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
(19138, 1019, 21568, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent the following email to Laura.Bevin@aetna.com  Hello, We need the enrollment application status for the following providers,   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Providers:  Barbara Hignite NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson  NPI: 1124622667  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Jessica Hartman  NPI: 1326665472  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Lynnetta Loveland  NPI: 1598163602  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Cemetrice Muhammed NPI: 1548843410  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Jonathan Schubert  NPI: 1235755505   Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Kerry Smith  NPI: 1275083230  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jennifer Ullrich  NPI: 1710489760  Secondary Location: 100 New State Highway, Raynham, MA, 02767      Regards, Alex G.', NULL, NULL, '2021-08-24 11:12:33', '2021-08-24 11:12:33'),
(19139, 1019, 21568, NULL, '2021-09-16 00:00:00.000', 'Approved', 'Received the following email from Laura.Bevin@aetna.com  Hello,  Barbara Hignite NPI: 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. – not linked to this location     Rodesia Edmundson  NPI: 1124622667  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. – 06/01/2021 effective date Secondary Location: 100 New State Highway, Raynham, MA, 02767.  – not linked to this location  Jessica Hartman  NPI: 1326665472  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. – application was not received for MA Secondary Location: 100 New State Highway, Raynham, MA, 02767.  - application was not received for MA   Lynnetta Loveland  NPI: 1598163602  Secondary Location: 100 New State Highway, Raynham, MA, 02767. – not linked to this address     Cemetrice Muhammed NPI: 1548843410  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. – just completed the credentialing process on 08/20/2021     Jonathan Schubert  NPI: 1235755505  Secondary Location: 100 New State Highway, Raynham, MA, 02767. – not linked to this address     Kerry Smith  NPI: 1275083230  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 – 06/01/2021 effective date Secondary Location: 100 New State Highway, Raynham, MA, 02767. - 06/01/2021 effective date  Jennifer Ullrich  NPI: 1710489760  Secondary Location: 100 New State Highway, Raynham, MA, 02767 – not linked to this address  For providers who need another service location added, this can be completed via the below link  Existing Medical Provider Resources | Aetna  The MA application for Jessica Hartman can be submitted via the below link  https://cldaz.aetna.com/pocui/join-the-aetna-network  Thank you           Laura Bevin  Credentialing Senior Analyst  Aetna Behavioral Health', NULL, NULL, '2021-09-09 08:39:32', '2021-09-09 08:39:32'),
(19140, 1006, 21569, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:26:09', '2021-03-16 10:26:09'),
(19141, 1019, 21569, NULL, '2021-04-29 00:00:00.000', 'Initiated', 'LOI was faxed to Aetna demographics update at (859) 455-8650 to Add New Location. see attachment for ref ', NULL, NULL, '2021-04-22 08:32:50', '2021-04-22 08:32:50'),
(19142, 1019, 21569, 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 10:38:25', '2021-05-03 10:38:25'),
(19143, 1019, 21569, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to Laura.Bevin@aetna.com SUB: Enrollment Query || Group & Providers || SNBCARE || Aetna  Hello, We need the enrollment application status for the following providers,   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Carlee Rozell 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Katie Tawakol 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jennifer Ullrich 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Justin Souliere 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Kerry Smith 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Fauzia Wali Khan 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Lynnetta Loveland 1598163602 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Peggy Pionke 1699307322 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Mahreen Rashid 1396393146 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Regards,', NULL, NULL, '2021-05-20 08:04:08', '2021-05-20 08:04:08'),
(19144, 1019, 21569, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Received the following email from Laura.Bevin@aetna.com  Good afternoon, Please see my below comments. Thank you  Mary Gibbons, 9080253 – application was not received NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman, 6715913 – credentialed for RI only, please submit an app for MA NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Carlee Rozell, 6712207 – 01/01/2021 effective date 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.       Jonathan Schubert, 6249193 – 06/15/2021 effective date 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.        Katie Tawakol, 6120037 – 01/01/2021 effective date 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767  Jennifer Ullrich, 6913357 – 05/01/2021 effective date 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767  Justin Souliere, 6893422 – 05/017/2021 effective date 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva, 4841425 – waiting to be linked 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.   Laura Bevin Credentialing Senior Analyst Aetna Behavioral Health', NULL, NULL, '2021-05-31 11:55:40', '2021-05-31 11:55:40'),
(19145, 1019, 21569, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to Laura.Bevin@aetna.com SUB: Enrollment Query || Group & Providers || SNBCARE || Aetna  Hello, We need the enrollment application status for the following providers,   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Carlee Rozell 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Katie Tawakol 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jennifer Ullrich 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Justin Souliere 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Kerry Smith 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Fauzia Wali Khan 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Lynnetta Loveland 1598163602 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Peggy Pionke 1699307322 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Mahreen Rashid 1396393146 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Regards,', NULL, NULL, '2021-06-16 07:57:06', '2021-06-16 07:57:06'),
(19146, 1019, 21569, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent the following email to Laura.Bevin@aetna.com  Hello, We need the enrollment application status for the following providers,   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Providers:  Barbara Hignite NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson  NPI: 1124622667  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Jessica Hartman  NPI: 1326665472  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Lynnetta Loveland  NPI: 1598163602  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Cemetrice Muhammed NPI: 1548843410  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Jonathan Schubert  NPI: 1235755505   Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Kerry Smith  NPI: 1275083230  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jennifer Ullrich  NPI: 1710489760  Secondary Location: 100 New State Highway, Raynham, MA, 02767      Regards, Alex G.', NULL, NULL, '2021-08-24 11:12:21', '2021-08-24 11:12:21'),
(19147, 1019, 21569, NULL, '2021-11-08 00:00:00.000', 'In Process', 'Received the following email from Laura Bevin.  Good afternoon,  Allie DiCostanzo, 6792883 – in the credentialing process  Dina Filoteo-Nichols, 6184053 – in the credentialing process  Helena Halterman – application was not received  Jessica Hartman, 6751913 – linked to the 63 Eddie Dowling Hwy Suite 9 N Smithfield, RI 02896 only, application was not received for MA  Barbara Hignite, 6369000 – linked to the 61 Lincoln Street Suite 203 Framingham, MA 01702 address only  Lynnetta Loveland, 6785859 – linked to the 61 Lincoln Street Suite 203 Framingham, MA 01702 address only  Jonathan Schubert, 6249193 - linked to the 61 Lincoln Street Suite 203 Framingham, MA 01702 address only  Jennifer Ullrich, 6913357 - linked to the 61 Lincoln Street Suite 203 Framingham, MA 01702 address only', NULL, NULL, '2021-11-01 08:10:08', '2021-11-01 08:10:08'),
(19148, 1019, 21569, NULL, '2021-11-08 00:00:00.000', 'In Process', 'LOI was faxed again to Aetna at 1-859-455-8650', NULL, NULL, '2021-11-01 08:22:27', '2021-11-01 08:22:27'),
(19149, 1019, 21569, NULL, '2021-11-23 00:00:00.000', 'In Process', 'Received the following email from Laura Bevin.  Hello,  Hartman, Jessica – waiting to be linked to the group contract  Halterman, Helena – early in the credentialing process  Filoteo-Nichols, Dina – waiting to be linked to the group contract  Rodrigues, Eliza – early in the credentialing process  Hignite, Barbara – only service location is 61 Lincoln Street Suite 203 Framingham, MA 01702  Loveland, Lynnetta - only service location is 61 Lincoln Street Suite 203 Framingham, MA 01702  Schubert, Jonathan - only service location is 61 Lincoln Street Suite 203 Framingham, MA 01702  Ullrich, Jennifer - only service location is 61 Lincoln Street Suite 203 Framingham, MA 01702  Thank you     Laura Bevin  Credentialing Senior Analyst  Aetna Behavioral Health', NULL, NULL, '2021-11-16 09:16:45', '2021-11-16 09:16:45'),
(19150, 11056, 21569, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email sent to:  Laura.Bevin@aetna.com  Sub : Fwd: Enrollment Query || Providers || SNBCARE || Aetna  Hello,  Can you please get back to me with an update on the following providers credentialing? as I have submitted the applications for address addition as well.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Hartman, Jessica	1326665472	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Hartman, Jessica	1326665472	100 New State Highway, Raynham, MA, 02767. Halterman, Helena	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Halterman, Helena	1801473749	100 New State Highway, Raynham, MA, 02767. Filoteo-Nichols, Dina	1770021099	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Filoteo-Nichols, Dina	1770021099	100 New State Highway, Raynham, MA, 02767. Rodrigues, Eliza	1821751405	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Rodrigues, Eliza	1821751405	100 New State Highway, Raynham, MA, 02767. Hignite, Barbara	1982617262	100 New State Highway, Raynham, MA, 02767. Loveland, Lynnetta	1598163602	100 New State Highway, Raynham, MA, 02767. Schubert, Jonathan	1235755505	100 New State Highway, Raynham, MA, 02767. Ullrich, Jennifer	1710489760	100 New State Highway, Raynham, MA, 02767.  Regards', NULL, NULL, '2021-12-01 17:08:17', '2021-12-01 17:08:17'),
(19151, 19067, 21569, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||   Hello,  Hope this email finds you well.  I want to know the enrollment status for the following providers under mentioned locations.  If any Provider is enrolled provide us with their Effective date and Welcome letter.   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Powell, Lauren	1285304980	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Powell, Lauren	1285304980	100 New State Highway, Raynham, MA, 02767. DiCostanzo, Allie	1669045738	63 Eddie Dowling Highway, Suite 8, North Smithfield, RI, 02896. Dina, Filoteo-Nichols	1770021099	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Dina, Filoteo-Nichols	1770021099	100 New State Highway, Raynham, MA, 02767. Halterman, Helena	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Halterman, Helena	1801473749	100 New State Highway, Raynham, MA, 02767. Hartman, Jessica	1326665472	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Hartman, Jessica	1326665472	100 New State Highway, Raynham, MA, 02767. Hignite, Barbara	1982617262	100 New State Highway, Raynham, MA, 02767. Loveland, Lynnetta	1598163602	100 New State Highway, Raynham, MA, 02767. Rodrigues, Eliza	1821751405	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Rodrigues, Eliza	1821751405	100 New State Highway, Raynham, MA, 02767. Schubert, Jonathan	1235755505	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Schubert, Jonathan	1235755505	100 New State Highway, Raynham, MA, 02767. Ullrich, Jennifer	1710489760	100 New State Highway, Raynham, MA, 02767.  Kindly respond to me promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-15 17:13:51', '2021-12-15 17:13:51'),
(19152, 19067, 21569, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email received from: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||   Good morning,     Powell, Lauren waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     DiCostanzo, Allie waiting to be linked to the contract  63 Eddie Dowling Highway, Suite 8, North Smithfield, RI, 02896     Dina, Filoteo-Nichols waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     Halterman, Helena waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     Hartman, Jessica waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     Hignite, Barbara not linked to this address yet  100 New State Highway, Raynham, MA, 02767     Loveland, Lynnetta not linked to this address yet  100 New State Highway, Raynham, MA, 02767     Rodrigues, Eliza waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     Schubert, Jonathan  61 Lincoln Street, Suite 203, Framingham, MA, 01702 06/15/2021 effective date  100 New State Highway, Raynham, MA, 02767 not linked to this address yet     Ullrich, Jennifer not linked to this address yet  100 New State Highway, Raynham, MA, 02767     Thank you     Laura Bevin  Credentialing Senior Analyst  Aetna Behavioral Health', NULL, NULL, '2021-12-16 10:57:33', '2021-12-16 10:57:33'),
(19153, 19067, 21569, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Called Aetna at 800-353-1232 Spoke with Kristeen, she said they need a W9. Sent fax at 859-455-8650 with W9 attached. Ref# 6064843883.', NULL, NULL, '2021-12-16 12:12:22', '2021-12-16 12:12:22'),
(19154, 19067, 21569, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Called Aetna at 800-353-1232 Spoke with Kristeen, she said they need a W9. Sent fax at 859-455-8650 with W9 attached. Ref# 6064843883.', NULL, NULL, '2021-12-16 12:12:46', '2021-12-16 12:12:46'),
(19155, 19067, 21569, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||    Good Morning!  Hope you had a great weekend,  I would like to know the enrollment status for mentioned providers.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Jennifer Ullrich	1710489760	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jonathan Schubert	1235755505	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Lynnetta Loveland	1598163602	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Barbara Hignite	1982617262	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jessica Hartman	1326665472	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jessica Hartman	1326665472	61 Lincoln St., Suite 203, Framingham, MA 01702 Helena Halterman	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Helena Halterman	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702 Allie DiCostanzo	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Dina Filoteo-Nichols	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Dina Filoteo-Nichols	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702 Eliza Rodrigues	1821751405	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Eliza Rodrigues	1821751405	61 Lincoln St., Suite 203, Framingham, MA 01702 Lauren Powell	1285304980	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Lauren Powell	1285304980	61 Lincoln St., Suite 203, Framingham, MA 01702   Kindly respond promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-20 10:30:12', '2021-12-20 10:30:12'),
(19156, 19067, 21569, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email received from: Laura.Bevin@aetna.com   Subject: Enrollment Status || SNBCARE || Providers || Aetna ||   Hello,  Please see my below comments.  Thank you     Jennifer Ullrich - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – not linked to this address  Jonathan Schubert - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - not linked to this address  Lynnetta Loveland - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – 12/16/2021 effective date  Barbara Hignite - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - 12/16/2021 effective date  Jessica Hartman - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – waiting to be linked  Jessica Hartman - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Helena Halterman - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Helena Halterman - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Allie DiCostanzo - 63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 – 11/12/2021 effective date  Dina Filoteo-Nichols - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – waiting to be linked  Dina Filoteo-Nichols - 61 Lincoln St., Suite 203, Framingham, MA 01702 – waiting to be linked  Eliza Rodrigues -  100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Eliza Rodrigues - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Lauren Powell - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Lauren Powell - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked     Laura Bevin  Credentialing Senior Analyst  Aetna Behavioral Health', NULL, NULL, '2021-12-28 13:20:25', '2021-12-28 13:20:25'),
(19157, 19067, 21569, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||    Greetings Laura!  Any updates on the providers which were waiting to be linked?   Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 11:34:13', '2022-01-10 11:34:13'),
(19158, 19067, 21569, NULL, '2022-02-06 00:00:00.000', 'In Process', 'Email received from: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||    Hello,  There are no changes for the providers listed below.  Thank you', NULL, NULL, '2022-01-30 12:14:13', '2022-01-30 12:14:13'),
(19159, 1019, 21569, NULL, '2022-02-08 00:00:00.000', 'In Process', 'Hello Laura,  Did the providers get linked on which we were waiting, and if yes please provide me there effective dates     Thank You, Hammad.', NULL, NULL, '2022-02-01 12:20:06', '2022-02-01 12:20:06'),
(19160, 19067, 21569, NULL, '2022-02-17 00:00:00.000', 'In Process', 'Email received from: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||    Hello,  Jennifer Ullrich - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – not linked to this address  Jonathan Schubert - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - not linked to this address  Jessica Hartman - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – 02/15/2022 effective date  Jessica Hartman - 61 Lincoln St., Suite 203, Framingham, MA 01702 – 02/15/2022 effective date  Helena Halterman - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Helena Halterman - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Dina Filoteo-Nichols - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – 02/15/2022 effective date  Dina Filoteo-Nichols - 61 Lincoln St., Suite 203, Framingham, MA 01702 – 02/15/2022 effective date  Eliza Rodrigues -  100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Eliza Rodrigues - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Lauren Powell - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Lauren Powell - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Thank you', NULL, NULL, '2022-02-10 15:13:39', '2022-02-10 15:13:39'),
(19161, 19067, 21569, NULL, '2022-02-17 00:00:00.000', 'In Process', 'Email received from: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||    Hello,  Jennifer Ullrich - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – not linked to this address  Jonathan Schubert - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - not linked to this address  Jessica Hartman - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – 02/15/2022 effective date  Jessica Hartman - 61 Lincoln St., Suite 203, Framingham, MA 01702 – 02/15/2022 effective date  Helena Halterman - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Helena Halterman - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Dina Filoteo-Nichols - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – 02/15/2022 effective date  Dina Filoteo-Nichols - 61 Lincoln St., Suite 203, Framingham, MA 01702 – 02/15/2022 effective date  Eliza Rodrigues -  100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Eliza Rodrigues - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Lauren Powell - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Lauren Powell - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Thank you', NULL, NULL, '2022-02-10 15:13:50', '2022-02-10 15:13:50'),
(19162, 19067, 21569, NULL, '2022-03-14 00:00:00.000', 'In Process', 'Spoke with Glen V. She gave me the effective date as of 06/15/2021 for primary location. Have to sent a fax of W9 to Aetna for secondary location.   Ref# 6078362674', NULL, NULL, '2022-03-07 13:08:57', '2022-03-07 13:08:57'),
(19163, 19067, 21569, NULL, '2022-03-14 00:00:00.000', 'In Process', 'LOI has been faxed for location addition.', NULL, NULL, '2022-03-07 13:24:34', '2022-03-07 13:24:34'),
(19164, 19067, 21569, NULL, '2022-03-14 00:00:00.000', 'In Process', 'LOI has been faxed for location addition.', NULL, NULL, '2022-03-07 13:24:36', '2022-03-07 13:24:36'),
(19165, 22077, 21569, NULL, '2022-04-13 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: 	Re: [EXTERNAL] Re: Enrollment Status || SNBCARE || Providers || Aetna ||  Hello, I would like to know the enrollment process for the following provider   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Jessica Hartman	1326665472	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Jonathan Schubert	1235755505	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Ullrich Jennifer	1710489760	100 NEW STATE HWY RAYNHAM, MA 02767-5423  Thanks', NULL, NULL, '2022-04-06 10:58:12', '2022-04-06 10:58:12'),
(19166, 1006, 21570, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:26:10', '2021-03-16 10:26:10'),
(19167, 1019, 21570, NULL, '2021-04-29 00:00:00.000', 'Initiated', 'LOI was faxed to Aetna demographics update at (859) 455-8650 to Add New Location. see attachment for ref ', NULL, NULL, '2021-04-22 08:36:45', '2021-04-22 08:36:45'),
(19168, 1019, 21570, 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 10:38:06', '2021-05-03 10:38:06'),
(19169, 1019, 21570, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to Laura.Bevin@aetna.com SUB: Enrollment Query || Group & Providers || SNBCARE || Aetna  Hello, We need the enrollment application status for the following providers,   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Carlee Rozell 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Katie Tawakol 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jennifer Ullrich 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Justin Souliere 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Kerry Smith 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Fauzia Wali Khan 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Lynnetta Loveland 1598163602 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Peggy Pionke 1699307322 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Mahreen Rashid 1396393146 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Regards,', NULL, NULL, '2021-05-20 08:04:58', '2021-05-20 08:04:58'),
(19170, 1019, 21570, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Received the following email from Laura.Bevin@aetna.com  Good afternoon, Please see my below comments. Thank you  Mary Gibbons, 9080253 – application was not received NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman, 6715913 – credentialed for RI only, please submit an app for MA NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Carlee Rozell, 6712207 – 01/01/2021 effective date 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.       Jonathan Schubert, 6249193 – 06/15/2021 effective date 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.        Katie Tawakol, 6120037 – 01/01/2021 effective date 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767  Jennifer Ullrich, 6913357 – 05/01/2021 effective date 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767  Justin Souliere, 6893422 – 05/017/2021 effective date 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva, 4841425 – waiting to be linked 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.   Laura Bevin Credentialing Senior Analyst Aetna Behavioral Health', NULL, NULL, '2021-05-31 11:54:33', '2021-05-31 11:54:33'),
