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
(42867, 11056, 30684, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email sent to :   joann.alanis@careallies.com   &   Chukwuma.Ezeokoli@careallies.com  Sub : Fwd: [External] Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Renaissance Physicians ||  Good evening!  Hope you are doing well. I want to inquire about the enrollment status of the below mentioned providers and practices. Please provide us with the latest updates soon.  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  Provider Details:  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  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you!  Have a great week ahead!', NULL, NULL, '2021-08-11 16:29:29', '2021-08-11 16:29:29'),
(42868, 3040, 30684, NULL, '2021-08-25 00:00:00.000', 'Not Eligible', 'Email rcvd from: JENNIFER.PEREZ@cigna.com  Subject: RE: [External] Re: Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring ||  08/03/2021 Normandy Urgent Care Center ATTN: Adil Abbas 779 Normandy Street, Suite 114 Houston, TX 77015 Dear Mr. Abbas, Thank you for your request to join the Renaissance Physician Organization/Eastside IPA, LLC. At the present time we do not have a network need in your particular specialty. As a result, we are not able to extend an invitation for participation at this time. We will however keep your request on file and reconsider in the event our network development needs change. If you have any questions, please feel free to call JoAnn Alanis at 832.553.3350. Sincerely, Julian Gonzalez, M.D. Chairman of The Board Eastside IPA, LLC', NULL, NULL, '2021-08-18 13:11:53', '2021-08-18 13:11:53'),
(42869, 1006, 30685, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:04:31', '2021-05-14 15:04:31'),
(42870, 3040, 30685, NULL, '2021-06-04 00:00:00.000', 'On Hold', 'Waiting for the enrollment in Molina healthcare.', NULL, NULL, '2021-05-28 14:28:32', '2021-05-28 14:28:32'),
(42871, 10057, 30685, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com & MHTContractrequest@molinahealthcare.com  Sub : Enrollment Status || NUCC - IVUC - LPMC || Molina Marketplace  Good Afternoon,  Hope you are doing well. I\'m writing this email to check the enrollment and provider directory status for remaining providers under the below mentioned locations with Molina Marketplace.  Also, I\'m able to see the groups on provider directory, I already got the effective dates via help desk, please send me the group agreement or facility contract at the earliest   Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  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 Fernandus, Limy	1972005189 Jacob, Jaya	1194336149 Thomas, Cini	1134777238 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067  Once you get a chance please get back to me. Have a great weekend ahead!  Regards,', NULL, NULL, '2021-12-30 15:38:18', '2021-12-30 15:38:18'),
(42872, 19067, 30685, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email received from: Michele.Thomas-Martin@molinahealthcare.com  Subject: Enrollment Status || NUCC - IVUC - LPMC || Molina Marketplace     Good Morning,     Thank you for your inquiry.  Please see the attached contracts for both TIN numbers.  Please see the updates below.     The only providers on the below list listed under TIN # 760612416 are Joseph, Vibitha and Rauf, Abdur.  Please submit a contract request form to MHTContractrequest@Molinahealthcare.com  to add the remaining providers.     The only providers not listed under TIN # 270796429 are Jacob Jaya and Jeny John.  Please submit a contract request form to MHTContractrequest@Molinahealthcare.com  to add the 2 providers under this TIN #.     Thank You,     Michele Thomas-Martin  Associate Specialist, Provider Contracts  1-888-562-5442 Ext. 200042  1 972-200-2688 - Direct  www.MolinaHealthcare.com  Your Extended Family', NULL, NULL, '2022-01-05 17:29:31', '2022-01-05 17:29:31'),
(42873, 20067, 30685, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@Molinahealthcare.com, Michele.Thomas-Martin@molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace  Good Morning, Hope you are doing well. Kindly see the attachment of the contract request form for Jaya Jacob & Jeny John Under TIN# 270796429  Thanks and Regards Syed Ahad', NULL, NULL, '2022-01-18 09:16:54', '2022-01-18 09:16:54'),
(42874, 20067, 30685, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email received from: MHTContractrequest@molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace  Good Morning Syed,     Happy Thursday! – I hope all is well. I have received your requests. However, I noticed Provider Jaya Jacob 1194336149 already has a record created for TIN 27-0796429. Also, per Jeny John’s 1073019493 request, the service location is not listed per the form. Please fill in the service location & resubmit along with a current W9.', NULL, NULL, '2022-01-28 09:16:31', '2022-01-28 09:16:31'),
(42875, 20067, 30685, NULL, '2022-02-16 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace   Good afternoon!  Thanks for the update. Kindly see the attachment for Jeny John 1073019493', NULL, NULL, '2022-02-09 15:29:21', '2022-02-09 15:29:21'),
(42876, 20067, 30685, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace   Good Morning!  Happy Monday! Hope this email finds you in good health. I would like to know the current status of the below-mentioned providers  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Jeny John	1073019493 Molly Joseph	1396380077 Jaya Jacob	1194336149 Limy Fernandus	1972005189 Cini Thomas	1134777238 Brittany Brown	1275163537 Abdur Rauf	1497726202 Jeemol George	1497219067 Vibitha Joseph	1952931560 Ancy Kurian	1316558935  Thank you, Syed Ahad.', NULL, NULL, '2022-02-21 09:29:37', '2022-02-21 09:29:37'),
(42877, 20067, 30685, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email received from: MHTContractrequest@molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace   Good Afternoon –     Happy Tuesday! Hope you are doing well. According to our record Ms. Thomas contracted you for all lobs. Please reach out to mhtxproviderservices@Molinahealthcare.com if you have any questions. They will be able to provide you with a roster for all par providers lines of business and effective dates. Thank you in advance have a wonderful day.  ', NULL, NULL, '2022-03-01 14:08:44', '2022-03-01 14:08:44'),
(42878, 20067, 30685, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email sent to: mhtxproviderservices@Molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace   Good Afternoon!  Happy Tuesday! Hope this email finds you in good health. I would like to know the current status of the below-mentioned providers  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Jeny John	1073019493 Molly Joseph	1396380077 Jaya Jacob	1194336149 Limy Fernandus	1972005189 Cini Thomas	1134777238 Brittany Brown	1275163537 Abdur Rauf	1497726202 Jeemol George	1497219067 Vibitha Joseph	1952931560 Ancy Kurian	1316558935  Thank you, Syed Ahad.', NULL, NULL, '2022-03-01 14:11:14', '2022-03-01 14:11:14'),
(42879, 20067, 30685, NULL, '2022-03-25 00:00:00.000', 'In Process', 'Email sent to: mhtxproviderservices@molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace   Good Morning!  Hope your day is going well. Kindly provide me the roster for the Par providers with effective dates.  Thank you, Syed.', NULL, NULL, '2022-03-18 10:47:54', '2022-03-18 10:47:54'),
(42880, 19067, 30685, NULL, '2022-04-06 00:00:00.000', 'Approved', 'Eff date: 09/15/2021. See the attachment for the approval letter.', NULL, NULL, '2022-03-30 15:06:30', '2022-03-30 15:06:30'),
(42881, 1006, 30686, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:04:31', '2021-05-14 15:04:31'),
(42882, 1019, 30686, NULL, '2021-06-15 00:00:00.000', 'Initiated', 'Sent the following email to colbee.snyder@primehealthservices.com SUB: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||   Greetings, Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Prime Health 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  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, '2021-05-31 14:51:35', '2021-05-31 14:51:35'),
(42883, 3040, 30686, NULL, '2021-06-25 00:00:00.000', 'In Process', 'Email rcvd from:  colbee.snyder@primehealthservices.com  Subject: RE: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||  Thank you for your email. As of February 1st, 2020 I have been moved to a position outside of the credentialing department and will no longer be your point of contact. I have copied our general credentialing email.  Going forward, please forward all new providers adds and demographic changes to credentialing@primehealthservices.com and copy updates@primehealthservices.com.  Thank you!  Colbee Snyder Patient Advocacy Specialist', NULL, NULL, '2021-06-18 13:21:00', '2021-06-18 13:21:00'),
(42884, 3040, 30686, NULL, '2021-06-25 00:00:00.000', 'In Process', 'Email sent to: credentialing@primehealthservices.com  Subject: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Prime Health 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  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  Provider 16:   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, '2021-06-18 13:24:52', '2021-06-18 13:24:52'),
(42885, 3040, 30686, NULL, '2021-07-14 00:00:00.000', 'In Process', 'Email sent to: credentialing@primehealthservices.com, updates@primehealthservices.com,  Subject: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||  Hello,   Has there been any update?  Thank you  ', NULL, NULL, '2021-07-07 16:52:18', '2021-07-07 16:52:18'),
(42886, 3040, 30686, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: credentialing@primehealthservices.com  Subject: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||  Hello,   Hope you are doing well. I was trying to reach out to know the enrollment status for the below mentioned group and providers in Prime Health 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  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  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks', NULL, NULL, '2021-07-22 11:56:16', '2021-07-22 11:56:16'),
(42887, 11056, 30686, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email received from : credentialing@primehealthservices.com  Sub : Fwd: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||  Good Morning,  Please see below for the credentialing status for each provider.  The dates given are for credentialing purposes only and not the effective date.  Thank you for including the Updates Department in your email.  They will assist you with the effective dates.  There are two providers (highlighted) that need to be credentialed.  Please email a current CAQH Credentialing application or State Credentialing application for these providers.  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  - In the process of being credentialed.  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061 - Needs to be credentialed.     Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 - In the process of being credentialed.   Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 - Last credentialed - 6-23-2020 - Not the effective date - For credentialing purposes only.   Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 - In the process of being credentialed.  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956 - In the process of being credentialed.   Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490 - In the process of being credentialed.   Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 - In the process of being credentialed.   Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 - Last credentialed - 7-15-2020 - Not the effective date - For credentialing purposes only.  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 - In the process of being credentialed.   Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 - In the process of being credentialed.   Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238 - In the process of being credentialed.   Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 - In the process of being credentialed.   Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616 - In the process of being credentialed.  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149 - In the process of being credentialed.  Provider 16:  Provider Name: Joseph, Molly Provider NPI# 1396380077 - In the process of being credentialed.  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493 - Needs to be Credentialed.', NULL, NULL, '2021-08-12 10:17:02', '2021-08-12 10:17:02'),
(42888, 3040, 30686, NULL, '2021-09-21 00:00:00.000', 'In Process', 'Email sent to: megan.wherry@primehealthservices.com  Subject: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Prime Health ||  Hello Megan,   Hope you are doing well. Can you please send the roster because I am trying to find out the providers on the Prime Health Services directory and it\'s not showing up.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-09-14 17:07:49', '2021-09-14 17:07:49'),
(42889, 12062, 30686, NULL, '2021-09-24 00:00:00.000', 'In Process', 'Email sent to:megan.wherry@primehealthservices.com; colbee.snyder@primehealthservices.com; credentialing@primehealthservices.com; nucc@claimsmedinc.com; ivuc@claimsmedinc.com; Credentialing - Claims Med credentialing@claimsmedinc.com  Hi Wherry,  Hope you are doing well !   May I have any updated status for the enrollment application of below providers under the Prime Health Services Network?  I would be glad to have your response as soon as possible. The practice\'s and provider\'s details are as follows;   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   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   Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077   Thanking You in advance.', NULL, NULL, '2021-09-17 12:31:49', '2021-09-17 12:31:49'),
(42890, 10057, 30686, NULL, '2021-11-04 00:00:00.000', 'In Process', 'Email Sent To : credentialing@primehealthservices.com, updates@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Good Afternoon,  Hope this email finds you well. I\'m writing this email to check the updated status for the mentioned request. Please get back to me as soon as you get a chance.  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-28 15:23:52', '2021-10-28 15:23:52'),
(42891, 10057, 30686, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : credentialing@primehealthservices.com>, updates@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Good Morning,  Hope this email finds you in good health. Can I get the latest update on all the below mentioned groups and providers enrollment status?  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Please respond back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-22 10:43:35', '2021-11-22 10:43:35'),
(42892, 10057, 30686, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : credentialing@primehealthservices.com, updates@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Hello,  Can I get the latest updates on the below mentioned providers enrollment request under the TIN?  Please get back to me ASAP!  Thanks & Regards,', NULL, NULL, '2021-12-02 14:04:12', '2021-12-02 14:04:12'),
(42893, 10057, 30686, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Received From : credentialing@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Please see attached Credentialing Status Roster.  The dates given are for Credentialing purposes only and not the effective date.  Thank you for including the Updates Department in your email.  They will respond regarding the effective dates.  Thank you, Nancy', NULL, NULL, '2021-12-15 10:52:07', '2021-12-15 10:52:07'),
(42894, 10057, 30686, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : credentialing@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Hello Nancy,  Thank you for your prompt response. I really appreciate your support. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-22 12:08:58', '2021-12-22 12:08:58'),
(42895, 10057, 30686, NULL, '2022-01-05 00:00:00.000', 'Approved', 'Email Received From : updates@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Hello, all of these providers are in our system with both locations added, thanks!  Alyssa DeNure Data Integrity Associate', NULL, NULL, '2021-12-29 14:46:58', '2021-12-29 14:46:58'),
(42896, 1006, 30687, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:04:31', '2021-05-14 15:04:31'),
(42897, 3040, 30687, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Subject: Need to Enroll|| Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || CHRISTUS HEALTH PLAN||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Christus Health Plan for our group under the below locations. We have 02 different locations under the same tax ID.     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  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, '2021-05-25 12:38:44', '2021-05-25 12:38:44'),
(42898, 3040, 30687, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Email sent to: CHP.networkdevelopment@christushealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Christus Health Plan ||  Greetings,   Hope you are doing well. Please find the attached Prospective Provider Form along with the Letter of Intent for below mentioned providers to enroll in Christus Health Plan in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Primary 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 Secondary Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  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, '2021-06-11 14:48:08', '2021-06-11 14:48:08'),
(42899, 11056, 30687, NULL, '2021-07-06 00:00:00.000', 'In Process', 'Email sent to : CHP.networkdevelopment@christushealth.org  Sub : Enroll Request Group & Providers || Normandy Urgent Care Center || Christus Health Plan ||  Greetings,  Hope you are doing well. I want to know enrollment status of the following groups and providers. Respond this as soon as possible.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Primary 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 Secondary Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Providers: 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 good day!', NULL, NULL, '2021-06-29 12:55:58', '2021-06-29 12:55:58'),
(42900, 3040, 30687, NULL, '2021-07-26 00:00:00.000', 'On Hold', 'Ancillary contract request sent for the group. Please see group task. ', NULL, NULL, '2021-07-19 09:23:45', '2021-07-19 09:23:45'),
(42901, 3040, 30687, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email sent to: hunter.barrett@christushealth.org  Subject: Re: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Hello Hunter,   Hope you are doing well. Please find attached Ancillary service agreement along with the Facility Ancillary application for our group to participate in Christus Health Plan 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 let me know. Waiting for your response.    Thanks ', NULL, NULL, '2021-07-28 11:39:19', '2021-07-28 11:39:19'),
(42902, 11056, 30687, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email sent to : Hunter Barrett   hunter.barrett@christushealth.org, CHP.networkdevelopment@christushealth.org  Sub  : ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Good evening!  Hope all is well. I just want to inquire about the enrollment status of the following groups for the ancillary contract. Please provide us with the latest updates soon.  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 feel free to reach out to me. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-08-11 17:08:05', '2021-08-11 17:08:05'),
(42903, 3040, 30687, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email rcvd from: hunter.barrett@christushealth.org  Subject: RE: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Contract was sent to credentialing about 3 weeks ago to process. Will take about 6 months to fully process and receive effective date.  Thanks,  Hunter Barrett Network Contracting CHRISTUS Health Plan CHRISTUS Health 919 Hidden Ridge | Irving, Texas 75038 (o) 469.282.3113', NULL, NULL, '2021-08-17 15:02:53', '2021-08-17 15:02:53'),
(42904, 3040, 30687, NULL, '2021-09-21 00:00:00.000', 'In Process', 'Email sent to: hunter.barrett@christushealth.org  Subject: Re: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Good evening!  Hope all is well. This is a follow up email to inquire about the enrollment status of the following groups for the ancillary contract.   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 feel free to reach out to me. Waiting for your response.  Thanks', NULL, NULL, '2021-09-14 16:14:50', '2021-09-14 16:14:50'),
(42905, 12062, 30687, NULL, '2021-09-29 00:00:00.000', 'In Process', ' Received below email under the group ancillary contract request; From :hunter.barrett@christushealth.org Subject :RE: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN Please reach out to our credentialing team in about 4 months for an update. You can reach out directly to them for updates on all of the contracts you are inquiring about. They are running around 6 months to process them so please give them adequate time to reach your file. Most of the contracts were sent to them around 1-2 months ago CHRISTUS.HP.Credentialing CHRISTUS.HP.Credentialing@christushealth.org  Thanks,   Hunter Barrett Network Contracting CHRISTUS Health Plan CHRISTUS Health 919 Hidden Ridge | Irving, Texas 75038 (o) 469.282.3113 www.christushealth.org  ', NULL, NULL, '2021-09-22 13:11:32', '2021-09-22 13:11:32'),
(42906, 10057, 30687, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Good Evening,  Hope you are doing well. I want to know the enrollment status of the following groups and providers. Please get back to me as soon as you get the time.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Jose, Julie	1447883061 George, Jeemol	1497219067 Brown, Brittany	1275163537 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Thomas, Cini	1134777238 Joseph, Vibitha	1952931560 Stephen, Ani	1588959118 Piccione JR, James M	1356321509 Chennemkara, Mini Philip	1841755956 Abraham, Glory	1194206490 Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-10-18 16:39:08', '2021-10-18 16:39:08'),
(42907, 10057, 30687, NULL, '2021-12-02 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : Need Credentialing Update - URGENT  Good Afternoon,  Hope you are doing well. Can I have the latest update on the below mentioned request. Also welcome letters?  Looking forward to your kind response. Have a great day!   Thanks & Regards,', NULL, NULL, '2021-11-18 13:52:34', '2021-11-18 13:52:34'),
(42908, 10057, 30687, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : Need Credentialing Update - URGENT  Hello,  Can I get the update on the below mentioned request, also I have not yet received any welcome letters yet.  Kindly revert back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-01 11:03:33', '2021-12-01 11:03:33'),
(42909, 10057, 30687, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email Received From : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Good Morning  Normandy Urgent Care Center  - has been processed effective contract date 01/01/2022  Longpoint Medical Center – facility has been processed effective contract date 01/01/2022  Imperial Valley - facility has been processed effective contract date 01/01/2022  Credentialing Verification Unit CHRISTUS Health Plan - US Family Health Plan 919 Hidden Ridge Irving, TX 75038 Phone: (469)-282-0368 Fax: 210-766-8857', NULL, NULL, '2021-12-14 09:53:31', '2021-12-14 09:53:31'),
(42910, 10057, 30687, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Thank you for the update. Could you please provide us with the facility agreement or contract along with the update for the providers credentialing status as well.  Your earliest response would be greatly appreciated.  Regards, Steve Albert', NULL, NULL, '2021-12-20 13:43:09', '2021-12-20 13:43:09'),
(42911, 10057, 30687, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Greetings!  Hope you are doing great. I\'m writing this email to get the update on my below request. Please get back to me as soon as possible!  Regards,', NULL, NULL, '2021-12-28 11:58:07', '2021-12-28 11:58:07'),
(42912, 19067, 30687, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: CHRISTUS.HP.Credentialing@christushealth.org, hunter.barrett@christushealth.org, CHP.networkdevelopment@christushealth.org  Subject: Enrollment Query || NUCC & IVUC || Providers & Group || Christus Health Plan ||   Hello!  You are having a productive day.  I would like to know the enrollment status of the following Providers and Group with Christus Health Plan.   Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Jeny John	1073019493	779 Normandy St STE 114, Houston, TX 77015-3441 Jeny John	1073019493	16272 Imperial Valley DR STE K, Houston, TX 77060 Molly Joseph	1396380077	779 Normandy St STE 114, Houston, TX 77015-3441 Molly Joseph	1396380077	16272 Imperial Valley DR STE K, Houston, TX 77060 Cini Thomas	1134777238	779 Normandy St STE 114, Houston, TX 77015-3441 Cini Thomas	1134777238	16272 Imperial Valley DR STE K, Houston, TX 77060 Ani Stephen	1588959118	779 Normandy St STE 114, Houston, TX 77015-3441 Ani Stephen	1588959118	16272 Imperial Valley DR STE K, Houston, TX 77060 Abdur Rauf	1497726202	779 Normandy St STE 114, Houston, TX 77015-3441 Abdur Rauf	1497726202	16272 Imperial Valley DR STE K, Houston, TX 77060 James Piccione JR	1356321509	779 Normandy St STE 114, Houston, TX 77015-3441 James Piccione JR	1356321509	16272 Imperial Valley DR STE K, Houston, TX 77060 Sigi Paul	1033623616	779 Normandy St STE 114, Houston, TX 77015-3441 Sigi Paul	1033623616	16272 Imperial Valley DR STE K, Houston, TX 77060 Odette Kourouma	1134525868	779 Normandy St STE 114, Houston, TX 77015-3441 Odette Kourouma	1134525868	16272 Imperial Valley DR STE K, Houston, TX 77060 Vibitha Joseph	1952931560	779 Normandy St STE 114, Houston, TX 77015-3441 Vibitha Joseph	1952931560	16272 Imperial Valley DR STE K, Houston, TX 77060 Julie Jose	1447883061	779 Normandy St STE 114, Houston, TX 77015-3441 Julie Jose	1447883061	16272 Imperial Valley DR STE K, Houston, TX 77060 Jaya Jacob	1194336149	779 Normandy St STE 114, Houston, TX 77015-3441 Jaya Jacob	1194336149	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeemol George	1497219067	779 Normandy St STE 114, Houston, TX 77015-3441 Jeemol George	1497219067	16272 Imperial Valley DR STE K, Houston, TX 77060 Limy Fernandus	1972005189	779 Normandy St STE 114, Houston, TX 77015-3441 Limy Fernandus	1972005189	16272 Imperial Valley DR STE K, Houston, TX 77060 Brittany Brown	1275163537	779 Normandy St STE 114, Houston, TX 77015-3441 Brittany Brown	1275163537	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeena Abraham	1467901587	779 Normandy St STE 114, Houston, TX 77015-3441 Jeena Abraham	1467901587	16272 Imperial Valley DR STE K, Houston, TX 77060 Mini Chennemkara	1841755956	779 Normandy St STE 114, Houston, TX 77015-3441 Mini Chennemkara	1841755956	16272 Imperial Valley DR STE K, Houston, TX 77060 Glory Abraham	1194206490	779 Normandy St STE 114, Houston, TX 77015-3441 Glory Abraham	1194206490	16272 Imperial Valley DR STE K, Houston, TX 77060  Eagerly waiting for your response.   Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 17:25:33', '2022-01-04 17:25:33'),
(42913, 19067, 30687, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email received from: Sonia.Gonzales@christushealth.org  Subject: Enrollment Query || NUCC & IVUC || Providers & Group || Christus Health Plan ||     Good Morning All,     Thank you for the request below, I do show contract for USFHP was signed and executed.   Information was sent over to get configuration of contract rates entered.       Once we have this process is completed we can have this sent to Credentialing to get group loaded with effective date.  When I get further updates will pass along!     Please remove Hunter Barrette from communications, unfortunately he is no longer with us, I am covering in the interim.       Thanks and appreciate your patience,     Respectfully,     Sonia D. Gonzales  CHRISTUS Health Plan – Physician Relations Consultant II/ Contracting  505-569-4856  sonia.gonzales@christushealth.org', NULL, NULL, '2022-01-05 11:33:57', '2022-01-05 11:33:57'),
(42914, 20067, 30687, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: Sonia.Gonzales@christushealth.org  Sub: Re: Enrollment Query || NUCC & IVUC || Providers & Group || Christus Health Plan ||  Good Afternoon, Hope this email finds you in good health. Any update on the previous request?  Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-14 13:27:47', '2022-01-14 13:27:47'),
(42915, 20067, 30687, NULL, '2022-01-28 00:00:00.000', 'In Process', 'Email sent to: Sonia.Gonzales@christushealth.org  Sub: Re: Enrollment Query || NUCC & IVUC || Providers & Group || Christus Health Plan ||  Good afternoon! Hope you are doing well. I haven\'t heard from your side, Kindly respond to the previous mail. If the process is complete, kindly send me the contract letter along with the effective date.  Thanks and Regards, Syed Ahad  ', NULL, NULL, '2022-01-21 16:46:38', '2022-01-21 16:46:38'),
(42916, 20067, 30687, NULL, '2022-02-01 00:00:00.000', 'Approved', 'Received the Ancillary contract from Christus Health Plan  Effective Date: 01/01/2022 Expiration Date: 12/31/9999', NULL, NULL, '2022-01-25 17:25:59', '2022-01-25 17:25:59'),
(42917, 1006, 30688, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:04:31', '2021-05-14 15:04:31'),
(42918, 3040, 30688, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: info@usamco.com  Subject: Copy of Executed Contract || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || MCO ||  Greetings,   Hope you are doing well. Can you please send me the copy of the executed contract for our group Normandy Urgent Care Center 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  Thank you ', NULL, NULL, '2021-05-28 12:24:29', '2021-05-28 12:24:29'),
(42919, 11056, 30688, NULL, '2021-06-23 00:00:00.000', 'Approved', '	 Group has an ancillary contract. No need to add individual providers. Please see group task.', NULL, NULL, '2021-06-16 12:26:47', '2021-06-16 12:26:47'),
(42920, 1006, 30689, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:04:31', '2021-05-14 15:04:31');
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
