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
(32296, 1006, 24160, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Sent f/u email @ Bharath, Bollu BharathB@aetna.com:  Sub: FW: Bay Area Quick Care - First Health Case# 13578624  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the following providers: Group Name: Bay Area Quick Care LLC NPI# 1437481421 TIN# 27-1702009 Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418-5148  Provider Name: Kynda Orsak NPI# 1528553724 License# AP137831  Provider Name: William Francis NPI# 1457994436 License# AP143937  Provider Name: Melissa Ramsden NPI# 1194376228 License# AP142173  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-07-23 15:39:25', '2021-07-23 15:39:25'),
(32297, 1006, 24160, NULL, '2021-08-17 00:00:00.000', 'In Process', 'Sent f/u email @ BharathB@aetna.com:  Sub: FW: Bay Area Quick Care - First Health Case# 13578624  \"Hello,   We\'re still waiting on an update regarding the status of this enrollment, please get back to me as soon as possible as this request has been pending for a few months now.  Thank you.\"', NULL, NULL, '2021-08-10 16:01:58', '2021-08-10 16:01:58'),
(32298, 11056, 24160, NULL, '2021-08-27 00:00:00.000', 'In Process', 'Email sent to : BharathB@aetna.com  Sub : Fwd: FW: Bay Area Quick Care - First Health Case# 13578624  Good morning!  Hope you are doing well. We\'re still waiting on an update regarding the status of this enrollment, please get back to me as soon as possible as this request has been pending for a few months now.  Group Name: Bay Area Quick Care LLC NPI# 1437481421 TIN# 27-1702009 Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418-5148  Provider Name: Kynda Orsak NPI# 1528553724 License# AP137831  Provider Name: William Francis NPI# 1457994436 License# AP143937  Provider Name: Melissa Ramsden NPI# 1194376228 License# AP142173  If you have any questions  or concerns please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-20 13:24:32', '2021-08-20 13:24:32'),
(32299, 11056, 24160, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email sent to : PDSDallas@aetna.com & Machado-PetryS@aetna.com  &  	BharathB@aetna.com  Sub : Fwd: FW: Bay Area Quick Care - First Health Case# 13578624  Good morning!  Hope you are doing well. We\'re still waiting on an update regarding the status of this enrollment, please get back to me as soon as possible as this request has been pending for a few months now.  Practice Details: Practice Name: Bay Area Quick Care LLC Practice NPI# 1437481421 Practice TIN# 27-1702009 Practice Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418-5148  Provider Details: Provider Name: Kynda Orsak NPI# 1528553724 License# AP137831  Provider Name: William Francis NPI# 1457994436 License# AP143937  Provider Name: Melissa Ramsden NPI# 1194376228 License# AP142173  If you have any questions or concerns please let me know. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-30 09:26:29', '2021-08-30 09:26:29'),
(32300, 11056, 24160, NULL, '2021-10-01 00:00:00.000', 'In Process', 'Email sent to : SidleyJ1@firsthealth.com & DillikarA@aetna.com  Sub : Fwd: FW: Bay Area Quick Care - First Health Case# 13578624  Good morning!  Hope you are doing well. We are still waiting to get the latest updates regarding the enrollment status in First Health of the below mentioned providers and practice as soon as possible. Please respond to my query soon.  Group Name	Bay Area Quick Care PLLC Tax ID	27-1702009 Group NPI	1437481421 Primary Location	9929 South Padre Island Drive, Suite 109, Corpus Christi , TX 78418-5148  Provider Name	NPI William Francis	1457994436 Kynda Orsak	1528553724 Cynthia Malowitz	  1336173244 Melissa Ramsden	1194376228   If you have any questions or concerns please let me know. Eagerly,waiting to get the response from you.  Thank you! Have a great weekend!', NULL, NULL, '2021-09-24 09:30:15', '2021-09-24 09:30:15'),
(32301, 11056, 24160, NULL, '2021-10-08 00:00:00.000', 'In Process', 'Email received from : sidleyj1@firsthealth.com>  Sub : Signature requested on \"TX_Grp_Agmt_Bay Area Quick Care PLLC_MRT210\"  Hello,  As a follow-up to my email, attached is the document for your review and signature.  After you sign TX_Grp_Agmt_Bay Area Quick Care PLLC_MRT210, the agreement will be sent to Jeanette Sidley. Then, all parties will receive a final PDF copy by email.  Thank you.  Jeanette Sidley JEANETTE SIDLEY sidleyj1@firsthealth.com  Signed by our side. Please see the attachment.   You finished signing “TX_Grp_Agmt_Bay Area Quick Care PLLC_MRT210”.  Next, Jeanette Sidley will sign.', NULL, NULL, '2021-10-01 10:06:33', '2021-10-01 10:06:33'),
(32302, 11056, 24160, NULL, '2021-10-18 00:00:00.000', 'In Process', 'Email sent to : SidleyJ1@firsthealth.com  Sub : Fwd: FW: Bay Area Quick Care - First Health Case# 13578624  Good afternoon Jeanette!  Hope you are doing great. Yes, the practice is interested in a group agreement. You may send the agreement to baqc@claimsmedinc.com and sta@claimsmedinc.com for review. Please find the roster in attachments.  I am grateful to you. Bundle of thanks for your prompt responses and assistance.  Take care! Have a wonderful & blessed week ahead!', NULL, NULL, '2021-10-11 10:12:20', '2021-10-11 10:12:20'),
(32303, 11056, 24160, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email received from: SidleyJ1@firsthealth.com  Sub: Fwd: FW: Bay Area Quick Care - First Health Case# 13578624  Hello Ahmed,  I hope that this email finds you well! I apologize that I have not been able to respond sooner, my son has been ill so I have been in and out of the office.   I will send the agreement over shortly for review. Thank you for providing the roster.  As always, please do not hesitate to reach out if you have any questions or concerns when reviewing.  Take care of yourself!  Jeanette', NULL, NULL, '2021-10-18 10:15:02', '2021-10-18 10:15:02'),
(32304, 11056, 24160, NULL, '2021-11-02 00:00:00.000', 'In Process', 'Email sent to :  SidleyJ1@firsthealth.com  Sub : Fwd: FW: Bay Area Quick Care - First Health Case# 13578624  Good morning Jeanette!  Hope this email finds you well. There is no need for an apology. How is he now? Hope he finds strength with each new day.  Please don\'t hesitate if you have any queries or concerns. Send the agreement whenever it is convenient for you.  Take care of your son & yourself too!  Thank you! Have a blessed & great week ahead!', NULL, NULL, '2021-10-26 10:31:46', '2021-10-26 10:31:46'),
(32305, 11056, 24160, NULL, '2021-11-11 00:00:00.000', 'In Process', 'Email received from : SidleyJ1@firsthealth.com  Sub : Fwd: FW: Bay Area Quick Care - First Health Case# 13578624  Good morning Ahmed,     I hope that this email finds you well! Thank you for the well wishes, we are hoping he starts to feel better soon.     I sent the agreement over for review yesterday. Please let me know if you did not receive it, I can resend the link.     Have a wonderful Friday!     Take care,', NULL, NULL, '2021-11-04 14:30:52', '2021-11-04 14:30:52'),
(32306, 11056, 24160, NULL, '2021-11-25 00:00:00.000', 'In Process', 'Email sent to: SidleyJ1@firsthealth.com  Sub: Fwd: FW: Bay Area Quick Care - First Health Case# 13578624   Good morning Jeanette!  Hope this email finds you well. He will feel better soon. He is in my prayers.  Yes, we have received that & after reviewing signed that too.  Thank you! Have a wonderful & blessed weekend ahead!', NULL, NULL, '2021-11-18 17:03:03', '2021-11-18 17:03:03'),
(32307, 11056, 24160, NULL, '2021-12-08 00:00:00.000', 'Not Eligible', 'Please mark there task to Not Eligible so we can avoid errors and save time, also if you get any approval for them they will counted  Please see the attachment too.', NULL, NULL, '2021-12-01 12:21:39', '2021-12-01 12:21:39'),
(32308, 1006, 24164, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-04-20 10:37:11', '2021-04-20 10:37:11'),
(32309, 9057, 24164, NULL, '2021-06-05 00:00:00.000', 'Initiated', 'Form for the enrollment of group has been submitted  Waiting for the Response', NULL, NULL, '2021-05-28 14:42:33', '2021-05-28 14:42:33'),
(32310, 1006, 24164, NULL, '2021-06-23 00:00:00.000', 'In Process', 'Sent f/u email @ SWHP REGION 4 SWHPRegion4@BSWhealth.org:  Sub: Enrollment Status - BAQC - Scott & White   \"Hello,   I wanted to get an update regarding the enrollment status for the following group and providers as we submitted an enrollment request back in May, their information is as follows:  Group Name: Bay Area Quick Care PLLC NPI# 1437481421 TIN# 27-1702009  Provider Name: Cynthia Malowitz NPI# 1336173244  Provider Name: Kynda Orsak NPI# 1528553724  Provider Name: Francis William NPI# 1457994436  Provider Name: Melissa Ramsden NPI# 1194376228  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-06-16 13:39:58', '2021-06-16 13:39:58'),
(32311, 1006, 24164, NULL, '2021-06-29 00:00:00.000', 'Not Eligible', 'Received the following denial notification from SWHP PROVIDER NETWORK DEVELOPMENT SWHPPROVIDERNETWORKDEVELOPMENT@bswhealth.org:  Sub: New Contract Request  \"Tax ID#: 27-1702009  RE: Network Denial Letter  Dear Bay Area Quick Care PLLC  Thank you for your recent application.  Scott and White Health Plans (SWHP) and SHA, LLC dba FirstCare Health Plans (FirstCare) appreciates your interest in becoming a part of our network.  After reviewing your online application to contract submitted on 5/28/2021, SWHP and FirstCare regretfully declines to contract with Bay Area Quick Care PLLCat this time. The determination was made based on our current network needs. However, we encourage you to reapply in 6 months; as those needs may change.  For commercial providers, we welcome you to review 28 TAC 3.3706 for more detail on denial review.  Thank you again for your interest in SWHP and FirstCare Health Plans.  Best Regards,  Scott and White Health Plans |SHA, LLC dba FirstCare Health Plans Network Development Department 1206 West Campus Dr. Temple, Texas 76502\"', NULL, NULL, '2021-06-22 16:37:39', '2021-06-22 16:37:39'),
(32312, 1006, 24165, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-04-20 10:37:13', '2021-04-20 10:37:13'),
(32313, 1006, 24165, NULL, '2021-05-17 00:00:00.000', 'Initiated', 'We received the following email from Superior Healthplan @ SHP Network Development NPR Contracting SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com:  Sub: Important request from Superior HealthPlan  \"Hello Provider,  We received a request for TIN 27-1702009 to receive a new contract from Superior Health Plan.   In order to process your request:  Ø  Can you provide me the name of the group/ facility or if (provider) practices alone? Ø  Please respond with a copy of your W9. Ø  Does the provider want to participate with all of our products (Medicaid, Chip, Medicare, and Ambetter)? Ø  Please provide a good call back number.  Without a response, we are unable to move forward.   Jeannie Lopez Superior Health Plan | Network Operations\"  Replied to them with requested information. ', NULL, NULL, '2021-05-10 12:17:02', '2021-05-10 12:17:02'),
(32314, 1006, 24165, NULL, '2021-06-17 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Subject: Important request from Superior HealthPlan Hello,   Please find the requested information below:  Group Name: Bay Area Quick Care PLLC Yes, we wish to participate in all products. Call back# 713-893-6214 W9 is attached for your reference, please let me know if anything else is required and what the expected timeframe is for this to be completed?  Thank you. ', NULL, NULL, '2021-06-10 12:32:42', '2021-06-10 12:32:42'),
(32315, 1006, 24165, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent f/u email @ SHP Network Development NPR Contracting SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com:  Sub: Enrollment Status - BAQC - Superior Health  \"Hello,  I wanted to get an update regarding the enrollment status for the following group and providers:   Group Name: Bay Area Quick Care PLLC NPI# 1437481421 TIN# 27-1702009  Provider Name: Cynthia Malowitz NPI# 1336173244  Provider Name: Kynda Orsak NPI# 1528553724  Provider Name: Francis William NPI# 1457994436  Provider Name: Melissa Ramsden NPI# 1194376228  Please get back to me as soon as possible. Thank you.\"', NULL, NULL, '2021-06-11 11:48:19', '2021-06-11 11:48:19'),
(32316, 1006, 24165, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Left voicemail @ (877) 687-1196 asking for enrollment updates as we\'re not getting any updates through the email.  ', NULL, NULL, '2021-06-15 12:03:41', '2021-06-15 12:03:41'),
(32317, 1006, 24165, NULL, '2021-06-23 00:00:00.000', 'In Process', 'We received the following reply from Credentialing Credentialing@superiorhealthplan.com:  Sub: 1437481421  \"Good Morning,  We received a voice message from you and I am happy to assist you. I understand that you would like to check the status for NPI: 1437481421.  I do not currently show information for this provider. The process to inquire about a new contract/adding provider or service to your existing contract begins by completing a Network Participation Inquiry through our website.   http://www.superiorhealthplan.com/for-providers/join-our-network/  Thank you,  Credentialing Department | Superior Health Plan 5900 E. Ben White Blvd | Austin, TX 78741 Phone: 800-820-5686 |Fax: 866-702-4831 Credentialing@superiorhealthplan.com\"  Submitted ancillary enrollment request, attached in main group task for reference. ', NULL, NULL, '2021-06-16 16:39:02', '2021-06-16 16:39:02'),
(32318, 1006, 24165, NULL, '2021-07-09 00:00:00.000', 'In Process', 'We rcvd the following reply from SHP.NetworkDevelopment@superiorhealthplan.com:  Sub: MELISSA RAMSDEN  \"We received your signed contract. However, we have not received your Credentialing Application packet. Attached is the email that was sent. Please complete the forms & return along with a copy of your current W9 so that we can start the process.  Thank you, Leslie Gilchrist Intake Coordinator Contract Management\"  Replied with:  \"Hello Leslie,  Please find the requested documents attached, do let me know if anything else is required.  Thank you. \"  The ancillary contracting request is attached in the main group task for reference. ', NULL, NULL, '2021-07-02 10:59:36', '2021-07-02 10:59:36'),
(32319, 1006, 24165, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Sent f/u email @ SHP-Network Development SHP.NetworkDevelopment@superiorhealthplan.com:  Sub: MELISSA RAMSDEN  \"Hello,   I wanted to get an update regarding the enrollment status for our provider. Please get back to me as soon as possible.  Thank you.\" ', NULL, NULL, '2021-07-23 16:33:17', '2021-07-23 16:33:17'),
(32320, 1006, 24165, NULL, '2021-08-17 00:00:00.000', 'In Process', 'We received the following update from SHP-NETWORKDEVELOPMENT@superiorhealthplan.com:  Sub: MELISSA RAMSDEN  \"Hello,  We received your completed application on July 2, 2021 Your projected effective date is August 1, 2021. Currently, it is in the process of being loaded in our system. Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.  Sincerely,  Lucy Escobar Lead Contracts Coordinatoor, Contract Management\"  Need to allow more time for it to process and complete. ', NULL, NULL, '2021-08-10 12:57:34', '2021-08-10 12:57:34'),
(32321, 11056, 24165, NULL, '2021-08-27 00:00:00.000', 'In Process', 'Email sent to : SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : RE: MELISSA RAMSDEN  Hello,   I appreciate the update, I just wanted to confirm what the status for the ancillary contract is as well?  Thank you. ', NULL, NULL, '2021-08-20 10:21:21', '2021-08-20 10:21:21'),
(32322, 11056, 24165, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email sent to : SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : RE: MELISSA RAMSDEN   We received your completed application on July 2, 2021 Your projected effective date is August 1, 2021. Currently, it is in the process of being loaded in our system. Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.     Thank you,  ', NULL, NULL, '2021-08-30 10:18:55', '2021-08-30 10:18:55'),
(32323, 11056, 24165, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email sent to : SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : RE: MELISSA RAMSDEN  Good morning!  Hope this email finds you well. Whenever the application is uploaded and the provider\'s enrollment is completed, please inform us. Please keep us updated with the process. Please let us know the latest status for the ancillary contract too.  If you need any document or information feel free to reach out to me. Waiting for your response.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-30 10:20:18', '2021-08-30 10:20:18'),
(32324, 11056, 24165, NULL, '2021-10-01 00:00:00.000', 'In Process', 'Email sent to : SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : RE: MELISSA RAMSDEN  Good morning!  Hope you are doing well. We are still waiting to get the latest updates regarding the enrollment status of the below mentioned providers and practice as soon as possible. We haven\'t received the welcome packet yet.   Group Name	Bay Area Quick Care PLLC Tax ID	27-1702009 Group NPI	1437481421 Primary Location	9929 South Padre Island Drive, Suite 109, Corpus Christi , TX 78418-5148  Provider Name	NPI William Francis	1457994436 Kynda Orsak	1528553724 Cynthia Malowitz	  1336173244 Melissa Ramsden	1194376228    If you have any questions or concerns please let me know. Eagerly,waiting to get the response from you.  Thank you! Have a great weekend!', NULL, NULL, '2021-09-24 09:12:17', '2021-09-24 09:12:17'),
(32325, 11056, 24165, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Attached is the final agreement for your reference. You can also open it online to review its activity history.', NULL, NULL, '2021-09-28 13:30:48', '2021-09-28 13:30:48'),
(32326, 11056, 24165, NULL, '2021-10-18 00:00:00.000', 'In Process', 'Email received from : SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : RE: MELISSA RAMSDEN   Hello  We received your completed application for Melissa Ramsden on 7/2/21. Your effective date is 8/1/21  and will be receiving a welcome packet shortly. ', NULL, NULL, '2021-10-11 09:52:58', '2021-10-11 09:52:58'),
(32327, 11056, 24165, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email sent to : SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : RE: MELISSA RAMSDEN  Please assist me with the query at your earliest convenience. Does the Superior Health plan come under Medicare or Medicaid?', NULL, NULL, '2021-10-18 09:05:35', '2021-10-18 09:05:35'),
(32328, 11056, 24165, NULL, '2021-11-02 00:00:00.000', 'In Process', 'Email received from: SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : RE: MELISSA RAMSDEN   Good morning!  Hope all is well. Please find the attached forms for the remaining providers mentioned below. If further information or documents are needed please let me know.  Group Name	Bay Area Quick Care PLLC Tax ID	27-1702009 Group NPI	1437481421 Primary Location	9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418-5148 Provider Name	NPI William Francis	1457994436 Kynda Orsak	1528553724 Cynthia Malowitz	1336173244   In the meantime, please do not hesitate to reach out if you have any questions or concerns.  Thank you! Have a great day!', NULL, NULL, '2021-10-26 09:58:47', '2021-10-26 09:58:47'),
(32329, 11056, 24165, NULL, '2021-11-02 00:00:00.000', 'Not Eligible', 'Please mark there task to Not Eligible so we can avoid errors and save time, also if you get any approval for them they will counted  Please see the attachment too.', NULL, NULL, '2021-10-26 10:40:33', '2021-10-26 10:40:33'),
(32330, 19067, 24165, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email received from: Anayi.Galvan@superiorhealthplan.com  Subject: FIRST Attempt - Credentialing Request; William Francis_1457994436    Hello,     We received your credentialing application for William Francis; however, we did not receive all of the documentation necessary to complete the credentialing process.  Please submit the information marked below:                        Copy of your current malpractice insurance (showing amounts and dates of coverage)     You can email the requested information to the contact information listed below.     Thank you,  Anayi Galvan  Credentialing Specialist | Superior Health Plan  5900 Ben White Blvd  Austin, TX 78741  Fax: 866-702-4831  Anayi.galvan@superiorhealthplan.com', NULL, NULL, '2022-02-21 09:39:02', '2022-02-21 09:39:02'),
(32331, 19067, 24165, NULL, '2022-02-28 00:00:00.000', 'Not Eligible', 'Please see attached.', NULL, NULL, '2022-02-21 09:50:56', '2022-02-21 09:50:56'),
(32332, 1006, 24166, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-04-20 10:37:14', '2021-04-20 10:37:14'),
(32333, 1006, 24166, NULL, '2021-05-20 00:00:00.000', 'Initiated', 'Sent an enrollment request @ trpndataentry@trpnppo.com & providerrelations@trpnppo.com:  Sub: Provider Enrollment Request - BAQC- TRPN  \"Hello,   We want to get the following providers and group enrolled with TRPN, their information is as follows:  Group Name: Bay Area Quick Care PLLC TIN# 27-1702009 NPI# 1437481421 Group Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418-5148  Provider Name: Cynthia Malowitz NPI# 1336173244  Provider Name: Kynda Orsak NPI# 1528553724  Provider Name: William Francis NPI# 1457994436  Provider Name: Melissa Ramsden NPI# 1194376228  Please let me know what is required to initiate this request and what the enrollment timeframe is?  Thank you.\"', NULL, NULL, '2021-05-04 10:32:48', '2021-05-04 10:32:48'),
(32334, 9057, 24166, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to trpndataentry@trpnppo.com, providerrelations@trpnppo.com Sub: Request for enrollment status - BAQC - Three Rivers Provider Network - TRPN  Hello, We submitted an enrollment form for the below mentioned providers under the following group.  Group Name: Bay Area Quick Care PLLC TIN# 27-1702009 NPI# 1437481421 Group Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418-5148  Provider 1 Provider Name: Cynthia Malowitz NPI# 1336173244  Provider 2 Provider Name: Kynda Orsak NPI# 1528553724  Provider 3 Provider Name: William Francis NPI# 1457994436  Provider 4 Provider Name: Melissa Ramsden NPI# 1194376228  Kindly update me with the current status regarding the above mentioned request.  Thank you', NULL, NULL, '2021-05-27 11:04:51', '2021-05-27 11:04:51'),
(32335, 1006, 24166, NULL, '2021-06-23 00:00:00.000', 'In Process', 'Called @ 800-966-8776 and spoke to Brixcia as per her we need to send an email as our group contract is under Cynthia Malowitz and we need to update it.   Email sent @ bcastillo@trpnppo.com & providerrelations@trpnppo.com:  \"Hello,  As per my discussion with Brixcia, we want to update our group contract to add the following individual providers under it, the group and providers information is as follows:   Group Name: Bay Area Quick Care PLLC TIN# 27-1702009 NPI# 1437481421 Group Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418-5148  Provider 1 Provider Name: Cynthia Malowitz NPI# 1336173244  Provider 2 Provider Name: Kynda Orsak NPI# 1528553724  Provider 3 Provider Name: William Francis NPI# 1457994436  Provider 4 Provider Name: Melissa Ramsden NPI# 1194376228  Please let me know what is required to update the contract.   Thank you!\"', NULL, NULL, '2021-06-16 13:59:17', '2021-06-16 13:59:17'),
(32336, 1006, 24166, NULL, '2021-06-29 00:00:00.000', 'In Process', 'We received the following reply from Max Flores mflores@trpnppo.com:  Sub: Request for enrollment status - BAQC - Three Rivers Provider Network - TRPN  \"Good morning Brad,  I hope this message finds you well. Thank you for taking the time to speak to me today, per our conversation attached you will find the proposal if you have any questions please feel free to contact me directly for assistance. Thank you for your time today have a great Tuesday.  Kind regards,  Max Flores Contracting Manager 6970 O’Bannon Drive Las Vegas, Nevada 89117 Phone: (619) 737-9546 Fax: (619) 271-6316 mflores@trpnppo.com www.trpnppo.com\"  Sent following reply:  \"Hello, Max,   Thank you for the update, here\'s the group agreement filled out and signed. Do let me know if anything else is needed.  Thank you\"', NULL, NULL, '2021-06-22 16:16:28', '2021-06-22 16:16:28'),
(32337, 11056, 24166, NULL, '2021-07-14 00:00:00.000', 'In Process', 'Email received from : mflores@trpnppo.com  Sub : Request for enrollment status - BAQC - Three Rivers Provider Network - TRPN  Brad,   I will have the agreement processed and you can expect to receive the countersigned copy in 3 weeks, if you have any questions in the meantime please feel free to contact me directly for assistance.     Kind regards,  Max Flores Contracting Manager 6970 O’Bannon Drive  Las Vegas, Nevada 89117  Phone: (619) 737-9546  Fax: (619) 271-6316 mflores@trpnppo.com www.trpnppo.com', NULL, NULL, '2021-07-06 15:03:12', '2021-07-06 15:03:12'),
(32338, 1006, 24166, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Sent f/u email @ Max Flores mflores@trpnppo.com:  Sub: Request for enrollment status - BAQC - Three Rivers Provider Network - TRPN  \"Hello Max,  I hope you\'re doing well, I wanted to get an update regarding this request. Please get back to me as soon as you\'re able.  Thank you!\"', NULL, NULL, '2021-07-23 16:36:42', '2021-07-23 16:36:42'),
(32339, 1006, 24166, NULL, '2021-08-03 00:00:00.000', 'Approved', 'The group and providers have been approved.   Eff: 06/22/2021  An executed contract is attached for reference. ', NULL, NULL, '2021-07-27 12:28:49', '2021-07-27 12:28:49'),
(32340, 1006, 24167, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-04-20 10:37:16', '2021-04-20 10:37:16'),
(32341, 1006, 24167, NULL, '2021-05-20 00:00:00.000', 'Initiated', 'Submitted enrollment form for Group and Cynthia as main provider via Wellcare portal:  \"Become A Provider  Your form was submitted successfully.  Thank you for contacting us. A representative will be in contact to discuss your interest in becoming a participating Provider.\"  Form attached in group task for reference. ', NULL, NULL, '2021-05-04 10:19:46', '2021-05-04 10:19:46'),
(32342, 1006, 24167, NULL, '2021-06-17 00:00:00.000', 'In Process', 'I had a word with (John) with Wellcare representative and he advises their network development department will contact us.   Ref: 1012719812', NULL, NULL, '2021-06-10 12:20:55', '2021-06-10 12:20:55'),
(32343, 1006, 24167, NULL, '2021-07-06 00:00:00.000', 'In Process', 'Sent f/u email @ \".ProspectiveProviderTX\" ProspectiveProviderTX@wellcare.com:  Sub: Enrollment Status - BAQC - Wellcare  \"Hello,   I wanted to get an update regarding the enrollment status for our group and providers, we submitted the enrollment application via the website last month. The group and provider information is as follows:  Group Name: Bay Area Quick Care LLC NPI# 1437481421 TIN# 27-1702009 Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418-5148  Provider name: Cynthia Malowitz NPI# 1336173244  Provider Name: Kynda Orsak NPI# 1528553724  Provider Name: William Francis NPI# 1457994436  Provider Name: Melissa Ramsden NPI# 1194376228  Please get back to me on the updated status of the enrollment.  Thank you!\"', NULL, NULL, '2021-06-29 11:06:31', '2021-06-29 11:06:31'),
(32344, 1006, 24167, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Sent f/u email @ \".ProspectiveProviderTX\" ProspectiveProviderTX@wellcare.com:  Sub: Enrollment Status - BAQC - Wellcare  \"Hello,   I hope you\'re doing well, please get back to me on the enrollment request for our group and providers.  Thank you!\"', NULL, NULL, '2021-07-23 16:47:45', '2021-07-23 16:47:45'),
(32345, 1006, 24167, NULL, '2021-08-05 00:00:00.000', 'In Process', 'Received response:  \"What is the TIN & NPI?  Thank you, Leslie Gilchrist Intake Coordinator Contract Management\"  Replied: \"Hello Melissa,   Sure thing, the information is as follows:  Group Name: Bay Area Quick Care PLLC NPI# 1437481421 TIN# 27-1702009  Provider Name: Melissa Ramsden NPI# 1194376228  Thank you. \"', NULL, NULL, '2021-07-29 13:00:05', '2021-07-29 13:00:05'),
(32346, 1006, 24167, NULL, '2021-08-17 00:00:00.000', 'In Process', 'Sent f/u email @ SHP.NetworkDevelopment@superiorhealthplan.com:  Sub: MELISSA RAMSDEN  \"Hello Lucy,   I just wanted to check with you if there had been any new updates, please let me know.   Thank you. \"', NULL, NULL, '2021-08-10 16:22:46', '2021-08-10 16:22:46'),
(32347, 11056, 24167, NULL, '2021-08-27 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Updates - BAQC - WELCARE  Good morning!  Hope this email finds you well. I wanted to get an latest updates regarding the enrollment status of the following providers and practice:  Practice Details: Practice Name: Bay Area Quick Care LLC Practice NPI# 1437481421 Practice TIN# 27-1702009 Practice Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418-5148  Provider Details:  Provider name: Cynthia Malowitz NPI# 1336173244  Provider Name: Kynda Orsak NPI# 1528553724  Provider Name: William Francis NPI# 1457994436  Provider Name: Melissa Ramsden NPI# 1194376228  If you have any questions or need documents please let me know. Waiting for your response.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-20 10:36:17', '2021-08-20 10:36:17'),
(32348, 11056, 24167, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com & cynthia.barnett@wellcare.com &  TERESA.Argueta@wellcare.com  Sub : Enrollment Status Updates - BAQC - WELCARE  Good morning!  Hope this email finds you well. I wanted to get an latest updates regarding the enrollment status of the following providers and practice:  Practice Details: Practice Name: Bay Area Quick Care LLC Practice NPI# 1437481421 Practice TIN# 27-1702009 Practice Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418-5148  Provider Details:  Provider name: Cynthia Malowitz NPI# 1336173244  Provider Name: Kynda Orsak NPI# 1528553724  Provider Name: William Francis NPI# 1457994436  Provider Name: Melissa Ramsden NPI# 1194376228  If you have any questions or need documents please let me know. Waiting for your response.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-30 10:27:35', '2021-08-30 10:27:35'),
(32349, 11056, 24167, NULL, '2021-10-01 00:00:00.000', 'In Process', 'Email sent to : Cynthia.Barnett@wellcare.com  Sub : Enrollment Status Updates - BAQC - WELCARE  Good morning Cynthia!  Hope this email finds you well. Please provide me with someone who can respond to my query for Wellcare, because no one hasn\'t responded to me since August. Kindly provide with the representative\'s email or contact no. for this address :Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418-5148.  I will be grateful to you.   Thank you! Have a wonderful Weekend!', NULL, NULL, '2021-09-24 09:20:21', '2021-09-24 09:20:21'),
(32350, 11056, 24167, NULL, '2021-10-18 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Updates - BAQC - WELCARE  Good morning!  Hope you are doing great. I am still waiting for the representative details in the Corpus Christi area. Please assist me with that soon.  Eagerly, waiting to hear from you soon.  Thank you! Have a blessed day!  Contacted Miss Cynthia. She informed me that she gonna confirm if they provide services in Corpus christi area or  not.', NULL, NULL, '2021-10-11 10:36:24', '2021-10-11 10:36:24'),
(32351, 11056, 24167, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email received from : Schlonda.Ramee@wellcare.com  Sub : Enrollment Status Updates - BAQC - WELCARE  Good afternoon,     Ahmed, please excuse my tardiness.  The assigned Account Manager is Jetori Campbell. Jetori can be reached at Jetori.campbell@wellcare.com I have also included her in this email.     Jetori, can you please assist Ahmed?     Thanks,     Schlonda Ramee Jackson, Notary Public  Manager, Provider Network, G&A-Provider Relations     4888 Loop Central Drive, Suite 300  Houston, Texas 77081  Direct Mobile 713-409-6354  schlonda.rameejackson@wellcare.com | https://www.wellcare.com', NULL, NULL, '2021-10-18 09:22:22', '2021-10-18 09:22:22'),
(32352, 11056, 24167, NULL, '2021-11-02 00:00:00.000', 'In Process', 'Email received from : Jetori.Campbell@wellcare.com  Sub : Enrollment Status Updates - BAQC - WELCARE   Good Morning Ahmed,  Thank you for following up on your request to Join Our Network.  You should have received correspondence from Superior Health Plan/ WellCare in response to your request. Once all information is signed and received from both parties; please anticipate up to 90 days for credentialing to be completed.   Please let me know if you have any questions.  Thank You  Ms. JeTori Campbell Provider Account Manager 4888 Loop Central Drive, Suite 300  Houston, Texas 77081 Direct Mobile 972-795-8691 jetori.campbell@wellcare.com | https://www.wellcare.com', NULL, NULL, '2021-10-26 10:18:23', '2021-10-26 10:18:23'),
(32353, 11056, 24167, NULL, '2021-11-02 00:00:00.000', 'Not Eligible', 'Please mark there task to Not Eligible so we can avoid errors and save time, also if you get any approval for them they will counted  Please see the attachment too.', NULL, NULL, '2021-10-26 10:42:20', '2021-10-26 10:42:20'),
(32354, 11056, 24167, NULL, '2021-11-02 00:00:00.000', 'Not Eligible', 'Please mark there task to Not Eligible so we can avoid errors and save time, also if you get any approval for them they will counted  Please see the attachment too.', NULL, NULL, '2021-10-26 10:43:54', '2021-10-26 10:43:54'),
(32355, 1006, 24168, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-04-20 10:44:53', '2021-04-20 10:44:53'),
(32356, 1006, 24168, NULL, '2021-05-10 00:00:00.000', 'Initiated', 'Enrollment request was submitted via Ambetter online portal.   \"Thank You Thank you for your Ambetter network participation request! We have received your inquiry. Please allow 7-10 business days for our reply.\"', NULL, NULL, '2021-05-03 14:27:00', '2021-05-03 14:27:00'),
(32357, 9057, 24168, NULL, '2021-06-03 00:00:00.000', 'In Process', 'we sent an email to credentialing@superiorhealthplan.com Sub: Enrollment status request - RHC - Ambetta  Hello , We submitted request for the enrollment of providers under the following group  Practice Detail: Practice Name: Bay Area Quick Care PLLC Practice Tax ID# 27-1702009 Practice NPI# 1437481421 Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi , TX 78418-5148  Provider Details Provider Name: Ramsden, Melissa Provider NPI#   1194376228  Kindly update me on the current status of the above mentioned request as soon as possible.  Thank you', NULL, NULL, '2021-05-26 17:10:23', '2021-05-26 17:10:23'),
(32358, 1006, 24168, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Left voicemail @ (877) 687-1196 asking for enrollment updates as we\'re not getting any updates through the email. ', NULL, NULL, '2021-06-15 12:02:29', '2021-06-15 12:02:29'),
(32359, 1006, 24168, NULL, '2021-07-09 00:00:00.000', 'In Process', 'We rcvd the following reply from SHP.NetworkDevelopment@superiorhealthplan.com:  Sub: MELISSA RAMSDEN  \"We received your signed contract. However, we have not received your Credentialing Application packet. Attached is the email that was sent. Please complete the forms & return along with a copy of your current W9 so that we can start the process.  Thank you, Leslie Gilchrist Intake Coordinator Contract Management\"  Replied with:  \"Hello Leslie,  Please find the requested documents attached, do let me know if anything else is required.  Thank you. \"  The ancillary contracting request is attached in the main group task for reference.', NULL, NULL, '2021-07-02 10:58:59', '2021-07-02 10:58:59'),
(32360, 1006, 24168, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Sent f/u email @ SHP-Network Development SHP.NetworkDevelopment@superiorhealthplan.com:  Sub; MELISSA RAMSDEN  \"Hello,   I wanted to get an update regarding the enrollment status for our provider. Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-23 14:36:07', '2021-07-23 14:36:07'),
(32361, 1006, 24168, NULL, '2021-08-09 00:00:00.000', 'In Process', 'We received the following update from SHP-NETWORKDEVELOPMENT@superiorhealthplan.com:  Sub: MELISSA RAMSDEN  \"Hello,  We received your completed application on July 2, 2021 Your projected effective date is August 1, 2021. Currently, it is in the process of being loaded in our system. Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.  Sincerely,  Lucy Escobar Lead Contracts Coordinatoor, Contract Management Email-Block-6 Superior HealthPlan       7990 IH10 West San Antonio, TX 78230 Lucy.escobar@superiorhealthplan.com | SuperiorHealthPlan.com\"  ', NULL, NULL, '2021-08-02 15:59:36', '2021-08-02 15:59:36'),
