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
(9911, 3040, 13591, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Limy Fernandus in-network with Tricare. Effective Date: 01/28/2021.  Please see attachment. ', NULL, NULL, '2021-02-25 13:03:14', '2021-02-25 13:03:14'),
(9912, 3040, 13591, NULL, '2021-03-11 00:00:00.000', 'In Process', 'Email sent to: mduffee@humana.com  Subject: Need Enroll || Fernandus, Limy || Columbus Urgent Care PA || Humana ||  Hello Micheal,  Can you please send me the contact info for provider service.  Thanks', NULL, NULL, '2021-03-04 14:36:12', '2021-03-04 14:36:12'),
(9913, 3040, 13591, NULL, '2021-03-11 00:00:00.000', 'In Process', 'Email rcvd from: mduffee@humana.com  Subject: Need Enroll || Fernandus, Limy || Columbus Urgent Care PA || Humana ||  Please contact provider services for a status. Thank you.', NULL, NULL, '2021-03-04 14:36:49', '2021-03-04 14:36:49'),
(9914, 3040, 13591, NULL, '2021-03-18 00:00:00.000', 'In Process', 'Email rcvd from: MDuffee@humana.com  Subject: Need Enroll || Fernandus, Limy || Columbus Urgent Care PA || Humana ||  The provider has not been added as of yet to the group contract. The request does take 30 to 45 process for the received date I will forward your request for a response. Thank you and have a good day.', NULL, NULL, '2021-03-11 12:41:36', '2021-03-11 12:41:36'),
(9915, 3040, 13591, NULL, '2021-03-19 00:00:00.000', 'Approved', 'Email rcvd from: MDuffee@humana.com  Subject: Need Enroll || Fernandus, Limy || Columbus Urgent Care PA || Humana  The providers are under a group contract. We do not add physicians or midlevel\'s to ancillary agreements.', NULL, NULL, '2021-03-12 15:18:12', '2021-03-12 15:18:12'),
(9916, 3040, 13592, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-27 17:34:59', '2021-01-27 17:34:59'),
(9917, 3040, 13592, NULL, '2021-02-03 00:00:00.000', 'Initiated', 'Provider on boarding form submitted online. See attachment.  Thank you for completing the BCBSTX enrollment. We will notify you once your application has been processed. If you requested to be contracted, please note that your claims may pay out of network for services rendered until your contracts have been accepted, the credentialing process has been completed, and you receive an effective date. Application ID: 278969  This email is confirmation we have received your request, case number 02173780, for VALLEY MED URGENT CARE PLLC.', NULL, NULL, '2021-01-27 17:36:15', '2021-01-27 17:36:15'),
(9918, 3040, 13592, NULL, '2021-02-10 00:00:00.000', 'In Process', 'Email sent to: Provider_Relations_Houston@bcbstx.com, tx_standard_contracting_team@bcbstx.com  Subject: Enrollment Status || Potter, Deborah || Valley Med Urgent Care PLLC || BCBS ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status of the below mentioned provider. Application ID: 278969.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address:2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider 1: Provider Name: Deborah Potter, Provider NPI# 1861914053  Please let me know if you need any additional information. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-02-03 09:40:11', '2021-02-03 09:40:11'),
(9919, 3040, 13592, NULL, '2021-02-10 00:00:00.000', 'In Process', 'Email rcvd from: tx_standard_contracting_team@bcbstx.com  Subject: BCBSTX - PROVIDER INQUIRY - VALLEY MED URGENT CARE PLLC : Case Number - 02189306  Good Morning,   We have reviewed your application ID, and it appears that the application has been received. It has not begun being processed just yet, but you should soon begin to receive updates and emails from the processing teams if anything further is required of you.   Thank you,', NULL, NULL, '2021-02-03 12:17:22', '2021-02-03 12:17:22'),
(9920, 3040, 13592, NULL, '2021-02-17 00:00:00.000', 'In Process', 'Email sent to: noemi_martinez@bcbstx.com  Subject: Application ID: 278969 || Potter, Deborah || Valley Med Urgent Care PLLC || BCBS || : Case Number - 02190141  Good afternoon,  I apologize if this is a duplicate response.  It seems my email a few minutes ago did not go through.  The onboarding application (case #02173780) for Deborah Potter is still in progress.  The case was submitted on 1.27.21 and these cases can take at least 3 months to for processing.  No additional information is needed at this time.  All the Best,   Noemi Diaz Network Management Consultant | Network Management Blue Cross and Blue Shield of Texas phone (210) 558-5149 | fax (361) 852-0624 email Noemi_Diaz@bcbstx.com', NULL, NULL, '2021-02-10 13:03:25', '2021-02-10 13:03:25'),
(9921, 3040, 13592, NULL, '2021-02-24 00:00:00.000', 'In Process', 'Still in process', NULL, NULL, '2021-02-17 17:27:49', '2021-02-17 17:27:49'),
(9922, 3040, 13592, NULL, '2021-03-03 00:00:00.000', 'In Process', 'Email sent to: noemi_martinez@bcbstx.com  Subject: Re: Application ID: 278969 || Potter, Deborah || Valley Med Urgent Care PLLC || BCBS || : Case Number - 02190141  Good Morning,  Please advise me the enrollment status for the below mentioned provider.   Practice: Practice Name: Valley Med Urgent Care PLLC   Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248       Provider: Provider Name:  Deborah Potter Provider NPI# 1861914053  If you need any additional information please let me know. Waiting for your response.   Thanks', NULL, NULL, '2021-02-24 12:07:42', '2021-02-24 12:07:42'),
(9923, 3040, 13592, NULL, '2021-03-10 00:00:00.000', 'In Process', 'Email rcvd from: Noemi_Diaz@bcbstx.com  Subject: RE: Application ID: 278969 || Potter, Deborah || Valley Med Urgent Care PLLC || BCBS || : Case Number - 02190141  Good afternoon,  Her onboarding case is still in progress (case #02173780).  All the Best,  Noemi Diaz Network Management Consultant | Network Management  Blue Cross and Blue Shield of Texas phone (210) 558-5149 | fax (361) 852-0624 email Noemi_Diaz@bcbstx.com   ', NULL, NULL, '2021-03-03 13:57:39', '2021-03-03 13:57:39'),
(9924, 3040, 13592, NULL, '2021-03-19 00:00:00.000', 'In Process', 'Still in process ', NULL, NULL, '2021-03-12 16:41:51', '2021-03-12 16:41:51'),
(9925, 3040, 13592, NULL, '2021-04-19 00:00:00.000', 'Approved', 'Provider enrolled with BCBS. Effective Date: 04/06/2021  Please see attachment ', NULL, NULL, '2021-04-12 13:23:24', '2021-04-12 13:23:24'),
(9926, 3040, 13593, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-27 17:36:18', '2021-01-27 17:36:18'),
(9927, 3040, 13593, NULL, '2021-02-03 00:00:00.000', 'In Process', 'Provider on boarding form submitted online. See attachment.  Thank you for completing the BCBSTX enrollment. We will notify you once your application has been processed. If you requested to be contracted, please note that your claims may pay out of network for services rendered until your contracts have been accepted, the credentialing process has been completed, and you receive an effective date. Application ID: 278969  This email is confirmation we have received your request, case number 02173780, for VALLEY MED URGENT CARE PLLC.', NULL, NULL, '2021-01-27 17:36:26', '2021-01-27 17:36:26'),
(9928, 3040, 13593, NULL, '2021-02-10 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com, Provider_Relations_Houston@bcbstx.com  Subject: Application ID: 278969 || Potter, Deborah || Valley Med Urgent Care PLLC || BCBS ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status of the below mentioned provider. Application ID 278969  Practice: Practice Name: Valley Med Urgent Care PLLC   Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248    Provider: Provider Name:  Deborah Potter Provider NPI# 1861914053  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-02-03 12:12:55', '2021-02-03 12:12:55'),
(9929, 3040, 13593, NULL, '2021-02-10 00:00:00.000', 'In Process', 'Email rcvd from: tx_standard_contracting_team@bcbstx.com  Subject: BCBSTX - PROVIDER INQUIRY - VALLEY MED URGENT CARE PLLC : Case Number - 02189306  Good Morning,   We have reviewed your application ID, and it appears that the application has been received. It has not begun being processed just yet, but you should soon begin to receive updates and emails from the processing teams if anything further is required of you.   Thank you,', NULL, NULL, '2021-02-03 12:17:29', '2021-02-03 12:17:29'),
(9930, 3040, 13593, NULL, '2021-02-10 00:00:00.000', 'In Process', 'Email rcvd from: tx_standard_contracting_team@bcbstx.com  Subject: BCBSTX - PROVIDER INQUIRY - VALLEY MED URGENT CARE PLLC : Case Number - 02189306  Good Morning,   We have reviewed your application ID, and it appears that the application has been received. It has not begun being processed just yet, but you should soon begin to receive updates and emails from the processing teams if anything further is required of you.   Thank you,', NULL, NULL, '2021-02-03 12:17:29', '2021-02-03 12:17:29'),
(9931, 3040, 13593, NULL, '2021-02-17 00:00:00.000', 'In Process', 'Email sent to: stxnm@humana.com, MDuffee@humana.com, KMoten4@humana.com  Subject: Need Enroll || Potter, Deborah, Wright, Larry Donald || Valley Med Urgent Care PLLC || Humana ||  Good Afternoon,  I wanted to enroll the below mentioned provider under the In-network existing tax ID.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address:2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider 1: Provider Name: Deborah Potter, Provider NPI# 1861914053  Provider 2:   Provider Name: Larry Donald Wright, Provider NPI# 1033769765  Waiting for your response.   Thanks', NULL, NULL, '2021-02-10 13:00:52', '2021-02-10 13:00:52'),
(9932, 3040, 13593, NULL, '2021-02-17 00:00:00.000', 'In Process', 'Email sent to: noemi_martinez@bcbstx.com  Subject: Application ID: 278969 || Potter, Deborah || Valley Med Urgent Care PLLC || BCBS || : Case Number - 02190141  Good afternoon,  I apologize if this is a duplicate response.  It seems my email a few minutes ago did not go through.  The onboarding application (case #02173780) for Deborah Potter is still in progress.  The case was submitted on 1.27.21 and these cases can take at least 3 months to for processing.  No additional information is needed at this time.  All the Best,   Noemi Diaz Network Management Consultant | Network Management Blue Cross and Blue Shield of Texas phone (210) 558-5149 | fax (361) 852-0624 email Noemi_Diaz@bcbstx.com', NULL, NULL, '2021-02-10 13:03:19', '2021-02-10 13:03:19'),
(9933, 3040, 13593, NULL, '2021-02-17 00:00:00.000', 'In Process', 'Email sent to: noemi_martinez@bcbstx.com  Subject: Application ID: 278969 || Potter, Deborah || Valley Med Urgent Care PLLC || BCBS || : Case Number - 02190141  Good afternoon,  I apologize if this is a duplicate response.  It seems my email a few minutes ago did not go through.  The onboarding application (case #02173780) for Deborah Potter is still in progress.  The case was submitted on 1.27.21 and these cases can take at least 3 months to for processing.  No additional information is needed at this time.  All the Best,   Noemi Diaz Network Management Consultant | Network Management Blue Cross and Blue Shield of Texas phone (210) 558-5149 | fax (361) 852-0624 email Noemi_Diaz@bcbstx.com', NULL, NULL, '2021-02-10 13:03:19', '2021-02-10 13:03:19'),
(9934, 3040, 13593, NULL, '2021-02-24 00:00:00.000', 'In Process', 'Still in process. ', NULL, NULL, '2021-02-17 17:26:53', '2021-02-17 17:26:53'),
(9935, 3040, 13593, NULL, '2021-03-03 00:00:00.000', 'In Process', 'Email sent to: noemi_martinez@bcbstx.com  Subject: Re: Application ID: 278969 || Potter, Deborah || Valley Med Urgent Care PLLC || BCBS || : Case Number - 02190141  Good Morning,  Please advise me the enrollment status for the below mentioned provider.   Practice: Practice Name: Valley Med Urgent Care PLLC   Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248       Provider: Provider Name:  Deborah Potter Provider NPI# 1861914053  If you need any additional information please let me know. Waiting for your response.   Thanks', NULL, NULL, '2021-02-24 12:07:37', '2021-02-24 12:07:37'),
(9936, 3040, 13593, NULL, '2021-03-10 00:00:00.000', 'In Process', 'Email rcvd from: Noemi_Diaz@bcbstx.com  Subject: RE: Application ID: 278969 || Potter, Deborah || Valley Med Urgent Care PLLC || BCBS || : Case Number - 02190141  Good afternoon,  Her onboarding case is still in progress (case #02173780).  All the Best,  Noemi Diaz Network Management Consultant | Network Management  Blue Cross and Blue Shield of Texas phone (210) 558-5149 | fax (361) 852-0624 email Noemi_Diaz@bcbstx.com   ', NULL, NULL, '2021-03-03 13:57:32', '2021-03-03 13:57:32'),
(9937, 3040, 13593, NULL, '2021-03-19 00:00:00.000', 'In Process', 'Still in process ', NULL, NULL, '2021-03-12 16:41:56', '2021-03-12 16:41:56'),
(9938, 3040, 13593, NULL, '2021-04-19 00:00:00.000', 'Approved', 'Provider enrolled with BCBS. Effective Date: 04/06/2021  Please see attachment ', NULL, NULL, '2021-04-12 13:23:31', '2021-04-12 13:23:31'),
(9939, 3040, 13594, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-27 17:36:29', '2021-01-27 17:36:29'),
(9940, 3040, 13594, NULL, '2021-02-03 00:00:00.000', 'Initiated', 'Provider on boarding form submitted online. See attachment.  Thank you for completing the BCBSTX enrollment. We will notify you once your application has been processed. If you requested to be contracted, please note that your claims may pay out of network for services rendered until your contracts have been accepted, the credentialing process has been completed, and you receive an effective date. Application ID: 278969  This email is confirmation we have received your request, case number 02173780, for VALLEY MED URGENT CARE PLLC.', NULL, NULL, '2021-01-27 17:36:35', '2021-01-27 17:36:35'),
(9941, 3040, 13594, NULL, '2021-02-10 00:00:00.000', 'In Process', 'Email sent to: Provider_Relations_Houston@bcbstx.com, tx_standard_contracting_team@bcbstx.com  Subject: Enrollment Status || Potter, Deborah || Valley Med Urgent Care PLLC || BCBS ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status of the below mentioned provider. Application ID: 278969.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address:2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider 1: Provider Name: Deborah Potter, Provider NPI# 1861914053  Please let me know if you need any additional information. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-02-03 09:40:19', '2021-02-03 09:40:19'),
(9942, 3040, 13594, NULL, '2021-02-10 00:00:00.000', 'In Process', 'Email rcvd from: tx_standard_contracting_team@bcbstx.com  Subject: BCBSTX - PROVIDER INQUIRY - VALLEY MED URGENT CARE PLLC : Case Number - 02189306  Good Morning,   We have reviewed your application ID, and it appears that the application has been received. It has not begun being processed just yet, but you should soon begin to receive updates and emails from the processing teams if anything further is required of you.   Thank you,', NULL, NULL, '2021-02-03 12:17:35', '2021-02-03 12:17:35'),
(9943, 3040, 13594, NULL, '2021-02-17 00:00:00.000', 'In Process', 'Email sent to: noemi_martinez@bcbstx.com  Subject: Application ID: 278969 || Potter, Deborah || Valley Med Urgent Care PLLC || BCBS || : Case Number - 02190141  Good afternoon,  I apologize if this is a duplicate response.  It seems my email a few minutes ago did not go through.  The onboarding application (case #02173780) for Deborah Potter is still in progress.  The case was submitted on 1.27.21 and these cases can take at least 3 months to for processing.  No additional information is needed at this time.  All the Best,   Noemi Diaz Network Management Consultant | Network Management Blue Cross and Blue Shield of Texas phone (210) 558-5149 | fax (361) 852-0624 email Noemi_Diaz@bcbstx.com', NULL, NULL, '2021-02-10 13:03:31', '2021-02-10 13:03:31'),
(9944, 3040, 13594, NULL, '2021-02-24 00:00:00.000', 'In Process', 'Application ID: 278969', NULL, NULL, '2021-02-17 17:27:54', '2021-02-17 17:27:54'),
(9945, 3040, 13594, NULL, '2021-03-03 00:00:00.000', 'In Process', 'Email sent to: noemi_martinez@bcbstx.com  Subject: Re: Application ID: 278969 || Potter, Deborah || Valley Med Urgent Care PLLC || BCBS || : Case Number - 02190141  Good Morning,  Please advise me the enrollment status for the below mentioned provider.   Practice: Practice Name: Valley Med Urgent Care PLLC   Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248       Provider: Provider Name:  Deborah Potter Provider NPI# 1861914053  If you need any additional information please let me know. Waiting for your response.   Thanks', NULL, NULL, '2021-02-24 12:07:57', '2021-02-24 12:07:57'),
(9946, 3040, 13594, NULL, '2021-03-10 00:00:00.000', 'In Process', 'Email rcvd from: Noemi_Diaz@bcbstx.com  Subject: RE: Application ID: 278969 || Potter, Deborah || Valley Med Urgent Care PLLC || BCBS || : Case Number - 02190141  Good afternoon,  Her onboarding case is still in progress (case #02173780).  All the Best,  Noemi Diaz Network Management Consultant | Network Management  Blue Cross and Blue Shield of Texas phone (210) 558-5149 | fax (361) 852-0624 email Noemi_Diaz@bcbstx.com   ', NULL, NULL, '2021-03-03 13:57:43', '2021-03-03 13:57:43'),
(9947, 3040, 13594, NULL, '2021-03-19 00:00:00.000', 'In Process', 'Still in process ', NULL, NULL, '2021-03-12 16:42:00', '2021-03-12 16:42:00'),
(9948, 3040, 13594, NULL, '2021-04-19 00:00:00.000', 'Approved', 'Provider enrolled with BCBS. Effective Date: 04/06/2021  Please see attachment ', NULL, NULL, '2021-04-12 13:23:41', '2021-04-12 13:23:41'),
(9949, 3040, 13595, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-28 12:05:39', '2021-01-28 12:05:39'),
(9950, 3040, 13595, NULL, '2021-02-04 00:00:00.000', 'Approved', 'Urgent Care Contract.   See Attachments.', NULL, NULL, '2021-01-28 12:11:13', '2021-01-28 12:11:13'),
(9951, 3040, 13596, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-28 12:05:43', '2021-01-28 12:05:43'),
(9952, 3040, 13596, NULL, '2021-02-04 00:00:00.000', 'Approved', 'Urgent Care Contract.   See Attachments.', NULL, NULL, '2021-01-28 12:11:03', '2021-01-28 12:11:03'),
(9953, 3040, 13597, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-28 12:27:03', '2021-01-28 12:27:03'),
(9954, 3040, 13597, NULL, '2021-02-04 00:00:00.000', 'Approved', 'Urgent Care Contract.   See Attachments.', NULL, NULL, '2021-01-28 12:28:53', '2021-01-28 12:28:53'),
(9955, 3040, 13598, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-28 12:27:06', '2021-01-28 12:27:06'),
(9956, 3040, 13598, NULL, '2021-02-04 00:00:00.000', 'Approved', 'Urgent Care Contract.   See Attachments.', NULL, NULL, '2021-01-28 12:28:54', '2021-01-28 12:28:54'),
(9957, 3040, 13599, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-28 12:31:38', '2021-01-28 12:31:38'),
(9958, 3040, 13599, NULL, '2021-02-04 00:00:00.000', 'Approved', 'Urgent Care Contract.   See Attachments', NULL, NULL, '2021-01-28 12:34:39', '2021-01-28 12:34:39'),
(9959, 3040, 13600, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-28 12:31:39', '2021-01-28 12:31:39'),
(9960, 3040, 13600, NULL, '2021-02-04 00:00:00.000', 'Approved', 'Urgent Care Contract.   See Attachments', NULL, NULL, '2021-01-28 12:34:45', '2021-01-28 12:34:45'),
(9961, 3040, 13601, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-28 16:36:33', '2021-01-28 16:36:33'),
(9962, 3040, 13601, NULL, '2021-02-04 00:00:00.000', 'Approved', 'We have an ancillary contract with Cigna, attached for reference.  ', NULL, NULL, '2021-01-28 16:37:37', '2021-01-28 16:37:37'),
(9963, 1006, 13602, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-29 10:24:43', '2021-01-29 10:24:43'),
(9964, 1006, 13602, NULL, '2021-02-05 00:00:00.000', 'Approved', 'Reassigning Benefits to	COLUMBUS URGENT CARE PA	1215330501	APPROVED	1A1350	399951	03/06/2020	N/A	N/A ', NULL, NULL, '2021-01-29 10:27:52', '2021-01-29 10:27:52'),
(9965, 1006, 13603, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-29 10:41:02', '2021-01-29 10:41:02'),
(9966, 1006, 13603, NULL, '2021-02-05 00:00:00.000', 'Approved', 'Provider is now linked with the insurance and the effective date is 03/06/2020 ', NULL, NULL, '2021-01-29 10:42:26', '2021-01-29 10:42:26'),
(9967, 1006, 13604, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-29 10:52:27', '2021-01-29 10:52:27'),
(9968, 1006, 13604, NULL, '2021-02-05 00:00:00.000', 'Approved', 'Provider is now linked with the insurance and the effective date is 03/06/2020 ', NULL, NULL, '2021-01-29 10:52:35', '2021-01-29 10:52:35'),
(9969, 1006, 13605, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-29 12:04:53', '2021-01-29 12:04:53'),
(9970, 1006, 13605, NULL, '2021-02-05 00:00:00.000', 'Initiated', 'Submitted enrollment request via TMHP website: \"Application Status   PEP Ticket Number      Submitted		   17556595\"', NULL, NULL, '2021-01-29 12:05:25', '2021-01-29 12:05:25'),
(9971, 1006, 13605, NULL, '2021-02-12 00:00:00.000', 'In Process', 'The request still shows as in-process on the TMHP website.', NULL, NULL, '2021-02-05 14:03:57', '2021-02-05 14:03:57'),
(9972, 3040, 13605, NULL, '2021-02-19 00:00:00.000', 'Approved', 'Medicaid Approved.   Effective Date: 03/06/2020', NULL, NULL, '2021-02-12 10:43:12', '2021-02-12 10:43:12'),
(9973, 1006, 13606, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-29 14:56:25', '2021-01-29 14:56:25'),
(9974, 1006, 13606, NULL, '2021-02-08 00:00:00.000', 'Initiated', 'Submitted enrollment request email @ TX Credentialing TXCredentialing@amerigroup.com ', NULL, NULL, '2021-01-29 14:57:07', '2021-01-29 14:57:07'),
(9975, 1006, 13606, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Sent a follow-up email @ TXCredentialing@amerigroup.com', NULL, NULL, '2021-02-12 11:17:08', '2021-02-12 11:17:08'),
(9976, 3040, 13606, NULL, '2021-03-08 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com, Jason.Hughes@amerigroup.com  Subject: Enrollment Status || Imperial Valley Urgent Care Center || Abraham, Glory, Chennemkara, Mini Philip || Amerigroup ||  Greetings,  Hope you are doing well. Please advise me the enrollment status for the below mentioned providers.   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider Name: Abraham, Glory Provider NPI# 1194206490  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-03-01 12:50:14', '2021-03-01 12:50:14'),
(9977, 1006, 13606, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Sent f/u email @ TX Credentialing TXCredentialing@amerigroup.com:  Sub: Enrollment Status - NUCC, IVUC, LPMC - Amerigroup  \"Hello,   I wanted to find out the enrollment status for the following providers, as well as what locations they are listed under for the following group:   Group Name: Normandy Urgent Care Center NPI# 1407171077 TIN# 27-0796429  Primary Address: 779 Normandy St Ste 114, Houston, TX 77015-3441 Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Tertiary Address: 9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider 1:Provider Name: George, Jeemol Provider NPI# 1497219067 Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061 Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956 Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490 Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238 Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616 Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-05-31 15:07:53', '2021-05-31 15:07:53'),
(9978, 11056, 13606, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email Sent to : TXCredentialing@amerigroup.com  nucc@claimsmedinc.com  Subj : Enrollment Status - NUCC, IVUC, LPMC - Amerigroup  Good Morning!  I wanted to inquire about the enrollment status for the following providers, as well as what locations they are listed or added into under for the following group:  Practice Name: Normandy Urgent Care Center Practice NPI#: 1407171077 Practice TIN# : 27-0796429 Primary Address: 779 Normandy St Ste 114, Houston, TX 77015-3441 Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Tertiary Address:9504 LONG POINT RD STE E, Houston , TX 77055-4226-  Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider name : PAUL, SIGI Provider NPI # : 1033623616   Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider name : Joseph, Vibitha Provider NPI # : 1952931560   Provider name : Jose, Julie Provider NPI # : 1447883061  Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider name : George, Jeemol Provider NPI # : 1497219067  Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider name : Abraham, Glory Provider NPI # : 1194206490  Please get back to me as soon as you\'re able to.  Thank you!', NULL, NULL, '2021-06-17 12:17:11', '2021-06-17 12:17:11'),
(9979, 3040, 13606, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: txcredentialing@amerigroup.com, Jason.Hughes@amerigroup.com,  Subject: Enrollment Status || Normandy Urgent Care Center - Amerigroup  Good Morning!  I wanted to inquire about the enrollment status for the following providers, as well as what locations they are listed under for the following group:  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Please get back to me as soon as you\'re able to.Waiting to hear from you soon.   Thank you!', NULL, NULL, '2021-07-06 09:58:51', '2021-07-06 09:58:51'),
(9980, 3040, 13606, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Jason.Hughes@amerigroup.com,  Subject: Enrollment Status || Normandy Urgent Care Center - Amerigroup  Hello Jason,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Provider 17: Provider Name: John, Jeny Provider NPI #  1073019493  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks', NULL, NULL, '2021-07-26 15:24:38', '2021-07-26 15:24:38'),
(9981, 11056, 13606, NULL, '2021-08-21 00:00:00.000', 'In Process', 'Email sent to : Jason.Hughes@amerigroup.com   &   TX Credentialing TXCredentialing@amerigroup.com  Sub : Fwd: Delivery Status Notification (Failure)  Good afternoon Jason!  Hope you are doing well. I want to inquire about the enrollment status for the below mentioned group and providers in our groups  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details:  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Provider 17: Provider Name: John, Jeny Provider NPI #  1073019493  If you need any documents or information feel free to reach out to me. Eagerly, waiting for your reply.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-13 14:23:01', '2021-08-13 14:23:01'),
(9982, 3040, 13606, NULL, '2021-09-01 00:00:00.000', 'In Process', 'Email sent to: mpsweb@amerigroup.com  Subject: Delivery Status Notification (Failure)  Greetings!  Hope you are doing well. I want to inquire about the enrollment status for the below mentioned group and providers in our groups under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details:  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Provider 17: Provider Name: John, Jeny Provider NPI #  1073019493  If you need any documents or information feel free to reach out to me. Eagerly, waiting for your reply.  Thanks', NULL, NULL, '2021-08-25 15:00:09', '2021-08-25 15:00:09'),
(9983, 3040, 13606, NULL, '2021-09-16 00:00:00.000', 'In Process', 'Email sent to: mpswebinquiries@amerigroup.com, Jason.Hughes@amerigroup.com, TXCredentialing@amerigroup.com  Subject: Need to Enroll || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || AMERIGROUP ||  Greetings,   Hope you are doing well. I received an email from your side in which you mentioned that our group &  providers are not contracted with Amerigroup under the below locations besides some of the providers are participating with Amerigroup but not under all the locations. I wanted to know how to enroll and add the additional locations for the below mentioned providers in Amerigroup under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Below are the providers need to enroll in Amerigroup:    Provider Name: Thomas, Cini  NPI: 1134777238  Tax ID: 270796429  Status: Non-Participating  Location: 16272 IMPERIAL VALLEY DR STE K,  Houston     Provider Name: Stephen, Ani  NPI: 1588959118  Tax ID: 270796429  Status: Non-Participating     Provider Name: Piccione JR, James  NPI: 1356321509  Tax ID: 270796429  Status: Non-Participating  Location: 9504 LONG POINT RD STE E  Houston     Provider Name: PAUL, SIGI  NPI: 1033623616  Tax ID: 270796429  Status: Non-Participating     Provider Name: Kourouma , Odette  NPI: 1134525868  Tax ID: 270796429  Status: Non-Participating     Provider/Group Name: Jacob, Jaya  NPI: 1194336149  Status: Non-Participating     Provider Name: Fernandus, Limy  NPI: 1972005189  Status: Non-Participating     Provider Name: Abraham, Jeena  NPI: 1467901587  Provider ID:  Status: Non-Participating     Provider Name: Chennemkara, Mini Philip  NPI: 1841755956  Tax ID: 270796429  Status: Non-Participating     Provider Name: Joseph, Molly  NPI: 1396380077  Status: Non-Participating     Provider Name: John, Jeny  NPI: 1073019493  Tax ID: 27-0796429  Status: Non-Participating     Provider Name: Rauf, Abdur   NPI: 1497726202  Tax ID: 27-0796429  Status: Non-Participating    Request to add the additional location for the below mentioned providers.     Provider Name: Joseph, Vibitha  NPI: 1952931560  Provider ID: 09743760  Tax ID: 760612416  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 9504 LONG POINT RD STE E  Houston  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Provider Name: Abraham, Glory  NPI: 1194206490  Provider ID: 07116206  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: Brown, Brittany  NPI: 1275163537  Provider ID: 09808410  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: George, Jeemol  NPI: 1497219067  Provider ID: 09805666  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: Jose, Julie  NPI: 1447883061  Provider ID: 09807037  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    If you need any additional information please feel free to call or email me. Please get back to me as soon as you can get a chance. Waiting to hear from you soon.     Thank you ', NULL, NULL, '2021-09-09 13:07:50', '2021-09-09 13:07:50'),
(9984, 10057, 13606, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : mpswebinquiries@amerigroup.com, Jason.Hughes@amerigroup.com, TXCredentialing@amerigroup.com  Sub : Need to Enroll || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || AMERIGROUP ||  Good Evening,  Hope this email finds you well. I want to inquire about the enrollment status of the below mentioned providers and practices. Please get back to me as soon as you get a chance.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Looking forward to hearing from you. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-18 15:09:46', '2021-10-18 15:09:46'),
(9985, 10057, 13606, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Hello,  Greetings for the day!  We want to enroll the below mentioned providers on an urgent basis with Amerigroup under below mentioned details. Also please find the attached LOI\'s for all providers.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441 Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Please get back to me with the update as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-11 13:06:38', '2021-11-11 13:06:38'),
(9986, 10057, 13606, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Greetings!  Can I get the latest update on the below mentioned request.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-11-30 10:53:17', '2021-11-30 10:53:17'),
(9987, 10057, 13606, NULL, '2021-12-14 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com, Jason.Hughes@amerigroup.com, mpswebinquiries@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Good Afternoon,  Hope this email finds you in good health. I\'m writing this email to check the status for the applications which we have submitted to enroll the providers with Amerigroup under the TIN\'s.  It is my second follow-up, please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-06 16:09:57', '2021-12-06 16:09:57'),
(9988, 10057, 13606, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Called to check the status: 800 - 600 - 4441  Applications has been received and credentialing started on 11/11/2021. Still need 30 working days to finish the process. Once request will be completed, welcome letter will be issued accordingly.  Call Reference: I145695020 - Representative - Courtney', NULL, NULL, '2021-12-13 10:52:18', '2021-12-13 10:52:18'),
(9989, 10057, 13606, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Please check previous Call Comments.  Will follow-up next week.', NULL, NULL, '2021-12-20 14:01:35', '2021-12-20 14:01:35'),
(9990, 10057, 13606, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Call Details: (800) 600-4441  Rep: Victor  Ref # I146789022  Still in process, need to check next week, also send reminder to below mentioned emails.  latina.small@anthem.com nena.graves@amerigroup.com  Regards, Steve Albert', NULL, NULL, '2021-12-29 11:10:39', '2021-12-29 11:10:39'),
(9991, 19067, 13606, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com, Jason.Hughes@amerigroup.com, mpswebinquiries@amerigroup.com  Subject: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||   Hello!  Hope you are having a productive day.  I would like to know the enrollment status of the following Providers & Groups.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Jeny John	1073019493	779 Normandy St STE 114, Houston, TX 77015-3441 Jeny John	1073019493	16272 Imperial Valley DR STE K, Houston, TX 77060 Molly Joseph	1396380077	779 Normandy St STE 114, Houston, TX 77015-3441 Molly Joseph	1396380077	16272 Imperial Valley DR STE K, Houston, TX 77060 Cini Thomas	1134777238	779 Normandy St STE 114, Houston, TX 77015-3441 Cini Thomas	1134777238	16272 Imperial Valley DR STE K, Houston, TX 77060 Ani Stephen	1588959118	779 Normandy St STE 114, Houston, TX 77015-3441 Ani Stephen	1588959118	16272 Imperial Valley DR STE K, Houston, TX 77060 Abdur Rauf	1497726202	779 Normandy St STE 114, Houston, TX 77015-3441 Abdur Rauf	1497726202	16272 Imperial Valley DR STE K, Houston, TX 77060 James Piccione JR	1356321509	779 Normandy St STE 114, Houston, TX 77015-3441 James Piccione JR	1356321509	16272 Imperial Valley DR STE K, Houston, TX 77060 Sigi Paul	1033623616	779 Normandy St STE 114, Houston, TX 77015-3441 Sigi Paul	1033623616	16272 Imperial Valley DR STE K, Houston, TX 77060 Odette Kourouma	1134525868	779 Normandy St STE 114, Houston, TX 77015-3441 Odette Kourouma	1134525868	16272 Imperial Valley DR STE K, Houston, TX 77060 Vibitha Joseph	1952931560	779 Normandy St STE 114, Houston, TX 77015-3441 Vibitha Joseph	1952931560	16272 Imperial Valley DR STE K, Houston, TX 77060 Julie Jose	1447883061	779 Normandy St STE 114, Houston, TX 77015-3441 Julie Jose	1447883061	16272 Imperial Valley DR STE K, Houston, TX 77060 Jaya Jacob	1194336149	779 Normandy St STE 114, Houston, TX 77015-3441 Jaya Jacob	1194336149	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeemol George	1497219067	16272 Imperial Valley DR STE K, Houston, TX 77060 Limy Fernandus	1972005189	779 Normandy St STE 114, Houston, TX 77015-3441 Limy Fernandus	1972005189	16272 Imperial Valley DR STE K, Houston, TX 77060 Brittany Brown	1275163537	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeena Abraham	1467901587	779 Normandy St STE 114, Houston, TX 77015-3441 Jeena Abraham	1467901587	16272 Imperial Valley DR STE K, Houston, TX 77060 Mini Chennemkara	1841755956	779 Normandy St STE 114, Houston, TX 77015-3441 Mini Chennemkara	1841755956	16272 Imperial Valley DR STE K, Houston, TX 77060  Kindly respond promptly.  Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 16:06:28', '2022-01-04 16:06:28'),
(9992, 20067, 13606, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com, Jason.Hughes@amerigroup.com & mpswebinquiries@amerigroup.com  Sub: Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||   Good Morning! Hope this email finds you well. Any updates on the below-mentioned request?  Thanks and regards, Syed Ahad', NULL, NULL, '2022-01-14 10:35:51', '2022-01-14 10:35:51');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(9993, 20067, 13606, NULL, '2022-01-31 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Sub: Re: {EXTERNAL} Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||  Hello,  Hope you had a good weekend. Can you please help me out with few queries mention below: What do I have to do to Par these providers at Imperial Valley Urgent Care Center?  Secondly, I can\'t locate Cini Thomas in the Amerigroup providers directory. Lastly, do I have to submit LOI for individual providers? Eagerly waiting for your reply, Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-24 17:11:27', '2022-01-24 17:11:27'),