(42921, 3040, 30689, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: providerservices@memorialhermann.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Memorial Hermann ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Memorial Hermann 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  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, '2021-05-28 13:25:25', '2021-05-28 13:25:25'),
(42922, 3040, 30689, NULL, '2021-06-23 00:00:00.000', 'On Hold', 'Group ancillary contract request sent to Memorial Hermann. For more details please see group task.  ', NULL, NULL, '2021-06-16 16:39:47', '2021-06-16 16:39:47'),
(42923, 3040, 30689, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: enterprise.credentialing@memorialhermann.org  Subject: Re: [EXTERNAL] Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Memorial Hermann ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Memorial Hermann 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  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-20 10:52:13', '2021-07-20 10:52:13'),
(42924, 11056, 30689, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Email sent to : ProviderServices@memorialhermann.org  &  MHHPContracting@memorialhermann.org  Sub : Fwd: [EXTERNAL] Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Memorial Hermann ||  Good morning!  Hope you are doing well. I want to know the enrollment status of the below mentioned group under the below locations for Ancillary contract in Memorial Hermann.  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  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 day! ', NULL, NULL, '2021-08-12 15:37:02', '2021-08-12 15:37:02'),
(42925, 3040, 30689, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Group has an ancillary contract no need to add individual providers. Please see group task for more details. ', NULL, NULL, '2021-08-27 10:00:28', '2021-08-27 10:00:28'),
(42926, 1006, 30690, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:04:31', '2021-05-14 15:04:31'),
(42927, 1006, 30690, NULL, '2021-05-28 00:00:00.000', 'Initiated', 'Submitted group enrollment request via Wellcare\'s online form, attached for reference in group task. ', NULL, NULL, '2021-05-20 21:01:53', '2021-05-20 21:01:53'),
(42928, 3040, 30690, NULL, '2021-06-16 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more details please see group task.', NULL, NULL, '2021-06-09 10:48:47', '2021-06-09 10:48:47'),
(42929, 3040, 30690, NULL, '2021-07-27 00:00:00.000', 'In Process', 'I spoke with Harvey D Wellcare representative and he advised me that processing time will take 60 business days. After reviewing the application the provider rep will contact you.   Ref: 544023676', NULL, NULL, '2021-07-20 10:36:08', '2021-07-20 10:36:08'),
(42930, 11056, 30690, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good afternoon!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Wellcare 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    Provider 16:    Provider Name: Joseph, Molly Provider NPI# 1396380077    Provider 17:    Provider Name: John, Jeny Provider NPI# 1073019493    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, '2021-08-11 13:59:14', '2021-08-11 13:59:14'),
(42931, 3040, 30690, NULL, '2021-09-14 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject: Re: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Greetings,    Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Wellcare 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  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 2:    Provider Name: Jose, Julie  Provider NPI# 1447883061  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 3:    Provider Name: Stephen, Ani (All three locations)  Provider NPI# 1588959118     Provider 4:    Provider Name: Piccione JR, James M (All three locations)  Provider NPI# 1356321509     Provider 5:    Provider Name: Brown, Brittany  Provider NPI# 1275163537  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 6:    Provider Name: Chennemkara, Mini Philip (All three locations)  Provider NPI# 1841755956     Provider 7:    Provider Name: Abraham, Glory  Provider NPI# 1194206490  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 8:    Provider Name: Fernandus, Limy (All three locations)  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider NPI# 1497726202  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 11:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 12:    Provider Name: Thomas, Cini (All three locations)  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider NPI# 1467901587  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 14:    Provider Name: PAUL, SIGI (All three locations)  Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya (All three locations)  Provider NPI# 1194336149    Provider 16:    Provider Name: Joseph, Molly  (All three locations) Provider NPI# 1396380077    Provider 17:    Provider Name: John, Jeny  (All three locations) Provider NPI# 1073019493    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!', NULL, NULL, '2021-09-07 16:28:03', '2021-09-07 16:28:03'),
(42932, 10057, 30690, NULL, '2021-10-26 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good Afternoon,  Hope this email finds you well. I want to follow-up for the mentioned providers and locations credentialing status?  Please get back to me as soon as you get a chance. Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-19 11:51:56', '2021-10-19 11:51:56'),
(42933, 10057, 30690, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : prospectiveprovidertx@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good Morning,  Can you please send us the copy of their Welcome Letters/ Contracts to us at your earliest convenience.  Regards, Alex Garrett', NULL, NULL, '2021-11-22 14:13:43', '2021-11-22 14:13:43'),
(42934, 10057, 30690, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good Afternoon,  Hope this email finds you well. I\'m writing this email to check the latest update on the below mentioned request?  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-02 15:10:40', '2021-12-02 15:10:40'),
(42935, 10057, 30690, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Hello,  This inbox is for contract change request only. If you need account specific information, please contact your Provider Relations Account Manager.   Sincerely,  Network Management– Texas', NULL, NULL, '2021-12-09 13:20:01', '2021-12-09 13:20:01'),
(42936, 10057, 30690, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com AM.Houston@superiorhealthplan.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Thank you for reaching out. Could you please provide me with the actual email address along with the contact number of our AM?  So I can directly reach out to them. I truly appreciate your support. Have a great day!  Regards,', NULL, NULL, '2021-12-17 14:10:02', '2021-12-17 14:10:02'),
(42937, 10057, 30690, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email Received From : AM.Houston@superiorhealthplan.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Please send email for WellCare status update to SM_TXNetDevProviderLoad@wellcare.com.  Sincerely,  Barbara McDonald', NULL, NULL, '2021-12-23 11:20:55', '2021-12-23 11:20:55'),
(42938, 10057, 30690, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Sent To : sm_txnetdevproviderload@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Greetings!  Hope this email finds you well. I\'m writing this email to get the enrollment status on the below mentioned group and providers under TIN\'s with wellcare.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  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  Limy  Fernandus 1972005189 Sigi Paul	1033623616 Jaya  Jacob	1194336149 Jeena  Abraham	1467901587 Cini  Thomas	1134777238 Odette Tiranke  Kourouma	1134525868 Abdur  Rauf	1497726202 Molly  Joseph	1396380077 Jeny John	1073019493 Ani Stephen	1588959118 Brittany Brown	1275163537 Vibitha Joseph	1952931560 Jeemol George	1497219067 Julie Jose	1447883061 Glory Abraham 1194206490 Mini Philip Chennemkara 1841755956 James Piccione JR	1356321509  Once you get a chance please get back to me. Have a great weekend ahead!  Regards,', NULL, NULL, '2021-12-30 13:53:17', '2021-12-30 13:53:17'),
(42939, 20067, 30690, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email sent to: ashley.stevens@wellcare.com, SM_TXNetDevProviderLoad@wellcare.com  Subject: Re: ENROLLMENT STATUS QUERRY - NUCC - IVUC - Wellcare   Hello,  Hope you are doing great. I would like to know the enrollment status of the below-mentioned providers under these locations, and if any of the provider is enrolled kindly send me the welcome letter.  Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston, TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Glory Abraham	1194206490 Jeena Abraham	1467901587 Brittany Brown	1275163537 Mini Chennemkara	1841755956 Limy Fernandus	1972005189 Jeemol George	1497219067 Jaya Jacob	1194336149 Jeny John	1073019493 Julie Jose	1447883061 Molly Joseph	1396380077 Vibitha Joseph	1952931560 Odette Kourouma	1134525868 SIGI PAUL	1033623616 James Piccione JR	1356321509 Abdur Rauf	1497726202 Ani Stephen	1588959118 Cini Thomas	1134777238  Thanks and Regards, Syed Ahad. ', NULL, NULL, '2022-01-06 12:27:51', '2022-01-06 12:27:51'),
(42940, 20067, 30690, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: ashley.stevens@wellcare.com, SM_TXNetDevProviderLoad@wellcare.com  Sub: Re: ENROLLMENT STATUS QUERRY - NUCC - IVUC - Wellcare  Good afternoon!  Hope you are doing well. Any update on the previous request? Your Early response will be highly appreciated  Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-14 16:38:44', '2022-01-14 16:38:44'),
(42941, 20067, 30690, NULL, '2022-01-27 00:00:00.000', 'Approved', 'Received the following email from: ashley.stevens@wellcare.com  Sub: Re: ENROLLMENT STATUS QUERRY - NUCC - IVUC - Wellcare  Please see welcome letter attached for roster of par providers.  Effective Date: 05/01/2021 Attached is the group roster and welcome letter for the provider', NULL, NULL, '2022-01-20 17:03:11', '2022-01-20 17:03:11'),
(42942, 1006, 30691, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:04:31', '2021-05-14 15:04:31'),
(42943, 3040, 30691, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Sent the following initiation request to trpndataentry@trpnppo.com & providerrelations@trpnppo.com:  Sub: Provider Enrollment Request - NUCC- TRPN  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Multiplan for our group under the below locations. Can you please send the roster.   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  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, '2021-05-28 17:02:11', '2021-05-28 17:02:11'),
(42944, 11056, 30691, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Good Evening!  Hope you are doing well. Please find the attached Provider update form to enroll the below mentioned group and providers in TRPN for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice NPI: 1407171077 Practice TIN: 27-0796429 Primary Address: 779 Normandy St Ste 114 Houston, TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice NPI: 1407171077 Practice TIN: 27-0796429P Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Provider Names enlisted below:-  Provider 1: Provider Name: Joseph, Molly Provider NPI : 1396380077  Provider 2: Provider Name:  Jacob, Jaya Provider NPI : 1194336149   Provider 3: Provider Name:  PAUL, SIGI Provider NPI : 1033623616  Provider 4:  Provider Name: Chennemkara, Mini Provider NPI : 1841755956     Provider 5:   Provider Name:  Abraham, Jeena Provider NPI :  1467901587    Provider 6:   Provider Name:  Kourouma , Odette Provider NPI :  1134525868  Provider 7:   Provider Name:  Piccione JR, James Provider NPI :  1356321509    Provider 8: Provider Name:  Abraham, Glory Provider NPI :  1194206490   Provider 9:   Provider Name:  Fernandus, Limy Provider NPI :  1972005189  Provider 10: Provider Name:  Thomas, Cini Provider NPI :  1134777238  Provider 11:   Provider Name:  Stephen, Ani Provider NPI :  1588959118   Provider 12:   Provider Name:  George, Jeemol Provider NPI :  1497219067    Provider 13:   Provider Name:  Jose, Julie Provider NPI :  1447883061    Provider 14:   Provider Name:  Brown, Brittany Provider NPI :   1275163537  Provider 15:   Provider Name:  Joseph, Vibitha Provider NPI :   1952931560    Provider 16:  Provider Name:  Abdur Rauf Provider NPI :  1497726202    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-16 17:12:31', '2021-06-16 17:12:31'),
(42945, 3040, 30691, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: trpndataentry@trpnppo.com, mflores@trpnppo.com, ccampos@trpnppo.com  Subject: Re: Provider Update Information Form- TRPN  Hello Max and Carlos,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in TRPN for our group under the below mentioned locations. We already sent the provider update form at trpndataentry@trpnppo.com.   Practice Details: Practice Name: Normandy Urgent Care Center Practice NPI: 1407171077 Practice TIN: 27-0796429 Primary Address: 779 Normandy St Ste 114 Houston, TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice NPI: 1407171077 Practice TIN: 27-0796429  Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Provider Names enlisted below:- Provider 1: Provider Name: Joseph, Molly Provider NPI : 1396380077  Provider 2: Provider Name:  Jacob, Jaya Provider NPI : 1194336149   Provider 3: Provider Name:  PAUL, SIGI Provider NPI : 1033623616  Provider 4:  Provider Name: Chennemkara, Mini Provider NPI : 1841755956     Provider 5:   Provider Name:  Abraham, Jeena Provider NPI :  1467901587    Provider 6:   Provider Name:  Kourouma , Odette Provider NPI :  1134525868  Provider 7:   Provider Name:  Piccione JR, James Provider NPI :  1356321509    Provider 8: Provider Name:  Abraham, Glory Provider NPI :  1194206490   Provider 9:   Provider Name:  Fernandus, Limy Provider NPI :  1972005189  Provider 10: Provider Name:  Thomas, Cini Provider NPI :  1134777238  Provider 11:   Provider Name:  Stephen, Ani Provider NPI :  1588959118  Provider 12:   Provider Name:  George, Jeemol Provider NPI :  1497219067   Provider 13:   Provider Name:  Jose, Julie Provider NPI :  1447883061    Provider 14:   Provider Name:  Brown, Brittany Provider NPI :   1275163537  Provider 15:   Provider Name:  Joseph, Vibitha Provider NPI :   1952931560    Provider 16:  Provider Name:  Abdur Rauf Provider NPI : 1497726202    Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-05 15:25:41', '2021-07-05 15:25:41'),
(42946, 3040, 30691, NULL, '2021-07-27 00:00:00.000', 'Approved', 'Email rcvd from: ccampos@trpnppo.com  Subject: Provider Update Information Form- TRPN Hi,  Provider Molly Joseph is Active, effective date 01/01/2021,  Provider Jacob Jaya is Active, effective date 01/01/2021,  Provider Sigi Paul is Active, effective date 01/01/2021,  Provider Mini Chennemkara is Active, effective date 01/01/2021,  Provider Jeena Abraham is Active, effective date 03/01/2016,  Provider Odette Kourouma is Active, effective date 01/01/2021,  Provider James Piccione is Active, effective date 01/01/2021,  Provider Glory Abraham is Active, effective date 05/29/2019,  Provider Limy Fernandus is Active, effective date 01/01/2021,  Provider Cini Thomas is Active, effective date 10/01/2019,  Provider Ani Stephen is Active, effective date 01/01/2021,  Provider Jeemol George is Active, effective date 06/09/2020,  Provider Julie Jose is Active, effective date 06/09/2020,  Provider Brittany Brown is Active, effective date 01/01/2021,  Provider Vibitha Joseph is Active, effective date 01/01/2021,  Provider Abdur Rauf is Active, effective date 01/01/2021,  Carlos Campos  Data Entry Department Supervisor Three Rivers Provider Network 6970 O’Bannon Drive Las Vegas, NV 89117 P: 619.869.8940 F: 619.271.2563 ccampos@trpnppo.com trpndataentry@trpnppo.com', NULL, NULL, '2021-07-20 08:32:39', '2021-07-20 08:32:39'),
(42947, 1006, 30692, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:04:32', '2021-05-14 15:04:32'),
(42948, 1006, 30692, NULL, '2021-06-07 00:00:00.000', 'Initiated', 'Sent following initiation request @ CSHNproviderrelations@christushealth.org:  Sub: Enrollment Request - NUCC, IVUC - Christus Spohn  \"Hello,  We wish to enroll the following providers under the mentioned group, please let me know what is required to get the enrollment process started. the details are as follows: Group Name: Normandy Urgent Care Center NPI# 1407171077 TIN# 27-0796429  Primary Address: 779 Normandy St Ste 114, Houston, TX 77015-3441 Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  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  Please get back to me as soon as you\'re able to.   Thank you. \"', NULL, NULL, '2021-05-31 16:21:11', '2021-05-31 16:21:11'),
(42949, 3040, 30692, NULL, '2021-06-25 00:00:00.000', 'In Process', 'I called the 800-419-3461 and left the VM. Because I didn\'t getting any reply from the insurance.  ', NULL, NULL, '2021-06-18 11:50:26', '2021-06-18 11:50:26'),
(42950, 3040, 30692, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Christus Spohn ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Christus Spohn for our group under the below locations. We have 02 different locations under the same tax ID.     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  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  Provider 16:   Provider Name: John, Jeny Provider NPI# 1073019493  Provider 17:   Provider Name: Joseph, Molly Provider NPI# 1073019493  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-12 11:52:19', '2021-07-12 11:52:19'),
(42951, 3040, 30692, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Email sent to: vicki.guerra@christushealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Christus Spohn ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Christus Spohn for our group under the below locations. We have 02 different locations under the same tax ID.     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  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  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you\'re able to.  Thank you   ', NULL, NULL, '2021-07-27 16:53:36', '2021-07-27 16:53:36'),
(42952, 3040, 30692, NULL, '2021-08-04 00:00:00.000', 'Not Eligible', 'Christus Spohn didn\'t provide services in the area. For more details please see group task.   ', NULL, NULL, '2021-07-28 11:20:35', '2021-07-28 11:20:35'),
(42953, 1006, 30693, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:04:32', '2021-05-14 15:04:32'),
(42954, 3040, 30693, NULL, '2021-06-09 00:00:00.000', 'On Hold', 'Facility/ Ancillary network interest form submitted. Please see group task.    ', NULL, NULL, '2021-06-02 10:35:56', '2021-06-02 10:35:56'),
(42955, 3040, 30693, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring ||  Hello Jennifer,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Cigna Healthspring for our group under the below mentioned 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  Waiting for your response.   Thank you  ', NULL, NULL, '2021-07-22 10:04:30', '2021-07-22 10:04:30'),
(42956, 11056, 30693, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email received from : JENNIFER.PEREZ@cigna.com  Sub : Re: Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring ||  Hi Adil,  My apologies, I forwarded this to the correct representative. She should be reaching out by this week. ', NULL, NULL, '2021-08-09 08:47:27', '2021-08-09 08:47:27'),
(42957, 3040, 30693, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: TXGQProviderRelations@healthspring.com  Subject: Re: [External] Re: Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring ||  Hello!  Hope you are doing well. As per conversation with Jennifer she requested to send an email to you. I wanted to know the enrollment status for the below mentioned group as I submitted the letter of interest form on 06/02/2021. Kindly review the chain of emails.   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  If you need any additional information please feel free to call or email me. Waiting to hear from you soon. Email sent to: TXGQProviderRelations@healthspring.com  Subject: Re: [External] Re: Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring ||  Hello!  Hope you are doing well. As per conversation with Jennifer she requested to send an email to you. I wanted to know the enrollment status for the below mentioned group as I submitted the letter of interest form on 06/02/2021. Kindly review the chain of emails.   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  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you Thank you', NULL, NULL, '2021-08-17 09:55:50', '2021-08-17 09:55:50'),
(42958, 10057, 30693, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email Sent To : TXMAContracting@cigna.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello,  Hope you are doing well. I wanted to know the enrollment updated status for the below mentioned group in Cigna Healthspring for our group Valley Med Urgent Care PLLC under the below mentioned locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Tertiary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-14 11:25:12', '2021-10-14 11:25:12'),
(42959, 10057, 30693, NULL, '2021-11-25 00:00:00.000', 'In Process', 'Email Sent To : TXGQProviderRelations@healthspring.com  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Hello,  Could you please provide me with the updated status of my application?  Response is pending since 08/09/2021. Your earliest response will be much appreciated.  Thanks & Regards,', NULL, NULL, '2021-11-18 16:17:34', '2021-11-18 16:17:34'),
(42960, 10057, 30693, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email Received From : lilien.alvarado@gulfquest.net  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Good afternoon,  Can you please send me the applications that you submitted?  Thank you.  Regards, Lilien Alvarado, MPA Provider Contracting Lead Analyst Cigna 2800 North Loop West,Ste 400', NULL, NULL, '2021-12-01 11:55:15', '2021-12-01 11:55:15'),
(42961, 10057, 30693, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : lilien.alvarado@gulfquest.net  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Hello Lilien,  Thank you for reaching out to me. Kindly find the attached application for your reference.  Please let me know if you have any questions and revert back to me with the latest updates.  Thanks & Regards,', NULL, NULL, '2021-12-08 10:34:46', '2021-12-08 10:34:46'),
(42962, 10057, 30693, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Sent To : lilien.alvarado@gulfquest.net & TXGQProviderRelations@healthspring.com  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Greetings!  Hope this email finds you in good health. I\'m writing this email to check the current status of the below mentioned request.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-16 11:09:35', '2021-12-16 11:09:35'),
(42963, 10057, 30693, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Received From : joann.alanis@careallies.com  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Please see attached communication from Renaissance.  Thank you.', NULL, NULL, '2021-12-22 10:18:40', '2021-12-22 10:18:40'),
(42964, 10057, 30693, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Sent To : joann.alanis@careallies.com  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Thank you for reaching out. The attached letter was from Renaissance. We are inquiring about credentialing status for NUCC & IVUC with Cigna Healthspring.  Please get back to me once you get a chance. Have a great day!  Regards,', NULL, NULL, '2021-12-29 11:25:48', '2021-12-29 11:25:48'),
(42965, 19067, 30693, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: joann.alanis@careallies.com  Subject: Enrollment Query || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers & Groups || Cigna Healthspring ||   Good Morning JoAnn!  Hope you are doing really well.  I would like to know the enrollment status of the following Providers & Groups.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Jeny John	1073019493	779 Normandy St STE 114, Houston, TX 77015-3441 Jeny John	1073019493	16272 Imperial Valley DR STE K, Houston, TX 77060 Molly Joseph	1396380077	779 Normandy St STE 114, Houston, TX 77015-3441 Molly Joseph	1396380077	16272 Imperial Valley DR STE K, Houston, TX 77060 Cini Thomas	1134777238	779 Normandy St STE 114, Houston, TX 77015-3441 Cini Thomas	1134777238	16272 Imperial Valley DR STE K, Houston, TX 77060 Ani Stephen	1588959118	779 Normandy St STE 114, Houston, TX 77015-3441 Ani Stephen	1588959118	16272 Imperial Valley DR STE K, Houston, TX 77060 Abdur Rauf	1497726202	779 Normandy St STE 114, Houston, TX 77015-3441 Abdur Rauf	1497726202	16272 Imperial Valley DR STE K, Houston, TX 77060 James Piccione JR	1356321509	779 Normandy St STE 114, Houston, TX 77015-3441 James Piccione JR	1356321509	16272 Imperial Valley DR STE K, Houston, TX 77060 Sigi Paul	1033623616	779 Normandy St STE 114, Houston, TX 77015-3441 Sigi Paul	1033623616	16272 Imperial Valley DR STE K, Houston, TX 77060 Odette Kourouma	1134525868	779 Normandy St STE 114, Houston, TX 77015-3441 Odette Kourouma	1134525868	16272 Imperial Valley DR STE K, Houston, TX 77060 Vibitha Joseph	1952931560	779 Normandy St STE 114, Houston, TX 77015-3441 Vibitha Joseph	1952931560	16272 Imperial Valley DR STE K, Houston, TX 77060 Julie Jose	1447883061	779 Normandy St STE 114, Houston, TX 77015-3441 Julie Jose	1447883061	16272 Imperial Valley DR STE K, Houston, TX 77060 Jaya Jacob	1194336149	779 Normandy St STE 114, Houston, TX 77015-3441 Jaya Jacob	1194336149	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeemol George	1497219067	779 Normandy St STE 114, Houston, TX 77015-3441 Jeemol George	1497219067	16272 Imperial Valley DR STE K, Houston, TX 77060 Limy Fernandus	1972005189	779 Normandy St STE 114, Houston, TX 77015-3441 Limy Fernandus	1972005189	16272 Imperial Valley DR STE K, Houston, TX 77060 Brittany Brown	1275163537	779 Normandy St STE 114, Houston, TX 77015-3441 Brittany Brown	1275163537	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeena Abraham	1467901587	779 Normandy St STE 114, Houston, TX 77015-3441 Jeena Abraham	1467901587	16272 Imperial Valley DR STE K, Houston, TX 77060 Mini Chennemkara	1841755956	779 Normandy St STE 114, Houston, TX 77015-3441 Mini Chennemkara	1841755956	16272 Imperial Valley DR STE K, Houston, TX 77060 Glory Abraham	1194206490	779 Normandy St STE 114, Houston, TX 77015-3441 Glory Abraham	1194206490	16272 Imperial Valley DR STE K, Houston, TX 77060   Kindly respond at your earliest convenience.   Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-05 11:24:17', '2022-01-05 11:24:17'),
(42966, 19067, 30693, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email received from: joann.alanis@careallies.com  Subject: Enrollment Query || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers & Groups || Cigna Healthspring ||   For Renaissance you are not contracted.', NULL, NULL, '2022-01-06 16:33:04', '2022-01-06 16:33:04'),
(42967, 20067, 30693, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: joann.alanis@careallies.com  Sub: Enrollment Query || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers & Groups || Cigna Healthspring ||  Good afternoon, Hope this email finds you well. Could you please tell me for the Renaissance contract what procedure will be followed?  Thanks and regards, Syed Ahad. ', NULL, NULL, '2022-01-14 14:07:25', '2022-01-14 14:07:25'),
(42968, 20067, 30693, NULL, '2022-01-21 00:00:00.000', 'Not Eligible', 'Email received from: joann.alanis@careallies.com  Sub: Enrollment Query || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers & Groups || Cigna Healthspring ||  Hello!  The Renaissance-Eastside Board reviewed your Letter of Interest form a few months ago.  A letter was sent indicating that they were unable to extend a contract.  compliance. Copyright (c) 2022 CareAllies', NULL, NULL, '2022-01-14 14:40:15', '2022-01-14 14:40:15'),
(42969, 1006, 30694, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:04:32', '2021-05-14 15:04:32'),
(42970, 3040, 30694, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: providerservices@triwest.com  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Triwest ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Triwest 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  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, '2021-05-31 14:59:06', '2021-05-31 14:59:06'),
(42971, 3040, 30694, NULL, '2021-06-25 00:00:00.000', 'On Hold', 'Group ancillary contract is already in process. For more details please see group task. ', NULL, NULL, '2021-06-18 10:14:12', '2021-06-18 10:14:12'),
(42972, 3040, 30694, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: jmonson@triwest.com  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Triwest ||  Hello Jess,   Can you please check and advise if the below mentioned group is in-network with Triwest or not. If not so can you please generate a contract for the below mentioned group. For your reference I attached the W9.   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  If you need any additional information please let me know. Waiting for your response.  Thank you ', NULL, NULL, '2021-07-20 11:05:03', '2021-07-20 11:05:03'),
(42973, 3040, 30694, NULL, '2021-07-29 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, '2021-07-22 14:31:42', '2021-07-22 14:31:42'),
(42974, 1006, 30695, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:04:32', '2021-05-14 15:04:32'),
(42975, 3040, 30695, NULL, '2021-05-27 00:00:00.000', 'Not Eligible', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes ', NULL, NULL, '2021-05-20 16:33:03', '2021-05-20 16:33:03'),
(42976, 1006, 30707, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:04:33', '2021-05-14 15:04:33');
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
(42977, 3040, 30707, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: providerservices@renaissancefamily.com  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Renaissance Physicians ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Renaissance Physicians 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  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, '2021-05-31 13:59:48', '2021-05-31 13:59:48'),
(42978, 3040, 30707, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: txgqproviderrelations@healthspring.com  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Renaissance Physicians ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Renaissance Physicians 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  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  Provider 16:   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, '2021-06-17 14:42:26', '2021-06-17 14:42:26'),
