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
(15286, 1006, 20783, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Sent f/u email @ Jennifer Maligaya Jennifer.Maligaya@healthsmart.com:  Sub: Enrollment Status - CUCC - Anci-Care  \"Hello Jennifer, I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the following group and providers with Anci-Care:  Group Name: Columbus Urgent Care PA NPI# 1215330501TIN# 47-1914151 Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-01 11:19:01', '2021-06-01 11:19:01'),
(15287, 3040, 20783, NULL, '2021-06-25 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. ', NULL, NULL, '2021-06-18 17:00:37', '2021-06-18 17:00:37'),
(15288, 3040, 20784, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:55:50', '2021-03-15 10:55:50'),
(15289, 3040, 20784, NULL, '2021-05-17 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Enroll Group & Providers || Columbus Urgent Care PA || Group & Providers || Anci Care ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in Ancicare 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 1: Provider Name: Rauf., Abdur Provider NPI# 1497726202   Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 5: Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 6: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8: Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 9: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 10: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 11: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12: Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 13: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 14: Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 15: Provider Name: PAUL, SIGI Provider NPI# 1033623616  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-10 07:31:20', '2021-05-10 07:31:20'),
(15290, 1006, 20784, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Sent f/u email @ Jennifer Maligaya Jennifer.Maligaya@healthsmart.com:  Sub: Enrollment Status - CUCC - Anci-Care  \"Hello Jennifer, I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the following group and providers with Anci-Care:  Group Name: Columbus Urgent Care PA NPI# 1215330501TIN# 47-1914151 Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-01 11:19:11', '2021-06-01 11:19:11'),
(15291, 3040, 20784, NULL, '2021-06-25 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. ', NULL, NULL, '2021-06-18 17:00:37', '2021-06-18 17:00:37'),
(15292, 3040, 20785, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:56:04', '2021-03-15 10:56:04'),
(15293, 3040, 20785, NULL, '2021-05-17 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Enroll Group & Providers || Columbus Urgent Care PA || Group & Providers || Anci Care ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in Ancicare 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 1: Provider Name: Rauf., Abdur Provider NPI# 1497726202   Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 5: Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 6: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8: Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 9: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 10: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 11: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12: Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 13: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 14: Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 15: Provider Name: PAUL, SIGI Provider NPI# 1033623616  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-10 07:31:25', '2021-05-10 07:31:25'),
(15294, 1006, 20785, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Sent f/u email @ Jennifer Maligaya Jennifer.Maligaya@healthsmart.com:  Sub: Enrollment Status - CUCC - Anci-Care  \"Hello Jennifer, I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the following group and providers with Anci-Care:  Group Name: Columbus Urgent Care PA NPI# 1215330501TIN# 47-1914151 Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-01 11:19:43', '2021-06-01 11:19:43'),
(15295, 3040, 20785, NULL, '2021-06-25 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. ', NULL, NULL, '2021-06-18 17:00:36', '2021-06-18 17:00:36'),
(15296, 3040, 20786, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:56:19', '2021-03-15 10:56:19'),
(15297, 3040, 20786, NULL, '2021-05-17 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Enroll Group & Providers || Columbus Urgent Care PA || Group & Providers || Anci Care ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in Ancicare 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 1: Provider Name: Rauf., Abdur Provider NPI# 1497726202   Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 5: Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 6: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8: Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 9: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 10: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 11: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12: Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 13: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 14: Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 15: Provider Name: PAUL, SIGI Provider NPI# 1033623616  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-10 07:31:31', '2021-05-10 07:31:31'),
(15298, 1006, 20786, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Sent f/u email @ Jennifer Maligaya Jennifer.Maligaya@healthsmart.com:  Sub: Enrollment Status - CUCC - Anci-Care  \"Hello Jennifer, I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the following group and providers with Anci-Care:  Group Name: Columbus Urgent Care PA NPI# 1215330501TIN# 47-1914151 Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-01 11:19:29', '2021-06-01 11:19:29'),
(15299, 3040, 20786, NULL, '2021-06-25 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. ', NULL, NULL, '2021-06-18 17:00:36', '2021-06-18 17:00:36'),
(15300, 3040, 20787, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:56:33', '2021-03-15 10:56:33'),
(15301, 3040, 20787, NULL, '2021-05-17 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Enroll Group & Providers || Columbus Urgent Care PA || Group & Providers || Anci Care ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in Ancicare 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 1: Provider Name: Rauf., Abdur Provider NPI# 1497726202   Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 5: Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 6: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8: Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 9: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 10: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 11: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12: Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 13: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 14: Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 15: Provider Name: PAUL, SIGI Provider NPI# 1033623616  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-10 07:31:40', '2021-05-10 07:31:40'),
(15302, 1006, 20787, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Sent f/u email @ Jennifer Maligaya Jennifer.Maligaya@healthsmart.com:  Sub: Enrollment Status - CUCC - Anci-Care  \"Hello Jennifer, I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the following group and providers with Anci-Care:  Group Name: Columbus Urgent Care PA NPI# 1215330501TIN# 47-1914151 Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-01 11:18:34', '2021-06-01 11:18:34'),
(15303, 3040, 20787, NULL, '2021-06-25 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. ', NULL, NULL, '2021-06-18 17:00:36', '2021-06-18 17:00:36'),
(15304, 3040, 20788, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:56:47', '2021-03-15 10:56:47'),
(15305, 3040, 20788, NULL, '2021-05-17 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Enroll Group & Providers || Columbus Urgent Care PA || Group & Providers || Anci Care ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in Ancicare 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 1: Provider Name: Rauf., Abdur Provider NPI# 1497726202   Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 5: Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 6: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8: Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 9: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 10: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 11: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12: Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 13: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 14: Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 15: Provider Name: PAUL, SIGI Provider NPI# 1033623616  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-10 07:31:48', '2021-05-10 07:31:48'),
(15306, 1006, 20788, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Sent f/u email @ Jennifer Maligaya Jennifer.Maligaya@healthsmart.com:  Sub: Enrollment Status - CUCC - Anci-Care  \"Hello Jennifer, I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the following group and providers with Anci-Care:  Group Name: Columbus Urgent Care PA NPI# 1215330501TIN# 47-1914151 Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-01 11:18:39', '2021-06-01 11:18:39'),
(15307, 3040, 20788, NULL, '2021-06-25 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. ', NULL, NULL, '2021-06-18 17:00:35', '2021-06-18 17:00:35'),
(15308, 3040, 20789, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:57:02', '2021-03-15 10:57:02'),
(15309, 1005, 20789, NULL, '2021-06-08 00:00:00.000', 'Not Eligible', 'Provider is no longer working for this Practice. Eff from 12/15/2020', NULL, NULL, '2021-06-01 12:47:32', '2021-06-01 12:47:32'),
(15310, 3040, 20790, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:57:17', '2021-03-15 10:57:17'),
(15311, 3040, 20790, NULL, '2021-05-17 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Enroll Group & Providers || Columbus Urgent Care PA || Group & Providers || Anci Care ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in Ancicare 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 1: Provider Name: Rauf., Abdur Provider NPI# 1497726202   Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 5: Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 6: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8: Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 9: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 10: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 11: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12: Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 13: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 14: Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 15: Provider Name: PAUL, SIGI Provider NPI# 1033623616  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-10 07:32:03', '2021-05-10 07:32:03'),
(15312, 1006, 20790, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Sent f/u email @ Jennifer Maligaya Jennifer.Maligaya@healthsmart.com:  Sub: Enrollment Status - CUCC - Anci-Care  \"Hello Jennifer, I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the following group and providers with Anci-Care:  Group Name: Columbus Urgent Care PA NPI# 1215330501TIN# 47-1914151 Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-01 11:19:38', '2021-06-01 11:19:38'),
(15313, 3040, 20790, NULL, '2021-06-25 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. ', NULL, NULL, '2021-06-18 17:00:35', '2021-06-18 17:00:35'),
(15314, 3040, 20791, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:57:31', '2021-03-15 10:57:31'),
(15315, 3040, 20791, NULL, '2021-05-17 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Enroll Group & Providers || Columbus Urgent Care PA || Group & Providers || Anci Care ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in Ancicare 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 1: Provider Name: Rauf., Abdur Provider NPI# 1497726202   Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 5: Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 6: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8: Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 9: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 10: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 11: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12: Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 13: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 14: Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 15: Provider Name: PAUL, SIGI Provider NPI# 1033623616  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-10 07:32:09', '2021-05-10 07:32:09'),
(15316, 1006, 20791, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Sent f/u email @ Jennifer Maligaya Jennifer.Maligaya@healthsmart.com:  Sub: Enrollment Status - CUCC - Anci-Care  \"Hello Jennifer, I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the following group and providers with Anci-Care:  Group Name: Columbus Urgent Care PA NPI# 1215330501TIN# 47-1914151 Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-01 11:18:57', '2021-06-01 11:18:57'),
(15317, 3040, 20791, NULL, '2021-06-25 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. ', NULL, NULL, '2021-06-18 17:00:34', '2021-06-18 17:00:34'),
(15318, 3040, 20792, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:57:43', '2021-03-15 10:57:43'),
(15319, 3040, 20792, NULL, '2021-05-17 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Enroll Group & Providers || Columbus Urgent Care PA || Group & Providers || Anci Care ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in Ancicare 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 1: Provider Name: Rauf., Abdur Provider NPI# 1497726202   Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 5: Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 6: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8: Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 9: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 10: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 11: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12: Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 13: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 14: Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 15: Provider Name: PAUL, SIGI Provider NPI# 1033623616  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-10 07:32:13', '2021-05-10 07:32:13'),
(15320, 1006, 20792, NULL, '2021-06-08 00:00:00.000', 'On Hold', 'Pending UHC enrollment. ', NULL, NULL, '2021-06-01 17:14:50', '2021-06-01 17:14:50'),
(15321, 3040, 20793, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:57:54', '2021-03-15 10:57:54'),
(15322, 3040, 20793, NULL, '2021-05-17 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Enroll Group & Providers || Columbus Urgent Care PA || Group & Providers || Anci Care ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in Ancicare 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 1: Provider Name: Rauf., Abdur Provider NPI# 1497726202   Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 5: Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 6: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8: Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 9: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 10: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 11: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12: Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 13: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 14: Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 15: Provider Name: PAUL, SIGI Provider NPI# 1033623616  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-10 07:32:20', '2021-05-10 07:32:20'),
(15323, 1006, 20793, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Sent f/u email @ Jennifer Maligaya Jennifer.Maligaya@healthsmart.com:  Sub: Enrollment Status - CUCC - Anci-Care  \"Hello Jennifer, I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the following group and providers with Anci-Care:  Group Name: Columbus Urgent Care PA NPI# 1215330501TIN# 47-1914151 Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-01 11:19:06', '2021-06-01 11:19:06'),
(15324, 3040, 20793, NULL, '2021-06-25 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. ', NULL, NULL, '2021-06-18 17:00:04', '2021-06-18 17:00:04'),
(15325, 3040, 20794, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:58:34', '2021-03-15 10:58:34'),
(15326, 3040, 20794, NULL, '2021-05-19 00:00:00.000', 'Approved', 'Email rcvd from: tx_standard_contracting_team@bcbstx.com  Subject: Enrollment Status || Columbus Urgent Care PA || Group & Providers || BCBS || : Case Number - 02453834  Good morning,  I have attached a roster of the listed providers in the group.  Thank you,  If you have any questions or concerns please us the contact information below.  Thank you,', NULL, NULL, '2021-05-12 12:38:19', '2021-05-12 12:38:19'),
(15327, 3040, 20795, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:59:05', '2021-03-15 10:59:05'),
(15328, 3040, 20795, NULL, '2021-05-19 00:00:00.000', 'Approved', 'Email rcvd from: tx_standard_contracting_team@bcbstx.com  Subject: Enrollment Status || Columbus Urgent Care PA || Group & Providers || BCBS || : Case Number - 02453834  Good morning,  I have attached a roster of the listed providers in the group.  Thank you,  If you have any questions or concerns please us the contact information below.  Thank you,', NULL, NULL, '2021-05-12 11:27:13', '2021-05-12 11:27:13'),
(15329, 3040, 20796, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:59:30', '2021-03-15 10:59:30'),
(15330, 3040, 20796, NULL, '2021-05-19 00:00:00.000', 'Approved', 'Email rcvd from: tx_standard_contracting_team@bcbstx.com  Subject: Enrollment Status || Columbus Urgent Care PA || Group & Providers || BCBS || : Case Number - 02453834  Good morning,  I have attached a roster of the listed providers in the group.  Thank you,  If you have any questions or concerns please us the contact information below.  Thank you,', NULL, NULL, '2021-05-12 11:28:08', '2021-05-12 11:28:08'),
(15331, 3040, 20797, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 11:00:19', '2021-03-15 11:00:19'),
(15332, 3040, 20797, NULL, '2021-05-19 00:00:00.000', 'Approved', 'Email rcvd from: tx_standard_contracting_team@bcbstx.com  Subject: Enrollment Status || Columbus Urgent Care PA || Group & Providers || BCBS || : Case Number - 02453834  Good morning,  I have attached a roster of the listed providers in the group.  Thank you,  If you have any questions or concerns please us the contact information below.  Thank you,', NULL, NULL, '2021-05-12 11:28:55', '2021-05-12 11:28:55'),
(15333, 3040, 20798, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 11:00:59', '2021-03-15 11:00:59'),
(15334, 3040, 20798, NULL, '2021-05-19 00:00:00.000', 'Approved', 'Email rcvd from: tx_standard_contracting_team@bcbstx.com  Subject: Enrollment Status || Columbus Urgent Care PA || Group & Providers || BCBS || : Case Number - 02453834  Good morning,  I have attached a roster of the listed providers in the group.  Thank you,  If you have any questions or concerns please us the contact information below.  Thank you,', NULL, NULL, '2021-05-12 11:29:37', '2021-05-12 11:29:37'),
(15335, 3040, 20799, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 11:01:45', '2021-03-15 11:01:45'),
(15336, 3040, 20799, NULL, '2021-05-19 00:00:00.000', 'In Process', '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: 304426', NULL, NULL, '2021-05-12 14:34:19', '2021-05-12 14:34:19'),
(15337, 1006, 20799, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Sent f/u email @ ProfessionalProviderNetworkDept@bcbstx.com:  Sub: Enrollment Status - CUCC - BCBSTX  \"Hello,  I wanted to get an update regarding the enrollment status for the following providers under our group, their information is as follows:  Group Name: Columbus Urgent Care PA NPI# 1215330501 TIN# 47-1914151   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-06-01 14:11:36', '2021-06-01 14:11:36'),
(15338, 3040, 20799, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: ProfessionalProviderNetworkDept@bcbstx.com, tx_standard_contracting_team@bcbstx.com, txproviderupdatesubmission@bcbstx.com   Subject: Application ID: 304426 || Columbus Urgent Care PA || Jacob, Jaya, PAUL, SIGI & Abraham, Jeena || BCBS ||  Hello,  I wanted to get an update regarding the enrollment status for the following providers under our group, their information is as follows:  Practice Details: Group Name: Columbus Urgent Care PA Group NPI# 1215330501 Group TIN# 47-1914151 Group Address: 926 Walnut St, Columbus TX, 78934  Provider 1: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 2:  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 3: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-21 15:16:42', '2021-06-21 15:16:42'),
(15339, 3040, 20799, NULL, '2021-06-29 00:00:00.000', 'Approved', 'Group Name : COLUMBUS URGENT CARE PA Group Record Id : H000J5J401  Provider Name : JEENA ABRAHAM Provider Record Number : H08PL95701 Specialty : ANP/CERT/CLNP  Effective date: 06/22/2021 ', NULL, NULL, '2021-06-22 08:41:36', '2021-06-22 08:41:36'),
(15340, 3040, 20800, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 11:02:05', '2021-03-15 11:02:05'),
(15341, 1005, 20800, NULL, '2021-06-08 00:00:00.000', 'Not Eligible', 'Provider is no longer working for this Practice. Eff from 12/15/2020', NULL, NULL, '2021-06-01 12:47:52', '2021-06-01 12:47:52'),
(15342, 3040, 20801, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 11:02:31', '2021-03-15 11:02:31'),
(15343, 3040, 20801, NULL, '2021-05-19 00:00:00.000', 'In Process', '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: 304426', NULL, NULL, '2021-05-12 14:34:20', '2021-05-12 14:34:20'),
(15344, 1006, 20801, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Sent f/u email @ ProfessionalProviderNetworkDept@bcbstx.com:  Sub: Enrollment Status - CUCC - BCBSTX  \"Hello,  I wanted to get an update regarding the enrollment status for the following providers under our group, their information is as follows:  Group Name: Columbus Urgent Care PA NPI# 1215330501 TIN# 47-1914151   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-06-01 14:11:42', '2021-06-01 14:11:42'),
(15345, 3040, 20801, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: ProfessionalProviderNetworkDept@bcbstx.com, tx_standard_contracting_team@bcbstx.com, txproviderupdatesubmission@bcbstx.com   Subject: Application ID: 304426 || Columbus Urgent Care PA || Jacob, Jaya, PAUL, SIGI & Abraham, Jeena || BCBS ||  Hello,  I wanted to get an update regarding the enrollment status for the following providers under our group, their information is as follows:  Practice Details: Group Name: Columbus Urgent Care PA Group NPI# 1215330501 Group TIN# 47-1914151 Group Address: 926 Walnut St, Columbus TX, 78934  Provider 1: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 2:  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 3: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-21 15:16:39', '2021-06-21 15:16:39'),
(15346, 3040, 20801, NULL, '2021-07-09 00:00:00.000', 'Approved', 'Email rcvd from: txintaketeampiermailbox@bcbstx.com  Subject: BCBSTX New Provider Information  Group Name : COLUMBUS URGENT CARE PA Group Record Id : H000J5J401  Provider Name : SIGI PAUL Provider Record Number : H08PL95801 Specialty : ANP/CERT/CLNP  Networks : Network Name	Network Effective Date BAV - Blue Advantage HMO	07/02/2021 HMO - Blue Essentials	07/02/2021 HMH - Blue Premier HMO	07/02/2021 BCA - BlueChoice PPO	07/02/2021 HME - Health Select	07/02/2021 PMC - Medicare Advantage PPO	07/02/2021', NULL, NULL, '2021-07-02 11:23:22', '2021-07-02 11:23:22'),
