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
(13825, 3040, 20249, NULL, '2021-04-01 00:00:00.000', 'Approved', 'Mr. Moses Campos Valley Med Urgent Care PLLC 2534 Boca Chica Blvd Brownsville TX 78521  Dear Provider:  Welcome! Your application has been processed, effective 2/4/2021 and we are pleased to have you join MultiPlan as a participating provider in our provider networks. Please see your provider agreement(s) and/or amendment(s) for specific network participation.', NULL, NULL, '2021-03-25 14:23:34', '2021-03-25 14:23:34'),
(13826, 3040, 20250, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:19:37', '2021-03-12 14:19:37'),
(13827, 3040, 20250, NULL, '2021-04-01 00:00:00.000', 'Initiated', NULL, NULL, NULL, '2021-03-25 14:30:50', '2021-03-25 14:30:50'),
(13828, 3040, 20250, NULL, '2021-04-07 00:00:00.000', 'Approved', '3/23/2021 Ms. Deborah Potter Valley Med Urgent Care PLLC 2534 Boca Chica Blvd Brownsville TX 78521  Dear Provider: Welcome! Your application has been processed, effective 2/4/2021 and we are pleased to have you join MultiPlan as a participating provider in our provider networks. Please see your provider agreement(s) and/or amendment(s) for specific network participation.', NULL, NULL, '2021-03-31 16:42:55', '2021-03-31 16:42:55'),
(13829, 3040, 20251, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:20:10', '2021-03-12 14:20:10'),
(13830, 3040, 20251, NULL, '2021-04-01 00:00:00.000', 'Approved', '03/25/2021  Valley Med Urgent Care PLLC 2534 Boca Chica Blvd Brownsville, TX. 78521  Case # 7557020  Dear Valley Med Urgent Care PLLC: MultiPlan has received your request to confirm the MultiPlan\'s network(s) in which you participate. Our records indicate that per your network agreement, you are a network provider in the following network(s) for the Tax ID(s) and address(es) noted below:  Network                                    MPI  Contract Effective Date 07/01/2017  Contract Termination Date  12/31/9999  Tax ID  81-5123542  Service Address 2534 Boca Chica Blvd, Brownsville, TX. 78521  800 E Alton Gloor Blvd, Brownsville, TX. 78526  101 E Expwy 83 Ste 170, McAllen, TX. 78501   Network                                    PHCS  Contract Effective Date 07/01/2017  Contract Termination Date  12/31/9999', NULL, NULL, '2021-03-25 15:04:18', '2021-03-25 15:04:18'),
(13831, 3040, 20252, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:20:36', '2021-03-12 14:20:36'),
(13832, 3040, 20252, NULL, '2021-04-01 00:00:00.000', 'Approved', '4/6/2019 Ms. Angiollet Escobar Valley Med Urgent Care PLLC 2534 Boca Chica Blvd Brownsville TX 78521 Dear Provider: Welcome! Your application has been processed, effective 4/5/2019 and we are pleased to have you join MultiPlan as a participating provider in our provider networks. Please see your provider agreement(s) and/or amendment(s) for specific network participation. (Note that you may participate with MultiPlan under multiple agreements.)', NULL, NULL, '2021-03-25 13:31:01', '2021-03-25 13:31:01'),
(13833, 3040, 20253, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:20:51', '2021-03-12 14:20:51'),
(13834, 3040, 20253, NULL, '2021-04-01 00:00:00.000', 'Approved', '11/2/2018 Mr. Homero Garcia Valley Med Urgent Care PLLC 2534 Boca Chica Blvd Brownsville TX 78521 Dear Provider: Welcome! Your application has been processed, effective 11/1/2018 and we are pleased to have you join MultiPlan as a participating provider in our provider networks. Please see your provider agreement(s) and/or amendment(s) for specific network participation.', NULL, NULL, '2021-03-25 13:39:19', '2021-03-25 13:39:19'),
(13835, 3040, 20254, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:21:10', '2021-03-12 14:21:10'),
(13836, 3040, 20254, NULL, '2021-04-01 00:00:00.000', 'Approved', 'Provider enrolled with Multiplan.   Please see attachment. ', NULL, NULL, '2021-03-25 13:46:45', '2021-03-25 13:46:45'),
(13837, 3040, 20255, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:21:22', '2021-03-12 14:21:22'),
(13838, 3040, 20255, NULL, '2021-04-01 00:00:00.000', 'Approved', 'Provider enrolled with Multiplan. ', NULL, NULL, '2021-03-25 13:51:26', '2021-03-25 13:51:26'),
(13839, 3040, 20256, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:21:39', '2021-03-12 14:21:39'),
(13840, 3040, 20256, NULL, '2021-04-01 00:00:00.000', 'Approved', 'Provider enrolled with Multiplan. See attachment.  ', NULL, NULL, '2021-03-25 14:07:13', '2021-03-25 14:07:13'),
(13841, 3040, 20257, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:21:56', '2021-03-12 14:21:56'),
(13842, 3040, 20257, NULL, '2021-04-01 00:00:00.000', 'Approved', 'Provider enrolled with Multiplan. See attachment. ', NULL, NULL, '2021-03-25 14:11:20', '2021-03-25 14:11:20'),
(13843, 3040, 20258, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:22:37', '2021-03-12 14:22:37'),
(13844, 3040, 20258, NULL, '2021-04-01 00:00:00.000', 'Approved', 'Mr. Moses Campos Valley Med Urgent Care PLLC 2534 Boca Chica Blvd Brownsville TX 78521  Dear Provider:  Welcome! Your application has been processed, effective 2/4/2021 and we are pleased to have you join MultiPlan as a participating provider in our provider networks. Please see your provider agreement(s) and/or amendment(s) for specific network participation.', NULL, NULL, '2021-03-25 14:23:45', '2021-03-25 14:23:45'),
(13845, 3046, 20259, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:22:44', '2021-03-12 14:22:44'),
(13846, 1005, 20259, NULL, '2021-06-10 00:00:00.000', 'Approved', 'Approval confirmation attached.', NULL, NULL, '2021-06-03 13:35:02', '2021-06-03 13:35:02'),
(13847, 3046, 20260, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:22:45', '2021-03-12 14:22:45'),
(13848, 1005, 20260, NULL, '2021-06-10 00:00:00.000', 'Approved', 'Approval confirmation attached.', NULL, NULL, '2021-06-03 13:31:00', '2021-06-03 13:31:00'),
(13849, 3046, 20261, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:22:47', '2021-03-12 14:22:47'),
(13850, 1005, 20261, NULL, '2021-06-10 00:00:00.000', 'Approved', 'Reference Number :	21154000840 Approval confirmation attached.', NULL, NULL, '2021-06-03 13:27:15', '2021-06-03 13:27:15'),
(13851, 3040, 20262, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:22:47', '2021-03-12 14:22:47'),
(13852, 3040, 20262, NULL, '2021-04-01 00:00:00.000', 'Initiated', NULL, NULL, NULL, '2021-03-25 14:30:49', '2021-03-25 14:30:49'),
(13853, 3040, 20262, NULL, '2021-04-07 00:00:00.000', 'Approved', '3/23/2021 Ms. Deborah Potter Valley Med Urgent Care PLLC 2534 Boca Chica Blvd Brownsville TX 78521  Dear Provider: Welcome! Your application has been processed, effective 2/4/2021 and we are pleased to have you join MultiPlan as a participating provider in our provider networks. Please see your provider agreement(s) and/or amendment(s) for specific network participation.', NULL, NULL, '2021-03-31 16:42:59', '2021-03-31 16:42:59'),
(13854, 3046, 20263, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:24:41', '2021-03-12 14:24:41'),
(13855, 3040, 20263, NULL, '2021-06-14 00:00:00.000', 'Not Eligible', 'We received the following Network Denial/Rejection email from Scott & White:   Sub: New Contract Request  \"Tax ID#: 811890349  RE: Network Denial  Dear Katherine  D Paterson  Thank you for your recent application.  Scott and White Health Plans (SWHP) and SHA, LLC dba FirstCare Health Plans (FirstCare) appreciates your interest in becoming a part of our network.  After reviewing your online application to contract submitted on 03/03/2021, SWHP and FirstCare regretfully declines to contract with Katherine  D Paterson this time. The determination was made based on our current network needs. However, we encourage you to reapply in 6 months; as those needs may change.   Thank you again for your interest in SWHP and FirstCare Health Plans.  Best Regards,  Scott and White Health Plans |SHA, LLC dba FirstCare Health Plans Network Development Department 1206 West Campus Dr. Temple, Texas 76502\"', NULL, NULL, '2021-06-07 12:38:02', '2021-06-07 12:38:02'),
(13856, 3046, 20264, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:24:52', '2021-03-12 14:24:52'),
(13857, 3040, 20264, NULL, '2021-06-14 00:00:00.000', 'Not Eligible', 'We received the following Network Denial/Rejection email from Scott & White:   Sub: New Contract Request  \"Tax ID#: 811890349  RE: Network Denial  Dear Katherine  D Paterson  Thank you for your recent application.  Scott and White Health Plans (SWHP) and SHA, LLC dba FirstCare Health Plans (FirstCare) appreciates your interest in becoming a part of our network.  After reviewing your online application to contract submitted on 03/03/2021, SWHP and FirstCare regretfully declines to contract with Katherine  D Paterson this time. The determination was made based on our current network needs. However, we encourage you to reapply in 6 months; as those needs may change.   Thank you again for your interest in SWHP and FirstCare Health Plans.  Best Regards,  Scott and White Health Plans |SHA, LLC dba FirstCare Health Plans Network Development Department 1206 West Campus Dr. Temple, Texas 76502\"', NULL, NULL, '2021-06-07 12:38:06', '2021-06-07 12:38:06'),
(13858, 3046, 20265, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:24:54', '2021-03-12 14:24:54'),
(13859, 3040, 20265, NULL, '2021-06-14 00:00:00.000', 'Not Eligible', 'We received the following Network Denial/Rejection email from Scott & White:   Sub: New Contract Request  \"Tax ID#: 811890349  RE: Network Denial  Dear Katherine  D Paterson  Thank you for your recent application.  Scott and White Health Plans (SWHP) and SHA, LLC dba FirstCare Health Plans (FirstCare) appreciates your interest in becoming a part of our network.  After reviewing your online application to contract submitted on 03/03/2021, SWHP and FirstCare regretfully declines to contract with Katherine  D Paterson this time. The determination was made based on our current network needs. However, we encourage you to reapply in 6 months; as those needs may change.   Thank you again for your interest in SWHP and FirstCare Health Plans.  Best Regards,  Scott and White Health Plans |SHA, LLC dba FirstCare Health Plans Network Development Department 1206 West Campus Dr. Temple, Texas 76502\"', NULL, NULL, '2021-06-07 12:38:09', '2021-06-07 12:38:09'),
(13860, 3040, 20266, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:25:30', '2021-03-12 14:25:30'),
(13861, 3040, 20266, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-03-26 14:12:16', '2021-03-26 14:12:16'),
(13862, 3040, 20267, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:26:15', '2021-03-12 14:26:15'),
(13863, 3040, 20267, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-03-26 14:15:47', '2021-03-26 14:15:47'),
(13864, 3040, 20268, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:26:31', '2021-03-12 14:26:31'),
(13865, 3040, 20268, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-03-26 14:16:42', '2021-03-26 14:16:42'),
(13866, 3040, 20269, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:26:46', '2021-03-12 14:26:46'),
(13867, 3040, 20269, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-03-26 14:17:06', '2021-03-26 14:17:06'),
(13868, 3040, 20270, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:27:04', '2021-03-12 14:27:04'),
(13869, 3040, 20270, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-03-26 14:18:07', '2021-03-26 14:18:07'),
(13870, 3040, 20271, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:27:18', '2021-03-12 14:27:18'),
(13871, 3040, 20271, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-03-26 14:18:21', '2021-03-26 14:18:21'),
(13872, 3040, 20272, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:27:35', '2021-03-12 14:27:35'),
(13873, 3040, 20272, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-03-26 14:19:59', '2021-03-26 14:19:59'),
(13874, 3040, 20273, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:27:49', '2021-03-12 14:27:49'),
(13875, 3040, 20273, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-03-26 14:20:18', '2021-03-26 14:20:18'),
(13876, 3046, 20274, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:28:01', '2021-03-12 14:28:01'),
(13877, 1006, 20274, NULL, '2021-06-15 00:00:00.000', 'Not Eligible', 'The provider only works in CBUC main location, no need to enroll her in GWMC location as per our discussion with Ryan. ', NULL, NULL, '2021-06-08 16:57:19', '2021-06-08 16:57:19'),
(13878, 3040, 20275, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:28:05', '2021-03-12 14:28:05'),
(13879, 3040, 20275, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-03-26 14:20:40', '2021-03-26 14:20:40'),
(13880, 3046, 20276, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:28:05', '2021-03-12 14:28:05'),
(13881, 3040, 20276, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Location Addition || George West Medical Clinic || Group || Superior Health Plan ||  Greetings,  Hope you are doing well. I wanted to add the below mentioned location in our group George West Medical Clinic under the below location.   Practice Name: George West Medical Clinic Practice NPI# 1427509264 Practice Tax ID# 81-1890349 Practice Address: 504A Houston Street George West , TX 78022-3663  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-08 17:10:12', '2021-06-08 17:10:12'),
(13882, 1006, 20276, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Sent following enrollment query @ AM.Austin@SuperiorHealthPlan.com & SHP.NetworkDevelopment@superiorhealthplan.com:  Sub: Enrollment Query - CBUC/GWMC -  Superior Health/Ambetter  \"Hello,  I wanted to verify if the following group and providers were enrolled with Superior Healthplan & Ambetter under the mentioned addresses:  Group Name: Coastal Bend Urgent Care, LLC NPI# 1427509264TIN# 81-1890349  Primary Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Name: Katherine Paterson NPI# 1164776548  Provider Name: Mercedita Flynn NPI# 1619166188  Provider Name: Jennifer Tudor NPI# 1720455835  Please get back to me as soon as you\'re able. Thank you. \"', NULL, NULL, '2021-06-09 09:49:52', '2021-06-09 09:49:52'),
(13883, 1006, 20276, NULL, '2021-07-06 00:00:00.000', 'Approved', 'Received the following approval confirmation from AM.CorpusChristi@superiorhealthplan.com:  Sub: Approvals and Test Claims (Providers/Groups) - (GWMC) - (Cigna)  \"Good afternoon Brad  Hope all is well today  Here is the information you requested, I have included all the Providers in a SS with all the products associated with the TID#811890349  And I have also included a snip-it of the address associated with the group TID Have a great rest of the week   Veronica Botello Rocha Provider Relations Coordinator II Provider Relations Department Nueces, Harris & Jefferson SDAs cid:image002.jpg@01D0C3DA.F54AEF00 711 N. Carancahua Street, Suite 600 Corpus Christi, Texas 78401 Fax: (866) 683-5630 AM.CorpusChristi@superiorhealthplan.com| SuperiorHealthPlan.com Provider Relations Dept. 1-800-656-4817 Option 3\"  Approval confirmation is attached for reference.  ', NULL, NULL, '2021-06-29 14:11:14', '2021-06-29 14:11:14'),
(13884, 3040, 20277, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:28:19', '2021-03-12 14:28:19'),
(13885, 3040, 20277, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-03-26 14:20:54', '2021-03-26 14:20:54'),
(13886, 3040, 20278, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:28:33', '2021-03-12 14:28:33'),
(13887, 3040, 20278, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-03-26 14:21:12', '2021-03-26 14:21:12'),
(13888, 3040, 20279, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:29:38', '2021-03-12 14:29:38'),
(13889, 3040, 20279, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group has an ancillary contract.   Please see attachment.  ', NULL, NULL, '2021-03-26 12:58:09', '2021-03-26 12:58:09'),
(13890, 3046, 20280, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:30:10', '2021-03-12 14:30:10'),
(13891, 3040, 20280, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: trpndataentry@trpnppo.com, providerrelations@trpnppo.com   Subject:Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || TRPN ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers TRPN for our group under the below locations.   Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice Name: George West Medical Clinic Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 504A Houston Street George West , TX 78022-3663  Provider 1: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 2:   Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider 3:   Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-07 12:43:58', '2021-06-07 12:43:58'),
(13892, 1006, 20280, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Sent f/u email @ trpndataentry@trpnppo.com & TRPN Provider Relations providerrelations@trpnppo.com:  Sub: Enrollment Status/Request - CBUC/GWMC - TRPN  \"Hello, I hope you\'re doing well, we wanted to verify if the following group and providers were enrolled with TRPN or not? If so, what is required to get them enrolled.   The information is as follows: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, Beeville, TX 78102-5324 Secondary Practice Address: 504A Houston Street, George West, TX 78022-3663  Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Katherine Paterson  Provider NPI# 1164776548  Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-06-25 09:23:24', '2021-06-25 09:23:24'),
(13893, 11056, 20280, NULL, '2021-07-14 00:00:00.000', 'In Process', 'Email sent to : trpndataentry@trpnppo.com  Sub : Enrollment Requisition Query - Coastal Bend Urgent Care & George West Medical Clinic - TRPN  Greetings,  Hope you\'re doing well, we wanted to verify if the following group and providers were enrolled with TRPN or not? If so, what is required to get them enrolled. The information is as follows:  Practices: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, Beeville, TX 78102-5324 Secondary Practice Address: 504A Houston Street, George West, TX 78022-3663  Practice Name: George West Medical Clinic Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 504A Houston Street George West , TX 78022-3663  Providers: Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Katherine Paterson Provider NPI# 1164776548  Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  Kindly get back to me as soon as possible.  Thank you!', NULL, NULL, '2021-07-06 16:49:08', '2021-07-06 16:49:08'),
(13894, 1006, 20280, NULL, '2021-08-17 00:00:00.000', 'In Process', 'As per my discussion with TRPN we need to send a provider update form to them, requested a copy, and sent it to trpndataentry@trpnppo.com:  Sub: Provider Update Form - CBUC/GWMC - TRPN  \"Hello,   Please find the attached provider update forms for our providers. Please let me know if anything else is required to continue.   Thank you!\"  Attached for reference in provider tasks. ', NULL, NULL, '2021-08-10 12:44:26', '2021-08-10 12:44:26'),
(13895, 11056, 20280, NULL, '2021-08-26 00:00:00.000', 'In Process', 'Email sent to : 	trpndataentry@trpnppo.com  Sub : Enrollment Status Updates - CBUC/GWMC - TRPN  Good morning!  Hope all is well. I want to inquire about the enrollment status of the below mentioned practice and providers. Please respond to me soon.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Katherine Paterson Provider NPI# 1164776548  If you need any documents or information regarding this feel free to contact me.  Thank you! Have a great day!', NULL, NULL, '2021-08-18 14:09:27', '2021-08-18 14:09:27'),
(13896, 11056, 20280, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Email sent to :  trpndataentry@trpnppo.com, providerrelations@trpnppo.com   & AVasquez@trpnppo.com  Sub : Provider Update Form - CBUC/GWMC - TRPN   Good afternoon!  Hope this email finds you well. Please inform me with the latest updates regarding enrollment status of the following providers under the practice in TRPN. Please also inform me about the provider\'s update forms.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Monica Gonzalez Provider NPI# 1871132811  Provider Name: Katherine Paterson Provider NPI# 1164776548  Provider Name: Flynn, Mercedita N Provider NPI# : 1619166188  If you have any questions or queries or need any information or documents feel free to reach out to me. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-24 13:33:06', '2021-08-24 13:33:06'),
(13897, 11056, 20280, NULL, '2021-09-09 00:00:00.000', 'Approved', 'Approval Email received from : trpndataentry@trpnppo.com  Sub : RE: Enrollment Status Updates - CBUC/GWMC - TRPN  Hi,     This request is completed,     Provider Mercedita Flynn is Active, effective date 01/01/2017,  Provider Katherine Paterson is Active, effective date 01/01/2017,  Provider Monica Gonzalez is Active, effective date 01/01/2021.', NULL, NULL, '2021-09-01 16:03:21', '2021-09-01 16:03:21'),
(13898, 3046, 20281, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:30:16', '2021-03-12 14:30:16'),
(13899, 3040, 20281, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: trpndataentry@trpnppo.com, providerrelations@trpnppo.com   Subject:Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || TRPN ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers TRPN for our group under the below locations.   Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice Name: George West Medical Clinic Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 504A Houston Street George West , TX 78022-3663  Provider 1: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 2:   Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider 3:   Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-07 12:44:01', '2021-06-07 12:44:01'),
(13900, 1006, 20281, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Sent f/u email @ trpndataentry@trpnppo.com & TRPN Provider Relations providerrelations@trpnppo.com:  Sub: Enrollment Status/Request - CBUC/GWMC - TRPN  \"Hello, I hope you\'re doing well, we wanted to verify if the following group and providers were enrolled with TRPN or not? If so, what is required to get them enrolled.   The information is as follows: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, Beeville, TX 78102-5324 Secondary Practice Address: 504A Houston Street, George West, TX 78022-3663  Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Katherine Paterson  Provider NPI# 1164776548  Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-06-25 09:23:21', '2021-06-25 09:23:21'),
(13901, 11056, 20281, NULL, '2021-07-14 00:00:00.000', 'In Process', 'Email sent to : trpndataentry@trpnppo.com  Sub : Enrollment Requisition Query - Coastal Bend Urgent Care & George West Medical Clinic - TRPN  Greetings,  Hope you\'re doing well, we wanted to verify if the following group and providers were enrolled with TRPN or not? If so, what is required to get them enrolled. The information is as follows:  Practices: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, Beeville, TX 78102-5324 Secondary Practice Address: 504A Houston Street, George West, TX 78022-3663  Practice Name: George West Medical Clinic Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 504A Houston Street George West , TX 78022-3663  Providers: Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Katherine Paterson Provider NPI# 1164776548  Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  Kindly get back to me as soon as possible.  Thank you!', NULL, NULL, '2021-07-06 16:49:38', '2021-07-06 16:49:38'),
(13902, 1006, 20281, NULL, '2021-08-17 00:00:00.000', 'In Process', 'As per my discussion with TRPN we need to send a provider update form to them, requested a copy, and sent it to trpndataentry@trpnppo.com:  Sub: Provider Update Form - CBUC/GWMC - TRPN  \"Hello,   Please find the attached provider update forms for our providers. Please let me know if anything else is required to continue.   Thank you!\"  Attached for reference in provider tasks. ', NULL, NULL, '2021-08-10 12:43:09', '2021-08-10 12:43:09'),
(13903, 11056, 20281, NULL, '2021-08-26 00:00:00.000', 'In Process', 'Email sent to : 	trpndataentry@trpnppo.com  Sub : Enrollment Status Updates - CBUC/GWMC - TRPN  Good morning!  Hope all is well. I want to inquire about the enrollment status of the below mentioned practice and providers. Please respond to me soon.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Katherine Paterson Provider NPI# 1164776548  If you need any documents or information regarding this feel free to contact me.  Thank you! Have a great day!', NULL, NULL, '2021-08-18 14:09:12', '2021-08-18 14:09:12'),
(13904, 11056, 20281, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Email sent to :  trpndataentry@trpnppo.com, providerrelations@trpnppo.com   & AVasquez@trpnppo.com  Sub : Provider Update Form - CBUC/GWMC - TRPN   Good afternoon!  Hope this email finds you well. Please inform me with the latest updates regarding enrollment status of the following providers under the practice in TRPN. Please also inform me about the provider\'s update forms.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Monica Gonzalez Provider NPI# 1871132811  Provider Name: Katherine Paterson Provider NPI# 1164776548  Provider Name: Flynn, Mercedita N Provider NPI# : 1619166188  If you have any questions or queries or need any information or documents feel free to reach out to me. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-24 13:33:01', '2021-08-24 13:33:01'),
(13905, 11056, 20281, NULL, '2021-09-11 00:00:00.000', 'In Process', 'Approval Email received from : trpndataentry@trpnppo.com  Sub : RE: Enrollment Status Updates - CBUC/GWMC - TRPN  Hi,     This request is completed,     Provider Mercedita Flynn is Active, effective date 01/01/2017,  Provider Katherine Paterson is Active, effective date 01/01/2017,  Provider Monica Gonzalez is Active, effective date 01/01/2021.    Providers approved now group is in processing', NULL, NULL, '2021-09-03 14:46:09', '2021-09-03 14:46:09'),
(13906, 11056, 20281, NULL, '2021-10-01 00:00:00.000', 'In Process', 'Email sent to : 	efry@trpnppo.com  Sub : Group Enrollment Verification - CBUC / GWMC - TRPN  Hope this email finds you well. Please provide me with the welcome or approval letter and effective date for the facility mentioned below with TRPN under the Tax ID with both locations listed below.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Location 504A Houston Street, George West, TX 78022-3663  If you need any information or documents related to this please let me know. Waiting for your reply.  Thank you! Have a great weekend!', NULL, NULL, '2021-09-24 11:27:23', '2021-09-24 11:27:23'),
(13907, 11056, 20281, NULL, '2021-10-01 00:00:00.000', 'Approved', 'Email received from : providerrelations@trpnppo.com  Sub : RE: Group Enrollment Verification - CBUC / GWMC - TRPN  Good morning Ahmed,  Effective date for below group is 01/01/2017, also, please see attached for your review.  Thank you,  Brixcia Castillo Provider Relations Department 6970 O’Bannon Drive  Las Vegas, Nevada 89117 Phone: (866) 393-0966 Fax: (619) 600-4818 providerrelations@trpnppo.com www.trpnppo.com', NULL, NULL, '2021-09-24 13:40:16', '2021-09-24 13:40:16'),
(13908, 3046, 20282, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:30:32', '2021-03-12 14:30:32'),
(13909, 3040, 20282, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: trpndataentry@trpnppo.com, providerrelations@trpnppo.com   Subject:Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || TRPN ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers TRPN for our group under the below locations.   Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice Name: George West Medical Clinic Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 504A Houston Street George West , TX 78022-3663  Provider 1: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 2:   Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider 3:   Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-07 12:44:04', '2021-06-07 12:44:04'),
(13910, 1006, 20282, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Sent f/u email @ trpndataentry@trpnppo.com & TRPN Provider Relations providerrelations@trpnppo.com:  Sub: Enrollment Status/Request - CBUC/GWMC - TRPN  \"Hello, I hope you\'re doing well, we wanted to verify if the following group and providers were enrolled with TRPN or not? If so, what is required to get them enrolled.   The information is as follows: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, Beeville, TX 78102-5324 Secondary Practice Address: 504A Houston Street, George West, TX 78022-3663  Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Katherine Paterson  Provider NPI# 1164776548  Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-06-25 09:23:18', '2021-06-25 09:23:18'),
(13911, 11056, 20282, NULL, '2021-07-14 00:00:00.000', 'In Process', 'Email sent to : trpndataentry@trpnppo.com  Sub : Enrollment Requisition Query - Coastal Bend Urgent Care & George West Medical Clinic - TRPN  Greetings,  Hope you\'re doing well, we wanted to verify if the following group and providers were enrolled with TRPN or not? If so, what is required to get them enrolled. The information is as follows:  Practices: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, Beeville, TX 78102-5324 Secondary Practice Address: 504A Houston Street, George West, TX 78022-3663  Practice Name: George West Medical Clinic Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 504A Houston Street George West , TX 78022-3663  Providers: Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Katherine Paterson Provider NPI# 1164776548  Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  Kindly get back to me as soon as possible.  Thank you!', NULL, NULL, '2021-07-06 16:49:33', '2021-07-06 16:49:33'),
(13912, 1006, 20282, NULL, '2021-08-17 00:00:00.000', 'In Process', 'As per my discussion with TRPN we need to send a provider update form to them, requested a copy, and sent it to trpndataentry@trpnppo.com:  Sub: Provider Update Form - CBUC/GWMC - TRPN  \"Hello,   Please find the attached provider update forms for our providers. Please let me know if anything else is required to continue.   Thank you!\"  Attached for reference in provider tasks. ', NULL, NULL, '2021-08-10 12:44:53', '2021-08-10 12:44:53'),
(13913, 11056, 20282, NULL, '2021-08-26 00:00:00.000', 'In Process', 'Email sent to : 	trpndataentry@trpnppo.com  Sub : Enrollment Status Updates - CBUC/GWMC - TRPN  Good morning!  Hope all is well. I want to inquire about the enrollment status of the below mentioned practice and providers. Please respond to me soon.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Katherine Paterson Provider NPI# 1164776548  If you need any documents or information regarding this feel free to contact me.  Thank you! Have a great day!', NULL, NULL, '2021-08-18 14:08:56', '2021-08-18 14:08:56'),
(13914, 11056, 20282, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Email sent to :  trpndataentry@trpnppo.com, providerrelations@trpnppo.com   & AVasquez@trpnppo.com  Sub : Provider Update Form - CBUC/GWMC - TRPN   Good afternoon!  Hope this email finds you well. Please inform me with the latest updates regarding enrollment status of the following providers under the practice in TRPN. Please also inform me about the provider\'s update forms.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Monica Gonzalez Provider NPI# 1871132811  Provider Name: Katherine Paterson Provider NPI# 1164776548  Provider Name: Flynn, Mercedita N Provider NPI# : 1619166188  If you have any questions or queries or need any information or documents feel free to reach out to me. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-24 13:32:55', '2021-08-24 13:32:55'),
(13915, 11056, 20282, NULL, '2021-09-09 00:00:00.000', 'Approved', 'Approval Email received from : trpndataentry@trpnppo.com  Sub : RE: Enrollment Status Updates - CBUC/GWMC - TRPN  Hi,     This request is completed,     Provider Mercedita Flynn is Active, effective date 01/01/2017,  Provider Katherine Paterson is Active, effective date 01/01/2017,  Provider Monica Gonzalez is Active, effective date 01/01/2021.', NULL, NULL, '2021-09-01 15:58:48', '2021-09-01 15:58:48'),
(13916, 3040, 20283, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:31:05', '2021-03-12 14:31:05'),
(13917, 3040, 20283, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-03-26 14:12:23', '2021-03-26 14:12:23'),
(13918, 3040, 20284, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:31:44', '2021-03-12 14:31:44'),
(13919, 3040, 20284, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-03-26 14:15:54', '2021-03-26 14:15:54'),
(13920, 3040, 20285, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:31:55', '2021-03-12 14:31:55'),
(13921, 3040, 20285, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-03-26 14:16:47', '2021-03-26 14:16:47'),
(13922, 3046, 20286, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:32:07', '2021-03-12 14:32:07'),
(13923, 3040, 20286, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Tricare ||  Hello Katherine,  Hope you are doing well. I wanted to enroll the below mentioned group and providers Tricare for our group under the below locations.   Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice Name: George West Medical Clinic Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 504A Houston Street George West , TX 78022-3663  Provider 1: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 2:   Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider 3:   Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-07 12:56:06', '2021-06-07 12:56:06'),
(13924, 1006, 20286, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Sent f/u email @ Katherine Moten KMoten4@humana.com & Yvonne Wyatt ywyatt@humana.com:  Sub: Enrollment Status - CBUC/GWMC - Tricare  \"Hello,   I hope you\'re doing well, I wanted to verify if the following group and providers were enrolled with Tricare or not? If not, please let me know what is required to get them enrolled. The information is as follows:   Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, Beeville, TX 78102-5324 Secondary Practice Address: 504A Houston Street, George West, TX 78022-3663  Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Katherine Paterson Provider NPI# 1164776548  Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-06-25 09:59:34', '2021-06-25 09:59:34'),
(13925, 1006, 20286, NULL, '2021-07-21 00:00:00.000', 'In Process', 'We received the following response from Yvonne:  \"Good Morning Brad,     Costal Bend Urgent Care address location is not in my area.  Katherine Moten is the TRICARE Liaison for Beeville and George West Texas. The street address happened to have a street name of Houston.  Katherine can assist you with any additional questions. You do not need to include me on the emails for her area.     I work Houston ,Galveston and the surrounding areas of these cities.        Here is the status: We show the tax id as network. The current status for each provider are listed below. You can check status on a provider by creating a log in on the provider Portal or search online under find care. Both can be found on the humanamilitary.com website.     Provider Name: Flynn, Mercedita N- we show has been added to both address locations. Provider NPI# 1619166188  Provider Name: Katherine Paterson- we show this provider is not affiliated to this group tax id you need to complete the spreadsheet to add this provider to this tax id. Provider NPI# 1164776548  Provider Name: Tudor, Jennifer M- we show has been added to both address locations Provider NPI# 1720455835\"  Tried calling Katherine but no one picked up, left VM and resent f/u email @ :  \"Hello Katherine,   I hope you\'re doing well, please get back to me on this as soon as you\'re able.  Thanks. \"', NULL, NULL, '2021-07-14 17:13:04', '2021-07-14 17:13:04'),
(13926, 11056, 20286, NULL, '2021-08-26 00:00:00.000', 'In Process', 'Email sent to : 	ywyatt@humana.com, & KMoten4@humana.com  Sub : Enrollment Status Updates - CBUC/GWMC - Tricare  Good evening!  Hope all is well. I want to inquire about the spreadsheet to affiliate the provider Katherine Paterson to this group tax id, which you were going to provide in the month of July but haven\'t yet. Please provide it soon.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Katherine Paterson Provider NPI# 1164776548  If you need any documents or information regarding this feel free to contact me.  Thank you! Have a great day!', NULL, NULL, '2021-08-18 14:49:33', '2021-08-18 14:49:33'),
(13927, 11056, 20286, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Email sent to : ywyatt@humana.com  Sub : Enrollment Status Updates - CBUC/GWMC - Tricare  Good morning Yvonne!  Hope this email finds you well. Thank you so much for your prompt response and submission of request to Provider network to display Katherine Paterson as network under the Beeville, Texas location. Could you please update me with the latest enrollment status of the below mentioned providers ?  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Katherine Paterson Provider NPI# 1164776548  Provider Name: Monica Gonzalez Provider NPI# 1871132811  If you have any questions or concerns feel free to reach out to me. Waiting to hear back from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-24 11:00:10', '2021-08-24 11:00:10'),
(13928, 11056, 20286, NULL, '2021-09-09 00:00:00.000', 'In Process', 'Email received from : ywyatt@humana.com  Sub : Enrollment Status Updates - CBUC/GWMC - Tricare  Good Morning Ahmed,    I have submitted a request to Provider network to display Katherine Paterson as network under the Beeville, Texas location.        Thanks,  Yvonne W. Wyatt,  Humana Military  TRICARE Community Liaison II  Houston/Galveston  502-318-5409 Telephone  502-322-8018 Fax  ywyatt@humana.com     https://www.humanamilitary.com/coronavirus/provider     https://infocenter.humana-military.com/provider/service/Account/Login     Certification takes 90 days, and I do not have visual access to check the status. To check the status on a Tricare Certification applications, Please call WPS at  800-444-5445 and ask to speak to the Certfication Unit.     Certification applications forms please visit: https://www.humanamilitary.com/provider/education-and-resources/quick-access/forms Certification Fax: 608-221-7535  Provider Handbook: http://apps.humana.com/marketing/documents.asp?file=3262194', NULL, NULL, '2021-09-02 10:20:37', '2021-09-02 10:20:37'),
(13929, 11056, 20286, NULL, '2021-09-27 00:00:00.000', 'In Process', 'Email received from : ywyatt@humana.com  Sub : Enrollment Status Updates - CBUC/GWMC - Tricare  Good afternoon Ahmed,  I am doing well, thanks  This tax id do not appear in my area. Katherine can assist you with your questions.   Thanks, Yvonne  Emailed at KMoten4@humana.com to get updates.', NULL, NULL, '2021-09-20 13:14:01', '2021-09-20 13:14:01'),
(13930, 11056, 20286, NULL, '2021-09-27 00:00:00.000', 'In Process', 'I have words with Jada H & Rheshonda at 18004445445. Both advised me to fax the form for adding the secondary location and the form has been faxed at 608-221-7535  Mercedita - is credentialed and in network  Ref code : 13844672   Please see the attachment.', NULL, NULL, '2021-09-20 14:22:10', '2021-09-20 14:22:10'),
(13931, 11056, 20286, NULL, '2021-10-07 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com & ywyatt@humana.com  Sub : Enrollment Status Updates - CBUC/GWMC - Tricare  Good Morning  Ahmed,     Katherine, has taken another position.  This address location do not appear in my area. I will assist you with this question but any additional questions please reach out to Jacqueline Trenz. I have include her on this email.  You do not need to include me on the emails for this area    Provider Details: Provider Name: Flynn, Mercedita N  Provider NPI# 1619166188 - Show affiliated with this group tax id but is not display on the portal a request was submitted to update. Allow up to five business days to process.   Provider Name: Katherine Paterson- Show affiliated with this group tax id and is displayed  Provider NPI# 1164776548  Provider Name: Monica Gonzalez Provider NPI# 1871132811 - Do not appear in our system as TRICARE certified. Below is the link to the certification application for you to complete and fax to WPS.', NULL, NULL, '2021-09-30 15:51:28', '2021-09-30 15:51:28'),
(13932, 11056, 20286, NULL, '2021-10-14 00:00:00.000', 'In Process', 'Email sent to : jtrenz@humana.com  Sub : Enrollment Status Updates - CBUC/GWMC - Tricare   Good afternoon!  Hope all is well with you. Please assist with the below at your earliest opportunity.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name	NPI & Queries Katherine Paterson	1164776548 : Please provide eff date & Please update the main                           location with proper address on your director  Mercedita Flynn	1619166188 : Latest updates on this application Monica Gonzalez	1871132811 : We have faxed the certification and credentialing                                      application to Tricare.  If you have any questions or require additional information or documents please don\'t hesitate in contacting me. Please see the attachment.  Thank you! Have a great day!', NULL, NULL, '2021-10-07 16:16:52', '2021-10-07 16:16:52'),
(13933, 11056, 20286, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Updates - CBUC/GWMC - Tricare  Please allow 90 days for processing of Ms. Gonzalez.  Application was faxed 9/20/2021.      Thank you,  Jacque Trenz Health System Consultant Humana Military TRICARE East', NULL, NULL, '2021-10-14 16:05:36', '2021-10-14 16:05:36'),
(13934, 11056, 20286, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email sent to : jtrenz@humana.com  Sub : Enrollment Status Updates - CBUC/GWMC - Tricare  Hello Jacqueline!  Hope you are doing great. Please help me out with the issue mentioned below:  Katherine Paterson - The main location is not appearing in your directory.  Mercedita Flynn - The secondary location is not appearing in your directory.  Please also see the attachments related to this. Kindly sort this out for me as soon as possible.  Thank you! Have a great weekend!', NULL, NULL, '2021-10-22 10:35:35', '2021-10-22 10:35:35');
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
(13935, 11056, 20286, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Email received from: jtrenz@humana.com  Sub:  Enrollment Status Updates - CBUC/GWMC - Tricare   Good morning,     The correct locations are showing up in my systems, so I have to send this the my provider administration team for a review.  Please email  a copy of the W-9 for the group so I can send my request.   Have provided them with their demands.', NULL, NULL, '2021-11-09 15:47:00', '2021-11-09 15:47:00'),
(13936, 11056, 20286, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email received from:  ywyatt@humana.com  Sub: Enrollment Status Updates - CBUC/GWMC - Tricare   Good afternoon Ahmed,     You can check the status and effective dates on a provider by creating a log-in on the Provide Portal using the links listed below. This address location is not in my area. You do not need to include me on the email for Coastal Bend unless there is a location in Houston Texas.     https://infocenter.humana-military.com/provider/service/Account/Login  Katherine Paterson is listed as network the effective date is listed on the Provider Portal    Mercedita Flynn is listed as network the effective date is listed on the Provider Portal  Monica Gonzalez- certification faxed to WPS can take up to 120 days to process. WPS will send you a letter once the application is complete. I do not have access to WPS system to give you the status. You can call 1800 444 5445 and ask to speak to the certification unit to check status.', NULL, NULL, '2021-11-24 12:43:25', '2021-11-24 12:43:25'),