(42979, 3040, 30707, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: Chukwuma.Ezeokoli@careallies.com cc:	catherine.chang@careallies.com, shannon.luke@careallies.com,  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Renaissance Physicians ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Renaissance Physicians 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  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  Provider 16:   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, '2021-07-05 16:48:30', '2021-07-05 16:48:30'),
(42980, 3040, 30707, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: joann.alanis@careallies.com  Subject: Re: [External] Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Renaissance Physicians ||  Hello Alanis,   Hope you are doing well. Do you have any update regarding the enrollment for the below mentioned group and providers.   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  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  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-26 12:43:38', '2021-07-26 12:43:38'),
(42981, 11056, 30707, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email sent to :   joann.alanis@careallies.com   &   Chukwuma.Ezeokoli@careallies.com  Sub : Fwd: [External] Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Renaissance Physicians ||  Good evening!  Hope you are doing well. I want to inquire about the enrollment status of the below mentioned providers and practices. Please provide us with the latest updates soon.  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  Provider Details:  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  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you!  Have a great week ahead!', NULL, NULL, '2021-08-11 16:29:22', '2021-08-11 16:29:22'),
(42982, 3040, 30707, NULL, '2021-08-25 00:00:00.000', 'Not Eligible', 'Email rcvd from: JENNIFER.PEREZ@cigna.com  Subject: RE: [External] Re: Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring ||  08/03/2021 Normandy Urgent Care Center ATTN: Adil Abbas 779 Normandy Street, Suite 114 Houston, TX 77015 Dear Mr. Abbas, Thank you for your request to join the Renaissance Physician Organization/Eastside IPA, LLC. At the present time we do not have a network need in your particular specialty. As a result, we are not able to extend an invitation for participation at this time. We will however keep your request on file and reconsider in the event our network development needs change. If you have any questions, please feel free to call JoAnn Alanis at 832.553.3350. Sincerely, Julian Gonzalez, M.D. Chairman of The Board Eastside IPA, LLC', NULL, NULL, '2021-08-18 13:11:53', '2021-08-18 13:11:53'),
(42983, 1006, 30708, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:04:33', '2021-05-14 15:04:33'),
(42984, 3040, 30708, NULL, '2021-06-04 00:00:00.000', 'On Hold', 'Waiting for the enrollment in Molina healthcare.', NULL, NULL, '2021-05-28 14:28:34', '2021-05-28 14:28:34'),
(42985, 10057, 30708, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com & MHTContractrequest@molinahealthcare.com  Sub : Enrollment Status || NUCC - IVUC - LPMC || Molina Marketplace  Good Afternoon,  Hope you are doing well. I\'m writing this email to check the enrollment and provider directory status for remaining providers under the below mentioned locations with Molina Marketplace.  Also, I\'m able to see the groups on provider directory, I already got the effective dates via help desk, please send me the group agreement or facility contract at the earliest   Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  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 Fernandus, Limy	1972005189 Jacob, Jaya	1194336149 Thomas, Cini	1134777238 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067  Once you get a chance please get back to me. Have a great weekend ahead!  Regards,', NULL, NULL, '2021-12-30 15:38:12', '2021-12-30 15:38:12'),
(42986, 19067, 30708, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email received from: Michele.Thomas-Martin@molinahealthcare.com  Subject: Enrollment Status || NUCC - IVUC - LPMC || Molina Marketplace     Good Morning,     Thank you for your inquiry.  Please see the attached contracts for both TIN numbers.  Please see the updates below.     The only providers on the below list listed under TIN # 760612416 are Joseph, Vibitha and Rauf, Abdur.  Please submit a contract request form to MHTContractrequest@Molinahealthcare.com  to add the remaining providers.     The only providers not listed under TIN # 270796429 are Jacob Jaya and Jeny John.  Please submit a contract request form to MHTContractrequest@Molinahealthcare.com  to add the 2 providers under this TIN #.     Thank You,     Michele Thomas-Martin  Associate Specialist, Provider Contracts  1-888-562-5442 Ext. 200042  1 972-200-2688 - Direct  www.MolinaHealthcare.com  Your Extended Family', NULL, NULL, '2022-01-05 17:29:17', '2022-01-05 17:29:17'),
(42987, 20067, 30708, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@Molinahealthcare.com, Michele.Thomas-Martin@molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace  Good Morning, Hope you are doing well. Kindly see the attachment of the contract request form for Jaya Jacob & Jeny John Under TIN# 270796429  Thanks and Regards Syed Ahad', NULL, NULL, '2022-01-18 09:16:47', '2022-01-18 09:16:47'),
(42988, 20067, 30708, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email received from: MHTContractrequest@molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace  Good Morning Syed,     Happy Thursday! – I hope all is well. I have received your requests. However, I noticed Provider Jaya Jacob 1194336149 already has a record created for TIN 27-0796429. Also, per Jeny John’s 1073019493 request, the service location is not listed per the form. Please fill in the service location & resubmit along with a current W9.', NULL, NULL, '2022-01-28 09:16:25', '2022-01-28 09:16:25'),
(42989, 20067, 30708, NULL, '2022-02-16 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace   Good afternoon!  Thanks for the update. Kindly see the attachment for Jeny John 1073019493', NULL, NULL, '2022-02-09 15:29:26', '2022-02-09 15:29:26'),
(42990, 20067, 30708, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace   Good Morning!  Happy Monday! Hope this email finds you in good health. I would like to know the current status of the below-mentioned providers  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Jeny John	1073019493 Molly Joseph	1396380077 Jaya Jacob	1194336149 Limy Fernandus	1972005189 Cini Thomas	1134777238 Brittany Brown	1275163537 Abdur Rauf	1497726202 Jeemol George	1497219067 Vibitha Joseph	1952931560 Ancy Kurian	1316558935  Thank you, Syed Ahad.', NULL, NULL, '2022-02-21 09:29:31', '2022-02-21 09:29:31'),
(42991, 20067, 30708, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email received from: MHTContractrequest@molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace   Good Afternoon –     Happy Tuesday! Hope you are doing well. According to our record Ms. Thomas contracted you for all lobs. Please reach out to mhtxproviderservices@Molinahealthcare.com if you have any questions. They will be able to provide you with a roster for all par providers lines of business and effective dates. Thank you in advance have a wonderful day.  ', NULL, NULL, '2022-03-01 14:08:37', '2022-03-01 14:08:37'),
(42992, 20067, 30708, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email sent to: mhtxproviderservices@Molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace   Good Afternoon!  Happy Tuesday! Hope this email finds you in good health. I would like to know the current status of the below-mentioned providers  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Jeny John	1073019493 Molly Joseph	1396380077 Jaya Jacob	1194336149 Limy Fernandus	1972005189 Cini Thomas	1134777238 Brittany Brown	1275163537 Abdur Rauf	1497726202 Jeemol George	1497219067 Vibitha Joseph	1952931560 Ancy Kurian	1316558935  Thank you, Syed Ahad.', NULL, NULL, '2022-03-01 14:11:09', '2022-03-01 14:11:09'),
(42993, 20067, 30708, NULL, '2022-03-25 00:00:00.000', 'In Process', 'Email sent to: mhtxproviderservices@molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace   Good Morning!  Hope your day is going well. Kindly provide me the roster for the Par providers with effective dates.  Thank you, Syed.', NULL, NULL, '2022-03-18 10:47:48', '2022-03-18 10:47:48'),
(42994, 19067, 30708, NULL, '2022-04-06 00:00:00.000', 'Approved', 'Eff date: 09/15/2021. See the attachment for the approval letter.', NULL, NULL, '2022-03-30 15:05:15', '2022-03-30 15:05:15'),
(42995, 1006, 30709, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:04:33', '2021-05-14 15:04:33'),
(42996, 1019, 30709, NULL, '2021-06-15 00:00:00.000', 'Initiated', 'Sent the following email to colbee.snyder@primehealthservices.com SUB: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||   Greetings, Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Prime Health 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  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, '2021-05-31 14:52:26', '2021-05-31 14:52:26'),
(42997, 3040, 30709, NULL, '2021-06-25 00:00:00.000', 'In Process', 'Email rcvd from:  colbee.snyder@primehealthservices.com  Subject: RE: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||  Thank you for your email. As of February 1st, 2020 I have been moved to a position outside of the credentialing department and will no longer be your point of contact. I have copied our general credentialing email.  Going forward, please forward all new providers adds and demographic changes to credentialing@primehealthservices.com and copy updates@primehealthservices.com.  Thank you!  Colbee Snyder Patient Advocacy Specialist', NULL, NULL, '2021-06-18 13:20:57', '2021-06-18 13:20:57'),
(42998, 3040, 30709, NULL, '2021-06-25 00:00:00.000', 'In Process', 'Email sent to: credentialing@primehealthservices.com  Subject: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Prime Health 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  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  Provider 16:   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, '2021-06-18 13:24:48', '2021-06-18 13:24:48'),
(42999, 3040, 30709, NULL, '2021-07-14 00:00:00.000', 'In Process', 'Email sent to: credentialing@primehealthservices.com, updates@primehealthservices.com,  Subject: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||  Hello,   Has there been any update?  Thank you  ', NULL, NULL, '2021-07-07 16:52:18', '2021-07-07 16:52:18'),
(43000, 3040, 30709, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: credentialing@primehealthservices.com  Subject: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||  Hello,   Hope you are doing well. I was trying to reach out to know the enrollment status for the below mentioned group and providers in Prime Health 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  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  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks', NULL, NULL, '2021-07-22 11:56:15', '2021-07-22 11:56:15'),
(43001, 11056, 30709, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email received from : credentialing@primehealthservices.com  Sub : Fwd: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||  Good Morning,  Please see below for the credentialing status for each provider.  The dates given are for credentialing purposes only and not the effective date.  Thank you for including the Updates Department in your email.  They will assist you with the effective dates.  There are two providers (highlighted) that need to be credentialed.  Please email a current CAQH Credentialing application or State Credentialing application for these providers.  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  - In the process of being credentialed.  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061 - Needs to be credentialed.     Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 - In the process of being credentialed.   Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 - Last credentialed - 6-23-2020 - Not the effective date - For credentialing purposes only.   Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 - In the process of being credentialed.  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956 - In the process of being credentialed.   Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490 - In the process of being credentialed.   Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 - In the process of being credentialed.   Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 - Last credentialed - 7-15-2020 - Not the effective date - For credentialing purposes only.  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 - In the process of being credentialed.   Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 - In the process of being credentialed.   Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238 - In the process of being credentialed.   Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 - In the process of being credentialed.   Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616 - In the process of being credentialed.  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149 - In the process of being credentialed.  Provider 16:  Provider Name: Joseph, Molly Provider NPI# 1396380077 - In the process of being credentialed.  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493 - Needs to be Credentialed.', NULL, NULL, '2021-08-12 10:16:50', '2021-08-12 10:16:50'),
(43002, 3040, 30709, NULL, '2021-09-21 00:00:00.000', 'In Process', 'Email sent to: megan.wherry@primehealthservices.com  Subject: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Prime Health ||  Hello Megan,   Hope you are doing well. Can you please send the roster because I am trying to find out the providers on the Prime Health Services directory and it\'s not showing up.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-09-14 17:07:45', '2021-09-14 17:07:45'),
(43003, 12062, 30709, NULL, '2021-09-24 00:00:00.000', 'In Process', 'Email sent to:megan.wherry@primehealthservices.com; colbee.snyder@primehealthservices.com; credentialing@primehealthservices.com; nucc@claimsmedinc.com; ivuc@claimsmedinc.com; Credentialing - Claims Med credentialing@claimsmedinc.com  Hi Wherry,  Hope you are doing well !   May I have any updated status for the enrollment application of below providers under the Prime Health Services Network?  I would be glad to have your response as soon as possible. The practice\'s and provider\'s details are as follows;   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   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   Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077   Thanking You in advance.', NULL, NULL, '2021-09-17 12:27:48', '2021-09-17 12:27:48'),
(43004, 10057, 30709, NULL, '2021-11-04 00:00:00.000', 'In Process', 'Email Sent To : credentialing@primehealthservices.com, updates@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Good Afternoon,  Hope this email finds you well. I\'m writing this email to check the updated status for the mentioned request. Please get back to me as soon as you get a chance.  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-28 15:23:45', '2021-10-28 15:23:45'),
(43005, 10057, 30709, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : credentialing@primehealthservices.com>, updates@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Good Morning,  Hope this email finds you in good health. Can I get the latest update on all the below mentioned groups and providers enrollment status?  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Please respond back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-22 10:43:29', '2021-11-22 10:43:29'),
(43006, 10057, 30709, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : credentialing@primehealthservices.com, updates@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Hello,  Can I get the latest updates on the below mentioned providers enrollment request under the TIN?  Please get back to me ASAP!  Thanks & Regards,', NULL, NULL, '2021-12-02 14:04:03', '2021-12-02 14:04:03'),
(43007, 10057, 30709, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Received From : credentialing@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Please see attached Credentialing Status Roster.  The dates given are for Credentialing purposes only and not the effective date.  Thank you for including the Updates Department in your email.  They will respond regarding the effective dates.  Thank you, Nancy', NULL, NULL, '2021-12-15 10:51:55', '2021-12-15 10:51:55'),
(43008, 10057, 30709, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : credentialing@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Hello Nancy,  Thank you for your prompt response. I really appreciate your support. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-22 12:08:53', '2021-12-22 12:08:53'),
(43009, 10057, 30709, NULL, '2022-01-05 00:00:00.000', 'Approved', 'Email Received From : updates@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Hello, all of these providers are in our system with both locations added, thanks!  Alyssa DeNure Data Integrity Associate', NULL, NULL, '2021-12-29 14:18:13', '2021-12-29 14:18:13'),
(43010, 1006, 30710, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:04:33', '2021-05-14 15:04:33'),
(43011, 3040, 30710, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Subject: Need to Enroll|| Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || CHRISTUS HEALTH PLAN||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Christus Health Plan for our group under the below locations. We have 02 different locations under the same tax ID.     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  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, '2021-05-25 12:38:48', '2021-05-25 12:38:48'),
(43012, 3040, 30710, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Email sent to: CHP.networkdevelopment@christushealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Christus Health Plan ||  Greetings,   Hope you are doing well. Please find the attached Prospective Provider Form along with the Letter of Intent for below mentioned providers to enroll in Christus Health Plan in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Primary 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 Secondary Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  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, '2021-06-11 14:48:05', '2021-06-11 14:48:05'),
(43013, 11056, 30710, NULL, '2021-07-06 00:00:00.000', 'In Process', 'Email sent to : CHP.networkdevelopment@christushealth.org  Sub : Enroll Request Group & Providers || Normandy Urgent Care Center || Christus Health Plan ||  Greetings,  Hope you are doing well. I want to know enrollment status of the following groups and providers. Respond this as soon as possible.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Primary 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 Secondary Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Providers: 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 good day!', NULL, NULL, '2021-06-29 12:56:07', '2021-06-29 12:56:07'),
(43014, 3040, 30710, NULL, '2021-07-26 00:00:00.000', 'On Hold', 'Ancillary contract request sent for the group. Please see group task. ', NULL, NULL, '2021-07-19 09:23:44', '2021-07-19 09:23:44'),
(43015, 3040, 30710, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email sent to: hunter.barrett@christushealth.org  Subject: Re: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Hello Hunter,   Hope you are doing well. Please find attached Ancillary service agreement along with the Facility Ancillary application for our group to participate in Christus Health Plan 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 let me know. Waiting for your response.    Thanks ', NULL, NULL, '2021-07-28 11:39:19', '2021-07-28 11:39:19'),
(43016, 11056, 30710, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email sent to : Hunter Barrett   hunter.barrett@christushealth.org, CHP.networkdevelopment@christushealth.org  Sub  : ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Good evening!  Hope all is well. I just want to inquire about the enrollment status of the following groups for the ancillary contract. Please provide us with the latest updates soon.  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 feel free to reach out to me. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-08-11 17:07:59', '2021-08-11 17:07:59'),
(43017, 3040, 30710, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email rcvd from: hunter.barrett@christushealth.org  Subject: RE: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Contract was sent to credentialing about 3 weeks ago to process. Will take about 6 months to fully process and receive effective date.  Thanks,  Hunter Barrett Network Contracting CHRISTUS Health Plan CHRISTUS Health 919 Hidden Ridge | Irving, Texas 75038 (o) 469.282.3113', NULL, NULL, '2021-08-17 15:02:52', '2021-08-17 15:02:52'),
(43018, 3040, 30710, NULL, '2021-09-21 00:00:00.000', 'In Process', 'Email sent to: hunter.barrett@christushealth.org  Subject: Re: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Good evening!  Hope all is well. This is a follow up email to inquire about the enrollment status of the following groups for the ancillary contract.   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 feel free to reach out to me. Waiting for your response.  Thanks', NULL, NULL, '2021-09-14 16:14:49', '2021-09-14 16:14:49'),
(43019, 12062, 30710, NULL, '2021-09-29 00:00:00.000', 'In Process', ' Received below email under the group ancillary contract request; From :hunter.barrett@christushealth.org Subject :RE: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN Please reach out to our credentialing team in about 4 months for an update. You can reach out directly to them for updates on all of the contracts you are inquiring about. They are running around 6 months to process them so please give them adequate time to reach your file. Most of the contracts were sent to them around 1-2 months ago CHRISTUS.HP.Credentialing CHRISTUS.HP.Credentialing@christushealth.org  Thanks,   Hunter Barrett Network Contracting CHRISTUS Health Plan CHRISTUS Health 919 Hidden Ridge | Irving, Texas 75038 (o) 469.282.3113 www.christushealth.org  ', NULL, NULL, '2021-09-22 13:11:16', '2021-09-22 13:11:16'),
(43020, 10057, 30710, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Good Evening,  Hope you are doing well. I want to know the enrollment status of the following groups and providers. Please get back to me as soon as you get the time.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Jose, Julie	1447883061 George, Jeemol	1497219067 Brown, Brittany	1275163537 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Thomas, Cini	1134777238 Joseph, Vibitha	1952931560 Stephen, Ani	1588959118 Piccione JR, James M	1356321509 Chennemkara, Mini Philip	1841755956 Abraham, Glory	1194206490 Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-10-18 16:39:01', '2021-10-18 16:39:01'),
(43021, 10057, 30710, NULL, '2021-12-02 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : Need Credentialing Update - URGENT  Good Afternoon,  Hope you are doing well. Can I have the latest update on the below mentioned request. Also welcome letters?  Looking forward to your kind response. Have a great day!   Thanks & Regards,', NULL, NULL, '2021-11-18 13:52:25', '2021-11-18 13:52:25'),
(43022, 10057, 30710, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : Need Credentialing Update - URGENT  Hello,  Can I get the update on the below mentioned request, also I have not yet received any welcome letters yet.  Kindly revert back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-01 11:03:10', '2021-12-01 11:03:10'),
(43023, 10057, 30710, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email Received From : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Good Morning  Normandy Urgent Care Center  - has been processed effective contract date 01/01/2022  Longpoint Medical Center – facility has been processed effective contract date 01/01/2022  Imperial Valley - facility has been processed effective contract date 01/01/2022  Credentialing Verification Unit CHRISTUS Health Plan - US Family Health Plan 919 Hidden Ridge Irving, TX 75038 Phone: (469)-282-0368 Fax: 210-766-8857', NULL, NULL, '2021-12-14 09:53:25', '2021-12-14 09:53:25');
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
(43024, 10057, 30710, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Thank you for the update. Could you please provide us with the facility agreement or contract along with the update for the providers credentialing status as well.  Your earliest response would be greatly appreciated.  Regards, Steve Albert', NULL, NULL, '2021-12-20 13:43:01', '2021-12-20 13:43:01'),
(43025, 10057, 30710, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Greetings!  Hope you are doing great. I\'m writing this email to get the update on my below request. Please get back to me as soon as possible!  Regards,', NULL, NULL, '2021-12-28 11:58:01', '2021-12-28 11:58:01'),
(43026, 19067, 30710, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: CHRISTUS.HP.Credentialing@christushealth.org, hunter.barrett@christushealth.org, CHP.networkdevelopment@christushealth.org  Subject: Enrollment Query || NUCC & IVUC || Providers & Group || Christus Health Plan ||   Hello!  You are having a productive day.  I would like to know the enrollment status of the following Providers and Group with Christus Health Plan.   Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Jeny John	1073019493	779 Normandy St STE 114, Houston, TX 77015-3441 Jeny John	1073019493	16272 Imperial Valley DR STE K, Houston, TX 77060 Molly Joseph	1396380077	779 Normandy St STE 114, Houston, TX 77015-3441 Molly Joseph	1396380077	16272 Imperial Valley DR STE K, Houston, TX 77060 Cini Thomas	1134777238	779 Normandy St STE 114, Houston, TX 77015-3441 Cini Thomas	1134777238	16272 Imperial Valley DR STE K, Houston, TX 77060 Ani Stephen	1588959118	779 Normandy St STE 114, Houston, TX 77015-3441 Ani Stephen	1588959118	16272 Imperial Valley DR STE K, Houston, TX 77060 Abdur Rauf	1497726202	779 Normandy St STE 114, Houston, TX 77015-3441 Abdur Rauf	1497726202	16272 Imperial Valley DR STE K, Houston, TX 77060 James Piccione JR	1356321509	779 Normandy St STE 114, Houston, TX 77015-3441 James Piccione JR	1356321509	16272 Imperial Valley DR STE K, Houston, TX 77060 Sigi Paul	1033623616	779 Normandy St STE 114, Houston, TX 77015-3441 Sigi Paul	1033623616	16272 Imperial Valley DR STE K, Houston, TX 77060 Odette Kourouma	1134525868	779 Normandy St STE 114, Houston, TX 77015-3441 Odette Kourouma	1134525868	16272 Imperial Valley DR STE K, Houston, TX 77060 Vibitha Joseph	1952931560	779 Normandy St STE 114, Houston, TX 77015-3441 Vibitha Joseph	1952931560	16272 Imperial Valley DR STE K, Houston, TX 77060 Julie Jose	1447883061	779 Normandy St STE 114, Houston, TX 77015-3441 Julie Jose	1447883061	16272 Imperial Valley DR STE K, Houston, TX 77060 Jaya Jacob	1194336149	779 Normandy St STE 114, Houston, TX 77015-3441 Jaya Jacob	1194336149	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeemol George	1497219067	779 Normandy St STE 114, Houston, TX 77015-3441 Jeemol George	1497219067	16272 Imperial Valley DR STE K, Houston, TX 77060 Limy Fernandus	1972005189	779 Normandy St STE 114, Houston, TX 77015-3441 Limy Fernandus	1972005189	16272 Imperial Valley DR STE K, Houston, TX 77060 Brittany Brown	1275163537	779 Normandy St STE 114, Houston, TX 77015-3441 Brittany Brown	1275163537	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeena Abraham	1467901587	779 Normandy St STE 114, Houston, TX 77015-3441 Jeena Abraham	1467901587	16272 Imperial Valley DR STE K, Houston, TX 77060 Mini Chennemkara	1841755956	779 Normandy St STE 114, Houston, TX 77015-3441 Mini Chennemkara	1841755956	16272 Imperial Valley DR STE K, Houston, TX 77060 Glory Abraham	1194206490	779 Normandy St STE 114, Houston, TX 77015-3441 Glory Abraham	1194206490	16272 Imperial Valley DR STE K, Houston, TX 77060  Eagerly waiting for your response.   Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 17:25:21', '2022-01-04 17:25:21'),
(43027, 19067, 30710, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email received from: Sonia.Gonzales@christushealth.org  Subject: Enrollment Query || NUCC & IVUC || Providers & Group || Christus Health Plan ||     Good Morning All,     Thank you for the request below, I do show contract for USFHP was signed and executed.   Information was sent over to get configuration of contract rates entered.       Once we have this process is completed we can have this sent to Credentialing to get group loaded with effective date.  When I get further updates will pass along!     Please remove Hunter Barrette from communications, unfortunately he is no longer with us, I am covering in the interim.       Thanks and appreciate your patience,     Respectfully,     Sonia D. Gonzales  CHRISTUS Health Plan – Physician Relations Consultant II/ Contracting  505-569-4856  sonia.gonzales@christushealth.org', NULL, NULL, '2022-01-05 11:33:52', '2022-01-05 11:33:52'),
(43028, 20067, 30710, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: Sonia.Gonzales@christushealth.org  Sub: Re: Enrollment Query || NUCC & IVUC || Providers & Group || Christus Health Plan ||  Good Afternoon, Hope this email finds you in good health. Any update on the previous request?  Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-14 13:27:39', '2022-01-14 13:27:39'),
(43029, 20067, 30710, NULL, '2022-01-28 00:00:00.000', 'In Process', 'Email sent to: Sonia.Gonzales@christushealth.org  Sub: Re: Enrollment Query || NUCC & IVUC || Providers & Group || Christus Health Plan ||  Good afternoon! Hope you are doing well. I haven\'t heard from your side, Kindly respond to the previous mail. If the process is complete, kindly send me the contract letter along with the effective date.  Thanks and Regards, Syed Ahad  ', NULL, NULL, '2022-01-21 16:46:30', '2022-01-21 16:46:30'),