(32362, 1006, 24168, NULL, '2021-08-17 00:00:00.000', 'In Process', 'We received the following update from SHP-NETWORKDEVELOPMENT@superiorhealthplan.com:  Sub: MELISSA RAMSDEN  \"Hello,  We received your completed application on July 2, 2021 Your projected effective date is August 1, 2021. Currently, it is in the process of being loaded in our system. Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.  Sincerely,  Lucy Escobar Lead Contracts Coordinatoor, Contract Management\"  Need to allow more time for it to process and complete. ', NULL, NULL, '2021-08-10 12:58:32', '2021-08-10 12:58:32'),
(32363, 11056, 24168, NULL, '2021-08-27 00:00:00.000', 'In Process', 'Email sent to : SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : RE: MELISSA RAMSDEN  Hello,   I appreciate the update, I just wanted to confirm what the status for the ancillary contract is as well?  Thank you. ', NULL, NULL, '2021-08-20 08:52:39', '2021-08-20 08:52:39'),
(32364, 11056, 24168, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email sent to : SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : RE: MELISSA RAMSDEN  Good morning!  Hope this email finds you well. Whenever the application is uploaded and the provider\'s enrollment is completed, please inform us. Please keep us updated with the process. Please let us know the latest status for the ancillary contract too.  If you need any document or information feel free to reach out to me. Waiting for your response.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-30 09:31:02', '2021-08-30 09:31:02'),
(32365, 11056, 24168, NULL, '2021-09-17 00:00:00.000', 'In Process', 'We received the following update from SHP-NETWORKDEVELOPMENT@superiorhealthplan.com:  Sub : RE: MELISSA RAMSDEN  Hello     We received your completed application on 7/2/21. Your effective date is 8/1/21 and will be receiving a welcome packet shortly. ', NULL, NULL, '2021-09-10 08:39:26', '2021-09-10 08:39:26'),
(32366, 11056, 24168, NULL, '2021-10-04 00:00:00.000', 'In Process', 'Email sent to : SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : RE: MELISSA RAMSDEN  Good morning!  Hope you are doing well. We are still waiting to get the latest updates regarding the enrollment status of the below mentioned providers and practice as soon as possible. We haven\'t received the welcome packet yet.   Group Name	Bay Area Quick Care PLLC Tax ID	27-1702009 Group NPI	1437481421 Primary Location	9929 South Padre Island Drive, Suite 109, Corpus Christi , TX 78418-5148  Provider Name	NPI William Francis	1457994436 Kynda Orsak	1528553724 Cynthia Malowitz	  1336173244 Melissa Ramsden	1194376228    If you have any questions or concerns please let me know. Eagerly,waiting to get the response from you.  Thank you! Have a great weekend! ', NULL, NULL, '2021-09-27 09:26:15', '2021-09-27 09:26:15'),
(32367, 11056, 24168, NULL, '2021-10-18 00:00:00.000', 'In Process', 'Email received from : SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : RE: MELISSA RAMSDEN   Hello  We received your completed application for Melissa Ramsden on 7/2/21. Your effective date is 8/1/21  and will be receiving a welcome packet shortly. ', NULL, NULL, '2021-10-11 14:58:38', '2021-10-11 14:58:38'),
(32368, 11056, 24168, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email sent to : SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : RE: MELISSA RAMSDEN  Please assist me with the query at your earliest convenience. Does the Superior Health plan come under Medicare or Medicaid?', NULL, NULL, '2021-10-18 09:06:10', '2021-10-18 09:06:10'),
(32369, 11056, 24168, NULL, '2021-11-02 00:00:00.000', 'In Process', 'Email received from: SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : RE: MELISSA RAMSDEN   Good morning!  Hope all is well. Please find the attached forms for the remaining providers mentioned below. If further information or documents are needed please let me know.  Group Name	Bay Area Quick Care PLLC Tax ID	27-1702009 Group NPI	1437481421 Primary Location	9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418-5148 Provider Name	NPI William Francis	1457994436 Kynda Orsak	1528553724 Cynthia Malowitz	1336173244   In the meantime, please do not hesitate to reach out if you have any questions or concerns.  Thank you! Have a great day!', NULL, NULL, '2021-10-26 10:01:06', '2021-10-26 10:01:06'),
(32370, 11056, 24168, NULL, '2021-11-02 00:00:00.000', 'Not Eligible', 'Please mark there task to Not Eligible so we can avoid errors and save time, also if you get any approval for them they will counted  Please see the attachment too.', NULL, NULL, '2021-10-26 10:41:34', '2021-10-26 10:41:34'),
(32371, 1006, 24169, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-04-20 10:44:55', '2021-04-20 10:44:55'),
(32372, 1006, 24169, NULL, '2021-04-27 00:00:00.000', 'On Hold', 'Pending Medicaid Enrollment.', NULL, NULL, '2021-04-20 12:20:16', '2021-04-20 12:20:16'),
(32373, 9057, 24169, NULL, '2021-06-08 00:00:00.000', 'Not Eligible', '', NULL, NULL, '2021-05-31 17:02:16', '2021-05-31 17:02:16'),
(32374, 9057, 24169, NULL, '2021-06-08 00:00:00.000', 'Not Eligible', 'We sent an email to: registrar@multiplan.com Sub: Request for Enrollment Status - BAQC - Multiplan  Hello, I want to get the current status of the below mentioned group & providers  Group Name: Bay Area Quick Care LLC NPI: 1437481421 TIN# 27-1702009 Main Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418  Provider name: Orsak, Kynda  NPI# 1528553724  Provider Name: Malowitz, Cynthia NPI# 1336173244  Provider Name: Ramsden, Melissa NPI# 1194376228  Kindly respond to us as soon as possible.  Thank you ', NULL, NULL, '2021-05-31 17:02:27', '2021-05-31 17:02:27'),
(32375, 1006, 24170, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-04-20 10:44:57', '2021-04-20 10:44:57'),
(32376, 9057, 24170, NULL, '2021-06-08 00:00:00.000', 'Initiated', 'We Sent an email to: CSHNproviderrelations@christushealth.org Sub: Requisition of Enrollment - BAQC - Christus Spohn  Hello, Hope you are doing well, We wish to enroll our group and providers, find details given below.   Group Name: Bay Area Quick Care LLC NPI: 1437481421 TIN# 27-1702009 Main Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418  Provider name: Orsak, Kynda NPI# 1528553724  Provider Name: Malowitz, Cynthia NPI# 1336173244  Provider Name: Ramsden, Melissa NPI# 1194376228  Provider Name: Francis, William: NPI# 1457994436  If you need any more details, please let me know.  Thank you', NULL, NULL, '2021-06-01 09:57:35', '2021-06-01 09:57:35'),
(32377, 1006, 24170, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Sent f/u email @ CSHNproviderrelations@christushealth.org:  Sub: Enrollment Status - BAQC - Christus Spohn  \"Hello,   I wanted to get an update regarding the enrollment query we submitted for the following group and providers, their information is as follows:   Group Name: Bay Area Quick Care LLC NPI: 1437481421 TIN# 27-1702009  Main Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418  Provider name: Orsak, Kynda NPI# 1528553724  Provider Name: Malowitz, Cynthia NPI# 1336173244  Provider Name: Ramsden, Melissa NPI# 1194376228  Provider Name: Francis, William: NPI# 1457994436  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-06-17 10:46:58', '2021-06-17 10:46:58'),
(32378, 11056, 24170, NULL, '2021-07-14 00:00:00.000', 'In Process', 'Email sent to :   CSHNproviderrelations@christushealth.org  Sub : Enrollment Status - BAQC - Christus Spohn  Greetings,  Hope you are doing well. I wanted to get an update regarding the enrollment query we submitted for the following group and providers, their information is as follows:   Practice: Practice Name: Bay Area Quick Care LLC NPI: 1437481421 TIN# 27-1702009 Main Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418  Providers: Provider name: Orsak, Kynda NPI# 1528553724  Provider Name: Malowitz, Cynthia NPI# 1336173244  Provider Name: Ramsden, Melissa NPI# 1194376228  Provider Name: Francis, William: NPI# 1457994436  Please get back to me as soon as possible. Kindly Respond.  Thank you!', NULL, NULL, '2021-07-06 15:46:07', '2021-07-06 15:46:07'),
(32379, 1006, 24170, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Sent f/u email @ \"Guerra, Vicki A.\" vicki.guerra@christushealth.org', NULL, NULL, '2021-07-27 16:33:17', '2021-07-27 16:33:17'),
(32380, 1006, 24170, NULL, '2021-08-12 00:00:00.000', 'In Process', 'We received the following update from vicki.guerra@christushealth.org:  Sub: Enrollment Status - BAQC - Christus Spohn  \"Hi Brad,  Happy Thursday!  Does this provider group have hospital affiliations with a Christus facility? Or, is there a physician this group utilizes who does have hospital affiliations?  Thanks,  Vicki Ann Guerra Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  Replied with:  \"Hello Vicki,   The group and provider do have a supervising physician David Gray (NPI# 1902814874) who has hospital affiliations. Please let me know if this works for you?  Thank you. \"', NULL, NULL, '2021-08-05 12:38:55', '2021-08-05 12:38:55'),
(32381, 1006, 24170, NULL, '2021-08-25 00:00:00.000', 'Not Eligible', 'We received the following denial notification from vicki.guerra@christushealth.org:  Sub: Gray MD Affiliations Expired: Enrollment Status - BAQC - Christus Spohn  \"Hi Brad,  I reviewed Dr. Grays affiliations and they have expired with the hospital. Please see the attached. Dr. Gray will need to be credentialed again with the hospital in order for the group to be extended a contract. He may have missed his reappointment. Please see attached documentation.  Is this possible for Dr. Gray or yourself to reach out to medical staff administration and inquire?  Medical Staff Administration Tel: (361) 881-3151 Fax: (361) 881-3714  Vicki Ann Guerra Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"', NULL, NULL, '2021-08-18 10:57:02', '2021-08-18 10:57:02'),
(32382, 1006, 24173, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-04-20 10:45:02', '2021-04-20 10:45:02'),
(32383, 1006, 24173, NULL, '2021-04-27 00:00:00.000', 'Initiated', 'Sent following email to PDSDallas@aetna.com:  Sub: Enrollment Request/Status - Bay Area Quick Care - First Health  \"Hello,  I hope you\'re doing well, I wanted to verify the enrollment status for the following group and providers:   Group Name: Bay Area Quick Care LLC NPI# 1437481421  Provider Name: Cynthia Malowitz NPI# 1336173244  Provider Name: Kynda Orsak NPI# 1528553724  Provider Name: William Francis NPI# 1457994436  Provider Name: Melissa Ramsden NPI# 1194376228  If the above-mentioned providers are enrolled please send over their welcome letters and if they require enrollment please let me know what the process is.   Thank you.\"', NULL, NULL, '2021-04-20 13:06:04', '2021-04-20 13:06:04'),
(32384, 1006, 24173, NULL, '2021-05-05 00:00:00.000', 'In Process', 'Sent a f/u email @ PDSDallas@aetna.com:  Sub: Enrollment Request/Status - Bay Area Quick Care - First Health  \"Hello,   I hope you\'re doing well, I wanted to follow-up on this request again, Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-04-28 12:43:57', '2021-04-28 12:43:57'),
(32385, 9057, 24173, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to DillikarA@aetna.com, pdsdallas@aetna.com: Sub: Status: [EXTERNAL] Enrollment Request/Status - Bay Area Quick Care - First Health Case# 12591444  \"Hello,   I wanted to follow up on this request, what information is needed for these providers?  Thank you. \" ', NULL, NULL, '2021-05-27 09:34:09', '2021-05-27 09:34:09');
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
(32386, 3040, 24173, NULL, '2021-06-17 00:00:00.000', 'In Process', 'Email sent to: DillikarA@aetna.com  Subject:  Status: [EXTERNAL] Enrollment Request/Status - Bay Area Quick Care - First Health Case# 12591444   Hi,  Provider (Cynthia Malowitz) is active under Tax ID: 271702009 With effective 11/01/2012 in First Health Networks.  And rest providers are not linked with First Health if they needs to be enrolled please send their complete provider details to pdsdallas@aetna.com from there your request will be taken care by a particular user.  Thanks, Akhilesh Dillikar', NULL, NULL, '2021-06-10 10:42:28', '2021-06-10 10:42:28'),
(32387, 1006, 24173, NULL, '2021-07-06 00:00:00.000', 'In Process', 'Sent requested information @ Bharath, Bollu BharathB@aetna.com, TalasilaB@aetna.com, DillikarA@aetna.com:  Sub: FW: Bay Area Quick Care - First Health Case# 13578624  \"Hello,   Please find the attached information:   Group Name: Bay Area Quick Care LLC NPI# 1437481421 TIN# 27-1702009  Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418-5148  Provider Name: Kynda Orsak NPI# 1528553724 License# AP137831  Provider Name: William Francis NPI# 1457994436 License# AP143937  Provider Name: Melissa Ramsden NPI# 1194376228 License# AP142173  Please let me know what else is required to proceed with this request.  Thank you!\"', NULL, NULL, '2021-06-29 10:44:44', '2021-06-29 10:44:44'),
(32388, 1006, 24173, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Sent f/u email @ Bharath, Bollu BharathB@aetna.com:  Sub: FW: Bay Area Quick Care - First Health Case# 13578624  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the following providers: Group Name: Bay Area Quick Care LLC NPI# 1437481421 TIN# 27-1702009 Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418-5148  Provider Name: Kynda Orsak NPI# 1528553724 License# AP137831  Provider Name: William Francis NPI# 1457994436 License# AP143937  Provider Name: Melissa Ramsden NPI# 1194376228 License# AP142173  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-07-23 15:39:33', '2021-07-23 15:39:33'),
(32389, 1006, 24173, NULL, '2021-08-17 00:00:00.000', 'In Process', 'Sent f/u email @ BharathB@aetna.com:  Sub: FW: Bay Area Quick Care - First Health Case# 13578624  \"Hello,   We\'re still waiting on an update regarding the status of this enrollment, please get back to me as soon as possible as this request has been pending for a few months now.  Thank you.\"', NULL, NULL, '2021-08-10 16:01:47', '2021-08-10 16:01:47'),
(32390, 11056, 24173, NULL, '2021-08-27 00:00:00.000', 'In Process', 'Email sent to : BharathB@aetna.com  Sub : Fwd: FW: Bay Area Quick Care - First Health Case# 13578624  Good morning!  Hope you are doing well. We\'re still waiting on an update regarding the status of this enrollment, please get back to me as soon as possible as this request has been pending for a few months now.  Group Name: Bay Area Quick Care LLC NPI# 1437481421 TIN# 27-1702009 Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418-5148  Provider Name: Kynda Orsak NPI# 1528553724 License# AP137831  Provider Name: William Francis NPI# 1457994436 License# AP143937  Provider Name: Melissa Ramsden NPI# 1194376228 License# AP142173  If you have any questions  or concerns please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-20 13:24:00', '2021-08-20 13:24:00'),
(32391, 11056, 24173, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email sent to : PDSDallas@aetna.com & Machado-PetryS@aetna.com  &  	BharathB@aetna.com  Sub : Fwd: FW: Bay Area Quick Care - First Health Case# 13578624  Good morning!  Hope you are doing well. We\'re still waiting on an update regarding the status of this enrollment, please get back to me as soon as possible as this request has been pending for a few months now.  Practice Details: Practice Name: Bay Area Quick Care LLC Practice NPI# 1437481421 Practice TIN# 27-1702009 Practice Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418-5148  Provider Details: Provider Name: Kynda Orsak NPI# 1528553724 License# AP137831  Provider Name: William Francis NPI# 1457994436 License# AP143937  Provider Name: Melissa Ramsden NPI# 1194376228 License# AP142173  If you have any questions or concerns please let me know. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-30 09:26:05', '2021-08-30 09:26:05'),
(32392, 11056, 24173, NULL, '2021-10-01 00:00:00.000', 'In Process', 'Email sent to : SidleyJ1@firsthealth.com & DillikarA@aetna.com  Sub : Fwd: FW: Bay Area Quick Care - First Health Case# 13578624  Good morning!  Hope you are doing well. We are still waiting to get the latest updates regarding the enrollment status in First Health of the below mentioned providers and practice as soon as possible. Please respond to my query soon.  Group Name	Bay Area Quick Care PLLC Tax ID	27-1702009 Group NPI	1437481421 Primary Location	9929 South Padre Island Drive, Suite 109, Corpus Christi , TX 78418-5148  Provider Name	NPI William Francis	1457994436 Kynda Orsak	1528553724 Cynthia Malowitz	  1336173244 Melissa Ramsden	1194376228   If you have any questions or concerns please let me know. Eagerly,waiting to get the response from you.  Thank you! Have a great weekend!', NULL, NULL, '2021-09-24 09:29:58', '2021-09-24 09:29:58'),
(32393, 11056, 24173, NULL, '2021-10-08 00:00:00.000', 'In Process', 'Email received from : sidleyj1@firsthealth.com>  Sub : Signature requested on \"TX_Grp_Agmt_Bay Area Quick Care PLLC_MRT210\"  Hello,  As a follow-up to my email, attached is the document for your review and signature.  After you sign TX_Grp_Agmt_Bay Area Quick Care PLLC_MRT210, the agreement will be sent to Jeanette Sidley. Then, all parties will receive a final PDF copy by email.  Thank you.  Jeanette Sidley JEANETTE SIDLEY sidleyj1@firsthealth.com  Signed by our side. Please see the attachment.   You finished signing “TX_Grp_Agmt_Bay Area Quick Care PLLC_MRT210”.  Next, Jeanette Sidley will sign.', NULL, NULL, '2021-10-01 10:06:14', '2021-10-01 10:06:14'),
(32394, 11056, 24173, NULL, '2021-10-18 00:00:00.000', 'In Process', 'Email sent to :   Sub :   Good afternoon Jeanette!  Hope you are doing great. Yes, the practice is interested in a group agreement. You may send the agreement to baqc@claimsmedinc.com and sta@claimsmedinc.com for review. Please find the roster in attachments.  I am grateful to you. Bundle of thanks for your prompt responses and assistance.  Take care! Have a wonderful & blessed week ahead!', NULL, NULL, '2021-10-11 10:11:38', '2021-10-11 10:11:38'),
(32395, 11056, 24173, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email received from: SidleyJ1@firsthealth.com  Sub: Fwd: FW: Bay Area Quick Care - First Health Case# 13578624  Hello Ahmed,  I hope that this email finds you well! I apologize that I have not been able to respond sooner, my son has been ill so I have been in and out of the office.   I will send the agreement over shortly for review. Thank you for providing the roster.  As always, please do not hesitate to reach out if you have any questions or concerns when reviewing.  Take care of yourself!  Jeanette', NULL, NULL, '2021-10-18 10:15:16', '2021-10-18 10:15:16'),
(32396, 11056, 24173, NULL, '2021-11-02 00:00:00.000', 'In Process', 'Email sent to :  SidleyJ1@firsthealth.com  Sub : Fwd: FW: Bay Area Quick Care - First Health Case# 13578624  Good morning Jeanette!  Hope this email finds you well. There is no need for an apology. How is he now? Hope he finds strength with each new day.  Please don\'t hesitate if you have any queries or concerns. Send the agreement whenever it is convenient for you.  Take care of your son & yourself too!  Thank you! Have a blessed & great week ahead!', NULL, NULL, '2021-10-26 10:30:44', '2021-10-26 10:30:44'),
(32397, 11056, 24173, NULL, '2021-11-11 00:00:00.000', 'In Process', 'Email received from : SidleyJ1@firsthealth.com  Sub : Fwd: FW: Bay Area Quick Care - First Health Case# 13578624  Good morning Ahmed,     I hope that this email finds you well! Thank you for the well wishes, we are hoping he starts to feel better soon.     I sent the agreement over for review yesterday. Please let me know if you did not receive it, I can resend the link.     Have a wonderful Friday!     Take care,', NULL, NULL, '2021-11-04 14:30:35', '2021-11-04 14:30:35'),
(32398, 11056, 24173, NULL, '2021-11-25 00:00:00.000', 'In Process', 'Email sent to: SidleyJ1@firsthealth.com  Sub: Fwd: FW: Bay Area Quick Care - First Health Case# 13578624   Good morning Jeanette!  Hope this email finds you well. He will feel better soon. He is in my prayers.  Yes, we have received that & after reviewing signed that too.  Thank you! Have a wonderful & blessed weekend ahead!', NULL, NULL, '2021-11-18 17:02:49', '2021-11-18 17:02:49'),
(32399, 11056, 24173, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email sent to:  SidleyJ1@firsthealth.com  Sub :  Fwd: FW: Bay Area Quick Care - First Health Case# 13578624  Good morning!  Hope this email finds you well. Are there any updates regarding the providers\' enrollment process? How is your son now?  Thank you! Have a blessed day!', NULL, NULL, '2021-12-01 12:19:46', '2021-12-01 12:19:46'),
(32400, 11056, 24173, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Email received from:  SidleyJ1@firsthealth.com  Sub: Fwd: FW: Bay Area Quick Care - First Health Case# 13578624   Good morning Ahmed,   I hope that this email finds you well! My son is finally doing much better, thank you so much for asking!   The agreement for this practice is effective 11/1/21. It is still in the implementation stage with our Data Team. Once I have the new group ID number I will be sending over the welcome letter.   In the meantime, please do not hesitate to reach out if you have any questions or concerns.  Take care!', NULL, NULL, '2021-12-08 13:51:25', '2021-12-08 13:51:25'),
(32401, 11056, 24173, NULL, '2021-12-29 00:00:00.000', 'Approved', 'Email received from: SidleyJ1@firsthealth.com  Sub: Bay Area Quick Care PLLC - First Health Network   Hello,  It is with great pleasure to welcome you to the First Health Network. I would like to personally thank you for all of your time and efforts during the contracting process. You should have already received your fully executed copy of the First Health Agreement.  You may reference your CPD ID # 1074082 (which became effective 11/01/2021)   Please see the attachment.', NULL, NULL, '2021-12-22 15:14:57', '2021-12-22 15:14:57'),
(32402, 1006, 24177, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-04-20 10:45:08', '2021-04-20 10:45:08'),
(32403, 1006, 24177, NULL, '2021-05-11 00:00:00.000', 'Not Eligible', 'Received the below email for network closure .-------------------------------- MHHP Contracting 9:16 AM (7 hours ago) to me  Good morning Sherry. At this time, Corpus Christi, Texas is out of our network area, and we do not contract out of network at this time. I am withdrawing your application for participation. If something changes in the near future, we will let you know. Please let me know if you have any questions.     Thank you.     Camilla Paige', NULL, NULL, '2021-05-04 10:38:29', '2021-05-04 10:38:29'),
(32404, 1006, 24178, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-04-20 10:45:10', '2021-04-20 10:45:10'),
(32405, 9057, 24178, NULL, '2021-06-05 00:00:00.000', 'Initiated', 'Form for the enrollment of group has been submitted  Waiting for the Response', NULL, NULL, '2021-05-28 14:44:40', '2021-05-28 14:44:40'),
(32406, 1006, 24178, NULL, '2021-06-23 00:00:00.000', 'In Process', 'Sent f/u email @ SWHP REGION 4 SWHPRegion4@BSWhealth.org:  Sub: Enrollment Status - BAQC - Scott & White   \"Hello,   I wanted to get an update regarding the enrollment status for the following group and providers as we submitted an enrollment request back in May, their information is as follows:  Group Name: Bay Area Quick Care PLLC NPI# 1437481421 TIN# 27-1702009  Provider Name: Cynthia Malowitz NPI# 1336173244  Provider Name: Kynda Orsak NPI# 1528553724  Provider Name: Francis William NPI# 1457994436  Provider Name: Melissa Ramsden NPI# 1194376228  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-06-16 13:40:01', '2021-06-16 13:40:01'),
(32407, 1006, 24178, NULL, '2021-06-29 00:00:00.000', 'Not Eligible', 'Received the following denial notification from SWHP PROVIDER NETWORK DEVELOPMENT SWHPPROVIDERNETWORKDEVELOPMENT@bswhealth.org:  Sub: New Contract Request  \"Tax ID#: 27-1702009  RE: Network Denial Letter  Dear Bay Area Quick Care PLLC  Thank you for your recent application.  Scott and White Health Plans (SWHP) and SHA, LLC dba FirstCare Health Plans (FirstCare) appreciates your interest in becoming a part of our network.  After reviewing your online application to contract submitted on 5/28/2021, SWHP and FirstCare regretfully declines to contract with Bay Area Quick Care PLLCat this time. The determination was made based on our current network needs. However, we encourage you to reapply in 6 months; as those needs may change.  For commercial providers, we welcome you to review 28 TAC 3.3706 for more detail on denial review.  Thank you again for your interest in SWHP and FirstCare Health Plans.  Best Regards,  Scott and White Health Plans |SHA, LLC dba FirstCare Health Plans Network Development Department 1206 West Campus Dr. Temple, Texas 76502\"', NULL, NULL, '2021-06-22 16:37:31', '2021-06-22 16:37:31'),
(32408, 1006, 24179, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-04-20 10:45:12', '2021-04-20 10:45:12'),
(32409, 1006, 24179, NULL, '2021-05-20 00:00:00.000', 'Initiated', 'Sent an enrollment request @ trpndataentry@trpnppo.com & providerrelations@trpnppo.com:  Sub: Provider Enrollment Request - BAQC- TRPN  \"Hello,   We want to get the following providers and group enrolled with TRPN, their information is as follows:  Group Name: Bay Area Quick Care PLLC TIN# 27-1702009 NPI# 1437481421 Group Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418-5148  Provider Name: Cynthia Malowitz NPI# 1336173244  Provider Name: Kynda Orsak NPI# 1528553724  Provider Name: William Francis NPI# 1457994436  Provider Name: Melissa Ramsden NPI# 1194376228  Please let me know what is required to initiate this request and what the enrollment timeframe is?  Thank you.\"', NULL, NULL, '2021-05-04 10:32:36', '2021-05-04 10:32:36'),
(32410, 9057, 24179, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to trpndataentry@trpnppo.com, providerrelations@trpnppo.com Sub: Request for enrollment status - BAQC - Three Rivers Provider Network - TRPN  Hello, We submitted an enrollment form for the below mentioned providers under the following group.  Group Name: Bay Area Quick Care PLLC TIN# 27-1702009 NPI# 1437481421 Group Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418-5148  Provider 1 Provider Name: Cynthia Malowitz NPI# 1336173244  Provider 2 Provider Name: Kynda Orsak NPI# 1528553724  Provider 3 Provider Name: William Francis NPI# 1457994436  Provider 4 Provider Name: Melissa Ramsden NPI# 1194376228  Kindly update me with the current status regarding the above mentioned request.  Thank you', NULL, NULL, '2021-05-27 11:02:52', '2021-05-27 11:02:52'),
(32411, 1006, 24179, NULL, '2021-06-23 00:00:00.000', 'In Process', 'Called @ 800-966-8776 and spoke to Brixcia as per her we need to send an email as our group contract is under Cynthia Malowitz and we need to update it.   Email sent @ bcastillo@trpnppo.com & providerrelations@trpnppo.com:  \"Hello,  As per my discussion with Brixcia, we want to update our group contract to add the following individual providers under it, the group and providers information is as follows:   Group Name: Bay Area Quick Care PLLC TIN# 27-1702009 NPI# 1437481421 Group Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418-5148  Provider 1 Provider Name: Cynthia Malowitz NPI# 1336173244  Provider 2 Provider Name: Kynda Orsak NPI# 1528553724  Provider 3 Provider Name: William Francis NPI# 1457994436  Provider 4 Provider Name: Melissa Ramsden NPI# 1194376228  Please let me know what is required to update the contract.   Thank you!\"', NULL, NULL, '2021-06-16 13:59:21', '2021-06-16 13:59:21'),
(32412, 1006, 24179, NULL, '2021-06-29 00:00:00.000', 'In Process', 'We received the following reply from Max Flores mflores@trpnppo.com:  Sub: Request for enrollment status - BAQC - Three Rivers Provider Network - TRPN  \"Good morning Brad,  I hope this message finds you well. Thank you for taking the time to speak to me today, per our conversation attached you will find the proposal if you have any questions please feel free to contact me directly for assistance. Thank you for your time today have a great Tuesday.  Kind regards,  Max Flores Contracting Manager 6970 O’Bannon Drive Las Vegas, Nevada 89117 Phone: (619) 737-9546 Fax: (619) 271-6316 mflores@trpnppo.com www.trpnppo.com\"  Sent following reply:  \"Hello, Max,   Thank you for the update, here\'s the group agreement filled out and signed. Do let me know if anything else is needed.  Thank you\"', NULL, NULL, '2021-06-22 16:16:33', '2021-06-22 16:16:33'),
(32413, 11056, 24179, NULL, '2021-07-14 00:00:00.000', 'In Process', 'Email received from : mflores@trpnppo.com  Sub : Request for enrollment status - BAQC - Three Rivers Provider Network - TRPN  Brad,   I will have the agreement processed and you can expect to receive the countersigned copy in 3 weeks, if you have any questions in the meantime please feel free to contact me directly for assistance.     Kind regards,  Max Flores Contracting Manager 6970 O’Bannon Drive  Las Vegas, Nevada 89117  Phone: (619) 737-9546  Fax: (619) 271-6316 mflores@trpnppo.com www.trpnppo.com', NULL, NULL, '2021-07-06 15:04:17', '2021-07-06 15:04:17'),
(32414, 1006, 24179, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Sent f/u email @ Max Flores mflores@trpnppo.com:  Sub: Request for enrollment status - BAQC - Three Rivers Provider Network - TRPN  \"Hello Max,  I hope you\'re doing well, I wanted to get an update regarding this request. Please get back to me as soon as you\'re able.  Thank you!\"', NULL, NULL, '2021-07-23 16:36:36', '2021-07-23 16:36:36'),
(32415, 1006, 24179, NULL, '2021-08-03 00:00:00.000', 'Approved', 'The group and providers have been approved.   Eff: 06/22/2021  An executed contract is attached for reference. ', NULL, NULL, '2021-07-27 12:28:43', '2021-07-27 12:28:43'),
(32416, 1006, 24180, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-04-20 10:45:15', '2021-04-20 10:45:15'),
(32417, 1006, 24180, NULL, '2021-05-20 00:00:00.000', 'Initiated', 'Submitted enrollment form for Group and Cynthia as main provider via Wellcare portal:  \"Become A Provider  Your form was submitted successfully.  Thank you for contacting us. A representative will be in contact to discuss your interest in becoming a participating Provider.\"  Form attached in group task for reference. ', NULL, NULL, '2021-05-04 10:19:50', '2021-05-04 10:19:50'),
(32418, 1006, 24180, NULL, '2021-06-17 00:00:00.000', 'In Process', 'I had a word with (John) with Wellcare representative and he advises their network development department will contact us.   Ref: 1012719812', NULL, NULL, '2021-06-10 12:20:51', '2021-06-10 12:20:51'),
(32419, 1006, 24180, NULL, '2021-07-06 00:00:00.000', 'In Process', 'Sent f/u email @ \".ProspectiveProviderTX\" ProspectiveProviderTX@wellcare.com:  Sub: Enrollment Status - BAQC - Wellcare  \"Hello,   I wanted to get an update regarding the enrollment status for our group and providers, we submitted the enrollment application via the website last month. The group and provider information is as follows:  Group Name: Bay Area Quick Care LLC NPI# 1437481421 TIN# 27-1702009 Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418-5148  Provider name: Cynthia Malowitz NPI# 1336173244  Provider Name: Kynda Orsak NPI# 1528553724  Provider Name: William Francis NPI# 1457994436  Provider Name: Melissa Ramsden NPI# 1194376228  Please get back to me on the updated status of the enrollment.  Thank you!\"', NULL, NULL, '2021-06-29 11:06:27', '2021-06-29 11:06:27'),
(32420, 1006, 24180, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Sent f/u email @ \".ProspectiveProviderTX\" ProspectiveProviderTX@wellcare.com:  Sub: Enrollment Status - BAQC - Wellcare  \"Hello,   I hope you\'re doing well, please get back to me on the enrollment request for our group and providers.  Thank you!\"', NULL, NULL, '2021-07-23 16:47:37', '2021-07-23 16:47:37'),
(32421, 1006, 24180, NULL, '2021-08-05 00:00:00.000', 'In Process', 'Received response:  \"What is the TIN & NPI?  Thank you, Leslie Gilchrist Intake Coordinator Contract Management\"  Replied: \"Hello Melissa,   Sure thing, the information is as follows:  Group Name: Bay Area Quick Care PLLC NPI# 1437481421 TIN# 27-1702009  Provider Name: Melissa Ramsden NPI# 1194376228  Thank you. \"', NULL, NULL, '2021-07-29 13:00:00', '2021-07-29 13:00:00'),
(32422, 1006, 24180, NULL, '2021-08-09 00:00:00.000', 'In Process', 'We received the following update from SHP-NETWORKDEVELOPMENT@superiorhealthplan.com:  Sub: MELISSA RAMSDEN  \"Hello,  We received your completed application on July 2, 2021 Your projected effective date is August 1, 2021. Currently, it is in the process of being loaded in our system. Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.  Sincerely,  Lucy Escobar Lead Contracts Coordinatoor, Contract Management Email-Block-6 Superior HealthPlan       7990 IH10 West San Antonio, TX 78230 Lucy.escobar@superiorhealthplan.com | SuperiorHealthPlan.com\"  ', NULL, NULL, '2021-08-02 15:59:24', '2021-08-02 15:59:24'),
(32423, 1006, 24180, NULL, '2021-08-17 00:00:00.000', 'In Process', 'Sent f/u email @ SHP.NetworkDevelopment@superiorhealthplan.com:  Sub: MELISSA RAMSDEN  \"Hello Lucy,   I just wanted to check with you if there had been any new updates, please let me know.   Thank you. \"', NULL, NULL, '2021-08-10 16:22:50', '2021-08-10 16:22:50'),
(32424, 11056, 24180, NULL, '2021-08-27 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Updates - BAQC - WELCARE  Good morning!  Hope this email finds you well. I wanted to get an latest updates regarding the enrollment status of the following providers and practice:  Practice Details: Practice Name: Bay Area Quick Care LLC Practice NPI# 1437481421 Practice TIN# 27-1702009 Practice Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418-5148  Provider Details:  Provider name: Cynthia Malowitz NPI# 1336173244  Provider Name: Kynda Orsak NPI# 1528553724  Provider Name: William Francis NPI# 1457994436  Provider Name: Melissa Ramsden NPI# 1194376228  If you have any questions or need documents please let me know. Waiting for your response.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-20 10:33:58', '2021-08-20 10:33:58'),
(32425, 11056, 24180, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com & cynthia.barnett@wellcare.com &  TERESA.Argueta@wellcare.com  Sub : Enrollment Status Updates - BAQC - WELCARE  Good morning!  Hope this email finds you well. I wanted to get an latest updates regarding the enrollment status of the following providers and practice:  Practice Details: Practice Name: Bay Area Quick Care LLC Practice NPI# 1437481421 Practice TIN# 27-1702009 Practice Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418-5148  Provider Details:  Provider name: Cynthia Malowitz NPI# 1336173244  Provider Name: Kynda Orsak NPI# 1528553724  Provider Name: William Francis NPI# 1457994436  Provider Name: Melissa Ramsden NPI# 1194376228  If you have any questions or need documents please let me know. Waiting for your response.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-30 10:27:10', '2021-08-30 10:27:10'),
(32426, 11056, 24180, NULL, '2021-10-01 00:00:00.000', 'In Process', 'Email sent to : Cynthia.Barnett@wellcare.com  Sub : Enrollment Status Updates - BAQC - WELCARE  Good morning Cynthia!  Hope this email finds you well. Please provide me with someone who can respond to my query for Wellcare, because no one hasn\'t responded to me since August. Kindly provide with the representative\'s email or contact no. for this address :Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418-5148.  I will be grateful to you.   Thank you! Have a wonderful Weekend!', NULL, NULL, '2021-09-24 09:20:08', '2021-09-24 09:20:08'),
(32427, 11056, 24180, NULL, '2021-10-18 00:00:00.000', 'In Process', 'Emial sent to : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Updates - BAQC - WELCARE  Good morning!  Hope you are doing great. I am still waiting for the representative details in the Corpus Christi area. Please assist me with that soon.  Eagerly, waiting to hear from you soon.  Thank you! Have a blessed day!  Contacted Miss Cynthia. She informed me that she gonna confirm if they provide services in Corpus christi area or  not.', NULL, NULL, '2021-10-11 10:36:03', '2021-10-11 10:36:03'),
(32428, 11056, 24180, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email received from : Schlonda.Ramee@wellcare.com  Sub : Enrollment Status Updates - BAQC - WELCARE  Good afternoon,     Ahmed, please excuse my tardiness.  The assigned Account Manager is Jetori Campbell. Jetori can be reached at Jetori.campbell@wellcare.com I have also included her in this email.     Jetori, can you please assist Ahmed?     Thanks,     Schlonda Ramee Jackson, Notary Public  Manager, Provider Network, G&A-Provider Relations     4888 Loop Central Drive, Suite 300  Houston, Texas 77081  Direct Mobile 713-409-6354  schlonda.rameejackson@wellcare.com | https://www.wellcare.com', NULL, NULL, '2021-10-18 09:21:25', '2021-10-18 09:21:25'),
