialing status.  Please allow additional time to process and feel free to proceed requesting status updates.  Respectfully,  Daniel Velez Provider Account Manager, Region 4 - Provider Relations Hidalgo SDA', NULL, NULL, '2021-09-01 10:01:16', '2021-09-01 10:01:16'),
(30007, 10057, 23286, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : Daniel.Velez@superiorhealthplan.com  Sub : [SECURE] - VALLEY MED URGENT CARE PLLC  Good Afternoon,  Hope this email finds you well. I wanted to follow up regarding the enrollment status for the below mentioned provider in Superior Healthplan in our group under the below locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Wert, Jeniece K	1659919702  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-18 11:14:37', '2021-10-18 11:14:37'),
(30008, 10057, 23286, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email Received From : Daniel.Velez@superiorhealthplan.com  Sub : [SECURE] - VALLEY MED URGENT CARE PLLC  Good Morning,  I sent an email to our contracting team for additional review of JENIECE K WERT NPI 1659919702 TIN 815123542, which is in the credentialing process.  I will inform you of the outcome as soon as I receive notification, please allow additional time to process.  Respectfully, Daniel Velez  Provider Account Manager,', NULL, NULL, '2021-10-22 09:17:28', '2021-10-22 09:17:28'),
(30009, 10057, 23286, NULL, '2021-11-23 00:00:00.000', 'In Process', 'Email Sent To : SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com Daniel.Velez@superiorhealthplan.com  Sub : Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Good Morning,  Hope this email finds you in good health. Could you please help me out to get the latest enrollment status for below mentioned providers under TIN including all given locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Juan Hernandez	1225617558 Wert, Jeniece K	1659919702  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-11-16 09:33:14', '2021-11-16 09:33:14'),
(30010, 10057, 23286, NULL, '2021-11-23 00:00:00.000', 'In Process', 'Email Received From : SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Daniel.Velez@superiorhealthplan.com  Sub : Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Good morning,  Here are the statuses below-  Juan Hernandez- We received your completed application on 09/13/21.  It is currently in credentialing.  Please note that we will notify you of acceptance and/or participation status within 90 days of receipt of completed application.  Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.  Jeniece Wert- We received your completed application on 06/24/2021.  Your effective date is 12/01/2021 and you will be receiving a welcome packet shortly.  Thank you,  Samantha Cazares  Contracts Coordinator', NULL, NULL, '2021-11-16 13:50:39', '2021-11-16 13:50:39'),
(30011, 10057, 23286, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub : Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Greetings!  Thank you for your prompt response. Have a great day!  Regards,', NULL, NULL, '2021-11-30 15:08:42', '2021-11-30 15:08:42'),
(30012, 10057, 23286, NULL, '2021-12-14 00:00:00.000', 'In Process', 'Email Sent To : SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com Daniel.Velez@superiorhealthplan.com  Sub : Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Good Afternoon,  Hope this email finds you well. I\'m writing this email to get the welcome packets. Your earliest response will be highly appreciated.   Thanks & Regards,', NULL, NULL, '2021-12-07 14:11:44', '2021-12-07 14:11:44'),
(30013, 10057, 23286, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email Received From : SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub : Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Good afternoon,  I have requested the welcome packet for Jeniece Wert and you should be receiving it shortly.  JUAN ALONSO HERNANDEZ- is currently still in credentialing. We appreciate your patience as credentialing can take up to 90 days.', NULL, NULL, '2021-12-14 13:31:40', '2021-12-14 13:31:40'),
(30014, 10057, 23286, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Received From : ECMExecutionTeam@superiorhealthplan.com  Sub : Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Good morning Steve,  Here is the Welcome Packet for Jeniece Wert is attached.  Thank you,  Richard Salas', NULL, NULL, '2021-12-21 13:23:04', '2021-12-21 13:23:04'),
(30015, 10057, 23286, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email Sent To : ECMExecutionTeam@superiorhealthplan.com & SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub : Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Thank you for your response. Is there any update on JUAN ALONSO HERNANDEZ request. Please let me know.  Have a great day ahead!  Regards,', NULL, NULL, '2021-12-28 15:23:03', '2021-12-28 15:23:03'),
(30016, 20067, 23286, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: ECMExecutionTeam@superiorhealthplan.com, SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Subject: Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health   Good Afternoon,  Hope you are doing well. I would like to know the enrollment status of the below-mentioned providers, and if any provider is enrolled kindly send me their welcome letter.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Edna Michi	1992293906 Nubia Olivama Benavides	1801371935  Thanks and Regards, Syed Ahad. ', NULL, NULL, '2022-01-05 16:34:15', '2022-01-05 16:34:15'),
(30017, 20067, 23286, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to: ECMExecutionTeam@superiorhealthplan.com  Sub: Re: Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Good afternoon, Hope you are doing well. I would like to know the enrollment status of the below-mentioned providers and if any of them is enrolled kindly send me their welcome kit.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Juan hernandez	1225617558 jeniece Wert	1659919702  Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-11 12:44:43', '2022-01-11 12:44:43'),
(30018, 20067, 23286, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email received from: ECMExecutionTeam@superiorhealthplan.com  Sub: FW: JENIECE K WERT WELCOME LETTER  Welcome to the Superior HealthPlan network. We are excited to have you as a partner of our growing network of high quality health care professionals. You play a key role as we pursue our commitment to improve the health and well-being of the members we serve.Your records were reviewed and approved by our credentialing committee. You are now able to provide covered services to Superior members.     Your effective date is:   12/01/2021                                                  C/ 53007   ', NULL, NULL, '2022-01-12 17:57:20', '2022-01-12 17:57:20'),
(30019, 20067, 23286, NULL, '2022-02-07 00:00:00.000', 'In Process', 'Email sent to: ECMExecutionTeam@superiorhealthplan.com  Sub: Re: Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Good Morning!  I would like to know the enrollment status of Juan Hernandez 1225617558 and also I would like to add the secondary and tertiary locations for provider Jeniece Wert 1659919702, Locations are listed below:  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166  Thanks & Regards, Syed Ahad. ', NULL, NULL, '2022-01-31 11:41:55', '2022-01-31 11:41:55'),
(30020, 20067, 23286, NULL, '2022-02-24 00:00:00.000', 'In Process', 'Email received from: Daniel.Velez@superiorhealthplan.com  Sub: Re: Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health   Hello Syed,     Provider Juan Alonso Hernandez NPI 1225617558 TIN: 815123542 displays an effective date of 3/1/2022.     Respectfully,', NULL, NULL, '2022-02-17 13:02:54', '2022-02-17 13:02:54'),
(30021, 20067, 23286, NULL, '2022-03-03 00:00:00.000', 'In Process', 'Email sent to: Daniel.Velez@superiorhealthplan.com  Sub: Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Good Afternoon Daniel!  Hope you are doing well. Kindly send me the welcome letter for Juan Hernandez. And what about Jeniece K Wert? Kindly update me.  Thank you,', NULL, NULL, '2022-02-24 10:19:01', '2022-02-24 10:19:01'),
(30022, 20067, 23286, NULL, '2022-03-03 00:00:00.000', 'In Process', 'Email received from: Daniel.Velez@superiorhealthplan.com  Sub: Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Hello Syed,     Provider: JENIECE K WERT NPI: 1659919702 TIN: 815123542 displays an effective date 12/1/2021.     A request was sent to our contracting department to send the Welcome Letters.     Please allow time to process and be sent.', NULL, NULL, '2022-02-24 10:19:33', '2022-02-24 10:19:33'),
(30023, 20067, 23286, NULL, '2022-03-24 00:00:00.000', 'In Process', 'all superior Health for Credentialing status check.  Provider Jeniece Wert: Secondary and Tertiary Locations added over the call. Location will be update 30 days Ref# I73428875', NULL, NULL, '2022-03-17 16:48:09', '2022-03-17 16:48:09'),
(30024, 22077, 23286, NULL, '2022-04-15 00:00:00.000', 'In Process', 'Email sent to: ECMExecutionTeam@superiorhealthplan.com  Subject: Re: Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Hi,  I would like to know the enrollment process of the following provider  Group Name: Valley Med Urgent Care PLLC Tax ID: 81-5123542 Group NPI: 1518404631 Primary Location: 2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location: 800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location: 101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Jeniece Wert	1659919702  Looking forward to your kind response. Have a great day!  Thanks & Regards,', NULL, NULL, '2022-04-08 10:17:46', '2022-04-08 10:17:46'),
(30025, 19067, 23286, NULL, '2022-04-19 00:00:00.000', 'Approved', 'Spoke with Vanessa @ 877-391-5921. Got the eff date as of 12/01/2021. Ref# I752633305', NULL, NULL, '2022-04-12 11:12:06', '2022-04-12 11:12:06'),
(30026, 3040, 23287, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-22 12:15:01', '2021-03-22 12:15:01'),
(30027, 3040, 23287, NULL, '2021-06-05 00:00:00.000', 'In Process', 'Application initiated through CIgna Representative:  Application no: 12576287 Provider ID: 8119307  ', NULL, NULL, '2021-04-28 07:53:49', '2021-04-28 07:53:49'),
(30028, 3040, 23287, NULL, '2021-06-03 00:00:00.000', 'In Process', 'I had a word with (RONNY) Cigna representative and the application is loaded in the system.   Ref: RONNY 05/27/2021', NULL, NULL, '2021-05-27 12:29:13', '2021-05-27 12:29:13'),
(30029, 3040, 23287, NULL, '2021-06-23 00:00:00.000', 'In Process', 'I had a word with (Ella G) Cigna representative and she said the application is still not loaded in the system. The process will take 90-120 days.   Ref: Ella G 06/16/2021', NULL, NULL, '2021-06-16 10:01:51', '2021-06-16 10:01:51'),
(30030, 3040, 23287, NULL, '2021-07-09 00:00:00.000', 'Approved', 'Email rcvd from: discovercigna@information.cigna.com  Subject: Welcome to the Cigna network  WELCOME TO CIGNA We’re happy to have you in our network Dear JENIECE WERT PA,  Congratulations! Your application to participate in the Cigna network has been approved. Our shared focus is on the health and well-being of every person we serve. Working together, we can help them live a healthy life.  Jeff Panter  Vice President  Provider Relations & Solutions Management  Jeff Panter	 Let’s get started Your effective date is 06/29/2021. Your provider identification number is‍ ‌8119307. Please take a moment to register for the Cigna for Health Care Professionals website (CignaforHCP.com).', NULL, NULL, '2021-07-02 12:02:21', '2021-07-02 12:02:21'),
(30031, 3040, 23288, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-22 12:15:13', '2021-03-22 12:15:13'),
(30032, 3040, 23288, NULL, '2021-05-05 00:00:00.000', 'In Process', 'Application initiated through CIgna Representative:  Application no: 12576287 Provider ID: 8119307  ', NULL, NULL, '2021-04-28 07:53:57', '2021-04-28 07:53:57'),
(30033, 3040, 23288, NULL, '2021-06-03 00:00:00.000', 'In Process', 'I had a word with (RONNY) Cigna representative and the application is loaded in the system.   Ref: RONNY 05/27/2021', NULL, NULL, '2021-05-27 12:29:46', '2021-05-27 12:29:46'),
(30034, 3040, 23288, NULL, '2021-06-23 00:00:00.000', 'In Process', 'I had a word with (Ella G) Cigna representative and she said the application is still not loaded in the system. The process will take 90-120 days.   Ref: Ella G 06/16/2021', NULL, NULL, '2021-06-16 10:01:47', '2021-06-16 10:01:47'),
(30035, 3040, 23288, NULL, '2021-07-09 00:00:00.000', 'Approved', 'Email rcvd from: discovercigna@information.cigna.com  Subject: Welcome to the Cigna network  WELCOME TO CIGNA We’re happy to have you in our network Dear JENIECE WERT PA,  Congratulations! Your application to participate in the Cigna network has been approved. Our shared focus is on the health and well-being of every person we serve. Working together, we can help them live a healthy life.  Jeff Panter  Vice President  Provider Relations & Solutions Management  Jeff Panter	 Let’s get started Your effective date is 06/29/2021. Your provider identification number is‍ ‌8119307. Please take a moment to register for the Cigna for Health Care Professionals website (CignaforHCP.com).', NULL, NULL, '2021-07-02 12:02:20', '2021-07-02 12:02:20'),
(30036, 3040, 23289, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-22 12:15:25', '2021-03-22 12:15:25'),
(30037, 3040, 23289, NULL, '2021-05-05 00:00:00.000', 'In Process', 'Application initiated through CIgna Representative:  Application no: 12576287 Provider ID: 8119307  ', NULL, NULL, '2021-04-28 07:54:05', '2021-04-28 07:54:05'),
(30038, 3040, 23289, NULL, '2021-06-03 00:00:00.000', 'In Process', 'I had a word with (RONNY) Cigna representative and the application is loaded in the system.   Ref: RONNY 05/27/2021', NULL, NULL, '2021-05-27 12:29:41', '2021-05-27 12:29:41'),
(30039, 3040, 23289, NULL, '2021-06-23 00:00:00.000', 'In Process', 'I had a word with (Ella G) Cigna representative and she said the application is still not loaded in the system. The process will take 90-120 days.   Ref: Ella G 06/16/2021', NULL, NULL, '2021-06-16 10:01:43', '2021-06-16 10:01:43'),
(30040, 3040, 23289, NULL, '2021-07-09 00:00:00.000', 'Approved', 'Email rcvd from: discovercigna@information.cigna.com  Subject: Welcome to the Cigna network  WELCOME TO CIGNA We’re happy to have you in our network Dear JENIECE WERT PA,  Congratulations! Your application to participate in the Cigna network has been approved. Our shared focus is on the health and well-being of every person we serve. Working together, we can help them live a healthy life.  Jeff Panter  Vice President  Provider Relations & Solutions Management  Jeff Panter	 Let’s get started Your effective date is 06/29/2021. Your provider identification number is‍ ‌8119307. Please take a moment to register for the Cigna for Health Care Professionals website (CignaforHCP.com).', NULL, NULL, '2021-07-02 12:02:18', '2021-07-02 12:02:18'),
(30041, 3040, 23290, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-22 12:15:46', '2021-03-22 12:15:46'),
(30042, 3040, 23290, NULL, '2021-05-05 00:00:00.000', 'In Process', 'Provider certification form was sent out through fax at (608)221-7535. ', NULL, NULL, '2021-04-28 10:02:56', '2021-04-28 10:02:56'),
(30043, 3040, 23290, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Wert, Jeniece K || Tricare ||  Hello Katherine,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in the Tricare for our group Valley Med Urgent Care PLLC. We already sent the credentialing form through fax.    Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-01 09:17:15', '2021-06-01 09:17:15'),
(30044, 3040, 23290, NULL, '2021-06-10 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Wert, Jeniece K || Tricare ||  Hello Katherine,   Hope you are doing well. Please find the attached provider credentialing application from along with the requested documents as per your previous email.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-03 13:17:08', '2021-06-03 13:17:08'),
(30045, 3040, 23290, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email rcvd from: KMoten4@humana.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Wert, Jeniece K || Tricare ||  The provider below is showing certified as of 5/4/2021. Please provide a credentialing application with all documents: CV, License, Malpractice Insurance, DEA.   Respectfully, Katherine Moten TRICARE Community Liaison II Humana T 502-318-5250', NULL, NULL, '2021-06-21 10:50:54', '2021-06-21 10:50:54'),
(30046, 3040, 23290, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Wert, Jeniece K || Tricare || Hello Katherine,  Hope you had a great weekend. I wanted to know the enrollment status for the below mentioned provider in the Tricare for our group Valley Med Urgent Care PLLC. We already sent the credentialing application from along with the requested documents.    Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166    Provider 1: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-21 10:53:28', '2021-06-21 10:53:28'),
(30047, 3040, 23290, NULL, '2021-07-16 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Wert, Jeniece K || Tricare ||  This application has been submitted for processing. Please allow 90 days.   Respectfully, Katherine Moten TRICARE Community Liaison II Humana  T 502-318-5250  F 210-239-0401 kmoten4@humana.com HumanaMilitary.com', NULL, NULL, '2021-07-09 11:11:22', '2021-07-09 11:11:22'),
(30048, 3040, 23290, NULL, '2021-09-16 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Wert, Jeniece, Lira, Arturo & Hernandez, Juan || Tricare ||  Hello Katherine,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Tricare in our group under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 1: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 2: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 3: Provider Name: Hernandez, Juan Provider NPI# 1225617558  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-09-09 16:16:57', '2021-09-09 16:16:57'),
(30049, 10057, 23290, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email Sent To : ywyatt@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Good Evening,  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned group Valley Med Urgent Care PLLC and provider in Tricare for our group under the below locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Luyando, Mariana	1700960556 Hernandez, Juan	1225617558 Wert, Jeniece K	1659919702 Naranjo, Diego	1568929800 Garcia, Homero	1730564857 Lira, Arturo	1245789502  Please get back to me as soon as you have time. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-21 15:27:22', '2021-10-21 15:27:22'),
(30050, 10057, 23290, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From: ywyatt@humana.com & jtrenz@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Good Morning Steve,  Jacqueline Trenz can assist you with your request.    Brownsville and McAllen Texas is not in my area.  Thanks, Yvonne W. Wyatt,  Humana Military TRICARE Community Liaison II Houston/Galveston', NULL, NULL, '2021-11-23 17:35:31', '2021-11-23 17:35:31'),
(30051, 10057, 23290, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email Sent To : ywyatt@humana.com & jtrenz@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Hello Yvonne,  Thank you for the update. Have a great day!  Regards,', NULL, NULL, '2021-12-01 16:24:32', '2021-12-01 16:24:32'),
(30052, 10057, 23290, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Email Sent To : jtrenz@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Hello Jacqueline,  Hope this email finds you well. Could you please check and confirm once again, since I\'m unable to find the below mentioned providers on the Humana - Tricare directory.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Juan Hernandez	1225617558 Jeniece K Wert	1659919702 Homero Garcia	1730564857  Juan Hernandez we are still in contact to get his Malpractice.  Jeniece K Wert not showing for secondary and tertiary locations - previous email you have mentioned to fill out the roster, but there is no file attached.  Homero Garcia not showing in the directory.   Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-08 11:51:56', '2021-12-08 11:51:56'),
(30053, 10057, 23290, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email Sent To : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Greetings!  Hope you are doing well. Can I get a quick response to the below mentioned request.  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-12-14 13:39:35', '2021-12-14 13:39:35'),
(30054, 10057, 23290, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Sent To : jtrenz@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Hello,  Any update on the below request. This is my SECOND REMINDER. Please get back to me with the latest update ASAP.  Regards,', NULL, NULL, '2021-12-21 13:39:39', '2021-12-21 13:39:39'),
(30055, 10057, 23290, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email Received From : jtrenz@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Good afternoon,  1) Juan Hernandez - We cannot move further on his application due to not having received his malpractice insurance certificate. Please see below.  2) Jeniece Wert – please see the attached Provider Roster to submit a request, to add a secondary & tertiary location.  Please email to HGBProviderRosters@humana.com.  3) Homero Garcia – provider profile is complete.  I have submitted a request to my data team to update the directory.  Thank you,  Jacque Trenz Health System Consultant Humana Military TRICARE East', NULL, NULL, '2021-12-28 15:29:30', '2021-12-28 15:29:30'),
