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
(48798, 11056, 31722, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email sent to  :  Chukwuma.Ezeokoli@careallies.   & TXGQProviderRelations@healthspring.com  Sub : Fwd: [External] Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Renaissance Physicians ||  Good evening!  Hope you are doing well. I want to inquire about the enrollment status of the below mentioned providers and practices. Please provide us with the latest updates soon.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details:  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you!  Have a great week ahead!', NULL, NULL, '2021-08-11 16:40:32', '2021-08-11 16:40:32'),
(48799, 3040, 31722, NULL, '2021-09-14 00:00:00.000', 'In Process', 'Email sent to: Chukwuma.Ezeokoli@careallies.com  Subject: Re: [External] Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Renaissance Physicians ||  Hello, Ezeokoli,   I wanted to know the enrollment status for the below mentioned providers and practice in Renaissance Physician in our group under the below location.   Practice Details: Practice Name:Longpoint Medical Center  Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details:  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you', NULL, NULL, '2021-09-07 11:25:02', '2021-09-07 11:25:02'),
(48800, 10057, 31722, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : Chukwuma.Ezeokoli@careallies.com  Sub : [External] Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Renaissance Physicians ||  Hello,  Hope this email finds you well. I want to inquire about the enrollment status of the below mentioned providers and practice. Please get back to me as soon as you get a chance.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Primary Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI George, Jeemol	1497219067 Jose, Julie	1447883061 Stephen, Ani	1588959118 Piccione JR, James M	1356321509 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Abraham, Glory	1194206490 Fernandus, Limy	1972005189 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Joseph, Vibitha	1952931560 Thomas, Cini	1134777238 Abraham, Jeena	1467901587 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 John, Jeny	1073019493 Joseph, Molly	1396380077  Looking forward to hearing from you. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-18 14:48:30', '2021-10-18 14:48:30'),
(48801, 10057, 31722, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Sent To : Chukwuma.Ezeokoli@careallies.com, providerservices@renaissancefamily.com  Sub : [External] Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Renaissance Physicians ||  Hello,  Hope all is well with you. Can I get the latest updates on below mentioned request.  Kindly revert back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-23 16:08:40', '2021-11-23 16:08:40'),
(48802, 10057, 31722, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email Received From : KJones@renaissancefamily.com  Sub : [External] Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Renaissance Physicians ||  Good afternoon! We received your inquiry below. We do not deal with any kind of medical facility we are a dental insurance carrier only. This was sent to us in error. Thanks  Kathy Jones Provider Services Representative Cell: 317-744-1241', NULL, NULL, '2021-11-24 09:21:08', '2021-11-24 09:21:08'),
(48803, 10057, 31722, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Sent To : kjones@renaissancefamily.com  Sub : [External] Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Renaissance Physicians ||  Thank you for the update. Have a great weekend ahead!  Regards,', NULL, NULL, '2021-12-03 15:50:07', '2021-12-03 15:50:07'),
(48804, 10057, 31722, NULL, '2021-12-22 00:00:00.000', 'Not Eligible', 'Email Received From : KJones@renaissancefamily.com  Sub : [External] Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Renaissance Physicians ||  Good afternoon! We received your inquiry below. We do not deal with any kind of medical facility we are a dental insurance carrier only. This was sent to us in error. Thanks  *** After discuss with ALEX did it not eligible *** Steve Albert', NULL, NULL, '2021-12-15 13:11:12', '2021-12-15 13:11:12'),
(48805, 1006, 31723, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:27:18', '2021-07-01 10:27:18'),
(48806, 11056, 31723, NULL, '2021-07-13 00:00:00.000', 'On Hold', 'Waiting for the enrollment in Molina healthcare.', NULL, NULL, '2021-07-05 15:36:21', '2021-07-05 15:36:21'),
(48807, 10057, 31723, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com & MHTContractrequest@molinahealthcare.com  Sub : Enrollment Status || NUCC - IVUC - LPMC || Molina Marketplace  Good Afternoon,  Hope you are doing well. I\'m writing this email to check the enrollment and provider directory status for remaining providers under the below mentioned locations with Molina Marketplace.  Also, I\'m able to see the groups on provider directory, I already got the effective dates via help desk, please send me the group agreement or facility contract at the earliest   Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI Fernandus, Limy	1972005189 Jacob, Jaya	1194336149 Thomas, Cini	1134777238 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067  Once you get a chance please get back to me. Have a great weekend ahead!  Regards,', NULL, NULL, '2021-12-30 15:39:21', '2021-12-30 15:39:21'),
(48808, 19067, 31723, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email received from: Michele.Thomas-Martin@molinahealthcare.com  Subject: Enrollment Status || NUCC - IVUC - LPMC || Molina Marketplace     Good Morning,     Thank you for your inquiry.  Please see the attached contracts for both TIN numbers.  Please see the updates below.     The only providers on the below list listed under TIN # 760612416 are Joseph, Vibitha and Rauf, Abdur.  Please submit a contract request form to MHTContractrequest@Molinahealthcare.com  to add the remaining providers.     The only providers not listed under TIN # 270796429 are Jacob Jaya and Jeny John.  Please submit a contract request form to MHTContractrequest@Molinahealthcare.com  to add the 2 providers under this TIN #.     Thank You,     Michele Thomas-Martin  Associate Specialist, Provider Contracts  1-888-562-5442 Ext. 200042  1 972-200-2688 - Direct  www.MolinaHealthcare.com  Your Extended Family', NULL, NULL, '2022-01-05 17:26:52', '2022-01-05 17:26:52'),
(48809, 20067, 31723, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email received from: rehman@claimsmedinc.com  Subject: Enrollment Status || NUCC - IVUC - LPMC || Molina Marketplace    Good Morning,     Thank you for your inquiry.  Please see the attached contracts for both TIN numbers.  Please see the updates below.     The only providers on the below list listed under TIN # 760612416 are Joseph, Vibitha and Rauf, Abdur.  Please submit a contract request form to MHTContractrequest@Molinahealthcare.com  to add the remaining providers.     The only providers not listed under TIN # 270796429 are Jacob Jaya and Jeny John.  Please submit a contract request form to MHTContractrequest@Molinahealthcare.com  to add the 2 providers under this TIN #.     Thank You,     Michele Thomas-Martin  Associate Specialist, Provider Contracts  1-888-562-5442 Ext. 200042  1 972-200-2688 - Direct  www.MolinaHealthcare.com  Your Extended Family', NULL, NULL, '2022-01-06 13:17:20', '2022-01-06 13:17:20'),
(48810, 20067, 31723, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@Molinahealthcare.com  Subject: Enrollment || NUCC - IVUC - LPMC || Molina Marketplace   Good afternoon,  Hope you are doing well. I would like to enroll the below-mentioned providers under these locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI John, Jeny	1073019493 Jacob, Jaya	1194336149   I look forward to hearing from you.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-06 13:20:12', '2022-01-06 13:20:12'),
(48811, 20067, 31723, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub: Enrollment Status ||  Longpoint Medical center || Molina Marketplace  Good Morning! Hope all is well with you. I would like to know the enrollment status of the below-mentioned providers.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1771763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Fernandus, Limy	1972005189 Brown, Brittany	1275163537 Jacob, Jaya	1194336149 Thomas, Cini	1134777238 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-18 09:40:29', '2022-01-18 09:40:29'),
(48812, 20067, 31723, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email received from: Michele.Thomas-Martin@molinahealthcare.com  Sub: Re: Enrollment Status || Longpoint Medical center || Molina Marketplace  Good Morning,     Thank you for your inquiry.  Please see the status updates below for each provider.     Fernandus, Limy - If you would like to add the provider under the below TIN & facility please submit a new request.  If you’ve already submitted the request, please follow up with the contracting mailbox at MHTContractrequest@molinahealthcare.com  for status.  Brown, Brittany - provider loaded under the service location 9504 Long point but under different TIN # 270796429.  If you would like to add the provider under the below TIN & facility please submit a new request.  If you’ve already submitted the request, please follow up with the contracting mailbox at MHTContractrequest@molinahealthcare.com  for status.  Jacob, Jaya – The request on file is to load the provider under TIN # 27-0796429.  The request under credentialing.  If you would like to add the provider under the below TIN & facility please submit a new request.  If you’ve already submitted the request, please follow up with the contracting mailbox at MHTContractrequest@molinahealthcare.com  for status.  Thomas, Cini - provider loaded under the service location 9504 Long point but under different TIN # 270796429. If you would like to add the provider under the below TIN & facility please submit a new request.  If you’ve already submitted the request, please follow up with the contracting mailbox at MHTContractrequest@molinahealthcare.com  for status.  Rauf, Abdur – The provider showing under the below location eff 1/1/22  Joseph, Molly -  provider loaded under the service location 9504 Long point but under different TIN # 270796429.  If you would like to add the provider under the below TIN & facility please submit a new request.  If you’ve already submitted the request, please follow up with the contracting mailbox at MHTContractrequest@molinahealthcare.com  for status.  John, Jeny - The request is under credentialing.  Please allow a few more weeks for the credentialing application to process.  Once approved the request will be sent for loading in the billing system.     Thank You,', NULL, NULL, '2022-01-28 15:21:10', '2022-01-28 15:21:10'),
(48813, 20067, 31723, NULL, '2022-02-23 00:00:00.000', 'In Process', 'Email received from: Michele.Thomas-Martin@molinahealthcare.com  Sub: Enrollment Status || Longpoint Medical center || Molina Marketplace  Good Afternoon,     Thank you for your inquiry.  The request for the below providers have been sent for loading in the billing system for TIN # 76-0612416.  There is no effective date at this time, please allow a few more weeks for this process to complete.     Brittany Brown  Jaya Jacob  Jeny John     There is no request on file for the below providers under TIN # 76-0612416     Fernandus, Limy, Thomas, Cini, Joseph, Molly  ', NULL, NULL, '2022-02-16 14:38:53', '2022-02-16 14:38:53'),
(48814, 20067, 31723, NULL, '2022-03-21 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub: Enrollment Status || Longpoint Medical center || Molina Marketplace   Good Afternoon!  Hope you had a great weekend. Can you please help me out with the current Credentialing Status of the listed providers?  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Jeny John	1073019493 Molly Joseph	1396380077 Jaya Jacob	1194336149 Limy Fernandus	1972005189 Cini Thomas	1134777238 Brittany Brown	1275163537 Abdur Rauf	1497726202  Thank you, Syed.', NULL, NULL, '2022-03-14 15:12:41', '2022-03-14 15:12:41'),
(48815, 1006, 31724, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:27:18', '2021-07-01 10:27:18'),
(48816, 11056, 31724, NULL, '2021-07-13 00:00:00.000', 'Initiated', 'Email sent to : michal.simms@christushealth.org  Sub : ENROLLMENT REQUEST - LPMC - CHRISTUS HEALTH PLAN  Greetings,  Hope you are doing well. I wanted to  enroll the below provider in the group mentioned below:  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Provider Name :  John, Jeny Provider NPI# : 1073019493  Kindly respond to me soon. If you need any information feel free to contact me.  Thank you!', NULL, NULL, '2021-07-05 15:48:54', '2021-07-05 15:48:54'),
(48817, 11056, 31724, NULL, '2021-07-13 00:00:00.000', 'Initiated', 'Email sent to : CHP.networkdevelopment@christushealth.org  Sub : ENROLLMENT REQUEST - LPMC - CHRISTUS HEALTH PLAN  Greetings,  Hope you are doing well. I wanted to  enroll the below provider in the group mentioned below:  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Provider Name :  John, Jeny Provider NPI# : 1073019493  Kindly respond to me soon. If you need any information feel free to contact me.  Thank you!', NULL, NULL, '2021-07-05 15:50:50', '2021-07-05 15:50:50'),
(48818, 3040, 31724, NULL, '2021-07-26 00:00:00.000', 'On Hold', 'Ancillary contract request sent for the group. Please see group task. ', NULL, NULL, '2021-07-19 09:23:20', '2021-07-19 09:23:20'),
(48819, 3040, 31724, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email sent to: hunter.barrett@christushealth.org  Subject: Re: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Hello Hunter,   Hope you are doing well. Please find attached Ancillary service agreement along with the Facility Ancillary application for our group to participate in Christus Health Plan under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:9504 LONG POINT RD STE E Houston , TX 77055-4226   If you need any additional information please let me know. Waiting for your response.    Thanks ', NULL, NULL, '2021-07-28 11:39:04', '2021-07-28 11:39:04'),
(48820, 11056, 31724, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email sent to : Hunter Barrett   hunter.barrett@christushealth.org, CHP.networkdevelopment@christushealth.org  Sub  : ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Good evening!  Hope all is well. I just want to inquire about the enrollment status of the following groups for the ancillary contract. Please provide us with the latest updates soon.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:9504 LONG POINT RD STE E Houston , TX 77055-4226   If you need any additional information feel free to reach out to me. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-08-11 16:59:24', '2021-08-11 16:59:24'),
(48821, 3040, 31724, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email rcvd from: hunter.barrett@christushealth.org  Subject: RE: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Contract was sent to credentialing about 3 weeks ago to process. Will take about 6 months to fully process and receive effective date.  Thanks,  Hunter Barrett Network Contracting CHRISTUS Health Plan CHRISTUS Health 919 Hidden Ridge | Irving, Texas 75038 (o) 469.282.3113', NULL, NULL, '2021-08-17 15:02:37', '2021-08-17 15:02:37'),
(48822, 3040, 31724, NULL, '2021-09-21 00:00:00.000', 'In Process', 'Email sent to: hunter.barrett@christushealth.org  Subject: Re: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Good evening!  Hope all is well. This is a follow up email to inquire about the enrollment status of the following groups for the ancillary contract.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:9504 LONG POINT RD STE E Houston , TX 77055-4226  If you need any additional information feel free to reach out to me. Waiting for your response.  Thanks', NULL, NULL, '2021-09-14 16:14:37', '2021-09-14 16:14:37'),
(48823, 12062, 31724, NULL, '2021-09-29 00:00:00.000', 'In Process', ' Received below email under the group ancillary contract request; From :hunter.barrett@christushealth.org Subject :RE: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN Please reach out to our credentialing team in about 4 months for an update. You can reach out directly to them for updates on all of the contracts you are inquiring about. They are running around 6 months to process them so please give them adequate time to reach your file. Most of the contracts were sent to them around 1-2 months ago CHRISTUS.HP.Credentialing CHRISTUS.HP.Credentialing@christushealth.org  Thanks,   Hunter Barrett Network Contracting CHRISTUS Health Plan CHRISTUS Health 919 Hidden Ridge | Irving, Texas 75038 (o) 469.282.3113 www.christushealth.org  ', NULL, NULL, '2021-09-22 13:14:37', '2021-09-22 13:14:37'),
(48824, 10057, 31724, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Good Evening,  Hope you are doing well. I want to know the enrollment status of the following groups and providers. Please get back to me as soon as you get the time.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Jose, Julie	1447883061 George, Jeemol	1497219067 Brown, Brittany	1275163537 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Thomas, Cini	1134777238 Joseph, Vibitha	1952931560 Stephen, Ani	1588959118 Piccione JR, James M	1356321509 Chennemkara, Mini Philip	1841755956 Abraham, Glory	1194206490 Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-10-18 16:31:39', '2021-10-18 16:31:39'),
(48825, 10057, 31724, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Hello,  Hope this email finds you in good health. Could you please let me know the updated status for the below mentioned updated status.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-23 15:52:51', '2021-11-23 15:52:51'),
(48826, 10057, 31724, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org vicki.guerra@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Good afternoon,  Hope this email finds you well. I\'m writing this email to check the status for the below mentioned request.  Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-03 14:31:43', '2021-12-03 14:31:43'),
(48827, 10057, 31724, NULL, '2021-12-20 00:00:00.000', 'In Process', 'Email Received From : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Good Morning  Normandy Urgent Care Center  - has been processed effective contract date 01/01/2022  Longpoint Medical Center – facility has been processed effective contract date 01/01/2022  Imperial Valley - facility has been processed effective contract date 01/01/2022  Credentialing Verification Unit CHRISTUS Health Plan - US Family Health Plan 919 Hidden Ridge Irving, TX 75038 Phone: (469)-282-0368 Fax: 210-766-8857', NULL, NULL, '2021-12-13 10:59:17', '2021-12-13 10:59:17'),
(48828, 10057, 31724, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Thank you for the update. Could you please provide us with the facility agreement or contract along with the update for the providers credentialing status as well.  Your earliest response would be greatly appreciated.  Regards, Steve Albert', NULL, NULL, '2021-12-20 10:04:57', '2021-12-20 10:04:57'),
(48829, 10057, 31724, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Greetings!  Hope you are doing great. I\'m writing this email to get the update on my below request. Please get back to me as soon as possible!  Regards,', NULL, NULL, '2021-12-28 12:01:37', '2021-12-28 12:01:37'),
(48830, 20067, 31724, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: christus.hp.credentialing@christushealth.org  Sub: Re: ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Good afternoon, Hope all is well with you. I would like to know the enrollment status of the below-mentioned group and providers, if any of them is enrolled kindly send me their welcome letter.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Joseph Molly	1396380077 Mini Channamakara	1841755956 Odette Kourouma	1134525868 Jeena Abraham	1467901587 SIGI PAUL	1033623616 Glory Abraham	1194206490 James Piccione JR	1356321509 Limy Fernandus	1972005189 Vibitha Joseph	1952931560 Brittany Brown	1275163537 Abdur Rauf	1497726202 Ani Stephen	1588959118 Cini Thomas	1134777238 Jeemol George	1497219067 Julie Jose	1447883061 Jaya Jacob	1194336149 Jeny John	1073019493  Could you please provide us with the facility agreement or contract along with the update for the providers credentialing status as well. Your earliest response would be greatly appreciated.  Eagerly waiting to hear from you,  Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-10 13:23:21', '2022-01-10 13:23:21'),
(48831, 20067, 31724, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: christus.hp.credentialing@christushealth.org  Sub: Re: ENROLLMENT REQUEST - LPMC - CHRISTUS HEALTH PLAN  Good Afternoon! Hope this email finds you in good health. I sent the email 9 days ago but I haven\'t received any response yet. Kindly respond to the previous request.  Eager to hear from you. Thanks & Regards, Syed Ahad', NULL, NULL, '2022-01-19 15:23:41', '2022-01-19 15:23:41'),
(48832, 20067, 31724, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: christus.hp.credentialing@christushealth.org  Sub: Re: ENROLLMENT REQUEST- URGENT - LPMC - CHRISTUS HEALTH PLAN  Good afternoon!  Hope this email finds you in good health. Kindly respond to the Urgent request.  Eagerly waiting to hear from you. Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-28 13:15:24', '2022-01-28 13:15:24'),
(48833, 20067, 31724, NULL, '2022-02-15 00:00:00.000', 'In Process', 'Email received from: christus.hp.credentialing@christushealth.org  Sub: Re: ENROLLMENT REQUEST- URGENT - LPMC - CHRISTUS HEALTH PLAN  Good Afternoon  Facility has been processed contract effective date 01/01/22  Thank you', NULL, NULL, '2022-02-08 13:43:56', '2022-02-08 13:43:56'),
(48834, 20067, 31724, NULL, '2022-02-25 00:00:00.000', 'In Process', 'Email sent to: christus.hp.credentialing@christushealth.org  Sub: Re: ENROLLMENT REQUEST- URGENT - LPMC - CHRISTUS HEALTH PLAN  Good Morning!  Kindly send me a copy of the facility contract. I emailed you on 02/03/2022 and I haven\'t received any response from you yet.  Kindly respond promptly this is my SECOND reminder.  Thank you, ', NULL, NULL, '2022-02-18 09:50:19', '2022-02-18 09:50:19'),
(48835, 20067, 31724, NULL, '2022-03-11 00:00:00.000', 'In Process', 'Email sent to: christus.hp.credentialing@christushealth.org  Sub: Re: ENROLLMENT REQUEST- URGENT - LPMC - CHRISTUS HEALTH PLAN  Good Evening!  Kindly send me the copy of the Facility contract. This is my THIRD REMINDER.  Kindly respond promptly.  Thank you,', NULL, NULL, '2022-03-04 15:33:47', '2022-03-04 15:33:47'),
(48836, 20067, 31724, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email sent to: jrbrunin@christushealth.org  Sub:  Facility Contract Request || Longpoint Medical Center || Christus Health Plan   Hello Jackie!  This is Syed. I was trying to reach you but you were unavailable over the call. I want a copy of Facility Contract as it is effective from 01/01/2022. Also please confirm to me that all of the 17 providers have been linked to this group.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Jeny John	1073019493 Molly Joseph	1396380077 Jaya Jacob	1194336149 Sigi paul	1033623616 Mini Chennemkara	1841755956 Jeena Abraham	1467901587 Odette Kourouma	1134525868 James Piccione	1356321509 Glory Abraham	1194206490 Limy Fernandus	1972005189 Cini Thomas	1134777238 Ani Stephen	1588959118 Jeemol George	1497219067 Julie Jose	1447883061 Brittany Brown	1275163537 Vibitha Joseph	1952931560 Abdur Rauf	1497726202  Thank you,', NULL, NULL, '2022-03-17 10:42:39', '2022-03-17 10:42:39'),
(48837, 1006, 31725, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:28:44', '2021-07-01 10:28:44'),
(48838, 11056, 31725, NULL, '2021-07-12 00:00:00.000', 'Initiated', 'Thank you for completing the BCBSTX enrollment. We will notify you once your application has been processed. If you requested to be contracted, please note that your claims may pay out of network for services rendered until your contracts have been accepted, the credentialing process has been completed, and you receive an effective date. Application ID: 317694 Application has been submitted and attached.', NULL, NULL, '2021-07-05 12:57:14', '2021-07-05 12:57:14'),
(48839, 3040, 31725, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com, txproviderupdatesubmission@bcbstx.com, Provider_Relations_Houston@bcbstx.com  Subject: Application ID: 317694 || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || John, Jeny || BCBS ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in BCBS for our group under the below location.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1:   Provider Name: John, Jeny Provider NPI# 1073019493  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-26 14:43:14', '2021-07-26 14:43:14'),
(48840, 11056, 31725, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Email received from : txproviderupdatesubmission@bcbstx.com   Sub : Application ID: 317694 || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || John, Jeny || BCBS || : Case Number - 02659064  Good afternoon,  I have located your application and see the provider’s record number for the group has been set up.  Jeny K John Provider record # 8PU638  For any questions regarding network contracting, credentialing, network effective dates or status requests, please contact your network representative. If you do not know who your representative is, please click here and look under Network Management Office Locations - https://www.bcbstx.com/provider/contact_us.html#localnetwork There you will find the phone (local and/or toll free number), fax, and email contact methods.  Thank you,  Network Operations & Solution Delivery Blue Cross Blue Shield of Texas', NULL, NULL, '2021-08-13 09:50:58', '2021-08-13 09:50:58'),
(48841, 3040, 31725, NULL, '2021-09-14 00:00:00.000', 'In Process', 'Email sent to: txproviderupdatesubmission@bcbstx.com, Provider_Relations_Houston@bcbstx.com  Subject: Application ID: 317694 || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || John, Jeny || BCBS ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in BCBS for our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1:   Provider Name: John, Jeny Provider NPI# 1073019493  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-09-07 10:51:28', '2021-09-07 10:51:28'),
(48842, 10057, 31725, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To :  tx_standard_contracting_team@bcbstx.com, txproviderupdatesubmission@bcbstx.com, Provider_Relations_Houston@bcbstx.com  Sub : Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS ||  Good Afternoon,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers for our groups under the below locations. Please get back to me as soon as you get the time.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI John, Jeny	1073019493 Stephen, Ani	1588959118 George, Jeemol	1497219067 Brown, Brittany	1275163537 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Thomas, Cini	1134777238 Joseph, Vibitha	1952931560 PAUL, SIGI	1033623616 Joseph, Molly	1396380077 Jacob, Jaya	1194336149  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-18 13:26:55', '2021-10-18 13:26:55'),
(48843, 10057, 31725, NULL, '2021-11-25 00:00:00.000', 'In Process', 'Email Sent To : tx_standard_contracting_team@bcbstx.com, txproviderupdatesubmission@bcbstx.com, Provider_Relations_Houston@bcbstx.com, Noemi_Diaz@bcbstx.com  Sub : Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS ||  Hello,  I wanted to know the enrollment status for group NUCC and for IVUC providers under the mentioned TIN number.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI John, Jeny	1073019493 Joseph, Molly	1396380077 Brown, Brittany	1275163537 Thomas, Cini	1134777238 Stephen, Ani	1588959118 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Joseph, Vibitha	1952931560 Jacob, Jaya	1194336149 George, Jeemol	1497219067  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-11-18 13:17:52', '2021-11-18 13:17:52'),
(48844, 10057, 31725, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From: txproviderupdatesubmission@bcbstx.com  Sub : Re: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS || : Case Number - 03164645  Good afternoon,  I have researched your request and listed the provider’s record numbers linked to the Tax ID below.   Provider Name	Provider record #	779 Normandy	16272 Imperial Valley John, Jeny	8PU638	Yes	Yes Joseph, Molly	8PR752	Yes	No Brown, Brittany	8MF387	Yes	No Thomas, Cini	8LW737	Yes	No Stephen, Ani	8MC701	Yes	No Rauf, Abdur	8CU663	Yes	No Kourouma , Odette Tiranke	8ME162	Yes	No Joseph, Vibitha	8MH707	Yes	No Jacob, Jaya	8PR751	Yes	No George, Jeemol	8ML243	Yes	No  All of the providers listed show the Normandy location as their primary service address.  However, the providers I indicated \"No\" in the column above do not have the Imperial Valley address listed as an additional location.  To add this address to these providers’ records, please submit a Demographic Change Request form via the following link information:   https://www.bcbstx.com/forms/provider/update_info.html Click on the link for Demographic Change Form - https://hcscproviderintake.secure.force.com/TXDemographUpdate  For any questions regarding network contracting, credentialing, network or PAR effective dates or status requests, please contact your network representative. If you do not know who your representative is, please click here and look under Network Management Office Locations - https://www.bcbstx.com/provider/contact_us.html#localnetwork There you will find the phone (local and/or toll free number) and fax contact methods.  Thank you,  Network Operations & Solution Delivery Blue Cross Blue Shield of Texas', NULL, NULL, '2021-11-23 10:42:10', '2021-11-23 10:42:10'),
(48845, 10057, 31725, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Thank you for submitting the form.  Your case number:03210228  Your request may take up to 30 days to complete. Once completed, a notification will be sent to the email address submitted with the Demographic Change Request Form.  Please close the tab using X (Close) Button.', NULL, NULL, '2021-12-03 11:45:37', '2021-12-03 11:45:37'),
(48846, 10057, 31725, NULL, '2021-12-17 00:00:00.000', 'Approved', 'Email Received From : Carol_DelaO@bcbstx.com  Sub : PHI- Provider Roster - Normandy Urgent Care  Hello Steve –  Please find attach provider roster for provider.  Please review and let me know if you have any questions.  Thank you.  Carol DeLaO, Network Management Consultant  BlueCross BlueShield of Texas', NULL, NULL, '2021-12-10 10:41:26', '2021-12-10 10:41:26'),
(48847, 1006, 31726, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:28:44', '2021-07-01 10:28:44'),
(48848, 11056, 31726, NULL, '2021-07-12 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.', NULL, NULL, '2021-07-05 09:15:24', '2021-07-05 09:15:24'),
(48849, 1006, 31727, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:28:44', '2021-07-01 10:28:44'),
(48850, 11056, 31727, NULL, '2021-07-14 00:00:00.000', 'On Hold', 'Pending due to CAQH issue. Please see the attachment', NULL, NULL, '2021-07-06 16:52:42', '2021-07-06 16:52:42'),
(48851, 3040, 31727, NULL, '2021-09-17 00:00:00.000', 'In Process', 'Jeny John Application no: 12743773 Provider id: 0211248', NULL, NULL, '2021-09-10 14:03:30', '2021-09-10 14:03:30'),
(48852, 12062, 31727, NULL, '2021-09-24 00:00:00.000', 'In Process', 'Received Email from CIGNA;  see attached mail for your reference.', NULL, NULL, '2021-09-17 13:19:58', '2021-09-17 13:19:58'),
(48853, 10057, 31727, NULL, '2021-11-15 00:00:00.000', 'In Process', 'Email Sent To : John.Maguire@cigna.com  Sub : Enrollment Query || NUCC - IVUC || Jeny John || Cigna  Good Morning,  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned provider in Cigna under the below locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  John, Jeny 1073019493  Please get back to me as soon as you get a chance. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-08 11:17:14', '2021-11-08 11:17:14'),
(48854, 10057, 31727, NULL, '2021-11-15 00:00:00.000', 'In Process', 'Email Received From : John.Maguire@cigna.com  Sub : Enrollment Query || NUCC - IVUC || Jeny John || Cigna  Good afternoon Steve,  Unfortunately I don’t have full access to this information in credentialing.  Please call Cigna Provider Services at 1-800-88Cigna (882-4462) for more accurate assistance.  Thank you,  Provider SOLUTIONS & OPERATIONS  John Maguire', NULL, NULL, '2021-11-08 17:12:24', '2021-11-08 17:12:24'),
(48855, 10057, 31727, NULL, '2021-11-25 00:00:00.000', 'Approved', 'Approval Via Call Reference Code : Jefferey V 11/18/2021  Effective Date : 10/20/2021', NULL, NULL, '2021-11-18 14:26:47', '2021-11-18 14:26:47'),
(48856, 10057, 31727, NULL, '2021-11-25 00:00:00.000', 'Approved', 'Approval Via Call Reference Code : Jefferey V 11/18/2021  Effective Date : 10/20/2021', NULL, NULL, '2021-11-18 14:26:55', '2021-11-18 14:26:55'),
(48857, 10057, 31727, NULL, '2021-11-25 00:00:00.000', 'Approved', 'Approval Via Call Reference Code : Jefferey V 11/18/2021  Effective Date : 10/20/2021', NULL, NULL, '2021-11-18 14:26:58', '2021-11-18 14:26:58'),
(48858, 10057, 31727, NULL, '2021-11-25 00:00:00.000', 'Approved', 'Approval Via Call Reference Code : Jefferey V 11/18/2021  Effective Date : 10/20/2021', NULL, NULL, '2021-11-18 14:27:00', '2021-11-18 14:27:00'),
(48859, 10057, 31727, NULL, '2021-11-25 00:00:00.000', 'Approved', 'Approval Via Call Reference Code : Jefferey V 11/18/2021  Effective Date : 10/20/2021', NULL, NULL, '2021-11-18 14:27:01', '2021-11-18 14:27:01'),
(48860, 1006, 31728, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:28:44', '2021-07-01 10:28:44'),
(48861, 11056, 31728, NULL, '2021-07-12 00:00:00.000', 'Initiated', 'Email sent to : 	networkhelp@uhc.com  Sub : ENROLLMENT REQUEST - NUCC - IVUC - UNITED HEALTH CARE  Greetings,  I wanted to know how to enroll the below provider in mentioned groups below:  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider  Provider Name: John, Jeny Provider NPI# : 1073019493  Kindly, respond to me soon. If you have any questions feel free to contact me.  Thank you!', NULL, NULL, '2021-07-05 09:32:06', '2021-07-05 09:32:06'),
(48862, 3040, 31728, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Request for participation form sent please see attachment.', NULL, NULL, '2021-07-26 14:44:16', '2021-07-26 14:44:16'),
(48863, 11056, 31728, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email sent to : networkhelp@uhc.com  Sub : Enrollment Status Query - NUCC - IVUC - UHC  Good afternoon!  Hope all is well. I wanted to know the enrollment status for the below mentioned provider in UHC.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Details: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider Name: John, Jeny Provider NPI# : 1073019493  Please get back to me as soon as you can get a chance. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-08-11 14:52:34', '2021-08-11 14:52:34'),
(48864, 11056, 31728, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email sent to : networkhelp@uhc.com  Sub : Enrollment Status Query - NUCC - IVUC - UHC  Good afternoon!  Hope all is well. I wanted to know the enrollment status for the below mentioned provider in UHC.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Details: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider Name: John, Jeny Provider NPI# : 1073019493  Please get back to me as soon as you can get a chance. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-08-11 14:53:33', '2021-08-11 14:53:33'),
(48865, 3040, 31728, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Subject: Re: Enrollment Status Query - NUCC - IVUC - UHC  Greetings,   Hope you are doing well. Please provide the enrollment status for the below mentioned providers in UHC in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 2: Provider Name: John, Jeny Provider NPI# : 1073019493  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks  ', NULL, NULL, '2021-08-30 11:11:51', '2021-08-30 11:11:51'),
(48866, 10057, 31728, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email Sent To : networkhelp@uhc.com  Sub : Enrollment Status || Longpoint Medical Center || UHC ||  Good Morning,  Hope this email finds you well. Please provide the enrollment status for the below mentioned provider in UHC in our group under the below two locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI John, Jeny 1073019493  Looking forward to hearing from you. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-22 10:02:10', '2021-10-22 10:02:10');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(48867, 10057, 31728, NULL, '2021-11-04 00:00:00.000', 'In Process', 'Email Received From : networkhelp@uhc.com  Sub : Enrollment Status Query - NUCC - IVUC - UHC  Thank you for contacting the Network Management Resource Team . I have included the product roster reflecting the demographic information, lines of business, and effective dates for the providers requested.  The provider reflects associated to the Normandy location but not the Imperial Valley. Upon review of PR 6042930 and PR 6042929 both requests for the Normandy address. You may submit a request with W9 to the Imperial Valley address to have the provider added to hpdemo@uhc.com  If we can be of any further assistance regarding your Network or Credentialing matters please contact us via email at networkhelp@uhc.com  Sincerely, Debi Keck,                                                          Senior Provider Data Specialist; Culture Ambassador  Network Management Resource Team (NMRT)', NULL, NULL, '2021-10-28 09:37:04', '2021-10-28 09:37:04'),
(48868, 10057, 31728, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : networkhelp@uhc.com  Sub : Enrollment Status Query - NUCC - IVUC - UHC  Hello,  Any update on below mentioned request. Please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-22 14:06:51', '2021-11-22 14:06:51'),
(48869, 10057, 31728, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Sent To : networkhelp@uhc.com  Sub : Enrollment Status Query - NUCC - IVUC - UHC  Good Afternoon,  Hope this email finds you well. I\'m writing this email to check the latest update on the below mentioned details.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-02 14:50:54', '2021-12-02 14:50:54'),
