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
(15863, 3040, 20914, 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 13:47:29', '2021-06-21 13:47:29'),
(15864, 3040, 20914, 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 14:27:21', '2021-06-21 14:27:21'),
(15865, 3040, 20914, 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 10:11:32', '2021-07-09 10:11:32'),
(15866, 3040, 20914, 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'),
(15867, 10057, 20914, 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 16:43:43', '2021-10-08 16:43:43'),
(15868, 10057, 20914, 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 09:41:29', '2021-10-12 09:41:29'),
(15869, 3040, 20915, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:54:02', '2021-03-15 12:54:02'),
(15870, 3040, 20915, 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 16:00:14', '2021-05-11 16:00:14'),
(15871, 1006, 20915, 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 16:41:49', '2021-06-01 16:41:49'),
(15872, 3040, 20915, 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 13:45:35', '2021-06-21 13:45:35'),
(15873, 3040, 20915, 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 13:47:26', '2021-06-21 13:47:26'),
(15874, 3040, 20915, 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 14:27:16', '2021-06-21 14:27:16'),
(15875, 3040, 20915, NULL, '2021-07-19 00:00:00.000', 'Not Eligible', 'Provider is no longer working. ', NULL, NULL, '2021-07-12 13:18:13', '2021-07-12 13:18:13'),
(15876, 3040, 20916, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:54:15', '2021-03-15 12:54:15'),
(15877, 3040, 20916, 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 16:00:18', '2021-05-11 16:00:18'),
(15878, 1006, 20916, 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 16:41:54', '2021-06-01 16:41:54'),
(15879, 3040, 20916, 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 13:45:45', '2021-06-21 13:45:45'),
(15880, 3040, 20916, 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 13:46:58', '2021-06-21 13:46:58'),
(15881, 3040, 20916, 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 14:27:28', '2021-06-21 14:27:28'),
(15882, 3040, 20916, 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 10:11:29', '2021-07-09 10:11:29'),
(15883, 3040, 20916, 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 10:31:38', '2021-08-26 10:31:38'),
(15884, 10057, 20916, 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 16:43:28', '2021-10-08 16:43:28'),
(15885, 10057, 20916, 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 09:38:07', '2021-10-12 09:38:07'),
(15886, 3040, 20917, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:55:23', '2021-03-15 12:55:23'),
(15887, 3040, 20917, NULL, '2021-05-19 00:00:00.000', 'Approved', 'Group has an ancillary contract. Please see attachment. ', NULL, NULL, '2021-05-12 10:56:40', '2021-05-12 10:56:40'),
(15888, 3040, 20918, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:55:41', '2021-03-15 12:55:41'),
(15889, 3040, 20918, NULL, '2021-05-19 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. See group task. ', NULL, NULL, '2021-05-12 10:57:28', '2021-05-12 10:57:28'),
(15890, 3040, 20919, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:55:52', '2021-03-15 12:55:52'),
(15891, 3040, 20919, NULL, '2021-05-19 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. See group task. ', NULL, NULL, '2021-05-12 10:57:33', '2021-05-12 10:57:33'),
(15892, 3040, 20920, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:56:02', '2021-03-15 12:56:02'),
(15893, 3040, 20920, NULL, '2021-05-19 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. See group task. ', NULL, NULL, '2021-05-12 10:57:38', '2021-05-12 10:57:38'),
(15894, 3040, 20921, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:56:29', '2021-03-15 12:56:29'),
(15895, 3040, 20921, NULL, '2021-05-19 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. See group task. ', NULL, NULL, '2021-05-12 10:57:45', '2021-05-12 10:57:45'),
(15896, 3040, 20922, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:56:47', '2021-03-15 12:56:47'),
(15897, 3040, 20922, NULL, '2021-05-19 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. See group task. ', NULL, NULL, '2021-05-12 10:57:50', '2021-05-12 10:57:50'),
(15898, 3040, 20923, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:57:37', '2021-03-15 12:57:37'),
(15899, 3040, 20923, NULL, '2021-05-19 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. See group task. ', NULL, NULL, '2021-05-12 10:57:54', '2021-05-12 10:57:54'),
(15900, 3040, 20924, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:57:49', '2021-03-15 12:57:49'),
(15901, 3040, 20924, NULL, '2021-05-19 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. See group task. ', NULL, NULL, '2021-05-12 10:57:59', '2021-05-12 10:57:59'),
(15902, 3040, 20925, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:58:10', '2021-03-15 12:58:10'),
(15903, 3040, 20925, NULL, '2021-05-19 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. See group task. ', NULL, NULL, '2021-05-12 10:58:03', '2021-05-12 10:58:03'),
(15904, 3040, 20926, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:58:22', '2021-03-15 12:58:22'),
(15905, 3040, 20926, NULL, '2021-05-19 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. See group task. ', NULL, NULL, '2021-05-12 10:58:07', '2021-05-12 10:58:07'),
(15906, 3040, 20927, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:58:34', '2021-03-15 12:58:34'),
(15907, 1005, 20927, 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 12:51:38', '2021-06-01 12:51:38'),
(15908, 3040, 20928, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:58:55', '2021-03-15 12:58:55'),
(15909, 3040, 20928, NULL, '2021-05-19 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. See group task. ', NULL, NULL, '2021-05-12 10:58:15', '2021-05-12 10:58:15'),
(15910, 3040, 20929, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:59:07', '2021-03-15 12:59:07'),
(15911, 3040, 20929, NULL, '2021-05-19 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. See group task. ', NULL, NULL, '2021-05-12 10:58:19', '2021-05-12 10:58:19'),
(15912, 3040, 20930, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:59:20', '2021-03-15 12:59:20'),
(15913, 3040, 20930, NULL, '2021-05-19 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. See group task. ', NULL, NULL, '2021-05-12 10:58:24', '2021-05-12 10:58:24'),
(15914, 3040, 20931, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 12:59:32', '2021-03-15 12:59:32'),
(15915, 3040, 20931, NULL, '2021-05-19 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. See group task. ', NULL, NULL, '2021-05-12 10:58:28', '2021-05-12 10:58:28'),
(15916, 3046, 20932, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:02:24', '2021-03-15 13:02:24'),
(15917, 1005, 20932, 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 14:04:12', '2021-06-01 14:04:12'),
(15918, 3046, 20933, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:02:47', '2021-03-15 13:02:47'),
(15919, 1005, 20933, 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 14:04:36', '2021-06-01 14:04:36'),
(15920, 3046, 20934, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:03:26', '2021-03-15 13:03:26'),
(15921, 1005, 20934, 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 14:05:12', '2021-06-01 14:05:12'),
(15922, 3046, 20935, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:03:55', '2021-03-15 13:03:55'),
(15923, 1005, 20935, NULL, '2021-06-09 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 14:05:20', '2021-06-01 14:05:20'),
(15924, 3046, 20936, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:04:28', '2021-03-15 13:04:28'),
(15925, 1005, 20936, NULL, '2021-06-09 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 14:05:34', '2021-06-01 14:05:34'),
(15926, 3040, 20937, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:04:29', '2021-03-15 13:04:29'),
(15927, 3040, 20937, NULL, '2021-05-25 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Request Roster || Columbus Urgent Care PA || Tax ID: 47-1914151 || Health Smart ||  Greetings,  Hope you are doing well. Can you please send me the provider roster for the below mentioned group.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-05-18 16:09:58', '2021-05-18 16:09:58'),
(15928, 3040, 20937, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Enrollment Status || Columbus Urgent Care PA || Group & Providers || Health Smart ||  Greetings,  Hope you are doing well. Please advise me the enrollment status for the below mentioned group and providers in Health Smart for our group Columbus Urgent Care PA for below location. Can you please send me the provider roster.    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  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you   ', NULL, NULL, '2021-06-08 10:22:31', '2021-06-08 10:22:31'),
(15929, 3040, 20937, NULL, '2021-06-21 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Enrollment Status || Columbus Urgent Care PA || Group & Providers || Health Smart ||  Greetings,   Hope you are doing well. Please find the attached Demographic information form for the below mentioned providers as per previous email requested.  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: Stephen, Ani Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  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: PAUL, SIGI  Provider NPI# 1033623616  Provider 7:   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, '2021-06-14 09:30:11', '2021-06-14 09:30:11'),
(15930, 11056, 20937, NULL, '2021-07-08 00:00:00.000', 'In Process', 'Email sent to : pr.south@healthsmart.com  Sub : Enrollment Status Query- Columbus Urgent Care PA - Health Smart  Good morning!  Hope you are doing well. I want to inquire about the enrollment status of the following providers.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Providers: Provider 1:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  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: PAUL, SIGI Provider NPI# 1033623616  Provider 7:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-01 09:16:31', '2021-07-01 09:16:31'),
(15931, 11056, 20937, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email received from : mdiprsupport@healthsmart.com  Sub : Enrollment Status Query- Columbus Urgent Care PA - Health Smart  Hi,  01- Following Providers are currently in the credentialing process.  Provider Name   Stephen, Ani   PICCIONE JR, JAMES M   Chennemkara, Mini Philip   Abraham, Glory   Abraham, Jeena   Paul, Sigi   Jacob, Jaya   02- We are returning your application due to missing information listed below.  Provider Name   Missing Information   Joseph, Molly NP   The application form does not have the tin \" 47-1914151 \" on it.  Please update the CAQH to include the missing tax id. ', NULL, NULL, '2021-07-05 08:47:55', '2021-07-05 08:47:55'),
(15932, 3040, 20937, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Re: Fw: Enrollment Status Query- Columbus Urgent Care PA - Health Smart  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Health Smart 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: Stephen, Ani Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  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: 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, '2021-07-23 13:43:35', '2021-07-23 13:43:35'),
(15933, 11056, 20937, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email sent to : pr.south@healthsmart.com  Sub : Enrollment Status Query - Columbus Urgent Care PA - Health Smart  Good morning!  Hope you are doing well. I want to inquire about the enrollment status of the following provider. Please provide me with updates soon.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# : 47-1914151 Practice NPI# : 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider  Provider Name: John, Jeny Provider NPI# : 1073019493  If you need any information or documents please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-04 16:42:21', '2021-08-04 16:42:21'),
(15934, 3040, 20937, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: HealthSmart.com - Join Our Network - Individual Provider - John  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in Health Smart in our group under the below location.   Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-30 13:48:33', '2021-08-30 13:48:33'),
(15935, 3040, 20937, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: HealthSmart.com - Join Our Network - Individual Provider - John  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in Health Smart in our group under the below location.   Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-30 13:50:36', '2021-08-30 13:50:36'),
(15936, 10057, 20937, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email Sent To : pr.south@healthsmart.com  Sub : Enrollment Status Query- Columbus Urgent Care PA - Health Smart  Good Afternoon,  Hope you are doing well. I wanted to know the group enrollment status under the below location in Health Smart.   Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-14 14:57:02', '2021-10-14 14:57:02'),
(15937, 10057, 20937, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Email Sent To : mdiprsupport@healthsmart.com  Enrollment Status || Columbus Urgent Care PA || Group || Health Smart ||  Hello,  Hope this email finds you well. I\'m writing this email to get the latest update on group enrollment status. Since I\'m able to see the CUCC on the provider search directory.  Please get back to me with the effective date for the group. Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-11-17 17:28:49', '2021-11-17 17:28:49'),
(15938, 10057, 20937, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : mdiprsupport@healthsmart.com & pr.south@healthsmart.com  Sub : Enrollment Status || Columbus Urgent Care PA || Group || Health Smart ||  Greetings!  Could you please provide me with the latest update on the below mentioned details.  Thanks & Regards,', NULL, NULL, '2021-11-30 13:51:41', '2021-11-30 13:51:41'),
(15939, 10057, 20937, NULL, '2021-12-14 00:00:00.000', 'In Process', 'Email Received From : pr.south@healthsmart.com  Sub : Enrollment Status || Columbus Urgent Care PA || Group || Health Smart ||  Please provide name TIN and NPI.  Diamond Lucero |Sr. Provider Relations', NULL, NULL, '2021-12-07 11:01:57', '2021-12-07 11:01:57'),
(15940, 10057, 20937, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email Sent To : pr.south@healthsmart.com  Sub : Enrollment Status || Columbus Urgent Care PA || Group || Health Smart ||  Thank you for reaching out. Please find the details below.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Please get back to me with the latest updates.  Thanks & Regards,', NULL, NULL, '2021-12-14 11:06:42', '2021-12-14 11:06:42'),
(15941, 10057, 20937, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Sent To : pr.south@healthsmart.com & mdiprsupport@healthsmart.com  Sub : Thank you for reaching out. Please find the below mentioned provider details along with the TIN.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  All the providers have been enrolled earlier, we just want to get the update about GROUP ENROLLMENT. if it is done please provide us the agreement or contract accordingly.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-21 10:37:56', '2021-12-21 10:37:56'),
(15942, 10057, 20937, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email Received From : mdiprsupport@healthsmart.com  Sub : Enrollment Status || Columbus Urgent Care PA || Group || Health Smart ||  Hi,  Please see the following Providers with effective dates.  PROVIDER NAME   EFFECTIVE DATE   FERNANDUS, LIMY  11/1/2020   SIGI CARE PAUL, NP   7/1/2021   JAYA JACOB, NP      7/1/2021   ABRAHAM, JEENA  6/1/2021   CINI THOMAS, NP       2/1/2020   KOUROUMA, ODETTE T  10/28/2019   RAUF, ABDUR  2/1/2018   JOSEPH MOLLY, NP  9/1/2021   JOHN, JENY  5/1/2021   STEPHEN, ANI  6/1/2021   BROWN, BRITTANY  1/24/2020   VIBITHA JOSEPH, NP   6/1/2020   JEEMOL GEORGE, NP        7/1/2020   JOSE, JULIE  6/8/2020   ABRAHAM, GLORY  6/1/2021   CHENNEMKARA, MINI P  6/1/2021   PICCIONE JR, JAMES M  6/1/2021   All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com.  Thanks HealthSmart Provider Relations.', NULL, NULL, '2021-12-28 13:15:07', '2021-12-28 13:15:07'),
(15943, 19067, 20937, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Enrollment Query || CUCC || Group || Health Smart ||    Hello!  Hope you are having a productive day.  I would like to know the enrollment status of the following Group.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus, TX 78934-2215  Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 14:14:51', '2022-01-04 14:14:51'),
(15944, 20067, 20937, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Sub: Re: Enrollment Query || CUCC || Group || Health Smart ||  Good Morning! Hope this email finds you in good health. Any updates on the previously mentioned request.  Thanks & Regards, Syed Ahad. ', NULL, NULL, '2022-01-19 13:12:26', '2022-01-19 13:12:26'),
(15945, 20067, 20937, NULL, '2022-02-03 00:00:00.000', 'In Process', 'Email received from: mdiprsupport@healthsmart.com  Sub: Enrollment Query || CUCC || Group || Health Smart ||  Hi,  Please send the list of providers affected by this update,  Provider Name Provider NPI #  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com  Thanks HealthSmart Provider Relations.', NULL, NULL, '2022-01-27 12:43:03', '2022-01-27 12:43:03'),
(15946, 20067, 20937, NULL, '2022-02-24 00:00:00.000', 'In Process', 'Email sent to: mdiprsupport@healthsmart.com  Sub: Re: Fw: Enrollment Query || CUCC || Group || Health Smart ||  Good Afternoon!  Hope this email finds you in good health. Can you please send me a copy of the group contract?  Eagerly waiting to hear from you.  Thank you,', NULL, NULL, '2022-02-17 17:25:13', '2022-02-17 17:25:13'),
(15947, 20067, 20937, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email received from: mdiprsupport@healthsmart.com  Sub: Nominate a Provider Form || CUCC || Ancy Kurian ||   Hi,  Please provide the listed below information.  *Provider Name *Provider individual NPI #  All communication, including requested documents should be sent to pr.south@healthsmart.com. Please do not submit to MDIPR@healthsmart.com  Thanks Healthsmart Provider Relations.', NULL, NULL, '2022-03-01 12:03:38', '2022-03-01 12:03:38'),
(15948, 20067, 20937, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email sent to: mdiprsupport@healthsmart.com  Sub: Nominate a Provider Form || CUCC || Ancy Kurian || HealthSmart ||  Good Morning!  Hope you are doing great. Kindly respond to the previous email.   Eagerly waiting to hear from you, Thank you,', NULL, NULL, '2022-03-01 12:03:51', '2022-03-01 12:03:51'),
(15949, 20067, 20937, NULL, '2022-03-16 00:00:00.000', 'In Process', 'Email received from: mdiprsupport@healthsmart.com  Sub: Nominate a Provider Form || CUCC || Ancy Kurian || HealthSmart ||  Hi,  Provider \" Kurian, Ancy V NP \" is currently in the credentialing process.  All communication, including requested documents should be sent to pr.south@healthsmart.com. Please do not submit to MDIPR@healthsmart.com.  Document ID : 3559653  Thanks Healthsmart Provider Relations.', NULL, NULL, '2022-03-09 14:10:48', '2022-03-09 14:10:48'),
(15950, 20067, 20937, NULL, '2022-03-28 00:00:00.000', 'In Process', 'Email sent to: mdiprsupport@healthsmart.com  Sub: Credentialing Status || CUCC || Ancy Kurian || HealthSmart ||  Good Afternoon!  Hope you had a great weekend. What\'s the current status of provider Ancy Kurian. If the provider is loaded, kindly send me the welcome letter.  Thank you,', NULL, NULL, '2022-03-21 12:45:27', '2022-03-21 12:45:27'),
(15951, 3046, 20938, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:04:37', '2021-03-15 13:04:37'),
(15952, 1005, 20938, NULL, '2021-06-09 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 14:05:50', '2021-06-01 14:05:50'),
(15953, 3040, 20939, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:04:54', '2021-03-15 13:04:54'),
(15954, 3040, 20939, NULL, '2021-05-25 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Request Roster || Columbus Urgent Care PA || Tax ID: 47-1914151 || Health Smart ||  Greetings,  Hope you are doing well. Can you please send me the provider roster for the below mentioned group.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-05-18 16:10:06', '2021-05-18 16:10:06');
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
(15955, 3040, 20939, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Enrollment Status || Columbus Urgent Care PA || Group & Providers || Health Smart ||  Greetings,  Hope you are doing well. Please advise me the enrollment status for the below mentioned group and providers in Health Smart for our group Columbus Urgent Care PA for below location. Can you please send me the provider roster.    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  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-06-08 14:06:17', '2021-06-08 14:06:17'),
(15956, 3040, 20939, NULL, '2021-06-21 00:00:00.000', 'Approved', 'Email rcvd from: mdiprsupport@healthsmart.com  Subject: Fw: Enrollment Status || Columbus Urgent Care PA || Group & Providers || Health Smart ||  Hi,  1. Please see below providers effective date.  Providers Name                                Effective Date  GEORGE, JEEMOL                              07/01/2020   JOSE, JULIE                                          06/08/2020   BROWN, BRITTANY                           01/24/2020   FERNANDUS, LIMY                            11/01/2020   RAUF, ABDUR                                     02/01/2018   KOUROUMA, ODETTE T                    10/28/2019   JOSEPH, VIBITHA                                06/01/2020   THOMAS, CINI                                    02/01/2020   ', NULL, NULL, '2021-06-14 09:23:31', '2021-06-14 09:23:31'),
(15957, 3040, 20942, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:06:03', '2021-03-15 13:06:03'),
(15958, 3040, 20942, NULL, '2021-05-25 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Request Roster || Columbus Urgent Care PA || Tax ID: 47-1914151 || Health Smart ||  Greetings,  Hope you are doing well. Can you please send me the provider roster for the below mentioned group.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-05-18 16:10:10', '2021-05-18 16:10:10'),
(15959, 3040, 20942, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Enrollment Status || Columbus Urgent Care PA || Group & Providers || Health Smart ||  Greetings,  Hope you are doing well. Please advise me the enrollment status for the below mentioned group and providers in Health Smart for our group Columbus Urgent Care PA for below location. Can you please send me the provider roster.    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  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you   ', NULL, NULL, '2021-06-08 10:22:05', '2021-06-08 10:22:05'),
(15960, 3040, 20942, NULL, '2021-06-21 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Enrollment Status || Columbus Urgent Care PA || Group & Providers || Health Smart ||  Greetings,   Hope you are doing well. Please find the attached Demographic information form for the below mentioned providers as per previous email requested.  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: Stephen, Ani Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  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: PAUL, SIGI  Provider NPI# 1033623616  Provider 7:   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, '2021-06-14 09:30:07', '2021-06-14 09:30:07'),
(15961, 11056, 20942, NULL, '2021-07-08 00:00:00.000', 'In Process', 'Email sent to : pr.south@healthsmart.com  Sub : Enrollment Status Query- Columbus Urgent Care PA - Health Smart  Good morning!  Hope you are doing well. I want to inquire about the enrollment status of the following providers.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Providers: Provider 1:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  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: PAUL, SIGI Provider NPI# 1033623616  Provider 7:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-01 09:16:20', '2021-07-01 09:16:20'),
(15962, 11056, 20942, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email received from : mdiprsupport@healthsmart.com  Sub : Enrollment Status Query- Columbus Urgent Care PA - Health Smart  Hi,  01- Following Providers are currently in the credentialing process.  Provider Name   Stephen, Ani   PICCIONE JR, JAMES M   Chennemkara, Mini Philip   Abraham, Glory   Abraham, Jeena   Paul, Sigi   Jacob, Jaya   All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com  (Inventory Log ID : 81523)  Thanks HealthSmart Provider Relations.', NULL, NULL, '2021-07-05 08:52:55', '2021-07-05 08:52:55'),
(15963, 3040, 20942, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Re: Fw: Enrollment Status Query- Columbus Urgent Care PA - Health Smart  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Health Smart 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: Stephen, Ani Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  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: 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, '2021-07-23 13:43:35', '2021-07-23 13:43:35'),
(15964, 3040, 20942, NULL, '2021-08-04 00:00:00.000', 'Approved', 'Email rcvd from: mdiprsupport@healthsmart.com  Subject: Fw: Fw: Enrollment Status Query- Columbus Urgent Care PA - Health Smart  Hi,  Please see the following Providers with effective dates.  Provider Name                                 Effective Date   STEPHEN, ANI                                      06/01/2021   CHENNEMKARA, MINI P                     06/01/2021   PICCIONE JR, JAMES M                        06/01/2021   ABRAHAM, GLORY                               06/01/2021   ABRAHAM, JEENA                                 06/01/2021   Joseph Molly, NP                                   09/01/2021   All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com   (Inventory Log ID : 81523)  Thanks HealthSmart Provider Relations.', NULL, NULL, '2021-07-28 09:11:26', '2021-07-28 09:11:26'),
(15965, 3046, 20943, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:06:16', '2021-03-15 13:06:16'),
(15966, 1005, 20943, NULL, '2021-06-09 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 14:06:37', '2021-06-01 14:06:37'),
(15967, 3046, 20944, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:07:16', '2021-03-15 13:07:16'),
(15968, 1005, 20944, NULL, '2021-06-09 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 14:11:58', '2021-06-01 14:11:58'),
(15969, 3046, 20945, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:07:34', '2021-03-15 13:07:34'),
(15970, 1005, 20945, NULL, '2021-06-09 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 14:17:36', '2021-06-01 14:17:36'),
(15971, 3040, 20946, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:07:46', '2021-03-15 13:07:46'),
(15972, 3040, 20946, NULL, '2021-05-25 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Request Roster || Columbus Urgent Care PA || Tax ID: 47-1914151 || Health Smart ||  Greetings,  Hope you are doing well. Can you please send me the provider roster for the below mentioned group.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-05-18 16:10:14', '2021-05-18 16:10:14'),
(15973, 3040, 20946, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Enrollment Status || Columbus Urgent Care PA || Group & Providers || Health Smart ||  Greetings,  Hope you are doing well. Please advise me the enrollment status for the below mentioned group and providers in Health Smart for our group Columbus Urgent Care PA for below location. Can you please send me the provider roster.    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  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you   ', NULL, NULL, '2021-06-08 10:20:25', '2021-06-08 10:20:25'),
(15974, 3040, 20946, NULL, '2021-06-21 00:00:00.000', 'Approved', 'Email rcvd from: mdiprsupport@healthsmart.com  Subject: Fw: Enrollment Status || Columbus Urgent Care PA || Group & Providers || Health Smart ||  Hi,  1. Please see below providers effective date.  Providers Name                                Effective Date  GEORGE, JEEMOL                              07/01/2020   JOSE, JULIE                                          06/08/2020   BROWN, BRITTANY                           01/24/2020   FERNANDUS, LIMY                            11/01/2020   RAUF, ABDUR                                     02/01/2018   KOUROUMA, ODETTE T                    10/28/2019   JOSEPH, VIBITHA                                06/01/2020   THOMAS, CINI                                    02/01/2020', NULL, NULL, '2021-06-14 09:25:19', '2021-06-14 09:25:19'),
(15975, 3046, 20947, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:08:00', '2021-03-15 13:08:00'),
(15976, 1005, 20947, NULL, '2021-06-09 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 14:13:00', '2021-06-01 14:13:00'),
(15977, 3046, 20948, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:08:04', '2021-03-15 13:08:04'),
(15978, 1005, 20948, NULL, '2021-06-09 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 14:13:10', '2021-06-01 14:13:10'),
(15979, 3040, 20949, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:08:17', '2021-03-15 13:08:17'),
(15980, 3040, 20949, NULL, '2021-05-25 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Request Roster || Columbus Urgent Care PA || Tax ID: 47-1914151 || Health Smart ||  Greetings,  Hope you are doing well. Can you please send me the provider roster for the below mentioned group.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-05-18 16:10:19', '2021-05-18 16:10:19'),
(15981, 3040, 20949, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Enrollment Status || Columbus Urgent Care PA || Group & Providers || Health Smart ||  Greetings,  Hope you are doing well. Please advise me the enrollment status for the below mentioned group and providers in Health Smart for our group Columbus Urgent Care PA for below location. Can you please send me the provider roster.    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  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you   ', NULL, NULL, '2021-06-08 10:20:18', '2021-06-08 10:20:18'),
(15982, 3040, 20949, NULL, '2021-06-21 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Enrollment Status || Columbus Urgent Care PA || Group & Providers || Health Smart ||  Greetings,   Hope you are doing well. Please find the attached Demographic information form for the below mentioned providers as per previous email requested.  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: Stephen, Ani Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  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: PAUL, SIGI  Provider NPI# 1033623616  Provider 7:   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, '2021-06-14 09:30:03', '2021-06-14 09:30:03'),
(15983, 11056, 20949, NULL, '2021-07-08 00:00:00.000', 'In Process', 'Email sent to : pr.south@healthsmart.com  Sub : Enrollment Status Query- Columbus Urgent Care PA - Health Smart  Good morning!  Hope you are doing well. I want to inquire about the enrollment status of the following providers.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Providers: Provider 1:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  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: PAUL, SIGI Provider NPI# 1033623616  Provider 7:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-01 09:16:12', '2021-07-01 09:16:12'),
(15984, 11056, 20949, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email received from : mdiprsupport@healthsmart.com  Sub : Enrollment Status Query- Columbus Urgent Care PA - Health Smart  Hi,  01- Following Providers are currently in the credentialing process.  Provider Name   Stephen, Ani   PICCIONE JR, JAMES M   Chennemkara, Mini Philip   Abraham, Glory   Abraham, Jeena   Paul, Sigi   Jacob, Jaya   All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com  (Inventory Log ID : 81523)  Thanks HealthSmart Provider Relations.', NULL, NULL, '2021-07-05 08:53:01', '2021-07-05 08:53:01'),
(15985, 3040, 20949, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Re: Fw: Enrollment Status Query- Columbus Urgent Care PA - Health Smart  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Health Smart 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: Stephen, Ani Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  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: 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, '2021-07-23 13:43:36', '2021-07-23 13:43:36'),
(15986, 3040, 20949, NULL, '2021-08-04 00:00:00.000', 'Approved', 'Email rcvd from: mdiprsupport@healthsmart.com  Subject: Fw: Fw: Enrollment Status Query- Columbus Urgent Care PA - Health Smart  Hi,  Please see the following Providers with effective dates.  Provider Name                                 Effective Date   STEPHEN, ANI                                      06/01/2021   CHENNEMKARA, MINI P                     06/01/2021   PICCIONE JR, JAMES M                        06/01/2021   ABRAHAM, GLORY                               06/01/2021   ABRAHAM, JEENA                                 06/01/2021   Joseph Molly, NP                                   09/01/2021   All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com   (Inventory Log ID : 81523)  Thanks HealthSmart Provider Relations.', NULL, NULL, '2021-07-28 09:11:27', '2021-07-28 09:11:27'),
(15987, 3046, 20950, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:08:30', '2021-03-15 13:08:30'),
(15988, 1005, 20950, NULL, '2021-06-09 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 14:13:21', '2021-06-01 14:13:21'),
(15989, 3040, 20951, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:08:32', '2021-03-15 13:08:32'),
(15990, 3040, 20951, NULL, '2021-05-25 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Request Roster || Columbus Urgent Care PA || Tax ID: 47-1914151 || Health Smart ||  Greetings,  Hope you are doing well. Can you please send me the provider roster for the below mentioned group.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-05-18 16:10:23', '2021-05-18 16:10:23'),
(15991, 3040, 20951, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Enrollment Status || Columbus Urgent Care PA || Group & Providers || Health Smart ||  Greetings,  Hope you are doing well. Please advise me the enrollment status for the below mentioned group and providers in Health Smart for our group Columbus Urgent Care PA for below location. Can you please send me the provider roster.    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  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you   ', NULL, NULL, '2021-06-08 10:20:09', '2021-06-08 10:20:09'),
(15992, 3040, 20951, NULL, '2021-06-21 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Enrollment Status || Columbus Urgent Care PA || Group & Providers || Health Smart ||  Greetings,   Hope you are doing well. Please find the attached Demographic information form for the below mentioned providers as per previous email requested.  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: Stephen, Ani Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  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: PAUL, SIGI  Provider NPI# 1033623616  Provider 7:   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, '2021-06-14 09:29:59', '2021-06-14 09:29:59'),
(15993, 11056, 20951, NULL, '2021-07-08 00:00:00.000', 'In Process', 'Email sent to : pr.south@healthsmart.com  Sub : Enrollment Status Query- Columbus Urgent Care PA - Health Smart  Good morning!  Hope you are doing well. I want to inquire about the enrollment status of the following providers.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Providers: Provider 1:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  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: PAUL, SIGI Provider NPI# 1033623616  Provider 7:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-01 09:16:05', '2021-07-01 09:16:05'),
(15994, 11056, 20951, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email received from : mdiprsupport@healthsmart.com  Sub : Enrollment Status Query- Columbus Urgent Care PA - Health Smart  Hi,  01- Following Providers are currently in the credentialing process.  Provider Name   Stephen, Ani   PICCIONE JR, JAMES M   Chennemkara, Mini Philip   Abraham, Glory   Abraham, Jeena   Paul, Sigi   Jacob, Jaya   All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com  (Inventory Log ID : 81523)  Thanks HealthSmart Provider Relations.', NULL, NULL, '2021-07-05 08:53:10', '2021-07-05 08:53:10'),
