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
(17847, 1019, 21369, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to ASantulli@humana.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tricare  Hello Anne, Hope you are doing good, I need the enrollment status for the following providers. I will really appreciate your help with this.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-06-16 08:03:00', '2021-06-16 08:03:00'),
(17848, 1019, 21369, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Effective date 04/20/2020, I have attached the group roster for Ref.', NULL, NULL, '2021-08-27 09:37:47', '2021-08-27 09:37:47'),
(17849, 1006, 21370, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:52:36', '2021-03-15 17:52:36'),
(17850, 1006, 21370, NULL, '2021-04-27 00:00:00.000', 'Initiated', 'Enrollment Application faxed to Tricare East Provider Certification at 608 221-7535 ', NULL, NULL, '2021-04-20 15:06:55', '2021-04-20 15:06:55'),
(17851, 1019, 21370, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to ASantulli@humana.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tricare  Hello Anne, Hope you are doing good, I need the enrollment status for the following providers. I will really appreciate your help with this.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-05-20 11:22:14', '2021-05-20 11:22:14'),
(17852, 1019, 21370, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Received the following email from ASantulli@humana.com The status for each practitioner is below, adjacent to each name.  Individual Providers:  Melody L\'Etoile                     Credentialing in progress, not yet approved, locations confirmed NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons                       Credentialing in progress, not yet approved, locations confirmed NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson                         Credentialing in progress, not yet approved, locations confirmed NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith                                        Credentialing in progress, not yet approved, locations confirmed NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland                           Credentialing in progress, not yet approved, locations confirmed NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid                    Credentialed/linked 4/3/2020, locations confirmed NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite                                 Credentialing in progress, not yet approved, locations confirmed NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert                            Credentialing in progress, not yet approved, locations confirmed  NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell                                      Credentialing in progress, not yet approved, location confirmed NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol                       Credentialed 4/28/2020, Waiting to add location NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan                 Credentialed 5/19/2020, added to locations 4/20/2020 & Waiting to add to Raynham Loc. NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.            Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti                            Credentialed 5/5/2020, added to location 5/4/2021 NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva                              Not recognized by name or NPI, not certified/credentialed/linked NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere                       Not credentialed, pls send DOB, SSN & CAQH number for credentialing NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.', NULL, NULL, '2021-05-31 10:58:53', '2021-05-31 10:58:53'),
(17853, 1019, 21370, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to ASantulli@humana.com  Hello Anne, I have listed the details below. Let me know if anything else is required.  Erin Oliva NPI: 1407349632 DOB: 06/11/1975 CAQH: 14282970 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere NPI: 1710576004 DOB: 06/19/1987 SSN: 035-60-6399 CAQH: 15057248 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards, Alex', NULL, NULL, '2021-06-14 10:51:03', '2021-06-14 10:51:03'),
(17854, 1019, 21370, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to ASantulli@humana.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tricare  Hello Anne, Hope you are doing good, I need the enrollment status for the following providers. I will really appreciate your help with this.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-06-16 08:02:42', '2021-06-16 08:02:42'),
(17855, 1019, 21370, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Effective date 05/20/2021, I have attached the group roster for Ref.', NULL, NULL, '2021-08-27 09:39:28', '2021-08-27 09:39:28'),
(17856, 1006, 21371, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:52:38', '2021-03-15 17:52:38'),
(17857, 1006, 21371, NULL, '2021-04-27 00:00:00.000', 'Initiated', 'Sent following email to Chuck @ John McGrew jmcgrew3@humana.com to verify when the provider was enrolled with Tricare:  Sub: Affiliation Query  \"Hello Chuck,  I hope you\'re doing well, I wanted to verify the affiliation dates for the following providers and the group as well:  Group Name: Spectrum Neuro Behavioral Care LLC NPI# 1356906572  Provider Name: Mahreen Rashid NPI# 1396393146  Also, could you please let me know what addresses are listed for the group? Since if the group has the address listed the providers should be able to bill under it no matter what address they have listed on their end, iirc.  Thank you.\"', NULL, NULL, '2021-04-20 14:45:53', '2021-04-20 14:45:53'),
(17858, 1019, 21371, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to ASantulli@humana.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tricare  Hello Anne, Hope you are doing good, I need the enrollment status for the following providers. I will really appreciate your help with this.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-05-20 11:21:40', '2021-05-20 11:21:40'),
(17859, 1019, 21371, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Received the following email from ASantulli@humana.com The status for each practitioner is below, adjacent to each name.  Individual Providers:  Melody L\'Etoile                     Credentialing in progress, not yet approved, locations confirmed NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons                       Credentialing in progress, not yet approved, locations confirmed NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson                         Credentialing in progress, not yet approved, locations confirmed NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith                                        Credentialing in progress, not yet approved, locations confirmed NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland                           Credentialing in progress, not yet approved, locations confirmed NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid                    Credentialed/linked 4/3/2020, locations confirmed NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite                                 Credentialing in progress, not yet approved, locations confirmed NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert                            Credentialing in progress, not yet approved, locations confirmed  NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell                                      Credentialing in progress, not yet approved, location confirmed NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol                       Credentialed 4/28/2020, Waiting to add location NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan                 Credentialed 5/19/2020, added to locations 4/20/2020 & Waiting to add to Raynham Loc. NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.            Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti                            Credentialed 5/5/2020, added to location 5/4/2021 NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva                              Not recognized by name or NPI, not certified/credentialed/linked NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere                       Not credentialed, pls send DOB, SSN & CAQH number for credentialing NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.', NULL, NULL, '2021-05-31 10:52:47', '2021-05-31 10:52:47'),
(17860, 1019, 21371, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to ASantulli@humana.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tricare  Hello Anne, Hope you are doing good, I need the enrollment status for the following providers. I will really appreciate your help with this.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-06-16 08:02:34', '2021-06-16 08:02:34'),
(17861, 1019, 21371, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Effective date 04/20/2020, I have attached the group roster for Ref.', NULL, NULL, '2021-08-27 09:38:47', '2021-08-27 09:38:47'),
(17862, 1006, 21372, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:52:39', '2021-03-15 17:52:39'),
(17863, 1019, 21372, NULL, '2021-04-08 00:00:00.000', 'Initiated', 'Enrollment Application faxed to Tricare East Provider Certification at 608 221-7535 ', NULL, NULL, '2021-04-01 09:39:48', '2021-04-01 09:39:48'),
(17864, 3040, 21372, NULL, '2021-04-23 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com  Subject: Enroll Providers || Spectrum Neuro Behavioral Care || Smith, Kerry R & Souliere, Justin R || Tricare ||  Greetings,   Hope you are doing great. Please note that we sent the provider enrollment form through fax on 04/01/2021 for below mentioned providers. Can you please check if you received it or not.     Practice Name: Spectrum Neuro Behavioral Care Practice Tax ID# 83-4482753 Practice NPI# 1356906572 Practice Address: 61 Lincoln St., Suite 203, Framingham , MA 01702  Provider Name: Smith, Kerry R Provider NPI# 1275083230    Practice Name: Spectrum Neuro Behavioral Care Practice Tax ID# 83-4482753 Practice NPI# 1356906572 Practice Address: 63 Eddie Dowling Hwy, Suite 9 North Smithfield , RI 02896-7322  Provider Name: Souliere, Justin R Provider NPI# 1710576004  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-16 13:59:16', '2021-04-16 13:59:16'),
(17865, 1019, 21372, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to ASantulli@humana.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tricare  Hello Anne, Hope you are doing good, I need the enrollment status for the following providers. I will really appreciate your help with this.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-05-20 11:22:25', '2021-05-20 11:22:25'),
(17866, 1019, 21372, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Received the following email from ASantulli@humana.com The status for each practitioner is below, adjacent to each name.  Individual Providers:  Melody L\'Etoile                     Credentialing in progress, not yet approved, locations confirmed NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons                       Credentialing in progress, not yet approved, locations confirmed NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson                         Credentialing in progress, not yet approved, locations confirmed NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith                                        Credentialing in progress, not yet approved, locations confirmed NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland                           Credentialing in progress, not yet approved, locations confirmed NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid                    Credentialed/linked 4/3/2020, locations confirmed NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite                                 Credentialing in progress, not yet approved, locations confirmed NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert                            Credentialing in progress, not yet approved, locations confirmed  NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell                                      Credentialing in progress, not yet approved, location confirmed NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol                       Credentialed 4/28/2020, Waiting to add location NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan                 Credentialed 5/19/2020, added to locations 4/20/2020 & Waiting to add to Raynham Loc. NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.            Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti                            Credentialed 5/5/2020, added to location 5/4/2021 NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva                              Not recognized by name or NPI, not certified/credentialed/linked NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere                       Not credentialed, pls send DOB, SSN & CAQH number for credentialing NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.', NULL, NULL, '2021-05-31 10:59:25', '2021-05-31 10:59:25'),
(17867, 1019, 21372, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to ASantulli@humana.com  Hello Anne, I have listed the details below. Let me know if anything else is required.  Erin Oliva NPI: 1407349632 DOB: 06/11/1975 CAQH: 14282970 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere NPI: 1710576004 DOB: 06/19/1987 SSN: 035-60-6399 CAQH: 15057248 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards, Alex', NULL, NULL, '2021-06-14 10:51:23', '2021-06-14 10:51:23'),
(17868, 1019, 21372, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to ASantulli@humana.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tricare  Hello Anne, Hope you are doing good, I need the enrollment status for the following providers. I will really appreciate your help with this.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-06-16 08:02:27', '2021-06-16 08:02:27'),
(17869, 11056, 21372, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Rep: Raven   Status:  Sent a FAX to 6082217535 with W9, LOI. Attn Provider Demographic.   Refcode:  14611201   Please see the attachment.', NULL, NULL, '2021-12-09 10:32:46', '2021-12-09 10:32:46'),
(17870, 19067, 21372, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com, asantulli@humana.com  Subject: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Hello,  Hope you are having a productive day and you are staying healthy,  I would like to know the enrollment status of the following providers with mentioned locations.  If any Provider is enrolled then provide us with the Effective date and Welcome letter for each provider that would be very helpful for us.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Filoteo-Nichols, Dina	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Filoteo-Nichols, Dina	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702 Halterman, Helena	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Halterman, Helena	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702 Hartman, Jessica	1326665472	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Oliva, Erin	1407349632	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  Kindly reply to me promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-16 14:11:13', '2021-12-16 14:11:13'),
(17871, 19067, 21372, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Secure email received from: ASantulli@humana.com  Subject: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   The status for each practitioner is listed below, adjacent to each name.  Group Name	Spectrum Neuro Behavioral Care LLC	 Tax ID	83-4482753	 Group NPI	1356906572	 		 Provider Name	NPI	Location Filoteo-Nichols, Dina	1770021099	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Certified 11/6/2021, not credentialed\" Filoteo-Nichols, Dina	1770021099	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Certified 11/6/2021, not credentialed\" Halterman, Helena	1801473749	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Certified 11/6/2021, not credentialed\" Halterman, Helena	1801473749	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Certified 11/6/2021, not credentialed\" Hartman, Jessica	1356906572	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Not recognized, not yet certified/credentialed\" Hartman, Jessica	1356906572	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Not recognized, not yet certified/credentialed\" Hefti, Prisca	1508133182	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\" Hignite, Barbara	1982617262	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/5/2020, linked 5/4/2021\" Khan, Fauzia	1699761965	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\" Loveland, Lynnetta	1598163602	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/19/2018, linked 4/22/2021\" Rashid, Mahreen	1396393146	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\" Schubert, Jonathan	1235755505	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 7/19/2021\" Smith, Kerry	1275083230	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Credentialed 9/21/2021\" Souliere, Justin	1710576004	\"63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Not recognized, not yet certified/credentialed\" Tawakol, Katie	1609222116	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\"', NULL, NULL, '2021-12-29 12:07:57', '2021-12-29 12:07:57'),
(17872, 19067, 21372, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com, asantulli@humana.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Greetings!  How can I enroll the providers which are not yet credentialed?  Kindly respond promptly.  Thanks,  Hammad Ahmed. ', NULL, NULL, '2022-01-10 14:15:23', '2022-01-10 14:15:23'),
(17873, 19067, 21372, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email received from: JMcGrew3@humana.com  Subject: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Hi, Hammad!     I’ll just need their CAQH numbers; their CAQH info should be newly attested and up to date, and Humana Military will need access. For Souliere, I’ll also need the attached form; his current status means I have to submit for another department to affiliate him.     Thanks!             Chuck McGrew  Tricare Community Liaison II  Servicing provider relations matters in the following areas:  RI / CT / Western MA     Humana Military     T 502-313-9524  F 806-517-2809  jmcgrew3@humana.com     www.humanamilitary.com', NULL, NULL, '2022-01-11 09:36:17', '2022-01-11 09:36:17'),
(17874, 19067, 21372, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Good Morning Chuck!  Hope this email finds you well.  Kindly see the attached forms for the provider as per your request.  Don\'t hesitate to reach me if you need anything.  Regards, Hammad Ahmed.', NULL, NULL, '2022-01-11 10:48:04', '2022-01-11 10:48:04'),
(17875, 19067, 21372, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Secure email received from: JMcGrew3@humana.com  Subject: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Hi, Hammad!     OK, except for Souliere, everybody here is already attached to these sites except for 63 Eddy Dowling Suite 8, which doesn’t exist for us. We do have Suite NINE; is this a typo on our end, or do we need to build Suite 8?     Thanks!   Chuck McGrew  Tricare Community Liaison II  Servicing provider relations matters in the following areas:  RI / CT / Western MA     Humana Military     T 502-313-9524  F 806-517-2809  jmcgrew3@humana.com     www.humanamilitary.com', NULL, NULL, '2022-02-11 11:16:58', '2022-02-11 11:16:58'),
(17876, 19067, 21372, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com  Subject: Re: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||  Hello!  The correct address is 63 Eddie Dowling Hwy, Suite 8. Kindly make an update on it.  Regards, Hammad Ahmed.', NULL, NULL, '2022-02-11 11:23:48', '2022-02-11 11:23:48'),
(17877, 19067, 21372, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Secure email sent to: JMcGrew3@humana.com  Subject: Re: Secured: RE: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Hi Chuck!  Has the address been updated for all the providers? Kindly make an update on it.  Thanks,', NULL, NULL, '2022-03-17 09:49:57', '2022-03-17 09:49:57'),
(17878, 19067, 21372, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Secure email received from: JMcGrew3@humana.com  Subject: Re: Secured:  RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Oh, yeah. That sort of update isn’t provider-by-provider, it applies to the site itself, to which the practitioners are attached. A change like that affects all affiliated providers.', NULL, NULL, '2022-03-17 10:35:08', '2022-03-17 10:35:08'),
(17879, 19067, 21372, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Secure email sent to: jmcgrew3@humana.com  Subject: Re: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||    Hi John,  Can you please confirm me that all the providers are in-network with Tricare and can you send me the welcome kit and effective date for all the providers. It will be of very help.  Thanks, Hammad Ahmed', NULL, NULL, '2022-03-17 10:37:05', '2022-03-17 10:37:05'),
(17880, 19067, 21372, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Secure email received from: JMcGrew3@humana.com  Subject: Secured: RE: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||    Hi again!     We don’t send out any kind of welcome kit, I’m afraid. Confirmation letters are, in theory, sent when a provider certifies, and then again if they credential as in-network, but that’s it. I’ve attached a roster of all providers we have attached to Spectrum’s TIN; we’re unable to generate one with effective dates, but that information is available on the Portal. It’s totally irrelevant for claims, though; no matter what effective date a provider has on their end, the claim will process over here.', NULL, NULL, '2022-03-17 13:59:16', '2022-03-17 13:59:16'),
(17881, 19067, 21372, NULL, '2022-03-24 00:00:00.000', 'Approved', 'Secure email received from: JMcGrew3@humana.com  Subject: Secured: RE: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||    Hi again!     We don’t send out any kind of welcome kit, I’m afraid. Confirmation letters are, in theory, sent when a provider certifies, and then again if they credential as in-network, but that’s it. I’ve attached a roster of all providers we have attached to Spectrum’s TIN; we’re unable to generate one with effective dates, but that information is available on the Portal. It’s totally irrelevant for claims, though; no matter what effective date a provider has on their end, the claim will process over here.', NULL, NULL, '2022-03-17 17:58:27', '2022-03-17 17:58:27'),
(17882, 19067, 21372, NULL, '2022-03-24 00:00:00.000', 'Approved', 'Eff date: 01/11/2022. See attachment for location confirmation.', NULL, NULL, '2022-03-17 17:59:51', '2022-03-17 17:59:51'),
(17883, 1006, 21373, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:52:41', '2021-03-15 17:52:41'),
(17884, 1006, 21373, NULL, '2021-04-26 00:00:00.000', 'Approved', 'Group is credentialed and contracted with Tricare, attached location approval & contract for reference:  \"TIN/EIN: 834482753 Contract Effective Date: 05/01/2020   Dear Spectrum Neuro Behavioral Care,  Humana Military would like to welcome you as an East Region network provider and thank you for becoming a preferred provider for TRICARE beneficiaries.  Humana Military is committed to maintaining access to high quality care with an emphasis on premium customer service for both beneficiaries and providers. As a valued TRICARE network provider, we look forward to working with you to ensure that the health care needs of our military and their families are met.\"', NULL, NULL, '2021-04-19 15:31:08', '2021-04-19 15:31:08'),
(17885, 3046, 21374, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:52:58', '2021-03-15 17:52:58'),
(17886, 1006, 21374, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Received the following update from Cigna rep, waiing on copy of welcome letter that we should be receiving in 10~15 business days;  Juan - Provider ID# 3642374 Eff: 05/01/2020  Ref: Lynette 03/29/2021', NULL, NULL, '2021-03-29 10:11:10', '2021-03-29 10:11:10'),
(17887, 3046, 21375, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:53:53', '2021-03-15 17:53:53'),
(17888, 1006, 21375, NULL, '2021-04-05 00:00:00.000', 'Approved', 'As per my discussion with Cigna provider rep:   Katherine - Provider ID# 3353951 Eff: 02/18/2013  Ref: Lynette 03/29/2021', NULL, NULL, '2021-03-29 09:58:45', '2021-03-29 09:58:45'),
(17889, 1006, 21376, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:56:46', '2021-03-15 17:56:46'),
(17890, 1019, 21376, NULL, '2021-04-29 00:00:00.000', 'Initiated', 'Enrollment Application faxed to Tricare East Provider Certification at (608) 221-7535 ', NULL, NULL, '2021-04-22 07:33:48', '2021-04-22 07:33:48'),
(17891, 1019, 21376, NULL, '2021-05-03 00:00:00.000', 'Initiated', 'Sent the following email to ASantulli@humana.com Hello Anne, Hope you are doing good, as per your request attached is the Location addition form, with the list of practitioners need to be linked under this address. Also we have attached the printed CAQH form and document for credentialing of the providers you requested for.Let me know if you need anything else.  Regards, Alex', NULL, NULL, '2021-04-26 11:45:01', '2021-04-26 11:45:01'),
(17892, 1019, 21376, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to ASantulli@humana.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tricare  Hello Anne, Hope you are doing good, I need the enrollment status for the following providers. I will really appreciate your help with this.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-05-20 11:20:20', '2021-05-20 11:20:20');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(17893, 1019, 21376, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Received the following email from ASantulli@humana.com The status for each practitioner is below, adjacent to each name.  Individual Providers:  Melody L\'Etoile                     Credentialing in progress, not yet approved, locations confirmed NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons                       Credentialing in progress, not yet approved, locations confirmed NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson                         Credentialing in progress, not yet approved, locations confirmed NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith                                        Credentialing in progress, not yet approved, locations confirmed NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland                           Credentialing in progress, not yet approved, locations confirmed NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid                    Credentialed/linked 4/3/2020, locations confirmed NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite                                 Credentialing in progress, not yet approved, locations confirmed NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert                            Credentialing in progress, not yet approved, locations confirmed  NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell                                      Credentialing in progress, not yet approved, location confirmed NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol                       Credentialed 4/28/2020, Waiting to add location NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan                 Credentialed 5/19/2020, added to locations 4/20/2020 & Waiting to add to Raynham Loc. NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.            Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti                            Credentialed 5/5/2020, added to location 5/4/2021 NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva                              Not recognized by name or NPI, not certified/credentialed/linked NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere                       Not credentialed, pls send DOB, SSN & CAQH number for credentialing NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.', NULL, NULL, '2021-05-31 10:48:44', '2021-05-31 10:48:44'),
(17894, 1019, 21376, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to ASantulli@humana.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tricare  Hello Anne, Hope you are doing good, I need the enrollment status for the following providers. I will really appreciate your help with this.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-06-16 08:02:20', '2021-06-16 08:02:20'),
(17895, 1019, 21376, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Effective date 04/28/2021, I have attached the group roster for Ref.', NULL, NULL, '2021-08-27 09:35:01', '2021-08-27 09:35:01'),
(17896, 1019, 21376, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Effective date 04/28/2021, I have attached the group roster for Ref.', NULL, NULL, '2021-08-27 09:35:02', '2021-08-27 09:35:02'),
(17897, 1006, 21377, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:56:48', '2021-03-15 17:56:48'),
(17898, 1006, 21377, NULL, '2021-04-29 00:00:00.000', 'Initiated', 'Sent following email to Chuck @ John McGrew jmcgrew3@humana.com:  Sub: Certification Verification - Lynnetta Loveland  \"Hello, Chuck,   I hope you\'re doing well, I wanted to verify if the following provider is showing up as certified or not? If she is, could you please send me the credentialing form for her?   The information is as follows:  Provider Name: Lynnetta Loveland NPI# 1598163602  Thank you very much!\"', NULL, NULL, '2021-04-22 16:42:24', '2021-04-22 16:42:24'),
(17899, 1019, 21377, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to ASantulli@humana.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tricare  Hello Anne, Hope you are doing good, I need the enrollment status for the following providers. I will really appreciate your help with this.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-05-20 11:21:03', '2021-05-20 11:21:03'),
