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
(34897, 3040, 27301, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Email rcvd from: EriHernandez@wellmed.net, contracthelpdesk@wellmed.net  Subject: RE: [EXTERNAL] Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Good morning Erica ,  I sow the location was added as of 06/01/2021  WellMed-Horz_no tagline_COLOR logo_SIG ____________________________  Joe Gallegos Contract Specialist WellMed Medical Management, Inc.', NULL, NULL, '2021-08-27 09:17:11', '2021-08-27 09:17:11'),
(34898, 3040, 27302, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 10:12:52', '2021-05-03 10:12:52'),
(34899, 3040, 27302, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to: EriHernandez@wellmed.net  Subject: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Erica,   Hope you are doing well. Please find the attached Ancillary Credentialing application form for our group Valley Med Urgent Care under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-05-03 10:33:42', '2021-05-03 10:33:42'),
(34900, 3040, 27302, NULL, '2021-06-08 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more detail please see group task. ', NULL, NULL, '2021-06-01 11:10:37', '2021-06-01 11:10:37'),
(34901, 3040, 27302, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: rbyrd@wellmed.net  Subject: Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Rhonda,   Please advise the status of an additional location that was requested in the previous email. I already sent the credentialing form for an additional location along with W9.   If you need further information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 09:22:33', '2021-07-20 09:22:33'),
(34902, 3040, 27302, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: contracthelpdesk@wellmed.net  Subject: Secure Message from contracthelpdesk@wellmed.net   Hello Erica & CHD,   Hope you are doing well. This is a follow up email regarding the status for additional location in our Valley Med Urgent Care PLLC. Has there been any update?   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-17 09:20:36', '2021-08-17 09:20:36'),
(34903, 3040, 27302, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Email rcvd from: EriHernandez@wellmed.net, contracthelpdesk@wellmed.net  Subject: RE: [EXTERNAL] Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Good morning Erica ,  I sow the location was added as of 06/01/2021  WellMed-Horz_no tagline_COLOR logo_SIG ____________________________  Joe Gallegos Contract Specialist WellMed Medical Management, Inc.', NULL, NULL, '2021-08-27 09:17:09', '2021-08-27 09:17:09'),
(34904, 3040, 27303, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 10:12:52', '2021-05-03 10:12:52'),
(34905, 3040, 27303, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to: EriHernandez@wellmed.net  Subject: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Erica,   Hope you are doing well. Please find the attached Ancillary Credentialing application form for our group Valley Med Urgent Care under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-05-03 10:33:05', '2021-05-03 10:33:05'),
(34906, 3040, 27303, NULL, '2021-06-08 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more detail please see group task. ', NULL, NULL, '2021-06-01 11:10:43', '2021-06-01 11:10:43'),
(34907, 3040, 27303, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: rbyrd@wellmed.net  Subject: Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Rhonda,   Please advise the status of an additional location that was requested in the previous email. I already sent the credentialing form for an additional location along with W9.   If you need further information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 09:22:33', '2021-07-20 09:22:33'),
(34908, 3040, 27303, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: contracthelpdesk@wellmed.net  Subject: Secure Message from contracthelpdesk@wellmed.net   Hello Erica & CHD,   Hope you are doing well. This is a follow up email regarding the status for additional location in our Valley Med Urgent Care PLLC. Has there been any update?   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-17 09:20:36', '2021-08-17 09:20:36'),
(34909, 3040, 27303, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Email rcvd from: EriHernandez@wellmed.net, contracthelpdesk@wellmed.net  Subject: RE: [EXTERNAL] Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Good morning Erica ,  I sow the location was added as of 06/01/2021  WellMed-Horz_no tagline_COLOR logo_SIG ____________________________  Joe Gallegos Contract Specialist WellMed Medical Management, Inc.', NULL, NULL, '2021-08-27 09:17:09', '2021-08-27 09:17:09'),
(34910, 3040, 27304, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 10:12:53', '2021-05-03 10:12:53'),
(34911, 3040, 27304, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to: EriHernandez@wellmed.net  Subject: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Erica,   Hope you are doing well. Please find the attached Ancillary Credentialing application form for our group Valley Med Urgent Care under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-05-03 10:33:53', '2021-05-03 10:33:53'),
(34912, 3040, 27304, NULL, '2021-06-08 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more detail please see group task. ', NULL, NULL, '2021-06-01 11:10:47', '2021-06-01 11:10:47'),
(34913, 3040, 27304, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: rbyrd@wellmed.net  Subject: Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Rhonda,   Please advise the status of an additional location that was requested in the previous email. I already sent the credentialing form for an additional location along with W9.   If you need further information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 09:22:32', '2021-07-20 09:22:32'),
(34914, 3040, 27304, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: contracthelpdesk@wellmed.net  Subject: Secure Message from contracthelpdesk@wellmed.net   Hello Erica & CHD,   Hope you are doing well. This is a follow up email regarding the status for additional location in our Valley Med Urgent Care PLLC. Has there been any update?   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-17 09:20:36', '2021-08-17 09:20:36'),
(34915, 3040, 27304, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Email rcvd from: EriHernandez@wellmed.net, contracthelpdesk@wellmed.net  Subject: RE: [EXTERNAL] Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Good morning Erica ,  I sow the location was added as of 06/01/2021  WellMed-Horz_no tagline_COLOR logo_SIG ____________________________  Joe Gallegos Contract Specialist WellMed Medical Management, Inc.', NULL, NULL, '2021-08-27 09:17:08', '2021-08-27 09:17:08'),
(34916, 3040, 27305, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 10:12:53', '2021-05-03 10:12:53'),
(34917, 3040, 27305, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to: EriHernandez@wellmed.net  Subject: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Erica,   Hope you are doing well. Please find the attached Ancillary Credentialing application form for our group Valley Med Urgent Care under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-05-03 10:33:20', '2021-05-03 10:33:20'),
(34918, 3040, 27305, NULL, '2021-06-08 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more detail please see group task. ', NULL, NULL, '2021-06-01 11:10:53', '2021-06-01 11:10:53'),
(34919, 3040, 27305, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: rbyrd@wellmed.net  Subject: Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Rhonda,   Please advise the status of an additional location that was requested in the previous email. I already sent the credentialing form for an additional location along with W9.   If you need further information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 09:22:32', '2021-07-20 09:22:32'),
(34920, 3040, 27305, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: contracthelpdesk@wellmed.net  Subject: Secure Message from contracthelpdesk@wellmed.net   Hello Erica & CHD,   Hope you are doing well. This is a follow up email regarding the status for additional location in our Valley Med Urgent Care PLLC. Has there been any update?   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-17 09:20:35', '2021-08-17 09:20:35'),
(34921, 3040, 27305, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Email rcvd from: EriHernandez@wellmed.net, contracthelpdesk@wellmed.net  Subject: RE: [EXTERNAL] Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Good morning Erica ,  I sow the location was added as of 06/01/2021  WellMed-Horz_no tagline_COLOR logo_SIG ____________________________  Joe Gallegos Contract Specialist WellMed Medical Management, Inc.', NULL, NULL, '2021-08-27 09:17:07', '2021-08-27 09:17:07'),
(34922, 3040, 27306, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 10:12:53', '2021-05-03 10:12:53'),
(34923, 3040, 27306, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to: EriHernandez@wellmed.net  Subject: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Erica,   Hope you are doing well. Please find the attached Ancillary Credentialing application form for our group Valley Med Urgent Care under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-05-03 10:34:16', '2021-05-03 10:34:16'),
(34924, 3040, 27306, NULL, '2021-06-08 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more detail please see group task. ', NULL, NULL, '2021-06-01 11:10:57', '2021-06-01 11:10:57'),
(34925, 3040, 27306, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: rbyrd@wellmed.net  Subject: Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Rhonda,   Please advise the status of an additional location that was requested in the previous email. I already sent the credentialing form for an additional location along with W9.   If you need further information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 09:22:31', '2021-07-20 09:22:31'),
(34926, 3040, 27306, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: contracthelpdesk@wellmed.net  Subject: Secure Message from contracthelpdesk@wellmed.net   Hello Erica & CHD,   Hope you are doing well. This is a follow up email regarding the status for additional location in our Valley Med Urgent Care PLLC. Has there been any update?   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-17 09:20:35', '2021-08-17 09:20:35'),
(34927, 3040, 27306, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Email rcvd from: EriHernandez@wellmed.net, contracthelpdesk@wellmed.net  Subject: RE: [EXTERNAL] Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Good morning Erica ,  I sow the location was added as of 06/01/2021  WellMed-Horz_no tagline_COLOR logo_SIG ____________________________  Joe Gallegos Contract Specialist WellMed Medical Management, Inc.', NULL, NULL, '2021-08-27 09:17:07', '2021-08-27 09:17:07'),
(34928, 3040, 27307, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 10:12:53', '2021-05-03 10:12:53'),
(34929, 3040, 27307, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to: EriHernandez@wellmed.net  Subject: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Erica,   Hope you are doing well. Please find the attached Ancillary Credentialing application form for our group Valley Med Urgent Care under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-05-03 10:33:32', '2021-05-03 10:33:32'),
(34930, 3040, 27307, NULL, '2021-06-08 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more detail please see group task. ', NULL, NULL, '2021-06-01 11:11:02', '2021-06-01 11:11:02'),
(34931, 3040, 27307, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: rbyrd@wellmed.net  Subject: Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Rhonda,   Please advise the status of an additional location that was requested in the previous email. I already sent the credentialing form for an additional location along with W9.   If you need further information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 09:22:31', '2021-07-20 09:22:31'),
(34932, 3040, 27307, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: contracthelpdesk@wellmed.net  Subject: Secure Message from contracthelpdesk@wellmed.net   Hello Erica & CHD,   Hope you are doing well. This is a follow up email regarding the status for additional location in our Valley Med Urgent Care PLLC. Has there been any update?   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-17 09:20:34', '2021-08-17 09:20:34'),
(34933, 3040, 27307, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Email rcvd from: EriHernandez@wellmed.net, contracthelpdesk@wellmed.net  Subject: RE: [EXTERNAL] Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Good morning Erica ,  I sow the location was added as of 06/01/2021  WellMed-Horz_no tagline_COLOR logo_SIG ____________________________  Joe Gallegos Contract Specialist WellMed Medical Management, Inc.', NULL, NULL, '2021-08-27 09:17:06', '2021-08-27 09:17:06'),
(34934, 3040, 27308, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 10:12:53', '2021-05-03 10:12:53'),
(34935, 3040, 27308, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to: EriHernandez@wellmed.net  Subject: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Erica,   Hope you are doing well. Please find the attached Ancillary Credentialing application form for our group Valley Med Urgent Care under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-05-03 10:35:09', '2021-05-03 10:35:09'),
(34936, 3040, 27308, NULL, '2021-06-08 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more detail please see group task. ', NULL, NULL, '2021-06-01 11:11:06', '2021-06-01 11:11:06'),
(34937, 3040, 27308, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: rbyrd@wellmed.net  Subject: Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Rhonda,   Please advise the status of an additional location that was requested in the previous email. I already sent the credentialing form for an additional location along with W9.   If you need further information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 09:22:31', '2021-07-20 09:22:31'),
(34938, 3040, 27308, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: contracthelpdesk@wellmed.net  Subject: Secure Message from contracthelpdesk@wellmed.net   Hello Erica & CHD,   Hope you are doing well. This is a follow up email regarding the status for additional location in our Valley Med Urgent Care PLLC. Has there been any update?   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-17 09:20:34', '2021-08-17 09:20:34'),
(34939, 3040, 27308, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Email rcvd from: EriHernandez@wellmed.net, contracthelpdesk@wellmed.net  Subject: RE: [EXTERNAL] Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Good morning Erica ,  I sow the location was added as of 06/01/2021  WellMed-Horz_no tagline_COLOR logo_SIG ____________________________  Joe Gallegos Contract Specialist WellMed Medical Management, Inc.', NULL, NULL, '2021-08-27 09:17:06', '2021-08-27 09:17:06'),
(34940, 3040, 27309, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 10:12:53', '2021-05-03 10:12:53'),
(34941, 3040, 27309, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to: EriHernandez@wellmed.net  Subject: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Erica,   Hope you are doing well. Please find the attached Ancillary Credentialing application form for our group Valley Med Urgent Care under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-05-03 10:34:28', '2021-05-03 10:34:28'),
(34942, 3040, 27309, NULL, '2021-06-08 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more detail please see group task. ', NULL, NULL, '2021-06-01 11:12:11', '2021-06-01 11:12:11'),
(34943, 3040, 27309, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: rbyrd@wellmed.net  Subject: Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Rhonda,   Please advise the status of an additional location that was requested in the previous email. I already sent the credentialing form for an additional location along with W9.   If you need further information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 09:22:30', '2021-07-20 09:22:30'),
(34944, 3040, 27309, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: contracthelpdesk@wellmed.net  Subject: Secure Message from contracthelpdesk@wellmed.net   Hello Erica & CHD,   Hope you are doing well. This is a follow up email regarding the status for additional location in our Valley Med Urgent Care PLLC. Has there been any update?   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-17 09:20:33', '2021-08-17 09:20:33'),
(34945, 3040, 27309, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Email rcvd from: EriHernandez@wellmed.net, contracthelpdesk@wellmed.net  Subject: RE: [EXTERNAL] Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Good morning Erica ,  I sow the location was added as of 06/01/2021  WellMed-Horz_no tagline_COLOR logo_SIG ____________________________  Joe Gallegos Contract Specialist WellMed Medical Management, Inc.', NULL, NULL, '2021-08-27 09:17:06', '2021-08-27 09:17:06'),
(34946, 3040, 27310, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 10:12:53', '2021-05-03 10:12:53'),
(34947, 3040, 27310, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to: EriHernandez@wellmed.net  Subject: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Erica,   Hope you are doing well. Please find the attached Ancillary Credentialing application form for our group Valley Med Urgent Care under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-05-03 10:34:05', '2021-05-03 10:34:05'),
(34948, 3040, 27310, NULL, '2021-06-08 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more detail please see group task. ', NULL, NULL, '2021-06-01 11:12:30', '2021-06-01 11:12:30'),
(34949, 3040, 27310, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: rbyrd@wellmed.net  Subject: Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Rhonda,   Please advise the status of an additional location that was requested in the previous email. I already sent the credentialing form for an additional location along with W9.   If you need further information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 09:22:30', '2021-07-20 09:22:30'),
(34950, 3040, 27310, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: contracthelpdesk@wellmed.net  Subject: Secure Message from contracthelpdesk@wellmed.net   Hello Erica & CHD,   Hope you are doing well. This is a follow up email regarding the status for additional location in our Valley Med Urgent Care PLLC. Has there been any update?   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-17 09:20:33', '2021-08-17 09:20:33'),
(34951, 3040, 27310, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Email rcvd from: EriHernandez@wellmed.net, contracthelpdesk@wellmed.net  Subject: RE: [EXTERNAL] Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Good morning Erica ,  I sow the location was added as of 06/01/2021  WellMed-Horz_no tagline_COLOR logo_SIG ____________________________  Joe Gallegos Contract Specialist WellMed Medical Management, Inc.', NULL, NULL, '2021-08-27 09:17:05', '2021-08-27 09:17:05'),
(34952, 3040, 27311, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 10:12:53', '2021-05-03 10:12:53'),
(34953, 3040, 27311, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to: EriHernandez@wellmed.net  Subject: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Erica,   Hope you are doing well. Please find the attached Ancillary Credentialing application form for our group Valley Med Urgent Care under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-05-03 10:34:55', '2021-05-03 10:34:55'),
(34954, 3040, 27311, NULL, '2021-06-08 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more detail please see group task. ', NULL, NULL, '2021-06-01 11:12:35', '2021-06-01 11:12:35'),
(34955, 3040, 27311, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: rbyrd@wellmed.net  Subject: Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Rhonda,   Please advise the status of an additional location that was requested in the previous email. I already sent the credentialing form for an additional location along with W9.   If you need further information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 09:22:29', '2021-07-20 09:22:29'),
(34956, 3040, 27311, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: contracthelpdesk@wellmed.net  Subject: Secure Message from contracthelpdesk@wellmed.net   Hello Erica & CHD,   Hope you are doing well. This is a follow up email regarding the status for additional location in our Valley Med Urgent Care PLLC. Has there been any update?   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-17 09:20:33', '2021-08-17 09:20:33'),
(34957, 3040, 27311, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Email rcvd from: EriHernandez@wellmed.net, contracthelpdesk@wellmed.net  Subject: RE: [EXTERNAL] Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Good morning Erica ,  I sow the location was added as of 06/01/2021  WellMed-Horz_no tagline_COLOR logo_SIG ____________________________  Joe Gallegos Contract Specialist WellMed Medical Management, Inc.', NULL, NULL, '2021-08-27 09:17:04', '2021-08-27 09:17:04'),
(34958, 3040, 27312, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 10:13:02', '2021-05-03 10:13:02'),
(34959, 3040, 27312, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to: EriHernandez@wellmed.net  Subject: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Erica,   Hope you are doing well. Please find the attached Ancillary Credentialing application form for our group Valley Med Urgent Care under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-05-03 10:34:45', '2021-05-03 10:34:45'),
(34960, 3040, 27312, NULL, '2021-06-08 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more detail please see group task. ', NULL, NULL, '2021-06-01 11:12:40', '2021-06-01 11:12:40'),
(34961, 3040, 27312, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: rbyrd@wellmed.net  Subject: Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Rhonda,   Please advise the status of an additional location that was requested in the previous email. I already sent the credentialing form for an additional location along with W9.   If you need further information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 09:22:29', '2021-07-20 09:22:29'),
(34962, 3040, 27312, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: contracthelpdesk@wellmed.net  Subject: Secure Message from contracthelpdesk@wellmed.net   Hello Erica & CHD,   Hope you are doing well. This is a follow up email regarding the status for additional location in our Valley Med Urgent Care PLLC. Has there been any update?   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-17 09:20:32', '2021-08-17 09:20:32'),
(34963, 3040, 27312, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Email rcvd from: EriHernandez@wellmed.net, contracthelpdesk@wellmed.net  Subject: RE: [EXTERNAL] Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Good morning Erica ,  I sow the location was added as of 06/01/2021  WellMed-Horz_no tagline_COLOR logo_SIG ____________________________  Joe Gallegos Contract Specialist WellMed Medical Management, Inc.', NULL, NULL, '2021-08-27 09:17:04', '2021-08-27 09:17:04'),
(34964, 3040, 27313, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 10:13:02', '2021-05-03 10:13:02'),
(34965, 3040, 27313, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to: EriHernandez@wellmed.net  Subject: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Erica,   Hope you are doing well. Please find the attached Ancillary Credentialing application form for our group Valley Med Urgent Care under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-05-03 10:33:46', '2021-05-03 10:33:46'),
(34966, 3040, 27313, NULL, '2021-06-08 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more detail please see group task. ', NULL, NULL, '2021-06-01 11:12:44', '2021-06-01 11:12:44'),
(34967, 3040, 27313, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: rbyrd@wellmed.net  Subject: Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Rhonda,   Please advise the status of an additional location that was requested in the previous email. I already sent the credentialing form for an additional location along with W9.   If you need further information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 09:22:29', '2021-07-20 09:22:29'),
(34968, 3040, 27313, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: contracthelpdesk@wellmed.net  Subject: Secure Message from contracthelpdesk@wellmed.net   Hello Erica & CHD,   Hope you are doing well. This is a follow up email regarding the status for additional location in our Valley Med Urgent Care PLLC. Has there been any update?   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-17 09:20:32', '2021-08-17 09:20:32'),
(34969, 3040, 27313, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Email rcvd from: EriHernandez@wellmed.net, contracthelpdesk@wellmed.net  Subject: RE: [EXTERNAL] Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Good morning Erica ,  I sow the location was added as of 06/01/2021  WellMed-Horz_no tagline_COLOR logo_SIG ____________________________  Joe Gallegos Contract Specialist WellMed Medical Management, Inc.', NULL, NULL, '2021-08-27 09:17:03', '2021-08-27 09:17:03'),
(34970, 3040, 27314, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 10:13:02', '2021-05-03 10:13:02'),
(34971, 3040, 27314, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to: EriHernandez@wellmed.net  Subject: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Erica,   Hope you are doing well. Please find the attached Ancillary Credentialing application form for our group Valley Med Urgent Care under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-05-03 10:33:11', '2021-05-03 10:33:11'),
(34972, 3040, 27314, NULL, '2021-06-08 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more detail please see group task. ', NULL, NULL, '2021-06-01 11:12:49', '2021-06-01 11:12:49'),
(34973, 3040, 27314, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: rbyrd@wellmed.net  Subject: Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Rhonda,   Please advise the status of an additional location that was requested in the previous email. I already sent the credentialing form for an additional location along with W9.   If you need further information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 09:22:28', '2021-07-20 09:22:28'),