(15995, 3040, 20951, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Re: Fw: Enrollment Status Query- Columbus Urgent Care PA - Health Smart  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Health Smart 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: Stephen, Ani Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  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: 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, '2021-07-23 13:43:36', '2021-07-23 13:43:36'),
(15996, 3040, 20951, NULL, '2021-08-04 00:00:00.000', 'Approved', 'Email rcvd from: mdiprsupport@healthsmart.com  Subject: Fw: Fw: Enrollment Status Query- Columbus Urgent Care PA - Health Smart  Hi,  Please see the following Providers with effective dates.  Provider Name                                 Effective Date   STEPHEN, ANI                                      06/01/2021   CHENNEMKARA, MINI P                     06/01/2021   PICCIONE JR, JAMES M                        06/01/2021   ABRAHAM, GLORY                               06/01/2021   ABRAHAM, JEENA                                 06/01/2021   Joseph Molly, NP                                   09/01/2021   All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com   (Inventory Log ID : 81523)  Thanks HealthSmart Provider Relations.', NULL, NULL, '2021-07-28 09:11:27', '2021-07-28 09:11:27'),
(15997, 3040, 20952, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:08:42', '2021-03-15 13:08:42'),
(15998, 1005, 20952, 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 12:50:56', '2021-06-01 12:50:56'),
(15999, 3046, 20953, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:08:45', '2021-03-15 13:08:45'),
(16000, 1005, 20953, NULL, '2021-06-09 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 14:13:36', '2021-06-01 14:13:36'),
(16001, 3040, 20954, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:09:03', '2021-03-15 13:09:03'),
(16002, 3040, 20954, NULL, '2021-05-25 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Request Roster || Columbus Urgent Care PA || Tax ID: 47-1914151 || Health Smart ||  Greetings,  Hope you are doing well. Can you please send me the provider roster for the below mentioned group.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-05-18 16:10:28', '2021-05-18 16:10:28'),
(16003, 3040, 20954, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Enrollment Status || Columbus Urgent Care PA || Group & Providers || Health Smart ||  Greetings,  Hope you are doing well. Please advise me the enrollment status for the below mentioned group and providers in Health Smart for our group Columbus Urgent Care PA for below location. Can you please send me the provider roster.    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  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you   ', NULL, NULL, '2021-06-08 10:20:05', '2021-06-08 10:20:05'),
(16004, 3040, 20954, NULL, '2021-06-21 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Enrollment Status || Columbus Urgent Care PA || Group & Providers || Health Smart ||  Greetings,   Hope you are doing well. Please find the attached Demographic information form for the below mentioned providers as per previous email requested.  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: Stephen, Ani Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  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: PAUL, SIGI  Provider NPI# 1033623616  Provider 7:   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, '2021-06-14 09:29:56', '2021-06-14 09:29:56'),
(16005, 11056, 20954, NULL, '2021-07-08 00:00:00.000', 'In Process', 'Email sent to : pr.south@healthsmart.com  Sub : Enrollment Status Query- Columbus Urgent Care PA - Health Smart  Good morning!  Hope you are doing well. I want to inquire about the enrollment status of the following providers.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Providers: Provider 1:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  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: PAUL, SIGI Provider NPI# 1033623616  Provider 7:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-01 09:15:56', '2021-07-01 09:15:56'),
(16006, 11056, 20954, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email received from : mdiprsupport@healthsmart.com  Sub : Enrollment Status Query- Columbus Urgent Care PA - Health Smart  Hi,  01- Following Providers are currently in the credentialing process.  Provider Name   Stephen, Ani   PICCIONE JR, JAMES M   Chennemkara, Mini Philip   Abraham, Glory   Abraham, Jeena   Paul, Sigi   Jacob, Jaya   All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com  (Inventory Log ID : 81523)  Thanks HealthSmart Provider Relations.', NULL, NULL, '2021-07-05 08:53:17', '2021-07-05 08:53:17'),
(16007, 3040, 20954, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Re: Fw: Enrollment Status Query- Columbus Urgent Care PA - Health Smart  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Health Smart 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: Stephen, Ani Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  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: 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, '2021-07-23 13:43:34', '2021-07-23 13:43:34'),
(16008, 3040, 20954, NULL, '2021-08-04 00:00:00.000', 'Approved', 'Email rcvd from: mdiprsupport@healthsmart.com  Subject: Fw: Fw: Enrollment Status Query- Columbus Urgent Care PA - Health Smart  Hi,  Please see the following Providers with effective dates.  Provider Name                                 Effective Date   STEPHEN, ANI                                      06/01/2021   CHENNEMKARA, MINI P                     06/01/2021   PICCIONE JR, JAMES M                        06/01/2021   ABRAHAM, GLORY                               06/01/2021   ABRAHAM, JEENA                                 06/01/2021   Joseph Molly, NP                                   09/01/2021   All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com   (Inventory Log ID : 81523)  Thanks HealthSmart Provider Relations.', NULL, NULL, '2021-07-28 09:11:30', '2021-07-28 09:11:30'),
(16009, 3046, 20955, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:09:12', '2021-03-15 13:09:12'),
(16010, 1005, 20955, NULL, '2021-06-09 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 14:13:52', '2021-06-01 14:13:52'),
(16011, 3046, 20956, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:09:16', '2021-03-15 13:09:16'),
(16012, 1005, 20956, NULL, '2021-06-09 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 14:15:02', '2021-06-01 14:15:02'),
(16013, 3040, 20957, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:09:25', '2021-03-15 13:09:25'),
(16014, 3040, 20957, NULL, '2021-05-25 00:00:00.000', 'In Process', 'Application was submitted online.   Your form has been submitted! For new provider applications, please allow 15 business days for a HealthSmart team member to contact you.', NULL, NULL, '2021-05-18 16:14:29', '2021-05-18 16:14:29'),
(16015, 3040, 20957, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Enrollment Status || Columbus Urgent Care PA || Group & Providers || Health Smart ||  Greetings,  Hope you are doing well. Please advise me the enrollment status for the below mentioned group and providers in Health Smart for our group Columbus Urgent Care PA for below location. Can you please send me the provider roster.    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  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you   ', NULL, NULL, '2021-06-08 10:19:58', '2021-06-08 10:19:58'),
(16016, 3040, 20957, NULL, '2021-06-21 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Enrollment Status || Columbus Urgent Care PA || Group & Providers || Health Smart ||  Greetings,   Hope you are doing well. Please find the attached Demographic information form for the below mentioned providers as per previous email requested.  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: Stephen, Ani Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  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: PAUL, SIGI  Provider NPI# 1033623616  Provider 7:   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, '2021-06-14 09:29:45', '2021-06-14 09:29:45'),
(16017, 11056, 20957, NULL, '2021-07-08 00:00:00.000', 'In Process', 'Email sent to : pr.south@healthsmart.com  Sub : Enrollment Status Query- Columbus Urgent Care PA - Health Smart  Good morning!  Hope you are doing well. I want to inquire about the enrollment status of the following providers.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Providers: Provider 1:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  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: PAUL, SIGI Provider NPI# 1033623616  Provider 7:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-01 09:15:42', '2021-07-01 09:15:42'),
(16018, 11056, 20957, NULL, '2021-07-08 00:00:00.000', 'In Process', 'Email sent to : pr.south@healthsmart.com  Sub : Enrollment Status Query- Columbus Urgent Care PA - Health Smart  Good morning!  Hope you are doing well. I want to inquire about the enrollment status of the following providers.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Providers: Provider 1:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  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: PAUL, SIGI Provider NPI# 1033623616  Provider 7:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-01 09:15:43', '2021-07-01 09:15:43'),
(16019, 11056, 20957, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email received from : mdiprsupport@healthsmart.com  Sub : Enrollment Status Query- Columbus Urgent Care PA - Health Smart  Hi,  01- Following Providers are currently in the credentialing process.  Provider Name   Stephen, Ani   PICCIONE JR, JAMES M   Chennemkara, Mini Philip   Abraham, Glory   Abraham, Jeena   Paul, Sigi   Jacob, Jaya ', NULL, NULL, '2021-07-05 08:48:55', '2021-07-05 08:48:55'),
(16020, 3040, 20957, NULL, '2021-07-12 00:00:00.000', 'Approved', 'Provider enrolled in Health Smart. For more details please see attachments.', NULL, NULL, '2021-07-05 17:01:47', '2021-07-05 17:01:47'),
(16021, 3040, 20958, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:09:36', '2021-03-15 13:09:36'),
(16022, 3040, 20958, NULL, '2021-05-25 00:00:00.000', 'In Process', 'Application was submitted online.   Your form has been submitted! For new provider applications, please allow 15 business days for a HealthSmart team member to contact you.', NULL, NULL, '2021-05-18 16:17:35', '2021-05-18 16:17:35'),
(16023, 3040, 20958, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Enrollment Status || Columbus Urgent Care PA || Group & Providers || Health Smart ||  Greetings,  Hope you are doing well. Please advise me the enrollment status for the below mentioned group and providers in Health Smart for our group Columbus Urgent Care PA for below location. Can you please send me the provider roster.    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  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you   ', NULL, NULL, '2021-06-08 10:19:38', '2021-06-08 10:19:38');
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
(16024, 3040, 20958, NULL, '2021-06-21 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Enrollment Status || Columbus Urgent Care PA || Group & Providers || Health Smart ||  Greetings,   Hope you are doing well. Please find the attached Demographic information form for the below mentioned providers as per previous email requested.  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: Stephen, Ani Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  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: PAUL, SIGI  Provider NPI# 1033623616  Provider 7:   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, '2021-06-14 09:29:51', '2021-06-14 09:29:51'),
(16025, 11056, 20958, NULL, '2021-07-08 00:00:00.000', 'In Process', 'Email sent to : pr.south@healthsmart.com  Sub : Enrollment Status Query- Columbus Urgent Care PA - Health Smart  Good morning!  Hope you are doing well. I want to inquire about the enrollment status of the following providers.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Providers: Provider 1:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  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: PAUL, SIGI Provider NPI# 1033623616  Provider 7:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-01 09:22:21', '2021-07-01 09:22:21'),
(16026, 11056, 20958, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email received from : mdiprsupport@healthsmart.com  Sub : Enrollment Status Query- Columbus Urgent Care PA - Health Smart  Hi,  01- Following Providers are currently in the credentialing process.  Provider Name   Stephen, Ani   PICCIONE JR, JAMES M   Chennemkara, Mini Philip   Abraham, Glory   Abraham, Jeena   Paul, Sigi   Jacob, Jaya ', NULL, NULL, '2021-07-05 08:48:31', '2021-07-05 08:48:31'),
(16027, 3040, 20958, NULL, '2021-07-12 00:00:00.000', 'Approved', 'Provider enrolled in Health Smart. For more details please see attachments.', NULL, NULL, '2021-07-05 17:01:56', '2021-07-05 17:01:56'),
(16028, 3046, 20959, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:09:53', '2021-03-15 13:09:53'),
(16029, 1005, 20959, NULL, '2021-06-09 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 14:15:14', '2021-06-01 14:15:14'),
(16030, 3046, 20960, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:09:57', '2021-03-15 13:09:57'),
(16031, 1005, 20960, NULL, '2021-06-09 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 14:15:49', '2021-06-01 14:15:49'),
(16032, 3046, 20961, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:10:57', '2021-03-15 13:10:57'),
(16033, 1005, 20961, NULL, '2021-06-09 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 14:15:59', '2021-06-01 14:15:59'),
(16034, 3046, 20962, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:11:01', '2021-03-15 13:11:01'),
(16035, 1005, 20962, NULL, '2021-06-09 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 14:16:08', '2021-06-01 14:16:08'),
(16036, 3046, 20963, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:11:32', '2021-03-15 13:11:32'),
(16037, 1005, 20963, NULL, '2021-06-09 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 14:16:56', '2021-06-01 14:16:56'),
(16038, 3046, 20964, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:11:38', '2021-03-15 13:11:38'),
(16039, 1005, 20964, NULL, '2021-06-09 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 14:17:19', '2021-06-01 14:17:19'),
(16040, 3046, 20967, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:13:47', '2021-03-15 13:13:47'),
(16041, 1005, 20967, 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 13:57:21', '2021-06-01 13:57:21'),
(16042, 3046, 20968, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:13:58', '2021-03-15 13:13:58'),
(16043, 1005, 20968, 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 13:57:29', '2021-06-01 13:57:29'),
(16044, 3040, 20969, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:22:14', '2021-03-15 13:22:14'),
(16045, 3040, 20969, NULL, '2021-05-14 00:00:00.000', 'In Process', 'Waiting for Medicare enrollment. ', NULL, NULL, '2021-05-07 14:43:07', '2021-05-07 14:43:07'),
(16046, 3040, 20969, NULL, '2021-05-19 00:00:00.000', 'Approved', 'Provider enrolled with Medicaid.  ', NULL, NULL, '2021-05-12 13:17:26', '2021-05-12 13:17:26'),
(16047, 3040, 20970, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:23:41', '2021-03-15 13:23:41'),
(16048, 3040, 20970, NULL, '2021-05-14 00:00:00.000', 'In Process', 'Application Status           Submitted		 PEP Ticket Number         17770324', NULL, NULL, '2021-05-07 15:36:18', '2021-05-07 15:36:18'),
(16049, 3040, 20970, NULL, '2021-05-19 00:00:00.000', 'In Process', 'Application Status PEP Ticket Number In Progress		17770324 ', NULL, NULL, '2021-05-12 07:50:26', '2021-05-12 07:50:26'),
(16050, 3040, 20970, NULL, '2021-06-10 00:00:00.000', 'Approved', 'Provider enrolled with Medicaid. Please see attachment ', NULL, NULL, '2021-06-03 16:51:06', '2021-06-03 16:51:06'),
(16051, 3040, 20971, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:25:30', '2021-03-15 13:25:30'),
(16052, 3040, 20971, NULL, '2021-05-14 00:00:00.000', 'Approved', 'Provider participating with Medicaid. ', NULL, NULL, '2021-05-07 14:47:27', '2021-05-07 14:47:27'),
(16053, 3040, 20972, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:26:05', '2021-03-15 13:26:05'),
(16054, 3040, 20972, NULL, '2021-05-14 00:00:00.000', 'In Process', 'Application Status PEP Ticket Number Submitted		17770402 ', NULL, NULL, '2021-05-07 16:06:31', '2021-05-07 16:06:31'),
(16055, 3040, 20972, NULL, '2021-05-24 00:00:00.000', 'Approved', 'Provider enrolled with Medicaid.   Please see attachment. ', NULL, NULL, '2021-05-17 08:24:23', '2021-05-17 08:24:23'),
(16056, 3040, 20973, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:26:24', '2021-03-15 13:26:24'),
(16057, 3040, 20973, NULL, '2021-05-14 00:00:00.000', 'In Process', 'Waiting for Medicare approval ', NULL, NULL, '2021-05-07 14:50:44', '2021-05-07 14:50:44'),
(16058, 3040, 20973, NULL, '2021-05-26 00:00:00.000', 'In Process', 'Application Status PEP Ticket Number Submitted		17785483 ', NULL, NULL, '2021-05-19 13:16:11', '2021-05-19 13:16:11'),
(16059, 3040, 20973, NULL, '2021-06-10 00:00:00.000', 'Approved', 'Provider enrolled with Medicaid. Please see attachment ', NULL, NULL, '2021-06-03 16:51:10', '2021-06-03 16:51:10'),
(16060, 3040, 20974, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:27:15', '2021-03-15 13:27:15'),
(16061, 1005, 20974, 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 12:51:59', '2021-06-01 12:51:59'),
(16062, 3040, 20975, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:27:56', '2021-03-15 13:27:56'),
(16063, 3040, 20975, NULL, '2021-04-21 00:00:00.000', 'Initiated', 'Application Status  Submitted		  PEP Ticket Number 17715421', NULL, NULL, '2021-04-14 08:30:34', '2021-04-14 08:30:34'),
(16064, 3040, 20975, NULL, '2021-05-14 00:00:00.000', 'Approved', 'Provider participating with Medicaid. ', NULL, NULL, '2021-05-07 14:51:46', '2021-05-07 14:51:46'),
(16065, 3040, 20976, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:28:43', '2021-03-15 13:28:43'),
(16066, 3040, 20976, NULL, '2021-05-14 00:00:00.000', 'Approved', 'Group enrolled with Medicare.   Effective Date: 01/18/2015', NULL, NULL, '2021-05-07 11:58:38', '2021-05-07 11:58:38'),
(16067, 3040, 20977, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:30:16', '2021-03-15 13:30:16'),
(16068, 3040, 20977, NULL, '2021-05-14 00:00:00.000', 'In Process', 'Enrollment Tracking Information Applicant Name: ABDUR RAUF  Tracking ID: T050720210002290  Submitted Date: FRI - MAY 07 2021 02:35:33 PM EST  Submitted By: Abdur Rauf  Contact Email(s): CUCC@CLAIMSMEDINC.COM', NULL, NULL, '2021-05-07 13:35:50', '2021-05-07 13:35:50'),
(16069, 3040, 20977, NULL, '2021-05-19 00:00:00.000', 'Approved', 'Email rcvd from: 	medenroll@novitas-solutions.com  Subject: Medicare Provider Enrollment Notification ABDUR RAUF  Individual Name: ABDUR RAUF Individual Specialty: INTERNAL MEDICINE Individual National Provider Identifier (NPI): 1497726202 Individual Provider Transaction Access Number (PTAN): 396952ZM9E Group Legal Business Name (LBN): COLUMBUS URGENT CARE PA Group NPI: 1215330501 Group PTAN: 399951 Reassignment Effective Date: N/A Changed Information: CONTACT PERSON', NULL, NULL, '2021-05-12 12:44:12', '2021-05-12 12:44:12'),
(16070, 3040, 20978, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:30:40', '2021-03-15 13:30:40'),
(16071, 3040, 20978, NULL, '2021-05-14 00:00:00.000', 'Approved', 'Provider participating with Medicare. ', NULL, NULL, '2021-05-07 12:00:43', '2021-05-07 12:00:43'),
(16072, 3040, 20979, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:31:11', '2021-03-15 13:31:11'),
(16073, 3040, 20979, NULL, '2021-05-14 00:00:00.000', 'Approved', 'Provider enrolled with Medicare. ', NULL, NULL, '2021-05-07 12:48:56', '2021-05-07 12:48:56'),
(16074, 3040, 20980, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:31:47', '2021-03-15 13:31:47'),
(16075, 3040, 20980, NULL, '2021-05-14 00:00:00.000', 'Approved', 'Provider enrolled with Medicare.', NULL, NULL, '2021-05-07 12:50:03', '2021-05-07 12:50:03'),
(16076, 3040, 20981, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:32:44', '2021-03-15 13:32:44'),
(16077, 3040, 20981, NULL, '2021-05-14 00:00:00.000', 'In Process', 'Enrollment Tracking Information Applicant Name: JEENA ABRAHAM  Tracking ID: T050720210002530  Submitted Date: FRI - MAY 07 2021 03:10:25 PM EST  Submitted By: JEENA ABRAHAM  Contact Email(s): CUCC@CLAIMSMEDINC.COM NUCC@EMRBS.COM', NULL, NULL, '2021-05-07 14:10:41', '2021-05-07 14:10:41'),
(16078, 3040, 20981, NULL, '2021-05-21 00:00:00.000', 'Approved', 'Medicare Enrollment Information Individual Name: JEENA ABRAHAM Individual Specialty: NURSE PRACTITIONER Individual National Provider Identifier (NPI): 1467901587 Individual Provider Transaction Access Number (PTAN): 1P1654 Group Legal Business Name (LBN): Columbus Urgent Care PA Group NPI: 1215330501 Group PTAN: 399951 Reassignment Effective Date: FEBRUARY 6, 2021 Changed Information: N/A', NULL, NULL, '2021-05-14 13:23:21', '2021-05-14 13:23:21'),
(16079, 3040, 20982, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:33:17', '2021-03-15 13:33:17'),
(16080, 1005, 20982, 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 12:52:19', '2021-06-01 12:52:19'),
(16081, 3040, 20983, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:33:48', '2021-03-15 13:33:48'),
(16082, 3040, 20983, NULL, '2021-05-14 00:00:00.000', 'Approved', 'Provider enrolled with Medicare.', NULL, NULL, '2021-05-07 12:53:01', '2021-05-07 12:53:01'),
(16083, 3040, 20984, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:36:44', '2021-03-15 13:36:44'),
(16084, 3040, 20984, NULL, '2021-05-25 00:00:00.000', 'Approved', 'Group has an ancillary contract. Please see attachment.   Effective date: 03/15/2020', NULL, NULL, '2021-05-18 09:33:30', '2021-05-18 09:33:30'),
(16085, 3040, 20985, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:36:58', '2021-03-15 13:36:58'),
(16086, 3040, 20985, NULL, '2021-05-25 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add the individual providers.   Contract attached in group task. ', NULL, NULL, '2021-05-18 09:34:44', '2021-05-18 09:34:44'),
(16087, 3040, 20986, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:37:14', '2021-03-15 13:37:14'),
(16088, 3040, 20986, NULL, '2021-05-25 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add the individual providers.   Contract attached in group task. ', NULL, NULL, '2021-05-18 09:36:14', '2021-05-18 09:36:14'),
(16089, 3040, 20987, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:37:36', '2021-03-15 13:37:36'),
(16090, 3040, 20987, NULL, '2021-05-25 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add the individual providers.   Contract attached in group task. ', NULL, NULL, '2021-05-18 09:36:18', '2021-05-18 09:36:18'),
(16091, 3046, 20988, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:38:26', '2021-03-15 13:38:26'),
(16092, 1006, 20988, NULL, '2021-04-01 00:00:00.000', 'Approved', 'We have an urgent care contract with Aetna. We don\'t need to individually enroll/credential providers separately, a copy of the executed contract has been attached and directory/plans are also attached for reference. ', NULL, NULL, '2021-03-25 13:53:17', '2021-03-25 13:53:17'),
(16093, 3046, 20989, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:38:42', '2021-03-15 13:38:42'),
(16094, 1006, 20989, NULL, '2021-04-01 00:00:00.000', 'Approved', 'We have an urgent care contract with Aetna. We don\'t need to individually enroll/credential providers separately, a copy of the executed contract has been attached and directory/plans are also attached for reference.  ', NULL, NULL, '2021-03-25 13:53:52', '2021-03-25 13:53:52'),
(16095, 3040, 20990, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:39:08', '2021-03-15 13:39:08'),
(16096, 3040, 20990, NULL, '2021-05-25 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add the individual providers.   Contract attached in group task. ', NULL, NULL, '2021-05-18 09:36:22', '2021-05-18 09:36:22'),
(16097, 3040, 20991, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:39:38', '2021-03-15 13:39:38'),
(16098, 3040, 20991, NULL, '2021-05-25 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add the individual providers.   Contract attached in group task. ', NULL, NULL, '2021-05-18 09:36:26', '2021-05-18 09:36:26'),
(16099, 3040, 20992, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:40:16', '2021-03-15 13:40:16'),
(16100, 3040, 20992, NULL, '2021-05-25 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add the individual providers.   Contract attached in group task. ', NULL, NULL, '2021-05-18 09:36:31', '2021-05-18 09:36:31'),
(16101, 3040, 20993, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:40:35', '2021-03-15 13:40:35'),
(16102, 3040, 20993, NULL, '2021-05-25 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add the individual providers.   Contract attached in group task. ', NULL, NULL, '2021-05-18 09:36:35', '2021-05-18 09:36:35'),
(16103, 3040, 20994, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:40:49', '2021-03-15 13:40:49'),
(16104, 1005, 20994, 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 12:53:10', '2021-06-01 12:53:10'),
(16105, 3040, 20995, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:41:08', '2021-03-15 13:41:08'),
(16106, 3040, 20995, NULL, '2021-05-25 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add the individual providers.   Contract attached in group task. ', NULL, NULL, '2021-05-18 09:36:42', '2021-05-18 09:36:42'),
(16107, 3040, 20996, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:41:18', '2021-03-15 13:41:18'),
(16108, 3040, 20996, NULL, '2021-05-25 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add the individual providers.   Contract attached in group task. ', NULL, NULL, '2021-05-18 09:36:46', '2021-05-18 09:36:46'),
(16109, 3040, 20997, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:41:30', '2021-03-15 13:41:30'),
(16110, 3040, 20997, NULL, '2021-05-25 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add the individual providers.   Contract attached in group task. ', NULL, NULL, '2021-05-18 09:36:50', '2021-05-18 09:36:50'),
(16111, 3040, 20998, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:41:41', '2021-03-15 13:41:41'),
(16112, 3040, 20998, NULL, '2021-05-25 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add the individual providers.   Contract attached in group task. ', NULL, NULL, '2021-05-18 09:36:56', '2021-05-18 09:36:56'),
(16113, 3040, 20999, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:42:22', '2021-03-15 13:42:22'),
(16114, 3040, 20999, NULL, '2021-05-24 00:00:00.000', 'Approved', 'Group is participating with Multiplan.   Effective date: 03/15/2016  Please see attachment', NULL, NULL, '2021-05-17 14:27:17', '2021-05-17 14:27:17'),
(16115, 3040, 21000, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:42:40', '2021-03-15 13:42:40'),
(16116, 3040, 21000, NULL, '2021-05-24 00:00:00.000', 'Approved', 'Provider participating in Multiplan.   Effective Date: 03/15/2016  Please see attachment', NULL, NULL, '2021-05-17 13:58:37', '2021-05-17 13:58:37'),
(16117, 3040, 21001, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:43:05', '2021-03-15 13:43:05'),
(16118, 3040, 21001, NULL, '2021-05-25 00:00:00.000', 'In Process', 'Request submitted online through Multiplan website.   Service Case Number:	7612502 Details have been emailed to you at: cucc@claimsmedinc.com', NULL, NULL, '2021-05-18 10:30:52', '2021-05-18 10:30:52'),
(16119, 3040, 21001, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Greetings,   Has there been any update?  Thanks', NULL, NULL, '2021-06-07 17:56:38', '2021-06-07 17:56:38'),
(16120, 3040, 21001, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, registrarmissinginfo@multiplan.com  Subject: Enrollment Status || Columbus Urgent Care PA || Providers || Multiplan ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Multiplan for our group under the below locations. I submitted the request online and the case number mentioned below.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-221  Provider 1: Provider Name: PAUL, SIGI Provider NPI# 1033623616 Service Case Number: 7613296  Provider 2: Provider Name: Jacob, Jaya Provider NPI# 1194336149 Service Case Number: 7612872  Provider 3: Provider Name: Stephen, Ani Provider NPI# 1588959118 Service Case Number: 7612579  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587 Service Case Number: 7612867  Provider 5: Provider Name: Abraham, Glory Provider NPI# 1194206490 Service Case Number: 7612515  Provider 6: Provider Name: Kourouma , Odette Provider NPI# 1134525868 Service Case Number: 7612502  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-25 16:35:04', '2021-06-25 16:35:04'),
(16121, 3040, 21001, NULL, '2021-07-22 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Requested Form || Columbus Urgent Care PA || Providers || Multiplan ||  Greetings,  Hope you are doing well. As per the email received from provider services please find attached the credentialing application form along with the W9 form for the below mentioned providers to enroll in Multiplan 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 78934-221  Provider 1: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 2: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6: Provider Name: Kourouma , Odette Provider NPI# 1134525868  Provider 7: Provider Name: Jose, Julie Provider NPI# 1447883061  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-15 14:30:03', '2021-07-15 14:30:03'),
(16122, 1006, 21001, NULL, '2021-08-10 00:00:00.000', 'In Process', 'We received a fax from Multiplan requesting specialty information for the provider, replied @ registrarmissinginfo@multiplan.com:  Sub: Missing Items Request   \"Hello,   Please find the requested information, do let me know if you need any other information.   Thank you. \"', NULL, NULL, '2021-08-03 10:32:14', '2021-08-03 10:32:14'),
(16123, 3040, 21001, NULL, '2021-08-25 00:00:00.000', 'Approved', '8/17/2021 Ms. Odette Tiranke Kourouma Columbus Urgent Care, PA 926 Walnut St Columbus TX 78934 Dear Provider: Welcome! Your application has been processed, effective 7/15/2021 and we are pleased to have you join MultiPlan as a participating provider in our provider networks. Please see your provider agreement(s) and/or amendment(s) for specific network participation. (Note that you may participate with MultiPlan under multiple agreements.) Your practice will be listed in our provider directories under the following specialty(ies): Nurse Practitioner', NULL, NULL, '2021-08-18 11:52:23', '2021-08-18 11:52:23'),
(16124, 3040, 21002, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:43:58', '2021-03-15 13:43:58'),
(16125, 3040, 21002, NULL, '2021-05-24 00:00:00.000', 'Approved', 'Provider is participating with Multiplan.   Effective Date: 12/02/2019  Please see attachment', NULL, NULL, '2021-05-17 14:39:21', '2021-05-17 14:39:21'),
(16126, 3046, 21003, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:44:10', '2021-03-15 13:44:10'),
(16127, 1006, 21003, NULL, '2021-04-01 00:00:00.000', 'Approved', 'We have an urgent care contract with Aetna. We don\'t need to individually enroll/credential providers separately, a copy of the executed contract has been attached and directory/plans are also attached for reference.  ', NULL, NULL, '2021-03-25 13:54:49', '2021-03-25 13:54:49'),
(16128, 3040, 21004, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:44:19', '2021-03-15 13:44:19'),
(16129, 3040, 21004, NULL, '2021-05-25 00:00:00.000', 'In Process', 'Request submitted online through Multiplan website.  Service Case Number:	7612515 Details have been emailed to you at: cucc@claimsmedinc.com', NULL, NULL, '2021-05-18 10:33:48', '2021-05-18 10:33:48'),
(16130, 3040, 21004, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Greetings,   Has there been any update?  Thanks', NULL, NULL, '2021-06-07 17:56:34', '2021-06-07 17:56:34'),
(16131, 3040, 21004, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, registrarmissinginfo@multiplan.com  Subject: Enrollment Status || Columbus Urgent Care PA || Providers || Multiplan ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Multiplan for our group under the below locations. I submitted the request online and the case number mentioned below.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-221  Provider 1: Provider Name: PAUL, SIGI Provider NPI# 1033623616 Service Case Number: 7613296  Provider 2: Provider Name: Jacob, Jaya Provider NPI# 1194336149 Service Case Number: 7612872  Provider 3: Provider Name: Stephen, Ani Provider NPI# 1588959118 Service Case Number: 7612579  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587 Service Case Number: 7612867  Provider 5: Provider Name: Abraham, Glory Provider NPI# 1194206490 Service Case Number: 7612515  Provider 6: Provider Name: Kourouma , Odette Provider NPI# 1134525868 Service Case Number: 7612502  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-25 16:34:59', '2021-06-25 16:34:59'),
(16132, 3040, 21004, NULL, '2021-07-22 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Requested Form || Columbus Urgent Care PA || Providers || Multiplan ||  Greetings,  Hope you are doing well. As per the email received from provider services please find attached the credentialing application form along with the W9 form for the below mentioned providers to enroll in Multiplan 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 78934-221  Provider 1: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 2: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6: Provider Name: Kourouma , Odette Provider NPI# 1134525868  Provider 7: Provider Name: Jose, Julie Provider NPI# 1447883061  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-15 14:30:02', '2021-07-15 14:30:02'),
(16133, 11056, 21004, NULL, '2021-08-12 00:00:00.000', 'In Process', 'We received a fax from Multiplan requesting specialty information for the provider, replied @ registrarmissinginfo@multiplan.com:  Sub: Missing Items Request   \"Hello,   Please find the requested information, do let me know if you need any other information.   Thank you. \"', NULL, NULL, '2021-08-05 10:07:19', '2021-08-05 10:07:19'),
(16134, 3040, 21004, NULL, '2021-08-25 00:00:00.000', 'Approved', 'Email rcvd from: notification@multiplan-secure.com  Subject: SECURE: MultiPlan Network Participation (13745970-9736955)  8/17/2021 Ms. Glory Abraham Columbus Urgent Care, PA 926 Walnut St Columbus TX 78934 Dear Provider: Welcome! Your application has been processed, effective 7/15/2021 and we are pleased to have you join MultiPlan as a participating provider in our provider networks. Please see your provider agreement(s) and/or amendment(s) for specific network participation. (Note that you may participate with MultiPlan under multiple agreements.) Your practice will be listed in our provider directories under the following specialty(ies): Nurse Practitioner', NULL, NULL, '2021-08-18 11:45:08', '2021-08-18 11:45:08'),
(16135, 3040, 21005, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:44:34', '2021-03-15 13:44:34'),
(16136, 3040, 21005, NULL, '2021-05-25 00:00:00.000', 'In Process', 'Service Case Number:	7612867 Details have been emailed to you at: cucc@claimsmedinc.com', NULL, NULL, '2021-05-18 12:35:37', '2021-05-18 12:35:37'),
(16137, 3040, 21005, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Greetings,   Has there been any update?  Thanks', NULL, NULL, '2021-06-07 17:56:30', '2021-06-07 17:56:30'),
(16138, 3040, 21005, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, registrarmissinginfo@multiplan.com  Subject: Enrollment Status || Columbus Urgent Care PA || Providers || Multiplan ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Multiplan for our group under the below locations. I submitted the request online and the case number mentioned below.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-221  Provider 1: Provider Name: PAUL, SIGI Provider NPI# 1033623616 Service Case Number: 7613296  Provider 2: Provider Name: Jacob, Jaya Provider NPI# 1194336149 Service Case Number: 7612872  Provider 3: Provider Name: Stephen, Ani Provider NPI# 1588959118 Service Case Number: 7612579  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587 Service Case Number: 7612867  Provider 5: Provider Name: Abraham, Glory Provider NPI# 1194206490 Service Case Number: 7612515  Provider 6: Provider Name: Kourouma , Odette Provider NPI# 1134525868 Service Case Number: 7612502  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-25 16:34:54', '2021-06-25 16:34:54'),