(30056, 10057, 23290, NULL, '2022-01-06 00:00:00.000', 'Approved', 'Email Received From : jtrenz@humana.com  Sub :   NPI 1659919702 Provider credentialing is complete effective 8/31/21. Prov is affiliated with Valley med, 2534 Boca Chica, Brownsville, TX Please use attached Provider Roster to request adding second & third location.  Thank you,  Jacque Trenz Health System Consultant Humana Military TRICARE East', NULL, NULL, '2021-12-30 17:48:15', '2021-12-30 17:48:15'),
(30057, 3040, 23291, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-22 12:15:56', '2021-03-22 12:15:56'),
(30058, 3040, 23291, NULL, '2021-05-05 00:00:00.000', 'In Process', 'Provider certification form was sent out through fax at (608)221-7535.', NULL, NULL, '2021-04-28 10:03:02', '2021-04-28 10:03:02'),
(30059, 3040, 23291, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Wert, Jeniece K || Tricare ||  Hello Katherine,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in the Tricare for our group Valley Med Urgent Care PLLC. We already sent the credentialing form through fax.    Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-01 09:17:29', '2021-06-01 09:17:29'),
(30060, 3040, 23291, NULL, '2021-06-10 00:00:00.000', 'New/Not Initiated', 'Email sent to: kmoten4@humana.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Wert, Jeniece K || Tricare ||  Hello Katherine,   Hope you are doing well. Please find the attached provider credentialing application from along with the requested documents as per your previous email.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-03 13:17:18', '2021-06-03 13:17:18'),
(30061, 1005, 23291, NULL, '2021-06-15 00:00:00.000', 'In Process', '', NULL, NULL, '2021-06-07 14:29:44', '2021-06-07 14:29:44'),
(30062, 3040, 23291, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email rcvd from: KMoten4@humana.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Wert, Jeniece K || Tricare ||  The provider below is showing certified as of 5/4/2021. Please provide a credentialing application with all documents: CV, License, Malpractice Insurance, DEA.   Respectfully, Katherine Moten TRICARE Community Liaison II Humana T 502-318-5250', NULL, NULL, '2021-06-21 10:50:50', '2021-06-21 10:50:50'),
(30063, 3040, 23291, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Wert, Jeniece K || Tricare || Hello Katherine,  Hope you had a great weekend. I wanted to know the enrollment status for the below mentioned provider in the Tricare for our group Valley Med Urgent Care PLLC. We already sent the credentialing application from along with the requested documents.    Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166    Provider 1: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-21 10:53:14', '2021-06-21 10:53:14'),
(30064, 3040, 23291, NULL, '2021-07-16 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Wert, Jeniece K || Tricare ||  This application has been submitted for processing. Please allow 90 days.   Respectfully, Katherine Moten TRICARE Community Liaison II Humana  T 502-318-5250  F 210-239-0401 kmoten4@humana.com HumanaMilitary.com', NULL, NULL, '2021-07-09 11:11:25', '2021-07-09 11:11:25'),
(30065, 3040, 23291, NULL, '2021-09-16 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Wert, Jeniece, Lira, Arturo & Hernandez, Juan || Tricare ||  Hello Katherine,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Tricare in our group under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 1: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 2: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 3: Provider Name: Hernandez, Juan Provider NPI# 1225617558  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-09-09 16:16:58', '2021-09-09 16:16:58'),
(30066, 10057, 23291, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email Sent To : ywyatt@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Good Evening,  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned group Valley Med Urgent Care PLLC and provider in Tricare for our group under the below locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Luyando, Mariana	1700960556 Hernandez, Juan	1225617558 Wert, Jeniece K	1659919702 Naranjo, Diego	1568929800 Garcia, Homero	1730564857 Lira, Arturo	1245789502  Please get back to me as soon as you have time. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-21 15:27:09', '2021-10-21 15:27:09'),
(30067, 10057, 23291, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From: ywyatt@humana.com & jtrenz@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Good Morning Steve,  Jacqueline Trenz can assist you with your request.    Brownsville and McAllen Texas is not in my area.  Thanks, Yvonne W. Wyatt,  Humana Military TRICARE Community Liaison II Houston/Galveston', NULL, NULL, '2021-11-23 17:35:25', '2021-11-23 17:35:25'),
(30068, 10057, 23291, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email Sent To : ywyatt@humana.com & jtrenz@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Hello Yvonne,  Thank you for the update. Have a great day!  Regards,', NULL, NULL, '2021-12-01 16:24:26', '2021-12-01 16:24:26'),
(30069, 10057, 23291, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Email Sent To : jtrenz@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Hello Jacqueline,  Hope this email finds you well. Could you please check and confirm once again, since I\'m unable to find the below mentioned providers on the Humana - Tricare directory.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Juan Hernandez	1225617558 Jeniece K Wert	1659919702 Homero Garcia	1730564857  Juan Hernandez we are still in contact to get his Malpractice.  Jeniece K Wert not showing for secondary and tertiary locations - previous email you have mentioned to fill out the roster, but there is no file attached.  Homero Garcia not showing in the directory.   Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-08 11:51:50', '2021-12-08 11:51:50'),
(30070, 10057, 23291, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email Sent To : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Greetings!  Hope you are doing well. Can I get a quick response to the below mentioned request.  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-12-14 13:39:30', '2021-12-14 13:39:30'),
(30071, 10057, 23291, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Sent To : jtrenz@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Hello,  Any update on the below request. This is my SECOND REMINDER. Please get back to me with the latest update ASAP.  Regards,', NULL, NULL, '2021-12-21 13:39:32', '2021-12-21 13:39:32'),
(30072, 10057, 23291, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email Received From : jtrenz@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Good afternoon,  1) Juan Hernandez - We cannot move further on his application due to not having received his malpractice insurance certificate. Please see below.  2) Jeniece Wert – please see the attached Provider Roster to submit a request, to add a secondary & tertiary location.  Please email to HGBProviderRosters@humana.com.  3) Homero Garcia – provider profile is complete.  I have submitted a request to my data team to update the directory.  Thank you,  Jacque Trenz Health System Consultant Humana Military TRICARE East', NULL, NULL, '2021-12-28 15:29:23', '2021-12-28 15:29:23'),
(30073, 20067, 23291, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Subject: Enrollment Query || Valley Med Urgent Care PLLC || Provider || Tricare ||  Good afternoon,  Hope you are doing well. I want to know the enrollment status of the below-mentioned providers under these locations. If any provider is enrolled kindly send me the welcome letter.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Nubia Olivama Benavides	1801371935 Edna Michi	1992293906 Garcia Homero	1730564857 Wert Jeniece	1659919702 Juan Hernandez	1225617558   Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-05 17:10:39', '2022-01-05 17:10:39'),
(30074, 20067, 23291, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Sub: Re: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare   Good Morning Jacqueline!  Hope all is well with you. Can you please provide me with the welcome kits for:  Homero Garcia NPI 1730564857 Teresa Saavedra NPI 1255676151  And also, I would like to know the enrollment status of the mentioned providers.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Juan hernandez	1225617558 jeniece Wert	1659919702 Nubia Olivama Benavides	1801371935 Edna Michi	1992293906  Thanks & regards, Syed Ahad ', NULL, NULL, '2022-01-18 14:09:52', '2022-01-18 14:09:52'),
(30075, 20067, 23291, NULL, '2022-02-07 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Sub: Re: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare   Good Morning Jacqueline!  Hope all is well with you. Can you please provide me with the welcome kits for:  Homero Garcia NPI 1730564857 Teresa Saavedra NPI 1255676151  And also, I would like to know the enrollment status of the mentioned providers.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Juan hernandez	1225617558 jeniece Wert	1659919702 Nubia Olivama Benavides	1801371935 Edna Michi	1992293906  Thanks & regards, Syed Ahad', NULL, NULL, '2022-01-31 11:08:16', '2022-01-31 11:08:16'),
(30076, 20067, 23291, NULL, '2022-02-23 00:00:00.000', 'In Process', 'Email received from: jtrenz@humana.com  Sub: Re: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare   Good afternoon,     TRICARE does not send Welcome Kits or Letters.     Thank you,  Jacque Trenz  Health System Consultant  Humana Military TRICARE', NULL, NULL, '2022-02-16 17:30:33', '2022-02-16 17:30:33'),
(30077, 20067, 23291, NULL, '2022-03-09 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Sub: Re: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare   Good Evening!  Hope this email finds you in good condition. I would like to know the enrollment status of the below-listed providers.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Nubia Benavides	1801371935	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Nubia Benavides	1801371935	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Nubia Benavides	1801371935	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Edna Michi	1992293906	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Edna Michi	1992293906	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Edna Michi	1992293906	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Juan Hernandez	1225617558	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Juan Hernandez	1225617558	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Juan Hernandez	1225617558	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Jeniece Wert	1659919702	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Jeniece Wert	1659919702	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Thank you,', NULL, NULL, '2022-03-02 17:06:30', '2022-03-02 17:06:30'),
(30078, 20067, 23291, NULL, '2022-03-17 00:00:00.000', 'Approved', 'Secure Email received from: jtrenz@humana.com   Sub: RE: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Good afternoon –     1)  Nubia Benavides  -   There is a discrepancy with this providers’ name in the TRICARE system.  In our system, the name is showing as    Please use the attached form to submit a name update/correction.  Be sure to check the box at the top which states “Update Solo Practitioner Name”.  This needs to be corrected before credentialing can be completed. Please fax completed form to 608-221-7535.     2) Edna Michi – Please complete the 2nd attachment (Provider Roster).  On the first spreadsheet tab, include all information of the three locations.  On the second tab for Professional Info, please complete with all information on the professional provider. This will add the provider to the 3 locations.  Once complete, please email this form to HGBProviderRosters@humana.com.     3)  Juan Hernandez – There is a discrepancy with this providers’ name in the TRICARE system.  In our system, the name is showing as    Please follow the same instructions for the form as with #1, Nubia Benavides.     4)  Jeniece Wert – Provider profile is complete.   101 E Expressway 83, Ste 170, McAllen Texas – Effective date 1/31/2022  800 E Alton Gloor, Brownsville TX – Effective date 1/31/2022.     Thank you,  Jacque Trenz', NULL, NULL, '2022-03-10 15:17:27', '2022-03-10 15:17:27'),
(30079, 3040, 23292, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-22 12:16:02', '2021-03-22 12:16:02'),
(30080, 3040, 23292, NULL, '2021-05-05 00:00:00.000', 'In Process', 'Provider certification form was sent out through fax at (608)221-7535.', NULL, NULL, '2021-04-28 10:03:07', '2021-04-28 10:03:07');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(30081, 3040, 23292, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Wert, Jeniece K || Tricare ||  Hello Katherine,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in the Tricare for our group Valley Med Urgent Care PLLC. We already sent the credentialing form through fax.    Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-01 09:17:23', '2021-06-01 09:17:23'),
(30082, 3040, 23292, NULL, '2021-06-10 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Wert, Jeniece K || Tricare ||  Hello Katherine,   Hope you are doing well. Please find the attached provider credentialing application from along with the requested documents as per your previous email.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-03 13:17:17', '2021-06-03 13:17:17'),
(30083, 3040, 23292, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email rcvd from: KMoten4@humana.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Wert, Jeniece K || Tricare ||  The provider below is showing certified as of 5/4/2021. Please provide a credentialing application with all documents: CV, License, Malpractice Insurance, DEA.   Respectfully, Katherine Moten TRICARE Community Liaison II Humana T 502-318-5250', NULL, NULL, '2021-06-21 10:50:42', '2021-06-21 10:50:42'),
(30084, 3040, 23292, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Wert, Jeniece K || Tricare || Hello Katherine,  Hope you had a great weekend. I wanted to know the enrollment status for the below mentioned provider in the Tricare for our group Valley Med Urgent Care PLLC. We already sent the credentialing application from along with the requested documents.    Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166    Provider 1: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-21 10:53:10', '2021-06-21 10:53:10'),
(30085, 3040, 23292, NULL, '2021-07-16 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Wert, Jeniece K || Tricare ||  This application has been submitted for processing. Please allow 90 days.   Respectfully, Katherine Moten TRICARE Community Liaison II Humana  T 502-318-5250  F 210-239-0401 kmoten4@humana.com HumanaMilitary.com', NULL, NULL, '2021-07-09 11:11:27', '2021-07-09 11:11:27'),
(30086, 3040, 23292, NULL, '2021-09-16 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Wert, Jeniece, Lira, Arturo & Hernandez, Juan || Tricare ||  Hello Katherine,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Tricare in our group under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 1: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 2: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 3: Provider Name: Hernandez, Juan Provider NPI# 1225617558  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-09-09 16:16:59', '2021-09-09 16:16:59'),
(30087, 10057, 23292, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email Sent To : ywyatt@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Good Evening,  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned group Valley Med Urgent Care PLLC and provider in Tricare for our group under the below locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Luyando, Mariana	1700960556 Hernandez, Juan	1225617558 Wert, Jeniece K	1659919702 Naranjo, Diego	1568929800 Garcia, Homero	1730564857 Lira, Arturo	1245789502  Please get back to me as soon as you have time. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-21 15:27:03', '2021-10-21 15:27:03'),
(30088, 10057, 23292, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From: ywyatt@humana.com & jtrenz@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Good Morning Steve,  Jacqueline Trenz can assist you with your request.    Brownsville and McAllen Texas is not in my area.  Thanks, Yvonne W. Wyatt,  Humana Military TRICARE Community Liaison II Houston/Galveston', NULL, NULL, '2021-11-23 17:35:19', '2021-11-23 17:35:19'),
(30089, 10057, 23292, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email Sent To : ywyatt@humana.com & jtrenz@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Hello Yvonne,  Thank you for the update. Have a great day!  Regards,', NULL, NULL, '2021-12-01 16:24:20', '2021-12-01 16:24:20'),
(30090, 10057, 23292, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Email Sent To : jtrenz@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Hello Jacqueline,  Hope this email finds you well. Could you please check and confirm once again, since I\'m unable to find the below mentioned providers on the Humana - Tricare directory.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Juan Hernandez	1225617558 Jeniece K Wert	1659919702 Homero Garcia	1730564857  Juan Hernandez we are still in contact to get his Malpractice.  Jeniece K Wert not showing for secondary and tertiary locations - previous email you have mentioned to fill out the roster, but there is no file attached.  Homero Garcia not showing in the directory.   Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-08 11:51:44', '2021-12-08 11:51:44'),
(30091, 10057, 23292, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email Sent To : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Greetings!  Hope you are doing well. Can I get a quick response to the below mentioned request.  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-12-14 13:39:23', '2021-12-14 13:39:23'),
(30092, 10057, 23292, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Sent To : jtrenz@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Hello,  Any update on the below request. This is my SECOND REMINDER. Please get back to me with the latest update ASAP.  Regards,', NULL, NULL, '2021-12-21 13:39:27', '2021-12-21 13:39:27'),
(30093, 10057, 23292, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email Received From : jtrenz@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Good afternoon,  1) Juan Hernandez - We cannot move further on his application due to not having received his malpractice insurance certificate. Please see below.  2) Jeniece Wert – please see the attached Provider Roster to submit a request, to add a secondary & tertiary location.  Please email to HGBProviderRosters@humana.com.  3) Homero Garcia – provider profile is complete.  I have submitted a request to my data team to update the directory.  Thank you,  Jacque Trenz Health System Consultant Humana Military TRICARE East', NULL, NULL, '2021-12-28 15:29:17', '2021-12-28 15:29:17'),
(30094, 20067, 23292, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Subject: Enrollment Query || Valley Med Urgent Care PLLC || Provider || Tricare ||  Good afternoon,  Hope you are doing well. I want to know the enrollment status of the below-mentioned providers under these locations. If any provider is enrolled kindly send me the welcome letter.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Nubia Olivama Benavides	1801371935 Edna Michi	1992293906 Garcia Homero	1730564857 Wert Jeniece	1659919702 Juan Hernandez	1225617558   Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-05 17:10:26', '2022-01-05 17:10:26'),
(30095, 20067, 23292, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Sub: Re: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare   Good Morning Jacqueline!  Hope all is well with you. Can you please provide me with the welcome kits for:  Homero Garcia NPI 1730564857 Teresa Saavedra NPI 1255676151  And also, I would like to know the enrollment status of the mentioned providers.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Juan hernandez	1225617558 jeniece Wert	1659919702 Nubia Olivama Benavides	1801371935 Edna Michi	1992293906  Thanks & regards, Syed Ahad ', NULL, NULL, '2022-01-18 14:09:44', '2022-01-18 14:09:44'),
(30096, 20067, 23292, NULL, '2022-02-07 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Sub: Re: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare   Good Morning Jacqueline!  Hope all is well with you. Can you please provide me with the welcome kits for:  Homero Garcia NPI 1730564857 Teresa Saavedra NPI 1255676151  And also, I would like to know the enrollment status of the mentioned providers.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Juan hernandez	1225617558 jeniece Wert	1659919702 Nubia Olivama Benavides	1801371935 Edna Michi	1992293906  Thanks & regards, Syed Ahad', NULL, NULL, '2022-01-31 11:08:10', '2022-01-31 11:08:10'),
(30097, 20067, 23292, NULL, '2022-02-23 00:00:00.000', 'In Process', '', NULL, NULL, '2022-02-16 17:30:22', '2022-02-16 17:30:22'),
(30098, 20067, 23292, NULL, '2022-03-09 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Sub: Re: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare   Good Evening!  Hope this email finds you in good condition. I would like to know the enrollment status of the below-listed providers.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Nubia Benavides	1801371935	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Nubia Benavides	1801371935	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Nubia Benavides	1801371935	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Edna Michi	1992293906	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Edna Michi	1992293906	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Edna Michi	1992293906	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Juan Hernandez	1225617558	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Juan Hernandez	1225617558	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Juan Hernandez	1225617558	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Jeniece Wert	1659919702	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Jeniece Wert	1659919702	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Thank you,', NULL, NULL, '2022-03-02 17:06:23', '2022-03-02 17:06:23'),