(9994, 20067, 13606, NULL, '2022-01-31 00:00:00.000', 'In Process', 'Email received from: TXCredentialing@amerigroup.com  Sub: RE: {EXTERNAL} Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||  I added a column with my notes     Group Name  Normandy Urgent Care Center     Tax ID  27-0796429     Group NPI  1407171077     Provider Name  NPI  Location  AGP Notes  Jeny John  1073019493  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 12190140  Jeny John  1073019493  16272 Imperial Valley DR STE K, Houston, TX 77060  Not par at this location, include phone and Fax  Molly Joseph  1396380077  779 Normandy St STE 114, Houston, TX 77015-3441  Complete the attached LOI so I can link her to this tax ID  Molly Joseph  1396380077  16272 Imperial Valley DR STE K, Houston, TX 77060  Complete the attached LOI so I can link her to this tax ID  Cini Thomas  1134777238  779 Normandy St STE 114, Houston, TX 77015-3441  Not par at this location, include phone and Fax  Cini Thomas  1134777238  16272 Imperial Valley DR STE K, Houston, TX 77060  -                                        Eff date 11/22/2021 P# 10869221  Ani Stephen  1588959118  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 12/20/2021.  P# 12190275  Ani Stephen  1588959118  16272 Imperial Valley DR STE K, Houston, TX 77060  Not par at this location, include phone and Fax  Abdur Rauf  1497726202  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 01641188  Abdur Rauf  1497726202  16272 Imperial Valley DR STE K, Houston, TX 77060  Eff date 11/11/2021.  P# 01641188  James Piccione JR  1356321509  779 Normandy St STE 114, Houston, TX 77015-3441  Complete the attached LOI so I can link her to this tax ID  James Piccione JR  1356321509  16272 Imperial Valley DR STE K, Houston, TX 77060  Complete the attached LOI so I can link her to this tax ID  Sigi Paul  1033623616  779 Normandy St STE 114, Houston, TX 77015-3441  Complete the attached LOI so I can link her to this tax ID  Sigi Paul  1033623616  16272 Imperial Valley DR STE K, Houston, TX 77060  Complete the attached LOI so I can link her to this tax ID  Odette Kourouma  1134525868  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 12190157  Odette Kourouma  1134525868  16272 Imperial Valley DR STE K, Houston, TX 77060  Not par at this location, include phone and Fax  Vibitha Joseph  1952931560  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 12221497  Vibitha Joseph  1952931560  16272 Imperial Valley DR STE K, Houston, TX 77060  Eff date 11/11/2021.  P# 12221497  Julie Jose  1447883061  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 09807037  Julie Jose  1447883061  16272 Imperial Valley DR STE K, Houston, TX 77060  Eff date 11/11/2021.  P# 09807037  Jaya Jacob  1194336149  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 12205914  Jaya Jacob  1194336149  16272 Imperial Valley DR STE K, Houston, TX 77060  Eff date 11/11/2021.  P# 12205914  Jeemol George  1497219067  16272 Imperial Valley DR STE K, Houston, TX 77060  Effective 05/29/2020 (Amerivantage only) – 09805666   - not par at the Imperial Valley location, include the phone and fax  Limy Fernandus  1972005189  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 12190801  Limy Fernandus  1972005189  16272 Imperial Valley DR STE K, Houston, TX 77060  Not par at this location, include phone and Fax  Brittany Brown  1275163537  16272 Imperial Valley DR STE K, Houston, TX 77060  Effective 11/11/2021.  P# 09808410 (not par at the Imperial Valley location, include the phone and fax)  Jeena Abraham  1467901587  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 10286831  Jeena Abraham  1467901587  16272 Imperial Valley DR STE K, Houston, TX 77060  Not par at this location, include phone and Fax  Mini Chennemkara  1841755956  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 12190610  Mini Chennemkara  1841755956  16272 Imperial Valley DR STE K, Houston, TX 77060  Not par at this location, include phone and Fax', NULL, NULL, '2022-01-24 17:17:09', '2022-01-24 17:17:09'),
(9995, 20067, 13606, NULL, '2022-02-09 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Sub: RE: {EXTERNAL} Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||   Hello,  Hope you had a good weekend. Can you please help me out with few queries mention below: What do I have to do to Par these providers at Imperial Valley Urgent Care Center?  Secondly, I can\'t locate Cini Thomas in the Amerigroup providers directory. Lastly, do I have to submit LOI for individual providers? Eagerly waiting for your reply, Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-02-02 14:43:10', '2022-02-02 14:43:10'),
(9996, 20067, 13606, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Sub: Re: {EXTERNAL} Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||   Good Afternoon!  Hope you are doing well. Attached are the LOI for the Non-Par Providers. Can you please tell me how I can add a location under the remaining providers?  Thank you,', NULL, NULL, '2022-03-01 13:39:13', '2022-03-01 13:39:13'),
(9997, 20067, 13606, NULL, '2022-03-25 00:00:00.000', 'In Process', 'Email received from: txcredentialing@amerigroup.com  Sub: FW: {EXTERNAL} Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||  Does this provider wish to be in the directory?  If so, please resend the lOI', NULL, NULL, '2022-03-18 16:59:54', '2022-03-18 16:59:54'),
(9998, 22077, 13606, NULL, '2022-04-21 00:00:00.000', 'In Process', 'Email sent to: txcredentialing@amerigroup.com  Subject: Re: {EXTERNAL} Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||  Hi,  Any update on the mentioned request?  Looking forward to your kind response. Have a great day!  Thanks & Regards, Alex.', NULL, NULL, '2022-04-14 14:01:23', '2022-04-14 14:01:23'),
(9999, 1006, 13607, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-29 14:56:26', '2021-01-29 14:56:26'),
(10000, 1006, 13607, NULL, '2021-02-08 00:00:00.000', 'Initiated', 'Submitted enrollment request email @ TX Credentialing TXCredentialing@amerigroup.com ', NULL, NULL, '2021-01-29 14:57:15', '2021-01-29 14:57:15'),
(10001, 1006, 13607, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Sent a follow-up email @ TXCredentialing@amerigroup.com', NULL, NULL, '2021-02-12 11:17:14', '2021-02-12 11:17:14'),
(10002, 3040, 13607, NULL, '2021-03-05 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Subject: Provider Enrollment Status - Normandy Urgent Care Center  Hello,   I want an update regarding the status of enrollment for the following providers under our group as their enrollment requests have been in process since the start of last year:   Practice Details: Practice Name: Normandy Urgent Care Center Practice NPI# 1407171077 Practice Tax ID# 27-0796429 Practice Address: 779 Normandy St Ste 114 Houston , TX 77015-3441  Practice Details: Practice Name: Imperial Valley Urgent Care Center Practice NPI# 1407171077 Practice Tax ID# 27-0796429 Practice Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name: Vibitha Joseph Provider NPI# 1952931560  Provider Name: Odette Kourouma Provider NPI# 1134525868  Provider Name: Jeena Abaham Provider NPI# 1467901587  Provider Name: Ani Stephen  Provider NPI# 1588959118  Provider Name: Chennemkara, Mini Philip Provider NPI#  1841755956  Please get back to me as soon as you get a chance. Waiting to hear from you soon.   Thank you. ', NULL, NULL, '2021-02-26 14:14:45', '2021-02-26 14:14:45'),
(10003, 1006, 13607, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Sent f/u email @ TX Credentialing TXCredentialing@amerigroup.com:  Sub: Enrollment Status - NUCC, IVUC, LPMC - Amerigroup  \"Hello,   I wanted to find out the enrollment status for the following providers, as well as what locations they are listed under for the following group:   Group Name: Normandy Urgent Care Center NPI# 1407171077 TIN# 27-0796429  Primary Address: 779 Normandy St Ste 114, Houston, TX 77015-3441 Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Tertiary Address: 9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider 1:Provider Name: George, Jeemol Provider NPI# 1497219067 Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061 Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956 Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490 Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238 Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616 Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-05-31 15:06:59', '2021-05-31 15:06:59'),
(10004, 11056, 13607, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email Sent to : TXCredentialing@amerigroup.com  nucc@claimsmedinc.com  Subj : Enrollment Status - NUCC, IVUC, LPMC - Amerigroup  Good Morning!  I wanted to inquire about the enrollment status for the following providers, as well as what locations they are listed or added into under for the following group:  Practice Name: Normandy Urgent Care Center Practice NPI#: 1407171077 Practice TIN# : 27-0796429 Primary Address: 779 Normandy St Ste 114, Houston, TX 77015-3441 Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Tertiary Address:9504 LONG POINT RD STE E, Houston , TX 77055-4226-  Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider name : PAUL, SIGI Provider NPI # : 1033623616   Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider name : Joseph, Vibitha Provider NPI # : 1952931560   Provider name : Jose, Julie Provider NPI # : 1447883061  Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider name : George, Jeemol Provider NPI # : 1497219067  Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider name : Abraham, Glory Provider NPI # : 1194206490  Please get back to me as soon as you\'re able to.  Thank you!', NULL, NULL, '2021-06-17 12:16:40', '2021-06-17 12:16:40'),
(10005, 3040, 13607, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: txcredentialing@amerigroup.com, Jason.Hughes@amerigroup.com,  Subject: Enrollment Status || Normandy Urgent Care Center - Amerigroup  Good Morning!  I wanted to inquire about the enrollment status for the following providers, as well as what locations they are listed under for the following group:  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Please get back to me as soon as you\'re able to.Waiting to hear from you soon.   Thank you!', NULL, NULL, '2021-07-06 09:58:51', '2021-07-06 09:58:51'),
(10006, 3040, 13607, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Jason.Hughes@amerigroup.com,  Subject: Enrollment Status || Normandy Urgent Care Center - Amerigroup  Hello Jason,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Provider 17: Provider Name: John, Jeny Provider NPI #  1073019493  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks', NULL, NULL, '2021-07-26 15:24:38', '2021-07-26 15:24:38'),
(10007, 11056, 13607, NULL, '2021-08-21 00:00:00.000', 'In Process', 'Email sent to : Jason.Hughes@amerigroup.com   &   TX Credentialing TXCredentialing@amerigroup.com  Sub : Fwd: Delivery Status Notification (Failure)  Good afternoon Jason!  Hope you are doing well. I want to inquire about the enrollment status for the below mentioned group and providers in our groups  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details:  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Provider 17: Provider Name: John, Jeny Provider NPI #  1073019493  If you need any documents or information feel free to reach out to me. Eagerly, waiting for your reply.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-13 14:13:13', '2021-08-13 14:13:13'),
(10008, 3040, 13607, NULL, '2021-09-01 00:00:00.000', 'In Process', 'Email sent to: mpsweb@amerigroup.com  Subject: Delivery Status Notification (Failure)  Greetings!  Hope you are doing well. I want to inquire about the enrollment status for the below mentioned group and providers in our groups under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details:  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Provider 17: Provider Name: John, Jeny Provider NPI #  1073019493  If you need any documents or information feel free to reach out to me. Eagerly, waiting for your reply.  Thanks', NULL, NULL, '2021-08-25 15:00:08', '2021-08-25 15:00:08'),
(10009, 3040, 13607, NULL, '2021-09-01 00:00:00.000', 'In Process', 'Email sent to: mpsweb@amerigroup.com  Subject: Delivery Status Notification (Failure)  Greetings!  Hope you are doing well. I want to inquire about the enrollment status for the below mentioned group and providers in our groups under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details:  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Provider 17: Provider Name: John, Jeny Provider NPI #  1073019493  If you need any documents or information feel free to reach out to me. Eagerly, waiting for your reply.  Thanks', NULL, NULL, '2021-08-25 15:00:09', '2021-08-25 15:00:09'),
(10010, 3040, 13607, NULL, '2021-09-16 00:00:00.000', 'In Process', 'Email sent to: mpswebinquiries@amerigroup.com, Jason.Hughes@amerigroup.com, TXCredentialing@amerigroup.com  Subject: Need to Enroll || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || AMERIGROUP ||  Greetings,   Hope you are doing well. I received an email from your side in which you mentioned that our group &  providers are not contracted with Amerigroup under the below locations besides some of the providers are participating with Amerigroup but not under all the locations. I wanted to know how to enroll and add the additional locations for the below mentioned providers in Amerigroup under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Below are the providers need to enroll in Amerigroup:    Provider Name: Thomas, Cini  NPI: 1134777238  Tax ID: 270796429  Status: Non-Participating  Location: 16272 IMPERIAL VALLEY DR STE K,  Houston     Provider Name: Stephen, Ani  NPI: 1588959118  Tax ID: 270796429  Status: Non-Participating     Provider Name: Piccione JR, James  NPI: 1356321509  Tax ID: 270796429  Status: Non-Participating  Location: 9504 LONG POINT RD STE E  Houston     Provider Name: PAUL, SIGI  NPI: 1033623616  Tax ID: 270796429  Status: Non-Participating     Provider Name: Kourouma , Odette  NPI: 1134525868  Tax ID: 270796429  Status: Non-Participating     Provider/Group Name: Jacob, Jaya  NPI: 1194336149  Status: Non-Participating     Provider Name: Fernandus, Limy  NPI: 1972005189  Status: Non-Participating     Provider Name: Abraham, Jeena  NPI: 1467901587  Provider ID:  Status: Non-Participating     Provider Name: Chennemkara, Mini Philip  NPI: 1841755956  Tax ID: 270796429  Status: Non-Participating     Provider Name: Joseph, Molly  NPI: 1396380077  Status: Non-Participating     Provider Name: John, Jeny  NPI: 1073019493  Tax ID: 27-0796429  Status: Non-Participating     Provider Name: Rauf, Abdur   NPI: 1497726202  Tax ID: 27-0796429  Status: Non-Participating    Request to add the additional location for the below mentioned providers.     Provider Name: Joseph, Vibitha  NPI: 1952931560  Provider ID: 09743760  Tax ID: 760612416  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 9504 LONG POINT RD STE E  Houston  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Provider Name: Abraham, Glory  NPI: 1194206490  Provider ID: 07116206  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: Brown, Brittany  NPI: 1275163537  Provider ID: 09808410  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: George, Jeemol  NPI: 1497219067  Provider ID: 09805666  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: Jose, Julie  NPI: 1447883061  Provider ID: 09807037  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    If you need any additional information please feel free to call or email me. Please get back to me as soon as you can get a chance. Waiting to hear from you soon.     Thank you ', NULL, NULL, '2021-09-09 13:07:50', '2021-09-09 13:07:50'),
(10011, 10057, 13607, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : mpswebinquiries@amerigroup.com, Jason.Hughes@amerigroup.com, TXCredentialing@amerigroup.com  Sub : Need to Enroll || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || AMERIGROUP ||  Good Evening,  Hope this email finds you well. I want to inquire about the enrollment status of the below mentioned providers and practices. Please get back to me as soon as you get a chance.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Looking forward to hearing from you. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-18 15:16:15', '2021-10-18 15:16:15'),
(10012, 10057, 13607, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Hello,  Greetings for the day!  We want to enroll the below mentioned providers on an urgent basis with Amerigroup under below mentioned details. Also please find the attached LOI\'s for all providers.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441 Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Please get back to me with the update as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-11 13:00:54', '2021-11-11 13:00:54'),
(10013, 10057, 13607, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Greetings!  Can I get the latest update on the below mentioned request.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-11-30 10:48:34', '2021-11-30 10:48:34'),
(10014, 10057, 13607, NULL, '2021-12-14 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com, Jason.Hughes@amerigroup.com, mpswebinquiries@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Good Afternoon,  Hope this email finds you in good health. I\'m writing this email to check the status for the applications which we have submitted to enroll the providers with Amerigroup under the TIN\'s.  It is my second follow-up, please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-06 16:04:40', '2021-12-06 16:04:40'),
(10015, 10057, 13607, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Called to check the status: 800 - 600 - 4441  Applications has been received and credentialing started on 11/11/2021. Still need 30 working days to finish the process. Once request will be completed, welcome letter will be issued accordingly.  Call Reference: I145695020 - Representative - Courtney', NULL, NULL, '2021-12-13 10:48:32', '2021-12-13 10:48:32'),
(10016, 10057, 13607, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Please check previous Call Comments.  Will follow-up next week.', NULL, NULL, '2021-12-20 13:54:44', '2021-12-20 13:54:44'),
(10017, 10057, 13607, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : latina.small@anthem.com  Sub : RE: {EXTERNAL} Re: Enrollment Queries || Providers || Amerigroup ||  Good Morning Latina,  We have send the LOI and group roster to credentialing dept, but no one from that department is responding back to us, its been more than 45 calender days we have send them the LOI and can you please get back to me with an update.  Regards, Alex Credentialing Manager', NULL, NULL, '2021-12-27 09:54:50', '2021-12-27 09:54:50'),
(10018, 10057, 13607, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Received From : latina.small@Amerigroup.com & txcredentialing@amerigroup.com  Sub : RE: {EXTERNAL} Re: Enrollment Queries || Providers || Amerigroup ||  Good Morning,  You can respond directly to the credentialing  email for assistance with credentialing concerns. I have included them on the email as well.  Thank You in Advance,  Latina Small Provider Experience Consultant Amerigroup, Inc.', NULL, NULL, '2021-12-30 09:22:14', '2021-12-30 09:22:14'),
(10019, 19067, 13607, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com, Jason.Hughes@amerigroup.com, mpswebinquiries@amerigroup.com  Subject: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||   Hello!  Hope you are having a productive day.  I would like to know the enrollment status of the following Providers & Groups.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Jeny John	1073019493	779 Normandy St STE 114, Houston, TX 77015-3441 Jeny John	1073019493	16272 Imperial Valley DR STE K, Houston, TX 77060 Molly Joseph	1396380077	779 Normandy St STE 114, Houston, TX 77015-3441 Molly Joseph	1396380077	16272 Imperial Valley DR STE K, Houston, TX 77060 Cini Thomas	1134777238	779 Normandy St STE 114, Houston, TX 77015-3441 Cini Thomas	1134777238	16272 Imperial Valley DR STE K, Houston, TX 77060 Ani Stephen	1588959118	779 Normandy St STE 114, Houston, TX 77015-3441 Ani Stephen	1588959118	16272 Imperial Valley DR STE K, Houston, TX 77060 Abdur Rauf	1497726202	779 Normandy St STE 114, Houston, TX 77015-3441 Abdur Rauf	1497726202	16272 Imperial Valley DR STE K, Houston, TX 77060 James Piccione JR	1356321509	779 Normandy St STE 114, Houston, TX 77015-3441 James Piccione JR	1356321509	16272 Imperial Valley DR STE K, Houston, TX 77060 Sigi Paul	1033623616	779 Normandy St STE 114, Houston, TX 77015-3441 Sigi Paul	1033623616	16272 Imperial Valley DR STE K, Houston, TX 77060 Odette Kourouma	1134525868	779 Normandy St STE 114, Houston, TX 77015-3441 Odette Kourouma	1134525868	16272 Imperial Valley DR STE K, Houston, TX 77060 Vibitha Joseph	1952931560	779 Normandy St STE 114, Houston, TX 77015-3441 Vibitha Joseph	1952931560	16272 Imperial Valley DR STE K, Houston, TX 77060 Julie Jose	1447883061	779 Normandy St STE 114, Houston, TX 77015-3441 Julie Jose	1447883061	16272 Imperial Valley DR STE K, Houston, TX 77060 Jaya Jacob	1194336149	779 Normandy St STE 114, Houston, TX 77015-3441 Jaya Jacob	1194336149	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeemol George	1497219067	16272 Imperial Valley DR STE K, Houston, TX 77060 Limy Fernandus	1972005189	779 Normandy St STE 114, Houston, TX 77015-3441 Limy Fernandus	1972005189	16272 Imperial Valley DR STE K, Houston, TX 77060 Brittany Brown	1275163537	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeena Abraham	1467901587	779 Normandy St STE 114, Houston, TX 77015-3441 Jeena Abraham	1467901587	16272 Imperial Valley DR STE K, Houston, TX 77060 Mini Chennemkara	1841755956	779 Normandy St STE 114, Houston, TX 77015-3441 Mini Chennemkara	1841755956	16272 Imperial Valley DR STE K, Houston, TX 77060  Kindly respond promptly.  Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 16:06:21', '2022-01-04 16:06:21'),
(10020, 20067, 13607, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com, Jason.Hughes@amerigroup.com & mpswebinquiries@amerigroup.com  Sub: Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||   Good Morning! Hope this email finds you well. Any updates on the below-mentioned request?  Thanks and regards, Syed Ahad', NULL, NULL, '2022-01-14 10:36:19', '2022-01-14 10:36:19'),
(10021, 20067, 13607, NULL, '2022-01-31 00:00:00.000', 'Approved', 'Kindly see the attachment of Directory  Effective Date: 11/11/2021', NULL, NULL, '2022-01-24 13:11:00', '2022-01-24 13:11:00'),
(10022, 1006, 13608, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-29 14:56:27', '2021-01-29 14:56:27'),
(10023, 1006, 13608, NULL, '2021-02-08 00:00:00.000', 'Initiated', 'Submitted enrollment request email @ TX Credentialing TXCredentialing@amerigroup.com ', NULL, NULL, '2021-01-29 14:57:28', '2021-01-29 14:57:28'),
(10024, 1006, 13608, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Sent a follow-up email @ TXCredentialing@amerigroup.com', NULL, NULL, '2021-02-12 11:17:18', '2021-02-12 11:17:18'),
(10025, 3040, 13608, NULL, '2021-03-08 00:00:00.000', 'In Process', 'Email sent to: 	TXCredentialing@amerigroup.com  Subject: Enrollment Status || Longpoint Medical Center || Chennemkara, Mini Philip || Amerigroup ||  Greetings,  Hope you are doing well. Please advise me the enrollment status for the below mentioned providers.   Practice Name: Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Please get back to me as soon as you get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-03-01 15:33:00', '2021-03-01 15:33:00'),
(10026, 1006, 13608, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Sent f/u email @ TX Credentialing TXCredentialing@amerigroup.com:  Sub: Enrollment Status - NUCC, IVUC, LPMC - Amerigroup  \"Hello,   I wanted to find out the enrollment status for the following providers, as well as what locations they are listed under for the following group:   Group Name: Normandy Urgent Care Center NPI# 1407171077 TIN# 27-0796429  Primary Address: 779 Normandy St Ste 114, Houston, TX 77015-3441 Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Tertiary Address: 9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider 1:Provider Name: George, Jeemol Provider NPI# 1497219067 Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061 Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956 Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490 Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238 Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616 Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-05-31 15:27:29', '2021-05-31 15:27:29'),
(10027, 11056, 13608, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email Sent to : TXCredentialing@amerigroup.com  nucc@claimsmedinc.com  Subj : Enrollment Status - NUCC, IVUC, LPMC - Amerigroup  Good Morning!  I wanted to inquire about the enrollment status for the following providers, as well as what locations they are listed or added into under for the following group:  Practice Name: Normandy Urgent Care Center Practice NPI#: 1407171077 Practice TIN# : 27-0796429 Primary Address: 779 Normandy St Ste 114, Houston, TX 77015-3441 Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Tertiary Address:9504 LONG POINT RD STE E, Houston , TX 77055-4226-  Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider name : PAUL, SIGI Provider NPI # : 1033623616   Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider name : Joseph, Vibitha Provider NPI # : 1952931560   Provider name : Jose, Julie Provider NPI # : 1447883061  Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider name : George, Jeemol Provider NPI # : 1497219067  Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider name : Abraham, Glory Provider NPI # : 1194206490  Please get back to me as soon as you\'re able to.  Thank you!', NULL, NULL, '2021-06-17 12:16:14', '2021-06-17 12:16:14'),
(10028, 3040, 13608, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: txcredentialing@amerigroup.com, Jason.Hughes@amerigroup.com,  Subject: Enrollment Status || Normandy Urgent Care Center - Amerigroup  Good Morning!  I wanted to inquire about the enrollment status for the following providers, as well as what locations they are listed under for the following group:  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Please get back to me as soon as you\'re able to.Waiting to hear from you soon.   Thank you!', NULL, NULL, '2021-07-06 09:58:50', '2021-07-06 09:58:50'),
(10029, 3040, 13608, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Jason.Hughes@amerigroup.com,  Subject: Enrollment Status || Normandy Urgent Care Center - Amerigroup  Hello Jason,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Provider 17: Provider Name: John, Jeny Provider NPI #  1073019493  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks', NULL, NULL, '2021-07-26 15:24:37', '2021-07-26 15:24:37'),
(10030, 11056, 13608, NULL, '2021-08-21 00:00:00.000', 'In Process', 'Email sent to : Jason.Hughes@amerigroup.com   &   TX Credentialing TXCredentialing@amerigroup.com  Sub : Fwd: Delivery Status Notification (Failure)  Good afternoon Jason!  Hope you are doing well. I want to inquire about the enrollment status for the below mentioned group and providers in our groups  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details:  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Provider 17: Provider Name: John, Jeny Provider NPI #  1073019493  If you need any documents or information feel free to reach out to me. Eagerly, waiting for your reply.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-13 14:28:42', '2021-08-13 14:28:42');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(10031, 3040, 13608, NULL, '2021-09-01 00:00:00.000', 'In Process', 'Email sent to: mpsweb@amerigroup.com  Subject: Delivery Status Notification (Failure)  Greetings!  Hope you are doing well. I want to inquire about the enrollment status for the below mentioned group and providers in our groups under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details:  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Provider 17: Provider Name: John, Jeny Provider NPI #  1073019493  If you need any documents or information feel free to reach out to me. Eagerly, waiting for your reply.  Thanks', NULL, NULL, '2021-08-25 15:00:08', '2021-08-25 15:00:08'),
(10032, 3040, 13608, NULL, '2021-09-16 00:00:00.000', 'In Process', 'Email sent to: mpswebinquiries@amerigroup.com, Jason.Hughes@amerigroup.com, TXCredentialing@amerigroup.com  Subject: Need to Enroll || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || AMERIGROUP ||  Greetings,   Hope you are doing well. I received an email from your side in which you mentioned that our group &  providers are not contracted with Amerigroup under the below locations besides some of the providers are participating with Amerigroup but not under all the locations. I wanted to know how to enroll and add the additional locations for the below mentioned providers in Amerigroup under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Below are the providers need to enroll in Amerigroup:    Provider Name: Thomas, Cini  NPI: 1134777238  Tax ID: 270796429  Status: Non-Participating  Location: 16272 IMPERIAL VALLEY DR STE K,  Houston     Provider Name: Stephen, Ani  NPI: 1588959118  Tax ID: 270796429  Status: Non-Participating     Provider Name: Piccione JR, James  NPI: 1356321509  Tax ID: 270796429  Status: Non-Participating  Location: 9504 LONG POINT RD STE E  Houston     Provider Name: PAUL, SIGI  NPI: 1033623616  Tax ID: 270796429  Status: Non-Participating     Provider Name: Kourouma , Odette  NPI: 1134525868  Tax ID: 270796429  Status: Non-Participating     Provider/Group Name: Jacob, Jaya  NPI: 1194336149  Status: Non-Participating     Provider Name: Fernandus, Limy  NPI: 1972005189  Status: Non-Participating     Provider Name: Abraham, Jeena  NPI: 1467901587  Provider ID:  Status: Non-Participating     Provider Name: Chennemkara, Mini Philip  NPI: 1841755956  Tax ID: 270796429  Status: Non-Participating     Provider Name: Joseph, Molly  NPI: 1396380077  Status: Non-Participating     Provider Name: John, Jeny  NPI: 1073019493  Tax ID: 27-0796429  Status: Non-Participating     Provider Name: Rauf, Abdur   NPI: 1497726202  Tax ID: 27-0796429  Status: Non-Participating    Request to add the additional location for the below mentioned providers.     Provider Name: Joseph, Vibitha  NPI: 1952931560  Provider ID: 09743760  Tax ID: 760612416  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 9504 LONG POINT RD STE E  Houston  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Provider Name: Abraham, Glory  NPI: 1194206490  Provider ID: 07116206  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: Brown, Brittany  NPI: 1275163537  Provider ID: 09808410  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: George, Jeemol  NPI: 1497219067  Provider ID: 09805666  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: Jose, Julie  NPI: 1447883061  Provider ID: 09807037  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    If you need any additional information please feel free to call or email me. Please get back to me as soon as you can get a chance. Waiting to hear from you soon.     Thank you ', NULL, NULL, '2021-09-09 13:07:49', '2021-09-09 13:07:49'),
(10033, 10057, 13608, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : mpswebinquiries@amerigroup.com, Jason.Hughes@amerigroup.com, TXCredentialing@amerigroup.com  Sub : Need to Enroll || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || AMERIGROUP ||  Good Evening,  Hope this email finds you well. I want to inquire about the enrollment status of the below mentioned providers and practices. Please get back to me as soon as you get a chance.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Looking forward to hearing from you. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-18 15:13:31', '2021-10-18 15:13:31'),
(10034, 10057, 13608, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Hello,  Greetings for the day!  We want to enroll the below mentioned providers on an urgent basis with Amerigroup under below mentioned details. Also please find the attached LOI\'s for all providers.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441 Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Please get back to me with the update as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-11 13:03:59', '2021-11-11 13:03:59'),
(10035, 10057, 13608, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Greetings!  Can I get the latest update on the below mentioned request.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-11-30 10:57:01', '2021-11-30 10:57:01'),
(10036, 10057, 13608, NULL, '2021-12-14 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com, Jason.Hughes@amerigroup.com, mpswebinquiries@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Good Afternoon,  Hope this email finds you in good health. I\'m writing this email to check the status for the applications which we have submitted to enroll the providers with Amerigroup under the TIN\'s.  It is my second follow-up, please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-06 16:13:34', '2021-12-06 16:13:34'),
(10037, 10057, 13608, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Called to check the status: 800 - 600 - 4441  Applications has been received and credentialing started on 11/11/2021. Still need 30 working days to finish the process. Once request will be completed, welcome letter will be issued accordingly.  Call Reference: I145695020 - Representative - Courtney', NULL, NULL, '2021-12-13 10:55:06', '2021-12-13 10:55:06'),
(10038, 10057, 13608, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Please check previous Call Comments.  Will follow-up next week.', NULL, NULL, '2021-12-20 14:06:33', '2021-12-20 14:06:33'),
(10039, 10057, 13608, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Call Details: (800) 600-4441  Rep: Victor  Ref # I146789022  Still in process, need to check next week, also send reminder to below mentioned emails.  latina.small@anthem.com nena.graves@amerigroup.com  Regards, Steve Albert', NULL, NULL, '2021-12-29 11:08:06', '2021-12-29 11:08:06'),
(10040, 20067, 13608, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: latina.small@anthem.com, nena.graves@amerigroup.com  Sub: Re: || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Good Morning, Hope all is well with you. I would like to know the enrollment status of the below-mentioned group and providers and if any of them is enrolled kindly send me their welcome letter.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Eagerly waiting for your response.   Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-10 12:19:21', '2022-01-10 12:19:21'),
(10041, 20067, 13608, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email Received from: latina.small@anthem.com  Sub: RE: {EXTERNAL} Re: || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Good Morning,     Yes, I can look up and confirm the provider(s) status. Please allow me some time to review and respond.     Thank You in Advance,     Latina Small  Provider Experience Consultant  Amerigroup, Inc.', NULL, NULL, '2022-01-11 13:08:26', '2022-01-11 13:08:26'),
(10042, 20067, 13608, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: latina.small@anthem.com, nena.graves@amerigroup.com  Sub: Re: {EXTERNAL} Re: || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Good Afternoon Latina and Nena! Hope this email finds you in good health. Haven\'t received any updates from your side. Kindly update me on the previous request.  Eagerly waiting for your response. Thanks & Regards. Syed Ahad', NULL, NULL, '2022-01-19 15:15:37', '2022-01-19 15:15:37'),
(10043, 20067, 13608, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: latina.small@anthem.com, nena.graves@amerigroup.com  Sub: Re: {EXTERNAL} Re: || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Good Morning!  Eagerly waiting for your response. Kindly respond promptly,  Thank you,', NULL, NULL, '2022-01-28 11:58:53', '2022-01-28 11:58:53'),
(10044, 20067, 13608, NULL, '2022-02-15 00:00:00.000', 'In Process', 'Email received from: latina.small@anthem.com  Sub: Re: {EXTERNAL} Re: || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||   Good Afternoon,     Sincere apologies for any delays. Please see the status for the providers below. If any providers need to be added to the group, please complete the attached LOI and Group App form and return to credentialing with a W9.        Group Name  Longpoint Medical Center  Tax ID  76-0612416  Group NPI  1770763815  Practice Location  9504 LONG POINT RD STE E Houston , TX 77055-4226     Provider Name     NPI  Amerigroup Status Update  Fernandus, Limy     1972005189  PAR - PR ID 12190801; Effective Date 11/11/2021(Medicaid, Medicare, CHIP)  PAUL, SIGI     1033623616  Non PAR  Jacob, Jaya     1194336149  Non PAR  Abraham, Jeena     1467901587  Non PAR  Thomas, Cini     1134777238  Non PAR  Kourouma , Odette Tiranke     1134525868  Non PAR  Rauf, Abdur     1497726202  PAR – PR ID 10007623; Effective Date 3/1/2012 (Medicaid, Medicare, CHIP, MMP)  Joseph, Molly     1396380077  Non PAR  John, Jeny     1073019493  Non PAR  Stephen, Ani     1588959118  Non PAR  Brown, Brittany     1275163537  Non PAR  Joseph, Vibitha     1952931560  PAR – PR ID 09743760; Effective Date 4/27/2020 (Medicare)  George, Jeemol     1497219067  Non PAR  Jose, Julie     1447883061  Non PAR  Abraham, Glory     1194206490  PAR – PR ID 08200815; Effective Date 10/01/2019 (Medicare)  Chennemkara, Mini Philip     1841755956  Non PAR  Piccione JR, James M     1356321509  Non PAR        Thank You in Advance,     Latina Small, MBA, BSBM', NULL, NULL, '2022-02-08 13:14:11', '2022-02-08 13:14:11'),
(10045, 20067, 13608, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com CC: latina.small@anthem.com  Sub: LOI and Group App || Longpoint Medical Center || Providers || Amerigroup  Good Afternoon!  Hope you had a great weekend. Attached are the LOI and Group App for Non-par Providers along with W9.  Kindly let me know if anything else is required from my end.  Regards, ', NULL, NULL, '2022-02-21 13:46:52', '2022-02-21 13:46:52'),
