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
(18663, 20067, 21480, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: latina.small@anthem.com, nena.graves@amerigroup.com  Sub: Re: {EXTERNAL} Re: || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Good Morning!  Eagerly waiting for your response. Kindly respond promptly,  Thank you,', NULL, NULL, '2022-01-28 11:57:38', '2022-01-28 11:57:38'),
(18664, 20067, 21480, NULL, '2022-02-15 00:00:00.000', 'In Process', 'Email received from: latina.small@anthem.com  Sub: Re: {EXTERNAL} Re: || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||   Good Afternoon,     Sincere apologies for any delays. Please see the status for the providers below. If any providers need to be added to the group, please complete the attached LOI and Group App form and return to credentialing with a W9.        Group Name  Longpoint Medical Center  Tax ID  76-0612416  Group NPI  1770763815  Practice Location  9504 LONG POINT RD STE E Houston , TX 77055-4226     Provider Name     NPI  Amerigroup Status Update  Fernandus, Limy     1972005189  PAR - PR ID 12190801; Effective Date 11/11/2021(Medicaid, Medicare, CHIP)  PAUL, SIGI     1033623616  Non PAR  Jacob, Jaya     1194336149  Non PAR  Abraham, Jeena     1467901587  Non PAR  Thomas, Cini     1134777238  Non PAR  Kourouma , Odette Tiranke     1134525868  Non PAR  Rauf, Abdur     1497726202  PAR – PR ID 10007623; Effective Date 3/1/2012 (Medicaid, Medicare, CHIP, MMP)  Joseph, Molly     1396380077  Non PAR  John, Jeny     1073019493  Non PAR  Stephen, Ani     1588959118  Non PAR  Brown, Brittany     1275163537  Non PAR  Joseph, Vibitha     1952931560  PAR – PR ID 09743760; Effective Date 4/27/2020 (Medicare)  George, Jeemol     1497219067  Non PAR  Jose, Julie     1447883061  Non PAR  Abraham, Glory     1194206490  PAR – PR ID 08200815; Effective Date 10/01/2019 (Medicare)  Chennemkara, Mini Philip     1841755956  Non PAR  Piccione JR, James M     1356321509  Non PAR        Thank You in Advance,     Latina Small, MBA, BSBM', NULL, NULL, '2022-02-08 13:12:54', '2022-02-08 13:12:54'),
(18665, 20067, 21480, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com CC: latina.small@anthem.com  Sub: LOI and Group App || Longpoint Medical Center || Providers || Amerigroup  Good Afternoon!  Hope you had a great weekend. Attached are the LOI and Group App for Non-par Providers along with W9.  Kindly let me know if anything else is required from my end.  Regards, ', NULL, NULL, '2022-02-21 13:42:35', '2022-02-21 13:42:35'),
(18666, 20067, 21480, NULL, '2022-03-15 00:00:00.000', 'In Process', 'Secure Email received from:  TX Credentialing  Sub: RE: FW: {EXTERNAL} LOI and Group App || Longpoint Medical Center || Providers || Amerigroup  the LOI has a mix match of the group name with the tax ID.     There is one tax ID listed on the LOI, the group name should correspond to the tax ID.', NULL, NULL, '2022-03-08 09:25:24', '2022-03-08 09:25:24'),
(18667, 20067, 21480, NULL, '2022-03-15 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Sub:   Good Morning!  Attached are the LOI and Group applications for the providers.  Let me know if anything else is required from my end.  Thank you,', NULL, NULL, '2022-03-08 09:55:39', '2022-03-08 09:55:39'),
(18668, 20067, 21480, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com, latina.small@anthem.com   Sub:  Re: LOI and Group App || Longpoint Medical Center || Providers || Amerigroup  Good Morning!  Hope this email finds you in good health. Any updates on the Submitted LOIs of Longpoint Medical Center providers.  Thank you, Syed', NULL, NULL, '2022-03-17 10:02:50', '2022-03-17 10:02:50'),
(18669, 20067, 21480, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email received from: TXCredentialing@amerigroup.com   Sub: FW: {EXTERNAL} Re: LOI and Group App || Longpoint Medical Center || Providers || Amerigroup  Those were received and pending completion.     Check back in 7 business days', NULL, NULL, '2022-03-17 16:41:54', '2022-03-17 16:41:54'),
(18670, 3040, 21481, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 09:49:20', '2021-03-16 09:49:20'),
(18671, 3040, 21481, NULL, '2021-05-31 00:00:00.000', 'In Process', 'Email sent to: vipproviders@anci-care.com, pr.south@healthsmart.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Greetings,   Hope you are doing well . I wanted to know the enrollment status for the below mentioned group & providers under below locations.   Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-05-24 15:54:25', '2021-05-24 15:54:25'),
(18672, 3040, 21481, NULL, '2021-06-17 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Greetings,  Hope you are doing well. Please find the attached requested forms as per above email requested along with the W9.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-10 14:09:19', '2021-06-10 14:09:19'),
(18673, 3040, 21481, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Health Smart for our group under the below location.   Practice Details: Practice Name: Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 2:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 6:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-28 14:37:45', '2021-06-28 14:37:45'),
(18674, 3040, 21481, NULL, '2021-07-20 00:00:00.000', 'Approved', 'As per Jennifer email the group is participating with Anci Care. For more details please see attachment. ', NULL, NULL, '2021-07-13 13:19:38', '2021-07-13 13:19:38'),
(18675, 3040, 21482, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 09:49:48', '2021-03-16 09:49:48'),
(18676, 3040, 21482, NULL, '2021-05-31 00:00:00.000', 'In Process', 'Email sent to: vipproviders@anci-care.com, pr.south@healthsmart.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Greetings,   Hope you are doing well . I wanted to know the enrollment status for the below mentioned group & providers under below locations.   Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-05-24 15:54:35', '2021-05-24 15:54:35'),
(18677, 3040, 21482, NULL, '2021-06-17 00:00:00.000', 'In Process', 'Email rcvd from: mdiprsupport@healthsmart.com  Subject: Fw: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Hi,  1. Please see below providers effective date. Providers Name                                                     Effective Date GEORGE, JEEMOL                                                      03/11/2020 JOSE, JULIE                                                                  03/11/2020 PICCIONE JR, JAMES M                                              12/01/2018 BROWN, BRITTANY                                                    01/24/2020 ABRAHAM, GLORY                                                     09/01/2019 FERNANDUS, LIMY                                                     12/01/2020 KOUROUMA, ODETTE T                                            02/01/2020 JOSEPH, VIBITHA                                                        02/05/2020 THOMAS, CINI                                                            02/01/2020   2. Provider not found in the system. Please complete the attached CAQH Access form and send w9 to begin credentialing.  Providers Name Stephen, Ani Chennemkara, Mini Philip  Rauf, Abdur JEENA ABRAHAM,  3. We currently show the following provider(s) credentialed with HealthSmart.  Please complete the attached demographic information form and return so we may add your group information to the provider’s record.  Providers Name Paul, Sigi C NP Jacob, Jaya NP   All communication, including requested documents should be sent to pr.south@healthsmart.com. Please do not submit to MDIPR@healthsmart.com  (Inventory Log ID : 80648)  Thanks Healthsmart Provider Relations.', NULL, NULL, '2021-06-10 13:51:12', '2021-06-10 13:51:12'),
(18678, 3040, 21482, NULL, '2021-06-17 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Greetings,  Hope you are doing well. Please find the attached requested forms as per above email requested along with the W9.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-10 13:52:26', '2021-06-10 13:52:26'),
(18679, 3040, 21482, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Health Smart for our group under the below location.   Practice Details: Practice Name: Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 2:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 6:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-28 14:37:42', '2021-06-28 14:37:42'),
(18680, 3040, 21482, NULL, '2021-07-20 00:00:00.000', 'Approved', 'Group has an ancillary contract no need to add individual providers. Please see group task. ', NULL, NULL, '2021-07-13 13:21:12', '2021-07-13 13:21:12'),
(18681, 3040, 21483, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 09:50:27', '2021-03-16 09:50:27'),
(18682, 3040, 21483, NULL, '2021-05-31 00:00:00.000', 'In Process', 'Email sent to: vipproviders@anci-care.com, pr.south@healthsmart.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Greetings,   Hope you are doing well . I wanted to know the enrollment status for the below mentioned group & providers under below locations.   Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-05-24 15:54:39', '2021-05-24 15:54:39'),
(18683, 3040, 21483, NULL, '2021-06-17 00:00:00.000', 'Approved', 'Email rcvd from: mdiprsupport@healthsmart.com  Subject: Fw: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Hi,  1. Please see below providers effective date. Providers Name                                                     Effective Date GEORGE, JEEMOL                                                      03/11/2020 JOSE, JULIE                                                                  03/11/2020 PICCIONE JR, JAMES M                                              12/01/2018 BROWN, BRITTANY                                                    01/24/2020 ABRAHAM, GLORY                                                     09/01/2019 FERNANDUS, LIMY                                                     12/01/2020 KOUROUMA, ODETTE T                                            02/01/2020 JOSEPH, VIBITHA                                                        02/05/2020 THOMAS, CINI                                                            02/01/2020', NULL, NULL, '2021-06-10 14:02:01', '2021-06-10 14:02:01'),
(18684, 3040, 21484, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 09:51:08', '2021-03-16 09:51:08'),
(18685, 3040, 21484, NULL, '2021-05-31 00:00:00.000', 'In Process', 'Email sent to: vipproviders@anci-care.com, pr.south@healthsmart.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Greetings,   Hope you are doing well . I wanted to know the enrollment status for the below mentioned group & providers under below locations.   Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-05-24 15:54:44', '2021-05-24 15:54:44'),
(18686, 3040, 21484, NULL, '2021-06-17 00:00:00.000', 'Approved', 'Email rcvd from: mdiprsupport@healthsmart.com  Subject: Fw: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Hi,  1. Please see below providers effective date. Providers Name                                                     Effective Date GEORGE, JEEMOL                                                      03/11/2020 JOSE, JULIE                                                                  03/11/2020 PICCIONE JR, JAMES M                                              12/01/2018 BROWN, BRITTANY                                                    01/24/2020 ABRAHAM, GLORY                                                     09/01/2019 FERNANDUS, LIMY                                                     12/01/2020 KOUROUMA, ODETTE T                                            02/01/2020 JOSEPH, VIBITHA                                                        02/05/2020 THOMAS, CINI                                                            02/01/2020', NULL, NULL, '2021-06-10 14:01:50', '2021-06-10 14:01:50'),
(18687, 3040, 21485, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 09:51:23', '2021-03-16 09:51:23'),
(18688, 3040, 21485, NULL, '2021-05-31 00:00:00.000', 'In Process', 'Email sent to: vipproviders@anci-care.com, pr.south@healthsmart.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Greetings,   Hope you are doing well . I wanted to know the enrollment status for the below mentioned group & providers under below locations.   Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-05-24 15:54:47', '2021-05-24 15:54:47'),
(18689, 3040, 21485, NULL, '2021-06-17 00:00:00.000', 'Approved', 'Email rcvd from: mdiprsupport@healthsmart.com  Subject: Fw: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Hi,  1. Please see below providers effective date. Providers Name                                                     Effective Date GEORGE, JEEMOL                                                      03/11/2020 JOSE, JULIE                                                                  03/11/2020 PICCIONE JR, JAMES M                                              12/01/2018 BROWN, BRITTANY                                                    01/24/2020 ABRAHAM, GLORY                                                     09/01/2019 FERNANDUS, LIMY                                                     12/01/2020 KOUROUMA, ODETTE T                                            02/01/2020 JOSEPH, VIBITHA                                                        02/05/2020 THOMAS, CINI                                                            02/01/2020', NULL, NULL, '2021-06-10 14:01:34', '2021-06-10 14:01:34'),
(18690, 3040, 21486, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 09:51:46', '2021-03-16 09:51:46'),
(18691, 3040, 21486, NULL, '2021-05-31 00:00:00.000', 'In Process', 'Email sent to: vipproviders@anci-care.com, pr.south@healthsmart.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Greetings,   Hope you are doing well . I wanted to know the enrollment status for the below mentioned group & providers under below locations.   Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-05-24 15:54:52', '2021-05-24 15:54:52'),
(18692, 3040, 21486, NULL, '2021-06-17 00:00:00.000', 'In Process', 'Email rcvd from: mdiprsupport@healthsmart.com  Subject: Fw: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Hi,  1. Please see below providers effective date. Providers Name                                                     Effective Date GEORGE, JEEMOL                                                      03/11/2020 JOSE, JULIE                                                                  03/11/2020 PICCIONE JR, JAMES M                                              12/01/2018 BROWN, BRITTANY                                                    01/24/2020 ABRAHAM, GLORY                                                     09/01/2019 FERNANDUS, LIMY                                                     12/01/2020 KOUROUMA, ODETTE T                                            02/01/2020 JOSEPH, VIBITHA                                                        02/05/2020 THOMAS, CINI                                                            02/01/2020   2. Provider not found in the system. Please complete the attached CAQH Access form and send w9 to begin credentialing.  Providers Name Stephen, Ani Chennemkara, Mini Philip  Rauf, Abdur JEENA ABRAHAM,  3. We currently show the following provider(s) credentialed with HealthSmart.  Please complete the attached demographic information form and return so we may add your group information to the provider’s record.  Providers Name Paul, Sigi C NP Jacob, Jaya NP   All communication, including requested documents should be sent to pr.south@healthsmart.com. Please do not submit to MDIPR@healthsmart.com  (Inventory Log ID : 80648)  Thanks Healthsmart Provider Relations.', NULL, NULL, '2021-06-10 13:50:07', '2021-06-10 13:50:07'),
(18693, 3040, 21486, NULL, '2021-06-17 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Greetings,  Hope you are doing well. Please find the attached requested forms as per above email requested along with the W9.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-10 13:52:07', '2021-06-10 13:52:07'),
(18694, 3040, 21486, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Health Smart for our group under the below location.   Practice Details: Practice Name: Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 2:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 6:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-28 14:37:39', '2021-06-28 14:37:39'),
(18695, 3040, 21486, NULL, '2021-07-20 00:00:00.000', 'Approved', 'Group has an ancillary contract no need to add individual providers. Please see group task. ', NULL, NULL, '2021-07-13 13:21:12', '2021-07-13 13:21:12'),
(18696, 3040, 21487, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 09:52:12', '2021-03-16 09:52:12'),
(18697, 3040, 21487, NULL, '2021-05-31 00:00:00.000', 'In Process', 'Email sent to: vipproviders@anci-care.com, pr.south@healthsmart.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Greetings,   Hope you are doing well . I wanted to know the enrollment status for the below mentioned group & providers under below locations.   Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-05-24 15:54:55', '2021-05-24 15:54:55'),
(18698, 3040, 21487, NULL, '2021-06-17 00:00:00.000', 'Approved', 'Email rcvd from: mdiprsupport@healthsmart.com  Subject: Fw: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Hi,  1. Please see below providers effective date. Providers Name                                                     Effective Date GEORGE, JEEMOL                                                      03/11/2020 JOSE, JULIE                                                                  03/11/2020 PICCIONE JR, JAMES M                                              12/01/2018 BROWN, BRITTANY                                                    01/24/2020 ABRAHAM, GLORY                                                     09/01/2019 FERNANDUS, LIMY                                                     12/01/2020 KOUROUMA, ODETTE T                                            02/01/2020 JOSEPH, VIBITHA                                                        02/05/2020 THOMAS, CINI                                                            02/01/2020', NULL, NULL, '2021-06-10 14:01:16', '2021-06-10 14:01:16'),
(18699, 3040, 21488, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 09:52:27', '2021-03-16 09:52:27'),
(18700, 3040, 21488, NULL, '2021-05-31 00:00:00.000', 'In Process', 'Email sent to: vipproviders@anci-care.com, pr.south@healthsmart.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Greetings,   Hope you are doing well . I wanted to know the enrollment status for the below mentioned group & providers under below locations.   Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-05-24 15:55:00', '2021-05-24 15:55:00'),
(18701, 3040, 21488, NULL, '2021-06-17 00:00:00.000', 'Approved', 'Email rcvd from: mdiprsupport@healthsmart.com  Subject: Fw: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Hi,  1. Please see below providers effective date. Providers Name                                                     Effective Date GEORGE, JEEMOL                                                      03/11/2020 JOSE, JULIE                                                                  03/11/2020 PICCIONE JR, JAMES M                                              12/01/2018 BROWN, BRITTANY                                                    01/24/2020 ABRAHAM, GLORY                                                     09/01/2019 FERNANDUS, LIMY                                                     12/01/2020 KOUROUMA, ODETTE T                                            02/01/2020 JOSEPH, VIBITHA                                                        02/05/2020 THOMAS, CINI                                                            02/01/2020', NULL, NULL, '2021-06-10 14:00:52', '2021-06-10 14:00:52'),
(18702, 3040, 21489, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 09:52:48', '2021-03-16 09:52:48'),
(18703, 3040, 21489, NULL, '2021-05-31 00:00:00.000', 'In Process', 'Email sent to: vipproviders@anci-care.com, pr.south@healthsmart.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Greetings,   Hope you are doing well . I wanted to know the enrollment status for the below mentioned group & providers under below locations.   Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-05-24 15:55:03', '2021-05-24 15:55:03'),
(18704, 3040, 21489, NULL, '2021-06-17 00:00:00.000', 'Approved', 'Email rcvd from: mdiprsupport@healthsmart.com  Subject: Fw: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Hi,  1. Please see below providers effective date. Providers Name                                                     Effective Date GEORGE, JEEMOL                                                      03/11/2020 JOSE, JULIE                                                                  03/11/2020 PICCIONE JR, JAMES M                                              12/01/2018 BROWN, BRITTANY                                                    01/24/2020 ABRAHAM, GLORY                                                     09/01/2019 FERNANDUS, LIMY                                                     12/01/2020 KOUROUMA, ODETTE T                                            02/01/2020 JOSEPH, VIBITHA                                                        02/05/2020 THOMAS, CINI                                                            02/01/2020', NULL, NULL, '2021-06-10 14:00:45', '2021-06-10 14:00:45'),
(18705, 3040, 21490, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 09:53:03', '2021-03-16 09:53:03'),
(18706, 3040, 21490, NULL, '2021-05-31 00:00:00.000', 'In Process', 'Email sent to: vipproviders@anci-care.com, pr.south@healthsmart.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Greetings,   Hope you are doing well . I wanted to know the enrollment status for the below mentioned group & providers under below locations.   Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-05-24 15:55:07', '2021-05-24 15:55:07'),
(18707, 3040, 21490, NULL, '2021-06-17 00:00:00.000', 'Approved', 'Email rcvd from: mdiprsupport@healthsmart.com  Subject: Fw: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Hi,  1. Please see below providers effective date. Providers Name                                                     Effective Date GEORGE, JEEMOL                                                      03/11/2020 JOSE, JULIE                                                                  03/11/2020 PICCIONE JR, JAMES M                                              12/01/2018 BROWN, BRITTANY                                                    01/24/2020 ABRAHAM, GLORY                                                     09/01/2019 FERNANDUS, LIMY                                                     12/01/2020 KOUROUMA, ODETTE T                                            02/01/2020 JOSEPH, VIBITHA                                                        02/05/2020 THOMAS, CINI                                                            02/01/2020', NULL, NULL, '2021-06-10 14:00:16', '2021-06-10 14:00:16'),
(18708, 3040, 21491, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 09:53:17', '2021-03-16 09:53:17'),
(18709, 3040, 21491, NULL, '2021-05-31 00:00:00.000', 'In Process', 'Email sent to: vipproviders@anci-care.com, pr.south@healthsmart.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Greetings,   Hope you are doing well . I wanted to know the enrollment status for the below mentioned group & providers under below locations.   Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-05-24 15:55:11', '2021-05-24 15:55:11'),
(18710, 3040, 21491, NULL, '2021-06-17 00:00:00.000', 'Approved', 'Email rcvd from: mdiprsupport@healthsmart.com  Subject: Fw: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Hi,  1. Please see below providers effective date. Providers Name                                                     Effective Date GEORGE, JEEMOL                                                      03/11/2020 JOSE, JULIE                                                                  03/11/2020 PICCIONE JR, JAMES M                                              12/01/2018 BROWN, BRITTANY                                                    01/24/2020 ABRAHAM, GLORY                                                     09/01/2019 FERNANDUS, LIMY                                                     12/01/2020 KOUROUMA, ODETTE T                                            02/01/2020 JOSEPH, VIBITHA                                                        02/05/2020 THOMAS, CINI                                                            02/01/2020', NULL, NULL, '2021-06-10 13:59:56', '2021-06-10 13:59:56'),
(18711, 3040, 21492, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 09:53:35', '2021-03-16 09:53:35'),
(18712, 3040, 21492, NULL, '2021-05-31 00:00:00.000', 'In Process', 'Email sent to: vipproviders@anci-care.com, pr.south@healthsmart.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Greetings,   Hope you are doing well . I wanted to know the enrollment status for the below mentioned group & providers under below locations.   Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-05-24 15:55:15', '2021-05-24 15:55:15'),
(18713, 3040, 21492, NULL, '2021-06-17 00:00:00.000', 'In Process', 'Email rcvd from: mdiprsupport@healthsmart.com  Subject: Fw: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Hi,  1. Please see below providers effective date. Providers Name                                                     Effective Date GEORGE, JEEMOL                                                      03/11/2020 JOSE, JULIE                                                                  03/11/2020 PICCIONE JR, JAMES M                                              12/01/2018 BROWN, BRITTANY                                                    01/24/2020 ABRAHAM, GLORY                                                     09/01/2019 FERNANDUS, LIMY                                                     12/01/2020 KOUROUMA, ODETTE T                                            02/01/2020 JOSEPH, VIBITHA                                                        02/05/2020 THOMAS, CINI                                                            02/01/2020   2. Provider not found in the system. Please complete the attached CAQH Access form and send w9 to begin credentialing.  Providers Name Stephen, Ani Chennemkara, Mini Philip  Rauf, Abdur JEENA ABRAHAM,  3. We currently show the following provider(s) credentialed with HealthSmart.  Please complete the attached demographic information form and return so we may add your group information to the provider’s record.  Providers Name Paul, Sigi C NP Jacob, Jaya NP   All communication, including requested documents should be sent to pr.south@healthsmart.com. Please do not submit to MDIPR@healthsmart.com  (Inventory Log ID : 80648)  Thanks Healthsmart Provider Relations.', NULL, NULL, '2021-06-10 13:49:33', '2021-06-10 13:49:33'),
(18714, 3040, 21492, NULL, '2021-06-17 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Greetings,  Hope you are doing well. Please find the attached requested forms as per above email requested along with the W9.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-10 13:51:50', '2021-06-10 13:51:50'),
(18715, 3040, 21492, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Health Smart for our group under the below location.   Practice Details: Practice Name: Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 2:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 6:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-28 14:37:35', '2021-06-28 14:37:35'),
(18716, 3040, 21492, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Email rcvd from: mdiprsupport@healthsmart.com  Subject: Fw: Fw: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Hi,  1. \" ABRAHAM, JEENA NP \" is effective date \" 07/01/2021 \".', NULL, NULL, '2021-06-28 14:52:28', '2021-06-28 14:52:28'),
(18717, 3040, 21492, NULL, '2021-07-05 00:00:00.000', 'Approved', 'Email rcvd from: mdiprsupport@healthsmart.com  Subject: Fw: Fw: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Hi,  1. \" ABRAHAM, JEENA NP \" is effective date \" 07/01/2021 \".', NULL, NULL, '2021-06-28 14:55:02', '2021-06-28 14:55:02'),
(18718, 3040, 21493, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 09:53:50', '2021-03-16 09:53:50');
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
(18719, 3040, 21493, NULL, '2021-05-31 00:00:00.000', 'In Process', 'Email sent to: vipproviders@anci-care.com, pr.south@healthsmart.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Greetings,   Hope you are doing well . I wanted to know the enrollment status for the below mentioned group & providers under below locations.   Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-05-24 15:55:19', '2021-05-24 15:55:19'),
(18720, 1005, 21493, NULL, '2021-06-08 00:00:00.000', 'Not Eligible', 'Provider is no longer working for this Practice. Eff from 12/15/2020', NULL, NULL, '2021-06-01 13:01:48', '2021-06-01 13:01:48'),
(18721, 3040, 21494, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 09:54:02', '2021-03-16 09:54:02'),