(43030, 20067, 30710, NULL, '2022-02-01 00:00:00.000', 'Approved', 'Received the Ancillary contract from Christus Health Plan  Effective Date: 01/01/2022 Expiration Date: 12/31/9999', NULL, NULL, '2022-01-25 17:23:44', '2022-01-25 17:23:44'),
(43031, 1006, 30711, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:04:33', '2021-05-14 15:04:33'),
(43032, 1006, 30711, NULL, '2021-05-26 00:00:00.000', 'Approved', 'The provider is enrolled with UHC, approval confirmation and location confirmation are attached for reference. ', NULL, NULL, '2021-05-19 11:20:41', '2021-05-19 11:20:41'),
(43033, 1006, 30712, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:04:33', '2021-05-14 15:04:33'),
(43034, 3040, 30712, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: info@usamco.com  Subject: Copy of Executed Contract || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || MCO ||  Greetings,   Hope you are doing well. Can you please send me the copy of the executed contract for our group Normandy Urgent Care Center 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  Thank you ', NULL, NULL, '2021-05-28 12:24:33', '2021-05-28 12:24:33'),
(43035, 11056, 30712, NULL, '2021-06-23 00:00:00.000', 'Approved', '	 Group has an ancillary contract. No need to add individual providers. Please see group task.', NULL, NULL, '2021-06-16 12:25:55', '2021-06-16 12:25:55'),
(43036, 1006, 30713, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:04:33', '2021-05-14 15:04:33'),
(43037, 3040, 30713, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: providerservices@memorialhermann.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Memorial Hermann ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Memorial Hermann 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  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, '2021-05-28 13:25:29', '2021-05-28 13:25:29'),
(43038, 3040, 30713, NULL, '2021-06-23 00:00:00.000', 'On Hold', 'Group ancillary contract request sent to Memorial Hermann. For more details please see group task.  ', NULL, NULL, '2021-06-16 16:39:44', '2021-06-16 16:39:44'),
(43039, 3040, 30713, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: enterprise.credentialing@memorialhermann.org  Subject: Re: [EXTERNAL] Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Memorial Hermann ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Memorial Hermann 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  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-20 10:52:12', '2021-07-20 10:52:12'),
(43040, 11056, 30713, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Email sent to : ProviderServices@memorialhermann.org  &  MHHPContracting@memorialhermann.org  Sub : Fwd: [EXTERNAL] Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Memorial Hermann ||  Good morning!  Hope you are doing well. I want to know the enrollment status of the below mentioned group under the below locations for Ancillary contract in Memorial Hermann.  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  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 day! ', NULL, NULL, '2021-08-12 15:35:43', '2021-08-12 15:35:43'),
(43041, 3040, 30713, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Group has an ancillary contract no need to add individual providers. Please see group task for more details. ', NULL, NULL, '2021-08-27 10:00:27', '2021-08-27 10:00:27'),
(43042, 1006, 30714, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:04:33', '2021-05-14 15:04:33'),
(43043, 3040, 30714, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Tricare ||  Hello Katherine,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Tricare 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  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-02 16:09:32', '2021-06-02 16:09:32'),
(43044, 3040, 30714, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Tricare 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  Provider 16:   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, '2021-06-22 09:41:22', '2021-06-22 09:41:22'),
(43045, 3040, 30714, NULL, '2021-07-16 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Need Effective Date || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers ||  Hello,   Hope you are doing well. As per your email the below mentioned providers are participating with Tricare in our group under the below locations. Can you please send the effective date.   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: Abraham, Glory (Need Effective Date) Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy (Need Effective Date) Provider NPI# 1972005189  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-09 14:41:35', '2021-07-09 14:41:35'),
(43046, 3040, 30714, NULL, '2021-07-19 00:00:00.000', 'Approved', 'Email rcvd from: ywyatt@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare || Provider 7:    Provider Name: Abraham, Glory- network all three locations  Provider NPI# 1194206490', NULL, NULL, '2021-07-12 13:29:26', '2021-07-12 13:29:26'),
(43047, 1006, 30715, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:04:33', '2021-05-14 15:04:33'),
(43048, 1006, 30715, NULL, '2021-05-28 00:00:00.000', 'Initiated', 'Submitted group enrollment request via Wellcare\'s online form, attached for reference in group task. ', NULL, NULL, '2021-05-20 21:01:47', '2021-05-20 21:01:47'),
(43049, 3040, 30715, NULL, '2021-06-16 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more details please see group task.', NULL, NULL, '2021-06-09 10:48:51', '2021-06-09 10:48:51'),
(43050, 3040, 30715, NULL, '2021-07-27 00:00:00.000', 'In Process', 'I spoke with Harvey D Wellcare representative and he advised me that processing time will take 60 business days. After reviewing the application the provider rep will contact you.   Ref: 544023676', NULL, NULL, '2021-07-20 10:36:08', '2021-07-20 10:36:08'),
(43051, 11056, 30715, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good afternoon!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Wellcare 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    Provider 16:    Provider Name: Joseph, Molly Provider NPI# 1396380077    Provider 17:    Provider Name: John, Jeny Provider NPI# 1073019493    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, '2021-08-11 13:59:07', '2021-08-11 13:59:07'),
(43052, 3040, 30715, NULL, '2021-09-14 00:00:00.000', 'Approved', 'Email rcvd from: ProspectiveProviderTX@wellcare.com  Subject: Re: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Please see providers we have currently loaded:  For more details please see attachment.   Thanks ', NULL, NULL, '2021-09-07 15:16:56', '2021-09-07 15:16:56'),
(43053, 1006, 30716, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:04:33', '2021-05-14 15:04:33'),
(43054, 3040, 30716, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Sent the following initiation request to trpndataentry@trpnppo.com & providerrelations@trpnppo.com:  Sub: Provider Enrollment Request - NUCC- TRPN  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Multiplan for our group under the below locations. Can you please send the roster.   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  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, '2021-05-28 17:02:14', '2021-05-28 17:02:14'),
(43055, 11056, 30716, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Good Evening!  Hope you are doing well. Please find the attached Provider update form to enroll the below mentioned group and providers in TRPN for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice NPI: 1407171077 Practice TIN: 27-0796429 Primary Address: 779 Normandy St Ste 114 Houston, TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice NPI: 1407171077 Practice TIN: 27-0796429P Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Provider Names enlisted below:-  Provider 1: Provider Name: Joseph, Molly Provider NPI : 1396380077  Provider 2: Provider Name:  Jacob, Jaya Provider NPI : 1194336149   Provider 3: Provider Name:  PAUL, SIGI Provider NPI : 1033623616  Provider 4:  Provider Name: Chennemkara, Mini Provider NPI : 1841755956     Provider 5:   Provider Name:  Abraham, Jeena Provider NPI :  1467901587    Provider 6:   Provider Name:  Kourouma , Odette Provider NPI :  1134525868  Provider 7:   Provider Name:  Piccione JR, James Provider NPI :  1356321509    Provider 8: Provider Name:  Abraham, Glory Provider NPI :  1194206490   Provider 9:   Provider Name:  Fernandus, Limy Provider NPI :  1972005189  Provider 10: Provider Name:  Thomas, Cini Provider NPI :  1134777238  Provider 11:   Provider Name:  Stephen, Ani Provider NPI :  1588959118   Provider 12:   Provider Name:  George, Jeemol Provider NPI :  1497219067    Provider 13:   Provider Name:  Jose, Julie Provider NPI :  1447883061    Provider 14:   Provider Name:  Brown, Brittany Provider NPI :   1275163537  Provider 15:   Provider Name:  Joseph, Vibitha Provider NPI :   1952931560    Provider 16:  Provider Name:  Abdur Rauf Provider NPI :  1497726202    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-16 17:11:46', '2021-06-16 17:11:46'),
(43056, 3040, 30716, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: trpndataentry@trpnppo.com, mflores@trpnppo.com, ccampos@trpnppo.com  Subject: Re: Provider Update Information Form- TRPN  Hello Max and Carlos,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in TRPN for our group under the below mentioned locations. We already sent the provider update form at trpndataentry@trpnppo.com.   Practice Details: Practice Name: Normandy Urgent Care Center Practice NPI: 1407171077 Practice TIN: 27-0796429 Primary Address: 779 Normandy St Ste 114 Houston, TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice NPI: 1407171077 Practice TIN: 27-0796429  Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Provider Names enlisted below:- Provider 1: Provider Name: Joseph, Molly Provider NPI : 1396380077  Provider 2: Provider Name:  Jacob, Jaya Provider NPI : 1194336149   Provider 3: Provider Name:  PAUL, SIGI Provider NPI : 1033623616  Provider 4:  Provider Name: Chennemkara, Mini Provider NPI : 1841755956     Provider 5:   Provider Name:  Abraham, Jeena Provider NPI :  1467901587    Provider 6:   Provider Name:  Kourouma , Odette Provider NPI :  1134525868  Provider 7:   Provider Name:  Piccione JR, James Provider NPI :  1356321509    Provider 8: Provider Name:  Abraham, Glory Provider NPI :  1194206490   Provider 9:   Provider Name:  Fernandus, Limy Provider NPI :  1972005189  Provider 10: Provider Name:  Thomas, Cini Provider NPI :  1134777238  Provider 11:   Provider Name:  Stephen, Ani Provider NPI :  1588959118  Provider 12:   Provider Name:  George, Jeemol Provider NPI :  1497219067   Provider 13:   Provider Name:  Jose, Julie Provider NPI :  1447883061    Provider 14:   Provider Name:  Brown, Brittany Provider NPI :   1275163537  Provider 15:   Provider Name:  Joseph, Vibitha Provider NPI :   1952931560    Provider 16:  Provider Name:  Abdur Rauf Provider NPI : 1497726202    Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-05 15:25:40', '2021-07-05 15:25:40'),
(43057, 3040, 30716, NULL, '2021-07-27 00:00:00.000', 'Approved', 'Email rcvd from: ccampos@trpnppo.com  Subject: Provider Update Information Form- TRPN Hi,  Provider Molly Joseph is Active, effective date 01/01/2021,  Provider Jacob Jaya is Active, effective date 01/01/2021,  Provider Sigi Paul is Active, effective date 01/01/2021,  Provider Mini Chennemkara is Active, effective date 01/01/2021,  Provider Jeena Abraham is Active, effective date 03/01/2016,  Provider Odette Kourouma is Active, effective date 01/01/2021,  Provider James Piccione is Active, effective date 01/01/2021,  Provider Glory Abraham is Active, effective date 05/29/2019,  Provider Limy Fernandus is Active, effective date 01/01/2021,  Provider Cini Thomas is Active, effective date 10/01/2019,  Provider Ani Stephen is Active, effective date 01/01/2021,  Provider Jeemol George is Active, effective date 06/09/2020,  Provider Julie Jose is Active, effective date 06/09/2020,  Provider Brittany Brown is Active, effective date 01/01/2021,  Provider Vibitha Joseph is Active, effective date 01/01/2021,  Provider Abdur Rauf is Active, effective date 01/01/2021,  Carlos Campos  Data Entry Department Supervisor Three Rivers Provider Network 6970 O’Bannon Drive Las Vegas, NV 89117 P: 619.869.8940 F: 619.271.2563 ccampos@trpnppo.com trpndataentry@trpnppo.com', NULL, NULL, '2021-07-20 08:32:38', '2021-07-20 08:32:38'),
(43058, 1006, 30717, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:04:33', '2021-05-14 15:04:33'),
(43059, 1006, 30717, NULL, '2021-06-07 00:00:00.000', 'Initiated', 'Sent following initiation request @ CSHNproviderrelations@christushealth.org:  Sub: Enrollment Request - NUCC, IVUC - Christus Spohn  \"Hello,  We wish to enroll the following providers under the mentioned group, please let me know what is required to get the enrollment process started. the details are as follows: Group Name: Normandy Urgent Care Center NPI# 1407171077 TIN# 27-0796429  Primary Address: 779 Normandy St Ste 114, Houston, TX 77015-3441 Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  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  Please get back to me as soon as you\'re able to.   Thank you. \"', NULL, NULL, '2021-05-31 16:21:02', '2021-05-31 16:21:02'),
(43060, 3040, 30717, NULL, '2021-06-25 00:00:00.000', 'In Process', 'I called the 800-419-3461 and left the VM. Because I didn\'t getting any reply from the insurance.  ', NULL, NULL, '2021-06-18 11:50:24', '2021-06-18 11:50:24'),
(43061, 3040, 30717, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Christus Spohn ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Christus Spohn for our group under the below locations. We have 02 different locations under the same tax ID.     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  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  Provider 16:   Provider Name: John, Jeny Provider NPI# 1073019493  Provider 17:   Provider Name: Joseph, Molly Provider NPI# 1073019493  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-06 14:45:25', '2021-07-06 14:45:25'),
(43062, 3040, 30717, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Email sent to: vicki.guerra@christushealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Christus Spohn ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Christus Spohn for our group under the below locations. We have 02 different locations under the same tax ID.     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  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  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you\'re able to.  Thank you   ', NULL, NULL, '2021-07-27 16:53:35', '2021-07-27 16:53:35'),
(43063, 3040, 30717, NULL, '2021-08-04 00:00:00.000', 'Not Eligible', 'Christus Spohn didn\'t provide services in the area. For more details please see group task.   ', NULL, NULL, '2021-07-28 11:20:34', '2021-07-28 11:20:34'),
(43064, 1006, 30718, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:04:33', '2021-05-14 15:04:33'),
(43065, 3040, 30718, NULL, '2021-06-09 00:00:00.000', 'On Hold', 'Facility/ Ancillary network interest form submitted. Please see group task.    ', NULL, NULL, '2021-06-02 10:36:00', '2021-06-02 10:36:00'),
(43066, 3040, 30718, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring ||  Hello Jennifer,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Cigna Healthspring for our group under the below mentioned 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  Waiting for your response.   Thank you  ', NULL, NULL, '2021-07-22 10:04:30', '2021-07-22 10:04:30'),
(43067, 11056, 30718, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email received from : JENNIFER.PEREZ@cigna.com  Sub : Re: Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring ||  Hi Adil,  My apologies, I forwarded this to the correct representative. She should be reaching out by this week. ', NULL, NULL, '2021-08-09 08:47:54', '2021-08-09 08:47:54'),
(43068, 11056, 30718, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email received from : JENNIFER.PEREZ@cigna.com  Sub : Re: Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring ||  Hi Adil,  My apologies, I forwarded this to the correct representative. She should be reaching out by this week. ', NULL, NULL, '2021-08-09 08:49:18', '2021-08-09 08:49:18'),
(43069, 3040, 30718, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: TXGQProviderRelations@healthspring.com  Subject: Re: [External] Re: Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring ||  Hello!  Hope you are doing well. As per conversation with Jennifer she requested to send an email to you. I wanted to know the enrollment status for the below mentioned group as I submitted the letter of interest form on 06/02/2021. Kindly review the chain of emails.   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  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you', NULL, NULL, '2021-08-17 09:55:49', '2021-08-17 09:55:49'),
(43070, 10057, 30718, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email Sent To : TXMAContracting@cigna.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello,  Hope you are doing well. I wanted to know the enrollment updated status for the below mentioned group in Cigna Healthspring for our group Valley Med Urgent Care PLLC under the below mentioned locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Tertiary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-14 11:22:49', '2021-10-14 11:22:49'),
(43071, 10057, 30718, NULL, '2021-11-25 00:00:00.000', 'In Process', 'Email Sent To : TXGQProviderRelations@healthspring.com  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Hello,  Could you please provide me with the updated status of my application?  Response is pending since 08/09/2021. Your earliest response will be much appreciated.  Thanks & Regards,', NULL, NULL, '2021-11-18 16:17:27', '2021-11-18 16:17:27'),
(43072, 10057, 30718, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email Received From : lilien.alvarado@gulfquest.net  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Good afternoon,  Can you please send me the applications that you submitted?  Thank you.  Regards, Lilien Alvarado, MPA Provider Contracting Lead Analyst Cigna 2800 North Loop West,Ste 400', NULL, NULL, '2021-12-14 10:46:22', '2021-12-14 10:46:22'),
(43073, 10057, 30718, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Sent To : lilien.alvarado@gulfquest.net & TXGQProviderRelations@healthspring.com  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Greetings!  Hope this email finds you in good health. I\'m writing this email to check the current status of the below mentioned request.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-16 11:09:29', '2021-12-16 11:09:29'),
(43074, 10057, 30718, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Received From : joann.alanis@careallies.com  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Please see attached communication from Renaissance.  Thank you.', NULL, NULL, '2021-12-22 10:18:35', '2021-12-22 10:18:35'),
(43075, 10057, 30718, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Sent To : joann.alanis@careallies.com  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Thank you for reaching out. The attached letter was from Renaissance. We are inquiring about credentialing status for NUCC & IVUC with Cigna Healthspring.  Please get back to me once you get a chance. Have a great day!  Regards,', NULL, NULL, '2021-12-29 11:25:42', '2021-12-29 11:25:42'),
(43076, 19067, 30718, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: joann.alanis@careallies.com  Subject: Enrollment Query || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers & Groups || Cigna Healthspring ||   Good Morning JoAnn!  Hope you are doing really well.  I would like to know the enrollment status of the following Providers & Groups.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Jeny John	1073019493	779 Normandy St STE 114, Houston, TX 77015-3441 Jeny John	1073019493	16272 Imperial Valley DR STE K, Houston, TX 77060 Molly Joseph	1396380077	779 Normandy St STE 114, Houston, TX 77015-3441 Molly Joseph	1396380077	16272 Imperial Valley DR STE K, Houston, TX 77060 Cini Thomas	1134777238	779 Normandy St STE 114, Houston, TX 77015-3441 Cini Thomas	1134777238	16272 Imperial Valley DR STE K, Houston, TX 77060 Ani Stephen	1588959118	779 Normandy St STE 114, Houston, TX 77015-3441 Ani Stephen	1588959118	16272 Imperial Valley DR STE K, Houston, TX 77060 Abdur Rauf	1497726202	779 Normandy St STE 114, Houston, TX 77015-3441 Abdur Rauf	1497726202	16272 Imperial Valley DR STE K, Houston, TX 77060 James Piccione JR	1356321509	779 Normandy St STE 114, Houston, TX 77015-3441 James Piccione JR	1356321509	16272 Imperial Valley DR STE K, Houston, TX 77060 Sigi Paul	1033623616	779 Normandy St STE 114, Houston, TX 77015-3441 Sigi Paul	1033623616	16272 Imperial Valley DR STE K, Houston, TX 77060 Odette Kourouma	1134525868	779 Normandy St STE 114, Houston, TX 77015-3441 Odette Kourouma	1134525868	16272 Imperial Valley DR STE K, Houston, TX 77060 Vibitha Joseph	1952931560	779 Normandy St STE 114, Houston, TX 77015-3441 Vibitha Joseph	1952931560	16272 Imperial Valley DR STE K, Houston, TX 77060 Julie Jose	1447883061	779 Normandy St STE 114, Houston, TX 77015-3441 Julie Jose	1447883061	16272 Imperial Valley DR STE K, Houston, TX 77060 Jaya Jacob	1194336149	779 Normandy St STE 114, Houston, TX 77015-3441 Jaya Jacob	1194336149	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeemol George	1497219067	779 Normandy St STE 114, Houston, TX 77015-3441 Jeemol George	1497219067	16272 Imperial Valley DR STE K, Houston, TX 77060 Limy Fernandus	1972005189	779 Normandy St STE 114, Houston, TX 77015-3441 Limy Fernandus	1972005189	16272 Imperial Valley DR STE K, Houston, TX 77060 Brittany Brown	1275163537	779 Normandy St STE 114, Houston, TX 77015-3441 Brittany Brown	1275163537	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeena Abraham	1467901587	779 Normandy St STE 114, Houston, TX 77015-3441 Jeena Abraham	1467901587	16272 Imperial Valley DR STE K, Houston, TX 77060 Mini Chennemkara	1841755956	779 Normandy St STE 114, Houston, TX 77015-3441 Mini Chennemkara	1841755956	16272 Imperial Valley DR STE K, Houston, TX 77060 Glory Abraham	1194206490	779 Normandy St STE 114, Houston, TX 77015-3441 Glory Abraham	1194206490	16272 Imperial Valley DR STE K, Houston, TX 77060   Kindly respond at your earliest convenience.   Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-05 11:23:43', '2022-01-05 11:23:43'),
(43077, 19067, 30718, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email received from: joann.alanis@careallies.com  Subject: Enrollment Query || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers & Groups || Cigna Healthspring ||   For Renaissance you are not contracted.', NULL, NULL, '2022-01-06 16:32:37', '2022-01-06 16:32:37'),
(43078, 20067, 30718, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: joann.alanis@careallies.com  Sub: Enrollment Query || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers & Groups || Cigna Healthspring ||  Good afternoon, Hope this email finds you well. Could you please tell me for the Renaissance contract what procedure will be followed?  Thanks and regards, Syed Ahad. ', NULL, NULL, '2022-01-14 14:07:17', '2022-01-14 14:07:17'),
(43079, 20067, 30718, NULL, '2022-01-21 00:00:00.000', 'Not Eligible', 'Email received from: joann.alanis@careallies.com  Sub: Enrollment Query || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers & Groups || Cigna Healthspring ||  Hello!  The Renaissance-Eastside Board reviewed your Letter of Interest form a few months ago.  A letter was sent indicating that they were unable to extend a contract.  compliance. Copyright (c) 2022 CareAllies', NULL, NULL, '2022-01-14 14:40:01', '2022-01-14 14:40:01'),
(43080, 1006, 30719, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:04:34', '2021-05-14 15:04:34');
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
(43081, 3040, 30719, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: providerservices@triwest.com  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Triwest ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Triwest 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  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, '2021-05-31 14:59:09', '2021-05-31 14:59:09'),
(43082, 3040, 30719, NULL, '2021-06-25 00:00:00.000', 'On Hold', 'Group ancillary contract is already in process. For more details please see group task. ', NULL, NULL, '2021-06-18 10:14:10', '2021-06-18 10:14:10'),
(43083, 3040, 30719, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: jmonson@triwest.com  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Triwest ||  Hello Jess,   Can you please check and advise if the below mentioned group is in-network with Triwest or not. If not so can you please generate a contract for the below mentioned group. For your reference I attached the W9.   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  If you need any additional information please let me know. Waiting for your response.  Thank you ', NULL, NULL, '2021-07-20 11:05:03', '2021-07-20 11:05:03'),
(43084, 3040, 30719, NULL, '2021-07-29 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, '2021-07-22 14:31:41', '2021-07-22 14:31:41'),
(43085, 1006, 30720, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:04:34', '2021-05-14 15:04:34'),
(43086, 3040, 30720, NULL, '2021-05-27 00:00:00.000', 'Not Eligible', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes ', NULL, NULL, '2021-05-20 16:33:08', '2021-05-20 16:33:08'),
(43087, 1006, 30732, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:04:35', '2021-05-14 15:04:35'),
(43088, 3040, 30732, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: providerservices@renaissancefamily.com  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Renaissance Physicians ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Renaissance Physicians 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  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, '2021-05-31 13:59:51', '2021-05-31 13:59:51'),
(43089, 3040, 30732, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: txgqproviderrelations@healthspring.com  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Renaissance Physicians ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Renaissance Physicians 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  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  Provider 16:   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, '2021-06-17 14:42:23', '2021-06-17 14:42:23'),
(43090, 3040, 30732, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: Chukwuma.Ezeokoli@careallies.com cc:	catherine.chang@careallies.com, shannon.luke@careallies.com,  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Renaissance Physicians ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Renaissance Physicians 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  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  Provider 16:   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, '2021-07-05 16:48:29', '2021-07-05 16:48:29'),
(43091, 3040, 30732, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: joann.alanis@careallies.com  Subject: Re: [External] Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Renaissance Physicians ||  Hello Alanis,   Hope you are doing well. Do you have any update regarding the enrollment for the below mentioned group and providers.   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  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  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-26 12:43:37', '2021-07-26 12:43:37'),
(43092, 11056, 30732, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email sent to :   joann.alanis@careallies.com   &   Chukwuma.Ezeokoli@careallies.com  Sub : Fwd: [External] Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Renaissance Physicians ||  Good evening!  Hope you are doing well. I want to inquire about the enrollment status of the below mentioned providers and practices. Please provide us with the latest updates soon.  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  Provider Details:  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  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you!  Have a great week ahead!', NULL, NULL, '2021-08-11 16:29:15', '2021-08-11 16:29:15'),
(43093, 3040, 30732, NULL, '2021-08-25 00:00:00.000', 'Not Eligible', 'Email rcvd from: JENNIFER.PEREZ@cigna.com  Subject: RE: [External] Re: Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring ||  08/03/2021 Normandy Urgent Care Center ATTN: Adil Abbas 779 Normandy Street, Suite 114 Houston, TX 77015 Dear Mr. Abbas, Thank you for your request to join the Renaissance Physician Organization/Eastside IPA, LLC. At the present time we do not have a network need in your particular specialty. As a result, we are not able to extend an invitation for participation at this time. We will however keep your request on file and reconsider in the event our network development needs change. If you have any questions, please feel free to call JoAnn Alanis at 832.553.3350. Sincerely, Julian Gonzalez, M.D. Chairman of The Board Eastside IPA, LLC', NULL, NULL, '2021-08-18 13:11:52', '2021-08-18 13:11:52'),
(43094, 1006, 30733, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:04:35', '2021-05-14 15:04:35'),
(43095, 3040, 30733, NULL, '2021-06-04 00:00:00.000', 'On Hold', 'Waiting for the enrollment in Molina healthcare.', NULL, NULL, '2021-05-28 14:28:36', '2021-05-28 14:28:36'),
(43096, 10057, 30733, NULL, '2022-01-04 00:00:00.000', 'Approved', 'Call Details: (855) 322-4080   Rep: Sharona  Reference # SF 5820908  Effective Date: 07/15/2020', NULL, NULL, '2021-12-28 17:56:08', '2021-12-28 17:56:08'),
(43097, 1006, 30734, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:04:35', '2021-05-14 15:04:35'),
(43098, 1019, 30734, NULL, '2021-06-15 00:00:00.000', 'Initiated', 'Sent the following email to colbee.snyder@primehealthservices.com SUB: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||   Greetings, Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Prime Health 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  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, '2021-05-31 14:52:54', '2021-05-31 14:52:54'),