(19171, 1019, 21570, NULL, '2021-06-10 00:00:00.000', 'Approved', 'Received the following email from Laura.Bevin@aetna.com  Good afternoon,  Please see my comments below. Thank you Carlee Rozell, 6712207 – 01/01/2021 effective date 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      See attachment of Provider directory for reference and Plans', NULL, NULL, '2021-06-03 16:53:03', '2021-06-03 16:53:03'),
(19172, 1006, 21571, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:26:12', '2021-03-16 10:26:12'),
(19173, 1019, 21571, NULL, '2021-04-29 00:00:00.000', 'Initiated', 'LOI was faxed to Aetna demographics update at (859) 455-8650 to Add New Location. see attachment for ref ', NULL, NULL, '2021-04-22 08:27:57', '2021-04-22 08:27:57'),
(19174, 1019, 21571, 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 10:37:48', '2021-05-03 10:37:48'),
(19175, 1019, 21571, 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 08:06:04', '2021-05-20 08:06:04'),
(19176, 1019, 21571, 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 13:16:15', '2021-05-31 13:16:15'),
(19177, 1019, 21571, 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 07:56:58', '2021-06-16 07:56:58'),
(19178, 1019, 21571, NULL, '2021-07-15 00:00:00.000', 'Approved', '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, '2021-07-08 10:05:22', '2021-07-08 10:05:22'),
(19179, 1006, 21572, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:26:14', '2021-03-16 10:26:14'),
(19180, 1019, 21572, NULL, '2021-04-29 00:00:00.000', 'Initiated', 'LOI was faxed to Aetna demographics update at (859) 455-8650 to Add New Location. see attachment for ref ', NULL, NULL, '2021-04-22 08:30:28', '2021-04-22 08:30:28');
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
(19181, 1019, 21572, 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 10:32:30', '2021-05-03 10:32:30'),
(19182, 1019, 21572, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Sent the following email to Laura.Bevin@aetna.com SUB: Enrollment Query || Group & Providers || SNBCARE || Aetna  Hello, We need the enrollment application status for the following providers,   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Carlee Rozell 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Katie Tawakol 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jennifer Ullrich 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Justin Souliere 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Kerry Smith 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Fauzia Wali Khan 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Lynnetta Loveland 1598163602 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Peggy Pionke 1699307322 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Mahreen Rashid 1396393146 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Regards,', NULL, NULL, '2021-05-20 08:05:40', '2021-05-20 08:05:40'),
(19183, 1019, 21572, 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 13:15:25', '2021-05-31 13:15:25'),
(19184, 1019, 21572, 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 07:56:52', '2021-06-16 07:56:52'),
(19185, 1019, 21572, NULL, '2021-07-15 00:00:00.000', 'Approved', '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, '2021-07-08 09:56:43', '2021-07-08 09:56:43'),
(19186, 1006, 21573, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:26:15', '2021-03-16 10:26:15'),
(19187, 1019, 21573, NULL, '2021-04-29 00:00:00.000', 'Initiated', 'LOI was faxed to Aetna demographics update at (859) 455-8650 to Add New Location. see attachment for ref ', NULL, NULL, '2021-04-22 08:37:43', '2021-04-22 08:37:43'),
(19188, 1019, 21573, 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 10:32:08', '2021-05-03 10:32:08'),
(19189, 1019, 21573, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Sent the following email to Laura.Bevin@aetna.com SUB: Enrollment Query || Group & Providers || SNBCARE || Aetna  Hello, We need the enrollment application status for the following providers,   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Carlee Rozell 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Katie Tawakol 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jennifer Ullrich 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Justin Souliere 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Kerry Smith 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Fauzia Wali Khan 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Lynnetta Loveland 1598163602 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Peggy Pionke 1699307322 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Mahreen Rashid 1396393146 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Regards,', NULL, NULL, '2021-05-20 08:04:44', '2021-05-20 08:04:44'),
(19190, 1019, 21573, 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 13:15:04', '2021-05-31 13:15:04'),
(19191, 1019, 21573, 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 07:56:45', '2021-06-16 07:56:45'),
(19192, 1019, 21573, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent the following email to Laura.Bevin@aetna.com  Hello, We need the enrollment application status for the following providers,   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Providers:  Barbara Hignite NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson  NPI: 1124622667  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Jessica Hartman  NPI: 1326665472  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Lynnetta Loveland  NPI: 1598163602  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Cemetrice Muhammed NPI: 1548843410  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Jonathan Schubert  NPI: 1235755505   Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Kerry Smith  NPI: 1275083230  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jennifer Ullrich  NPI: 1710489760  Secondary Location: 100 New State Highway, Raynham, MA, 02767      Regards, Alex G.', NULL, NULL, '2021-08-24 11:11:53', '2021-08-24 11:11:53'),
(19193, 1019, 21573, NULL, '2021-11-08 00:00:00.000', 'In Process', 'Received the following email from Laura Bevin.  Good afternoon,  Allie DiCostanzo, 6792883 – in the credentialing process  Dina Filoteo-Nichols, 6184053 – in the credentialing process  Helena Halterman – application was not received  Jessica Hartman, 6751913 – linked to the 63 Eddie Dowling Hwy Suite 9 N Smithfield, RI 02896 only, application was not received for MA  Barbara Hignite, 6369000 – linked to the 61 Lincoln Street Suite 203 Framingham, MA 01702 address only  Lynnetta Loveland, 6785859 – linked to the 61 Lincoln Street Suite 203 Framingham, MA 01702 address only  Jonathan Schubert, 6249193 - linked to the 61 Lincoln Street Suite 203 Framingham, MA 01702 address only  Jennifer Ullrich, 6913357 - linked to the 61 Lincoln Street Suite 203 Framingham, MA 01702 address only', NULL, NULL, '2021-11-01 08:09:52', '2021-11-01 08:09:52'),
(19194, 1019, 21573, NULL, '2021-11-08 00:00:00.000', 'In Process', 'LOI was faxed again to Aetna at 1-859-455-8650', NULL, NULL, '2021-11-01 08:24:22', '2021-11-01 08:24:22'),
(19195, 1019, 21573, NULL, '2021-11-23 00:00:00.000', 'In Process', 'Received the following email from Laura Bevin.  Hello,  Hartman, Jessica – waiting to be linked to the group contract  Halterman, Helena – early in the credentialing process  Filoteo-Nichols, Dina – waiting to be linked to the group contract  Rodrigues, Eliza – early in the credentialing process  Hignite, Barbara – only service location is 61 Lincoln Street Suite 203 Framingham, MA 01702  Loveland, Lynnetta - only service location is 61 Lincoln Street Suite 203 Framingham, MA 01702  Schubert, Jonathan - only service location is 61 Lincoln Street Suite 203 Framingham, MA 01702  Ullrich, Jennifer - only service location is 61 Lincoln Street Suite 203 Framingham, MA 01702  Thank you     Laura Bevin  Credentialing Senior Analyst  Aetna Behavioral Health', NULL, NULL, '2021-11-16 09:16:32', '2021-11-16 09:16:32'),
(19196, 11056, 21573, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email sent to:  Laura.Bevin@aetna.com  Sub : Fwd: Enrollment Query || Providers || SNBCARE || Aetna  Hello,  Can you please get back to me with an update on the following providers credentialing? as I have submitted the applications for address addition as well.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Hartman, Jessica	1326665472	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Hartman, Jessica	1326665472	100 New State Highway, Raynham, MA, 02767. Halterman, Helena	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Halterman, Helena	1801473749	100 New State Highway, Raynham, MA, 02767. Filoteo-Nichols, Dina	1770021099	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Filoteo-Nichols, Dina	1770021099	100 New State Highway, Raynham, MA, 02767. Rodrigues, Eliza	1821751405	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Rodrigues, Eliza	1821751405	100 New State Highway, Raynham, MA, 02767. Hignite, Barbara	1982617262	100 New State Highway, Raynham, MA, 02767. Loveland, Lynnetta	1598163602	100 New State Highway, Raynham, MA, 02767. Schubert, Jonathan	1235755505	100 New State Highway, Raynham, MA, 02767. Ullrich, Jennifer	1710489760	100 New State Highway, Raynham, MA, 02767.  Regards', NULL, NULL, '2021-12-01 17:08:06', '2021-12-01 17:08:06'),
(19197, 19067, 21573, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||   Hello,  Hope this email finds you well.  I want to know the enrollment status for the following providers under mentioned locations.  If any Provider is enrolled provide us with their Effective date and Welcome letter.   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Powell, Lauren	1285304980	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Powell, Lauren	1285304980	100 New State Highway, Raynham, MA, 02767. DiCostanzo, Allie	1669045738	63 Eddie Dowling Highway, Suite 8, North Smithfield, RI, 02896. Dina, Filoteo-Nichols	1770021099	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Dina, Filoteo-Nichols	1770021099	100 New State Highway, Raynham, MA, 02767. Halterman, Helena	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Halterman, Helena	1801473749	100 New State Highway, Raynham, MA, 02767. Hartman, Jessica	1326665472	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Hartman, Jessica	1326665472	100 New State Highway, Raynham, MA, 02767. Hignite, Barbara	1982617262	100 New State Highway, Raynham, MA, 02767. Loveland, Lynnetta	1598163602	100 New State Highway, Raynham, MA, 02767. Rodrigues, Eliza	1821751405	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Rodrigues, Eliza	1821751405	100 New State Highway, Raynham, MA, 02767. Schubert, Jonathan	1235755505	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Schubert, Jonathan	1235755505	100 New State Highway, Raynham, MA, 02767. Ullrich, Jennifer	1710489760	100 New State Highway, Raynham, MA, 02767.  Kindly respond to me promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-15 17:13:32', '2021-12-15 17:13:32'),
(19198, 19067, 21573, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email received from: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||   Good morning,     Powell, Lauren waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     DiCostanzo, Allie waiting to be linked to the contract  63 Eddie Dowling Highway, Suite 8, North Smithfield, RI, 02896     Dina, Filoteo-Nichols waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     Halterman, Helena waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     Hartman, Jessica waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     Hignite, Barbara not linked to this address yet  100 New State Highway, Raynham, MA, 02767     Loveland, Lynnetta not linked to this address yet  100 New State Highway, Raynham, MA, 02767     Rodrigues, Eliza waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     Schubert, Jonathan  61 Lincoln Street, Suite 203, Framingham, MA, 01702 06/15/2021 effective date  100 New State Highway, Raynham, MA, 02767 not linked to this address yet     Ullrich, Jennifer not linked to this address yet  100 New State Highway, Raynham, MA, 02767     Thank you     Laura Bevin  Credentialing Senior Analyst  Aetna Behavioral Health', NULL, NULL, '2021-12-16 10:57:15', '2021-12-16 10:57:15'),
(19199, 19067, 21573, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Called Aetna at 800-353-1232 Spoke with Kristeen, she said they need a W9. Sent fax at 859-455-8650 with W9 attached. Ref# 6064843883.', NULL, NULL, '2021-12-16 12:11:49', '2021-12-16 12:11:49'),
(19200, 19067, 21573, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||    Good Morning!  Hope you had a great weekend,  I would like to know the enrollment status for mentioned providers.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Jennifer Ullrich	1710489760	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jonathan Schubert	1235755505	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Lynnetta Loveland	1598163602	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Barbara Hignite	1982617262	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jessica Hartman	1326665472	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jessica Hartman	1326665472	61 Lincoln St., Suite 203, Framingham, MA 01702 Helena Halterman	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Helena Halterman	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702 Allie DiCostanzo	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Dina Filoteo-Nichols	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Dina Filoteo-Nichols	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702 Eliza Rodrigues	1821751405	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Eliza Rodrigues	1821751405	61 Lincoln St., Suite 203, Framingham, MA 01702 Lauren Powell	1285304980	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Lauren Powell	1285304980	61 Lincoln St., Suite 203, Framingham, MA 01702   Kindly respond promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-20 10:30:17', '2021-12-20 10:30:17'),
(19201, 19067, 21573, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email received from: Laura.Bevin@aetna.com   Subject: Enrollment Status || SNBCARE || Providers || Aetna ||   Hello,  Please see my below comments.  Thank you     Jennifer Ullrich - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – not linked to this address  Jonathan Schubert - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - not linked to this address  Lynnetta Loveland - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – 12/16/2021 effective date  Barbara Hignite - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - 12/16/2021 effective date  Jessica Hartman - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – waiting to be linked  Jessica Hartman - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Helena Halterman - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Helena Halterman - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Allie DiCostanzo - 63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 – 11/12/2021 effective date  Dina Filoteo-Nichols - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – waiting to be linked  Dina Filoteo-Nichols - 61 Lincoln St., Suite 203, Framingham, MA 01702 – waiting to be linked  Eliza Rodrigues -  100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Eliza Rodrigues - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Lauren Powell - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Lauren Powell - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked     Laura Bevin  Credentialing Senior Analyst  Aetna Behavioral Health', NULL, NULL, '2021-12-28 13:20:35', '2021-12-28 13:20:35'),
(19202, 19067, 21573, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||    Greetings Laura!  Any updates on the providers which were waiting to be linked?   Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 11:34:04', '2022-01-10 11:34:04'),
(19203, 19067, 21573, NULL, '2022-01-20 00:00:00.000', 'Approved', 'See Attachment for Aetna\'s Provider Directory.', NULL, NULL, '2022-01-13 16:17:03', '2022-01-13 16:17:03'),
(19204, 1006, 21574, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:26:17', '2021-03-16 10:26:17'),
(19205, 1019, 21574, NULL, '2021-04-29 00:00:00.000', 'Initiated', 'LOI was faxed to Aetna demographics update at (859) 455-8650 to Add New Location. see attachment for ref ', NULL, NULL, '2021-04-22 08:29:51', '2021-04-22 08:29:51'),
(19206, 1019, 21574, 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 10:31:48', '2021-05-03 10:31:48'),
(19207, 1019, 21574, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Sent the following email to Laura.Bevin@aetna.com SUB: Enrollment Query || Group & Providers || SNBCARE || Aetna  Hello, We need the enrollment application status for the following providers,   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Carlee Rozell 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Katie Tawakol 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jennifer Ullrich 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Justin Souliere 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Kerry Smith 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Fauzia Wali Khan 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Lynnetta Loveland 1598163602 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Peggy Pionke 1699307322 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Mahreen Rashid 1396393146 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Regards,', NULL, NULL, '2021-05-20 08:06:14', '2021-05-20 08:06:14'),
(19208, 1019, 21574, 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 13:12:21', '2021-05-31 13:12:21'),
(19209, 1019, 21574, 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 07:56:38', '2021-06-16 07:56:38'),
(19210, 1019, 21574, NULL, '2021-07-15 00:00:00.000', 'Approved', '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, '2021-07-08 10:03:37', '2021-07-08 10:03:37'),
(19211, 1006, 21575, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:26:18', '2021-03-16 10:26:18'),
(19212, 1019, 21575, NULL, '2021-04-29 00:00:00.000', 'Initiated', 'LOI was faxed to Aetna demographics update at (859) 455-8650 to Add New Location. see attachment for ref ', NULL, NULL, '2021-04-22 08:36:18', '2021-04-22 08:36:18'),
(19213, 1019, 21575, 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 10:31:24', '2021-05-03 10:31:24');
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
(19214, 1019, 21575, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Sent the following email to Laura.Bevin@aetna.com SUB: Enrollment Query || Group & Providers || SNBCARE || Aetna  Hello, We need the enrollment application status for the following providers,   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Carlee Rozell 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Katie Tawakol 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jennifer Ullrich 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Justin Souliere 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Kerry Smith 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Fauzia Wali Khan 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Lynnetta Loveland 1598163602 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Peggy Pionke 1699307322 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Mahreen Rashid 1396393146 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Regards,', NULL, NULL, '2021-05-20 08:03:01', '2021-05-20 08:03:01'),
(19215, 1019, 21575, 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 13:08:26', '2021-05-31 13:08:26'),
(19216, 1019, 21575, 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 07:56:31', '2021-06-16 07:56:31'),
(19217, 1019, 21575, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent the following email to Laura.Bevin@aetna.com  Hello, We need the enrollment application status for the following providers,   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Providers:  Barbara Hignite NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson  NPI: 1124622667  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Jessica Hartman  NPI: 1326665472  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Lynnetta Loveland  NPI: 1598163602  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Cemetrice Muhammed NPI: 1548843410  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Jonathan Schubert  NPI: 1235755505   Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Kerry Smith  NPI: 1275083230  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jennifer Ullrich  NPI: 1710489760  Secondary Location: 100 New State Highway, Raynham, MA, 02767      Regards, Alex G.', NULL, NULL, '2021-08-24 11:11:26', '2021-08-24 11:11:26'),
(19218, 1019, 21575, NULL, '2021-11-08 00:00:00.000', 'In Process', 'Received the following email from Laura Bevin.  Good afternoon,  Allie DiCostanzo, 6792883 – in the credentialing process  Dina Filoteo-Nichols, 6184053 – in the credentialing process  Helena Halterman – application was not received  Jessica Hartman, 6751913 – linked to the 63 Eddie Dowling Hwy Suite 9 N Smithfield, RI 02896 only, application was not received for MA  Barbara Hignite, 6369000 – linked to the 61 Lincoln Street Suite 203 Framingham, MA 01702 address only  Lynnetta Loveland, 6785859 – linked to the 61 Lincoln Street Suite 203 Framingham, MA 01702 address only  Jonathan Schubert, 6249193 - linked to the 61 Lincoln Street Suite 203 Framingham, MA 01702 address only  Jennifer Ullrich, 6913357 - linked to the 61 Lincoln Street Suite 203 Framingham, MA 01702 address only', NULL, NULL, '2021-11-01 08:09:35', '2021-11-01 08:09:35'),
(19219, 1019, 21575, NULL, '2021-11-08 00:00:00.000', 'Initiated', 'LOI was faxed again to Aetna at 1-859-455-8650', NULL, NULL, '2021-11-01 08:23:05', '2021-11-01 08:23:05'),
(19220, 1019, 21575, NULL, '2021-11-08 00:00:00.000', 'In Process', 'LOI was faxed again to Aetna at 1-859-455-8650', NULL, NULL, '2021-11-01 08:23:55', '2021-11-01 08:23:55'),
(19221, 1019, 21575, NULL, '2021-11-23 00:00:00.000', 'In Process', 'Received the following email from Laura Bevin.  Hello,  Hartman, Jessica – waiting to be linked to the group contract  Halterman, Helena – early in the credentialing process  Filoteo-Nichols, Dina – waiting to be linked to the group contract  Rodrigues, Eliza – early in the credentialing process  Hignite, Barbara – only service location is 61 Lincoln Street Suite 203 Framingham, MA 01702  Loveland, Lynnetta - only service location is 61 Lincoln Street Suite 203 Framingham, MA 01702  Schubert, Jonathan - only service location is 61 Lincoln Street Suite 203 Framingham, MA 01702  Ullrich, Jennifer - only service location is 61 Lincoln Street Suite 203 Framingham, MA 01702  Thank you     Laura Bevin  Credentialing Senior Analyst  Aetna Behavioral Health', NULL, NULL, '2021-11-16 09:16:17', '2021-11-16 09:16:17'),
(19222, 11056, 21575, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email sent to:  Laura.Bevin@aetna.com  Sub : Fwd: Enrollment Query || Providers || SNBCARE || Aetna  Hello,  Can you please get back to me with an update on the following providers credentialing? as I have submitted the applications for address addition as well.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Hartman, Jessica	1326665472	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Hartman, Jessica	1326665472	100 New State Highway, Raynham, MA, 02767. Halterman, Helena	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Halterman, Helena	1801473749	100 New State Highway, Raynham, MA, 02767. Filoteo-Nichols, Dina	1770021099	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Filoteo-Nichols, Dina	1770021099	100 New State Highway, Raynham, MA, 02767. Rodrigues, Eliza	1821751405	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Rodrigues, Eliza	1821751405	100 New State Highway, Raynham, MA, 02767. Hignite, Barbara	1982617262	100 New State Highway, Raynham, MA, 02767. Loveland, Lynnetta	1598163602	100 New State Highway, Raynham, MA, 02767. Schubert, Jonathan	1235755505	100 New State Highway, Raynham, MA, 02767. Ullrich, Jennifer	1710489760	100 New State Highway, Raynham, MA, 02767.  Regards', NULL, NULL, '2021-12-01 17:07:54', '2021-12-01 17:07:54'),