(48870, 10057, 31728, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : networkhelp@uhc.com  Sub : Enrollment Status Query - NUCC - IVUC - UHC  Good Afternoon,  Hope this email finds you well. Please provide the enrollment status for the below mentioned provider in UHC in our group under the below locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI John, Jeny	1073019493  Looking forward to hearing from you. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-09 13:08:48', '2021-12-09 13:08:48'),
(48871, 10057, 31728, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Sent To : networkhelp@uhc.com  Sub : Enrollment Status Query - NUCC - IVUC - UHC  Good afternoon,  I want to get the status for LPMC & IVUC locations for Jeny John, since the NUCC locations have already been updated.  Please let me know how long it will take it to update.  Thanks & Regards,', NULL, NULL, '2021-12-16 15:12:11', '2021-12-16 15:12:11'),
(48872, 10057, 31728, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email Received From : networkhelp@uhc.com  Sub: Re: Enrollment Status Query - NUCC - IVUC – UHC  Good Morning,   Thank you for contacting the Network Management Resource Team. The provider shows to be linked to TIN 27-0796429 at the listed address; however, the provider is not linked to TIN 76-0612416. Please feel free to submit a request to hpdemo@uhc.com to add the TIN and location.   Please let us know if we can assist further via email.   Thank you, Estrellita “Nikki” Thomas UnitedHealthcare Network Management Resource Team (NMRT)', NULL, NULL, '2021-12-22 13:58:24', '2021-12-22 13:58:24'),
(48873, 10057, 31728, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Sent To : networkhelp@uhc.com  Sub : Enrollment Status Query - NUCC - IVUC - UHC  Thank you for the update. We will submit the forms for LPMC & IVUC locations.  Regards, Steve Albert', NULL, NULL, '2021-12-29 16:28:32', '2021-12-29 16:28:32'),
(48874, 20067, 31728, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Sub: Re: Enrollment Status Query - NUCC - IVUC - UHC  Good afternoon, Hope this email finds you well.Any updates on the below mentioned request.  Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-12 15:11:39', '2022-01-12 15:11:39'),
(48875, 20067, 31728, NULL, '2022-01-20 00:00:00.000', 'In Process', 'Email received from: networkhelpresponse@uhc.com  Sub: Re Enrollment Status Query - NUCC - IVUC - UHC - [ref:_02670681:ref]   Hello,  Jeny John MPIN 7691416 is not credentialed  -         Linked to TIN 270796429  -         Not linked to TIN 760612416  Please update CAQH and initiate credentialing online at https://ncc-optum.secure.force.com/rfp/  Thank you     Re- Enrollment Status Query - NUCC - IVUC - UHC Good afternoon, Hope this email finds you well.Any updates on the below mentioned request. Thanks and regards,   This e-mail, including attachments, may include confidential and/or proprietary information, and may be used only by the person or entity to which it is addressed. If the reader of this e-mail is not the intended recipient or intended recipient’s authorized agent, the reader is hereby notified that any dissemination, distribution or copying of this e-mail is prohibited. If you have received this e-mail in error, please notify the sender by replying to this message and delete this e-mail immediately.', NULL, NULL, '2022-01-13 09:19:37', '2022-01-13 09:19:37'),
(48876, 20067, 31728, NULL, '2022-01-20 00:00:00.000', 'In Process', 'Email sent to: networkhelpresponse@27s8pfl30fqwgc1t1ivmnoq43eo15cildqeve2dnafevawdimx.5-jldwea4.na123.apex.salesforce.com  Sub: Re: Re Enrollment Status Query - NUCC - IVUC - UHC - [ref:_02670681:ref]   Hope this email finds you in good health. Thanks for the update. For Jeny John NPI: 1073019493  Group Name: Normandy Urgent Care Center Tax ID: 270796429 Group NPI: 1407171077 Location: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Can you provide me with the welcome letter for this location?    Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-13 09:27:46', '2022-01-13 09:27:46'),
(48877, 20067, 31728, NULL, '2022-01-20 00:00:00.000', 'In Process', 'Email sent to: networkhelpresponse@uhc.com, networkhelpresponse@27s8pfl30fqwgc1t1ivmnoq43eo15cildqeve2dnafevawdimx.5-jldwea4.na123.apex.salesforce.com  Sub: Demographic update - NUCC - IVUC - UHC -  Good Afternoon, Hope this email finds you in good health. I would like to add the secondary location for provider Jeny John  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston, TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Jeny John	1073019493  Thanks and Regards Syed Ahad.', NULL, NULL, '2022-01-13 15:02:37', '2022-01-13 15:02:37'),
(48878, 20067, 31728, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Will follow-up next week Haven\'t received the email yet.', NULL, NULL, '2022-01-19 10:18:52', '2022-01-19 10:18:52'),
(48879, 20067, 31728, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Called UHC Automated gave the status, Application is in Initial process If any information is required we will contact you.', NULL, NULL, '2022-01-28 11:17:20', '2022-01-28 11:17:20'),
(48880, 20067, 31728, NULL, '2022-03-09 00:00:00.000', 'In Process', 'Email sent to: networkhelpresponse@uhc.com  Sub: Enrollment Status || Providers || NUCC & IVUC || UHC  Good Afternoon!  Hope this email finds you well. I would like to know the enrollment status of Ancy Kurian & the Demographic update for Jeny John, Information is listed below.  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Ancy Kurian	1316558935 Jeny John	1073019493  Thank you,', NULL, NULL, '2022-03-02 13:00:57', '2022-03-02 13:00:57'),
(48881, 20067, 31728, NULL, '2022-03-25 00:00:00.000', 'In Process', 'Demographic updates has been submitted through UHC Portal  Waiting for the address update', NULL, NULL, '2022-03-18 14:16:20', '2022-03-18 14:16:20'),
(48882, 22077, 31728, NULL, '2022-04-26 00:00:00.000', 'In Process', 'Email sent to: networkhelpresponse@uhc.com  Subject: 	Re: Enrollment Status || Providers || NUCC & IVUC || UHC  Hi,  I would like to know the enrollment process for the following providers.  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston, TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Ancy Kurian	1316558935 Jeny John	1073019493  I am looking forward to your kind response!  Thanks & Regards.', NULL, NULL, '2022-04-19 15:59:34', '2022-04-19 15:59:34'),
(48883, 1006, 31729, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:28:44', '2021-07-01 10:28:44'),
(48884, 11056, 31729, NULL, '2021-07-12 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s enrollment.', NULL, NULL, '2021-07-05 14:03:22', '2021-07-05 14:03:22'),
(48885, 3040, 31729, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Email rcvd from: kdelam@texaschildrens.org  Subject: Provider Contracts  Hello Adil,  Attached is the Provider Information Form to add locations and a Provider Information Change Form changes to existing providers.  I have included a breakdown of the contracts under your TIN.  Please contact me directly if you have any concerns getting the additional updates needed from contracting.     Thank you,  Kim', NULL, NULL, '2021-08-26 08:45:32', '2021-08-26 08:45:32'),
(48886, 10057, 31729, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : kdelam@texaschildrens.org  Sub : Provider Contracts  Hello Elam,  Hope this email finds you well. I\'m writing this email to follow-up against Adil\'s email which was sent to you on 08/25/2021.  For any questions please reach out to me. Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-08 13:25:23', '2021-10-08 13:25:23'),
(48887, 10057, 31729, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org, kdelam@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Greetings!  Any update on below mentioned credentialing request?  Please get back to me as soon as you get a chance. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-21 11:05:25', '2021-10-21 11:05:25'),
(48888, 10057, 31729, NULL, '2021-11-05 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello Liz/Kimberly,  It should be Kimberly\'s responsibility to update you and us rather than we are trying to reach her or you for an application. Can someone please check that and respond. Thanks  Regards, Alex', NULL, NULL, '2021-10-29 09:49:16', '2021-10-29 09:49:16'),
(48889, 10057, 31729, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. Can I get the latest update on below mentioned providers enrollment status and facility contracts / agreements.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Joseph, Molly	1396380077 Thomas, Cini	1134777238 Rauf, Abdur	1497726202 Piccione JR, James M	1356321509 Jacob, Jaya	1194336149 PAUL, SIGI	1033623616 Fernandus, Limy	1972005189 Abraham, Jeena	1467901587 Chennemkara, Mini Philip	1841755956 Joseph, Vibitha	1952931560 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Brown, Brittany	1275163537 George, Jeemol	1497219067 Jose, Julie	1447883061  Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-22 13:34:44', '2021-11-22 13:34:44'),
(48890, 10057, 31729, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Sure, for each provider please provide the date their application was submitted and which application did you submit (LOI or PIF).  Thank you', NULL, NULL, '2021-12-02 14:24:19', '2021-12-02 14:24:19'),
(48891, 10057, 31729, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Thank you for reaching out. The person before me has resigned. I can see that he has submitted the LOI forms for those providers which are already approved.  Please check from your side which providers are enrolled and updated in the system. Rest let me know so I can submit the application again.  Kindly revert back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-09 11:51:28', '2021-12-09 11:51:28'),
(48892, 10057, 31729, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  I can provide status on application.  To check which providers are in network or not, please reach out to your PR.  They should be able to provide you with a roster for the group.  Thank you  -Liz', NULL, NULL, '2021-12-16 14:54:40', '2021-12-16 14:54:40'),
(48893, 10057, 31729, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Thank you for reaching out. Could you please provide me with the PR details. It will be highly appreciated.  Regards,', NULL, NULL, '2021-12-22 13:47:56', '2021-12-22 13:47:56'),
(48894, 10057, 31729, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  If your group is PAR, you can reach out to your PR at Provider Relations providerrelations@texaschildrens.org  If you are not in our network, reach out to provider assistance 832-828-1004.', NULL, NULL, '2021-12-29 12:02:49', '2021-12-29 12:02:49'),
(48895, 20067, 31729, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org  Sub: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good afternoon,  Hope this email finds you well. I would like to know the enrollment status of the below-mentioned providers under these locations  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Molly Joseph	1396380077 Mini Chennemkara	1841755956 Odette Kourouma	1134525868 Ani Stephen	1588959118 James Piccione JR	1356321509 Jeny John	1073019493 Abdur Rauf	1497726202 Cini THomas	1134777238 James Piccione JR	1356321509 Vibitha Joseph	1952931560 SIGI PAUL	1033623616 Jeena Abraham	1467901587 Jaya Jacob	1194336149 Limy fernandus	1972005189 Brittany Brown	1275163537 Jeemol George	1497219067 Julie Jose	1447883061   Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-12 14:56:53', '2022-01-12 14:56:53'),
(48896, 20067, 31729, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org, tchpnetworkmanagement@texaschildrens.org   Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good Morning! Hope you are doing well. Any updates on the previous request?  Your Early response will be highly appreciated Thanks & Regards Syed Ahad.', NULL, NULL, '2022-01-19 09:55:08', '2022-01-19 09:55:08'),
(48897, 20067, 31729, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email received from: tchpnetworkmanagement@texaschildrens.org  Sub: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello Syed,     Your PR will be able to assist you with your below request.     Thank you  -Liz', NULL, NULL, '2022-01-28 10:26:15', '2022-01-28 10:26:15'),
(48898, 20067, 31729, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org  Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Group & Providers || TCHP ||  Good afternoon!  Hope this email finds you in good health. I would like to know the enrollment status of the below-mentioned groups and providers.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Molly Joseph	1396380077 Mini Chennemkara	1841755956 Odette Kourouma	1134525868 Ani Stephen	1588959118 James Piccione JR	1356321509 Jeny John	1073019493 Abdur Rauf	1497726202 Cini THomas	1134777238 James Piccione JR	1356321509 Vibitha Joseph	1952931560 SIGI PAUL	1033623616 Jeena Abraham	1467901587 Jaya Jacob	1194336149 Limy fernandus	1972005189 Brittany Brown	1275163537 Jeemol George	1497219067 Julie Jose	1447883061  Thanks & Regards, Syed Ahad ', NULL, NULL, '2022-03-01 15:26:21', '2022-03-01 15:26:21'),
(48899, 22077, 31729, NULL, '2022-04-25 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Group & Providers || TCHP ||  Hi,  Any updates on the previously mentioned request?  I am looking forward to your kind response!  Thanks & Regards.', NULL, NULL, '2022-04-18 11:58:13', '2022-04-18 11:58:13'),
(48900, 1006, 31730, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:28:44', '2021-07-01 10:28:44'),
(48901, 11056, 31730, NULL, '2021-07-13 00:00:00.000', 'Initiated', 'Email sent to : MDuffee@humana.com  Sub : ENROLLMENT REQUEST - NUCC - IVUC - Humana  Greetings,  Hope you are doing well. I wanted to enroll the below provider in the groups mentioned below:  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Provider Name :  John, Jeny Provider NPI# : 1073019493  Kindly respond to me soon. If you need any information feel free to contact me. Thank you! ', NULL, NULL, '2021-07-05 16:03:12', '2021-07-05 16:03:12'),
(48902, 3040, 31730, NULL, '2021-07-23 00:00:00.000', 'Approved', 'Group is enrolled under an ancillary contract, it is attached in main group task for reference.  Eff: 12/01/2012', NULL, NULL, '2021-07-16 16:19:03', '2021-07-16 16:19:03'),
(48903, 1006, 31731, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:28:44', '2021-07-01 10:28:44'),
(48904, 11056, 31731, NULL, '2021-07-12 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s approval.', NULL, NULL, '2021-07-05 09:41:10', '2021-07-05 09:41:10'),
(48905, 3040, 31731, NULL, '2021-09-01 00:00:00.000', 'In Process', 'Email sent to: mpsweb@amerigroup.com  Subject: Delivery Status Notification (Failure)  Greetings!  Hope you are doing well. I want to inquire about the enrollment status for the below mentioned group and providers in our groups under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details:  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Provider 17: Provider Name: John, Jeny Provider NPI #  1073019493  If you need any documents or information feel free to reach out to me. Eagerly, waiting for your reply.  Thanks', NULL, NULL, '2021-08-25 14:59:44', '2021-08-25 14:59:44'),
(48906, 3040, 31731, NULL, '2021-09-16 00:00:00.000', 'In Process', 'Email sent to: mpswebinquiries@amerigroup.com, Jason.Hughes@amerigroup.com, TXCredentialing@amerigroup.com  Subject: Need to Enroll || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || AMERIGROUP ||  Greetings,   Hope you are doing well. I received an email from your side in which you mentioned that our group &  providers are not contracted with Amerigroup under the below locations besides some of the providers are participating with Amerigroup but not under all the locations. I wanted to know how to enroll and add the additional locations for the below mentioned providers in Amerigroup under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Below are the providers need to enroll in Amerigroup:    Provider Name: Thomas, Cini  NPI: 1134777238  Tax ID: 270796429  Status: Non-Participating  Location: 16272 IMPERIAL VALLEY DR STE K,  Houston     Provider Name: Stephen, Ani  NPI: 1588959118  Tax ID: 270796429  Status: Non-Participating     Provider Name: Piccione JR, James  NPI: 1356321509  Tax ID: 270796429  Status: Non-Participating  Location: 9504 LONG POINT RD STE E  Houston     Provider Name: PAUL, SIGI  NPI: 1033623616  Tax ID: 270796429  Status: Non-Participating     Provider Name: Kourouma , Odette  NPI: 1134525868  Tax ID: 270796429  Status: Non-Participating     Provider/Group Name: Jacob, Jaya  NPI: 1194336149  Status: Non-Participating     Provider Name: Fernandus, Limy  NPI: 1972005189  Status: Non-Participating     Provider Name: Abraham, Jeena  NPI: 1467901587  Provider ID:  Status: Non-Participating     Provider Name: Chennemkara, Mini Philip  NPI: 1841755956  Tax ID: 270796429  Status: Non-Participating     Provider Name: Joseph, Molly  NPI: 1396380077  Status: Non-Participating     Provider Name: John, Jeny  NPI: 1073019493  Tax ID: 27-0796429  Status: Non-Participating     Provider Name: Rauf, Abdur   NPI: 1497726202  Tax ID: 27-0796429  Status: Non-Participating    Request to add the additional location for the below mentioned providers.     Provider Name: Joseph, Vibitha  NPI: 1952931560  Provider ID: 09743760  Tax ID: 760612416  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 9504 LONG POINT RD STE E  Houston  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Provider Name: Abraham, Glory  NPI: 1194206490  Provider ID: 07116206  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: Brown, Brittany  NPI: 1275163537  Provider ID: 09808410  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: George, Jeemol  NPI: 1497219067  Provider ID: 09805666  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: Jose, Julie  NPI: 1447883061  Provider ID: 09807037  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    If you need any additional information please feel free to call or email me. Please get back to me as soon as you can get a chance. Waiting to hear from you soon.     Thank you ', NULL, NULL, '2021-09-09 13:07:55', '2021-09-09 13:07:55'),
(48907, 10057, 31731, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : mpswebinquiries@amerigroup.com, Jason.Hughes@amerigroup.com, TXCredentialing@amerigroup.com  Sub : Need to Enroll || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || AMERIGROUP ||  Good Evening,  Hope this email finds you well. I want to inquire about the enrollment status of the below mentioned providers and practices. Please get back to me as soon as you get a chance.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Looking forward to hearing from you. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-18 15:07:12', '2021-10-18 15:07:12'),
(48908, 10057, 31731, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Hello,  Greetings for the day!  We want to enroll the below mentioned providers on an urgent basis with Amerigroup under below mentioned details. Also please find the attached LOI\'s for all providers.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441 Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Please get back to me with the update as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-11 13:07:10', '2021-11-11 13:07:10'),
(48909, 10057, 31731, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Greetings!  Can I get the latest update on the below mentioned request.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-11-30 10:50:39', '2021-11-30 10:50:39'),
(48910, 10057, 31731, NULL, '2021-12-14 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com, Jason.Hughes@amerigroup.com, mpswebinquiries@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Good Afternoon,  Hope this email finds you in good health. I\'m writing this email to check the status for the applications which we have submitted to enroll the providers with Amerigroup under the TIN\'s.  It is my second follow-up, please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-06 16:07:01', '2021-12-06 16:07:01'),
(48911, 10057, 31731, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Called to check the status: 800 - 600 - 4441  Applications has been received and credentialing started on 11/11/2021. Still need 30 working days to finish the process. Once request will be completed, welcome letter will be issued accordingly.  Call Reference: I145695020 - Representative - Courtney', NULL, NULL, '2021-12-13 10:49:59', '2021-12-13 10:49:59'),
(48912, 10057, 31731, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Please check previous Call Comments.  Will follow-up next week.', NULL, NULL, '2021-12-20 13:57:40', '2021-12-20 13:57:40'),
(48913, 10057, 31731, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Call Details: (800) 600-4441  Rep: Victor  Ref # I146789022  Still in process, need to check next week, also send reminder to below mentioned emails.  latina.small@anthem.com nena.graves@amerigroup.com  Regards, Steve Albert', NULL, NULL, '2021-12-29 11:09:17', '2021-12-29 11:09:17'),
(48914, 19067, 31731, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com, Jason.Hughes@amerigroup.com, mpswebinquiries@amerigroup.com  Subject: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||   Hello!  Hope you are having a productive day.  I would like to know the enrollment status of the following Providers & Groups.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Jeny John	1073019493	779 Normandy St STE 114, Houston, TX 77015-3441 Jeny John	1073019493	16272 Imperial Valley DR STE K, Houston, TX 77060 Molly Joseph	1396380077	779 Normandy St STE 114, Houston, TX 77015-3441 Molly Joseph	1396380077	16272 Imperial Valley DR STE K, Houston, TX 77060 Cini Thomas	1134777238	779 Normandy St STE 114, Houston, TX 77015-3441 Cini Thomas	1134777238	16272 Imperial Valley DR STE K, Houston, TX 77060 Ani Stephen	1588959118	779 Normandy St STE 114, Houston, TX 77015-3441 Ani Stephen	1588959118	16272 Imperial Valley DR STE K, Houston, TX 77060 Abdur Rauf	1497726202	779 Normandy St STE 114, Houston, TX 77015-3441 Abdur Rauf	1497726202	16272 Imperial Valley DR STE K, Houston, TX 77060 James Piccione JR	1356321509	779 Normandy St STE 114, Houston, TX 77015-3441 James Piccione JR	1356321509	16272 Imperial Valley DR STE K, Houston, TX 77060 Sigi Paul	1033623616	779 Normandy St STE 114, Houston, TX 77015-3441 Sigi Paul	1033623616	16272 Imperial Valley DR STE K, Houston, TX 77060 Odette Kourouma	1134525868	779 Normandy St STE 114, Houston, TX 77015-3441 Odette Kourouma	1134525868	16272 Imperial Valley DR STE K, Houston, TX 77060 Vibitha Joseph	1952931560	779 Normandy St STE 114, Houston, TX 77015-3441 Vibitha Joseph	1952931560	16272 Imperial Valley DR STE K, Houston, TX 77060 Julie Jose	1447883061	779 Normandy St STE 114, Houston, TX 77015-3441 Julie Jose	1447883061	16272 Imperial Valley DR STE K, Houston, TX 77060 Jaya Jacob	1194336149	779 Normandy St STE 114, Houston, TX 77015-3441 Jaya Jacob	1194336149	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeemol George	1497219067	16272 Imperial Valley DR STE K, Houston, TX 77060 Limy Fernandus	1972005189	779 Normandy St STE 114, Houston, TX 77015-3441 Limy Fernandus	1972005189	16272 Imperial Valley DR STE K, Houston, TX 77060 Brittany Brown	1275163537	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeena Abraham	1467901587	779 Normandy St STE 114, Houston, TX 77015-3441 Jeena Abraham	1467901587	16272 Imperial Valley DR STE K, Houston, TX 77060 Mini Chennemkara	1841755956	779 Normandy St STE 114, Houston, TX 77015-3441 Mini Chennemkara	1841755956	16272 Imperial Valley DR STE K, Houston, TX 77060  Kindly respond promptly.  Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 16:02:33', '2022-01-04 16:02:33'),
(48915, 20067, 31731, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com, Jason.Hughes@amerigroup.com & mpswebinquiries@amerigroup.com  Sub: Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||   Good Morning! Hope this email finds you well. Any updates on the below-mentioned request?  Thanks and regards, Syed Ahad', NULL, NULL, '2022-01-14 10:48:35', '2022-01-14 10:48:35'),
(48916, 20067, 31731, NULL, '2022-01-31 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Sub: Re: {EXTERNAL} Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||  Hello,  Hope you had a good weekend. Can you please help me out with few queries mention below: What do I have to do to Par these providers at Imperial Valley Urgent Care Center?  Secondly, I can\'t locate Cini Thomas in the Amerigroup providers directory. Lastly, do I have to submit LOI for individual providers? Eagerly waiting for your reply, Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-24 17:08:55', '2022-01-24 17:08:55'),
(48917, 20067, 31731, NULL, '2022-01-31 00:00:00.000', 'In Process', 'Email received from: TXCredentialing@amerigroup.com  Sub: RE: {EXTERNAL} Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||  I added a column with my notes     Group Name  Normandy Urgent Care Center     Tax ID  27-0796429     Group NPI  1407171077     Provider Name  NPI  Location  AGP Notes  Jeny John  1073019493  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 12190140  Jeny John  1073019493  16272 Imperial Valley DR STE K, Houston, TX 77060  Not par at this location, include phone and Fax  Molly Joseph  1396380077  779 Normandy St STE 114, Houston, TX 77015-3441  Complete the attached LOI so I can link her to this tax ID  Molly Joseph  1396380077  16272 Imperial Valley DR STE K, Houston, TX 77060  Complete the attached LOI so I can link her to this tax ID  Cini Thomas  1134777238  779 Normandy St STE 114, Houston, TX 77015-3441  Not par at this location, include phone and Fax  Cini Thomas  1134777238  16272 Imperial Valley DR STE K, Houston, TX 77060  -                                        Eff date 11/22/2021 P# 10869221  Ani Stephen  1588959118  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 12/20/2021.  P# 12190275  Ani Stephen  1588959118  16272 Imperial Valley DR STE K, Houston, TX 77060  Not par at this location, include phone and Fax  Abdur Rauf  1497726202  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 01641188  Abdur Rauf  1497726202  16272 Imperial Valley DR STE K, Houston, TX 77060  Eff date 11/11/2021.  P# 01641188  James Piccione JR  1356321509  779 Normandy St STE 114, Houston, TX 77015-3441  Complete the attached LOI so I can link her to this tax ID  James Piccione JR  1356321509  16272 Imperial Valley DR STE K, Houston, TX 77060  Complete the attached LOI so I can link her to this tax ID  Sigi Paul  1033623616  779 Normandy St STE 114, Houston, TX 77015-3441  Complete the attached LOI so I can link her to this tax ID  Sigi Paul  1033623616  16272 Imperial Valley DR STE K, Houston, TX 77060  Complete the attached LOI so I can link her to this tax ID  Odette Kourouma  1134525868  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 12190157  Odette Kourouma  1134525868  16272 Imperial Valley DR STE K, Houston, TX 77060  Not par at this location, include phone and Fax  Vibitha Joseph  1952931560  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 12221497  Vibitha Joseph  1952931560  16272 Imperial Valley DR STE K, Houston, TX 77060  Eff date 11/11/2021.  P# 12221497  Julie Jose  1447883061  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 09807037  Julie Jose  1447883061  16272 Imperial Valley DR STE K, Houston, TX 77060  Eff date 11/11/2021.  P# 09807037  Jaya Jacob  1194336149  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 12205914  Jaya Jacob  1194336149  16272 Imperial Valley DR STE K, Houston, TX 77060  Eff date 11/11/2021.  P# 12205914  Jeemol George  1497219067  16272 Imperial Valley DR STE K, Houston, TX 77060  Effective 05/29/2020 (Amerivantage only) – 09805666   - not par at the Imperial Valley location, include the phone and fax  Limy Fernandus  1972005189  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 12190801  Limy Fernandus  1972005189  16272 Imperial Valley DR STE K, Houston, TX 77060  Not par at this location, include phone and Fax  Brittany Brown  1275163537  16272 Imperial Valley DR STE K, Houston, TX 77060  Effective 11/11/2021.  P# 09808410 (not par at the Imperial Valley location, include the phone and fax)  Jeena Abraham  1467901587  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 10286831  Jeena Abraham  1467901587  16272 Imperial Valley DR STE K, Houston, TX 77060  Not par at this location, include phone and Fax  Mini Chennemkara  1841755956  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 12190610  Mini Chennemkara  1841755956  16272 Imperial Valley DR STE K, Houston, TX 77060  Not par at this location, include phone and Fax', NULL, NULL, '2022-01-24 17:14:42', '2022-01-24 17:14:42'),
(48918, 20067, 31731, NULL, '2022-02-09 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Sub: RE: {EXTERNAL} Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||   Hello,  Hope you had a good weekend. Can you please help me out with few queries mention below: What do I have to do to Par these providers at Imperial Valley Urgent Care Center?  Secondly, I can\'t locate Cini Thomas in the Amerigroup providers directory. Lastly, do I have to submit LOI for individual providers? Eagerly waiting for your reply, Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-02-02 14:44:29', '2022-02-02 14:44:29'),
(48919, 20067, 31731, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Sub: Re: {EXTERNAL} Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||   Good Afternoon!  Hope you are doing well. Attached are the LOI for the Non-Par Providers. Can you please tell me how I can add a location under the remaining providers?  Thank you,', NULL, NULL, '2022-03-01 13:37:25', '2022-03-01 13:37:25'),
(48920, 20067, 31731, NULL, '2022-03-25 00:00:00.000', 'In Process', 'Email received from: txcredentialing@amerigroup.com  Sub: FW: {EXTERNAL} Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||  Does this provider wish to be in the directory?  If so, please resend the lOI', NULL, NULL, '2022-03-18 17:01:43', '2022-03-18 17:01:43'),
(48921, 22077, 31731, NULL, '2022-04-21 00:00:00.000', 'In Process', 'Email sent to: txcredentialing@amerigroup.com  Subject: Re: {EXTERNAL} Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||  Hi,  Any update on the mentioned request?  Looking forward to your kind response. Have a great day!  Thanks & Regards, Alex.', NULL, NULL, '2022-04-14 13:58:33', '2022-04-14 13:58:33'),
(48922, 1006, 31732, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:28:44', '2021-07-01 10:28:44'),
(48923, 3040, 31732, NULL, '2021-07-12 00:00:00.000', 'On Hold', 'We have an ancillary contract with CHC. Location addition request sent out. For more details please see the group task.  ', NULL, NULL, '2021-07-05 09:32:52', '2021-07-05 09:32:52'),
(48924, 3040, 31732, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: Rajika.Reid@communityhealthchoice.org  Subject: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Hello Rajika,   Hope you are doing well. Please find the attached signed contract as per your request email for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  If you need any additional information please feel free to call or email me.  Thank you ', NULL, NULL, '2021-07-20 10:43:05', '2021-07-20 10:43:05'),
(48925, 11056, 31732, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email sent to : Rajika.Reid@communityhealthchoice.org  Sub : FW: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Community Health Choice for our group under the below locations. And provide us with the updates regarding the signed contract which we have submitted to you in the month of June, 2021.    Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: George, Jeemol  Provider NPI# 1497219067     Provider 2:    Provider Name: Jose, Julie  Provider NPI# 1447883061     Provider 3:    Provider Name: Stephen, Ani  Provider NPI# 1588959118     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Brown, Brittany  Provider NPI# 1275163537     Provider 6:    Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956     Provider 7:    Provider Name: Abraham, Glory  Provider NPI# 1194206490     Provider 8:    Provider Name: Fernandus, Limy  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider NPI# 1497726202     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868     Provider 11:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560     Provider 12:    Provider Name: Thomas, Cini  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider NPI# 1467901587     Provider 14:    Provider Name: PAUL, SIGI   Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149     If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!  Have a great week ahead!', NULL, NULL, '2021-08-09 10:20:05', '2021-08-09 10:20:05'),
(48926, 11056, 31732, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email sent to : Rajika.Reid@communityhealthchoice.org  Sub : FW: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Community Health Choice for our group under the below locations. And provide us with the updates regarding the signed contract which we have submitted to you in the month of June, 2021.    Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: George, Jeemol  Provider NPI# 1497219067     Provider 2:    Provider Name: Jose, Julie  Provider NPI# 1447883061     Provider 3:    Provider Name: Stephen, Ani  Provider NPI# 1588959118     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Brown, Brittany  Provider NPI# 1275163537     Provider 6:    Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956     Provider 7:    Provider Name: Abraham, Glory  Provider NPI# 1194206490     Provider 8:    Provider Name: Fernandus, Limy  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider NPI# 1497726202     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868     Provider 11:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560     Provider 12:    Provider Name: Thomas, Cini  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider NPI# 1467901587     Provider 14:    Provider Name: PAUL, SIGI   Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149     If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!  Have a great week ahead!', NULL, NULL, '2021-08-09 10:23:43', '2021-08-09 10:23:43'),
(48927, 3040, 31732, NULL, '2021-08-24 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. For more details please see group task. ', NULL, NULL, '2021-08-17 13:57:49', '2021-08-17 13:57:49'),
(48928, 1006, 31733, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:28:44', '2021-07-01 10:28:44'),
(48929, 11056, 31733, NULL, '2021-07-13 00:00:00.000', 'On Hold', 'Awaiting Aetna\' and Medicaid\'s approval.', NULL, NULL, '2021-07-05 16:09:15', '2021-07-05 16:09:15'),
(48930, 3040, 31733, NULL, '2021-07-19 00:00:00.000', 'Approved', 'I had a word with First Health and she advised me we have an ancillary contract with Aetna so our group is enrolled with First Health because First Health is the part of Aetna.  ', NULL, NULL, '2021-07-12 16:22:58', '2021-07-12 16:22:58');
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
(48931, 1006, 31734, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:28:44', '2021-07-01 10:28:44'),
(48932, 11056, 31734, NULL, '2021-07-13 00:00:00.000', 'Initiated', 'Your form has been submitted! For new provider applications, please allow 15 business days for a HealthSmart team member to contact you. Form has been submitted and attached. Kindly see the attachment.', NULL, NULL, '2021-07-05 16:35:48', '2021-07-05 16:35:48'),
(48933, 3040, 31734, NULL, '2021-08-06 00:00:00.000', 'In Process', 'Email rcvd from: mdiprsupport@healthsmart.com  Subject: Fw: Provider Application – John  Hi,  We are returning your application due to missing information listed below.  * SSN # * Current state license * Current certificate of Insurance * Explain in Work History * Explain in Employment * Current Release and Attestation date * ALL Disclosure Questions Answered * CAQH not Updated please update CAQH and advise once completed.', NULL, NULL, '2021-07-30 14:33:30', '2021-07-30 14:33:30'),
(48934, 3040, 31734, NULL, '2021-08-06 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Re: Fw: Provider Application – John  Hello,   Hope you are doing well. Please note that the provider CAQH updated now you can access the information from CAQH if you need the CAQH access form please let me know.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-30 14:34:19', '2021-07-30 14:34:19'),
(48935, 11056, 31734, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email sent to : pr.south@healthsmart.com   &   mdiprsupport@healthsmart.com  Sub : Enrollment Status Query - NUCC - IUVC - Health smart  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in Health Smart in our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Details: Provider Name : Joseph, Molly Provider NPI # : 1396380077  Provider Name : John, Jeny Provider NPI # : 1073019493  If you need any documents or information please let me know. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-09 13:42:04', '2021-08-09 13:42:04'),
(48936, 3040, 31734, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Re: Fw: Enrollment Status Query - NUCC - IUVC - Health smart  Hello,   Hope you are doing well. Please advise the enrollment status for the below mentioned provider in Health Smart in our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Details: Provider Name : John, Jeny Provider NPI # : 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-08-30 15:06:28', '2021-08-30 15:06:28'),
(48937, 3040, 31734, NULL, '2021-09-08 00:00:00.000', 'Approved', 'Email rcvd to: mdiprsupport@healthsmart.com  Subject: Fw: Fw: Enrollment Status Query - NUCC - IUVC - Health smart  Hi,  Provider \'\' John, Jeny NP \'\' is Effective \'\' 10/01/2021 \'\'  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com.   (Inventory Log ID :83345)  Thanks. HealthSmart Provider Relations.', NULL, NULL, '2021-09-01 14:17:37', '2021-09-01 14:17:37'),
(48938, 1006, 31735, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:28:45', '2021-07-01 10:28:45'),
(48939, 11056, 31735, NULL, '2021-07-12 00:00:00.000', 'Initiated', 'Email sent to : registrar@multiplan.com  Sub : ENROLLMENT REQUEST - NUCC - IVUC -MULTIPLAN  Greetings,  I wanted to know how to enroll the below provider in the groups mentioned below:  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Provider Name :  John, Jeny Provider NPI# : 1073019493  Kindly respond to me soon. If you need any information feel free to contact me. Thank you!', NULL, NULL, '2021-07-05 13:37:20', '2021-07-05 13:37:20'),