(32429, 11056, 24180, NULL, '2021-11-02 00:00:00.000', 'In Process', 'Email received from : Jetori.Campbell@wellcare.com  Sub : Enrollment Status Updates - BAQC - WELCARE   Good Morning Ahmed,  Thank you for following up on your request to Join Our Network.  You should have received correspondence from Superior Health Plan/ WellCare in response to your request. Once all information is signed and received from both parties; please anticipate up to 90 days for credentialing to be completed.   Please let me know if you have any questions.  Thank You  Ms. JeTori Campbell Provider Account Manager 4888 Loop Central Drive, Suite 300  Houston, Texas 77081 Direct Mobile 972-795-8691 jetori.campbell@wellcare.com | https://www.wellcare.com', NULL, NULL, '2021-10-26 10:17:38', '2021-10-26 10:17:38'),
(32430, 11056, 24180, NULL, '2021-11-02 00:00:00.000', 'Not Eligible', 'Please mark there task to Not Eligible so we can avoid errors and save time, also if you get any approval for them they will counted  Please see the attachment too.', NULL, NULL, '2021-10-26 10:44:10', '2021-10-26 10:44:10'),
(32431, 1019, 25127, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 07:24:25', '2021-04-23 07:24:25'),
(32432, 1019, 25127, NULL, '2021-04-30 00:00:00.000', 'New/Not Initiated', 'Sent the following email to Debra.Draheim@bcbsma.com  Hello Debra, Good Afternoon hope you\'re doing good, we need to enroll a provider under our group in MA, the provider is already credentialed under our group in the state of Rhode Island, let me know the procedure to enroll her with Massachusetts locations as well.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Provider: Melody L\'Etoile NPI: 1942687108  Regards, Alex', NULL, NULL, '2021-04-23 14:04:52', '2021-04-23 14:04:52'),
(32433, 1019, 25127, NULL, '2021-05-05 00:00:00.000', 'Not Eligible', 'Received the following email from providerapplicationstatus@bcbsma.com Thank you for your email,  BCBSMA does not currently enroll LCSW providers.    Thank you, Network Management Blue Cross & Blue Shield of Massachusetts 800-316-2583', NULL, NULL, '2021-04-28 11:53:30', '2021-04-28 11:53:30'),
(32434, 1019, 25128, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 07:24:25', '2021-04-23 07:24:25'),
(32435, 1019, 25128, NULL, '2021-04-30 00:00:00.000', 'Initiated', 'Application Submitted Online thru website. see attachments for ref', NULL, NULL, '2021-04-23 11:14:48', '2021-04-23 11:14:48'),
(32436, 1019, 25128, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Sent the following email to : Laura.Bevin@aetna.com, ChandraKumarU@aetna.com SUB: Enrollment Query || Group & Providers || SNBCARE || Aetna  Hello,   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Melody L\'Etoile 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Barbara Hignite 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Fauzia Wali Khan 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Lynnetta Loveland 1598163602 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Peggy Pionke 1699307322 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Mahreen Rashid 1396393146 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Carlee Rozell 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Kerry Smith 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Katie Tawakol 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jennifer Ullrich 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Justin Souliere 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. ', NULL, NULL, '2021-05-03 10:28:16', '2021-05-03 10:28:16'),
(32437, 1019, 25128, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to Laura.Bevin@aetna.com SUB: Enrollment Query || Group & Providers || SNBCARE || Aetna  Hello, We need the enrollment application status for the following providers,   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Carlee Rozell 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Katie Tawakol 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jennifer Ullrich 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Justin Souliere 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Kerry Smith 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Fauzia Wali Khan 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Lynnetta Loveland 1598163602 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Peggy Pionke 1699307322 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Mahreen Rashid 1396393146 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Regards,', NULL, NULL, '2021-05-20 08:01:37', '2021-05-20 08:01:37'),
(32438, 1019, 25128, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Received the following email from Laura.Bevin@aetna.com  Good afternoon, Please see my comments below. Thank you  Melody L\'Etoile, 6466643 – CAQH application is being reviewed 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Rodesia Edmundson, 6301243 – 06/01/2021 effective date 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite, 6369000 - 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. – 03/01/2021 effective date Secondary Location: 100 New State Highway, Raynham, MA, 02767.  – address can be added via Existing Medical Provider Resources | Aetna  Kerry Smith, 6164300 – 06/01/2021 effective date 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti, 6846902 – 06/01/2021 effective date 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Fauzia Wali Khan, 7686597 – 01/01/2021 effective date 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Lynnetta Loveland, 6785859 1598163602 Secondary Location: 100 New State Highway, Raynham, MA, 02767. – address can be added via Existing Medical Provider Resources | Aetna    Peggy Pionke, 6507988 – 02/01/2021 effective date 1699307322 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Mahreen Rashid, 6557417 – 01/01/2021 effective date 1396393146 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Laura Bevin Credentialing Senior Analyst Aetna Behavioral Health', NULL, NULL, '2021-05-31 13:06:00', '2021-05-31 13:06:00'),
(32439, 1019, 25128, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to Laura.Bevin@aetna.com SUB: Enrollment Query || Group & Providers || SNBCARE || Aetna  Hello, We need the enrollment application status for the following providers,   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Carlee Rozell 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Katie Tawakol 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jennifer Ullrich 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Justin Souliere 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Kerry Smith 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Fauzia Wali Khan 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Lynnetta Loveland 1598163602 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Peggy Pionke 1699307322 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Mahreen Rashid 1396393146 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Regards,', NULL, NULL, '2021-06-16 07:56:11', '2021-06-16 07:56:11'),
(32440, 1019, 25128, NULL, '2021-08-30 00:00:00.000', 'Not Eligible', 'Provider no longer working with SNBCARE', NULL, NULL, '2021-08-23 13:51:29', '2021-08-23 13:51:29'),
(32441, 1019, 25129, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 07:24:25', '2021-04-23 07:24:25'),
(32442, 1019, 25129, NULL, '2021-04-30 00:00:00.000', 'Initiated', 'Spoke to Maddie J Rep at Cigna (800) 882-4462 conversation is mentioned below.  As per her she has process the request to add Melody under 61 Lincoln Street Address with our group, as only framingham address is showing under group just Need to fax at 8606877257 copy of her State License Attn: Network Operations. 10 Business days   Ref# 04/23/2021 - Maddie J ', NULL, NULL, '2021-04-23 12:48:25', '2021-04-23 12:48:25'),
(32443, 1019, 25129, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to BehavioralContracting@cigna.com SUB: Enrollment Status || Group & Providers || SNBCARE || CIGNA  Hello, Can you please let me know about the enrollment status for following providers under our group.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Carlee Rozell NPI: 1225645393 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Secondary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Tertiary Location: 100 New State Highway, Raynham, MA, 02767.    Hignite, Barbara NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.    Loveland, Lynnetta NPI: 1598163602 Location: 100 New State Highway, Raynham, MA, 02767.   Tawakol, Katie NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.    Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.    Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767.      Hefti, Prisca NPI: 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-05-20 09:23:48', '2021-05-20 09:23:48'),
(32444, 1019, 25129, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to panplais.lor@cigna.com ​ SUB: Group Roster || Group & Providers || SNBCARE || CIGNA   Hello Pa,  Can you please send me our group provider roster ASAP. I have mentioned the group information below.  Group Information:  Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-06-03 15:31:45', '2021-06-03 15:31:45'),
(32445, 1019, 25129, NULL, '2021-08-30 00:00:00.000', 'Not Eligible', 'Provider no longer working with SNBCARE', NULL, NULL, '2021-08-23 13:51:57', '2021-08-23 13:51:57'),
(32446, 1019, 25130, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 07:24:25', '2021-04-23 07:24:25'),
(32447, 1019, 25130, NULL, '2021-05-05 00:00:00.000', 'Initiated', 'Sent the following email to mtasby2@humana.com Hello Monica, Hope you are doing good great, we need to add a provider under our Massachusetts Locations for our group, as that provider is already added under our Rhode Island Location. So what will be the procedure to add her under MA location.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Provider: Melody L\'Etoile NPI: 1942687108   Regards, Alex', NULL, NULL, '2021-04-28 10:51:27', '2021-04-28 10:51:27'),
(32448, 1019, 25130, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to credentialinginquiries@humana.com SUB: Re: Secured: RE: Secured: RE: Welcome Letters - Providers - SNBCARE - Humana  Hello, We need the Welcome letter for the following providers and also if you can send me the copy of our Group contract with all 3 Locations on it.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Carlee Rozell NPI: 1225645393  Fauzia Wali Khan NPI: 1699761965  Jonathan Schubert NPI: 1235755505  Raveendran Pandeswari NPI: 1124247267  Melody Letoile NPI: 1942687108  Erin Oliva NPI: 1407349632  Rodesia Edmundson NPI: 1124622667  Kerry Smith NPI: 1275083230  Justin Souliere NPI: 1710576004  Regards, Alex', NULL, NULL, '2021-06-10 09:47:54', '2021-06-10 09:47:54'),
(32449, 1019, 25130, NULL, '2021-08-30 00:00:00.000', 'Not Eligible', 'Provider no longer working with SNBCARE', NULL, NULL, '2021-08-23 13:52:58', '2021-08-23 13:52:58'),
(32450, 1019, 25131, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 07:24:25', '2021-04-23 07:24:25'),
(32451, 1019, 25131, NULL, '2021-06-05 00:00:00.000', 'On Hold', 'Waiting to enroll with Aetna first. ', NULL, NULL, '2021-04-28 14:54:23', '2021-04-28 14:54:23'),
(32452, 1019, 25131, NULL, '2021-08-30 00:00:00.000', 'Not Eligible', 'Provider no longer working with SNBCARE', NULL, NULL, '2021-08-23 13:52:19', '2021-08-23 13:52:19'),
(32453, 1019, 25132, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 07:24:25', '2021-04-23 07:24:25'),
(32454, 1019, 25132, NULL, '2021-05-05 00:00:00.000', 'Initiated', 'Sent the following email to ASantulli@humana.com  Hello Anne, Appreciate your help, also we need to add a provider under our group in Massachusetts as she is already enrolled in Rhode Island location under our group. Please let me know the procedure to add her under MA locations.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Provider:  Melody L\'Etoile NPI: 1942687108  Regards, Alex', NULL, NULL, '2021-04-28 10:41:48', '2021-04-28 10:41:48'),
(32455, 1019, 25132, NULL, '2021-05-05 00:00:00.000', 'In Process', 'Received the following email from ASantulli@humana.com  The request to add the practitioner to your MA location has been received for processing. Nothing further is needed at this time.  Thank you, Anne Santulli Senior Consumer Operations Professional TRICARE Community Liaison 2 Field Operations, Humana Military Servicing provider relations for Maine, New Hampshire, Massachusetts T 502.318.5146 F 603.371.2404 asantulli@humana.com', NULL, NULL, '2021-04-28 11:47:53', '2021-04-28 11:47:53'),
(32456, 1019, 25132, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to ASantulli@humana.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tricare  Hello Anne, Hope you are doing good, I need the enrollment status for the following providers. I will really appreciate your help with this.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-05-20 11:19:04', '2021-05-20 11:19:04');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(32457, 1019, 25132, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Received the following email from The status for each practitioner is below, adjacent to each name.  Individual Providers:  Melody L\'Etoile                     Credentialing in progress, not yet approved, locations confirmed NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons                       Credentialing in progress, not yet approved, locations confirmed NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson                         Credentialing in progress, not yet approved, locations confirmed NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith                                        Credentialing in progress, not yet approved, locations confirmed NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland                           Credentialing in progress, not yet approved, locations confirmed NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid                    Credentialed/linked 4/3/2020, locations confirmed NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite                                 Credentialing in progress, not yet approved, locations confirmed NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert                            Credentialing in progress, not yet approved, locations confirmed  NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell                                      Credentialing in progress, not yet approved, location confirmed NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol                       Credentialed 4/28/2020, Waiting to add location NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan                 Credentialed 5/19/2020, added to locations 4/20/2020 & Waiting to add to Raynham Loc. NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.            Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti                            Credentialed 5/5/2020, added to location 5/4/2021 NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva                              Not recognized by name or NPI, not certified/credentialed/linked NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere                       Not credentialed, pls send DOB, SSN & CAQH number for credentialing NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.', NULL, NULL, '2021-05-31 10:45:14', '2021-05-31 10:45:14'),
(32458, 1019, 25132, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to ASantulli@humana.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tricare  Hello Anne, Hope you are doing good, I need the enrollment status for the following providers. I will really appreciate your help with this.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-06-16 08:00:36', '2021-06-16 08:00:36'),
(32459, 1019, 25132, NULL, '2021-08-30 00:00:00.000', 'Not Eligible', 'Provider no longer working with SNBCARE', NULL, NULL, '2021-08-23 13:53:21', '2021-08-23 13:53:21'),
(32460, 1019, 25133, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 07:24:25', '2021-04-23 07:24:25'),
(32461, 1019, 25133, NULL, '2021-05-03 00:00:00.000', 'On Hold', 'Waiting for Medicare PTAN to load in Railroad systems, its showing up will f/u in 3 days. ', NULL, NULL, '2021-04-28 14:52:36', '2021-04-28 14:52:36'),
(32462, 1019, 25133, NULL, '2021-05-18 00:00:00.000', 'Initiated', 'PTAN request submitted online thorough Portal, see attachment for Ref ', NULL, NULL, '2021-05-11 07:16:48', '2021-05-11 07:16:48'),
(32463, 1019, 25133, NULL, '2021-06-12 00:00:00.000', 'Approved', 'PTAN has been active effective from 01/22/2021. see attachment for approval Also sent test email', NULL, NULL, '2021-06-05 12:26:55', '2021-06-05 12:26:55'),
(32464, 1019, 25134, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 07:24:25', '2021-04-23 07:24:25'),
(32465, 1019, 25134, NULL, '2021-04-30 00:00:00.000', 'Initiated', 'Application Submitted through PECOS  To: MELODY.LETOILE@GMAIL.COM,SNBC@CLAIMSMEDINC.COM   Subject: Medicare Enrollment Application Receipt Notification (Tracking ID: T042220210002309)   Sent: 04/22/2021 15:22 PM   This message is to confirm receipt of your Medicare enrollment application that was submitted from (https://pecos.cms.hhs.gov). You are listed as the contact person for this application. The information provided below is for your future reference:    ----------------------------------------------------------------------------------------------------------------------       Application Tracking ID: T042220210002309        NPI: 1942687108        Medicare ID:         Name: MELODY CELINE L\'ETOILE          State: MA        Fee-for-Service Contractor: NATIONAL GOVERNMENT SERVICES, INC. ', NULL, NULL, '2021-04-23 07:42:56', '2021-04-23 07:42:56'),
(32466, 1019, 25134, NULL, '2021-05-04 00:00:00.000', 'Approved', 'Received the following email from customerservice-donotreply@cms.hhs.gov  This message is in response to your Medicare enrollment application that was submitted from (https://pecos.cms.hhs.gov). You are listed as the contact person for this application. Your application is assigned the Tracking Identifier of T042220210002309. The application listed below has reached a final status.  IMPORTANT NOTE: Please wait until you receive official notification from your Fee-for-Service Contractor before submitting claims. Claims submitted before official notification from your Fee-for-Service Contractor may be rejected.  ----------------------------------------------------------------------------------------------------------------------------------------------------------------------  Application Tracking ID: T042220210002309   NPI ID: 1942687108   Medicare ID: S400743652   Name: MELODY L\'ETOILE  State: MA   Form Type: 855I  Date: 04/27/2021  Status: APPROVED', NULL, NULL, '2021-04-27 10:42:37', '2021-04-27 10:42:37'),
(32467, 1019, 25135, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 07:24:25', '2021-04-23 07:24:25'),
(32468, 1019, 25135, NULL, '2021-05-04 00:00:00.000', 'Initiated', 'CAQH Application faxed to Network Operations at (866) 612-7790. ', NULL, NULL, '2021-04-27 13:10:57', '2021-04-27 13:10:57'),
(32469, 1019, 25135, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: RE: Enrollment Status || Providers || SNBCARE || Beacon attn Shashi  Hello Shashi, Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.   Individual Provider   L\'Etoile, Melody NPI: 1942687108 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Edmundson, Rodesia NPI: 1124622667 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Hefti, Prisca NPI: 1508133182 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Khan, Fauzia Wali NPI: 1699761965 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Pionke, Peggy NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rashid, Mahreen NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Schubert, Jonathan NPI: 1235755505 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Smith, Kerry NPI: 1275083230 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Tawakol, Katie NPI:1609222116 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-05-03 12:47:54', '2021-05-03 12:47:54'),
(32470, 1019, 25135, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: Enrollment Query || Group & Providers || SNBCARE || BHS/BHO ATTN Shashi  Hello Shashi,  Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Individual Provider     Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    L\'Etoile, Melody  NPI: 1942687108  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Edmundson, Rodesia NPI: 1124622667 Location: 100 New State Highway, Raynham, MA, 02767.     Hefti, Prisca NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.     Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.   Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Schubert, Jonathan NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.     Smith, Kerry NPI: 1275083230 Location: 100 New State Highway, Raynham, MA, 02767.     Tawakol, Katie NPI:1609222116 Location: 100 New State Highway, Raynham, MA, 02767.     Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-05-20 08:30:38', '2021-05-20 08:30:38'),
(32471, 1019, 25135, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com  SUB: Enrollment Query || Group & Providers || SNBCARE || BHS/BHO ATTN Shashi 2nd Attempt  Hello Shashi,  Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Individual Provider     Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    L\'Etoile, Melody  NPI: 1942687108  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Edmundson, Rodesia NPI: 1124622667 Location: 100 New State Highway, Raynham, MA, 02767.     Hefti, Prisca NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.     Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.   Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Schubert, Jonathan NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.     Smith, Kerry NPI: 1275083230 Location: 100 New State Highway, Raynham, MA, 02767.     Tawakol, Katie NPI:1609222116 Location: 100 New State Highway, Raynham, MA, 02767.     Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-06-05 11:15:44', '2021-06-05 11:15:44'),
(32472, 1019, 25135, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Received the following email from provider.relations@beaconhealthoptions.com  Good afternoon Alex,  I am looking into it.    Thank you! Shashi Seth Network Management Rep I, Northeast Provider Relations', NULL, NULL, '2021-06-24 07:59:06', '2021-06-24 07:59:06'),
(32473, 1019, 25135, NULL, '2021-09-03 00:00:00.000', 'Not Eligible', 'Provider is no longer working with SNBCARE ', NULL, NULL, '2021-08-27 08:34:19', '2021-08-27 08:34:19'),
(32474, 1019, 25136, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 07:24:25', '2021-04-23 07:24:25'),
(32475, 1019, 25136, NULL, '2021-05-10 00:00:00.000', 'Initiated', 'Called UBH @ (877) 614-0484 Spoken with Rep Haydie M  Asked the Rep to send the request for demographic update as we are unable to request Location addition thru provider express. She has send the request to Demographic Update for both Locations of MA. It will take up to 10 business days to load these addresses in their Systems.  Ticket #: EPUF1982913 Ref#: 04/30/2021 Haydie M', NULL, NULL, '2021-04-30 10:34:56', '2021-04-30 10:34:56'),
(32476, 1019, 25136, NULL, '2021-06-16 00:00:00.000', 'Approved', 'Spoken to Rep Ian, the Location has been added eff 11/16/2020. Also I have attached a copy of Location Confirmation for Reference Call Ref: IAN I- 06/09/2021 - (877) 614-0484', NULL, NULL, '2021-06-09 11:27:02', '2021-06-09 11:27:02'),
(32477, 1019, 25137, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 07:24:25', '2021-04-23 07:24:25'),
(32478, 1019, 25137, NULL, '2021-05-05 00:00:00.000', 'Initiated', 'Sent the following email to provider_information_dept@tufts-health.com Sub: Location Addition || Melody L\'Etoile || SNBCARE || Tufts Health   Hello, Attached is the Provider Information form, for Melody L\'Etoile to add her under our group. Let me know if you need further assistance.  Regards, Alex', NULL, NULL, '2021-04-28 14:43:18', '2021-04-28 14:43:18'),
(32479, 1019, 25137, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to provider_data_request@tufts-health.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tufts Health Plans  Hello, We need the enrollment status for the following providers under our group, as their applications have been in process for a while now.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert NPI: 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  ', NULL, NULL, '2021-06-05 12:58:41', '2021-06-05 12:58:41'),
(32480, 1019, 25137, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Sent the following email to Kody_Dunnett@tufts-health.com  Hello Kody,  We need to expedite the applications for the following providers of Credentialing and Contracting as it is In process since a while now as it is adversely affecting our business, also we are not getting proper responses on our emails.  Spectrum Neuro Behavioral Care LLC. 1356906572 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rodesia Edmundson  1124622667  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Mary Gibbons  NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Lynnetta Loveland  NPI: 1598163602  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Jonathan Schubert  NPI: 1235755505  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jennifer Ullrich NPI: 1710489760  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Prisca Hefti NPI: 1508133182  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767  Regards, Alex G', NULL, NULL, '2021-06-23 09:25:52', '2021-06-23 09:25:52'),
(32481, 1019, 25137, NULL, '2021-07-14 00:00:00.000', 'Approved', 'Received the following email from Brady_Roche@tufts-health.com  Hi Alex,  My department can help with effective dates, I have provided them on the spreadsheet. I have included Katherine in Allied and Christine in Credentialing as one is still in cred process and the other needs to be linked to the group.  Thanks,  Effective Date is 12/31/2020 Attached are the Location Addition and Provider Roster of Tufts', NULL, NULL, '2021-07-07 11:52:21', '2021-07-07 11:52:21'),
(32482, 1019, 25138, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 07:24:25', '2021-04-23 07:24:25'),
(32483, 1019, 25138, NULL, '2021-05-05 00:00:00.000', 'Not Eligible', 'We received the following update regarding LCSW/LICSW enrollment guidelines of Mass Health @ Rippstein, Kyle KyleRippstein@maximus.com:   Sub: Enrollment || Providers || SNBCARE || MassHealth  \"Hi Alex,  We do not enroll LCSWs at this time.  We DO enroll LICSWs, but in a non-billing capacity (they would not “link” to the Group as would a Physician or NP, for example).  I have attached the proper applications for LICSWs. Let us know if you need any further assistance.  Thanks,  Kyle Rippstein Supervisor, Provider Enrollment and Credentialing MassHealth MAXIMUS , Inc 55 Summer St, 8th floor Boston, MA 02110 Office (617)948-5537 Fax (617)988-8904\"  Non-billing capacity implies that we aren\'t able to submit claims under those providers, so there is no point with that process either. ', NULL, NULL, '2021-04-28 08:36:15', '2021-04-28 08:36:15'),
(32484, 1019, 25139, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 07:24:26', '2021-04-23 07:24:26'),
(32485, 1019, 25139, NULL, '2021-05-04 00:00:00.000', 'Initiated', 'Application submitted thru Online Portal ', NULL, NULL, '2021-04-27 14:48:11', '2021-04-27 14:48:11'),
(32486, 1019, 25139, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to JWright@magellanhealth.com SUB: Enrollment Query || Providers || SNBCARE || Magellan  Hello Judith, Hope you\'re doing good, we need the Credentialing Status for the following providers.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Regards,', NULL, NULL, '2021-05-20 10:11:39', '2021-05-20 10:11:39'),
(32487, 1019, 25139, NULL, '2021-06-03 00:00:00.000', 'Approved', 'Received the following email from JWright@magellanhealth.com  Melody L\'Etoile: Has been linked to your group effective date 12/9/2020. Previously informed on 12/21/2020.  NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   ', NULL, NULL, '2021-05-27 09:05:35', '2021-05-27 09:05:35'),
(32488, 1019, 25140, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 07:24:26', '2021-04-23 07:24:26'),
(32489, 1019, 25140, NULL, '2021-05-05 00:00:00.000', 'Initiated', 'Sent the following email to provider_data_request@tufts-health.com Sub: Location Addition || Melody L\'Etoile || SNBCARE || Tufts Health   Hello, Attached is the Provider Information form, for Melody L\'Etoile to add her under our group. Let me know if you need further assistance.  Regards, Alex', NULL, NULL, '2021-04-28 14:46:39', '2021-04-28 14:46:39'),
(32490, 1019, 25140, NULL, '2021-05-12 00:00:00.000', 'In Process', 'Received the following email from Provider_Data_Request@tufts-health.com  SUB: PRO0135416 - Request Received  Hello , We are in receipt of your request regarding Location Addition || Melody L\'Etoile || SNBCARE || Tufts Health that was submitted on 2021-04-28 15:42:56 EDT.  Please reference ticket number PRO0135416 for further communications about this request. Thank you,  Tufts Health Public Plans, Provider Information Management Team  Ref:MSG6887111 REMINDER: Please limit PHI to the minimum necessary to process your request. For Tufts Health Plan Compliance policy on documentation guidelines, refer to the Corporate Confidentiality Policy Regarding Protected Health Information (DMS# 1020907). thpwatsmr2.tufts-health.com made the following annotations', NULL, NULL, '2021-05-05 15:41:38', '2021-05-05 15:41:38'),
(32491, 1019, 25140, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to provider_data_request@tufts-health.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tufts Health Plans   Hello, We need the enrollment status for the following providers under our group, as their applications have been in process for a while now.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert NPI: 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Regards,', NULL, NULL, '2021-06-07 07:55:40', '2021-06-07 07:55:40'),
(32492, 1019, 25140, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Sent the following email to Kody_Dunnett@tufts-health.com  Hello Kody,  We need to expedite the applications for the following providers of Credentialing and Contracting as it is In process since a while now as it is adversely affecting our business, also we are not getting proper responses on our emails.  Spectrum Neuro Behavioral Care LLC. 1356906572 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rodesia Edmundson  1124622667  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Mary Gibbons  NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Lynnetta Loveland  NPI: 1598163602  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Jonathan Schubert  NPI: 1235755505  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jennifer Ullrich NPI: 1710489760  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Prisca Hefti NPI: 1508133182  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767  Regards, Alex G', NULL, NULL, '2021-06-23 09:27:22', '2021-06-23 09:27:22'),
(32493, 1019, 25140, NULL, '2021-08-18 00:00:00.000', 'Approved', 'Received the following email from Brady_Roche@tufts-health.com  Hi Alex,  My department can help with effective dates, I have provided them on the spreadsheet. I have included Katherine in Allied and Christine in Credentialing as one is still in cred process and the other needs to be linked to the group.  Thanks,  Effective Date is 04/28/2021 Attached are the Location Addition and Provider Roster of Tufts', NULL, NULL, '2021-08-10 23:24:30', '2021-08-10 23:24:30'),
(32494, 1019, 25141, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 07:24:26', '2021-04-23 07:24:26'),
(32495, 1019, 25141, NULL, '2021-05-04 00:00:00.000', 'Initiated', 'Sent following email to PNMDepartment@commonwealthcare.org, Credentialing@commonwealthcare.org  Sub: HCAS Provider Enrollment - Kerry Smith - CCA - SNBCARE Hello,   Please find the attached enrollment form for our provider and expedite the enrollment process as much as possible. Do let me know how long it will take to get her added to our group.     Regards, Alex G.', NULL, NULL, '2021-04-27 14:19:36', '2021-04-27 14:19:36'),
(32496, 1019, 25141, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to Credentialing@commonwealthcare.org, PNMDepartment@commonwealthcare.org  SUB: Enrollment Query || Group & Providers || SNBCARE || CCA Hello, We want the enrollment status for our Group and Providers under our group, also please provide us the effective dates for the providers as well.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753   Locations: Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.  Barbara Hignite NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.  Lynetta Loveland NPI:1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Peggy Pionke NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1356906572 Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Location: 100 New State Highway, Raynham, MA, 02767.', NULL, NULL, '2021-06-03 16:05:15', '2021-06-03 16:05:15'),
(32497, 1019, 25141, NULL, '2021-06-28 00:00:00.000', 'Approved', 'See Attached for the email SS received from CCA for Approval Confirmation.  Also spoken with Rep Gilsen F, as per rep the provider is linked under both (Framingham & Raynham) locations.  Call ref #: Gislen F - 06/21/2021 ', NULL, NULL, '2021-06-21 09:04:26', '2021-06-21 09:04:26'),
(32498, 1019, 25142, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 07:24:26', '2021-04-23 07:24:26'),
(32499, 1019, 25142, NULL, '2021-05-07 00:00:00.000', 'On Hold', 'Spoke to Furquan regarding this, providers will do their cultural competency and update me when that has been completed so we can move forward with this request.  ', NULL, NULL, '2021-04-30 07:50:39', '2021-04-30 07:50:39'),
(32500, 1019, 25143, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 07:24:26', '2021-04-23 07:24:26'),
(32501, 1019, 25143, NULL, '2021-05-05 00:00:00.000', 'On Hold', 'Provider cannot enroll, because New Health England doesn\'t enroll provider from Framingham. ', NULL, NULL, '2021-04-28 14:56:29', '2021-04-28 14:56:29'),
(32502, 1019, 25143, NULL, '2021-08-30 00:00:00.000', 'Not Eligible', 'Provider no longer working with SNBCARE', NULL, NULL, '2021-08-23 13:52:48', '2021-08-23 13:52:48'),
(32503, 1019, 25144, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 07:26:46', '2021-04-23 07:26:46'),
(32504, 1019, 25144, NULL, '2021-05-05 00:00:00.000', 'Not Eligible', 'Received the following email from providerapplicationstatus@bcbsma.com Thank you for your email,  BCBSMA does not currently enroll LCSW providers.    Thank you, Network Management Blue Cross & Blue Shield of Massachusetts 800-316-2583', NULL, NULL, '2021-04-28 11:52:53', '2021-04-28 11:52:53'),
(32505, 1019, 25145, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 07:26:46', '2021-04-23 07:26:46'),
(32506, 1019, 25145, NULL, '2021-04-30 00:00:00.000', 'On Hold', 'Waiting to get credential first with Framingham location.', NULL, NULL, '2021-04-23 12:52:08', '2021-04-23 12:52:08'),
(32507, 1019, 25145, NULL, '2021-08-30 00:00:00.000', 'Not Eligible', 'Provider no longer working with SNBCARE', NULL, NULL, '2021-08-23 13:51:42', '2021-08-23 13:51:42'),
(32508, 1019, 25146, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 07:26:46', '2021-04-23 07:26:46'),
(32509, 1019, 25146, NULL, '2021-04-30 00:00:00.000', 'On Hold', 'Waiting for group to get credential under Raynham Location.', NULL, NULL, '2021-04-23 12:50:59', '2021-04-23 12:50:59'),
(32510, 1019, 25147, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 07:26:46', '2021-04-23 07:26:46'),
(32511, 1019, 25147, NULL, '2021-05-05 00:00:00.000', 'Initiated', 'Sent the following email to mtasby2@humana.com Hello Monica, Hope you are doing good great, we need to add a provider under our Massachusetts Locations for our group, as that provider is already added under our Rhode Island Location. So what will be the procedure to add her under MA location.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Provider: Melody L\'Etoile NPI: 1942687108   Regards, Alex', NULL, NULL, '2021-04-28 10:51:01', '2021-04-28 10:51:01'),