(30099, 20067, 23292, NULL, '2022-03-17 00:00:00.000', 'Approved', 'Secure Email received from: jtrenz@humana.com   Sub: RE: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Good afternoon –     1)  Nubia Benavides  -   There is a discrepancy with this providers’ name in the TRICARE system.  In our system, the name is showing as    Please use the attached form to submit a name update/correction.  Be sure to check the box at the top which states “Update Solo Practitioner Name”.  This needs to be corrected before credentialing can be completed. Please fax completed form to 608-221-7535.     2) Edna Michi – Please complete the 2nd attachment (Provider Roster).  On the first spreadsheet tab, include all information of the three locations.  On the second tab for Professional Info, please complete with all information on the professional provider. This will add the provider to the 3 locations.  Once complete, please email this form to HGBProviderRosters@humana.com.     3)  Juan Hernandez – There is a discrepancy with this providers’ name in the TRICARE system.  In our system, the name is showing as    Please follow the same instructions for the form as with #1, Nubia Benavides.     4)  Jeniece Wert – Provider profile is complete.   101 E Expressway 83, Ste 170, McAllen Texas – Effective date 1/31/2022  800 E Alton Gloor, Brownsville TX – Effective date 1/31/2022.     Thank you,  Jacque Trenz', NULL, NULL, '2022-03-10 15:17:07', '2022-03-10 15:17:07'),
(30100, 3040, 23293, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-22 12:16:18', '2021-03-22 12:16:18'),
(30101, 3040, 23293, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Waiting for Medicaid Approval.', NULL, NULL, '2021-05-03 10:46:46', '2021-05-03 10:46:46'),
(30102, 3040, 23293, NULL, '2021-05-10 00:00:00.000', 'On Hold', 'Waiting for Medicaid Approval.', NULL, NULL, '2021-05-03 10:47:03', '2021-05-03 10:47:03'),
(30103, 3040, 23293, NULL, '2021-06-21 00:00:00.000', 'In Process', 'Email sent to: dhpcontracting@dchstx.org  Subject: Need To Enroll || Valley Med Urgent Care PLLC || Wert, Jeniece || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned provider in our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Wert, Jeniece Provider NPI# 1659919702  If you need any additional information please let me know. Waiting for your response.   Thank you ', NULL, NULL, '2021-06-14 15:53:11', '2021-06-14 15:53:11'),
(30104, 3040, 23293, NULL, '2021-06-23 00:00:00.000', 'In Process', 'Email sent to: martha.butler@dchstx.org, Miguel.Zamora@dchstx.org, Diana.Flores@dchstx.org  Subject: Need To Enroll || Valley Med Urgent Care PLLC || Wert, Jeniece || Driscoll ||.  Hello,   Hope you are doing well. I wanted to enroll the below mentioned provider in Driscoll for our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Wert, Jeniece Provider NPI# 1659919702  If you need any additional information please let me know. Waiting for your response.   Thank you  ', NULL, NULL, '2021-06-16 13:29:37', '2021-06-16 13:29:37'),
(30105, 3040, 23293, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject:Re: Need To Enroll || Valley Med Urgent Care PLLC || Wert, Jeniece || Driscoll ||  Hello Karla,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in Driscoll for our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Wert, Jeniece Provider NPI# 1659919702  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-07-05 14:04:53', '2021-07-05 14:04:53'),
(30106, 3040, 23293, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Re: Need To Enroll || Valley Med Urgent Care PLLC || Wert, Jeniece || Driscoll ||  Hello Karla,   Hope you are doing well. Please advise the enrollment status for the below mentioned provider in Driscoll for our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Wert, Jeniece Provider NPI# 1659919702  Waiting for your reply.   Thank you ', NULL, NULL, '2021-07-26 13:36:09', '2021-07-26 13:36:09'),
(30107, 3040, 23293, NULL, '2021-09-08 00:00:00.000', 'In Process', 'Email sent to: Patricia.Garcia@dchstx.org  Subject: Re: Credentialing - J Wert PA  Hello Patricia,   I really apologise for the inconvenience. I already requested the above information from the provider. Hopefully I will get it by today or tomorrow. Once I have all the information that was requested in the previous email. I will forward it to you.   Thank you  ', NULL, NULL, '2021-09-01 15:03:58', '2021-09-01 15:03:58'),
(30108, 3040, 23293, NULL, '2021-09-08 00:00:00.000', 'In Process', 'Email sent to: Patricia.Garcia@dchstx.org  Subject: Re: Credentialing - J Wert PA  Hello Patricia,   I really apologise for the inconvenience. I already requested the above information from the provider. Hopefully I will get it by today or tomorrow. Once I have all the information that was requested in the previous email. I will forward it to you.   Thank you  ', NULL, NULL, '2021-09-01 15:04:08', '2021-09-01 15:04:08'),
(30109, 12062, 23293, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Sent email reponse.  Subject:RE: Credentialing - J Wert PA  TO:patricia.garcia@dchstx.org Dear Garcia,  Apologize for a late response .  Please find attached documents as requested.  If you have any other questions, please feel free to ask me.  ', NULL, NULL, '2021-09-20 16:49:53', '2021-09-20 16:49:53'),
(30110, 12062, 23293, NULL, '2021-09-28 00:00:00.000', 'In Process', '', NULL, NULL, '2021-09-21 10:09:57', '2021-09-21 10:09:57'),
(30111, 12062, 23293, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Hi Patricia,  As per your below mail, the requested info has been updated and attached the docs for your reference.  Kindly check and advise if any further editing required or advise the receipt for further processing.   ', NULL, NULL, '2021-09-21 10:11:16', '2021-09-21 10:11:16'),
(30112, 12062, 23293, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Sent email to :Patricia.Garcia@dchstx.org, See attached mail for reference.  Subject: RE: Credentialing - J Wert PA  Dear Patricia,  Good Day!  As discussed with you on call, I am sending you a providers signed PAA with their Supervising Physician.  The agreement is attached . Kindly check and advise the receipt for further processing.', NULL, NULL, '2021-09-22 12:44:51', '2021-09-22 12:44:51'),
(30113, 10057, 23293, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Email Received From : Karla.Claunch@dchstx.org  Sub : Jeniece K Wert PA  Good afternoon,  Please find the attached Welcome letter for this provider effective November 01, 2021  Karla Claunch, C.M.A. Driscoll Health Plan Provider Contracting and Credentialing Intake Specialist 4525 Ayers St Corpus Christi TX 78415-1401 Phone: 361-694-6554 Fax: 361-808-2182 Email: karla.claunch@dchstx.org', NULL, NULL, '2021-11-09 10:58:41', '2021-11-09 10:58:41'),
(30114, 10057, 23293, NULL, '2021-11-16 00:00:00.000', 'Approved', 'Email Received From : Karla.Claunch@dchstx.org  Sub : Jeniece K Wert PA  Good afternoon,  Please find the attached Welcome letter for this provider effective November 01, 2021  Karla Claunch, C.M.A. Driscoll Health Plan Provider Contracting and Credentialing Intake Specialist 4525 Ayers St Corpus Christi TX 78415-1401 Phone: 361-694-6554 Fax: 361-808-2182 Email: karla.claunch@dchstx.org', NULL, NULL, '2021-11-09 10:59:19', '2021-11-09 10:59:19'),
(30115, 3040, 23294, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-22 12:16:25', '2021-03-22 12:16:25'),
(30116, 3040, 23294, NULL, '2021-05-10 00:00:00.000', 'On Hold', 'Waiting for Medicaid Approval.', NULL, NULL, '2021-05-03 10:46:58', '2021-05-03 10:46:58'),
(30117, 3040, 23294, NULL, '2021-06-21 00:00:00.000', 'In Process', 'Email sent to: dhpcontracting@dchstx.org  Subject: Need To Enroll || Valley Med Urgent Care PLLC || Wert, Jeniece || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned provider in our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Wert, Jeniece Provider NPI# 1659919702  If you need any additional information please let me know. Waiting for your response.   Thank you ', NULL, NULL, '2021-06-14 15:53:07', '2021-06-14 15:53:07'),
(30118, 3040, 23294, NULL, '2021-06-23 00:00:00.000', 'In Process', 'Email sent to: martha.butler@dchstx.org, Miguel.Zamora@dchstx.org, Diana.Flores@dchstx.org  Subject: Need To Enroll || Valley Med Urgent Care PLLC || Wert, Jeniece || Driscoll ||.  Hello,   Hope you are doing well. I wanted to enroll the below mentioned provider in Driscoll for our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Wert, Jeniece Provider NPI# 1659919702  If you need any additional information please let me know. Waiting for your response.   Thank you  ', NULL, NULL, '2021-06-16 13:29:33', '2021-06-16 13:29:33'),
(30119, 3040, 23294, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject:Re: Need To Enroll || Valley Med Urgent Care PLLC || Wert, Jeniece || Driscoll ||  Hello Karla,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in Driscoll for our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Wert, Jeniece Provider NPI# 1659919702  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-07-05 14:05:01', '2021-07-05 14:05:01'),
(30120, 3040, 23294, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Re: Need To Enroll || Valley Med Urgent Care PLLC || Wert, Jeniece || Driscoll ||  Hello Karla,   Hope you are doing well. Please advise the enrollment status for the below mentioned provider in Driscoll for our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Wert, Jeniece Provider NPI# 1659919702  Waiting for your reply.   Thank you ', NULL, NULL, '2021-07-26 13:36:09', '2021-07-26 13:36:09'),
(30121, 3040, 23294, NULL, '2021-09-08 00:00:00.000', 'In Process', 'Email sent to: Patricia.Garcia@dchstx.org  Subject: Re: Credentialing - J Wert PA  Hello Patricia,   I really apologise for the inconvenience. I already requested the above information from the provider. Hopefully I will get it by today or tomorrow. Once I have all the information that was requested in the previous email. I will forward it to you.   Thank you  ', NULL, NULL, '2021-09-01 15:04:23', '2021-09-01 15:04:23'),
(30122, 12062, 23294, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Sent email reponse.  Subject:RE: Credentialing - J Wert PA  TO:patricia.garcia@dchstx.org Dear Garcia,  Apologize for a late response .  Please find attached documents as requested.  If you have any other questions, please feel free to ask me.  ', NULL, NULL, '2021-09-20 16:49:05', '2021-09-20 16:49:05'),
(30123, 12062, 23294, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Hi Patricia,  As per your below mail, the requested info has been updated and attached the docs for your reference.  Kindly check and advise if any further editing required or advise the receipt for further processing.   ', NULL, NULL, '2021-09-21 10:09:20', '2021-09-21 10:09:20'),
(30124, 12062, 23294, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Sent email to :Patricia.Garcia@dchstx.org, See attached mail for reference.  Subject: RE: Credentialing - J Wert PA  Dear Patricia,  Good Day!  As discussed with you on call, I am sending you a providers signed PAA with their Supervising Physician.  The agreement is attached . Kindly check and advise the receipt for further processing.', NULL, NULL, '2021-09-22 12:44:11', '2021-09-22 12:44:11'),
(30125, 10057, 23294, NULL, '2021-11-16 00:00:00.000', 'Approved', 'Email Received From : Karla.Claunch@dchstx.org  Sub : Jeniece K Wert PA  Good afternoon,  Please find the attached Welcome letter for this provider effective November 01, 2021  Karla Claunch, C.M.A. Driscoll Health Plan Provider Contracting and Credentialing Intake Specialist 4525 Ayers St Corpus Christi TX 78415-1401 Phone: 361-694-6554 Fax: 361-808-2182 Email: karla.claunch@dchstx.org', NULL, NULL, '2021-11-09 10:54:42', '2021-11-09 10:54:42'),
(30126, 3040, 23295, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-22 12:16:32', '2021-03-22 12:16:32'),
(30127, 3040, 23295, NULL, '2021-05-10 00:00:00.000', 'On Hold', 'Waiting for Medicaid Approval.', NULL, NULL, '2021-05-03 10:47:08', '2021-05-03 10:47:08'),
(30128, 3040, 23295, NULL, '2021-06-21 00:00:00.000', 'In Process', 'Email sent to: dhpcontracting@dchstx.org  Subject: Need To Enroll || Valley Med Urgent Care PLLC || Wert, Jeniece || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned provider in our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Wert, Jeniece Provider NPI# 1659919702  If you need any additional information please let me know. Waiting for your response.   Thank you ', NULL, NULL, '2021-06-14 15:53:03', '2021-06-14 15:53:03'),
(30129, 3040, 23295, NULL, '2021-06-23 00:00:00.000', 'In Process', 'Email sent to: martha.butler@dchstx.org, Miguel.Zamora@dchstx.org, Diana.Flores@dchstx.org  Subject: Need To Enroll || Valley Med Urgent Care PLLC || Wert, Jeniece || Driscoll ||.  Hello,   Hope you are doing well. I wanted to enroll the below mentioned provider in Driscoll for our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Wert, Jeniece Provider NPI# 1659919702  If you need any additional information please let me know. Waiting for your response.   Thank you  ', NULL, NULL, '2021-06-16 13:29:29', '2021-06-16 13:29:29'),
(30130, 3040, 23295, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject:Re: Need To Enroll || Valley Med Urgent Care PLLC || Wert, Jeniece || Driscoll ||  Hello Karla,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in Driscoll for our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Wert, Jeniece Provider NPI# 1659919702  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-07-05 14:04:58', '2021-07-05 14:04:58'),
(30131, 3040, 23295, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Re: Need To Enroll || Valley Med Urgent Care PLLC || Wert, Jeniece || Driscoll ||  Hello Karla,   Hope you are doing well. Please advise the enrollment status for the below mentioned provider in Driscoll for our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Wert, Jeniece Provider NPI# 1659919702  Waiting for your reply.   Thank you ', NULL, NULL, '2021-07-26 13:36:08', '2021-07-26 13:36:08'),
(30132, 3040, 23295, NULL, '2021-09-08 00:00:00.000', 'In Process', 'Email sent to: Patricia.Garcia@dchstx.org  Subject: Re: Credentialing - J Wert PA  Hello Patricia,   I really apologise for the inconvenience. I already requested the above information from the provider. Hopefully I will get it by today or tomorrow. Once I have all the information that was requested in the previous email. I will forward it to you.   Thank you  ', NULL, NULL, '2021-09-01 15:04:26', '2021-09-01 15:04:26'),
(30133, 12062, 23295, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Sent email reponse.  Subject:RE: Credentialing - J Wert PA  TO:patricia.garcia@dchstx.org Dear Garcia,  Apologize for a late response .  Please find attached documents as requested.  If you have any other questions, please feel free to ask me.  ', NULL, NULL, '2021-09-20 16:48:21', '2021-09-20 16:48:21'),
(30134, 12062, 23295, NULL, '2021-09-28 00:00:00.000', 'In Process', 'responded on email  Hi Patricia,  As per your below mail, the requested info has been updated and attached the docs for your reference.  Kindly check and advise if any further editing required or advise the receipt for further processing.   ', NULL, NULL, '2021-09-21 10:05:31', '2021-09-21 10:05:31'),
(30135, 12062, 23295, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Sent email to :Patricia.Garcia@dchstx.org, See attached mail for reference.  Subject: RE: Credentialing - J Wert PA  Dear Patricia,  Good Day!  As discussed with you on call, I am sending you a providers signed PAA with their Supervising Physician.  The agreement is attached . Kindly check and advise the receipt for further processing.  ', NULL, NULL, '2021-09-22 12:43:01', '2021-09-22 12:43:01'),
(30136, 10057, 23295, NULL, '2021-11-16 00:00:00.000', 'Approved', 'Email Received From : Karla.Claunch@dchstx.org  Sub : Jeniece K Wert PA  Good afternoon,  Please find the attached Welcome letter for this provider effective November 01, 2021  Karla Claunch, C.M.A. Driscoll Health Plan Provider Contracting and Credentialing Intake Specialist 4525 Ayers St Corpus Christi TX 78415-1401 Phone: 361-694-6554 Fax: 361-808-2182 Email: karla.claunch@dchstx.org', NULL, NULL, '2021-11-09 10:59:54', '2021-11-09 10:59:54'),
(30137, 3040, 23296, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-22 12:16:53', '2021-03-22 12:16:53'),
(30138, 3040, 23296, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.  ', NULL, NULL, '2021-03-26 15:01:43', '2021-03-26 15:01:43'),
(30139, 3040, 23296, NULL, NULL, 'Revalidation', 'Email sent to: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Hello David,   Hope you are doing well. The contract request form that was sent out in your previous email I would like to ask you in the provider type section what option you want me to mark for the providers. If you could reach out to me on 713-893-6214 that would be better.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you', NULL, NULL, '2021-04-26 10:47:12', '2021-04-26 10:47:12'),
(30140, 3040, 23296, NULL, NULL, 'Revalidated', 'Group has an ancillary contract. No need to add individual providers as per Jasmine.Guerrero@molinahealthcare.com ', NULL, NULL, '2021-05-31 09:08:27', '2021-05-31 09:08:27'),
(30141, 3040, 23297, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-22 12:17:02', '2021-03-22 12:17:02'),
(30142, 3040, 23297, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.  ', NULL, NULL, '2021-03-26 15:01:48', '2021-03-26 15:01:48'),
(30143, 3040, 23297, NULL, NULL, 'Revalidation', 'Email sent to: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Hello David,   Hope you are doing well. The contract request form that was sent out in your previous email I would like to ask you in the provider type section what option you want me to mark for the providers. If you could reach out to me on 713-893-6214 that would be better.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you', NULL, NULL, '2021-04-26 10:47:08', '2021-04-26 10:47:08'),
(30144, 3040, 23297, NULL, NULL, 'Revalidated', 'Group has an ancillary contract. No need to add individual providers as per Jasmine.Guerrero@molinahealthcare.com ', NULL, NULL, '2021-05-31 09:11:45', '2021-05-31 09:11:45'),
(30145, 3040, 23298, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-22 12:17:09', '2021-03-22 12:17:09'),
(30146, 3040, 23298, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.  ', NULL, NULL, '2021-03-26 15:01:54', '2021-03-26 15:01:54'),
(30147, 3040, 23298, NULL, NULL, 'Revalidation', 'Email sent to: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Hello David,   Hope you are doing well. The contract request form that was sent out in your previous email I would like to ask you in the provider type section what option you want me to mark for the providers. If you could reach out to me on 713-893-6214 that would be better.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you', NULL, NULL, '2021-04-26 10:46:47', '2021-04-26 10:46:47'),
(30148, 3040, 23298, NULL, NULL, 'Revalidated', 'Group has an ancillary contract. No need to add individual providers as per Jasmine.Guerrero@molinahealthcare.com ', NULL, NULL, '2021-05-31 09:10:15', '2021-05-31 09:10:15'),
(30149, 3040, 23299, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-22 12:17:29', '2021-03-22 12:17:29'),
(30150, 3040, 23299, NULL, '2021-03-31 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add the providers.  ', NULL, NULL, '2021-03-24 15:42:17', '2021-03-24 15:42:17'),
(30151, 3040, 23300, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-22 12:17:36', '2021-03-22 12:17:36'),
(30152, 3040, 23300, NULL, '2021-03-31 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add the providers.  ', NULL, NULL, '2021-03-24 15:42:23', '2021-03-24 15:42:23'),
(30153, 3040, 23301, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-22 12:17:44', '2021-03-22 12:17:44'),
(30154, 3040, 23301, NULL, '2021-03-31 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add the providers.  ', NULL, NULL, '2021-03-24 15:42:28', '2021-03-24 15:42:28'),
(30155, 3040, 23302, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-22 12:17:58', '2021-03-22 12:17:58'),
(30156, 3040, 23302, NULL, '2021-04-01 00:00:00.000', 'Approved', 'Group has an ancillary contract. No Need to add individual provider. ', NULL, NULL, '2021-03-25 10:01:02', '2021-03-25 10:01:02'),
(30157, 3040, 23303, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-22 12:18:07', '2021-03-22 12:18:07'),
(30158, 3040, 23303, NULL, '2021-04-01 00:00:00.000', 'Initiated', 'Email sent to: stxnm@humana.com  Subject: Add Location || Group || Valley Med Urgent Care PLLC || Humana ||  Greetings,   Hope you are doing well. Please find the attached roster to add the practice location in the Humana for our group Valley Med Urgent Care PLLC under below location.  Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Thank you  ', NULL, NULL, '2021-03-25 10:01:24', '2021-03-25 10:01:24'),
(30159, 3040, 23303, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Email sent to: stxnm@humana.com  Subject: Add Location || Group || Valley Med Urgent Care PLLC || Humana || Greetings,   Hope you are doing well. Please find the attached facility credentialing application form as per your previous email requested.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-04-14 14:45:31', '2021-04-14 14:45:31'),