(17900, 1019, 21377, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Received the following email from ASantulli@humana.com The status for each practitioner is below, adjacent to each name.  Individual Providers:  Melody L\'Etoile                     Credentialing in progress, not yet approved, locations confirmed NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons                       Credentialing in progress, not yet approved, locations confirmed NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson                         Credentialing in progress, not yet approved, locations confirmed NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith                                        Credentialing in progress, not yet approved, locations confirmed NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland                           Credentialing in progress, not yet approved, locations confirmed NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid                    Credentialed/linked 4/3/2020, locations confirmed NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite                                 Credentialing in progress, not yet approved, locations confirmed NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert                            Credentialing in progress, not yet approved, locations confirmed  NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell                                      Credentialing in progress, not yet approved, location confirmed NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol                       Credentialed 4/28/2020, Waiting to add location NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan                 Credentialed 5/19/2020, added to locations 4/20/2020 & Waiting to add to Raynham Loc. NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.            Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti                            Credentialed 5/5/2020, added to location 5/4/2021 NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva                              Not recognized by name or NPI, not certified/credentialed/linked NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere                       Not credentialed, pls send DOB, SSN & CAQH number for credentialing NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.', NULL, NULL, '2021-05-31 10:51:01', '2021-05-31 10:51:01'),
(17901, 1019, 21377, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to ASantulli@humana.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tricare  Hello Anne, Hope you are doing good, I need the enrollment status for the following providers. I will really appreciate your help with this.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-06-16 08:02:13', '2021-06-16 08:02:13'),
(17902, 1019, 21377, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Effective date 04/22/2021, I have attached the group roster for Ref.', NULL, NULL, '2021-08-27 09:35:54', '2021-08-27 09:35:54'),
(17903, 1006, 21378, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:56:50', '2021-03-15 17:56:50'),
(17904, 1006, 21378, NULL, '2021-04-29 00:00:00.000', 'Initiated', 'Submitted the following email to Chuck @ John McGrew jmcgrew3@humana.com:  Sub: Affiliation Query  \"Hello Chuck,  I hope you\'re doing well, I wanted to verify the affiliation dates for the following providers and the group as well:  Group Name: Spectrum Neuro Behavioral Care LLC NPI# 1356906572  Provider Name: Mahreen Rashid NPI# 1396393146  Provider Name: Melody L\'Etoile NPI# 1942687108  Also, could you please let me know what addresses are listed for the group? Since if the group has the address listed the providers should be able to bill under it no matter what address they have listed on their end, iirc.  Thank you.\"', NULL, NULL, '2021-04-22 16:39:52', '2021-04-22 16:39:52'),
(17905, 1019, 21378, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to ASantulli@humana.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tricare  Hello Anne, Hope you are doing good, I need the enrollment status for the following providers. I will really appreciate your help with this.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-05-20 11:21:51', '2021-05-20 11:21:51'),
(17906, 1019, 21378, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Received the following email from ASantulli@humana.com The status for each practitioner is below, adjacent to each name.  Individual Providers:  Melody L\'Etoile                     Credentialing in progress, not yet approved, locations confirmed NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons                       Credentialing in progress, not yet approved, locations confirmed NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson                         Credentialing in progress, not yet approved, locations confirmed NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith                                        Credentialing in progress, not yet approved, locations confirmed NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland                           Credentialing in progress, not yet approved, locations confirmed NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid                    Credentialed/linked 4/3/2020, locations confirmed NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite                                 Credentialing in progress, not yet approved, locations confirmed NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert                            Credentialing in progress, not yet approved, locations confirmed  NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell                                      Credentialing in progress, not yet approved, location confirmed NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol                       Credentialed 4/28/2020, Waiting to add location NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan                 Credentialed 5/19/2020, added to locations 4/20/2020 & Waiting to add to Raynham Loc. NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.            Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti                            Credentialed 5/5/2020, added to location 5/4/2021 NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva                              Not recognized by name or NPI, not certified/credentialed/linked NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere                       Not credentialed, pls send DOB, SSN & CAQH number for credentialing NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.', NULL, NULL, '2021-05-31 10:52:56', '2021-05-31 10:52:56'),
(17907, 1019, 21378, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to ASantulli@humana.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tricare  Hello Anne, Hope you are doing good, I need the enrollment status for the following providers. I will really appreciate your help with this.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-06-16 08:02:07', '2021-06-16 08:02:07'),
(17908, 1019, 21378, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Effective date 04/03/2020, I have attached the group roster for Ref.', NULL, NULL, '2021-08-27 09:36:48', '2021-08-27 09:36:48'),
(17909, 1006, 21379, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:56:52', '2021-03-15 17:56:52'),
(17910, 1006, 21379, NULL, '2021-04-29 00:00:00.000', 'Not Eligible', 'Request could not be completed due to provider specialty of LCSW, but tricare recommended to submit claims under different providers.  ', NULL, NULL, '2021-04-22 16:37:17', '2021-04-22 16:37:17'),
(17911, 19067, 21379, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Secure email received from: JMcGrew3@humana.com  Subject: Secured: RE: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||    Hi again!     We don’t send out any kind of welcome kit, I’m afraid. Confirmation letters are, in theory, sent when a provider certifies, and then again if they credential as in-network, but that’s it. I’ve attached a roster of all providers we have attached to Spectrum’s TIN; we’re unable to generate one with effective dates, but that information is available on the Portal. It’s totally irrelevant for claims, though; no matter what effective date a provider has on their end, the claim will process over here.', NULL, NULL, '2022-03-17 13:58:09', '2022-03-17 13:58:09'),
(17912, 19067, 21379, NULL, '2022-03-24 00:00:00.000', 'Approved', 'Effective date: 04/28/2021. See attachment of Provider Portal with all locations.', NULL, NULL, '2022-03-17 16:16:45', '2022-03-17 16:16:45'),
(17913, 19067, 21379, NULL, '2022-03-24 00:00:00.000', 'Approved', 'Effective date: 04/28/2021. See attachment of Provider Portal with all locations.', NULL, NULL, '2022-03-17 16:16:52', '2022-03-17 16:16:52'),
(17914, 19067, 21379, NULL, '2022-03-24 00:00:00.000', 'Approved', 'Effective date: 04/28/2021. See attachment of Provider Portal with all locations.', NULL, NULL, '2022-03-17 16:16:52', '2022-03-17 16:16:52'),
(17915, 19067, 21379, NULL, '2022-03-24 00:00:00.000', 'Approved', 'Effective date: 04/28/2021. See attachment of Provider Portal with all locations.', NULL, NULL, '2022-03-17 16:16:53', '2022-03-17 16:16:53'),
(17916, 19067, 21379, NULL, '2022-03-24 00:00:00.000', 'Approved', 'Effective date: 04/28/2021. See attachment of Provider Portal with all locations.', NULL, NULL, '2022-03-17 16:16:53', '2022-03-17 16:16:53'),
(17917, 1006, 21380, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:56:54', '2021-03-15 17:56:54'),
(17918, 1019, 21380, NULL, '2021-04-08 00:00:00.000', 'Initiated', 'Enrollment Application faxed to Tricare East Provider Certification at 608 221-7535 ', NULL, NULL, '2021-04-01 10:17:44', '2021-04-01 10:17:44'),
(17919, 3040, 21380, NULL, '2021-04-23 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com  Subject: Enroll Providers || Spectrum Neuro Behavioral Care || Smith, Kerry R & Souliere, Justin R || Tricare ||  Greetings,   Hope you are doing great. Please note that we sent the provider enrollment form through fax on 04/01/2021 for below mentioned providers. Can you please check if you received it or not.     Practice Name: Spectrum Neuro Behavioral Care Practice Tax ID# 83-4482753 Practice NPI# 1356906572 Practice Address: 61 Lincoln St., Suite 203, Framingham , MA 01702  Provider Name: Smith, Kerry R Provider NPI# 1275083230    Practice Name: Spectrum Neuro Behavioral Care Practice Tax ID# 83-4482753 Practice NPI# 1356906572 Practice Address: 63 Eddie Dowling Hwy, Suite 9 North Smithfield , RI 02896-7322  Provider Name: Souliere, Justin R Provider NPI# 1710576004  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-16 13:58:58', '2021-04-16 13:58:58'),
(17920, 1019, 21380, NULL, '2021-05-03 00:00:00.000', 'In Process', 'Received the following message from asantulli@humana.com  Thank you for your email. The location, 100 New State Highway, Raynham MA 02767 is not currently listed under your TIN. Please complete the attached New Location Form and email back to me to have this location added and the practitioners linked.  In addition to the above, the practitioners , Peggy Pionke, Jennifer Ullrich, Jonathan Schubert, Rodesia Edmundson, and Kerry Smith are not credentialed and require credentialing to be network to your TIN. For credentialing, please email me a printed copy of the CAQH with a copy of the practitioner’s license, DEA, & Malpractice Certificate reflecting the practitioner’s name and coverage for each one. Please allow a minimum of one week for any updates made to be visible in your Portal.  Thank you, Anne Santulli  Senior Consumer Operations Professional TRICARE Community Liaison 2 Field Operations, Humana Military Servicing provider relations for Maine, New Hampshire, Massachusetts T 502.318.5146 F 603.371.2404 asantulli@humana.com Find us on the web at www.humanamilitary.com', NULL, NULL, '2021-04-26 10:01:47', '2021-04-26 10:01:47'),
(17921, 1019, 21380, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to ASantulli@humana.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tricare  Hello Anne, Hope you are doing good, I need the enrollment status for the following providers. I will really appreciate your help with this.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-05-20 11:20:49', '2021-05-20 11:20:49'),
(17922, 1019, 21380, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Received the following email from ASantulli@humana.com The status for each practitioner is below, adjacent to each name.  Individual Providers:  Melody L\'Etoile                     Credentialing in progress, not yet approved, locations confirmed NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons                       Credentialing in progress, not yet approved, locations confirmed NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson                         Credentialing in progress, not yet approved, locations confirmed NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith                                        Credentialing in progress, not yet approved, locations confirmed NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland                           Credentialing in progress, not yet approved, locations confirmed NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid                    Credentialed/linked 4/3/2020, locations confirmed NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite                                 Credentialing in progress, not yet approved, locations confirmed NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert                            Credentialing in progress, not yet approved, locations confirmed  NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell                                      Credentialing in progress, not yet approved, location confirmed NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol                       Credentialed 4/28/2020, Waiting to add location NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan                 Credentialed 5/19/2020, added to locations 4/20/2020 & Waiting to add to Raynham Loc. NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.            Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti                            Credentialed 5/5/2020, added to location 5/4/2021 NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva                              Not recognized by name or NPI, not certified/credentialed/linked NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere                       Not credentialed, pls send DOB, SSN & CAQH number for credentialing NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.', NULL, NULL, '2021-05-31 10:50:07', '2021-05-31 10:50:07'),
(17923, 1019, 21380, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to ASantulli@humana.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tricare  Hello Anne, Hope you are doing good, I need the enrollment status for the following providers. I will really appreciate your help with this.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-06-16 08:02:00', '2021-06-16 08:02:00'),
(17924, 19067, 21380, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com, asantulli@humana.com  Subject: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Hello,  Hope you are having a productive day and you are staying healthy,  I would like to know the enrollment status of the following providers with mentioned locations.  If any Provider is enrolled then provide us with the Effective date and Welcome letter for each provider that would be very helpful for us.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Filoteo-Nichols, Dina	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Filoteo-Nichols, Dina	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702 Halterman, Helena	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Halterman, Helena	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702 Hartman, Jessica	1326665472	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Oliva, Erin	1407349632	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  Kindly reply to me promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-16 14:11:08', '2021-12-16 14:11:08'),
(17925, 19067, 21380, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Secure email received from: ASantulli@humana.com  Subject: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   The status for each practitioner is listed below, adjacent to each name.  Group Name	Spectrum Neuro Behavioral Care LLC	 Tax ID	83-4482753	 Group NPI	1356906572	 		 Provider Name	NPI	Location Filoteo-Nichols, Dina	1770021099	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Certified 11/6/2021, not credentialed\" Filoteo-Nichols, Dina	1770021099	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Certified 11/6/2021, not credentialed\" Halterman, Helena	1801473749	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Certified 11/6/2021, not credentialed\" Halterman, Helena	1801473749	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Certified 11/6/2021, not credentialed\" Hartman, Jessica	1356906572	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Not recognized, not yet certified/credentialed\" Hartman, Jessica	1356906572	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Not recognized, not yet certified/credentialed\" Hefti, Prisca	1508133182	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\" Hignite, Barbara	1982617262	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/5/2020, linked 5/4/2021\" Khan, Fauzia	1699761965	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\" Loveland, Lynnetta	1598163602	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/19/2018, linked 4/22/2021\" Rashid, Mahreen	1396393146	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\" Schubert, Jonathan	1235755505	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 7/19/2021\" Smith, Kerry	1275083230	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Credentialed 9/21/2021\" Souliere, Justin	1710576004	\"63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Not recognized, not yet certified/credentialed\" Tawakol, Katie	1609222116	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\"', NULL, NULL, '2021-12-29 12:07:50', '2021-12-29 12:07:50'),
(17926, 19067, 21380, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com, asantulli@humana.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Greetings!  How can I enroll the providers which are not yet credentialed?  Kindly respond promptly.  Thanks,  Hammad Ahmed. ', NULL, NULL, '2022-01-10 14:15:18', '2022-01-10 14:15:18'),
(17927, 19067, 21380, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email received from: JMcGrew3@humana.com  Subject: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Hi, Hammad!     I’ll just need their CAQH numbers; their CAQH info should be newly attested and up to date, and Humana Military will need access. For Souliere, I’ll also need the attached form; his current status means I have to submit for another department to affiliate him.     Thanks!             Chuck McGrew  Tricare Community Liaison II  Servicing provider relations matters in the following areas:  RI / CT / Western MA     Humana Military     T 502-313-9524  F 806-517-2809  jmcgrew3@humana.com     www.humanamilitary.com', NULL, NULL, '2022-01-11 09:36:24', '2022-01-11 09:36:24'),
(17928, 19067, 21380, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Good Morning Chuck!  Hope this email finds you well.  Kindly see the attached forms for the provider as per your request.  Don\'t hesitate to reach me if you need anything.  Regards, Hammad Ahmed.', NULL, NULL, '2022-01-11 10:47:59', '2022-01-11 10:47:59'),
(17929, 19067, 21380, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Secure email received from: JMcGrew3@humana.com  Subject: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Hi, Hammad!     OK, except for Souliere, everybody here is already attached to these sites except for 63 Eddy Dowling Suite 8, which doesn’t exist for us. We do have Suite NINE; is this a typo on our end, or do we need to build Suite 8?     Thanks!   Chuck McGrew  Tricare Community Liaison II  Servicing provider relations matters in the following areas:  RI / CT / Western MA     Humana Military     T 502-313-9524  F 806-517-2809  jmcgrew3@humana.com     www.humanamilitary.com', NULL, NULL, '2022-02-11 11:16:52', '2022-02-11 11:16:52'),
(17930, 19067, 21380, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com  Subject: Re: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||  Hello!  The correct address is 63 Eddie Dowling Hwy, Suite 8. Kindly make an update on it.  Regards, Hammad Ahmed.', NULL, NULL, '2022-02-11 11:23:42', '2022-02-11 11:23:42'),
(17931, 19067, 21380, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Secure email sent to: JMcGrew3@humana.com  Subject: Re: Secured: RE: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Hi Chuck!  Has the address been updated for all the providers? Kindly make an update on it.  Thanks,', NULL, NULL, '2022-03-17 09:49:52', '2022-03-17 09:49:52'),
(17932, 19067, 21380, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Secure email received from: JMcGrew3@humana.com  Subject: Re: Secured:  RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Oh, yeah. That sort of update isn’t provider-by-provider, it applies to the site itself, to which the practitioners are attached. A change like that affects all affiliated providers.', NULL, NULL, '2022-03-17 10:35:03', '2022-03-17 10:35:03'),
(17933, 19067, 21380, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Secure email sent to: jmcgrew3@humana.com  Subject: Re: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||    Hi John,  Can you please confirm me that all the providers are in-network with Tricare and can you send me the welcome kit and effective date for all the providers. It will be of very help.  Thanks, Hammad Ahmed', NULL, NULL, '2022-03-17 10:36:59', '2022-03-17 10:36:59'),
(17934, 19067, 21380, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Secure email received from: JMcGrew3@humana.com  Subject: Secured: RE: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||    Hi again!     We don’t send out any kind of welcome kit, I’m afraid. Confirmation letters are, in theory, sent when a provider certifies, and then again if they credential as in-network, but that’s it. I’ve attached a roster of all providers we have attached to Spectrum’s TIN; we’re unable to generate one with effective dates, but that information is available on the Portal. It’s totally irrelevant for claims, though; no matter what effective date a provider has on their end, the claim will process over here.', NULL, NULL, '2022-03-17 13:59:08', '2022-03-17 13:59:08'),
(17935, 19067, 21380, NULL, '2022-03-24 00:00:00.000', 'Approved', 'Secure email received from: JMcGrew3@humana.com  Subject: Secured: RE: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||    Hi again!     We don’t send out any kind of welcome kit, I’m afraid. Confirmation letters are, in theory, sent when a provider certifies, and then again if they credential as in-network, but that’s it. I’ve attached a roster of all providers we have attached to Spectrum’s TIN; we’re unable to generate one with effective dates, but that information is available on the Portal. It’s totally irrelevant for claims, though; no matter what effective date a provider has on their end, the claim will process over here.', NULL, NULL, '2022-03-17 17:52:50', '2022-03-17 17:52:50'),
(17936, 19067, 21380, NULL, '2022-03-24 00:00:00.000', 'Approved', 'Eff date: 04/28/2021. See attachment for location confirmation. ', NULL, NULL, '2022-03-17 17:54:44', '2022-03-17 17:54:44'),
(17937, 1006, 21381, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:56:56', '2021-03-15 17:56:56'),
(17938, 1006, 21381, NULL, '2021-04-29 00:00:00.000', 'Approved', 'The group is enrolled with Tricare, the approval letter and contract are attached for reference.   Eff: 05/01/2020', NULL, NULL, '2021-04-22 16:35:23', '2021-04-22 16:35:23'),
(17939, 3046, 21382, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 18:00:09', '2021-03-15 18:00:09'),
(17940, 1006, 21382, NULL, '2021-04-02 00:00:00.000', 'Not Eligible', 'CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @ https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/  It is also attached for reference.  ', NULL, NULL, '2021-03-26 14:15:15', '2021-03-26 14:15:15'),
(17941, 3046, 21383, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 18:00:11', '2021-03-15 18:00:11'),
(17942, 1006, 21383, NULL, '2021-04-02 00:00:00.000', 'Not Eligible', 'CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @ https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/  It is also attached for reference.  ', NULL, NULL, '2021-03-26 14:15:29', '2021-03-26 14:15:29'),
(17943, 3046, 21384, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 18:00:13', '2021-03-15 18:00:13');
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
(17944, 1006, 21384, NULL, '2021-04-02 00:00:00.000', 'Not Eligible', 'CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @ https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/  It is also attached for reference.  ', NULL, NULL, '2021-03-26 14:15:37', '2021-03-26 14:15:37'),
(17945, 3046, 21385, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 18:00:16', '2021-03-15 18:00:16'),
(17946, 1006, 21385, NULL, '2021-04-02 00:00:00.000', 'Not Eligible', 'CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @ https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/  It is also attached for reference.  ', NULL, NULL, '2021-03-26 14:15:44', '2021-03-26 14:15:44'),
(17947, 3046, 21386, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 18:00:19', '2021-03-15 18:00:19'),
(17948, 1006, 21386, NULL, '2021-04-02 00:00:00.000', 'Not Eligible', 'CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @ https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/  It is also attached for reference.  ', NULL, NULL, '2021-03-26 14:15:51', '2021-03-26 14:15:51'),
(17949, 3046, 21387, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 18:00:21', '2021-03-15 18:00:21'),
(17950, 1006, 21387, NULL, '2021-04-02 00:00:00.000', 'Not Eligible', 'CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @ https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/  It is also attached for reference.  ', NULL, NULL, '2021-03-26 14:15:57', '2021-03-26 14:15:57'),
(17951, 3046, 21388, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 18:00:23', '2021-03-15 18:00:23'),
(17952, 1006, 21388, NULL, '2021-04-02 00:00:00.000', 'Not Eligible', 'CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @ https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/  It is also attached for reference.  ', NULL, NULL, '2021-03-26 14:16:04', '2021-03-26 14:16:04'),
(17953, 3046, 21389, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 18:00:26', '2021-03-15 18:00:26'),
(17954, 1006, 21389, NULL, '2021-04-02 00:00:00.000', 'Not Eligible', 'CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @ https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/  It is also attached for reference.  ', NULL, NULL, '2021-03-26 14:16:10', '2021-03-26 14:16:10'),
(17955, 3046, 21390, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 18:00:27', '2021-03-15 18:00:27'),
(17956, 1006, 21390, NULL, '2021-04-02 00:00:00.000', 'Not Eligible', 'CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @ https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/  It is also attached for reference.  ', NULL, NULL, '2021-03-26 14:16:16', '2021-03-26 14:16:16'),
(17957, 3046, 21391, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 18:00:30', '2021-03-15 18:00:30'),
(17958, 1006, 21391, NULL, '2021-04-02 00:00:00.000', 'Not Eligible', 'CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @ https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/  It is also attached for reference.  ', NULL, NULL, '2021-03-26 14:16:22', '2021-03-26 14:16:22'),
(17959, 1006, 21392, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 18:02:38', '2021-03-15 18:02:38'),
(17960, 1019, 21392, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'To: Tufts_Health_Plan_Credentialing_Department@tufts-health.com Cc: Spectrum Neuro Behavioral Health snbc@claimsmedinc.com Hello,  Please find the attached request to initiate the credentialing/contracting for our provider Rodesia Edmundson. Do let me know if anything else is required. ', NULL, NULL, '2021-04-07 16:40:32', '2021-04-07 16:40:32'),
(17961, 3040, 21392, NULL, '2021-04-23 00:00:00.000', 'In Process', 'Email sent to: alliedcontracting@tuff-health.com  Subject: Enrollment Status || Spectrum Neuro Behavioral Care || Edmundson, Rodesia Sharese & Smith, Kerry R || Tufts Health ||  Greetings,   Hope you are doing well. Please advise me the enrollment status for the below mentioned providers.   Practice Name: Spectrum Neuro Behavioral Care  Practice Tax ID# 83-4482753 Practice NPI# 1356906572 Practice Address: 61 Lincoln St., Suite 203, Framingham , MA 01702  Provider Name: Edmundson, Rodesia Sharese Provider NPI# 1124622667   Practice Name: Spectrum Neuro Behavioral Care Practice Tax ID# 83-4482753 Practice NPI# 1356906572 Practice Address: 61 Lincoln St., Suite 203, Framingham , MA 01702  Provider Name: Smith, Kerry R Provider NPI# 1275083230  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-04-16 14:24:53', '2021-04-16 14:24:53'),
(17962, 1019, 21392, NULL, '2021-05-03 00:00:00.000', 'In Process', 'Received the following email from Tufts_Health_Plan_Credentialing_Department@tufts-health.com SUB: PPO0097388 - Fwd: Enrollment Status || Spectrum Neuro Behavioral Care || Edmundson, Rodesia Sharese & Smith, Kerry R || Tufts Health ||  incident number - PPO0097388       Hello   Rodesia S Edmundson, APRN - app received, contract will be sent out in roughly 2 weeks.  Once we get the signed copy, she will enter credentialing.  Once cred is complete, she will be all set.   Kerry Smith, LICSW - same as her, but will be sent a contract this week.   Just an FYI, all contracts require the provider\'s signature... no one else can put their name in place of theirs.   Thank you Provider Operations   Ref:MSG6840834', NULL, NULL, '2021-04-26 09:47:22', '2021-04-26 09:47:22'),
(17963, 1019, 21392, NULL, '2021-06-10 00:00:00.000', 'In Process', 'Received the following email from Tufts_Health_Plan_Credentialing_Department@tufts-health.com SUB: Allied Health Provider Agreement for Rodesia S Edmundson, APRN  Hello, Attached please find your Allied Health Provider Agreement with Tufts Associated Health Maintenance Organization, Inc., Total Health Plan, Inc.  Complete the signature page (signature, printed name, title, and date) and return to us so that we may countersign it.  If you make any changes to the contract document we will not be able to process your contract for you.  You may return the completed signature page via email to:  Tufts_Health_Plan_Credentialing_Department@tufts-health.com or fax it to 617-972-9591  Once we are in receipt of your completed contract, the credentialing process will begin.    Thank you   Tufts Health Plan', NULL, NULL, '2021-05-26 14:40:29', '2021-05-26 14:40:29'),
(17964, 1019, 21392, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Sent the following email to Tufts_Health_Plan_Credentialing_Department@tufts-health.com   Hello, Attached is the Signed provider agreement, Let me know if anything else is required.  Thank  you,', NULL, NULL, '2021-05-26 14:41:52', '2021-05-26 14:41:52'),