(48940, 3040, 31735, NULL, '2021-07-13 00:00:00.000', 'In Process', 'I had a word with Dan Multiplan representative and he said under the group contract we have all three location  (NUCC, IVUC & LPMC). He advised to send the LOI through fax and they can process our request. Also he said LPMC is not contracted separately because that already coming under the NUCC tax ID .  Case # 7660656', NULL, NULL, '2021-07-06 11:57:11', '2021-07-06 11:57:11'),
(48941, 3040, 31735, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Letter of Intent || NUCC, IVUC & LPMC || Providers || Multiplan ||  Greetings,   Hope you are doing well. Please find attached Letter of Intent as per request of (Sam) Multiplan representative and he advises to send it through email as per him Multiplan did not receive the fax.    Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 9:   Provider Name: Joseph, Molly  Provider NPI# 1396380077  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 12:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 13:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: John, Jeny Provider NPI# 1073019493   Thank you  ', NULL, NULL, '2021-07-27 16:42:06', '2021-07-27 16:42:06'),
(48942, 1006, 31735, NULL, '2021-08-10 00:00:00.000', 'In Process', 'We received a fax from Multiplan requesting specialty information for the provider, replied @ registrarmissinginfo@multiplan.com:  Sub: Missing Items Request   \"Hello,   Please find the requested information, do let me know if you need any other information.   Thank you. \"', NULL, NULL, '2021-08-03 10:31:42', '2021-08-03 10:31:42'),
(48943, 11056, 31735, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email sent to : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good morning!  Hope you are doing well. I want to inquire about the enrollment status of the following providers and practices for the Multiplan.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider 1:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 9:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 12:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 13:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: John, Jeny Provider NPI# 1073019493  If you need any information or documents feel free to reach out to me. Waiting for your response.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-09 12:39:08', '2021-08-09 12:39:08'),
(48944, 3040, 31735, NULL, '2021-08-30 00:00:00.000', 'In Process', 'Email sent to: appmissinginfo@multiplan.com   Subject: Missing Information || NUCC - IVUC - LPMC || John, Jeny || Multiplan ||  Hello,   Hope you are doing well. I had a word with a Multiplan representative and she requested that the below information is missing in the application.  Practice Details: Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226 Phone Number: (713) 461-3535 Fax Number: (713) 461-3518  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-23 14:28:58', '2021-08-23 14:28:58'),
(48945, 10057, 31735, NULL, '2021-10-14 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good Evening!  Hope this email finds you well. I want to inquire about the updated enrollment status of the following providers and practices for the Multiplan.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Brown, Brittany	1275163537 Stephen, Ani	1588959118 Thomas, Cini	1134777238 Rauf, Abdur	1497726202 Abraham, Jeena	1467901587 Kourouma , Odette Tiranke	1134525868 Fernandus, Limy	1972005189 Joseph, Molly	1073019493 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Jose, Julie	1447883061 Piccione JR, James M	1356321509 Abraham, Glory	1194206490 Joseph, Vibitha	1952931560 John, Jeny	1073019493  Looking forward to your response. Have a great evening!  Thanks & Regards,', NULL, NULL, '2021-10-07 16:47:53', '2021-10-07 16:47:53'),
(48946, 10057, 31735, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good Morning,  Hope you are doing well. Please let me know the latest enrollment status for the below mentioned providers and groups.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Stephen, Ani	1588959118 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Piccione JR, James M	1356321509  Kindly revert back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-22 09:32:48', '2021-11-22 09:32:48'),
(48947, 10057, 31735, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com & registrarmissinginfo@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Hello,  Can I get the latest updates on the below mentioned providers enrollment request?  Please get back to me ASAP!  Thanks & Regards,', NULL, NULL, '2021-12-02 13:45:24', '2021-12-02 13:45:24'),
(48948, 10057, 31735, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com & registrarmissinginfo@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good Morning,  Hope you are doing great. I\'m writing this email to check the latest update on the below mentioned request. It is my second reminder.  Looking forward to your earliest response.  Thanks & Regards,', NULL, NULL, '2021-12-09 11:15:29', '2021-12-09 11:15:29'),
(48949, 10057, 31735, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Received From : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Please do not respond to this email. Registrar only handles first time submissions to update your information.  You may inquire about submission status, request a contract copy or inquire about your fee schedule through MultiPlan\'s customer service portal. There is no log-in or account set-up required. Simply select \"Rendering Practitioner/Facility\" and follow the on screen instructions in order to submit your inquiry.https://provider.multiplan.com.  If you need assistance navigating the portal please contact customer service at 800-950-7040.  When submitting missing information please email the information registrarmissinginfo@multiplan.com or via fax to 781-487-8278.', NULL, NULL, '2021-12-16 14:42:04', '2021-12-16 14:42:04'),
(48950, 10057, 31735, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Thank you for your response. I have tried to get the details from the portal as well but it has not worked, is there any way that any person from the credentialing department can contact me?  Call back number - 713-893-6214  It will be very helpful for me. Have a great day!  Regards,', NULL, NULL, '2021-12-22 11:26:56', '2021-12-22 11:26:56'),
(48951, 10057, 31735, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Still waiting to get a response from your side?  Regards,', NULL, NULL, '2021-12-29 11:56:22', '2021-12-29 11:56:22'),
(48952, 20067, 31735, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, registrarmissinginfo@multiplan.com  Sub: Re: Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good afternoon, Hope this email finds you in good health. Any Updates on the previously mentioned request?  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-12 17:42:32', '2022-01-12 17:42:32'),
(48953, 20067, 31735, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, registrarmissinginfo@multiplan.com  Sub: Re: Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan   Good afternoon!  Hope this email finds you in good health. It\'s been a long time I\'ve not heard from you Kindly respond promptly.  Thanks & Regards Syed Ahad.', NULL, NULL, '2022-01-18 16:59:15', '2022-01-18 16:59:15'),
(48954, 20067, 31735, NULL, '2022-02-04 00:00:00.000', 'Approved', 'Provider is participating with Multiplan. See the Attachment Effective Date: 09/30/2021 ', NULL, NULL, '2022-01-28 10:06:20', '2022-01-28 10:06:20'),
(48955, 1006, 31736, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:28:45', '2021-07-01 10:28:45'),
(48956, 11056, 31736, NULL, '2021-07-12 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. See group task.', NULL, NULL, '2021-07-05 13:20:52', '2021-07-05 13:20:52'),
(48957, 1006, 31737, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:28:45', '2021-07-01 10:28:45'),
(48958, 11056, 31737, NULL, '2021-07-12 00:00:00.000', 'On Hold', 'Awaiting Medicare\'s approval.', NULL, NULL, '2021-07-05 09:08:22', '2021-07-05 09:08:22'),
(48959, 11056, 31737, NULL, '2021-07-16 00:00:00.000', 'In Process', 'Enrollment Application Status  Application Status : Submitted  PEP Ticket Number : 17907922', NULL, NULL, '2021-07-09 11:10:40', '2021-07-09 11:10:40'),
(48960, 11056, 31737, NULL, '2021-08-20 00:00:00.000', 'Approved', 'Portal Ticket #  Application Name  NPI	Status Update Date	Transction Type	Status	   17907922	Jeny-nucc	1073019493	7/28/2021	Enrollment - First Time Applicant	Closed Approved  Please see attachment.', NULL, NULL, '2021-08-13 09:44:09', '2021-08-13 09:44:09'),
(48961, 1006, 31738, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:28:45', '2021-07-01 10:28:45'),
(48962, 11056, 31738, NULL, '2021-07-13 00:00:00.000', 'On Hold', 'Group ancillary contract request sent to Memorial Hermann. For more details please see group task. ', NULL, NULL, '2021-07-05 14:20:58', '2021-07-05 14:20:58'),
(48963, 3040, 31738, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: enterprise.credentialing@memorialhermann.org  Subject: Re: [EXTERNAL] Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Memorial Hermann ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Memorial Hermann for our group under the below locations.    Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-20 10:52:07', '2021-07-20 10:52:07'),
(48964, 11056, 31738, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Email sent to : ProviderServices@memorialhermann.org  &  MHHPContracting@memorialhermann.org  Sub : Fwd: [EXTERNAL] Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Memorial Hermann ||  Good morning!  Hope you are doing well. I want to know the enrollment status of the below mentioned group under the below locations for Ancillary contract in Memorial Hermann.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great day! ', NULL, NULL, '2021-08-12 15:32:11', '2021-08-12 15:32:11'),
(48965, 3040, 31738, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Group has an ancillary contract no need to add individual providers. Please see group task for more details. ', NULL, NULL, '2021-08-27 09:59:27', '2021-08-27 09:59:27'),
(48966, 1006, 31739, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:28:45', '2021-07-01 10:28:45'),
(48967, 11056, 31739, NULL, '2021-07-12 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s enrollment.', NULL, NULL, '2021-07-05 13:30:53', '2021-07-05 13:30:53'),
(48968, 10057, 31739, NULL, '2021-11-26 00:00:00.000', 'Initiated', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Query || NUCC - IVUC || Jeny John || Molina Health  Good Afternoon,  Hope you are doing well. We want to enroll the below mentioned provider under given TIN and locations. Please let me know the process.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441 Group Name	Imperial Valley Urgent Care Center  Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI Jeny John 	1073019493  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-11-19 17:24:04', '2021-11-19 17:24:04'),
(48969, 10057, 31739, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email Received From : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Query || NUCC - IVUC || Jeny John || Molina Health  Good Morning,  Thank you for your inquiry.  Please complete the attached contract request form and submit with a valid W9.   The form and the W9 must be sent together to the contracting mailbox MHTContractrequest@Molinahealthcare.com.  Thank You,  Michele Thomas-Martin Associate Specialist, Provider Contracts 1-888-562-5442 Ext. 200042', NULL, NULL, '2021-12-01 13:34:56', '2021-12-01 13:34:56'),
(48970, 10057, 31739, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Query || NUCC - IVUC || Jeny John || Molina Health  Please find the attached file for your reference. If you require anything else please let me know.  Thanks & Regards,', NULL, NULL, '2021-12-08 10:51:42', '2021-12-08 10:51:42'),
(48971, 10057, 31739, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com MHTContractrequest@molinahealthcare.com  Sub : Enrollment Query || NUCC - IVUC || Jeny John || Molina Health  Hello,  Could you please provide me with the latest update for the below mentioned request.  Kindly revert back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-14 11:33:54', '2021-12-14 11:33:54'),
(48972, 10057, 31739, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Query || NUCC - IVUC || Jeny John || Molina Health  Any update on the below request?  Regards, Steve Albert', NULL, NULL, '2021-12-21 11:02:51', '2021-12-21 11:02:51'),
(48973, 10057, 31739, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Received From : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Query || NUCC - IVUC || Jeny John || Molina Health  Record # 185307  Provider: Jeny John  Good Afternoon,  Thank you for your inquiry.   The contract request is under credentialing.  Please allow a few more weeks for the credentialing application to process.  Thank You,  Michele Thomas-Martin', NULL, NULL, '2021-12-27 17:06:59', '2021-12-27 17:06:59'),
(48974, 20067, 31739, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to:Michele.Thomas-Martin@molinahealthcare.com  Sub: Re: Enrollment Query || NUCC - IVUC || Jeny John || Molina Health   Good Morning, Hope all is well with you. Any update on the below mentioned request  Thanks and Regards, Syed Ahad. ', NULL, NULL, '2022-01-12 12:09:53', '2022-01-12 12:09:53'),
(48975, 20067, 31739, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email Received from:Michele.Thomas-Martin@molinahealthcare.com  Sub: Fwd: Enrollment Query || NUCC - IVUC || Jeny John || Molina Health Good Morning,     The request is under credentialing.  Please allow a few more weeks for the credentialing application to process.  Once approved the request will be sent for loading in the billing system.      Thank You,', NULL, NULL, '2022-01-12 12:19:50', '2022-01-12 12:19:50'),
(48976, 20067, 31739, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub:  Enrollment Query || NUCC - IVUC || Jeny John || Molina Health   Hi Michele! Hope you are doing great. Any update on the previous request.  Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-18 17:46:14', '2022-01-18 17:46:14'),
(48977, 20067, 31739, NULL, '2022-02-03 00:00:00.000', 'In Process', 'Email received from: Michele.Thomas-Martin@molinahealthcare.com  Sub: Enrollment Query || NUCC - IVUC || Jeny John || Molina Health   Good Morning,    Thank you for your inquiry.   There hasn’t been any updates.  The request is under credentialing.  Please allow a few more weeks for the credentialing application to process.  Once approved the request will be sent for loading in the billing system.', NULL, NULL, '2022-01-27 18:04:55', '2022-01-27 18:04:55'),
(48978, 20067, 31739, NULL, '2022-02-09 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub: Re: Enrollment Query || NUCC - IVUC || Jeny John || Molina Health  Good Afternoon!  Hope you are doing well. Any updates for the follow-up?  Thanks & Regards, Syed Ahad.', NULL, NULL, '2022-02-02 16:20:10', '2022-02-02 16:20:10'),
(48979, 20067, 31739, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub:  Michele.Thomas-Martin@molinahealthcare.com  Good Afternoon!  Hope this email finds you in good health. Is there any update for provider Jeny John?  Thank you, ', NULL, NULL, '2022-03-01 14:30:52', '2022-03-01 14:30:52'),
(48980, 20067, 31739, NULL, '2022-03-16 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub: Enrollment Query || NUCC - IVUC || Jeny John || Molina Health  Good Afternoon!  Hope this email finds you in good health. I want the welcome letter for Jeny John.  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Jeny John	1073019493   Thank you,', NULL, NULL, '2022-03-09 14:28:49', '2022-03-09 14:28:49'),
(48981, 20067, 31739, NULL, '2022-03-28 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub: Enrollment Query || NUCC - IVUC || Jeny John || Molina Health    Good Afternoon!  Hope this email finds you in good condition. Can you please confirm the locations for provider Jeny John?  Is a Secondary location added to the provider profile?  Location: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Thank you,', NULL, NULL, '2022-03-21 15:34:59', '2022-03-21 15:34:59'),
(48982, 20067, 31739, NULL, '2022-03-28 00:00:00.000', 'Approved', 'Email received from: Michele.Thomas-Martin@molinahealthcare.com  Sub: Fwd: Enrollment Query || NUCC - IVUC || Jeny John || Molina Health  Good Afternoon,   The provider has been loaded under all service locations.  ', NULL, NULL, '2022-03-21 15:45:50', '2022-03-21 15:45:50'),
(48983, 1006, 31740, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:28:45', '2021-07-01 10:28:45'),
(48984, 11056, 31740, NULL, '2021-07-12 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s enrollment.', NULL, NULL, '2021-07-05 14:00:33', '2021-07-05 14:00:33'),
(48985, 20067, 31740, NULL, '2022-02-23 00:00:00.000', 'In Process', 'Email received from: NETOPS-ADMIN@centene.com  Sub: LONG POINT MEDICAL CENTER- ADD PROVIDER JENY JOHN  Dear Provider,                    We have received your request to add a provider(s) to your existing contract and we have attached the add provider application to this email for your convenience.  Once complete, please email your application to SHP.NetworkDevelopment@superiorhealthplan.com for processing. Please include only one provider application per email and “Add Provider- Provider Name” in the subject line of the email. This will allow us to keep track of your application and avoid any confusion or delay in having it processed.      To check status of the application, please contact your Provider Relations Representative. To locate your PR rep please use the following link:     http://www.superiorhealthplan.com/contact-us/find-my-provider-representative/        For Re-Credentialing, please email your information to credentialing@centene.com.           Thank you,  Zujey Ashbaugh (Zuzy)  Contract Coordinator  Network Participation Request related info     Phone Number 866-615-9399', NULL, NULL, '2022-02-16 13:57:12', '2022-02-16 13:57:12'),
(48986, 20067, 31740, NULL, '2022-02-23 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Sub: LONG POINT MEDICAL CENTER- ADD PROVIDER JENY JOHN    Good Afternoon!  Hope this email finds you well. Kindly see the attachment for provider Jeny John.  Thank you,', NULL, NULL, '2022-02-16 13:58:36', '2022-02-16 13:58:36'),
(48987, 20067, 31740, NULL, '2022-03-09 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Sub: ${SECURE}{secure} RE: [Secure] Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505  Good Afternoon!  Hope this email finds you in good condition. I would like to know the enrollment status of the below-mentioned providers. Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Jaya Jacob	1194336149 Sigi Paul	1033623616 Jeny John	1073019493  Thank you,', NULL, NULL, '2022-03-02 12:11:02', '2022-03-02 12:11:02'),
(48988, 20067, 31740, NULL, '2022-03-25 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Sub: Re: [Secure] Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505   Good Afternoon!  Hope this email finds you well. I would like to know the status of the Listed providers with mentioned locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Jeny John	1073019493	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Jeny John	1073019493	779 Normandy St Ste 114 Houston , TX 77015-3441 Sigi Paul	1033623616	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Jaya Jacob	1194336149	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Thank you, Syed.', NULL, NULL, '2022-03-18 15:21:22', '2022-03-18 15:21:22'),
(48989, 20067, 31740, NULL, '2022-03-29 00:00:00.000', 'Approved', 'Email received from: txps-coord@superiorhealthplan.com   Sub: RE: [Secure] Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505  Hello,     Thank you for contacting Superior Health Plan. Your reference# is R-16163706.     Below is the requested credentialing status under Tax ID  270796429.     Provider Name:  Jeny John  Provider NPI: 1073019493  Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Effective date: 04/01/2022  We do show this address on file for this provider. Please allow up to  30 days to receive a welcome letter.     Provider Name:  Jeny John  Provider NPI: Jeny John  Address: 779 Normandy St Ste 114 Houston , TX 77015-3441  Effective date: 04/01/2022  We do show this address on file for this provider. Please allow up to  30 days to receive a welcome letter.     Provider Name:  Sigi Paul  Provider NPI: 1033623616  Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  We do not show this address on file for this provider. Should you  have additional questions or concerns, please contact your regional  account manager at AM.Houston@superiorhealthplan.com.     Provider Name:  Jaya Jacob  Provider NPI: 1194336149  Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 7706  We do not show this address on file for this provider. Should you  have additional questions or concerns, please contact your regional  account manager at AM.Houston@superiorhealthplan.com.', NULL, NULL, '2022-03-22 13:00:43', '2022-03-22 13:00:43'),
(48990, 1006, 31741, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:28:45', '2021-07-01 10:28:45'),
(48991, 11056, 31741, NULL, '2021-07-13 00:00:00.000', 'Initiated', 'Email sent to : KMoten4@humana.com  Sub : ENROLLMENT REQUEST - LPMC - NUCC - IVUC - TRICARE  Greetings,  I wanted to know how to enroll the below provider in the groups mentioned below:  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name : Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider: Provider Name :  John, Jeny Provider NPI# : 1073019493  Kindly respond to me soon. If you need any information feel free to contact me. Thank you!', NULL, NULL, '2021-07-05 14:07:55', '2021-07-05 14:07:55'),
(48992, 11056, 31741, NULL, '2021-07-17 00:00:00.000', 'In Process', 'Online Enrollment form has been faxed at (608) 221-7535. Kindly see the attachment.', NULL, NULL, '2021-07-09 16:27:22', '2021-07-09 16:27:22'),
(48993, 11056, 31741, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email received from : KMoten4@humana.com  Sub : Secured: RE: ENROLLMENT REQUEST - LPMC - NUCC - IVUC - TRICARE  This provider below needs to be certified. Please complete that process using the link below:  https://www.humanamilitary.com/provider/access/become-a-tricare-provider/get-certified        Respectfully,  Katherine Moten  TRICARE Community Liaison II  Humana  T 502-318-5250  F 210-239-0401  kmoten4@humana.com  HumanaMilitary.com     TRICARE 101 Webinar: https://www.brainshark.com/hgb/vu?pi=zIHzFuMwczRw6Vz0   ', NULL, NULL, '2021-08-11 11:39:30', '2021-08-11 11:39:30'),
(48994, 11056, 31741, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email received from : KMoten4@humana.com  Sub : Secured: RE: ENROLLMENT REQUEST - LPMC - NUCC - IVUC - TRICARE  This provider below needs to be certified. Please complete that process using the link below:  https://www.humanamilitary.com/provider/access/become-a-tricare-provider/get-certified        Respectfully,  Katherine Moten  TRICARE Community Liaison II  Humana  T 502-318-5250  F 210-239-0401  kmoten4@humana.com  HumanaMilitary.com     TRICARE 101 Webinar: https://www.brainshark.com/hgb/vu?pi=zIHzFuMwczRw6Vz0   ', NULL, NULL, '2021-08-11 11:39:31', '2021-08-11 11:39:31'),
(48995, 3040, 31741, NULL, '2021-08-27 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Re: Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Hello Yvonne,   Please note that I already sent the provider certification application form through fax for the below mentioned providers. Can you please check and advise?   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: Joseph, Molly  Provider NPI# 1396380077  Provider 2:  Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-08-20 14:28:23', '2021-08-20 14:28:23'),
(48996, 3040, 31741, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email rcvd from: ywyatt@humana.com  Subject: RE: Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good Afternoon Adil,  You faxed the form to WPS. I do not have visual access to their system to see if an application was received. You may contact WPS at 1 800 444 5445 and ask to speak with the certifications Unit.    Thanks, Yvonne W. Wyatt, Humana Military TRICARE Community Liaison II Houston/Galveston 502-318-5409 Telephone 502-322-8018 Fax ywyatt@humana.com', NULL, NULL, '2021-08-30 09:35:59', '2021-08-30 09:35:59'),
(48997, 3040, 31741, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Re: Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Greetings,  Hope you are doing well. I had a word with (Wyonna) Tricare representative and she advised the application was received for both the below mentioned providers. Provider Joseph, Molly is already certified on 08/12/2021 and already in the network but I couldn\'t find the provider on Tricare provider directory. The second provider she requested to send the copy of the state license through fax.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: Joseph, Molly  Provider NPI# 1396380077  Provider 2:  Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-30 09:37:00', '2021-08-30 09:37:00'),
(48998, 10057, 31741, NULL, '2021-10-18 00:00:00.000', 'In Process', 'Email Sent To : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good Afternoon,  Hope you are doing well. I\'m writing this email to check the updated status about our credentialing request. Provider Joseph, Molly is already certified on 08/12/2021 and already in the network but I couldn\'t find the provider on Tricare provider directory. The second provider she requested to send the copy of the state license through fax. But still not yet received any further update from your side.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Joseph, Molly	1073019493 John, Jeny	1073019493  Could you please check and revert back to me. Your early response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-10-11 14:41:58', '2021-10-11 14:41:58'),
(48999, 10057, 31741, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email Received From : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Hello Steve,  Updates emailed to HGB Roster team can take up to 60 days to process. There is no changed in the status from the email I sent on Tuesday.  Thanks,  Yvonne W. Wyatt, Humana Military TRICARE Community Liaison II Houston/Galveston 502-318-5409 Telephone 502-322-8018 Fax ywyatt@humana.com', NULL, NULL, '2021-11-11 17:29:37', '2021-11-11 17:29:37'),
(49000, 10057, 31741, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good morning,  Hope this email finds you well. Could you please let me know the latest update on the below mentioned request.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-02 09:49:49', '2021-12-02 09:49:49'),
(49001, 10057, 31741, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email Received From : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good Morning Steve,  The status is listed below. You can check status by using the self-service Provider Portal.  In order to serve our providers more efficiently, we have begun using Humana Military’s Provider Self-Service Portal.  The secure messaging feature through Provider Self Service increases the timeliness of responses to your questions.  If you are not currently registered on the Provider Self-Service Portal, please visit:  Provider Self-Service (humana-military.com)  To verify provider status, please utilize the NPI search tool in the Provider Self-Service Portal.  If the provider does not populate in this tool, then the provider is not TRICARE certified.  Thanks,  Yvonne W. Wyatt, TRICARE Community Liaison II Humana Military', NULL, NULL, '2021-12-15 13:26:28', '2021-12-15 13:26:28'),
(49002, 10057, 31741, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Thank you for reaching out. Unfortunately, we do not have access to the provider self service portal. Is there any way that we can get the status for below mentioned providers enrollment status?  Your earliest response will be highly appreciated.  Kind Regards, Steve Albert ', NULL, NULL, '2021-12-21 15:13:24', '2021-12-21 15:13:24'),
(49003, 10057, 31741, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Received From : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Hello Steve,  We are requesting Providers to create a log in on the Provider Portal highlighted below is the link', NULL, NULL, '2021-12-29 13:09:09', '2021-12-29 13:09:09'),
(49004, 20067, 31741, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to:   Sub:   Good afternoon,  Hope this email finds you well, Kindly see the attachment of the Provider Self-Service portal. Provider Jeny John is in one more location of Normandy Urgent Care Center which is not listed on your directory.  Location: 16272 IMPERIAL VALLEY DR STEK, Houston, TX 77060 Tax ID: 270796429 NPI:1407171077  Kindly add this location.  Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-12 13:40:05', '2022-01-12 13:40:05'),
(49005, 20067, 31741, NULL, '2022-01-20 00:00:00.000', 'In Process', 'Email received from: ywyatt@humana.com  Sub: RE: Enrollment Status Query - NUCC - IVUC - LPMC - Tricare   Good Morning Syed,     I have submitted a request to Provider network to update Jeny John to display on the Provider Portal as network. This process can take up to ten business days.     In order to serve our providers more efficiently, we have begun using Humana Military’s Provider Self-Service Portal.  The secure messaging feature through Provider Self Service increases the timeliness of responses to your questions.  If you are not currently registered on the Provider Self-Service Portal, please visit:  Provider Self-Service (humana-military.com)  To verify provider status, please utilize the NPI search tool in the Provider Self-Service Portal.  If the provider does not populate in this tool, then the provider is not TRICARE certified.     Thanks,  Yvonne W. Wyatt,  TRICARE Community Liaison II  Humana Military     502-318-5409 Telephone  502-322-8018 Fax  ywyatt@humana.com     HumanaMilitary.com  Additional Resources:', NULL, NULL, '2022-01-13 12:28:04', '2022-01-13 12:28:04'),
(49006, 20067, 31741, NULL, '2022-01-20 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Sub: Re: Secured: RE: Enrollment Status Query - NUCC - IVUC - LPMC - Tricare   Good Morning,  Thanks for the update. Once the provider is credentialed kindly send me the welcome letter.  Thanks and Regards, Syed Ahad. ', NULL, NULL, '2022-01-13 12:34:58', '2022-01-13 12:34:58'),
(49007, 20067, 31741, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email  received from: ywyatt@humana.com  Sub:  RE: Secured: RE: Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good Morning Syed,  Credentialing will send you an approval letter. You can also check the Provider Portal and it will show complete.  Thanks, Yvonne W. Wyatt,  TRICARE Community Liaison II Humana Military', NULL, NULL, '2022-01-14 13:02:32', '2022-01-14 13:02:32'),
(49008, 20067, 31741, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Sub: Re: Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good afternoon, Hope this email finds you in good health. Can you please tell me the effective date for below mentioned request?  Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-14 13:12:18', '2022-01-14 13:12:18'),
(49009, 20067, 31741, NULL, '2022-01-31 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Sub: Re: Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good Morning!  Hope you had a great weekend. I haven\'t received the welcome packet yet. Please do the needful.  Thanks and regards, Syed Ahad. ', NULL, NULL, '2022-01-24 09:51:54', '2022-01-24 09:51:54'),
(49010, 20067, 31741, NULL, '2022-02-10 00:00:00.000', 'Approved', 'Called Tricare and spoke to Rikki  Effective Dates for all 3 locations for Jeny John NUCC 11/02/2021 IVUC  10/14/2021 LPMC 11/03/2021  Ref# 15097280 ', NULL, NULL, '2022-02-03 10:40:13', '2022-02-03 10:40:13'),
(49011, 1006, 31742, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:28:45', '2021-07-01 10:28:45'),
(49012, 11056, 31742, NULL, '2021-07-13 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more details please see group task.', NULL, NULL, '2021-07-05 14:23:11', '2021-07-05 14:23:11'),
(49013, 3040, 31742, NULL, '2021-07-27 00:00:00.000', 'In Process', 'I spoke with Harvey D Wellcare representative and he advised me that processing time will take 60 business days. After reviewing the application the provider rep will contact you.   Ref: 544023676', NULL, NULL, '2021-07-20 10:36:02', '2021-07-20 10:36:02'),
(49014, 11056, 31742, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good afternoon!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Wellcare for our group under the below locations.       Practice Details:  Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID#  27-0796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Practice Name: Longpoint Medical Center  Practice Tax ID#  27-0796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 1:  Provider Name: George, Jeemol  Provider NPI# 1497219067     Provider 2:    Provider Name: Jose, Julie  Provider NPI# 1447883061     Provider 3:    Provider Name: Stephen, Ani  Provider NPI# 1588959118     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Brown, Brittany  Provider NPI# 1275163537     Provider 6:    Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956     Provider 7:    Provider Name: Abraham, Glory  Provider NPI# 1194206490     Provider 8:    Provider Name: Fernandus, Limy  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider NPI# 1497726202     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868     Provider 11:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560     Provider 12:    Provider Name: Thomas, Cini  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider NPI# 1467901587     Provider 14:    Provider Name: PAUL, SIGI   Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149    Provider 16:    Provider Name: Joseph, Molly Provider NPI# 1396380077    Provider 17:    Provider Name: John, Jeny Provider NPI# 1073019493    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!  Have a great week ahead!', NULL, NULL, '2021-08-11 13:56:45', '2021-08-11 13:56:45');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(49015, 3040, 31742, NULL, '2021-09-14 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject: Re: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Greetings,    Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Wellcare for our group under the below locations.       Practice Details:  Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID#  27-0796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Practice Name: Longpoint Medical Center  Practice Tax ID#  27-0796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 1:  Provider Name: George, Jeemol  Provider NPI# 1497219067  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 2:    Provider Name: Jose, Julie  Provider NPI# 1447883061  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 3:    Provider Name: Stephen, Ani (All three locations)  Provider NPI# 1588959118     Provider 4:    Provider Name: Piccione JR, James M (All three locations)  Provider NPI# 1356321509     Provider 5:    Provider Name: Brown, Brittany  Provider NPI# 1275163537  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 6:    Provider Name: Chennemkara, Mini Philip (All three locations)  Provider NPI# 1841755956     Provider 7:    Provider Name: Abraham, Glory  Provider NPI# 1194206490  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 8:    Provider Name: Fernandus, Limy (All three locations)  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider NPI# 1497726202  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 11:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 12:    Provider Name: Thomas, Cini (All three locations)  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider NPI# 1467901587  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 14:    Provider Name: PAUL, SIGI (All three locations)  Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya (All three locations)  Provider NPI# 1194336149    Provider 16:    Provider Name: Joseph, Molly  (All three locations) Provider NPI# 1396380077    Provider 17:    Provider Name: John, Jeny  (All three locations) Provider NPI# 1073019493    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!', NULL, NULL, '2021-09-07 16:27:50', '2021-09-07 16:27:50'),
(49016, 10057, 31742, NULL, '2021-10-26 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good Afternoon,  Hope this email finds you well. I want to follow-up for the mentioned providers and locations credentialing status?  Please get back to me as soon as you get a chance. Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-19 11:51:10', '2021-10-19 11:51:10'),
(49017, 10057, 31742, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : prospectiveprovidertx@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good Morning,  Can you please send us the copy of their Welcome Letters/ Contracts to us at your earliest convenience.  Regards, Alex Garrett', NULL, NULL, '2021-11-22 14:13:10', '2021-11-22 14:13:10'),
(49018, 10057, 31742, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good Afternoon,  Hope this email finds you well. I\'m writing this email to check the latest update on the below mentioned request?  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-02 15:09:56', '2021-12-02 15:09:56'),
(49019, 10057, 31742, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Hello,  This inbox is for contract change request only. If you need account specific information, please contact your Provider Relations Account Manager.   Sincerely,  Network Management– Texas', NULL, NULL, '2021-12-09 13:19:09', '2021-12-09 13:19:09'),
(49020, 10057, 31742, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com AM.Houston@superiorhealthplan.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Thank you for reaching out. Could you please provide me with the actual email address along with the contact number of our AM?  So I can directly reach out to them. I truly appreciate your support. Have a great day!  Regards,', NULL, NULL, '2021-12-17 14:09:05', '2021-12-17 14:09:05'),
(49021, 10057, 31742, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email Received From : AM.Houston@superiorhealthplan.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Please send email for WellCare status update to SM_TXNetDevProviderLoad@wellcare.com.  Sincerely,  Barbara McDonald', NULL, NULL, '2021-12-23 11:20:21', '2021-12-23 11:20:21'),