(30160, 3040, 23303, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: stxnm@humana.com  Subject: Add Location || Group || Valley Med Urgent Care PLLC || Humana ||  Greetings,   Hope you are doing well. I wanted to know the status for an additional location in Humana for our group Valley Med Urgent Care PLLC under the below location.  Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Thank you ', NULL, NULL, '2021-05-28 10:47:05', '2021-05-28 10:47:05'),
(30161, 3040, 23303, NULL, '2021-06-23 00:00:00.000', 'In Process', 'Email rcvd from: stxnm@humana.com  Subject: Add Location || Group || Valley Med Urgent Care PLLC || Humana ||  Your request was received and is in the queue to be worked.  You will receive an email notification once your request has been completed.  Thank you', NULL, NULL, '2021-06-16 15:05:30', '2021-06-16 15:05:30'),
(30162, 3040, 23303, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to: stxnm@humana.com  Subject: Re: Add Location || Group || Valley Med Urgent Care PLLC || Humana ||  Greetings,   Hope you are doing well. I wanted to know the status for an additional location in Humana for our group Valley Med Urgent Care PLLC under the below location.  Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-06-22 11:47:43', '2021-06-22 11:47:43'),
(30163, 3040, 23303, NULL, '2021-07-16 00:00:00.000', 'On Hold', 'Group has an ancillary contract. No need to add individual providers. We already sent the request for location addition once the location under the contract we gonna update the providers task. ', NULL, NULL, '2021-07-09 12:02:28', '2021-07-09 12:02:28'),
(30164, 3040, 23303, NULL, '2021-07-27 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers.', NULL, NULL, '2021-07-20 11:50:39', '2021-07-20 11:50:39'),
(30165, 3040, 23304, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-22 12:18:14', '2021-03-22 12:18:14'),
(30166, 3040, 23304, NULL, '2021-04-01 00:00:00.000', 'Approved', 'Group has an ancillary contract. No Need to add individual provider. ', NULL, NULL, '2021-03-25 10:01:07', '2021-03-25 10:01:07'),
(30167, 3040, 23308, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-22 12:19:05', '2021-03-22 12:19:05'),
(30168, 3040, 23308, NULL, '2021-05-05 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Need To Enroll Providers || Valley Med Urgent Care PLLC || Wert, Jeniece K || Health Smart ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned providers in Healthsmart for our group Valley Med Urgent Care PLLC in all three locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider Details: Provider Name: Wert, Jeniece K Provider NPI# 1659919702 CAQH# 15133802  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-04-28 12:57:45', '2021-04-28 12:57:45'),
(30169, 3040, 23308, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: mdiprsupport@healthsmart.com  Subject:  Need To Enroll Providers || Valley Med Urgent Care PLLC || Wert, Jeniece K || Health Smart ||  Hi,  Thank you for your submission. The application has been forwarded to credentialing. Please follow up in 30 days for a status.  * Wert, Jeniece K PA.  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com (Inventory Log ID : 79277)  Thanks HealthSmart Provider Relations', NULL, NULL, '2021-05-28 09:45:57', '2021-05-28 09:45:57'),
(30170, 3040, 23308, NULL, '2021-06-23 00:00:00.000', 'In Process', 'Email rcvd from: mdiprsupport@healthsmart.com  Subject: Need To Enroll Providers || Valley Med Urgent Care PLLC || Wert, Jeniece K || Health Smart |  Hi,  We are returning your application due to missing information listed below.  Name of Supervising Physicians  Please review the attached Application Review Form and forward the missing information within the next 5 days. Alternatively, please update CAQH and advise once completed.  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com  (Inventory Log ID : 79277) ', NULL, NULL, '2021-06-16 14:38:34', '2021-06-16 14:38:34'),
(30171, 3040, 23308, NULL, '2021-06-23 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Need To Enroll Providers || Valley Med Urgent Care PLLC || Wert, Jeniece K || Health Smart ||  Greetings,   Please find below the missing information that you requested in your previous email.   Name of Supervising Physicians: Teresa Saavedra  Thanks ', NULL, NULL, '2021-06-16 14:39:35', '2021-06-16 14:39:35'),
(30172, 3040, 23308, NULL, '2021-06-23 00:00:00.000', 'In Process', 'Email rcvd from: mdiprsupport@healthsmart.com  Subject: Need To Enroll Providers || Valley Med Urgent Care PLLC || Wert, Jeniece K || Health Smart |  Hi,  Thank you for your submission. The application has been forwarded to credentialing. Please follow up in 30 days for a status.  * Wert, Jeniece K PA.  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com (Inventory Log ID : 79277)  Thanks HealthSmart Provider Relations', NULL, NULL, '2021-06-16 14:40:38', '2021-06-16 14:40:38'),
(30173, 3040, 23308, NULL, '2021-06-25 00:00:00.000', 'Approved', 'Email rcvd from: mdiprsupport@healthsmart.com  Subject: Need To Enroll Providers || Valley Med Urgent Care PLLC || Wert, Jeniece K || Health Smart ||  Hi,  Provider \'\' Wert, Jeniece K PA \'\' is Effective \'\' 07/01/2021 \'\'  Our system has been updated as requested.  * The locations below have been added.  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com.   (Inventory Log ID :79277)  Thanks. HealthSmart Provider Relations.', NULL, NULL, '2021-06-18 14:48:29', '2021-06-18 14:48:29'),
(30174, 3040, 23309, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-22 12:20:29', '2021-03-22 12:20:29'),
(30175, 3040, 23309, NULL, '2021-05-05 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Need To Enroll Providers || Valley Med Urgent Care PLLC || Wert, Jeniece K || Health Smart ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned providers in Healthsmart for our group Valley Med Urgent Care PLLC in all three locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider Details: Provider Name: Wert, Jeniece K Provider NPI# 1659919702 CAQH# 15133802  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-04-28 12:58:01', '2021-04-28 12:58:01'),
(30176, 3040, 23309, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: mdiprsupport@healthsmart.com  Subject:  Need To Enroll Providers || Valley Med Urgent Care PLLC || Wert, Jeniece K || Health Smart ||  Hi,  Thank you for your submission. The application has been forwarded to credentialing. Please follow up in 30 days for a status.  * Wert, Jeniece K PA.  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com (Inventory Log ID : 79277)  Thanks HealthSmart Provider Relations', NULL, NULL, '2021-05-28 09:46:14', '2021-05-28 09:46:14');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(30177, 3040, 23309, NULL, '2021-06-23 00:00:00.000', 'In Process', 'Email rcvd from: mdiprsupport@healthsmart.com  Subject: Need To Enroll Providers || Valley Med Urgent Care PLLC || Wert, Jeniece K || Health Smart |  Hi,  We are returning your application due to missing information listed below.  Name of Supervising Physicians  Please review the attached Application Review Form and forward the missing information within the next 5 days. Alternatively, please update CAQH and advise once completed.  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com  (Inventory Log ID : 79277) ', NULL, NULL, '2021-06-16 14:38:29', '2021-06-16 14:38:29'),
(30178, 3040, 23309, NULL, '2021-06-23 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Need To Enroll Providers || Valley Med Urgent Care PLLC || Wert, Jeniece K || Health Smart ||  Greetings,   Please find below the missing information that you requested in your previous email.   Name of Supervising Physicians: Teresa Saavedra  Thanks ', NULL, NULL, '2021-06-16 14:39:31', '2021-06-16 14:39:31'),
(30179, 3040, 23309, NULL, '2021-06-23 00:00:00.000', 'In Process', 'Email rcvd from: mdiprsupport@healthsmart.com  Subject: Need To Enroll Providers || Valley Med Urgent Care PLLC || Wert, Jeniece K || Health Smart |  Hi,  Thank you for your submission. The application has been forwarded to credentialing. Please follow up in 30 days for a status.  * Wert, Jeniece K PA.  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com (Inventory Log ID : 79277)  Thanks HealthSmart Provider Relations', NULL, NULL, '2021-06-16 14:40:36', '2021-06-16 14:40:36'),
(30180, 3040, 23309, NULL, '2021-06-25 00:00:00.000', 'Approved', 'Email rcvd from: mdiprsupport@healthsmart.com  Subject: Need To Enroll Providers || Valley Med Urgent Care PLLC || Wert, Jeniece K || Health Smart ||  Hi,  Provider \'\' Wert, Jeniece K PA \'\' is Effective \'\' 07/01/2021 \'\'  Our system has been updated as requested.  * The locations below have been added.  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com.   (Inventory Log ID :79277)  Thanks. HealthSmart Provider Relations.', NULL, NULL, '2021-06-18 14:48:25', '2021-06-18 14:48:25'),
(30181, 3040, 23310, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-22 12:20:38', '2021-03-22 12:20:38'),
(30182, 3040, 23310, NULL, '2021-05-05 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Need To Enroll Providers || Valley Med Urgent Care PLLC || Wert, Jeniece K || Health Smart ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned providers in Healthsmart for our group Valley Med Urgent Care PLLC in all three locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider Details: Provider Name: Wert, Jeniece K Provider NPI# 1659919702 CAQH# 15133802  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-04-28 12:58:16', '2021-04-28 12:58:16'),
(30183, 3040, 23310, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: mdiprsupport@healthsmart.com  Subject:  Need To Enroll Providers || Valley Med Urgent Care PLLC || Wert, Jeniece K || Health Smart ||  Hi,  Thank you for your submission. The application has been forwarded to credentialing. Please follow up in 30 days for a status.  * Wert, Jeniece K PA.  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com (Inventory Log ID : 79277)  Thanks HealthSmart Provider Relations', NULL, NULL, '2021-05-28 09:46:08', '2021-05-28 09:46:08'),
(30184, 3040, 23310, NULL, '2021-06-23 00:00:00.000', 'In Process', 'Email sent to: mdiprsupport@healthsmart.com  Subject: Need To Enroll Providers || Valley Med Urgent Care PLLC || Wright, Larry Donald, Moses Campos, Deborah Potter & Arturo A Lira || Health Smart ||  Hello,   Thank you so much for your response. I checked the provider on Health Smart provider directory but I couldn\'t find the below mentioned provider on directory. Can you please check and advise?   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Potter, Deborah Provider NPI#  1861914053  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-06-16 14:36:55', '2021-06-16 14:36:55'),
(30185, 3040, 23310, NULL, '2021-06-23 00:00:00.000', 'In Process', 'Email rcvd from: mdiprsupport@healthsmart.com  Subject: Need To Enroll Providers || Valley Med Urgent Care PLLC || Wert, Jeniece K || Health Smart |  Hi,  We are returning your application due to missing information listed below.  Name of Supervising Physicians  Please review the attached Application Review Form and forward the missing information within the next 5 days. Alternatively, please update CAQH and advise once completed.  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com  (Inventory Log ID : 79277) ', NULL, NULL, '2021-06-16 14:38:26', '2021-06-16 14:38:26'),
(30186, 3040, 23310, NULL, '2021-06-23 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Need To Enroll Providers || Valley Med Urgent Care PLLC || Wert, Jeniece K || Health Smart ||  Greetings,   Please find below the missing information that you requested in your previous email.   Name of Supervising Physicians: Teresa Saavedra  Thanks ', NULL, NULL, '2021-06-16 14:39:27', '2021-06-16 14:39:27'),
(30187, 3040, 23310, NULL, '2021-06-23 00:00:00.000', 'In Process', 'Email rcvd from: mdiprsupport@healthsmart.com  Subject: Need To Enroll Providers || Valley Med Urgent Care PLLC || Wert, Jeniece K || Health Smart |  Hi,  Thank you for your submission. The application has been forwarded to credentialing. Please follow up in 30 days for a status.  * Wert, Jeniece K PA.  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com (Inventory Log ID : 79277)  Thanks HealthSmart Provider Relations', NULL, NULL, '2021-06-16 14:40:28', '2021-06-16 14:40:28'),
(30188, 3040, 23310, NULL, '2021-06-25 00:00:00.000', 'Approved', 'Email rcvd from: mdiprsupport@healthsmart.com  Subject: Need To Enroll Providers || Valley Med Urgent Care PLLC || Wert, Jeniece K || Health Smart ||  Hi,  Provider \'\' Wert, Jeniece K PA \'\' is Effective \'\' 07/01/2021 \'\'  Our system has been updated as requested.  * The locations below have been added.  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com.   (Inventory Log ID :79277)  Thanks. HealthSmart Provider Relations.', NULL, NULL, '2021-06-18 14:48:20', '2021-06-18 14:48:20'),
(30189, 3040, 23311, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-22 12:20:50', '2021-03-22 12:20:50'),
(30190, 3040, 23311, NULL, '2021-06-08 00:00:00.000', 'On Hold', 'Facility/ Ancillary network interest form submitted. Please see group task.   ', NULL, NULL, '2021-06-01 14:25:54', '2021-06-01 14:25:54'),
(30191, 3040, 23311, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com   Subject: Re: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Cigna Healthspring for our group Valley Med Urgent Care PLLC under the below mentioned locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address:101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Tertiary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-07-20 14:04:20', '2021-07-20 14:04:20'),
(30192, 3040, 23311, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello Jennifer,  Please advise the enrollment status for the below mentioned group in Cigna Healthspring for our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address:101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Tertiary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Please get back to me as soon as you can get a chance. Waiting for your reply,   Thanks  ', NULL, NULL, '2021-07-28 14:32:34', '2021-07-28 14:32:34'),
(30193, 3040, 23311, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: [External] Re: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello Jennifer,   Hope you are doing well. I sent the emails which are mentioned on the letter of interest form but I couldn\'t get any reply from their side. Can you please check the status and advise?  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address:101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Tertiary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Please get back to me as soon as you can get a chance. Waiting for your reply,  Thank you  ', NULL, NULL, '2021-08-17 09:37:01', '2021-08-17 09:37:01'),
(30194, 10057, 23311, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email Sent To : TXMAContracting@cigna.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello,  Hope you are doing well. I wanted to know the enrollment updated status for the below mentioned group in Cigna Healthspring for our group Valley Med Urgent Care PLLC under the below mentioned locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Tertiary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-14 11:06:41', '2021-10-14 11:06:41'),
(30195, 10057, 23311, NULL, '2021-11-22 00:00:00.000', 'In Process', 'Email Sent To : JENNIFER.PEREZ@cigna.com, TXGQProviderRelations@healthspring.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello,  Hope this email finds you well. I want to know the enrollment status for the below mentioned providers under these locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Hernandez, Juan	1225617558 Wert, Jeniece K	1659919702 Wright, Larry	1033769765 Saavedra, Teresa	1255676151 Hernandez, Eder	1386956852 Garcia, Homero	1730564857 Potter, Deborah	1861914053 Naranjo, Diego	1568929800 Lopez, Mayra	1265945125  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-11-15 17:51:24', '2021-11-15 17:51:24'),
(30196, 10057, 23311, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : TXGQProviderRelations@healthspring.com, TXMAContracting@cigna.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello,  Can I get the latest update on the below mentioned request.  Please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-30 13:05:13', '2021-11-30 13:05:13'),
(30197, 10057, 23311, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Email Sent To : TXGQProviderRelations@healthspring.com, TXMAContracting@cigna.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello,  Hope this email finds you in good health. I want to know the enrollment status for the below mentioned providers under these locations.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Juan  Hernandez	1225617558 Jeniece K  Wert	1659919702 Larry  Wright	1033769765 Teresa  Saavedra	1255676151 Eder  Hernandez	1386956852 Homero  Garcia	1730564857 Deborah  Potter	1861914053 Diego  Naranjo	1568929800 Mayra  Lopez	1265945125  Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-06 17:36:07', '2021-12-06 17:36:07'),
(30198, 10057, 23311, NULL, '2021-12-20 00:00:00.000', 'In Process', 'Email Sent To : TXGQProviderRelations@healthspring.com, TXMAContracting@cigna.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hey,  I\'m writing this email to check the current status on the below mentioned request. This is my second reminder.  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-12-13 12:43:17', '2021-12-13 12:43:17'),
(30199, 10057, 23311, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email Received From : iliana.cortez@careallies.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello Steve,  The last Letter of Interest that was submitted to Valley Organized Physicians/LVPA was in October of 2018. The LVPA Board of Directors determined that there was no network need and appropriate communication was provided via mail. If the group would like to be reconsidered, please fill out the attached LOI and we can make sure to review during our January 2022 Board of Directors meeting. I is going to be important that you list out all locations as well.  Please let me know if you have any other questions.  Thank you, Iliana', NULL, NULL, '2021-12-20 11:45:34', '2021-12-20 11:45:34'),
(30200, 10057, 23311, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : iliana.cortez@careallies.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Thank you for reaching out. Please find the attached LOI for groups and providers.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Juan Hernandez	1225617558 Wert, Jeniece K	1659919702 Wright, Larry	1033769765 Saavedra, Teresa	1255676151 Hernandez, Eder	1386956852 Garcia, Homero	1730564857 Potter, Deborah	1861914053 Naranjo, Diego	1568929800 Lopez, Mayra	1265945125 Escobar, Angiollet	1962917997 Rodriguez, Cynthia	1124282553  Please revert back to me once you have the update. Have a great day!  Regards,', NULL, NULL, '2021-12-27 11:08:04', '2021-12-27 11:08:04'),
(30201, 20067, 23311, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: iliana.cortez@careallies.com  Subject: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring   Hello Good Morning,  Hope you are doing well. I want to know the enrollment status for the below-mentioned providers under these locations.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Juan Hernandez	1225617558 Jeniece Wert	1659919702 Cynthia Rodriguez	1124282553 Deborah Potter	1861914053 Larry Wright	1033769765 Teresa Saavedra	1255676151 Diego Naranjo	1568929800 Eder Hernandez	1386956852 Homero Garcia	1730564857 Angiollet Escobar	1962917997 Mayra Lopez	1265945125   Thanks and Regards, Syed Ahad.  ', NULL, NULL, '2022-01-05 12:47:11', '2022-01-05 12:47:11'),
(30202, 20067, 23311, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email Received from: iliana.cortez@careallies.com  Sub:  Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring  Hello Syed,     I emailed Steve Albert, but the email bounced back.     We will be meeting with our LVPA and HOPE Board of Directors the week of the  24th where we will be discussing your group. Please fill out 1 LOI for the group with all location listed.  Please email me with any questions that you may have.     Thank you.     Iliana', NULL, NULL, '2022-01-11 13:55:49', '2022-01-11 13:55:49'),
(30203, 20067, 23311, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to: iliana.cortez@careallies.com  Sub: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring  Good afternoon,  Hope all is well with you. The LOI form which you sent me doesn\'t have fields for additional locations. Kindly see the attachment below  Eagerly waiting to hear from you   Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-11 14:03:13', '2022-01-11 14:03:13'),
(30204, 20067, 23311, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email Received from: iliana.cortez@careallies.com  Sub: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring   Thank you for the updated LOI. I added all locations. We meet with our Board of Directors on January 24th. Will be InTouch. ', NULL, NULL, '2022-01-11 17:48:22', '2022-01-11 17:48:22'),
(30205, 20067, 23311, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Will follow-up next week because the meeting of Board of Directors will be on  24th January', NULL, NULL, '2022-01-18 10:59:56', '2022-01-18 10:59:56'),