(34974, 3040, 27314, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: contracthelpdesk@wellmed.net  Subject: Secure Message from contracthelpdesk@wellmed.net   Hello Erica & CHD,   Hope you are doing well. This is a follow up email regarding the status for additional location in our Valley Med Urgent Care PLLC. Has there been any update?   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-17 09:20:31', '2021-08-17 09:20:31'),
(34975, 3040, 27314, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Email rcvd from: EriHernandez@wellmed.net, contracthelpdesk@wellmed.net  Subject: RE: [EXTERNAL] Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Good morning Erica ,  I sow the location was added as of 06/01/2021  WellMed-Horz_no tagline_COLOR logo_SIG ____________________________  Joe Gallegos Contract Specialist WellMed Medical Management, Inc.', NULL, NULL, '2021-08-27 09:17:03', '2021-08-27 09:17:03'),
(34976, 3040, 27315, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 10:13:02', '2021-05-03 10:13:02'),
(34977, 3040, 27315, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to: EriHernandez@wellmed.net  Subject: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Erica,   Hope you are doing well. Please find the attached Ancillary Credentialing application form for our group Valley Med Urgent Care under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-05-03 10:33:57', '2021-05-03 10:33:57'),
(34978, 3040, 27315, NULL, '2021-06-08 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more detail please see group task. ', NULL, NULL, '2021-06-01 11:12:52', '2021-06-01 11:12:52'),
(34979, 3040, 27315, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: rbyrd@wellmed.net  Subject: Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Rhonda,   Please advise the status of an additional location that was requested in the previous email. I already sent the credentialing form for an additional location along with W9.   If you need further information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 09:22:28', '2021-07-20 09:22:28'),
(34980, 3040, 27315, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: contracthelpdesk@wellmed.net  Subject: Secure Message from contracthelpdesk@wellmed.net   Hello Erica & CHD,   Hope you are doing well. This is a follow up email regarding the status for additional location in our Valley Med Urgent Care PLLC. Has there been any update?   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-17 09:20:31', '2021-08-17 09:20:31'),
(34981, 3040, 27315, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Email rcvd from: EriHernandez@wellmed.net, contracthelpdesk@wellmed.net  Subject: RE: [EXTERNAL] Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Good morning Erica ,  I sow the location was added as of 06/01/2021  WellMed-Horz_no tagline_COLOR logo_SIG ____________________________  Joe Gallegos Contract Specialist WellMed Medical Management, Inc.', NULL, NULL, '2021-08-27 09:17:02', '2021-08-27 09:17:02'),
(34982, 3040, 27316, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 10:13:02', '2021-05-03 10:13:02'),
(34983, 3040, 27316, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to: EriHernandez@wellmed.net  Subject: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Erica,   Hope you are doing well. Please find the attached Ancillary Credentialing application form for our group Valley Med Urgent Care under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-05-03 10:33:24', '2021-05-03 10:33:24'),
(34984, 3040, 27316, NULL, '2021-06-08 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more detail please see group task. ', NULL, NULL, '2021-06-01 11:12:56', '2021-06-01 11:12:56'),
(34985, 3040, 27316, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: rbyrd@wellmed.net  Subject: Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Rhonda,   Please advise the status of an additional location that was requested in the previous email. I already sent the credentialing form for an additional location along with W9.   If you need further information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 09:22:27', '2021-07-20 09:22:27'),
(34986, 3040, 27316, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: contracthelpdesk@wellmed.net  Subject: Secure Message from contracthelpdesk@wellmed.net   Hello Erica & CHD,   Hope you are doing well. This is a follow up email regarding the status for additional location in our Valley Med Urgent Care PLLC. Has there been any update?   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-17 09:20:30', '2021-08-17 09:20:30'),
(34987, 3040, 27316, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Email rcvd from: EriHernandez@wellmed.net, contracthelpdesk@wellmed.net  Subject: RE: [EXTERNAL] Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Good morning Erica ,  I sow the location was added as of 06/01/2021  WellMed-Horz_no tagline_COLOR logo_SIG ____________________________  Joe Gallegos Contract Specialist WellMed Medical Management, Inc.', NULL, NULL, '2021-08-27 09:17:02', '2021-08-27 09:17:02'),
(34988, 3040, 27317, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 10:13:02', '2021-05-03 10:13:02'),
(34989, 3040, 27317, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to: EriHernandez@wellmed.net  Subject: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Erica,   Hope you are doing well. Please find the attached Ancillary Credentialing application form for our group Valley Med Urgent Care under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-05-03 10:34:20', '2021-05-03 10:34:20'),
(34990, 3040, 27317, NULL, '2021-06-08 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more detail please see group task. ', NULL, NULL, '2021-06-01 11:13:00', '2021-06-01 11:13:00'),
(34991, 3040, 27317, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: rbyrd@wellmed.net  Subject: Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Rhonda,   Please advise the status of an additional location that was requested in the previous email. I already sent the credentialing form for an additional location along with W9.   If you need further information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 09:22:27', '2021-07-20 09:22:27'),
(34992, 3040, 27317, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: contracthelpdesk@wellmed.net  Subject: Secure Message from contracthelpdesk@wellmed.net   Hello Erica & CHD,   Hope you are doing well. This is a follow up email regarding the status for additional location in our Valley Med Urgent Care PLLC. Has there been any update?   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-17 09:20:30', '2021-08-17 09:20:30');
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
(34993, 3040, 27317, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Email rcvd from: EriHernandez@wellmed.net, contracthelpdesk@wellmed.net  Subject: RE: [EXTERNAL] Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Good morning Erica ,  I sow the location was added as of 06/01/2021  WellMed-Horz_no tagline_COLOR logo_SIG ____________________________  Joe Gallegos Contract Specialist WellMed Medical Management, Inc.', NULL, NULL, '2021-08-27 09:17:01', '2021-08-27 09:17:01'),
(34994, 3040, 27318, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 10:13:03', '2021-05-03 10:13:03'),
(34995, 3040, 27318, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to: EriHernandez@wellmed.net  Subject: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Erica,   Hope you are doing well. Please find the attached Ancillary Credentialing application form for our group Valley Med Urgent Care under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-05-03 10:33:35', '2021-05-03 10:33:35'),
(34996, 3040, 27318, NULL, '2021-06-08 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more detail please see group task. ', NULL, NULL, '2021-06-01 11:13:05', '2021-06-01 11:13:05'),
(34997, 3040, 27318, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: rbyrd@wellmed.net  Subject: Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Rhonda,   Please advise the status of an additional location that was requested in the previous email. I already sent the credentialing form for an additional location along with W9.   If you need further information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 09:22:26', '2021-07-20 09:22:26'),
(34998, 3040, 27318, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: contracthelpdesk@wellmed.net  Subject: Secure Message from contracthelpdesk@wellmed.net   Hello Erica & CHD,   Hope you are doing well. This is a follow up email regarding the status for additional location in our Valley Med Urgent Care PLLC. Has there been any update?   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-17 09:20:29', '2021-08-17 09:20:29'),
(34999, 3040, 27318, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Email rcvd from: EriHernandez@wellmed.net, contracthelpdesk@wellmed.net  Subject: RE: [EXTERNAL] Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Good morning Erica ,  I sow the location was added as of 06/01/2021  WellMed-Horz_no tagline_COLOR logo_SIG ____________________________  Joe Gallegos Contract Specialist WellMed Medical Management, Inc.', NULL, NULL, '2021-08-27 09:17:01', '2021-08-27 09:17:01'),
(35000, 3040, 27319, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 10:13:03', '2021-05-03 10:13:03'),
(35001, 3040, 27319, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to: EriHernandez@wellmed.net  Subject: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Erica,   Hope you are doing well. Please find the attached Ancillary Credentialing application form for our group Valley Med Urgent Care under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-05-03 10:35:28', '2021-05-03 10:35:28'),
(35002, 3040, 27319, NULL, '2021-06-08 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more detail please see group task. ', NULL, NULL, '2021-06-01 11:13:09', '2021-06-01 11:13:09'),
(35003, 3040, 27319, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: rbyrd@wellmed.net  Subject: Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Rhonda,   Please advise the status of an additional location that was requested in the previous email. I already sent the credentialing form for an additional location along with W9.   If you need further information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 09:22:26', '2021-07-20 09:22:26'),
(35004, 3040, 27319, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: contracthelpdesk@wellmed.net  Subject: Secure Message from contracthelpdesk@wellmed.net   Hello Erica & CHD,   Hope you are doing well. This is a follow up email regarding the status for additional location in our Valley Med Urgent Care PLLC. Has there been any update?   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-17 09:20:29', '2021-08-17 09:20:29'),
(35005, 3040, 27319, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Email rcvd from: EriHernandez@wellmed.net, contracthelpdesk@wellmed.net  Subject: RE: [EXTERNAL] Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Good morning Erica ,  I sow the location was added as of 06/01/2021  WellMed-Horz_no tagline_COLOR logo_SIG ____________________________  Joe Gallegos Contract Specialist WellMed Medical Management, Inc.', NULL, NULL, '2021-08-27 09:17:00', '2021-08-27 09:17:00'),
(35006, 3040, 27320, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 10:13:03', '2021-05-03 10:13:03'),
(35007, 3040, 27320, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to: EriHernandez@wellmed.net  Subject: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Erica,   Hope you are doing well. Please find the attached Ancillary Credentialing application form for our group Valley Med Urgent Care under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-05-03 10:34:33', '2021-05-03 10:34:33'),
(35008, 3040, 27320, NULL, '2021-06-08 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more detail please see group task. ', NULL, NULL, '2021-06-01 11:13:13', '2021-06-01 11:13:13'),
(35009, 3040, 27320, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: rbyrd@wellmed.net  Subject: Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Rhonda,   Please advise the status of an additional location that was requested in the previous email. I already sent the credentialing form for an additional location along with W9.   If you need further information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 09:22:26', '2021-07-20 09:22:26'),
(35010, 3040, 27320, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: contracthelpdesk@wellmed.net  Subject: Secure Message from contracthelpdesk@wellmed.net   Hello Erica & CHD,   Hope you are doing well. This is a follow up email regarding the status for additional location in our Valley Med Urgent Care PLLC. Has there been any update?   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-17 09:20:28', '2021-08-17 09:20:28'),
(35011, 3040, 27320, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Email rcvd from: EriHernandez@wellmed.net, contracthelpdesk@wellmed.net  Subject: RE: [EXTERNAL] Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Good morning Erica ,  I sow the location was added as of 06/01/2021  WellMed-Horz_no tagline_COLOR logo_SIG ____________________________  Joe Gallegos Contract Specialist WellMed Medical Management, Inc.', NULL, NULL, '2021-08-27 09:17:00', '2021-08-27 09:17:00'),
(35012, 3040, 27321, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 10:13:03', '2021-05-03 10:13:03'),
(35013, 3040, 27321, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to: EriHernandez@wellmed.net  Subject: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Erica,   Hope you are doing well. Please find the attached Ancillary Credentialing application form for our group Valley Med Urgent Care under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-05-03 10:34:09', '2021-05-03 10:34:09'),
(35014, 3040, 27321, NULL, '2021-06-08 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more detail please see group task. ', NULL, NULL, '2021-06-01 11:13:19', '2021-06-01 11:13:19'),
(35015, 3040, 27321, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: rbyrd@wellmed.net  Subject: Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Rhonda,   Please advise the status of an additional location that was requested in the previous email. I already sent the credentialing form for an additional location along with W9.   If you need further information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 09:22:25', '2021-07-20 09:22:25'),
(35016, 3040, 27321, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: contracthelpdesk@wellmed.net  Subject: Secure Message from contracthelpdesk@wellmed.net   Hello Erica & CHD,   Hope you are doing well. This is a follow up email regarding the status for additional location in our Valley Med Urgent Care PLLC. Has there been any update?   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-17 09:20:28', '2021-08-17 09:20:28'),
(35017, 3040, 27321, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Email rcvd from: EriHernandez@wellmed.net, contracthelpdesk@wellmed.net  Subject: RE: [EXTERNAL] Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Good morning Erica ,  I sow the location was added as of 06/01/2021  WellMed-Horz_no tagline_COLOR logo_SIG ____________________________  Joe Gallegos Contract Specialist WellMed Medical Management, Inc.', NULL, NULL, '2021-08-27 09:16:59', '2021-08-27 09:16:59'),
(35018, 3040, 27322, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 10:13:03', '2021-05-03 10:13:03'),
(35019, 3040, 27322, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to: EriHernandez@wellmed.net  Subject: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Erica,   Hope you are doing well. Please find the attached Ancillary Credentialing application form for our group Valley Med Urgent Care under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-05-03 10:34:59', '2021-05-03 10:34:59'),
(35020, 3040, 27322, NULL, '2021-06-08 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more detail please see group task. ', NULL, NULL, '2021-06-01 11:13:23', '2021-06-01 11:13:23'),
(35021, 3040, 27322, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: rbyrd@wellmed.net  Subject: Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Rhonda,   Please advise the status of an additional location that was requested in the previous email. I already sent the credentialing form for an additional location along with W9.   If you need further information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 09:22:25', '2021-07-20 09:22:25'),
(35022, 3040, 27322, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: contracthelpdesk@wellmed.net  Subject: Secure Message from contracthelpdesk@wellmed.net   Hello Erica & CHD,   Hope you are doing well. This is a follow up email regarding the status for additional location in our Valley Med Urgent Care PLLC. Has there been any update?   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-17 09:20:28', '2021-08-17 09:20:28'),
(35023, 3040, 27322, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Email rcvd from: EriHernandez@wellmed.net, contracthelpdesk@wellmed.net  Subject: RE: [EXTERNAL] Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Good morning Erica ,  I sow the location was added as of 06/01/2021  WellMed-Horz_no tagline_COLOR logo_SIG ____________________________  Joe Gallegos Contract Specialist WellMed Medical Management, Inc.', NULL, NULL, '2021-08-27 09:16:58', '2021-08-27 09:16:58'),
(35024, 3040, 27323, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 10:13:09', '2021-05-03 10:13:09'),
(35025, 3040, 27323, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to: EriHernandez@wellmed.net  Subject: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Erica,   Hope you are doing well. Please find the attached Ancillary Credentialing application form for our group Valley Med Urgent Care under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-05-03 10:34:49', '2021-05-03 10:34:49'),
(35026, 3040, 27323, NULL, '2021-06-08 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more detail please see group task. ', NULL, NULL, '2021-06-01 11:13:32', '2021-06-01 11:13:32'),
(35027, 3040, 27323, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: rbyrd@wellmed.net  Subject: Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Rhonda,   Please advise the status of an additional location that was requested in the previous email. I already sent the credentialing form for an additional location along with W9.   If you need further information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 09:22:24', '2021-07-20 09:22:24'),
(35028, 3040, 27323, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: contracthelpdesk@wellmed.net  Subject: Secure Message from contracthelpdesk@wellmed.net   Hello Erica & CHD,   Hope you are doing well. This is a follow up email regarding the status for additional location in our Valley Med Urgent Care PLLC. Has there been any update?   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-17 09:20:27', '2021-08-17 09:20:27'),
(35029, 3040, 27323, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Email rcvd from: EriHernandez@wellmed.net, contracthelpdesk@wellmed.net  Subject: RE: [EXTERNAL] Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Good morning Erica ,  I sow the location was added as of 06/01/2021  WellMed-Horz_no tagline_COLOR logo_SIG ____________________________  Joe Gallegos Contract Specialist WellMed Medical Management, Inc.', NULL, NULL, '2021-08-27 09:16:58', '2021-08-27 09:16:58'),
(35030, 3040, 27324, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 10:13:09', '2021-05-03 10:13:09'),
(35031, 3040, 27324, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to: EriHernandez@wellmed.net  Subject: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Erica,   Hope you are doing well. Please find the attached Ancillary Credentialing application form for our group Valley Med Urgent Care under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-05-03 10:33:50', '2021-05-03 10:33:50'),
(35032, 3040, 27324, NULL, '2021-06-08 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more detail please see group task. ', NULL, NULL, '2021-06-01 11:13:36', '2021-06-01 11:13:36'),
(35033, 3040, 27324, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: rbyrd@wellmed.net  Subject: Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Rhonda,   Please advise the status of an additional location that was requested in the previous email. I already sent the credentialing form for an additional location along with W9.   If you need further information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 09:22:24', '2021-07-20 09:22:24'),
(35034, 3040, 27324, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: contracthelpdesk@wellmed.net  Subject: Secure Message from contracthelpdesk@wellmed.net   Hello Erica & CHD,   Hope you are doing well. This is a follow up email regarding the status for additional location in our Valley Med Urgent Care PLLC. Has there been any update?   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-17 09:20:27', '2021-08-17 09:20:27'),
(35035, 3040, 27324, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Email rcvd from: EriHernandez@wellmed.net, contracthelpdesk@wellmed.net  Subject: RE: [EXTERNAL] Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Good morning Erica ,  I sow the location was added as of 06/01/2021  WellMed-Horz_no tagline_COLOR logo_SIG ____________________________  Joe Gallegos Contract Specialist WellMed Medical Management, Inc.', NULL, NULL, '2021-08-27 09:16:57', '2021-08-27 09:16:57'),
(35036, 3040, 27325, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 10:13:09', '2021-05-03 10:13:09'),
(35037, 3040, 27325, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to: EriHernandez@wellmed.net  Subject: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Erica,   Hope you are doing well. Please find the attached Ancillary Credentialing application form for our group Valley Med Urgent Care under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-05-03 10:33:16', '2021-05-03 10:33:16'),
(35038, 3040, 27325, NULL, '2021-06-08 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more detail please see group task. ', NULL, NULL, '2021-06-01 11:13:39', '2021-06-01 11:13:39'),
(35039, 3040, 27325, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: rbyrd@wellmed.net  Subject: Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Rhonda,   Please advise the status of an additional location that was requested in the previous email. I already sent the credentialing form for an additional location along with W9.   If you need further information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 09:22:24', '2021-07-20 09:22:24'),
(35040, 3040, 27325, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: contracthelpdesk@wellmed.net  Subject: Secure Message from contracthelpdesk@wellmed.net   Hello Erica & CHD,   Hope you are doing well. This is a follow up email regarding the status for additional location in our Valley Med Urgent Care PLLC. Has there been any update?   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-17 09:20:26', '2021-08-17 09:20:26'),
(35041, 3040, 27325, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Email rcvd from: EriHernandez@wellmed.net, contracthelpdesk@wellmed.net  Subject: RE: [EXTERNAL] Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Good morning Erica ,  I sow the location was added as of 06/01/2021  WellMed-Horz_no tagline_COLOR logo_SIG ____________________________  Joe Gallegos Contract Specialist WellMed Medical Management, Inc.', NULL, NULL, '2021-08-27 09:16:57', '2021-08-27 09:16:57'),
(35042, 3040, 27326, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 10:13:09', '2021-05-03 10:13:09'),
(35043, 3040, 27326, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to: EriHernandez@wellmed.net  Subject: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Erica,   Hope you are doing well. Please find the attached Ancillary Credentialing application form for our group Valley Med Urgent Care under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-05-03 10:34:02', '2021-05-03 10:34:02'),
(35044, 3040, 27326, NULL, '2021-06-08 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more detail please see group task. ', NULL, NULL, '2021-06-01 11:13:43', '2021-06-01 11:13:43'),
(35045, 3040, 27326, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: rbyrd@wellmed.net  Subject: Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Rhonda,   Please advise the status of an additional location that was requested in the previous email. I already sent the credentialing form for an additional location along with W9.   If you need further information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 09:22:23', '2021-07-20 09:22:23'),
(35046, 3040, 27326, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: contracthelpdesk@wellmed.net  Subject: Secure Message from contracthelpdesk@wellmed.net   Hello Erica & CHD,   Hope you are doing well. This is a follow up email regarding the status for additional location in our Valley Med Urgent Care PLLC. Has there been any update?   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-17 09:20:26', '2021-08-17 09:20:26'),
(35047, 3040, 27326, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Email rcvd from: EriHernandez@wellmed.net, contracthelpdesk@wellmed.net  Subject: RE: [EXTERNAL] Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Good morning Erica ,  I sow the location was added as of 06/01/2021  WellMed-Horz_no tagline_COLOR logo_SIG ____________________________  Joe Gallegos Contract Specialist WellMed Medical Management, Inc.', NULL, NULL, '2021-08-27 09:16:56', '2021-08-27 09:16:56'),
(35048, 3040, 27327, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 10:13:10', '2021-05-03 10:13:10'),
(35049, 3040, 27327, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to: EriHernandez@wellmed.net  Subject: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Erica,   Hope you are doing well. Please find the attached Ancillary Credentialing application form for our group Valley Med Urgent Care under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-05-03 10:33:28', '2021-05-03 10:33:28'),