(32512, 1019, 25147, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to credentialinginquiries@humana.com SUB: Re: Secured: RE: Secured: RE: Welcome Letters - Providers - SNBCARE - Humana  Hello, We need the Welcome letter for the following providers and also if you can send me the copy of our Group contract with all 3 Locations on it.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Carlee Rozell NPI: 1225645393  Fauzia Wali Khan NPI: 1699761965  Jonathan Schubert NPI: 1235755505  Raveendran Pandeswari NPI: 1124247267  Melody Letoile NPI: 1942687108  Erin Oliva NPI: 1407349632  Rodesia Edmundson NPI: 1124622667  Kerry Smith NPI: 1275083230  Justin Souliere NPI: 1710576004  Regards, Alex', NULL, NULL, '2021-06-10 09:47:42', '2021-06-10 09:47:42'),
(32513, 1019, 25147, NULL, '2021-08-30 00:00:00.000', 'Not Eligible', 'Provider no longer working with SNBCARE', NULL, NULL, '2021-08-23 13:51:17', '2021-08-23 13:51:17'),
(32514, 1019, 25148, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 07:26:46', '2021-04-23 07:26:46'),
(32515, 1019, 25148, NULL, '2021-06-05 00:00:00.000', 'On Hold', 'Waiting to enroll with Aetna first.', NULL, NULL, '2021-04-28 14:54:02', '2021-04-28 14:54:02'),
(32516, 1019, 25148, NULL, '2021-08-30 00:00:00.000', 'Not Eligible', 'Provider no longer working with SNBCARE', NULL, NULL, '2021-08-23 13:52:09', '2021-08-23 13:52:09'),
(32517, 1019, 25149, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 07:26:46', '2021-04-23 07:26:46'),
(32518, 1019, 25149, NULL, '2021-05-03 00:00:00.000', 'Initiated', 'Sent the following email to ASantulli@humana.com Hello Anne, Hope you are doing good, as per your request attached is the Location addition form, with the list of practitioners need to be linked under this address. Also we have attached the printed CAQH form and document for credentialing of the providers you requested for.Let me know if you need anything else.  Regards, Alex', NULL, NULL, '2021-04-26 15:10:00', '2021-04-26 15:10:00'),
(32519, 1019, 25149, NULL, '2021-05-05 00:00:00.000', 'Initiated', 'Sent the following email to ASantulli@humana.com  Hello Anne, Appreciate your help, also we need to add a provider under our group in Massachusetts as she is already enrolled in Rhode Island location under our group. Please let me know the procedure to add her under MA locations.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Provider:  Melody L\'Etoile NPI: 1942687108  Regards, Alex', NULL, NULL, '2021-04-28 10:42:20', '2021-04-28 10:42:20'),
(32520, 1019, 25149, NULL, '2021-05-05 00:00:00.000', 'In Process', 'Received the following email from ASantulli@humana.com  The request to add the practitioner to your MA location has been received for processing. Nothing further is needed at this time.  Thank you, Anne Santulli Senior Consumer Operations Professional TRICARE Community Liaison 2 Field Operations, Humana Military Servicing provider relations for Maine, New Hampshire, Massachusetts T 502.318.5146 F 603.371.2404 asantulli@humana.com', NULL, NULL, '2021-04-28 11:47:27', '2021-04-28 11:47:27');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(32521, 1019, 25149, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to ASantulli@humana.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tricare  Hello Anne, Hope you are doing good, I need the enrollment status for the following providers. I will really appreciate your help with this.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-05-20 11:19:38', '2021-05-20 11:19:38'),
(32522, 1019, 25149, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Received the following email from ASantulli@humana.com The status for each practitioner is below, adjacent to each name.  Individual Providers:  Melody L\'Etoile                     Credentialing in progress, not yet approved, locations confirmed NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons                       Credentialing in progress, not yet approved, locations confirmed NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson                         Credentialing in progress, not yet approved, locations confirmed NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith                                        Credentialing in progress, not yet approved, locations confirmed NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland                           Credentialing in progress, not yet approved, locations confirmed NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid                    Credentialed/linked 4/3/2020, locations confirmed NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite                                 Credentialing in progress, not yet approved, locations confirmed NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert                            Credentialing in progress, not yet approved, locations confirmed  NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell                                      Credentialing in progress, not yet approved, location confirmed NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol                       Credentialed 4/28/2020, Waiting to add location NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan                 Credentialed 5/19/2020, added to locations 4/20/2020 & Waiting to add to Raynham Loc. NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.            Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti                            Credentialed 5/5/2020, added to location 5/4/2021 NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva                              Not recognized by name or NPI, not certified/credentialed/linked NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere                       Not credentialed, pls send DOB, SSN & CAQH number for credentialing NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.', NULL, NULL, '2021-05-31 10:47:22', '2021-05-31 10:47:22'),
(32523, 1019, 25149, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to ASantulli@humana.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tricare  Hello Anne, Hope you are doing good, I need the enrollment status for the following providers. I will really appreciate your help with this.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-06-16 08:00:29', '2021-06-16 08:00:29'),
(32524, 1019, 25149, NULL, '2021-08-30 00:00:00.000', 'Not Eligible', 'Provider no longer working with SNBCARE', NULL, NULL, '2021-08-23 13:53:09', '2021-08-23 13:53:09'),
(32525, 1019, 25150, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 07:26:46', '2021-04-23 07:26:46'),
(32526, 1019, 25150, NULL, '2021-05-03 00:00:00.000', 'On Hold', 'Waiting for Medicare PTAN to load in Railroad systems, its showing up will f/u in 3 days.', NULL, NULL, '2021-04-28 14:52:17', '2021-04-28 14:52:17'),
(32527, 1019, 25150, NULL, '2021-05-20 00:00:00.000', 'Initiated', 'PTAN request submitted online thorough Portal, see attachment for Ref', NULL, NULL, '2021-05-11 07:17:41', '2021-05-11 07:17:41'),
(32528, 1019, 25150, NULL, '2021-06-12 00:00:00.000', 'Approved', 'PTAN has been active effective from 01/22/2021. see attachment for approval Also sent test email', NULL, NULL, '2021-06-05 12:26:18', '2021-06-05 12:26:18'),
(32529, 1019, 25151, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 07:26:46', '2021-04-23 07:26:46'),
(32530, 1019, 25151, NULL, '2021-04-30 00:00:00.000', 'Initiated', 'Application Submitted through PECOS  To: MELODY.LETOILE@GMAIL.COM,SNBC@CLAIMSMEDINC.COM   Subject: Medicare Enrollment Application Receipt Notification (Tracking ID: T042220210002309)   Sent: 04/22/2021 15:22 PM   This message is to confirm receipt of your Medicare enrollment application that was submitted from (https://pecos.cms.hhs.gov). You are listed as the contact person for this application. The information provided below is for your future reference:    ----------------------------------------------------------------------------------------------------------------------       Application Tracking ID: T042220210002309        NPI: 1942687108        Medicare ID:         Name: MELODY CELINE L\'ETOILE          State: MA        Fee-for-Service Contractor: NATIONAL GOVERNMENT SERVICES, INC.', NULL, NULL, '2021-04-23 07:45:40', '2021-04-23 07:45:40'),
(32531, 1019, 25151, NULL, '2021-05-04 00:00:00.000', 'Approved', 'Received the following email from customerservice-donotreply@cms.hhs.gov  This message is in response to your Medicare enrollment application that was submitted from (https://pecos.cms.hhs.gov). You are listed as the contact person for this application. Your application is assigned the Tracking Identifier of T042220210002309. The application listed below has reached a final status.  IMPORTANT NOTE: Please wait until you receive official notification from your Fee-for-Service Contractor before submitting claims. Claims submitted before official notification from your Fee-for-Service Contractor may be rejected.  ----------------------------------------------------------------------------------------------------------------------------------------------------------------------  Application Tracking ID: T042220210002309   NPI ID: 1942687108   Medicare ID: S400743652   Name: MELODY L\'ETOILE  State: MA   Form Type: 855I  Date: 04/27/2021  Status: APPROVED', NULL, NULL, '2021-04-27 10:42:11', '2021-04-27 10:42:11'),
(32532, 1019, 25152, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 07:26:46', '2021-04-23 07:26:46'),
(32533, 1019, 25152, NULL, '2021-05-04 00:00:00.000', 'Initiated', 'CAQH Application faxed to Network Operations at (866) 612-7790. ', NULL, NULL, '2021-04-27 13:12:59', '2021-04-27 13:12:59'),
(32534, 1019, 25152, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: RE: Enrollment Status || Providers || SNBCARE || Beacon attn Shashi  Hello Shashi, Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.   Individual Provider   L\'Etoile, Melody NPI: 1942687108 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Edmundson, Rodesia NPI: 1124622667 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Hefti, Prisca NPI: 1508133182 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Khan, Fauzia Wali NPI: 1699761965 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Pionke, Peggy NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rashid, Mahreen NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Schubert, Jonathan NPI: 1235755505 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Smith, Kerry NPI: 1275083230 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Tawakol, Katie NPI:1609222116 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-05-03 12:47:46', '2021-05-03 12:47:46'),
(32535, 1019, 25152, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: Enrollment Query || Group & Providers || SNBCARE || BHS/BHO ATTN Shashi  Hello Shashi,  Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Individual Provider     Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    L\'Etoile, Melody  NPI: 1942687108  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Edmundson, Rodesia NPI: 1124622667 Location: 100 New State Highway, Raynham, MA, 02767.     Hefti, Prisca NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.     Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.   Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Schubert, Jonathan NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.     Smith, Kerry NPI: 1275083230 Location: 100 New State Highway, Raynham, MA, 02767.     Tawakol, Katie NPI:1609222116 Location: 100 New State Highway, Raynham, MA, 02767.     Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-05-20 08:30:46', '2021-05-20 08:30:46'),
(32536, 1019, 25152, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com  SUB: Enrollment Query || Group & Providers || SNBCARE || BHS/BHO ATTN Shashi 2nd Attempt  Hello Shashi,  Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Individual Provider     Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    L\'Etoile, Melody  NPI: 1942687108  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Edmundson, Rodesia NPI: 1124622667 Location: 100 New State Highway, Raynham, MA, 02767.     Hefti, Prisca NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.     Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.   Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Schubert, Jonathan NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.     Smith, Kerry NPI: 1275083230 Location: 100 New State Highway, Raynham, MA, 02767.     Tawakol, Katie NPI:1609222116 Location: 100 New State Highway, Raynham, MA, 02767.     Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-06-05 11:15:36', '2021-06-05 11:15:36'),
(32537, 1019, 25152, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Received the following email from provider.relations@beaconhealthoptions.com  Good afternoon Alex,  I am looking into it.    Thank you! Shashi Seth Network Management Rep I, Northeast Provider Relations', NULL, NULL, '2021-06-24 07:59:00', '2021-06-24 07:59:00'),
(32538, 1019, 25152, NULL, '2021-09-03 00:00:00.000', 'Not Eligible', 'Provider is no longer working with SNBCARE ', NULL, NULL, '2021-08-27 08:34:28', '2021-08-27 08:34:28'),
(32539, 1019, 25153, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 07:26:46', '2021-04-23 07:26:46'),
(32540, 1019, 25153, NULL, '2021-05-10 00:00:00.000', 'Initiated', 'Called UBH @ (877) 614-0484 Spoken with Rep Haydie M  Asked the Rep to send the request for demographic update as we are unable to request Location addition thru provider express. She has send the request to Demographic Update for both Locations of MA. It will take up to 10 business days to load these addresses in their Systems.  Ticket #: EPUF1982913 Ref#: 04/30/2021 Haydie M ', NULL, NULL, '2021-04-30 10:34:36', '2021-04-30 10:34:36'),
(32541, 1019, 25153, NULL, '2021-06-16 00:00:00.000', 'Approved', 'Spoken to Rep Ian, the Location has been added eff 11/16/2020. Also I have attached a copy of Location Confirmation for Reference Call Ref: IAN I- 06/09/2021 - (877) 614-0484', NULL, NULL, '2021-06-09 11:25:21', '2021-06-09 11:25:21'),
(32542, 1019, 25154, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 07:26:46', '2021-04-23 07:26:46'),
(32543, 1019, 25154, NULL, '2021-05-05 00:00:00.000', 'Initiated', 'Sent the following email to provider_information_dept@tufts-health.com Sub: Location Addition || Melody L\'Etoile || SNBCARE || Tufts Health   Hello, Attached is the Provider Information form, for Melody L\'Etoile to add her under our group. Let me know if you need further assistance.  Regards, Alex', NULL, NULL, '2021-04-28 14:45:38', '2021-04-28 14:45:38'),
(32544, 1019, 25154, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to provider_data_request@tufts-health.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tufts Health Plans  Hello, We need the enrollment status for the following providers under our group, as their applications have been in process for a while now.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert NPI: 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  ', NULL, NULL, '2021-06-05 12:58:14', '2021-06-05 12:58:14'),
(32545, 1019, 25154, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Sent the following email to Kody_Dunnett@tufts-health.com  Hello Kody,  We need to expedite the applications for the following providers of Credentialing and Contracting as it is In process since a while now as it is adversely affecting our business, also we are not getting proper responses on our emails.  Spectrum Neuro Behavioral Care LLC. 1356906572 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rodesia Edmundson  1124622667  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Mary Gibbons  NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Lynnetta Loveland  NPI: 1598163602  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Jonathan Schubert  NPI: 1235755505  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jennifer Ullrich NPI: 1710489760  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Prisca Hefti NPI: 1508133182  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767  Regards, Alex G', NULL, NULL, '2021-06-23 09:34:22', '2021-06-23 09:34:22'),
(32546, 1019, 25154, NULL, '2021-07-14 00:00:00.000', 'Approved', 'Received the following email from Brady_Roche@tufts-health.com  Hi Alex,  My department can help with effective dates, I have provided them on the spreadsheet. I have included Katherine in Allied and Christine in Credentialing as one is still in cred process and the other needs to be linked to the group.  Thanks,  Effective Date is 12/31/2020 Attached are the Location Addition and Provider Roster of Tufts', NULL, NULL, '2021-07-07 11:53:33', '2021-07-07 11:53:33'),
(32547, 1019, 25155, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 07:26:46', '2021-04-23 07:26:46'),
(32548, 1019, 25155, NULL, '2021-05-05 00:00:00.000', 'Not Eligible', 'We received the following update regarding LCSW/LICSW enrollment guidelines of Mass Health @ Rippstein, Kyle KyleRippstein@maximus.com:   Sub: Enrollment || Providers || SNBCARE || MassHealth  \"Hi Alex,  We do not enroll LCSWs at this time.  We DO enroll LICSWs, but in a non-billing capacity (they would not “link” to the Group as would a Physician or NP, for example).  I have attached the proper applications for LICSWs. Let us know if you need any further assistance.  Thanks,  Kyle Rippstein Supervisor, Provider Enrollment and Credentialing MassHealth MAXIMUS , Inc 55 Summer St, 8th floor Boston, MA 02110 Office (617)948-5537 Fax (617)988-8904\"  Non-billing capacity implies that we aren\'t able to submit claims under those providers, so there is no point with that process either. ', NULL, NULL, '2021-04-28 08:35:57', '2021-04-28 08:35:57'),
(32549, 1019, 25156, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 07:26:46', '2021-04-23 07:26:46'),
(32550, 1019, 25156, NULL, '2021-05-04 00:00:00.000', 'Initiated', 'Application submitted thru Online Portal', NULL, NULL, '2021-04-27 14:46:41', '2021-04-27 14:46:41'),
(32551, 1019, 25156, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to JWright@magellanhealth.com SUB: Enrollment Query || Providers || SNBCARE || Magellan  Hello Judith, Hope you\'re doing good, we need the Credentialing Status for the following providers.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Regards,', NULL, NULL, '2021-05-20 10:11:52', '2021-05-20 10:11:52'),
(32552, 1019, 25156, NULL, '2021-06-03 00:00:00.000', 'Approved', 'Received the following email from JWright@magellanhealth.com  Melody L\'Etoile: Has been linked to your group effective date 12/9/2020. Previously informed on 12/21/2020.  NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   ', NULL, NULL, '2021-05-27 09:27:19', '2021-05-27 09:27:19'),
(32553, 1019, 25157, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 07:26:46', '2021-04-23 07:26:46'),
(32554, 1019, 25157, NULL, '2021-05-05 00:00:00.000', 'Initiated', 'Sent the following email to provider_data_request@tufts-health.com Sub: Location Addition || Melody L\'Etoile || SNBCARE || Tufts Health   Hello, Attached is the Provider Information form, for Melody L\'Etoile to add her under our group. Let me know if you need further assistance.  Regards, Alex', NULL, NULL, '2021-04-28 14:46:48', '2021-04-28 14:46:48'),
(32555, 1019, 25157, NULL, '2021-05-12 00:00:00.000', 'In Process', 'Received the following email from Provider_Data_Request@tufts-health.com  SUB: PRO0135416 - Request Received  Hello , We are in receipt of your request regarding Location Addition || Melody L\'Etoile || SNBCARE || Tufts Health that was submitted on 2021-04-28 15:42:56 EDT.  Please reference ticket number PRO0135416 for further communications about this request. Thank you,  Tufts Health Public Plans, Provider Information Management Team  Ref:MSG6887111 REMINDER: Please limit PHI to the minimum necessary to process your request. For Tufts Health Plan Compliance policy on documentation guidelines, refer to the Corporate Confidentiality Policy Regarding Protected Health Information (DMS# 1020907). thpwatsmr2.tufts-health.com made the following annotations', NULL, NULL, '2021-05-05 15:42:00', '2021-05-05 15:42:00'),
(32556, 1019, 25157, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to provider_data_request@tufts-health.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tufts Health Plans   Hello, We need the enrollment status for the following providers under our group, as their applications have been in process for a while now.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert NPI: 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Regards,', NULL, NULL, '2021-06-07 07:55:32', '2021-06-07 07:55:32'),
(32557, 1019, 25157, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Sent the following email to Kody_Dunnett@tufts-health.com  Hello Kody,  We need to expedite the applications for the following providers of Credentialing and Contracting as it is In process since a while now as it is adversely affecting our business, also we are not getting proper responses on our emails.  Spectrum Neuro Behavioral Care LLC. 1356906572 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rodesia Edmundson  1124622667  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Mary Gibbons  NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Lynnetta Loveland  NPI: 1598163602  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Jonathan Schubert  NPI: 1235755505  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jennifer Ullrich NPI: 1710489760  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Prisca Hefti NPI: 1508133182  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767  Regards, Alex G', NULL, NULL, '2021-06-23 09:36:39', '2021-06-23 09:36:39'),
(32558, 1019, 25157, NULL, '2021-08-18 00:00:00.000', 'Approved', 'Received the following email from Brady_Roche@tufts-health.com  Hi Alex,  My department can help with effective dates, I have provided them on the spreadsheet. I have included Katherine in Allied and Christine in Credentialing as one is still in cred process and the other needs to be linked to the group.  Thanks,  Effective Date is 03/09/2021 Attached are the Location Addition and Provider Roster of Tufts', NULL, NULL, '2021-08-10 23:24:07', '2021-08-10 23:24:07'),
(32559, 1019, 25158, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 07:26:46', '2021-04-23 07:26:46'),
(32560, 1019, 25158, NULL, '2021-05-04 00:00:00.000', 'Initiated', 'Sent following email to PNMDepartment@commonwealthcare.org, Credentialing@commonwealthcare.org  Sub: HCAS Provider Enrollment - Kerry Smith - CCA - SNBCARE Hello,   Please find the attached enrollment form for our provider and expedite the enrollment process as much as possible. Do let me know how long it will take to get her added to our group.     Regards, Alex G.', NULL, NULL, '2021-04-27 14:19:00', '2021-04-27 14:19:00'),
(32561, 1019, 25158, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to Credentialing@commonwealthcare.org, PNMDepartment@commonwealthcare.org  SUB: Enrollment Query || Group & Providers || SNBCARE || CCA Hello, We want the enrollment status for our Group and Providers under our group, also please provide us the effective dates for the providers as well.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753   Locations: Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.  Barbara Hignite NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.  Lynetta Loveland NPI:1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Peggy Pionke NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1356906572 Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Location: 100 New State Highway, Raynham, MA, 02767.', NULL, NULL, '2021-06-03 16:05:04', '2021-06-03 16:05:04'),
(32562, 1019, 25158, NULL, '2021-06-28 00:00:00.000', 'Approved', 'See Attached for the email SS received from CCA for Approval Confirmation.  Also spoken with Rep Gilsen F, as per rep the provider is linked under both (Framingham & Raynham) locations.  Call ref #: Gislen F - 06/21/2021 ', NULL, NULL, '2021-06-21 09:03:35', '2021-06-21 09:03:35'),
(32563, 1019, 25159, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 07:26:46', '2021-04-23 07:26:46'),
(32564, 1019, 25159, NULL, '2021-05-07 00:00:00.000', 'On Hold', 'Spoke to Furquan regarding this, providers will do their cultural competency and update me when that has been completed so we can move forward with this request.  ', NULL, NULL, '2021-04-30 07:50:26', '2021-04-30 07:50:26'),
(32565, 1019, 25160, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 07:26:46', '2021-04-23 07:26:46'),
(32566, 1019, 25160, NULL, '2021-05-05 00:00:00.000', 'On Hold', 'Waiting for response from Health New England as they don\'t credential in every city in MA. ', NULL, NULL, '2021-04-28 14:55:25', '2021-04-28 14:55:25'),
(32567, 1019, 25160, NULL, '2021-08-30 00:00:00.000', 'Not Eligible', 'Provider no longer working with SNBCARE', NULL, NULL, '2021-08-23 13:52:37', '2021-08-23 13:52:37'),
(32568, 3040, 25193, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 15:16:04', '2021-04-23 15:16:04'),
(32569, 3040, 25193, NULL, '2021-05-03 00:00:00.000', 'In Process', 'Email sent to: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Hello David,   Hope you are doing well. The contract request form that was sent out in your previous email I would like to ask you in the provider type section what option you want me to mark for the providers. If you could reach out to me on 713-893-6214 that would be better.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you', NULL, NULL, '2021-04-26 10:40:37', '2021-04-26 10:40:37'),
(32570, 3040, 25193, NULL, '2021-05-03 00:00:00.000', 'In Process', 'Email sent to: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Hello David,   Hope you are doing well. The contract request form that was sent out in your previous email I would like to ask you in the provider type section what option you want me to mark for the providers. If you could reach out to me on 713-893-6214 that would be better.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you', NULL, NULL, '2021-04-26 10:41:09', '2021-04-26 10:41:09'),
(32571, 3040, 25193, NULL, '2021-06-07 00:00:00.000', 'Approved', 'Facility has an ancillary contract. No need to add individual providers. Facility contract attached in group task.  ', NULL, NULL, '2021-05-31 09:13:55', '2021-05-31 09:13:55'),
(32572, 3040, 25194, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 15:16:04', '2021-04-23 15:16:04'),
(32573, 3040, 25194, NULL, '2021-05-03 00:00:00.000', 'Approved', 'Facility has an ancillary contract. No need to add individual providers. Facility contract attached in group task. ', NULL, NULL, '2021-04-26 10:13:26', '2021-04-26 10:13:26'),
(32574, 3040, 25194, NULL, NULL, 'Revalidation', 'Email sent to: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Hello David,   Hope you are doing well. The contract request form that was sent out in your previous email I would like to ask you in the provider type section what option you want me to mark for the providers. If you could reach out to me on 713-893-6214 that would be better.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you', NULL, NULL, '2021-04-26 10:39:28', '2021-04-26 10:39:28'),
(32575, 3040, 25194, NULL, NULL, 'Revalidated', 'Email rcvd from: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Good Afternoon Brad  I reviewed each of the PCP’s individual NPI numbers.  The majority of the providers are not contracted or affiliated to Valley Med.  Please fill out the contract request form to add or affiliate them to the group and to get them contracted, please review the attached spreadsheet.  I have attached the Contract request form, please fill out the form for each provider and email or fax it in, information located at the top of the form.   Please call me if you have any questions.    Provider Name               NPI#                Contract  Eder Hernandez      1386956852         Affiliated         Yes  Thank you David Balli Representative Provider Service  II Molina Healthcare of Texas, Inc.', NULL, NULL, '2021-04-26 11:16:13', '2021-04-26 11:16:13'),
(32576, 3040, 25195, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 15:16:04', '2021-04-23 15:16:04'),
(32577, 3040, 25195, NULL, '2021-05-03 00:00:00.000', 'Approved', 'Facility has an ancillary contract. No need to add individual providers. Facility contract attached in group task. ', NULL, NULL, '2021-04-26 10:10:22', '2021-04-26 10:10:22'),
(32578, 3040, 25195, NULL, NULL, 'Revalidation', 'Email sent to: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Hello David,   Hope you are doing well. The contract request form that was sent out in your previous email I would like to ask you in the provider type section what option you want me to mark for the providers. If you could reach out to me on 713-893-6214 that would be better.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you', NULL, NULL, '2021-04-26 10:36:18', '2021-04-26 10:36:18');
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
(32579, 3040, 25195, NULL, NULL, 'Revalidated', 'Facility has an ancillary contract. No need to add individual providers. Facility contract attached in group task.  ', NULL, NULL, '2021-05-31 09:14:28', '2021-05-31 09:14:28'),
(32580, 3040, 25196, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 15:16:04', '2021-04-23 15:16:04'),
(32581, 3040, 25196, NULL, '2021-05-03 00:00:00.000', 'Approved', 'Facility has an ancillary contract. No need to add individual providers. Facility contract attached in group task. ', NULL, NULL, '2021-04-26 10:14:08', '2021-04-26 10:14:08'),
(32582, 3040, 25196, NULL, NULL, 'Revalidation', 'Email sent to: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Hello David,   Hope you are doing well. The contract request form that was sent out in your previous email I would like to ask you in the provider type section what option you want me to mark for the providers. If you could reach out to me on 713-893-6214 that would be better.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you', NULL, NULL, '2021-04-26 10:39:40', '2021-04-26 10:39:40'),
(32583, 3040, 25196, NULL, NULL, 'Revalidated', 'Facility has an ancillary contract. No need to add individual providers. Facility contract attached in group task.  ', NULL, NULL, '2021-05-31 09:14:33', '2021-05-31 09:14:33'),
(32584, 3040, 25197, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 15:16:04', '2021-04-23 15:16:04'),
(32585, 3040, 25197, NULL, '2021-05-03 00:00:00.000', 'Approved', 'Facility has an ancillary contract. No need to add individual providers. Facility contract attached in group task. ', NULL, NULL, '2021-04-26 10:11:31', '2021-04-26 10:11:31'),
(32586, 3040, 25197, NULL, NULL, 'Revalidation', 'Email sent to: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Hello David,   Hope you are doing well. The contract request form that was sent out in your previous email I would like to ask you in the provider type section what option you want me to mark for the providers. If you could reach out to me on 713-893-6214 that would be better.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you', NULL, NULL, '2021-04-26 10:36:46', '2021-04-26 10:36:46'),
(32587, 3040, 25197, NULL, NULL, 'Revalidated', 'Facility has an ancillary contract. No need to add individual providers. Facility contract attached in group task.  ', NULL, NULL, '2021-05-31 09:14:41', '2021-05-31 09:14:41'),
(32588, 3040, 25198, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 15:16:04', '2021-04-23 15:16:04'),
(32589, 3040, 25198, NULL, '2021-05-03 00:00:00.000', 'Approved', 'Facility has an ancillary contract. No need to add individual providers. Facility contract attached in group task. ', NULL, NULL, '2021-04-26 10:15:45', '2021-04-26 10:15:45'),
(32590, 3040, 25198, NULL, NULL, 'Revalidation', 'Email sent to: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Hello David,   Hope you are doing well. The contract request form that was sent out in your previous email I would like to ask you in the provider type section what option you want me to mark for the providers. If you could reach out to me on 713-893-6214 that would be better.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you', NULL, NULL, '2021-04-26 10:40:07', '2021-04-26 10:40:07'),
(32591, 3040, 25198, NULL, NULL, 'Revalidated', 'Facility has an ancillary contract. No need to add individual providers. Facility contract attached in group task.  ', NULL, NULL, '2021-05-31 09:14:45', '2021-05-31 09:14:45'),
(32592, 3040, 25199, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 15:16:04', '2021-04-23 15:16:04'),
(32593, 3040, 25199, NULL, '2021-05-03 00:00:00.000', 'Approved', 'Facility has an ancillary contract. No need to add individual providers. Facility contract attached in group task. ', NULL, NULL, '2021-04-26 10:12:40', '2021-04-26 10:12:40'),
(32594, 3040, 25199, NULL, NULL, 'Revalidation', 'Email sent to: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Hello David,   Hope you are doing well. The contract request form that was sent out in your previous email I would like to ask you in the provider type section what option you want me to mark for the providers. If you could reach out to me on 713-893-6214 that would be better.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you', NULL, NULL, '2021-04-26 10:37:16', '2021-04-26 10:37:16'),
(32595, 3040, 25199, NULL, NULL, 'Revalidated', 'Facility has an ancillary contract. No need to add individual providers. Facility contract attached in group task.  ', NULL, NULL, '2021-05-31 09:14:49', '2021-05-31 09:14:49'),
(32596, 3040, 25200, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 15:16:04', '2021-04-23 15:16:04'),
(32597, 3040, 25200, NULL, '2021-05-03 00:00:00.000', 'In Process', 'Email sent to: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Hello David,   Hope you are doing well. The contract request form that was sent out in your previous email I would like to ask you in the provider type section what option you want me to mark for the providers. If you could reach out to me on 713-893-6214 that would be better.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you', NULL, NULL, '2021-04-26 10:41:56', '2021-04-26 10:41:56'),
(32598, 3040, 25200, NULL, '2021-06-07 00:00:00.000', 'Approved', 'Facility has an ancillary contract. No need to add individual providers. Facility contract attached in group task.  ', NULL, NULL, '2021-05-31 09:15:01', '2021-05-31 09:15:01'),
(32599, 3040, 25201, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 15:16:04', '2021-04-23 15:16:04'),
(32600, 3040, 25201, NULL, '2021-05-03 00:00:00.000', 'In Process', 'Email sent to: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Hello David,   Hope you are doing well. The contract request form that was sent out in your previous email I would like to ask you in the provider type section what option you want me to mark for the providers. If you could reach out to me on 713-893-6214 that would be better.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you', NULL, NULL, '2021-04-26 10:40:27', '2021-04-26 10:40:27'),
(32601, 3040, 25201, NULL, '2021-06-07 00:00:00.000', 'Approved', 'Facility has an ancillary contract. No need to add individual providers. Facility contract attached in group task.  ', NULL, NULL, '2021-05-31 09:15:12', '2021-05-31 09:15:12'),
(32602, 3040, 25202, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 15:16:04', '2021-04-23 15:16:04'),
(32603, 3040, 25202, NULL, '2021-05-03 00:00:00.000', 'Approved', 'Facility has an ancillary contract. No need to add individual providers. Facility contract attached in group task. ', NULL, NULL, '2021-04-26 10:14:42', '2021-04-26 10:14:42'),
(32604, 3040, 25202, NULL, NULL, 'Revalidation', 'Email sent to: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Hello David,   Hope you are doing well. The contract request form that was sent out in your previous email I would like to ask you in the provider type section what option you want me to mark for the providers. If you could reach out to me on 713-893-6214 that would be better.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you', NULL, NULL, '2021-04-26 10:39:57', '2021-04-26 10:39:57'),
(32605, 3040, 25202, NULL, NULL, 'Revalidated', 'Facility has an ancillary contract. No need to add individual providers. Facility contract attached in group task.  ', NULL, NULL, '2021-05-31 09:15:20', '2021-05-31 09:15:20'),
(32606, 3040, 25203, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 15:16:04', '2021-04-23 15:16:04'),
(32607, 3040, 25203, NULL, '2021-05-03 00:00:00.000', 'In Process', 'Email sent to: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Hello David,   Hope you are doing well. The contract request form that was sent out in your previous email I would like to ask you in the provider type section what option you want me to mark for the providers. If you could reach out to me on 713-893-6214 that would be better.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you', NULL, NULL, '2021-04-26 10:41:43', '2021-04-26 10:41:43'),
