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
(820, 3040, 120, NULL, '2021-07-16 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Additional Location || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Greetings,   Hope you are doing well. I wanted to add the location under the below mentioned providers in Tricare in our group under the below mentioned locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Jose, Julie Provider NPI# 1447883061 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 2:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 3:   Provider Name: Rauf, Abdur  Provider NPI# 1497726202 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 4:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 5:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238 Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226   Provider 7:   Provider Name: Abraham, Jeena  Provider NPI# 1467901587 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-07-09 14:33:11', '2021-07-09 14:33:11'),
(821, 11056, 120, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email received from :    ywyatt@humana.com  Sub : Fwd: Additional Location || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Good Morning Adil,     To add a provider to a network location you need to complete the attached spreadsheet and email it to the HGB Roster team to process.     Send the completed spreadsheet to the following email address     HGBProviderRosters@Humana.com              Thanks,  Yvonne', NULL, NULL, '2021-08-11 11:29:11', '2021-08-11 11:29:11'),
(822, 3040, 120, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to: HGBProviderRosters@humana.com, ywyatt@humana.com  Subject: Re: Additional Location || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Received Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in an additional location in Tricare in our group under the below highlighted locations. We already submitted the roster for an additional location on 07/19/2021.   Practice Details: Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider 1:     Provider Name: Jose, Julie  Provider NPI# 1447883061  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 2:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 3:    Provider Name: Rauf, Abdur   Provider NPI# 1497726202  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 4:    Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 5:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 6:    Provider Name: Thomas, Cini   Provider NPI# 1134777238  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226   Provider 7:    Provider Name: Abraham, Jeena   Provider NPI# 1467901587  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you!! ', NULL, NULL, '2021-08-18 16:51:30', '2021-08-18 16:51:30'),
(823, 3040, 120, NULL, '2021-09-08 00:00:00.000', 'Approved', 'Email rcvd from: ywyatt@humana.com  Subject: RE: Additional Location || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Good Afternoon Adil,  We show the following.  This information is available on the Providers Portal or directory Highlighted is the link to check status. I have attached a copy of the spreadsheet of the Providers we show affiliated to these groups under this tax id.   https://infocenter.humana-military.com/provider/service/Account/Login  HumanaMilitary - Find care (goperspecta.com)  Provider 1:   Provider Name: Jose, Julie- Show has been added Provider NPI# 1447883061 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 2:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 – Show added Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226- Show not added yet  Provider 3:  Show Added Provider Name: Rauf, Abdur  Provider NPI# 1497726202 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 4:  Show added to both locations Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 5:  - Show added Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 6:   Provider Name: Thomas, Cini – show added to all three locations Provider NPI# 1134777238 Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 7:  - Show added. Provider Name: Abraham, Jeena  Provider NPI# 1467901587 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Thanks, Yvonne W. Wyatt, Humana Military TRICARE Community Liaison II Houston/Galveston 502-318-5409 Telephone 502-322-8018 Fax ywyatt@humana.com', NULL, NULL, '2021-09-01 13:08:11', '2021-09-01 13:08:11'),
(824, 2027, 123, NULL, '2020-09-08 00:00:00.000', 'In Process', 'To: SWHPPROVIDERNETWORKDEVELOPMENT@bswhealth.org  Sub: (Joseph, Vibitha)-(Longpoint Medical Center)-(Scott & White)  May i know the current status of the provider mentioned below: Provider Name-Joseph, Vibitha Provider NPI#1952931560 Group Name-Longpoint Medical Center Group Tax-ID-76-0612416  Thanks.', NULL, NULL, '2020-09-01 16:45:54', '2020-09-01 16:45:54'),
(825, 1006, 123, NULL, '2020-10-23 00:00:00.000', 'In Process', 'Sent a followup email to swhpregion2@bswhealth.org for status update. ', NULL, NULL, '2020-10-16 14:18:24', '2020-10-16 14:18:24'),
(826, 2037, 123, NULL, '2020-11-16 00:00:00.000', 'In Process', 'Sent a followup email to swhpregion2@bswhealth.org for status update. ', NULL, NULL, '2020-10-26 17:11:03', '2020-10-26 17:11:03'),
(827, 2037, 123, NULL, '2020-11-26 00:00:00.000', 'In Process', 'Follow up email sent to SWHPPROVIDERNETWORKDEVELOPMENT@bswhealth.org', NULL, NULL, '2020-11-16 12:31:13', '2020-11-16 12:31:13'),
(828, 2037, 123, NULL, '2020-11-26 00:00:00.000', 'Approved', 'URGENT CARE CONTRACT-LPMC -------------------  Herrera, Jose L Jose.Herrera@bswhealth.org Tue, Nov 17, 8:55 AM (2 days ago) to Martin, me, SWHP  Sherry,  Your TAX ID was contracted as a facility only contract.  We did not credential or load any providers under this contract    We would not have been given any providers to credential or load in our systems under a facility contract.   Thank you,   Jose Herrera  Provider Relations Representative  FirstCare Health Plans—part of Baylor Scott & White Health  1901 W. Loop 289, Suite 9 | Lubbock, TX 79407  806-784-4306 Office | 806-784-4396 Fax  FirstCare.com     ', NULL, NULL, '2020-11-19 15:46:32', '2020-11-19 15:46:32'),
(829, 2027, 124, NULL, NULL, 'In Process', 'From: Michele.Thomas-Martin@molinahealthcare.com  To: LPMC@claimssmedinc.com  Good Morning,     Follow up     I hope your morning is going great.  Please confirm if the facility or provider listed below would like to complete the contracting process with Molina.   If so, please complete the attached documents and submit within 15 days.  If no documents are received within 15 days the request for the below provider will be discontinued.     Thank You,', NULL, NULL, '2020-07-02 17:32:32', '2020-07-02 17:32:32'),
(830, 2027, 124, NULL, NULL, 'In Process', 'To: Michele.Thomas-Martin@molinahealthcare.com  Please find the attached documents you have requested, let me know if anything is missing or required.  Thanks.', NULL, NULL, '2020-07-02 17:33:51', '2020-07-02 17:33:51'),
(831, 2027, 124, NULL, NULL, 'In Process', 'From: Michele.Thomas-Martin@molinahealthcare.com  Record # 165931     Good Afternoon,     Thank you for submitting the documents.  Please submit the signed compensation pages 15,16.   Also the sample claim form is blank, please complete boxes 25,33.  The sample claim form should include the TIN in box 25 and the pay to name , address, phone # and NPI in box 33.     Thank You,', NULL, NULL, '2020-07-07 12:02:08', '2020-07-07 12:02:08'),
(832, 2027, 124, NULL, NULL, 'In Process', 'To: Michele.Thomas-Martin@molinahealthcare.com  Please find the attached documents which you have requested.  Thanks.', NULL, NULL, '2020-07-07 12:09:42', '2020-07-07 12:09:42'),
(833, 2027, 124, NULL, NULL, 'In Process', 'To: Michele.Thomas-Martin@molinahealthcare.com  The supervising physician details for vibitha joseph are as follows:  Supervising Physician Name: James M Piccione JR  NPI# 1356321509  Thanks.', NULL, NULL, '2020-07-07 18:00:16', '2020-07-07 18:00:16'),
(834, 2027, 124, NULL, NULL, 'In Process', 'From: Michele.Thomas-Martin@molinahealthcare.com  Good Morning,     Please update CAQH application to allow Molina authorization, if you haven’t already done so.     Thank you for submitting the contracting documents, the documents have been loaded in the system and forwarded to credentialing.  The credentialing process could take 30-45 days to complete.     If not yet registered for Availity, go to www.Availity.com, click register in the top right of the page, then follow the organization registration process.  Once your registration is approved, you can proceed to the next step.     “Effective April 1, 2018, the state of Texas established a statewide concept to facilitate the credentialing process for Medicaid and CHIP providers in Texas.  This is facilitated by the Texas Association of Health Plans (TAHP), using a Credentialing Verification Organization (CVO) called Aperture.     Individual providers can use CAQH to enter their credentialing information and can upload any supporting documents.  This can be found at https://proview.caqh.org.  Or you may choose to complete the Texas Standardized Application for providers that is attached.     Facility providers can complete the Texas Standardized Application for HDO’s on the Availity portal.  You can register and complete the application by visiting www.availity.com.   Or you may choose to complete the Texas Standardized Application for facilities that is attached.”                We look forward to having you as a part of our network and encourage you to visit www.molinahealthcare.com to learn more about us.  My contact information is listed below should you have any questions or concerns.     Thank you,', NULL, NULL, '2020-07-08 09:35:06', '2020-07-08 09:35:06'),
(835, 2027, 124, NULL, NULL, 'In Process', 'To: Michele.Thomas-Martin@molinahealthcare.com  I have updated the CAQH of  Vibitha Joseph and James M Piccione JR Which you have requested.  Thanks. ', NULL, NULL, '2020-07-08 09:36:22', '2020-07-08 09:36:22'),
(836, 2027, 124, NULL, NULL, 'In Process', 'From: Michele.Thomas-Martin@molinahealthcare.com  To: mk@claimsmedinc.com  Good Morning,     Thank you, the record has been updated and sent to credentialing to add new group information.', NULL, NULL, '2020-07-08 12:01:40', '2020-07-08 12:01:40'),
(837, 2027, 124, NULL, '2020-09-01 00:00:00.000', 'Approved', 'From: Michele.Thomas-Martin@molinahealthcare.com  Record # 165931     Provider:  Vibitha Joseph     Good Afternoon,     Thank you for your inquiry.  The above provider has been loaded under all plans effective 9/1/2020.  The provider may start seeing members under the group 9/1/2020.  Please see the attached welcome letter and copy of executed agreement.     Thank You,', NULL, NULL, '2020-08-25 17:29:07', '2020-08-25 17:29:07'),
(838, 2027, 129, NULL, NULL, 'In Process', 'Karla.Claunch@dchstx.org  Provider-Angiollet Solis Escobar, NPI# 1962917997  \"Hello, Hope you are doing great, I want know about the current status of the provider Angiollet Solis Escobar, NPI# 1962917997. We have already submitted the enrollment form for this provider. so kindly update me regarding the expected time for completion of this request.  Thanks\"  ', NULL, NULL, '2020-06-12 14:53:51', '2020-06-12 14:53:51'),
(839, 2027, 129, NULL, NULL, 'In Process', 'Talk to the insurance representative his name is Julian ref# 372282  he said i takes some more time for this request to be completed.', NULL, NULL, '2020-06-23 12:45:12', '2020-06-23 12:45:12'),
(840, 2027, 129, NULL, NULL, 'In Process', 'Talk to the representative she said it may take 60 more days to complete the request ', NULL, NULL, '2020-06-29 13:13:16', '2020-06-29 13:13:16'),
(841, 2027, 129, NULL, NULL, 'In Process', 'To: Karla.Claunch@dchstx.org  Sub: (Escobar, Angiollet Solis)-(Valley Med Urgent Care PLLC (Brownsville)-(Driscoll)  May I know the current enrollment status of the below mentioned provider: Provider Name:  Escobar, Angiollet Solis  Provider NPI# 1962917997 Group Name: Valley Med Urgent Care PLLC (Brownsville) Tax ID: 81-5123542   Thanks', NULL, NULL, '2020-07-09 17:03:54', '2020-07-09 17:03:54'),
(842, 2027, 129, NULL, NULL, 'In Process', 'From: Martha.Butler@dchstx.org  Good evening Martin,     As per your request, below is the information needed to complete the addition of a secondary location change as well as to update a practice location. I have also attached the Request to Credential for Existing Group form, and included a contact point for your reference and/or credentialing inquires in the future. Please submit the Request to Credential for Existing Group Form to Karla Claunch, and submit the company letterhead to me with the necessary information.     Do not hesitate to contact me with questions or concerns.', NULL, NULL, '2020-07-16 12:43:45', '2020-07-16 12:43:45'),
(843, 2027, 129, NULL, NULL, 'In Process', 'To: 	DHPContracting@dchstx.org  Sub: (Escobar, Angiollet Solis)-(Valley Med Urgent Care PLLC (Brownsville)-(Driscoll)  Please find the attached request credential for existing group form.  Thanks.', NULL, NULL, '2020-07-16 12:44:49', '2020-07-16 12:44:49'),
(844, 2027, 129, NULL, '2020-09-28 00:00:00.000', 'In Process', 'To: Martha.Butler@dchstx.org  Sub: (Escobar, Angiollet Solis)-(Valley Med Urgent Care PLLC (Brownsville)-(Driscoll)  May I know the current status of the below mentioned provider: Provider Name: Escobar, Angiollet Solis Provider NPI: 1962917997 Group Name: Valley Med Urgent Care PLLC Group Tax-ID: 81-5123542  Thanks. ', NULL, NULL, '2020-09-21 09:39:27', '2020-09-21 09:39:27'),
(845, 2027, 129, NULL, '2020-10-28 00:00:00.000', 'In Process', 'To: Martha.Butler@dchstx.org  Sub: (Escobar, Angiollet Solis)-(Valley Med Urgent Care)-(Driscoll)  May I know the current status of the below mentioned provider: Provider Name: Escobar, Angiollet Solis Provider NPI: 1962917997 Group Name: Valley Med Urgent Care PLLC Group Tax-ID: 81-5123542  Thanks.', NULL, NULL, '2020-10-21 14:54:37', '2020-10-21 14:54:37'),
(846, 1006, 129, NULL, '2020-11-06 00:00:00.000', 'In Process', 'Sent a follow-up email to Martha Butler Martha.Butler@dchstx.org> for status of enrollment. ', NULL, NULL, '2020-10-28 18:13:33', '2020-10-28 18:13:33'),
(847, 2027, 129, NULL, '2020-11-13 00:00:00.000', 'In Process', 'To: Martha.Butler@dchstx.org  This is a followup email. Please reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-11-06 13:17:36', '2020-11-06 13:17:36'),
(848, 2027, 129, NULL, '2020-11-20 00:00:00.000', 'In Process', 'To: 	Anna.Bartholomew@dchstx.org  May I know the current status of the below mentioned provider: Provider Name: Escobar, Angiollet Solis Provider NPI: 1962917997 Group Name: Valley Med Urgent Care PLLC Group Tax-ID: 81-5123542  Thanks.  ', NULL, NULL, '2020-11-13 14:05:06', '2020-11-13 14:05:06'),
(849, 2027, 129, NULL, '2020-11-23 00:00:00.000', 'In Process', 'To: Anna.Bartholomew@dchstx.org  Please find the application attached in this email.', NULL, NULL, '2020-11-16 17:36:56', '2020-11-16 17:36:56'),
(850, 2027, 129, NULL, '2020-11-25 00:00:00.000', 'In Process', 'To: Karla.Claunch@dchstx.org  Please find the requested documents attached in this email to complete the enrollment process.   Thanks.', NULL, NULL, '2020-11-18 14:54:39', '2020-11-18 14:54:39'),
(851, 2027, 129, NULL, '2020-12-02 00:00:00.000', 'In Process', 'Waiting for the documents to receive from eder PAA and collaborative agreement to continue the process with insurance', NULL, NULL, '2020-11-25 10:23:20', '2020-11-25 10:23:20'),
(852, 2027, 129, NULL, '2020-12-09 00:00:00.000', 'In Process', 'Waiting for the documents to receive from eder PAA and collaborative agreement to continue the process with insurance', NULL, NULL, '2020-12-02 10:22:03', '2020-12-02 10:22:03'),
(853, 2027, 129, NULL, '2020-12-17 00:00:00.000', 'In Process', 'Waiting for the documents to receive from eder PAA and collaborative agreement to continue the process with insurance', NULL, NULL, '2020-12-10 12:52:16', '2020-12-10 12:52:16'),
(854, 3040, 129, NULL, '2020-12-24 00:00:00.000', 'In Process', 'We requested to Mr. Atif for Collaborative PAA and Collaborative agreement.   ', NULL, NULL, '2020-12-17 15:52:00', '2020-12-17 15:52:00'),
(855, 3040, 129, NULL, '2020-12-31 00:00:00.000', 'In Process', 'Waiting for the reply from Mr. Arif', NULL, NULL, '2020-12-24 13:15:26', '2020-12-24 13:15:26'),
(856, 3040, 129, NULL, '2021-01-07 00:00:00.000', 'In Process', 'Waiting for the reply from Mr. Arif', NULL, NULL, '2020-12-31 12:09:50', '2020-12-31 12:09:50'),
(857, 3040, 129, NULL, '2021-01-14 00:00:00.000', 'In Process', 'Waiting for the reply from Mr. Atif. ', NULL, NULL, '2021-01-07 15:28:43', '2021-01-07 15:28:43'),
(858, 3040, 129, NULL, '2021-01-19 00:00:00.000', 'In Process', 'Email sent to: Diana.Flores@dchstx.org  Subject: CREDENTIALING-Angiollet S Escobar NP  Greetings,  Hope you are doing well. First and foremost I really appreciate your prompt response. Please find the attached documents and information that you requested in your previous email. I also attached the Form F for more location.   If you need anything else from my side please feel to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-01-12 17:40:07', '2021-01-12 17:40:07'),
(859, 3040, 129, NULL, '2021-01-19 00:00:00.000', 'In Process', 'Email rcvd from: Diana.Flores@dchstx.org  Subject: CREDENTIALING-Angiollet S Escobar NP  Angiollet S Escobar NP NPI # 1962917997 Valley Med Urgent Care Tax ID # 81-5123542  Good morning,  In order to initiate the credentialing process, please provide the following information to avoid delay in credentialing the provider. Information missing, incomplete or expired.  ·         Attestation pages with current signature and date ·         Addendum * see attached addendum * has a different supervising physician then the physician on the PAA, please complete a new addendum Dr. Abdur Rauf does not have Angiollett Listed on his License as her supervising physician. *see PAA attached with Dr. Teresa Saavedra as her supervising physician ·         Copy of current board certification * If applicable Copy of W-9 with current signature and dated 2021  Texas Standardized Credentialing application * See attached pages missing information required. Page 4-5 – 3 References needed with full name/title/address/phone number * Call coverage, should be supervising physician Page 6-7- Practice location please review in its entirety for accuracy and provide your in-house billing contact’s name/address/phone and fax number/ email address/Check payable to Page F- missing page F for practice location 101 E Expy. 83 Ste. 170 McAllen Texas 78501-1166   I have attached forms needed, please provide the above required documents to process the application.  If you have any questions please contact me via email or phone  Thank you in advance for your cooperation.', NULL, NULL, '2021-01-12 17:41:19', '2021-01-12 17:41:19'),