(49022, 10057, 31742, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Sent To : sm_txnetdevproviderload@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Greetings!  Hope this email finds you well. I\'m writing this email to get the enrollment status on the below mentioned group and providers under TIN\'s with wellcare.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI  Limy  Fernandus 1972005189 Sigi Paul	1033623616 Jaya  Jacob	1194336149 Jeena  Abraham	1467901587 Cini  Thomas	1134777238 Odette Tiranke  Kourouma	1134525868 Abdur  Rauf	1497726202 Molly  Joseph	1396380077 Jeny John	1073019493 Ani Stephen	1588959118 Brittany Brown	1275163537 Vibitha Joseph	1952931560 Jeemol George	1497219067 Julie Jose	1447883061 Glory Abraham 1194206490 Mini Philip Chennemkara 1841755956 James Piccione JR	1356321509  Once you get a chance please get back to me. Have a great weekend ahead!  Regards,', NULL, NULL, '2021-12-30 13:52:42', '2021-12-30 13:52:42'),
(49023, 20067, 31742, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email sent to: ashley.stevens@wellcare.com, SM_TXNetDevProviderLoad@wellcare.com  Subject: Re: ENROLLMENT STATUS QUERRY - NUCC - IVUC - Wellcare   Hello,  Hope you are doing great. I would like to know the enrollment status of the below-mentioned providers under these locations, and if any of the provider is enrolled kindly send me the welcome letter.  Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston, TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Glory Abraham	1194206490 Jeena Abraham	1467901587 Brittany Brown	1275163537 Mini Chennemkara	1841755956 Limy Fernandus	1972005189 Jeemol George	1497219067 Jaya Jacob	1194336149 Jeny John	1073019493 Julie Jose	1447883061 Molly Joseph	1396380077 Vibitha Joseph	1952931560 Odette Kourouma	1134525868 SIGI PAUL	1033623616 James Piccione JR	1356321509 Abdur Rauf	1497726202 Ani Stephen	1588959118 Cini Thomas	1134777238  Thanks and Regards, Syed Ahad. ', NULL, NULL, '2022-01-06 12:29:05', '2022-01-06 12:29:05'),
(49024, 20067, 31742, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email received from:  ashley.stevens@wellcare.com  Sub: RE: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare   Good Afternoon,     All providers are still in progress for all 3 contract, however our credentialing department is asking for a Collaborative form to credential Jeny John 1073019493. Can you provide that for us?     Thanks     Ashley Stevens  Contracts Coordinator, Contracting & Network Development ', NULL, NULL, '2022-01-11 09:35:01', '2022-01-11 09:35:01'),
(49025, 20067, 31742, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to: ashley.stevens@wellcare.com  Sub: RE: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good morning, I Hope this email finds you well. Kindly see the attachment for Jeny John 1073019493.  Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-11 09:36:31', '2022-01-11 09:36:31'),
(49026, 20067, 31742, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email Received from: ashley.stevens@wellcare.com  Sub: RE: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare   Good morning,     Thank you, we will let you know once provider is complete.     Thanks     Ashley Stevens  Contracts Coordinator, Contracting & Network Development ', NULL, NULL, '2022-01-11 12:31:44', '2022-01-11 12:31:44'),
(49027, 20067, 31742, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: ashley.stevens@wellcare.com, SM_TXNetDevProviderLoad@wellcare.com  Sub: Re: ENROLLMENT STATUS QUERRY - NUCC - IVUC - Wellcare  Good afternoon!  Hope you are doing well. Any update on the previous request? Your Early response will be highly appreciated  Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-14 16:41:21', '2022-01-14 16:41:21'),
(49028, 20067, 31742, NULL, '2022-01-27 00:00:00.000', 'Approved', 'Received the following email from: ashley.stevens@wellcare.com  Sub: Re: ENROLLMENT STATUS QUERRY - NUCC - IVUC - Wellcare  Please see welcome letter attached for roster of par providers.  Effective Date: 01/13/2022 Attached is the group roster and welcome letter for the provider', NULL, NULL, '2022-01-20 17:30:37', '2022-01-20 17:30:37'),
(49029, 1006, 31743, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:28:45', '2021-07-01 10:28:45'),
(49030, 11056, 31743, NULL, '2021-07-12 00:00:00.000', 'On Hold', 'Awaiting Medicare\'s approval.', NULL, NULL, '2021-07-05 13:28:54', '2021-07-05 13:28:54'),
(49031, 3040, 31743, NULL, '2021-07-19 00:00:00.000', 'On Hold', 'Railroad Medicare PTAN Lookup and Request Tool	 Click to Chat Now At this time, we are unable to process your request because one or more of the data elements entered into this tool did not match your local Medicare Administrative Contractor (A/B MAC). If you believe you have received this message in error, please contact your local A/B MAC to validate the accuracy of the provider information you have entered into this tool.  You can locate contact information for your local A/B MAC on the CMS MAC Website List page at https://www.cms.gov/Medicare/Medicare-Contracting/FFSProvCustSvcGen/MAC-Website-List.  Reference Number :	21193000262 ', NULL, NULL, '2021-07-12 09:20:54', '2021-07-12 09:20:54'),
(49032, 1006, 31744, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:28:45', '2021-07-01 10:28:45'),
(49033, 1006, 31744, NULL, '2021-07-08 00:00:00.000', 'Initiated', 'Applicant Name: JENY JOHN  Tracking ID: T070120210004902  Submitted Date: THU - JULY 01 2021 05:50:12 PM EST  Submitted By: Jeny John  Contact Email(s): JENYLAIJU@YAHOO.COM NUCC@CLAIMSMEDINC.COM PHOENIXDATA@MSN.COM Reason(s) for submission: A Medicare Part B practitioner is currently enrolled in Medicare and is reassigning his/her benefits to a Part B supplier, Part B practitioner or Part A provider currently enrolled in Medicare. ', NULL, NULL, '2021-07-01 16:51:16', '2021-07-01 16:51:16'),
(49034, 3040, 31744, NULL, '2021-07-16 00:00:00.000', 'Approved', 'Medicare Enrollment Information  Individual Name: Jeny John NP Individual Specialty: NURSE PRACTITIONER Individual National Provider Identifier (NPI): 1073019493 Individual Provider Transaction Access Number (PTAN): 1R3189 Group Legal Business Name (LBN): NORMANDY URGENT CARE CENTER Group NPI: 1407171077 Group PTAN: 396951 Reassignment Effective Date: June 01, 2021 Changed Information: N/A', NULL, NULL, '2021-07-09 08:39:14', '2021-07-09 08:39:14'),
(49035, 1006, 31745, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:28:45', '2021-07-01 10:28:45'),
(49036, 3040, 31745, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email rcvd from: dmarley@ghn-mci.com  Subject: Normandy Urgent Care  Hello Adil,  I am writing you in response to an e-mail that you sent requesting to add providers to Normandy Urgent Care and Imperial Valley Urgent Care.  After review, I do show a contract for Normandy Urgent Care and if that group wishes your company, Claims Med Inc to be able to add providers etc. then you will need to return written notice signed by an authorized signatory of the group stating that your company Claims Med Inc is authorized to add new providers, etc. to their agreement. We will also need full credentialing for all new providers. This information can be faxed to 1-800-645-0154 for processing.  I do not show an agreement for Imperial Valley Urgent Care. If this group would like a contract, please let me know, however, can you please confirm that these two different groups are using the same tin? If this is to be the case the providers will have to submit written notice for one group affiliation to take precedence over the other.  Please do not hesitate to contact me with any question or concerns I am happy to help.  Thanks,  Daniel M. Contract Specialist Galaxy Health Network (P) 800-975-3322 X 1124 (F) 1-800-645-0154', NULL, NULL, '2021-07-05 10:02:01', '2021-07-05 10:02:01'),
(49037, 3040, 31745, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: longpointmedcenter9504@yahoo.com  Subject: Normandy Urgent Care  Greetings,  Hope you are doing well. Please find attached Letter of intent to enroll the providers in Galaxy Health. They requested the authorized person\'s signature on the letterhead in which it stated we need to enroll the providers individually with Galaxy Health. For your reference please review the above email.   Kindly sign it and send it back to me so we can start the credentialing process.   Thank you ', NULL, NULL, '2021-07-05 10:03:41', '2021-07-05 10:03:41'),
(49038, 3040, 31745, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Subject: Normandy Urgent Care   Hello Daniel,   Hope you are doing well. As per our phone conversation please find below the list of the providers and see which providers are participating with Galaxy Health and need the effective date. For the remaining providers please send me the credentialing application form so I can fill it out and send it through fax.  Also advise that below mentioned addresses are updated in the contract.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-22 10:01:14', '2021-07-22 10:01:14'),
(49039, 11056, 31745, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email received from : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Adil,  To confirm Imperial Valley Urgent Care does not have a contract with Galaxy Health. Providers under this TIN participate with a group affiliation with Normandy Urgent Care Center.  I already e-mailed you the forms you requested for credentialing. In regards to the listed providers please see the below:  Dr. Abdur Rauf – effective 7-31-15 Odette Kourouma FNP – effective 77015  I show the two providers from your list below as participating under Normandy Urgent Care Center. I do not show any other providers from the roster you sent as participating.  Imperial Valley Urgent Care does not have a contract with Galaxy Health.  Thanks, Daniel M. Contract Specialist  Galaxy Health Network (P) 800-975-3322 X 1124 (F) 1-800-645-0154', NULL, NULL, '2021-08-12 11:39:20', '2021-08-12 11:39:20'),
(49040, 10057, 31745, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Hello Daniel,  Greetings for the day!  I\'m writing this email to check the updated status about our credentialing request for Normandy Urgent Care and Imperial Valley Urgent Care.  Let me know if there are any documents needed from our side. Also we have already forwarded your requested forms via fax 800-645-0154.on 07/12/2021.  Have a great day ahead.  Thanks & Regards,', NULL, NULL, '2021-10-08 10:40:09', '2021-10-08 10:40:09'),
(49041, 10057, 31745, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Dear Sir,  After review, I have not been able to locate a written notice signed by an authorized Signatory of Normandy Urgent Care stating that your company, Claims Med Inc. is authorized to represent the group, or make changes on their behalf. If you would please fax that to 1-800-645-0154.  Further, I show a roster of Physicians for Normandy Urgent Care as having been received, however, I do not show either the authorization letter above or any  credentialing or supporting document for the providers who are to be added as having been received back. I am reattaching the forms that were sent previously here. They can be faxed back to 1-800-645-0154 along with the letter authorizing Claims Med Inc. to represent Normandy Urgent Care group.  Further, to confirm Imperial Valley Urgent Care does not have a contract with Galaxy Health to which providers can be added. If they would like to consider a contract for review, please let me know.', NULL, NULL, '2021-11-09 15:24:38', '2021-11-09 15:24:38'),
(49042, 10057, 31745, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Greetings!  I have forwarded you the following provider(s) details via fax 1-800-645-0154 just now, please check and let me know what else needed, also guide me how we can make a contract for Imperial Valley Urgent Care.  Group Name	Normandy Urgent Care Center Tax ID	81-5123542 Group NPI	1518404631 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Tertiary Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Abraham, Jeena	1467901587 Abraham, Glory	1194206490 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Fernandus, Limy	1972005189 George, Jeemol	1497219067 Jacob, Jaya	1194336149 John, Jeny	1073019493 Jose, Julie	1447883061 Joseph, Molly	1396380077 Joseph, Vibitha	1952931560 Kourouma , Odette Tiranke	1134525868 PAUL, SIGI	1033623616 Piccione JR, James M	1356321509 Rauf, Abdur	1497726202 Stephen, Ani	1588959118 Thomas, Cini	1134777238  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-11-30 13:36:29', '2021-11-30 13:36:29'),
(49043, 10057, 31745, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Sir,  I will review, however, did you also include a written notice signed by an authorized signatory of Normandy Urgent Care stating that your company Claims Med Inc. is representing them and is authorized to make changes, etc. on the groups behalf?', NULL, NULL, '2021-12-06 17:46:37', '2021-12-06 17:46:37'),
(49044, 10057, 31745, NULL, '2021-12-20 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Good Afternoon,  Hope this email finds you in good health. I want to set up a short telephonic meeting with you, so please let me know the day/date and time.  Our practice manager from NORMANDY URGENT CARE wants to discuss to resolve this issue.  Please get back to me as soon as you get a chance. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-13 12:50:39', '2021-12-13 12:50:39'),
(49045, 10057, 31745, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Follow-up Sent.', NULL, NULL, '2021-12-20 13:15:17', '2021-12-20 13:15:17'),
(49046, 10057, 31745, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  It was great speaking with you today Sir, please see the below.  Sir,  I am writing you in response to several e-mails you have sent regarding various urgent cares.  After review, I show the following:  We have received partial credentialing for providers for Normandy Urgent Care, however, I show the physician group for Normandy Urgent Care is under a different TIN then the one you provided on 10-14-2021 and I don’t show having received anything from the Normandy Urgent Care Group in writing signed by an authorized signatory of Normandy Urgent Care stating that your company, Claims Med Inc. is representing them and is authorized to make changes etc. on their behalf.  If you could please fax that authorization and include the correct TIN to 1-800-645-0154 along with the supporting documents, and please confirm that all credentialing documents were physically signed by the providers and not electronically signed, I will forward that for processing for the providers.  In regards to the e-mail you sent regarding Valley Med Urgent Care which has the correct TIN for Valley Med (which is the same TIN you submitted for Normandy Urgent Care but I show Normandy under a different TIN),  I show a facility agreement for Valley Med Urgent Care. If the physicians bill under the facilities Tax Id Number, and the facility has an agreement then the physicians do not need to be added/listed.', NULL, NULL, '2021-12-27 11:24:24', '2021-12-27 11:24:24'),
(49047, 19067, 31745, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com, kavalos@ghn-mci.com  Subject: Enrollment Query || NUCC & IVUC || Providers & Group || Galaxy Health ||   Hello!  You are having a productive day.  I would like to know the enrollment status of the following Providers and Group with Galaxy Health.   Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Jeny John	1073019493	779 Normandy St STE 114, Houston, TX 77015-3441 Jeny John	1073019493	16272 Imperial Valley DR STE K, Houston, TX 77060 Molly Joseph	1396380077	779 Normandy St STE 114, Houston, TX 77015-3441 Molly Joseph	1396380077	16272 Imperial Valley DR STE K, Houston, TX 77060 Cini Thomas	1134777238	779 Normandy St STE 114, Houston, TX 77015-3441 Cini Thomas	1134777238	16272 Imperial Valley DR STE K, Houston, TX 77060 Ani Stephen	1588959118	779 Normandy St STE 114, Houston, TX 77015-3441 Ani Stephen	1588959118	16272 Imperial Valley DR STE K, Houston, TX 77060 Abdur Rauf	1497726202	779 Normandy St STE 114, Houston, TX 77015-3441 Abdur Rauf	1497726202	16272 Imperial Valley DR STE K, Houston, TX 77060 James Piccione JR	1356321509	779 Normandy St STE 114, Houston, TX 77015-3441 James Piccione JR	1356321509	16272 Imperial Valley DR STE K, Houston, TX 77060 Sigi Paul	1033623616	779 Normandy St STE 114, Houston, TX 77015-3441 Sigi Paul	1033623616	16272 Imperial Valley DR STE K, Houston, TX 77060 Odette Kourouma	1134525868	779 Normandy St STE 114, Houston, TX 77015-3441 Odette Kourouma	1134525868	16272 Imperial Valley DR STE K, Houston, TX 77060 Vibitha Joseph	1952931560	779 Normandy St STE 114, Houston, TX 77015-3441 Vibitha Joseph	1952931560	16272 Imperial Valley DR STE K, Houston, TX 77060 Julie Jose	1447883061	779 Normandy St STE 114, Houston, TX 77015-3441 Julie Jose	1447883061	16272 Imperial Valley DR STE K, Houston, TX 77060 Jaya Jacob	1194336149	779 Normandy St STE 114, Houston, TX 77015-3441 Jaya Jacob	1194336149	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeemol George	1497219067	779 Normandy St STE 114, Houston, TX 77015-3441 Jeemol George	1497219067	16272 Imperial Valley DR STE K, Houston, TX 77060 Limy Fernandus	1972005189	779 Normandy St STE 114, Houston, TX 77015-3441 Limy Fernandus	1972005189	16272 Imperial Valley DR STE K, Houston, TX 77060 Brittany Brown	1275163537	779 Normandy St STE 114, Houston, TX 77015-3441 Brittany Brown	1275163537	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeena Abraham	1467901587	779 Normandy St STE 114, Houston, TX 77015-3441 Jeena Abraham	1467901587	16272 Imperial Valley DR STE K, Houston, TX 77060 Mini Chennemkara	1841755956	779 Normandy St STE 114, Houston, TX 77015-3441 Mini Chennemkara	1841755956	16272 Imperial Valley DR STE K, Houston, TX 77060 Glory Abraham	1194206490	779 Normandy St STE 114, Houston, TX 77015-3441 Glory Abraham	1194206490	16272 Imperial Valley DR STE K, Houston, TX 77060  Eagerly waiting for your response.   Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 17:40:03', '2022-01-04 17:40:03'),
(49048, 20067, 31745, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com, kavalos@ghn-mci.com  Sub: Re: Enrollment Query || NUCC & IVUC || Providers & Group || Galaxy Health ||  Good Afternoon! Hope this email finds you in good health.Any update on the below mentioned request?  Your Early response will be highly appreciated Thanks & Regards, Syed Ahad.', NULL, NULL, '2022-01-14 15:26:58', '2022-01-14 15:26:58'),
(49049, 20067, 31745, NULL, '2022-01-31 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com, kavalos@ghn-mci.com  Sub: Re: Enrollment Query || NUCC & IVUC || Providers & Group || Galaxy Health ||  Good Morning!   Hope you had a great weekend. Kindly update me on the previous request which was sent on 01/04/2022.  Thanks & Regards, Syed Ahad. ', NULL, NULL, '2022-01-24 10:03:51', '2022-01-24 10:03:51'),
(49050, 20067, 31745, NULL, '2022-02-09 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com, kavalos@ghn-mci.com,   Sub: Enrollment Query || NUCC & IVUC || Providers & Group || Galaxy Health ||  Good afternoon!  This is my SECOND REMINDER on the previous request. Kindly respond promptly  Thanks & Regards, Syed Ahad.', NULL, NULL, '2022-02-02 16:03:26', '2022-02-02 16:03:26'),
(49051, 20067, 31745, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email sent to: kavalos@ghn-mci.com, dmarley@ghn-mci.com, providers@ghn-mci.com, contracting@ghn-mci.com  Sub: Enrollment Query || NUCC & IVUC || Providers & Group || Galaxy Health ||   Good Afternoon!  Hope this email finds you well. I would like to know the enrollment status of the group and providers below.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Jeny John	1073019493	779 Normandy St STE 114, Houston, TX 77015-3441 Jeny John	1073019493	16272 Imperial Valley DR STE K, Houston, TX 77060 Molly Joseph	1396380077	779 Normandy St STE 114, Houston, TX 77015-3441 Molly Joseph	1396380077	16272 Imperial Valley DR STE K, Houston, TX 77060 Cini Thomas	1134777238	779 Normandy St STE 114, Houston, TX 77015-3441 Cini Thomas	1134777238	16272 Imperial Valley DR STE K, Houston, TX 77060 Ani Stephen	1588959118	779 Normandy St STE 114, Houston, TX 77015-3441 Ani Stephen	1588959118	16272 Imperial Valley DR STE K, Houston, TX 77060 Abdur Rauf	1497726202	779 Normandy St STE 114, Houston, TX 77015-3441 Abdur Rauf	1497726202	16272 Imperial Valley DR STE K, Houston, TX 77060 James Piccione JR	1356321509	779 Normandy St STE 114, Houston, TX 77015-3441 James Piccione JR	1356321509	16272 Imperial Valley DR STE K, Houston, TX 77060 Sigi Paul	1033623616	779 Normandy St STE 114, Houston, TX 77015-3441 Sigi Paul	1033623616	16272 Imperial Valley DR STE K, Houston, TX 77060 Odette Kourouma	1134525868	779 Normandy St STE 114, Houston, TX 77015-3441 Odette Kourouma	1134525868	16272 Imperial Valley DR STE K, Houston, TX 77060 Vibitha Joseph	1952931560	779 Normandy St STE 114, Houston, TX 77015-3441 Vibitha Joseph	1952931560	16272 Imperial Valley DR STE K, Houston, TX 77060 Julie Jose	1447883061	779 Normandy St STE 114, Houston, TX 77015-3441 Julie Jose	1447883061	16272 Imperial Valley DR STE K, Houston, TX 77060 Jaya Jacob	1194336149	779 Normandy St STE 114, Houston, TX 77015-3441 Jaya Jacob	1194336149	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeemol George	1497219067	779 Normandy St STE 114, Houston, TX 77015-3441 Jeemol George	1497219067	16272 Imperial Valley DR STE K, Houston, TX 77060 Limy Fernandus	1972005189	779 Normandy St STE 114, Houston, TX 77015-3441 Limy Fernandus	1972005189	16272 Imperial Valley DR STE K, Houston, TX 77060 Brittany Brown	1275163537	779 Normandy St STE 114, Houston, TX 77015-3441 Brittany Brown	1275163537	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeena Abraham	1467901587	779 Normandy St STE 114, Houston, TX 77015-3441 Jeena Abraham	1467901587	16272 Imperial Valley DR STE K, Houston, TX 77060 Mini Chennemkara	1841755956	779 Normandy St STE 114, Houston, TX 77015-3441 Mini Chennemkara	1841755956	16272 Imperial Valley DR STE K, Houston, TX 77060 Glory Abraham	1194206490	779 Normandy St STE 114, Houston, TX 77015-3441 Glory Abraham	1194206490	16272 Imperial Valley DR STE K, Houston, TX 77060  Thank you,', NULL, NULL, '2022-03-01 15:06:51', '2022-03-01 15:06:51'),
(49052, 20067, 31745, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email sent to: Karen Avalos, Daniel Marley, providers@ghn-mci.com, contracting@ghn-mci.com  Sub: Enrollment Query || NUCC & IVUC || Providers & Group || Galaxy Health ||  Hello!  Kindly update me on the request which was sent on 03/01/2022.  Thank you, Syed ', NULL, NULL, '2022-03-17 18:00:03', '2022-03-17 18:00:03'),
(49053, 22077, 31745, NULL, '2022-04-22 00:00:00.000', 'In Process', 'Email sent to: \"dmarley@ghn-mci.com,kavalos@ghn-mci.com  Subject: Re: Enrollment Query || NUCC & IVUC || Providers & Group || Galaxy Health ||  Hi,  Any updates on the previously mentioned request?  I am looking forward to your kind response. Have a great day!  Thanks & Regards, Alex.', NULL, NULL, '2022-04-15 08:02:10', '2022-04-15 08:02:10'),
(49054, 22077, 31745, NULL, '2022-04-26 00:00:00.000', 'In Process', 'Email received from: dmarley@ghn-mci.com  Subject: RE: Enrollment Query || NUCC & IVUC || Providers & Group || Galaxy Health ||  Dear Alex,     Please be advised that I am currently working with Syed Ahad to resolve issues with the Long Point Medical Center Agreement. Once those issues are resolved then we can move forward and address issues with your company’s other groups.     Thanks,     Daniel M.  Contract Specialist  Galaxy Health Network  (P) 800-975-3322 X 1124 (F) 1-800-645-0154', NULL, NULL, '2022-04-19 13:15:18', '2022-04-19 13:15:18'),
(49055, 22077, 31745, NULL, '2022-04-26 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Subject: Re: Enrollment Query || NUCC & IVUC || Providers & Group || Galaxy Health ||  Hi,  Unfortunately, Syed Ahad no longer works here, I will be handling the credentialing now. Do update me about the queries and whenever you want some document or information I\'d be happy to assist you on that.', NULL, NULL, '2022-04-19 13:26:39', '2022-04-19 13:26:39'),
(49056, 1006, 31746, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:28:45', '2021-07-01 10:28:45'),
(49057, 11056, 31746, NULL, '2021-07-12 00:00:00.000', 'Initiated', 'Email sent to : SWHPEXPEDITES@bswhealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - SCOTT & WHITE  Greetings,  I wanted to know how to enroll the below provider in the groups mentioned below:  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Provider Name :  John, Jeny Provider NPI# : 1073019493  Kindly respond to me soon. If you need any information feel free to contact me. Thank you!', NULL, NULL, '2021-07-05 13:53:27', '2021-07-05 13:53:27'),
(49058, 11056, 31746, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Thank you again for your request to add a provider to your Scott and White Health Plan contracted group.  Please allow 30-45 days before checking on status.  Your form submission identifier is: 4846e1a0-aeaf-430c-a2d4-7f5718297039  Form has been submitted and attached. Please see the attachment.', NULL, NULL, '2021-07-06 13:45:35', '2021-07-06 13:45:35'),
(49059, 3040, 31746, NULL, '2021-07-15 00:00:00.000', 'In Process', 'Email sent to: SWHPREGION2@bswhealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Hello,    Hope you are doing well. I tried numerous email addresses to get the information regarding enrollment status for the below mentioned group and providers in Scott & White for our group under the below locations. Can you please send me the roster?   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Joseph, Molly Provider NPI#   Provider 16:   Provider Name: John, Jeny Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-08 09:49:05', '2021-07-08 09:49:05'),
(49060, 3040, 31746, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email rcvd from: SWHPREGION2@bswhealth.org  Subject: RE: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Hello, Below  is a snip it of the locations and plans that the provider(s) in question is contracted for under TIN: 270796429. Please keep in mind that not all provieers listed below are active under TIN 270796429.  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 – NOT ACTIVE UNDER TIN 270796429  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 - NOT ACTIVE UNDER TIN 270796429  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537- NOT ACTIVE UNDER TIN 270796429  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956- NOT ACTIVE UNDER TIN 270796429  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490- NOT ACTIVE UNDER TIN 270796429  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 - NOT ACTIVE UNDER TIN 270796429  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202   Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 - NOT ACTIVE UNDER TIN 270796429  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616- NOT ACTIVE UNDER TIN 270796429  Provider 15:   Provider Name: Joseph, Molly Provider NPI# NOT ACTIVE UNDER TIN 270796429  Provider 16:   Provider Name: John, Jeny Provider NPI# 1396380077 NOT ACTIVE UNDER TIN 270796429  Thanks,  Jennifer C. Provider Relations Representative', NULL, NULL, '2021-07-28 16:43:45', '2021-07-28 16:43:45'),
(49061, 11056, 31746, NULL, '2021-08-17 00:00:00.000', 'In Process', 'Email received from : SWHPREGION2@bswhealth.org  Sub : Re: Re: FW: Re: Re: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Hello,  To add a provider to an already existing contract, you will need to send in a request via online. Below is the link to the form that you will need to fill out and submit.  https://swhp.org/forms/html/add-provider-to-contract-request.html   Thank you,  Jennifer C. Provider Relations Representative', NULL, NULL, '2021-08-09 14:47:33', '2021-08-09 14:47:33'),
(49062, 3040, 31746, NULL, '2021-09-01 00:00:00.000', 'Approved', 'Email rcvd from: SWHPEXPEDITES@bswhealth.org  Subject: To add Joseph, Stephen, Piccione, Paul, Jacob, Fernandus, Chennemkara, Brown, Abraham, Abraham and John to Normandy Urgent Care Center  The provider information for Molly Joseph, Ani Stephen, James Piccione, Sigi Paul, Jaya Jacob, Limy Fernandus, Mini Chennemkara, Brittany Brown, Jeena Abraham, Glory Abraham and Jeny John to be added to Normandy Urgent Care Center has been received and is in process.  He/she has an effective date of 9/7/2021.  However, please allow 3-4 weeks before submitting claims to ensure he/she is completely configured in our system; otherwise, claims may deny.  Note:  For the RightCare (Medicaid) line of business:  If an active/attested TPI is not provided to us upon submission of the PDF, the Provider will not be set up to see our Medicaid RightCare Members until one is provided.    For the Medicare line of business: If an active Medicare/PTAN is not provided to us upon submission of the PDF, the Provider will not be set up to see our Medicare Members until one is provided.  Please email the Medicare/TPI once available to:  SWHPEXPEDITES@BSWHealth.org     Thank you and have a great day. Provider Services', NULL, NULL, '2021-08-25 08:44:05', '2021-08-25 08:44:05'),
(49063, 1006, 31747, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:28:45', '2021-07-01 10:28:45'),
(49064, 11056, 31747, NULL, '2021-07-12 00:00:00.000', 'On Hold', 'Waiting for Medicaid', NULL, NULL, '2021-07-05 09:39:16', '2021-07-05 09:39:16'),
(49065, 1006, 31748, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:28:45', '2021-07-01 10:28:45'),
(49066, 11056, 31748, NULL, '2021-07-13 00:00:00.000', 'Initiated', 'Email sent to : trpndataentry@trpnppo.com  Sub : ENROLLMENT REQUEST - NUCC - IVUC - TRPN  Greetings,  I wanted to know how to enroll the below provider in the groups mentioned below:  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Provider Name :  John, Jeny Provider NPI# : 1073019493  Kindly respond to me soon. If you need any information feel free to contact me. Thank you! ', NULL, NULL, '2021-07-05 14:41:24', '2021-07-05 14:41:24'),
(49067, 3040, 31748, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: trpndataentry@trpnppo.com, mflores@trpnppo.com, ccampos@trpnppo.com  Subject: Enroll Provider || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || John, Jeny || TRPN ||  Hello,   Hope you are doing well. Please find attached the provider update form to enroll the below mentioned provider in TRPN in our group under the below location.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name :  John, Jeny Provider NPI# : 1073019493  If you need any additional information please feel free to call or email me. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-22 16:52:23', '2021-07-22 16:52:23'),
(49068, 11056, 31748, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Email sent to  : 	trpndataentry@trpnppo.com  &   mflores@trpnppo.com  Sub : Enroll Provider || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || John, Jeny || TRPN ||  Good morning!  Hope all is well. I want to inquire about the enrollment status of the below mentioned provider under the practice in TRPN.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider Details: Provider Name :  John, Jeny Provider NPI# : 1073019493  If you need any additional information please feel free to call or email me. Waiting for your response.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-13 11:53:15', '2021-08-13 11:53:15'),
(49069, 12062, 31748, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Sent A follow up email;  To:trpndataentry@trpnppo.com;ccampos@trpnppo.com  Subject:RE: Enroll Provider || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || John, Jeny || TRPN ||  Dear TRPN Team,  May I have any updated status for below?  ', NULL, NULL, '2021-09-21 15:56:14', '2021-09-21 15:56:14'),
(49070, 12062, 31748, NULL, '2021-10-01 00:00:00.000', 'In Process', 'As per the attached mail received from TRPN, the request is completed .However I replied back for a welcome letter and Effective date.  To:ccampos@trpnppo.com  Subject:RE: Enroll Provider || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || John, Jeny || TRPN ||  Dear Campos,  Good Day!  Please provide references such as effective date, plans and onboarding letter for a provider with below details in TRPN network.  ', NULL, NULL, '2021-09-23 16:38:13', '2021-09-23 16:38:13'),
(49071, 10057, 31748, NULL, '2021-11-09 00:00:00.000', 'In Process', 'Email Sent To : trpndataentry@trpnppo.com & ccampos@trpnppo.com  Sub : Enroll Provider || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || John, Jeny || TRPN ||  Hello,  Hope you are doing well. I\'m writing this email to check the status and to get the effective date along with the welcome letters as well for the below mentioned provider under these locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI John, Jeny	1073019493  Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-02 15:13:35', '2021-11-02 15:13:35'),
(49072, 10057, 31748, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : trpndataentry@trpnppo.com & ccampos@trpnppo.com  Sub : Enroll Provider || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || John, Jeny || TRPN ||  Good Afternoon,  Hope this email finds you in good health. Can I get the latest updates on the below mentioned provider enrollment request.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI John, Jeny	1073019493  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-11-22 13:52:15', '2021-11-22 13:52:15'),
(49073, 10057, 31748, NULL, '2021-12-01 00:00:00.000', 'Approved', 'Email Received From : ccampos@trpnppo.com  Sub : RE: Enroll Provider || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || John, Jeny || TRPN ||  This provider is Active, effective date 05/01/2021,  Carlos Campos Data Entry Department Supervisor Three Rivers Provider Network', NULL, NULL, '2021-11-24 13:45:22', '2021-11-24 13:45:22'),
(49074, 1006, 31749, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:28:45', '2021-07-01 10:28:45'),
(49075, 11056, 31749, NULL, '2021-07-13 00:00:00.000', 'Not Eligible', 'Email rcvd from: DHPContracting@dchstx.org, Karla.Claunch@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Good morning,  These locations are out of our service area so, we are unable to contract or credential them.  Please see the attached map of our service area.  We will only have members within this area.  If you have any questions, please let me know.  Karla Claunch    ', NULL, NULL, '2021-07-05 14:18:01', '2021-07-05 14:18:01'),
(49076, 1006, 31750, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:28:45', '2021-07-01 10:28:45'),
(49077, 11056, 31750, NULL, '2021-07-13 00:00:00.000', 'Initiated', 'Email sent to : CSHNproviderrelations@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS SPOHN  Greetings,  I wanted to know how to enroll the below provider in the groups mentioned below:  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Provider Name :  John, Jeny Provider NPI# : 1073019493  Kindly respond to me soon. If you need any information feel free to contact me. Thank you! ', NULL, NULL, '2021-07-05 14:48:14', '2021-07-05 14:48:14');
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
(49078, 3040, 31750, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Christus Spohn ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Christus Spohn for our group under the below locations. We have 02 different locations under the same tax ID.     Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: John, Jeny Provider NPI# 1073019493  Provider 17:   Provider Name: Joseph, Molly Provider NPI# 1073019493  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-06 14:46:54', '2021-07-06 14:46:54'),
(49079, 3040, 31750, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Email sent to: vicki.guerra@christushealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Christus Spohn ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Christus Spohn for our group under the below locations. We have 02 different locations under the same tax ID.     Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you\'re able to.  Thank you   ', NULL, NULL, '2021-07-27 16:53:28', '2021-07-27 16:53:28'),
(49080, 3040, 31750, NULL, '2021-08-04 00:00:00.000', 'Not Eligible', 'Christus Spohn didn\'t provide services in the area. For more details please see group task.   ', NULL, NULL, '2021-07-28 11:20:16', '2021-07-28 11:20:16'),
(49081, 1006, 31751, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:28:45', '2021-07-01 10:28:45'),
(49082, 11056, 31751, NULL, '2021-07-13 00:00:00.000', 'On Hold', 'Awaiting Medicare and Cigna\'s Enrollment.', NULL, NULL, '2021-07-05 14:53:31', '2021-07-05 14:53:31'),
(49083, 3040, 31751, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring ||  Hello Jennifer,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Cigna Healthspring for our group under the below mentioned locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Waiting for your response.   Thank you  ', NULL, NULL, '2021-07-22 10:04:24', '2021-07-22 10:04:24'),
(49084, 11056, 31751, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email received from : JENNIFER.PEREZ@cigna.com  Sub : Re: Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring ||  Hi Adil,  My apologies, I forwarded this to the correct representative. She should be reaching out by this week. ', NULL, NULL, '2021-08-09 08:41:53', '2021-08-09 08:41:53'),
(49085, 3040, 31751, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: TXGQProviderRelations@healthspring.com  Subject: Re: [External] Re: Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring ||  Hello!  Hope you are doing well. As per conversation with Jennifer she requested to send an email to you. I wanted to know the enrollment status for the below mentioned group as I submitted the letter of interest form on 06/02/2021. Kindly review the chain of emails.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you', NULL, NULL, '2021-08-17 09:55:41', '2021-08-17 09:55:41'),
(49086, 10057, 31751, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : TXGQProviderRelations@healthspring.com  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned groups as we have submitted the letter of interest form on 06/02/2021. Kindly review the chain of emails and let me know the current status of our application.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Please feel free to contact or email me if you have any questions or concerns.  Thanks & Regards,', NULL, NULL, '2021-10-08 11:05:54', '2021-10-08 11:05:54'),