(30206, 20067, 23311, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: iliana.cortez@careallies.com  Sub: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring   Good Evening! Hope this email finds you well. Any updates on the request?  Eagerly waiting to hear from you, Thanks and Regards,', NULL, NULL, '2022-01-28 17:54:17', '2022-01-28 17:54:17'),
(30207, 20067, 23311, NULL, '2022-02-11 00:00:00.000', 'Not Eligible', 'Email received from: dulce.lumbrera@careallies.com  Sub:  Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring   Hi Syed,  Thank you for reaching out. Please see attached for a response to the letter of interest that was presented at the Board of Director meeting. Thank you', NULL, NULL, '2022-02-04 10:46:26', '2022-02-04 10:46:26'),
(30208, 3040, 23312, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-22 12:21:10', '2021-03-22 12:21:10'),
(30209, 3040, 23312, NULL, '2021-06-08 00:00:00.000', 'On Hold', 'Facility/ Ancillary network interest form submitted. Please see group task.   ', NULL, NULL, '2021-06-01 14:32:42', '2021-06-01 14:32:42'),
(30210, 3040, 23312, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com   Subject: Re: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Cigna Healthspring for our group Valley Med Urgent Care PLLC under the below mentioned locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address:101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Tertiary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-07-20 14:04:20', '2021-07-20 14:04:20'),
(30211, 3040, 23312, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello Jennifer,  Please advise the enrollment status for the below mentioned group in Cigna Healthspring for our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address:101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Tertiary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Please get back to me as soon as you can get a chance. Waiting for your reply,   Thanks  ', NULL, NULL, '2021-07-28 14:32:33', '2021-07-28 14:32:33'),
(30212, 3040, 23312, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: [External] Re: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello Jennifer,   Hope you are doing well. I sent the emails which are mentioned on the letter of interest form but I couldn\'t get any reply from their side. Can you please check the status and advise?  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address:101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Tertiary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Please get back to me as soon as you can get a chance. Waiting for your reply,  Thank you  ', NULL, NULL, '2021-08-17 09:37:00', '2021-08-17 09:37:00'),
(30213, 10057, 23312, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email Sent To : TXMAContracting@cigna.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello,  Hope you are doing well. I wanted to know the enrollment updated status for the below mentioned group in Cigna Healthspring for our group Valley Med Urgent Care PLLC under the below mentioned locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Tertiary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-14 11:06:28', '2021-10-14 11:06:28'),
(30214, 10057, 23312, NULL, '2021-11-22 00:00:00.000', 'In Process', 'Email Sent To : JENNIFER.PEREZ@cigna.com, TXGQProviderRelations@healthspring.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello,  Hope this email finds you well. I want to know the enrollment status for the below mentioned providers under these locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Hernandez, Juan	1225617558 Wert, Jeniece K	1659919702 Wright, Larry	1033769765 Saavedra, Teresa	1255676151 Hernandez, Eder	1386956852 Garcia, Homero	1730564857 Potter, Deborah	1861914053 Naranjo, Diego	1568929800 Lopez, Mayra	1265945125  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-11-15 17:51:17', '2021-11-15 17:51:17'),
(30215, 10057, 23312, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : TXGQProviderRelations@healthspring.com, TXMAContracting@cigna.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello,  Can I get the latest update on the below mentioned request.  Please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-30 13:05:07', '2021-11-30 13:05:07'),
(30216, 10057, 23312, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Email Sent To : TXGQProviderRelations@healthspring.com, TXMAContracting@cigna.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello,  Hope this email finds you in good health. I want to know the enrollment status for the below mentioned providers under these locations.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Juan  Hernandez	1225617558 Jeniece K  Wert	1659919702 Larry  Wright	1033769765 Teresa  Saavedra	1255676151 Eder  Hernandez	1386956852 Homero  Garcia	1730564857 Deborah  Potter	1861914053 Diego  Naranjo	1568929800 Mayra  Lopez	1265945125  Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-06 17:41:28', '2021-12-06 17:41:28'),
(30217, 10057, 23312, NULL, '2021-12-20 00:00:00.000', 'In Process', 'Email Sent To : TXGQProviderRelations@healthspring.com, TXMAContracting@cigna.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hey,  I\'m writing this email to check the current status on the below mentioned request. This is my second reminder.  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-12-13 12:46:31', '2021-12-13 12:46:31'),
(30218, 10057, 23312, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email Received From : iliana.cortez@careallies.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello Steve,  The last Letter of Interest that was submitted to Valley Organized Physicians/LVPA was in October of 2018. The LVPA Board of Directors determined that there was no network need and appropriate communication was provided via mail. If the group would like to be reconsidered, please fill out the attached LOI and we can make sure to review during our January 2022 Board of Directors meeting. I is going to be important that you list out all locations as well.  Please let me know if you have any other questions.  Thank you, Iliana', NULL, NULL, '2021-12-20 11:48:37', '2021-12-20 11:48:37'),
(30219, 10057, 23312, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : iliana.cortez@careallies.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Thank you for reaching out. Please find the attached LOI for groups and providers.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Juan Hernandez	1225617558 Wert, Jeniece K	1659919702 Wright, Larry	1033769765 Saavedra, Teresa	1255676151 Hernandez, Eder	1386956852 Garcia, Homero	1730564857 Potter, Deborah	1861914053 Naranjo, Diego	1568929800 Lopez, Mayra	1265945125 Escobar, Angiollet	1962917997 Rodriguez, Cynthia	1124282553  Please revert back to me once you have the update. Have a great day!  Regards,', NULL, NULL, '2021-12-27 11:07:57', '2021-12-27 11:07:57'),
(30220, 20067, 23312, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: iliana.cortez@careallies.com  Subject: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring   Hello Good Morning,  Hope you are doing well. I want to know the enrollment status for the below-mentioned providers under these locations.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Juan Hernandez	1225617558 Jeniece Wert	1659919702 Cynthia Rodriguez	1124282553 Deborah Potter	1861914053 Larry Wright	1033769765 Teresa Saavedra	1255676151 Diego Naranjo	1568929800 Eder Hernandez	1386956852 Homero Garcia	1730564857 Angiollet Escobar	1962917997 Mayra Lopez	1265945125   Thanks and Regards, Syed Ahad.  ', NULL, NULL, '2022-01-05 12:46:47', '2022-01-05 12:46:47'),
(30221, 20067, 23312, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email Received from: iliana.cortez@careallies.com  Sub:  Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring  Hello Syed,     I emailed Steve Albert, but the email bounced back.     We will be meeting with our LVPA and HOPE Board of Directors the week of the  24th where we will be discussing your group. Please fill out 1 LOI for the group with all location listed.  Please email me with any questions that you may have.     Thank you.     Iliana', NULL, NULL, '2022-01-11 13:55:39', '2022-01-11 13:55:39'),
(30222, 20067, 23312, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to: iliana.cortez@careallies.com  Sub: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring  Good afternoon,  Hope all is well with you. The LOI form which you sent me doesn\'t have fields for additional locations. Kindly see the attachment below  Eagerly waiting to hear from you   Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-11 14:02:35', '2022-01-11 14:02:35'),
(30223, 20067, 23312, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email Received from: iliana.cortez@careallies.com  Sub: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring   Thank you for the updated LOI. I added all locations. We meet with our Board of Directors on January 24th. Will be InTouch. ', NULL, NULL, '2022-01-11 17:48:15', '2022-01-11 17:48:15'),
(30224, 20067, 23312, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Will follow-up next week because the meeting of Board of Directors will be on  24th January', NULL, NULL, '2022-01-18 10:59:50', '2022-01-18 10:59:50'),
(30225, 20067, 23312, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: iliana.cortez@careallies.com  Sub: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring   Good Evening! Hope this email finds you well. Any updates on the request?  Eagerly waiting to hear from you, Thanks and Regards,', NULL, NULL, '2022-01-28 17:54:09', '2022-01-28 17:54:09'),
(30226, 20067, 23312, NULL, '2022-02-11 00:00:00.000', 'Not Eligible', 'Email received from: dulce.lumbrera@careallies.com  Sub:  Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring   Hi Syed,  Thank you for reaching out. Please see attached for a response to the letter of interest that was presented at the Board of Director meeting. Thank you', NULL, NULL, '2022-02-04 10:45:20', '2022-02-04 10:45:20'),
(30227, 3040, 23313, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-22 12:21:17', '2021-03-22 12:21:17'),
(30228, 3040, 23313, NULL, '2021-06-08 00:00:00.000', 'On Hold', 'Facility/ Ancillary network interest form submitted. Please see group task.   ', NULL, NULL, '2021-06-01 14:26:43', '2021-06-01 14:26:43'),
(30229, 3040, 23313, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com   Subject: Re: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Cigna Healthspring for our group Valley Med Urgent Care PLLC under the below mentioned locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address:101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Tertiary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-07-20 14:04:20', '2021-07-20 14:04:20'),
(30230, 3040, 23313, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello Jennifer,  Please advise the enrollment status for the below mentioned group in Cigna Healthspring for our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address:101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Tertiary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Please get back to me as soon as you can get a chance. Waiting for your reply,   Thanks  ', NULL, NULL, '2021-07-28 14:32:33', '2021-07-28 14:32:33'),
(30231, 3040, 23313, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: [External] Re: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello Jennifer,   Hope you are doing well. I sent the emails which are mentioned on the letter of interest form but I couldn\'t get any reply from their side. Can you please check the status and advise?  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address:101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Tertiary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Please get back to me as soon as you can get a chance. Waiting for your reply,  Thank you  ', NULL, NULL, '2021-08-17 09:37:00', '2021-08-17 09:37:00'),
(30232, 10057, 23313, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email Sent To : TXMAContracting@cigna.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello,  Hope you are doing well. I wanted to know the enrollment updated status for the below mentioned group in Cigna Healthspring for our group Valley Med Urgent Care PLLC under the below mentioned locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Tertiary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-14 11:06:20', '2021-10-14 11:06:20'),
(30233, 10057, 23313, NULL, '2021-11-22 00:00:00.000', 'In Process', 'Email Sent To : JENNIFER.PEREZ@cigna.com, TXGQProviderRelations@healthspring.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello,  Hope this email finds you well. I want to know the enrollment status for the below mentioned providers under these locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Hernandez, Juan	1225617558 Wert, Jeniece K	1659919702 Wright, Larry	1033769765 Saavedra, Teresa	1255676151 Hernandez, Eder	1386956852 Garcia, Homero	1730564857 Potter, Deborah	1861914053 Naranjo, Diego	1568929800 Lopez, Mayra	1265945125  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-11-15 17:51:11', '2021-11-15 17:51:11'),
(30234, 10057, 23313, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : TXGQProviderRelations@healthspring.com, TXMAContracting@cigna.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello,  Can I get the latest update on the below mentioned request.  Please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-30 13:05:00', '2021-11-30 13:05:00'),
(30235, 10057, 23313, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Email Sent To : TXGQProviderRelations@healthspring.com, TXMAContracting@cigna.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello,  Hope this email finds you in good health. I want to know the enrollment status for the below mentioned providers under these locations.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Juan  Hernandez	1225617558 Jeniece K  Wert	1659919702 Larry  Wright	1033769765 Teresa  Saavedra	1255676151 Eder  Hernandez	1386956852 Homero  Garcia	1730564857 Deborah  Potter	1861914053 Diego  Naranjo	1568929800 Mayra  Lopez	1265945125  Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-06 17:39:21', '2021-12-06 17:39:21'),
(30236, 10057, 23313, NULL, '2021-12-20 00:00:00.000', 'In Process', 'Email Sent To : TXGQProviderRelations@healthspring.com, TXMAContracting@cigna.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hey,  I\'m writing this email to check the current status on the below mentioned request. This is my second reminder.  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-12-13 12:44:48', '2021-12-13 12:44:48'),
(30237, 10057, 23313, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email Received From : iliana.cortez@careallies.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello Steve,  The last Letter of Interest that was submitted to Valley Organized Physicians/LVPA was in October of 2018. The LVPA Board of Directors determined that there was no network need and appropriate communication was provided via mail. If the group would like to be reconsidered, please fill out the attached LOI and we can make sure to review during our January 2022 Board of Directors meeting. I is going to be important that you list out all locations as well.  Please let me know if you have any other questions.  Thank you, Iliana', NULL, NULL, '2021-12-20 11:47:08', '2021-12-20 11:47:08'),
(30238, 10057, 23313, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : iliana.cortez@careallies.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Thank you for reaching out. Please find the attached LOI for groups and providers.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Juan Hernandez	1225617558 Wert, Jeniece K	1659919702 Wright, Larry	1033769765 Saavedra, Teresa	1255676151 Hernandez, Eder	1386956852 Garcia, Homero	1730564857 Potter, Deborah	1861914053 Naranjo, Diego	1568929800 Lopez, Mayra	1265945125 Escobar, Angiollet	1962917997 Rodriguez, Cynthia	1124282553  Please revert back to me once you have the update. Have a great day!  Regards,', NULL, NULL, '2021-12-27 11:07:51', '2021-12-27 11:07:51'),
(30239, 20067, 23313, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: iliana.cortez@careallies.com  Subject: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring   Hello Good Morning,  Hope you are doing well. I want to know the enrollment status for the below-mentioned providers under these locations.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Juan Hernandez	1225617558 Jeniece Wert	1659919702 Cynthia Rodriguez	1124282553 Deborah Potter	1861914053 Larry Wright	1033769765 Teresa Saavedra	1255676151 Diego Naranjo	1568929800 Eder Hernandez	1386956852 Homero Garcia	1730564857 Angiollet Escobar	1962917997 Mayra Lopez	1265945125   Thanks and Regards, Syed Ahad.  ', NULL, NULL, '2022-01-05 12:46:25', '2022-01-05 12:46:25'),
(30240, 20067, 23313, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email Received from: iliana.cortez@careallies.com  Sub:  Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring  Hello Syed,     I emailed Steve Albert, but the email bounced back.     We will be meeting with our LVPA and HOPE Board of Directors the week of the  24th where we will be discussing your group. Please fill out 1 LOI for the group with all location listed.  Please email me with any questions that you may have.     Thank you.     Iliana', NULL, NULL, '2022-01-11 13:55:30', '2022-01-11 13:55:30'),
(30241, 20067, 23313, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to: iliana.cortez@careallies.com  Sub: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring  Good afternoon,  Hope all is well with you. The LOI form which you sent me doesn\'t have fields for additional locations. Kindly see the attachment below  Eagerly waiting to hear from you   Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-11 14:02:28', '2022-01-11 14:02:28'),
(30242, 20067, 23313, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email Received from: iliana.cortez@careallies.com  Sub: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring   Thank you for the updated LOI. I added all locations. We meet with our Board of Directors on January 24th. Will be InTouch. ', NULL, NULL, '2022-01-11 17:48:08', '2022-01-11 17:48:08'),
(30243, 20067, 23313, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Will follow-up next week because the meeting of Board of Directors will be on  24th January', NULL, NULL, '2022-01-18 10:59:43', '2022-01-18 10:59:43'),
(30244, 20067, 23313, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: iliana.cortez@careallies.com  Sub: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring   Good Evening! Hope this email finds you well. Any updates on the request?  Eagerly waiting to hear from you, Thanks and Regards,', NULL, NULL, '2022-01-28 17:54:03', '2022-01-28 17:54:03'),
(30245, 20067, 23313, NULL, '2022-02-11 00:00:00.000', 'Not Eligible', 'Email received from: dulce.lumbrera@careallies.com  Sub:  Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring   Hi Syed,  Thank you for reaching out. Please see attached for a response to the letter of interest that was presented at the Board of Director meeting. Thank you', NULL, NULL, '2022-02-04 10:45:04', '2022-02-04 10:45:04'),
(30246, 3040, 23314, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-22 12:22:04', '2021-03-22 12:22:04'),
(30247, 3040, 23314, NULL, '2021-05-07 00:00:00.000', 'In Process', 'Application Status: Submitted		 PEP Ticket Number: 17755204 ', NULL, NULL, '2021-04-30 08:29:47', '2021-04-30 08:29:47'),
(30248, 3040, 23314, NULL, '2021-06-10 00:00:00.000', 'Approved', 'Provider enrolled in Medicaid. Please see attachment. ', NULL, NULL, '2021-06-03 16:21:24', '2021-06-03 16:21:24'),
(30249, 3040, 23315, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-22 12:22:10', '2021-03-22 12:22:10'),
(30250, 3040, 23315, NULL, '2021-05-07 00:00:00.000', 'In Process', 'Application Status: Submitted		 PEP Ticket Number: 17755204 ', NULL, NULL, '2021-04-30 08:29:56', '2021-04-30 08:29:56'),
(30251, 3040, 23315, NULL, '2021-06-10 00:00:00.000', 'Approved', 'Provider enrolled in Medicaid. Please see attachment. ', NULL, NULL, '2021-06-03 16:21:20', '2021-06-03 16:21:20'),
(30252, 3040, 23316, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-22 12:23:23', '2021-03-22 12:23:23'),
(30253, 3040, 23316, NULL, '2021-05-07 00:00:00.000', 'In Process', 'Application Status: Submitted		 PEP Ticket Number: 17755204 ', NULL, NULL, '2021-04-30 08:29:51', '2021-04-30 08:29:51'),
(30254, 3040, 23316, NULL, '2021-06-10 00:00:00.000', 'Approved', 'Provider enrolled in Medicaid. Please see attachment. ', NULL, NULL, '2021-06-03 16:21:23', '2021-06-03 16:21:23'),
(30255, 3040, 23317, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-22 12:23:39', '2021-03-22 12:23:39'),
(30256, 3040, 23317, NULL, '2021-05-05 00:00:00.000', 'In Process', 'Request was submitted online through Multiplan website:   Service Case Number:	7592880 Details have been emailed to you at: vmuc@claimsmedinc.com ', NULL, NULL, '2021-04-28 15:20:20', '2021-04-28 15:20:20'),
(30257, 3040, 23317, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Case # 7592880 || Valley Med Urgent Care PLLC || Wert, Jeniece K || Multiplan ||  Greetings,  Hope you are doing well. Please advise me the enrollment status for the below mentioned provider in our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations)    Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name: Wert, Jeniece K Provider NPI# 1659919702  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-31 09:29:05', '2021-05-31 09:29:05'),