(15347, 3040, 20802, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 11:02:40', '2021-03-15 11:02:40'),
(15348, 3040, 20802, NULL, '2021-05-19 00:00:00.000', 'In Process', '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: 304426', NULL, NULL, '2021-05-12 14:34:20', '2021-05-12 14:34:20'),
(15349, 1006, 20802, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Sent f/u email @ ProfessionalProviderNetworkDept@bcbstx.com:  Sub: Enrollment Status - CUCC - BCBSTX  \"Hello,  I wanted to get an update regarding the enrollment status for the following providers under our group, their information is as follows:  Group Name: Columbus Urgent Care PA NPI# 1215330501 TIN# 47-1914151   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-06-01 14:11:46', '2021-06-01 14:11:46'),
(15350, 3040, 20802, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: ProfessionalProviderNetworkDept@bcbstx.com, tx_standard_contracting_team@bcbstx.com, txproviderupdatesubmission@bcbstx.com   Subject: Application ID: 304426 || Columbus Urgent Care PA || Jacob, Jaya, PAUL, SIGI & Abraham, Jeena || BCBS ||  Hello,  I wanted to get an update regarding the enrollment status for the following providers under our group, their information is as follows:  Practice Details: Group Name: Columbus Urgent Care PA Group NPI# 1215330501 Group TIN# 47-1914151 Group Address: 926 Walnut St, Columbus TX, 78934  Provider 1: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 2:  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 3: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-21 15:16:35', '2021-06-21 15:16:35'),
(15351, 3040, 20802, NULL, '2021-07-06 00:00:00.000', 'Approved', 'Email rcvd from: txintaketeampiermailbox@bcbstx.com  Subject:BCBSTX New Provider Information  Group Name : COLUMBUS URGENT CARE PA Group Record Id : H000J5J401  Provider Name : JAYA JACOB Provider Record Number : H08PL95901 Specialty : ANP/CERT/CLNP  Networks : Network Name	Network Effective Date BAV - Blue Advantage HMO	06/23/2021 HMO - Blue Essentials	06/23/2021 HMH - Blue Premier HMO	06/23/2021 BCA - BlueChoice PPO	06/23/2021 HME - Health Select	06/23/2021 PMC - Medicare Advantage PPO	06/23/2021', NULL, NULL, '2021-06-29 13:17:58', '2021-06-29 13:17:58'),
(15352, 3040, 20803, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:06:03', '2021-03-15 12:06:03'),
(15353, 3040, 20803, NULL, '2021-05-17 00:00:00.000', 'In Process', 'Email sent to: psscentral@cigna.com  Subject: Enroll Group || Columbus Urgent Care PA || Group || Cigna ||  Greetings,   Hope you are doing well.  Please find the attached Letter of Intent along with the W9 to add the below mentioned group in Cigna for our group Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-10 10:47:44', '2021-05-10 10:47:44'),
(15354, 1006, 20803, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Sent new request @ psscentral@cigna.com since as per my discussion with Cigna rep we should have received a follow-up email from Cigna on this, which we have not:  Sub: Group Enrollment Request || Columbus Urgent Care PA || Cigna  \"Hello, We wish to enroll the following group with Cigna, please find the attached LOI & W9. Do let me know if anything else is required. Thank you. \"', NULL, NULL, '2021-06-01 15:04:28', '2021-06-01 15:04:28'),
(15355, 1006, 20803, NULL, '2021-06-08 00:00:00.000', 'In Process', '***THE FOLLOWING IS AN AUTO RESPONSE.  PLEASE DO NOT RESPOND TO THIS EMAIL***     Thank you for contacting the Cigna Provider Services Unit.  We will respond to your inquiry as soon as possible.  We will contact you if we need additional information.      Are you a health care professional that has already submitted your request to join the Cigna Medical Network?   The credentialing process typically takes 60 to 90 days to complete.  However, we are experiencing a higher than normal volume of credentialing request, which may result in some delays in processing your application.  We will do our best to process your application as soon as possible.  You will receive an email once you have been approved and credentialed as a network-participating provider with your effective date, or to notify you that you have not been approved.        Did you know…you can request copies of fee schedules and participating provider agreements on CignaforHCP.com? Log in to the Cigna for Health Care Professionals website (CignaforHCP.com), Click “Working with Cigna” at the top of page. Request a copy of your fee schedule under the “Fee Schedule” column Request a copy of your participating provider agreement under the “Information Requests” column For assistance with the website, call us at 1.800.853.2713   Easy demographic updates Submit all demographic updates to us using the information below to save time and help ensure accuracy.   Online form: Log in to CignaforHCP.com > Working with Cigna >Update Demographic Information, or   Email (all states except California): Intake_PDM@Cigna.com   Email (California only): CA_DirectoryCompliance@Cigna.com, or   Fax: 1.877.358.4301, or   Mail: Two College Park Dr., Hooksett, NH 03106   Thank you.   Cigna  THN-2013-365', NULL, NULL, '2021-06-01 15:09:35', '2021-06-01 15:09:35'),
(15356, 3040, 20803, NULL, '2021-06-28 00:00:00.000', 'In Process', 'As per my discussion with Cigna rep, the request still shows as in process. Need to allow 90~120 business days for this to be processed  Ref# Kamaria 06/01/2021', NULL, NULL, '2021-06-21 08:49:45', '2021-06-21 08:49:45'),
(15357, 3040, 20803, NULL, '2021-07-15 00:00:00.000', 'In Process', 'As per my discussion with Cigna rep, the request still shows as in process. Need to allow 90~120 business days for this to be processed ', NULL, NULL, '2021-07-08 16:38:36', '2021-07-08 16:38:36'),
(15358, 3040, 20803, NULL, '2021-08-04 00:00:00.000', 'In Process', 'As per my discussion with Cigna rep, the request still shows as in process. Need to allow 90~120 business days for this to be processed ', NULL, NULL, '2021-07-28 14:17:15', '2021-07-28 14:17:15');
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
(15359, 11056, 20803, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email sent to : 	psscentral@cigna.com  Sub : Enrollment Status Query - Columbus Urgent Care PA - Cigna  Good morning!  Hope you are doing well. I want to inquire about the enrollment status of the following provider under the following practice. The application has been submitted online on 06/14/2021. Application no. : 12643004  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: Joseph, Molly Provider NPI# : 1396380077  Kindly respond as soon as possible. Feel free to reach out for any further information.  Thank you! Have a great day!', NULL, NULL, '2021-08-04 15:16:17', '2021-08-04 15:16:17'),
(15360, 12062, 20803, NULL, '2021-09-21 00:00:00.000', 'Approved', 'I spoke with ariana , a cigna rep .as per her  statement the group is in network with the effective date 05/18/2021 and the reference to my conversation is rep name and 09/13/2021 see attached screenshot for reference.', NULL, NULL, '2021-09-13 17:04:28', '2021-09-13 17:04:28'),
(15361, 3040, 20804, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:06:25', '2021-03-15 12:06:25'),
(15362, 3040, 20804, NULL, '2021-05-17 00:00:00.000', 'Approved', 'Provider participating with Cigna.   Pls see attachment', NULL, NULL, '2021-05-10 08:51:04', '2021-05-10 08:51:04'),
(15363, 3040, 20805, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:08:00', '2021-03-15 12:08:00'),
(15364, 3040, 20805, NULL, '2021-05-17 00:00:00.000', 'In Process', 'I had a word with (TOM) Cigna representative and he process the application for the provider. It will take 90-120 days. Below are the information.   Application# 12594456 Cigna Provider ID#  7954947 ', NULL, NULL, '2021-05-10 08:30:20', '2021-05-10 08:30:20'),
(15365, 1006, 20805, NULL, '2021-06-08 00:00:00.000', 'In Process', 'As per my discussion with Cigna rep, the request still shows as in process. Need to allow 90~120 business days for this to be processed  Ref# Kamaria 06/01/2021', NULL, NULL, '2021-06-01 14:52:55', '2021-06-01 14:52:55'),
(15366, 3040, 20805, NULL, '2021-06-28 00:00:00.000', 'In Process', 'I had a word with (Kristine H) with Cigna representative and she said the application is still in process.   Ref: Kristine H 06/21/2021', NULL, NULL, '2021-06-21 15:10:35', '2021-06-21 15:10:35'),
(15367, 3040, 20805, NULL, '2021-07-15 00:00:00.000', 'Approved', 'Email rcvd from: discovercigna@information.cigna.com  Subject:Welcome to the Cigna network  Dear MINI CHENNEMKARA FNP,  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.  Jeff Panter  Vice President  Provider Relations & Solutions Management  Jeff Panter	 Let’s get started Your effective date is 07/07/2021. Your provider identification number is‍ ‌7954947. Please take a moment to register for the Cigna for Health Care Professionals website (CignaforHCP.com).', NULL, NULL, '2021-07-08 14:02:57', '2021-07-08 14:02:57'),
(15368, 3040, 20806, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:08:48', '2021-03-15 12:08:48'),
(15369, 3040, 20806, NULL, '2021-05-17 00:00:00.000', 'In Process', 'I had a word with (TOM) Cigna representative and he process the application for the provider. It will take 90-120 days. Below are the information.   Application# 12594459 Cigna Provider ID# 8396912', NULL, NULL, '2021-05-10 08:30:36', '2021-05-10 08:30:36'),
(15370, 1006, 20806, NULL, '2021-06-08 00:00:00.000', 'In Process', 'As per my discussion with Cigna rep, the request still shows as in process. Need to allow 90~120 business days for this to be processed  Ref# Kamaria 06/01/2021', NULL, NULL, '2021-06-01 14:53:04', '2021-06-01 14:53:04'),
(15371, 3040, 20806, NULL, '2021-06-28 00:00:00.000', 'In Process', 'I had a word with (Kristine H) with Cigna representative and she said the application is still in process.   Ref: Kristine H 06/21/2021', NULL, NULL, '2021-06-21 15:10:31', '2021-06-21 15:10:31'),
(15372, 3040, 20806, NULL, '2021-07-15 00:00:00.000', 'Approved', 'I had a word with Joe C Cigna representative and he advised the provider is participating with Cigna with the effective date 07/07/2021.   Ref: Joe C 07/08/2021', NULL, NULL, '2021-07-08 16:45:40', '2021-07-08 16:45:40'),
(15373, 3040, 20807, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:09:05', '2021-03-15 12:09:05'),
(15374, 1005, 20807, NULL, '2021-06-08 00:00:00.000', 'Not Eligible', 'Provider is no longer working for this Practice. Eff from 12/15/2020', NULL, NULL, '2021-06-01 12:48:12', '2021-06-01 12:48:12'),
(15375, 3040, 20808, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:09:29', '2021-03-15 12:09:29'),
(15376, 3040, 20808, NULL, '2021-05-17 00:00:00.000', 'In Process', 'I had a word with (Brian) Cigna representative and the Application was submitted.   Application# 12594609 Cigna Provider ID# 9712079 ', NULL, NULL, '2021-05-10 11:07:25', '2021-05-10 11:07:25'),
(15377, 1006, 20808, NULL, '2021-06-08 00:00:00.000', 'In Process', 'As per my discussion with Cigna rep, the request still shows as in process. Need to allow 90~120 business days for this to be processed  Ref# Kamaria 06/01/2021', NULL, NULL, '2021-06-01 14:53:09', '2021-06-01 14:53:09'),
(15378, 3040, 20808, NULL, '2021-06-28 00:00:00.000', 'In Process', 'I had a word with (Kristine H) with Cigna representative and she said the application is still in process.   Ref: Kristine H 06/21/2021', NULL, NULL, '2021-06-21 15:10:27', '2021-06-21 15:10:27'),
(15379, 3040, 20808, NULL, '2021-07-09 00:00:00.000', 'Approved', 'Email rcvd from: discovercigna@information.cigna.com  Subject: Welcome to the Cigna network  Dear JAYA JACOB FNP,  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.  Jeff Panter  Vice President  Provider Relations & Solutions Management  Jeff Panter	 Let’s get started Your effective date is 06/29/2021. Your provider identification number is‍ ‌9712079. Please take a moment to register for the Cigna for Health Care Professionals website (CignaforHCP.com).   ', NULL, NULL, '2021-07-02 13:25:22', '2021-07-02 13:25:22'),
(15380, 3040, 20809, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:09:38', '2021-03-15 12:09:38'),
(15381, 3040, 20809, NULL, '2021-05-18 00:00:00.000', 'In Process', 'I had a word with (Brian) Cigna representative and the Application was submitted.   Application# 12594611 Cigna Provider ID# 3836154 ', NULL, NULL, '2021-05-11 12:51:11', '2021-05-11 12:51:11'),
(15382, 1006, 20809, NULL, '2021-06-08 00:00:00.000', 'In Process', 'As per my discussion with Cigna rep, the request still shows as in process. Need to allow 90~120 business days for this to be processed  Ref# Kamaria 06/01/2021', NULL, NULL, '2021-06-01 14:53:13', '2021-06-01 14:53:13'),
(15383, 3040, 20809, NULL, '2021-06-28 00:00:00.000', 'In Process', 'I had a word with (Kristine H) with Cigna representative and she said the application is still in process.   Ref: Kristine H 06/21/2021', NULL, NULL, '2021-06-21 15:10:22', '2021-06-21 15:10:22'),
(15384, 3040, 20809, NULL, '2021-07-09 00:00:00.000', 'Approved', 'Email rcvd from: discovercigna@information.cigna.com  Subject: Welcome to the Cigna network  Dear SIGI PAUL FNP,  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.  Jeff Panter  Vice President  Provider Relations & Solutions Management  Jeff Panter	 Let’s get started Your effective date is 06/29/2021. Your provider identification number is‍ ‌3836154. Please take a moment to register for the Cigna for Health Care Professionals website (CignaforHCP.com).', NULL, NULL, '2021-07-02 13:25:08', '2021-07-02 13:25:08'),
(15385, 3046, 20810, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:13:57', '2021-03-15 12:13:57'),
(15386, 1005, 20810, NULL, '2021-06-08 00:00:00.000', 'Not Eligible', 'Not receiving their Nasa\'s Bills for this location. Updating the task as Not Eligible after Supervisor\'s confirmation.', NULL, NULL, '2021-06-01 13:50:34', '2021-06-01 13:50:34'),
(15387, 3040, 20811, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:14:25', '2021-03-15 12:14:25'),
(15388, 3040, 20811, NULL, '2021-05-18 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, '2021-05-11 15:48:02', '2021-05-11 15:48:02'),
(15389, 3040, 20812, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:14:46', '2021-03-15 12:14:46'),
(15390, 3040, 20812, NULL, '2021-05-18 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, '2021-05-11 15:48:09', '2021-05-11 15:48:09'),
(15391, 3040, 20813, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:14:59', '2021-03-15 12:14:59'),
(15392, 3040, 20813, NULL, '2021-05-18 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, '2021-05-11 15:48:14', '2021-05-11 15:48:14'),
(15393, 3040, 20814, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:15:12', '2021-03-15 12:15:12'),
(15394, 3040, 20814, NULL, '2021-05-18 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, '2021-05-11 15:48:19', '2021-05-11 15:48:19'),
(15395, 3040, 20815, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:15:28', '2021-03-15 12:15:28'),
(15396, 3040, 20815, NULL, '2021-05-18 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, '2021-05-11 15:48:24', '2021-05-11 15:48:24'),
(15397, 3040, 20816, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:15:41', '2021-03-15 12:15:41'),
(15398, 3040, 20816, NULL, '2021-05-18 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, '2021-05-11 15:48:30', '2021-05-11 15:48:30'),
(15399, 3046, 20817, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:16:13', '2021-03-15 12:16:13'),
(15400, 1005, 20817, NULL, '2021-06-08 00:00:00.000', 'Not Eligible', 'Not receiving the Bills for this location. Updating the task as Not Eligible after Supervisor\'s confirmation.', NULL, NULL, '2021-06-01 13:51:18', '2021-06-01 13:51:18'),
(15401, 3040, 20818, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:16:43', '2021-03-15 12:16:43'),
(15402, 3040, 20818, NULL, '2021-05-18 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, '2021-05-11 15:48:35', '2021-05-11 15:48:35'),
(15403, 3046, 20819, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:16:48', '2021-03-15 12:16:48'),
(15404, 1005, 20819, NULL, '2021-06-08 00:00:00.000', 'Not Eligible', 'Not receiving the Bills for this location. Updating the task as Not Eligible after Supervisor\'s confirmation.', NULL, NULL, '2021-06-01 13:51:40', '2021-06-01 13:51:40'),
(15405, 3040, 20820, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:16:56', '2021-03-15 12:16:56'),
(15406, 3040, 20820, NULL, '2021-05-18 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, '2021-05-11 15:48:41', '2021-05-11 15:48:41'),
(15407, 3040, 20821, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:17:16', '2021-03-15 12:17:16'),
(15408, 3040, 20821, NULL, '2021-05-18 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, '2021-05-11 15:48:47', '2021-05-11 15:48:47'),
(15409, 3040, 20822, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:17:28', '2021-03-15 12:17:28'),
(15410, 3040, 20822, NULL, '2021-05-18 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, '2021-05-11 15:49:04', '2021-05-11 15:49:04'),
(15411, 3040, 20823, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:17:40', '2021-03-15 12:17:40'),
(15412, 1005, 20823, NULL, '2021-06-08 00:00:00.000', 'Not Eligible', 'Provider is no longer working for this Practice. Eff from 12/15/2020', NULL, NULL, '2021-06-01 12:48:39', '2021-06-01 12:48:39'),
(15413, 3040, 20824, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:17:53', '2021-03-15 12:17:53'),
(15414, 3040, 20824, NULL, '2021-05-18 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, '2021-05-11 15:49:15', '2021-05-11 15:49:15'),
(15415, 3040, 20825, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:18:05', '2021-03-15 12:18:05'),
(15416, 3040, 20825, NULL, '2021-05-18 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, '2021-05-11 15:49:21', '2021-05-11 15:49:21'),
(15417, 3040, 20826, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:18:17', '2021-03-15 12:18:17'),
(15418, 3040, 20826, NULL, '2021-05-18 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, '2021-05-11 15:49:27', '2021-05-11 15:49:27'),
(15419, 3040, 20827, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:18:27', '2021-03-15 12:18:27'),
(15420, 3040, 20827, NULL, '2021-05-18 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, '2021-05-11 15:49:32', '2021-05-11 15:49:32'),
(15421, 3046, 20828, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:19:49', '2021-03-15 12:19:49'),
(15422, 1005, 20828, NULL, '2021-06-08 00:00:00.000', 'Not Eligible', 'Not receiving their Nasa\'s Bills for this location. Updating the task as Not Eligible after Supervisor\'s confirmation.', NULL, NULL, '2021-06-01 13:49:18', '2021-06-01 13:49:18'),
(15423, 3046, 20829, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:20:18', '2021-03-15 12:20:18'),
(15424, 1005, 20829, NULL, '2021-06-08 00:00:00.000', 'Not Eligible', 'Not receiving the Bills for this location. Updating the task as Not Eligible after Supervisor\'s confirmation.', NULL, NULL, '2021-06-01 13:52:18', '2021-06-01 13:52:18'),
(15425, 3046, 20830, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:20:37', '2021-03-15 12:20:37'),
(15426, 1005, 20830, NULL, '2021-06-08 00:00:00.000', 'Not Eligible', 'Not receiving the Bills for this location. Updating the task as Not Eligible after Supervisor\'s confirmation.', NULL, NULL, '2021-06-01 13:52:31', '2021-06-01 13:52:31'),
(15427, 3046, 20831, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:21:33', '2021-03-15 12:21:33'),
(15428, 1005, 20831, NULL, '2021-06-08 00:00:00.000', 'Not Eligible', 'Not receiving the Bills for this location. Updating the task as Not Eligible after Supervisor\'s confirmation.', NULL, NULL, '2021-06-01 13:52:50', '2021-06-01 13:52:50'),
(15429, 3046, 20832, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:21:54', '2021-03-15 12:21:54'),
(15430, 1005, 20832, NULL, '2021-06-08 00:00:00.000', 'Not Eligible', 'Not receiving the Bills for this location. Updating the task as Not Eligible after Supervisor\'s confirmation.', NULL, NULL, '2021-06-01 13:53:12', '2021-06-01 13:53:12'),
(15431, 3046, 20833, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:22:15', '2021-03-15 12:22:15'),
(15432, 1005, 20833, NULL, '2021-06-08 00:00:00.000', 'Not Eligible', 'Not receiving the Bills for this location. Updating the task as Not Eligible after Supervisor\'s confirmation.', NULL, NULL, '2021-06-01 13:53:42', '2021-06-01 13:53:42'),
(15433, 3046, 20834, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:23:38', '2021-03-15 12:23:38'),
(15434, 1005, 20834, NULL, '2021-06-08 00:00:00.000', 'Not Eligible', 'Not receiving the Bills for this location. Updating the task as Not Eligible after Supervisor\'s confirmation.', NULL, NULL, '2021-06-01 13:55:37', '2021-06-01 13:55:37'),
(15435, 3046, 20835, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:23:56', '2021-03-15 12:23:56'),
(15436, 1005, 20835, NULL, '2021-06-08 00:00:00.000', 'Not Eligible', 'Not receiving the Bills for this location. Updating the task as Not Eligible after Supervisor\'s confirmation.', NULL, NULL, '2021-06-01 13:56:00', '2021-06-01 13:56:00'),
(15437, 3040, 20836, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:24:05', '2021-03-15 12:24:05'),
(15438, 3040, 20836, NULL, '2021-05-26 00:00:00.000', 'In Process', 'Email sent to: martha.butler@dchstx.org, dhpcontracting@dchstx.org  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Driscoll 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: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-19 15:01:08', '2021-05-19 15:01:08'),
(15439, 3040, 20836, NULL, '2021-05-31 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, '2021-05-24 08:42:27', '2021-05-24 08:42:27'),
(15440, 3046, 20837, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:24:17', '2021-03-15 12:24:17'),
(15441, 1005, 20837, NULL, '2021-06-08 00:00:00.000', 'Not Eligible', 'Not receiving the Bills for this location. Updating the task as Not Eligible after Supervisor\'s confirmation.', NULL, NULL, '2021-06-01 13:56:17', '2021-06-01 13:56:17'),
(15442, 3040, 20838, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:24:19', '2021-03-15 12:24:19'),
(15443, 3040, 20838, NULL, '2021-05-26 00:00:00.000', 'In Process', 'Email sent to: martha.butler@dchstx.org, dhpcontracting@dchstx.org  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Driscoll 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: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-19 15:02:22', '2021-05-19 15:02:22'),
(15444, 3040, 20838, NULL, '2021-05-31 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, '2021-05-24 08:42:49', '2021-05-24 08:42:49'),
(15445, 3040, 20839, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:24:37', '2021-03-15 12:24:37'),
(15446, 3040, 20839, NULL, '2021-05-26 00:00:00.000', 'In Process', 'Email sent to: martha.butler@dchstx.org, dhpcontracting@dchstx.org  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Driscoll 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: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-19 15:02:23', '2021-05-19 15:02:23'),
(15447, 3040, 20839, NULL, '2021-05-31 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, '2021-05-24 08:42:55', '2021-05-24 08:42:55'),
(15448, 3040, 20841, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:24:49', '2021-03-15 12:24:49'),