(10046, 20067, 13608, NULL, '2022-03-15 00:00:00.000', 'In Process', 'Secure Email received from:  TX Credentialing  Sub: RE: FW: {EXTERNAL} LOI and Group App || Longpoint Medical Center || Providers || Amerigroup  the LOI has a mix match of the group name with the tax ID.     There is one tax ID listed on the LOI, the group name should correspond to the tax ID.', NULL, NULL, '2022-03-08 09:26:14', '2022-03-08 09:26:14'),
(10047, 20067, 13608, NULL, '2022-03-15 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Sub:   Good Morning!  Attached are the LOI and Group applications for the providers.  Let me know if anything else is required from my end.  Thank you,', NULL, NULL, '2022-03-08 09:56:31', '2022-03-08 09:56:31'),
(10048, 20067, 13608, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com, latina.small@anthem.com   Sub:  Re: LOI and Group App || Longpoint Medical Center || Providers || Amerigroup  Good Morning!  Hope this email finds you in good health. Any updates on the Submitted LOIs of Longpoint Medical Center providers.  Thank you, Syed', NULL, NULL, '2022-03-17 10:03:43', '2022-03-17 10:03:43'),
(10049, 20067, 13608, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email received from: TXCredentialing@amerigroup.com   Sub: FW: {EXTERNAL} Re: LOI and Group App || Longpoint Medical Center || Providers || Amerigroup  Those were received and pending completion.     Check back in 7 business days', NULL, NULL, '2022-03-17 16:43:18', '2022-03-17 16:43:18'),
(10050, 3040, 13609, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-03 16:33:49', '2021-02-03 16:33:49'),
(10051, 3040, 13609, NULL, '2021-02-10 00:00:00.000', 'Approved', 'Group has an ancillary contract.', NULL, NULL, '2021-02-03 16:37:52', '2021-02-03 16:37:52'),
(10052, 3040, 13609, NULL, NULL, 'Revalidation', 'Email sent to: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Hello David,   Hope you are doing well. The contract request form that was sent out in your previous email I would like to ask you in the provider type section what option you want me to mark for the providers. If you could reach out to me on 713-893-6214 that would be better.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you', NULL, NULL, '2021-04-26 10:44:45', '2021-04-26 10:44:45'),
(10053, 3040, 13609, NULL, NULL, 'Revalidated', 'Group has an ancillary contract. No need to add individual providers as per Jasmine.Guerrero@molinahealthcare.com ', NULL, NULL, '2021-05-31 09:08:04', '2021-05-31 09:08:04'),
(10054, 3040, 13610, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-03 16:33:54', '2021-02-03 16:33:54'),
(10055, 3040, 13610, NULL, '2021-02-10 00:00:00.000', 'Approved', 'Group has an ancillary contract.', NULL, NULL, '2021-02-03 16:38:02', '2021-02-03 16:38:02'),
(10056, 3040, 13610, NULL, NULL, 'Revalidation', 'Email sent to: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Hello David,   Hope you are doing well. The contract request form that was sent out in your previous email I would like to ask you in the provider type section what option you want me to mark for the providers. If you could reach out to me on 713-893-6214 that would be better.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you', NULL, NULL, '2021-04-26 10:44:39', '2021-04-26 10:44:39'),
(10057, 3040, 13610, NULL, NULL, 'Revalidated', 'Group has an ancillary contract. No need to add individual providers as per Jasmine.Guerrero@molinahealthcare.com ', NULL, NULL, '2021-05-31 09:11:15', '2021-05-31 09:11:15'),
(10058, 3040, 13611, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-03 16:33:57', '2021-02-03 16:33:57'),
(10059, 3040, 13611, NULL, '2021-02-10 00:00:00.000', 'Approved', 'Group has an ancillary contract.', NULL, NULL, '2021-02-03 16:38:10', '2021-02-03 16:38:10'),
(10060, 3040, 13611, NULL, NULL, 'Revalidation', 'Email sent to: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Hello David,   Hope you are doing well. The contract request form that was sent out in your previous email I would like to ask you in the provider type section what option you want me to mark for the providers. If you could reach out to me on 713-893-6214 that would be better.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you', NULL, NULL, '2021-04-26 10:44:34', '2021-04-26 10:44:34'),
(10061, 3040, 13611, NULL, NULL, 'Revalidated', 'Group has an ancillary contract. No need to add individual providers as per Jasmine.Guerrero@molinahealthcare.com ', NULL, NULL, '2021-05-31 09:09:38', '2021-05-31 09:09:38'),
(10062, 3040, 13612, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-03 16:41:15', '2021-02-03 16:41:15'),
(10063, 3040, 13612, NULL, '2021-02-10 00:00:00.000', 'Approved', 'Group has an ancillary contract', NULL, NULL, '2021-02-03 16:45:25', '2021-02-03 16:45:25'),
(10064, 3040, 13612, NULL, NULL, 'Revalidation', 'Email sent to: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Hello David,   Hope you are doing well. The contract request form that was sent out in your previous email I would like to ask you in the provider type section what option you want me to mark for the providers. If you could reach out to me on 713-893-6214 that would be better.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you', NULL, NULL, '2021-04-26 10:47:27', '2021-04-26 10:47:27'),
(10065, 3040, 13612, NULL, NULL, 'Revalidated', 'Group has an ancillary contract. No need to add individual providers as per Jasmine.Guerrero@molinahealthcare.com ', NULL, NULL, '2021-05-31 09:08:08', '2021-05-31 09:08:08'),
(10066, 3040, 13613, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-03 16:41:17', '2021-02-03 16:41:17'),
(10067, 3040, 13613, NULL, '2021-02-10 00:00:00.000', 'Approved', 'Group has an ancillary contract', NULL, NULL, '2021-02-03 16:45:27', '2021-02-03 16:45:27'),
(10068, 3040, 13613, NULL, NULL, 'Revalidation', 'Email sent to: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Hello David,   Hope you are doing well. The contract request form that was sent out in your previous email I would like to ask you in the provider type section what option you want me to mark for the providers. If you could reach out to me on 713-893-6214 that would be better.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you', NULL, NULL, '2021-04-26 10:47:21', '2021-04-26 10:47:21'),
(10069, 3040, 13613, NULL, NULL, 'Revalidated', 'Group has an ancillary contract. No need to add individual providers as per Jasmine.Guerrero@molinahealthcare.com ', NULL, NULL, '2021-05-31 09:11:17', '2021-05-31 09:11:17'),
(10070, 3040, 13614, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-03 16:41:19', '2021-02-03 16:41:19'),
(10071, 3040, 13614, NULL, '2021-02-10 00:00:00.000', 'Approved', 'Group has an ancillary contract', NULL, NULL, '2021-02-03 16:45:23', '2021-02-03 16:45:23'),
(10072, 3040, 13614, NULL, NULL, 'Revalidation', 'Email sent to: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Hello David,   Hope you are doing well. The contract request form that was sent out in your previous email I would like to ask you in the provider type section what option you want me to mark for the providers. If you could reach out to me on 713-893-6214 that would be better.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you', NULL, NULL, '2021-04-26 10:47:16', '2021-04-26 10:47:16'),
(10073, 3040, 13614, NULL, NULL, 'Revalidated', 'Group has an ancillary contract. No need to add individual providers as per Jasmine.Guerrero@molinahealthcare.com ', NULL, NULL, '2021-05-31 09:09:41', '2021-05-31 09:09:41'),
(10074, 1006, 13615, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-03 16:45:58', '2021-02-03 16:45:58'),
(10075, 1006, 13615, NULL, '2021-02-10 00:00:00.000', 'In Process', 'Submitted enrollment request via Palmetto GBA Reference Number :	21034001781 ', NULL, NULL, '2021-02-03 16:49:19', '2021-02-03 16:49:19'),
(10076, 1006, 13615, NULL, '2021-02-17 00:00:00.000', 'Approved', 'Your active Railroad Medicare PTAN has been located and is shown here :  PROVIDER NAME	LYNNETTA LOVELAND PROVIDER PTAN	Q00018358 PROVIDER NPI	1598163602 EFFECTIVE DATE	10/01/2020 END DATE	 GROUP NAME	SPECTRUM NEURO BEHAVIORAL CA GROUP PTAN	EA0358 BUSINESS STATE	MA EFFECTIVE DATE	08/05/2019 END DATE	 ', NULL, NULL, '2021-02-10 11:19:55', '2021-02-10 11:19:55'),
(10077, 3040, 13616, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-03 16:46:54', '2021-02-03 16:46:54'),
(10078, 3040, 13616, NULL, '2021-02-10 00:00:00.000', 'Approved', 'Group has an ancillary contract', NULL, NULL, '2021-02-03 16:51:09', '2021-02-03 16:51:09'),
(10079, 3040, 13617, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-03 16:46:57', '2021-02-03 16:46:57'),
(10080, 3040, 13617, NULL, '2021-02-10 00:00:00.000', 'Approved', 'Group has an ancillary contract', NULL, NULL, '2021-02-03 16:51:14', '2021-02-03 16:51:14'),
(10081, 3040, 13618, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-03 16:46:59', '2021-02-03 16:46:59'),
(10082, 3040, 13618, NULL, '2021-02-10 00:00:00.000', 'Approved', 'Group has an ancillary contract', NULL, NULL, '2021-02-03 16:51:30', '2021-02-03 16:51:30'),
(10083, 3040, 13619, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-03 16:53:08', '2021-02-03 16:53:08'),
(10084, 3040, 13619, NULL, '2021-02-10 00:00:00.000', 'Approved', 'Group has an ancillary contract.', NULL, NULL, '2021-02-03 16:56:01', '2021-02-03 16:56:01'),
(10085, 3040, 13619, NULL, NULL, 'Revalidation', 'Email sent to: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Hello David,   Hope you are doing well. The contract request form that was sent out in your previous email I would like to ask you in the provider type section what option you want me to mark for the providers. If you could reach out to me on 713-893-6214 that would be better.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you', NULL, NULL, '2021-04-26 10:46:33', '2021-04-26 10:46:33'),
(10086, 3040, 13619, NULL, NULL, 'Revalidated', 'Group has an ancillary contract. No need to add individual providers as per Jasmine.Guerrero@molinahealthcare.com ', NULL, NULL, '2021-05-31 09:08:12', '2021-05-31 09:08:12'),
(10087, 3040, 13620, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-03 16:53:11', '2021-02-03 16:53:11'),
(10088, 3040, 13620, NULL, '2021-02-10 00:00:00.000', 'Approved', 'Group has an ancillary contract.', NULL, NULL, '2021-02-03 16:56:08', '2021-02-03 16:56:08'),
(10089, 3040, 13620, NULL, NULL, 'Revalidation', 'Email sent to: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Hello David,   Hope you are doing well. The contract request form that was sent out in your previous email I would like to ask you in the provider type section what option you want me to mark for the providers. If you could reach out to me on 713-893-6214 that would be better.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you', NULL, NULL, '2021-04-26 10:46:28', '2021-04-26 10:46:28'),
(10090, 3040, 13620, NULL, NULL, 'Revalidated', 'Group has an ancillary contract. No need to add individual providers as per Jasmine.Guerrero@molinahealthcare.com ', NULL, NULL, '2021-05-31 09:11:24', '2021-05-31 09:11:24'),
(10091, 3040, 13621, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-03 16:53:12', '2021-02-03 16:53:12'),
(10092, 3040, 13621, NULL, '2021-02-10 00:00:00.000', 'Approved', 'Group has an ancillary contract.', NULL, NULL, '2021-02-03 16:56:16', '2021-02-03 16:56:16'),
(10093, 3040, 13621, NULL, NULL, 'Revalidation', 'Email sent to: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Hello David,   Hope you are doing well. The contract request form that was sent out in your previous email I would like to ask you in the provider type section what option you want me to mark for the providers. If you could reach out to me on 713-893-6214 that would be better.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you', NULL, NULL, '2021-04-26 10:46:23', '2021-04-26 10:46:23'),
(10094, 3040, 13621, NULL, NULL, 'Revalidated', 'Group has an ancillary contract. No need to add individual providers as per Jasmine.Guerrero@molinahealthcare.com ', NULL, NULL, '2021-05-31 09:09:50', '2021-05-31 09:09:50'),
(10095, 3040, 13622, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-03 16:57:41', '2021-02-03 16:57:41'),
(10096, 3040, 13622, NULL, '2021-02-10 00:00:00.000', 'Approved', 'Group has an ancillary contract.', NULL, NULL, '2021-02-03 17:00:38', '2021-02-03 17:00:38'),
(10097, 3040, 13622, NULL, NULL, 'Revalidation', 'Email sent to: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Hello David,   Hope you are doing well. The contract request form that was sent out in your previous email I would like to ask you in the provider type section what option you want me to mark for the providers. If you could reach out to me on 713-893-6214 that would be better.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you', NULL, NULL, '2021-04-26 10:46:04', '2021-04-26 10:46:04'),
(10098, 3040, 13622, NULL, NULL, 'Revalidated', 'Group has an ancillary contract. No need to add individual providers as per Jasmine.Guerrero@molinahealthcare.com ', NULL, NULL, '2021-05-31 09:08:15', '2021-05-31 09:08:15'),
(10099, 3040, 13623, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-03 16:57:44', '2021-02-03 16:57:44'),
(10100, 3040, 13623, NULL, '2021-02-10 00:00:00.000', 'Approved', 'Group has an ancillary contract.', NULL, NULL, '2021-02-03 17:00:44', '2021-02-03 17:00:44'),
(10101, 3040, 13623, NULL, NULL, 'Revalidation', 'Email sent to: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Hello David,   Hope you are doing well. The contract request form that was sent out in your previous email I would like to ask you in the provider type section what option you want me to mark for the providers. If you could reach out to me on 713-893-6214 that would be better.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you', NULL, NULL, '2021-04-26 10:46:00', '2021-04-26 10:46:00'),
(10102, 3040, 13623, NULL, NULL, 'Revalidated', 'Group has an ancillary contract. No need to add individual providers as per Jasmine.Guerrero@molinahealthcare.com ', NULL, NULL, '2021-05-31 09:11:27', '2021-05-31 09:11:27'),
(10103, 3040, 13624, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-03 16:57:45', '2021-02-03 16:57:45'),
(10104, 3040, 13624, NULL, '2021-02-10 00:00:00.000', 'Approved', 'Group has an ancillary contract.', NULL, NULL, '2021-02-03 17:00:52', '2021-02-03 17:00:52'),
(10105, 3040, 13624, NULL, NULL, 'Revalidation', 'Email sent to: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Hello David,   Hope you are doing well. The contract request form that was sent out in your previous email I would like to ask you in the provider type section what option you want me to mark for the providers. If you could reach out to me on 713-893-6214 that would be better.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you', NULL, NULL, '2021-04-26 10:45:55', '2021-04-26 10:45:55'),
(10106, 3040, 13624, NULL, NULL, 'Revalidated', 'Group has an ancillary contract. No need to add individual providers as per Jasmine.Guerrero@molinahealthcare.com ', NULL, NULL, '2021-05-31 09:09:53', '2021-05-31 09:09:53'),
(10107, 1006, 13625, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-03 17:01:00', '2021-02-03 17:01:00'),
(10108, 1006, 13625, NULL, '2021-02-12 00:00:00.000', 'Initiated', 'Submitted enrollment form @ PNMDepartment@commonwealthcare.org. Attached for reference.', NULL, NULL, '2021-02-03 17:28:49', '2021-02-03 17:28:49'),
(10109, 1006, 13625, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Sent a follow-up email @ PNM Department PNMDepartment@commonwealthcare.org & #Credentialing Credentialing@commonwealthcare.org', NULL, NULL, '2021-02-12 11:19:24', '2021-02-12 11:19:24'),
(10110, 1006, 13625, NULL, '2021-03-09 00:00:00.000', 'In Process', 'Sent a follow-up email @ PNM Department PNMDepartment@commonwealthcare.org & #Credentialing Credentialing@commonwealthcare.org:  \"Hello,   I wanted to get an update regarding the enrollment status for the following provider:  Provider Name: Lynnetta Loveland NPI# 1598163602 TIN# 83-4482753  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-03-02 12:02:31', '2021-03-02 12:02:31'),
(10111, 1019, 13625, NULL, '2021-04-07 00:00:00.000', 'In Process', 'Receive the following message from  :PNMDepartment@commonwealthcare.org Hello,     Provider Lynnetta Loveland, PMHNP is in process, please allow time for credentialing period.     Credentialing period can take 30-60 days and you will receive confirmation once completed.     Thank you,', NULL, NULL, '2021-03-31 15:08:09', '2021-03-31 15:08:09'),
(10112, 1006, 13625, NULL, '2021-04-14 00:00:00.000', 'In Process', 'Received the following update from @ PNM Department PNMDepartment@commonwealthcare.org:  Sub: Enrollment Status - Lynnetta Loveland  \"Hello,  Provider is in process, please allow time for credentialing period.  Credentialing period can take 30-60 days and you will receive confirmation once completed.  Thank You,  cid:image001.png@01D6B0FA.A2419D50 Provider Network Management Commonwealth Care Alliance 2 Avenue De Lafayette 5th Floor Boston MA 02111 PNMDepartment@commonwealthcare.org\"', NULL, NULL, '2021-04-07 13:22:58', '2021-04-07 13:22:58'),
(10113, 1019, 13625, NULL, '2021-05-04 00:00:00.000', 'In Process', 'Received the following email from ybratslavskaya@commonwealthcare.org  Lynnetta Loveland, PMHNP    Good Morning, The above listed provider is in the process of Credentialing with CCA.  Please submit a current and active copy of the providers ANCC board certification and DEA Certificate Credentialing cannot be completed without this.', NULL, NULL, '2021-04-27 07:15:06', '2021-04-27 07:15:06'),
(10114, 1019, 13625, NULL, '2021-05-04 00:00:00.000', 'In Process', 'Sent the following email to ybratslavskaya@commonwealthcare.org  Good Morning Yelena, Hope you are doing good, I have attached the active copy of providers ANCC board certification and DEA Certificate. Let me know if you need further assistance.  Regards, Alex', NULL, NULL, '2021-04-27 07:15:47', '2021-04-27 07:15:47'),
(10115, 1019, 13625, NULL, '2021-05-04 00:00:00.000', 'In Process', ' Received the following email from ybratslavskaya@commonwealthcare.org Thank you Alex,  The professional liability insurance expirees within a week.  Please provide a new one.  Thank you, Yelena', NULL, NULL, '2021-04-27 07:24:28', '2021-04-27 07:24:28'),
(10116, 1019, 13625, NULL, '2021-05-04 00:00:00.000', 'In Process', 'Sent the following email to ybratslavskaya@commonwealthcare.org  Thanks Yelena for the prompt response, I have attached the updated  professional liability insurance.  Regards, Alex', NULL, NULL, '2021-04-27 07:24:53', '2021-04-27 07:24:53'),
(10117, 1019, 13625, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to Credentialing@commonwealthcare.org, PNMDepartment@commonwealthcare.org  SUB: Enrollment Query || Group & Providers || SNBCARE || CCA Hello, We want the enrollment status for our Group and Providers under our group, also please provide us the effective dates for the providers as well.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753   Locations: Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.  Barbara Hignite NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.  Lynetta Loveland NPI:1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Peggy Pionke NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1356906572 Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Location: 100 New State Highway, Raynham, MA, 02767.', NULL, NULL, '2021-06-03 16:08:32', '2021-06-03 16:08:32'),
(10118, 1019, 13625, NULL, '2021-07-20 00:00:00.000', 'Approved', 'Received the following email from PNMDepartment@commonwealthcare.org  Good Morning Alex,  The additional location of 100 New State Hwy was added for the below providers effective 04/15/2021.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753   Locations: Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.  Barbara Hignite NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.  Lynetta Loveland NPI:1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Peggy Pionke NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1356906572 Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Location: 100 New State Highway, Raynham, MA, 02767.  Please clarify the request for a copy of their contracts if they’re linked or credentialed. The contract is with Spectrum Neuro Behavioral Care not the individual providers.  Many Thanks, Yesenia', NULL, NULL, '2021-07-13 10:15:35', '2021-07-13 10:15:35'),
(10119, 1006, 13626, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-03 17:33:51', '2021-02-03 17:33:51'),
(10120, 1006, 13626, NULL, '2021-02-15 00:00:00.000', 'Initiated', 'Submitted enrollment request @ Tufts Health Plan Credentialing Department Tufts_Health_Plan_Credentialing_Department@tufts-health.com, attached for reference.', NULL, NULL, '2021-02-03 17:57:11', '2021-02-03 17:57:11'),
(10121, 1006, 13626, NULL, '2021-02-23 00:00:00.000', 'In Process', 'Sent a follow-up email @ Tufts_Health_Plan_Credentialing_Department@tufts-health.com:  \"Hello,   I wanted to follow-up on our enrollment request and see if there have been any updates on it and what the expected time-frame is for completion?  Thanks. \" ', NULL, NULL, '2021-02-16 09:44:22', '2021-02-16 09:44:22'),
(10122, 1006, 13626, NULL, '2021-03-10 00:00:00.000', 'In Process', 'Sent a follow-up email @ Tufts Health Plan Credentialing Department Tufts_Health_Plan_Credentialing_Department@tufts-health.com & AHCBehavioralHealth@tufts-health.com. ', NULL, NULL, '2021-03-03 17:54:55', '2021-03-03 17:54:55'),
(10123, 1006, 13626, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Received following email from :  \"Hello,  Attached please find your Allied Health Provider Agreement with Tufts Associated Health Maintenance Organization, Inc., Total Health Plan, Inc.  Complete the signature page (signature, printed name, title, and date) and return to us so that we may countersign it.  If you make any changes to the contract document we will not be able to process your contract for you.  You may return the completed signature page via email to:  Tufts_Health_Plan_Credentialing_Department@tufts-health.com or fax it to 617-972-9591  Once we are in receipt of your completed contract, the credentialing process will begin.    Thank you   Tufts Health Plan\"  Contract signed and sent back. ', NULL, NULL, '2021-03-08 10:53:17', '2021-03-08 10:53:17'),
(10124, 1006, 13626, NULL, '2021-03-30 00:00:00.000', 'In Process', 'Sent a follow-up email @ AHCBehavioralHealth@tufts-health.com & Tufts_Health_Plan_Credentialing_Department@tufts-health.com:  \"Hello,   I hope you\'re doing well, I want to get an update regarding the credentialing/contracting status for the following provider:    Provider Name: Lynnetta Loveland NPI# 1598163602 TIN# 83-4482753  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-03-23 16:25:05', '2021-03-23 16:25:05'),
(10125, 1019, 13626, NULL, '2021-04-07 00:00:00.000', 'In Process', 'Received following email from : Tufts_Health_Plan_Credentialing_Department@tufts-health.com  Incident number - PPO0093957       Hello   Lynnetta Loveland\'s contract was received and processed a couple weeks ago.  She is in credentialing.  Once cred is complete, she will be all set.   Thank you Provider Operations   Ref:MSG6727350', NULL, NULL, '2021-03-31 15:06:02', '2021-03-31 15:06:02'),
(10126, 1019, 13626, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to provider_data_request@tufts-health.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tufts Health Plans  Hello, We need the enrollment status for the following providers under our group, as their applications have been in process for a while now.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert NPI: 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  ', NULL, NULL, '2021-06-05 13:03:27', '2021-06-05 13:03:27'),
(10127, 1019, 13626, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Sent the following email to Kody_Dunnett@tufts-health.com  Hello Kody,  We need to expedite the applications for the following providers of Credentialing and Contracting as it is In process since a while now as it is adversely affecting our business, also we are not getting proper responses on our emails.  Spectrum Neuro Behavioral Care LLC. 1356906572 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rodesia Edmundson  1124622667  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Mary Gibbons  NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Lynnetta Loveland  NPI: 1598163602  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Jonathan Schubert  NPI: 1235755505  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jennifer Ullrich NPI: 1710489760  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Prisca Hefti NPI: 1508133182  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767  Regards, Alex G', NULL, NULL, '2021-06-23 09:26:59', '2021-06-23 09:26:59');
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
(10128, 11056, 13626, NULL, '2021-12-10 00:00:00.000', 'Approved', 'Email received from:  Denise_Rysinger@tufts-health.com  Sub:  Fwd: Enrollment Issue with Tufts Health Plan  Hello,  I apologize for the late response. Please see my responses in red for each provider below.     Group:  Spectrum Neuro Behavioral Care LLC. NPI: 1356906572     Providers  Loveland, Lynnetta - Provider is contracted effective 11/15/2021 NPI: 1598163602   Denise Rysinger  Director, Provider Operations  Tufts Health Public Plans 617-972-9400 ext. 54137 Denise_Rysinger@tufts-health.com  www.point32health.org www.harvardpilgrim.org www.tuftshealthplan.com', NULL, NULL, '2021-12-03 13:56:53', '2021-12-03 13:56:53'),
(10129, 3040, 13627, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-05 14:44:52', '2021-02-05 14:44:52'),
(10130, 3040, 13627, NULL, '2021-02-12 00:00:00.000', 'Initiated', 'Link Letter sent through fax 608-221-7535.  See attachment.', NULL, NULL, '2021-02-05 14:45:31', '2021-02-05 14:45:31'),
(10131, 3040, 13627, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Link letter rcvd process will take 60-90 days ', NULL, NULL, '2021-02-12 16:33:55', '2021-02-12 16:33:55'),
(10132, 3040, 13627, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Abraham, Jeena || Tricare ||  Greetings,  Hope you are doing well. Please advise me the enrollment status for the below mentioned provider. I already sent the link letter through fax.   Practice 1: Practice Name: Normandy Urgent Care Center Practice NPI# 1407171077 Practice Tax ID# 27-0796429 Address: 779 Normandy St Ste 114 Houston , TX 77015-3441  Practice 2: Practice Name: Imperial Valley Urgent Care Center Practice NPI# 1407171077 Practice Tax ID# 27-0796429 Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060   Provider Name: Abraham, Jeena Provider NPI# 1467901587  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-02-25 15:33:09', '2021-02-25 15:33:09'),
(10133, 3040, 13627, NULL, '2021-03-19 00:00:00.000', 'In Process', 'Email sent to: HGBProviderRosters@humana.com, ywyatt@humana.com  Subject: Enrollment || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Abraham, Jeena, Nampimadom, Sheena F, Stephen, Ani, PAUL, SIGI & Jacob, Jaya || Tricare ||  Greetings,  Please advise me the enrollment status for the below mentioned providers.   Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Name:   Jeena Abraham   Provider NPI#  1467901587  Provider Name:  Sheena F Nampimadom    Provider NPI# 1245789346  Provider Name:  Ani Stephen Provider NPI# 1588959118  Provider Name: Mini P  Chennemkara Provider NPI# 1841755956  Provider Name: Brittany  Brown  Provider NPI# 1275163537  Provider Name: Sigi Paul  Provider NPI# 1033623616  Provider Name: Jaya Jacob  Provider NPI# 1194336149   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.    Thank you ', NULL, NULL, '2021-03-12 17:56:36', '2021-03-12 17:56:36'),
(10134, 3040, 13627, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Tricare ||  Hello Katherine,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Tricare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-02 16:07:28', '2021-06-02 16:07:28'),
(10135, 3040, 13627, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Tricare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-22 09:44:20', '2021-06-22 09:44:20'),
(10136, 3040, 13627, NULL, '2021-07-19 00:00:00.000', 'Approved', 'Email rcvd from: ywyatt@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||    Provider 13:    Provider Name: Abraham, Jeena show network under one location (Normandy)  Provider NPI# 1467901587', NULL, NULL, '2021-07-12 13:32:32', '2021-07-12 13:32:32'),
(10137, 3040, 13628, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-05 14:46:08', '2021-02-05 14:46:08'),
(10138, 3040, 13628, NULL, '2021-02-12 00:00:00.000', 'Initiated', 'Link Letter send through fax 608-221-7535 for location addition.  See attachment', NULL, NULL, '2021-02-05 14:48:25', '2021-02-05 14:48:25'),
(10139, 3040, 13628, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Link letter rcvd process will take 60-90 days ', NULL, NULL, '2021-02-12 16:33:46', '2021-02-12 16:33:46'),
(10140, 3040, 13628, NULL, '2021-03-10 00:00:00.000', 'Approved', 'Location added in Tricare Portal ', NULL, NULL, '2021-03-03 14:02:17', '2021-03-03 14:02:17'),
(10141, 3040, 13629, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-05 14:46:54', '2021-02-05 14:46:54'),
(10142, 3040, 13629, NULL, '2021-02-12 00:00:00.000', 'Initiated', 'Link Letter send through fax 608-221-7535.  See attachment.', NULL, NULL, '2021-02-05 14:47:33', '2021-02-05 14:47:33'),
(10143, 3040, 13629, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Link letter rcvd process will take 60-90 days ', NULL, NULL, '2021-02-12 16:34:08', '2021-02-12 16:34:08'),
(10144, 3040, 13629, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Abraham, Jeena || Tricare ||  Greetings,  Hope you are doing well. Please advise me the enrollment status for the below mentioned provider. I already sent the link letter through fax.   Practice 1: Practice Name: Normandy Urgent Care Center Practice NPI# 1407171077 Practice Tax ID# 27-0796429 Address: 779 Normandy St Ste 114 Houston , TX 77015-3441  Practice 2: Practice Name: Imperial Valley Urgent Care Center Practice NPI# 1407171077 Practice Tax ID# 27-0796429 Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060   Provider Name: Abraham, Jeena Provider NPI# 1467901587  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-02-25 15:33:19', '2021-02-25 15:33:19'),
(10145, 3040, 13629, NULL, '2021-03-19 00:00:00.000', 'In Process', 'Email sent to: HGBProviderRosters@humana.com, ywyatt@humana.com  Subject: Enrollment || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Abraham, Jeena, Nampimadom, Sheena F, Stephen, Ani, PAUL, SIGI & Jacob, Jaya || Tricare ||  Greetings,  Please advise me the enrollment status for the below mentioned providers.   Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Name:   Jeena Abraham   Provider NPI#  1467901587  Provider Name:  Sheena F Nampimadom    Provider NPI# 1245789346  Provider Name:  Ani Stephen Provider NPI# 1588959118  Provider Name: Mini P  Chennemkara Provider NPI# 1841755956  Provider Name: Brittany  Brown  Provider NPI# 1275163537  Provider Name: Sigi Paul  Provider NPI# 1033623616  Provider Name: Jaya Jacob  Provider NPI# 1194336149   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.    Thank you ', NULL, NULL, '2021-03-12 17:56:45', '2021-03-12 17:56:45'),
(10146, 3040, 13629, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Tricare ||  Hello Katherine,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Tricare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-02 16:09:06', '2021-06-02 16:09:06'),
(10147, 3040, 13629, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Tricare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-22 09:44:17', '2021-06-22 09:44:17'),
(10148, 3040, 13629, NULL, '2021-07-16 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Additional Location || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Greetings,   Hope you are doing well. I wanted to add the location under the below mentioned providers in Tricare in our group under the below mentioned locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Jose, Julie Provider NPI# 1447883061 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 2:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 3:   Provider Name: Rauf, Abdur  Provider NPI# 1497726202 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 4:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 5:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238 Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226   Provider 7:   Provider Name: Abraham, Jeena  Provider NPI# 1467901587 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-07-09 14:33:15', '2021-07-09 14:33:15'),
(10149, 11056, 13629, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email received from :    ywyatt@humana.com  Sub : Fwd: Additional Location || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Good Morning Adil,     To add a provider to a network location you need to complete the attached spreadsheet and email it to the HGB Roster team to process.     Send the completed spreadsheet to the following email address     HGBProviderRosters@Humana.com              Thanks,  Yvonne', NULL, NULL, '2021-08-11 11:28:50', '2021-08-11 11:28:50'),
(10150, 3040, 13629, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to: HGBProviderRosters@humana.com, ywyatt@humana.com  Subject: Re: Additional Location || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Received Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in an additional location in Tricare in our group under the below highlighted locations. We already submitted the roster for an additional location on 07/19/2021.   Practice Details: Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider 1:     Provider Name: Jose, Julie  Provider NPI# 1447883061  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 2:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 3:    Provider Name: Rauf, Abdur   Provider NPI# 1497726202  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 4:    Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 5:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 6:    Provider Name: Thomas, Cini   Provider NPI# 1134777238  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226   Provider 7:    Provider Name: Abraham, Jeena   Provider NPI# 1467901587  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you!! ', NULL, NULL, '2021-08-18 16:51:41', '2021-08-18 16:51:41'),
(10151, 3040, 13629, NULL, '2021-09-08 00:00:00.000', 'Approved', 'Email rcvd from: ywyatt@humana.com  Subject: RE: Additional Location || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Good Afternoon Adil,  We show the following.  This information is available on the Providers Portal or directory Highlighted is the link to check status. I have attached a copy of the spreadsheet of the Providers we show affiliated to these groups under this tax id.   https://infocenter.humana-military.com/provider/service/Account/Login  HumanaMilitary - Find care (goperspecta.com)  Provider 1:   Provider Name: Jose, Julie- Show has been added Provider NPI# 1447883061 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 2:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 – Show added Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226- Show not added yet  Provider 3:  Show Added Provider Name: Rauf, Abdur  Provider NPI# 1497726202 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 4:  Show added to both locations Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 5:  - Show added Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 6:   Provider Name: Thomas, Cini – show added to all three locations Provider NPI# 1134777238 Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 7:  - Show added. Provider Name: Abraham, Jeena  Provider NPI# 1467901587 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Thanks, Yvonne W. Wyatt, Humana Military TRICARE Community Liaison II Houston/Galveston 502-318-5409 Telephone 502-322-8018 Fax ywyatt@humana.com', NULL, NULL, '2021-09-01 13:09:09', '2021-09-01 13:09:09'),
(10152, 1006, 13630, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-08 16:50:56', '2021-02-08 16:50:56'),
(10153, 1006, 13630, NULL, '2021-02-15 00:00:00.000', 'Initiated', 'Sent following email @ va_triwest@bcbstx.com:  \"Hello,  We wanted to update the name and add location information under our group CCN contract as well as to reinstate a location which was termed, the requests are as follows:  Name: Statcare Minor Emergency Clinic (Update) TIN# 46-0575924 Address: 4042 River Hill, Corpus Christi, TX 78410 (Re-instate) Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 (Add)  Please let me know what is required to get all of this done and what the expected time-frame is.   Thank you.\"', NULL, NULL, '2021-02-08 17:11:39', '2021-02-08 17:11:39'),
(10154, 1006, 13630, NULL, '2021-02-23 00:00:00.000', 'In Process', 'Sent a follow-up email @ va_triwest@bcbstx.com regarding the status of requests.', NULL, NULL, '2021-02-16 09:46:19', '2021-02-16 09:46:19'),