(18722, 3040, 21494, NULL, '2021-05-31 00:00:00.000', 'In Process', 'Email sent to: vipproviders@anci-care.com, pr.south@healthsmart.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Greetings,   Hope you are doing well . I wanted to know the enrollment status for the below mentioned group & providers under below locations.   Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-05-24 15:55:23', '2021-05-24 15:55:23'),
(18723, 3040, 21494, NULL, '2021-06-17 00:00:00.000', 'In Process', 'Email rcvd from: mdiprsupport@healthsmart.com  Subject: Fw: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Hi,  1. Please see below providers effective date. Providers Name                                                     Effective Date GEORGE, JEEMOL                                                      03/11/2020 JOSE, JULIE                                                                  03/11/2020 PICCIONE JR, JAMES M                                              12/01/2018 BROWN, BRITTANY                                                    01/24/2020 ABRAHAM, GLORY                                                     09/01/2019 FERNANDUS, LIMY                                                     12/01/2020 KOUROUMA, ODETTE T                                            02/01/2020 JOSEPH, VIBITHA                                                        02/05/2020 THOMAS, CINI                                                            02/01/2020   2. Provider not found in the system. Please complete the attached CAQH Access form and send w9 to begin credentialing.  Providers Name Stephen, Ani Chennemkara, Mini Philip  Rauf, Abdur JEENA ABRAHAM,  3. We currently show the following provider(s) credentialed with HealthSmart.  Please complete the attached demographic information form and return so we may add your group information to the provider’s record.  Providers Name Paul, Sigi C NP Jacob, Jaya NP   All communication, including requested documents should be sent to pr.south@healthsmart.com. Please do not submit to MDIPR@healthsmart.com  (Inventory Log ID : 80648)  Thanks Healthsmart Provider Relations.', NULL, NULL, '2021-06-10 13:48:21', '2021-06-10 13:48:21'),
(18724, 3040, 21494, NULL, '2021-06-17 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Greetings,  Hope you are doing well. Please find the attached requested forms as per above email requested along with the W9.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-10 13:48:43', '2021-06-10 13:48:43'),
(18725, 3040, 21494, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Health Smart for our group under the below location.   Practice Details: Practice Name: Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 2:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 6:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-28 14:37:31', '2021-06-28 14:37:31'),
(18726, 3040, 21494, NULL, '2021-07-20 00:00:00.000', 'Approved', 'Group has an ancillary contract no need to add individual providers. Please see group task. ', NULL, NULL, '2021-07-13 13:21:11', '2021-07-13 13:21:11'),
(18727, 3040, 21495, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 09:54:13', '2021-03-16 09:54:13'),
(18728, 3040, 21495, NULL, '2021-05-31 00:00:00.000', 'In Process', 'Email sent to: vipproviders@anci-care.com, pr.south@healthsmart.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Greetings,   Hope you are doing well . I wanted to know the enrollment status for the below mentioned group & providers under below locations.   Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-05-24 15:55:27', '2021-05-24 15:55:27'),
(18729, 3040, 21495, NULL, '2021-06-17 00:00:00.000', 'Approved', 'Email rcvd from: mdiprsupport@healthsmart.com  Subject: Fw: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Hi,  1. Please see below providers effective date. Providers Name                                                     Effective Date GEORGE, JEEMOL                                                      03/11/2020 JOSE, JULIE                                                                  03/11/2020 PICCIONE JR, JAMES M                                              12/01/2018 BROWN, BRITTANY                                                    01/24/2020 ABRAHAM, GLORY                                                     09/01/2019 FERNANDUS, LIMY                                                     12/01/2020 KOUROUMA, ODETTE T                                            02/01/2020 JOSEPH, VIBITHA                                                        02/05/2020 THOMAS, CINI                                                            02/01/2020 ', NULL, NULL, '2021-06-10 13:39:35', '2021-06-10 13:39:35'),
(18730, 3040, 21496, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 09:54:25', '2021-03-16 09:54:25'),
(18731, 3040, 21496, NULL, '2021-05-31 00:00:00.000', 'In Process', 'Email sent to: vipproviders@anci-care.com, pr.south@healthsmart.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Greetings,   Hope you are doing well . I wanted to know the enrollment status for the below mentioned group & providers under below locations.   Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-05-24 15:55:31', '2021-05-24 15:55:31'),
(18732, 3040, 21496, NULL, '2021-06-17 00:00:00.000', 'In Process', 'Email rcvd from: mdiprsupport@healthsmart.com  Subject: Fw: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Hi,  1. Please see below providers effective date. Providers Name Effective Date GEORGE, JEEMOL 03/11/2020 JOSE, JULIE 03/11/2020 PICCIONE JR, JAMES M 12/01/2018 BROWN, BRITTANY 01/24/2020 ABRAHAM, GLORY 09/01/2019 FERNANDUS, LIMY 12/01/2020 KOUROUMA, ODETTE T 02/01/2020 JOSEPH, VIBITHA 02/05/2020 THOMAS, CINI 02/01/2020   2. Provider not found in the system. Please complete the attached CAQH Access form and send w9 to begin credentialing.  Providers Name Stephen, Ani Chennemkara, Mini Philip  Rauf, Abdur JEENA ABRAHAM,  3. We currently show the following provider(s) credentialed with HealthSmart.  Please complete the attached demographic information form and return so we may add your group information to the provider’s record.  Providers Name Paul, Sigi C NP Jacob, Jaya NP   All communication, including requested documents should be sent to pr.south@healthsmart.com. Please do not submit to MDIPR@healthsmart.com  (Inventory Log ID : 80648)  Thanks Healthsmart Provider Relations.', NULL, NULL, '2021-06-10 13:31:35', '2021-06-10 13:31:35'),
(18733, 3040, 21496, NULL, '2021-06-17 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Greetings,  Hope you are doing well. Please find the attached requested forms as per above email requested along with the W9.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-10 13:31:48', '2021-06-10 13:31:48'),
(18734, 3040, 21496, NULL, '2021-06-17 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Greetings,  Hope you are doing well. Please find the attached requested forms as per above email requested along with the W9.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-10 13:31:48', '2021-06-10 13:31:48'),
(18735, 3040, 21496, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Health Smart for our group under the below location.   Practice Details: Practice Name: Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 2:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 6:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-28 14:37:27', '2021-06-28 14:37:27'),
(18736, 3040, 21496, NULL, '2021-07-20 00:00:00.000', 'Approved', 'Group has an ancillary contract no need to add individual providers. Please see group task. ', NULL, NULL, '2021-07-13 13:21:11', '2021-07-13 13:21:11'),
(18737, 3040, 21497, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 09:54:39', '2021-03-16 09:54:39'),
(18738, 3040, 21497, NULL, '2021-05-31 00:00:00.000', 'In Process', 'Email sent to: vipproviders@anci-care.com, pr.south@healthsmart.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Greetings,   Hope you are doing well . I wanted to know the enrollment status for the below mentioned group & providers under below locations.   Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-05-24 15:55:35', '2021-05-24 15:55:35'),
(18739, 3040, 21497, NULL, '2021-06-17 00:00:00.000', 'In Process', 'Email rcvd from: mdiprsupport@healthsmart.com  Subject: Fw: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Hi,  1. Please see below providers effective date. Providers Name Effective Date GEORGE, JEEMOL 03/11/2020 JOSE, JULIE 03/11/2020 PICCIONE JR, JAMES M 12/01/2018 BROWN, BRITTANY 01/24/2020 ABRAHAM, GLORY 09/01/2019 FERNANDUS, LIMY 12/01/2020 KOUROUMA, ODETTE T 02/01/2020 JOSEPH, VIBITHA 02/05/2020 THOMAS, CINI 02/01/2020   2. Provider not found in the system. Please complete the attached CAQH Access form and send w9 to begin credentialing.  Providers Name Stephen, Ani Chennemkara, Mini Philip  Rauf, Abdur JEENA ABRAHAM,  3. We currently show the following provider(s) credentialed with HealthSmart.  Please complete the attached demographic information form and return so we may add your group information to the provider’s record.  Providers Name Paul, Sigi C NP Jacob, Jaya NP   All communication, including requested documents should be sent to pr.south@healthsmart.com. Please do not submit to MDIPR@healthsmart.com  (Inventory Log ID : 80648)  Thanks Healthsmart Provider Relations.', NULL, NULL, '2021-06-10 13:28:19', '2021-06-10 13:28:19'),
(18740, 3040, 21497, NULL, '2021-06-17 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Greetings,  Hope you are doing well. Please find the attached requested forms as per above email requested along with the W9.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-10 13:29:03', '2021-06-10 13:29:03'),
(18741, 3040, 21497, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Health Smart for our group under the below location.   Practice Details: Practice Name: Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 2:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 6:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-28 14:37:23', '2021-06-28 14:37:23'),
(18742, 3040, 21497, NULL, '2021-07-20 00:00:00.000', 'Approved', 'Group has an ancillary contract no need to add individual providers. Please see group task. ', NULL, NULL, '2021-07-13 13:21:10', '2021-07-13 13:21:10'),
(18743, 3040, 21498, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 09:55:32', '2021-03-16 09:55:32'),
(18744, 3040, 21498, NULL, '2021-05-31 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com, Provider_Relations_Houston@bcbstx.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || BCBS ||  Greetings,   Hope you are doing well . I wanted to know the enrollment status for the below mentioned group & providers in BCBS under the below location.   Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-24 16:15:44', '2021-05-24 16:15:44'),
(18745, 3040, 21498, NULL, '2021-06-17 00:00:00.000', 'In Process', 'Email sent to: provider_relations_houston@bcbstx.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || BCBS || : Case Number - 02490445  Greetings,  Thank you for the roster. Can you please send me the effective date for the group.   Waiting for your reply.   Thank you ', NULL, NULL, '2021-06-10 16:13:24', '2021-06-10 16:13:24'),
(18746, 3040, 21498, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Email sent to: provider_relations_houston@bcbstx.com  Subject: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || BCBS || : Case Number - 02490445  Hello,   Can you please advise an effective date for the group.   Thank you  ', NULL, NULL, '2021-06-28 15:07:27', '2021-06-28 15:07:27'),
(18747, 3040, 21498, NULL, '2021-07-23 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com  Subject:  Re: Enrollment Status || Longpoint Medical Center || Group & Providers || BCBS || : Case Number - 02490445  Hello,   I wanted to know the effective date for the group.   Thank you  ', NULL, NULL, '2021-07-16 16:41:22', '2021-07-16 16:41:22'),
(18748, 11056, 21498, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Email sent to : tx_standard_contracting_team@bcbstx.com, Provider_Relations_Houston@bcbstx.com, TXProviderUpdateSubmission@bcbstx.com  Sub : Fwd: Enrollment Status || Longpoint Medical Center || Group & Providers || BCBS || : Case Number - 02490445  Good morning!  Hope all is well. Please provide us the effective date for the group. Kindly respond to our email soon.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  If you need any documents and information regarding that feel free to reach out to me. Eagerly, waiting for your response.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-13 11:28:07', '2021-08-13 11:28:07'),
(18749, 3040, 21498, NULL, '2021-09-17 00:00:00.000', 'In Process', 'Email sent to: txproviderupdatesubmission@bcbstx.com  Subject: Re: Application ID: 311683 || Longpoint Medical Center || Jacob, Jaya & PAUL, SIGI || BCBS || : Case Number - 02588262  Greetings,   Hope you are doing well. Please advise the enrollment status for the below mentioned providers in BCBS in our group under the below location. If the provider is already linked to the below Tax ID, advise the effective date.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226   Provider 1: Provider Name: John, Jeny Provider NPI# 1073019493   Provider 2: Provider Name: PAUL, SIGI Provider NPI# 1033623616   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-09-10 15:06:30', '2021-09-10 15:06:30'),
(18750, 3040, 21498, NULL, '2021-09-17 00:00:00.000', 'In Process', 'Email sent to: txproviderupdatesubmission@bcbstx.com  Subject: Re: Application ID: 311683 || Longpoint Medical Center || Jacob, Jaya & PAUL, SIGI || BCBS || : Case Number - 02588262  Greetings,   Hope you are doing well. Please advise the enrollment status for the below mentioned providers in BCBS in our group under the below location. If the provider is already linked to the below Tax ID, advise the effective date.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226   Provider 1: Provider Name: John, Jeny Provider NPI# 1073019493   Provider 2: Provider Name: PAUL, SIGI Provider NPI# 1033623616   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-09-10 15:06:31', '2021-09-10 15:06:31'),
(18751, 10057, 21498, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email Sent To : txproviderupdatesubmission@bcbstx.com  Sub : Application ID: 311683 || Longpoint Medical Center || PAUL, SIGI || BCBS || : Case Number - 02588262  Greetings!  Hope all is well. I\'m writing this email to follow-up about our group location & provider credentialing request. Please get back to me once you get a chance.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Address	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI PAUL, SIGI	1033623616  Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-22 10:44:13', '2021-10-22 10:44:13'),
(18752, 10057, 21498, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : TXProviderUpdateSubmission@bcbstx.com txproviderupdatesubmission@bcbstx.com  Sub : Application ID: 311683 || Longpoint Medical Center || PAUL, SIGI || BCBS || : Case Number - 02588262 : Case Number - 03036699  Greetings!  Hope this email finds you in good health. Could you please let me know the updated status with effective dates for the below mentioned provider under the group TIN. Also facility contract / agreement.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI PAUL, SIGI	1033623616  Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-22 14:32:19', '2021-11-22 14:32:19'),
(18753, 10057, 21498, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Received From : Noemi_Diaz@bcbstx.com  Sub : Application ID: 311683 || Longpoint Medical Center || PAUL, SIGI || BCBS || : Case Number - 02588262 : Case Number - 03036699  Good morning,  Please reach out directly to your BCBSTX rep.  Contact information is listed below.  Latrice Thomas  Latrice_Thomas@bcbstx.com  713.354.7067  Thank you,  All the Best, Noemi Diaz Network Management Consultant | Network Management - West Region', NULL, NULL, '2021-12-02 13:25:17', '2021-12-02 13:25:17'),
(18754, 10057, 21498, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : latrice_thomas@bcbstx.com  Sub : Application ID: 311683 || Longpoint Medical Center || PAUL, SIGI || BCBS || : Case Number - 02588262 : Case Number - 03036699  Hello,  Hope this email finds you well. Could you please let me know the status for the below mentioned provider under the TIN.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Primary Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI PAUL, SIGI	1033623616  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-09 10:51:52', '2021-12-09 10:51:52'),
(18755, 10057, 21498, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email Sent To : latrice_thomas@bcbstx.com & connie_traylor@bcbstx.com  Sub : Application ID: 311683 || Longpoint Medical Center || PAUL, SIGI || BCBS || : Case Number - 02588262 : Case Number - 03036699  Greetings!  Any update on the below request. Please get back to me as soon as you get a chance.  Thanks & Regards,', NULL, NULL, '2021-12-16 14:25:17', '2021-12-16 14:25:17'),
(18756, 10057, 21498, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email Sent To : latrice_thomas@bcbstx.com & connie_traylor@bcbstx.com  Sub : Application ID: 311683 || Longpoint Medical Center || PAUL, SIGI || BCBS || : Case Number - 02588262 : Case Number - 03036699  Good Morning,  Hope this email finds you well. I\'m still waiting to get the updated status from your side for SIGI PAUL. This is my SECOND REMINDER. Please get back to me as soon as possible.  Kind Regards,', NULL, NULL, '2021-12-23 09:51:12', '2021-12-23 09:51:12'),
(18757, 10057, 21498, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Sent To : latrice_thomas@bcbstx.com  Sub : Application ID: 311683 || Longpoint Medical Center || PAUL, SIGI || BCBS || : Case Number - 02588262 : Case Number - 03036699  Greetings!  This is THIRD REMINDER on the below request. Process is getting delayed from your side, please look into this and do the needful.  Regards,', NULL, NULL, '2021-12-30 11:08:14', '2021-12-30 11:08:14'),
(18758, 20067, 21498, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: latrice_thomas@bcbstx.com, Noemi_Diaz@bcbstx.com  Subject: Re: Application ID: 311683 || Longpoint Medical Center || PAUL, SIGI || BCBS || : Case Number - 02588262 : Case Number - 03036699   Good afternoon,  Hope all is well with you. I would like to know the enrollment status of SIGI PAUL under Longpoint Medical Center.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Provider Name	NPI	Location SIGI PAUL	1033623616	9504 LONG POINT RD STE E, Houston,TX 77055-4226  Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-14 12:13:31', '2022-01-14 12:13:31'),
(18759, 20067, 21498, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to:  Application ID: 311683 || Longpoint Medical Center || PAUL, SIGI || BCBS || : Case Number - 02588262 : Case Number - 03036699  Sub:   Good Morning! Hope this email finds you in good health. Any updates on the below-mentioned request?  Thanks and regards, Syed Ahad', NULL, NULL, '2022-01-14 12:15:27', '2022-01-14 12:15:27'),
(18760, 20067, 21498, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: latrice_thomas@bcbstx.com  Sub: Re: Application ID: 311683 || Longpoint Medical Center || PAUL, SIGI || BCBS || : Case Number - 02588262 : Case Number - 03036699  Good afternoon!  Hope all is well with you. Kindly respond to the previous email.  Thank you,', NULL, NULL, '2022-01-26 12:44:22', '2022-01-26 12:44:22'),
(18761, 20067, 21498, NULL, '2022-02-15 00:00:00.000', 'In Process', 'Email sent to: latrice_thomas@bcbstx.com  Sub: Re: Application ID: 311683 || Longpoint Medical Center || PAUL, SIGI || BCBS || : Case Number - 02588262 : Case Number - 03036699  Good afternoon,  Hope all is well with you. I would like to know the enrollment status of the below-mentioned group & Provider.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Provider Name	NPI	Location SIGI PAUL	1033623616	9504 LONG POINT RD STE E, Houston,TX 77055-4226  Thanks and regards, Syed Ahad.', NULL, NULL, '2022-02-08 13:37:18', '2022-02-08 13:37:18'),
(18762, 20067, 21498, NULL, '2022-03-21 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com, Provider_Relations_Houston@bcbstx.com  Sub: Credentialing Status || Providers || LPMC || BCBSTX  Good Afternoon!  Hope you had a great weekend. Can you please confirm the credentialing status of the listed providers?  For Provider Sigi Paul I checked the status from the credentialing status check and it is showing the application has been approved since 07/29/2021 but we haven\'t received the approval letter yet.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Sigi Paul	1033623616 Ancy Kurian	1316558935   Thank you,', NULL, NULL, '2022-03-14 14:26:14', '2022-03-14 14:26:14'),
(18763, 20067, 21498, NULL, '2022-03-29 00:00:00.000', 'In Process', 'Secure Email sent to: Marina_Machuca@BCBSTX.COM  Sub: RE: FW: PHI RE: Credentialing Status - Ancy V. Kurian, APN  Hey Marina!  I\'d submitted the provider onboarding Form for Ancy Kurian on 03/16/2022. Can you please confirm me whether the application is received or not?  NPI: 1316558935  TIN# 81-5123542  Thank you,', NULL, NULL, '2022-03-22 17:45:39', '2022-03-22 17:45:39'),
(18764, 3040, 21499, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 09:55:48', '2021-03-16 09:55:48'),
(18765, 3040, 21499, NULL, '2021-05-31 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com, Provider_Relations_Houston@bcbstx.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || BCBS ||  Greetings,   Hope you are doing well . I wanted to know the enrollment status for the below mentioned group & providers in BCBS under the below location.   Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-24 16:15:48', '2021-05-24 16:15:48'),
(18766, 3040, 21499, NULL, '2021-06-17 00:00:00.000', 'Approved', 'Provider is participating in BCBS. Roster attached. ', NULL, NULL, '2021-06-10 16:07:52', '2021-06-10 16:07:52'),
(18767, 3040, 21500, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 09:56:12', '2021-03-16 09:56:12'),
(18768, 3040, 21500, NULL, '2021-05-31 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com, Provider_Relations_Houston@bcbstx.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || BCBS ||  Greetings,   Hope you are doing well . I wanted to know the enrollment status for the below mentioned group & providers in BCBS under the below location.   Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-24 16:15:52', '2021-05-24 16:15:52'),
(18769, 3040, 21500, NULL, '2021-06-17 00:00:00.000', 'Approved', 'Provider is participating in BCBS. Roster attached. ', NULL, NULL, '2021-06-10 15:59:50', '2021-06-10 15:59:50'),
(18770, 3040, 21501, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 09:57:03', '2021-03-16 09:57:03'),
(18771, 3040, 21501, NULL, '2021-05-31 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com, Provider_Relations_Houston@bcbstx.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || BCBS ||  Greetings,   Hope you are doing well . I wanted to know the enrollment status for the below mentioned group & providers in BCBS under the below location.   Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-24 16:15:56', '2021-05-24 16:15:56'),
(18772, 3040, 21501, NULL, '2021-06-17 00:00:00.000', 'Approved', 'Provider is participating in BCBS. Roster attached. ', NULL, NULL, '2021-06-10 15:59:27', '2021-06-10 15:59:27'),
(18773, 3040, 21502, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 09:57:28', '2021-03-16 09:57:28'),
(18774, 3040, 21502, NULL, '2021-05-31 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com, Provider_Relations_Houston@bcbstx.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || BCBS ||  Greetings,   Hope you are doing well . I wanted to know the enrollment status for the below mentioned group & providers in BCBS under the below location.   Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-24 16:16:00', '2021-05-24 16:16:00'),
(18775, 3040, 21502, NULL, '2021-06-17 00:00:00.000', 'Approved', 'Provider is participating in BCBS. Roster attached.', NULL, NULL, '2021-06-10 15:58:21', '2021-06-10 15:58:21'),
(18776, 3040, 21503, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 09:57:41', '2021-03-16 09:57:41'),
(18777, 3040, 21503, NULL, '2021-05-31 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com, Provider_Relations_Houston@bcbstx.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || BCBS ||  Greetings,   Hope you are doing well . I wanted to know the enrollment status for the below mentioned group & providers in BCBS under the below location.   Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-24 16:16:05', '2021-05-24 16:16:05'),
(18778, 1005, 21503, NULL, '2021-06-08 00:00:00.000', 'Not Eligible', 'Provider is no longer working for this Practice. Eff from 12/15/2020', NULL, NULL, '2021-06-01 13:02:01', '2021-06-01 13:02:01'),
(18779, 3040, 21504, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 09:57:59', '2021-03-16 09:57:59'),
(18780, 3040, 21504, NULL, '2021-05-31 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com, Provider_Relations_Houston@bcbstx.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || BCBS ||  Greetings,   Hope you are doing well . I wanted to know the enrollment status for the below mentioned group & providers in BCBS under the below location.   Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-24 16:16:08', '2021-05-24 16:16:08'),
(18781, 3040, 21504, NULL, '2021-06-17 00:00:00.000', 'Approved', 'Provider is participating in BCBS. Roster attached. ', NULL, NULL, '2021-06-10 16:00:45', '2021-06-10 16:00:45'),
(18782, 3040, 21505, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 09:58:48', '2021-03-16 09:58:48'),
(18783, 3040, 21505, NULL, '2021-05-31 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com, Provider_Relations_Houston@bcbstx.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || BCBS ||  Greetings,   Hope you are doing well . I wanted to know the enrollment status for the below mentioned group & providers in BCBS under the below location.   Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-24 16:16:13', '2021-05-24 16:16:13'),
(18784, 3040, 21505, NULL, '2021-06-17 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: 311683', NULL, NULL, '2021-06-10 16:48:27', '2021-06-10 16:48:27');
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
(18785, 3040, 21505, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com, txproviderupdatesubmission@bcbstx.com, Provider_Relations_Houston@bcbstx.com  Subject: Application ID: 311683 || Longpoint Medical Center || Jacob, Jaya & PAUL, SIGI || BCBS ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in BCBS for our group under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 2: Provider Name: PAUL, SIGI Provider NPI# 1033623616  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-28 15:05:13', '2021-06-28 15:05:13'),
(18786, 3040, 21505, NULL, '2021-07-23 00:00:00.000', 'In Process', 'Email rcvd from: txproviderupdatesubmission@bcbstx.com  Subject: Application ID: 311683 || Longpoint Medical Center || Jacob, Jaya & PAUL, SIGI || BCBS || : Case Number - 02588262  Good afternoon,  I have located your application and have provided more information below.  The name of the group under the Tax ID you mentioned that begins with 27xxxxx29 is Normandy Urgent Care Center PA. Here are the providers’ record numbers for this group mentioned above: Sigi Paul Provider Record # 8PR750 Jaya Jacob Provider Record # 8PR751  I did locate Longpoint Medical Center in our system (Tax ID starts with 76) and see these two providers are also linked to that group.  Here are the providers’ record numbers for this group mentioned above: Sigi Paul Provider Record # 8PE305 Jaya Jacob Provider Record # 8PE306  For any questions regarding network contracting, credentialing, network effective dates or status requests, please reach out to your network representative. If you do not know who your representative is, please click here and look under Network Management Office Locations - https://www.bcbstx.com/provider/contact_us.html#localnetwork There you will find the phone (local and/or toll free number), fax, and email contact methods.  Thank you,  Network Operations & Solution Delivery Blue Cross Blue Shield of Texas', NULL, NULL, '2021-07-16 16:41:56', '2021-07-16 16:41:56'),
(18787, 3040, 21505, NULL, '2021-07-26 00:00:00.000', 'Approved', 'Email rcvd from: txintaketeampiermailbox@bcbstx.com  Subject: BCBSTX New Provider Information  Group Name : LONG POINT MEDICAL PA Group Record Id : H000429N01  Provider Name : JAYA JACOB Provider Record Number : H08PE30601 Specialty : ANP/CERT/CLNP', NULL, NULL, '2021-07-19 16:44:24', '2021-07-19 16:44:24'),
(18788, 3040, 21506, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 09:59:34', '2021-03-16 09:59:34'),
(18789, 3040, 21506, NULL, '2021-05-31 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com, Provider_Relations_Houston@bcbstx.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || BCBS ||  Greetings,   Hope you are doing well . I wanted to know the enrollment status for the below mentioned group & providers in BCBS under the below location.   Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-24 16:16:17', '2021-05-24 16:16:17'),