(32608, 3040, 25203, NULL, '2021-06-07 00:00:00.000', 'Approved', 'Facility has an ancillary contract. No need to add individual providers. Facility contract attached in group task.  ', NULL, NULL, '2021-05-31 09:15:25', '2021-05-31 09:15:25'),
(32609, 3040, 25204, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 15:16:13', '2021-04-23 15:16:13'),
(32610, 3040, 25204, NULL, '2021-05-03 00:00:00.000', 'In Process', 'Email sent to: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Hello David,   Hope you are doing well. The contract request form that was sent out in your previous email I would like to ask you in the provider type section what option you want me to mark for the providers. If you could reach out to me on 713-893-6214 that would be better.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you', NULL, NULL, '2021-04-26 10:40:32', '2021-04-26 10:40:32'),
(32611, 3040, 25204, NULL, '2021-05-03 00:00:00.000', 'In Process', 'Email sent to: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Hello David,   Hope you are doing well. The contract request form that was sent out in your previous email I would like to ask you in the provider type section what option you want me to mark for the providers. If you could reach out to me on 713-893-6214 that would be better.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you', NULL, NULL, '2021-04-26 10:40:58', '2021-04-26 10:40:58'),
(32612, 3040, 25204, NULL, '2021-06-07 00:00:00.000', 'Approved', 'Facility has an ancillary contract. No need to add individual providers. Facility contract attached in group task.  ', NULL, NULL, '2021-05-31 09:16:10', '2021-05-31 09:16:10'),
(32613, 3040, 25205, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 15:16:14', '2021-04-23 15:16:14'),
(32614, 3040, 25205, NULL, '2021-05-03 00:00:00.000', 'Approved', 'Facility has an ancillary contract. No need to add individual providers. Facility contract attached in group task. ', NULL, NULL, '2021-04-26 10:13:30', '2021-04-26 10:13:30'),
(32615, 3040, 25205, NULL, NULL, 'Revalidation', 'Email sent to: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Hello David,   Hope you are doing well. The contract request form that was sent out in your previous email I would like to ask you in the provider type section what option you want me to mark for the providers. If you could reach out to me on 713-893-6214 that would be better.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you', NULL, NULL, '2021-04-26 10:39:24', '2021-04-26 10:39:24'),
(32616, 3040, 25205, NULL, NULL, 'Revalidated', 'Email rcvd from: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Good Afternoon Brad  I reviewed each of the PCP’s individual NPI numbers.  The majority of the providers are not contracted or affiliated to Valley Med.  Please fill out the contract request form to add or affiliate them to the group and to get them contracted, please review the attached spreadsheet.  I have attached the Contract request form, please fill out the form for each provider and email or fax it in, information located at the top of the form.   Please call me if you have any questions.    Provider Name               NPI#                Contract  Eder Hernandez      1386956852         Affiliated         Yes  Thank you David Balli Representative Provider Service  II Molina Healthcare of Texas, Inc.', NULL, NULL, '2021-04-26 11:16:17', '2021-04-26 11:16:17'),
(32617, 3040, 25206, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 15:16:14', '2021-04-23 15:16:14'),
(32618, 3040, 25206, NULL, '2021-05-03 00:00:00.000', 'Approved', 'Facility has an ancillary contract. No need to add individual providers. Facility contract attached in group task. ', NULL, NULL, '2021-04-26 10:10:31', '2021-04-26 10:10:31'),
(32619, 3040, 25206, NULL, NULL, 'Revalidation', 'Email sent to: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Hello David,   Hope you are doing well. The contract request form that was sent out in your previous email I would like to ask you in the provider type section what option you want me to mark for the providers. If you could reach out to me on 713-893-6214 that would be better.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you', NULL, NULL, '2021-04-26 10:36:15', '2021-04-26 10:36:15'),
(32620, 3040, 25206, NULL, NULL, 'Revalidated', 'Facility has an ancillary contract. No need to add individual providers. Facility contract attached in group task.  ', NULL, NULL, '2021-05-31 09:16:17', '2021-05-31 09:16:17'),
(32621, 3040, 25207, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 15:16:14', '2021-04-23 15:16:14'),
(32622, 3040, 25207, NULL, '2021-05-03 00:00:00.000', 'Approved', 'Facility has an ancillary contract. No need to add individual providers. Facility contract attached in group task. ', NULL, NULL, '2021-04-26 10:14:12', '2021-04-26 10:14:12'),
(32623, 3040, 25207, NULL, NULL, 'Revalidation', 'Email sent to: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Hello David,   Hope you are doing well. The contract request form that was sent out in your previous email I would like to ask you in the provider type section what option you want me to mark for the providers. If you could reach out to me on 713-893-6214 that would be better.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you', NULL, NULL, '2021-04-26 10:39:36', '2021-04-26 10:39:36'),
(32624, 3040, 25207, NULL, NULL, 'Revalidated', 'Facility has an ancillary contract. No need to add individual providers. Facility contract attached in group task.  ', NULL, NULL, '2021-05-31 09:16:20', '2021-05-31 09:16:20'),
(32625, 3040, 25208, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 15:16:14', '2021-04-23 15:16:14'),
(32626, 3040, 25208, NULL, '2021-05-03 00:00:00.000', 'Approved', 'Facility has an ancillary contract. No need to add individual providers. Facility contract attached in group task. ', NULL, NULL, '2021-04-26 10:11:39', '2021-04-26 10:11:39'),
(32627, 3040, 25208, NULL, NULL, 'Revalidation', 'Email sent to: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Hello David,   Hope you are doing well. The contract request form that was sent out in your previous email I would like to ask you in the provider type section what option you want me to mark for the providers. If you could reach out to me on 713-893-6214 that would be better.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you', NULL, NULL, '2021-04-26 10:36:42', '2021-04-26 10:36:42'),
(32628, 3040, 25208, NULL, NULL, 'Revalidated', 'Facility has an ancillary contract. No need to add individual providers. Facility contract attached in group task.  ', NULL, NULL, '2021-05-31 09:16:23', '2021-05-31 09:16:23'),
(32629, 3040, 25209, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 15:16:14', '2021-04-23 15:16:14'),
(32630, 3040, 25209, NULL, '2021-05-03 00:00:00.000', 'Approved', 'Facility has an ancillary contract. No need to add individual providers. Facility contract attached in group task. ', NULL, NULL, '2021-04-26 10:15:50', '2021-04-26 10:15:50'),
(32631, 3040, 25209, NULL, NULL, 'Revalidation', 'Email sent to: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Hello David,   Hope you are doing well. The contract request form that was sent out in your previous email I would like to ask you in the provider type section what option you want me to mark for the providers. If you could reach out to me on 713-893-6214 that would be better.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you', NULL, NULL, '2021-04-26 10:40:04', '2021-04-26 10:40:04'),
(32632, 3040, 25209, NULL, NULL, 'Revalidated', 'Facility has an ancillary contract. No need to add individual providers. Facility contract attached in group task.  ', NULL, NULL, '2021-05-31 09:16:26', '2021-05-31 09:16:26'),
(32633, 3040, 25210, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 15:16:14', '2021-04-23 15:16:14'),
(32634, 3040, 25210, NULL, '2021-05-03 00:00:00.000', 'Approved', 'Facility has an ancillary contract. No need to add individual providers. Facility contract attached in group task. ', NULL, NULL, '2021-04-26 10:12:44', '2021-04-26 10:12:44'),
(32635, 3040, 25210, NULL, NULL, 'Revalidation', 'Email sent to: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Hello David,   Hope you are doing well. The contract request form that was sent out in your previous email I would like to ask you in the provider type section what option you want me to mark for the providers. If you could reach out to me on 713-893-6214 that would be better.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you', NULL, NULL, '2021-04-26 10:37:12', '2021-04-26 10:37:12'),
(32636, 3040, 25210, NULL, NULL, 'Revalidated', 'Facility has an ancillary contract. No need to add individual providers. Facility contract attached in group task.  ', NULL, NULL, '2021-05-31 09:16:29', '2021-05-31 09:16:29'),
(32637, 3040, 25211, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 15:16:14', '2021-04-23 15:16:14'),
(32638, 3040, 25211, NULL, '2021-05-03 00:00:00.000', 'In Process', 'Email sent to: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Hello David,   Hope you are doing well. The contract request form that was sent out in your previous email I would like to ask you in the provider type section what option you want me to mark for the providers. If you could reach out to me on 713-893-6214 that would be better.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you', NULL, NULL, '2021-04-26 10:41:52', '2021-04-26 10:41:52'),
(32639, 3040, 25211, NULL, '2021-06-07 00:00:00.000', 'Approved', 'Facility has an ancillary contract. No need to add individual providers. Facility contract attached in group task.  ', NULL, NULL, '2021-05-31 09:16:34', '2021-05-31 09:16:34'),
(32640, 3040, 25212, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 15:16:14', '2021-04-23 15:16:14'),
(32641, 3040, 25212, NULL, '2021-05-03 00:00:00.000', 'In Process', 'Email sent to: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Hello David,   Hope you are doing well. The contract request form that was sent out in your previous email I would like to ask you in the provider type section what option you want me to mark for the providers. If you could reach out to me on 713-893-6214 that would be better.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you', NULL, NULL, '2021-04-26 10:40:20', '2021-04-26 10:40:20'),
(32642, 3040, 25212, NULL, '2021-06-07 00:00:00.000', 'Approved', 'Facility has an ancillary contract. No need to add individual providers. Facility contract attached in group task.  ', NULL, NULL, '2021-05-31 09:16:45', '2021-05-31 09:16:45'),
(32643, 3040, 25213, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 15:16:14', '2021-04-23 15:16:14'),
(32644, 3040, 25213, NULL, '2021-05-03 00:00:00.000', 'Approved', 'Facility has an ancillary contract. No need to add individual providers. Facility contract attached in group task. ', NULL, NULL, '2021-04-26 10:14:46', '2021-04-26 10:14:46'),
(32645, 3040, 25213, NULL, NULL, 'Revalidation', 'Email sent to: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Hello David,   Hope you are doing well. The contract request form that was sent out in your previous email I would like to ask you in the provider type section what option you want me to mark for the providers. If you could reach out to me on 713-893-6214 that would be better.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you', NULL, NULL, '2021-04-26 10:39:50', '2021-04-26 10:39:50'),
(32646, 3040, 25213, NULL, NULL, 'Revalidated', 'Facility has an ancillary contract. No need to add individual providers. Facility contract attached in group task.  ', NULL, NULL, '2021-05-31 09:16:48', '2021-05-31 09:16:48'),
(32647, 3040, 25214, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 15:16:14', '2021-04-23 15:16:14'),
(32648, 3040, 25214, NULL, '2021-05-03 00:00:00.000', 'In Process', 'Email sent to: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Hello David,   Hope you are doing well. The contract request form that was sent out in your previous email I would like to ask you in the provider type section what option you want me to mark for the providers. If you could reach out to me on 713-893-6214 that would be better.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you', NULL, NULL, '2021-04-26 10:41:37', '2021-04-26 10:41:37'),
(32649, 3040, 25214, NULL, '2021-06-07 00:00:00.000', 'Approved', 'Facility has an ancillary contract. No need to add individual providers. Facility contract attached in group task.  ', NULL, NULL, '2021-05-31 09:16:57', '2021-05-31 09:16:57'),
(32650, 3040, 25215, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 15:16:20', '2021-04-23 15:16:20'),
(32651, 3040, 25215, NULL, '2021-05-03 00:00:00.000', 'Approved', 'Facility has an ancillary contract. No need to add individual providers. Facility contract attached in group task. ', NULL, NULL, '2021-04-26 10:13:35', '2021-04-26 10:13:35'),
(32652, 3040, 25215, NULL, NULL, 'Revalidation', 'Email sent to: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Hello David,   Hope you are doing well. The contract request form that was sent out in your previous email I would like to ask you in the provider type section what option you want me to mark for the providers. If you could reach out to me on 713-893-6214 that would be better.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you', NULL, NULL, '2021-04-26 10:39:20', '2021-04-26 10:39:20'),
(32653, 3040, 25215, NULL, NULL, 'Revalidated', 'Email rcvd from: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Good Afternoon Brad  I reviewed each of the PCP’s individual NPI numbers.  The majority of the providers are not contracted or affiliated to Valley Med.  Please fill out the contract request form to add or affiliate them to the group and to get them contracted, please review the attached spreadsheet.  I have attached the Contract request form, please fill out the form for each provider and email or fax it in, information located at the top of the form.   Please call me if you have any questions.    Provider Name               NPI#                Contract  Eder Hernandez      1386956852         Affiliated         Yes  Thank you David Balli Representative Provider Service  II Molina Healthcare of Texas, Inc.', NULL, NULL, '2021-04-26 11:16:20', '2021-04-26 11:16:20'),
(32654, 3040, 25216, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 15:16:20', '2021-04-23 15:16:20'),
(32655, 3040, 25216, NULL, '2021-05-03 00:00:00.000', 'Approved', 'Facility has an ancillary contract. No need to add individual providers. Facility contract attached in group task. ', NULL, NULL, '2021-04-26 10:10:36', '2021-04-26 10:10:36'),
(32656, 3040, 25216, NULL, NULL, 'Revalidation', 'Email sent to: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Hello David,   Hope you are doing well. The contract request form that was sent out in your previous email I would like to ask you in the provider type section what option you want me to mark for the providers. If you could reach out to me on 713-893-6214 that would be better.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you', NULL, NULL, '2021-04-26 10:36:11', '2021-04-26 10:36:11'),
(32657, 3040, 25216, NULL, NULL, 'Revalidated', 'Facility has an ancillary contract. No need to add individual providers. Facility contract attached in group task.  ', NULL, NULL, '2021-05-31 09:19:25', '2021-05-31 09:19:25'),
(32658, 3040, 25217, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 15:16:20', '2021-04-23 15:16:20'),
(32659, 3040, 25217, NULL, '2021-05-03 00:00:00.000', 'Approved', 'Facility has an ancillary contract. No need to add individual providers. Facility contract attached in group task. ', NULL, NULL, '2021-04-26 10:14:18', '2021-04-26 10:14:18'),
(32660, 3040, 25217, NULL, NULL, 'Revalidation', 'Email sent to: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Hello David,   Hope you are doing well. The contract request form that was sent out in your previous email I would like to ask you in the provider type section what option you want me to mark for the providers. If you could reach out to me on 713-893-6214 that would be better.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you', NULL, NULL, '2021-04-26 10:39:33', '2021-04-26 10:39:33'),
(32661, 3040, 25217, NULL, NULL, 'Revalidated', 'Facility has an ancillary contract. No need to add individual providers. Facility contract attached in group task.  ', NULL, NULL, '2021-05-31 09:19:28', '2021-05-31 09:19:28'),
(32662, 3040, 25218, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 15:16:20', '2021-04-23 15:16:20'),
(32663, 3040, 25218, NULL, '2021-05-03 00:00:00.000', 'Approved', 'Facility has an ancillary contract. No need to add individual providers. Facility contract attached in group task. ', NULL, NULL, '2021-04-26 10:11:47', '2021-04-26 10:11:47'),
(32664, 3040, 25218, NULL, NULL, 'Revalidation', 'Email sent to: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Hello David,   Hope you are doing well. The contract request form that was sent out in your previous email I would like to ask you in the provider type section what option you want me to mark for the providers. If you could reach out to me on 713-893-6214 that would be better.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you', NULL, NULL, '2021-04-26 10:36:39', '2021-04-26 10:36:39'),
(32665, 3040, 25218, NULL, NULL, 'Revalidated', 'Facility has an ancillary contract. No need to add individual providers. Facility contract attached in group task.  ', NULL, NULL, '2021-05-31 09:19:32', '2021-05-31 09:19:32'),
(32666, 3040, 25219, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 15:16:20', '2021-04-23 15:16:20'),
(32667, 3040, 25219, NULL, '2021-05-03 00:00:00.000', 'Approved', 'Facility has an ancillary contract. No need to add individual providers. Facility contract attached in group task. ', NULL, NULL, '2021-04-26 10:15:54', '2021-04-26 10:15:54'),
(32668, 3040, 25219, NULL, NULL, 'Revalidation', 'Email sent to: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Hello David,   Hope you are doing well. The contract request form that was sent out in your previous email I would like to ask you in the provider type section what option you want me to mark for the providers. If you could reach out to me on 713-893-6214 that would be better.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you', NULL, NULL, '2021-04-26 10:40:01', '2021-04-26 10:40:01'),
(32669, 3040, 25219, NULL, NULL, 'Revalidated', 'Facility has an ancillary contract. No need to add individual providers. Facility contract attached in group task.  ', NULL, NULL, '2021-05-31 09:19:35', '2021-05-31 09:19:35'),
(32670, 3040, 25220, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 15:16:20', '2021-04-23 15:16:20'),
(32671, 3040, 25220, NULL, '2021-05-03 00:00:00.000', 'Approved', 'Facility has an ancillary contract. No need to add individual providers. Facility contract attached in group task. ', NULL, NULL, '2021-04-26 10:12:49', '2021-04-26 10:12:49'),
(32672, 3040, 25220, NULL, NULL, 'Revalidation', 'Email sent to: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Hello David,   Hope you are doing well. The contract request form that was sent out in your previous email I would like to ask you in the provider type section what option you want me to mark for the providers. If you could reach out to me on 713-893-6214 that would be better.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you', NULL, NULL, '2021-04-26 10:37:06', '2021-04-26 10:37:06'),
(32673, 3040, 25220, NULL, NULL, 'Revalidated', 'Facility has an ancillary contract. No need to add individual providers. Facility contract attached in group task.  ', NULL, NULL, '2021-05-31 09:19:38', '2021-05-31 09:19:38'),
(32674, 3040, 25221, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 15:16:20', '2021-04-23 15:16:20'),
(32675, 3040, 25221, NULL, '2021-05-03 00:00:00.000', 'In Process', 'Email sent to: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Hello David,   Hope you are doing well. The contract request form that was sent out in your previous email I would like to ask you in the provider type section what option you want me to mark for the providers. If you could reach out to me on 713-893-6214 that would be better.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you', NULL, NULL, '2021-04-26 10:41:48', '2021-04-26 10:41:48'),
(32676, 3040, 25221, NULL, '2021-06-07 00:00:00.000', 'Approved', 'Facility has an ancillary contract. No need to add individual providers. Facility contract attached in group task.  ', NULL, NULL, '2021-05-31 09:19:44', '2021-05-31 09:19:44'),
(32677, 3040, 25222, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 15:16:20', '2021-04-23 15:16:20'),
(32678, 3040, 25222, NULL, '2021-05-03 00:00:00.000', 'In Process', 'Email sent to: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Hello David,   Hope you are doing well. The contract request form that was sent out in your previous email I would like to ask you in the provider type section what option you want me to mark for the providers. If you could reach out to me on 713-893-6214 that would be better.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you', NULL, NULL, '2021-04-26 10:40:15', '2021-04-26 10:40:15'),
(32679, 3040, 25222, NULL, '2021-06-07 00:00:00.000', 'Approved', 'Facility has an ancillary contract. No need to add individual providers. Facility contract attached in group task.  ', NULL, NULL, '2021-05-31 09:19:54', '2021-05-31 09:19:54'),
(32680, 3040, 25223, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 15:16:20', '2021-04-23 15:16:20'),
(32681, 3040, 25223, NULL, '2021-05-03 00:00:00.000', 'Approved', 'Facility has an ancillary contract. No need to add individual providers. Facility contract attached in group task. ', NULL, NULL, '2021-04-26 10:14:52', '2021-04-26 10:14:52'),
(32682, 3040, 25223, NULL, NULL, 'Revalidation', 'Email sent to: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Hello David,   Hope you are doing well. The contract request form that was sent out in your previous email I would like to ask you in the provider type section what option you want me to mark for the providers. If you could reach out to me on 713-893-6214 that would be better.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you', NULL, NULL, '2021-04-26 10:39:46', '2021-04-26 10:39:46'),
(32683, 3040, 25223, NULL, NULL, 'Revalidated', 'Facility has an ancillary contract. No need to add individual providers. Facility contract attached in group task.  ', NULL, NULL, '2021-05-31 09:19:58', '2021-05-31 09:19:58'),
(32684, 3040, 25224, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 15:16:20', '2021-04-23 15:16:20'),
(32685, 3040, 25224, NULL, '2021-05-03 00:00:00.000', 'In Process', 'Email sent to: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Hello David,   Hope you are doing well. The contract request form that was sent out in your previous email I would like to ask you in the provider type section what option you want me to mark for the providers. If you could reach out to me on 713-893-6214 that would be better.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you', NULL, NULL, '2021-04-26 10:41:30', '2021-04-26 10:41:30'),
(32686, 3040, 25224, NULL, '2021-06-07 00:00:00.000', 'Approved', 'Facility has an ancillary contract. No need to add individual providers. Facility contract attached in group task.  ', NULL, NULL, '2021-05-31 09:20:04', '2021-05-31 09:20:04'),
(32687, 3040, 25225, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 15:25:43', '2021-04-23 15:25:43'),
(32688, 3040, 25225, NULL, '2021-05-03 00:00:00.000', 'Approved', 'We already have a urgent care contract with Molina Health Care. It also cover Molina Medicaid. Facility contract attached.   Effective date: 10/01/2017', NULL, NULL, '2021-04-26 10:07:48', '2021-04-26 10:07:48'),
(32689, 3040, 25225, NULL, NULL, 'Revalidation', 'Email sent to: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Hello David,   Hope you are doing well. The contract request form that was sent out in your previous email I would like to ask you in the provider type section what option you want me to mark for the providers. If you could reach out to me on 713-893-6214 that would be better.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you', NULL, NULL, '2021-04-26 10:35:39', '2021-04-26 10:35:39'),
(32690, 3040, 25225, NULL, NULL, 'Revalidated', 'Facility has an ancillary contract. No need to add individual providers. Facility contract attached in group task.  ', NULL, NULL, '2021-05-31 09:15:36', '2021-05-31 09:15:36'),
(32691, 3040, 25226, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-23 15:26:01', '2021-04-23 15:26:01'),
(32692, 3040, 25226, NULL, '2021-05-03 00:00:00.000', 'Approved', 'We already have a urgent care contract with Molina Health Care. It also cover Molina Medicaid. Facility contract attached.   Effective date: 10/01/2017', NULL, NULL, '2021-04-26 10:07:53', '2021-04-26 10:07:53'),
(32693, 3040, 25226, NULL, NULL, 'Revalidation', 'Email sent to: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Hello David,   Hope you are doing well. The contract request form that was sent out in your previous email I would like to ask you in the provider type section what option you want me to mark for the providers. If you could reach out to me on 713-893-6214 that would be better.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you', NULL, NULL, '2021-04-26 10:35:42', '2021-04-26 10:35:42'),
(32694, 3040, 25226, NULL, NULL, 'Revalidated', 'Facility has an ancillary contract. No need to add individual providers. Facility contract attached in group task.  ', NULL, NULL, '2021-05-31 09:17:08', '2021-05-31 09:17:08'),
(32695, 1006, 25239, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 12:08:46', '2021-04-26 12:08:46'),
(32696, 1019, 25239, NULL, NULL, 'Not Eligible', 'The provider is no longer participating under any VMUC locations, hence they are not eligible for enrollment.  As per Brad.', NULL, NULL, '2021-04-30 07:08:04', '2021-04-30 07:08:04'),
(32697, 1006, 25240, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 12:08:46', '2021-04-26 12:08:46'),
(32698, 1019, 25240, NULL, NULL, 'Not Eligible', 'The provider is no longer participating under any VMUC locations, hence they are not eligible for enrollment.  As per Brad.', NULL, NULL, '2021-04-30 07:07:48', '2021-04-30 07:07:48'),
(32699, 1006, 25241, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 12:08:46', '2021-04-26 12:08:46'),
(32700, 1019, 25241, NULL, NULL, 'Not Eligible', 'The provider is no longer participating under any VMUC locations, hence they are not eligible for enrollment.  As per Brad.', NULL, NULL, '2021-04-30 07:07:33', '2021-04-30 07:07:33'),
(32701, 1006, 25242, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 12:08:46', '2021-04-26 12:08:46'),
(32702, 1019, 25242, NULL, NULL, 'Not Eligible', 'The provider is no longer participating under any VMUC locations, hence they are not eligible for enrollment.  As per Brad.', NULL, NULL, '2021-04-30 07:07:20', '2021-04-30 07:07:20'),
(32703, 1006, 25243, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 12:08:46', '2021-04-26 12:08:46'),
(32704, 1019, 25243, NULL, NULL, 'Not Eligible', 'The provider is no longer participating under any VMUC locations, hence they are not eligible for enrollment.  As per Brad.', NULL, NULL, '2021-04-30 07:07:05', '2021-04-30 07:07:05'),
(32705, 1006, 25244, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 12:08:46', '2021-04-26 12:08:46'),
(32706, 1019, 25244, NULL, NULL, 'Not Eligible', 'The provider is no longer participating under any VMUC locations, hence they are not eligible for enrollment.  As per Brad.', NULL, NULL, '2021-04-30 07:06:21', '2021-04-30 07:06:21'),
(32707, 1006, 25245, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 12:08:46', '2021-04-26 12:08:46'),
(32708, 1019, 25245, NULL, NULL, 'Not Eligible', 'The provider is no longer participating under any VMUC locations, hence they are not eligible for enrollment.  As per Brad.', NULL, NULL, '2021-04-30 07:05:47', '2021-04-30 07:05:47'),
(32709, 1006, 25246, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 12:08:46', '2021-04-26 12:08:46'),
(32710, 1019, 25246, NULL, NULL, 'Not Eligible', 'The provider is no longer participating under any VMUC locations, hence they are not eligible for enrollment.  As per Brad.', NULL, NULL, '2021-04-30 07:05:26', '2021-04-30 07:05:26'),
(32711, 1006, 25247, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 12:08:46', '2021-04-26 12:08:46'),
(32712, 1019, 25247, NULL, NULL, 'Not Eligible', 'The provider is no longer participating under any VMUC locations, hence they are not eligible for enrollment.  As per Brad.', NULL, NULL, '2021-04-30 07:05:11', '2021-04-30 07:05:11'),
(32713, 1006, 25248, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 12:08:46', '2021-04-26 12:08:46'),
(32714, 1019, 25248, NULL, NULL, 'Not Eligible', 'The provider is no longer participating under any VMUC locations, hence they are not eligible for enrollment.  As per Brad.', NULL, NULL, '2021-04-30 07:04:57', '2021-04-30 07:04:57'),
(32715, 1006, 25249, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 12:08:46', '2021-04-26 12:08:46'),
(32716, 1019, 25249, NULL, NULL, 'Not Eligible', 'The provider is no longer participating under any VMUC locations, hence they are not eligible for enrollment.  As per Brad.', NULL, NULL, '2021-04-30 07:04:45', '2021-04-30 07:04:45'),
(32717, 1006, 25250, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 12:08:47', '2021-04-26 12:08:47'),
(32718, 1019, 25250, NULL, NULL, 'Not Eligible', 'The provider is no longer participating under any VMUC locations, hence they are not eligible for enrollment.  As per Brad.', NULL, NULL, '2021-04-30 07:04:18', '2021-04-30 07:04:18'),
(32719, 1006, 25255, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 12:08:47', '2021-04-26 12:08:47'),
(32720, 1019, 25255, NULL, NULL, 'Not Eligible', 'The provider is no longer participating under any VMUC locations, hence they are not eligible for enrollment.  As per Brad.', NULL, NULL, '2021-04-30 07:03:11', '2021-04-30 07:03:11'),
(32721, 1006, 25256, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 12:09:35', '2021-04-26 12:09:35'),
(32722, 3040, 25256, NULL, '2021-06-08 00:00:00.000', 'On Hold', 'Facility/ Ancillary network interest form submitted. Please see group task.   ', NULL, NULL, '2021-06-01 14:25:58', '2021-06-01 14:25:58'),
(32723, 3040, 25256, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com   Subject: Re: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Cigna Healthspring for our group Valley Med Urgent Care PLLC under the below mentioned locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address:101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Tertiary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-07-20 14:04:21', '2021-07-20 14:04:21'),
(32724, 3040, 25256, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello Jennifer,  Please advise the enrollment status for the below mentioned group in Cigna Healthspring for our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address:101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Tertiary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Please get back to me as soon as you can get a chance. Waiting for your reply,   Thanks  ', NULL, NULL, '2021-07-28 14:32:32', '2021-07-28 14:32:32'),
(32725, 3040, 25256, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: [External] Re: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello Jennifer,   Hope you are doing well. I sent the emails which are mentioned on the letter of interest form but I couldn\'t get any reply from their side. Can you please check the status and advise?  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address:101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Tertiary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Please get back to me as soon as you can get a chance. Waiting for your reply,  Thank you  ', NULL, NULL, '2021-08-17 09:36:59', '2021-08-17 09:36:59'),
(32726, 10057, 25256, 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 11:05:58', '2021-10-14 11:05:58'),
(32727, 10057, 25256, NULL, '2021-11-22 00:00:00.000', 'In Process', 'Email Sent To : JENNIFER.PEREZ@cigna.com, TXGQProviderRelations@healthspring.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello,  Hope this email finds you well. I want to know the enrollment status for the below mentioned providers under these locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Hernandez, Juan	1225617558 Wert, Jeniece K	1659919702 Wright, Larry	1033769765 Saavedra, Teresa	1255676151 Hernandez, Eder	1386956852 Garcia, Homero	1730564857 Potter, Deborah	1861914053 Naranjo, Diego	1568929800 Lopez, Mayra	1265945125  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-11-15 17:59:15', '2021-11-15 17:59:15'),
(32728, 10057, 25256, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : TXGQProviderRelations@healthspring.com, TXMAContracting@cigna.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello,  Can I get the latest update on the below mentioned request.  Please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-30 13:04:54', '2021-11-30 13:04:54'),
(32729, 10057, 25256, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Email Sent To : TXGQProviderRelations@healthspring.com, TXMAContracting@cigna.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello,  Hope this email finds you in good health. I want to know the enrollment status for the below mentioned providers under these locations.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Juan  Hernandez	1225617558 Jeniece K  Wert	1659919702 Larry  Wright	1033769765 Teresa  Saavedra	1255676151 Eder  Hernandez	1386956852 Homero  Garcia	1730564857 Deborah  Potter	1861914053 Diego  Naranjo	1568929800 Mayra  Lopez	1265945125  Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-06 17:36:01', '2021-12-06 17:36:01'),
(32730, 10057, 25256, NULL, '2021-12-20 00:00:00.000', 'In Process', 'Email Sent To : TXGQProviderRelations@healthspring.com, TXMAContracting@cigna.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hey,  I\'m writing this email to check the current status on the below mentioned request. This is my second reminder.  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-12-13 12:43:11', '2021-12-13 12:43:11'),
(32731, 10057, 25256, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email Received From : iliana.cortez@careallies.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello Steve,  The last Letter of Interest that was submitted to Valley Organized Physicians/LVPA was in October of 2018. The LVPA Board of Directors determined that there was no network need and appropriate communication was provided via mail. If the group would like to be reconsidered, please fill out the attached LOI and we can make sure to review during our January 2022 Board of Directors meeting. I is going to be important that you list out all locations as well.  Please let me know if you have any other questions.  Thank you, Iliana', NULL, NULL, '2021-12-20 11:45:29', '2021-12-20 11:45:29');
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
(32732, 10057, 25256, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : iliana.cortez@careallies.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Thank you for reaching out. Please find the attached LOI for groups and providers.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Juan Hernandez	1225617558 Wert, Jeniece K	1659919702 Wright, Larry	1033769765 Saavedra, Teresa	1255676151 Hernandez, Eder	1386956852 Garcia, Homero	1730564857 Potter, Deborah	1861914053 Naranjo, Diego	1568929800 Lopez, Mayra	1265945125 Escobar, Angiollet	1962917997 Rodriguez, Cynthia	1124282553  Please revert back to me once you have the update. Have a great day!  Regards,', NULL, NULL, '2021-12-27 11:07:46', '2021-12-27 11:07:46'),
(32733, 20067, 25256, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: iliana.cortez@careallies.com  Subject: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring   Hello Good Morning,  Hope you are doing well. I want to know the enrollment status for the below-mentioned providers under these locations.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Juan Hernandez	1225617558 Jeniece Wert	1659919702 Cynthia Rodriguez	1124282553 Deborah Potter	1861914053 Larry Wright	1033769765 Teresa Saavedra	1255676151 Diego Naranjo	1568929800 Eder Hernandez	1386956852 Homero Garcia	1730564857 Angiollet Escobar	1962917997 Mayra Lopez	1265945125   Thanks and Regards, Syed Ahad.  ', NULL, NULL, '2022-01-05 12:47:39', '2022-01-05 12:47:39'),