(35050, 3040, 27327, NULL, '2021-06-08 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more detail please see group task. ', NULL, NULL, '2021-06-01 11:13:47', '2021-06-01 11:13:47'),
(35051, 3040, 27327, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: rbyrd@wellmed.net  Subject: Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Rhonda,   Please advise the status of an additional location that was requested in the previous email. I already sent the credentialing form for an additional location along with W9.   If you need further information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 09:22:23', '2021-07-20 09:22:23'),
(35052, 3040, 27327, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: contracthelpdesk@wellmed.net  Subject: Secure Message from contracthelpdesk@wellmed.net   Hello Erica & CHD,   Hope you are doing well. This is a follow up email regarding the status for additional location in our Valley Med Urgent Care PLLC. Has there been any update?   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-17 09:20:25', '2021-08-17 09:20:25'),
(35053, 3040, 27327, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Email rcvd from: EriHernandez@wellmed.net, contracthelpdesk@wellmed.net  Subject: RE: [EXTERNAL] Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Good morning Erica ,  I sow the location was added as of 06/01/2021  WellMed-Horz_no tagline_COLOR logo_SIG ____________________________  Joe Gallegos Contract Specialist WellMed Medical Management, Inc.', NULL, NULL, '2021-08-27 09:16:56', '2021-08-27 09:16:56'),
(35054, 3040, 27328, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 10:13:10', '2021-05-03 10:13:10'),
(35055, 3040, 27328, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to: EriHernandez@wellmed.net  Subject: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Erica,   Hope you are doing well. Please find the attached Ancillary Credentialing application form for our group Valley Med Urgent Care under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-05-03 10:34:23', '2021-05-03 10:34:23'),
(35056, 3040, 27328, NULL, '2021-06-08 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more detail please see group task. ', NULL, NULL, '2021-06-01 11:13:51', '2021-06-01 11:13:51'),
(35057, 3040, 27328, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: rbyrd@wellmed.net  Subject: Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Rhonda,   Please advise the status of an additional location that was requested in the previous email. I already sent the credentialing form for an additional location along with W9.   If you need further information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 09:22:22', '2021-07-20 09:22:22'),
(35058, 3040, 27328, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: contracthelpdesk@wellmed.net  Subject: Secure Message from contracthelpdesk@wellmed.net   Hello Erica & CHD,   Hope you are doing well. This is a follow up email regarding the status for additional location in our Valley Med Urgent Care PLLC. Has there been any update?   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-17 09:20:25', '2021-08-17 09:20:25'),
(35059, 3040, 27328, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Email rcvd from: EriHernandez@wellmed.net, contracthelpdesk@wellmed.net  Subject: RE: [EXTERNAL] Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Good morning Erica ,  I sow the location was added as of 06/01/2021  WellMed-Horz_no tagline_COLOR logo_SIG ____________________________  Joe Gallegos Contract Specialist WellMed Medical Management, Inc.', NULL, NULL, '2021-08-27 09:16:55', '2021-08-27 09:16:55'),
(35060, 3040, 27329, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 10:13:10', '2021-05-03 10:13:10'),
(35061, 3040, 27329, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to: EriHernandez@wellmed.net  Subject: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Erica,   Hope you are doing well. Please find the attached Ancillary Credentialing application form for our group Valley Med Urgent Care under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-05-03 10:33:39', '2021-05-03 10:33:39'),
(35062, 3040, 27329, NULL, '2021-06-08 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more detail please see group task. ', NULL, NULL, '2021-06-01 11:13:55', '2021-06-01 11:13:55'),
(35063, 3040, 27329, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: rbyrd@wellmed.net  Subject: Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Rhonda,   Please advise the status of an additional location that was requested in the previous email. I already sent the credentialing form for an additional location along with W9.   If you need further information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 09:22:22', '2021-07-20 09:22:22'),
(35064, 3040, 27329, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: contracthelpdesk@wellmed.net  Subject: Secure Message from contracthelpdesk@wellmed.net   Hello Erica & CHD,   Hope you are doing well. This is a follow up email regarding the status for additional location in our Valley Med Urgent Care PLLC. Has there been any update?   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-17 09:20:24', '2021-08-17 09:20:24'),
(35065, 3040, 27329, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Email rcvd from: EriHernandez@wellmed.net, contracthelpdesk@wellmed.net  Subject: RE: [EXTERNAL] Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Good morning Erica ,  I sow the location was added as of 06/01/2021  WellMed-Horz_no tagline_COLOR logo_SIG ____________________________  Joe Gallegos Contract Specialist WellMed Medical Management, Inc.', NULL, NULL, '2021-08-27 09:16:54', '2021-08-27 09:16:54'),
(35066, 3040, 27330, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 10:13:10', '2021-05-03 10:13:10'),
(35067, 3040, 27330, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to: EriHernandez@wellmed.net  Subject: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Erica,   Hope you are doing well. Please find the attached Ancillary Credentialing application form for our group Valley Med Urgent Care under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-05-03 10:35:32', '2021-05-03 10:35:32'),
(35068, 3040, 27330, NULL, '2021-06-08 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more detail please see group task. ', NULL, NULL, '2021-06-01 11:13:59', '2021-06-01 11:13:59'),
(35069, 3040, 27330, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: rbyrd@wellmed.net  Subject: Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Rhonda,   Please advise the status of an additional location that was requested in the previous email. I already sent the credentialing form for an additional location along with W9.   If you need further information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 09:22:21', '2021-07-20 09:22:21'),
(35070, 3040, 27330, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: contracthelpdesk@wellmed.net  Subject: Secure Message from contracthelpdesk@wellmed.net   Hello Erica & CHD,   Hope you are doing well. This is a follow up email regarding the status for additional location in our Valley Med Urgent Care PLLC. Has there been any update?   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-17 09:20:24', '2021-08-17 09:20:24'),
(35071, 3040, 27330, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Email rcvd from: EriHernandez@wellmed.net, contracthelpdesk@wellmed.net  Subject: RE: [EXTERNAL] Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Good morning Erica ,  I sow the location was added as of 06/01/2021  WellMed-Horz_no tagline_COLOR logo_SIG ____________________________  Joe Gallegos Contract Specialist WellMed Medical Management, Inc.', NULL, NULL, '2021-08-27 09:16:54', '2021-08-27 09:16:54'),
(35072, 3040, 27331, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 10:13:10', '2021-05-03 10:13:10'),
(35073, 3040, 27331, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to: EriHernandez@wellmed.net  Subject: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Erica,   Hope you are doing well. Please find the attached Ancillary Credentialing application form for our group Valley Med Urgent Care under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-05-03 10:34:36', '2021-05-03 10:34:36'),
(35074, 3040, 27331, NULL, '2021-06-08 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more detail please see group task. ', NULL, NULL, '2021-06-01 11:14:03', '2021-06-01 11:14:03'),
(35075, 3040, 27331, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: rbyrd@wellmed.net  Subject: Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Rhonda,   Please advise the status of an additional location that was requested in the previous email. I already sent the credentialing form for an additional location along with W9.   If you need further information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 09:22:21', '2021-07-20 09:22:21'),
(35076, 3040, 27331, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: contracthelpdesk@wellmed.net  Subject: Secure Message from contracthelpdesk@wellmed.net   Hello Erica & CHD,   Hope you are doing well. This is a follow up email regarding the status for additional location in our Valley Med Urgent Care PLLC. Has there been any update?   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-17 09:20:23', '2021-08-17 09:20:23'),
(35077, 3040, 27331, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Email rcvd from: EriHernandez@wellmed.net, contracthelpdesk@wellmed.net  Subject: RE: [EXTERNAL] Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Good morning Erica ,  I sow the location was added as of 06/01/2021  WellMed-Horz_no tagline_COLOR logo_SIG ____________________________  Joe Gallegos Contract Specialist WellMed Medical Management, Inc.', NULL, NULL, '2021-08-27 09:16:53', '2021-08-27 09:16:53'),
(35078, 3040, 27332, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 10:13:10', '2021-05-03 10:13:10'),
(35079, 3040, 27332, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to: EriHernandez@wellmed.net  Subject: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Erica,   Hope you are doing well. Please find the attached Ancillary Credentialing application form for our group Valley Med Urgent Care under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-05-03 10:34:13', '2021-05-03 10:34:13'),
(35080, 3040, 27332, NULL, '2021-06-08 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more detail please see group task. ', NULL, NULL, '2021-06-01 11:14:07', '2021-06-01 11:14:07'),
(35081, 3040, 27332, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: rbyrd@wellmed.net  Subject: Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Rhonda,   Please advise the status of an additional location that was requested in the previous email. I already sent the credentialing form for an additional location along with W9.   If you need further information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 09:22:20', '2021-07-20 09:22:20'),
(35082, 3040, 27332, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: contracthelpdesk@wellmed.net  Subject: Secure Message from contracthelpdesk@wellmed.net   Hello Erica & CHD,   Hope you are doing well. This is a follow up email regarding the status for additional location in our Valley Med Urgent Care PLLC. Has there been any update?   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-17 09:20:23', '2021-08-17 09:20:23'),
(35083, 3040, 27332, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Email rcvd from: EriHernandez@wellmed.net, contracthelpdesk@wellmed.net  Subject: RE: [EXTERNAL] Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Good morning Erica ,  I sow the location was added as of 06/01/2021  WellMed-Horz_no tagline_COLOR logo_SIG ____________________________  Joe Gallegos Contract Specialist WellMed Medical Management, Inc.', NULL, NULL, '2021-08-27 09:16:53', '2021-08-27 09:16:53'),
(35084, 3040, 27333, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 10:13:10', '2021-05-03 10:13:10'),
(35085, 3040, 27333, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to: EriHernandez@wellmed.net  Subject: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Erica,   Hope you are doing well. Please find the attached Ancillary Credentialing application form for our group Valley Med Urgent Care under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-05-03 10:35:03', '2021-05-03 10:35:03'),
(35086, 3040, 27333, NULL, '2021-06-08 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more detail please see group task. ', NULL, NULL, '2021-06-01 11:14:11', '2021-06-01 11:14:11'),
(35087, 3040, 27333, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: rbyrd@wellmed.net  Subject: Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Rhonda,   Please advise the status of an additional location that was requested in the previous email. I already sent the credentialing form for an additional location along with W9.   If you need further information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 09:22:20', '2021-07-20 09:22:20'),
(35088, 3040, 27333, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: contracthelpdesk@wellmed.net  Subject: Secure Message from contracthelpdesk@wellmed.net   Hello Erica & CHD,   Hope you are doing well. This is a follow up email regarding the status for additional location in our Valley Med Urgent Care PLLC. Has there been any update?   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-17 09:20:23', '2021-08-17 09:20:23');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(35089, 3040, 27333, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Email rcvd from: EriHernandez@wellmed.net, contracthelpdesk@wellmed.net  Subject: RE: [EXTERNAL] Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Good morning Erica ,  I sow the location was added as of 06/01/2021  WellMed-Horz_no tagline_COLOR logo_SIG ____________________________  Joe Gallegos Contract Specialist WellMed Medical Management, Inc.', NULL, NULL, '2021-08-27 09:16:52', '2021-08-27 09:16:52'),
(35090, 3040, 27334, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 10:13:20', '2021-05-03 10:13:20'),
(35091, 3040, 27334, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to: EriHernandez@wellmed.net  Subject: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Erica,   Hope you are doing well. Please find the attached Ancillary Credentialing application form for our group Valley Med Urgent Care under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-05-03 10:18:25', '2021-05-03 10:18:25'),
(35092, 3040, 27334, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email rcvd from: EriHernandez@wellmed.net  Subject: Valley Med Urgent Care PLLC - TIN 81-5123542  Good Afternoon,     Thank you for your continued participation with Wellmed Medical Management, Inc. Your facility is due for re-credentialing in the near future. Please complete the attached WellMed re-appointment application. Page 1 is required for each address. Return all required documentation for each facility listed below and listed on page 3 of the attached application as soon as possible.  Please attach copies of following documents:  Ø  State license if applicable         Ø  Documentation (such as a letter) of participation in the Medicare program  Ø  Accreditation approval letter and/or certificate with expiration date. If NOT accredited by any of the named accreditation organizations, please submit a CMS or state report that a site survey has been performed for your facility.  (A site visit on behalf of CMS suffices as documentation of participation in the Medicare program as well)  Ø  CLIA certificate, as applicable  Ø  Bureau of Radiation Control certificate(s), as applicable  Ø  Liability face sheet  Ø  W-9  Ø  Additional Locations – All addresses require an application.  Please submit application and all supporting documentation for each address to erhernandez@wellmed.net  Your timely response is greatly appreciated! Let me know if you have any questions.  J', NULL, NULL, '2021-05-03 10:19:34', '2021-05-03 10:19:34'),
(35093, 3040, 27334, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: EriHernandez@wellmed.net  Subject:Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Erica,   Hope you are doing well. I wanted to check the application status for the below mentioned group.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need further assistance regarding the documents please feel free to call or email me. Waiting for your response.   Thanks ', NULL, NULL, '2021-06-01 11:14:50', '2021-06-01 11:14:50'),
(35094, 3040, 27334, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email rcvd from: EriHernandez@wellmed.net  Subject: Valley Med Urgent Care PLLC - TIN 81-5123542  Good morning,       Applications were received both locations:  2534 Boca Chica and 800 E Alton Gloor and re-credentialing will be completed.  Their current credentialing is good thru Dec 2021.    As for the 3rd location 101 E Expressway 83, Ste 170 we do not have that location in our database.   To add any additional locations please contact Contract Help Desk (contracthelpdesk@wellmed.net ).   Thank you.', NULL, NULL, '2021-06-21 09:03:10', '2021-06-21 09:03:10'),
(35095, 3040, 27334, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: contracthelpdesk@wellmed.net  Subject: Valley Med Urgent Care PLLC - TIN 81-5123542  Greetings,   Hope you are doing well. I wanted to add the additional location in our group Valley Med Urgent Care PLLC. As per Erica Hernandez our 3rd location is not showing in the database. Can you please advise the process to add location in Wellmed.   Below are the mentioned details:  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-21 09:06:51', '2021-06-21 09:06:51'),
(35096, 3040, 27334, NULL, '2021-07-15 00:00:00.000', 'In Process', 'Email sent to: rbyrd@wellmed.net  Subject: Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Rhonda,  Hope you are doing well. I received an email from your side in which you requested to send the credentialing form for additional location along with the W9. I already sent the credentialing application form to Erica Hernandez along with the documents.   If you need further information please let me know. Waiting for your response.   Thank you  ', NULL, NULL, '2021-07-08 16:34:32', '2021-07-08 16:34:32'),
(35097, 3040, 27334, NULL, '2021-07-15 00:00:00.000', 'In Process', 'Email rcvd from: rbyrd@wellmed.net  Subject: RE: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  I forwarded that to the contracting department this morning. Thank you!', NULL, NULL, '2021-07-08 16:35:21', '2021-07-08 16:35:21'),
(35098, 3040, 27334, NULL, '2021-07-15 00:00:00.000', 'In Process', 'Email sent to: rbyrd@wellmed.net  Subject: Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Rhonda,   Please advise the status of an additional location that was requested in the previous email. I already sent the credentialing form for an additional location along with W9.   If you need further information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-08 16:36:17', '2021-07-08 16:36:17'),
(35099, 3040, 27334, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email rcvd from: EriHernandez@wellmed.net  Subject: RE: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  CHD,  Please assist with email below for status on the additional location for Valley Med Urgent Care.', NULL, NULL, '2021-07-26 12:23:27', '2021-07-26 12:23:27'),
(35100, 3040, 27334, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: EriHernandez@wellmed.net  Subject: Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Erica,   Hope you are doing well. I wanted to know the status for the additional location in our group Valley Med Urgent Care PLLC.   Below are the mentioned details:  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-26 12:24:06', '2021-07-26 12:24:06'),
(35101, 3040, 27334, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: contracthelpdesk@wellmed.net  Subject: Secure Message from contracthelpdesk@wellmed.net   Hello Erica & CHD,   Hope you are doing well. This is a follow up email regarding the status for additional location in our Valley Med Urgent Care PLLC. Has there been any update?   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-17 09:20:22', '2021-08-17 09:20:22'),
(35102, 3040, 27334, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Email rcvd from: EriHernandez@wellmed.net, contracthelpdesk@wellmed.net  Subject: RE: [EXTERNAL] Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Good morning Erica ,  I sow the location was added as of 06/01/2021  WellMed-Horz_no tagline_COLOR logo_SIG ____________________________  Joe Gallegos Contract Specialist WellMed Medical Management, Inc.', NULL, NULL, '2021-08-27 09:16:52', '2021-08-27 09:16:52'),
(35103, 3040, 27335, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 10:13:31', '2021-05-03 10:13:31'),
(35104, 3040, 27335, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to: EriHernandez@wellmed.net  Subject: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Erica,   Hope you are doing well. Please find the attached Ancillary Credentialing application form for our group Valley Med Urgent Care under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-05-03 10:18:29', '2021-05-03 10:18:29'),
(35105, 3040, 27335, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email rcvd from: EriHernandez@wellmed.net  Subject: Valley Med Urgent Care PLLC - TIN 81-5123542  Good Afternoon,     Thank you for your continued participation with Wellmed Medical Management, Inc. Your facility is due for re-credentialing in the near future. Please complete the attached WellMed re-appointment application. Page 1 is required for each address. Return all required documentation for each facility listed below and listed on page 3 of the attached application as soon as possible.  Please attach copies of following documents:  Ø  State license if applicable         Ø  Documentation (such as a letter) of participation in the Medicare program  Ø  Accreditation approval letter and/or certificate with expiration date. If NOT accredited by any of the named accreditation organizations, please submit a CMS or state report that a site survey has been performed for your facility.  (A site visit on behalf of CMS suffices as documentation of participation in the Medicare program as well)  Ø  CLIA certificate, as applicable  Ø  Bureau of Radiation Control certificate(s), as applicable  Ø  Liability face sheet  Ø  W-9  Ø  Additional Locations – All addresses require an application.  Please submit application and all supporting documentation for each address to erhernandez@wellmed.net  Your timely response is greatly appreciated! Let me know if you have any questions.  J', NULL, NULL, '2021-05-03 10:19:38', '2021-05-03 10:19:38'),
(35106, 3040, 27335, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: EriHernandez@wellmed.net  Subject:Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Erica,   Hope you are doing well. I wanted to check the application status for the below mentioned group.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need further assistance regarding the documents please feel free to call or email me. Waiting for your response.   Thanks ', NULL, NULL, '2021-06-01 11:14:57', '2021-06-01 11:14:57'),
(35107, 3040, 27335, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email rcvd from: EriHernandez@wellmed.net  Subject: Valley Med Urgent Care PLLC - TIN 81-5123542  Good morning,       Applications were received both locations:  2534 Boca Chica and 800 E Alton Gloor and re-credentialing will be completed.  Their current credentialing is good thru Dec 2021.    As for the 3rd location 101 E Expressway 83, Ste 170 we do not have that location in our database.   To add any additional locations please contact Contract Help Desk (contracthelpdesk@wellmed.net ).   Thank you.', NULL, NULL, '2021-06-21 09:03:05', '2021-06-21 09:03:05'),
(35108, 3040, 27335, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: contracthelpdesk@wellmed.net  Subject: Valley Med Urgent Care PLLC - TIN 81-5123542  Greetings,   Hope you are doing well. I wanted to add the additional location in our group Valley Med Urgent Care PLLC. As per Erica Hernandez our 3rd location is not showing in the database. Can you please advise the process to add location in Wellmed.   Below are the mentioned details:  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-21 09:06:47', '2021-06-21 09:06:47'),
(35109, 3040, 27335, NULL, '2021-07-15 00:00:00.000', 'In Process', 'Email sent to: rbyrd@wellmed.net  Subject: Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Rhonda,  Hope you are doing well. I received an email from your side in which you requested to send the credentialing form for additional location along with the W9. I already sent the credentialing application form to Erica Hernandez along with the documents.   If you need further information please let me know. Waiting for your response.   Thank you  ', NULL, NULL, '2021-07-08 16:34:31', '2021-07-08 16:34:31'),
(35110, 3040, 27335, NULL, '2021-07-15 00:00:00.000', 'In Process', 'Email rcvd from: rbyrd@wellmed.net  Subject: RE: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  I forwarded that to the contracting department this morning. Thank you!', NULL, NULL, '2021-07-08 16:35:21', '2021-07-08 16:35:21'),
(35111, 3040, 27335, NULL, '2021-07-15 00:00:00.000', 'In Process', 'Email sent to: rbyrd@wellmed.net  Subject: Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Rhonda,   Please advise the status of an additional location that was requested in the previous email. I already sent the credentialing form for an additional location along with W9.   If you need further information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-08 16:36:17', '2021-07-08 16:36:17'),
(35112, 3040, 27335, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email rcvd from: EriHernandez@wellmed.net  Subject: RE: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  CHD,  Please assist with email below for status on the additional location for Valley Med Urgent Care.', NULL, NULL, '2021-07-26 12:23:24', '2021-07-26 12:23:24'),