(30258, 3040, 23317, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email rcvd from: registrar@multiplan.com  Subject: Re: Case # 7592880 || Valley Med Urgent Care PLLC || Wert, Jeniece K || Multiplan ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations)    Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-06-17 15:28:47', '2021-06-17 15:28:47'),
(30259, 3040, 23317, NULL, '2021-07-15 00:00:00.000', 'In Process', 'Service Case Number:	7663765 Details have been emailed to you at: vmuc@claimsmedinc.com', NULL, NULL, '2021-07-08 09:42:15', '2021-07-08 09:42:15'),
(30260, 3040, 23317, NULL, '2021-08-04 00:00:00.000', 'In Process', 'I had a word with (Pam) Multiplan representative and she said it will take 15 business days for review the request. ', NULL, NULL, '2021-07-28 16:26:20', '2021-07-28 16:26:20');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(30261, 3040, 23317, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject:  Re: Case # 7592880 || Valley Med Urgent Care PLLC || Wert, Jeniece K || Multiplan ||   Hello,   Hope you are doing well. Please find attached the Letter of intent to enroll the below mentioned provider in Multiplan in our group as per request of the Multiplan representative.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations)    Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name: Wert, Jeniece K Provider NPI# 1659919702  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-26 15:02:21', '2021-08-26 15:02:21'),
(30262, 10057, 23317, NULL, '2021-10-18 00:00:00.000', 'Approved', 'Email Received From : Welcomepackets@multiplan.com  Sub : Welcome Letter - Multiplan - VMUC - Jeniece K Wert  Effective Date : 08/26/2021', NULL, NULL, '2021-10-11 13:27:06', '2021-10-11 13:27:06'),
(30263, 3040, 23318, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-22 12:23:48', '2021-03-22 12:23:48'),
(30264, 3040, 23318, NULL, '2021-05-05 00:00:00.000', 'In Process', 'Request was submitted online through Multiplan website:   Service Case Number:	7592880 Details have been emailed to you at: vmuc@claimsmedinc.com ', NULL, NULL, '2021-04-28 15:20:27', '2021-04-28 15:20:27'),
(30265, 3040, 23318, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Case # 7592880 || Valley Med Urgent Care PLLC || Wert, Jeniece K || Multiplan ||  Greetings,  Hope you are doing well. Please advise me the enrollment status for the below mentioned provider in our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations)    Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name: Wert, Jeniece K Provider NPI# 1659919702  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-31 09:29:02', '2021-05-31 09:29:02'),
(30266, 3040, 23318, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email rcvd from: registrar@multiplan.com  Subject: Re: Case # 7592880 || Valley Med Urgent Care PLLC || Wert, Jeniece K || Multiplan ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations)    Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-06-17 15:28:43', '2021-06-17 15:28:43'),
(30267, 3040, 23318, NULL, '2021-07-15 00:00:00.000', 'In Process', 'Service Case Number:	7663765 Details have been emailed to you at: vmuc@claimsmedinc.com', NULL, NULL, '2021-07-08 09:42:14', '2021-07-08 09:42:14'),
(30268, 3040, 23318, NULL, '2021-08-04 00:00:00.000', 'In Process', 'I had a word with (Pam) Multiplan representative and she said it will take 15 business days for review the request. ', NULL, NULL, '2021-07-28 16:26:21', '2021-07-28 16:26:21'),
(30269, 3040, 23318, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject:  Re: Case # 7592880 || Valley Med Urgent Care PLLC || Wert, Jeniece K || Multiplan ||   Hello,   Hope you are doing well. Please find attached the Letter of intent to enroll the below mentioned provider in Multiplan in our group as per request of the Multiplan representative.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations)    Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name: Wert, Jeniece K Provider NPI# 1659919702  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-26 15:02:22', '2021-08-26 15:02:22'),
(30270, 10057, 23318, NULL, '2021-10-18 00:00:00.000', 'Approved', 'Email Received From : Welcomepackets@multiplan.com  Sub : Welcome Letter - Multiplan - VMUC - Jeniece K Wert  Effective Date : 08/26/2021', NULL, NULL, '2021-10-11 13:26:44', '2021-10-11 13:26:44'),
(30271, 3040, 23319, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-22 12:23:55', '2021-03-22 12:23:55'),
(30272, 3040, 23319, NULL, '2021-05-05 00:00:00.000', 'In Process', 'Request was submitted online through Multiplan website:   Service Case Number:	7592880 Details have been emailed to you at: vmuc@claimsmedinc.com ', NULL, NULL, '2021-04-28 15:20:34', '2021-04-28 15:20:34'),
(30273, 3040, 23319, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Case # 7592880 || Valley Med Urgent Care PLLC || Wert, Jeniece K || Multiplan ||  Greetings,  Hope you are doing well. Please advise me the enrollment status for the below mentioned provider in our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations)    Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name: Wert, Jeniece K Provider NPI# 1659919702  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-31 09:29:07', '2021-05-31 09:29:07'),
(30274, 3040, 23319, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email rcvd from: registrar@multiplan.com  Subject: Re: Case # 7592880 || Valley Med Urgent Care PLLC || Wert, Jeniece K || Multiplan ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations)    Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-06-17 15:28:39', '2021-06-17 15:28:39'),
(30275, 3040, 23319, NULL, '2021-07-15 00:00:00.000', 'In Process', 'Service Case Number:	7663765 Details have been emailed to you at: vmuc@claimsmedinc.com', NULL, NULL, '2021-07-08 09:42:14', '2021-07-08 09:42:14'),
(30276, 3040, 23319, NULL, '2021-08-04 00:00:00.000', 'In Process', 'I had a word with (Pam) Multiplan representative and she said it will take 15 business days for review the request. ', NULL, NULL, '2021-07-28 16:26:21', '2021-07-28 16:26:21'),
(30277, 3040, 23319, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject:  Re: Case # 7592880 || Valley Med Urgent Care PLLC || Wert, Jeniece K || Multiplan ||   Hello,   Hope you are doing well. Please find attached the Letter of intent to enroll the below mentioned provider in Multiplan in our group as per request of the Multiplan representative.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations)    Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name: Wert, Jeniece K Provider NPI# 1659919702  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-26 15:02:23', '2021-08-26 15:02:23'),
(30278, 10057, 23319, NULL, '2021-10-18 00:00:00.000', 'Approved', 'Email Received From : Welcomepackets@multiplan.com  Sub : Welcome Letter - Multiplan - VMUC - Jeniece K Wert  Effective Date : 08/26/2021 ', NULL, NULL, '2021-10-11 13:25:48', '2021-10-11 13:25:48'),
(30279, 3040, 23320, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-22 12:24:07', '2021-03-22 12:24:07'),
(30280, 3040, 23320, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-03-26 14:21:26', '2021-03-26 14:21:26'),
(30281, 3040, 23321, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-22 12:24:15', '2021-03-22 12:24:15'),
(30282, 3040, 23321, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-03-26 14:21:31', '2021-03-26 14:21:31'),
(30283, 3040, 23322, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-22 12:24:24', '2021-03-22 12:24:24'),
(30284, 3040, 23322, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-03-26 14:21:36', '2021-03-26 14:21:36'),
(30285, 3040, 23323, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-22 12:24:33', '2021-03-22 12:24:33'),
(30286, 3040, 23323, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.  ', NULL, NULL, '2021-03-26 09:25:11', '2021-03-26 09:25:11'),
(30287, 3040, 23324, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-22 12:24:40', '2021-03-22 12:24:40'),
(30288, 3040, 23324, NULL, '2021-04-02 00:00:00.000', 'Initiated', 'LOI send it through fax for adding the locations.   Fax No: 817-633-5729  Please see attachment. ', NULL, NULL, '2021-03-26 09:26:54', '2021-03-26 09:26:54'),
(30289, 3040, 23324, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Email sent to: mmedina@ghn-mci.com  Subject: Additional Locations || Valley Med Urgent Care PLLC || Group || Galaxy Health ||  Greetings,   In response to our conversation a few minutes ago please find the attached Letter of interest that was sent out to Susie on 03/25/2021 for adding the location in our facility contract for our group Valley Med Urgent Care PLLC.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please let me know. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-14 13:40:23', '2021-04-14 13:40:23'),
(30290, 3040, 23324, NULL, '2021-05-11 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.   Please find contract in group task. ', NULL, NULL, '2021-05-04 14:11:47', '2021-05-04 14:11:47'),
(30291, 3040, 23325, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-22 12:24:46', '2021-03-22 12:24:46'),
(30292, 3040, 23325, NULL, '2021-04-02 00:00:00.000', 'Approved', 'LOI send it through fax for adding the locations.   Fax No: 817-633-5729  Please see attachment. ', NULL, NULL, '2021-03-26 09:27:08', '2021-03-26 09:27:08'),
(30293, 3040, 23325, NULL, NULL, 'Revalidation', 'Email sent to: mmedina@ghn-mci.com  Subject: Additional Locations || Valley Med Urgent Care PLLC || Group || Galaxy Health ||  Greetings,   In response to our conversation a few minutes ago please find the attached Letter of interest that was sent out to Susie on 03/25/2021 for adding the location in our facility contract for our group Valley Med Urgent Care PLLC.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please let me know. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-14 13:40:37', '2021-04-14 13:40:37'),
(30294, 3040, 23325, NULL, NULL, 'Revalidated', 'Group has an ancillary contract. No need to add individual provider.   Please find contract in group task. ', NULL, NULL, '2021-05-04 14:11:53', '2021-05-04 14:11:53'),
(30295, 3040, 23332, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-22 16:13:14', '2021-03-22 16:13:14'),
(30296, 3040, 23332, NULL, '2021-03-29 00:00:00.000', 'Approved', 'Provider is now showing linked with medicare railroad and effective date is 08/01/2020 ', NULL, NULL, '2021-03-22 16:14:55', '2021-03-22 16:14:55'),
(30297, 3040, 23333, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-22 16:17:57', '2021-03-22 16:17:57'),
(30298, 3040, 23333, NULL, '2021-03-29 00:00:00.000', 'In Process', 'Request initiated online.   Please see attachment  Reference number: 21081001397', NULL, NULL, '2021-03-22 16:23:19', '2021-03-22 16:23:19'),
(30299, 3040, 23333, NULL, '2021-04-19 00:00:00.000', 'Approved', 'Provider enrolled with Medicare Railroad.   Please see attachment.', NULL, NULL, '2021-04-12 16:33:56', '2021-04-12 16:33:56'),
(30300, 3040, 23334, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-24 09:05:14', '2021-03-24 09:05:14'),
(30301, 3040, 23334, NULL, '2021-03-31 00:00:00.000', 'Initiated', 'Emails sent to: pr.south@healthsmart.com  Subject: Add Locations || Tax ID# 81-5123542 || Valley Med Urgent Care PLLC || AnciCare ||  Greetings,   Hope you are doing well. I wanted to add the locations in Anci-Care for our group Valley Med Urgent Care PLLC under below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Effective Date: 03/15/2018 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-24 09:06:39', '2021-03-24 09:06:39'),
(30302, 3040, 23334, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Add Locations || Tax ID# 81-5123542 || Valley Med Urgent Care PLLC || AnciCare || Greetings,   Has there been any update?   Thanks ', NULL, NULL, '2021-04-14 07:25:35', '2021-04-14 07:25:35'),
(30303, 3040, 23334, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: vipproviders@anci-care.com  Subject: Add Locations || Tax ID# 81-5123542 || Valley Med Urgent Care PLLC || AnciCare ||  Greetings,   Hope you are doing well. I wanted to add the locations in Anci-Care for our group Valley Med Urgent Care PLLC under the below locations. Can you please send me the copt of contract.  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Effective Date: 03/15/2018 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-01 15:02:55', '2021-06-01 15:02:55'),
(30304, 3040, 23334, NULL, '2021-06-09 00:00:00.000', 'Approved', 'No need to add the providers because our group has an ancillary contract. ', NULL, NULL, '2021-06-02 16:48:19', '2021-06-02 16:48:19'),
(30305, 3040, 23335, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-24 09:13:38', '2021-03-24 09:13:38'),
(30306, 3040, 23335, NULL, '2021-03-31 00:00:00.000', 'Approved', 'Ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-03-24 09:14:11', '2021-03-24 09:14:11'),
(30307, 3040, 23336, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-24 09:13:39', '2021-03-24 09:13:39'),
(30308, 3040, 23336, NULL, '2021-03-31 00:00:00.000', 'Approved', 'Ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-03-24 09:14:26', '2021-03-24 09:14:26'),
(30309, 3040, 23337, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-24 09:17:14', '2021-03-24 09:17:14'),
(30310, 3040, 23337, NULL, '2021-03-31 00:00:00.000', 'Approved', 'Ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-03-24 09:17:25', '2021-03-24 09:17:25'),
(30311, 1006, 23338, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 08:59:59', '2021-03-25 08:59:59'),
(30312, 3040, 23338, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Group contracted with BCBS.   Please see attachment. ', NULL, NULL, '2021-03-29 10:47:56', '2021-03-29 10:47:56'),
(30313, 1006, 23339, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 09:02:02', '2021-03-25 09:02:02'),
(30314, 1006, 23339, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Sent following enrollment request email @ CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,   I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?   Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.   Thank you. \" ', NULL, NULL, '2021-04-08 18:48:11', '2021-04-08 18:48:11'),
(30315, 9057, 23339, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent following email to CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Status - RHC - Christus Spohn  \"Hello, We want to know the current status of the request we sent to you last month about the enrollment for the following group and its providers:  Group Name: Statcare Minor Emergency Clinic NPI#  1689924904  TIN#  46-0575924  Please get back to us as soon as possible.  Thank you\"', NULL, NULL, '2021-05-25 10:10:06', '2021-05-25 10:10:06'),
(30316, 1006, 23339, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent a VM to Vicki Gera @ (800) 419-3461 as we haven\'t been receiving any replies on emails. ', NULL, NULL, '2021-06-11 14:13:30', '2021-06-11 14:13:30'),
(30317, 3040, 23339, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email sent to: vicki.guerra@christushealth.org  Subject:  Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,  I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?  Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-30 15:21:16', '2021-06-30 15:21:16'),
(30318, 1006, 23339, NULL, '2021-07-08 00:00:00.000', 'In Process', 'We received the following update from vicki.guerra@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hi Adil,  Happy Wednesday!  Thank you for reaching out. We would like for Statcare Minor Emergency Clinic to come back on board. The last time we spoke it was to my understanding that Ms. Rabagos did not have a sponsoring physician with hospital privileges for a Christus facility. This is one of the requirements to bring this provider group back on board with a new contract.  Is there a sponsor/supervising physician who has hospital affiliations at a Christus Facility that Ms. Rabagos will be utilizing?  Vicki Ann Guerra  Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  Sent following reply:  \"Hello Vicki,   I appreciate the update, would you be able to check again if David Gray (NPI# 1902814874) now has hospital privileges with a Christus facility?   Thank you. \" ', NULL, NULL, '2021-07-01 13:46:48', '2021-07-01 13:46:48'),
(30319, 1006, 23339, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Sent following email to Vicki @ Guerra, Vicki A. vicki.guerra@christushealth.org:  Sub: Hospital Privileges - Gray  \"Hello Vicki,   I apologize for the incorrect information, the correct supervising physician for Katherine is Luis Leyton Gonzalez (NPI# 1013911601), please look into this provider instead.   Thank you. \"', NULL, NULL, '2021-07-12 13:29:45', '2021-07-12 13:29:45'),
(30320, 1006, 23339, NULL, '2021-08-09 00:00:00.000', 'In Process', 'We received the following reply from vicki.guerra@christushealth.org:  Sub: vicki.guerra@christushealth.org  \"Hi Brad,  Happy Tuesday!  Can I have the last 4 of Dr. Leyton Gonzalez SS? This is the only way for me to verify in the portal along with NPI.  Thanks,  Vicki Ann Guerra Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  I replied with the requested information to her.', NULL, NULL, '2021-08-02 17:07:00', '2021-08-02 17:07:00'),
(30321, 1006, 23339, NULL, '2021-08-12 00:00:00.000', 'Not Eligible', 'Received the following denial notification:  Sub: Denial Letter CSHN: STATCARE Contract  \"August 3, 2021  STATCARE Administrator/Owner Rabagos C/O – Office Manager  Dear Administrator and Owner Rabagos (OM), Thank you for your continuous efforts to participate in the Christus Spohn Health Network. Currently to contract with CSHN, Ms. Rabagos will need to have a sponsoring physician to participate in the network. The requirement for a sponsoring physician is to have and maintain  hospital affiliations/memberships with a Christus facility as per Article 5.5 in CSHNs contract agreement and Section I, Article III, Section(s) 3.2-1 and 3.6. CSHN would love to see STACARE back on the Spohn Network directory. Until this criterion for a sponsoring physician is met with hospital affiliations/memberships with a Christus facility CSHN cannot extend a contract.  Locations: STATCARE Kingsville 500 E Caesar Ave, Kingsville Texas 78363 STATCARE Calallen 4042 River Hill Drive Corpus Christi Texas 78410 STATCARE Corpus Christi Southside 6646 S Staples St #122 Corpus Christi Texas 78413 STATCARE Corpus Christi SPID 3817 S. Padre Island Dr. Corpus Christi Texas 78415 STATCARE Rockport 2102 FM 2165 Rockport Texas 78382  Have a blessed and wonderful day. Sincerely,  Vicki Ann Guerra Provider Relations Representative\"', NULL, NULL, '2021-08-05 09:46:23', '2021-08-05 09:46:23'),
(30322, 11056, 23339, NULL, '2021-10-07 00:00:00.000', 'Approved', 'There is no need to enrolled the provider in Ancillary contract.', NULL, NULL, '2021-09-30 13:36:59', '2021-09-30 13:36:59'),
(30323, 1006, 23340, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 09:02:03', '2021-03-25 09:02:03'),
(30324, 1006, 23340, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Sent following enrollment request email @ CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,   I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?   Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.   Thank you. \" ', NULL, NULL, '2021-04-08 18:48:15', '2021-04-08 18:48:15'),
(30325, 9057, 23340, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent following email to CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Status - RHC - Christus Spohn  \"Hello, We want to know the current status of the request we sent to you last month about the enrollment for the following group and its providers:  Group Name: Statcare Minor Emergency Clinic NPI#  1689924904  TIN#  46-0575924  Please get back to us as soon as possible.  Thank you\"', NULL, NULL, '2021-05-25 10:10:34', '2021-05-25 10:10:34'),
(30326, 1006, 23340, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent a VM to Vicki Gera @ (800) 419-3461 as we haven\'t been receiving any replies on emails. ', NULL, NULL, '2021-06-11 14:13:27', '2021-06-11 14:13:27'),
(30327, 3040, 23340, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email sent to: vicki.guerra@christushealth.org  Subject:  Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,  I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?  Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-30 15:21:16', '2021-06-30 15:21:16'),
(30328, 1006, 23340, NULL, '2021-07-08 00:00:00.000', 'In Process', 'We received the following update from vicki.guerra@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hi Adil,  Happy Wednesday!  Thank you for reaching out. We would like for Statcare Minor Emergency Clinic to come back on board. The last time we spoke it was to my understanding that Ms. Rabagos did not have a sponsoring physician with hospital privileges for a Christus facility. This is one of the requirements to bring this provider group back on board with a new contract.  Is there a sponsor/supervising physician who has hospital affiliations at a Christus Facility that Ms. Rabagos will be utilizing?  Vicki Ann Guerra  Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  Sent following reply:  \"Hello Vicki,   I appreciate the update, would you be able to check again if David Gray (NPI# 1902814874) now has hospital privileges with a Christus facility?   Thank you. \" ', NULL, NULL, '2021-07-01 13:46:51', '2021-07-01 13:46:51'),
(30329, 1006, 23340, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Sent following email to Vicki @ Guerra, Vicki A. vicki.guerra@christushealth.org:  Sub: Hospital Privileges - Gray  \"Hello Vicki,   I apologize for the incorrect information, the correct supervising physician for Katherine is Luis Leyton Gonzalez (NPI# 1013911601), please look into this provider instead.   Thank you. \"', NULL, NULL, '2021-07-12 13:29:49', '2021-07-12 13:29:49'),