(10155, 3046, 13630, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Email sent to: va_triwest@bcbstx.com Subject: Request for Name & Add Location Status  || Statcare Minor Emergency Clinic || TriWest|| Greetings, Hello, Hope you are well. Kindly advise the status of the name updates and the request to add and reinstate a location information under our group CCN contract which was termed. For your reference, kindly find below requests. Name: Statcare Minor Emergency Clinic (Update) TIN# 46-0575924 Address: 4042 River Hill, Corpus Christi, TX 78410 (Re-instate) Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 (Add) Also, please advise if there is any other action to be taken to change it. Moreover, kindly advise how much time it will take to be completed. I hope to hear from you soon. Thank you. ', NULL, NULL, '2021-02-25 15:31:39', '2021-02-25 15:31:39'),
(10156, 3046, 13630, NULL, '2021-03-11 00:00:00.000', 'In Process', 'Email sent to: va_triwest@bcbstx.com Subject: Request for Name & Add Location Status || Statcare Minor Emergency Clinic || Triwest ||  Greetings,  I hope my email will find you well.  Please note that this is a gentle reminder for my previous email for the request for the status of the name updates and the request to add and reinstate a location information under our group CCN contract which was termed. For your reference, kindly find below requests.  Name: Statcare Minor Emergency Clinic (Update) TIN# 46-0575924 Address: 4042 River Hill, Corpus Christi, TX 78410 (Re-instate) Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 (Add)  Also, please advise if there is any other action to be taken to change it. Moreover, kindly advise how much time it will take to be completed.  I hope to hear from you soon.  Thank you.  ', NULL, NULL, '2021-03-04 13:07:03', '2021-03-04 13:07:03'),
(10157, 3046, 13630, NULL, '2021-03-26 00:00:00.000', 'In Process', 'Email sent to: va_triwest@bcbstx.com Subject: Request for Name & Add Location Status || Statcare Minor Emergency Clinic || TriWest|| Hello, May I know if there is any update on this. Thank you.', NULL, NULL, '2021-03-19 14:02:04', '2021-03-19 14:02:04'),
(10158, 1006, 13630, NULL, '2021-04-15 00:00:00.000', 'Approved', 'SPID location has been added to our CCN Contract. The group is effective as of 08/10/2020 holding an Ancillary contract, so no need to add individual providers.  Location addition approval, contract, and welcome letter are attached on group task for reference.  ', NULL, NULL, '2021-04-08 18:25:55', '2021-04-08 18:25:55'),
(10159, 1006, 13631, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-08 17:41:04', '2021-02-08 17:41:04'),
(10160, 1006, 13631, NULL, '2021-02-15 00:00:00.000', 'Initiated', 'Sent following email @ CHC Contracting CHC.Contracting@communityhealthchoice.org: \"Hello,   I appreciate the update, we also want this provider to show up on the following tertiary address that should already be listed under Normandy Urgent Care Center PA: Address: 9504 LONG POINT RD STE E, Houston, TX 77055-4226  Please let me know what is required to get this updated ASAP.   Thank you. \"', NULL, NULL, '2021-02-08 17:41:36', '2021-02-08 17:41:36'),
(10161, 1006, 13631, NULL, '2021-02-23 00:00:00.000', 'In Process', 'Sent a follow-up email to Kris regarding the status. ', NULL, NULL, '2021-02-16 13:56:37', '2021-02-16 13:56:37'),
(10162, 3040, 13631, NULL, '2021-03-08 00:00:00.000', 'In Process', 'Email sent to: Rajika.Reid@communityhealthchoice.org  Subject: Enrollment Status || Longpoint Medical Center || Jose, Julie, George, Jeemol & Abraham, Glory || Community Health Choice ||  Greetings,   Hope you are doing well. Please advise me the enrollment status for the below mentioned providers.   Practice Name: Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Name: Jose, Julie Provider NPI# 1447883061  Provider Name: George, Jeemol Provider NPI# 1497219067  Provider Name: Abraham, Glory Provider NPI# 1194206490  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-03-01 15:44:10', '2021-03-01 15:44:10'),
(10163, 3040, 13631, NULL, '2021-03-26 00:00:00.000', 'In Process', 'Email sent to: Rajika.Reid@communityhealthchoice.org  Subject: Enrollment Status || Longpoint Medical Center || Jose, Julie, George, Jeemol & Abraham, Glory || Community Health Choice ||  Greetings,   Hope you are doing well. I just wanted to follow up regarding the enrollment status for the below mentioned providers.   Practice Name: Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Name: Jose, Julie Provider NPI# 1447883061  Provider Name: George, Jeemol Provider NPI# 1497219067  Provider Name: Abraham, Glory Provider NPI# 1194206490  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you  ', NULL, NULL, '2021-03-19 14:05:16', '2021-03-19 14:05:16'),
(10164, 3040, 13631, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: CHC.Contracting@communityhealthchoice.org  Subject: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Community Health Choice for our group under the below locations.     Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 14:02:54', '2021-05-26 14:02:54'),
(10165, 3040, 13631, NULL, '2021-06-21 00:00:00.000', 'On Hold', 'We have an ancillary contract with CHC. Location addition request sent out. For more details please see the group task. ', NULL, NULL, '2021-06-14 10:51:39', '2021-06-14 10:51:39'),
(10166, 3040, 13631, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: Rajika.Reid@communityhealthchoice.org  Subject: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Hello Rajika,   Hope you are doing well. Please find the attached signed contract as per your request email for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  If you need any additional information please feel free to call or email me.  Thank you ', NULL, NULL, '2021-07-20 10:43:26', '2021-07-20 10:43:26'),
(10167, 11056, 13631, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email sent to : Rajika.Reid@communityhealthchoice.org  Sub : FW: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Community Health Choice for our group under the below locations. And provide us with the updates regarding the signed contract which we have submitted to you in the month of June, 2021.    Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: George, Jeemol  Provider NPI# 1497219067     Provider 2:    Provider Name: Jose, Julie  Provider NPI# 1447883061     Provider 3:    Provider Name: Stephen, Ani  Provider NPI# 1588959118     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Brown, Brittany  Provider NPI# 1275163537     Provider 6:    Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956     Provider 7:    Provider Name: Abraham, Glory  Provider NPI# 1194206490     Provider 8:    Provider Name: Fernandus, Limy  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider NPI# 1497726202     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868     Provider 11:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560     Provider 12:    Provider Name: Thomas, Cini  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider NPI# 1467901587     Provider 14:    Provider Name: PAUL, SIGI   Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149     If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!  Have a great week ahead!', NULL, NULL, '2021-08-09 10:35:54', '2021-08-09 10:35:54'),
(10168, 3040, 13631, NULL, '2021-08-24 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. For more details please see group task. ', NULL, NULL, '2021-08-17 13:58:06', '2021-08-17 13:58:06'),
(10169, 1006, 13632, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-10 11:16:05', '2021-02-10 11:16:05'),
(10170, 1006, 13632, NULL, '2021-02-17 00:00:00.000', 'Initiated', 'Applicant Name: RODESIA EDMUNDSON  Tracking ID: T021020210000913  Reassignment Tracking ID: T021020210000935  Submitted Date: WED - FEBRUARY 10 2021 11:05:14 AM EST  Submitted By: Rodesia Edmundson  Contact Email(s): SNBC@CLAIMSMEDINC.COM Reason(s) for submission: A Medicare Part B practitioner is enrolling in the Medicare program for the first time to bill for Part B services. A reassignment of benefits may exist. ', NULL, NULL, '2021-02-10 11:16:12', '2021-02-10 11:16:12'),
(10171, 1006, 13632, NULL, '2021-03-09 00:00:00.000', 'Approved', 'Application Tracking ID: T021020210000913   NPI ID: 1124622667   Medicare ID: S400728296   Name: RODESIA EDMUNDSON  State: MA   Form Type: 855I  Date: 02/26/2021  Status: APPROVED ', NULL, NULL, '2021-03-02 11:31:10', '2021-03-02 11:31:10'),
(10172, 1006, 13633, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-10 11:46:18', '2021-02-10 11:46:18'),
(10173, 1006, 13633, NULL, '2021-02-17 00:00:00.000', 'Initiated', 'Submitted enrollment application via PalmettoGBA: Reference Number :	21041000558 ', NULL, NULL, '2021-02-10 11:46:40', '2021-02-10 11:46:40'),
(10174, 1006, 13633, NULL, '2021-02-24 00:00:00.000', 'Approved', 'our active Railroad Medicare PTAN has been located and is shown here :  PROVIDER NAME	JUSTIN SOULIERE PROVIDER PTAN	Q00021988 PROVIDER NPI	1710576004 EFFECTIVE DATE	12/29/2020 END DATE	 GROUP NAME	SPECTRUM NEURO BEHAVIORAL CA GROUP PTAN	EA0360 BUSINESS STATE	RI EFFECTIVE DATE	07/29/2019 END DATE	', NULL, NULL, '2021-02-17 10:50:56', '2021-02-17 10:50:56'),
(10175, 3040, 13634, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-12 17:27:00', '2021-02-12 17:27:00'),
(10176, 3040, 13634, NULL, '2021-02-19 00:00:00.000', 'Approved', 'Group has an ancillary contract.  Effective date: 11/01/2017', NULL, NULL, '2021-02-12 17:31:23', '2021-02-12 17:31:23'),
(10177, 3040, 13635, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-12 17:27:01', '2021-02-12 17:27:01'),
(10178, 3040, 13635, NULL, '2021-02-19 00:00:00.000', 'Approved', 'Group has an ancillary contract.  Effective date: 11/01/2017', NULL, NULL, '2021-02-12 17:31:24', '2021-02-12 17:31:24'),
(10179, 3040, 13636, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-12 17:27:27', '2021-02-12 17:27:27'),
(10180, 3040, 13636, NULL, '2021-02-19 00:00:00.000', 'Approved', 'Group has an ancillary contract.  Effective date: 11/01/2017', NULL, NULL, '2021-02-12 17:31:26', '2021-02-12 17:31:26'),
(10181, 3040, 13636, NULL, NULL, 'Revalidation', 'Email sent to: stxnm@humana.com  Subject: Add Location || Group || Valley Med Urgent Care PLLC || Humana ||  Greetings,   Hope you are doing well. Please find the attached roster to add the practice location in the Humana for our group Valley Med Urgent Care PLLC under below location.  Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Thank you', NULL, NULL, '2021-03-25 09:59:49', '2021-03-25 09:59:49'),
(10182, 1005, 13636, NULL, '2021-06-08 00:00:00.000', 'Revalidated', 'The provider Moses Campos is no longer with Valley Med Urgent Care \\ Updating the status to Revalidated since there is no other status option available.', NULL, NULL, '2021-06-01 14:39:29', '2021-06-01 14:39:29'),
(10183, 3040, 13636, NULL, '2021-07-27 00:00:00.000', 'Revalidated', 'Group has an ancillary contract. No need to add individual providers.', NULL, NULL, '2021-07-20 11:50:34', '2021-07-20 11:50:34'),
(10184, 3040, 13637, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-12 17:27:27', '2021-02-12 17:27:27'),
(10185, 3040, 13637, NULL, '2021-02-19 00:00:00.000', 'Approved', 'Group has an ancillary contract.  Effective date: 11/01/2017', NULL, NULL, '2021-02-12 17:31:30', '2021-02-12 17:31:30'),
(10186, 3040, 13638, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-12 17:27:27', '2021-02-12 17:27:27'),
(10187, 3040, 13638, NULL, '2021-02-19 00:00:00.000', 'Approved', 'Group has an ancillary contract.  Effective date: 11/01/2017', NULL, NULL, '2021-02-12 17:31:25', '2021-02-12 17:31:25'),
(10188, 3040, 13638, NULL, NULL, 'Revalidation', 'Email sent to: stxnm@humana.com  Subject: Add Location || Group || Valley Med Urgent Care PLLC || Humana ||  Greetings,   Hope you are doing well. Please find the attached roster to add the practice location in the Humana for our group Valley Med Urgent Care PLLC under below location.  Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Thank you', NULL, NULL, '2021-03-25 10:00:29', '2021-03-25 10:00:29'),
(10189, 3040, 13638, NULL, '2021-06-23 00:00:00.000', 'Revalidation', 'Email rcvd from: stxnm@humana.com  Subject: Add Location || Group || Valley Med Urgent Care PLLC || Humana ||  Your request was received and is in the queue to be worked.  You will receive an email notification once your request has been completed.  Thank you', NULL, NULL, '2021-06-16 15:05:37', '2021-06-16 15:05:37'),
(10190, 3040, 13638, NULL, '2021-06-29 00:00:00.000', 'Revalidation', 'Email sent to: stxnm@humana.com  Subject: Re: Add Location || Group || Valley Med Urgent Care PLLC || Humana ||  Greetings,   Hope you are doing well. I wanted to know the status for an additional location in Humana for our group Valley Med Urgent Care PLLC under the below location.  Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-06-22 11:47:45', '2021-06-22 11:47:45'),
(10191, 3040, 13638, NULL, '2021-07-16 00:00:00.000', 'Revalidation', 'Group has an ancillary contract. No need to add individual providers. We already sent the request for location addition once the location under the contract we gonna update the providers task. ', NULL, NULL, '2021-07-09 12:02:21', '2021-07-09 12:02:21'),
(10192, 3040, 13638, NULL, '2021-07-27 00:00:00.000', 'Revalidated', 'Group has an ancillary contract. No need to add individual providers.', NULL, NULL, '2021-07-20 11:50:36', '2021-07-20 11:50:36'),
(10193, 3040, 13639, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-12 17:27:28', '2021-02-12 17:27:28'),
(10194, 3040, 13639, NULL, '2021-02-19 00:00:00.000', 'Approved', 'Group has an ancillary contract.  Effective date: 11/01/2017', NULL, NULL, '2021-02-12 17:31:29', '2021-02-12 17:31:29'),
(10195, 3040, 13640, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-15 15:41:57', '2021-02-15 15:41:57'),
(10196, 3040, 13640, NULL, '2021-02-22 00:00:00.000', 'In Process', 'Medicare Application submitted.  Tracking ID: T021520210001860  Reassignment Tracking ID: T021520210001931  Submitted Date: MON - FEBRUARY 15 2021 03:34:40 PM EST ', NULL, NULL, '2021-02-15 15:42:56', '2021-02-15 15:42:56'),
(10197, 3040, 13640, NULL, '2021-02-25 00:00:00.000', 'Approved', 'Individual Name: JAYA JACOB Individual Specialty: NURSE PRACTITIONER Individual National Provider Identifier (NPI): 1194336149 Individual Provider Transaction Access Number (PTAN): 1M3039 Group Legal Business Name (LBN): Normandy Urgent Care Center Group NPI: 1407171077 Group PTAN: 396951 Reassignment Effective Date: January 1, 2021', NULL, NULL, '2021-02-18 17:07:05', '2021-02-18 17:07:05'),
(10198, 3040, 13641, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-15 15:42:01', '2021-02-15 15:42:01'),
(10199, 3040, 13641, NULL, '2021-02-22 00:00:00.000', 'In Process', 'Medicare Application submitted.  Tracking ID: T021520210001860  Reassignment Tracking ID: T021520210001931  Submitted Date: MON - FEBRUARY 15 2021 03:34:40 PM EST ', NULL, NULL, '2021-02-15 15:43:07', '2021-02-15 15:43:07'),
(10200, 3040, 13641, NULL, '2021-02-25 00:00:00.000', 'Approved', 'Individual Name: JAYA JACOB Individual Specialty: NURSE PRACTITIONER Individual National Provider Identifier (NPI): 1194336149 Individual Provider Transaction Access Number (PTAN): 1M3039 Group Legal Business Name (LBN): Normandy Urgent Care Center Group NPI: 1407171077 Group PTAN: 396951 Reassignment Effective Date: January 1, 2021', NULL, NULL, '2021-02-18 17:07:07', '2021-02-18 17:07:07'),
(10201, 3040, 13642, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-15 15:42:04', '2021-02-15 15:42:04'),
(10202, 3040, 13642, NULL, '2021-02-22 00:00:00.000', 'In Process', 'Medicare Application submitted.  Tracking ID: T021520210001860  Reassignment Tracking ID: T021520210001931  Submitted Date: MON - FEBRUARY 15 2021 03:34:40 PM EST ', NULL, NULL, '2021-02-15 15:43:16', '2021-02-15 15:43:16'),
(10203, 3040, 13642, NULL, '2021-02-25 00:00:00.000', 'Approved', 'Individual Name: JAYA JACOB Individual Specialty: NURSE PRACTITIONER Individual National Provider Identifier (NPI): 1194336149 Individual Provider Transaction Access Number (PTAN): 1M3039 Group Legal Business Name (LBN): Normandy Urgent Care Center Group NPI: 1407171077 Group PTAN: 396951 Reassignment Effective Date: January 1, 2021', NULL, NULL, '2021-02-18 17:07:08', '2021-02-18 17:07:08'),
(10204, 3040, 13643, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-15 15:42:06', '2021-02-15 15:42:06'),
(10205, 3040, 13643, NULL, '2021-02-22 00:00:00.000', 'In Process', 'Medicare Application submitted.  Tracking ID: T021520210001860  Reassignment Tracking ID: T021520210001931  Submitted Date: MON - FEBRUARY 15 2021 03:34:40 PM EST ', NULL, NULL, '2021-02-15 15:43:23', '2021-02-15 15:43:23'),
(10206, 3040, 13643, NULL, '2021-02-25 00:00:00.000', 'Approved', 'Individual Name: JAYA JACOB Individual Specialty: NURSE PRACTITIONER Individual National Provider Identifier (NPI): 1194336149 Individual Provider Transaction Access Number (PTAN): 1M3046 Group Legal Business Name (LBN): Columbus Urgent Care PA Group NPI: 1215330501 Group PTAN: 399951 Reassignment Effective Date: January 1, 2021', NULL, NULL, '2021-02-18 17:07:01', '2021-02-18 17:07:01'),
(10207, 1006, 13644, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-15 17:05:14', '2021-02-15 17:05:14'),
(10208, 1006, 13644, NULL, '2021-02-22 00:00:00.000', 'Initiated', 'Applicant Name: ROSE TREVINO  Tracking ID: T021520210002383  Submitted Date: MON - FEBRUARY 15 2021 04:58:29 PM EST  Submitted By: Rose Trevino  Contact Email(s): ANNISSA.GOINS@EMCARE.COM SHAWNTELL_ALFRED@SCHUMACHERCLINICAL.COM ROSEPTREVINO@GMAIL.COM RHC@CLAIMSMEDINC.COM Reason(s) for submission: A Medicare Part B practitioner is currently enrolled in the Medicare program. The practitioner is adding, deleting, or changing general Medicare enrollment information. ', NULL, NULL, '2021-02-15 17:05:30', '2021-02-15 17:05:30'),
(10209, 1006, 13644, NULL, '2021-02-25 00:00:00.000', 'Approved', 'Application Tracking ID: T021520210002383   NPI ID: 1437174794   Medicare ID: 633644AT3H, 633645AS8U, 1M2933   Name: ROSE TREVINO  State: TX   Form Type: 855I  Date: 02/18/2021  Status: APPROVED', NULL, NULL, '2021-02-18 14:31:34', '2021-02-18 14:31:34'),
(10210, 3040, 13645, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-15 17:24:42', '2021-02-15 17:24:42'),
(10211, 3040, 13645, NULL, '2021-02-22 00:00:00.000', 'In Process', 'Medicare application submitted online.   Tracking ID: T021520210002348  Reassignment Tracking ID: T021520210002373  Submitted Date: MON - FEBRUARY 15 2021 04:59:37 PM EST', NULL, NULL, '2021-02-15 17:27:10', '2021-02-15 17:27:10'),
(10212, 3040, 13645, NULL, '2021-03-01 00:00:00.000', 'In Process', 'Waiting for the documents', NULL, NULL, '2021-02-22 10:31:44', '2021-02-22 10:31:44'),
(10213, 3040, 13645, NULL, '2021-03-22 00:00:00.000', 'In Process', 'Email sent to: longpointmedcenter9504@yahoo.com, drpjobiponraj@yahoo.com  Subject:  Requested Documents Sigi Paul  Greetings,,   Can you please send me the below requested documents for the provider because her Credentialing is pending due to lack of documents.   Sigi Paul: 1- Master Degree  2- Updated Resume  3- AANP Certificate  Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-03-15 10:24:24', '2021-03-15 10:24:24'),
(10214, 3040, 13645, NULL, '2021-03-22 00:00:00.000', 'In Process', 'Enrollment Tracking Information Applicant Name: SIGI PAUL  Tracking ID: T021520210002348  Submitted Date: MON - MARCH 15 2021 04:18:31 PM EST  Submitted By: sigi paul  Contact Email(s): NUCC@CLAIMSMEDINC.COM', NULL, NULL, '2021-03-15 15:26:04', '2021-03-15 15:26:04'),
(10215, 3040, 13645, NULL, '2021-03-23 00:00:00.000', 'Approved', 'Medicare Enrollment Information  Individual Name: Sigi Paul NP Individual Specialty: NURSE PRACTITIONER Individual National Provider Identifier (NPI): 1033623616 Individual Provider Transaction Access Number (PTAN): 1N1652 Group Legal Business Name (LBN): Normandy Urgent Care Center PA Group NPI: 1407171077 Group PTAN: 396951 Reassignment Effective Date: January 01, 2021', NULL, NULL, '2021-03-16 08:31:45', '2021-03-16 08:31:45'),
(10216, 3040, 13646, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-15 17:24:44', '2021-02-15 17:24:44');
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
(10217, 3040, 13646, NULL, '2021-02-22 00:00:00.000', 'In Process', 'Medicare application submitted online.   Tracking ID: T021520210002348  Reassignment Tracking ID: T021520210002373  Submitted Date: MON - FEBRUARY 15 2021 04:59:37 PM EST', NULL, NULL, '2021-02-15 17:27:16', '2021-02-15 17:27:16'),
(10218, 3040, 13646, NULL, '2021-03-01 00:00:00.000', 'In Process', 'Waiting for the documents.', NULL, NULL, '2021-02-22 10:19:11', '2021-02-22 10:19:11'),
(10219, 3040, 13646, NULL, '2021-03-08 00:00:00.000', 'In Process', 'Email sent to: longpointmedcenter9504@yahoo.com  Subject: Requested Documents Sigi Paul & Jaya Jacob  Greetings,  Hope you are doing well. Can you please send me the below requested documents for the providers.   1- Master Degree (For Sigi Paul) 2- Bachelor Degree  (For Sigi Paul) 3- AANP Certificate  (For Sigi Paul) 4- Professional Liability Insurance (For both Providers) 5- DEA (For Sigi Paul)  Thanks', NULL, NULL, '2021-03-01 12:38:27', '2021-03-01 12:38:27'),
(10220, 3040, 13646, NULL, '2021-03-22 00:00:00.000', 'In Process', 'Email sent to: longpointmedcenter9504@yahoo.com, drpjobiponraj@yahoo.com  Subject:  Requested Documents Sigi Paul  Greetings,,   Can you please send me the below requested documents for the provider because her Credentialing is pending due to lack of documents.   Sigi Paul: 1- Master Degree  2- Updated Resume  3- AANP Certificate  Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-03-15 10:24:12', '2021-03-15 10:24:12'),
(10221, 3040, 13646, NULL, '2021-03-22 00:00:00.000', 'In Process', 'Enrollment Tracking Information Applicant Name: SIGI PAUL  Tracking ID: T021520210002348  Submitted Date: MON - MARCH 15 2021 04:18:31 PM EST  Submitted By: sigi paul  Contact Email(s): NUCC@CLAIMSMEDINC.COM', NULL, NULL, '2021-03-15 15:26:01', '2021-03-15 15:26:01'),
(10222, 3040, 13646, NULL, '2021-03-23 00:00:00.000', 'Approved', 'Medicare Enrollment Information  Individual Name: Sigi Paul NP Individual Specialty: NURSE PRACTITIONER Individual National Provider Identifier (NPI): 1033623616 Individual Provider Transaction Access Number (PTAN): 1N1652 Group Legal Business Name (LBN): Normandy Urgent Care Center PA Group NPI: 1407171077 Group PTAN: 396951 Reassignment Effective Date: January 01, 2021', NULL, NULL, '2021-03-16 08:31:51', '2021-03-16 08:31:51'),
(10223, 3040, 13647, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-15 17:24:45', '2021-02-15 17:24:45'),
(10224, 3040, 13647, NULL, '2021-02-22 00:00:00.000', 'In Process', 'Medicare application submitted online.   Tracking ID: T021520210002348  Reassignment Tracking ID: T021520210002373  Submitted Date: MON - FEBRUARY 15 2021 04:59:37 PM EST', NULL, NULL, '2021-02-15 17:27:21', '2021-02-15 17:27:21'),
(10225, 3040, 13647, NULL, '2021-03-01 00:00:00.000', 'In Process', 'Waiting for the documents', NULL, NULL, '2021-02-22 10:28:11', '2021-02-22 10:28:11'),
(10226, 3040, 13647, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email sent to: longpointmedcenter9504@yahoo.com  Subject: Requested Documents Sigi Paul Hello,   Can you please send me the below requested documents for the provider because her Medicare insurance is pending because the lack of documents.   Sigi Paul: 1- Master Degree  2- Bachelor Degree   3- AANP Certificate  Thank you ', NULL, NULL, '2021-03-08 12:36:25', '2021-03-08 12:36:25'),
(10227, 3040, 13647, NULL, '2021-03-22 00:00:00.000', 'In Process', 'Email sent to: longpointmedcenter9504@yahoo.com, drpjobiponraj@yahoo.com  Subject:  Requested Documents Sigi Paul  Greetings,,   Can you please send me the below requested documents for the provider because her Credentialing is pending due to lack of documents.   Sigi Paul: 1- Master Degree  2- Updated Resume  3- AANP Certificate  Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-03-15 10:24:17', '2021-03-15 10:24:17'),
(10228, 3040, 13647, NULL, '2021-03-22 00:00:00.000', 'In Process', 'Enrollment Tracking Information Applicant Name: SIGI PAUL  Tracking ID: T021520210002348  Submitted Date: MON - MARCH 15 2021 04:18:31 PM EST  Submitted By: sigi paul  Contact Email(s): NUCC@CLAIMSMEDINC.COM', NULL, NULL, '2021-03-15 15:26:01', '2021-03-15 15:26:01'),
(10229, 3040, 13647, NULL, '2021-03-23 00:00:00.000', 'Approved', 'Medicare Enrollment Information  Individual Name: Sigi Paul NP Individual Specialty: NURSE PRACTITIONER Individual National Provider Identifier (NPI): 1033623616 Individual Provider Transaction Access Number (PTAN): 1N1652 Group Legal Business Name (LBN): Normandy Urgent Care Center PA Group NPI: 1407171077 Group PTAN: 396951 Reassignment Effective Date: January 01, 2021', NULL, NULL, '2021-03-16 08:31:56', '2021-03-16 08:31:56'),
(10230, 3040, 13648, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-15 17:24:46', '2021-02-15 17:24:46'),
(10231, 3040, 13648, NULL, '2021-02-22 00:00:00.000', 'In Process', 'Medicare application submitted online.   Tracking ID: T021520210002348  Reassignment Tracking ID: T021520210002373  Submitted Date: MON - FEBRUARY 15 2021 04:59:37 PM EST', NULL, NULL, '2021-02-15 17:27:26', '2021-02-15 17:27:26'),
(10232, 3040, 13648, NULL, '2021-03-01 00:00:00.000', 'In Process', 'Waiting for the documents ', NULL, NULL, '2021-02-22 15:15:35', '2021-02-22 15:15:35'),
(10233, 3040, 13648, NULL, '2021-03-08 00:00:00.000', 'In Process', 'Email sent to: longpointmedcenter9504@yahoo.com  Subject: Requested Documents Sigi Paul & Jaya Jacob  Greetings,  Hope you are doing well. Can you please send me the below requested documents for the providers.   1- Master Degree (For Sigi Paul) 2- Bachelor Degree  (For Sigi Paul) 3- AANP Certificate  (For Sigi Paul) 4- Professional Liability Insurance (For both Providers) 5- DEA (For Sigi Paul)  Thanks ', NULL, NULL, '2021-03-01 12:36:37', '2021-03-01 12:36:37'),
(10234, 3040, 13648, NULL, '2021-03-22 00:00:00.000', 'In Process', 'Email sent to: longpointmedcenter9504@yahoo.com, drpjobiponraj@yahoo.com  Subject:  Requested Documents Sigi Paul  Greetings,,   Can you please send me the below requested documents for the provider because her Credentialing is pending due to lack of documents.   Sigi Paul: 1- Master Degree  2- Updated Resume  3- AANP Certificate  Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-03-15 10:22:45', '2021-03-15 10:22:45'),
(10235, 3040, 13648, NULL, '2021-03-22 00:00:00.000', 'In Process', 'Enrollment Tracking Information Applicant Name: SIGI PAUL  Tracking ID: T021520210002348  Submitted Date: MON - MARCH 15 2021 04:18:31 PM EST  Submitted By: sigi paul  Contact Email(s): NUCC@CLAIMSMEDINC.COM', NULL, NULL, '2021-03-15 15:26:02', '2021-03-15 15:26:02'),
(10236, 3040, 13648, NULL, '2021-03-23 00:00:00.000', 'Approved', ' Medicare Enrollment Information  Individual Name: Sigi Paul NP Individual Specialty: NURSE PRACTITIONER Individual National Provider Identifier (NPI): 1033623616 Individual Provider Transaction Access Number (PTAN): 1N1656 Group Legal Business Name (LBN): Columbus Urgent Care PA Group NPI: 1215330501 Group PTAN: 399951 Reassignment Effective Date: January 01, 2021', NULL, NULL, '2021-03-16 08:30:18', '2021-03-16 08:30:18'),
(10237, 1006, 13649, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-15 17:47:59', '2021-02-15 17:47:59'),
(10238, 1006, 13649, NULL, '2021-02-22 00:00:00.000', 'Initiated', 'Applicant Name: RABAGOS HEALTH CARE PLLC  Tracking ID: T021520210002477  Submitted Date: MON - FEBRUARY 15 2021 05:46:51 PM EST  Submitted By: Katherine Rabagos  Contact Email(s): KATHERINERABAGOS@YAHOO.COM RHC@CLAIMSMEDINC.COM ', NULL, NULL, '2021-02-15 17:48:14', '2021-02-15 17:48:14'),
(10239, 1006, 13649, NULL, '2021-02-25 00:00:00.000', 'Approved', 'Application Tracking ID: T021520210002477   NPI ID: 1689924904   Medicare ID: 369376   Name: RABAGOS HEALTH CARE PLLC  State: TX   Form Type: 855B  Date: 02/18/2021  Status: APPROVED', NULL, NULL, '2021-02-18 14:14:19', '2021-02-18 14:14:19'),
(10240, 1006, 13650, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-16 13:21:20', '2021-02-16 13:21:20'),
(10241, 1006, 13650, NULL, '2021-02-23 00:00:00.000', 'Initiated', 'Enrollment request initiated online via Aetna website. Attached copy for reference.', NULL, NULL, '2021-02-16 13:21:40', '2021-02-16 13:21:40'),
(10242, 3046, 13650, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Called Aetna and they advised that it has been enrolled and the Application Checking # is PVB1254113 and the TKT # is NAF404777 and will take up to 60 Business days to get approved.', NULL, NULL, '2021-02-25 12:34:48', '2021-02-25 12:34:48'),
(10243, 3046, 13650, NULL, '2021-03-12 00:00:00.000', 'In Process', 'Still in Process and will take up to 45-60 business days.. Tracking # PVB1254113', NULL, NULL, '2021-03-05 14:42:11', '2021-03-05 14:42:11'),
(10244, 1006, 13650, NULL, '2021-04-01 00:00:00.000', 'Approved', 'We have an urgent care contract with Aetna. We don\'t need to individually enroll/credential providers separately, a copy of the executed contract has been attached and directory/plans are also attached for reference.  ', NULL, NULL, '2021-03-25 14:19:00', '2021-03-25 14:19:00'),
(10245, 1006, 13651, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-16 13:36:11', '2021-02-16 13:36:11'),
(10246, 1006, 13651, NULL, '2021-02-25 00:00:00.000', 'Initiated', 'Sent an LOI to Aetna for location addition @ (859) 455-8650. Attached for reference.', NULL, NULL, '2021-02-16 13:36:47', '2021-02-16 13:36:47'),
(10247, 3046, 13651, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Called Aetna and requested them regarding the LOI status and as per Aetna it will take up to 30 Business days and the Tkt # is NAF404777.', NULL, NULL, '2021-02-25 12:35:31', '2021-02-25 12:35:31'),
(10248, 3046, 13651, NULL, '2021-03-12 00:00:00.000', 'In Process', 'Still in process. Ref: Pauline 03/05/2021', NULL, NULL, '2021-03-05 14:31:08', '2021-03-05 14:31:08'),
(10249, 1006, 13651, NULL, '2021-04-01 00:00:00.000', 'In Process', 'Request is still in-process, need to allow 30 business days to elapse. Ticket# NAF404777', NULL, NULL, '2021-03-25 15:50:33', '2021-03-25 15:50:33'),
(10250, 1006, 13651, NULL, '2021-06-10 00:00:00.000', 'In Process', 'As per my discussion with Aetna rep May, the request has been completed as of Feb 15, 2021.  We are currently waiting on the directory to be updated with this information.   Ref# 6022699351', NULL, NULL, '2021-06-03 14:49:55', '2021-06-03 14:49:55'),
(10251, 1006, 13651, NULL, '2021-06-28 00:00:00.000', 'Approved', 'The location has been update for the group and since this is an ancillary contract all the providers have the update location as well.   Eff: 03/02/2017  Approval confirmation is attached in main group task for reference. ', NULL, NULL, '2021-06-21 14:39:18', '2021-06-21 14:39:18'),
(10252, 1006, 13652, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-17 13:48:05', '2021-02-17 13:48:05'),
(10253, 1006, 13652, NULL, '2021-02-24 00:00:00.000', 'Initiated', 'Sent email to \'Jennifer Maligaya\' via Rabagos HealthCare rhc@claimsmedinc.com to add quaternary location.   Received reply:   \"Thank you for the prompt response. I will have the locations added.  Best Regards, Jennifer Maligaya | Sr. Provider Relations, ACS and MyDecision HealthSmart | Network Solutions Office: 405 241 4811 | Fax: 214 574 1121 Jennifer.maligaya@healthsmart.com | www.HealthSmart.com\" ', NULL, NULL, '2021-02-17 13:50:02', '2021-02-17 13:50:02'),
(10254, 3046, 13652, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Email Sent to: Jennifer.maligaya@healthsmart.com Subject: Request For Status Update on Locations.  Greetings Jennifer,  Hope my email finds you well. I would like to request you to kindly advise if the location was added for the below mentioned practice: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID: 46-0575924 Practice NPI: 1689924904 Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 I hope to hear from you soon. Thank you.', NULL, NULL, '2021-02-25 10:40:00', '2021-02-25 10:40:00'),
(10255, 3046, 13652, NULL, '2021-03-04 00:00:00.000', 'Approved', 'Email from: Jennifer.maligaya@healthsmart.com Subject: Request For Status Update on Locations  Good Morning,  Yes, this location has been added into our database on 2/18/21. Thank you!  Best Regards,  Jennifer Maligaya | Sr. Provider Relations, ACS and MyDecision  HealthSmart | Network Solutions  Office: 405 241 4811 | Fax: 214 574 1121  Jennifer.maligaya@healthsmart.com | www.HealthSmart.com', NULL, NULL, '2021-02-25 13:48:40', '2021-02-25 13:48:40'),
(10256, 3040, 14640, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-22 15:50:54', '2021-02-22 15:50:54'),
(10257, 3040, 14640, NULL, '2021-03-01 00:00:00.000', 'Initiated', 'Request initiated through online.    ', NULL, NULL, '2021-02-22 15:51:51', '2021-02-22 15:51:51'),
(10258, 3040, 14640, NULL, '2021-03-05 00:00:00.000', 'Approved', 'Ancillary Contract. No need to add the provider individually. ', NULL, NULL, '2021-02-26 09:54:01', '2021-02-26 09:54:01'),
(10259, 3040, 14641, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-22 15:52:37', '2021-02-22 15:52:37'),
(10260, 3040, 14641, NULL, '2021-03-01 00:00:00.000', 'Initiated', 'Application submitted online and request initiated.', NULL, NULL, '2021-02-22 15:53:30', '2021-02-22 15:53:30'),
(10261, 3040, 14641, NULL, '2021-03-05 00:00:00.000', 'Approved', 'Ancillary Contract. No need to add the provider individually. ', NULL, NULL, '2021-02-26 09:53:59', '2021-02-26 09:53:59'),
(10262, 3040, 15640, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-23 15:25:46', '2021-02-23 15:25:46'),
(10263, 3040, 15640, NULL, '2021-03-02 00:00:00.000', 'In Process', 'Application Status : Submitted		 PEP Ticket Number: 17610778 ', NULL, NULL, '2021-02-23 15:26:35', '2021-02-23 15:26:35'),
(10264, 3040, 15640, NULL, '2021-03-09 00:00:00.000', 'In Process', 'Still in process.', NULL, NULL, '2021-03-02 14:22:50', '2021-03-02 14:22:50'),
(10265, 3040, 15640, NULL, '2021-03-17 00:00:00.000', 'In Process', 'Still in process.', NULL, NULL, '2021-03-10 17:07:22', '2021-03-10 17:07:22'),
(10266, 3040, 15640, NULL, '2021-03-25 00:00:00.000', 'In Process', 'Still in process.', NULL, NULL, '2021-03-18 09:34:07', '2021-03-18 09:34:07'),
(10267, 3040, 15640, NULL, '2021-04-01 00:00:00.000', 'In Process', 'Still in process.', NULL, NULL, '2021-03-18 09:34:40', '2021-03-18 09:34:40'),
(10268, 3040, 15640, NULL, '2021-04-19 00:00:00.000', 'Approved', 'Provider enrolled with Medicaid.   Please see attachments', NULL, NULL, '2021-04-12 16:17:08', '2021-04-12 16:17:08'),
(10269, 3040, 15641, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-23 15:27:11', '2021-02-23 15:27:11'),
(10270, 3040, 15641, NULL, '2021-03-02 00:00:00.000', 'In Process', 'Application Status : Submitted		 PEP Ticket Number: 17610778', NULL, NULL, '2021-02-23 15:27:28', '2021-02-23 15:27:28'),
(10271, 3040, 15641, NULL, '2021-03-09 00:00:00.000', 'In Process', 'Still in process.', NULL, NULL, '2021-03-02 14:22:55', '2021-03-02 14:22:55'),
(10272, 3040, 15641, NULL, '2021-03-18 00:00:00.000', 'In Process', 'Still in process', NULL, NULL, '2021-03-11 12:59:43', '2021-03-11 12:59:43'),
(10273, 3040, 15641, NULL, '2021-04-01 00:00:00.000', 'In Process', NULL, NULL, NULL, '2021-03-18 09:34:16', '2021-03-18 09:34:16'),
(10274, 3040, 15641, NULL, '2021-04-19 00:00:00.000', 'Approved', 'Provider enrolled with Medicaid.   Please see attachments', NULL, NULL, '2021-04-12 16:17:16', '2021-04-12 16:17:16'),
(10275, 3040, 15642, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-23 15:28:07', '2021-02-23 15:28:07'),
(10276, 3040, 15642, NULL, '2021-03-02 00:00:00.000', 'In Process', 'Application Status : Submitted		 PEP Ticket Number: 17610778', NULL, NULL, '2021-02-23 15:28:14', '2021-02-23 15:28:14'),
(10277, 3040, 15642, NULL, '2021-03-09 00:00:00.000', 'In Process', 'Still in process.', NULL, NULL, '2021-03-02 14:23:08', '2021-03-02 14:23:08'),
(10278, 3040, 15642, NULL, '2021-03-17 00:00:00.000', 'In Process', 'Still in process', NULL, NULL, '2021-03-10 17:06:18', '2021-03-10 17:06:18'),
(10279, 3040, 15642, NULL, '2021-03-17 00:00:00.000', 'In Process', 'Still in process.', NULL, NULL, '2021-03-10 17:07:27', '2021-03-10 17:07:27'),
(10280, 3040, 15642, NULL, '2021-04-01 00:00:00.000', 'In Process', 'Still in process.', NULL, NULL, '2021-03-18 09:34:27', '2021-03-18 09:34:27'),
(10281, 3040, 15642, NULL, '2021-04-19 00:00:00.000', 'Approved', 'Provider enrolled with Medicaid.   Please see attachments', NULL, NULL, '2021-04-12 16:17:21', '2021-04-12 16:17:21'),
(10282, 3040, 15643, NULL, NULL, 'New/Not Initiated', 'Application Status Submitted PEP Ticket Number 17611249', NULL, NULL, '2021-02-23 16:52:37', '2021-02-23 16:52:37'),
(10283, 3040, 15643, NULL, '2021-03-09 00:00:00.000', 'In Process', 'Still in process.', NULL, NULL, '2021-03-02 14:23:20', '2021-03-02 14:23:20'),
(10284, 3040, 15643, NULL, '2021-03-16 00:00:00.000', 'In Process', 'Still in process', NULL, NULL, '2021-03-09 13:31:42', '2021-03-09 13:31:42'),
(10285, 3040, 15643, NULL, '2021-04-01 00:00:00.000', 'In Process', 'Still in process ', NULL, NULL, '2021-03-18 09:33:03', '2021-03-18 09:33:03'),