(43099, 3040, 30734, NULL, '2021-06-25 00:00:00.000', 'In Process', 'Email rcvd from:  colbee.snyder@primehealthservices.com  Subject: RE: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||  Thank you for your email. As of February 1st, 2020 I have been moved to a position outside of the credentialing department and will no longer be your point of contact. I have copied our general credentialing email.  Going forward, please forward all new providers adds and demographic changes to credentialing@primehealthservices.com and copy updates@primehealthservices.com.  Thank you!  Colbee Snyder Patient Advocacy Specialist', NULL, NULL, '2021-06-18 13:20:54', '2021-06-18 13:20:54'),
(43100, 3040, 30734, NULL, '2021-06-25 00:00:00.000', 'In Process', 'Email sent to: credentialing@primehealthservices.com  Subject: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Prime Health 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  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  Provider 16:   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, '2021-06-18 13:24:47', '2021-06-18 13:24:47'),
(43101, 3040, 30734, NULL, '2021-07-14 00:00:00.000', 'In Process', 'Email sent to: credentialing@primehealthservices.com, updates@primehealthservices.com,  Subject: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||  Hello,   Has there been any update?  Thank you  ', NULL, NULL, '2021-07-07 16:52:17', '2021-07-07 16:52:17'),
(43102, 3040, 30734, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: credentialing@primehealthservices.com  Subject: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||  Hello,   Hope you are doing well. I was trying to reach out to know the enrollment status for the below mentioned group and providers in Prime Health 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  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  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks', NULL, NULL, '2021-07-22 11:56:14', '2021-07-22 11:56:14'),
(43103, 11056, 30734, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email received from : credentialing@primehealthservices.com  Sub : Fwd: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||  Good Morning,  Please see below for the credentialing status for each provider.  The dates given are for credentialing purposes only and not the effective date.  Thank you for including the Updates Department in your email.  They will assist you with the effective dates.  There are two providers (highlighted) that need to be credentialed.  Please email a current CAQH Credentialing application or State Credentialing application for these providers.  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  - In the process of being credentialed.  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061 - Needs to be credentialed.     Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 - In the process of being credentialed.   Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 - Last credentialed - 6-23-2020 - Not the effective date - For credentialing purposes only.   Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 - In the process of being credentialed.  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956 - In the process of being credentialed.   Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490 - In the process of being credentialed.   Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 - In the process of being credentialed.   Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 - Last credentialed - 7-15-2020 - Not the effective date - For credentialing purposes only.  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 - In the process of being credentialed.   Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 - In the process of being credentialed.   Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238 - In the process of being credentialed.   Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 - In the process of being credentialed.   Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616 - In the process of being credentialed.  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149 - In the process of being credentialed.  Provider 16:  Provider Name: Joseph, Molly Provider NPI# 1396380077 - In the process of being credentialed.  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493 - Needs to be Credentialed.', NULL, NULL, '2021-08-12 10:16:36', '2021-08-12 10:16:36'),
(43104, 3040, 30734, NULL, '2021-09-21 00:00:00.000', 'In Process', 'Email sent to: megan.wherry@primehealthservices.com  Subject: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Prime Health ||  Hello Megan,   Hope you are doing well. Can you please send the roster because I am trying to find out the providers on the Prime Health Services directory and it\'s not showing up.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-09-14 17:07:44', '2021-09-14 17:07:44'),
(43105, 12062, 30734, NULL, '2021-09-24 00:00:00.000', 'In Process', 'Email sent to:megan.wherry@primehealthservices.com; colbee.snyder@primehealthservices.com; credentialing@primehealthservices.com; nucc@claimsmedinc.com; ivuc@claimsmedinc.com; Credentialing - Claims Med credentialing@claimsmedinc.com  Hi Wherry,  Hope you are doing well !   May I have any updated status for the enrollment application of below providers under the Prime Health Services Network?  I would be glad to have your response as soon as possible. The practice\'s and provider\'s details are as follows;   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   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   Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077   Thanking You in advance.', NULL, NULL, '2021-09-17 12:26:58', '2021-09-17 12:26:58'),
(43106, 10057, 30734, NULL, '2021-11-04 00:00:00.000', 'In Process', 'Email Sent To : credentialing@primehealthservices.com, updates@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Good Afternoon,  Hope this email finds you well. I\'m writing this email to check the updated status for the mentioned request. Please get back to me as soon as you get a chance.  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-28 15:23:39', '2021-10-28 15:23:39'),
(43107, 10057, 30734, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : credentialing@primehealthservices.com>, updates@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Good Morning,  Hope this email finds you in good health. Can I get the latest update on all the below mentioned groups and providers enrollment status?  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Please respond back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-22 10:43:23', '2021-11-22 10:43:23'),
(43108, 10057, 30734, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email Sent To : credentialing@primehealthservices.com, updates@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Hello,  Can I get the latest updates on the below mentioned providers enrollment request under the TIN?  Please get back to me ASAP!  Thanks & Regards,', NULL, NULL, '2021-12-14 13:18:22', '2021-12-14 13:18:22'),
(43109, 10057, 30734, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Received From : credentialing@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Please see attached Credentialing Status Roster.  The dates given are for Credentialing purposes only and not the effective date.  Thank you for including the Updates Department in your email.  They will respond regarding the effective dates.  Thank you, Nancy', NULL, NULL, '2021-12-15 10:51:42', '2021-12-15 10:51:42'),
(43110, 10057, 30734, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : credentialing@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Hello Nancy,  Thank you for your prompt response. I really appreciate your support. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-22 12:08:47', '2021-12-22 12:08:47'),
(43111, 10057, 30734, NULL, '2022-01-05 00:00:00.000', 'Approved', 'Email Received From : updates@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Hello, all of these providers are in our system with both locations added, thanks!  Alyssa DeNure Data Integrity Associate', NULL, NULL, '2021-12-29 14:12:20', '2021-12-29 14:12:20'),
(43112, 1006, 30735, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:04:35', '2021-05-14 15:04:35'),
(43113, 3040, 30735, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Subject: Need to Enroll|| Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || CHRISTUS HEALTH PLAN||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Christus Health Plan for our group under the below locations. We have 02 different locations under the same tax ID.     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  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, '2021-05-25 12:39:35', '2021-05-25 12:39:35'),
(43114, 3040, 30735, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Email sent to: CHP.networkdevelopment@christushealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Christus Health Plan ||  Greetings,   Hope you are doing well. Please find the attached Prospective Provider Form along with the Letter of Intent for below mentioned providers to enroll in Christus Health Plan in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Primary 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 Secondary Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  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, '2021-06-11 14:48:00', '2021-06-11 14:48:00'),
(43115, 11056, 30735, NULL, '2021-07-06 00:00:00.000', 'In Process', 'Email sent to : CHP.networkdevelopment@christushealth.org  Sub : Enroll Request Group & Providers || Normandy Urgent Care Center || Christus Health Plan ||  Greetings,  Hope you are doing well. I want to know enrollment status of the following groups and providers. Respond this as soon as possible.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Primary 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 Secondary Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Providers: 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 good day!', NULL, NULL, '2021-06-29 12:52:48', '2021-06-29 12:52:48'),
(43116, 3040, 30735, NULL, '2021-07-26 00:00:00.000', 'On Hold', 'Ancillary contract request sent for the group. Please see group task. ', NULL, NULL, '2021-07-19 09:23:44', '2021-07-19 09:23:44'),
(43117, 3040, 30735, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email sent to: hunter.barrett@christushealth.org  Subject: Re: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Hello Hunter,   Hope you are doing well. Please find attached Ancillary service agreement along with the Facility Ancillary application for our group to participate in Christus Health Plan 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 let me know. Waiting for your response.    Thanks ', NULL, NULL, '2021-07-28 11:39:18', '2021-07-28 11:39:18'),
(43118, 11056, 30735, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email sent to : Hunter Barrett   hunter.barrett@christushealth.org, CHP.networkdevelopment@christushealth.org  Sub  : ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Good evening!  Hope all is well. I just want to inquire about the enrollment status of the following groups for the ancillary contract. Please provide us with the latest updates soon.  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 feel free to reach out to me. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-08-11 17:07:53', '2021-08-11 17:07:53'),
(43119, 3040, 30735, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email rcvd from: hunter.barrett@christushealth.org  Subject: RE: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Contract was sent to credentialing about 3 weeks ago to process. Will take about 6 months to fully process and receive effective date.  Thanks,  Hunter Barrett Network Contracting CHRISTUS Health Plan CHRISTUS Health 919 Hidden Ridge | Irving, Texas 75038 (o) 469.282.3113', NULL, NULL, '2021-08-17 15:02:52', '2021-08-17 15:02:52'),
(43120, 3040, 30735, NULL, '2021-09-21 00:00:00.000', 'In Process', 'Email sent to: hunter.barrett@christushealth.org  Subject: Re: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Good evening!  Hope all is well. This is a follow up email to inquire about the enrollment status of the following groups for the ancillary contract.   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 feel free to reach out to me. Waiting for your response.  Thanks', NULL, NULL, '2021-09-14 16:14:49', '2021-09-14 16:14:49'),
(43121, 12062, 30735, NULL, '2021-09-29 00:00:00.000', 'In Process', ' Received below email under the group ancillary contract request; From :hunter.barrett@christushealth.org Subject :RE: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN Please reach out to our credentialing team in about 4 months for an update. You can reach out directly to them for updates on all of the contracts you are inquiring about. They are running around 6 months to process them so please give them adequate time to reach your file. Most of the contracts were sent to them around 1-2 months ago CHRISTUS.HP.Credentialing CHRISTUS.HP.Credentialing@christushealth.org  Thanks,   Hunter Barrett Network Contracting CHRISTUS Health Plan CHRISTUS Health 919 Hidden Ridge | Irving, Texas 75038 (o) 469.282.3113 www.christushealth.org  ', NULL, NULL, '2021-09-22 13:10:40', '2021-09-22 13:10:40'),
(43122, 10057, 30735, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Good Evening,  Hope you are doing well. I want to know the enrollment status of the following groups and providers. Please get back to me as soon as you get the time.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Jose, Julie	1447883061 George, Jeemol	1497219067 Brown, Brittany	1275163537 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Thomas, Cini	1134777238 Joseph, Vibitha	1952931560 Stephen, Ani	1588959118 Piccione JR, James M	1356321509 Chennemkara, Mini Philip	1841755956 Abraham, Glory	1194206490 Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-10-18 16:38:54', '2021-10-18 16:38:54'),
(43123, 10057, 30735, NULL, '2021-12-02 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : Need Credentialing Update - URGENT  Good Afternoon,  Hope you are doing well. Can I have the latest update on the below mentioned request. Also welcome letters?  Looking forward to your kind response. Have a great day!   Thanks & Regards,', NULL, NULL, '2021-11-18 13:52:15', '2021-11-18 13:52:15'),
(43124, 10057, 30735, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email Received From : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Good Morning  Normandy Urgent Care Center  - has been processed effective contract date 01/01/2022  Longpoint Medical Center – facility has been processed effective contract date 01/01/2022  Imperial Valley - facility has been processed effective contract date 01/01/2022  Credentialing Verification Unit CHRISTUS Health Plan - US Family Health Plan 919 Hidden Ridge Irving, TX 75038 Phone: (469)-282-0368 Fax: 210-766-8857', NULL, NULL, '2021-12-14 09:53:19', '2021-12-14 09:53:19'),
(43125, 10057, 30735, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Thank you for the update. Could you please provide us with the facility agreement or contract along with the update for the providers credentialing status as well.  Your earliest response would be greatly appreciated.  Regards, Steve Albert', NULL, NULL, '2021-12-20 13:42:53', '2021-12-20 13:42:53'),
(43126, 10057, 30735, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Greetings!  Hope you are doing great. I\'m writing this email to get the update on my below request. Please get back to me as soon as possible!  Regards,', NULL, NULL, '2021-12-28 11:57:56', '2021-12-28 11:57:56');
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
(43127, 19067, 30735, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: CHRISTUS.HP.Credentialing@christushealth.org, hunter.barrett@christushealth.org, CHP.networkdevelopment@christushealth.org  Subject: Enrollment Query || NUCC & IVUC || Providers & Group || Christus Health Plan ||   Hello!  You are having a productive day.  I would like to know the enrollment status of the following Providers and Group with Christus Health Plan.   Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Jeny John	1073019493	779 Normandy St STE 114, Houston, TX 77015-3441 Jeny John	1073019493	16272 Imperial Valley DR STE K, Houston, TX 77060 Molly Joseph	1396380077	779 Normandy St STE 114, Houston, TX 77015-3441 Molly Joseph	1396380077	16272 Imperial Valley DR STE K, Houston, TX 77060 Cini Thomas	1134777238	779 Normandy St STE 114, Houston, TX 77015-3441 Cini Thomas	1134777238	16272 Imperial Valley DR STE K, Houston, TX 77060 Ani Stephen	1588959118	779 Normandy St STE 114, Houston, TX 77015-3441 Ani Stephen	1588959118	16272 Imperial Valley DR STE K, Houston, TX 77060 Abdur Rauf	1497726202	779 Normandy St STE 114, Houston, TX 77015-3441 Abdur Rauf	1497726202	16272 Imperial Valley DR STE K, Houston, TX 77060 James Piccione JR	1356321509	779 Normandy St STE 114, Houston, TX 77015-3441 James Piccione JR	1356321509	16272 Imperial Valley DR STE K, Houston, TX 77060 Sigi Paul	1033623616	779 Normandy St STE 114, Houston, TX 77015-3441 Sigi Paul	1033623616	16272 Imperial Valley DR STE K, Houston, TX 77060 Odette Kourouma	1134525868	779 Normandy St STE 114, Houston, TX 77015-3441 Odette Kourouma	1134525868	16272 Imperial Valley DR STE K, Houston, TX 77060 Vibitha Joseph	1952931560	779 Normandy St STE 114, Houston, TX 77015-3441 Vibitha Joseph	1952931560	16272 Imperial Valley DR STE K, Houston, TX 77060 Julie Jose	1447883061	779 Normandy St STE 114, Houston, TX 77015-3441 Julie Jose	1447883061	16272 Imperial Valley DR STE K, Houston, TX 77060 Jaya Jacob	1194336149	779 Normandy St STE 114, Houston, TX 77015-3441 Jaya Jacob	1194336149	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeemol George	1497219067	779 Normandy St STE 114, Houston, TX 77015-3441 Jeemol George	1497219067	16272 Imperial Valley DR STE K, Houston, TX 77060 Limy Fernandus	1972005189	779 Normandy St STE 114, Houston, TX 77015-3441 Limy Fernandus	1972005189	16272 Imperial Valley DR STE K, Houston, TX 77060 Brittany Brown	1275163537	779 Normandy St STE 114, Houston, TX 77015-3441 Brittany Brown	1275163537	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeena Abraham	1467901587	779 Normandy St STE 114, Houston, TX 77015-3441 Jeena Abraham	1467901587	16272 Imperial Valley DR STE K, Houston, TX 77060 Mini Chennemkara	1841755956	779 Normandy St STE 114, Houston, TX 77015-3441 Mini Chennemkara	1841755956	16272 Imperial Valley DR STE K, Houston, TX 77060 Glory Abraham	1194206490	779 Normandy St STE 114, Houston, TX 77015-3441 Glory Abraham	1194206490	16272 Imperial Valley DR STE K, Houston, TX 77060  Eagerly waiting for your response.   Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 17:25:10', '2022-01-04 17:25:10'),
(43128, 19067, 30735, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email received from: Sonia.Gonzales@christushealth.org  Subject: Enrollment Query || NUCC & IVUC || Providers & Group || Christus Health Plan ||     Good Morning All,     Thank you for the request below, I do show contract for USFHP was signed and executed.   Information was sent over to get configuration of contract rates entered.       Once we have this process is completed we can have this sent to Credentialing to get group loaded with effective date.  When I get further updates will pass along!     Please remove Hunter Barrette from communications, unfortunately he is no longer with us, I am covering in the interim.       Thanks and appreciate your patience,     Respectfully,     Sonia D. Gonzales  CHRISTUS Health Plan – Physician Relations Consultant II/ Contracting  505-569-4856  sonia.gonzales@christushealth.org', NULL, NULL, '2022-01-05 11:33:48', '2022-01-05 11:33:48'),
(43129, 20067, 30735, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: Sonia.Gonzales@christushealth.org  Sub: Re: Enrollment Query || NUCC & IVUC || Providers & Group || Christus Health Plan ||  Good Afternoon, Hope this email finds you in good health. Any update on the previous request?  Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-14 13:27:32', '2022-01-14 13:27:32'),
(43130, 20067, 30735, NULL, '2022-01-28 00:00:00.000', 'In Process', 'Email sent to: Sonia.Gonzales@christushealth.org  Sub: Re: Enrollment Query || NUCC & IVUC || Providers & Group || Christus Health Plan ||  Good afternoon! Hope you are doing well. I haven\'t heard from your side, Kindly respond to the previous mail. If the process is complete, kindly send me the contract letter along with the effective date.  Thanks and Regards, Syed Ahad  ', NULL, NULL, '2022-01-21 16:46:23', '2022-01-21 16:46:23'),
(43131, 20067, 30735, NULL, '2022-02-01 00:00:00.000', 'Approved', 'Received the Ancillary contract from Christus Health Plan  Effective Date: 01/01/2022 Expiration Date: 12/31/9999', NULL, NULL, '2022-01-25 17:22:37', '2022-01-25 17:22:37'),
(43132, 1006, 30736, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:04:35', '2021-05-14 15:04:35'),
(43133, 1006, 30736, NULL, '2021-05-26 00:00:00.000', 'Approved', 'The provider is enrolled with UHC, approval confirmation and location confirmation are attached for reference. ', NULL, NULL, '2021-05-19 11:20:39', '2021-05-19 11:20:39'),
(43134, 1006, 30737, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:04:35', '2021-05-14 15:04:35'),
(43135, 3040, 30737, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: info@usamco.com  Subject: Copy of Executed Contract || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || MCO ||  Greetings,   Hope you are doing well. Can you please send me the copy of the executed contract for our group Normandy Urgent Care Center 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  Thank you ', NULL, NULL, '2021-05-28 12:24:37', '2021-05-28 12:24:37'),
(43136, 11056, 30737, NULL, '2021-06-23 00:00:00.000', 'Approved', '	 Group has an ancillary contract. No need to add individual providers. Please see group task.', NULL, NULL, '2021-06-16 12:25:12', '2021-06-16 12:25:12'),
(43137, 1006, 30738, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:04:35', '2021-05-14 15:04:35'),
(43138, 3040, 30738, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: providerservices@memorialhermann.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Memorial Hermann ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Memorial Hermann 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  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, '2021-05-28 13:25:32', '2021-05-28 13:25:32'),
(43139, 3040, 30738, NULL, '2021-06-23 00:00:00.000', 'On Hold', 'Group ancillary contract request sent to Memorial Hermann. For more details please see group task.  ', NULL, NULL, '2021-06-16 16:39:41', '2021-06-16 16:39:41'),
(43140, 3040, 30738, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: enterprise.credentialing@memorialhermann.org  Subject: Re: [EXTERNAL] Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Memorial Hermann ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Memorial Hermann 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  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-20 10:52:11', '2021-07-20 10:52:11'),
(43141, 11056, 30738, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Email sent to : ProviderServices@memorialhermann.org  &  MHHPContracting@memorialhermann.org  Sub : Fwd: [EXTERNAL] Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Memorial Hermann ||  Good morning!  Hope you are doing well. I want to know the enrollment status of the below mentioned group under the below locations for Ancillary contract in Memorial Hermann.  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  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 day! ', NULL, NULL, '2021-08-12 15:35:09', '2021-08-12 15:35:09'),
(43142, 3040, 30738, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Group has an ancillary contract no need to add individual providers. Please see group task for more details. ', NULL, NULL, '2021-08-27 10:00:27', '2021-08-27 10:00:27'),
(43143, 1006, 30739, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:04:35', '2021-05-14 15:04:35'),
(43144, 3040, 30739, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Tricare ||  Hello Katherine,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Tricare 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  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-02 16:09:36', '2021-06-02 16:09:36'),
(43145, 3040, 30739, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Tricare 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  Provider 16:   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, '2021-06-22 09:41:20', '2021-06-22 09:41:20'),
(43146, 3040, 30739, NULL, '2021-07-16 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Additional Location || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Greetings,   Hope you are doing well. I wanted to add the location under the below mentioned providers in Tricare in our group under the below mentioned 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: Jose, Julie Provider NPI# 1447883061 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 2:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 3:   Provider Name: Rauf, Abdur  Provider NPI# 1497726202 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 4:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 5:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238 Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226   Provider 7:   Provider Name: Abraham, Jeena  Provider NPI# 1467901587 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-07-09 14:33:08', '2021-07-09 14:33:08'),
(43147, 11056, 30739, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email received from :    ywyatt@humana.com  Sub : Fwd: Additional Location || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Good Morning Adil,     To add a provider to a network location you need to complete the attached spreadsheet and email it to the HGB Roster team to process.     Send the completed spreadsheet to the following email address     HGBProviderRosters@Humana.com              Thanks,  Yvonne', NULL, NULL, '2021-08-11 11:28:06', '2021-08-11 11:28:06'),
(43148, 3040, 30739, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to: HGBProviderRosters@humana.com, ywyatt@humana.com  Subject: Re: Additional Location || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Received Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in an additional location in Tricare in our group under the below highlighted locations. We already submitted the roster for an additional location on 07/19/2021.   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: Jose, Julie  Provider NPI# 1447883061  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 2:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 3:    Provider Name: Rauf, Abdur   Provider NPI# 1497726202  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 4:    Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 5:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 6:    Provider Name: Thomas, Cini   Provider NPI# 1134777238  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226   Provider 7:    Provider Name: Abraham, Jeena   Provider NPI# 1467901587  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you!! ', NULL, NULL, '2021-08-18 16:51:54', '2021-08-18 16:51:54'),
(43149, 3040, 30739, NULL, '2021-09-08 00:00:00.000', 'Approved', 'Email rcvd from: ywyatt@humana.com  Subject: RE: Additional Location || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Good Afternoon Adil,  We show the following.  This information is available on the Providers Portal or directory Highlighted is the link to check status. I have attached a copy of the spreadsheet of the Providers we show affiliated to these groups under this tax id.   https://infocenter.humana-military.com/provider/service/Account/Login  HumanaMilitary - Find care (goperspecta.com)  Provider 1:   Provider Name: Jose, Julie- Show has been added Provider NPI# 1447883061 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 2:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 – Show added Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226- Show not added yet  Provider 3:  Show Added Provider Name: Rauf, Abdur  Provider NPI# 1497726202 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 4:  Show added to both locations Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 5:  - Show added Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 6:   Provider Name: Thomas, Cini – show added to all three locations Provider NPI# 1134777238 Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 7:  - Show added. Provider Name: Abraham, Jeena  Provider NPI# 1467901587 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Thanks, Yvonne W. Wyatt, Humana Military TRICARE Community Liaison II Houston/Galveston 502-318-5409 Telephone 502-322-8018 Fax ywyatt@humana.com', NULL, NULL, '2021-09-01 13:08:08', '2021-09-01 13:08:08'),
(43150, 1006, 30740, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:04:35', '2021-05-14 15:04:35'),
(43151, 1006, 30740, NULL, '2021-05-28 00:00:00.000', 'Initiated', 'Submitted group enrollment request via Wellcare\'s online form, attached for reference in group task. ', NULL, NULL, '2021-05-20 21:01:31', '2021-05-20 21:01:31'),
(43152, 3040, 30740, NULL, '2021-06-16 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more details please see group task.', NULL, NULL, '2021-06-09 10:48:54', '2021-06-09 10:48:54'),
(43153, 3040, 30740, NULL, '2021-07-27 00:00:00.000', 'In Process', 'I spoke with Harvey D Wellcare representative and he advised me that processing time will take 60 business days. After reviewing the application the provider rep will contact you.   Ref: 544023676', NULL, NULL, '2021-07-20 10:36:07', '2021-07-20 10:36:07'),
(43154, 11056, 30740, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good afternoon!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Wellcare 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    Provider 16:    Provider Name: Joseph, Molly Provider NPI# 1396380077    Provider 17:    Provider Name: John, Jeny Provider NPI# 1073019493    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, '2021-08-11 13:58:59', '2021-08-11 13:58:59'),