(15449, 3040, 20841, NULL, '2021-05-26 00:00:00.000', 'In Process', 'Email sent to: martha.butler@dchstx.org, dhpcontracting@dchstx.org  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Driscoll 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: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-19 15:02:24', '2021-05-19 15:02:24'),
(15450, 3040, 20841, NULL, '2021-05-31 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, '2021-05-24 08:43:00', '2021-05-24 08:43:00'),
(15451, 3040, 20842, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:25:02', '2021-03-15 12:25:02'),
(15452, 3040, 20842, NULL, '2021-05-26 00:00:00.000', 'In Process', 'Email sent to: martha.butler@dchstx.org, dhpcontracting@dchstx.org  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Driscoll 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: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-19 15:02:24', '2021-05-19 15:02:24'),
(15453, 3040, 20842, NULL, '2021-05-31 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, '2021-05-24 08:43:05', '2021-05-24 08:43:05'),
(15454, 3040, 20843, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:25:14', '2021-03-15 12:25:14'),
(15455, 3040, 20843, NULL, '2021-05-26 00:00:00.000', 'In Process', 'Email sent to: martha.butler@dchstx.org, dhpcontracting@dchstx.org  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Driscoll 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: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-19 15:02:25', '2021-05-19 15:02:25'),
(15456, 3040, 20843, NULL, '2021-05-31 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, '2021-05-24 08:43:09', '2021-05-24 08:43:09'),
(15457, 3040, 20844, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:25:29', '2021-03-15 12:25:29'),
(15458, 3040, 20844, NULL, '2021-05-26 00:00:00.000', 'In Process', 'Email sent to: martha.butler@dchstx.org, dhpcontracting@dchstx.org  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Driscoll 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: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-19 15:02:26', '2021-05-19 15:02:26'),
(15459, 3040, 20844, NULL, '2021-05-31 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, '2021-05-24 08:43:14', '2021-05-24 08:43:14'),
(15460, 3040, 20845, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:25:44', '2021-03-15 12:25:44'),
(15461, 3040, 20845, NULL, '2021-05-26 00:00:00.000', 'In Process', 'Email sent to: martha.butler@dchstx.org, dhpcontracting@dchstx.org  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Driscoll 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: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-19 15:02:27', '2021-05-19 15:02:27'),
(15462, 3040, 20845, NULL, '2021-05-31 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, '2021-05-24 08:43:19', '2021-05-24 08:43:19'),
(15463, 3040, 20846, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:25:55', '2021-03-15 12:25:55'),
(15464, 3040, 20846, NULL, '2021-05-26 00:00:00.000', 'In Process', 'Email sent to: martha.butler@dchstx.org, dhpcontracting@dchstx.org  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Driscoll 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: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-19 15:02:27', '2021-05-19 15:02:27'),
(15465, 3040, 20846, NULL, '2021-05-31 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, '2021-05-24 08:43:24', '2021-05-24 08:43:24'),
(15466, 3040, 20847, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:26:08', '2021-03-15 12:26:08'),
(15467, 3040, 20847, NULL, '2021-05-26 00:00:00.000', 'In Process', 'Email sent to: martha.butler@dchstx.org, dhpcontracting@dchstx.org  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Driscoll 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: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-19 15:02:28', '2021-05-19 15:02:28'),
(15468, 3040, 20847, NULL, '2021-05-31 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, '2021-05-24 08:43:28', '2021-05-24 08:43:28'),
(15469, 3040, 20848, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:26:22', '2021-03-15 12:26:22'),
(15470, 3040, 20848, NULL, '2021-05-26 00:00:00.000', 'In Process', 'Email sent to: martha.butler@dchstx.org, dhpcontracting@dchstx.org  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Driscoll 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: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-19 15:02:29', '2021-05-19 15:02:29'),
(15471, 3040, 20848, NULL, '2021-05-31 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, '2021-05-24 08:43:33', '2021-05-24 08:43:33'),
(15472, 3040, 20849, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:26:35', '2021-03-15 12:26:35');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(15473, 3040, 20849, NULL, '2021-05-26 00:00:00.000', 'In Process', 'Email sent to: martha.butler@dchstx.org, dhpcontracting@dchstx.org  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Driscoll 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: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-19 15:02:29', '2021-05-19 15:02:29'),
(15474, 3040, 20849, NULL, '2021-05-31 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, '2021-05-24 08:43:38', '2021-05-24 08:43:38'),
(15475, 3040, 20850, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:26:48', '2021-03-15 12:26:48'),
(15476, 1005, 20850, NULL, '2021-06-08 00:00:00.000', 'Not Eligible', 'Provider is no longer working for this Practice. Eff from 12/15/2020', NULL, NULL, '2021-06-01 12:49:00', '2021-06-01 12:49:00'),
(15477, 3040, 20851, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:26:59', '2021-03-15 12:26:59'),
(15478, 3040, 20851, NULL, '2021-05-26 00:00:00.000', 'In Process', 'Email sent to: martha.butler@dchstx.org, dhpcontracting@dchstx.org  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Driscoll 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: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-19 15:02:30', '2021-05-19 15:02:30'),
(15479, 3040, 20851, NULL, '2021-05-31 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, '2021-05-24 08:43:46', '2021-05-24 08:43:46'),
(15480, 3040, 20852, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:27:11', '2021-03-15 12:27:11'),
(15481, 3040, 20852, NULL, '2021-05-26 00:00:00.000', 'In Process', 'Email sent to: martha.butler@dchstx.org, dhpcontracting@dchstx.org  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Driscoll 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: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-19 15:02:31', '2021-05-19 15:02:31'),
(15482, 3040, 20852, NULL, '2021-05-31 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, '2021-05-24 08:43:51', '2021-05-24 08:43:51'),
(15483, 3040, 20853, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:27:25', '2021-03-15 12:27:25'),
(15484, 3040, 20853, NULL, '2021-05-26 00:00:00.000', 'In Process', 'Email sent to: martha.butler@dchstx.org, dhpcontracting@dchstx.org  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Driscoll 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: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-19 15:02:32', '2021-05-19 15:02:32'),
(15485, 3040, 20853, NULL, '2021-05-31 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, '2021-05-24 08:43:56', '2021-05-24 08:43:56'),
(15486, 3040, 20854, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:27:41', '2021-03-15 12:27:41'),
(15487, 3040, 20854, NULL, '2021-05-26 00:00:00.000', 'In Process', 'Email sent to: martha.butler@dchstx.org, dhpcontracting@dchstx.org  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Driscoll 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: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-19 15:02:33', '2021-05-19 15:02:33'),
(15488, 3040, 20854, NULL, '2021-05-31 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, '2021-05-24 08:44:01', '2021-05-24 08:44:01'),
(15489, 3040, 20855, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:29:13', '2021-03-15 12:29:13'),
(15490, 3040, 20855, NULL, '2021-05-27 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, '2021-05-20 09:09:02', '2021-05-20 09:09:02'),
(15491, 3040, 20856, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:29:38', '2021-03-15 12:29:38'),
(15492, 3040, 20856, NULL, '2021-05-27 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, '2021-05-20 09:09:06', '2021-05-20 09:09:06'),
(15493, 3040, 20857, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:30:26', '2021-03-15 12:30:26'),
(15494, 3040, 20857, NULL, '2021-05-27 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, '2021-05-20 09:09:11', '2021-05-20 09:09:11'),
(15495, 3040, 20858, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:31:00', '2021-03-15 12:31:00'),
(15496, 3040, 20858, NULL, '2021-05-27 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, '2021-05-20 09:09:15', '2021-05-20 09:09:15'),
(15497, 3040, 20859, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:31:14', '2021-03-15 12:31:14'),
(15498, 3040, 20859, NULL, '2021-05-27 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, '2021-05-20 09:09:20', '2021-05-20 09:09:20'),
(15499, 3040, 20860, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:31:27', '2021-03-15 12:31:27'),
(15500, 3040, 20860, NULL, '2021-05-27 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, '2021-05-20 09:09:24', '2021-05-20 09:09:24'),
(15501, 3040, 20861, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:31:38', '2021-03-15 12:31:38'),
(15502, 3040, 20861, NULL, '2021-05-27 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, '2021-05-20 09:09:28', '2021-05-20 09:09:28'),
(15503, 3040, 20862, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:32:06', '2021-03-15 12:32:06'),
(15504, 3040, 20862, NULL, '2021-05-27 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, '2021-05-20 09:09:33', '2021-05-20 09:09:33'),
(15505, 3040, 20863, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:32:20', '2021-03-15 12:32:20'),
(15506, 3040, 20863, NULL, '2021-05-27 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, '2021-05-20 09:09:36', '2021-05-20 09:09:36'),
(15507, 3040, 20864, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:32:38', '2021-03-15 12:32:38'),
(15508, 3040, 20864, NULL, '2021-05-27 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, '2021-05-20 09:09:40', '2021-05-20 09:09:40'),
(15509, 3040, 20865, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:32:51', '2021-03-15 12:32:51'),
(15510, 3040, 20865, NULL, '2021-05-27 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, '2021-05-20 09:09:45', '2021-05-20 09:09:45'),
(15511, 3040, 20866, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:35:44', '2021-03-15 12:35:44'),
(15512, 3040, 20866, NULL, '2021-05-24 00:00:00.000', 'In Process', 'Email sent to: PDSDallas@aetna.com  Subject: Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Greetings,   Hope you are doing well. I wanted to enroll status for the below mentioned group & providers in First Health in our group Columbus Urgent Care PA under below locations. We have an ancillary contract with Aetna so do we need to do the credentialing separately?  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: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-17 16:21:21', '2021-05-17 16:21:21'),
(15513, 3040, 20866, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: PDSDallas@aetna.com   Subject:Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||    Greetings,   Has there been any update?  Thanks ', NULL, NULL, '2021-06-07 17:54:29', '2021-06-07 17:54:29'),
(15514, 3040, 20866, NULL, '2021-06-22 00:00:00.000', 'Approved', 'Email rcvd from: AlagarSamyN@aetna.com  Subject: Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Hi Adil,  Please find the status of the below mentioned providers  CPD ID                      Provider Name                         Tax id                   Status             Effective date  2909784               Columbus Urgent Care PA     47-1914151             Active               3/1/2020  N/A                        George, Jeemol                        47-1914151          not found           Not Applicable  3365489                      Jose, Julie                            47-1914151   given tin not linked  Not Applicable  3028331                  Stephen, Ani                          47-1914151   given tin not linked  Not Applicable  1107473           Piccione JR, James M                   47-1914151              Active                   10/1/2019  3362053               Brown, Brittany                        47-1914151    given tin not linked Not Applicable  N/A                Chennemkara, Mini Philip              47-1914151          not found         Not Applicable  N/A                        Abraham, Glory                        47-1914151          not found         Not Applicable  N/A                      Fernandus, Limy                         47-1914151         not found         Not Applicable  2551832                 Rauf, Abdur                              47-1914151  given tin not linked Not Applicable  N/A            Kourouma , Odette Tiranke                47-1914151         not found         Not Applicable  3362048            Joseph, Vibitha                              47-1914151  given tin not linked Not Applicable  3315496                Thomas, Cini                             47-1914151 given tin not linked Not Applicable  N/A                    Abraham, Jeena                            47-1914151         not found          Not Applicable  N/A                         PAUL, SIGI                                 47-1914151         not found         Not Applicable  N/A                         Jacob, Jaya                                 47-1914151         not found        Not Applicable', NULL, NULL, '2021-06-15 10:40:16', '2021-06-15 10:40:16'),
(15515, 3040, 20867, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:36:19', '2021-03-15 12:36:19'),
(15516, 3040, 20867, NULL, '2021-05-24 00:00:00.000', 'In Process', 'Email sent to: PDSDallas@aetna.com  Subject: Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Greetings,   Hope you are doing well. I wanted to enroll status for the below mentioned group & providers in First Health in our group Columbus Urgent Care PA under below locations. We have an ancillary contract with Aetna so do we need to do the credentialing separately?  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: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-17 16:14:58', '2021-05-17 16:14:58'),
(15517, 3040, 20867, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: PDSDallas@aetna.com   Subject:Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||    Greetings,   Has there been any update?  Thanks ', NULL, NULL, '2021-06-07 17:54:23', '2021-06-07 17:54:23'),
(15518, 3040, 20867, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email rcvd from: AlagarSamyN@aetna.com  Subject: Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Hi Adil,  Please find the status of the below mentioned providers  CPD ID                      Provider Name                         Tax id                   Status             Effective date  2909784               Columbus Urgent Care PA     47-1914151             Active               3/1/2020  N/A                        George, Jeemol                        47-1914151          not found           Not Applicable  3365489                      Jose, Julie                            47-1914151   given tin not linked  Not Applicable  3028331                  Stephen, Ani                          47-1914151   given tin not linked  Not Applicable  1107473           Piccione JR, James M                   47-1914151              Active                   10/1/2019  3362053               Brown, Brittany                        47-1914151    given tin not linked Not Applicable  N/A                Chennemkara, Mini Philip              47-1914151          not found         Not Applicable  N/A                        Abraham, Glory                        47-1914151          not found         Not Applicable  N/A                      Fernandus, Limy                         47-1914151         not found         Not Applicable  2551832                 Rauf, Abdur                              47-1914151  given tin not linked Not Applicable  N/A            Kourouma , Odette Tiranke                47-1914151         not found         Not Applicable  3362048            Joseph, Vibitha                              47-1914151  given tin not linked Not Applicable  3315496                Thomas, Cini                             47-1914151 given tin not linked Not Applicable  N/A                    Abraham, Jeena                            47-1914151         not found          Not Applicable  N/A                         PAUL, SIGI                                 47-1914151         not found         Not Applicable  N/A                         Jacob, Jaya                                 47-1914151         not found        Not Applicable', NULL, NULL, '2021-06-15 10:40:02', '2021-06-15 10:40:02'),
(15519, 11056, 20867, NULL, '2021-07-08 00:00:00.000', 'In Process', 'Email sent to : AlagarSamyN@aetna.com  Sub : Enrollment (linking) Query - CUCC - First Health  Good morning,  Hope you are doing well. Kindly guide me the procedure to link the providers to the TAX I.D.   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 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  Kindly Respond to me soon. If you need any further information feel free to contact me.  Thank you!', NULL, NULL, '2021-07-01 10:30:41', '2021-07-01 10:30:41'),
(15520, 3040, 20867, 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 11:31:52', '2021-07-19 11:31:52'),
(15521, 11056, 20867, 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 16:22:11', '2021-08-04 16:22:11'),
(15522, 3040, 20867, 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 12:01:23', '2021-08-30 12:01:23'),
(15523, 10057, 20867, 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 17:00:17', '2021-10-11 17:00:17'),
(15524, 10057, 20867, 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 10:34:20', '2021-10-18 10:34:20'),
(15525, 10057, 20867, 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 17:09:15', '2021-11-17 17:09:15'),
(15526, 10057, 20867, 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 17:35:22', '2021-11-22 17:35:22'),
(15527, 10057, 20867, 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 17:41:37', '2021-11-22 17:41:37'),
(15528, 10057, 20867, 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 13:36:53', '2021-12-02 13:36:53'),
(15529, 10057, 20867, 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 11:05:14', '2021-12-09 11:05:14'),
(15530, 10057, 20867, 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 14:33:32', '2021-12-16 14:33:32'),
(15531, 10057, 20867, 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 10:54:38', '2021-12-22 10:54:38'),
(15532, 10057, 20867, 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 15:52:22', '2021-12-29 15:52:22'),
(15533, 19067, 20867, 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 13:33:53', '2022-01-04 13:33:53'),
(15534, 20067, 20867, 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 12:19:55', '2022-01-19 12:19:55'),
(15535, 20067, 20867, 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 12:34:24', '2022-01-27 12:34:24'),
(15536, 20067, 20867, NULL, '2022-02-09 00:00:00.000', 'In Process', 'Application submitted online. Allow 45-60 Days to process the request. See the attachment', NULL, NULL, '2022-02-02 11:00:10', '2022-02-02 11:00:10'),
(15537, 20067, 20867, 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 17:11:25', '2022-02-17 17:11:25'),
(15538, 20067, 20867, 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 10:51:14', '2022-03-01 10:51:14'),
(15539, 3040, 20868, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:36:39', '2021-03-15 12:36:39'),
(15540, 3040, 20868, NULL, '2021-05-24 00:00:00.000', 'In Process', 'Email sent to: PDSDallas@aetna.com  Subject: Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Greetings,   Hope you are doing well. I wanted to enroll status for the below mentioned group & providers in First Health in our group Columbus Urgent Care PA under below locations. We have an ancillary contract with Aetna so do we need to do the credentialing separately?  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: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-17 16:15:03', '2021-05-17 16:15:03');
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
(15541, 3040, 20868, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: PDSDallas@aetna.com   Subject:Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||    Greetings,   Has there been any update?  Thanks ', NULL, NULL, '2021-06-07 17:54:16', '2021-06-07 17:54:16'),
(15542, 3040, 20868, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email rcvd from: AlagarSamyN@aetna.com  Subject: Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Hi Adil,  Please find the status of the below mentioned providers  CPD ID                      Provider Name                         Tax id                   Status             Effective date  2909784               Columbus Urgent Care PA     47-1914151             Active               3/1/2020  N/A                        George, Jeemol                        47-1914151          not found           Not Applicable  3365489                      Jose, Julie                            47-1914151   given tin not linked  Not Applicable  3028331                  Stephen, Ani                          47-1914151   given tin not linked  Not Applicable  1107473           Piccione JR, James M                   47-1914151              Active                   10/1/2019  3362053               Brown, Brittany                        47-1914151    given tin not linked Not Applicable  N/A                Chennemkara, Mini Philip              47-1914151          not found         Not Applicable  N/A                        Abraham, Glory                        47-1914151          not found         Not Applicable  N/A                      Fernandus, Limy                         47-1914151         not found         Not Applicable  2551832                 Rauf, Abdur                              47-1914151  given tin not linked Not Applicable  N/A            Kourouma , Odette Tiranke                47-1914151         not found         Not Applicable  3362048            Joseph, Vibitha                              47-1914151  given tin not linked Not Applicable  3315496                Thomas, Cini                             47-1914151 given tin not linked Not Applicable  N/A                    Abraham, Jeena                            47-1914151         not found          Not Applicable  N/A                         PAUL, SIGI                                 47-1914151         not found         Not Applicable  N/A                         Jacob, Jaya                                 47-1914151         not found        Not Applicable', NULL, NULL, '2021-06-15 10:39:16', '2021-06-15 10:39:16'),
(15543, 11056, 20868, NULL, '2021-07-08 00:00:00.000', 'In Process', 'Email sent to : AlagarSamyN@aetna.com  Sub : Enrollment (linking) Query - CUCC - First Health  Good morning,  Hope you are doing well. Kindly guide me the procedure to link the providers to the TAX I.D.   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 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  Kindly Respond to me soon.If you need any further information feel free to contact me.  Thank you!', NULL, NULL, '2021-07-01 10:30:25', '2021-07-01 10:30:25'),
(15544, 3040, 20868, 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 11:31:49', '2021-07-19 11:31:49'),
(15545, 11056, 20868, 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 16:22:02', '2021-08-04 16:22:02'),