(17965, 1019, 21392, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to provider_data_request@tufts-health.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tufts Health Plans  Hello, We need the enrollment status for the following providers under our group, as their applications have been in process for a while now.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert NPI: 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  ', NULL, NULL, '2021-06-05 13:03:21', '2021-06-05 13:03:21'),
(17966, 1019, 21392, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Sent the following email to Kody_Dunnett@tufts-health.com  Hello Kody,  We need to expedite the applications for the following providers of Credentialing and Contracting as it is In process since a while now as it is adversely affecting our business, also we are not getting proper responses on our emails.  Spectrum Neuro Behavioral Care LLC. 1356906572 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rodesia Edmundson  1124622667  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Mary Gibbons  NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Lynnetta Loveland  NPI: 1598163602  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Jonathan Schubert  NPI: 1235755505  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jennifer Ullrich NPI: 1710489760  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Prisca Hefti NPI: 1508133182  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767  Regards, Alex G', NULL, NULL, '2021-06-23 09:26:51', '2021-06-23 09:26:51'),
(17967, 1019, 21392, NULL, '2021-07-08 00:00:00.000', 'Approved', 'Received the following email from AHCBehavioralHealth@tufts-health.com  Dear Provider, Welcome to Tufts Health Plan! We are pleased to have you as part of our provider network.  Please find a copy of your fully executed Allied Health Services Provider Agreement attached. Your in-network effective date is: 06/29/2021  Please check member eligibility, benefits, and authorization requirements prior to rendering services by contacting the Tufts Health Plan Behavioral Health Department at (800) 208-9565 or via the Secure Provider Website.  Please refer to the following links for additional resources:  - Behavioral Health Provider Resource Guide   - Registration Instructions for Secure Provider Websites - All Products - Product Overview and Member ID Card Guide - Electronic Data Interchange (EDI) Overview - Electronic Claim Submission Frequently Asked Questions - Provider Contact Information - Provider Information Change Form  We look forward to working with you! thpwatsmr1.tufts-health.com made the following annotations', NULL, NULL, '2021-07-01 13:16:35', '2021-07-01 13:16:35'),
(17968, 1006, 21393, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 18:02:40', '2021-03-15 18:02:40'),
(17969, 1006, 21393, NULL, '2021-04-28 00:00:00.000', 'In Process', 'Sent a f/u email to Kody Dunnett Kody_Dunnett@tufts-health.com & Bennett Tansey Bennett_Tansey@tufts-health.com to get an update on the status of enrollment and get welcome letters:  Sub: Provider/Group Enrollment Query - SNBCare - Tufts Health Plan  \"Hello,   I hope you\'re doing well, I wanted to verify the effective dates for the following providers and group as well as get their welcome letters if possible, the information is as follows:  Group Name: Spectrum Neuro Behavioral Care LLC NPI# 1356906572  Provider Name: Mahreen Rashid NPI# 1396393146  Provider Name: Katie Tawakol NPI# 1609222116  Provider Name: Prisca Hefti NPI# 1508133182  Also, please let me know what addresses the providers are enrolled under if possible. Please get back to me as soon as you\'re able to.   Thank you. \" ', NULL, NULL, '2021-04-21 12:47:44', '2021-04-21 12:47:44'),
(17970, 1019, 21393, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to provider_data_request@tufts-health.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tufts Health Plans  Hello, We need the enrollment status for the following providers under our group, as their applications have been in process for a while now.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert NPI: 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  ', NULL, NULL, '2021-06-05 13:03:14', '2021-06-05 13:03:14'),
(17971, 1019, 21393, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Sent the following email to Kody_Dunnett@tufts-health.com  Hello Kody,  We need to expedite the applications for the following providers of Credentialing and Contracting as it is In process since a while now as it is adversely affecting our business, also we are not getting proper responses on our emails.  Spectrum Neuro Behavioral Care LLC. 1356906572 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rodesia Edmundson  1124622667  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Mary Gibbons  NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Lynnetta Loveland  NPI: 1598163602  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Jonathan Schubert  NPI: 1235755505  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jennifer Ullrich NPI: 1710489760  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Prisca Hefti NPI: 1508133182  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767  Regards, Alex G', NULL, NULL, '2021-06-23 09:26:37', '2021-06-23 09:26:37'),
(17972, 1019, 21393, NULL, '2021-07-14 00:00:00.000', 'Approved', 'Received the following email from Brady_Roche@tufts-health.com  Hi Alex,  My department can help with effective dates, I have provided them on the spreadsheet. I have included Katherine in Allied and Christine in Credentialing as one is still in cred process and the other needs to be linked to the group.  Thanks,  Effective Date is 04/08/2020 Attached are the Location Addition and Provider Roster of Tufts', NULL, NULL, '2021-07-07 09:35:10', '2021-07-07 09:35:10'),
(17973, 1006, 21394, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 18:02:42', '2021-03-15 18:02:42'),
(17974, 1006, 21394, NULL, '2021-04-28 00:00:00.000', 'Approved', 'Received the following reply from IT Service Desk Tufts_Health_Plan_Credentialing_Department@tufts-health.com:  \"Hi Brad   Barbara Hignite, APRN - all set eff 1.7.2021, ID 370708   Carlee Rozell, NP - all set eff 1.22.2021, ID 228943   Jessica Hartman, APRN - all set eff 12.31.2021, ID 869409   Thank you Provider Operations\" ', NULL, NULL, '2021-04-21 12:08:56', '2021-04-21 12:08:56'),
(17975, 1006, 21395, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 18:02:44', '2021-03-15 18:02:44'),
(17976, 1006, 21395, NULL, '2021-04-27 00:00:00.000', 'Approved', 'The provider is enrolled with Tufts as of 05/09/2019, I\'ve attached an approval confirmation & location confirmation for reference as Tufts did not send welcome letters for provider addition.  ', NULL, NULL, '2021-04-20 15:50:04', '2021-04-20 15:50:04'),
(17977, 1006, 21396, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 18:02:46', '2021-03-15 18:02:46'),
(17978, 1006, 21396, NULL, '2021-04-29 00:00:00.000', 'Initiated', 'Sent an update inquiry email @ Tufts Health Plan Credentialing Department Tufts_Health_Plan_Credentialing_Department@tufts-health.com & Provider Data Request Provider_Data_Request@tufts-health.com:  Sub: Provider/Group Enrollment Query - SNBCare - Tufts Health  \"Hello,   I hope you\'re doing well, I wanted to verify the effective dates for the following providers and group as well as get their welcome letters if possible, the information is as follows:  Group Name: Spectrum Neuro Behavioral Care LLC NPI# 1356906572  Provider Name: Mahreen Rashid NPI# 1396393146  Provider Name: Katie Tawakol NPI# 1609222116  Provider Name: Prisca Hefti NPI# 1508133182  Provider Name: Peggy Pionke NPI# 1699307322  Also, please let me know what addresses and plans the providers are enrolled under if possible. Please get back to me as soon as you\'re able to.   Thank you. \"', NULL, NULL, '2021-04-22 08:22:59', '2021-04-22 08:22:59'),
(17979, 1019, 21396, NULL, '2021-05-18 00:00:00.000', 'In Process', 'Received the following email from  Tufts_Health_Plan_Credentialing_Department@tufts-health.com   Hello,  Attached please find your Allied Health Provider Agreement with Tufts Associated Health Maintenance Organization, Inc., Total Health Plan, Inc.     Complete the signature page (signature, printed name, title, and date) and return to us so that we may countersign it.     If you make any changes to the contract document we will not be able to process your contract for you.     You may return the completed signature page via email to:  Tufts_Health_Plan_Credentialing_Department@tufts-health.com or fax it to 617-972-9591     Once we are in receipt of your completed contract, the credentialing process will begin.       Thank you    Tufts Health Plan   ', NULL, NULL, '2021-05-10 08:22:52', '2021-05-10 08:22:52'),
(17980, 1019, 21396, NULL, '2021-05-18 00:00:00.000', 'In Process', 'Sent the following email to Tufts_Health_Plan_Credentialing_Department@tufts-health.com  Hello, Find the attached signed document, let us know if anything else is needed.     Thank you,', NULL, NULL, '2021-05-10 08:28:53', '2021-05-10 08:28:53'),
(17981, 1019, 21396, NULL, '2021-05-24 00:00:00.000', 'In Process', 'Received the following email from Tufts_Health_Plan_Credentialing_Department@tufts-health.com SUB: PPO0100592 - RE: Allied Health Provider Agreement for Peggy Pionke, LCSW  Incident number - PPO0100592   Hello,  We have submitted your contract to our Behavioral Health Department for review. Please allow at least 14 days for our systems to reflect the changes made to your contract. Thank you and have a great day.  Ref:MSG6923137', NULL, NULL, '2021-05-17 08:08:58', '2021-05-17 08:08:58'),
(17982, 1019, 21396, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to provider_data_request@tufts-health.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tufts Health Plans  Hello, We need the enrollment status for the following providers under our group, as their applications have been in process for a while now.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert NPI: 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  ', NULL, NULL, '2021-06-05 13:03:08', '2021-06-05 13:03:08'),
(17983, 1019, 21396, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Sent the following email to Kody_Dunnett@tufts-health.com  Hello Kody,  We need to expedite the applications for the following providers of Credentialing and Contracting as it is In process since a while now as it is adversely affecting our business, also we are not getting proper responses on our emails.  Spectrum Neuro Behavioral Care LLC. 1356906572 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rodesia Edmundson  1124622667  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Mary Gibbons  NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Lynnetta Loveland  NPI: 1598163602  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Jonathan Schubert  NPI: 1235755505  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jennifer Ullrich NPI: 1710489760  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Prisca Hefti NPI: 1508133182  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767  Regards, Alex G', NULL, NULL, '2021-06-23 09:26:29', '2021-06-23 09:26:29'),
(17984, 1019, 21396, NULL, '2021-07-14 00:00:00.000', 'Approved', 'Received the following email from Brady_Roche@tufts-health.com  Hi Alex,  My department can help with effective dates, I have provided them on the spreadsheet. I have included Katherine in Allied and Christine in Credentialing as one is still in cred process and the other needs to be linked to the group.  Thanks,  Effective Date is 05/04/2021 Attached are the Location Addition and Provider Roster of Tufts', NULL, NULL, '2021-07-07 11:58:35', '2021-07-07 11:58:35'),
(17985, 1006, 21397, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 18:02:48', '2021-03-15 18:02:48'),
(17986, 1006, 21397, NULL, '2021-04-28 00:00:00.000', 'In Process', 'Sent a f/u email to Kody Dunnett Kody_Dunnett@tufts-health.com & Bennett Tansey Bennett_Tansey@tufts-health.com to get an update on the status of enrollment and get welcome letters:  Sub: Provider/Group Enrollment Query - SNBCare - Tufts Health Plan  \"Hello,   I hope you\'re doing well, I wanted to verify the effective dates for the following providers and group as well as get their welcome letters if possible, the information is as follows:  Group Name: Spectrum Neuro Behavioral Care LLC NPI# 1356906572  Provider Name: Mahreen Rashid NPI# 1396393146  Provider Name: Katie Tawakol NPI# 1609222116  Provider Name: Prisca Hefti NPI# 1508133182  Also, please let me know what addresses the providers are enrolled under if possible. Please get back to me as soon as you\'re able to.   Thank you. \"', NULL, NULL, '2021-04-21 12:28:45', '2021-04-21 12:28:45'),
(17987, 1019, 21397, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to provider_data_request@tufts-health.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tufts Health Plans  Hello, We need the enrollment status for the following providers under our group, as their applications have been in process for a while now.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert NPI: 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  ', NULL, NULL, '2021-06-05 13:03:00', '2021-06-05 13:03:00'),
(17988, 1019, 21397, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Sent the following email to Kody_Dunnett@tufts-health.com  Hello Kody,  We need to expedite the applications for the following providers of Credentialing and Contracting as it is In process since a while now as it is adversely affecting our business, also we are not getting proper responses on our emails.  Spectrum Neuro Behavioral Care LLC. 1356906572 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rodesia Edmundson  1124622667  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Mary Gibbons  NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Lynnetta Loveland  NPI: 1598163602  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Jonathan Schubert  NPI: 1235755505  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jennifer Ullrich NPI: 1710489760  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Prisca Hefti NPI: 1508133182  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767  Regards, Alex G', NULL, NULL, '2021-06-23 09:26:21', '2021-06-23 09:26:21'),
(17989, 1019, 21397, NULL, '2021-07-14 00:00:00.000', 'Approved', 'Received the following email from Brady_Roche@tufts-health.com  Hi Alex,  My department can help with effective dates, I have provided them on the spreadsheet. I have included Katherine in Allied and Christine in Credentialing as one is still in cred process and the other needs to be linked to the group.  Thanks,  Effective Date is 12/09/2019 Attached are the Location Addition and Provider Roster of Tufts', NULL, NULL, '2021-07-07 12:01:23', '2021-07-07 12:01:23'),
(17990, 1006, 21398, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 18:02:50', '2021-03-15 18:02:50'),
(17991, 1006, 21398, NULL, '2021-04-28 00:00:00.000', 'Approved', 'We received the following approval confirmation from @ Kody Dunnett Kody_Dunnett@tufts-health.com:  Sub: Provider Addition Request - Pandeeswari Raveendran  \"Hi  Pandeeswari Raveendran, MD – ID 223592, in network, linked to Spectrum Neuro  Behavioral Care effective 10.8.2020  Thanks\"  No welcome letter or contract since provider was linked to group, directory confirmation is attached for reference.', NULL, NULL, '2021-04-21 12:16:23', '2021-04-21 12:16:23'),
(17992, 1006, 21399, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 18:02:51', '2021-03-15 18:02:51'),
(17993, 1006, 21399, NULL, '2021-04-28 00:00:00.000', 'Approved', 'Received the following reply from IT Service Desk Tufts_Health_Plan_Credentialing_Department@tufts-health.com:  \"Hi Brad   Barbara Hignite, APRN - all set eff 1.7.2021, ID 370708   Carlee Rozell, NP - all set eff 1.22.2021, ID 228943   Jessica Hartman, APRN - all set eff 12.31.2021, ID 869409   Thank you Provider Operations\" ', NULL, NULL, '2021-04-21 12:05:21', '2021-04-21 12:05:21'),
(17994, 1006, 21400, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 18:02:53', '2021-03-15 18:02:53'),
(17995, 1006, 21400, NULL, '2021-04-28 00:00:00.000', 'Not Eligible', 'Received following rejection from Kody: \"Hi Brad  Jennifer Lee Ullrich, LICSW and Jonathan Schubert, LCSW both had their apps discontinued.  The Cred Specialist wrote “Discontinued as provider only holds LCSW and not required LICSW”  Thanks\" ', NULL, NULL, '2021-04-21 12:03:33', '2021-04-21 12:03:33'),
(17996, 1019, 21400, NULL, '2021-10-06 00:00:00.000', 'In Process', 'Sent the following email to Tufts_Health_Plan_Credentialing_Department@tufts-health.com, - provider_data_request@tufts-health.com  Good Morning, Attached is the application for our provider as he is LICSW now, please expedite this application as we were waiting on it for several months now.', NULL, NULL, '2021-09-29 07:57:05', '2021-09-29 07:57:05'),
(17997, 1019, 21400, NULL, '2021-10-26 00:00:00.000', 'In Process', 'Received the following email from Tufts. Hello ,  We are in receipt of your request regarding Enrollment Application || Jonathan Schubert || SNBCARE || Tufts Health/ Tufts Public Plans that was submitted on 2021-09-29 08:57:52 EDT.  Please reference ticket number PRO0150549 for further communications about this request.  Thank you,  Tufts Health Public Plans, Provider Information Management Team    Ref:MSG7645241', NULL, NULL, '2021-10-19 08:22:38', '2021-10-19 08:22:38'),
(17998, 11056, 21400, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email sent to: Denise_Rysinger@tufts-health.com  Sub: Fwd: Enrollment Issue with Tufts Health Plan  Hello,  We are facing issues getting our provider credentialed with Tufts as your process has been too long, due to which we are having issues seeing our patients. We have submitted the signed agreement for the following back in March and the rest others we have sent an enrollment application to Tufts but still didn\'t hear anything.     Group:  Spectrum Neuro Behavioral Care LLC. NPI: 1356906572     Providers  Loveland, Lynnetta -  NPI: 1598163602  Schubert, Jonathan –  NPI: 1235755505  Filoteo-Nichols, Dina - NPI: 1770021099  Halterman, Helena –  NPI: 1801473749', NULL, NULL, '2021-12-03 14:53:01', '2021-12-03 14:53:01'),
(17999, 19067, 21400, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com  Subject: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||   Hello,  Hope this email finds you well.  I want to know the enrollment status for the following providers under mentioned locations and also the group credentialing status.  If any Provider is enrolled provide me with their Effective date and Welcome letter.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Dina, Filoteo-Nichols	1770021099	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Dina, Filoteo-Nichols	1770021099	100 New State Highway, Raynham, MA, 02767. Loveland, Lynnetta	1598163602	100 New State Highway, Raynham, MA, 02767. Loveland, Lynnetta	1598163602	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Oliva, Erin	1407349632	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Schubert, Jonathan	1235755505	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Schubert, Jonathan	1235755505	100 New State Highway, Raynham, MA, 02767.  Kindly respond to me in a timely manner.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-15 17:41:05', '2021-12-15 17:41:05'),
(18000, 19067, 21400, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: Provider_Data_Request@tufts-health.com, tufts_health_plan_credentialing_department@tufts-health.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||   Good Morning!  Hope you are doing well and having a productive day.  I would like to know the enrollment status of the following Providers and Groups.   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Dina Filoteo-Nichols	1770021099	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Dina Filoteo-Nichols	1770021099	100 New State HWY, Raynham, MA 02767-5423 Helena Halterman	1801473749	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Helena Halterman	1801473749	100 New State HWY, Raynham, MA 02767-5423 Jonathan Schubert	1235755505	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Jonathan Schubert	1235755505	100 New State HWY, Raynham, MA 02767-5423 Lynnetta Loveland	1598163602	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Lynnetta Loveland	1598163602	100 New State HWY, Raynham, MA 02767-5423 Erin Oliva	1407349632	63 Eddie Dowling HWY, Suite 8, North Smithfield, RI 02896-7322   Kindly respond to us in a timely manner.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 10:06:00', '2021-12-29 10:06:00'),
(18001, 19067, 21400, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com, Provider_Data_Request@tufts-health.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||  Greetings!  Hope this email finds you well.  Any updates on the previously mentioned request?  Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 14:45:45', '2022-01-10 14:45:45'),
(18002, 19067, 21400, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com, Provider_Data_Request@tufts-health.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||   Hello!  This is my SECOND REMINDER on the previously mentioned request.  Kindly respond as per your convenience.  Regards, Hammad Ahmed. ', NULL, NULL, '2022-02-11 11:39:28', '2022-02-11 11:39:28'),
(18003, 22077, 21400, NULL, '2022-04-12 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com  Subject: Fwd: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||  Hello,  Hope this email finds you well.  Any updates on the previously mentioned request?  Kindly respond promptly.  Thanks,', NULL, NULL, '2022-04-05 10:09:37', '2022-04-05 10:09:37'),
(18004, 1006, 21401, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 18:02:55', '2021-03-15 18:02:55'),
(18005, 1019, 21401, NULL, '2021-04-07 00:00:00.000', 'Initiated', 'To: Tufts_Health_Plan_Credentialing_Department@tufts-health.com Cc: Spectrum Neuro Behavioral Health snbc@claimsmedinc.com Hello,  Please find the attached request to initiate the credentialing/contracting for our provider Kerry Smith. Do let me know if anything else is required. ', NULL, NULL, '2021-03-31 08:17:14', '2021-03-31 08:17:14'),
(18006, 3040, 21401, NULL, '2021-04-23 00:00:00.000', 'In Process', 'Email sent to: alliedcontracting@tuff-health.com  Subject: Enrollment Status || Spectrum Neuro Behavioral Care || Edmundson, Rodesia Sharese & Smith, Kerry R || Tufts Health ||  Greetings,   Hope you are doing well. Please advise me the enrollment status for the below mentioned providers.   Practice Name: Spectrum Neuro Behavioral Care  Practice Tax ID# 83-4482753 Practice NPI# 1356906572 Practice Address: 61 Lincoln St., Suite 203, Framingham , MA 01702  Provider Name: Edmundson, Rodesia Sharese Provider NPI# 1124622667   Practice Name: Spectrum Neuro Behavioral Care Practice Tax ID# 83-4482753 Practice NPI# 1356906572 Practice Address: 61 Lincoln St., Suite 203, Framingham , MA 01702  Provider Name: Smith, Kerry R Provider NPI# 1275083230  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-04-16 14:24:57', '2021-04-16 14:24:57');
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
(18007, 1019, 21401, NULL, '2021-05-03 00:00:00.000', 'In Process', 'Received the following email from Tufts_Health_Plan_Credentialing_Department@tufts-health.com SUB: PPO0097388 - Fwd: Enrollment Status || Spectrum Neuro Behavioral Care || Edmundson, Rodesia Sharese & Smith, Kerry R || Tufts Health ||  incident number - PPO0097388       Hello   Rodesia S Edmundson, APRN - app received, contract will be sent out in roughly 2 weeks.  Once we get the signed copy, she will enter credentialing.  Once cred is complete, she will be all set.   Kerry Smith, LICSW - same as her, but will be sent a contract this week.   Just an FYI, all contracts require the provider\'s signature... no one else can put their name in place of theirs.   Thank you Provider Operations   Ref:MSG6840834', NULL, NULL, '2021-04-26 09:47:45', '2021-04-26 09:47:45'),
(18008, 1019, 21401, NULL, '2021-05-18 00:00:00.000', 'In Process', 'Received the following email from  Tufts_Health_Plan_Credentialing_Department@tufts-health.com   Hello,  Attached please find your Allied Health Provider Agreement with Tufts Associated Health Maintenance Organization, Inc., Total Health Plan, Inc.     Complete the signature page (signature, printed name, title, and date) and return to us so that we may countersign it.     If you make any changes to the contract document we will not be able to process your contract for you.     You may return the completed signature page via email to:  Tufts_Health_Plan_Credentialing_Department@tufts-health.com or fax it to 617-972-9591     Once we are in receipt of your completed contract, the credentialing process will begin.       Thank you    Tufts Health Plan', NULL, NULL, '2021-05-10 07:49:53', '2021-05-10 07:49:53'),
(18009, 1019, 21401, NULL, '2021-05-18 00:00:00.000', 'In Process', 'Sent the following email to Tufts_Health_Plan_Credentialing_Department@tufts-health.com Hello, Find the attached signed document, let us know if anything else is needed.     Thank you,', NULL, NULL, '2021-05-10 07:52:09', '2021-05-10 07:52:09'),
(18010, 1019, 21401, NULL, '2021-05-21 00:00:00.000', 'In Process', 'Received the following email from Tufts_Health_Plan_Credentialing_Department@tufts-health.com SUB: PPO0100584 - Re: Allied Health Provider Agreement for Kerry Smith, LICSW  incident number - PPO0100584   Hello,  The contract has been received and is being reviewed by a credentialing specialist. We will contact you if any other information is needed. Please allow at least 30 business days for us to complete credentialing. Thank you and have a wonderful day.   Ref:MSG6923033', NULL, NULL, '2021-05-14 13:09:47', '2021-05-14 13:09:47'),
(18011, 1019, 21401, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to provider_data_request@tufts-health.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tufts Health Plans  Hello, We need the enrollment status for the following providers under our group, as their applications have been in process for a while now.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert NPI: 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  ', NULL, NULL, '2021-06-05 13:02:54', '2021-06-05 13:02:54'),
(18012, 1019, 21401, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Sent the following email to Kody_Dunnett@tufts-health.com  Hello Kody,  We need to expedite the applications for the following providers of Credentialing and Contracting as it is In process since a while now as it is adversely affecting our business, also we are not getting proper responses on our emails.  Spectrum Neuro Behavioral Care LLC. 1356906572 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rodesia Edmundson  1124622667  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Mary Gibbons  NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Lynnetta Loveland  NPI: 1598163602  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Jonathan Schubert  NPI: 1235755505  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jennifer Ullrich NPI: 1710489760  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Prisca Hefti NPI: 1508133182  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767  Regards, Alex G', NULL, NULL, '2021-06-23 09:26:13', '2021-06-23 09:26:13'),
(18013, 1019, 21401, NULL, '2021-07-14 00:00:00.000', 'Approved', 'Received the following email from AHCBehavioralHealth@tufts-health.com  Dear Provider, Welcome to Tufts Health Plan! We are pleased to have you as part of our provider network.  Please find a copy of your fully executed Allied Health Services Provider Agreement attached.  Your in-network effective date is: 06/10/2021', NULL, NULL, '2021-07-07 12:07:39', '2021-07-07 12:07:39'),
(18014, 1006, 21402, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 18:02:57', '2021-03-15 18:02:57'),
(18015, 1006, 21402, NULL, '2021-04-28 00:00:00.000', 'In Process', 'Sent a f/u email to Kody Dunnett Kody_Dunnett@tufts-health.com & Bennett Tansey Bennett_Tansey@tufts-health.com to get an update on the status of enrollment and get welcome letters:  Sub: Provider/Group Enrollment Query - SNBCare - Tufts Health Plan  \"Hello,   I hope you\'re doing well, I wanted to verify the effective dates for the following providers and group as well as get their welcome letters if possible, the information is as follows:  Group Name: Spectrum Neuro Behavioral Care LLC NPI# 1356906572  Provider Name: Mahreen Rashid NPI# 1396393146  Provider Name: Katie Tawakol NPI# 1609222116  Provider Name: Prisca Hefti NPI# 1508133182  Also, please let me know what addresses the providers are enrolled under if possible. Please get back to me as soon as you\'re able to.   Thank you. \" ', NULL, NULL, '2021-04-21 12:47:23', '2021-04-21 12:47:23'),
(18016, 1019, 21402, NULL, '2021-06-12 00:00:00.000', 'In Process', 'Sent the following email to provider_data_request@tufts-health.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tufts Health Plans  Hello, We need the enrollment status for the following providers under our group, as their applications have been in process for a while now.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert NPI: 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  ', NULL, NULL, '2021-06-05 13:02:32', '2021-06-05 13:02:32'),
(18017, 1019, 21402, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Sent the following email to Kody_Dunnett@tufts-health.com  Hello Kody,  We need to expedite the applications for the following providers of Credentialing and Contracting as it is In process since a while now as it is adversely affecting our business, also we are not getting proper responses on our emails.  Spectrum Neuro Behavioral Care LLC. 1356906572 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rodesia Edmundson  1124622667  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Mary Gibbons  NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Lynnetta Loveland  NPI: 1598163602  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Jonathan Schubert  NPI: 1235755505  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jennifer Ullrich NPI: 1710489760  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Prisca Hefti NPI: 1508133182  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767  Regards, Alex G', NULL, NULL, '2021-06-23 09:39:17', '2021-06-23 09:39:17'),