(860, 3040, 129, NULL, '2021-01-26 00:00:00.000', 'In Process', 'Follow up email sent to: Diana.Flores@dchstx.org  Subject: CREDENTIALING-Angiollet S Escobar NP  Greetings,  Hope you are doing well. This a follow up regarding the below mentioned provider. Has there been any update?  Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631  Provider Name: Angiollet Solis  Escobar Provide NPI# 1962917997  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-01-19 10:50:51', '2021-01-19 10:50:51'),
(861, 3040, 129, NULL, '2021-01-26 00:00:00.000', 'In Process', 'Email rcvd from: Diana.Flores@dchstx.org  Subject: CREDENTIALING-Angiollet S Escobar NP  Good morning Adil,  The application was complete on my end, it is pending second review, also screening /reviewing the Supervising physicians application too.  If anything is needed for the supervising physician you will hear from the associate working Dr. Saavedra’s application.  I hope this helps! Thanks for reaching out.   ', NULL, NULL, '2021-01-19 12:30:27', '2021-01-19 12:30:27'),
(862, 3040, 129, NULL, '2021-01-26 00:00:00.000', 'In Process', 'Email rcvd from: Karla.Claunch@dchstx.org  Subject: (Escobar, Angiollet Solis)-(Valley Med Urgent Care PLLC (Brownsville)-(Driscoll)  Good afternoon,  I finally got an answer to this for you.  This provider will be going to committee this month and hopefully will be ready to go 02/01/2021.  You will receive an email with her welcome letter very soon.  Have a great day!  Karla Claunch    ', NULL, NULL, '2021-01-19 14:38:23', '2021-01-19 14:38:23'),
(863, 3040, 129, NULL, '2021-02-02 00:00:00.000', 'In Process', 'Follow up email sent to: Diana.Flores@dchstx.org  Subject: CREDENTIALING-Angiollet S Escobar NP  Greetings,  Hope you are doing well. I just wanted to know the enrollment status of the below mentioned provider.   Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166       Provider Name: Escobar, Angiollet Solis Provider NPI: 1962917997  Please feel free to call or email me if you have any questions. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-01-26 11:05:08', '2021-01-26 11:05:08'),
(864, 3040, 129, NULL, '2021-02-09 00:00:00.000', 'In Process', 'Email rcvd from: Diana.Flores@dchstx.org  Subject: CREDENTIALING-Angiollet S Escobar NP  Good morning Adil,  Angiollett’s account is on hold due to incomplete application for supervising physician (Teresa Saavedra).  Christine Rodriguez is assigned to screen Dr. Saavedra’s account.  I provided Christine with your email address to see if you can help with the items needed to complete Dr. Saavedra’s enrollment.', NULL, NULL, '2021-02-02 12:48:11', '2021-02-02 12:48:11'),
(865, 3040, 129, NULL, '2021-02-16 00:00:00.000', 'In Process', 'Email sent to: Diana.Flores@dchstx.org  Subject: CREDENTIALING-Angiollet S Escobar NP  Greetings,  Hope you are doing well. We submitted the requested documents to Christine Rodriguez for Dr. Saavedra. Can you please start the processing for the below mentioned provider.   Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider Name: Escobar, Angiollet Solis Provider NPI: 1962917997  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-02-09 10:26:28', '2021-02-09 10:26:28'),
(866, 3040, 129, NULL, '2021-02-23 00:00:00.000', 'In Process', 'Email sent to: Diana.Flores@dchstx.org  Subject: CREDENTIALING-Angiollet S Escobar NP  Hello,  Please advise me the enrollment status of the below mentioned provider.   Practice Detail: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider: Provider Name: Escobar, Angiollet Solis Provider NPI: 1962917997  Please get back to me as soon as you can get the chance. Waiting for your response.  Thanks', NULL, NULL, '2021-02-16 12:30:45', '2021-02-16 12:30:45'),
(867, 3040, 129, NULL, '2021-03-02 00:00:00.000', 'In Process', 'Email sent to: Diana.Flores@dchstx.org  Subject: CREDENTIALING-Angiollet S Escobar NP  Hello Adil,  The application was complete on my end. It was forwarded to the next stage of the credentialing process.  The committee meets and reviews the applications at the end of each month. Once reviewed you will receive a letter in the mail or an email, within 14 days after the committee reviews your application. The process may sometimes take up to 90- days once the credentialing process is complete.  Hope this helps.', NULL, NULL, '2021-02-23 17:47:43', '2021-02-23 17:47:43'),
(868, 3040, 129, NULL, '2021-03-10 00:00:00.000', 'In Process', 'Email sent to: Diana.Flores@dchstx.org  Subject:Re: CREDENTIALING-Angiollet S Escobar NP  Good Afternoon,  This is a follow up email regarding the enrollment status for the below mentioned provider.  Practice Detail: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider: Provider Name: Escobar, Angiollet Solis Provider NPI: 1962917997  Waiting for your reply.   Thank you', NULL, NULL, '2021-03-03 14:00:52', '2021-03-03 14:00:52'),
(869, 3040, 129, NULL, '2021-03-10 00:00:00.000', 'Approved', 'Provider enrolled under Driscoll.    Welcome Letter attached. ', NULL, NULL, '2021-03-03 14:57:07', '2021-03-03 14:57:07'),
(870, 2027, 130, NULL, NULL, 'In Process', 'To: 	TCHPNetworkManagemen@texaschildrens.org, rgmudali@texaschildrens.org, mydavis@texaschildrens.org, mamiller@texaschildrens.org  (Joseph, Vibitha)-(Longpoint Medical Center)-(Texas Children Health Plan - TCHP)  May i know the current application status of this provider, her details are mentioned below: Provider Name:Joseph, Vibitha Provider NPI# 1952931560    Group Name: Longpoint Medical Center Tax ID: 76-0612416  Thanks.', NULL, NULL, '2020-07-10 15:29:41', '2020-07-10 15:29:41'),
(871, 2027, 130, NULL, '2020-10-18 00:00:00.000', 'In Process', 'To: jxalanis@texaschildrens.org  May i know the current application status of this provider, her details are mentioned below: Provider Name:Joseph, Vibitha Provider NPI# 1952931560   Thanks.', NULL, NULL, '2020-10-11 15:57:08', '2020-10-11 15:57:08'),
(872, 2037, 130, NULL, '2020-11-05 00:00:00.000', 'In Process', 'Follow up email Sent .', NULL, NULL, '2020-10-26 17:13:46', '2020-10-26 17:13:46'),
(873, 2027, 130, NULL, '2020-11-12 00:00:00.000', 'In Process', 'From: jxalanis@texaschildrens.org  Sub: (Joseph, Vibitha)-(Longpoint Medical Center)-(Texas Children Health Plan)  Mr. Rodriguez,  The Credentialing process can take up to 90 days. Make sure the providers are attested to the service address.  Thank you     Juanita Alanis  Provider Relations   Texas Children\'s Health Plan  6330 West Loop South', NULL, NULL, '2020-11-05 13:12:08', '2020-11-05 13:12:08'),
(874, 2037, 130, NULL, '2020-11-24 00:00:00.000', 'In Process', 'Follow up email sent to Juanita', NULL, NULL, '2020-11-12 10:49:18', '2020-11-12 10:49:18'),
(875, 2037, 130, NULL, '2020-12-23 00:00:00.000', 'In Process', 'Credentialing is in process under Normandy. Will request to add location once the process finalizes.  ------------------------- Alanis, Juanita 11:39 AM (22 minutes ago) to me  Sherry,  These providers, Ani Stephen NPI: 1588959118, Jeemol George. NPI: 1497219067, Julie Jose, NPI: 1447883061 and Brittany Brown.  NPI: 1275163537 are not contracted with TCHP yet; there for cannot be added to the locations you are requesting. ', NULL, NULL, '2020-11-20 13:08:42', '2020-11-20 13:08:42'),
(876, 2037, 130, NULL, '2021-01-05 00:00:00.000', 'In Process', 'Currently being credentialed under normandy.Need to allow a bit more time.', NULL, NULL, '2020-12-23 17:19:17', '2020-12-23 17:19:17'),
(877, 1006, 130, NULL, '2021-02-03 00:00:00.000', 'In Process', 'Follow up email sent for credentialing to jxalanis@texaschildrens.org', NULL, NULL, '2021-01-27 12:29:09', '2021-01-27 12:29:09'),
(878, 1006, 130, NULL, '2021-02-23 00:00:00.000', 'In Process', 'Sent a follow-up email @ TCHP CA Contract Admin tchpnetworkmanagement@texaschildrens.org for updated status.  ', NULL, NULL, '2021-02-16 17:36:37', '2021-02-16 17:36:37'),
(879, 1006, 130, NULL, '2021-03-01 00:00:00.000', 'In Process', 'Received the following reply from TCHP CA Contract Admin tchpnetworkmanagement@texaschildrens.org:  \"Hello,  PIF for provider Vibitha Joseph is in process.   Thank you\"', NULL, NULL, '2021-02-19 15:51:22', '2021-02-19 15:51:22'),
(880, 1006, 130, NULL, '2021-03-01 00:00:00.000', 'In Process', 'Received the following reply from TCHP CA Contract Admin tchpnetworkmanagement@texaschildrens.org:  \"Hello,  PIF for provider Vibitha Joseph is in process.   Thank you  Self Note 20210115034283571\" ', NULL, NULL, '2021-02-19 16:43:49', '2021-02-19 16:43:49'),
(881, 3040, 130, NULL, '2021-03-08 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org, jxalanis@texaschildrens.org  Subject: Enrollment Status || Longpoint Medical Center || Joseph, Vibitha, Stephen, Ani || TCHP  Greetings,  Hope you are doing well. Please advise me the enrollment status for the below mentioned providers.   Practice Name: Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider Name: Stephen, Ani Provider NPI# 1588959118  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-03-01 13:30:03', '2021-03-01 13:30:03'),
(882, 3040, 130, NULL, '2021-03-26 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Location Addition || Imperial Valley Urgent Care Center & Longpoint Medical Center || Joseph, Vibitha || TCHP  Greetings,  Hope you are doing well. Please find the attached PIF form along with W9 to add the below provider in the locations.   Practice Details: Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-03-19 12:19:32', '2021-03-19 12:19:32'),
(883, 3040, 130, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: axhartma@texaschildrens.org   Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-31 15:48:47', '2021-05-31 15:48:47'),
(884, 3040, 130, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-06-17 12:21:38', '2021-06-17 12:21:38'),
(885, 3040, 130, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email rcvd from: tchpnetworkmanagement@texaschildrens.org  Subject; Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Normandy Urgent Care Center  Imperial Valley Urgent Care Center  Longpoint Medical Center  Are these groups in our network? If so, please reach out to you PR.  Thank you', NULL, NULL, '2021-07-06 13:39:22', '2021-07-06 13:39:22'),
(886, 3040, 130, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject:Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. I called the above number that you sent to find out if the above groups are in-network with TCHP or not. I am unable to find out the information because the provider relations department is not available over the phone. Can you please advise me if there is any other way I can find out the information.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-06 13:42:43', '2021-07-06 13:42:43'),
(887, 3040, 130, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Re: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,   I am still waiting for the PR contact information. Can you please forward it to me so I can contact the PR directly because our claims are getting denied by insurance.   Please look into this matter personally so we are able to resolve the issue. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-26 16:39:15', '2021-07-26 16:39:15'),
(888, 11056, 130, NULL, '2021-08-21 00:00:00.000', 'In Process', 'Email received from : tchpnetworkmanagement@texaschildrens.org  Sub : FW: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello PR,  Group Normandy Urgent Care Center, would like to know who is their group PR.  Thank you', NULL, NULL, '2021-08-13 15:32:24', '2021-08-13 15:32:24'),
(889, 3040, 130, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Email rcvd from: kdelam@texaschildrens.org  Subject: Provider Contracts  Hello Adil,  Attached is the Provider Information Form to add locations and a Provider Information Change Form changes to existing providers.  I have included a breakdown of the contracts under your TIN.  Please contact me directly if you have any concerns getting the additional updates needed from contracting.     Thank you,  Kim', NULL, NULL, '2021-08-26 08:45:48', '2021-08-26 08:45:48'),
(890, 10057, 130, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Subject : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Good Afternoon,  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI George, Jeemo	1497219067 Jose, Julie	1447883061 Stephen, Ani	1588959118 Piccione JR, James M	1356321509 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Fernandus, Limy	1972005189 Abraham, Glory	1194206490 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Thomas, Cini	1134777238 Joseph, Vibitha	1952931560 Abraham, Jeena	1467901587 PAUL, SIGI	1033623616 Joseph, Molly	1073019493 Jacob, Jaya	1194336149  Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-08 13:56:43', '2021-10-08 13:56:43'),
(891, 10057, 130, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org, kdelam@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Greetings!  Any update on below mentioned credentialing request?  Please get back to me as soon as you get a chance. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-21 11:03:50', '2021-10-21 11:03:50'),
(892, 10057, 130, NULL, '2021-11-05 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello Liz/Kimberly,  It should be Kimberly\'s responsibility to update you and us rather than we are trying to reach her or you for an application. Can someone please check that and respond. Thanks  Regards, Alex', NULL, NULL, '2021-10-29 09:47:53', '2021-10-29 09:47:53'),
(893, 10057, 130, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. Can I get the latest update on below mentioned providers enrollment status and facility contracts / agreements.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Joseph, Molly	1396380077 Thomas, Cini	1134777238 Rauf, Abdur	1497726202 Piccione JR, James M	1356321509 Jacob, Jaya	1194336149 PAUL, SIGI	1033623616 Fernandus, Limy	1972005189 Abraham, Jeena	1467901587 Chennemkara, Mini Philip	1841755956 Joseph, Vibitha	1952931560 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Brown, Brittany	1275163537 George, Jeemol	1497219067 Jose, Julie	1447883061  Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-22 13:42:31', '2021-11-22 13:42:31'),
(894, 10057, 130, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Sure, for each provider please provide the date their application was submitted and which application did you submit (LOI or PIF).  Thank you', NULL, NULL, '2021-12-02 14:33:36', '2021-12-02 14:33:36'),
(895, 10057, 130, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Thank you for reaching out. The person before me has resigned. I can see that he has submitted the LOI forms for those providers which are already approved.  Please check from your side which providers are enrolled and updated in the system. Rest let me know so I can submit the application again.  Kindly revert back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-09 11:55:08', '2021-12-09 11:55:08'),
(896, 10057, 130, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  I can provide status on application.  To check which providers are in network or not, please reach out to your PR.  They should be able to provide you with a roster for the group.  Thank you  -Liz', NULL, NULL, '2021-12-16 14:57:52', '2021-12-16 14:57:52'),
(897, 10057, 130, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Thank you for reaching out. Could you please provide me with the PR details. It will be highly appreciated.  Regards,', NULL, NULL, '2021-12-22 13:51:14', '2021-12-22 13:51:14'),
(898, 10057, 130, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  If your group is PAR, you can reach out to your PR at Provider Relations providerrelations@texaschildrens.org  If you are not in our network, reach out to provider assistance 832-828-1004.', NULL, NULL, '2021-12-29 12:05:30', '2021-12-29 12:05:30'),
(899, 20067, 130, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org  Sub: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good afternoon,  Hope this email finds you well. I would like to know the enrollment status of the below-mentioned providers under these locations  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Molly Joseph	1396380077 Mini Chennemkara	1841755956 Odette Kourouma	1134525868 Ani Stephen	1588959118 James Piccione JR	1356321509 Jeny John	1073019493 Abdur Rauf	1497726202 Cini THomas	1134777238 James Piccione JR	1356321509 Vibitha Joseph	1952931560 SIGI PAUL	1033623616 Jeena Abraham	1467901587 Jaya Jacob	1194336149 Limy fernandus	1972005189 Brittany Brown	1275163537 Jeemol George	1497219067 Julie Jose	1447883061   Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-12 15:01:51', '2022-01-12 15:01:51');
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
(900, 20067, 130, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org, tchpnetworkmanagement@texaschildrens.org   Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good Morning! Hope you are doing well. Any updates on the previous request?  Your Early response will be highly appreciated Thanks & Regards Syed Ahad.', NULL, NULL, '2022-01-19 09:59:12', '2022-01-19 09:59:12'),
(901, 20067, 130, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org  Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good afternoon!  Hope this email finds you in good health. I would like to know the enrollment status of the below-mentioned groups and providers. Thanks & Regards, Syed Ahad', NULL, NULL, '2022-01-28 14:44:25', '2022-01-28 14:44:25'),
(902, 1006, 131, NULL, NULL, 'Approved', 'Clarification: LPMC is not enrolled with Medicaid because we do not want to disrupt TCHP payments, since medicaid is not enrolled the only plan Amerigroup can enroll us under is Amerivantage, hence the approval.  ', NULL, NULL, '2020-07-14 10:49:24', '2020-07-14 10:49:24'),