(13937, 11056, 20286, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub : Enrollment Status Updates - CBUC/GWMC - Tricare  Good afternoon Jacqueline!  Hope this email finds you well. Any update on the location listing in the provider directory? Have the locations been updated?  For Katherine : 301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324  For Mercedita : 504A Houston Street, George West , TX 78022-3663  Take Care! Have a wonderful week ahead!', NULL, NULL, '2021-12-10 13:04:18', '2021-12-10 13:04:18'),
(13938, 11056, 20286, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email sent to: JTRENZ@humana.com  Sub: Enrollment Status Updates - CBUC/GWMC - Tricare  Good afternoon!  Hope this email finds you well. Please update me with the certification & credentialing process of the below-mentioned provider at your earliest convenience.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Location	504A Houston Street, George West, TX 78022-3663 Provider Name	NPI Monica Gonzalez  	1871132811   If you require any further information or documents please let me know.  Thank you!', NULL, NULL, '2021-12-17 17:53:50', '2021-12-17 17:53:50'),
(13939, 11056, 20286, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: JTRENZ@humana.com  Sub: Enrollment Status Updates - CBUC/GWMC - Tricare   Good morning Jacqueline!  Hope you had a wonderful week yet. Please respond to the below query soon. I am still waiting to get the latest updates regarding the provider, Monica\'s certification, and credentialing with Tricare.  Please get back to me at your earliest convenience.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-22 13:19:06', '2021-12-22 13:19:06'),
(13940, 19067, 20286, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Query || CBUC & GWMC || Providers & Group || Tricare ||     Good Morning!  Hope you are doing really well.  I would like to know the enrollment status of the following Providers and Group.   Group Name	Beeville Medical Clinic Tax ID	81-1890349 Group NPI	1427509264 Provider Name	NPI	Location Leticia Aleman-Listenbee	1154999654	504A Houston Street, Live Oak County, George West, TX 78022-3663 Leticia Aleman-Listenbee	1154999654	301 S Hillside DR, STE 4, Beeville, TX 78102-5324 Mocia Gonzalez	1871132811	504A Houston Street, Live Oak County, George West, TX 78022-3663 Mocia Gonzalez	1871132811	301 S Hillside DR, STE 4, Beeville, TX 78102-5324 Mercedita Flynn	1619166188	504A Houston Street, Live Oak County, George West, TX 78022-3663   Eagerly waiting for your response.   Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 10:59:34', '2022-01-04 10:59:34'),
(13941, 19067, 20286, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email received from: ywyatt@humana.com  Subject: Enrollment Query || CBUC & GWMC || Providers & Group || Tricare ||   Good Morning Hammad,     This group tax id is not in my area. Celeste Santiago is the Rep for that area. I have include her on this email.  Please reach out to her to assist.  You can also check status by creating a log in on the Provider portal.', NULL, NULL, '2022-01-10 10:12:54', '2022-01-10 10:12:54'),
(13942, 19067, 20286, NULL, '2022-01-28 00:00:00.000', 'In Process', 'Email sent to: CSantiago20@humana.com, ywyatt@humana.com  Subject: Re: Enrollment Query || CBUC & GWMC || Providers & Group || Tricare ||    Greetings Celeste!  Hope this email finds you well.  Can you look into the request mentioned below?   Have a beautiful day! Hammad Ahmed.', NULL, NULL, '2022-01-20 20:27:54', '2022-01-20 20:27:54'),
(13943, 19067, 20286, NULL, '2022-02-23 00:00:00.000', 'In Process', 'Received the following email from: CSantiago20@humana.com    Hammad,  Thank you for reaching out to me.  I am the new Provider Rep for the Corpus Christi Area, as well as Austin, and Del Rio area.  I have researched your providers you listed and have annotated in RED below  Group Name  Beeville Medical Clinic   Tax ID  81-1890349    Group NPI  1427509264        Provider Name  NPI  Location        Leticia Aleman-Listenbee  1154999654  504A Houston Street, Live Oak County, George West, TX 78022-3663  Certified Authorized TRICARE Provider-assigned this location     Leticia Aleman-Listenbee  1154999654  301 S Hillside DR, STE 4, Beeville, TX 78102-5324  Certified Authorized TRICARE Provider-assigned to this location     Mocia Gonzalez  1871132811  504A Houston Street, Live Oak County, George West, TX 78022-3663  Credentialed Network Provider assigned to this location     Mocia Gonzalez  1871132811  301 S Hillside DR, STE 4, Beeville, TX 78102-5324  Credentialed Network Provider assigned to this location     Mercedita Flynn  1619166188  504A Houston Street, Live Oak County, George West, TX 78022-3663  Credentialed Network Provider assigned to this location        I have identified an issue for Mercedita Flynn, but that does not impact her as a provider and certification and or credentialing.  That alert has been submitted and is set to be corrected.     In order to serve our providers more efficiently, we have begun using Humana Military’s Provider Self-Service Portal.  The secure messaging feature through Provider Self Service increases the timeliness of responses to your questions.  If you are not currently registered on the Provider Self-Service Portal, please visit:  Provider Self-Service (humana-military.com)  To verify provider status, please utilize the NPI search tool in the Provider Self-Service Portal.  If the provider does not populate in this tool, then the provider is not TRICARE certified.     Respectfully,  Celeste Santiago  TRICARE Community Liasion II, South Texas| Field Operations  Senior Consumer Service Operations Professional  Humana Military  T (502) 318-5068  C (210) 968-6257  F (502) 212-7667  csantiago20@humana.com', NULL, NULL, '2022-02-16 12:00:47', '2022-02-16 12:00:47'),
(13944, 22077, 20286, NULL, '2022-04-21 00:00:00.000', 'In Process', 'Email sent to: HPPROVIDERNETWORKDEVELOPMENT@bswhealth.org  Subject; 	Re: Re: Fwd: Enrollment Query || CBUC & GWMC || Leticia Aleman-Listenbee || Scott & White ||  Hi,  Hope this email finds you well,  I would like to know the effective date of the providers mentioned previously,   Looking forward to your kind response. Have a great day!  Thanks & Regards Alex', NULL, NULL, '2022-04-14 08:12:37', '2022-04-14 08:12:37'),
(13945, 22077, 20286, NULL, '2022-04-21 00:00:00.000', 'In Process', 'Email sent to: CSantiago20@humana.com  Subject: 	Re: Enrollment Query || CBUC & GWMC || Providers & Group || Tricare ||  Hi,  Hope this email finds you well,  I would like to know the effective date of the providers mentioned previously,   Looking forward to your kind response. Have a great day!  Thanks & Regards Alex', NULL, NULL, '2022-04-14 08:20:05', '2022-04-14 08:20:05'),
(13946, 3046, 20287, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:32:20', '2021-03-12 14:32:20'),
(13947, 3040, 20287, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Tricare ||  Hello Katherine,  Hope you are doing well. I wanted to enroll the below mentioned group and providers Tricare for our group under the below locations.   Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice Name: George West Medical Clinic Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 504A Houston Street George West , TX 78022-3663  Provider 1: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 2:   Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider 3:   Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-07 12:56:10', '2021-06-07 12:56:10'),
(13948, 1006, 20287, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Sent f/u email @ Katherine Moten KMoten4@humana.com & Yvonne Wyatt ywyatt@humana.com:  Sub: Enrollment Status - CBUC/GWMC - Tricare  \"Hello,   I hope you\'re doing well, I wanted to verify if the following group and providers were enrolled with Tricare or not? If not, please let me know what is required to get them enrolled. The information is as follows:   Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, Beeville, TX 78102-5324 Secondary Practice Address: 504A Houston Street, George West, TX 78022-3663  Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Katherine Paterson Provider NPI# 1164776548  Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-06-25 09:59:24', '2021-06-25 09:59:24'),
(13949, 1006, 20287, NULL, '2021-07-21 00:00:00.000', 'In Process', 'We received the following response from Yvonne:  \"Good Morning Brad,     Costal Bend Urgent Care address location is not in my area.  Katherine Moten is the TRICARE Liaison for Beeville and George West Texas. The street address happened to have a street name of Houston.  Katherine can assist you with any additional questions. You do not need to include me on the emails for her area.     I work Houston ,Galveston and the surrounding areas of these cities.        Here is the status: We show the tax id as network. The current status for each provider are listed below. You can check status on a provider by creating a log in on the provider Portal or search online under find care. Both can be found on the humanamilitary.com website.     Provider Name: Flynn, Mercedita N- we show has been added to both address locations. Provider NPI# 1619166188  Provider Name: Katherine Paterson- we show this provider is not affiliated to this group tax id you need to complete the spreadsheet to add this provider to this tax id. Provider NPI# 1164776548  Provider Name: Tudor, Jennifer M- we show has been added to both address locations Provider NPI# 1720455835\"  Tried calling Katherine but no one picked up, left VM and resent f/u email @ :  \"Hello Katherine,   I hope you\'re doing well, please get back to me on this as soon as you\'re able.  Thanks. \"', NULL, NULL, '2021-07-14 17:13:01', '2021-07-14 17:13:01'),
(13950, 1006, 20287, NULL, '2021-08-02 00:00:00.000', 'Not Eligible', 'The provider is no longer a part of the group as per Ryan. ', NULL, NULL, '2021-07-26 09:01:14', '2021-07-26 09:01:14'),
(13951, 3040, 20288, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:32:22', '2021-03-12 14:32:22'),
(13952, 3040, 20288, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-03-26 14:18:12', '2021-03-26 14:18:12'),
(13953, 3046, 20289, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:32:22', '2021-03-12 14:32:22'),
(13954, 3040, 20289, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Tricare ||  Hello Katherine,  Hope you are doing well. I wanted to enroll the below mentioned group and providers Tricare for our group under the below locations.   Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice Name: George West Medical Clinic Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 504A Houston Street George West , TX 78022-3663  Provider 1: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 2:   Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider 3:   Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-07 12:56:14', '2021-06-07 12:56:14'),
(13955, 1006, 20289, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Sent f/u email @ Katherine Moten KMoten4@humana.com & Yvonne Wyatt ywyatt@humana.com:  Sub: Enrollment Status - CBUC/GWMC - Tricare  \"Hello,   I hope you\'re doing well, I wanted to verify if the following group and providers were enrolled with Tricare or not? If not, please let me know what is required to get them enrolled. The information is as follows:   Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, Beeville, TX 78102-5324 Secondary Practice Address: 504A Houston Street, George West, TX 78022-3663  Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Katherine Paterson Provider NPI# 1164776548  Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-06-25 09:59:14', '2021-06-25 09:59:14'),
(13956, 1006, 20289, NULL, '2021-07-21 00:00:00.000', 'In Process', 'We received the following response from Yvonne:  \"Good Morning Brad,     Costal Bend Urgent Care address location is not in my area.  Katherine Moten is the TRICARE Liaison for Beeville and George West Texas. The street address happened to have a street name of Houston.  Katherine can assist you with any additional questions. You do not need to include me on the emails for her area.     I work Houston ,Galveston and the surrounding areas of these cities.        Here is the status: We show the tax id as network. The current status for each provider are listed below. You can check status on a provider by creating a log in on the provider Portal or search online under find care. Both can be found on the humanamilitary.com website.     Provider Name: Flynn, Mercedita N- we show has been added to both address locations. Provider NPI# 1619166188  Provider Name: Katherine Paterson- we show this provider is not affiliated to this group tax id you need to complete the spreadsheet to add this provider to this tax id. Provider NPI# 1164776548  Provider Name: Tudor, Jennifer M- we show has been added to both address locations Provider NPI# 1720455835\"  Tried calling Katherine but no one picked up, left VM and resent f/u email @ :  \"Hello Katherine,   I hope you\'re doing well, please get back to me on this as soon as you\'re able.  Thanks. \"', NULL, NULL, '2021-07-14 17:12:57', '2021-07-14 17:12:57'),
(13957, 11056, 20289, NULL, '2021-08-26 00:00:00.000', 'In Process', 'Email sent to : 	ywyatt@humana.com, & KMoten4@humana.com  Sub : Enrollment Status Updates - CBUC/GWMC - Tricare  Good evening!  Hope all is well. I want to inquire about the spreadsheet to affiliate the provider Katherine Paterson to this group tax id, which you were going to provide in the month of July but haven\'t yet. Please provide it soon.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Katherine Paterson Provider NPI# 1164776548  If you need any documents or information regarding this feel free to contact me.  Thank you! Have a great day!', NULL, NULL, '2021-08-18 14:49:05', '2021-08-18 14:49:05'),
(13958, 11056, 20289, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Email sent to : ywyatt@humana.com  Sub : Enrollment Status Updates - CBUC/GWMC - Tricare  Good morning Yvonne!  Hope this email finds you well. Thank you so much for your prompt response and submission of request to Provider network to display Katherine Paterson as network under the Beeville, Texas location. Could you please update me with the latest enrollment status of the below mentioned providers ?  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Katherine Paterson Provider NPI# 1164776548  Provider Name: Monica Gonzalez Provider NPI# 1871132811  If you have any questions or concerns feel free to reach out to me. Waiting to hear back from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-24 10:59:44', '2021-08-24 10:59:44'),
(13959, 11056, 20289, NULL, '2021-09-09 00:00:00.000', 'In Process', 'Email received from : ywyatt@humana.com  Sub : Enrollment Status Updates - CBUC/GWMC - Tricare  Good Morning Ahmed,    I have submitted a request to Provider network to display Katherine Paterson as network under the Beeville, Texas location.        Thanks,  Yvonne W. Wyatt,  Humana Military  TRICARE Community Liaison II  Houston/Galveston  502-318-5409 Telephone  502-322-8018 Fax  ywyatt@humana.com     https://www.humanamilitary.com/coronavirus/provider     https://infocenter.humana-military.com/provider/service/Account/Login     Certification takes 90 days, and I do not have visual access to check the status. To check the status on a Tricare Certification applications, Please call WPS at  800-444-5445 and ask to speak to the Certfication Unit.     Certification applications forms please visit: https://www.humanamilitary.com/provider/education-and-resources/quick-access/forms Certification Fax: 608-221-7535  Provider Handbook: http://apps.humana.com/marketing/documents.asp?file=3262194', NULL, NULL, '2021-09-02 10:20:22', '2021-09-02 10:20:22'),
(13960, 11056, 20289, NULL, '2021-09-27 00:00:00.000', 'In Process', 'Email received from : ywyatt@humana.com  Sub : Enrollment Status Updates - CBUC/GWMC - Tricare  Good afternoon Ahmed,  I am doing well, thanks  This tax id do not appear in my area. Katherine can assist you with your questions.   Thanks, Yvonne  Emailed at KMoten4@humana.com to get updates.', NULL, NULL, '2021-09-20 13:13:55', '2021-09-20 13:13:55'),
(13961, 11056, 20289, NULL, '2021-09-27 00:00:00.000', 'In Process', 'I have words with Jada H & Rheshonda at 18004445445. Both advised me to fax the form for adding the secondary location and the form has been faxed at 608-221-7535  Mercedita - is credentialed and in network  Ref code : 13844672   Please see the attachment.', NULL, NULL, '2021-09-20 14:21:29', '2021-09-20 14:21:29'),
(13962, 11056, 20289, NULL, '2021-10-07 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com & ywyatt@humana.com  Sub : Enrollment Status Updates - CBUC/GWMC - Tricare  Good Morning  Ahmed,     Katherine, has taken another position.  This address location do not appear in my area. I will assist you with this question but any additional questions please reach out to Jacqueline Trenz. I have include her on this email.  You do not need to include me on the emails for this area    Provider Details: Provider Name: Flynn, Mercedita N  Provider NPI# 1619166188 - Show affiliated with this group tax id but is not display on the portal a request was submitted to update. Allow up to five business days to process.   Provider Name: Katherine Paterson- Show affiliated with this group tax id and is displayed  Provider NPI# 1164776548  Provider Name: Monica Gonzalez Provider NPI# 1871132811 - Do not appear in our system as TRICARE certified. Below is the link to the certification application for you to complete and fax to WPS.', NULL, NULL, '2021-09-30 15:52:20', '2021-09-30 15:52:20'),
(13963, 11056, 20289, NULL, '2021-10-14 00:00:00.000', 'In Process', 'Email sent to : jtrenz@humana.com  Sub : Enrollment Status Updates - CBUC/GWMC - Tricare   Good afternoon!  Hope all is well with you. Please assist with the below at your earliest opportunity.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name	NPI & Queries Katherine Paterson	1164776548 : Please provide eff date & Please update the main                           location with proper address on your director  Mercedita Flynn	1619166188 : Latest updates on this application Monica Gonzalez	1871132811 : We have faxed the certification and credentialing                                      application to Tricare.  If you have any questions or require additional information or documents please don\'t hesitate in contacting me. Please see the attachment.  Thank you! Have a great day!', NULL, NULL, '2021-10-07 16:16:46', '2021-10-07 16:16:46'),
(13964, 11056, 20289, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Updates - CBUC/GWMC - Tricare  Please allow 90 days for processing of Ms. Gonzalez.  Application was faxed 9/20/2021.      Thank you,  Jacque Trenz Health System Consultant Humana Military TRICARE East', NULL, NULL, '2021-10-14 16:05:45', '2021-10-14 16:05:45'),
(13965, 11056, 20289, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email sent to : jtrenz@humana.com  Sub : Enrollment Status Updates - CBUC/GWMC - Tricare  Hello Jacqueline!  Hope you are doing great. Please help me out with the issue mentioned below:  Katherine Paterson - The main location is not appearing in your directory.  Mercedita Flynn - The secondary location is not appearing in your directory.  Please also see the attachments related to this. Kindly sort this out for me as soon as possible.  Thank you! Have a great weekend!', NULL, NULL, '2021-10-22 10:35:42', '2021-10-22 10:35:42'),
(13966, 11056, 20289, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Email received from: jtrenz@humana.com  Sub:  Enrollment Status Updates - CBUC/GWMC - Tricare   Good morning,     The correct locations are showing up in my systems, so I have to send this the my provider administration team for a review.  Please email  a copy of the W-9 for the group so I can send my request.   Have provided them with their demands.', NULL, NULL, '2021-11-09 15:46:53', '2021-11-09 15:46:53'),
(13967, 11056, 20289, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email received from:  ywyatt@humana.com  Sub: Enrollment Status Updates - CBUC/GWMC - Tricare   Good afternoon Ahmed,     You can check the status and effective dates on a provider by creating a log-in on the Provide Portal using the links listed below. This address location is not in my area. You do not need to include me on the email for Coastal Bend unless there is a location in Houston Texas.     https://infocenter.humana-military.com/provider/service/Account/Login  Katherine Paterson is listed as network the effective date is listed on the Provider Portal    Mercedita Flynn is listed as network the effective date is listed on the Provider Portal  Monica Gonzalez- certification faxed to WPS can take up to 120 days to process. WPS will send you a letter once the application is complete. I do not have access to WPS system to give you the status. You can call 1800 444 5445 and ask to speak to the certification unit to check status.', NULL, NULL, '2021-11-24 12:43:20', '2021-11-24 12:43:20'),
(13968, 11056, 20289, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub : Enrollment Status Updates - CBUC/GWMC - Tricare  Good afternoon Jacqueline!  Hope this email finds you well. Any update on the location listing in the provider directory? Have the locations been updated?  For Katherine : 301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324  For Mercedita : 504A Houston Street, George West , TX 78022-3663  Take Care! Have a wonderful week ahead!', NULL, NULL, '2021-12-10 13:04:13', '2021-12-10 13:04:13'),
(13969, 11056, 20289, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email sent to: JTRENZ@humana.com  Sub: Enrollment Status Updates - CBUC/GWMC - Tricare  Good afternoon!  Hope this email finds you well. Please update me with the certification & credentialing process of the below-mentioned provider at your earliest convenience.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Location	504A Houston Street, George West, TX 78022-3663 Provider Name	NPI Monica Gonzalez  	1871132811   If you require any further information or documents please let me know.  Thank you!', NULL, NULL, '2021-12-17 17:53:45', '2021-12-17 17:53:45'),
(13970, 11056, 20289, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: JTRENZ@humana.com  Sub: Enrollment Status Updates - CBUC/GWMC - Tricare   Good morning Jacqueline!  Hope you had a wonderful week yet. Please respond to the below query soon. I am still waiting to get the latest updates regarding the provider, Monica\'s certification, and credentialing with Tricare.  Please get back to me at your earliest convenience.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-22 13:19:00', '2021-12-22 13:19:00'),
(13971, 19067, 20289, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Query || CBUC & GWMC || Providers & Group || Tricare ||     Good Morning!  Hope you are doing really well.  I would like to know the enrollment status of the following Providers and Group.   Group Name	Beeville Medical Clinic Tax ID	81-1890349 Group NPI	1427509264 Provider Name	NPI	Location Leticia Aleman-Listenbee	1154999654	504A Houston Street, Live Oak County, George West, TX 78022-3663 Leticia Aleman-Listenbee	1154999654	301 S Hillside DR, STE 4, Beeville, TX 78102-5324 Mocia Gonzalez	1871132811	504A Houston Street, Live Oak County, George West, TX 78022-3663 Mocia Gonzalez	1871132811	301 S Hillside DR, STE 4, Beeville, TX 78102-5324 Mercedita Flynn	1619166188	504A Houston Street, Live Oak County, George West, TX 78022-3663   Eagerly waiting for your response.   Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 10:59:25', '2022-01-04 10:59:25'),
(13972, 19067, 20289, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email received from: ywyatt@humana.com  Subject: Enrollment Query || CBUC & GWMC || Providers & Group || Tricare ||   Good Morning Hammad,     This group tax id is not in my area. Celeste Santiago is the Rep for that area. I have include her on this email.  Please reach out to her to assist.  You can also check status by creating a log in on the Provider portal.', NULL, NULL, '2022-01-10 10:12:46', '2022-01-10 10:12:46'),
(13973, 19067, 20289, NULL, '2022-01-28 00:00:00.000', 'In Process', 'Email sent to: CSantiago20@humana.com, ywyatt@humana.com  Subject: Re: Enrollment Query || CBUC & GWMC || Providers & Group || Tricare ||    Greetings Celeste!  Hope this email finds you well.  Can you look into the request mentioned below?   Have a beautiful day! Hammad Ahmed.', NULL, NULL, '2022-01-20 20:27:42', '2022-01-20 20:27:42'),
(13974, 19067, 20289, NULL, '2022-02-23 00:00:00.000', 'Approved', 'Received the following email from: CSantiago20@humana.com    Hammad,  Thank you for reaching out to me.  I am the new Provider Rep for the Corpus Christi Area, as well as Austin, and Del Rio area.  I have researched your providers you listed and have annotated in RED below  Group Name  Beeville Medical Clinic   Tax ID  81-1890349    Group NPI  1427509264        Provider Name  NPI  Location        Leticia Aleman-Listenbee  1154999654  504A Houston Street, Live Oak County, George West, TX 78022-3663  Certified Authorized TRICARE Provider-assigned this location     Leticia Aleman-Listenbee  1154999654  301 S Hillside DR, STE 4, Beeville, TX 78102-5324  Certified Authorized TRICARE Provider-assigned to this location     Mocia Gonzalez  1871132811  504A Houston Street, Live Oak County, George West, TX 78022-3663  Credentialed Network Provider assigned to this location     Mocia Gonzalez  1871132811  301 S Hillside DR, STE 4, Beeville, TX 78102-5324  Credentialed Network Provider assigned to this location     Mercedita Flynn  1619166188  504A Houston Street, Live Oak County, George West, TX 78022-3663  Credentialed Network Provider assigned to this location        I have identified an issue for Mercedita Flynn, but that does not impact her as a provider and certification and or credentialing.  That alert has been submitted and is set to be corrected.     In order to serve our providers more efficiently, we have begun using Humana Military’s Provider Self-Service Portal.  The secure messaging feature through Provider Self Service increases the timeliness of responses to your questions.  If you are not currently registered on the Provider Self-Service Portal, please visit:  Provider Self-Service (humana-military.com)  To verify provider status, please utilize the NPI search tool in the Provider Self-Service Portal.  If the provider does not populate in this tool, then the provider is not TRICARE certified.     Respectfully,  Celeste Santiago  TRICARE Community Liasion II, South Texas| Field Operations  Senior Consumer Service Operations Professional  Humana Military  T (502) 318-5068  C (210) 968-6257  F (502) 212-7667  csantiago20@humana.com', NULL, NULL, '2022-02-16 12:00:27', '2022-02-16 12:00:27'),
(13975, 3040, 20290, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:32:33', '2021-03-12 14:32:33'),
(13976, 3040, 20290, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-03-26 14:18:27', '2021-03-26 14:18:27'),
(13977, 3040, 20291, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:32:45', '2021-03-12 14:32:45'),
(13978, 3040, 20291, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-03-26 14:20:06', '2021-03-26 14:20:06'),
(13979, 3040, 20292, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:32:57', '2021-03-12 14:32:57'),
(13980, 3040, 20292, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-03-26 14:20:25', '2021-03-26 14:20:25'),
(13981, 3040, 20293, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:33:12', '2021-03-12 14:33:12'),
(13982, 3040, 20293, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-03-26 14:20:44', '2021-03-26 14:20:44'),
(13983, 3040, 20294, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:33:23', '2021-03-12 14:33:23'),
(13984, 3040, 20294, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-03-26 14:20:59', '2021-03-26 14:20:59'),
(13985, 3040, 20295, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:33:35', '2021-03-12 14:33:35'),
(13986, 3040, 20295, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-03-26 14:21:17', '2021-03-26 14:21:17'),
(13987, 3040, 20296, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:34:06', '2021-03-12 14:34:06'),
(13988, 3040, 20296, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group has an ancillary contract.   Please see attachment.  ', NULL, NULL, '2021-03-26 12:58:18', '2021-03-26 12:58:18'),
(13989, 3040, 20297, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:34:22', '2021-03-12 14:34:22'),
(13990, 3040, 20297, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-03-26 14:12:28', '2021-03-26 14:12:28'),
(13991, 3040, 20298, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:34:46', '2021-03-12 14:34:46'),
(13992, 3040, 20298, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-03-26 14:16:00', '2021-03-26 14:16:00'),
(13993, 3040, 20299, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:35:02', '2021-03-12 14:35:02'),
(13994, 3040, 20299, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-03-26 14:16:52', '2021-03-26 14:16:52'),
(13995, 3040, 20300, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:35:13', '2021-03-12 14:35:13'),
(13996, 3040, 20300, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-03-26 14:17:19', '2021-03-26 14:17:19'),
(13997, 3040, 20301, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:35:30', '2021-03-12 14:35:30'),
(13998, 3040, 20301, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-03-26 14:18:17', '2021-03-26 14:18:17'),
(13999, 3040, 20302, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:35:41', '2021-03-12 14:35:41'),
(14000, 3040, 20302, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-03-26 14:18:32', '2021-03-26 14:18:32'),
(14001, 3040, 20303, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:35:53', '2021-03-12 14:35:53'),
(14002, 3040, 20303, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-03-26 14:20:12', '2021-03-26 14:20:12'),
(14003, 3040, 20304, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:36:05', '2021-03-12 14:36:05'),
(14004, 3040, 20304, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-03-26 14:20:32', '2021-03-26 14:20:32'),
(14005, 3040, 20305, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:36:16', '2021-03-12 14:36:16'),
(14006, 3040, 20305, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-03-26 14:20:49', '2021-03-26 14:20:49'),
(14007, 3040, 20306, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:36:30', '2021-03-12 14:36:30'),
(14008, 3040, 20306, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-03-26 14:21:07', '2021-03-26 14:21:07'),
(14009, 3040, 20307, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:36:41', '2021-03-12 14:36:41'),
(14010, 3040, 20307, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-03-26 14:21:22', '2021-03-26 14:21:22'),
(14011, 3040, 20308, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:38:22', '2021-03-12 14:38:22'),
(14012, 3040, 20308, NULL, '2021-04-02 00:00:00.000', 'Initiated', 'LOI send it through fax for adding the locations.   Fax No: 817-633-5729  Please see attachment. ', NULL, NULL, '2021-03-26 09:08:16', '2021-03-26 09:08:16'),
(14013, 3040, 20308, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Email sent to: mmedina@ghn-mci.com  Subject: Additional Locations || Valley Med Urgent Care PLLC || Group || Galaxy Health ||  Greetings,   In response to our conversation a few minutes ago please find the attached Letter of interest that was sent out to Susie on 03/25/2021 for adding the location in our facility contract for our group Valley Med Urgent Care PLLC.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please let me know. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-14 13:38:39', '2021-04-14 13:38:39'),
(14014, 3040, 20308, NULL, '2021-05-11 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.   Please find contract in group task. ', NULL, NULL, '2021-05-04 14:12:22', '2021-05-04 14:12:22'),
(14015, 3040, 20309, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:38:43', '2021-03-12 14:38:43'),
(14016, 3040, 20309, NULL, '2021-04-02 00:00:00.000', 'Initiated', 'LOI send it through fax for adding the locations.   Fax No: 817-633-5729  Please see attachment.  ', NULL, NULL, '2021-03-26 09:11:09', '2021-03-26 09:11:09'),
(14017, 3040, 20309, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Email sent to: mmedina@ghn-mci.com  Subject: Additional Locations || Valley Med Urgent Care PLLC || Group || Galaxy Health ||  Greetings,   In response to our conversation a few minutes ago please find the attached Letter of interest that was sent out to Susie on 03/25/2021 for adding the location in our facility contract for our group Valley Med Urgent Care PLLC.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please let me know. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-14 13:39:26', '2021-04-14 13:39:26'),
(14018, 3040, 20309, NULL, '2021-05-11 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.   Please find contract in group task. ', NULL, NULL, '2021-05-04 14:10:43', '2021-05-04 14:10:43'),
(14019, 3040, 20310, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:39:25', '2021-03-12 14:39:25'),
(14020, 3040, 20310, NULL, '2021-04-02 00:00:00.000', 'Initiated', 'LOI send it through fax for adding the locations.   Fax No: 817-633-5729  Please see attachment. ', NULL, NULL, '2021-03-26 09:15:50', '2021-03-26 09:15:50'),
(14021, 3040, 20310, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Email sent to: mmedina@ghn-mci.com  Subject: Additional Locations || Valley Med Urgent Care PLLC || Group || Galaxy Health ||  Greetings,   In response to our conversation a few minutes ago please find the attached Letter of interest that was sent out to Susie on 03/25/2021 for adding the location in our facility contract for our group Valley Med Urgent Care PLLC.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please let me know. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-14 13:39:44', '2021-04-14 13:39:44'),
(14022, 3040, 20310, NULL, '2021-05-11 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.   Please find contract in group task. ', NULL, NULL, '2021-05-04 14:11:07', '2021-05-04 14:11:07'),
(14023, 3040, 20311, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:39:45', '2021-03-12 14:39:45'),
(14024, 3040, 20311, NULL, '2021-04-02 00:00:00.000', 'Initiated', 'LOI send it through fax for adding the locations.   Fax No: 817-633-5729  Please see attachment. ', NULL, NULL, '2021-03-26 09:16:02', '2021-03-26 09:16:02'),
(14025, 3040, 20311, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Email sent to: mmedina@ghn-mci.com  Subject: Additional Locations || Valley Med Urgent Care PLLC || Group || Galaxy Health ||  Greetings,   In response to our conversation a few minutes ago please find the attached Letter of interest that was sent out to Susie on 03/25/2021 for adding the location in our facility contract for our group Valley Med Urgent Care PLLC.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please let me know. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-14 13:38:59', '2021-04-14 13:38:59'),
(14026, 3040, 20311, NULL, '2021-05-11 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.   Please find contract in group task. ', NULL, NULL, '2021-05-04 14:10:12', '2021-05-04 14:10:12'),
(14027, 3040, 20312, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:40:15', '2021-03-12 14:40:15'),
(14028, 3040, 20312, NULL, '2021-04-02 00:00:00.000', 'Initiated', 'LOI send it through fax for adding the locations.   Fax No: 817-633-5729  Please see attachment. ', NULL, NULL, '2021-03-26 09:18:16', '2021-03-26 09:18:16'),
(14029, 3040, 20312, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Email sent to: mmedina@ghn-mci.com  Subject: Additional Locations || Valley Med Urgent Care PLLC || Group || Galaxy Health ||  Greetings,   In response to our conversation a few minutes ago please find the attached Letter of interest that was sent out to Susie on 03/25/2021 for adding the location in our facility contract for our group Valley Med Urgent Care PLLC.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please let me know. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-14 13:38:51', '2021-04-14 13:38:51'),
(14030, 3040, 20312, NULL, '2021-05-11 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.   Please find contract in group task. ', NULL, NULL, '2021-05-04 14:09:53', '2021-05-04 14:09:53'),
(14031, 3040, 20313, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:40:27', '2021-03-12 14:40:27'),
(14032, 3040, 20313, NULL, '2021-04-02 00:00:00.000', 'Initiated', 'LOI send it through fax for adding the locations.   Fax No: 817-633-5729  Please see attachment. ', NULL, NULL, '2021-03-26 09:19:36', '2021-03-26 09:19:36'),
(14033, 3040, 20313, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Email sent to: mmedina@ghn-mci.com  Subject: Additional Locations || Valley Med Urgent Care PLLC || Group || Galaxy Health ||  Greetings,   In response to our conversation a few minutes ago please find the attached Letter of interest that was sent out to Susie on 03/25/2021 for adding the location in our facility contract for our group Valley Med Urgent Care PLLC.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please let me know. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-14 13:40:02', '2021-04-14 13:40:02'),
(14034, 3040, 20313, NULL, '2021-05-11 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.   Please find contract in group task. ', NULL, NULL, '2021-05-04 14:11:36', '2021-05-04 14:11:36'),
(14035, 3040, 20314, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:40:41', '2021-03-12 14:40:41'),
(14036, 3040, 20314, NULL, '2021-04-02 00:00:00.000', 'Initiated', 'LOI send it through fax for adding the locations.   Fax No: 817-633-5729  Please see attachment.  ', NULL, NULL, '2021-03-26 09:21:31', '2021-03-26 09:21:31'),
(14037, 3040, 20314, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Email sent to: mmedina@ghn-mci.com  Subject: Additional Locations || Valley Med Urgent Care PLLC || Group || Galaxy Health ||  Greetings,   In response to our conversation a few minutes ago please find the attached Letter of interest that was sent out to Susie on 03/25/2021 for adding the location in our facility contract for our group Valley Med Urgent Care PLLC.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please let me know. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-14 13:40:13', '2021-04-14 13:40:13'),
(14038, 3040, 20314, NULL, '2021-05-11 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.   Please find contract in group task. ', NULL, NULL, '2021-05-04 14:12:05', '2021-05-04 14:12:05'),
(14039, 3040, 20315, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:40:57', '2021-03-12 14:40:57'),
(14040, 3040, 20315, NULL, '2021-04-02 00:00:00.000', 'Initiated', 'LOI send it through fax for adding the locations.   Fax No: 817-633-5729  Please see attachment.  ', NULL, NULL, '2021-03-26 09:22:31', '2021-03-26 09:22:31'),
(14041, 1005, 20315, NULL, '2021-06-09 00:00:00.000', 'Not Eligible', 'The provider Moses Campos is no longer with Valley Med Urgent Care', NULL, NULL, '2021-06-01 14:37:39', '2021-06-01 14:37:39'),
(14042, 3040, 20316, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:41:12', '2021-03-12 14:41:12'),
(14043, 3040, 20316, NULL, '2021-04-02 00:00:00.000', 'Initiated', 'LOI send it through fax for adding the locations.   Fax No: 817-633-5729  Please see attachment.  ', NULL, NULL, '2021-03-26 09:25:29', '2021-03-26 09:25:29'),
(14044, 3040, 20316, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Email sent to: mmedina@ghn-mci.com  Subject: Additional Locations || Valley Med Urgent Care PLLC || Group || Galaxy Health ||  Greetings,   In response to our conversation a few minutes ago please find the attached Letter of interest that was sent out to Susie on 03/25/2021 for adding the location in our facility contract for our group Valley Med Urgent Care PLLC.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please let me know. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-14 13:39:53', '2021-04-14 13:39:53'),
(14045, 3040, 20316, NULL, '2021-05-11 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.   Please find contract in group task. ', NULL, NULL, '2021-05-04 14:11:20', '2021-05-04 14:11:20'),
(14046, 3040, 20317, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:41:24', '2021-03-12 14:41:24');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(14047, 3040, 20317, NULL, '2021-04-02 00:00:00.000', 'Initiated', 'LOI send it through fax for adding the locations.   Fax No: 817-633-5729  Please see attachment. ', NULL, NULL, '2021-03-26 09:26:00', '2021-03-26 09:26:00'),
(14048, 3040, 20317, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Email sent to: mmedina@ghn-mci.com  Subject: Additional Locations || Valley Med Urgent Care PLLC || Group || Galaxy Health ||  Greetings,   In response to our conversation a few minutes ago please find the attached Letter of interest that was sent out to Susie on 03/25/2021 for adding the location in our facility contract for our group Valley Med Urgent Care PLLC.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please let me know. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-14 13:39:36', '2021-04-14 13:39:36'),
(14049, 3040, 20317, NULL, '2021-05-11 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.   Please find contract in group task. ', NULL, NULL, '2021-05-04 14:10:55', '2021-05-04 14:10:55'),
(14050, 3040, 20318, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:42:00', '2021-03-12 14:42:00'),
(14051, 3040, 20318, NULL, '2021-04-01 00:00:00.000', 'Approved', 'Group has an ancillary contract. ', NULL, NULL, '2021-03-25 16:55:51', '2021-03-25 16:55:51'),
(14052, 3040, 20319, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:42:12', '2021-03-12 14:42:12'),
(14053, 3040, 20319, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-03-26 09:06:51', '2021-03-26 09:06:51'),
(14054, 3040, 20320, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:42:27', '2021-03-12 14:42:27'),
(14055, 3040, 20320, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.  ', NULL, NULL, '2021-03-26 09:10:53', '2021-03-26 09:10:53'),
(14056, 3040, 20321, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:42:43', '2021-03-12 14:42:43'),
(14057, 3040, 20321, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.  ', NULL, NULL, '2021-03-26 09:11:45', '2021-03-26 09:11:45'),
(14058, 3040, 20322, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:42:58', '2021-03-12 14:42:58'),
(14059, 3040, 20322, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.  ', NULL, NULL, '2021-03-26 09:15:31', '2021-03-26 09:15:31'),
(14060, 3040, 20323, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:43:15', '2021-03-12 14:43:15'),
(14061, 3040, 20323, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.  ', NULL, NULL, '2021-03-26 09:15:37', '2021-03-26 09:15:37'),
(14062, 3046, 20324, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:43:38', '2021-03-12 14:43:38'),
(14063, 3040, 20324, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Subject: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Amerigroup ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Amerigroup for our group under the below locations.   Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice Name: George West Medical Clinic Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 504A Houston Street George West , TX 78022-3663  Provider 1: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 2:   Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider 3:   Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-07 09:56:46', '2021-06-07 09:56:46'),