(10286, 3040, 15643, NULL, '2021-04-19 00:00:00.000', 'Approved', 'Provider enrolled with Medicaid.   Please see attachments', NULL, NULL, '2021-04-12 16:17:27', '2021-04-12 16:17:27'),
(10287, 3040, 15644, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-24 15:30:22', '2021-02-24 15:30:22'),
(10288, 3040, 15644, NULL, '2021-03-03 00:00:00.000', 'Initiated', 'Thank you for your interest in participating with MultiPlan. You should receive an application within ten to fifteen business days. If you do not receive the application, or if you have any questions upon reviewing it, please contact our Service Operations department at (800) 950-7040. You can check the status of your request anytime through the Check Nomination Status option on this page.  Nomination Tracking Number: 022421O5B', NULL, NULL, '2021-02-24 15:31:02', '2021-02-24 15:31:02'),
(10289, 3040, 15644, NULL, '2021-03-10 00:00:00.000', 'In Process', 'I had a word with (Tenise) Multiplan representative and she said the request received from our side but its too early.   Tracking No: 022421O5B', NULL, NULL, '2021-03-03 13:02:47', '2021-03-03 13:02:47'),
(10290, 3040, 15644, NULL, '2021-03-17 00:00:00.000', 'In Process', 'I had a word with (April) Multiplan representative and she said the application rcvd and it will take 15 days to check the status. ', NULL, NULL, '2021-03-10 15:41:07', '2021-03-10 15:41:07'),
(10291, 3040, 15644, NULL, '2021-03-22 00:00:00.000', 'On Hold', 'We need to enroll the group first and after that we can enroll the provider.', NULL, NULL, '2021-03-15 17:13:37', '2021-03-15 17:13:37'),
(10292, 1006, 15644, NULL, '2021-06-08 00:00:00.000', 'In Process', 'We received the following email from Multiplan @ nominations@multiplan.com:  Sub: Notification regarding your nomination for - Atinuke Dada MSN - Seid: 21225244042  \"Dear Provider Contact:  We have received your request to join MultiPlan\'s provider network. Your request has been processed by MultiPlan\'s Contracts and Development Team. We have released the necessary documents to our Registrar Department for review and processing. You will be contacted if additional information is needed. Once credentialing is approved; you will be notified of the provider\'s effective date.  Please note that implementation of a contract can take approximately 90 - 120 days unless otherwise mandated by state law.  As we process this provider\'s request, we ask that you assist us with the following:  Providers that participate in CAQH:  Authorize MultiPlan to access your CAQH Application Attest to your application within 90 days Complete your CAQH Application in its entirety Provide applicable supporting documents Providers NOT participating in CAQH:   you may initiate the process by clicking the following link: CAQH For future requests to add providers to your existing provider group contract, you can streamline the process by using our Online Portal. Please reference your Group Name and MultiPlan Contract ID.  If you need assistance with identifying your MultiPlan Contract ID or have questions regarding this email, please contact our Service Operations Department at 800-950-7040, 8:30 a.m. - 5:30 p.m. ET.  Among other things, Service Operations can answer questions about your credentialing application, correct erroneous information submitted in your credentialing application, or report the status of your credentialing application. If you would like additional information about MultiPlan or the services we offer, please visit our website at www.multiplan.com.  Sincerely, Contracts and Development Team\"', NULL, NULL, '2021-06-01 08:52:54', '2021-06-01 08:52:54'),
(10293, 1006, 15644, NULL, '2021-06-23 00:00:00.000', 'In Process', 'Sent f/u email @ \"Downing, Barbara\" barbara.downing@multiplan.com & registrar@multiplan.com:  Sub: Re: Regarding Id 2132021984 - Ladot Healthcare LLC  \"Hello,   I wanted to get an update regarding the enrollment status for the following group and providers:  Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City, TX 77573  Provider Name: Oladipo  Dada Provider NPI# 1760700223  Provider Name: Atinuke Dada Provider NPI# 1154782720  Please get back to me as soon as possible. Thank you!\"', NULL, NULL, '2021-06-16 09:56:57', '2021-06-16 09:56:57'),
(10294, 1006, 15644, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Opened new service case to verify enrollment status:   \"MultiPlan has received your inquiry.  One of our Customer Service representatives will research and respond to you via email with updates and/or resolution.  If you have questions regarding this service case, please call Customer Service at the number listed below.  MultiPlan Inquiry 1-800-950-7040 and refer to the case number when speaking with our representative.  Viant Inquiry 1-800-877-1444 and refer to the case number when speaking with our representative.  Case Number: 7660238    Submitter Name: Brad Peterson Date of submission: 07/05/2021 \"', NULL, NULL, '2021-07-05 10:41:30', '2021-07-05 10:41:30'),
(10295, 11056, 15644, NULL, '2021-07-22 00:00:00.000', 'In Process', 'I had words with Miss Charlie. She informed me about the enrollment status of both the providers. She has notified us that the Malpractice limits for Atinuke need to be increased, as the minimum amount is $200,000 Per Occurrence & $600,000 Aggregate. For Mr. Dada enrollment, there is no application in their records sysytem.  We have emailed Mr. Dada about the Malpractice limit expansion. Waiting for his response.  The enrollment application is submitted again.  Thank you for your interest in participating with MultiPlan. You should receive an application within ten to fifteen business days. If you do not receive the application, or if you have any questions upon reviewing it, please contact our Service Operations department at (800) 950-7040. You can check the status of your request anytime through the Check Nomination Status option on this page.  Nomination Tracking Number: 071521O14', NULL, NULL, '2021-07-15 13:25:47', '2021-07-15 13:25:47'),
(10296, 11056, 15644, NULL, '2021-08-03 00:00:00.000', 'In Process', 'I have words with Sam at 1-800-950-7040. He provide me with the updates  OLADIPO application is in review for eligibility by Multiplan\'s Board. Atinuke application is in process. Ref code no. : 7660238   MLP of both the providers have been sent to appmissinginfo@multiplan.com for resolving the MLP- issue.', NULL, NULL, '2021-07-26 17:07:09', '2021-07-26 17:07:09'),
(10297, 11056, 15644, NULL, '2021-08-10 00:00:00.000', 'In Process', 'Email sent to : appmissinginfo@multiplan.com  Sub : MALPRACTICE OF THE PROVIDERS - LHC - MULTIPLAN  Good evening!  Hope all is well. Here are the Malpractices attached of both the providers. Please see the attachment. If you further need any document or info please let me know.  Practice Details: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City, TX 77573  Provider Details: Provider Name: Dada, Atinuke Provider NPI# 1154782720  Provider Name: Oladipo  Dada Provider NPI# 1760700223  Eagerly, waiting for your response. Feel free to contact me if you have any questions or concerns.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-03 10:51:06', '2021-08-03 10:51:06'),
(10298, 11056, 15644, NULL, '2021-08-17 00:00:00.000', 'In Process', 'Email received from : registrar@multiplan.com  Sub : MALPRACTICE OF THE PROVIDERS - LHC - MULTIPLAN  Please do not respond to this email. Registrar only handles first time submissions to update your information.  You may inquire about submission status, request a contract copy or inquire about your fee schedule through MultiPlan\'s customer service portal. There is no log-in or account set-up required. Simply select \"Rendering Practitioner/Facility\" and follow the on screen instructions in order to submit your inquiry. https://custservice.multiplan.com. If you need assistance navigating the portal please contact customer service at 800-950-7040.  When submitting missing information please email the information registrarmissinginfo@multiplan.com or via fax to 781-487-8278.', NULL, NULL, '2021-08-09 15:36:41', '2021-08-09 15:36:41'),
(10299, 11056, 15644, NULL, '2021-08-23 00:00:00.000', 'In Process', 'Email sent to :  	appmissinginfo@multiplan.com, registrar  registrar@multiplan.com, barbara.downing@multiplan.com  Sub : MALPRACTICE OF THE PROVIDERS - LHC - MULTIPLAN  Good morning!  Hope you are doing well. I wanted to get an update regarding the enrollment status for the following group and providers mentioned below:  Practice Details: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City, TX 77573  Provider Details: Provider Name: Dada, Atinuke Provider NPI # : 1154782720  Provider Name: Oladipo  Dada Provider NPI # : 1760700223  Eagerly, waiting for your response. Feel free to contact me if you have any questions or concerns.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-16 09:09:30', '2021-08-16 09:09:30'),
(10300, 11056, 15644, NULL, '2021-08-30 00:00:00.000', 'In Process', 'Email sent to : appmissinginfo@multiplan.com, registrar  registrar@multiplan.com, barbara.downing@multiplan.com  Sub : MALPRACTICE OF THE PROVIDERS - LHC - MULTIPLAN  Good morning!  Hope you are doing well. I wanted to get an update regarding the enrollment status for the following group and providers mentioned below:  Practice Details: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City, TX 77573  Provider Details: Provider Name: Dada, Atinuke Provider NPI # : 1154782720  Provider Name: Oladipo  Dada Provider NPI # : 1760700223  Eagerly, waiting for your response. Feel free to contact me if you have any questions or concerns.  Thank you! Have a great weekend ahead!', NULL, NULL, '2021-08-23 13:01:49', '2021-08-23 13:01:49'),
(10301, 11056, 15644, NULL, '2021-09-20 00:00:00.000', 'In Process', 'Last Application Closed due to Malpractice issue and now The policy have changed so new case has been reopened for Atinuke Dada.  Nomination Tracking Number:  0913214Z2', NULL, NULL, '2021-09-13 17:03:25', '2021-09-13 17:03:25'),
(10302, 11056, 15644, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Dear Provider:  Thank you for your interest in participating in one or more of MultiPlan\'s provider networks.  An agreement for signature is enclosed and available to sign electronically by clicking the following link:  Individual Agreement We have included a sample fee schedule for your review.  Please note, the applicability of the SLCP State Law Coordinating Provisions is determined by your service location(s). Please refer to your State Law Provisions.  Once we have received the signed agreement, we will begin the credentialing process. You will be notified of your effective date upon acceptance into the network(s) and a fully executed copy of the agreement will be sent to you via DocuSign email  If you need to nominate additional providers then please submit your provider nomination request by clicking the following link:  Nominate Provider If you already participate in CAQH, we ask that you assist us with the following:  Authorize MultiPlan to access your CAQH Application Attest to your application within 90 days Complete your CAQH Application in its entirety If you do not participate in CAQH, you may initiate the process by clicking the following link:  CAQH If you have questions regarding this letter, please contact our Service Operations Department at 800-950-7040 from 8:30 a.m. to 5:30 p.m. ET. Service Operations can answer questions about your credentialing application, correct erroneous information submitted in your credentialing application, or report the status of your credentialing application. If you would like additional information about MultiPlan or the services we offer, please visit our website at www.multiplan.com.  Sincerely, Gloria Esplana Director, Network Contract Support', NULL, NULL, '2021-09-22 09:22:48', '2021-09-22 09:22:48'),
(10303, 11056, 15644, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Email received from : nominations@multiplan.com  Sub : Multiplan Individual Agreement for Signature for Atinuke Dada MSN - State: TX - SEID: 210917195934  Dear Provider:  Thank you for your interest in participating in one or more of MultiPlan\'s provider networks.  An agreement for signature is enclosed and available to sign electronically by clicking the following link:  Individual Agreement We have included a sample fee schedule for your review.  Please note, the applicability of the SLCP State Law Coordinating Provisions is determined by your service location(s). Please refer to your State Law Provisions.  Once we have received the signed agreement, we will begin the credentialing process. You will be notified of your effective date upon acceptance into the network(s) and a fully executed copy of the agreement will be sent to you via DocuSign email  If you need to nominate additional providers then please submit your provider nomination request by clicking the following link:  Nominate Provider If you already participate in CAQH, we ask that you assist us with the following:  Authorize MultiPlan to access your CAQH Application Attest to your application within 90 days Complete your CAQH Application in its entirety If you do not participate in CAQH, you may initiate the process by clicking the following link:  CAQH If you have questions regarding this letter, please contact our Service Operations Department at 800-950-7040 from 8:30 a.m. to 5:30 p.m. ET. Service Operations can answer questions about your credentialing application, correct erroneous information submitted in your credentialing application, or report the status of your credentialing application. If you would like additional information about MultiPlan or the services we offer, please visit our website at www.multiplan.com.  Sincerely, Gloria Esplana Director, Network Contract Support', NULL, NULL, '2021-09-22 09:23:51', '2021-09-22 09:23:51'),
(10304, 11056, 15644, NULL, '2021-10-07 00:00:00.000', 'In Process', 'Email sent to : 	nominations@multiplan.com  Sub  : Multiplan Individual Agreement for Signature for Atinuke Dada MSN - State: TX - SEID: 210917195934  Good morning!  Hope this email finds you well. I have attested and authorised Multiplan to access CAQH application. The CAQH application is entirely completed of the provider,Atinuke Dada (CAQH: 15021030).  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you!', NULL, NULL, '2021-09-30 16:12:19', '2021-09-30 16:12:19'),
(10305, 11056, 15644, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Rep : Jane  D  Status : In process. Agreement has been received by them . In credentialing Dept.  take 60 days.  Ref code :  JaneD0843  Contact no. : 800-950-7040  Please see the attachment.', NULL, NULL, '2021-10-06 08:44:45', '2021-10-06 08:44:45'),
(10306, 11056, 15644, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Rep : Natasha C  Status :   Oladipo : they received a contract and is in processing.  Atinuke : Contract received on sept 28 still in processing.   Ref code : Natashac1236', NULL, NULL, '2021-10-14 12:43:35', '2021-10-14 12:43:35'),
(10307, 11056, 15644, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Rep: Jeff N  Status: Atinuke is still in the process 09/28/2021 Oladipo is also in process 10/09/2021  Case no. : 7660238  Ref code : SEID of the providers   Contact no. : 800-950-7040', NULL, NULL, '2021-10-21 15:17:00', '2021-10-21 15:17:00'),
(10308, 11056, 15644, NULL, '2021-11-19 00:00:00.000', 'In Process', 'Rep:  Sarah N  Status:  Is under review. And with the contracting team   Ref code: 766203811122021Sarah', NULL, NULL, '2021-11-12 17:22:49', '2021-11-12 17:22:49'),
(10309, 11056, 15644, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Rep: Taylor M  Status: The provider is still in process. The complete case was started in the month of October. Working on it. It is in the credentialing process.  case no. : 7824454', NULL, NULL, '2021-11-24 14:49:40', '2021-11-24 14:49:40'),
(10310, 11056, 15644, NULL, '2021-12-06 00:00:00.000', 'In Process', 'Rep: James D  Status : It is in the final process of credentialing.  Ref code: 7825718', NULL, NULL, '2021-11-29 12:59:24', '2021-11-29 12:59:24'),
(10311, 11056, 15644, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Rep: Amber C   Status: MLP expired. Credentialing has been stopped due to that. MLP needed to continue the process   Ref code: 7825718', NULL, NULL, '2021-12-08 14:50:55', '2021-12-08 14:50:55'),
(10312, 11056, 15644, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Rep: Asia P   Stattus: On hold due to Malpractice issue. Credentialing is completed. Welcome letter is remaining.Will be provided after malpractice   Ref code: 12172021asiap', NULL, NULL, '2021-12-17 13:03:08', '2021-12-17 13:03:08'),
(10313, 11056, 15644, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Rep: Maegan K    Atinuke: Approval is in process. Allow some time. Waiting for the MLP  Ref code: 7825718', NULL, NULL, '2021-12-23 10:42:36', '2021-12-23 10:42:36'),
(10314, 19067, 15644, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Called @ (800) 950-7040 Spoke with Paul. Got effective date as of 11/29/2021. Asked him to email me the Approval letter.  Ref# 7824454', NULL, NULL, '2022-01-10 16:01:34', '2022-01-10 16:01:34'),
(10315, 3040, 15645, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-24 15:44:41', '2021-02-24 15:44:41'),
(10316, 3040, 15645, NULL, '2021-03-03 00:00:00.000', 'Initiated', 'Email sent to: registrar@multiplan.com  Subject: Link Letter || Ladot Healthcare LLC || Dada, Oladipo || Multiplan ||  Greetings,  Hope you are doing well. Please find attached the Link Letter including W9 form for enrollment in Multiplan for our group Ladot Healthcare LLC .  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-02-24 15:45:28', '2021-02-24 15:45:28'),
(10317, 3040, 15645, NULL, '2021-03-08 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: MultiPlan- Re: Your Update Request – Ref: Task ID: 1875700  Greetings,  Hope you are doing well. I received an email from your side in which they are unable to determine the contract request. The speciality for the facility I mentioned is Multi Speciality Group. The provider is already In-network under the different Tax ID and now I want to Link the provider under the Tax ID that I mentioned in the Link letter.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-03-01 14:09:14', '2021-03-01 14:09:14'),
(10318, 3040, 15645, NULL, '2021-03-08 00:00:00.000', 'In Process', 'Email rcvd from: fax7814878278@multiplan.com  Subject:  MultiPlan- Re: Your Update Request – Ref: Task ID: 1875700  MultiPlan- Re: Your Update Request – Ref: Task ID: 1875700  Thank you for your interest in MultiPlan’s provider networks. MultiPlan, with the nation’s oldest and largest independent provider networks, delivers patient volume from a diverse base of healthcare payers, offers administrative ease, and helps you evolve with the market through a wide range of network-based solutions.  Based on the information you provided, we are unable to determine a contract for your request.   If you are submitting an update to your current contract with the MultiPlan provider networks, please provide additional information that clearly identifies what contract you are asking us to update for and re-submit to registrar@multiplan.com.   If you do not participate with MultiPlan under the contract name and info provided in the submission and would like to submit a request to join our networks, please complete our online provider nomination form.  If your practice has more than one provider, please nominate yourself as a Group Entity, include the Group TIN and Group NPI as part of your nomination. Please include a valid email address on ALL NOMINATIONS to support MultiPlan’s paperless contracting process. When we receive your request, we will evaluate the information and send you instructions on the next step in the contract process.  For all other inquiries, including adding an additional provider to an existing group contract, please use our online portal or call 800-950-7040.  Karen F. Provider Data Management registrarmissinginfo@multiplan.com  MultiPlan 16 Crosby Drive Bedford, MA 01730', NULL, NULL, '2021-03-01 14:10:23', '2021-03-01 14:10:23'),
(10319, 3040, 15645, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, christos.ziogas@multiplan.com  Subject: MultiPlan- Re: Your Update Request – Ref: Task ID: 1875700  Hello,  Hope you are doing well. Please advise me the enrollment status for the below mentioned provider. I already sent the Link Letter.   Practice Details:  Practice Name: Ladot Healthcare LLC Practice Tax ID # 85-2432283 Practice NPI # 1912502626 Practice Address: 2577 Madison Avenue  League City , TX 77573  Provider Name: Dada, Oladipo Provider NPI# 1760700223  If you need any additional information please feel free to call or email me. Waiting for your reply.   Thank you ', NULL, NULL, '2021-03-08 12:16:46', '2021-03-08 12:16:46'),
(10320, 3040, 15645, NULL, '2021-03-22 00:00:00.000', 'On Hold', 'We need to enroll the group first and after that we can enroll the provider.', NULL, NULL, '2021-03-15 17:13:39', '2021-03-15 17:13:39'),
(10321, 1006, 15645, NULL, '2021-06-23 00:00:00.000', 'In Process', 'Sent f/u email @ \"Downing, Barbara\" barbara.downing@multiplan.com & registrar@multiplan.com:  Sub: Re: Regarding Id 2132021984 - Ladot Healthcare LLC  \"Hello,   I wanted to get an update regarding the enrollment status for the following group and providers:  Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City, TX 77573  Provider Name: Oladipo  Dada Provider NPI# 1760700223  Provider Name: Atinuke Dada Provider NPI# 1154782720  Please get back to me as soon as possible. Thank you!\"', NULL, NULL, '2021-06-16 09:56:53', '2021-06-16 09:56:53'),
(10322, 1006, 15645, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Opened new service case to verify enrollment status:   \"MultiPlan has received your inquiry.  One of our Customer Service representatives will research and respond to you via email with updates and/or resolution.  If you have questions regarding this service case, please call Customer Service at the number listed below.  MultiPlan Inquiry 1-800-950-7040 and refer to the case number when speaking with our representative.  Viant Inquiry 1-800-877-1444 and refer to the case number when speaking with our representative.  Case Number: 7660238    Submitter Name: Brad Peterson Date of submission: 07/05/2021 \"', NULL, NULL, '2021-07-05 10:41:24', '2021-07-05 10:41:24'),
(10323, 11056, 15645, NULL, '2021-07-22 00:00:00.000', 'In Process', 'I had words with Miss Charlie. She informed me about the enrollment status of both the providers. She has notified us that the Malpractice limits for Atinuke need to be increased, as the minimum amount is $200,000 Per Occurrence & $600,000 Aggregate. For Mr. Dada enrollment, there is no application in their records sysytem.  We have emailed Mr. Dada about the Malpractice limit expansion. Waiting for his response.  The enrollment application is submitted again.  Thank you for your interest in participating with MultiPlan. You should receive an application within ten to fifteen business days. If you do not receive the application, or if you have any questions upon reviewing it, please contact our Service Operations department at (800) 950-7040. You can check the status of your request anytime through the Check Nomination Status option on this page.  Nomination Tracking Number: 071521O14', NULL, NULL, '2021-07-15 13:25:35', '2021-07-15 13:25:35'),
(10324, 11056, 15645, NULL, '2021-08-03 00:00:00.000', 'In Process', 'I have words with Sam at 1-800-950-7040. He provide me with the updates  OLADIPO application is in review for eligibility by Multiplan\'s Board. Atinuke application is in process. Ref code no. : 7660238   MLP of both the providers have been sent to appmissinginfo@multiplan.com for resolving the MLP- issue.', NULL, NULL, '2021-07-26 17:07:02', '2021-07-26 17:07:02'),
(10325, 11056, 15645, NULL, '2021-08-10 00:00:00.000', 'In Process', 'Email sent to : appmissinginfo@multiplan.com  Sub : MALPRACTICE OF THE PROVIDERS - LHC - MULTIPLAN  Good evening!  Hope all is well. Here are the Malpractices attached of both the providers. Please see the attachment. If you further need any document or info please let me know.  Practice Details: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City, TX 77573  Provider Details: Provider Name: Dada, Atinuke Provider NPI# 1154782720  Provider Name: Oladipo  Dada Provider NPI# 1760700223  Eagerly, waiting for your response. Feel free to contact me if you have any questions or concerns.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-03 10:50:56', '2021-08-03 10:50:56'),
(10326, 11056, 15645, NULL, '2021-08-17 00:00:00.000', 'In Process', 'Email received from : registrar@multiplan.com  Sub : MALPRACTICE OF THE PROVIDERS - LHC - MULTIPLAN  Please do not respond to this email. Registrar only handles first time submissions to update your information.  You may inquire about submission status, request a contract copy or inquire about your fee schedule through MultiPlan\'s customer service portal. There is no log-in or account set-up required. Simply select \"Rendering Practitioner/Facility\" and follow the on screen instructions in order to submit your inquiry. https://custservice.multiplan.com. If you need assistance navigating the portal please contact customer service at 800-950-7040.  When submitting missing information please email the information registrarmissinginfo@multiplan.com or via fax to 781-487-8278.', NULL, NULL, '2021-08-09 15:36:32', '2021-08-09 15:36:32'),
(10327, 11056, 15645, NULL, '2021-08-23 00:00:00.000', 'In Process', 'Email sent to :  	appmissinginfo@multiplan.com, registrar  registrar@multiplan.com, barbara.downing@multiplan.com  Sub : MALPRACTICE OF THE PROVIDERS - LHC - MULTIPLAN  Good morning!  Hope you are doing well. I wanted to get an update regarding the enrollment status for the following group and providers mentioned below:  Practice Details: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City, TX 77573  Provider Details: Provider Name: Dada, Atinuke Provider NPI # : 1154782720  Provider Name: Oladipo  Dada Provider NPI # : 1760700223  Eagerly, waiting for your response. Feel free to contact me if you have any questions or concerns.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-16 09:09:17', '2021-08-16 09:09:17'),
(10328, 11056, 15645, NULL, '2021-08-30 00:00:00.000', 'In Process', 'Email sent to : appmissinginfo@multiplan.com, registrar  registrar@multiplan.com, barbara.downing@multiplan.com  Sub : MALPRACTICE OF THE PROVIDERS - LHC - MULTIPLAN  Good morning!  Hope you are doing well. I wanted to get an update regarding the enrollment status for the following group and providers mentioned below:  Practice Details: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City, TX 77573  Provider Details: Provider Name: Dada, Atinuke Provider NPI # : 1154782720  Provider Name: Oladipo  Dada Provider NPI # : 1760700223  Eagerly, waiting for your response. Feel free to contact me if you have any questions or concerns.  Thank you! Have a great weekend ahead!', NULL, NULL, '2021-08-23 13:01:41', '2021-08-23 13:01:41'),
(10329, 11056, 15645, NULL, '2021-09-20 00:00:00.000', 'In Process', 'Good morning!  Hope you are doing well. I wanted to get an update regarding the enrollment status for the following group and providers mentioned below:  Practice Details: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City, TX 77573  Provider Details: Provider Name: Dada, Atinuke Provider NPI # : 1154782720  Provider Name: Oladipo  Dada Provider NPI # : 1760700223  Eagerly, waiting for your response. Feel free to contact me if you have any questions or concerns.  Thank you! Have a great weekend ahead!   Contacted to : JESSIKA N Ref code : 7660238 Atinuke\'s application closed because of Malpractice issue. Oladipo\'s application is in process.', NULL, NULL, '2021-09-13 17:06:18', '2021-09-13 17:06:18'),
(10330, 11056, 15645, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Rep : Natasha C  Status : Still in process, Complete Application submitted on 07/17/2021. It\'s been 46 business days yet & take 90 - 120 days from the day application complete submitted.  Ref code : 7660238  Contact no. : 800-950-7040', NULL, NULL, '2021-09-22 10:03:04', '2021-09-22 10:03:04'),
(10331, 11056, 15645, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Email received from : nominations@multiplan.com  Sub : Multiplan Individual Agreement for Signature for Oladipo A Dada MD - State: TX - SEID: 210717200640  Dear Provider:  Thank you for your interest in participating in one or more of MultiPlan\'s provider networks.  An agreement for signature is enclosed and available to sign electronically by clicking the following link:  Individual Agreement We have included a sample fee schedule for your review.  Please note, the applicability of the SLCP State Law Coordinating Provisions is determined by your service location(s). Please refer to your State Law Provisions.  Once we have received the signed agreement, we will begin the credentialing process. You will be notified of your effective date upon acceptance into the network(s) and a fully executed copy of the agreement will be sent to you via DocuSign email  If you need to nominate additional providers then please submit your provider nomination request by clicking the following link:  Nominate Provider If you already participate in CAQH, we ask that you assist us with the following:  Authorize MultiPlan to access your CAQH Application Attest to your application within 90 days Complete your CAQH Application in its entirety If you do not participate in CAQH, you may initiate the process by clicking the following link:  CAQH If you have questions regarding this letter, please contact our Service Operations Department at 800-950-7040 from 8:30 a.m. to 5:30 p.m. ET. Service Operations can answer questions about your credentialing application, correct erroneous information submitted in your credentialing application, or report the status of your credentialing application. If you would like additional information about MultiPlan or the services we offer, please visit our website at www.multiplan.com.  Sincerely, Gloria Esplana Director, Network Contract Support   Agreement has been signed via DocuSign.', NULL, NULL, '2021-10-06 08:28:20', '2021-10-06 08:28:20'),
(10332, 11056, 15645, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Rep : Natasha C  Status :   Oladipo : they received a contract and is in processing.  Atinuke : Contract received on sept 28 still in processing.   Ref code : Natashac1236', NULL, NULL, '2021-10-14 12:43:28', '2021-10-14 12:43:28'),
(10333, 11056, 15645, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Rep: Jeff N  Status: Atinuke is still in the process 09/28/2021 Oladipo is also in process 10/09/2021  Case no. : 7660238  Ref code : SEID of the providers   Contact no. : 800-950-7040', NULL, NULL, '2021-10-21 15:16:52', '2021-10-21 15:16:52'),
(10334, 11056, 15645, NULL, '2021-11-19 00:00:00.000', 'In Process', 'Rep:  Sarah N  Status:  Is under review. And with the contracting team   Ref code: 766203811122021Sarah', NULL, NULL, '2021-11-12 17:22:39', '2021-11-12 17:22:39'),
(10335, 11056, 15645, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Rep: Taylor M  Status: The provider is still in process. The complete case was started in the month of October. Working on it. It is in the credentialing process.  case no. : 7824454', NULL, NULL, '2021-11-24 14:49:28', '2021-11-24 14:49:28');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(10336, 11056, 15645, NULL, '2021-12-06 00:00:00.000', 'In Process', 'Rep: James D  Status : It is in the final process of credentialing.  Ref code: 7825718', NULL, NULL, '2021-11-29 12:59:34', '2021-11-29 12:59:34'),
(10337, 11056, 15645, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Rep: Amber C   Status: MLP expired. Credentialing has been stopped due to that. MLP needed to continue the process   Ref code: 7825718', NULL, NULL, '2021-12-08 14:50:39', '2021-12-08 14:50:39'),
(10338, 11056, 15645, NULL, '2021-12-20 00:00:00.000', 'Approved', 'Email received from: welcomepackets@multiplan.com  Sub: SECURE: MultiPlan Network Participation (13327468-15)  Dear Provider/Administrator,  Welcome! Your application has been processed, effective 11/29/2021  Please review the attached documents regarding the participation of Dada, Oladipo, MD, in the MultiPlan Networks.  If you have any questions regarding the content of this email, you may request service online at: https://custservice.multiplan.com.  Attachments include: o Participation Letter o Working with Multiplan Information o A copy of your executed Participating Professional Agreement', NULL, NULL, '2021-12-13 15:26:33', '2021-12-13 15:26:33'),
(10339, 3040, 15646, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-24 16:46:16', '2021-02-24 16:46:16'),
(10340, 3040, 15646, NULL, '2021-03-03 00:00:00.000', 'Initiated', 'Thank you for your Ambetter network participation request! We have received your inquiry. Please allow 7-10 business days for our reply. Request initiated through online. Please see attachment. ', NULL, NULL, '2021-02-24 16:47:51', '2021-02-24 16:47:51'),
(10341, 3040, 15646, NULL, '2021-03-10 00:00:00.000', 'In Process', 'Email sent to: credentialing@superiorhealthplan.com  Subject: Enrollment Status || Dada, Oladipo & Dada, Atinuke || Ladot Healthcare LLC || Ambetter ||  Greetings,   Hope you are doing well. I just wanted to follow up with the participation request that was submitted online for below mentioned providers.   Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Practice Address: 2577 Madison Avenue League City , TX 77573  Provider Name: Dada, Oladipo Provider NPI# 1760700223  Provider Name: Dada, Atinuke Provider NPI# 1154782720  If you need any additional information please let me know. Waiting for your response.   Thanks ', NULL, NULL, '2021-03-03 13:21:42', '2021-03-03 13:21:42'),
(10342, 3040, 15646, NULL, '2021-03-11 00:00:00.000', 'New/Not Initiated', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Re: Enrollment Status || Dada, Oladipo & Dada, Atinuke || Ladot Healthcare LLC || Ambetter ||  Hello,  I just wanted to follow up with the participation request that was submitted online for below mentioned providers.   Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Practice Address: 2577 Madison Avenue League City , TX 77573  Provider Name: Dada, Oladipo Provider NPI# 1760700223  Provider Name: Dada, Atinuke Provider NPI# 1154782720  If you need any additional information please let me know. Waiting for your response.   Thank you', NULL, NULL, '2021-03-04 13:22:43', '2021-03-04 13:22:43'),
(10343, 3040, 15646, NULL, '2021-03-11 00:00:00.000', 'In Process', 'Email rcvd from: Credentialing@superiorhealthplan.com  Subject: RE: Enrollment Status || Dada, Oladipo & Dada, Atinuke || Ladot Healthcare LLC || Ambetter ||  Hi,  Please check with our Network Development team as it appears the file was discontinued, their email is below.  SHP.NetworkDevelopment@superiorhealthplan.com  Thank you,  Credentialing Department | Superior Health Plan 5900 E. Ben White Blvd | Austin, TX 78741 Phone: 800-820-5686 |Fax: 866-702-4831 Credentialing@superiorhealthplan.com   ', NULL, NULL, '2021-03-04 13:24:24', '2021-03-04 13:24:24'),
(10344, 3040, 15646, NULL, '2021-03-18 00:00:00.000', 'In Process', 'Email sent to: credentialing@superiorhealthplan.com  Subject: Enrollment Status || Dada, Oladipo & Dada, Atinuke || Ladot Healthcare LLC || Ambetter ||  Greetings,  Hope you are doing well. I just wanted to follow up with the participation request that was submitted online for below mentioned providers.   Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Practice Address: 2577 Madison Avenue League City , TX 77573  Provider Name: Dada, Oladipo Provider NPI# 1760700223  Provider Name: Dada, Atinuke Provider NPI# 1154782720  If you need any additional information please let me know. Waiting for your response.   Thanks ', NULL, NULL, '2021-03-11 14:19:17', '2021-03-11 14:19:17'),
(10345, 3040, 15646, NULL, '2021-03-25 00:00:00.000', 'In Process', 'Email rcvd from: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Dada, Oladipo & Dada, Atinuke || Ladot Healthcare LLC || Ambetter ||  Good evening,                    I am showing that the providers are currently in progress for credentialed and have not been completed at this time. Should there be any information needed, the cred spec will reach out to you directly.', NULL, NULL, '2021-03-18 13:08:36', '2021-03-18 13:08:36'),
(10346, 3040, 15646, NULL, '2021-05-12 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Dada, Oladipo & Dada, Atinuke || Ladot Healthcare LLC || Ambetter ||  Greetings,  This is a follow up email regarding the enrollment status for below the mentioned providers.   Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Practice Address: 2577 Madison Avenue League City , TX 77573  Provider 1: Provider Name: Dada, Oladipo Provider NPI# 1760700223  Provider 2:   Provider Name: Dada, Atinuke Provider NPI# 1154782720  If you need any additional information please let me know. Waiting for your response.   Thank you', NULL, NULL, '2021-05-05 14:43:08', '2021-05-05 14:43:08'),