(16139, 3040, 21005, NULL, '2021-07-22 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Requested Form || Columbus Urgent Care PA || Providers || Multiplan ||  Greetings,  Hope you are doing well. As per the email received from provider services please find attached the credentialing application form along with the W9 form for the below mentioned providers to enroll in Multiplan 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 78934-221  Provider 1: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 2: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6: Provider Name: Kourouma , Odette Provider NPI# 1134525868  Provider 7: Provider Name: Jose, Julie Provider NPI# 1447883061  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-15 14:30:03', '2021-07-15 14:30:03'),
(16140, 11056, 21005, NULL, '2021-08-12 00:00:00.000', 'In Process', 'We received a fax from Multiplan requesting specialty information for the provider, replied @ registrarmissinginfo@multiplan.com:  Sub: Missing Items Request   \"Hello,   Please find the requested information, do let me know if you need any other information.   Thank you. \"', NULL, NULL, '2021-08-05 10:06:56', '2021-08-05 10:06:56'),
(16141, 3040, 21005, NULL, '2021-08-25 00:00:00.000', 'Approved', '8/17/2021 Ms. Jeena Abraham Columbus Urgent Care, PA 926 Walnut St Columbus TX 78934 Dear Provider: Welcome! Your application has been processed, effective 7/15/2021 and we are pleased to have you join MultiPlan as a participating provider in our provider networks. Please see your provider agreement(s) and/or amendment(s) for specific network participation. (Note that you may participate with MultiPlan under multiple agreements.) Your practice will be listed in our provider directories under the following specialty(ies): Nurse Practitioner', NULL, NULL, '2021-08-18 11:52:46', '2021-08-18 11:52:46'),
(16142, 3040, 21006, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:44:49', '2021-03-15 13:44:49'),
(16143, 1005, 21006, 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 12:53:39', '2021-06-01 12:53:39'),
(16144, 3046, 21007, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:45:03', '2021-03-15 13:45:03'),
(16145, 1006, 21007, NULL, '2021-04-01 00:00:00.000', 'Approved', 'We have an urgent care contract with Aetna. We don\'t need to individually enroll/credential providers separately, a copy of the executed contract has been attached and directory/plans are also attached for reference.  ', NULL, NULL, '2021-03-25 13:55:38', '2021-03-25 13:55:38'),
(16146, 3040, 21008, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:45:06', '2021-03-15 13:45:06'),
(16147, 3040, 21008, NULL, '2021-05-25 00:00:00.000', 'In Process', 'Service Case Number:	7612579 Details have been emailed to you at: cucc@claimsmedinc.com', NULL, NULL, '2021-05-18 12:33:33', '2021-05-18 12:33:33'),
(16148, 3040, 21008, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Greetings,   Has there been any update?  Thanks', NULL, NULL, '2021-06-07 17:56:25', '2021-06-07 17:56:25'),
(16149, 3040, 21008, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, registrarmissinginfo@multiplan.com  Subject: Enrollment Status || Columbus Urgent Care PA || Providers || Multiplan ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Multiplan for our group under the below locations. I submitted the request online and the case number mentioned below.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-221  Provider 1: Provider Name: PAUL, SIGI Provider NPI# 1033623616 Service Case Number: 7613296  Provider 2: Provider Name: Jacob, Jaya Provider NPI# 1194336149 Service Case Number: 7612872  Provider 3: Provider Name: Stephen, Ani Provider NPI# 1588959118 Service Case Number: 7612579  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587 Service Case Number: 7612867  Provider 5: Provider Name: Abraham, Glory Provider NPI# 1194206490 Service Case Number: 7612515  Provider 6: Provider Name: Kourouma , Odette Provider NPI# 1134525868 Service Case Number: 7612502  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-25 16:34:49', '2021-06-25 16:34:49'),
(16150, 3040, 21008, NULL, '2021-07-22 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Requested Form || Columbus Urgent Care PA || Providers || Multiplan ||  Greetings,  Hope you are doing well. As per the email received from provider services please find attached the credentialing application form along with the W9 form for the below mentioned providers to enroll in Multiplan 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 78934-221  Provider 1: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 2: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6: Provider Name: Kourouma , Odette Provider NPI# 1134525868  Provider 7: Provider Name: Jose, Julie Provider NPI# 1447883061  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-15 14:30:01', '2021-07-15 14:30:01'),
(16151, 1006, 21008, NULL, '2021-08-10 00:00:00.000', 'In Process', 'We received a fax from Multiplan requesting specialty information for the provider, replied @ registrarmissinginfo@multiplan.com:  Sub: Missing Items Request   \"Hello,   Please find the requested information, do let me know if you need any other information.   Thank you. \"', NULL, NULL, '2021-08-03 10:30:42', '2021-08-03 10:30:42'),
(16152, 3040, 21008, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Email sent to: registrarmissinginfo@multiplan.com  Subject; Re: Missing Items Request  Hello,   Hope you are doing well. I had a word with Randy Multiplan representative and he advise to send the below information through email because the following information is missing in application for the providers.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-221  Provider 1: Provider Name: Stephen, Ani Provider NPI# 1588959118 Admitting Hospital Privilege\'s: Memorial Hermann Memorial City Medical Center Hospital Address: 921 Gessner Rd, Houston, TX 77024 Professional Labiality Insurance: Attached  Provider 2: Provider Name: PAUL, SIGI Provider NPI# 1033623616 Admitting Hospital Privilege\'s: Memorial Hermann Memorial City Medical Center Hospital Address: 921 Gessner Rd, Houston, TX 77024 Professional Labiality Insurance: Attached  Provider 3: Provider Name: Jacob, Jaya Provider NPI# 1194336149 Admitting Hospital Privilege\'s: Memorial Hermann Memorial City Medical Center Hospital Address: 921 Gessner Rd, Houston, TX 77024 Professional Labiality Insurance: Attached  Provider 4: Provider Name: John, Jeny Provider NPI# 1073019493 Admitting Hospital Privilege\'s: Memorial Hermann Memorial City Medical Center Hospital Address: 921 Gessner Rd, Houston, TX 77024 CAQH: CAQH access is authorize Multiplan to access the provider information.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-26 14:04:50', '2021-08-26 14:04:50'),
(16153, 10057, 21008, NULL, '2021-10-20 00:00:00.000', 'Approved', 'Email Received From : notification@multiplan-secure.com  Sub : SECURE: MultiPlan Network Participation (13012504-9736955)  Effective Date : 09/15/2021', NULL, NULL, '2021-10-13 11:02:45', '2021-10-13 11:02:45'),
(16154, 3040, 21009, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:45:18', '2021-03-15 13:45:18'),
(16155, 3040, 21009, NULL, '2021-05-25 00:00:00.000', 'In Process', 'Service Case Number:	7612872 Details have been emailed to you at: cucc@claimsmedinc.com', NULL, NULL, '2021-05-18 12:37:31', '2021-05-18 12:37:31'),
(16156, 3040, 21009, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Greetings,   Has there been any update?  Thanks', NULL, NULL, '2021-06-07 17:56:20', '2021-06-07 17:56:20'),
(16157, 3040, 21009, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, registrarmissinginfo@multiplan.com  Subject: Enrollment Status || Columbus Urgent Care PA || Providers || Multiplan ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Multiplan for our group under the below locations. I submitted the request online and the case number mentioned below.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-221  Provider 1: Provider Name: PAUL, SIGI Provider NPI# 1033623616 Service Case Number: 7613296  Provider 2: Provider Name: Jacob, Jaya Provider NPI# 1194336149 Service Case Number: 7612872  Provider 3: Provider Name: Stephen, Ani Provider NPI# 1588959118 Service Case Number: 7612579  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587 Service Case Number: 7612867  Provider 5: Provider Name: Abraham, Glory Provider NPI# 1194206490 Service Case Number: 7612515  Provider 6: Provider Name: Kourouma , Odette Provider NPI# 1134525868 Service Case Number: 7612502  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-25 16:34:44', '2021-06-25 16:34:44'),
(16158, 3040, 21009, NULL, '2021-07-22 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Requested Form || Columbus Urgent Care PA || Providers || Multiplan ||  Greetings,  Hope you are doing well. As per the email received from provider services please find attached the credentialing application form along with the W9 form for the below mentioned providers to enroll in Multiplan 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 78934-221  Provider 1: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 2: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6: Provider Name: Kourouma , Odette Provider NPI# 1134525868  Provider 7: Provider Name: Jose, Julie Provider NPI# 1447883061  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-15 14:30:05', '2021-07-15 14:30:05'),
(16159, 1006, 21009, NULL, '2021-08-10 00:00:00.000', 'In Process', 'We received a fax from Multiplan requesting specialty information for the provider, replied @ registrarmissinginfo@multiplan.com:  Sub: Missing Items Request   \"Hello,   Please find the requested information, do let me know if you need any other information.   Thank you. \"', NULL, NULL, '2021-08-03 10:31:21', '2021-08-03 10:31:21'),
(16160, 3040, 21009, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Email sent to: registrarmissinginfo@multiplan.com  Subject; Re: Missing Items Request  Hello,   Hope you are doing well. I had a word with Randy Multiplan representative and he advise to send the below information through email because the following information is missing in application for the providers.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-221  Provider 1: Provider Name: Stephen, Ani Provider NPI# 1588959118 Admitting Hospital Privilege\'s: Memorial Hermann Memorial City Medical Center Hospital Address: 921 Gessner Rd, Houston, TX 77024 Professional Labiality Insurance: Attached  Provider 2: Provider Name: PAUL, SIGI Provider NPI# 1033623616 Admitting Hospital Privilege\'s: Memorial Hermann Memorial City Medical Center Hospital Address: 921 Gessner Rd, Houston, TX 77024 Professional Labiality Insurance: Attached  Provider 3: Provider Name: Jacob, Jaya Provider NPI# 1194336149 Admitting Hospital Privilege\'s: Memorial Hermann Memorial City Medical Center Hospital Address: 921 Gessner Rd, Houston, TX 77024 Professional Labiality Insurance: Attached  Provider 4: Provider Name: John, Jeny Provider NPI# 1073019493 Admitting Hospital Privilege\'s: Memorial Hermann Memorial City Medical Center Hospital Address: 921 Gessner Rd, Houston, TX 77024 CAQH: CAQH access is authorize Multiplan to access the provider information.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-26 14:04:53', '2021-08-26 14:04:53'),
(16161, 12062, 21009, NULL, '2021-09-24 00:00:00.000', 'In Process', 'I had a word with a tele rep at Multiplan. As per her statement , the provider is effective from August Multiplan\'s network from 27,2021 with Multiplan ID as 13943879   Currently we are unable to find a provider as enrolled because it has not been updated on  a website and neither we have a received a welcome packet . So as per Mr. Uzair (supervisor) the status would remained as in process  ', NULL, NULL, '2021-09-16 14:35:14', '2021-09-16 14:35:14'),
(16162, 12062, 21009, NULL, '2021-10-01 00:00:00.000', 'In Process', 'Replied to a below email via fax; See attached file faxed.  From: noreplycustserv@multiplan.com Subject: Initial request for additional information regarding case number 7612872  Thank you for your inquiry. To expedite your request we will need additional information. For your convenience we have listed the required documents below and attached coversheet(s) to be used when faxing in your documents.  In order for us to complete your inquiry, we must receive all requested documentation by 09/02/2021 or your case will be closed. Once all documents are received, your case will be re-opened and researched in full.  Documentation Required	Additional Description	Status Misc Application Missing Materials	Jacob, Jaya - Professional liability insurance; Admitting privileges or other admitting arrangements with participating hospital	Not Received Thank you, Service Operations   ', NULL, NULL, '2021-09-23 16:31:45', '2021-09-23 16:31:45'),
(16163, 12062, 21009, NULL, '2021-10-04 00:00:00.000', 'Approved', 'The provider is enrolled.  see attached mail for your reference.  ', NULL, NULL, '2021-09-27 13:19:23', '2021-09-27 13:19:23'),
(16164, 3040, 21010, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:45:32', '2021-03-15 13:45:32'),
(16165, 3040, 21010, NULL, '2021-05-25 00:00:00.000', 'In Process', 'Service Case Number:	7613296 Details have been emailed to you at: cucc@claimsmedinc.com', NULL, NULL, '2021-05-18 15:12:02', '2021-05-18 15:12:02'),
(16166, 3040, 21010, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Greetings,   Has there been any update?  Thanks', NULL, NULL, '2021-06-07 17:56:16', '2021-06-07 17:56:16'),
(16167, 3040, 21010, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, registrarmissinginfo@multiplan.com  Subject: Enrollment Status || Columbus Urgent Care PA || Providers || Multiplan ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Multiplan for our group under the below locations. I submitted the request online and the case number mentioned below.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-221  Provider 1: Provider Name: PAUL, SIGI Provider NPI# 1033623616 Service Case Number: 7613296  Provider 2: Provider Name: Jacob, Jaya Provider NPI# 1194336149 Service Case Number: 7612872  Provider 3: Provider Name: Stephen, Ani Provider NPI# 1588959118 Service Case Number: 7612579  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587 Service Case Number: 7612867  Provider 5: Provider Name: Abraham, Glory Provider NPI# 1194206490 Service Case Number: 7612515  Provider 6: Provider Name: Kourouma , Odette Provider NPI# 1134525868 Service Case Number: 7612502  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-25 16:34:39', '2021-06-25 16:34:39'),
(16168, 3040, 21010, NULL, '2021-07-22 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Requested Form || Columbus Urgent Care PA || Providers || Multiplan ||  Greetings,  Hope you are doing well. As per the email received from provider services please find attached the credentialing application form along with the W9 form for the below mentioned providers to enroll in Multiplan 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 78934-221  Provider 1: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 2: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6: Provider Name: Kourouma , Odette Provider NPI# 1134525868  Provider 7: Provider Name: Jose, Julie Provider NPI# 1447883061  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-15 14:30:04', '2021-07-15 14:30:04'),
(16169, 1006, 21010, NULL, '2021-08-10 00:00:00.000', 'In Process', 'We received a fax from Multiplan requesting specialty information for the provider, replied @ registrarmissinginfo@multiplan.com:  Sub: Missing Items Request   \"Hello,   Please find the requested information, do let me know if you need any other information.   Thank you. \"', NULL, NULL, '2021-08-03 10:32:51', '2021-08-03 10:32:51');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(16170, 3040, 21010, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Email sent to: registrarmissinginfo@multiplan.com  Subject; Re: Missing Items Request  Hello,   Hope you are doing well. I had a word with Randy Multiplan representative and he advise to send the below information through email because the following information is missing in application for the providers.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-221  Provider 1: Provider Name: Stephen, Ani Provider NPI# 1588959118 Admitting Hospital Privilege\'s: Memorial Hermann Memorial City Medical Center Hospital Address: 921 Gessner Rd, Houston, TX 77024 Professional Labiality Insurance: Attached  Provider 2: Provider Name: PAUL, SIGI Provider NPI# 1033623616 Admitting Hospital Privilege\'s: Memorial Hermann Memorial City Medical Center Hospital Address: 921 Gessner Rd, Houston, TX 77024 Professional Labiality Insurance: Attached  Provider 3: Provider Name: Jacob, Jaya Provider NPI# 1194336149 Admitting Hospital Privilege\'s: Memorial Hermann Memorial City Medical Center Hospital Address: 921 Gessner Rd, Houston, TX 77024 Professional Labiality Insurance: Attached  Provider 4: Provider Name: John, Jeny Provider NPI# 1073019493 Admitting Hospital Privilege\'s: Memorial Hermann Memorial City Medical Center Hospital Address: 921 Gessner Rd, Houston, TX 77024 CAQH: CAQH access is authorize Multiplan to access the provider information.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-26 14:04:52', '2021-08-26 14:04:52'),
(16171, 12062, 21010, NULL, '2021-09-24 00:00:00.000', 'In Process', 'I had a word with a tele rep at Multiplan. As per her statement , the provider is effective on Multiplan\'s network from August 27,2021 with Multiplan ID as 13943881. This call reference number is #  Currently we are unable to find a provider as enrolled because it has not been updated on  a website and neither we have a received a welcome packet . So as per Mr. Uzair (supervisor) the status would remained as in process', NULL, NULL, '2021-09-16 14:31:24', '2021-09-16 14:31:24'),
(16172, 12062, 21010, NULL, '2021-09-30 00:00:00.000', 'Approved', 'Received Below email: From: notification@multiplan-secure.com Subject: SECURE: MultiPlan Network Participation (13943881-9736955)  Dear Provider/Administrator,  Please review the attached documents regarding the participation of Paul, Sigi C., MSN, in the MultiPlan Networks.  If you have any questions regarding the content of this email, you may request service online at: https://custservice.multiplan.com.  Attachments include: o Participation Letter o Working with Multiplan Information', NULL, NULL, '2021-09-23 12:13:17', '2021-09-23 12:13:17'),
(16173, 12062, 21010, NULL, '2021-09-30 00:00:00.000', 'Approved', 'Received Below email: From: notification@multiplan-secure.com Subject: SECURE: MultiPlan Network Participation (13943881-9736955)  Dear Provider/Administrator,  Please review the attached documents regarding the participation of Paul, Sigi C., MSN, in the MultiPlan Networks.  If you have any questions regarding the content of this email, you may request service online at: https://custservice.multiplan.com.  Attachments include: o Participation Letter o Working with Multiplan Information', NULL, NULL, '2021-09-23 12:13:23', '2021-09-23 12:13:23'),
(16174, 3046, 21011, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:45:35', '2021-03-15 13:45:35'),
(16175, 1006, 21011, NULL, '2021-04-01 00:00:00.000', 'Approved', 'We have an urgent care contract with Aetna. We don\'t need to individually enroll/credential providers separately, a copy of the executed contract has been attached and directory/plans are also attached for reference.  ', NULL, NULL, '2021-03-25 13:57:05', '2021-03-25 13:57:05'),
(16176, 3046, 21012, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:46:32', '2021-03-15 13:46:32'),
(16177, 1006, 21012, NULL, '2021-04-01 00:00:00.000', 'Approved', 'We have an urgent care contract with Aetna. We don\'t need to individually enroll/credential providers separately, a copy of the executed contract has been attached and directory/plans are also attached for reference.  ', NULL, NULL, '2021-03-25 13:57:39', '2021-03-25 13:57:39'),
(16178, 3046, 21013, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:46:59', '2021-03-15 13:46:59'),
(16179, 1006, 21013, NULL, '2021-04-01 00:00:00.000', 'Approved', 'We have an urgent care contract with Aetna. We don\'t need to individually enroll/credential providers separately, a copy of the executed contract has been attached and directory/plans are also attached for reference.  ', NULL, NULL, '2021-03-25 13:58:12', '2021-03-25 13:58:12'),
(16180, 3046, 21014, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:48:57', '2021-03-15 13:48:57'),
(16181, 1006, 21014, NULL, '2021-04-01 00:00:00.000', 'Approved', 'We have an urgent care contract with Aetna. We don\'t need to individually enroll/credential providers separately, a copy of the executed contract has been attached and directory/plans are also attached for reference.  ', NULL, NULL, '2021-03-25 14:00:04', '2021-03-25 14:00:04'),
(16182, 3040, 21015, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:49:23', '2021-03-15 13:49:23'),
(16183, 3040, 21015, NULL, '2021-05-24 00:00:00.000', 'Approved', 'Your active Railroad Medicare PTAN has been located and is shown here :  GROUP NAME	                           COLUMBUS URGENT CARE PA GROUP PTAN	                           DW0852 GROUP NPI	                                   1215330501 BUSINESS STATE	                           TX EFFECTIVE DATE	                           01/18/2015', NULL, NULL, '2021-05-17 08:35:08', '2021-05-17 08:35:08'),
(16184, 3040, 21016, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:49:39', '2021-03-15 13:49:39'),
(16185, 3040, 21016, NULL, '2021-05-24 00:00:00.000', 'Approved', 'Your active Railroad Medicare PTAN has been located and is shown here :  PROVIDER NAME	ABDUR RAUF MD PROVIDER PTAN	P01554284 PROVIDER NPI	1497726202 EFFECTIVE DATE	01/18/2015', NULL, NULL, '2021-05-17 08:42:50', '2021-05-17 08:42:50'),
(16186, 3040, 21017, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:50:00', '2021-03-15 13:50:00'),
(16187, 3040, 21017, NULL, '2021-05-24 00:00:00.000', 'In Process', 'Reference Number :	21137000296 ', NULL, NULL, '2021-05-17 09:05:55', '2021-05-17 09:05:55'),
(16188, 3040, 21017, NULL, '2021-06-14 00:00:00.000', 'Approved', 'Your active Railroad Medicare PTAN has been located and is shown here :  PROVIDER NAME	ODETTE T KOUROUMA NP PROVIDER PTAN	Q00072696 PROVIDER NPI	1134525868 EFFECTIVE DATE	01/22/2020 END DATE	 ', NULL, NULL, '2021-06-07 16:02:19', '2021-06-07 16:02:19'),
(16189, 3040, 21018, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:50:22', '2021-03-15 13:50:22'),
(16190, 3040, 21018, NULL, '2021-05-24 00:00:00.000', 'In Process', 'Reference Number :	21137000250 ', NULL, NULL, '2021-05-17 08:48:48', '2021-05-17 08:48:48'),
(16191, 3040, 21018, NULL, '2021-06-14 00:00:00.000', 'Approved', 'Provider enrolled in Medicare railroad. ', NULL, NULL, '2021-06-07 17:39:40', '2021-06-07 17:39:40'),
(16192, 3040, 21019, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:50:37', '2021-03-15 13:50:37'),
(16193, 3040, 21019, NULL, '2021-05-24 00:00:00.000', 'In Process', 'Reference Number :	21137000279 ', NULL, NULL, '2021-05-17 08:58:17', '2021-05-17 08:58:17'),
(16194, 3040, 21019, NULL, '2021-06-14 00:00:00.000', 'Approved', 'Provider enrolled in Medicare railroad. ', NULL, NULL, '2021-06-07 17:39:34', '2021-06-07 17:39:34'),
(16195, 3040, 21020, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:51:04', '2021-03-15 13:51:04'),
(16196, 3040, 21020, NULL, '2021-05-24 00:00:00.000', 'In Process', 'Reference Number :	21137000293 ', NULL, NULL, '2021-05-17 09:04:08', '2021-05-17 09:04:08'),
(16197, 3040, 21020, NULL, '2021-06-14 00:00:00.000', 'Approved', 'Provider enrolled in Medicare railroad. ', NULL, NULL, '2021-06-07 17:39:28', '2021-06-07 17:39:28'),
(16198, 3040, 21021, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:51:33', '2021-03-15 13:51:33'),
(16199, 3040, 21021, NULL, '2021-05-24 00:00:00.000', 'Approved', 'Your active Railroad Medicare PTAN has been located and is shown here :  PROVIDER NAME	JAMES M PICCIONE JR. MD PROVIDER PTAN	P02187249 PROVIDER NPI	1356321509 EFFECTIVE DATE	10/01/2018', NULL, NULL, '2021-05-17 08:55:20', '2021-05-17 08:55:20'),
(16200, 3040, 21022, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:51:57', '2021-03-15 13:51:57'),
(16201, 3040, 21022, NULL, '2021-05-24 00:00:00.000', 'In Process', 'Reference Number :	21137000261 ', NULL, NULL, '2021-05-17 08:52:01', '2021-05-17 08:52:01'),
(16202, 3040, 21022, NULL, '2021-06-14 00:00:00.000', 'Approved', 'Provider enrolled in Medicare railroad. ', NULL, NULL, '2021-06-07 17:39:23', '2021-06-07 17:39:23'),
(16203, 3040, 21023, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:52:14', '2021-03-15 13:52:14'),
(16204, 3040, 21023, NULL, '2021-05-24 00:00:00.000', 'In Process', 'Waiting for Medicare', NULL, NULL, '2021-05-17 08:58:43', '2021-05-17 08:58:43'),
(16205, 3040, 21023, NULL, '2021-05-31 00:00:00.000', 'In Process', 'Your new Railroad Medicare PTAN has been assigned and is shown here :  PROVIDER NAME	JEENA ABRAHAM PROVIDER PTAN	Q00076351 PROVIDER NPI	1467901587 EFFECTIVE DATE	02/06/2021 ', NULL, NULL, '2021-05-24 16:59:50', '2021-05-24 16:59:50'),
(16206, 3040, 21023, NULL, '2021-06-14 00:00:00.000', 'Approved', 'Provider enrolled in Medicare railroad. ', NULL, NULL, '2021-06-07 17:39:19', '2021-06-07 17:39:19'),
(16207, 3040, 21024, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:52:31', '2021-03-15 13:52:31'),
(16208, 1005, 21024, 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 12:52:52', '2021-06-01 12:52:52'),
(16209, 3040, 21025, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:52:45', '2021-03-15 13:52:45'),
(16210, 3040, 21025, NULL, '2021-05-24 00:00:00.000', 'In Process', 'Reference Number :	21137000239 ', NULL, NULL, '2021-05-17 08:46:17', '2021-05-17 08:46:17'),
(16211, 3040, 21025, NULL, '2021-06-14 00:00:00.000', 'Approved', 'Provider enrolled in Medicare railroad. ', NULL, NULL, '2021-06-07 17:38:59', '2021-06-07 17:38:59'),
(16212, 3040, 21026, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:53:00', '2021-03-15 13:53:00'),
(16213, 3040, 21026, NULL, '2021-05-24 00:00:00.000', 'In Process', 'Reference Number :	21137000258', NULL, NULL, '2021-05-17 08:50:19', '2021-05-17 08:50:19'),
(16214, 3040, 21026, NULL, '2021-06-15 00:00:00.000', 'Approved', 'Provider enrolled in Medicare Railroad. ', NULL, NULL, '2021-06-08 09:19:34', '2021-06-08 09:19:34'),
(16215, 3040, 21027, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:53:11', '2021-03-15 13:53:11'),
(16216, 3040, 21027, NULL, '2021-05-24 00:00:00.000', 'In Process', 'Reference Number :	21137000263 ', NULL, NULL, '2021-05-17 08:53:15', '2021-05-17 08:53:15'),
(16217, 3040, 21027, NULL, '2021-06-14 00:00:00.000', 'Approved', 'Provider enrolled in Medicare railroad. ', NULL, NULL, '2021-06-07 17:37:54', '2021-06-07 17:37:54'),
(16218, 3040, 21028, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:53:22', '2021-03-15 13:53:22'),
(16219, 3040, 21028, NULL, '2021-05-24 00:00:00.000', 'In Process', 'Reference Number :	21137000298 ', NULL, NULL, '2021-05-17 09:07:20', '2021-05-17 09:07:20'),
(16220, 3040, 21028, NULL, '2021-06-14 00:00:00.000', 'Approved', 'Provider enrolled in Medicare rail road. ', NULL, NULL, '2021-06-07 17:35:49', '2021-06-07 17:35:49'),
(16221, 3046, 21029, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:54:31', '2021-03-15 13:54:31'),
(16222, 1006, 21029, NULL, '2021-04-01 00:00:00.000', 'Approved', 'We have an urgent care contract with Aetna. We don\'t need to individually enroll/credential providers separately, a copy of the executed contract has been attached and directory/plans are also attached for reference.  ', NULL, NULL, '2021-03-25 14:01:32', '2021-03-25 14:01:32'),
(16223, 3040, 21030, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:55:43', '2021-03-15 13:55:43'),
(16224, 3040, 21030, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Ambetter 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  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-20 16:18:48', '2021-05-20 16:18:48'),
(16225, 3040, 21030, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject:Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Greetings,   I wanted to know the enrollment status for the below mentioned providers.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider Name:Abraham, Glory Provider NPI# 1194206490  Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider Name:Brown, Brittany Provider NPI# 1275163537   Thank you ', NULL, NULL, '2021-06-07 17:52:02', '2021-06-07 17:52:02'),
(16226, 3040, 21030, NULL, '2021-07-01 00:00:00.000', 'In Process', 'Email rcvd from: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Greetings,   I wanted to know the enrollment status for the below mentioned providers.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider Name: PAUL, SIGI- in credentialing Provider NPI# 1033623616  Provider Name: Jacob, Jaya- in credentialing Provider NPI# 1194336149  Provider Name: Stephen, Ani- in credentialing Provider NPI# 1588959118  Provider Name: Abraham, Jeena- in credentialing Provider NPI# 1467901587  Provider Name:Abraham, Glory- in credentialing Provider NPI# 1194206490  Provider Name: Thomas, Cini- in credentialing Provider NPI# 1134777238  Provider Name: Chennemkara, Mini- in credentialing Provider NPI# 1841755956  Provider Name: Brown, Brittany- Effective 7/1/2021 Provider NPI# 1275163537  Thank you ', NULL, NULL, '2021-06-24 09:12:46', '2021-06-24 09:12:46'),
(16227, 3040, 21030, NULL, '2021-07-20 00:00:00.000', 'In Process', 'Email rcvd to: AM.Austin@superiorhealthplan.com  Subject: Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Greetings,   I wanted to know the enrollment status for the below mentioned providers.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider Name: PAUL, SIGI- in credentialing Provider NPI# 1033623616  Provider Name: Jacob, Jaya- in credentialing Provider NPI# 1194336149  Provider Name: Stephen, Ani- in credentialing Provider NPI# 1588959118  Provider Name: Abraham, Jeena- in credentialing Provider NPI# 1467901587  Provider Name:Abraham, Glory- in credentialing Provider NPI# 1194206490  Provider Name: Thomas, Cini- in credentialing Provider NPI# 1134777238  Provider Name: Chennemkara, Mini- in credentialing Provider NPI# 1841755956  Provider Name:Brown, Brittany- Effective 7/1/2021 Provider NPI# 1275163537  Thank you ', NULL, NULL, '2021-07-13 10:40:59', '2021-07-13 10:40:59'),
(16228, 11056, 21030, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email sent to :  AM.Austin@superiorhealthplan.com  &  Credentialing  credentialing@superiorhealthplan.com  Sub : Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Good morning!  I wanted to know the enrollment status for the below mentioned providers. Please respond to us soon.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider Details: Provider Name: PAUL, SIGI- in credentialing Provider NPI# 1033623616  Provider Name: Jacob, Jaya- in credentialing Provider NPI# 1194336149  Provider Name: Stephen, Ani- in credentialing Provider NPI# 1588959118  Provider Name: Abraham, Jeena- in credentialing Provider NPI# 1467901587  Provider Name:Abraham, Glory- in credentialing Provider NPI# 1194206490  Provider Name: Thomas, Cini- in credentialing Provider NPI# 1134777238  Provider Name: Chennemkara, Mini- in credentialing Provider NPI# 1841755956  Provider Name:Brown, Brittany- Effective 7/1/2021 Provider NPI# 1275163537  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great day!     I have called Superior Health plan twice. But no one pickup the call & there was a recorder which inform me that they are working from home due to COVID after the recorder we have recorded our message and sent the voice mail for updation regarding our enrollment request.', NULL, NULL, '2021-08-05 11:30:25', '2021-08-05 11:30:25'),
(16229, 3040, 21030, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to: AM.Austin@superiorhealthplan.com  Subject: Re: Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Superior Healthplan 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 Details:  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider Name:Abraham, Glory Provider NPI# 1194206490  Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider Name: Chennemkara, Mini Provider NPI# 1841755956  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-08-27 11:08:18', '2021-08-27 11:08:18'),
(16230, 10057, 21030, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email Received From : credentialing@superiorhealthplan.com  Sub: Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Good morning,  I am able to locate the following information per the status request below for the providers:  1396380077-I currently show the file is in progress and has not been completed at this time, the credentialing specialist will contact you directly if there is any missing/incomplete information.  1033623616-The providers credentialing is complete, the effective date is 09/01/2021 and the re-credential date is 08/31/2024.  1194336149-The providers credentialing is complete, the effective date is 10/01/2021 and the re-credential date is 08/31/2024.  Thank you,  Credentialing Department | Superior Health Plan 5900 E. Ben White Blvd | Austin, TX 78741 Phone: 800-820-5686 |Fax: 866-702-4831  Credentialing@superiorhealthplan.com', NULL, NULL, '2021-10-20 14:30:32', '2021-10-20 14:30:32'),
(16231, 10057, 21030, NULL, '2021-11-04 00:00:00.000', 'In Process', 'Email Sent To : AM.Austin@superiorhealthplan.com  Sub : Need Copy of Welcome Packet  Dear Concern, Can you please send me the copy of the Welcome Packets and effective dates for the following providers, at your earliest convenience as we have tried to get those from you guys but didn\'t get any proper response on those.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Provider Name	NPI PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Joseph, Molly	1396380077 Stephen, Ani	1588959118 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956  Please get back to me asap.  Regards,', NULL, NULL, '2021-10-28 08:21:13', '2021-10-28 08:21:13'),
(16232, 10057, 21030, NULL, '2021-11-25 00:00:00.000', 'In Process', 'Email Sent To : AM.Austin@superiorhealthplan.com & credentialing@superiorhealthplan.com  Sub : Need Copy of Welcome Packet  Good Morning,  Hope this email finds you well. Can I get the latest updates on the below highlighted provider enrollment request under the group TIN.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Provider Name	NPI Joseph, Molly	1396380077  Looking forward to your early response.  Thanks & Regards,', NULL, NULL, '2021-11-18 09:27:44', '2021-11-18 09:27:44'),
(16233, 10057, 21030, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email Received From : AM.Austin@superiorhealthplan.com  Sub : Need Copy of Welcome Packet  Good morning,  Provider 1396380077- is in credentialing process no effective date at this time.  Thanks,  YA Account Management  Region 3', NULL, NULL, '2021-12-01 13:49:21', '2021-12-01 13:49:21'),
(16234, 10057, 21030, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Email Sent To : AM.Austin@superiorhealthplan.com  Sub : Need Copy of Welcome Packet  Thank you for providing the updated information.   Regards,', NULL, NULL, '2021-12-08 11:07:55', '2021-12-08 11:07:55'),
(16235, 10057, 21030, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email Sent To : AM.Austin@superiorhealthplan.com  Sub : Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Greetings!  Any update on the below request?  Thanks & Regards,', NULL, NULL, '2021-12-14 13:28:28', '2021-12-14 13:28:28'),
(16236, 10057, 21030, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Received From : AM.Austin@superiorhealthplan.com  Sub : Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Hello,  Provider 1396380077- is currently in make par status with an effective date of 1/1/21.  Thanks Account Management', NULL, NULL, '2021-12-21 13:20:33', '2021-12-21 13:20:33'),
(16237, 10057, 21030, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email Sent To : AM.Austin@superiorhealthplan.com  Sub : Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Greetings!  Thank you for providing me with the update. When can I get the welcome packet?  Regards,', NULL, NULL, '2021-12-28 15:15:36', '2021-12-28 15:15:36'),