(18790, 3040, 21506, NULL, '2021-06-17 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: 311683', NULL, NULL, '2021-06-10 16:48:21', '2021-06-10 16:48:21'),
(18791, 3040, 21506, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com, txproviderupdatesubmission@bcbstx.com, Provider_Relations_Houston@bcbstx.com  Subject: Application ID: 311683 || Longpoint Medical Center || Jacob, Jaya & PAUL, SIGI || BCBS ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in BCBS for our group under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 2: Provider Name: PAUL, SIGI Provider NPI# 1033623616  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-28 15:05:09', '2021-06-28 15:05:09'),
(18792, 3040, 21506, NULL, '2021-07-23 00:00:00.000', 'In Process', 'Email rcvd from: txproviderupdatesubmission@bcbstx.com  Subject: Application ID: 311683 || Longpoint Medical Center || Jacob, Jaya & PAUL, SIGI || BCBS || : Case Number - 02588262  Good afternoon,  I have located your application and have provided more information below.  The name of the group under the Tax ID you mentioned that begins with 27xxxxx29 is Normandy Urgent Care Center PA. Here are the providers’ record numbers for this group mentioned above: Sigi Paul Provider Record # 8PR750 Jaya Jacob Provider Record # 8PR751  I did locate Longpoint Medical Center in our system (Tax ID starts with 76) and see these two providers are also linked to that group.  Here are the providers’ record numbers for this group mentioned above: Sigi Paul Provider Record # 8PE305 Jaya Jacob Provider Record # 8PE306  For any questions regarding network contracting, credentialing, network effective dates or status requests, please reach out to your network representative. If you do not know who your representative is, please click here and look under Network Management Office Locations - https://www.bcbstx.com/provider/contact_us.html#localnetwork There you will find the phone (local and/or toll free number), fax, and email contact methods.  Thank you,  Network Operations & Solution Delivery Blue Cross Blue Shield of Texas', NULL, NULL, '2021-07-16 16:39:22', '2021-07-16 16:39:22'),
(18793, 11056, 21506, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Email sent to : 	txproviderupdatesubmission@bcbstx.com  Sub : Application ID: 311683 || Longpoint Medical Center || Jacob, Jaya & PAUL, SIGI || BCBS || : Case Number - 02588262  Good morning!   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in BCBS. Please provide us with the latest updates soon.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider 1: Provider Name: Jacob, Jaya Provider NPI# 1194336149   Provider 2: Provider Name: PAUL, SIGI Provider NPI# 1033623616   If you need any information or documents feel free to contact me. Waiting for your response.   Thank you! Have a great weekend!', NULL, NULL, '2021-08-13 11:34:21', '2021-08-13 11:34:21'),
(18794, 3040, 21506, NULL, '2021-09-17 00:00:00.000', 'In Process', 'Email sent to: txproviderupdatesubmission@bcbstx.com  Subject: Re: Application ID: 311683 || Longpoint Medical Center || Jacob, Jaya & PAUL, SIGI || BCBS || : Case Number - 02588262  Greetings,   Hope you are doing well. Please advise the enrollment status for the below mentioned providers in BCBS in our group under the below location. If the provider is already linked to the below Tax ID, advise the effective date.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226   Provider 1: Provider Name: John, Jeny Provider NPI# 1073019493   Provider 2: Provider Name: PAUL, SIGI Provider NPI# 1033623616   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-09-10 15:06:30', '2021-09-10 15:06:30'),
(18795, 10057, 21506, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email Sent To : txproviderupdatesubmission@bcbstx.com  Sub : Application ID: 311683 || Longpoint Medical Center || PAUL, SIGI || BCBS || : Case Number - 02588262  Greetings!  Hope all is well. I\'m writing this email to follow-up about our group location & provider credentialing request. Please get back to me once you get a chance.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Address	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI PAUL, SIGI	1033623616  Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-22 10:43:58', '2021-10-22 10:43:58'),
(18796, 10057, 21506, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : TXProviderUpdateSubmission@bcbstx.com txproviderupdatesubmission@bcbstx.com  Sub : Application ID: 311683 || Longpoint Medical Center || PAUL, SIGI || BCBS || : Case Number - 02588262 : Case Number - 03036699  Greetings!  Hope this email finds you in good health. Could you please let me know the updated status with effective dates for the below mentioned provider under the group TIN. Also facility contract / agreement.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI PAUL, SIGI	1033623616  Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-22 14:32:14', '2021-11-22 14:32:14'),
(18797, 10057, 21506, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Received From : Noemi_Diaz@bcbstx.com  Sub : Application ID: 311683 || Longpoint Medical Center || PAUL, SIGI || BCBS || : Case Number - 02588262 : Case Number - 03036699  Good morning,  Please reach out directly to your BCBSTX rep.  Contact information is listed below.  Latrice Thomas  Latrice_Thomas@bcbstx.com  713.354.7067  Thank you,  All the Best, Noemi Diaz Network Management Consultant | Network Management - West Region', NULL, NULL, '2021-12-02 13:25:11', '2021-12-02 13:25:11'),
(18798, 10057, 21506, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : latrice_thomas@bcbstx.com  Sub : Application ID: 311683 || Longpoint Medical Center || PAUL, SIGI || BCBS || : Case Number - 02588262 : Case Number - 03036699  Hello,  Hope this email finds you well. Could you please let me know the status for the below mentioned provider under the TIN.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Primary Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI PAUL, SIGI	1033623616  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-09 10:51:45', '2021-12-09 10:51:45'),
(18799, 10057, 21506, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email Sent To : latrice_thomas@bcbstx.com & connie_traylor@bcbstx.com  Sub : Application ID: 311683 || Longpoint Medical Center || PAUL, SIGI || BCBS || : Case Number - 02588262 : Case Number - 03036699  Greetings!  Any update on the below request. Please get back to me as soon as you get a chance.  Thanks & Regards,', NULL, NULL, '2021-12-16 14:25:00', '2021-12-16 14:25:00'),
(18800, 10057, 21506, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email Sent To : latrice_thomas@bcbstx.com & connie_traylor@bcbstx.com  Sub : Application ID: 311683 || Longpoint Medical Center || PAUL, SIGI || BCBS || : Case Number - 02588262 : Case Number - 03036699  Good Morning,  Hope this email finds you well. I\'m still waiting to get the updated status from your side for SIGI PAUL. This is my SECOND REMINDER. Please get back to me as soon as possible.  Kind Regards,', NULL, NULL, '2021-12-23 09:51:01', '2021-12-23 09:51:01'),
(18801, 10057, 21506, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Sent To : latrice_thomas@bcbstx.com  Sub : Application ID: 311683 || Longpoint Medical Center || PAUL, SIGI || BCBS || : Case Number - 02588262 : Case Number - 03036699  Greetings!  This is THIRD REMINDER on the below request. Process is getting delayed from your side, please look into this and do the needful.  Regards,', NULL, NULL, '2021-12-30 11:08:20', '2021-12-30 11:08:20'),
(18802, 20067, 21506, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email sent to: latrice_thomas@bcbstx.com, Noemi_Diaz@bcbstx.com  Subject: Re: Application ID: 311683 || Longpoint Medical Center || PAUL, SIGI || BCBS || : Case Number - 02588262 : Case Number - 03036699   Good afternoon,  Hope all is well with you. I would like to know the enrollment status of SIGI PAUL under Longpoint Medical Center.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Provider Name	NPI	Location SIGI PAUL	1033623616	9504 LONG POINT RD STE E, Houston,TX 77055-4226  Thanks and regards, Syed Ahad. ', NULL, NULL, '2022-01-06 14:12:14', '2022-01-06 14:12:14'),
(18803, 20067, 21506, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to:  Application ID: 311683 || Longpoint Medical Center || PAUL, SIGI || BCBS || : Case Number - 02588262 : Case Number - 03036699  Sub:   Good Morning! Hope this email finds you in good health. Any updates on the below-mentioned request?  Thanks and regards, Syed Ahad', NULL, NULL, '2022-01-14 12:15:20', '2022-01-14 12:15:20'),
(18804, 20067, 21506, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: latrice_thomas@bcbstx.com  Sub: Re: Application ID: 311683 || Longpoint Medical Center || PAUL, SIGI || BCBS || : Case Number - 02588262 : Case Number - 03036699  Good afternoon!  Hope all is well with you. Kindly respond to the previous email.  Thank you,', NULL, NULL, '2022-01-26 12:44:14', '2022-01-26 12:44:14'),
(18805, 20067, 21506, NULL, '2022-02-15 00:00:00.000', 'In Process', 'Email sent to: latrice_thomas@bcbstx.com  Sub: Re: Application ID: 311683 || Longpoint Medical Center || PAUL, SIGI || BCBS || : Case Number - 02588262 : Case Number - 03036699  Good afternoon,  Hope all is well with you. I would like to know the enrollment status of the below-mentioned group & Provider.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Provider Name	NPI	Location SIGI PAUL	1033623616	9504 LONG POINT RD STE E, Houston,TX 77055-4226  Thanks and regards, Syed Ahad.', NULL, NULL, '2022-02-08 13:37:09', '2022-02-08 13:37:09'),
(18806, 20067, 21506, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Check status through BSBS credentialing status check.  Your application has been approved. COMPLETION OF THE CREDENTIALING PROCESS DOES NOT MEAN THAT YOU ARE A CONTRACTED PROVIDER. Please await notification via letter or email  Kindly see the attchment', NULL, NULL, '2022-02-21 17:37:47', '2022-02-21 17:37:47'),
(18807, 20067, 21506, NULL, '2022-03-21 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com, Provider_Relations_Houston@bcbstx.com  Sub: Credentialing Status || Providers || LPMC || BCBSTX  Good Afternoon!  Hope you had a great weekend. Can you please confirm the credentialing status of the listed providers?  For Provider Sigi Paul I checked the status from the credentialing status check and it is showing the application has been approved since 07/29/2021 but we haven\'t received the approval letter yet.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Sigi Paul	1033623616 Ancy Kurian	1316558935   Thank you,', NULL, NULL, '2022-03-14 14:26:23', '2022-03-14 14:26:23'),
(18808, 20067, 21506, NULL, '2022-03-22 00:00:00.000', 'Approved', 'Email received from: marina_machuca@bcbstx.com  Sub: Credentialing Status  We have received a request for Network Status on  Sigi Paul - NPI# 1033623616 and Ancy Kurian NPI# 1316558935 under TAX ID# 76-0612416.  Sig Paul is In Network effective 8/10/21 for BAV, PPO, Blue Premier, HMO, Medicare HMO and Medicare PPO.  Ancy Kurian - We need the Case# for this provider in order to Add Networks to your TAX ID#.  Thank you Marina Machuca', NULL, NULL, '2022-03-15 16:42:36', '2022-03-15 16:42:36'),
(18809, 3040, 21507, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:00:46', '2021-03-16 10:00:46'),
(18810, 1006, 21507, NULL, '2021-05-27 00:00:00.000', 'Initiated', 'Sent f/u email @ humanahoustonpd@humana.com requesting group enrollment status:  Sub: Facility Enrollment/Location Status - NUCC - Humana  \"Hello,   I wanted to verify if the following facility has the listed locations coming up under it or not? Information is as follows:  Group name: Normandy Urgent Care Center NPI# 1407171077 TIN# 27-0796429  Address 1: 779 Normandy St Ste 114, Houston, TX 77015-3441 Address 2: 9504 LONG POINT RD STE E, Houston, TX 77055-4226 Address 3: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-05-20 16:22:19', '2021-05-20 16:22:19'),
(18811, 3040, 21507, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: humanahoustonpd@humana.com  Subject: Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Greetings,  Hope you are doing well. I wanted to know enrollment status for the below mentioned provider in our group under the below locations.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: Rauf., Abdur Provider NPI# 1497726202  Provider 2: Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 3: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 5: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 9: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting for your response.   Thank you  ', NULL, NULL, '2021-06-08 16:37:36', '2021-06-08 16:37:36'),
(18812, 3040, 21507, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Email sent to: HumanaHoustonPD@humana.com  Subject: Re: Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Greetings,   Hope you are doing well. Can you please advise the enrollment status for the below mentioned group and providers in Humana under the below Tax ID and location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID#  76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 2: Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 3: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 6: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 7: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 8: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 9: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 10: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting for your response.   Thank you ', NULL, NULL, '2021-06-25 09:23:35', '2021-06-25 09:23:35'),
(18813, 3040, 21507, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Email sent to: HumanaHoustonPD@humana.com  Subject: Re: FW: Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Hello,   Thank you for your prompt response. Please find the attached Standard Market Roster as per your previous email requested. All the providers CAQH updated.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID#   Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 3: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 5: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 6: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-14 15:25:59', '2021-07-14 15:25:59'),
(18814, 3040, 21507, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Email sent to: HumanaHoustonPD@humana.com  Subject: Re: FW: Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Hello,   Hope you are doing well. Please advise the enrollment status for the below mentioned providers in Humana in our group under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID#    Practice NPI# 1770763815  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: Brown, Brittany  Provider NPI# 1275163537     Provider 2:  Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956    Provider 3:  Provider Name: Stephen, Ani  Provider NPI# 1588959118     Provider 4:  Provider Name: Jacob, Jaya  Provider NPI# 1194336149     Provider 5:  Provider Name: PAUL, SIGI  Provider NPI# 1033623616     Provider 6:  Provider Name: Joseph, Molly  Provider NPI# 1396380077     Please get back to me as soon as you can get a chance. Waiting to hear from you soon.     Thank you  ', NULL, NULL, '2021-08-26 10:56:44', '2021-08-26 10:56:44'),
(18815, 10057, 21507, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : HumanaHoustonPD@humana.com  Sub : Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Good Evening,  Hope this email finds you well. I\'m writing this email to check the updated enrollment status for the below mentioned providers in Humana in our group under the below location.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Address	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Stephen, Ani	1588959118 Jacob, Jaya	1194336149 PAUL, SIGI	1033623616 Joseph, Molly	1073019493  Looking forward to your kind response, Have a great weekend ahead!  Thanks & Regards,', NULL, NULL, '2021-10-08 16:30:01', '2021-10-08 16:30:01'),
(18816, 10057, 21507, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From : HumanaHoustonPD@humana.com  Sub : Enrollment Status || Longpoint Medical Center || Providers || Humana ||  All are loaded and linked to the TIN provided.', NULL, NULL, '2021-11-23 13:48:07', '2021-11-23 13:48:07'),
(18817, 10057, 21507, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Sent To : HumanaHoustonPD@humana.com  Sub : Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Good Afternoon,  Hope you are doing well. Kindly share with me the effective dates along with the welcome letters for all the mentioned provides, also for facility contract / agreement as well.  Please get back to me as soon possible.  Thanks & Regards,', NULL, NULL, '2021-11-23 13:50:16', '2021-11-23 13:50:16'),
(18818, 10057, 21507, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email Received From : HumanaHoustonPD@humana.com  Sub : Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Please see item highlighted in yellow.  Please read the following instructions carefully:  For the following requests (fee schedules, copies of contracts, network participation, credentialing status, or effective dates) call provider relations at 800-448-6262 or 800-626-2741. All maintenance requests (provider adds, terms and changes)  need to be sent through Humanahoustonpd@humana.com.  Note:  This mailbox is only for these intents (adds, terms, changes). Requests for fee schedules, copies of contracts, network participation, credentialing status, or effective dates will not be processed through this mailbox.  Allow 60 days for processing of new applicants submission. Allow 30 days for processing of terminations and demographic updates. Status requests should be sent on your original email submission for tracking purposes. Please do not send direct emails to associates as there may not be a response to your request, and the request will not be processed.  In addition, please do not cc a Humana associate on your email requests to the above mailbox or this may delay the processing of your request. Disputing a claim paid/denied and appeals: contact humanaproviderservices@humana.com Log on to Humana.com or Availity.com for Provider updates, claim inquiries, eligibility/benefits information, fee schedule inquiries and more! For Humana.com issues and password resets, please call a Humana Web Specialist at 877-845-3480.  Thank you,  HumanaHoustonPD', NULL, NULL, '2021-11-24 10:41:25', '2021-11-24 10:41:25'),
(18819, 10057, 21507, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Need to call on mentioned number in next 15 days.  800-448-6262 or 800-626-2741', NULL, NULL, '2021-12-03 15:35:00', '2021-12-03 15:35:00'),
(18820, 10057, 21507, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Called to check the status - 800-448-6262  Reference for this call : 200015318382 - Rep. Abby  Provider is effective from 07/23/2021.  Waiting to update location in provider directory  It takes 15 to 20 more day from today.', NULL, NULL, '2021-12-10 14:10:50', '2021-12-10 14:10:50'),
(18821, 10057, 21507, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Will Follow-up in Next Week.  Please see previous Call Comments. Thank you', NULL, NULL, '2021-12-17 10:56:39', '2021-12-17 10:56:39'),
(18822, 10057, 21507, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To: HumanaHoustonPD@humana.com  Sub : Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Thank you for reaching out. We called and got the status from given numbers. However, we have been updated that providers are still in the middle of the directory portal.  Regards,', NULL, NULL, '2021-12-27 12:36:48', '2021-12-27 12:36:48'),
(18823, 20067, 21507, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Didn\'t receive the welcome letters till yet. Will follow-up next week', NULL, NULL, '2022-01-18 10:31:10', '2022-01-18 10:31:10'),
(18824, 20067, 21507, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email received from insurance rep: VDelaPaz2@humana.com  Sub: Humana_Welcome Letter Request_Interaction#:2000229422892  Hi Syed,     Thank you for reaching us out. This is regarding with your request for the welcome letter of the providers. This is to inform you that we can just provide the credentialing or welcome letters by individual providers only not by group.  And I do apologize but I tried to check all of the providers record if we have a copy of welcome letters, and since we have a limited access here in our end, and we cannot see the letters here, then, I cannot provide you the welcome letters of the providers.  My advice to you is to reach out with the individual providers to get the copy of the letters as we really send the letters by individual providers and by the date they are effective or credentialed.        Thank you,     Vanessa Dela Paz', NULL, NULL, '2022-02-21 17:10:51', '2022-02-21 17:10:51'),
(18825, 20067, 21507, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Email sent to: HumanaHoustonPD@humana.com  Sub: Group Agreement || Longpoint Medical Center || Humana  Good Afternoon!  Hope you are doing well. I need the Group Agreement of Longpoint Medical Center as all providers have been linked to this group.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Thank you,', NULL, NULL, '2022-03-15 12:55:56', '2022-03-15 12:55:56'),
(18826, 20067, 21507, NULL, '2022-03-29 00:00:00.000', 'Approved', 'Call Humana at (800) 457-4708. Group Effective Date: 01/01/2019  Plans: Humana HMO medicare Humana PPO medicare PFFS Humana PPO Choice care PPO  Ref# 2000235088272 Rep: Aya  See the Attachment for contract', NULL, NULL, '2022-03-22 14:43:35', '2022-03-22 14:43:35'),
(18827, 3040, 21508, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:01:14', '2021-03-16 10:01:14'),
(18828, 1006, 21508, NULL, '2021-05-27 00:00:00.000', 'Initiated', 'Sent f/u email @ humanahoustonpd@humana.com requesting group enrollment status:  Sub: Facility Enrollment/Location Status - NUCC - Humana  \"Hello,   I wanted to verify if the following facility has the listed locations coming up under it or not? Information is as follows:  Group name: Normandy Urgent Care Center NPI# 1407171077 TIN# 27-0796429  Address 1: 779 Normandy St Ste 114, Houston, TX 77015-3441 Address 2: 9504 LONG POINT RD STE E, Houston, TX 77055-4226 Address 3: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-05-20 16:22:25', '2021-05-20 16:22:25'),
(18829, 3040, 21508, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: humanahoustonpd@humana.com  Subject: Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Greetings,  Hope you are doing well. I wanted to know enrollment status for the below mentioned provider in our group under the below locations.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: Rauf., Abdur Provider NPI# 1497726202  Provider 2: Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 3: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 5: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 9: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting for your response.   Thank you  ', NULL, NULL, '2021-06-08 16:37:49', '2021-06-08 16:37:49'),
(18830, 3040, 21508, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Email sent to: HumanaHoustonPD@humana.com  Subject: Re: Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Greetings,   Hope you are doing well. Can you please advise the enrollment status for the below mentioned group and providers in Humana under the below Tax ID and location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID#  76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 2: Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 3: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 6: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 7: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 8: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 9: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 10: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting for your response.   Thank you ', NULL, NULL, '2021-06-25 09:23:27', '2021-06-25 09:23:27'),
(18831, 3040, 21508, NULL, '2021-07-21 00:00:00.000', 'Approved', 'Email rcvd from: HumanaHoustonPD@humana.com  Subject: FW: Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Follow the below instructions to add new practitioners to an existing group.  The providers highlighted in yellow below are also currently linked to the TIN and do not need to be submitted through this process.  Complete and return the attached document, in its original excel format, along with a W-9. Include all providers in the practice that wish to participate on the Standard roster on the Practitioner Adds Tab.  Make sure CAQH is updated for all providers to prevent any delays in the contracting process. Additionally, ensure that Humana is included in the “List of Authorized Organizations” in order for Humana to have on-line access to the provider’s CAQH account and the provider has granted access to Humana to view the CAQH credentialing information.  Additionally, please advise if the below practitioners are still with the group.  If they are not, please supply the termination date for each.  Clement Sali Piccione James M Nampimadom Sheena Abraham Gloria George Jeemol Joseph Vibitha Jose Julie  Look forward to receiving your documents.  HumanaHoustonPD', NULL, NULL, '2021-07-14 15:21:22', '2021-07-14 15:21:22'),
(18832, 3040, 21509, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:01:46', '2021-03-16 10:01:46'),
(18833, 1006, 21509, NULL, '2021-05-27 00:00:00.000', 'Initiated', 'Sent f/u email @ humanahoustonpd@humana.com requesting group enrollment status:  Sub: Facility Enrollment/Location Status - NUCC - Humana  \"Hello,   I wanted to verify if the following facility has the listed locations coming up under it or not? Information is as follows:  Group name: Normandy Urgent Care Center NPI# 1407171077 TIN# 27-0796429  Address 1: 779 Normandy St Ste 114, Houston, TX 77015-3441 Address 2: 9504 LONG POINT RD STE E, Houston, TX 77055-4226 Address 3: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-05-20 16:22:30', '2021-05-20 16:22:30'),
(18834, 3040, 21509, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: humanahoustonpd@humana.com  Subject: Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Greetings,  Hope you are doing well. I wanted to know enrollment status for the below mentioned provider in our group under the below locations.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: Rauf., Abdur Provider NPI# 1497726202  Provider 2: Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 3: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 5: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 9: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting for your response.   Thank you  ', NULL, NULL, '2021-06-08 16:37:52', '2021-06-08 16:37:52'),
(18835, 3040, 21509, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Email sent to: HumanaHoustonPD@humana.com  Subject: Re: Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Greetings,   Hope you are doing well. Can you please advise the enrollment status for the below mentioned group and providers in Humana under the below Tax ID and location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID#  76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 2: Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 3: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 6: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 7: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 8: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 9: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 10: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting for your response.   Thank you ', NULL, NULL, '2021-06-25 09:23:20', '2021-06-25 09:23:20'),
(18836, 3040, 21509, NULL, '2021-07-21 00:00:00.000', 'Approved', 'Email rcvd from: HumanaHoustonPD@humana.com  Subject: FW: Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Follow the below instructions to add new practitioners to an existing group.  The providers highlighted in yellow below are also currently linked to the TIN and do not need to be submitted through this process.  Complete and return the attached document, in its original excel format, along with a W-9. Include all providers in the practice that wish to participate on the Standard roster on the Practitioner Adds Tab.  Make sure CAQH is updated for all providers to prevent any delays in the contracting process. Additionally, ensure that Humana is included in the “List of Authorized Organizations” in order for Humana to have on-line access to the provider’s CAQH account and the provider has granted access to Humana to view the CAQH credentialing information.  Additionally, please advise if the below practitioners are still with the group.  If they are not, please supply the termination date for each.  Clement Sali Piccione James M Nampimadom Sheena Abraham Gloria George Jeemol Joseph Vibitha Jose Julie  Look forward to receiving your documents.  HumanaHoustonPD', NULL, NULL, '2021-07-14 15:21:25', '2021-07-14 15:21:25'),