(15546, 3040, 20868, 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 12:01:24', '2021-08-30 12:01:24'),
(15547, 10057, 20868, 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 17:00:10', '2021-10-11 17:00:10'),
(15548, 10057, 20868, 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 10:34:08', '2021-10-18 10:34:08'),
(15549, 10057, 20868, 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 17:09:08', '2021-11-17 17:09:08'),
(15550, 10057, 20868, 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 17:35:15', '2021-11-22 17:35:15'),
(15551, 10057, 20868, 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 17:41:31', '2021-11-22 17:41:31'),
(15552, 10057, 20868, 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 13:36:45', '2021-12-02 13:36:45'),
(15553, 10057, 20868, 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 11:05:08', '2021-12-09 11:05:08'),
(15554, 10057, 20868, 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 14:33:25', '2021-12-16 14:33:25'),
(15555, 10057, 20868, 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 10:54:30', '2021-12-22 10:54:30'),
(15556, 10057, 20868, 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 15:52:17', '2021-12-29 15:52:17'),
(15557, 19067, 20868, 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 13:33:47', '2022-01-04 13:33:47'),
(15558, 20067, 20868, 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 12:19:49', '2022-01-19 12:19:49'),
(15559, 20067, 20868, 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 12:34:17', '2022-01-27 12:34:17'),
(15560, 20067, 20868, NULL, '2022-02-09 00:00:00.000', 'In Process', '	 Application submitted online. Allow 45-60 Days to process the request. See the attachment', NULL, NULL, '2022-02-02 10:55:15', '2022-02-02 10:55:15'),
(15561, 20067, 20868, 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 17:11:18', '2022-02-17 17:11:18'),
(15562, 20067, 20868, 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 10:51:08', '2022-03-01 10:51:08'),
(15563, 3040, 20869, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:37:25', '2021-03-15 12:37:25'),
(15564, 3040, 20869, NULL, '2021-05-24 00:00:00.000', 'In Process', 'Email sent to: PDSDallas@aetna.com  Subject: Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Greetings,   Hope you are doing well. I wanted to enroll status for the below mentioned group & providers in First Health in our group Columbus Urgent Care PA under below locations. We have an ancillary contract with Aetna so do we need to do the credentialing separately?  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: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-17 16:15:07', '2021-05-17 16:15:07'),
(15565, 3040, 20869, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: PDSDallas@aetna.com   Subject:Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||    Greetings,   Has there been any update?  Thanks ', NULL, NULL, '2021-06-07 17:54:11', '2021-06-07 17:54:11'),
(15566, 3040, 20869, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email rcvd from: AlagarSamyN@aetna.com  Subject: Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Hi Adil,  Please find the status of the below mentioned providers  CPD ID                      Provider Name                         Tax id                   Status             Effective date  2909784               Columbus Urgent Care PA     47-1914151             Active               3/1/2020  N/A                        George, Jeemol                        47-1914151          not found           Not Applicable  3365489                      Jose, Julie                            47-1914151   given tin not linked  Not Applicable  3028331                  Stephen, Ani                          47-1914151   given tin not linked  Not Applicable  1107473           Piccione JR, James M                   47-1914151              Active                   10/1/2019  3362053               Brown, Brittany                        47-1914151    given tin not linked Not Applicable  N/A                Chennemkara, Mini Philip              47-1914151          not found         Not Applicable  N/A                        Abraham, Glory                        47-1914151          not found         Not Applicable  N/A                      Fernandus, Limy                         47-1914151         not found         Not Applicable  2551832                 Rauf, Abdur                              47-1914151  given tin not linked Not Applicable  N/A            Kourouma , Odette Tiranke                47-1914151         not found         Not Applicable  3362048            Joseph, Vibitha                              47-1914151  given tin not linked Not Applicable  3315496                Thomas, Cini                             47-1914151 given tin not linked Not Applicable  N/A                    Abraham, Jeena                            47-1914151         not found          Not Applicable  N/A                         PAUL, SIGI                                 47-1914151         not found         Not Applicable  N/A                         Jacob, Jaya                                 47-1914151         not found        Not Applicable', NULL, NULL, '2021-06-15 10:39:11', '2021-06-15 10:39:11'),
(15567, 11056, 20869, NULL, '2021-07-08 00:00:00.000', 'In Process', 'Email sent to : AlagarSamyN@aetna.com  Sub : Enrollment (linking) Query - CUCC - First Health  Good morning,  Hope you are doing well. Kindly guide me the procedure to link the providers to the TAX I.D.   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 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  Kindly Respond to me soon.If you need any further information feel free to contact me.  Thank you!', NULL, NULL, '2021-07-01 10:30:18', '2021-07-01 10:30:18'),
(15568, 3040, 20869, 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 11:31:47', '2021-07-19 11:31:47'),
(15569, 11056, 20869, 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 16:21:46', '2021-08-04 16:21:46'),
(15570, 3040, 20869, 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 12:01:23', '2021-08-30 12:01:23'),
(15571, 10057, 20869, 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 17:00:01', '2021-10-11 17:00:01'),
(15572, 10057, 20869, 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 10:33:59', '2021-10-18 10:33:59'),
(15573, 10057, 20869, 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 17:09:01', '2021-11-17 17:09:01'),
(15574, 10057, 20869, 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 17:35:09', '2021-11-22 17:35:09'),
(15575, 10057, 20869, 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 17:41:20', '2021-11-22 17:41:20'),
(15576, 10057, 20869, 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 13:36:38', '2021-12-02 13:36:38'),
(15577, 10057, 20869, 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 11:05:02', '2021-12-09 11:05:02'),
(15578, 10057, 20869, 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 14:33:19', '2021-12-16 14:33:19'),
(15579, 10057, 20869, 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 10:54:20', '2021-12-22 10:54:20'),
(15580, 10057, 20869, 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 15:52:12', '2021-12-29 15:52:12'),
(15581, 19067, 20869, 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 13:33:43', '2022-01-04 13:33:43'),
(15582, 20067, 20869, 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 12:19:44', '2022-01-19 12:19:44'),
(15583, 20067, 20869, 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 12:34:11', '2022-01-27 12:34:11'),
(15584, 20067, 20869, NULL, '2022-02-09 00:00:00.000', 'In Process', 'Application submitted online. Allow 45-60 Days to process the request. See the attachment', NULL, NULL, '2022-02-02 10:50:34', '2022-02-02 10:50:34'),
(15585, 20067, 20869, 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 17:11:13', '2022-02-17 17:11:13'),
(15586, 20067, 20869, 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 10:51:02', '2022-03-01 10:51:02'),
(15587, 3040, 20870, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:38:20', '2021-03-15 12:38:20'),
(15588, 3040, 20870, NULL, '2021-05-24 00:00:00.000', 'In Process', 'Email sent to: PDSDallas@aetna.com  Subject: Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Greetings,   Hope you are doing well. I wanted to enroll status for the below mentioned group & providers in First Health in our group Columbus Urgent Care PA under below locations. We have an ancillary contract with Aetna so do we need to do the credentialing separately?  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: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-17 16:15:12', '2021-05-17 16:15:12'),
(15589, 3040, 20870, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: PDSDallas@aetna.com   Subject:Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||    Greetings,   Has there been any update?  Thanks ', NULL, NULL, '2021-06-07 17:54:07', '2021-06-07 17:54:07'),
(15590, 3040, 20870, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email rcvd from: AlagarSamyN@aetna.com  Subject: Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Hi Adil,  Please find the status of the below mentioned providers  CPD ID                      Provider Name                         Tax id                   Status             Effective date  2909784               Columbus Urgent Care PA     47-1914151             Active               3/1/2020  N/A                        George, Jeemol                        47-1914151          not found           Not Applicable  3365489                      Jose, Julie                            47-1914151   given tin not linked  Not Applicable  3028331                  Stephen, Ani                          47-1914151   given tin not linked  Not Applicable  1107473           Piccione JR, James M                   47-1914151              Active                   10/1/2019  3362053               Brown, Brittany                        47-1914151    given tin not linked Not Applicable  N/A                Chennemkara, Mini Philip              47-1914151          not found         Not Applicable  N/A                        Abraham, Glory                        47-1914151          not found         Not Applicable  N/A                      Fernandus, Limy                         47-1914151         not found         Not Applicable  2551832                 Rauf, Abdur                              47-1914151  given tin not linked Not Applicable  N/A            Kourouma , Odette Tiranke                47-1914151         not found         Not Applicable  3362048            Joseph, Vibitha                              47-1914151  given tin not linked Not Applicable  3315496                Thomas, Cini                             47-1914151 given tin not linked Not Applicable  N/A                    Abraham, Jeena                            47-1914151         not found          Not Applicable  N/A                         PAUL, SIGI                                 47-1914151         not found         Not Applicable  N/A                         Jacob, Jaya                                 47-1914151         not found        Not Applicable', NULL, NULL, '2021-06-15 10:39:06', '2021-06-15 10:39:06'),
(15591, 11056, 20870, NULL, '2021-07-08 00:00:00.000', 'In Process', 'Email sent to : AlagarSamyN@aetna.com  Sub : Enrollment (linking) Query - CUCC - First Health  Good morning,  Hope you are doing well. Kindly guide me the procedure to link the providers to the TAX I.D.   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 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  Kindly Respond to me soon.If you need any further information feel free to contact me.  Thank you!', NULL, NULL, '2021-07-01 10:30:12', '2021-07-01 10:30:12'),
(15592, 3040, 20870, 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 11:31:44', '2021-07-19 11:31:44'),
(15593, 11056, 20870, 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 16:21:33', '2021-08-04 16:21:33'),
(15594, 3040, 20870, 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 12:01:22', '2021-08-30 12:01:22'),
(15595, 10057, 20870, 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 16:59:54', '2021-10-11 16:59:54');
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
(15596, 10057, 20870, 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 10:33:49', '2021-10-18 10:33:49'),
(15597, 10057, 20870, 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 17:08:55', '2021-11-17 17:08:55'),
(15598, 10057, 20870, 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 17:35:02', '2021-11-22 17:35:02'),
(15599, 10057, 20870, 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 17:41:14', '2021-11-22 17:41:14'),
(15600, 10057, 20870, NULL, '2021-12-21 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, '2021-12-14 10:59:48', '2021-12-14 10:59:48'),
(15601, 10057, 20870, 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 14:33:12', '2021-12-16 14:33:12'),
(15602, 10057, 20870, 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 10:54:10', '2021-12-22 10:54:10'),
(15603, 10057, 20870, 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 15:52:07', '2021-12-29 15:52:07'),
(15604, 19067, 20870, 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 13:33:35', '2022-01-04 13:33:35'),
(15605, 20067, 20870, 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 12:19:36', '2022-01-19 12:19:36'),
(15606, 20067, 20870, 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 12:34:03', '2022-01-27 12:34:03'),
(15607, 20067, 20870, NULL, '2022-02-09 00:00:00.000', 'In Process', 'Application submitted online. Allow 45-60 Days to process the request. See the attachment', NULL, NULL, '2022-02-02 10:45:19', '2022-02-02 10:45:19'),
(15608, 20067, 20870, 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 17:11:08', '2022-02-17 17:11:08'),
(15609, 20067, 20870, 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 10:50:56', '2022-03-01 10:50:56'),
(15610, 3046, 20871, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:38:30', '2021-03-15 12:38:30'),
(15611, 1005, 20871, NULL, '2021-06-08 00:00:00.000', 'Not Eligible', 'Not receiving the Bills for this location. Updating the task as Not Eligible after Supervisor\'s confirmation.', NULL, NULL, '2021-06-01 13:51:51', '2021-06-01 13:51:51'),
(15612, 3040, 20872, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:38:42', '2021-03-15 12:38:42'),
(15613, 3040, 20872, NULL, '2021-05-24 00:00:00.000', 'In Process', 'Email sent to: PDSDallas@aetna.com  Subject: Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Greetings,   Hope you are doing well. I wanted to enroll status for the below mentioned group & providers in First Health in our group Columbus Urgent Care PA under below locations. We have an ancillary contract with Aetna so do we need to do the credentialing separately?  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: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-17 16:15:16', '2021-05-17 16:15:16'),
(15614, 3040, 20872, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: PDSDallas@aetna.com   Subject:Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||    Greetings,   Has there been any update?  Thanks ', NULL, NULL, '2021-06-07 17:54:02', '2021-06-07 17:54:02'),
(15615, 3040, 20872, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email rcvd from: AlagarSamyN@aetna.com  Subject: Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Hi Adil,  Please find the status of the below mentioned providers  CPD ID                      Provider Name                         Tax id                   Status             Effective date  2909784               Columbus Urgent Care PA     47-1914151             Active               3/1/2020  N/A                        George, Jeemol                        47-1914151          not found           Not Applicable  3365489                      Jose, Julie                            47-1914151   given tin not linked  Not Applicable  3028331                  Stephen, Ani                          47-1914151   given tin not linked  Not Applicable  1107473           Piccione JR, James M                   47-1914151              Active                   10/1/2019  3362053               Brown, Brittany                        47-1914151    given tin not linked Not Applicable  N/A                Chennemkara, Mini Philip              47-1914151          not found         Not Applicable  N/A                        Abraham, Glory                        47-1914151          not found         Not Applicable  N/A                      Fernandus, Limy                         47-1914151         not found         Not Applicable  2551832                 Rauf, Abdur                              47-1914151  given tin not linked Not Applicable  N/A            Kourouma , Odette Tiranke                47-1914151         not found         Not Applicable  3362048            Joseph, Vibitha                              47-1914151  given tin not linked Not Applicable  3315496                Thomas, Cini                             47-1914151 given tin not linked Not Applicable  N/A                    Abraham, Jeena                            47-1914151         not found          Not Applicable  N/A                         PAUL, SIGI                                 47-1914151         not found         Not Applicable  N/A                         Jacob, Jaya                                 47-1914151         not found        Not Applicable', NULL, NULL, '2021-06-15 10:38:56', '2021-06-15 10:38:56'),
(15616, 11056, 20872, NULL, '2021-07-08 00:00:00.000', 'In Process', 'Email sent to : AlagarSamyN@aetna.com  Sub : Enrollment (linking) Query - CUCC - First Health  Good morning,  Hope you are doing well. Kindly guide me the procedure to link the providers to the TAX I.D.   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 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  Kindly Respond to me soon.If you need any further information feel free to contact me.  Thank you!', NULL, NULL, '2021-07-01 10:30:04', '2021-07-01 10:30:04'),
(15617, 3040, 20872, 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 11:31:41', '2021-07-19 11:31:41'),
(15618, 11056, 20872, 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 16:21:20', '2021-08-04 16:21:20'),
(15619, 3040, 20872, 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 12:01:22', '2021-08-30 12:01:22'),
(15620, 10057, 20872, 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 16:59:47', '2021-10-11 16:59:47'),
(15621, 10057, 20872, 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 10:33:38', '2021-10-18 10:33:38'),
(15622, 10057, 20872, 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 17:08:47', '2021-11-17 17:08:47'),
(15623, 10057, 20872, 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 17:34:56', '2021-11-22 17:34:56'),
(15624, 10057, 20872, 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 17:41:07', '2021-11-22 17:41:07'),
(15625, 10057, 20872, 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 13:36:32', '2021-12-02 13:36:32'),
(15626, 10057, 20872, 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 11:04:55', '2021-12-09 11:04:55'),
(15627, 10057, 20872, 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 14:33:06', '2021-12-16 14:33:06'),
(15628, 10057, 20872, 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 10:54:01', '2021-12-22 10:54:01'),
(15629, 10057, 20872, 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 15:52:02', '2021-12-29 15:52:02'),
(15630, 19067, 20872, 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 13:33:28', '2022-01-04 13:33:28'),
(15631, 20067, 20872, 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 12:19:30', '2022-01-19 12:19:30'),
(15632, 20067, 20872, 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 12:33:50', '2022-01-27 12:33:50'),
(15633, 20067, 20872, NULL, '2022-02-09 00:00:00.000', 'In Process', 'Application submitted online. Allow 45-60 Days to process the request. See the attachment', NULL, NULL, '2022-02-02 10:40:10', '2022-02-02 10:40:10'),
(15634, 20067, 20872, 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 17:11:00', '2022-02-17 17:11:00'),
(15635, 20067, 20872, 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 10:50:35', '2022-03-01 10:50:35'),
(15636, 3040, 20873, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:38:57', '2021-03-15 12:38:57'),
(15637, 1005, 20873, NULL, '2021-06-08 00:00:00.000', 'Not Eligible', 'Provider is no longer working for this Practice. Eff from 12/15/2020', NULL, NULL, '2021-06-01 12:49:19', '2021-06-01 12:49:19'),
(15638, 3040, 20874, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:39:28', '2021-03-15 12:39:28'),
(15639, 3040, 20874, NULL, '2021-05-24 00:00:00.000', 'In Process', 'Email sent to: PDSDallas@aetna.com  Subject: Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Greetings,   Hope you are doing well. I wanted to enroll status for the below mentioned group & providers in First Health in our group Columbus Urgent Care PA under below locations. We have an ancillary contract with Aetna so do we need to do the credentialing separately?  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: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-17 16:15:20', '2021-05-17 16:15:20'),
(15640, 3040, 20874, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: PDSDallas@aetna.com   Subject:Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||    Greetings,   Has there been any update?  Thanks ', NULL, NULL, '2021-06-07 17:53:57', '2021-06-07 17:53:57'),
(15641, 3040, 20874, NULL, '2021-06-22 00:00:00.000', 'Approved', 'Group has an ancillary contract. There is no need to add the individual providers.  ', NULL, NULL, '2021-06-15 09:56:21', '2021-06-15 09:56:21'),
(15642, 3040, 20874, NULL, '2021-06-22 00:00:00.000', 'Revalidation', 'Email rcvd from: AlagarSamyN@aetna.com  Subject: Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Hi Adil,  Please find the status of the below mentioned providers  CPD ID                      Provider Name                         Tax id                   Status             Effective date  2909784               Columbus Urgent Care PA     47-1914151             Active               3/1/2020  N/A                        George, Jeemol                        47-1914151          not found           Not Applicable  3365489                      Jose, Julie                            47-1914151   given tin not linked  Not Applicable  3028331                  Stephen, Ani                          47-1914151   given tin not linked  Not Applicable  1107473           Piccione JR, James M                   47-1914151              Active                   10/1/2019  3362053               Brown, Brittany                        47-1914151    given tin not linked Not Applicable  N/A                Chennemkara, Mini Philip              47-1914151          not found         Not Applicable  N/A                        Abraham, Glory                        47-1914151          not found         Not Applicable  N/A                      Fernandus, Limy                         47-1914151         not found         Not Applicable  2551832                 Rauf, Abdur                              47-1914151  given tin not linked Not Applicable  N/A            Kourouma , Odette Tiranke                47-1914151         not found         Not Applicable  3362048            Joseph, Vibitha                              47-1914151  given tin not linked Not Applicable  3315496                Thomas, Cini                             47-1914151 given tin not linked Not Applicable  N/A                    Abraham, Jeena                            47-1914151         not found          Not Applicable  N/A                         PAUL, SIGI                                 47-1914151         not found         Not Applicable  N/A                         Jacob, Jaya                                 47-1914151         not found        Not Applicable', NULL, NULL, '2021-06-15 10:38:50', '2021-06-15 10:38:50'),