(14064, 1006, 20324, NULL, '2021-07-01 00:00:00.000', 'In Process', 'We received the following reply from TX Credentialing txcredentialing@amerigroup.com:  Sub: RE: {EXTERNAL} Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Amerigroup ||  \"Good Day to you.  Is this a PCP clinic or a true Urgent Care?  The latter option means that the entity bills globally.\"  Sent reply:  \"Hello,   This is a true Urgent care, please let me know how we can proceed with the request.  Thank you!\"', NULL, NULL, '2021-06-24 14:38:48', '2021-06-24 14:38:48'),
(14065, 11056, 20324, NULL, '2021-07-14 00:00:00.000', 'In Process', 'Email received from : txcredentialing@amerigroup.com  Sub : Enrollment Query || Coastal Bend Urgent Care & George West Medical Clinic - Amerigroup   Please send us a letterhead with the following and include a w9:   **Legal name / DBA  **NPI#  **Taxonomy Code  **Service locations  **Billing location  **phone / Fax / office hours / age limits  **TPI / Medicare #  **CLIA #', NULL, NULL, '2021-07-06 17:04:24', '2021-07-06 17:04:24'),
(14066, 11056, 20324, NULL, '2021-07-14 00:00:00.000', 'In Process', 'Email sent to : txcredentialing@amerigroup.com  Sub : Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group  Greetings,  Hope you are doing well. Here is the information you requested for and kindly see the attachments.  Practice Details: Practice  Legal name / DBA  : Coastal Bend Urgent Care, LLC Practice NP I# :  1427509264 Practice Tax ID# : 81-1890349 Taxonomy Code :  261QU0200X - Clinic/Center Urgent Care  Main practice & billing location : 301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Address : 504A Houston Street George West , TX 78022-3663  Practice phone : 361-226-1126 Practice  Fax :  361 542-4076 TPI / Medicare # : 588832 CLIA # : 45D2132336 Practice age limits : 0 till 100  Practice  office hours :   Monday 9AM–5PM Tuesday 9AM–5PM Wednesday 9AM–5PM Thursday 9AM–5PM Friday 9AM–5PM Saturday Closed Sunday Closed  If you have any questions or concerns feel free to contact me.  Thank you! Have a great day!', NULL, NULL, '2021-07-07 09:10:33', '2021-07-07 09:10:33'),
(14067, 1006, 20324, NULL, '2021-08-13 00:00:00.000', 'In Process', 'Sent f/u email @ txcredentialing@amerigroup.com:  Sub: RE: {EXTERNAL} Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Amerigroup ||  \"Hello,   I wanted to get an update regarding the enrollment status for the following group and providers:  Group Name: Coastal Bend Urgent Care, LLC Practice NP I# :  1427509264 Practice Tax ID# : 81-1890349  Main practice & billing location: 301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Address: 504A Houston Street George West , TX 78022-3663  Provider Name: Katherine Moten Provider NPI# 1164776548  Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-08-06 13:50:53', '2021-08-06 13:50:53'),
(14068, 1006, 20324, NULL, '2021-08-23 00:00:00.000', 'In Process', 'Sent f/u email @ TX Credentialing txcredentialing@amerigroup.com:  Sub: RE: {EXTERNAL} Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Amerigroup ||  \"Hello,   I hope you\'re doing well, I am still waiting on the status of my application. Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-08-16 16:00:54', '2021-08-16 16:00:54'),
(14069, 11056, 20324, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Email sent to : txcredentialing@amerigroup.com, latoyna.henry@amerigroup.com, Jason.Hughes@amerigroup.com  Sub : Fwd: {EXTERNAL} Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Amerigroup ||  Good afternoon!  Hope you are doing well. I am still waiting for the enrollment status for my applications of the below mentioned providers and practice:  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324 Secondary Address: 504A Houston Street George West , TX 78022-3663  Provider Details: Provider 1: Provider Name: Paterson, Katherine Provider NPI# : 1164776548  Provider 2:   Provider Name: Flynn, Mercedita N Provider NPI# : 1619166188  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great week ahead! ', NULL, NULL, '2021-08-23 16:34:21', '2021-08-23 16:34:21'),
(14070, 11056, 20324, NULL, '2021-09-27 00:00:00.000', 'In Process', 'Email sent to : txcredentialing@amerigroup.com  Sub : Fwd: {EXTERNAL} Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Amerigroup ||  Good morning!  Hope all is well with you. It had been a long since our email got responded back. We are still waiting to get the latest updates related our enrollment applications for the following providers under the Practice Tax I.D mentioned below:  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324 Secondary Address: 504A Houston Street George West , TX 78022-3663  Provider Details: Provider Name: Katherine Paterson Provider NPI# : 1164776548  Provider Name: Mercedita N Flynn Provider NPI# : 1619166188  Provider Name: Monica Gonzalez Provider NPI# : 1871132811  Please respond back to us soon with the updates. Eagerly, waiting for your response.  Thank you! Have a blessed day!  I had words with Kim U at 800-454-3730. She said that there is no contact no. of Amerigroup Credentialing dept. they only contact through emails.  Ref code : i-140308714', NULL, NULL, '2021-09-20 12:23:14', '2021-09-20 12:23:14'),
(14071, 11056, 20324, NULL, '2021-10-07 00:00:00.000', 'In Process', 'Email sent to : txcredentialing@amerigroup.com & Jason.Hughes@amerigroup.com  Sub : Fwd: {EXTERNAL} Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Amerigroup ||   Good evening!  Hope this email finds you well. Please see the location again. Please note that our facilities are located in BEEVILLE , TX & George West , TX, not in Corpus Christi.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name	NPI Katherine Paterson	1164776548 Mercedita Flynn	1619166188 Monica Gonzalez	1871132811  Please respond back to us soon with the updates. Eagerly, waiting for your response.  Thank you! Have a blessed day!', NULL, NULL, '2021-09-30 15:36:54', '2021-09-30 15:36:54'),
(14072, 11056, 20324, NULL, '2021-10-14 00:00:00.000', 'Not Eligible', 'Email received from : txcredentialing@amerigroup.com  Sub : Fwd: {EXTERNAL} Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Amerigroup ||  Good Morning,  Your request has been received for provider enrollment.  Please note that Amerigroup currently does not service the Hidalgo or the Corpus Christi Service Delivery Areas.   Hi There, those locations are within the Corpus Christi service delivery area, Amerigroup currently does not have membership down in that region.   Those areas are managed by other Medicaid Managed Care Organizations.   Thank you again for your interest.  Sincerely,', NULL, NULL, '2021-10-07 15:35:14', '2021-10-07 15:35:14'),
(14073, 3040, 20325, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:43:43', '2021-03-12 14:43:43'),
(14074, 3040, 20325, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.  ', NULL, NULL, '2021-03-26 09:21:08', '2021-03-26 09:21:08'),
(14075, 3040, 20326, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:43:55', '2021-03-12 14:43:55'),
(14076, 3040, 20326, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.  ', NULL, NULL, '2021-03-26 09:22:14', '2021-03-26 09:22:14'),
(14077, 3040, 20327, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:44:06', '2021-03-12 14:44:06'),
(14078, 3040, 20327, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.  ', NULL, NULL, '2021-03-26 09:24:33', '2021-03-26 09:24:33'),
(14079, 3040, 20328, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:44:18', '2021-03-12 14:44:18'),
(14080, 3040, 20328, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.  ', NULL, NULL, '2021-03-26 09:24:56', '2021-03-26 09:24:56'),
(14081, 3040, 20329, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:44:45', '2021-03-12 14:44:45'),
(14082, 3040, 20329, NULL, '2021-04-01 00:00:00.000', 'Initiated', 'LOI send it through fax for adding the locations.   Fax No: 817-633-5729  Please see attachment. ', NULL, NULL, '2021-03-25 16:55:29', '2021-03-25 16:55:29'),
(14083, 3040, 20329, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Email sent to: mmedina@ghn-mci.com  Subject: Additional Locations || Valley Med Urgent Care PLLC || Group || Galaxy Health ||  Greetings,   In response to our conversation a few minutes ago please find the attached Letter of interest that was sent out to Susie on 03/25/2021 for adding the location in our facility contract for our group Valley Med Urgent Care PLLC.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please let me know. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-14 13:36:00', '2021-04-14 13:36:00'),
(14084, 3040, 20329, NULL, '2021-05-11 00:00:00.000', 'Approved', 'Location added with Galaxy Health Plan.   Please see attachment. ', NULL, NULL, '2021-05-04 13:56:21', '2021-05-04 13:56:21'),
(14085, 3040, 20330, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:45:17', '2021-03-12 14:45:17'),
(14086, 3040, 20330, NULL, '2021-04-02 00:00:00.000', 'Initiated', 'LOI send it through fax for adding the locations.   Fax No: 817-633-5729  Please see attachment. ', NULL, NULL, '2021-03-26 09:08:18', '2021-03-26 09:08:18'),
(14087, 3040, 20330, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Email sent to: mmedina@ghn-mci.com  Subject: Additional Locations || Valley Med Urgent Care PLLC || Group || Galaxy Health ||  Greetings,   In response to our conversation a few minutes ago please find the attached Letter of interest that was sent out to Susie on 03/25/2021 for adding the location in our facility contract for our group Valley Med Urgent Care PLLC.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please let me know. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-14 13:38:46', '2021-04-14 13:38:46'),
(14088, 3040, 20330, NULL, '2021-05-11 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.   Please find contract in group task. ', NULL, NULL, '2021-05-04 14:12:17', '2021-05-04 14:12:17'),
(14089, 3040, 20331, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:45:31', '2021-03-12 14:45:31'),
(14090, 3040, 20331, NULL, '2021-04-02 00:00:00.000', 'Initiated', 'LOI send it through fax for adding the locations.   Fax No: 817-633-5729  Please see attachment. ', NULL, NULL, '2021-03-26 09:11:13', '2021-03-26 09:11:13'),
(14091, 3040, 20331, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Email sent to: mmedina@ghn-mci.com  Subject: Additional Locations || Valley Med Urgent Care PLLC || Group || Galaxy Health ||  Greetings,   In response to our conversation a few minutes ago please find the attached Letter of interest that was sent out to Susie on 03/25/2021 for adding the location in our facility contract for our group Valley Med Urgent Care PLLC.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please let me know. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-14 13:39:32', '2021-04-14 13:39:32'),
(14092, 3040, 20331, NULL, '2021-05-11 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.   Please find contract in group task. ', NULL, NULL, '2021-05-04 14:10:38', '2021-05-04 14:10:38'),
(14093, 3040, 20332, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:45:43', '2021-03-12 14:45:43'),
(14094, 3040, 20332, NULL, '2021-04-02 00:00:00.000', 'Initiated', 'LOI send it through fax for adding the locations.   Fax No: 817-633-5729  Please see attachment. ', NULL, NULL, '2021-03-26 09:11:27', '2021-03-26 09:11:27'),
(14095, 3040, 20332, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Email sent to: mmedina@ghn-mci.com  Subject: Additional Locations || Valley Med Urgent Care PLLC || Group || Galaxy Health ||  Greetings,   In response to our conversation a few minutes ago please find the attached Letter of interest that was sent out to Susie on 03/25/2021 for adding the location in our facility contract for our group Valley Med Urgent Care PLLC.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please let me know. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-14 13:39:15', '2021-04-14 13:39:15'),
(14096, 3040, 20332, NULL, '2021-05-11 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.   Please find contract in group task. ', NULL, NULL, '2021-05-04 14:10:20', '2021-05-04 14:10:20'),
(14097, 3040, 20333, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:45:55', '2021-03-12 14:45:55'),
(14098, 3040, 20333, NULL, '2021-04-02 00:00:00.000', 'Initiated', 'LOI send it through fax for adding the locations.   Fax No: 817-633-5729  Please see attachment. ', NULL, NULL, '2021-03-26 09:15:55', '2021-03-26 09:15:55'),
(14099, 3040, 20333, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Email sent to: mmedina@ghn-mci.com  Subject: Additional Locations || Valley Med Urgent Care PLLC || Group || Galaxy Health ||  Greetings,   In response to our conversation a few minutes ago please find the attached Letter of interest that was sent out to Susie on 03/25/2021 for adding the location in our facility contract for our group Valley Med Urgent Care PLLC.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please let me know. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-14 13:39:49', '2021-04-14 13:39:49'),
(14100, 3040, 20333, NULL, '2021-05-11 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.   Please find contract in group task. ', NULL, NULL, '2021-05-04 14:11:02', '2021-05-04 14:11:02'),
(14101, 3040, 20334, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:46:07', '2021-03-12 14:46:07'),
(14102, 3040, 20334, NULL, '2021-04-02 00:00:00.000', 'Initiated', 'LOI send it through fax for adding the locations.   Fax No: 817-633-5729  Please see attachment. ', NULL, NULL, '2021-03-26 09:16:07', '2021-03-26 09:16:07'),
(14103, 3040, 20334, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Email sent to: mmedina@ghn-mci.com  Subject: Additional Locations || Valley Med Urgent Care PLLC || Group || Galaxy Health ||  Greetings,   In response to our conversation a few minutes ago please find the attached Letter of interest that was sent out to Susie on 03/25/2021 for adding the location in our facility contract for our group Valley Med Urgent Care PLLC.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please let me know. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-14 13:39:03', '2021-04-14 13:39:03'),
(14104, 3040, 20334, NULL, '2021-05-11 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.   Please find contract in group task. ', NULL, NULL, '2021-05-04 14:10:05', '2021-05-04 14:10:05'),
(14105, 3040, 20335, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:46:20', '2021-03-12 14:46:20'),
(14106, 3040, 20335, NULL, '2021-04-02 00:00:00.000', 'Initiated', 'LOI send it through fax for adding the locations.   Fax No: 817-633-5729  Please see attachment. ', NULL, NULL, '2021-03-26 09:18:37', '2021-03-26 09:18:37'),
(14107, 3040, 20335, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Email sent to: mmedina@ghn-mci.com  Subject: Additional Locations || Valley Med Urgent Care PLLC || Group || Galaxy Health ||  Greetings,   In response to our conversation a few minutes ago please find the attached Letter of interest that was sent out to Susie on 03/25/2021 for adding the location in our facility contract for our group Valley Med Urgent Care PLLC.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please let me know. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-14 13:38:55', '2021-04-14 13:38:55'),
(14108, 3040, 20335, NULL, '2021-05-11 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.   Please find contract in group task. ', NULL, NULL, '2021-05-04 14:09:57', '2021-05-04 14:09:57'),
(14109, 3040, 20336, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:46:31', '2021-03-12 14:46:31'),
(14110, 3040, 20336, NULL, '2021-04-02 00:00:00.000', 'Initiated', 'LOI send it through fax for adding the locations.   Fax No: 817-633-5729  Please see attachment. ', NULL, NULL, '2021-03-26 09:19:40', '2021-03-26 09:19:40'),
(14111, 3040, 20336, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Email sent to: mmedina@ghn-mci.com  Subject: Additional Locations || Valley Med Urgent Care PLLC || Group || Galaxy Health ||  Greetings,   In response to our conversation a few minutes ago please find the attached Letter of interest that was sent out to Susie on 03/25/2021 for adding the location in our facility contract for our group Valley Med Urgent Care PLLC.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please let me know. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-14 13:40:07', '2021-04-14 13:40:07'),
(14112, 3040, 20336, NULL, '2021-05-11 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.   Please find contract in group task. ', NULL, NULL, '2021-05-04 14:11:41', '2021-05-04 14:11:41'),
(14113, 3046, 20337, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:46:42', '2021-03-12 14:46:42'),
(14114, 1006, 20337, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent query @ ProfessionalProviderNetworkDept@bcbstx.com:  Sub: Enrollment & Location Status Query - NASA Healthclinic - BCBSTX  \"Hello,   I hope you\'re doing well, we wanted to verify if the following groups and provider were enrolled with BCBSTX and if the mentioned addresses were also correctly listed under them:  Group Name: Nasa Health Clinic NPI# 1740661453 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 16:49:48', '2021-06-07 16:49:48'),
(14115, 1006, 20337, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Sent f/u email @ ProfessionalProviderNetworkDept@bcbstx.com:  Sub: Enrollment & Location Status Query - NASA Healthclinic - BCBSTX  \"Hello,   We\'re still waiting for an update regarding the enrollment status of the mentioned group and provider, please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-06-28 10:25:07', '2021-06-28 10:25:07'),
(14116, 11056, 20337, NULL, '2021-08-05 00:00:00.000', 'Approved', 'Email received from : provider_relations_houston@bcbstx.com  Sub : Enrollment & Location Status Query - NASA Healthclinic - BCBSTX : Case Number - 02652508  Good Evening,  Please see attached provider roster report for your group.  If any changes need to be made, please email your provider rep. Angie Cardenas (Angie_Cardenas@bcbstx.com).  Have a great day!  Best Regards,   Provider Relations-Houston BlueCross BlueShield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company 1800 West Loop South, Suite 600, Houston, TX. 77027 Office: 713.663.1149 | Fax: 713.663.1227 | Email: Provider_Relations_Houston@bcbstx.com Visit our website:  www.bcbstx.com Experience.  Wellness.  Everywhere.', NULL, NULL, '2021-07-29 09:21:36', '2021-07-29 09:21:36'),
(14117, 3040, 20338, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:46:45', '2021-03-12 14:46:45'),
(14118, 3040, 20338, NULL, '2021-04-02 00:00:00.000', 'Initiated', 'LOI send it through fax for adding the locations.   Fax No: 817-633-5729  Please see attachment. ', NULL, NULL, '2021-03-26 09:21:49', '2021-03-26 09:21:49'),
(14119, 3040, 20338, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Email sent to: mmedina@ghn-mci.com  Subject: Additional Locations || Valley Med Urgent Care PLLC || Group || Galaxy Health ||  Greetings,   In response to our conversation a few minutes ago please find the attached Letter of interest that was sent out to Susie on 03/25/2021 for adding the location in our facility contract for our group Valley Med Urgent Care PLLC.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please let me know. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-14 13:40:18', '2021-04-14 13:40:18'),
(14120, 3040, 20338, NULL, '2021-05-11 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.   Please find contract in group task. ', NULL, NULL, '2021-05-04 14:12:00', '2021-05-04 14:12:00'),
(14121, 3040, 20339, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:46:56', '2021-03-12 14:46:56'),
(14122, 3040, 20339, NULL, '2021-04-02 00:00:00.000', 'Initiated', 'LOI send it through fax for adding the locations.   Fax No: 817-633-5729  Please see attachment. ', NULL, NULL, '2021-03-26 09:22:47', '2021-03-26 09:22:47'),
(14123, 1005, 20339, NULL, '2021-06-09 00:00:00.000', 'Not Eligible', 'The provider Moses Campos is no longer with Valley Med Urgent Care', NULL, NULL, '2021-06-01 14:37:19', '2021-06-01 14:37:19'),
(14124, 3040, 20340, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:47:07', '2021-03-12 14:47:07'),
(14125, 3040, 20340, NULL, '2021-04-02 00:00:00.000', 'Initiated', 'LOI send it through fax for adding the locations.   Fax No: 817-633-5729  Please see attachment. ', NULL, NULL, '2021-03-26 09:25:45', '2021-03-26 09:25:45'),
(14126, 3040, 20340, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Email sent to: mmedina@ghn-mci.com  Subject: Additional Locations || Valley Med Urgent Care PLLC || Group || Galaxy Health ||  Greetings,   In response to our conversation a few minutes ago please find the attached Letter of interest that was sent out to Susie on 03/25/2021 for adding the location in our facility contract for our group Valley Med Urgent Care PLLC.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please let me know. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-14 13:39:58', '2021-04-14 13:39:58'),
(14127, 3040, 20340, NULL, '2021-05-11 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.   Please find contract in group task. ', NULL, NULL, '2021-05-04 14:11:13', '2021-05-04 14:11:13'),
(14128, 3040, 20341, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:47:18', '2021-03-12 14:47:18'),
(14129, 3040, 20341, NULL, '2021-04-02 00:00:00.000', 'Initiated', 'LOI send it through fax for adding the locations.   Fax No: 817-633-5729  Please see attachment. ', NULL, NULL, '2021-03-26 09:26:33', '2021-03-26 09:26:33'),
(14130, 3040, 20341, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Email sent to: mmedina@ghn-mci.com  Subject: Additional Locations || Valley Med Urgent Care PLLC || Group || Galaxy Health ||  Greetings,   In response to our conversation a few minutes ago please find the attached Letter of interest that was sent out to Susie on 03/25/2021 for adding the location in our facility contract for our group Valley Med Urgent Care PLLC.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please let me know. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-14 13:39:40', '2021-04-14 13:39:40'),
(14131, 3040, 20341, NULL, '2021-05-11 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.   Please find contract in group task. ', NULL, NULL, '2021-05-04 14:10:50', '2021-05-04 14:10:50'),
(14132, 3046, 20342, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:47:30', '2021-03-12 14:47:30'),
(14133, 1006, 20342, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent following enrollment query @ CHC Contracting CHC.Contracting@CommunityHealthChoice.org:  Sub: Enrollment & Location Status Query - NASA HealthClinic - Community Health Choice  \"Hello,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Community Health Choice and if the mentioned addresses are also correctly listed under them: Group Name: Nasa Health ClinicNPI# 1740661453TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Provider Name: Segun AdeoyeNPI# 1629418025 Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 18:08:36', '2021-06-07 18:08:36'),
(14134, 1006, 20342, NULL, '2021-07-05 00:00:00.000', 'Approved', 'We received the following approval confirmation from CHC Contracting CHC.Contracting@communityhealthchoice.org:  Sub: Enrollment & Location Status Query - NASA HealthClinic - Community Health Choice  \"Good Morning,  After review, we have determined Segun Adeoye to be participating under NASA Health Clinic (47-2682655). The effective date varies by line of business, which can be found on the attached Provider Profile. Please see attached for your records.  Should you require further assistance, please do not hesitate to contact us.  Best Regards, Contracting Dept.\"  Approval roster attached for reference. ', NULL, NULL, '2021-06-28 13:44:34', '2021-06-28 13:44:34'),
(14135, 3046, 20343, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 14:48:55', '2021-03-12 14:48:55'),
(14136, 1006, 20343, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Enrollment query email @ Provider Relations - South pr.south@healthsmart.com:  Sub: Enrollment & Location Status Query - NASA HealthClinic - HealthSmart  \"Hello,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Health Smart and if the mentioned addresses are also correctly listed under them:  Group Name: Nasa Health Clinic NPI# 1740661453 TIN# 47-2682655  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 17:34:15', '2021-06-07 17:34:15'),
(14137, 1006, 20343, NULL, '2021-07-05 00:00:00.000', 'Approved', 'We received the following confirmation email from Healthsmart MDI PR Support mdiprsupport@healthsmart.com:  Sub: Enrollment & Location Status Query - NASA HealthClinic - HealthSmart  \"Hi,  Provider \'\' ADEOYE, SEGUN P \'\' is Effective \'\' 11/01/2018 \'\'.  Our system has been updated as requested.  * The locations below have been added.  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com.   (Inventory Log ID :81494)  Thanks. HealthSmart Provider Relations.\"', NULL, NULL, '2021-06-28 09:44:30', '2021-06-28 09:44:30'),
(14138, 3046, 20344, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 15:17:16', '2021-03-12 15:17:16'),
(14139, 1006, 20344, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent enrollment query @ HumanaHoustonPD humanahoustonpd@humana.com:  Sub: Enrollment & Location Status Query - NASA HealthClinic - Humana  \"Hello,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Humana and if the mentioned addresses were also correctly listed under them:  Group Name: Nasa Health Clinic NPI# 1740661453 TIN# 47-2682655  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 17:28:52', '2021-06-07 17:28:52'),
(14140, 1006, 20344, NULL, '2021-07-05 00:00:00.000', 'In Process', 'We received the following reply from HumanaHoustonPD HumanaHoustonPD@humana.com:  Sub: Enrollment & Location Status Query - NASA HealthClinic - Humana  \"Group is participating with Humana.  Both addresses are correctly listed.  The following addresses are also listed:  1946 Pasadena Blvd Pasadena, TX 77502-2742 2101 Raspberry Ln Pasadena, TX 77502  If these addresses are no longer valid, please provide the date these locations were closed.  HumanaHoustonPD\"  Sent reply:   \"Hello,   I appreciate the reply, could you please let me know what the effective date is for the group and mentioned provider?  Thank you!\"', NULL, NULL, '2021-06-28 10:07:18', '2021-06-28 10:07:18'),
(14141, 11056, 20344, NULL, '2021-08-10 00:00:00.000', 'In Process', 'Email sent to : HumanaHoustonPD@humana.com  Sub : Fwd: Enrollment & Location Status Query - NASA HealthClinic - Humana  Good Afternoon!  Hope all is well. I appreciate the reply, could you please let me know what the effective date is for the group and mentioned provider? Kindly respond to us soon. Eagerly, waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-02 16:34:13', '2021-08-02 16:34:13'),
(14142, 11056, 20344, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email received from : HumanaHoustonPD@humana.com  Sub : Fwd: Enrollment & Location Status Query - NASA HealthClinic - Humana  Please see item highlighted in yellow.      Please read the following instructions carefully:     For the following requests (fee schedules, copies of contracts, network participation, credentialing status, or effective dates) call provider relations at 800-448-6262 or 800-626-2741. All maintenance requests (provider adds, terms and changes)  need to be sent through Humanahoustonpd@humana.com.  Note:  This mailbox is only for these intents (adds, terms, changes). Requests for fee schedules, copies of contracts, network participation, credentialing status, or effective dates will not be processed through this mailbox.  Allow 60 days for processing of new applicants submission. Allow 30 days for processing of terminations and demographic updates. Status requests should be sent on your original email submission for tracking purposes. Please do not send direct emails to associates as there may not be a response to your request, and the request will not be processed.  In addition, please do not cc a Humana associate on your email requests to the above mailbox or this may delay the processing of your request. Disputing a claim paid/denied and appeals: contact humanaproviderservices@humana.com Log on to Humana.com or Availity.com for Provider updates, claim inquiries, eligibility/benefits information, fee schedule inquiries and more! For Humana.com issues and password resets, please call a Humana Web Specialist at 877-845-3480.    Thank you,  HumanaHoustonPD', NULL, NULL, '2021-08-17 13:49:13', '2021-08-17 13:49:13'),
(14143, 11056, 20344, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email received from : HumanaHoustonPD@humana.com  Sub : Fwd: Enrollment & Location Status Query - NASA HealthClinic - Humana  Please see item highlighted in yellow.      Please read the following instructions carefully:     For the following requests (fee schedules, copies of contracts, network participation, credentialing status, or effective dates) call provider relations at 800-448-6262 or 800-626-2741. All maintenance requests (provider adds, terms and changes)  need to be sent through Humanahoustonpd@humana.com.  Note:  This mailbox is only for these intents (adds, terms, changes). Requests for fee schedules, copies of contracts, network participation, credentialing status, or effective dates will not be processed through this mailbox.  Allow 60 days for processing of new applicants submission. Allow 30 days for processing of terminations and demographic updates. Status requests should be sent on your original email submission for tracking purposes. Please do not send direct emails to associates as there may not be a response to your request, and the request will not be processed.  In addition, please do not cc a Humana associate on your email requests to the above mailbox or this may delay the processing of your request. Disputing a claim paid/denied and appeals: contact humanaproviderservices@humana.com Log on to Humana.com or Availity.com for Provider updates, claim inquiries, eligibility/benefits information, fee schedule inquiries and more! For Humana.com issues and password resets, please call a Humana Web Specialist at 877-845-3480.    Thank you,  HumanaHoustonPD', NULL, NULL, '2021-08-17 13:53:01', '2021-08-17 13:53:01'),
(14144, 11056, 20344, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to : humanaproviderservices@humana.com  Sub : Fwd: Enrollment & Location Status Query - NASA HealthClinic - Humana  Good morning!  I hope you\'re doing well. Could you please let me know what the effective date is for the group and mentioned provider?  Practice Details: Practice  Name: Nasa Urgent Care Inc. Practice NPI# : 1821542432 Practice TIN# : 81-3237149 Practice  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Practice  Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Practice Phone # : 2812186777 Practice Fax # : 8666656208  Provider: Provider Name: Segun Adeoye Provider NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-26 16:31:13', '2021-08-26 16:31:13'),
(14145, 11056, 20344, NULL, '2021-09-14 00:00:00.000', 'Approved', 'The provider is IN NETWORK PROVIDER EFF DATE IS : 03/01/2019  The participating plans are :  Humana PPO Humana HMO Humana CHOICE CARE PPO Humana + NETWORK PPO PFFS MEDICARE PPO MEDICARE PPO 2022 MEDICARE PPO/ PPO +   Rep Name : SUMMER REF CODE : 2000199462184  Please see the attachment.', NULL, NULL, '2021-09-07 10:26:56', '2021-09-07 10:26:56'),
(14146, 3046, 20345, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 15:17:58', '2021-03-12 15:17:58'),
(14147, 1006, 20345, NULL, '2021-06-15 00:00:00.000', 'Initiated', 'Submitted address addition request via TMHP website: \"Portal Ticket #	Application Name	NPI	Status Update Date	Transction Type	Status	Messages	Available Action  	17833777	PIMS Address		6/8/2021	Provider Information Change (PIC) Form	In Progress	View	\"', NULL, NULL, '2021-06-08 09:16:07', '2021-06-08 09:16:07'),
(14148, 11056, 20345, NULL, '2021-07-06 00:00:00.000', 'Initiated', 'I have called at TMHP for inquiring about the enrollment status. She is going to fax us  a letter of Deficiency and why our application had been closed. Ref no. : 41728865000', NULL, NULL, '2021-06-28 16:43:10', '2021-06-28 16:43:10'),
(14149, 11056, 20345, NULL, '2021-08-28 00:00:00.000', 'In Process', 'Waiting for the letter of deficiency. We haven\'t received it yet', NULL, NULL, '2021-08-20 17:22:01', '2021-08-20 17:22:01'),
(14150, 11056, 20345, NULL, '2021-09-22 00:00:00.000', 'In Process', '	 Portal Ticket #  Application Name  Status Update Date         Transction Type	                   Status	   17833777	     PIMS Address		6/16/2021   Provider Information Change (PIC) Form	Closed	', NULL, NULL, '2021-09-15 10:25:37', '2021-09-15 10:25:37'),
(14151, 11056, 20345, NULL, '2021-10-04 00:00:00.000', 'In Process', 'Portal Ticket #	Application Name	NPI	Status Update Date	Transction Type	Status  18123058	PIMS Address		9/27/2021	Provider Information Change (PIC) Form	In Progress', NULL, NULL, '2021-09-27 16:28:38', '2021-09-27 16:28:38'),
(14152, 11056, 20345, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Ref code : 42435791000  Rep : Sarah C  Status:   Have to fax a form for additional location 512-514-4214.   Form has been faxed . Please see the attachment', NULL, NULL, '2021-10-08 13:20:43', '2021-10-08 13:20:43'),
(14153, 11056, 20345, NULL, '2021-10-25 00:00:00.000', 'In Process', 'The issue has been resolved and faxed them again with the corrected one.', NULL, NULL, '2021-10-18 15:40:17', '2021-10-18 15:40:17'),
(14154, 11056, 20345, NULL, '2021-11-02 00:00:00.000', 'In Process', 'Ref code : 402556888000  Rep. : Sierra P  Status:  Request has been placed someone gonna contact us from provider relations dept. or credentialing team for the issue to be resolve  Contact no. : 800-925-9126 ', NULL, NULL, '2021-10-26 13:45:23', '2021-10-26 13:45:23'),
(14155, 11056, 20345, NULL, '2021-11-25 00:00:00.000', 'In Process', 'Rep: Miesha   Status: Another Application has to be submitted.   Refcode: 42726745000  Applications have been faxed with a coversheet as well.', NULL, NULL, '2021-11-18 17:44:18', '2021-11-18 17:44:18'),
(14156, 11056, 20345, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Rep: Jermaine S   Status: The applications are in process. It will take around 2 weeks.   Interaction code: 42820232000', NULL, NULL, '2021-12-06 15:08:00', '2021-12-06 15:08:00'),
(14157, 11056, 20345, NULL, '2021-12-29 00:00:00.000', 'In Process', 'The Medicaid portal is under processing.', NULL, NULL, '2021-12-22 17:26:19', '2021-12-22 17:26:19'),
(14158, 19067, 20345, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: PEMSSupport@tmhp.com  Subject: Enrollment Status || NASA HC || Segun Adeoye & Group  || MEDICAID ||  Hello!  Hope you\'re doing really well.  I would like to know the enrollment status of the following Group & Provider with Medicaid.  Group Name	NASA Health Clinic Tax ID	47-2682655 Group NPI	1740661453 Primary & Billing Location	985 NASA Parkway Houston, TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 15:15:03', '2021-12-29 15:15:03'),
(14159, 3046, 20346, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 15:21:48', '2021-03-12 15:21:48'),
(14160, 1005, 20346, NULL, '2021-06-09 00:00:00.000', 'Approved', 'Medicare ID: 426470 Eff: 06/15/2015', NULL, NULL, '2021-06-01 16:12:01', '2021-06-01 16:12:01'),
(14161, 3046, 20347, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 15:22:49', '2021-03-12 15:22:49'),
(14162, 1005, 20347, NULL, '2021-06-09 00:00:00.000', 'Approved', 'GROUP NAME	NASA HEALTH CLINIC GROUP PTAN	DZ1819 GROUP NPI	1740661453 BUSINESS STATE	TX EFFECTIVE DATE	06/15/2015 ', NULL, NULL, '2021-06-01 16:33:29', '2021-06-01 16:33:29'),
(14163, 3046, 20348, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 15:24:32', '2021-03-12 15:24:32'),
(14164, 1006, 20348, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent enrollment request @ SWHP PROVIDER SERVICES SWHPPROVSERVICES@bswhealth.org:  Sub: Enrollment & Location Status Query - NASA HealthClinic - Scott & White  \"Hello,  I hope you\'re doing well, we wanted to enroll the following group and provider with Scott & White under the mentioned addresses, their information is as follows: Group Name: Nasa Health ClinicNPI# 1740661453TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Provider Name: Segun AdeoyeNPI# 1629418025 Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 18:13:26', '2021-06-07 18:13:26'),
(14165, 1006, 20348, NULL, '2021-07-05 00:00:00.000', 'In Process', 'We received the following reply from SWHP PROVIDER SERVICES SWHPPROVSERVICES@bswhealth.org:  Sub: Enrollment & Location Status Query - NASA HealthClinic - Scott & White  \"Good morning Brad,  I do not show TIN 472682655 as contracted with SWHP/FC.  In order to join the network, you would need to click on the link below and submit a request to join our network.  Someone from our contracting department will then reach out to you once your information has been reviewed.  https://swhp.org/en-us/prov/provider-account-management#prov-join  Thank you so much,  Lacey B\"  Form filled out and attached in main group task for reference.   \"Success! Thank you again for your interest in becoming a Scott and White Health Plan contracted provider.  Please allow 30-45 days before checking on status.  Your form submission identifier is: b0c9167f-ad67-48fa-be7a-d1d59db6a17f\"', NULL, NULL, '2021-06-28 09:06:45', '2021-06-28 09:06:45');
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
(14166, 11056, 20348, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to  : SWHPPROVSERVICES@bswhealth.org  Sub : Enrollment & Location Status Query - NASA HealthClinic - Scott & White  Greetings,  Hope you are doing well. Could you Please let me know the current status of our Credentialing request and inform us as soon as possible.I have mentioned the details below of our group and providers :  Practice Details: Practice Name: Nasa Health Clinic Practice NPI# : 1740661453 Practice TIN# : 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider: Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-07-19 16:04:09', '2021-07-19 16:04:09'),
(14167, 11056, 20348, NULL, '2021-08-07 00:00:00.000', 'In Process', 'Email received from : SWHPPROVSERVICES@bswhealth.org  Sub : Enrollment & Location Status Query - NASA HealthClinic - Scott & White  Good afternoon,     I do not show that TIN 472682655 is currently contracted in our system.  If you have submitted a request to join our network, you will need to reach out to your contact for the new contract for a status request.  Unfortunately, this department only handles requests after the group/provider has been contracted and credentialed, and don’t have access to the systems that our contracting and credentialing teams use.   Thank you so much,     Lacey B', NULL, NULL, '2021-07-30 17:28:22', '2021-07-30 17:28:22'),
(14168, 1006, 20348, NULL, '2021-08-10 00:00:00.000', 'Not Eligible', 'We received the following denial notification from SWHPPROVIDERNETWORKDEVELOPMENT@bswhealth.org:  Sub: New Contract Request  \"Tax ID#: 47-2682655  RE: Network Denial Letter  Dear Nasa Health Clinic  Thank you for your recent application.  Scott and White Health Plans (SWHP) and SHA, LLC dba FirstCare Health Plans (FirstCare) appreciates your interest in becoming a part of our network.  After reviewing your online application to contract submitted on 06/28/2021,  SWHP and FirstCare regretfully declines to contract with Nasa Health Clinic at this time. The determination was made based on our current network needs. However, we encourage you to reapply in 6 months; as those needs may change.  For commercial providers, we welcome you to review 28 TAC 3.3706 for more detail on denial review.  Thank you again for your interest in SWHP and FirstCare Health Plans.  Best Regards,  Scott and White Health Plans |SHA, LLC dba FirstCare Health Plans Network Development Department 1206 West Campus Dr. Temple, Texas 76502\"', NULL, NULL, '2021-08-03 14:30:19', '2021-08-03 14:30:19'),
(14169, 3046, 20349, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 15:26:11', '2021-03-12 15:26:11'),
(14170, 1006, 20349, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent enrollment query @ TCHP CA Contract Admin TCHPnetworkmanagemen@texaschildrens.org:  Sub: Enrollment & Location Status Query - NASA HealthClinic - TCHP  \"Hello,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with TCHP and if the mentioned addresses are also correctly listed under them: Group Name: Nasa Health ClinicNPI# 1740661453TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Provider Name: Segun AdeoyeNPI# 1629418025 Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 17:54:12', '2021-06-07 17:54:12'),
(14171, 1006, 20349, NULL, '2021-07-05 00:00:00.000', 'In Process', 'We received the following response from TCHP CA Contract Admin tchpnetworkmanagement@texaschildrens.org:  Sub: Enrollment & Location Status Query - NASA HealthClinic - TCHP  \"This is the contracting team, we are able to check the status of a Letter of interest or Provider information form. To check if you are in our network please reach out to either your PR or a  Provider assistance 832-828-1004 opt3. Thank you\"  Sent reply:   \"Hello,  Can you please inform us who our provider representative is so we can get in touch with them?  Thank you!\"', NULL, NULL, '2021-06-28 10:03:38', '2021-06-28 10:03:38'),
(14172, 11056, 20349, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Email received from : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment & Location Status Query - NASA HealthClinic - TCHP  Is your group in network? If so, what is your zip code?   Email replied to : tchpnetworkmanagement@texaschildrens.org  Hello,  Yes, the group should be in-network. The zip code for the main location is 77058.   Let me know if you have any other questions.  Thank you.', NULL, NULL, '2021-07-22 17:15:57', '2021-07-22 17:15:57'),
(14173, 11056, 20349, NULL, '2021-07-31 00:00:00.000', 'In Process', 'Email received from : providerrelations@texaschildrens.org  Sub : Enrollment & Location Status Query - NASA HealthClinic - TCHP  Good morning! Your PR rep is:  Johnna Blount 346-319-7740 Jlblount@texaschildrens.org  Have a great day!  Marty', NULL, NULL, '2021-07-23 14:39:38', '2021-07-23 14:39:38'),
(14174, 11056, 20349, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email received from : tchpnetworkmanagement@texaschildrens.org      &                                                  JLBlount@texaschildrens.org  Sub : Enrollment & Location Status Query - NASA HealthClinic - TCHP  PR,  Please assist with inquiring below. This group is in network group looking for their assigned PR.  Thank you', NULL, NULL, '2021-07-28 09:25:38', '2021-07-28 09:25:38'),
(14175, 11056, 20349, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email received from : providerrelations@texaschildrens.org  Sub : Re: Enrollment & Location Status Query - NASA HealthClinic - TCHP  Good morning! Your PR rep is:     Johnna Blount  346-319-7740  Jlblount@texaschildrens.org     Have a great day!  Marty', NULL, NULL, '2021-08-17 09:28:25', '2021-08-17 09:28:25'),
(14176, 11056, 20349, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to : providerrelations@texaschildrens.org  &  Jlblount@texaschildrens.org  Sub : Re: Enrollment & Location Status Query - NASA HealthClinic - TCHP Good Afternoon Johnna,   I hope you\'re doing well. I wanted to inquire about the enrollment status of the following group and provider with the given addresses. The information is as follows:  Practice: Practice Name: Nasa Health Clinic Practice  NPI# 1740661453 Practice TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider: Provider Name: Segun Adeoye Provider NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-26 16:23:07', '2021-08-26 16:23:07'),