(19223, 19067, 21575, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||   Hello,  Hope this email finds you well.  I want to know the enrollment status for the following providers under mentioned locations.  If any Provider is enrolled provide us with their Effective date and Welcome letter.   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Powell, Lauren	1285304980	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Powell, Lauren	1285304980	100 New State Highway, Raynham, MA, 02767. DiCostanzo, Allie	1669045738	63 Eddie Dowling Highway, Suite 8, North Smithfield, RI, 02896. Dina, Filoteo-Nichols	1770021099	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Dina, Filoteo-Nichols	1770021099	100 New State Highway, Raynham, MA, 02767. Halterman, Helena	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Halterman, Helena	1801473749	100 New State Highway, Raynham, MA, 02767. Hartman, Jessica	1326665472	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Hartman, Jessica	1326665472	100 New State Highway, Raynham, MA, 02767. Hignite, Barbara	1982617262	100 New State Highway, Raynham, MA, 02767. Loveland, Lynnetta	1598163602	100 New State Highway, Raynham, MA, 02767. Rodrigues, Eliza	1821751405	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Rodrigues, Eliza	1821751405	100 New State Highway, Raynham, MA, 02767. Schubert, Jonathan	1235755505	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Schubert, Jonathan	1235755505	100 New State Highway, Raynham, MA, 02767. Ullrich, Jennifer	1710489760	100 New State Highway, Raynham, MA, 02767.  Kindly respond to me promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-15 17:13:26', '2021-12-15 17:13:26'),
(19224, 19067, 21575, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email received from: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||   Good morning,     Powell, Lauren waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     DiCostanzo, Allie waiting to be linked to the contract  63 Eddie Dowling Highway, Suite 8, North Smithfield, RI, 02896     Dina, Filoteo-Nichols waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     Halterman, Helena waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     Hartman, Jessica waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     Hignite, Barbara not linked to this address yet  100 New State Highway, Raynham, MA, 02767     Loveland, Lynnetta not linked to this address yet  100 New State Highway, Raynham, MA, 02767     Rodrigues, Eliza waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     Schubert, Jonathan  61 Lincoln Street, Suite 203, Framingham, MA, 01702 06/15/2021 effective date  100 New State Highway, Raynham, MA, 02767 not linked to this address yet     Ullrich, Jennifer not linked to this address yet  100 New State Highway, Raynham, MA, 02767     Thank you     Laura Bevin  Credentialing Senior Analyst  Aetna Behavioral Health', NULL, NULL, '2021-12-16 10:56:43', '2021-12-16 10:56:43'),
(19225, 19067, 21575, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Called Aetna at 800-353-1232 Spoke with Kristeen, she said they need a W9. Sent fax at 859-455-8650 with W9 attached. Ref# 6064843883.', NULL, NULL, '2021-12-16 12:11:08', '2021-12-16 12:11:08'),
(19226, 19067, 21575, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Called Aetna at 800-353-1232 Spoke with Kristeen, she said they need a W9. Sent fax at 859-455-8650 with W9 attached. Ref# 6064843883.', NULL, NULL, '2021-12-16 12:11:16', '2021-12-16 12:11:16'),
(19227, 19067, 21575, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||    Good Morning!  Hope you had a great weekend,  I would like to know the enrollment status for mentioned providers.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Jennifer Ullrich	1710489760	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jonathan Schubert	1235755505	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Lynnetta Loveland	1598163602	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Barbara Hignite	1982617262	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jessica Hartman	1326665472	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jessica Hartman	1326665472	61 Lincoln St., Suite 203, Framingham, MA 01702 Helena Halterman	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Helena Halterman	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702 Allie DiCostanzo	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Dina Filoteo-Nichols	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Dina Filoteo-Nichols	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702 Eliza Rodrigues	1821751405	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Eliza Rodrigues	1821751405	61 Lincoln St., Suite 203, Framingham, MA 01702 Lauren Powell	1285304980	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Lauren Powell	1285304980	61 Lincoln St., Suite 203, Framingham, MA 01702   Kindly respond promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-20 10:30:22', '2021-12-20 10:30:22'),
(19228, 19067, 21575, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email received from: Laura.Bevin@aetna.com   Subject: Enrollment Status || SNBCARE || Providers || Aetna ||   Hello,  Please see my below comments.  Thank you     Jennifer Ullrich - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – not linked to this address  Jonathan Schubert - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - not linked to this address  Lynnetta Loveland - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – 12/16/2021 effective date  Barbara Hignite - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - 12/16/2021 effective date  Jessica Hartman - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – waiting to be linked  Jessica Hartman - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Helena Halterman - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Helena Halterman - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Allie DiCostanzo - 63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 – 11/12/2021 effective date  Dina Filoteo-Nichols - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – waiting to be linked  Dina Filoteo-Nichols - 61 Lincoln St., Suite 203, Framingham, MA 01702 – waiting to be linked  Eliza Rodrigues -  100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Eliza Rodrigues - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Lauren Powell - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Lauren Powell - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked     Laura Bevin  Credentialing Senior Analyst  Aetna Behavioral Health', NULL, NULL, '2021-12-28 13:20:40', '2021-12-28 13:20:40'),
(19229, 19067, 21575, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||    Greetings Laura!  Any updates on the providers which were waiting to be linked?   Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 11:33:58', '2022-01-10 11:33:58'),
(19230, 19067, 21575, NULL, '2022-01-31 00:00:00.000', 'Approved', 'See attachment for provider directory as a reference.', NULL, NULL, '2022-01-24 17:09:33', '2022-01-24 17:09:33'),
(19231, 1006, 21576, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:26:21', '2021-03-16 10:26:21'),
(19232, 1019, 21576, NULL, '2021-04-29 00:00:00.000', 'Initiated', 'LOI was faxed to Aetna demographics update at (859) 455-8650 to Add New Location. see attachment for ref ', NULL, NULL, '2021-04-22 08:28:49', '2021-04-22 08:28:49'),
(19233, 1019, 21576, 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 10:30:54', '2021-05-03 10:30:54'),
(19234, 1019, 21576, 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 08:06:31', '2021-05-20 08:06:31'),
(19235, 1019, 21576, 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 13:11:38', '2021-05-31 13:11:38'),
(19236, 1019, 21576, NULL, '2021-06-10 00:00:00.000', 'Approved', 'Received the following email from Laura.Bevin@aetna.com  Good afternoon,  Please see my comments below. Thank you Prisca Hefti, 6846902 – 06/01/2021 effective date 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      See attachment of Provider directory for reference and Plans', NULL, NULL, '2021-06-03 16:51:12', '2021-06-03 16:51:12'),
(19237, 1006, 21577, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:26:23', '2021-03-16 10:26:23'),
(19238, 1019, 21577, NULL, '2021-04-29 00:00:00.000', 'Initiated', 'LOI was faxed to Aetna demographics update at (859) 455-8650 to Add New Location. see attachment for ref ', NULL, NULL, '2021-04-22 08:33:50', '2021-04-22 08:33:50'),
(19239, 1019, 21577, 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 10:30:13', '2021-05-03 10:30:13'),
(19240, 1019, 21577, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Sent the following email to Laura.Bevin@aetna.com SUB: Enrollment Query || Group & Providers || SNBCARE || Aetna  Hello, We need the enrollment application status for the following providers,   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Carlee Rozell 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Katie Tawakol 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jennifer Ullrich 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Justin Souliere 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Kerry Smith 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Fauzia Wali Khan 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Lynnetta Loveland 1598163602 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Peggy Pionke 1699307322 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Mahreen Rashid 1396393146 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Regards,', NULL, NULL, '2021-05-20 08:03:23', '2021-05-20 08:03:23'),
(19241, 1019, 21577, 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 13:07:38', '2021-05-31 13:07:38'),
(19242, 1019, 21577, 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 07:56:24', '2021-06-16 07:56:24'),
(19243, 1019, 21577, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent the following email to Laura.Bevin@aetna.com  Hello, We need the enrollment application status for the following providers,   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Providers:  Barbara Hignite NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson  NPI: 1124622667  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Jessica Hartman  NPI: 1326665472  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Lynnetta Loveland  NPI: 1598163602  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Cemetrice Muhammed NPI: 1548843410  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Jonathan Schubert  NPI: 1235755505   Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Kerry Smith  NPI: 1275083230  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jennifer Ullrich  NPI: 1710489760  Secondary Location: 100 New State Highway, Raynham, MA, 02767      Regards, Alex G.', NULL, NULL, '2021-08-24 11:10:30', '2021-08-24 11:10:30'),
(19244, 1019, 21577, NULL, '2021-11-01 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCare.', NULL, NULL, '2021-10-25 10:42:11', '2021-10-25 10:42:11'),
(19245, 3040, 21578, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:26:31', '2021-03-16 10:26:31'),
(19246, 3040, 21578, NULL, '2021-06-07 00:00:00.000', 'Approved', 'URGENT CARE CONTRACT-LPMC -------------------  Herrera, Jose L Jose.Herrera@bswhealth.org Tue, Nov 17, 8:55 AM (2 days ago) to Martin, me, SWHP  Sherry,  Your TAX ID was contracted as a facility only contract.  We did not credential or load any providers under this contract    We would not have been given any providers to credential or load in our systems under a facility contract.   Thank you,   Jose Herrera  Provider Relations Representative  FirstCare Health Plans—part of Baylor Scott & White Health  1901 W. Loop 289, Suite 9 | Lubbock, TX 79407  806-784-4306 Office | 806-784-4396 Fax  FirstCare.com', NULL, NULL, '2021-05-31 14:20:32', '2021-05-31 14:20:32'),
(19247, 3040, 21579, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:26:59', '2021-03-16 10:26:59'),
(19248, 3040, 21579, NULL, '2021-06-07 00:00:00.000', 'Approved', 'URGENT CARE CONTRACT-LPMC -------------------  Herrera, Jose L Jose.Herrera@bswhealth.org Tue, Nov 17, 8:55 AM (2 days ago) to Martin, me, SWHP  Sherry,  Your TAX ID was contracted as a facility only contract.  We did not credential or load any providers under this contract    We would not have been given any providers to credential or load in our systems under a facility contract.   Thank you,   Jose Herrera  Provider Relations Representative  FirstCare Health Plans—part of Baylor Scott & White Health  1901 W. Loop 289, Suite 9 | Lubbock, TX 79407  806-784-4306 Office | 806-784-4396 Fax  FirstCare.com', NULL, NULL, '2021-05-31 14:20:36', '2021-05-31 14:20:36'),
(19249, 3040, 21580, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:27:26', '2021-03-16 10:27:26'),
(19250, 3040, 21580, NULL, '2021-06-07 00:00:00.000', 'Approved', 'URGENT CARE CONTRACT-LPMC -------------------  Herrera, Jose L Jose.Herrera@bswhealth.org Tue, Nov 17, 8:55 AM (2 days ago) to Martin, me, SWHP  Sherry,  Your TAX ID was contracted as a facility only contract.  We did not credential or load any providers under this contract    We would not have been given any providers to credential or load in our systems under a facility contract.   Thank you,   Jose Herrera  Provider Relations Representative  FirstCare Health Plans—part of Baylor Scott & White Health  1901 W. Loop 289, Suite 9 | Lubbock, TX 79407  806-784-4306 Office | 806-784-4396 Fax  FirstCare.com', NULL, NULL, '2021-05-31 14:20:40', '2021-05-31 14:20:40'),
(19251, 1006, 21581, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:27:43', '2021-03-16 10:27:43'),
(19252, 1019, 21581, NULL, '2021-04-12 00:00:00.000', 'Initiated', 'CAQH Application faxed to Network Operations at (866) 612-7790. ', NULL, NULL, '2021-04-05 09:17:42', '2021-04-05 09:17:42'),
(19253, 1019, 21581, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Sent the following email to : provider.relations@beaconhealthoptions.com SUB: Enrollment Status || Providers || SNBCARE || Beacon   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 NPI:  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Barbara Hignite NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 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.    Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Jessica Hartman NPI: 1326665472 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile NPI: 1942687108  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-04-14 07:06:46', '2021-04-14 07:06:46'),
(19254, 1019, 21581, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Received the following email from Sarah: provider.relations@beaconhealthoptions.com Good Morning, I have reviewed each provider file and have left notes below in red. Rodesia Edmundson – Application received 4/6/21 and still processing – Event 9091975 NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Barbara Hignite – Application received 4/6/21 and still processing – Event 9091459 NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell – Application received 4/7/21 and still processing – Event 9093081 NPI: 1225645393 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich – Application received 4/5/21 and still processing – Event 9091316 NPI: 1710489760 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Justin Souliere – Application received 4/7/21 and still processing – Event 1098601 NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Jessica Hartman – CAQH Application needed – please complete attached application and return for processing NPI: 1326665472 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva – Application received 4/7/21 and still processing – Event 9093128 NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile – Application received 4/7/21 and still processing – Event 9093091 NPI: 1942687108  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Thank You!     Sarah Oakes  Network Management Rep I, Northeast  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive Suite 401  Woburn, MA 01801  Office: 800.397.1630  Direct: 781-496-4024  www.beaconhealthoptions.com', NULL, NULL, '2021-04-14 08:09:39', '2021-04-14 08:09:39'),
(19255, 1019, 21581, NULL, '2021-04-29 00:00:00.000', 'In Process', 'Called Beacon @ (800) 397-1630 spoke with rep Sierra conversation is mentioned below:  All providers applications have been received and are under review and group is added under all three locations under both plans (BHO/BHS) we have request the copy of group contract. we\'ll receive the contract in 3-2 business days.  Ref# 04/22/2021 - 1371173 Sierra Y', NULL, NULL, '2021-04-22 15:53:11', '2021-04-22 15:53:11'),
(19256, 1019, 21581, 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 12:45:36', '2021-05-03 12:45:36');
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
(19257, 1019, 21581, 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 08:37:53', '2021-05-20 08:37:53'),
(19258, 1019, 21581, 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 11:18:21', '2021-06-05 11:18:21'),
(19259, 1019, 21581, 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. Need some time. Thank you for your patience.   Thank you! Shashi Seth Network Management Rep I, Northeast Provider Relations', NULL, NULL, '2021-06-24 08:02:48', '2021-06-24 08:02:48'),
(19260, 1019, 21581, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com  Hello, Can you please let me know about the enrollment status for the following providers under our group.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual NPI:  Rodesia Edmundson NPI: 1124622667 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.  Prisca Hefti NPI: 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Barbara Hignite NPI: 1982617262 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.   Lynetta Loveland NPI: 1598163602  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Cemetrice Muhammed NPI: 1548843410  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Regards,  Alex', NULL, NULL, '2021-08-24 11:26:07', '2021-08-24 11:26:07'),
(19261, 1019, 21581, NULL, '2021-09-02 00:00:00.000', 'Approved', 'Location added effective date 05/04/2021, see attached for ref', NULL, NULL, '2021-08-26 14:05:17', '2021-08-26 14:05:17'),
(19262, 1006, 21582, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:27:44', '2021-03-16 10:27:44'),
(19263, 1019, 21582, NULL, '2021-04-21 00:00:00.000', 'Initiated', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: RE: Enrollment Status || Providers || SNBCARE || Beacon attn RI  Hello Sarah, We have to add a new location for our group, and also providers as well, please let us know the process to add our group and providers under our new location.   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 New Location: 100 New State Highway, Raynham, MA, 02767.   Individual Providers :   Fauzia Wali Khan NPI:1699761965 New Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 New Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 New Location: 100 New State Highway, Raynham, MA, 02767.   Mahreen Rashid NPI:1396393146 New Location: 100 New State Highway, Raynham, MA, 02767.   Peggy Pionke NPI: 1699307322 New Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 New Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182 New Location: 100 New State Highway, Raynham, MA, 02767.   Regards, Alex', NULL, NULL, '2021-04-14 08:38:35', '2021-04-14 08:38:35'),
(19264, 1019, 21582, NULL, '2021-04-21 00:00:00.000', 'Initiated', 'Sent the following email to Shashi: provider.relations@beaconhealthoptions.com  Hello Shashi,   Attached are forms for Location addition for the group and individuals providers under that group. Let me know the timeframe for this request to be completed.     Regards, Alex', NULL, NULL, '2021-04-14 13:11:31', '2021-04-14 13:11:31'),
(19265, 3040, 21582, NULL, '2021-04-26 00:00:00.000', 'In Process', 'Email sent to: mu@claimsmedinc.com, provider.relations@beaconhealthoptions.com  Subject: Enrollment Status || Providers || SNBCARE || Beacon attn RI  Hello Shashi,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers.   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 New Location: 100 New State Highway, Raynham, MA, 02767.   Individual Providers:   Fauzia Wali Khan NPI:1699761965 New Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 New Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 New Location: 100 New State Highway, Raynham, MA, 02767.   Mahreen Rashid NPI:1396393146 New Location: 100 New State Highway, Raynham, MA, 02767.   Peggy Pionke NPI: 1699307322 New Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 New Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182 New Location: 100 New State Highway, Raynham, MA, 02767.   Regards, Adil ', NULL, NULL, '2021-04-19 08:21:11', '2021-04-19 08:21:11'),
(19266, 1019, 21582, 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 12:45:12', '2021-05-03 12:45:12'),
(19267, 1019, 21582, 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 08:37:15', '2021-05-20 08:37:15'),
(19268, 1019, 21582, 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 11:17:53', '2021-06-05 11:17:53'),
(19269, 1019, 21582, 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. Need some time. Thank you for your patience.   Thank you! Shashi Seth Network Management Rep I, Northeast Provider Relations', NULL, NULL, '2021-06-24 08:02:42', '2021-06-24 08:02:42'),
(19270, 1019, 21582, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com  Hello, Can you please let me know about the enrollment status for the following providers under our group.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual NPI:  Rodesia Edmundson NPI: 1124622667 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.  Prisca Hefti NPI: 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Barbara Hignite NPI: 1982617262 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.   Lynetta Loveland NPI: 1598163602  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Cemetrice Muhammed NPI: 1548843410  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Regards,  Alex', NULL, NULL, '2021-08-24 11:25:48', '2021-08-24 11:25:48'),
(19271, 1019, 21582, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Location added effective date 02/05/2021, see attachment for ref ', NULL, NULL, '2021-08-27 08:15:32', '2021-08-27 08:15:32'),
(19272, 1006, 21583, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:27:46', '2021-03-16 10:27:46'),
(19273, 1019, 21583, NULL, '2021-04-09 00:00:00.000', 'Initiated', 'Enrollment Application faxed to Network Operations at (866) 612-7790 ', NULL, NULL, '2021-04-02 14:24:32', '2021-04-02 14:24:32'),
(19274, 1019, 21583, NULL, '2021-04-15 00:00:00.000', 'In Process', 'Received the following email from provider.relations@beaconhealthoptions.com Good Afternoon,     I can confirm the application was received via fax on 3.31.21 and is currently being processed. Once a completed application is received it takes an additional 45 days for credentialing to be completed. It is with the credentialing department at this time. Please allow more time. Once completed a welcome letter with be sent out.     Thank You!     Sarah Oakes  Network Management Rep I, Northeast', NULL, NULL, '2021-04-08 13:16:59', '2021-04-08 13:16:59'),
(19275, 1019, 21583, NULL, '2021-04-15 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com Hello Sarah, Can you please put a request to Expediate this application becasue we have waited for a long time now, we were submitting enrollment application thru your portal but last week we got to know that we were supposed to fill CAQH forms, so we did that now, due to this issue we already are in a big loss now as we have 300+ active patients of BEACON in our organization.  Regards, Alex', NULL, NULL, '2021-04-08 13:51:31', '2021-04-08 13:51:31'),
(19276, 3040, 21583, NULL, '2021-04-26 00:00:00.000', 'In Process', 'Still in process', NULL, NULL, '2021-04-19 08:52:08', '2021-04-19 08:52:08'),
(19277, 1019, 21583, NULL, '2021-05-10 00:00:00.000', 'Initiated', '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 12:35:49', '2021-05-03 12:35:49'),
(19278, 1019, 21583, 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 08:36:13', '2021-05-20 08:36:13'),
(19279, 1019, 21583, 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 11:17:46', '2021-06-05 11:17:46'),
(19280, 1019, 21583, 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. Need some time. Thank you for your patience.   Thank you! Shashi Seth Network Management Rep I, Northeast Provider Relations', NULL, NULL, '2021-06-24 08:02:32', '2021-06-24 08:02:32'),