(15643, 11056, 20874, NULL, '2021-07-08 00:00:00.000', 'Revalidation', 'Email sent to : AlagarSamyN@aetna.com  Sub : Enrollment (linking) Query - CUCC - First Health  Good morning,  Hope you are doing well. Kindly guide me the procedure to link the providers to the TAX I.D.   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 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  Kindly Respond to me soon. If you need any further information feel free to contact me.  Thank you!', NULL, NULL, '2021-07-01 10:29:55', '2021-07-01 10:29:55'),
(15644, 3040, 20874, NULL, '2021-07-26 00:00:00.000', 'Revalidation', '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 11:31:38', '2021-07-19 11:31:38'),
(15645, 11056, 20874, NULL, '2021-08-12 00:00:00.000', 'Revalidation', '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 16:21:12', '2021-08-04 16:21:12'),
(15646, 3040, 20874, NULL, '2021-09-06 00:00:00.000', 'Revalidation', '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 12:01:21', '2021-08-30 12:01:21'),
(15647, 10057, 20874, NULL, '2021-11-12 00:00:00.000', 'Revalidation', 'Email Sent To : thandapanim@aetna.com  Sub: First Health Networks - Enrollment Request Log #9266762102525124 location information required  Good Afternoon,  Hope this email finds you well. Please advise me on the enrollment status for the below mentioned 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 Jose, Julie	1447883061 Thomas, Cini	1134777238 Brown, Brittany	1275163537 Stephen, Ani	1588959118 Joseph, Vibitha	1952931560 George, Jeemol	1497219067   Looking forward to your kind response.', NULL, NULL, '2021-11-02 14:06:05', '2021-11-02 14:06:05'),
(15648, 10057, 20874, NULL, '2021-11-29 00:00:00.000', 'Revalidation', '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 17:36:37', '2021-11-22 17:36:37'),
(15649, 10057, 20874, NULL, '2021-11-29 00:00:00.000', 'Revalidation', '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 17:40:59', '2021-11-22 17:40:59'),
(15650, 10057, 20874, NULL, '2021-12-16 00:00:00.000', 'Revalidation', '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 11:04:48', '2021-12-09 11:04:48'),
(15651, 10057, 20874, NULL, '2021-12-23 00:00:00.000', 'Revalidation', '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 14:33:00', '2021-12-16 14:33:00'),
(15652, 10057, 20874, NULL, '2021-12-30 00:00:00.000', 'Revalidation', '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 10:53:53', '2021-12-22 10:53:53'),
(15653, 10057, 20874, NULL, '2022-01-05 00:00:00.000', 'Revalidation', '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 15:51:57', '2021-12-29 15:51:57'),
(15654, 20067, 20874, NULL, '2022-01-26 00:00:00.000', 'Revalidation', '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 12:19:25', '2022-01-19 12:19:25'),
(15655, 20067, 20874, NULL, '2022-02-03 00:00:00.000', 'Revalidation', '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 12:32:16', '2022-01-27 12:32:16'),
(15656, 20067, 20874, NULL, '2022-02-09 00:00:00.000', 'Revalidation', 'Application submitted online. Allow 45-60 Days to process the request. See the attachment ', NULL, NULL, '2022-02-02 10:34:06', '2022-02-02 10:34:06'),
(15657, 20067, 20874, NULL, '2022-02-24 00:00:00.000', 'Revalidation', 'There is no follow ups,  Allow 90 days to process the request.', NULL, NULL, '2022-02-17 17:10:53', '2022-02-17 17:10:53'),
(15658, 3046, 20875, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:39:32', '2021-03-15 12:39:32'),
(15659, 1005, 20875, NULL, '2021-06-08 00:00:00.000', 'Not Eligible', 'Not receiving their Nasa\'s Bills for this location. Updating the task as Not Eligible after Supervisor\'s confirmation.', NULL, NULL, '2021-06-01 13:50:48', '2021-06-01 13:50:48'),
(15660, 3040, 20876, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:39:38', '2021-03-15 12:39:38'),
(15661, 3040, 20876, NULL, '2021-05-24 00:00:00.000', 'In Process', 'Email sent to: PDSDallas@aetna.com  Subject: Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Greetings,   Hope you are doing well. I wanted to enroll status for the below mentioned group & providers in First Health in our group Columbus Urgent Care PA under below locations. We have an ancillary contract with Aetna so do we need to do the credentialing separately?  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: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-17 16:15:24', '2021-05-17 16:15:24'),
(15662, 3040, 20876, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: PDSDallas@aetna.com   Subject:Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||    Greetings,   Has there been any update?  Thanks ', NULL, NULL, '2021-06-07 17:53:52', '2021-06-07 17:53:52'),
(15663, 3040, 20876, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email rcvd from: AlagarSamyN@aetna.com  Subject: Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Hi Adil,  Please find the status of the below mentioned providers  CPD ID                      Provider Name                         Tax id                   Status             Effective date  2909784               Columbus Urgent Care PA     47-1914151             Active               3/1/2020  N/A                        George, Jeemol                        47-1914151          not found           Not Applicable  3365489                      Jose, Julie                            47-1914151   given tin not linked  Not Applicable  3028331                  Stephen, Ani                          47-1914151   given tin not linked  Not Applicable  1107473           Piccione JR, James M                   47-1914151              Active                   10/1/2019  3362053               Brown, Brittany                        47-1914151    given tin not linked Not Applicable  N/A                Chennemkara, Mini Philip              47-1914151          not found         Not Applicable  N/A                        Abraham, Glory                        47-1914151          not found         Not Applicable  N/A                      Fernandus, Limy                         47-1914151         not found         Not Applicable  2551832                 Rauf, Abdur                              47-1914151  given tin not linked Not Applicable  N/A            Kourouma , Odette Tiranke                47-1914151         not found         Not Applicable  3362048            Joseph, Vibitha                              47-1914151  given tin not linked Not Applicable  3315496                Thomas, Cini                             47-1914151 given tin not linked Not Applicable  N/A                    Abraham, Jeena                            47-1914151         not found          Not Applicable  N/A                         PAUL, SIGI                                 47-1914151         not found         Not Applicable  N/A                         Jacob, Jaya                                 47-1914151         not found        Not Applicable', NULL, NULL, '2021-06-15 10:38:23', '2021-06-15 10:38:23');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(15664, 11056, 20876, NULL, '2021-07-08 00:00:00.000', 'In Process', 'Email sent to : AlagarSamyN@aetna.com  Sub : Enrollment (linking) Query - CUCC - First Health  Good morning,  Hope you are doing well. Kindly guide me the procedure to link the providers to the TAX I.D.   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 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  Kindly Respond to me soon.If you need any further information feel free to contact me.  Thank you!', NULL, NULL, '2021-07-01 10:29:42', '2021-07-01 10:29:42'),
(15665, 3040, 20876, 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 11:31:34', '2021-07-19 11:31:34'),
(15666, 11056, 20876, 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 16:21:01', '2021-08-04 16:21:01'),
(15667, 3040, 20876, 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 12:01:21', '2021-08-30 12:01:21'),
(15668, 10057, 20876, 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 16:59:39', '2021-10-11 16:59:39'),
(15669, 10057, 20876, 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 10:32:09', '2021-10-18 10:32:09'),
(15670, 10057, 20876, 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 17:08:41', '2021-11-17 17:08:41'),
(15671, 10057, 20876, 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 17:34:40', '2021-11-22 17:34:40'),
(15672, 10057, 20876, 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 17:40:53', '2021-11-22 17:40:53'),
(15673, 10057, 20876, 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 13:36:26', '2021-12-02 13:36:26'),
(15674, 10057, 20876, 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 11:04:41', '2021-12-09 11:04:41'),
(15675, 10057, 20876, 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 14:32:54', '2021-12-16 14:32:54'),
(15676, 10057, 20876, 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 10:53:45', '2021-12-22 10:53:45'),
(15677, 10057, 20876, 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 15:51:53', '2021-12-29 15:51:53'),
(15678, 19067, 20876, 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 13:33:23', '2022-01-04 13:33:23'),
(15679, 20067, 20876, 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 12:19:20', '2022-01-19 12:19:20'),
(15680, 20067, 20876, 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 12:32:11', '2022-01-27 12:32:11'),
(15681, 20067, 20876, NULL, '2022-02-09 00:00:00.000', 'In Process', 'Application submitted online. Allow 45-60 Days to process the request. See the attachment ', NULL, NULL, '2022-02-02 10:28:16', '2022-02-02 10:28:16'),
(15682, 20067, 20876, 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 17:10:47', '2022-02-17 17:10:47'),
(15683, 20067, 20876, 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 10:49:31', '2022-03-01 10:49:31'),
(15684, 3040, 20877, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:40:27', '2021-03-15 12:40:27'),
(15685, 3040, 20877, NULL, '2021-05-24 00:00:00.000', 'In Process', 'Email sent to: PDSDallas@aetna.com  Subject: Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Greetings,   Hope you are doing well. I wanted to enroll status for the below mentioned group & providers in First Health in our group Columbus Urgent Care PA under below locations. We have an ancillary contract with Aetna so do we need to do the credentialing separately?  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: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-17 16:15:28', '2021-05-17 16:15:28'),
(15686, 3040, 20877, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: PDSDallas@aetna.com   Subject:Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||    Greetings,   Has there been any update?  Thanks ', NULL, NULL, '2021-06-07 17:53:47', '2021-06-07 17:53:47'),
(15687, 3040, 20877, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email rcvd from: AlagarSamyN@aetna.com  Subject: Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Hi Adil,  Please find the status of the below mentioned providers  CPD ID                      Provider Name                         Tax id                   Status             Effective date  2909784               Columbus Urgent Care PA     47-1914151             Active               3/1/2020  N/A                        George, Jeemol                        47-1914151          not found           Not Applicable  3365489                      Jose, Julie                            47-1914151   given tin not linked  Not Applicable  3028331                  Stephen, Ani                          47-1914151   given tin not linked  Not Applicable  1107473           Piccione JR, James M                   47-1914151              Active                   10/1/2019  3362053               Brown, Brittany                        47-1914151    given tin not linked Not Applicable  N/A                Chennemkara, Mini Philip              47-1914151          not found         Not Applicable  N/A                        Abraham, Glory                        47-1914151          not found         Not Applicable  N/A                      Fernandus, Limy                         47-1914151         not found         Not Applicable  2551832                 Rauf, Abdur                              47-1914151  given tin not linked Not Applicable  N/A            Kourouma , Odette Tiranke                47-1914151         not found         Not Applicable  3362048            Joseph, Vibitha                              47-1914151  given tin not linked Not Applicable  3315496                Thomas, Cini                             47-1914151 given tin not linked Not Applicable  N/A                    Abraham, Jeena                            47-1914151         not found          Not Applicable  N/A                         PAUL, SIGI                                 47-1914151         not found         Not Applicable  N/A                         Jacob, Jaya                                 47-1914151         not found        Not Applicable', NULL, NULL, '2021-06-15 10:38:17', '2021-06-15 10:38:17'),
(15688, 11056, 20877, NULL, '2021-07-08 00:00:00.000', 'In Process', 'Email sent to : AlagarSamyN@aetna.com  Sub : Enrollment (linking) Query - CUCC - First Health  Good morning,  Hope you are doing well. Kindly guide me the procedure to link the providers to the TAX I.D.   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 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  Kindly Respond to me soon.If you need any further information feel free to contact me.  Thank you!', NULL, NULL, '2021-07-01 10:27:58', '2021-07-01 10:27:58'),
(15689, 3040, 20877, 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 11:31:32', '2021-07-19 11:31:32'),
(15690, 11056, 20877, 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 16:20:46', '2021-08-04 16:20:46'),
(15691, 3040, 20877, 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 12:01:20', '2021-08-30 12:01:20'),
(15692, 10057, 20877, 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 16:59:32', '2021-10-11 16:59:32'),
(15693, 10057, 20877, 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 10:31:52', '2021-10-18 10:31:52'),
(15694, 10057, 20877, 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 17:08:34', '2021-11-17 17:08:34'),
(15695, 10057, 20877, 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 17:34:34', '2021-11-22 17:34:34'),
(15696, 10057, 20877, 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 17:40:37', '2021-11-22 17:40:37'),
(15697, 10057, 20877, 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 13:36:19', '2021-12-02 13:36:19'),
(15698, 10057, 20877, 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 11:04:35', '2021-12-09 11:04:35'),
(15699, 10057, 20877, 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 14:32:47', '2021-12-16 14:32:47'),
(15700, 10057, 20877, 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 10:53:35', '2021-12-22 10:53:35'),
(15701, 10057, 20877, 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 15:51:47', '2021-12-29 15:51:47'),
(15702, 19067, 20877, 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 13:33:18', '2022-01-04 13:33:18'),
(15703, 20067, 20877, 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 12:19:14', '2022-01-19 12:19:14'),
(15704, 20067, 20877, 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 12:32:03', '2022-01-27 12:32:03'),
(15705, 20067, 20877, NULL, '2022-02-09 00:00:00.000', 'In Process', 'Application submitted online. Allow 45-60 Days to process the request. See the attachment ', NULL, NULL, '2022-02-02 10:23:05', '2022-02-02 10:23:05'),
(15706, 20067, 20877, 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 17:10:40', '2022-02-17 17:10:40'),
(15707, 20067, 20877, 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 10:49:25', '2022-03-01 10:49:25'),
(15708, 3046, 20878, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:40:46', '2021-03-15 12:40:46'),
(15709, 1005, 20878, NULL, '2021-06-08 00:00:00.000', 'Not Eligible', 'Not receiving the Bills for this location. Updating the task as Not Eligible after Supervisor\'s confirmation.', NULL, NULL, '2021-06-01 13:51:28', '2021-06-01 13:51:28'),
(15710, 3040, 20880, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:42:45', '2021-03-15 12:42:45'),
(15711, 3040, 20880, NULL, '2021-05-26 00:00:00.000', 'Approved', 'Group participating with Galaxy Health. ', NULL, NULL, '2021-05-19 13:02:32', '2021-05-19 13:02:32'),
(15712, 3040, 20881, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:42:58', '2021-03-15 12:42:58'),
(15713, 3040, 20881, NULL, '2021-05-26 00:00:00.000', 'Approved', 'Provider is participating with Galaxy health.', NULL, NULL, '2021-05-19 08:45:55', '2021-05-19 08:45:55'),
(15714, 3040, 20882, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:43:08', '2021-03-15 12:43:08'),
(15715, 3040, 20882, NULL, '2021-05-26 00:00:00.000', 'Approved', 'Provider is participating with Galaxy health.', NULL, NULL, '2021-05-19 13:03:02', '2021-05-19 13:03:02'),
(15716, 3046, 20883, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:43:19', '2021-03-15 12:43:19'),
(15717, 1005, 20883, NULL, '2021-06-08 00:00:00.000', 'Not Eligible', 'Not receiving the Bills for this location. Updating the task as Not Eligible after Supervisor\'s confirmation.', NULL, NULL, '2021-06-01 13:59:40', '2021-06-01 13:59:40'),
(15718, 3040, 20884, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:43:23', '2021-03-15 12:43:23'),
(15719, 3040, 20884, NULL, '2021-05-26 00:00:00.000', 'In Process', 'Email sent to: cguerue@ghn-mci.com  Subject: Galaxy Provider Application  Hello Chris,   Hope you are doing well. Please find the attached Provider Questionnaire Form to enroll the provider in Galaxy Health in our group Columbus Urgent Care PA under 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 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 09:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 10:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 11:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 12:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 13:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-19 12:47:40', '2021-05-19 12:47:40'),
(15720, 3040, 20884, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: cguerue@ghn-mci.com  Subject: Galaxy Provider Application  Good Morning Adil,  All provider applications have now been processed, two providers, Dr Piccione Jr and Limy Fernandus will need the following additional information for completion:  Piccione Jr – a copy of his DEA, as an MD and Family Practice provider, a DEA is required for participation  Fernandus – malpractice insurance copy  The remaining providers applications have all been marked complete and they will be added to the group agreement as requested effective 1/1/21.  Please feel free to contact me with any questions…  Thank you and have a nice day!  Christine Guerue Credentialing Dept cguerue@ghn-mci.com', NULL, NULL, '2021-06-08 12:42:59', '2021-06-08 12:42:59'),
(15721, 3040, 20884, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Email sent to: cguerue@ghn-mci.com  Subject: Galaxy Provider Application  Hello Chris,   Hope you are doing well. Please advise me the enrollment status for the below mentioned group and providers in Galaxy Health for 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: 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 09:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 10:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 11:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 12:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 13:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 14:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you', NULL, NULL, '2021-06-25 09:40:32', '2021-06-25 09:40:32'),
(15722, 3040, 20884, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Email rcvd from: cguerue@ghn-mci.com  Subject: RE: Galaxy Provider Application  Good Morning,  I found that all providers are linked to the group agreement effective 1/1/21.  Karen Avalos, kavalos@ghn-mci.com is the contact for TX groups, should you have any additional questions please direct them to her, however, I do the new provider enrollments should you have any providers to add in future. ', NULL, NULL, '2021-07-14 11:05:15', '2021-07-14 11:05:15'),
(15723, 3040, 20884, NULL, '2021-07-21 00:00:00.000', 'Approved', 'I had a word with Karen Galaxy Health representative and she advised the provider is in-network with the effective date 01/01/2021.   Ref: Karen 07/14/2021', NULL, NULL, '2021-07-14 13:09:40', '2021-07-14 13:09:40'),
(15724, 3040, 20885, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:43:37', '2021-03-15 12:43:37'),
(15725, 3040, 20885, NULL, '2021-05-26 00:00:00.000', 'In Process', 'Email sent to: cguerue@ghn-mci.com  Subject: Galaxy Provider Application  Hello Chris,   Hope you are doing well. Please find the attached Provider Questionnaire Form to enroll the provider in Galaxy Health in our group Columbus Urgent Care PA under 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 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 09:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 10:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 11:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 12:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 13:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-19 12:47:44', '2021-05-19 12:47:44'),
(15726, 3040, 20885, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: cguerue@ghn-mci.com  Subject: Galaxy Provider Application  Good Morning Adil,  All provider applications have now been processed, two providers, Dr Piccione Jr and Limy Fernandus will need the following additional information for completion:  Piccione Jr – a copy of his DEA, as an MD and Family Practice provider, a DEA is required for participation  Fernandus – malpractice insurance copy  The remaining providers applications have all been marked complete and they will be added to the group agreement as requested effective 1/1/21.  Please feel free to contact me with any questions…  Thank you and have a nice day!  Christine Guerue Credentialing Dept cguerue@ghn-mci.com', NULL, NULL, '2021-06-08 12:42:55', '2021-06-08 12:42:55'),
(15727, 3040, 20885, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Email sent to: cguerue@ghn-mci.com  Subject: Galaxy Provider Application  Hello Chris,   Hope you are doing well. Please advise me the enrollment status for the below mentioned group and providers in Galaxy Health for 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: 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 09:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 10:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 11:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 12:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 13:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 14:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you', NULL, NULL, '2021-06-25 09:40:29', '2021-06-25 09:40:29'),
(15728, 3040, 20885, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Email rcvd from: cguerue@ghn-mci.com  Subject: RE: Galaxy Provider Application  Good Morning,  I found that all providers are linked to the group agreement effective 1/1/21.  Karen Avalos, kavalos@ghn-mci.com is the contact for TX groups, should you have any additional questions please direct them to her, however, I do the new provider enrollments should you have any providers to add in future. ', NULL, NULL, '2021-07-14 11:05:16', '2021-07-14 11:05:16'),