(35113, 3040, 27335, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: EriHernandez@wellmed.net  Subject: Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Erica,   Hope you are doing well. I wanted to know the status for the additional location in our group Valley Med Urgent Care PLLC.   Below are the mentioned details:  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-26 12:24:06', '2021-07-26 12:24:06'),
(35114, 3040, 27335, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: contracthelpdesk@wellmed.net  Subject: Secure Message from contracthelpdesk@wellmed.net   Hello Erica & CHD,   Hope you are doing well. This is a follow up email regarding the status for additional location in our Valley Med Urgent Care PLLC. Has there been any update?   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-17 09:20:22', '2021-08-17 09:20:22'),
(35115, 3040, 27335, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Email rcvd from: EriHernandez@wellmed.net, contracthelpdesk@wellmed.net  Subject: RE: [EXTERNAL] Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Good morning Erica ,  I sow the location was added as of 06/01/2021  WellMed-Horz_no tagline_COLOR logo_SIG ____________________________  Joe Gallegos Contract Specialist WellMed Medical Management, Inc.', NULL, NULL, '2021-08-27 09:16:51', '2021-08-27 09:16:51'),
(35116, 3040, 27336, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 10:13:38', '2021-05-03 10:13:38'),
(35117, 3040, 27336, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to: EriHernandez@wellmed.net  Subject: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Erica,   Hope you are doing well. Please find the attached Ancillary Credentialing application form for our group Valley Med Urgent Care under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-05-03 10:18:17', '2021-05-03 10:18:17'),
(35118, 3040, 27336, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email rcvd from: EriHernandez@wellmed.net  Subject: Valley Med Urgent Care PLLC - TIN 81-5123542  Good Afternoon,     Thank you for your continued participation with Wellmed Medical Management, Inc. Your facility is due for re-credentialing in the near future. Please complete the attached WellMed re-appointment application. Page 1 is required for each address. Return all required documentation for each facility listed below and listed on page 3 of the attached application as soon as possible.  Please attach copies of following documents:  Ø  State license if applicable         Ø  Documentation (such as a letter) of participation in the Medicare program  Ø  Accreditation approval letter and/or certificate with expiration date. If NOT accredited by any of the named accreditation organizations, please submit a CMS or state report that a site survey has been performed for your facility.  (A site visit on behalf of CMS suffices as documentation of participation in the Medicare program as well)  Ø  CLIA certificate, as applicable  Ø  Bureau of Radiation Control certificate(s), as applicable  Ø  Liability face sheet  Ø  W-9  Ø  Additional Locations – All addresses require an application.  Please submit application and all supporting documentation for each address to erhernandez@wellmed.net  Your timely response is greatly appreciated! Let me know if you have any questions.  J', NULL, NULL, '2021-05-03 10:19:42', '2021-05-03 10:19:42'),
(35119, 3040, 27336, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: EriHernandez@wellmed.net  Subject:Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Erica,   Hope you are doing well. I wanted to check the application status for the below mentioned group.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need further assistance regarding the documents please feel free to call or email me. Waiting for your response.   Thanks ', NULL, NULL, '2021-06-01 11:15:04', '2021-06-01 11:15:04'),
(35120, 3040, 27336, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email rcvd from: EriHernandez@wellmed.net  Subject: Valley Med Urgent Care PLLC - TIN 81-5123542  Good morning,       Applications were received both locations:  2534 Boca Chica and 800 E Alton Gloor and re-credentialing will be completed.  Their current credentialing is good thru Dec 2021.    As for the 3rd location 101 E Expressway 83, Ste 170 we do not have that location in our database.   To add any additional locations please contact Contract Help Desk (contracthelpdesk@wellmed.net ).   Thank you.', NULL, NULL, '2021-06-21 09:03:01', '2021-06-21 09:03:01'),
(35121, 3040, 27336, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: contracthelpdesk@wellmed.net  Subject: Valley Med Urgent Care PLLC - TIN 81-5123542  Greetings,   Hope you are doing well. I wanted to add the additional location in our group Valley Med Urgent Care PLLC. As per Erica Hernandez our 3rd location is not showing in the database. Can you please advise the process to add location in Wellmed.   Below are the mentioned details:  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-21 09:06:42', '2021-06-21 09:06:42'),
(35122, 3040, 27336, NULL, '2021-07-15 00:00:00.000', 'In Process', 'Email sent to: rbyrd@wellmed.net  Subject: Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Rhonda,  Hope you are doing well. I received an email from your side in which you requested to send the credentialing form for additional location along with the W9. I already sent the credentialing application form to Erica Hernandez along with the documents.   If you need further information please let me know. Waiting for your response.   Thank you  ', NULL, NULL, '2021-07-08 16:34:30', '2021-07-08 16:34:30'),
(35123, 3040, 27336, NULL, '2021-07-15 00:00:00.000', 'In Process', 'Email rcvd from: rbyrd@wellmed.net  Subject: RE: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  I forwarded that to the contracting department this morning. Thank you!', NULL, NULL, '2021-07-08 16:35:20', '2021-07-08 16:35:20'),
(35124, 3040, 27336, NULL, '2021-07-15 00:00:00.000', 'In Process', 'Email sent to: rbyrd@wellmed.net  Subject: Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Rhonda,   Please advise the status of an additional location that was requested in the previous email. I already sent the credentialing form for an additional location along with W9.   If you need further information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-08 16:36:16', '2021-07-08 16:36:16'),
(35125, 3040, 27336, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email rcvd from: EriHernandez@wellmed.net  Subject: RE: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  CHD,  Please assist with email below for status on the additional location for Valley Med Urgent Care.', NULL, NULL, '2021-07-26 12:23:20', '2021-07-26 12:23:20'),
(35126, 3040, 27336, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: EriHernandez@wellmed.net  Subject: Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Erica,   Hope you are doing well. I wanted to know the status for the additional location in our group Valley Med Urgent Care PLLC.   Below are the mentioned details:  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-26 12:24:05', '2021-07-26 12:24:05'),
(35127, 3040, 27336, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: contracthelpdesk@wellmed.net  Subject: Secure Message from contracthelpdesk@wellmed.net   Hello Erica & CHD,   Hope you are doing well. This is a follow up email regarding the status for additional location in our Valley Med Urgent Care PLLC. Has there been any update?   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-17 09:20:21', '2021-08-17 09:20:21'),
(35128, 3040, 27336, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Email rcvd from: EriHernandez@wellmed.net, contracthelpdesk@wellmed.net  Subject: RE: [EXTERNAL] Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Good morning Erica ,  I sow the location was added as of 06/01/2021  WellMed-Horz_no tagline_COLOR logo_SIG ____________________________  Joe Gallegos Contract Specialist WellMed Medical Management, Inc.', NULL, NULL, '2021-08-27 09:16:50', '2021-08-27 09:16:50'),
(35129, 1019, 27337, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 15:22:29', '2021-05-03 15:22:29'),
(35130, 1019, 27337, NULL, '2021-05-11 00:00:00.000', 'Approved', 'Welcome Letter Attached. Effective date 01/23/2018 ', NULL, NULL, '2021-05-04 06:54:23', '2021-05-04 06:54:23'),
(35131, 1019, 27338, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 15:22:29', '2021-05-03 15:22:29'),
(35132, 1019, 27338, NULL, '2021-05-11 00:00:00.000', 'Approved', 'Welcome Letter Attached. Eff 11/27/2019', NULL, NULL, '2021-05-04 10:43:52', '2021-05-04 10:43:52'),
(35133, 1019, 27339, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 15:22:29', '2021-05-03 15:22:29'),
(35134, 1019, 27339, NULL, '2021-05-11 00:00:00.000', 'Approved', 'Welcome Letter attached, effective date 04/07/2020.', NULL, NULL, '2021-05-04 10:23:34', '2021-05-04 10:23:34'),
(35135, 1019, 27340, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 15:22:29', '2021-05-03 15:22:29'),
(35136, 1019, 27340, NULL, NULL, 'Approved', 'Approval Confirmation attached.  Eff 05/06/2020', NULL, NULL, '2021-05-04 11:09:18', '2021-05-04 11:09:18'),
(35137, 1019, 27341, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 15:22:29', '2021-05-03 15:22:29'),
(35138, 1019, 27341, NULL, NULL, 'Approved', 'Welcome Letter Attached- Eff 03/17/2020', NULL, NULL, '2021-05-04 10:59:12', '2021-05-04 10:59:12'),
(35139, 1019, 27342, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 15:22:44', '2021-05-03 15:22:44'),
(35140, 1019, 27342, NULL, '2021-05-11 00:00:00.000', 'Initiated', 'CAQH Application faxed to Network Operations at (866) 612-7790. ', NULL, NULL, '2021-05-04 08:45:27', '2021-05-04 08:45:27'),
(35141, 1019, 27342, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Sent the following email to : provider.relations@beaconhealthoptions.com SUB: Enrollment Status || Providers || SNBCARE || Beacon   Hello, Can you please let me know about the enrollment status for following providers under our group.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual NPI:  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Barbara Hignite NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Jessica Hartman NPI: 1326665472 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile NPI: 1942687108  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-05-04 08:45:36', '2021-05-04 08:45:36'),
(35142, 1019, 27342, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Received the following email from Sarah: provider.relations@beaconhealthoptions.com Good Morning, I have reviewed each provider file and have left notes below in red.  Rodesia Edmundson – Application received 4/6/21 and still processing – Event 9091975 NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Barbara Hignite – Application received 4/6/21 and still processing – Event 9091459 NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell – Application received 4/7/21 and still processing – Event 9093081 NPI: 1225645393 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich – Application received 4/5/21 and still processing – Event 9091316 NPI: 1710489760 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Justin Souliere – Application received 4/7/21 and still processing – Event 1098601 NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Jessica Hartman – CAQH Application needed – please complete attached application and return for processing NPI: 1326665472 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva – Application received 4/7/21 and still processing – Event 9093128 NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile – Application received 4/7/21 and still processing – Event 9093091 NPI: 1942687108  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Thank You!     Sarah Oakes  Network Management Rep I, Northeast  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive Suite 401  Woburn, MA 01801  Office: 800.397.1630  Direct: 781-496-4024  www.beaconhealthoptions.com ', NULL, NULL, '2021-05-04 08:45:49', '2021-05-04 08:45:49'),
(35143, 1019, 27342, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: RE: Enrollment Status || Providers || SNBCARE || Beacon attn Shashi  Hello Shashi, Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.   Individual Provider   L\'Etoile, Melody NPI: 1942687108 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Edmundson, Rodesia NPI: 1124622667 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Hefti, Prisca NPI: 1508133182 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Khan, Fauzia Wali NPI: 1699761965 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Pionke, Peggy NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rashid, Mahreen NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Schubert, Jonathan NPI: 1235755505 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Smith, Kerry NPI: 1275083230 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Tawakol, Katie NPI:1609222116 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-05-04 08:46:06', '2021-05-04 08:46:06'),
(35144, 1019, 27342, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: Enrollment Query || Group & Providers || SNBCARE || BHS/BHO ATTN Shashi  Hello Shashi,  Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Individual Provider     Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    L\'Etoile, Melody  NPI: 1942687108  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Edmundson, Rodesia NPI: 1124622667 Location: 100 New State Highway, Raynham, MA, 02767.     Hefti, Prisca NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.     Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.   Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Schubert, Jonathan NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.     Smith, Kerry NPI: 1275083230 Location: 100 New State Highway, Raynham, MA, 02767.     Tawakol, Katie NPI:1609222116 Location: 100 New State Highway, Raynham, MA, 02767.     Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-05-20 08:38:03', '2021-05-20 08:38:03'),
(35145, 1019, 27342, NULL, '2021-06-01 00:00:00.000', 'Approved', 'Received the Welcome Letter, for BHS Eff 05/04/2021.', NULL, NULL, '2021-05-25 08:09:40', '2021-05-25 08:09:40'),
(35146, 1019, 27343, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 15:22:44', '2021-05-03 15:22:44'),
(35147, 1019, 27343, NULL, '2021-05-11 00:00:00.000', 'Approved', 'Welcome Letter attached, eff 07/28/2021', NULL, NULL, '2021-05-04 10:26:55', '2021-05-04 10:26:55'),
(35148, 1019, 27344, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 15:22:44', '2021-05-03 15:22:44'),
(35149, 1019, 27344, NULL, '2021-05-11 00:00:00.000', 'Initiated', 'CAQH Application faxed to Network Operations at (866) 612-7790. ', NULL, NULL, '2021-05-04 07:11:02', '2021-05-04 07:11:02'),
(35150, 1019, 27344, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: RE: Enrollment Status || Providers || SNBCARE || Beacon attn Shashi  Hello Shashi, Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.   Individual Provider   L\'Etoile, Melody NPI: 1942687108 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Edmundson, Rodesia NPI: 1124622667 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Hefti, Prisca NPI: 1508133182 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Khan, Fauzia Wali NPI: 1699761965 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Pionke, Peggy NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rashid, Mahreen NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Schubert, Jonathan NPI: 1235755505 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Smith, Kerry NPI: 1275083230 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Tawakol, Katie NPI:1609222116 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-05-04 07:11:37', '2021-05-04 07:11:37'),
(35151, 1019, 27344, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: Enrollment Query || Group & Providers || SNBCARE || BHS/BHO ATTN Shashi  Hello Shashi,  Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Individual Provider     Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    L\'Etoile, Melody  NPI: 1942687108  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Edmundson, Rodesia NPI: 1124622667 Location: 100 New State Highway, Raynham, MA, 02767.     Hefti, Prisca NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.     Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.   Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Schubert, Jonathan NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.     Smith, Kerry NPI: 1275083230 Location: 100 New State Highway, Raynham, MA, 02767.     Tawakol, Katie NPI:1609222116 Location: 100 New State Highway, Raynham, MA, 02767.     Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-05-20 08:30:54', '2021-05-20 08:30:54'),
(35152, 1019, 27344, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com  SUB: Enrollment Query || Group & Providers || SNBCARE || BHS/BHO ATTN Shashi 2nd Attempt  Hello Shashi,  Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Individual Provider     Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    L\'Etoile, Melody  NPI: 1942687108  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Edmundson, Rodesia NPI: 1124622667 Location: 100 New State Highway, Raynham, MA, 02767.     Hefti, Prisca NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.     Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.   Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Schubert, Jonathan NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.     Smith, Kerry NPI: 1275083230 Location: 100 New State Highway, Raynham, MA, 02767.     Tawakol, Katie NPI:1609222116 Location: 100 New State Highway, Raynham, MA, 02767.     Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-06-05 11:25:11', '2021-06-05 11:25:11');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(35153, 1019, 27344, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Received the following email from provider.relations@beaconhealthoptions.com  Good afternoon Alex,  I am looking into. Need some time. Thank you for your patience.   Thank you! Shashi Seth Network Management Rep I, Northeast Provider Relations', NULL, NULL, '2021-06-24 08:22:41', '2021-06-24 08:22:41'),
(35154, 1019, 27344, NULL, '2021-09-03 00:00:00.000', 'Not Eligible', 'Provider is no longer working with SNBCARE ', NULL, NULL, '2021-08-27 08:34:54', '2021-08-27 08:34:54'),
(35155, 1019, 27345, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 15:22:45', '2021-05-03 15:22:45'),
(35156, 1019, 27345, NULL, '2021-05-11 00:00:00.000', 'On Hold', 'Waiting for Medicare. ', NULL, NULL, '2021-05-04 08:49:22', '2021-05-04 08:49:22'),
(35157, 1019, 27345, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Waiting to get credentialed first as Application already in process for NSF location, once done then will send application for Location Additions.', NULL, NULL, '2021-05-24 09:04:23', '2021-05-24 09:04:23'),
(35158, 1019, 27346, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 15:22:45', '2021-05-03 15:22:45'),
(35159, 1019, 27346, NULL, '2021-05-11 00:00:00.000', 'Initiated', 'CAQH Application faxed to Network Operations at (866) 612-7790. ', NULL, NULL, '2021-05-04 07:19:39', '2021-05-04 07:19:39'),
(35160, 1019, 27346, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Sent the following email to : provider.relations@beaconhealthoptions.com SUB: Enrollment Status || Providers || SNBCARE || Beacon   Hello, Can you please let me know about the enrollment status for following providers under our group.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual NPI:  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Barbara Hignite NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Jessica Hartman NPI: 1326665472 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile NPI: 1942687108  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-05-04 07:20:06', '2021-05-04 07:20:06'),
(35161, 1019, 27346, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Received the following email from Sarah: provider.relations@beaconhealthoptions.com Good Morning, I have reviewed each provider file and have left notes below in red.  Rodesia Edmundson – Application received 4/6/21 and still processing – Event 9091975 NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Barbara Hignite – Application received 4/6/21 and still processing – Event 9091459 NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell – Application received 4/7/21 and still processing – Event 9093081 NPI: 1225645393 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich – Application received 4/5/21 and still processing – Event 9091316 NPI: 1710489760 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Justin Souliere – Application received 4/7/21 and still processing – Event 1098601 NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Jessica Hartman – CAQH Application needed – please complete attached application and return for processing NPI: 1326665472 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva – Application received 4/7/21 and still processing – Event 9093128 NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile – Application received 4/7/21 and still processing – Event 9093091 NPI: 1942687108  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Thank You!     Sarah Oakes  Network Management Rep I, Northeast  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive Suite 401  Woburn, MA 01801  Office: 800.397.1630  Direct: 781-496-4024  www.beaconhealthoptions.com', NULL, NULL, '2021-05-04 07:20:20', '2021-05-04 07:20:20'),
(35162, 1019, 27346, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: RE: Enrollment Status || Providers || SNBCARE || Beacon attn Shashi Hello Shashi, Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.   Individual Provider   L\'Etoile, Melody NPI: 1942687108 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Edmundson, Rodesia NPI: 1124622667 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Hefti, Prisca NPI: 1508133182 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Khan, Fauzia Wali NPI: 1699761965 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Pionke, Peggy NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rashid, Mahreen NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Schubert, Jonathan NPI: 1235755505 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Smith, Kerry NPI: 1275083230 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Tawakol, Katie NPI:1609222116 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-05-04 07:20:34', '2021-05-04 07:20:34'),
(35163, 1019, 27346, NULL, '2021-05-24 00:00:00.000', 'Approved', '', NULL, NULL, '2021-05-17 07:43:26', '2021-05-17 07:43:26'),
(35164, 1019, 27347, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 15:22:45', '2021-05-03 15:22:45'),
(35165, 1019, 27347, NULL, '2021-05-11 00:00:00.000', 'Initiated', 'CAQH Application faxed to Network Operations at (866) 612-7790. ', NULL, NULL, '2021-05-04 07:32:05', '2021-05-04 07:32:05'),
(35166, 1019, 27347, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Sent the following email to : provider.relations@beaconhealthoptions.com SUB: Enrollment Status || Providers || SNBCARE || Beacon   Hello, Can you please let me know about the enrollment status for following providers under our group.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual NPI:  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Barbara Hignite NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Jessica Hartman NPI: 1326665472 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile NPI: 1942687108  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-05-04 07:32:18', '2021-05-04 07:32:18'),
(35167, 1019, 27347, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Received the following email from Sarah: provider.relations@beaconhealthoptions.com Good Morning, I have reviewed each provider file and have left notes below in red.  Rodesia Edmundson – Application received 4/6/21 and still processing – Event 9091975 NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Barbara Hignite – Application received 4/6/21 and still processing – Event 9091459 NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell – Application received 4/7/21 and still processing – Event 9093081 NPI: 1225645393 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich – Application received 4/5/21 and still processing – Event 9091316 NPI: 1710489760 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Justin Souliere – Application received 4/7/21 and still processing – Event 1098601 NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Jessica Hartman – CAQH Application needed – please complete attached application and return for processing NPI: 1326665472 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva – Application received 4/7/21 and still processing – Event 9093128 NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile – Application received 4/7/21 and still processing – Event 9093091 NPI: 1942687108  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Thank You!     Sarah Oakes  Network Management Rep I, Northeast  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive Suite 401  Woburn, MA 01801  Office: 800.397.1630  Direct: 781-496-4024  www.beaconhealthoptions.com', NULL, NULL, '2021-05-04 07:32:36', '2021-05-04 07:32:36'),
(35168, 1019, 27347, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Called Beacon @ (800) 397-1630 spoke with rep Sierra conversation is mentioned below:  All providers applications have been received and are under review and group is added under all three locations under both plans (BHO/BHS) we have request the copy of group contract. we\'ll receive the contract in 3-2 business days.  Ref# 04/22/2021 - 1371173 Sierra Y', NULL, NULL, '2021-05-04 07:32:48', '2021-05-04 07:32:48'),
(35169, 1019, 27347, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: RE: Enrollment Status || Providers || SNBCARE || Beacon attn Shashi Hello Shashi, Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.   Individual Provider   L\'Etoile, Melody NPI: 1942687108 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Edmundson, Rodesia NPI: 1124622667 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Hefti, Prisca NPI: 1508133182 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Khan, Fauzia Wali NPI: 1699761965 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Pionke, Peggy NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rashid, Mahreen NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Schubert, Jonathan NPI: 1235755505 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Smith, Kerry NPI: 1275083230 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Tawakol, Katie NPI:1609222116 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-05-04 07:33:01', '2021-05-04 07:33:01'),