(19281, 1019, 21583, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com  Hello, Can you please let me know about the enrollment status for the following providers under our group.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual NPI:  Rodesia Edmundson NPI: 1124622667 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.  Prisca Hefti NPI: 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Barbara Hignite NPI: 1982617262 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.   Lynetta Loveland NPI: 1598163602  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Cemetrice Muhammed NPI: 1548843410  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Regards,  Alex', NULL, NULL, '2021-08-24 11:25:19', '2021-08-24 11:25:19'),
(19282, 1019, 21583, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Location added effective date 04/30/2021, see attachment for ref', NULL, NULL, '2021-08-27 08:17:46', '2021-08-27 08:17:46'),
(19283, 1006, 21584, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:27:47', '2021-03-16 10:27:47'),
(19284, 1019, 21584, NULL, '2021-04-21 00:00:00.000', 'Initiated', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: RE: Enrollment Status || Providers || SNBCARE || Beacon attn RI  Hello Sarah, We have to add a new location for our group, and also providers as well, please let us know the process to add our group and providers under our new location.   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 New Location: 100 New State Highway, Raynham, MA, 02767.   Individual Providers :   Fauzia Wali Khan NPI:1699761965 New Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 New Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 New Location: 100 New State Highway, Raynham, MA, 02767.   Mahreen Rashid NPI:1396393146 New Location: 100 New State Highway, Raynham, MA, 02767.   Peggy Pionke NPI: 1699307322 New Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 New Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182 New Location: 100 New State Highway, Raynham, MA, 02767.   Regards, Alex', NULL, NULL, '2021-04-14 08:38:29', '2021-04-14 08:38:29'),
(19285, 1019, 21584, NULL, '2021-04-21 00:00:00.000', 'Initiated', 'Sent the following email to Shashi: provider.relations@beaconhealthoptions.com  Hello Shashi,   Attached are forms for Location addition for the group and individuals providers under that group. Let me know the timeframe for this request to be completed.     Regards, Alex', NULL, NULL, '2021-04-14 13:12:20', '2021-04-14 13:12:20'),
(19286, 3040, 21584, NULL, '2021-04-26 00:00:00.000', 'In Process', 'Email sent to: mu@claimsmedinc.com, provider.relations@beaconhealthoptions.com  Subject: Enrollment Status || Providers || SNBCARE || Beacon attn RI  Hello Shashi,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers.   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 New Location: 100 New State Highway, Raynham, MA, 02767.   Individual Providers:   Fauzia Wali Khan NPI:1699761965 New Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 New Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 New Location: 100 New State Highway, Raynham, MA, 02767.   Mahreen Rashid NPI:1396393146 New Location: 100 New State Highway, Raynham, MA, 02767.   Peggy Pionke NPI: 1699307322 New Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 New Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182 New Location: 100 New State Highway, Raynham, MA, 02767.   Regards, Adil ', NULL, NULL, '2021-04-19 08:21:07', '2021-04-19 08:21:07'),
(19287, 1019, 21584, 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 12:35:06', '2021-05-03 12:35:06'),
(19288, 1019, 21584, 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 08:35:04', '2021-05-20 08:35:04'),
(19289, 1019, 21584, 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 11:17:39', '2021-06-05 11:17:39'),
(19290, 1019, 21584, 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 08:00:13', '2021-06-24 08:00:13');
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
(19291, 1019, 21584, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com  Hello, Can you please let me know about the enrollment status for the following providers under our group.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual NPI:  Rodesia Edmundson NPI: 1124622667 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.  Prisca Hefti NPI: 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Barbara Hignite NPI: 1982617262 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.   Lynetta Loveland NPI: 1598163602  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Cemetrice Muhammed NPI: 1548843410  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Regards,  Alex', NULL, NULL, '2021-08-24 11:24:56', '2021-08-24 11:24:56'),
(19292, 1019, 21584, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Location added effective date 07/28/2020, see attachment for ref', NULL, NULL, '2021-08-27 08:19:47', '2021-08-27 08:19:47'),
(19293, 1006, 21585, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:27:48', '2021-03-16 10:27:48'),
(19294, 1019, 21585, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'CAQH Application faxed to Network Operations at (866) 612-7790. ', NULL, NULL, '2021-04-07 08:23:42', '2021-04-07 08:23:42'),
(19295, 1019, 21585, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Sent the following email to : provider.relations@beaconhealthoptions.com SUB: Enrollment Status || Providers || SNBCARE || Beacon   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 NPI:  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Barbara Hignite NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 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.    Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Jessica Hartman NPI: 1326665472 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile NPI: 1942687108  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-04-14 07:06:19', '2021-04-14 07:06:19'),
(19296, 1019, 21585, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Received the following email from Sarah: provider.relations@beaconhealthoptions.com Good Morning, I have reviewed each provider file and have left notes below in red. Rodesia Edmundson – Application received 4/6/21 and still processing – Event 9091975 NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Barbara Hignite – Application received 4/6/21 and still processing – Event 9091459 NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell – Application received 4/7/21 and still processing – Event 9093081 NPI: 1225645393 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich – Application received 4/5/21 and still processing – Event 9091316 NPI: 1710489760 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Justin Souliere – Application received 4/7/21 and still processing – Event 1098601 NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Jessica Hartman – CAQH Application needed – please complete attached application and return for processing NPI: 1326665472 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva – Application received 4/7/21 and still processing – Event 9093128 NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile – Application received 4/7/21 and still processing – Event 9093091 NPI: 1942687108  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Thank You!     Sarah Oakes  Network Management Rep I, Northeast  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive Suite 401  Woburn, MA 01801  Office: 800.397.1630  Direct: 781-496-4024  www.beaconhealthoptions.com', NULL, NULL, '2021-04-14 08:09:30', '2021-04-14 08:09:30'),
(19297, 1019, 21585, NULL, '2021-04-29 00:00:00.000', 'In Process', 'Called Beacon @ (800) 397-1630 spoke with rep Sierra conversation is mentioned below:  All providers applications have been received and are under review and group is added under all three locations under both plans (BHO/BHS) we have request the copy of group contract. we\'ll receive the contract in 3-2 business days.  Ref# 04/22/2021 - 1371173 Sierra Y', NULL, NULL, '2021-04-22 15:52:35', '2021-04-22 15:52:35'),
(19298, 1019, 21585, 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 12:34:36', '2021-05-03 12:34:36'),
(19299, 1019, 21585, 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 08:34:24', '2021-05-20 08:34:24'),
(19300, 1019, 21585, 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 11:17:31', '2021-06-05 11:17:31'),
(19301, 1019, 21585, NULL, '2021-06-30 00:00:00.000', 'Not Eligible', 'Received the following Denial Letter from Beacon as her ANCC certification is for AGNP.', NULL, NULL, '2021-06-23 08:37:11', '2021-06-23 08:37:11'),
(19302, 1006, 21586, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:27:49', '2021-03-16 10:27:49'),
(19303, 1019, 21586, NULL, '2021-04-21 00:00:00.000', 'Initiated', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: RE: Enrollment Status || Providers || SNBCARE || Beacon attn RI  Hello Sarah, We have to add a new location for our group, and also providers as well, please let us know the process to add our group and providers under our new location.   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 New Location: 100 New State Highway, Raynham, MA, 02767.   Individual Providers :   Fauzia Wali Khan NPI:1699761965 New Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 New Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 New Location: 100 New State Highway, Raynham, MA, 02767.   Mahreen Rashid NPI:1396393146 New Location: 100 New State Highway, Raynham, MA, 02767.   Peggy Pionke NPI: 1699307322 New Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 New Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182 New Location: 100 New State Highway, Raynham, MA, 02767.   Regards, Alex', NULL, NULL, '2021-04-14 08:38:17', '2021-04-14 08:38:17'),
(19304, 1019, 21586, NULL, '2021-04-21 00:00:00.000', 'Initiated', 'Sent the following email to Shashi: provider.relations@beaconhealthoptions.com  Hello Shashi,   Attached are forms for Location addition for the group and individuals providers under that group. Let me know the timeframe for this request to be completed.     Regards, Alex', NULL, NULL, '2021-04-14 13:12:59', '2021-04-14 13:12:59'),
(19305, 3040, 21586, NULL, '2021-04-26 00:00:00.000', 'In Process', 'Email sent to: mu@claimsmedinc.com, provider.relations@beaconhealthoptions.com  Subject: Enrollment Status || Providers || SNBCARE || Beacon attn RI  Hello Shashi,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers.   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 New Location: 100 New State Highway, Raynham, MA, 02767.   Individual Providers:   Fauzia Wali Khan NPI:1699761965 New Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 New Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 New Location: 100 New State Highway, Raynham, MA, 02767.   Mahreen Rashid NPI:1396393146 New Location: 100 New State Highway, Raynham, MA, 02767.   Peggy Pionke NPI: 1699307322 New Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 New Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182 New Location: 100 New State Highway, Raynham, MA, 02767.   Regards, Adil ', NULL, NULL, '2021-04-19 08:21:02', '2021-04-19 08:21:02'),
(19306, 1019, 21586, 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 12:34:15', '2021-05-03 12:34:15'),
(19307, 1019, 21586, 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 08:33:42', '2021-05-20 08:33:42'),
(19308, 1019, 21586, 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 11:17:24', '2021-06-05 11:17:24'),
(19309, 1019, 21586, 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 08:00:05', '2021-06-24 08:00:05'),
(19310, 1019, 21586, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com  Hello, Can you please let me know about the enrollment status for the following providers under our group.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual NPI:  Rodesia Edmundson NPI: 1124622667 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.  Prisca Hefti NPI: 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Barbara Hignite NPI: 1982617262 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.   Lynetta Loveland NPI: 1598163602  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Cemetrice Muhammed NPI: 1548843410  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Regards,  Alex', NULL, NULL, '2021-08-24 11:24:33', '2021-08-24 11:24:33'),
(19311, 1019, 21586, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Location added effective date 04/14/2021, see attachment for ref', NULL, NULL, '2021-08-27 08:22:04', '2021-08-27 08:22:04'),
(19312, 1006, 21587, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:27:51', '2021-03-16 10:27:51'),
(19313, 1019, 21587, NULL, '2021-04-21 00:00:00.000', 'Initiated', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: RE: Enrollment Status || Providers || SNBCARE || Beacon attn RI  Hello Sarah, We have to add a new location for our group, and also providers as well, please let us know the process to add our group and providers under our new location.   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 New Location: 100 New State Highway, Raynham, MA, 02767.   Individual Providers :   Fauzia Wali Khan NPI:1699761965 New Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 New Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 New Location: 100 New State Highway, Raynham, MA, 02767.   Mahreen Rashid NPI:1396393146 New Location: 100 New State Highway, Raynham, MA, 02767.   Peggy Pionke NPI: 1699307322 New Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 New Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182 New Location: 100 New State Highway, Raynham, MA, 02767.   Regards, Alex', NULL, NULL, '2021-04-14 08:38:11', '2021-04-14 08:38:11'),
(19314, 1019, 21587, NULL, '2021-04-21 00:00:00.000', 'Initiated', 'Sent the following email to Shashi: provider.relations@beaconhealthoptions.com  Hello Shashi,   Attached are forms for Location addition for the group and individuals providers under that group. Let me know the timeframe for this request to be completed.     Regards, Alex', NULL, NULL, '2021-04-14 13:13:49', '2021-04-14 13:13:49'),
(19315, 3040, 21587, NULL, '2021-04-26 00:00:00.000', 'In Process', 'Email sent to: mu@claimsmedinc.com, provider.relations@beaconhealthoptions.com  Subject: Enrollment Status || Providers || SNBCARE || Beacon attn RI  Hello Shashi,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers.   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 New Location: 100 New State Highway, Raynham, MA, 02767.   Individual Providers:   Fauzia Wali Khan NPI:1699761965 New Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 New Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 New Location: 100 New State Highway, Raynham, MA, 02767.   Mahreen Rashid NPI:1396393146 New Location: 100 New State Highway, Raynham, MA, 02767.   Peggy Pionke NPI: 1699307322 New Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 New Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182 New Location: 100 New State Highway, Raynham, MA, 02767.   Regards, Adil ', NULL, NULL, '2021-04-19 08:20:58', '2021-04-19 08:20:58'),
(19316, 1019, 21587, 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 12:33:49', '2021-05-03 12:33:49'),
(19317, 1019, 21587, NULL, '2021-05-27 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 08:33:06', '2021-05-20 08:33:06'),
(19318, 1019, 21587, 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 11:17:02', '2021-06-05 11:17:02'),
(19319, 1019, 21587, 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 07:59:56', '2021-06-24 07:59:56'),
(19320, 1019, 21587, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com  Hello, Can you please let me know about the enrollment status for the following providers under our group.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual NPI:  Rodesia Edmundson NPI: 1124622667 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.  Prisca Hefti NPI: 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Barbara Hignite NPI: 1982617262 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.   Lynetta Loveland NPI: 1598163602  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Cemetrice Muhammed NPI: 1548843410  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Regards,  Alex', NULL, NULL, '2021-08-24 11:24:04', '2021-08-24 11:24:04'),
(19321, 1019, 21587, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Location added effective date 04/19/2021, see attachment for ref', NULL, NULL, '2021-08-27 08:24:21', '2021-08-27 08:24:21'),
(19322, 1006, 21588, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:27:52', '2021-03-16 10:27:52'),
(19323, 1019, 21588, NULL, '2021-04-21 00:00:00.000', 'Initiated', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: RE: Enrollment Status || Providers || SNBCARE || Beacon attn RI  Hello Sarah, We have to add a new location for our group, and also providers as well, please let us know the process to add our group and providers under our new location.   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 New Location: 100 New State Highway, Raynham, MA, 02767.   Individual Providers :   Fauzia Wali Khan NPI:1699761965 New Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 New Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 New Location: 100 New State Highway, Raynham, MA, 02767.   Mahreen Rashid NPI:1396393146 New Location: 100 New State Highway, Raynham, MA, 02767.   Peggy Pionke NPI: 1699307322 New Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 New Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182 New Location: 100 New State Highway, Raynham, MA, 02767.   Regards, Alex', NULL, NULL, '2021-04-14 08:37:52', '2021-04-14 08:37:52'),
(19324, 1019, 21588, NULL, '2021-04-21 00:00:00.000', 'Initiated', 'Sent the following email to Shashi: provider.relations@beaconhealthoptions.com  Hello Shashi,   Attached are forms for Location addition for the group and individuals providers under that group. Let me know the timeframe for this request to be completed.     Regards, Alex', NULL, NULL, '2021-04-14 13:14:57', '2021-04-14 13:14:57'),
(19325, 3040, 21588, NULL, '2021-04-26 00:00:00.000', 'In Process', 'Email sent to: mu@claimsmedinc.com, provider.relations@beaconhealthoptions.com  Subject: Enrollment Status || Providers || SNBCARE || Beacon attn RI  Hello Shashi,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers.   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 New Location: 100 New State Highway, Raynham, MA, 02767.   Individual Providers:   Fauzia Wali Khan NPI:1699761965 New Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 New Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 New Location: 100 New State Highway, Raynham, MA, 02767.   Mahreen Rashid NPI:1396393146 New Location: 100 New State Highway, Raynham, MA, 02767.   Peggy Pionke NPI: 1699307322 New Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 New Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182 New Location: 100 New State Highway, Raynham, MA, 02767.   Regards, Adil ', NULL, NULL, '2021-04-19 08:20:54', '2021-04-19 08:20:54');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(19326, 1019, 21588, 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 12:33:26', '2021-05-03 12:33:26'),
(19327, 1019, 21588, 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 08:31:39', '2021-05-20 08:31:39'),
(19328, 1019, 21588, 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 11:16:55', '2021-06-05 11:16:55'),
(19329, 1019, 21588, 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 07:59:49', '2021-06-24 07:59:49'),
(19330, 1019, 21588, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com  Hello, Can you please let me know about the enrollment status for the following providers under our group.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual NPI:  Rodesia Edmundson NPI: 1124622667 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.  Prisca Hefti NPI: 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Barbara Hignite NPI: 1982617262 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.   Lynetta Loveland NPI: 1598163602  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Cemetrice Muhammed NPI: 1548843410  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Regards,  Alex', NULL, NULL, '2021-08-24 11:22:41', '2021-08-24 11:22:41'),
(19331, 1019, 21588, NULL, '2021-09-20 00:00:00.000', 'Approved', 'Attached is the Confirmation of location addition, eff 08/06/2021. ', NULL, NULL, '2021-09-13 08:55:57', '2021-09-13 08:55:57'),
(19332, 1006, 21589, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:27:53', '2021-03-16 10:27:53'),
(19333, 1019, 21589, NULL, '2021-04-21 00:00:00.000', 'Initiated', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: RE: Enrollment Status || Providers || SNBCARE || Beacon attn RI  Hello Sarah, We have to add a new location for our group, and also providers as well, please let us know the process to add our group and providers under our new location.   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 New Location: 100 New State Highway, Raynham, MA, 02767.   Individual Providers :   Fauzia Wali Khan NPI:1699761965 New Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 New Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 New Location: 100 New State Highway, Raynham, MA, 02767.   Mahreen Rashid NPI:1396393146 New Location: 100 New State Highway, Raynham, MA, 02767.   Peggy Pionke NPI: 1699307322 New Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 New Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182 New Location: 100 New State Highway, Raynham, MA, 02767.   Regards, Alex', NULL, NULL, '2021-04-14 08:38:04', '2021-04-14 08:38:04'),
(19334, 1019, 21589, NULL, '2021-04-21 00:00:00.000', 'Initiated', 'Sent the following email to Shashi: provider.relations@beaconhealthoptions.com  Hello Shashi,   Attached are forms for Location addition for the group and individuals providers under that group. Let me know the timeframe for this request to be completed.     Regards, Alex', NULL, NULL, '2021-04-14 13:15:44', '2021-04-14 13:15:44'),
(19335, 3040, 21589, NULL, '2021-04-26 00:00:00.000', 'In Process', 'Email sent to: mu@claimsmedinc.com, provider.relations@beaconhealthoptions.com  Subject: Enrollment Status || Providers || SNBCARE || Beacon attn RI  Hello Shashi,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers.   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 New Location: 100 New State Highway, Raynham, MA, 02767.   Individual Providers:   Fauzia Wali Khan NPI:1699761965 New Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 New Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 New Location: 100 New State Highway, Raynham, MA, 02767.   Mahreen Rashid NPI:1396393146 New Location: 100 New State Highway, Raynham, MA, 02767.   Peggy Pionke NPI: 1699307322 New Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 New Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182 New Location: 100 New State Highway, Raynham, MA, 02767.   Regards, Adil ', NULL, NULL, '2021-04-19 08:20:50', '2021-04-19 08:20:50'),
(19336, 1019, 21589, 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 12:33:06', '2021-05-03 12:33:06'),
(19337, 1019, 21589, 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 08:29:56', '2021-05-20 08:29:56'),
(19338, 1019, 21589, 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 11:16:47', '2021-06-05 11:16:47'),
(19339, 1019, 21589, 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 07:59:43', '2021-06-24 07:59:43'),
(19340, 1019, 21589, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com  Hello, Can you please let me know about the enrollment status for the following providers under our group.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual NPI:  Rodesia Edmundson NPI: 1124622667 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.  Prisca Hefti NPI: 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Barbara Hignite NPI: 1982617262 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.   Lynetta Loveland NPI: 1598163602  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Cemetrice Muhammed NPI: 1548843410  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Regards,  Alex', NULL, NULL, '2021-08-24 11:22:09', '2021-08-24 11:22:09'),
(19341, 1019, 21589, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Location added effective date 04/19/2021, see attachment for ref', NULL, NULL, '2021-08-27 08:26:31', '2021-08-27 08:26:31'),
(19342, 1006, 21590, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:27:54', '2021-03-16 10:27:54'),