(18837, 3040, 21510, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:02:11', '2021-03-16 10:02:11'),
(18838, 1006, 21510, NULL, '2021-05-27 00:00:00.000', 'Initiated', 'Sent f/u email @ humanahoustonpd@humana.com requesting group enrollment status:  Sub: Facility Enrollment/Location Status - NUCC - Humana  \"Hello,   I wanted to verify if the following facility has the listed locations coming up under it or not? Information is as follows:  Group name: Normandy Urgent Care Center NPI# 1407171077 TIN# 27-0796429  Address 1: 779 Normandy St Ste 114, Houston, TX 77015-3441 Address 2: 9504 LONG POINT RD STE E, Houston, TX 77055-4226 Address 3: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-05-20 16:22:34', '2021-05-20 16:22:34'),
(18839, 3040, 21510, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: humanahoustonpd@humana.com  Subject: Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Greetings,  Hope you are doing well. I wanted to know enrollment status for the below mentioned provider in our group under the below locations.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: Rauf., Abdur Provider NPI# 1497726202  Provider 2: Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 3: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 5: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 9: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting for your response.   Thank you  ', NULL, NULL, '2021-06-08 16:37:55', '2021-06-08 16:37:55'),
(18840, 3040, 21510, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Email sent to: HumanaHoustonPD@humana.com  Subject: Re: Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Greetings,   Hope you are doing well. Can you please advise the enrollment status for the below mentioned group and providers in Humana under the below Tax ID and location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID#  76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 2: Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 3: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 6: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 7: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 8: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 9: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 10: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting for your response.   Thank you ', NULL, NULL, '2021-06-25 09:23:13', '2021-06-25 09:23:13'),
(18841, 3040, 21510, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Email sent to: HumanaHoustonPD@humana.com  Subject: Re: FW: Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Hello,   Thank you for your prompt response. Please find the attached Standard Market Roster as per your previous email requested. All the providers CAQH updated.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID#   Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 3: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 5: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 6: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-14 15:23:45', '2021-07-14 15:23:45'),
(18842, 3040, 21510, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Email sent to: HumanaHoustonPD@humana.com  Subject: Re: FW: Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Hello,   Hope you are doing well. Please advise the enrollment status for the below mentioned providers in Humana in our group under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID#    Practice NPI# 1770763815  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: Brown, Brittany  Provider NPI# 1275163537     Provider 2:  Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956    Provider 3:  Provider Name: Stephen, Ani  Provider NPI# 1588959118     Provider 4:  Provider Name: Jacob, Jaya  Provider NPI# 1194336149     Provider 5:  Provider Name: PAUL, SIGI  Provider NPI# 1033623616     Provider 6:  Provider Name: Joseph, Molly  Provider NPI# 1396380077     Please get back to me as soon as you can get a chance. Waiting to hear from you soon.     Thank you  ', NULL, NULL, '2021-08-26 10:56:43', '2021-08-26 10:56:43'),
(18843, 10057, 21510, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : HumanaHoustonPD@humana.com  Sub : Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Good Evening,  Hope this email finds you well. I\'m writing this email to check the updated enrollment status for the below mentioned providers in Humana in our group under the below location.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Address	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Stephen, Ani	1588959118 Jacob, Jaya	1194336149 PAUL, SIGI	1033623616 Joseph, Molly	1073019493  Looking forward to your kind response, Have a great weekend ahead!  Thanks & Regards,', NULL, NULL, '2021-10-08 16:29:50', '2021-10-08 16:29:50'),
(18844, 10057, 21510, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From : HumanaHoustonPD@humana.com  Sub : Enrollment Status || Longpoint Medical Center || Providers || Humana ||  All are loaded and linked to the TIN provided.', NULL, NULL, '2021-11-23 13:47:58', '2021-11-23 13:47:58'),
(18845, 10057, 21510, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Sent To : HumanaHoustonPD@humana.com  Sub : Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Good Afternoon,  Hope you are doing well. Kindly share with me the effective dates along with the welcome letters for all the mentioned provides, also for facility contract / agreement as well.  Please get back to me as soon possible.  Thanks & Regards,', NULL, NULL, '2021-11-23 13:50:10', '2021-11-23 13:50:10'),
(18846, 10057, 21510, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email Received From : HumanaHoustonPD@humana.com  Sub : Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Please see item highlighted in yellow.  Please read the following instructions carefully:  For the following requests (fee schedules, copies of contracts, network participation, credentialing status, or effective dates) call provider relations at 800-448-6262 or 800-626-2741. All maintenance requests (provider adds, terms and changes)  need to be sent through Humanahoustonpd@humana.com.  Note:  This mailbox is only for these intents (adds, terms, changes). Requests for fee schedules, copies of contracts, network participation, credentialing status, or effective dates will not be processed through this mailbox.  Allow 60 days for processing of new applicants submission. Allow 30 days for processing of terminations and demographic updates. Status requests should be sent on your original email submission for tracking purposes. Please do not send direct emails to associates as there may not be a response to your request, and the request will not be processed.  In addition, please do not cc a Humana associate on your email requests to the above mailbox or this may delay the processing of your request. Disputing a claim paid/denied and appeals: contact humanaproviderservices@humana.com Log on to Humana.com or Availity.com for Provider updates, claim inquiries, eligibility/benefits information, fee schedule inquiries and more! For Humana.com issues and password resets, please call a Humana Web Specialist at 877-845-3480.  Thank you,  HumanaHoustonPD', NULL, NULL, '2021-11-24 10:41:20', '2021-11-24 10:41:20'),
(18847, 10057, 21510, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Need to call on mentioned number in next 15 days.  800-448-6262 or 800-626-2741', NULL, NULL, '2021-12-03 15:34:54', '2021-12-03 15:34:54');
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
(18848, 10057, 21510, NULL, '2021-12-17 00:00:00.000', 'Approved', 'Called to check the status - 800-448-6262  Reference for this call : 200015318382 - Rep. Abby  Effective date: 07/23/2021  Please see attachment', NULL, NULL, '2021-12-10 13:59:48', '2021-12-10 13:59:48'),
(18849, 3040, 21511, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:02:35', '2021-03-16 10:02:35'),
(18850, 1006, 21511, NULL, '2021-05-27 00:00:00.000', 'Initiated', 'Sent f/u email @ humanahoustonpd@humana.com requesting group enrollment status:  Sub: Facility Enrollment/Location Status - NUCC - Humana  \"Hello,   I wanted to verify if the following facility has the listed locations coming up under it or not? Information is as follows:  Group name: Normandy Urgent Care Center NPI# 1407171077 TIN# 27-0796429  Address 1: 779 Normandy St Ste 114, Houston, TX 77015-3441 Address 2: 9504 LONG POINT RD STE E, Houston, TX 77055-4226 Address 3: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-05-20 16:22:39', '2021-05-20 16:22:39'),
(18851, 3040, 21511, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: humanahoustonpd@humana.com  Subject: Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Greetings,  Hope you are doing well. I wanted to know enrollment status for the below mentioned provider in our group under the below locations.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: Rauf., Abdur Provider NPI# 1497726202  Provider 2: Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 3: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 5: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 9: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting for your response.   Thank you  ', NULL, NULL, '2021-06-08 16:37:58', '2021-06-08 16:37:58'),
(18852, 3040, 21511, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Email sent to: HumanaHoustonPD@humana.com  Subject: Re: Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Greetings,   Hope you are doing well. Can you please advise the enrollment status for the below mentioned group and providers in Humana under the below Tax ID and location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID#  76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 2: Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 3: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 6: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 7: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 8: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 9: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 10: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting for your response.   Thank you ', NULL, NULL, '2021-06-25 09:23:05', '2021-06-25 09:23:05'),
(18853, 3040, 21511, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Email sent to: HumanaHoustonPD@humana.com  Subject: Re: FW: Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Hello,   Thank you for your prompt response. Please find the attached Standard Market Roster as per your previous email requested. All the providers CAQH updated.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID#   Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 3: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 5: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 6: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-14 15:23:46', '2021-07-14 15:23:46'),
(18854, 3040, 21511, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Email sent to: HumanaHoustonPD@humana.com  Subject: Re: FW: Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Hello,   Hope you are doing well. Please advise the enrollment status for the below mentioned providers in Humana in our group under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID#    Practice NPI# 1770763815  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: Brown, Brittany  Provider NPI# 1275163537     Provider 2:  Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956    Provider 3:  Provider Name: Stephen, Ani  Provider NPI# 1588959118     Provider 4:  Provider Name: Jacob, Jaya  Provider NPI# 1194336149     Provider 5:  Provider Name: PAUL, SIGI  Provider NPI# 1033623616     Provider 6:  Provider Name: Joseph, Molly  Provider NPI# 1396380077     Please get back to me as soon as you can get a chance. Waiting to hear from you soon.     Thank you  ', NULL, NULL, '2021-08-26 10:56:44', '2021-08-26 10:56:44'),
(18855, 10057, 21511, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : HumanaHoustonPD@humana.com  Sub : Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Good Evening,  Hope this email finds you well. I\'m writing this email to check the updated enrollment status for the below mentioned providers in Humana in our group under the below location.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Address	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Stephen, Ani	1588959118 Jacob, Jaya	1194336149 PAUL, SIGI	1033623616 Joseph, Molly	1073019493  Looking forward to your kind response, Have a great weekend ahead!  Thanks & Regards,', NULL, NULL, '2021-10-08 16:29:42', '2021-10-08 16:29:42'),
(18856, 10057, 21511, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From : HumanaHoustonPD@humana.com  Sub : Enrollment Status || Longpoint Medical Center || Providers || Humana ||  All are loaded and linked to the TIN provided.', NULL, NULL, '2021-11-23 13:47:51', '2021-11-23 13:47:51'),
(18857, 10057, 21511, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Sent To : HumanaHoustonPD@humana.com  Sub : Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Good Afternoon,  Hope you are doing well. Kindly share with me the effective dates along with the welcome letters for all the mentioned provides, also for facility contract / agreement as well.  Please get back to me as soon possible.  Thanks & Regards,', NULL, NULL, '2021-11-23 13:50:04', '2021-11-23 13:50:04'),
(18858, 10057, 21511, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email Received From : HumanaHoustonPD@humana.com  Sub : Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Please see item highlighted in yellow.  Please read the following instructions carefully:  For the following requests (fee schedules, copies of contracts, network participation, credentialing status, or effective dates) call provider relations at 800-448-6262 or 800-626-2741. All maintenance requests (provider adds, terms and changes)  need to be sent through Humanahoustonpd@humana.com.  Note:  This mailbox is only for these intents (adds, terms, changes). Requests for fee schedules, copies of contracts, network participation, credentialing status, or effective dates will not be processed through this mailbox.  Allow 60 days for processing of new applicants submission. Allow 30 days for processing of terminations and demographic updates. Status requests should be sent on your original email submission for tracking purposes. Please do not send direct emails to associates as there may not be a response to your request, and the request will not be processed.  In addition, please do not cc a Humana associate on your email requests to the above mailbox or this may delay the processing of your request. Disputing a claim paid/denied and appeals: contact humanaproviderservices@humana.com Log on to Humana.com or Availity.com for Provider updates, claim inquiries, eligibility/benefits information, fee schedule inquiries and more! For Humana.com issues and password resets, please call a Humana Web Specialist at 877-845-3480.  Thank you,  HumanaHoustonPD', NULL, NULL, '2021-11-24 10:41:15', '2021-11-24 10:41:15'),
(18859, 10057, 21511, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Need to call on mentioned number in next 15 days.  800-448-6262 or 800-626-2741', NULL, NULL, '2021-12-03 15:34:49', '2021-12-03 15:34:49'),
(18860, 10057, 21511, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Called to check the status - 800-448-6262  Reference for this call : 200015318382 - Rep. Abby  Provider is effective from 07/23/2021.  Waiting to update location in provider directory  It takes 15 to 20 more day from today.', NULL, NULL, '2021-12-10 14:10:45', '2021-12-10 14:10:45'),
(18861, 10057, 21511, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Will Follow-up in Next Week.  Please see previous Call Comments. Thank you', NULL, NULL, '2021-12-17 10:56:29', '2021-12-17 10:56:29'),
(18862, 10057, 21511, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To: HumanaHoustonPD@humana.com  Sub : Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Thank you for reaching out. We called and got the status from given numbers. However, we have been updated that providers are still in the middle of the directory portal.  Regards,', NULL, NULL, '2021-12-27 12:36:42', '2021-12-27 12:36:42'),
(18863, 20067, 21511, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Called Humana at 800-448-6262  Mini Chennemkara 06/25/2021 effective date for all the network  Credentialing was completed on 07/29/2021 and location is updated in providers directory   REQUESTED FOR WELCOME LETTER  Ref 2000221097974 Rep: Mira T ', NULL, NULL, '2022-01-11 17:37:27', '2022-01-11 17:37:27'),
(18864, 20067, 21511, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Didn\'t receive the welcome letters till yet. Will follow-up next week', NULL, NULL, '2022-01-18 10:31:22', '2022-01-18 10:31:22'),
(18865, 20067, 21511, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email received from insurance rep: VDelaPaz2@humana.com  Sub: Humana_Welcome Letter Request_Interaction#:2000229422892  Hi Syed,     Thank you for reaching us out. This is regarding with your request for the welcome letter of the providers. This is to inform you that we can just provide the credentialing or welcome letters by individual providers only not by group.  And I do apologize but I tried to check all of the providers record if we have a copy of welcome letters, and since we have a limited access here in our end, and we cannot see the letters here, then, I cannot provide you the welcome letters of the providers.  My advice to you is to reach out with the individual providers to get the copy of the letters as we really send the letters by individual providers and by the date they are effective or credentialed.        Thank you,     Vanessa Dela Paz', NULL, NULL, '2022-02-21 17:10:42', '2022-02-21 17:10:42'),
(18866, 20067, 21511, NULL, '2022-03-18 00:00:00.000', 'Approved', 'Humana does not disperse welcome letters.   Provider is Effective from: 06/25/2021', NULL, NULL, '2022-03-11 10:24:22', '2022-03-11 10:24:22'),
(18867, 3040, 21512, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:05:24', '2021-03-16 10:05:24'),
(18868, 1006, 21512, NULL, '2021-05-27 00:00:00.000', 'Initiated', 'Sent f/u email @ humanahoustonpd@humana.com requesting group enrollment status:  Sub: Facility Enrollment/Location Status - NUCC - Humana  \"Hello,   I wanted to verify if the following facility has the listed locations coming up under it or not? Information is as follows:  Group name: Normandy Urgent Care Center NPI# 1407171077 TIN# 27-0796429  Address 1: 779 Normandy St Ste 114, Houston, TX 77015-3441 Address 2: 9504 LONG POINT RD STE E, Houston, TX 77055-4226 Address 3: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-05-20 16:22:46', '2021-05-20 16:22:46'),
(18869, 3040, 21512, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: humanahoustonpd@humana.com  Subject: Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Greetings,  Hope you are doing well. I wanted to know enrollment status for the below mentioned provider in our group under the below locations.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: Rauf., Abdur Provider NPI# 1497726202  Provider 2: Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 3: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 5: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 9: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting for your response.   Thank you  ', NULL, NULL, '2021-06-08 16:38:00', '2021-06-08 16:38:00'),
(18870, 3040, 21512, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Email sent to: HumanaHoustonPD@humana.com  Subject: Re: Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Greetings,   Hope you are doing well. Can you please advise the enrollment status for the below mentioned group and providers in Humana under the below Tax ID and location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID#  76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 2: Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 3: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 6: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 7: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 8: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 9: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 10: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting for your response.   Thank you ', NULL, NULL, '2021-06-25 09:22:57', '2021-06-25 09:22:57'),
(18871, 3040, 21512, NULL, '2021-07-21 00:00:00.000', 'Approved', 'Email rcvd from: HumanaHoustonPD@humana.com  Subject: FW: Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Follow the below instructions to add new practitioners to an existing group.  The providers highlighted in yellow below are also currently linked to the TIN and do not need to be submitted through this process.  Complete and return the attached document, in its original excel format, along with a W-9. Include all providers in the practice that wish to participate on the Standard roster on the Practitioner Adds Tab.  Make sure CAQH is updated for all providers to prevent any delays in the contracting process. Additionally, ensure that Humana is included in the “List of Authorized Organizations” in order for Humana to have on-line access to the provider’s CAQH account and the provider has granted access to Humana to view the CAQH credentialing information.  Additionally, please advise if the below practitioners are still with the group.  If they are not, please supply the termination date for each.  Clement Sali Piccione James M Nampimadom Sheena Abraham Gloria George Jeemol Joseph Vibitha Jose Julie  Look forward to receiving your documents.  HumanaHoustonPD', NULL, NULL, '2021-07-14 15:21:27', '2021-07-14 15:21:27'),
(18872, 3040, 21513, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:05:49', '2021-03-16 10:05:49'),
(18873, 1006, 21513, NULL, '2021-05-27 00:00:00.000', 'Initiated', 'Sent f/u email @ humanahoustonpd@humana.com requesting group enrollment status:  Sub: Facility Enrollment/Location Status - NUCC - Humana  \"Hello,   I wanted to verify if the following facility has the listed locations coming up under it or not? Information is as follows:  Group name: Normandy Urgent Care Center NPI# 1407171077 TIN# 27-0796429  Address 1: 779 Normandy St Ste 114, Houston, TX 77015-3441 Address 2: 9504 LONG POINT RD STE E, Houston, TX 77055-4226 Address 3: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-05-20 16:22:51', '2021-05-20 16:22:51'),
(18874, 3040, 21513, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: humanahoustonpd@humana.com  Subject: Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Greetings,  Hope you are doing well. I wanted to know enrollment status for the below mentioned provider in our group under the below locations.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: Rauf., Abdur Provider NPI# 1497726202  Provider 2: Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 3: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 5: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 9: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting for your response.   Thank you  ', NULL, NULL, '2021-06-08 16:38:03', '2021-06-08 16:38:03'),
(18875, 3040, 21513, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Email sent to: HumanaHoustonPD@humana.com  Subject: Re: Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Greetings,   Hope you are doing well. Can you please advise the enrollment status for the below mentioned group and providers in Humana under the below Tax ID and location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID#  76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 2: Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 3: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 6: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 7: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 8: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 9: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 10: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting for your response.   Thank you ', NULL, NULL, '2021-06-25 09:22:48', '2021-06-25 09:22:48'),
(18876, 3040, 21513, NULL, '2021-07-21 00:00:00.000', 'Approved', 'Email rcvd from: HumanaHoustonPD@humana.com  Subject: FW: Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Follow the below instructions to add new practitioners to an existing group.  The providers highlighted in yellow below are also currently linked to the TIN and do not need to be submitted through this process.  Complete and return the attached document, in its original excel format, along with a W-9. Include all providers in the practice that wish to participate on the Standard roster on the Practitioner Adds Tab.  Make sure CAQH is updated for all providers to prevent any delays in the contracting process. Additionally, ensure that Humana is included in the “List of Authorized Organizations” in order for Humana to have on-line access to the provider’s CAQH account and the provider has granted access to Humana to view the CAQH credentialing information.  Additionally, please advise if the below practitioners are still with the group.  If they are not, please supply the termination date for each.  Clement Sali Piccione James M Nampimadom Sheena Abraham Gloria George Jeemol Joseph Vibitha Jose Julie  Look forward to receiving your documents.  HumanaHoustonPD', NULL, NULL, '2021-07-14 15:21:30', '2021-07-14 15:21:30'),
(18877, 3040, 21514, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:05:58', '2021-03-16 10:05:58'),
(18878, 1006, 21514, NULL, '2021-05-27 00:00:00.000', 'Initiated', 'Sent f/u email @ humanahoustonpd@humana.com requesting group enrollment status:  Sub: Facility Enrollment/Location Status - NUCC - Humana  \"Hello,   I wanted to verify if the following facility has the listed locations coming up under it or not? Information is as follows:  Group name: Normandy Urgent Care Center NPI# 1407171077 TIN# 27-0796429  Address 1: 779 Normandy St Ste 114, Houston, TX 77015-3441 Address 2: 9504 LONG POINT RD STE E, Houston, TX 77055-4226 Address 3: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-05-20 16:22:56', '2021-05-20 16:22:56'),
(18879, 1005, 21514, NULL, '2021-06-08 00:00:00.000', 'Not Eligible', 'Provider is no longer working for this Practice. Eff from 12/15/2020', NULL, NULL, '2021-06-01 13:02:35', '2021-06-01 13:02:35'),
(18880, 3040, 21515, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:06:19', '2021-03-16 10:06:19'),
(18881, 1006, 21515, NULL, '2021-05-27 00:00:00.000', 'Initiated', 'Sent f/u email @ humanahoustonpd@humana.com requesting group enrollment status:  Sub: Facility Enrollment/Location Status - NUCC - Humana  \"Hello,   I wanted to verify if the following facility has the listed locations coming up under it or not? Information is as follows:  Group name: Normandy Urgent Care Center NPI# 1407171077 TIN# 27-0796429  Address 1: 779 Normandy St Ste 114, Houston, TX 77015-3441 Address 2: 9504 LONG POINT RD STE E, Houston, TX 77055-4226 Address 3: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-05-20 16:23:01', '2021-05-20 16:23:01'),
(18882, 3040, 21515, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: humanahoustonpd@humana.com  Subject: Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Greetings,  Hope you are doing well. I wanted to know enrollment status for the below mentioned provider in our group under the below locations.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: Rauf., Abdur Provider NPI# 1497726202  Provider 2: Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 3: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 5: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 9: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting for your response.   Thank you  ', NULL, NULL, '2021-06-08 16:38:05', '2021-06-08 16:38:05'),
(18883, 3040, 21515, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Email sent to: HumanaHoustonPD@humana.com  Subject: Re: Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Greetings,   Hope you are doing well. Can you please advise the enrollment status for the below mentioned group and providers in Humana under the below Tax ID and location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID#  76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 2: Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 3: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 6: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 7: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 8: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 9: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 10: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting for your response.   Thank you ', NULL, NULL, '2021-06-25 09:22:25', '2021-06-25 09:22:25'),
(18884, 3040, 21515, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Email sent to: HumanaHoustonPD@humana.com  Subject: Re: FW: Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Hello,   Thank you for your prompt response. Please find the attached Standard Market Roster as per your previous email requested. All the providers CAQH updated.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID#   Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 3: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 5: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 6: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-14 15:23:46', '2021-07-14 15:23:46'),