(35170, 1019, 27347, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: Enrollment Query || Group & Providers || SNBCARE || BHS/BHO ATTN Shashi  Hello Shashi,  Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Individual Provider     Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    L\'Etoile, Melody  NPI: 1942687108  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Edmundson, Rodesia NPI: 1124622667 Location: 100 New State Highway, Raynham, MA, 02767.     Hefti, Prisca NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.     Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.   Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Schubert, Jonathan NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.     Smith, Kerry NPI: 1275083230 Location: 100 New State Highway, Raynham, MA, 02767.     Tawakol, Katie NPI:1609222116 Location: 100 New State Highway, Raynham, MA, 02767.     Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-05-20 08:29:18', '2021-05-20 08:29:18'),
(35171, 1019, 27347, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com  SUB: Enrollment Query || Group & Providers || SNBCARE || BHS/BHO ATTN Shashi 2nd Attempt  Hello Shashi,  Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Individual Provider     Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    L\'Etoile, Melody  NPI: 1942687108  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Edmundson, Rodesia NPI: 1124622667 Location: 100 New State Highway, Raynham, MA, 02767.     Hefti, Prisca NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.     Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.   Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Schubert, Jonathan NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.     Smith, Kerry NPI: 1275083230 Location: 100 New State Highway, Raynham, MA, 02767.     Tawakol, Katie NPI:1609222116 Location: 100 New State Highway, Raynham, MA, 02767.     Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-06-05 11:25:04', '2021-06-05 11:25:04'),
(35172, 1019, 27347, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Received the following email from provider.relations@beaconhealthoptions.com  Good afternoon Alex,  I am looking into. Need some time. Thank you for your patience.   Thank you! Shashi Seth Network Management Rep I, Northeast Provider Relations', NULL, NULL, '2021-06-24 08:20:12', '2021-06-24 08:20:12'),
(35173, 1019, 27347, NULL, '2021-08-31 00:00:00.000', 'Not Eligible', 'Cannot be enrolled due to her specialty see attached', NULL, NULL, '2021-08-24 11:20:41', '2021-08-24 11:20:41'),
(35174, 1019, 27348, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 15:22:57', '2021-05-03 15:22:57'),
(35175, 1019, 27348, NULL, '2021-05-11 00:00:00.000', 'Initiated', 'CAQH Application faxed to Network Operations at (866) 612-7790. ', NULL, NULL, '2021-05-04 07:47:27', '2021-05-04 07:47:27'),
(35176, 1019, 27348, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Sent the following email to : provider.relations@beaconhealthoptions.com SUB: Enrollment Status || Providers || SNBCARE || Beacon   Hello, Can you please let me know about the enrollment status for following providers under our group.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual NPI:  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Barbara Hignite NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Jessica Hartman NPI: 1326665472 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile NPI: 1942687108  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-05-04 07:47:44', '2021-05-04 07:47:44'),
(35177, 1019, 27348, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Received the following email from Sarah: provider.relations@beaconhealthoptions.com Good Morning, I have reviewed each provider file and have left notes below in red.  Rodesia Edmundson – Application received 4/6/21 and still processing – Event 9091975 NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Barbara Hignite – Application received 4/6/21 and still processing – Event 9091459 NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell – Application received 4/7/21 and still processing – Event 9093081 NPI: 1225645393 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich – Application received 4/5/21 and still processing – Event 9091316 NPI: 1710489760 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Justin Souliere – Application received 4/7/21 and still processing – Event 1098601 NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Jessica Hartman – CAQH Application needed – please complete attached application and return for processing NPI: 1326665472 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva – Application received 4/7/21 and still processing – Event 9093128 NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile – Application received 4/7/21 and still processing – Event 9093091 NPI: 1942687108  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Thank You!     Sarah Oakes  Network Management Rep I, Northeast  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive Suite 401  Woburn, MA 01801  Office: 800.397.1630  Direct: 781-496-4024  www.beaconhealthoptions.com', NULL, NULL, '2021-05-04 07:48:00', '2021-05-04 07:48:00'),
(35178, 1019, 27348, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Called Beacon @ (800) 397-1630 spoke with rep Sierra conversation is mentioned below:  All providers applications have been received and are under review and group is added under all three locations under both plans (BHO/BHS) we have request the copy of group contract. we\'ll receive the contract in 3-2 business days.  Ref# 04/22/2021 - 1371173 Sierra Y', NULL, NULL, '2021-05-04 07:48:12', '2021-05-04 07:48:12'),
(35179, 1019, 27348, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: RE: Enrollment Status || Providers || SNBCARE || Beacon attn Shashi  Hello Shashi, Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.   Individual Provider   L\'Etoile, Melody NPI: 1942687108 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Edmundson, Rodesia NPI: 1124622667 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Hefti, Prisca NPI: 1508133182 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Khan, Fauzia Wali NPI: 1699761965 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Pionke, Peggy NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rashid, Mahreen NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Schubert, Jonathan NPI: 1235755505 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Smith, Kerry NPI: 1275083230 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Tawakol, Katie NPI:1609222116 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-05-04 07:48:29', '2021-05-04 07:48:29'),
(35180, 1019, 27348, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: Enrollment Query || Group & Providers || SNBCARE || BHS/BHO ATTN Shashi  Hello Shashi,  Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Individual Provider     Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    L\'Etoile, Melody  NPI: 1942687108  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Edmundson, Rodesia NPI: 1124622667 Location: 100 New State Highway, Raynham, MA, 02767.     Hefti, Prisca NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.     Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.   Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Schubert, Jonathan NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.     Smith, Kerry NPI: 1275083230 Location: 100 New State Highway, Raynham, MA, 02767.     Tawakol, Katie NPI:1609222116 Location: 100 New State Highway, Raynham, MA, 02767.     Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-05-20 08:34:31', '2021-05-20 08:34:31'),
(35181, 1019, 27348, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com  SUB: Enrollment Query || Group & Providers || SNBCARE || BHS/BHO ATTN Shashi 2nd Attempt  Hello Shashi,  Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Individual Provider     Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    L\'Etoile, Melody  NPI: 1942687108  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Edmundson, Rodesia NPI: 1124622667 Location: 100 New State Highway, Raynham, MA, 02767.     Hefti, Prisca NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.     Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.   Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Schubert, Jonathan NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.     Smith, Kerry NPI: 1275083230 Location: 100 New State Highway, Raynham, MA, 02767.     Tawakol, Katie NPI:1609222116 Location: 100 New State Highway, Raynham, MA, 02767.     Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-06-05 11:24:57', '2021-06-05 11:24:57'),
(35182, 1019, 27348, NULL, '2021-06-30 00:00:00.000', 'Not Eligible', 'Received the following Denial Letter from Beacon as her ANCC certification is for AGNP. ', NULL, NULL, '2021-06-23 08:39:19', '2021-06-23 08:39:19'),
(35183, 1019, 27349, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 15:22:57', '2021-05-03 15:22:57'),
(35184, 1019, 27349, NULL, '2021-05-11 00:00:00.000', 'Initiated', 'Submitted RFA form to RFA@beaconhealthoptions.com. Attached for reference.  ', NULL, NULL, '2021-05-04 10:17:23', '2021-05-04 10:17:23'),
(35185, 1019, 27349, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Sent follow-up email @ provider.relations@beaconhealthoptions.com: \"Hello,   I need an update regarding the enrollment status of the following providers:   Provider Name: Lynneta Loveland NPI# 1598163602  Provider Name: Melody L\'Etoile NPI# 1942687108  Provider Name: Jessica Hartman NPI# 1326665472  Please get back to me as soon as you\'re able to.  Thanks.\"', NULL, NULL, '2021-05-04 10:17:36', '2021-05-04 10:17:36'),
(35186, 1019, 27349, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Submitted online application for enrollment', NULL, NULL, '2021-05-04 10:17:42', '2021-05-04 10:17:42'),
(35187, 1019, 27349, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: Enrollment Query || Group & Providers || SNBCARE || BHS/BHO ATTN Shashi  Hello Shashi,  Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Individual Provider     Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    L\'Etoile, Melody  NPI: 1942687108  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Edmundson, Rodesia NPI: 1124622667 Location: 100 New State Highway, Raynham, MA, 02767.     Hefti, Prisca NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.     Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.   Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Schubert, Jonathan NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.     Smith, Kerry NPI: 1275083230 Location: 100 New State Highway, Raynham, MA, 02767.     Tawakol, Katie NPI:1609222116 Location: 100 New State Highway, Raynham, MA, 02767.     Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-05-20 08:31:46', '2021-05-20 08:31:46'),
(35188, 1019, 27349, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com  SUB: Enrollment Query || Group & Providers || SNBCARE || BHS/BHO ATTN Shashi 2nd Attempt  Hello Shashi,  Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Individual Provider     Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    L\'Etoile, Melody  NPI: 1942687108  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Edmundson, Rodesia NPI: 1124622667 Location: 100 New State Highway, Raynham, MA, 02767.     Hefti, Prisca NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.     Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.   Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Schubert, Jonathan NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.     Smith, Kerry NPI: 1275083230 Location: 100 New State Highway, Raynham, MA, 02767.     Tawakol, Katie NPI:1609222116 Location: 100 New State Highway, Raynham, MA, 02767.     Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-06-05 11:24:49', '2021-06-05 11:24:49'),
(35189, 1019, 27349, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Received the following email from provider.relations@beaconhealthoptions.com  Good afternoon Alex,  I am looking into. Need some time. Thank you for your patience.   Thank you! Shashi Seth Network Management Rep I, Northeast Provider Relations', NULL, NULL, '2021-06-24 08:20:05', '2021-06-24 08:20:05'),
(35190, 1019, 27349, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com  Hello, Can you please let me know about the enrollment status for the following providers under our group.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual NPI:  Rodesia Edmundson NPI: 1124622667 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons  NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702.  Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Jessica Hartman NPI: 1326665472 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Prisca Hefti NPI: 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Barbara Hignite NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan  NPI: 1699761965  Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Lynetta Loveland NPI: 1598163602  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Cemetrice Muhammed NPI: 1548843410  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Regards,  Alex', NULL, NULL, '2021-08-24 11:22:59', '2021-08-24 11:22:59'),
(35191, 1019, 27349, NULL, '2021-09-20 00:00:00.000', 'Approved', 'Attached is the Welcome letter, eff 08/06/2021. ', NULL, NULL, '2021-09-13 08:55:00', '2021-09-13 08:55:00'),
(35192, 1019, 27350, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 15:22:57', '2021-05-03 15:22:57'),
(35193, 1019, 27350, NULL, '2021-05-11 00:00:00.000', 'Initiated', 'Enrollment Application faxed to Network Operations at (866) 612-7790 ', NULL, NULL, '2021-05-04 06:49:34', '2021-05-04 06:49:34'),
(35194, 1019, 27350, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Received the following email from provider.relations@beaconhealthoptions.com Good Afternoon,     I can confirm the application was received via fax on 3.31.21 and is currently being processed. Once a completed application is received it takes an additional 45 days for credentialing to be completed. It is with the credentialing department at this time. Please allow more time. Once completed a welcome letter with be sent out.     Thank You!     Sarah Oakes  Network Management Rep I, Northeast  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive Suite 401  Woburn, MA 01801  Office: 800.397.1630  Direct: 781-496-4024', NULL, NULL, '2021-05-04 06:49:49', '2021-05-04 06:49:49'),
(35195, 1019, 27350, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com Sub: Enrollment Status || Kerry Smith|| SNBCARE || Beacon  HelloCan you please let me know about the enrollment status for the following provider under our group. Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual NPI:  Kerry SmithNPI: 1275083230Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Regards, Alex', NULL, NULL, '2021-05-04 06:50:20', '2021-05-04 06:50:20');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(35196, 1019, 27350, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: RE: Enrollment Status || Providers || SNBCARE || Beacon attn Shashi  Hello Shashi, Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.   Individual Provider   L\'Etoile, Melody NPI: 1942687108 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Edmundson, Rodesia NPI: 1124622667 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Hefti, Prisca NPI: 1508133182 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Khan, Fauzia Wali NPI: 1699761965 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Pionke, Peggy NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rashid, Mahreen NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Schubert, Jonathan NPI: 1235755505 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Smith, Kerry NPI: 1275083230 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Tawakol, Katie NPI:1609222116 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-05-04 06:50:39', '2021-05-04 06:50:39'),
(35197, 1019, 27350, NULL, '2021-05-24 00:00:00.000', 'Approved', 'Welcome Letter Received, eff 04/30/2021', NULL, NULL, '2021-05-17 07:52:37', '2021-05-17 07:52:37'),
(35198, 1019, 27351, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 15:22:57', '2021-05-03 15:22:57'),
(35199, 1019, 27351, NULL, NULL, 'On Hold', 'Waiting on Missing Info from provider, so we can start credentialing.', NULL, NULL, '2021-05-04 08:53:11', '2021-05-04 08:53:11'),
(35200, 1019, 27351, NULL, '2021-05-17 00:00:00.000', 'Initiated', 'Sent the following email to provider.relations@beaconhealthoptions.com Hello Shashi,  We want to add the following under our group, I have attached the CAQH form for the provider. Let me know if you need anything else.  See attachment for reference', NULL, NULL, '2021-05-10 14:13:45', '2021-05-10 14:13:45'),
(35201, 1019, 27351, NULL, '2021-05-18 00:00:00.000', 'In Process', 'Received the following email from provider.relations@beaconhealthoptions.com-------- Good morning Alex, The clinician form for Mary Gibbons has been received and submitted. Thank you, Shashi Seth Network Management Rep I, Northeast', NULL, NULL, '2021-05-11 10:03:52', '2021-05-11 10:03:52'),
(35202, 1019, 27351, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: Enrollment Query || Group & Providers || SNBCARE || BHS/BHO ATTN Shashi  Hello Shashi,  Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Individual Provider     Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    L\'Etoile, Melody  NPI: 1942687108  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Edmundson, Rodesia NPI: 1124622667 Location: 100 New State Highway, Raynham, MA, 02767.     Hefti, Prisca NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.     Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.   Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Schubert, Jonathan NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.     Smith, Kerry NPI: 1275083230 Location: 100 New State Highway, Raynham, MA, 02767.     Tawakol, Katie NPI:1609222116 Location: 100 New State Highway, Raynham, MA, 02767.     Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-05-20 08:27:01', '2021-05-20 08:27:01'),
(35203, 1019, 27351, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com  SUB: Enrollment Query || Group & Providers || SNBCARE || BHS/BHO ATTN Shashi 2nd Attempt  Hello Shashi,  Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Individual Provider     Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    L\'Etoile, Melody  NPI: 1942687108  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Edmundson, Rodesia NPI: 1124622667 Location: 100 New State Highway, Raynham, MA, 02767.     Hefti, Prisca NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.     Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.   Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Schubert, Jonathan NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.     Smith, Kerry NPI: 1275083230 Location: 100 New State Highway, Raynham, MA, 02767.     Tawakol, Katie NPI:1609222116 Location: 100 New State Highway, Raynham, MA, 02767.     Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-06-05 11:24:31', '2021-06-05 11:24:31'),
(35204, 1019, 27351, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Received the following email from provider.relations@beaconhealthoptions.com  Good afternoon Alex,  I am looking into. Need some time. Thank you for your patience.   Thank you! Shashi Seth Network Management Rep I, Northeast Provider Relations', NULL, NULL, '2021-06-24 08:18:54', '2021-06-24 08:18:54'),
(35205, 1019, 27351, NULL, '2021-08-31 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCARE.', NULL, NULL, '2021-08-24 11:15:55', '2021-08-24 11:15:55'),
(35206, 1019, 27352, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 15:23:37', '2021-05-03 15:23:37'),
(35207, 1019, 27352, NULL, '2021-05-11 00:00:00.000', 'Initiated', 'Sent the following email to Shashi: provider.relations@beaconhealthoptions.com  Hello Shashi,   Attached are forms for Location addition for the group and individuals providers under that group. Let me know the timeframe for this request to be completed.     Regards, Alex', NULL, NULL, '2021-05-04 08:00:02', '2021-05-04 08:00:02'),
(35208, 1019, 27352, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: RE: Enrollment Status || Providers || SNBCARE || Beacon attn RI  Hello Sarah, We have to add a new location for our group, and also providers as well, please let us know the process to add our group and providers under our new location.   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 New Location: 100 New State Highway, Raynham, MA, 02767.   Individual Providers :   Fauzia Wali Khan NPI:1699761965 New Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 New Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 New Location: 100 New State Highway, Raynham, MA, 02767.   Mahreen Rashid NPI:1396393146 New Location: 100 New State Highway, Raynham, MA, 02767.   Peggy Pionke NPI: 1699307322 New Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 New Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182 New Location: 100 New State Highway, Raynham, MA, 02767.   Regards, Alex', NULL, NULL, '2021-05-04 08:00:20', '2021-05-04 08:00:20'),
(35209, 1019, 27352, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: RE: Enrollment Status || Providers || SNBCARE || Beacon attn Shashi  Hello Shashi, Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.   Individual Provider   L\'Etoile, Melody NPI: 1942687108 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Edmundson, Rodesia NPI: 1124622667 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Hefti, Prisca NPI: 1508133182 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Khan, Fauzia Wali NPI: 1699761965 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Pionke, Peggy NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rashid, Mahreen NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Schubert, Jonathan NPI: 1235755505 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Smith, Kerry NPI: 1275083230 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Tawakol, Katie NPI:1609222116 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-05-04 08:00:33', '2021-05-04 08:00:33'),
(35210, 1019, 27352, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: Enrollment Query || Group & Providers || SNBCARE || BHS/BHO ATTN Shashi  Hello Shashi,  Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Individual Provider     Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    L\'Etoile, Melody  NPI: 1942687108  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Edmundson, Rodesia NPI: 1124622667 Location: 100 New State Highway, Raynham, MA, 02767.     Hefti, Prisca NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.     Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.   Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Schubert, Jonathan NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.     Smith, Kerry NPI: 1275083230 Location: 100 New State Highway, Raynham, MA, 02767.     Tawakol, Katie NPI:1609222116 Location: 100 New State Highway, Raynham, MA, 02767.     Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-05-20 08:37:29', '2021-05-20 08:37:29'),
(35211, 1019, 27352, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com  SUB: Enrollment Query || Group & Providers || SNBCARE || BHS/BHO ATTN Shashi 2nd Attempt  Hello Shashi,  Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Individual Provider     Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    L\'Etoile, Melody  NPI: 1942687108  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Edmundson, Rodesia NPI: 1124622667 Location: 100 New State Highway, Raynham, MA, 02767.     Hefti, Prisca NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.     Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.   Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Schubert, Jonathan NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.     Smith, Kerry NPI: 1275083230 Location: 100 New State Highway, Raynham, MA, 02767.     Tawakol, Katie NPI:1609222116 Location: 100 New State Highway, Raynham, MA, 02767.     Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-06-05 11:24:24', '2021-06-05 11:24:24'),
(35212, 1019, 27352, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Received the following email from provider.relations@beaconhealthoptions.com  Good afternoon Alex,  I am looking into. Need some time. Thank you for your patience.   Thank you! Shashi Seth Network Management Rep I, Northeast Provider Relations', NULL, NULL, '2021-06-24 08:18:48', '2021-06-24 08:18:48'),
(35213, 1019, 27352, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com  Hello, Can you please let me know about the enrollment status for the following providers under our group.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual NPI:  Rodesia Edmundson NPI: 1124622667 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons  NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702.  Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Jessica Hartman NPI: 1326665472 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Prisca Hefti NPI: 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Barbara Hignite NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan  NPI: 1699761965  Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Lynetta Loveland NPI: 1598163602  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Cemetrice Muhammed NPI: 1548843410  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Regards,  Alex', NULL, NULL, '2021-08-24 11:25:55', '2021-08-24 11:25:55'),
(35214, 1019, 27352, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Location added effective date 02/05/2021, see attachment for ref ', NULL, NULL, '2021-08-27 08:16:06', '2021-08-27 08:16:06'),