(43155, 3040, 30740, NULL, '2021-09-14 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject: Re: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Greetings,    Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Wellcare 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  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 2:    Provider Name: Jose, Julie  Provider NPI# 1447883061  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 3:    Provider Name: Stephen, Ani (All three locations)  Provider NPI# 1588959118     Provider 4:    Provider Name: Piccione JR, James M (All three locations)  Provider NPI# 1356321509     Provider 5:    Provider Name: Brown, Brittany  Provider NPI# 1275163537  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 6:    Provider Name: Chennemkara, Mini Philip (All three locations)  Provider NPI# 1841755956     Provider 7:    Provider Name: Abraham, Glory  Provider NPI# 1194206490  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 8:    Provider Name: Fernandus, Limy (All three locations)  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider NPI# 1497726202  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 11:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 12:    Provider Name: Thomas, Cini (All three locations)  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider NPI# 1467901587  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 14:    Provider Name: PAUL, SIGI (All three locations)  Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya (All three locations)  Provider NPI# 1194336149    Provider 16:    Provider Name: Joseph, Molly  (All three locations) Provider NPI# 1396380077    Provider 17:    Provider Name: John, Jeny  (All three locations) Provider NPI# 1073019493    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!', NULL, NULL, '2021-09-07 16:28:03', '2021-09-07 16:28:03'),
(43156, 10057, 30740, NULL, '2021-10-26 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good Afternoon,  Hope this email finds you well. I want to follow-up for the mentioned providers and locations credentialing status?  Please get back to me as soon as you get a chance. Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-19 11:51:49', '2021-10-19 11:51:49'),
(43157, 10057, 30740, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : prospectiveprovidertx@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good Morning,  Can you please send us the copy of their Welcome Letters/ Contracts to us at your earliest convenience.  Regards, Alex Garrett', NULL, NULL, '2021-11-22 14:13:37', '2021-11-22 14:13:37'),
(43158, 10057, 30740, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good Afternoon,  Hope this email finds you well. I\'m writing this email to check the latest update on the below mentioned request?  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-02 15:10:34', '2021-12-02 15:10:34'),
(43159, 10057, 30740, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Hello,  This inbox is for contract change request only. If you need account specific information, please contact your Provider Relations Account Manager.   Sincerely,  Network Management– Texas', NULL, NULL, '2021-12-09 13:19:52', '2021-12-09 13:19:52'),
(43160, 10057, 30740, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com AM.Houston@superiorhealthplan.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Thank you for reaching out. Could you please provide me with the actual email address along with the contact number of our AM?  So I can directly reach out to them. I truly appreciate your support. Have a great day!  Regards,', NULL, NULL, '2021-12-17 14:09:58', '2021-12-17 14:09:58'),
(43161, 10057, 30740, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email Received From : AM.Houston@superiorhealthplan.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Please send email for WellCare status update to SM_TXNetDevProviderLoad@wellcare.com.  Sincerely,  Barbara McDonald', NULL, NULL, '2021-12-23 11:20:50', '2021-12-23 11:20:50'),
(43162, 10057, 30740, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Sent To : sm_txnetdevproviderload@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Greetings!  Hope this email finds you well. I\'m writing this email to get the enrollment status on the below mentioned group and providers under TIN\'s with wellcare.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  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  Limy  Fernandus 1972005189 Sigi Paul	1033623616 Jaya  Jacob	1194336149 Jeena  Abraham	1467901587 Cini  Thomas	1134777238 Odette Tiranke  Kourouma	1134525868 Abdur  Rauf	1497726202 Molly  Joseph	1396380077 Jeny John	1073019493 Ani Stephen	1588959118 Brittany Brown	1275163537 Vibitha Joseph	1952931560 Jeemol George	1497219067 Julie Jose	1447883061 Glory Abraham 1194206490 Mini Philip Chennemkara 1841755956 James Piccione JR	1356321509  Once you get a chance please get back to me. Have a great weekend ahead!  Regards,', NULL, NULL, '2021-12-30 13:53:12', '2021-12-30 13:53:12'),
(43163, 20067, 30740, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email sent to: ashley.stevens@wellcare.com, SM_TXNetDevProviderLoad@wellcare.com  Subject: Re: ENROLLMENT STATUS QUERRY - NUCC - IVUC - Wellcare   Hello,  Hope you are doing great. I would like to know the enrollment status of the below-mentioned providers under these locations, and if any of the provider is enrolled kindly send me the welcome letter.  Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston, TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Glory Abraham	1194206490 Jeena Abraham	1467901587 Brittany Brown	1275163537 Mini Chennemkara	1841755956 Limy Fernandus	1972005189 Jeemol George	1497219067 Jaya Jacob	1194336149 Jeny John	1073019493 Julie Jose	1447883061 Molly Joseph	1396380077 Vibitha Joseph	1952931560 Odette Kourouma	1134525868 SIGI PAUL	1033623616 James Piccione JR	1356321509 Abdur Rauf	1497726202 Ani Stephen	1588959118 Cini Thomas	1134777238  Thanks and Regards, Syed Ahad. ', NULL, NULL, '2022-01-06 12:30:24', '2022-01-06 12:30:24'),
(43164, 20067, 30740, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: ashley.stevens@wellcare.com, SM_TXNetDevProviderLoad@wellcare.com  Sub: Re: ENROLLMENT STATUS QUERRY - NUCC - IVUC - Wellcare  Good afternoon!  Hope you are doing well. Any update on the previous request? Your Early response will be highly appreciated  Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-14 16:38:20', '2022-01-14 16:38:20'),
(43165, 20067, 30740, NULL, '2022-01-27 00:00:00.000', 'Approved', 'Received the following email from: ashley.stevens@wellcare.com  Sub: Re: ENROLLMENT STATUS QUERRY - NUCC - IVUC - Wellcare  Please see welcome letter attached for roster of par providers.  Effective Date: 08/25/2021 Attached is the group roster and welcome letter for the provider', NULL, NULL, '2022-01-20 17:27:31', '2022-01-20 17:27:31'),
(43166, 1006, 30741, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:04:36', '2021-05-14 15:04:36'),
(43167, 3040, 30741, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Sent the following initiation request to trpndataentry@trpnppo.com & providerrelations@trpnppo.com:  Sub: Provider Enrollment Request - NUCC- TRPN  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Multiplan for our group under the below locations. Can you please send the roster.   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  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, '2021-05-28 17:02:19', '2021-05-28 17:02:19'),
(43168, 11056, 30741, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Good Evening!  Hope you are doing well. Please find the attached Provider update form to enroll the below mentioned group and providers in TRPN for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice NPI: 1407171077 Practice TIN: 27-0796429 Primary Address: 779 Normandy St Ste 114 Houston, TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice NPI: 1407171077 Practice TIN: 27-0796429P Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Provider Names enlisted below:-  Provider 1: Provider Name: Joseph, Molly Provider NPI : 1396380077  Provider 2: Provider Name:  Jacob, Jaya Provider NPI : 1194336149   Provider 3: Provider Name:  PAUL, SIGI Provider NPI : 1033623616  Provider 4:  Provider Name: Chennemkara, Mini Provider NPI : 1841755956     Provider 5:   Provider Name:  Abraham, Jeena Provider NPI :  1467901587    Provider 6:   Provider Name:  Kourouma , Odette Provider NPI :  1134525868  Provider 7:   Provider Name:  Piccione JR, James Provider NPI :  1356321509    Provider 8: Provider Name:  Abraham, Glory Provider NPI :  1194206490   Provider 9:   Provider Name:  Fernandus, Limy Provider NPI :  1972005189  Provider 10: Provider Name:  Thomas, Cini Provider NPI :  1134777238  Provider 11:   Provider Name:  Stephen, Ani Provider NPI :  1588959118   Provider 12:   Provider Name:  George, Jeemol Provider NPI :  1497219067    Provider 13:   Provider Name:  Jose, Julie Provider NPI :  1447883061    Provider 14:   Provider Name:  Brown, Brittany Provider NPI :   1275163537  Provider 15:   Provider Name:  Joseph, Vibitha Provider NPI :   1952931560    Provider 16:  Provider Name:  Abdur Rauf Provider NPI :  1497726202    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-16 17:11:05', '2021-06-16 17:11:05'),
(43169, 3040, 30741, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: trpndataentry@trpnppo.com, mflores@trpnppo.com, ccampos@trpnppo.com  Subject: Re: Provider Update Information Form- TRPN  Hello Max and Carlos,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in TRPN for our group under the below mentioned locations. We already sent the provider update form at trpndataentry@trpnppo.com.   Practice Details: Practice Name: Normandy Urgent Care Center Practice NPI: 1407171077 Practice TIN: 27-0796429 Primary Address: 779 Normandy St Ste 114 Houston, TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice NPI: 1407171077 Practice TIN: 27-0796429  Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Provider Names enlisted below:- Provider 1: Provider Name: Joseph, Molly Provider NPI : 1396380077  Provider 2: Provider Name:  Jacob, Jaya Provider NPI : 1194336149   Provider 3: Provider Name:  PAUL, SIGI Provider NPI : 1033623616  Provider 4:  Provider Name: Chennemkara, Mini Provider NPI : 1841755956     Provider 5:   Provider Name:  Abraham, Jeena Provider NPI :  1467901587    Provider 6:   Provider Name:  Kourouma , Odette Provider NPI :  1134525868  Provider 7:   Provider Name:  Piccione JR, James Provider NPI :  1356321509    Provider 8: Provider Name:  Abraham, Glory Provider NPI :  1194206490   Provider 9:   Provider Name:  Fernandus, Limy Provider NPI :  1972005189  Provider 10: Provider Name:  Thomas, Cini Provider NPI :  1134777238  Provider 11:   Provider Name:  Stephen, Ani Provider NPI :  1588959118  Provider 12:   Provider Name:  George, Jeemol Provider NPI :  1497219067   Provider 13:   Provider Name:  Jose, Julie Provider NPI :  1447883061    Provider 14:   Provider Name:  Brown, Brittany Provider NPI :   1275163537  Provider 15:   Provider Name:  Joseph, Vibitha Provider NPI :   1952931560    Provider 16:  Provider Name:  Abdur Rauf Provider NPI : 1497726202    Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-05 15:25:39', '2021-07-05 15:25:39'),
(43170, 3040, 30741, NULL, '2021-07-27 00:00:00.000', 'Approved', 'Email rcvd from: ccampos@trpnppo.com  Subject: Provider Update Information Form- TRPN Hi,  Provider Molly Joseph is Active, effective date 01/01/2021,  Provider Jacob Jaya is Active, effective date 01/01/2021,  Provider Sigi Paul is Active, effective date 01/01/2021,  Provider Mini Chennemkara is Active, effective date 01/01/2021,  Provider Jeena Abraham is Active, effective date 03/01/2016,  Provider Odette Kourouma is Active, effective date 01/01/2021,  Provider James Piccione is Active, effective date 01/01/2021,  Provider Glory Abraham is Active, effective date 05/29/2019,  Provider Limy Fernandus is Active, effective date 01/01/2021,  Provider Cini Thomas is Active, effective date 10/01/2019,  Provider Ani Stephen is Active, effective date 01/01/2021,  Provider Jeemol George is Active, effective date 06/09/2020,  Provider Julie Jose is Active, effective date 06/09/2020,  Provider Brittany Brown is Active, effective date 01/01/2021,  Provider Vibitha Joseph is Active, effective date 01/01/2021,  Provider Abdur Rauf is Active, effective date 01/01/2021,  Carlos Campos  Data Entry Department Supervisor Three Rivers Provider Network 6970 O’Bannon Drive Las Vegas, NV 89117 P: 619.869.8940 F: 619.271.2563 ccampos@trpnppo.com trpndataentry@trpnppo.com', NULL, NULL, '2021-07-20 08:32:37', '2021-07-20 08:32:37'),
(43171, 1006, 30742, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:04:36', '2021-05-14 15:04:36'),
(43172, 1006, 30742, NULL, '2021-06-07 00:00:00.000', 'Initiated', 'Sent following initiation request @ CSHNproviderrelations@christushealth.org:  Sub: Enrollment Request - NUCC, IVUC - Christus Spohn  \"Hello,  We wish to enroll the following providers under the mentioned group, please let me know what is required to get the enrollment process started. the details are as follows: Group Name: Normandy Urgent Care Center NPI# 1407171077 TIN# 27-0796429  Primary Address: 779 Normandy St Ste 114, Houston, TX 77015-3441 Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  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  Please get back to me as soon as you\'re able to.   Thank you. \"', NULL, NULL, '2021-05-31 16:21:06', '2021-05-31 16:21:06'),
(43173, 3040, 30742, NULL, '2021-06-25 00:00:00.000', 'In Process', 'I called the 800-419-3461 and left the VM. Because I didn\'t getting any reply from the insurance.  ', NULL, NULL, '2021-06-18 11:50:21', '2021-06-18 11:50:21'),
(43174, 3040, 30742, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Christus Spohn ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Christus Spohn for our group under the below locations. We have 02 different locations under the same tax ID.     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  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  Provider 16:   Provider Name: John, Jeny Provider NPI# 1073019493  Provider 17:   Provider Name: Joseph, Molly Provider NPI# 1073019493  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-06 14:45:22', '2021-07-06 14:45:22');
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
(43175, 3040, 30742, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Email sent to: vicki.guerra@christushealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Christus Spohn ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Christus Spohn for our group under the below locations. We have 02 different locations under the same tax ID.     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  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  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you\'re able to.  Thank you   ', NULL, NULL, '2021-07-27 16:53:34', '2021-07-27 16:53:34'),
(43176, 3040, 30742, NULL, '2021-08-04 00:00:00.000', 'Not Eligible', 'Christus Spohn didn\'t provide services in the area. For more details please see group task.   ', NULL, NULL, '2021-07-28 11:20:33', '2021-07-28 11:20:33'),
(43177, 1006, 30743, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:04:36', '2021-05-14 15:04:36'),
(43178, 3040, 30743, NULL, '2021-06-09 00:00:00.000', 'On Hold', 'Facility/ Ancillary network interest form submitted. Please see group task.    ', NULL, NULL, '2021-06-02 10:36:04', '2021-06-02 10:36:04'),
(43179, 3040, 30743, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring ||  Hello Jennifer,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Cigna Healthspring for our group under the below mentioned 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  Waiting for your response.   Thank you  ', NULL, NULL, '2021-07-22 10:04:29', '2021-07-22 10:04:29'),
(43180, 11056, 30743, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email received from : JENNIFER.PEREZ@cigna.com  Sub : Re: Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring ||  Hi Adil,  My apologies, I forwarded this to the correct representative. She should be reaching out by this week. ', NULL, NULL, '2021-08-09 08:49:47', '2021-08-09 08:49:47'),
(43181, 3040, 30743, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: TXGQProviderRelations@healthspring.com  Subject: Re: [External] Re: Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring ||  Hello!  Hope you are doing well. As per conversation with Jennifer she requested to send an email to you. I wanted to know the enrollment status for the below mentioned group as I submitted the letter of interest form on 06/02/2021. Kindly review the chain of emails.   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  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you', NULL, NULL, '2021-08-17 09:55:49', '2021-08-17 09:55:49'),
(43182, 10057, 30743, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email Sent To : TXMAContracting@cigna.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello,  Hope you are doing well. I wanted to know the enrollment updated status for the below mentioned group in Cigna Healthspring for our group Valley Med Urgent Care PLLC under the below mentioned locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Tertiary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-14 11:22:42', '2021-10-14 11:22:42'),
(43183, 10057, 30743, NULL, '2021-11-25 00:00:00.000', 'In Process', 'Email Sent To : TXGQProviderRelations@healthspring.com  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Hello,  Could you please provide me with the updated status of my application?  Response is pending since 08/09/2021. Your earliest response will be much appreciated.  Thanks & Regards,', NULL, NULL, '2021-11-18 16:17:20', '2021-11-18 16:17:20'),
(43184, 10057, 30743, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email Received From : lilien.alvarado@gulfquest.net  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Good afternoon,  Can you please send me the applications that you submitted?  Thank you.  Regards, Lilien Alvarado, MPA Provider Contracting Lead Analyst Cigna 2800 North Loop West,Ste 400', NULL, NULL, '2021-12-01 11:55:09', '2021-12-01 11:55:09'),
(43185, 10057, 30743, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : lilien.alvarado@gulfquest.net  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Hello Lilien,  Thank you for reaching out to me. Kindly find the attached application for your reference.  Please let me know if you have any questions and revert back to me with the latest updates.  Thanks & Regards,', NULL, NULL, '2021-12-08 10:34:38', '2021-12-08 10:34:38'),
(43186, 10057, 30743, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Sent To : lilien.alvarado@gulfquest.net & TXGQProviderRelations@healthspring.com  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Greetings!  Hope this email finds you in good health. I\'m writing this email to check the current status of the below mentioned request.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-16 11:09:22', '2021-12-16 11:09:22'),
(43187, 10057, 30743, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Received From : joann.alanis@careallies.com  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Please see attached communication from Renaissance.  Thank you.', NULL, NULL, '2021-12-22 10:18:27', '2021-12-22 10:18:27'),
(43188, 10057, 30743, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Sent To : joann.alanis@careallies.com  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Thank you for reaching out. The attached letter was from Renaissance. We are inquiring about credentialing status for NUCC & IVUC with Cigna Healthspring.  Please get back to me once you get a chance. Have a great day!  Regards,', NULL, NULL, '2021-12-29 11:25:36', '2021-12-29 11:25:36'),
(43189, 19067, 30743, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: joann.alanis@careallies.com  Subject: Enrollment Query || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers & Groups || Cigna Healthspring ||   Good Morning JoAnn!  Hope you are doing really well.  I would like to know the enrollment status of the following Providers & Groups.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Jeny John	1073019493	779 Normandy St STE 114, Houston, TX 77015-3441 Jeny John	1073019493	16272 Imperial Valley DR STE K, Houston, TX 77060 Molly Joseph	1396380077	779 Normandy St STE 114, Houston, TX 77015-3441 Molly Joseph	1396380077	16272 Imperial Valley DR STE K, Houston, TX 77060 Cini Thomas	1134777238	779 Normandy St STE 114, Houston, TX 77015-3441 Cini Thomas	1134777238	16272 Imperial Valley DR STE K, Houston, TX 77060 Ani Stephen	1588959118	779 Normandy St STE 114, Houston, TX 77015-3441 Ani Stephen	1588959118	16272 Imperial Valley DR STE K, Houston, TX 77060 Abdur Rauf	1497726202	779 Normandy St STE 114, Houston, TX 77015-3441 Abdur Rauf	1497726202	16272 Imperial Valley DR STE K, Houston, TX 77060 James Piccione JR	1356321509	779 Normandy St STE 114, Houston, TX 77015-3441 James Piccione JR	1356321509	16272 Imperial Valley DR STE K, Houston, TX 77060 Sigi Paul	1033623616	779 Normandy St STE 114, Houston, TX 77015-3441 Sigi Paul	1033623616	16272 Imperial Valley DR STE K, Houston, TX 77060 Odette Kourouma	1134525868	779 Normandy St STE 114, Houston, TX 77015-3441 Odette Kourouma	1134525868	16272 Imperial Valley DR STE K, Houston, TX 77060 Vibitha Joseph	1952931560	779 Normandy St STE 114, Houston, TX 77015-3441 Vibitha Joseph	1952931560	16272 Imperial Valley DR STE K, Houston, TX 77060 Julie Jose	1447883061	779 Normandy St STE 114, Houston, TX 77015-3441 Julie Jose	1447883061	16272 Imperial Valley DR STE K, Houston, TX 77060 Jaya Jacob	1194336149	779 Normandy St STE 114, Houston, TX 77015-3441 Jaya Jacob	1194336149	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeemol George	1497219067	779 Normandy St STE 114, Houston, TX 77015-3441 Jeemol George	1497219067	16272 Imperial Valley DR STE K, Houston, TX 77060 Limy Fernandus	1972005189	779 Normandy St STE 114, Houston, TX 77015-3441 Limy Fernandus	1972005189	16272 Imperial Valley DR STE K, Houston, TX 77060 Brittany Brown	1275163537	779 Normandy St STE 114, Houston, TX 77015-3441 Brittany Brown	1275163537	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeena Abraham	1467901587	779 Normandy St STE 114, Houston, TX 77015-3441 Jeena Abraham	1467901587	16272 Imperial Valley DR STE K, Houston, TX 77060 Mini Chennemkara	1841755956	779 Normandy St STE 114, Houston, TX 77015-3441 Mini Chennemkara	1841755956	16272 Imperial Valley DR STE K, Houston, TX 77060 Glory Abraham	1194206490	779 Normandy St STE 114, Houston, TX 77015-3441 Glory Abraham	1194206490	16272 Imperial Valley DR STE K, Houston, TX 77060   Kindly respond at your earliest convenience.   Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-05 11:23:54', '2022-01-05 11:23:54'),
(43190, 19067, 30743, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email received from: joann.alanis@careallies.com  Subject: Enrollment Query || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers & Groups || Cigna Healthspring ||   For Renaissance you are not contracted.', NULL, NULL, '2022-01-06 16:32:19', '2022-01-06 16:32:19'),
(43191, 20067, 30743, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: joann.alanis@careallies.com  Sub: Enrollment Query || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers & Groups || Cigna Healthspring ||  Good afternoon, Hope this email finds you well. Could you please tell me for the Renaissance contract what procedure will be followed?  Thanks and regards, Syed Ahad. ', NULL, NULL, '2022-01-14 14:07:08', '2022-01-14 14:07:08'),
(43192, 20067, 30743, NULL, '2022-01-21 00:00:00.000', 'Not Eligible', 'Email received from: joann.alanis@careallies.com  Sub: Enrollment Query || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers & Groups || Cigna Healthspring ||  Hello!  The Renaissance-Eastside Board reviewed your Letter of Interest form a few months ago.  A letter was sent indicating that they were unable to extend a contract.  compliance. Copyright (c) 2022 CareAllies', NULL, NULL, '2022-01-14 14:39:16', '2022-01-14 14:39:16'),
(43193, 20067, 30743, NULL, '2022-01-21 00:00:00.000', 'Not Eligible', 'Email received from: joann.alanis@careallies.com  Sub: Enrollment Query || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers & Groups || Cigna Healthspring ||  Hello!  The Renaissance-Eastside Board reviewed your Letter of Interest form a few months ago.  A letter was sent indicating that they were unable to extend a contract.  compliance. Copyright (c) 2022 CareAllies', NULL, NULL, '2022-01-14 14:39:45', '2022-01-14 14:39:45'),
(43194, 1006, 30744, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:04:36', '2021-05-14 15:04:36'),
(43195, 3040, 30744, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: providerservices@triwest.com  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Triwest ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Triwest 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  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, '2021-05-31 14:59:13', '2021-05-31 14:59:13'),
(43196, 3040, 30744, NULL, '2021-06-25 00:00:00.000', 'On Hold', 'Group ancillary contract is already in process. For more details please see group task. ', NULL, NULL, '2021-06-18 10:14:07', '2021-06-18 10:14:07'),
(43197, 3040, 30744, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: jmonson@triwest.com  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Triwest ||  Hello Jess,   Can you please check and advise if the below mentioned group is in-network with Triwest or not. If not so can you please generate a contract for the below mentioned group. For your reference I attached the W9.   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  If you need any additional information please let me know. Waiting for your response.  Thank you ', NULL, NULL, '2021-07-20 11:05:03', '2021-07-20 11:05:03'),
(43198, 3040, 30744, NULL, '2021-07-29 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, '2021-07-22 14:31:38', '2021-07-22 14:31:38'),
(43199, 1006, 30745, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:04:36', '2021-05-14 15:04:36'),
(43200, 3040, 30745, NULL, '2021-05-27 00:00:00.000', 'Not Eligible', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes ', NULL, NULL, '2021-05-20 16:33:14', '2021-05-20 16:33:14'),
(43201, 1006, 30757, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:04:37', '2021-05-14 15:04:37'),
(43202, 3040, 30757, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: providerservices@renaissancefamily.com  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Renaissance Physicians ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Renaissance Physicians 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  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, '2021-05-31 13:59:56', '2021-05-31 13:59:56'),
(43203, 3040, 30757, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: txgqproviderrelations@healthspring.com  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Renaissance Physicians ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Renaissance Physicians 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  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  Provider 16:   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, '2021-06-17 14:42:20', '2021-06-17 14:42:20'),
(43204, 3040, 30757, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: Chukwuma.Ezeokoli@careallies.com cc:	catherine.chang@careallies.com, shannon.luke@careallies.com,  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Renaissance Physicians ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Renaissance Physicians 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  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  Provider 16:   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, '2021-07-05 16:48:28', '2021-07-05 16:48:28'),
(43205, 3040, 30757, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: joann.alanis@careallies.com  Subject: Re: [External] Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Renaissance Physicians ||  Hello Alanis,   Hope you are doing well. Do you have any update regarding the enrollment for the below mentioned group and providers.   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  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  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-26 12:43:37', '2021-07-26 12:43:37'),
(43206, 11056, 30757, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email sent to :   joann.alanis@careallies.com   &   Chukwuma.Ezeokoli@careallies.com  Sub : Fwd: [External] Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Renaissance Physicians ||  Good evening!  Hope you are doing well. I want to inquire about the enrollment status of the below mentioned providers and practices. Please provide us with the latest updates soon.  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  Provider Details:  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  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you!  Have a great week ahead!', NULL, NULL, '2021-08-11 16:29:07', '2021-08-11 16:29:07'),
(43207, 3040, 30757, NULL, '2021-08-25 00:00:00.000', 'Not Eligible', 'Email rcvd from: JENNIFER.PEREZ@cigna.com  Subject: RE: [External] Re: Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring ||  08/03/2021 Normandy Urgent Care Center ATTN: Adil Abbas 779 Normandy Street, Suite 114 Houston, TX 77015 Dear Mr. Abbas, Thank you for your request to join the Renaissance Physician Organization/Eastside IPA, LLC. At the present time we do not have a network need in your particular specialty. As a result, we are not able to extend an invitation for participation at this time. We will however keep your request on file and reconsider in the event our network development needs change. If you have any questions, please feel free to call JoAnn Alanis at 832.553.3350. Sincerely, Julian Gonzalez, M.D. Chairman of The Board Eastside IPA, LLC', NULL, NULL, '2021-08-18 13:11:52', '2021-08-18 13:11:52'),
(43208, 1006, 30758, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:04:37', '2021-05-14 15:04:37'),
(43209, 3040, 30758, NULL, '2021-06-04 00:00:00.000', 'On Hold', 'Waiting for the enrollment in Molina healthcare.', NULL, NULL, '2021-05-28 14:28:38', '2021-05-28 14:28:38'),
(43210, 10057, 30758, NULL, '2022-01-04 00:00:00.000', 'Approved', 'Call Details: (855) 322-4080   Rep: Sharona  Reference # SF 5820908  Effective Date: 10/01/2019', NULL, NULL, '2021-12-28 17:46:22', '2021-12-28 17:46:22'),