(19343, 1019, 21590, NULL, '2021-04-12 00:00:00.000', 'Initiated', 'CAQH Application faxed to Network Operations at (866) 612-7790. ', NULL, NULL, '2021-04-05 09:54:42', '2021-04-05 09:54:42'),
(19344, 1019, 21590, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Sent the following email to : provider.relations@beaconhealthoptions.com SUB: Enrollment Status || Providers || SNBCARE || Beacon   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 NPI:  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Barbara Hignite NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 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.    Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Jessica Hartman NPI: 1326665472 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile NPI: 1942687108  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-04-14 07:06:02', '2021-04-14 07:06:02'),
(19345, 1019, 21590, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Received the following email from Sarah: provider.relations@beaconhealthoptions.com Good Morning, I have reviewed each provider file and have left notes below in red. Rodesia Edmundson – Application received 4/6/21 and still processing – Event 9091975 NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Barbara Hignite – Application received 4/6/21 and still processing – Event 9091459 NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell – Application received 4/7/21 and still processing – Event 9093081 NPI: 1225645393 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich – Application received 4/5/21 and still processing – Event 9091316 NPI: 1710489760 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Justin Souliere – Application received 4/7/21 and still processing – Event 1098601 NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Jessica Hartman – CAQH Application needed – please complete attached application and return for processing NPI: 1326665472 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva – Application received 4/7/21 and still processing – Event 9093128 NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile – Application received 4/7/21 and still processing – Event 9093091 NPI: 1942687108  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Thank You!     Sarah Oakes  Network Management Rep I, Northeast  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive Suite 401  Woburn, MA 01801  Office: 800.397.1630  Direct: 781-496-4024  www.beaconhealthoptions.com', NULL, NULL, '2021-04-14 08:09:22', '2021-04-14 08:09:22'),
(19346, 1019, 21590, NULL, '2021-04-29 00:00:00.000', 'In Process', 'Called Beacon @ (800) 397-1630 spoke with rep Sierra conversation is mentioned below:  All providers applications have been received and are under review and group is added under all three locations under both plans (BHO/BHS) we have request the copy of group contract. we\'ll receive the contract in 3-2 business days.  Ref# 04/22/2021 - 1371173 Sierra Y', NULL, NULL, '2021-04-22 15:51:50', '2021-04-22 15:51:50'),
(19347, 1019, 21590, 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 11:45:33', '2021-05-03 11:45:33'),
(19348, 1019, 21590, 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 08:29:12', '2021-05-20 08:29:12'),
(19349, 1019, 21590, 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 11:16:37', '2021-06-05 11:16:37'),
(19350, 1019, 21590, 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 07:59:36', '2021-06-24 07:59:36'),
(19351, 1019, 21590, NULL, '2021-08-31 00:00:00.000', 'Not Eligible', 'Cannot be enrolled due to her specialty see attached', NULL, NULL, '2021-08-24 11:19:49', '2021-08-24 11:19:49'),
(19352, 1006, 21591, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:27:56', '2021-03-16 10:27:56'),
(19353, 1019, 21591, NULL, '2021-04-21 00:00:00.000', 'Initiated', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: RE: Enrollment Status || Providers || SNBCARE || Beacon attn RI  Hello Sarah, We have to add a new location for our group, and also providers as well, please let us know the process to add our group and providers under our new location.   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 New Location: 100 New State Highway, Raynham, MA, 02767.   Individual Providers :   Fauzia Wali Khan NPI:1699761965 New Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 New Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 New Location: 100 New State Highway, Raynham, MA, 02767.   Mahreen Rashid NPI:1396393146 New Location: 100 New State Highway, Raynham, MA, 02767.   Peggy Pionke NPI: 1699307322 New Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 New Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182 New Location: 100 New State Highway, Raynham, MA, 02767.   Regards, Alex', NULL, NULL, '2021-04-14 08:37:44', '2021-04-14 08:37:44'),
(19354, 1019, 21591, NULL, '2021-04-21 00:00:00.000', 'Initiated', 'Sent the following email to Shashi: provider.relations@beaconhealthoptions.com  Hello Shashi,   Attached are forms for Location addition for the group and individuals providers under that group. Let me know the timeframe for this request to be completed.     Regards, Alex', NULL, NULL, '2021-04-14 13:16:52', '2021-04-14 13:16:52'),
(19355, 3040, 21591, NULL, '2021-04-26 00:00:00.000', 'In Process', 'Email sent to: mu@claimsmedinc.com, provider.relations@beaconhealthoptions.com  Subject: Enrollment Status || Providers || SNBCARE || Beacon attn RI  Hello Shashi,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers.   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 New Location: 100 New State Highway, Raynham, MA, 02767.   Individual Providers:   Fauzia Wali Khan NPI:1699761965 New Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 New Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 New Location: 100 New State Highway, Raynham, MA, 02767.   Mahreen Rashid NPI:1396393146 New Location: 100 New State Highway, Raynham, MA, 02767.   Peggy Pionke NPI: 1699307322 New Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 New Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182 New Location: 100 New State Highway, Raynham, MA, 02767.   Regards, Adil ', NULL, NULL, '2021-04-19 08:20:46', '2021-04-19 08:20:46'),
(19356, 1019, 21591, 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 11:45:13', '2021-05-03 11:45:13'),
(19357, 1019, 21591, 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 08:28:27', '2021-05-20 08:28:27');
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
(19358, 1019, 21591, 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 11:16:30', '2021-06-05 11:16:30'),
(19359, 1019, 21591, 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 07:59:28', '2021-06-24 07:59:28'),
(19360, 1019, 21591, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com  Hello, Can you please let me know about the enrollment status for the following providers under our group.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual NPI:  Rodesia Edmundson NPI: 1124622667 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.  Prisca Hefti NPI: 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Barbara Hignite NPI: 1982617262 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.   Lynetta Loveland NPI: 1598163602  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Cemetrice Muhammed NPI: 1548843410  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Regards,  Alex', NULL, NULL, '2021-08-24 11:17:18', '2021-08-24 11:17:18'),
(19361, 1019, 21591, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Location added effective date 04/19/2021, see attachment for ref', NULL, NULL, '2021-08-27 08:27:50', '2021-08-27 08:27:50'),
(19362, 1006, 21592, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:27:57', '2021-03-16 10:27:57'),
(19363, 1019, 21592, NULL, '2021-04-13 00:00:00.000', 'Initiated', 'CAQH Application faxed to Network Operations at (866) 612-7790. ', NULL, NULL, '2021-04-06 08:31:16', '2021-04-06 08:31:16'),
(19364, 1019, 21592, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Sent the following email to : provider.relations@beaconhealthoptions.com SUB: Enrollment Status || Providers || SNBCARE || Beacon   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 NPI:  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Barbara Hignite NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 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.    Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Jessica Hartman NPI: 1326665472 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile NPI: 1942687108  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-04-14 07:05:29', '2021-04-14 07:05:29'),
(19365, 1019, 21592, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Received the following email from Sarah: provider.relations@beaconhealthoptions.com Good Morning, I have reviewed each provider file and have left notes below in red. Rodesia Edmundson – Application received 4/6/21 and still processing – Event 9091975 NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Barbara Hignite – Application received 4/6/21 and still processing – Event 9091459 NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell – Application received 4/7/21 and still processing – Event 9093081 NPI: 1225645393 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich – Application received 4/5/21 and still processing – Event 9091316 NPI: 1710489760 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Justin Souliere – Application received 4/7/21 and still processing – Event 1098601 NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Jessica Hartman – CAQH Application needed – please complete attached application and return for processing NPI: 1326665472 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva – Application received 4/7/21 and still processing – Event 9093128 NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile – Application received 4/7/21 and still processing – Event 9093091 NPI: 1942687108  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Thank You!     Sarah Oakes  Network Management Rep I, Northeast  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive Suite 401  Woburn, MA 01801  Office: 800.397.1630  Direct: 781-496-4024  www.beaconhealthoptions.com', NULL, NULL, '2021-04-14 08:08:43', '2021-04-14 08:08:43'),
(19366, 1019, 21592, NULL, '2021-04-29 00:00:00.000', 'In Process', 'Called Beacon @ (800) 397-1630 spoke with rep Sierra conversation is mentioned below:  All providers applications have been received and are under review and group is added under all three locations under both plans (BHO/BHS) we have request the copy of group contract. we\'ll receive the contract in 3-2 business days.  Ref# 04/22/2021 - 1371173 Sierra Y', NULL, NULL, '2021-04-22 15:50:55', '2021-04-22 15:50:55'),
(19367, 1019, 21592, NULL, '2021-04-29 00:00:00.000', 'In Process', 'Called Beacon @ (800) 397-1630 spoke with rep Sierra conversation is mentioned below:  All providers applications have been received and are under review and group is added under all three locations under both plans (BHO/BHS) we have request the copy of group contract. we\'ll receive the contract in 3-2 business days.  Ref# 04/22/2021 - 1371173 Sierra Y', NULL, NULL, '2021-04-22 15:51:18', '2021-04-22 15:51:18'),
(19368, 1019, 21592, 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 11:33:08', '2021-05-03 11:33:08'),
(19369, 1019, 21592, NULL, '2021-05-27 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 08:25:21', '2021-05-20 08:25:21'),
(19370, 1019, 21592, 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 11:16:03', '2021-06-05 11:16:03'),
(19371, 1019, 21592, 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 07:59:20', '2021-06-24 07:59:20'),
(19372, 1019, 21592, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent the following email to Laura.Bevin@aetna.com  Hello, We need the enrollment application status for the following providers,   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Providers:  Barbara Hignite NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson  NPI: 1124622667  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Jessica Hartman  NPI: 1326665472  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Lynnetta Loveland  NPI: 1598163602  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Cemetrice Muhammed NPI: 1548843410  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Jonathan Schubert  NPI: 1235755505   Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Kerry Smith  NPI: 1275083230  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jennifer Ullrich  NPI: 1710489760  Secondary Location: 100 New State Highway, Raynham, MA, 02767      Regards, Alex G.', NULL, NULL, '2021-08-24 11:13:43', '2021-08-24 11:13:43'),
(19373, 1019, 21592, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com  Hello, Can you please let me know about the enrollment status for the following providers under our group.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual NPI:  Rodesia Edmundson NPI: 1124622667 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.  Prisca Hefti NPI: 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Barbara Hignite NPI: 1982617262 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.   Lynetta Loveland NPI: 1598163602  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Cemetrice Muhammed NPI: 1548843410  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Regards,  Alex', NULL, NULL, '2021-08-24 11:14:37', '2021-08-24 11:14:37'),
(19374, 1019, 21592, NULL, '2021-09-20 00:00:00.000', 'Approved', 'Provider is linked to the following location eff 05/07/2021,  attached is the confirmations for additional location.', NULL, NULL, '2021-09-13 08:49:17', '2021-09-13 08:49:17'),
(19375, 3040, 21593, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:28:07', '2021-03-16 10:28:07'),
(19376, 3040, 21593, NULL, '2021-06-07 00:00:00.000', 'Approved', 'URGENT CARE CONTRACT-LPMC -------------------  Herrera, Jose L Jose.Herrera@bswhealth.org Tue, Nov 17, 8:55 AM (2 days ago) to Martin, me, SWHP  Sherry,  Your TAX ID was contracted as a facility only contract.  We did not credential or load any providers under this contract    We would not have been given any providers to credential or load in our systems under a facility contract.   Thank you,   Jose Herrera  Provider Relations Representative  FirstCare Health Plans—part of Baylor Scott & White Health  1901 W. Loop 289, Suite 9 | Lubbock, TX 79407  806-784-4306 Office | 806-784-4396 Fax  FirstCare.com', NULL, NULL, '2021-05-31 14:20:43', '2021-05-31 14:20:43'),
(19377, 3040, 21594, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:28:20', '2021-03-16 10:28:20'),
(19378, 3040, 21594, NULL, '2021-06-07 00:00:00.000', 'Approved', 'URGENT CARE CONTRACT-LPMC -------------------  Herrera, Jose L Jose.Herrera@bswhealth.org Tue, Nov 17, 8:55 AM (2 days ago) to Martin, me, SWHP  Sherry,  Your TAX ID was contracted as a facility only contract.  We did not credential or load any providers under this contract    We would not have been given any providers to credential or load in our systems under a facility contract.   Thank you,   Jose Herrera  Provider Relations Representative  FirstCare Health Plans—part of Baylor Scott & White Health  1901 W. Loop 289, Suite 9 | Lubbock, TX 79407  806-784-4306 Office | 806-784-4396 Fax  FirstCare.com', NULL, NULL, '2021-05-31 14:20:47', '2021-05-31 14:20:47'),
(19379, 1006, 21595, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:28:30', '2021-03-16 10:28:30'),
(19380, 3040, 21595, NULL, '2021-04-26 00:00:00.000', 'In Process', 'I had a word with (NIKKO) Aetna representative and he said that our group is participating with Aetna network. Effective Date: 02/15/2020.   We already sent the request for the copy of group contract.   Ref: 6013939899', NULL, NULL, '2021-04-19 12:49:41', '2021-04-19 12:49:41'),
(19381, 1006, 21595, NULL, '2021-04-28 00:00:00.000', 'In Process', 'Location Addition Request submitted via LOI. Attached for reference.', NULL, NULL, '2021-04-21 14:23:35', '2021-04-21 14:23:35'),
(19382, 1019, 21595, NULL, '2021-04-29 00:00:00.000', 'In Process', 'LOI was faxed to Aetna demographics update at (859) 455-8650 to Add New Location. see attachment for ref ', NULL, NULL, '2021-04-22 08:21:04', '2021-04-22 08:21:04'),
(19383, 1019, 21595, 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 10:28:55', '2021-05-03 10:28:55'),
(19384, 1019, 21595, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Sent the following email to Laura.Bevin@aetna.com SUB: Enrollment Query || Group & Providers || SNBCARE || Aetna  Hello, We need the enrollment application status for the following providers,   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Carlee Rozell 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Katie Tawakol 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jennifer Ullrich 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Justin Souliere 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Kerry Smith 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Fauzia Wali Khan 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Lynnetta Loveland 1598163602 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Peggy Pionke 1699307322 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Mahreen Rashid 1396393146 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Regards,', NULL, NULL, '2021-05-20 08:07:18', '2021-05-20 08:07:18'),
(19385, 1019, 21595, 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 07:56:18', '2021-06-16 07:56:18'),
(19386, 1019, 21595, NULL, '2021-09-06 00:00:00.000', 'Approved', 'Effective date 02/19/2020, attached is the agreement Brad received.', NULL, NULL, '2021-08-30 10:35:10', '2021-08-30 10:35:10'),
(19387, 1006, 21596, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:28:31', '2021-03-16 10:28:31'),
(19388, 1019, 21596, NULL, '2021-04-21 00:00:00.000', 'Initiated', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: RE: Enrollment Status || Providers || SNBCARE || Beacon attn RI  Hello Sarah, We have to add a new location for our group, and also providers as well, please let us know the process to add our group and providers under our new location.   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 New Location: 100 New State Highway, Raynham, MA, 02767.   Individual Providers :   Fauzia Wali Khan NPI:1699761965 New Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 New Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 New Location: 100 New State Highway, Raynham, MA, 02767.   Mahreen Rashid NPI:1396393146 New Location: 100 New State Highway, Raynham, MA, 02767.   Peggy Pionke NPI: 1699307322 New Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 New Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182 New Location: 100 New State Highway, Raynham, MA, 02767.   Regards, Alex', NULL, NULL, '2021-04-14 08:39:12', '2021-04-14 08:39:12'),
(19389, 1019, 21596, NULL, '2021-04-21 00:00:00.000', 'Initiated', 'Sent the following email to Shashi: provider.relations@beaconhealthoptions.com  Hello Shashi,   Attached are forms for Location addition for the group and individuals providers under that group. Let me know the timeframe for this request to be completed.     Regards, Alex', NULL, NULL, '2021-04-14 13:18:21', '2021-04-14 13:18:21'),
(19390, 3040, 21596, NULL, '2021-04-26 00:00:00.000', 'In Process', 'Email sent to: mu@claimsmedinc.com, provider.relations@beaconhealthoptions.com  Subject: Enrollment Status || Providers || SNBCARE || Beacon attn RI  Hello Shashi,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers.   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 New Location: 100 New State Highway, Raynham, MA, 02767.   Individual Providers:   Fauzia Wali Khan NPI:1699761965 New Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 New Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 New Location: 100 New State Highway, Raynham, MA, 02767.   Mahreen Rashid NPI:1396393146 New Location: 100 New State Highway, Raynham, MA, 02767.   Peggy Pionke NPI: 1699307322 New Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 New Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182 New Location: 100 New State Highway, Raynham, MA, 02767.   Regards, Adil ', NULL, NULL, '2021-04-19 08:20:41', '2021-04-19 08:20:41'),
(19391, 1019, 21596, NULL, '2021-04-30 00:00:00.000', 'In Process', 'Contract request form faxed at (866) 612-7795. Attached is the copy of request contract form see attachment. ', NULL, NULL, '2021-04-23 06:46:13', '2021-04-23 06:46:13'),
(19392, 1019, 21596, 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 08:40:25', '2021-05-20 08:40:25'),
(19393, 1019, 21596, 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 11:15:53', '2021-06-05 11:15:53'),
(19394, 1019, 21596, 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 07:59:12', '2021-06-24 07:59:12'),
(19395, 1019, 21596, NULL, '2021-09-06 00:00:00.000', 'Approved', 'Group enrolled effective date 11/27/2019, attached is the Welcome Letter', NULL, NULL, '2021-08-30 10:22:05', '2021-08-30 10:22:05'),
(19396, 3040, 21597, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:28:34', '2021-03-16 10:28:34'),
(19397, 3040, 21597, NULL, '2021-06-07 00:00:00.000', 'Approved', 'URGENT CARE CONTRACT-LPMC -------------------  Herrera, Jose L Jose.Herrera@bswhealth.org Tue, Nov 17, 8:55 AM (2 days ago) to Martin, me, SWHP  Sherry,  Your TAX ID was contracted as a facility only contract.  We did not credential or load any providers under this contract    We would not have been given any providers to credential or load in our systems under a facility contract.   Thank you,   Jose Herrera  Provider Relations Representative  FirstCare Health Plans—part of Baylor Scott & White Health  1901 W. Loop 289, Suite 9 | Lubbock, TX 79407  806-784-4306 Office | 806-784-4396 Fax  FirstCare.com', NULL, NULL, '2021-05-31 14:20:52', '2021-05-31 14:20:52'),
(19398, 3040, 21598, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:28:45', '2021-03-16 10:28:45'),
(19399, 3040, 21598, NULL, '2021-06-07 00:00:00.000', 'Approved', 'URGENT CARE CONTRACT-LPMC -------------------  Herrera, Jose L Jose.Herrera@bswhealth.org Tue, Nov 17, 8:55 AM (2 days ago) to Martin, me, SWHP  Sherry,  Your TAX ID was contracted as a facility only contract.  We did not credential or load any providers under this contract    We would not have been given any providers to credential or load in our systems under a facility contract.   Thank you,   Jose Herrera  Provider Relations Representative  FirstCare Health Plans—part of Baylor Scott & White Health  1901 W. Loop 289, Suite 9 | Lubbock, TX 79407  806-784-4306 Office | 806-784-4396 Fax  FirstCare.com', NULL, NULL, '2021-05-31 14:20:56', '2021-05-31 14:20:56'),
(19400, 3040, 21599, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:28:56', '2021-03-16 10:28:56'),
(19401, 3040, 21599, NULL, '2021-06-07 00:00:00.000', 'Approved', 'URGENT CARE CONTRACT-LPMC -------------------  Herrera, Jose L Jose.Herrera@bswhealth.org Tue, Nov 17, 8:55 AM (2 days ago) to Martin, me, SWHP  Sherry,  Your TAX ID was contracted as a facility only contract.  We did not credential or load any providers under this contract    We would not have been given any providers to credential or load in our systems under a facility contract.   Thank you,   Jose Herrera  Provider Relations Representative  FirstCare Health Plans—part of Baylor Scott & White Health  1901 W. Loop 289, Suite 9 | Lubbock, TX 79407  806-784-4306 Office | 806-784-4396 Fax  FirstCare.com', NULL, NULL, '2021-05-31 14:20:59', '2021-05-31 14:20:59'),
(19402, 1006, 21600, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:29:01', '2021-03-16 10:29:01'),
(19403, 3040, 21600, NULL, '2021-04-26 00:00:00.000', 'Initiated', 'Email sent to: providerapplicationstatus@bcbsma.com  Subject: Enrollment || Spectrum Neuro Behavioral Care LLC || Group & Providers || BCBS MA ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers for our group Spectrum Neuro Behavioral Care LLC under below locations.   Practice Details: Practice Name: Spectrum Neuro Behavioral Care LLC Practice Tax ID# 83-4482753 Practice NPI# 1356906572 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702 Secondary Address: 100 New State Hwy. Raynham , MA 02767  Provider 1: Provider Name: Tawakol, Katie  Provider NPI# 1609222116  Provider 2: Provider Name: Rashid, Mahreen Provider NPI# 1396393146  Provider 3:   Provider Name: Hefti, Prisca Provider NPI# 1508133182  Provider 4:   Provider Name: Khan, Fauzia Wali Provider NPI# 1699761965  Provider 5:   Provider Name: Pionke, Peggy Provider NPI# 1699307322  Provider 6:   Provider Name: Ullrich, Jennifer Lee Provider NPI# 1710489760  Provider 7:   Provider Name: Schubert, Jonathan Provider NPI# 1235755505  Provider 8:   Provider Name: Edmundson, Rodesia Sharese Provider NPI# 1124622667  Provider 9:   Provider Name: Hignite, Barbara Provider NPI# 1982617262  Provider 10:   Provider Name: Loveland, Lynnetta Provider NPI# 1598163602  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-19 14:29:29', '2021-04-19 14:29:29'),