(903, 2027, 132, NULL, NULL, 'In Process', 'Karla.Claunch@dchstx.org  Provider-Angiollet Solis Escobar, NPI# 1962917997  \"Hello, Hope you are doing great, I want to know about the current status of the provider Angiollet Solis Escobar, NPI# 1962917997. We have already submitted the enrollment form for this provider. so kindly update me regarding the expected time for completion of this request.  Thanks\" ', NULL, NULL, '2020-06-12 15:17:11', '2020-06-12 15:17:11'),
(904, 2027, 132, NULL, NULL, 'In Process', 'To: 	Tanillya_Gass@bcbstx.com  Sub; Need Status Update For The Provider Angiollet Solis Escobar  Hello,																									 Hope you are doing great, I want to know about the current status of the provider Angiollet Solis Escobar . Following are the details:  Group Name: Valley Med Urgent Care PLLC (Brownsville)   Provider NPI: 1962917997   Group Tax ID: 81-5123542 Thanks.', NULL, NULL, '2020-06-23 12:57:01', '2020-06-23 12:57:01'),
(905, 2027, 132, NULL, NULL, 'In Process', 'From: Tanillya_Gass@bcbstx.com  To: mk@claimsmedinc.com  Good Afternoon Martin,     Angiollet S Escobar, APN is effective 06/01/2020 with Blue Choice PPO, Blue Essentials, Blue Advantage HMO, Medicare Advantage PPO, CHIP, STAR, STAR Plus, and STAR Kids under Tax ID 815123542.', NULL, NULL, '2020-06-24 12:44:40', '2020-06-24 12:44:40'),
(906, 2027, 132, NULL, NULL, 'In Process', 'From: Tanillya_Gass@bcbstx.com  To: mk@claimsmedinc.com  Good Afternoon Martin,     The welcome letters are mailed to the physical address of the provider.', NULL, NULL, '2020-06-24 13:32:02', '2020-06-24 13:32:02'),
(907, 2027, 132, NULL, NULL, 'In Process', 'To: Tanillya_Gass@bcbstx.com  Sub: (Escobar, Angiollet Solis)-(Valley Med Urgent Care PLLC (Brownsville)-(Blue Cross Blue Shield - BCBS)  Hello  Can you send the welcome letter again to the physical address of the below mentioned provider because i have not received it yet her effective date is 06/01/2020. Provider Name:  Escobar, Angiollet Solis  Provider NPI# 1962917997 Group Name: Valley Med Urgent Care PLLC (Brownsville) Tax ID: 81-5123542   Thanks', NULL, NULL, '2020-07-09 16:53:04', '2020-07-09 16:53:04'),
(908, 2027, 132, NULL, NULL, 'In Process', 'voice mail sent to insurance and recorded a massage that the effective date for this provider has already issued now waiting for the welcome letter', NULL, NULL, '2020-07-10 14:55:03', '2020-07-10 14:55:03'),
(909, 2027, 132, NULL, NULL, 'Approved', 'From: tx_network_south_voicemail@bcbstx.com  ANGIOLLET S ESCOBAR APN  8JB834 linked to VALLEY MED URGENT CARE PLLC tax  815123542. She is an in network provider as of 06/01/2020 with the following networks.  BLUE ADVANTAGE HMO - network sold on the exchange under the ACA BLUE ESSENTIALS HMO BLUE CHOICE PPO MEDICAID CHIP HEALTHSELECT - network available to current and retired State of Texas employees and their families MEDICARE ADVANTAGE PPO MEDICAID STARPLUS MEDICAID STAR MEDICAID STARKIDS  Her primary location is listed as 2534 Boca Chica Blvd., Brownsville, Texas  78521 Satellite location  800 E Alton Gloor Blvd., Brownsville, Texas 78526 Satellite location  101 E Expressway 83. Ste. 170, McAllen, Texas  78501  Thank you. ', NULL, NULL, '2020-07-10 15:44:49', '2020-07-10 15:44:49'),
(910, 2027, 133, NULL, '2020-09-18 00:00:00.000', 'Approved', 'Provider is showing linked with insurance and effective date is 04/08/2020. Screenshot from provider directory is attached', NULL, NULL, '2020-09-11 10:59:10', '2020-09-11 10:59:10'),
(911, 2027, 136, NULL, NULL, 'In Process', 'i have checked through online portal case still in process', NULL, NULL, '2020-06-18 15:51:57', '2020-06-18 15:51:57'),
(912, 2027, 136, NULL, '2020-08-20 00:00:00.000', 'In Process', 'Railroad re initiated need some time to be completed reference PDF file is attached ', NULL, NULL, '2020-08-13 17:38:23', '2020-08-13 17:38:23'),
(913, 2027, 136, NULL, '2020-09-30 00:00:00.000', 'Approved', 'Provider is now showing linked with medicare railroad and effective date is 03/19/2020', NULL, NULL, '2020-09-23 17:29:20', '2020-09-23 17:29:20'),
(914, 2027, 137, NULL, '2020-10-18 00:00:00.000', 'In Process', 'To: txcredentialing@amerigroup.com Jason.Hughes@amerigroup.com  Sub: (Jose, Julie)-(Longpoint Medical Center)-(Amerigroup)  I want to enroll this provider with amerigroup please assist me how can I start the process. Details of the provider are mentioned below:  Provider Name: Jose, Julie  Provider NPI# 1447883061  Thanks. ', NULL, NULL, '2020-10-11 15:27:35', '2020-10-11 15:27:35'),
(915, 2037, 137, NULL, '2020-11-16 00:00:00.000', 'In Process', 'Follow up email sent', NULL, NULL, '2020-10-22 17:55:51', '2020-10-22 17:55:51'),
(916, 2037, 137, NULL, '2020-11-23 00:00:00.000', 'In Process', '	 Follow up email sent', NULL, NULL, '2020-11-16 12:22:32', '2020-11-16 12:22:32'),
(917, 2037, 137, NULL, '2020-12-10 00:00:00.000', 'In Process', 'LOI with W9 form sent @ txcredentialing@amerigroup.com  & jason.hughes@amerigroup.com to link julie jose to the existing in-network goup LPMC. -------------------- Sherry Deen sd@claimsmedinc.com Attachments 11:33 AM (1 minute ago) to txcredentialing, jason.hughes  Greetings,  Kindly find attached the Letter of Intent with the W9 to add Julie Jose to an existing group. Details mentioned below:   Group Name-Longpoint Medical Center Group Tax-ID-76-0612416   Provider Name: Jose, Julie Provider NPI# 1447883061 Regards', NULL, NULL, '2020-11-23 12:39:29', '2020-11-23 12:39:29'),
(918, 2027, 137, NULL, '2020-12-17 00:00:00.000', 'In Process', 'To: txcredentialing@amerigroup.com  This is a follow up email. Please reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-12-10 14:29:08', '2020-12-10 14:29:08'),
(919, 2037, 137, NULL, '2020-12-29 00:00:00.000', 'In Process', 'Follow up email sent', NULL, NULL, '2020-12-17 16:48:47', '2020-12-17 16:48:47'),
(920, 2037, 137, NULL, '2021-01-05 00:00:00.000', 'In Process', 'Follow up email sent', NULL, NULL, '2020-12-29 10:34:19', '2020-12-29 10:34:19'),
(921, 1006, 137, NULL, '2021-01-27 00:00:00.000', 'In Process', 'Sent a follow-up email for LPMC with it\'s own TIN instead of NUCC.', NULL, NULL, '2021-01-20 09:55:26', '2021-01-20 09:55:26'),
(922, 1006, 137, NULL, '2021-02-03 00:00:00.000', 'In Process', 'Follow up email sent for credentialing to txcredentialing@amerigroup.com ', NULL, NULL, '2021-01-27 14:19:09', '2021-01-27 14:19:09'),
(923, 3040, 137, NULL, '2021-03-08 00:00:00.000', 'In Process', 'Email sent to: txcredentialing@amerigroup.com  Subject: Enrollment Status || Longpoint Medical Center || Jose, Julie || Amerigroup ||  Greetings,  Hope you are doing well. Please advise me the enrollment status for the below mentioned providers.   Practice Name: Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Name: Jose, Julie Provider NPI# 1447883061  Provider Name: George, Jeemol Provider NPI# 1497219067  If you need any additional information please let me know. Waiting for your response.   Thanks ', NULL, NULL, '2021-03-01 15:30:48', '2021-03-01 15:30:48'),
(924, 1006, 137, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Sent f/u email @ TX Credentialing TXCredentialing@amerigroup.com:  Sub: Enrollment Status - NUCC, IVUC, LPMC - Amerigroup  \"Hello,   I wanted to find out the enrollment status for the following providers, as well as what locations they are listed under for the following group:   Group Name: Normandy Urgent Care Center NPI# 1407171077 TIN# 27-0796429  Primary Address: 779 Normandy St Ste 114, Houston, TX 77015-3441 Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Tertiary Address: 9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider 1:Provider Name: George, Jeemol Provider NPI# 1497219067 Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061 Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956 Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490 Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238 Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616 Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-05-31 15:29:35', '2021-05-31 15:29:35'),
(925, 11056, 137, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email Sent to : TXCredentialing@amerigroup.com  nucc@claimsmedinc.com  Subj : Enrollment Status - NUCC, IVUC, LPMC - Amerigroup  Good Morning!  I wanted to inquire about the enrollment status for the following providers, as well as what locations they are listed or added into under for the following group:  Practice Name: Normandy Urgent Care Center Practice NPI#: 1407171077 Practice TIN# : 27-0796429 Primary Address: 779 Normandy St Ste 114, Houston, TX 77015-3441 Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Tertiary Address:9504 LONG POINT RD STE E, Houston , TX 77055-4226-  Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider name : PAUL, SIGI Provider NPI # : 1033623616   Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider name : Joseph, Vibitha Provider NPI # : 1952931560   Provider name : Jose, Julie Provider NPI # : 1447883061  Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider name : George, Jeemol Provider NPI # : 1497219067  Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider name : Abraham, Glory Provider NPI # : 1194206490  Please get back to me as soon as you\'re able to.  Thank you!', NULL, NULL, '2021-06-17 12:20:51', '2021-06-17 12:20:51'),
(926, 3040, 137, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: txcredentialing@amerigroup.com, Jason.Hughes@amerigroup.com,  Subject: Enrollment Status || Normandy Urgent Care Center - Amerigroup  Good Morning!  I wanted to inquire about the enrollment status for the following providers, as well as what locations they are listed under for the following group:  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Please get back to me as soon as you\'re able to.Waiting to hear from you soon.   Thank you!', NULL, NULL, '2021-07-06 09:58:55', '2021-07-06 09:58:55'),
(927, 3040, 137, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Jason.Hughes@amerigroup.com,  Subject: Enrollment Status || Normandy Urgent Care Center - Amerigroup  Hello Jason,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Provider 17: Provider Name: John, Jeny Provider NPI #  1073019493  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks', NULL, NULL, '2021-07-26 15:24:43', '2021-07-26 15:24:43'),
(928, 11056, 137, NULL, '2021-08-21 00:00:00.000', 'In Process', 'Email sent to : Jason.Hughes@amerigroup.com   &   TX Credentialing TXCredentialing@amerigroup.com  Sub : Fwd: Delivery Status Notification (Failure)  Good afternoon Jason!  Hope you are doing well. I want to inquire about the enrollment status for the below mentioned group and providers in our groups  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details:  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Provider 17: Provider Name: John, Jeny Provider NPI #  1073019493  If you need any documents or information feel free to reach out to me. Eagerly, waiting for your reply.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-13 14:27:30', '2021-08-13 14:27:30'),
(929, 11056, 137, NULL, '2021-08-21 00:00:00.000', 'In Process', 'Email sent to : Jason.Hughes@amerigroup.com   &   TX Credentialing TXCredentialing@amerigroup.com  Sub : Fwd: Delivery Status Notification (Failure)  Good afternoon Jason!  Hope you are doing well. I want to inquire about the enrollment status for the below mentioned group and providers in our groups  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details:  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Provider 17: Provider Name: John, Jeny Provider NPI #  1073019493  If you need any documents or information feel free to reach out to me. Eagerly, waiting for your reply.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-13 14:27:31', '2021-08-13 14:27:31'),
(930, 3040, 137, NULL, '2021-09-01 00:00:00.000', 'In Process', 'Email sent to: mpsweb@amerigroup.com  Subject: Delivery Status Notification (Failure)  Greetings!  Hope you are doing well. I want to inquire about the enrollment status for the below mentioned group and providers in our groups under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details:  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Provider 17: Provider Name: John, Jeny Provider NPI #  1073019493  If you need any documents or information feel free to reach out to me. Eagerly, waiting for your reply.  Thanks', NULL, NULL, '2021-08-25 15:00:22', '2021-08-25 15:00:22'),
(931, 3040, 137, NULL, '2021-09-16 00:00:00.000', 'In Process', 'Email sent to: mpswebinquiries@amerigroup.com, Jason.Hughes@amerigroup.com, TXCredentialing@amerigroup.com  Subject: Need to Enroll || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || AMERIGROUP ||  Greetings,   Hope you are doing well. I received an email from your side in which you mentioned that our group &  providers are not contracted with Amerigroup under the below locations besides some of the providers are participating with Amerigroup but not under all the locations. I wanted to know how to enroll and add the additional locations for the below mentioned providers in Amerigroup under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Below are the providers need to enroll in Amerigroup:    Provider Name: Thomas, Cini  NPI: 1134777238  Tax ID: 270796429  Status: Non-Participating  Location: 16272 IMPERIAL VALLEY DR STE K,  Houston     Provider Name: Stephen, Ani  NPI: 1588959118  Tax ID: 270796429  Status: Non-Participating     Provider Name: Piccione JR, James  NPI: 1356321509  Tax ID: 270796429  Status: Non-Participating  Location: 9504 LONG POINT RD STE E  Houston     Provider Name: PAUL, SIGI  NPI: 1033623616  Tax ID: 270796429  Status: Non-Participating     Provider Name: Kourouma , Odette  NPI: 1134525868  Tax ID: 270796429  Status: Non-Participating     Provider/Group Name: Jacob, Jaya  NPI: 1194336149  Status: Non-Participating     Provider Name: Fernandus, Limy  NPI: 1972005189  Status: Non-Participating     Provider Name: Abraham, Jeena  NPI: 1467901587  Provider ID:  Status: Non-Participating     Provider Name: Chennemkara, Mini Philip  NPI: 1841755956  Tax ID: 270796429  Status: Non-Participating     Provider Name: Joseph, Molly  NPI: 1396380077  Status: Non-Participating     Provider Name: John, Jeny  NPI: 1073019493  Tax ID: 27-0796429  Status: Non-Participating     Provider Name: Rauf, Abdur   NPI: 1497726202  Tax ID: 27-0796429  Status: Non-Participating    Request to add the additional location for the below mentioned providers.     Provider Name: Joseph, Vibitha  NPI: 1952931560  Provider ID: 09743760  Tax ID: 760612416  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 9504 LONG POINT RD STE E  Houston  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Provider Name: Abraham, Glory  NPI: 1194206490  Provider ID: 07116206  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: Brown, Brittany  NPI: 1275163537  Provider ID: 09808410  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: George, Jeemol  NPI: 1497219067  Provider ID: 09805666  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: Jose, Julie  NPI: 1447883061  Provider ID: 09807037  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    If you need any additional information please feel free to call or email me. Please get back to me as soon as you can get a chance. Waiting to hear from you soon.     Thank you ', NULL, NULL, '2021-09-09 13:07:54', '2021-09-09 13:07:54'),
(932, 10057, 137, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : mpswebinquiries@amerigroup.com, Jason.Hughes@amerigroup.com, TXCredentialing@amerigroup.com  Sub : Need to Enroll || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || AMERIGROUP ||  Good Evening,  Hope this email finds you well. I want to inquire about the enrollment status of the below mentioned providers and practices. Please get back to me as soon as you get a chance.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Looking forward to hearing from you. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-18 15:13:58', '2021-10-18 15:13:58'),
(933, 10057, 137, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Hello,  Greetings for the day!  We want to enroll the below mentioned providers on an urgent basis with Amerigroup under below mentioned details. Also please find the attached LOI\'s for all providers.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441 Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Please get back to me with the update as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-11 13:04:10', '2021-11-11 13:04:10'),
(934, 10057, 137, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Greetings!  Can I get the latest update on the below mentioned request.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-11-30 10:57:13', '2021-11-30 10:57:13'),
(935, 10057, 137, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Greetings!  Can I get the latest update on the below mentioned request.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-11-30 10:57:20', '2021-11-30 10:57:20'),
(936, 10057, 137, NULL, '2021-12-14 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com, Jason.Hughes@amerigroup.com, mpswebinquiries@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Good Afternoon,  Hope this email finds you in good health. I\'m writing this email to check the status for the applications which we have submitted to enroll the providers with Amerigroup under the TIN\'s.  It is my second follow-up, please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-06 16:13:52', '2021-12-06 16:13:52'),
(937, 10057, 137, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Called to check the status: 800 - 600 - 4441  Applications has been received and credentialing started on 11/11/2021. Still need 30 working days to finish the process. Once request will be completed, welcome letter will be issued accordingly.  Call Reference: I145695020 - Representative - Courtney', NULL, NULL, '2021-12-13 10:55:24', '2021-12-13 10:55:24'),
(938, 10057, 137, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Please check previous Call Comments.  Will follow-up next week.', NULL, NULL, '2021-12-20 14:06:49', '2021-12-20 14:06:49'),
(939, 10057, 137, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Call Details: (800) 600-4441  Rep: Victor  Ref # I146789022  Still in process, need to check next week, also send reminder to below mentioned emails.  latina.small@anthem.com nena.graves@amerigroup.com  Regards, Steve Albert', NULL, NULL, '2021-12-29 11:08:17', '2021-12-29 11:08:17'),