(18885, 3040, 21515, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Email sent to: HumanaHoustonPD@humana.com  Subject: Re: FW: Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Hello,   Hope you are doing well. Please advise the enrollment status for the below mentioned providers in Humana in our group under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID#    Practice NPI# 1770763815  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: Brown, Brittany  Provider NPI# 1275163537     Provider 2:  Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956    Provider 3:  Provider Name: Stephen, Ani  Provider NPI# 1588959118     Provider 4:  Provider Name: Jacob, Jaya  Provider NPI# 1194336149     Provider 5:  Provider Name: PAUL, SIGI  Provider NPI# 1033623616     Provider 6:  Provider Name: Joseph, Molly  Provider NPI# 1396380077     Please get back to me as soon as you can get a chance. Waiting to hear from you soon.     Thank you  ', NULL, NULL, '2021-08-26 10:56:43', '2021-08-26 10:56:43'),
(18886, 10057, 21515, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : HumanaHoustonPD@humana.com  Sub : Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Good Evening,  Hope this email finds you well. I\'m writing this email to check the updated enrollment status for the below mentioned providers in Humana in our group under the below location.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Address	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Stephen, Ani	1588959118 Jacob, Jaya	1194336149 PAUL, SIGI	1033623616 Joseph, Molly	1073019493  Looking forward to your kind response, Have a great weekend ahead!  Thanks & Regards,', NULL, NULL, '2021-10-08 16:29:32', '2021-10-08 16:29:32'),
(18887, 10057, 21515, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From : HumanaHoustonPD@humana.com  Sub : Enrollment Status || Longpoint Medical Center || Providers || Humana ||  All are loaded and linked to the TIN provided.', NULL, NULL, '2021-11-23 13:47:43', '2021-11-23 13:47:43'),
(18888, 10057, 21515, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Sent To : HumanaHoustonPD@humana.com  Sub : Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Good Afternoon,  Hope you are doing well. Kindly share with me the effective dates along with the welcome letters for all the mentioned provides, also for facility contract / agreement as well.  Please get back to me as soon possible.  Thanks & Regards,', NULL, NULL, '2021-11-23 13:49:58', '2021-11-23 13:49:58'),
(18889, 10057, 21515, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email Received From : HumanaHoustonPD@humana.com  Sub : Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Please see item highlighted in yellow.  Please read the following instructions carefully:  For the following requests (fee schedules, copies of contracts, network participation, credentialing status, or effective dates) call provider relations at 800-448-6262 or 800-626-2741. All maintenance requests (provider adds, terms and changes)  need to be sent through Humanahoustonpd@humana.com.  Note:  This mailbox is only for these intents (adds, terms, changes). Requests for fee schedules, copies of contracts, network participation, credentialing status, or effective dates will not be processed through this mailbox.  Allow 60 days for processing of new applicants submission. Allow 30 days for processing of terminations and demographic updates. Status requests should be sent on your original email submission for tracking purposes. Please do not send direct emails to associates as there may not be a response to your request, and the request will not be processed.  In addition, please do not cc a Humana associate on your email requests to the above mailbox or this may delay the processing of your request. Disputing a claim paid/denied and appeals: contact humanaproviderservices@humana.com Log on to Humana.com or Availity.com for Provider updates, claim inquiries, eligibility/benefits information, fee schedule inquiries and more! For Humana.com issues and password resets, please call a Humana Web Specialist at 877-845-3480.  Thank you,  HumanaHoustonPD', NULL, NULL, '2021-11-24 10:41:10', '2021-11-24 10:41:10'),
(18890, 10057, 21515, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Need to call on mentioned number in next 15 days.  800-448-6262 or 800-626-2741', NULL, NULL, '2021-12-03 15:34:43', '2021-12-03 15:34:43'),
(18891, 10057, 21515, NULL, '2021-12-17 00:00:00.000', 'Approved', 'Called to check the status - 800-448-6262  Reference for this call : 200015318382 - Rep. Abby  Effective date: 07/23/2021  Please see attachment', NULL, NULL, '2021-12-10 13:58:41', '2021-12-10 13:58:41'),
(18892, 3040, 21516, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:06:51', '2021-03-16 10:06:51'),
(18893, 1006, 21516, NULL, '2021-05-27 00:00:00.000', 'Initiated', 'Sent f/u email @ humanahoustonpd@humana.com requesting group enrollment status:  Sub: Facility Enrollment/Location Status - NUCC - Humana  \"Hello,   I wanted to verify if the following facility has the listed locations coming up under it or not? Information is as follows:  Group name: Normandy Urgent Care Center NPI# 1407171077 TIN# 27-0796429  Address 1: 779 Normandy St Ste 114, Houston, TX 77015-3441 Address 2: 9504 LONG POINT RD STE E, Houston, TX 77055-4226 Address 3: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-05-20 16:23:06', '2021-05-20 16:23:06'),
(18894, 3040, 21516, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: humanahoustonpd@humana.com  Subject: Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Greetings,  Hope you are doing well. I wanted to know enrollment status for the below mentioned provider in our group under the below locations.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: Rauf., Abdur Provider NPI# 1497726202  Provider 2: Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 3: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 5: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 9: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting for your response.   Thank you  ', NULL, NULL, '2021-06-08 16:38:09', '2021-06-08 16:38:09'),
(18895, 3040, 21516, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Email sent to: HumanaHoustonPD@humana.com  Subject: Re: Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Greetings,   Hope you are doing well. Can you please advise the enrollment status for the below mentioned group and providers in Humana under the below Tax ID and location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID#  76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 2: Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 3: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 6: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 7: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 8: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 9: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 10: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting for your response.   Thank you ', NULL, NULL, '2021-06-25 09:22:12', '2021-06-25 09:22:12'),
(18896, 3040, 21516, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Email sent to: HumanaHoustonPD@humana.com  Subject: Re: FW: Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Hello,   Thank you for your prompt response. Please find the attached Standard Market Roster as per your previous email requested. All the providers CAQH updated.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID#   Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 3: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 5: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 6: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-14 15:23:47', '2021-07-14 15:23:47'),
(18897, 3040, 21516, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Email sent to: HumanaHoustonPD@humana.com  Subject: Re: FW: Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Hello,   Hope you are doing well. Please advise the enrollment status for the below mentioned providers in Humana in our group under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID#    Practice NPI# 1770763815  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: Brown, Brittany  Provider NPI# 1275163537     Provider 2:  Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956    Provider 3:  Provider Name: Stephen, Ani  Provider NPI# 1588959118     Provider 4:  Provider Name: Jacob, Jaya  Provider NPI# 1194336149     Provider 5:  Provider Name: PAUL, SIGI  Provider NPI# 1033623616     Provider 6:  Provider Name: Joseph, Molly  Provider NPI# 1396380077     Please get back to me as soon as you can get a chance. Waiting to hear from you soon.     Thank you  ', NULL, NULL, '2021-08-26 10:56:47', '2021-08-26 10:56:47'),
(18898, 10057, 21516, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : HumanaHoustonPD@humana.com  Sub : Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Good Evening,  Hope this email finds you well. I\'m writing this email to check the updated enrollment status for the below mentioned providers in Humana in our group under the below location.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Address	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Stephen, Ani	1588959118 Jacob, Jaya	1194336149 PAUL, SIGI	1033623616 Joseph, Molly	1073019493  Looking forward to your kind response, Have a great weekend ahead!  Thanks & Regards,', NULL, NULL, '2021-10-08 16:29:22', '2021-10-08 16:29:22'),
(18899, 10057, 21516, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From : HumanaHoustonPD@humana.com  Sub : Enrollment Status || Longpoint Medical Center || Providers || Humana ||  All are loaded and linked to the TIN provided.', NULL, NULL, '2021-11-23 13:47:37', '2021-11-23 13:47:37'),
(18900, 10057, 21516, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Sent To : HumanaHoustonPD@humana.com  Sub : Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Good Afternoon,  Hope you are doing well. Kindly share with me the effective dates along with the welcome letters for all the mentioned provides, also for facility contract / agreement as well.  Please get back to me as soon possible.  Thanks & Regards,', NULL, NULL, '2021-11-23 13:49:52', '2021-11-23 13:49:52'),
(18901, 10057, 21516, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email Received From : HumanaHoustonPD@humana.com  Sub : Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Please see item highlighted in yellow.  Please read the following instructions carefully:  For the following requests (fee schedules, copies of contracts, network participation, credentialing status, or effective dates) call provider relations at 800-448-6262 or 800-626-2741. All maintenance requests (provider adds, terms and changes)  need to be sent through Humanahoustonpd@humana.com.  Note:  This mailbox is only for these intents (adds, terms, changes). Requests for fee schedules, copies of contracts, network participation, credentialing status, or effective dates will not be processed through this mailbox.  Allow 60 days for processing of new applicants submission. Allow 30 days for processing of terminations and demographic updates. Status requests should be sent on your original email submission for tracking purposes. Please do not send direct emails to associates as there may not be a response to your request, and the request will not be processed.  In addition, please do not cc a Humana associate on your email requests to the above mailbox or this may delay the processing of your request. Disputing a claim paid/denied and appeals: contact humanaproviderservices@humana.com Log on to Humana.com or Availity.com for Provider updates, claim inquiries, eligibility/benefits information, fee schedule inquiries and more! For Humana.com issues and password resets, please call a Humana Web Specialist at 877-845-3480.  Thank you,  HumanaHoustonPD', NULL, NULL, '2021-11-24 10:41:04', '2021-11-24 10:41:04'),
(18902, 10057, 21516, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Need to call on mentioned number in next 15 days.  800-448-6262 or 800-626-2741', NULL, NULL, '2021-12-03 15:34:38', '2021-12-03 15:34:38'),
(18903, 10057, 21516, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Called to check the status - 800-448-6262  Reference for this call : 200015318382 - Rep. Abby  Provider is effective from 07/23/2021.  Waiting to update location in provider directory  It takes 15 to 20 more day from today.', NULL, NULL, '2021-12-10 14:10:39', '2021-12-10 14:10:39'),
(18904, 10057, 21516, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Will Follow-up in Next Week.  Please see previous Call Comments. Thank you', NULL, NULL, '2021-12-17 10:56:19', '2021-12-17 10:56:19'),
(18905, 10057, 21516, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To: HumanaHoustonPD@humana.com  Sub : Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Thank you for reaching out. We called and got the status from given numbers. However, we have been updated that providers are still in the middle of the directory portal.  Regards,', NULL, NULL, '2021-12-27 12:36:36', '2021-12-27 12:36:36'),
(18906, 20067, 21516, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Called Humana at 800-448-6262  Jaya Jacob 06/25/2021 effective date for all the network  Credentialing completed on 08/03/2021 and location is updated in providers directory  Requested for welcome letter  Ref 2000221097974 Rep: Mira T', NULL, NULL, '2022-01-11 17:35:43', '2022-01-11 17:35:43'),
(18907, 20067, 21516, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Didn\'t receive the welcome letters till yet. Will follow-up next week', NULL, NULL, '2022-01-18 10:31:32', '2022-01-18 10:31:32'),
(18908, 20067, 21516, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email received from insurance rep: VDelaPaz2@humana.com  Sub: Humana_Welcome Letter Request_Interaction#:2000229422892  Hi Syed,     Thank you for reaching us out. This is regarding with your request for the welcome letter of the providers. This is to inform you that we can just provide the credentialing or welcome letters by individual providers only not by group.  And I do apologize but I tried to check all of the providers record if we have a copy of welcome letters, and since we have a limited access here in our end, and we cannot see the letters here, then, I cannot provide you the welcome letters of the providers.  My advice to you is to reach out with the individual providers to get the copy of the letters as we really send the letters by individual providers and by the date they are effective or credentialed.        Thank you,     Vanessa Dela Paz', NULL, NULL, '2022-02-21 17:10:35', '2022-02-21 17:10:35'),
(18909, 20067, 21516, NULL, '2022-03-18 00:00:00.000', 'Approved', 'Humana does not disperse welcome letters.   Provider is Effective from: 06/25/2021', NULL, NULL, '2022-03-11 10:25:00', '2022-03-11 10:25:00'),
(18910, 3040, 21517, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:07:02', '2021-03-16 10:07:02'),
(18911, 1006, 21517, NULL, '2021-05-27 00:00:00.000', 'Initiated', 'Sent f/u email @ humanahoustonpd@humana.com requesting group enrollment status:  Sub: Facility Enrollment/Location Status - NUCC - Humana  \"Hello,   I wanted to verify if the following facility has the listed locations coming up under it or not? Information is as follows:  Group name: Normandy Urgent Care Center NPI# 1407171077 TIN# 27-0796429  Address 1: 779 Normandy St Ste 114, Houston, TX 77015-3441 Address 2: 9504 LONG POINT RD STE E, Houston, TX 77055-4226 Address 3: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-05-20 16:23:10', '2021-05-20 16:23:10'),
(18912, 3040, 21517, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: humanahoustonpd@humana.com  Subject: Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Greetings,  Hope you are doing well. I wanted to know enrollment status for the below mentioned provider in our group under the below locations.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: Rauf., Abdur Provider NPI# 1497726202  Provider 2: Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 3: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 5: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 9: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting for your response.   Thank you  ', NULL, NULL, '2021-06-08 16:38:12', '2021-06-08 16:38:12'),
(18913, 3040, 21517, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Email sent to: HumanaHoustonPD@humana.com  Subject: Re: Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Greetings,   Hope you are doing well. Can you please advise the enrollment status for the below mentioned group and providers in Humana under the below Tax ID and location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID#  76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 2: Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 3: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 6: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 7: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 8: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 9: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 10: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting for your response.   Thank you ', NULL, NULL, '2021-06-25 09:22:04', '2021-06-25 09:22:04');
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
(18914, 3040, 21517, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Email sent to: HumanaHoustonPD@humana.com  Subject: Re: FW: Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Hello,   Thank you for your prompt response. Please find the attached Standard Market Roster as per your previous email requested. All the providers CAQH updated.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID#   Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 3: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 5: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 6: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-14 15:23:47', '2021-07-14 15:23:47'),
(18915, 3040, 21517, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Email sent to: HumanaHoustonPD@humana.com  Subject: Re: FW: Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Hello,   Hope you are doing well. Please advise the enrollment status for the below mentioned providers in Humana in our group under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID#    Practice NPI# 1770763815  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: Brown, Brittany  Provider NPI# 1275163537     Provider 2:  Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956    Provider 3:  Provider Name: Stephen, Ani  Provider NPI# 1588959118     Provider 4:  Provider Name: Jacob, Jaya  Provider NPI# 1194336149     Provider 5:  Provider Name: PAUL, SIGI  Provider NPI# 1033623616     Provider 6:  Provider Name: Joseph, Molly  Provider NPI# 1396380077     Please get back to me as soon as you can get a chance. Waiting to hear from you soon.     Thank you  ', NULL, NULL, '2021-08-26 10:56:55', '2021-08-26 10:56:55'),
(18916, 10057, 21517, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : HumanaHoustonPD@humana.com  Sub : Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Good Evening,  Hope this email finds you well. I\'m writing this email to check the updated enrollment status for the below mentioned providers in Humana in our group under the below location.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Address	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Stephen, Ani	1588959118 Jacob, Jaya	1194336149 PAUL, SIGI	1033623616 Joseph, Molly	1073019493  Looking forward to your kind response, Have a great weekend ahead!  Thanks & Regards,', NULL, NULL, '2021-10-08 16:29:12', '2021-10-08 16:29:12'),
(18917, 10057, 21517, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From : HumanaHoustonPD@humana.com  Sub : Enrollment Status || Longpoint Medical Center || Providers || Humana ||  All are loaded and linked to the TIN provided.', NULL, NULL, '2021-11-23 13:47:31', '2021-11-23 13:47:31'),
(18918, 10057, 21517, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Sent To : HumanaHoustonPD@humana.com  Sub : Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Good Afternoon,  Hope you are doing well. Kindly share with me the effective dates along with the welcome letters for all the mentioned provides, also for facility contract / agreement as well.  Please get back to me as soon possible.  Thanks & Regards,', NULL, NULL, '2021-11-23 13:49:47', '2021-11-23 13:49:47'),
(18919, 10057, 21517, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email Received From : HumanaHoustonPD@humana.com  Sub : Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Please see item highlighted in yellow.  Please read the following instructions carefully:  For the following requests (fee schedules, copies of contracts, network participation, credentialing status, or effective dates) call provider relations at 800-448-6262 or 800-626-2741. All maintenance requests (provider adds, terms and changes)  need to be sent through Humanahoustonpd@humana.com.  Note:  This mailbox is only for these intents (adds, terms, changes). Requests for fee schedules, copies of contracts, network participation, credentialing status, or effective dates will not be processed through this mailbox.  Allow 60 days for processing of new applicants submission. Allow 30 days for processing of terminations and demographic updates. Status requests should be sent on your original email submission for tracking purposes. Please do not send direct emails to associates as there may not be a response to your request, and the request will not be processed.  In addition, please do not cc a Humana associate on your email requests to the above mailbox or this may delay the processing of your request. Disputing a claim paid/denied and appeals: contact humanaproviderservices@humana.com Log on to Humana.com or Availity.com for Provider updates, claim inquiries, eligibility/benefits information, fee schedule inquiries and more! For Humana.com issues and password resets, please call a Humana Web Specialist at 877-845-3480.  Thank you,  HumanaHoustonPD', NULL, NULL, '2021-11-24 10:40:58', '2021-11-24 10:40:58'),
(18920, 10057, 21517, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Need to call on mentioned number in next 15 days.  800-448-6262 or 800-626-2741', NULL, NULL, '2021-12-03 15:34:33', '2021-12-03 15:34:33'),
(18921, 10057, 21517, NULL, '2021-12-17 00:00:00.000', 'Approved', 'Called to check the status - 800-448-6262  Reference for this call : 200015318382 - Rep. Abby  Effective date: 07/23/2021  Please see attachment', NULL, NULL, '2021-12-10 13:56:36', '2021-12-10 13:56:36'),
(18922, 3040, 21518, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:08:09', '2021-03-16 10:08:09'),
(18923, 3040, 21518, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: 	intake_pdm@cigna.com, PDMCOGZ@cigna.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Cigna ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Cigna in our group under the below location.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 2:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 3:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 6:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks   ', NULL, NULL, '2021-05-31 16:21:53', '2021-05-31 16:21:53'),
(18924, 3040, 21518, NULL, '2021-06-25 00:00:00.000', 'Approved', 'Provider is participating with Cigna. Please see attachment. ', NULL, NULL, '2021-06-18 08:19:07', '2021-06-18 08:19:07'),
(18925, 3040, 21519, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:08:47', '2021-03-16 10:08:47'),
(18926, 3040, 21519, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: 	intake_pdm@cigna.com, PDMCOGZ@cigna.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Cigna ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Cigna in our group under the below location.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 2:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 3:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 6:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks   ', NULL, NULL, '2021-05-31 16:22:01', '2021-05-31 16:22:01'),
(18927, 3040, 21519, NULL, '2021-06-25 00:00:00.000', 'In Process', 'Application submitted online through Cigna.   Application no: 12650233 Provider ID: 7954947   Danny V 06/18/2021', NULL, NULL, '2021-06-18 08:56:44', '2021-06-18 08:56:44'),
(18928, 3040, 21519, NULL, '2021-07-13 00:00:00.000', 'In Process', 'I had a word with Ariana and she said the application is still in process and will take 90 to 120 calendar days. ', NULL, NULL, '2021-07-06 15:33:00', '2021-07-06 15:33:00'),
(18929, 3040, 21519, NULL, '2021-07-29 00:00:00.000', 'In Process', 'I had a word with (Paul) Cigna representative and he said the provider is out of network and application is still in the process.   ', NULL, NULL, '2021-07-22 10:52:29', '2021-07-22 10:52:29'),
(18930, 1006, 21519, NULL, '2021-08-12 00:00:00.000', 'Approved', 'Approval confirmation received from PDMCOGZ@cigna.com:  Sub: Completion Notification - W202107281820680  \"Dear Healthcare Professional,  We received your recent request and this request has been completed Under work ID: W202107281820680 for your reference.  PID: 7954947   HCP Name: MINI P CHENNEMKARA  Effective  date: 03/06/2020  Thank you for your submission. This is to confirm that your request has been completed. Please do not reply to this email message. The return address is not monitored. All future requests should be sent to Intake_PDM@cigna.com\"  Regards,  PDM.\"', NULL, NULL, '2021-08-05 10:42:52', '2021-08-05 10:42:52'),
(18931, 3040, 21520, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:10:03', '2021-03-16 10:10:03'),
(18932, 3040, 21520, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: 	intake_pdm@cigna.com, PDMCOGZ@cigna.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Cigna ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Cigna in our group under the below location.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 2:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 3:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 6:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks   ', NULL, NULL, '2021-05-31 16:22:06', '2021-05-31 16:22:06'),
(18933, 3040, 21520, NULL, '2021-06-25 00:00:00.000', 'In Process', 'Application submitted online through Cigna.    Application no: 12650223 Provider ID: 8396912   Danny V 06/18/2021 ', NULL, NULL, '2021-06-18 08:56:05', '2021-06-18 08:56:05'),
(18934, 3040, 21520, NULL, '2021-07-13 00:00:00.000', 'In Process', 'I had a word with Ariana and she said the application is still in process and will take 90 to 120 calendar days. ', NULL, NULL, '2021-07-06 15:33:06', '2021-07-06 15:33:06'),
(18935, 3040, 21520, NULL, '2021-07-29 00:00:00.000', 'In Process', 'I had a word with (Paul) Cigna representative and he said the provider is out of network and application is still in the process.   ', NULL, NULL, '2021-07-22 10:52:25', '2021-07-22 10:52:25'),
(18936, 3040, 21520, NULL, '2021-09-17 00:00:00.000', 'Approved', 'I had a word with (Maurice) With Cigna representative  and he said the provider is effective 07/07/2021. ', NULL, NULL, '2021-09-10 13:09:28', '2021-09-10 13:09:28'),
(18937, 3040, 21521, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:10:23', '2021-03-16 10:10:23'),
(18938, 1005, 21521, NULL, '2021-06-08 00:00:00.000', 'Not Eligible', 'Provider is no longer working for this Practice. Eff from 12/15/2020', NULL, NULL, '2021-06-01 12:57:57', '2021-06-01 12:57:57'),
(18939, 3040, 21522, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:11:01', '2021-03-16 10:11:01'),
(18940, 3040, 21522, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: 	intake_pdm@cigna.com, PDMCOGZ@cigna.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Cigna ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Cigna in our group under the below location.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 2:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 3:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 6:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks   ', NULL, NULL, '2021-05-31 16:22:10', '2021-05-31 16:22:10'),
(18941, 3040, 21522, NULL, '2021-06-25 00:00:00.000', 'In Process', 'Application submitted online through Cigna.   Application no: 12650199 Provider ID: 3836154  Danny V 06/18/2021', NULL, NULL, '2021-06-18 08:56:07', '2021-06-18 08:56:07'),
(18942, 3040, 21522, NULL, '2021-07-13 00:00:00.000', 'In Process', 'I had a word with Ariana and she said the application is still in process and will take 90 to 120 calendar days. ', NULL, NULL, '2021-07-06 15:33:10', '2021-07-06 15:33:10'),