(19404, 1019, 21600, NULL, '2021-05-05 00:00:00.000', 'Initiated', 'Received the following email from providerapplicationstatus@bcbsma.com  Thank you for your email, Please fill out a standardized information change form to add an additional address. This can be found on provider.bluecrossma.com under the forms section.   Thank you, Network Management Blue Cross & Blue Shield of Massachusetts 800-316-2583', NULL, NULL, '2021-04-28 06:59:07', '2021-04-28 06:59:07'),
(19405, 1019, 21600, 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 07:04:42', '2021-04-28 07:04:42'),
(19406, 1006, 21601, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:29:02', '2021-03-16 10:29:02');
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
(19407, 3040, 21601, NULL, '2021-04-26 00:00:00.000', 'Initiated', 'Email sent to: providerapplicationstatus@bcbsma.com  Subject: Enrollment || Spectrum Neuro Behavioral Care LLC || Group & Providers || BCBS MA ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers for our group Spectrum Neuro Behavioral Care LLC under below locations.   Practice Details: Practice Name: Spectrum Neuro Behavioral Care LLC Practice Tax ID# 83-4482753 Practice NPI# 1356906572 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702 Secondary Address: 100 New State Hwy. Raynham , MA 02767  Provider 1: Provider Name: Tawakol, Katie  Provider NPI# 1609222116  Provider 2: Provider Name: Rashid, Mahreen Provider NPI# 1396393146  Provider 3:   Provider Name: Hefti, Prisca Provider NPI# 1508133182  Provider 4:   Provider Name: Khan, Fauzia Wali Provider NPI# 1699761965  Provider 5:   Provider Name: Pionke, Peggy Provider NPI# 1699307322  Provider 6:   Provider Name: Ullrich, Jennifer Lee Provider NPI# 1710489760  Provider 7:   Provider Name: Schubert, Jonathan Provider NPI# 1235755505  Provider 8:   Provider Name: Edmundson, Rodesia Sharese Provider NPI# 1124622667  Provider 9:   Provider Name: Hignite, Barbara Provider NPI# 1982617262  Provider 10:   Provider Name: Loveland, Lynnetta Provider NPI# 1598163602  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-19 14:28:51', '2021-04-19 14:28:51'),
(19408, 1019, 21601, NULL, '2021-05-05 00:00:00.000', 'Initiated', 'Received the following email from providerapplicationstatus@bcbsma.com  Thank you for your email, Please fill out a standardized information change form to add an additional address. This can be found on provider.bluecrossma.com under the forms section.   Thank you, Network Management Blue Cross & Blue Shield of Massachusetts 800-316-2583', NULL, NULL, '2021-04-28 06:58:55', '2021-04-28 06:58:55'),
(19409, 1019, 21601, NULL, '2021-05-05 00:00:00.000', 'Initiated', 'Hello, Attached is the Location addition form for our group with List of Providers and W9 forms. Please expediate this case as we are already running behind because of your late response on queries as you guys never respond timely.   Regards, Alex Garrett', NULL, NULL, '2021-04-28 07:40:27', '2021-04-28 07:40:27'),
(19410, 1019, 21601, NULL, '2021-05-12 00:00:00.000', 'In Process', 'Sent the following email to providerapplicationstatus@bcbsma.com, Debra.Draheim@bcbsma.com  SUB: Enrollment Query || Group & Providers || SNBCARE || BCBSMA  Hello, Can you please let me know the enrollment status for the following group and providers with Blue Cross Blue Shield of Massachusetts.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Providers:  Edmundson, Rodesia NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hefti, Prisca NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hignite, Barbara NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.    Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.    Loveland, Lynnetta NPI: 1598163602 Location: 100 New State Highway, Raynham, MA, 02767.   Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.    Tawakol, Katie NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Regards,', NULL, NULL, '2021-05-05 07:57:38', '2021-05-05 07:57:38'),
(19411, 1019, 21601, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to  providerapplicationstatus@bcbsma.com,  Debra.Draheim@bcbsma.com SUB: Enrollment Query || Group & Provider || SNBCARE || BCBS MA  Hello Debra, Hope you\'re doing good, I want to bring this in your knowledge that I\'m not receiving timely responses on my queries as I sent a couple of emails to BCBS MA regarding enrollments, can you please look into my request and help out with enrollment status for our providers.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Individual Providers:  Edmundson, Rodesia NPI: 1124622667 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hefti, Prisca NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hignite, Barbara NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.    Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.    Loveland, Lynnetta NPI: 1598163602 Location: 100 New State Highway, Raynham, MA, 02767.   Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.    Tawakol, Katie NPI: 1609222116 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.    Mary Gibbons NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  ', NULL, NULL, '2021-05-20 08:57:27', '2021-05-20 08:57:27'),
(19412, 1019, 21601, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to providerapplicationstatus@bcbsma.com, provider-enrollment@bcbsma.com, debra.draheim@bcbsma.com  SUB: Enrollment Query || Group & Provider || SNBCARE || BCBS MA 3rd Atttempt  Hello,  We need the enrollment status for the following providers under our group, also I want to bring this in your knowledge that I\'m not receiving timely responses on my queries as I have sent couple of emails to BCBS MA regarding enrollments query.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Individual Providers:  Edmundson, Rodesia NPI: 1124622667 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hefti, Prisca NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hignite, Barbara NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.    Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.    Loveland, Lynnetta NPI: 1598163602 Location: 100 New State Highway, Raynham, MA, 02767.   Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.    Tawakol, Katie NPI: 1609222116 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.    Mary Gibbons NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Regards, Alex ', NULL, NULL, '2021-06-03 10:53:25', '2021-06-03 10:53:25'),
(19413, 1019, 21601, NULL, '2021-07-19 00:00:00.000', 'Approved', 'Received the following email from Debra.Draheim@bcbsma.com  Hi Alex,     We apologize for the delay, I have reviewed and added the status’ for you below.  Let me know if you have any questions.  Thank you     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Individual Providers:  Edmundson, Rodesia-provider effective 4/28/2021 with both sites NPI: 1124622667 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hefti, Prisca-provider effective 6/21/2021 with both sites NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hignite, Barbara-provider effective 4/1/2021 with site below NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.    Khan, Fauzia Wali-provider effective 6/21/2021 with site below NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.    Loveland, Lynnetta-provider effective 2/22/2021 with site below NPI: 1598163602 Location: 100 New State Highway, Raynham, MA, 02767.   Rashid, Mahreen-provider effective 3/2/2021 with site below NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.    Tawakol, Katie-provider effective 3/25/2021 with both sites NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jessica Hartman-no record of receipt of initial credentialing request. NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Mary Gibbons-no record of receipt of maintenance to add addresses. NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Deb Draheim, CPCS  Credentialing Manager, Provider Operations|Blue Cross Blue Shield of Massachusetts 25 Technology Place | Hingham, MA  02043|T(617) 246-7675 | F(617) 246-5055 |e-mail: Debra.Draheim@BCBSMA.com Blue Cross Blue Shield of Massachusetts', NULL, NULL, '2021-07-12 14:13:59', '2021-07-12 14:13:59'),
(19414, 1006, 21602, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:29:03', '2021-03-16 10:29:03'),
(19415, 1019, 21602, NULL, '2021-04-09 00:00:00.000', 'Initiated', 'Sent the following email to : ProviderApplicationStatus@bcbsma.com  Sub: Enroll Provider || SNBCARE || Kerry Smith || BCBS MA  Hello, We wanted to enroll the below mentioned provider in Blue Cross Blue Shield MA, under our group. Can you let us know if you do enroll in these types of providers. Group Information: Spectrum Neuro Behavioral Care LLC Tax ID: 834482753 NPI: 1356906572 Individual Provider: Kerry Smith NPI: 1275083230 Speciality: Licensed Clinical Social Worker', NULL, NULL, '2021-04-02 14:26:05', '2021-04-02 14:26:05'),
(19416, 1019, 21602, NULL, '2021-04-19 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, '2021-04-12 08:11:14', '2021-04-12 08:11:14'),
(19417, 1006, 21603, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:29:05', '2021-03-16 10:29:05'),
(19418, 3040, 21603, NULL, '2021-04-26 00:00:00.000', 'Rejected', 'Received following rejection email from BCBS: \"Hello,  We were unable to credential Jonathan Schubert as he is showing as having only a LCSW license and no LICSW. Notification sent to snbc@claimsmedinc.com on 08-10-2020.  Regards, Network Management Services Blue Cross Blue Shield of Massachusetts\"', NULL, NULL, '2021-04-19 14:27:36', '2021-04-19 14:27:36'),
(19419, 1019, 21603, NULL, '2021-10-06 00:00:00.000', 'Revalidation', 'Faxed the application to BCBS MA via fax.', NULL, NULL, '2021-09-29 10:33:34', '2021-09-29 10:33:34'),
(19420, 11056, 21603, NULL, '2021-12-09 00:00:00.000', 'Revalidation', 'Email sent to: providerapplicationstatus@bcbsma.com  Sub:  Enrollment Status Updates - SNBCARE - BCBS  Good afternoon!  Hope this email finds you well. Please provide me with the latest updates on the below-mentioned providers under the facility TIN with both locations with BCBS.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Jessica Hartman	1326665472	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Jessica Hartman	1326665472	100 New State Highway, Raynham, MA, 02767. Jonathan Schubert	1235755505	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Jonathan Schubert	1235755505	100 New State Highway, Raynham, MA, 02767.  If you have any concerns or queries feel free to contact me.  Thank you! Have a great day!', NULL, NULL, '2021-12-02 17:12:37', '2021-12-02 17:12:37'),
(19421, 11056, 21603, NULL, '2021-12-10 00:00:00.000', 'Revalidation', 'RE: Infosecure RE: Enrollment Status Updates - SNBCARE - BCBS', NULL, NULL, '2021-12-03 10:11:00', '2021-12-03 10:11:00'),
(19422, 19067, 21603, NULL, '2022-03-29 00:00:00.000', 'Revalidated', 'Effective date: 02/17/2022. The agreement is attached.', NULL, NULL, '2022-03-22 14:09:15', '2022-03-22 14:09:15'),
(19423, 1006, 21604, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:29:06', '2021-03-16 10:29:06'),
(19424, 3040, 21604, NULL, '2021-04-26 00:00:00.000', 'On Hold', 'Furquan suggested waiting on this until Carlee has done her PMHNP so we can re-initiate. ', NULL, NULL, '2021-04-19 14:11:00', '2021-04-19 14:11:00'),
(19425, 1019, 21604, NULL, '2021-11-16 00:00:00.000', 'Not Eligible', 'Provider will no longer with SNBCARE.', NULL, NULL, '2021-11-09 10:31:48', '2021-11-09 10:31:48'),
(19426, 1006, 21605, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:29:07', '2021-03-16 10:29:07'),
(19427, 3040, 21605, NULL, '2021-04-26 00:00:00.000', 'Initiated', 'Email sent to: providerapplicationstatus@bcbsma.com  Subject: Enrollment || Spectrum Neuro Behavioral Care LLC || Group & Providers || BCBS MA ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers for our group Spectrum Neuro Behavioral Care LLC under below locations.   Practice Details: Practice Name: Spectrum Neuro Behavioral Care LLC Practice Tax ID# 83-4482753 Practice NPI# 1356906572 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702 Secondary Address: 100 New State Hwy. Raynham , MA 02767  Provider 1: Provider Name: Tawakol, Katie  Provider NPI# 1609222116  Provider 2: Provider Name: Rashid, Mahreen Provider NPI# 1396393146  Provider 3:   Provider Name: Hefti, Prisca Provider NPI# 1508133182  Provider 4:   Provider Name: Khan, Fauzia Wali Provider NPI# 1699761965  Provider 5:   Provider Name: Pionke, Peggy Provider NPI# 1699307322  Provider 6:   Provider Name: Ullrich, Jennifer Lee Provider NPI# 1710489760  Provider 7:   Provider Name: Schubert, Jonathan Provider NPI# 1235755505  Provider 8:   Provider Name: Edmundson, Rodesia Sharese Provider NPI# 1124622667  Provider 9:   Provider Name: Hignite, Barbara Provider NPI# 1982617262  Provider 10:   Provider Name: Loveland, Lynnetta Provider NPI# 1598163602  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-19 14:28:56', '2021-04-19 14:28:56'),
(19428, 1019, 21605, NULL, '2021-05-05 00:00:00.000', 'Initiated', 'Received the following email from providerapplicationstatus@bcbsma.com  Thank you for your email, Please fill out a standardized information change form to add an additional address. This can be found on provider.bluecrossma.com under the forms section.   Thank you, Network Management Blue Cross & Blue Shield of Massachusetts 800-316-2583', NULL, NULL, '2021-04-28 06:58:32', '2021-04-28 06:58:32'),
(19429, 1019, 21605, NULL, '2021-05-05 00:00:00.000', 'Initiated', 'Sent the attached form in email to providerapplicationstatus@bcbsma.com  Hello, Attached is the Location addition form for our group with List of Providers and W9 forms. Please expediate this case as we are already running behind because of your late response on queries as you guys never respond timely.   Regards, Alex Garrett', NULL, NULL, '2021-04-28 07:41:16', '2021-04-28 07:41:16'),
(19430, 1019, 21605, NULL, '2021-05-12 00:00:00.000', 'In Process', 'Sent the following email to providerapplicationstatus@bcbsma.com, Debra.Draheim@bcbsma.com  SUB: Enrollment Query || Group & Providers || SNBCARE || BCBSMA  Hello, Can you please let me know the enrollment status for the following group and providers with Blue Cross Blue Shield of Massachusetts.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Providers:  Edmundson, Rodesia NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hefti, Prisca NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hignite, Barbara NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.    Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.    Loveland, Lynnetta NPI: 1598163602 Location: 100 New State Highway, Raynham, MA, 02767.   Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.    Tawakol, Katie NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Regards,', NULL, NULL, '2021-05-05 07:57:22', '2021-05-05 07:57:22'),
(19431, 1019, 21605, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to  providerapplicationstatus@bcbsma.com,  Debra.Draheim@bcbsma.com SUB: Enrollment Query || Group & Provider || SNBCARE || BCBS MA  Hello Debra, Hope you\'re doing good, I want to bring this in your knowledge that I\'m not receiving timely responses on my queries as I sent a couple of emails to BCBS MA regarding enrollments, can you please look into my request and help out with enrollment status for our providers.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Individual Providers:  Edmundson, Rodesia NPI: 1124622667 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hefti, Prisca NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hignite, Barbara NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.    Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.    Loveland, Lynnetta NPI: 1598163602 Location: 100 New State Highway, Raynham, MA, 02767.   Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.    Tawakol, Katie NPI: 1609222116 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.    Mary Gibbons NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  ', NULL, NULL, '2021-05-20 08:58:23', '2021-05-20 08:58:23'),
(19432, 1019, 21605, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to providerapplicationstatus@bcbsma.com, provider-enrollment@bcbsma.com, debra.draheim@bcbsma.com  SUB: Enrollment Query || Group & Provider || SNBCARE || BCBS MA 3rd Atttempt  Hello,  We need the enrollment status for the following providers under our group, also I want to bring this in your knowledge that I\'m not receiving timely responses on my queries as I have sent couple of emails to BCBS MA regarding enrollments query.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Individual Providers:  Edmundson, Rodesia NPI: 1124622667 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hefti, Prisca NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hignite, Barbara NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.    Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.    Loveland, Lynnetta NPI: 1598163602 Location: 100 New State Highway, Raynham, MA, 02767.   Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.    Tawakol, Katie NPI: 1609222116 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.    Mary Gibbons NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Regards, Alex ', NULL, NULL, '2021-06-03 10:53:14', '2021-06-03 10:53:14'),
(19433, 1019, 21605, NULL, '2021-07-19 00:00:00.000', 'Approved', 'Received the following email from Debra.Draheim@bcbsma.com  Hi Alex,     We apologize for the delay, I have reviewed and added the status’ for you below.  Let me know if you have any questions.  Thank you     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Individual Providers:  Edmundson, Rodesia-provider effective 4/28/2021 with both sites NPI: 1124622667 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hefti, Prisca-provider effective 6/21/2021 with both sites NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hignite, Barbara-provider effective 4/1/2021 with site below NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.    Khan, Fauzia Wali-provider effective 6/21/2021 with site below NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.    Loveland, Lynnetta-provider effective 2/22/2021 with site below NPI: 1598163602 Location: 100 New State Highway, Raynham, MA, 02767.   Rashid, Mahreen-provider effective 3/2/2021 with site below NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.    Tawakol, Katie-provider effective 3/25/2021 with both sites NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jessica Hartman-no record of receipt of initial credentialing request. NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Mary Gibbons-no record of receipt of maintenance to add addresses. NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Deb Draheim, CPCS  Credentialing Manager, Provider Operations|Blue Cross Blue Shield of Massachusetts 25 Technology Place | Hingham, MA  02043|T(617) 246-7675 | F(617) 246-5055 |e-mail: Debra.Draheim@BCBSMA.com Blue Cross Blue Shield of Massachusetts', NULL, NULL, '2021-07-12 14:13:28', '2021-07-12 14:13:28'),
(19434, 3040, 21606, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:29:08', '2021-03-16 10:29:08'),
(19435, 3040, 21606, NULL, '2021-06-07 00:00:00.000', 'Approved', 'URGENT CARE CONTRACT-LPMC -------------------  Herrera, Jose L Jose.Herrera@bswhealth.org Tue, Nov 17, 8:55 AM (2 days ago) to Martin, me, SWHP  Sherry,  Your TAX ID was contracted as a facility only contract.  We did not credential or load any providers under this contract    We would not have been given any providers to credential or load in our systems under a facility contract.   Thank you,   Jose Herrera  Provider Relations Representative  FirstCare Health Plans—part of Baylor Scott & White Health  1901 W. Loop 289, Suite 9 | Lubbock, TX 79407  806-784-4306 Office | 806-784-4396 Fax  FirstCare.com', NULL, NULL, '2021-05-31 14:21:03', '2021-05-31 14:21:03'),
(19436, 1006, 21607, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:29:08', '2021-03-16 10:29:08'),
(19437, 3040, 21607, NULL, '2021-04-26 00:00:00.000', 'Initiated', 'Email sent to: providerapplicationstatus@bcbsma.com  Subject: Enrollment || Spectrum Neuro Behavioral Care LLC || Group & Providers || BCBS MA ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers for our group Spectrum Neuro Behavioral Care LLC under below locations.   Practice Details: Practice Name: Spectrum Neuro Behavioral Care LLC Practice Tax ID# 83-4482753 Practice NPI# 1356906572 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702 Secondary Address: 100 New State Hwy. Raynham , MA 02767  Provider 1: Provider Name: Tawakol, Katie  Provider NPI# 1609222116  Provider 2: Provider Name: Rashid, Mahreen Provider NPI# 1396393146  Provider 3:   Provider Name: Hefti, Prisca Provider NPI# 1508133182  Provider 4:   Provider Name: Khan, Fauzia Wali Provider NPI# 1699761965  Provider 5:   Provider Name: Pionke, Peggy Provider NPI# 1699307322  Provider 6:   Provider Name: Ullrich, Jennifer Lee Provider NPI# 1710489760  Provider 7:   Provider Name: Schubert, Jonathan Provider NPI# 1235755505  Provider 8:   Provider Name: Edmundson, Rodesia Sharese Provider NPI# 1124622667  Provider 9:   Provider Name: Hignite, Barbara Provider NPI# 1982617262  Provider 10:   Provider Name: Loveland, Lynnetta Provider NPI# 1598163602  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-19 14:29:20', '2021-04-19 14:29:20'),
(19438, 1019, 21607, NULL, '2021-05-05 00:00:00.000', 'Initiated', 'Received the following email from providerapplicationstatus@bcbsma.com  Thank you for your email, Please fill out a standardized information change form to add an additional address. This can be found on provider.bluecrossma.com under the forms section.   Thank you, Network Management Blue Cross & Blue Shield of Massachusetts 800-316-2583', NULL, NULL, '2021-04-28 06:58:20', '2021-04-28 06:58:20'),
(19439, 1019, 21607, 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 07:05:57', '2021-04-28 07:05:57'),
(19440, 1006, 21608, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:29:09', '2021-03-16 10:29:09'),
(19441, 3040, 21608, NULL, '2021-04-26 00:00:00.000', 'Initiated', 'Email sent to: providerapplicationstatus@bcbsma.com  Subject: Enrollment || Spectrum Neuro Behavioral Care LLC || Group & Providers || BCBS MA ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers for our group Spectrum Neuro Behavioral Care LLC under below locations.   Practice Details: Practice Name: Spectrum Neuro Behavioral Care LLC Practice Tax ID# 83-4482753 Practice NPI# 1356906572 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702 Secondary Address: 100 New State Hwy. Raynham , MA 02767  Provider 1: Provider Name: Tawakol, Katie  Provider NPI# 1609222116  Provider 2: Provider Name: Rashid, Mahreen Provider NPI# 1396393146  Provider 3:   Provider Name: Hefti, Prisca Provider NPI# 1508133182  Provider 4:   Provider Name: Khan, Fauzia Wali Provider NPI# 1699761965  Provider 5:   Provider Name: Pionke, Peggy Provider NPI# 1699307322  Provider 6:   Provider Name: Ullrich, Jennifer Lee Provider NPI# 1710489760  Provider 7:   Provider Name: Schubert, Jonathan Provider NPI# 1235755505  Provider 8:   Provider Name: Edmundson, Rodesia Sharese Provider NPI# 1124622667  Provider 9:   Provider Name: Hignite, Barbara Provider NPI# 1982617262  Provider 10:   Provider Name: Loveland, Lynnetta Provider NPI# 1598163602  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-19 14:29:57', '2021-04-19 14:29:57'),
(19442, 1019, 21608, NULL, '2021-05-05 00:00:00.000', 'Initiated', 'Received the following email from providerapplicationstatus@bcbsma.com  Thank you for your email, Please fill out a standardized information change form to add an additional address. This can be found on provider.bluecrossma.com under the forms section.   Thank you, Network Management Blue Cross & Blue Shield of Massachusetts 800-316-2583', NULL, NULL, '2021-04-28 06:58:07', '2021-04-28 06:58:07'),