(14177, 11056, 20349, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Email sent to : JLBlount@texaschildrens.org  Sub : Re: Enrollment & Location Status Query - NASA HealthClinic - TCHP  Good morning Johnna!  Hope you are doing well. Here is the filled form for adding the additional location you requested for in the last email. Please see the attachment.  Practice: Practice Name: Nasa Health Clinic Practice  NPI# 1740661453 Practice TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider: Provider Name: Segun Adeoye Provider NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-09-15 13:11:48', '2021-09-15 13:11:48'),
(14178, 11056, 20349, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email recived from : JLBlount@texaschildrens.org  Sub : Re: Enrollment & Location Status Query - NASA HealthClinic - TCHP  Hello,  I do not personally make the changes, and I am not notified when the changes are made, but give it a week and check back with me.  Thanks,  Johnna Blount Provider Relations Texas Children’s Health Plan Ph #  409-543-3667 Fax#  832-825-8825', NULL, NULL, '2021-09-28 15:56:09', '2021-09-28 15:56:09'),
(14179, 11056, 20349, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email sent to : JLBlount@texaschildrens.org  Sub : Re: Enrollment & Location Status Query - NASA HealthClinic - TCHP  Good afternoon Johnna!  Hope you are doing well. It has been a month but you haven\'t informed me about the listing of secondary location. Please inform me soon. Has the secondary location been listed yet or not?  Thank you! Have a great week ahead!', NULL, NULL, '2021-10-08 15:59:26', '2021-10-08 15:59:26'),
(14180, 11056, 20349, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email received from : JLBlount@texaschildrens.org  Sub : Re: Enrollment & Location Status Query - NASA HealthClinic - TCHP  Hi Ahmed,  As you can see in my email below, I do not get notified, so I asked you to email me back to inquire.    I have checked and the secondary address has been added.   Thanks, Johnna', NULL, NULL, '2021-10-18 15:44:45', '2021-10-18 15:44:45'),
(14181, 11056, 20349, NULL, '2021-11-01 00:00:00.000', 'In Process', 'Email sent to : JLBlount@texaschildrens.org  Sub : Re: Enrollment & Location Status Query - NASA HealthClinic - TCHP   Hey Johnna!  Hope this email finds you well. Please provide me with the Screenshot of the secondary location because I am unable to find it in the directory.  Thank you! Have a wonderful week ahead!', NULL, NULL, '2021-10-25 16:55:38', '2021-10-25 16:55:38'),
(14182, 11056, 20349, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email received from: JLBlount@texaschildrens.org  Sub : Re: Enrollment & Location Status Query - NASA HealthClinic - TCHP  Hello,  I am being told that if the provider’s NPI is not attested to the address through TMHP, we cannot add the second location.  I do not see where NASA Clinic or Dr. Adeoye is attested to this address.  We have added it in our system, but it cannot be added to the directory until it is attested.     Thanks,     Johnna Blount  Provider Relations Liaison  Texas Children’s Health Plan  Phone| 409-543-3667  Email|jlblount@texaschildrens.org', NULL, NULL, '2021-11-11 13:01:46', '2021-11-11 13:01:46'),
(14183, 11056, 20349, NULL, '2021-12-06 00:00:00.000', 'In Process', 'Email received from: JLBlount@texaschildrens.org  Sub : Re: Enrollment & Location Status Query - NASA HealthClinic - TCHP  Hello,  I am being told that if the provider’s NPI is not attested to the address through TMHP, we cannot add the second location.  I do not see where NASA Clinic or Dr. Adeoye is attested to this address.  We have added it to our system, but it cannot be added to the directory until it is attested.     Thanks,     Johnna Blount  Provider Relations Liaison  Texas Children’s Health Plan  Phone| 409-543-3667  Email|jlblount@texaschildrens.org   Waiting for the TMHP approval of the location.', NULL, NULL, '2021-11-29 13:24:01', '2021-11-29 13:24:01'),
(14184, 11056, 20349, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Waiting for the TMHP updation of the address.', NULL, NULL, '2021-12-03 18:03:17', '2021-12-03 18:03:17'),
(14185, 11056, 20349, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Waiting for the TMHP updation of the address.', NULL, NULL, '2021-12-20 10:29:03', '2021-12-20 10:29:03'),
(14186, 19067, 20349, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: JLBlount@texaschildrens.org  Subject: Enrollment Status || NASA HC || Segun Adeoye & Group || TCHP ||  Hello!  Hope you\'re doing really well.  I would like to know the enrollment status of the following Group & Provider with TCHP.  Group Name	NASA Health Clinic Tax ID	47-2682655 Group NPI	1740661453 Primary & Billing Location	985 NASA Parkway Houston, TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 15:19:21', '2021-12-29 15:19:21'),
(14187, 19067, 20349, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email received from: JLBlount@texaschildrens.org  Subject: Enrollment Status || NASA HC || Segun Adeoye & Group || TCHP ||    Hi  Ahmed,  The secondary location has been added in our system, but the address is not attested to Dr. Adeoye or the group in the Master Provider File.  If you look up the NPI with TMHP, you will see that he nor the group is attested to this address; therefore, TCHP will not list it in the directory, nor will we pay claims billed with that address.     You need to call TMHP and get that address added to your information.     Thanks,     Johnna Blount  Provider Relations Liaison  Texas Children’s Health Plan  Phone| 409-543-3667  Email|jlblount@texaschildrens.org', NULL, NULL, '2022-01-06 09:56:16', '2022-01-06 09:56:16'),
(14188, 3046, 20350, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 15:27:09', '2021-03-12 15:27:09'),
(14189, 1006, 20350, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent following enrollment query @ Yvonne Wyatt ywyatt@humana.com:  Sub: Enrollment & Location Status Query - NASA HealthClinic - Tricare  \"Hello Yvonne,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Tricare and if the mentioned addresses are also correctly listed under them: Group Name: Nasa Health ClinicNPI# 1740661453TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Provider Name: Segun AdeoyeNPI# 1629418025 Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 17:45:28', '2021-06-07 17:45:28'),
(14190, 1006, 20350, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Sent f/u email @ Yvonne Wyatt ywyatt@humana.com:  Sub: Enrollment & Location Status Query - NASA HealthClinic - Tricare  \"Hello Yvonne,  I wanted to get an update regarding the status of enrollment for the mentioned group. Please get back to me as soon as you\'re able to.   Thank you!\"', NULL, NULL, '2021-06-28 09:31:27', '2021-06-28 09:31:27'),
(14191, 11056, 20350, NULL, '2021-07-24 00:00:00.000', 'In Process', 'Email received from : ywyatt@humana.com  Sub : Enrollment & Location Status Query - NASA HealthClinic - Tricare  Good Afternoon Brad,  We show this group tax id as non-network and TRICARE certified who can see Tricare Beneficiaries with the following Tricare Plans.  Tricare Select Tricare for Life Tricare Reserve Select Tricare Retired Reserve Tricare Retired Reserved Tricare Young Adult  Thanks, Yvonne W. Wyatt, Humana Military TRICARE Community Liaison II Houston/Galveston', NULL, NULL, '2021-07-16 15:39:10', '2021-07-16 15:39:10'),
(14192, 11056, 20350, NULL, '2021-07-27 00:00:00.000', 'Not Eligible', 'Email received from : ywyatt@humana.com  Sub : Enrollment & Location Status Query - NASA HealthClinic - Tricare  Good Morning Ahmed,        Humana Military thanks you for your interest in joining the TRICARE East Region network to provide care for our beneficiaries.  At this time, we are not currently expanding our network based on your specialty and location within the East Region.  Please understand that every market is different based on the beneficiary population, and the types of services needed in a particular location.  We will continue to evaluate our network needs for your community, and will reach out to you should those needs change in the future. Thank you again for your inquiry     As a TRICARE certified non-network provider, you are authorized to provide care to TRICARE beneficiaries with the following TRICARE plans below:  The reimbursement should be 100% of CMAC https://www.health.mil/Military-Health-Topics/Business-Support/Rates-and-Reimbursement/TRICARE-Allowable-Charges. Providers must seek applicable copayments, cost-shares and deductibles from the beneficiary     •            Tricare Select   •            Tricare for Life  •            Tricare Reserve Select  •            Tricare Retired Reserve  •            Tricare Retired Reserved  •            Tricare Young Adult        Thanks,  Yvonne W. Wyatt,  Humana Military  TRICARE Community Liaison II  Houston/Galveston  502-318-5409 Telephone  502-322-8018 Fax  ywyatt@humana.com', NULL, NULL, '2021-07-20 13:45:03', '2021-07-20 13:45:03'),
(14193, 3046, 20351, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 15:27:57', '2021-03-12 15:27:57'),
(14194, 1006, 20351, NULL, '2021-06-14 00:00:00.000', 'On Hold', 'The request is in process in main UHC task, need to allow more time to process. ', NULL, NULL, '2021-06-07 17:51:17', '2021-06-07 17:51:17'),
(14195, 11056, 20351, NULL, '2021-07-01 00:00:00.000', 'Approved', 'Enrollment letter received. Please see the attachment.', NULL, NULL, '2021-06-24 13:42:00', '2021-06-24 13:42:00'),
(14196, 3046, 20352, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 15:29:34', '2021-03-12 15:29:34'),
(14197, 1006, 20352, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent following query @ NMRT networkhelp@uhc.com:  Sub: Enrollment & Location Status Query - NASA HealthClinic - UHC  \"Hello,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with UHC and if the mentioned addresses are also correctly listed under them: Group Name: Nasa Health ClinicNPI# 1740661453TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Provider Name: Segun AdeoyeNPI# 1629418025 Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 17:49:53', '2021-06-07 17:49:53'),
(14198, 1006, 20352, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Sent f/u email @ NMRT networkhelp@uhc.com:  Sub: Enrollment & Location Status Query - NASA HealthClinic - UHC  \"Hello,   We are still waiting for a response regarding the enrollment status for the mentioned group and provider, please get back to me as soon as possible.   Thank you!\"', NULL, NULL, '2021-06-28 09:49:36', '2021-06-28 09:49:36'),
(14199, 11056, 20352, NULL, '2021-07-27 00:00:00.000', 'Approved', 'Approval Email received from : networkhelp@uhc.com  Thank you for contacting the Network Management Resource Team. The provider has been linked to the TIN below. I’ve included the product roster showing the demographic information, lines of business, and effective dates.      Did you know that you can get a product listing at any time from our website? Please see the attached handout for more information. If you have further questions regarding this system, please feel free to contact the LINK help desk (866-842-3278, option 1).     Please let us know if we can assist further via email.  Greg Carte UnitedHealthcare Network Management Resource Team (NMRT)  Product roster has been attached. Please see the attachment for approval verification.', NULL, NULL, '2021-07-20 05:57:48', '2021-07-20 05:57:48'),
(14200, 11056, 20352, NULL, '2021-07-31 00:00:00.000', 'Approved', 'Email received from : networkhelp@uhc.com  Sub : Secure Message from kathleen_m_mcnulty@uhc.com  Thank you for contacting the Network Management Resource Team. We will be glad to assist regarding your inquiry. I have included the product roster showing the demographic information, lines of business, and effective dates for the group and provider requested.     Additionally, if you are wanting the specific lines of business that the providers are linked to this information is now in your LINK/My Practice Profile (https://www.uhcprovider.com/en/demographics-profiles-attestation/link-my-practice-profile.html). Please see the attached handout for more information.  If you have further questions regarding this system, please feel free to contact the LINK help desk (866-842-3278, option 1).  Please let us know if we can assist further.     If you have any questions or concerns about the content of this email, please do not reply to this email as they will be deleted, but rather email directly to: networkhelp@uhc.com  for further assistance; thank you.     For all Mental Health contracting issues, please contact Mental Health at 877-614-0484.   For all Chiropractic, Physical Therapy, Occupational Therapy, and Speech Therapy contracting issues, please contact Optum Physical Health at 800-873-4575.   Please Note:  Credentialing approval does not imply or guarantee participation with the health plans.  Approved and signed physician contracts are required for participation     Thank you,     Kathleen McNulty  Network Management Resource Team', NULL, NULL, '2021-07-23 16:57:50', '2021-07-23 16:57:50'),
(14201, 3046, 20353, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 15:30:03', '2021-03-12 15:30:03'),
(14202, 1006, 20353, NULL, '2021-06-15 00:00:00.000', 'Initiated', 'Enrollment request submitted via wellcare website, enrollment form is attached in main group task for reference.', NULL, NULL, '2021-06-08 11:31:12', '2021-06-08 11:31:12'),
(14203, 11056, 20353, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Update - NASA HEALTH CLINIC - WELLCARE  Hello,   I appreciate the update, I just wanted to verify if the secondary address is also listed for the group and provider?  Thank you!', NULL, NULL, '2021-06-25 10:36:57', '2021-06-25 10:36:57'),
(14204, 1006, 20353, NULL, '2021-07-22 00:00:00.000', 'In Process', 'We received the following update from .ProspectiveProviderTX ProspectiveProviderTX@wellcare.com:  Sub; RE: Become A Provider - Unsecured - General Practice - Texas  \"Hello,  This provider is already PAR with NASA HEALTH CLINIC effective 5/1/2021.\"  Sent query:  \"Hello,   I appreciate the update, I just wanted to verify if the secondary address is also listed for the group and provider?  Thank you!\"', NULL, NULL, '2021-07-15 16:10:11', '2021-07-15 16:10:11'),
(14205, 11056, 20353, NULL, '2021-08-07 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : RE: Become A Provider - Unsecured - General Practice - Texas  Hello,   I appreciate the update, I just wanted to verify if the secondary address is also listed for the group and provider?  Thank you', NULL, NULL, '2021-07-30 17:23:13', '2021-07-30 17:23:13'),
(14206, 11056, 20353, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : Re: Become A Provider - Unsecured - General Practice - Texas  Hello,  I appreciate the update, I just wanted to verify if the secondary address is also listed for the group and provider?  Practice: Practice Name : Nasa Health Clinic Practice NPI# : 1740661453 Practice TIN# : 47-2682655 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider: Provider Name: Segun Adeoye Provider NPI # : 1629418025  Thank you! Have a great day!', NULL, NULL, '2021-08-17 08:48:55', '2021-08-17 08:48:55'),
(14207, 11056, 20353, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : Re: Become A Provider - Unsecured - General Practice - Texas  Good morning!  Hope all is well. I appreciate the update. I just wanted to verify if the secondary address is also listed for the group and provider? Please inform me soon.  Practice Details: Practice Name : Nasa Health Clinic Practice NPI# : 1740661453 Practice TIN# : 47-2682655 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider Details: Provider Name: Segun Adeoye Provider NPI # : 1629418025  If you have any questions or queries let me know. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-26 16:11:39', '2021-08-26 16:11:39'),
(14208, 11056, 20353, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Your form was submitted successfully. Thank you for contacting us. A representative will be in contact to discuss your interest in becoming a participating Provider.   Online Application has been submitted.', NULL, NULL, '2021-09-15 09:35:29', '2021-09-15 09:35:29'),
(14209, 11056, 20353, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email received from : webuser@wellcare.com & ProspectiveProviderTX@wellcare.com  Sub : Re: Become A Provider - Unsecured - Internal Medicine - Texas  Provider First Name Segun  Provider Last Name Adeoye  Degree Type MD  Check to add provider to existing agreement: False  Check to join as a group: True  Check if you service more than one state: False  Group Name Nasa Health Clinic  Tax Identification Number 47-2682655  Specialty Internal Medicine  Line of Business All  Street Address 985 NASA Parkway  City Houston  State Texas  ZIP Code 77058  County Harris  Facility Walk in clinic  NPI 1629418025  CAQH Number 12779522  Medicare Number 746150  Medicaid Number 391190102  License Number R7637  Primary Contact Name Ahmed Talha  Email nasa@claimsmedinc.com  Phone Number (713) 893-6214  Please provide any additional information Secondary Location : 3623 S. Main St. Suite 109 Stafford , TX 77477-5406 Please list the secondary location too under same Tax I.D and NPI  Confirmation email of our application submission', NULL, NULL, '2021-09-28 15:31:26', '2021-09-28 15:31:26'),
(14210, 11056, 20353, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : Re: Become A Provider - Unsecured - Internal Medicine - Texas  Good afternoon!  Hope all is well with you. Please let us know who is our provider Relations representative and provide us with his contact no. and email address as soon as possible.  Thank you! Have a great day!', NULL, NULL, '2021-10-08 15:51:29', '2021-10-08 15:51:29'),
(14211, 11056, 20353, NULL, '2021-10-22 00:00:00.000', 'In Process', 'Email sent to : Macy.Mertens@wellcare.com  Sub : Re: Become A Provider - Unsecured - Internal Medicine - Texas  Good afternoon!  Hope all is well. Please provide the latest updates regarding the credentialing process of the practice and provider mentioned below as soon as possible.  Group Name	Nasa Health Clinic Tax ID	47-2682655 Group NPI	1740661453 Primary Location	985 NASA Parkway, Houston , TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025  If you have any questions or need any additional information please let me know. Eagerly waiting to hear from you.  Thank you! Have a great day!', NULL, NULL, '2021-10-15 16:48:21', '2021-10-15 16:48:21'),
(14212, 11056, 20353, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email received from: Macy.Mertens@wellcare.com  Sub : Re: Become A Provider - Unsecured - Internal Medicine - Texas  Hello-   I have responded before… Dr. Adeoye is loaded properly and so are both addresses.   You will be able to see that using our directory as well. His Provider ID is 2504675.    Kindest Regards, Macy Mertens, LL.M. Network Performance Advisor', NULL, NULL, '2021-10-22 15:48:19', '2021-10-22 15:48:19'),
(14213, 11056, 20353, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email sent to: Macy.Mertens@wellcare.com  Sub : Re: Become A Provider - Unsecured - Internal Medicine - Texas  Good afternoon!  Hope this email finds you well. My question is simply that the effective date mentioned in the agreement is for both locations and the provider or not? Kindly, also do assist me in finding the provider in the Wellcare provider directory.  Take Care of Yourself!  Thank you! Have a wonderful weekend!', NULL, NULL, '2021-11-11 12:30:12', '2021-11-11 12:30:12'),
(14214, 11056, 20353, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email sent to: Macy.Mertens@wellcare.com  Sub : Re: Become A Provider - Unsecured - Internal Medicine - Texas  Good afternoon!  Hope this email finds you well. My question is simply that the effective date mentioned in the agreement is for both locations and the provider or not? Kindly, also do assist me in finding the provider in the Wellcare provider directory.  Take Care of Yourself!  Thank you! Have a wonderful weekend!', NULL, NULL, '2021-11-11 12:34:57', '2021-11-11 12:34:57'),
(14215, 11056, 20353, NULL, '2021-11-22 00:00:00.000', 'Approved', 'Email received from: Macy.Mertens@wellcare.com  Sub:  Re: Become A Provider - Unsecured - Internal Medicine - Texas   Dr. Adeoye is effective 5/1/21 for UXR, which is the WellCare LOB.  I understand. NASA Health is loaded and so is the provider.  His Provider ID is 2504675.  Hi-     Locations are added. Update is completed.', NULL, NULL, '2021-11-15 16:35:10', '2021-11-15 16:35:10'),
(14216, 3046, 20354, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 15:33:09', '2021-03-12 15:33:09'),
(14217, 1006, 20354, NULL, '2021-06-15 00:00:00.000', 'Initiated', 'Group enrollment request submitted via wellcare website, attachment of form is attached in main group task for reference. ', NULL, NULL, '2021-06-08 11:27:09', '2021-06-08 11:27:09'),
(14218, 11056, 20354, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub :  Enrollment Request Status - NASA Urgent Care - Wellcare  Good Morning !  Hope you are doing well. I want to know the enrollment status of the provider and group mentioned below. We have already filled out the form starting this month. Waiting for your reply.  Practice: Practice name : Nasa Urgent Care Inc. Practice NPI :1821542432 Practice TIN : 81-3237149 Main Address : 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address : 3623 S. Main St. Suite 109,, Stafford , TX 77477-5406  Provider: Provider name : Adeoye, Segun P Provider NPI # : 1629418025  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-06-25 10:15:21', '2021-06-25 10:15:21'),
(14219, 1006, 20354, NULL, '2021-07-22 00:00:00.000', 'In Process', 'Sent f/u email @ \".ProspectiveProviderTX\" ProspectiveProviderTX@wellcare.com:  Sub: Enrollment Request Status - NASA Urgent Care - Wellcare  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status of our group and provider.  Please get back to me as soon as possible.  Thanks.\"', NULL, NULL, '2021-07-15 16:32:58', '2021-07-15 16:32:58'),
(14220, 11056, 20354, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Email received from : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Request Status - NASA Urgent Care - Wellcare  Good Morning,  We are looking into your request.  Thanks', NULL, NULL, '2021-07-22 17:26:22', '2021-07-22 17:26:22'),
(14221, 11056, 20354, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Request Status - NASA Urgent Care - Wellcare  Good Evening!  Hope you are doing well. I want to know the enrollment status of the provider and group mentioned below. We have already filled out the form starting this month. Waiting for your reply.  Practice: Practice name : Nasa Urgent Care Inc. Practice NPI :1821542432 Practice TIN : 81-3237149 Main Address : 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address : 3623 S. Main St. Suite 109,, Stafford , TX 77477-5406  Provider: Provider name : Adeoye, Segun P Provider NPI # : 1629418025  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-07-28 11:12:32', '2021-07-28 11:12:32'),
(14222, 11056, 20354, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email received from : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Request Status - NASA Urgent Care - Wellcare   Good morning,  I have reached out to the Contract Negotiators and they said the amendment to add WellCare to their existing Superior HealthPlan agreement will be sent through Adobe for electronic signature.   Have you signed and returned it to be processed?  Thanks Network Management – Texas | www.wellcare.com | www.superiorhealthplan.com', NULL, NULL, '2021-08-17 08:34:58', '2021-08-17 08:34:58'),
(14223, 11056, 20354, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Request Status - NASA Urgent Care - Wellcare  Good Evening!  Hope you are doing well. I want to know the enrollment status of the provider and group mentioned below. We have already signed and returned Superior HealthPlan agreement through Adobe .  Practice Details: Practice name : Nasa Urgent Care Inc. Practice NPI :1821542432 Practice TIN : 81-3237149 Main Address : 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address : 3623 S. Main St. Suite 109,, Stafford , TX 77477-5406  Provider Details: Provider name : Adeoye, Segun P Provider NPI # : 1629418025  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-26 16:07:23', '2021-08-26 16:07:23'),
(14224, 11056, 20354, NULL, '2021-09-22 00:00:00.000', 'In Process', '	 Your form was submitted successfully. Thank you for contacting us. A representative will be in contact to discuss your interest in becoming a participating Provider.   Online Application has been submitted.', NULL, NULL, '2021-09-15 09:41:44', '2021-09-15 09:41:44'),
(14225, 11056, 20354, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email received from : ProspectiveProviderTX@wellcare.com  Sub : Re: Become A Provider - Unsecured - Internal Medicine - Texas  Provider First Name Segun  Provider Last Name Adeoye  Degree Type MD  Check to add provider to existing agreement: False  Check to join as a group: True  Check if you service more than one state: False  Group Name Nasa Urgent Care Inc.  Tax Identification Number 81-3237149  Specialty Internal Medicine  Street Address 985 NASA Parkway  City Houston  State Texas  ZIP Code 77058  County Harris  Facility Urgent Care  NPI 1629418025  CAQH Number 12779522  Medicare Number 738034  Medicaid Number 391190101  License Number R7637  Primary Contact Name Ahmed Talha  Email nasa@claimsmedinc.com  Phone Number (713) 893-6214  Please provide any additional information Secondary Location : 3623 S. Main St. Suite 109 Stafford , TX 77477-5406 Please list the secondary location too under same Tax I.D and NPI.  Confirmation email of our application submission.', NULL, NULL, '2021-09-28 15:35:32', '2021-09-28 15:35:32'),
(14226, 11056, 20354, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email sent to : Macy.Mertens@wellcare.com  Sub : Re: Become A Provider - Unsecured - Internal Medicine - Texas  Good afternoon!  Hope all is well with you. Please provide the latest updates regarding the credentialing of the practice and provider mentioned below as soon as possible.  Group Name	Nasa Urgent Care Inc. Tax ID	81-3237149 Group NPI	1821542432 Primary Location	985 NASA Parkway, Houston , TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025  If you have any questions or need any additional information please let me know. Eagerly waiting to hear from you.  Thank you! Have a great day! ', NULL, NULL, '2021-10-08 15:44:44', '2021-10-08 15:44:44'),
(14227, 11056, 20354, NULL, '2021-10-22 00:00:00.000', 'In Process', 'Email received from : Macy.Mertens@wellcare.com  Sub  : Re: Become A Provider - Unsecured - Internal Medicine - Texas  Hello Macy,  The provider below would like to add an additional location for the provider below.    Talha,   The Prospective Provider box does not need to be included on further emails.  Thank you, Network Development', NULL, NULL, '2021-10-15 16:43:16', '2021-10-15 16:43:16'),
(14228, 11056, 20354, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email received from: Macy.Mertens@wellcare.com  Sub  : Re: Become A Provider - Unsecured - Internal Medicine - Texas  Hello-     Please see the email attached which I never got a response to…so I do apologize but I have not added the second location.     I will submit a request for the 2nd location and process it as STAT. I’m very sorry for the delay.', NULL, NULL, '2021-10-22 15:55:44', '2021-10-22 15:55:44'),
(14229, 11056, 20354, NULL, '2021-11-18 00:00:00.000', 'In Process', '	 Email sent to: Macy.Mertens@wellcare.com  Sub : Re: Become A Provider - Unsecured - Internal Medicine - Texas  Good evening Macy!  Hope this email finds you well.  No problem, thank you for the update. There is no need for any apology. Please do add the locations properly as  Practice Name: Primary/ billing Address : 985 NASA Parkway, Houston , TX 77058-3039    I thought so this one is missing.& it is the main location. Secondary Address : 3623 S. Main St. Suite 109, Stafford , TX 77477-5406 .  Please also confirm the effective dates.  Thank you! Have a wonderful weekend!', NULL, NULL, '2021-11-11 12:13:01', '2021-11-11 12:13:01'),
(14230, 11056, 20354, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email received from: Macy.Mertens@wellcare.com  Sub: Re: Become A Provider - Unsecured - Internal Medicine - Texas   Hi-   Location is added. The update is completed.    Kindest Regards,  Macy Mertens, LL.M. Network Performance Advisor cid:image002.png@01D79E5C.9D608FD0  4888 Loop Central Drive, Suite 300 Houston, Texas 77081 Direct Mobile 281-217-0142', NULL, NULL, '2021-11-19 11:16:26', '2021-11-19 11:16:26'),
(14231, 11056, 20354, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email sent to:  Macy.Mertens@wellcare.com  Sub:  Re: Become A Provider - Unsecured - Internal Medicine - Texas   Good afternoon Macy!  I am very grateful to you. Great, thank you so much!  Please provide me with a welcome letter. Can we send claims on that address?  Take Care!  Have a wonderful day!', NULL, NULL, '2021-12-03 16:55:47', '2021-12-03 16:55:47'),
(14232, 11056, 20354, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email received from: Sara.Sanchez@wellcare.com  Sub: Re: Become A Provider - Unsecured - Internal Medicine - Texas   Good morning,     Macy is out of the office but I have pulled a copy of our provider report.  You can see Dr. Adeoye’s effective date, along with other information.  If you scroll right you can see the addresses that are affiliated with the practice.   Please let me know if I can assist with anything else.     Hope this helps!  Have a great day,        Sara Sanchez  Provider Account Manager  1700 N. Zaragoza Ste 140     El Paso, TX 79936  Direct Line: 1.915.856.2502   Mobile: 1.915.801.5226    Fax: 1.915.856.2513  sara.sanchez@wellcare.com   |   https://www.wellcare.com', NULL, NULL, '2021-12-14 18:12:53', '2021-12-14 18:12:53'),
(14233, 11056, 20354, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: Macy.N.Roberts@wellcare.com  Sub: Re: Become A Provider - Unsecured - Internal Medicine - Texas   Good afternoon!  Hope you are staying healthy. I have already submitted the Online application for it in the past. And again on 15, September 2021. Kindly let me know what to do now, and how many times I have to submit an application for credentialing and enrolling.  Kindly, do us a favor, please figure this out soon. Let this be resolved permanently and properly.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-22 17:31:38', '2021-12-22 17:31:38'),
(14234, 19067, 20354, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email sent to: Macy.N.Roberts@wellcare.com  Subject: Enrollment Query || Nasa Urgent Care || Segun Adeoye & Groups || Wellcare ||    Hello!  Hope you are doing well.  I would like to know the enrollment status of the following Provider and Groups with Wellcare.  Group Name	Nasa Urgent Care Inc. Tax ID	81-3237149 Group NPI	1821542432 Provider Name	NPI	Location Segun Adeoye	1629418025	985 NASA Parkway, Houston, TX 77058-3039 Segun Adeoye	1629418025	3623 S. Main St. Suite 109, Stafford, TX 77477-5406   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-30 14:39:22', '2021-12-30 14:39:22'),
(14235, 19067, 20354, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: Macy.N.Roberts@wellcare.com  Subject: Enrollment Query || Nasa Urgent Care || Segun Adeoye & Groups || Wellcare ||    Hello!  Hope you are doing well.  This is my Second reminder on the previous mentioned request.  Kindly get in touch as soon as you have time.   Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-09 19:09:38', '2022-01-09 19:09:38'),
(14236, 3046, 20355, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 15:33:42', '2021-03-12 15:33:42'),
(14237, 1006, 20355, NULL, '2021-06-14 00:00:00.000', 'Approved', 'We have an urgentcare contract with Aetna for NASA UC, approval confirmation is attached for reference. ', NULL, NULL, '2021-06-07 16:29:54', '2021-06-07 16:29:54'),
(14238, 3046, 20356, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 15:41:12', '2021-03-12 15:41:12'),
(14239, 1006, 20356, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Enrollment query sent @ TX Credentialing txcredentialing@amerigroup.com:  Sub: Enrollment & Location Status Query - NASA UrgentCare - Amerigroup  \"Hello,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Amerigroup and if the mentioned addresses were also correctly listed under them:  Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 17:21:36', '2021-06-07 17:21:36'),
(14240, 1006, 20356, NULL, '2021-07-05 00:00:00.000', 'In Process', 'We received the following reply from TX Credentialing txcredentialing@amerigroup.com:  Sub: RE: {EXTERNAL} Enrollment & Location Status Query - NASA UrgentCare - Amerigroup  \"NASA Urgent Care is contracted as an Urgent Care, not a PCP clinic.  That means the facility bills globally (Rendering and Billing NPI are that of the clinic)  We do not have the 2nd location loaded.  Please include the phone, fax, office hours and age limits.  G#09758933\"  Sent following reply:   \"Hello,  I appreciate the reply, the requested information is as follows: Phone# 281-821-8200Fax# 718-640-2713 Office Hours: Mon-Fri: 9AM to 6PM & Sat: 9AM to 3PMAge Limits: None Please let me know if you have any other questions. Thank you!\"', NULL, NULL, '2021-06-28 10:58:09', '2021-06-28 10:58:09'),
(14241, 11056, 20356, NULL, '2021-07-24 00:00:00.000', 'In Process', 'Email received from : txcredentialing@amerigroup.com  Sub : Enrollment & Location Status Query - NASA UrgentCare - Amerigroup  The secondary location is still pending, no other information is needed.', NULL, NULL, '2021-07-16 14:14:56', '2021-07-16 14:14:56'),
(14242, 11056, 20356, NULL, '2021-08-10 00:00:00.000', 'In Process', 'Email sent to : txcredentialing@amerigroup.com  Sub : Fwd: {EXTERNAL} Enrollment & Location Status Query - NASA UrgentCare - Amerigroup  Good morning!  Hope all is well. This is just a follow-up email regarding the secondary location. Has the secondary location been added to the Group or not yet?  Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406   Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.   Thank you! Have a great week ahead! ', NULL, NULL, '2021-08-03 08:53:30', '2021-08-03 08:53:30'),
(14243, 11056, 20356, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to : txcredentialing@amerigroup.com  Sub : Fwd: {EXTERNAL} Enrollment & Location Status Query - NASA UrgentCare - Amerigroup  Good morning!  Hope all is well. This is just a follow-up email regarding the secondary location. Has the secondary location been added to the Group or not yet?  Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406   Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.   Thank you! Have a great week ahead!', NULL, NULL, '2021-08-18 09:39:59', '2021-08-18 09:39:59'),
(14244, 11056, 20356, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to : txcredentialing@amerigroup.com &  keth.jackson@amerigroup.com  Sub : Enrollment & Location Status Query - NASA UrgentCare - Amerigroup  Greetings,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Amerigroup and if the mentioned addresses were also correctly listed under them:  Group Name: Nasa Health Clinic NPI# 1740661453 TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon. Thank you!   Contacted thrice on different phone numbers but no one received . Voice mails have been left out for the updates', NULL, NULL, '2021-08-27 09:37:09', '2021-08-27 09:37:09'),
(14245, 11056, 20356, NULL, '2021-09-30 00:00:00.000', 'In Process', 'Email sent to : txcredentialing@amerigroup.com  Sub : Fwd: {EXTERNAL} Enrollment & Location Status Query - NASA UrgentCare - Amerigroup  Good evening!  Hope all is well. We are still waiting to get an update regarding the secondary location. Has the secondary location been added to the Group or not yet? It has been a long time since our emails were being ignored.  Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.  Thank you! Have a great week ahead!   Try to contact through call no one had received. Voice mail has been left out  for the updates.', NULL, NULL, '2021-09-23 17:08:14', '2021-09-23 17:08:14'),
(14246, 11056, 20356, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email received from : txcredentialing@amerigroup.com  Sub : Fwd: {EXTERNAL} Enrollment & Location Status Query - NASA UrgentCare - Amerigroup  Still pending, I know this is taking a while, there is currently high volume.  I will see if I can get this moved along', NULL, NULL, '2021-10-08 09:59:15', '2021-10-08 09:59:15'),
(14247, 11056, 20356, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Rep : May D & Maya & Cristel M  Status :  Try to contact 3 or 4 contact no.s to get updates but every one transferred my call to the provider relations depart but haven\'t get a response.  The voice mail has been left out on every contact no.s  Contacted no.s :  9405312496 8004543730 (800) 454-3730  Also sent an email too.', NULL, NULL, '2021-10-18 15:36:04', '2021-10-18 15:36:04'),
(14248, 11056, 20356, NULL, '2021-11-01 00:00:00.000', 'In Process', 'Email sent to : txcredentialing@amerigroup.com  Sub : Fwd: {EXTERNAL} Enrollment & Location Status Query - NASA UrgentCare - Amerigroup   Good morning!  Hope all is well with you. Could you let me know the exact time period for the credentialing process?  Because we have been waiting for this since May and we are losing our patience.  Group Name	Nasa Urgent Care Inc. Tax ID	81-3237149 Group NPI	1821542432 Primary Location	985 NASA Parkway, Houston , TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025  If you have any questions or require information please let me know.  Thank you! Have a great day!   Also left out voice mails. Contacting no.s are on recording process', NULL, NULL, '2021-10-25 16:51:54', '2021-10-25 16:51:54'),
(14249, 11056, 20356, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email sent to : txcredentialing@amerigroup.com  Sub : Fwd: {EXTERNAL} Enrollment & Location Status Query - NASA UrgentCare - Amerigroup   Good morning!  Hope all is well with you. Could you let me know the exact time period for the credentialing process?  Because we have been waiting for this since May and we are losing our patience.  Group Name	Nasa Urgent Care Inc. Tax ID	81-3237149 Group NPI	1821542432 Primary Location	985 NASA Parkway, Houston , TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025  If you have any questions or require information please let me know.  Thank you! Have a great day!', NULL, NULL, '2021-11-11 13:14:11', '2021-11-11 13:14:11');
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
(14250, 11056, 20356, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email sent to: txcredentialing@amerigroup.com  Sub : RE: {EXTERNAL} Re: Delivery Status Notification (Failure) I-Q3-818  Greetings,     Amerigroup has received your request to contract directly with our Healthplan.     We will be glad to assist.     To ensure that we have your credentialing updated, please complete the attached Letter of Intent to begin that process.        When finished completing the LOI, please email it back to me along with a copy of your W9 and group application release form.     We ask that the Letter of Interest be completed in its entirety.     **For Nurse Practitioners completing the Letter of Interest:    Your Specialty type would be considered “Family Nurse Practitioner, Geriatric Nurse Practitioner, Psychiatric Nurse Practitioner” or whichever applies to your training.     Thank you', NULL, NULL, '2021-11-19 10:22:44', '2021-11-19 10:22:44'),
(14251, 11056, 20356, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email sent to:  TXCredentialing@amerigroup.com  Sub:  RE: {EXTERNAL} Re: Delivery Status Notification (Failure) I-Q3-818   Good afternoon!  Hope this email finds you well. Please provide me with the latest updates on the credentialing process of the provider, Segun Adeoye under the facility, Nasa Health Clinic.  Eagerly, waiting for your reply.  Thank you!', NULL, NULL, '2021-12-03 18:00:52', '2021-12-03 18:00:52'),
(14252, 11056, 20356, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Sub: RE: {EXTERNAL} Re: Delivery Status Notification (Failure) I-Q3-818   Good afternoon!  Hope you are doing great. Please provide me with the welcome letter & effective dates for the provider & practice. Please expedite my request for processing.  Group Name	Nasa Health Clinic Tax ID	47-2682655 Group NPI	1740661453 Primary Location	985 NASA Parkway, Houston, TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025  In the meantime, please do not hesitate to reach out if you have any questions or concerns.  Thank you! Have a wonderful weekend!  Voice msgs have been left out.', NULL, NULL, '2021-12-14 17:46:56', '2021-12-14 17:46:56'),
(14253, 11056, 20356, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Rep: Madonna h & Jennifer P  Status:  1st one rep didn\'t find the provider in her system. Second one found the provider with only the secondary location and with only Nasa Health Clinic Tax ID. File is in the credentaling.  Ref code: 12202021', NULL, NULL, '2021-12-20 10:25:26', '2021-12-20 10:25:26'),
(14254, 11056, 20356, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Sub: RE: {EXTERNAL} Re: Delivery Status Notification (Failure) I-Q3-818   Good afternoon!  Hope all is well with you. I am still waiting to get the latest updates on the applications as well as on the facilities Nasa Health Clinic and Nasa Urgent care Inc.s\' Credentialing accomplishments yet. Please try to cope up with us through emails as your contact no.s aren\'t responded to us by anyone except the voice recorders. And we have left out so many Voice mails for the updates of the enrollment process, But haven\'t got the response yet.  Kindly respond to us as soon as possible. Please don\'t test our patience.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-23 09:38:56', '2021-12-23 09:38:56'),
(14255, 19067, 20356, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Subject: Enrollment Query || NASA Urgent Care || Segun Adeoye & Groups || Ameri Group ||   Hello!  Hope you are doing well.  I would like to know the enrollment status of the following Provider and Group as well with Ameri Group.  Group Name	Nasa Urgent Care Inc. Tax ID	81-3237149 Group NPI	1821542432 Provider Name	NPI	Location Segun Adeoye	1629418025	985 NASA Parkway Houston, TX 77058-3039 Segun Adeoye	1629418025	3623 S. Main St. Suite 109, Stafford, TX 77477-5406   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-30 14:05:42', '2021-12-30 14:05:42'),
(14256, 19067, 20356, NULL, '2022-01-15 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Subject: Re: Enrollment Query || NASA Urgent Care || Segun Adeoye & Groups || Ameri Group ||   Hello!  This is my second reminder on the previously mentioned request.  Kindly respond promptly.  Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-07 23:41:42', '2022-01-07 23:41:42'),
(14257, 3046, 20357, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 15:42:10', '2021-03-12 15:42:10'),
(14258, 1006, 20357, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent query @ ProfessionalProviderNetworkDept@bcbstx.com:  Sub: Enrollment & Location Status Query - NASA UrgentCare - BCBSTX  \"Hello,  I hope you\'re doing well, we wanted to verify if the following groups and provider were enrolled with BCBSTX and if the mentioned addresses were also correctly listed under them:  Group Name: Nasa Urgent Care Inc. NPI# 1821542432  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 16:51:21', '2021-06-07 16:51:21'),