(18943, 3040, 21522, NULL, '2021-07-29 00:00:00.000', 'In Process', 'I had a word with (Paul) Cigna representative and he said the provider is out of network and application is still in the process.   ', NULL, NULL, '2021-07-22 10:52:34', '2021-07-22 10:52:34'),
(18944, 3040, 21522, NULL, '2021-09-17 00:00:00.000', 'Approved', 'I had a word with (Maurice) With Cigna representative  and he said the provider is effective 01/01/2021. ', NULL, NULL, '2021-09-10 13:09:01', '2021-09-10 13:09:01'),
(18945, 3040, 21523, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:11:13', '2021-03-16 10:11:13'),
(18946, 3040, 21523, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: 	intake_pdm@cigna.com, PDMCOGZ@cigna.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Cigna ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Cigna in our group under the below location.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 2:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 3:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 6:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks   ', NULL, NULL, '2021-05-31 16:22:13', '2021-05-31 16:22:13'),
(18947, 3040, 21523, NULL, '2021-06-25 00:00:00.000', 'In Process', 'Email sent to: intake_pdm@cigna.com  Subject: Letter of Intent || Longpoint Medical Center || Jacob, Jaya || Cigna ||  Greetings,  Hope you are doing well. Please find the attached Letter of Intent to link the below mentioned provider in Cigna for our group under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-18 14:08:38', '2021-06-18 14:08:38'),
(18948, 3040, 21523, NULL, '2021-06-30 00:00:00.000', 'In Process', 'Email rcvd from: PDMCOGZ@cigna.com  Subject: Completion Notification-Cigna Reference ID W202106181755803 Dear Health Care Professional,     \"Thank you for your submission. This is to confirm that your request has been completed. Please do not reply to this email message. The return address is not monitored. All future request should be sent to Intake_PDM@cigna.com     Name: JAYA JACOB  PID: 9712079  Effective date: 01/01/2021    Sincerely, Data Management Enclosure: A copy of your original request', NULL, NULL, '2021-06-23 14:06:09', '2021-06-23 14:06:09'),
(18949, 3040, 21523, NULL, '2021-07-13 00:00:00.000', 'Approved', 'Email rcvd from: PDMCOGZ@cigna.com  Subject: Completion Notification-Cigna Reference ID W202106181755803 Dear Health Care Professional,     \"Thank you for your submission. This is to confirm that your request has been completed. Please do not reply to this email message. The return address is not monitored. All future request should be sent to Intake_PDM@cigna.com     Name: JAYA JACOB  PID: 9712079  Effective date: 01/01/2021    Sincerely, Data Management Enclosure: A copy of your original request', NULL, NULL, '2021-07-06 15:07:37', '2021-07-06 15:07:37'),
(18950, 3040, 21524, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:17:15', '2021-03-16 10:17:15'),
(18951, 3040, 21524, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: CHC.Contracting@communityhealthchoice.org  Subject: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Community Health Choice for our group under the below locations.     Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 14:02:58', '2021-05-26 14:02:58'),
(18952, 3040, 21524, NULL, '2021-06-21 00:00:00.000', 'On Hold', 'We have an ancillary contract with CHC. Location addition request sent out. For more details please see the group task. ', NULL, NULL, '2021-06-14 10:51:36', '2021-06-14 10:51:36'),
(18953, 3040, 21524, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: Rajika.Reid@communityhealthchoice.org  Subject: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Hello Rajika,   Hope you are doing well. Please find the attached signed contract as per your request email for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  If you need any additional information please feel free to call or email me.  Thank you ', NULL, NULL, '2021-07-20 10:43:26', '2021-07-20 10:43:26'),
(18954, 11056, 21524, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email sent to : Rajika.Reid@communityhealthchoice.org  Sub : FW: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Community Health Choice for our group under the below locations. And provide us with the updates regarding the signed contract which we have submitted to you in the month of June, 2021.    Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: George, Jeemol  Provider NPI# 1497219067     Provider 2:    Provider Name: Jose, Julie  Provider NPI# 1447883061     Provider 3:    Provider Name: Stephen, Ani  Provider NPI# 1588959118     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Brown, Brittany  Provider NPI# 1275163537     Provider 6:    Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956     Provider 7:    Provider Name: Abraham, Glory  Provider NPI# 1194206490     Provider 8:    Provider Name: Fernandus, Limy  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider NPI# 1497726202     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868     Provider 11:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560     Provider 12:    Provider Name: Thomas, Cini  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider NPI# 1467901587     Provider 14:    Provider Name: PAUL, SIGI   Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149     If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!  Have a great week ahead!', NULL, NULL, '2021-08-09 10:35:31', '2021-08-09 10:35:31'),
(18955, 3040, 21524, NULL, '2021-08-24 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. For more details please see group task. ', NULL, NULL, '2021-08-17 13:58:05', '2021-08-17 13:58:05'),
(18956, 3040, 21525, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:17:29', '2021-03-16 10:17:29'),
(18957, 3040, 21525, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: CHC.Contracting@communityhealthchoice.org  Subject: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Community Health Choice for our group under the below locations.     Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 14:03:02', '2021-05-26 14:03:02'),
(18958, 3040, 21525, NULL, '2021-06-21 00:00:00.000', 'On Hold', 'We have an ancillary contract with CHC. Location addition request sent out. For more details please see the group task. ', NULL, NULL, '2021-06-14 10:51:32', '2021-06-14 10:51:32'),
(18959, 3040, 21525, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: Rajika.Reid@communityhealthchoice.org  Subject: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Hello Rajika,   Hope you are doing well. Please find the attached signed contract as per your request email for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  If you need any additional information please feel free to call or email me.  Thank you ', NULL, NULL, '2021-07-20 10:43:25', '2021-07-20 10:43:25'),
(18960, 11056, 21525, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email sent to : Rajika.Reid@communityhealthchoice.org  Sub : FW: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Community Health Choice for our group under the below locations. And provide us with the updates regarding the signed contract which we have submitted to you in the month of June, 2021.    Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: George, Jeemol  Provider NPI# 1497219067     Provider 2:    Provider Name: Jose, Julie  Provider NPI# 1447883061     Provider 3:    Provider Name: Stephen, Ani  Provider NPI# 1588959118     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Brown, Brittany  Provider NPI# 1275163537     Provider 6:    Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956     Provider 7:    Provider Name: Abraham, Glory  Provider NPI# 1194206490     Provider 8:    Provider Name: Fernandus, Limy  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider NPI# 1497726202     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868     Provider 11:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560     Provider 12:    Provider Name: Thomas, Cini  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider NPI# 1467901587     Provider 14:    Provider Name: PAUL, SIGI   Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149     If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!  Have a great week ahead!', NULL, NULL, '2021-08-09 10:35:04', '2021-08-09 10:35:04'),
(18961, 3040, 21525, NULL, '2021-08-24 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. For more details please see group task. ', NULL, NULL, '2021-08-17 13:58:05', '2021-08-17 13:58:05'),
(18962, 3040, 21526, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:17:55', '2021-03-16 10:17:55'),
(18963, 3040, 21526, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: CHC.Contracting@communityhealthchoice.org  Subject: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Community Health Choice for our group under the below locations.     Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 14:03:05', '2021-05-26 14:03:05'),
(18964, 3040, 21526, NULL, '2021-06-21 00:00:00.000', 'On Hold', 'We have an ancillary contract with CHC. Location addition request sent out. For more details please see the group task. ', NULL, NULL, '2021-06-14 10:51:28', '2021-06-14 10:51:28'),
(18965, 3040, 21526, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: Rajika.Reid@communityhealthchoice.org  Subject: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Hello Rajika,   Hope you are doing well. Please find the attached signed contract as per your request email for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  If you need any additional information please feel free to call or email me.  Thank you ', NULL, NULL, '2021-07-20 10:43:25', '2021-07-20 10:43:25'),
(18966, 11056, 21526, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email sent to : Rajika.Reid@communityhealthchoice.org  Sub : FW: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Community Health Choice for our group under the below locations. And provide us with the updates regarding the signed contract which we have submitted to you in the month of June, 2021.    Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: George, Jeemol  Provider NPI# 1497219067     Provider 2:    Provider Name: Jose, Julie  Provider NPI# 1447883061     Provider 3:    Provider Name: Stephen, Ani  Provider NPI# 1588959118     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Brown, Brittany  Provider NPI# 1275163537     Provider 6:    Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956     Provider 7:    Provider Name: Abraham, Glory  Provider NPI# 1194206490     Provider 8:    Provider Name: Fernandus, Limy  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider NPI# 1497726202     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868     Provider 11:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560     Provider 12:    Provider Name: Thomas, Cini  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider NPI# 1467901587     Provider 14:    Provider Name: PAUL, SIGI   Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149     If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!  Have a great week ahead!', NULL, NULL, '2021-08-09 10:34:24', '2021-08-09 10:34:24'),
(18967, 3040, 21526, NULL, '2021-08-24 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. For more details please see group task. ', NULL, NULL, '2021-08-17 13:58:04', '2021-08-17 13:58:04'),
(18968, 3040, 21527, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:18:12', '2021-03-16 10:18:12'),
(18969, 3040, 21527, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: CHC.Contracting@communityhealthchoice.org  Subject: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Community Health Choice for our group under the below locations.     Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 14:03:10', '2021-05-26 14:03:10'),
(18970, 3040, 21527, NULL, '2021-06-21 00:00:00.000', 'On Hold', 'We have an ancillary contract with CHC. Location addition request sent out. For more details please see the group task. ', NULL, NULL, '2021-06-14 10:51:25', '2021-06-14 10:51:25'),
(18971, 3040, 21527, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: Rajika.Reid@communityhealthchoice.org  Subject: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Hello Rajika,   Hope you are doing well. Please find the attached signed contract as per your request email for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  If you need any additional information please feel free to call or email me.  Thank you ', NULL, NULL, '2021-07-20 10:43:24', '2021-07-20 10:43:24'),
(18972, 11056, 21527, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email sent to : Rajika.Reid@communityhealthchoice.org  Sub : FW: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Community Health Choice for our group under the below locations. And provide us with the updates regarding the signed contract which we have submitted to you in the month of June, 2021.    Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: George, Jeemol  Provider NPI# 1497219067     Provider 2:    Provider Name: Jose, Julie  Provider NPI# 1447883061     Provider 3:    Provider Name: Stephen, Ani  Provider NPI# 1588959118     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Brown, Brittany  Provider NPI# 1275163537     Provider 6:    Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956     Provider 7:    Provider Name: Abraham, Glory  Provider NPI# 1194206490     Provider 8:    Provider Name: Fernandus, Limy  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider NPI# 1497726202     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868     Provider 11:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560     Provider 12:    Provider Name: Thomas, Cini  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider NPI# 1467901587     Provider 14:    Provider Name: PAUL, SIGI   Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149     If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!  Have a great week ahead!', NULL, NULL, '2021-08-09 10:34:36', '2021-08-09 10:34:36'),
(18973, 3040, 21527, NULL, '2021-08-24 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. For more details please see group task. ', NULL, NULL, '2021-08-17 13:58:04', '2021-08-17 13:58:04'),
(18974, 3040, 21528, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:18:30', '2021-03-16 10:18:30'),
(18975, 3040, 21528, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: CHC.Contracting@communityhealthchoice.org  Subject: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Community Health Choice for our group under the below locations.     Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 14:03:15', '2021-05-26 14:03:15'),
(18976, 3040, 21528, NULL, '2021-06-21 00:00:00.000', 'On Hold', 'We have an ancillary contract with CHC. Location addition request sent out. For more details please see the group task. ', NULL, NULL, '2021-06-14 10:51:20', '2021-06-14 10:51:20'),
(18977, 3040, 21528, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: Rajika.Reid@communityhealthchoice.org  Subject: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Hello Rajika,   Hope you are doing well. Please find the attached signed contract as per your request email for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  If you need any additional information please feel free to call or email me.  Thank you ', NULL, NULL, '2021-07-20 10:43:24', '2021-07-20 10:43:24'),
(18978, 11056, 21528, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email sent to : Rajika.Reid@communityhealthchoice.org  Sub : FW: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Community Health Choice for our group under the below locations. And provide us with the updates regarding the signed contract which we have submitted to you in the month of June, 2021.    Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: George, Jeemol  Provider NPI# 1497219067     Provider 2:    Provider Name: Jose, Julie  Provider NPI# 1447883061     Provider 3:    Provider Name: Stephen, Ani  Provider NPI# 1588959118     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Brown, Brittany  Provider NPI# 1275163537     Provider 6:    Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956     Provider 7:    Provider Name: Abraham, Glory  Provider NPI# 1194206490     Provider 8:    Provider Name: Fernandus, Limy  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider NPI# 1497726202     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868     Provider 11:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560     Provider 12:    Provider Name: Thomas, Cini  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider NPI# 1467901587     Provider 14:    Provider Name: PAUL, SIGI   Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149     If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!  Have a great week ahead!', NULL, NULL, '2021-08-09 10:33:53', '2021-08-09 10:33:53');
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
(18979, 11056, 21528, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email sent to : Rajika.Reid@communityhealthchoice.org  Sub : FW: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Community Health Choice for our group under the below locations. And provide us with the updates regarding the signed contract which we have submitted to you in the month of June, 2021.    Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: George, Jeemol  Provider NPI# 1497219067     Provider 2:    Provider Name: Jose, Julie  Provider NPI# 1447883061     Provider 3:    Provider Name: Stephen, Ani  Provider NPI# 1588959118     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Brown, Brittany  Provider NPI# 1275163537     Provider 6:    Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956     Provider 7:    Provider Name: Abraham, Glory  Provider NPI# 1194206490     Provider 8:    Provider Name: Fernandus, Limy  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider NPI# 1497726202     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868     Provider 11:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560     Provider 12:    Provider Name: Thomas, Cini  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider NPI# 1467901587     Provider 14:    Provider Name: PAUL, SIGI   Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149     If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!  Have a great week ahead!', NULL, NULL, '2021-08-09 10:33:54', '2021-08-09 10:33:54'),
(18980, 3040, 21528, NULL, '2021-08-24 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. For more details please see group task. ', NULL, NULL, '2021-08-17 13:58:04', '2021-08-17 13:58:04'),
(18981, 3040, 21529, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:18:53', '2021-03-16 10:18:53'),
(18982, 3040, 21529, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: CHC.Contracting@communityhealthchoice.org  Subject: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Community Health Choice for our group under the below locations.     Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 14:03:19', '2021-05-26 14:03:19'),
(18983, 3040, 21529, NULL, '2021-06-21 00:00:00.000', 'On Hold', 'We have an ancillary contract with CHC. Location addition request sent out. For more details please see the group task. ', NULL, NULL, '2021-06-14 10:51:17', '2021-06-14 10:51:17'),
(18984, 3040, 21529, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: Rajika.Reid@communityhealthchoice.org  Subject: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Hello Rajika,   Hope you are doing well. Please find the attached signed contract as per your request email for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  If you need any additional information please feel free to call or email me.  Thank you ', NULL, NULL, '2021-07-20 10:43:23', '2021-07-20 10:43:23'),
(18985, 11056, 21529, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email sent to : Rajika.Reid@communityhealthchoice.org  Sub : FW: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Community Health Choice for our group under the below locations. And provide us with the updates regarding the signed contract which we have submitted to you in the month of June, 2021.    Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: George, Jeemol  Provider NPI# 1497219067     Provider 2:    Provider Name: Jose, Julie  Provider NPI# 1447883061     Provider 3:    Provider Name: Stephen, Ani  Provider NPI# 1588959118     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Brown, Brittany  Provider NPI# 1275163537     Provider 6:    Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956     Provider 7:    Provider Name: Abraham, Glory  Provider NPI# 1194206490     Provider 8:    Provider Name: Fernandus, Limy  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider NPI# 1497726202     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868     Provider 11:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560     Provider 12:    Provider Name: Thomas, Cini  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider NPI# 1467901587     Provider 14:    Provider Name: PAUL, SIGI   Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149     If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!  Have a great week ahead!', NULL, NULL, '2021-08-09 10:33:47', '2021-08-09 10:33:47'),
(18986, 3040, 21529, NULL, '2021-08-24 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. For more details please see group task. ', NULL, NULL, '2021-08-17 13:58:03', '2021-08-17 13:58:03'),
(18987, 3040, 21530, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:19:07', '2021-03-16 10:19:07'),
(18988, 3040, 21530, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: CHC.Contracting@communityhealthchoice.org  Subject: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Community Health Choice for our group under the below locations.     Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 14:03:23', '2021-05-26 14:03:23'),
(18989, 3040, 21530, NULL, '2021-06-21 00:00:00.000', 'On Hold', 'We have an ancillary contract with CHC. Location addition request sent out. For more details please see the group task. ', NULL, NULL, '2021-06-14 10:51:13', '2021-06-14 10:51:13'),
(18990, 3040, 21530, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: Rajika.Reid@communityhealthchoice.org  Subject: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Hello Rajika,   Hope you are doing well. Please find the attached signed contract as per your request email for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  If you need any additional information please feel free to call or email me.  Thank you ', NULL, NULL, '2021-07-20 10:43:23', '2021-07-20 10:43:23'),
(18991, 11056, 21530, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email sent to : Rajika.Reid@communityhealthchoice.org  Sub : FW: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Community Health Choice for our group under the below locations. And provide us with the updates regarding the signed contract which we have submitted to you in the month of June, 2021.    Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: George, Jeemol  Provider NPI# 1497219067     Provider 2:    Provider Name: Jose, Julie  Provider NPI# 1447883061     Provider 3:    Provider Name: Stephen, Ani  Provider NPI# 1588959118     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Brown, Brittany  Provider NPI# 1275163537     Provider 6:    Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956     Provider 7:    Provider Name: Abraham, Glory  Provider NPI# 1194206490     Provider 8:    Provider Name: Fernandus, Limy  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider NPI# 1497726202     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868     Provider 11:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560     Provider 12:    Provider Name: Thomas, Cini  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider NPI# 1467901587     Provider 14:    Provider Name: PAUL, SIGI   Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149     If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!  Have a great week ahead!', NULL, NULL, '2021-08-09 10:33:38', '2021-08-09 10:33:38'),
(18992, 3040, 21530, NULL, '2021-08-24 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. For more details please see group task. ', NULL, NULL, '2021-08-17 13:58:03', '2021-08-17 13:58:03'),
(18993, 3040, 21531, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:19:35', '2021-03-16 10:19:35'),
(18994, 3040, 21531, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: CHC.Contracting@communityhealthchoice.org  Subject: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Community Health Choice for our group under the below locations.     Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 14:03:27', '2021-05-26 14:03:27'),
(18995, 3040, 21531, NULL, '2021-06-21 00:00:00.000', 'On Hold', 'We have an ancillary contract with CHC. Location addition request sent out. For more details please see the group task. ', NULL, NULL, '2021-06-14 10:51:09', '2021-06-14 10:51:09'),
(18996, 3040, 21531, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: Rajika.Reid@communityhealthchoice.org  Subject: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Hello Rajika,   Hope you are doing well. Please find the attached signed contract as per your request email for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  If you need any additional information please feel free to call or email me.  Thank you ', NULL, NULL, '2021-07-20 10:43:22', '2021-07-20 10:43:22'),
(18997, 11056, 21531, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email sent to : Rajika.Reid@communityhealthchoice.org  Sub : FW: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Community Health Choice for our group under the below locations. And provide us with the updates regarding the signed contract which we have submitted to you in the month of June, 2021.    Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: George, Jeemol  Provider NPI# 1497219067     Provider 2:    Provider Name: Jose, Julie  Provider NPI# 1447883061     Provider 3:    Provider Name: Stephen, Ani  Provider NPI# 1588959118     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Brown, Brittany  Provider NPI# 1275163537     Provider 6:    Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956     Provider 7:    Provider Name: Abraham, Glory  Provider NPI# 1194206490     Provider 8:    Provider Name: Fernandus, Limy  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider NPI# 1497726202     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868     Provider 11:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560     Provider 12:    Provider Name: Thomas, Cini  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider NPI# 1467901587     Provider 14:    Provider Name: PAUL, SIGI   Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149     If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!  Have a great week ahead!', NULL, NULL, '2021-08-09 10:33:29', '2021-08-09 10:33:29'),
(18998, 3040, 21531, NULL, '2021-08-24 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. For more details please see group task. ', NULL, NULL, '2021-08-17 13:58:02', '2021-08-17 13:58:02'),
(18999, 3040, 21532, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:19:46', '2021-03-16 10:19:46'),
(19000, 3040, 21532, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: CHC.Contracting@communityhealthchoice.org  Subject: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Community Health Choice for our group under the below locations.     Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 14:03:31', '2021-05-26 14:03:31'),
(19001, 1005, 21532, NULL, '2021-06-08 00:00:00.000', 'Not Eligible', 'Provider is no longer working for this Practice. Eff from 12/15/2020', NULL, NULL, '2021-06-01 13:02:16', '2021-06-01 13:02:16'),
(19002, 3040, 21533, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:19:59', '2021-03-16 10:19:59'),
(19003, 3040, 21533, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: CHC.Contracting@communityhealthchoice.org  Subject: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Community Health Choice for our group under the below locations.     Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 14:03:35', '2021-05-26 14:03:35'),
(19004, 3040, 21533, NULL, '2021-06-21 00:00:00.000', 'On Hold', 'We have an ancillary contract with CHC. Location addition request sent out. For more details please see the group task. ', NULL, NULL, '2021-06-14 10:51:04', '2021-06-14 10:51:04'),
(19005, 3040, 21533, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: Rajika.Reid@communityhealthchoice.org  Subject: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Hello Rajika,   Hope you are doing well. Please find the attached signed contract as per your request email for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  If you need any additional information please feel free to call or email me.  Thank you ', NULL, NULL, '2021-07-20 10:43:22', '2021-07-20 10:43:22'),