(16238, 19067, 21030, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: AM.Austin@superiorhealthplan.com  Subject: Enrollment Status || Columbus Urgent Care PA || Molly Joseph & Group || Superior Health ||  Hello!  Hope you are doing well.  I would like to know the enrollment status of the following Provider and Group with Superior Health.  Group Name	Columbus Urgent Care PA Tax ID	47-1914151 Group NPI	1215330501 Provider Name	NPI	Location Molly Joseph	1396380077	926 Walnut St, Columbus, TX 78934-2215   Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 13:17:39', '2022-01-04 13:17:39'),
(16239, 19067, 21030, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email received from: AM.Austin@superiorhealthplan.com  Subject: Enrollment Status || Columbus Urgent Care PA || Molly Joseph & Group || Superior Health ||     Good afternoon,     Provider 1396380077 is effective 1/1/22.        Thanks,     YA  Account Management  Region 3', NULL, NULL, '2022-01-05 17:59:15', '2022-01-05 17:59:15'),
(16240, 20067, 21030, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: AM.Austin@superiorhealthplan.com  Sub: Enrollment Status || Columbus Urgent Care PA || Molly Joseph & Group || Superior Health ||  Good afternoon!  Hope this email finds you in good spirits. Any update on the below-mentioned provider?  Kindly respond promptly. Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-26 16:46:41', '2022-01-26 16:46:41'),
(16241, 20067, 21030, NULL, '2022-02-09 00:00:00.000', 'In Process', 'Called Superior Healthplan. The group is PAR and Effective date is 07/01/2021. Plans:  Starplus Medicare Chip Chip RSA Star kids  Star Medicaid  With the group NPI Cini Thomas is coming up on provider directory Have to discuss this issue with Account Manager phone: 800-218-7453  Ref#  I-70588307', NULL, NULL, '2022-02-02 13:46:18', '2022-02-02 13:46:18'),
(16242, 20067, 21030, NULL, '2022-02-24 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Sub: Enrollment Status || CUCC || Jeny John & GROUP || Superior Health  Good Evening!  Hope this email finds you in good health. I would like to know the enrollment status of the below-mentioned Group & Provider.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus, TX 78934-2215 NPI	Provider 1073019493	Jeny John  Regards,', NULL, NULL, '2022-02-17 17:35:31', '2022-02-17 17:35:31'),
(16243, 20067, 21030, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email received from: AM.Austin@superiorhealthplan.com  Sub: Enrollment Status || CUCC || Jeny John & GROUP || Superior Health  Thank you for contacting the Travis/Central Account Management Team.  Provider is in credentialing status. No effective date available at this time     Thank you,     Account Management  Region 3', NULL, NULL, '2022-03-01 12:11:26', '2022-03-01 12:11:26'),
(16244, 20067, 21030, NULL, '2022-03-16 00:00:00.000', 'In Process', 'Email received from: AM.Austin@superiorhealthplan.com  Sub: Re: Enrollment Status || Columbus Urgent Care PA || Jeny John || Superior Health ||  Good afternoon,     Provider is in credentialing process at this time. No effective date available at this time.     Thank you,', NULL, NULL, '2022-03-09 15:55:47', '2022-03-09 15:55:47'),
(16245, 20067, 21030, NULL, '2022-03-28 00:00:00.000', 'In Process', 'Email sent to: AM.Austin@superiorhealthplan.com  Sub: Re: Enrollment Status || Columbus Urgent Care PA || Jeny John || Superior Health ||  Good Afternoon!  Hope you had a great weekend. What\'s the current status of the provider Jeny John. Also please confirm that this provider is in process with both Superior Health plan and Ambetter.?  Thank you, Syed ', NULL, NULL, '2022-03-21 12:32:19', '2022-03-21 12:32:19'),
(16246, 3040, 21031, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:56:07', '2021-03-15 13:56:07'),
(16247, 3040, 21031, NULL, '2021-05-24 00:00:00.000', 'Approved', 'Provider enrolled with Superior Health.   Effective Date: 04/01/2016  REF: I-55809211', NULL, NULL, '2021-05-17 10:19:22', '2021-05-17 10:19:22'),
(16248, 3040, 21032, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:56:41', '2021-03-15 13:56:41'),
(16249, 3040, 21032, NULL, '2021-05-24 00:00:00.000', 'In Process', 'Thank You for Your Interest in Becoming a Part of Superior HealthPlan’s Growing Network! Important to Note:  Please ensure you’ve completed the IRS W-9 Form (PDF) and submit it to SHP.NetworkDevelopment@SuperiorHealthPlan.com. Prior to a new provider’s provision of services and receipt of claims reimbursement, program enrollment must be confirmed on requests for Superior Medicaid (STAR, STAR Health, STAR Kids and STAR+PLUS), CHIP and/or Long-Term Services and Supports (LTSS) programs. Superior will notify you of acceptance or non-acceptance to our network no later than 90 days from receipt of a complete application for participation. If additional information is required to process your request, a Superior representative will contact you.', NULL, NULL, '2021-05-17 12:10:15', '2021-05-17 12:10:15'),
(16250, 3040, 21032, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject:Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Greetings,   I wanted to know the enrollment status for the below mentioned providers.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider Name:Abraham, Glory Provider NPI# 1194206490  Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider Name:Brown, Brittany Provider NPI# 1275163537   Thank you ', NULL, NULL, '2021-06-07 17:51:57', '2021-06-07 17:51:57'),
(16251, 3040, 21032, NULL, '2021-07-01 00:00:00.000', 'In Process', 'Email rcvd from: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Greetings,   I wanted to know the enrollment status for the below mentioned providers.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider Name: PAUL, SIGI- in credentialing Provider NPI# 1033623616  Provider Name: Jacob, Jaya- in credentialing Provider NPI# 1194336149  Provider Name: Stephen, Ani- in credentialing Provider NPI# 1588959118  Provider Name: Abraham, Jeena- in credentialing Provider NPI# 1467901587  Provider Name:Abraham, Glory- in credentialing Provider NPI# 1194206490  Provider Name: Thomas, Cini- in credentialing Provider NPI# 1134777238  Provider Name: Chennemkara, Mini- in credentialing Provider NPI# 1841755956  Provider Name: Brown, Brittany- Effective 7/1/2021 Provider NPI# 1275163537  Thank you ', NULL, NULL, '2021-06-24 09:12:44', '2021-06-24 09:12:44'),
(16252, 3040, 21032, NULL, '2021-07-20 00:00:00.000', 'Approved', 'Greetings,   I wanted to know the enrollment status for the below mentioned providers.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider Name: PAUL, SIGI- in credentialing Provider NPI# 1033623616  Provider Name: Jacob, Jaya- in credentialing Provider NPI# 1194336149  Provider Name: Stephen, Ani- in credentialing Provider NPI# 1588959118  Provider Name: Abraham, Jeena- in credentialing Provider NPI# 1467901587  Provider Name:Abraham, Glory- in credentialing Provider NPI# 1194206490  Provider Name: Thomas, Cini- in credentialing Provider NPI# 1134777238  Provider Name: Chennemkara, Mini- in credentialing Provider NPI# 1841755956  Provider Name:Brown, Brittany- Effective 7/1/2021 Provider NPI# 1275163537  Thank you ', NULL, NULL, '2021-07-13 10:32:52', '2021-07-13 10:32:52'),
(16253, 3040, 21033, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:57:26', '2021-03-15 13:57:26'),
(16254, 3040, 21033, NULL, '2021-05-24 00:00:00.000', 'In Process', 'Thank You for Your Interest in Becoming a Part of Superior HealthPlan’s Growing Network! Important to Note:  Please ensure you’ve completed the IRS W-9 Form (PDF) and submit it to SHP.NetworkDevelopment@SuperiorHealthPlan.com. Prior to a new provider’s provision of services and receipt of claims reimbursement, program enrollment must be confirmed on requests for Superior Medicaid (STAR, STAR Health, STAR Kids and STAR+PLUS), CHIP and/or Long-Term Services and Supports (LTSS) programs. Superior will notify you of acceptance or non-acceptance to our network no later than 90 days from receipt of a complete application for participation. If additional information is required to process your request, a Superior representative will contact you.  ', NULL, NULL, '2021-05-17 12:13:25', '2021-05-17 12:13:25'),
(16255, 3040, 21033, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject:Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Greetings,   I wanted to know the enrollment status for the below mentioned providers.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider Name:Abraham, Glory Provider NPI# 1194206490  Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider Name:Brown, Brittany Provider NPI# 1275163537   Thank you ', NULL, NULL, '2021-06-07 17:51:52', '2021-06-07 17:51:52'),
(16256, 3040, 21033, NULL, '2021-07-01 00:00:00.000', 'In Process', 'Email rcvd from: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Greetings,   I wanted to know the enrollment status for the below mentioned providers.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider Name: PAUL, SIGI- in credentialing Provider NPI# 1033623616  Provider Name: Jacob, Jaya- in credentialing Provider NPI# 1194336149  Provider Name: Stephen, Ani- in credentialing Provider NPI# 1588959118  Provider Name: Abraham, Jeena- in credentialing Provider NPI# 1467901587  Provider Name:Abraham, Glory- in credentialing Provider NPI# 1194206490  Provider Name: Thomas, Cini- in credentialing Provider NPI# 1134777238  Provider Name: Chennemkara, Mini- in credentialing Provider NPI# 1841755956  Provider Name: Brown, Brittany- Effective 7/1/2021 Provider NPI# 1275163537  Thank you ', NULL, NULL, '2021-06-24 09:12:41', '2021-06-24 09:12:41'),
(16257, 3040, 21033, NULL, '2021-07-20 00:00:00.000', 'In Process', 'Email rcvd to: AM.Austin@superiorhealthplan.com  Subject: Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Greetings,   I wanted to know the enrollment status for the below mentioned providers.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider Name: PAUL, SIGI- in credentialing Provider NPI# 1033623616  Provider Name: Jacob, Jaya- in credentialing Provider NPI# 1194336149  Provider Name: Stephen, Ani- in credentialing Provider NPI# 1588959118  Provider Name: Abraham, Jeena- in credentialing Provider NPI# 1467901587  Provider Name:Abraham, Glory- in credentialing Provider NPI# 1194206490  Provider Name: Thomas, Cini- in credentialing Provider NPI# 1134777238  Provider Name: Chennemkara, Mini- in credentialing Provider NPI# 1841755956  Provider Name:Brown, Brittany- Effective 7/1/2021 Provider NPI# 1275163537  Thank you ', NULL, NULL, '2021-07-13 10:41:00', '2021-07-13 10:41:00'),
(16258, 11056, 21033, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email sent to :  AM.Austin@superiorhealthplan.com  &  Credentialing  credentialing@superiorhealthplan.com  Sub : Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Good morning!  I wanted to know the enrollment status for the below mentioned providers. Please respond to us soon.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider Details: Provider Name: PAUL, SIGI- in credentialing Provider NPI# 1033623616  Provider Name: Jacob, Jaya- in credentialing Provider NPI# 1194336149  Provider Name: Stephen, Ani- in credentialing Provider NPI# 1588959118  Provider Name: Abraham, Jeena- in credentialing Provider NPI# 1467901587  Provider Name:Abraham, Glory- in credentialing Provider NPI# 1194206490  Provider Name: Thomas, Cini- in credentialing Provider NPI# 1134777238  Provider Name: Chennemkara, Mini- in credentialing Provider NPI# 1841755956  Provider Name:Brown, Brittany- Effective 7/1/2021 Provider NPI# 1275163537  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great day!     I have called Superior Health plan twice. But no one pickup the call & there was a recorder which inform me that they are working from home due to COVID after the recorder we have recorded our message and sent the voice mail for updation regarding our enrollment request.', NULL, NULL, '2021-08-05 11:30:43', '2021-08-05 11:30:43'),
(16259, 3040, 21033, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to: AM.Austin@superiorhealthplan.com  Subject: Re: Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Superior Healthplan 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 Details:  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider Name:Abraham, Glory Provider NPI# 1194206490  Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider Name: Chennemkara, Mini Provider NPI# 1841755956  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-08-27 11:07:34', '2021-08-27 11:07:34'),
(16260, 3040, 21033, NULL, '2021-09-10 00:00:00.000', 'Approved', 'Email rcvd from: SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Subject: RE: Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Hello,  Provider Name: Stephen, Ani Provider NPI# 1588959118      -We received your completed application on 5/19/2021 Your projected effective date is 7/1/2021. Currently In the process of being loaded in our system. Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.  Provider Name: Abraham, Jeena Provider NPI# 1467901587 -We received your completed application on 5/19/2021 Your projected effective date is 7/1/2021. Currently In the process of being loaded in our system. Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.  Provider Name:Abraham, Glory Provider NPI# 1194206490 -We received your completed application on 5/19/2021 Your projected effective date is 7/1/2021. Currently In the process of being loaded in our system. Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.  Provider Name: Thomas, Cini Provider NPI# 1134777238 We received your completed application on 5/19/2021 Your projected effective date is 7/1/2021. Currently In the process of being loaded in our system. Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.  Provider Name: Chennemkara, Mini Provider NPI# 1841755956- We received your completed application on 5/19/2021 Your projected effective date is 8/1/2021. Currently In the process of being loaded in our system. Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.  Blessings,  Jillyan Galindo Project Coordinator I, Contract Management', NULL, NULL, '2021-09-03 11:38:59', '2021-09-03 11:38:59'),
(16261, 3040, 21034, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:57:57', '2021-03-15 13:57:57'),
(16262, 3040, 21034, NULL, '2021-05-24 00:00:00.000', 'In Process', 'Thank You for Your Interest in Becoming a Part of Superior HealthPlan’s Growing Network! Important to Note:  Please ensure you’ve completed the IRS W-9 Form (PDF) and submit it to SHP.NetworkDevelopment@SuperiorHealthPlan.com. Prior to a new provider’s provision of services and receipt of claims reimbursement, program enrollment must be confirmed on requests for Superior Medicaid (STAR, STAR Health, STAR Kids and STAR+PLUS), CHIP and/or Long-Term Services and Supports (LTSS) programs. Superior will notify you of acceptance or non-acceptance to our network no later than 90 days from receipt of a complete application for participation. If additional information is required to process your request, a Superior representative will contact you.', NULL, NULL, '2021-05-17 12:16:43', '2021-05-17 12:16:43'),
(16263, 3040, 21034, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject:Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Greetings,   I wanted to know the enrollment status for the below mentioned providers.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider Name:Abraham, Glory Provider NPI# 1194206490  Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider Name:Brown, Brittany Provider NPI# 1275163537   Thank you ', NULL, NULL, '2021-06-07 17:51:47', '2021-06-07 17:51:47'),
(16264, 3040, 21034, NULL, '2021-07-01 00:00:00.000', 'In Process', 'Email rcvd from: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Greetings,   I wanted to know the enrollment status for the below mentioned providers.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider Name: PAUL, SIGI- in credentialing Provider NPI# 1033623616  Provider Name: Jacob, Jaya- in credentialing Provider NPI# 1194336149  Provider Name: Stephen, Ani- in credentialing Provider NPI# 1588959118  Provider Name: Abraham, Jeena- in credentialing Provider NPI# 1467901587  Provider Name:Abraham, Glory- in credentialing Provider NPI# 1194206490  Provider Name: Thomas, Cini- in credentialing Provider NPI# 1134777238  Provider Name: Chennemkara, Mini- in credentialing Provider NPI# 1841755956  Provider Name: Brown, Brittany- Effective 7/1/2021 Provider NPI# 1275163537  Thank you ', NULL, NULL, '2021-06-24 09:12:39', '2021-06-24 09:12:39'),
(16265, 3040, 21034, NULL, '2021-07-20 00:00:00.000', 'In Process', 'Email rcvd to: AM.Austin@superiorhealthplan.com  Subject: Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Greetings,   I wanted to know the enrollment status for the below mentioned providers.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider Name: PAUL, SIGI- in credentialing Provider NPI# 1033623616  Provider Name: Jacob, Jaya- in credentialing Provider NPI# 1194336149  Provider Name: Stephen, Ani- in credentialing Provider NPI# 1588959118  Provider Name: Abraham, Jeena- in credentialing Provider NPI# 1467901587  Provider Name:Abraham, Glory- in credentialing Provider NPI# 1194206490  Provider Name: Thomas, Cini- in credentialing Provider NPI# 1134777238  Provider Name: Chennemkara, Mini- in credentialing Provider NPI# 1841755956  Provider Name:Brown, Brittany- Effective 7/1/2021 Provider NPI# 1275163537  Thank you ', NULL, NULL, '2021-07-13 10:40:59', '2021-07-13 10:40:59'),
(16266, 11056, 21034, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email sent to :  AM.Austin@superiorhealthplan.com  &  Credentialing  credentialing@superiorhealthplan.com  Sub : Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Good morning!  I wanted to know the enrollment status for the below mentioned providers. Please respond to us soon.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider Details: Provider Name: PAUL, SIGI- in credentialing Provider NPI# 1033623616  Provider Name: Jacob, Jaya- in credentialing Provider NPI# 1194336149  Provider Name: Stephen, Ani- in credentialing Provider NPI# 1588959118  Provider Name: Abraham, Jeena- in credentialing Provider NPI# 1467901587  Provider Name:Abraham, Glory- in credentialing Provider NPI# 1194206490  Provider Name: Thomas, Cini- in credentialing Provider NPI# 1134777238  Provider Name: Chennemkara, Mini- in credentialing Provider NPI# 1841755956  Provider Name:Brown, Brittany- Effective 7/1/2021 Provider NPI# 1275163537  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great day!     I have called Superior Health plan twice. But no one pickup the call & there was a recorder which inform me that they are working from home due to COVID after the recorder we have recorded our message and sent the voice mail for updation regarding our enrollment request.', NULL, NULL, '2021-08-05 11:39:40', '2021-08-05 11:39:40'),
(16267, 3040, 21034, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to: AM.Austin@superiorhealthplan.com  Subject: Re: Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Superior Healthplan 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 Details:  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider Name:Abraham, Glory Provider NPI# 1194206490  Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider Name: Chennemkara, Mini Provider NPI# 1841755956  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-08-27 11:08:15', '2021-08-27 11:08:15'),
(16268, 3040, 21034, NULL, '2021-09-10 00:00:00.000', 'Approved', 'Email rcvd from: SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Subject: RE: Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Hello,  Provider Name: Stephen, Ani Provider NPI# 1588959118      -We received your completed application on 5/19/2021 Your projected effective date is 7/1/2021. Currently In the process of being loaded in our system. Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.  Provider Name: Abraham, Jeena Provider NPI# 1467901587 -We received your completed application on 5/19/2021 Your projected effective date is 7/1/2021. Currently In the process of being loaded in our system. Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.  Provider Name:Abraham, Glory Provider NPI# 1194206490 -We received your completed application on 5/19/2021 Your projected effective date is 7/1/2021. Currently In the process of being loaded in our system. Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.  Provider Name: Thomas, Cini Provider NPI# 1134777238 We received your completed application on 5/19/2021 Your projected effective date is 7/1/2021. Currently In the process of being loaded in our system. Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.  Provider Name: Chennemkara, Mini Provider NPI# 1841755956- We received your completed application on 5/19/2021 Your projected effective date is 8/1/2021. Currently In the process of being loaded in our system. Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.  Blessings,  Jillyan Galindo Project Coordinator I, Contract Management', NULL, NULL, '2021-09-03 11:38:56', '2021-09-03 11:38:56'),
(16269, 3040, 21035, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:58:22', '2021-03-15 13:58:22');
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
(16270, 3040, 21035, NULL, '2021-05-24 00:00:00.000', 'In Process', 'Thank You for Your Interest in Becoming a Part of Superior HealthPlan’s Growing Network! Important to Note:  Please ensure you’ve completed the IRS W-9 Form (PDF) and submit it to SHP.NetworkDevelopment@SuperiorHealthPlan.com. Prior to a new provider’s provision of services and receipt of claims reimbursement, program enrollment must be confirmed on requests for Superior Medicaid (STAR, STAR Health, STAR Kids and STAR+PLUS), CHIP and/or Long-Term Services and Supports (LTSS) programs. Superior will notify you of acceptance or non-acceptance to our network no later than 90 days from receipt of a complete application for participation. If additional information is required to process your request, a Superior representative will contact you.  ', NULL, NULL, '2021-05-17 12:18:47', '2021-05-17 12:18:47'),
(16271, 3040, 21035, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject:Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Greetings,   I wanted to know the enrollment status for the below mentioned providers.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider Name:Abraham, Glory Provider NPI# 1194206490  Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider Name:Brown, Brittany Provider NPI# 1275163537   Thank you ', NULL, NULL, '2021-06-07 17:51:42', '2021-06-07 17:51:42'),
(16272, 3040, 21035, NULL, '2021-07-01 00:00:00.000', 'In Process', 'Email rcvd from: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Greetings,   I wanted to know the enrollment status for the below mentioned providers.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider Name: PAUL, SIGI- in credentialing Provider NPI# 1033623616  Provider Name: Jacob, Jaya- in credentialing Provider NPI# 1194336149  Provider Name: Stephen, Ani- in credentialing Provider NPI# 1588959118  Provider Name: Abraham, Jeena- in credentialing Provider NPI# 1467901587  Provider Name:Abraham, Glory- in credentialing Provider NPI# 1194206490  Provider Name: Thomas, Cini- in credentialing Provider NPI# 1134777238  Provider Name: Chennemkara, Mini- in credentialing Provider NPI# 1841755956  Provider Name: Brown, Brittany- Effective 7/1/2021 Provider NPI# 1275163537  Thank you ', NULL, NULL, '2021-06-24 09:12:37', '2021-06-24 09:12:37'),
(16273, 3040, 21035, NULL, '2021-07-20 00:00:00.000', 'In Process', 'Email rcvd to: AM.Austin@superiorhealthplan.com  Subject: Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Greetings,   I wanted to know the enrollment status for the below mentioned providers.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider Name: PAUL, SIGI- in credentialing Provider NPI# 1033623616  Provider Name: Jacob, Jaya- in credentialing Provider NPI# 1194336149  Provider Name: Stephen, Ani- in credentialing Provider NPI# 1588959118  Provider Name: Abraham, Jeena- in credentialing Provider NPI# 1467901587  Provider Name:Abraham, Glory- in credentialing Provider NPI# 1194206490  Provider Name: Thomas, Cini- in credentialing Provider NPI# 1134777238  Provider Name: Chennemkara, Mini- in credentialing Provider NPI# 1841755956  Provider Name:Brown, Brittany- Effective 7/1/2021 Provider NPI# 1275163537  Thank you ', NULL, NULL, '2021-07-13 10:41:00', '2021-07-13 10:41:00'),
(16274, 11056, 21035, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email sent to :  AM.Austin@superiorhealthplan.com  &  Credentialing  credentialing@superiorhealthplan.com  Sub : Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Good morning!  I wanted to know the enrollment status for the below mentioned providers. Please respond to us soon.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider Details: Provider Name: PAUL, SIGI- in credentialing Provider NPI# 1033623616  Provider Name: Jacob, Jaya- in credentialing Provider NPI# 1194336149  Provider Name: Stephen, Ani- in credentialing Provider NPI# 1588959118  Provider Name: Abraham, Jeena- in credentialing Provider NPI# 1467901587  Provider Name:Abraham, Glory- in credentialing Provider NPI# 1194206490  Provider Name: Thomas, Cini- in credentialing Provider NPI# 1134777238  Provider Name: Chennemkara, Mini- in credentialing Provider NPI# 1841755956  Provider Name:Brown, Brittany- Effective 7/1/2021 Provider NPI# 1275163537  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great day!     I have called Superior Health plan twice. But no one pickup the call & there was a recorder which inform me that they are working from home due to COVID after the recorder we have recorded our message and sent the voice mail for updation regarding our enrollment request.', NULL, NULL, '2021-08-05 11:38:22', '2021-08-05 11:38:22'),
(16275, 11056, 21035, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email sent to :  AM.Austin@superiorhealthplan.com  &  Credentialing  credentialing@superiorhealthplan.com  Sub : Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Good morning!  I wanted to know the enrollment status for the below mentioned providers. Please respond to us soon.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider Details: Provider Name: PAUL, SIGI- in credentialing Provider NPI# 1033623616  Provider Name: Jacob, Jaya- in credentialing Provider NPI# 1194336149  Provider Name: Stephen, Ani- in credentialing Provider NPI# 1588959118  Provider Name: Abraham, Jeena- in credentialing Provider NPI# 1467901587  Provider Name:Abraham, Glory- in credentialing Provider NPI# 1194206490  Provider Name: Thomas, Cini- in credentialing Provider NPI# 1134777238  Provider Name: Chennemkara, Mini- in credentialing Provider NPI# 1841755956  Provider Name:Brown, Brittany- Effective 7/1/2021 Provider NPI# 1275163537  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great day!     I have called Superior Health plan twice. But no one pickup the call & there was a recorder which inform me that they are working from home due to COVID after the recorder we have recorded our message and sent the voice mail for updation regarding our enrollment request.', NULL, NULL, '2021-08-05 11:38:33', '2021-08-05 11:38:33'),
(16276, 3040, 21035, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to: AM.Austin@superiorhealthplan.com  Subject: Re: Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Superior Healthplan 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 Details:  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider Name:Abraham, Glory Provider NPI# 1194206490  Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider Name: Chennemkara, Mini Provider NPI# 1841755956  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-08-27 11:08:20', '2021-08-27 11:08:20'),
(16277, 3040, 21035, NULL, '2021-09-10 00:00:00.000', 'Approved', 'Email rcvd from: SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Subject: RE: Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Hello,  Provider Name: Stephen, Ani Provider NPI# 1588959118      -We received your completed application on 5/19/2021 Your projected effective date is 7/1/2021. Currently In the process of being loaded in our system. Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.  Provider Name: Abraham, Jeena Provider NPI# 1467901587 -We received your completed application on 5/19/2021 Your projected effective date is 7/1/2021. Currently In the process of being loaded in our system. Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.  Provider Name:Abraham, Glory Provider NPI# 1194206490 -We received your completed application on 5/19/2021 Your projected effective date is 7/1/2021. Currently In the process of being loaded in our system. Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.  Provider Name: Thomas, Cini Provider NPI# 1134777238 We received your completed application on 5/19/2021 Your projected effective date is 7/1/2021. Currently In the process of being loaded in our system. Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.  Provider Name: Chennemkara, Mini Provider NPI# 1841755956- We received your completed application on 5/19/2021 Your projected effective date is 8/1/2021. Currently In the process of being loaded in our system. Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.  Blessings,  Jillyan Galindo Project Coordinator I, Contract Management', NULL, NULL, '2021-09-03 11:24:37', '2021-09-03 11:24:37'),
(16278, 3040, 21036, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:58:39', '2021-03-15 13:58:39'),
(16279, 3040, 21036, NULL, '2021-05-24 00:00:00.000', 'In Process', 'Thank You for Your Interest in Becoming a Part of Superior HealthPlan’s Growing Network! Important to Note:  Please ensure you’ve completed the IRS W-9 Form (PDF) and submit it to SHP.NetworkDevelopment@SuperiorHealthPlan.com. Prior to a new provider’s provision of services and receipt of claims reimbursement, program enrollment must be confirmed on requests for Superior Medicaid (STAR, STAR Health, STAR Kids and STAR+PLUS), CHIP and/or Long-Term Services and Supports (LTSS) programs. Superior will notify you of acceptance or non-acceptance to our network no later than 90 days from receipt of a complete application for participation. If additional information is required to process your request, a Superior representative will contact you.  ', NULL, NULL, '2021-05-17 12:22:25', '2021-05-17 12:22:25'),
(16280, 3040, 21036, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject:Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Greetings,   I wanted to know the enrollment status for the below mentioned providers.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider Name:Abraham, Glory Provider NPI# 1194206490  Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider Name:Brown, Brittany Provider NPI# 1275163537   Thank you ', NULL, NULL, '2021-06-07 17:51:35', '2021-06-07 17:51:35'),
(16281, 3040, 21036, NULL, '2021-07-01 00:00:00.000', 'In Process', 'Email rcvd from: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Greetings,   I wanted to know the enrollment status for the below mentioned providers.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider Name: PAUL, SIGI- in credentialing Provider NPI# 1033623616  Provider Name: Jacob, Jaya- in credentialing Provider NPI# 1194336149  Provider Name: Stephen, Ani- in credentialing Provider NPI# 1588959118  Provider Name: Abraham, Jeena- in credentialing Provider NPI# 1467901587  Provider Name:Abraham, Glory- in credentialing Provider NPI# 1194206490  Provider Name: Thomas, Cini- in credentialing Provider NPI# 1134777238  Provider Name: Chennemkara, Mini- in credentialing Provider NPI# 1841755956  Provider Name: Brown, Brittany- Effective 7/1/2021 Provider NPI# 1275163537  Thank you ', NULL, NULL, '2021-06-24 09:12:33', '2021-06-24 09:12:33'),
(16282, 3040, 21036, NULL, '2021-07-20 00:00:00.000', 'In Process', 'Email rcvd to: AM.Austin@superiorhealthplan.com  Subject: Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Greetings,   I wanted to know the enrollment status for the below mentioned providers.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider Name: PAUL, SIGI- in credentialing Provider NPI# 1033623616  Provider Name: Jacob, Jaya- in credentialing Provider NPI# 1194336149  Provider Name: Stephen, Ani- in credentialing Provider NPI# 1588959118  Provider Name: Abraham, Jeena- in credentialing Provider NPI# 1467901587  Provider Name:Abraham, Glory- in credentialing Provider NPI# 1194206490  Provider Name: Thomas, Cini- in credentialing Provider NPI# 1134777238  Provider Name: Chennemkara, Mini- in credentialing Provider NPI# 1841755956  Provider Name:Brown, Brittany- Effective 7/1/2021 Provider NPI# 1275163537  Thank you ', NULL, NULL, '2021-07-13 10:41:01', '2021-07-13 10:41:01'),
(16283, 11056, 21036, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email sent to :  AM.Austin@superiorhealthplan.com  &  Credentialing  credentialing@superiorhealthplan.com  Sub : Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Good morning!  I wanted to know the enrollment status for the below mentioned providers. Please respond to us soon.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider Details: Provider Name: PAUL, SIGI- in credentialing Provider NPI# 1033623616  Provider Name: Jacob, Jaya- in credentialing Provider NPI# 1194336149  Provider Name: Stephen, Ani- in credentialing Provider NPI# 1588959118  Provider Name: Abraham, Jeena- in credentialing Provider NPI# 1467901587  Provider Name:Abraham, Glory- in credentialing Provider NPI# 1194206490  Provider Name: Thomas, Cini- in credentialing Provider NPI# 1134777238  Provider Name: Chennemkara, Mini- in credentialing Provider NPI# 1841755956  Provider Name:Brown, Brittany- Effective 7/1/2021 Provider NPI# 1275163537  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great day!     I have called Superior Health plan twice. But no one pickup the call & there was a recorder which inform me that they are working from home due to COVID after the recorder we have recorded our message and sent the voice mail for updation regarding our enrollment request.', NULL, NULL, '2021-08-05 11:38:45', '2021-08-05 11:38:45'),
(16284, 3040, 21036, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to: AM.Austin@superiorhealthplan.com  Subject: Re: Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Superior Healthplan 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 Details:  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider Name:Abraham, Glory Provider NPI# 1194206490  Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider Name: Chennemkara, Mini Provider NPI# 1841755956  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-08-27 11:08:22', '2021-08-27 11:08:22'),
(16285, 3040, 21036, NULL, '2021-09-10 00:00:00.000', 'Approved', 'Email rcvd from: SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Subject: RE: Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Hello,  Provider Name: Stephen, Ani Provider NPI# 1588959118      -We received your completed application on 5/19/2021 Your projected effective date is 7/1/2021. Currently In the process of being loaded in our system. Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.  Provider Name: Abraham, Jeena Provider NPI# 1467901587 -We received your completed application on 5/19/2021 Your projected effective date is 7/1/2021. Currently In the process of being loaded in our system. Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.  Provider Name:Abraham, Glory Provider NPI# 1194206490 -We received your completed application on 5/19/2021 Your projected effective date is 7/1/2021. Currently In the process of being loaded in our system. Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.  Provider Name: Thomas, Cini Provider NPI# 1134777238 We received your completed application on 5/19/2021 Your projected effective date is 7/1/2021. Currently In the process of being loaded in our system. Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.  Provider Name: Chennemkara, Mini Provider NPI# 1841755956- We received your completed application on 5/19/2021 Your projected effective date is 8/1/2021. Currently In the process of being loaded in our system. Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.  Blessings,  Jillyan Galindo Project Coordinator I, Contract Management', NULL, NULL, '2021-09-03 11:24:37', '2021-09-03 11:24:37'),
(16286, 3040, 21037, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:58:54', '2021-03-15 13:58:54'),
(16287, 1005, 21037, 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 12:53:58', '2021-06-01 12:53:58'),