(18018, 1019, 21402, NULL, '2021-07-14 00:00:00.000', 'Approved', 'Received the following email from Brady_Roche@tufts-health.com  Hi Alex,  My department can help with effective dates, I have provided them on the spreadsheet. I have included Katherine in Allied and Christine in Credentialing as one is still in cred process and the other needs to be linked to the group.  Thanks,  Effective Date is 02/10/2020 Attached are the Location Addition and Provider Roster of Tufts', NULL, NULL, '2021-07-07 12:03:35', '2021-07-07 12:03:35'),
(18019, 1006, 21403, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 18:02:59', '2021-03-15 18:02:59'),
(18020, 1006, 21403, NULL, '2021-04-28 00:00:00.000', 'Not Eligible', 'Received following rejection from Kody: \"Hi Brad  Jennifer Lee Ullrich, LICSW and Jonathan Schubert, LCSW both had their apps discontinued.  The Cred Specialist wrote “Discontinued as provider only holds LCSW and not required LICSW”  Thanks\" ', NULL, NULL, '2021-04-21 12:03:23', '2021-04-21 12:03:23'),
(18021, 1006, 21404, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 18:03:01', '2021-03-15 18:03:01'),
(18022, 1006, 21404, NULL, '2021-04-28 00:00:00.000', 'In Process', 'Sent a f/u email to Kody Dunnett Kody_Dunnett@tufts-health.com & Bennett Tansey Bennett_Tansey@tufts-health.com to get an update on the status of enrollment and get welcome letters:  Sub: Provider/Group Enrollment Query - SNBCare - Tufts Health Plan  \"Hello,   I hope you\'re doing well, I wanted to verify the effective dates for the following providers and group as well as get their welcome letters if possible, the information is as follows:  Group Name: Spectrum Neuro Behavioral Care LLC NPI# 1356906572  Provider Name: Mahreen Rashid NPI# 1396393146  Provider Name: Katie Tawakol NPI# 1609222116  Provider Name: Prisca Hefti NPI# 1508133182  Also, please let me know what addresses the providers are enrolled under if possible. Please get back to me as soon as you\'re able to.   Thank you. \"', NULL, NULL, '2021-04-21 12:28:24', '2021-04-21 12:28:24'),
(18023, 1019, 21404, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to provider_data_request@tufts-health.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tufts Health Plans  Hello, We need the enrollment status for the following providers under our group, as their applications have been in process for a while now.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert NPI: 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  ', NULL, NULL, '2021-06-05 13:02:21', '2021-06-05 13:02:21'),
(18024, 1019, 21404, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Sent the following email to Kody_Dunnett@tufts-health.com  Hello Kody,  We need to expedite the applications for the following providers of Credentialing and Contracting as it is In process since a while now as it is adversely affecting our business, also we are not getting proper responses on our emails.  Spectrum Neuro Behavioral Care LLC. 1356906572 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rodesia Edmundson  1124622667  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Mary Gibbons  NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Lynnetta Loveland  NPI: 1598163602  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Jonathan Schubert  NPI: 1235755505  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jennifer Ullrich NPI: 1710489760  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Prisca Hefti NPI: 1508133182  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767  Regards, Alex G', NULL, NULL, '2021-06-23 09:26:02', '2021-06-23 09:26:02'),
(18025, 11056, 21404, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email sent to: Denise_Rysinger@tufts-health.com  Sub: Fwd: Enrollment Issue with Tufts Health Plan  Hello,  We are facing issues getting our provider credentialed with Tufts as your process has been too long, due to which we are having issues seeing our patients. We have submitted the signed agreement for the following back in March and the rest others we have sent an enrollment application to Tufts but still didn\'t hear anything.     Group:  Spectrum Neuro Behavioral Care LLC. NPI: 1356906572     Providers  Loveland, Lynnetta -  NPI: 1598163602  Schubert, Jonathan –  NPI: 1235755505  Filoteo-Nichols, Dina - NPI: 1770021099  Halterman, Helena –  NPI: 1801473749', NULL, NULL, '2021-12-03 14:52:50', '2021-12-03 14:52:50'),
(18026, 19067, 21404, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: Provider_Data_Request@tufts-health.com, tufts_health_plan_credentialing_department@tufts-health.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||   Good Morning!  Hope you are doing well and having a productive day.  I would like to know the enrollment status of the following Providers and Groups.   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Dina Filoteo-Nichols	1770021099	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Dina Filoteo-Nichols	1770021099	100 New State HWY, Raynham, MA 02767-5423 Helena Halterman	1801473749	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Helena Halterman	1801473749	100 New State HWY, Raynham, MA 02767-5423 Jonathan Schubert	1235755505	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Jonathan Schubert	1235755505	100 New State HWY, Raynham, MA 02767-5423 Lynnetta Loveland	1598163602	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Lynnetta Loveland	1598163602	100 New State HWY, Raynham, MA 02767-5423 Erin Oliva	1407349632	63 Eddie Dowling HWY, Suite 8, North Smithfield, RI 02896-7322   Kindly respond to us in a timely manner.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 10:07:10', '2021-12-29 10:07:10'),
(18027, 19067, 21404, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com, Provider_Data_Request@tufts-health.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||  Greetings!  Hope this email finds you well.  Any updates on the previously mentioned request?  Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 14:45:40', '2022-01-10 14:45:40'),
(18028, 19067, 21404, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com, Provider_Data_Request@tufts-health.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||   Hello!  This is my SECOND REMINDER on the previously mentioned request.  Kindly respond as per your convenience.  Regards, Hammad Ahmed. ', NULL, NULL, '2022-02-11 11:40:15', '2022-02-11 11:40:15'),
(18029, 19067, 21404, NULL, '2022-03-04 00:00:00.000', 'In Process', 'Email sent to: Padrick_Shaughnessey@tufts-health.com  Subject: Enrollment Request || SNBCARE || TMS || Tufts Health Plans ||   To Whom It May Concern,    I am writing to formally request that the following CPT codes be amended to our existing contract.     90867 – Therapeutic Repetitive Transcranial Magnetic Stimulation (TMS) Treatment; Initial, Including Cortical Mapping, Motor Threshold Determination, Delivery and Management     90868 –  Therapeutic Repetitive Transcranial Magnetic Stimulation (TMS) Treatment; Subsequent Delivery and Management, Per Session     90869 – Therapeutic Repetitive Transcranial Magnetic Stimulation (TMS) Treatment; Subsequent Motor Threshold Re-Determination with Delivery and Management     Kindly advise when the addition of the codes listed above is complete and include an amended fee schedule with contracted rates for our reference.    Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	834482753 Group NPI	1356906572 Primary & Billing Address	61 Lincoln St, Ste 203, Framingham, MA 01702 Secondary Address	100 New State Highway, Raynham, MA 02767 Tertiary Address	63 Eddie Dowling Hwy, Suite 8, North Smithfield, RI 02896 Provider Name	NPI Fauzia Wali Khan	1699761965 Katie Tawakol	1609222116 Mahreen Rashid	1396393146 Prisca Hefti	1508133182 Peggy Pionke	1699307322 Barbara Arnold	1922432053 Lauren Powell	1285304980 Eliza Rodrigues	1821751405 Dina Filoteo-Nichols	1770021099 Allie DiCostanzo	1669045738 Helena Halterman	1801473749 Jessica Hartman	1326665472 Barbara Hignite	1982617262 Lynnetta Loveland	1598163602 Jonathan Schubert	1235755505 Kerry Smith	1275083230 Erin Oliva	1407349632      Thank you,', NULL, NULL, '2022-02-25 18:04:01', '2022-02-25 18:04:01'),
(18030, 19067, 21404, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email received from: Padrick.Shaughnessey@point32health.org  Subject: RE: Enrollment Request || SNBCARE || TMS || Tufts Health Plans || (Spectrum Neuro Behavioral Care LLC)    Hi Hammad & Alex     See attached TMS exhibit that need signature.  I have included the rates.  We will need both the group contract and exhibit signed before they are implemented.     We are awaiting on both.     Thanks,  Padrick', NULL, NULL, '2022-03-01 13:03:43', '2022-03-01 13:03:43'),
(18031, 19067, 21404, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email sent to: padrick.shaughnessey@point32health.org  Subject: RE: Enrollment Request || SNBCARE || TMS || Tufts Health Plans || (Spectrum Neuro Behavioral Care LLC)    Hi Padrick,  Kindly see the attached as per you requested and don\'t hesitate to reach me if you need any document or information.   Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-03-01 13:19:53', '2022-03-01 13:19:53'),
(18032, 19067, 21404, NULL, '2022-03-09 00:00:00.000', 'In Process', 'Email received from: Padrick.Shaughnessey@point32health.org  Subject: RE: Enrollment Request || SNBCARE || TMS || Tufts Health Plans || (Spectrum Neuro Behavioral Care LLC)    Hi Hammad,     Do you have signing authority for Spectrum Neuro Behavioral Care LLC?     Normal it would be a VP or higher that signs and exhibit or the contract.  Plus we need back the signed group contract that was sent to Alex.     We still do not have it.     Thanks,  Padrick', NULL, NULL, '2022-03-02 09:26:04', '2022-03-02 09:26:04'),
(18033, 19067, 21404, NULL, '2022-03-09 00:00:00.000', 'In Process', 'Email sent to: Padrick.Shaughnessey@point32health.org  Subject: Re: Enrollment Request || SNBCARE || TMS || Tufts Health Plans || (Spectrum Neuro Behavioral Care LLC)    Hello Padrick,   Attached is the Signed TMS exhibit, also I\'m still waiting for you to sent me that group contract as I never received that, also I have sent you several email to you with no reponse on them. Please share the group contract again here,    Regards, Alex', NULL, NULL, '2022-03-02 09:27:08', '2022-03-02 09:27:08'),
(18034, 22077, 21404, NULL, '2022-04-12 00:00:00.000', 'In Process', 'Email sent to: 	tufts_health_plan_credentialing_department@tufts-health.com  Subject: Fwd: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||  Hello,  Hope this email finds you well.  Any updates on the previously mentioned request?  Kindly respond promptly.  Thanks,', NULL, NULL, '2022-04-05 10:03:20', '2022-04-05 10:03:20'),
(18035, 1006, 21405, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 18:04:01', '2021-03-15 18:04:01'),
(18036, 1006, 21405, NULL, '2021-04-16 00:00:00.000', 'On Hold', 'The enrollment request is pending on the provider\'s RI PMHNP license to be issued. ', NULL, NULL, '2021-04-09 14:58:22', '2021-04-09 14:58:22'),
(18037, 1019, 21405, NULL, '2021-11-01 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCare.', NULL, NULL, '2021-10-25 10:45:38', '2021-10-25 10:45:38'),
(18038, 1006, 21406, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 18:04:04', '2021-03-15 18:04:04'),
(18039, 1006, 21406, NULL, '2021-04-27 00:00:00.000', 'Approved', 'The provider is enrolled with Tufts as of 05/09/2019, I\'ve attached an approval confirmation & location confirmation for reference as Tufts did not send welcome letters for provider addition. ', NULL, NULL, '2021-04-20 15:44:55', '2021-04-20 15:44:55'),
(18040, 1006, 21407, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 18:04:05', '2021-03-15 18:04:05'),
(18041, 1006, 21407, NULL, '2021-04-27 00:00:00.000', 'Approved', 'The provider has been enrolled: \"incident number - PPO0074495   Hello   Melody L\'Etoile, LICSW is all set, effective 12.31.2020.  ID 648533   Thank you Provider Operations Ref:MSG6380204\" ', NULL, NULL, '2021-04-20 16:01:00', '2021-04-20 16:01:00'),
(18042, 1006, 21408, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 18:04:11', '2021-03-15 18:04:11'),
(18043, 1006, 21408, NULL, '2021-04-27 00:00:00.000', 'Rejected', 'Received following reply from Tufts @ Tufts_Health_Plan_Credentialing_Department@tufts-health.com: \"incident number - PPO0072768   Hello   Erin Olivia, LICSW\'s application was discontinued due to not holding the required LICSW, per the Cred Specialist.   Thank you Provider Operations   Ref:MSG6318672\" ', NULL, NULL, '2021-04-20 16:18:49', '2021-04-20 16:18:49'),
(18044, 1019, 21408, NULL, '2021-10-06 00:00:00.000', 'Revalidation', 'Sent the following email to Tufts_Health_Plan_Credentialing_Department@tufts-health.com, - provider_data_request@tufts-health.com  Good Morning,  Attached is the application for our provider as he is LICSW now, please expedite this application as we were waiting on it for several months now.    Regards Alex', NULL, NULL, '2021-09-29 08:22:43', '2021-09-29 08:22:43'),
(18045, 1019, 21408, NULL, '2021-11-25 00:00:00.000', 'Revalidation', 'Sent the signed agreement back to tufts see attached for reference.', NULL, NULL, '2021-11-18 09:51:04', '2021-11-18 09:51:04'),
(18046, 11056, 21408, NULL, '2021-12-10 00:00:00.000', 'Revalidation', 'Email sent to: Denise_Rysinger@tufts-health.com  Sub: Fwd: Enrollment Issue with Tufts Health Plan  Hello,  We are facing issues getting our provider credentialed with Tufts as your process has been too long, due to which we are having issues seeing our patients. We have submitted the signed agreement for the following back in March and the rest others we have sent an enrollment application to Tufts but still didn\'t hear anything.     Group:  Spectrum Neuro Behavioral Care LLC. NPI: 1356906572     Providers  Loveland, Lynnetta -  NPI: 1598163602  Schubert, Jonathan –  NPI: 1235755505  Filoteo-Nichols, Dina - NPI: 1770021099  Halterman, Helena –  NPI: 1801473749', NULL, NULL, '2021-12-03 14:58:33', '2021-12-03 14:58:33'),
(18047, 1006, 21409, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 18:04:12', '2021-03-15 18:04:12'),
(18048, 1006, 21409, NULL, '2021-04-29 00:00:00.000', 'Initiated', 'Sent an update inquiry email @ Tufts Health Plan Credentialing Department Tufts_Health_Plan_Credentialing_Department@tufts-health.com & Provider Data Request Provider_Data_Request@tufts-health.com:  Sub: Provider/Group Enrollment Query - SNBCare - Tufts Health  \"Hello,   I hope you\'re doing well, I wanted to verify the effective dates for the following providers and group as well as get their welcome letters if possible, the information is as follows:  Group Name: Spectrum Neuro Behavioral Care LLC NPI# 1356906572  Provider Name: Mahreen Rashid NPI# 1396393146  Provider Name: Katie Tawakol NPI# 1609222116  Provider Name: Prisca Hefti NPI# 1508133182  Provider Name: Peggy Pionke NPI# 1699307322  Also, please let me know what addresses and plans the providers are enrolled under if possible. Please get back to me as soon as you\'re able to.   Thank you. \"', NULL, NULL, '2021-04-22 08:22:51', '2021-04-22 08:22:51'),
(18049, 1019, 21409, NULL, '2021-05-17 00:00:00.000', 'In Process', 'Received the following email from  Tufts_Health_Plan_Credentialing_Department@tufts-health.com    Hello,   Attached please find your Allied Health Provider Agreement with Tufts Associated Health Maintenance Organization, Inc., Total Health Plan, Inc.      Complete the signature page (signature, printed name, title, and date) and return to us so that we may countersign it.      If you make any changes to the contract document we will not be able to process your contract for you.      You may return the completed signature page via email to:  Tufts_Health_Plan_Credentialing_Department@tufts-health.com or fax it to 617-972-9591      Once we are in receipt of your completed contract, the credentialing process will begin.        Thank you     Tufts Health Plan    ', NULL, NULL, '2021-05-10 09:00:10', '2021-05-10 09:00:10'),
(18050, 1019, 21409, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to provider_data_request@tufts-health.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tufts Health Plans  Hello, We need the enrollment status for the following providers under our group, as their applications have been in process for a while now.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert NPI: 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  ', NULL, NULL, '2021-06-05 13:02:14', '2021-06-05 13:02:14'),
(18051, 1019, 21409, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Sent the following email to Kody_Dunnett@tufts-health.com  Hello Kody,  We need to expedite the applications for the following providers of Credentialing and Contracting as it is In process since a while now as it is adversely affecting our business, also we are not getting proper responses on our emails.  Spectrum Neuro Behavioral Care LLC. 1356906572 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rodesia Edmundson  1124622667  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Mary Gibbons  NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Lynnetta Loveland  NPI: 1598163602  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Jonathan Schubert  NPI: 1235755505  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jennifer Ullrich NPI: 1710489760  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Prisca Hefti NPI: 1508133182  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767  Regards, Alex G', NULL, NULL, '2021-06-23 09:32:08', '2021-06-23 09:32:08'),
(18052, 1019, 21409, NULL, '2021-07-14 00:00:00.000', 'Approved', 'Received the following email from Brady_Roche@tufts-health.com  Hi Alex,  My department can help with effective dates, I have provided them on the spreadsheet. I have included Katherine in Allied and Christine in Credentialing as one is still in cred process and the other needs to be linked to the group.  Thanks,  Effective Date is 05/04/2021 Attached are the Location Addition and Provider Roster of Tufts', NULL, NULL, '2021-07-07 11:58:06', '2021-07-07 11:58:06'),
(18053, 1006, 21410, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 18:04:14', '2021-03-15 18:04:14'),
(18054, 1006, 21410, NULL, '2021-04-28 00:00:00.000', 'In Process', 'Sent a f/u email to Kody Dunnett Kody_Dunnett@tufts-health.com & Bennett Tansey Bennett_Tansey@tufts-health.com to get an update on the status of enrollment and get welcome letters:  Sub: Provider/Group Enrollment Query - SNBCare - Tufts Health Plan  \"Hello,   I hope you\'re doing well, I wanted to verify the effective dates for the following providers and group as well as get their welcome letters if possible, the information is as follows:  Group Name: Spectrum Neuro Behavioral Care LLC NPI# 1356906572  Provider Name: Mahreen Rashid NPI# 1396393146  Provider Name: Katie Tawakol NPI# 1609222116  Provider Name: Prisca Hefti NPI# 1508133182  Also, please let me know what addresses the providers are enrolled under if possible. Please get back to me as soon as you\'re able to.   Thank you. \"', NULL, NULL, '2021-04-21 12:28:50', '2021-04-21 12:28:50'),
(18055, 1019, 21410, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to provider_data_request@tufts-health.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tufts Health Plans  Hello, We need the enrollment status for the following providers under our group, as their applications have been in process for a while now.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert NPI: 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  ', NULL, NULL, '2021-06-05 13:02:07', '2021-06-05 13:02:07');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(18056, 1019, 21410, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Sent the following email to Kody_Dunnett@tufts-health.com  Hello Kody,  We need to expedite the applications for the following providers of Credentialing and Contracting as it is In process since a while now as it is adversely affecting our business, also we are not getting proper responses on our emails.  Spectrum Neuro Behavioral Care LLC. 1356906572 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rodesia Edmundson  1124622667  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Mary Gibbons  NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Lynnetta Loveland  NPI: 1598163602  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Jonathan Schubert  NPI: 1235755505  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jennifer Ullrich NPI: 1710489760  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Prisca Hefti NPI: 1508133182  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767  Regards, Alex G', NULL, NULL, '2021-06-23 09:31:59', '2021-06-23 09:31:59'),
(18057, 1019, 21410, NULL, '2021-07-14 00:00:00.000', 'Approved', 'Received the following email from Brady_Roche@tufts-health.com  Hi Alex,  My department can help with effective dates, I have provided them on the spreadsheet. I have included Katherine in Allied and Christine in Credentialing as one is still in cred process and the other needs to be linked to the group.  Thanks,  Effective Date is 12/09/2019 Attached are the Location Addition and Provider Roster of Tufts', NULL, NULL, '2021-07-07 12:00:38', '2021-07-07 12:00:38'),
(18058, 1006, 21411, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 18:04:17', '2021-03-15 18:04:17'),
(18059, 1019, 21411, NULL, '2021-03-25 00:00:00.000', 'Initiated', 'To: Tufts_Health_Plan_Credentialing_Department@tufts-health.com Cc: Spectrum Neuro Behavioral Health snbc@claimsmedinc.com Hello,  Please find the attached request to initiate the credentialing/contracting for our provider Justin Souliere. Do let me know if anything else is required. ', NULL, NULL, '2021-03-18 17:15:13', '2021-03-18 17:15:13'),
(18060, 1019, 21411, NULL, '2021-04-19 00:00:00.000', 'Not Eligible', 'Received the following message from Tufts: Allison_Morris@tufts-health.com Hello,  I’m writing in response to the provider application we received for Justin Souliere, LCSW. Unfortunately we cannot proceed with contracting this provider as we are only able to credential and contract LICSW providers, not LCSWs.        Thank you,  _____________________________________  Allison Morris  Associate Contract Specialist, Behavioral Health Services  Allied Health Contracting  Tufts Health Plan', NULL, NULL, '2021-04-12 08:08:47', '2021-04-12 08:08:47'),
(18061, 1006, 21412, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 18:04:19', '2021-03-15 18:04:19'),
(18062, 1006, 21412, NULL, '2021-04-28 00:00:00.000', 'In Process', 'Sent a f/u email to Kody Dunnett Kody_Dunnett@tufts-health.com & Bennett Tansey Bennett_Tansey@tufts-health.com to get an update on the status of enrollment and get welcome letters:  Sub: Provider/Group Enrollment Query - SNBCare - Tufts Health Plan  \"Hello,   I hope you\'re doing well, I wanted to verify the effective dates for the following providers and group as well as get their welcome letters if possible, the information is as follows:  Group Name: Spectrum Neuro Behavioral Care LLC NPI# 1356906572  Provider Name: Mahreen Rashid NPI# 1396393146  Provider Name: Katie Tawakol NPI# 1609222116  Provider Name: Prisca Hefti NPI# 1508133182  Also, please let me know what addresses the providers are enrolled under if possible. Please get back to me as soon as you\'re able to.   Thank you. \"', NULL, NULL, '2021-04-21 12:28:39', '2021-04-21 12:28:39'),
(18063, 1019, 21412, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to provider_data_request@tufts-health.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tufts Health Plans  Hello, We need the enrollment status for the following providers under our group, as their applications have been in process for a while now.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert NPI: 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  ', NULL, NULL, '2021-06-05 13:01:58', '2021-06-05 13:01:58'),
(18064, 1019, 21412, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Sent the following email to Kody_Dunnett@tufts-health.com  Hello Kody,  We need to expedite the applications for the following providers of Credentialing and Contracting as it is In process since a while now as it is adversely affecting our business, also we are not getting proper responses on our emails.  Spectrum Neuro Behavioral Care LLC. 1356906572 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rodesia Edmundson  1124622667  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Mary Gibbons  NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Lynnetta Loveland  NPI: 1598163602  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Jonathan Schubert  NPI: 1235755505  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jennifer Ullrich NPI: 1710489760  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Prisca Hefti NPI: 1508133182  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767  Regards, Alex G', NULL, NULL, '2021-06-23 09:31:51', '2021-06-23 09:31:51'),
(18065, 11056, 21412, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email sent to: Denise_Rysinger@tufts-health.com  Sub: Fwd: Enrollment Issue with Tufts Health Plan  Hello,  We are facing issues getting our provider credentialed with Tufts as your process has been too long, due to which we are having issues seeing our patients. We have submitted the signed agreement for the following back in March and the rest others we have sent an enrollment application to Tufts but still didn\'t hear anything.     Group:  Spectrum Neuro Behavioral Care LLC. NPI: 1356906572     Providers  Loveland, Lynnetta -  NPI: 1598163602  Schubert, Jonathan –  NPI: 1235755505  Filoteo-Nichols, Dina - NPI: 1770021099  Halterman, Helena –  NPI: 1801473749', NULL, NULL, '2021-12-03 14:52:38', '2021-12-03 14:52:38'),
(18066, 19067, 21412, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Effective date 12/01/2021 Welcome Letter not issued yet. Ref# 574806', NULL, NULL, '2021-12-09 12:22:37', '2021-12-09 12:22:37'),
(18067, 19067, 21412, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: Provider_Data_Request@tufts-health.com, tufts_health_plan_credentialing_department@tufts-health.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||   Good Morning!  Hope you are doing well and having a productive day.  I would like to know the enrollment status of the following Providers and Groups.   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Dina Filoteo-Nichols	1770021099	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Dina Filoteo-Nichols	1770021099	100 New State HWY, Raynham, MA 02767-5423 Helena Halterman	1801473749	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Helena Halterman	1801473749	100 New State HWY, Raynham, MA 02767-5423 Jonathan Schubert	1235755505	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Jonathan Schubert	1235755505	100 New State HWY, Raynham, MA 02767-5423 Lynnetta Loveland	1598163602	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Lynnetta Loveland	1598163602	100 New State HWY, Raynham, MA 02767-5423 Erin Oliva	1407349632	63 Eddie Dowling HWY, Suite 8, North Smithfield, RI 02896-7322   Kindly respond to us in a timely manner.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 10:07:05', '2021-12-29 10:07:05'),
(18068, 19067, 21412, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com, Provider_Data_Request@tufts-health.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||  Greetings!  Hope this email finds you well.  Any updates on the previously mentioned request?  Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 14:45:29', '2022-01-10 14:45:29'),
(18069, 19067, 21412, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com, Provider_Data_Request@tufts-health.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||   Hello!  This is my SECOND REMINDER on the previously mentioned request.  Kindly respond as per your convenience.  Regards, Hammad Ahmed. ', NULL, NULL, '2022-02-11 11:40:10', '2022-02-11 11:40:10'),
(18070, 19067, 21412, NULL, '2022-03-04 00:00:00.000', 'In Process', 'Email sent to: Padrick_Shaughnessey@tufts-health.com  Subject: Enrollment Request || SNBCARE || TMS || Tufts Health Plans ||   To Whom It May Concern,    I am writing to formally request that the following CPT codes be amended to our existing contract.     90867 – Therapeutic Repetitive Transcranial Magnetic Stimulation (TMS) Treatment; Initial, Including Cortical Mapping, Motor Threshold Determination, Delivery and Management     90868 –  Therapeutic Repetitive Transcranial Magnetic Stimulation (TMS) Treatment; Subsequent Delivery and Management, Per Session     90869 – Therapeutic Repetitive Transcranial Magnetic Stimulation (TMS) Treatment; Subsequent Motor Threshold Re-Determination with Delivery and Management     Kindly advise when the addition of the codes listed above is complete and include an amended fee schedule with contracted rates for our reference.    Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	834482753 Group NPI	1356906572 Primary & Billing Address	61 Lincoln St, Ste 203, Framingham, MA 01702 Secondary Address	100 New State Highway, Raynham, MA 02767 Tertiary Address	63 Eddie Dowling Hwy, Suite 8, North Smithfield, RI 02896 Provider Name	NPI Fauzia Wali Khan	1699761965 Katie Tawakol	1609222116 Mahreen Rashid	1396393146 Prisca Hefti	1508133182 Peggy Pionke	1699307322 Barbara Arnold	1922432053 Lauren Powell	1285304980 Eliza Rodrigues	1821751405 Dina Filoteo-Nichols	1770021099 Allie DiCostanzo	1669045738 Helena Halterman	1801473749 Jessica Hartman	1326665472 Barbara Hignite	1982617262 Lynnetta Loveland	1598163602 Jonathan Schubert	1235755505 Kerry Smith	1275083230 Erin Oliva	1407349632      Thank you,', NULL, NULL, '2022-02-25 18:03:55', '2022-02-25 18:03:55'),
(18071, 19067, 21412, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email received from: Padrick.Shaughnessey@point32health.org  Subject: RE: Enrollment Request || SNBCARE || TMS || Tufts Health Plans || (Spectrum Neuro Behavioral Care LLC)    Hi Hammad & Alex     See attached TMS exhibit that need signature.  I have included the rates.  We will need both the group contract and exhibit signed before they are implemented.     We are awaiting on both.     Thanks,  Padrick', NULL, NULL, '2022-03-01 13:03:35', '2022-03-01 13:03:35'),
(18072, 19067, 21412, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email sent to: padrick.shaughnessey@point32health.org  Subject: RE: Enrollment Request || SNBCARE || TMS || Tufts Health Plans || (Spectrum Neuro Behavioral Care LLC)    Hi Padrick,  Kindly see the attached as per you requested and don\'t hesitate to reach me if you need any document or information.   Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-03-01 13:19:48', '2022-03-01 13:19:48'),