(32734, 20067, 25256, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email Received from: iliana.cortez@careallies.com  Sub:  Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring  Hello Syed,     I emailed Steve Albert, but the email bounced back.     We will be meeting with our LVPA and HOPE Board of Directors the week of the  24th where we will be discussing your group. Please fill out 1 LOI for the group with all location listed.  Please email me with any questions that you may have.     Thank you.     Iliana', NULL, NULL, '2022-01-11 13:55:20', '2022-01-11 13:55:20'),
(32735, 20067, 25256, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to: iliana.cortez@careallies.com  Sub: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring  Good afternoon,  Hope all is well with you. The LOI form which you sent me doesn\'t have fields for additional locations. Kindly see the attachment below  Eagerly waiting to hear from you   Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-11 14:02:19', '2022-01-11 14:02:19'),
(32736, 20067, 25256, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email Received from: iliana.cortez@careallies.com  Sub: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring   Thank you for the updated LOI. I added all locations. We meet with our Board of Directors on January 24th. Will be InTouch. ', NULL, NULL, '2022-01-11 17:48:00', '2022-01-11 17:48:00'),
(32737, 20067, 25256, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Will follow-up next week because the meeting of Board of Directors will be on  24th January', NULL, NULL, '2022-01-18 10:59:36', '2022-01-18 10:59:36'),
(32738, 20067, 25256, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: iliana.cortez@careallies.com  Sub: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring   Good Evening! Hope this email finds you well. Any updates on the request?  Eagerly waiting to hear from you, Thanks and Regards,', NULL, NULL, '2022-01-28 17:53:57', '2022-01-28 17:53:57'),
(32739, 20067, 25256, NULL, '2022-02-11 00:00:00.000', 'Not Eligible', 'Email received from: dulce.lumbrera@careallies.com  Sub:  Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring   Hi Syed,  Thank you for reaching out. Please see attached for a response to the letter of interest that was presented at the Board of Director meeting. Thank you', NULL, NULL, '2022-02-04 10:44:50', '2022-02-04 10:44:50'),
(32740, 3040, 25257, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:18', '2021-04-26 14:17:18'),
(32741, 1019, 25257, NULL, NULL, 'Not Eligible', 'The provider is no longer participating under any VMUC locations, hence they are not eligible for enrollment.  As per Brad.', NULL, NULL, '2021-04-30 07:02:58', '2021-04-30 07:02:58'),
(32742, 3040, 25258, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:18', '2021-04-26 14:17:18'),
(32743, 1019, 25258, NULL, NULL, 'Not Eligible', 'The provider is no longer participating under any VMUC locations, hence they are not eligible for enrollment.  As per Brad.', NULL, NULL, '2021-04-30 07:02:01', '2021-04-30 07:02:01'),
(32744, 3040, 25259, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:18', '2021-04-26 14:17:18'),
(32745, 1019, 25259, NULL, NULL, 'Not Eligible', 'The provider is no longer participating under any VMUC locations, hence they are not eligible for enrollment.  As per Brad.', NULL, NULL, '2021-04-30 07:01:48', '2021-04-30 07:01:48'),
(32746, 3040, 25260, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:18', '2021-04-26 14:17:18'),
(32747, 1019, 25260, NULL, NULL, 'Not Eligible', 'The provider is no longer participating under any VMUC locations, hence they are not eligible for enrollment.  As per Brad.', NULL, NULL, '2021-04-30 07:01:31', '2021-04-30 07:01:31'),
(32748, 3040, 25262, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:18', '2021-04-26 14:17:18'),
(32749, 1019, 25262, NULL, NULL, 'Not Eligible', 'The provider is no longer participating under any VMUC locations, hence they are not eligible for enrollment.  As per Brad.', NULL, NULL, '2021-04-30 07:00:58', '2021-04-30 07:00:58'),
(32750, 3040, 25263, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:18', '2021-04-26 14:17:18'),
(32751, 1019, 25263, NULL, NULL, 'Not Eligible', 'The provider is no longer participating under any VMUC locations, hence they are not eligible for enrollment.  As per Brad.', NULL, NULL, '2021-04-30 07:00:45', '2021-04-30 07:00:45'),
(32752, 3040, 25264, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:18', '2021-04-26 14:17:18'),
(32753, 1019, 25264, NULL, NULL, 'Not Eligible', 'The provider is no longer participating under any VMUC locations, hence they are not eligible for enrollment.  As per Brad.', NULL, NULL, '2021-04-30 07:00:31', '2021-04-30 07:00:31'),
(32754, 3040, 25265, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:18', '2021-04-26 14:17:18'),
(32755, 1019, 25265, NULL, NULL, 'Not Eligible', 'The provider is no longer participating under any VMUC locations, hence they are not eligible for enrollment.  As per Brad.', NULL, NULL, '2021-04-30 07:00:12', '2021-04-30 07:00:12'),
(32756, 3040, 25266, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:18', '2021-04-26 14:17:18'),
(32757, 1019, 25266, NULL, NULL, 'Not Eligible', 'The provider is no longer participating under any VMUC locations, hence they are not eligible for enrollment.  As per Brad.', NULL, NULL, '2021-04-30 06:59:52', '2021-04-30 06:59:52'),
(32758, 3040, 25272, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:18', '2021-04-26 14:17:18'),
(32759, 1019, 25272, NULL, NULL, 'Not Eligible', 'The provider is no longer participating under any VMUC locations, hence they are not eligible for enrollment.  As per Brad.', NULL, NULL, '2021-04-30 06:56:52', '2021-04-30 06:56:52'),
(32760, 3040, 25273, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:19', '2021-04-26 14:17:19'),
(32761, 1019, 25273, NULL, NULL, 'Not Eligible', 'The provider is no longer participating under any VMUC locations, hence they are not eligible for enrollment.  As per Brad.', NULL, NULL, '2021-04-30 06:56:34', '2021-04-30 06:56:34'),
(32762, 3040, 25274, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:19', '2021-04-26 14:17:19'),
(32763, 3040, 25274, NULL, '2021-05-06 00:00:00.000', 'Rejected', 'TCHP does not cover Hidalgo or Cameron County for VMUC.', NULL, NULL, '2021-04-29 16:04:43', '2021-04-29 16:04:43'),
(32764, 3040, 25275, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:19', '2021-04-26 14:17:19'),
(32765, 3040, 25275, NULL, '2021-05-03 00:00:00.000', 'Not Eligible', 'From: txcredentialing@amerigroup.com  To: mk@claimsmedinc.com  Sub: RE: {EXTERNAL} Request to add new service location  HI There, Amerigroup does not service that region.  Please find below link from Amerigroup Website in which it shows they do not cover the counties for VMUC i.e. Hidalgo & Cameron: https://www.myamerigroup.com/tx/apply/know-your-service-area.html  ', NULL, NULL, '2021-04-26 15:01:04', '2021-04-26 15:01:04'),
(32766, 3040, 25276, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:19', '2021-04-26 14:17:19'),
(32767, 3040, 25276, NULL, '2021-05-06 00:00:00.000', 'Rejected', 'CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @   https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/  It is also attached for reference.  ', NULL, NULL, '2021-04-29 09:17:59', '2021-04-29 09:17:59'),
(32768, 3040, 25277, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:19', '2021-04-26 14:17:19'),
(32769, 3040, 25277, NULL, '2021-05-07 00:00:00.000', 'In Process', 'Email sent to: providerservices@memorialhermann.org, enterprise.credentialing@memorialhermann.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Memorial Hermann for our group Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-04-30 08:56:09', '2021-04-30 08:56:09'),
(32770, 3040, 25277, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Good morning,  Are these requests for Memorial Hermann Health Plan only? If yes, please submit a request for application form for each practitioners. Below is the link:  CLICK HERE to access and complete the Request for Application form for Memorial Hermann hospitals, affiliated hospitals, surgery centers, MHMD membership or Health Plan participation. To avoid any delays, please submit the form in its entirety (via link above) or email the form to enterprise.credentialing@memorialhermann.org. If the pre-screening qualifications are met, you should receive both your eCredentialing Portal and application username and password via email or additional communication within 3 business days.  If you have any questions, please contact us at enterprise.credentialing@memorialhermann.org.  Memorial Hermann Central Credentialing Team', NULL, NULL, '2021-05-28 11:01:09', '2021-05-28 11:01:09'),
(32771, 3040, 25277, 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 16:23:32', '2021-06-16 16:23:32'),
(32772, 3040, 25277, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: enterprise.credentialing@memorialhermann.org  Subject: Re: [EXTERNAL] Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Memorial Hermann in our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-07-20 11:30:22', '2021-07-20 11:30:22'),
(32773, 3040, 25277, NULL, '2021-08-03 00:00:00.000', 'Not Eligible', 'Please see group task. ', NULL, NULL, '2021-07-27 16:19:07', '2021-07-27 16:19:07'),
(32774, 3040, 25279, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:19', '2021-04-26 14:17:19'),
(32775, 1006, 25279, NULL, '2021-05-07 00:00:00.000', 'Initiated', 'Submitted an online enrollment form for group enrollment:  \"Your form was submitted successfully. Thank you for contacting us. A representative will be in contact to discuss your interest in becoming a participating Provider.\"  Form attached in main group task.', NULL, NULL, '2021-04-30 16:12:26', '2021-04-30 16:12:26'),
(32776, 3040, 25279, NULL, '2021-06-08 00:00:00.000', 'In Process', 'I had a word with (Liya) Wellcare representative and she sent the request to provider rep. department and they will contact us regarding the enrollment.   Ref: 507756828', NULL, NULL, '2021-06-01 12:53:35', '2021-06-01 12:53:35'),
(32777, 3040, 25279, NULL, '2021-06-08 00:00:00.000', 'In Process', 'I had a word with (Liya) Wellcare representative and she sent the request to provider rep. department and they will contact us regarding the enrollment.   Ref: 507756828', NULL, NULL, '2021-06-01 12:53:38', '2021-06-01 12:53:38'),
(32778, 3040, 25279, NULL, '2021-06-25 00:00:00.000', 'On Hold', 'We sent the ancillary contract request for group. For more details please see group task. ', NULL, NULL, '2021-06-18 16:23:00', '2021-06-18 16:23:00'),
(32779, 3040, 25279, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject; Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in our group Valley Med Urgent Care PLLC under the below locations. As we submitted an online form.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 11:18:19', '2021-07-20 11:18:19'),
(32780, 3040, 25279, NULL, '2021-08-03 00:00:00.000', 'Approved', 'Email rcvd from: ProspectiveProviderTX@wellcare.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Hello,  The group and provider below shows PAR effective 5/1/2021.', NULL, NULL, '2021-07-27 14:10:48', '2021-07-27 14:10:48'),
(32781, 3040, 25280, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:19', '2021-04-26 14:17:19'),
(32782, 1006, 25280, NULL, '2021-05-07 00:00:00.000', 'Initiated', 'Sent the following initiation request to trpndataentry@trpnppo.com & providerrelations@trpnppo.com:  Sub: Provider Enrollment Request - VMUC - TRPN  \"Hello,   We want to get the following providers and group enrolled with TRPN, their information is as follows:  Practice Details:  Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997 Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800 Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857 Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502 Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053 Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151 Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765 Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702 Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment timeframe is?  Thank you.\"', NULL, NULL, '2021-04-30 15:49:32', '2021-04-30 15:49:32'),
(32783, 3040, 25280, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || TRPN ||  Hello Max,   I wanted to get the following providers and group enrolled with TRPN, their information is as follows:  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment time frame is?  Thank you. ', NULL, NULL, '2021-06-01 09:46:38', '2021-06-01 09:46:38'),
(32784, 11056, 25280, NULL, '2021-06-26 00:00:00.000', 'In Process', 'Email sent to : 	trpndataentry@trpnppo.com  Sub :  Provider Update Information Form- TRPN  Greetings,  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: Valley Med Urgent Care PLLC (Brownsville) Practice NPI: 1518404631 Practice TIN: 81-5123542 Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248    Provider Names enlisted below:-  Provider 1: Provider Name: Hernandez, Juan Provider NPI : 1225617558  Provider 2: Provider Name:  Wert, Jeniece Provider NPI : 1659919702   Provider 3: Provider Name:  Lira, Arturo Provider NPI : 1245789502  Provider 4:  Provider Name: Potter, Deborah Provider NPI : 1861914053   Provider 5:   Provider Name:  Wright, Larry Provider NPI :   1033769765  Provider 6:   Provider Name: Naranjo, Diego Provider NPI :  1568929800  Provider 7:   Provider Name: Lopez, Mayra Provider NPI :  1265945125    Provider 8: Provider Name: Rodriguez, Cynthia Provider NPI :  1124282553  Provider 9:   Provider Name:  Garcia, Homero Provider NPI :  1730564857  Provider 10: Provider Name:  Escobar, Angiollet Provider NPI : 1962917997  Provider 11:   Provider Name: Hernandez, Eder Provider NPI :  1386956852  Provider 12:   Provider Name:  Saavedra, Teresa Provider NPI :  1255676151  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-18 16:40:17', '2021-06-18 16:40:17'),
(32785, 3040, 25280, 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,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in TRPN for our group Valley Med Urgent Care PLLC under the below locations. We already submitted the provider update form.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (Brownsville) Practice NPI: 1518404631 Practice TIN: 81-5123542 Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248    Provider 1: Provider Name: Hernandez, Juan Provider NPI : 1225617558  Provider 2: Provider Name:  Wert, Jeniece Provider NPI : 1659919702   Provider 3: Provider Name:  Lira, Arturo Provider NPI : 1245789502  Provider 4:  Provider Name: Potter, Deborah Provider NPI : 1861914053   Provider 5:   Provider Name:  Wright, Larry Provider NPI :   1033769765  Provider 6:   Provider Name: Naranjo, Diego Provider NPI :  1568929800  Provider 7:   Provider Name: Lopez, Mayra Provider NPI :  1265945125    Provider 8: Provider Name: Rodriguez, Cynthia Provider NPI :  1124282553  Provider 9:   Provider Name:  Garcia, Homero Provider NPI :  1730564857  Provider 10: Provider Name:  Escobar, Angiollet Provider NPI : 1962917997  Provider 11:   Provider Name: Hernandez, Eder Provider NPI :  1386956852  Provider 12:   Provider Name:  Saavedra, Teresa Provider NPI :  1255676151  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-05 14:48:07', '2021-07-05 14:48:07'),
(32786, 3040, 25280, NULL, '2021-07-22 00:00:00.000', 'Approved', 'Email rcvd from: ccampos@trpnppo.com  Subject: Provider Update Information Form- TRPN  Hi,  Provider Jeniece Wert is Active, effective date 04/30/2021,  Provider Arturo Lira is Active, effective date 04/30/2021,  Provider Deborah Potter is Active, effective date 04/30/2021,  Provider Larry Wright is Active, effective date 04/30/2021,  Provider Diego Naranjo is Active, effective date 10/01/2019,  Provider Mayra Lopez is Active, effective date 09/24/2019,  Provider Cynthia Rodriguez is Active, effective date 06/24/2019,  Provider Homero Garcia is Active, effective date 10/16/2018,  Provider Angiollet Escobar is Active, effective date 10/01/2019,  Provider Eder Hernandez is Active, effective date 02/01/2016,  Provider Teresa Saavedra is Active, effective date 04/30/2021,  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 www.trpnppo.com', NULL, NULL, '2021-07-15 12:03:33', '2021-07-15 12:03:33'),
(32787, 3040, 25281, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:19', '2021-04-26 14:17:19'),
(32788, 3040, 25281, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to:  CSHNproviderrelations@christushealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Christus Spohn ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Christus Spohn in our group Valley Med Urgent Care PLLC under below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-03 07:46:45', '2021-05-03 07:46:45'),
(32789, 3040, 25281, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Christus Spohn ||  Hello,   Can you please advise the process for credentialing?  Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-05-27 10:45:05', '2021-05-27 10:45:05'),
(32790, 3040, 25281, NULL, '2021-06-22 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, '2021-06-15 13:26:35', '2021-06-15 13:26:35'),
(32791, 11056, 25281, NULL, '2021-07-08 00:00:00.000', 'In Process', 'Email sent to : CSHNproviderrelations@christushealth.org  Sub : ENROLLMENT REQUEST || Valley Med Urgent Care PLLC || Christus Spohn ||  Greetings,  Kindly respond soon. Hope you are doing well. I wanted to enroll the below mentioned group & providers in Christus Spohn in our group Valley Med Urgent Care PLLC under below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Providers: Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Provider 12: Provider Name: Hernandez, Juan Provider NPI#: 1225617558  Please get back to me as soon as possible. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-01 13:30:23', '2021-07-01 13:30:23'),
(32792, 3040, 25281, NULL, '2021-07-15 00:00:00.000', 'Not Eligible', 'Email rcvd from: michal.simms@christushealth.org  Subject;:Enroll Group & Providers || Valley Med Urgent Care PLLC || USFHP|  Adil,  CHRISTUS Health Plan and CHRISTUS Spohn Health Network are two separate health plans…  I work for CHRISTUS Health Plan.  This is the service area Vicki at Spohn sent you in an email last week… I don’t see Cameron listed.', NULL, NULL, '2021-07-08 16:56:52', '2021-07-08 16:56:52'),
(32793, 3040, 25282, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:19', '2021-04-26 14:17:19'),
(32794, 3040, 25282, NULL, '2021-05-12 00:00:00.000', 'In Process', 'Email sent to: ccnprovider@triwest.com  Subject: Enrollment Request || Group & Providers || VMUC || Triwest  Hello,   We want to get the following providers and group enrolled with Triwest, their information is as follows:  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment time frame is?', NULL, NULL, '2021-05-05 14:14:30', '2021-05-05 14:14:30'),
(32795, 3040, 25282, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: providerservices@triwest.com  Subject: Re: Enrollment Request || Group & Providers || VMUC || Triwest  Greetings,   I wanted to enroll the below mentioned group and providers in our group Valley Med Urgent Care PLLC under the below locations. The request was directed to state representative and I didn\'t hear from them.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please get back to me as soon as you get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-01 09:30:36', '2021-06-01 09:30:36'),
(32796, 3040, 25282, NULL, '2021-06-25 00:00:00.000', 'On Hold', 'Group enrollment request sent. Please see group task. ', NULL, NULL, '2021-06-18 15:41:00', '2021-06-18 15:41:00'),
(32797, 3040, 25282, NULL, '2021-07-23 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. Please see group task.  ', NULL, NULL, '2021-07-16 11:35:16', '2021-07-16 11:35:16'),
(32798, 3040, 25283, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:19', '2021-04-26 14:17:19'),
(32799, 3040, 25283, NULL, '2021-05-07 00:00:00.000', 'Rejected', '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, '2021-04-30 09:16:33', '2021-04-30 09:16:33'),
(32800, 3040, 25288, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:19', '2021-04-26 14:17:19'),
(32801, 1006, 25288, NULL, '2021-05-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Brownsville or McAllen, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-04-30 13:56:56', '2021-04-30 13:56:56'),
(32802, 3040, 25289, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:19', '2021-04-26 14:17:19'),
(32803, 3040, 25289, NULL, '2021-05-07 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || 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 Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-30 10:26:00', '2021-04-30 10:26:00'),
(32804, 3040, 25289, NULL, '2021-05-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: michal.simms@christushealth.org  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || CHRISTUS HEALTH PLAN ||  Hello Adil, I hope you are doing well too!  Please review the letter attached and let me know if you have any questions.  Best regards, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan (o) 469-282-3227 www.christushealthplan.org  Please see attachment in group task. ', NULL, NULL, '2021-05-03 11:19:05', '2021-05-03 11:19:05'),
(32805, 3040, 25290, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:19', '2021-04-26 14:17:19'),
(32806, 3040, 25290, NULL, '2021-05-06 00:00:00.000', 'Rejected', 'TCHP does not cover Hidalgo or Cameron County for VMUC.', NULL, NULL, '2021-04-29 16:04:29', '2021-04-29 16:04:29'),
(32807, 3040, 25291, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:19', '2021-04-26 14:17:19'),
(32808, 3040, 25291, NULL, '2021-05-03 00:00:00.000', 'Not Eligible', 'From: txcredentialing@amerigroup.com  To: mk@claimsmedinc.com  Sub: RE: {EXTERNAL} Request to add new service location  HI There, Amerigroup does not service that region.  Please find below link from Amerigroup Website in which it shows they do not cover the counties for VMUC i.e. Hidalgo & Cameron: https://www.myamerigroup.com/tx/apply/know-your-service-area.html  ', NULL, NULL, '2021-04-26 14:59:58', '2021-04-26 14:59:58'),
(32809, 3040, 25292, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:19', '2021-04-26 14:17:19'),
(32810, 3040, 25292, NULL, '2021-05-06 00:00:00.000', 'Rejected', 'CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @   https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/  It is also attached for reference.  ', NULL, NULL, '2021-04-29 09:16:41', '2021-04-29 09:16:41'),
(32811, 3040, 25293, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:20', '2021-04-26 14:17:20'),
(32812, 3040, 25293, NULL, '2021-05-07 00:00:00.000', 'In Process', 'Email sent to: providerservices@memorialhermann.org, enterprise.credentialing@memorialhermann.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Memorial Hermann for our group Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-04-30 08:55:48', '2021-04-30 08:55:48'),
(32813, 3040, 25293, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Good morning,  Are these requests for Memorial Hermann Health Plan only? If yes, please submit a request for application form for each practitioners. Below is the link:  CLICK HERE to access and complete the Request for Application form for Memorial Hermann hospitals, affiliated hospitals, surgery centers, MHMD membership or Health Plan participation. To avoid any delays, please submit the form in its entirety (via link above) or email the form to enterprise.credentialing@memorialhermann.org. If the pre-screening qualifications are met, you should receive both your eCredentialing Portal and application username and password via email or additional communication within 3 business days.  If you have any questions, please contact us at enterprise.credentialing@memorialhermann.org.  Memorial Hermann Central Credentialing Team', NULL, NULL, '2021-05-28 11:01:13', '2021-05-28 11:01:13'),
(32814, 3040, 25293, 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 16:23:29', '2021-06-16 16:23:29'),
(32815, 3040, 25293, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: enterprise.credentialing@memorialhermann.org  Subject: Re: [EXTERNAL] Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Memorial Hermann in our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-07-20 11:30:21', '2021-07-20 11:30:21'),
(32816, 3040, 25293, NULL, '2021-08-03 00:00:00.000', 'Not Eligible', 'Please see group task. ', NULL, NULL, '2021-07-27 16:19:07', '2021-07-27 16:19:07'),
(32817, 3040, 25295, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:20', '2021-04-26 14:17:20'),
(32818, 1006, 25295, NULL, '2021-05-07 00:00:00.000', 'Initiated', 'Submitted an online enrollment form for group enrollment:  \"Your form was submitted successfully. Thank you for contacting us. A representative will be in contact to discuss your interest in becoming a participating Provider.\"  Form attached in main group task.', NULL, NULL, '2021-04-30 16:12:24', '2021-04-30 16:12:24'),
(32819, 3040, 25295, NULL, '2021-06-08 00:00:00.000', 'In Process', 'I had a word with (Liya) Wellcare representative and she sent the request to provider rep. department and they will contact us regarding the enrollment.   Ref: 507756828', NULL, NULL, '2021-06-01 12:53:42', '2021-06-01 12:53:42'),
(32820, 3040, 25295, NULL, '2021-06-25 00:00:00.000', 'On Hold', 'We sent the ancillary contract request for group. For more details please see group task. ', NULL, NULL, '2021-06-18 16:22:58', '2021-06-18 16:22:58'),
(32821, 3040, 25295, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject; Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in our group Valley Med Urgent Care PLLC under the below locations. As we submitted an online form.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 11:18:18', '2021-07-20 11:18:18'),
(32822, 3040, 25295, NULL, '2021-08-03 00:00:00.000', 'Approved', 'Email rcvd from: ProspectiveProviderTX@wellcare.com  Subject:  Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Good Afternoon,  We have completed the request for the following providers:  Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 5: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 6: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 7: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let us know if you have any questions.  Thanks   Network Management – Texas | www.wellcare.com | www.superiorhealthplan.com', NULL, NULL, '2021-07-27 14:13:22', '2021-07-27 14:13:22'),
(32823, 3040, 25296, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:20', '2021-04-26 14:17:20'),
(32824, 1006, 25296, NULL, '2021-05-07 00:00:00.000', 'Initiated', 'Sent the following initiation request to trpndataentry@trpnppo.com & providerrelations@trpnppo.com:  Sub: Provider Enrollment Request - VMUC - TRPN  \"Hello,   We want to get the following providers and group enrolled with TRPN, their information is as follows:  Practice Details:  Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997 Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800 Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857 Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502 Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053 Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151 Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765 Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702 Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment timeframe is?  Thank you.\"', NULL, NULL, '2021-04-30 15:49:30', '2021-04-30 15:49:30'),
(32825, 3040, 25296, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || TRPN ||  Hello Max,   I wanted to get the following providers and group enrolled with TRPN, their information is as follows:  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment time frame is?  Thank you. ', NULL, NULL, '2021-06-01 09:46:42', '2021-06-01 09:46:42');
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
(32826, 11056, 25296, NULL, '2021-06-26 00:00:00.000', 'In Process', 'Email sent to : 	trpndataentry@trpnppo.com  Sub :  Provider Update Information Form- TRPN  Greetings,  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: Valley Med Urgent Care PLLC (Brownsville) Practice NPI: 1518404631 Practice TIN: 81-5123542 Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248    Provider Names enlisted below:-  Provider 1: Provider Name: Hernandez, Juan Provider NPI : 1225617558  Provider 2: Provider Name:  Wert, Jeniece Provider NPI : 1659919702   Provider 3: Provider Name:  Lira, Arturo Provider NPI : 1245789502  Provider 4:  Provider Name: Potter, Deborah Provider NPI : 1861914053   Provider 5:   Provider Name:  Wright, Larry Provider NPI :   1033769765  Provider 6:   Provider Name: Naranjo, Diego Provider NPI :  1568929800  Provider 7:   Provider Name: Lopez, Mayra Provider NPI :  1265945125    Provider 8: Provider Name: Rodriguez, Cynthia Provider NPI :  1124282553  Provider 9:   Provider Name:  Garcia, Homero Provider NPI :  1730564857  Provider 10: Provider Name:  Escobar, Angiollet Provider NPI : 1962917997  Provider 11:   Provider Name: Hernandez, Eder Provider NPI :  1386956852  Provider 12:   Provider Name:  Saavedra, Teresa Provider NPI :  1255676151  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-18 16:39:49', '2021-06-18 16:39:49'),
(32827, 3040, 25296, 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,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in TRPN for our group Valley Med Urgent Care PLLC under the below locations. We already submitted the provider update form.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (Brownsville) Practice NPI: 1518404631 Practice TIN: 81-5123542 Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248    Provider 1: Provider Name: Hernandez, Juan Provider NPI : 1225617558  Provider 2: Provider Name:  Wert, Jeniece Provider NPI : 1659919702   Provider 3: Provider Name:  Lira, Arturo Provider NPI : 1245789502  Provider 4:  Provider Name: Potter, Deborah Provider NPI : 1861914053   Provider 5:   Provider Name:  Wright, Larry Provider NPI :   1033769765  Provider 6:   Provider Name: Naranjo, Diego Provider NPI :  1568929800  Provider 7:   Provider Name: Lopez, Mayra Provider NPI :  1265945125    Provider 8: Provider Name: Rodriguez, Cynthia Provider NPI :  1124282553  Provider 9:   Provider Name:  Garcia, Homero Provider NPI :  1730564857  Provider 10: Provider Name:  Escobar, Angiollet Provider NPI : 1962917997  Provider 11:   Provider Name: Hernandez, Eder Provider NPI :  1386956852  Provider 12:   Provider Name:  Saavedra, Teresa Provider NPI :  1255676151  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-05 14:48:06', '2021-07-05 14:48:06'),
(32828, 3040, 25296, NULL, '2021-07-22 00:00:00.000', 'Approved', 'Email rcvd from: ccampos@trpnppo.com  Subject: Provider Update Information Form- TRPN  Hi,  Provider Jeniece Wert is Active, effective date 04/30/2021,  Provider Arturo Lira is Active, effective date 04/30/2021,  Provider Deborah Potter is Active, effective date 04/30/2021,  Provider Larry Wright is Active, effective date 04/30/2021,  Provider Diego Naranjo is Active, effective date 10/01/2019,  Provider Mayra Lopez is Active, effective date 09/24/2019,  Provider Cynthia Rodriguez is Active, effective date 06/24/2019,  Provider Homero Garcia is Active, effective date 10/16/2018,  Provider Angiollet Escobar is Active, effective date 10/01/2019,  Provider Eder Hernandez is Active, effective date 02/01/2016,  Provider Teresa Saavedra is Active, effective date 04/30/2021,  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 www.trpnppo.com', NULL, NULL, '2021-07-15 11:56:37', '2021-07-15 11:56:37'),
(32829, 3040, 25297, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:20', '2021-04-26 14:17:20'),
(32830, 3040, 25297, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to:  CSHNproviderrelations@christushealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Christus Spohn ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Christus Spohn in our group Valley Med Urgent Care PLLC under below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-03 07:45:40', '2021-05-03 07:45:40'),
(32831, 3040, 25297, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Christus Spohn ||  Hello,   Can you please advise the process for credentialing?  Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-05-27 10:45:09', '2021-05-27 10:45:09'),
(32832, 3040, 25297, NULL, '2021-06-22 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, '2021-06-15 13:26:31', '2021-06-15 13:26:31'),
(32833, 11056, 25297, NULL, '2021-07-08 00:00:00.000', 'In Process', 'Email sent to : CSHNproviderrelations@christushealth.org  Sub : ENROLLMENT REQUEST || Valley Med Urgent Care PLLC || Christus Spohn ||  Greetings,  Kindly respond soon. Hope you are doing well. I wanted to enroll the below mentioned group & providers in Christus Spohn in our group Valley Med Urgent Care PLLC under below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Providers: Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Provider 12: Provider Name: Hernandez, Juan Provider NPI#: 1225617558  Please get back to me as soon as possible. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-01 13:30:15', '2021-07-01 13:30:15'),
(32834, 3040, 25297, NULL, '2021-07-15 00:00:00.000', 'Not Eligible', 'Email rcvd from: michal.simms@christushealth.org  Subject;:Enroll Group & Providers || Valley Med Urgent Care PLLC || USFHP|  Adil,  CHRISTUS Health Plan and CHRISTUS Spohn Health Network are two separate health plans…  I work for CHRISTUS Health Plan.  This is the service area Vicki at Spohn sent you in an email last week… I don’t see Cameron listed.', NULL, NULL, '2021-07-08 16:56:51', '2021-07-08 16:56:51'),
(32835, 3040, 25298, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:20', '2021-04-26 14:17:20'),
(32836, 3040, 25298, NULL, '2021-05-12 00:00:00.000', 'In Process', 'Email sent to: ccnprovider@triwest.com  Subject: Enrollment Request || Group & Providers || VMUC || Triwest  Hello,   We want to get the following providers and group enrolled with Triwest, their information is as follows:  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment time frame is?', NULL, NULL, '2021-05-05 14:14:18', '2021-05-05 14:14:18'),
(32837, 3040, 25298, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: providerservices@triwest.com  Subject: Re: Enrollment Request || Group & Providers || VMUC || Triwest  Greetings,   I wanted to enroll the below mentioned group and providers in our group Valley Med Urgent Care PLLC under the below locations. The request was directed to state representative and I didn\'t hear from them.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please get back to me as soon as you get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-01 09:30:41', '2021-06-01 09:30:41'),
(32838, 3040, 25298, NULL, '2021-06-25 00:00:00.000', 'On Hold', 'Group enrollment request sent. Please see group task. ', NULL, NULL, '2021-06-18 15:40:57', '2021-06-18 15:40:57'),
(32839, 3040, 25298, NULL, '2021-07-23 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. Please see group task.  ', NULL, NULL, '2021-07-16 11:35:16', '2021-07-16 11:35:16'),
(32840, 3040, 25299, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:20', '2021-04-26 14:17:20'),
(32841, 3040, 25299, NULL, '2021-05-07 00:00:00.000', 'Rejected', '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, '2021-04-30 09:16:22', '2021-04-30 09:16:22'),
(32842, 3040, 25304, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:20', '2021-04-26 14:17:20'),
(32843, 1006, 25304, NULL, '2021-05-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Brownsville or McAllen, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-04-30 13:56:50', '2021-04-30 13:56:50'),
(32844, 3040, 25305, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:20', '2021-04-26 14:17:20'),
(32845, 3040, 25305, NULL, '2021-05-07 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || 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 Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-30 10:24:53', '2021-04-30 10:24:53'),
(32846, 3040, 25305, NULL, '2021-05-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: michal.simms@christushealth.org  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || CHRISTUS HEALTH PLAN ||  Hello Adil, I hope you are doing well too!  Please review the letter attached and let me know if you have any questions.  Best regards, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan (o) 469-282-3227 www.christushealthplan.org  Please see attachment in group task. ', NULL, NULL, '2021-05-03 11:17:14', '2021-05-03 11:17:14'),