(16288, 3040, 21038, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:59:10', '2021-03-15 13:59:10'),
(16289, 3040, 21038, NULL, '2021-05-24 00:00:00.000', 'In Process', 'Thank You for Your Interest in Becoming a Part of Superior HealthPlan’s Growing Network! Important to Note:  Please ensure you’ve completed the IRS W-9 Form (PDF) and submit it to SHP.NetworkDevelopment@SuperiorHealthPlan.com. Prior to a new provider’s provision of services and receipt of claims reimbursement, program enrollment must be confirmed on requests for Superior Medicaid (STAR, STAR Health, STAR Kids and STAR+PLUS), CHIP and/or Long-Term Services and Supports (LTSS) programs. Superior will notify you of acceptance or non-acceptance to our network no later than 90 days from receipt of a complete application for participation. If additional information is required to process your request, a Superior representative will contact you.', NULL, NULL, '2021-05-17 12:24:14', '2021-05-17 12:24:14'),
(16290, 3040, 21038, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject:Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Greetings,   I wanted to know the enrollment status for the below mentioned providers.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider Name:Abraham, Glory Provider NPI# 1194206490  Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider Name:Brown, Brittany Provider NPI# 1275163537   Thank you ', NULL, NULL, '2021-06-07 17:51:30', '2021-06-07 17:51:30'),
(16291, 3040, 21038, NULL, '2021-07-01 00:00:00.000', 'In Process', 'Email rcvd from: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Greetings,   I wanted to know the enrollment status for the below mentioned providers.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider Name: PAUL, SIGI- in credentialing Provider NPI# 1033623616  Provider Name: Jacob, Jaya- in credentialing Provider NPI# 1194336149  Provider Name: Stephen, Ani- in credentialing Provider NPI# 1588959118  Provider Name: Abraham, Jeena- in credentialing Provider NPI# 1467901587  Provider Name:Abraham, Glory- in credentialing Provider NPI# 1194206490  Provider Name: Thomas, Cini- in credentialing Provider NPI# 1134777238  Provider Name: Chennemkara, Mini- in credentialing Provider NPI# 1841755956  Provider Name: Brown, Brittany- Effective 7/1/2021 Provider NPI# 1275163537  Thank you ', NULL, NULL, '2021-06-24 09:12:31', '2021-06-24 09:12:31'),
(16292, 3040, 21038, NULL, '2021-07-20 00:00:00.000', 'In Process', 'Email rcvd to: AM.Austin@superiorhealthplan.com  Subject: Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Greetings,   I wanted to know the enrollment status for the below mentioned providers.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider Name: PAUL, SIGI- in credentialing Provider NPI# 1033623616  Provider Name: Jacob, Jaya- in credentialing Provider NPI# 1194336149  Provider Name: Stephen, Ani- in credentialing Provider NPI# 1588959118  Provider Name: Abraham, Jeena- in credentialing Provider NPI# 1467901587  Provider Name:Abraham, Glory- in credentialing Provider NPI# 1194206490  Provider Name: Thomas, Cini- in credentialing Provider NPI# 1134777238  Provider Name: Chennemkara, Mini- in credentialing Provider NPI# 1841755956  Provider Name:Brown, Brittany- Effective 7/1/2021 Provider NPI# 1275163537  Thank you ', NULL, NULL, '2021-07-13 10:40:58', '2021-07-13 10:40:58'),
(16293, 11056, 21038, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email sent to :  AM.Austin@superiorhealthplan.com  &  Credentialing  credentialing@superiorhealthplan.com  Sub : Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Good morning!  I wanted to know the enrollment status for the below mentioned providers. Please respond to us soon.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider Details: Provider Name: PAUL, SIGI- in credentialing Provider NPI# 1033623616  Provider Name: Jacob, Jaya- in credentialing Provider NPI# 1194336149  Provider Name: Stephen, Ani- in credentialing Provider NPI# 1588959118  Provider Name: Abraham, Jeena- in credentialing Provider NPI# 1467901587  Provider Name:Abraham, Glory- in credentialing Provider NPI# 1194206490  Provider Name: Thomas, Cini- in credentialing Provider NPI# 1134777238  Provider Name: Chennemkara, Mini- in credentialing Provider NPI# 1841755956  Provider Name:Brown, Brittany- Effective 7/1/2021 Provider NPI# 1275163537  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great day!     I have called Superior Health plan twice. But no one pickup the call & there was a recorder which inform me that they are working from home due to COVID after the recorder we have recorded our message and sent the voice mail for updation regarding our enrollment request.', NULL, NULL, '2021-08-05 11:30:05', '2021-08-05 11:30:05'),
(16294, 3040, 21038, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to: AM.Austin@superiorhealthplan.com  Subject: Re: Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Superior Healthplan 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 Details:  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider Name:Abraham, Glory Provider NPI# 1194206490  Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider Name: Chennemkara, Mini Provider NPI# 1841755956  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-08-27 11:08:11', '2021-08-27 11:08:11'),
(16295, 3040, 21038, NULL, '2021-09-10 00:00:00.000', 'Approved', 'Email rcvd from: SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Subject: RE: Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Hello,  Provider Name: Stephen, Ani Provider NPI# 1588959118      -We received your completed application on 5/19/2021 Your projected effective date is 7/1/2021. Currently In the process of being loaded in our system. Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.  Provider Name: Abraham, Jeena Provider NPI# 1467901587 -We received your completed application on 5/19/2021 Your projected effective date is 7/1/2021. Currently In the process of being loaded in our system. Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.  Provider Name:Abraham, Glory Provider NPI# 1194206490 -We received your completed application on 5/19/2021 Your projected effective date is 7/1/2021. Currently In the process of being loaded in our system. Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.  Provider Name: Thomas, Cini Provider NPI# 1134777238 We received your completed application on 5/19/2021 Your projected effective date is 7/1/2021. Currently In the process of being loaded in our system. Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.  Provider Name: Chennemkara, Mini Provider NPI# 1841755956- We received your completed application on 5/19/2021 Your projected effective date is 8/1/2021. Currently In the process of being loaded in our system. Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.  Blessings,  Jillyan Galindo Project Coordinator I, Contract Management', NULL, NULL, '2021-09-03 11:24:35', '2021-09-03 11:24:35'),
(16296, 3040, 21039, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:59:27', '2021-03-15 13:59:27'),
(16297, 3040, 21039, NULL, '2021-05-24 00:00:00.000', 'In Process', 'Thank You for Your Interest in Becoming a Part of Superior HealthPlan’s Growing Network! Important to Note:  Please ensure you’ve completed the IRS W-9 Form (PDF) and submit it to SHP.NetworkDevelopment@SuperiorHealthPlan.com. Prior to a new provider’s provision of services and receipt of claims reimbursement, program enrollment must be confirmed on requests for Superior Medicaid (STAR, STAR Health, STAR Kids and STAR+PLUS), CHIP and/or Long-Term Services and Supports (LTSS) programs. Superior will notify you of acceptance or non-acceptance to our network no later than 90 days from receipt of a complete application for participation. If additional information is required to process your request, a Superior representative will contact you.  ', NULL, NULL, '2021-05-17 12:26:02', '2021-05-17 12:26:02'),
(16298, 3040, 21039, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject:Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Greetings,   I wanted to know the enrollment status for the below mentioned providers.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider Name:Abraham, Glory Provider NPI# 1194206490  Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider Name:Brown, Brittany Provider NPI# 1275163537   Thank you ', NULL, NULL, '2021-06-07 17:51:25', '2021-06-07 17:51:25'),
(16299, 3040, 21039, NULL, '2021-07-01 00:00:00.000', 'In Process', 'Email rcvd from: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Greetings,   I wanted to know the enrollment status for the below mentioned providers.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider Name: PAUL, SIGI- in credentialing Provider NPI# 1033623616  Provider Name: Jacob, Jaya- in credentialing Provider NPI# 1194336149  Provider Name: Stephen, Ani- in credentialing Provider NPI# 1588959118  Provider Name: Abraham, Jeena- in credentialing Provider NPI# 1467901587  Provider Name:Abraham, Glory- in credentialing Provider NPI# 1194206490  Provider Name: Thomas, Cini- in credentialing Provider NPI# 1134777238  Provider Name: Chennemkara, Mini- in credentialing Provider NPI# 1841755956  Provider Name: Brown, Brittany- Effective 7/1/2021 Provider NPI# 1275163537  Thank you ', NULL, NULL, '2021-06-24 09:12:27', '2021-06-24 09:12:27'),
(16300, 3040, 21039, NULL, '2021-07-20 00:00:00.000', 'In Process', 'Email rcvd to: AM.Austin@superiorhealthplan.com  Subject: Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Greetings,   I wanted to know the enrollment status for the below mentioned providers.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider Name: PAUL, SIGI- in credentialing Provider NPI# 1033623616  Provider Name: Jacob, Jaya- in credentialing Provider NPI# 1194336149  Provider Name: Stephen, Ani- in credentialing Provider NPI# 1588959118  Provider Name: Abraham, Jeena- in credentialing Provider NPI# 1467901587  Provider Name:Abraham, Glory- in credentialing Provider NPI# 1194206490  Provider Name: Thomas, Cini- in credentialing Provider NPI# 1134777238  Provider Name: Chennemkara, Mini- in credentialing Provider NPI# 1841755956  Provider Name:Brown, Brittany- Effective 7/1/2021 Provider NPI# 1275163537  Thank you ', NULL, NULL, '2021-07-13 10:41:01', '2021-07-13 10:41:01'),
(16301, 11056, 21039, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email sent to :  AM.Austin@superiorhealthplan.com  &  Credentialing  credentialing@superiorhealthplan.com  Sub : Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Good morning!  I wanted to know the enrollment status for the below mentioned providers. Please respond to us soon.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider Details: Provider Name: PAUL, SIGI- in credentialing Provider NPI# 1033623616  Provider Name: Jacob, Jaya- in credentialing Provider NPI# 1194336149  Provider Name: Stephen, Ani- in credentialing Provider NPI# 1588959118  Provider Name: Abraham, Jeena- in credentialing Provider NPI# 1467901587  Provider Name:Abraham, Glory- in credentialing Provider NPI# 1194206490  Provider Name: Thomas, Cini- in credentialing Provider NPI# 1134777238  Provider Name: Chennemkara, Mini- in credentialing Provider NPI# 1841755956  Provider Name:Brown, Brittany- Effective 7/1/2021 Provider NPI# 1275163537  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great day!     I have called Superior Health plan twice. But no one pickup the call & there was a recorder which inform me that they are working from home due to COVID after the recorder we have recorded our message and sent the voice mail for updation regarding our enrollment request.', NULL, NULL, '2021-08-05 11:29:14', '2021-08-05 11:29:14'),
(16302, 3040, 21039, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to: AM.Austin@superiorhealthplan.com  Subject: Re: Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Superior Healthplan 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 Details:  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider Name:Abraham, Glory Provider NPI# 1194206490  Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider Name: Chennemkara, Mini Provider NPI# 1841755956  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-08-27 11:08:04', '2021-08-27 11:08:04'),
(16303, 12062, 21039, NULL, '2021-09-27 00:00:00.000', 'In Process', 'sent Collaborating Physicians Addendum  as requested on below mail. from :shaqueetta.blanchard@SuperiorHealthPlan.com  Sent mail is attached in attachments  Subject:Re: OutreachAttempt#2: Credentialing Request; Jaya Jacob_1194336149 Good afternoon,  I attempted to call today and was advised that the credentialing contact was not in. I have received a response in regards to the providers missing information. May you assist with information in order to avoid delay in credentialing.    We received your credentialing application for Jaya Jacob;  however, we did not receive all of the documentation necessary to complete the credentialing process.  Please submit the information marked below: ☐ Collaborating Physicians Addendum                                   *Piccione,James is not currently contracted.   You may fax or email the requested information to the contact information listed below.   Fax: 866-702-4831               Phone: 1-800-820-5686   Thank you, Renay Blanchard Credentialing Specialist | Superior Health Plan Image 5900 Ben White Blvd  Austin, TX 78741 Phone: 800-218-7453 Ext 89185 Fax: 866-702-4831 shaqueetta.blanchard@SuperiorHealthPlan.com ', NULL, NULL, '2021-09-20 09:37:15', '2021-09-20 09:37:15'),
(16304, 12062, 21039, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Received  below email ; From:Credentialing@superiorhealthplan.com Subject : RE: OutreachAttempt#2: Credentialing Request; Jaya Jacob_1194336149  Good afternoon,              I am currently reflecting that this provider is awaiting approval by the medical director. If all goes well, the anticipated effective date will be 10/01/2021.  Thank you,  Credentialing Department | Superior Health Plan 5900 E. Ben White Blvd | Austin, TX 78741 Phone: 800-820-5686 |Fax: 866-702-4831 Credentialing@superiorhealthplan.com', NULL, NULL, '2021-09-21 12:43:34', '2021-09-21 12:43:34'),
(16305, 10057, 21039, NULL, '2021-10-26 00:00:00.000', 'In Process', 'Email Sent To : credentialing@superiorhealthplan.com  Sub : Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Good Afternoon,  Hope this email finds you well. I want to get the latest updates on my credentialing application of the below mentioned providers under the facility Columbus Urgent Care PA.  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, Molly	1396380077 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-19 11:25:22', '2021-10-19 11:25:22'),
(16306, 10057, 21039, NULL, '2021-10-27 00:00:00.000', 'Approved', 'Email Received From : credentialing@superiorhealthplan.com  Sub: Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Good morning,  I am able to locate the following information per the status request below for the providers:  1396380077-I currently show the file is in progress and has not been completed at this time, the credentialing specialist will contact you directly if there is any missing/incomplete information.  1033623616-The providers credentialing is complete, the effective date is 09/01/2021 and the re-credential date is 08/31/2024.  1194336149-The providers credentialing is complete, the effective date is 10/01/2021 and the re-credential date is 08/31/2024.  Thank you,  Credentialing Department | Superior Health Plan 5900 E. Ben White Blvd | Austin, TX 78741 Phone: 800-820-5686 |Fax: 866-702-4831  Credentialing@superiorhealthplan.com', NULL, NULL, '2021-10-20 09:07:18', '2021-10-20 09:07:18'),
(16307, 3040, 21040, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 13:59:37', '2021-03-15 13:59:37'),
(16308, 3040, 21040, NULL, '2021-05-24 00:00:00.000', 'In Process', 'Thank You for Your Interest in Becoming a Part of Superior HealthPlan’s Growing Network! Important to Note:  Please ensure you’ve completed the IRS W-9 Form (PDF) and submit it to SHP.NetworkDevelopment@SuperiorHealthPlan.com. Prior to a new provider’s provision of services and receipt of claims reimbursement, program enrollment must be confirmed on requests for Superior Medicaid (STAR, STAR Health, STAR Kids and STAR+PLUS), CHIP and/or Long-Term Services and Supports (LTSS) programs. Superior will notify you of acceptance or non-acceptance to our network no later than 90 days from receipt of a complete application for participation. If additional information is required to process your request, a Superior representative will contact you.  ', NULL, NULL, '2021-05-17 12:27:41', '2021-05-17 12:27:41'),
(16309, 3040, 21040, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject:Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Greetings,   I wanted to know the enrollment status for the below mentioned providers.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider Name:Abraham, Glory Provider NPI# 1194206490  Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider Name:Brown, Brittany Provider NPI# 1275163537   Thank you ', NULL, NULL, '2021-06-07 17:51:21', '2021-06-07 17:51:21'),
(16310, 3040, 21040, NULL, '2021-07-01 00:00:00.000', 'In Process', 'Email rcvd from: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Greetings,   I wanted to know the enrollment status for the below mentioned providers.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider Name: PAUL, SIGI- in credentialing Provider NPI# 1033623616  Provider Name: Jacob, Jaya- in credentialing Provider NPI# 1194336149  Provider Name: Stephen, Ani- in credentialing Provider NPI# 1588959118  Provider Name: Abraham, Jeena- in credentialing Provider NPI# 1467901587  Provider Name:Abraham, Glory- in credentialing Provider NPI# 1194206490  Provider Name: Thomas, Cini- in credentialing Provider NPI# 1134777238  Provider Name: Chennemkara, Mini- in credentialing Provider NPI# 1841755956  Provider Name: Brown, Brittany- Effective 7/1/2021 Provider NPI# 1275163537  Thank you ', NULL, NULL, '2021-06-24 09:11:20', '2021-06-24 09:11:20'),
(16311, 3040, 21040, NULL, '2021-07-20 00:00:00.000', 'In Process', 'Email rcvd to: AM.Austin@superiorhealthplan.com  Subject: Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Greetings,   I wanted to know the enrollment status for the below mentioned providers.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider Name: PAUL, SIGI- in credentialing Provider NPI# 1033623616  Provider Name: Jacob, Jaya- in credentialing Provider NPI# 1194336149  Provider Name: Stephen, Ani- in credentialing Provider NPI# 1588959118  Provider Name: Abraham, Jeena- in credentialing Provider NPI# 1467901587  Provider Name:Abraham, Glory- in credentialing Provider NPI# 1194206490  Provider Name: Thomas, Cini- in credentialing Provider NPI# 1134777238  Provider Name: Chennemkara, Mini- in credentialing Provider NPI# 1841755956  Provider Name:Brown, Brittany- Effective 7/1/2021 Provider NPI# 1275163537  Thank you ', NULL, NULL, '2021-07-13 10:41:02', '2021-07-13 10:41:02'),
(16312, 11056, 21040, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email sent to :   Sub :   Good morning!  I wanted to know the enrollment status for the below mentioned providers. Please respond to us soon.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider Details: Provider Name: PAUL, SIGI- in credentialing Provider NPI# 1033623616  Provider Name: Jacob, Jaya- in credentialing Provider NPI# 1194336149  Provider Name: Stephen, Ani- in credentialing Provider NPI# 1588959118  Provider Name: Abraham, Jeena- in credentialing Provider NPI# 1467901587  Provider Name:Abraham, Glory- in credentialing Provider NPI# 1194206490  Provider Name: Thomas, Cini- in credentialing Provider NPI# 1134777238  Provider Name: Chennemkara, Mini- in credentialing Provider NPI# 1841755956  Provider Name:Brown, Brittany- Effective 7/1/2021 Provider NPI# 1275163537  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great day!     I have called Superior Health plan twice. But no one pickup the call & there was a recorder which inform me that they are working from home due to COVID after the recorder we have recorded our message and sent the voice mail for updation regarding our enrollment request.', NULL, NULL, '2021-08-05 11:27:37', '2021-08-05 11:27:37'),
(16313, 11056, 21040, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email sent to :  AM.Austin@superiorhealthplan.com  &  Credentialing  credentialing@superiorhealthplan.com  Sub : Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Good morning!  I wanted to know the enrollment status for the below mentioned providers. Please respond to us soon.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider Details: Provider Name: PAUL, SIGI- in credentialing Provider NPI# 1033623616  Provider Name: Jacob, Jaya- in credentialing Provider NPI# 1194336149  Provider Name: Stephen, Ani- in credentialing Provider NPI# 1588959118  Provider Name: Abraham, Jeena- in credentialing Provider NPI# 1467901587  Provider Name:Abraham, Glory- in credentialing Provider NPI# 1194206490  Provider Name: Thomas, Cini- in credentialing Provider NPI# 1134777238  Provider Name: Chennemkara, Mini- in credentialing Provider NPI# 1841755956  Provider Name:Brown, Brittany- Effective 7/1/2021 Provider NPI# 1275163537  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great day!     I have called Superior Health plan twice. But no one pickup the call & there was a recorder which inform me that they are working from home due to COVID after the recorder we have recorded our message and sent the voice mail for updation regarding our enrollment request.', NULL, NULL, '2021-08-05 11:29:50', '2021-08-05 11:29:50'),
(16314, 3040, 21040, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to: AM.Austin@superiorhealthplan.com  Subject: Re: Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Superior Healthplan 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 Details:  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider Name:Abraham, Glory Provider NPI# 1194206490  Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider Name: Chennemkara, Mini Provider NPI# 1841755956  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-08-27 11:08:05', '2021-08-27 11:08:05'),
(16315, 10057, 21040, NULL, '2021-10-26 00:00:00.000', 'In Process', 'Email Sent To : credentialing@superiorhealthplan.com  Sub : Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Good Afternoon,  Hope this email finds you well. I want to get the latest updates on my credentialing application of the below mentioned providers under the facility Columbus Urgent Care PA.  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, Molly	1396380077 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-19 11:25:16', '2021-10-19 11:25:16'),
(16316, 10057, 21040, NULL, '2021-10-27 00:00:00.000', 'Approved', 'Email Received From : credentialing@superiorhealthplan.com  Sub: Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Good morning,  I am able to locate the following information per the status request below for the providers:  1396380077-I currently show the file is in progress and has not been completed at this time, the credentialing specialist will contact you directly if there is any missing/incomplete information.  1033623616-The providers credentialing is complete, the effective date is 09/01/2021 and the re-credential date is 08/31/2024.  1194336149-The providers credentialing is complete, the effective date is 10/01/2021 and the re-credential date is 08/31/2024.  Thank you,  Credentialing Department | Superior Health Plan 5900 E. Ben White Blvd | Austin, TX 78741 Phone: 800-820-5686 |Fax: 866-702-4831  Credentialing@superiorhealthplan.com', NULL, NULL, '2021-10-20 09:05:31', '2021-10-20 09:05:31'),
(16317, 3040, 21041, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:00:26', '2021-03-15 14:00:26');
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
(16318, 3040, 21041, NULL, '2021-05-26 00:00:00.000', 'Not Eligible', 'Rejection letter received, attached for reference: Dear Provider: Thank you for your interest in becoming a participating provider in the Texas Children’s Health Plan network. We regret to inform you that we will not be able to offer you an Agreement at this time. We are not licensed to contract in Colorado County for the STAR, STAR Kids or CHIP Programs. We will keep your letter of interest on file should our service area change in the future.  Thank you again for your interest.  Sincerely, Contracts Administration Texas Children’s Health Plan', NULL, NULL, '2021-05-19 13:50:27', '2021-05-19 13:50:27'),
(16319, 3040, 21042, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:00:38', '2021-03-15 14:00:38'),
(16320, 3040, 21042, NULL, '2021-05-26 00:00:00.000', 'Not Eligible', 'Rejection letter received, attached for reference: Dear Provider: Thank you for your interest in becoming a participating provider in the Texas Children’s Health Plan network. We regret to inform you that we will not be able to offer you an Agreement at this time. We are not licensed to contract in Colorado County for the STAR, STAR Kids or CHIP Programs. We will keep your letter of interest on file should our service area change in the future.  Thank you again for your interest.  Sincerely, Contracts Administration Texas Children’s Health Plan', NULL, NULL, '2021-05-19 13:57:31', '2021-05-19 13:57:31'),
(16321, 3046, 21043, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:00:40', '2021-03-15 14:00:40'),
(16322, 1006, 21043, NULL, '2021-04-01 00:00:00.000', 'Approved', 'We have an urgent care contract with Aetna. We don\'t need to individually enroll/credential providers separately, a copy of the executed contract has been attached and directory/plans are also attached for reference.  ', NULL, NULL, '2021-03-25 14:02:46', '2021-03-25 14:02:46'),
(16323, 3040, 21044, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:00:49', '2021-03-15 14:00:49'),
(16324, 3040, 21044, NULL, '2021-05-26 00:00:00.000', 'Not Eligible', 'Rejection letter received, attached for reference: Dear Provider: Thank you for your interest in becoming a participating provider in the Texas Children’s Health Plan network. We regret to inform you that we will not be able to offer you an Agreement at this time. We are not licensed to contract in Colorado County for the STAR, STAR Kids or CHIP Programs. We will keep your letter of interest on file should our service area change in the future.  Thank you again for your interest.  Sincerely, Contracts Administration Texas Children’s Health Plan', NULL, NULL, '2021-05-19 13:57:35', '2021-05-19 13:57:35'),
(16325, 3040, 21045, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:01:02', '2021-03-15 14:01:02'),
(16326, 3040, 21045, NULL, '2021-05-26 00:00:00.000', 'Not Eligible', 'Rejection letter received, attached for reference: Dear Provider: Thank you for your interest in becoming a participating provider in the Texas Children’s Health Plan network. We regret to inform you that we will not be able to offer you an Agreement at this time. We are not licensed to contract in Colorado County for the STAR, STAR Kids or CHIP Programs. We will keep your letter of interest on file should our service area change in the future.  Thank you again for your interest.  Sincerely, Contracts Administration Texas Children’s Health Plan', NULL, NULL, '2021-05-19 13:57:39', '2021-05-19 13:57:39'),
(16327, 3040, 21046, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:01:31', '2021-03-15 14:01:31'),
(16328, 3040, 21046, NULL, '2021-05-26 00:00:00.000', 'Not Eligible', 'Rejection letter received, attached for reference: Dear Provider: Thank you for your interest in becoming a participating provider in the Texas Children’s Health Plan network. We regret to inform you that we will not be able to offer you an Agreement at this time. We are not licensed to contract in Colorado County for the STAR, STAR Kids or CHIP Programs. We will keep your letter of interest on file should our service area change in the future.  Thank you again for your interest.  Sincerely, Contracts Administration Texas Children’s Health Plan', NULL, NULL, '2021-05-19 13:57:44', '2021-05-19 13:57:44'),
(16329, 3040, 21047, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:02:06', '2021-03-15 14:02:06'),
(16330, 3040, 21047, NULL, '2021-05-26 00:00:00.000', 'Not Eligible', 'Rejection letter received, attached for reference: Dear Provider: Thank you for your interest in becoming a participating provider in the Texas Children’s Health Plan network. We regret to inform you that we will not be able to offer you an Agreement at this time. We are not licensed to contract in Colorado County for the STAR, STAR Kids or CHIP Programs. We will keep your letter of interest on file should our service area change in the future.  Thank you again for your interest.  Sincerely, Contracts Administration Texas Children’s Health Plan', NULL, NULL, '2021-05-19 13:57:49', '2021-05-19 13:57:49'),
(16331, 3040, 21048, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:02:21', '2021-03-15 14:02:21'),
(16332, 3040, 21048, NULL, '2021-05-26 00:00:00.000', 'Not Eligible', 'Rejection letter received, attached for reference: Dear Provider: Thank you for your interest in becoming a participating provider in the Texas Children’s Health Plan network. We regret to inform you that we will not be able to offer you an Agreement at this time. We are not licensed to contract in Colorado County for the STAR, STAR Kids or CHIP Programs. We will keep your letter of interest on file should our service area change in the future.  Thank you again for your interest.  Sincerely, Contracts Administration Texas Children’s Health Plan', NULL, NULL, '2021-05-19 13:57:53', '2021-05-19 13:57:53'),
(16333, 3040, 21049, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:02:34', '2021-03-15 14:02:34'),
(16334, 3040, 21049, NULL, '2021-05-26 00:00:00.000', 'Not Eligible', 'Rejection letter received, attached for reference: Dear Provider: Thank you for your interest in becoming a participating provider in the Texas Children’s Health Plan network. We regret to inform you that we will not be able to offer you an Agreement at this time. We are not licensed to contract in Colorado County for the STAR, STAR Kids or CHIP Programs. We will keep your letter of interest on file should our service area change in the future.  Thank you again for your interest.  Sincerely, Contracts Administration Texas Children’s Health Plan', NULL, NULL, '2021-05-19 13:57:58', '2021-05-19 13:57:58'),
(16335, 3040, 21050, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:02:54', '2021-03-15 14:02:54'),
(16336, 3040, 21050, NULL, '2021-05-26 00:00:00.000', 'Not Eligible', 'Rejection letter received, attached for reference: Dear Provider: Thank you for your interest in becoming a participating provider in the Texas Children’s Health Plan network. We regret to inform you that we will not be able to offer you an Agreement at this time. We are not licensed to contract in Colorado County for the STAR, STAR Kids or CHIP Programs. We will keep your letter of interest on file should our service area change in the future.  Thank you again for your interest.  Sincerely, Contracts Administration Texas Children’s Health Plan', NULL, NULL, '2021-05-19 13:58:03', '2021-05-19 13:58:03'),
(16337, 3040, 21051, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:03:06', '2021-03-15 14:03:06'),
(16338, 3040, 21051, NULL, '2021-05-26 00:00:00.000', 'Not Eligible', 'Rejection letter received, attached for reference: Dear Provider: Thank you for your interest in becoming a participating provider in the Texas Children’s Health Plan network. We regret to inform you that we will not be able to offer you an Agreement at this time. We are not licensed to contract in Colorado County for the STAR, STAR Kids or CHIP Programs. We will keep your letter of interest on file should our service area change in the future.  Thank you again for your interest.  Sincerely, Contracts Administration Texas Children’s Health Plan', NULL, NULL, '2021-05-19 13:58:08', '2021-05-19 13:58:08'),
(16339, 3040, 21052, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:03:17', '2021-03-15 14:03:17'),
(16340, 3040, 21052, NULL, '2021-05-26 00:00:00.000', 'Not Eligible', 'Rejection letter received, attached for reference: Dear Provider: Thank you for your interest in becoming a participating provider in the Texas Children’s Health Plan network. We regret to inform you that we will not be able to offer you an Agreement at this time. We are not licensed to contract in Colorado County for the STAR, STAR Kids or CHIP Programs. We will keep your letter of interest on file should our service area change in the future.  Thank you again for your interest.  Sincerely, Contracts Administration Texas Children’s Health Plan', NULL, NULL, '2021-05-19 13:58:12', '2021-05-19 13:58:12'),
(16341, 3040, 21053, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:03:29', '2021-03-15 14:03:29'),
(16342, 3040, 21053, NULL, '2021-06-07 00:00:00.000', 'Not Eligible', 'Rejection letter received, attached for reference: Dear Provider: Thank you for your interest in becoming a participating provider in the Texas Children’s Health Plan network. We regret to inform you that we will not be able to offer you an Agreement at this time. We are not licensed to contract in Colorado County for the STAR, STAR Kids or CHIP Programs. We will keep your letter of interest on file should our service area change in the future.  Thank you again for your interest.  Sincerely, Contracts Administration Texas Children’s Health Plan', NULL, NULL, '2021-05-31 16:41:09', '2021-05-31 16:41:09'),
(16343, 3040, 21054, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:03:39', '2021-03-15 14:03:39'),
(16344, 3040, 21054, NULL, '2021-05-26 00:00:00.000', 'Not Eligible', 'Rejection letter received, attached for reference: Dear Provider: Thank you for your interest in becoming a participating provider in the Texas Children’s Health Plan network. We regret to inform you that we will not be able to offer you an Agreement at this time. We are not licensed to contract in Colorado County for the STAR, STAR Kids or CHIP Programs. We will keep your letter of interest on file should our service area change in the future.  Thank you again for your interest.  Sincerely, Contracts Administration Texas Children’s Health Plan', NULL, NULL, '2021-05-19 13:58:17', '2021-05-19 13:58:17'),
(16345, 3040, 21055, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:03:49', '2021-03-15 14:03:49'),
(16346, 3040, 21055, NULL, '2021-05-26 00:00:00.000', 'Not Eligible', 'Rejection letter received, attached for reference: Dear Provider: Thank you for your interest in becoming a participating provider in the Texas Children’s Health Plan network. We regret to inform you that we will not be able to offer you an Agreement at this time. We are not licensed to contract in Colorado County for the STAR, STAR Kids or CHIP Programs. We will keep your letter of interest on file should our service area change in the future.  Thank you again for your interest.  Sincerely, Contracts Administration Texas Children’s Health Plan', NULL, NULL, '2021-05-19 13:58:21', '2021-05-19 13:58:21'),
(16347, 3040, 21056, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:04:32', '2021-03-15 14:04:32'),
(16348, 3040, 21056, NULL, '2021-05-17 00:00:00.000', 'Approved', 'Group has an urgent care contract. We need to certified the provider only.   Please see attachment', NULL, NULL, '2021-05-10 12:03:38', '2021-05-10 12:03:38'),
(16349, 3040, 21057, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:04:48', '2021-03-15 14:04:48'),
(16350, 3040, 21057, NULL, '2021-05-17 00:00:00.000', 'Approved', 'I had a word with (Cheyenne) and she advised the provider is certified with Tricare.   Ref: 12573507', NULL, NULL, '2021-05-10 12:05:00', '2021-05-10 12:05:00'),
(16351, 3040, 21058, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:05:07', '2021-03-15 14:05:07'),
(16352, 3040, 21058, NULL, '2021-05-17 00:00:00.000', 'In Process', 'Provider certification form sent @ 6082217535.   Please see attachment. ', NULL, NULL, '2021-05-10 15:01:37', '2021-05-10 15:01:37'),
(16353, 1006, 21058, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Sent f/u email @ Katherine Moten KMoten4@humana.com:  Sub: Certification Status - CUCC - Tricare  \"Hello Katherine, I hope you\'re doing well, I wanted to get an update regarding the certification status for the following providers under our group:   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-01 17:11:09', '2021-06-01 17:11:09'),