(14259, 1006, 20357, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Sent f/u email @ ProfessionalProviderNetworkDept@bcbstx.com:  Sub: Enrollment & Location Status Query - NASA UrgentCare - BCBSTX  \"Hello,   I wanted to get an update regarding the enrollment status for our group and provider, please get back to me as soon as possible.  Thank you!\"  ', NULL, NULL, '2021-06-28 10:23:33', '2021-06-28 10:23:33'),
(14260, 11056, 20357, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Email sent to : ProfessionalProviderNetworkDept@bcbstx.com  Sub : Enrollment & Location Status Query - NASA UrgentCare - BCBSTX  Good Afternoon!  I hope you\'re doing well. Kindly respond to us soon .We wanted to verify if the following groups and provider were enrolled with BCBSTX and if the mentioned addresses were also correctly listed under them:  Group Name: Nasa Health Clinic NPI# 1740661453 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as possible. Eagerly waiting to hear back from you.  Thank you! Have a great day!', NULL, NULL, '2021-07-22 16:39:56', '2021-07-22 16:39:56'),
(14261, 11056, 20357, NULL, '2021-08-05 00:00:00.000', 'Approved', 'Email received from : provider_relations_houston@bcbstx.com  Sub :   Enrollment & Location Status Query - NASA UrgentCare - BCBSTX : Case Number - 02586903  Hi Brad,  I am attaching a group roster for you with all the information you are requesting on it.  Thank you.', NULL, NULL, '2021-07-29 09:15:56', '2021-07-29 09:15:56'),
(14262, 3046, 20358, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 15:42:53', '2021-03-12 15:42:53'),
(14263, 1006, 20358, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent following query @ PDM COGZ PDMCOGZ@cigna.com:  Sub: Enrollment & Location Status Query - NASA UrgentCare - Cigna  \"Hello,  I hope you\'re doing well, we wanted to verify if the following groups and provider were enrolled with Cigna and if the mentioned addresses were also correctly listed under them:  Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 17:06:36', '2021-06-07 17:06:36'),
(14264, 1006, 20358, NULL, '2021-07-05 00:00:00.000', 'In Process', 'We received the following reply from :  Sub: Status Check W202106091738211  \"Dear Healthcare Professional,  As per the below request, We have mentioned the status for your reference.  PRACTICE NAME   CPF PROVIDER PID    TAX-ID         STATUS  Segun Adeoye                5883559       81-3237149  Participating  Note: Given Provider locations are already added.  Regards, PDM\"  Sent following reply:  \"Hello,   The locations aren\'t showing up on the Cigna provider directory for the group and provider, please let me know what is required to get that updated?  Thank you!\" ', NULL, NULL, '2021-06-28 13:01:25', '2021-06-28 13:01:25'),
(14265, 11056, 20358, NULL, '2021-08-10 00:00:00.000', 'In Process', 'Email sent to : 	PDMCOGZ@cigna.com  Sub : Enrollment & Location Status Query - NASA UrgentCare - Cigna  Good morning!  Hope all is well.The locations aren\'t showing up on the Cigna provider directory for the group and provider, please let me know what is required to get that updated?  Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Eagerly waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-08-03 09:28:12', '2021-08-03 09:28:12'),
(14266, 11056, 20358, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email received from : 	PDM COGZ  Sub :   Status Check- W202108041831586  Dear Healthcare Professional,     As per the below request, We have mentioned the status for your reference.     PRACTICE NAME/PROVIDER NAME  CPF PROVIDER PID  TAX-ID  STATUS  Nasa Urgent Care Inc  6647163  813237149  Active  Adeoye Segun  5883559  813237149  Active  Belakera Ramegowda  8912478  813237149  Term  Mathai Priya  1862263  813237149  Term ', NULL, NULL, '2021-08-18 11:32:05', '2021-08-18 11:32:05'),
(14267, 11056, 20358, NULL, '2021-09-04 00:00:00.000', 'In Process', 'Email sent to : 	PDMCOGZ@cigna.com  &  PSSCentral@cigna.com  Sub : Enrollment & Location Status Query - NASA UrgentCare - Cigna  Good morning!  Hope all is well.The locations aren\'t showing up on the Cigna provider directory for the group and provider, please let me know what is required to get that updated?  Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Eagerly waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-08-27 17:19:20', '2021-08-27 17:19:20'),
(14268, 11056, 20358, NULL, '2021-09-23 00:00:00.000', 'In Process', 'Email received from : 	PDMCOGZ@cigna.com  Sub : Completion Notification - W202109091890831  Dear Healthcare Professional,  We received your recent request., We have mentioned the status for your reference.  GROUP NAME : Nasa Urgent Care Inc  CPF PROVIDER PID : 6647163  TAX-ID : 81-3237149    Addresses are active under the above mentioned TIN.  Regards, PDM', NULL, NULL, '2021-09-16 14:02:37', '2021-09-16 14:02:37'),
(14269, 11056, 20358, NULL, '2021-09-23 00:00:00.000', 'Not Eligible', 'Cigna don\'t approves the group which have only one provider as their policy. I had words with Dani & Racheal at 860-226-1848. Both has verified this policy  Ref code : 09162021', NULL, NULL, '2021-09-16 14:42:41', '2021-09-16 14:42:41'),
(14270, 3046, 20359, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 15:43:31', '2021-03-12 15:43:31'),
(14271, 1006, 20359, NULL, '2021-06-15 00:00:00.000', 'Initiated', 'Submitted enrollment request @ TXMAContracting@cigna.com:  Sub: Enrollment Request - NASA UrgentCare - Cigna Healthspring  \"Hello,   Please find the attached enrollment application for our ancillary group, please let me know if anything else is needed to proceed with this request.  Thank you. \"', NULL, NULL, '2021-06-08 13:53:49', '2021-06-08 13:53:49'),
(14272, 11056, 20359, NULL, '2021-07-03 00:00:00.000', 'Initiated', 'Email sent to : TXMAContracting@cigna.com  Sub : Enrollment Request - NASA Urgent Care - Cigna Health spring  Good Evening,  Please find the attached enrollment application for our ancillary group, please let me know if anything else is needed to proceed with this request.  Thank you! Have a great day!', NULL, NULL, '2021-06-25 16:23:51', '2021-06-25 16:23:51'),
(14273, 1006, 20359, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Sent f/u email to same email:  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the above-mentioned facility.   Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-14 17:31:37', '2021-07-14 17:31:37'),
(14274, 11056, 20359, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Email sent to : TXMAContracting@cigna.com  Sub  : Enrollment & Location Status Query - NASA Urgent Care - Cigna Healthspring  Good Afternoon!  I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the below-mentioned facility  Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-07-22 16:57:26', '2021-07-22 16:57:26'),
(14275, 11056, 20359, NULL, '2021-08-10 00:00:00.000', 'In Process', 'Email sent to : 	txgqproviderrelations@healthspring.com  Sub : Enrollment & Location Status Query - NASA Urgent Care - Cigna Healthspring  Good Afternoon!  I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the below-mentioned facility  Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-03 09:31:52', '2021-08-03 09:31:52'),
(14276, 11056, 20359, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email received from : 	txgqproviderrelations@healthspring.com  Sub : Enrollment & Location Status Query - NASA Urgent Care - Cigna Healthspring  May you send me the LOI for Nasa Health Clinic, Nasa Urgent Clinic and BHUCC by today so I may forward them to our committee for our next meeting.   Thank you,   Jennifer Perez  Network Operations Senior Analyst | Cigna-Medicare  2800 North Loop West, Suite 400 | Houston, Texas 77092', NULL, NULL, '2021-08-17 09:36:24', '2021-08-17 09:36:24'),
(14277, 11056, 20359, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to : JENNIFER.PEREZ@cigna.com  Sub  : Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring  Hey Jennifer!  For sure. Here is the LOI of the facility. Please see the attachment.  If you need any information or documents further, feel free to reach out to me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-26 16:00:08', '2021-08-26 16:00:08'),
(14278, 11056, 20359, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Email received from : JENNIFER.PEREZ@cigna.com  Sub : Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring  Hi Ahmad,   Thank you for sending this over. In order to be credentialed we will need our letter of interest to be filled out. Once completed for all 3 facilities, may you send them back to me.   Jennifer Perez  Filled and submitted.', NULL, NULL, '2021-09-15 10:37:53', '2021-09-15 10:37:53'),
(14279, 11056, 20359, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email received from : JENNIFER.PEREZ@cigna.com  Sub : Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring  Hi Ahmed,  I saw you replied to another email I sent, may you fill out the letter of interest using the following form and send back to me at your earliest convenience.   Thank you   Jennifer Perez Network Operations Senior Analyst | Cigna-Medicare 2800 North Loop West, Suite 400 | Houston, Texas 77092  New LOI has been filled and submitted.', NULL, NULL, '2021-09-28 16:05:43', '2021-09-28 16:05:43'),
(14280, 11056, 20359, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email sent to : TXMAContracting@cigna.com  Sub : Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring   Good morning!  Hope all is well. Here is the letter of interest for the below mentioned practice and provider. Please see the attachment.  Practice Details: Practice Name: Nasa Health Clinic Practice  NPI# 1740661453 Practice TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Details: Provider Name: Segun Adeoye Provider NPI# 1629418025  If further documents or information is needed please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-10-08 13:38:45', '2021-10-08 13:38:45'),
(14281, 11056, 20359, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Rep : Rica C  Status: Segun Adeoye is in network Cigna-healthspring and credentialed But the Tax ID and Facility name is not appearing on the screen.  Ref code : 767288758', NULL, NULL, '2021-10-18 14:30:38', '2021-10-18 14:30:38'),
(14282, 11056, 20359, NULL, '2021-11-01 00:00:00.000', 'In Process', 'Rep : Len J  Status:  The provider is still out of network. Linked to the Tax ID of Nasa Health Clinic but the Nasa Urgent Care is not showing up on their system.  Emailed at: txmacontracting@cigna.com as she guided for the follow-up & query.  Ref code: 768092704', NULL, NULL, '2021-10-25 16:44:42', '2021-10-25 16:44:42'),
(14283, 11056, 20359, NULL, '2021-11-18 00:00:00.000', 'In Process', '	 Email sent to: pdm@healthspring.com  Sub: Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring   Good afternoon!  Hope all is well with you. Please let us know the latest updates on our applications for both practices, NASA health Clinic & NASA Urgent Care Inc.  Kindly assist us soon regarding our query.  Eagerly, waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-11 12:53:37', '2021-11-11 12:53:37'),
(14284, 11056, 20359, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email sent to: pdm@healthspring.com & txmacontracting@cigna.com & JENNIFER.PEREZ@cigna.com  Sub: Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring  Good afternoon!   Hope this email finds you well. It has been along that our emails haven\'t been responded to and ignored by your side. Please don\'t let us get disheartened and lose our patience. Kindly, respond to our query regarding the enrollment of the provider, Segun Adeoye with the practices, NASA health Clinic & NASA Urgent Care Inc. as soon as possible.  We also have called Cigna Health spring for the follow-up and the ref code is:  768092704   Eagerly, waiting to get back from you soon.  Thank you!', NULL, NULL, '2021-11-19 11:29:48', '2021-11-19 11:29:48'),
(14285, 11056, 20359, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email sent to: pdm@healthspring.com & txmacontracting@cigna.com & JENNIFER.PEREZ@cigna.com  Sub: Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring  Good afternoon!   Hope this email finds you well. It has been along that our emails haven\'t been responded to and ignored by your side. Please don\'t let us get disheartened and lose our patience. Kindly, respond to our query regarding the enrollment of the provider, Segun Adeoye with the practices, NASA health Clinic & NASA Urgent Care Inc. as soon as possible.  We also have called Cigna Health spring for the follow-up and the ref code is:  768092704   Eagerly, waiting to get back from you soon.  Thank you!', NULL, NULL, '2021-11-19 11:29:48', '2021-11-19 11:29:48'),
(14286, 11056, 20359, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email received from:  cresta.smith@careallies.com  Sub:  Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring  Are these for Renaissance or Cigna Medicare direct?     Thanks,  Cresta  Replied:  Good afternoon!  Hope all is well with you. This is for Cigna Healthspring.  Please get back to me soon.  Thank you! Have a great day!', NULL, NULL, '2021-12-03 16:43:00', '2021-12-03 16:43:00'),
(14287, 11056, 20359, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email sent to:  cresta.smith@careallies.com  Sub: Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring   Good afternoon!   Hope this email finds you well. It has been along that our emails haven\'t been responded to and ignored by your side. Please don\'t let us get disheartened and lose our patience. Kindly, respond to our query regarding the enrollment of the provider, Segun Adeoye with the practices, NASA health Clinic & NASA Urgent Care Inc. as soon as possible.  We also have called Cigna Health spring for the follow-up and the ref code is:  768092704  Eagerly, waiting to get back from you soon. If you guys are not interested in responding back to us or do not want to credential our provider, Please let me know.  Thank you! Have a great day!', NULL, NULL, '2021-12-14 17:59:47', '2021-12-14 17:59:47'),
(14288, 11056, 20359, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: cresta.smith@careallies.com  Sub: Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring   Good afternoon!  Hope all is well with you. Please let us know the latest updates on our applications for both practices, NASA health Clinic & NASA Urgent Care Inc. Kindly assist us soon regarding our query.  Eagerly, waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-12-22 17:22:34', '2021-12-22 17:22:34'),
(14289, 19067, 20359, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email sent to: TXMAContracting@cigna.com, txgqproviderrelations@healthspring.com, JENNIFER.PEREZ@cigna.com, pdm@healthspring.com, cresta.smith@careallies.com  Subject: Enrollment Query || NASA Urgent Care || Segun Adeoye & Groups || Cigna Healthspring ||   Good Morning!   Hope you\'re doing well.  I would like to know the enrollment status of the following Provider & Group.  Group Name	Nasa Urgent Care Inc. Tax ID	81-3237149 Group NPI	1821542432 Provider Name	NPI	Location Segun Adeoye	1629418025	985 NASA Parkway Houston, TX 77058-3039 Segun Adeoye	1629418025	3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Kindly respond in a timely manner!  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-30 10:56:40', '2021-12-30 10:56:40'),
(14290, 19067, 20359, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: TXMAContracting@cigna.com, txgqproviderrelations@healthspring.com, JENNIFER.PEREZ@cigna.com, pdm@healthspring.com, cresta.smith@careallies.com  Subject: Enrollment Query || NASA Urgent Care || Segun Adeoye & Groups || Cigna Healthspring ||   Hello!  Hope this email finds you well.  This is my Second reminder on the previous request.  Kindly get in touch as soon as you have time.  Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-09 19:04:26', '2022-01-09 19:04:26'),
(14291, 3046, 20360, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 15:44:01', '2021-03-12 15:44:01'),
(14292, 1006, 20360, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent following enrollment query @ CHC Contracting CHC.Contracting@CommunityHealthChoice.org:  Sub: Enrollment & Location Status Query - NASA UrgentCare - Community Health Choice  \"Hello,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Community Health Choice and if the mentioned addresses are also correctly listed under them: Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Provider Name: Segun AdeoyeNPI# 1629418025 Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 18:09:30', '2021-06-07 18:09:30'),
(14293, 1006, 20360, NULL, '2021-07-05 00:00:00.000', 'In Process', 'We received the following update from CHC Contracting CHC.Contracting@communityhealthchoice.org:  Sub: Enrollment & Location Status Query - NASA UrgentCare - Community Health Choice  \"Good Morning Brad,  Upon review, we have determined Segun Adeoye and the group are participating providers under Tax id, 81-3237149. The effective date varies by line of business, which can be found highlighted on the attached Provider Profiles. Please see attached profiles for your records.  If further questions or concerns, feel free to advise.  Best Regards, Contracting Dept.\"  Sent reply:  \"Hello,   I appreciate the update, can you please let me know what is required to add the secondary addresses as well?   Thank you. \"', NULL, NULL, '2021-06-28 13:55:21', '2021-06-28 13:55:21'),
(14294, 11056, 20360, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email received from : CHC.Contracting@communityhealthchoice.org  Sub : Enrollment & Location Status Query - NASA UrgentCare - Community Health Choice  Good Afternoon Brad,  In order to assist with the demographic update, we ask that you submit a formal written request on letterhead. Make sure to provide the office/fax number for the additional service location. If there is a change in the billing address, we will need a W-9 dated in 2021.  Should you have questions or need further assistance, feel free to advise.  Best Regards, Contracting Dept.', NULL, NULL, '2021-07-20 06:09:19', '2021-07-20 06:09:19'),
(14295, 11056, 20360, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email sent to : CHC.Contracting@communityhealthchoice.org  Sub : Enrollment & Location Status Query - NASA UrgentCare - Community Health Choice  Good morning!  Hope you are doing well. Here is the letterhead with W9 which you have requested for the below mentioned group. Please see the attachments.    Practice: Practice  Name: Nasa Urgent Care Inc. Practice NPI# : 1821542432 Practice TIN# : 81-3237149 Practice  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Practice  Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Practice Phone # : 2812186777 Practice Fax # : 8666656208  Provider:  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to. Eagerly, waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-07-28 08:54:02', '2021-07-28 08:54:02'),
(14296, 11056, 20360, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email received from :  CHC.Contracting@communityhealthchoice.org  Sub : Fwd: Enrollment & Location Status Query - NASA UrgentCare - Community Health Choice  Good Afternoon,     The Contracting Dept. is in receipt of the demographic request. Please allow up to fifteen business days to update the provider’s record.  Should you need further assistance, feel free to contact us.  Best Regards,  Contracting Team', NULL, NULL, '2021-08-17 08:25:23', '2021-08-17 08:25:23'),
(14297, 11056, 20360, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to  :  CHC.Contracting@communityhealthchoice.org  Sub : Fwd: Enrollment & Location Status Query - NASA UrgentCare - Community Health Choice  Good morning!  Hope all is well. I want to inquire about the enrollment status of the practice and providers mentioned below. Please provide me with the latest updates soon.  Practice Details: Practice  Name: Nasa Urgent Care Inc. Practice NPI# : 1821542432 Practice TIN# : 81-3237149 Practice  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Practice  Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Practice Phone # : 2812186777 Practice Fax # : 8666656208  Provider  Details: Provider Name: Segun Adeoye NPI# 1629418025  If you need any documents or information please let me know. Eagerly, waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-08-26 16:36:31', '2021-08-26 16:36:31'),
(14298, 11056, 20360, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Email received from : Kris.Olier@communityhealthchoice.org  Sub : Fwd: Enrollment & Location Status Query - NASA UrgentCare - Community Health Choice  Good Morning Kris,   Segun Adeoye is currently participating under Nasa Urgent Care however is not linked to 985 NASA Parkway service location. Please follow up on request id #4985 and advise if additional information is needed to process the request.   Thank you ', NULL, NULL, '2021-09-15 12:04:41', '2021-09-15 12:04:41'),
(14299, 11056, 20360, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email received from : Kris.Olier@communityhealthchoice.org  Sub : Fwd: Enrollment & Location Status Query - NASA UrgentCare - Community Health Choice  Rajika,   Please review ticket 4985 to create an amendment to add the new location to Nasa Urgent Care.   Kris', NULL, NULL, '2021-09-28 15:51:15', '2021-09-28 15:51:15'),
(14300, 11056, 20360, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email received  from : Kris.Olier@CommunityHealthChoice.org  Sub : Fwd: Enrollment & Location Status Query - NASA UrgentCare - Community Health Choice  Hi Ahmed,  Please provide a W9 signed in the current year, we are unable to proceed with update until that is received.  W-9 has been provided.', NULL, NULL, '2021-10-08 14:58:25', '2021-10-08 14:58:25'),
(14301, 11056, 20360, NULL, '2021-10-22 00:00:00.000', 'In Process', 'Email received  from : Kris.Olier@CommunityHealthChoice.org  Sub : Fwd: Enrollment & Location Status Query - NASA UrgentCare - Community Health Choice  Good afternoon!  Hope all is well with you. Please provide the latest updates regarding the credentialing of the practice and provider mentioned below as soon as possible.  Group Name	Nasa Urgent Care Inc. Tax ID	81-3237149 Group NPI	1821542432 Primary Location	985 NASA Parkway, Houston , TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025  If you have any questions or need any additional information please let me know. Eagerly waiting to hear from you.  Thank you! Have a great day! ', NULL, NULL, '2021-10-15 16:21:09', '2021-10-15 16:21:09'),
(14302, 11056, 20360, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email received from : CHC.Contracting@communityhealthchoice.org  Sub : Fwd: Enrollment & Location Status Query - NASA UrgentCare - Community Health Choice  Good Morning Kris,   Please follow up on request #4985 and advise if additional information is needed to process the demographic update.', NULL, NULL, '2021-10-22 16:51:14', '2021-10-22 16:51:14'),
(14303, 11056, 20360, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email received from: Rajika.Reid@communityhealthchoice.org  Sub : Fwd: Enrollment & Location Status Query - NASA UrgentCare - Community Health Choice  Good morning:  The agreement is awaiting Executive Signature this week.  Once signed, it will be forwarded for loading.  Best Regards,', NULL, NULL, '2021-11-11 10:19:22', '2021-11-11 10:19:22'),
(14304, 11056, 20360, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email sent to: CHC.Contracting@communityhealthchoice.org  Sub : Fwd: Enrollment & Location Status Query - NASA UrgentCare - Community Health Choice   Good morning!  Hope all is well with you. Could you please provide me with the time frame for the signatures because you have already been taken along for that?  Please get back to me as soon as possible. If you need any assistance from my side, I am happy to help.  Thank you!', NULL, NULL, '2021-11-19 10:35:02', '2021-11-19 10:35:02'),
(14305, 11056, 20360, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email sent to:  Kris.Olier@communityhealthchoice.org  Sub:  Fwd: Enrollment & Location Status Query - NASA UrgentCare - Community Health Choice  Good morning!  Hope this email finds you well. Has your Mr.Executive got the time to sign our contracts yet or not? Any updates on the credentialing process for the provider and facility?  Could you please provide me with the time frame for the signatures because you have already been taken along for that?  Waiting for your cooperation.  Thank you!', NULL, NULL, '2021-12-03 17:10:41', '2021-12-03 17:10:41'),
(14306, 11056, 20360, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email received from: Rajika.Reid@communityhealthchoice.org  Sub:  Fwd: Enrollment & Location Status Query - NASA UrgentCare - Community Health Choice   Good day:  They will be back in the office next week.  Once the agreement is signed, I will have the Contract Coordinator emailed it to you.  Best Regards,  Rajika​	 Reid Provider Contract Specialist Rajika.Reid@CommunityHealthChoice.org Phone: 713-295-2414 Fax: 713-295-7058', NULL, NULL, '2021-12-14 17:53:13', '2021-12-14 17:53:13'),
(14307, 19067, 20360, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: Rajika.Reid@communityhealthchoice.org  Subject: Re: FW: Enrollment & Location Status Query - NASA UrgentCare - Community Health Choice  Good Morning!  Hope you are having a productive day. Have the agreements been signed as per your hope?  Kindly, provide the latest updates related to the contract and credentialing.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 09:30:16', '2021-12-29 09:30:16'),
(14308, 19067, 20360, NULL, '2022-01-15 00:00:00.000', 'In Process', 'Email received from: Rajika.Reid@communityhealthchoice.org  Subject: Re: FW: Enrollment & Location Status Query - NASA UrgentCare - Community Health Choice    Good morning:  The amendment was signed and the effective date is 12/7/2021.     Rajika​	 Reid Provider Contract Specialist Rajika.Reid@CommunityHealthChoice.org Phone: 713-295-2414 Fax: 713-295-7058 ', NULL, NULL, '2022-01-07 20:14:31', '2022-01-07 20:14:31'),
(14309, 3046, 20361, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 15:45:19', '2021-03-12 15:45:19'),
(14310, 1006, 20361, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent following query @ pdsdallas@aetna.com:  Sub: Enrollment & Location Status Query - NASA UrgentCare - First Health  \"Hello,   I hope you\'re doing well, we wanted to verify if the following groups and provider were enrolled with First Health and if the mentioned addresses were also correctly listed under them:  Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 17:14:26', '2021-06-07 17:14:26'),
(14311, 1006, 20361, NULL, '2021-07-05 00:00:00.000', 'In Process', 'We received the following reply from Madiraju, Phani X MadirajuP@aetna.com:  Sub; Enrollment & Location Status Query - NASA UrgentCare - First Health  \"Hi,   Good Afternoon!  Please find the status of the below Provider  PROVIDER NAME  CPD ID  TAX ID  NPI  EFFECTIVE DATE  Status  Segun Adeoye  2679981  81-3237149  1629418025  12/01/2019  Active  Thank you, Phani\"  Sent reply:   \"Hello Phani,   I appreciate the update, could you please let me know if both the mentioned practice addresses are also loaded under the group and provider?  Thanks.\"', NULL, NULL, '2021-06-28 13:18:09', '2021-06-28 13:18:09'),
(14312, 1006, 20361, NULL, '2021-07-15 00:00:00.000', 'Approved', 'We received the following update from Madiraju, Phani X MadirajuP@aetna.com:  Sub; Enrollment & Location Status Query - NASA UrgentCare - First Health  \"Hi,  Both the addresses have been updated under the given TIN# 81-3237149 & Group.  Thank You,\"  Eff: 12/01/2019', NULL, NULL, '2021-07-08 12:32:58', '2021-07-08 12:32:58'),
(14313, 3046, 20362, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 15:52:54', '2021-03-12 15:52:54'),
(14314, 1006, 20362, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent enrollment request @ contracting@ghn-mci.com & providers@ghn-mci.com:  Sub: Enrollment Request - NASA UrgentCare - Galaxy Health  \"Hello,  I hope you\'re doing well, we wanted to enroll the following group and provider with Galaxy Health under the mentioned addresses, their information is as follows: Group Name: Nasa Urgent Care Inc. NPI# 1821542432TIN# 81-3237149 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Provider Name: Segun AdeoyeNPI# 1629418025 Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 17:40:34', '2021-06-07 17:40:34'),
(14315, 11056, 20362, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Email sent to : cguerue@ghn-mci.com  Sub :  CREDENTIALING DEPT - GALAXY HEALTH - NASA  Greetings,  Hope you are doing well. Enrollment form and documents are attached. please see the attachments.  Group Name: Nasa Urgent Care Inc. NPI# 1821542432  TIN# 81-3237149     Primary Address: 985 NASA Parkway, Houston, TX 77058-3039  Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406     Provider Name: Segun Adeoye  NPI# 1629418025   if you need any additional documents or details feel free to contact me.    Thank you!', NULL, NULL, '2021-06-25 09:09:10', '2021-06-25 09:09:10'),
(14316, 1006, 20362, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Sent f/u email @ Chris Guerue cguerue@ghn-mci.com:  Sub: RE: FW: CREDENTIALING DEPT - GALAXY HEALTH - NASA  \"Hello Chris,   I just wanted to verify if both the locations were listed under the group and provider, their information is as follows:  Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Thank you!\"', NULL, NULL, '2021-07-14 17:44:28', '2021-07-14 17:44:28'),
(14317, 11056, 20362, NULL, '2021-07-23 00:00:00.000', 'Approved', 'Email received from : cguerue@ghn-mci.com  Sub : CREDENTIALING DEPT - GALAXY HEALTH - NASA  Good Morning,  I can confirm that both locations are listed for Segun Adeoye effective 1/1/21.  Please feel free to contact me with any questions…  Thank you!  Christine Guerue Credentialing Dept cguerue@ghn-mci.com   Kindly see the attachment.', NULL, NULL, '2021-07-16 13:03:32', '2021-07-16 13:03:32'),
(14318, 3046, 20363, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 15:53:27', '2021-03-12 15:53:27'),
(14319, 1006, 20363, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent enrollment request @ contracting@ghn-mci.com & providers@ghn-mci.com:  Sub: Enrollment Request - NASA UrgentCare - Galaxy Health  \"Hello,  I hope you\'re doing well, we wanted to enroll the following group and provider with Galaxy Health under the mentioned addresses, their information is as follows: Group Name: Nasa Urgent Care Inc. NPI# 1821542432TIN# 81-3237149 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Provider Name: Segun AdeoyeNPI# 1629418025 Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 17:40:31', '2021-06-07 17:40:31'),
(14320, 11056, 20363, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Email sent to : cguerue@ghn-mci.com  Sub :  CREDENTIALING DEPT - GALAXY HEALTH - NASA  Greetings,  Hope you are doing well. Enrollment form and documents are attached. please see the attachments.  Group Name: Nasa Urgent Care Inc. NPI# 1821542432  TIN# 81-3237149     Primary Address: 985 NASA Parkway, Houston, TX 77058-3039  Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406     Provider Name: Segun Adeoye  NPI# 1629418025   if you need any additional documents or details feel free to contact me.    Thank you!', NULL, NULL, '2021-06-25 09:08:31', '2021-06-25 09:08:31'),
(14321, 1006, 20363, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Sent f/u email @ Chris Guerue cguerue@ghn-mci.com:  Sub: RE: FW: CREDENTIALING DEPT - GALAXY HEALTH - NASA  \"Hello Chris,   I just wanted to verify if both the locations were listed under the group and provider, their information is as follows:  Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Thank you!\"', NULL, NULL, '2021-07-14 17:44:23', '2021-07-14 17:44:23'),
(14322, 11056, 20363, NULL, '2021-08-09 00:00:00.000', 'In Process', 'Email sent to: cguerue@ghn-mci.com  Sub : CREDENTIALING DEPT - GALAXY HEALTH - NASA  Good Morning Chris,  Hope you are doing well. Please verify the enrollment of both locations. Are both locations also listed under the Practice?   Practice: Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider: Provider Name: Segun Adeoye NPI# 1629418025  If you have any questions please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-02 11:39:37', '2021-08-02 11:39:37'),
(14323, 11056, 20363, NULL, '2021-08-09 00:00:00.000', 'Approved', 'Email received from : cguerue@ghn-mci.com  Sub : Enrollment Request - NASA Urgent Care- Galaxy Health  There is a group agreement for NASA Urgent Care, the TIN is 813237149, Segun Adeoye was linked to this group and TIN eff 1/1/21 at the two locations listed below.   Please see the attachment.', NULL, NULL, '2021-08-02 13:31:44', '2021-08-02 13:31:44'),
(14324, 3046, 20364, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 15:54:19', '2021-03-12 15:54:19'),
(14325, 1006, 20364, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent following enrollment query @ Provider Relations - South pr.south@healthsmart.com:  Sub: Enrollment & Location Status Query - NASA UrgentCare - HealthSmart  \"Hello,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Health Smart and if the mentioned addresses are also correctly listed under them: Group Name: Nasa Urgent Care Inc. NPI# 1821542432TIN# 81-3237149 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Provider Name: Segun AdeoyeNPI# 1629418025 Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 17:35:15', '2021-06-07 17:35:15'),
(14326, 1006, 20364, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Sent f/u email @ Provider Relations - South pr.south@healthsmart.com:  Sub: Enrollment & Location Status Query - NASA UrgentCare - HealthSmart   \"Hello,   We are still waiting to get an update regarding the status of enrollment for the mentioned group and provider on the previous email, please get back to me as soon as possible.   Thank you!\"', NULL, NULL, '2021-06-28 09:42:21', '2021-06-28 09:42:21'),
(14327, 11056, 20364, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to : pr.south@healthsmart.com  Sub  : Enrollment & Location Status Query - NASA UrgentCare - HealthSmart  Greetings,   I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Health Smart and if the mentioned addresses are also correctly listed under them:  Practice Details: Practice Name: Nasa Urgent Care Inc. Practice NPI# : 1821542432 Practice TIN# : 81-3237149 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider: Provider Name: Segun Adeoye Provider NPI# : 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-07-19 16:54:27', '2021-07-19 16:54:27'),
(14328, 11056, 20364, NULL, '2021-08-10 00:00:00.000', 'In Process', 'Email received from : pr.south@healthsmart.com  Sub : Enrollment & Location Status Query - NASA UrgentCare - HealthSmart  Hello, yes the provider is PAR and under addresses beloq.  Diamond Lucero |Sr. Provider Relations  HealthSmart | Network Solutions  Office: 214 574 1174 I Fax: 214 574 2368  6303 Commerce Drive | Suite 180 | Irving, TX 75039  pr.south@healthsmart.com | www.HealthSmart.com ', NULL, NULL, '2021-08-03 09:04:49', '2021-08-03 09:04:49'),
(14329, 11056, 20364, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to : pr.south@healthsmart.com  Sub : Enrollment & Location Status Query - NASA UrgentCare - HealthSmart  Greetings Diamond,  Hope you are doing well. Kindly provide us with a welcome letter or roster soon.  If you need any further information or documents please let me know.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-18 10:45:21', '2021-08-18 10:45:21'),
(14330, 11056, 20364, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to : pr.south@healthsmart.com  Sub : Enrollment & Location Status Query - NASA UrgentCare - HealthSmart  Greetings Diamond,  Hope you are doing well. Kindly provide us with a welcome letter or roster soon.  If you need any further information or documents please let me know. Eagerly, waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-27 11:16:56', '2021-08-27 11:16:56'),
(14331, 11056, 20364, NULL, '2021-09-08 00:00:00.000', 'Approved', 'Email received from : pr.south@healthsmart.com  Sub : Enrollment & Location Status Query - NASA UrgentCare - HealthSmart  Hello, yes the provider is PAR and under addresses beloq. eff date is : 11/01/2018     Diamond Lucero |Sr. Provider Relations  HealthSmart | Network Solutions  Office: 214 574 1174 I Fax: 214 574 2368  6303 Commerce Drive | Suite 180 | Irving, TX 75039  pr.south@healthsmart.com | www.HealthSmart.com ', NULL, NULL, '2021-08-31 16:47:50', '2021-08-31 16:47:50'),
(14332, 3046, 20365, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 15:59:02', '2021-03-12 15:59:02'),
(14333, 1005, 20365, NULL, '2021-06-09 00:00:00.000', 'Approved', ' GROUP NAME	NASA URGENT CARE INC GROUP PTAN	DX2199 GROUP NPI	1821542432 BUSINESS STATE	TX EFFECTIVE DATE	09/11/2016', NULL, NULL, '2021-06-01 16:35:10', '2021-06-01 16:35:10'),
(14334, 3046, 20366, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 16:00:27', '2021-03-12 16:00:27'),
(14335, 1006, 20366, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent following enrollment query @ SWHP PROVIDER SERVICES SWHPPROVSERVICES@bswhealth.org:  Sub: Enrollment & Location Status Query - NASA UrgentCare - Scott & White  \"Hello,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Scott & White and if the mentioned addresses are also correctly listed under them: Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Provider Name: Segun AdeoyeNPI# 1629418025 Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 18:15:11', '2021-06-07 18:15:11'),
(14336, 1006, 20366, NULL, '2021-07-05 00:00:00.000', 'Approved', 'Received following confirmation email from Scott & White:   \"Good morning,  TIN 813237149 is contracted in our system eff 10/15/2017 with both locations below.  This is a facility set up, so the provider would not be listed in our system under this TIN.  Please reach out to your provider rep for further assistance and to get specifics on the plans that you are currently contracted with.  If you are unsure who your rep is, please click on the link below to review our representative map and corresponding provider rep info.   https://swhp.org/Portals/0/Files/Forms/ProviderNews/SWHP-Provider-Relations-Representative-Territory-Map.pdf  Thank you so much,  Lacey B\"', NULL, NULL, '2021-06-28 08:53:50', '2021-06-28 08:53:50'),
(14337, 3046, 20367, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 16:00:58', '2021-03-12 16:00:58'),
(14338, 1006, 20367, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent following enrollment query @ Account Management - Corpus Christi AM.CorpusChristi@SuperiorHealthPlan.com:  Sub: Enrollment & Location Status Query - NASA UrgentCare - Superior Health  \"Hello,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Superior Health and if the mentioned addresses are also correctly listed under them: Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Provider Name: Segun AdeoyeNPI# 1629418025 Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 17:59:49', '2021-06-07 17:59:49'),
(14339, 1006, 20367, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Sent f/u email @ Account Management - Corpus Christi AM.CorpusChristi@superiorhealthplan.com:  Sub: Enrollment & Location Status Query - NASA UrgentCare - Superior Health  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the above-mentioned group and provider. Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-06-28 09:38:10', '2021-06-28 09:38:10');
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
(14340, 11056, 20367, NULL, '2021-07-31 00:00:00.000', 'In Process', 'Email received from : Semetra Brazle\' via Nasa Health & Urgent Care nasa@claimsmedinc.com  Sub : Signature requested on \"ECM 546265 NASA URGENT CARE  Semetra Brazle requests your signature on ECM 546265 NASA URGENT CARE  Review and sign  Please Sign.  SEMETRA BRAZLE SEMETRA.BRAZLE@SUPERIORHEALTHPLAN.COM  Reviewing and signing done through Adobe. Please see attachment ', NULL, NULL, '2021-07-23 17:14:24', '2021-07-23 17:14:24'),
(14341, 11056, 20367, NULL, '2021-08-09 00:00:00.000', 'In Process', 'Email sent to : AM.CorpusChristi@superiorhealthplan.com  Sub  : Enrollment & Location Status Query - NASA Urgent Care - Superior Health  Good morning!  I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the below-mentioned facility and provider soon.  Practice: Practice Name: Nasa Urgent Care Inc. Practice NPI # : 1821542432 Practice TIN # : 81-3237149 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider: Provider Name: Segun Adeoye NPI# 1629418025 Please get back to me as soon as you\'re able to. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-02 11:14:31', '2021-08-02 11:14:31'),
(14342, 11056, 20367, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to : AM.CorpusChristi@superiorhealthplan.com  Sub : Enrollment & Location Status Query - NASA Urgent Care - Superior Health  Good morning!  Hope all is well. Are the Primary & secondary locations also listed & added under the practice Tax I.D?  Practice Details: Practice Name: Nasa Urgent Care Inc. Practice NPI # : 1821542432 Practice TIN # : 81-3237149 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  If you have any questions or queries please let me know.   Thank you! Have a great day!', NULL, NULL, '2021-08-18 09:53:44', '2021-08-18 09:53:44'),
(14343, 11056, 20367, NULL, '2021-09-04 00:00:00.000', 'Approved', 'Approval Email received from: AM.CorpusChristi@superiorhealthplan.com  Sub : Enrollment & Location Status Query - NASA Urgent Care - Superior Health  Good afternoon Ahmed  My apologies for the delay in response  Here is the information you requested Here is the locations under the Group TID  For the following Provider  eff date is : 06/01/2019', NULL, NULL, '2021-08-27 16:52:52', '2021-08-27 16:52:52'),
(14344, 3046, 20368, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 16:01:32', '2021-03-12 16:01:32'),
(14345, 1006, 20368, NULL, '2021-06-14 00:00:00.000', 'Not Eligible', 'Received following email from: Davis, Margie Y. (Margie) (mydavis@texaschildrens.org) Sub: RE: Need Status-Sugun-NASA UC  Luis,   We cannot add NASA Urgent Care since it shares the same address as NASA Health Clinic.  The provider can only be credentialed under the clinic at the time.   Thank you,', NULL, NULL, '2021-06-07 17:52:46', '2021-06-07 17:52:46'),
(14346, 3046, 20369, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 16:02:00', '2021-03-12 16:02:00'),
(14347, 1006, 20369, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent following enrollment request @ Yvonne Wyatt ywyatt@humana.com:  Sub: Enrollment & Location Status Query - NASA UrgentCare - Tricare  \"Hello Yvonne,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Tricare and if the mentioned addresses are also correctly listed under them: Group Name: Nasa Urgent Care Inc. NPI# 1821542432TIN# 81-3237149 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Provider Name: Segun AdeoyeNPI# 1629418025 Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 17:46:17', '2021-06-07 17:46:17'),
(14348, 1006, 20369, NULL, '2021-07-05 00:00:00.000', 'Approved', 'We received the following response from Tricare :Yvonne Wyatt ywyatt@humana.com ​  Sub: Enrollment & Location Status Query - NASA UrgentCare - Tricare  \"Good Morning Brad,  We show this provider as network. You can check network status by creating a log in on the Provider Portal using this link Provider Self-Service (humana-military.com)', NULL, NULL, '2021-06-28 09:23:53', '2021-06-28 09:23:53'),