(35215, 1019, 27353, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 15:23:37', '2021-05-03 15:23:37'),
(35216, 1019, 27353, NULL, '2021-05-11 00:00:00.000', 'Initiated', 'Sent the following email to Shashi: provider.relations@beaconhealthoptions.com  Hello Shashi,   Attached are forms for Location addition for the group and individuals providers under that group. Let me know the timeframe for this request to be completed.     Regards, Alex', NULL, NULL, '2021-05-04 07:41:24', '2021-05-04 07:41:24'),
(35217, 1019, 27353, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: RE: Enrollment Status || Providers || SNBCARE || Beacon attn RI  Hello Sarah, We have to add a new location for our group, and also providers as well, please let us know the process to add our group and providers under our new location.   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 New Location: 100 New State Highway, Raynham, MA, 02767.   Individual Providers :   Fauzia Wali Khan NPI:1699761965 New Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 New Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 New Location: 100 New State Highway, Raynham, MA, 02767.   Mahreen Rashid NPI:1396393146 New Location: 100 New State Highway, Raynham, MA, 02767.   Peggy Pionke NPI: 1699307322 New Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 New Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182 New Location: 100 New State Highway, Raynham, MA, 02767.   Regards, Alex', NULL, NULL, '2021-05-04 07:41:39', '2021-05-04 07:41:39'),
(35218, 1019, 27353, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: RE: Enrollment Status || Providers || SNBCARE || Beacon attn Shashi  Hello Shashi, Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.   Individual Provider   L\'Etoile, Melody NPI: 1942687108 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Edmundson, Rodesia NPI: 1124622667 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Hefti, Prisca NPI: 1508133182 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Khan, Fauzia Wali NPI: 1699761965 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Pionke, Peggy NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rashid, Mahreen NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Schubert, Jonathan NPI: 1235755505 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Smith, Kerry NPI: 1275083230 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Tawakol, Katie NPI:1609222116 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-05-04 07:41:56', '2021-05-04 07:41:56'),
(35219, 1019, 27353, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: Enrollment Query || Group & Providers || SNBCARE || BHS/BHO ATTN Shashi  Hello Shashi,  Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Individual Provider     Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    L\'Etoile, Melody  NPI: 1942687108  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Edmundson, Rodesia NPI: 1124622667 Location: 100 New State Highway, Raynham, MA, 02767.     Hefti, Prisca NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.     Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.   Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Schubert, Jonathan NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.     Smith, Kerry NPI: 1275083230 Location: 100 New State Highway, Raynham, MA, 02767.     Tawakol, Katie NPI:1609222116 Location: 100 New State Highway, Raynham, MA, 02767.     Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-05-20 08:33:49', '2021-05-20 08:33:49'),
(35220, 1019, 27353, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com  SUB: Enrollment Query || Group & Providers || SNBCARE || BHS/BHO ATTN Shashi 2nd Attempt  Hello Shashi,  Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Individual Provider     Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    L\'Etoile, Melody  NPI: 1942687108  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Edmundson, Rodesia NPI: 1124622667 Location: 100 New State Highway, Raynham, MA, 02767.     Hefti, Prisca NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.     Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.   Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Schubert, Jonathan NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.     Smith, Kerry NPI: 1275083230 Location: 100 New State Highway, Raynham, MA, 02767.     Tawakol, Katie NPI:1609222116 Location: 100 New State Highway, Raynham, MA, 02767.     Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-06-05 11:24:18', '2021-06-05 11:24:18'),
(35221, 1019, 27353, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Received the following email from provider.relations@beaconhealthoptions.com  Good afternoon Alex,  I am looking into. Need some time. Thank you for your patience.   Thank you! Shashi Seth Network Management Rep I, Northeast Provider Relations', NULL, NULL, '2021-06-24 08:18:41', '2021-06-24 08:18:41'),
(35222, 1019, 27353, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com  Hello, Can you please let me know about the enrollment status for the following providers under our group.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual NPI:  Rodesia Edmundson NPI: 1124622667 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons  NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702.  Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Jessica Hartman NPI: 1326665472 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Prisca Hefti NPI: 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Barbara Hignite NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan  NPI: 1699761965  Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Lynetta Loveland NPI: 1598163602  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Cemetrice Muhammed NPI: 1548843410  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Regards,  Alex', NULL, NULL, '2021-08-24 11:24:39', '2021-08-24 11:24:39'),
(35223, 1019, 27353, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Location added effective date 04/14/2021, see attachment for ref', NULL, NULL, '2021-08-27 08:22:33', '2021-08-27 08:22:33'),
(35224, 1019, 27354, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 15:23:37', '2021-05-03 15:23:37'),
(35225, 1019, 27354, NULL, '2021-05-11 00:00:00.000', 'Initiated', 'Sent the following email to Shashi: provider.relations@beaconhealthoptions.com  Hello Shashi,   Attached are forms for Location addition for the group and individuals providers under that group. Let me know the timeframe for this request to be completed.     Regards, Alex', NULL, NULL, '2021-05-04 07:24:27', '2021-05-04 07:24:27'),
(35226, 1019, 27354, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: RE: Enrollment Status || Providers || SNBCARE || Beacon attn RI  Hello Sarah, We have to add a new location for our group, and also providers as well, please let us know the process to add our group and providers under our new location.   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 New Location: 100 New State Highway, Raynham, MA, 02767.   Individual Providers :   Fauzia Wali Khan NPI:1699761965 New Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 New Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 New Location: 100 New State Highway, Raynham, MA, 02767.   Mahreen Rashid NPI:1396393146 New Location: 100 New State Highway, Raynham, MA, 02767.   Peggy Pionke NPI: 1699307322 New Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 New Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182 New Location: 100 New State Highway, Raynham, MA, 02767.   Regards, Alex', NULL, NULL, '2021-05-04 07:24:45', '2021-05-04 07:24:45'),
(35227, 1019, 27354, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Email sent to: mu@claimsmedinc.com, provider.relations@beaconhealthoptions.com  Subject: Enrollment Status || Providers || SNBCARE || Beacon attn RI  Hello Shashi,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers.   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 New Location: 100 New State Highway, Raynham, MA, 02767.   Individual Providers:   Fauzia Wali Khan NPI:1699761965 New Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 New Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 New Location: 100 New State Highway, Raynham, MA, 02767.   Mahreen Rashid NPI:1396393146 New Location: 100 New State Highway, Raynham, MA, 02767.   Peggy Pionke NPI: 1699307322 New Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 New Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182 New Location: 100 New State Highway, Raynham, MA, 02767.   Regards,', NULL, NULL, '2021-05-04 07:25:03', '2021-05-04 07:25:03'),
(35228, 1019, 27354, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: RE: Enrollment Status || Providers || SNBCARE || Beacon attn Shashi  Hello Shashi, Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.   Individual Provider   L\'Etoile, Melody NPI: 1942687108 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Edmundson, Rodesia NPI: 1124622667 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Hefti, Prisca NPI: 1508133182 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Khan, Fauzia Wali NPI: 1699761965 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Pionke, Peggy NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rashid, Mahreen NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Schubert, Jonathan NPI: 1235755505 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Smith, Kerry NPI: 1275083230 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Tawakol, Katie NPI:1609222116 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-05-04 07:25:28', '2021-05-04 07:25:28'),
(35229, 1019, 27354, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: Enrollment Query || Group & Providers || SNBCARE || BHS/BHO ATTN Shashi  Hello Shashi,  Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Individual Provider     Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    L\'Etoile, Melody  NPI: 1942687108  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Edmundson, Rodesia NPI: 1124622667 Location: 100 New State Highway, Raynham, MA, 02767.     Hefti, Prisca NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.     Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.   Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Schubert, Jonathan NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.     Smith, Kerry NPI: 1275083230 Location: 100 New State Highway, Raynham, MA, 02767.     Tawakol, Katie NPI:1609222116 Location: 100 New State Highway, Raynham, MA, 02767.     Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-05-20 08:28:37', '2021-05-20 08:28:37');
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
(35230, 1019, 27354, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com  SUB: Enrollment Query || Group & Providers || SNBCARE || BHS/BHO ATTN Shashi 2nd Attempt  Hello Shashi,  Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Individual Provider     Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    L\'Etoile, Melody  NPI: 1942687108  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Edmundson, Rodesia NPI: 1124622667 Location: 100 New State Highway, Raynham, MA, 02767.     Hefti, Prisca NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.     Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.   Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Schubert, Jonathan NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.     Smith, Kerry NPI: 1275083230 Location: 100 New State Highway, Raynham, MA, 02767.     Tawakol, Katie NPI:1609222116 Location: 100 New State Highway, Raynham, MA, 02767.     Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-06-05 11:24:12', '2021-06-05 11:24:12'),
(35231, 1019, 27354, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Received the following email from provider.relations@beaconhealthoptions.com  Good afternoon Alex,  I am looking into. Need some time. Thank you for your patience.   Thank you! Shashi Seth Network Management Rep I, Northeast Provider Relations', NULL, NULL, '2021-06-24 08:18:35', '2021-06-24 08:18:35'),
(35232, 1019, 27354, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com  Hello, Can you please let me know about the enrollment status for the following providers under our group.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual NPI:  Rodesia Edmundson NPI: 1124622667 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons  NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702.  Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Jessica Hartman NPI: 1326665472 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Prisca Hefti NPI: 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Barbara Hignite NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan  NPI: 1699761965  Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Lynetta Loveland NPI: 1598163602  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Cemetrice Muhammed NPI: 1548843410  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Regards,  Alex', NULL, NULL, '2021-08-24 11:17:24', '2021-08-24 11:17:24'),
(35233, 1019, 27354, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Location added effective date 04/19/2021, see attachment for ref', NULL, NULL, '2021-08-27 08:28:13', '2021-08-27 08:28:13'),
(35234, 1019, 27355, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 15:23:37', '2021-05-03 15:23:37'),
(35235, 1019, 27355, NULL, '2021-05-11 00:00:00.000', 'Initiated', 'Sent the following email to Shashi: provider.relations@beaconhealthoptions.com  Hello Shashi,   Attached are forms for Location addition for the group and individuals providers under that group. Let me know the timeframe for this request to be completed.     Regards, Alex', NULL, NULL, '2021-05-04 08:04:36', '2021-05-04 08:04:36'),
(35236, 1019, 27355, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: RE: Enrollment Status || Providers || SNBCARE || Beacon attn RI  Hello Sarah, We have to add a new location for our group, and also providers as well, please let us know the process to add our group and providers under our new location.   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 New Location: 100 New State Highway, Raynham, MA, 02767.   Individual Providers :   Fauzia Wali Khan NPI:1699761965 New Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 New Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 New Location: 100 New State Highway, Raynham, MA, 02767.   Mahreen Rashid NPI:1396393146 New Location: 100 New State Highway, Raynham, MA, 02767.   Peggy Pionke NPI: 1699307322 New Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 New Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182 New Location: 100 New State Highway, Raynham, MA, 02767.   Regards, Alex', NULL, NULL, '2021-05-04 08:04:48', '2021-05-04 08:04:48'),
(35237, 1019, 27355, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: RE: Enrollment Status || Providers || SNBCARE || Beacon attn Shashi Hello Shashi, Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.   Individual Provider   L\'Etoile, Melody NPI: 1942687108 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Edmundson, Rodesia NPI: 1124622667 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Hefti, Prisca NPI: 1508133182 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Khan, Fauzia Wali NPI: 1699761965 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Pionke, Peggy NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rashid, Mahreen NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Schubert, Jonathan NPI: 1235755505 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Smith, Kerry NPI: 1275083230 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Tawakol, Katie NPI:1609222116 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-05-04 08:05:02', '2021-05-04 08:05:02'),
(35238, 1019, 27355, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: Enrollment Query || Group & Providers || SNBCARE || BHS/BHO ATTN Shashi  Hello Shashi,  Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Individual Provider     Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    L\'Etoile, Melody  NPI: 1942687108  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Edmundson, Rodesia NPI: 1124622667 Location: 100 New State Highway, Raynham, MA, 02767.     Hefti, Prisca NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.     Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.   Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Schubert, Jonathan NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.     Smith, Kerry NPI: 1275083230 Location: 100 New State Highway, Raynham, MA, 02767.     Tawakol, Katie NPI:1609222116 Location: 100 New State Highway, Raynham, MA, 02767.     Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-05-20 08:30:04', '2021-05-20 08:30:04'),
(35239, 1019, 27355, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com  SUB: Enrollment Query || Group & Providers || SNBCARE || BHS/BHO ATTN Shashi 2nd Attempt  Hello Shashi,  Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Individual Provider     Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    L\'Etoile, Melody  NPI: 1942687108  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Edmundson, Rodesia NPI: 1124622667 Location: 100 New State Highway, Raynham, MA, 02767.     Hefti, Prisca NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.     Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.   Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Schubert, Jonathan NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.     Smith, Kerry NPI: 1275083230 Location: 100 New State Highway, Raynham, MA, 02767.     Tawakol, Katie NPI:1609222116 Location: 100 New State Highway, Raynham, MA, 02767.     Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-06-05 11:24:04', '2021-06-05 11:24:04'),
(35240, 1019, 27355, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Received the following email from provider.relations@beaconhealthoptions.com  Good afternoon Alex,  I am looking into. Need some time. Thank you for your patience.   Thank you! Shashi Seth Network Management Rep I, Northeast Provider Relations', NULL, NULL, '2021-06-24 08:18:29', '2021-06-24 08:18:29'),
(35241, 1019, 27355, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com  Hello, Can you please let me know about the enrollment status for the following providers under our group.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual NPI:  Rodesia Edmundson NPI: 1124622667 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons  NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702.  Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Jessica Hartman NPI: 1326665472 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Prisca Hefti NPI: 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Barbara Hignite NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan  NPI: 1699761965  Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Lynetta Loveland NPI: 1598163602  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Cemetrice Muhammed NPI: 1548843410  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Regards,  Alex', NULL, NULL, '2021-08-24 11:22:17', '2021-08-24 11:22:17'),
(35242, 1019, 27355, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Location added effective date 04/19/2021, see attachment for ref', NULL, NULL, '2021-08-27 08:26:55', '2021-08-27 08:26:55'),
(35243, 1019, 27356, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 15:23:37', '2021-05-03 15:23:37'),
(35244, 1019, 27356, NULL, '2021-05-11 00:00:00.000', 'Initiated', 'Sent the following email to Shashi: provider.relations@beaconhealthoptions.com  Hello Shashi,   Attached are forms for Location addition for the group and individuals providers under that group. Let me know the timeframe for this request to be completed.     Regards, Alex', NULL, NULL, '2021-05-04 07:39:15', '2021-05-04 07:39:15'),
(35245, 1019, 27356, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: RE: Enrollment Status || Providers || SNBCARE || Beacon attn RI  Hello Sarah, We have to add a new location for our group, and also providers as well, please let us know the process to add our group and providers under our new location.   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 New Location: 100 New State Highway, Raynham, MA, 02767.   Individual Providers :   Fauzia Wali Khan NPI:1699761965 New Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 New Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 New Location: 100 New State Highway, Raynham, MA, 02767.   Mahreen Rashid NPI:1396393146 New Location: 100 New State Highway, Raynham, MA, 02767.   Peggy Pionke NPI: 1699307322 New Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 New Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182 New Location: 100 New State Highway, Raynham, MA, 02767.   Regards, Alex', NULL, NULL, '2021-05-04 07:39:32', '2021-05-04 07:39:32'),
(35246, 1019, 27356, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: RE: Enrollment Status || Providers || SNBCARE || Beacon attn Shashi Hello Shashi, Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.   Individual Provider   L\'Etoile, Melody NPI: 1942687108 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Edmundson, Rodesia NPI: 1124622667 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Hefti, Prisca NPI: 1508133182 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Khan, Fauzia Wali NPI: 1699761965 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Pionke, Peggy NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rashid, Mahreen NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Schubert, Jonathan NPI: 1235755505 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Smith, Kerry NPI: 1275083230 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Tawakol, Katie NPI:1609222116 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-05-04 07:39:46', '2021-05-04 07:39:46'),
(35247, 1019, 27356, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: Enrollment Query || Group & Providers || SNBCARE || BHS/BHO ATTN Shashi  Hello Shashi,  Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Individual Provider     Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    L\'Etoile, Melody  NPI: 1942687108  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Edmundson, Rodesia NPI: 1124622667 Location: 100 New State Highway, Raynham, MA, 02767.     Hefti, Prisca NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.     Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.   Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Schubert, Jonathan NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.     Smith, Kerry NPI: 1275083230 Location: 100 New State Highway, Raynham, MA, 02767.     Tawakol, Katie NPI:1609222116 Location: 100 New State Highway, Raynham, MA, 02767.     Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-05-20 08:33:13', '2021-05-20 08:33:13'),
(35248, 1019, 27356, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com  SUB: Enrollment Query || Group & Providers || SNBCARE || BHS/BHO ATTN Shashi 2nd Attempt  Hello Shashi,  Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Individual Provider     Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    L\'Etoile, Melody  NPI: 1942687108  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Edmundson, Rodesia NPI: 1124622667 Location: 100 New State Highway, Raynham, MA, 02767.     Hefti, Prisca NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.     Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.   Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Schubert, Jonathan NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.     Smith, Kerry NPI: 1275083230 Location: 100 New State Highway, Raynham, MA, 02767.     Tawakol, Katie NPI:1609222116 Location: 100 New State Highway, Raynham, MA, 02767.     Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-06-05 11:23:40', '2021-06-05 11:23:40'),
(35249, 1019, 27356, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Received the following email from provider.relations@beaconhealthoptions.com  Good afternoon Alex,  I am looking into. Need some time. Thank you for your patience.   Thank you! Shashi Seth Network Management Rep I, Northeast Provider Relations', NULL, NULL, '2021-06-24 08:18:22', '2021-06-24 08:18:22'),
(35250, 1019, 27356, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com  Hello, Can you please let me know about the enrollment status for the following providers under our group.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual NPI:  Rodesia Edmundson NPI: 1124622667 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons  NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702.  Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Jessica Hartman NPI: 1326665472 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Prisca Hefti NPI: 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Barbara Hignite NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan  NPI: 1699761965  Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Lynetta Loveland NPI: 1598163602  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Cemetrice Muhammed NPI: 1548843410  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Regards,  Alex', NULL, NULL, '2021-08-24 11:24:11', '2021-08-24 11:24:11'),
(35251, 1019, 27356, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Location added effective date 04/19/2021, see attachment for ref', NULL, NULL, '2021-08-27 08:24:44', '2021-08-27 08:24:44'),
(35252, 1019, 27357, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 15:23:37', '2021-05-03 15:23:37'),
(35253, 1019, 27357, NULL, '2021-05-11 00:00:00.000', 'Initiated', 'CAQH Application faxed to Network Operations at (866) 612-7790. ', NULL, NULL, '2021-05-04 08:02:24', '2021-05-04 08:02:24'),
(35254, 1019, 27357, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Sent the following email to : provider.relations@beaconhealthoptions.com SUB: Enrollment Status || Providers || SNBCARE || Beacon   Hello, Can you please let me know about the enrollment status for following providers under our group.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual NPI:  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Barbara Hignite NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Jessica Hartman NPI: 1326665472 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile NPI: 1942687108  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-05-04 08:02:37', '2021-05-04 08:02:37'),