(49087, 10057, 31751, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email Sent To : TXMAContracting@cigna.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello,  Hope you are doing well. I wanted to know the enrollment updated status for the below mentioned group in Cigna Healthspring for our group Valley Med Urgent Care PLLC under the below mentioned locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Tertiary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-14 11:21:31', '2021-10-14 11:21:31'),
(49088, 10057, 31751, NULL, '2021-11-25 00:00:00.000', 'In Process', 'Email Sent To : TXGQProviderRelations@healthspring.com  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Hello,  Could you please provide me with the updated status of my application?  Response is pending since 08/09/2021. Your earliest response will be much appreciated.  Thanks & Regards,', NULL, NULL, '2021-11-18 16:16:16', '2021-11-18 16:16:16'),
(49089, 10057, 31751, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email Received From : lilien.alvarado@gulfquest.net  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Good afternoon,  Can you please send me the applications that you submitted?  Thank you.  Regards, Lilien Alvarado, MPA Provider Contracting Lead Analyst Cigna 2800 North Loop West,Ste 400', NULL, NULL, '2021-12-01 11:54:11', '2021-12-01 11:54:11'),
(49090, 10057, 31751, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : lilien.alvarado@gulfquest.net  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Hello Lilien,  Thank you for reaching out to me. Kindly find the attached application for your reference.  Please let me know if you have any questions and revert back to me with the latest updates.  Thanks & Regards,', NULL, NULL, '2021-12-08 10:33:16', '2021-12-08 10:33:16'),
(49091, 10057, 31751, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Sent To : lilien.alvarado@gulfquest.net & TXGQProviderRelations@healthspring.com  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Greetings!  Hope this email finds you in good health. I\'m writing this email to check the current status of the below mentioned request.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-16 11:08:29', '2021-12-16 11:08:29'),
(49092, 10057, 31751, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Received From : joann.alanis@careallies.com  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Please see attached communication from Renaissance.  Thank you.', NULL, NULL, '2021-12-22 10:17:34', '2021-12-22 10:17:34'),
(49093, 10057, 31751, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Sent To : joann.alanis@careallies.com  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Thank you for reaching out. The attached letter was from Renaissance. We are inquiring about credentialing status for NUCC & IVUC with Cigna Healthspring.  Please get back to me once you get a chance. Have a great day!  Regards,', NULL, NULL, '2021-12-29 11:24:49', '2021-12-29 11:24:49'),
(49094, 19067, 31751, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: joann.alanis@careallies.com  Subject: Enrollment Query || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers & Groups || Cigna Healthspring ||   Good Morning JoAnn!  Hope you are doing really well.  I would like to know the enrollment status of the following Providers & Groups.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Jeny John	1073019493	779 Normandy St STE 114, Houston, TX 77015-3441 Jeny John	1073019493	16272 Imperial Valley DR STE K, Houston, TX 77060 Molly Joseph	1396380077	779 Normandy St STE 114, Houston, TX 77015-3441 Molly Joseph	1396380077	16272 Imperial Valley DR STE K, Houston, TX 77060 Cini Thomas	1134777238	779 Normandy St STE 114, Houston, TX 77015-3441 Cini Thomas	1134777238	16272 Imperial Valley DR STE K, Houston, TX 77060 Ani Stephen	1588959118	779 Normandy St STE 114, Houston, TX 77015-3441 Ani Stephen	1588959118	16272 Imperial Valley DR STE K, Houston, TX 77060 Abdur Rauf	1497726202	779 Normandy St STE 114, Houston, TX 77015-3441 Abdur Rauf	1497726202	16272 Imperial Valley DR STE K, Houston, TX 77060 James Piccione JR	1356321509	779 Normandy St STE 114, Houston, TX 77015-3441 James Piccione JR	1356321509	16272 Imperial Valley DR STE K, Houston, TX 77060 Sigi Paul	1033623616	779 Normandy St STE 114, Houston, TX 77015-3441 Sigi Paul	1033623616	16272 Imperial Valley DR STE K, Houston, TX 77060 Odette Kourouma	1134525868	779 Normandy St STE 114, Houston, TX 77015-3441 Odette Kourouma	1134525868	16272 Imperial Valley DR STE K, Houston, TX 77060 Vibitha Joseph	1952931560	779 Normandy St STE 114, Houston, TX 77015-3441 Vibitha Joseph	1952931560	16272 Imperial Valley DR STE K, Houston, TX 77060 Julie Jose	1447883061	779 Normandy St STE 114, Houston, TX 77015-3441 Julie Jose	1447883061	16272 Imperial Valley DR STE K, Houston, TX 77060 Jaya Jacob	1194336149	779 Normandy St STE 114, Houston, TX 77015-3441 Jaya Jacob	1194336149	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeemol George	1497219067	779 Normandy St STE 114, Houston, TX 77015-3441 Jeemol George	1497219067	16272 Imperial Valley DR STE K, Houston, TX 77060 Limy Fernandus	1972005189	779 Normandy St STE 114, Houston, TX 77015-3441 Limy Fernandus	1972005189	16272 Imperial Valley DR STE K, Houston, TX 77060 Brittany Brown	1275163537	779 Normandy St STE 114, Houston, TX 77015-3441 Brittany Brown	1275163537	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeena Abraham	1467901587	779 Normandy St STE 114, Houston, TX 77015-3441 Jeena Abraham	1467901587	16272 Imperial Valley DR STE K, Houston, TX 77060 Mini Chennemkara	1841755956	779 Normandy St STE 114, Houston, TX 77015-3441 Mini Chennemkara	1841755956	16272 Imperial Valley DR STE K, Houston, TX 77060 Glory Abraham	1194206490	779 Normandy St STE 114, Houston, TX 77015-3441 Glory Abraham	1194206490	16272 Imperial Valley DR STE K, Houston, TX 77060   Kindly respond at your earliest convenience.   Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-05 11:24:51', '2022-01-05 11:24:51'),
(49095, 19067, 31751, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email received from: joann.alanis@careallies.com  Subject: Enrollment Query || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers & Groups || Cigna Healthspring ||   For Renaissance you are not contracted.', NULL, NULL, '2022-01-06 16:31:32', '2022-01-06 16:31:32'),
(49096, 20067, 31751, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: joann.alanis@careallies.com  Sub: Enrollment Query || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers & Groups || Cigna Healthspring ||  Good afternoon, Hope this email finds you well. Could you please tell me for the Renaissance contract what procedure will be followed?  Thanks and regards, Syed Ahad. ', NULL, NULL, '2022-01-14 14:04:50', '2022-01-14 14:04:50'),
(49097, 20067, 31751, NULL, '2022-01-21 00:00:00.000', 'Not Eligible', 'Email received from: joann.alanis@careallies.com  Sub: Enrollment Query || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers & Groups || Cigna Healthspring ||  Hello!  The Renaissance-Eastside Board reviewed your Letter of Interest form a few months ago.  A letter was sent indicating that they were unable to extend a contract.  compliance. Copyright (c) 2022 CareAllies', NULL, NULL, '2022-01-14 14:35:18', '2022-01-14 14:35:18'),
(49098, 1006, 31752, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:28:45', '2021-07-01 10:28:45'),
(49099, 11056, 31752, NULL, '2021-07-13 00:00:00.000', 'Initiated', 'Email sent to : vipproviders@anci-care.com  Sub : ENROLLMENT REQUEST - NUCC - IVUC - ANCI CARE  Greetings,  I wanted to know how to enroll the below provider in the groups mentioned below:  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Provider Name :  John, Jeny Provider NPI# : 1073019493  Kindly respond to me soon. If you need any information feel free to contact me. Thank you!', NULL, NULL, '2021-07-05 14:11:58', '2021-07-05 14:11:58'),
(49100, 3040, 31752, NULL, '2021-07-20 00:00:00.000', 'Approved', 'Group has an ancillary contract no need to add individual provider. Please see group task. ', NULL, NULL, '2021-07-13 11:36:16', '2021-07-13 11:36:16'),
(49101, 1006, 31753, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:28:45', '2021-07-01 10:28:45'),
(49102, 11056, 31753, NULL, '2021-07-13 00:00:00.000', 'On Hold', 'Group ancillary contract is already in process. For more details please see group task. ', NULL, NULL, '2021-07-05 14:56:04', '2021-07-05 14:56:04'),
(49103, 3040, 31753, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: jmonson@triwest.com  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Triwest ||  Hello Jess,   Can you please check and advise if the below mentioned group is in-network with Triwest or not. If not so can you please generate a contract for the below mentioned group. For your reference I attached the W9.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  If you need any additional information please let me know. Waiting for your response.  Thank you ', NULL, NULL, '2021-07-20 11:04:59', '2021-07-20 11:04:59'),
(49104, 3040, 31753, NULL, '2021-07-29 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. For more details please see group task. ', NULL, NULL, '2021-07-22 14:31:32', '2021-07-22 14:31:32'),
(49105, 1006, 31754, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:28:45', '2021-07-01 10:28:45'),
(49106, 11056, 31754, NULL, '2021-07-13 00:00:00.000', 'Initiated', 'Email sent to : providerservices@renaissancefamily.com  Sub : ENROLLMENT REQUEST - NUCC - IVUC - RENAISSANCE PHYSICIANS  Greetings,  I wanted to know how to enroll the below provider in the groups mentioned below:  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Provider Name :  John, Jeny Provider NPI# : 1073019493  Kindly respond to me soon. If you need any information feel free to contact me. Thank you! ', NULL, NULL, '2021-07-05 15:03:39', '2021-07-05 15:03:39'),
(49107, 11056, 31754, NULL, '2021-07-13 00:00:00.000', 'Initiated', 'Email sent to : providerservices@renaissancefamily.com  Sub : ENROLLMENT REQUEST - NUCC - IVUC - RENAISSANCE PHYSICIANS  Greetings,  I wanted to know how to enroll the below provider in the groups mentioned below:  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Provider Name :  John, Jeny Provider NPI# : 1073019493  Kindly respond to me soon. If you need any information feel free to contact me. Thank you! ', NULL, NULL, '2021-07-05 15:03:40', '2021-07-05 15:03:40'),
(49108, 3040, 31754, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: joann.alanis@careallies.com  Subject: Re: [External] Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Renaissance Physicians ||  Hello Alanis,   Hope you are doing well. Do you have any update regarding the enrollment for the below mentioned group and providers.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  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 12:43:30', '2021-07-26 12:43:30'),
(49109, 11056, 31754, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email sent to :   joann.alanis@careallies.com   &   Chukwuma.Ezeokoli@careallies.com  Sub : Fwd: [External] Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Renaissance Physicians ||  Good evening!  Hope you are doing well. I want to inquire about the enrollment status of the below mentioned providers and practices. Please provide us with the latest updates soon.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Details:  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you!  Have a great week ahead!', NULL, NULL, '2021-08-11 16:25:28', '2021-08-11 16:25:28'),
(49110, 3040, 31754, NULL, '2021-08-25 00:00:00.000', 'Not Eligible', 'Email rcvd from: JENNIFER.PEREZ@cigna.com  Subject: RE: [External] Re: Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring ||  08/03/2021 Normandy Urgent Care Center ATTN: Adil Abbas 779 Normandy Street, Suite 114 Houston, TX 77015 Dear Mr. Abbas, Thank you for your request to join the Renaissance Physician Organization/Eastside IPA, LLC. At the present time we do not have a network need in your particular specialty. As a result, we are not able to extend an invitation for participation at this time. We will however keep your request on file and reconsider in the event our network development needs change. If you have any questions, please feel free to call JoAnn Alanis at 832.553.3350. Sincerely, Julian Gonzalez, M.D. Chairman of The Board Eastside IPA, LLC', NULL, NULL, '2021-08-18 13:11:42', '2021-08-18 13:11:42'),
(49111, 1006, 31755, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:28:45', '2021-07-01 10:28:45'),
(49112, 11056, 31755, NULL, '2021-07-13 00:00:00.000', 'On Hold', 'Waiting for the enrollment in Molina healthcare.', NULL, NULL, '2021-07-05 15:36:08', '2021-07-05 15:36:08'),
(49113, 10057, 31755, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com & MHTContractrequest@molinahealthcare.com  Sub : Enrollment Status || NUCC - IVUC - LPMC || Molina Marketplace  Good Afternoon,  Hope you are doing well. I\'m writing this email to check the enrollment and provider directory status for remaining providers under the below mentioned locations with Molina Marketplace.  Also, I\'m able to see the groups on provider directory, I already got the effective dates via help desk, please send me the group agreement or facility contract at the earliest   Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI Fernandus, Limy	1972005189 Jacob, Jaya	1194336149 Thomas, Cini	1134777238 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067  Once you get a chance please get back to me. Have a great weekend ahead!  Regards,', NULL, NULL, '2021-12-30 15:37:55', '2021-12-30 15:37:55'),
(49114, 19067, 31755, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email received from: Michele.Thomas-Martin@molinahealthcare.com  Subject: Enrollment Status || NUCC - IVUC - LPMC || Molina Marketplace     Good Morning,     Thank you for your inquiry.  Please see the attached contracts for both TIN numbers.  Please see the updates below.     The only providers on the below list listed under TIN # 760612416 are Joseph, Vibitha and Rauf, Abdur.  Please submit a contract request form to MHTContractrequest@Molinahealthcare.com  to add the remaining providers.     The only providers not listed under TIN # 270796429 are Jacob Jaya and Jeny John.  Please submit a contract request form to MHTContractrequest@Molinahealthcare.com  to add the 2 providers under this TIN #.     Thank You,     Michele Thomas-Martin  Associate Specialist, Provider Contracts  1-888-562-5442 Ext. 200042  1 972-200-2688 - Direct  www.MolinaHealthcare.com  Your Extended Family', NULL, NULL, '2022-01-05 17:26:42', '2022-01-05 17:26:42'),
(49115, 20067, 31755, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email received from: rehman@claimsmedinc.com  Subject: Enrollment Status || NUCC - IVUC - LPMC || Molina Marketplace    Good Morning,     Thank you for your inquiry.  Please see the attached contracts for both TIN numbers.  Please see the updates below.     The only providers on the below list listed under TIN # 760612416 are Joseph, Vibitha and Rauf, Abdur.  Please submit a contract request form to MHTContractrequest@Molinahealthcare.com  to add the remaining providers.     The only providers not listed under TIN # 270796429 are Jacob Jaya and Jeny John.  Please submit a contract request form to MHTContractrequest@Molinahealthcare.com  to add the 2 providers under this TIN #.     Thank You,     Michele Thomas-Martin  Associate Specialist, Provider Contracts  1-888-562-5442 Ext. 200042  1 972-200-2688 - Direct  www.MolinaHealthcare.com  Your Extended Family', NULL, NULL, '2022-01-06 13:17:10', '2022-01-06 13:17:10'),
(49116, 20067, 31755, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@Molinahealthcare.com  Subject: Enrollment || NUCC - IVUC - LPMC || Molina Marketplace   Good afternoon,  Hope you are doing well. I would like to enroll the below-mentioned providers under these locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI John, Jeny	1073019493 Jacob, Jaya	1194336149   I look forward to hearing from you.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-06 13:20:01', '2022-01-06 13:20:01'),
(49117, 20067, 31755, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@Molinahealthcare.com, Michele.Thomas-Martin@molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace  Good Morning, Hope you are doing well. Kindly see the attachment of the contract request form for Jaya Jacob & Jeny John Under TIN# 270796429  Thanks and Regards Syed Ahad', NULL, NULL, '2022-01-18 09:12:41', '2022-01-18 09:12:41'),
(49118, 20067, 31755, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email received from: MHTContractrequest@molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace  Good Morning Syed,     Happy Thursday! – I hope all is well. I have received your requests. However, I noticed Provider Jaya Jacob 1194336149 already has a record created for TIN 27-0796429. Also, per Jeny John’s 1073019493 request, the service location is not listed per the form. Please fill in the service location & resubmit along with a current W9.', NULL, NULL, '2022-01-28 09:15:52', '2022-01-28 09:15:52'),
(49119, 20067, 31755, NULL, '2022-02-16 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace   Good afternoon!  Thanks for the update. Kindly see the attachment for Jeny John 1073019493', NULL, NULL, '2022-02-09 15:29:56', '2022-02-09 15:29:56'),
(49120, 20067, 31755, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace   Good Morning!  Happy Monday! Hope this email finds you in good health. I would like to know the current status of the below-mentioned providers  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Jeny John	1073019493 Molly Joseph	1396380077 Jaya Jacob	1194336149 Limy Fernandus	1972005189 Cini Thomas	1134777238 Brittany Brown	1275163537 Abdur Rauf	1497726202 Jeemol George	1497219067 Vibitha Joseph	1952931560 Ancy Kurian	1316558935  Thank you, Syed Ahad.', NULL, NULL, '2022-02-21 09:28:55', '2022-02-21 09:28:55'),
(49121, 20067, 31755, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email received from: MHTContractrequest@molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace   Good Afternoon –     Happy Tuesday! Hope you are doing well. According to our record Ms. Thomas contracted you for all lobs. Please reach out to mhtxproviderservices@Molinahealthcare.com if you have any questions. They will be able to provide you with a roster for all par providers lines of business and effective dates. Thank you in advance have a wonderful day.  ', NULL, NULL, '2022-03-01 14:08:07', '2022-03-01 14:08:07'),
(49122, 20067, 31755, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email sent to: mhtxproviderservices@Molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace   Good Afternoon!  Happy Tuesday! Hope this email finds you in good health. I would like to know the current status of the below-mentioned providers  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Jeny John	1073019493 Molly Joseph	1396380077 Jaya Jacob	1194336149 Limy Fernandus	1972005189 Cini Thomas	1134777238 Brittany Brown	1275163537 Abdur Rauf	1497726202 Jeemol George	1497219067 Vibitha Joseph	1952931560 Ancy Kurian	1316558935  Thank you, Syed Ahad.', NULL, NULL, '2022-03-01 14:10:28', '2022-03-01 14:10:28'),
(49123, 20067, 31755, NULL, '2022-03-25 00:00:00.000', 'In Process', 'Email sent to: mhtxproviderservices@molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace   Good Morning!  Hope your day is going well. Kindly provide me the roster for the Par providers with effective dates.  Thank you, Syed.', NULL, NULL, '2022-03-18 10:47:20', '2022-03-18 10:47:20'),
(49124, 19067, 31755, NULL, '2022-04-06 00:00:00.000', 'Approved', 'Eff date: 03/15/2022. See the attachment for the approval letter.', NULL, NULL, '2022-03-30 15:00:05', '2022-03-30 15:00:05'),
(49125, 1006, 31756, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:28:46', '2021-07-01 10:28:46'),
(49126, 11056, 31756, NULL, '2021-07-13 00:00:00.000', 'Initiated', 'Email sent to : CHP.networkdevelopment@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Greetings,  Hope you are doing well. I wanted to enroll the below provider in the groups mentioned below:  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Provider Name :  John, Jeny Provider NPI# : 1073019493  Kindly respond to me soon. If you need any information feel free to contact me. Thank you! ', NULL, NULL, '2021-07-05 15:54:07', '2021-07-05 15:54:07'),
(49127, 3040, 31756, NULL, '2021-07-26 00:00:00.000', 'On Hold', 'Ancillary contract request sent for the group. Please see group task. ', NULL, NULL, '2021-07-19 09:23:19', '2021-07-19 09:23:19'),
(49128, 3040, 31756, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email sent to: hunter.barrett@christushealth.org  Subject: Re: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Hello Hunter,   Hope you are doing well. Please find attached Ancillary service agreement along with the Facility Ancillary application for our group to participate in Christus Health Plan under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:9504 LONG POINT RD STE E Houston , TX 77055-4226   If you need any additional information please let me know. Waiting for your response.    Thanks ', NULL, NULL, '2021-07-28 11:39:03', '2021-07-28 11:39:03'),
(49129, 11056, 31756, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email sent to : Hunter Barrett   hunter.barrett@christushealth.org, CHP.networkdevelopment@christushealth.org  Sub  : ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Good evening!  Hope all is well. I just want to inquire about the enrollment status of the following groups for the ancillary contract. Please provide us with the latest updates soon.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:9504 LONG POINT RD STE E Houston , TX 77055-4226   If you need any additional information feel free to reach out to me. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-08-11 17:06:48', '2021-08-11 17:06:48'),
(49130, 3040, 31756, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email rcvd from: hunter.barrett@christushealth.org  Subject: RE: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Contract was sent to credentialing about 3 weeks ago to process. Will take about 6 months to fully process and receive effective date.  Thanks,  Hunter Barrett Network Contracting CHRISTUS Health Plan CHRISTUS Health 919 Hidden Ridge | Irving, Texas 75038 (o) 469.282.3113', NULL, NULL, '2021-08-17 15:02:36', '2021-08-17 15:02:36'),
(49131, 3040, 31756, NULL, '2021-09-21 00:00:00.000', 'In Process', 'Email sent to: hunter.barrett@christushealth.org  Subject: Re: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Good evening!  Hope all is well. This is a follow up email to inquire about the enrollment status of the following groups for the ancillary contract.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:9504 LONG POINT RD STE E Houston , TX 77055-4226  If you need any additional information feel free to reach out to me. Waiting for your response.  Thanks', NULL, NULL, '2021-09-14 16:14:36', '2021-09-14 16:14:36'),
(49132, 12062, 31756, NULL, '2021-09-29 00:00:00.000', 'In Process', ' Received below email under the group ancillary contract request; From :hunter.barrett@christushealth.org Subject :RE: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN Please reach out to our credentialing team in about 4 months for an update. You can reach out directly to them for updates on all of the contracts you are inquiring about. They are running around 6 months to process them so please give them adequate time to reach your file. Most of the contracts were sent to them around 1-2 months ago CHRISTUS.HP.Credentialing CHRISTUS.HP.Credentialing@christushealth.org  Thanks,   Hunter Barrett Network Contracting CHRISTUS Health Plan CHRISTUS Health 919 Hidden Ridge | Irving, Texas 75038 (o) 469.282.3113 www.christushealth.org  ', NULL, NULL, '2021-09-22 13:08:45', '2021-09-22 13:08:45'),
(49133, 10057, 31756, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Good Evening,  Hope you are doing well. I want to know the enrollment status of the following groups and providers. Please get back to me as soon as you get the time.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Jose, Julie	1447883061 George, Jeemol	1497219067 Brown, Brittany	1275163537 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Thomas, Cini	1134777238 Joseph, Vibitha	1952931560 Stephen, Ani	1588959118 Piccione JR, James M	1356321509 Chennemkara, Mini Philip	1841755956 Abraham, Glory	1194206490 Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-10-18 16:37:20', '2021-10-18 16:37:20'),
(49134, 10057, 31756, NULL, '2021-12-02 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : Need Credentialing Update - URGENT  Good Afternoon,  Hope you are doing well. Can I have the latest update on the below mentioned request. Also welcome letters?  Looking forward to your kind response. Have a great day!   Thanks & Regards,', NULL, NULL, '2021-11-18 13:50:31', '2021-11-18 13:50:31'),
(49135, 10057, 31756, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : Need Credentialing Update - URGENT  Hello,  Can I get the update on the below mentioned request, also I have not yet received any welcome letters yet.  Kindly revert back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-01 10:58:18', '2021-12-01 10:58:18'),
(49136, 10057, 31756, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email Received From : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Good Morning  Normandy Urgent Care Center  - has been processed effective contract date 01/01/2022  Longpoint Medical Center – facility has been processed effective contract date 01/01/2022  Imperial Valley - facility has been processed effective contract date 01/01/2022  Credentialing Verification Unit CHRISTUS Health Plan - US Family Health Plan 919 Hidden Ridge Irving, TX 75038 Phone: (469)-282-0368 Fax: 210-766-8857', NULL, NULL, '2021-12-14 09:52:28', '2021-12-14 09:52:28'),
(49137, 10057, 31756, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Thank you for the update. Could you please provide us with the facility agreement or contract along with the update for the providers credentialing status as well.  Your earliest response would be greatly appreciated.  Regards, Steve Albert', NULL, NULL, '2021-12-20 13:40:48', '2021-12-20 13:40:48'),
(49138, 10057, 31756, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Greetings!  Hope you are doing great. I\'m writing this email to get the update on my below request. Please get back to me as soon as possible!  Regards,', NULL, NULL, '2021-12-28 11:56:57', '2021-12-28 11:56:57'),
(49139, 19067, 31756, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: CHRISTUS.HP.Credentialing@christushealth.org, hunter.barrett@christushealth.org, CHP.networkdevelopment@christushealth.org  Subject: Enrollment Query || NUCC & IVUC || Providers & Group || Christus Health Plan ||   Hello!  You are having a productive day.  I would like to know the enrollment status of the following Providers and Group with Christus Health Plan.   Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Jeny John	1073019493	779 Normandy St STE 114, Houston, TX 77015-3441 Jeny John	1073019493	16272 Imperial Valley DR STE K, Houston, TX 77060 Molly Joseph	1396380077	779 Normandy St STE 114, Houston, TX 77015-3441 Molly Joseph	1396380077	16272 Imperial Valley DR STE K, Houston, TX 77060 Cini Thomas	1134777238	779 Normandy St STE 114, Houston, TX 77015-3441 Cini Thomas	1134777238	16272 Imperial Valley DR STE K, Houston, TX 77060 Ani Stephen	1588959118	779 Normandy St STE 114, Houston, TX 77015-3441 Ani Stephen	1588959118	16272 Imperial Valley DR STE K, Houston, TX 77060 Abdur Rauf	1497726202	779 Normandy St STE 114, Houston, TX 77015-3441 Abdur Rauf	1497726202	16272 Imperial Valley DR STE K, Houston, TX 77060 James Piccione JR	1356321509	779 Normandy St STE 114, Houston, TX 77015-3441 James Piccione JR	1356321509	16272 Imperial Valley DR STE K, Houston, TX 77060 Sigi Paul	1033623616	779 Normandy St STE 114, Houston, TX 77015-3441 Sigi Paul	1033623616	16272 Imperial Valley DR STE K, Houston, TX 77060 Odette Kourouma	1134525868	779 Normandy St STE 114, Houston, TX 77015-3441 Odette Kourouma	1134525868	16272 Imperial Valley DR STE K, Houston, TX 77060 Vibitha Joseph	1952931560	779 Normandy St STE 114, Houston, TX 77015-3441 Vibitha Joseph	1952931560	16272 Imperial Valley DR STE K, Houston, TX 77060 Julie Jose	1447883061	779 Normandy St STE 114, Houston, TX 77015-3441 Julie Jose	1447883061	16272 Imperial Valley DR STE K, Houston, TX 77060 Jaya Jacob	1194336149	779 Normandy St STE 114, Houston, TX 77015-3441 Jaya Jacob	1194336149	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeemol George	1497219067	779 Normandy St STE 114, Houston, TX 77015-3441 Jeemol George	1497219067	16272 Imperial Valley DR STE K, Houston, TX 77060 Limy Fernandus	1972005189	779 Normandy St STE 114, Houston, TX 77015-3441 Limy Fernandus	1972005189	16272 Imperial Valley DR STE K, Houston, TX 77060 Brittany Brown	1275163537	779 Normandy St STE 114, Houston, TX 77015-3441 Brittany Brown	1275163537	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeena Abraham	1467901587	779 Normandy St STE 114, Houston, TX 77015-3441 Jeena Abraham	1467901587	16272 Imperial Valley DR STE K, Houston, TX 77060 Mini Chennemkara	1841755956	779 Normandy St STE 114, Houston, TX 77015-3441 Mini Chennemkara	1841755956	16272 Imperial Valley DR STE K, Houston, TX 77060 Glory Abraham	1194206490	779 Normandy St STE 114, Houston, TX 77015-3441 Glory Abraham	1194206490	16272 Imperial Valley DR STE K, Houston, TX 77060  Eagerly waiting for your response.   Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 17:23:43', '2022-01-04 17:23:43');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(49140, 19067, 31756, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email received from: Sonia.Gonzales@christushealth.org  Subject: Enrollment Query || NUCC & IVUC || Providers & Group || Christus Health Plan ||     Good Morning All,     Thank you for the request below, I do show contract for USFHP was signed and executed.   Information was sent over to get configuration of contract rates entered.       Once we have this process is completed we can have this sent to Credentialing to get group loaded with effective date.  When I get further updates will pass along!     Please remove Hunter Barrette from communications, unfortunately he is no longer with us, I am covering in the interim.       Thanks and appreciate your patience,     Respectfully,     Sonia D. Gonzales  CHRISTUS Health Plan – Physician Relations Consultant II/ Contracting  505-569-4856  sonia.gonzales@christushealth.org', NULL, NULL, '2022-01-05 11:32:48', '2022-01-05 11:32:48'),
(49141, 20067, 31756, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: Sonia.Gonzales@christushealth.org  Sub: Re: Enrollment Query || NUCC & IVUC || Providers & Group || Christus Health Plan ||  Good Afternoon, Hope this email finds you in good health. Any update on the previous request?  Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-14 13:22:39', '2022-01-14 13:22:39'),
(49142, 20067, 31756, NULL, '2022-01-28 00:00:00.000', 'In Process', 'Email sent to: Sonia.Gonzales@christushealth.org  Sub: Re: Enrollment Query || NUCC & IVUC || Providers & Group || Christus Health Plan ||  Good afternoon! Hope you are doing well. I haven\'t heard from your side, Kindly respond to the previous mail. If the process is complete, kindly send me the contract letter along with the effective date.  Thanks and Regards, Syed Ahad  ', NULL, NULL, '2022-01-21 16:45:00', '2022-01-21 16:45:00'),
(49143, 20067, 31756, NULL, '2022-02-01 00:00:00.000', 'Approved', 'Received the Ancillary contract from Christus Health Plan  Effective Date: 01/01/2022 Expiration Date: 12/31/9999', NULL, NULL, '2022-01-25 17:02:16', '2022-01-25 17:02:16'),
(49144, 1006, 31757, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:30:21', '2021-07-01 10:30:21'),
(49145, 11056, 31757, NULL, '2021-07-09 00:00:00.000', 'On Hold', 'CAQH is pending because of Mal practice and informed client and waiting for the response. Whenever we gonna receive Mal practice, we will procced soon .', NULL, NULL, '2021-07-02 09:44:46', '2021-07-02 09:44:46'),
(49146, 3040, 31757, NULL, '2021-09-08 00:00:00.000', 'In Process', 'View Summary Thank you for completing the BCBSTX enrollment. We will notify you once your application has been processed. If you requested to be contracted, please note that your claims may pay out of network for services rendered until your contracts have been accepted, the credentialing process has been completed, and you receive an effective date. Application ID: 334130', NULL, NULL, '2021-09-01 17:02:04', '2021-09-01 17:02:04'),
(49147, 12062, 31757, NULL, '2021-10-02 00:00:00.000', 'Approved', 'As per the attached mail received from BCBSTX , The provider is enrolled. Please refer to the attached email.', NULL, NULL, '2021-09-24 16:33:46', '2021-09-24 16:33:46'),
(49148, 1006, 31758, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:30:21', '2021-07-01 10:30:21'),
(49149, 11056, 31758, NULL, '2021-07-09 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-07-02 09:06:07', '2021-07-02 09:06:07'),
(49150, 1006, 31759, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:30:21', '2021-07-01 10:30:21'),
(49151, 11056, 31759, NULL, '2021-07-09 00:00:00.000', 'On Hold', 'Waiting for CAQH completion .', NULL, NULL, '2021-07-02 09:47:12', '2021-07-02 09:47:12'),
(49152, 3040, 31759, NULL, '2021-09-17 00:00:00.000', 'In Process', 'Jeny John Application no: 12743773 Provider id: 0211248', NULL, NULL, '2021-09-10 14:03:34', '2021-09-10 14:03:34'),
(49153, 12062, 31759, NULL, '2021-09-24 00:00:00.000', 'In Process', 'Received Email from CIGNA;  see attached mail for your reference.', NULL, NULL, '2021-09-17 13:19:35', '2021-09-17 13:19:35'),
(49154, 10057, 31759, NULL, '2021-11-09 00:00:00.000', 'Approved', 'Email Received From : WelcomeHealthCareProvider@cigna.com  Sub : Welcome to the Cigna network  Dear JENY JOHN MSN,  Congratulations! Your application to participate in the Cigna network has been approved. Our shared focus is on the health and well-being of every person we serve. Working together, we can help them live a healthy life.  Your effective date is 10/20/2021. Your provider identification number is‍ ‌0211248. Please take a moment to register for the Cigna for Health Care Professionals website (CignaforHCP.com).  Please see attachments:', NULL, NULL, '2021-11-02 14:39:11', '2021-11-02 14:39:11'),
(49155, 1006, 31760, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:30:21', '2021-07-01 10:30:21'),
(49156, 11056, 31760, NULL, '2021-07-10 00:00:00.000', 'On Hold', 'Pending group enrollment. ', NULL, NULL, '2021-07-02 14:55:14', '2021-07-02 14:55:14'),
(49157, 1006, 31761, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:30:21', '2021-07-01 10:30:21'),
(49158, 11056, 31761, NULL, '2021-07-09 00:00:00.000', 'On Hold', '	 Awaiting Medicaid\'s enrollment.', NULL, NULL, '2021-07-02 13:11:48', '2021-07-02 13:11:48'),
(49159, 3040, 31761, NULL, '2021-07-27 00:00:00.000', 'Not Eligible', 'Rejection letter received, attached for reference: Dear Provider: Thank you for your interest in becoming a participating provider in the Texas Children’s Health Plan network. We regret to inform you that we will not be able to offer you an Agreement at this time. We are not licensed to contract in Colorado County for the STAR, STAR Kids or CHIP Programs. We will keep your letter of interest on file should our service area change in the future.  Thank you again for your interest.  Sincerely, Contracts Administration Texas Children’s Health Plan', NULL, NULL, '2021-07-20 09:40:18', '2021-07-20 09:40:18'),
(49160, 1006, 31762, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:30:21', '2021-07-01 10:30:21'),
(49161, 11056, 31762, NULL, '2021-07-10 00:00:00.000', 'Initiated', 'Email sent to : MDuffee@humana.com  Sub : Provider Enrollment Request - CUCC - Humana  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned provider in Humana in our group under the below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider : Provider Name : John, Jeny Provider NPI# : 1073019493 Degree : MSN Primary Speciality : FNP  Feel free to reach out for any further information. Kindly respond soon.  Thank you!', NULL, NULL, '2021-07-02 17:09:32', '2021-07-02 17:09:32'),
(49162, 3040, 31762, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: MDuffee@humana.com  Subject; Re: Provider Enrollment Request - CUCC - Humana  Hello Michael,   Hope you are doing well. I wanted to enroll the below mentioned provider in Humana in our group under the below location.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider : Provider Name : John, Jeny Provider NPI# : 1073019493  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-07-22 13:23:32', '2021-07-22 13:23:32'),
(49163, 11056, 31762, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email sent to : humanahoustonpd@humana.com  &  mduffee@humana.com  Sub : Provider Enrollment Request - CUCC - Humana  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned provider in Humana in our group under the below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider : Provider Name : John, Jeny Provider NPI# : 1073019493 Degree : MSN Primary Speciality : FNP  Feel free to reach out for any further information. Kindly respond soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-04 17:09:39', '2021-08-04 17:09:39'),
(49164, 3040, 31762, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Email sent to: humanahoustonpd@humana.com  Subject: Re: Provider Enrollment Request - CUCC - Humana  Greetings,   Hope you are doing well. Please find attached the roster that was requested in the previous email.   If you need any additional information please let me know. Waiting for your response.   Thank you ', NULL, NULL, '2021-08-26 10:51:10', '2021-08-26 10:51:10'),