(940, 20067, 137, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: latina.small@anthem.com, nena.graves@amerigroup.com  Sub: Re: || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Good Morning, Hope all is well with you. I would like to know the enrollment status of the below-mentioned group and providers and if any of them is enrolled kindly send me their welcome letter.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Eagerly waiting for your response.   Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-10 12:18:54', '2022-01-10 12:18:54'),
(941, 20067, 137, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email Received from: latina.small@anthem.com  Sub: RE: {EXTERNAL} Re: || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Good Morning,     Yes, I can look up and confirm the provider(s) status. Please allow me some time to review and respond.     Thank You in Advance,     Latina Small  Provider Experience Consultant  Amerigroup, Inc.', NULL, NULL, '2022-01-11 13:08:03', '2022-01-11 13:08:03'),
(942, 20067, 137, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: latina.small@anthem.com, nena.graves@amerigroup.com  Sub: Re: {EXTERNAL} Re: || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Good Afternoon Latina and Nena! Hope this email finds you in good health. Haven\'t received any updates from your side. Kindly update me on the previous request.  Eagerly waiting for your response. Thanks & Regards. Syed Ahad', NULL, NULL, '2022-01-19 15:16:02', '2022-01-19 15:16:02'),
(943, 20067, 137, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: latina.small@anthem.com, nena.graves@amerigroup.com  Sub: Re: {EXTERNAL} Re: || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Good Morning!  Eagerly waiting for your response. Kindly respond promptly,  Thank you,', NULL, NULL, '2022-01-28 11:59:05', '2022-01-28 11:59:05'),
(944, 20067, 137, NULL, '2022-02-15 00:00:00.000', 'In Process', 'Email received from: latina.small@anthem.com  Sub: Re: {EXTERNAL} Re: || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||   Good Afternoon,     Sincere apologies for any delays. Please see the status for the providers below. If any providers need to be added to the group, please complete the attached LOI and Group App form and return to credentialing with a W9.        Group Name  Longpoint Medical Center  Tax ID  76-0612416  Group NPI  1770763815  Practice Location  9504 LONG POINT RD STE E Houston , TX 77055-4226     Provider Name     NPI  Amerigroup Status Update  Fernandus, Limy     1972005189  PAR - PR ID 12190801; Effective Date 11/11/2021(Medicaid, Medicare, CHIP)  PAUL, SIGI     1033623616  Non PAR  Jacob, Jaya     1194336149  Non PAR  Abraham, Jeena     1467901587  Non PAR  Thomas, Cini     1134777238  Non PAR  Kourouma , Odette Tiranke     1134525868  Non PAR  Rauf, Abdur     1497726202  PAR – PR ID 10007623; Effective Date 3/1/2012 (Medicaid, Medicare, CHIP, MMP)  Joseph, Molly     1396380077  Non PAR  John, Jeny     1073019493  Non PAR  Stephen, Ani     1588959118  Non PAR  Brown, Brittany     1275163537  Non PAR  Joseph, Vibitha     1952931560  PAR – PR ID 09743760; Effective Date 4/27/2020 (Medicare)  George, Jeemol     1497219067  Non PAR  Jose, Julie     1447883061  Non PAR  Abraham, Glory     1194206490  PAR – PR ID 08200815; Effective Date 10/01/2019 (Medicare)  Chennemkara, Mini Philip     1841755956  Non PAR  Piccione JR, James M     1356321509  Non PAR        Thank You in Advance,     Latina Small, MBA, BSBM', NULL, NULL, '2022-02-08 13:14:25', '2022-02-08 13:14:25'),
(945, 20067, 137, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com CC: latina.small@anthem.com  Sub: LOI and Group App || Longpoint Medical Center || Providers || Amerigroup  Good Afternoon!  Hope you had a great weekend. Attached are the LOI and Group App for Non-par Providers along with W9.  Kindly let me know if anything else is required from my end.  Regards, ', NULL, NULL, '2022-02-21 13:47:24', '2022-02-21 13:47:24'),
(946, 20067, 137, NULL, '2022-03-15 00:00:00.000', 'In Process', 'Secure Email received from:  TX Credentialing  Sub: RE: FW: {EXTERNAL} LOI and Group App || Longpoint Medical Center || Providers || Amerigroup  the LOI has a mix match of the group name with the tax ID.     There is one tax ID listed on the LOI, the group name should correspond to the tax ID.', NULL, NULL, '2022-03-08 09:26:26', '2022-03-08 09:26:26'),
(947, 20067, 137, NULL, '2022-03-15 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Sub:   Good Morning!  Attached are the LOI and Group applications for the providers.  Let me know if anything else is required from my end.  Thank you,', NULL, NULL, '2022-03-08 09:56:42', '2022-03-08 09:56:42'),
(948, 20067, 137, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com, latina.small@anthem.com   Sub:  Re: LOI and Group App || Longpoint Medical Center || Providers || Amerigroup  Good Morning!  Hope this email finds you in good health. Any updates on the Submitted LOIs of Longpoint Medical Center providers.  Thank you, Syed', NULL, NULL, '2022-03-17 10:03:56', '2022-03-17 10:03:56'),
(949, 20067, 137, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email received from: TXCredentialing@amerigroup.com   Sub: FW: {EXTERNAL} Re: LOI and Group App || Longpoint Medical Center || Providers || Amerigroup  Those were received and pending completion.     Check back in 7 business days', NULL, NULL, '2022-03-17 16:43:31', '2022-03-17 16:43:31'),
(950, 2027, 140, NULL, '2020-10-18 00:00:00.000', 'In Process', 'To: CHC.Contracting@communityhealthchoice.org  I want to enroll this provider with Community Health Choice please assist me how can I start the process. Details of the provider are mentioned below:  Provider Name: Jose, Julie  Provider NPI# 1447883061  Thanks. ', NULL, NULL, '2020-10-11 15:31:29', '2020-10-11 15:31:29'),
(951, 2037, 140, NULL, '2020-11-19 00:00:00.000', 'In Process', 'Follow up email sent: -----------', NULL, NULL, '2020-10-26 16:59:28', '2020-10-26 16:59:28'),
(952, 2037, 140, NULL, '2020-11-26 00:00:00.000', 'In Process', 'Waiting for the location to be added to the group.', NULL, NULL, '2020-11-19 17:59:14', '2020-11-19 17:59:14'),
(953, 2037, 140, NULL, '2020-12-15 00:00:00.000', 'In Process', 'Waiting for the location to be added to the group. Corresponding with Rajika Reid. Rajika.Reid@communityhealthchoice.org', NULL, NULL, '2020-11-30 14:51:26', '2020-11-30 14:51:26'),
(954, 1006, 140, NULL, '2020-12-24 00:00:00.000', 'In Process', 'Sent a follow-up email @ Rajika.Reid@communityhealthchoice.org regarding updated status. ', NULL, NULL, '2020-12-15 18:02:49', '2020-12-15 18:02:49'),
(955, 2037, 140, NULL, '2021-01-05 00:00:00.000', 'In Process', 'Follow up email sent:', NULL, NULL, '2020-12-29 10:43:15', '2020-12-29 10:43:15'),
(956, 1006, 140, NULL, '2021-02-03 00:00:00.000', 'New/Not Initiated', 'follow up email sent for credentialing toRajika.Reid@communityhealthchoice.org', NULL, NULL, '2021-01-27 12:56:05', '2021-01-27 12:56:05'),
(957, 1006, 140, NULL, '2021-02-03 00:00:00.000', 'In Process', NULL, NULL, NULL, '2021-01-27 13:48:18', '2021-01-27 13:48:18'),
(958, 3040, 140, NULL, '2021-03-08 00:00:00.000', 'In Process', 'Email sent to: Rajika.Reid@communityhealthchoice.org  Subject: Enrollment Status || Longpoint Medical Center || Jose, Julie, George, Jeemol & Abraham, Glory || Community Health Choice ||  Greetings,   Hope you are doing well. Please advise me the enrollment status for the below mentioned providers.   Practice Name: Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Name: Jose, Julie Provider NPI# 1447883061  Provider Name: George, Jeemol Provider NPI# 1497219067  Provider Name: Abraham, Glory Provider NPI# 1194206490  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-03-01 15:44:00', '2021-03-01 15:44:00'),
(959, 3040, 140, NULL, '2021-03-26 00:00:00.000', 'In Process', 'Email sent to: Rajika.Reid@communityhealthchoice.org  Subject: Enrollment Status || Longpoint Medical Center || Jose, Julie, George, Jeemol & Abraham, Glory || Community Health Choice ||  Greetings,   Hope you are doing well. I just wanted to follow up regarding the enrollment status for the below mentioned providers.   Practice Name: Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Name: Jose, Julie Provider NPI# 1447883061  Provider Name: George, Jeemol Provider NPI# 1497219067  Provider Name: Abraham, Glory Provider NPI# 1194206490  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you  ', NULL, NULL, '2021-03-19 14:05:26', '2021-03-19 14:05:26'),
(960, 3040, 140, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: CHC.Contracting@communityhealthchoice.org  Subject: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Community Health Choice for our group under the below locations.     Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 14:02:41', '2021-05-26 14:02:41'),
(961, 3040, 140, NULL, '2021-06-21 00:00:00.000', 'On Hold', 'We have an ancillary contract with CHC. Location addition request sent out. For more details please see the group task. ', NULL, NULL, '2021-06-14 10:51:46', '2021-06-14 10:51:46'),
(962, 3040, 140, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: Rajika.Reid@communityhealthchoice.org  Subject: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Hello Rajika,   Hope you are doing well. Please find the attached signed contract as per your request email for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  If you need any additional information please feel free to call or email me.  Thank you ', NULL, NULL, '2021-07-20 10:43:27', '2021-07-20 10:43:27'),
(963, 11056, 140, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email sent to : Rajika.Reid@communityhealthchoice.org  Sub : FW: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Community Health Choice for our group under the below locations. And provide us with the updates regarding the signed contract which we have submitted to you in the month of June, 2021.    Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: George, Jeemol  Provider NPI# 1497219067     Provider 2:    Provider Name: Jose, Julie  Provider NPI# 1447883061     Provider 3:    Provider Name: Stephen, Ani  Provider NPI# 1588959118     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Brown, Brittany  Provider NPI# 1275163537     Provider 6:    Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956     Provider 7:    Provider Name: Abraham, Glory  Provider NPI# 1194206490     Provider 8:    Provider Name: Fernandus, Limy  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider NPI# 1497726202     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868     Provider 11:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560     Provider 12:    Provider Name: Thomas, Cini  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider NPI# 1467901587     Provider 14:    Provider Name: PAUL, SIGI   Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149     If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!  Have a great week ahead!', NULL, NULL, '2021-08-09 10:36:38', '2021-08-09 10:36:38'),
(964, 3040, 140, NULL, '2021-08-24 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. For more details please see group task. ', NULL, NULL, '2021-08-17 13:58:06', '2021-08-17 13:58:06'),
(965, 2027, 141, NULL, '2020-08-17 00:00:00.000', 'Approved', 'Provider is now in network with  effective date of 7/28/2020 and welcome letter is attached', NULL, NULL, '2020-08-10 15:54:56', '2020-08-10 15:54:56'),
(966, 2027, 142, NULL, '2020-08-20 00:00:00.000', 'In Process', 'Medicaid is now in process ticket screenshot is attached', NULL, NULL, '2020-08-13 16:50:55', '2020-08-13 16:50:55'),
(967, 2027, 142, NULL, '2020-09-04 00:00:00.000', 'New/Not Initiated', 'Provider is now linked with medicaid and effective date is 2/7/2020', NULL, NULL, '2020-08-28 10:37:43', '2020-08-28 10:37:43'),
(968, 2027, 142, NULL, '2020-09-04 00:00:00.000', 'Approved', 'Provider is now linked with medicaid and effective date is 2/7/2020', NULL, NULL, '2020-08-28 10:39:44', '2020-08-28 10:39:44');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(969, 2027, 143, NULL, NULL, 'Approved', 'From: LMMoreno@FirstHealth.com  To: Lpmc@claimsmedinc.com  Hello Luis,     Attached is the provider counter signed agreement. On the first page of the provider agreement the effective date has been populated effective 8/1/2020. I have also attached our welcome letter and our First Health Quick Overview sheet these documents are useful references. Please keep all documents for your records.     Kindest Regards,  LaTrish Tomanogi', NULL, NULL, '2020-06-30 12:38:23', '2020-06-30 12:38:23'),
(970, 2027, 144, NULL, '2020-08-31 00:00:00.000', 'In Process', 'To: ywyatt@humana.com       HumanaHoustonPD@humana.com       kmoten4@humana.com  Sub: (Jose, Julie)-(Longpoint Medical Center)-(Humana)  May i know the current status of the provider mentioned below: Provider Name-Jose, Julie Provider NPI#1447883061 Group Name-Longpoint Medical Center Group Tax-ID-76-0612416  Thanks.', NULL, NULL, '2020-08-24 12:54:37', '2020-08-24 12:54:37'),
(971, 2027, 144, NULL, '2020-08-31 00:00:00.000', 'In Process', 'From: KMoten4@humana.com  Good Afternoon,     That provider is not showing certified in our system. If a certification application was submitted to WPS, please allow 120 days for that process to be completed. WPS will send a letter informing you once the application has been processed and completed.     Respectfully,  Katherine Moten  TRICARE Community Liaison II  Humana', NULL, NULL, '2020-08-24 13:09:40', '2020-08-24 13:09:40'),
(972, 1005, 144, NULL, '2020-10-03 00:00:00.000', 'In Process', 'No Response. Sent a reminder.', NULL, NULL, '2020-09-24 14:24:39', '2020-09-24 14:24:39'),
(973, 2027, 144, NULL, '2020-10-29 00:00:00.000', 'In Process', 'To: HumanaHoustonPD@humana.com  Sub: (Jose, Julie)-(Longpoint Medical Center)-(Humana)  May I know the current status of the provider mentioned below: Provider Name- Jose, Julie Provider NPI# 1447883061 Group Name- Longpoint Medical Center Group Tax-ID- 76-0612416  Thanks.', NULL, NULL, '2020-10-22 10:30:01', '2020-10-22 10:30:01'),
(974, 2027, 144, NULL, '2020-10-29 00:00:00.000', 'Approved', 'Provider is showing linked to the insurance and the effective date is 05/15/2020', NULL, NULL, '2020-10-22 13:17:49', '2020-10-22 13:17:49'),
(975, 2027, 145, NULL, NULL, 'In Process', 'To: SWHPPROVIDERNETWORKDEVELOPMENT@bswhealth.org  Sub: Need Status Update Of Provider Cini Thomas  Hello,   Hope you are doing great, I want to know about the current status of the provider. Following are the details:  Provider Name: Cini Thomas NPI# 1134777238 Group Name: Columbus Urgent Care PA Tax-ID: 471914151  Kindly update me how much time is required for the completion of this request.  Thanks.', NULL, NULL, '2020-06-18 17:30:26', '2020-06-18 17:30:26'),
(976, 2027, 145, NULL, '2020-08-20 00:00:00.000', 'In Process', 'To: SWHPPROVIDERNETWORKDEVELOPMENT@bswhealth.org  Sub: (Thomas, Cini)-(Columbus Urgent Care PA)-(Scott & White)  Hello,  Hope you are doing great, I want to know about the current status of the provider. Following are the details: Provider Name: Cini Thomas NPI# 1134777238 Group Name: Columbus Urgent Care PA Tax-ID: 471914151  Kindly update me how much time is required for the completion of this request.  Thanks.  ', NULL, NULL, '2020-08-13 17:51:16', '2020-08-13 17:51:16'),
(977, 2027, 145, NULL, '2020-09-09 00:00:00.000', 'In Process', 'From: SWHPREGION1@bswhealth.org  This provider is still in the applicant status which means the provider service and credentialing teams are still working on processing this provider.  I cannot give you an ETA on the completion date because that is completely out of this unit’s hands but when the team is working on the provider, they will contact you for any documentation needed to complete contracting process.        Thanks,  Region 1 (BW)', NULL, NULL, '2020-09-02 14:47:37', '2020-09-02 14:47:37'),
(978, 1006, 145, NULL, '2020-10-23 00:00:00.000', 'In Process', 'Sent a followup email to swhpregion2@bswhealth.org for updated status. ', NULL, NULL, '2020-10-16 14:32:11', '2020-10-16 14:32:11'),
(979, 1006, 145, NULL, '2020-10-29 00:00:00.000', 'In Process', 'Received following update from SWHP REGION 2 SWHPREGION2@bswhealth.org>:  \"Hello,  Please see notes in blue/red.   Provider Name: Vibitha Joseph – shows active under TIN 270796429 NPI# 1952931560  Provider Name: Cini Thomas – Pending CVO review. NPI# 1134777238  Provider Name: Julie Jose – Applicant in review. NPI# 1447883061  Provider Name: Odette Tiranke Kourouma – No records found, when did you submit the request? NPI# 1134525868  Provider Name: Jeemol George - Applicant in review. NPI# 1497219067  Group Name: Columbus Urgent Care PA- Applicant in review. TIN# 47-1914151  Thanks,  Jennifer C. Provider Relations Representative cid:image001.png@01D42404.EBBCB8F0 1206 West Campus Dr | MS-A4-126 | Temple, TX  76502 254-298-3064 Office | 254-298-3044 Fax\"', NULL, NULL, '2020-10-23 19:01:54', '2020-10-23 19:01:54'),
(980, 2027, 145, NULL, '2020-11-06 00:00:00.000', 'In Process', 'From: SWHP REGION 2 SWHPREGION2@bswhealth.org>:  \"Hello,  Please see notes in blue/red.  Provider Name: Cini Thomas – Pending CVO review. NPI# 1134777238', NULL, NULL, '2020-10-30 10:58:10', '2020-10-30 10:58:10'),
(981, 2027, 145, NULL, '2020-11-13 00:00:00.000', 'In Process', 'To: SWHPREGION2@bswhealth.org  Sub: (Thomas, Cini)-(Columbus Urgent Care PA)-(Scott & White)  May I know the current status of the below mentioned provider: Provider Name:  Thomas, Cini  Provider NPI# 1134777238 Group Name: Columbus Urgent Care PA Group Tax-ID: 471914151  Thanks. ', NULL, NULL, '2020-11-06 16:01:07', '2020-11-06 16:01:07'),
(982, 2027, 145, NULL, '2020-11-20 00:00:00.000', 'In Process', 'From: SWHPREGION2@bswhealth.org  Hello,     The applicant is pending CVO review at this time. Please allow more time.     Thanks,     Jennifer C.  Provider Relations Representative  ', NULL, NULL, '2020-11-13 15:21:26', '2020-11-13 15:21:26'),
(983, 2027, 145, NULL, '2020-11-27 00:00:00.000', 'In Process', 'To: SWHPREGION2@bswhealth.org  May I know the current status of this request ?', NULL, NULL, '2020-11-20 09:33:10', '2020-11-20 09:33:10'),
(984, 2027, 145, NULL, '2020-12-07 00:00:00.000', 'In Process', 'Request is still in process ', NULL, NULL, '2020-11-30 13:34:05', '2020-11-30 13:34:05'),