(35255, 1019, 27357, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Received the following email from Sarah: provider.relations@beaconhealthoptions.com Good Morning, I have reviewed each provider file and have left notes below in red. Rodesia Edmundson – Application received 4/6/21 and still processing – Event 9091975 NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Barbara Hignite – Application received 4/6/21 and still processing – Event 9091459 NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell – Application received 4/7/21 and still processing – Event 9093081 NPI: 1225645393 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich – Application received 4/5/21 and still processing – Event 9091316 NPI: 1710489760 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Justin Souliere – Application received 4/7/21 and still processing – Event 1098601 NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Jessica Hartman – CAQH Application needed – please complete attached application and return for processing NPI: 1326665472 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva – Application received 4/7/21 and still processing – Event 9093128 NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile – Application received 4/7/21 and still processing – Event 9093091 NPI: 1942687108  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Thank You!     Sarah Oakes  Network Management Rep I, Northeast  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive Suite 401  Woburn, MA 01801  Office: 800.397.1630  Direct: 781-496-4024  www.beaconhealthoptions.com', NULL, NULL, '2021-05-04 08:02:49', '2021-05-04 08:02:49'),
(35256, 1019, 27357, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Called Beacon @ (800) 397-1630 spoke with rep Sierra conversation is mentioned below:  All providers applications have been received and are under review and group is added under all three locations under both plans (BHO/BHS) we have request the copy of group contract. we\'ll receive the contract in 3-2 business days.  Ref# 04/22/2021 - 1371173 Sierra Y', NULL, NULL, '2021-05-04 08:02:58', '2021-05-04 08:02:58'),
(35257, 1019, 27357, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: RE: Enrollment Status || Providers || SNBCARE || Beacon attn Shashi  Hello Shashi, Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.   Individual Provider   L\'Etoile, Melody NPI: 1942687108 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Edmundson, Rodesia NPI: 1124622667 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Hefti, Prisca NPI: 1508133182 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Khan, Fauzia Wali NPI: 1699761965 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Pionke, Peggy NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rashid, Mahreen NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Schubert, Jonathan NPI: 1235755505 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Smith, Kerry NPI: 1275083230 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Tawakol, Katie NPI:1609222116 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-05-04 08:03:13', '2021-05-04 08:03:13'),
(35258, 1019, 27357, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: Enrollment Query || Group & Providers || SNBCARE || BHS/BHO ATTN Shashi  Hello Shashi,  Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Individual Provider     Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    L\'Etoile, Melody  NPI: 1942687108  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Edmundson, Rodesia NPI: 1124622667 Location: 100 New State Highway, Raynham, MA, 02767.     Hefti, Prisca NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.     Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.   Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Schubert, Jonathan NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.     Smith, Kerry NPI: 1275083230 Location: 100 New State Highway, Raynham, MA, 02767.     Tawakol, Katie NPI:1609222116 Location: 100 New State Highway, Raynham, MA, 02767.     Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-05-20 08:38:13', '2021-05-20 08:38:13'),
(35259, 1019, 27357, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com  SUB: Enrollment Query || Group & Providers || SNBCARE || BHS/BHO ATTN Shashi 2nd Attempt  Hello Shashi,  Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Individual Provider     Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    L\'Etoile, Melody  NPI: 1942687108  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Edmundson, Rodesia NPI: 1124622667 Location: 100 New State Highway, Raynham, MA, 02767.     Hefti, Prisca NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.     Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.   Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Schubert, Jonathan NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.     Smith, Kerry NPI: 1275083230 Location: 100 New State Highway, Raynham, MA, 02767.     Tawakol, Katie NPI:1609222116 Location: 100 New State Highway, Raynham, MA, 02767.     Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-06-05 11:23:32', '2021-06-05 11:23:32'),
(35260, 1019, 27357, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Received the following email from provider.relations@beaconhealthoptions.com  Good afternoon Alex,  I am looking into. Need some time. Thank you for your patience.   Thank you! Shashi Seth Network Management Rep I, Northeast Provider Relations', NULL, NULL, '2021-06-24 08:18:11', '2021-06-24 08:18:11'),
(35261, 1019, 27357, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com  Hello, Can you please let me know about the enrollment status for the following providers under our group.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual NPI:  Rodesia Edmundson NPI: 1124622667 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons  NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702.  Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Jessica Hartman NPI: 1326665472 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Prisca Hefti NPI: 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Barbara Hignite NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan  NPI: 1699761965  Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Lynetta Loveland NPI: 1598163602  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Cemetrice Muhammed NPI: 1548843410  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Regards,  Alex', NULL, NULL, '2021-08-24 11:26:14', '2021-08-24 11:26:14'),
(35262, 1019, 27357, NULL, '2021-09-02 00:00:00.000', 'Approved', 'Location added effective date 05/04/2021, see attached for ref', NULL, NULL, '2021-08-26 14:05:50', '2021-08-26 14:05:50'),
(35263, 1019, 27358, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 15:23:37', '2021-05-03 15:23:37'),
(35264, 1019, 27358, NULL, '2021-05-11 00:00:00.000', 'Initiated', 'Sent the following email to Shashi: provider.relations@beaconhealthoptions.com  Hello Shashi,   Attached are forms for Location addition for the group and individuals providers under that group. Let me know the timeframe for this request to be completed.     Regards, Alex', NULL, NULL, '2021-05-04 07:51:02', '2021-05-04 07:51:02'),
(35265, 1019, 27358, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: RE: Enrollment Status || Providers || SNBCARE || Beacon attn RI  Hello Sarah, We have to add a new location for our group, and also providers as well, please let us know the process to add our group and providers under our new location.   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 New Location: 100 New State Highway, Raynham, MA, 02767.   Individual Providers :   Fauzia Wali Khan NPI:1699761965 New Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 New Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 New Location: 100 New State Highway, Raynham, MA, 02767.   Mahreen Rashid NPI:1396393146 New Location: 100 New State Highway, Raynham, MA, 02767.   Peggy Pionke NPI: 1699307322 New Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 New Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182 New Location: 100 New State Highway, Raynham, MA, 02767.   Regards, Alex', NULL, NULL, '2021-05-04 07:51:20', '2021-05-04 07:51:20');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(35266, 1019, 27358, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: RE: Enrollment Status || Providers || SNBCARE || Beacon attn Shashi  Hello Shashi, Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.   Individual Provider   L\'Etoile, Melody NPI: 1942687108 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Edmundson, Rodesia NPI: 1124622667 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Hefti, Prisca NPI: 1508133182 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Khan, Fauzia Wali NPI: 1699761965 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Pionke, Peggy NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rashid, Mahreen NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Schubert, Jonathan NPI: 1235755505 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Smith, Kerry NPI: 1275083230 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Tawakol, Katie NPI:1609222116 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-05-04 07:51:38', '2021-05-04 07:51:38'),
(35267, 1019, 27358, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: Enrollment Query || Group & Providers || SNBCARE || BHS/BHO ATTN Shashi  Hello Shashi,  Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Individual Provider     Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    L\'Etoile, Melody  NPI: 1942687108  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Edmundson, Rodesia NPI: 1124622667 Location: 100 New State Highway, Raynham, MA, 02767.     Hefti, Prisca NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.     Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.   Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Schubert, Jonathan NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.     Smith, Kerry NPI: 1275083230 Location: 100 New State Highway, Raynham, MA, 02767.     Tawakol, Katie NPI:1609222116 Location: 100 New State Highway, Raynham, MA, 02767.     Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-05-20 08:35:12', '2021-05-20 08:35:12'),
(35268, 1019, 27358, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com  SUB: Enrollment Query || Group & Providers || SNBCARE || BHS/BHO ATTN Shashi 2nd Attempt  Hello Shashi,  Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Individual Provider     Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    L\'Etoile, Melody  NPI: 1942687108  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Edmundson, Rodesia NPI: 1124622667 Location: 100 New State Highway, Raynham, MA, 02767.     Hefti, Prisca NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.     Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.   Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Schubert, Jonathan NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.     Smith, Kerry NPI: 1275083230 Location: 100 New State Highway, Raynham, MA, 02767.     Tawakol, Katie NPI:1609222116 Location: 100 New State Highway, Raynham, MA, 02767.     Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-06-05 11:23:26', '2021-06-05 11:23:26'),
(35269, 1019, 27358, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Received the following email from provider.relations@beaconhealthoptions.com  Good afternoon Alex,  I am looking into. Need some time. Thank you for your patience.   Thank you! Shashi Seth Network Management Rep I, Northeast Provider Relations', NULL, NULL, '2021-06-24 08:18:04', '2021-06-24 08:18:04'),
(35270, 1019, 27358, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com  Hello, Can you please let me know about the enrollment status for the following providers under our group.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual NPI:  Rodesia Edmundson NPI: 1124622667 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons  NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702.  Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Jessica Hartman NPI: 1326665472 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Prisca Hefti NPI: 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Barbara Hignite NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan  NPI: 1699761965  Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Lynetta Loveland NPI: 1598163602  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Cemetrice Muhammed NPI: 1548843410  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Regards,  Alex', NULL, NULL, '2021-08-24 11:25:02', '2021-08-24 11:25:02'),
(35271, 1019, 27358, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Location added effective date 07/28/2020, see attachment for ref', NULL, NULL, '2021-08-27 08:20:10', '2021-08-27 08:20:10'),
(35272, 1019, 27359, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 15:23:38', '2021-05-03 15:23:38'),
(35273, 1019, 27359, NULL, '2021-05-11 00:00:00.000', 'Initiated', 'CAQH Application faxed to Network Operations at (866) 612-7790. ', NULL, NULL, '2021-05-04 07:08:04', '2021-05-04 07:08:04'),
(35274, 1019, 27359, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: RE: Enrollment Status || Providers || SNBCARE || Beacon attn Shashi  Hello Shashi, Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.   Individual Provider   L\'Etoile, Melody NPI: 1942687108 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Edmundson, Rodesia NPI: 1124622667 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Hefti, Prisca NPI: 1508133182 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Khan, Fauzia Wali NPI: 1699761965 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Pionke, Peggy NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rashid, Mahreen NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Schubert, Jonathan NPI: 1235755505 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Smith, Kerry NPI: 1275083230 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Tawakol, Katie NPI:1609222116 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-05-04 07:08:21', '2021-05-04 07:08:21'),
(35275, 1019, 27359, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: Enrollment Query || Group & Providers || SNBCARE || BHS/BHO ATTN Shashi  Hello Shashi,  Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Individual Provider     Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    L\'Etoile, Melody  NPI: 1942687108  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Edmundson, Rodesia NPI: 1124622667 Location: 100 New State Highway, Raynham, MA, 02767.     Hefti, Prisca NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.     Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.   Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Schubert, Jonathan NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.     Smith, Kerry NPI: 1275083230 Location: 100 New State Highway, Raynham, MA, 02767.     Tawakol, Katie NPI:1609222116 Location: 100 New State Highway, Raynham, MA, 02767.     Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-05-20 08:31:01', '2021-05-20 08:31:01'),
(35276, 1019, 27359, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com  SUB: Enrollment Query || Group & Providers || SNBCARE || BHS/BHO ATTN Shashi 2nd Attempt  Hello Shashi,  Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Individual Provider     Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    L\'Etoile, Melody  NPI: 1942687108  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Edmundson, Rodesia NPI: 1124622667 Location: 100 New State Highway, Raynham, MA, 02767.     Hefti, Prisca NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.     Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.   Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Schubert, Jonathan NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.     Smith, Kerry NPI: 1275083230 Location: 100 New State Highway, Raynham, MA, 02767.     Tawakol, Katie NPI:1609222116 Location: 100 New State Highway, Raynham, MA, 02767.     Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-06-05 11:23:19', '2021-06-05 11:23:19'),
(35277, 1019, 27359, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Received the following email from provider.relations@beaconhealthoptions.com  Good afternoon Alex,  I am looking into. Need some time. Thank you for your patience.   Thank you! Shashi Seth Network Management Rep I, Northeast Provider Relations', NULL, NULL, '2021-06-24 08:17:55', '2021-06-24 08:17:55'),
(35278, 1019, 27359, NULL, '2021-09-03 00:00:00.000', 'Not Eligible', 'Provider is no longer working with SNBCARE ', NULL, NULL, '2021-08-27 08:34:43', '2021-08-27 08:34:43'),
(35279, 1019, 27360, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 15:23:38', '2021-05-03 15:23:38'),
(35280, 1019, 27360, NULL, '2021-05-11 00:00:00.000', 'On Hold', 'Waiting for Medicare. ', NULL, NULL, '2021-05-04 08:49:16', '2021-05-04 08:49:16'),
(35281, 1019, 27360, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Waiting to get credentialed first as Application already in process for NSF location, once done then will send application for Location Additions.', NULL, NULL, '2021-05-24 09:04:40', '2021-05-24 09:04:40'),
(35282, 1019, 27361, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 15:23:56', '2021-05-03 15:23:56'),
(35283, 1019, 27361, NULL, '2021-05-11 00:00:00.000', 'Initiated', 'CAQH Application faxed to Network Operations at (866) 612-7790. ', NULL, NULL, '2021-05-04 07:17:17', '2021-05-04 07:17:17'),
(35284, 1019, 27361, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Sent the following email to : provider.relations@beaconhealthoptions.com SUB: Enrollment Status || Providers || SNBCARE || Beacon   Hello, Can you please let me know about the enrollment status for following providers under our group.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual NPI:  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Barbara Hignite NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Jessica Hartman NPI: 1326665472 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile NPI: 1942687108  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-05-04 07:17:53', '2021-05-04 07:17:53'),
(35285, 1019, 27361, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Received the following email from Sarah: provider.relations@beaconhealthoptions.com Good Morning, I have reviewed each provider file and have left notes below in red. Rodesia Edmundson – Application received 4/6/21 and still processing – Event 9091975 NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Barbara Hignite – Application received 4/6/21 and still processing – Event 9091459 NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell – Application received 4/7/21 and still processing – Event 9093081 NPI: 1225645393 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich – Application received 4/5/21 and still processing – Event 9091316 NPI: 1710489760 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Justin Souliere – Application received 4/7/21 and still processing – Event 1098601 NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Jessica Hartman – CAQH Application needed – please complete attached application and return for processing NPI: 1326665472 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva – Application received 4/7/21 and still processing – Event 9093128 NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile – Application received 4/7/21 and still processing – Event 9093091 NPI: 1942687108  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Thank You!     Sarah Oakes  Network Management Rep I, Northeast  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive Suite 401  Woburn, MA 01801  Office: 800.397.1630  Direct: 781-496-4024  www.beaconhealthoptions.com', NULL, NULL, '2021-05-04 07:18:06', '2021-05-04 07:18:06'),
(35286, 1019, 27361, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Called Beacon @ (800) 397-1630 spoke with rep Sierra conversation is mentioned below:  All providers applications have been received and are under review and group is added under all three locations under both plans (BHO/BHS) we have request the copy of group contract. we\'ll receive the contract in 3-2 business days.  Ref# 04/22/2021 - 1371173 Sierra Y', NULL, NULL, '2021-05-04 07:18:25', '2021-05-04 07:18:25'),
(35287, 1019, 27361, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: RE: Enrollment Status || Providers || SNBCARE || Beacon attn Shashi Hello Shashi, Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.   Individual Provider   L\'Etoile, Melody NPI: 1942687108 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Edmundson, Rodesia NPI: 1124622667 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Hefti, Prisca NPI: 1508133182 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Khan, Fauzia Wali NPI: 1699761965 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Pionke, Peggy NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rashid, Mahreen NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Schubert, Jonathan NPI: 1235755505 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Smith, Kerry NPI: 1275083230 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Tawakol, Katie NPI:1609222116 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-05-04 07:18:47', '2021-05-04 07:18:47'),
(35288, 1019, 27361, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: Enrollment Query || Group & Providers || SNBCARE || BHS/BHO ATTN Shashi  Hello Shashi,  Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Individual Provider     Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    L\'Etoile, Melody  NPI: 1942687108  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Edmundson, Rodesia NPI: 1124622667 Location: 100 New State Highway, Raynham, MA, 02767.     Hefti, Prisca NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.     Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.   Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Schubert, Jonathan NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.     Smith, Kerry NPI: 1275083230 Location: 100 New State Highway, Raynham, MA, 02767.     Tawakol, Katie NPI:1609222116 Location: 100 New State Highway, Raynham, MA, 02767.     Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-05-20 08:26:01', '2021-05-20 08:26:01'),
(35289, 1019, 27361, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com  SUB: Enrollment Query || Group & Providers || SNBCARE || BHS/BHO ATTN Shashi 2nd Attempt  Hello Shashi,  Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Individual Provider     Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    L\'Etoile, Melody  NPI: 1942687108  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Edmundson, Rodesia NPI: 1124622667 Location: 100 New State Highway, Raynham, MA, 02767.     Hefti, Prisca NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.     Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.   Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Schubert, Jonathan NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.     Smith, Kerry NPI: 1275083230 Location: 100 New State Highway, Raynham, MA, 02767.     Tawakol, Katie NPI:1609222116 Location: 100 New State Highway, Raynham, MA, 02767.     Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-06-05 11:23:13', '2021-06-05 11:23:13'),
(35290, 1019, 27361, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Received the following email from provider.relations@beaconhealthoptions.com  Good afternoon Alex,  I am looking into. Need some time. Thank you for your patience.   Thank you! Shashi Seth Network Management Rep I, Northeast Provider Relations', NULL, NULL, '2021-06-24 08:17:48', '2021-06-24 08:17:48'),
(35291, 1019, 27361, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com  Hello, Can you please let me know about the enrollment status for the following providers under our group.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual NPI:  Rodesia Edmundson NPI: 1124622667 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons  NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702.  Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Jessica Hartman NPI: 1326665472 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Prisca Hefti NPI: 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Barbara Hignite NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan  NPI: 1699761965  Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Lynetta Loveland NPI: 1598163602  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Cemetrice Muhammed NPI: 1548843410  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Regards,  Alex', NULL, NULL, '2021-08-24 11:14:44', '2021-08-24 11:14:44'),
(35292, 1019, 27361, NULL, '2021-09-20 00:00:00.000', 'Approved', 'Provider is linked to the following location eff 05/07/2021,  attached is the confirmations for additional location.', NULL, NULL, '2021-09-13 08:49:43', '2021-09-13 08:49:43'),
(35293, 1019, 27362, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 15:23:56', '2021-05-03 15:23:56'),
(35294, 1019, 27362, NULL, '2021-05-11 00:00:00.000', 'Initiated', 'CAQH Application faxed to Network Operations at (866) 612-7790. ', NULL, NULL, '2021-05-04 07:28:58', '2021-05-04 07:28:58'),
(35295, 1019, 27362, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Sent the following email to : provider.relations@beaconhealthoptions.com SUB: Enrollment Status || Providers || SNBCARE || Beacon   Hello, Can you please let me know about the enrollment status for following providers under our group.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual NPI:  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Barbara Hignite NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Jessica Hartman NPI: 1326665472 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile NPI: 1942687108  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-05-04 07:29:19', '2021-05-04 07:29:19'),