(49165, 10057, 31762, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : humanahoustonpd@humana.com & mduffee@humana.com  Sub : Provider Enrollment Request - CUCC - Humana  Good Evening,  Hope this email finds you well. I\'m writing this email to check the updated enrollment status for the below mentioned providers in Humana in our group under the below location.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Provider Name	NPI Joseph, Vibitha	1952931560 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Abraham, Glory	1194206490 Stephen, Ani	1588959118 PAUL, SIGI	1033623616 John, Jeny	1073019493  Looking forward to your kind response, Have a great weekend ahead!  Thanks & Regards,', NULL, NULL, '2021-10-08 16:42:47', '2021-10-08 16:42:47'),
(49166, 10057, 31762, NULL, '2021-10-19 00:00:00.000', 'Approved', 'Email Received From : mduffee@humana.com  Sub : Provider Enrollment Request - CUCC - Humana  Hi Steve, All are loaded and linked to the TIN provided. Please see below, take care and enjoy your day.  Effective Date : 10/05/2021  ', NULL, NULL, '2021-10-12 09:33:12', '2021-10-12 09:33:12'),
(49167, 1006, 31763, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:30:21', '2021-07-01 10:30:21'),
(49168, 11056, 31763, NULL, '2021-07-09 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s approval.', NULL, NULL, '2021-07-02 09:22:19', '2021-07-02 09:22:19'),
(49169, 3040, 31763, NULL, '2021-07-27 00:00:00.000', 'Approved', 'From: Hughes, Jason T. -jason.hughes@amerigroup.com Sub: RE: {EXTERNAL} Provider Credentialing Status Request  Columbus UC is contracted as a facility, meaning that the facility only needs to be in network.  Eff date 03/26/2020', NULL, NULL, '2021-07-20 09:41:21', '2021-07-20 09:41:21'),
(49170, 1006, 31764, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:30:21', '2021-07-01 10:30:21'),
(49171, 11056, 31764, NULL, '2021-07-09 00:00:00.000', 'In Process', 'Awaiting Medicare\'s approval.', NULL, NULL, '2021-07-02 09:49:09', '2021-07-02 09:49:09'),
(49172, 3040, 31764, NULL, '2021-07-27 00:00:00.000', 'Not Eligible', 'CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @   https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/', NULL, NULL, '2021-07-20 09:39:18', '2021-07-20 09:39:18'),
(49173, 1006, 31765, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:30:22', '2021-07-01 10:30:22'),
(49174, 11056, 31765, NULL, '2021-07-09 00:00:00.000', 'On Hold', 'Awaiting Medicare\'s approval.', NULL, NULL, '2021-07-02 10:25:53', '2021-07-02 10:25:53'),
(49175, 3040, 31765, NULL, '2021-07-26 00:00:00.000', 'In Process', 'Email sent to: AlagarSamyN@aetna.com  Subject: Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Hello Nandhini,  Hope you are doing well. Kindly advise the procedure to link the providers under the below Tax ID. As you mentioned in your previous email that most of the providers are not linked to the Tax ID.    Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: PAUL, SIGI Provider NPI#  1033623616  Provider 2:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Kourouma , Odette Provider NPI# 1134525868  Provider 8:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 9:   Provider Name: John, Jeny Provider NPI# 1073019493  Provider 10:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 11:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 16:   Provider Name: Jose, Julie Provider NPI# 1447883061  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you! ', NULL, NULL, '2021-07-19 11:31:27', '2021-07-19 11:31:27'),
(49176, 11056, 31765, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email sent to : AlagarSamyN@aetna.com  Sub : Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Good morning!  Hope you are doing well. Kindly advise the procedure to link the providers under the below Tax ID. As you mentioned in your previous email that most of the providers are not linked to the Tax ID.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider Details:  Provider 1: Provider Name: PAUL, SIGI Provider NPI#  1033623616  Provider 2:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Kourouma , Odette Provider NPI# 1134525868  Provider 8:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 9:   Provider Name: John, Jeny Provider NPI# 1073019493  Provider 10:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 11:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 16:   Provider Name: Jose, Julie Provider NPI# 1447883061  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-04 16:19:59', '2021-08-04 16:19:59'),
(49177, 11056, 31765, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email sent to : AlagarSamyN@aetna.com  Sub : Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Good morning!  Hope you are doing well. Kindly advise the procedure to link the providers under the below Tax ID. As you mentioned in your previous email that most of the providers are not linked to the Tax ID.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider Details:  Provider 1: Provider Name: PAUL, SIGI Provider NPI#  1033623616  Provider 2:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Kourouma , Odette Provider NPI# 1134525868  Provider 8:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 9:   Provider Name: John, Jeny Provider NPI# 1073019493  Provider 10:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 11:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 16:   Provider Name: Jose, Julie Provider NPI# 1447883061  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-04 16:20:00', '2021-08-04 16:20:00'),
(49178, 3040, 31765, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email sent to: AlagarSamyN@aetna.com  Subject; Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Hello Nandhini,  Hope you are doing well. Kindly advise the procedure to link the providers under the below Tax ID. As you mentioned in your previous email that most of the providers are not linked to the Tax ID.    Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: PAUL, SIGI Provider NPI#  1033623616  Provider 2:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Kourouma , Odette Provider NPI# 1134525868  Provider 8:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 9:   Provider Name: John, Jeny Provider NPI# 1073019493  Provider 10:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 11:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 16:   Provider Name: Jose, Julie Provider NPI# 1447883061  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you!', NULL, NULL, '2021-08-30 12:01:19', '2021-08-30 12:01:19'),
(49179, 10057, 31765, NULL, '2021-10-18 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Good Evening,  Hope this email finds you well. I want to inquire about the enrollment status for the below-mentioned providers and practice Columbus Urgent Care PA in First Health.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Provider Name	NPI Chennemkara, Mini Philip	1841755956 Abraham, Glory	1194206490 Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1073019493 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061  Your earlier response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-10-11 16:59:14', '2021-10-11 16:59:14'),
(49180, 10057, 31765, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Received From : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hi,  Good Evening!  Please find the status of the Providers list attached.  Thank You,  Phani', NULL, NULL, '2021-10-18 10:30:43', '2021-10-18 10:30:43'),
(49181, 10057, 31765, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Email Sent To : AlagarSamyN@aetna.com & MadirajuP@aetna.com  Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Hello,  Hope you are doing well. Could you please let me know the updated status on our enrollment request for the mentioned details.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-11-17 17:08:18', '2021-11-17 17:08:18'),
(49182, 10057, 31765, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Received From : MadirajuP@aetna.com  Sub: Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Hi,  Please find the status of the list of Provider’s status attached.  Thank You, Phani', NULL, NULL, '2021-11-22 17:34:08', '2021-11-22 17:34:08'),
(49183, 10057, 31765, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Hello,  Thank you for reaching out. As per your given attached file providers not yet credentialed, are they in a credentialing process? If yes, then how long will it take more.  If not in a credentialing process then please let me know the process.  Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-22 17:40:24', '2021-11-22 17:40:24'),
(49184, 10057, 31765, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Good Afternoon,  Hope you are doing well. I\'m writing this email to check the updated status for the below mentioned providers under the TIN.  Kindly revert back to me as soon as possible!  Thanks & Regards,', NULL, NULL, '2021-12-02 13:36:05', '2021-12-02 13:36:05'),
(49185, 10057, 31765, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : AlagarSamyN@aetna.com & MadirajuP@aetna.com  Sub : Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Hello,  Can I get an update on the below mentioned providers enrollment request. It is my second reminder.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Provider Name	NPI Chennemkara, Mini Philip	1841755956 Abraham, Glory	1194206490 Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1073019493 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-09 11:04:17', '2021-12-09 11:04:17'),
(49186, 10057, 31765, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Sent To : AlagarSamyN@aetna.com & MadirajuP@aetna.com  Sub : Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Good afternoon,  Any update on the below request? Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-16 14:32:24', '2021-12-16 14:32:24'),
(49187, 10057, 31765, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email Sent To : AlagarSamyN@aetna.com & MadirajuP@aetna.com  Sub : Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Greetings!  Hope this email finds you well. This is my THIRD REMINDER on the below request.  Looking forward to your early response.  Regards,', NULL, NULL, '2021-12-22 10:53:16', '2021-12-22 10:53:16'),
(49188, 10057, 31765, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com & AlagarSamyN@aetna.com  Sub : Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Still waiting to get an update from your side, the process is getting late day by day. Please let me know the status?  Regards,', NULL, NULL, '2021-12-29 15:51:35', '2021-12-29 15:51:35'),
(49189, 19067, 31765, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: MadirajuP@aetna.com & AlagarSamyN@aetna.com  Subject: Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||   Hello!  Hope you are having a productive day.  I would like to know the enrollment status of the following Providers.   Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus, TX 78934-2215 Provider Name	NPI Chennemkara, Mini Philip	1841755956 Abraham, Glory	1194206490 Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1073019493 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061   Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 13:33:06', '2022-01-04 13:33:06'),
(49190, 20067, 31765, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: MadirajuP@aetna.com, AlagarSamyN@aetna.com  Sub: Re: Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Good Morning! Hope you are doing great. Any update on the below-mentioned request?  Kindly respond promptly.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-19 12:19:02', '2022-01-19 12:19:02'),
(49191, 20067, 31765, NULL, '2022-02-03 00:00:00.000', 'In Process', 'Email sent to: MadirajuP@aetna.com, AlagarSamyN@aetna.com  Sub: Re: Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Good Afternoon!  Kindly respond promptly or provide me with the email address where I can send the queries.  Thanks & Regards, Syed Ahad.', NULL, NULL, '2022-01-27 12:29:41', '2022-01-27 12:29:41'),
(49192, 20067, 31765, NULL, '2022-02-09 00:00:00.000', 'In Process', 'Application subitted through online. Please allow 45-60 Days to process the request. See the attachment', NULL, NULL, '2022-02-02 10:07:40', '2022-02-02 10:07:40'),
(49193, 20067, 31765, NULL, '2022-02-24 00:00:00.000', 'In Process', 'There is no follow ups,  Allow 90 days to process the request.', NULL, NULL, '2022-02-17 17:10:20', '2022-02-17 17:10:20'),
(49194, 20067, 31765, NULL, '2022-03-08 00:00:00.000', 'On Hold', 'Called Aetna and Spoke to Jesseca  Ref# 6077272236  Panel is currently closed for contacting since 01/12/2022 Call us back after 30 business days to check if the panel is open.', NULL, NULL, '2022-03-01 10:49:09', '2022-03-01 10:49:09'),
(49195, 1006, 31766, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:30:22', '2021-07-01 10:30:22'),
(49196, 11056, 31766, NULL, '2021-07-10 00:00:00.000', 'In Process', 'Enrollment form has been submitted through online protal. Please see attachment. Your form has been submitted! For new provider applications, please allow 15 business days for a HealthSmart team member to contact you.', NULL, NULL, '2021-07-02 16:34:09', '2021-07-02 16:34:09'),
(49197, 11056, 31766, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email sent to : pr.south@healthsmart.com  Sub : Enrollment Status Query - Columbus Urgent Care PA - Health Smart  Good morning!  Hope you are doing well. I want to inquire about the enrollment status of the following provider. Please provide me with updates soon.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# : 47-1914151 Practice NPI# : 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider  Provider Name: John, Jeny Provider NPI# : 1073019493  If you need any information or documents please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-04 16:41:43', '2021-08-04 16:41:43'),
(49198, 3040, 31766, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: HealthSmart.com - Join Our Network - Individual Provider - John  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in Health Smart in our group under the below location.   Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-30 13:39:02', '2021-08-30 13:39:02'),
(49199, 3040, 31766, NULL, '2021-09-08 00:00:00.000', 'Approved', 'Email rcvd from: mdiprsupport@healthsmart.com  Subject: Fw: Fw: Fw: HealthSmart.com - Join Our Network - Individual Provider - John  Hi,  \" John, Jeny NP \" is effective date \" 05/01/2021 \".  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com   (Inventory Log ID : 83417)  Thanks HealthSmart Provider Relations', NULL, NULL, '2021-09-01 14:19:07', '2021-09-01 14:19:07'),
(49200, 1006, 31767, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:30:22', '2021-07-01 10:30:22'),
(49201, 11056, 31767, NULL, '2021-07-10 00:00:00.000', 'Initiated', 'Email sent to : registrar@multiplan.com  Sub : ENROLLMENT QUERY - CUCC - MULTIPLAN  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned provider in the Multiplan for our group.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-221  Provider  Provider Name: John, Jeny Provider NPI# : 1073019493  Please respond soon. If you need any further information please let me know. Thank you!', NULL, NULL, '2021-07-02 16:48:26', '2021-07-02 16:48:26'),
(49202, 3040, 31767, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Service Case Number:	7683891 Details have been emailed to you at: cucc@claimsmedinc.com', NULL, NULL, '2021-07-26 16:44:13', '2021-07-26 16:44:13'),
(49203, 1006, 31767, NULL, '2021-08-10 00:00:00.000', 'In Process', 'We received a fax from Multiplan requesting specialty information for the provider, replied @ registrarmissinginfo@multiplan.com:  Sub: Missing Items Request   \"Hello,   Please find the requested information, do let me know if you need any other information.   Thank you. \"', NULL, NULL, '2021-08-03 10:31:38', '2021-08-03 10:31:38'),
(49204, 3040, 31767, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Email sent to: registrarmissinginfo@multiplan.com  Subject; Re: Missing Items Request  Hello,   Hope you are doing well. I had a word with Randy Multiplan representative and he advise to send the below information through email because the following information is missing in application for the providers.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-221  Provider 1: Provider Name: Stephen, Ani Provider NPI# 1588959118 Admitting Hospital Privilege\'s: Memorial Hermann Memorial City Medical Center Hospital Address: 921 Gessner Rd, Houston, TX 77024 Professional Labiality Insurance: Attached  Provider 2: Provider Name: PAUL, SIGI Provider NPI# 1033623616 Admitting Hospital Privilege\'s: Memorial Hermann Memorial City Medical Center Hospital Address: 921 Gessner Rd, Houston, TX 77024 Professional Labiality Insurance: Attached  Provider 3: Provider Name: Jacob, Jaya Provider NPI# 1194336149 Admitting Hospital Privilege\'s: Memorial Hermann Memorial City Medical Center Hospital Address: 921 Gessner Rd, Houston, TX 77024 Professional Labiality Insurance: Attached  Provider 4: Provider Name: John, Jeny Provider NPI# 1073019493 Admitting Hospital Privilege\'s: Memorial Hermann Memorial City Medical Center Hospital Address: 921 Gessner Rd, Houston, TX 77024 CAQH: CAQH access is authorize Multiplan to access the provider information.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-26 14:05:00', '2021-08-26 14:05:00'),
(49205, 10057, 31767, NULL, '2021-10-22 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com  Sub : ENROLLMENT QUERY - CUCC - MULTIPLAN  Good Morning,  Hope this email finds you well. I\'m writing this email to check the enrollment status with Multiplan for the below-mentioned provider under the group location.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215 Provider Name	NPI  John, Jeny 1073019493  Looking forward to your kind response. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-15 08:54:07', '2021-10-15 08:54:07'),
(49206, 10057, 31767, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com  Enrollment Status || CUCC || Jeny John || Multiplan  Hello,  Hope this email finds you well. I\'m writing this email to check the enrollment status for Jeny John under the group location.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Provider Name	NPI John, Jeny	1073019493  Please get back to me with the latest updates. Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-11-17 17:56:31', '2021-11-17 17:56:31'),
(49207, 10057, 31767, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com  Sub : Enrollment Status || CUCC || Jeny John || Multiplan  Hello,  Can I get the latest update on the below mentioned request.  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-11-30 14:12:54', '2021-11-30 14:12:54'),
(49208, 10057, 31767, NULL, '2021-12-14 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com  Sub : Enrollment Status || CUCC || Jeny John || Multiplan  Hello Team,  Hope this email finds you in good health. I\'m writing this email to check the current status about the below mentioned provider enrollment process under the TIN.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Provider Name	NPI John, Jeny	1073019493  Kindly get back to me as soon as you get a chance.  Thanks & Regards,', NULL, NULL, '2021-12-07 13:28:55', '2021-12-07 13:28:55'),
(49209, 10057, 31767, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com  Sub : Enrollment Status || CUCC || Jeny John || Multiplan  Greetings!  Any update on the below mentioned request, it is my second reminder.  Please get back to me as soon as possible!  Thanks & Regards,', NULL, NULL, '2021-12-14 11:51:03', '2021-12-14 11:51:03'),
(49210, 10057, 31767, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com  Sub : Enrollment Status || CUCC || Jeny John || Multiplan  Still waiting to get a response from your side.  Regards,', NULL, NULL, '2021-12-21 13:02:45', '2021-12-21 13:02:45'),
(49211, 10057, 31767, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com  Sub : Enrollment Status || CUCC || Jeny John || Multiplan  Good Afternoon,  This is THIRD REMINDER on the below request. Please get back to me as soon as possible.  Regards,', NULL, NULL, '2021-12-28 15:10:57', '2021-12-28 15:10:57'),
(49212, 19067, 31767, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Enrollment Query || CUCC || Jeny John || Multiplan ||   Hello!  I would like to know the enrollment status of the following Provider.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215 Provider Name	NPI Jeny John	1073019493  Kindly respond promptly.  Thanks & Regards, Hammad Ahmed. ', NULL, NULL, '2022-01-04 14:20:21', '2022-01-04 14:20:21'),
(49213, 20067, 31767, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Sub: Re: Enrollment Query || CUCC || Jeny John || Multiplan ||  Good Morning! Hope this email finds you in good health. Kindly respond to the previously mentioned request.  Eagerly waiting for your response Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-19 13:06:27', '2022-01-19 13:06:27'),
(49214, 20067, 31767, NULL, '2022-02-03 00:00:00.000', 'In Process', 'Called Multiplan  Application is in process It will take 60 days Application Tracking ID# APP0008241630  Call Ref#7683891 Rep: Melissa', NULL, NULL, '2022-01-27 13:36:20', '2022-01-27 13:36:20'),
(49215, 20067, 31767, NULL, '2022-02-09 00:00:00.000', 'In Process', 'Called Multiplan and spoke to Jennifer The application is in process and it will take 10 more business days from today.  Ref# 7899694 Rep: Jennifer', NULL, NULL, '2022-02-02 14:17:21', '2022-02-02 14:17:21'),
(49216, 20067, 31767, NULL, '2022-02-15 00:00:00.000', 'Approved', 'Received the welcome letter for Jeny John , see attachment Effective Date: 11/15/2021', NULL, NULL, '2022-02-08 12:14:01', '2022-02-08 12:14:01'),
(49217, 1006, 31768, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:30:22', '2021-07-01 10:30:22'),
(49218, 11056, 31768, NULL, '2021-07-09 00:00:00.000', 'On Hold', 'Awaiting Medicare\'s approval.', NULL, NULL, '2021-07-02 10:33:37', '2021-07-02 10:33:37'),
(49219, 11056, 31768, NULL, '2021-10-08 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. See group task.', NULL, NULL, '2021-10-01 10:25:52', '2021-10-01 10:25:52'),
(49220, 1006, 31769, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:30:22', '2021-07-01 10:30:22'),
(49221, 11056, 31769, NULL, '2021-07-09 00:00:00.000', 'On Hold', 'Awaiting Medicare\'s approval.', NULL, NULL, '2021-07-02 09:17:25', '2021-07-02 09:17:25'),
(49222, 11056, 31769, NULL, '2021-07-16 00:00:00.000', 'In Process', 'Application Enrollment Status  Application Status : Submitted PEP Ticket Number : 17908534', NULL, NULL, '2021-07-09 13:27:07', '2021-07-09 13:27:07'),
(49223, 3040, 31769, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Application Status PEP Ticket Number In Progress		17908534 ', NULL, NULL, '2021-07-14 09:33:52', '2021-07-14 09:33:52'),
(49224, 11056, 31769, NULL, '2021-10-20 00:00:00.000', 'Approved', ' Portal Ticket # Application Name  NPI	Status Update Date  Transction Type	Status	   17908534  jeny-cucc  1073019493  8/13/2021 Enrollment - First Time Applicant  Closed Approved    Revalidation Date : 07/25/2025   Please see the attachment.', NULL, NULL, '2021-10-13 13:50:17', '2021-10-13 13:50:17'),
(49225, 1006, 31770, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:30:22', '2021-07-01 10:30:22'),
(49226, 11056, 31770, NULL, '2021-07-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: Enterprise.Credentialing@memorialhermann.org  Subject: Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann ||  Good morning. At this time, Columbus, Texas is out of our network area, and we do not contract out of network at this time. Please let me know if you have any questions.  Thank you. Camilla Paige', NULL, NULL, '2021-07-02 15:01:21', '2021-07-02 15:01:21'),
(49227, 1006, 31771, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:30:22', '2021-07-01 10:30:22'),
(49228, 11056, 31771, NULL, '2021-07-09 00:00:00.000', 'On Hold', 'Awaiting Medicare\'s enrollment.', NULL, NULL, '2021-07-02 10:45:17', '2021-07-02 10:45:17'),
(49229, 3040, 31771, NULL, '2021-07-27 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add the individual providers.   Contract attached in group task. ', NULL, NULL, '2021-07-20 10:29:14', '2021-07-20 10:29:14'),
(49230, 1006, 31772, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:30:22', '2021-07-01 10:30:22'),
(49231, 11056, 31772, NULL, '2021-07-09 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s enrollment.', NULL, NULL, '2021-07-02 13:10:29', '2021-07-02 13:10:29'),
(49232, 20067, 31772, NULL, '2022-02-09 00:00:00.000', 'In Process', 'Application submitted online.   Prior to a new provider’s provision of services and receipt of claims reimbursement, program enrollment must be confirmed on requests for Superior Medicaid (STAR, STAR Health, STAR Kids and STAR+PLUS), CHIP and/or Long-Term Services and Supports (LTSS) programs.  Superior will notify you of acceptance or non-acceptance to our network no later than 90 days from receipt of a complete application for participation.  If additional information is required to process your request, a Superior representative will contact you soon.', NULL, NULL, '2022-02-02 13:15:20', '2022-02-02 13:15:20'),
(49233, 20067, 31772, NULL, '2022-02-24 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Sub: Enrollment Status || CUCC || Jeny John & GROUP || Superior Health  Good Evening!  Hope this email finds you in good health. I would like to know the enrollment status of the below-mentioned Group & Provider.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus, TX 78934-2215 NPI	Provider 1073019493	Jeny John  Regards,', NULL, NULL, '2022-02-17 17:35:13', '2022-02-17 17:35:13'),
(49234, 20067, 31772, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email received from: AM.Austin@superiorhealthplan.com  Sub: Enrollment Status || CUCC || Jeny John & GROUP || Superior Health  Thank you for contacting the Travis/Central Account Management Team.  Provider is in credentialing status. No effective date available at this time     Thank you,     Account Management  Region 3', NULL, NULL, '2022-03-01 12:11:19', '2022-03-01 12:11:19'),
(49235, 20067, 31772, NULL, '2022-03-16 00:00:00.000', 'In Process', 'Email received from: AM.Austin@superiorhealthplan.com  Sub: Re: Enrollment Status || Columbus Urgent Care PA || Jeny John || Superior Health ||  Good afternoon,     Provider is in credentialing process at this time. No effective date available at this time.     Thank you,', NULL, NULL, '2022-03-09 15:55:42', '2022-03-09 15:55:42'),
(49236, 20067, 31772, NULL, '2022-03-28 00:00:00.000', 'In Process', 'Email sent to: AM.Austin@superiorhealthplan.com  Sub: Re: Enrollment Status || Columbus Urgent Care PA || Jeny John || Superior Health ||  Good Afternoon!  Hope you had a great weekend. What\'s the current status of the provider Jeny John. Also please confirm that this provider is in process with both Superior Health plan and Ambetter.?  Thank you, Syed ', NULL, NULL, '2022-03-21 12:30:33', '2022-03-21 12:30:33'),
(49237, 1006, 31773, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:30:22', '2021-07-01 10:30:22'),
(49238, 11056, 31773, NULL, '2021-07-10 00:00:00.000', 'Initiated', 'Provider certification application from sent it through fax.  Please see the attachment.', NULL, NULL, '2021-07-02 14:34:55', '2021-07-02 14:34:55'),
(49239, 3040, 31773, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Columbus Urgent Care PA || John, Jeny || Tricare ||  Hello Katherine,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Tricare in our group under the below locations.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider 1:  Provider Name: John, Jeny Provider NPI# 1073019493 Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you  ', NULL, NULL, '2021-07-22 17:09:55', '2021-07-22 17:09:55'),
(49240, 11056, 31773, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email sent to : 	KMoten4@humana.com  Sub : Enrollment Status Query - CUCC - Tricare  Hey Katherine!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Tricare in our group under the below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider Details: Provider 1: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 2: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6: Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 7: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 9: Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 10: Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you  Have a great day!', NULL, NULL, '2021-08-05 12:07:32', '2021-08-05 12:07:32'),
(49241, 11056, 31773, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email sent to : KMoten4@humana.com  Sub : Enrollment Status Query - CUCC - Tricare  Hey Katherine!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Tricare in our group under the below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider Details: Provider 1: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 2: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6: Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 7: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 9: Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 10: Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you  Have a great day!', NULL, NULL, '2021-08-05 13:08:17', '2021-08-05 13:08:17'),
(49242, 3040, 31773, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Re: Enrollment Status || Columbus Urgent Care PA || John, Jeny || Tricare ||  Hello Katherine,  Please send the credentialing application form and the list of the documents.   Waiting for your reply.   Thank you ', NULL, NULL, '2021-08-18 15:43:38', '2021-08-18 15:43:38'),
(49243, 10057, 31773, NULL, '2021-10-22 00:00:00.000', 'In Process', 'Email Sent To : KMoten4@humana.com & ywyatt@humana.com & HGBProviderRosters@humana.com  Sub : Enrollment Status Query - CUCC - Tricare  Good Morning,  Any update on below credentialing request.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Provider Name	NPI John, Jeny	1073019493 Joseph, Molly	1396380077  Please get back to me as soon as you get a chance.  Thanks & Regards,', NULL, NULL, '2021-10-15 08:30:01', '2021-10-15 08:30:01'),
(49244, 10057, 31773, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email Received From : ywyatt@humana.com  Sub : Enrollment Status Query - CUCC - Tricare  Hello Steve,  The updates emailed to HGB Roster team can take up to 60 days to process. There is not changed in the status from the email I sent on Tuesday.  Thanks,  Yvonne W. Wyatt, Humana Military TRICARE Community Liaison II Houston/Galveston 502-318-5409 Telephone 502-322-8018 Fax ywyatt@humana.com', NULL, NULL, '2021-11-11 17:33:25', '2021-11-11 17:33:25'),
(49245, 10057, 31773, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : ywyatt@humana.com  Sub : Enrollment Status Query - CUCC - Tricare  Good morning,  Hope this email finds you well. Could you please let me know the latest update on the below mentioned request.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-02 09:53:21', '2021-12-02 09:53:21'),
(49246, 10057, 31773, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email Sent To : ywyatt@humana.com  Sub : Enrollment Status Query - CUCC - Tricare  Greetings!  Any update on the below request?  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-15 13:22:59', '2021-12-15 13:22:59');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(49247, 10057, 31773, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email Received From : ywyatt@humana.com  Sub : Enrollment Status Query - CUCC - Tricare  Good Morning Steve,  We show Jeny John 1073019493 has not been added to this tax id. There are two ways to add  a Provider and it is via the secured Provider Portal are you can send a spreadsheet to the HGB Roster team to add a Provider. I have attached a copy of the instruction on how to add a provider via the Secured Provider Portal.  Molly Joseph 1396380077 is added to the Columbus Texas location. You can check status by creating a log in on the Provider Portal.  The link is highlighted below.  In order to serve our providers more efficiently, we have begun using Humana Military’s Provider Self-Service Portal.  The secure messaging feature through Provider Self Service increases the timeliness of responses to your questions.  If you are not currently registered on the Provider Self-Service Portal, please visit:  Provider Self-Service (humana-military.com)  To verify provider status, please utilize the NPI search tool in the Provider Self-Service Portal.  If the provider does not populate in this tool, then the provider is not TRICARE certified.  Thanks,  Yvonne W. Wyatt, TRICARE Community Liaison II Humana Military', NULL, NULL, '2021-12-21 13:27:53', '2021-12-21 13:27:53'),
(49248, 10057, 31773, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Sent To : ywyatt@humana.com  Sub : Enrollment Status Query - CUCC - Tricare  Thank you for sharing this information and update with me.  Kind Regards,', NULL, NULL, '2021-12-29 16:24:53', '2021-12-29 16:24:53'),
(49249, 19067, 31773, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Query || CUCC || Jeny John & Molly Joseph || Tricare ||  Hello!  Hope you are having a productive day.  I would like to know the enrollment status of the following Providers with Tricare.  Group Name	Columbus Urgent Care PA Tax ID	47-1914151 Group NPI	1215330501 Provider Name	NPI	Location Jeny John	1073019493	926 Walnut St, Columbus, TX 78934-2215 Molly Joseph	1396380077	926 Walnut St, Columbus, TX 78934-2215   Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 13:11:37', '2022-01-04 13:11:37'),
(49250, 19067, 31773, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email received from: ywyatt@humana.com  Subject: Enrollment Query || CUCC || Jeny John & Molly Joseph || Tricare ||     Good Morning Hammad,     We show these providers has been added to this group tax id. You can check status on a provider by creating a log in on the Provider Portal or check the network Directory.     HumanaMilitary - Find care (goperspecta.com)', NULL, NULL, '2022-01-10 10:08:27', '2022-01-10 10:08:27'),
(49251, 20067, 31773, NULL, '2022-01-28 00:00:00.000', 'Approved', 'Called Tricare and spoke to Ashley  ID: 471914151-78934-A021 EFFECTIVE DATE: 12/29/2021 Expiration date 06/30/2022 Ref#14977246 ', NULL, NULL, '2022-01-21 13:01:08', '2022-01-21 13:01:08'),
(49252, 1006, 31774, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:30:22', '2021-07-01 10:30:22'),
(49253, 11056, 31774, NULL, '2021-07-10 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more details please see group task.', NULL, NULL, '2021-07-02 15:02:48', '2021-07-02 15:02:48'),
(49254, 3040, 31774, NULL, '2021-07-27 00:00:00.000', 'In Process', 'I spoke with Wellcare representative and he advised me that processing time will take time. After reviewing the application the provider rep will contact you.  ', NULL, NULL, '2021-07-20 09:44:32', '2021-07-20 09:44:32'),
(49255, 11056, 31774, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Wellcare in our group under the below locations.  Practice Details: Practice Name : Columbus Urgent Care PA Practice Tax ID # : 47-1914151 Practice NPI # : 1215330501 Practice Address : 926 Walnut St, Columbus, TX 78934-2215  Provider Details: Provider 1: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 2: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6: Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 7: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 9: Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 10: Provider Name: John, Jeny Provider NPI# 1073019493  Provider 11: Provider Name: Kourouma ,Odette 1134525868  Provider 12: Provider Name : Piccione JR, James 1356321509  Provider 13: Provider Name : Fernandus, Limy 1972005189  Provider 14: Provider Name : Thomas, Cini 1134777238  Provider 15: Provider Name : George, Jeemol 1497219067  Provider 16: Provider Name : Jose, Julie 1447883061  Provider 17: Provider Name : Rauf, Abdur 1497726202  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-05 13:40:07', '2021-08-05 13:40:07'),
(49256, 3040, 31774, NULL, '2021-09-10 00:00:00.000', 'In Process', 'I had a word with Jessie Wellcare representative and she advise that one of your provider is already participating with Wellcare. For group you need a submit a separate request. And we already send the request for ancillary contract. Please see attachment. ', NULL, NULL, '2021-09-03 14:38:30', '2021-09-03 14:38:30'),
(49257, 10057, 31774, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Afternoon,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Wellcare in our group under the below location. We have already forwarded an ancillary contract earlier.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Looking forward to hearing from you. Have a great day.  Thanks & Regards,', NULL, NULL, '2021-10-18 11:41:11', '2021-10-18 11:41:11'),
(49258, 10057, 31774, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Enrollment Status Query - CUCC - Wellcare  Hello,  We currently have two providers PAR for this group effective 5/1/2021.  Please submit a Roster with all of the necessary information filled in for the remaining providers that you need added or you can submit your requests via our website below.  https://www.wellcare.com/en/Texas/Become-a-Provider  Join Our Network | Wellcare www.wellcare.com', NULL, NULL, '2021-11-23 17:37:45', '2021-11-23 17:37:45'),
(49259, 10057, 31774, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Request Submitted  Please see attachments:', NULL, NULL, '2021-12-06 10:37:13', '2021-12-06 10:37:13'),
(49260, 10057, 31774, NULL, '2021-12-20 00:00:00.000', 'In Process', ' Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Afternoon,  Hope this email finds you in good health. Could you please provide me with the welcome packets for Abdur Rauf & James Piccione.  Furthermore, the request for other remaining providers has been submitted. Kindly revert back to me once you get any update.  Thanks & Regards,', NULL, NULL, '2021-12-13 13:03:48', '2021-12-13 13:03:48'),
(49261, 10057, 31774, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Greetings!  Any update on my below request. This is my SECOND REMINDER. Please get back to me ASAP!  Thanks & Regards,', NULL, NULL, '2021-12-20 13:29:16', '2021-12-20 13:29:16'),
(49262, 10057, 31774, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com & Cynthia.Barnett@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Afternoon,  This is my THIRD REMINDER on the below mentioned request and I have still not yet got any update.  Kindly get back to me as soon as possible.  Regards,', NULL, NULL, '2021-12-27 12:46:49', '2021-12-27 12:46:49'),