(14349, 3046, 20370, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 16:02:40', '2021-03-12 16:02:40'),
(14350, 1006, 20370, NULL, '2021-06-15 00:00:00.000', 'Not Eligible', 'We cannot enroll NASA Healthclinic as Triwest can only be enrolled with Urgentcares. Closing task. ', NULL, NULL, '2021-06-08 13:56:11', '2021-06-08 13:56:11'),
(14351, 1006, 20370, NULL, '2021-06-15 00:00:00.000', 'Approved', 'Group is already enrolled, no need to enroll individual providers separately since it\'s an ancillary urgentcare contract. ', NULL, NULL, '2021-06-08 14:40:57', '2021-06-08 14:40:57'),
(14352, 3046, 20371, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 16:03:17', '2021-03-12 16:03:17'),
(14353, 1006, 20371, NULL, '2021-06-14 00:00:00.000', 'On Hold', 'The request is in process in main UHC task, need to allow more time to process. ', NULL, NULL, '2021-06-07 17:51:21', '2021-06-07 17:51:21'),
(14354, 11056, 20371, NULL, '2021-08-04 00:00:00.000', 'Initiated', 'Email sent to : 	networkhelp@uhc.com  Sub : Enrollment & Location Status Query - NASA UrgentCare - UHC  Good morning!  I hope you\'re doing well. I want to verify if the following group and provider were enrolled with UHC and if the mentioned addresses are also correctly listed under them:  Practice Details: Practice  Name: Nasa Urgent Care Inc. Practice NPI# : 1821542432 Practice TIN# : 81-3237149 Practice  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Practice  Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Practice Phone # : 2812186777 Practice Fax # : 8666656208  Provider: Provider Name: Segun Adeoye Provider NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-07-28 09:13:10', '2021-07-28 09:13:10'),
(14355, 11056, 20371, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to :  networkhelp@uhc.com  Sub : Enrollment & Location Status Query - NASA UrgentCare - UHC  Good morning!  I hope you\'re doing well. I want to verify if the following group and provider were enrolled with UHC and if the mentioned addresses are also correctly listed under them:  Practice Details: Practice  Name: Nasa Urgent Care Inc. Practice NPI# : 1821542432 Practice TIN# : 81-3237149 Practice  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Practice  Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Practice Phone # : 2812186777 Practice Fax # : 8666656208  Provider Details: Provider Name: Segun Adeoye Provider NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-17 09:22:09', '2021-08-17 09:22:09'),
(14356, 11056, 20371, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Approval Email received from : networkhelp@uhc.com  Sub : Secure Message from tracy_brooks@uhc.com  Thank you for contacting the Network Management Resource Team. The group and the provider have been linked to the TIN below. I’ve included the product roster showing the demographic information, lines of business, and effective dates.      Did you know that you can get a product listing at any time from our website? Please see the attached handout for more information. If you have further questions regarding this system, please feel free to contact the LINK help desk (866-842-3278, option 1).     Please let us know if we can assist further via email.     Please do not reply directly to this email. Send all responses or questions pertaining to this email to networkhelp@uhc.com for further assistance.  If sent to tracy_brooks@uhc.com, it will be considered responded to already and will be deleted.     Thank You,     Tracy Brooks  UnitedHealthcare  Network Management Resource Team (NMRT)', NULL, NULL, '2021-08-26 17:04:32', '2021-08-26 17:04:32'),
(14357, 3046, 20372, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 16:03:51', '2021-03-12 16:03:51'),
(14358, 1006, 20372, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent enrollment query @ NMRT networkhelp@uhc.com:  Sub: Enrollment & Location Status Query - NASA UrgentCare - UHC  \"Hello,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with UHC and if the mentioned addresses are also correctly listed under them: Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Provider Name: Segun AdeoyeNPI# 1629418025 Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 17:50:51', '2021-06-07 17:50:51'),
(14359, 1006, 20372, NULL, '2021-07-05 00:00:00.000', 'Approved', 'The provider is enrolled, the roster is attached for reference.   Eff: 06/01/2018 Provider ID# 3701044 ', NULL, NULL, '2021-06-28 09:55:58', '2021-06-28 09:55:58'),
(14360, 3046, 20373, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 17:05:40', '2021-03-12 17:05:40'),
(14361, 1006, 20373, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'As per my discussion with Aetna we need to submit a location addition request via an LOI, it will take 30 business days to be updated. ', NULL, NULL, '2021-06-07 16:36:22', '2021-06-07 16:36:22'),
(14362, 1006, 20373, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Sent following LOI @ (859) 455-8650 ', NULL, NULL, '2021-06-28 16:04:46', '2021-06-28 16:04:46'),
(14363, 11056, 20373, NULL, '2021-08-10 00:00:00.000', 'In Process', 'Email sent to : SoTXNetworkManagement25WS@aetna.com  Sub : Enrollment & Location Status Query - NASA Health Clinic - Aetna  Good Evening!  Hope you are doing well. I want to know the enrollment status of the below mentioned group and provider :   Practice Details: Practice Name: Nasa Health Clinic Practice NPI# : 1740661453 Practice TIN# : 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider: Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-02 16:46:07', '2021-08-02 16:46:07'),
(14364, 11056, 20373, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to : SoTXNetworkManagement25WS@aetna.com  Sub : Enrollment & Location Status Query - NASA Health Clinic - Aetna  Good morning!  Hope you are doing well. I want to know the enrollment status of the below mentioned group and provider :   Practice Details: Practice Name: Nasa Health Clinic Practice NPI# : 1740661453 Practice TIN# : 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider: Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-18 11:23:23', '2021-08-18 11:23:23'),
(14365, 11056, 20373, NULL, '2021-09-04 00:00:00.000', 'In Process', 'Email received from : SoTXNetworkManagement25WS@aetna.com  Sub :  [EXTERNAL] Enrollment & Location Status Query - NASA Urgent Care - Aetna  Please note this mailbox is no longer being monitored     For timely resolution of your eligibility, benefits and claims questions, please contact our Provider or Customer Service Center by calling:  ·         Aetna  at 1-888-632-3862 for Indemnity and PPO based plans or 1-800-624-0756 for HMO based plans     New credentialing provider steps:  ·         Go to www.aetna.com  ·         Choose Health Care Professional  ·         Choose Join the Network  ·         Choose Medical Providers     Check on credentialing status at 1-800-353-1232.     For convenient real-time status and tools, log onto our secure Provider Websites:  ·         Aetna’s Secure Provider Website:  https://navinet.navimedix.com/Main.asp  Coventry’s Secure Provider Website:  https://directprovider.com', NULL, NULL, '2021-08-27 17:24:49', '2021-08-27 17:24:49'),
(14366, 11056, 20373, NULL, '2021-09-30 00:00:00.000', 'In Process', 'Rep : Eva   Effective date: NASA UC : 06/28/2021 NASA HC : 11/04/2019   Status : We have to FAX Letter of request or LOI at 859-455-8650 for the additional address to be listed below the provider.   Ref code. : 6044173727  Contact no. : 800-353-1232 & 859-455-8650', NULL, NULL, '2021-09-23 13:06:51', '2021-09-23 13:06:51'),
(14367, 11056, 20373, NULL, '2021-09-30 00:00:00.000', 'In Process', 'LOI has been faxed at 859-455-8650  Please see the attachment.', NULL, NULL, '2021-09-23 13:35:33', '2021-09-23 13:35:33'),
(14368, 11056, 20373, NULL, '2021-10-15 00:00:00.000', 'Approved', 'Rep : Louise G & Avy A  Status :  Approved , Linked to the TIN  NASA HC  & Segun Adeoye Eff date : 09/04/2019  Ref code :  6048475365 & 6047930364', NULL, NULL, '2021-10-08 10:47:31', '2021-10-08 10:47:31'),
(14369, 3046, 20374, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 17:10:54', '2021-03-12 17:10:54'),
(14370, 1006, 20374, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'As per my discussion with Aetna we need to submit a location addition request via an LOI, it will take 30 business days to be updated. ', NULL, NULL, '2021-06-07 16:36:18', '2021-06-07 16:36:18'),
(14371, 1006, 20374, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Sent following LOI @ (859) 455-8650 ', NULL, NULL, '2021-06-28 16:04:33', '2021-06-28 16:04:33'),
(14372, 11056, 20374, NULL, '2021-08-10 00:00:00.000', 'In Process', 'Good Evening!  Hope you are doing well. I want to know the enrollment status of the below mentioned group and provider :   Practice Details: Practice Name: Nasa Health Clinic Practice NPI# : 1740661453 Practice TIN# : 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider: Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-02 16:45:08', '2021-08-02 16:45:08'),
(14373, 11056, 20374, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to : SoTXNetworkManagement25WS@aetna.com  Sub : Enrollment & Location Status Query - NASA Health Clinic - Aetna  Good morning!  Hope you are doing well. I want to know the enrollment status of the below mentioned group and provider :   Practice Details: Practice Name: Nasa Health Clinic Practice NPI# : 1740661453 Practice TIN# : 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider: Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-18 11:23:05', '2021-08-18 11:23:05'),
(14374, 11056, 20374, NULL, '2021-09-04 00:00:00.000', 'In Process', 'Email received from : SoTXNetworkManagement25WS@aetna.com  Sub :  [EXTERNAL] Enrollment & Location Status Query - NASA Urgent Care - Aetna  Please note this mailbox is no longer being monitored     For timely resolution of your eligibility, benefits and claims questions, please contact our Provider or Customer Service Center by calling:  ·         Aetna  at 1-888-632-3862 for Indemnity and PPO based plans or 1-800-624-0756 for HMO based plans     New credentialing provider steps:  ·         Go to www.aetna.com  ·         Choose Health Care Professional  ·         Choose Join the Network  ·         Choose Medical Providers     Check on credentialing status at 1-800-353-1232.     For convenient real-time status and tools, log onto our secure Provider Websites:  ·         Aetna’s Secure Provider Website:  https://navinet.navimedix.com/Main.asp  Coventry’s Secure Provider Website:  https://directprovider.com', NULL, NULL, '2021-08-27 17:24:42', '2021-08-27 17:24:42'),
(14375, 11056, 20374, NULL, '2021-09-30 00:00:00.000', 'In Process', 'Rep : Eva   Effective date: NASA UC : 06/28/2021 NASA HC : 11/04/2019   Status : We have to FAX Letter of request or LOI at 859-455-8650 for the additional address to be listed below the provider.   Ref code. : 6044173727  Contact no. : 800-353-1232 & 859-455-8650', NULL, NULL, '2021-09-23 13:06:45', '2021-09-23 13:06:45'),
(14376, 11056, 20374, NULL, '2021-09-30 00:00:00.000', 'In Process', 'LOI has been faxed at 859-455-8650  Please see the attachment.', NULL, NULL, '2021-09-23 13:34:38', '2021-09-23 13:34:38'),
(14377, 11056, 20374, NULL, '2021-09-30 00:00:00.000', 'In Process', 'LOI has been faxed at 859-455-8650  Please see the attachment.', NULL, NULL, '2021-09-23 13:34:45', '2021-09-23 13:34:45'),
(14378, 11056, 20374, NULL, '2021-09-30 00:00:00.000', 'In Process', 'LOI has been faxed at 859-455-8650  Please see the attachment.', NULL, NULL, '2021-09-23 13:34:53', '2021-09-23 13:34:53'),
(14379, 11056, 20374, NULL, '2021-10-15 00:00:00.000', 'Approved', 'Rep : Louise G & Avy A  Status :  Approved , Linked to the TIN  NASA UC  & Segun Adeoye Eff date : 09/04/2019  Ref code :  6048475365 & 6047930364', NULL, NULL, '2021-10-08 10:47:08', '2021-10-08 10:47:08'),
(14380, 3046, 20375, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 17:14:18', '2021-03-12 17:14:18'),
(14381, 1006, 20375, NULL, '2021-06-14 00:00:00.000', 'On Hold', 'The request is in process in Superior Health task, need to allow more time. ', NULL, NULL, '2021-06-07 18:01:13', '2021-06-07 18:01:13'),
(14382, 3046, 20376, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 17:14:47', '2021-03-12 17:14:47'),
(14383, 1006, 20376, NULL, '2021-06-14 00:00:00.000', 'On Hold', 'The request is in process in Superior Health task, need to allow more time. ', NULL, NULL, '2021-06-07 18:01:10', '2021-06-07 18:01:10'),
(14384, 3046, 20377, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 17:17:17', '2021-03-12 17:17:17'),
(14385, 1006, 20377, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent following query @ TX Credentialing txcredentialing@amerigroup.com:  Sub: Enrollment & Location Status Query - NASA HealthClinic - Amerigroup  \"Hello,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Amerigroup and if the mentioned addresses were also correctly listed under them:  Group Name: Nasa Health Clinic NPI# 1740661453 TIN# 47-2682655  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 17:18:56', '2021-06-07 17:18:56'),
(14386, 1006, 20377, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Sent f/u email @ TX Credentialing txcredentialing@amerigroup.com:  Sub; Enrollment & Location Status Query - NASA HealthClinic - Amerigroup  \"Hello,   We are still waiting on an update regarding the enrollment status of the group and provider mentioned, please get back to us as soon as possible.  Thank you. \"', NULL, NULL, '2021-06-28 10:41:00', '2021-06-28 10:41:00'),
(14387, 11056, 20377, NULL, '2021-07-24 00:00:00.000', 'In Process', 'Email sent to : txcredentialing@amerigroup.com  Sub : Enrollment & Location Status Query - NASA Health Clinic - Amerigroup  Greetings,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Amerigroup and if the mentioned addresses were also correctly listed under them:  Group Name: Nasa Health Clinic NPI# 1740661453 TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon. Thank you!', NULL, NULL, '2021-07-16 14:56:04', '2021-07-16 14:56:04'),
(14388, 11056, 20377, NULL, '2021-08-10 00:00:00.000', 'In Process', '	 Email sent to : txcredentialing@amerigroup.com  Sub : Enrollment & Location Status Query - NASA Health Clinic - Amerigroup  Greetings,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Amerigroup and if the mentioned addresses were also correctly listed under them:  Group Name: Nasa Health Clinic NPI# 1740661453 TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon. Thank you!', NULL, NULL, '2021-08-03 08:52:02', '2021-08-03 08:52:02'),
(14389, 11056, 20377, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to : txcredentialing@amerigroup.com  Sub : Enrollment & Location Status Query - NASA Health Clinic - Amerigroup  Greetings,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Amerigroup and if the mentioned addresses were also correctly listed under them:  Group Name: Nasa Health Clinic NPI# 1740661453 TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon. Thank you!', NULL, NULL, '2021-08-18 09:41:24', '2021-08-18 09:41:24'),
(14390, 11056, 20377, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to : txcredentialing@amerigroup.com &  keth.jackson@amerigroup.com  Sub : Enrollment & Location Status Query - NASA Health Clinic - Amerigroup  Greetings,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Amerigroup and if the mentioned addresses were also correctly listed under them:  Group Name: Nasa Health Clinic NPI# 1740661453 TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon. Thank you!   Contacted thrice on different phone numbers but no one received . Voice mails have been left out for the updates', NULL, NULL, '2021-08-27 09:35:55', '2021-08-27 09:35:55'),
(14391, 11056, 20377, NULL, '2021-09-30 00:00:00.000', 'In Process', 'Email received from : mpswebinquiries@amerigroup.com  Sub  : RE: {EXTERNAL} Re: Delivery Status Notification (Failure) I-Q3-818  Good Afternoon,   Thank you for contacting us. I will be happy to assist you.  After review, the provider Segun Adeoye is non-participating in the network. The group practice Nasa Health Clinic is also non participating. To get the status of your application you will need to email your request to txcredentialing@amerigroup.com. Please note many providers apply, once we have a panel opening the credentialing team will contact you.    This mailbox is for general questions. We are encouraging all of our providers, to please log-on and/or register on our website (website per market)/Availity, and submit your questions and/or concerns via our secure portal. Using our secure portal helps maintain  the Provider’s and Member’s privacy and assists us in responding to you in a thorough and timely manner.  Please use this link to access our website.  https://availity.com/healthplans  If the provider is requiring assistance please contact Availity technical support at 800-973-3957.   Please advise if there is any other way we can assist.  Thank you,  Nordra D. MPS Inquiries', NULL, NULL, '2021-09-23 16:42:31', '2021-09-23 16:42:31'),
(14392, 11056, 20377, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email sent to : txcredentialing@amerigroup.com  Sub : RE: {EXTERNAL} Re: Delivery Status Notification (Failure) I-Q3-818  Good morning!  Hope all is well with you. We are still waiting to get updates regarding our credentialing process of our below mentioned provider & facility. We have been waiting for this since May and we are losing our patience, please respond to our emails soon.  Group Name	Nasa Health Clinic Tax ID	47-2682655 Group NPI	1740661453 Primary Location	985 NASA Parkway, Houston , TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025  If you have any questions or require information please let me know.  Thank you! Have a blessed day!', NULL, NULL, '2021-10-08 10:06:23', '2021-10-08 10:06:23'),
(14393, 11056, 20377, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Rep : May D & Maya & Cristel M  Status :  Try to contact 3 or 4 contact no.s to get updates but every one transferred my call to the provider relations depart but haven\'t get a response.  The voice mail has been left out on every contact no.s  Contacted no.s :  9405312496 8004543730 (800) 454-3730  Also sent an email too.', NULL, NULL, '2021-10-18 15:35:59', '2021-10-18 15:35:59'),
(14394, 11056, 20377, NULL, '2021-11-01 00:00:00.000', 'In Process', 'Email sent to : txcredentialing@amerigroup.com  Sub : Fwd: {EXTERNAL} Enrollment & Location Status Query - NASA UrgentCare - Amerigroup   Good morning!  Hope all is well with you. Could you let me know the exact time period for the credentialing process?  Because we have been waiting for this since May and we are losing our patience.  Group Name	Nasa Urgent Care Inc. Tax ID	81-3237149 Group NPI	1821542432 Primary Location	985 NASA Parkway, Houston , TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025  If you have any questions or require information please let me know.  Thank you! Have a great day!   Also left out voice mails. Contacting no.s are on recording process', NULL, NULL, '2021-10-25 16:52:49', '2021-10-25 16:52:49'),
(14395, 11056, 20377, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email received from : txcredentialing@amerigroup.com  Sub : RE: {EXTERNAL} Re: Delivery Status Notification (Failure) I-Q3-818   Greetings,     Amerigroup has received your request to contract directly with our Healthplan.     We will be glad to assist.     To ensure that we have your credentialing updated, please complete the attached Letter of Intent to begin that process.        When finished completing the LOI, please email it back to me along with a copy of your W9 and group application release form.     We ask that the Letter of Interest be completed in its entirety.     **For Nurse Practitioners completing the Letter of Interest:    Your Specialty type would be considered “Family Nurse Practitioner, Geriatric Nurse Practitioner, Psychiatric Nurse Practitioner” or whichever applies to your training.     Thank you', NULL, NULL, '2021-11-10 17:16:34', '2021-11-10 17:16:34'),
(14396, 11056, 20377, NULL, '2021-11-25 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Sub : RE: {EXTERNAL} Re: Delivery Status Notification (Failure) I-Q3-818  Good afternoon!  Hope this email finds you well. Pardon us. Please accept our apology for the delay. Please find the attached Letter of Intent for credentialing.  Furthermore, any documents or information is required don\'t hesitate to contact us.  Thank you! Have a wonderful day!', NULL, NULL, '2021-11-18 18:03:52', '2021-11-18 18:03:52'),
(14397, 11056, 20377, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email sent to:  TXCredentialing@amerigroup.com  Sub:  RE: {EXTERNAL} Re: Delivery Status Notification (Failure) I-Q3-818  Good afternoon!  Hope this email finds you well. Please provide me with the latest updates on the credentialing process of the provider, Segun Adeoye under the facility, Nasa Health Clinic.  Eagerly, waiting for your reply.  Thank you!', NULL, NULL, '2021-12-03 17:58:04', '2021-12-03 17:58:04'),
(14398, 11056, 20377, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Sub: RE: {EXTERNAL} Re: Delivery Status Notification (Failure) I-Q3-818   Good afternoon!  Hope you are doing great. Please provide me with the welcome letter & effective dates for the provider & practice. Please expedite my request for processing.  Group Name	Nasa Health Clinic Tax ID	47-2682655 Group NPI	1740661453 Primary Location	985 NASA Parkway, Houston, TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025  In the meantime, please do not hesitate to reach out if you have any questions or concerns.  Thank you! Have a wonderful weekend!  Voice msgs have been left out.', NULL, NULL, '2021-12-14 17:46:51', '2021-12-14 17:46:51'),
(14399, 11056, 20377, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Rep: Madonna h & Jennifer P  Status:  1st one rep didn\'t find the provider in her system. Second one found the provider with only the secondary location and with only Nasa Health Clinic Tax ID. File is in the credentaling.  Ref code: 12202021', NULL, NULL, '2021-12-20 10:25:16', '2021-12-20 10:25:16'),
(14400, 11056, 20377, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Sub: RE: {EXTERNAL} Re: Delivery Status Notification (Failure) I-Q3-818   Good afternoon!  Hope all is well with you. I am still waiting to get the latest updates on the applications as well as on the facilities Nasa Health Clinic and Nasa Urgent care Inc.s\' Credentialing accomplishments yet. Please try to cope up with us through emails as your contact no.s aren\'t responded to us by anyone except the voice recorders. And we have left out so many Voice mails for the updates of the enrollment process, But haven\'t got the response yet.  Kindly respond to us as soon as possible. Please don\'t test our patience.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-23 09:38:52', '2021-12-23 09:38:52'),
(14401, 19067, 20377, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Subject: Enrollment Query || NASA Health Clinic || Segun Adeoye & Groups || Ameri Group ||  Hello!  Hope you are doing well.  I would like to know the enrollment status of the following Provider and Group as well with Ameri Group.   Group Name	Nasa Health Clinic Tax ID	47-2682655 Group NPI	1740661453 Provider Name	NPI	Location Segun Adeoye	1629418025	985 NASA Parkway Houston, TX 77058-3039 Segun Adeoye	1629418025	3623 S. Main St. Suite 109, Stafford, TX 77477-5406   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-30 14:00:26', '2021-12-30 14:00:26'),
(14402, 19067, 20377, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Subject: Enrollment Query || NASA Health Clinic || Segun Adeoye & Groups || Ameri Group ||   Hello!  Any update on below mentioned Providers.  Eagerly waiting for your response.  Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-06 17:51:02', '2022-01-06 17:51:02'),
(14403, 3046, 20378, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 17:17:48', '2021-03-12 17:17:48'),
(14404, 1006, 20378, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent following query @ TX Credentialing txcredentialing@amerigroup.com:  Sub: Enrollment & Location Status Query - NASA HealthClinic - Amerigroup  \"Hello,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Amerigroup and if the mentioned addresses were also correctly listed under them:  Group Name: Nasa Health Clinic NPI# 1740661453 TIN# 47-2682655  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 17:18:45', '2021-06-07 17:18:45'),
(14405, 1006, 20378, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Sent f/u email @ TX Credentialing txcredentialing@amerigroup.com:  Sub; Enrollment & Location Status Query - NASA HealthClinic - Amerigroup  \"Hello,   We are still waiting on an update regarding the enrollment status of the group and provider mentioned, please get back to us as soon as possible.  Thank you. \"', NULL, NULL, '2021-06-28 10:40:56', '2021-06-28 10:40:56'),
(14406, 11056, 20378, NULL, '2021-07-24 00:00:00.000', 'In Process', 'Email sent to : txcredentialing@amerigroup.com  Sub : Enrollment & Location Status Query - NASA Health Clinic - Amerigroup  Greetings,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Amerigroup and if the mentioned addresses were also correctly listed under them:  Group Name: Nasa Health Clinic NPI# 1740661453 TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon. Thank you!', NULL, NULL, '2021-07-16 14:56:08', '2021-07-16 14:56:08'),
(14407, 11056, 20378, NULL, '2021-08-10 00:00:00.000', 'In Process', 'Email sent to : txcredentialing@amerigroup.com  Sub : Enrollment & Location Status Query - NASA Health Clinic - Amerigroup  Greetings,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Amerigroup and if the mentioned addresses were also correctly listed under them:  Group Name: Nasa Health Clinic NPI# 1740661453 TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon. Thank you!', NULL, NULL, '2021-08-03 08:51:51', '2021-08-03 08:51:51'),
(14408, 11056, 20378, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to : txcredentialing@amerigroup.com  Sub : Enrollment & Location Status Query - NASA Health Clinic - Amerigroup  Greetings,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Amerigroup and if the mentioned addresses were also correctly listed under them:  Group Name: Nasa Health Clinic NPI# 1740661453 TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon. Thank you!', NULL, NULL, '2021-08-18 09:41:15', '2021-08-18 09:41:15'),
(14409, 11056, 20378, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to : txcredentialing@amerigroup.com &  keth.jackson@amerigroup.com  Sub : Enrollment & Location Status Query - NASA Health Clinic - Amerigroup  Greetings,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Amerigroup and if the mentioned addresses were also correctly listed under them:  Group Name: Nasa Health Clinic NPI# 1740661453 TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon. Thank you!   Contacted thrice on different phone numbers but no one received . Voice mails have been left out for the updates', NULL, NULL, '2021-08-27 09:35:49', '2021-08-27 09:35:49'),
(14410, 11056, 20378, NULL, '2021-09-30 00:00:00.000', 'In Process', 'Email received from : mpswebinquiries@amerigroup.com  Sub  : RE: {EXTERNAL} Re: Delivery Status Notification (Failure) I-Q3-818  Good Afternoon,   Thank you for contacting us. I will be happy to assist you.  After review, the provider Segun Adeoye is non-participating in the network. The group practice Nasa Health Clinic is also non participating. To get the status of your application you will need to email your request to txcredentialing@amerigroup.com. Please note many providers apply, once we have a panel opening the credentialing team will contact you.    This mailbox is for general questions. We are encouraging all of our providers, to please log-on and/or register on our website (website per market)/Availity, and submit your questions and/or concerns via our secure portal. Using our secure portal helps maintain  the Provider’s and Member’s privacy and assists us in responding to you in a thorough and timely manner.  Please use this link to access our website.  https://availity.com/healthplans  If the provider is requiring assistance please contact Availity technical support at 800-973-3957.   Please advise if there is any other way we can assist.  Thank you,  Nordra D. MPS Inquiries', NULL, NULL, '2021-09-23 16:42:24', '2021-09-23 16:42:24'),
(14411, 11056, 20378, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email sent to : txcredentialing@amerigroup.com  Sub : RE: {EXTERNAL} Re: Delivery Status Notification (Failure) I-Q3-818  Good morning!  Hope all is well with you. We are still waiting to get updates regarding our credentialing process of our below mentioned provider & facility. We have been waiting for this since May and we are losing our patience, please respond to our emails soon.  Group Name	Nasa Health Clinic Tax ID	47-2682655 Group NPI	1740661453 Primary Location	985 NASA Parkway, Houston , TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025  If you have any questions or require information please let me know.  Thank you! Have a blessed day!', NULL, NULL, '2021-10-08 10:06:17', '2021-10-08 10:06:17'),
(14412, 11056, 20378, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Rep : May D & Maya & Cristel M  Status :  Try to contact 3 or 4 contact no.s to get updates but every one transferred my call to the provider relations depart but haven\'t get a response.  The voice mail has been left out on every contact no.s  Contacted no.s :  9405312496 8004543730 (800) 454-3730  Also sent an email too.', NULL, NULL, '2021-10-18 15:35:53', '2021-10-18 15:35:53'),
(14413, 11056, 20378, NULL, '2021-11-01 00:00:00.000', 'In Process', 'Email sent to : txcredentialing@amerigroup.com  Sub : Fwd: {EXTERNAL} Enrollment & Location Status Query - NASA UrgentCare - Amerigroup   Good morning!  Hope all is well with you. Could you let me know the exact time period for the credentialing process?  Because we have been waiting for this since May and we are losing our patience.  Group Name	Nasa Urgent Care Inc. Tax ID	81-3237149 Group NPI	1821542432 Primary Location	985 NASA Parkway, Houston , TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025  If you have any questions or require information please let me know.  Thank you! Have a great day!   Also left out voice mails. Contacting no.s are on recording process', NULL, NULL, '2021-10-25 16:52:44', '2021-10-25 16:52:44'),
(14414, 11056, 20378, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email received from : txcredentialing@amerigroup.com  Sub : RE: {EXTERNAL} Re: Delivery Status Notification (Failure) I-Q3-818   Greetings,     Amerigroup has received your request to contract directly with our Healthplan.     We will be glad to assist.     To ensure that we have your credentialing updated, please complete the attached Letter of Intent to begin that process.        When finished completing the LOI, please email it back to me along with a copy of your W9 and group application release form.     We ask that the Letter of Interest be completed in its entirety.     **For Nurse Practitioners completing the Letter of Interest:    Your Specialty type would be considered “Family Nurse Practitioner, Geriatric Nurse Practitioner, Psychiatric Nurse Practitioner” or whichever applies to your training.     Thank you', NULL, NULL, '2021-11-10 17:16:26', '2021-11-10 17:16:26'),
(14415, 11056, 20378, NULL, '2021-11-25 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Sub : RE: {EXTERNAL} Re: Delivery Status Notification (Failure) I-Q3-818  Good afternoon!  Hope this email finds you well. Pardon us. Please accept our apology for the delay. Please find the attached Letter of Intent for credentialing.  Furthermore, any documents or information is required don\'t hesitate to contact us.  Thank you! Have a wonderful day!', NULL, NULL, '2021-11-18 18:04:04', '2021-11-18 18:04:04'),
(14416, 11056, 20378, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email sent to:  TXCredentialing@amerigroup.com  Sub:  RE: {EXTERNAL} Re: Delivery Status Notification (Failure) I-Q3-818  Good afternoon!  Hope this email finds you well. Please provide me with the latest updates on the credentialing process of the provider, Segun Adeoye under the facility, Nasa Health Clinic.  Eagerly, waiting for your reply.  Thank you!', NULL, NULL, '2021-12-03 17:57:59', '2021-12-03 17:57:59'),
(14417, 11056, 20378, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Sub: RE: {EXTERNAL} Re: Delivery Status Notification (Failure) I-Q3-818   Good afternoon!  Hope you are doing great. Please provide me with the welcome letter & effective dates for the provider & practice. Please expedite my request for processing.  Group Name	Nasa Health Clinic Tax ID	47-2682655 Group NPI	1740661453 Primary Location	985 NASA Parkway, Houston, TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025  In the meantime, please do not hesitate to reach out if you have any questions or concerns.  Thank you! Have a wonderful weekend!  Voice msgs have been left out.', NULL, NULL, '2021-12-14 17:46:46', '2021-12-14 17:46:46'),
(14418, 11056, 20378, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Rep: Madonna h & Jennifer P  Status:  1st one rep didn\'t find the provider in her system. Second one found the provider with only the secondary location and with only Nasa Health Clinic Tax ID. File is in the credentaling.  Ref code: 12202021', NULL, NULL, '2021-12-20 10:24:52', '2021-12-20 10:24:52'),
(14419, 11056, 20378, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Sub: RE: {EXTERNAL} Re: Delivery Status Notification (Failure) I-Q3-818   Good afternoon!  Hope all is well with you. I am still waiting to get the latest updates on the applications as well as on the facilities Nasa Health Clinic and Nasa Urgent care Inc.s\' Credentialing accomplishments yet. Please try to cope up with us through emails as your contact no.s aren\'t responded to us by anyone except the voice recorders. And we have left out so many Voice mails for the updates of the enrollment process, But haven\'t got the response yet.  Kindly respond to us as soon as possible. Please don\'t test our patience.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-23 09:38:48', '2021-12-23 09:38:48'),
(14420, 19067, 20378, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Subject: Enrollment Query || NASA Health Clinic || Segun Adeoye & Groups || Ameri Group ||  Hello!  Hope you are doing well.  I would like to know the enrollment status of the following Provider and Group as well with Ameri Group.   Group Name	Nasa Health Clinic Tax ID	47-2682655 Group NPI	1740661453 Provider Name	NPI	Location Segun Adeoye	1629418025	985 NASA Parkway Houston, TX 77058-3039 Segun Adeoye	1629418025	3623 S. Main St. Suite 109, Stafford, TX 77477-5406   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-30 14:00:10', '2021-12-30 14:00:10'),
(14421, 19067, 20378, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Subject: Enrollment Query || NASA Health Clinic || Segun Adeoye & Groups || Ameri Group ||   Hello!  Any update on below mentioned Providers.  Eagerly waiting for your response.  Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-06 17:50:54', '2022-01-06 17:50:54'),
(14422, 3046, 20379, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 17:18:52', '2021-03-12 17:18:52'),
(14423, 1006, 20379, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent enrollment query @ Provider Relations - South pr.south@healthsmart.com:  Sub: Enrollment & Location Status Query - NASA HealthClinic - HealthSmart  \"Hello,   I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Health Smart and if the mentioned addresses are also correctly listed under them:  Group Name: Nasa Health Clinic NPI# 1740661453 TIN# 47-2682655  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to.   Thank you. \"', NULL, NULL, '2021-06-07 18:05:16', '2021-06-07 18:05:16'),
(14424, 1006, 20379, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Sent f/u email at corrected email @ credentialing@anci-care.com & VIPproviders@anci-care.com:  Sub; Enrollment & Location Status Query - NASA HealthClinic - Anci-Care  \"Hello,    I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Anci-Care and if the mentioned addresses are also correctly listed under them:  Group Name: Nasa Health Clinic NPI# 1740661453 TIN# 47-2682655  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to.   Thank you.\"', NULL, NULL, '2021-06-28 13:38:02', '2021-06-28 13:38:02'),
(14425, 11056, 20379, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to : credentialing@anci-care.com   &   VIPproviders@anci-care.com  Sub :  Enrollment & Location Status Query - NASA HealthClinic - Anci-Care  Greetings,  I hope you\'re doing well. We wanted to verify if the following group and provider were enrolled with Health Smart and if the mentioned addresses are also correctly listed under them. If not then guide me the procedure for enrollment soon.  Practice Details: Practice Name: Nasa Health Clinic Practice NPI# : 1740661453 Practice TIN# : 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider: Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-07-19 16:22:08', '2021-07-19 16:22:08'),
(14426, 11056, 20379, NULL, '2021-08-10 00:00:00.000', 'In Process', 'Email sent to :   credentialing@anci-care.com,    ACS VIP Providers  VIPproviders@anci-care.com,  &  Jennifer MaligayaACS  jmaligaya@anci-care.com   Sub : Enrollment & Location Status Query - NASA HealthClinic - Anci-Care  Greetings,  I hope you\'re doing well. We wanted to verify if the following group and provider were enrolled with Anci Care and if the mentioned addresses are also correctly listed under them. If not then guide me the procedure for enrollment soon.  Practice Details: Practice Name: Nasa Health Clinic Practice NPI# : 1740661453 Practice TIN# : 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider: Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-03 09:02:52', '2021-08-03 09:02:52'),
(14427, 11056, 20379, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Waiting for the Segun\'s Malpractice for the forms to be submitted. Contacted alot but haven\'t responded back yet', NULL, NULL, '2021-08-25 16:16:05', '2021-08-25 16:16:05'),
(14428, 11056, 20379, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Email received from : pdavidson@anci-care.com  Sub : Enrollment & Location Status Query - NASA HealthClinic - Anci-Care  Hi.  The Agreement Packet for Nasa Urgent Care was sent to Brad.  I have not received it back signed for processing.  Nasa Health Clinic – primary healthcare clinic – not Urgent Care.  ACS only contracts with ancillary providers such as Urgent Care or Walk in Clinic not primary healthcare.  Practice Details: Practice Name: Nasa Health Clinic Practice NPI# : 1740661453 Practice TIN# : 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406   Thank you, Patti Davidson | Manager, Network Development HealthSmart | Network Solutions Office: 972 388 3091 | Fax: 214 574 1121 patti.davidson@healthsmart.com | www.HealthSmart.com', NULL, NULL, '2021-09-22 14:52:32', '2021-09-22 14:52:32');
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
(14429, 11056, 20379, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email received from : pdavidson@anci-care.com  Sub : NASA HealthClinic - Anci-Care  Hi.  Please see attached.  Email to my attention:  patti.davidson@healthsmart.com  Thank you,  Patti Davidson | Manager, Network Development HealthSmart | Network Solutions Office: 972 388 3091 | Fax: 214 574 1121 patti.davidson@healthsmart.com | www.HealthSmart.com', NULL, NULL, '2021-10-08 08:31:08', '2021-10-08 08:31:08'),
(14430, 11056, 20379, NULL, '2021-10-22 00:00:00.000', 'In Process', 'Email sent to : 	Patti DavidsonACS pdavidson@anci-care.com & patti.davidson@healthsmart.com  Sub  : NASA HealthClinic - Anci-Care  Good morning Patti!  Hope this email finds you well. Here are the documents you requested for the following Practice enrollment and contracting with Anci-Care. If any corrections are needed please let me know.   Group Name	Nasa Health Clinic Tax ID	47-2682655 Group NPI	1740661453 Primary Location	985 NASA Parkway, Houston , TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider Name	NPI Segun Adeoye	1629418025   If you need any further information or documents feel free to reach out to me. Please see the attachments. Thank you! Have a blessed day!', NULL, NULL, '2021-10-15 16:52:31', '2021-10-15 16:52:31'),
(14431, 11056, 20379, NULL, '2021-11-01 00:00:00.000', 'In Process', 'Email received from : pdavidson@anci-care.com  Sub : NASA HealthClinic - Anci-Care  Ahmed,  Hi.   Please complete the ACS Application questions:   PROVIDER APPLICATION CONFIDENTIAL INFORMATION  Resend to me and copy:  Leslie.perez@healthsmart.com For Credentialing processing.', NULL, NULL, '2021-10-25 16:07:00', '2021-10-25 16:07:00'),
(14432, 11056, 20379, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email sent to: Leslie.perez@healthsmart.com  Sub: NASA HealthClinic - Anci-Care  Good morning Leslie!  Hope this email finds you well. Please find the attached PROVIDER APPLICATION form for the credentialing process of Nasa Health Clinic. If any corrections or documents are required please let me know.   Thank you! Have a great day! ', NULL, NULL, '2021-11-11 10:31:44', '2021-11-11 10:31:44'),
(14433, 11056, 20379, NULL, '2021-11-22 00:00:00.000', 'On Hold', 'Email received from:  Leslie.Perez@healthsmart.com  Sub : NASA HealthClinic - Anci-Care   Hello,     The approval for this facility will be on hold until I receive the information requested to complete processing.     Once you receive a copy please send me a copy.   emailed to Mr. Segun on 21, Sept,2021:  Good morning Sir!  Hope you are doing great and had a wonderful week yet.  We have not received the documents below that are necessary to complete the credentialing process yet.  DOCUMENTS IN DEMAND: 1. Business License  2. Accreditation letter.  3. CLIA  ( for both Nasa Urgent Care & Nasa Health Clinic )  Eagerly, waiting for the documents.  Take Care of yourself!  Thank you! Have a wonderful weekend!   He hasn\'t provided the documents yet.', NULL, NULL, '2021-11-15 15:11:15', '2021-11-15 15:11:15'),
(14434, 3046, 20380, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 17:19:10', '2021-03-12 17:19:10'),
(14435, 1006, 20380, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent enrollment query @ Provider Relations - South pr.south@healthsmart.com:  Sub: Enrollment & Location Status Query - NASA HealthClinic - HealthSmart  \"Hello,   I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Health Smart and if the mentioned addresses are also correctly listed under them:  Group Name: Nasa Health Clinic NPI# 1740661453 TIN# 47-2682655  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to.   Thank you. \"', NULL, NULL, '2021-06-07 18:05:12', '2021-06-07 18:05:12'),
(14436, 1006, 20380, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Sent f/u email at corrected email @ credentialing@anci-care.com & VIPproviders@anci-care.com:  Sub; Enrollment & Location Status Query - NASA HealthClinic - Anci-Care  \"Hello,    I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Anci-Care and if the mentioned addresses are also correctly listed under them:  Group Name: Nasa Health Clinic NPI# 1740661453 TIN# 47-2682655  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to.   Thank you.\"', NULL, NULL, '2021-06-28 13:37:55', '2021-06-28 13:37:55'),