(10347, 3040, 15646, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Email rcvd from: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Dada, Oladipo & Dada, Atinuke || Ladot Healthcare LLC || Ambetter ||  Good afternoon,  I am able to locate the following information per the status request below for the providers:  Provider Name: Dada, Oladipo  Provider NPI# 1760700223: The providers credentialing is complete, the effective date will be 06/01/2021 ,the re-credential date will be 04/30/2024.   Provider Name: Dada, Atinuke  Provider NPI# 1154782720 : I currently show the file is in progress and has not been completed at this time, the cred spec will contact you directly if there is any missing/incomplete information.  ', NULL, NULL, '2021-05-25 13:48:44', '2021-05-25 13:48:44'),
(10348, 1006, 15646, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent f/u email @ Credentialing Credentialing@superiorhealthplan.com:  Sub: Enrollment Status - LHC - Ambetter  \"Hello,  I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the following providers with Ambetter, their information is as follows: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Practice Address: 2577 Madison Avenue, League City, TX 77573  Provider Name: Dada, Oladipo Provider NPI# 1760700223  Provider Name: Dada, Atinuke Provider NPI# 1154782720  Please get back to me as soon as possible. Thank you. \"', NULL, NULL, '2021-06-11 11:54:09', '2021-06-11 11:54:09'),
(10349, 1006, 15646, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Sub : Enrollment Status - LHC - Ambetter  Hello,  I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the following providers with Ambetter, their information is as follows:  Practice:  Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Practice Address: 2577 Madison Avenue, League City, TX 77573  Provider : Provider Name: Dada, Oladipo Provider NPI# 1760700223  Provider Name: Dada, Atinuke Provider NPI# 1154782720  Please get back to me as soon as possible.  Thank you!', NULL, NULL, '2021-06-30 14:28:04', '2021-06-30 14:28:04'),
(10350, 1006, 15646, NULL, '2021-07-09 00:00:00.000', 'Approved', 'We received the following approval confirmation from AM Houston AM.Houston@superiorhealthplan.com:  Sub: Enrollment Status - LHC - Ambetter  \"Good morning Ahmed  Happy Friday  Here is the information you requested for the following Providers:  Provider Name: Dada, Oladipo Provider NPI# 1760700223  Provider Name: Dada, Atinuke Provider NPI# 1154782720   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, '2021-07-02 14:19:10', '2021-07-02 14:19:10'),
(10351, 3040, 15647, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-24 17:00:50', '2021-02-24 17:00:50'),
(10352, 3040, 15647, NULL, '2021-03-03 00:00:00.000', 'Initiated', 'Thank you for your Ambetter network participation request! We have received your inquiry. Please allow 7-10 business days for our reply.  Request initiated online. please see attachment', NULL, NULL, '2021-02-24 17:01:28', '2021-02-24 17:01:28'),
(10353, 3040, 15647, NULL, '2021-03-10 00:00:00.000', 'In Process', 'Email sent to: credentialing@superiorhealthplan.com  Subject: Enrollment Status || Dada, Oladipo & Dada, Atinuke || Ladot Healthcare LLC || Ambetter ||  Greetings,   Hope you are doing well. I just wanted to follow up with the participation request that was submitted online for below mentioned providers.   Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Practice Address: 2577 Madison Avenue League City , TX 77573  Provider Name: Dada, Oladipo Provider NPI# 1760700223  Provider Name: Dada, Atinuke Provider NPI# 1154782720  If you need any additional information please let me know. Waiting for your response.   Thanks ', NULL, NULL, '2021-03-03 13:21:45', '2021-03-03 13:21:45'),
(10354, 3040, 15647, NULL, '2021-03-11 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Re: Enrollment Status || Dada, Oladipo & Dada, Atinuke || Ladot Healthcare LLC || Ambetter ||  Hello,  I just wanted to follow up with the participation request that was submitted online for below mentioned providers.   Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Practice Address: 2577 Madison Avenue League City , TX 77573  Provider Name: Dada, Oladipo Provider NPI# 1760700223  Provider Name: Dada, Atinuke Provider NPI# 1154782720  If you need any additional information please let me know. Waiting for your response.   Thank you', NULL, NULL, '2021-03-04 13:22:50', '2021-03-04 13:22:50'),
(10355, 3040, 15647, NULL, '2021-03-11 00:00:00.000', 'In Process', 'Email rcvd from: Credentialing@superiorhealthplan.com  Subject: RE: Enrollment Status || Dada, Oladipo & Dada, Atinuke || Ladot Healthcare LLC || Ambetter ||  Hi,  Please check with our Network Development team as it appears the file was discontinued, their email is below.  SHP.NetworkDevelopment@superiorhealthplan.com  Thank you,  Credentialing Department | Superior Health Plan 5900 E. Ben White Blvd | Austin, TX 78741 Phone: 800-820-5686 |Fax: 866-702-4831 Credentialing@superiorhealthplan.com   ', NULL, NULL, '2021-03-04 13:24:29', '2021-03-04 13:24:29'),
(10356, 3040, 15647, NULL, '2021-03-18 00:00:00.000', 'In Process', 'Email sent to: credentialing@superiorhealthplan.com  Subject: Enrollment Status || Dada, Oladipo & Dada, Atinuke || Ladot Healthcare LLC || Ambetter ||  Greetings,  Hope you are doing well. I just wanted to follow up with the participation request that was submitted online for below mentioned providers.   Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Practice Address: 2577 Madison Avenue League City , TX 77573  Provider Name: Dada, Oladipo Provider NPI# 1760700223  Provider Name: Dada, Atinuke Provider NPI# 1154782720  If you need any additional information please let me know. Waiting for your response.   Thanks ', NULL, NULL, '2021-03-11 14:19:22', '2021-03-11 14:19:22'),
(10357, 3040, 15647, NULL, '2021-03-25 00:00:00.000', 'In Process', 'Email rcvd from: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Dada, Oladipo & Dada, Atinuke || Ladot Healthcare LLC || Ambetter ||  Good evening,                    I am showing that the providers are currently in progress for credentialed and have not been completed at this time. Should there be any information needed, the cred spec will reach out to you directly.', NULL, NULL, '2021-03-18 13:08:41', '2021-03-18 13:08:41'),
(10358, 3040, 15647, NULL, '2021-05-12 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Dada, Oladipo & Dada, Atinuke || Ladot Healthcare LLC || Ambetter ||  Greetings,  This is a follow up email regarding the enrollment status for below the mentioned providers.   Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Practice Address: 2577 Madison Avenue League City , TX 77573  Provider 1: Provider Name: Dada, Oladipo Provider NPI# 1760700223  Provider 2:   Provider Name: Dada, Atinuke Provider NPI# 1154782720  If you need any additional information please let me know. Waiting for your response.   Thank you', NULL, NULL, '2021-05-05 14:43:03', '2021-05-05 14:43:03'),
(10359, 3040, 15647, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Email rcvd from: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Dada, Oladipo & Dada, Atinuke || Ladot Healthcare LLC || Ambetter ||  Good afternoon,  I am able to locate the following information per the status request below for the providers:  Provider Name: Dada, Oladipo  Provider NPI# 1760700223: The providers credentialing is complete, the effective date will be 06/01/2021 ,the re-credential date will be 04/30/2024.   Provider Name: Dada, Atinuke  Provider NPI# 1154782720 : I currently show the file is in progress and has not been completed at this time, the cred spec will contact you directly if there is any missing/incomplete information.  ', NULL, NULL, '2021-05-25 13:48:48', '2021-05-25 13:48:48'),
(10360, 1006, 15647, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent f/u email @ Credentialing Credentialing@superiorhealthplan.com:  Sub: Enrollment Status - LHC - Ambetter  \"Hello,  I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the following providers with Ambetter, their information is as follows: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Practice Address: 2577 Madison Avenue, League City, TX 77573  Provider Name: Dada, Oladipo Provider NPI# 1760700223  Provider Name: Dada, Atinuke Provider NPI# 1154782720  Please get back to me as soon as possible. Thank you. \"', NULL, NULL, '2021-06-11 11:54:05', '2021-06-11 11:54:05'),
(10361, 1006, 15647, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Sub : Enrollment Status - LHC - Ambetter  Hello,  I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the following providers with Ambetter, their information is as follows:  Practice:  Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Practice Address: 2577 Madison Avenue, League City, TX 77573  Provider : Provider Name: Dada, Oladipo Provider NPI# 1760700223  Provider Name: Dada, Atinuke Provider NPI# 1154782720  Please get back to me as soon as possible.  Thank you!', NULL, NULL, '2021-06-30 14:27:52', '2021-06-30 14:27:52'),
(10362, 1006, 15647, NULL, '2021-07-09 00:00:00.000', 'Approved', 'We received the following approval confirmation from AM Houston AM.Houston@superiorhealthplan.com:  Sub: Enrollment Status - LHC - Ambetter  \"Good morning Ahmed  Happy Friday  Here is the information you requested for the following Providers:  Provider Name: Dada, Oladipo Provider NPI# 1760700223  Provider Name: Dada, Atinuke Provider NPI# 1154782720   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, '2021-07-02 14:19:00', '2021-07-02 14:19:00'),
(10363, 3040, 15648, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-25 16:02:23', '2021-02-25 16:02:23'),
(10364, 3040, 15648, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center|| Joseph, Vibitha || Tricare ||  Greetings,  Hope you are doing well. Please advise me the enrollment status for the below mentioned provider.   Practice 1: Practice Name: Normandy Urgent Care Center Practice NPI# 1407171077 Practice Tax ID# 27-0796429 Practice Address: 779 Normandy St Ste 114 Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice NPI# 1407171077 Practice Tax ID# 27-0796429 Practice Address: 16272 IMPERIAL VALLEY DR STE K Houston , TX 77060  Practice 2: Practice Name: Longpoint Medical Center Practice NPI# 1770763815 Practice Tax ID# 76-0612416 Practice Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name: Joseph, Vibitha Provider NPI# 1952931560  If you need any additional information please let me know. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-02-25 16:03:23', '2021-02-25 16:03:23'),
(10365, 3040, 15648, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Email rcvd from: KMoten4@humana.com  Subject:  Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center|| Joseph, Vibitha || Tricare ||  Please allow 3 business days for updates to show. Provider will be showing under all 3 locations.   ', NULL, NULL, '2021-02-25 17:18:29', '2021-02-25 17:18:29'),
(10366, 3040, 15648, NULL, '2021-03-23 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center|| Joseph, Vibitha || Tricare ||  Hello Katherine,  Hope you are doing well. Please note that I checked the Tricare provider portal and over there provider is not showing at 01 location. I attached the screenshot for your reference.  Under below address provider is not showing in the portal  Practice Name: Longpoint Medical Center Practice NPI# 1407171077 Practice Tax ID# 27-0796429 Practice Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226  Waiting to hear from you soon.  Thank you', NULL, NULL, '2021-03-16 16:52:25', '2021-03-16 16:52:25'),
(10367, 3040, 15648, NULL, '2021-03-23 00:00:00.000', 'In Process', 'Email rcvd from: KMoten4@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center|| Joseph, Vibitha || Tricare ||  Please allow 3 business days for updates to show.  Provider will be showing under all 3 locations. ', NULL, NULL, '2021-03-16 16:53:38', '2021-03-16 16:53:38'),
(10368, 3040, 15648, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Tricare ||  Hello Katherine,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Tricare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-02 16:09:10', '2021-06-02 16:09:10'),
(10369, 3040, 15648, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Tricare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-22 09:44:14', '2021-06-22 09:44:14'),
(10370, 3040, 15648, NULL, '2021-07-19 00:00:00.000', 'Approved', 'Email rcvd from: ywyatt@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Provider 11:    Provider Name: Joseph, Vibitha- Network under two locations need to submit a request to add her to the Long Point  Provider NPI# 1952931560', NULL, NULL, '2021-07-12 13:31:25', '2021-07-12 13:31:25'),
(10371, 3040, 15649, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-26 09:49:21', '2021-02-26 09:49:21'),
(10372, 3040, 15649, NULL, '2021-03-05 00:00:00.000', 'Approved', 'Ancillary Contract. No need to add the provider individually. ', NULL, NULL, '2021-02-26 09:53:55', '2021-02-26 09:53:55'),
(10373, 3040, 15650, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-26 09:49:44', '2021-02-26 09:49:44'),
(10374, 3040, 15650, NULL, '2021-03-05 00:00:00.000', 'Approved', 'Ancillary Contract. No need to add the provider individually. ', NULL, NULL, '2021-02-26 09:53:55', '2021-02-26 09:53:55'),
(10375, 3040, 15651, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-26 09:49:53', '2021-02-26 09:49:53'),
(10376, 3040, 15651, NULL, '2021-03-05 00:00:00.000', 'Approved', 'Ancillary Contract. No need to add the provider individually. ', NULL, NULL, '2021-02-26 09:53:58', '2021-02-26 09:53:58'),
(10377, 3040, 15652, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-26 09:49:58', '2021-02-26 09:49:58'),
(10378, 3040, 15652, NULL, '2021-03-05 00:00:00.000', 'Approved', 'Ancillary Contract. No need to add the provider individually. ', NULL, NULL, '2021-02-26 09:53:52', '2021-02-26 09:53:52'),
(10379, 3040, 15653, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-26 10:29:42', '2021-02-26 10:29:42'),
(10380, 3040, 15653, NULL, '2021-03-05 00:00:00.000', 'Approved', 'Ancillary Contract. No need to add individual provider. ', NULL, NULL, '2021-02-26 10:54:56', '2021-02-26 10:54:56'),
(10381, 1006, 15653, NULL, NULL, 'Revalidation', 'Need to individually enroll providers as the ancillary contract is no longer applicable. ', NULL, NULL, '2021-05-19 09:59:32', '2021-05-19 09:59:32'),
(10382, 3040, 15653, NULL, '2021-06-15 00:00:00.000', 'Revalidation', 'Email sent to: networkhelp@uhc.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || PAUL, SIGI & Jacob, Jaya || UHC ||  Greetings,  Hope you are doing well. I wanted to know enrollment status for the below mentioned provider in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 1: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you', NULL, NULL, '2021-06-08 14:46:11', '2021-06-08 14:46:11'),
(10383, 3040, 15653, NULL, '2021-07-02 00:00:00.000', 'Revalidation', 'Email rcvd from: networkhelp@uhc.com  Subject: Secure Message from gburns@uhc.com  Thank you for contacting the Network Management Resource Team.  The request to have both providers added to the network is still in process under reference PR-5921427. Demographically the providers are already linked to the 779 Normandy address. The process to contract the providers can take up to 45 business days and was started 5/24/21.  Gary M Burns Jr. UnitedHealthcare Network Management Resource Team (NMRT)', NULL, NULL, '2021-06-25 13:08:04', '2021-06-25 13:08:04'),
(10384, 3040, 15653, NULL, '2021-07-02 00:00:00.000', 'Revalidation', 'Email sent to: networkhelp@uhc.com  Subject: Re: Enrollment Status || Longpoint Medical Center || PAUL, SIGI & Jacob, Jaya || UHC ||  Hello,    Hope you are doing well. Please advise the enrollment status for the below mentioned providers in United Healthcare for our group under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 1: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks', NULL, NULL, '2021-06-25 13:08:53', '2021-06-25 13:08:53'),
(10385, 3040, 15653, NULL, '2021-07-22 00:00:00.000', 'Revalidation', 'Email sent to: networkhelp@uhc.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers || UHC ||  Greetings,  Hope you are doing well. I wanted to know enrollment status for the below mentioned provider in UHC in our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 2: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Please get back to me as soon as you can get a chance. Waiting for your response.  Thank you', NULL, NULL, '2021-07-15 14:45:25', '2021-07-15 14:45:25'),
(10386, 3040, 15653, NULL, '2021-07-29 00:00:00.000', 'Revalidation', 'Email rcvd from: networkhelp@uhc.com  Subject: Secure Message from barbara_jordan@uhc.com  Hello  Thank you for contacting the Network Management Resource Team.  An escalated request has been submitted to add the providers to the group.  I apologize for the delay in getting the providers loaded but the team will be working on this issue and should have it completed within 10 to 14 days.  TIN 270796429   Impact:  02354768  Provider 1: Provider Name: Jacob, Jaya  Provider NPI# 1194336149  Provider 2: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Please let us know if we can assist further via email.  Kind Regards  Barbara Jordan UnitedHealthcare Network Management Resource Team (NMRT)', NULL, NULL, '2021-07-22 14:54:29', '2021-07-22 14:54:29'),
(10387, 11056, 15653, NULL, '2021-08-19 00:00:00.000', 'Revalidation', 'Email sent to : networkhelp@uhc.com  Sub : Enrollment Status Query - NUCC - IVUC - UHC  Good afternoon!  Hope all is well. I wanted to know the enrollment status for the below mentioned provider in UHC.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Details: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider Name: John, Jeny Provider NPI# : 1073019493  Please get back to me as soon as you can get a chance. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-08-11 14:52:20', '2021-08-11 14:52:20'),
(10388, 3040, 15653, NULL, '2021-09-06 00:00:00.000', 'Revalidation', 'Email sent to: networkhelp@uhc.com  Subject: Re: Enrollment Status Query - NUCC - IVUC - UHC  Greetings,   Hope you are doing well. Please provide the enrollment status for the below mentioned providers in UHC in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 2: Provider Name: John, Jeny Provider NPI# : 1073019493  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks  ', NULL, NULL, '2021-08-30 11:11:52', '2021-08-30 11:11:52'),
(10389, 3040, 15653, NULL, '2021-09-10 00:00:00.000', 'Revalidation', 'Email rcvd from: networkhelp@uhc.com  Subject: Secure Message from david_russell@uhc.com  Hello,  Thank you for contacting the Network Management Resource Team.  Jacob, Jaya, NPI: 1194336149 – Linked to TIN 270796429, credentialing in good standing (delegated by a 3rd party), in-network under the group contract effective July 19, 2021, linked to both addresses in your email  John, Jeny, NPI: 1073019493 - Linked to TIN 270796429, listed as a Hospital Based Provider (or “inpatient only”) and therefore exempt from credentialing, out-of-network (request to add to contract and addresses is pending on work order PR-6042930)  Please let us know if you have any other questions.  David Russell UnitedHealthcare Network Management Resource Team (NMRT)', NULL, NULL, '2021-09-03 10:16:49', '2021-09-03 10:16:49'),
(10390, 3040, 15653, NULL, '2021-09-21 00:00:00.000', 'Revalidated', 'Email rcvd from: United_Healthcare_Provider_Operations@uhc.com  Subject: Secure message from United_Healthcare_Provider_Operations@uhc.com   UnitedHealthcare Insurance Company  Good news! We’ve completed the provider/group updates you requested on Jul 19, 2021 8:41:04 PM. Your request was assigned reference number PR-6026374 .  Please see the attached report for details. For your convenience, your original submission is also attached.  If you have questions or need further assistance, please contact your Network Account Manager.  Thank you.  UnitedHealthcare Provider Operations', NULL, NULL, '2021-09-14 13:41:27', '2021-09-14 13:41:27'),
(10391, 3040, 15654, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-26 10:29:43', '2021-02-26 10:29:43'),
(10392, 3040, 15654, NULL, '2021-03-05 00:00:00.000', 'Approved', 'Ancillary Contract. No need to add individual provider. ', NULL, NULL, '2021-02-26 10:54:58', '2021-02-26 10:54:58'),
(10393, 1006, 15654, NULL, NULL, 'Revalidation', 'Need to individually enroll providers as the ancillary contract is no longer applicable. ', NULL, NULL, '2021-05-19 09:59:37', '2021-05-19 09:59:37'),
(10394, 3040, 15654, NULL, '2021-06-15 00:00:00.000', 'Revalidation', 'Email sent to: networkhelp@uhc.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || PAUL, SIGI & Jacob, Jaya || UHC ||  Greetings,  Hope you are doing well. I wanted to know enrollment status for the below mentioned provider in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 1: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you', NULL, NULL, '2021-06-08 14:46:22', '2021-06-08 14:46:22'),
(10395, 3040, 15654, NULL, '2021-07-02 00:00:00.000', 'Revalidation', 'Email rcvd from: networkhelp@uhc.com  Subject: Secure Message from gburns@uhc.com  Thank you for contacting the Network Management Resource Team.  The request to have both providers added to the network is still in process under reference PR-5921427. Demographically the providers are already linked to the 779 Normandy address. The process to contract the providers can take up to 45 business days and was started 5/24/21.  Gary M Burns Jr. UnitedHealthcare Network Management Resource Team (NMRT)', NULL, NULL, '2021-06-25 13:07:55', '2021-06-25 13:07:55'),
(10396, 3040, 15654, NULL, '2021-07-02 00:00:00.000', 'Revalidation', 'Email sent to: networkhelp@uhc.com  Subject: Re: Enrollment Status || Longpoint Medical Center || PAUL, SIGI & Jacob, Jaya || UHC ||  Hello,    Hope you are doing well. Please advise the enrollment status for the below mentioned providers in United Healthcare for our group under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 1: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks', NULL, NULL, '2021-06-25 13:08:45', '2021-06-25 13:08:45'),
(10397, 3040, 15654, NULL, '2021-07-22 00:00:00.000', 'Revalidation', 'Email sent to: networkhelp@uhc.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers || UHC ||  Greetings,  Hope you are doing well. I wanted to know enrollment status for the below mentioned provider in UHC in our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 2: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Please get back to me as soon as you can get a chance. Waiting for your response.  Thank you', NULL, NULL, '2021-07-15 14:45:27', '2021-07-15 14:45:27'),
(10398, 3040, 15654, NULL, '2021-07-29 00:00:00.000', 'Revalidation', 'Email rcvd from: networkhelp@uhc.com  Subject: Secure Message from barbara_jordan@uhc.com  Hello  Thank you for contacting the Network Management Resource Team.  An escalated request has been submitted to add the providers to the group.  I apologize for the delay in getting the providers loaded but the team will be working on this issue and should have it completed within 10 to 14 days.  TIN 270796429   Impact:  02354768  Provider 1: Provider Name: Jacob, Jaya  Provider NPI# 1194336149  Provider 2: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Please let us know if we can assist further via email.  Kind Regards  Barbara Jordan UnitedHealthcare Network Management Resource Team (NMRT)', NULL, NULL, '2021-07-22 14:54:31', '2021-07-22 14:54:31'),
(10399, 11056, 15654, NULL, '2021-08-19 00:00:00.000', 'Revalidation', 'Email sent to : networkhelp@uhc.com  Sub : Enrollment Status Query - NUCC - IVUC - UHC  Good afternoon!  Hope all is well. I wanted to know the enrollment status for the below mentioned provider in UHC.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Details: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider Name: John, Jeny Provider NPI# : 1073019493  Please get back to me as soon as you can get a chance. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-08-11 14:51:15', '2021-08-11 14:51:15'),
(10400, 3040, 15654, NULL, '2021-08-25 00:00:00.000', 'Revalidated', 'Email rcvd from: networkhelp@uhc.com  Subject: Secure Message from tracy_brooks@uhc.com   Thank you for contacting the Network Management Resource Team. We will be happy to try to assist with your inquiry. Jaya Jacob is demographically linked to the Tax ID. Contracting is still in process under PR 5921427. Sigi Paul is linked and contracted under the Tax ID. I have attached this providers product participation report.  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, '2021-08-18 13:28:54', '2021-08-18 13:28:54'),
(10401, 3040, 15655, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-26 10:29:52', '2021-02-26 10:29:52'),
(10402, 3040, 15655, NULL, '2021-03-05 00:00:00.000', 'Approved', 'Ancillary Contract. No need to add individual provider. ', NULL, NULL, '2021-02-26 10:54:57', '2021-02-26 10:54:57'),
(10403, 1006, 15655, NULL, NULL, 'Revalidation', 'Ancillary contract is no longer in effect, need to start enrollment. ', NULL, NULL, '2021-05-19 11:15:36', '2021-05-19 11:15:36'),
(10404, 3040, 15655, NULL, '2021-06-15 00:00:00.000', 'Revalidation', 'Email sent to: networkhelp@uhc.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || PAUL, SIGI & Jacob, Jaya || UHC ||  Greetings,  Hope you are doing well. I wanted to know enrollment status for the below mentioned provider in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 1: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you', NULL, NULL, '2021-06-08 14:46:16', '2021-06-08 14:46:16'),
(10405, 3040, 15655, NULL, '2021-07-02 00:00:00.000', 'Revalidation', 'Email rcvd from: networkhelp@uhc.com  Subject: Secure Message from gburns@uhc.com  Thank you for contacting the Network Management Resource Team.  The request to have both providers added to the network is still in process under reference PR-5921427. Demographically the providers are already linked to the 779 Normandy address. The process to contract the providers can take up to 45 business days and was started 5/24/21.  Gary M Burns Jr. UnitedHealthcare Network Management Resource Team (NMRT)', NULL, NULL, '2021-06-25 13:08:08', '2021-06-25 13:08:08'),
(10406, 3040, 15655, NULL, '2021-07-02 00:00:00.000', 'Revalidation', 'Email sent to: networkhelp@uhc.com  Subject: Re: Enrollment Status || Longpoint Medical Center || PAUL, SIGI & Jacob, Jaya || UHC ||  Hello,    Hope you are doing well. Please advise the enrollment status for the below mentioned providers in United Healthcare for our group under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 1: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks', NULL, NULL, '2021-06-25 13:08:56', '2021-06-25 13:08:56'),
(10407, 3040, 15655, NULL, '2021-07-22 00:00:00.000', 'Revalidation', 'Email sent to: networkhelp@uhc.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers || UHC ||  Greetings,  Hope you are doing well. I wanted to know enrollment status for the below mentioned provider in UHC in our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 2: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Please get back to me as soon as you can get a chance. Waiting for your response.  Thank you', NULL, NULL, '2021-07-15 14:45:26', '2021-07-15 14:45:26'),
(10408, 3040, 15655, NULL, '2021-07-29 00:00:00.000', 'Revalidation', 'Email rcvd from: networkhelp@uhc.com  Subject: Secure Message from barbara_jordan@uhc.com  Hello  Thank you for contacting the Network Management Resource Team.  An escalated request has been submitted to add the providers to the group.  I apologize for the delay in getting the providers loaded but the team will be working on this issue and should have it completed within 10 to 14 days.  TIN 270796429   Impact:  02354768  Provider 1: Provider Name: Jacob, Jaya  Provider NPI# 1194336149  Provider 2: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Please let us know if we can assist further via email.  Kind Regards  Barbara Jordan UnitedHealthcare Network Management Resource Team (NMRT)', NULL, NULL, '2021-07-22 14:54:33', '2021-07-22 14:54:33'),
(10409, 11056, 15655, NULL, '2021-08-19 00:00:00.000', 'Revalidation', 'Email sent to : networkhelp@uhc.com  Sub : Enrollment Status Query - NUCC - IVUC - UHC  Good afternoon!  Hope all is well. I wanted to know the enrollment status for the below mentioned provider in UHC.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Details: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider Name: John, Jeny Provider NPI# : 1073019493  Please get back to me as soon as you can get a chance. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-08-11 14:53:51', '2021-08-11 14:53:51'),
(10410, 3040, 15655, NULL, '2021-09-06 00:00:00.000', 'Revalidation', 'Email sent to: networkhelp@uhc.com  Subject: Re: Enrollment Status Query - NUCC - IVUC - UHC  Greetings,   Hope you are doing well. Please provide the enrollment status for the below mentioned providers in UHC in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 2: Provider Name: John, Jeny Provider NPI# : 1073019493  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks  ', NULL, NULL, '2021-08-30 11:11:54', '2021-08-30 11:11:54'),
(10411, 3040, 15655, NULL, '2021-09-10 00:00:00.000', 'Revalidation', 'Email rcvd from: networkhelp@uhc.com  Subject: Secure Message from david_russell@uhc.com  Hello,  Thank you for contacting the Network Management Resource Team.  Jacob, Jaya, NPI: 1194336149 – Linked to TIN 270796429, credentialing in good standing (delegated by a 3rd party), in-network under the group contract effective July 19, 2021, linked to both addresses in your email  John, Jeny, NPI: 1073019493 - Linked to TIN 270796429, listed as a Hospital Based Provider (or “inpatient only”) and therefore exempt from credentialing, out-of-network (request to add to contract and addresses is pending on work order PR-6042930)  Please let us know if you have any other questions.  David Russell UnitedHealthcare Network Management Resource Team (NMRT)', NULL, NULL, '2021-09-03 10:16:52', '2021-09-03 10:16:52'),
(10412, 3040, 15655, NULL, '2021-09-21 00:00:00.000', 'Revalidated', 'Email rcvd from: United_Healthcare_Provider_Operations@uhc.com  Subject: Secure message from United_Healthcare_Provider_Operations@uhc.com   UnitedHealthcare Insurance Company  Good news! We’ve completed the provider/group updates you requested on Jul 19, 2021 8:41:04 PM. Your request was assigned reference number PR-6026374 .  Please see the attached report for details. For your convenience, your original submission is also attached.  If you have questions or need further assistance, please contact your Network Account Manager.  Thank you.  UnitedHealthcare Provider Operations', NULL, NULL, '2021-09-14 13:41:28', '2021-09-14 13:41:28'),
(10413, 3040, 15656, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-26 10:29:55', '2021-02-26 10:29:55'),
(10414, 3040, 15656, NULL, '2021-03-05 00:00:00.000', 'Approved', 'Ancillary Contract. No need to add individual provider. ', NULL, NULL, '2021-02-26 10:54:59', '2021-02-26 10:54:59');
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
(10415, 1006, 15656, NULL, NULL, 'Revalidation', 'Ancillary contract is no longer in effect, need to start enrollment. ', NULL, NULL, '2021-05-19 11:15:41', '2021-05-19 11:15:41'),
(10416, 3040, 15656, NULL, '2021-06-15 00:00:00.000', 'Revalidation', 'Email sent to: networkhelp@uhc.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || PAUL, SIGI & Jacob, Jaya || UHC ||  Greetings,  Hope you are doing well. I wanted to know enrollment status for the below mentioned provider in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 1: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you', NULL, NULL, '2021-06-08 14:46:28', '2021-06-08 14:46:28'),
(10417, 3040, 15656, NULL, '2021-07-02 00:00:00.000', 'Revalidation', 'Email rcvd from: networkhelp@uhc.com  Subject: Secure Message from gburns@uhc.com  Thank you for contacting the Network Management Resource Team.  The request to have both providers added to the network is still in process under reference PR-5921427. Demographically the providers are already linked to the 779 Normandy address. The process to contract the providers can take up to 45 business days and was started 5/24/21.  Gary M Burns Jr. UnitedHealthcare Network Management Resource Team (NMRT)', NULL, NULL, '2021-06-25 13:07:58', '2021-06-25 13:07:58'),
(10418, 3040, 15656, NULL, '2021-07-02 00:00:00.000', 'Revalidation', 'Email sent to: networkhelp@uhc.com  Subject: Re: Enrollment Status || Longpoint Medical Center || PAUL, SIGI & Jacob, Jaya || UHC ||  Hello,    Hope you are doing well. Please advise the enrollment status for the below mentioned providers in United Healthcare for our group under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 1: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks', NULL, NULL, '2021-06-25 13:08:49', '2021-06-25 13:08:49'),
(10419, 3040, 15656, NULL, '2021-07-22 00:00:00.000', 'Revalidation', 'Email sent to: networkhelp@uhc.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers || UHC ||  Greetings,  Hope you are doing well. I wanted to know enrollment status for the below mentioned provider in UHC in our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 2: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Please get back to me as soon as you can get a chance. Waiting for your response.  Thank you', NULL, NULL, '2021-07-15 14:45:28', '2021-07-15 14:45:28'),
(10420, 3040, 15656, NULL, '2021-07-29 00:00:00.000', 'Revalidation', 'Email rcvd from: networkhelp@uhc.com  Subject: Secure Message from barbara_jordan@uhc.com  Hello  Thank you for contacting the Network Management Resource Team.  An escalated request has been submitted to add the providers to the group.  I apologize for the delay in getting the providers loaded but the team will be working on this issue and should have it completed within 10 to 14 days.  TIN 270796429   Impact:  02354768  Provider 1: Provider Name: Jacob, Jaya  Provider NPI# 1194336149  Provider 2: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Please let us know if we can assist further via email.  Kind Regards  Barbara Jordan UnitedHealthcare Network Management Resource Team (NMRT)', NULL, NULL, '2021-07-22 14:54:34', '2021-07-22 14:54:34'),
(10421, 11056, 15656, NULL, '2021-08-19 00:00:00.000', 'Revalidation', 'Email sent to : networkhelp@uhc.com  Sub : Enrollment Status Query - NUCC - IVUC - UHC  Good afternoon!  Hope all is well. I wanted to know the enrollment status for the below mentioned provider in UHC.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Details: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider Name: John, Jeny Provider NPI# : 1073019493  Please get back to me as soon as you can get a chance. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-08-11 14:53:19', '2021-08-11 14:53:19'),
(10422, 3040, 15656, NULL, '2021-09-06 00:00:00.000', 'Revalidated', 'Provider is participating with UHC. For more details please see attachment. ', NULL, NULL, '2021-08-30 11:06:09', '2021-08-30 11:06:09'),
(10423, 3046, 15657, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-26 10:40:16', '2021-02-26 10:40:16'),
(10424, 3046, 15657, NULL, '2021-03-05 00:00:00.000', 'Initiated', 'Reference # for Rail Road 21057000391', NULL, NULL, '2021-02-26 10:40:53', '2021-02-26 10:40:53'),
(10425, 3046, 15657, NULL, '2021-03-12 00:00:00.000', 'Approved', 'Your active Railroad Medicare PTAN has been located and is shown here :  PROVIDER NAME	KATHERINE D PATERSON NP PROVIDER PTAN	Q00030753 PROVIDER NPI	1164776548 EFFECTIVE DATE	12/01/2020 END DATE	 GROUP NAME	COASTAL BEND URGENT CARE LLC GROUP PTAN	DX7086 BUSINESS STATE	TX EFFECTIVE DATE	07/03/2017 END DATE	', NULL, NULL, '2021-03-05 13:22:26', '2021-03-05 13:22:26'),
(10426, 3046, 15658, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-26 12:39:51', '2021-02-26 12:39:51'),
(10427, 3046, 15658, NULL, '2021-03-05 00:00:00.000', 'Initiated', 'Enrollment application submitted online MultiPlan Service Case Number:	7527268 ', NULL, NULL, '2021-02-26 12:41:04', '2021-02-26 12:41:04'),
(10428, 3046, 15658, NULL, '2021-03-12 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com Subject: Request for Enrollment Status || Katherine D Paterson || CBUC & GWMC || MultiPlan  Greetings Hope my email finds you well. Kindly advise the enrollment status of the below mentioned provider which was submitted online. Please note that the MultiPlan Service Case Number is 7527268 :  Practice 1Details: Name: Coastal Bend Urgent Care NPI: 1427509264 Tax ID: 81-1890349Address: 301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324  Practice 2 Details: Name: George West Medical Clinic NPI: 1427509264 Tax ID: 81-1890349 Address: 504A Houston Street Live Oak County George West , TX 78022-3663  Provider Details: Name: Katherine D Paterson NPI:    1164776548  Your quick response in this regard is highly appreciated. Thank you', NULL, NULL, '2021-03-05 13:12:19', '2021-03-05 13:12:19'),