(16354, 3040, 21058, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email rcvd from: KMoten4@humana.com  Subject: Certification Status - CUCC - Tricare  All credentialing applications have been submitted for processing. Please allow 90 days.   Respectfully, Katherine Moten TRICARE Community Liaison II Humana  T 502-318-5250  F 210-239-0401 kmoten4@humana.com HumanaMilitary.com', NULL, NULL, '2021-06-21 12:21:48', '2021-06-21 12:21:48'),
(16355, 3040, 21058, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Certification Status - CUCC - Tricare  Hello Katherine,  I hope you\'re doing well, I wanted to get an update regarding the certification status for the following providers under our group:  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider 1:  Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 2:  Provider Name: Jacob, Jaya  Provider NPI# 1194336149  Provider 3: Provider Name: Stephen, Ani  Provider NPI# 1588959118  Provider 4:  Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956  Provider 5:   Provider Name: Brown, Brittany  Provider NPI# 1275163537  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-21 12:27:05', '2021-06-21 12:27:05'),
(16356, 3040, 21058, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email rcvd from: KMoten4@humana.com  Subject: Certification Status - CUCC - Tricare  All credentialing applications have been submitted for processing. Please allow 90 days.   Respectfully, Katherine Moten TRICARE Community Liaison II Humana  T 502-318-5250  F 210-239-0401 kmoten4@humana.com HumanaMilitary.com', NULL, NULL, '2021-07-05 15:13:45', '2021-07-05 15:13:45'),
(16357, 3040, 21058, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Certification Status - CUCC - Tricare  Hello Katherine,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Tricare in our group under the below locations.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider 1:  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 2:  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:  Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5:  Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6:  Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 7:  Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8:  Provider Name: Brown, Brittany Provider NPI# 1275163537  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-07-22 17:05:48', '2021-07-22 17:05:48'),
(16358, 11056, 21058, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email sent to : KMoten4@humana.com  Sub : Enrollment Status Query - CUCC - Tricare  Hey Katherine!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Tricare in our group under the below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider Details: Provider 1: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 2: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6: Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 7: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 9: Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 10: Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you  Have a great day!', NULL, NULL, '2021-08-05 13:12:14', '2021-08-05 13:12:14'),
(16359, 3040, 21058, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Columbus Urgent Care PA || Providers || Tricare ||  Hello Katherine,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Tricare in our group under the below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215 Provider 1:  Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 2:  Provider Name: Jacob, Jaya. Provider NPI# 1194336149  Provider 3:  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:  Provider Name: Abraham, Jeena  Provider NPI# 1467901587  Provider 5:  Provider Name: Chennemkara, Mini  Provider NPI# 1841755956  Provider 6:  Provider Name: Brown, Brittany Provider NPI# 1275163537 Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-08-18 15:36:12', '2021-08-18 15:36:12'),
(16360, 3040, 21058, NULL, '2021-08-27 00:00:00.000', 'Approved', 'Email rcvd from: KMoten4@humana.com  Subject: Secured: RE: Enrollment Status || Columbus Urgent Care PA || Providers || Tricare ||  Please see the effective dates below for each provider. In the future, you can see these updates in the Humana Military provider portal.  Respectfully, Katherine Moten TRICARE Community Liaison II Humana T 502-318-5250 F 210-239-0401 kmoten4@humana.com HumanaMilitary.com  TRICARE 101 Webinar: https://www.brainshark.com/hgb/vu?pi=zIHzFuMwczRw6Vz0 ', NULL, NULL, '2021-08-20 09:14:22', '2021-08-20 09:14:22'),
(16361, 3040, 21058, NULL, '2021-08-27 00:00:00.000', 'Approved', 'Email rcvd from: KMoten4@humana.com  Subject: Secured: RE: Enrollment Status || Columbus Urgent Care PA || Providers || Tricare ||  Please see the effective dates below for each provider. In the future, you can see these updates in the Humana Military provider portal.  Respectfully, Katherine Moten TRICARE Community Liaison II Humana T 502-318-5250 F 210-239-0401 kmoten4@humana.com HumanaMilitary.com  TRICARE 101 Webinar: https://www.brainshark.com/hgb/vu?pi=zIHzFuMwczRw6Vz0 ', NULL, NULL, '2021-08-20 09:14:23', '2021-08-20 09:14:23'),
(16362, 3040, 21059, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:05:43', '2021-03-15 14:05:43'),
(16363, 3040, 21059, NULL, '2021-05-17 00:00:00.000', 'In Process', 'Provider certification form sent @ 6082217535.   Please see attachment.  ', NULL, NULL, '2021-05-10 15:02:10', '2021-05-10 15:02:10'),
(16364, 1006, 21059, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Sent f/u email @ Katherine Moten KMoten4@humana.com:  Sub: Certification Status - CUCC - Tricare  \"Hello Katherine, I hope you\'re doing well, I wanted to get an update regarding the certification status for the following providers under our group:   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-01 17:11:27', '2021-06-01 17:11:27'),
(16365, 3040, 21059, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: HGBProviderRosters@humana.com  Subject: Re: Roster || Columbus Urgent Care PA || Joseph, Vibitha, Abraham, Glory & Abraham, Jeena || Tricare ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers. We already sent the roster as per Katherine\'s email that was received on 06/03/2021.    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: Abraham, Glory  Provider NPI# 1194206490  Provider 3: Provider Name: Abraham, Jeena  Provider NPI# 1467901587  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 12:35:20', '2021-06-21 12:35:20'),
(16366, 3040, 21059, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: HGBProviderRosters@humana.com  Subject: Re: Roster || Columbus Urgent Care PA || Joseph, Vibitha, Abraham, Glory & Abraham, Jeena || Tricare ||  Hello,   Hope you are doing well. Please advise the enrollment status for the below mentioned providers in Tricare in our group Columbus Urgent Care PA under the below locations. We already sent the roster as per Katherine\'s email that was received on 06/03/2021.    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: Abraham, Glory  Provider NPI# 1194206490  Provider 3: Provider Name: Abraham, Jeena  Provider NPI# 1467901587  Waiting for your reply.   Thanks ', NULL, NULL, '2021-07-05 15:11:48', '2021-07-05 15:11:48'),
(16367, 3040, 21059, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Certification Status - CUCC - Tricare  Hello Katherine,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Tricare in our group under the below locations.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider 1:  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 2:  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:  Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5:  Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6:  Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 7:  Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8:  Provider Name: Brown, Brittany Provider NPI# 1275163537  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-07-22 17:05:47', '2021-07-22 17:05:47'),
(16368, 3040, 21059, NULL, '2021-07-30 00:00:00.000', 'Approved', 'Email rcvd from: KMoten4@humana.com  Subject: Certification Status - CUCC - Tricare  Please see updated below.  Thank you.   Respectfully, Katherine Moten TRICARE Community Liaison II Humana  T 502-318-5250  F 210-239-0401 kmoten4@humana.com HumanaMilitary.com  Provider 7:  Provider Name: Joseph, Vibitha- added to location eff: 6/9/2021 Provider NPI# 1952931560 ', NULL, NULL, '2021-07-23 10:47:23', '2021-07-23 10:47:23'),
(16369, 3040, 21060, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:06:03', '2021-03-15 14:06:03'),
(16370, 3040, 21060, NULL, '2021-05-17 00:00:00.000', 'In Process', 'Provider certification form sent @ 6082217535.   Please see attachment.  ', NULL, NULL, '2021-05-10 15:02:14', '2021-05-10 15:02:14'),
(16371, 1006, 21060, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Sent f/u email @ Katherine Moten KMoten4@humana.com:  Sub: Certification Status - CUCC - Tricare  \"Hello Katherine, I hope you\'re doing well, I wanted to get an update regarding the certification status for the following providers under our group:   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-01 17:11:32', '2021-06-01 17:11:32'),
(16372, 3040, 21060, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email rcvd from: KMoten4@humana.com  Subject: Certification Status - CUCC - Tricare  All credentialing applications have been submitted for processing. Please allow 90 days.   Respectfully, Katherine Moten TRICARE Community Liaison II Humana  T 502-318-5250  F 210-239-0401 kmoten4@humana.com HumanaMilitary.com', NULL, NULL, '2021-06-21 12:21:46', '2021-06-21 12:21:46'),
(16373, 3040, 21060, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Certification Status - CUCC - Tricare  Hello Katherine,  I hope you\'re doing well, I wanted to get an update regarding the certification status for the following providers under our group:  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider 1:  Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 2:  Provider Name: Jacob, Jaya  Provider NPI# 1194336149  Provider 3: Provider Name: Stephen, Ani  Provider NPI# 1588959118  Provider 4:  Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956  Provider 5:   Provider Name: Brown, Brittany  Provider NPI# 1275163537  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-21 12:27:00', '2021-06-21 12:27:00'),
(16374, 3040, 21060, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email rcvd from: KMoten4@humana.com  Subject: Certification Status - CUCC - Tricare  All credentialing applications have been submitted for processing. Please allow 90 days.   Respectfully, Katherine Moten TRICARE Community Liaison II Humana  T 502-318-5250  F 210-239-0401 kmoten4@humana.com HumanaMilitary.com', NULL, NULL, '2021-07-05 15:13:51', '2021-07-05 15:13:51'),
(16375, 3040, 21060, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Certification Status - CUCC - Tricare  Hello Katherine,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Tricare in our group under the below locations.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider 1:  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 2:  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:  Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5:  Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6:  Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 7:  Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8:  Provider Name: Brown, Brittany Provider NPI# 1275163537  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-07-22 17:05:47', '2021-07-22 17:05:47'),
(16376, 11056, 21060, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email sent to : KMoten4@humana.com  Sub : Enrollment Status Query - CUCC - Tricare  Hey Katherine!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Tricare in our group under the below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider Details: Provider 1: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 2: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6: Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 7: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 9: Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 10: Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you  Have a great day!', NULL, NULL, '2021-08-05 13:11:24', '2021-08-05 13:11:24'),
(16377, 3040, 21060, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Columbus Urgent Care PA || Providers || Tricare ||  Hello Katherine,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Tricare in our group under the below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215 Provider 1:  Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 2:  Provider Name: Jacob, Jaya. Provider NPI# 1194336149  Provider 3:  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:  Provider Name: Abraham, Jeena  Provider NPI# 1467901587  Provider 5:  Provider Name: Chennemkara, Mini  Provider NPI# 1841755956  Provider 6:  Provider Name: Brown, Brittany Provider NPI# 1275163537 Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-08-18 15:36:14', '2021-08-18 15:36:14'),
(16378, 3040, 21060, NULL, '2021-08-27 00:00:00.000', 'Approved', 'Email rcvd from: KMoten4@humana.com  Subject: Secured: RE: Enrollment Status || Columbus Urgent Care PA || Providers || Tricare ||  Please see the effective dates below for each provider. In the future, you can see these updates in the Humana Military provider portal.  Respectfully, Katherine Moten TRICARE Community Liaison II Humana T 502-318-5250 F 210-239-0401 kmoten4@humana.com HumanaMilitary.com  TRICARE 101 Webinar: https://www.brainshark.com/hgb/vu?pi=zIHzFuMwczRw6Vz0 ', NULL, NULL, '2021-08-20 09:14:21', '2021-08-20 09:14:21'),
(16379, 1006, 21061, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:06:28', '2021-03-15 14:06:28'),
(16380, 3040, 21061, NULL, '2021-04-27 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Group & Provider Status || Spectrum Neuro Behavioral Care LLC || Group & Providers || First Health ||  Hello Laura,   Please advise me the enrollment status for the below mentioned group and providers for our group with First Health under the below location. If the providers are in-network so can you please send me the welcome letter for them.   Practice Details: Practice Name: Spectrum Neuro Behavioral Care LLC Practice Tax ID# 83-4482753 Practice NPI# 1356906572 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702 Secondary Address: 100 New State Hwy. Raynham , MA 02767  Provider 1: Provider Name: Tawakol, Katie Provider NPI# 1609222116  Provider 2: Provider Name: Rashid, Mahreen Provider NPI# 1396393146  Provider 3: Provider Name: Hefti, Prisca Provider NPI# 1508133182  Provider 4: Provider Name: Khan, Fauzia Wali Provider NPI# 1699761965  Provider 5: Provider Name: Pionke, Peggy Provider NPI# 1699307322  Provider 6: Provider Name: Ullrich, Jennifer Lee Provider NPI# 1710489760  Provider 7: Provider Name: Schubert, Jonathan Provider NPI# 1235755505  Provider 8: Provider Name: Edmundson, Rodesia Sharese Provider NPI# 1124622667  Provider 9: Provider Name: Hignite, Barbara Provider NPI# 1982617262  Provider 10: Provider Name: Rozell, Carlee Provider NPI# 1225645393  Provider 11: Provider Name: Loveland, Lynnetta Provider NPI# 1598163602  Provider 12: Provider Name: Smith, Kerry R Provider NPI# 1275083230  Please get back to me as soon as you can get a chance. Waiting for your reply.   Thanks ', NULL, NULL, '2021-04-20 13:16:01', '2021-04-20 13:16:01'),
(16381, 1019, 21061, NULL, '2021-05-27 00:00:00.000', 'On Hold', 'Waiting for Aetna', NULL, NULL, '2021-05-20 09:31:49', '2021-05-20 09:31:49'),
(16382, 1019, 21061, NULL, '2021-11-01 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCare.', NULL, NULL, '2021-10-25 10:43:22', '2021-10-25 10:43:22'),
(16383, 1006, 21062, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:06:29', '2021-03-15 14:06:29'),
(16384, 3040, 21062, NULL, '2021-04-27 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Group & Provider Status || Spectrum Neuro Behavioral Care LLC || Group & Providers || First Health ||  Hello Laura,   Please advise me the enrollment status for the below mentioned group and providers for our group with First Health under the below location. If the providers are in-network so can you please send me the welcome letter for them.   Practice Details: Practice Name: Spectrum Neuro Behavioral Care LLC Practice Tax ID# 83-4482753 Practice NPI# 1356906572 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702 Secondary Address: 100 New State Hwy. Raynham , MA 02767  Provider 1: Provider Name: Tawakol, Katie Provider NPI# 1609222116  Provider 2: Provider Name: Rashid, Mahreen Provider NPI# 1396393146  Provider 3: Provider Name: Hefti, Prisca Provider NPI# 1508133182  Provider 4: Provider Name: Khan, Fauzia Wali Provider NPI# 1699761965  Provider 5: Provider Name: Pionke, Peggy Provider NPI# 1699307322  Provider 6: Provider Name: Ullrich, Jennifer Lee Provider NPI# 1710489760  Provider 7: Provider Name: Schubert, Jonathan Provider NPI# 1235755505  Provider 8: Provider Name: Edmundson, Rodesia Sharese Provider NPI# 1124622667  Provider 9: Provider Name: Hignite, Barbara Provider NPI# 1982617262  Provider 10: Provider Name: Rozell, Carlee Provider NPI# 1225645393  Provider 11: Provider Name: Loveland, Lynnetta Provider NPI# 1598163602  Provider 12: Provider Name: Smith, Kerry R Provider NPI# 1275083230  Please get back to me as soon as you can get a chance. Waiting for your reply.   Thanks ', NULL, NULL, '2021-04-20 13:16:11', '2021-04-20 13:16:11'),
(16385, 1019, 21062, NULL, '2021-05-27 00:00:00.000', 'On Hold', 'Waiting for Aetna', NULL, NULL, '2021-05-20 09:31:57', '2021-05-20 09:31:57'),
(16386, 1006, 21063, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:06:30', '2021-03-15 14:06:30'),
(16387, 3040, 21063, NULL, '2021-04-27 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Group & Provider Status || Spectrum Neuro Behavioral Care LLC || Group & Providers || First Health ||  Hello Laura,   Please advise me the enrollment status for the below mentioned group and providers for our group with First Health under the below location. If the providers are in-network so can you please send me the welcome letter for them.   Practice Details: Practice Name: Spectrum Neuro Behavioral Care LLC Practice Tax ID# 83-4482753 Practice NPI# 1356906572 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702 Secondary Address: 100 New State Hwy. Raynham , MA 02767  Provider 1: Provider Name: Tawakol, Katie Provider NPI# 1609222116  Provider 2: Provider Name: Rashid, Mahreen Provider NPI# 1396393146  Provider 3: Provider Name: Hefti, Prisca Provider NPI# 1508133182  Provider 4: Provider Name: Khan, Fauzia Wali Provider NPI# 1699761965  Provider 5: Provider Name: Pionke, Peggy Provider NPI# 1699307322  Provider 6: Provider Name: Ullrich, Jennifer Lee Provider NPI# 1710489760  Provider 7: Provider Name: Schubert, Jonathan Provider NPI# 1235755505  Provider 8: Provider Name: Edmundson, Rodesia Sharese Provider NPI# 1124622667  Provider 9: Provider Name: Hignite, Barbara Provider NPI# 1982617262  Provider 10: Provider Name: Rozell, Carlee Provider NPI# 1225645393  Provider 11: Provider Name: Loveland, Lynnetta Provider NPI# 1598163602  Provider 12: Provider Name: Smith, Kerry R Provider NPI# 1275083230  Please get back to me as soon as you can get a chance. Waiting for your reply.   Thanks ', NULL, NULL, '2021-04-20 13:14:46', '2021-04-20 13:14:46'),
(16388, 3040, 21063, NULL, '2021-04-27 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Group & Provider Status || Spectrum Neuro Behavioral Care LLC || Group & Providers || First Health ||  Hello Laura,   Please advise me the enrollment status for the below mentioned group and providers for our group with First Health under the below location. If the providers are in-network so can you please send me the welcome letter for them.   Practice Details: Practice Name: Spectrum Neuro Behavioral Care LLC Practice Tax ID# 83-4482753 Practice NPI# 1356906572 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702 Secondary Address: 100 New State Hwy. Raynham , MA 02767  Provider 1: Provider Name: Tawakol, Katie Provider NPI# 1609222116  Provider 2: Provider Name: Rashid, Mahreen Provider NPI# 1396393146  Provider 3: Provider Name: Hefti, Prisca Provider NPI# 1508133182  Provider 4: Provider Name: Khan, Fauzia Wali Provider NPI# 1699761965  Provider 5: Provider Name: Pionke, Peggy Provider NPI# 1699307322  Provider 6: Provider Name: Ullrich, Jennifer Lee Provider NPI# 1710489760  Provider 7: Provider Name: Schubert, Jonathan Provider NPI# 1235755505  Provider 8: Provider Name: Edmundson, Rodesia Sharese Provider NPI# 1124622667  Provider 9: Provider Name: Hignite, Barbara Provider NPI# 1982617262  Provider 10: Provider Name: Rozell, Carlee Provider NPI# 1225645393  Provider 11: Provider Name: Loveland, Lynnetta Provider NPI# 1598163602  Provider 12: Provider Name: Smith, Kerry R Provider NPI# 1275083230  Please get back to me as soon as you can get a chance. Waiting for your reply.   Thanks ', NULL, NULL, '2021-04-20 13:15:18', '2021-04-20 13:15:18'),
(16389, 1019, 21063, NULL, '2021-05-27 00:00:00.000', 'On Hold', 'Waiting for Aetna', NULL, NULL, '2021-05-20 09:32:08', '2021-05-20 09:32:08'),
(16390, 1006, 21064, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:06:31', '2021-03-15 14:06:31'),
(16391, 3040, 21064, NULL, '2021-04-27 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Group & Provider Status || Spectrum Neuro Behavioral Care LLC || Group & Providers || First Health ||  Hello Laura,   Please advise me the enrollment status for the below mentioned group and providers for our group with First Health under the below location. If the providers are in-network so can you please send me the welcome letter for them.   Practice Details: Practice Name: Spectrum Neuro Behavioral Care LLC Practice Tax ID# 83-4482753 Practice NPI# 1356906572 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702 Secondary Address: 100 New State Hwy. Raynham , MA 02767  Provider 1: Provider Name: Tawakol, Katie Provider NPI# 1609222116  Provider 2: Provider Name: Rashid, Mahreen Provider NPI# 1396393146  Provider 3: Provider Name: Hefti, Prisca Provider NPI# 1508133182  Provider 4: Provider Name: Khan, Fauzia Wali Provider NPI# 1699761965  Provider 5: Provider Name: Pionke, Peggy Provider NPI# 1699307322  Provider 6: Provider Name: Ullrich, Jennifer Lee Provider NPI# 1710489760  Provider 7: Provider Name: Schubert, Jonathan Provider NPI# 1235755505  Provider 8: Provider Name: Edmundson, Rodesia Sharese Provider NPI# 1124622667  Provider 9: Provider Name: Hignite, Barbara Provider NPI# 1982617262  Provider 10: Provider Name: Rozell, Carlee Provider NPI# 1225645393  Provider 11: Provider Name: Loveland, Lynnetta Provider NPI# 1598163602  Provider 12: Provider Name: Smith, Kerry R Provider NPI# 1275083230  Please get back to me as soon as you can get a chance. Waiting for your reply.   Thanks ', NULL, NULL, '2021-04-20 13:16:28', '2021-04-20 13:16:28'),
(16392, 1019, 21064, NULL, '2021-05-27 00:00:00.000', 'On Hold', 'Waiting for Aetna', NULL, NULL, '2021-05-20 09:32:16', '2021-05-20 09:32:16'),
(16393, 1006, 21065, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:06:32', '2021-03-15 14:06:32'),
(16394, 3040, 21065, NULL, '2021-04-27 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Group & Provider Status || Spectrum Neuro Behavioral Care LLC || Group & Providers || First Health ||  Hello Laura,   Please advise me the enrollment status for the below mentioned group and providers for our group with First Health under the below location. If the providers are in-network so can you please send me the welcome letter for them.   Practice Details: Practice Name: Spectrum Neuro Behavioral Care LLC Practice Tax ID# 83-4482753 Practice NPI# 1356906572 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702 Secondary Address: 100 New State Hwy. Raynham , MA 02767  Provider 1: Provider Name: Tawakol, Katie Provider NPI# 1609222116  Provider 2: Provider Name: Rashid, Mahreen Provider NPI# 1396393146  Provider 3: Provider Name: Hefti, Prisca Provider NPI# 1508133182  Provider 4: Provider Name: Khan, Fauzia Wali Provider NPI# 1699761965  Provider 5: Provider Name: Pionke, Peggy Provider NPI# 1699307322  Provider 6: Provider Name: Ullrich, Jennifer Lee Provider NPI# 1710489760  Provider 7: Provider Name: Schubert, Jonathan Provider NPI# 1235755505  Provider 8: Provider Name: Edmundson, Rodesia Sharese Provider NPI# 1124622667  Provider 9: Provider Name: Hignite, Barbara Provider NPI# 1982617262  Provider 10: Provider Name: Rozell, Carlee Provider NPI# 1225645393  Provider 11: Provider Name: Loveland, Lynnetta Provider NPI# 1598163602  Provider 12: Provider Name: Smith, Kerry R Provider NPI# 1275083230  Please get back to me as soon as you can get a chance. Waiting for your reply.   Thanks ', NULL, NULL, '2021-04-20 13:14:35', '2021-04-20 13:14:35'),
(16395, 1019, 21065, NULL, '2021-05-27 00:00:00.000', 'On Hold', 'Waiting for Aetna', NULL, NULL, '2021-05-20 09:32:30', '2021-05-20 09:32:30'),
(16396, 1006, 21066, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:06:33', '2021-03-15 14:06:33'),
(16397, 3040, 21066, NULL, '2021-04-27 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Group & Provider Status || Spectrum Neuro Behavioral Care LLC || Group & Providers || First Health ||  Hello Laura,   Please advise me the enrollment status for the below mentioned group and providers for our group with First Health under the below location. If the providers are in-network so can you please send me the welcome letter for them.   Practice Details: Practice Name: Spectrum Neuro Behavioral Care LLC Practice Tax ID# 83-4482753 Practice NPI# 1356906572 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702 Secondary Address: 100 New State Hwy. Raynham , MA 02767  Provider 1: Provider Name: Tawakol, Katie Provider NPI# 1609222116  Provider 2: Provider Name: Rashid, Mahreen Provider NPI# 1396393146  Provider 3: Provider Name: Hefti, Prisca Provider NPI# 1508133182  Provider 4: Provider Name: Khan, Fauzia Wali Provider NPI# 1699761965  Provider 5: Provider Name: Pionke, Peggy Provider NPI# 1699307322  Provider 6: Provider Name: Ullrich, Jennifer Lee Provider NPI# 1710489760  Provider 7: Provider Name: Schubert, Jonathan Provider NPI# 1235755505  Provider 8: Provider Name: Edmundson, Rodesia Sharese Provider NPI# 1124622667  Provider 9: Provider Name: Hignite, Barbara Provider NPI# 1982617262  Provider 10: Provider Name: Rozell, Carlee Provider NPI# 1225645393  Provider 11: Provider Name: Loveland, Lynnetta Provider NPI# 1598163602  Provider 12: Provider Name: Smith, Kerry R Provider NPI# 1275083230  Please get back to me as soon as you can get a chance. Waiting for your reply.   Thanks ', NULL, NULL, '2021-04-20 13:16:19', '2021-04-20 13:16:19'),
(16398, 1019, 21066, NULL, '2021-05-27 00:00:00.000', 'On Hold', 'Waiting for Aetna', NULL, NULL, '2021-05-20 09:32:36', '2021-05-20 09:32:36'),
(16399, 1019, 21066, NULL, '2021-11-16 00:00:00.000', 'Not Eligible', 'Provider will no longer with SNBCARE.', NULL, NULL, '2021-11-09 10:32:15', '2021-11-09 10:32:15'),
(16400, 1006, 21067, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:06:33', '2021-03-15 14:06:33'),
(16401, 3040, 21067, NULL, '2021-04-27 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Group & Provider Status || Spectrum Neuro Behavioral Care LLC || Group & Providers || First Health ||  Hello Laura,   Please advise me the enrollment status for the below mentioned group and providers for our group with First Health under the below location. If the providers are in-network so can you please send me the welcome letter for them.   Practice Details: Practice Name: Spectrum Neuro Behavioral Care LLC Practice Tax ID# 83-4482753 Practice NPI# 1356906572 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702 Secondary Address: 100 New State Hwy. Raynham , MA 02767  Provider 1: Provider Name: Tawakol, Katie Provider NPI# 1609222116  Provider 2: Provider Name: Rashid, Mahreen Provider NPI# 1396393146  Provider 3: Provider Name: Hefti, Prisca Provider NPI# 1508133182  Provider 4: Provider Name: Khan, Fauzia Wali Provider NPI# 1699761965  Provider 5: Provider Name: Pionke, Peggy Provider NPI# 1699307322  Provider 6: Provider Name: Ullrich, Jennifer Lee Provider NPI# 1710489760  Provider 7: Provider Name: Schubert, Jonathan Provider NPI# 1235755505  Provider 8: Provider Name: Edmundson, Rodesia Sharese Provider NPI# 1124622667  Provider 9: Provider Name: Hignite, Barbara Provider NPI# 1982617262  Provider 10: Provider Name: Rozell, Carlee Provider NPI# 1225645393  Provider 11: Provider Name: Loveland, Lynnetta Provider NPI# 1598163602  Provider 12: Provider Name: Smith, Kerry R Provider NPI# 1275083230  Please get back to me as soon as you can get a chance. Waiting for your reply.   Thanks ', NULL, NULL, '2021-04-20 13:15:43', '2021-04-20 13:15:43'),
(16402, 1019, 21067, NULL, '2021-05-27 00:00:00.000', 'On Hold', 'Waiting for Aetna', NULL, NULL, '2021-05-20 09:32:41', '2021-05-20 09:32:41'),
(16403, 1006, 21068, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:06:34', '2021-03-15 14:06:34'),
(16404, 1019, 21068, NULL, '2021-04-09 00:00:00.000', 'New/Not Initiated', 'Waiting to get enrolled with Aetna', NULL, NULL, '2021-04-02 14:58:06', '2021-04-02 14:58:06'),
(16405, 1006, 21068, NULL, '2021-04-29 00:00:00.000', 'On Hold', 'Waiting to get enrolled with Aetna to begin Firsthealth enrollment process. ', NULL, NULL, '2021-04-22 15:54:03', '2021-04-22 15:54:03'),
(16406, 1006, 21069, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:06:35', '2021-03-15 14:06:35');
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
(16407, 3040, 21069, NULL, '2021-04-27 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Group & Provider Status || Spectrum Neuro Behavioral Care LLC || Group & Providers || First Health ||  Hello Laura,   Please advise me the enrollment status for the below mentioned group and providers for our group with First Health under the below location. If the providers are in-network so can you please send me the welcome letter for them.   Practice Details: Practice Name: Spectrum Neuro Behavioral Care LLC Practice Tax ID# 83-4482753 Practice NPI# 1356906572 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702 Secondary Address: 100 New State Hwy. Raynham , MA 02767  Provider 1: Provider Name: Tawakol, Katie Provider NPI# 1609222116  Provider 2: Provider Name: Rashid, Mahreen Provider NPI# 1396393146  Provider 3: Provider Name: Hefti, Prisca Provider NPI# 1508133182  Provider 4: Provider Name: Khan, Fauzia Wali Provider NPI# 1699761965  Provider 5: Provider Name: Pionke, Peggy Provider NPI# 1699307322  Provider 6: Provider Name: Ullrich, Jennifer Lee Provider NPI# 1710489760  Provider 7: Provider Name: Schubert, Jonathan Provider NPI# 1235755505  Provider 8: Provider Name: Edmundson, Rodesia Sharese Provider NPI# 1124622667  Provider 9: Provider Name: Hignite, Barbara Provider NPI# 1982617262  Provider 10: Provider Name: Rozell, Carlee Provider NPI# 1225645393  Provider 11: Provider Name: Loveland, Lynnetta Provider NPI# 1598163602  Provider 12: Provider Name: Smith, Kerry R Provider NPI# 1275083230  Please get back to me as soon as you can get a chance. Waiting for your reply.   Thanks ', NULL, NULL, '2021-04-20 13:15:35', '2021-04-20 13:15:35'),
(16408, 1019, 21069, NULL, '2021-05-27 00:00:00.000', 'On Hold', 'Waiting for Aetna', NULL, NULL, '2021-05-20 09:32:47', '2021-05-20 09:32:47'),
(16409, 3040, 21070, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:06:54', '2021-03-15 14:06:54'),
(16410, 3040, 21070, NULL, '2021-05-17 00:00:00.000', 'In Process', 'Provider certification form sent @ 6082217535.   Please see attachment.  ', NULL, NULL, '2021-05-10 15:02:18', '2021-05-10 15:02:18'),
(16411, 1006, 21070, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Sent f/u email @ Katherine Moten KMoten4@humana.com:  Sub: Certification Status - CUCC - Tricare  \"Hello Katherine, I hope you\'re doing well, I wanted to get an update regarding the certification status for the following providers under our group:   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-01 17:11:37', '2021-06-01 17:11:37'),
(16412, 3040, 21070, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: HGBProviderRosters@humana.com  Subject: Re: Roster || Columbus Urgent Care PA || Joseph, Vibitha, Abraham, Glory & Abraham, Jeena || Tricare ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers. We already sent the roster as per Katherine\'s email that was received on 06/03/2021.    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: Abraham, Glory  Provider NPI# 1194206490  Provider 3: Provider Name: Abraham, Jeena  Provider NPI# 1467901587  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 12:35:15', '2021-06-21 12:35:15'),
(16413, 3040, 21070, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: HGBProviderRosters@humana.com  Subject: Re: Roster || Columbus Urgent Care PA || Joseph, Vibitha, Abraham, Glory & Abraham, Jeena || Tricare ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers. We already sent the roster as per Katherine\'s email that was received on 06/03/2021.    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: Abraham, Glory  Provider NPI# 1194206490  Provider 3: Provider Name: Abraham, Jeena  Provider NPI# 1467901587  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 12:35:17', '2021-06-21 12:35:17'),
(16414, 3040, 21070, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: HGBProviderRosters@humana.com  Subject: Re: Roster || Columbus Urgent Care PA || Joseph, Vibitha, Abraham, Glory & Abraham, Jeena || Tricare ||  Hello,   Hope you are doing well. Please advise the enrollment status for the below mentioned providers in Tricare in our group Columbus Urgent Care PA under the below locations. We already sent the roster as per Katherine\'s email that was received on 06/03/2021.    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: Abraham, Glory  Provider NPI# 1194206490  Provider 3: Provider Name: Abraham, Jeena  Provider NPI# 1467901587  Waiting for your reply.   Thanks ', NULL, NULL, '2021-07-05 15:11:51', '2021-07-05 15:11:51'),
(16415, 3040, 21070, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Certification Status - CUCC - Tricare  Hello Katherine,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Tricare in our group under the below locations.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider 1:  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 2:  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:  Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5:  Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6:  Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 7:  Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8:  Provider Name: Brown, Brittany Provider NPI# 1275163537  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-07-22 17:05:46', '2021-07-22 17:05:46'),
(16416, 3040, 21070, NULL, '2021-07-30 00:00:00.000', 'Approved', 'Email rcvd from: KMoten4@humana.com  Subject: Certification Status - CUCC - Tricare  Please see updated below.  Thank you.   Respectfully, Katherine Moten TRICARE Community Liaison II Humana  T 502-318-5250  F 210-239-0401 kmoten4@humana.com HumanaMilitary.com  Provider 5:  Provider Name: Abraham, Glory - added to location eff: 6/9/2021 Provider NPI# 1194206490', NULL, NULL, '2021-07-23 10:47:25', '2021-07-23 10:47:25'),
(16417, 3040, 21071, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:07:11', '2021-03-15 14:07:11'),
(16418, 3040, 21071, NULL, '2021-05-17 00:00:00.000', 'In Process', 'Provider certification form sent @ 6082217535.   Please see attachment.  ', NULL, NULL, '2021-05-10 15:02:23', '2021-05-10 15:02:23'),
(16419, 1006, 21071, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Sent f/u email @ Katherine Moten KMoten4@humana.com:  Sub: Certification Status - CUCC - Tricare  \"Hello Katherine, I hope you\'re doing well, I wanted to get an update regarding the certification status for the following providers under our group:   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-01 17:11:41', '2021-06-01 17:11:41'),
(16420, 3040, 21071, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: HGBProviderRosters@humana.com  Subject: Re: Roster || Columbus Urgent Care PA || Joseph, Vibitha, Abraham, Glory & Abraham, Jeena || Tricare ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers. We already sent the roster as per Katherine\'s email that was received on 06/03/2021.    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: Abraham, Glory  Provider NPI# 1194206490  Provider 3: Provider Name: Abraham, Jeena  Provider NPI# 1467901587  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 12:35:07', '2021-06-21 12:35:07'),