(30330, 1006, 23340, NULL, '2021-08-09 00:00:00.000', 'In Process', 'We received the following reply from vicki.guerra@christushealth.org:  Sub: vicki.guerra@christushealth.org  \"Hi Brad,  Happy Tuesday!  Can I have the last 4 of Dr. Leyton Gonzalez SS? This is the only way for me to verify in the portal along with NPI.  Thanks,  Vicki Ann Guerra Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  I replied with the requested information to her.', NULL, NULL, '2021-08-02 17:06:56', '2021-08-02 17:06:56'),
(30331, 1006, 23340, NULL, '2021-08-12 00:00:00.000', 'Not Eligible', 'Received the following denial notification:  Sub: Denial Letter CSHN: STATCARE Contract  \"August 3, 2021  STATCARE Administrator/Owner Rabagos C/O – Office Manager  Dear Administrator and Owner Rabagos (OM), Thank you for your continuous efforts to participate in the Christus Spohn Health Network. Currently to contract with CSHN, Ms. Rabagos will need to have a sponsoring physician to participate in the network. The requirement for a sponsoring physician is to have and maintain  hospital affiliations/memberships with a Christus facility as per Article 5.5 in CSHNs contract agreement and Section I, Article III, Section(s) 3.2-1 and 3.6. CSHN would love to see STACARE back on the Spohn Network directory. Until this criterion for a sponsoring physician is met with hospital affiliations/memberships with a Christus facility CSHN cannot extend a contract.  Locations: STATCARE Kingsville 500 E Caesar Ave, Kingsville Texas 78363 STATCARE Calallen 4042 River Hill Drive Corpus Christi Texas 78410 STATCARE Corpus Christi Southside 6646 S Staples St #122 Corpus Christi Texas 78413 STATCARE Corpus Christi SPID 3817 S. Padre Island Dr. Corpus Christi Texas 78415 STATCARE Rockport 2102 FM 2165 Rockport Texas 78382  Have a blessed and wonderful day. Sincerely,  Vicki Ann Guerra Provider Relations Representative\"', NULL, NULL, '2021-08-05 09:46:20', '2021-08-05 09:46:20'),
(30332, 11056, 23340, NULL, '2021-10-07 00:00:00.000', 'Approved', 'There is no need to enrolled the provider in Ancillary contract.', NULL, NULL, '2021-09-30 13:37:35', '2021-09-30 13:37:35'),
(30333, 1006, 23341, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 09:02:05', '2021-03-25 09:02:05'),
(30334, 1006, 23341, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Sent following enrollment request email @ CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,   I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?   Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.   Thank you. \" ', NULL, NULL, '2021-04-08 18:48:18', '2021-04-08 18:48:18'),
(30335, 9057, 23341, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent following email to CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Status - RHC - Christus Spohn  \"Hello, We want to know the current status of the request we sent to you last month about the enrollment for the following group and its providers:  Group Name: Statcare Minor Emergency Clinic NPI#  1689924904  TIN#  46-0575924  Please get back to us as soon as possible.  Thank you\"', NULL, NULL, '2021-05-25 10:10:46', '2021-05-25 10:10:46'),
(30336, 1006, 23341, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent a VM to Vicki Gera @ (800) 419-3461 as we haven\'t been receiving any replies on emails. ', NULL, NULL, '2021-06-11 14:13:24', '2021-06-11 14:13:24'),
(30337, 3040, 23341, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email sent to: vicki.guerra@christushealth.org  Subject:  Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,  I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?  Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-30 15:21:15', '2021-06-30 15:21:15'),
(30338, 1006, 23341, NULL, '2021-07-08 00:00:00.000', 'In Process', 'We received the following update from vicki.guerra@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hi Adil,  Happy Wednesday!  Thank you for reaching out. We would like for Statcare Minor Emergency Clinic to come back on board. The last time we spoke it was to my understanding that Ms. Rabagos did not have a sponsoring physician with hospital privileges for a Christus facility. This is one of the requirements to bring this provider group back on board with a new contract.  Is there a sponsor/supervising physician who has hospital affiliations at a Christus Facility that Ms. Rabagos will be utilizing?  Vicki Ann Guerra  Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  Sent following reply:  \"Hello Vicki,   I appreciate the update, would you be able to check again if David Gray (NPI# 1902814874) now has hospital privileges with a Christus facility?   Thank you. \" ', NULL, NULL, '2021-07-01 13:46:54', '2021-07-01 13:46:54'),
(30339, 1006, 23341, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Sent following email to Vicki @ Guerra, Vicki A. vicki.guerra@christushealth.org:  Sub: Hospital Privileges - Gray  \"Hello Vicki,   I apologize for the incorrect information, the correct supervising physician for Katherine is Luis Leyton Gonzalez (NPI# 1013911601), please look into this provider instead.   Thank you. \"', NULL, NULL, '2021-07-12 13:29:53', '2021-07-12 13:29:53'),
(30340, 1006, 23341, NULL, '2021-08-09 00:00:00.000', 'In Process', 'We received the following reply from vicki.guerra@christushealth.org:  Sub: vicki.guerra@christushealth.org  \"Hi Brad,  Happy Tuesday!  Can I have the last 4 of Dr. Leyton Gonzalez SS? This is the only way for me to verify in the portal along with NPI.  Thanks,  Vicki Ann Guerra Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  I replied with the requested information to her.', NULL, NULL, '2021-08-02 17:06:52', '2021-08-02 17:06:52'),
(30341, 1006, 23341, NULL, '2021-08-12 00:00:00.000', 'Not Eligible', 'Received the following denial notification:  Sub: Denial Letter CSHN: STATCARE Contract  \"August 3, 2021  STATCARE Administrator/Owner Rabagos C/O – Office Manager  Dear Administrator and Owner Rabagos (OM), Thank you for your continuous efforts to participate in the Christus Spohn Health Network. Currently to contract with CSHN, Ms. Rabagos will need to have a sponsoring physician to participate in the network. The requirement for a sponsoring physician is to have and maintain  hospital affiliations/memberships with a Christus facility as per Article 5.5 in CSHNs contract agreement and Section I, Article III, Section(s) 3.2-1 and 3.6. CSHN would love to see STACARE back on the Spohn Network directory. Until this criterion for a sponsoring physician is met with hospital affiliations/memberships with a Christus facility CSHN cannot extend a contract.  Locations: STATCARE Kingsville 500 E Caesar Ave, Kingsville Texas 78363 STATCARE Calallen 4042 River Hill Drive Corpus Christi Texas 78410 STATCARE Corpus Christi Southside 6646 S Staples St #122 Corpus Christi Texas 78413 STATCARE Corpus Christi SPID 3817 S. Padre Island Dr. Corpus Christi Texas 78415 STATCARE Rockport 2102 FM 2165 Rockport Texas 78382  Have a blessed and wonderful day. Sincerely,  Vicki Ann Guerra Provider Relations Representative\"', NULL, NULL, '2021-08-05 09:46:17', '2021-08-05 09:46:17'),
(30342, 11056, 23341, NULL, '2021-10-07 00:00:00.000', 'Approved', 'There is no need to enrolled the provider in Ancillary contract.', NULL, NULL, '2021-09-30 13:37:41', '2021-09-30 13:37:41'),
(30343, 1006, 23342, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 09:02:06', '2021-03-25 09:02:06'),
(30344, 1006, 23342, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Sent following enrollment request email @ CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,   I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?   Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.   Thank you. \" ', NULL, NULL, '2021-04-08 18:48:23', '2021-04-08 18:48:23'),
(30345, 9057, 23342, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent following email to CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Status - RHC - Christus Spohn  \"Hello, We want to know the current status of the request we sent to you last month about the enrollment for the following group and its providers:  Group Name: Statcare Minor Emergency Clinic NPI#  1689924904  TIN#  46-0575924  Please get back to us as soon as possible.  Thank you\"', NULL, NULL, '2021-05-25 10:10:57', '2021-05-25 10:10:57'),
(30346, 1006, 23342, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent a VM to Vicki Gera @ (800) 419-3461 as we haven\'t been receiving any replies on emails. ', NULL, NULL, '2021-06-11 14:13:20', '2021-06-11 14:13:20'),
(30347, 3040, 23342, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email sent to: vicki.guerra@christushealth.org  Subject:  Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,  I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?  Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-30 15:21:14', '2021-06-30 15:21:14'),
(30348, 1006, 23342, NULL, '2021-07-08 00:00:00.000', 'In Process', 'We received the following update from vicki.guerra@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hi Adil,  Happy Wednesday!  Thank you for reaching out. We would like for Statcare Minor Emergency Clinic to come back on board. The last time we spoke it was to my understanding that Ms. Rabagos did not have a sponsoring physician with hospital privileges for a Christus facility. This is one of the requirements to bring this provider group back on board with a new contract.  Is there a sponsor/supervising physician who has hospital affiliations at a Christus Facility that Ms. Rabagos will be utilizing?  Vicki Ann Guerra  Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  Sent following reply:  \"Hello Vicki,   I appreciate the update, would you be able to check again if David Gray (NPI# 1902814874) now has hospital privileges with a Christus facility?   Thank you. \" ', NULL, NULL, '2021-07-01 13:47:05', '2021-07-01 13:47:05'),
(30349, 1006, 23342, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Sent following email to Vicki @ Guerra, Vicki A. vicki.guerra@christushealth.org:  Sub: Hospital Privileges - Gray  \"Hello Vicki,   I apologize for the incorrect information, the correct supervising physician for Katherine is Luis Leyton Gonzalez (NPI# 1013911601), please look into this provider instead.   Thank you. \"', NULL, NULL, '2021-07-12 13:29:56', '2021-07-12 13:29:56'),
(30350, 1006, 23342, NULL, '2021-08-09 00:00:00.000', 'In Process', 'We received the following reply from vicki.guerra@christushealth.org:  Sub: vicki.guerra@christushealth.org  \"Hi Brad,  Happy Tuesday!  Can I have the last 4 of Dr. Leyton Gonzalez SS? This is the only way for me to verify in the portal along with NPI.  Thanks,  Vicki Ann Guerra Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  I replied with the requested information to her.', NULL, NULL, '2021-08-02 17:06:48', '2021-08-02 17:06:48');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(30351, 1006, 23342, NULL, '2021-08-12 00:00:00.000', 'Not Eligible', 'Received the following denial notification:  Sub: Denial Letter CSHN: STATCARE Contract  \"August 3, 2021  STATCARE Administrator/Owner Rabagos C/O – Office Manager  Dear Administrator and Owner Rabagos (OM), Thank you for your continuous efforts to participate in the Christus Spohn Health Network. Currently to contract with CSHN, Ms. Rabagos will need to have a sponsoring physician to participate in the network. The requirement for a sponsoring physician is to have and maintain  hospital affiliations/memberships with a Christus facility as per Article 5.5 in CSHNs contract agreement and Section I, Article III, Section(s) 3.2-1 and 3.6. CSHN would love to see STACARE back on the Spohn Network directory. Until this criterion for a sponsoring physician is met with hospital affiliations/memberships with a Christus facility CSHN cannot extend a contract.  Locations: STATCARE Kingsville 500 E Caesar Ave, Kingsville Texas 78363 STATCARE Calallen 4042 River Hill Drive Corpus Christi Texas 78410 STATCARE Corpus Christi Southside 6646 S Staples St #122 Corpus Christi Texas 78413 STATCARE Corpus Christi SPID 3817 S. Padre Island Dr. Corpus Christi Texas 78415 STATCARE Rockport 2102 FM 2165 Rockport Texas 78382  Have a blessed and wonderful day. Sincerely,  Vicki Ann Guerra Provider Relations Representative\"', NULL, NULL, '2021-08-05 09:46:13', '2021-08-05 09:46:13'),
(30352, 11056, 23342, NULL, '2021-10-07 00:00:00.000', 'Approved', 'There is no need to enrolled the provider in Ancillary contract.', NULL, NULL, '2021-09-30 13:37:48', '2021-09-30 13:37:48'),
(30353, 1006, 23343, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 09:02:07', '2021-03-25 09:02:07'),
(30354, 1006, 23343, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Sent following enrollment request email @ CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,   I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?   Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.   Thank you. \" ', NULL, NULL, '2021-04-08 18:48:27', '2021-04-08 18:48:27'),
(30355, 9057, 23343, NULL, '2021-06-01 00:00:00.000', 'In Process', '', NULL, NULL, '2021-05-25 10:11:08', '2021-05-25 10:11:08'),
(30356, 1006, 23343, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent a VM to Vicki Gera @ (800) 419-3461 as we haven\'t been receiving any replies on emails. ', NULL, NULL, '2021-06-11 14:13:16', '2021-06-11 14:13:16'),
(30357, 3040, 23343, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email sent to: vicki.guerra@christushealth.org  Subject:  Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,  I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?  Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-30 15:21:14', '2021-06-30 15:21:14'),
(30358, 1006, 23343, NULL, '2021-07-08 00:00:00.000', 'In Process', 'We received the following update from vicki.guerra@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hi Adil,  Happy Wednesday!  Thank you for reaching out. We would like for Statcare Minor Emergency Clinic to come back on board. The last time we spoke it was to my understanding that Ms. Rabagos did not have a sponsoring physician with hospital privileges for a Christus facility. This is one of the requirements to bring this provider group back on board with a new contract.  Is there a sponsor/supervising physician who has hospital affiliations at a Christus Facility that Ms. Rabagos will be utilizing?  Vicki Ann Guerra  Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  Sent following reply:  \"Hello Vicki,   I appreciate the update, would you be able to check again if David Gray (NPI# 1902814874) now has hospital privileges with a Christus facility?   Thank you. \" ', NULL, NULL, '2021-07-01 13:47:08', '2021-07-01 13:47:08'),
(30359, 1006, 23343, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Sent following email to Vicki @ Guerra, Vicki A. vicki.guerra@christushealth.org:  Sub: Hospital Privileges - Gray  \"Hello Vicki,   I apologize for the incorrect information, the correct supervising physician for Katherine is Luis Leyton Gonzalez (NPI# 1013911601), please look into this provider instead.   Thank you. \"', NULL, NULL, '2021-07-12 13:29:59', '2021-07-12 13:29:59'),
(30360, 1006, 23343, NULL, '2021-08-09 00:00:00.000', 'In Process', 'We received the following reply from vicki.guerra@christushealth.org:  Sub: vicki.guerra@christushealth.org  \"Hi Brad,  Happy Tuesday!  Can I have the last 4 of Dr. Leyton Gonzalez SS? This is the only way for me to verify in the portal along with NPI.  Thanks,  Vicki Ann Guerra Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  I replied with the requested information to her.', NULL, NULL, '2021-08-02 17:06:43', '2021-08-02 17:06:43'),
(30361, 1006, 23343, NULL, '2021-08-12 00:00:00.000', 'Not Eligible', 'Received the following denial notification:  Sub: Denial Letter CSHN: STATCARE Contract  \"August 3, 2021  STATCARE Administrator/Owner Rabagos C/O – Office Manager  Dear Administrator and Owner Rabagos (OM), Thank you for your continuous efforts to participate in the Christus Spohn Health Network. Currently to contract with CSHN, Ms. Rabagos will need to have a sponsoring physician to participate in the network. The requirement for a sponsoring physician is to have and maintain  hospital affiliations/memberships with a Christus facility as per Article 5.5 in CSHNs contract agreement and Section I, Article III, Section(s) 3.2-1 and 3.6. CSHN would love to see STACARE back on the Spohn Network directory. Until this criterion for a sponsoring physician is met with hospital affiliations/memberships with a Christus facility CSHN cannot extend a contract.  Locations: STATCARE Kingsville 500 E Caesar Ave, Kingsville Texas 78363 STATCARE Calallen 4042 River Hill Drive Corpus Christi Texas 78410 STATCARE Corpus Christi Southside 6646 S Staples St #122 Corpus Christi Texas 78413 STATCARE Corpus Christi SPID 3817 S. Padre Island Dr. Corpus Christi Texas 78415 STATCARE Rockport 2102 FM 2165 Rockport Texas 78382  Have a blessed and wonderful day. Sincerely,  Vicki Ann Guerra Provider Relations Representative\"', NULL, NULL, '2021-08-05 09:46:09', '2021-08-05 09:46:09'),
(30362, 11056, 23343, NULL, '2021-10-07 00:00:00.000', 'Approved', 'There is no need to enrolled the provider in Ancillary contract.', NULL, NULL, '2021-09-30 13:37:56', '2021-09-30 13:37:56'),
(30363, 1006, 23344, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 09:02:08', '2021-03-25 09:02:08'),
(30364, 1006, 23344, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Sent following enrollment request email @ CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,   I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?   Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.   Thank you. \" ', NULL, NULL, '2021-04-08 18:48:31', '2021-04-08 18:48:31'),
(30365, 9057, 23344, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent following email to CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Status - RHC - Christus Spohn  \"Hello, We want to know the current status of the request we sent to you last month about the enrollment for the following group and its providers:  Group Name: Statcare Minor Emergency Clinic NPI#  1689924904  TIN#  46-0575924  Please get back to us as soon as possible.  Thank you\"', NULL, NULL, '2021-05-25 10:11:17', '2021-05-25 10:11:17'),
(30366, 1006, 23344, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent a VM to Vicki Gera @ (800) 419-3461 as we haven\'t been receiving any replies on emails. ', NULL, NULL, '2021-06-11 14:13:13', '2021-06-11 14:13:13'),
(30367, 3040, 23344, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email sent to: vicki.guerra@christushealth.org  Subject:  Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,  I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?  Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-30 15:21:13', '2021-06-30 15:21:13'),
(30368, 1006, 23344, NULL, '2021-07-08 00:00:00.000', 'In Process', 'We received the following update from vicki.guerra@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hi Adil,  Happy Wednesday!  Thank you for reaching out. We would like for Statcare Minor Emergency Clinic to come back on board. The last time we spoke it was to my understanding that Ms. Rabagos did not have a sponsoring physician with hospital privileges for a Christus facility. This is one of the requirements to bring this provider group back on board with a new contract.  Is there a sponsor/supervising physician who has hospital affiliations at a Christus Facility that Ms. Rabagos will be utilizing?  Vicki Ann Guerra  Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  Sent following reply:  \"Hello Vicki,   I appreciate the update, would you be able to check again if David Gray (NPI# 1902814874) now has hospital privileges with a Christus facility?   Thank you. \" ', NULL, NULL, '2021-07-01 13:47:11', '2021-07-01 13:47:11'),
(30369, 1006, 23344, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Sent following email to Vicki @ Guerra, Vicki A. vicki.guerra@christushealth.org:  Sub: Hospital Privileges - Gray  \"Hello Vicki,   I apologize for the incorrect information, the correct supervising physician for Katherine is Luis Leyton Gonzalez (NPI# 1013911601), please look into this provider instead.   Thank you. \"', NULL, NULL, '2021-07-12 13:30:02', '2021-07-12 13:30:02'),
(30370, 1006, 23344, NULL, '2021-08-09 00:00:00.000', 'In Process', 'We received the following reply from vicki.guerra@christushealth.org:  Sub: vicki.guerra@christushealth.org  \"Hi Brad,  Happy Tuesday!  Can I have the last 4 of Dr. Leyton Gonzalez SS? This is the only way for me to verify in the portal along with NPI.  Thanks,  Vicki Ann Guerra Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  I replied with the requested information to her.', NULL, NULL, '2021-08-02 17:06:40', '2021-08-02 17:06:40'),