(14437, 11056, 20380, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to : credentialing@anci-care.com   &   VIPproviders@anci-care.com  Sub :  Enrollment & Location Status Query - NASA HealthClinic - Anci-Care  Greetings,  I hope you\'re doing well. We wanted to verify if the following group and provider were enrolled with Health Smart and if the mentioned addresses are also correctly listed under them. If not then guide me the procedure for enrollment soon.  Practice Details: Practice Name: Nasa Health Clinic Practice NPI# : 1740661453 Practice TIN# : 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider: Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-07-19 16:21:49', '2021-07-19 16:21:49'),
(14438, 11056, 20380, NULL, '2021-08-10 00:00:00.000', 'In Process', 'Email sent to :   credentialing@anci-care.com,    ACS VIP Providers  VIPproviders@anci-care.com,  &  Jennifer MaligayaACS  jmaligaya@anci-care.com   Sub : Enrollment & Location Status Query - NASA HealthClinic - Anci-Care  Greetings,  I hope you\'re doing well. We wanted to verify if the following group and provider were enrolled with Anci Care and if the mentioned addresses are also correctly listed under them. If not then guide me the procedure for enrollment soon.  Practice Details: Practice Name: Nasa Health Clinic Practice NPI# : 1740661453 Practice TIN# : 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider: Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-03 09:02:34', '2021-08-03 09:02:34'),
(14439, 11056, 20380, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Waiting for the Segun\'s Malpractice for the forms to be submitted. Contacted alot but haven\'t responded back yet', NULL, NULL, '2021-08-25 16:16:00', '2021-08-25 16:16:00'),
(14440, 11056, 20380, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Email received from : pdavidson@anci-care.com  Sub : Enrollment & Location Status Query - NASA HealthClinic - Anci-Care  Hi.  The Agreement Packet for Nasa Urgent Care was sent to Brad.  I have not received it back signed for processing.  Nasa Health Clinic – primary healthcare clinic – not Urgent Care.  ACS only contracts with ancillary providers such as Urgent Care or Walk in Clinic not primary healthcare.  Practice Details: Practice Name: Nasa Health Clinic Practice NPI# : 1740661453 Practice TIN# : 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406   Thank you, Patti Davidson | Manager, Network Development HealthSmart | Network Solutions Office: 972 388 3091 | Fax: 214 574 1121 patti.davidson@healthsmart.com | www.HealthSmart.com', NULL, NULL, '2021-09-22 14:52:25', '2021-09-22 14:52:25'),
(14441, 11056, 20380, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email received from : pdavidson@anci-care.com  Sub : NASA HealthClinic - Anci-Care  Hi.  Please see attached.  Email to my attention:  patti.davidson@healthsmart.com  Thank you,  Patti Davidson | Manager, Network Development HealthSmart | Network Solutions Office: 972 388 3091 | Fax: 214 574 1121 patti.davidson@healthsmart.com | www.HealthSmart.com', NULL, NULL, '2021-10-08 08:30:53', '2021-10-08 08:30:53'),
(14442, 11056, 20380, NULL, '2021-10-22 00:00:00.000', 'In Process', 'Email sent to : 	Patti DavidsonACS pdavidson@anci-care.com & patti.davidson@healthsmart.com  Sub  : NASA HealthClinic - Anci-Care  Good morning Patti!  Hope this email finds you well. Here are the documents you requested for the following Practice enrollment and contracting with Anci-Care. If any corrections are needed please let me know.   Group Name	Nasa Health Clinic Tax ID	47-2682655 Group NPI	1740661453 Primary Location	985 NASA Parkway, Houston , TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider Name	NPI Segun Adeoye	1629418025   If you need any further information or documents feel free to reach out to me. Please see the attachments. Thank you! Have a blessed day!', NULL, NULL, '2021-10-15 16:52:18', '2021-10-15 16:52:18'),
(14443, 11056, 20380, NULL, '2021-11-01 00:00:00.000', 'In Process', 'Email received from : pdavidson@anci-care.com  Sub : NASA HealthClinic - Anci-Care  Ahmed,  Hi.   Please complete the ACS Application questions:   PROVIDER APPLICATION CONFIDENTIAL INFORMATION  Resend to me and copy:  Leslie.perez@healthsmart.com For Credentialing processing.', NULL, NULL, '2021-10-25 16:06:55', '2021-10-25 16:06:55'),
(14444, 11056, 20380, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email sent to: Leslie.perez@healthsmart.com  Sub: NASA HealthClinic - Anci-Care  Good morning Leslie!  Hope this email finds you well. Please find the attached PROVIDER APPLICATION form for the credentialing process of Nasa Health Clinic. If any corrections or documents are required please let me know.   Thank you! Have a great day! ', NULL, NULL, '2021-11-11 10:31:34', '2021-11-11 10:31:34'),
(14445, 11056, 20380, NULL, '2021-11-22 00:00:00.000', 'On Hold', 'Email received from:  Leslie.Perez@healthsmart.com  Sub : NASA HealthClinic - Anci-Care   Hello,     The approval for this facility will be on hold until I receive the information requested to complete processing.     Once you receive a copy please send me a copy.   emailed to Mr. Segun on 21, Sept,2021:  Good morning Sir!  Hope you are doing great and had a wonderful week yet.  We have not received the documents below that are necessary to complete the credentialing process yet.  DOCUMENTS IN DEMAND: 1. Business License  2. Accreditation letter.  3. CLIA  ( for both Nasa Urgent Care & Nasa Health Clinic )  Eagerly, waiting for the documents.  Take Care of yourself!  Thank you! Have a wonderful weekend!   He hasn\'t provided the documents yet.', NULL, NULL, '2021-11-15 15:11:34', '2021-11-15 15:11:34'),
(14446, 3046, 20381, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 17:20:38', '2021-03-12 17:20:38'),
(14447, 1006, 20381, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent query @ ProfessionalProviderNetworkDept@bcbstx.com:  Sub: Enrollment & Location Status Query - NASA Healthclinic - BCBSTX  \"Hello,   I hope you\'re doing well, we wanted to verify if the following groups and provider were enrolled with BCBSTX and if the mentioned addresses were also correctly listed under them:  Group Name: Nasa Health Clinic NPI# 1740661453 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 16:49:54', '2021-06-07 16:49:54'),
(14448, 1006, 20381, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Sent f/u email @ ProfessionalProviderNetworkDept@bcbstx.com:  Sub: Enrollment & Location Status Query - NASA Healthclinic - BCBSTX  \"Hello,   We\'re still waiting for an update regarding the enrollment status of the mentioned group and provider, please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-06-28 10:25:03', '2021-06-28 10:25:03'),
(14449, 11056, 20381, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Email sent to : ProfessionalProviderNetworkDept@bcbstx.com  Sub : Enrollment & Location Status Query - NASA UrgentCare - BCBSTX  Good Afternoon!  I hope you\'re doing well. Kindly respond to us soon .We wanted to verify if the following groups and provider were enrolled with BCBSTX and if the mentioned addresses were also correctly listed under them:  Group Name: Nasa Health Clinic NPI# 1740661453 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as possible. Eagerly waiting to hear back from you.  Thank you! Have a great day!', NULL, NULL, '2021-07-22 16:39:44', '2021-07-22 16:39:44'),
(14450, 11056, 20381, NULL, '2021-08-05 00:00:00.000', 'Approved', 'Email received from : provider_relations_houston@bcbstx.com  Sub : Enrollment & Location Status Query - NASA Healthclinic - BCBSTX : Case Number - 02652508  Good Evening,  Please see attached provider roster report for your group.  If any changes need to be made, please email your provider rep. Angie Cardenas (Angie_Cardenas@bcbstx.com).  Have a great day!  Best Regards,   Provider Relations-Houston BlueCross BlueShield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company 1800 West Loop South, Suite 600, Houston, TX. 77027 Office: 713.663.1149 | Fax: 713.663.1227 | Email: Provider_Relations_Houston@bcbstx.com Visit our website:  www.bcbstx.com Experience.  Wellness.  Everywhere.', NULL, NULL, '2021-07-29 09:21:04', '2021-07-29 09:21:04'),
(14451, 3046, 20382, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 17:20:45', '2021-03-12 17:20:45'),
(14452, 1006, 20382, NULL, '2021-06-14 00:00:00.000', 'Not Eligible', 'Redundant task, plan is covered under BCBSTX. ', NULL, NULL, '2021-06-07 16:40:18', '2021-06-07 16:40:18'),
(14453, 3046, 20383, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 17:30:55', '2021-03-12 17:30:55'),
(14454, 1006, 20383, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent following query @ PDM COGZ PDMCOGZ@cigna.com:  Sub: Enrollment & Location Status Query - NASA HealthClinic- Cigna  \"Hello,  I hope you\'re doing well, we wanted to verify if the following groups and provider were enrolled with Cigna and if the mentioned addresses were also correctly listed under them:  Group Name: Nasa Health Clinic NPI# 1740661453 TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 17:05:34', '2021-06-07 17:05:34'),
(14455, 1006, 20383, NULL, '2021-07-05 00:00:00.000', 'Approved', 'The following approval confirmation was received:   \"Dear Healthcare Professional  Provider Name / Group Name  CPF Provider ID/NPI  Completed:   Yes or No.  Transaction Type  Effective date  (If No, give reason as to Why)  SEGUN ADEOYE  5883559  YES  UPDATE  6/9/2021  Thank you for your submission. This is to confirm that your request has been completed. Please do not reply to this email message. The return address is not monitored. All future requests should be sent to Intake_PDM@cigna.com\"  Regards, PDM\"  Location confirmation is attached for reference.  ', NULL, NULL, '2021-06-28 13:13:04', '2021-06-28 13:13:04'),
(14456, 3046, 20384, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 17:31:09', '2021-03-12 17:31:09'),
(14457, 1006, 20384, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent following query @ PDM COGZ PDMCOGZ@cigna.com:  Sub: Enrollment & Location Status Query - NASA HealthClinic- Cigna  \"Hello,  I hope you\'re doing well, we wanted to verify if the following groups and provider were enrolled with Cigna and if the mentioned addresses were also correctly listed under them:  Group Name: Nasa Health Clinic NPI# 1740661453 TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 17:05:28', '2021-06-07 17:05:28'),
(14458, 1006, 20384, NULL, '2021-07-05 00:00:00.000', 'Approved', 'The following approval confirmation was received:   \"Dear Healthcare Professional  Provider Name / Group Name  CPF Provider ID/NPI  Completed:   Yes or No.  Transaction Type  Effective date  (If No, give reason as to Why)  SEGUN ADEOYE  5883559  YES  UPDATE  6/9/2021  Thank you for your submission. This is to confirm that your request has been completed. Please do not reply to this email message. The return address is not monitored. All future requests should be sent to Intake_PDM@cigna.com\"  Regards, PDM\"  Location confirmation is attached for reference. ', NULL, NULL, '2021-06-28 13:12:24', '2021-06-28 13:12:24'),
(14459, 3046, 20385, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 17:55:41', '2021-03-12 17:55:41'),
(14460, 1006, 20385, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent following enrollment query @ CHC Contracting CHC.Contracting@CommunityHealthChoice.org:  Sub: Enrollment & Location Status Query - NASA HealthClinic - Community Health Choice  \"Hello,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Community Health Choice and if the mentioned addresses are also correctly listed under them: Group Name: Nasa Health ClinicNPI# 1740661453TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Provider Name: Segun AdeoyeNPI# 1629418025 Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 18:08:41', '2021-06-07 18:08:41'),
(14461, 1006, 20385, NULL, '2021-07-05 00:00:00.000', 'Approved', 'We received the following approval confirmation from CHC Contracting CHC.Contracting@communityhealthchoice.org:  Sub: Enrollment & Location Status Query - NASA HealthClinic - Community Health Choice  \"Good Morning,  After review, we have determined Segun Adeoye to be participating under NASA Health Clinic (47-2682655). The effective date varies by line of business, which can be found on the attached Provider Profile. Please see attached for your records.  Should you require further assistance, please do not hesitate to contact us.  Best Regards, Contracting Dept.\"  Approval roster attached for reference. ', NULL, NULL, '2021-06-28 13:44:23', '2021-06-28 13:44:23'),
(14462, 3046, 20386, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 17:55:43', '2021-03-12 17:55:43'),
(14463, 1006, 20386, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent following enrollment query @ CHC Contracting CHC.Contracting@CommunityHealthChoice.org:  Sub: Enrollment & Location Status Query - NASA HealthClinic - Community Health Choice  \"Hello,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Community Health Choice and if the mentioned addresses are also correctly listed under them: Group Name: Nasa Health ClinicNPI# 1740661453TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Provider Name: Segun AdeoyeNPI# 1629418025 Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 18:08:45', '2021-06-07 18:08:45'),
(14464, 1006, 20386, NULL, '2021-07-05 00:00:00.000', 'Approved', 'We received the following approval confirmation from CHC Contracting CHC.Contracting@communityhealthchoice.org:  Sub: Enrollment & Location Status Query - NASA HealthClinic - Community Health Choice  \"Good Morning,  After review, we have determined Segun Adeoye to be participating under NASA Health Clinic (47-2682655). The effective date varies by line of business, which can be found on the attached Provider Profile. Please see attached for your records.  Should you require further assistance, please do not hesitate to contact us.  Best Regards, Contracting Dept.\"  Approval roster attached for reference. ', NULL, NULL, '2021-06-28 13:44:01', '2021-06-28 13:44:01'),
(14465, 3046, 20387, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 17:56:25', '2021-03-12 17:56:25'),
(14466, 1006, 20387, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent enrollment request @ SWHP PROVIDER SERVICES SWHPPROVSERVICES@bswhealth.org:  Sub: Enrollment & Location Status Query - NASA HealthClinic - Scott & White  \"Hello,  I hope you\'re doing well, we wanted to enroll the following group and provider with Scott & White under the mentioned addresses, their information is as follows: Group Name: Nasa Health ClinicNPI# 1740661453TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Provider Name: Segun AdeoyeNPI# 1629418025 Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 18:13:31', '2021-06-07 18:13:31'),
(14467, 1006, 20387, NULL, '2021-07-05 00:00:00.000', 'In Process', 'We received the following reply from SWHP PROVIDER SERVICES SWHPPROVSERVICES@bswhealth.org:  Sub: Enrollment & Location Status Query - NASA HealthClinic - Scott & White  \"Good morning Brad,  I do not show TIN 472682655 as contracted with SWHP/FC.  In order to join the network, you would need to click on the link below and submit a request to join our network.  Someone from our contracting department will then reach out to you once your information has been reviewed.  https://swhp.org/en-us/prov/provider-account-management#prov-join  Thank you so much,  Lacey B\"  Form filled out and attached in main group task for reference.   \"Success! Thank you again for your interest in becoming a Scott and White Health Plan contracted provider.  Please allow 30-45 days before checking on status.  Your form submission identifier is: b0c9167f-ad67-48fa-be7a-d1d59db6a17f\"', NULL, NULL, '2021-06-28 09:06:29', '2021-06-28 09:06:29'),
(14468, 11056, 20387, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to  : SWHPPROVSERVICES@bswhealth.org  Sub : Enrollment & Location Status Query - NASA HealthClinic - Scott & White  Greetings,  Hope you are doing well. Could you Please let me know the current status of our Credentialing request and inform us as soon as possible.I have mentioned the details below of our group and providers :  Practice Details: Practice Name: Nasa Health Clinic Practice NPI# : 1740661453 Practice TIN# : 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider: Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-07-19 16:04:02', '2021-07-19 16:04:02'),
(14469, 11056, 20387, NULL, '2021-08-07 00:00:00.000', 'In Process', 'Email received from : SWHPPROVSERVICES@bswhealth.org  Sub : Enrollment & Location Status Query - NASA HealthClinic - Scott & White  Good afternoon,     I do not show that TIN 472682655 is currently contracted in our system.  If you have submitted a request to join our network, you will need to reach out to your contact for the new contract for a status request.  Unfortunately, this department only handles requests after the group/provider has been contracted and credentialed, and don’t have access to the systems that our contracting and credentialing teams use.   Thank you so much,     Lacey B', NULL, NULL, '2021-07-30 17:28:08', '2021-07-30 17:28:08'),
(14470, 1006, 20387, NULL, '2021-08-10 00:00:00.000', 'Not Eligible', 'We received the following denial notification from SWHPPROVIDERNETWORKDEVELOPMENT@bswhealth.org:  Sub: New Contract Request  \"Tax ID#: 47-2682655  RE: Network Denial Letter  Dear Nasa Health Clinic  Thank you for your recent application.  Scott and White Health Plans (SWHP) and SHA, LLC dba FirstCare Health Plans (FirstCare) appreciates your interest in becoming a part of our network.  After reviewing your online application to contract submitted on 06/28/2021,  SWHP and FirstCare regretfully declines to contract with Nasa Health Clinic at this time. The determination was made based on our current network needs. However, we encourage you to reapply in 6 months; as those needs may change.  For commercial providers, we welcome you to review 28 TAC 3.3706 for more detail on denial review.  Thank you again for your interest in SWHP and FirstCare Health Plans.  Best Regards,  Scott and White Health Plans |SHA, LLC dba FirstCare Health Plans Network Development Department 1206 West Campus Dr. Temple, Texas 76502\"', NULL, NULL, '2021-08-03 14:30:15', '2021-08-03 14:30:15'),
(14471, 3046, 20388, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 17:56:28', '2021-03-12 17:56:28'),
(14472, 1006, 20388, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent enrollment request @ SWHP PROVIDER SERVICES SWHPPROVSERVICES@bswhealth.org:  Sub: Enrollment & Location Status Query - NASA HealthClinic - Scott & White  \"Hello,  I hope you\'re doing well, we wanted to enroll the following group and provider with Scott & White under the mentioned addresses, their information is as follows: Group Name: Nasa Health ClinicNPI# 1740661453TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Provider Name: Segun AdeoyeNPI# 1629418025 Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 18:13:35', '2021-06-07 18:13:35'),
(14473, 1006, 20388, NULL, '2021-07-05 00:00:00.000', 'In Process', 'We received the following reply from SWHP PROVIDER SERVICES SWHPPROVSERVICES@bswhealth.org:  Sub: Enrollment & Location Status Query - NASA HealthClinic - Scott & White  \"Good morning Brad,  I do not show TIN 472682655 as contracted with SWHP/FC.  In order to join the network, you would need to click on the link below and submit a request to join our network.  Someone from our contracting department will then reach out to you once your information has been reviewed.  https://swhp.org/en-us/prov/provider-account-management#prov-join  Thank you so much,  Lacey B\"  Form filled out and attached in main group task for reference.   \"Success! Thank you again for your interest in becoming a Scott and White Health Plan contracted provider.  Please allow 30-45 days before checking on status.  Your form submission identifier is: b0c9167f-ad67-48fa-be7a-d1d59db6a17f\"', NULL, NULL, '2021-06-28 09:06:42', '2021-06-28 09:06:42'),
(14474, 11056, 20388, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to  : SWHPPROVSERVICES@bswhealth.org  Sub : Enrollment & Location Status Query - NASA HealthClinic - Scott & White  Greetings,  Hope you are doing well. Could you Please let me know the current status of our Credentialing request and inform us as soon as possible.I have mentioned the details below of our group and providers :  Practice Details: Practice Name: Nasa Health Clinic Practice NPI# : 1740661453 Practice TIN# : 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider: Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-07-19 16:03:39', '2021-07-19 16:03:39'),
(14475, 11056, 20388, NULL, '2021-08-07 00:00:00.000', 'In Process', 'Email received from : SWHPPROVSERVICES@bswhealth.org  Sub : Enrollment & Location Status Query - NASA HealthClinic - Scott & White  Good afternoon,     I do not show that TIN 472682655 is currently contracted in our system.  If you have submitted a request to join our network, you will need to reach out to your contact for the new contract for a status request.  Unfortunately, this department only handles requests after the group/provider has been contracted and credentialed, and don’t have access to the systems that our contracting and credentialing teams use.   Thank you so much,     Lacey B', NULL, NULL, '2021-07-30 17:27:54', '2021-07-30 17:27:54'),
(14476, 1006, 20388, NULL, '2021-08-10 00:00:00.000', 'Not Eligible', 'We received the following denial notification from SWHPPROVIDERNETWORKDEVELOPMENT@bswhealth.org:  Sub: New Contract Request  \"Tax ID#: 47-2682655  RE: Network Denial Letter  Dear Nasa Health Clinic  Thank you for your recent application.  Scott and White Health Plans (SWHP) and SHA, LLC dba FirstCare Health Plans (FirstCare) appreciates your interest in becoming a part of our network.  After reviewing your online application to contract submitted on 06/28/2021,  SWHP and FirstCare regretfully declines to contract with Nasa Health Clinic at this time. The determination was made based on our current network needs. However, we encourage you to reapply in 6 months; as those needs may change.  For commercial providers, we welcome you to review 28 TAC 3.3706 for more detail on denial review.  Thank you again for your interest in SWHP and FirstCare Health Plans.  Best Regards,  Scott and White Health Plans |SHA, LLC dba FirstCare Health Plans Network Development Department 1206 West Campus Dr. Temple, Texas 76502\"', NULL, NULL, '2021-08-03 14:30:09', '2021-08-03 14:30:09'),
(14477, 3046, 20389, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 17:59:58', '2021-03-12 17:59:58'),
(14478, 1006, 20389, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent following query @ pdsdallas@aetna.com:  Sub: Enrollment & Location Status Query - NASA HealthClinic - First Health  \"Hello,  I hope you\'re doing well, we wanted to verify if the following groups and provider were enrolled with Cigna and if the mentioned addresses were also correctly listed under them:  Group Name: Nasa Health Clinic NPI# 1740661453 TIN# 47-2682655  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 17:15:54', '2021-06-07 17:15:54'),
(14479, 1006, 20389, NULL, '2021-06-28 00:00:00.000', 'In Process', 'We received the following reply from BharathB@aetna.com:  Sub: Re: RE {SEND SECURE} Enrollment & Location Status Query - NASA HealthClinic - First Health  \"Hi Brad,  Please find the status of below provider as per requested.  S.no  Provider Name  NPI  Cpd Id  TIN  Effective date  1  Adeoye, Segun P  1629418025  2679981  472682655  Tax Id not linked   Regards, Bharath\"  Sent reply:   \"Hello Bollu,  Please let me know what is required to link the provider to the group TIN and update the listed addresses as well? Thank you!\"', NULL, NULL, '2021-06-21 13:23:27', '2021-06-21 13:23:27'),
(14480, 1006, 20389, NULL, '2021-07-15 00:00:00.000', 'In Process', 'Sent f/u email @ Bharath, Bollu bharathb@aetna.com via Aetna Secure Portal https://aetna.login-us.mimecast.com/:  Sub; Re: RE {SEND SECURE} Enrollment & Location Status Query - NASA HealthClinic - First Health  \"Hello Bollu,   I would appreciate it if you can please get back to me ASAP on this request, as it\'s been pending since last month.   Thank you.\"', NULL, NULL, '2021-07-08 12:38:58', '2021-07-08 12:38:58'),
(14481, 11056, 20389, NULL, '2021-08-10 00:00:00.000', 'In Process', 'Email sent to : bharathb@aetna.com  Sub : Enrollment & Location Status Query - NASA HealthClinic - First Health  Greetings!  Hope all is well. Please verify the enrollment of secondary locations of the below mentioned practice:  Practice Details: Practice Name : Nasa Health Clinic Practice NPI# : 1740661453 Practice TIN# : 47-2682655 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider Details: Provider Name: Segun Adeoye Provider NPI # : 1629418025  If you need any documents or information please let me know. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-08-02 16:58:35', '2021-08-02 16:58:35'),
(14482, 11056, 20389, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to : bharathb@aetna.com  &  pdsdallas@aetna.com  Sub : Enrollment & Location Status Query - NASA HealthClinic - First Health  Greetings!  Hope all is well. Please verify the enrollment of secondary locations of the below mentioned practice:  Practice Details: Practice Name : Nasa Health Clinic Practice NPI# : 1740661453 Practice TIN# : 47-2682655 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider Details: Provider Name: Segun Adeoye Provider NPI # : 1629418025  If you need any documents or information please let me know. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-08-18 10:34:41', '2021-08-18 10:34:41'),
(14483, 11056, 20389, NULL, '2021-09-04 00:00:00.000', 'In Process', 'Email sent to : bharathb@aetna.com  &  pdsdallas@aetna.com & SidleyJ1@firsthealth.com  Sub : Enrollment & Location Status Query - NASA HealthClinic - First Health  Greetings!  Hope all is well. Please verify the enrollment of secondary locations of the below mentioned practice:  Practice Details: Practice Name : Nasa Health Clinic Practice NPI# : 1740661453 Practice TIN# : 47-2682655 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider Details: Provider Name: Segun Adeoye Provider NPI # : 1629418025  If you need any documents or information please let me know. Waiting for your response.  Thank you! Have a great day! ', NULL, NULL, '2021-08-27 17:09:21', '2021-08-27 17:09:21'),
(14484, 11056, 20389, NULL, '2021-09-14 00:00:00.000', 'In Process', 'Sent at PDS@aetna.com LOI & W-9 to link the address and provider.  As advised by the call rep. Ropin H Ref code : 83028', NULL, NULL, '2021-09-07 13:25:27', '2021-09-07 13:25:27'),
(14485, 11056, 20389, NULL, '2021-09-23 00:00:00.000', 'In Process', '	 Online Application has been submitted. Because get an update through a rep. Jesse R that the group and provider are not participating.   Please see the attachment.', NULL, NULL, '2021-09-16 09:54:15', '2021-09-16 09:54:15'),
(14486, 11056, 20389, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email received from : sidleyj1@firsthealth.com  Sub : Signature requested on \"TX_Grp_Agmt_Nasa Health Clinic_MRT210\"  Hello,  As a follow-up to my email, attached is the document for your review and signature.   Thank you.  Jeanette Sidley JEANETTE SIDLEY sidleyj1@firsthealth.com  Agreement has been filled and signed.', NULL, NULL, '2021-09-28 16:42:53', '2021-09-28 16:42:53'),
(14487, 11056, 20389, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email received from : adobesign@adobesign.com & sidleyj1@firsthealth.com  Sub : Completed: \"TX_Grp_Agmt_Nasa Health Clinic_MRT210\"  Attached is the final agreement between:  Aetna Segun Adeoye Megan Weatherford   Signed by both sides.', NULL, NULL, '2021-10-08 14:40:24', '2021-10-08 14:40:24'),
(14488, 11056, 20389, NULL, '2021-10-22 00:00:00.000', 'In Process', 'Email sent to : SidleyJ1@firsthealth.com  Sub : Enrollment & Location Status Query - NASA HealthClinic - First Health  Good afternoon!  Hope you are doing great. Please provide me with the welcome letter & effective dates for the provider & practice. Please expedite my request for processing.  Group Name	Nasa Health Clinic Tax ID	47-2682655 Group NPI	1740661453 Primary Location	985 NASA Parkway, Houston , TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025  In the meantime, please do not hesitate to reach out if you have any questions or concerns.  Thank you! Have a wonderful weekend!', NULL, NULL, '2021-10-15 16:27:56', '2021-10-15 16:27:56'),
(14489, 11056, 20389, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email received from  : SidleyJ1@firsthealth.com  Sub : Enrollment & Location Status Query - NASA HealthClinic - First Health  Hello Ahmed,   I hope that this email finds you well!   The effective date for the new group agreement we just established is 11/1/2021. I will be sending over a welcome letter once implementation has reached a certain point.   Please do not hesitate to reach out if you have any questions or concerns.   Take care! Jeanette', NULL, NULL, '2021-10-22 16:43:37', '2021-10-22 16:43:37'),
(14490, 11056, 20389, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email sent to: SidleyJ1@firsthealth.com  Sub : Enrollment & Location Status Query - NASA HealthClinic - First Health  Good afternoon!  Hope this email finds you and your son well. Any updates regarding the implementation? I am still waiting for the welcome letter for the provider, Segun Adeoye with both locations listed on it.  In the meantime, please do not hesitate to reach out if you have any questions or concerns.  Take Care of yourself and your son!  Thank you! Have a blessed weekend!', NULL, NULL, '2021-11-11 10:40:31', '2021-11-11 10:40:31'),
(14491, 11056, 20389, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email received from: SidleyJ1@firsthealth.com  Sub: Enrollment & Location Status Query - NASA HealthClinic - First Health   Good morning,   I hope that this email finds you well!  This contract is still in implementation. I will absolutely send over a welcome letter for the group as soon as it has reached the point to where I have the group ID number.  Have a wonderful day!   Jeanette Sidley 750 Riverpoint Drive  West Sacramento, CA 95605 Phone: 916-374-4876 SidleyJ1@firsthealth.com TX, CO, KS, OK and MI', NULL, NULL, '2021-11-19 10:45:41', '2021-11-19 10:45:41'),
(14492, 11056, 20389, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email sent to:  SidleyJ1@firsthealth.com  Sub:  Enrollment & Location Status Query - NASA HealthClinic - First Health  Good morning Jeanette!  Hope you are having a blessed day. Has the implementation been completed? Have you got the group ID no.? Please respond to my queries and do provide me with the welcome letter.  Take Care!  Thanking you in anticipation.  Have a wonderful day!', NULL, NULL, '2021-12-03 17:54:18', '2021-12-03 17:54:18'),
(14493, 11056, 20389, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email received from: SidleyJ1@firsthealth.com  Sub: Nasa Health Clinic - First Health Network  Hello,  It is with great pleasure to welcome you to the First Health Network. I would like to personally thank you for all of your time and efforts during the contracting process. You should have already received your fully executed copy of the First Health Agreement.  I would like to take a moment to share what to expect next and share important resources with you in order to allow a smooth process as your contract is implemented and beyond.  Next steps:  * While your contract is completely executed, your contract is currently in the process of being implemented in our system and your practitioners may still need to undergo the credentialing process. Please ensure you have updated your CAQH applications and attestations to ensure there will be no delays.  * Please send your provider group additions or terminations to the following email address: pdsdallas@aetna.com. You may reference your CPD ID # 1074093 (which becomes effective 11/01/2021).  * To check on the status of your requests, please contact either our Provider Services department at 800-226-5116 or you can send an inquiry via email to firsthealthcustomerservicemailbox@aetna.com.     * The Provider Services 800-line can also be contacted for questions related to provider effective dates, fee schedules, claim issues, ect. If they are unable to resolve your issue, they will document your concern & Contact information and route it to the appropriate department.     * For credentialing inquiries please contact 800-353-1232. It has been a pleasure working with you and I look forward to a mutually beneficial relationship.     Please feel free to forward this information to anyone that you feel would benefit.     Thank you,', NULL, NULL, '2021-12-14 18:05:38', '2021-12-14 18:05:38'),
(14494, 11056, 20389, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: SidleyJ1@firsthealth.com  Sub: Nasa Health Clinic - First Health Network   Good morning!  Hope you are having a blessed day. Please confirm the secondary location: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Because I am unable to locate it on the first health provider directory.  Please see the attached attachments.  Thank you! Have a great day!', NULL, NULL, '2021-12-23 09:37:04', '2021-12-23 09:37:04'),
(14495, 19067, 20389, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email sent to: SidleyJ1@firsthealth.com  Subject: Enrollment Query || NASA Health Clinic || Segun Adeoye & Group || First Health ||   Hello!  Hope you are doing well.  I would like to know the enrollment status of the following Provider and Group with First Health.  Group Name	Nasa Health Clinic Tax ID	47-2682655 Group NPI	1740661453 Provider Name	NPI	Location Segun Adeoye	1629418025	3623 S. Main St. Suite 109, Stafford, TX 77477-5406   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-30 13:10:01', '2021-12-30 13:10:01'),
(14496, 19067, 20389, NULL, '2022-01-15 00:00:00.000', 'In Process', 'Email sent to: SidleyJ1@firsthealth.com, pdsdallas@aetna.com  Subject: Re: [EXTERNAL] Re: Nasa Health Clinic - First Health Network   Hello! Hope this email finds you well. I want to confirm the secondary location as mentioned in the previous email.And also list the provider Segun Adeoye with this location in the provider directory. Kindly get in touch as soon as you have time. Thanks & Regards,Hammad Ahmed.', NULL, NULL, '2022-01-07 23:34:05', '2022-01-07 23:34:05'),
(14497, 3046, 20390, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 18:00:01', '2021-03-12 18:00:01'),
(14498, 1006, 20390, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent following query @ pdsdallas@aetna.com:  Sub: Enrollment & Location Status Query - NASA HealthClinic - First Health  \"Hello,  I hope you\'re doing well, we wanted to verify if the following groups and provider were enrolled with Cigna and if the mentioned addresses were also correctly listed under them:  Group Name: Nasa Health Clinic NPI# 1740661453 TIN# 47-2682655  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 17:15:49', '2021-06-07 17:15:49'),
(14499, 1006, 20390, NULL, '2021-06-28 00:00:00.000', 'In Process', 'We received the following reply from BharathB@aetna.com:  Sub: Re: RE {SEND SECURE} Enrollment & Location Status Query - NASA HealthClinic - First Health  \"Hi Brad,  Please find the status of below provider as per requested.  S.no  Provider Name  NPI  Cpd Id  TIN  Effective date  1  Adeoye, Segun P  1629418025  2679981  472682655  Tax Id not linked   Regards, Bharath\"  Sent reply:   \"Hello Bollu,  Please let me know what is required to link the provider to the group TIN and update the listed addresses as well? Thank you!\"', NULL, NULL, '2021-06-21 13:23:22', '2021-06-21 13:23:22'),
(14500, 1006, 20390, NULL, '2021-07-15 00:00:00.000', 'In Process', 'Sent f/u email @ Bharath, Bollu bharathb@aetna.com via Aetna Secure Portal https://aetna.login-us.mimecast.com/:  Sub; Re: RE {SEND SECURE} Enrollment & Location Status Query - NASA HealthClinic - First Health  \"Hello Bollu,   I would appreciate it if you can please get back to me ASAP on this request, as it\'s been pending since last month.   Thank you.\"', NULL, NULL, '2021-07-08 12:38:53', '2021-07-08 12:38:53'),
(14501, 11056, 20390, NULL, '2021-08-10 00:00:00.000', 'In Process', 'Email sent to : bharathb@aetna.com  Sub : Enrollment & Location Status Query - NASA HealthClinic - First Health  Greetings!  Hope all is well. Please verify the enrollment of secondary locations of the below mentioned practice:  Practice Details: Practice Name : Nasa Health Clinic Practice NPI# : 1740661453 Practice TIN# : 47-2682655 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider Details: Provider Name: Segun Adeoye Provider NPI # : 1629418025  If you need any documents or information please let me know. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-08-02 16:57:44', '2021-08-02 16:57:44'),
(14502, 11056, 20390, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to : bharathb@aetna.com  &  pdsdallas@aetna.com  Sub : Enrollment & Location Status Query - NASA HealthClinic - First Health  Greetings!  Hope all is well. Please verify the enrollment of secondary locations of the below mentioned practice:  Practice Details: Practice Name : Nasa Health Clinic Practice NPI# : 1740661453 Practice TIN# : 47-2682655 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider Details: Provider Name: Segun Adeoye Provider NPI # : 1629418025  If you need any documents or information please let me know. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-08-18 10:35:02', '2021-08-18 10:35:02'),
(14503, 11056, 20390, NULL, '2021-09-04 00:00:00.000', 'In Process', 'Email sent to : bharathb@aetna.com  &  pdsdallas@aetna.com  Sub : Enrollment & Location Status Query - NASA HealthClinic - First Health  Greetings!  Hope all is well. Please verify the enrollment of secondary locations of the below mentioned practice:  Practice Details: Practice Name : Nasa Health Clinic Practice NPI# : 1740661453 Practice TIN# : 47-2682655 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider Details: Provider Name: Segun Adeoye Provider NPI # : 1629418025  If you need any documents or information please let me know. Waiting for your response.  Thank you! Have a great day!  ', NULL, NULL, '2021-08-27 17:08:51', '2021-08-27 17:08:51'),
(14504, 11056, 20390, NULL, '2021-09-14 00:00:00.000', 'In Process', 'Sent at PDS@aetna.com LOI & W-9 to link the address and provider.  As advised by the call rep. Ropin H Ref code : 83028', NULL, NULL, '2021-09-07 13:25:11', '2021-09-07 13:25:11'),
(14505, 11056, 20390, NULL, '2021-09-23 00:00:00.000', 'In Process', '	 Online Application has been submitted. Because get an update through a rep. Jesse R that the group and provider are not participating.   Please see the attachment.', NULL, NULL, '2021-09-16 09:54:05', '2021-09-16 09:54:05'),
(14506, 11056, 20390, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email received from : sidleyj1@firsthealth.com  Sub : Signature requested on \"TX_Grp_Agmt_Nasa Health Clinic_MRT210\"  Hello,  As a follow-up to my email, attached is the document for your review and signature.   Thank you.  Jeanette Sidley JEANETTE SIDLEY sidleyj1@firsthealth.com  Agreement has been filled and signed.', NULL, NULL, '2021-09-28 16:42:29', '2021-09-28 16:42:29'),
(14507, 11056, 20390, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email received from : sidleyj1@firsthealth.com  Sub : Signature requested on \"TX_Grp_Agmt_Nasa Health Clinic_MRT210\"  Hello,  As a follow-up to my email, attached is the document for your review and signature.   Thank you.  Jeanette Sidley JEANETTE SIDLEY sidleyj1@firsthealth.com  Agreement has been filled and signed.', NULL, NULL, '2021-09-28 16:42:33', '2021-09-28 16:42:33'),
(14508, 11056, 20390, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email received from : adobesign@adobesign.com & sidleyj1@firsthealth.com  Sub : Completed: \"TX_Grp_Agmt_Nasa Health Clinic_MRT210\"  Attached is the final agreement between:  Aetna Segun Adeoye Megan Weatherford   Signed by both sides.', NULL, NULL, '2021-10-08 14:40:14', '2021-10-08 14:40:14'),
(14509, 11056, 20390, NULL, '2021-10-22 00:00:00.000', 'In Process', 'Email sent to : SidleyJ1@firsthealth.com  Sub : Enrollment & Location Status Query - NASA HealthClinic - First Health  Good afternoon!  Hope you are doing great. Please provide me with the welcome letter & effective dates for the provider & practice. Please expedite my request for processing.  Group Name	Nasa Health Clinic Tax ID	47-2682655 Group NPI	1740661453 Primary Location	985 NASA Parkway, Houston , TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025  In the meantime, please do not hesitate to reach out if you have any questions or concerns.  Thank you! Have a wonderful weekend!', NULL, NULL, '2021-10-15 16:27:21', '2021-10-15 16:27:21');
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
(14510, 11056, 20390, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email received from  : SidleyJ1@firsthealth.com  Sub : Enrollment & Location Status Query - NASA HealthClinic - First Health  Hello Ahmed,   I hope that this email finds you well!   The effective date for the new group agreement we just established is 11/1/2021. I will be sending over a welcome letter once implementation has reached a certain point.   Please do not hesitate to reach out if you have any questions or concerns.   Take care! Jeanette', NULL, NULL, '2021-10-22 16:43:31', '2021-10-22 16:43:31'),
(14511, 11056, 20390, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email sent to: SidleyJ1@firsthealth.com  Sub : Enrollment & Location Status Query - NASA HealthClinic - First Health  Good afternoon!  Hope this email finds you and your son well. Any updates regarding the implementation? I am still waiting for the welcome letter for the provider, Segun Adeoye with both locations listed on it.  In the meantime, please do not hesitate to reach out if you have any questions or concerns.  Take Care of yourself and your son!  Thank you! Have a blessed weekend!', NULL, NULL, '2021-11-11 10:40:18', '2021-11-11 10:40:18'),
(14512, 11056, 20390, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email received from: SidleyJ1@firsthealth.com  Sub: Enrollment & Location Status Query - NASA HealthClinic - First Health   Good morning,   I hope that this email finds you well!  This contract is still in implementation. I will absolutely send over a welcome letter for the group as soon as it has reached the point to where I have the group ID number.  Have a wonderful day!   Jeanette Sidley 750 Riverpoint Drive  West Sacramento, CA 95605 Phone: 916-374-4876 SidleyJ1@firsthealth.com TX, CO, KS, OK and MI', NULL, NULL, '2021-11-19 10:45:35', '2021-11-19 10:45:35'),
(14513, 11056, 20390, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email sent to:  SidleyJ1@firsthealth.com  Sub:  Enrollment & Location Status Query - NASA HealthClinic - First Health  Good morning Jeanette!  Hope you are having a blessed day. Has the implementation been completed? Have you got the group ID no.? Please respond to my queries and do provide me with the welcome letter.  Take Care!  Thanking you in anticipation.  Have a wonderful day!', NULL, NULL, '2021-12-03 17:54:13', '2021-12-03 17:54:13'),