(985, 2027, 145, NULL, '2020-12-09 00:00:00.000', 'Approved', 'From: Richard.Hinkley@bswhealth.org  Good morning,     Please see the attached contract for Columbus Urgent Care PA TIN: 471914751  This contract contains: HMO, PPO, EPO  You contract also includes Medicare Advantage & RightCare (Medicaid)     Congratulations on joining the health plan. I have attached your contract, portal activation materials, and the current Commercial Provider Manual. You can also visit our website at the following link to access the current quick reference guide as well as the most current versions of all provider materials you may need including claims and billing information, reimbursement policies, and authorization information: https://swhp.org/en-us/prov/provider-training-manual. Please also see this link for the most current quick reference guide for the health plan: https://swhp.org/Portals/0/Files/Forms/Prov_FormsGuides/SWHP-Provider-Reference-Guide.pdf. This is updated fairly regularly and contains quick links and guidelines for web resources, claims/appeals addresses and guidelines, prior auths, how to read ID cards, and other necessary information. This final link is the most current Medicare specific orientation information: https://swhp.org/Portals/0/Files/Forms/Providers/Provider_Orientation_Medicare_Advantage.pdf. Please let me know if you have any questions or concerns and I will do my best to assist you. As part of your introduction, let me know if you would like to schedule a new provider orientation where we can discuss these materials and I can try and answer any questions you may have about joining the health plan. I will also send along information on the RightCare Medicaid line of business in just a few minutes.     Thank you,', NULL, NULL, '2020-12-02 09:53:22', '2020-12-02 09:53:22'),
(986, 2027, 149, NULL, '2020-10-18 00:00:00.000', 'In Process', 'To: Michele.Thomas-Martin@molinahealthcare.com  I want to enroll this provider with Molina Health please assist me how I can start the process. Details of the provider are mentioned below:  Provider Name: Jose, Julie  Provider NPI# 1447883061  Thanks. ', NULL, NULL, '2020-10-11 15:35:08', '2020-10-11 15:35:08'),
(987, 2027, 149, NULL, '2020-10-19 00:00:00.000', 'In Process', 'From: Michele.Thomas-Martin@molinahealthcare.com  Good Morning,     Thank you for your interest in becoming part of the Molina Healthcare network. Please see attached Contract Request Form. Please complete and return with a W-9 to the email listed on the form     Thank You,     Michele Thomas-Martin  Associate Specialist, Provider Contracts  1-888-562-5442 Ext. 200042  www.MolinaHealthcare.com  Your Extended Family   ', NULL, NULL, '2020-10-12 13:13:48', '2020-10-12 13:13:48'),
(988, 2027, 149, NULL, '2020-10-19 00:00:00.000', 'In Process', 'To: Michele.Thomas-Martin@molinahealthcare.com  Please find the (CRF) attached in this email.  Thanks.', NULL, NULL, '2020-10-12 15:42:50', '2020-10-12 15:42:50'),
(989, 2027, 149, NULL, '2020-10-19 00:00:00.000', 'In Process', 'From: Michele.Thomas-Martin@molinahealthcare.com  Record # 167855     New Record # 171443     Good Afternoon,     Thank you for submitting the contract request.   The provider has been loaded in the billing system effective 9/1/2020 under service location 779 Normandy St.   I’ve submitted a new record to add the provider under service location 9504 Long Point RD Suite E.  Please allow 30 days for the new request to be processed.   Please see the attached welcome letter for record  # 167855', NULL, NULL, '2020-10-12 17:30:54', '2020-10-12 17:30:54'),
(990, 1006, 149, NULL, '2020-11-04 00:00:00.000', 'In Process', 'Sent a follow-up email to \"Thomas-Martin, Michele\" Michele.Thomas-Martin@molinahealthcare.com>:  \"Hello Michele,   I wanted to check in with you regarding the status of the address addition for the following provider:   Provider Name: Julie Jose NPI# 1447883061 Address: 9504 LONG POINT RD STE E, Houston, TX, 77055-4226  Please get back to me as soon as you\'re able.   Thanks. \"', NULL, NULL, '2020-10-26 10:35:59', '2020-10-26 10:35:59'),
(991, 2027, 149, NULL, '2020-11-11 00:00:00.000', 'In Process', 'From: Michele.Thomas-Martin@molinahealthcare.com  Sub: (Jose, Julie)-(Longpoint Medical Center)-(Molina Health)  Record # 167855     New Record # 171443     Good Afternoon,     Thank you for submitting the contract request.   The provider has been loaded in the billing system effective 9/1/2020 under service location 779 Normandy St.   I’ve submitted a new record to add the provider under service location 9504 Long Point RD Suite E.  Please allow 30 days for the new request to be processed.   Please see the attached welcome letter for record  # 167855      Thank You,     Michele Thomas-Martin  Associate Specialist, Provider Contracts  1-888-562-5442 Ext. 200042  www.MolinaHealthcare.com  Your Extended Family', NULL, NULL, '2020-11-04 15:28:33', '2020-11-04 15:28:33'),
(992, 2027, 149, NULL, '2020-11-11 00:00:00.000', 'In Process', 'To: Michele.Thomas-Martin@molinahealthcare.com  May I know the current status of this request.', NULL, NULL, '2020-11-04 15:29:26', '2020-11-04 15:29:26'),
(993, 2027, 149, NULL, '2020-11-18 00:00:00.000', 'In Process', 'To: Michele.Thomas-Martin@molinahealthcare.com  May I know the current status of the request regarding the provider (Julie Jose) to be added in another location of  9504 Long Point RD Suite E.  Thanks.', NULL, NULL, '2020-11-11 14:45:35', '2020-11-11 14:45:35'),
(994, 2037, 149, NULL, '2020-12-04 00:00:00.000', 'In Process', 'Follow up email sent to michele for location addition', NULL, NULL, '2020-11-18 14:29:58', '2020-11-18 14:29:58'),
(995, 2037, 149, NULL, '2020-12-04 00:00:00.000', 'In Process', 'Thomas-Martin, Michele Wed, Nov 18, 3:33 PM (1 day ago) to me  Record # 171433     Good Afternoon,     Thank you for your inquiry.  The service location hasn’t been loaded in the billing system yet.   I’ve sent a request to the analyst to check on the request.     Thank You,     Michele Thomas-Martin  Associate Specialist, Provider Contracts  1-888-562-5442 Ext. 200042  www.MolinaHealthcare.com  Your Extended Family', NULL, NULL, '2020-11-19 16:50:59', '2020-11-19 16:50:59'),
(996, 2037, 149, NULL, '2020-12-17 00:00:00.000', 'In Process', 'Michele.Thomas-Martin@molinahealthcare.com+ Follow up email sent Subject: (Jose, Julie)-(Longpoint Medical Center)-(Molina Health)', NULL, NULL, '2020-12-07 14:35:03', '2020-12-07 14:35:03'),
(997, 2037, 149, NULL, '2020-12-30 00:00:00.000', 'In Process', 'Received following email from Michele Thomas Martin ------------ Thomas-Martin, Michele Dec 7, 2020, 4:37 PM (2 days ago) to me  Record # 171443 Good Afternoon,  Thank you for your inquiry.  The request is still in process.   Please accept my apology for the inconvenience.   The request should be updated in a few weeks.  Thank You,  Michele Thomas-Martin Associate Specialist, Provider Contracts 1-888-562-5442 Ext. 200042 www.MolinaHealthcare.com Your Extended Family', NULL, NULL, '2020-12-09 13:49:25', '2020-12-09 13:49:25'),
(998, 1006, 149, NULL, '2021-02-03 00:00:00.000', 'In Process', 'Follow up email sent for credentialing to Michele.Thomas-Martin@molinahealthcare.com', NULL, NULL, '2021-01-27 14:26:55', '2021-01-27 14:26:55'),
(999, 1006, 149, NULL, '2021-02-04 00:00:00.000', 'In Process', 'Location addition still in process, need to allow more time: \"Good Morning,  Thank you for your inquiry.  The provider listed below was approved for credentialing 7/24/2020 and loaded in the billing system effective 9/1/2020 under all plans.  The provider was loaded under service location 779 Normandy Street Suite 114 Houston TX 77015.   I’ve submitted a new request to add another service location (9504 LONG POINT RD) for the provider that is still in process.   Please allow a few more weeks for the service location to be added.  Please see the welcome letter that was sent.  Thank You,  Michele Thomas-Martin Associate Specialist, Provider Contracts 1-888-562-5442 Ext. 200042 www.MolinaHealthcare.com Your Extended Family\"', NULL, NULL, '2021-01-28 13:56:12', '2021-01-28 13:56:12'),
(1000, 3040, 149, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: david.balli@molinahealthcare.com  Subject: No Subject  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-28 14:13:02', '2021-05-28 14:13:02'),
(1001, 3040, 149, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: MHMSProviderContracting@molinahealthcare.com, MHTXProviderServices@molinahealthcare.com, MHT.Credentialing@molinahealthcare.com, Jasmine.Guerrero@molinahealthcare.com, david.balli@molinahealthcare.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-17 09:07:40', '2021-06-17 09:07:40'),
(1002, 3040, 149, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com, Michele.Thomas-Martin@molinahealthcare.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-06 09:23:00', '2021-07-06 09:23:00'),
(1003, 3040, 149, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Hello Thomas,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Molina Health in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: 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: Fernandus, Limy  Provider NPI# 1972005189  Provider 5:   Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238  Provider 7:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Also please add the below mentioned providers under the below highlighted locations.   Provider 1:   Provider Name: Jose, Julie  Provider NPI# 1447883061 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 2:   Provider Name: Brown, Brittany  Provider NPI# 1275163537 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 3:   Provider Name: Abraham, Glory  Provider NPI# 1194206490 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 5:   Provider Name: Joseph, Vibitha  Provider NPI# 1952931560 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-07-26 15:03:16', '2021-07-26 15:03:16'),
(1004, 3040, 149, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Hello Thomas,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Molina Health in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: 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: Fernandus, Limy  Provider NPI# 1972005189  Provider 5:   Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238  Provider 7:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Also please add the below mentioned providers under the below highlighted locations.   Provider 1:   Provider Name: Jose, Julie  Provider NPI# 1447883061 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 2:   Provider Name: Brown, Brittany  Provider NPI# 1275163537 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 3:   Provider Name: Abraham, Glory  Provider NPI# 1194206490 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 5:   Provider Name: Joseph, Vibitha  Provider NPI# 1952931560 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-07-26 15:03:29', '2021-07-26 15:03:29'),
(1005, 11056, 149, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email sent to : Michele.Thomas-Martin@molinahealthcare.com  Sub : Fwd: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good morning!  Record # 179917  Hope you are doing well. I am facing an issue regarding the providers mentioned below. I can\'t find the providers on the directory for the additional locations of Longpoint Medical Center & Imperial Valley Urgent Care Center. All of them are showing only for the location of the Normandy Urgent Care centre. Please assist us soon related to the additional locations.  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 9: Provider Name: Rauf, Abdur Provider NPI # 14977726202  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  If you need any documents or information please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-11 09:19:02', '2021-08-11 09:19:02'),
(1006, 3040, 149, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject; Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Hello Thomas,   Hope you are doing well. Please note I checked the above mentioned providers on the Molina Healthcare provider directory but I couldn\'t find the providers overthere. Would it be possible that you can send me the any confirmation stated that the providers participating under the below locations.   Waiting for your reply.   Thank you ', NULL, NULL, '2021-08-18 14:58:29', '2021-08-18 14:58:29'),
(1007, 10057, 149, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning Michele,  Thank you for reaching out to me, could you please let me know that all the locations are listed for the mentioned providers, also please assist me to search for providers in the provider directory.  Thanks & Regards,', NULL, NULL, '2021-10-08 11:51:54', '2021-10-08 11:51:54'),
(1008, 10057, 149, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Evening,  Hope this email finds you well. I want to know the enrollment status for below mentioned providers under TIN.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Tertiary Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Joseph, Vibitha	1952931560 Jose, Julie	1447883061 Brown, Brittany	1275163537 Abraham, Glory	1194206490  Please get back to me as soon as you get a chance. Have a great weekend ahead!  Thanks & Regards,', NULL, NULL, '2021-11-19 18:13:55', '2021-11-19 18:13:55'),
(1009, 10057, 149, NULL, '2021-12-01 00:00:00.000', 'Approved', 'Email Received From : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Afternoon,  Thank you for your inquiry.  Please see the status for each provider below.  Jaya Jacob – There is no request on file.  Please submit a contract request with valid W9 to MHTContractRequest@Molinahealthcare.com.  Jeena Abraham - There is no request on file.  Please submit a contract request with valid W9 to MHTContractRequest@Molinahealthcare.com.  Vibitha Joseph -  The provider was added under the group effective 7/15/2020.    Please see a copy of the welcome letter.  Julie Rose - The provider was added under the group effective 11/1/2020 under additional locations and under the group effective 9/1/20.    Please see a copy of the welcome letter.  Brittany Brown – The provider was added under the group effective 9/15/2020 .  Please see a copy of the welcome letter.  Glory Abraham - The provider was added under the group effective 7/15/2020.    Please see a copy of the welcome letter.', NULL, NULL, '2021-11-24 14:44:45', '2021-11-24 14:44:45'),
(1010, 2027, 150, NULL, NULL, 'In Process', 'To: SWHPPROVIDERNETWORKDEVELOPMENT@bswhealth.org  Sub: (Thomas, Cini)-(Longpoint Medical Center)-(Scott & White)  May I know if we can submit the enrollment application for this provider in your network. Below are the provider details: Provider Name: Thomas, Cini Provider NPI# 1134777238 Group Name: Longpoint Medical Center Tax ID: 76-0612416  Thanks. ', NULL, NULL, '2020-07-10 16:43:31', '2020-07-10 16:43:31'),
(1011, 2027, 150, NULL, NULL, 'In Process', 'From: Richard.Hinkley@bswhealth.org  Good evening,     I was forwarded the request you sent to provider networking inquiring about applying for this provider with TIN: 760612416. Please be aware that there is no current new contracting request for this Group/TIN. This group is also not in our credentialing system at this time. If this group is not currently contracted with SWHP you will need to submit a contract request to Provider Networking for review and approval at the following link: https://swhp.org/forms/html/provider-account-request.html     Thank you,', NULL, NULL, '2020-07-17 17:39:57', '2020-07-17 17:39:57'),
(1012, 2027, 150, NULL, NULL, 'In Process', 'Online application form for group contracting submitted with scott&White and attached ', NULL, NULL, '2020-07-17 17:43:08', '2020-07-17 17:43:08'),
(1013, 2027, 150, NULL, '2020-10-18 00:00:00.000', 'In Process', 'To: Richard.Hinkley@bswhealth.org  May i know the current application status of this provider. Details are mentioned below:  Provider Name: Thomas, Cini Provider NPI# 1134777238 Group Name: Longpoint Medical Center Tax ID: 76-0612416  Thanks. ', NULL, NULL, '2020-10-11 16:16:03', '2020-10-11 16:16:03'),
(1014, 2037, 150, NULL, '2020-11-17 00:00:00.000', 'In Process', 'Follow up email sent.', NULL, NULL, '2020-10-26 17:19:31', '2020-10-26 17:19:31'),
(1015, 2037, 150, NULL, '2020-11-30 00:00:00.000', 'In Process', 'follow up email sent to Richard.Hinkley@bswhealth.org', NULL, NULL, '2020-11-18 14:51:08', '2020-11-18 14:51:08'),
(1016, 2037, 150, NULL, '2020-11-26 00:00:00.000', 'Approved', 'URGENT CARE CONTRACT-LPMC -------------------  Herrera, Jose L Jose.Herrera@bswhealth.org Tue, Nov 17, 8:55 AM (2 days ago) to Martin, me, SWHP  Sherry,  Your TAX ID was contracted as a facility only contract.  We did not credential or load any providers under this contract    We would not have been given any providers to credential or load in our systems under a facility contract.   Thank you,   Jose Herrera  Provider Relations Representative  FirstCare Health Plans—part of Baylor Scott & White Health  1901 W. Loop 289, Suite 9 | Lubbock, TX 79407  806-784-4306 Office | 806-784-4396 Fax  FirstCare.com', NULL, NULL, '2020-11-19 15:46:43', '2020-11-19 15:46:43'),
(1017, 2027, 151, NULL, '2020-10-18 00:00:00.000', 'In Process', 'To: 	registrar@multiplan.com christos.ziogas@multiplan.com  I want to enroll this provider with Multiplan please assist me how I can start the process. Details of the provider are mentioned below:  Provider Name: Jose, Julie  Provider NPI# 1447883061  Thanks. ', NULL, NULL, '2020-10-11 15:38:23', '2020-10-11 15:38:23'),
(1018, 2037, 151, NULL, '2020-11-19 00:00:00.000', 'In Process', 'Follow up email sent regarding the process.', NULL, NULL, '2020-10-26 17:03:28', '2020-10-26 17:03:28'),
(1019, 2037, 151, NULL, '2020-11-26 00:00:00.000', 'In Process', 'Follow up email sent regarding the process.', NULL, NULL, '2020-11-19 17:25:07', '2020-11-19 17:25:07'),
(1020, 2037, 151, NULL, '2020-12-23 00:00:00.000', 'In Process', 'LOI sent to add LPMC location as the group is already credentialed and Contracted under Normandy and the provider is in network With Normandy aswell.', NULL, NULL, '2020-11-30 17:45:24', '2020-11-30 17:45:24'),
(1021, 2037, 151, NULL, '2020-12-30 00:00:00.000', 'In Process', 'Location addition in process need to allow more time', NULL, NULL, '2020-12-23 17:14:37', '2020-12-23 17:14:37'),
(1022, 1006, 151, NULL, '2021-02-03 00:00:00.000', 'In Process', 'Follow up email sent for location update to registrar@multiplan.com ', NULL, NULL, '2021-01-27 14:36:57', '2021-01-27 14:36:57'),