(35296, 1019, 27362, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Received the following email from Sarah: provider.relations@beaconhealthoptions.com Good Morning, I have reviewed each provider file and have left notes below in red. Rodesia Edmundson – Application received 4/6/21 and still processing – Event 9091975 NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Barbara Hignite – Application received 4/6/21 and still processing – Event 9091459 NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell – Application received 4/7/21 and still processing – Event 9093081 NPI: 1225645393 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich – Application received 4/5/21 and still processing – Event 9091316 NPI: 1710489760 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Justin Souliere – Application received 4/7/21 and still processing – Event 1098601 NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Jessica Hartman – CAQH Application needed – please complete attached application and return for processing NPI: 1326665472 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva – Application received 4/7/21 and still processing – Event 9093128 NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile – Application received 4/7/21 and still processing – Event 9093091 NPI: 1942687108  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Thank You!     Sarah Oakes  Network Management Rep I, Northeast  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive Suite 401  Woburn, MA 01801  Office: 800.397.1630  Direct: 781-496-4024  www.beaconhealthoptions.com', NULL, NULL, '2021-05-04 07:29:41', '2021-05-04 07:29:41'),
(35297, 1019, 27362, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Called Beacon @ (800) 397-1630 spoke with rep Sierra conversation is mentioned below:  All providers applications have been received and are under review and group is added under all three locations under both plans (BHO/BHS) we have request the copy of group contract. we\'ll receive the contract in 3-2 business days.  Ref# 04/22/2021 - 1371173 Sierra Y', NULL, NULL, '2021-05-04 07:29:52', '2021-05-04 07:29:52'),
(35298, 1019, 27362, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: RE: Enrollment Status || Providers || SNBCARE || Beacon attn Shashi Hello Shashi, Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.   Individual Provider   L\'Etoile, Melody NPI: 1942687108 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Edmundson, Rodesia NPI: 1124622667 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Hefti, Prisca NPI: 1508133182 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Khan, Fauzia Wali NPI: 1699761965 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Pionke, Peggy NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rashid, Mahreen NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Schubert, Jonathan NPI: 1235755505 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Smith, Kerry NPI: 1275083230 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Tawakol, Katie NPI:1609222116 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-05-04 07:30:09', '2021-05-04 07:30:09'),
(35299, 1019, 27362, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: Enrollment Query || Group & Providers || SNBCARE || BHS/BHO ATTN Shashi  Hello Shashi,  Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Individual Provider     Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    L\'Etoile, Melody  NPI: 1942687108  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Edmundson, Rodesia NPI: 1124622667 Location: 100 New State Highway, Raynham, MA, 02767.     Hefti, Prisca NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.     Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.   Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Schubert, Jonathan NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.     Smith, Kerry NPI: 1275083230 Location: 100 New State Highway, Raynham, MA, 02767.     Tawakol, Katie NPI:1609222116 Location: 100 New State Highway, Raynham, MA, 02767.     Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-05-20 08:29:25', '2021-05-20 08:29:25');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(35300, 1019, 27362, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com  SUB: Enrollment Query || Group & Providers || SNBCARE || BHS/BHO ATTN Shashi 2nd Attempt  Hello Shashi,  Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Individual Provider     Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    L\'Etoile, Melody  NPI: 1942687108  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Edmundson, Rodesia NPI: 1124622667 Location: 100 New State Highway, Raynham, MA, 02767.     Hefti, Prisca NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.     Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.   Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Schubert, Jonathan NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.     Smith, Kerry NPI: 1275083230 Location: 100 New State Highway, Raynham, MA, 02767.     Tawakol, Katie NPI:1609222116 Location: 100 New State Highway, Raynham, MA, 02767.     Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-06-05 11:22:49', '2021-06-05 11:22:49'),
(35301, 1019, 27362, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Received the following email from provider.relations@beaconhealthoptions.com  Good afternoon Alex,  I am looking into. Need some time. Thank you for your patience.   Thank you! Shashi Seth Network Management Rep I, Northeast Provider Relations', NULL, NULL, '2021-06-24 08:17:41', '2021-06-24 08:17:41'),
(35302, 1019, 27362, NULL, '2021-08-31 00:00:00.000', 'Not Eligible', 'Cannot be enrolled due to her specialty see attached', NULL, NULL, '2021-08-24 11:20:25', '2021-08-24 11:20:25'),
(35303, 1019, 27363, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 15:23:56', '2021-05-03 15:23:56'),
(35304, 1019, 27363, NULL, '2021-05-11 00:00:00.000', 'Initiated', 'CAQH Application faxed to Network Operations at (866) 612-7790. ', NULL, NULL, '2021-05-04 07:43:51', '2021-05-04 07:43:51'),
(35305, 1019, 27363, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Sent the following email to : provider.relations@beaconhealthoptions.com SUB: Enrollment Status || Providers || SNBCARE || Beacon   Hello, Can you please let me know about the enrollment status for following providers under our group.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual NPI:  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Barbara Hignite NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Jessica Hartman NPI: 1326665472 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile NPI: 1942687108  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-05-04 07:44:34', '2021-05-04 07:44:34'),
(35306, 1019, 27363, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Called Beacon @ (800) 397-1630 spoke with rep Sierra conversation is mentioned below:  All providers applications have been received and are under review and group is added under all three locations under both plans (BHO/BHS) we have request the copy of group contract. we\'ll receive the contract in 3-2 business days.  Ref# 04/22/2021 - 1371173 Sierra Y', NULL, NULL, '2021-05-04 07:45:18', '2021-05-04 07:45:18'),
(35307, 1019, 27363, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: RE: Enrollment Status || Providers || SNBCARE || Beacon attn Shashi  Hello Shashi, Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.   Individual Provider   L\'Etoile, Melody NPI: 1942687108 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Edmundson, Rodesia NPI: 1124622667 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Hefti, Prisca NPI: 1508133182 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Khan, Fauzia Wali NPI: 1699761965 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Pionke, Peggy NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rashid, Mahreen NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Schubert, Jonathan NPI: 1235755505 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Smith, Kerry NPI: 1275083230 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Tawakol, Katie NPI:1609222116 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-05-04 07:45:58', '2021-05-04 07:45:58'),
(35308, 1019, 27363, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: Enrollment Query || Group & Providers || SNBCARE || BHS/BHO ATTN Shashi  Hello Shashi,  Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Individual Provider     Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    L\'Etoile, Melody  NPI: 1942687108  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Edmundson, Rodesia NPI: 1124622667 Location: 100 New State Highway, Raynham, MA, 02767.     Hefti, Prisca NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.     Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.   Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Schubert, Jonathan NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.     Smith, Kerry NPI: 1275083230 Location: 100 New State Highway, Raynham, MA, 02767.     Tawakol, Katie NPI:1609222116 Location: 100 New State Highway, Raynham, MA, 02767.     Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-05-20 08:34:38', '2021-05-20 08:34:38'),
(35309, 1019, 27363, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com  SUB: Enrollment Query || Group & Providers || SNBCARE || BHS/BHO ATTN Shashi 2nd Attempt  Hello Shashi,  Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Individual Provider     Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    L\'Etoile, Melody  NPI: 1942687108  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Edmundson, Rodesia NPI: 1124622667 Location: 100 New State Highway, Raynham, MA, 02767.     Hefti, Prisca NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.     Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.   Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Schubert, Jonathan NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.     Smith, Kerry NPI: 1275083230 Location: 100 New State Highway, Raynham, MA, 02767.     Tawakol, Katie NPI:1609222116 Location: 100 New State Highway, Raynham, MA, 02767.     Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-06-05 11:22:42', '2021-06-05 11:22:42'),
(35310, 1019, 27363, NULL, '2021-06-30 00:00:00.000', 'Not Eligible', 'Received the following Denial Letter from Beacon as her ANCC certification is for AGNP. ', NULL, NULL, '2021-06-23 08:39:01', '2021-06-23 08:39:01'),
(35311, 1019, 27364, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 15:23:56', '2021-05-03 15:23:56'),
(35312, 1019, 27364, NULL, '2021-05-11 00:00:00.000', 'Initiated', 'Sent the following email to Shashi: provider.relations@beaconhealthoptions.com  Hello Shashi,   Attached are forms for Location addition for the group and individuals providers under that group. Let me know the timeframe for this request to be completed.     Regards, Alex', NULL, NULL, '2021-05-04 07:35:31', '2021-05-04 07:35:31'),
(35313, 1019, 27364, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: RE: Enrollment Status || Providers || SNBCARE || Beacon attn RI  Hello Sarah, We have to add a new location for our group, and also providers as well, please let us know the process to add our group and providers under our new location.   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 New Location: 100 New State Highway, Raynham, MA, 02767.   Individual Providers :   Fauzia Wali Khan NPI:1699761965 New Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 New Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 New Location: 100 New State Highway, Raynham, MA, 02767.   Mahreen Rashid NPI:1396393146 New Location: 100 New State Highway, Raynham, MA, 02767.   Peggy Pionke NPI: 1699307322 New Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 New Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182 New Location: 100 New State Highway, Raynham, MA, 02767.   Regards, Alex', NULL, NULL, '2021-05-04 07:35:54', '2021-05-04 07:35:54'),
(35314, 1019, 27364, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: RE: Enrollment Status || Providers || SNBCARE || Beacon attn Shashi Hello Shashi, Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.   Individual Provider   L\'Etoile, Melody NPI: 1942687108 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Edmundson, Rodesia NPI: 1124622667 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Hefti, Prisca NPI: 1508133182 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Khan, Fauzia Wali NPI: 1699761965 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Pionke, Peggy NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rashid, Mahreen NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Schubert, Jonathan NPI: 1235755505 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Smith, Kerry NPI: 1275083230 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Tawakol, Katie NPI:1609222116 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-05-04 07:36:07', '2021-05-04 07:36:07'),
(35315, 1019, 27364, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: Enrollment Query || Group & Providers || SNBCARE || BHS/BHO ATTN Shashi  Hello Shashi,  Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Individual Provider     Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    L\'Etoile, Melody  NPI: 1942687108  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Edmundson, Rodesia NPI: 1124622667 Location: 100 New State Highway, Raynham, MA, 02767.     Hefti, Prisca NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.     Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.   Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Schubert, Jonathan NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.     Smith, Kerry NPI: 1275083230 Location: 100 New State Highway, Raynham, MA, 02767.     Tawakol, Katie NPI:1609222116 Location: 100 New State Highway, Raynham, MA, 02767.     Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-05-20 08:31:51', '2021-05-20 08:31:51'),
(35316, 1019, 27364, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com  SUB: Enrollment Query || Group & Providers || SNBCARE || BHS/BHO ATTN Shashi 2nd Attempt  Hello Shashi,  Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Individual Provider     Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    L\'Etoile, Melody  NPI: 1942687108  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Edmundson, Rodesia NPI: 1124622667 Location: 100 New State Highway, Raynham, MA, 02767.     Hefti, Prisca NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.     Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.   Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Schubert, Jonathan NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.     Smith, Kerry NPI: 1275083230 Location: 100 New State Highway, Raynham, MA, 02767.     Tawakol, Katie NPI:1609222116 Location: 100 New State Highway, Raynham, MA, 02767.     Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-06-05 11:22:33', '2021-06-05 11:22:33'),
(35317, 1019, 27364, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Received the following email from provider.relations@beaconhealthoptions.com  Good afternoon Alex,  I am looking into. Need some time. Thank you for your patience.   Thank you! Shashi Seth Network Management Rep I, Northeast Provider Relations', NULL, NULL, '2021-06-24 08:17:33', '2021-06-24 08:17:33'),
(35318, 1019, 27364, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com  Hello, Can you please let me know about the enrollment status for the following providers under our group.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual NPI:  Rodesia Edmundson NPI: 1124622667 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons  NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702.  Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Jessica Hartman NPI: 1326665472 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Prisca Hefti NPI: 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Barbara Hignite NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan  NPI: 1699761965  Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Lynetta Loveland NPI: 1598163602  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Cemetrice Muhammed NPI: 1548843410  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Regards,  Alex', NULL, NULL, '2021-08-24 11:22:51', '2021-08-24 11:22:51'),
(35319, 1019, 27364, NULL, '2021-09-20 00:00:00.000', 'Approved', 'Attached is the Confirmation of location addition, eff 08/06/2021. ', NULL, NULL, '2021-09-13 08:56:21', '2021-09-13 08:56:21'),
(35320, 1019, 27365, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 15:23:56', '2021-05-03 15:23:56'),
(35321, 1019, 27365, NULL, '2021-05-11 00:00:00.000', 'Initiated', 'Enrollment Application faxed to Network Operations at (866) 612-7790 ', NULL, NULL, '2021-05-04 07:55:02', '2021-05-04 07:55:02'),
(35322, 1019, 27365, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com Hello Sarah, Can you please put a request to Expediate this application becasue we have waited for a long time now, we were submitting enrollment application thru your portal but last week we got to know that we were supposed to fill CAQH forms, so we did that now, due to this issue we already are in a big loss now as we have 300+ active patients of BEACON in our organization.  Regards, Alex', NULL, NULL, '2021-05-04 07:55:15', '2021-05-04 07:55:15'),
(35323, 1019, 27365, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Received the following email from provider.relations@beaconhealthoptions.com Good Afternoon,     I can confirm the application was received via fax on 3.31.21 and is currently being processed. Once a completed application is received it takes an additional 45 days for credentialing to be completed. It is with the credentialing department at this time. Please allow more time. Once completed a welcome letter with be sent out.     Thank You!     Sarah Oakes  Network Management Rep I, Northeast', NULL, NULL, '2021-05-04 07:55:25', '2021-05-04 07:55:25'),
(35324, 1019, 27365, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: RE: Enrollment Status || Providers || SNBCARE || Beacon attn Shashi  Hello Shashi, Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.   Individual Provider   L\'Etoile, Melody NPI: 1942687108 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Edmundson, Rodesia NPI: 1124622667 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Hefti, Prisca NPI: 1508133182 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Khan, Fauzia Wali NPI: 1699761965 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Pionke, Peggy NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rashid, Mahreen NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Schubert, Jonathan NPI: 1235755505 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Smith, Kerry NPI: 1275083230 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Tawakol, Katie NPI:1609222116 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-05-04 07:55:43', '2021-05-04 07:55:43'),
(35325, 1019, 27365, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: Enrollment Query || Group & Providers || SNBCARE || BHS/BHO ATTN Shashi  Hello Shashi,  Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Individual Provider     Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    L\'Etoile, Melody  NPI: 1942687108  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Edmundson, Rodesia NPI: 1124622667 Location: 100 New State Highway, Raynham, MA, 02767.     Hefti, Prisca NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.     Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.   Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Schubert, Jonathan NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.     Smith, Kerry NPI: 1275083230 Location: 100 New State Highway, Raynham, MA, 02767.     Tawakol, Katie NPI:1609222116 Location: 100 New State Highway, Raynham, MA, 02767.     Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-05-20 08:36:24', '2021-05-20 08:36:24'),
(35326, 1019, 27365, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com  SUB: Enrollment Query || Group & Providers || SNBCARE || BHS/BHO ATTN Shashi 2nd Attempt  Hello Shashi,  Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Individual Provider     Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    L\'Etoile, Melody  NPI: 1942687108  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Edmundson, Rodesia NPI: 1124622667 Location: 100 New State Highway, Raynham, MA, 02767.     Hefti, Prisca NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.     Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.   Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Schubert, Jonathan NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.     Smith, Kerry NPI: 1275083230 Location: 100 New State Highway, Raynham, MA, 02767.     Tawakol, Katie NPI:1609222116 Location: 100 New State Highway, Raynham, MA, 02767.     Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-06-05 11:22:25', '2021-06-05 11:22:25'),
(35327, 1019, 27365, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Received the following email from provider.relations@beaconhealthoptions.com  Good afternoon Alex,  I am looking into. Need some time. Thank you for your patience.   Thank you! Shashi Seth Network Management Rep I, Northeast Provider Relations', NULL, NULL, '2021-06-24 08:17:23', '2021-06-24 08:17:23'),
(35328, 1019, 27365, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com  Hello, Can you please let me know about the enrollment status for the following providers under our group.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual NPI:  Rodesia Edmundson NPI: 1124622667 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons  NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702.  Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Jessica Hartman NPI: 1326665472 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Prisca Hefti NPI: 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Barbara Hignite NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan  NPI: 1699761965  Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Lynetta Loveland NPI: 1598163602  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Cemetrice Muhammed NPI: 1548843410  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Regards,  Alex', NULL, NULL, '2021-08-24 11:25:25', '2021-08-24 11:25:25'),
(35329, 1019, 27365, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Location added effective date 04/30/2021, see attachment for ref', NULL, NULL, '2021-08-27 08:18:17', '2021-08-27 08:18:17'),
(35330, 1019, 27366, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 15:23:56', '2021-05-03 15:23:56'),
(35331, 1019, 27366, NULL, NULL, 'On Hold', 'Waiting on Missing Info from provider, so we can start credentialing.', NULL, NULL, '2021-05-04 08:52:57', '2021-05-04 08:52:57'),
(35332, 1019, 27366, NULL, '2021-05-17 00:00:00.000', 'Initiated', 'Sent the following email to provider.relations@beaconhealthoptions.com Hello Shashi,  We want to add the following under our group, I have attached the CAQH form for the provider. Let me know if you need anything else.  See attachment for reference', NULL, NULL, '2021-05-10 14:13:05', '2021-05-10 14:13:05'),
(35333, 1019, 27366, NULL, '2021-05-20 00:00:00.000', 'In Process', 'Received the following email from provider.relations@beaconhealthoptions.com-------- Good morning Alex, The clinician form for Mary Gibbons has been received and submitted. Thank you, Shashi Seth Network Management Rep I, Northeast', NULL, NULL, '2021-05-11 10:02:15', '2021-05-11 10:02:15'),
(35334, 1019, 27366, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: Enrollment Query || Group & Providers || SNBCARE || BHS/BHO ATTN Shashi  Hello Shashi,  Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Individual Provider     Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    L\'Etoile, Melody  NPI: 1942687108  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Edmundson, Rodesia NPI: 1124622667 Location: 100 New State Highway, Raynham, MA, 02767.     Hefti, Prisca NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.     Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.   Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Schubert, Jonathan NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.     Smith, Kerry NPI: 1275083230 Location: 100 New State Highway, Raynham, MA, 02767.     Tawakol, Katie NPI:1609222116 Location: 100 New State Highway, Raynham, MA, 02767.     Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-05-20 08:27:11', '2021-05-20 08:27:11'),
(35335, 1019, 27366, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com  SUB: Enrollment Query || Group & Providers || SNBCARE || BHS/BHO ATTN Shashi 2nd Attempt  Hello Shashi,  Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Individual Provider     Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    L\'Etoile, Melody  NPI: 1942687108  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Edmundson, Rodesia NPI: 1124622667 Location: 100 New State Highway, Raynham, MA, 02767.     Hefti, Prisca NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.     Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.   Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Schubert, Jonathan NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.     Smith, Kerry NPI: 1275083230 Location: 100 New State Highway, Raynham, MA, 02767.     Tawakol, Katie NPI:1609222116 Location: 100 New State Highway, Raynham, MA, 02767.     Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-06-05 11:22:19', '2021-06-05 11:22:19'),
(35336, 1019, 27366, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Received the following email from provider.relations@beaconhealthoptions.com  Good afternoon Alex,  I am looking into. Need some time. Thank you for your patience.   Thank you! Shashi Seth Network Management Rep I, Northeast Provider Relations', NULL, NULL, '2021-06-24 08:04:17', '2021-06-24 08:04:17'),
(35337, 1019, 27366, NULL, '2021-08-31 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCARE.', NULL, NULL, '2021-08-24 11:15:49', '2021-08-24 11:15:49'),
(35338, 1019, 27367, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 15:24:23', '2021-05-03 15:24:23');