(19006, 11056, 21533, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email sent to : Rajika.Reid@communityhealthchoice.org  Sub : FW: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Community Health Choice for our group under the below locations. And provide us with the updates regarding the signed contract which we have submitted to you in the month of June, 2021.    Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: George, Jeemol  Provider NPI# 1497219067     Provider 2:    Provider Name: Jose, Julie  Provider NPI# 1447883061     Provider 3:    Provider Name: Stephen, Ani  Provider NPI# 1588959118     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Brown, Brittany  Provider NPI# 1275163537     Provider 6:    Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956     Provider 7:    Provider Name: Abraham, Glory  Provider NPI# 1194206490     Provider 8:    Provider Name: Fernandus, Limy  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider NPI# 1497726202     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868     Provider 11:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560     Provider 12:    Provider Name: Thomas, Cini  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider NPI# 1467901587     Provider 14:    Provider Name: PAUL, SIGI   Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149     If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!  Have a great week ahead!', NULL, NULL, '2021-08-09 10:33:22', '2021-08-09 10:33:22'),
(19007, 3040, 21533, NULL, '2021-08-24 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. For more details please see group task. ', NULL, NULL, '2021-08-17 13:58:02', '2021-08-17 13:58:02'),
(19008, 3040, 21534, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:20:15', '2021-03-16 10:20:15'),
(19009, 3040, 21534, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: CHC.Contracting@communityhealthchoice.org  Subject: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Community Health Choice for our group under the below locations.     Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 14:03:39', '2021-05-26 14:03:39'),
(19010, 3040, 21534, NULL, '2021-06-21 00:00:00.000', 'On Hold', 'We have an ancillary contract with CHC. Location addition request sent out. For more details please see the group task. ', NULL, NULL, '2021-06-14 10:51:00', '2021-06-14 10:51:00'),
(19011, 3040, 21534, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: Rajika.Reid@communityhealthchoice.org  Subject: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Hello Rajika,   Hope you are doing well. Please find the attached signed contract as per your request email for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  If you need any additional information please feel free to call or email me.  Thank you ', NULL, NULL, '2021-07-20 10:43:21', '2021-07-20 10:43:21'),
(19012, 11056, 21534, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email sent to : Rajika.Reid@communityhealthchoice.org  Sub : FW: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Community Health Choice for our group under the below locations. And provide us with the updates regarding the signed contract which we have submitted to you in the month of June, 2021.    Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: George, Jeemol  Provider NPI# 1497219067     Provider 2:    Provider Name: Jose, Julie  Provider NPI# 1447883061     Provider 3:    Provider Name: Stephen, Ani  Provider NPI# 1588959118     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Brown, Brittany  Provider NPI# 1275163537     Provider 6:    Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956     Provider 7:    Provider Name: Abraham, Glory  Provider NPI# 1194206490     Provider 8:    Provider Name: Fernandus, Limy  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider NPI# 1497726202     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868     Provider 11:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560     Provider 12:    Provider Name: Thomas, Cini  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider NPI# 1467901587     Provider 14:    Provider Name: PAUL, SIGI   Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149     If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!  Have a great week ahead!', NULL, NULL, '2021-08-09 10:33:13', '2021-08-09 10:33:13'),
(19013, 3040, 21534, NULL, '2021-08-24 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. For more details please see group task. ', NULL, NULL, '2021-08-17 13:58:02', '2021-08-17 13:58:02'),
(19014, 3040, 21535, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:20:27', '2021-03-16 10:20:27'),
(19015, 3040, 21535, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: CHC.Contracting@communityhealthchoice.org  Subject: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Community Health Choice for our group under the below locations.     Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 14:03:43', '2021-05-26 14:03:43'),
(19016, 3040, 21535, NULL, '2021-06-21 00:00:00.000', 'On Hold', 'We have an ancillary contract with CHC. Location addition request sent out. For more details please see the group task. ', NULL, NULL, '2021-06-14 10:50:56', '2021-06-14 10:50:56'),
(19017, 3040, 21535, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: Rajika.Reid@communityhealthchoice.org  Subject: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Hello Rajika,   Hope you are doing well. Please find the attached signed contract as per your request email for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  If you need any additional information please feel free to call or email me.  Thank you ', NULL, NULL, '2021-07-20 10:43:21', '2021-07-20 10:43:21'),
(19018, 11056, 21535, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email sent to : Rajika.Reid@communityhealthchoice.org  Sub : FW: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Community Health Choice for our group under the below locations. And provide us with the updates regarding the signed contract which we have submitted to you in the month of June, 2021.    Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: George, Jeemol  Provider NPI# 1497219067     Provider 2:    Provider Name: Jose, Julie  Provider NPI# 1447883061     Provider 3:    Provider Name: Stephen, Ani  Provider NPI# 1588959118     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Brown, Brittany  Provider NPI# 1275163537     Provider 6:    Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956     Provider 7:    Provider Name: Abraham, Glory  Provider NPI# 1194206490     Provider 8:    Provider Name: Fernandus, Limy  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider NPI# 1497726202     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868     Provider 11:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560     Provider 12:    Provider Name: Thomas, Cini  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider NPI# 1467901587     Provider 14:    Provider Name: PAUL, SIGI   Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149     If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!  Have a great week ahead!', NULL, NULL, '2021-08-09 10:33:04', '2021-08-09 10:33:04'),
(19019, 3040, 21535, NULL, '2021-08-24 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. For more details please see group task. ', NULL, NULL, '2021-08-17 13:58:01', '2021-08-17 13:58:01'),
(19020, 3040, 21536, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:20:42', '2021-03-16 10:20:42'),
(19021, 3040, 21536, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: CHC.Contracting@communityhealthchoice.org  Subject: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Community Health Choice for our group under the below locations.     Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 14:03:47', '2021-05-26 14:03:47'),
(19022, 3040, 21536, NULL, '2021-06-21 00:00:00.000', 'On Hold', 'We have an ancillary contract with CHC. Location addition request sent out. For more details please see the group task. ', NULL, NULL, '2021-06-14 10:50:52', '2021-06-14 10:50:52'),
(19023, 3040, 21536, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: Rajika.Reid@communityhealthchoice.org  Subject: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Hello Rajika,   Hope you are doing well. Please find the attached signed contract as per your request email for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  If you need any additional information please feel free to call or email me.  Thank you ', NULL, NULL, '2021-07-20 10:43:20', '2021-07-20 10:43:20'),
(19024, 11056, 21536, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email sent to : Rajika.Reid@communityhealthchoice.org  Sub : FW: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Community Health Choice for our group under the below locations. And provide us with the updates regarding the signed contract which we have submitted to you in the month of June, 2021.    Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: George, Jeemol  Provider NPI# 1497219067     Provider 2:    Provider Name: Jose, Julie  Provider NPI# 1447883061     Provider 3:    Provider Name: Stephen, Ani  Provider NPI# 1588959118     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Brown, Brittany  Provider NPI# 1275163537     Provider 6:    Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956     Provider 7:    Provider Name: Abraham, Glory  Provider NPI# 1194206490     Provider 8:    Provider Name: Fernandus, Limy  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider NPI# 1497726202     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868     Provider 11:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560     Provider 12:    Provider Name: Thomas, Cini  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider NPI# 1467901587     Provider 14:    Provider Name: PAUL, SIGI   Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149     If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!  Have a great week ahead!', NULL, NULL, '2021-08-09 10:32:32', '2021-08-09 10:32:32'),
(19025, 3040, 21536, NULL, '2021-08-24 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. For more details please see group task. ', NULL, NULL, '2021-08-17 13:58:01', '2021-08-17 13:58:01'),
(19026, 3040, 21537, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:22:07', '2021-03-16 10:22:07');
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
(19027, 3040, 21537, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Driscoll for our group under the below locations.     Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 15:47:29', '2021-05-26 15:47:29'),
(19028, 3040, 21537, NULL, '2021-06-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: DHPContracting@dchstx.org, Karla.Claunch@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Good morning,  These locations are out of our service area so, we are unable to contract or credential them.  Please see the attached map of our service area.  We will only have members within this area.  If you have any questions, please let me know.  Karla Claunch    ', NULL, NULL, '2021-06-03 08:55:55', '2021-06-03 08:55:55'),
(19029, 3040, 21538, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:22:19', '2021-03-16 10:22:19'),
(19030, 3040, 21538, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Driscoll for our group under the below locations.     Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 15:47:33', '2021-05-26 15:47:33'),
(19031, 3040, 21538, NULL, '2021-06-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: DHPContracting@dchstx.org, Karla.Claunch@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Good morning,  These locations are out of our service area so, we are unable to contract or credential them.  Please see the attached map of our service area.  We will only have members within this area.  If you have any questions, please let me know.  Karla Claunch    ', NULL, NULL, '2021-06-03 08:55:59', '2021-06-03 08:55:59'),
(19032, 3040, 21539, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:22:34', '2021-03-16 10:22:34'),
(19033, 3040, 21539, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Driscoll for our group under the below locations.     Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 15:47:37', '2021-05-26 15:47:37'),
(19034, 3040, 21539, NULL, '2021-06-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: DHPContracting@dchstx.org, Karla.Claunch@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Good morning,  These locations are out of our service area so, we are unable to contract or credential them.  Please see the attached map of our service area.  We will only have members within this area.  If you have any questions, please let me know.  Karla Claunch    ', NULL, NULL, '2021-06-03 08:57:35', '2021-06-03 08:57:35'),
(19035, 3040, 21540, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:22:49', '2021-03-16 10:22:49'),
(19036, 3040, 21540, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Driscoll for our group under the below locations.     Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 15:47:41', '2021-05-26 15:47:41'),
(19037, 3040, 21540, NULL, '2021-06-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: DHPContracting@dchstx.org, Karla.Claunch@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Good morning,  These locations are out of our service area so, we are unable to contract or credential them.  Please see the attached map of our service area.  We will only have members within this area.  If you have any questions, please let me know.  Karla Claunch    ', NULL, NULL, '2021-06-03 08:57:39', '2021-06-03 08:57:39'),
(19038, 3040, 21541, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:23:01', '2021-03-16 10:23:01'),
(19039, 3040, 21541, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Driscoll for our group under the below locations.     Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 15:47:44', '2021-05-26 15:47:44'),
(19040, 3040, 21541, NULL, '2021-06-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: DHPContracting@dchstx.org, Karla.Claunch@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Good morning,  These locations are out of our service area so, we are unable to contract or credential them.  Please see the attached map of our service area.  We will only have members within this area.  If you have any questions, please let me know.  Karla Claunch    ', NULL, NULL, '2021-06-03 08:57:43', '2021-06-03 08:57:43'),
(19041, 3040, 21542, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:23:14', '2021-03-16 10:23:14'),
(19042, 3040, 21542, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Driscoll for our group under the below locations.     Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 15:47:48', '2021-05-26 15:47:48'),
(19043, 3040, 21542, NULL, '2021-06-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: DHPContracting@dchstx.org, Karla.Claunch@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Good morning,  These locations are out of our service area so, we are unable to contract or credential them.  Please see the attached map of our service area.  We will only have members within this area.  If you have any questions, please let me know.  Karla Claunch    ', NULL, NULL, '2021-06-03 08:57:49', '2021-06-03 08:57:49'),
(19044, 3040, 21543, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:23:28', '2021-03-16 10:23:28'),
(19045, 3040, 21543, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Driscoll for our group under the below locations.     Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 15:47:52', '2021-05-26 15:47:52'),
(19046, 3040, 21543, NULL, '2021-06-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: DHPContracting@dchstx.org, Karla.Claunch@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Good morning,  These locations are out of our service area so, we are unable to contract or credential them.  Please see the attached map of our service area.  We will only have members within this area.  If you have any questions, please let me know.  Karla Claunch    ', NULL, NULL, '2021-06-03 08:57:58', '2021-06-03 08:57:58'),
(19047, 3040, 21544, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:23:41', '2021-03-16 10:23:41'),
(19048, 3040, 21544, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Driscoll for our group under the below locations.     Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 15:47:55', '2021-05-26 15:47:55'),
(19049, 3040, 21544, NULL, '2021-06-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: DHPContracting@dchstx.org, Karla.Claunch@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Good morning,  These locations are out of our service area so, we are unable to contract or credential them.  Please see the attached map of our service area.  We will only have members within this area.  If you have any questions, please let me know.  Karla Claunch    ', NULL, NULL, '2021-06-03 08:58:02', '2021-06-03 08:58:02'),
(19050, 3040, 21545, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:23:52', '2021-03-16 10:23:52'),
(19051, 3040, 21545, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Driscoll for our group under the below locations.     Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 15:47:59', '2021-05-26 15:47:59'),
(19052, 3040, 21545, NULL, '2021-06-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: DHPContracting@dchstx.org, Karla.Claunch@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Good morning,  These locations are out of our service area so, we are unable to contract or credential them.  Please see the attached map of our service area.  We will only have members within this area.  If you have any questions, please let me know.  Karla Claunch    ', NULL, NULL, '2021-06-03 08:58:06', '2021-06-03 08:58:06'),
(19053, 3040, 21546, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:24:07', '2021-03-16 10:24:07'),
(19054, 3040, 21546, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Driscoll for our group under the below locations.     Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 15:48:04', '2021-05-26 15:48:04'),
(19055, 3040, 21546, NULL, '2021-06-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: DHPContracting@dchstx.org, Karla.Claunch@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Good morning,  These locations are out of our service area so, we are unable to contract or credential them.  Please see the attached map of our service area.  We will only have members within this area.  If you have any questions, please let me know.  Karla Claunch    ', NULL, NULL, '2021-06-03 08:58:10', '2021-06-03 08:58:10'),
(19056, 3040, 21547, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:24:21', '2021-03-16 10:24:21'),
(19057, 3040, 21547, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Driscoll for our group under the below locations.     Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 15:48:08', '2021-05-26 15:48:08'),
(19058, 3040, 21547, NULL, '2021-06-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: DHPContracting@dchstx.org, Karla.Claunch@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Good morning,  These locations are out of our service area so, we are unable to contract or credential them.  Please see the attached map of our service area.  We will only have members within this area.  If you have any questions, please let me know.  Karla Claunch    ', NULL, NULL, '2021-06-03 08:58:23', '2021-06-03 08:58:23'),
(19059, 3040, 21548, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:24:35', '2021-03-16 10:24:35'),
(19060, 3040, 21548, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Driscoll for our group under the below locations.     Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 15:48:12', '2021-05-26 15:48:12'),
(19061, 3040, 21548, NULL, '2021-06-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: DHPContracting@dchstx.org, Karla.Claunch@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Good morning,  These locations are out of our service area so, we are unable to contract or credential them.  Please see the attached map of our service area.  We will only have members within this area.  If you have any questions, please let me know.  Karla Claunch    ', NULL, NULL, '2021-06-03 09:00:27', '2021-06-03 09:00:27'),
(19062, 3040, 21549, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:24:46', '2021-03-16 10:24:46'),
(19063, 1005, 21549, NULL, '2021-06-08 00:00:00.000', 'Not Eligible', 'Provider is no longer working for this Practice. Eff from 12/15/2020', NULL, NULL, '2021-06-01 12:58:11', '2021-06-01 12:58:11'),
(19064, 1006, 21550, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:24:46', '2021-03-16 10:24:46'),
(19065, 3040, 21550, NULL, '2021-04-27 00:00:00.000', 'Approved', 'Application Tracking ID: T021020210000913   NPI ID: 1124622667   Medicare ID: S400728296   Name: RODESIA EDMUNDSON  State: MA   Form Type: 855I  Date: 02/26/2021  Status: APPROVED', NULL, NULL, '2021-04-20 14:44:09', '2021-04-20 14:44:09'),
(19066, 1006, 21551, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:24:49', '2021-03-16 10:24:49'),
(19067, 3040, 21551, NULL, '2021-04-27 00:00:00.000', 'Approved', 'The provider is enrolled with Medicare. Approval confirmation is attached for reference.   Eff: 02/24/2020 ID# S400638550', NULL, NULL, '2021-04-20 14:31:12', '2021-04-20 14:31:12'),
(19068, 1006, 21552, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:24:54', '2021-03-16 10:24:54'),
(19069, 3040, 21552, NULL, '2021-04-27 00:00:00.000', 'Approved', 'Application Tracking ID: T102720200002605   NPI ID: 1982617262   Medicare ID: S400701622   Name: BARBARA HIGNITE  State: MA   Form Type: 855I  Date: 11/20/2020  Status: APPROVED', NULL, NULL, '2021-04-20 14:45:37', '2021-04-20 14:45:37'),
(19070, 3040, 21553, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:24:57', '2021-03-16 10:24:57'),
(19071, 3040, 21553, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Driscoll for our group under the below locations.     Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 15:48:18', '2021-05-26 15:48:18'),
(19072, 3040, 21553, NULL, '2021-06-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: DHPContracting@dchstx.org, Karla.Claunch@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Good morning,  These locations are out of our service area so, we are unable to contract or credential them.  Please see the attached map of our service area.  We will only have members within this area.  If you have any questions, please let me know.  Karla Claunch    ', NULL, NULL, '2021-06-03 09:00:42', '2021-06-03 09:00:42'),
(19073, 1006, 21554, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:24:57', '2021-03-16 10:24:57'),
(19074, 3040, 21554, NULL, '2021-04-27 00:00:00.000', 'Approved', 'The provider is enrolled with Medicare. Approval confirmation is attached for reference.   Eff: 08/05/2019 ID# S400592362', NULL, NULL, '2021-04-20 14:33:32', '2021-04-20 14:33:32'),
(19075, 1006, 21555, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:24:59', '2021-03-16 10:24:59'),
(19076, 3040, 21555, NULL, '2021-04-27 00:00:00.000', 'Approved', 'Application Tracking ID: T111820200002023   NPI ID: 1598163602   Medicare ID: S400706440   Name: LYNNETTA LOVELAND  State: MA   Form Type: 855I  Date: 12/09/2020  Status: APPROVED', NULL, NULL, '2021-04-20 14:47:32', '2021-04-20 14:47:32'),
(19077, 1006, 21556, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:25:00', '2021-03-16 10:25:00'),
(19078, 3040, 21556, NULL, '2021-04-27 00:00:00.000', 'Approved', 'The provider is enrolled with Medicare. Approval confirmation is attached for reference.   Eff: 01/21/2020 ID# S400634712', NULL, NULL, '2021-04-20 14:34:44', '2021-04-20 14:34:44'),
(19079, 1006, 21557, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:25:02', '2021-03-16 10:25:02'),
(19080, 3040, 21557, NULL, '2021-04-27 00:00:00.000', 'Approved', 'The provider is enrolled with Medicare. Approval confirmation is attached for reference.   Eff: 05/13/2020 ID# S400654658', NULL, NULL, '2021-04-20 14:29:31', '2021-04-20 14:29:31'),
(19081, 1006, 21558, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:25:03', '2021-03-16 10:25:03'),
(19082, 3040, 21558, NULL, '2021-04-27 00:00:00.000', 'Approved', 'Application Tracking ID: T111120200000937   NPI ID: 1225645393   Medicare ID: S400704092   Name: CARLEE ROZELL  State: MA   Form Type: 855I  Date: 12/02/2020  Status: APPROVED', NULL, NULL, '2021-04-20 14:46:26', '2021-04-20 14:46:26'),
(19083, 1006, 21559, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:25:05', '2021-03-16 10:25:05'),
(19084, 3040, 21559, NULL, '2021-04-27 00:00:00.000', 'Approved', 'Application Tracking ID: T071020200001025   NPI ID: 1235755505   Medicare ID: S400672892   Name: JONATHAN SCHUBERT  State: MA   Form Type: 855I  Date: 08/11/2020  Status: APPROVED', NULL, NULL, '2021-04-20 14:40:54', '2021-04-20 14:40:54'),
(19085, 1006, 21560, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:25:06', '2021-03-16 10:25:06'),
(19086, 1019, 21560, NULL, '2021-04-09 00:00:00.000', 'Approved', 'Spoke with Audrie at (888) 379-3807 Kerry is enrolled under group and group is enrolled in all 3 locations. Ref # 936762 Audrie. Attached is the ref from PECOS ', NULL, NULL, '2021-04-02 13:04:53', '2021-04-02 13:04:53'),
(19087, 3040, 21561, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:25:06', '2021-03-16 10:25:06'),
(19088, 3040, 21561, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Driscoll for our group under the below locations.     Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 15:48:22', '2021-05-26 15:48:22'),
(19089, 3040, 21561, NULL, '2021-06-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: DHPContracting@dchstx.org, Karla.Claunch@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Good morning,  These locations are out of our service area so, we are unable to contract or credential them.  Please see the attached map of our service area.  We will only have members within this area.  If you have any questions, please let me know.  Karla Claunch    ', NULL, NULL, '2021-06-03 09:00:52', '2021-06-03 09:00:52'),
(19090, 1006, 21562, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:25:07', '2021-03-16 10:25:07'),
(19091, 3040, 21562, NULL, '2021-04-27 00:00:00.000', 'Approved', 'The provider is enrolled with Medicare. Approval confirmation is attached for reference.   Eff:01/12/2020	 ID# S400632499	', NULL, NULL, '2021-04-20 14:27:35', '2021-04-20 14:27:35'),
(19092, 1006, 21563, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:25:09', '2021-03-16 10:25:09'),
(19093, 3040, 21563, NULL, '2021-04-27 00:00:00.000', 'Approved', 'Application Tracking ID: T070620200004002 NPI ID: 1710489760 Medicare ID: S400676729 Name: JENNIFER ULLRICH State: MA Form Type: 855I Date: 08/26/2020 Status: APPROVED', NULL, NULL, '2021-04-20 14:36:11', '2021-04-20 14:36:11'),
(19094, 3040, 21564, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:25:17', '2021-03-16 10:25:17'),
(19095, 3040, 21564, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Driscoll for our group under the below locations.     Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 15:48:27', '2021-05-26 15:48:27'),
(19096, 3040, 21564, NULL, '2021-06-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: DHPContracting@dchstx.org, Karla.Claunch@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Good morning,  These locations are out of our service area so, we are unable to contract or credential them.  Please see the attached map of our service area.  We will only have members within this area.  If you have any questions, please let me know.  Karla Claunch    ', NULL, NULL, '2021-06-03 09:00:56', '2021-06-03 09:00:56'),
(19097, 3040, 21565, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:25:30', '2021-03-16 10:25:30');
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
(19098, 3040, 21565, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Driscoll for our group under the below locations.     Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 15:48:31', '2021-05-26 15:48:31'),
(19099, 3040, 21565, NULL, '2021-06-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: DHPContracting@dchstx.org, Karla.Claunch@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Good morning,  These locations are out of our service area so, we are unable to contract or credential them.  Please see the attached map of our service area.  We will only have members within this area.  If you have any questions, please let me know.  Karla Claunch    ', NULL, NULL, '2021-06-03 09:01:02', '2021-06-03 09:01:02'),
(19100, 1006, 21566, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:26:05', '2021-03-16 10:26:05'),
(19101, 1019, 21566, NULL, '2021-04-29 00:00:00.000', 'Initiated', 'LOI was faxed to Aetna demographics update at (859) 455-8650 to Add New Location. see attachment for ref ', NULL, NULL, '2021-04-22 08:31:44', '2021-04-22 08:31:44'),