(15729, 3040, 20885, NULL, '2021-07-21 00:00:00.000', 'Approved', 'I had a word with Karen Galaxy Health representative and she advised the provider is in-network with the effective date 01/01/2021.   Ref: Karen 07/14/2021', NULL, NULL, '2021-07-14 13:09:43', '2021-07-14 13:09:43'),
(15730, 3046, 20886, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:43:39', '2021-03-15 12:43:39'),
(15731, 1005, 20886, NULL, '2021-06-08 00:00:00.000', 'Not Eligible', 'Not receiving the Bills for this location. Updating the task as Not Eligible after Supervisor\'s confirmation.', NULL, NULL, '2021-06-01 13:53:02', '2021-06-01 13:53:02'),
(15732, 3040, 20887, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:43:46', '2021-03-15 12:43:46'),
(15733, 3040, 20887, NULL, '2021-05-26 00:00:00.000', 'In Process', 'Email sent to: cguerue@ghn-mci.com  Subject: Galaxy Provider Application  Hello Chris,   Hope you are doing well. Please find the attached Provider Questionnaire Form to enroll the provider in Galaxy Health in our group Columbus Urgent Care PA under 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 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 09:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 10:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 11:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 12:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 13:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-19 12:47:49', '2021-05-19 12:47:49'),
(15734, 3040, 20887, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: cguerue@ghn-mci.com  Subject: Galaxy Provider Application  Good Morning Adil,  All provider applications have now been processed, two providers, Dr Piccione Jr and Limy Fernandus will need the following additional information for completion:  Piccione Jr – a copy of his DEA, as an MD and Family Practice provider, a DEA is required for participation  Fernandus – malpractice insurance copy  The remaining providers applications have all been marked complete and they will be added to the group agreement as requested effective 1/1/21.  Please feel free to contact me with any questions…  Thank you and have a nice day!  Christine Guerue Credentialing Dept cguerue@ghn-mci.com', NULL, NULL, '2021-06-08 12:42:52', '2021-06-08 12:42:52');
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
(15735, 3040, 20887, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Email sent to: cguerue@ghn-mci.com  Subject: Galaxy Provider Application  Hello Chris,   Hope you are doing well. Please advise me the enrollment status for the below mentioned group and providers in Galaxy Health for 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: 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 09:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 10:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 11:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 12:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 13:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 14:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you', NULL, NULL, '2021-06-25 09:40:27', '2021-06-25 09:40:27'),
(15736, 3040, 20887, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Email rcvd from: cguerue@ghn-mci.com  Subject: RE: Galaxy Provider Application  Good Morning,  I found that all providers are linked to the group agreement effective 1/1/21.  Karen Avalos, kavalos@ghn-mci.com is the contact for TX groups, should you have any additional questions please direct them to her, however, I do the new provider enrollments should you have any providers to add in future. ', NULL, NULL, '2021-07-14 11:05:17', '2021-07-14 11:05:17'),
(15737, 3040, 20887, NULL, '2021-07-21 00:00:00.000', 'Approved', 'I had a word with Karen Galaxy Health representative and she advised the provider is in-network with the effective date 01/01/2021.   Ref: Karen 07/14/2021', NULL, NULL, '2021-07-14 13:09:45', '2021-07-14 13:09:45'),
(15738, 3040, 20888, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:44:00', '2021-03-15 12:44:00'),
(15739, 3040, 20888, NULL, '2021-05-26 00:00:00.000', 'In Process', 'Email sent to: cguerue@ghn-mci.com  Subject: Galaxy Provider Application  Hello Chris,   Hope you are doing well. Please find the attached Provider Questionnaire Form to enroll the provider in Galaxy Health in our group Columbus Urgent Care PA under 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 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 09:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 10:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 11:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 12:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 13:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-19 12:47:53', '2021-05-19 12:47:53'),
(15740, 3040, 20888, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: cguerue@ghn-mci.com  Subject: Galaxy Provider Application  Good Morning Adil,  All provider applications have now been processed, two providers, Dr Piccione Jr and Limy Fernandus will need the following additional information for completion:  Piccione Jr – a copy of his DEA, as an MD and Family Practice provider, a DEA is required for participation  Fernandus – malpractice insurance copy  The remaining providers applications have all been marked complete and they will be added to the group agreement as requested effective 1/1/21.  Please feel free to contact me with any questions…  Thank you and have a nice day!  Christine Guerue Credentialing Dept cguerue@ghn-mci.com', NULL, NULL, '2021-06-08 12:42:48', '2021-06-08 12:42:48'),
(15741, 3040, 20888, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Email sent to: cguerue@ghn-mci.com  Subject: Galaxy Provider Application  Hello Chris,   Hope you are doing well. Please advise me the enrollment status for the below mentioned group and providers in Galaxy Health for 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: 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 09:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 10:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 11:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 12:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 13:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 14:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you', NULL, NULL, '2021-06-25 09:40:25', '2021-06-25 09:40:25'),
(15742, 3040, 20888, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Email rcvd from: cguerue@ghn-mci.com  Subject: RE: Galaxy Provider Application  Good Morning,  I found that all providers are linked to the group agreement effective 1/1/21.  Karen Avalos, kavalos@ghn-mci.com is the contact for TX groups, should you have any additional questions please direct them to her, however, I do the new provider enrollments should you have any providers to add in future. ', NULL, NULL, '2021-07-14 11:05:17', '2021-07-14 11:05:17'),
(15743, 3040, 20888, NULL, '2021-07-21 00:00:00.000', 'Approved', 'I had a word with Karen Galaxy Health representative and she advised the provider is in-network with the effective date 01/01/2021.   Ref: Karen 07/14/2021', NULL, NULL, '2021-07-14 13:09:47', '2021-07-14 13:09:47'),
(15744, 3040, 20889, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:44:15', '2021-03-15 12:44:15'),
(15745, 3040, 20889, NULL, '2021-05-26 00:00:00.000', 'In Process', 'Email sent to: cguerue@ghn-mci.com  Subject: Galaxy Provider Application  Hello Chris,   Hope you are doing well. Please find the attached Provider Questionnaire Form to enroll the provider in Galaxy Health in our group Columbus Urgent Care PA under 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 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 09:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 10:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 11:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 12:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 13:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-19 12:47:58', '2021-05-19 12:47:58'),
(15746, 3040, 20889, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: cguerue@ghn-mci.com  Subject: Galaxy Provider Application  Good Morning Adil,  All provider applications have now been processed, two providers, Dr Piccione Jr and Limy Fernandus will need the following additional information for completion:  Piccione Jr – a copy of his DEA, as an MD and Family Practice provider, a DEA is required for participation  Fernandus – malpractice insurance copy  The remaining providers applications have all been marked complete and they will be added to the group agreement as requested effective 1/1/21.  Please feel free to contact me with any questions…  Thank you and have a nice day!  Christine Guerue Credentialing Dept cguerue@ghn-mci.com', NULL, NULL, '2021-06-08 12:42:45', '2021-06-08 12:42:45'),
(15747, 3040, 20889, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Email sent to: cguerue@ghn-mci.com  Subject: Galaxy Provider Application  Hello Chris,   Hope you are doing well. Please advise me the enrollment status for the below mentioned group and providers in Galaxy Health for 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: 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 09:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 10:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 11:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 12:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 13:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 14:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you', NULL, NULL, '2021-06-25 09:40:23', '2021-06-25 09:40:23'),
(15748, 3040, 20889, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Email rcvd from: cguerue@ghn-mci.com  Subject: RE: Galaxy Provider Application  Good Morning,  I found that all providers are linked to the group agreement effective 1/1/21.  Karen Avalos, kavalos@ghn-mci.com is the contact for TX groups, should you have any additional questions please direct them to her, however, I do the new provider enrollments should you have any providers to add in future. ', NULL, NULL, '2021-07-14 11:05:18', '2021-07-14 11:05:18'),
(15749, 3040, 20889, NULL, '2021-07-21 00:00:00.000', 'Approved', 'I had a word with Karen Galaxy Health representative and she advised the provider is in-network with the effective date 01/01/2021.   Ref: Karen 07/14/2021', NULL, NULL, '2021-07-14 13:09:49', '2021-07-14 13:09:49'),
(15750, 3046, 20890, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:44:20', '2021-03-15 12:44:20'),
(15751, 1005, 20890, NULL, '2021-06-08 00:00:00.000', 'Not Eligible', 'Not receiving the Bills for this location. Updating the task as Not Eligible after Supervisor\'s confirmation.', NULL, NULL, '2021-06-01 13:53:24', '2021-06-01 13:53:24'),
(15752, 3040, 20891, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:44:29', '2021-03-15 12:44:29'),
(15753, 3040, 20891, NULL, '2021-05-26 00:00:00.000', 'In Process', 'Email sent to: cguerue@ghn-mci.com  Subject: Galaxy Provider Application  Hello Chris,   Hope you are doing well. Please find the attached Provider Questionnaire Form to enroll the provider in Galaxy Health in our group Columbus Urgent Care PA under 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 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 09:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 10:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 11:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 12:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 13:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-19 12:48:02', '2021-05-19 12:48:02'),
(15754, 3040, 20891, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: cguerue@ghn-mci.com  Subject: Galaxy Provider Application  Good Morning Adil,  All provider applications have now been processed, two providers, Dr Piccione Jr and Limy Fernandus will need the following additional information for completion:  Piccione Jr – a copy of his DEA, as an MD and Family Practice provider, a DEA is required for participation  Fernandus – malpractice insurance copy  The remaining providers applications have all been marked complete and they will be added to the group agreement as requested effective 1/1/21.  Please feel free to contact me with any questions…  Thank you and have a nice day!  Christine Guerue Credentialing Dept cguerue@ghn-mci.com', NULL, NULL, '2021-06-08 12:42:41', '2021-06-08 12:42:41'),
(15755, 3040, 20891, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Email sent to: cguerue@ghn-mci.com  Subject: Galaxy Provider Application  Hello Chris,   Hope you are doing well. Please advise me the enrollment status for the below mentioned group and providers in Galaxy Health for 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: 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 09:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 10:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 11:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 12:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 13:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 14:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you', NULL, NULL, '2021-06-25 09:40:21', '2021-06-25 09:40:21'),
(15756, 3040, 20891, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Email rcvd from: cguerue@ghn-mci.com  Subject: RE: Galaxy Provider Application  Good Morning,  I found that all providers are linked to the group agreement effective 1/1/21.  Karen Avalos, kavalos@ghn-mci.com is the contact for TX groups, should you have any additional questions please direct them to her, however, I do the new provider enrollments should you have any providers to add in future. ', NULL, NULL, '2021-07-14 11:05:18', '2021-07-14 11:05:18'),
(15757, 3040, 20891, NULL, '2021-07-21 00:00:00.000', 'Approved', 'I had a word with Karen Galaxy Health representative and she advised the provider is in-network with the effective date 01/01/2021.   Ref: Karen 07/14/2021', NULL, NULL, '2021-07-14 13:09:54', '2021-07-14 13:09:54'),
(15758, 3040, 20892, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:44:43', '2021-03-15 12:44:43'),
(15759, 3040, 20892, NULL, '2021-05-26 00:00:00.000', 'In Process', 'Email sent to: cguerue@ghn-mci.com  Subject: Galaxy Provider Application  Hello Chris,   Hope you are doing well. Please find the attached Provider Questionnaire Form to enroll the provider in Galaxy Health in our group Columbus Urgent Care PA under 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 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 09:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 10:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 11:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 12:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 13:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-19 12:48:06', '2021-05-19 12:48:06'),
(15760, 3040, 20892, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: cguerue@ghn-mci.com  Subject: Galaxy Provider Application  Good Morning Adil,  All provider applications have now been processed, two providers, Dr Piccione Jr and Limy Fernandus will need the following additional information for completion:  Piccione Jr – a copy of his DEA, as an MD and Family Practice provider, a DEA is required for participation  Fernandus – malpractice insurance copy  The remaining providers applications have all been marked complete and they will be added to the group agreement as requested effective 1/1/21.  Please feel free to contact me with any questions…  Thank you and have a nice day!  Christine Guerue Credentialing Dept cguerue@ghn-mci.com', NULL, NULL, '2021-06-08 12:42:37', '2021-06-08 12:42:37'),
(15761, 3040, 20892, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Email sent to: cguerue@ghn-mci.com  Subject: Galaxy Provider Application  Hello Chris,   Hope you are doing well. Please advise me the enrollment status for the below mentioned group and providers in Galaxy Health for 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: 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 09:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 10:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 11:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 12:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 13:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 14:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you', NULL, NULL, '2021-06-25 09:40:18', '2021-06-25 09:40:18'),
(15762, 3040, 20892, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Email rcvd from: cguerue@ghn-mci.com  Subject: RE: Galaxy Provider Application  Good Morning,  I found that all providers are linked to the group agreement effective 1/1/21.  Karen Avalos, kavalos@ghn-mci.com is the contact for TX groups, should you have any additional questions please direct them to her, however, I do the new provider enrollments should you have any providers to add in future. ', NULL, NULL, '2021-07-14 11:05:19', '2021-07-14 11:05:19'),
(15763, 3040, 20892, NULL, '2021-07-21 00:00:00.000', 'Approved', 'I had a word with Karen Galaxy Health representative and she advised the provider is in-network with the effective date 01/01/2021.   Ref: Karen 07/14/2021', NULL, NULL, '2021-07-14 13:09:56', '2021-07-14 13:09:56'),
(15764, 3046, 20893, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:44:44', '2021-03-15 12:44:44'),
(15765, 1005, 20893, NULL, '2021-06-08 00:00:00.000', 'Not Eligible', 'Not receiving the Bills for this location. Updating the task as Not Eligible after Supervisor\'s confirmation.', NULL, NULL, '2021-06-01 13:54:35', '2021-06-01 13:54:35'),
(15766, 3040, 20894, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:44:56', '2021-03-15 12:44:56'),
(15767, 3040, 20894, NULL, '2021-05-26 00:00:00.000', 'In Process', 'Email sent to: cguerue@ghn-mci.com  Subject: Galaxy Provider Application  Hello Chris,   Hope you are doing well. Please find the attached Provider Questionnaire Form to enroll the provider in Galaxy Health in our group Columbus Urgent Care PA under 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 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 09:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 10:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 11:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 12:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 13:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-19 12:48:10', '2021-05-19 12:48:10'),
(15768, 3040, 20894, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: cguerue@ghn-mci.com  Subject: Galaxy Provider Application  Good Morning Adil,  All provider applications have now been processed, two providers, Dr Piccione Jr and Limy Fernandus will need the following additional information for completion:  Piccione Jr – a copy of his DEA, as an MD and Family Practice provider, a DEA is required for participation  Fernandus – malpractice insurance copy  The remaining providers applications have all been marked complete and they will be added to the group agreement as requested effective 1/1/21.  Please feel free to contact me with any questions…  Thank you and have a nice day!  Christine Guerue Credentialing Dept cguerue@ghn-mci.com', NULL, NULL, '2021-06-08 12:42:34', '2021-06-08 12:42:34'),
(15769, 3040, 20894, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Email sent to: cguerue@ghn-mci.com  Subject: Galaxy Provider Application  Hello Chris,   Hope you are doing well. Please advise me the enrollment status for the below mentioned group and providers in Galaxy Health for 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: 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 09:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 10:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 11:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 12:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 13:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 14:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you', NULL, NULL, '2021-06-25 09:40:16', '2021-06-25 09:40:16'),
(15770, 3040, 20894, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Email rcvd from: cguerue@ghn-mci.com  Subject: RE: Galaxy Provider Application  Good Morning,  I found that all providers are linked to the group agreement effective 1/1/21.  Karen Avalos, kavalos@ghn-mci.com is the contact for TX groups, should you have any additional questions please direct them to her, however, I do the new provider enrollments should you have any providers to add in future. ', NULL, NULL, '2021-07-14 11:05:19', '2021-07-14 11:05:19'),
(15771, 3040, 20894, NULL, '2021-07-21 00:00:00.000', 'Approved', 'I had a word with Karen Galaxy Health representative and she advised the provider is in-network with the effective date 01/01/2021.   Ref: Karen 07/14/2021', NULL, NULL, '2021-07-14 13:09:59', '2021-07-14 13:09:59'),
(15772, 3040, 20895, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:45:10', '2021-03-15 12:45:10'),
(15773, 3040, 20895, NULL, '2021-05-26 00:00:00.000', 'In Process', 'Email sent to: cguerue@ghn-mci.com  Subject: Galaxy Provider Application  Hello Chris,   Hope you are doing well. Please find the attached Provider Questionnaire Form to enroll the provider in Galaxy Health in our group Columbus Urgent Care PA under 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 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 09:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 10:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 11:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 12:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 13:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-19 12:48:14', '2021-05-19 12:48:14'),
(15774, 3040, 20895, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: cguerue@ghn-mci.com  Subject: Galaxy Provider Application  Good Morning Adil,  All provider applications have now been processed, two providers, Dr Piccione Jr and Limy Fernandus will need the following additional information for completion:  Piccione Jr – a copy of his DEA, as an MD and Family Practice provider, a DEA is required for participation  Fernandus – malpractice insurance copy  The remaining providers applications have all been marked complete and they will be added to the group agreement as requested effective 1/1/21.  Please feel free to contact me with any questions…  Thank you and have a nice day!  Christine Guerue Credentialing Dept cguerue@ghn-mci.com', NULL, NULL, '2021-06-08 12:42:31', '2021-06-08 12:42:31'),
(15775, 3040, 20895, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Email sent to: cguerue@ghn-mci.com  Subject: Galaxy Provider Application  Hello Chris,   Hope you are doing well. Please advise me the enrollment status for the below mentioned group and providers in Galaxy Health for 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: 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 09:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 10:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 11:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 12:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 13:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 14:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you', NULL, NULL, '2021-06-25 09:40:14', '2021-06-25 09:40:14'),