(18073, 19067, 21412, NULL, '2022-03-09 00:00:00.000', 'In Process', 'Email received from: Padrick.Shaughnessey@point32health.org  Subject: RE: Enrollment Request || SNBCARE || TMS || Tufts Health Plans || (Spectrum Neuro Behavioral Care LLC)    Hi Hammad,     Do you have signing authority for Spectrum Neuro Behavioral Care LLC?     Normal it would be a VP or higher that signs and exhibit or the contract.  Plus we need back the signed group contract that was sent to Alex.     We still do not have it.     Thanks,  Padrick', NULL, NULL, '2022-03-02 09:26:15', '2022-03-02 09:26:15'),
(18074, 19067, 21412, NULL, '2022-03-09 00:00:00.000', 'In Process', 'Email sent to: Padrick.Shaughnessey@point32health.org  Subject: Re: Enrollment Request || SNBCARE || TMS || Tufts Health Plans || (Spectrum Neuro Behavioral Care LLC)    Hello Padrick,   Attached is the Signed TMS exhibit, also I\'m still waiting for you to sent me that group contract as I never received that, also I have sent you several email to you with no reponse on them. Please share the group contract again here,    Regards, Alex', NULL, NULL, '2022-03-02 09:27:17', '2022-03-02 09:27:17'),
(18075, 22077, 21412, NULL, '2022-04-12 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com  Subject: Fwd: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||  Hello,  Hope this email finds you well.  Any updates on the previously mentioned request?  Kindly respond promptly.  Thanks,', NULL, NULL, '2022-04-05 10:03:55', '2022-04-05 10:03:55'),
(18076, 3040, 21413, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 08:56:56', '2021-03-16 08:56:56'),
(18077, 1006, 21413, NULL, '2021-05-27 00:00:00.000', 'Approved', 'The group has an Ancillary contract. No need to add any providers individually, the contract is attached for reference in the main group task.   Facility new effective date: 03/01/2021 Locations listed: 779 NUCC, 16272 IVUC, 9504 Longpoint Ref# 6019877016', NULL, NULL, '2021-05-20 11:21:31', '2021-05-20 11:21:31'),
(18078, 3040, 21414, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 08:57:29', '2021-03-16 08:57:29'),
(18079, 1006, 21414, NULL, '2021-05-27 00:00:00.000', 'Approved', 'The group has an Ancillary contract. No need to add any providers individually, the contract is attached for reference in the main group task.   Facility new effective date: 03/01/2021 Locations listed: 779 NUCC, 16272 IVUC, 9504 Longpoint Ref# 6019877016', NULL, NULL, '2021-05-20 11:24:43', '2021-05-20 11:24:43'),
(18080, 3040, 21415, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 08:58:23', '2021-03-16 08:58:23'),
(18081, 1006, 21415, NULL, '2021-05-27 00:00:00.000', 'Approved', 'The group has an Ancillary contract. No need to add any providers individually, the contract is attached for reference in the main group task.   Facility new effective date: 03/01/2021 Locations listed: 779 NUCC, 16272 IVUC, 9504 Longpoint Ref# 6019877016', NULL, NULL, '2021-05-20 11:24:31', '2021-05-20 11:24:31'),
(18082, 3040, 21416, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 08:58:56', '2021-03-16 08:58:56'),
(18083, 1006, 21416, NULL, '2021-05-27 00:00:00.000', 'Approved', 'The group has an Ancillary contract. No need to add any providers individually, the contract is attached for reference in the main group task.   Facility new effective date: 03/01/2021 Locations listed: 779 NUCC, 16272 IVUC, 9504 Longpoint Ref# 6019877016', NULL, NULL, '2021-05-20 11:24:18', '2021-05-20 11:24:18'),
(18084, 3040, 21416, NULL, NULL, 'Revalidation', 'Your request to join network has been received. You can expect to hear from us in the next 45 days. If it has been more than 60 days and you haven\'t heard from us regarding next steps, you can call 1-800-353-1232 for assistance. Please reference code \"Medical\". ', NULL, NULL, '2021-06-02 13:41:02', '2021-06-02 13:41:02'),
(18085, 3040, 21416, NULL, '2021-06-18 00:00:00.000', 'Revalidated', 'Email rcvd from: Aetna Provider Communications\' via Abdur Rauf Practices  Subject: 	Welcome to our network. Let’s get started  Greetings,  We’d like to welcome the following providers to our network:  Glory Abraham - Effective Jun 15 2021 12:00AM. Your identification Number (PIN) is: 6981124.  Jeena Abraham - Effective Jun 15 2021 12:00AM. Your identification Number (PIN) is: To be determined.  Sigi Paul - Effective Jun 15 2021 12:00AM. Your identification Number (PIN) is: To be determined.', NULL, NULL, '2021-06-11 08:31:30', '2021-06-11 08:31:30'),
(18086, 3040, 21417, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 08:59:16', '2021-03-16 08:59:16'),
(18087, 1006, 21417, NULL, '2021-05-27 00:00:00.000', 'Approved', 'The group has an Ancillary contract. No need to add any providers individually, the contract is attached for reference in the main group task.   Facility new effective date: 03/01/2021 Locations listed: 779 NUCC, 16272 IVUC, 9504 Longpoint Ref# 6019877016', NULL, NULL, '2021-05-20 11:24:06', '2021-05-20 11:24:06'),
(18088, 3040, 21417, NULL, NULL, 'Revalidation', 'Thank You! Request ID for this Submission: 43900677  Your request to join the network has been received.', NULL, NULL, '2021-06-02 13:57:57', '2021-06-02 13:57:57'),
(18089, 3040, 21417, NULL, '2021-06-18 00:00:00.000', 'Revalidated', 'Email rcvd from: Aetna Provider Communications\' via Abdur Rauf Practices  Subject: 	Welcome to our network. Let’s get started  Greetings,  We’d like to welcome the following providers to our network:  Glory Abraham - Effective Jun 15 2021 12:00AM. Your identification Number (PIN) is: 6981124.  Jeena Abraham - Effective Jun 15 2021 12:00AM. Your identification Number (PIN) is: To be determined.  Sigi Paul - Effective Jun 15 2021 12:00AM. Your identification Number (PIN) is: To be determined.', NULL, NULL, '2021-06-11 08:31:25', '2021-06-11 08:31:25'),
(18090, 3040, 21418, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 08:59:31', '2021-03-16 08:59:31'),
(18091, 1006, 21418, NULL, '2021-05-27 00:00:00.000', 'Approved', 'The group has an Ancillary contract. No need to add any providers individually, the contract is attached for reference in the main group task.   Facility new effective date: 03/01/2021 Locations listed: 779 NUCC, 16272 IVUC, 9504 Longpoint Ref# 6019877016', NULL, NULL, '2021-05-20 11:23:51', '2021-05-20 11:23:51'),
(18092, 3040, 21419, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 09:00:14', '2021-03-16 09:00:14'),
(18093, 1006, 21419, NULL, '2021-05-27 00:00:00.000', 'Approved', 'The group has an Ancillary contract. No need to add any providers individually, the contract is attached for reference in the main group task.   Facility new effective date: 03/01/2021 Locations listed: 779 NUCC, 16272 IVUC, 9504 Longpoint Ref# 6019877016', NULL, NULL, '2021-05-20 11:23:38', '2021-05-20 11:23:38'),
(18094, 3040, 21420, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 09:00:24', '2021-03-16 09:00:24'),
(18095, 1006, 21420, NULL, '2021-05-27 00:00:00.000', 'Approved', 'The group has an Ancillary contract. No need to add any providers individually, the contract is attached for reference in the main group task.   Facility new effective date: 03/01/2021 Locations listed: 779 NUCC, 16272 IVUC, 9504 Longpoint Ref# 6019877016', NULL, NULL, '2021-05-20 11:23:19', '2021-05-20 11:23:19'),
(18096, 3040, 21420, NULL, NULL, 'Revalidation', 'Thank You! Request ID for this Submission: 02614655  Your request to join the network has been received.', NULL, NULL, '2021-06-02 14:00:53', '2021-06-02 14:00:53'),
(18097, 3040, 21420, NULL, '2021-06-18 00:00:00.000', 'Revalidated', 'Email rcvd from: Aetna Provider Communications\' via Abdur Rauf Practices  Subject: 	Welcome to our network. Let’s get started  Greetings,  We’d like to welcome the following providers to our network:  Glory Abraham - Effective Jun 15 2021 12:00AM. Your identification Number (PIN) is: 6981124.  Jeena Abraham - Effective Jun 15 2021 12:00AM. Your identification Number (PIN) is: To be determined.  Sigi Paul - Effective Jun 15 2021 12:00AM. Your identification Number (PIN) is: To be determined.', NULL, NULL, '2021-06-11 08:31:20', '2021-06-11 08:31:20'),
(18098, 3040, 21421, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 09:02:09', '2021-03-16 09:02:09'),
(18099, 3040, 21421, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || Normandy Urgent Care Center || Group & Providers || Ambetter ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Ambetter for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-02 15:37:40', '2021-06-02 15:37:40'),
(18100, 3040, 21421, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Greetings,   Hope you are doing well. I wanted to enroll  the below mentioned group and providers in Ambetter for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: Piccione JR, James Provider NPI# 1356321509  Provider 2:  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:  Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 4:  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 5:  Provider Name: Rauf., Abdur Provider NPI# 1497726202  Provider 6:  Provider Name: Thomas, Cini Provider NPI# 1134777238  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-21 17:04:57', '2021-06-21 17:04:57'),
(18101, 3040, 21421, NULL, '2021-07-19 00:00:00.000', 'Approved', 'Email rcvd from: AM.Houston@superiorhealthplan.com  Subject: RE: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter || ref#45298  Please see the attached contract showing your contracted for both.     Have a great weekend', NULL, NULL, '2021-07-12 11:23:07', '2021-07-12 11:23:07'),
(18102, 3040, 21422, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 09:03:45', '2021-03-16 09:03:45'),
(18103, 3040, 21422, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || Normandy Urgent Care Center || Group & Providers || Ambetter ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Ambetter for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-02 15:37:44', '2021-06-02 15:37:44'),
(18104, 3040, 21422, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Greetings,   Hope you are doing well. I wanted to enroll  the below mentioned group and providers in Ambetter for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: Piccione JR, James Provider NPI# 1356321509  Provider 2:  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:  Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 4:  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 5:  Provider Name: Rauf., Abdur Provider NPI# 1497726202  Provider 6:  Provider Name: Thomas, Cini Provider NPI# 1134777238  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-21 17:03:59', '2021-06-21 17:03:59'),
(18105, 11056, 21422, NULL, '2021-07-17 00:00:00.000', 'In Process', 'Email received from : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter || ref#47964  Good Morning Ahmed     I hope you are doing well. I wanted to advise that account management does not handle application requests. When you are submitting applications in which you have attached on each email you would submit them to our Network Development Team at SHP.NetworkDevelopment@superiorhealthplan.com     Also when the providers are in credentialing status we do not submit the requests to update the locations as that department is already working on the request based on what you submitted on the application.     With that being said your request is not required as these providers are already in credentialing status and the same information you listed on these applications is what is already on the original applications that were received. I provided a screenshot below.     Please keep in mind our credentialing process could take up to 90-120 days to complete. Although 3 providers have an anticipated effective date they still have to go through the cred process until everything is completed. The locations will be added in this process and everything will not be finalized until it says complete in our system.     You are more than welcome to follow-up in another month for cred status or complete status. And again all location requests for new providers are submitted on the application to our Network Development Team and does not come to us.     Have a great rest of the day!     Best Regards,     Brittney Kendle  Provider Account Manager  Region 7 (Harris & Jefferson SDA)  4888 Loop Central Drive  Houston, TX 77081  1-800-656-4817; Press 1 for English or 2 for Spanish and select Option #3 Provider Relations  Fax: 1-866-683-5630  AM.Houston@superiorhealthplan.com | SuperiorHealthPlan.com', NULL, NULL, '2021-07-09 14:39:25', '2021-07-09 14:39:25'),
(18106, 3040, 21422, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter || ref#45298  Greetings,  Hope you are doing well. Please advise the enrollment status for the below mentioned providers in Ambetter in our group under the below locations.   Practice Details:  Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Practice Name:Longpoint Medical Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider 1:   Provider Name: Thomas, Cini  Provider NPI# 1134777238    Provider 2:   Provider Name: Piccione JR, James  Provider NPI# 1356321509   Provider 3:   Provider Name: Chennemkara, Mini  Provider NPI# 1841755956    Provider 4:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616     Provider 5:   Provider Name: Rauf., Abdur  Provider NPI# 1497726202   Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you', NULL, NULL, '2021-07-28 14:10:10', '2021-07-28 14:10:10'),
(18107, 11056, 21422, NULL, '2021-08-21 00:00:00.000', 'In Process', 'Email sent to : AM.Houston@superiorhealthplan.com  Sub : Fwd: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter || ref#45298  Good evening!  Hope you are doing well. I want to inquire about the enrollment status for the following providers and practices in Ambetter. Please provide me with the latest updates soon.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 2:  Provider Name: Piccione JR, James Provider NPI# 1356321509  Provider 3:  Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 4:  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 5:  Provider Name: Rauf., Abdur Provider NPI# 1497726202  Provider 6: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you have any queries or need any documents please let me know. Waiting to hear from you soon.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-13 16:31:08', '2021-08-13 16:31:08'),
(18108, 3040, 21422, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Provider is participating with Ambetter. Please see attachment. ', NULL, NULL, '2021-08-27 16:34:34', '2021-08-27 16:34:34'),
(18109, 3040, 21423, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 09:04:03', '2021-03-16 09:04:03'),
(18110, 3040, 21423, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || Normandy Urgent Care Center || Group & Providers || Ambetter ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Ambetter for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-02 15:37:48', '2021-06-02 15:37:48'),
(18111, 3040, 21423, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center || Group & Providers || Ambetter ||  Greetings,  Thank you so much for the roster that was really helpful. I wanted to add the additional locations under the below mentioned providers in Ambetter for our group. Can you please advise the process?  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 2:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider 3:   Provider Name: Jose, Julie Provider NPI# 1447883061 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider 4:   Provider Name: Stephen, Ani Provider NPI# 1588959118 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider 5:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-21 16:57:30', '2021-06-21 16:57:30'),
(18112, 3040, 21423, NULL, '2021-07-15 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center || Group & Providers || Ambetter || ref# 45297  Hello Brittney,   Please find attached the demographic information form for the below mentioned providers for adding the locations in Ambetter in our group.   Provider 1:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 2:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider 4:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-08 16:24:22', '2021-07-08 16:24:22'),
(18113, 3040, 21423, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email rcvd from: AM.Houston@superiorhealthplan.com  Subject: RE: Enrollment Status || Normandy Urgent Care Center || Group & Providers || Ambetter || ref# 45297  Adil  I hope all is well. I am not sure what you are looking at but I just ran the report and looked in our systems and the providers locations were updated and the ticket is completed. Please see attached report as there is nothing further required on our end.  Have a great rest of the day!  Best Regards,  Brittney Kendle Provider Account Manager Region 7 (Harris & Jefferson SDA)', NULL, NULL, '2021-07-28 13:38:53', '2021-07-28 13:38:53'),
(18114, 3040, 21423, NULL, '2021-08-06 00:00:00.000', 'Approved', 'Provider is participating with Ambetter. Please see attachment.', NULL, NULL, '2021-07-30 13:17:15', '2021-07-30 13:17:15'),
(18115, 3040, 21424, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 09:04:18', '2021-03-16 09:04:18'),
(18116, 3040, 21424, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || Normandy Urgent Care Center || Group & Providers || Ambetter ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Ambetter for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-02 15:38:07', '2021-06-02 15:38:07');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(18117, 3040, 21424, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center || Group & Providers || Ambetter ||  Greetings,  Thank you so much for the roster that was really helpful. I wanted to add the additional locations under the below mentioned providers in Ambetter for our group. Can you please advise the process?  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 2:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider 3:   Provider Name: Jose, Julie Provider NPI# 1447883061 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider 4:   Provider Name: Stephen, Ani Provider NPI# 1588959118 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider 5:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-21 16:57:35', '2021-06-21 16:57:35'),
(18118, 3040, 21424, NULL, '2021-07-15 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center || Group & Providers || Ambetter || ref# 45297  Hello Brittney,   Please find attached the demographic information form for the below mentioned providers for adding the locations in Ambetter in our group.   Provider 1:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 2:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider 4:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-08 16:24:29', '2021-07-08 16:24:29'),
(18119, 3040, 21424, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email rcvd from: AM.Houston@superiorhealthplan.com  Subject: RE: Enrollment Status || Normandy Urgent Care Center || Group & Providers || Ambetter || ref# 45297  Adil  I hope all is well. I am not sure what you are looking at but I just ran the report and looked in our systems and the providers locations were updated and the ticket is completed. Please see attached report as there is nothing further required on our end.  Have a great rest of the day!  Best Regards,  Brittney Kendle Provider Account Manager Region 7 (Harris & Jefferson SDA)', NULL, NULL, '2021-07-28 13:38:54', '2021-07-28 13:38:54'),
(18120, 3040, 21424, NULL, '2021-08-06 00:00:00.000', 'Approved', 'Provider is participating with Ambetter. Please see attachment.', NULL, NULL, '2021-07-30 13:17:10', '2021-07-30 13:17:10'),
(18121, 3040, 21425, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 09:04:34', '2021-03-16 09:04:34'),
(18122, 3040, 21425, NULL, '2021-05-28 00:00:00.000', 'Approved', 'Provider participating with Ambetter. Please see attachment. ', NULL, NULL, '2021-05-21 10:27:53', '2021-05-21 10:27:53'),
(18123, 3040, 21426, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 09:04:47', '2021-03-16 09:04:47'),
(18124, 3040, 21426, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || Normandy Urgent Care Center || Group & Providers || Ambetter ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Ambetter for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-02 15:38:12', '2021-06-02 15:38:12'),
(18125, 3040, 21426, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Greetings,   Hope you are doing well. I wanted to enroll  the below mentioned group and providers in Ambetter for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: Piccione JR, James Provider NPI# 1356321509  Provider 2:  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:  Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 4:  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 5:  Provider Name: Rauf., Abdur Provider NPI# 1497726202  Provider 6:  Provider Name: Thomas, Cini Provider NPI# 1134777238  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-21 17:03:55', '2021-06-21 17:03:55'),
(18126, 11056, 21426, NULL, '2021-07-17 00:00:00.000', 'In Process', 'Email received from : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter || ref#47964  Good Morning Ahmed     I hope you are doing well. I wanted to advise that account management does not handle application requests. When you are submitting applications in which you have attached on each email you would submit them to our Network Development Team at SHP.NetworkDevelopment@superiorhealthplan.com     Also when the providers are in credentialing status we do not submit the requests to update the locations as that department is already working on the request based on what you submitted on the application.     With that being said your request is not required as these providers are already in credentialing status and the same information you listed on these applications is what is already on the original applications that were received. I provided a screenshot below.     Please keep in mind our credentialing process could take up to 90-120 days to complete. Although 3 providers have an anticipated effective date they still have to go through the cred process until everything is completed. The locations will be added in this process and everything will not be finalized until it says complete in our system.     You are more than welcome to follow-up in another month for cred status or complete status. And again all location requests for new providers are submitted on the application to our Network Development Team and does not come to us.     Have a great rest of the day!     Best Regards,     Brittney Kendle  Provider Account Manager  Region 7 (Harris & Jefferson SDA)  4888 Loop Central Drive  Houston, TX 77081  1-800-656-4817; Press 1 for English or 2 for Spanish and select Option #3 Provider Relations  Fax: 1-866-683-5630  AM.Houston@superiorhealthplan.com | SuperiorHealthPlan.com', NULL, NULL, '2021-07-09 14:29:34', '2021-07-09 14:29:34'),
(18127, 3040, 21426, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter || ref#45298  Greetings,  Hope you are doing well. Please advise the enrollment status for the below mentioned providers in Ambetter in our group under the below locations.   Practice Details:  Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Practice Name:Longpoint Medical Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider 1:   Provider Name: Thomas, Cini  Provider NPI# 1134777238    Provider 2:   Provider Name: Piccione JR, James  Provider NPI# 1356321509   Provider 3:   Provider Name: Chennemkara, Mini  Provider NPI# 1841755956    Provider 4:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616     Provider 5:   Provider Name: Rauf., Abdur  Provider NPI# 1497726202   Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you', NULL, NULL, '2021-07-28 14:10:14', '2021-07-28 14:10:14'),
(18128, 11056, 21426, NULL, '2021-08-21 00:00:00.000', 'In Process', 'Email sent to : AM.Houston@superiorhealthplan.com  Sub : Fwd: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter || ref#45298  Good evening!  Hope you are doing well. I want to inquire about the enrollment status for the following providers and practices in Ambetter. Please provide me with the latest updates soon.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 2:  Provider Name: Piccione JR, James Provider NPI# 1356321509  Provider 3:  Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 4:  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 5:  Provider Name: Rauf., Abdur Provider NPI# 1497726202  Provider 6: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you have any queries or need any documents please let me know. Waiting to hear from you soon.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-13 16:30:56', '2021-08-13 16:30:56'),
(18129, 3040, 21426, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Provider is participating with Ambetter. For more details please see attachment. ', NULL, NULL, '2021-08-27 16:39:12', '2021-08-27 16:39:12'),
(18130, 3040, 21427, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 09:05:04', '2021-03-16 09:05:04'),
(18131, 3040, 21427, NULL, '2021-05-28 00:00:00.000', 'Approved', 'Provider participating with Ambetter. Please see attachment. ', NULL, NULL, '2021-05-21 09:25:27', '2021-05-21 09:25:27'),
(18132, 3040, 21428, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 09:05:47', '2021-03-16 09:05:47'),
(18133, 3040, 21428, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || Normandy Urgent Care Center || Group & Providers || Ambetter ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Ambetter for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-02 15:38:20', '2021-06-02 15:38:20'),
(18134, 3040, 21428, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center || Group & Providers || Ambetter ||  Greetings,  Thank you so much for the roster that was really helpful. I wanted to add the additional locations under the below mentioned providers in Ambetter for our group. Can you please advise the process?  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 2:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider 3:   Provider Name: Jose, Julie Provider NPI# 1447883061 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider 4:   Provider Name: Stephen, Ani Provider NPI# 1588959118 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider 5:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-21 16:57:38', '2021-06-21 16:57:38'),
(18135, 3040, 21428, NULL, '2021-07-15 00:00:00.000', 'Approved', 'Provider participating with Ambetter. Please see attachment. ', NULL, NULL, '2021-07-08 16:19:19', '2021-07-08 16:19:19'),
(18136, 3040, 21429, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 09:06:05', '2021-03-16 09:06:05'),
(18137, 3040, 21429, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || Normandy Urgent Care Center || Group & Providers || Ambetter ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Ambetter for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-02 15:38:23', '2021-06-02 15:38:23'),
(18138, 3040, 21429, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Greetings,   Hope you are doing well. I wanted to enroll  the below mentioned group and providers in Ambetter for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: Piccione JR, James Provider NPI# 1356321509  Provider 2:  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:  Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 4:  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 5:  Provider Name: Rauf., Abdur Provider NPI# 1497726202  Provider 6:  Provider Name: Thomas, Cini Provider NPI# 1134777238  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-21 17:04:01', '2021-06-21 17:04:01'),
(18139, 11056, 21429, NULL, '2021-07-17 00:00:00.000', 'In Process', 'Email received from : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter || ref#47964  Good Morning Ahmed     I hope you are doing well. I wanted to advise that account management does not handle application requests. When you are submitting applications in which you have attached on each email you would submit them to our Network Development Team at SHP.NetworkDevelopment@superiorhealthplan.com     Also when the providers are in credentialing status we do not submit the requests to update the locations as that department is already working on the request based on what you submitted on the application.     With that being said your request is not required as these providers are already in credentialing status and the same information you listed on these applications is what is already on the original applications that were received. I provided a screenshot below.     Please keep in mind our credentialing process could take up to 90-120 days to complete. Although 3 providers have an anticipated effective date they still have to go through the cred process until everything is completed. The locations will be added in this process and everything will not be finalized until it says complete in our system.     You are more than welcome to follow-up in another month for cred status or complete status. And again all location requests for new providers are submitted on the application to our Network Development Team and does not come to us.     Have a great rest of the day!     Best Regards,     Brittney Kendle  Provider Account Manager  Region 7 (Harris & Jefferson SDA)  4888 Loop Central Drive  Houston, TX 77081  1-800-656-4817; Press 1 for English or 2 for Spanish and select Option #3 Provider Relations  Fax: 1-866-683-5630  AM.Houston@superiorhealthplan.com | SuperiorHealthPlan.com', NULL, NULL, '2021-07-09 14:27:51', '2021-07-09 14:27:51'),
(18140, 3040, 21429, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter || ref#45298  Greetings,  Hope you are doing well. Please advise the enrollment status for the below mentioned providers in Ambetter in our group under the below locations.   Practice Details:  Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Practice Name:Longpoint Medical Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider 1:   Provider Name: Thomas, Cini  Provider NPI# 1134777238    Provider 2:   Provider Name: Piccione JR, James  Provider NPI# 1356321509   Provider 3:   Provider Name: Chennemkara, Mini  Provider NPI# 1841755956    Provider 4:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616     Provider 5:   Provider Name: Rauf., Abdur  Provider NPI# 1497726202   Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you', NULL, NULL, '2021-07-28 14:10:08', '2021-07-28 14:10:08'),