(49263, 10057, 31774, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Moring,  Here is a list of providers who are par. The rest are still in process.  Please see attachment.  Sincerely,  Network Management', NULL, NULL, '2021-12-30 14:07:21', '2021-12-30 14:07:21'),
(49264, 19067, 31774, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email received from: ProspectiveProviderTX@wellcare.com  Subject: Enrollment Status Query - CUCC - Wellcare    Good morning,   The providers are now par. Please see roster.    PROVIDER_ID	FIRST_NAME	LAST_NAME	EFFECTIVE_DATE	NPI	IRS_TAX_ID 2819571	GLORY	ABRAHAM	12/01/2021	1194206490	471914151 2819342	JEENA	ABRAHAM	12/01/2021	1467901587	471914151 2819600	BRITTANY	BROWN	12/01/2021	1275163537	471914151 2799031	MINI	CHENNEMKARA	06/25/2021	1841755956	471914151 2799319	LIMY	FERNANDUS	02/25/2021	1972005189	471914151 2798161	JEEMOL	GEORGE	12/08/2021	1497219067	471914151 2798172	JAYA	JACOB	12/08/2021	1194336149	471914151 2799505	JULIE	JOSE	09/30/2020	1447883061	471914151 2796048	MOLLY	JOSEPH	11/21/2021	1396380077	471914151 2799274	VIBITHA	JOSEPH	06/24/2020	1952931560	471914151 2798134	ODETTE	KOUROUMA	12/08/2021	1134525868	471914151 2799018	SIGI	PAUL	08/08/2021	1033623616	471914151 2494093	JAMES	PICCIONE	05/03/2021	1356321509	471914151 2499814	ABDUR	RAUF	05/03/2021	1497726202	471914151 2800692	ANI	STEPHEN	12/08/2021	1588959118	471914151 2799016	CINI	THOMAS	07/09/2021	1134777238	471914151   Sincerely,', NULL, NULL, '2022-01-10 09:40:16', '2022-01-10 09:40:16'),
(49265, 20067, 31774, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com, Cynthia.Barnett@wellcare.com  Sub: Re: Enrollment Status Query - CUCC - Wellcare  Good Morning! Hope all is well with you. Could you please facilitate us with the welcome kit of these providers.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-19 12:27:19', '2022-01-19 12:27:19'),
(49266, 20067, 31774, NULL, '2022-02-03 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Sub: Re: Enrollment Status Query - CUCC - Wellcare  Good Afternoon!  Hope you are doing well. I would like to know the enrollment status of the below mentioned provider.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus, TX 78934-2215 NPI	Provider 1073019493	Jeny John  Thanks & Regards,  Syed Ahad', NULL, NULL, '2022-01-27 14:34:58', '2022-01-27 14:34:58'),
(49267, 20067, 31774, NULL, '2022-02-09 00:00:00.000', 'Approved', 'Email received from: ProspectiveProviderTX@wellcare.com  Sub: Re: Enrollment Status Query - CUCC - Wellcare   Please see welcome letter for requested provider. Sincerely,', NULL, NULL, '2022-02-02 14:24:51', '2022-02-02 14:24:51'),
(49268, 1006, 31775, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:30:22', '2021-07-01 10:30:22'),
(49269, 11056, 31775, NULL, '2021-07-09 00:00:00.000', 'On Hold', 'Awaiting Medicare\'s approval.', NULL, NULL, '2021-07-02 10:48:00', '2021-07-02 10:48:00'),
(49270, 3040, 31775, NULL, '2021-07-27 00:00:00.000', 'In Process', 'PROVIDER NAME	JENY K JOHN NP PROVIDER PTAN	Q00101824 PROVIDER NPI	1073019493 EFFECTIVE DATE	06/01/2021  Reference Number :	21201000356 ', NULL, NULL, '2021-07-20 09:29:03', '2021-07-20 09:29:03'),
(49271, 3040, 31775, NULL, '2021-08-03 00:00:00.000', 'Approved', 'Provider is participating with Medicare Railroad. Please see attachment.', NULL, NULL, '2021-07-27 11:14:48', '2021-07-27 11:14:48'),
(49272, 1006, 31776, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:30:22', '2021-07-01 10:30:22'),
(49273, 1006, 31776, NULL, '2021-07-08 00:00:00.000', 'Initiated', 'Applicant Name: JENY JOHN  Tracking ID: T070120210004902  Submitted Date: THU - JULY 01 2021 05:50:12 PM EST  Submitted By: Jeny John  Contact Email(s): JENYLAIJU@YAHOO.COM NUCC@CLAIMSMEDINC.COM PHOENIXDATA@MSN.COM Reason(s) for submission: A Medicare Part B practitioner is currently enrolled in Medicare and is reassigning his/her benefits to a Part B supplier, Part B practitioner or Part A provider currently enrolled in Medicare. ', NULL, NULL, '2021-07-01 16:51:12', '2021-07-01 16:51:12'),
(49274, 3040, 31776, NULL, '2021-07-16 00:00:00.000', 'Approved', 'Medicare Enrollment Information Individual Name: Jeny John NP Individual Specialty: NURSE PRACTITIONER Individual National Provider Identifier (NPI): 1073019493 Individual Provider Transaction Access Number (PTAN): 1R3191 Group Legal Business Name (LBN): COLUMBUS URGENT CARE PA Group NPI: 1215330501 Group PTAN: 399951 Reassignment Effective Date: June 01, 2021 Changed Information: N/A', NULL, NULL, '2021-07-09 08:37:54', '2021-07-09 08:37:54'),
(49275, 1006, 31777, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:30:22', '2021-07-01 10:30:22'),
(49276, 11056, 31777, NULL, '2021-07-09 00:00:00.000', 'Initiated', 'Email sent to : cguerue@ghn-mci.com  Sub: ENROLLMENT FORM - GALAXY HEALTH - CUCC  Greetings,  Hope you are doing well. Enrollment form is attached for the provider. Please see the attachments.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# : 47-1914151 Practice NPI# : 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider  Provider Name: John, Jeny Provider NPI# : 1073019493  Feel free to reach out for any further information.  Thank you!', NULL, NULL, '2021-07-02 13:34:56', '2021-07-02 13:34:56'),
(49277, 3040, 31777, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: cguerue@ghn-mci.com  Subject: RE: ENROLLMENT FORM - GALAXY HEALTH - CUCC  Good Morning,  The application for Jeny John has been processed, a copy of malpractice insurance will be needed, once this is received her application will be complete.     Please feel free to contact me with any questions…  Thank you!     Christine Guerue  Credentialing Dept  cguerue@ghn-mci.com  800-975-3322 x1130  817-633-5729 fax  Galaxy Health Network  2261 Brookhollow Plaza Dr, Ste 106  Arlington, TX 76006  PO Box 201425  Arlington, TX 76006-1425', NULL, NULL, '2021-07-22 09:03:54', '2021-07-22 09:03:54'),
(49278, 11056, 31777, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email sent to : cguerue@ghn-mci.com  Sub : ENROLLMENT FORM - GALAXY HEALTH - CUCC   Hey Christine!  Hope you are doing well. Here is the Malpractice for the below mentioned provider. Please see the attachment.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# : 47-1914151 Practice NPI# : 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider: Provider Name: John, Jeny Provider NPI# : 1073019493  Feel free to reach out for any further information or documents. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-04 16:35:35', '2021-08-04 16:35:35'),
(49279, 10057, 31777, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Email sent to : cguerue@ghn-mci.com  Sub : ENROLLMENT FORM - GALAXY HEALTH - CUCC   I\'m writing this email to check the updated status about my request, also Malpractice has been submitted earlier.  Group Name	Columbus Urgent Care PA Tax ID	47-1914151 Group NPI	1215330501 Primary Location	926 Walnut St, Columbus , TX 78934-2215 Provider Name	NPI John, Jeny	1073019493  Please feel free to reach out for any further information.  Thanks & Regards.', NULL, NULL, '2021-10-06 12:28:55', '2021-10-06 12:28:55'),
(49280, 10057, 31777, NULL, '2021-10-14 00:00:00.000', 'Approved', 'Email Received From : cguerue@ghn-mci.com  Sub : ENROLLMENT FORM - GALAXY HEALTH - CUCC  Good Afternoon,  Jeny John is effective 8/4/21, I have attached the notice I sent back in August in case you would like a copy for your files.   Please feel free to contact me with any questions…  Thank you and have a good afternoon!!!  Christine Guerue Credentialing Dept cguerue@ghn-mci.com 800-975-3322 x1130 817-633-5729 fax   Please check the below attachment for approval.', NULL, NULL, '2021-10-07 09:50:33', '2021-10-07 09:50:33'),
(49281, 1006, 31778, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:30:22', '2021-07-01 10:30:22'),
(49282, 11056, 31778, NULL, '2021-07-09 00:00:00.000', 'Approved', 'From: Richard.Hinkley@bswhealth.org  Good afternoon Martin,  As previously stated the individual providers are no longer credentialed only the facility. The Facility Credentialing has been completed and I submitted SR and SAM tickets to have them setup with configuration before I went on vacation. I believe you got a few different automatic replies from me so sorry for the delay. Those tickets are still in process but I will submit a copy of the contract which goes into effect today in just a few moments.  Thank you, Rick Hinkley Provider Relations Representative Provider Network Management', NULL, NULL, '2021-07-02 10:23:25', '2021-07-02 10:23:25'),
(49283, 1006, 31779, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:30:22', '2021-07-01 10:30:22'),
(49284, 11056, 31779, NULL, '2021-07-09 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s approval.', NULL, NULL, '2021-07-02 09:20:44', '2021-07-02 09:20:44'),
(49285, 20067, 31779, NULL, '2022-02-09 00:00:00.000', 'In Process', 'Email sent to: AM.Austin@superiorhealthplan.com  Sub: Re: Enrollment Status || Columbus Urgent Care PA || Jeny John || Superior Health ||  Good Morning!  Hope this email finds you in good health. I would like to know the enrollment status of the below-mentioned provider.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus, TX 78934-2215 NPI	Provider 1073019493	Jeny John  Thanks & Regards, Syed Ahad', NULL, NULL, '2022-02-02 11:40:31', '2022-02-02 11:40:31'),
(49286, 20067, 31779, NULL, '2022-02-24 00:00:00.000', 'In Process', 'Application to add a provider into an existing group has been submitted online Kindly see the attachment', NULL, NULL, '2022-02-17 14:00:00', '2022-02-17 14:00:00'),
(49287, 20067, 31779, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email sent to: AM.Austin@superiorhealthplan.com  Sub: Enrollment Status || Columbus Urgent Care PA || Jeny John || Superior Health ||  Good Morning!  Hope you are doing well. I\'ve submitted the application to add a provider into an existing group. I would like to know the status of the application.  Provider Name: Jeny John NPI: 1073019493  Thank you', NULL, NULL, '2022-03-01 10:02:55', '2022-03-01 10:02:55'),
(49288, 20067, 31779, NULL, '2022-03-16 00:00:00.000', 'In Process', 'Email received from: AM.Austin@superiorhealthplan.com  Sub: Re: Enrollment Status || Columbus Urgent Care PA || Jeny John || Superior Health ||  Good afternoon,     Provider is in credentialing process at this time. No effective date available at this time.     Thank you,  ', NULL, NULL, '2022-03-09 15:11:11', '2022-03-09 15:11:11'),
(49289, 20067, 31779, NULL, '2022-03-28 00:00:00.000', 'In Process', 'Email sent to: AM.Austin@superiorhealthplan.com  Sub: Re: Enrollment Status || Columbus Urgent Care PA || Jeny John || Superior Health ||  Good Afternoon!  Hope you had a great weekend. What\'s the current status of the provider Jeny John. Also please confirm that this provider is in process with both Superior Health plan and Ambetter.?  Thank you, Syed ', NULL, NULL, '2022-03-21 12:30:25', '2022-03-21 12:30:25'),
(49290, 1006, 31780, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:30:22', '2021-07-01 10:30:22'),
(49291, 11056, 31780, NULL, '2021-07-10 00:00:00.000', 'Initiated', 'Email sent to :  trpndataentry@trpnppo.com  Sub : Provider Enrollment Form - CUCC - TRPN  Greetings,  Hope you are doing well. Enrollment form is attached for the provider. Please see the attachments.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# : 47-1914151 Practice NPI# : 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider: Provider Name: John, Jeny Provider NPI : 1073019493  Feel free to reach out for any further information.  Thank you!', NULL, NULL, '2021-07-02 16:49:36', '2021-07-02 16:49:36'),
(49292, 3040, 31780, NULL, '2021-07-29 00:00:00.000', 'Approved', 'Email rcvd from: ccampos@trpnppo.com  Subject: RE: Enroll Providers || Columbus Urgent Care PA || Providers || TRPN||  Hi,  This provider is Active, effective date 05/25/2021,  Carlos Campos  Data Entry Department Supervisor Three Rivers Provider Network 6970 O’Bannon Drive Las Vegas, NV 89117 P: 619.869.8940 F: 619.271.2563 ccampos@trpnppo.com trpndataentry@trpnppo.com www.trpnppo.com ', NULL, NULL, '2021-07-22 16:09:38', '2021-07-22 16:09:38'),
(49293, 1006, 31781, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:30:23', '2021-07-01 10:30:23'),
(49294, 11056, 31781, NULL, '2021-07-09 00:00:00.000', 'Not Eligible', 'Email rcvd from: Karla.Claunch@dchstx.org  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || Driscoll ||  Good afternoon Adil,  I have attached a map of our service area for your convenience.  We don’t have any members in the Columbus area.  If you have any plans on providing services within our area, we will be glad to work with you but, this practice is not within our service area.  If you need any further assistance on credentialing or contracting questions, please let me know.  I have attached our Request for Contract for your convenience.  Please use this form when requesting to add providers or contracts by emailing to dhpcpntracting@dchsytx.org  Thank you  Karla Claunch', NULL, NULL, '2021-07-02 09:51:50', '2021-07-02 09:51:50'),
(49295, 1006, 31782, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:30:23', '2021-07-01 10:30:23'),
(49296, 11056, 31782, NULL, '2021-07-10 00:00:00.000', 'Initiated', 'I had a word with (VICKI) in Christus Spohn provider relation department and she advised the insurance will not provider the services in Colorado county. I requested her to send me an email so I can update in my system. Once we received the email will update accordingly.   ', NULL, NULL, '2021-07-02 15:38:26', '2021-07-02 15:38:26'),
(49297, 3040, 31782, NULL, '2021-07-20 00:00:00.000', 'Not Eligible', 'County not covered by insurance. ', NULL, NULL, '2021-07-13 13:14:54', '2021-07-13 13:14:54'),
(49298, 1006, 31783, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:30:23', '2021-07-01 10:30:23'),
(49299, 11056, 31783, NULL, '2021-07-10 00:00:00.000', 'On Hold', 'Ancillary enrollment request is submitted, check group task for reference. ', NULL, NULL, '2021-07-02 15:40:22', '2021-07-02 15:40:22'),
(49300, 3040, 31783, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: Enrollment Request - CUCC - Cigna Healthspring  Hello Jennifer,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Cigna Healthspring under the below location.   Practice Name: Columbus Urgent Care PA Practice Tax ID#  471914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus TX, 78934  Waiting for your response.   Thank you ', NULL, NULL, '2021-07-22 10:06:20', '2021-07-22 10:06:20'),
(49301, 11056, 31783, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email received from : JENNIFER.PEREZ@cigna.com  Sub : Re: Enrollment Request - CUCC - Cigna Healthspring  Thank you! I will provide this to our network committee to review at our next committee meeting. The meeting will take place at the end of the month, and I will be able to provide you an update closer to this time.        Jennifer Perez  Network Operations Senior Analyst | Cigna-Medicare  2800 North Loop West, Suite 400 | Houston, Texas 77092', NULL, NULL, '2021-08-04 15:24:16', '2021-08-04 15:24:16'),
(49302, 3040, 31783, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: [External] Re: Enrollment Request - CUCC - Cigna Healthspring  Hello Jennifer,   Hope you are doing well. I wanted to get an update regarding the enrollment request for the below mentioned facility. As per your previous email the network committee will review the request. We requested an ancillary contract for our facility.   Practice Name: Columbus Urgent Care PA Practice Tax ID#  471914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus TX, 78934  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-08-17 10:58:20', '2021-08-17 10:58:20'),
(49303, 3040, 31783, NULL, '2021-08-24 00:00:00.000', 'Not Eligible', 'Email rcvd from: JENNIFER.PEREZ@cigna.com  Subject: RE: [External] Re: Enrollment Request - CUCC - Cigna Healthspring  August 17, 2021 Attn: Brad Peterson RE: Network Interest Form Denial Dear Columbus Urgent Care PA : Thank you for your interest in participating with Cigna-HealthSpring® to provide service to our Medicare Advantage customers. The information you provided in your Network Interest Form was reviewed by the Network Interest Committee on 8/5/21. At this time, it has been determined there is not a need for additional providers in our network specific to your practice area and geographic location. However, we will keep your Network Interest Profile Form on file should our network needs change in the future.  We appreciate your interest in Cigna-HealthSpring.  Sincerely, South Texas Network Operations', NULL, NULL, '2021-08-17 13:14:17', '2021-08-17 13:14:17'),
(49304, 1006, 31784, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:30:23', '2021-07-01 10:30:23'),
(49305, 11056, 31784, NULL, '2021-07-09 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. ', NULL, NULL, '2021-07-02 09:34:08', '2021-07-02 09:34:08'),
(49306, 1006, 31785, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:30:23', '2021-07-01 10:30:23'),
(49307, 11056, 31785, NULL, '2021-07-10 00:00:00.000', 'On Hold', 'Group enrollment request sent. Waiting for the contract. ', NULL, NULL, '2021-07-02 15:43:02', '2021-07-02 15:43:02'),
(49308, 3040, 31785, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to; jmonson@triwest.com  Subject: Re: FW: Enroll Group & Providers || Columbus Urgent Care PA || TriWest ||  Hello Jess,   Hope you are doing well. Please advise me the enrollment status for the below mentioned group in Triwest in our group Columbus Urgent Care PA under the below location.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 10:27:05', '2021-07-20 10:27:05'),
(49309, 3040, 31785, NULL, '2021-08-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. For more details please see group task. ', NULL, NULL, '2021-07-26 12:02:24', '2021-07-26 12:02:24'),
(49310, 1006, 31786, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:30:23', '2021-07-01 10:30:23'),
(49311, 11056, 31786, NULL, '2021-07-10 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Columbus, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-07-02 15:44:26', '2021-07-02 15:44:26'),
(49312, 1006, 31787, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:30:23', '2021-07-01 10:30:23'),
(49313, 11056, 31787, NULL, '2021-07-14 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s enrollment.', NULL, NULL, '2021-07-06 16:55:32', '2021-07-06 16:55:32'),
(49314, 3040, 31787, NULL, '2021-07-27 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. Contract attached in group task.  ', NULL, NULL, '2021-07-20 10:29:49', '2021-07-20 10:29:49'),
(49315, 1006, 31788, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:30:23', '2021-07-01 10:30:23'),
(49316, 11056, 31788, NULL, '2021-07-10 00:00:00.000', 'On Hold', 'We sent the ancillary contract request for the group. For more details please see the group task. ', NULL, NULL, '2021-07-02 14:59:38', '2021-07-02 14:59:38'),
(49317, 3040, 31788, NULL, '2021-07-20 00:00:00.000', 'In Process', 'Email sent to: CHP.NetworkDevelopment@christushealth.org  Subject: Enroll Group & Providers || Columbus Urgent Care PA || CHRISTUS HEALTH PLAN ||  Hello,   Hope you are doing well. Please find attached the prospective provider form for the below mentioned providers to enroll in Christus Health plan in our group Columbus Urgent Care PA under the below locations.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name:  Joseph, Molly Provider NPI# 1396380077  Provider 16:   Provider Name:  John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-07-13 09:36:20', '2021-07-13 09:36:20'),
(49318, 11056, 31788, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email received from : hunter.barrett@christushealth.org  Sub : Enroll Group & Providers || Columbus Urgent Care PA || CHRISTUS HEALTH PLAN ||  Would the provider bill as an Urgent Care/Ancillary?     Thanks,     Hunter Barrett  Network Contracting  CHRISTUS Health Plan  CHRISTUS Health  919 Hidden Ridge | Irving, Texas 75038  (o) 469.282.3113  www.christushealth.org    Replied :   Hello Hunter,   No, we are doing a group contract under the facility.   Thank you.', NULL, NULL, '2021-08-04 14:29:02', '2021-08-04 14:29:02'),
(49319, 3040, 31788, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: hunter.barrett@christushealth.org  Subject: Re: Enroll Group & Providers || Columbus Urgent Care PA || CHRISTUS HEALTH PLAN ||  Hello Hunter,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Christus Health plan in our group under the below location.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  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 14:19:48', '2021-08-17 14:19:48'),
(49320, 12062, 31788, NULL, '2021-09-30 00:00:00.000', 'In Process', 'Sent a follow up mail as below;  To:hunter.barrett@christushealth.org Subject:RE: Enroll Group & Providers || Columbus Urgent Care PA || CHRISTUS HEALTH PLAN ||  Hi Barrett,  Hope You are doing well !  I want to inquire about about the subject case, please advise if there is any further proceedings.   ', NULL, NULL, '2021-09-22 14:46:23', '2021-09-22 14:46:23'),
(49321, 12062, 31788, NULL, '2021-10-01 00:00:00.000', 'In Process', 'Replied to an atatched email received ;  To:hunter.barrett@christushealth.org Subject :RE: Enroll Group & Providers || Columbus Urgent Care PA || CHRISTUS HEALTH PLAN ||  Dear Barrett,  Thanks for you acknowledgement.   Can you check and advise any estimated time from now to which the provider must get enrolled? ', NULL, NULL, '2021-09-24 09:06:39', '2021-09-24 09:06:39'),
(49322, 10057, 31788, NULL, '2021-11-05 00:00:00.000', 'In Process', 'Email Sent To : hunter.barrett@christushealth.org, CHP.NetworkDevelopment@christushealth.org  Sub : Enroll Group & Providers || Columbus Urgent Care PA || CHRISTUS HEALTH PLAN ||  Good Morning,  Hope you are doing well. Please let me know the updated status for below mentioned providers under the location TIN.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Looking forward to hearing from you. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-29 08:46:43', '2021-10-29 08:46:43'),
(49323, 10057, 31788, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Received From : hunter.barrett@christushealth.org  Sub : Enroll Group & Providers || Columbus Urgent Care PA || CHRISTUS HEALTH PLAN ||  Please reach out to our credentialing team directly for updates. I sent them the contract 3 months ago and they typically take 6 months to get the new application. Please allow them that 6 months.  CHRISTUS.HP.Credentialing CHRISTUS.HP.Credentialing@christushealth.org  Thanks,  Hunter Barrett Network Contracting CHRISTUS Health Plan CHRISTUS Health', NULL, NULL, '2021-11-02 09:07:52', '2021-11-02 09:07:52'),
(49324, 10057, 31788, NULL, '2021-11-22 00:00:00.000', 'In Process', 'Email Sent To : michal.simms@christushealth.org  Sub : Enrollment Query - CUCC  Hello Michal,  Hope you are doing good!  Can you please help me out with the query of our providers, we have sent their applications back in April, but still didn\'t have any update. I have attached our group roster, please get back to me at your earliest convenience.  Regards, Alex', NULL, NULL, '2021-11-15 14:52:16', '2021-11-15 14:52:16'),
(49325, 10057, 31788, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Received From : michal.simms@christushealth.org  Sub : Enrollment Query - CUCC  Hello Alex,  Our department email address is CHP.NetworkDevelopment@CHRISTUSHealth.org.  Please send your requests to that mailbox so that the requests are sent to the correct person handling a territory.  I do not see Columbus Urgent Care PA in our system.  Has the request been submitted to the department mailbox?  I do not handle Columbus, Texas region.  Thanks, Michal  CLAIMS MED PERSONNEL:  PLEASE DIRECT YOUR CONTRACTING INQUIRES TO CHP.NetworkDevelopment@CHRISTUSHealth.org', NULL, NULL, '2021-11-30 11:32:06', '2021-11-30 11:32:06'),
(49326, 10057, 31788, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Email Sent To : hunter.barrett@christushealth.org & CHRISTUS.HP.Credentialing@christushealth.org  Sub : Enroll Group & Providers || Columbus Urgent Care PA || CHRISTUS HEALTH PLAN ||  Thank you for your response. Have a great day.  Regards,', NULL, NULL, '2021-12-06 17:08:59', '2021-12-06 17:08:59'),
(49327, 10057, 31788, NULL, '2021-12-20 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : Enroll Group & Providers || Columbus Urgent Care PA || CHRISTUS HEALTH PLAN ||  Good afternoon,  Hope this email finds you in good health. I\'m writing this email to check the latest update on the below mentioned providers and group enrollment status under the TIN.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-13 12:21:25', '2021-12-13 12:21:25'),
(49328, 10057, 31788, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org & hunter.barrett@christushealth.org  Sub : Enroll Group & Providers || Columbus Urgent Care PA || CHRISTUS HEALTH PLAN ||  Greetings for the day!  Any update on the below request. It is my SECOND REMINDER, please reach out to me ASAP...  Kind Regards,', NULL, NULL, '2021-12-20 09:54:42', '2021-12-20 09:54:42'),
(49329, 10057, 31788, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : Enroll Group & Providers || Columbus Urgent Care PA || CHRISTUS HEALTH PLAN ||  Good Morning,  Hope this email finds you well. This is THIRD REMINDER on the below request.  your earliest response will be highly appreciated!  Regards,', NULL, NULL, '2021-12-28 11:47:07', '2021-12-28 11:47:07'),
(49330, 19067, 31788, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: CHRISTUS.HP.Credentialing@christushealth.org  Subject: Enrollment Query  || Columbus Urgent Care PA || Providers & Group || CHRISTUS HEALTH PLAN ||  Hello!  Hope you are doing well.  I would like to know the enrollment status of the following Providers and Group with Christus Health Plan.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus, TX 78934-2215 Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509   Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 13:45:19', '2022-01-04 13:45:19'),
(49331, 20067, 31788, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: christus.hp.credentialing@christushealth.org, CHP.NetworkDevelopment@christushealth.org   Sub: Re: Enrollment Query || Columbus Urgent Care PA || Providers & Group || CHRISTUS HEALTH PLAN ||   Good Morning! Hope this email finds you well. We are continuously emailing you guys but haven\'t received any response from your side. Kindly respond to the previous request as soon as possible.  Thanks & Regards, Syed Ahad.', NULL, NULL, '2022-01-19 13:37:23', '2022-01-19 13:37:23'),
(49332, 20067, 31788, NULL, '2022-01-28 00:00:00.000', 'Approved', 'Received the following email from: Sonia.Gonzales@christushealth.org  Hello,  Perfect contract is effective as of 01/01/2022,  all claims should be billed on a CMS  with group information in box 31 instead of rendering provider.  Thanks and have a wonderful day!   Respectfully,  This is an Ancillary group contract.', NULL, NULL, '2022-01-21 14:10:02', '2022-01-21 14:10:02'),
(49333, 1006, 31789, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:35:15', '2021-07-01 10:35:15'),
(49334, 11056, 31789, NULL, '2021-07-13 00:00:00.000', 'Initiated', 'Email sent to :  credentialing@primehealthservices.com  Sub : ENROLLMENT REQUEST - LPMC - Prime Health Services  Greetings,  I wanted to  enroll the below provider in the group mentioned below:  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Provider Name :  John, Jeny Provider NPI# : 1073019493  Kindly respond to me soon. If you need any information feel free to contact me.  Thank you!', NULL, NULL, '2021-07-05 15:43:09', '2021-07-05 15:43:09'),
(49335, 11056, 31789, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email received from : credentialing@primehealthservices.com  Sub : ENROLLMENT REQUEST - LPMC - Prime Health Services  Dear Ahmed Talha, We\'ve got your ticket! This is a generic response from the Prime Health Services Credentialing ticket system.  We have received your ticket and it has been placed into our queue. Your request has been created with id 161261. The title of the request is : ENROLLMENT REQUEST - LPMC - Prime Health Services. Thank you for your patience as we look into your issue. -Prime Health Services Credentialing Team', NULL, NULL, '2021-07-06 12:56:13', '2021-07-06 12:56:13'),
(49336, 3040, 31789, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email rcvd from: credentialing@primehealthservices.com  Subject: Re: Re: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Prime Health ||  Hi,  We cannot access CAQH applications.  This is why we are asking for them to be emailed to us.  Thank you, Nancy', NULL, NULL, '2021-07-22 11:09:12', '2021-07-22 11:09:12'),
(49337, 3040, 31789, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: credentialing@primehealthservices.com  Subject: Re: Re: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Prime Health ||  Hello Nancy,   Hope you are doing well. Please find attached the CAQH application as per your previous email requested.   If you need any additional information please feel free to call or email me. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-22 11:10:09', '2021-07-22 11:10:09'),
(49338, 10057, 31789, NULL, '2021-10-08 00:00:00.000', 'In Process', 'Email sent to: megan.wherry@primehealthservices.com  Subject: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Prime Health ||  Hello Megan,   Hope you are doing well. Can you please send the roster because I am trying to find out the providers on the Prime Health Services directory and it\'s not showing up.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-10-01 14:59:42', '2021-10-01 14:59:42'),
(49339, 10057, 31789, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email Sent To : credentialing@primehealthservices.com>, megan.wherry@primehealthservices.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || Prime Health ||  Good Afternoon,  Hope this email finds you well. I\'m writing this email to check the enrollment status with Prime Health for our providers under the below mentioned practice.  Group Name Longpoint Medical Center Tax ID	76-0612416 Group NPI 1770763815 Primary Location 9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI George, Jeemol 1497219067 Jose, Julie1447883061 Stephen, Ani 1588959118 Piccione JR, James M 1356321509 Brown, Brittany	1275163537 Chennemkara, Mini Philip 1841755956 Abraham, Glory 1194206490 Fernandus, Limy	1972005189 Kourouma , Odette Tiranke1134525868 Joseph, Vibitha	1952931560 Thomas, Cini 1134777238 Abraham, Jeena 1467901587 PAUL, SIGI 1033623616 Jacob, Jaya 1194336149 John, Jeny 1073019493 Joseph, Molly1396380077  Please let me know the updated status. Furthermore, if you have any questions, please feel free to contact me.  Thanks & Regards,', NULL, NULL, '2021-10-19 14:25:24', '2021-10-19 14:25:24'),
(49340, 10057, 31789, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : credentialing@primehealthservices.com, megan.wherry@primehealthservices.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || Prime Health ||  Hello,  Greetings for the day!  Any update on the below mentioned enrollment request?  Please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-22 10:54:10', '2021-11-22 10:54:10'),
(49341, 10057, 31789, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : providerrelations@primehealthservices.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || Prime Health ||  Follow-up Sent.', NULL, NULL, '2021-12-02 14:09:40', '2021-12-02 14:09:40'),
(49342, 10057, 31789, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Received From : credentialing@primehealthservices.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || Prime Health ||  Good Afternoon,  Please see the attached Credentialing status roster.  The dates given are for Credentialing purposes only and not the effective date.  Please refer inquiries regarding the effective dates, Tax ID links and locations to: updates@primehealthservices.com  Thank you, Nancy', NULL, NULL, '2021-12-15 11:16:56', '2021-12-15 11:16:56'),
(49343, 10057, 31789, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : credentialing@primehealthservices.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || Prime Health ||  Hello Nancy,  Thank you for the update. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-22 12:10:49', '2021-12-22 12:10:49'),
(49344, 10057, 31789, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Received From : updates@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Hello, all of these providers are in our system with both locations added, thanks!  Alyssa DeNure Data Integrity Associate', NULL, NULL, '2021-12-29 15:18:57', '2021-12-29 15:18:57'),
(49345, 20067, 31789, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: credentialing@primehealthservices.com  Sub:  Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |   Good afternoon, Hope all is well with you. i would like to know the enrollment status of the below-mentioned providers.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Jeny John	1073019493 Abdur Rauf	1497726202 Brittany Brown	1275163537 Vibitha Joseph	1952931560   Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-12 15:41:47', '2022-01-12 15:41:47'),
(49346, 20067, 31789, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Email received from: credentialing@primehealthservices.com  Sub: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Good Morning,  Providers Julie Josie and Jeny John have been credentialed as of 11-23-2021.  This date is for credentialing purposes only and not the effective date.  The Updates Department will respond regarding the effective date, Tax ID link and locations. ', NULL, NULL, '2022-01-20 12:06:11', '2022-01-20 12:06:11'),
(49347, 20067, 31789, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Email sent to: updates@primehealthservices.com, credentialing@primehealthservices.com  Sub: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Good Morning! Hope this email finds you well. Can you please provide me with the effective date and welcome kit for the below-mentioned provider?  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Jeny John	1073019493  Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-20 12:11:27', '2022-01-20 12:11:27'),
(49348, 20067, 31789, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Emails sent to: updates@primehealthservices.com, credentialing@primehealthservices.com  Sub: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Good Afternoon!  Eagerly waiting to hear from you, Thanks & Regards, Syed Ahad.', NULL, NULL, '2022-01-28 17:09:56', '2022-01-28 17:09:56');
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
(49349, 20067, 31789, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: updates@primehealthservices.com  Sub: Enrollment Status || Jeny John || Longpoint Medical Center || Prime Health  Good Afternoon!  I want the welcome kit and effective date of the below-mentioned providers.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Jeny John	1073019493  Thank you,', NULL, NULL, '2022-02-21 15:19:35', '2022-02-21 15:19:35'),
(49350, 20067, 31789, NULL, '2022-03-01 00:00:00.000', 'In Process', 'Email received from: clientservices@primehealthservices.com  Sub: Longpoint Medical Center - Prime Health Services Contract  Good Morning,     I would be happy to assist with your request below but it appears we are going to need some additional information.  Can you please clarify exactly what you are looking for?  We only provide welcome packets when the initial group contract is signed, in this case back in July 2018, and we do not provide per individual provider.  In addition, I am not seeing Jeny John to be a part of the current roster we have on file.  Are you wanting that provider to be added?     Thank you,', NULL, NULL, '2022-02-22 09:23:31', '2022-02-22 09:23:31'),
(49351, 20067, 31789, NULL, '2022-03-01 00:00:00.000', 'In Process', 'Email sent to: clientservices@primehealthservices.com  Sub: Longpoint Medical Center - Prime Health Services Contract  Good Morning!  Yes, I would like to add Jeny John ( 1073019493 ) under TIN# 760612416.  Let me know if anything is required from my end.  Thank you. ', NULL, NULL, '2022-02-22 09:25:04', '2022-02-22 09:25:04'),
(49352, 20067, 31789, NULL, '2022-03-03 00:00:00.000', 'Approved', 'Email received from: providerrelations@primehealthservices.com  Sub: Re: Longpoint Medical Center - Prime Health Services Contract  Good morning Syed,  This provider has been added and the provider ID is 12991794.  Please let me know if there is anything else I may assist with.  Best, Provider Relations   Effective Date: 06/01/2021', NULL, NULL, '2022-02-24 10:09:51', '2022-02-24 10:09:51'),
(49353, 1006, 31790, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:35:24', '2021-07-01 10:35:24'),
(49354, 11056, 31790, NULL, '2021-07-13 00:00:00.000', 'Initiated', 'Email sent to : credentialing@primehealthservices.com  Sub : ENROLLMENT REQUEST - NUCC - IVUC - Prime Health Services  Greetings,  I wanted to enroll the below provider in the groups mentioned below:  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Provider Name :  John, Jeny Provider NPI# : 1073019493  Kindly respond to me soon. If you need any information feel free to contact me. Thank you! ', NULL, NULL, '2021-07-05 15:40:56', '2021-07-05 15:40:56'),
(49355, 11056, 31790, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email received from : credentialing@primehealthservices.com  Sub : ENROLLMENT REQUEST - NUCC - IVUC - Prime Health Services  Dear Ahmed Talha, We\'ve got your ticket! This is a generic response from the Prime Health Services Credentialing ticket system.  We have received your ticket and it has been placed into our queue. Your request has been created with id 161260. The title of the request is : ENROLLMENT REQUEST - NUCC - IVUC - Prime Health Services. Thank you for your patience as we look into your issue. -Prime Health Services Credentialing Team', NULL, NULL, '2021-07-06 12:59:40', '2021-07-06 12:59:40'),
(49356, 3040, 31790, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: credentialing@primehealthservices.com  Subject: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||  Hello,   Hope you are doing well. I was trying to reach out to know the enrollment status for the below mentioned group and providers in Prime Health for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks', NULL, NULL, '2021-07-22 11:56:08', '2021-07-22 11:56:08'),