(10429, 3046, 15658, NULL, '2021-03-26 00:00:00.000', 'In Process', 'Hello,  I would like to request for the enrollment status for below mentioned provider: Please note that the MultiPlan Service Case Number is 7527268 :  Practice 1 Details: Name: Coastal Bend Urgent Care NPI:     1427509264 Tax ID: 81-1890349 Address: 301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324  Practice 2 Details: Name: George West Medical Clinic NPI:     1427509264 Tax ID: 81-1890349 Address: 504A Houston Street Live Oak County George West , TX 78022-3663  Provider Details: Name: Katherine D  Paterson NPI:    1164776548  Your quick response in this regard is highly appreciated.  Thank you', NULL, NULL, '2021-03-19 12:15:54', '2021-03-19 12:15:54'),
(10430, 1006, 15658, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Sent f/u email @ registrar@multiplan.com:  Sub: Enrollment Status - CBUC/GWMC - Multiplan - Case# 7527268  \"Hello,   We wanted to get an update regarding the enrollment status for the following provider under the mentioned group and addresses:  Group Name: Coastal Bend Urgent Care, LLC NPI# 1427509264 TIN# 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  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-06-09 11:26:19', '2021-06-09 11:26:19'),
(10431, 1006, 15658, NULL, '2021-07-06 00:00:00.000', 'In Process', 'Created new service case for f/u since emails weren\'t going through: \"MultiPlan has received your inquiry.  One of our Customer Service representatives will research and respond to you via email with updates and/or resolution.  If you have questions regarding this service case, please call Customer Service at the number listed below.  MultiPlan Inquiry 1-800-950-7040 and refer to the case number when speaking with our representative.  Viant Inquiry 1-800-877-1444 and refer to the case number when speaking with our representative.  Case Number: 7656098    Submitter Name: Brad  Peterson Date of submission: 06/29/2021 \"', NULL, NULL, '2021-06-29 17:22:09', '2021-06-29 17:22:09'),
(10432, 1006, 15658, NULL, '2021-08-16 00:00:00.000', 'In Process', 'As per my discussion with Multiplan they still haven\'t received the nomination form, requested them to give us access to the group access on Multiplan will submit request: \"The Request RITM0314009 has been opened.     Requested For: Brad Peterson  Short Description: Provider Customer Service Portal access request  Description:  Please make Brad Peterson PH 713-893-6214 Ext 405 Administrator for Coastal Bend Urgent Care LLC (9933249) TIN: 81-1890349. Case 7699579. Thank you.  Subsequent to manager approval, this request will be subject to up to two additional approvals by a Business Application Owner and IT Application Environment Owner.  Once your manager has approved, you may view the status of other approvals along with other request details in IT Self-Service: RITM0314009  Please use the above link or reply directly to this e-mail to add any further comments or instruction.    Ref:MSG9151120\" ', NULL, NULL, '2021-08-09 15:04:54', '2021-08-09 15:04:54'),
(10433, 1006, 15658, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Sent following request @ registrar@multiplan.com:  Sub: Practitioner Application - CBUC/GWMC - Multiplan  \"Hello,   Please find the attached information for our providers, do let me know if anything else is required to proceed.  Thank you. \"', NULL, NULL, '2021-08-11 10:57:03', '2021-08-11 10:57:03'),
(10434, 11056, 15658, NULL, '2021-08-26 00:00:00.000', 'In Process', 'Email sent to : registrar@multiplan.com  Sub : Enrollment Status Updates - CBUC/GWMC - Multiplan  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: Katherine Paterson Provider NPI# 1164776548  Provider Name: Gonzalez, Monica Provider NPI# 1871132811  If you need any documents or information regarding this feel free to contact me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-18 15:16:10', '2021-08-18 15:16:10'),
(10435, 11056, 15658, NULL, '2021-08-31 00:00:00.000', 'In Process', '	 Email sent to : registrar@multiplan.com, pif@multiplan.com  &  ProviderServices@multiplan.com  Sub : Pracititioner Application - CBUC/GWMC - Multiplan  Good morning!  Hope this email finds you well. Here are the Group Cover Sheet for Practitioner Applications for the enrollment of the below mentioned providers under the practice in Multiplan.  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  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 11:55:15', '2021-08-24 11:55:15'),
(10436, 11056, 15658, NULL, '2021-09-11 00:00:00.000', 'In Process', 'Email received from : ProviderServices@multiplan.com  Sub : Pracititioner Application - CBUC/GWMC - Multiplan  Hello,  Thank you for contacting our Service Department at MultiPlan/PHCS.  Unfortunately the email box you have submitted your request to providerservices@multiplan.com does not process these types of requests.  You may contact us at our Customer Service department by calling 800-950-7040 or you may visit our website at https://custservice.multiplan.com (note there is no www. for the link) to request service online.  As a reminder under the MultiPlan and/or PHCS provider agreement, MultiPlan does not make determinations with respect to benefits or eligibility or pay claims. For these types of inquiries please contact the patient\'s insurance company.  **Please do not reply back to this email. We will not be able to process your request.**  Thank you,  Service Operations', NULL, NULL, '2021-09-03 14:59:50', '2021-09-03 14:59:50'),
(10437, 11056, 15658, NULL, '2021-09-27 00:00:00.000', 'In Process', 'Email sent to : appmissinginfo@multiplan.com  Sub : Regarding Paterson, Katherine D., MSN\'s MultiPlan Application – Reference: APP0008265762  Good afternoon!  Hope all is well with you.Here is the Malpractice for the provider Katherine Paterson. Please find the attachment below.  Practice Details: Practice/ Group Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Primary Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324 Secondary Address: 504A Houston Street George West , TX 78022-3663  Furthermore, If anything is required by you please let me know without any hesitation.  Thank you! Have a great day!', NULL, NULL, '2021-09-20 12:39:49', '2021-09-20 12:39:49'),
(10438, 11056, 15658, NULL, '2021-10-06 00:00:00.000', 'In Process', 'Email sent to : registrar@multiplan.com  Sub : Regarding Gonzalez, Monica D., MSN\'s MultiPlan Application – Reference: APP0008265760 Regarding Paterson, Katherine D., MSN\'s MultiPlan Application – Reference: APP0008265762   Good afternoon!  Hope this email finds you well. Please provide me with the latest updates regarding the enrollment status of the following providers under the Facility TIN. Are both locations listed below the TIN and providers too?  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 Monica Gonzalez	1871132811  If you need any additional information or documents please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-09-29 16:23:53', '2021-09-29 16:23:53'),
(10439, 11056, 15658, NULL, '2021-10-11 00:00:00.000', 'Approved', 'Approved Email received from : welcomepackets@multiplan.com  Sub : SECURE: MultiPlan Network Participation (13346720-9933249)  Dear Provider/Administrator,  Please review the attached documents regarding the participation of Paterson, Katherine, D., M.S.N., in the MultiPlan Networks.  If you have any questions regarding the content of this email, you may request service online at: https://custservice.multiplan.com.  Attachments include: o Participation Letter o Working with Multiplan Information  eff date : 09/15/2021', NULL, NULL, '2021-10-04 09:46:08', '2021-10-04 09:46:08'),
(10440, 3046, 15659, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-26 14:38:11', '2021-02-26 14:38:11'),
(10441, 3046, 15659, NULL, '2021-03-05 00:00:00.000', 'Initiated', 'Humana enrollment was initiated over the phone for Katherine.', NULL, NULL, '2021-02-26 14:39:28', '2021-02-26 14:39:28'),
(10442, 3046, 15659, NULL, '2021-03-12 00:00:00.000', 'In Process', 'Had a word with Humana over the phone and as per their instructions the APEX Standard Market Roster Template has been filled and sent to stxnm@humana.com. Kindly find the attached.', NULL, NULL, '2021-03-05 17:29:22', '2021-03-05 17:29:22'),
(10443, 1006, 15659, NULL, '2021-03-30 00:00:00.000', 'In Process', 'As per the representative (Maila), the request still does not show on her end yet. We need to allow more time. Sent a f/u email @ stxnm@humana.com as well. ', NULL, NULL, '2021-03-23 15:43:50', '2021-03-23 15:43:50'),
(10444, 1006, 15659, NULL, '2021-03-31 00:00:00.000', 'In Process', 'Received the following response from S TX Network Mgmt stxnm@humana.com:  \"The request was received on 3/5/2021 and placed in our queue to be processed. You will receive an email notification once the request is complete. Please allow additional time.  Thank you Network Operations Coordinator /Provider Contracting South Texas Network Management Humana 8119 Datapoint  Dr. 6th floor / San Antonio, TX 78229 T 800-626-2741 F 855.461.6048 stxnm@humana.com Learn more about our Bold Goal #MoreHealthyDays #startwithhealthy\"', NULL, NULL, '2021-03-24 09:59:24', '2021-03-24 09:59:24'),
(10445, 1006, 15659, NULL, '2021-06-11 00:00:00.000', 'In Process', 'Sent f/u email @ S TX Network Mgmt stxnm@humana.com:  Sub: Enrollment Status - CBUC - Humana  \"Hello,  I wanted to get an update regarding the enrollment status for the following provider under our group:  Group Name: Coastal Bend Urgent Care, LLC NPI# 1427509264 TIN# 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  Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-06-04 15:14:15', '2021-06-04 15:14:15'),
(10446, 1006, 15659, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Sent another f/u email @ S TX Network Mgmt stxnm@humana.com:  Sub: APEX Standard Market Roster Template || CBUC & GWMC ||  \'Hello,  I wanted to get an update regarding the enrollment status for our provider, the information is as follows:  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  Please get back to me as soon as possible. Thanks.\"', NULL, NULL, '2021-06-09 10:47:00', '2021-06-09 10:47:00'),
(10447, 1006, 15659, NULL, '2021-07-06 00:00:00.000', 'In Process', 'We received the following response from S TX Network Mgmt stxnm@humana.com:  \"Hello Brad,   The provider is not active  on the group contract. I’m unable to locate the original request to add the provider.  Please forward the original email and all documents to further research and/or fill out the attached provider add template.  Thank you Network Operations Coordinator /Provider Contracting South Texas Network Management Humana 8119 Datapoint  Dr. 6th floor / San Antonio, TX 78229 T 800-626-2741 F 855.461.6048 stxnm@humana.com  Learn more about our Bold Goal #MoreHealthyDays #startwithhealthy\"  Sent f/u email @ S TX Network Mgmt stxnm@humana.com:  Sub; APEX Standard Market Roster Template || CBUC & GWMC ||  \"Hello,   I hope you\'re doing well, can you please get back to me on the status of this request?  Thank you. \"', NULL, NULL, '2021-06-29 17:10:09', '2021-06-29 17:10:09'),
(10448, 1006, 15659, NULL, '2021-08-04 00:00:00.000', 'In Process', 'We received the following reply from S TX Network Mgmt stxnm@humana.com:  Sub: APEX Standard Market Roster Template || CBUC & GWMC ||  \"Hello,  Please consider this confirmation that NP Paterson is active under the group contract with the requested effective date of 1/1/2021.  If this is duplicate notification, please disregard.  Thank you,  Network Operations Coordinator /Provider Contracting South Texas Network Management Humana 8119 Datapoint  Dr. 6th floor / San Antonio, TX 78229 stxnm@humana.com\"  Replied:  \"Hello,  I appreciate the update but I cannot find the provider on the Humana provider directory, can you please send me a roster for the provider showcasing all the plans that she is enrolled under or a welcome letter?   Thank you. \"', NULL, NULL, '2021-07-28 16:46:31', '2021-07-28 16:46:31'),
(10449, 1006, 15659, NULL, '2021-08-06 00:00:00.000', 'Approved', 'Approval confirmation received from stxnm@humana.com:  Sub: APEX Standard Market Roster Template || CBUC & GWMC ||  \"Hello,  Please consider this confirmation that NP Paterson is active under the group contract with the requested effective date of 1/1/2021.  If this is duplicate notification, please disregard.  Thank you,  Network Operations Coordinator /Provider Contracting South Texas Network Management Humana 8119 Datapoint  Dr. 6th floor / San Antonio, TX 78229 stxnm@humana.com\"  ', NULL, NULL, '2021-07-30 10:27:14', '2021-07-30 10:27:14'),
(10450, 3046, 15660, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-26 14:53:07', '2021-02-26 14:53:07'),
(10451, 3046, 15660, NULL, '2021-03-05 00:00:00.000', 'Initiated', 'Reference # for Rail Road 21057000391 ', NULL, NULL, '2021-02-26 14:53:36', '2021-02-26 14:53:36'),
(10452, 3046, 15660, NULL, '2021-03-12 00:00:00.000', 'Approved', 'Your active Railroad Medicare PTAN has been located and is shown here :  PROVIDER NAME	KATHERINE D PATERSON NP PROVIDER PTAN	Q00030753 PROVIDER NPI	1164776548 EFFECTIVE DATE	12/01/2020 END DATE	 GROUP NAME	COASTAL BEND URGENT CARE LLC GROUP PTAN	DX7086 BUSINESS STATE	TX EFFECTIVE DATE	07/03/2017 END DATE	', NULL, NULL, '2021-03-05 13:33:32', '2021-03-05 13:33:32'),
(10453, 3046, 15661, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-26 14:58:04', '2021-02-26 14:58:04'),
(10454, 3046, 15661, NULL, '2021-03-05 00:00:00.000', 'Initiated', 'Enrollment application submitted online MultiPlan Service Case Number:	7527268', NULL, NULL, '2021-02-26 14:58:55', '2021-02-26 14:58:55'),
(10455, 3046, 15661, NULL, '2021-03-12 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com Subject: Request for Enrollment Status || Katherine D Paterson || CBUC & GWMC || MultiPlan  Greetings Hope my email finds you well. Kindly advise the enrollment status of the below mentioned provider which was submitted online. Please note that the MultiPlan Service Case Number is 7527268 :  Practice 1Details: Name: Coastal Bend Urgent Care NPI: 1427509264 Tax ID: 81-1890349Address: 301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324  Practice 2 Details: Name: George West Medical Clinic NPI: 1427509264 Tax ID: 81-1890349 Address: 504A Houston Street Live Oak County George West , TX 78022-3663  Provider Details: Name: Katherine D Paterson NPI:    1164776548  Your quick response in this regard is highly appreciated. Thank you', NULL, NULL, '2021-03-05 13:13:26', '2021-03-05 13:13:26'),
(10456, 3046, 15661, NULL, '2021-03-26 00:00:00.000', 'In Process', 'Hello,  I would like to request for the enrollment status for below mentioned provider: Please note that the MultiPlan Service Case Number is 7527268 :  Practice 1 Details: Name: Coastal Bend Urgent Care NPI:     1427509264 Tax ID: 81-1890349 Address: 301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324  Practice 2 Details: Name: George West Medical Clinic NPI:     1427509264 Tax ID: 81-1890349 Address: 504A Houston Street Live Oak County George West , TX 78022-3663  Provider Details: Name: Katherine D  Paterson NPI:    1164776548  Your quick response in this regard is highly appreciated.  Thank you', NULL, NULL, '2021-03-19 12:15:56', '2021-03-19 12:15:56'),
(10457, 1006, 15661, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Sent f/u email @ registrar@multiplan.com:  Sub: Enrollment Status - CBUC/GWMC - Multiplan - Case# 7527268  \"Hello,   We wanted to get an update regarding the enrollment status for the following provider under the mentioned group and addresses:  Group Name: Coastal Bend Urgent Care, LLC NPI# 1427509264 TIN# 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  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-06-09 11:26:13', '2021-06-09 11:26:13'),
(10458, 1006, 15661, NULL, '2021-07-06 00:00:00.000', 'In Process', 'Created new service case for f/u since emails weren\'t going through: \"MultiPlan has received your inquiry.  One of our Customer Service representatives will research and respond to you via email with updates and/or resolution.  If you have questions regarding this service case, please call Customer Service at the number listed below.  MultiPlan Inquiry 1-800-950-7040 and refer to the case number when speaking with our representative.  Viant Inquiry 1-800-877-1444 and refer to the case number when speaking with our representative.  Case Number: 7656098    Submitter Name: Brad  Peterson Date of submission: 06/29/2021 \"', NULL, NULL, '2021-06-29 17:22:06', '2021-06-29 17:22:06'),
(10459, 1006, 15661, NULL, '2021-08-16 00:00:00.000', 'In Process', 'As per my discussion with Multiplan they still haven\'t received the nomination form, requested them to give us access to the group access on Multiplan will submit request: \"The Request RITM0314009 has been opened.     Requested For: Brad Peterson  Short Description: Provider Customer Service Portal access request  Description:  Please make Brad Peterson PH 713-893-6214 Ext 405 Administrator for Coastal Bend Urgent Care LLC (9933249) TIN: 81-1890349. Case 7699579. Thank you.  Subsequent to manager approval, this request will be subject to up to two additional approvals by a Business Application Owner and IT Application Environment Owner.  Once your manager has approved, you may view the status of other approvals along with other request details in IT Self-Service: RITM0314009  Please use the above link or reply directly to this e-mail to add any further comments or instruction.    Ref:MSG9151120\" ', NULL, NULL, '2021-08-09 15:04:49', '2021-08-09 15:04:49'),
(10460, 1006, 15661, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Sent following request @ registrar@multiplan.com:  Sub: Practitioner Application - CBUC/GWMC - Multiplan  \"Hello,   Please find the attached information for our providers, do let me know if anything else is required to proceed.  Thank you. \" ', NULL, NULL, '2021-08-11 11:01:24', '2021-08-11 11:01:24'),
(10461, 11056, 15661, NULL, '2021-08-26 00:00:00.000', 'In Process', 'Email sent to : registrar@multiplan.com  Sub : Enrollment Status Updates - CBUC/GWMC - Multiplan  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: Katherine Paterson Provider NPI# 1164776548  Provider Name: Gonzalez, Monica Provider NPI# 1871132811  If you need any documents or information regarding this feel free to contact me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-18 15:16:02', '2021-08-18 15:16:02'),
(10462, 11056, 15661, NULL, '2021-08-31 00:00:00.000', 'In Process', '	 Email sent to : registrar@multiplan.com, pif@multiplan.com  &  ProviderServices@multiplan.com  Sub : Pracititioner Application - CBUC/GWMC - Multiplan  Good morning!  Hope this email finds you well. Here are the Group Cover Sheet for Practitioner Applications for the enrollment of the below mentioned providers under the practice in Multiplan.  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  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 11:55:09', '2021-08-24 11:55:09'),
(10463, 11056, 15661, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Email sent to : registrar@multiplan.com, pif@multiplan.com  &  ProviderServices@multiplan.com  Sub : Pracititioner Application - CBUC/GWMC - Multiplan  Good morning!  Hope this email finds you well. Here are the Group Cover Sheet for Practitioner Applications for the enrollment of the below mentioned providers under the practice in Multiplan.  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  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 11:57:34', '2021-08-24 11:57:34'),
(10464, 11056, 15661, NULL, '2021-09-27 00:00:00.000', 'In Process', 'Email sent to : appmissinginfo@multiplan.com  Sub : Regarding Paterson, Katherine D., MSN\'s MultiPlan Application – Reference: APP0008265762  Good afternoon!  Hope all is well with you.Here is the Malpractice for the provider Katherine Paterson. Please find the attachment below.  Practice Details: Practice/ Group Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Primary Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324 Secondary Address: 504A Houston Street George West , TX 78022-3663  Furthermore, If anything is required by you please let me know without any hesitation.  Thank you! Have a great day!', NULL, NULL, '2021-09-20 12:39:26', '2021-09-20 12:39:26'),
(10465, 11056, 15661, NULL, '2021-10-06 00:00:00.000', 'In Process', 'Email sent to : appmissinginfo@multiplan.com  Sub : Regarding Paterson, Katherine D., MSN\'s MultiPlan Application – Reference: APP0008265762  Good afternoon!  Hope all is well with you.Here is the Malpractice for the provider Katherine Paterson. Please find the attachment below.  Practice Details: Practice/ Group Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Primary Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324 Secondary Address: 504A Houston Street George West , TX 78022-3663  Furthermore, If anything is required by you please let me know without any hesitation.  Thank you! Have a great day!', NULL, NULL, '2021-09-29 16:24:27', '2021-09-29 16:24:27'),
(10466, 11056, 15661, NULL, '2021-10-11 00:00:00.000', 'Approved', 'Approved Email received from : welcomepackets@multiplan.com  Sub : SECURE: MultiPlan Network Participation (13346720-9933249)  Dear Provider/Administrator,  Please review the attached documents regarding the participation of Paterson, Katherine, D., M.S.N., in the MultiPlan Networks.  If you have any questions regarding the content of this email, you may request service online at: https://custservice.multiplan.com.  Attachments include: o Participation Letter o Working with Multiplan Information  eff date : 09/15/2021   Please see the attachment. ', NULL, NULL, '2021-10-04 09:49:19', '2021-10-04 09:49:19'),
(10467, 3046, 15662, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-26 15:00:11', '2021-02-26 15:00:11'),
(10468, 3046, 15662, NULL, '2021-03-05 00:00:00.000', 'Initiated', 'Humana enrollment was initiated over the phone for Katherine.', NULL, NULL, '2021-02-26 15:00:38', '2021-02-26 15:00:38'),
(10469, 3046, 15662, NULL, '2021-03-12 00:00:00.000', 'In Process', 'Had a word with Humana over the phone and as per their instructions the APEX Standard Market Roster Template has been filled and sent to stxnm@humana.com. Kindly find the attached.', NULL, NULL, '2021-03-05 17:29:26', '2021-03-05 17:29:26'),
(10470, 1006, 15662, NULL, '2021-03-30 00:00:00.000', 'In Process', 'As per the representative (Maila), the request still does not show on her end yet. We need to allow more time. Sent a f/u email @ stxnm@humana.com as well.  ', NULL, NULL, '2021-03-23 15:49:23', '2021-03-23 15:49:23'),
(10471, 1006, 15662, NULL, '2021-03-31 00:00:00.000', 'In Process', 'Received the following response from S TX Network Mgmt stxnm@humana.com:  \"The request was received on 3/5/2021 and placed in our queue to be processed. You will receive an email notification once the request is complete. Please allow additional time.  Thank you Network Operations Coordinator /Provider Contracting South Texas Network Management Humana 8119 Datapoint  Dr. 6th floor / San Antonio, TX 78229 T 800-626-2741 F 855.461.6048 stxnm@humana.com Learn more about our Bold Goal #MoreHealthyDays #startwithhealthy\"', NULL, NULL, '2021-03-24 09:59:42', '2021-03-24 09:59:42'),
(10472, 1006, 15662, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Sent another f/u email @ S TX Network Mgmt stxnm@humana.com:  Sub: APEX Standard Market Roster Template || CBUC & GWMC ||  \'Hello,  I wanted to get an update regarding the enrollment status for our provider, the information is as follows:  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  Please get back to me as soon as possible. Thanks.\"', NULL, NULL, '2021-06-09 10:55:57', '2021-06-09 10:55:57'),
(10473, 1006, 15662, NULL, '2021-07-06 00:00:00.000', 'In Process', 'We received the following response from S TX Network Mgmt stxnm@humana.com:  \"Hello Brad,   The provider is not active  on the group contract. I’m unable to locate the original request to add the provider.  Please forward the original email and all documents to further research and/or fill out the attached provider add template.  Thank you Network Operations Coordinator /Provider Contracting South Texas Network Management Humana 8119 Datapoint  Dr. 6th floor / San Antonio, TX 78229 T 800-626-2741 F 855.461.6048 stxnm@humana.com  Learn more about our Bold Goal #MoreHealthyDays #startwithhealthy\"  Sent f/u email @ S TX Network Mgmt stxnm@humana.com:  Sub; APEX Standard Market Roster Template || CBUC & GWMC ||  \"Hello,   I hope you\'re doing well, can you please get back to me on the status of this request?  Thank you. \"', NULL, NULL, '2021-06-29 17:10:29', '2021-06-29 17:10:29'),
(10474, 1006, 15662, NULL, '2021-08-04 00:00:00.000', 'In Process', 'We received the following reply from S TX Network Mgmt stxnm@humana.com:  Sub: APEX Standard Market Roster Template || CBUC & GWMC ||  \"Hello,  Please consider this confirmation that NP Paterson is active under the group contract with the requested effective date of 1/1/2021.  If this is duplicate notification, please disregard.  Thank you,  Network Operations Coordinator /Provider Contracting South Texas Network Management Humana 8119 Datapoint  Dr. 6th floor / San Antonio, TX 78229 stxnm@humana.com\"  Replied:  \"Hello,  I appreciate the update but I cannot find the provider on the Humana provider directory, can you please send me a roster for the provider showcasing all the plans that she is enrolled under or a welcome letter?   Thank you. \"', NULL, NULL, '2021-07-28 16:45:48', '2021-07-28 16:45:48'),
(10475, 1006, 15662, NULL, '2021-08-06 00:00:00.000', 'Approved', 'Approval confirmation received from stxnm@humana.com:  Sub: APEX Standard Market Roster Template || CBUC & GWMC ||  \"Hello,  Please consider this confirmation that NP Paterson is active under the group contract with the requested effective date of 1/1/2021.  If this is duplicate notification, please disregard.  Thank you,  Network Operations Coordinator /Provider Contracting South Texas Network Management Humana 8119 Datapoint  Dr. 6th floor / San Antonio, TX 78229 stxnm@humana.com\"  ', NULL, NULL, '2021-07-30 10:26:35', '2021-07-30 10:26:35'),
(10476, 3046, 15663, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-26 15:33:47', '2021-02-26 15:33:47'),
(10477, 3046, 15663, NULL, '2021-03-05 00:00:00.000', 'Initiated', 'Enrolled on website. Your form submission identifier is: 009d6382-8ceb-4514-baa3-b4db66a58713', NULL, NULL, '2021-02-26 15:34:43', '2021-02-26 15:34:43'),
(10478, 3046, 15663, NULL, '2021-03-12 00:00:00.000', 'In Process', 'Email sent to: SWHPRegion4@BSWHealth.org Subject: Request for Enrollment Status || Katherine D Paterson || CBUC & GWMC || Scott&White||  Good Afternoon, Greetings Hope my email finds you well. Kindly advise the enrollment status of the below mentioned provider which was submitted online. Please note that the submission identifier is: 009d6382-8ceb-4514-baa3-b4db66a58713:  Practice 1 Details: Name: Coastal Bend Urgent Care NPI:  1427509264 Tax ID: 81-1890349 Address: 301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Practice 2 Details: Name: George West Medical Clinic NPI:  1427509264 Tax ID: 81-1890349 Address: 504A Houston Street Live Oak County George West , TX 78022-3663 Provider Details: Name: Katherine D  Paterson NPI: 1164776548  Your quick response in this regard is highly appreciated. Thank you ', NULL, NULL, '2021-03-05 15:21:56', '2021-03-05 15:21:56'),
(10479, 3046, 15663, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email received from:SWHPPROVIDERNETWORKDEVELOPMENT@bswhealth.org Subject: new contract request  Dear Provider,  We received a new contract request for Katherine  D Paterson NP.  Please provider the contracted Supervising Physician information by 3/20/2021.  Thank you', NULL, NULL, '2021-03-08 10:03:00', '2021-03-08 10:03:00'),
(10480, 3046, 15663, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email sent to: SWHPPROVIDERNETWORKDEVELOPMENT@bswhealth.org Subject: new contract request   Hello,  Kindly find below the requested details: Supervising Physician Name: Dehnisch, Frank R  NPI: 1952376345', NULL, NULL, '2021-03-08 10:12:01', '2021-03-08 10:12:01'),
(10481, 3046, 15663, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email sent to: SWHPPROVIDERNETWORKDEVELOPMENT@bswhealth.org Subject: new contract request   Dear Provider, I am unable to locate this NPI in our system.  Are you sure Dr. Dehnisch is contracted with SWHP? Thank you  Dear Katherine, Would you mind me asking what the procedure is in order to enroll the supervising physician.  Thank you ', NULL, NULL, '2021-03-08 12:36:24', '2021-03-08 12:36:24'),
(10482, 3046, 15663, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email from: SWHPREGION4@bswhealth.org Subject: Request for Enrollment Status || Katherine D Paterson || CBUC & GWMC || Scott&White||  Good Afternoon,  The request has been received and is currently in review, please allow 45 days from submission  date for a status update.  Kind Regards, Irene S (Region 4) Provider Relations Representative', NULL, NULL, '2021-03-08 14:39:21', '2021-03-08 14:39:21'),
(10483, 3046, 15663, NULL, '2021-03-16 00:00:00.000', 'In Process', 'Email sent to:SWHPPROVIDERNETWORKDEVELOPMENT@bswhealth.org Subject: new contract request  They would need to submit an application at https://swhp.org/forms/html/provider-account-request.html I will hold the NP application open for 2 weeks, to allow time for the Supervising Physician to apply. Thank you  Network Development  It has been initiated as it was required by Scott&White to enroll Katherine D Paterson  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: 11f9c6ef-e908-4409-9ad5-f73d4e05fd29  ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Greetings  Hope you are doing.  As per your instructions, Frank R Dehnisch application has been initiated on the said link. Kindly note the form submission identifier is: 11f9c6ef-e908-4409-9ad5-f73d4e05fd29   Thank you. ', NULL, NULL, '2021-03-09 10:02:31', '2021-03-09 10:02:31'),
(10484, 3046, 15663, NULL, '2021-03-26 00:00:00.000', 'In Process', 'Hello, Hope my email finds you well. I would like to request you for the enrollment status for below mentioned provider.  Please note that the form submission identifier is: 11f9c6ef-e908-4409-9ad5-f73d4e05fd29.  Provider DetailsProvider Name: Dehnisch, Frank RProvider NPI:     1952376345 Practice Details Practice Name: Coastal Bend Urgent Care Practice Tax ID: 81-1890349 Your quick response in this regard is highly appreciated.  Thank you.', NULL, NULL, '2021-03-19 11:07:05', '2021-03-19 11:07:05'),
(10485, 1006, 15663, NULL, '2021-04-15 00:00:00.000', 'Rejected', '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, '2021-04-08 08:44:08', '2021-04-08 08:44:08'),
(10486, 3046, 15664, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-26 15:35:23', '2021-02-26 15:35:23'),
(10487, 3046, 15664, NULL, '2021-03-05 00:00:00.000', 'Initiated', 'Enrolled on website. Your form submission identifier is: 009d6382-8ceb-4514-baa3-b4db66a58713', NULL, NULL, '2021-02-26 15:35:46', '2021-02-26 15:35:46'),
(10488, 3046, 15664, NULL, '2021-03-12 00:00:00.000', 'In Process', 'Email sent to: SWHPRegion4@BSWHealth.org Subject: Request for Enrollment Status || Katherine D Paterson || CBUC & GWMC || Scott&White||  Good Afternoon, Greetings Hope my email finds you well. Kindly advise the enrollment status of the below mentioned provider which was submitted online. Please note that the submission identifier is: 009d6382-8ceb-4514-baa3-b4db66a58713:  Practice 1 Details: Name: Coastal Bend Urgent Care NPI:  1427509264 Tax ID: 81-1890349 Address: 301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324  Practice 2 Details: Name: George West Medical Clinic NPI:  1427509264 Tax ID: 81-1890349 Address: 504A Houston Street Live Oak County George West , TX 78022-3663 Provider Details:  Name: Katherine D  Paterson NPI: 1164776548  Your quick response in this regard is highly appreciated. Thank you ', NULL, NULL, '2021-03-05 15:21:08', '2021-03-05 15:21:08'),
(10489, 3046, 15664, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email received from:SWHPPROVIDERNETWORKDEVELOPMENT@bswhealth.org Subject: new contract request  Dear Provider,  We received a new contract request for Katherine  D Paterson NP.  Please provider the contracted Supervising Physician information by 3/20/2021.  Thank you', NULL, NULL, '2021-03-08 10:03:49', '2021-03-08 10:03:49'),
(10490, 3046, 15664, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email sent to: SWHPPROVIDERNETWORKDEVELOPMENT@bswhealth.org Subject: new contract request   Hello,  Kindly find below the requested details: Supervising Physician Name: Dehnisch, Frank R  NPI: 1952376345', NULL, NULL, '2021-03-08 10:12:22', '2021-03-08 10:12:22'),
(10491, 3046, 15664, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email sent to: SWHPPROVIDERNETWORKDEVELOPMENT@bswhealth.org Subject: new contract request   Dear Provider, I am unable to locate this NPI in our system.  Are you sure Dr. Dehnisch is contracted with SWHP? Thank you  Would you mind me asking what the procedure is in order to enroll the supervising physician.  Thank you', NULL, NULL, '2021-03-08 12:38:05', '2021-03-08 12:38:05'),
(10492, 3046, 15664, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email from: SWHPREGION4@bswhealth.org Subject: Request for Enrollment Status || Katherine D Paterson || CBUC & GWMC || Scott&White||  Good Afternoon,  The request has been received and is currently in review, please allow 45 days from submission  date for a status update.  Kind Regards, Irene S (Region 4) Provider Relations Representative', NULL, NULL, '2021-03-08 14:40:00', '2021-03-08 14:40:00'),
(10493, 3046, 15664, NULL, '2021-03-26 00:00:00.000', 'In Process', 'Hello, Hope my email finds you well. I would like to request you for the enrollment status for below mentioned provider.  Please note that the form submission identifier is: 11f9c6ef-e908-4409-9ad5-f73d4e05fd29.  Provider DetailsProvider Name: Dehnisch, Frank RProvider NPI:     1952376345 Practice Details Practice Name: Coastal Bend Urgent Care Practice Tax ID: 81-1890349 Your quick response in this regard is highly appreciated.  Thank you.', NULL, NULL, '2021-03-19 11:08:41', '2021-03-19 11:08:41'),
(10494, 1006, 15664, NULL, '2021-04-15 00:00:00.000', 'Rejected', '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, '2021-04-08 08:44:16', '2021-04-08 08:44:16'),
(10495, 3046, 15665, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-26 15:47:25', '2021-02-26 15:47:25'),
(10496, 3046, 15665, NULL, '2021-03-05 00:00:00.000', 'Initiated', 'Online Form submitted please see attachment.', NULL, NULL, '2021-02-26 15:48:19', '2021-02-26 15:48:19'),
(10497, 3046, 15665, NULL, '2021-03-10 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com Subject: SHP Provider Contracting Packet || Katherine D Paterson || CBUC & GWMC ||  Hello, I hope my finds you in good health. Kindly find the attached Provider Contracting Packet and W-9 for Katherine D Paterson.  Thank you', NULL, NULL, '2021-03-03 14:48:36', '2021-03-03 14:48:36'),
(10498, 3046, 15665, NULL, '2021-03-17 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com Subject: SHP Provider Contracting Packet || Katherine D Paterson || CBUC & GWMC ||  Hello, Hope you are doing well. I would like to request you for the status of the provider contracting packet and W-9 for Katherine D Paterson, if it was received and if it has been processed accordingly. Thank you', NULL, NULL, '2021-03-10 09:21:43', '2021-03-10 09:21:43'),
(10499, 3046, 15665, NULL, '2021-03-26 00:00:00.000', 'New/Not Initiated', 'What is your TIN & NPI?  ______________________________  Hello Leslie, Hope you are doing good. Kindly find below are the required details: TIN: 81-1890349NPI: 1164776548', NULL, NULL, '2021-03-19 12:10:57', '2021-03-19 12:10:57');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(10500, 3046, 15665, NULL, '2021-03-26 00:00:00.000', 'In Process', 'Email from: SHP.NetworkDevelopment@superiorhealthplan.com Subject: SHP Provider Contracting Packet || Katherine D Paterson || CBUC & GWMC || Hello We received your completed application on 3/3/2021.  It is currently in credentialing.  Please note that we will notify you of acceptance / participation status within 90 days of receipt of completed application.  Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.', NULL, NULL, '2021-03-19 13:58:20', '2021-03-19 13:58:20'),
(10501, 1006, 15665, 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 09:48:33', '2021-06-09 09:48:33'),
(10502, 1006, 15665, 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 14:12:49', '2021-06-29 14:12:49'),
(10503, 3046, 15666, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-02-26 15:51:15', '2021-02-26 15:51:15'),
(10504, 3046, 15666, NULL, '2021-03-05 00:00:00.000', 'Initiated', 'Online Form submitted please see attachment.', NULL, NULL, '2021-02-26 15:51:31', '2021-02-26 15:51:31'),
(10505, 3046, 15666, NULL, '2021-03-10 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com Subject: SHP Provider Contracting Packet || Katherine D Paterson || CBUC & GWMC ||  Hello, I hope my finds you in good health. Kindly find the attached Provider Contracting Packet and W-9 for Katherine D Paterson.  Thank you ', NULL, NULL, '2021-03-03 14:51:24', '2021-03-03 14:51:24'),