(32847, 3040, 25306, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:20', '2021-04-26 14:17:20'),
(32848, 3040, 25306, NULL, '2021-05-06 00:00:00.000', 'Rejected', 'TCHP does not cover Hidalgo or Cameron County for VMUC.', NULL, NULL, '2021-04-29 16:02:02', '2021-04-29 16:02:02'),
(32849, 3040, 25307, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:20', '2021-04-26 14:17:20'),
(32850, 3040, 25307, NULL, '2021-05-03 00:00:00.000', 'Not Eligible', 'From: txcredentialing@amerigroup.com  To: mk@claimsmedinc.com  Sub: RE: {EXTERNAL} Request to add new service location  HI There, Amerigroup does not service that region.  Please find below link from Amerigroup Website in which it shows they do not cover the counties for VMUC i.e. Hidalgo & Cameron: https://www.myamerigroup.com/tx/apply/know-your-service-area.html  ', NULL, NULL, '2021-04-26 14:59:13', '2021-04-26 14:59:13'),
(32851, 3040, 25308, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:20', '2021-04-26 14:17:20'),
(32852, 3040, 25308, NULL, '2021-05-06 00:00:00.000', 'Rejected', 'CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @   https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/  It is also attached for reference.  ', NULL, NULL, '2021-04-29 09:15:56', '2021-04-29 09:15:56'),
(32853, 3040, 25309, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:20', '2021-04-26 14:17:20'),
(32854, 3040, 25309, NULL, '2021-05-07 00:00:00.000', 'In Process', 'Email sent to: providerservices@memorialhermann.org, enterprise.credentialing@memorialhermann.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Memorial Hermann for our group Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-04-30 08:55:40', '2021-04-30 08:55:40'),
(32855, 3040, 25309, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Email sent to: Enterprise.Credentialing@memorialhermann.org, ProviderServices@memorialhermann.org  Subject: Enroll Provider || Valley Med Urgent Care PLLC || Escobar, Angiollet Solis || Memorial Hermann ||  Greetings,   Hope you are doing well. Please find the attached request for participation to enroll the below mentioned provider in Memorial Hermann under the below location.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-04 15:52:18', '2021-05-04 15:52:18'),
(32856, 3040, 25309, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: Enterprise.Credentialing@memorialhermann.org, ProviderServices@memorialhermann.org  Subject: Enroll Provider || Valley Med Urgent Care PLLC || Escobar, Angiollet Solis || Memorial Hermann ||  Greetings,   I wanted to know the enrollment status for the below mentioned providers for our group Valley Med Urgent Care under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-05-28 10:56:15', '2021-05-28 10:56:15'),
(32857, 3040, 25309, 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 16:23:25', '2021-06-16 16:23:25'),
(32858, 3040, 25309, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: enterprise.credentialing@memorialhermann.org  Subject: Re: [EXTERNAL] Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Memorial Hermann in our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-07-20 11:30:20', '2021-07-20 11:30:20'),
(32859, 3040, 25309, NULL, '2021-08-03 00:00:00.000', 'Not Eligible', 'Please see group task. ', NULL, NULL, '2021-07-27 16:19:06', '2021-07-27 16:19:06'),
(32860, 3040, 25309, NULL, '2021-08-03 00:00:00.000', 'Not Eligible', 'Please see group task. ', NULL, NULL, '2021-07-27 16:19:07', '2021-07-27 16:19:07'),
(32861, 3040, 25311, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:20', '2021-04-26 14:17:20'),
(32862, 1006, 25311, NULL, '2021-05-07 00:00:00.000', 'Initiated', 'Submitted an online enrollment form for group enrollment:  \"Your form was submitted successfully. Thank you for contacting us. A representative will be in contact to discuss your interest in becoming a participating Provider.\"  Form attached in main group task.', NULL, NULL, '2021-04-30 16:12:21', '2021-04-30 16:12:21'),
(32863, 3040, 25311, NULL, '2021-06-08 00:00:00.000', 'In Process', 'I had a word with (Liya) Wellcare representative and she sent the request to provider rep. department and they will contact us regarding the enrollment.   Ref: 507756828', NULL, NULL, '2021-06-01 12:53:45', '2021-06-01 12:53:45'),
(32864, 3040, 25311, NULL, '2021-06-25 00:00:00.000', 'On Hold', 'We sent the ancillary contract request for group. For more details please see group task. ', NULL, NULL, '2021-06-18 16:22:55', '2021-06-18 16:22:55'),
(32865, 3040, 25311, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject; Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in our group Valley Med Urgent Care PLLC under the below locations. As we submitted an online form.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 11:18:18', '2021-07-20 11:18:18'),
(32866, 3040, 25311, NULL, '2021-08-03 00:00:00.000', 'Approved', 'Email rcvd from: ProspectiveProviderTX@wellcare.com  Subject:  Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Good Afternoon,  We have completed the request for the following providers:  Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 5: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 6: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 7: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let us know if you have any questions.  Thanks   Network Management – Texas | www.wellcare.com | www.superiorhealthplan.com', NULL, NULL, '2021-07-27 14:13:12', '2021-07-27 14:13:12'),
(32867, 3040, 25312, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:20', '2021-04-26 14:17:20'),
(32868, 1006, 25312, NULL, '2021-05-07 00:00:00.000', 'Initiated', 'Sent the following initiation request to trpndataentry@trpnppo.com & providerrelations@trpnppo.com:  Sub: Provider Enrollment Request - VMUC - TRPN  \"Hello,   We want to get the following providers and group enrolled with TRPN, their information is as follows:  Practice Details:  Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997 Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800 Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857 Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502 Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053 Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151 Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765 Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702 Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment timeframe is?  Thank you.\"', NULL, NULL, '2021-04-30 15:49:27', '2021-04-30 15:49:27'),
(32869, 3040, 25312, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || TRPN ||  Hello Max,   I wanted to get the following providers and group enrolled with TRPN, their information is as follows:  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment time frame is?  Thank you. ', NULL, NULL, '2021-06-01 09:46:45', '2021-06-01 09:46:45'),
(32870, 11056, 25312, NULL, '2021-06-26 00:00:00.000', 'In Process', 'Email sent to : 	trpndataentry@trpnppo.com  Sub :  Provider Update Information Form- TRPN  Greetings,  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: Valley Med Urgent Care PLLC (Brownsville) Practice NPI: 1518404631 Practice TIN: 81-5123542 Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248    Provider Names enlisted below:-  Provider 1: Provider Name: Hernandez, Juan Provider NPI : 1225617558  Provider 2: Provider Name:  Wert, Jeniece Provider NPI : 1659919702   Provider 3: Provider Name:  Lira, Arturo Provider NPI : 1245789502  Provider 4:  Provider Name: Potter, Deborah Provider NPI : 1861914053   Provider 5:   Provider Name:  Wright, Larry Provider NPI :   1033769765  Provider 6:   Provider Name: Naranjo, Diego Provider NPI :  1568929800  Provider 7:   Provider Name: Lopez, Mayra Provider NPI :  1265945125    Provider 8: Provider Name: Rodriguez, Cynthia Provider NPI :  1124282553  Provider 9:   Provider Name:  Garcia, Homero Provider NPI :  1730564857  Provider 10: Provider Name:  Escobar, Angiollet Provider NPI : 1962917997  Provider 11:   Provider Name: Hernandez, Eder Provider NPI :  1386956852  Provider 12:   Provider Name:  Saavedra, Teresa Provider NPI :  1255676151  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-18 16:39:13', '2021-06-18 16:39:13'),
(32871, 3040, 25312, 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,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in TRPN for our group Valley Med Urgent Care PLLC under the below locations. We already submitted the provider update form.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (Brownsville) Practice NPI: 1518404631 Practice TIN: 81-5123542 Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248    Provider 1: Provider Name: Hernandez, Juan Provider NPI : 1225617558  Provider 2: Provider Name:  Wert, Jeniece Provider NPI : 1659919702   Provider 3: Provider Name:  Lira, Arturo Provider NPI : 1245789502  Provider 4:  Provider Name: Potter, Deborah Provider NPI : 1861914053   Provider 5:   Provider Name:  Wright, Larry Provider NPI :   1033769765  Provider 6:   Provider Name: Naranjo, Diego Provider NPI :  1568929800  Provider 7:   Provider Name: Lopez, Mayra Provider NPI :  1265945125    Provider 8: Provider Name: Rodriguez, Cynthia Provider NPI :  1124282553  Provider 9:   Provider Name:  Garcia, Homero Provider NPI :  1730564857  Provider 10: Provider Name:  Escobar, Angiollet Provider NPI : 1962917997  Provider 11:   Provider Name: Hernandez, Eder Provider NPI :  1386956852  Provider 12:   Provider Name:  Saavedra, Teresa Provider NPI :  1255676151  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-05 14:48:06', '2021-07-05 14:48:06'),
(32872, 3040, 25312, NULL, '2021-07-22 00:00:00.000', 'Approved', 'Email rcvd from: ccampos@trpnppo.com  Subject: Provider Update Information Form- TRPN  Hi,  Provider Jeniece Wert is Active, effective date 04/30/2021,  Provider Arturo Lira is Active, effective date 04/30/2021,  Provider Deborah Potter is Active, effective date 04/30/2021,  Provider Larry Wright is Active, effective date 04/30/2021,  Provider Diego Naranjo is Active, effective date 10/01/2019,  Provider Mayra Lopez is Active, effective date 09/24/2019,  Provider Cynthia Rodriguez is Active, effective date 06/24/2019,  Provider Homero Garcia is Active, effective date 10/16/2018,  Provider Angiollet Escobar is Active, effective date 10/01/2019,  Provider Eder Hernandez is Active, effective date 02/01/2016,  Provider Teresa Saavedra is Active, effective date 04/30/2021,  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 www.trpnppo.com', NULL, NULL, '2021-07-15 11:44:47', '2021-07-15 11:44:47'),
(32873, 3040, 25313, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:21', '2021-04-26 14:17:21'),
(32874, 3040, 25313, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to:  CSHNproviderrelations@christushealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Christus Spohn ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Christus Spohn in our group Valley Med Urgent Care PLLC under below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-03 07:45:06', '2021-05-03 07:45:06'),
(32875, 3040, 25313, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Christus Spohn ||  Hello,   Can you please advise the process for credentialing?  Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-05-27 10:45:13', '2021-05-27 10:45:13'),
(32876, 3040, 25313, NULL, '2021-06-22 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, '2021-06-15 13:26:27', '2021-06-15 13:26:27'),
(32877, 11056, 25313, NULL, '2021-07-08 00:00:00.000', 'In Process', 'Email sent to : CSHNproviderrelations@christushealth.org  Sub : ENROLLMENT REQUEST || Valley Med Urgent Care PLLC || Christus Spohn ||  Greetings,  Kindly respond soon. Hope you are doing well. I wanted to enroll the below mentioned group & providers in Christus Spohn in our group Valley Med Urgent Care PLLC under below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Providers: Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Provider 12: Provider Name: Hernandez, Juan Provider NPI#: 1225617558  Please get back to me as soon as possible. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-01 13:30:07', '2021-07-01 13:30:07'),
(32878, 3040, 25313, NULL, '2021-07-15 00:00:00.000', 'Not Eligible', 'Email rcvd from: michal.simms@christushealth.org  Subject;:Enroll Group & Providers || Valley Med Urgent Care PLLC || USFHP|  Adil,  CHRISTUS Health Plan and CHRISTUS Spohn Health Network are two separate health plans…  I work for CHRISTUS Health Plan.  This is the service area Vicki at Spohn sent you in an email last week… I don’t see Cameron listed.', NULL, NULL, '2021-07-08 16:56:51', '2021-07-08 16:56:51'),
(32879, 3040, 25314, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:21', '2021-04-26 14:17:21'),
(32880, 3040, 25314, NULL, '2021-05-12 00:00:00.000', 'In Process', 'Email sent to: ccnprovider@triwest.com  Subject: Enrollment Request || Group & Providers || VMUC || Triwest  Hello,   We want to get the following providers and group enrolled with Triwest, their information is as follows:  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment time frame is?', NULL, NULL, '2021-05-05 14:14:12', '2021-05-05 14:14:12'),
(32881, 3040, 25314, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: providerservices@triwest.com  Subject: Re: Enrollment Request || Group & Providers || VMUC || Triwest  Greetings,   I wanted to enroll the below mentioned group and providers in our group Valley Med Urgent Care PLLC under the below locations. The request was directed to state representative and I didn\'t hear from them.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please get back to me as soon as you get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-01 09:30:44', '2021-06-01 09:30:44'),
(32882, 3040, 25314, NULL, '2021-06-25 00:00:00.000', 'On Hold', 'Group enrollment request sent. Please see group task. ', NULL, NULL, '2021-06-18 15:40:54', '2021-06-18 15:40:54'),
(32883, 3040, 25314, NULL, '2021-07-23 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. Please see group task.  ', NULL, NULL, '2021-07-16 11:35:15', '2021-07-16 11:35:15'),
(32884, 3040, 25315, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:21', '2021-04-26 14:17:21'),
(32885, 3040, 25315, NULL, '2021-05-07 00:00:00.000', 'Rejected', '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, '2021-04-30 09:16:13', '2021-04-30 09:16:13'),
(32886, 3040, 25320, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:21', '2021-04-26 14:17:21'),
(32887, 1006, 25320, NULL, '2021-05-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Brownsville or McAllen, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-04-30 13:56:43', '2021-04-30 13:56:43'),
(32888, 3040, 25321, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:21', '2021-04-26 14:17:21'),
(32889, 3040, 25321, NULL, '2021-05-07 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || 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 Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-30 10:23:55', '2021-04-30 10:23:55'),
(32890, 3040, 25321, NULL, '2021-05-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: michal.simms@christushealth.org  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || CHRISTUS HEALTH PLAN ||  Hello Adil, I hope you are doing well too!  Please review the letter attached and let me know if you have any questions.  Best regards, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan (o) 469-282-3227 www.christushealthplan.org  Please see attachment in group task. ', NULL, NULL, '2021-05-03 11:16:27', '2021-05-03 11:16:27'),
(32891, 3040, 25322, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:21', '2021-04-26 14:17:21'),
(32892, 3040, 25322, NULL, '2021-05-06 00:00:00.000', 'Rejected', 'TCHP does not cover Hidalgo or Cameron County for VMUC.', NULL, NULL, '2021-04-29 16:04:31', '2021-04-29 16:04:31'),
(32893, 3040, 25323, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:21', '2021-04-26 14:17:21'),
(32894, 3040, 25323, NULL, '2021-05-03 00:00:00.000', 'Not Eligible', 'From: txcredentialing@amerigroup.com  To: mk@claimsmedinc.com  Sub: RE: {EXTERNAL} Request to add new service location  HI There, Amerigroup does not service that region.  Please find below link from Amerigroup Website in which it shows they do not cover the counties for VMUC i.e. Hidalgo & Cameron: https://www.myamerigroup.com/tx/apply/know-your-service-area.html  ', NULL, NULL, '2021-04-26 15:00:11', '2021-04-26 15:00:11'),
(32895, 3040, 25324, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:21', '2021-04-26 14:17:21'),
(32896, 3040, 25324, NULL, '2021-05-06 00:00:00.000', 'Rejected', 'CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @   https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/  It is also attached for reference.  ', NULL, NULL, '2021-04-29 09:17:01', '2021-04-29 09:17:01'),
(32897, 3040, 25325, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:21', '2021-04-26 14:17:21'),
(32898, 3040, 25325, NULL, '2021-05-07 00:00:00.000', 'In Process', 'Email sent to: providerservices@memorialhermann.org, enterprise.credentialing@memorialhermann.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Memorial Hermann for our group Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-04-30 08:55:51', '2021-04-30 08:55:51');
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
(32899, 3040, 25325, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Good morning,  Are these requests for Memorial Hermann Health Plan only? If yes, please submit a request for application form for each practitioners. Below is the link:  CLICK HERE to access and complete the Request for Application form for Memorial Hermann hospitals, affiliated hospitals, surgery centers, MHMD membership or Health Plan participation. To avoid any delays, please submit the form in its entirety (via link above) or email the form to enterprise.credentialing@memorialhermann.org. If the pre-screening qualifications are met, you should receive both your eCredentialing Portal and application username and password via email or additional communication within 3 business days.  If you have any questions, please contact us at enterprise.credentialing@memorialhermann.org.  Memorial Hermann Central Credentialing Team', NULL, NULL, '2021-05-28 11:01:20', '2021-05-28 11:01:20'),
(32900, 3040, 25325, 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 16:23:17', '2021-06-16 16:23:17'),
(32901, 3040, 25325, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: enterprise.credentialing@memorialhermann.org  Subject: Re: [EXTERNAL] Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Memorial Hermann in our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-07-20 11:30:20', '2021-07-20 11:30:20'),
(32902, 3040, 25325, NULL, '2021-08-03 00:00:00.000', 'Not Eligible', 'Please see group task. ', NULL, NULL, '2021-07-27 16:19:05', '2021-07-27 16:19:05'),
(32903, 3040, 25327, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:22', '2021-04-26 14:17:22'),
(32904, 1006, 25327, NULL, '2021-05-07 00:00:00.000', 'Initiated', 'Submitted an online enrollment form for group enrollment:  \"Your form was submitted successfully. Thank you for contacting us. A representative will be in contact to discuss your interest in becoming a participating Provider.\"  Form attached in main group task.', NULL, NULL, '2021-04-30 16:12:18', '2021-04-30 16:12:18'),
(32905, 3040, 25327, NULL, '2021-06-08 00:00:00.000', 'In Process', 'I had a word with (Liya) Wellcare representative and she sent the request to provider rep. department and they will contact us regarding the enrollment.   Ref: 507756828', NULL, NULL, '2021-06-01 12:53:49', '2021-06-01 12:53:49'),
(32906, 3040, 25327, NULL, '2021-06-25 00:00:00.000', 'On Hold', 'We sent the ancillary contract request for group. For more details please see group task. ', NULL, NULL, '2021-06-18 16:22:52', '2021-06-18 16:22:52'),
(32907, 3040, 25327, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject; Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in our group Valley Med Urgent Care PLLC under the below locations. As we submitted an online form.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 11:18:17', '2021-07-20 11:18:17'),
(32908, 3040, 25327, NULL, '2021-09-14 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject: Re: Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Hello,    Hope you are doing well. Please advise the enrollment status for the remaining providers in Wellcare in our group Valley Med Urgent Care PLLC under the below locations.      Practice Details:  Practice Name: Valley Med Urgent Care PLLC (All three locations)  Practice Tax-ID# 81-5123542  Practice NPI# 1518404631  Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166    Provider 1:  Provider Name: Garcia, Homero  Provider NPI# 1730564857     Provider 2:  Provider Name: Lira, Arturo Alejandro  Provider NPI# 1245789502     Provider 3:  Provider Name: Lopez, Mayra Alejandra  Provider NPI# 1265945125    Provider 4:  Provider Name: Hernandez, Juan  Provider NPI# 1225617558    If you need any additional information please let me know. Waiting to hear from you soon.     Thank you   ', NULL, NULL, '2021-09-07 13:57:03', '2021-09-07 13:57:03'),
(32909, 10057, 25327, NULL, '2021-10-26 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Good Afternoon,  Hope you are doing well. I\'m writing this email to check the status for the remaining providers in Wellcare in our group Valley Med Urgent Care PLLC under the below locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Garcia, Homero	1730564857 Lira, Arturo Alejandro	1245789502 Lopez, Mayra Alejandra	1265945125 Hernandez, Juan	1225617558  Please get back to me as soon as you get a chance. Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-19 13:25:41', '2021-10-19 13:25:41'),
(32910, 10057, 25327, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : Re: Become A Provider - Unsecured - General Practice - Texas  Dear Provider:  Thank you for your interest in joining the Wellcare network.  Please allow us 30 calendar days to review your request.  A Centene contracting representative will reach out to you within 30 calendar days.  Please note:  In response to your request to join the Wellcare network, you may receive correspondence from a Superior Health Plan email address.   Thank you once again for your interest.  Sincerely, Network Management', NULL, NULL, '2021-11-17 10:10:07', '2021-11-17 10:10:07'),
(32911, 10057, 25327, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Good Afternoon,  I have submitted the remaining below mentioned provider forms via your website, let me know the update.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Edna Michi	1992293906 Nubia Benavides	1801371935 Garcia, Homero	1730564857 Juan Hernandez	1225617558 Lopez, Mayra	1265945125  Please find the attached forms for your reference as well.  Thanks & Regards,', NULL, NULL, '2021-11-30 16:11:01', '2021-11-30 16:11:01'),
(32912, 10057, 25327, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Hello,  Hope this email finds you well. I\'m writing this email to check the latest update on the below mentioned providers request.  Please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-07 15:40:22', '2021-12-07 15:40:22'),
(32913, 10057, 25327, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Hello,  The providers below are PAR.  Sincerely, Network Management– Texas', NULL, NULL, '2021-12-17 15:31:45', '2021-12-17 15:31:45'),
(32914, 10057, 25327, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Thank you for reaching out. Can I get the welcome packets of mentioned providers?  Looking forward to hearing from you soon.  Regards,', NULL, NULL, '2021-12-27 12:57:43', '2021-12-27 12:57:43'),
(32915, 10057, 25327, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Good Morning,  Here is a list of par providers for your contract, and the welcome letter.  Please see attachment.  Sincerely,  Network Management– Texas', NULL, NULL, '2021-12-30 14:27:55', '2021-12-30 14:27:55'),
(32916, 20067, 25327, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Group || WellCare ||   Good afternoon,  Hope you are doing well. I want to know the enrollment status of the below-mentioned providers. If any provider is enrolled kindly send me the welcome letter.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Nubia Olivama Benavides	1801371935 Edna Michi	1992293906 Juan Hernandez	1225617558 Homero garcia	1730564857 Mayra Lopez	1265945125  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-05 17:53:55', '2022-01-05 17:53:55'),
(32917, 20067, 25327, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Sub: Re: Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Good Afternoon!  Hope you had a great weekend. Any updates on the below-mentioned request?  Thanks & Regards, Syed Ahad', NULL, NULL, '2022-01-18 14:23:39', '2022-01-18 14:23:39'),
(32918, 20067, 25327, NULL, '2022-02-07 00:00:00.000', 'In Process', 'Received the effective date but not confirm for which location, Will approve the task next week after the confirmation.', NULL, NULL, '2022-01-31 09:50:14', '2022-01-31 09:50:14'),
(32919, 20067, 25327, NULL, '2022-02-15 00:00:00.000', 'Approved', 'Email received from: ProspectiveProviderTX@wellcare.com  Sub: Re: Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||   Good Morning,   Welcome letters will only have one address on them. The provider was requested to be loaded to 3 addresses and they are par for them all:  ', NULL, NULL, '2022-02-08 12:39:13', '2022-02-08 12:39:13'),
(32920, 3040, 25328, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:22', '2021-04-26 14:17:22'),
(32921, 1006, 25328, NULL, '2021-05-07 00:00:00.000', 'Initiated', 'Sent the following initiation request to trpndataentry@trpnppo.com & providerrelations@trpnppo.com:  Sub: Provider Enrollment Request - VMUC - TRPN  \"Hello,   We want to get the following providers and group enrolled with TRPN, their information is as follows:  Practice Details:  Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997 Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800 Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857 Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502 Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053 Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151 Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765 Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702 Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment timeframe is?  Thank you.\"', NULL, NULL, '2021-04-30 15:49:23', '2021-04-30 15:49:23'),
(32922, 3040, 25328, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || TRPN ||  Hello Max,   I wanted to get the following providers and group enrolled with TRPN, their information is as follows:  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment time frame is?  Thank you. ', NULL, NULL, '2021-06-01 09:46:48', '2021-06-01 09:46:48'),
(32923, 11056, 25328, NULL, '2021-06-26 00:00:00.000', 'In Process', 'Email sent to : 	trpndataentry@trpnppo.com  Sub :  Provider Update Information Form- TRPN  Greetings,  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: Valley Med Urgent Care PLLC (Brownsville) Practice NPI: 1518404631 Practice TIN: 81-5123542 Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248    Provider Names enlisted below:-  Provider 1: Provider Name: Hernandez, Juan Provider NPI : 1225617558  Provider 2: Provider Name:  Wert, Jeniece Provider NPI : 1659919702   Provider 3: Provider Name:  Lira, Arturo Provider NPI : 1245789502  Provider 4:  Provider Name: Potter, Deborah Provider NPI : 1861914053   Provider 5:   Provider Name:  Wright, Larry Provider NPI :   1033769765  Provider 6:   Provider Name: Naranjo, Diego Provider NPI :  1568929800  Provider 7:   Provider Name: Lopez, Mayra Provider NPI :  1265945125    Provider 8: Provider Name: Rodriguez, Cynthia Provider NPI :  1124282553  Provider 9:   Provider Name:  Garcia, Homero Provider NPI :  1730564857  Provider 10: Provider Name:  Escobar, Angiollet Provider NPI : 1962917997  Provider 11:   Provider Name: Hernandez, Eder Provider NPI :  1386956852  Provider 12:   Provider Name:  Saavedra, Teresa Provider NPI :  1255676151  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-18 16:38:36', '2021-06-18 16:38:36'),
(32924, 3040, 25328, 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,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in TRPN for our group Valley Med Urgent Care PLLC under the below locations. We already submitted the provider update form.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (Brownsville) Practice NPI: 1518404631 Practice TIN: 81-5123542 Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248    Provider 1: Provider Name: Hernandez, Juan Provider NPI : 1225617558  Provider 2: Provider Name:  Wert, Jeniece Provider NPI : 1659919702   Provider 3: Provider Name:  Lira, Arturo Provider NPI : 1245789502  Provider 4:  Provider Name: Potter, Deborah Provider NPI : 1861914053   Provider 5:   Provider Name:  Wright, Larry Provider NPI :   1033769765  Provider 6:   Provider Name: Naranjo, Diego Provider NPI :  1568929800  Provider 7:   Provider Name: Lopez, Mayra Provider NPI :  1265945125    Provider 8: Provider Name: Rodriguez, Cynthia Provider NPI :  1124282553  Provider 9:   Provider Name:  Garcia, Homero Provider NPI :  1730564857  Provider 10: Provider Name:  Escobar, Angiollet Provider NPI : 1962917997  Provider 11:   Provider Name: Hernandez, Eder Provider NPI :  1386956852  Provider 12:   Provider Name:  Saavedra, Teresa Provider NPI :  1255676151  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-05 14:48:05', '2021-07-05 14:48:05'),
(32925, 3040, 25328, NULL, '2021-07-22 00:00:00.000', 'Approved', 'Email rcvd from: ccampos@trpnppo.com  Subject: Provider Update Information Form- TRPN  Hi,  Provider Jeniece Wert is Active, effective date 04/30/2021,  Provider Arturo Lira is Active, effective date 04/30/2021,  Provider Deborah Potter is Active, effective date 04/30/2021,  Provider Larry Wright is Active, effective date 04/30/2021,  Provider Diego Naranjo is Active, effective date 10/01/2019,  Provider Mayra Lopez is Active, effective date 09/24/2019,  Provider Cynthia Rodriguez is Active, effective date 06/24/2019,  Provider Homero Garcia is Active, effective date 10/16/2018,  Provider Angiollet Escobar is Active, effective date 10/01/2019,  Provider Eder Hernandez is Active, effective date 02/01/2016,  Provider Teresa Saavedra is Active, effective date 04/30/2021,  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 www.trpnppo.com', NULL, NULL, '2021-07-15 11:37:19', '2021-07-15 11:37:19'),
(32926, 3040, 25329, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:22', '2021-04-26 14:17:22'),
(32927, 3040, 25329, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to:  CSHNproviderrelations@christushealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Christus Spohn ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Christus Spohn in our group Valley Med Urgent Care PLLC under below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-03 07:45:52', '2021-05-03 07:45:52'),
(32928, 3040, 25329, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Christus Spohn ||  Hello,   Can you please advise the process for credentialing?  Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-05-27 10:45:19', '2021-05-27 10:45:19'),
(32929, 3040, 25329, NULL, '2021-06-22 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, '2021-06-15 13:26:23', '2021-06-15 13:26:23'),
(32930, 11056, 25329, NULL, '2021-07-08 00:00:00.000', 'In Process', 'Email sent to : CSHNproviderrelations@christushealth.org  Sub : ENROLLMENT REQUEST || Valley Med Urgent Care PLLC || Christus Spohn ||  Greetings,  Kindly respond soon. Hope you are doing well. I wanted to enroll the below mentioned group & providers in Christus Spohn in our group Valley Med Urgent Care PLLC under below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Providers: Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Provider 12: Provider Name: Hernandez, Juan Provider NPI#: 1225617558  Please get back to me as soon as possible. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-01 13:29:38', '2021-07-01 13:29:38'),
(32931, 3040, 25329, NULL, '2021-07-15 00:00:00.000', 'Not Eligible', 'Email rcvd from: michal.simms@christushealth.org  Subject;:Enroll Group & Providers || Valley Med Urgent Care PLLC || USFHP|  Adil,  CHRISTUS Health Plan and CHRISTUS Spohn Health Network are two separate health plans…  I work for CHRISTUS Health Plan.  This is the service area Vicki at Spohn sent you in an email last week… I don’t see Cameron listed.', NULL, NULL, '2021-07-08 16:56:51', '2021-07-08 16:56:51'),
(32932, 3040, 25330, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:22', '2021-04-26 14:17:22'),
(32933, 3040, 25330, NULL, '2021-05-12 00:00:00.000', 'In Process', 'Email sent to: ccnprovider@triwest.com  Subject: Enrollment Request || Group & Providers || VMUC || Triwest  Hello,   We want to get the following providers and group enrolled with Triwest, their information is as follows:  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment time frame is?', NULL, NULL, '2021-05-05 14:14:20', '2021-05-05 14:14:20'),
(32934, 3040, 25330, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: providerservices@triwest.com  Subject: Re: Enrollment Request || Group & Providers || VMUC || Triwest  Greetings,   I wanted to enroll the below mentioned group and providers in our group Valley Med Urgent Care PLLC under the below locations. The request was directed to state representative and I didn\'t hear from them.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please get back to me as soon as you get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-01 09:30:47', '2021-06-01 09:30:47'),
(32935, 3040, 25330, NULL, '2021-06-25 00:00:00.000', 'On Hold', 'Group enrollment request sent. Please see group task. ', NULL, NULL, '2021-06-18 15:40:51', '2021-06-18 15:40:51'),
(32936, 3040, 25330, NULL, '2021-07-23 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. Please see group task.  ', NULL, NULL, '2021-07-16 11:35:14', '2021-07-16 11:35:14'),
(32937, 3040, 25331, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:22', '2021-04-26 14:17:22'),
(32938, 3040, 25331, NULL, '2021-05-07 00:00:00.000', 'Rejected', '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, '2021-04-30 09:16:24', '2021-04-30 09:16:24'),
(32939, 3040, 25336, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:22', '2021-04-26 14:17:22'),
(32940, 1006, 25336, NULL, '2021-05-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Brownsville or McAllen, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-04-30 13:56:36', '2021-04-30 13:56:36'),
(32941, 3040, 25337, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:22', '2021-04-26 14:17:22'),
(32942, 3040, 25337, NULL, '2021-05-07 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || 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 Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-30 10:25:03', '2021-04-30 10:25:03'),
(32943, 3040, 25337, NULL, '2021-05-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: michal.simms@christushealth.org  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || CHRISTUS HEALTH PLAN ||  Hello Adil, I hope you are doing well too!  Please review the letter attached and let me know if you have any questions.  Best regards, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan (o) 469-282-3227 www.christushealthplan.org  Please see attachment in group task. ', NULL, NULL, '2021-05-03 11:17:51', '2021-05-03 11:17:51'),
(32944, 3040, 25338, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:22', '2021-04-26 14:17:22'),
(32945, 3040, 25338, NULL, '2021-05-06 00:00:00.000', 'Rejected', 'TCHP does not cover Hidalgo or Cameron County for VMUC.', NULL, NULL, '2021-04-29 16:02:19', '2021-04-29 16:02:19'),
(32946, 3040, 25339, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:22', '2021-04-26 14:17:22'),
(32947, 3040, 25339, NULL, '2021-05-03 00:00:00.000', 'Not Eligible', 'From: txcredentialing@amerigroup.com  To: mk@claimsmedinc.com  Sub: RE: {EXTERNAL} Request to add new service location  HI There, Amerigroup does not service that region.  Please find below link from Amerigroup Website in which it shows they do not cover the counties for VMUC i.e. Hidalgo & Cameron: https://www.myamerigroup.com/tx/apply/know-your-service-area.html  ', NULL, NULL, '2021-04-26 14:59:29', '2021-04-26 14:59:29'),
(32948, 3040, 25340, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:22', '2021-04-26 14:17:22'),
(32949, 3040, 25340, NULL, '2021-05-06 00:00:00.000', 'Rejected', 'CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @   https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/  It is also attached for reference.  ', NULL, NULL, '2021-04-29 09:16:11', '2021-04-29 09:16:11'),