(15776, 3040, 20895, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Email rcvd from: cguerue@ghn-mci.com  Subject: RE: Galaxy Provider Application  Good Morning,  I found that all providers are linked to the group agreement effective 1/1/21.  Karen Avalos, kavalos@ghn-mci.com is the contact for TX groups, should you have any additional questions please direct them to her, however, I do the new provider enrollments should you have any providers to add in future. ', NULL, NULL, '2021-07-14 11:05:20', '2021-07-14 11:05:20'),
(15777, 3040, 20895, NULL, '2021-07-21 00:00:00.000', 'Approved', 'I had a word with Karen Galaxy Health representative and she advised the provider is in-network with the effective date 01/01/2021.   Ref: Karen 07/14/2021', NULL, NULL, '2021-07-14 13:10:02', '2021-07-14 13:10:02'),
(15778, 3046, 20896, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:45:16', '2021-03-15 12:45:16'),
(15779, 1005, 20896, NULL, '2021-06-08 00:00:00.000', 'Not Eligible', 'Not receiving the Bills for this location. Updating the task as Not Eligible after Supervisor\'s confirmation.', NULL, NULL, '2021-06-01 13:55:49', '2021-06-01 13:55:49'),
(15780, 3040, 20897, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:45:24', '2021-03-15 12:45:24'),
(15781, 1005, 20897, NULL, '2021-06-08 00:00:00.000', 'Not Eligible', 'Provider is no longer working for this Practice. Eff from 12/15/2020', NULL, NULL, '2021-06-01 12:50:00', '2021-06-01 12:50:00'),
(15782, 3046, 20898, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:45:35', '2021-03-15 12:45:35'),
(15783, 1005, 20898, NULL, '2021-06-08 00:00:00.000', 'Not Eligible', 'Not receiving the Bills for this location. Updating the task as Not Eligible after Supervisor\'s confirmation.', NULL, NULL, '2021-06-01 13:56:08', '2021-06-01 13:56:08'),
(15784, 3040, 20899, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:45:38', '2021-03-15 12:45:38'),
(15785, 3040, 20899, NULL, '2021-05-26 00:00:00.000', 'In Process', 'Email sent to: cguerue@ghn-mci.com  Subject: Galaxy Provider Application  Hello Chris,   Hope you are doing well. Please find the attached Provider Questionnaire Form to enroll the provider in Galaxy Health in our group Columbus Urgent Care PA under 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 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 09:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 10:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 11:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 12:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 13:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-19 12:48:18', '2021-05-19 12:48:18'),
(15786, 3040, 20899, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: cguerue@ghn-mci.com  Subject: Galaxy Provider Application  Good Morning Adil,  All provider applications have now been processed, two providers, Dr Piccione Jr and Limy Fernandus will need the following additional information for completion:  Piccione Jr – a copy of his DEA, as an MD and Family Practice provider, a DEA is required for participation  Fernandus – malpractice insurance copy  The remaining providers applications have all been marked complete and they will be added to the group agreement as requested effective 1/1/21.  Please feel free to contact me with any questions…  Thank you and have a nice day!  Christine Guerue Credentialing Dept cguerue@ghn-mci.com', NULL, NULL, '2021-06-08 12:42:27', '2021-06-08 12:42:27'),
(15787, 3040, 20899, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Email sent to: cguerue@ghn-mci.com  Subject: Galaxy Provider Application  Hello Chris,   Hope you are doing well. Please advise me the enrollment status for the below mentioned group and providers in Galaxy Health for 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: 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 09:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 10:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 11:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 12:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 13:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 14:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you', NULL, NULL, '2021-06-25 09:40:10', '2021-06-25 09:40:10'),
(15788, 3040, 20899, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Email rcvd from: cguerue@ghn-mci.com  Subject: RE: Galaxy Provider Application  Good Morning,  I found that all providers are linked to the group agreement effective 1/1/21.  Karen Avalos, kavalos@ghn-mci.com is the contact for TX groups, should you have any additional questions please direct them to her, however, I do the new provider enrollments should you have any providers to add in future. ', NULL, NULL, '2021-07-14 11:05:20', '2021-07-14 11:05:20'),
(15789, 3040, 20899, NULL, '2021-07-21 00:00:00.000', 'Approved', 'I had a word with Karen Galaxy Health representative and she advised the provider is in-network with the effective date 01/01/2021.   Ref: Karen 07/14/2021', NULL, NULL, '2021-07-14 13:10:04', '2021-07-14 13:10:04'),
(15790, 3040, 20900, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:45:50', '2021-03-15 12:45:50'),
(15791, 3040, 20900, NULL, '2021-05-26 00:00:00.000', 'In Process', 'Email sent to: cguerue@ghn-mci.com  Subject: Galaxy Provider Application  Hello Chris,   Hope you are doing well. Please find the attached Provider Questionnaire Form to enroll the provider in Galaxy Health in our group Columbus Urgent Care PA under 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 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 09:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 10:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 11:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 12:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 13:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-19 12:48:24', '2021-05-19 12:48:24'),
(15792, 3040, 20900, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: cguerue@ghn-mci.com  Subject: Galaxy Provider Application  Good Morning Adil,  All provider applications have now been processed, two providers, Dr Piccione Jr and Limy Fernandus will need the following additional information for completion:  Piccione Jr – a copy of his DEA, as an MD and Family Practice provider, a DEA is required for participation  Fernandus – malpractice insurance copy  The remaining providers applications have all been marked complete and they will be added to the group agreement as requested effective 1/1/21.  Please feel free to contact me with any questions…  Thank you and have a nice day!  Christine Guerue Credentialing Dept cguerue@ghn-mci.com', NULL, NULL, '2021-06-08 12:42:25', '2021-06-08 12:42:25'),
(15793, 3040, 20900, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Email sent to: cguerue@ghn-mci.com  Subject: Galaxy Provider Application  Hello Chris,   Hope you are doing well. Please advise me the enrollment status for the below mentioned group and providers in Galaxy Health for 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: 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 09:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 10:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 11:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 12:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 13:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 14:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you', NULL, NULL, '2021-06-25 09:40:08', '2021-06-25 09:40:08'),
(15794, 3040, 20900, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Email rcvd from: cguerue@ghn-mci.com  Subject: RE: Galaxy Provider Application  Good Morning,  I found that all providers are linked to the group agreement effective 1/1/21.  Karen Avalos, kavalos@ghn-mci.com is the contact for TX groups, should you have any additional questions please direct them to her, however, I do the new provider enrollments should you have any providers to add in future. ', NULL, NULL, '2021-07-14 11:05:21', '2021-07-14 11:05:21'),
(15795, 3040, 20900, NULL, '2021-07-21 00:00:00.000', 'Approved', 'I had a word with Karen Galaxy Health representative and she advised the provider is in-network with the effective date 01/01/2021.   Ref: Karen 07/14/2021', NULL, NULL, '2021-07-14 13:10:07', '2021-07-14 13:10:07'),
(15796, 3040, 20901, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:45:59', '2021-03-15 12:45:59'),
(15797, 3040, 20901, NULL, '2021-05-26 00:00:00.000', 'In Process', 'Email sent to: cguerue@ghn-mci.com  Subject: Galaxy Provider Application  Hello Chris,   Hope you are doing well. Please find the attached Provider Questionnaire Form to enroll the provider in Galaxy Health in our group Columbus Urgent Care PA under 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 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 09:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 10:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 11:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 12:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 13:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-19 12:48:28', '2021-05-19 12:48:28'),
(15798, 3040, 20901, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: cguerue@ghn-mci.com  Subject: Galaxy Provider Application  Good Morning Adil,  All provider applications have now been processed, two providers, Dr Piccione Jr and Limy Fernandus will need the following additional information for completion:  Piccione Jr – a copy of his DEA, as an MD and Family Practice provider, a DEA is required for participation  Fernandus – malpractice insurance copy  The remaining providers applications have all been marked complete and they will be added to the group agreement as requested effective 1/1/21.  Please feel free to contact me with any questions…  Thank you and have a nice day!  Christine Guerue Credentialing Dept cguerue@ghn-mci.com', NULL, NULL, '2021-06-08 12:42:22', '2021-06-08 12:42:22'),
(15799, 3040, 20901, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Email sent to: cguerue@ghn-mci.com  Subject: Galaxy Provider Application  Hello Chris,   Hope you are doing well. Please advise me the enrollment status for the below mentioned group and providers in Galaxy Health for 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: 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 09:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 10:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 11:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 12:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 13:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 14:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you', NULL, NULL, '2021-06-25 09:40:05', '2021-06-25 09:40:05'),
(15800, 3040, 20901, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Email rcvd from: cguerue@ghn-mci.com  Subject: RE: Galaxy Provider Application  Good Morning,  I found that all providers are linked to the group agreement effective 1/1/21.  Karen Avalos, kavalos@ghn-mci.com is the contact for TX groups, should you have any additional questions please direct them to her, however, I do the new provider enrollments should you have any providers to add in future. ', NULL, NULL, '2021-07-14 11:05:21', '2021-07-14 11:05:21'),
(15801, 3040, 20901, NULL, '2021-07-21 00:00:00.000', 'Approved', 'I had a word with Karen Galaxy Health representative and she advised the provider is in-network with the effective date 01/01/2021.   Ref: Karen 07/14/2021', NULL, NULL, '2021-07-14 13:10:09', '2021-07-14 13:10:09'),
(15802, 3046, 20902, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:45:59', '2021-03-15 12:45:59'),
(15803, 1005, 20902, NULL, '2021-06-08 00:00:00.000', 'Not Eligible', 'Not receiving the Bills for this location. Updating the task as Not Eligible after Supervisor\'s confirmation.', NULL, NULL, '2021-06-01 13:56:26', '2021-06-01 13:56:26'),
(15804, 3040, 20903, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:46:09', '2021-03-15 12:46:09');
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
(15805, 3040, 20903, NULL, '2021-05-26 00:00:00.000', 'In Process', 'Email sent to: cguerue@ghn-mci.com  Subject: Galaxy Provider Application  Hello Chris,   Hope you are doing well. Please find the attached Provider Questionnaire Form to enroll the provider in Galaxy Health in our group Columbus Urgent Care PA under 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 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 09:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 10:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 11:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 12:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 13:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-19 12:48:32', '2021-05-19 12:48:32'),
(15806, 3040, 20903, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: cguerue@ghn-mci.com  Subject: Galaxy Provider Application  Good Morning Adil,  All provider applications have now been processed, two providers, Dr Piccione Jr and Limy Fernandus will need the following additional information for completion:  Piccione Jr – a copy of his DEA, as an MD and Family Practice provider, a DEA is required for participation  Fernandus – malpractice insurance copy  The remaining providers applications have all been marked complete and they will be added to the group agreement as requested effective 1/1/21.  Please feel free to contact me with any questions…  Thank you and have a nice day!  Christine Guerue Credentialing Dept cguerue@ghn-mci.com', NULL, NULL, '2021-06-08 12:42:07', '2021-06-08 12:42:07'),
(15807, 3040, 20903, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Email sent to: cguerue@ghn-mci.com  Subject: Galaxy Provider Application  Hello Chris,   Hope you are doing well. Please advise me the enrollment status for the below mentioned group and providers in Galaxy Health for 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: 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 09:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 10:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 11:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 12:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 13:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 14:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you', NULL, NULL, '2021-06-25 09:40:36', '2021-06-25 09:40:36'),
(15808, 3040, 20903, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Email rcvd from: cguerue@ghn-mci.com  Subject: RE: Galaxy Provider Application  Good Morning,  I found that all providers are linked to the group agreement effective 1/1/21.  Karen Avalos, kavalos@ghn-mci.com is the contact for TX groups, should you have any additional questions please direct them to her, however, I do the new provider enrollments should you have any providers to add in future. ', NULL, NULL, '2021-07-14 11:05:23', '2021-07-14 11:05:23'),
(15809, 3040, 20903, NULL, '2021-07-21 00:00:00.000', 'Approved', 'I had a word with Karen Galaxy Health representative and she advised the provider is in-network with the effective date 01/01/2021.   Ref: Karen 07/14/2021', NULL, NULL, '2021-07-14 13:10:12', '2021-07-14 13:10:12'),
(15810, 3040, 20905, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:50:13', '2021-03-15 12:50:13'),
(15811, 3040, 20905, NULL, '2021-05-18 00:00:00.000', 'Approved', 'Group is participating with Humana. Group contract attached.', NULL, NULL, '2021-05-11 14:21:04', '2021-05-11 14:21:04'),
(15812, 3040, 20906, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:50:43', '2021-03-15 12:50:43'),
(15813, 3040, 20906, NULL, '2021-05-18 00:00:00.000', 'Approved', 'I had a word with (Gill) Humana representative and he advised me the provider is linked to Tax Id.   Ref: 2000183268199', NULL, NULL, '2021-05-11 14:09:59', '2021-05-11 14:09:59'),
(15814, 3040, 20907, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:51:03', '2021-03-15 12:51:03'),
(15815, 3040, 20907, NULL, '2021-05-18 00:00:00.000', 'Approved', 'I had a word with (Gill) Humana representative and he advised me the provider is linked to Tax Id.   Ref: 2000183268199', NULL, NULL, '2021-05-11 14:10:35', '2021-05-11 14:10:35'),
(15816, 3040, 20908, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:51:22', '2021-03-15 12:51:22'),
(15817, 3040, 20908, NULL, '2021-05-18 00:00:00.000', 'In Process', 'Email sent to: humanahoustonpd@humana.com  Subject: Provider Roster  Greetings,   Hope you are doing well. Please find the attached roster for the below mentioned provider to get linked with Humana for our group Columbus Urgent Care PA under 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 1: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 2:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 3:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 4:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 7:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-11 15:59:51', '2021-05-11 15:59:51'),
(15818, 1006, 20908, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Sent a f/u email @ HumanaHoustonPD humanahoustonpd@humana.com:  Sub: Enrollment Status - CUCC - Humana  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for our group and providers, their information is as follows:  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: Joseph, Vibitha Provider NPI# 1952931560  Provider 2:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 3:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 4:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 7:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Please get back to me as soon as possible. Thank you. \"', NULL, NULL, '2021-06-01 16:41:11', '2021-06-01 16:41:11'),
(15819, 3040, 20908, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email rcvd from: HumanaHoustonPD@humana.com  Subject: Enrollment Status - CUCC - Humana  No previous record of receipt of a request to add these practitioners.   Follow the below instructions to add new practitioners to an existing group.  Please complete and return the attached document, in its original excel format, along with a W-9. Include all providers in the practice that wish to participate on the standard roster, on the Practitioner Adds tab.  Make sure CAQH is updated for all providers to prevent any delays in the contracting process. Additionally, ensure that Humana is included in the “List of Authorized Organizations” in order for Humana to have on-line access to the provider’s CAQH account and the provider has granted access to Humana to view the CAQH credentialing information.  Look forward to receiving your documents.  HumanaHoustonPD', NULL, NULL, '2021-06-21 13:45:28', '2021-06-21 13:45:28'),
(15820, 3040, 20908, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: HumanaHoustonPD@humana.com  Subject: Enrollment Status - CUCC - Humana  Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for our group and providers, their information is as follows:  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID#  Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider 1: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 2:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 3:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 4:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 7:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8:   Provider Name: PAUL, SIGI Provider NPI# 1033623616   Please get back to me as soon as possible.  Thank you. ', NULL, NULL, '2021-06-21 13:47:20', '2021-06-21 13:47:20'),
(15821, 3040, 20908, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: mduffee@humana.com  Subject: Provider Roster  Hello Micheal,   Hope you are doing well. I reviewed all the corrections that you mentioned on roster. Can you please advise rather than panel assignment if we added the providers in group contract so can we bill those provider under the group.   Please get back to me as soon as  you can get a chance. Waiting to hear from you soon.   Thank you    On 9 June 2021, \"Michael Duffee\"  wrote: > Hello Adil, I have review the roster and only one provider is eligible for credentialing at this time, the remainder are not at this time.  Please review my comments and make the necessary updates.  Once all have been updated, please notify me when the documents are viewable and I will review further at this time.  One provider Jaya Jacob is not eligible until December 2022 and provider Ani Stephen  had a incorrect CAQH number on the roster and that also needs to be corrected for further review.  Any questions, please let me know.  Thank you.  ', NULL, NULL, '2021-06-21 14:27:02', '2021-06-21 14:27:02'),
(15822, 3040, 20908, NULL, '2021-07-16 00:00:00.000', 'In Process', 'Email sent to: humanahoustonpd@humana.com  Subject: Provider Roster  Hello,   Hope you are doing well. As per Michael Dufee email please find the attached updated roster for the below mentioned provider to get linked with Humana for our group Columbus Urgent Care PA under 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 1: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 2:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 3:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 4:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 7:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-09 10:11:38', '2021-07-09 10:11:38'),
(15823, 3040, 20908, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Email sent to: humanahoustonpd@humana.com  Subject: Provider Roster Hello,   Hope you are doing well. As per Micheal email I updated the information in CAQH for the below mentioned providers. I added the remarks below for your review.   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: Joseph, Vibitha Provider NPI# 1952931560  **** DEA and Medical License needed. Incomplete education listed, No Medicare, Full Hospital privileges needed.   Doesn\'t have DEA Education lited updated Medicare Updated Hospital Privileges under supervising physician   Provider 2: Provider Name: Brown, Brittany Provider NPI# 1275163537  **** No DEA or State License indicated. No Medicare, Full Hospital privileges needed  Doesn\'t have DEA State license updated  Medicare Updated Hospital Privileges under supervising physician   Provider 3: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  **** No State License or Medicare. Full Hospital privileges needed  State license updated Medciare updated  Hospital Privileges under supervising physician   Provider 4: Provider Name: Abraham, Glory Provider NPI# 1194206490  **** Full Medical License needed with expiration date needed, No DEA   DEA updated in the system  Full medical license updated   Provider 6: Provider Name: Stephen, Ani Provider NPI# 1588959118  *** Full Medical License needed with expiration date needed,  No Medicare, Full Hospital privileges needed.  Updated medical license  Medicare updated Hospital Privileges under supervising physician   Provider 7: Provider Name: PAUL, SIGI Provider NPI# 1033623616  **** Liability insurance can not be used as its for a different location. Employment gap January 2017-January 2021. Any gaps greater than 6 months, need a explanation.  Full Hospital privileges needed  Hospital Privileges under supervising physician  Liability insurance updated  Employment details updated in CAQH  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 10:31:29', '2021-08-26 10:31:29'),
(15824, 10057, 20908, 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 16:44:16', '2021-10-08 16:44:16'),
(15825, 10057, 20908, 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 : 07/09/2021', NULL, NULL, '2021-10-12 09:51:38', '2021-10-12 09:51:38'),
(15826, 3040, 20909, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:51:46', '2021-03-15 12:51:46'),