(19443, 1019, 21608, NULL, '2021-05-05 00:00:00.000', 'Initiated', 'Sent the attached form in email to providerapplicationstatus@bcbsma.com  Hello, Attached is the Location addition form for our group with List of Providers and W9 forms. Please expediate this case as we are already running behind because of your late response on queries as you guys never respond timely.   Regards, Alex Garrett', NULL, NULL, '2021-04-28 07:47:47', '2021-04-28 07:47:47'),
(19444, 1019, 21608, NULL, '2021-05-12 00:00:00.000', 'In Process', 'Sent the following email to providerapplicationstatus@bcbsma.com, Debra.Draheim@bcbsma.com  SUB: Enrollment Query || Group & Providers || SNBCARE || BCBSMA  Hello, Can you please let me know the enrollment status for the following group and providers with Blue Cross Blue Shield of Massachusetts.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Providers:  Edmundson, Rodesia NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hefti, Prisca NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hignite, Barbara NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.    Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.    Loveland, Lynnetta NPI: 1598163602 Location: 100 New State Highway, Raynham, MA, 02767.   Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.    Tawakol, Katie NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Regards,', NULL, NULL, '2021-05-05 07:56:59', '2021-05-05 07:56:59'),
(19445, 1019, 21608, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to  providerapplicationstatus@bcbsma.com,  Debra.Draheim@bcbsma.com SUB: Enrollment Query || Group & Provider || SNBCARE || BCBS MA  Hello Debra, Hope you\'re doing good, I want to bring this in your knowledge that I\'m not receiving timely responses on my queries as I sent a couple of emails to BCBS MA regarding enrollments, can you please look into my request and help out with enrollment status for our providers.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Individual Providers:  Edmundson, Rodesia NPI: 1124622667 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hefti, Prisca NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hignite, Barbara NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.    Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.    Loveland, Lynnetta NPI: 1598163602 Location: 100 New State Highway, Raynham, MA, 02767.   Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.    Tawakol, Katie NPI: 1609222116 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.    Mary Gibbons NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  ', NULL, NULL, '2021-05-20 08:58:09', '2021-05-20 08:58:09'),
(19446, 1019, 21608, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to providerapplicationstatus@bcbsma.com, provider-enrollment@bcbsma.com, debra.draheim@bcbsma.com  SUB: Enrollment Query || Group & Provider || SNBCARE || BCBS MA 3rd Atttempt  Hello,  We need the enrollment status for the following providers under our group, also I want to bring this in your knowledge that I\'m not receiving timely responses on my queries as I have sent couple of emails to BCBS MA regarding enrollments query.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Individual Providers:  Edmundson, Rodesia NPI: 1124622667 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hefti, Prisca NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hignite, Barbara NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.    Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.    Loveland, Lynnetta NPI: 1598163602 Location: 100 New State Highway, Raynham, MA, 02767.   Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.    Tawakol, Katie NPI: 1609222116 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.    Mary Gibbons NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Regards, Alex ', NULL, NULL, '2021-06-03 10:52:49', '2021-06-03 10:52:49'),
(19447, 1019, 21608, NULL, '2021-07-19 00:00:00.000', 'Approved', 'Received the following email from Debra.Draheim@bcbsma.com  Hi Alex,     We apologize for the delay, I have reviewed and added the status’ for you below.  Let me know if you have any questions.  Thank you     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Individual Providers:  Edmundson, Rodesia-provider effective 4/28/2021 with both sites NPI: 1124622667 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hefti, Prisca-provider effective 6/21/2021 with both sites NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hignite, Barbara-provider effective 4/1/2021 with site below NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.    Khan, Fauzia Wali-provider effective 6/21/2021 with site below NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.    Loveland, Lynnetta-provider effective 2/22/2021 with site below NPI: 1598163602 Location: 100 New State Highway, Raynham, MA, 02767.   Rashid, Mahreen-provider effective 3/2/2021 with site below NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.    Tawakol, Katie-provider effective 3/25/2021 with both sites NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jessica Hartman-no record of receipt of initial credentialing request. NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Mary Gibbons-no record of receipt of maintenance to add addresses. NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Deb Draheim, CPCS  Credentialing Manager, Provider Operations|Blue Cross Blue Shield of Massachusetts 25 Technology Place | Hingham, MA  02043|T(617) 246-7675 | F(617) 246-5055 |e-mail: Debra.Draheim@BCBSMA.com Blue Cross Blue Shield of Massachusetts', NULL, NULL, '2021-07-12 14:12:56', '2021-07-12 14:12:56'),
(19448, 1006, 21609, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:29:11', '2021-03-16 10:29:11'),
(19449, 3040, 21609, NULL, '2021-04-26 00:00:00.000', 'Initiated', 'Email sent to: providerapplicationstatus@bcbsma.com  Subject: Enrollment || Spectrum Neuro Behavioral Care LLC || Group & Providers || BCBS MA ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers for our group Spectrum Neuro Behavioral Care LLC under below locations.   Practice Details: Practice Name: Spectrum Neuro Behavioral Care LLC Practice Tax ID# 83-4482753 Practice NPI# 1356906572 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702 Secondary Address: 100 New State Hwy. Raynham , MA 02767  Provider 1: Provider Name: Tawakol, Katie  Provider NPI# 1609222116  Provider 2: Provider Name: Rashid, Mahreen Provider NPI# 1396393146  Provider 3:   Provider Name: Hefti, Prisca Provider NPI# 1508133182  Provider 4:   Provider Name: Khan, Fauzia Wali Provider NPI# 1699761965  Provider 5:   Provider Name: Pionke, Peggy Provider NPI# 1699307322  Provider 6:   Provider Name: Ullrich, Jennifer Lee Provider NPI# 1710489760  Provider 7:   Provider Name: Schubert, Jonathan Provider NPI# 1235755505  Provider 8:   Provider Name: Edmundson, Rodesia Sharese Provider NPI# 1124622667  Provider 9:   Provider Name: Hignite, Barbara Provider NPI# 1982617262  Provider 10:   Provider Name: Loveland, Lynnetta Provider NPI# 1598163602  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-19 14:29:13', '2021-04-19 14:29:13'),
(19450, 1019, 21609, NULL, '2021-05-05 00:00:00.000', 'Initiated', 'Received the following email from providerapplicationstatus@bcbsma.com  Thank you for your email, Please fill out a standardized information change form to add an additional address. This can be found on provider.bluecrossma.com under the forms section.   Thank you, Network Management Blue Cross & Blue Shield of Massachusetts 800-316-2583', NULL, NULL, '2021-04-28 06:57:51', '2021-04-28 06:57:51'),
(19451, 1019, 21609, NULL, '2021-05-05 00:00:00.000', 'Initiated', 'Sent the attached form in email to providerapplicationstatus@bcbsma.com  Hello, Attached is the Location addition form for our group with List of Providers and W9 forms. Please expediate this case as we are already running behind because of your late response on queries as you guys never respond timely.   Regards, Alex Garrett', NULL, NULL, '2021-04-28 07:44:23', '2021-04-28 07:44:23'),
(19452, 1019, 21609, NULL, '2021-05-12 00:00:00.000', 'In Process', 'Sent the following email to providerapplicationstatus@bcbsma.com, Debra.Draheim@bcbsma.com  SUB: Enrollment Query || Group & Providers || SNBCARE || BCBSMA  Hello, Can you please let me know the enrollment status for the following group and providers with Blue Cross Blue Shield of Massachusetts.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Providers:  Edmundson, Rodesia NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hefti, Prisca NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hignite, Barbara NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.    Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.    Loveland, Lynnetta NPI: 1598163602 Location: 100 New State Highway, Raynham, MA, 02767.   Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.    Tawakol, Katie NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Regards,', NULL, NULL, '2021-05-05 07:56:41', '2021-05-05 07:56:41'),
(19453, 1019, 21609, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to  providerapplicationstatus@bcbsma.com,  Debra.Draheim@bcbsma.com SUB: Enrollment Query || Group & Provider || SNBCARE || BCBS MA  Hello Debra, Hope you\'re doing good, I want to bring this in your knowledge that I\'m not receiving timely responses on my queries as I sent a couple of emails to BCBS MA regarding enrollments, can you please look into my request and help out with enrollment status for our providers.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Individual Providers:  Edmundson, Rodesia NPI: 1124622667 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hefti, Prisca NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hignite, Barbara NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.    Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.    Loveland, Lynnetta NPI: 1598163602 Location: 100 New State Highway, Raynham, MA, 02767.   Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.    Tawakol, Katie NPI: 1609222116 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.    Mary Gibbons NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  ', NULL, NULL, '2021-05-20 08:58:40', '2021-05-20 08:58:40'),
(19454, 1019, 21609, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to providerapplicationstatus@bcbsma.com, provider-enrollment@bcbsma.com, debra.draheim@bcbsma.com  SUB: Enrollment Query || Group & Provider || SNBCARE || BCBS MA 3rd Atttempt  Hello,  We need the enrollment status for the following providers under our group, also I want to bring this in your knowledge that I\'m not receiving timely responses on my queries as I have sent couple of emails to BCBS MA regarding enrollments query.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Individual Providers:  Edmundson, Rodesia NPI: 1124622667 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hefti, Prisca NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hignite, Barbara NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.    Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.    Loveland, Lynnetta NPI: 1598163602 Location: 100 New State Highway, Raynham, MA, 02767.   Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.    Tawakol, Katie NPI: 1609222116 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.    Mary Gibbons NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Regards, Alex ', NULL, NULL, '2021-06-03 10:52:34', '2021-06-03 10:52:34'),
(19455, 1019, 21609, NULL, '2021-07-19 00:00:00.000', 'Approved', 'Received the following email from Debra.Draheim@bcbsma.com  Hi Alex,     We apologize for the delay, I have reviewed and added the status’ for you below.  Let me know if you have any questions.  Thank you     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Individual Providers:  Edmundson, Rodesia-provider effective 4/28/2021 with both sites NPI: 1124622667 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hefti, Prisca-provider effective 6/21/2021 with both sites NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hignite, Barbara-provider effective 4/1/2021 with site below NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.    Khan, Fauzia Wali-provider effective 6/21/2021 with site below NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.    Loveland, Lynnetta-provider effective 2/22/2021 with site below NPI: 1598163602 Location: 100 New State Highway, Raynham, MA, 02767.   Rashid, Mahreen-provider effective 3/2/2021 with site below NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.    Tawakol, Katie-provider effective 3/25/2021 with both sites NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jessica Hartman-no record of receipt of initial credentialing request. NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Mary Gibbons-no record of receipt of maintenance to add addresses. NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Deb Draheim, CPCS  Credentialing Manager, Provider Operations|Blue Cross Blue Shield of Massachusetts 25 Technology Place | Hingham, MA  02043|T(617) 246-7675 | F(617) 246-5055 |e-mail: Debra.Draheim@BCBSMA.com Blue Cross Blue Shield of Massachusetts', NULL, NULL, '2021-07-12 13:55:52', '2021-07-12 13:55:52'),
(19456, 1006, 21610, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:29:12', '2021-03-16 10:29:12');
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
(19457, 3040, 21610, NULL, '2021-04-26 00:00:00.000', 'Initiated', 'Email sent to: providerapplicationstatus@bcbsma.com  Subject: Enrollment || Spectrum Neuro Behavioral Care LLC || Group & Providers || BCBS MA ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers for our group Spectrum Neuro Behavioral Care LLC under below locations.   Practice Details: Practice Name: Spectrum Neuro Behavioral Care LLC Practice Tax ID# 83-4482753 Practice NPI# 1356906572 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702 Secondary Address: 100 New State Hwy. Raynham , MA 02767  Provider 1: Provider Name: Tawakol, Katie  Provider NPI# 1609222116  Provider 2: Provider Name: Rashid, Mahreen Provider NPI# 1396393146  Provider 3:   Provider Name: Hefti, Prisca Provider NPI# 1508133182  Provider 4:   Provider Name: Khan, Fauzia Wali Provider NPI# 1699761965  Provider 5:   Provider Name: Pionke, Peggy Provider NPI# 1699307322  Provider 6:   Provider Name: Ullrich, Jennifer Lee Provider NPI# 1710489760  Provider 7:   Provider Name: Schubert, Jonathan Provider NPI# 1235755505  Provider 8:   Provider Name: Edmundson, Rodesia Sharese Provider NPI# 1124622667  Provider 9:   Provider Name: Hignite, Barbara Provider NPI# 1982617262  Provider 10:   Provider Name: Loveland, Lynnetta Provider NPI# 1598163602  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-19 14:29:50', '2021-04-19 14:29:50'),
(19458, 1019, 21610, NULL, '2021-05-05 00:00:00.000', 'Initiated', 'Received the following email from providerapplicationstatus@bcbsma.com  Thank you for your email, Please fill out a standardized information change form to add an additional address. This can be found on provider.bluecrossma.com under the forms section.   Thank you, Network Management Blue Cross & Blue Shield of Massachusetts 800-316-2583', NULL, NULL, '2021-04-28 06:57:22', '2021-04-28 06:57:22'),
(19459, 1019, 21610, NULL, '2021-05-05 00:00:00.000', 'Initiated', 'Received the following email from providerapplicationstatus@bcbsma.com  Thank you for your email, Please fill out a standardized information change form to add an additional address. This can be found on provider.bluecrossma.com under the forms section.   Thank you, Network Management Blue Cross & Blue Shield of Massachusetts 800-316-2583', NULL, NULL, '2021-04-28 06:57:32', '2021-04-28 06:57:32'),
(19460, 1019, 21610, NULL, '2021-05-05 00:00:00.000', 'Initiated', 'Sent the attached form in email to providerapplicationstatus@bcbsma.com  Hello, Attached is the Location addition form for our group with List of Providers and W9 forms. Please expediate this case as we are already running behind because of your late response on queries as you guys never respond timely.   Regards, Alex Garrett', NULL, NULL, '2021-04-28 07:46:44', '2021-04-28 07:46:44'),
(19461, 1019, 21610, NULL, '2021-05-12 00:00:00.000', 'In Process', 'Sent the following email to providerapplicationstatus@bcbsma.com, Debra.Draheim@bcbsma.com  SUB: Enrollment Query || Group & Providers || SNBCARE || BCBSMA  Hello, Can you please let me know the enrollment status for the following group and providers with Blue Cross Blue Shield of Massachusetts.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Providers:  Edmundson, Rodesia NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hefti, Prisca NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hignite, Barbara NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.    Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.    Loveland, Lynnetta NPI: 1598163602 Location: 100 New State Highway, Raynham, MA, 02767.   Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.    Tawakol, Katie NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Regards,', NULL, NULL, '2021-05-05 07:56:23', '2021-05-05 07:56:23'),
(19462, 1019, 21610, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to  providerapplicationstatus@bcbsma.com,  Debra.Draheim@bcbsma.com SUB: Enrollment Query || Group & Provider || SNBCARE || BCBS MA  Hello Debra, Hope you\'re doing good, I want to bring this in your knowledge that I\'m not receiving timely responses on my queries as I sent a couple of emails to BCBS MA regarding enrollments, can you please look into my request and help out with enrollment status for our providers.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Individual Providers:  Edmundson, Rodesia NPI: 1124622667 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hefti, Prisca NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hignite, Barbara NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.    Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.    Loveland, Lynnetta NPI: 1598163602 Location: 100 New State Highway, Raynham, MA, 02767.   Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.    Tawakol, Katie NPI: 1609222116 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.    Mary Gibbons NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  ', NULL, NULL, '2021-05-20 08:57:43', '2021-05-20 08:57:43'),
(19463, 1019, 21610, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to providerapplicationstatus@bcbsma.com, provider-enrollment@bcbsma.com, debra.draheim@bcbsma.com  SUB: Enrollment Query || Group & Provider || SNBCARE || BCBS MA 3rd Atttempt  Hello,  We need the enrollment status for the following providers under our group, also I want to bring this in your knowledge that I\'m not receiving timely responses on my queries as I have sent couple of emails to BCBS MA regarding enrollments query.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Individual Providers:  Edmundson, Rodesia NPI: 1124622667 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hefti, Prisca NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hignite, Barbara NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.    Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.    Loveland, Lynnetta NPI: 1598163602 Location: 100 New State Highway, Raynham, MA, 02767.   Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.    Tawakol, Katie NPI: 1609222116 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.    Mary Gibbons NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Regards, Alex ', NULL, NULL, '2021-06-03 10:51:57', '2021-06-03 10:51:57'),
(19464, 1019, 21610, NULL, '2021-07-19 00:00:00.000', 'Approved', 'Received the following email from Debra.Draheim@bcbsma.com  Hi Alex,     We apologize for the delay, I have reviewed and added the status’ for you below.  Let me know if you have any questions.  Thank you     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Individual Providers:  Edmundson, Rodesia-provider effective 4/28/2021 with both sites NPI: 1124622667 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hefti, Prisca-provider effective 6/21/2021 with both sites NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hignite, Barbara-provider effective 4/1/2021 with site below NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.    Khan, Fauzia Wali-provider effective 6/21/2021 with site below NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.    Loveland, Lynnetta-provider effective 2/22/2021 with site below NPI: 1598163602 Location: 100 New State Highway, Raynham, MA, 02767.   Rashid, Mahreen-provider effective 3/2/2021 with site below NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.    Tawakol, Katie-provider effective 3/25/2021 with both sites NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jessica Hartman-no record of receipt of initial credentialing request. NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Mary Gibbons-no record of receipt of maintenance to add addresses. NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Deb Draheim, CPCS  Credentialing Manager, Provider Operations|Blue Cross Blue Shield of Massachusetts 25 Technology Place | Hingham, MA  02043|T(617) 246-7675 | F(617) 246-5055 |e-mail: Debra.Draheim@BCBSMA.com Blue Cross Blue Shield of Massachusetts', NULL, NULL, '2021-07-12 13:55:16', '2021-07-12 13:55:16'),
(19465, 1006, 21611, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:29:13', '2021-03-16 10:29:13'),
(19466, 3040, 21611, NULL, '2021-04-26 00:00:00.000', 'Initiated', 'Email sent to: providerapplicationstatus@bcbsma.com  Subject: Enrollment || Spectrum Neuro Behavioral Care LLC || Group & Providers || BCBS MA ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers for our group Spectrum Neuro Behavioral Care LLC under below locations.   Practice Details: Practice Name: Spectrum Neuro Behavioral Care LLC Practice Tax ID# 83-4482753 Practice NPI# 1356906572 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702 Secondary Address: 100 New State Hwy. Raynham , MA 02767  Provider 1: Provider Name: Tawakol, Katie  Provider NPI# 1609222116  Provider 2: Provider Name: Rashid, Mahreen Provider NPI# 1396393146  Provider 3:   Provider Name: Hefti, Prisca Provider NPI# 1508133182  Provider 4:   Provider Name: Khan, Fauzia Wali Provider NPI# 1699761965  Provider 5:   Provider Name: Pionke, Peggy Provider NPI# 1699307322  Provider 6:   Provider Name: Ullrich, Jennifer Lee Provider NPI# 1710489760  Provider 7:   Provider Name: Schubert, Jonathan Provider NPI# 1235755505  Provider 8:   Provider Name: Edmundson, Rodesia Sharese Provider NPI# 1124622667  Provider 9:   Provider Name: Hignite, Barbara Provider NPI# 1982617262  Provider 10:   Provider Name: Loveland, Lynnetta Provider NPI# 1598163602  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-19 14:29:04', '2021-04-19 14:29:04'),
(19467, 1019, 21611, NULL, '2021-05-05 00:00:00.000', 'Initiated', 'Received the following email from providerapplicationstatus@bcbsma.com  Thank you for your email, Please fill out a standardized information change form to add an additional address. This can be found on provider.bluecrossma.com under the forms section.   Thank you, Network Management Blue Cross & Blue Shield of Massachusetts 800-316-2583', NULL, NULL, '2021-04-28 06:57:11', '2021-04-28 06:57:11'),
(19468, 1019, 21611, NULL, '2021-05-05 00:00:00.000', 'Initiated', 'Sent the attached form in email to providerapplicationstatus@bcbsma.com  Hello, Attached is the Location addition form for our group with List of Providers and W9 forms. Please expediate this case as we are already running behind because of your late response on queries as you guys never respond timely.   Regards, Alex Garrett', NULL, NULL, '2021-04-28 07:43:13', '2021-04-28 07:43:13'),
(19469, 1019, 21611, NULL, '2021-05-12 00:00:00.000', 'In Process', 'Sent the following email to providerapplicationstatus@bcbsma.com, Debra.Draheim@bcbsma.com  SUB: Enrollment Query || Group & Providers || SNBCARE || BCBSMA  Hello, Can you please let me know the enrollment status for the following group and providers with Blue Cross Blue Shield of Massachusetts.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Providers:  Edmundson, Rodesia NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hefti, Prisca NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hignite, Barbara NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.    Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.    Loveland, Lynnetta NPI: 1598163602 Location: 100 New State Highway, Raynham, MA, 02767.   Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.    Tawakol, Katie NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Regards,', NULL, NULL, '2021-05-05 07:56:04', '2021-05-05 07:56:04'),