(1023, 3040, 151, NULL, '2021-03-08 00:00:00.000', 'In Process', 'Email sent to: 	registrar@multiplan.com  Subject: Location Update Request - Julie Jose  Greetings,  Hope you are doing well. I just wanted to get an update regarding the location addition for the following provider.   Practice Name: Longpoint Medical Center Practice NPI# 1770763815 Practice Tax ID# 76-0612416 Practice Address: 9504 LONG POINT RD STE E,  Houston , TX 77055-4226  Provider Name: Jose, Julie Provider NPI# 1447883061  Please get back to me as soon as possible. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-03-01 13:38:20', '2021-03-01 13:38:20'),
(1024, 3040, 151, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Multiplan ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Multiplan for our group under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-28 16:26:36', '2021-05-28 16:26:36'),
(1025, 3040, 151, NULL, '2021-06-24 00:00:00.000', 'Approved', 'Provider is participating with Multiplan. Please see attachment. ', NULL, NULL, '2021-06-17 10:07:06', '2021-06-17 10:07:06'),
(1026, 2027, 153, NULL, '2020-10-18 00:00:00.000', 'In Process', 'To: AM.Houston@superiorhealthplan.com  May I know the current status of the provider mentioned below: Provider Name- Jose, Julie Provider NPI# 1447883061 Group Name- Longpoint Medical Center Group Tax-ID- 76-0612416   Thanks.', NULL, NULL, '2020-10-11 15:42:30', '2020-10-11 15:42:30'),
(1027, 2027, 153, NULL, '2020-10-21 00:00:00.000', 'In Process', 'From: AM.Houston@superiorhealthplan.com  Hi Martin,  The credentialing process for Julie Jose has been discontinued.     Sincerely,', NULL, NULL, '2020-10-14 09:16:23', '2020-10-14 09:16:23'),
(1028, 2037, 153, NULL, '2020-11-04 00:00:00.000', 'In Process', 'From: AM.Houston@superiorhealthplan.com  Hi Martin,  The credentialing process for Julie Jose has been discontinued.     Sincerely,', NULL, NULL, '2020-10-28 17:13:55', '2020-10-28 17:13:55'),
(1029, 2027, 153, NULL, '2020-11-11 00:00:00.000', 'In Process', 'To: AM.Houston@superiorhealthplan.com  Sub: (Jose, Julie)-(Longpoint Medical Center)-(Superior Health)  May I know the reason why this credentialing process has been discontinued?', NULL, NULL, '2020-11-04 15:43:54', '2020-11-04 15:43:54'),
(1030, 2027, 153, NULL, '2020-11-18 00:00:00.000', 'In Process', 'From: AM.Houston@superiorhealthplan.com  Hi Martin,  Credentialing is usually discontinued due to a provider being nonresponsive to a request for additional information. The Add a Provider Packet was sent to lpmc@claimsmedinc.com on 6/1/2020 with no response. At this time you would need to resubmit the request. I’ve included the link below to assist you in your resubmission.     Add a Product to an Existing Contract:  https://www.superiorhealthplan.com/providers/become-a-provider/Add-New-Product.html     Sincerely,', NULL, NULL, '2020-11-11 13:37:25', '2020-11-11 13:37:25'),
(1031, 2027, 153, NULL, '2020-11-18 00:00:00.000', 'In Process', 'Online application has been submitted for this provider. screenshot is attached', NULL, NULL, '2020-11-11 14:02:22', '2020-11-11 14:02:22'),
(1032, 2037, 153, NULL, '2020-11-27 00:00:00.000', 'In Process', 'Request is in process need to allow more time', NULL, NULL, '2020-11-18 15:46:16', '2020-11-18 15:46:16'),
(1033, 2037, 153, NULL, '2020-12-10 00:00:00.000', 'In Process', 'In process need to allow more time', NULL, NULL, '2020-11-30 17:47:04', '2020-11-30 17:47:04'),
(1034, 2037, 153, NULL, '2020-12-28 00:00:00.000', 'In Process', 'Request is in process need to allow more time', NULL, NULL, '2020-12-11 13:42:28', '2020-12-11 13:42:28'),
(1035, 2037, 153, NULL, '2021-01-05 00:00:00.000', 'In Process', 'Follow up email sent', NULL, NULL, '2020-12-29 16:50:37', '2020-12-29 16:50:37'),
(1036, 1006, 153, NULL, '2021-02-03 00:00:00.000', 'In Process', 'Follow up email sent for credentialing to AM.Houston@superiorhealthplan.com', NULL, NULL, '2021-01-27 14:40:54', '2021-01-27 14:40:54'),
(1037, 1006, 153, NULL, '2021-02-03 00:00:00.000', 'In Process', 'Email received:  Your email was received. An Account Manager will be contacting you to address your request. When contacting Account Management for updates on this issue, you can Reference Case #  24272     If you are in need of immediate assistance, you can call to speak to an Account Manager by phone at 1-800-656-4817 (English 1, Spanish 2), and Option 3 Provider Relations Team', NULL, NULL, '2021-01-27 17:31:33', '2021-01-27 17:31:33'),
(1038, 1006, 153, NULL, '2021-02-09 00:00:00.000', 'In Process', 'Received the following update from AM.Houston@superiorhealthplan.com:  \"Good morning Victor,  my apologies for the late response. Here is the following information for the provider Julie Jose:  For the provider Julie Jose NPI#1447883061 Tax ID#760612416 ---provider discontinued due to no response from provider --- you can resubmit  Under TID#270796429--- contract completed with effective date of 11/1/2020  Under TID# 471914151- contact completed with effective date of 11/1/2020   Veronica Botello Rocha Provider Relations Coordinator II Provider Relations Department Nueces, Harris & Jefferson SDAs cid:image002.jpg@01D0C3DA.F54AEF00 711 N. Carancahua Street, Suite 600 Corpus Christi, Texas 78401 Fax: (866) 683-5630 AM.CorpusChristi@superiorhealthplan.com| SuperiorHealthPlan.com Provider Relations Dept. 1-800-656-4817 Option 3 \"', NULL, NULL, '2021-02-02 13:52:44', '2021-02-02 13:52:44'),
(1039, 1006, 153, NULL, '2021-02-09 00:00:00.000', 'In Process', 'Submitted application for adding the provider to the group contract again @ https://www.superiorhealthplan.com/providers/become-a-provider/Add-New-Provider.html: \"Thank You For Your Request! Important to Note:  Prior to a new provider’s provision of services and receipt of claims reimbursement, program enrollment must be confirmed on requests for Superior Medicaid (STAR, STAR Health, STAR Kids and STAR+PLUS), CHIP and/or Long-Term Services and Supports (LTSS) programs.  Superior will notify you of acceptance or non-acceptance to our network no later than 90 days from receipt of a complete application for participation.  If additional information is required to process your request, a Superior representative will contact you soon.\"', NULL, NULL, '2021-02-02 14:16:19', '2021-02-02 14:16:19'),
(1040, 3040, 153, NULL, '2021-03-05 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Update on Credentialing for Julie Jose  Greetings,  Hope you are doing well. Please advise me the enrollment status for the below mentioned provider.   Practice Name- Longpoint Medical Center Practice Tax-ID- 76-0612416  Practice NPI# 1770763815  Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226    Provider Name- Jose, Julie Provider NPI# 1447883061  Please get back to me as soon as you get a chance. Waiting for your response.   Thanks', NULL, NULL, '2021-02-26 13:19:15', '2021-02-26 13:19:15'),
(1041, 3040, 153, NULL, '2021-03-10 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: Update on Credentialing for Julie Jose  Hello Veronica,  Hope you are doing well. Please advise me the enrollment process for the below mentioned provider.   Practice Name- Longpoint Medical Center Practice Tax-ID- 76-0612416  Practice NPI# 1770763815  Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226    Provider Name- Jose, Julie Provider NPI# 1447883061  Waiting for your reply.   Thank you ', NULL, NULL, '2021-03-03 15:06:47', '2021-03-03 15:06:47'),
(1042, 3040, 153, NULL, '2021-03-10 00:00:00.000', 'In Process', 'Email rcvd from: AM.Houston@superiorhealthplan.com  Subject: Update on Credentialing for Julie Jose  Good morning, sorry for the delay in response  But per review for Provider Name: Julie Jose, NPI# 1447883061 TIN# 76-0612416 under the TID # 760612416 provider was discontinued due to no response from provider on 6/11/2020. Under TID# 270796429- approved with an effective date of 11/1/2020, and under TID# 471914151 approved with effective date of 11/1/2020.   Veronica Botello Rocha Provider Relations Coordinator II Provider Relations Department Nueces, Harris & Jefferson SDAs', NULL, NULL, '2021-03-03 15:07:27', '2021-03-03 15:07:27'),
(1043, 3040, 153, NULL, '2021-03-10 00:00:00.000', 'In Process', 'Email rcvd from: AM.Houston@superiorhealthplan.com  Subject: Update on Credentialing for Julie Jose  Good afternoon,  Your email was received. An Account Manager will be contacting you to address your request. When contacting Account Management for updates on this issue, you can Reference Case # 28532  ', NULL, NULL, '2021-03-03 15:08:13', '2021-03-03 15:08:13'),
(1044, 3040, 153, NULL, '2021-03-19 00:00:00.000', 'In Process', 'Request submitted again online', NULL, NULL, '2021-03-12 17:36:11', '2021-03-12 17:36:11'),
(1045, 3040, 153, NULL, '2021-03-26 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Update on Credentialing for Julie Jose  Hello,  Hope you are doing well. As per your previous email I submitted the request online. Can you please check and advise did you receive it?  Practice Name- Longpoint Medical Center Practice Tax-ID- 76-0612416 Practice NPI# 1770763815 Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226   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.   Thanks ', NULL, NULL, '2021-03-19 15:40:24', '2021-03-19 15:40:24'),
(1046, 3040, 153, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Update on Credentialing for Julie Jose Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in our group Long Point Medical Center under the below location.   Practice Name- Longpoint Medical Center Practice Tax-ID- 76-0612416 Practice NPI# 1770763815 Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226   Provider Name- Jose, Julie Provider NPI# 1447883061  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you  ', NULL, NULL, '2021-06-08 13:34:15', '2021-06-08 13:34:15'),
(1047, 3040, 153, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Re: Update on Credentialing for Julie Jose Ref# 43513  Greetings,   Hope you are doing well. Please find the attached Individual Provider Contracting form as per email requested.   If you need any additional information please feel free to call or email me. Waiting for your response.   Thank you ', NULL, NULL, '2021-06-25 16:23:35', '2021-06-25 16:23:35'),
(1048, 1006, 153, NULL, '2021-07-08 00:00:00.000', 'In Process', 'We received the following email from SEMETRA.BRAZLE@superiorhealthplan.com:  Sub: Signature requested on \"ECM 546259 LONGPOINT MEDICAL CENTER\"  \"Semetra Brazle requests your signature on ECM 546259 LONGPOINT MEDICAL CENTER  Review and sign   Please Sign.  SEMETRA BRAZLE SEMETRA.BRAZLE@SUPERIORHEALTHPLAN.COM\"  The contract is signed and attached in the main group task for reference. ', NULL, NULL, '2021-07-01 15:44:14', '2021-07-01 15:44:14'),
(1049, 3040, 153, NULL, '2021-07-21 00:00:00.000', 'Approved', 'Email rcvd from: ECMExecutionTeam@superiorhealthplan.com  Subject: JULIE JOSE WELCOME LETTER  JULIE JOSE  LONG POINT MEDICAL CENTER  LPMC@CLAIMSMEDINC.COM  Welcome to the Superior HealthPlan network. We are excited to have you as a partner of our growing network of high quality health care professionals. You play a key role as we pursue our commitment to improve the health and well-being of the members we serve.Your records were reviewed and approved by our credentialing committee. You are now able to provide covered services to Superior members.  Your effective date is: 07/01/2021                                                    C/ 41057', NULL, NULL, '2021-07-14 14:09:25', '2021-07-14 14:09:25'),
(1050, 2027, 154, NULL, '2020-10-18 00:00:00.000', 'In Process', 'To: jxalanis@texaschildrens.org  I want to enroll this provider with Texas Children Health Plan please assist me how I can start the process. Details of the provider are mentioned below:  Provider Name: Jose, Julie  Provider NPI# 1447883061  Thanks. ', NULL, NULL, '2020-10-11 15:45:39', '2020-10-11 15:45:39'),
(1051, 2037, 154, NULL, '2020-11-20 00:00:00.000', 'In Process', 'Follow up email sent for process.', NULL, NULL, '2020-10-26 17:05:55', '2020-10-26 17:05:55');
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
(1052, 2037, 154, NULL, '2020-12-23 00:00:00.000', 'In Process', 'Credentialing is in process under Normandy. Will request to add location once the process finalizes.  ------------------------- Alanis, Juanita 11:39 AM (22 minutes ago) to me  Sherry,  These providers, Ani Stephen NPI: 1588959118, Jeemol George. NPI: 1497219067, Julie Jose, NPI: 1447883061 and Brittany Brown.  NPI: 1275163537 are not contracted with TCHP yet; there for cannot be added to the locations you are requesting.  ', NULL, NULL, '2020-11-20 13:06:02', '2020-11-20 13:06:02'),
(1053, 2037, 154, NULL, '2021-01-05 00:00:00.000', 'In Process', 'Currently being credentialed under normandy.Need to allow a bit more time.', NULL, NULL, '2020-12-23 17:19:08', '2020-12-23 17:19:08'),
(1054, 1006, 154, NULL, '2021-02-03 00:00:00.000', 'In Process', 'Follow up email sent for credentialing to jxalanis@texaschildrens.org', NULL, NULL, '2021-01-27 12:28:37', '2021-01-27 12:28:37'),
(1055, 3040, 154, NULL, '2021-03-08 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org, jxalanis@texaschildrens.org  Subject: Enrollment Status || Longpoint Medical Center || Jose, Julie, George, Jeemol || TCHP  Greetings,  Hope you are doing well. Please advise me the enrollment status for the below mentioned providers.   Practice Name: Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Name: Jose, Julie Provider NPI# 1447883061  Provider Name: George, Jeemol Provider NPI# 1497219067  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-03-01 13:26:33', '2021-03-01 13:26:33'),
(1056, 3040, 154, NULL, '2021-03-26 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Location Addition || Longpoint Medical Center || Jose, Julie, George, Jeemol & Stephen, Ani || TCHP  Greetings,  Hope you are doing well. Please find the attached provider information form including the W9 for adding the providers in additional locations.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-19 10:58:55', '2021-03-19 10:58:55'),
(1057, 3040, 154, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: axhartma@texaschildrens.org   Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-31 15:48:50', '2021-05-31 15:48:50'),
(1058, 3040, 154, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-06-17 12:21:33', '2021-06-17 12:21:33'),
(1059, 3040, 154, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email rcvd from: tchpnetworkmanagement@texaschildrens.org  Subject; Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Normandy Urgent Care Center  Imperial Valley Urgent Care Center  Longpoint Medical Center  Are these groups in our network? If so, please reach out to you PR.  Thank you', NULL, NULL, '2021-07-06 13:39:20', '2021-07-06 13:39:20'),
(1060, 3040, 154, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject:Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. I called the above number that you sent to find out if the above groups are in-network with TCHP or not. I am unable to find out the information because the provider relations department is not available over the phone. Can you please advise me if there is any other way I can find out the information.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-06 13:42:42', '2021-07-06 13:42:42'),
(1061, 3040, 154, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Re: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,   I am still waiting for the PR contact information. Can you please forward it to me so I can contact the PR directly because our claims are getting denied by insurance.   Please look into this matter personally so we are able to resolve the issue. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-26 16:39:14', '2021-07-26 16:39:14'),
(1062, 11056, 154, NULL, '2021-08-21 00:00:00.000', 'In Process', 'Email received from : tchpnetworkmanagement@texaschildrens.org  Sub : FW: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello PR,  Group Normandy Urgent Care Center, would like to know who is their group PR.  Thank you', NULL, NULL, '2021-08-13 15:32:18', '2021-08-13 15:32:18'),
(1063, 3040, 154, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Email rcvd from: kdelam@texaschildrens.org  Subject: Provider Contracts  Hello Adil,  Attached is the Provider Information Form to add locations and a Provider Information Change Form changes to existing providers.  I have included a breakdown of the contracts under your TIN.  Please contact me directly if you have any concerns getting the additional updates needed from contracting.     Thank you,  Kim', NULL, NULL, '2021-08-26 08:45:46', '2021-08-26 08:45:46'),
(1064, 10057, 154, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Subject : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Good Afternoon,  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI George, Jeemo	1497219067 Jose, Julie	1447883061 Stephen, Ani	1588959118 Piccione JR, James M	1356321509 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Fernandus, Limy	1972005189 Abraham, Glory	1194206490 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Thomas, Cini	1134777238 Joseph, Vibitha	1952931560 Abraham, Jeena	1467901587 PAUL, SIGI	1033623616 Joseph, Molly	1073019493 Jacob, Jaya	1194336149  Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-08 13:56:12', '2021-10-08 13:56:12'),
(1065, 10057, 154, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org, kdelam@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Greetings!  Any update on below mentioned credentialing request?  Please get back to me as soon as you get a chance. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-21 11:03:43', '2021-10-21 11:03:43'),
(1066, 10057, 154, NULL, '2021-11-05 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello Liz/Kimberly,  It should be Kimberly\'s responsibility to update you and us rather than we are trying to reach her or you for an application. Can someone please check that and respond. Thanks  Regards, Alex', NULL, NULL, '2021-10-29 09:47:46', '2021-10-29 09:47:46'),