(10506, 3046, 15666, NULL, '2021-03-17 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com Subject: SHP Provider Contracting Packet || Katherine D Paterson || CBUC & GWMC ||  Hello, Hope you are doing well. I would like to request you for the status of the provider contracting packet and W-9 for Katherine D Paterson, if it was received and if it has been processed accordingly. Thank you', NULL, NULL, '2021-03-10 09:22:07', '2021-03-10 09:22:07'),
(10507, 3046, 15666, NULL, '2021-03-26 00:00:00.000', 'In Process', 'What is your TIN & NPI?  ______________________________  Hello Leslie, Hope you are doing good. Kindly find below are the required details: TIN: 81-1890349NPI: 1164776548', NULL, NULL, '2021-03-19 12:11:12', '2021-03-19 12:11:12'),
(10508, 3046, 15666, NULL, '2021-03-26 00:00:00.000', 'In Process', 'Email from: SHP.NetworkDevelopment@superiorhealthplan.com Subject: SHP Provider Contracting Packet || Katherine D Paterson || CBUC & GWMC || Hello We received your completed application on 3/3/2021.  It is currently in credentialing.  Please note that we will notify you of acceptance / participation status within 90 days of receipt of completed application.  Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.', NULL, NULL, '2021-03-19 13:57:20', '2021-03-19 13:57:20'),
(10509, 1006, 15666, 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 09:48:46', '2021-06-09 09:48:46'),
(10510, 1006, 15666, 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 14:12:57', '2021-06-29 14:12:57'),
(10511, 3040, 15667, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-01 09:26:20', '2021-03-01 09:26:20'),
(10512, 3040, 15667, NULL, '2021-03-08 00:00:00.000', 'Approved', 'Medicare Enrollment Information Individual Name: JAYA JACOB Individual Specialty: NURSE PRACTITIONER Individual National Provider Identifier (NPI): 1194336149 Individual Provider Transaction Access Number (PTAN): 1M3046 Group Legal Business Name (LBN): Columbus Urgent Care PA Group NPI: 1215330501 Group PTAN: 399951 Reassignment Effective Date: January 1, 2021', NULL, NULL, '2021-03-01 09:29:33', '2021-03-01 09:29:33'),
(10513, 1006, 16667, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-01 16:56:45', '2021-03-01 16:56:45'),
(10514, 1006, 16667, NULL, '2021-03-08 00:00:00.000', 'Initiated', 'Enrollment Tracking Information Applicant Name: SPECTRUM NEURO BEHAVIORAL CARE LLC  Tracking ID: T030120210003065  Submitted Date: MON - MARCH 01 2021 04:56:04 PM EST  Submitted By: Furquan Syed  Contact Email(s): SNBC@CLAIMSMEDINC.COM Reason(s) for submission: A Part B supplier is currently enrolled in the Medicare program. The supplier is adding, deleting, or changing general Medicare enrollment information. ', NULL, NULL, '2021-03-01 16:56:51', '2021-03-01 16:56:51'),
(10515, 1006, 16667, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Received following deficiency: \"Application Tracking ID: T030120210003065   NPI ID: 1356906572   Medicare ID: S100592314   Name: SPECTRUM NEURO BEHAVIORAL CARE LLC   State: MA  Fee-for-Service Contractor: NATIONAL GOVERNMENT SERVICES, INC.  ----------------------------------------------------------------------------------------------------------------------------------------------------------------------  PHYSICAL LOCATION AND SPECIAL PAYMENTS ADDRESS Please be advised that only 1 payment address is allowed per enrollment, while there are 2 different payment addresses listed on the 855B application. Please correct so the payment address matches for all practice locations. This can be completed through PECOS and submitted with new e-signatures.\"', NULL, NULL, '2021-03-08 18:08:04', '2021-03-08 18:08:04'),
(10516, 1006, 16667, NULL, '2021-03-25 00:00:00.000', 'Approved', 'Application Tracking ID: T030120210003065   NPI ID: 1356906572   Medicare ID: S100592314   Name: SPECTRUM NEURO BEHAVIORAL CARE LLC  State: MA   Form Type: 855B  Date: 03/15/2021  Status: APPROVED', NULL, NULL, '2021-03-18 11:28:25', '2021-03-18 11:28:25'),
(10517, 1006, 16668, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-01 18:01:39', '2021-03-01 18:01:39'),
(10518, 1006, 16668, NULL, '2021-03-08 00:00:00.000', 'Initiated', 'Sent following email to Furquan: \"Hello Furquan,  Please print and send the following documents to the following address:  Gainwell Technologies Provider Enrollment Unit P.O. Box 2010 Warwick, RI 02887-2010  Thank you. \"', NULL, NULL, '2021-03-01 18:03:55', '2021-03-01 18:03:55'),
(10519, 1006, 16668, NULL, '2021-03-16 00:00:00.000', 'In Process', 'The request has still not been received by Medicaid, need to allow another week for processing.  Ref# 480709', NULL, NULL, '2021-03-09 12:04:05', '2021-03-09 12:04:05'),
(10520, 1006, 16668, NULL, '2021-03-24 00:00:00.000', 'In Process', 'As per the rep, nothing is currently pulling up in their system will need to allow more time for processing. Ref# 482724', NULL, NULL, '2021-03-19 11:24:45', '2021-03-19 11:24:45'),
(10521, 1006, 16668, NULL, '2021-04-19 00:00:00.000', 'Approved', 'Confirmed the effective date for the provider from Medicaid Provider line @ (401) 784-8100.   Justin Souliere Effective: 03/01/2021 Ref# 486147  Attached confirmation from the provider directory for reference. ', NULL, NULL, '2021-04-12 15:00:50', '2021-04-12 15:00:50'),
(10522, 3040, 17667, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-03 14:57:24', '2021-03-03 14:57:24'),
(10523, 3040, 17667, NULL, '2021-03-10 00:00:00.000', 'Approved', 'Provider enrolled under Driscoll.    Welcome Letter attached. ', NULL, NULL, '2021-03-03 14:57:36', '2021-03-03 14:57:36'),
(10524, 3046, 18667, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-04 15:57:36', '2021-03-04 15:57:36'),
(10525, 3046, 18667, NULL, '2021-03-11 00:00:00.000', 'Initiated', 'Reference Number: 21063001183 for Railroad Medicare', NULL, NULL, '2021-03-04 16:53:09', '2021-03-04 16:53:09'),
(10526, 3046, 18667, NULL, '2021-03-18 00:00:00.000', 'Approved', 'PROVIDER NAME	ROSE P TREVINO PA PROVIDER PTAN	Q00034027 PROVIDER NPI	1437174794 EFFECTIVE DATE	01/01/2021 END DATE	 GROUP NAME	RABAGOS HEALTH CARE PLLC GROUP PTAN	DW2792 BUSINESS STATE	TX EFFECTIVE DATE	04/12/2014 END DATE	', NULL, NULL, '2021-03-11 15:17:28', '2021-03-11 15:17:28'),
(10527, 3046, 18668, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-04 16:55:25', '2021-03-04 16:55:25'),
(10528, 3046, 18668, NULL, '2021-03-11 00:00:00.000', 'Initiated', 'Reference Number: 21063001183', NULL, NULL, '2021-03-04 16:55:41', '2021-03-04 16:55:41'),
(10529, 3046, 18668, NULL, '2021-03-18 00:00:00.000', 'Approved', 'PROVIDER NAME	ROSE P TREVINO PA PROVIDER PTAN	Q00034027 PROVIDER NPI	1437174794 EFFECTIVE DATE	01/01/2021 END DATE	 GROUP NAME	RABAGOS HEALTH CARE PLLC GROUP PTAN	DW2792 BUSINESS STATE	TX EFFECTIVE DATE	04/12/2014 END DATE	', NULL, NULL, '2021-03-11 15:18:40', '2021-03-11 15:18:40'),
(10530, 3046, 18669, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-04 16:56:12', '2021-03-04 16:56:12'),
(10531, 3046, 18669, NULL, '2021-03-11 00:00:00.000', 'Initiated', 'Reference Number: 21063001183', NULL, NULL, '2021-03-04 16:56:36', '2021-03-04 16:56:36'),
(10532, 3046, 18669, NULL, '2021-03-18 00:00:00.000', 'Approved', 'PROVIDER NAME	ROSE P TREVINO PA PROVIDER PTAN	Q00034027 PROVIDER NPI	1437174794 EFFECTIVE DATE	01/01/2021 END DATE	 GROUP NAME	RABAGOS HEALTH CARE PLLC GROUP PTAN	DW2792 BUSINESS STATE	TX EFFECTIVE DATE	04/12/2014 END DATE	', NULL, NULL, '2021-03-11 15:02:51', '2021-03-11 15:02:51'),
(10533, 3046, 18670, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-04 17:01:18', '2021-03-04 17:01:18'),
(10534, 3046, 18670, NULL, '2021-03-11 00:00:00.000', 'New/Not Initiated', 'Reference Number: 21063001183', NULL, NULL, '2021-03-04 17:01:40', '2021-03-04 17:01:40'),
(10535, 1006, 18670, NULL, '2021-04-02 00:00:00.000', 'Approved', 'All locations are added under group PTAN and provider is linked to group.  Your active Railroad Medicare PTAN has been located and is shown here :  PROVIDER NAME	ROSE P TREVINO PA PROVIDER PTAN	Q00034027 PROVIDER NPI	1437174794 EFFECTIVE DATE	01/01/2021 END DATE	 GROUP NAME	RABAGOS HEALTH CARE PLLC GROUP PTAN	DW2792 BUSINESS STATE	TX EFFECTIVE DATE	04/12/2014 END DATE	 ', NULL, NULL, '2021-03-26 10:55:43', '2021-03-26 10:55:43'),
(10536, 3040, 18671, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-08 12:41:24', '2021-03-08 12:41:24'),
(10537, 3040, 18671, NULL, '2021-03-15 00:00:00.000', 'Initiated', 'Request form submitted online to add a provider to an existing group contract.', NULL, NULL, '2021-03-08 12:42:27', '2021-03-08 12:42:27'),
(10538, 3040, 18671, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email sent to: shp.networkdevelopment@superiorhealthplan.com  Subject: Normandy Urgent Care Center || Limy Fernandus || Superior Healthplan  Greetings,  Hope you are doing well. Please find the attached the provider application form for Limy Fernandus.  Please feel free to call or email me if you have any questions. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-03-08 12:42:40', '2021-03-08 12:42:40'),
(10539, 3040, 18671, NULL, '2021-03-22 00:00:00.000', 'In Process', 'Email rcvd from: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Normandy Urgent Care Center || Limy Fernandus || Superior Healthplan  Hello  We received your completed application on 1/11/2021.  It is currently in credentialing.  Please note that we will notify you of acceptance / participation status within 90 days of receipt of completed application.  Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.  Thank you,  Leslie Gilchrist Intake Coordinator Contract Management Superior HealthPlan', NULL, NULL, '2021-03-15 15:47:40', '2021-03-15 15:47:40'),
(10540, 3040, 18671, NULL, '2021-05-28 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject:  Normandy Urgent Care Center || Limy Fernandus || Superior Healthplan  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider. Application received on 01/11/2021.   Practice 1: Practice Name: Normandy Urgent Care Center Practice   Tax-ID: 27-0796429 Practice   NPI#  1407171077 Address: 779 Normandy St Ste 114 Houston , TX 77015-3441  Practice 2: Practice Name: Imperial Valley Urgent Care Center Practice Tax-ID: 27-0796429 Practice NPI#  1407171077 Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider: Provider Name: Limy Fernandus Provider NPI# 1972005189  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-21 14:02:13', '2021-05-21 14:02:13'),
(10541, 3040, 18671, NULL, '2021-06-17 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject:  Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in our group under below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 270796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 2:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 3: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 4: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 5: Provider Name: Thomas, Cini Provider NPI# 1134777238  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-06-10 09:25:40', '2021-06-10 09:25:40'),
(10542, 3040, 18671, NULL, '2021-07-06 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Add Location || Imperial Valley Urgent Care Center || Fernandus, Limy || Superior Healthplan ||  Greetings,   Hope you are doing well. I wanted to add the provider in an additional location in Superior Healthplan for our group under the below location.   Practice Details: Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 270796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: Fernandus, Limy Provider NPI# 1972005189  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-29 10:05:38', '2021-06-29 10:05:38'),
(10543, 3040, 18671, NULL, '2021-07-26 00:00:00.000', 'In Process', 'Email rcvd from: AM.Houston@superiorhealthplan.com  Subject: Add Location || Imperial Valley Urgent Care Center || Fernandus, Limy || Superior Healthplan ||  Good morning,  To better assist you, I am attaching a Provider Demographic Update form for you to complete and return to us.   Our provider data management team requests that you be specific on the email response in regards to what you would like to have updated/changed.   For example, if you are wanting to add a servicing location, please specify if the current location is to be suppressed or if you are just providing an additional location.   Additionally, if you are wanting to update the billing address, please submit a W9.   Thank you,  Yesenia Prado Provider Relations Coordinator II Provider Relations Department', NULL, NULL, '2021-07-19 08:40:09', '2021-07-19 08:40:09'),
(10544, 3040, 18671, NULL, '2021-07-26 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Add Location || Imperial Valley Urgent Care Center || Fernandus, Limy || Superior Healthplan || REF # 46388    Greetings,  Please find attached the information requested in your previous email for the below mentioned provider.   Practice Details: Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 270796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: Fernandus, Limy Provider NPI# 1972005189  Thank you ', NULL, NULL, '2021-07-19 08:42:22', '2021-07-19 08:42:22'),
(10545, 3040, 18671, NULL, '2021-07-26 00:00:00.000', 'In Process', 'Email rcvd from: AM.Houston@superiorhealthplan.com  Subject: RE: Add Location || Imperial Valley Urgent Care Center || Fernandus, Limy || Superior Healthplan || REF # 47197  Good Morning  I hope all is well. Before I submit this request I need to clarify what you are asking. I see that you would like to add the location for the provider Limy Fernandus and that request is correct. However I am confused on the W9.  When you submit a W9 our provider data team assumes you are wanting to change the billing/financial address. This is the address where the payments are going to.  This location is already listed under the practice NPI however the current billing address is what is listed below. Are you saying you want to remove what we have and change the billing address to what is listed on the W9? Please confirm  If you do not need to change the billing address then a W9 is not required just the demo to add the location for that provider.', NULL, NULL, '2021-07-19 08:42:57', '2021-07-19 08:42:57'),
(10546, 3040, 18671, NULL, '2021-08-03 00:00:00.000', 'Approved', 'Email rcvd from: AM.Houston@superiorhealthplan.com  Subject: RE: Add Location || Imperial Valley Urgent Care Center || Fernandus, Limy || Superior Healthplan || REF # 45297  Adil  I hope all is well. I am not sure what you are looking at but I just ran the report and looked in our systems and the providers locations were updated and the ticket is completed. Please see attached report as there is nothing further required on our end.  ', NULL, NULL, '2021-07-27 15:14:00', '2021-07-27 15:14:00'),
(10547, 3040, 18672, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-08 13:23:06', '2021-03-08 13:23:06'),
(10548, 3040, 18672, NULL, '2021-03-15 00:00:00.000', 'In Process', '	 Email sent to: noemi_martinez@bcbstx.com, provider_relations_south_texas@bcbstx.com  Subject: Re: Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS || : Case Number - 02137524 : Case Number - 02160702  Hello,  Hope you are doing well. Please advise me the enrollment status for the below mentioned providers. I checked the provider directory and it only showed 02 providers only 02 locations not showing in McAllen location.   Moses Campos is not showing in the provider directory.  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address: 534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Moses Campos Provider NPI# 1558680009 Provider Record ID# 8NU756  Provider 2: Provider Name: Arturo Alejandro Lira Provider NPI# 1245789502 Provider Record ID#  8NU757  Provider 3: Provider Name: Larry Donald Wright Provider NPI# 1033769765 Provider Record ID# 8NU758  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-03-08 13:24:11', '2021-03-08 13:24:11'),
(10549, 3040, 18672, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email sent to: provider_relations_south_texas@bcbstx.com   Subject: RE: PHI Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS || : Case Number - 02137524 : Case Number - 02160703  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status for the below mentioned providers.  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address: 534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Moses Campos Provider NPI# 1558680009 Provider Record ID# 8NU756  Provider 2: Provider Name: Arturo Alejandro Lira Provider NPI# 1245789502 Provider Record ID#  8NU757  Provider 3: Provider Name: Larry Donald Wright  Provider NPI# 1033769765 Provider Record ID# 8NU758  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-03-08 13:24:33', '2021-03-08 13:24:33'),
(10550, 3040, 18672, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Follow up email sent. ', NULL, NULL, '2021-03-08 13:24:57', '2021-03-08 13:24:57'),
(10551, 3040, 18672, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email rcvd from: provider_relations_south_texas@bcbstx.com  Subject: PHI Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS || : Case Number - 02137524 : Case Number - 02160703  Hello,  Per your request, the status for case number 02137524 is still processing, for all providers on the request. We are not currently showing a request for additional information.  If additional information is needed from our Credentialing team, they will reach out to the credentialing contact information listed on the provider\'s CAQH.  In the meantime please do, allow more time for completion.  Sincerely,  Network Management Southwest Region Blue Cross Blue Shield of Texas', NULL, NULL, '2021-03-08 13:25:11', '2021-03-08 13:25:11'),
(10552, 3040, 18672, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Still in process.', NULL, NULL, '2021-03-08 13:25:25', '2021-03-08 13:25:25'),
(10553, 3040, 18672, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email rcvd from: noemi_martinez@bcbstx.com  Subject: Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS || : Case Number - 02137524 : Case Number - 02160702  Good evening,  The onboariding case for the 3 providers is still in process.  Their case (#02076377) was submitted on 12.16.20 and these cases can take at least 2-3 months to be processed.', NULL, NULL, '2021-03-08 13:25:39', '2021-03-08 13:25:39'),
(10554, 3040, 18672, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Follow up email sent to: Provider_Relations_Houston@bcbstx.com,  tx_standard_contracting_team@bcbstx.com,   Subject: Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS || : Case Number - 02137524  Greetings,  Hope you are doing well. I wanted to know the enrollment status of below mentioned providers.  Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address: 534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Moses Campos Provider NPI# 1558680009 Provider Record ID# 8NU756  Provider 2: Provider Name: Arturo Alejandro Lira  Provider NPI# 1245789502 Provider Record ID#  8NU757  Provider 3: Provider Name: Larry Donald Wright  Provider NPI# 1033769765 Provider Record ID# 8NU758  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-03-08 13:25:59', '2021-03-08 13:25:59'),
(10555, 3040, 18672, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email rcvd from: noemi_martinez@bcbstx.com  Subject: Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS || : Case Number - 02137524  Good afternoon,  A provider record ID number has been assigned to each provider. Their onboarding case (#02076377) was submitted on 12.16.20 and these cases can take at least 2-3 months to be completed.  Below are the record ID numbers for each provider.  Larry Donald Wright - Provider Record ID #8NU758  All the Best,', NULL, NULL, '2021-03-08 13:26:15', '2021-03-08 13:26:15'),
(10556, 3040, 18672, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email sent to: Provider_Relations_Houston@bcbstx.com,  tx_standard_contracting_team@bcbstx.com  Subject: Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status of the below mentioned providers.   Practice Name: Valley Med Urgent Care PLLC  Tax ID# 81-5123542 NPI# 1518404631  Provider Name: Arturo Alejandro Lira Provider NPI# 1245789502  Provider Name: Moses Campos Provider NPI# 1558680009  Provider Name: Larry Donald Wright Provider NPI# 1033769765  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-03-08 13:26:36', '2021-03-08 13:26:36'),
(10557, 3040, 18672, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Enrollment showing still in process. ', NULL, NULL, '2021-03-08 13:26:59', '2021-03-08 13:26:59'),
(10558, 3040, 18672, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Enrollment showing in process ', NULL, NULL, '2021-03-08 13:27:24', '2021-03-08 13:27:24'),
(10559, 3040, 18672, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Enrollment request showing in process. ', NULL, NULL, '2021-03-08 13:27:37', '2021-03-08 13:27:37'),
(10560, 3040, 18672, NULL, '2021-03-15 00:00:00.000', 'In Process', 'This email is confirmation we have received your request, case number 02076377, for VALLEY MED URGENT CARE PLLC ', NULL, NULL, '2021-03-08 13:27:49', '2021-03-08 13:27:49'),
(10561, 3040, 18672, NULL, '2021-03-22 00:00:00.000', 'In Process', 'Email sent to: noemi_martinez@bcbstx.com, provider_relations_south_texas@bcbstx.com, tx_standard_contracting_team@bcbstx.com  Subject: Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS  Greetings,  Has there been any update?  Thanks ', NULL, NULL, '2021-03-15 17:58:23', '2021-03-15 17:58:23'),
(10562, 3040, 18672, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Email sent to: Noemi_Diaz@bcbstx.com  Subject:  Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS  Greetings,   Hope you are doing well. Please note the providers are not showing up in the BCBS provider directory in all three locations except (2534 Boca Chica Blvd, Brownsville TX, 78521). Can you please advise how much time will it take to show up in the directory?  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address: 534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Arturo Alejandro Lira Provider NPI# 1245789502 Provider Record ID#  8NU757 Effective Date:  03/04/2021  Provider 2: Provider Name: Larry Donald Wright Provider NPI# 1033769765 Provider Record ID# 8NU75 Effective Date:  03/03/2021    Please get back to me as soon as possible. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-14 10:34:28', '2021-04-14 10:34:28'),
(10563, 3040, 18672, NULL, '2021-04-23 00:00:00.000', 'In Process', 'Email rcvd From: Noemi_Diaz@bcbstx.com  Subject:  Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS || : Case Number - 02137524 : Case Number - 02160702  Good afternoon,  My apologies that the locations still aren’t showing up for the providers.  Let me see what I can find out for you.  Thank you,  ', NULL, NULL, '2021-04-16 14:37:10', '2021-04-16 14:37:10'),
(10564, 3040, 18672, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to: Noemi_Diaz@bcbstx.com  Subject: Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS  Hello Noemi,  I checked the BCBS online provider directory and the providers are still not showing in other 02 locations. Can you please check and update.   Thank you ', NULL, NULL, '2021-05-03 13:35:39', '2021-05-03 13:35:39'),
(10565, 3040, 18672, NULL, '2021-05-11 00:00:00.000', 'Approved', 'Email rcvd from: Noemi_Diaz@bcbstx.com  Subject: Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS  Good afternoon,  The satellite locations have now been added to the providers.  Provider 1: Provider Name: Arturo Alejandro Lira Provider NPI# 1245789502 Provider Record ID#  8NU757 Effective Date:  03/04/2021  Provider 2: Provider Name: Larry Donald Wright Provider NPI# 1033769765 Provider Record ID# 8NU75 Effective Date:  03/03/2021    All the Best,', NULL, NULL, '2021-05-04 08:12:43', '2021-05-04 08:12:43'),
(10566, 3040, 18673, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-08 13:23:08', '2021-03-08 13:23:08'),
(10567, 3040, 18673, NULL, '2021-03-15 00:00:00.000', 'In Process', '	 Email sent to: noemi_martinez@bcbstx.com, provider_relations_south_texas@bcbstx.com  Subject: Re: Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS || : Case Number - 02137524 : Case Number - 02160702  Hello,  Hope you are doing well. Please advise me the enrollment status for the below mentioned providers. I checked the provider directory and it only showed 02 providers only 02 locations not showing in McAllen location.   Moses Campos is not showing in the provider directory.  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address: 534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Moses Campos Provider NPI# 1558680009 Provider Record ID# 8NU756  Provider 2: Provider Name: Arturo Alejandro Lira Provider NPI# 1245789502 Provider Record ID#  8NU757  Provider 3: Provider Name: Larry Donald Wright Provider NPI# 1033769765 Provider Record ID# 8NU758  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-03-08 13:24:06', '2021-03-08 13:24:06'),
(10568, 3040, 18673, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email sent to: provider_relations_south_texas@bcbstx.com   Subject: RE: PHI Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS || : Case Number - 02137524 : Case Number - 02160703  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status for the below mentioned providers.  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address: 534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Moses Campos Provider NPI# 1558680009 Provider Record ID# 8NU756  Provider 2: Provider Name: Arturo Alejandro Lira Provider NPI# 1245789502 Provider Record ID#  8NU757  Provider 3: Provider Name: Larry Donald Wright  Provider NPI# 1033769765 Provider Record ID# 8NU758  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-03-08 13:24:28', '2021-03-08 13:24:28'),
(10569, 3040, 18673, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Follow up email sent. ', NULL, NULL, '2021-03-08 13:24:44', '2021-03-08 13:24:44'),
(10570, 3040, 18673, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email rcvd from: provider_relations_south_texas@bcbstx.com  Subject: PHI Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS || : Case Number - 02137524 : Case Number - 02160703  Hello,  Per your request, the status for case number 02137524 is still processing, for all providers on the request. We are not currently showing a request for additional information.  If additional information is needed from our Credentialing team, they will reach out to the credentialing contact information listed on the provider\'s CAQH.  In the meantime please do, allow more time for completion.  Sincerely,  Network Management Southwest Region Blue Cross Blue Shield of Texas', NULL, NULL, '2021-03-08 13:25:06', '2021-03-08 13:25:06'),
(10571, 3040, 18673, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Still in process.', NULL, NULL, '2021-03-08 13:25:20', '2021-03-08 13:25:20'),
(10572, 3040, 18673, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email rcvd from: noemi_martinez@bcbstx.com  Subject: Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS || : Case Number - 02137524 : Case Number - 02160702  Good evening,  The onboariding case for the 3 providers is still in process.  Their case (#02076377) was submitted on 12.16.20 and these cases can take at least 2-3 months to be processed.', NULL, NULL, '2021-03-08 13:25:33', '2021-03-08 13:25:33'),
(10573, 3040, 18673, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Follow up email sent to: Provider_Relations_Houston@bcbstx.com,  tx_standard_contracting_team@bcbstx.com,   Subject: Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS || : Case Number - 02137524  Greetings,  Hope you are doing well. I wanted to know the enrollment status of below mentioned providers.  Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address: 534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Moses Campos Provider NPI# 1558680009 Provider Record ID# 8NU756  Provider 2: Provider Name: Arturo Alejandro Lira  Provider NPI# 1245789502 Provider Record ID#  8NU757  Provider 3: Provider Name: Larry Donald Wright  Provider NPI# 1033769765 Provider Record ID# 8NU758  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-03-08 13:25:54', '2021-03-08 13:25:54'),
(10574, 3040, 18673, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email rcvd from: noemi_martinez@bcbstx.com  Subject: Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS || : Case Number - 02137524  Good afternoon,  A provider record ID number has been assigned to each provider. Their onboarding case (#02076377) was submitted on 12.16.20 and these cases can take at least 2-3 months to be completed.  Below are the record ID numbers for each provider.  Larry Donald Wright - Provider Record ID #8NU758  All the Best,', NULL, NULL, '2021-03-08 13:26:10', '2021-03-08 13:26:10'),
(10575, 3040, 18673, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email sent to: Provider_Relations_Houston@bcbstx.com,  tx_standard_contracting_team@bcbstx.com  Subject: Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status of the below mentioned providers.   Practice Name: Valley Med Urgent Care PLLC  Tax ID# 81-5123542 NPI# 1518404631  Provider Name: Arturo Alejandro Lira Provider NPI# 1245789502  Provider Name: Moses Campos Provider NPI# 1558680009  Provider Name: Larry Donald Wright Provider NPI# 1033769765  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-03-08 13:26:28', '2021-03-08 13:26:28'),
(10576, 3040, 18673, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Enrollment showing still in process. ', NULL, NULL, '2021-03-08 13:26:47', '2021-03-08 13:26:47'),
(10577, 3040, 18673, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Enrollment showing in process ', NULL, NULL, '2021-03-08 13:27:20', '2021-03-08 13:27:20'),
(10578, 3040, 18673, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Enrollment request showing in process. ', NULL, NULL, '2021-03-08 13:27:32', '2021-03-08 13:27:32'),
(10579, 3040, 18673, NULL, '2021-03-15 00:00:00.000', 'In Process', 'This email is confirmation we have received your request, case number 02076377, for VALLEY MED URGENT CARE PLLC ', NULL, NULL, '2021-03-08 13:27:45', '2021-03-08 13:27:45'),
(10580, 3040, 18673, NULL, '2021-03-22 00:00:00.000', 'In Process', 'Email sent to: noemi_martinez@bcbstx.com, provider_relations_south_texas@bcbstx.com, tx_standard_contracting_team@bcbstx.com  Subject: Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS  Greetings,  Has there been any update?  Thanks ', NULL, NULL, '2021-03-15 17:56:26', '2021-03-15 17:56:26'),
(10581, 3040, 18673, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Email sent to: Noemi_Diaz@bcbstx.com  Subject:  Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS  Greetings,   Hope you are doing well. Please note the providers are not showing up in the BCBS provider directory in all three locations except (2534 Boca Chica Blvd, Brownsville TX, 78521). Can you please advise how much time will it take to show up in the directory?  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address: 534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Arturo Alejandro Lira Provider NPI# 1245789502 Provider Record ID#  8NU757 Effective Date:  03/04/2021  Provider 2: Provider Name: Larry Donald Wright Provider NPI# 1033769765 Provider Record ID# 8NU75 Effective Date:  03/03/2021    Please get back to me as soon as possible. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-14 10:34:32', '2021-04-14 10:34:32'),
(10582, 3040, 18673, NULL, '2021-04-23 00:00:00.000', 'In Process', 'Email rcvd From: Noemi_Diaz@bcbstx.com  Subject:  Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS || : Case Number - 02137524 : Case Number - 02160702  Good afternoon,  My apologies that the locations still aren’t showing up for the providers.  Let me see what I can find out for you.  Thank you,  ', NULL, NULL, '2021-04-16 14:37:24', '2021-04-16 14:37:24'),
(10583, 3040, 18673, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to: Noemi_Diaz@bcbstx.com  Subject: Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS  Hello Noemi,  I checked the BCBS online provider directory and the providers are still not showing in other 02 locations. Can you please check and update.   Thank you ', NULL, NULL, '2021-05-03 13:35:44', '2021-05-03 13:35:44'),
(10584, 3040, 18673, NULL, '2021-05-11 00:00:00.000', 'Approved', 'Email rcvd from: Noemi_Diaz@bcbstx.com  Subject: Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS  Good afternoon,  The satellite locations have now been added to the providers.  Provider 1: Provider Name: Arturo Alejandro Lira Provider NPI# 1245789502 Provider Record ID#  8NU757 Effective Date:  03/04/2021  Provider 2: Provider Name: Larry Donald Wright Provider NPI# 1033769765 Provider Record ID# 8NU75 Effective Date:  03/03/2021    All the Best,', NULL, NULL, '2021-05-04 08:12:48', '2021-05-04 08:12:48'),
(10585, 3040, 18674, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-08 13:59:35', '2021-03-08 13:59:35'),
(10586, 3040, 18674, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email sent to:  noemi_martinez@bcbstx.com, provider_relations_south_texas@bcbstx.com, tx_standard_contracting_team@bcbstx.com  Subject: Re: Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS || : Case Number - 02137524 : Case Number - 02160702  Greetings,   Please advise me the enrollment status for the below mentioned providers. As I mentioned in my previous email I checked BCBS online provider portal and now its showing the providers only at 01 location which is (2534 Boca Chica Blvd, Brownsville TX, 78521) the other 02 locations providers are not showing for your reference I attached the screenshot with the location zip code from the website.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address: 534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Moses Campos Provider NPI# 1558680009 Provider Record ID# 8NU756  Provider 2: Provider Name: Arturo Alejandro Lira Provider NPI# 1245789502 Provider Record ID#  8NU757  Provider 3: Provider Name: Larry Donald Wright Provider NPI# 1033769765 Provider Record ID# 8NU758  Kindly back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you. ', NULL, NULL, '2021-03-08 14:01:27', '2021-03-08 14:01:27'),
(10587, 3040, 18674, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email sent to: noemi_martinez@bcbstx.com, provider_relations_south_texas@bcbstx.com  Subject: Re: Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS || : Case Number - 02137524 : Case Number - 02160702  Hello,  Hope you are doing well. Please advise me the enrollment status for the below mentioned providers. I checked the provider directory and it only showed 02 providers only 02 locations not showing in McAllen location.   Moses Campos is not showing in the provider directory.  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address: 534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Moses Campos Provider NPI# 1558680009 Provider Record ID# 8NU756  Provider 2: Provider Name: Arturo Alejandro Lira Provider NPI# 1245789502 Provider Record ID#  8NU757  Provider 3: Provider Name: Larry Donald Wright Provider NPI# 1033769765 Provider Record ID# 8NU758  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-03-08 14:02:03', '2021-03-08 14:02:03'),
(10588, 3040, 18674, NULL, '2021-03-22 00:00:00.000', 'In Process', 'Email sent to: noemi_martinez@bcbstx.com, provider_relations_south_texas@bcbstx.com, tx_standard_contracting_team@bcbstx.com  Subject: Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS  Greetings,  Has there been any update?  Thanks ', NULL, NULL, '2021-03-15 17:56:41', '2021-03-15 17:56:41'),
(10589, 3040, 18674, NULL, '2021-04-19 00:00:00.000', 'Approved', 'Email rcvd from: txintaketeampiermailbox@bcbstx.com  Subject: BCBSTX New Provider Information  Group Name : VALLEY MED URGENT CARE PLLC Group Record Id : H000Q9Z701  Provider Name : MOSES CAMPOS Provider Record Number : H08NU75601 Specialty : Physician Assistant Effective Date: 03/15/2021', NULL, NULL, '2021-04-12 13:57:40', '2021-04-12 13:57:40'),
(10590, 3040, 18675, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-08 13:59:37', '2021-03-08 13:59:37'),
(10591, 3040, 18675, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email sent to:  noemi_martinez@bcbstx.com, provider_relations_south_texas@bcbstx.com, tx_standard_contracting_team@bcbstx.com  Subject: Re: Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS || : Case Number - 02137524 : Case Number - 02160702  Greetings,   Please advise me the enrollment status for the below mentioned providers. As I mentioned in my previous email I checked BCBS online provider portal and now its showing the providers only at 01 location which is (2534 Boca Chica Blvd, Brownsville TX, 78521) the other 02 locations providers are not showing for your reference I attached the screenshot with the location zip code from the website.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address: 534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Moses Campos Provider NPI# 1558680009 Provider Record ID# 8NU756  Provider 2: Provider Name: Arturo Alejandro Lira Provider NPI# 1245789502 Provider Record ID#  8NU757  Provider 3: Provider Name: Larry Donald Wright Provider NPI# 1033769765 Provider Record ID# 8NU758  Kindly back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you. ', NULL, NULL, '2021-03-08 14:01:25', '2021-03-08 14:01:25');