(30371, 1006, 23344, NULL, '2021-08-12 00:00:00.000', 'Not Eligible', 'Received the following denial notification:  Sub: Denial Letter CSHN: STATCARE Contract  \"August 3, 2021  STATCARE Administrator/Owner Rabagos C/O – Office Manager  Dear Administrator and Owner Rabagos (OM), Thank you for your continuous efforts to participate in the Christus Spohn Health Network. Currently to contract with CSHN, Ms. Rabagos will need to have a sponsoring physician to participate in the network. The requirement for a sponsoring physician is to have and maintain  hospital affiliations/memberships with a Christus facility as per Article 5.5 in CSHNs contract agreement and Section I, Article III, Section(s) 3.2-1 and 3.6. CSHN would love to see STACARE back on the Spohn Network directory. Until this criterion for a sponsoring physician is met with hospital affiliations/memberships with a Christus facility CSHN cannot extend a contract.  Locations: STATCARE Kingsville 500 E Caesar Ave, Kingsville Texas 78363 STATCARE Calallen 4042 River Hill Drive Corpus Christi Texas 78410 STATCARE Corpus Christi Southside 6646 S Staples St #122 Corpus Christi Texas 78413 STATCARE Corpus Christi SPID 3817 S. Padre Island Dr. Corpus Christi Texas 78415 STATCARE Rockport 2102 FM 2165 Rockport Texas 78382  Have a blessed and wonderful day. Sincerely,  Vicki Ann Guerra Provider Relations Representative\"', NULL, NULL, '2021-08-05 09:46:05', '2021-08-05 09:46:05'),
(30372, 11056, 23344, NULL, '2021-10-07 00:00:00.000', 'Approved', 'There is no need to enrolled the provider in Ancillary contract.', NULL, NULL, '2021-09-30 13:38:02', '2021-09-30 13:38:02'),
(30373, 1006, 23345, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 09:02:09', '2021-03-25 09:02:09'),
(30374, 1006, 23345, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Sent following enrollment request email @ CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,   I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?   Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.   Thank you. \" ', NULL, NULL, '2021-04-08 18:48:35', '2021-04-08 18:48:35'),
(30375, 9057, 23345, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent following email to CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Status - RHC - Christus Spohn  \"Hello, We want to know the current status of the request we sent to you last month about the enrollment for the following group and its providers:  Group Name: Statcare Minor Emergency Clinic NPI#  1689924904  TIN#  46-0575924  Please get back to us as soon as possible.  Thank you\"', NULL, NULL, '2021-05-25 10:11:26', '2021-05-25 10:11:26'),
(30376, 1006, 23345, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent a VM to Vicki Gera @ (800) 419-3461 as we haven\'t been receiving any replies on emails. ', NULL, NULL, '2021-06-11 14:13:10', '2021-06-11 14:13:10'),
(30377, 3040, 23345, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email sent to: vicki.guerra@christushealth.org  Subject:  Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,  I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?  Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-30 15:21:12', '2021-06-30 15:21:12'),
(30378, 1006, 23345, NULL, '2021-07-08 00:00:00.000', 'In Process', 'We received the following update from vicki.guerra@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hi Adil,  Happy Wednesday!  Thank you for reaching out. We would like for Statcare Minor Emergency Clinic to come back on board. The last time we spoke it was to my understanding that Ms. Rabagos did not have a sponsoring physician with hospital privileges for a Christus facility. This is one of the requirements to bring this provider group back on board with a new contract.  Is there a sponsor/supervising physician who has hospital affiliations at a Christus Facility that Ms. Rabagos will be utilizing?  Vicki Ann Guerra  Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  Sent following reply:  \"Hello Vicki,   I appreciate the update, would you be able to check again if David Gray (NPI# 1902814874) now has hospital privileges with a Christus facility?   Thank you. \" ', NULL, NULL, '2021-07-01 13:47:14', '2021-07-01 13:47:14'),
(30379, 1006, 23345, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Sent following email to Vicki @ Guerra, Vicki A. vicki.guerra@christushealth.org:  Sub: Hospital Privileges - Gray  \"Hello Vicki,   I apologize for the incorrect information, the correct supervising physician for Katherine is Luis Leyton Gonzalez (NPI# 1013911601), please look into this provider instead.   Thank you. \"', NULL, NULL, '2021-07-12 13:30:09', '2021-07-12 13:30:09'),
(30380, 1006, 23345, NULL, '2021-08-09 00:00:00.000', 'In Process', 'We received the following reply from vicki.guerra@christushealth.org:  Sub: vicki.guerra@christushealth.org  \"Hi Brad,  Happy Tuesday!  Can I have the last 4 of Dr. Leyton Gonzalez SS? This is the only way for me to verify in the portal along with NPI.  Thanks,  Vicki Ann Guerra Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  I replied with the requested information to her.', NULL, NULL, '2021-08-02 17:06:36', '2021-08-02 17:06:36'),
(30381, 1006, 23345, NULL, '2021-08-12 00:00:00.000', 'Not Eligible', 'Received the following denial notification:  Sub: Denial Letter CSHN: STATCARE Contract  \"August 3, 2021  STATCARE Administrator/Owner Rabagos C/O – Office Manager  Dear Administrator and Owner Rabagos (OM), Thank you for your continuous efforts to participate in the Christus Spohn Health Network. Currently to contract with CSHN, Ms. Rabagos will need to have a sponsoring physician to participate in the network. The requirement for a sponsoring physician is to have and maintain  hospital affiliations/memberships with a Christus facility as per Article 5.5 in CSHNs contract agreement and Section I, Article III, Section(s) 3.2-1 and 3.6. CSHN would love to see STACARE back on the Spohn Network directory. Until this criterion for a sponsoring physician is met with hospital affiliations/memberships with a Christus facility CSHN cannot extend a contract.  Locations: STATCARE Kingsville 500 E Caesar Ave, Kingsville Texas 78363 STATCARE Calallen 4042 River Hill Drive Corpus Christi Texas 78410 STATCARE Corpus Christi Southside 6646 S Staples St #122 Corpus Christi Texas 78413 STATCARE Corpus Christi SPID 3817 S. Padre Island Dr. Corpus Christi Texas 78415 STATCARE Rockport 2102 FM 2165 Rockport Texas 78382  Have a blessed and wonderful day. Sincerely,  Vicki Ann Guerra Provider Relations Representative\"', NULL, NULL, '2021-08-05 09:46:02', '2021-08-05 09:46:02'),
(30382, 11056, 23345, NULL, '2021-10-07 00:00:00.000', 'Approved', 'There is no need to enrolled the provider in Ancillary contract.', NULL, NULL, '2021-09-30 13:38:09', '2021-09-30 13:38:09'),
(30383, 1006, 23346, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 09:02:10', '2021-03-25 09:02:10'),
(30384, 1006, 23346, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Sent following enrollment request email @ CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,   I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?   Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.   Thank you. \" ', NULL, NULL, '2021-04-08 18:48:39', '2021-04-08 18:48:39'),
(30385, 9057, 23346, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent following email to CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Status - RHC - Christus Spohn  \"Hello, We want to know the current status of the request we sent to you last month about the enrollment for the following group and its providers:  Group Name: Statcare Minor Emergency Clinic NPI#  1689924904  TIN#  46-0575924  Please get back to us as soon as possible.  Thank you\"', NULL, NULL, '2021-05-25 10:11:35', '2021-05-25 10:11:35'),
(30386, 1006, 23346, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent a VM to Vicki Gera @ (800) 419-3461 as we haven\'t been receiving any replies on emails. ', NULL, NULL, '2021-06-11 14:13:07', '2021-06-11 14:13:07'),
(30387, 3040, 23346, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email sent to: vicki.guerra@christushealth.org  Subject:  Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,  I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?  Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-30 15:21:11', '2021-06-30 15:21:11'),
(30388, 1006, 23346, NULL, '2021-07-08 00:00:00.000', 'In Process', 'We received the following update from vicki.guerra@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hi Adil,  Happy Wednesday!  Thank you for reaching out. We would like for Statcare Minor Emergency Clinic to come back on board. The last time we spoke it was to my understanding that Ms. Rabagos did not have a sponsoring physician with hospital privileges for a Christus facility. This is one of the requirements to bring this provider group back on board with a new contract.  Is there a sponsor/supervising physician who has hospital affiliations at a Christus Facility that Ms. Rabagos will be utilizing?  Vicki Ann Guerra  Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  Sent following reply:  \"Hello Vicki,   I appreciate the update, would you be able to check again if David Gray (NPI# 1902814874) now has hospital privileges with a Christus facility?   Thank you. \" ', NULL, NULL, '2021-07-01 13:47:17', '2021-07-01 13:47:17'),
(30389, 1006, 23346, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Sent following email to Vicki @ Guerra, Vicki A. vicki.guerra@christushealth.org:  Sub: Hospital Privileges - Gray  \"Hello Vicki,   I apologize for the incorrect information, the correct supervising physician for Katherine is Luis Leyton Gonzalez (NPI# 1013911601), please look into this provider instead.   Thank you. \"', NULL, NULL, '2021-07-12 13:30:12', '2021-07-12 13:30:12'),
(30390, 1006, 23346, NULL, '2021-08-09 00:00:00.000', 'In Process', 'We received the following reply from vicki.guerra@christushealth.org:  Sub: vicki.guerra@christushealth.org  \"Hi Brad,  Happy Tuesday!  Can I have the last 4 of Dr. Leyton Gonzalez SS? This is the only way for me to verify in the portal along with NPI.  Thanks,  Vicki Ann Guerra Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  I replied with the requested information to her.', NULL, NULL, '2021-08-02 17:06:33', '2021-08-02 17:06:33'),
(30391, 1006, 23346, NULL, '2021-08-12 00:00:00.000', 'Not Eligible', 'Received the following denial notification:  Sub: Denial Letter CSHN: STATCARE Contract  \"August 3, 2021  STATCARE Administrator/Owner Rabagos C/O – Office Manager  Dear Administrator and Owner Rabagos (OM), Thank you for your continuous efforts to participate in the Christus Spohn Health Network. Currently to contract with CSHN, Ms. Rabagos will need to have a sponsoring physician to participate in the network. The requirement for a sponsoring physician is to have and maintain  hospital affiliations/memberships with a Christus facility as per Article 5.5 in CSHNs contract agreement and Section I, Article III, Section(s) 3.2-1 and 3.6. CSHN would love to see STACARE back on the Spohn Network directory. Until this criterion for a sponsoring physician is met with hospital affiliations/memberships with a Christus facility CSHN cannot extend a contract.  Locations: STATCARE Kingsville 500 E Caesar Ave, Kingsville Texas 78363 STATCARE Calallen 4042 River Hill Drive Corpus Christi Texas 78410 STATCARE Corpus Christi Southside 6646 S Staples St #122 Corpus Christi Texas 78413 STATCARE Corpus Christi SPID 3817 S. Padre Island Dr. Corpus Christi Texas 78415 STATCARE Rockport 2102 FM 2165 Rockport Texas 78382  Have a blessed and wonderful day. Sincerely,  Vicki Ann Guerra Provider Relations Representative\"', NULL, NULL, '2021-08-05 09:45:57', '2021-08-05 09:45:57'),
(30392, 11056, 23346, NULL, '2021-10-07 00:00:00.000', 'Approved', 'There is no need to enrolled the provider in Ancillary contract.', NULL, NULL, '2021-09-30 13:38:56', '2021-09-30 13:38:56'),
(30393, 1006, 23347, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 09:02:11', '2021-03-25 09:02:11'),
(30394, 1006, 23347, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Sent following enrollment request email @ CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,   I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?   Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.   Thank you. \" ', NULL, NULL, '2021-04-08 18:48:43', '2021-04-08 18:48:43'),
(30395, 9057, 23347, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent following email to CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Status - RHC - Christus Spohn  \"Hello, We want to know the current status of the request we sent to you last month about the enrollment for the following group and its providers:  Group Name: Statcare Minor Emergency Clinic NPI#  1689924904  TIN#  46-0575924  Please get back to us as soon as possible.  Thank you\"', NULL, NULL, '2021-05-25 10:11:45', '2021-05-25 10:11:45'),
(30396, 1006, 23347, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent a VM to Vicki Gera @ (800) 419-3461 as we haven\'t been receiving any replies on emails. ', NULL, NULL, '2021-06-11 14:13:03', '2021-06-11 14:13:03'),
(30397, 3040, 23347, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email sent to: vicki.guerra@christushealth.org  Subject:  Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,  I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?  Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-30 15:21:11', '2021-06-30 15:21:11'),
(30398, 1006, 23347, NULL, '2021-07-08 00:00:00.000', 'In Process', 'We received the following update from vicki.guerra@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hi Adil,  Happy Wednesday!  Thank you for reaching out. We would like for Statcare Minor Emergency Clinic to come back on board. The last time we spoke it was to my understanding that Ms. Rabagos did not have a sponsoring physician with hospital privileges for a Christus facility. This is one of the requirements to bring this provider group back on board with a new contract.  Is there a sponsor/supervising physician who has hospital affiliations at a Christus Facility that Ms. Rabagos will be utilizing?  Vicki Ann Guerra  Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  Sent following reply:  \"Hello Vicki,   I appreciate the update, would you be able to check again if David Gray (NPI# 1902814874) now has hospital privileges with a Christus facility?   Thank you. \" ', NULL, NULL, '2021-07-01 13:47:20', '2021-07-01 13:47:20'),
(30399, 1006, 23347, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Sent following email to Vicki @ Guerra, Vicki A. vicki.guerra@christushealth.org:  Sub: Hospital Privileges - Gray  \"Hello Vicki,   I apologize for the incorrect information, the correct supervising physician for Katherine is Luis Leyton Gonzalez (NPI# 1013911601), please look into this provider instead.   Thank you. \"', NULL, NULL, '2021-07-12 13:30:16', '2021-07-12 13:30:16'),
(30400, 1006, 23347, NULL, '2021-08-09 00:00:00.000', 'In Process', 'We received the following reply from vicki.guerra@christushealth.org:  Sub: vicki.guerra@christushealth.org  \"Hi Brad,  Happy Tuesday!  Can I have the last 4 of Dr. Leyton Gonzalez SS? This is the only way for me to verify in the portal along with NPI.  Thanks,  Vicki Ann Guerra Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  I replied with the requested information to her.', NULL, NULL, '2021-08-02 17:06:29', '2021-08-02 17:06:29'),
(30401, 1006, 23347, NULL, '2021-08-12 00:00:00.000', 'Not Eligible', 'Received the following denial notification:  Sub: Denial Letter CSHN: STATCARE Contract  \"August 3, 2021  STATCARE Administrator/Owner Rabagos C/O – Office Manager  Dear Administrator and Owner Rabagos (OM), Thank you for your continuous efforts to participate in the Christus Spohn Health Network. Currently to contract with CSHN, Ms. Rabagos will need to have a sponsoring physician to participate in the network. The requirement for a sponsoring physician is to have and maintain  hospital affiliations/memberships with a Christus facility as per Article 5.5 in CSHNs contract agreement and Section I, Article III, Section(s) 3.2-1 and 3.6. CSHN would love to see STACARE back on the Spohn Network directory. Until this criterion for a sponsoring physician is met with hospital affiliations/memberships with a Christus facility CSHN cannot extend a contract.  Locations: STATCARE Kingsville 500 E Caesar Ave, Kingsville Texas 78363 STATCARE Calallen 4042 River Hill Drive Corpus Christi Texas 78410 STATCARE Corpus Christi Southside 6646 S Staples St #122 Corpus Christi Texas 78413 STATCARE Corpus Christi SPID 3817 S. Padre Island Dr. Corpus Christi Texas 78415 STATCARE Rockport 2102 FM 2165 Rockport Texas 78382  Have a blessed and wonderful day. Sincerely,  Vicki Ann Guerra Provider Relations Representative\"', NULL, NULL, '2021-08-05 09:45:54', '2021-08-05 09:45:54'),
(30402, 11056, 23347, NULL, '2021-10-07 00:00:00.000', 'Approved', 'There is no need to enrolled the provider in Ancillary contract.', NULL, NULL, '2021-09-30 13:39:06', '2021-09-30 13:39:06'),
(30403, 1006, 23348, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 09:02:12', '2021-03-25 09:02:12'),
(30404, 1006, 23348, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Sent following enrollment request email @ CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,   I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?   Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.   Thank you. \" ', NULL, NULL, '2021-04-08 18:48:46', '2021-04-08 18:48:46'),
(30405, 9057, 23348, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent following email to CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Status - RHC - Christus Spohn  \"Hello, We want to know the current status of the request we sent to you last month about the enrollment for the following group and its providers:  Group Name: Statcare Minor Emergency Clinic NPI#  1689924904  TIN#  46-0575924  Please get back to us as soon as possible.  Thank you\"', NULL, NULL, '2021-05-25 10:13:06', '2021-05-25 10:13:06'),
(30406, 1006, 23348, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent a VM to Vicki Gera @ (800) 419-3461 as we haven\'t been receiving any replies on emails. ', NULL, NULL, '2021-06-11 14:13:00', '2021-06-11 14:13:00'),
(30407, 3040, 23348, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email sent to: vicki.guerra@christushealth.org  Subject:  Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,  I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?  Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-30 15:21:10', '2021-06-30 15:21:10'),
(30408, 1006, 23348, NULL, '2021-07-08 00:00:00.000', 'In Process', 'We received the following update from vicki.guerra@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hi Adil,  Happy Wednesday!  Thank you for reaching out. We would like for Statcare Minor Emergency Clinic to come back on board. The last time we spoke it was to my understanding that Ms. Rabagos did not have a sponsoring physician with hospital privileges for a Christus facility. This is one of the requirements to bring this provider group back on board with a new contract.  Is there a sponsor/supervising physician who has hospital affiliations at a Christus Facility that Ms. Rabagos will be utilizing?  Vicki Ann Guerra  Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  Sent following reply:  \"Hello Vicki,   I appreciate the update, would you be able to check again if David Gray (NPI# 1902814874) now has hospital privileges with a Christus facility?   Thank you. \" ', NULL, NULL, '2021-07-01 13:47:24', '2021-07-01 13:47:24'),
(30409, 1006, 23348, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Sent following email to Vicki @ Guerra, Vicki A. vicki.guerra@christushealth.org:  Sub: Hospital Privileges - Gray  \"Hello Vicki,   I apologize for the incorrect information, the correct supervising physician for Katherine is Luis Leyton Gonzalez (NPI# 1013911601), please look into this provider instead.   Thank you. \"', NULL, NULL, '2021-07-12 13:30:20', '2021-07-12 13:30:20'),
(30410, 1006, 23348, NULL, '2021-08-09 00:00:00.000', 'In Process', 'We received the following reply from vicki.guerra@christushealth.org:  Sub: vicki.guerra@christushealth.org  \"Hi Brad,  Happy Tuesday!  Can I have the last 4 of Dr. Leyton Gonzalez SS? This is the only way for me to verify in the portal along with NPI.  Thanks,  Vicki Ann Guerra Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  I replied with the requested information to her.', NULL, NULL, '2021-08-02 17:06:25', '2021-08-02 17:06:25'),
(30411, 1006, 23348, NULL, '2021-08-12 00:00:00.000', 'Not Eligible', 'Received the following denial notification:  Sub: Denial Letter CSHN: STATCARE Contract  \"August 3, 2021  STATCARE Administrator/Owner Rabagos C/O – Office Manager  Dear Administrator and Owner Rabagos (OM), Thank you for your continuous efforts to participate in the Christus Spohn Health Network. Currently to contract with CSHN, Ms. Rabagos will need to have a sponsoring physician to participate in the network. The requirement for a sponsoring physician is to have and maintain  hospital affiliations/memberships with a Christus facility as per Article 5.5 in CSHNs contract agreement and Section I, Article III, Section(s) 3.2-1 and 3.6. CSHN would love to see STACARE back on the Spohn Network directory. Until this criterion for a sponsoring physician is met with hospital affiliations/memberships with a Christus facility CSHN cannot extend a contract.  Locations: STATCARE Kingsville 500 E Caesar Ave, Kingsville Texas 78363 STATCARE Calallen 4042 River Hill Drive Corpus Christi Texas 78410 STATCARE Corpus Christi Southside 6646 S Staples St #122 Corpus Christi Texas 78413 STATCARE Corpus Christi SPID 3817 S. Padre Island Dr. Corpus Christi Texas 78415 STATCARE Rockport 2102 FM 2165 Rockport Texas 78382  Have a blessed and wonderful day. Sincerely,  Vicki Ann Guerra Provider Relations Representative\"', NULL, NULL, '2021-08-05 09:45:45', '2021-08-05 09:45:45'),
(30412, 11056, 23348, NULL, '2021-10-07 00:00:00.000', 'Approved', 'There is no need to enrolled the provider in Ancillary contract.', NULL, NULL, '2021-09-30 13:39:12', '2021-09-30 13:39:12'),
(30413, 1006, 23369, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 09:09:13', '2021-03-25 09:09:13');