(1067, 10057, 154, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. Can I get the latest update on below mentioned providers enrollment status and facility contracts / agreements.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Joseph, Molly	1396380077 Thomas, Cini	1134777238 Rauf, Abdur	1497726202 Piccione JR, James M	1356321509 Jacob, Jaya	1194336149 PAUL, SIGI	1033623616 Fernandus, Limy	1972005189 Abraham, Jeena	1467901587 Chennemkara, Mini Philip	1841755956 Joseph, Vibitha	1952931560 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Brown, Brittany	1275163537 George, Jeemol	1497219067 Jose, Julie	1447883061  Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-22 13:42:23', '2021-11-22 13:42:23'),
(1068, 10057, 154, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Sure, for each provider please provide the date their application was submitted and which application did you submit (LOI or PIF).  Thank you', NULL, NULL, '2021-12-02 14:33:29', '2021-12-02 14:33:29'),
(1069, 10057, 154, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Thank you for reaching out. The person before me has resigned. I can see that he has submitted the LOI forms for those providers which are already approved.  Please check from your side which providers are enrolled and updated in the system. Rest let me know so I can submit the application again.  Kindly revert back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-09 11:55:02', '2021-12-09 11:55:02'),
(1070, 10057, 154, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  I can provide status on application.  To check which providers are in network or not, please reach out to your PR.  They should be able to provide you with a roster for the group.  Thank you  -Liz', NULL, NULL, '2021-12-16 14:57:46', '2021-12-16 14:57:46'),
(1071, 10057, 154, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Thank you for reaching out. Could you please provide me with the PR details. It will be highly appreciated.  Regards,', NULL, NULL, '2021-12-22 13:51:08', '2021-12-22 13:51:08'),
(1072, 10057, 154, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  If your group is PAR, you can reach out to your PR at Provider Relations providerrelations@texaschildrens.org  If you are not in our network, reach out to provider assistance 832-828-1004.', NULL, NULL, '2021-12-29 12:05:24', '2021-12-29 12:05:24'),
(1073, 20067, 154, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org  Sub: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good afternoon,  Hope this email finds you well. I would like to know the enrollment status of the below-mentioned providers under these locations  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Molly Joseph	1396380077 Mini Chennemkara	1841755956 Odette Kourouma	1134525868 Ani Stephen	1588959118 James Piccione JR	1356321509 Jeny John	1073019493 Abdur Rauf	1497726202 Cini THomas	1134777238 James Piccione JR	1356321509 Vibitha Joseph	1952931560 SIGI PAUL	1033623616 Jeena Abraham	1467901587 Jaya Jacob	1194336149 Limy fernandus	1972005189 Brittany Brown	1275163537 Jeemol George	1497219067 Julie Jose	1447883061   Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-12 15:01:43', '2022-01-12 15:01:43'),
(1074, 20067, 154, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org, tchpnetworkmanagement@texaschildrens.org   Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good Morning! Hope you are doing well. Any updates on the previous request?  Your Early response will be highly appreciated Thanks & Regards Syed Ahad.', NULL, NULL, '2022-01-19 09:59:03', '2022-01-19 09:59:03'),
(1075, 20067, 154, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org  Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good afternoon!  Hope this email finds you in good health. I would like to know the enrollment status of the below-mentioned groups and providers. Thanks & Regards, Syed Ahad', NULL, NULL, '2022-01-28 14:44:18', '2022-01-28 14:44:18'),
(1076, 2027, 156, NULL, '2020-10-18 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  Sub: (Jose, Julie)-(Longpoint Medical Center)-(Tricare)  May I know the current status of the provider mentioned below: Provider Name: Jose, Julie  Provider NPI#  1447883061  Group Name:Longpoint Medical Center Group Tax-ID: 76-0612416  Thanks. ', NULL, NULL, '2020-10-11 14:54:31', '2020-10-11 14:54:31'),
(1077, 2027, 156, NULL, '2020-10-19 00:00:00.000', 'In Process', 'From: KMoten4@humana.com  Sub: (Jose, Julie)-(Longpoint Medical Center)-(Tricare)  Good Morning,     This provider is not showing certified in our system.     Please provide a certification application to WPS.        Respectfully,  Katherine Moten', NULL, NULL, '2020-10-12 09:47:22', '2020-10-12 09:47:22'),
(1078, 2027, 156, NULL, '2020-11-09 00:00:00.000', 'In Process', 'Sent certification application to WPS by fax at 608-221-7535. ', NULL, NULL, '2020-11-02 10:39:48', '2020-11-02 10:39:48'),
(1079, 2027, 156, NULL, '2020-11-16 00:00:00.000', 'In Process', 'TO: KMoten4@humana.com  May I know the current status of this request.  Thanks.', NULL, NULL, '2020-11-09 15:31:04', '2020-11-09 15:31:04'),
(1080, 2037, 156, NULL, '2020-12-01 00:00:00.000', 'In Process', 'Follow up email sent to K Moten', NULL, NULL, '2020-11-16 12:49:15', '2020-11-16 12:49:15'),
(1081, 2037, 156, NULL, '2020-12-16 00:00:00.000', 'In Process', 'Currently being processed need to allow more time', NULL, NULL, '2020-12-01 14:53:04', '2020-12-01 14:53:04'),
(1082, 2037, 156, NULL, '2020-12-28 00:00:00.000', 'In Process', '	 Follow up email sent to K Moten', NULL, NULL, '2020-12-21 18:03:09', '2020-12-21 18:03:09'),
(1083, 2037, 156, NULL, '2021-01-05 00:00:00.000', 'In Process', 'This provider is showing certified in our system.  TIN: 76-0612416 is a NON-NETWORK group. When a group is NON-NETWORK you need to send those requests to WPS: All your updates to your group need to be faxed to 608.221.7536, Attn: Customer Service.     You will need to send the group information so that WPS can add the group to this provider profile.        Respectfully,  Katherine Moten  TRICARE Community Liaison II  Humana  T 502-318-5250  F 210-239-0401  kmoten4@humana.com  HumanaMilitary.com', NULL, NULL, '2020-12-29 15:52:29', '2020-12-29 15:52:29'),
(1084, 1006, 156, NULL, '2021-02-03 00:00:00.000', 'In Process', 'Follow up email sent for credentialing to KMoten4@humana.com ', NULL, NULL, '2021-01-27 12:17:28', '2021-01-27 12:17:28'),
(1085, 1006, 156, NULL, '2021-02-03 00:00:00.000', 'New/Not Initiated', 'Email received:  They are all credentialed and affiliated with the TIN’s you provided for each provider.  Follow up email sent:  Can you please provide me their welcome letters or executed contracts? Are all the providers listed under the following location as in-network & certified under the following address? 9504 LONG POINT RD STE E, Houston , TX 77055-422', NULL, NULL, '2021-01-27 14:03:11', '2021-01-27 14:03:11'),
(1086, 1006, 156, NULL, '2021-02-03 00:00:00.000', 'In Process', 'Email received:  They are all credentialed and affiliated with the TIN’s you provided for each provider.  Follow up email sent:  Can you please provide me their welcome letters or executed contracts? Are all the providers listed under the following location as in-network & certified under the following address? 9504 LONG POINT RD STE E, Houston , TX 77055-422', NULL, NULL, '2021-01-27 14:03:35', '2021-01-27 14:03:35'),
(1087, 3040, 156, NULL, '2021-03-04 00:00:00.000', 'Approved', 'Julie Jose approved in Tricare. Effective Date: 12/03/2020  Please see attachment.', NULL, NULL, '2021-02-25 15:11:54', '2021-02-25 15:11:54'),
(1088, 2027, 157, NULL, '2020-10-05 00:00:00.000', 'In Process', 'To: trpndataentry@trpnppo.com  Sub: (Jose, Julie)-(Longpoint Medical Center)-(Three Rivers Provider Network - TRPN)  May I know the current status of the below mentioned provider: Provider Name: Jose, Julie  Provider NPI# 1447883061 Group Name: Longpoint Medical Center Group Tax-ID: 76-0612416  Thanks.', NULL, NULL, '2020-09-28 17:52:17', '2020-09-28 17:52:17'),
(1089, 2037, 157, NULL, '2020-11-11 00:00:00.000', 'In Process', 'Another follow up email sent :  Greetings, May I know the current status of the below mentioned provider:  Provider Name: Jose, Julie  Provider NPI# 1447883061 Group Name: Longpoint Medical Center Group Tax-ID: 76-0612416  Thanks.', NULL, NULL, '2020-10-22 17:00:47', '2020-10-22 17:00:47'),
(1090, 2027, 157, NULL, '2020-11-18 00:00:00.000', 'In Process', 'To; trpndataentry@trpnppo.com  This is a follow up email. Please reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-11-11 15:01:54', '2020-11-11 15:01:54'),
(1091, 2037, 157, NULL, '2020-11-25 00:00:00.000', 'In Process', 'Follow up email sent to trpndataentry@trpnppo.com May I know the current status of the below mentioned provider: Provider Name: Jose, Julie Provider NPI# 1447883061 Group Name: Longpoint Medical Center Group Tax-ID: 76-0612416  Thanks. ', NULL, NULL, '2020-11-18 16:01:29', '2020-11-18 16:01:29'),
(1092, 2037, 157, NULL, '2020-12-14 00:00:00.000', 'In Process', 'Follow up email sent to trpndataentry@trpnppo.com', NULL, NULL, '2020-11-25 17:12:14', '2020-11-25 17:12:14'),
(1093, 2037, 157, NULL, '2020-12-23 00:00:00.000', 'In Process', 'Another follow up email sent to trpndataentry@trpnppo.com', NULL, NULL, '2020-12-14 15:14:17', '2020-12-14 15:14:17'),
(1094, 2037, 157, NULL, '2021-01-05 00:00:00.000', 'In Process', 'Another follow up email sent', NULL, NULL, '2020-12-23 10:49:38', '2020-12-23 10:49:38'),
(1095, 1006, 157, NULL, '2021-02-03 00:00:00.000', 'In Process', 'Follow up email sent for credentialing to trpndataentry@trpnppo.com', NULL, NULL, '2021-01-27 14:48:21', '2021-01-27 14:48:21'),
(1096, 3040, 157, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Sent the following initiation request to trpndataentry@trpnppo.com & providerrelations@trpnppo.com:  Sub: Provider Enrollment Request - NUCC- TRPN  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Multiplan for our group under the below locations. Can you please send the roster.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-28 17:04:06', '2021-05-28 17:04:06'),
(1097, 11056, 157, NULL, '2021-06-24 00:00:00.000', 'In Process', 'EMAIL sent to : lpmc@claimsmedinc.com  Sub:  Provider Update Information Form- TRPN  Good Evening!  Hope you are doing well. Please find the attached Provider update form to enroll the below mentioned group and providers in TRPN for our group under the below locations.   Practice Details: Practice Name: Longpoint Medical Center Practice NPI: 1770763815 Practice TIN: 76-0612416 Primary Address: 9504 LONG POINT RD STE EHouston , TX 77055-4226  Practice Name: Imperial Valley Urgent Care Center Practice NPI: 1407171077 Practice TIN: 27-0796429P Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Provider Names enlisted below:-  Provider 1: Provider Name: Joseph, Molly Provider NPI : 1396380077  Provider 2: Provider Name:  Jacob, Jaya Provider NPI : 1194336149   Provider 3: Provider Name:  PAUL, SIGI Provider NPI : 1033623616  Provider 4:  Provider Name: Chennemkara, Mini Provider NPI : 1841755956     Provider 5:   Provider Name:  Abraham, Jeena Provider NPI :  1467901587    Provider 6:   Provider Name:  Kourouma , Odette Provider NPI :  1134525868  Provider 7: Provider Name:  Abraham, Glory Provider NPI :  1194206490   Provider 8:  Provider Name:  Fernandus, Limy Provider NPI :  1972005189  Provider 9: Provider Name:  Thomas, Cini Provider NPI :  1134777238  Provider 10:  Provider Name:  Stephen, Ani Provider NPI :  1588959118   Provider 11:  Provider Name:  Jose, Julie Provider NPI :  1447883061    Provider 12:   Provider Name:  Brown, Brittany Provider NPI :   1275163537  Provider 13:  Provider Name:  Joseph, Vibitha Provider NPI :   1952931560    Provider 14:  Provider Name:  Abdur Rauf Provider NPI :  1497726202    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-17 13:51:26', '2021-06-17 13:51:26'),
(1098, 3040, 157, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: trpndataentry@trpnppo.com, mflores@trpnppo.com, ccampos@trpnppo.com  Subject: Re: Provider Update Information Form- TRPN  Hello Max and Carlos,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in TRPN for our group Longpoint Medical Center under the below location. We already sent the provider update form at trpndataentry@trpnppo.com.   Practice Details: Practice Name: Longpoint Medical Center Practice NPI: 1770763815 Practice TIN: 76-0612416 Primary Address: 9504 LONG POINT RD STE EHouston , TX 77055-4226  Provider 1: Provider Name: Joseph, Molly Provider NPI : 1396380077  Provider 2: Provider Name:  Jacob, Jaya Provider NPI : 1194336149   Provider 3: Provider Name:  PAUL, SIGI Provider NPI : 1033623616  Provider 4:  Provider Name: Chennemkara, Mini Provider NPI : 1841755956     Provider 5:   Provider Name:  Abraham, Jeena Provider NPI :  1467901587    Provider 6:   Provider Name:  Kourouma , Odette Provider NPI :  1134525868  Provider 7: Provider Name:  Abraham, Glory Provider NPI :  1194206490   Provider 8:  Provider Name:  Fernandus, Limy Provider NPI :  1972005189  Provider 9: Provider Name:  Thomas, Cini Provider NPI :  1134777238  Provider 10:  Provider Name:  Stephen, Ani Provider NPI :  1588959118  Provider 11:  Provider Name:  Jose, Julie Provider NPI :  1447883061    Provider 12:   Provider Name:  Brown, Brittany Provider NPI :   1275163537  Provider 13:  Provider Name:  Joseph, Vibitha Provider NPI :   1952931560    Provider 14:  Provider Name:  Abdur Rauf Provider NPI :  1497726202    Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-05 15:37:20', '2021-07-05 15:37:20'),
(1099, 3040, 157, NULL, '2021-07-27 00:00:00.000', 'Approved', 'Email rcvd from: ccampos@trpnppo.com  Subject:  Provider Update Information Form- TRPN  Hi,  Provider Molly Joseph is Active, effective date 01/01/2021,  Provider Jacob Jaya is Active, effective date 01/01/2021,  Provider Sigi Paul is Active, effective date 01/01/2021,  Provider Jeena Abraham is Active, effective date 01/01/2021,  Provider Odette Kourouma is Active, effective date 01/01/2021,  Provider Glory Abraham is Active, effective date 01/01/2021,  Provider Limy Fernandus is Active, effective date 01/01/2021,  Provider Cini Thomas is Active, effective date 10/28/2019,  Provider Ani Stephen is Active, effective date 01/01/2021,  Provider Julie Jose is Active, effective date 01/01/2021,  Provider Brittany Brown is Active, effective date 01/01/2021,  Provider Vibitha Joseph is Active, effective date 01/01/2021,  Provider Abdur Rauf is Active, effective date 01/01/2021,  Carlos Campos Data Entry Department Supervisor Three Rivers Provider Network 6970 O’Bannon Drive Las Vegas, NV 89117 P: 619.869.8940 F: 619.271.2563 ccampos@trpnppo.com', NULL, NULL, '2021-07-20 08:04:33', '2021-07-20 08:04:33'),
(1100, 2027, 160, NULL, '2020-10-15 00:00:00.000', 'In Process', 'To: txcredentialing@amerigroup.com Jason.Hughes@amerigroup.com  Sub: (George, Jeemol)-(Longpoint Medical Center)-(Amerigroup)  Hello hope you are doing great, May I know if the panels are open for credentialing. I want to enroll one provider under (Longpoint Medical Center). Details are mentioned below: Provider Name: George, Jeemol Provider NPI# 1497219067 Group Name: Longpoint Medical Center Group Tax-ID: 76-0612416 Group NPI# 1770763815   Thanks.  ', NULL, NULL, '2020-10-08 14:18:42', '2020-10-08 14:18:42'),
(1101, 2037, 160, NULL, '2020-11-11 00:00:00.000', 'In Process', 'Follow up email sent @	txcredentialing@amerigroup.com  May I know the current status of the below mentioned provider:  Provider Name: George, Jeemol Provider NPI# 1497219067 Group Name: Columbus Urgent Care PA Group Tax-ID: 471914151 Group NPI# 1215330501  Thanks.    ', NULL, NULL, '2020-10-22 17:53:02', '2020-10-22 17:53:02'),
(1102, 2027, 160, NULL, '2020-11-18 00:00:00.000', 'In Process', 'To: txcredentialing@amerigroup.com  This is a follow up email. Please reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-11-11 12:26:59', '2020-11-11 12:26:59'),
(1103, 2037, 160, NULL, '2020-12-02 00:00:00.000', 'In Process', 'LOI with W9 form sent to link jeemol george to LPMC TIN', NULL, NULL, '2020-11-18 13:30:50', '2020-11-18 13:30:50'),
(1104, 1006, 160, NULL, '2020-12-09 00:00:00.000', 'In Process', 'Followup email sent @ txcredentialing@amerigroup.com', NULL, NULL, '2020-12-02 18:06:10', '2020-12-02 18:06:10'),
(1105, 2027, 160, NULL, '2020-12-17 00:00:00.000', 'In Process', 'To: txcredentialing@amerigroup.com  May I know the current status of the below mentioned provider:  Provider Name: George, Jeemol Provider NPI# 1497219067 Group Name: Columbus Urgent Care PA Group Tax-ID: 471914151 Group NPI# 1215330501  Thanks.      ', NULL, NULL, '2020-12-10 14:44:27', '2020-12-10 14:44:27'),
(1106, 2037, 160, NULL, '2020-12-29 00:00:00.000', 'In Process', 'Follow up email sent', NULL, NULL, '2020-12-17 16:48:53', '2020-12-17 16:48:53'),
(1107, 2037, 160, NULL, '2021-01-05 00:00:00.000', 'In Process', 'Follow up email sent', NULL, NULL, '2020-12-29 10:34:44', '2020-12-29 10:34:44'),
(1108, 1006, 160, NULL, '2021-01-27 00:00:00.000', 'In Process', 'Sent a follow-up email for LPMC with it\'s own TIN instead of NUCC.', NULL, NULL, '2021-01-20 09:55:30', '2021-01-20 09:55:30'),
(1109, 1006, 160, NULL, '2021-02-03 00:00:00.000', 'In Process', 'Follow up email sent for credentialing to txcredentialing@amerigroup.com ', NULL, NULL, '2021-01-27 14:19:02', '2021-01-27 14:19:02'),
(1110, 3040, 160, NULL, '2021-03-08 00:00:00.000', 'In Process', 'Email sent to: txcredentialing@amerigroup.com  Subject: Enrollment Status || Longpoint Medical Center || Jose, Julie || Amerigroup ||  Greetings,  Hope you are doing well. Please advise me the enrollment status for the below mentioned providers.   Practice Name: Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Name: Jose, Julie Provider NPI# 1447883061  Provider Name: George, Jeemol Provider NPI# 1497219067  If you need any additional information please let me know. Waiting for your response.   Thanks ', NULL, NULL, '2021-03-01 15:30:54', '2021-03-01 15:30:54'),
(1111, 1006, 160, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Sent f/u email @ TX Credentialing TXCredentialing@amerigroup.com:  Sub: Enrollment Status - NUCC, IVUC, LPMC - Amerigroup  \"Hello,   I wanted to find out the enrollment status for the following providers, as well as what locations they are listed under for the following group:   Group Name: Normandy Urgent Care Center NPI# 1407171077 TIN# 27-0796429  Primary Address: 779 Normandy St Ste 114, Houston, TX 77015-3441 Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Tertiary Address: 9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider 1:Provider Name: George, Jeemol Provider NPI# 1497219067 Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061 Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956 Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490 Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238 Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616 Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-05-31 15:27:23', '2021-05-31 15:27:23'),