(16421, 3040, 21071, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: HGBProviderRosters@humana.com  Subject: Re: Roster || Columbus Urgent Care PA || Joseph, Vibitha, Abraham, Glory & Abraham, Jeena || Tricare ||  Hello,   Hope you are doing well. Please advise the enrollment status for the below mentioned providers in Tricare in our group Columbus Urgent Care PA under the below locations. We already sent the roster as per Katherine\'s email that was received on 06/03/2021.    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: Abraham, Glory  Provider NPI# 1194206490  Provider 3: Provider Name: Abraham, Jeena  Provider NPI# 1467901587  Waiting for your reply.   Thanks ', NULL, NULL, '2021-07-05 15:11:54', '2021-07-05 15:11:54'),
(16422, 3040, 21071, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Certification Status - CUCC - Tricare  Hello Katherine,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Tricare in our group under the below locations.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider 1:  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 2:  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:  Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5:  Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6:  Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 7:  Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8:  Provider Name: Brown, Brittany Provider NPI# 1275163537  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-07-22 17:05:46', '2021-07-22 17:05:46'),
(16423, 11056, 21071, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email sent to : KMoten4@humana.com  Sub : Enrollment Status Query - CUCC - Tricare  Hey Katherine!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Tricare in our group under the below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider Details: Provider 1: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 2: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6: Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 7: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 9: Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 10: Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you  Have a great day!', NULL, NULL, '2021-08-05 13:11:09', '2021-08-05 13:11:09'),
(16424, 3040, 21071, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Columbus Urgent Care PA || Providers || Tricare ||  Hello Katherine,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Tricare in our group under the below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215 Provider 1:  Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 2:  Provider Name: Jacob, Jaya. Provider NPI# 1194336149  Provider 3:  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:  Provider Name: Abraham, Jeena  Provider NPI# 1467901587  Provider 5:  Provider Name: Chennemkara, Mini  Provider NPI# 1841755956  Provider 6:  Provider Name: Brown, Brittany Provider NPI# 1275163537 Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-08-18 15:36:15', '2021-08-18 15:36:15'),
(16425, 3040, 21071, NULL, '2021-08-27 00:00:00.000', 'Approved', 'Email rcvd from: KMoten4@humana.com  Subject: Secured: RE: Enrollment Status || Columbus Urgent Care PA || Providers || Tricare ||  Please see the effective dates below for each provider. In the future, you can see these updates in the Humana Military provider portal.  Respectfully, Katherine Moten TRICARE Community Liaison II Humana T 502-318-5250 F 210-239-0401 kmoten4@humana.com HumanaMilitary.com  TRICARE 101 Webinar: https://www.brainshark.com/hgb/vu?pi=zIHzFuMwczRw6Vz0 ', NULL, NULL, '2021-08-20 09:14:21', '2021-08-20 09:14:21'),
(16426, 3040, 21072, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:07:22', '2021-03-15 14:07:22'),
(16427, 1005, 21072, 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 12:54:22', '2021-06-01 12:54:22'),
(16428, 3040, 21073, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:07:39', '2021-03-15 14:07:39'),
(16429, 3040, 21073, NULL, '2021-05-17 00:00:00.000', 'In Process', 'Provider certification form sent @ 6082217535.   Please see attachment.  ', NULL, NULL, '2021-05-10 15:02:28', '2021-05-10 15:02:28'),
(16430, 1006, 21073, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Sent f/u email @ Katherine Moten KMoten4@humana.com:  Sub: Certification Status - CUCC - Tricare  \"Hello Katherine, I hope you\'re doing well, I wanted to get an update regarding the certification status for the following providers under our group:   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-01 17:11:45', '2021-06-01 17:11:45'),
(16431, 3040, 21073, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email rcvd from: KMoten4@humana.com  Subject: Certification Status - CUCC - Tricare  All credentialing applications have been submitted for processing. Please allow 90 days.   Respectfully, Katherine Moten TRICARE Community Liaison II Humana  T 502-318-5250  F 210-239-0401 kmoten4@humana.com HumanaMilitary.com', NULL, NULL, '2021-06-21 12:21:44', '2021-06-21 12:21:44'),
(16432, 3040, 21073, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Certification Status - CUCC - Tricare  Hello Katherine,  I hope you\'re doing well, I wanted to get an update regarding the certification status for the following providers under our group:  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider 1:  Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 2:  Provider Name: Jacob, Jaya  Provider NPI# 1194336149  Provider 3: Provider Name: Stephen, Ani  Provider NPI# 1588959118  Provider 4:  Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956  Provider 5:   Provider Name: Brown, Brittany  Provider NPI# 1275163537  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-21 12:26:57', '2021-06-21 12:26:57'),
(16433, 3040, 21073, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email rcvd from: KMoten4@humana.com  Subject: Certification Status - CUCC - Tricare  All credentialing applications have been submitted for processing. Please allow 90 days.   Respectfully, Katherine Moten TRICARE Community Liaison II Humana  T 502-318-5250  F 210-239-0401 kmoten4@humana.com HumanaMilitary.com', NULL, NULL, '2021-07-05 15:13:52', '2021-07-05 15:13:52'),
(16434, 3040, 21073, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Certification Status - CUCC - Tricare  Hello Katherine,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Tricare in our group under the below locations.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider 1:  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 2:  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:  Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5:  Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6:  Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 7:  Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8:  Provider Name: Brown, Brittany Provider NPI# 1275163537  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-07-22 17:05:45', '2021-07-22 17:05:45'),
(16435, 11056, 21073, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email sent to : KMoten4@humana.com  Sub : Enrollment Status Query - CUCC - Tricare  Hey Katherine!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Tricare in our group under the below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider Details: Provider 1: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 2: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6: Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 7: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 9: Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 10: Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you  Have a great day!', NULL, NULL, '2021-08-05 13:10:58', '2021-08-05 13:10:58'),
(16436, 3040, 21073, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Columbus Urgent Care PA || Providers || Tricare ||  Hello Katherine,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Tricare in our group under the below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215 Provider 1:  Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 2:  Provider Name: Jacob, Jaya. Provider NPI# 1194336149  Provider 3:  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:  Provider Name: Abraham, Jeena  Provider NPI# 1467901587  Provider 5:  Provider Name: Chennemkara, Mini  Provider NPI# 1841755956  Provider 6:  Provider Name: Brown, Brittany Provider NPI# 1275163537 Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-08-18 15:36:17', '2021-08-18 15:36:17'),
(16437, 3040, 21073, NULL, '2021-08-27 00:00:00.000', 'Approved', 'Email rcvd from: KMoten4@humana.com  Subject: Secured: RE: Enrollment Status || Columbus Urgent Care PA || Providers || Tricare ||  Please see the effective dates below for each provider. In the future, you can see these updates in the Humana Military provider portal.  Respectfully, Katherine Moten TRICARE Community Liaison II Humana T 502-318-5250 F 210-239-0401 kmoten4@humana.com HumanaMilitary.com  TRICARE 101 Webinar: https://www.brainshark.com/hgb/vu?pi=zIHzFuMwczRw6Vz0 ', NULL, NULL, '2021-08-20 09:14:21', '2021-08-20 09:14:21'),
(16438, 3046, 21074, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:07:55', '2021-03-15 14:07:55'),
(16439, 1005, 21074, NULL, '2021-04-01 00:00:00.000', 'Approved', 'RHC-C got ancillary contracted, no need to credential individual provider. Ref Task Link: http://app.emrbs.com/Credentials/Details/8031', NULL, NULL, '2021-03-25 14:03:27', '2021-03-25 14:03:27'),
(16440, 3046, 21075, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:08:02', '2021-03-15 14:08:02'),
(16441, 1005, 21075, NULL, '2021-04-01 00:00:00.000', 'Approved', 'RHC-C got ancillary contracted, no need to credential individual provider. Ref Task Link: http://app.emrbs.com/Credentials/Details/8031', NULL, NULL, '2021-03-25 14:03:38', '2021-03-25 14:03:38'),
(16442, 3040, 21076, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:08:04', '2021-03-15 14:08:04'),
(16443, 3040, 21076, NULL, '2021-05-17 00:00:00.000', 'In Process', 'Provider certification form sent @ 6082217535.   Please see attachment.  ', NULL, NULL, '2021-05-10 15:02:31', '2021-05-10 15:02:31'),
(16444, 1006, 21076, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Sent f/u email @ Katherine Moten KMoten4@humana.com:  Sub: Certification Status - CUCC - Tricare  \"Hello Katherine, I hope you\'re doing well, I wanted to get an update regarding the certification status for the following providers under our group:   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-01 17:11:50', '2021-06-01 17:11:50'),
(16445, 3040, 21076, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email rcvd from: KMoten4@humana.com  Subject: Certification Status - CUCC - Tricare  All credentialing applications have been submitted for processing. Please allow 90 days.   Respectfully, Katherine Moten TRICARE Community Liaison II Humana  T 502-318-5250  F 210-239-0401 kmoten4@humana.com HumanaMilitary.com', NULL, NULL, '2021-06-21 12:21:43', '2021-06-21 12:21:43'),
(16446, 3040, 21076, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Certification Status - CUCC - Tricare  Hello Katherine,  I hope you\'re doing well, I wanted to get an update regarding the certification status for the following providers under our group:  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider 1:  Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 2:  Provider Name: Jacob, Jaya  Provider NPI# 1194336149  Provider 3: Provider Name: Stephen, Ani  Provider NPI# 1588959118  Provider 4:  Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956  Provider 5:   Provider Name: Brown, Brittany  Provider NPI# 1275163537  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-21 12:26:54', '2021-06-21 12:26:54'),
(16447, 3040, 21076, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email rcvd from: KMoten4@humana.com  Subject: Certification Status - CUCC - Tricare  All credentialing applications have been submitted for processing. Please allow 90 days.   Respectfully, Katherine Moten TRICARE Community Liaison II Humana  T 502-318-5250  F 210-239-0401 kmoten4@humana.com HumanaMilitary.com', NULL, NULL, '2021-07-05 15:13:54', '2021-07-05 15:13:54'),
(16448, 3040, 21076, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Certification Status - CUCC - Tricare  Hello Katherine,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Tricare in our group under the below locations.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider 1:  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 2:  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:  Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5:  Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6:  Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 7:  Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8:  Provider Name: Brown, Brittany Provider NPI# 1275163537  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-07-22 17:05:44', '2021-07-22 17:05:44'),
(16449, 11056, 21076, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email sent to : KMoten4@humana.com  Sub : Enrollment Status Query - CUCC - Tricare  Hey Katherine!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Tricare in our group under the below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider Details: Provider 1: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 2: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6: Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 7: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 9: Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 10: Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you  Have a great day!', NULL, NULL, '2021-08-05 13:10:46', '2021-08-05 13:10:46'),
(16450, 3040, 21076, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Columbus Urgent Care PA || Providers || Tricare ||  Hello Katherine,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Tricare in our group under the below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215 Provider 1:  Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 2:  Provider Name: Jacob, Jaya. Provider NPI# 1194336149  Provider 3:  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:  Provider Name: Abraham, Jeena  Provider NPI# 1467901587  Provider 5:  Provider Name: Chennemkara, Mini  Provider NPI# 1841755956  Provider 6:  Provider Name: Brown, Brittany Provider NPI# 1275163537 Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-08-18 15:36:16', '2021-08-18 15:36:16'),
(16451, 3040, 21076, NULL, '2021-08-27 00:00:00.000', 'Approved', 'Email rcvd from: KMoten4@humana.com  Subject: Secured: RE: Enrollment Status || Columbus Urgent Care PA || Providers || Tricare ||  Please see the effective dates below for each provider. In the future, you can see these updates in the Humana Military provider portal.  Respectfully, Katherine Moten TRICARE Community Liaison II Humana T 502-318-5250 F 210-239-0401 kmoten4@humana.com HumanaMilitary.com  TRICARE 101 Webinar: https://www.brainshark.com/hgb/vu?pi=zIHzFuMwczRw6Vz0 ', NULL, NULL, '2021-08-20 09:14:22', '2021-08-20 09:14:22'),
(16452, 1006, 21077, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:08:06', '2021-03-15 14:08:06'),
(16453, 1006, 21077, NULL, '2021-04-16 00:00:00.000', 'On Hold', 'The enrollment request is pending on the provider\'s RI PMHNP license to be issued. ', NULL, NULL, '2021-04-09 14:57:49', '2021-04-09 14:57:49'),
(16454, 1019, 21077, NULL, '2021-11-01 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCare.', NULL, NULL, '2021-10-25 10:43:13', '2021-10-25 10:43:13'),
(16455, 1006, 21078, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:08:08', '2021-03-15 14:08:08'),
(16456, 3040, 21078, NULL, '2021-04-27 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Group & Provider Status || Spectrum Neuro Behavioral Care LLC || Group & Providers || First Health ||  Hello Laura,   Hope you are doing well. Please advise me the enrollment status for the below mentioned group and providers for our group with First Health under the below location. If the providers are in-network so can you please send me the welcome letter for them.   Practice Details: Practice Name: Spectrum Neuro Behavioral Care LLC Practice Tax ID# 83-4482753 Practice NPI# 1356906572 Practice Address: 61 Lincoln St., Suite 203, Framingham , MA 01702  Provider 1: Provider Name: Rashid, Mahreen Provider NPI# 1396393146  Provider 2:   Provider Name: Khan, Fauzia Wali Provider NPI# 1699761965  Provider 3:   Provider Name: Pionke, Peggy Provider NPI# 1699307322  Provider 4:   Provider Name: L\'Etoile, Melody Provider NPI# 1942687108  Provider 5:   Provider Name: Hartman, Jessica Provider NPI# 1326665472  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-20 12:44:42', '2021-04-20 12:44:42'),
(16457, 1019, 21078, NULL, '2021-06-01 00:00:00.000', 'On Hold', 'Waiting for Aetna', NULL, NULL, '2021-05-20 09:30:54', '2021-05-20 09:30:54'),
(16458, 1006, 21079, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:08:09', '2021-03-15 14:08:09'),
(16459, 3040, 21079, NULL, '2021-04-27 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Group & Provider Status || Spectrum Neuro Behavioral Care LLC || Group & Providers || First Health ||  Hello Laura,   Hope you are doing well. Please advise me the enrollment status for the below mentioned group and providers for our group with First Health under the below location. If the providers are in-network so can you please send me the welcome letter for them.   Practice Details: Practice Name: Spectrum Neuro Behavioral Care LLC Practice Tax ID# 83-4482753 Practice NPI# 1356906572 Practice Address: 61 Lincoln St., Suite 203, Framingham , MA 01702  Provider 1: Provider Name: Rashid, Mahreen Provider NPI# 1396393146  Provider 2:   Provider Name: Khan, Fauzia Wali Provider NPI# 1699761965  Provider 3:   Provider Name: Pionke, Peggy Provider NPI# 1699307322  Provider 4:   Provider Name: L\'Etoile, Melody Provider NPI# 1942687108  Provider 5:   Provider Name: Hartman, Jessica Provider NPI# 1326665472  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-20 12:44:02', '2021-04-20 12:44:02'),
(16460, 1019, 21079, NULL, '2021-05-27 00:00:00.000', 'On Hold', 'Waiting for Aetna', NULL, NULL, '2021-05-20 09:31:03', '2021-05-20 09:31:03'),
(16461, 1006, 21080, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:08:10', '2021-03-15 14:08:10'),
(16462, 3040, 21080, NULL, '2021-04-27 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Group & Provider Status || Spectrum Neuro Behavioral Care LLC || Group & Providers || First Health ||  Hello Laura,   Hope you are doing well. Please advise me the enrollment status for the below mentioned group and providers for our group with First Health under the below location. If the providers are in-network so can you please send me the welcome letter for them.   Practice Details: Practice Name: Spectrum Neuro Behavioral Care LLC Practice Tax ID# 83-4482753 Practice NPI# 1356906572 Practice Address: 61 Lincoln St., Suite 203, Framingham , MA 01702  Provider 1: Provider Name: Rashid, Mahreen Provider NPI# 1396393146  Provider 2:   Provider Name: Khan, Fauzia Wali Provider NPI# 1699761965  Provider 3:   Provider Name: Pionke, Peggy Provider NPI# 1699307322  Provider 4:   Provider Name: L\'Etoile, Melody Provider NPI# 1942687108  Provider 5:   Provider Name: Hartman, Jessica Provider NPI# 1326665472  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-20 12:44:36', '2021-04-20 12:44:36'),
(16463, 1019, 21080, NULL, '2021-05-27 00:00:00.000', 'On Hold', 'Waiting for Aetna', NULL, NULL, '2021-05-20 09:31:11', '2021-05-20 09:31:11'),
(16464, 1019, 21080, NULL, '2021-08-30 00:00:00.000', 'Not Eligible', 'Provider no longer working with SNBCARE', NULL, NULL, '2021-08-23 13:52:28', '2021-08-23 13:52:28'),
(16465, 1006, 21081, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:08:10', '2021-03-15 14:08:10'),
(16466, 3040, 21081, NULL, '2021-04-27 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Group & Provider Status || Spectrum Neuro Behavioral Care LLC || Group & Providers || First Health ||  Hello Laura,   Can you please also advise me the enrollment status for the below mentioned providers for our group with First Health under the below location.    Practice Details: Practice Name: Spectrum Neuro Behavioral Care LLC Practice Tax ID# 83-4482753 Practice NPI# 1356906572 Practice Address: 61 Lincoln St., Suite 203, Framingham , MA 01702  Provider 6: Provider Name: Oliva, Erin Provider NPI# 1407349632  Provider 7:   Provider Name: Souliere, Justin R Provider NPI# 1710576004  Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-04-20 12:54:54', '2021-04-20 12:54:54'),
(16467, 1019, 21081, NULL, '2021-05-27 00:00:00.000', 'On Hold', 'Waiting for Aetna', NULL, NULL, '2021-05-20 09:31:18', '2021-05-20 09:31:18'),
(16468, 1006, 21082, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:08:11', '2021-03-15 14:08:11'),
(16469, 3040, 21082, NULL, '2021-04-27 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Group & Provider Status || Spectrum Neuro Behavioral Care LLC || Group & Providers || First Health ||  Hello Laura,   Hope you are doing well. Please advise me the enrollment status for the below mentioned group and providers for our group with First Health under the below location. If the providers are in-network so can you please send me the welcome letter for them.   Practice Details: Practice Name: Spectrum Neuro Behavioral Care LLC Practice Tax ID# 83-4482753 Practice NPI# 1356906572 Practice Address: 61 Lincoln St., Suite 203, Framingham , MA 01702  Provider 1: Provider Name: Rashid, Mahreen Provider NPI# 1396393146  Provider 2:   Provider Name: Khan, Fauzia Wali Provider NPI# 1699761965  Provider 3:   Provider Name: Pionke, Peggy Provider NPI# 1699307322  Provider 4:   Provider Name: L\'Etoile, Melody Provider NPI# 1942687108  Provider 5:   Provider Name: Hartman, Jessica Provider NPI# 1326665472  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-20 12:44:30', '2021-04-20 12:44:30'),
(16470, 1019, 21082, NULL, '2021-05-27 00:00:00.000', 'On Hold', 'Waiting for Aetna', NULL, NULL, '2021-05-20 09:31:24', '2021-05-20 09:31:24'),
(16471, 1006, 21083, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:08:12', '2021-03-15 14:08:12'),
(16472, 1019, 21083, NULL, '2021-04-15 00:00:00.000', 'New/Not Initiated', 'Waiting for Aetna', NULL, NULL, '2021-04-01 15:10:12', '2021-04-01 15:10:12'),
(16473, 3040, 21083, NULL, '2021-04-27 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Group & Provider Status || Spectrum Neuro Behavioral Care LLC || Group & Providers || First Health ||  Hello Laura,   Can you please also advise me the enrollment status for the below mentioned providers for our group with First Health under the below location.    Practice Details: Practice Name: Spectrum Neuro Behavioral Care LLC Practice Tax ID# 83-4482753 Practice NPI# 1356906572 Practice Address: 61 Lincoln St., Suite 203, Framingham , MA 01702  Provider 6: Provider Name: Oliva, Erin Provider NPI# 1407349632  Provider 7:   Provider Name: Souliere, Justin R Provider NPI# 1710576004  Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-04-20 12:54:59', '2021-04-20 12:54:59'),
(16474, 1019, 21083, NULL, '2021-05-27 00:00:00.000', 'On Hold', 'Waiting for Aetna', NULL, NULL, '2021-05-20 09:31:29', '2021-05-20 09:31:29'),
(16475, 3040, 21084, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:08:14', '2021-03-15 14:08:14'),
(16476, 3040, 21084, NULL, '2021-05-17 00:00:00.000', 'In Process', 'Provider certification form sent @ 6082217535.   Please see attachment.  ', NULL, NULL, '2021-05-10 15:02:35', '2021-05-10 15:02:35'),
(16477, 1006, 21084, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Sent f/u email @ Katherine Moten KMoten4@humana.com:  Sub: Certification Status - CUCC - Tricare  \"Hello Katherine, I hope you\'re doing well, I wanted to get an update regarding the certification status for the following providers under our group:   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-01 17:11:54', '2021-06-01 17:11:54'),
(16478, 3040, 21084, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email rcvd from: KMoten4@humana.com  Subject: Certification Status - CUCC - Tricare  All credentialing applications have been submitted for processing. Please allow 90 days.   Respectfully, Katherine Moten TRICARE Community Liaison II Humana  T 502-318-5250  F 210-239-0401 kmoten4@humana.com HumanaMilitary.com', NULL, NULL, '2021-06-21 12:21:41', '2021-06-21 12:21:41'),
(16479, 3040, 21084, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Certification Status - CUCC - Tricare  Hello Katherine,  I hope you\'re doing well, I wanted to get an update regarding the certification status for the following providers under our group:  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider 1:  Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 2:  Provider Name: Jacob, Jaya  Provider NPI# 1194336149  Provider 3: Provider Name: Stephen, Ani  Provider NPI# 1588959118  Provider 4:  Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956  Provider 5:   Provider Name: Brown, Brittany  Provider NPI# 1275163537  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-21 12:26:50', '2021-06-21 12:26:50'),
(16480, 3040, 21084, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email rcvd from: KMoten4@humana.com  Subject: Certification Status - CUCC - Tricare  All credentialing applications have been submitted for processing. Please allow 90 days.   Respectfully, Katherine Moten TRICARE Community Liaison II Humana  T 502-318-5250  F 210-239-0401 kmoten4@humana.com HumanaMilitary.com', NULL, NULL, '2021-07-05 15:13:57', '2021-07-05 15:13:57'),
(16481, 3040, 21084, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Certification Status - CUCC - Tricare  Hello Katherine,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Tricare in our group under the below locations.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider 1:  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 2:  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:  Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5:  Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6:  Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 7:  Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8:  Provider Name: Brown, Brittany Provider NPI# 1275163537  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-07-22 17:05:43', '2021-07-22 17:05:43'),
(16482, 11056, 21084, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email sent to : KMoten4@humana.com  Sub : Enrollment Status Query - CUCC - Tricare  Hey Katherine!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Tricare in our group under the below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider Details: Provider 1: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 2: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6: Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 7: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 9: Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 10: Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you  Have a great day!', NULL, NULL, '2021-08-05 13:10:32', '2021-08-05 13:10:32'),
(16483, 3040, 21084, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Columbus Urgent Care PA || Providers || Tricare ||  Hello Katherine,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Tricare in our group under the below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215 Provider 1:  Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 2:  Provider Name: Jacob, Jaya. Provider NPI# 1194336149  Provider 3:  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:  Provider Name: Abraham, Jeena  Provider NPI# 1467901587  Provider 5:  Provider Name: Chennemkara, Mini  Provider NPI# 1841755956  Provider 6:  Provider Name: Brown, Brittany Provider NPI# 1275163537 Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-08-18 15:36:16', '2021-08-18 15:36:16'),
(16484, 3040, 21084, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Columbus Urgent Care PA || Providers || Tricare ||  Hello Katherine,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Tricare in our group under the below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215 Provider 1:  Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 2:  Provider Name: Jacob, Jaya. Provider NPI# 1194336149  Provider 3:  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:  Provider Name: Abraham, Jeena  Provider NPI# 1467901587  Provider 5:  Provider Name: Chennemkara, Mini  Provider NPI# 1841755956  Provider 6:  Provider Name: Brown, Brittany Provider NPI# 1275163537 Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-08-18 15:36:17', '2021-08-18 15:36:17'),
(16485, 3040, 21084, NULL, '2021-08-27 00:00:00.000', 'Approved', 'Email rcvd from: KMoten4@humana.com  Subject: Secured: RE: Enrollment Status || Columbus Urgent Care PA || Providers || Tricare ||  Please see the effective dates below for each provider. In the future, you can see these updates in the Humana Military provider portal.  Respectfully, Katherine Moten TRICARE Community Liaison II Humana T 502-318-5250 F 210-239-0401 kmoten4@humana.com HumanaMilitary.com  TRICARE 101 Webinar: https://www.brainshark.com/hgb/vu?pi=zIHzFuMwczRw6Vz0 ', NULL, NULL, '2021-08-20 09:14:06', '2021-08-20 09:14:06'),
(16486, 3040, 21085, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:12:58', '2021-03-15 14:12:58'),
(16487, 3040, 21085, NULL, '2021-05-27 00:00:00.000', 'On Hold', 'Pending group enrollment. ', NULL, NULL, '2021-05-20 14:44:35', '2021-05-20 14:44:35'),
(16488, 3040, 21086, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:14:41', '2021-03-15 14:14:41'),
(16489, 3040, 21086, NULL, '2021-05-27 00:00:00.000', 'On Hold', 'Pending group enrollment. ', NULL, NULL, '2021-05-20 14:44:41', '2021-05-20 14:44:41'),
(16490, 3046, 21087, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:17:06', '2021-03-15 14:17:06'),
(16491, 1005, 21087, NULL, '2021-04-01 00:00:00.000', 'Approved', 'RHC-C got ancillary contracted, no need to credential individual provider. Ref Task Link: http://app.emrbs.com/Credentials/Details/8031', NULL, NULL, '2021-03-25 14:03:43', '2021-03-25 14:03:43');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(16492, 3046, 21088, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:17:11', '2021-03-15 14:17:11'),
(16493, 1005, 21088, NULL, '2021-04-01 00:00:00.000', 'Approved', 'RHC-C got ancillary contracted, no need to credential individual provider. Ref Task Link: http://app.emrbs.com/Credentials/Details/8031', NULL, NULL, '2021-03-25 14:03:48', '2021-03-25 14:03:48'),
(16494, 3046, 21089, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:17:14', '2021-03-15 14:17:14'),
(16495, 1005, 21089, NULL, '2021-04-01 00:00:00.000', 'Approved', 'RHC-C got ancillary contracted, no need to credential individual provider. Ref Task Link: http://app.emrbs.com/Credentials/Details/8031', NULL, NULL, '2021-03-25 14:03:52', '2021-03-25 14:03:52'),
(16496, 3046, 21090, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:17:17', '2021-03-15 14:17:17'),
(16497, 1005, 21090, NULL, '2021-04-01 00:00:00.000', 'Approved', 'RHC-C got ancillary contracted, no need to credential individual provider. Ref Task Link: http://app.emrbs.com/Credentials/Details/8031', NULL, NULL, '2021-03-25 14:03:54', '2021-03-25 14:03:54'),
(16498, 3046, 21091, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:17:20', '2021-03-15 14:17:20'),
(16499, 1005, 21091, NULL, '2021-04-01 00:00:00.000', 'Approved', 'RHC-C got ancillary contracted, no need to credential individual provider. Ref Task Link: http://app.emrbs.com/Credentials/Details/8031', NULL, NULL, '2021-03-25 14:07:10', '2021-03-25 14:07:10'),
(16500, 3046, 21092, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:17:24', '2021-03-15 14:17:24'),
(16501, 1005, 21092, NULL, '2021-04-01 00:00:00.000', 'Approved', 'RHC-C got ancillary contracted, no need to credential individual provider. Ref Task Link: http://app.emrbs.com/Credentials/Details/8031', NULL, NULL, '2021-03-25 14:07:13', '2021-03-25 14:07:13'),
(16502, 3046, 21093, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:17:27', '2021-03-15 14:17:27'),
(16503, 1005, 21093, NULL, '2021-04-01 00:00:00.000', 'Approved', 'RHC-C got ancillary contracted, no need to credential individual provider. Ref Task Link: http://app.emrbs.com/Credentials/Details/8031', NULL, NULL, '2021-03-25 14:07:24', '2021-03-25 14:07:24'),
(16504, 3046, 21094, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:17:31', '2021-03-15 14:17:31'),
(16505, 1005, 21094, NULL, '2021-04-01 00:00:00.000', 'Approved', 'RHC-C got ancillary contracted, no need to credential individual provider. Ref Task Link: http://app.emrbs.com/Credentials/Details/8031', NULL, NULL, '2021-03-25 14:07:22', '2021-03-25 14:07:22'),
(16506, 3040, 21095, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:17:56', '2021-03-15 14:17:56'),
(16507, 3040, 21095, NULL, '2021-05-27 00:00:00.000', 'On Hold', 'Pending group enrollment. ', NULL, NULL, '2021-05-20 14:44:47', '2021-05-20 14:44:47'),
(16508, 3040, 21096, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:18:16', '2021-03-15 14:18:16'),
(16509, 1005, 21096, 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 12:54:41', '2021-06-01 12:54:41'),
(16510, 3040, 21097, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:18:48', '2021-03-15 14:18:48'),
(16511, 1006, 21097, NULL, '2021-05-27 00:00:00.000', 'Initiated', 'Provider enrollment request has been submitted via Optum Link. ', NULL, NULL, '2021-05-20 08:42:34', '2021-05-20 08:42:34'),
(16512, 3040, 21097, NULL, '2021-05-27 00:00:00.000', 'On Hold', 'Pending group enrollment. ', NULL, NULL, '2021-05-20 14:44:52', '2021-05-20 14:44:52'),
(16513, 3040, 21098, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:19:01', '2021-03-15 14:19:01'),
(16514, 1006, 21098, NULL, '2021-05-27 00:00:00.000', 'Initiated', 'Provider enrollment request has been submitted via Optum Link. ', NULL, NULL, '2021-05-20 08:35:34', '2021-05-20 08:35:34'),
(16515, 3040, 21098, NULL, '2021-05-27 00:00:00.000', 'On Hold', 'Pending group enrollment. ', NULL, NULL, '2021-05-20 14:45:04', '2021-05-20 14:45:04'),
(16516, 3046, 21099, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:19:33', '2021-03-15 14:19:33'),
(16517, 3040, 21099, NULL, '2021-04-05 00:00:00.000', 'Approved', 'The following provider is showing to be in network.', NULL, NULL, '2021-03-29 12:19:07', '2021-03-29 12:19:07'),
(16518, 1006, 21099, NULL, NULL, 'Revalidation', 'Sent following email @ Credentialing Committee CredentialingCommittee@bcbstx.com for Juan\'s re-credentialing application:  Sub: Attn: Roshundra Flanders, Credentialing Coordinator  \"Hello Roshundra,  We received the following letter for one of our providers requesting an updated copy of their COI, please find the attached COI with the updated limits.   Let me know if you have any questions.  Thank you.\"', NULL, NULL, '2021-04-23 15:31:49', '2021-04-23 15:31:49'),
(16519, 3040, 21099, NULL, '2021-06-17 00:00:00.000', 'Revalidation', 'Email sent to: CredentialingCommittee@bcbstx.com  Subject:  Roshundra Flanders, Credentialing Coordinator   Hello,     The provider has been approved.  You will need to contact your network representative for effective dates.  Thank you.', NULL, NULL, '2021-06-10 10:56:35', '2021-06-10 10:56:35'),
(16520, 1006, 21099, NULL, '2021-07-07 00:00:00.000', 'Revalidation', 'Still waiting for the effective dates.', NULL, NULL, '2021-06-30 16:56:34', '2021-06-30 16:56:34'),
(16521, 1006, 21099, NULL, '2021-07-19 00:00:00.000', 'Revalidation', 'Sent f/u email @ Credentialing Committee CredentialingCommittee@bcbstx.com:  Sub: Attn: Roshundra Flanders, Credentialing Coordinator  \"Hello,   Can you please let me know who our network representative is so we can get in touch with them?  Thank you. \"', NULL, NULL, '2021-07-12 12:53:50', '2021-07-12 12:53:50'),
(16522, 1006, 21099, NULL, '2021-08-20 00:00:00.000', 'Revalidation', 'Sent f/u email @ connie_traylor@bcbstx.com:  Sub: Enrollment/Location Status - RHC - BCBS  \"Hello Connie,   I wanted to get an update regarding the enrollment status for the following provider under the mentioned addresses for our group:  Group Name: Statcare Minor Emergency Clinic TIN# 46-0575924  Addresses:Primary Location: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Location: 4042 River Hill, Corpus Christi, TX 78410 Tertiary Location: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Quaternary Location: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Provider Name: Juan Capupus NPI# 1891168597  Please get back to me as soon as possible. Thank you.\"', NULL, NULL, '2021-08-13 12:49:04', '2021-08-13 12:49:04'),