(19102, 1019, 21566, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Sent the following email to : Laura.Bevin@aetna.com, ChandraKumarU@aetna.com SUB: Enrollment Query || Group & Providers || SNBCARE || Aetna  Hello,   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Melody L\'Etoile 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Barbara Hignite 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Fauzia Wali Khan 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Lynnetta Loveland 1598163602 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Peggy Pionke 1699307322 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Mahreen Rashid 1396393146 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Carlee Rozell 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Kerry Smith 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Katie Tawakol 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jennifer Ullrich 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Justin Souliere 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.', NULL, NULL, '2021-05-03 10:42:45', '2021-05-03 10:42:45'),
(19103, 1019, 21566, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Sent the following email to Laura.Bevin@aetna.com SUB: Enrollment Query || Group & Providers || SNBCARE || Aetna  Hello, We need the enrollment application status for the following providers,   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Carlee Rozell 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Katie Tawakol 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jennifer Ullrich 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Justin Souliere 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Kerry Smith 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Fauzia Wali Khan 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Lynnetta Loveland 1598163602 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Peggy Pionke 1699307322 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Mahreen Rashid 1396393146 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Regards,', NULL, NULL, '2021-05-20 08:03:48', '2021-05-20 08:03:48'),
(19104, 1019, 21566, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Received the following email from Laura.Bevin@aetna.com  Good afternoon, Please see my below comments. Thank you  Mary Gibbons, 9080253 – application was not received NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman, 6715913 – credentialed for RI only, please submit an app for MA NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Carlee Rozell, 6712207 – 01/01/2021 effective date 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.       Jonathan Schubert, 6249193 – 06/15/2021 effective date 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.        Katie Tawakol, 6120037 – 01/01/2021 effective date 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767  Jennifer Ullrich, 6913357 – 05/01/2021 effective date 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767  Justin Souliere, 6893422 – 05/017/2021 effective date 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva, 4841425 – waiting to be linked 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.   Laura Bevin Credentialing Senior Analyst Aetna Behavioral Health', NULL, NULL, '2021-05-31 11:57:27', '2021-05-31 11:57:27'),
(19105, 1019, 21566, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to Laura.Bevin@aetna.com SUB: Enrollment Query || Group & Providers || SNBCARE || Aetna  Hello, We need the enrollment application status for the following providers,   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Carlee Rozell 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Katie Tawakol 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jennifer Ullrich 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Justin Souliere 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Kerry Smith 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Fauzia Wali Khan 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Lynnetta Loveland 1598163602 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Peggy Pionke 1699307322 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Mahreen Rashid 1396393146 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Regards,', NULL, NULL, '2021-06-16 07:57:28', '2021-06-16 07:57:28'),
(19106, 1019, 21566, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent the following email to Laura.Bevin@aetna.com  Hello, We need the enrollment application status for the following providers,   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Providers:  Barbara Hignite NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson  NPI: 1124622667  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Jessica Hartman  NPI: 1326665472  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Lynnetta Loveland  NPI: 1598163602  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Cemetrice Muhammed NPI: 1548843410  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Jonathan Schubert  NPI: 1235755505   Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Kerry Smith  NPI: 1275083230  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jennifer Ullrich  NPI: 1710489760  Secondary Location: 100 New State Highway, Raynham, MA, 02767      Regards, Alex G.', NULL, NULL, '2021-08-24 11:12:54', '2021-08-24 11:12:54'),
(19107, 1019, 21566, NULL, '2021-11-08 00:00:00.000', 'In Process', 'Received the following email from Laura Bevin.  Good afternoon,  Allie DiCostanzo, 6792883 – in the credentialing process  Dina Filoteo-Nichols, 6184053 – in the credentialing process  Helena Halterman – application was not received  Jessica Hartman, 6751913 – linked to the 63 Eddie Dowling Hwy Suite 9 N Smithfield, RI 02896 only, application was not received for MA  Barbara Hignite, 6369000 – linked to the 61 Lincoln Street Suite 203 Framingham, MA 01702 address only  Lynnetta Loveland, 6785859 – linked to the 61 Lincoln Street Suite 203 Framingham, MA 01702 address only  Jonathan Schubert, 6249193 - linked to the 61 Lincoln Street Suite 203 Framingham, MA 01702 address only  Jennifer Ullrich, 6913357 - linked to the 61 Lincoln Street Suite 203 Framingham, MA 01702 address only', NULL, NULL, '2021-11-01 08:10:28', '2021-11-01 08:10:28'),
(19108, 1019, 21566, NULL, '2021-11-08 00:00:00.000', 'In Process', 'LOI was faxed again to Aetna at 1-859-455-8650', NULL, NULL, '2021-11-01 08:21:33', '2021-11-01 08:21:33'),
(19109, 1019, 21566, NULL, '2021-11-23 00:00:00.000', 'In Process', 'Received the following email from Laura Bevin.  Hello,  Hartman, Jessica – waiting to be linked to the group contract  Halterman, Helena – early in the credentialing process  Filoteo-Nichols, Dina – waiting to be linked to the group contract  Rodrigues, Eliza – early in the credentialing process  Hignite, Barbara – only service location is 61 Lincoln Street Suite 203 Framingham, MA 01702  Loveland, Lynnetta - only service location is 61 Lincoln Street Suite 203 Framingham, MA 01702  Schubert, Jonathan - only service location is 61 Lincoln Street Suite 203 Framingham, MA 01702  Ullrich, Jennifer - only service location is 61 Lincoln Street Suite 203 Framingham, MA 01702  Thank you     Laura Bevin  Credentialing Senior Analyst  Aetna Behavioral Health', NULL, NULL, '2021-11-16 09:16:59', '2021-11-16 09:16:59'),
(19110, 11056, 21566, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email sent to:  Laura.Bevin@aetna.com  Sub : Fwd: Enrollment Query || Providers || SNBCARE || Aetna  Hello,  Can you please get back to me with an update on the following providers credentialing? as I have submitted the applications for address addition as well.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Hartman, Jessica	1326665472	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Hartman, Jessica	1326665472	100 New State Highway, Raynham, MA, 02767. Halterman, Helena	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Halterman, Helena	1801473749	100 New State Highway, Raynham, MA, 02767. Filoteo-Nichols, Dina	1770021099	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Filoteo-Nichols, Dina	1770021099	100 New State Highway, Raynham, MA, 02767. Rodrigues, Eliza	1821751405	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Rodrigues, Eliza	1821751405	100 New State Highway, Raynham, MA, 02767. Hignite, Barbara	1982617262	100 New State Highway, Raynham, MA, 02767. Loveland, Lynnetta	1598163602	100 New State Highway, Raynham, MA, 02767. Schubert, Jonathan	1235755505	100 New State Highway, Raynham, MA, 02767. Ullrich, Jennifer	1710489760	100 New State Highway, Raynham, MA, 02767.  Regards', NULL, NULL, '2021-12-01 17:08:30', '2021-12-01 17:08:30'),
(19111, 19067, 21566, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||   Hello,  Hope this email finds you well.  I want to know the enrollment status for the following providers under mentioned locations.  If any Provider is enrolled provide us with their Effective date and Welcome letter.   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Powell, Lauren	1285304980	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Powell, Lauren	1285304980	100 New State Highway, Raynham, MA, 02767. DiCostanzo, Allie	1669045738	63 Eddie Dowling Highway, Suite 8, North Smithfield, RI, 02896. Dina, Filoteo-Nichols	1770021099	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Dina, Filoteo-Nichols	1770021099	100 New State Highway, Raynham, MA, 02767. Halterman, Helena	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Halterman, Helena	1801473749	100 New State Highway, Raynham, MA, 02767. Hartman, Jessica	1326665472	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Hartman, Jessica	1326665472	100 New State Highway, Raynham, MA, 02767. Hignite, Barbara	1982617262	100 New State Highway, Raynham, MA, 02767. Loveland, Lynnetta	1598163602	100 New State Highway, Raynham, MA, 02767. Rodrigues, Eliza	1821751405	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Rodrigues, Eliza	1821751405	100 New State Highway, Raynham, MA, 02767. Schubert, Jonathan	1235755505	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Schubert, Jonathan	1235755505	100 New State Highway, Raynham, MA, 02767. Ullrich, Jennifer	1710489760	100 New State Highway, Raynham, MA, 02767.  Kindly respond to me promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-15 17:14:42', '2021-12-15 17:14:42'),
(19112, 19067, 21566, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email received from: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||   Good morning,     Powell, Lauren waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     DiCostanzo, Allie waiting to be linked to the contract  63 Eddie Dowling Highway, Suite 8, North Smithfield, RI, 02896     Dina, Filoteo-Nichols waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     Halterman, Helena waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     Hartman, Jessica waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     Hignite, Barbara not linked to this address yet  100 New State Highway, Raynham, MA, 02767     Loveland, Lynnetta not linked to this address yet  100 New State Highway, Raynham, MA, 02767     Rodrigues, Eliza waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     Schubert, Jonathan  61 Lincoln Street, Suite 203, Framingham, MA, 01702 06/15/2021 effective date  100 New State Highway, Raynham, MA, 02767 not linked to this address yet     Ullrich, Jennifer not linked to this address yet  100 New State Highway, Raynham, MA, 02767     Thank you     Laura Bevin  Credentialing Senior Analyst  Aetna Behavioral Health', NULL, NULL, '2021-12-16 10:57:55', '2021-12-16 10:57:55'),
(19113, 19067, 21566, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Called Aetna at 800-353-1232 Spoke with Kristeen, she said they need a W9. Sent fax at 859-455-8650 with W9 attached. Ref# 6064843883.', NULL, NULL, '2021-12-16 12:12:54', '2021-12-16 12:12:54'),
(19114, 19067, 21566, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||    Good Morning!  Hope you had a great weekend,  I would like to know the enrollment status for mentioned providers.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Jennifer Ullrich	1710489760	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jonathan Schubert	1235755505	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Lynnetta Loveland	1598163602	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Barbara Hignite	1982617262	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jessica Hartman	1326665472	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jessica Hartman	1326665472	61 Lincoln St., Suite 203, Framingham, MA 01702 Helena Halterman	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Helena Halterman	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702 Allie DiCostanzo	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Dina Filoteo-Nichols	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Dina Filoteo-Nichols	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702 Eliza Rodrigues	1821751405	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Eliza Rodrigues	1821751405	61 Lincoln St., Suite 203, Framingham, MA 01702 Lauren Powell	1285304980	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Lauren Powell	1285304980	61 Lincoln St., Suite 203, Framingham, MA 01702   Kindly respond promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-20 10:29:57', '2021-12-20 10:29:57'),
(19115, 19067, 21566, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email received from: Laura.Bevin@aetna.com   Subject: Enrollment Status || SNBCARE || Providers || Aetna ||   Hello,  Please see my below comments.  Thank you     Jennifer Ullrich - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – not linked to this address  Jonathan Schubert - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - not linked to this address  Lynnetta Loveland - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – 12/16/2021 effective date  Barbara Hignite - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - 12/16/2021 effective date  Jessica Hartman - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – waiting to be linked  Jessica Hartman - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Helena Halterman - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Helena Halterman - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Allie DiCostanzo - 63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 – 11/12/2021 effective date  Dina Filoteo-Nichols - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – waiting to be linked  Dina Filoteo-Nichols - 61 Lincoln St., Suite 203, Framingham, MA 01702 – waiting to be linked  Eliza Rodrigues -  100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Eliza Rodrigues - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Lauren Powell - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Lauren Powell - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked     Laura Bevin  Credentialing Senior Analyst  Aetna Behavioral Health', NULL, NULL, '2021-12-28 13:20:19', '2021-12-28 13:20:19'),
(19116, 19067, 21566, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||    Greetings Laura!  Any updates on the providers which were waiting to be linked?   Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 11:34:20', '2022-01-10 11:34:20'),
(19117, 19067, 21566, NULL, '2022-02-06 00:00:00.000', 'In Process', 'Email received from: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||    Hello,  There are no changes for the providers listed below.  Thank you', NULL, NULL, '2022-01-30 12:14:03', '2022-01-30 12:14:03'),
(19118, 1019, 21566, NULL, '2022-02-08 00:00:00.000', 'In Process', 'Hello Laura,  Did the providers get linked on which we were waiting, and if yes please provide me there effective dates     Thank You, Hammad.', NULL, NULL, '2022-02-01 12:20:12', '2022-02-01 12:20:12'),
(19119, 19067, 21566, NULL, '2022-02-17 00:00:00.000', 'In Process', 'Email received from: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||    Hello,  Jennifer Ullrich - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – not linked to this address  Jonathan Schubert - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - not linked to this address  Jessica Hartman - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – 02/15/2022 effective date  Jessica Hartman - 61 Lincoln St., Suite 203, Framingham, MA 01702 – 02/15/2022 effective date  Helena Halterman - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Helena Halterman - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Dina Filoteo-Nichols - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – 02/15/2022 effective date  Dina Filoteo-Nichols - 61 Lincoln St., Suite 203, Framingham, MA 01702 – 02/15/2022 effective date  Eliza Rodrigues -  100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Eliza Rodrigues - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Lauren Powell - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Lauren Powell - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Thank you', NULL, NULL, '2022-02-10 15:13:44', '2022-02-10 15:13:44'),
(19120, 19067, 21566, NULL, '2022-03-14 00:00:00.000', 'In Process', 'Spoke with Anne B. She gave me the effective date as of 05/01/2021 for primary location. Have to sent a fax of W9 to Aetna for secondary location.   Ref# 62078350613', NULL, NULL, '2022-03-07 11:56:10', '2022-03-07 11:56:10'),
(19121, 19067, 21566, NULL, '2022-03-14 00:00:00.000', 'In Process', 'LOI has been faxed for location addition.', NULL, NULL, '2022-03-07 13:24:20', '2022-03-07 13:24:20'),
(19122, 19067, 21566, NULL, '2022-03-14 00:00:00.000', 'In Process', 'LOI has been faxed for location addition.', NULL, NULL, '2022-03-07 13:24:26', '2022-03-07 13:24:26'),
(19123, 22077, 21566, NULL, '2022-04-13 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: 	Re: [EXTERNAL] Re: Enrollment Status || SNBCARE || Providers || Aetna ||  Hello, I would like to know the enrollment process for the following provider   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Jessica Hartman	1326665472	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Jonathan Schubert	1235755505	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Ullrich Jennifer	1710489760	100 NEW STATE HWY RAYNHAM, MA 02767-5423  Thanks', NULL, NULL, '2022-04-06 10:58:34', '2022-04-06 10:58:34'),
(19124, 1006, 21567, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:26:06', '2021-03-16 10:26:06'),
(19125, 1019, 21567, NULL, '2021-04-29 00:00:00.000', 'Initiated', 'LOI was faxed to Aetna demographics update at (859) 455-8650 to Add New Location. see attachment for ref ', NULL, NULL, '2021-04-22 08:27:09', '2021-04-22 08:27:09'),
(19126, 1019, 21567, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Sent the following email to : Laura.Bevin@aetna.com, ChandraKumarU@aetna.com SUB: Enrollment Query || Group & Providers || SNBCARE || Aetna  Hello,   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Melody L\'Etoile 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Barbara Hignite 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Fauzia Wali Khan 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Lynnetta Loveland 1598163602 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Peggy Pionke 1699307322 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Mahreen Rashid 1396393146 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Carlee Rozell 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Kerry Smith 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Katie Tawakol 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jennifer Ullrich 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Justin Souliere 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.', NULL, NULL, '2021-05-03 10:42:28', '2021-05-03 10:42:28'),
(19127, 1019, 21567, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Sent the following email to Laura.Bevin@aetna.com SUB: Enrollment Query || Group & Providers || SNBCARE || Aetna  Hello, We need the enrollment application status for the following providers,   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Carlee Rozell 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Katie Tawakol 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jennifer Ullrich 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Justin Souliere 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Kerry Smith 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Fauzia Wali Khan 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Lynnetta Loveland 1598163602 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Peggy Pionke 1699307322 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Mahreen Rashid 1396393146 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Regards,', NULL, NULL, '2021-05-20 08:05:53', '2021-05-20 08:05:53'),
(19128, 1019, 21567, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Received the following email from Laura.Bevin@aetna.com  Good afternoon, Please see my below comments. Thank you  Mary Gibbons, 9080253 – application was not received NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman, 6715913 – credentialed for RI only, please submit an app for MA NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Carlee Rozell, 6712207 – 01/01/2021 effective date 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.       Jonathan Schubert, 6249193 – 06/15/2021 effective date 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.        Katie Tawakol, 6120037 – 01/01/2021 effective date 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767  Jennifer Ullrich, 6913357 – 05/01/2021 effective date 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767  Justin Souliere, 6893422 – 05/017/2021 effective date 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva, 4841425 – waiting to be linked 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.   Laura Bevin Credentialing Senior Analyst Aetna Behavioral Health', NULL, NULL, '2021-05-31 11:57:09', '2021-05-31 11:57:09'),
(19129, 1019, 21567, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to Laura.Bevin@aetna.com SUB: Enrollment Query || Group & Providers || SNBCARE || Aetna  Hello, We need the enrollment application status for the following providers,   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Carlee Rozell 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Katie Tawakol 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jennifer Ullrich 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Justin Souliere 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Kerry Smith 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Fauzia Wali Khan 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Lynnetta Loveland 1598163602 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Peggy Pionke 1699307322 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Mahreen Rashid 1396393146 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Regards,', NULL, NULL, '2021-06-16 07:57:21', '2021-06-16 07:57:21'),
(19130, 1019, 21567, NULL, '2021-07-15 00:00:00.000', 'Approved', 'Received the following email from Laura.Bevin@aetna.com  Good afternoon,  Please see my below comments. Thank you     Mary Gibbons, 9080253 – application was not received  NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.       Jessica Hartman, 6715913 – credentialed for RI only, please submit an app for MA  NPI: 1326665472  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.       Carlee Rozell, 6712207 – 01/01/2021 effective date  1225645393  Secondary Location: 100 New State Highway, Raynham, MA, 02767.         Jonathan Schubert, 6249193 – 06/15/2021 effective date  1235755505  Secondary Location: 100 New State Highway, Raynham, MA, 02767.         Katie Tawakol, 6120037 – 01/01/2021 effective date  1609222116  Secondary Location: 100 New State Highway, Raynham, MA, 02767     Jennifer Ullrich, 6913357 – 05/01/2021 effective date  1710489760  Secondary Location: 100 New State Highway, Raynham, MA, 02767     Justin Souliere, 6893422 – 05/017/2021 effective date  1710576004  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Erin Oliva, 4841425 – waiting to be linked  1407349632  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.        Laura Bevin  Credentialing Senior Analyst  Aetna Behavioral Health', NULL, NULL, '2021-07-08 10:02:02', '2021-07-08 10:02:02'),
(19131, 1006, 21568, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:26:07', '2021-03-16 10:26:07'),
(19132, 1019, 21568, NULL, '2021-04-09 00:00:00.000', 'New/Not Initiated', 'Waiting to get enroll with Framingham location, once enrollment is completed with Framingham location, then will sent the LOI for Raynham Location.', NULL, NULL, '2021-04-02 15:01:20', '2021-04-02 15:01:20'),
(19133, 1019, 21568, NULL, '2021-04-29 00:00:00.000', 'Initiated', 'LOI was faxed to Aetna demographics update at (859) 455-8650 to Add New Location. see attachment for ref ', NULL, NULL, '2021-04-22 08:40:04', '2021-04-22 08:40:04'),
(19134, 1019, 21568, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Sent the following email to : Laura.Bevin@aetna.com, ChandraKumarU@aetna.com SUB: Enrollment Query || Group & Providers || SNBCARE || Aetna  Hello,   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Melody L\'Etoile 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Barbara Hignite 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Fauzia Wali Khan 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Lynnetta Loveland 1598163602 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Peggy Pionke 1699307322 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Mahreen Rashid 1396393146 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Carlee Rozell 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Kerry Smith 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Katie Tawakol 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jennifer Ullrich 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Justin Souliere 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.', NULL, NULL, '2021-05-03 10:41:30', '2021-05-03 10:41:30'),
(19135, 1019, 21568, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to Laura.Bevin@aetna.com SUB: Enrollment Query || Group & Providers || SNBCARE || Aetna  Hello, We need the enrollment application status for the following providers,   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Carlee Rozell 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Katie Tawakol 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jennifer Ullrich 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Justin Souliere 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Kerry Smith 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Fauzia Wali Khan 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Lynnetta Loveland 1598163602 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Peggy Pionke 1699307322 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Mahreen Rashid 1396393146 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Regards,', NULL, NULL, '2021-05-20 08:04:33', '2021-05-20 08:04:33'),
(19136, 1019, 21568, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Received the following email from Laura.Bevin@aetna.com  Good afternoon, Please see my comments below. Thank you  Melody L\'Etoile, 6466643 – CAQH application is being reviewed 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Rodesia Edmundson, 6301243 – 06/01/2021 effective date 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite, 6369000 - 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. – 03/01/2021 effective date Secondary Location: 100 New State Highway, Raynham, MA, 02767.  – address can be added via Existing Medical Provider Resources | Aetna  Kerry Smith, 6164300 – 06/01/2021 effective date 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti, 6846902 – 06/01/2021 effective date 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Fauzia Wali Khan, 7686597 – 01/01/2021 effective date 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Lynnetta Loveland, 6785859 1598163602 Secondary Location: 100 New State Highway, Raynham, MA, 02767. – address can be added via Existing Medical Provider Resources | Aetna    Peggy Pionke, 6507988 – 02/01/2021 effective date 1699307322 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Mahreen Rashid, 6557417 – 01/01/2021 effective date 1396393146 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Laura Bevin Credentialing Senior Analyst Aetna Behavioral Health', NULL, NULL, '2021-05-31 13:10:29', '2021-05-31 13:10:29'),
(19137, 1019, 21568, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to Laura.Bevin@aetna.com SUB: Enrollment Query || Group & Providers || SNBCARE || Aetna  Hello, We need the enrollment application status for the following providers,   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Carlee Rozell 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Katie Tawakol 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jennifer Ullrich 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Justin Souliere 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Kerry Smith 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Fauzia Wali Khan 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Lynnetta Loveland 1598163602 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Peggy Pionke 1699307322 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Mahreen Rashid 1396393146 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Regards,', NULL, NULL, '2021-06-16 07:57:15', '2021-06-16 07:57:15');