(14514, 11056, 20390, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email received from: SidleyJ1@firsthealth.com  Sub: Nasa Health Clinic - First Health Network  Hello,  It is with great pleasure to welcome you to the First Health Network. I would like to personally thank you for all of your time and efforts during the contracting process. You should have already received your fully executed copy of the First Health Agreement.  I would like to take a moment to share what to expect next and share important resources with you in order to allow a smooth process as your contract is implemented and beyond.  Next steps:  * While your contract is completely executed, your contract is currently in the process of being implemented in our system and your practitioners may still need to undergo the credentialing process. Please ensure you have updated your CAQH applications and attestations to ensure there will be no delays.  * Please send your provider group additions or terminations to the following email address: pdsdallas@aetna.com. You may reference your CPD ID # 1074093 (which becomes effective 11/01/2021).  * To check on the status of your requests, please contact either our Provider Services department at 800-226-5116 or you can send an inquiry via email to firsthealthcustomerservicemailbox@aetna.com.     * The Provider Services 800-line can also be contacted for questions related to provider effective dates, fee schedules, claim issues, ect. If they are unable to resolve your issue, they will document your concern & Contact information and route it to the appropriate department.     * For credentialing inquiries please contact 800-353-1232. It has been a pleasure working with you and I look forward to a mutually beneficial relationship.     Please feel free to forward this information to anyone that you feel would benefit.     Thank you,', NULL, NULL, '2021-12-14 18:05:33', '2021-12-14 18:05:33'),
(14515, 11056, 20390, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: SidleyJ1@firsthealth.com  Sub: Nasa Health Clinic - First Health Network   Good morning!  Hope you are having a blessed day. Please confirm the secondary location: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Because I am unable to locate it on the first health provider directory.  Please see the attached attachments.  Thank you! Have a great day!', NULL, NULL, '2021-12-23 09:36:45', '2021-12-23 09:36:45'),
(14516, 19067, 20390, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email sent to: SidleyJ1@firsthealth.com  Subject: Enrollment Query || NASA Health Clinic || Segun Adeoye & Group || First Health ||   Hello!  Hope you are doing well.  I would like to know the enrollment status of the following Provider and Group with First Health.  Group Name	Nasa Health Clinic Tax ID	47-2682655 Group NPI	1740661453 Provider Name	NPI	Location Segun Adeoye	1629418025	3623 S. Main St. Suite 109, Stafford, TX 77477-5406   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-30 13:09:54', '2021-12-30 13:09:54'),
(14517, 19067, 20390, NULL, '2022-01-15 00:00:00.000', 'In Process', 'Email sent to: SidleyJ1@firsthealth.com, pdsdallas@aetna.com  Subject: Re: [EXTERNAL] Re: Nasa Health Clinic - First Health Network   Hello! Hope this email finds you well. I want to confirm the secondary location as mentioned in the previous email.And also list the provider Segun Adeoye with this location in the provider directory. Kindly get in touch as soon as you have time. Thanks & Regards,Hammad Ahmed.', NULL, NULL, '2022-01-07 23:33:54', '2022-01-07 23:33:54'),
(14518, 3046, 20391, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 18:00:41', '2021-03-12 18:00:41'),
(14519, 1006, 20391, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent following enrollment request @ contracting@ghn-mci.com & providers@ghn-mci.com:  Sub: Enrollment Request - NASA HealthClinic - Galaxy Health  \"Hello,  I hope you\'re doing well, we wanted to enroll the following group and provider with Galaxy Health under the mentioned addresses, their information is as follows: Group Name: Nasa Health Clinic NPI# 1740661453 TIN# 47-2682655  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Provider Name: Segun AdeoyeNPI# 1629418025 Please get back to me as soon as you\'re able to.  Thank you.  \"', NULL, NULL, '2021-06-07 17:39:29', '2021-06-07 17:39:29'),
(14520, 11056, 20391, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Email sent to : contracting@ghn-mci.com  Sub : Enrollment Request - NASA Health Clinic- Galaxy Health    Good morning !  Hope you are doing well. I want to inquire about the enrollment status of the provider & group. What is the status of the last email ? You haven\'t responded yet.  Practice: Group Name: Nasa Health Clinic. Practice NPI # : 1740661453 Practice TIN # : 47-2682655 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider:   Provider Name: Segun Adeoye Provider NPI # : 1629418025  Please get back to me as soon as you\'re able to.   Thank you. ', NULL, NULL, '2021-06-25 09:29:04', '2021-06-25 09:29:04'),
(14521, 1006, 20391, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Sent f/u email @ contracting@ghn-mci.com:  Sub: Enrollment Request - NASA Health Clinic- Galaxy Health  \"Hello,   I hope you\'re doing well, I wanted to get an update on the status of this request.   Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-07-14 17:40:02', '2021-07-14 17:40:02'),
(14522, 11056, 20391, NULL, '2021-08-09 00:00:00.000', 'In Process', 'Email sent to : cguerue@ghn-mci.com  Sub : Enrollment Request - NASA Health Clinic- Galaxy Health  Good morning !  Hope you are doing well. I want to inquire about the enrollment status of the provider & group. What is the status of the last email ? You haven\'t responded yet.  Practice: Group Name: Nasa Health Clinic. Practice NPI # : 1740661453 Practice TIN # : 47-2682655 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider:   Provider Name: Segun Adeoye Provider NPI # : 1629418025  If you need any documents or information please let me know. Waiting for your response.   Thank you! Have a nice day!', NULL, NULL, '2021-08-02 11:45:56', '2021-08-02 11:45:56'),
(14523, 11056, 20391, NULL, '2021-08-25 00:00:00.000', 'Approved', 'Approval Email received from : cguerue@ghn-mci.com  Sub : Enrollment Request - NASA Health Clinic- Galaxy Health  Good Morning,  Attached please find a copy of the fully executed agreement for NASA Health Clinic, the effective date for the group is 8/2/21, Dr. Adeoye has been added to the Group/TIN effective 8/2/21 at both locations as well.   Please feel free to contact me with any questions…  Thank you and have a good day!   Please see the attachment.', NULL, NULL, '2021-08-18 10:13:24', '2021-08-18 10:13:24'),
(14524, 3046, 20392, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 18:00:42', '2021-03-12 18:00:42'),
(14525, 1006, 20392, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent following enrollment request @ contracting@ghn-mci.com & providers@ghn-mci.com:  Sub: Enrollment Request - NASA HealthClinic - Galaxy Health  \"Hello,  I hope you\'re doing well, we wanted to enroll the following group and provider with Galaxy Health under the mentioned addresses, their information is as follows: Group Name: Nasa Health Clinic NPI# 1740661453 TIN# 47-2682655  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Provider Name: Segun AdeoyeNPI# 1629418025 Please get back to me as soon as you\'re able to.  Thank you.  \"', NULL, NULL, '2021-06-07 17:39:25', '2021-06-07 17:39:25'),
(14526, 11056, 20392, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Email sent to : contracting@ghn-mci.com  Sub : Enrollment Request - NASA Health Clinic- Galaxy Health    Good morning !  Hope you are doing well. I want to inquire about the enrollment status of the provider & group. What is the status of the last email ? You haven\'t responded yet.  Practice: Group Name: Nasa Health Clinic. Practice NPI # : 1740661453 Practice TIN # : 47-2682655 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider:   Provider Name: Segun Adeoye Provider NPI # : 1629418025  Please get back to me as soon as you\'re able to.   Thank you. ', NULL, NULL, '2021-06-25 09:29:16', '2021-06-25 09:29:16'),
(14527, 1006, 20392, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Sent f/u email @ contracting@ghn-mci.com:  Sub: Enrollment Request - NASA Health Clinic- Galaxy Health  \"Hello,   I hope you\'re doing well, I wanted to get an update on the status of this request.   Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-07-14 17:39:58', '2021-07-14 17:39:58'),
(14528, 11056, 20392, NULL, '2021-08-09 00:00:00.000', 'In Process', 'Email sent to : cguerue@ghn-mci.com  Sub : Enrollment Request - NASA Health Clinic- Galaxy Health  Good morning !  Hope you are doing well. I want to inquire about the enrollment status of the provider & group. What is the status of the last email ? You haven\'t responded yet.  Practice: Group Name: Nasa Health Clinic. Practice NPI # : 1740661453 Practice TIN # : 47-2682655 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider:   Provider Name: Segun Adeoye Provider NPI # : 1629418025  If you need any documents or information please let me know. Waiting for your response.   Thank you! Have a nice day!', NULL, NULL, '2021-08-02 11:45:26', '2021-08-02 11:45:26'),
(14529, 11056, 20392, NULL, '2021-08-25 00:00:00.000', 'Approved', 'Approval Email received from : cguerue@ghn-mci.com  Sub : Enrollment Request - NASA Health Clinic- Galaxy Health  Good Morning,  Attached please find a copy of the fully executed agreement for NASA Health Clinic, the effective date for the group is 8/2/21, Dr. Adeoye has been added to the Group/TIN effective 8/2/21 at both locations as well.   Please feel free to contact me with any questions…  Thank you and have a good day!   Please see the attachment.', NULL, NULL, '2021-08-18 10:12:07', '2021-08-18 10:12:07'),
(14530, 11056, 20392, NULL, '2021-08-25 00:00:00.000', 'Approved', 'Approval Email received from : cguerue@ghn-mci.com  Sub : Enrollment Request - NASA Health Clinic- Galaxy Health  Good Morning,  Attached please find a copy of the fully executed agreement for NASA Health Clinic, the effective date for the group is 8/2/21, Dr. Adeoye has been added to the Group/TIN effective 8/2/21 at both locations as well.   Please feel free to contact me with any questions…  Thank you and have a good day!   Please see the attachment.', NULL, NULL, '2021-08-18 10:12:18', '2021-08-18 10:12:18'),
(14531, 3046, 20393, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 18:01:11', '2021-03-12 18:01:11'),
(14532, 1006, 20393, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent enrollment query @ HumanaHoustonPD humanahoustonpd@humana.com:  Sub: Enrollment & Location Status Query - NASA HealthClinic - Humana  \"Hello,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Humana and if the mentioned addresses were also correctly listed under them:  Group Name: Nasa Health Clinic NPI# 1740661453 TIN# 47-2682655  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 17:28:49', '2021-06-07 17:28:49'),
(14533, 1006, 20393, NULL, '2021-07-05 00:00:00.000', 'In Process', 'We received the following reply from HumanaHoustonPD HumanaHoustonPD@humana.com:  Sub: Enrollment & Location Status Query - NASA HealthClinic - Humana  \"Group is participating with Humana.  Both addresses are correctly listed.  The following addresses are also listed:  1946 Pasadena Blvd Pasadena, TX 77502-2742 2101 Raspberry Ln Pasadena, TX 77502  If these addresses are no longer valid, please provide the date these locations were closed.  HumanaHoustonPD\"  Sent reply:   \"Hello,   I appreciate the reply, could you please let me know what the effective date is for the group and mentioned provider?  Thank you!\"', NULL, NULL, '2021-06-28 10:07:22', '2021-06-28 10:07:22'),
(14534, 11056, 20393, NULL, '2021-08-10 00:00:00.000', 'In Process', 'Email sent to : HumanaHoustonPD@humana.com  Sub : Fwd: Enrollment & Location Status Query - NASA HealthClinic - Humana  Good Afternoon!  Hope all is well. I appreciate the reply, could you please let me know what the effective date is for the group and mentioned provider? Kindly respond to us soon. Eagerly, waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-02 16:33:41', '2021-08-02 16:33:41'),
(14535, 11056, 20393, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email received from : HumanaHoustonPD@humana.com  Sub : Fwd: Enrollment & Location Status Query - NASA HealthClinic - Humana  Please see item highlighted in yellow.      Please read the following instructions carefully:     For the following requests (fee schedules, copies of contracts, network participation, credentialing status, or effective dates) call provider relations at 800-448-6262 or 800-626-2741. All maintenance requests (provider adds, terms and changes)  need to be sent through Humanahoustonpd@humana.com.  Note:  This mailbox is only for these intents (adds, terms, changes). Requests for fee schedules, copies of contracts, network participation, credentialing status, or effective dates will not be processed through this mailbox.  Allow 60 days for processing of new applicants submission. Allow 30 days for processing of terminations and demographic updates. Status requests should be sent on your original email submission for tracking purposes. Please do not send direct emails to associates as there may not be a response to your request, and the request will not be processed.  In addition, please do not cc a Humana associate on your email requests to the above mailbox or this may delay the processing of your request. Disputing a claim paid/denied and appeals: contact humanaproviderservices@humana.com Log on to Humana.com or Availity.com for Provider updates, claim inquiries, eligibility/benefits information, fee schedule inquiries and more! For Humana.com issues and password resets, please call a Humana Web Specialist at 877-845-3480.    Thank you,  HumanaHoustonPD', NULL, NULL, '2021-08-17 13:49:05', '2021-08-17 13:49:05'),
(14536, 11056, 20393, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email received from : HumanaHoustonPD@humana.com  Sub : Fwd: Enrollment & Location Status Query - NASA HealthClinic - Humana  Please see item highlighted in yellow.      Please read the following instructions carefully:     For the following requests (fee schedules, copies of contracts, network participation, credentialing status, or effective dates) call provider relations at 800-448-6262 or 800-626-2741. All maintenance requests (provider adds, terms and changes)  need to be sent through Humanahoustonpd@humana.com.  Note:  This mailbox is only for these intents (adds, terms, changes). Requests for fee schedules, copies of contracts, network participation, credentialing status, or effective dates will not be processed through this mailbox.  Allow 60 days for processing of new applicants submission. Allow 30 days for processing of terminations and demographic updates. Status requests should be sent on your original email submission for tracking purposes. Please do not send direct emails to associates as there may not be a response to your request, and the request will not be processed.  In addition, please do not cc a Humana associate on your email requests to the above mailbox or this may delay the processing of your request. Disputing a claim paid/denied and appeals: contact humanaproviderservices@humana.com Log on to Humana.com or Availity.com for Provider updates, claim inquiries, eligibility/benefits information, fee schedule inquiries and more! For Humana.com issues and password resets, please call a Humana Web Specialist at 877-845-3480.    Thank you,  HumanaHoustonPD', NULL, NULL, '2021-08-17 13:52:36', '2021-08-17 13:52:36'),
(14537, 11056, 20393, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to : humanaproviderservices@humana.com  Sub : Fwd: Enrollment & Location Status Query - NASA HealthClinic - Humana  Good morning!  I hope you\'re doing well. Could you please let me know what the effective date is for the group and mentioned provider?  Practice Details: Practice  Name: Nasa Urgent Care Inc. Practice NPI# : 1821542432 Practice TIN# : 81-3237149 Practice  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Practice  Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Practice Phone # : 2812186777 Practice Fax # : 8666656208  Provider: Provider Name: Segun Adeoye Provider NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-26 16:31:08', '2021-08-26 16:31:08'),
(14538, 11056, 20393, NULL, '2021-09-14 00:00:00.000', 'Approved', 'The provider is IN NETWORK PROVIDER EFF DATE IS : 03/01/2019  The participating plans are :  Humana PPO Humana HMO Humana CHOICE CARE PPO Humana + NETWORK PPO PFFS MEDICARE PPO MEDICARE PPO 2022 MEDICARE PPO/ PPO +   Rep Name : SUMMER REF CODE : 2000199462184  Please see the attachment.', NULL, NULL, '2021-09-07 10:29:00', '2021-09-07 10:29:00'),
(14539, 3046, 20394, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 18:01:13', '2021-03-12 18:01:13'),
(14540, 1006, 20394, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent enrollment query @ HumanaHoustonPD humanahoustonpd@humana.com:  Sub: Enrollment & Location Status Query - NASA HealthClinic - Humana  \"Hello,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Humana and if the mentioned addresses were also correctly listed under them:  Group Name: Nasa Health Clinic NPI# 1740661453 TIN# 47-2682655  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 17:28:43', '2021-06-07 17:28:43'),
(14541, 1006, 20394, NULL, '2021-07-05 00:00:00.000', 'In Process', 'We received the following reply from HumanaHoustonPD HumanaHoustonPD@humana.com:  Sub: Enrollment & Location Status Query - NASA HealthClinic - Humana  \"Group is participating with Humana.  Both addresses are correctly listed.  The following addresses are also listed:  1946 Pasadena Blvd Pasadena, TX 77502-2742 2101 Raspberry Ln Pasadena, TX 77502  If these addresses are no longer valid, please provide the date these locations were closed.  HumanaHoustonPD\"  Sent reply:   \"Hello,   I appreciate the reply, could you please let me know what the effective date is for the group and mentioned provider?  Thank you!\"', NULL, NULL, '2021-06-28 10:07:25', '2021-06-28 10:07:25'),
(14542, 11056, 20394, NULL, '2021-08-10 00:00:00.000', 'In Process', 'Email sent to : HumanaHoustonPD@humana.com  Sub : Fwd: Enrollment & Location Status Query - NASA HealthClinic - Humana  Good Afternoon!  Hope all is well. I appreciate the reply, could you please let me know what the effective date is for the group and mentioned provider? Kindly respond to us soon. Eagerly, waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-03 08:32:35', '2021-08-03 08:32:35'),
(14543, 11056, 20394, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email received from : HumanaHoustonPD@humana.com  Sub : Fwd: Enrollment & Location Status Query - NASA HealthClinic - Humana  Please see item highlighted in yellow.      Please read the following instructions carefully:     For the following requests (fee schedules, copies of contracts, network participation, credentialing status, or effective dates) call provider relations at 800-448-6262 or 800-626-2741. All maintenance requests (provider adds, terms and changes)  need to be sent through Humanahoustonpd@humana.com.  Note:  This mailbox is only for these intents (adds, terms, changes). Requests for fee schedules, copies of contracts, network participation, credentialing status, or effective dates will not be processed through this mailbox.  Allow 60 days for processing of new applicants submission. Allow 30 days for processing of terminations and demographic updates. Status requests should be sent on your original email submission for tracking purposes. Please do not send direct emails to associates as there may not be a response to your request, and the request will not be processed.  In addition, please do not cc a Humana associate on your email requests to the above mailbox or this may delay the processing of your request. Disputing a claim paid/denied and appeals: contact humanaproviderservices@humana.com Log on to Humana.com or Availity.com for Provider updates, claim inquiries, eligibility/benefits information, fee schedule inquiries and more! For Humana.com issues and password resets, please call a Humana Web Specialist at 877-845-3480.    Thank you,  HumanaHoustonPD', NULL, NULL, '2021-08-17 13:48:45', '2021-08-17 13:48:45'),
(14544, 11056, 20394, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to : humanaproviderservices@humana.com  Sub : Fwd: Enrollment & Location Status Query - NASA HealthClinic - Humana  Good morning!  I hope you\'re doing well. Could you please let me know what the effective date is for the group and mentioned provider?  Practice Details: Practice  Name: Nasa Urgent Care Inc. Practice NPI# : 1821542432 Practice TIN# : 81-3237149 Practice  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Practice  Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Practice Phone # : 2812186777 Practice Fax # : 8666656208  Provider: Provider Name: Segun Adeoye Provider NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-26 16:30:26', '2021-08-26 16:30:26'),
(14545, 11056, 20394, NULL, '2021-09-14 00:00:00.000', 'Approved', ' The provider is IN NETWORK PROVIDER EFF DATE IS : 03/01/2019  The participating plans are :  Humana PPO Humana HMO Humana CHOICE CARE PPO Humana + NETWORK PPO PFFS MEDICARE PPO MEDICARE PPO 2022 MEDICARE PPO/ PPO +   Rep Name : SUMMER REF CODE : 2000199462184  Please see the attachment.', NULL, NULL, '2021-09-07 10:26:26', '2021-09-07 10:26:26'),
(14546, 3046, 20395, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 18:02:19', '2021-03-12 18:02:19'),
(14547, 1006, 20395, NULL, '2021-06-15 00:00:00.000', 'Initiated', 'Submitted enrollment query @ info@usamco.com:  Sub: Enrollment Query - Nasa HealthClinic - MCO  \"Hello,  We wanted to verify if the following group and provider were enrolled with MCO under the given addresses, their information is as follows: Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as possible. Thank you. \"', NULL, NULL, '2021-06-08 14:53:57', '2021-06-08 14:53:57'),
(14548, 11056, 20395, NULL, '2021-07-02 00:00:00.000', 'Initiated', 'Email sent to : info@usamco.com  Sub : Enrollment Query - Nasa Health Clinic - MCO  Hello,   We wanted to verify if the following group and provider were enrolled with MCO under the given addresses, their information is as follows:  Practice:  Practice Name : Nasa Health Clinic Practice NPI# : 1740661453 Practice TIN# : 47-2682655 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider:  Provider Name: Segun Adeoye Provider NPI # : 1629418025  Please get back to me as soon as possible.  Thank you!', NULL, NULL, '2021-06-25 12:30:56', '2021-06-25 12:30:56'),
(14549, 1006, 20395, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Sent f/u email @ providerinfo@usamco.com;   Sub: Enrollment Query - Nasa Health Clinic - MCO  \"Hello,   I hope you\'re doing well, I wanted to check in on the status of enrollment for the following group and provider:  Practice: Practice Name : Nasa Health Clinic Practice NPI# : 1740661453 Practice TIN# : 47-2682655 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider: Provider Name: Segun Adeoye Provider NPI # : 1629418025  Please get back to me as soon as you\'re able.  Thanks!\"', NULL, NULL, '2021-07-14 17:47:48', '2021-07-14 17:47:48'),
(14550, 1006, 20395, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Rcvd response from Jackie, replied:  \"Hello Jackie,   Yes, please go ahead and send us the provider application so we can initiate the enrollment process for the provider.   Thank you!\"', NULL, NULL, '2021-07-14 17:50:17', '2021-07-14 17:50:17'),
(14551, 11056, 20395, NULL, '2021-08-09 00:00:00.000', 'In Process', 'Email sent to : HIPOLITJ@usamco.com   &     providerinfo@usamco.com  Sub : Enrollment Query - Nasa Health Clinic - MCO  Good morning!  I hope you\'re doing well. I wanted to check in on the status of enrollment for the following group and provider:  Practice Details: Practice Name : Nasa Health Clinic Practice NPI# : 1740661453 Practice TIN# : 47-2682655 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider Details: Provider Name: Segun Adeoye Provider NPI # : 1629418025  Please get back to me as soon as you\'re able.  Thank you! Have a great day!', NULL, NULL, '2021-08-02 12:08:30', '2021-08-02 12:08:30'),
(14552, 11056, 20395, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email received from : HIPOLITJ@usamco.com  Sub  : Enrollment Query - Nasa Health Clinic - MCO  Good afternoon, we do currently show the provider Segun Adeoye par through two IPAs’s but not contracted for the group NASA HEALTH CLINIC.  I will fwd your email to our network development dept so an application can be sent to you.              Thank You,     Jackie Hipolito  Provider Relations', NULL, NULL, '2021-08-17 16:54:10', '2021-08-17 16:54:10'),
(14553, 11056, 20395, NULL, '2021-09-04 00:00:00.000', 'In Process', 'Email sent to : HIPOLITJ@usamco.com  Sub : Enrollment Query - Nasa Health Clinic - MCO  Great, thank you so much! Please forward our request soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-27 16:29:52', '2021-08-27 16:29:52'),
(14554, 11056, 20395, NULL, '2021-09-14 00:00:00.000', 'In Process', 'Email received from : ProviderMarketingInfo@usamco.com  Sub : Enrollment Query - Nasa Health Clinic - MCO  Attached is the application and checklist needed to add the provider to the group.     Please let us know if you have any other questions.     Thank you,     Austin Meador  Network Development Coordinator', NULL, NULL, '2021-09-07 13:28:37', '2021-09-07 13:28:37'),
(14555, 11056, 20395, NULL, '2021-09-23 00:00:00.000', 'In Process', 'Email sent to : ProviderMarketingInfo@usamco.com  Sub : Enrollment Query - Nasa Health Clinic - MCO  Good morning!  I hope you\'re doing well. Sorry for the delay. Please accept my apology.  Here is the attached form for the credentialing process with Managed Care Organization. Please see the attachment  Practice Details: Practice Name : Nasa Health Clinic Practice NPI# : 1740661453 Practice TIN# : 47-2682655 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider Details: Provider Name: Segun Adeoye Provider NPI # : 1629418025  Please get back to me as soon as you\'re able.  Thank you! Have a great day!', NULL, NULL, '2021-09-16 10:13:23', '2021-09-16 10:13:23'),
(14556, 11056, 20395, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email sent to : ProviderMarketingInfo@usamco.com & HIPOLITJ@usamco.com  Sub : Enrollment Query - Nasa Health Clinic - MCO   Good afternoon!  Hope all is well. Please provide the latest updates regarding the credentialing process of the practice and provider mentioned below as soon as possible.  Group Name	Nasa Health Clinic Tax ID	47-2682655 Group NPI	1740661453 Primary Location	985 NASA Parkway, Houston , TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025  If you have any questions or need any additional information please let me know. Eagerly waiting to hear from you.  Thank you! Have a great day!', NULL, NULL, '2021-09-28 16:35:07', '2021-09-28 16:35:07'),
(14557, 11056, 20395, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email received from : turnere@usamco.com  Sub : 	RE: [External]Enrollment Query - Nasa Health Clinic - MCO  Good afternoon Ahmed,     Thank you for submitting the application for Segun Adeoye, we look forward to adding your provider to the network. I apologize, the original application that was sent to you is not for Texas providers. I’ve transferred all information into the attached (Texas) provider application for Segun Aedoye. Again sorry for any inconveniences. Please feel free to reach out with any questions.   Thank you,        Erin Turner  Provider Network Development Representative  Ext: 4174', NULL, NULL, '2021-10-08 14:05:29', '2021-10-08 14:05:29'),
(14558, 11056, 20395, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email received from : turnere@usamco.com  Sub : 	RE: [External]Enrollment Query - Nasa Health Clinic - MCO  Good afternoon Ahmed,     Thank you for submitting the application for Segun Adeoye, we look forward to adding your provider to the network. I apologize, the original application that was sent to you is not for Texas providers. I’ve transferred all information into the attached (Texas) provider application for Segun Aedoye. Again sorry for any inconveniences. Please feel free to reach out with any questions.   Thank you,        Erin Turner  Provider Network Development Representative  Ext: 4174', NULL, NULL, '2021-10-08 14:06:01', '2021-10-08 14:06:01'),
(14559, 11056, 20395, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email received from : noreply@barracuda.com & turnere@usamco.com  Sub : Encrypted Message from USA Managed Care Organization RE: [External]Enrollment Query - Nasa Health Clinic - MCO  Good afternoon!  Please provide me with the application. I didn\'t find any attachments.   Thank you!', NULL, NULL, '2021-10-12 16:58:32', '2021-10-12 16:58:32'),
(14560, 11056, 20395, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email received from : turnere@usamco.com  Sub : RE: [External]Enrollment Query - Nasa Health Clinic - MCO  Hello,  Please see attached and let em know if you have any questions or issues viewing.  Thank you,', NULL, NULL, '2021-10-20 12:34:52', '2021-10-20 12:34:52'),
(14561, 11056, 20395, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email received from: turnere@usamco.com  Sub:RE: [External]Enrollment Query - Nasa Health Clinic - MCO  Good afternoon Ahmed,  Thank you for submitting the application for Segun Adeoye, we look forward to adding your provider to the network. I apologize, the original application that was sent to you is not for Texas providers. I’ve transferred all information into the attached (Texas) provider application for Segun Aedoye. Again sorry for any inconveniences. Please feel free to reach out with any questions.   Thank you,  Erin Turner Provider Network Development Representative Ext: 4174 attachment : Microsoft Word - USA103HATIN - TX 11-05-20', NULL, NULL, '2021-11-10 10:01:18', '2021-11-10 10:01:18'),
(14562, 11056, 20395, NULL, '2021-11-25 00:00:00.000', 'In Process', 'Email sent to:  ProviderMarketingInfo@usamco.com  Sub: Enrollment Query - Nasa Health Clinic - MCO   Good morning!  Hope all is well with you. Please provide me with the latest updates regarding the credentialing process of the below-mentioned provider and facility.  Group Name	Nasa Health Clinic Tax ID	47-2682655 Group NPI	1740661453 Primary Location	985 NASA Parkway, Houston, TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025  If you have any questions or need any additional information please let me know. Eagerly waiting to hear from you.  Thank you! Have a wonderful day!', NULL, NULL, '2021-11-18 17:58:19', '2021-11-18 17:58:19'),
(14563, 11056, 20395, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email received from:  turnere@usamco.com  Sub:  Encrypted Message from USA Managed Care Organization   Good morning,     The application for Segun Adeoya is pending, all we need to complete the application process is the attached supplemental information form. Let me know if you have any questions.     Thank you,     Erin Turner  Provider Network Development Representative  Ext: 4174', NULL, NULL, '2021-12-03 17:00:53', '2021-12-03 17:00:53'),
(14564, 11056, 20395, NULL, '2021-12-22 00:00:00.000', 'Approved', 'Email received from: HIPOLITJ@usamco.com  Sub:  Encrypted Message from USA Managed Care Organization  Subject: NASA HEALTH CLINIC  Good afternoon,  The USA appreciates the participation of the following provider below. The provider is now contracted through  The group contract for NASA HEALTH CLINIC.     USA                        PROVIDER                              EFFECTIVE  1221886   ADEOYE, SEGUN PATRICK MD           09/16/2021        Also included is a copy of our quick reference guide and client listing for your records.  If any questions please let us know.   	 Jackie Hipolito, Provider Relations USA Managed Care Organization usamco.com Austin:    P: 512.306.0201 F: 512.306.1921  Please see the attachments as well.', NULL, NULL, '2021-12-15 10:43:23', '2021-12-15 10:43:23'),
(14565, 3046, 20396, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 18:02:21', '2021-03-12 18:02:21'),
(14566, 1006, 20396, NULL, '2021-06-15 00:00:00.000', 'Initiated', 'Submitted enrollment query @ info@usamco.com:  Sub: Enrollment Query - Nasa HealthClinic - MCO  \"Hello,  We wanted to verify if the following group and provider were enrolled with MCO under the given addresses, their information is as follows: Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as possible. Thank you. \"', NULL, NULL, '2021-06-08 14:53:52', '2021-06-08 14:53:52'),
(14567, 11056, 20396, NULL, '2021-07-02 00:00:00.000', 'Initiated', 'Email sent to : info@usamco.com  Sub : Enrollment Query - Nasa Health Clinic - MCO  Hello,   We wanted to verify if the following group and provider were enrolled with MCO under the given addresses, their information is as follows:  Practice:  Practice Name : Nasa Health Clinic Practice NPI# : 1740661453 Practice TIN# : 47-2682655 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider:  Provider Name: Segun Adeoye Provider NPI # : 1629418025  Please get back to me as soon as possible.  Thank you!', NULL, NULL, '2021-06-25 12:30:46', '2021-06-25 12:30:46'),
(14568, 1006, 20396, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Sent f/u email @ providerinfo@usamco.com;   Sub: Enrollment Query - Nasa Health Clinic - MCO  \"Hello,   I hope you\'re doing well, I wanted to check in on the status of enrollment for the following group and provider:  Practice: Practice Name : Nasa Health Clinic Practice NPI# : 1740661453 Practice TIN# : 47-2682655 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider: Provider Name: Segun Adeoye Provider NPI # : 1629418025  Please get back to me as soon as you\'re able.  Thanks!\"', NULL, NULL, '2021-07-14 17:47:45', '2021-07-14 17:47:45'),
(14569, 1006, 20396, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Rcvd response from Jackie, replied:  \"Hello Jackie,   Yes, please go ahead and send us the provider application so we can initiate the enrollment process for the provider.   Thank you!\"', NULL, NULL, '2021-07-14 17:50:14', '2021-07-14 17:50:14'),
(14570, 11056, 20396, NULL, '2021-08-09 00:00:00.000', 'In Process', 'Email sent to : HIPOLITJ@usamco.com   &     providerinfo@usamco.com  Sub : Enrollment Query - Nasa Health Clinic - MCO  Good morning!  I hope you\'re doing well. I wanted to check in on the status of enrollment for the following group and provider:  Practice Details: Practice Name : Nasa Health Clinic Practice NPI# : 1740661453 Practice TIN# : 47-2682655 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider Details: Provider Name: Segun Adeoye Provider NPI # : 1629418025  Please get back to me as soon as you\'re able.  Thank you! Have a great day!', NULL, NULL, '2021-08-02 12:08:00', '2021-08-02 12:08:00'),
(14571, 11056, 20396, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email received from : HIPOLITJ@usamco.com  Sub  : Enrollment Query - Nasa Health Clinic - MCO  Good afternoon, we do currently show the provider Segun Adeoye par through two IPAs’s but not contracted for the group NASA HEALTH CLINIC.  I will fwd your email to our network development dept so an application can be sent to you.              Thank You,     Jackie Hipolito  Provider Relations', NULL, NULL, '2021-08-17 16:53:50', '2021-08-17 16:53:50'),
(14572, 11056, 20396, NULL, '2021-09-04 00:00:00.000', 'In Process', 'Email sent to : HIPOLITJ@usamco.com  Sub : Enrollment Query - Nasa Health Clinic - MCO  Great, thank you so much! Please forward our request soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-27 16:29:54', '2021-08-27 16:29:54'),
(14573, 11056, 20396, NULL, '2021-09-14 00:00:00.000', 'In Process', 'Email received from : ProviderMarketingInfo@usamco.com  Sub : Enrollment Query - Nasa Health Clinic - MCO  Attached is the application and checklist needed to add the provider to the group.     Please let us know if you have any other questions.     Thank you,     Austin Meador  Network Development Coordinator', NULL, NULL, '2021-09-07 13:28:32', '2021-09-07 13:28:32'),
(14574, 11056, 20396, NULL, '2021-09-23 00:00:00.000', 'In Process', 'Email sent to : ProviderMarketingInfo@usamco.com  Sub : Enrollment Query - Nasa Health Clinic - MCO  Good morning!  I hope you\'re doing well. Sorry for the delay. Please accept my apology.  Here is the attached form for the credentialing process with Managed Care Organization. Please see the attachment  Practice Details: Practice Name : Nasa Health Clinic Practice NPI# : 1740661453 Practice TIN# : 47-2682655 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider Details: Provider Name: Segun Adeoye Provider NPI # : 1629418025  Please get back to me as soon as you\'re able.  Thank you! Have a great day!', NULL, NULL, '2021-09-16 10:13:16', '2021-09-16 10:13:16'),
(14575, 11056, 20396, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email sent to : ProviderMarketingInfo@usamco.com & HIPOLITJ@usamco.com  Sub : Enrollment Query - Nasa Health Clinic - MCO   Good afternoon!  Hope all is well. Please provide the latest updates regarding the credentialing process of the practice and provider mentioned below as soon as possible.  Group Name	Nasa Health Clinic Tax ID	47-2682655 Group NPI	1740661453 Primary Location	985 NASA Parkway, Houston , TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025  If you have any questions or need any additional information please let me know. Eagerly waiting to hear from you.  Thank you! Have a great day!', NULL, NULL, '2021-09-28 16:35:01', '2021-09-28 16:35:01'),
(14576, 11056, 20396, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email sent to : ProviderMarketingInfo@usamco.com & HIPOLITJ@usamco.com  Sub : Enrollment Query - Nasa Health Clinic - MCO   Good afternoon!  Hope all is well. Please provide the latest updates regarding the credentialing process of the practice and provider mentioned below as soon as possible.  Group Name	Nasa Health Clinic Tax ID	47-2682655 Group NPI	1740661453 Primary Location	985 NASA Parkway, Houston , TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025  If you have any questions or need any additional information please let me know. Eagerly waiting to hear from you.  Thank you! Have a great day!', NULL, NULL, '2021-09-28 16:35:01', '2021-09-28 16:35:01'),
(14577, 11056, 20396, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email received from : turnere@usamco.com  Sub : 	RE: [External]Enrollment Query - Nasa Health Clinic - MCO  Good afternoon Ahmed,     Thank you for submitting the application for Segun Adeoye, we look forward to adding your provider to the network. I apologize, the original application that was sent to you is not for Texas providers. I’ve transferred all information into the attached (Texas) provider application for Segun Aedoye. Again sorry for any inconveniences. Please feel free to reach out with any questions.   Thank you,        Erin Turner  Provider Network Development Representative  Ext: 4174', NULL, NULL, '2021-10-08 14:05:22', '2021-10-08 14:05:22'),
(14578, 11056, 20396, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email received from : noreply@barracuda.com & turnere@usamco.com  Sub : Encrypted Message from USA Managed Care Organization RE: [External]Enrollment Query - Nasa Health Clinic - MCO  Good afternoon!  Please provide me with the application. I didn\'t find any attachments.   Thank you!', NULL, NULL, '2021-10-12 16:58:24', '2021-10-12 16:58:24'),
(14579, 11056, 20396, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email received from : turnere@usamco.com  Sub : RE: [External]Enrollment Query - Nasa Health Clinic - MCO  Hello,  Please see attached and let em know if you have any questions or issues viewing.  Thank you,', NULL, NULL, '2021-10-20 12:34:40', '2021-10-20 12:34:40'),
(14580, 11056, 20396, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email received from: turnere@usamco.com  Sub:RE: [External]Enrollment Query - Nasa Health Clinic - MCO  Good afternoon Ahmed,  Thank you for submitting the application for Segun Adeoye, we look forward to adding your provider to the network. I apologize, the original application that was sent to you is not for Texas providers. I’ve transferred all information into the attached (Texas) provider application for Segun Aedoye. Again sorry for any inconveniences. Please feel free to reach out with any questions.   Thank you,  Erin Turner Provider Network Development Representative Ext: 4174 attachment : Microsoft Word - USA103HATIN - TX 11-05-20', NULL, NULL, '2021-11-10 10:01:11', '2021-11-10 10:01:11'),
(14581, 11056, 20396, NULL, '2021-11-25 00:00:00.000', 'In Process', 'Email sent to:  ProviderMarketingInfo@usamco.com  Sub: Enrollment Query - Nasa Health Clinic - MCO   Good morning!  Hope all is well with you. Please provide me with the latest updates regarding the credentialing process of the below-mentioned provider and facility.  Group Name	Nasa Health Clinic Tax ID	47-2682655 Group NPI	1740661453 Primary Location	985 NASA Parkway, Houston, TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025  If you have any questions or need any additional information please let me know. Eagerly waiting to hear from you.  Thank you! Have a wonderful day!', NULL, NULL, '2021-11-18 17:58:14', '2021-11-18 17:58:14'),
(14582, 11056, 20396, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email received from:  turnere@usamco.com  Sub:  Encrypted Message from USA Managed Care Organization   Good morning,     The application for Segun Adeoya is pending, all we need to complete the application process is the attached supplemental information form. Let me know if you have any questions.     Thank you,     Erin Turner  Provider Network Development Representative  Ext: 4174', NULL, NULL, '2021-12-03 17:00:48', '2021-12-03 17:00:48'),
(14583, 11056, 20396, NULL, '2021-12-22 00:00:00.000', 'Approved', 'Email received from: HIPOLITJ@usamco.com  Sub:  Encrypted Message from USA Managed Care Organization  Subject: NASA HEALTH CLINIC  Good afternoon,  The USA appreciates the participation of the following provider below. The provider is now contracted through  The group contract for NASA HEALTH CLINIC.     USA                        PROVIDER                              EFFECTIVE  1221886   ADEOYE, SEGUN PATRICK MD           09/16/2021        Also included is a copy of our quick reference guide and client listing for your records.  If any questions please let us know.   	 Jackie Hipolito, Provider Relations USA Managed Care Organization usamco.com Austin:    P: 512.306.0201 F: 512.306.1921  Please see the attachments as well.', NULL, NULL, '2021-12-15 10:43:53', '2021-12-15 10:43:53'),
(14584, 3046, 20397, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 18:04:01', '2021-03-12 18:04:01'),
(14585, 1006, 20397, NULL, '2021-06-15 00:00:00.000', 'Initiated', 'Submitted address addition request via TMHP website: \"Portal Ticket #	Application Name	NPI	Status Update Date	Transction Type	Status	Messages	Available Action  	17833777	PIMS Address		6/8/2021	Provider Information Change (PIC) Form	In Progress	View	\"', NULL, NULL, '2021-06-08 09:16:03', '2021-06-08 09:16:03'),
(14586, 11056, 20397, NULL, '2021-07-06 00:00:00.000', 'Initiated', 'I have called at TMHP for inquiring about the enrollment status. She is going to fax us  a letter of Deficiency and why our application had been closed. Ref no. : 41728865000', NULL, NULL, '2021-06-28 16:43:14', '2021-06-28 16:43:14'),
(14587, 11056, 20397, NULL, '2021-08-28 00:00:00.000', 'In Process', 'Waiting for the letter of deficiency. We haven\'t received it yet', NULL, NULL, '2021-08-20 17:21:53', '2021-08-20 17:21:53'),
(14588, 11056, 20397, NULL, '2021-09-22 00:00:00.000', 'In Process', '	 Portal Ticket #  Application Name  Status Update Date         Transction Type	                   Status	   17833777	     PIMS Address		6/16/2021   Provider Information Change (PIC) Form	Closed	', NULL, NULL, '2021-09-15 10:25:29', '2021-09-15 10:25:29');