(32950, 3040, 25341, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:22', '2021-04-26 14:17:22'),
(32951, 3040, 25341, NULL, '2021-05-07 00:00:00.000', 'In Process', 'Email sent to: providerservices@memorialhermann.org, enterprise.credentialing@memorialhermann.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Memorial Hermann for our group Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-04-30 08:55:43', '2021-04-30 08:55:43'),
(32952, 3040, 25341, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Good morning,  Are these requests for Memorial Hermann Health Plan only? If yes, please submit a request for application form for each practitioners. Below is the link:  CLICK HERE to access and complete the Request for Application form for Memorial Hermann hospitals, affiliated hospitals, surgery centers, MHMD membership or Health Plan participation. To avoid any delays, please submit the form in its entirety (via link above) or email the form to enterprise.credentialing@memorialhermann.org. If the pre-screening qualifications are met, you should receive both your eCredentialing Portal and application username and password via email or additional communication within 3 business days.  If you have any questions, please contact us at enterprise.credentialing@memorialhermann.org.  Memorial Hermann Central Credentialing Team', NULL, NULL, '2021-05-28 11:01:24', '2021-05-28 11:01:24'),
(32953, 3040, 25341, 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 16:23:14', '2021-06-16 16:23:14'),
(32954, 3040, 25341, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: enterprise.credentialing@memorialhermann.org  Subject: Re: [EXTERNAL] Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Memorial Hermann in our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-07-20 11:30:19', '2021-07-20 11:30:19'),
(32955, 3040, 25341, NULL, '2021-08-03 00:00:00.000', 'Not Eligible', 'Please see group task. ', NULL, NULL, '2021-07-27 16:19:05', '2021-07-27 16:19:05'),
(32956, 3040, 25343, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:23', '2021-04-26 14:17:23'),
(32957, 1006, 25343, NULL, '2021-05-07 00:00:00.000', 'Initiated', 'Submitted an online enrollment form for group enrollment:  \"Your form was submitted successfully. Thank you for contacting us. A representative will be in contact to discuss your interest in becoming a participating Provider.\"  Form attached in main group task.', NULL, NULL, '2021-04-30 16:12:15', '2021-04-30 16:12:15'),
(32958, 3040, 25343, NULL, '2021-06-08 00:00:00.000', 'In Process', 'I had a word with (Liya) Wellcare representative and she sent the request to provider rep. department and they will contact us regarding the enrollment.   Ref: 507756828', NULL, NULL, '2021-06-01 12:53:53', '2021-06-01 12:53:53'),
(32959, 3040, 25343, NULL, '2021-06-25 00:00:00.000', 'On Hold', 'We sent the ancillary contract request for group. For more details please see group task. ', NULL, NULL, '2021-06-18 16:22:42', '2021-06-18 16:22:42'),
(32960, 3040, 25343, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject; Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in our group Valley Med Urgent Care PLLC under the below locations. As we submitted an online form.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 11:18:17', '2021-07-20 11:18:17'),
(32961, 3040, 25343, NULL, '2021-08-03 00:00:00.000', 'Approved', 'Email rcvd from: ProspectiveProviderTX@wellcare.com  Subject:  Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Good Afternoon,  We have completed the request for the following providers:  Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 5: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 6: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 7: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let us know if you have any questions.  Thanks   Network Management – Texas | www.wellcare.com | www.superiorhealthplan.com', NULL, NULL, '2021-07-27 14:13:15', '2021-07-27 14:13:15'),
(32962, 3040, 25344, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:23', '2021-04-26 14:17:23'),
(32963, 1006, 25344, NULL, '2021-05-07 00:00:00.000', 'Initiated', 'Sent the following initiation request to trpndataentry@trpnppo.com & providerrelations@trpnppo.com:  Sub: Provider Enrollment Request - VMUC - TRPN  \"Hello,   We want to get the following providers and group enrolled with TRPN, their information is as follows:  Practice Details:  Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997 Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800 Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857 Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502 Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053 Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151 Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765 Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702 Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment timeframe is?  Thank you.\"', NULL, NULL, '2021-04-30 15:49:20', '2021-04-30 15:49:20'),
(32964, 3040, 25344, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || TRPN ||  Hello Max,   I wanted to get the following providers and group enrolled with TRPN, their information is as follows:  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment time frame is?  Thank you. ', NULL, NULL, '2021-06-01 09:46:51', '2021-06-01 09:46:51'),
(32965, 11056, 25344, NULL, '2021-06-26 00:00:00.000', 'In Process', 'Email sent to : 	trpndataentry@trpnppo.com  Sub :  Provider Update Information Form- TRPN  Greetings,  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: Valley Med Urgent Care PLLC (Brownsville) Practice NPI: 1518404631 Practice TIN: 81-5123542 Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248    Provider Names enlisted below:-  Provider 1: Provider Name: Hernandez, Juan Provider NPI : 1225617558  Provider 2: Provider Name:  Wert, Jeniece Provider NPI : 1659919702   Provider 3: Provider Name:  Lira, Arturo Provider NPI : 1245789502  Provider 4:  Provider Name: Potter, Deborah Provider NPI : 1861914053   Provider 5:   Provider Name:  Wright, Larry Provider NPI :   1033769765  Provider 6:   Provider Name: Naranjo, Diego Provider NPI :  1568929800  Provider 7:   Provider Name: Lopez, Mayra Provider NPI :  1265945125    Provider 8: Provider Name: Rodriguez, Cynthia Provider NPI :  1124282553  Provider 9:   Provider Name:  Garcia, Homero Provider NPI :  1730564857  Provider 10: Provider Name:  Escobar, Angiollet Provider NPI : 1962917997  Provider 11:   Provider Name: Hernandez, Eder Provider NPI :  1386956852  Provider 12:   Provider Name:  Saavedra, Teresa Provider NPI :  1255676151  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-18 16:37:59', '2021-06-18 16:37:59'),
(32966, 3040, 25344, 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,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in TRPN for our group Valley Med Urgent Care PLLC under the below locations. We already submitted the provider update form.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (Brownsville) Practice NPI: 1518404631 Practice TIN: 81-5123542 Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248    Provider 1: Provider Name: Hernandez, Juan Provider NPI : 1225617558  Provider 2: Provider Name:  Wert, Jeniece Provider NPI : 1659919702   Provider 3: Provider Name:  Lira, Arturo Provider NPI : 1245789502  Provider 4:  Provider Name: Potter, Deborah Provider NPI : 1861914053   Provider 5:   Provider Name:  Wright, Larry Provider NPI :   1033769765  Provider 6:   Provider Name: Naranjo, Diego Provider NPI :  1568929800  Provider 7:   Provider Name: Lopez, Mayra Provider NPI :  1265945125    Provider 8: Provider Name: Rodriguez, Cynthia Provider NPI :  1124282553  Provider 9:   Provider Name:  Garcia, Homero Provider NPI :  1730564857  Provider 10: Provider Name:  Escobar, Angiollet Provider NPI : 1962917997  Provider 11:   Provider Name: Hernandez, Eder Provider NPI :  1386956852  Provider 12:   Provider Name:  Saavedra, Teresa Provider NPI :  1255676151  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-05 14:48:04', '2021-07-05 14:48:04'),
(32967, 3040, 25344, NULL, '2021-07-22 00:00:00.000', 'Approved', 'Email rcvd from: ccampos@trpnppo.com  Subject: Provider Update Information Form- TRPN  Hi,  Provider Jeniece Wert is Active, effective date 04/30/2021,  Provider Arturo Lira is Active, effective date 04/30/2021,  Provider Deborah Potter is Active, effective date 04/30/2021,  Provider Larry Wright is Active, effective date 04/30/2021,  Provider Diego Naranjo is Active, effective date 10/01/2019,  Provider Mayra Lopez is Active, effective date 09/24/2019,  Provider Cynthia Rodriguez is Active, effective date 06/24/2019,  Provider Homero Garcia is Active, effective date 10/16/2018,  Provider Angiollet Escobar is Active, effective date 10/01/2019,  Provider Eder Hernandez is Active, effective date 02/01/2016,  Provider Teresa Saavedra is Active, effective date 04/30/2021,  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 www.trpnppo.com', NULL, NULL, '2021-07-15 11:31:59', '2021-07-15 11:31:59'),
(32968, 3040, 25345, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:23', '2021-04-26 14:17:23');
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
(32969, 3040, 25345, NULL, '2021-05-12 00:00:00.000', 'In Process', 'Email sent to: ccnprovider@triwest.com  Subject: Enrollment Request || Group & Providers || VMUC || Triwest  Hello,   We want to get the following providers and group enrolled with Triwest, their information is as follows:  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment time frame is?', NULL, NULL, '2021-05-05 14:14:14', '2021-05-05 14:14:14'),
(32970, 3040, 25345, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: providerservices@triwest.com  Subject: Re: Enrollment Request || Group & Providers || VMUC || Triwest  Greetings,   I wanted to enroll the below mentioned group and providers in our group Valley Med Urgent Care PLLC under the below locations. The request was directed to state representative and I didn\'t hear from them.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please get back to me as soon as you get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-01 09:30:50', '2021-06-01 09:30:50'),
(32971, 3040, 25345, NULL, '2021-06-25 00:00:00.000', 'On Hold', 'Group enrollment request sent. Please see group task. ', NULL, NULL, '2021-06-18 15:40:49', '2021-06-18 15:40:49'),
(32972, 3040, 25345, NULL, '2021-07-23 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. Please see group task.  ', NULL, NULL, '2021-07-16 11:35:14', '2021-07-16 11:35:14'),
(32973, 3040, 25346, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:23', '2021-04-26 14:17:23'),
(32974, 3040, 25346, NULL, '2021-05-07 00:00:00.000', 'Rejected', '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, '2021-04-30 09:16:16', '2021-04-30 09:16:16'),
(32975, 3040, 25351, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:23', '2021-04-26 14:17:23'),
(32976, 1006, 25351, NULL, '2021-05-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Brownsville or McAllen, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-04-30 13:56:32', '2021-04-30 13:56:32'),
(32977, 3040, 25352, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:23', '2021-04-26 14:17:23'),
(32978, 3040, 25352, NULL, '2021-05-07 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || 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 Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-30 10:24:24', '2021-04-30 10:24:24'),
(32979, 3040, 25352, NULL, '2021-05-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: michal.simms@christushealth.org  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || CHRISTUS HEALTH PLAN ||  Hello Adil, I hope you are doing well too!  Please review the letter attached and let me know if you have any questions.  Best regards, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan (o) 469-282-3227 www.christushealthplan.org  Please see attachment in group task. ', NULL, NULL, '2021-05-03 11:16:48', '2021-05-03 11:16:48'),
(32980, 3040, 25353, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:23', '2021-04-26 14:17:23'),
(32981, 3040, 25353, NULL, '2021-05-06 00:00:00.000', 'Rejected', 'TCHP does not cover Hidalgo or Cameron County for VMUC.', NULL, NULL, '2021-04-29 16:04:37', '2021-04-29 16:04:37'),
(32982, 3040, 25354, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:23', '2021-04-26 14:17:23'),
(32983, 3040, 25354, NULL, '2021-05-03 00:00:00.000', 'Not Eligible', 'From: txcredentialing@amerigroup.com  To: mk@claimsmedinc.com  Sub: RE: {EXTERNAL} Request to add new service location  HI There, Amerigroup does not service that region.  Please find below link from Amerigroup Website in which it shows they do not cover the counties for VMUC i.e. Hidalgo & Cameron: https://www.myamerigroup.com/tx/apply/know-your-service-area.html  ', NULL, NULL, '2021-04-26 15:00:38', '2021-04-26 15:00:38'),
(32984, 3040, 25355, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:23', '2021-04-26 14:17:23'),
(32985, 3040, 25355, NULL, '2021-05-06 00:00:00.000', 'Rejected', 'CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @   https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/  It is also attached for reference.  ', NULL, NULL, '2021-04-29 09:17:31', '2021-04-29 09:17:31'),
(32986, 3040, 25356, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:23', '2021-04-26 14:17:23'),
(32987, 3040, 25356, NULL, '2021-05-07 00:00:00.000', 'In Process', 'Email sent to: providerservices@memorialhermann.org, enterprise.credentialing@memorialhermann.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Memorial Hermann for our group Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-04-30 08:56:03', '2021-04-30 08:56:03'),
(32988, 3040, 25356, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Good morning,  Are these requests for Memorial Hermann Health Plan only? If yes, please submit a request for application form for each practitioners. Below is the link:  CLICK HERE to access and complete the Request for Application form for Memorial Hermann hospitals, affiliated hospitals, surgery centers, MHMD membership or Health Plan participation. To avoid any delays, please submit the form in its entirety (via link above) or email the form to enterprise.credentialing@memorialhermann.org. If the pre-screening qualifications are met, you should receive both your eCredentialing Portal and application username and password via email or additional communication within 3 business days.  If you have any questions, please contact us at enterprise.credentialing@memorialhermann.org.  Memorial Hermann Central Credentialing Team', NULL, NULL, '2021-05-28 11:01:29', '2021-05-28 11:01:29'),
(32989, 3040, 25356, 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 16:23:11', '2021-06-16 16:23:11'),
(32990, 3040, 25356, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: enterprise.credentialing@memorialhermann.org  Subject: Re: [EXTERNAL] Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Memorial Hermann in our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-07-20 11:30:19', '2021-07-20 11:30:19'),
(32991, 3040, 25356, NULL, '2021-08-03 00:00:00.000', 'Not Eligible', 'Please see group task. ', NULL, NULL, '2021-07-27 16:19:04', '2021-07-27 16:19:04'),
(32992, 3040, 25358, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:24', '2021-04-26 14:17:24'),
(32993, 1006, 25358, NULL, '2021-05-07 00:00:00.000', 'Initiated', 'Submitted an online enrollment form for group enrollment:  \"Your form was submitted successfully. Thank you for contacting us. A representative will be in contact to discuss your interest in becoming a participating Provider.\"  Form attached in main group task.', NULL, NULL, '2021-04-30 16:12:12', '2021-04-30 16:12:12'),
(32994, 3040, 25358, NULL, '2021-06-08 00:00:00.000', 'In Process', 'I had a word with (Liya) Wellcare representative and she sent the request to provider rep. department and they will contact us regarding the enrollment.   Ref: 507756828', NULL, NULL, '2021-06-01 12:53:57', '2021-06-01 12:53:57'),
(32995, 3040, 25358, NULL, '2021-06-25 00:00:00.000', 'On Hold', 'We sent the ancillary contract request for group. For more details please see group task. ', NULL, NULL, '2021-06-18 16:22:38', '2021-06-18 16:22:38'),
(32996, 3040, 25358, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject; Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in our group Valley Med Urgent Care PLLC under the below locations. As we submitted an online form.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 11:18:16', '2021-07-20 11:18:16'),
(32997, 3040, 25358, NULL, '2021-09-14 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject: Re: Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Hello,    Hope you are doing well. Please advise the enrollment status for the remaining providers in Wellcare in our group Valley Med Urgent Care PLLC under the below locations.      Practice Details:  Practice Name: Valley Med Urgent Care PLLC (All three locations)  Practice Tax-ID# 81-5123542  Practice NPI# 1518404631  Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166    Provider 1:  Provider Name: Garcia, Homero  Provider NPI# 1730564857     Provider 2:  Provider Name: Lira, Arturo Alejandro  Provider NPI# 1245789502     Provider 3:  Provider Name: Lopez, Mayra Alejandra  Provider NPI# 1265945125    Provider 4:  Provider Name: Hernandez, Juan  Provider NPI# 1225617558    If you need any additional information please let me know. Waiting to hear from you soon.     Thank you   ', NULL, NULL, '2021-09-07 13:57:06', '2021-09-07 13:57:06'),
(32998, 10057, 25358, NULL, '2021-10-26 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Good Afternoon,  Hope you are doing well. I\'m writing this email to check the status for the remaining providers in Wellcare in our group Valley Med Urgent Care PLLC under the below locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Garcia, Homero	1730564857 Lira, Arturo Alejandro	1245789502 Lopez, Mayra Alejandra	1265945125 Hernandez, Juan	1225617558  Please get back to me as soon as you get a chance. Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-19 13:25:34', '2021-10-19 13:25:34'),
(32999, 10057, 25358, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : Re: Become A Provider - Unsecured - General Practice - Texas  Dear Provider:  Thank you for your interest in joining the Wellcare network.  Please allow us 30 calendar days to review your request.  A Centene contracting representative will reach out to you within 30 calendar days.  Please note:  In response to your request to join the Wellcare network, you may receive correspondence from a Superior Health Plan email address.   Thank you once again for your interest.  Sincerely, Network Management', NULL, NULL, '2021-11-17 10:12:36', '2021-11-17 10:12:36'),
(33000, 10057, 25358, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Good Afternoon,  I have submitted the remaining below mentioned provider forms via your website, let me know the update.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Edna Michi	1992293906 Nubia Benavides	1801371935 Garcia, Homero	1730564857 Juan Hernandez	1225617558 Lopez, Mayra	1265945125  Please find the attached forms for your reference as well.  Thanks & Regards,', NULL, NULL, '2021-11-30 16:10:56', '2021-11-30 16:10:56'),
(33001, 10057, 25358, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Hello,  Hope this email finds you well. I\'m writing this email to check the latest update on the below mentioned providers request.  Please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-07 15:40:12', '2021-12-07 15:40:12'),
(33002, 10057, 25358, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Hello,  The providers below are PAR.  Sincerely, Network Management– Texas', NULL, NULL, '2021-12-17 15:31:34', '2021-12-17 15:31:34'),
(33003, 10057, 25358, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Thank you for reaching out. Can I get the welcome packets of mentioned providers?  Looking forward to hearing from you soon.  Regards,', NULL, NULL, '2021-12-27 12:57:38', '2021-12-27 12:57:38'),
(33004, 10057, 25358, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Good Morning,  Here is a list of par providers for your contract, and the welcome letter.  Please see attachment.  Sincerely,  Network Management– Texas', NULL, NULL, '2021-12-30 14:27:48', '2021-12-30 14:27:48'),
(33005, 20067, 25358, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Group || WellCare ||   Good afternoon,  Hope you are doing well. I want to know the enrollment status of the below-mentioned providers. If any provider is enrolled kindly send me the welcome letter.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Nubia Olivama Benavides	1801371935 Edna Michi	1992293906 Juan Hernandez	1225617558 Homero garcia	1730564857 Mayra Lopez	1265945125  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-05 17:54:21', '2022-01-05 17:54:21'),
(33006, 20067, 25358, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Sub: Re: Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Good Afternoon!  Hope you had a great weekend. Any updates on the below-mentioned request?  Thanks & Regards, Syed Ahad', NULL, NULL, '2022-01-18 14:23:32', '2022-01-18 14:23:32'),
(33007, 20067, 25358, NULL, '2022-02-07 00:00:00.000', 'In Process', 'Received the effective date but not confirm for which location, Will approve the task next week after the confirmation.', NULL, NULL, '2022-01-31 09:50:08', '2022-01-31 09:50:08'),
(33008, 20067, 25358, NULL, '2022-02-10 00:00:00.000', 'Approved', 'Email received from: ProspectiveProviderTX@wellcare.com  Sub: Fwd: Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Good Morning,   The request to add Mayra Lopez NP to Valley Med Urgent Care PLLC TIN 815123542 is complete. Please see welcome letter attached.  Sincerely,', NULL, NULL, '2022-02-03 09:58:57', '2022-02-03 09:58:57'),
(33009, 3040, 25359, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:24', '2021-04-26 14:17:24'),
(33010, 1006, 25359, NULL, '2021-05-07 00:00:00.000', 'Initiated', 'Sent the following initiation request to trpndataentry@trpnppo.com & providerrelations@trpnppo.com:  Sub: Provider Enrollment Request - VMUC - TRPN  \"Hello,   We want to get the following providers and group enrolled with TRPN, their information is as follows:  Practice Details:  Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997 Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800 Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857 Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502 Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053 Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151 Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765 Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702 Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment timeframe is?  Thank you.\"', NULL, NULL, '2021-04-30 15:49:16', '2021-04-30 15:49:16'),
(33011, 3040, 25359, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || TRPN ||  Hello Max,   I wanted to get the following providers and group enrolled with TRPN, their information is as follows:  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment time frame is?  Thank you. ', NULL, NULL, '2021-06-01 09:47:07', '2021-06-01 09:47:07'),
(33012, 11056, 25359, NULL, '2021-06-26 00:00:00.000', 'In Process', 'Email sent to : 	trpndataentry@trpnppo.com  Sub :  Provider Update Information Form- TRPN  Greetings,  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: Valley Med Urgent Care PLLC (Brownsville) Practice NPI: 1518404631 Practice TIN: 81-5123542 Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248    Provider Names enlisted below:-  Provider 1: Provider Name: Hernandez, Juan Provider NPI : 1225617558  Provider 2: Provider Name:  Wert, Jeniece Provider NPI : 1659919702   Provider 3: Provider Name:  Lira, Arturo Provider NPI : 1245789502  Provider 4:  Provider Name: Potter, Deborah Provider NPI : 1861914053   Provider 5:   Provider Name:  Wright, Larry Provider NPI :   1033769765  Provider 6:   Provider Name: Naranjo, Diego Provider NPI :  1568929800  Provider 7:   Provider Name: Lopez, Mayra Provider NPI :  1265945125    Provider 8: Provider Name: Rodriguez, Cynthia Provider NPI :  1124282553  Provider 9:   Provider Name:  Garcia, Homero Provider NPI :  1730564857  Provider 10: Provider Name:  Escobar, Angiollet Provider NPI : 1962917997  Provider 11:   Provider Name: Hernandez, Eder Provider NPI :  1386956852  Provider 12:   Provider Name:  Saavedra, Teresa Provider NPI :  1255676151  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-18 16:37:05', '2021-06-18 16:37:05'),
(33013, 3040, 25359, 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,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in TRPN for our group Valley Med Urgent Care PLLC under the below locations. We already submitted the provider update form.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (Brownsville) Practice NPI: 1518404631 Practice TIN: 81-5123542 Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248    Provider 1: Provider Name: Hernandez, Juan Provider NPI : 1225617558  Provider 2: Provider Name:  Wert, Jeniece Provider NPI : 1659919702   Provider 3: Provider Name:  Lira, Arturo Provider NPI : 1245789502  Provider 4:  Provider Name: Potter, Deborah Provider NPI : 1861914053   Provider 5:   Provider Name:  Wright, Larry Provider NPI :   1033769765  Provider 6:   Provider Name: Naranjo, Diego Provider NPI :  1568929800  Provider 7:   Provider Name: Lopez, Mayra Provider NPI :  1265945125    Provider 8: Provider Name: Rodriguez, Cynthia Provider NPI :  1124282553  Provider 9:   Provider Name:  Garcia, Homero Provider NPI :  1730564857  Provider 10: Provider Name:  Escobar, Angiollet Provider NPI : 1962917997  Provider 11:   Provider Name: Hernandez, Eder Provider NPI :  1386956852  Provider 12:   Provider Name:  Saavedra, Teresa Provider NPI :  1255676151  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-05 14:48:04', '2021-07-05 14:48:04'),
(33014, 3040, 25359, NULL, '2021-07-22 00:00:00.000', 'Approved', 'Email rcvd from: ccampos@trpnppo.com  Subject: Provider Update Information Form- TRPN  Hi,  Provider Jeniece Wert is Active, effective date 04/30/2021,  Provider Arturo Lira is Active, effective date 04/30/2021,  Provider Deborah Potter is Active, effective date 04/30/2021,  Provider Larry Wright is Active, effective date 04/30/2021,  Provider Diego Naranjo is Active, effective date 10/01/2019,  Provider Mayra Lopez is Active, effective date 09/24/2019,  Provider Cynthia Rodriguez is Active, effective date 06/24/2019,  Provider Homero Garcia is Active, effective date 10/16/2018,  Provider Angiollet Escobar is Active, effective date 10/01/2019,  Provider Eder Hernandez is Active, effective date 02/01/2016,  Provider Teresa Saavedra is Active, effective date 04/30/2021,  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 www.trpnppo.com', NULL, NULL, '2021-07-15 11:21:52', '2021-07-15 11:21:52'),
(33015, 3040, 25360, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:24', '2021-04-26 14:17:24'),
(33016, 3040, 25360, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to:  CSHNproviderrelations@christushealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Christus Spohn ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Christus Spohn in our group Valley Med Urgent Care PLLC under below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-03 07:46:21', '2021-05-03 07:46:21'),
(33017, 3040, 25360, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Christus Spohn ||  Hello,   Can you please advise the process for credentialing?  Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-05-27 10:45:23', '2021-05-27 10:45:23'),
(33018, 3040, 25360, NULL, '2021-06-22 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, '2021-06-15 13:26:19', '2021-06-15 13:26:19'),
(33019, 11056, 25360, NULL, '2021-07-08 00:00:00.000', 'In Process', 'Email sent to : CSHNproviderrelations@christushealth.org  Sub : ENROLLMENT REQUEST || Valley Med Urgent Care PLLC || Christus Spohn ||  Greetings,  Kindly respond soon. Hope you are doing well. I wanted to enroll the below mentioned group & providers in Christus Spohn in our group Valley Med Urgent Care PLLC under below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Providers: Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Provider 12: Provider Name: Hernandez, Juan Provider NPI#: 1225617558  Please get back to me as soon as possible. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-01 13:29:29', '2021-07-01 13:29:29'),
(33020, 3040, 25360, NULL, '2021-07-15 00:00:00.000', 'Not Eligible', 'Email rcvd from: michal.simms@christushealth.org  Subject;:Enroll Group & Providers || Valley Med Urgent Care PLLC || USFHP|  Adil,  CHRISTUS Health Plan and CHRISTUS Spohn Health Network are two separate health plans…  I work for CHRISTUS Health Plan.  This is the service area Vicki at Spohn sent you in an email last week… I don’t see Cameron listed.', NULL, NULL, '2021-07-08 16:56:50', '2021-07-08 16:56:50'),
(33021, 3040, 25361, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:24', '2021-04-26 14:17:24'),
(33022, 3040, 25361, NULL, '2021-05-12 00:00:00.000', 'In Process', 'Email sent to: ccnprovider@triwest.com  Subject: Enrollment Request || Group & Providers || VMUC || Triwest  Hello,   We want to get the following providers and group enrolled with Triwest, their information is as follows:  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment time frame is?', NULL, NULL, '2021-05-05 14:14:24', '2021-05-05 14:14:24'),
(33023, 3040, 25361, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: providerservices@triwest.com  Subject: Re: Enrollment Request || Group & Providers || VMUC || Triwest  Greetings,   I wanted to enroll the below mentioned group and providers in our group Valley Med Urgent Care PLLC under the below locations. The request was directed to state representative and I didn\'t hear from them.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please get back to me as soon as you get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-01 09:30:55', '2021-06-01 09:30:55'),
(33024, 3040, 25361, NULL, '2021-06-25 00:00:00.000', 'On Hold', 'Group enrollment request sent. Please see group task. ', NULL, NULL, '2021-06-18 15:40:46', '2021-06-18 15:40:46'),
(33025, 3040, 25361, NULL, '2021-07-23 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. Please see group task.  ', NULL, NULL, '2021-07-16 11:35:13', '2021-07-16 11:35:13'),
(33026, 3040, 25362, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:24', '2021-04-26 14:17:24'),
(33027, 3040, 25362, NULL, '2021-05-07 00:00:00.000', 'Rejected', '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, '2021-04-30 09:16:28', '2021-04-30 09:16:28'),
(33028, 3040, 25367, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:24', '2021-04-26 14:17:24'),
(33029, 1006, 25367, NULL, '2021-05-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Brownsville or McAllen, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-04-30 13:56:27', '2021-04-30 13:56:27'),
(33030, 3040, 25368, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:24', '2021-04-26 14:17:24'),
(33031, 3040, 25368, NULL, '2021-05-07 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || 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 Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-30 10:25:29', '2021-04-30 10:25:29'),
(33032, 3040, 25368, NULL, '2021-05-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: michal.simms@christushealth.org  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || CHRISTUS HEALTH PLAN ||  Hello Adil, I hope you are doing well too!  Please review the letter attached and let me know if you have any questions.  Best regards, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan (o) 469-282-3227 www.christushealthplan.org  Please see attachment in group task. ', NULL, NULL, '2021-05-03 11:18:34', '2021-05-03 11:18:34'),
(33033, 3040, 25369, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:24', '2021-04-26 14:17:24'),
(33034, 3040, 25369, NULL, '2021-05-06 00:00:00.000', 'Rejected', 'TCHP does not cover Hidalgo or Cameron County for VMUC.', NULL, NULL, '2021-04-29 16:04:27', '2021-04-29 16:04:27'),
(33035, 3040, 25370, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:24', '2021-04-26 14:17:24'),
(33036, 3040, 25370, NULL, '2021-05-03 00:00:00.000', 'Not Eligible', 'From: txcredentialing@amerigroup.com  To: mk@claimsmedinc.com  Sub: RE: {EXTERNAL} Request to add new service location  HI There, Amerigroup does not service that region.  Please find below link from Amerigroup Website in which it shows they do not cover the counties for VMUC i.e. Hidalgo & Cameron: https://www.myamerigroup.com/tx/apply/know-your-service-area.html  ', NULL, NULL, '2021-04-26 14:59:43', '2021-04-26 14:59:43'),
(33037, 3040, 25371, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:25', '2021-04-26 14:17:25'),
(33038, 3040, 25371, NULL, '2021-05-06 00:00:00.000', 'Rejected', 'CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @   https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/  It is also attached for reference.  ', NULL, NULL, '2021-04-29 09:16:26', '2021-04-29 09:16:26'),
(33039, 3040, 25372, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:25', '2021-04-26 14:17:25'),
(33040, 3040, 25372, NULL, '2021-05-07 00:00:00.000', 'In Process', 'Email sent to: providerservices@memorialhermann.org, enterprise.credentialing@memorialhermann.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Memorial Hermann for our group Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-04-30 08:55:45', '2021-04-30 08:55:45'),
(33041, 3040, 25372, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Good morning,  Are these requests for Memorial Hermann Health Plan only? If yes, please submit a request for application form for each practitioners. Below is the link:  CLICK HERE to access and complete the Request for Application form for Memorial Hermann hospitals, affiliated hospitals, surgery centers, MHMD membership or Health Plan participation. To avoid any delays, please submit the form in its entirety (via link above) or email the form to enterprise.credentialing@memorialhermann.org. If the pre-screening qualifications are met, you should receive both your eCredentialing Portal and application username and password via email or additional communication within 3 business days.  If you have any questions, please contact us at enterprise.credentialing@memorialhermann.org.  Memorial Hermann Central Credentialing Team', NULL, NULL, '2021-05-28 11:01:32', '2021-05-28 11:01:32'),
(33042, 3040, 25372, 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 16:23:08', '2021-06-16 16:23:08'),
(33043, 3040, 25372, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: enterprise.credentialing@memorialhermann.org  Subject: Re: [EXTERNAL] Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Memorial Hermann in our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-07-20 11:30:19', '2021-07-20 11:30:19'),
(33044, 3040, 25372, NULL, '2021-08-03 00:00:00.000', 'Not Eligible', 'Please see group task. ', NULL, NULL, '2021-07-27 16:19:04', '2021-07-27 16:19:04'),
(33045, 3040, 25374, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:25', '2021-04-26 14:17:25'),
(33046, 1006, 25374, NULL, '2021-05-07 00:00:00.000', 'Initiated', 'Submitted an online enrollment form for group enrollment:  \"Your form was submitted successfully. Thank you for contacting us. A representative will be in contact to discuss your interest in becoming a participating Provider.\"  Form attached in main group task.', NULL, NULL, '2021-04-30 16:12:10', '2021-04-30 16:12:10'),
(33047, 3040, 25374, NULL, '2021-06-08 00:00:00.000', 'In Process', 'I had a word with (Liya) Wellcare representative and she sent the request to provider rep. department and they will contact us regarding the enrollment.   Ref: 507756828', NULL, NULL, '2021-06-01 12:54:00', '2021-06-01 12:54:00'),
(33048, 3040, 25374, NULL, '2021-06-25 00:00:00.000', 'On Hold', 'We sent the ancillary contract request for group. For more details please see group task. ', NULL, NULL, '2021-06-18 16:22:36', '2021-06-18 16:22:36'),
(33049, 3040, 25374, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject; Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in our group Valley Med Urgent Care PLLC under the below locations. As we submitted an online form.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 11:18:16', '2021-07-20 11:18:16');