(16523, 1006, 21099, NULL, '2021-08-24 00:00:00.000', 'Revalidated', 'Received the following confirmation from connie_traylor@bcbstx.com:  Sub: Enrollment/Location Status - RHC - BCBS  \"Good morning,  Juan Capupus has all of the below addresses added. 4042 River Hill Dr is showing as primary physical with 500 E. Caesar Ave, 3817 S. Padre Island Dr., and 6646 S Staples St, Ste 122, as satellite locations.  Thanks, Connie Traylor Network Management Consultant Blue Cross and Blue Shield of Texas Lubbock, Texas 79424 Ph: 806-798-6317 Fax: 806-783-4666 Helpful Links:  Availity -  800-282-4548 BCBSTX Provider Website -  http://www.bcbstx.com/provider/ Claims Adjustment -  800-451-0287 COVID-19/ Telehealth & Telemedicine - https://www.bcbstx.com/provider/covid-19-preparedness.html Provider Training -  https://www.bcbstx.com/provider/training/faqs.html\"', NULL, NULL, '2021-08-17 13:29:49', '2021-08-17 13:29:49'),
(16524, 3046, 21100, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:19:37', '2021-03-15 14:19:37'),
(16525, 3040, 21100, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Provider enrolled with BCBS. ', NULL, NULL, '2021-03-29 12:28:10', '2021-03-29 12:28:10'),
(16526, 3046, 21101, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:20:31', '2021-03-15 14:20:31'),
(16527, 3040, 21101, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Provider Participating with BCBS ', NULL, NULL, '2021-03-29 12:57:09', '2021-03-29 12:57:09'),
(16528, 3046, 21102, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:20:36', '2021-03-15 14:20:36'),
(16529, 3040, 21102, NULL, '2021-04-05 00:00:00.000', 'Initiated', 'Email sent to: provider_relations_houston@bcbstx.com tx_standard_contracting_team@bcbstx.com  Subject:  Add Location || Statcare Minor Emergency Clinic || Providers || BCBS ||   Greetings,   Hope you are doing well. I wanted to add the providers in the BCBS for our group Statcare Minor Emergency Clinic under the below locations.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Additional Location: 3817 South Padre Island Drive  Corpus Christi , TX 78415  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 (Not Showing on directory)  Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Additional Location: 4042 River Hill  Corpus Christi , TX 78410 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-29 13:04:26', '2021-03-29 13:04:26'),
(16530, 3040, 21102, NULL, '2021-04-06 00:00:00.000', 'In Process', 'Email sent to: Connie_Traylor@bcbstx.com, Provider_Relations_South_Texas@bcbstx.com  Subject: Add Location || Statcare Minor Emergency Clinic || Providers || BCBS ||  Greetings,   Hope you are doing well. I wanted to add the providers in the BCBS for our group Statcare Minor Emergency Clinic under the below locations.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Additional Location: 3817 South Padre Island Drive  Corpus Christi , TX 78415  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 (Not Showing on directory)  Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Additional Location: 4042 River Hill  Corpus Christi , TX 78410 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-30 08:40:41', '2021-03-30 08:40:41'),
(16531, 1006, 21102, NULL, '2021-05-04 00:00:00.000', 'Approved', 'Received an email from Bel Villarreal (Bel_Villarreal@bcbstx.com  \"RE: Credentialing Status - Petina Rogers- STATCARE MINOR EMERGENCY CLINIC  Good Afternoon Ahmed,   The providers effective network date is 11/19/2019, for the following networks: Blue Choice PPO, Blue Essentials HMO/Health select, Blue Advantage HMO, Chip, and Medicare Advantage PPO. \"  The provider has been added to the location, location confirmation is attached for reference.', NULL, NULL, '2021-04-27 07:22:52', '2021-04-27 07:22:52'),
(16532, 3046, 21103, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:20:48', '2021-03-15 14:20:48'),
(16533, 3040, 21103, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Provider enrolled in BCBS.', NULL, NULL, '2021-03-29 12:48:43', '2021-03-29 12:48:43'),
(16534, 3046, 21104, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:20:50', '2021-03-15 14:20:50'),
(16535, 3040, 21104, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Provider Contracted with RHC\'s. ', NULL, NULL, '2021-03-29 12:43:47', '2021-03-29 12:43:47'),
(16536, 3046, 21105, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:20:52', '2021-03-15 14:20:52'),
(16537, 3040, 21105, NULL, '2021-04-05 00:00:00.000', 'Approved', 'The provider is now in network effective 12/04/2020', NULL, NULL, '2021-03-29 12:32:31', '2021-03-29 12:32:31'),
(16538, 1006, 21106, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:24:44', '2021-03-15 14:24:44'),
(16539, 3040, 21106, NULL, '2021-04-27 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Group & Provider Status || Spectrum Neuro Behavioral Care LLC || Group & Providers || First Health ||  Hello Laura,   Hope you are doing well. Please advise me the enrollment status for the below mentioned group and providers for our group with First Health under the below location. If the providers are in-network so can you please send me the welcome letter for them.   Practice Details: Practice Name: Spectrum Neuro Behavioral Care LLC Practice Tax ID# 83-4482753 Practice NPI# 1356906572 Practice Address: 61 Lincoln St., Suite 203, Framingham , MA 01702  Provider 1: Provider Name: Rashid, Mahreen Provider NPI# 1396393146  Provider 2:   Provider Name: Khan, Fauzia Wali Provider NPI# 1699761965  Provider 3:   Provider Name: Pionke, Peggy Provider NPI# 1699307322  Provider 4:   Provider Name: L\'Etoile, Melody Provider NPI# 1942687108  Provider 5:   Provider Name: Hartman, Jessica Provider NPI# 1326665472  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-20 12:42:58', '2021-04-20 12:42:58'),
(16540, 1019, 21106, NULL, '2021-05-27 00:00:00.000', 'On Hold', 'Waiting for Aetna', NULL, NULL, '2021-05-20 09:31:38', '2021-05-20 09:31:38'),
(16541, 1006, 21107, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:24:45', '2021-03-15 14:24:45'),
(16542, 3040, 21107, NULL, '2021-04-27 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Group & Provider Status || Spectrum Neuro Behavioral Care LLC || Group & Providers || First Health ||  Hello Laura,   Please advise me the enrollment status for the below mentioned group and providers for our group with First Health under the below location. If the providers are in-network so can you please send me the welcome letter for them.   Practice Details: Practice Name: Spectrum Neuro Behavioral Care LLC Practice Tax ID# 83-4482753 Practice NPI# 1356906572 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702 Secondary Address: 100 New State Hwy. Raynham , MA 02767  Provider 1: Provider Name: Tawakol, Katie Provider NPI# 1609222116  Provider 2: Provider Name: Rashid, Mahreen Provider NPI# 1396393146  Provider 3: Provider Name: Hefti, Prisca Provider NPI# 1508133182  Provider 4: Provider Name: Khan, Fauzia Wali Provider NPI# 1699761965  Provider 5: Provider Name: Pionke, Peggy Provider NPI# 1699307322  Provider 6: Provider Name: Ullrich, Jennifer Lee Provider NPI# 1710489760  Provider 7: Provider Name: Schubert, Jonathan Provider NPI# 1235755505  Provider 8: Provider Name: Edmundson, Rodesia Sharese Provider NPI# 1124622667  Provider 9: Provider Name: Hignite, Barbara Provider NPI# 1982617262  Provider 10: Provider Name: Rozell, Carlee Provider NPI# 1225645393  Provider 11: Provider Name: Loveland, Lynnetta Provider NPI# 1598163602  Provider 12: Provider Name: Smith, Kerry R Provider NPI# 1275083230  Please get back to me as soon as you can get a chance. Waiting for your reply.   Thanks ', NULL, NULL, '2021-04-20 13:14:25', '2021-04-20 13:14:25'),
(16543, 1019, 21107, NULL, '2021-05-27 00:00:00.000', 'On Hold', 'Waiting for Aetna', NULL, NULL, '2021-05-20 09:32:54', '2021-05-20 09:32:54'),
(16544, 3046, 21108, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:28:49', '2021-03-15 14:28:49'),
(16545, 1006, 21108, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Welcome letter attached for reference as well as Plans/Network & Location.   Provider ID# 3642734 Eff: 05/01/2020  ', NULL, NULL, '2021-03-29 10:56:12', '2021-03-29 10:56:12'),
(16546, 3046, 21109, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:29:00', '2021-03-15 14:29:00'),
(16547, 1006, 21109, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Dear MAEGAN SVATEK, APRN,  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.  Julie A. Vayer  Vice President  Total Health & Network  Julie Vayer	 Let’s get started Your effective date is 05/01/2020. Your provider identification number is‍ ‌6115934. Please take a moment to register for the Cigna for Health Care Professionals website (CignaforHCP.com).  ', NULL, NULL, '2021-03-29 11:52:59', '2021-03-29 11:52:59'),
(16548, 1006, 21110, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:29:01', '2021-03-15 14:29:01'),
(16549, 1019, 21110, NULL, '2021-05-05 00:00:00.000', 'Not Eligible', 'Provider cannot enroll, because New Health England doesn\'t enroll provider from Framingham. ', NULL, NULL, '2021-04-28 14:56:20', '2021-04-28 14:56:20'),
(16550, 1006, 21111, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:29:03', '2021-03-15 14:29:03'),
(16551, 1019, 21111, NULL, '2021-05-05 00:00:00.000', 'On Hold', 'Provider cannot enroll, because New Health England doesn\'t enroll provider from Framingham. ', NULL, NULL, '2021-04-28 14:56:09', '2021-04-28 14:56:09'),
(16552, 1006, 21112, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:29:04', '2021-03-15 14:29:04'),
(16553, 1019, 21112, NULL, '2021-04-08 00:00:00.000', 'Not Eligible', 'Provider cannot enroll, because New Health England doesn\'t enroll provider from Framingham.', NULL, NULL, '2021-04-01 15:56:23', '2021-04-01 15:56:23'),
(16554, 3046, 21113, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:29:07', '2021-03-15 14:29:07'),
(16555, 1006, 21113, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Dear PATRICK AYARZAGOITIA,  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 02/05/2021. Your provider identification number is‍ ‌6223529. Please take a moment to register for the Cigna for Health Care Professionals website (CignaforHCP.com). ', NULL, NULL, '2021-03-29 11:19:27', '2021-03-29 11:19:27'),
(16556, 3046, 21114, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:29:15', '2021-03-15 14:29:15'),
(16557, 1006, 21114, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Dear MARI KATRINA CAPUPUS, PA,  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.  Julie A. Vayer  Vice President  Total Health & Network  Julie Vayer	 Let’s get started Your effective date is 05/01/2020. Your provider identification number is‍ ‌3986834. Please take a moment to register for the Cigna for Health Care Professionals website (CignaforHCP.com).', NULL, NULL, '2021-03-29 11:30:08', '2021-03-29 11:30:08'),
(16558, 3046, 21115, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:29:22', '2021-03-15 14:29:22'),
(16559, 1006, 21115, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Dear MARY GONZALEZ,  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 02/05/2021. Your provider identification number is‍ ‌0964158. Please take a moment to register for the Cigna for Health Care Professionals website (CignaforHCP.com).  ', NULL, NULL, '2021-03-29 11:36:09', '2021-03-29 11:36:09'),
(16560, 3046, 21116, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:29:27', '2021-03-15 14:29:27'),
(16561, 1006, 21116, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Dear TRACI MASON, MSN,  Congratulations! Your application to participate in the Cigna network has been approved. Our shared focus is on the health and well-being of every person we serve. Working together, we can help them live a healthy life.  Julie A. Vayer  Vice President  Total Health & Network  Julie Vayer	 Let’s get started Your effective date is 04/27/2020. Your provider identification number is‍ ‌4863679. Please take a moment to register for the Cigna for Health Care Professionals website (CignaforHCP.com).  ', NULL, NULL, '2021-03-29 11:43:42', '2021-03-29 11:43:42'),
(16562, 3046, 21117, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:29:36', '2021-03-15 14:29:36'),
(16563, 1006, 21117, NULL, '2021-04-05 00:00:00.000', 'Approved', 'As per my discussion with Cigna provider rep:   Katherine - Provider ID# 3353951 Eff: 02/18/2013  Ref: Lynette 03/29/2021 ', NULL, NULL, '2021-03-29 10:06:26', '2021-03-29 10:06:26'),
(16564, 3046, 21118, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:29:38', '2021-03-15 14:29:38'),
(16565, 1006, 21118, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Dear PETINA ROGERS, APRN,  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.  Julie A. Vayer  Vice President  Total Health & Network  Julie Vayer	 Let’s get started Your effective date is 05/01/2020. Your provider identification number is‍ ‌0355344. Please take a moment to register for the Cigna for Health Care Professionals website (CignaforHCP.com).  ', NULL, NULL, '2021-03-29 11:47:41', '2021-03-29 11:47:41'),
(16566, 3046, 21119, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:29:48', '2021-03-15 14:29:48'),
(16567, 1006, 21119, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Received the following update from Cigna rep, waiing on copy of welcome letter that we should be receiving in 10~15 business days;  Juan - Provider ID# 3642374 Eff: 05/01/2020  Ref: Lynette 03/29/2021 ', NULL, NULL, '2021-03-29 10:11:19', '2021-03-29 10:11:19'),
(16568, 1006, 21120, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:31:49', '2021-03-15 14:31:49'),
(16569, 1019, 21120, NULL, '2021-04-09 00:00:00.000', 'In Process', 'Receive the following email from mtasby2@humana.com   Per Humana contracting system \'Spectrum Neuro Behavioral Care LLC\' agreement will be executed 4/1/2021, you should receive an executed copy from the specialist.  Thanks,  Monica Tasby-Lafayette Provider Contracting Professional II |Network Operations ', NULL, NULL, '2021-04-02 13:47:41', '2021-04-02 13:47:41'),
(16570, 1019, 21120, NULL, '2021-04-09 00:00:00.000', 'New/Not Initiated', 'Recieved the following from mtasby2@humana.com  Hello Monica, We haven\'t received any Executed Contract till now and also, we sent the roster to add providers under our group were they linked under the group? and we also need to add a third location under the group details are mentioned below.  Group Details: Spectrum Neuro Behavioral Care LLC Tax ID: 834482753 NPI: 1356906572  Additional Location: 100 New State Highway, Raynham, MA, 02767    Regards, Alex', NULL, NULL, '2021-04-02 13:50:39', '2021-04-02 13:50:39'),
(16571, 1006, 21120, NULL, '2021-04-29 00:00:00.000', 'In Process', 'We received the following information from Humana Behavioral Health on-call @ 844-291-2162:  RI Addresses and both MA addresses are updated in the system for the group as in-network. Eff: 04/01/2021  RI Plans:  Commercial Network Medicare PPO   MA-Framingham Plans:  Commercial Network  Medicare PPO GoldPlus HMO  MA-Raynham Plans:  Commercial Network  Medicare PPO  Sent the following email to behavioralhealthproviderservices@humana.com:  Sub: Executed Contract & Effective Dates - SNBCare  \"Hello,  We wanted to get copies of our group and providers executed contracts and their effective dates, the information is as follows:  Group Name: Spectrum Neuro Behavioral Care LLC NPI# 1356906572 TIN# 83-4482753  Carlee Rozell NPI: 1225645393  Fauzia Wali Khan NPI: 1699761965  Jonathan Schubert NPI: 1235755505  Raveendran Pandeswari NPI: 1124247267  Melody Letoile NPI: 1942687108  Erin Oliva NPI: 1407349632  Please get back to me on the status of these providers and their welcome letter/executed contracts as soon as you\'re able to.  Thank you.\"', NULL, NULL, '2021-04-22 14:51:51', '2021-04-22 14:51:51'),
(16572, 1019, 21120, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to credentialinginquiries@humana.com SUB: Re: Secured: RE: Secured: RE: Welcome Letters - Providers - SNBCARE - Humana  Hello, We need the Welcome letter for the following providers and also if you can send me the copy of our Group contract with all 3 Locations on it.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Carlee Rozell NPI: 1225645393  Fauzia Wali Khan NPI: 1699761965  Jonathan Schubert NPI: 1235755505  Raveendran Pandeswari NPI: 1124247267  Melody Letoile NPI: 1942687108  Erin Oliva NPI: 1407349632  Rodesia Edmundson NPI: 1124622667  Kerry Smith NPI: 1275083230  Justin Souliere NPI: 1710576004  Regards, Alex', NULL, NULL, '2021-06-10 09:43:28', '2021-06-10 09:43:28'),
(16573, 11056, 21120, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Sub:  Fwd: Enrollment || Providers || SNBCARE || Humana  Good afternoon!  Hope this email finds you well. Please provide us with the welcome or approval letters for those providers whose credentialing processes are completed. Also, provide the updates related to the secondary location of the providers.  Kindly, also list these providers in the Humana provider directory. Please get back to me soon.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-09 17:36:38', '2021-12-09 17:36:38'),
(16574, 19067, 21120, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Enrollment Status || SNBCARE || Group & Providers || Humana ||  Hello,  Hope this email finds you well.  I want to know the enrollment status for the following providers under mentioned locations and also the group credentialing status.  If any Provider is enrolled provide me with their Effective date and Welcome letter.   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Halterman, Helena	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Halterman, Helena	1801473749	100 New State Highway, Raynham, MA, 02767. Smith, Kerry	1275083230	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Smith, Kerry	1275083230	100 New State Highway, Raynham, MA, 02767. Hignite, Barbara	1982617262	100 New State Highway, Raynham, MA, 02767. Hartman, Jessica	1326665472	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Hartman, Jessica	1326665472	100 New State Highway, Raynham, MA, 02767. DiCostanzo, Allie	1669045738	63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Filoteo-Nichols, Dina	1770021099	100 New State Highway, Raynham, MA, 02767. Filoteo-Nichols, Dina	1770021099	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Rodrigues, Eliza	1821751405	100 New State Highway, Raynham, MA, 02767. Rodrigues, Eliza	1821751405	61 Lincoln Street, Suite 203, Framingham, MA, 01702.  Kindly respond me in a timely manner.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-15 15:31:21', '2021-12-15 15:31:21'),
(16575, 19067, 21120, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||   Hello!  Hope you are doing really well.  I would like to know the enrollment status of the following Group and Providers with Humana.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Jessica Hartman	1326665472	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Jessica Hartman	1326665472	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Dina Filoteo Nichols	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Dina Filoteo Nichols	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Eliza Rodrigues	1821751405	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Eliza Rodrigues	1821751405	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Helena Halterman	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Helena Halterman	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Kerry Smith	1275083230	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Kerry Smith	1275083230	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Barbara Hignite	1982617262	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Allie DiCostanzo	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322   Waiting to hear from you soon!  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 14:38:15', '2021-12-29 14:38:15'),
(16576, 19067, 21120, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Re: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||    Greetings!  Any updates on the previously mentioned request?   Kindly respond promptly.  Thanks,  Hammad Ahmed.', NULL, NULL, '2022-01-10 13:18:09', '2022-01-10 13:18:09'),
(16577, 19067, 21120, NULL, '2022-02-06 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Re: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||   Hello!  Hope this email finds you well.  This is my Second Reminder on the request mentioned below. Kindly look into this.  Kindly reply as per your convenience.   Regards, Hammad Ahmed.', NULL, NULL, '2022-01-30 13:16:46', '2022-01-30 13:16:46'),
(16578, 19067, 21120, NULL, '2022-02-15 00:00:00.000', 'In Process', 'Email received from: mtasby2@humana.com  Subject: Re: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||  Hi Hammad,  Humana standard process, credential specialist mail approval letters are mailed to providers upon completion/approval.   Providers can also utilize the Availity Web Portal located at www.availity.com   Thank you,  Monica', NULL, NULL, '2022-02-08 14:25:25', '2022-02-08 14:25:25'),
(16579, 19067, 21120, NULL, '2022-03-16 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Re: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||   Hi Monica,  I haven\'t received a welcome letter yet. Kindly advise on how much time will it take?   Regards, Hammad Ahmed.', NULL, NULL, '2022-03-09 14:57:30', '2022-03-09 14:57:30'),
(16580, 19067, 21120, NULL, '2022-03-17 00:00:00.000', 'In Process', 'Email received from: mtasby2@humana.com  Subject: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||    Here are Humana standard process if approval letters are NOT received:     ·       system will not generate approval letters, if providers have existing records with (Humana/Choice Care), To check status you may call into customer service at 800-448-6262. Please also feel free to use Availity or the Humana directory. And/or verify with the provider,  if approval letter was received.     Reasons why provider credentialing will be denied:      CAQH application:  · Practice location missing  · Copy of license or license listed on application is not set to expire in the next 45 days  · Copy of insurance and/or insurance listed on application is not set to expire in the next 45 days  · At least 5 years of work history with gaps greater than 6 months explained on the application  · Education        Thank you,  Monica Tasby-Lafayette  Provider Contracting Professional II |Network Operations     Humana logo, return to homepage     * E-Mail: mtasby2@humana.com | : Web: www.humana.com', NULL, NULL, '2022-03-10 10:50:10', '2022-03-10 10:50:10'),
(16581, 22077, 21120, NULL, '2022-04-11 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Enrollment Status || Group & Providers || SNBCARE || HUMANA ||   Hello!  Hope you are doing really well.  I would like to know the enrollment status of the following Group and Providers with Humana. If any provider is enrolled provide us with their effective dates.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Jessica Hartman	1326665472	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Jessica Hartman	1326665472	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Dina Filoteo Nichols	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Dina Filoteo Nichols	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Eliza Rodrigues	1821751405	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Eliza Rodrigues	1821751405	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Helena Halterman	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Helena Halterman	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Kerry Smith	1275083230	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Kerry Smith	1275083230	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Barbara Hignite	1982617262	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Allie DiCostanzo	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322   Waiting to hear from you soon!  Thanks & Regards,', NULL, NULL, '2022-04-04 13:49:10', '2022-04-04 13:49:10'),
(16582, 1006, 21121, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:31:52', '2021-03-15 14:31:52'),
(16583, 1019, 21121, NULL, '2021-04-23 00:00:00.000', 'Initiated', 'Sent the following email to: mtasby2@humana.com  Hello Monica, We have attached the roster for the new Location address and the providers needed to be added under that location. Let us know if anything else is required and also if you need any further assistance let me know. Also I haven\'t heard from you about the credentialing process of our group and providers, you said that the effective date was 04/01/2021, so is it okay to start billing for our group and providers.   Group Information Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753   Regards, Alex', NULL, NULL, '2021-04-16 07:04:02', '2021-04-16 07:04:02'),
(16584, 1019, 21121, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to credentialinginquiries@humana.com SUB: Re: Secured: RE: Secured: RE: Welcome Letters - Providers - SNBCARE - Humana  Hello, We need the Welcome letter for the following providers and also if you can send me the copy of our Group contract with all 3 Locations on it.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Carlee Rozell NPI: 1225645393  Fauzia Wali Khan NPI: 1699761965  Jonathan Schubert NPI: 1235755505  Raveendran Pandeswari NPI: 1124247267  Melody Letoile NPI: 1942687108  Erin Oliva NPI: 1407349632  Rodesia Edmundson NPI: 1124622667  Kerry Smith NPI: 1275083230  Justin Souliere NPI: 1710576004  Regards, Alex', NULL, NULL, '2021-06-10 09:49:40', '2021-06-10 09:49:40'),
(16585, 1019, 21121, NULL, '2021-06-18 00:00:00.000', 'Approved', 'Spoken with Rep  Mark M as per the provider is effective 01/01/2021. Attached is the Location Confirmation Approvals from Humana Directory for Ref.', NULL, NULL, '2021-06-11 11:41:10', '2021-06-11 11:41:10'),
(16586, 1006, 21122, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:31:54', '2021-03-15 14:31:54'),
(16587, 1019, 21122, NULL, '2021-04-26 00:00:00.000', 'In Process', 'Sent the following email to : credentialinginquiries@humana.com Hello, As we have received the confirmation from the Network operations that our group and the following providers are In Network with effective dates 04/01/2021. They have asked us to asked you guys for the welcome letters. Can you please sent us the welcome letters for the following providers, we have attached the roster for our provider. Let me know if anything else is required.   Regards, Alex', NULL, NULL, '2021-04-19 10:43:35', '2021-04-19 10:43:35'),
(16588, 1019, 21122, NULL, '2021-04-27 00:00:00.000', 'Approved', 'Received the Approval Letter from Humana, effective date under group 04/01/2021 ', NULL, NULL, '2021-04-20 13:38:40', '2021-04-20 13:38:40'),
(16589, 1006, 21123, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:31:58', '2021-03-15 14:31:58'),
(16590, 1019, 21123, NULL, '2021-04-26 00:00:00.000', 'In Process', 'Sent the following email to : credentialinginquiries@humana.com Hello, As we have received the confirmation from the Network operations that our group and the following providers are In Network with effective dates 04/01/2021. They have asked us to asked you guys for the welcome letters. Can you please sent us the welcome letters for the following providers, we have attached the roster for our provider. Let me know if anything else is required.   Regards, Alex', NULL, NULL, '2021-04-19 10:44:13', '2021-04-19 10:44:13'),
(16591, 1019, 21123, NULL, '2021-04-27 00:00:00.000', 'Approved', 'Received the Approval Letter from Humana, effective date under group 04/01/2021 ', NULL, NULL, '2021-04-20 13:18:33', '2021-04-20 13:18:33'),
(16592, 1006, 21124, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:31:59', '2021-03-15 14:31:59'),
(16593, 1019, 21124, NULL, '2021-04-26 00:00:00.000', 'In Process', 'Sent the following email to : credentialinginquiries@humana.com Hello, As we have received the confirmation from the Network operations that our group and the following providers are In Network with effective dates 04/01/2021. They have asked us to asked you guys for the welcome letters. Can you please sent us the welcome letters for the following providers, we have attached the roster for our provider. Let me know if anything else is required.   Regards, Alex', NULL, NULL, '2021-04-19 10:39:44', '2021-04-19 10:39:44'),
(16594, 1019, 21124, NULL, '2021-04-27 00:00:00.000', 'Approved', 'Received the Approval Letter from Humana, effective date under group 04/01/2021 ', NULL, NULL, '2021-04-20 12:28:45', '2021-04-20 12:28:45'),
(16595, 1006, 21125, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:32:03', '2021-03-15 14:32:03'),
(16596, 1006, 21125, NULL, '2021-04-29 00:00:00.000', 'Initiated', 'Sent the following email to mtasby2@humana.com  Hello Monica, We have attached the roster for the new Location address and the providers needed to be added under that location. Let us know if anything else is required and also if you need any further assistance let me know. Also I haven\'t heard from you about the credentialing process of our group and providers, you said that the effective date was 04/01/2021, so is it okay to start billing for our group and providers.   Group Information Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753   Regards, Alex ', NULL, NULL, '2021-04-22 15:56:00', '2021-04-22 15:56:00'),
(16597, 1019, 21125, NULL, '2021-04-30 00:00:00.000', 'New/Not Initiated', 'Spoken with Anna @ (800) 890-8288, the conversation is mentioned below,  Spoken with rep Anna that Carlee is not showing that she was ever credentialed and as per the rep she cannot be linked until unless she is credentialed with Humana. Will need to send her application to Humana at behavioralhealthproviderservices@humana.comto get her credentialed with Humana.  Ref# 2000180791827 Anna L 04-23-2021', NULL, NULL, '2021-04-23 15:16:34', '2021-04-23 15:16:34'),
(16598, 1019, 21125, NULL, '2021-04-30 00:00:00.000', 'Initiated', 'Application submitted online thru website. See attachments for reference', NULL, NULL, '2021-04-23 15:49:20', '2021-04-23 15:49:20'),
(16599, 1019, 21125, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to credentialinginquiries@humana.com SUB: Re: Secured: RE: Secured: RE: Welcome Letters - Providers - SNBCARE - Humana  Hello, We need the Welcome letter for the following providers and also if you can send me the copy of our Group contract with all 3 Locations on it.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Carlee Rozell NPI: 1225645393  Fauzia Wali Khan NPI: 1699761965  Jonathan Schubert NPI: 1235755505  Raveendran Pandeswari NPI: 1124247267  Melody Letoile NPI: 1942687108  Erin Oliva NPI: 1407349632  Rodesia Edmundson NPI: 1124622667  Kerry Smith NPI: 1275083230  Justin Souliere NPI: 1710576004  Regards, Alex', NULL, NULL, '2021-06-10 09:49:32', '2021-06-10 09:49:32'),
(16600, 1019, 21125, NULL, '2021-11-16 00:00:00.000', 'Not Eligible', 'Provider will no longer with SNBCARE.', NULL, NULL, '2021-11-09 10:32:43', '2021-11-09 10:32:43'),
(16601, 1006, 21126, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:32:05', '2021-03-15 14:32:05'),
(16602, 1019, 21126, NULL, '2021-04-26 00:00:00.000', 'In Process', 'Sent the following email to : credentialinginquiries@humana.com Hello, As we have received the confirmation from the Network operations that our group and the following providers are In Network with effective dates 04/01/2021. They have asked us to asked you guys for the welcome letters. Can you please sent us the welcome letters for the following providers, we have attached the roster for our provider. Let me know if anything else is required.   Regards, Alex', NULL, NULL, '2021-04-19 10:42:28', '2021-04-19 10:42:28'),
(16603, 1019, 21126, NULL, '2021-04-27 00:00:00.000', 'In Process', 'Sent the following email to : credentialinginquiries@humana.com SUB: RE: Welcome Letters - Providers - SNBCARE - Humana  Hello, We haven\'t received any welcome letters for the following providers and our group.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753   Carlee Rozell NPI: 1225645393  Fauzia Wali Khan NPI: 1699761965  Jonathan Schubert NPI: 1235755505  Raveendran Pandeswari NPI: 1124247267  Melody Letoile NPI: 1942687108  Erin Oliva NPI: 1407349632   Regards, Alex ', NULL, NULL, '2021-04-20 14:32:49', '2021-04-20 14:32:49'),
(16604, 1019, 21126, NULL, '2021-04-30 00:00:00.000', 'In Process', 'Sent the following email to behavioralhealthproviderservices@humana.com  Hello, As we have received the confirmation from the Network operations that our group and the following providers are In Network with effective dates 04/01/2021. They have asked us to ask you guys for the welcome letters. Can you please send us the welcome letters for the following providers, we have attached the roster for our provider. Let me know if anything else is required.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers  Fauzia Wali Khan NPI: 1699761965  Jonathan Schubert NPI: 1235755505  Raveendran Pandeswari NPI: 1124247267  Melody Letoile NPI: 1942687108  Erin Oliva NPI: 1407349632  Regards, Alex', NULL, NULL, '2021-04-23 15:07:43', '2021-04-23 15:07:43'),
(16605, 1019, 21126, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to credentialinginquiries@humana.com SUB: Re: Secured: RE: Secured: RE: Welcome Letters - Providers - SNBCARE - Humana  Hello, We need the Welcome letter for the following providers and also if you can send me the copy of our Group contract with all 3 Locations on it.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Carlee Rozell NPI: 1225645393  Fauzia Wali Khan NPI: 1699761965  Jonathan Schubert NPI: 1235755505  Raveendran Pandeswari NPI: 1124247267  Melody Letoile NPI: 1942687108  Erin Oliva NPI: 1407349632  Rodesia Edmundson NPI: 1124622667  Kerry Smith NPI: 1275083230  Justin Souliere NPI: 1710576004  Regards, Alex', NULL, NULL, '2021-06-10 09:43:21', '2021-06-10 09:43:21'),
(16606, 1019, 21126, NULL, '2021-06-18 00:00:00.000', 'Approved', 'Spoken with Rep  Mark M as per the provider is effective 01/01/2021 Call Ref # 2000187394353. Attached is the Location Confirmation Approvals from Humana Directory for Ref.', NULL, NULL, '2021-06-11 11:55:36', '2021-06-11 11:55:36'),
(16607, 1006, 21127, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 14:32:06', '2021-03-15 14:32:06'),
(16608, 1019, 21127, NULL, '2021-04-09 00:00:00.000', 'Initiated', 'Sent the following email to : behavioralhealthproviderservices  Sub: Enroll Provider || SNBCARE || Kerry Smith || MBHP  Hello, We wanted to enroll the below mentioned provider in MBHP, under our group. Can you let us know if you do enroll these types of provider.  Group Information: Spectrum Neuro Behavioral Care LLC Tax ID: 834482753 NPI: 1356906572  Individual Provider: Kerry Smith NPI: 1275083230 Speciality: Licensed Clinical Social Worker ', NULL, NULL, '2021-04-02 14:05:56', '2021-04-02 14:05:56'),
(16609, 1019, 21127, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to credentialinginquiries@humana.com SUB: Re: Secured: RE: Secured: RE: Welcome Letters - Providers - SNBCARE - Humana  Hello, We need the Welcome letter for the following providers and also if you can send me the copy of our Group contract with all 3 Locations on it.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Carlee Rozell NPI: 1225645393  Fauzia Wali Khan NPI: 1699761965  Jonathan Schubert NPI: 1235755505  Raveendran Pandeswari NPI: 1124247267  Melody Letoile NPI: 1942687108  Erin Oliva NPI: 1407349632  Rodesia Edmundson NPI: 1124622667  Kerry Smith NPI: 1275083230  Justin Souliere NPI: 1710576004  Regards, Alex', NULL, NULL, '2021-06-10 09:49:20', '2021-06-10 09:49:20'),
(16610, 11056, 21127, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Sub:  Fwd: Enrollment || Providers || SNBCARE || Humana  Good afternoon!  Hope this email finds you well. Please provide us with the welcome or approval letters for those providers whose credentialing processes are completed. Also, provide the updates related to the secondary location of the providers.  Kindly, also list these providers in the Humana provider directory. Please get back to me soon.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-09 17:36:34', '2021-12-09 17:36:34');