(49357, 11056, 31790, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email received from : credentialing@primehealthservices.com  Sub : Fwd: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||  Good Morning,  Please see below for the credentialing status for each provider.  The dates given are for credentialing purposes only and not the effective date.  Thank you for including the Updates Department in your email.  They will assist you with the effective dates.  There are two providers (highlighted) that need to be credentialed.  Please email a current CAQH Credentialing application or State Credentialing application for these providers.  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  - In the process of being credentialed.  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061 - Needs to be credentialed.     Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 - In the process of being credentialed.   Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 - Last credentialed - 6-23-2020 - Not the effective date - For credentialing purposes only.   Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 - In the process of being credentialed.  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956 - In the process of being credentialed.   Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490 - In the process of being credentialed.   Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 - In the process of being credentialed.   Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 - Last credentialed - 7-15-2020 - Not the effective date - For credentialing purposes only.  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 - In the process of being credentialed.   Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 - In the process of being credentialed.   Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238 - In the process of being credentialed.   Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 - In the process of being credentialed.   Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616 - In the process of being credentialed.  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149 - In the process of being credentialed.  Provider 16:  Provider Name: Joseph, Molly Provider NPI# 1396380077 - In the process of being credentialed.  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493 - Needs to be Credentialed.', NULL, NULL, '2021-08-12 10:14:34', '2021-08-12 10:14:34'),
(49358, 10057, 31790, NULL, '2021-10-14 00:00:00.000', 'In Process', 'Email Sent To : credentialing@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Greetings for the day!  Hope you are doing well. I was trying to reach out to know the updated enrollment status for the below mentioned group and providers in Prime Health for our group under the below locations. Also, as per your request please find the attach credentialing application for two highlighted providers.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI George, Jeemo	1497219067 Stephen, Ani	1588959118 Jose, Julie	1447883061 Brown, Brittany	1275163537 Piccione JR, James M	1356321509 Chennemkara, Mini Philip	1841755956 Abraham, Glory	1194206490 Fernandus, Limy	1972005189 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Joseph, Vibitha	1952931560 Thomas, Cini	1134777238 Abraham, Jeena	1467901587 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 John, Jeny	1073019493 Joseph, Molly	1073019493  Please feel free to reach out to me. Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-10-07 10:55:02', '2021-10-07 10:55:02'),
(49359, 10057, 31790, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Received From : credentialing@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Good Afternoon,  I\'ve started the credentialing process for providers John and Jose.  I\'ve forwarded your email to the Updates Department (updates@primehealthservices.com ).  They handle effective dates, Tax ID links and locations.  Thank you, Nancy', NULL, NULL, '2021-10-18 14:18:43', '2021-10-18 14:18:43'),
(49360, 10057, 31790, NULL, '2021-11-04 00:00:00.000', 'In Process', 'Email Sent To : credentialing@primehealthservices.com, updates@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Good Afternoon,  Hope this email finds you well. I\'m writing this email to check the updated status for the mentioned request. Please get back to me as soon as you get a chance.  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-28 15:21:58', '2021-10-28 15:21:58'),
(49361, 10057, 31790, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : credentialing@primehealthservices.com>, updates@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Good Morning,  Hope this email finds you in good health. Can I get the latest update on all the below mentioned groups and providers enrollment status?  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Please respond back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-22 10:39:29', '2021-11-22 10:39:29'),
(49362, 10057, 31790, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : credentialing@primehealthservices.com, updates@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Hello,  Can I get the latest updates on the below mentioned providers enrollment request under the TIN?  Please get back to me ASAP!  Thanks & Regards,', NULL, NULL, '2021-12-02 14:01:41', '2021-12-02 14:01:41'),
(49363, 10057, 31790, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Received From : credentialing@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Please see attached Credentialing Status Roster.  The dates given are for Credentialing purposes only and not the effective date.  Thank you for including the Updates Department in your email.  They will respond regarding the effective dates.  Thank you, Nancy', NULL, NULL, '2021-12-15 10:49:39', '2021-12-15 10:49:39'),
(49364, 10057, 31790, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : credentialing@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Hello Nancy,  Thank you for your prompt response. I really appreciate your support. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-22 12:07:56', '2021-12-22 12:07:56'),
(49365, 10057, 31790, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Received From : updates@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Hello, all of these providers are in our system with both locations added, thanks!  Alyssa DeNure Data Integrity Associate', NULL, NULL, '2021-12-29 15:18:47', '2021-12-29 15:18:47'),
(49366, 20067, 31790, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: credentialing@primehealthservices.com  Sub:  Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |   Good afternoon, Hope all is well with you. i would like to know the enrollment status of the below-mentioned providers.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Jeny John	1073019493 Abdur Rauf	1497726202 Brittany Brown	1275163537 Vibitha Joseph	1952931560   Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-12 15:41:39', '2022-01-12 15:41:39'),
(49367, 20067, 31790, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: credentialing@primehealthservices.com,  updates@primehealthservices.com  Sub: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Good Evening! Hope you are doing great. Any updates on the below email?  Thanks & Regards, Syed Ahad.', NULL, NULL, '2022-01-18 17:53:29', '2022-01-18 17:53:29'),
(49368, 20067, 31790, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: credentialing@primehealthservices.com  Sub: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Good Morning!  Hope this email finds you in good health. I would like to know the enrolment status of the below-mentioned providers and if any of them is enrolled kindly send me the welcome kit along with the effective date.  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Provider Name	NPI	Location Jeny John	1407171077	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Jeny John	1407171077	779 Normandy St Ste 114 Houston, TX 77015-3441 Brittany Brown	1275163537	779 Normandy St Ste 114 Houston, TX 77015-3441 Vibitha Joseph	1952931560	779 Normandy St Ste 114 Houston, TX 77015-3441 Group	1407171077	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Thanks & Regards, Syed Ahad. ', NULL, NULL, '2022-01-28 11:44:12', '2022-01-28 11:44:12'),
(49369, 20067, 31790, NULL, '2022-03-09 00:00:00.000', 'In Process', 'Email received from: credentialing@primehealthservices.com  Sub: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Good Morning,  Providers Julie Josie and Jeny John have been credentialed as of 11-23-2021.  This date is for credentialing purposes only and not the effective date.  The Updates Department will respond regarding the effective date, Tax ID link and locations.  Thank you, Nancy', NULL, NULL, '2022-03-02 10:22:56', '2022-03-02 10:22:56'),
(49370, 20067, 31790, NULL, '2022-03-16 00:00:00.000', 'Approved', 'Email received from: patty.albright@primehealthservices.com  Sub: FW: [Fwd: ##RE-168872## : FW: [Fwd: ##RE-168872## : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |]]  Good Afternoon,  All of The providers indicated in your previous email have been added to both locations.  TIN  27-0796429  Julie Jose and Jeny John  Effective date: 11/19/2020     Thanks,', NULL, NULL, '2022-03-09 09:49:09', '2022-03-09 09:49:09'),
(49371, 1006, 31791, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:35:32', '2021-07-01 10:35:32'),
(49372, 11056, 31791, NULL, '2021-07-10 00:00:00.000', 'Initiated', 'Email sent to : austin.owens@primehealthservices.com  Sub: Provider Enrollment Request - CUCC - Prime Health Services  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned provider in Prime Health Services in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider : Provider Name : John, Jeny Provider NPI# : 1073019493  Feel free to reach out for any further information.  Thank you!', NULL, NULL, '2021-07-02 17:01:43', '2021-07-02 17:01:43'),
(49373, 3040, 31791, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: austin.owens@primehealthservices.com  Subject: Re: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned providers in Prime Health Services in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 6:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 7:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 9:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Joseph, Molly Provider NPI# 1396380077   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-22 10:54:36', '2021-07-22 10:54:36'),
(49374, 11056, 31791, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email sent to : 	austin.owens@primehealthservices.com  Sub : Re: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Good morning!  Hope you are doing well. I wanted to enroll the below mentioned providers in Prime Health Services in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider Details: Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 6:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 7:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 9:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 12 : Provider Name : John, Jeny Provider NPI# : 1073019493  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-05 11:01:37', '2021-08-05 11:01:37'),
(49375, 10057, 31791, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Email Sent To : austin.owens@primehealthservices.com  Sub : Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Greetings for the day!  I wanted to check the current status of the below mentioned providers request, Columbus Urgent Care PA under the below location.  Group Name	Columbus Urgent Care PA Tax ID	47-1914151 Group NPI	1215330501 Primary Location	926 Walnut St, Columbus , TX 78934-2215 Provider Name	NPI George, Jeemo	1497219067 Jose, Julie	1447883061 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Fernandus, Limy	1972005189 Rauf, Abdur 	1497726202 Joseph, Vibitha 	1952931560 Abraham, Jeena 	1467901587 PAUL, SIGI 	1033623616 Jacob, Jaya 	1194336149 Joseph, Molly 	1073019493 John, Jeny 	1073019493   If you need any further information please let me know, waiting for your prompt response.  Thanks & Regards,', NULL, NULL, '2021-10-06 12:44:39', '2021-10-06 12:44:39'),
(49376, 10057, 31791, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Email Sent To :  austin.owens@primehealthservices.com, providerrelations@primehealthservices.com, updates@primehealthservices.com  Sub : Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Hello,  Hope you are doing great. I\'m writing this email to get the latest update on below mentioned providers under facility.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Provider Name	NPI John, Jeny	1073019493 Joseph, Molly	1396380077  Please get back to me as soon as you get a chance. Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-11-09 17:20:17', '2021-11-09 17:20:17'),
(49377, 10057, 31791, NULL, '2021-11-22 00:00:00.000', 'In Process', 'Email Received From : providerrelations@primehealthservices.com  Sub : Fwd: RE: RE: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Good morning,  Can you please provide that request on official letterhead? Requests for contracts typically come directly from the provider group.  Thanks so much, Provider Relations', NULL, NULL, '2021-11-15 15:48:12', '2021-11-15 15:48:12'),
(49378, 10057, 31791, NULL, '2021-11-22 00:00:00.000', 'In Process', 'Email Sent To : providerrelations@primehealthservices.com updates@primehealthservices.com & austin.owens@primehealthservices.com  Sub : Fwd: RE: RE: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Hello,  Hope you are doing well. Please find the attached letter for your reference.  Looking forward to your kind response. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-15 15:49:48', '2021-11-15 15:49:48'),
(49379, 10057, 31791, NULL, '2021-12-07 00:00:00.000', 'Approved', 'Email Received From : providerrelations@primehealthservices.com  Sub : Fwd: RE: RE: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Good afternoon Steve,  Please see attached contract effective 08/10/2020 per your request.', NULL, NULL, '2021-11-30 14:37:14', '2021-11-30 14:37:14'),
(49380, 1006, 32626, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-14 09:10:35', '2021-07-14 09:10:35'),
(49381, 1006, 32626, NULL, '2021-07-21 00:00:00.000', 'On Hold', 'Facility enrollment request submitted @ MHHPContractingRFP@memorialhermann.org:  Sub: Enrollment Request - RHC - Memorial Hermann  \"Hello,   I hope you\'re doing well, please find the network participation form for our facility. Do let me know if anything else is required.  Thank you. \"  The enrollment form is attached in main group tasks for reference, as this is an ancillary/facility request. Putting rest of the tasks on hold until facility is enrolled. ', NULL, NULL, '2021-07-14 09:19:27', '2021-07-14 09:19:27'),
(49382, 1006, 32626, NULL, '2021-08-13 00:00:00.000', 'Not Eligible', 'Received the following denial notification @ MHHPContractingRFP@memorialhermann.org:   Sub: Enrollment Request - RHC - Memorial Hermann  \"Good evening. At this time, Kingsville, Texas is out of our network area, and we do not contract out of network at this time. I am withdrawing your application for participation. If something changes in the near future, we will let you know. Please let me know if you have any questions.  Thank you. Camilla Paige\"  &   \"Good afternoon Brad. We are currently contracting for the counties listed below:  HMO Brazoria Fort Bend Harris Montgomery Waller  PPO Brazoria Fort Bend Galveston Harris Montgomery Walker Wharton  MA Fort Bend Harris Montgomery  Soon to be expanding to Galveston, Jefferson, Liberty  Please let me know if you have any other questions.  Thank you. Camilla\" ', NULL, NULL, '2021-08-06 10:48:00', '2021-08-06 10:48:00'),
(49383, 1006, 32627, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-14 09:10:35', '2021-07-14 09:10:35'),
(49384, 1006, 32627, NULL, '2021-07-21 00:00:00.000', 'On Hold', 'Facility enrollment request submitted @ MHHPContractingRFP@memorialhermann.org:  Sub: Enrollment Request - RHC - Memorial Hermann  \"Hello,   I hope you\'re doing well, please find the network participation form for our facility. Do let me know if anything else is required.  Thank you. \"  The enrollment form is attached in main group tasks for reference, as this is an ancillary/facility request. Putting rest of the tasks on hold until facility is enrolled. ', NULL, NULL, '2021-07-14 09:19:23', '2021-07-14 09:19:23'),
(49385, 1006, 32627, NULL, '2021-08-13 00:00:00.000', 'Not Eligible', 'Received the following denial notification @ MHHPContractingRFP@memorialhermann.org:   Sub: Enrollment Request - RHC - Memorial Hermann  \"Good evening. At this time, Kingsville, Texas is out of our network area, and we do not contract out of network at this time. I am withdrawing your application for participation. If something changes in the near future, we will let you know. Please let me know if you have any questions.  Thank you. Camilla Paige\"  &   \"Good afternoon Brad. We are currently contracting for the counties listed below:  HMO Brazoria Fort Bend Harris Montgomery Waller  PPO Brazoria Fort Bend Galveston Harris Montgomery Walker Wharton  MA Fort Bend Harris Montgomery  Soon to be expanding to Galveston, Jefferson, Liberty  Please let me know if you have any other questions.  Thank you. Camilla\" ', NULL, NULL, '2021-08-06 10:47:55', '2021-08-06 10:47:55'),
(49386, 1006, 32628, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-14 09:10:35', '2021-07-14 09:10:35'),
(49387, 1006, 32628, NULL, '2021-07-21 00:00:00.000', 'On Hold', 'Facility enrollment request submitted @ MHHPContractingRFP@memorialhermann.org:  Sub: Enrollment Request - RHC - Memorial Hermann  \"Hello,   I hope you\'re doing well, please find the network participation form for our facility. Do let me know if anything else is required.  Thank you. \"  The enrollment form is attached in main group tasks for reference, as this is an ancillary/facility request. Putting rest of the tasks on hold until facility is enrolled. ', NULL, NULL, '2021-07-14 09:19:20', '2021-07-14 09:19:20'),
(49388, 1006, 32628, NULL, '2021-08-13 00:00:00.000', 'Not Eligible', 'Received the following denial notification @ MHHPContractingRFP@memorialhermann.org:   Sub: Enrollment Request - RHC - Memorial Hermann  \"Good evening. At this time, Kingsville, Texas is out of our network area, and we do not contract out of network at this time. I am withdrawing your application for participation. If something changes in the near future, we will let you know. Please let me know if you have any questions.  Thank you. Camilla Paige\"  &   \"Good afternoon Brad. We are currently contracting for the counties listed below:  HMO Brazoria Fort Bend Harris Montgomery Waller  PPO Brazoria Fort Bend Galveston Harris Montgomery Walker Wharton  MA Fort Bend Harris Montgomery  Soon to be expanding to Galveston, Jefferson, Liberty  Please let me know if you have any other questions.  Thank you. Camilla\" ', NULL, NULL, '2021-08-06 10:47:31', '2021-08-06 10:47:31'),
(49389, 1006, 32629, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-14 09:10:35', '2021-07-14 09:10:35'),
(49390, 1006, 32629, NULL, '2021-07-21 00:00:00.000', 'On Hold', 'Facility enrollment request submitted @ MHHPContractingRFP@memorialhermann.org:  Sub: Enrollment Request - RHC - Memorial Hermann  \"Hello,   I hope you\'re doing well, please find the network participation form for our facility. Do let me know if anything else is required.  Thank you. \"  The enrollment form is attached in main group tasks for reference, as this is an ancillary/facility request. Putting rest of the tasks on hold until facility is enrolled. ', NULL, NULL, '2021-07-14 09:19:16', '2021-07-14 09:19:16'),
(49391, 1006, 32629, NULL, '2021-08-13 00:00:00.000', 'Not Eligible', 'Received the following denial notification @ MHHPContractingRFP@memorialhermann.org:   Sub: Enrollment Request - RHC - Memorial Hermann  \"Good evening. At this time, Kingsville, Texas is out of our network area, and we do not contract out of network at this time. I am withdrawing your application for participation. If something changes in the near future, we will let you know. Please let me know if you have any questions.  Thank you. Camilla Paige\"  &   \"Good afternoon Brad. We are currently contracting for the counties listed below:  HMO Brazoria Fort Bend Harris Montgomery Waller  PPO Brazoria Fort Bend Galveston Harris Montgomery Walker Wharton  MA Fort Bend Harris Montgomery  Soon to be expanding to Galveston, Jefferson, Liberty  Please let me know if you have any other questions.  Thank you. Camilla\" ', NULL, NULL, '2021-08-06 10:47:22', '2021-08-06 10:47:22'),
(49392, 1006, 32630, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-14 09:10:35', '2021-07-14 09:10:35'),
(49393, 1006, 32630, NULL, '2021-07-21 00:00:00.000', 'On Hold', 'Facility enrollment request submitted @ MHHPContractingRFP@memorialhermann.org:  Sub: Enrollment Request - RHC - Memorial Hermann  \"Hello,   I hope you\'re doing well, please find the network participation form for our facility. Do let me know if anything else is required.  Thank you. \"  The enrollment form is attached in main group tasks for reference, as this is an ancillary/facility request. Putting rest of the tasks on hold until facility is enrolled. ', NULL, NULL, '2021-07-14 09:19:13', '2021-07-14 09:19:13'),
(49394, 1006, 32630, NULL, '2021-08-13 00:00:00.000', 'Not Eligible', 'Received the following denial notification @ MHHPContractingRFP@memorialhermann.org:   Sub: Enrollment Request - RHC - Memorial Hermann  \"Good evening. At this time, Kingsville, Texas is out of our network area, and we do not contract out of network at this time. I am withdrawing your application for participation. If something changes in the near future, we will let you know. Please let me know if you have any questions.  Thank you. Camilla Paige\"  &   \"Good afternoon Brad. We are currently contracting for the counties listed below:  HMO Brazoria Fort Bend Harris Montgomery Waller  PPO Brazoria Fort Bend Galveston Harris Montgomery Walker Wharton  MA Fort Bend Harris Montgomery  Soon to be expanding to Galveston, Jefferson, Liberty  Please let me know if you have any other questions.  Thank you. Camilla\" ', NULL, NULL, '2021-08-06 10:47:16', '2021-08-06 10:47:16'),
(49395, 1006, 32631, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-14 09:10:35', '2021-07-14 09:10:35'),
(49396, 1006, 32631, NULL, '2021-07-21 00:00:00.000', 'On Hold', 'Facility enrollment request submitted @ MHHPContractingRFP@memorialhermann.org:  Sub: Enrollment Request - RHC - Memorial Hermann  \"Hello,   I hope you\'re doing well, please find the network participation form for our facility. Do let me know if anything else is required.  Thank you. \"  The enrollment form is attached in main group tasks for reference, as this is an ancillary/facility request. Putting rest of the tasks on hold until facility is enrolled. ', NULL, NULL, '2021-07-14 09:19:10', '2021-07-14 09:19:10'),
(49397, 1006, 32631, NULL, '2021-08-13 00:00:00.000', 'Not Eligible', 'Received the following denial notification @ MHHPContractingRFP@memorialhermann.org:   Sub: Enrollment Request - RHC - Memorial Hermann  \"Good evening. At this time, Kingsville, Texas is out of our network area, and we do not contract out of network at this time. I am withdrawing your application for participation. If something changes in the near future, we will let you know. Please let me know if you have any questions.  Thank you. Camilla Paige\"  &   \"Good afternoon Brad. We are currently contracting for the counties listed below:  HMO Brazoria Fort Bend Harris Montgomery Waller  PPO Brazoria Fort Bend Galveston Harris Montgomery Walker Wharton  MA Fort Bend Harris Montgomery  Soon to be expanding to Galveston, Jefferson, Liberty  Please let me know if you have any other questions.  Thank you. Camilla\" ', NULL, NULL, '2021-08-06 10:47:12', '2021-08-06 10:47:12'),
(49398, 1006, 32632, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-14 09:10:35', '2021-07-14 09:10:35'),
(49399, 1006, 32632, NULL, '2021-07-21 00:00:00.000', 'On Hold', 'Facility enrollment request submitted @ MHHPContractingRFP@memorialhermann.org:  Sub: Enrollment Request - RHC - Memorial Hermann  \"Hello,   I hope you\'re doing well, please find the network participation form for our facility. Do let me know if anything else is required.  Thank you. \"  The enrollment form is attached in main group tasks for reference, as this is an ancillary/facility request. Putting rest of the tasks on hold until facility is enrolled. ', NULL, NULL, '2021-07-14 09:19:07', '2021-07-14 09:19:07'),
(49400, 1006, 32632, NULL, '2021-08-13 00:00:00.000', 'Not Eligible', 'Received the following denial notification @ MHHPContractingRFP@memorialhermann.org:   Sub: Enrollment Request - RHC - Memorial Hermann  \"Good evening. At this time, Kingsville, Texas is out of our network area, and we do not contract out of network at this time. I am withdrawing your application for participation. If something changes in the near future, we will let you know. Please let me know if you have any questions.  Thank you. Camilla Paige\"  &   \"Good afternoon Brad. We are currently contracting for the counties listed below:  HMO Brazoria Fort Bend Harris Montgomery Waller  PPO Brazoria Fort Bend Galveston Harris Montgomery Walker Wharton  MA Fort Bend Harris Montgomery  Soon to be expanding to Galveston, Jefferson, Liberty  Please let me know if you have any other questions.  Thank you. Camilla\" ', NULL, NULL, '2021-08-06 10:47:09', '2021-08-06 10:47:09'),
(49401, 1006, 32633, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-14 09:10:35', '2021-07-14 09:10:35'),
(49402, 1006, 32633, NULL, '2021-07-21 00:00:00.000', 'On Hold', 'Facility enrollment request submitted @ MHHPContractingRFP@memorialhermann.org:  Sub: Enrollment Request - RHC - Memorial Hermann  \"Hello,   I hope you\'re doing well, please find the network participation form for our facility. Do let me know if anything else is required.  Thank you. \"  The enrollment form is attached in main group tasks for reference, as this is an ancillary/facility request. Putting rest of the tasks on hold until facility is enrolled. ', NULL, NULL, '2021-07-14 09:19:04', '2021-07-14 09:19:04'),
(49403, 1006, 32633, NULL, '2021-08-13 00:00:00.000', 'Not Eligible', 'Received the following denial notification @ MHHPContractingRFP@memorialhermann.org:   Sub: Enrollment Request - RHC - Memorial Hermann  \"Good evening. At this time, Kingsville, Texas is out of our network area, and we do not contract out of network at this time. I am withdrawing your application for participation. If something changes in the near future, we will let you know. Please let me know if you have any questions.  Thank you. Camilla Paige\"  &   \"Good afternoon Brad. We are currently contracting for the counties listed below:  HMO Brazoria Fort Bend Harris Montgomery Waller  PPO Brazoria Fort Bend Galveston Harris Montgomery Walker Wharton  MA Fort Bend Harris Montgomery  Soon to be expanding to Galveston, Jefferson, Liberty  Please let me know if you have any other questions.  Thank you. Camilla\" ', NULL, NULL, '2021-08-06 10:47:05', '2021-08-06 10:47:05'),
(49404, 1006, 32634, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-14 09:10:35', '2021-07-14 09:10:35'),
(49405, 1006, 32634, NULL, '2021-07-21 00:00:00.000', 'On Hold', 'Facility enrollment request submitted @ MHHPContractingRFP@memorialhermann.org:  Sub: Enrollment Request - RHC - Memorial Hermann  \"Hello,   I hope you\'re doing well, please find the network participation form for our facility. Do let me know if anything else is required.  Thank you. \"  The enrollment form is attached in main group tasks for reference, as this is an ancillary/facility request. Putting rest of the tasks on hold until facility is enrolled. ', NULL, NULL, '2021-07-14 09:18:58', '2021-07-14 09:18:58'),
(49406, 1006, 32634, NULL, '2021-08-13 00:00:00.000', 'Not Eligible', 'Received the following denial notification @ MHHPContractingRFP@memorialhermann.org:   Sub: Enrollment Request - RHC - Memorial Hermann  \"Good evening. At this time, Kingsville, Texas is out of our network area, and we do not contract out of network at this time. I am withdrawing your application for participation. If something changes in the near future, we will let you know. Please let me know if you have any questions.  Thank you. Camilla Paige\"  &   \"Good afternoon Brad. We are currently contracting for the counties listed below:  HMO Brazoria Fort Bend Harris Montgomery Waller  PPO Brazoria Fort Bend Galveston Harris Montgomery Walker Wharton  MA Fort Bend Harris Montgomery  Soon to be expanding to Galveston, Jefferson, Liberty  Please let me know if you have any other questions.  Thank you. Camilla\" ', NULL, NULL, '2021-08-06 10:46:59', '2021-08-06 10:46:59'),
(49407, 1006, 32635, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-14 09:10:35', '2021-07-14 09:10:35'),
(49408, 1006, 32635, NULL, '2021-07-21 00:00:00.000', 'On Hold', 'Facility enrollment request submitted @ MHHPContractingRFP@memorialhermann.org:  Sub: Enrollment Request - RHC - Memorial Hermann  \"Hello,   I hope you\'re doing well, please find the network participation form for our facility. Do let me know if anything else is required.  Thank you. \"  The enrollment form is attached in main group tasks for reference, as this is an ancillary/facility request. Putting rest of the tasks on hold until facility is enrolled. ', NULL, NULL, '2021-07-14 09:18:48', '2021-07-14 09:18:48'),
(49409, 1006, 32635, NULL, '2021-08-13 00:00:00.000', 'Not Eligible', 'Received the following denial notification @ MHHPContractingRFP@memorialhermann.org:   Sub: Enrollment Request - RHC - Memorial Hermann  \"Good evening. At this time, Kingsville, Texas is out of our network area, and we do not contract out of network at this time. I am withdrawing your application for participation. If something changes in the near future, we will let you know. Please let me know if you have any questions.  Thank you. Camilla Paige\"  &   \"Good afternoon Brad. We are currently contracting for the counties listed below:  HMO Brazoria Fort Bend Harris Montgomery Waller  PPO Brazoria Fort Bend Galveston Harris Montgomery Walker Wharton  MA Fort Bend Harris Montgomery  Soon to be expanding to Galveston, Jefferson, Liberty  Please let me know if you have any other questions.  Thank you. Camilla\" ', NULL, NULL, '2021-08-06 10:46:54', '2021-08-06 10:46:54'),
(49410, 1006, 32636, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-14 09:10:41', '2021-07-14 09:10:41'),
(49411, 1006, 32636, NULL, '2021-07-21 00:00:00.000', 'Initiated', 'Facility enrollment request submitted @ MHHPContractingRFP@memorialhermann.org:  Sub: Enrollment Request - RHC - Memorial Hermann  \"Hello,   I hope you\'re doing well, please find the network participation form for our facility. Do let me know if anything else is required.  Thank you. \"  The enrollment form is attached in main group tasks for reference, as this is an ancillary/facility request.', NULL, NULL, '2021-07-14 09:15:58', '2021-07-14 09:15:58'),
(49412, 1006, 32636, NULL, '2021-08-13 00:00:00.000', 'Not Eligible', 'Received the following denial notification @ :   Sub:   \"Good evening. At this time, Kingsville, Texas is out of our network area, and we do not contract out of network at this time. I am withdrawing your application for participation. If something changes in the near future, we will let you know. Please let me know if you have any questions.  Thank you. Camilla Paige\"  &   \"Good afternoon Brad. We are currently contracting for the counties listed below:  HMO Brazoria Fort Bend Harris Montgomery Waller  PPO Brazoria Fort Bend Galveston Harris Montgomery Walker Wharton  MA Fort Bend Harris Montgomery  Soon to be expanding to Galveston, Jefferson, Liberty  Please let me know if you have any other questions.  Thank you. Camilla\"', NULL, NULL, '2021-08-06 10:05:18', '2021-08-06 10:05:18'),
(49413, 1006, 32637, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-14 09:11:03', '2021-07-14 09:11:03'),
(49414, 1006, 32637, NULL, '2021-07-21 00:00:00.000', 'On Hold', 'Facility enrollment request submitted @ MHHPContractingRFP@memorialhermann.org:  Sub: Enrollment Request - RHC - Memorial Hermann  \"Hello,   I hope you\'re doing well, please find the network participation form for our facility. Do let me know if anything else is required.  Thank you. \"  The enrollment form is attached in main group tasks for reference, as this is an ancillary/facility request. Putting rest of the tasks on hold until facility is enrolled.  ', NULL, NULL, '2021-07-14 09:25:50', '2021-07-14 09:25:50'),
(49415, 1006, 32637, NULL, '2021-08-13 00:00:00.000', 'Not Eligible', 'Received the following denial notification @ MHHPContractingRFP@memorialhermann.org:   Sub: Enrollment Request - RHC - Memorial Hermann  \"Good evening. At this time, Kingsville, Texas is out of our network area, and we do not contract out of network at this time. I am withdrawing your application for participation. If something changes in the near future, we will let you know. Please let me know if you have any questions.  Thank you. Camilla Paige\"  &   \"Good afternoon Brad. We are currently contracting for the counties listed below:  HMO Brazoria Fort Bend Harris Montgomery Waller  PPO Brazoria Fort Bend Galveston Harris Montgomery Walker Wharton  MA Fort Bend Harris Montgomery  Soon to be expanding to Galveston, Jefferson, Liberty  Please let me know if you have any other questions.  Thank you. Camilla\" ', NULL, NULL, '2021-08-06 10:44:37', '2021-08-06 10:44:37'),
(49416, 1006, 32638, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-14 09:11:03', '2021-07-14 09:11:03'),
(49417, 1006, 32638, NULL, '2021-07-21 00:00:00.000', 'On Hold', 'Facility enrollment request submitted @ MHHPContractingRFP@memorialhermann.org:  Sub: Enrollment Request - RHC - Memorial Hermann  \"Hello,   I hope you\'re doing well, please find the network participation form for our facility. Do let me know if anything else is required.  Thank you. \"  The enrollment form is attached in main group tasks for reference, as this is an ancillary/facility request. Putting rest of the tasks on hold until facility is enrolled.  ', NULL, NULL, '2021-07-14 09:25:45', '2021-07-14 09:25:45'),
(49418, 1006, 32638, NULL, '2021-08-13 00:00:00.000', 'Not Eligible', 'Received the following denial notification @ MHHPContractingRFP@memorialhermann.org:   Sub: Enrollment Request - RHC - Memorial Hermann  \"Good evening. At this time, Kingsville, Texas is out of our network area, and we do not contract out of network at this time. I am withdrawing your application for participation. If something changes in the near future, we will let you know. Please let me know if you have any questions.  Thank you. Camilla Paige\"  &   \"Good afternoon Brad. We are currently contracting for the counties listed below:  HMO Brazoria Fort Bend Harris Montgomery Waller  PPO Brazoria Fort Bend Galveston Harris Montgomery Walker Wharton  MA Fort Bend Harris Montgomery  Soon to be expanding to Galveston, Jefferson, Liberty  Please let me know if you have any other questions.  Thank you. Camilla\" ', NULL, NULL, '2021-08-06 10:44:34', '2021-08-06 10:44:34'),
(49419, 1006, 32639, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-14 09:11:03', '2021-07-14 09:11:03'),
(49420, 1006, 32639, NULL, '2021-07-21 00:00:00.000', 'On Hold', 'Facility enrollment request submitted @ MHHPContractingRFP@memorialhermann.org:  Sub: Enrollment Request - RHC - Memorial Hermann  \"Hello,   I hope you\'re doing well, please find the network participation form for our facility. Do let me know if anything else is required.  Thank you. \"  The enrollment form is attached in main group tasks for reference, as this is an ancillary/facility request. Putting rest of the tasks on hold until facility is enrolled.  ', NULL, NULL, '2021-07-14 09:25:42', '2021-07-14 09:25:42'),
(49421, 1006, 32639, NULL, '2021-08-13 00:00:00.000', 'Not Eligible', 'Received the following denial notification @ MHHPContractingRFP@memorialhermann.org:   Sub: Enrollment Request - RHC - Memorial Hermann  \"Good evening. At this time, Kingsville, Texas is out of our network area, and we do not contract out of network at this time. I am withdrawing your application for participation. If something changes in the near future, we will let you know. Please let me know if you have any questions.  Thank you. Camilla Paige\"  &   \"Good afternoon Brad. We are currently contracting for the counties listed below:  HMO Brazoria Fort Bend Harris Montgomery Waller  PPO Brazoria Fort Bend Galveston Harris Montgomery Walker Wharton  MA Fort Bend Harris Montgomery  Soon to be expanding to Galveston, Jefferson, Liberty  Please let me know if you have any other questions.  Thank you. Camilla\" ', NULL, NULL, '2021-08-06 10:44:31', '2021-08-06 10:44:31'),
(49422, 1006, 32640, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-14 09:11:03', '2021-07-14 09:11:03'),
(49423, 1006, 32640, NULL, '2021-07-21 00:00:00.000', 'On Hold', 'Facility enrollment request submitted @ MHHPContractingRFP@memorialhermann.org:  Sub: Enrollment Request - RHC - Memorial Hermann  \"Hello,   I hope you\'re doing well, please find the network participation form for our facility. Do let me know if anything else is required.  Thank you. \"  The enrollment form is attached in main group tasks for reference, as this is an ancillary/facility request. Putting rest of the tasks on hold until facility is enrolled.  ', NULL, NULL, '2021-07-14 09:25:38', '2021-07-14 09:25:38'),
(49424, 1006, 32640, NULL, '2021-08-13 00:00:00.000', 'Not Eligible', 'Received the following denial notification @ MHHPContractingRFP@memorialhermann.org:   Sub: Enrollment Request - RHC - Memorial Hermann  \"Good evening. At this time, Kingsville, Texas is out of our network area, and we do not contract out of network at this time. I am withdrawing your application for participation. If something changes in the near future, we will let you know. Please let me know if you have any questions.  Thank you. Camilla Paige\"  &   \"Good afternoon Brad. We are currently contracting for the counties listed below:  HMO Brazoria Fort Bend Harris Montgomery Waller  PPO Brazoria Fort Bend Galveston Harris Montgomery Walker Wharton  MA Fort Bend Harris Montgomery  Soon to be expanding to Galveston, Jefferson, Liberty  Please let me know if you have any other questions.  Thank you. Camilla\" ', NULL, NULL, '2021-08-06 10:44:28', '2021-08-06 10:44:28');