(18141, 11056, 21429, NULL, '2021-08-21 00:00:00.000', 'In Process', 'Email sent to : AM.Houston@superiorhealthplan.com  Sub : Fwd: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter || ref#45298  Good evening!  Hope you are doing well. I want to inquire about the enrollment status for the following providers and practices in Ambetter. Please provide me with the latest updates soon.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 2:  Provider Name: Piccione JR, James Provider NPI# 1356321509  Provider 3:  Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 4:  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 5:  Provider Name: Rauf., Abdur Provider NPI# 1497726202  Provider 6: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you have any queries or need any documents please let me know. Waiting to hear from you soon.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-13 16:30:48', '2021-08-13 16:30:48'),
(18142, 3040, 21429, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Provider is participating with Ambetter. Please see attachment.', NULL, NULL, '2021-08-27 16:31:38', '2021-08-27 16:31:38'),
(18143, 3040, 21430, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 09:07:58', '2021-03-16 09:07:58'),
(18144, 3040, 21430, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || Normandy Urgent Care Center || Group & Providers || Ambetter ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Ambetter for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-02 15:38:27', '2021-06-02 15:38:27'),
(18145, 3040, 21430, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Greetings,   Hope you are doing well. I wanted to enroll  the below mentioned group and providers in Ambetter for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: Piccione JR, James Provider NPI# 1356321509  Provider 2:  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:  Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 4:  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 5:  Provider Name: Rauf., Abdur Provider NPI# 1497726202  Provider 6:  Provider Name: Thomas, Cini Provider NPI# 1134777238  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-21 17:03:46', '2021-06-21 17:03:46'),
(18146, 11056, 21430, NULL, '2021-07-17 00:00:00.000', 'In Process', 'Email sent to : SHP.NetworkDevelopment@superiorhealthplan.com  Sub : Enrollment Forms Submission || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Greetings,  Hope you are doing well. Here are the enrollment forms filled out which you have provided for the below mentioned groups for Superior Health Plan .  Practice Details:  Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Practice Name:Longpoint Medical Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Providers:  Provider 1:   Provider Name: Piccione JR, James  Provider NPI# : 1356321509    Provider 2:   Provider Name : PAUL, SIGI  Provider NPI# : 1033623616    If you need further information feel free to reach out to me.     Thank you!  Have a great day!', NULL, NULL, '2021-07-09 14:17:51', '2021-07-09 14:17:51'),
(18147, 3040, 21430, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter || ref#45298  Greetings,  Hope you are doing well. Please advise the enrollment status for the below mentioned providers in Ambetter in our group under the below locations.   Practice Details:  Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Practice Name:Longpoint Medical Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider 1:   Provider Name: Thomas, Cini  Provider NPI# 1134777238    Provider 2:   Provider Name: Piccione JR, James  Provider NPI# 1356321509   Provider 3:   Provider Name: Chennemkara, Mini  Provider NPI# 1841755956    Provider 4:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616     Provider 5:   Provider Name: Rauf., Abdur  Provider NPI# 1497726202   Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you', NULL, NULL, '2021-07-28 14:10:12', '2021-07-28 14:10:12'),
(18148, 11056, 21430, NULL, '2021-08-21 00:00:00.000', 'In Process', 'Email sent to : AM.Houston@superiorhealthplan.com  Sub : Fwd: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter || ref#45298  Good evening!  Hope you are doing well. I want to inquire about the enrollment status for the following providers and practices in Ambetter. Please provide me with the latest updates soon.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 2:  Provider Name: Piccione JR, James Provider NPI# 1356321509  Provider 3:  Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 4:  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 5:  Provider Name: Rauf., Abdur Provider NPI# 1497726202  Provider 6: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you have any queries or need any documents please let me know. Waiting to hear from you soon.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-13 16:30:41', '2021-08-13 16:30:41'),
(18149, 3040, 21430, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter || ref#45298  Hello,  I wanted to know the enrollment status for the below mentioned providers in Ambetter in our group under the below locations.   Practice Details:  Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Practice Name:Longpoint Medical Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider 1:   Provider Name: Piccione JR, James  Provider NPI# 1356321509   Provider 2:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616    Provider 3: Provider Name: Joseph, Molly Provider NPI# 1396380077     Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you', NULL, NULL, '2021-08-27 16:43:22', '2021-08-27 16:43:22'),
(18150, 10057, 21430, NULL, '2021-10-18 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status Query - CUCC - Tricare  Good Evening,  Hope this email finds you well. I want to inquire about the enrollment status for the below-mentioned providers and practices in Ambetter.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Piccione JR, James M	1356321509 PAUL, SIGI	1033623616 Joseph, Molly	1073019493  Your earliest response will be highly appreciated. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-11 15:25:32', '2021-10-11 15:25:32'),
(18151, 10057, 21430, NULL, '2021-11-18 00:00:00.000', 'Approved', 'Email Received From : ECMExecutionTeam@superiorhealthplan.com  Sub : JAMES PICCIONE JR WELCOME LETTER  JAMES PICCIONE JR NORMANDY URGENT CARE CENTER PA rehman@claimsmedinc.com  Welcome to the Superior HealthPlan network. We are excited to have you as a partner of our growing network of high quality health care professionals. You play a key role as we pursue our commitment to improve the health and well-being of the members we serve.Your records were reviewed and approved by our credentialing committee. You are now able to provide covered services to Superior members.  Your effective date is:    10/01/2021  ', NULL, NULL, '2021-11-11 14:05:34', '2021-11-11 14:05:34'),
(18152, 3040, 21431, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 09:08:15', '2021-03-16 09:08:15'),
(18153, 3040, 21431, NULL, '2021-05-28 00:00:00.000', 'Approved', 'Provider participating with Ambetter. Please see attachment.  ', NULL, NULL, '2021-05-21 08:21:53', '2021-05-21 08:21:53'),
(18154, 3040, 21432, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 09:08:30', '2021-03-16 09:08:30'),
(18155, 3040, 21432, NULL, '2021-05-28 00:00:00.000', 'Approved', 'Provider participating with Ambetter. Please see attachment. ', NULL, NULL, '2021-05-21 10:50:50', '2021-05-21 10:50:50'),
(18156, 3040, 21433, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 09:08:46', '2021-03-16 09:08:46'),
(18157, 1005, 21433, NULL, '2021-06-08 00:00:00.000', 'Not Eligible', 'Provider is no longer working for this Practice. Eff from 12/15/2020', NULL, NULL, '2021-06-01 12:55:41', '2021-06-01 12:55:41'),
(18158, 3040, 21434, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 09:09:04', '2021-03-16 09:09:04'),
(18159, 3040, 21434, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || Normandy Urgent Care Center || Group & Providers || Ambetter ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Ambetter for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-02 15:38:31', '2021-06-02 15:38:31'),
(18160, 3040, 21434, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center || Group & Providers || Ambetter ||  Greetings,  Thank you so much for the roster that was really helpful. I wanted to add the additional locations under the below mentioned providers in Ambetter for our group. Can you please advise the process?  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 2:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider 3:   Provider Name: Jose, Julie Provider NPI# 1447883061 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider 4:   Provider Name: Stephen, Ani Provider NPI# 1588959118 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider 5:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-21 16:57:41', '2021-06-21 16:57:41'),
(18161, 3040, 21434, NULL, '2021-07-15 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center || Group & Providers || Ambetter || ref# 45297  Hello Brittney,   Please find attached the demographic information form for the below mentioned providers for adding the locations in Ambetter in our group.   Provider 1:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 2:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider 4:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-08 16:24:33', '2021-07-08 16:24:33'),
(18162, 3040, 21434, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email rcvd from: AM.Houston@superiorhealthplan.com  Subject: RE: Enrollment Status || Normandy Urgent Care Center || Group & Providers || Ambetter || ref# 45297  Adil  I hope all is well. I am not sure what you are looking at but I just ran the report and looked in our systems and the providers locations were updated and the ticket is completed. Please see attached report as there is nothing further required on our end.  Have a great rest of the day!  Best Regards,  Brittney Kendle Provider Account Manager Region 7 (Harris & Jefferson SDA)', NULL, NULL, '2021-07-28 13:38:55', '2021-07-28 13:38:55'),
(18163, 3040, 21434, NULL, '2021-08-06 00:00:00.000', 'Approved', 'Provider is participating with Ambetter. Please see attachment.', NULL, NULL, '2021-07-30 13:17:08', '2021-07-30 13:17:08'),
(18164, 3040, 21435, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 09:09:17', '2021-03-16 09:09:17'),
(18165, 3040, 21435, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || Normandy Urgent Care Center || Group & Providers || Ambetter ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Ambetter for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-02 15:38:34', '2021-06-02 15:38:34'),
(18166, 3040, 21435, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center || Group & Providers || Ambetter ||  Greetings,  Thank you so much for the roster that was really helpful. I wanted to add the additional locations under the below mentioned providers in Ambetter for our group. Can you please advise the process?  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 2:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider 3:   Provider Name: Jose, Julie Provider NPI# 1447883061 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider 4:   Provider Name: Stephen, Ani Provider NPI# 1588959118 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider 5:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-21 16:57:25', '2021-06-21 16:57:25');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(18167, 3040, 21435, NULL, '2021-07-21 00:00:00.000', 'Approved', 'I had a word with Palmira Ambetter representative and she said the provider is in-network with the effective date 06/01/2021. For more details please see attachment.  Ref: I58685955', NULL, NULL, '2021-07-14 10:54:06', '2021-07-14 10:54:06'),
(18168, 3040, 21436, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 09:09:34', '2021-03-16 09:09:34'),
(18169, 3040, 21436, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || Normandy Urgent Care Center || Group & Providers || Ambetter ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Ambetter for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-02 15:38:38', '2021-06-02 15:38:38'),
(18170, 3040, 21436, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Greetings,   Hope you are doing well. I wanted to enroll  the below mentioned group and providers in Ambetter for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: Piccione JR, James Provider NPI# 1356321509  Provider 2:  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:  Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 4:  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 5:  Provider Name: Rauf., Abdur Provider NPI# 1497726202  Provider 6:  Provider Name: Thomas, Cini Provider NPI# 1134777238  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-21 17:03:47', '2021-06-21 17:03:47'),
(18171, 3040, 21436, NULL, '2021-07-19 00:00:00.000', 'Not Eligible', 'Provider is no longer working in NUCC, IVUC, LPMC & CUCC.', NULL, NULL, '2021-07-12 11:04:44', '2021-07-12 11:04:44'),
(18172, 3040, 21437, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 09:10:04', '2021-03-16 09:10:04'),
(18173, 3040, 21437, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || Normandy Urgent Care Center || Group & Providers || Ambetter ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Ambetter for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-02 15:38:42', '2021-06-02 15:38:42'),
(18174, 3040, 21437, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Greetings,   Hope you are doing well. I wanted to enroll  the below mentioned group and providers in Ambetter for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: Piccione JR, James Provider NPI# 1356321509  Provider 2:  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:  Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 4:  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 5:  Provider Name: Rauf., Abdur Provider NPI# 1497726202  Provider 6:  Provider Name: Thomas, Cini Provider NPI# 1134777238  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-21 17:03:58', '2021-06-21 17:03:58'),
(18175, 11056, 21437, NULL, '2021-07-17 00:00:00.000', 'In Process', 'Email sent to : SHP.NetworkDevelopment@superiorhealthplan.com  Sub : Enrollment Forms Submission || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Greetings,  Hope you are doing well. Here are the enrollment forms filled out which you have provided for the below mentioned groups for Superior Health Plan .  Practice Details:  Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Practice Name:Longpoint Medical Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Providers:  Provider 1:   Provider Name: Piccione JR, James  Provider NPI# : 1356321509    Provider 2:   Provider Name : PAUL, SIGI  Provider NPI# : 1033623616    If you need further information feel free to reach out to me.     Thank you!  Have a great day!', NULL, NULL, '2021-07-09 14:23:11', '2021-07-09 14:23:11'),
(18176, 3040, 21437, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter || ref#45298  Greetings,  Hope you are doing well. Please advise the enrollment status for the below mentioned providers in Ambetter in our group under the below locations.   Practice Details:  Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Practice Name:Longpoint Medical Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider 1:   Provider Name: Thomas, Cini  Provider NPI# 1134777238    Provider 2:   Provider Name: Piccione JR, James  Provider NPI# 1356321509   Provider 3:   Provider Name: Chennemkara, Mini  Provider NPI# 1841755956    Provider 4:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616     Provider 5:   Provider Name: Rauf., Abdur  Provider NPI# 1497726202   Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you', NULL, NULL, '2021-07-28 14:10:14', '2021-07-28 14:10:14'),
(18177, 11056, 21437, NULL, '2021-08-21 00:00:00.000', 'In Process', 'Email sent to : AM.Houston@superiorhealthplan.com  Sub : Fwd: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter || ref#45298  Good evening!  Hope you are doing well. I want to inquire about the enrollment status for the following providers and practices in Ambetter. Please provide me with the latest updates soon.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 2:  Provider Name: Piccione JR, James Provider NPI# 1356321509  Provider 3:  Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 4:  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 5:  Provider Name: Rauf., Abdur Provider NPI# 1497726202  Provider 6: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you have any queries or need any documents please let me know. Waiting to hear from you soon.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-13 16:30:38', '2021-08-13 16:30:38'),
(18178, 3040, 21437, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter || ref#45298  Hello,  I wanted to know the enrollment status for the below mentioned providers in Ambetter in our group under the below locations.   Practice Details:  Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Practice Name:Longpoint Medical Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider 1:   Provider Name: Piccione JR, James  Provider NPI# 1356321509   Provider 2:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616    Provider 3: Provider Name: Joseph, Molly Provider NPI# 1396380077     Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you', NULL, NULL, '2021-08-27 16:43:24', '2021-08-27 16:43:24'),
(18179, 10057, 21437, NULL, '2021-10-18 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status Query - CUCC - Tricare  Good Evening,  Hope this email finds you well. I want to inquire about the enrollment status for the below-mentioned providers and practices in Ambetter.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Piccione JR, James M	1356321509 PAUL, SIGI	1033623616 Joseph, Molly	1073019493  Your earliest response will be highly appreciated. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-11 15:25:23', '2021-10-11 15:25:23'),
(18180, 10057, 21437, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Hello,  Can you please the status for below mentioned provider under the TIN:  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Address	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI PAUL, SIGI	1033623616  Kindly respond me as soon as you get a chance.  Thanks & Regards,', NULL, NULL, '2021-11-23 14:13:05', '2021-11-23 14:13:05'),
(18181, 10057, 21437, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Hello,  Can I get the update on provider Sigi Paul & Molly Joseph enrollment status?  Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-03 10:49:31', '2021-12-03 10:49:31'),
(18182, 10057, 21437, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Hello,  Can I get the update on provider Sigi Paul & Molly Joseph enrollment status?  Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-09 15:45:49', '2021-12-09 15:45:49'),
(18183, 10057, 21437, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Greetings!  Any update on the below request. This is my second reminder.  Looking forward to your early response.  Thanks & Regards,', NULL, NULL, '2021-12-16 10:07:17', '2021-12-16 10:07:17'),
(18184, 10057, 21437, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email Received From : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Good afternoon,  Your email was received. Your Account Manager will be contacting you to address your request. When contacting the Account Manager for updates on your issue, you can use this reference number #72511. If you need immediate assistance you can call to speak to an Account Manager by calling 1-800-656-4817 (English 1, Spanish 2) and option #3 for Provider Relations Team.  Thank you,  Teresa Rios Provider Account Manager', NULL, NULL, '2021-12-23 09:40:00', '2021-12-23 09:40:00'),
(18185, 10057, 21437, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Received From : AM.Houston@superiorhealthplan.com  Sub : [secure] Sigi Paul Credentialing Status Update  Hi, I show the effective date for Sigi Paul is 9/1/2021 and I’ve attached a spreadsheet showing the par products. Please reference ticket # 72511 if you have any questions.   Sincerely,   Barbara McDonald Account Manager, Provider Relations', NULL, NULL, '2021-12-30 10:59:31', '2021-12-30 10:59:31'),
(18186, 20067, 21437, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Good afternoon,  Hope you are doing well. I would like to know the enrollment status of the below-mentioned providers under these locations.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Provider Name	NPI	Location SIGI PAUL	1033623616	9504 LONG POINT RD STE E, Houston,TX 77055-4226 Molly Joseph	1396380077	9504 LONG POINT RD STE E, Houston,TX 77055-4226  Looking forward to hearing from you.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-06 14:01:05', '2022-01-06 14:01:05'),
(18187, 20067, 21437, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email Received from: AM.Houston@superiorhealthplan.com  Sub: Fwd: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Hello Syed,  The provider is effective 1/1/2022 and is listed with both of those address you provided below.     Timothy Do  Provider Account Manager II  Region 7 (Harris & Jefferson) ', NULL, NULL, '2022-01-11 10:06:01', '2022-01-11 10:06:01'),
(18188, 20067, 21437, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Sub: Re: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Good morning, Hope all is well with you. Kindly send me the welcome kit for both providers mentioned below  Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-11 10:10:30', '2022-01-11 10:10:30'),
(18189, 20067, 21437, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email received from: AM.Houston@superiorhealthplan.com  Sub: Fwd: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Good Afternoon,     Your email was received. An Account Manager will be contacting you to address your request. When contacting Account Management for updates on this issue, you can Reference Case #75028        If you are in need of immediate assistance, you can call to speak to an Account Manager by phone at 1-800-656-4817 (English 1, Spanish 2), and Option 3  Provider Relations Team', NULL, NULL, '2022-01-19 10:23:50', '2022-01-19 10:23:50'),
(18190, 20067, 21437, NULL, '2022-02-03 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Sub: Re: Enrollment Status || LPMC || SIGI PAUL || Ambetter ||  Good afternoon!  Hope this email finds you well. I would like to know the enrollment status of the below-mentioned providers.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI SIGI PAUL	1033623616  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-27 15:04:10', '2022-01-27 15:04:10'),
(18191, 20067, 21437, NULL, '2022-02-10 00:00:00.000', 'In Process', 'Application to add to an provider into an existing group has been submitted, See attachments.', NULL, NULL, '2022-02-03 15:08:42', '2022-02-03 15:08:42'),
(18192, 20067, 21437, NULL, '2022-02-24 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Sub: Re: Enrollment Status || LPMC || SIGI PAUL & Jeny John || Ambetter ||  Good Evening!  I have submitted the application on 02/03/2022 using the link which you provided for below mentioned providers.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus, TX 78934-2215 NPI	Provider 1073019493	Jeny John 1033623616	Sigi Paul  Kindly keep me updated about the application process.  Thank you,', NULL, NULL, '2022-02-17 17:50:27', '2022-02-17 17:50:27'),
(18193, 20067, 21437, NULL, '2022-03-11 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Sub: Re: Enrollment Status || LPMC || SIGI PAUL & Jeny John || Ambetter ||  Good Afternoon!  I have submitted the application on 02/03/2022 using the link which you provided for below-mentioned providers.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Jeny John	1073019493 Sigi Paul	1033623616 Kindly keep me updated about the application process.  Thank you,', NULL, NULL, '2022-03-04 14:51:22', '2022-03-04 14:51:22'),
(18194, 20067, 21437, NULL, '2022-03-16 00:00:00.000', 'In Process', 'Email sent to: shp-networkdevelopment@superiorhealthplan.com  Sub: PROVIDER PACKET || Sigi Paul || Longpoint Mdical Center || Superior Health  Good Afternoon!  Hope you are doing well. Attached is the provider packet For Jeny John.  Thank you, Syed Ahad. ', NULL, NULL, '2022-03-09 12:29:14', '2022-03-09 12:29:14'),
(18195, 20067, 21437, NULL, '2022-03-29 00:00:00.000', 'In Process', 'Email sent to: shp-networkdevelopment@superiorhealthplan.com   Sub: Re: PROVIDER PACKET || Sigi Paul || LPMC || Superior Health  Hello,  Hope you are doing great. Can you confirm the current credentialing status for provider Sigi Paul NPI: 1033623616  Thank you,', NULL, NULL, '2022-03-22 15:16:01', '2022-03-22 15:16:01'),
(18196, 1006, 21438, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 09:31:18', '2021-03-16 09:31:18'),
(18197, 1019, 21438, NULL, '2021-04-07 00:00:00.000', 'Initiated', 'Sent the following email to  Bennett_Tansey@tufts-health.com  Cc: Kody_Dunnett@tufts-health.com, Nilda_Amarante@tufts-health.com, snbc@claimsmedinc.com Sub: Enrollment Status for Providers || SNBCARE || Tufts Public Plans  Good Morning Bennett, Can you please let me know the Enrollment status of the following providers under Tufts Public Plans for the mentioned locations, also please provide the effective dates if enrolled.  Group Information: Spectrum Neuro Behavioral Care LLC. Tax ID: 83-4482753 Group NPI: 1356906572 Address 1: 61 Lincoln Street, Suite no 203, Framingham, MA, 01702. Address 2: 63 Eddie Dowling Highway, Suite No 9, North Smithfield, RI, 02896.  Individual Providers: Name: Tawakol, Katie NPI :    1609222116  Name:  Rashid, Mahreen NPI :    1396393146  Name:  Hefti, Prisca NPI :    1508133182  Name:  Khan, Fauzia Wali NPI :    1699761965  Name: Ullrich, Jennifer Lee NPI :    1710489760  Name:  Pionke, Peggy NPI :    1699307322  Name:  Schubert, Jonathan NPI :    1235755505  Name:  Hignite, Barbara NPI :    1982617262  Name:  Rozell, Carlee NPI :    1225645393  Name:  Loveland, Lynnetta NPI :    1598163602  Name:  L\'Etoile, Melody NPI :    1942687108  Name:  Oliva, Erin NPI :    1407349632  Name:  Hartman, Jessica NPI :    1326665472  Please get back to me ASAP also let me know if you have any questions.', NULL, NULL, '2021-03-31 10:05:40', '2021-03-31 10:05:40'),
(18198, 3040, 21438, NULL, '2021-04-23 00:00:00.000', 'In Process', 'Email sent to: Provider_Data_Request@tufts-health.com  Subject: Enrollment Status for Providers || SNBCARE || Tufts Public Plans  Greetings,  Can you please let me know the Enrollment status of the following providers under Tufts Public Plans for the mentioned locations, also please provide the effective dates if enrolled.  Group Information: Spectrum Neuro Behavioral Care LLC. Tax ID: 83-4482753 Group NPI: 1356906572 Address 1: 61 Lincoln Street, Suite no 203, Framingham, MA, 01702. Address 2: 63 Eddie Dowling Highway, Suite No 9, North Smithfield, RI, 02896.  Individual Providers: Name: Tawakol, Katie NPI :    1609222116  Name:  Rashid, Mahreen NPI :    1396393146  Name:  Hefti, Prisca NPI :    1508133182  Name:  Khan, Fauzia Wali NPI :    1699761965  Name: Ullrich, Jennifer Lee NPI :    1710489760  Name:  Pionke, Peggy NPI :    1699307322  Name:  Schubert, Jonathan NPI :    1235755505  Name:  Hignite, Barbara NPI :    1982617262  Name:  Rozell, Carlee NPI :    1225645393  Name:  Loveland, Lynnetta NPI :    1598163602  Name:  L\'Etoile, Melody NPI :    1942687108  Name:  Oliva, Erin NPI :    1407349632  Name:  Hartman, Jessica NPI :    1326665472  Name:  Souliere, Justin R NPI :    1710576004  Name:  Smith, Kerry R NPI :    1275083230  Please get back to me ASAP also let me know if you have any questions.', NULL, NULL, '2021-04-16 15:02:30', '2021-04-16 15:02:30'),
(18199, 1019, 21438, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to provider_data_request@tufts-health.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tufts Health Plans   Hello, We need the enrollment status for the following providers under our group, as their applications have been in process for a while now.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert NPI: 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Regards,', NULL, NULL, '2021-06-07 08:00:03', '2021-06-07 08:00:03'),
(18200, 1019, 21438, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Sent the following email to Kody_Dunnett@tufts-health.com  Hello Kody,  We need to expedite the applications for the following providers of Credentialing and Contracting as it is In process since a while now as it is adversely affecting our business, also we are not getting proper responses on our emails.  Spectrum Neuro Behavioral Care LLC. 1356906572 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rodesia Edmundson  1124622667  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Mary Gibbons  NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Lynnetta Loveland  NPI: 1598163602  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Jonathan Schubert  NPI: 1235755505  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jennifer Ullrich NPI: 1710489760  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Prisca Hefti NPI: 1508133182  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767  Regards, Alex G', NULL, NULL, '2021-06-23 09:31:43', '2021-06-23 09:31:43'),
(18201, 1019, 21438, NULL, '2021-08-18 00:00:00.000', 'Not Eligible', 'Received the following message from Tufts: Allison_Morris@tufts-health.com Hello,  I’m writing in response to the provider application we received for LCSW. Unfortunately we cannot proceed with contracting this provider as we are only able to credential and contract LICSW providers, not LCSWs.        Thank you,  _____________________________________  Allison Morris  Associate Contract Specialist, Behavioral Health Services  Allied Health Contracting  Tufts Health Plan', NULL, NULL, '2021-08-10 23:39:17', '2021-08-10 23:39:17'),
(18202, 1006, 21439, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 09:31:21', '2021-03-16 09:31:21'),
(18203, 1019, 21439, NULL, '2021-04-07 00:00:00.000', 'Initiated', 'Sent the following email to  Bennett_Tansey@tufts-health.com  Cc: Kody_Dunnett@tufts-health.com, Nilda_Amarante@tufts-health.com, snbc@claimsmedinc.com  Sub: Enrollment Status for Providers || SNBCARE || Tufts Public Plans  Good Morning Bennett, Can you please let me know the Enrollment status of the following providers under Tufts Public Plans for the mentioned locations, also please provide the effective dates if enrolled.  Group Information: Spectrum Neuro Behavioral Care LLC. Tax ID: 83-4482753 Group NPI: 1356906572 Address 1: 61 Lincoln Street, Suite no 203, Framingham, MA, 01702. Address 2: 63 Eddie Dowling Highway, Suite No 9, North Smithfield, RI, 02896.  Individual Providers: Name: Tawakol, Katie NPI :    1609222116  Name:  Rashid, Mahreen NPI :    1396393146  Name:  Hefti, Prisca NPI :    1508133182  Name:  Khan, Fauzia Wali NPI :    1699761965  Name: Ullrich, Jennifer Lee NPI :    1710489760  Name:  Pionke, Peggy NPI :    1699307322  Name:  Schubert, Jonathan NPI :    1235755505  Name:  Hignite, Barbara NPI :    1982617262  Name:  Rozell, Carlee NPI :    1225645393  Name:  Loveland, Lynnetta NPI :    1598163602  Name:  L\'Etoile, Melody NPI :    1942687108  Name:  Oliva, Erin NPI :    1407349632  Name:  Hartman, Jessica NPI :    1326665472  Please get back to me ASAP also let me know if you have any questions.', NULL, NULL, '2021-03-31 10:07:13', '2021-03-31 10:07:13'),