(43211, 1006, 30759, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:04:37', '2021-05-14 15:04:37'),
(43212, 1019, 30759, NULL, '2021-06-15 00:00:00.000', 'Initiated', 'Sent the following email to colbee.snyder@primehealthservices.com SUB: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||   Greetings, Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Prime Health 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  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, '2021-05-31 14:53:48', '2021-05-31 14:53:48'),
(43213, 3040, 30759, NULL, '2021-06-25 00:00:00.000', 'In Process', 'Email rcvd from:  colbee.snyder@primehealthservices.com  Subject: RE: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||  Thank you for your email. As of February 1st, 2020 I have been moved to a position outside of the credentialing department and will no longer be your point of contact. I have copied our general credentialing email.  Going forward, please forward all new providers adds and demographic changes to credentialing@primehealthservices.com and copy updates@primehealthservices.com.  Thank you!  Colbee Snyder Patient Advocacy Specialist', NULL, NULL, '2021-06-18 13:20:51', '2021-06-18 13:20:51'),
(43214, 3040, 30759, NULL, '2021-06-25 00:00:00.000', 'In Process', 'Email sent to: credentialing@primehealthservices.com  Subject: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Prime Health 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  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  Provider 16:   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, '2021-06-18 13:24:44', '2021-06-18 13:24:44'),
(43215, 3040, 30759, NULL, '2021-07-14 00:00:00.000', 'In Process', 'Email sent to: credentialing@primehealthservices.com, updates@primehealthservices.com,  Subject: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||  Hello,   Has there been any update?  Thank you  ', NULL, NULL, '2021-07-07 16:52:16', '2021-07-07 16:52:16'),
(43216, 3040, 30759, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: credentialing@primehealthservices.com  Subject: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||  Hello,   Hope you are doing well. I was trying to reach out to know the enrollment status for the below mentioned group and providers in Prime Health 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  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  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks', NULL, NULL, '2021-07-22 11:56:14', '2021-07-22 11:56:14'),
(43217, 11056, 30759, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email received from : credentialing@primehealthservices.com  Sub : Fwd: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||  Good Morning,  Please see below for the credentialing status for each provider.  The dates given are for credentialing purposes only and not the effective date.  Thank you for including the Updates Department in your email.  They will assist you with the effective dates.  There are two providers (highlighted) that need to be credentialed.  Please email a current CAQH Credentialing application or State Credentialing application for these providers.  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  - In the process of being credentialed.  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061 - Needs to be credentialed.     Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 - In the process of being credentialed.   Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 - Last credentialed - 6-23-2020 - Not the effective date - For credentialing purposes only.   Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 - In the process of being credentialed.  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956 - In the process of being credentialed.   Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490 - In the process of being credentialed.   Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 - In the process of being credentialed.   Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 - Last credentialed - 7-15-2020 - Not the effective date - For credentialing purposes only.  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 - In the process of being credentialed.   Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 - In the process of being credentialed.   Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238 - In the process of being credentialed.   Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 - In the process of being credentialed.   Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616 - In the process of being credentialed.  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149 - In the process of being credentialed.  Provider 16:  Provider Name: Joseph, Molly Provider NPI# 1396380077 - In the process of being credentialed.  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493 - Needs to be Credentialed.', NULL, NULL, '2021-08-12 10:16:17', '2021-08-12 10:16:17'),
(43218, 3040, 30759, NULL, '2021-09-21 00:00:00.000', 'In Process', 'Email sent to: megan.wherry@primehealthservices.com  Subject: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Prime Health ||  Hello Megan,   Hope you are doing well. Can you please send the roster because I am trying to find out the providers on the Prime Health Services directory and it\'s not showing up.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-09-14 17:07:39', '2021-09-14 17:07:39'),
(43219, 12062, 30759, NULL, '2021-09-24 00:00:00.000', 'In Process', 'Email sent to:megan.wherry@primehealthservices.com; colbee.snyder@primehealthservices.com; credentialing@primehealthservices.com; nucc@claimsmedinc.com; ivuc@claimsmedinc.com; Credentialing - Claims Med credentialing@claimsmedinc.com  Hi Wherry,  Hope you are doing well !   May I have any updated status for the enrollment application of below providers under the Prime Health Services Network?  I would be glad to have your response as soon as possible. The practice\'s and provider\'s details are as follows;   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   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   Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077   Thanking You in advance.', NULL, NULL, '2021-09-17 12:23:43', '2021-09-17 12:23:43'),
(43220, 10057, 30759, NULL, '2021-11-04 00:00:00.000', 'In Process', 'Email Sent To : credentialing@primehealthservices.com, updates@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Good Afternoon,  Hope this email finds you well. I\'m writing this email to check the updated status for the mentioned request. Please get back to me as soon as you get a chance.  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-28 15:23:32', '2021-10-28 15:23:32'),
(43221, 10057, 30759, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : credentialing@primehealthservices.com>, updates@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Good Morning,  Hope this email finds you in good health. Can I get the latest update on all the below mentioned groups and providers enrollment status?  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Please respond back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-22 10:43:17', '2021-11-22 10:43:17'),
(43222, 10057, 30759, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Sent To : credentialing@primehealthservices.com, updates@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Hello,  Can I get the latest updates on the below mentioned providers enrollment request under the TIN?  Please get back to me ASAP!  Thanks & Regards,', NULL, NULL, '2021-12-02 14:03:53', '2021-12-02 14:03:53'),
(43223, 10057, 30759, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : credentialing@primehealthservices.com, updates@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Hello,  Can I get the latest updates on the below mentioned providers enrollment request under the TIN?  Please get back to me ASAP!  Thanks & Regards,', NULL, NULL, '2021-12-09 11:20:21', '2021-12-09 11:20:21'),
(43224, 10057, 30759, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Received From : credentialing@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Please see attached Credentialing Status Roster.  The dates given are for Credentialing purposes only and not the effective date.  Thank you for including the Updates Department in your email.  They will respond regarding the effective dates.  Thank you, Nancy', NULL, NULL, '2021-12-15 10:51:28', '2021-12-15 10:51:28'),
(43225, 10057, 30759, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : credentialing@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Hello Nancy,  Thank you for your prompt response. I really appreciate your support. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-22 12:08:42', '2021-12-22 12:08:42'),
(43226, 10057, 30759, NULL, '2022-01-05 00:00:00.000', 'Approved', 'Email Received From : updates@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Hello, all of these providers are in our system with both locations added, thanks!  Alyssa DeNure Data Integrity Associate', NULL, NULL, '2021-12-29 14:03:16', '2021-12-29 14:03:16'),
(43227, 1006, 30760, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:04:37', '2021-05-14 15:04:37');
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
(43228, 3040, 30760, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Subject: Need to Enroll|| Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || CHRISTUS HEALTH PLAN||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Christus Health Plan for our group under the below locations. We have 02 different locations under the same tax ID.     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  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, '2021-05-25 12:41:02', '2021-05-25 12:41:02'),
(43229, 3040, 30760, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Email sent to: CHP.networkdevelopment@christushealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Christus Health Plan ||  Greetings,   Hope you are doing well. Please find the attached Prospective Provider Form along with the Letter of Intent for below mentioned providers to enroll in Christus Health Plan in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Primary 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 Secondary Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  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, '2021-06-11 14:47:57', '2021-06-11 14:47:57'),
(43230, 11056, 30760, NULL, '2021-07-06 00:00:00.000', 'In Process', 'Email sent to : CHP.networkdevelopment@christushealth.org  Sub : Enroll Request Group & Providers || Normandy Urgent Care Center || Christus Health Plan ||  Greetings,  Hope you are doing well. I want to know enrollment status of the following groups and providers. Respond this as soon as possible.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Primary 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 Secondary Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Providers: 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 good day!', NULL, NULL, '2021-06-29 12:53:05', '2021-06-29 12:53:05'),
(43231, 3040, 30760, NULL, '2021-07-26 00:00:00.000', 'On Hold', 'Ancillary contract request sent for the group. Please see group task. ', NULL, NULL, '2021-07-19 09:23:43', '2021-07-19 09:23:43'),
(43232, 3040, 30760, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email sent to: hunter.barrett@christushealth.org  Subject: Re: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Hello Hunter,   Hope you are doing well. Please find attached Ancillary service agreement along with the Facility Ancillary application for our group to participate in Christus Health Plan 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 let me know. Waiting for your response.    Thanks ', NULL, NULL, '2021-07-28 11:39:18', '2021-07-28 11:39:18'),
(43233, 11056, 30760, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email sent to : Hunter Barrett   hunter.barrett@christushealth.org, CHP.networkdevelopment@christushealth.org  Sub  : ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Good evening!  Hope all is well. I just want to inquire about the enrollment status of the following groups for the ancillary contract. Please provide us with the latest updates soon.  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 feel free to reach out to me. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-08-11 17:07:47', '2021-08-11 17:07:47'),
(43234, 3040, 30760, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email rcvd from: hunter.barrett@christushealth.org  Subject: RE: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Contract was sent to credentialing about 3 weeks ago to process. Will take about 6 months to fully process and receive effective date.  Thanks,  Hunter Barrett Network Contracting CHRISTUS Health Plan CHRISTUS Health 919 Hidden Ridge | Irving, Texas 75038 (o) 469.282.3113', NULL, NULL, '2021-08-17 15:02:51', '2021-08-17 15:02:51'),
(43235, 3040, 30760, NULL, '2021-09-21 00:00:00.000', 'In Process', 'Email sent to: hunter.barrett@christushealth.org  Subject: Re: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Good evening!  Hope all is well. This is a follow up email to inquire about the enrollment status of the following groups for the ancillary contract.   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 feel free to reach out to me. Waiting for your response.  Thanks', NULL, NULL, '2021-09-14 16:15:34', '2021-09-14 16:15:34'),
(43236, 12062, 30760, NULL, '2021-09-29 00:00:00.000', 'In Process', ' Received below email under the group ancillary contract request; From :hunter.barrett@christushealth.org Subject :RE: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN Please reach out to our credentialing team in about 4 months for an update. You can reach out directly to them for updates on all of the contracts you are inquiring about. They are running around 6 months to process them so please give them adequate time to reach your file. Most of the contracts were sent to them around 1-2 months ago CHRISTUS.HP.Credentialing CHRISTUS.HP.Credentialing@christushealth.org  Thanks,   Hunter Barrett Network Contracting CHRISTUS Health Plan CHRISTUS Health 919 Hidden Ridge | Irving, Texas 75038 (o) 469.282.3113 www.christushealth.org  ', NULL, NULL, '2021-09-22 13:10:29', '2021-09-22 13:10:29'),
(43237, 10057, 30760, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Good Evening,  Hope you are doing well. I want to know the enrollment status of the following groups and providers. Please get back to me as soon as you get the time.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Jose, Julie	1447883061 George, Jeemol	1497219067 Brown, Brittany	1275163537 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Thomas, Cini	1134777238 Joseph, Vibitha	1952931560 Stephen, Ani	1588959118 Piccione JR, James M	1356321509 Chennemkara, Mini Philip	1841755956 Abraham, Glory	1194206490 Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-10-18 16:38:43', '2021-10-18 16:38:43'),
(43238, 10057, 30760, NULL, '2021-12-02 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : Need Credentialing Update - URGENT  Good Afternoon,  Hope you are doing well. Can I have the latest update on the below mentioned request. Also welcome letters?  Looking forward to your kind response. Have a great day!   Thanks & Regards,', NULL, NULL, '2021-11-18 13:52:03', '2021-11-18 13:52:03'),
(43239, 10057, 30760, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : Need Credentialing Update - URGENT  Hello,  Can I get the update on the below mentioned request, also I have not yet received any welcome letters yet.  Kindly revert back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-01 11:02:01', '2021-12-01 11:02:01'),
(43240, 10057, 30760, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : Need Credentialing Update - URGENT  Hello,  Can I get the update on the below mentioned request, also I have not yet received any welcome letters yet.  Kindly revert back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-01 11:03:01', '2021-12-01 11:03:01'),
(43241, 10057, 30760, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email Received From : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Good Morning  Normandy Urgent Care Center  - has been processed effective contract date 01/01/2022  Longpoint Medical Center – facility has been processed effective contract date 01/01/2022  Imperial Valley - facility has been processed effective contract date 01/01/2022  Credentialing Verification Unit CHRISTUS Health Plan - US Family Health Plan 919 Hidden Ridge Irving, TX 75038 Phone: (469)-282-0368 Fax: 210-766-8857', NULL, NULL, '2021-12-14 09:53:14', '2021-12-14 09:53:14'),
(43242, 10057, 30760, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Thank you for the update. Could you please provide us with the facility agreement or contract along with the update for the providers credentialing status as well.  Your earliest response would be greatly appreciated.  Regards, Steve Albert', NULL, NULL, '2021-12-20 13:42:44', '2021-12-20 13:42:44'),
(43243, 10057, 30760, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Greetings!  Hope you are doing great. I\'m writing this email to get the update on my below request. Please get back to me as soon as possible!  Regards,', NULL, NULL, '2021-12-28 11:57:47', '2021-12-28 11:57:47'),
(43244, 19067, 30760, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: CHRISTUS.HP.Credentialing@christushealth.org, hunter.barrett@christushealth.org, CHP.networkdevelopment@christushealth.org  Subject: Enrollment Query || NUCC & IVUC || Providers & Group || Christus Health Plan ||   Hello!  You are having a productive day.  I would like to know the enrollment status of the following Providers and Group with Christus Health Plan.   Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Jeny John	1073019493	779 Normandy St STE 114, Houston, TX 77015-3441 Jeny John	1073019493	16272 Imperial Valley DR STE K, Houston, TX 77060 Molly Joseph	1396380077	779 Normandy St STE 114, Houston, TX 77015-3441 Molly Joseph	1396380077	16272 Imperial Valley DR STE K, Houston, TX 77060 Cini Thomas	1134777238	779 Normandy St STE 114, Houston, TX 77015-3441 Cini Thomas	1134777238	16272 Imperial Valley DR STE K, Houston, TX 77060 Ani Stephen	1588959118	779 Normandy St STE 114, Houston, TX 77015-3441 Ani Stephen	1588959118	16272 Imperial Valley DR STE K, Houston, TX 77060 Abdur Rauf	1497726202	779 Normandy St STE 114, Houston, TX 77015-3441 Abdur Rauf	1497726202	16272 Imperial Valley DR STE K, Houston, TX 77060 James Piccione JR	1356321509	779 Normandy St STE 114, Houston, TX 77015-3441 James Piccione JR	1356321509	16272 Imperial Valley DR STE K, Houston, TX 77060 Sigi Paul	1033623616	779 Normandy St STE 114, Houston, TX 77015-3441 Sigi Paul	1033623616	16272 Imperial Valley DR STE K, Houston, TX 77060 Odette Kourouma	1134525868	779 Normandy St STE 114, Houston, TX 77015-3441 Odette Kourouma	1134525868	16272 Imperial Valley DR STE K, Houston, TX 77060 Vibitha Joseph	1952931560	779 Normandy St STE 114, Houston, TX 77015-3441 Vibitha Joseph	1952931560	16272 Imperial Valley DR STE K, Houston, TX 77060 Julie Jose	1447883061	779 Normandy St STE 114, Houston, TX 77015-3441 Julie Jose	1447883061	16272 Imperial Valley DR STE K, Houston, TX 77060 Jaya Jacob	1194336149	779 Normandy St STE 114, Houston, TX 77015-3441 Jaya Jacob	1194336149	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeemol George	1497219067	779 Normandy St STE 114, Houston, TX 77015-3441 Jeemol George	1497219067	16272 Imperial Valley DR STE K, Houston, TX 77060 Limy Fernandus	1972005189	779 Normandy St STE 114, Houston, TX 77015-3441 Limy Fernandus	1972005189	16272 Imperial Valley DR STE K, Houston, TX 77060 Brittany Brown	1275163537	779 Normandy St STE 114, Houston, TX 77015-3441 Brittany Brown	1275163537	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeena Abraham	1467901587	779 Normandy St STE 114, Houston, TX 77015-3441 Jeena Abraham	1467901587	16272 Imperial Valley DR STE K, Houston, TX 77060 Mini Chennemkara	1841755956	779 Normandy St STE 114, Houston, TX 77015-3441 Mini Chennemkara	1841755956	16272 Imperial Valley DR STE K, Houston, TX 77060 Glory Abraham	1194206490	779 Normandy St STE 114, Houston, TX 77015-3441 Glory Abraham	1194206490	16272 Imperial Valley DR STE K, Houston, TX 77060  Eagerly waiting for your response.   Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 17:24:59', '2022-01-04 17:24:59'),
(43245, 19067, 30760, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email received from: Sonia.Gonzales@christushealth.org  Subject: Enrollment Query || NUCC & IVUC || Providers & Group || Christus Health Plan ||     Good Morning All,     Thank you for the request below, I do show contract for USFHP was signed and executed.   Information was sent over to get configuration of contract rates entered.       Once we have this process is completed we can have this sent to Credentialing to get group loaded with effective date.  When I get further updates will pass along!     Please remove Hunter Barrette from communications, unfortunately he is no longer with us, I am covering in the interim.       Thanks and appreciate your patience,     Respectfully,     Sonia D. Gonzales  CHRISTUS Health Plan – Physician Relations Consultant II/ Contracting  505-569-4856  sonia.gonzales@christushealth.org', NULL, NULL, '2022-01-05 11:33:42', '2022-01-05 11:33:42'),
(43246, 20067, 30760, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: Sonia.Gonzales@christushealth.org  Sub: Re: Enrollment Query || NUCC & IVUC || Providers & Group || Christus Health Plan ||  Good Afternoon, Hope this email finds you in good health. Any update on the previous request?  Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-14 13:27:13', '2022-01-14 13:27:13'),
(43247, 20067, 30760, NULL, '2022-01-28 00:00:00.000', 'In Process', 'Email sent to: Sonia.Gonzales@christushealth.org  Sub: Re: Enrollment Query || NUCC & IVUC || Providers & Group || Christus Health Plan ||  Good afternoon! Hope you are doing well. I haven\'t heard from your side, Kindly respond to the previous mail. If the process is complete, kindly send me the contract letter along with the effective date.  Thanks and Regards, Syed Ahad  ', NULL, NULL, '2022-01-21 16:46:16', '2022-01-21 16:46:16'),
(43248, 20067, 30760, NULL, '2022-02-01 00:00:00.000', 'Approved', 'Received the Ancillary contract from Christus Health Plan  Effective Date: 01/01/2022 Expiration Date: 12/31/9999', NULL, NULL, '2022-01-25 17:20:50', '2022-01-25 17:20:50'),
(43249, 1006, 30761, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:04:37', '2021-05-14 15:04:37'),
(43250, 1006, 30761, NULL, '2021-05-26 00:00:00.000', 'Approved', 'The provider is enrolled with UHC, approval confirmation and location confirmation are attached for reference. ', NULL, NULL, '2021-05-19 11:20:25', '2021-05-19 11:20:25'),
(43251, 1006, 30762, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:04:37', '2021-05-14 15:04:37'),
(43252, 3040, 30762, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: info@usamco.com  Subject: Copy of Executed Contract || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || MCO ||  Greetings,   Hope you are doing well. Can you please send me the copy of the executed contract for our group Normandy Urgent Care Center 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  Thank you ', NULL, NULL, '2021-05-28 12:24:41', '2021-05-28 12:24:41'),
(43253, 11056, 30762, NULL, '2021-06-23 00:00:00.000', 'Approved', '	 Group has an ancillary contract. No need to add individual providers. Please see group task.', NULL, NULL, '2021-06-16 12:24:03', '2021-06-16 12:24:03'),
(43254, 1006, 30763, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:04:37', '2021-05-14 15:04:37'),
(43255, 3040, 30763, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: providerservices@memorialhermann.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Memorial Hermann ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Memorial Hermann 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  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, '2021-05-28 13:25:36', '2021-05-28 13:25:36'),
(43256, 3040, 30763, NULL, '2021-06-23 00:00:00.000', 'On Hold', 'Group ancillary contract request sent to Memorial Hermann. For more details please see group task.  ', NULL, NULL, '2021-06-16 16:39:39', '2021-06-16 16:39:39'),
(43257, 3040, 30763, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: enterprise.credentialing@memorialhermann.org  Subject: Re: [EXTERNAL] Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Memorial Hermann ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Memorial Hermann 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  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-20 10:52:11', '2021-07-20 10:52:11'),
(43258, 11056, 30763, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Email sent to : ProviderServices@memorialhermann.org  &  MHHPContracting@memorialhermann.org  Sub : Fwd: [EXTERNAL] Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Memorial Hermann ||  Good morning!  Hope you are doing well. I want to know the enrollment status of the below mentioned group under the below locations for Ancillary contract in Memorial Hermann.  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  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 day! ', NULL, NULL, '2021-08-12 15:35:00', '2021-08-12 15:35:00'),
(43259, 3040, 30763, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Group has an ancillary contract no need to add individual providers. Please see group task for more details. ', NULL, NULL, '2021-08-27 10:00:26', '2021-08-27 10:00:26'),
(43260, 1006, 30764, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:04:38', '2021-05-14 15:04:38'),
(43261, 3040, 30764, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Tricare ||  Hello Katherine,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Tricare 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  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-02 16:09:39', '2021-06-02 16:09:39'),
(43262, 3040, 30764, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Tricare 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  Provider 16:   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, '2021-06-22 09:41:17', '2021-06-22 09:41:17'),
(43263, 3040, 30764, NULL, '2021-07-16 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Additional Location || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Greetings,   Hope you are doing well. I wanted to add the location under the below mentioned providers in Tricare in our group under the below mentioned 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: Jose, Julie Provider NPI# 1447883061 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 2:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 3:   Provider Name: Rauf, Abdur  Provider NPI# 1497726202 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 4:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 5:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238 Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226   Provider 7:   Provider Name: Abraham, Jeena  Provider NPI# 1467901587 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-07-09 14:33:07', '2021-07-09 14:33:07'),
(43264, 11056, 30764, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email received from :    ywyatt@humana.com  Sub : Fwd: Additional Location || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Good Morning Adil,     To add a provider to a network location you need to complete the attached spreadsheet and email it to the HGB Roster team to process.     Send the completed spreadsheet to the following email address     HGBProviderRosters@Humana.com              Thanks,  Yvonne', NULL, NULL, '2021-08-11 11:27:26', '2021-08-11 11:27:26'),
(43265, 3040, 30764, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to: HGBProviderRosters@humana.com, ywyatt@humana.com  Subject: Re: Additional Location || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Received Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in an additional location in Tricare in our group under the below highlighted locations. We already submitted the roster for an additional location on 07/19/2021.   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: Jose, Julie  Provider NPI# 1447883061  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 2:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 3:    Provider Name: Rauf, Abdur   Provider NPI# 1497726202  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 4:    Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 5:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 6:    Provider Name: Thomas, Cini   Provider NPI# 1134777238  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226   Provider 7:    Provider Name: Abraham, Jeena   Provider NPI# 1467901587  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you!! ', NULL, NULL, '2021-08-18 16:51:27', '2021-08-18 16:51:27'),
(43266, 10057, 30764, NULL, '2021-10-22 00:00:00.000', 'In Process', 'Email Sent To : ywyatt@humana.com & KMoten4@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good Afternoon!  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned group and provider in Tricare for our group under the below locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Joseph, Molly	1396380077 PAUL, SIGI	1033623616 Stephen, Ani	1588959118 Thomas, Cini	1134777238 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956  Please get back to me as soon as you have time!  Thanks & Regards,', NULL, NULL, '2021-10-15 08:38:13', '2021-10-15 08:38:13'),
(43267, 10057, 30764, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email Received From : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Hello Steve,  Updates emailed to HGB Roster team can take up to 60 days to process. There is no changed in the status from the email I sent on Tuesday.  Thanks,  Yvonne W. Wyatt, Humana Military TRICARE Community Liaison II Houston/Galveston 502-318-5409 Telephone 502-322-8018 Fax ywyatt@humana.com', NULL, NULL, '2021-11-11 17:30:04', '2021-11-11 17:30:04'),
(43268, 10057, 30764, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good morning,  Hope this email finds you well. Could you please let me know the latest update on the below mentioned request.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-02 09:50:14', '2021-12-02 09:50:14'),