(15827, 3040, 20909, NULL, '2021-05-18 00:00:00.000', 'In Process', 'Email sent to: humanahoustonpd@humana.com  Subject: Provider Roster  Greetings,   Hope you are doing well. Please find the attached roster for the below mentioned provider to get linked with Humana for our group Columbus Urgent Care PA under 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 1: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 2:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 3:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 4:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 7:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-11 15:59:56', '2021-05-11 15:59:56'),
(15828, 1006, 20909, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Sent a f/u email @ HumanaHoustonPD humanahoustonpd@humana.com:  Sub: Enrollment Status - CUCC - Humana  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for our group and providers, their information is as follows:  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: Joseph, Vibitha Provider NPI# 1952931560  Provider 2:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 3:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 4:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 7:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Please get back to me as soon as possible. Thank you. \"', NULL, NULL, '2021-06-01 16:41:29', '2021-06-01 16:41:29'),
(15829, 3040, 20909, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email rcvd from: HumanaHoustonPD@humana.com  Subject: Enrollment Status - CUCC - Humana  No previous record of receipt of a request to add these practitioners.   Follow the below instructions to add new practitioners to an existing group.  Please complete and return the attached document, in its original excel format, along with a W-9. Include all providers in the practice that wish to participate on the standard roster, on the Practitioner Adds tab.  Make sure CAQH is updated for all providers to prevent any delays in the contracting process. Additionally, ensure that Humana is included in the “List of Authorized Organizations” in order for Humana to have on-line access to the provider’s CAQH account and the provider has granted access to Humana to view the CAQH credentialing information.  Look forward to receiving your documents.  HumanaHoustonPD', NULL, NULL, '2021-06-21 13:45:25', '2021-06-21 13:45:25'),
(15830, 3040, 20909, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: HumanaHoustonPD@humana.com  Subject: Enrollment Status - CUCC - Humana  Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for our group and providers, their information is as follows:  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID#  Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider 1: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 2:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 3:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 4:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 7:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8:   Provider Name: PAUL, SIGI Provider NPI# 1033623616   Please get back to me as soon as possible.  Thank you. ', NULL, NULL, '2021-06-21 13:47:17', '2021-06-21 13:47:17'),
(15831, 3040, 20909, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: mduffee@humana.com  Subject: Provider Roster  Hello Micheal,   Hope you are doing well. I reviewed all the corrections that you mentioned on roster. Can you please advise rather than panel assignment if we added the providers in group contract so can we bill those provider under the group.   Please get back to me as soon as  you can get a chance. Waiting to hear from you soon.   Thank you    On 9 June 2021, \"Michael Duffee\"  wrote: > Hello Adil, I have review the roster and only one provider is eligible for credentialing at this time, the remainder are not at this time.  Please review my comments and make the necessary updates.  Once all have been updated, please notify me when the documents are viewable and I will review further at this time.  One provider Jaya Jacob is not eligible until December 2022 and provider Ani Stephen  had a incorrect CAQH number on the roster and that also needs to be corrected for further review.  Any questions, please let me know.  Thank you.  ', NULL, NULL, '2021-06-21 14:26:59', '2021-06-21 14:26:59'),
(15832, 3040, 20909, NULL, '2021-07-16 00:00:00.000', 'In Process', 'Email sent to: humanahoustonpd@humana.com  Subject: Provider Roster  Hello,   Hope you are doing well. As per Michael Dufee email please find the attached updated roster for the below mentioned provider to get linked with Humana for our group Columbus Urgent Care PA under 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 1: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 2:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 3:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 4:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 7:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-09 10:11:36', '2021-07-09 10:11:36'),
(15833, 3040, 20909, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Email sent to: humanahoustonpd@humana.com  Subject: Provider Roster Hello,   Hope you are doing well. As per Micheal email I updated the information in CAQH for the below mentioned providers. I added the remarks below for your review.   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: Joseph, Vibitha Provider NPI# 1952931560  **** DEA and Medical License needed. Incomplete education listed, No Medicare, Full Hospital privileges needed.   Doesn\'t have DEA Education lited updated Medicare Updated Hospital Privileges under supervising physician   Provider 2: Provider Name: Brown, Brittany Provider NPI# 1275163537  **** No DEA or State License indicated. No Medicare, Full Hospital privileges needed  Doesn\'t have DEA State license updated  Medicare Updated Hospital Privileges under supervising physician   Provider 3: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  **** No State License or Medicare. Full Hospital privileges needed  State license updated Medciare updated  Hospital Privileges under supervising physician   Provider 4: Provider Name: Abraham, Glory Provider NPI# 1194206490  **** Full Medical License needed with expiration date needed, No DEA   DEA updated in the system  Full medical license updated   Provider 6: Provider Name: Stephen, Ani Provider NPI# 1588959118  *** Full Medical License needed with expiration date needed,  No Medicare, Full Hospital privileges needed.  Updated medical license  Medicare updated Hospital Privileges under supervising physician   Provider 7: Provider Name: PAUL, SIGI Provider NPI# 1033623616  **** Liability insurance can not be used as its for a different location. Employment gap January 2017-January 2021. Any gaps greater than 6 months, need a explanation.  Full Hospital privileges needed  Hospital Privileges under supervising physician  Liability insurance updated  Employment details updated in CAQH  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 10:31:31', '2021-08-26 10:31:31'),
(15834, 10057, 20909, 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 16:44:06', '2021-10-08 16:44:06'),
(15835, 10057, 20909, 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 : 07/09/2021', NULL, NULL, '2021-10-12 09:49:47', '2021-10-12 09:49:47'),
(15836, 3040, 20910, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:52:12', '2021-03-15 12:52:12'),
(15837, 3040, 20910, NULL, '2021-05-18 00:00:00.000', 'Approved', 'I had a word with (Gill) Humana representative and he advised me the provider is linked to Tax Id.   Ref: 2000183268199', NULL, NULL, '2021-05-11 14:11:14', '2021-05-11 14:11:14'),
(15838, 3040, 20911, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:52:42', '2021-03-15 12:52:42'),
(15839, 3040, 20911, NULL, '2021-05-18 00:00:00.000', 'In Process', 'Email sent to: humanahoustonpd@humana.com  Subject: Provider Roster  Greetings,   Hope you are doing well. Please find the attached roster for the below mentioned provider to get linked with Humana for our group Columbus Urgent Care PA under 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 1: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 2:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 3:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 4:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 7:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-11 16:00:01', '2021-05-11 16:00:01'),
(15840, 1006, 20911, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Sent a f/u email @ HumanaHoustonPD humanahoustonpd@humana.com:  Sub: Enrollment Status - CUCC - Humana  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for our group and providers, their information is as follows:  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: Joseph, Vibitha Provider NPI# 1952931560  Provider 2:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 3:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 4:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 7:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Please get back to me as soon as possible. Thank you. \"', NULL, NULL, '2021-06-01 16:41:34', '2021-06-01 16:41:34'),
(15841, 3040, 20911, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email rcvd from: HumanaHoustonPD@humana.com  Subject: Enrollment Status - CUCC - Humana  No previous record of receipt of a request to add these practitioners.   Follow the below instructions to add new practitioners to an existing group.  Please complete and return the attached document, in its original excel format, along with a W-9. Include all providers in the practice that wish to participate on the standard roster, on the Practitioner Adds tab.  Make sure CAQH is updated for all providers to prevent any delays in the contracting process. Additionally, ensure that Humana is included in the “List of Authorized Organizations” in order for Humana to have on-line access to the provider’s CAQH account and the provider has granted access to Humana to view the CAQH credentialing information.  Look forward to receiving your documents.  HumanaHoustonPD', NULL, NULL, '2021-06-21 13:45:22', '2021-06-21 13:45:22'),
(15842, 3040, 20911, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: HumanaHoustonPD@humana.com  Subject: Enrollment Status - CUCC - Humana  Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for our group and providers, their information is as follows:  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID#  Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider 1: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 2:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 3:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 4:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 7:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8:   Provider Name: PAUL, SIGI Provider NPI# 1033623616   Please get back to me as soon as possible.  Thank you. ', NULL, NULL, '2021-06-21 13:47:12', '2021-06-21 13:47:12'),
(15843, 3040, 20911, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: mduffee@humana.com  Subject: Provider Roster  Hello Micheal,   Hope you are doing well. I reviewed all the corrections that you mentioned on roster. Can you please advise rather than panel assignment if we added the providers in group contract so can we bill those provider under the group.   Please get back to me as soon as  you can get a chance. Waiting to hear from you soon.   Thank you    On 9 June 2021, \"Michael Duffee\"  wrote: > Hello Adil, I have review the roster and only one provider is eligible for credentialing at this time, the remainder are not at this time.  Please review my comments and make the necessary updates.  Once all have been updated, please notify me when the documents are viewable and I will review further at this time.  One provider Jaya Jacob is not eligible until December 2022 and provider Ani Stephen  had a incorrect CAQH number on the roster and that also needs to be corrected for further review.  Any questions, please let me know.  Thank you.  ', NULL, NULL, '2021-06-21 14:26:54', '2021-06-21 14:26:54'),
(15844, 3040, 20911, NULL, '2021-07-16 00:00:00.000', 'In Process', 'Email sent to: humanahoustonpd@humana.com  Subject: Provider Roster  Hello,   Hope you are doing well. As per Michael Dufee email please find the attached updated roster for the below mentioned provider to get linked with Humana for our group Columbus Urgent Care PA under 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 1: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 2:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 3:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 4:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 7:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-09 10:11:34', '2021-07-09 10:11:34'),
(15845, 3040, 20911, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Email sent to: humanahoustonpd@humana.com  Subject: Provider Roster Hello,   Hope you are doing well. As per Micheal email I updated the information in CAQH for the below mentioned providers. I added the remarks below for your review.   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: Joseph, Vibitha Provider NPI# 1952931560  **** DEA and Medical License needed. Incomplete education listed, No Medicare, Full Hospital privileges needed.   Doesn\'t have DEA Education lited updated Medicare Updated Hospital Privileges under supervising physician   Provider 2: Provider Name: Brown, Brittany Provider NPI# 1275163537  **** No DEA or State License indicated. No Medicare, Full Hospital privileges needed  Doesn\'t have DEA State license updated  Medicare Updated Hospital Privileges under supervising physician   Provider 3: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  **** No State License or Medicare. Full Hospital privileges needed  State license updated Medciare updated  Hospital Privileges under supervising physician   Provider 4: Provider Name: Abraham, Glory Provider NPI# 1194206490  **** Full Medical License needed with expiration date needed, No DEA   DEA updated in the system  Full medical license updated   Provider 6: Provider Name: Stephen, Ani Provider NPI# 1588959118  *** Full Medical License needed with expiration date needed,  No Medicare, Full Hospital privileges needed.  Updated medical license  Medicare updated Hospital Privileges under supervising physician   Provider 7: Provider Name: PAUL, SIGI Provider NPI# 1033623616  **** Liability insurance can not be used as its for a different location. Employment gap January 2017-January 2021. Any gaps greater than 6 months, need a explanation.  Full Hospital privileges needed  Hospital Privileges under supervising physician  Liability insurance updated  Employment details updated in CAQH  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 10:31:30', '2021-08-26 10:31:30'),
(15846, 10057, 20911, 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 16:43:55', '2021-10-08 16:43:55'),
(15847, 10057, 20911, 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 : 07/09/2021', NULL, NULL, '2021-10-12 09:48:34', '2021-10-12 09:48:34'),
(15848, 3040, 20912, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:53:07', '2021-03-15 12:53:07'),
(15849, 3040, 20912, NULL, '2021-05-18 00:00:00.000', 'In Process', 'Email sent to: humanahoustonpd@humana.com  Subject: Provider Roster  Greetings,   Hope you are doing well. Please find the attached roster for the below mentioned provider to get linked with Humana for our group Columbus Urgent Care PA under 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 1: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 2:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 3:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 4:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 7:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-11 16:00:05', '2021-05-11 16:00:05'),
(15850, 1006, 20912, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Sent a f/u email @ HumanaHoustonPD humanahoustonpd@humana.com:  Sub: Enrollment Status - CUCC - Humana  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for our group and providers, their information is as follows:  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: Joseph, Vibitha Provider NPI# 1952931560  Provider 2:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 3:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 4:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 7:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Please get back to me as soon as possible. Thank you. \"', NULL, NULL, '2021-06-01 16:41:39', '2021-06-01 16:41:39'),
(15851, 3040, 20912, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email rcvd from: HumanaHoustonPD@humana.com  Subject: Enrollment Status - CUCC - Humana  No previous record of receipt of a request to add these practitioners.   Follow the below instructions to add new practitioners to an existing group.  Please complete and return the attached document, in its original excel format, along with a W-9. Include all providers in the practice that wish to participate on the standard roster, on the Practitioner Adds tab.  Make sure CAQH is updated for all providers to prevent any delays in the contracting process. Additionally, ensure that Humana is included in the “List of Authorized Organizations” in order for Humana to have on-line access to the provider’s CAQH account and the provider has granted access to Humana to view the CAQH credentialing information.  Look forward to receiving your documents.  HumanaHoustonPD', NULL, NULL, '2021-06-21 13:45:18', '2021-06-21 13:45:18'),
(15852, 3040, 20912, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: HumanaHoustonPD@humana.com  Subject: Enrollment Status - CUCC - Humana  Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for our group and providers, their information is as follows:  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID#  Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider 1: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 2:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 3:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 4:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 7:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8:   Provider Name: PAUL, SIGI Provider NPI# 1033623616   Please get back to me as soon as possible.  Thank you. ', NULL, NULL, '2021-06-21 13:47:09', '2021-06-21 13:47:09'),
(15853, 3040, 20912, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: mduffee@humana.com  Subject: Provider Roster  Hello Micheal,   Hope you are doing well. I reviewed all the corrections that you mentioned on roster. Can you please advise rather than panel assignment if we added the providers in group contract so can we bill those provider under the group.   Please get back to me as soon as  you can get a chance. Waiting to hear from you soon.   Thank you    On 9 June 2021, \"Michael Duffee\"  wrote: > Hello Adil, I have review the roster and only one provider is eligible for credentialing at this time, the remainder are not at this time.  Please review my comments and make the necessary updates.  Once all have been updated, please notify me when the documents are viewable and I will review further at this time.  One provider Jaya Jacob is not eligible until December 2022 and provider Ani Stephen  had a incorrect CAQH number on the roster and that also needs to be corrected for further review.  Any questions, please let me know.  Thank you.  ', NULL, NULL, '2021-06-21 14:28:03', '2021-06-21 14:28:03'),
(15854, 3040, 20912, NULL, '2021-07-16 00:00:00.000', 'In Process', 'Email sent to: MDuffee@humana.com  Subject: Enroll Provider || Columbus Urgent Care PA || Abraham, Jeena || Humana ||  Hello MIchael,   Hope you are doing well. Please find the attached roster as per your email requested for Jeena Abraham to enroll 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 1:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Thank you ', NULL, NULL, '2021-07-09 09:36:13', '2021-07-09 09:36:13'),
(15855, 3040, 20912, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Email sent to: MDuffee@humana.com  Subject: Re: Enroll Provider || Columbus Urgent Care PA || Abraham, Jeena || Humana ||  Hello Michael,  Hope you are doing well. I wanted to know the credentialing status for 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 1:   Provider Name: Abraham, Jeena Provider NPI# 1467901587Hello Michael,   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-26 10:34:44', '2021-08-26 10:34:44'),
(15856, 3040, 20912, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Email rcvd from: MDuffee@humana.com  Subject: Secured: RE: Enroll Provider || Columbus Urgent Care PA || Abraham, Jeena || Humana ||  Your provider is effective 8/1/21.  Have a good afternoon.   ', NULL, NULL, '2021-08-27 10:11:59', '2021-08-27 10:11:59'),
(15857, 3040, 20913, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:53:17', '2021-03-15 12:53:17'),
(15858, 1005, 20913, NULL, '2021-06-08 00:00:00.000', 'Not Eligible', 'Provider is no longer working for this Practice. Eff from 12/15/2020', NULL, NULL, '2021-06-01 12:51:17', '2021-06-01 12:51:17'),
(15859, 3040, 20914, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:53:37', '2021-03-15 12:53:37'),
(15860, 3040, 20914, NULL, '2021-05-18 00:00:00.000', 'In Process', 'Email sent to: humanahoustonpd@humana.com  Subject: Provider Roster  Greetings,   Hope you are doing well. Please find the attached roster for the below mentioned provider to get linked with Humana for our group Columbus Urgent Care PA under 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 1: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 2:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 3:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 4:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 7:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-11 16:00:09', '2021-05-11 16:00:09'),
(15861, 1006, 20914, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Sent a f/u email @ HumanaHoustonPD humanahoustonpd@humana.com:  Sub: Enrollment Status - CUCC - Humana  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for our group and providers, their information is as follows:  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: Joseph, Vibitha Provider NPI# 1952931560  Provider 2:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 3:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 4:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 7:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Please get back to me as soon as possible. Thank you. \"', NULL, NULL, '2021-06-01 16:41:44', '2021-06-01 16:41:44'),
(15862, 3040, 20914, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email rcvd from: HumanaHoustonPD@humana.com  Subject: Enrollment Status - CUCC - Humana  No previous record of receipt of a request to add these practitioners.   Follow the below instructions to add new practitioners to an existing group.  Please complete and return the attached document, in its original excel format, along with a W-9. Include all providers in the practice that wish to participate on the standard roster, on the Practitioner Adds tab.  Make sure CAQH is updated for all providers to prevent any delays in the contracting process. Additionally, ensure that Humana is included in the “List of Authorized Organizations” in order for Humana to have on-line access to the provider’s CAQH account and the provider has granted access to Humana to view the CAQH credentialing information.  Look forward to receiving your documents.  HumanaHoustonPD', NULL, NULL, '2021-06-21 13:45:42', '2021-06-21 13:45:42');