(18204, 3040, 21439, NULL, '2021-04-23 00:00:00.000', 'In Process', 'Email sent to: Provider_Data_Request@tufts-health.com  Subject: Enrollment Status for Providers || SNBCARE || Tufts Public Plans  Greetings,  Can you please let me know the Enrollment status of the following providers under Tufts Public Plans for the mentioned locations, also please provide the effective dates if enrolled.  Group Information: Spectrum Neuro Behavioral Care LLC. Tax ID: 83-4482753 Group NPI: 1356906572 Address 1: 61 Lincoln Street, Suite no 203, Framingham, MA, 01702. Address 2: 63 Eddie Dowling Highway, Suite No 9, North Smithfield, RI, 02896.  Individual Providers: Name: Tawakol, Katie NPI :    1609222116  Name:  Rashid, Mahreen NPI :    1396393146  Name:  Hefti, Prisca NPI :    1508133182  Name:  Khan, Fauzia Wali NPI :    1699761965  Name: Ullrich, Jennifer Lee NPI :    1710489760  Name:  Pionke, Peggy NPI :    1699307322  Name:  Schubert, Jonathan NPI :    1235755505  Name:  Hignite, Barbara NPI :    1982617262  Name:  Rozell, Carlee NPI :    1225645393  Name:  Loveland, Lynnetta NPI :    1598163602  Name:  L\'Etoile, Melody NPI :    1942687108  Name:  Oliva, Erin NPI :    1407349632  Name:  Hartman, Jessica NPI :    1326665472  Name:  Souliere, Justin R NPI :    1710576004  Name:  Smith, Kerry R NPI :    1275083230  Please get back to me ASAP also let me know if you have any questions.', NULL, NULL, '2021-04-16 15:02:26', '2021-04-16 15:02:26'),
(18205, 1019, 21439, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to provider_data_request@tufts-health.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tufts Health Plans   Hello, We need the enrollment status for the following providers under our group, as their applications have been in process for a while now.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert NPI: 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Regards,', NULL, NULL, '2021-06-07 07:59:54', '2021-06-07 07:59:54'),
(18206, 1019, 21439, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Sent the following email to Kody_Dunnett@tufts-health.com  Hello Kody,  We need to expedite the applications for the following providers of Credentialing and Contracting as it is In process since a while now as it is adversely affecting our business, also we are not getting proper responses on our emails.  Spectrum Neuro Behavioral Care LLC. 1356906572 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rodesia Edmundson  1124622667  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Mary Gibbons  NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Lynnetta Loveland  NPI: 1598163602  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Jonathan Schubert  NPI: 1235755505  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jennifer Ullrich NPI: 1710489760  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Prisca Hefti NPI: 1508133182  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767  Regards, Alex G', NULL, NULL, '2021-06-23 09:31:34', '2021-06-23 09:31:34'),
(18207, 1019, 21439, NULL, '2021-08-18 00:00:00.000', 'Approved', 'Received the following email from Brady_Roche@tufts-health.com  Hi Alex,  My department can help with effective dates, I have provided them on the spreadsheet. I have included Katherine in Allied and Christine in Credentialing as one is still in cred process and the other needs to be linked to the group.  Thanks,  Effective Date is 06/01/2020 Attached are the Location Addition and Provider Roster of Tufts', NULL, NULL, '2021-08-10 23:15:13', '2021-08-10 23:15:13'),
(18208, 1006, 21440, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 09:31:24', '2021-03-16 09:31:24'),
(18209, 1019, 21440, NULL, '2021-04-09 00:00:00.000', 'Initiated', 'To: Tufts_Health_Plan_Credentialing_Department@tufts-health.com Cc: Spectrum Neuro Behavioral Health snbc@claimsmedinc.com Hello,  Please find the attached request to initiate the credentialing/contracting for our provider Kerry Smith. Do let me know if anything else is required. ', NULL, NULL, '2021-04-02 15:08:21', '2021-04-02 15:08:21'),
(18210, 3040, 21440, NULL, '2021-04-23 00:00:00.000', 'In Process', 'Email sent to: Provider_Data_Request@tufts-health.com  Subject: Enrollment Status for Providers || SNBCARE || Tufts Public Plans  Greetings,  Can you please let me know the Enrollment status of the following providers under Tufts Public Plans for the mentioned locations, also please provide the effective dates if enrolled.  Group Information: Spectrum Neuro Behavioral Care LLC. Tax ID: 83-4482753 Group NPI: 1356906572 Address 1: 61 Lincoln Street, Suite no 203, Framingham, MA, 01702. Address 2: 63 Eddie Dowling Highway, Suite No 9, North Smithfield, RI, 02896.  Individual Providers: Name: Tawakol, Katie NPI :    1609222116  Name:  Rashid, Mahreen NPI :    1396393146  Name:  Hefti, Prisca NPI :    1508133182  Name:  Khan, Fauzia Wali NPI :    1699761965  Name: Ullrich, Jennifer Lee NPI :    1710489760  Name:  Pionke, Peggy NPI :    1699307322  Name:  Schubert, Jonathan NPI :    1235755505  Name:  Hignite, Barbara NPI :    1982617262  Name:  Rozell, Carlee NPI :    1225645393  Name:  Loveland, Lynnetta NPI :    1598163602  Name:  L\'Etoile, Melody NPI :    1942687108  Name:  Oliva, Erin NPI :    1407349632  Name:  Hartman, Jessica NPI :    1326665472  Name:  Souliere, Justin R NPI :    1710576004  Name:  Smith, Kerry R NPI :    1275083230  Please get back to me ASAP also let me know if you have any questions.', NULL, NULL, '2021-04-16 15:02:51', '2021-04-16 15:02:51'),
(18211, 1019, 21440, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to provider_data_request@tufts-health.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tufts Health Plans   Hello, We need the enrollment status for the following providers under our group, as their applications have been in process for a while now.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert NPI: 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Regards,', NULL, NULL, '2021-06-07 07:59:43', '2021-06-07 07:59:43');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(18212, 1019, 21440, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Sent the following email to Kody_Dunnett@tufts-health.com  Hello Kody,  We need to expedite the applications for the following providers of Credentialing and Contracting as it is In process since a while now as it is adversely affecting our business, also we are not getting proper responses on our emails.  Spectrum Neuro Behavioral Care LLC. 1356906572 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rodesia Edmundson  1124622667  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Mary Gibbons  NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Lynnetta Loveland  NPI: 1598163602  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Jonathan Schubert  NPI: 1235755505  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jennifer Ullrich NPI: 1710489760  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Prisca Hefti NPI: 1508133182  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767  Regards, Alex G', NULL, NULL, '2021-06-23 09:31:26', '2021-06-23 09:31:26'),
(18213, 1019, 21440, NULL, '2021-11-16 00:00:00.000', 'Approved', 'Effective Date 06/10/2021, attached is the Location Confirmation & Accepted Plans list.', NULL, NULL, '2021-11-09 11:01:04', '2021-11-09 11:01:04'),
(18214, 1006, 21441, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 09:31:26', '2021-03-16 09:31:26'),
(18215, 1019, 21441, NULL, '2021-04-07 00:00:00.000', 'Initiated', 'Sent the following email to  Bennett_Tansey@tufts-health.com  Cc: Kody_Dunnett@tufts-health.com, Nilda_Amarante@tufts-health.com, snbc@claimsmedinc.com  Sub: Enrollment Status for Providers || SNBCARE || Tufts Public Plans  Good Morning Bennett, Can you please let me know the Enrollment status of the following providers under Tufts Public Plans for the mentioned locations, also please provide the effective dates if enrolled.  Group Information: Spectrum Neuro Behavioral Care LLC. Tax ID: 83-4482753 Group NPI: 1356906572 Address 1: 61 Lincoln Street, Suite no 203, Framingham, MA, 01702. Address 2: 63 Eddie Dowling Highway, Suite No 9, North Smithfield, RI, 02896.  Individual Providers: Name: Tawakol, Katie NPI :    1609222116  Name:  Rashid, Mahreen NPI :    1396393146  Name:  Hefti, Prisca NPI :    1508133182  Name:  Khan, Fauzia Wali NPI :    1699761965  Name: Ullrich, Jennifer Lee NPI :    1710489760  Name:  Pionke, Peggy NPI :    1699307322  Name:  Schubert, Jonathan NPI :    1235755505  Name:  Hignite, Barbara NPI :    1982617262  Name:  Rozell, Carlee NPI :    1225645393  Name:  Loveland, Lynnetta NPI :    1598163602  Name:  L\'Etoile, Melody NPI :    1942687108  Name:  Oliva, Erin NPI :    1407349632  Name:  Hartman, Jessica NPI :    1326665472  Please get back to me ASAP also let me know if you have any questions.', NULL, NULL, '2021-03-31 10:08:16', '2021-03-31 10:08:16'),
(18216, 3040, 21441, NULL, '2021-04-23 00:00:00.000', 'In Process', 'Email sent to: Provider_Data_Request@tufts-health.com  Subject: Enrollment Status for Providers || SNBCARE || Tufts Public Plans  Greetings,  Can you please let me know the Enrollment status of the following providers under Tufts Public Plans for the mentioned locations, also please provide the effective dates if enrolled.  Group Information: Spectrum Neuro Behavioral Care LLC. Tax ID: 83-4482753 Group NPI: 1356906572 Address 1: 61 Lincoln Street, Suite no 203, Framingham, MA, 01702. Address 2: 63 Eddie Dowling Highway, Suite No 9, North Smithfield, RI, 02896.  Individual Providers: Name: Tawakol, Katie NPI :    1609222116  Name:  Rashid, Mahreen NPI :    1396393146  Name:  Hefti, Prisca NPI :    1508133182  Name:  Khan, Fauzia Wali NPI :    1699761965  Name: Ullrich, Jennifer Lee NPI :    1710489760  Name:  Pionke, Peggy NPI :    1699307322  Name:  Schubert, Jonathan NPI :    1235755505  Name:  Hignite, Barbara NPI :    1982617262  Name:  Rozell, Carlee NPI :    1225645393  Name:  Loveland, Lynnetta NPI :    1598163602  Name:  L\'Etoile, Melody NPI :    1942687108  Name:  Oliva, Erin NPI :    1407349632  Name:  Hartman, Jessica NPI :    1326665472  Name:  Souliere, Justin R NPI :    1710576004  Name:  Smith, Kerry R NPI :    1275083230  Please get back to me ASAP also let me know if you have any questions.', NULL, NULL, '2021-04-16 15:02:20', '2021-04-16 15:02:20'),
(18217, 1019, 21441, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to provider_data_request@tufts-health.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tufts Health Plans   Hello, We need the enrollment status for the following providers under our group, as their applications have been in process for a while now.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert NPI: 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Regards,', NULL, NULL, '2021-06-07 07:59:34', '2021-06-07 07:59:34'),
(18218, 1019, 21441, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Sent the following email to Kody_Dunnett@tufts-health.com  Hello Kody,  We need to expedite the applications for the following providers of Credentialing and Contracting as it is In process since a while now as it is adversely affecting our business, also we are not getting proper responses on our emails.  Spectrum Neuro Behavioral Care LLC. 1356906572 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rodesia Edmundson  1124622667  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Mary Gibbons  NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Lynnetta Loveland  NPI: 1598163602  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Jonathan Schubert  NPI: 1235755505  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jennifer Ullrich NPI: 1710489760  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Prisca Hefti NPI: 1508133182  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767  Regards, Alex G', NULL, NULL, '2021-06-23 09:31:04', '2021-06-23 09:31:04'),
(18219, 1019, 21441, NULL, '2021-08-18 00:00:00.000', 'Not Eligible', 'Received the following message from Tufts: Allison_Morris@tufts-health.com Hello,  I’m writing in response to the provider application we received for LCSW. Unfortunately we cannot proceed with contracting this provider as we are only able to credential and contract LICSW providers, not LCSWs.        Thank you,  _____________________________________  Allison Morris  Associate Contract Specialist, Behavioral Health Services  Allied Health Contracting  Tufts Health Plan', NULL, NULL, '2021-08-10 23:39:00', '2021-08-10 23:39:00'),
(18220, 1019, 21441, NULL, '2021-10-06 00:00:00.000', 'Initiated', 'Sent the following email to Tufts_Health_Plan_Credentialing_Department@tufts-health.com, - provider_data_request@tufts-health.com  Good Morning, Attached is the application for our provider as he is LICSW now, please expedite this application as we were waiting on it for several months now.', NULL, NULL, '2021-09-29 07:58:03', '2021-09-29 07:58:03'),
(18221, 1019, 21441, NULL, '2021-10-26 00:00:00.000', 'In Process', 'Received the following email from Tufts. Hello ,  We are in receipt of your request regarding Enrollment Application || Jonathan Schubert || SNBCARE || Tufts Health/ Tufts Public Plans that was submitted on 2021-09-29 08:57:52 EDT.  Please reference ticket number PRO0150549 for further communications about this request.  Thank you,  Tufts Health Public Plans, Provider Information Management Team    Ref:MSG7645241', NULL, NULL, '2021-10-19 08:23:17', '2021-10-19 08:23:17'),
(18222, 11056, 21441, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email sent to: Denise_Rysinger@tufts-health.com  Sub: Fwd: Enrollment Issue with Tufts Health Plan  Hello,  We are facing issues getting our provider credentialed with Tufts as your process has been too long, due to which we are having issues seeing our patients. We have submitted the signed agreement for the following back in March and the rest others we have sent an enrollment application to Tufts but still didn\'t hear anything.     Group:  Spectrum Neuro Behavioral Care LLC. NPI: 1356906572     Providers  Loveland, Lynnetta -  NPI: 1598163602  Schubert, Jonathan –  NPI: 1235755505  Filoteo-Nichols, Dina - NPI: 1770021099  Halterman, Helena –  NPI: 1801473749', NULL, NULL, '2021-12-03 14:56:45', '2021-12-03 14:56:45'),
(18223, 19067, 21441, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com  Subject: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||   Hello,  Hope this email finds you well.  I want to know the enrollment status for the following providers under mentioned locations and also the group credentialing status.  If any Provider is enrolled provide me with their Effective date and Welcome letter.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Dina, Filoteo-Nichols	1770021099	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Dina, Filoteo-Nichols	1770021099	100 New State Highway, Raynham, MA, 02767. Loveland, Lynnetta	1598163602	100 New State Highway, Raynham, MA, 02767. Loveland, Lynnetta	1598163602	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Oliva, Erin	1407349632	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Schubert, Jonathan	1235755505	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Schubert, Jonathan	1235755505	100 New State Highway, Raynham, MA, 02767.  Kindly respond to me in a timely manner.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-15 17:41:16', '2021-12-15 17:41:16'),
(18224, 19067, 21441, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: Provider_Data_Request@tufts-health.com, tufts_health_plan_credentialing_department@tufts-health.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||   Good Morning!  Hope you are doing well and having a productive day.  I would like to know the enrollment status of the following Providers and Groups.   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Dina Filoteo-Nichols	1770021099	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Dina Filoteo-Nichols	1770021099	100 New State HWY, Raynham, MA 02767-5423 Helena Halterman	1801473749	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Helena Halterman	1801473749	100 New State HWY, Raynham, MA 02767-5423 Jonathan Schubert	1235755505	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Jonathan Schubert	1235755505	100 New State HWY, Raynham, MA 02767-5423 Lynnetta Loveland	1598163602	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Lynnetta Loveland	1598163602	100 New State HWY, Raynham, MA 02767-5423 Erin Oliva	1407349632	63 Eddie Dowling HWY, Suite 8, North Smithfield, RI 02896-7322   Kindly respond to us in a timely manner.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 10:06:11', '2021-12-29 10:06:11'),
(18225, 19067, 21441, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com, Provider_Data_Request@tufts-health.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||  Greetings!  Hope this email finds you well.  Any updates on the previously mentioned request?  Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 14:44:14', '2022-01-10 14:44:14'),
(18226, 19067, 21441, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com, Provider_Data_Request@tufts-health.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||   Hello!  This is my SECOND REMINDER on the previously mentioned request.  Kindly respond as per your convenience.  Regards, Hammad Ahmed. ', NULL, NULL, '2022-02-11 11:39:19', '2022-02-11 11:39:19'),
(18227, 22077, 21441, NULL, '2022-04-12 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com  Subject: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans |  Hello,  Hope this email finds you well.  Any updates on the previously mentioned request?  Kindly respond promptly.  Thanks,', NULL, NULL, '2022-04-05 10:40:06', '2022-04-05 10:40:06'),
(18228, 1006, 21442, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 09:31:28', '2021-03-16 09:31:28'),
(18229, 1019, 21442, NULL, '2021-04-07 00:00:00.000', 'Initiated', 'Sent the following email to  Bennett_Tansey@tufts-health.com  Cc: Kody_Dunnett@tufts-health.com, Nilda_Amarante@tufts-health.com, snbc@claimsmedinc.com  Sub: Enrollment Status for Providers || SNBCARE || Tufts Public Plans  Good Morning Bennett, Can you please let me know the Enrollment status of the following providers under Tufts Public Plans for the mentioned locations, also please provide the effective dates if enrolled.  Group Information: Spectrum Neuro Behavioral Care LLC. Tax ID: 83-4482753 Group NPI: 1356906572 Address 1: 61 Lincoln Street, Suite no 203, Framingham, MA, 01702. Address 2: 63 Eddie Dowling Highway, Suite No 9, North Smithfield, RI, 02896.  Individual Providers: Name: Tawakol, Katie NPI :    1609222116  Name:  Rashid, Mahreen NPI :    1396393146  Name:  Hefti, Prisca NPI :    1508133182  Name:  Khan, Fauzia Wali NPI :    1699761965  Name: Ullrich, Jennifer Lee NPI :    1710489760  Name:  Pionke, Peggy NPI :    1699307322  Name:  Schubert, Jonathan NPI :    1235755505  Name:  Hignite, Barbara NPI :    1982617262  Name:  Rozell, Carlee NPI :    1225645393  Name:  Loveland, Lynnetta NPI :    1598163602  Name:  L\'Etoile, Melody NPI :    1942687108  Name:  Oliva, Erin NPI :    1407349632  Name:  Hartman, Jessica NPI :    1326665472  Please get back to me ASAP also let me know if you have any questions.', NULL, NULL, '2021-03-31 10:09:32', '2021-03-31 10:09:32'),
(18230, 3040, 21442, NULL, '2021-04-23 00:00:00.000', 'In Process', 'Email sent to: Provider_Data_Request@tufts-health.com  Subject: Enrollment Status for Providers || SNBCARE || Tufts Public Plans  Greetings,  Can you please let me know the Enrollment status of the following providers under Tufts Public Plans for the mentioned locations, also please provide the effective dates if enrolled.  Group Information: Spectrum Neuro Behavioral Care LLC. Tax ID: 83-4482753 Group NPI: 1356906572 Address 1: 61 Lincoln Street, Suite no 203, Framingham, MA, 01702. Address 2: 63 Eddie Dowling Highway, Suite No 9, North Smithfield, RI, 02896.  Individual Providers: Name: Tawakol, Katie NPI :    1609222116  Name:  Rashid, Mahreen NPI :    1396393146  Name:  Hefti, Prisca NPI :    1508133182  Name:  Khan, Fauzia Wali NPI :    1699761965  Name: Ullrich, Jennifer Lee NPI :    1710489760  Name:  Pionke, Peggy NPI :    1699307322  Name:  Schubert, Jonathan NPI :    1235755505  Name:  Hignite, Barbara NPI :    1982617262  Name:  Rozell, Carlee NPI :    1225645393  Name:  Loveland, Lynnetta NPI :    1598163602  Name:  L\'Etoile, Melody NPI :    1942687108  Name:  Oliva, Erin NPI :    1407349632  Name:  Hartman, Jessica NPI :    1326665472  Name:  Souliere, Justin R NPI :    1710576004  Name:  Smith, Kerry R NPI :    1275083230  Please get back to me ASAP also let me know if you have any questions.', NULL, NULL, '2021-04-16 15:02:15', '2021-04-16 15:02:15'),
(18231, 1019, 21442, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to provider_data_request@tufts-health.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tufts Health Plans   Hello, We need the enrollment status for the following providers under our group, as their applications have been in process for a while now.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert NPI: 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Regards,', NULL, NULL, '2021-06-07 07:59:23', '2021-06-07 07:59:23'),
(18232, 1019, 21442, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Sent the following email to Kody_Dunnett@tufts-health.com  Hello Kody,  We need to expedite the applications for the following providers of Credentialing and Contracting as it is In process since a while now as it is adversely affecting our business, also we are not getting proper responses on our emails.  Spectrum Neuro Behavioral Care LLC. 1356906572 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rodesia Edmundson  1124622667  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Mary Gibbons  NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Lynnetta Loveland  NPI: 1598163602  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Jonathan Schubert  NPI: 1235755505  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jennifer Ullrich NPI: 1710489760  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Prisca Hefti NPI: 1508133182  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767  Regards, Alex G', NULL, NULL, '2021-06-23 09:30:55', '2021-06-23 09:30:55'),
(18233, 1019, 21442, NULL, '2021-11-16 00:00:00.000', 'Not Eligible', 'Provider will no longer with SNBCARE.', NULL, NULL, '2021-11-09 10:33:34', '2021-11-09 10:33:34'),
(18234, 1006, 21443, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 09:31:29', '2021-03-16 09:31:29'),
(18235, 1019, 21443, NULL, '2021-04-07 00:00:00.000', 'Initiated', 'Sent the following email to  Bennett_Tansey@tufts-health.com  Cc: Kody_Dunnett@tufts-health.com, Nilda_Amarante@tufts-health.com, snbc@claimsmedinc.com  Sub: Enrollment Status for Providers || SNBCARE || Tufts Public Plans  Good Morning Bennett, Can you please let me know the Enrollment status of the following providers under Tufts Public Plans for the mentioned locations, also please provide the effective dates if enrolled.  Group Information: Spectrum Neuro Behavioral Care LLC. Tax ID: 83-4482753 Group NPI: 1356906572 Address 1: 61 Lincoln Street, Suite no 203, Framingham, MA, 01702. Address 2: 63 Eddie Dowling Highway, Suite No 9, North Smithfield, RI, 02896.  Individual Providers: Name: Tawakol, Katie NPI :    1609222116  Name:  Rashid, Mahreen NPI :    1396393146  Name:  Hefti, Prisca NPI :    1508133182  Name:  Khan, Fauzia Wali NPI :    1699761965  Name: Ullrich, Jennifer Lee NPI :    1710489760  Name:  Pionke, Peggy NPI :    1699307322  Name:  Schubert, Jonathan NPI :    1235755505  Name:  Hignite, Barbara NPI :    1982617262  Name:  Rozell, Carlee NPI :    1225645393  Name:  Loveland, Lynnetta NPI :    1598163602  Name:  L\'Etoile, Melody NPI :    1942687108  Name:  Oliva, Erin NPI :    1407349632  Name:  Hartman, Jessica NPI :    1326665472  Please get back to me ASAP also let me know if you have any questions.', NULL, NULL, '2021-03-31 10:10:30', '2021-03-31 10:10:30'),
(18236, 3040, 21443, NULL, '2021-04-23 00:00:00.000', 'In Process', 'Email sent to: Provider_Data_Request@tufts-health.com  Subject: Enrollment Status for Providers || SNBCARE || Tufts Public Plans  Greetings,  Can you please let me know the Enrollment status of the following providers under Tufts Public Plans for the mentioned locations, also please provide the effective dates if enrolled.  Group Information: Spectrum Neuro Behavioral Care LLC. Tax ID: 83-4482753 Group NPI: 1356906572 Address 1: 61 Lincoln Street, Suite no 203, Framingham, MA, 01702. Address 2: 63 Eddie Dowling Highway, Suite No 9, North Smithfield, RI, 02896.  Individual Providers: Name: Tawakol, Katie NPI :    1609222116  Name:  Rashid, Mahreen NPI :    1396393146  Name:  Hefti, Prisca NPI :    1508133182  Name:  Khan, Fauzia Wali NPI :    1699761965  Name: Ullrich, Jennifer Lee NPI :    1710489760  Name:  Pionke, Peggy NPI :    1699307322  Name:  Schubert, Jonathan NPI :    1235755505  Name:  Hignite, Barbara NPI :    1982617262  Name:  Rozell, Carlee NPI :    1225645393  Name:  Loveland, Lynnetta NPI :    1598163602  Name:  L\'Etoile, Melody NPI :    1942687108  Name:  Oliva, Erin NPI :    1407349632  Name:  Hartman, Jessica NPI :    1326665472  Name:  Souliere, Justin R NPI :    1710576004  Name:  Smith, Kerry R NPI :    1275083230  Please get back to me ASAP also let me know if you have any questions.', NULL, NULL, '2021-04-16 15:02:05', '2021-04-16 15:02:05'),
(18237, 1019, 21443, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to provider_data_request@tufts-health.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tufts Health Plans   Hello, We need the enrollment status for the following providers under our group, as their applications have been in process for a while now.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert NPI: 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Regards,', NULL, NULL, '2021-06-07 07:59:11', '2021-06-07 07:59:11'),
(18238, 1019, 21443, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Sent the following email to Kody_Dunnett@tufts-health.com  Hello Kody,  We need to expedite the applications for the following providers of Credentialing and Contracting as it is In process since a while now as it is adversely affecting our business, also we are not getting proper responses on our emails.  Spectrum Neuro Behavioral Care LLC. 1356906572 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rodesia Edmundson  1124622667  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Mary Gibbons  NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Lynnetta Loveland  NPI: 1598163602  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Jonathan Schubert  NPI: 1235755505  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jennifer Ullrich NPI: 1710489760  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Prisca Hefti NPI: 1508133182  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767  Regards, Alex G', NULL, NULL, '2021-06-23 09:30:46', '2021-06-23 09:30:46'),
(18239, 1019, 21443, NULL, '2021-08-18 00:00:00.000', 'Approved', 'Received the following email from Brady_Roche@tufts-health.com  Hi Alex,  My department can help with effective dates, I have provided them on the spreadsheet. I have included Katherine in Allied and Christine in Credentialing as one is still in cred process and the other needs to be linked to the group.  Thanks,  Effective Date is 06/01/2020 Attached are the Location Addition and Provider Roster of Tufts', NULL, NULL, '2021-08-10 23:20:04', '2021-08-10 23:20:04'),
(18240, 1006, 21444, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 09:31:31', '2021-03-16 09:31:31'),
(18241, 1019, 21444, NULL, '2021-04-07 00:00:00.000', 'Initiated', 'Sent the following email to  Bennett_Tansey@tufts-health.com  Cc: Kody_Dunnett@tufts-health.com, Nilda_Amarante@tufts-health.com, snbc@claimsmedinc.com  Sub: Enrollment Status for Providers || SNBCARE || Tufts Public Plans  Good Morning Bennett, Can you please let me know the Enrollment status of the following providers under Tufts Public Plans for the mentioned locations, also please provide the effective dates if enrolled.  Group Information: Spectrum Neuro Behavioral Care LLC. Tax ID: 83-4482753 Group NPI: 1356906572 Address 1: 61 Lincoln Street, Suite no 203, Framingham, MA, 01702. Address 2: 63 Eddie Dowling Highway, Suite No 9, North Smithfield, RI, 02896.  Individual Providers: Name: Tawakol, Katie NPI :    1609222116  Name:  Rashid, Mahreen NPI :    1396393146  Name:  Hefti, Prisca NPI :    1508133182  Name:  Khan, Fauzia Wali NPI :    1699761965  Name: Ullrich, Jennifer Lee NPI :    1710489760  Name:  Pionke, Peggy NPI :    1699307322  Name:  Schubert, Jonathan NPI :    1235755505  Name:  Hignite, Barbara NPI :    1982617262  Name:  Rozell, Carlee NPI :    1225645393  Name:  Loveland, Lynnetta NPI :    1598163602  Name:  L\'Etoile, Melody NPI :    1942687108  Name:  Oliva, Erin NPI :    1407349632  Name:  Hartman, Jessica NPI :    1326665472  Please get back to me ASAP also let me know if you have any questions.', NULL, NULL, '2021-03-31 10:11:21', '2021-03-31 10:11:21'),
(18242, 3040, 21444, NULL, '2021-04-23 00:00:00.000', 'In Process', 'Email sent to: Provider_Data_Request@tufts-health.com  Subject: Enrollment Status for Providers || SNBCARE || Tufts Public Plans  Greetings,  Can you please let me know the Enrollment status of the following providers under Tufts Public Plans for the mentioned locations, also please provide the effective dates if enrolled.  Group Information: Spectrum Neuro Behavioral Care LLC. Tax ID: 83-4482753 Group NPI: 1356906572 Address 1: 61 Lincoln Street, Suite no 203, Framingham, MA, 01702. Address 2: 63 Eddie Dowling Highway, Suite No 9, North Smithfield, RI, 02896.  Individual Providers: Name: Tawakol, Katie NPI :    1609222116  Name:  Rashid, Mahreen NPI :    1396393146  Name:  Hefti, Prisca NPI :    1508133182  Name:  Khan, Fauzia Wali NPI :    1699761965  Name: Ullrich, Jennifer Lee NPI :    1710489760  Name:  Pionke, Peggy NPI :    1699307322  Name:  Schubert, Jonathan NPI :    1235755505  Name:  Hignite, Barbara NPI :    1982617262  Name:  Rozell, Carlee NPI :    1225645393  Name:  Loveland, Lynnetta NPI :    1598163602  Name:  L\'Etoile, Melody NPI :    1942687108  Name:  Oliva, Erin NPI :    1407349632  Name:  Hartman, Jessica NPI :    1326665472  Name:  Souliere, Justin R NPI :    1710576004  Name:  Smith, Kerry R NPI :    1275083230  Please get back to me ASAP also let me know if you have any questions.', NULL, NULL, '2021-04-16 15:01:59', '2021-04-16 15:01:59'),