(43269, 10057, 30764, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email Received From : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good Morning Steve,  The status is listed below. You can check status by using the self-service Provider Portal.  In order to serve our providers more efficiently, we have begun using Humana Military’s Provider Self-Service Portal.  The secure messaging feature through Provider Self Service increases the timeliness of responses to your questions.  If you are not currently registered on the Provider Self-Service Portal, please visit:  Provider Self-Service (humana-military.com)  To verify provider status, please utilize the NPI search tool in the Provider Self-Service Portal.  If the provider does not populate in this tool, then the provider is not TRICARE certified.  Thanks,  Yvonne W. Wyatt, TRICARE Community Liaison II Humana Military', NULL, NULL, '2021-12-15 13:26:45', '2021-12-15 13:26:45'),
(43270, 10057, 30764, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Thank you for reaching out. Unfortunately, we do not have access to the provider self service portal. Is there any way that we can get the status for below mentioned providers enrollment status?  Your earliest response will be highly appreciated.  Kind Regards, Steve Albert ', NULL, NULL, '2021-12-21 15:13:56', '2021-12-21 15:13:56'),
(43271, 10057, 30764, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Received From : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Hello Steve,  We are requesting Providers to create a log in on the Provider Portal highlighted below is the link', NULL, NULL, '2021-12-29 13:09:26', '2021-12-29 13:09:26'),
(43272, 20067, 30764, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to:  ywyatt@humana.com  Sub: Re: Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good Afternoon, Hope this email finds you well. I would like to know the enrollment status of the below-mentioned provider under these locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 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 Molly Joseph	1396380077 Mini Chennemkara	1841755956 Odette Kourouma	1134525868 Ani Stephen	1588959118 James Piccione JR	1356321509  Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-12 14:21:01', '2022-01-12 14:21:01'),
(43273, 20067, 30764, NULL, '2022-01-31 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Sub: Re: Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good Morning!  Hope you had a great weekend. I haven\'t received the welcome packet yet. Please do the needful.  Thanks and regards, Syed Ahad. ', NULL, NULL, '2022-01-24 09:52:15', '2022-01-24 09:52:15'),
(43274, 20067, 30764, NULL, '2022-02-10 00:00:00.000', 'Approved', 'Called Tricare and spoke to Rikki  Effective dates for all 3 locations,  NUCC: 11/02/2021 IVUC; 11/03/2021 LPMC: 11/03/2021  Ref# 15097351 ', NULL, NULL, '2022-02-03 10:51:00', '2022-02-03 10:51:00'),
(43275, 1006, 30765, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:04:38', '2021-05-14 15:04:38'),
(43276, 1006, 30765, NULL, '2021-05-28 00:00:00.000', 'Initiated', 'Submitted group enrollment request via Wellcare\'s online form, attached for reference in group task. ', NULL, NULL, '2021-05-20 21:01:26', '2021-05-20 21:01:26'),
(43277, 3040, 30765, NULL, '2021-06-16 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more details please see group task.', NULL, NULL, '2021-06-09 10:48:56', '2021-06-09 10:48:56'),
(43278, 3040, 30765, NULL, '2021-07-27 00:00:00.000', 'In Process', 'I spoke with Harvey D Wellcare representative and he advised me that processing time will take 60 business days. After reviewing the application the provider rep will contact you.   Ref: 544023676', NULL, NULL, '2021-07-20 10:36:07', '2021-07-20 10:36:07'),
(43279, 11056, 30765, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good afternoon!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Wellcare 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    Provider 16:    Provider Name: Joseph, Molly Provider NPI# 1396380077    Provider 17:    Provider Name: John, Jeny Provider NPI# 1073019493    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, '2021-08-11 13:58:45', '2021-08-11 13:58:45'),
(43280, 3040, 30765, NULL, '2021-09-14 00:00:00.000', 'Approved', 'Email rcvd from: ProspectiveProviderTX@wellcare.com  Subject: Re: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Please see providers we have currently loaded:  For more details please see attachment.   Thanks ', NULL, NULL, '2021-09-07 15:16:57', '2021-09-07 15:16:57'),
(43281, 1006, 30766, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:04:38', '2021-05-14 15:04:38'),
(43282, 3040, 30766, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Sent the following initiation request to trpndataentry@trpnppo.com & providerrelations@trpnppo.com:  Sub: Provider Enrollment Request - NUCC- TRPN  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Multiplan for our group under the below locations. Can you please send the roster.   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  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, '2021-05-28 17:02:25', '2021-05-28 17:02:25');
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
(43283, 11056, 30766, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Good Evening!  Hope you are doing well. Please find the attached Provider update form to enroll the below mentioned group and providers in TRPN for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice NPI: 1407171077 Practice TIN: 27-0796429 Primary Address: 779 Normandy St Ste 114 Houston, TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice NPI: 1407171077 Practice TIN: 27-0796429P Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Provider Names enlisted below:-  Provider 1: Provider Name: Joseph, Molly Provider NPI : 1396380077  Provider 2: Provider Name:  Jacob, Jaya Provider NPI : 1194336149   Provider 3: Provider Name:  PAUL, SIGI Provider NPI : 1033623616  Provider 4:  Provider Name: Chennemkara, Mini Provider NPI : 1841755956     Provider 5:   Provider Name:  Abraham, Jeena Provider NPI :  1467901587    Provider 6:   Provider Name:  Kourouma , Odette Provider NPI :  1134525868  Provider 7:   Provider Name:  Piccione JR, James Provider NPI :  1356321509    Provider 8: Provider Name:  Abraham, Glory Provider NPI :  1194206490   Provider 9:   Provider Name:  Fernandus, Limy Provider NPI :  1972005189  Provider 10: Provider Name:  Thomas, Cini Provider NPI :  1134777238  Provider 11:   Provider Name:  Stephen, Ani Provider NPI :  1588959118   Provider 12:   Provider Name:  George, Jeemol Provider NPI :  1497219067    Provider 13:   Provider Name:  Jose, Julie Provider NPI :  1447883061    Provider 14:   Provider Name:  Brown, Brittany Provider NPI :   1275163537  Provider 15:   Provider Name:  Joseph, Vibitha Provider NPI :   1952931560    Provider 16:  Provider Name:  Abdur Rauf Provider NPI :  1497726202    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-16 17:10:26', '2021-06-16 17:10:26'),
(43284, 3040, 30766, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: trpndataentry@trpnppo.com, mflores@trpnppo.com, ccampos@trpnppo.com  Subject: Re: Provider Update Information Form- TRPN  Hello Max and Carlos,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in TRPN for our group under the below mentioned locations. We already sent the provider update form at trpndataentry@trpnppo.com.   Practice Details: Practice Name: Normandy Urgent Care Center Practice NPI: 1407171077 Practice TIN: 27-0796429 Primary Address: 779 Normandy St Ste 114 Houston, TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice NPI: 1407171077 Practice TIN: 27-0796429  Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Provider Names enlisted below:- Provider 1: Provider Name: Joseph, Molly Provider NPI : 1396380077  Provider 2: Provider Name:  Jacob, Jaya Provider NPI : 1194336149   Provider 3: Provider Name:  PAUL, SIGI Provider NPI : 1033623616  Provider 4:  Provider Name: Chennemkara, Mini Provider NPI : 1841755956     Provider 5:   Provider Name:  Abraham, Jeena Provider NPI :  1467901587    Provider 6:   Provider Name:  Kourouma , Odette Provider NPI :  1134525868  Provider 7:   Provider Name:  Piccione JR, James Provider NPI :  1356321509    Provider 8: Provider Name:  Abraham, Glory Provider NPI :  1194206490   Provider 9:   Provider Name:  Fernandus, Limy Provider NPI :  1972005189  Provider 10: Provider Name:  Thomas, Cini Provider NPI :  1134777238  Provider 11:   Provider Name:  Stephen, Ani Provider NPI :  1588959118  Provider 12:   Provider Name:  George, Jeemol Provider NPI :  1497219067   Provider 13:   Provider Name:  Jose, Julie Provider NPI :  1447883061    Provider 14:   Provider Name:  Brown, Brittany Provider NPI :   1275163537  Provider 15:   Provider Name:  Joseph, Vibitha Provider NPI :   1952931560    Provider 16:  Provider Name:  Abdur Rauf Provider NPI : 1497726202    Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-05 15:25:39', '2021-07-05 15:25:39'),
(43285, 3040, 30766, NULL, '2021-07-27 00:00:00.000', 'Approved', 'Email rcvd from: ccampos@trpnppo.com  Subject: Provider Update Information Form- TRPN Hi,  Provider Molly Joseph is Active, effective date 01/01/2021,  Provider Jacob Jaya is Active, effective date 01/01/2021,  Provider Sigi Paul is Active, effective date 01/01/2021,  Provider Mini Chennemkara is Active, effective date 01/01/2021,  Provider Jeena Abraham is Active, effective date 03/01/2016,  Provider Odette Kourouma is Active, effective date 01/01/2021,  Provider James Piccione is Active, effective date 01/01/2021,  Provider Glory Abraham is Active, effective date 05/29/2019,  Provider Limy Fernandus is Active, effective date 01/01/2021,  Provider Cini Thomas is Active, effective date 10/01/2019,  Provider Ani Stephen is Active, effective date 01/01/2021,  Provider Jeemol George is Active, effective date 06/09/2020,  Provider Julie Jose is Active, effective date 06/09/2020,  Provider Brittany Brown is Active, effective date 01/01/2021,  Provider Vibitha Joseph is Active, effective date 01/01/2021,  Provider Abdur Rauf is Active, effective date 01/01/2021,  Carlos Campos  Data Entry Department Supervisor Three Rivers Provider Network 6970 O’Bannon Drive Las Vegas, NV 89117 P: 619.869.8940 F: 619.271.2563 ccampos@trpnppo.com trpndataentry@trpnppo.com', NULL, NULL, '2021-07-20 08:32:32', '2021-07-20 08:32:32'),
(43286, 1006, 30767, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:04:38', '2021-05-14 15:04:38'),
(43287, 1006, 30767, NULL, '2021-06-07 00:00:00.000', 'Initiated', 'Sent following initiation request @ CSHNproviderrelations@christushealth.org:  Sub: Enrollment Request - NUCC, IVUC - Christus Spohn  \"Hello,  We wish to enroll the following providers under the mentioned group, please let me know what is required to get the enrollment process started. the details are as follows: Group Name: Normandy Urgent Care Center NPI# 1407171077 TIN# 27-0796429  Primary Address: 779 Normandy St Ste 114, Houston, TX 77015-3441 Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  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  Please get back to me as soon as you\'re able to.   Thank you. \"', NULL, NULL, '2021-05-31 16:21:15', '2021-05-31 16:21:15'),
(43288, 3040, 30767, NULL, '2021-06-25 00:00:00.000', 'In Process', 'I called the 800-419-3461 and left the VM. Because I didn\'t getting any reply from the insurance.  ', NULL, NULL, '2021-06-18 11:50:19', '2021-06-18 11:50:19'),
(43289, 3040, 30767, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Christus Spohn ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Christus Spohn for our group under the below locations. We have 02 different locations under the same tax ID.     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  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  Provider 16:   Provider Name: John, Jeny Provider NPI# 1073019493  Provider 17:   Provider Name: Joseph, Molly Provider NPI# 1073019493  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-06 14:45:20', '2021-07-06 14:45:20'),
(43290, 3040, 30767, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Email sent to: vicki.guerra@christushealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Christus Spohn ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Christus Spohn for our group under the below locations. We have 02 different locations under the same tax ID.     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  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  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you\'re able to.  Thank you   ', NULL, NULL, '2021-07-27 16:53:34', '2021-07-27 16:53:34'),
(43291, 3040, 30767, NULL, '2021-08-04 00:00:00.000', 'Not Eligible', 'Christus Spohn didn\'t provide services in the area. For more details please see group task.   ', NULL, NULL, '2021-07-28 11:20:33', '2021-07-28 11:20:33'),
(43292, 1006, 30768, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:04:38', '2021-05-14 15:04:38'),
(43293, 3040, 30768, NULL, '2021-06-09 00:00:00.000', 'On Hold', 'Facility/ Ancillary network interest form submitted. Please see group task.    ', NULL, NULL, '2021-06-02 10:36:08', '2021-06-02 10:36:08'),
(43294, 3040, 30768, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring ||  Hello Jennifer,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Cigna Healthspring for our group under the below mentioned 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  Waiting for your response.   Thank you  ', NULL, NULL, '2021-07-22 10:04:29', '2021-07-22 10:04:29'),
(43295, 11056, 30768, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email received from : JENNIFER.PEREZ@cigna.com  Sub : Re: Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring ||  Hi Adil,  My apologies, I forwarded this to the correct representative. She should be reaching out by this week. ', NULL, NULL, '2021-08-09 08:50:48', '2021-08-09 08:50:48'),
(43296, 3040, 30768, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: TXGQProviderRelations@healthspring.com  Subject: Re: [External] Re: Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring ||  Hello!  Hope you are doing well. As per conversation with Jennifer she requested to send an email to you. I wanted to know the enrollment status for the below mentioned group as I submitted the letter of interest form on 06/02/2021. Kindly review the chain of emails.   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  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you', NULL, NULL, '2021-08-17 09:55:48', '2021-08-17 09:55:48'),
(43297, 10057, 30768, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email Sent To : TXMAContracting@cigna.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello,  Hope you are doing well. I wanted to know the enrollment updated status for the below mentioned group in Cigna Healthspring for our group Valley Med Urgent Care PLLC under the below mentioned locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Tertiary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-14 11:22:36', '2021-10-14 11:22:36'),
(43298, 10057, 30768, NULL, '2021-11-25 00:00:00.000', 'In Process', 'Email Sent To : TXGQProviderRelations@healthspring.com  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Hello,  Could you please provide me with the updated status of my application?  Response is pending since 08/09/2021. Your earliest response will be much appreciated.  Thanks & Regards,', NULL, NULL, '2021-11-18 16:17:13', '2021-11-18 16:17:13'),
(43299, 10057, 30768, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email Received From : lilien.alvarado@gulfquest.net  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Good afternoon,  Can you please send me the applications that you submitted?  Thank you.  Regards, Lilien Alvarado, MPA Provider Contracting Lead Analyst Cigna 2800 North Loop West,Ste 400', NULL, NULL, '2021-12-01 11:55:01', '2021-12-01 11:55:01'),
(43300, 10057, 30768, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : lilien.alvarado@gulfquest.net  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Hello Lilien,  Thank you for reaching out to me. Kindly find the attached application for your reference.  Please let me know if you have any questions and revert back to me with the latest updates.  Thanks & Regards,', NULL, NULL, '2021-12-08 10:34:30', '2021-12-08 10:34:30'),
(43301, 10057, 30768, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Sent To : lilien.alvarado@gulfquest.net & TXGQProviderRelations@healthspring.com  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Greetings!  Hope this email finds you in good health. I\'m writing this email to check the current status of the below mentioned request.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-16 11:09:16', '2021-12-16 11:09:16'),
(43302, 10057, 30768, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Received From : joann.alanis@careallies.com  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Please see attached communication from Renaissance.  Thank you.', NULL, NULL, '2021-12-22 10:18:18', '2021-12-22 10:18:18'),
(43303, 10057, 30768, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Sent To : joann.alanis@careallies.com  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Thank you for reaching out. The attached letter was from Renaissance. We are inquiring about credentialing status for NUCC & IVUC with Cigna Healthspring.  Please get back to me once you get a chance. Have a great day!  Regards,', NULL, NULL, '2021-12-29 11:25:30', '2021-12-29 11:25:30'),
(43304, 19067, 30768, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: joann.alanis@careallies.com  Subject: Enrollment Query || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers & Groups || Cigna Healthspring ||   Good Morning JoAnn!  Hope you are doing really well.  I would like to know the enrollment status of the following Providers & Groups.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Jeny John	1073019493	779 Normandy St STE 114, Houston, TX 77015-3441 Jeny John	1073019493	16272 Imperial Valley DR STE K, Houston, TX 77060 Molly Joseph	1396380077	779 Normandy St STE 114, Houston, TX 77015-3441 Molly Joseph	1396380077	16272 Imperial Valley DR STE K, Houston, TX 77060 Cini Thomas	1134777238	779 Normandy St STE 114, Houston, TX 77015-3441 Cini Thomas	1134777238	16272 Imperial Valley DR STE K, Houston, TX 77060 Ani Stephen	1588959118	779 Normandy St STE 114, Houston, TX 77015-3441 Ani Stephen	1588959118	16272 Imperial Valley DR STE K, Houston, TX 77060 Abdur Rauf	1497726202	779 Normandy St STE 114, Houston, TX 77015-3441 Abdur Rauf	1497726202	16272 Imperial Valley DR STE K, Houston, TX 77060 James Piccione JR	1356321509	779 Normandy St STE 114, Houston, TX 77015-3441 James Piccione JR	1356321509	16272 Imperial Valley DR STE K, Houston, TX 77060 Sigi Paul	1033623616	779 Normandy St STE 114, Houston, TX 77015-3441 Sigi Paul	1033623616	16272 Imperial Valley DR STE K, Houston, TX 77060 Odette Kourouma	1134525868	779 Normandy St STE 114, Houston, TX 77015-3441 Odette Kourouma	1134525868	16272 Imperial Valley DR STE K, Houston, TX 77060 Vibitha Joseph	1952931560	779 Normandy St STE 114, Houston, TX 77015-3441 Vibitha Joseph	1952931560	16272 Imperial Valley DR STE K, Houston, TX 77060 Julie Jose	1447883061	779 Normandy St STE 114, Houston, TX 77015-3441 Julie Jose	1447883061	16272 Imperial Valley DR STE K, Houston, TX 77060 Jaya Jacob	1194336149	779 Normandy St STE 114, Houston, TX 77015-3441 Jaya Jacob	1194336149	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeemol George	1497219067	779 Normandy St STE 114, Houston, TX 77015-3441 Jeemol George	1497219067	16272 Imperial Valley DR STE K, Houston, TX 77060 Limy Fernandus	1972005189	779 Normandy St STE 114, Houston, TX 77015-3441 Limy Fernandus	1972005189	16272 Imperial Valley DR STE K, Houston, TX 77060 Brittany Brown	1275163537	779 Normandy St STE 114, Houston, TX 77015-3441 Brittany Brown	1275163537	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeena Abraham	1467901587	779 Normandy St STE 114, Houston, TX 77015-3441 Jeena Abraham	1467901587	16272 Imperial Valley DR STE K, Houston, TX 77060 Mini Chennemkara	1841755956	779 Normandy St STE 114, Houston, TX 77015-3441 Mini Chennemkara	1841755956	16272 Imperial Valley DR STE K, Houston, TX 77060 Glory Abraham	1194206490	779 Normandy St STE 114, Houston, TX 77015-3441 Glory Abraham	1194206490	16272 Imperial Valley DR STE K, Houston, TX 77060   Kindly respond at your earliest convenience.   Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-05 11:24:04', '2022-01-05 11:24:04'),
(43305, 19067, 30768, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email received from: joann.alanis@careallies.com  Subject: Enrollment Query || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers & Groups || Cigna Healthspring ||   For Renaissance you are not contracted.', NULL, NULL, '2022-01-06 16:32:13', '2022-01-06 16:32:13'),
(43306, 20067, 30768, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: joann.alanis@careallies.com  Sub: Enrollment Query || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers & Groups || Cigna Healthspring ||  Good afternoon, Hope this email finds you well. Could you please tell me for the Renaissance contract what procedure will be followed?  Thanks and regards, Syed Ahad. ', NULL, NULL, '2022-01-14 14:07:01', '2022-01-14 14:07:01'),
(43307, 20067, 30768, NULL, '2022-01-21 00:00:00.000', 'Not Eligible', 'Email received from: joann.alanis@careallies.com  Sub: Enrollment Query || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers & Groups || Cigna Healthspring ||  Hello!  The Renaissance-Eastside Board reviewed your Letter of Interest form a few months ago.  A letter was sent indicating that they were unable to extend a contract.  compliance. Copyright (c) 2022 CareAllies', NULL, NULL, '2022-01-14 14:39:01', '2022-01-14 14:39:01'),
(43308, 1006, 30769, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:04:38', '2021-05-14 15:04:38'),
(43309, 3040, 30769, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: providerservices@triwest.com  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Triwest ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Triwest 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  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, '2021-05-31 14:59:17', '2021-05-31 14:59:17'),
(43310, 3040, 30769, NULL, '2021-06-25 00:00:00.000', 'On Hold', 'Group ancillary contract is already in process. For more details please see group task. ', NULL, NULL, '2021-06-18 10:14:02', '2021-06-18 10:14:02'),
(43311, 3040, 30769, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: jmonson@triwest.com  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Triwest ||  Hello Jess,   Can you please check and advise if the below mentioned group is in-network with Triwest or not. If not so can you please generate a contract for the below mentioned group. For your reference I attached the W9.   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  If you need any additional information please let me know. Waiting for your response.  Thank you ', NULL, NULL, '2021-07-20 11:05:02', '2021-07-20 11:05:02'),
(43312, 3040, 30769, NULL, '2021-07-29 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, '2021-07-22 14:31:37', '2021-07-22 14:31:37'),
(43313, 3040, 30769, NULL, '2021-07-29 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, '2021-07-22 14:31:37', '2021-07-22 14:31:37'),
(43314, 1006, 30770, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:04:38', '2021-05-14 15:04:38'),
(43315, 3040, 30770, NULL, '2021-05-27 00:00:00.000', 'Not Eligible', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes ', NULL, NULL, '2021-05-20 16:33:18', '2021-05-20 16:33:18'),
(43316, 1006, 30782, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:04:39', '2021-05-14 15:04:39'),
(43317, 3040, 30782, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: providerservices@renaissancefamily.com  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Renaissance Physicians ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Renaissance Physicians 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  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, '2021-05-31 13:59:59', '2021-05-31 13:59:59'),
(43318, 3040, 30782, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: txgqproviderrelations@healthspring.com  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Renaissance Physicians ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Renaissance Physicians 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  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  Provider 16:   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, '2021-06-17 14:42:18', '2021-06-17 14:42:18'),
(43319, 3040, 30782, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: Chukwuma.Ezeokoli@careallies.com cc:	catherine.chang@careallies.com, shannon.luke@careallies.com,  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Renaissance Physicians ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Renaissance Physicians 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  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  Provider 16:   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, '2021-07-05 16:48:28', '2021-07-05 16:48:28'),
(43320, 3040, 30782, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: joann.alanis@careallies.com  Subject: Re: [External] Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Renaissance Physicians ||  Hello Alanis,   Hope you are doing well. Do you have any update regarding the enrollment for the below mentioned group and providers.   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  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  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-26 12:43:36', '2021-07-26 12:43:36'),
(43321, 11056, 30782, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email sent to :   joann.alanis@careallies.com   &   Chukwuma.Ezeokoli@careallies.com  Sub : Fwd: [External] Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Renaissance Physicians ||  Good evening!  Hope you are doing well. I want to inquire about the enrollment status of the below mentioned providers and practices. Please provide us with the latest updates soon.  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  Provider Details:  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  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you!  Have a great week ahead!', NULL, NULL, '2021-08-11 16:29:01', '2021-08-11 16:29:01'),
(43322, 3040, 30782, NULL, '2021-08-25 00:00:00.000', 'Not Eligible', 'Email rcvd from: JENNIFER.PEREZ@cigna.com  Subject: RE: [External] Re: Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring ||  08/03/2021 Normandy Urgent Care Center ATTN: Adil Abbas 779 Normandy Street, Suite 114 Houston, TX 77015 Dear Mr. Abbas, Thank you for your request to join the Renaissance Physician Organization/Eastside IPA, LLC. At the present time we do not have a network need in your particular specialty. As a result, we are not able to extend an invitation for participation at this time. We will however keep your request on file and reconsider in the event our network development needs change. If you have any questions, please feel free to call JoAnn Alanis at 832.553.3350. Sincerely, Julian Gonzalez, M.D. Chairman of The Board Eastside IPA, LLC', NULL, NULL, '2021-08-18 13:11:51', '2021-08-18 13:11:51'),
(43323, 1006, 30783, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:04:39', '2021-05-14 15:04:39'),
(43324, 3040, 30783, NULL, '2021-06-04 00:00:00.000', 'On Hold', 'Waiting for the enrollment in Molina healthcare.', NULL, NULL, '2021-05-28 14:28:41', '2021-05-28 14:28:41'),
(43325, 10057, 30783, NULL, '2022-01-04 00:00:00.000', 'Approved', 'Call Details: (855) 322-4080   Rep: Sharona  Reference # SF 5820908  Effective Date: 10/15/2021', NULL, NULL, '2021-12-28 17:51:58', '2021-12-28 17:51:58'),
(43326, 1006, 30784, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:04:39', '2021-05-14 15:04:39'),
(43327, 1019, 30784, NULL, '2021-06-15 00:00:00.000', 'Initiated', 'Sent the following email to colbee.snyder@primehealthservices.com SUB: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||   Greetings, Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Prime Health 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  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, '2021-05-31 14:57:22', '2021-05-31 14:57:22'),
(43328, 3040, 30784, NULL, '2021-06-25 00:00:00.000', 'In Process', 'Email rcvd from:  colbee.snyder@primehealthservices.com  Subject: RE: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||  Thank you for your email. As of February 1st, 2020 I have been moved to a position outside of the credentialing department and will no longer be your point of contact. I have copied our general credentialing email.  Going forward, please forward all new providers adds and demographic changes to credentialing@primehealthservices.com and copy updates@primehealthservices.com.  Thank you!  Colbee Snyder Patient Advocacy Specialist', NULL, NULL, '2021-06-18 13:20:48', '2021-06-18 13:20:48'),
(43329, 3040, 30784, NULL, '2021-06-25 00:00:00.000', 'In Process', 'Email sent to: credentialing@primehealthservices.com  Subject: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Prime Health 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  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  Provider 16:   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, '2021-06-18 13:24:41', '2021-06-18 13:24:41'),
(43330, 3040, 30784, NULL, '2021-07-14 00:00:00.000', 'In Process', 'Email sent to: credentialing@primehealthservices.com, updates@primehealthservices.com,  Subject: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||  Hello,   Has there been any update?  Thank you  ', NULL, NULL, '2021-07-07 16:52:16', '2021-07-07 16:52:16'),
(43331, 3040, 30784, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: credentialing@primehealthservices.com  Subject: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||  Hello,   Hope you are doing well. I was trying to reach out to know the enrollment status for the below mentioned group and providers in Prime Health 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  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  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks', NULL, NULL, '2021-07-22 11:56:13', '2021-07-22 11:56:13');