(19470, 1019, 21611, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to  providerapplicationstatus@bcbsma.com,  Debra.Draheim@bcbsma.com SUB: Enrollment Query || Group & Provider || SNBCARE || BCBS MA  Hello Debra, Hope you\'re doing good, I want to bring this in your knowledge that I\'m not receiving timely responses on my queries as I sent a couple of emails to BCBS MA regarding enrollments, can you please look into my request and help out with enrollment status for our providers.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Individual Providers:  Edmundson, Rodesia NPI: 1124622667 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hefti, Prisca NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hignite, Barbara NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.    Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.    Loveland, Lynnetta NPI: 1598163602 Location: 100 New State Highway, Raynham, MA, 02767.   Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.    Tawakol, Katie NPI: 1609222116 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.    Mary Gibbons NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  ', NULL, NULL, '2021-05-20 08:56:07', '2021-05-20 08:56:07'),
(19471, 1019, 21611, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to providerapplicationstatus@bcbsma.com, provider-enrollment@bcbsma.com, debra.draheim@bcbsma.com  SUB: Enrollment Query || Group & Provider || SNBCARE || BCBS MA 3rd Atttempt  Hello,  We need the enrollment status for the following providers under our group, also I want to bring this in your knowledge that I\'m not receiving timely responses on my queries as I have sent couple of emails to BCBS MA regarding enrollments query.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Individual Providers:  Edmundson, Rodesia NPI: 1124622667 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hefti, Prisca NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hignite, Barbara NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.    Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.    Loveland, Lynnetta NPI: 1598163602 Location: 100 New State Highway, Raynham, MA, 02767.   Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.    Tawakol, Katie NPI: 1609222116 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.    Mary Gibbons NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Regards, Alex ', NULL, NULL, '2021-06-03 10:51:41', '2021-06-03 10:51:41'),
(19472, 1019, 21611, NULL, '2021-07-19 00:00:00.000', 'Approved', 'Received the following email from Debra.Draheim@bcbsma.com  Hi Alex,     We apologize for the delay, I have reviewed and added the status’ for you below.  Let me know if you have any questions.  Thank you     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Individual Providers:  Edmundson, Rodesia-provider effective 4/28/2021 with both sites NPI: 1124622667 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hefti, Prisca-provider effective 6/21/2021 with both sites NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hignite, Barbara-provider effective 4/1/2021 with site below NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.    Khan, Fauzia Wali-provider effective 6/21/2021 with site below NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.    Loveland, Lynnetta-provider effective 2/22/2021 with site below NPI: 1598163602 Location: 100 New State Highway, Raynham, MA, 02767.   Rashid, Mahreen-provider effective 3/2/2021 with site below NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.    Tawakol, Katie-provider effective 3/25/2021 with both sites NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jessica Hartman-no record of receipt of initial credentialing request. NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Mary Gibbons-no record of receipt of maintenance to add addresses. NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Deb Draheim, CPCS  Credentialing Manager, Provider Operations|Blue Cross Blue Shield of Massachusetts 25 Technology Place | Hingham, MA  02043|T(617) 246-7675 | F(617) 246-5055 |e-mail: Debra.Draheim@BCBSMA.com Blue Cross Blue Shield of Massachusetts', NULL, NULL, '2021-07-12 13:54:43', '2021-07-12 13:54:43'),
(19473, 1006, 21612, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:29:15', '2021-03-16 10:29:15'),
(19474, 1019, 21612, NULL, '2021-04-12 00:00:00.000', 'Initiated', 'Enrollment application faxed to 617-246-5053. see attached ', NULL, NULL, '2021-04-05 15:13:00', '2021-04-05 15:13:00'),
(19475, 1019, 21612, NULL, '2021-04-15 00:00:00.000', 'In Process', 'Sent the following email to francine.riordan@bcbsma.com, providerapplicationstatus@bcbsma.com  Sub: Enrollment Status || Providers || SNBCARE || BCBS MA 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 NPI:  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.', NULL, NULL, '2021-04-08 10:53:13', '2021-04-08 10:53:13'),
(19476, 3040, 21612, NULL, '2021-04-26 00:00:00.000', 'Initiated', 'Email sent to: providerapplicationstatus@bcbsma.com  Subject: Enrollment || Spectrum Neuro Behavioral Care LLC || Group & Providers || BCBS MA ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers for our group Spectrum Neuro Behavioral Care LLC under below locations.   Practice Details: Practice Name: Spectrum Neuro Behavioral Care LLC Practice Tax ID# 83-4482753 Practice NPI# 1356906572 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702 Secondary Address: 100 New State Hwy. Raynham , MA 02767  Provider 1: Provider Name: Tawakol, Katie  Provider NPI# 1609222116  Provider 2: Provider Name: Rashid, Mahreen Provider NPI# 1396393146  Provider 3:   Provider Name: Hefti, Prisca Provider NPI# 1508133182  Provider 4:   Provider Name: Khan, Fauzia Wali Provider NPI# 1699761965  Provider 5:   Provider Name: Pionke, Peggy Provider NPI# 1699307322  Provider 6:   Provider Name: Ullrich, Jennifer Lee Provider NPI# 1710489760  Provider 7:   Provider Name: Schubert, Jonathan Provider NPI# 1235755505  Provider 8:   Provider Name: Edmundson, Rodesia Sharese Provider NPI# 1124622667  Provider 9:   Provider Name: Hignite, Barbara Provider NPI# 1982617262  Provider 10:   Provider Name: Loveland, Lynnetta Provider NPI# 1598163602  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-19 14:29:35', '2021-04-19 14:29:35'),
(19477, 1019, 21612, NULL, '2021-05-05 00:00:00.000', 'Initiated', 'Received the following email from providerapplicationstatus@bcbsma.com  Thank you for your email, Please fill out a standardized information change form to add an additional address. This can be found on provider.bluecrossma.com under the forms section.   Thank you, Network Management Blue Cross & Blue Shield of Massachusetts 800-316-2583', NULL, NULL, '2021-04-28 06:56:53', '2021-04-28 06:56:53'),
(19478, 1019, 21612, NULL, '2021-05-05 00:00:00.000', 'Initiated', 'Sent the attached form in email to providerapplicationstatus@bcbsma.com  Hello, Attached is the Location addition form for our group with List of Providers and W9 forms. Please expediate this case as we are already running behind because of your late response on queries as you guys never respond timely.   Regards, Alex Garrett', NULL, NULL, '2021-04-28 07:45:49', '2021-04-28 07:45:49'),
(19479, 1019, 21612, NULL, '2021-05-12 00:00:00.000', 'In Process', 'Sent the following email to providerapplicationstatus@bcbsma.com, Debra.Draheim@bcbsma.com  SUB: Enrollment Query || Group & Providers || SNBCARE || BCBSMA  Hello, Can you please let me know the enrollment status for the following group and providers with Blue Cross Blue Shield of Massachusetts.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Providers:  Edmundson, Rodesia NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hefti, Prisca NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hignite, Barbara NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.    Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.    Loveland, Lynnetta NPI: 1598163602 Location: 100 New State Highway, Raynham, MA, 02767.   Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.    Tawakol, Katie NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Regards,', NULL, NULL, '2021-05-05 07:55:45', '2021-05-05 07:55:45'),
(19480, 1019, 21612, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to  providerapplicationstatus@bcbsma.com,  Debra.Draheim@bcbsma.com SUB: Enrollment Query || Group & Provider || SNBCARE || BCBS MA  Hello Debra, Hope you\'re doing good, I want to bring this in your knowledge that I\'m not receiving timely responses on my queries as I sent a couple of emails to BCBS MA regarding enrollments, can you please look into my request and help out with enrollment status for our providers.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Individual Providers:  Edmundson, Rodesia NPI: 1124622667 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hefti, Prisca NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hignite, Barbara NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.    Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.    Loveland, Lynnetta NPI: 1598163602 Location: 100 New State Highway, Raynham, MA, 02767.   Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.    Tawakol, Katie NPI: 1609222116 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.    Mary Gibbons NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  ', NULL, NULL, '2021-05-20 08:57:57', '2021-05-20 08:57:57'),
(19481, 1019, 21612, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to providerapplicationstatus@bcbsma.com, provider-enrollment@bcbsma.com, debra.draheim@bcbsma.com  SUB: Enrollment Query || Group & Provider || SNBCARE || BCBS MA 3rd Atttempt  Hello,  We need the enrollment status for the following providers under our group, also I want to bring this in your knowledge that I\'m not receiving timely responses on my queries as I have sent couple of emails to BCBS MA regarding enrollments query.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Individual Providers:  Edmundson, Rodesia NPI: 1124622667 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hefti, Prisca NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hignite, Barbara NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.    Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.    Loveland, Lynnetta NPI: 1598163602 Location: 100 New State Highway, Raynham, MA, 02767.   Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.    Tawakol, Katie NPI: 1609222116 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.    Mary Gibbons NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Regards, Alex ', NULL, NULL, '2021-06-03 10:48:30', '2021-06-03 10:48:30'),
(19482, 1019, 21612, NULL, '2021-07-19 00:00:00.000', 'Approved', 'Received the following email from Debra.Draheim@bcbsma.com  Hi Alex,     We apologize for the delay, I have reviewed and added the status’ for you below.  Let me know if you have any questions.  Thank you     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Individual Providers:  Edmundson, Rodesia-provider effective 4/28/2021 with both sites NPI: 1124622667 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hefti, Prisca-provider effective 6/21/2021 with both sites NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hignite, Barbara-provider effective 4/1/2021 with site below NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.    Khan, Fauzia Wali-provider effective 6/21/2021 with site below NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.    Loveland, Lynnetta-provider effective 2/22/2021 with site below NPI: 1598163602 Location: 100 New State Highway, Raynham, MA, 02767.   Rashid, Mahreen-provider effective 3/2/2021 with site below NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.    Tawakol, Katie-provider effective 3/25/2021 with both sites NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jessica Hartman-no record of receipt of initial credentialing request. NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Mary Gibbons-no record of receipt of maintenance to add addresses. NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Deb Draheim, CPCS  Credentialing Manager, Provider Operations|Blue Cross Blue Shield of Massachusetts 25 Technology Place | Hingham, MA  02043|T(617) 246-7675 | F(617) 246-5055 |e-mail: Debra.Draheim@BCBSMA.com Blue Cross Blue Shield of Massachusetts', NULL, NULL, '2021-07-12 13:53:32', '2021-07-12 13:53:32'),
(19483, 1006, 21613, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:29:17', '2021-03-16 10:29:17'),
(19484, 1019, 21613, NULL, '2021-04-22 00:00:00.000', 'Initiated', 'Sent the following email to: Francine.Riordan@bcbsma.com SUB: Enrollment Status || Providers || SNBCARE || BCBS MA  Good Morning, We need to add a new Location to our group for BCBS MA. Let us know what will be the process for that.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 New Location: 100 New State Highway, Raynham, MA, 02767.   Regards, Alex ', NULL, NULL, '2021-04-15 06:40:15', '2021-04-15 06:40:15'),
(19485, 1019, 21613, NULL, '2021-04-22 00:00:00.000', 'Initiated', 'Sent the following email to Debra.Draheim@bcbsma.com; networkmanagement@bcbsma.com;   I appreciate your response. Yes we did complete the online application for Kerry Smith also, we need to add a new Location to our group for BCBS MA and also we want to add the mentioned provider under the new location for our group. Please advise   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 New Location: 100 New State Highway, Raynham, MA, 02767.   Individual Providers:  Jennifer Ullrich NPI:1710489760 New Location: 100 New State Highway, Raynham, MA, 02767.   Katie Tawakol NPI; 1609222116 New Location: 100 New State Highway, Raynham, MA, 02767.   Jonathan Schubert NPI: 1235755505 New Location: 100 New State Highway, Raynham, MA, 02767.   Carlee Rozell NPI: 1225645393 New Location: 100 New State Highway, Raynham, MA, 02767.   Mahreen Rashid NPI: 1396393146 New Location: 100 New State Highway, Raynham, MA, 02767.   Peggy Pionke NPI: 1699307322 New Location: 100 New State Highway, Raynham, MA, 02767.   Lynetta Loveland NPI: 1598163602 New Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali  Khan NPI: 1699761965 New Location: 100 New State Highway, Raynham, MA, 02767.   Barbara Hignite NPI: 1982617262 New Location: 100 New State Highway, Raynham, MA, 02767.   Prisca Hefti NPI: 1508133182 New Location: 100 New State Highway, Raynham, MA, 02767.    Regards, Alex', NULL, NULL, '2021-04-15 07:31:46', '2021-04-15 07:31:46'),
(19486, 3040, 21613, NULL, '2021-04-26 00:00:00.000', 'Initiated', 'Email sent to: providerapplicationstatus@bcbsma.com  Subject: Enrollment || Spectrum Neuro Behavioral Care LLC || Group & Providers || BCBS MA ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers for our group Spectrum Neuro Behavioral Care LLC under below locations.   Practice Details: Practice Name: Spectrum Neuro Behavioral Care LLC Practice Tax ID# 83-4482753 Practice NPI# 1356906572 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702 Secondary Address: 100 New State Hwy. Raynham , MA 02767  Provider 1: Provider Name: Tawakol, Katie  Provider NPI# 1609222116  Provider 2: Provider Name: Rashid, Mahreen Provider NPI# 1396393146  Provider 3:   Provider Name: Hefti, Prisca Provider NPI# 1508133182  Provider 4:   Provider Name: Khan, Fauzia Wali Provider NPI# 1699761965  Provider 5:   Provider Name: Pionke, Peggy Provider NPI# 1699307322  Provider 6:   Provider Name: Ullrich, Jennifer Lee Provider NPI# 1710489760  Provider 7:   Provider Name: Schubert, Jonathan Provider NPI# 1235755505  Provider 8:   Provider Name: Edmundson, Rodesia Sharese Provider NPI# 1124622667  Provider 9:   Provider Name: Hignite, Barbara Provider NPI# 1982617262  Provider 10:   Provider Name: Loveland, Lynnetta Provider NPI# 1598163602  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-19 14:30:22', '2021-04-19 14:30:22'),
(19487, 1019, 21613, NULL, '2021-05-05 00:00:00.000', 'Initiated', 'Received the following email from providerapplicationstatus@bcbsma.com  Thank you for your email, Please fill out a standardized information change form to add an additional address. This can be found on provider.bluecrossma.com under the forms section.   Thank you, Network Management Blue Cross & Blue Shield of Massachusetts 800-316-2583', NULL, NULL, '2021-04-28 06:56:31', '2021-04-28 06:56:31'),
(19488, 1019, 21613, NULL, '2021-05-05 00:00:00.000', 'Initiated', 'Sent the attached form in email to providerapplicationstatus@bcbsma.com  Hello, Attached is the Location addition form for our group with List of Providers and W9 forms. Please expediate this case as we are already running behind because of your late response on queries as you guys never respond timely.   Regards, Alex Garrett', NULL, NULL, '2021-04-28 07:36:51', '2021-04-28 07:36:51'),
(19489, 1019, 21613, NULL, '2021-05-12 00:00:00.000', 'In Process', 'Sent the following email to providerapplicationstatus@bcbsma.com, Debra.Draheim@bcbsma.com  SUB: Enrollment Query || Group & Providers || SNBCARE || BCBSMA  Hello, Can you please let me know the enrollment status for the following group and providers with Blue Cross Blue Shield of Massachusetts.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Providers:  Edmundson, Rodesia NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hefti, Prisca NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hignite, Barbara NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.    Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.    Loveland, Lynnetta NPI: 1598163602 Location: 100 New State Highway, Raynham, MA, 02767.   Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.    Tawakol, Katie NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Regards, ', NULL, NULL, '2021-05-05 07:06:01', '2021-05-05 07:06:01'),
(19490, 1019, 21613, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to  providerapplicationstatus@bcbsma.com,  Debra.Draheim@bcbsma.com SUB: Enrollment Query || Group & Provider || SNBCARE || BCBS MA  Hello Debra, Hope you\'re doing good, I want to bring this in your knowledge that I\'m not receiving timely responses on my queries as I sent a couple of emails to BCBS MA regarding enrollments, can you please look into my request and help out with enrollment status for our providers.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Individual Providers:  Edmundson, Rodesia NPI: 1124622667 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hefti, Prisca NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hignite, Barbara NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.    Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.    Loveland, Lynnetta NPI: 1598163602 Location: 100 New State Highway, Raynham, MA, 02767.   Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.    Tawakol, Katie NPI: 1609222116 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.    Mary Gibbons NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  ', NULL, NULL, '2021-05-20 08:56:54', '2021-05-20 08:56:54'),
(19491, 1019, 21613, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to providerapplicationstatus@bcbsma.com, provider-enrollment@bcbsma.com, debra.draheim@bcbsma.com  SUB: Enrollment Query || Group & Provider || SNBCARE || BCBS MA 3rd Atttempt  Hello,  We need the enrollment status for the following providers under our group, also I want to bring this in your knowledge that I\'m not receiving timely responses on my queries as I have sent couple of emails to BCBS MA regarding enrollments query.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Individual Providers:  Edmundson, Rodesia NPI: 1124622667 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hefti, Prisca NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hignite, Barbara NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.    Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.    Loveland, Lynnetta NPI: 1598163602 Location: 100 New State Highway, Raynham, MA, 02767.   Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.    Tawakol, Katie NPI: 1609222116 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.    Mary Gibbons NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Regards, Alex', NULL, NULL, '2021-06-03 10:50:11', '2021-06-03 10:50:11'),
(19492, 1019, 21613, NULL, '2021-09-06 00:00:00.000', 'Approved', 'As the location was added so BCBS hasn\'t provided us with the new contract as they have added this new location under the same contract eff 02/01/2021.', NULL, NULL, '2021-08-30 11:02:56', '2021-08-30 11:02:56'),
(19493, 3040, 21614, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:29:18', '2021-03-16 10:29:18'),
(19494, 3040, 21614, NULL, '2021-06-07 00:00:00.000', 'Approved', 'URGENT CARE CONTRACT-LPMC -------------------  Herrera, Jose L Jose.Herrera@bswhealth.org Tue, Nov 17, 8:55 AM (2 days ago) to Martin, me, SWHP  Sherry,  Your TAX ID was contracted as a facility only contract.  We did not credential or load any providers under this contract    We would not have been given any providers to credential or load in our systems under a facility contract.   Thank you,   Jose Herrera  Provider Relations Representative  FirstCare Health Plans—part of Baylor Scott & White Health  1901 W. Loop 289, Suite 9 | Lubbock, TX 79407  806-784-4306 Office | 806-784-4396 Fax  FirstCare.com', NULL, NULL, '2021-05-31 14:21:07', '2021-05-31 14:21:07'),
(19495, 3040, 21615, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:29:29', '2021-03-16 10:29:29'),
(19496, 3040, 21615, NULL, '2021-06-07 00:00:00.000', 'Approved', 'URGENT CARE CONTRACT-LPMC -------------------  Herrera, Jose L Jose.Herrera@bswhealth.org Tue, Nov 17, 8:55 AM (2 days ago) to Martin, me, SWHP  Sherry,  Your TAX ID was contracted as a facility only contract.  We did not credential or load any providers under this contract    We would not have been given any providers to credential or load in our systems under a facility contract.   Thank you,   Jose Herrera  Provider Relations Representative  FirstCare Health Plans—part of Baylor Scott & White Health  1901 W. Loop 289, Suite 9 | Lubbock, TX 79407  806-784-4306 Office | 806-784-4396 Fax  FirstCare.com', NULL, NULL, '2021-05-31 14:21:12', '2021-05-31 14:21:12'),
(19497, 1006, 21616, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:30:31', '2021-03-16 10:30:31'),
(19498, 3040, 21616, NULL, '2021-04-26 00:00:00.000', 'Not Eligible', 'Received the following email from Puente Saenz, Vanessa (Vanessa Puente Saenz) HHHH Vanessa.PuenteSaenz@cigna.com>:  \"Hello,  Thank you for applying to join Cigna Behavioral. Unfortunately at this time your process has been stopped during the Provider Verification stage of credentialing due to the following: Invalid License- LCSW is not valid for the state of MA  A letter containing the details of the process stop was sent to snbc@claimsmedinc.com.  If you have any further questions, please include the confidential email/mailing address where you wish to be contacted.   Thank you,  ConnectedCare PROVIDER OPERATIONS Vanessa Puente Saenz Behavioral NCU | Provider Relations Associate Analyst T: 770.281.3801 | F: 860.298.6461\"', NULL, NULL, '2021-04-19 16:01:53', '2021-04-19 16:01:53'),
(19499, 1006, 21617, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:30:34', '2021-03-16 10:30:34'),
(19500, 1019, 21617, NULL, '2021-04-28 00:00:00.000', 'Initiated', 'Sent the following email to :BehavioralContAdmin@cigna.com Sub: Location Addition || Group and Providers || SNBCARE || CIGNA  ATTN: Behavioral Provider Contract Administration Please find the attached Clinic Location Changes For Existing Clinic Contracts form to Add new location under our group and to add providers as well. All providers are listed in the form accordingly.   Regards, Alex G.', NULL, NULL, '2021-04-21 07:39:07', '2021-04-21 07:39:07'),
(19501, 1019, 21617, 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 09:27:25', '2021-05-20 09:27:25'),
(19502, 1019, 21617, 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 15:35:30', '2021-06-03 15:35:30'),
(19503, 1019, 21617, NULL, '2021-07-22 00:00:00.000', 'Approved', 'Provider added under new location effective date 05/04/2020. Attached is the group roster for ref.', NULL, NULL, '2021-07-15 07:49:54', '2021-07-15 07:49:54'),
(19504, 1006, 21618, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:30:35', '2021-03-16 10:30:35');