(18243, 1019, 21444, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to provider_data_request@tufts-health.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tufts Health Plans   Hello, We need the enrollment status for the following providers under our group, as their applications have been in process for a while now.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert NPI: 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Regards,', NULL, NULL, '2021-06-07 07:59:03', '2021-06-07 07:59:03'),
(18244, 1019, 21444, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Sent the following email to Kody_Dunnett@tufts-health.com  Hello Kody,  We need to expedite the applications for the following providers of Credentialing and Contracting as it is In process since a while now as it is adversely affecting our business, also we are not getting proper responses on our emails.  Spectrum Neuro Behavioral Care LLC. 1356906572 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rodesia Edmundson  1124622667  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Mary Gibbons  NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Lynnetta Loveland  NPI: 1598163602  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Jonathan Schubert  NPI: 1235755505  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jennifer Ullrich NPI: 1710489760  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Prisca Hefti NPI: 1508133182  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767  Regards, Alex G', NULL, NULL, '2021-06-23 09:30:35', '2021-06-23 09:30:35'),
(18245, 1019, 21444, NULL, '2021-08-18 00:00:00.000', 'Approved', 'Received the following email from Brady_Roche@tufts-health.com  Hi Alex,  My department can help with effective dates, I have provided them on the spreadsheet. I have included Katherine in Allied and Christine in Credentialing as one is still in cred process and the other needs to be linked to the group.  Thanks,  Effective Date is 12/18/2020 Attached are the Location Addition and Provider Roster of Tufts', NULL, NULL, '2021-08-10 23:29:59', '2021-08-10 23:29:59'),
(18246, 1006, 21445, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 09:31:33', '2021-03-16 09:31:33'),
(18247, 1019, 21445, NULL, '2021-04-07 00:00:00.000', 'Initiated', 'Sent the following email to  Bennett_Tansey@tufts-health.com  Cc: Kody_Dunnett@tufts-health.com, Nilda_Amarante@tufts-health.com, snbc@claimsmedinc.com  Sub: Enrollment Status for Providers || SNBCARE || Tufts Public Plans  Good Morning Bennett, Can you please let me know the Enrollment status of the following providers under Tufts Public Plans for the mentioned locations, also please provide the effective dates if enrolled.  Group Information: Spectrum Neuro Behavioral Care LLC. Tax ID: 83-4482753 Group NPI: 1356906572 Address 1: 61 Lincoln Street, Suite no 203, Framingham, MA, 01702. Address 2: 63 Eddie Dowling Highway, Suite No 9, North Smithfield, RI, 02896.  Individual Providers: Name: Tawakol, Katie NPI :    1609222116  Name:  Rashid, Mahreen NPI :    1396393146  Name:  Hefti, Prisca NPI :    1508133182  Name:  Khan, Fauzia Wali NPI :    1699761965  Name: Ullrich, Jennifer Lee NPI :    1710489760  Name:  Pionke, Peggy NPI :    1699307322  Name:  Schubert, Jonathan NPI :    1235755505  Name:  Hignite, Barbara NPI :    1982617262  Name:  Rozell, Carlee NPI :    1225645393  Name:  Loveland, Lynnetta NPI :    1598163602  Name:  L\'Etoile, Melody NPI :    1942687108  Name:  Oliva, Erin NPI :    1407349632  Name:  Hartman, Jessica NPI :    1326665472  Please get back to me ASAP also let me know if you have any questions.', NULL, NULL, '2021-03-31 10:12:13', '2021-03-31 10:12:13');
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
(18248, 3040, 21445, NULL, '2021-04-23 00:00:00.000', 'In Process', 'Email sent to: Provider_Data_Request@tufts-health.com  Subject: Enrollment Status for Providers || SNBCARE || Tufts Public Plans  Greetings,  Can you please let me know the Enrollment status of the following providers under Tufts Public Plans for the mentioned locations, also please provide the effective dates if enrolled.  Group Information: Spectrum Neuro Behavioral Care LLC. Tax ID: 83-4482753 Group NPI: 1356906572 Address 1: 61 Lincoln Street, Suite no 203, Framingham, MA, 01702. Address 2: 63 Eddie Dowling Highway, Suite No 9, North Smithfield, RI, 02896.  Individual Providers: Name: Tawakol, Katie NPI :    1609222116  Name:  Rashid, Mahreen NPI :    1396393146  Name:  Hefti, Prisca NPI :    1508133182  Name:  Khan, Fauzia Wali NPI :    1699761965  Name: Ullrich, Jennifer Lee NPI :    1710489760  Name:  Pionke, Peggy NPI :    1699307322  Name:  Schubert, Jonathan NPI :    1235755505  Name:  Hignite, Barbara NPI :    1982617262  Name:  Rozell, Carlee NPI :    1225645393  Name:  Loveland, Lynnetta NPI :    1598163602  Name:  L\'Etoile, Melody NPI :    1942687108  Name:  Oliva, Erin NPI :    1407349632  Name:  Hartman, Jessica NPI :    1326665472  Name:  Souliere, Justin R NPI :    1710576004  Name:  Smith, Kerry R NPI :    1275083230  Please get back to me ASAP also let me know if you have any questions.', NULL, NULL, '2021-04-16 15:01:51', '2021-04-16 15:01:51'),
(18249, 1019, 21445, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to provider_data_request@tufts-health.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tufts Health Plans   Hello, We need the enrollment status for the following providers under our group, as their applications have been in process for a while now.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert NPI: 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Regards,', NULL, NULL, '2021-06-07 07:58:53', '2021-06-07 07:58:53'),
(18250, 1019, 21445, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Sent the following email to Kody_Dunnett@tufts-health.com  Hello Kody,  We need to expedite the applications for the following providers of Credentialing and Contracting as it is In process since a while now as it is adversely affecting our business, also we are not getting proper responses on our emails.  Spectrum Neuro Behavioral Care LLC. 1356906572 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rodesia Edmundson  1124622667  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Mary Gibbons  NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Lynnetta Loveland  NPI: 1598163602  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Jonathan Schubert  NPI: 1235755505  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jennifer Ullrich NPI: 1710489760  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Prisca Hefti NPI: 1508133182  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767  Regards, Alex G', NULL, NULL, '2021-06-23 09:28:01', '2021-06-23 09:28:01'),
(18251, 11056, 21445, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email sent to: Denise_Rysinger@tufts-health.com  Sub: Fwd: Enrollment Issue with Tufts Health Plan  Hello,  We are facing issues getting our provider credentialed with Tufts as your process has been too long, due to which we are having issues seeing our patients. We have submitted the signed agreement for the following back in March and the rest others we have sent an enrollment application to Tufts but still didn\'t hear anything.     Group:  Spectrum Neuro Behavioral Care LLC. NPI: 1356906572     Providers  Loveland, Lynnetta -  NPI: 1598163602  Schubert, Jonathan –  NPI: 1235755505  Filoteo-Nichols, Dina - NPI: 1770021099  Halterman, Helena –  NPI: 1801473749', NULL, NULL, '2021-12-03 14:56:25', '2021-12-03 14:56:25'),
(18252, 19067, 21445, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com  Subject: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||   Hello,  Hope this email finds you well.  I want to know the enrollment status for the following providers under mentioned locations and also the group credentialing status.  If any Provider is enrolled provide me with their Effective date and Welcome letter.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Dina, Filoteo-Nichols	1770021099	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Dina, Filoteo-Nichols	1770021099	100 New State Highway, Raynham, MA, 02767. Loveland, Lynnetta	1598163602	100 New State Highway, Raynham, MA, 02767. Loveland, Lynnetta	1598163602	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Oliva, Erin	1407349632	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Schubert, Jonathan	1235755505	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Schubert, Jonathan	1235755505	100 New State Highway, Raynham, MA, 02767.  Kindly respond to me in a timely manner.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-15 17:40:24', '2021-12-15 17:40:24'),
(18253, 19067, 21445, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: Provider_Data_Request@tufts-health.com, tufts_health_plan_credentialing_department@tufts-health.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||   Good Morning!  Hope you are doing well and having a productive day.  I would like to know the enrollment status of the following Providers and Groups.   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Dina Filoteo-Nichols	1770021099	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Dina Filoteo-Nichols	1770021099	100 New State HWY, Raynham, MA 02767-5423 Helena Halterman	1801473749	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Helena Halterman	1801473749	100 New State HWY, Raynham, MA 02767-5423 Jonathan Schubert	1235755505	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Jonathan Schubert	1235755505	100 New State HWY, Raynham, MA 02767-5423 Lynnetta Loveland	1598163602	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Lynnetta Loveland	1598163602	100 New State HWY, Raynham, MA 02767-5423 Erin Oliva	1407349632	63 Eddie Dowling HWY, Suite 8, North Smithfield, RI 02896-7322   Kindly respond to us in a timely manner.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 10:06:25', '2021-12-29 10:06:25'),
(18254, 19067, 21445, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com, Provider_Data_Request@tufts-health.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||  Greetings!  Hope this email finds you well.  Any updates on the previously mentioned request?  Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 14:44:08', '2022-01-10 14:44:08'),
(18255, 19067, 21445, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com, Provider_Data_Request@tufts-health.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||   Hello!  This is my SECOND REMINDER on the previously mentioned request.  Kindly respond as per your convenience.  Regards, Hammad Ahmed. ', NULL, NULL, '2022-02-11 11:39:43', '2022-02-11 11:39:43'),
(18256, 1006, 21446, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 09:31:34', '2021-03-16 09:31:34'),
(18257, 1019, 21446, NULL, '2021-04-07 00:00:00.000', 'Initiated', 'Sent the following email to  Bennett_Tansey@tufts-health.com  Cc: Kody_Dunnett@tufts-health.com, Nilda_Amarante@tufts-health.com, snbc@claimsmedinc.com  Sub: Enrollment Status for Providers || SNBCARE || Tufts Public Plans  Good Morning Bennett, Can you please let me know the Enrollment status of the following providers under Tufts Public Plans for the mentioned locations, also please provide the effective dates if enrolled.  Group Information: Spectrum Neuro Behavioral Care LLC. Tax ID: 83-4482753 Group NPI: 1356906572 Address 1: 61 Lincoln Street, Suite no 203, Framingham, MA, 01702. Address 2: 63 Eddie Dowling Highway, Suite No 9, North Smithfield, RI, 02896.  Individual Providers: Name: Tawakol, Katie NPI :    1609222116  Name:  Rashid, Mahreen NPI :    1396393146  Name:  Hefti, Prisca NPI :    1508133182  Name:  Khan, Fauzia Wali NPI :    1699761965  Name: Ullrich, Jennifer Lee NPI :    1710489760  Name:  Pionke, Peggy NPI :    1699307322  Name:  Schubert, Jonathan NPI :    1235755505  Name:  Hignite, Barbara NPI :    1982617262  Name:  Rozell, Carlee NPI :    1225645393  Name:  Loveland, Lynnetta NPI :    1598163602  Name:  L\'Etoile, Melody NPI :    1942687108  Name:  Oliva, Erin NPI :    1407349632  Name:  Hartman, Jessica NPI :    1326665472  Please get back to me ASAP also let me know if you have any questions.', NULL, NULL, '2021-03-31 10:12:41', '2021-03-31 10:12:41'),
(18258, 3040, 21446, NULL, '2021-04-23 00:00:00.000', 'In Process', 'Email sent to: Provider_Data_Request@tufts-health.com  Subject: Enrollment Status for Providers || SNBCARE || Tufts Public Plans  Greetings,  Can you please let me know the Enrollment status of the following providers under Tufts Public Plans for the mentioned locations, also please provide the effective dates if enrolled.  Group Information: Spectrum Neuro Behavioral Care LLC. Tax ID: 83-4482753 Group NPI: 1356906572 Address 1: 61 Lincoln Street, Suite no 203, Framingham, MA, 01702. Address 2: 63 Eddie Dowling Highway, Suite No 9, North Smithfield, RI, 02896.  Individual Providers: Name: Tawakol, Katie NPI :    1609222116  Name:  Rashid, Mahreen NPI :    1396393146  Name:  Hefti, Prisca NPI :    1508133182  Name:  Khan, Fauzia Wali NPI :    1699761965  Name: Ullrich, Jennifer Lee NPI :    1710489760  Name:  Pionke, Peggy NPI :    1699307322  Name:  Schubert, Jonathan NPI :    1235755505  Name:  Hignite, Barbara NPI :    1982617262  Name:  Rozell, Carlee NPI :    1225645393  Name:  Loveland, Lynnetta NPI :    1598163602  Name:  L\'Etoile, Melody NPI :    1942687108  Name:  Oliva, Erin NPI :    1407349632  Name:  Hartman, Jessica NPI :    1326665472  Name:  Souliere, Justin R NPI :    1710576004  Name:  Smith, Kerry R NPI :    1275083230  Please get back to me ASAP also let me know if you have any questions.', NULL, NULL, '2021-04-16 15:01:41', '2021-04-16 15:01:41'),
(18259, 1019, 21446, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to provider_data_request@tufts-health.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tufts Health Plans   Hello, We need the enrollment status for the following providers under our group, as their applications have been in process for a while now.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert NPI: 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Regards,', NULL, NULL, '2021-06-07 07:58:44', '2021-06-07 07:58:44'),
(18260, 1019, 21446, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Sent the following email to Kody_Dunnett@tufts-health.com  Hello Kody,  We need to expedite the applications for the following providers of Credentialing and Contracting as it is In process since a while now as it is adversely affecting our business, also we are not getting proper responses on our emails.  Spectrum Neuro Behavioral Care LLC. 1356906572 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rodesia Edmundson  1124622667  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Mary Gibbons  NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Lynnetta Loveland  NPI: 1598163602  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Jonathan Schubert  NPI: 1235755505  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jennifer Ullrich NPI: 1710489760  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Prisca Hefti NPI: 1508133182  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767  Regards, Alex G', NULL, NULL, '2021-06-23 09:27:53', '2021-06-23 09:27:53'),
(18261, 1019, 21446, NULL, '2021-08-18 00:00:00.000', 'Approved', 'Received the following email from Brady_Roche@tufts-health.com  Hi Alex,  My department can help with effective dates, I have provided them on the spreadsheet. I have included Katherine in Allied and Christine in Credentialing as one is still in cred process and the other needs to be linked to the group.  Thanks,  Effective Date is 04/19/2021 Attached are the Location Addition and Provider Roster of Tufts', NULL, NULL, '2021-08-10 23:07:50', '2021-08-10 23:07:50'),
(18262, 1006, 21447, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 09:31:36', '2021-03-16 09:31:36'),
(18263, 1019, 21447, NULL, '2021-04-07 00:00:00.000', 'Initiated', 'Sent the following email to  Bennett_Tansey@tufts-health.com  Cc: Kody_Dunnett@tufts-health.com, Nilda_Amarante@tufts-health.com, snbc@claimsmedinc.com  Sub: Enrollment Status for Providers || SNBCARE || Tufts Public Plans  Good Morning Bennett, Can you please let me know the Enrollment status of the following providers under Tufts Public Plans for the mentioned locations, also please provide the effective dates if enrolled.  Group Information: Spectrum Neuro Behavioral Care LLC. Tax ID: 83-4482753 Group NPI: 1356906572 Address 1: 61 Lincoln Street, Suite no 203, Framingham, MA, 01702. Address 2: 63 Eddie Dowling Highway, Suite No 9, North Smithfield, RI, 02896.  Individual Providers: Name: Tawakol, Katie NPI :    1609222116  Name:  Rashid, Mahreen NPI :    1396393146  Name:  Hefti, Prisca NPI :    1508133182  Name:  Khan, Fauzia Wali NPI :    1699761965  Name: Ullrich, Jennifer Lee NPI :    1710489760  Name:  Pionke, Peggy NPI :    1699307322  Name:  Schubert, Jonathan NPI :    1235755505  Name:  Hignite, Barbara NPI :    1982617262  Name:  Rozell, Carlee NPI :    1225645393  Name:  Loveland, Lynnetta NPI :    1598163602  Name:  L\'Etoile, Melody NPI :    1942687108  Name:  Oliva, Erin NPI :    1407349632  Name:  Hartman, Jessica NPI :    1326665472  Please get back to me ASAP also let me know if you have any questions.', NULL, NULL, '2021-03-31 10:13:20', '2021-03-31 10:13:20'),
(18264, 1019, 21447, NULL, '2021-04-07 00:00:00.000', 'Initiated', 'Sent the following email to  Bennett_Tansey@tufts-health.com  Cc: Kody_Dunnett@tufts-health.com, Nilda_Amarante@tufts-health.com, snbc@claimsmedinc.com  Sub: Enrollment Status for Providers || SNBCARE || Tufts Public Plans  Good Morning Bennett, Can you please let me know the Enrollment status of the following providers under Tufts Public Plans for the mentioned locations, also please provide the effective dates if enrolled.  Group Information: Spectrum Neuro Behavioral Care LLC. Tax ID: 83-4482753 Group NPI: 1356906572 Address 1: 61 Lincoln Street, Suite no 203, Framingham, MA, 01702. Address 2: 63 Eddie Dowling Highway, Suite No 9, North Smithfield, RI, 02896.  Individual Providers: Name: Tawakol, Katie NPI :    1609222116  Name:  Rashid, Mahreen NPI :    1396393146  Name:  Hefti, Prisca NPI :    1508133182  Name:  Khan, Fauzia Wali NPI :    1699761965  Name: Ullrich, Jennifer Lee NPI :    1710489760  Name:  Pionke, Peggy NPI :    1699307322  Name:  Schubert, Jonathan NPI :    1235755505  Name:  Hignite, Barbara NPI :    1982617262  Name:  Rozell, Carlee NPI :    1225645393  Name:  Loveland, Lynnetta NPI :    1598163602  Name:  L\'Etoile, Melody NPI :    1942687108  Name:  Oliva, Erin NPI :    1407349632  Name:  Hartman, Jessica NPI :    1326665472  Please get back to me ASAP also let me know if you have any questions.', NULL, NULL, '2021-03-31 10:13:20', '2021-03-31 10:13:20'),
(18265, 3040, 21447, NULL, '2021-04-23 00:00:00.000', 'In Process', 'Email sent to: Provider_Data_Request@tufts-health.com  Subject: Enrollment Status for Providers || SNBCARE || Tufts Public Plans  Greetings,  Can you please let me know the Enrollment status of the following providers under Tufts Public Plans for the mentioned locations, also please provide the effective dates if enrolled.  Group Information: Spectrum Neuro Behavioral Care LLC. Tax ID: 83-4482753 Group NPI: 1356906572 Address 1: 61 Lincoln Street, Suite no 203, Framingham, MA, 01702. Address 2: 63 Eddie Dowling Highway, Suite No 9, North Smithfield, RI, 02896.  Individual Providers: Name: Tawakol, Katie NPI :    1609222116  Name:  Rashid, Mahreen NPI :    1396393146  Name:  Hefti, Prisca NPI :    1508133182  Name:  Khan, Fauzia Wali NPI :    1699761965  Name: Ullrich, Jennifer Lee NPI :    1710489760  Name:  Pionke, Peggy NPI :    1699307322  Name:  Schubert, Jonathan NPI :    1235755505  Name:  Hignite, Barbara NPI :    1982617262  Name:  Rozell, Carlee NPI :    1225645393  Name:  Loveland, Lynnetta NPI :    1598163602  Name:  L\'Etoile, Melody NPI :    1942687108  Name:  Oliva, Erin NPI :    1407349632  Name:  Hartman, Jessica NPI :    1326665472  Name:  Souliere, Justin R NPI :    1710576004  Name:  Smith, Kerry R NPI :    1275083230  Please get back to me ASAP also let me know if you have any questions.', NULL, NULL, '2021-04-16 15:01:37', '2021-04-16 15:01:37'),
(18266, 1019, 21447, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to provider_data_request@tufts-health.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tufts Health Plans   Hello, We need the enrollment status for the following providers under our group, as their applications have been in process for a while now.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert NPI: 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Regards,', NULL, NULL, '2021-06-07 07:58:35', '2021-06-07 07:58:35'),
(18267, 1019, 21447, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Sent the following email to Kody_Dunnett@tufts-health.com  Hello Kody,  We need to expedite the applications for the following providers of Credentialing and Contracting as it is In process since a while now as it is adversely affecting our business, also we are not getting proper responses on our emails.  Spectrum Neuro Behavioral Care LLC. 1356906572 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rodesia Edmundson  1124622667  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Mary Gibbons  NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Lynnetta Loveland  NPI: 1598163602  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Jonathan Schubert  NPI: 1235755505  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jennifer Ullrich NPI: 1710489760  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Prisca Hefti NPI: 1508133182  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767  Regards, Alex G', NULL, NULL, '2021-06-23 09:27:46', '2021-06-23 09:27:46'),
(18268, 1019, 21447, NULL, '2021-08-17 00:00:00.000', 'Approved', 'Received the following email from Brady_Roche@tufts-health.com  Hi Alex,  My department can help with effective dates, I have provided them on the spreadsheet. I have included Katherine in Allied and Christine in Credentialing as one is still in cred process and the other needs to be linked to the group.  Thanks,  Effective Date is 04/19/2021 Attached are the Location Addition and Provider Roster of Tufts', NULL, NULL, '2021-08-10 23:04:00', '2021-08-10 23:04:00'),
(18269, 1006, 21448, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 09:31:38', '2021-03-16 09:31:38'),
(18270, 1019, 21448, NULL, '2021-04-07 00:00:00.000', 'Initiated', 'Sent the following email to  Bennett_Tansey@tufts-health.com  Cc: Kody_Dunnett@tufts-health.com, Nilda_Amarante@tufts-health.com, snbc@claimsmedinc.com  Sub: Enrollment Status for Providers || SNBCARE || Tufts Public Plans  Good Morning Bennett, Can you please let me know the Enrollment status of the following providers under Tufts Public Plans for the mentioned locations, also please provide the effective dates if enrolled.  Group Information: Spectrum Neuro Behavioral Care LLC. Tax ID: 83-4482753 Group NPI: 1356906572 Address 1: 61 Lincoln Street, Suite no 203, Framingham, MA, 01702. Address 2: 63 Eddie Dowling Highway, Suite No 9, North Smithfield, RI, 02896.  Individual Providers: Name: Tawakol, Katie NPI :    1609222116  Name:  Rashid, Mahreen NPI :    1396393146  Name:  Hefti, Prisca NPI :    1508133182  Name:  Khan, Fauzia Wali NPI :    1699761965  Name: Ullrich, Jennifer Lee NPI :    1710489760  Name:  Pionke, Peggy NPI :    1699307322  Name:  Schubert, Jonathan NPI :    1235755505  Name:  Hignite, Barbara NPI :    1982617262  Name:  Rozell, Carlee NPI :    1225645393  Name:  Loveland, Lynnetta NPI :    1598163602  Name:  L\'Etoile, Melody NPI :    1942687108  Name:  Oliva, Erin NPI :    1407349632  Name:  Hartman, Jessica NPI :    1326665472  Please get back to me ASAP also let me know if you have any questions.', NULL, NULL, '2021-03-31 10:13:50', '2021-03-31 10:13:50'),
(18271, 3040, 21448, NULL, '2021-04-23 00:00:00.000', 'In Process', 'Email sent to: Provider_Data_Request@tufts-health.com  Subject: Enrollment Status for Providers || SNBCARE || Tufts Public Plans  Greetings,  Can you please let me know the Enrollment status of the following providers under Tufts Public Plans for the mentioned locations, also please provide the effective dates if enrolled.  Group Information: Spectrum Neuro Behavioral Care LLC. Tax ID: 83-4482753 Group NPI: 1356906572 Address 1: 61 Lincoln Street, Suite no 203, Framingham, MA, 01702. Address 2: 63 Eddie Dowling Highway, Suite No 9, North Smithfield, RI, 02896.  Individual Providers: Name: Tawakol, Katie NPI :    1609222116  Name:  Rashid, Mahreen NPI :    1396393146  Name:  Hefti, Prisca NPI :    1508133182  Name:  Khan, Fauzia Wali NPI :    1699761965  Name: Ullrich, Jennifer Lee NPI :    1710489760  Name:  Pionke, Peggy NPI :    1699307322  Name:  Schubert, Jonathan NPI :    1235755505  Name:  Hignite, Barbara NPI :    1982617262  Name:  Rozell, Carlee NPI :    1225645393  Name:  Loveland, Lynnetta NPI :    1598163602  Name:  L\'Etoile, Melody NPI :    1942687108  Name:  Oliva, Erin NPI :    1407349632  Name:  Hartman, Jessica NPI :    1326665472  Name:  Souliere, Justin R NPI :    1710576004  Name:  Smith, Kerry R NPI :    1275083230  Please get back to me ASAP also let me know if you have any questions.', NULL, NULL, '2021-04-16 15:01:32', '2021-04-16 15:01:32'),
(18272, 1019, 21448, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to provider_data_request@tufts-health.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tufts Health Plans   Hello, We need the enrollment status for the following providers under our group, as their applications have been in process for a while now.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert NPI: 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Regards,', NULL, NULL, '2021-06-07 07:58:27', '2021-06-07 07:58:27'),
(18273, 1019, 21448, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Sent the following email to Kody_Dunnett@tufts-health.com  Hello Kody,  We need to expedite the applications for the following providers of Credentialing and Contracting as it is In process since a while now as it is adversely affecting our business, also we are not getting proper responses on our emails.  Spectrum Neuro Behavioral Care LLC. 1356906572 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rodesia Edmundson  1124622667  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Mary Gibbons  NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Lynnetta Loveland  NPI: 1598163602  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Jonathan Schubert  NPI: 1235755505  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jennifer Ullrich NPI: 1710489760  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Prisca Hefti NPI: 1508133182  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767  Regards, Alex G', NULL, NULL, '2021-06-23 09:27:36', '2021-06-23 09:27:36'),
(18274, 1019, 21448, NULL, '2021-08-18 00:00:00.000', 'Approved', 'Received the following email from Brady_Roche@tufts-health.com  Hi Alex,  My department can help with effective dates, I have provided them on the spreadsheet. I have included Katherine in Allied and Christine in Credentialing as one is still in cred process and the other needs to be linked to the group.  Thanks,  Effective Date is 06/01/2020 Attached are the Location Addition and Provider Roster of Tufts', NULL, NULL, '2021-08-10 23:32:40', '2021-08-10 23:32:40'),
(18275, 1006, 21449, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 09:31:40', '2021-03-16 09:31:40'),
(18276, 1006, 21449, NULL, '2021-04-28 00:00:00.000', 'Initiated', 'To: Tufts_Health_Plan_Credentialing_Department@tufts-health.com Cc: Spectrum Neuro Behavioral Health snbc@claimsmedinc.com Hello,  Please find the attached request to initiate the credentialing/contracting for our provider Rodesia Edmundson. Do let me know if anything else is required.  ', NULL, NULL, '2021-04-21 14:16:37', '2021-04-21 14:16:37'),
(18277, 1019, 21449, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to provider_data_request@tufts-health.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tufts Health Plans   Hello, We need the enrollment status for the following providers under our group, as their applications have been in process for a while now.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert NPI: 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Regards,', NULL, NULL, '2021-06-07 07:53:42', '2021-06-07 07:53:42'),
(18278, 1019, 21449, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Sent the following email to Kody_Dunnett@tufts-health.com  Hello Kody,  We need to expedite the applications for the following providers of Credentialing and Contracting as it is In process since a while now as it is adversely affecting our business, also we are not getting proper responses on our emails.  Spectrum Neuro Behavioral Care LLC. 1356906572 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rodesia Edmundson  1124622667  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Mary Gibbons  NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Lynnetta Loveland  NPI: 1598163602  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Jonathan Schubert  NPI: 1235755505  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jennifer Ullrich NPI: 1710489760  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Prisca Hefti NPI: 1508133182  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767  Regards, Alex G', NULL, NULL, '2021-06-23 09:27:29', '2021-06-23 09:27:29'),
(18279, 1019, 21449, NULL, '2021-08-18 00:00:00.000', 'Approved', 'Received the following email from Brady_Roche@tufts-health.com  Hi Alex,  My department can help with effective dates, I have provided them on the spreadsheet. I have included Katherine in Allied and Christine in Credentialing as one is still in cred process and the other needs to be linked to the group.  Thanks,  Effective Date is 06/29/2021 Attached are the Location Addition and Provider Roster of Tufts', NULL, NULL, '2021-08-10 23:35:14', '2021-08-10 23:35:14'),
(18280, 1006, 21450, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 09:32:34', '2021-03-16 09:32:34');