(1112, 11056, 160, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email Sent to : TXCredentialing@amerigroup.com  nucc@claimsmedinc.com  Subj : Enrollment Status - NUCC, IVUC, LPMC - Amerigroup  Good Morning!  I wanted to inquire about the enrollment status for the following providers, as well as what locations they are listed or added into under for the following group:  Practice Name: Normandy Urgent Care Center Practice NPI#: 1407171077 Practice TIN# : 27-0796429 Primary Address: 779 Normandy St Ste 114, Houston, TX 77015-3441 Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Tertiary Address:9504 LONG POINT RD STE E, Houston , TX 77055-4226-  Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider name : PAUL, SIGI Provider NPI # : 1033623616   Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider name : Joseph, Vibitha Provider NPI # : 1952931560   Provider name : Jose, Julie Provider NPI # : 1447883061  Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider name : George, Jeemol Provider NPI # : 1497219067  Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider name : Abraham, Glory Provider NPI # : 1194206490  Please get back to me as soon as you\'re able to.  Thank you!', NULL, NULL, '2021-06-17 12:20:29', '2021-06-17 12:20:29'),
(1113, 3040, 160, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: txcredentialing@amerigroup.com, Jason.Hughes@amerigroup.com,  Subject: Enrollment Status || Normandy Urgent Care Center - Amerigroup  Good Morning!  I wanted to inquire about the enrollment status for the following providers, as well as what locations they are listed under for the following group:  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Please get back to me as soon as you\'re able to.Waiting to hear from you soon.   Thank you!', NULL, NULL, '2021-07-06 09:58:55', '2021-07-06 09:58:55'),
(1114, 3040, 160, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Jason.Hughes@amerigroup.com,  Subject: Enrollment Status || Normandy Urgent Care Center - Amerigroup  Hello Jason,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Provider 17: Provider Name: John, Jeny Provider NPI #  1073019493  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks', NULL, NULL, '2021-07-26 15:24:42', '2021-07-26 15:24:42'),
(1115, 11056, 160, NULL, '2021-08-21 00:00:00.000', 'In Process', 'Email sent to : Jason.Hughes@amerigroup.com   &   TX Credentialing TXCredentialing@amerigroup.com  Sub : Fwd: Delivery Status Notification (Failure)  Good afternoon Jason!  Hope you are doing well. I want to inquire about the enrollment status for the below mentioned group and providers in our groups  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details:  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Provider 17: Provider Name: John, Jeny Provider NPI #  1073019493  If you need any documents or information feel free to reach out to me. Eagerly, waiting for your reply.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-13 14:30:20', '2021-08-13 14:30:20'),
(1116, 3040, 160, NULL, '2021-09-01 00:00:00.000', 'In Process', 'Email sent to: mpsweb@amerigroup.com  Subject: Delivery Status Notification (Failure)  Greetings!  Hope you are doing well. I want to inquire about the enrollment status for the below mentioned group and providers in our groups under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details:  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Provider 17: Provider Name: John, Jeny Provider NPI #  1073019493  If you need any documents or information feel free to reach out to me. Eagerly, waiting for your reply.  Thanks', NULL, NULL, '2021-08-25 15:00:11', '2021-08-25 15:00:11');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(1117, 3040, 160, NULL, '2021-09-16 00:00:00.000', 'In Process', 'Email sent to: mpswebinquiries@amerigroup.com, Jason.Hughes@amerigroup.com, TXCredentialing@amerigroup.com  Subject: Need to Enroll || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || AMERIGROUP ||  Greetings,   Hope you are doing well. I received an email from your side in which you mentioned that our group &  providers are not contracted with Amerigroup under the below locations besides some of the providers are participating with Amerigroup but not under all the locations. I wanted to know how to enroll and add the additional locations for the below mentioned providers in Amerigroup under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Below are the providers need to enroll in Amerigroup:    Provider Name: Thomas, Cini  NPI: 1134777238  Tax ID: 270796429  Status: Non-Participating  Location: 16272 IMPERIAL VALLEY DR STE K,  Houston     Provider Name: Stephen, Ani  NPI: 1588959118  Tax ID: 270796429  Status: Non-Participating     Provider Name: Piccione JR, James  NPI: 1356321509  Tax ID: 270796429  Status: Non-Participating  Location: 9504 LONG POINT RD STE E  Houston     Provider Name: PAUL, SIGI  NPI: 1033623616  Tax ID: 270796429  Status: Non-Participating     Provider Name: Kourouma , Odette  NPI: 1134525868  Tax ID: 270796429  Status: Non-Participating     Provider/Group Name: Jacob, Jaya  NPI: 1194336149  Status: Non-Participating     Provider Name: Fernandus, Limy  NPI: 1972005189  Status: Non-Participating     Provider Name: Abraham, Jeena  NPI: 1467901587  Provider ID:  Status: Non-Participating     Provider Name: Chennemkara, Mini Philip  NPI: 1841755956  Tax ID: 270796429  Status: Non-Participating     Provider Name: Joseph, Molly  NPI: 1396380077  Status: Non-Participating     Provider Name: John, Jeny  NPI: 1073019493  Tax ID: 27-0796429  Status: Non-Participating     Provider Name: Rauf, Abdur   NPI: 1497726202  Tax ID: 27-0796429  Status: Non-Participating    Request to add the additional location for the below mentioned providers.     Provider Name: Joseph, Vibitha  NPI: 1952931560  Provider ID: 09743760  Tax ID: 760612416  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 9504 LONG POINT RD STE E  Houston  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Provider Name: Abraham, Glory  NPI: 1194206490  Provider ID: 07116206  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: Brown, Brittany  NPI: 1275163537  Provider ID: 09808410  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: George, Jeemol  NPI: 1497219067  Provider ID: 09805666  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: Jose, Julie  NPI: 1447883061  Provider ID: 09807037  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    If you need any additional information please feel free to call or email me. Please get back to me as soon as you can get a chance. Waiting to hear from you soon.     Thank you ', NULL, NULL, '2021-09-09 13:07:54', '2021-09-09 13:07:54'),
(1118, 10057, 160, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : mpswebinquiries@amerigroup.com, Jason.Hughes@amerigroup.com, TXCredentialing@amerigroup.com  Sub : Need to Enroll || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || AMERIGROUP ||  Good Evening,  Hope this email finds you well. I want to inquire about the enrollment status of the below mentioned providers and practices. Please get back to me as soon as you get a chance.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Looking forward to hearing from you. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-18 15:13:38', '2021-10-18 15:13:38'),
(1119, 10057, 160, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Hello,  Greetings for the day!  We want to enroll the below mentioned providers on an urgent basis with Amerigroup under below mentioned details. Also please find the attached LOI\'s for all providers.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441 Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Please get back to me with the update as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-11 13:04:05', '2021-11-11 13:04:05'),
(1120, 10057, 160, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Greetings!  Can I get the latest update on the below mentioned request.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-11-30 10:57:06', '2021-11-30 10:57:06'),
(1121, 10057, 160, NULL, '2021-12-14 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com, Jason.Hughes@amerigroup.com, mpswebinquiries@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Good Afternoon,  Hope this email finds you in good health. I\'m writing this email to check the status for the applications which we have submitted to enroll the providers with Amerigroup under the TIN\'s.  It is my second follow-up, please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-06 16:13:43', '2021-12-06 16:13:43'),
(1122, 10057, 160, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Called to check the status: 800 - 600 - 4441  Applications has been received and credentialing started on 11/11/2021. Still need 30 working days to finish the process. Once request will be completed, welcome letter will be issued accordingly.  Call Reference: I145695020 - Representative - Courtney', NULL, NULL, '2021-12-13 10:55:14', '2021-12-13 10:55:14'),
(1123, 10057, 160, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Please check previous Call Comments.  Will follow-up next week.', NULL, NULL, '2021-12-20 14:06:41', '2021-12-20 14:06:41'),
(1124, 10057, 160, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Call Details: (800) 600-4441  Rep: Victor  Ref # I146789022  Still in process, need to check next week, also send reminder to below mentioned emails.  latina.small@anthem.com nena.graves@amerigroup.com  Regards, Steve Albert', NULL, NULL, '2021-12-29 11:08:12', '2021-12-29 11:08:12'),
(1125, 20067, 160, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: latina.small@anthem.com, nena.graves@amerigroup.com  Sub: Re: || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Good Morning, Hope all is well with you. I would like to know the enrollment status of the below-mentioned group and providers and if any of them is enrolled kindly send me their welcome letter.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Eagerly waiting for your response.   Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-10 12:19:07', '2022-01-10 12:19:07'),
(1126, 20067, 160, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email Received from: latina.small@anthem.com  Sub: RE: {EXTERNAL} Re: || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Good Morning,     Yes, I can look up and confirm the provider(s) status. Please allow me some time to review and respond.     Thank You in Advance,     Latina Small  Provider Experience Consultant  Amerigroup, Inc.', NULL, NULL, '2022-01-11 13:07:56', '2022-01-11 13:07:56'),
(1127, 20067, 160, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: latina.small@anthem.com, nena.graves@amerigroup.com  Sub: Re: {EXTERNAL} Re: || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Good Afternoon Latina and Nena! Hope this email finds you in good health. Haven\'t received any updates from your side. Kindly update me on the previous request.  Eagerly waiting for your response. Thanks & Regards. Syed Ahad', NULL, NULL, '2022-01-19 15:15:46', '2022-01-19 15:15:46'),
(1128, 20067, 160, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: latina.small@anthem.com, nena.graves@amerigroup.com  Sub: Re: {EXTERNAL} Re: || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Good Morning!  Eagerly waiting for your response. Kindly respond promptly,  Thank you,', NULL, NULL, '2022-01-28 11:58:58', '2022-01-28 11:58:58'),
(1129, 20067, 160, NULL, '2022-02-15 00:00:00.000', 'In Process', 'Email received from: latina.small@anthem.com  Sub: Re: {EXTERNAL} Re: || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||   Good Afternoon,     Sincere apologies for any delays. Please see the status for the providers below. If any providers need to be added to the group, please complete the attached LOI and Group App form and return to credentialing with a W9.        Group Name  Longpoint Medical Center  Tax ID  76-0612416  Group NPI  1770763815  Practice Location  9504 LONG POINT RD STE E Houston , TX 77055-4226     Provider Name     NPI  Amerigroup Status Update  Fernandus, Limy     1972005189  PAR - PR ID 12190801; Effective Date 11/11/2021(Medicaid, Medicare, CHIP)  PAUL, SIGI     1033623616  Non PAR  Jacob, Jaya     1194336149  Non PAR  Abraham, Jeena     1467901587  Non PAR  Thomas, Cini     1134777238  Non PAR  Kourouma , Odette Tiranke     1134525868  Non PAR  Rauf, Abdur     1497726202  PAR – PR ID 10007623; Effective Date 3/1/2012 (Medicaid, Medicare, CHIP, MMP)  Joseph, Molly     1396380077  Non PAR  John, Jeny     1073019493  Non PAR  Stephen, Ani     1588959118  Non PAR  Brown, Brittany     1275163537  Non PAR  Joseph, Vibitha     1952931560  PAR – PR ID 09743760; Effective Date 4/27/2020 (Medicare)  George, Jeemol     1497219067  Non PAR  Jose, Julie     1447883061  Non PAR  Abraham, Glory     1194206490  PAR – PR ID 08200815; Effective Date 10/01/2019 (Medicare)  Chennemkara, Mini Philip     1841755956  Non PAR  Piccione JR, James M     1356321509  Non PAR        Thank You in Advance,     Latina Small, MBA, BSBM', NULL, NULL, '2022-02-08 13:14:17', '2022-02-08 13:14:17'),
(1130, 20067, 160, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com CC: latina.small@anthem.com  Sub: LOI and Group App || Longpoint Medical Center || Providers || Amerigroup  Good Afternoon!  Hope you had a great weekend. Attached are the LOI and Group App for Non-par Providers along with W9.  Kindly let me know if anything else is required from my end.  Regards, ', NULL, NULL, '2022-02-21 13:47:07', '2022-02-21 13:47:07'),
(1131, 20067, 160, NULL, '2022-03-15 00:00:00.000', 'In Process', 'Secure Email received from:  TX Credentialing  Sub: RE: FW: {EXTERNAL} LOI and Group App || Longpoint Medical Center || Providers || Amerigroup  the LOI has a mix match of the group name with the tax ID.     There is one tax ID listed on the LOI, the group name should correspond to the tax ID.', NULL, NULL, '2022-03-08 09:26:20', '2022-03-08 09:26:20'),
(1132, 20067, 160, NULL, '2022-03-15 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Sub:   Good Morning!  Attached are the LOI and Group applications for the providers.  Let me know if anything else is required from my end.  Thank you,', NULL, NULL, '2022-03-08 09:56:37', '2022-03-08 09:56:37'),
(1133, 20067, 160, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com, latina.small@anthem.com   Sub:  Re: LOI and Group App || Longpoint Medical Center || Providers || Amerigroup  Good Morning!  Hope this email finds you in good health. Any updates on the Submitted LOIs of Longpoint Medical Center providers.  Thank you, Syed', NULL, NULL, '2022-03-17 10:03:49', '2022-03-17 10:03:49'),
(1134, 20067, 160, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email received from: TXCredentialing@amerigroup.com   Sub: FW: {EXTERNAL} Re: LOI and Group App || Longpoint Medical Center || Providers || Amerigroup  Those were received and pending completion.     Check back in 7 business days', NULL, NULL, '2022-03-17 16:43:24', '2022-03-17 16:43:24'),
(1135, 2027, 161, NULL, '2020-10-15 00:00:00.000', 'In Process', 'To: Vanessa.Brown@communityhealthchoice.org CHC.Contracting@communityhealthchoice.org  Sub; (George, Jeemol)-(Longpoint Medical Center)-(Community Health Choice)  Hello hope you are doing great, I have checked through your provider directory that one of our  group practices is already linked with (Community Health Choice). So I want to add one more location in it as well as I want to add some providers in that location. Details are mentioned below: Existing group with CHC:(Normandy Urgent Care Center 779 Normandy St Ste 114 Houston , TX 77015-3441) Group Name: Normandy Urgent Care Center Group Tax-ID: 27-0796429 Location which I want to add: (9504 LONG POINT RD STE E Houston , TX 77055-4226)  Thanks.', NULL, NULL, '2020-10-08 15:24:49', '2020-10-08 15:24:49'),
(1136, 2037, 161, NULL, '2020-11-19 00:00:00.000', 'In Process', 'Follow up email sent to Vannessa for location addition.', NULL, NULL, '2020-10-26 15:28:48', '2020-10-26 15:28:48'),
(1137, 2037, 161, NULL, '2020-11-26 00:00:00.000', 'In Process', 'Waiting for the location to be added to the group.', NULL, NULL, '2020-11-19 17:59:19', '2020-11-19 17:59:19'),
(1138, 2037, 161, NULL, '2020-12-08 00:00:00.000', 'In Process', ' Brown, Vanessa Nov 23, 2020, 6:22 AM (1 day ago) to me, nucc@claimsmedinc.com  Good Morning,     I’ve submitted your request to add the secondary service location to Dr. Jeemol George profile per the email received below; I’ll let you know if anything else is needed     Thanks', NULL, NULL, '2020-11-24 10:53:06', '2020-11-24 10:53:06'),
(1139, 2037, 161, NULL, '2020-12-15 00:00:00.000', 'In Process', 'Forms received filled out and submitted back to Rajika. Reference emails are as follows: ----------------- Reid, Rajika Attachments Nov 24, 2020, 11:25 AM (21 hours ago) to me, CHC  Good afternoon:  Please fill out the attached form and return at your earliest convenience.  Once received, you will received an amendment adding this location.  Your assistance is appreciated.     Kindest Regards,   -------------- Hi Rajika, Kindly find the attached completed letter for location addition. Existing group with CHC:  (Normandy Urgent Care Center 779 Normandy St Ste 114 Houston , TX 77015-3441) Group Name: Normandy Urgent Care Center  Group Tax-ID: 27-0796429. Provider: George Jeemol. Location to add: (9504 LONG POINT RD STE E Houston , TX 77055-4226) ', NULL, NULL, '2020-11-25 09:50:10', '2020-11-25 09:50:10'),
(1140, 1006, 161, NULL, '2020-12-24 00:00:00.000', 'In Process', 'Sent a follow-up email @ Rajika.Reid@communityhealthchoice.org regarding updated status. ', NULL, NULL, '2020-12-15 18:02:54', '2020-12-15 18:02:54'),
(1141, 2037, 161, NULL, '2021-01-05 00:00:00.000', 'In Process', 'Follow up email sent:', NULL, NULL, '2020-12-29 10:43:21', '2020-12-29 10:43:21'),
(1142, 1006, 161, NULL, '2021-02-03 00:00:00.000', 'In Process', 'follow up email sent for credentialing to Rajika.Reid@communityhealthchoice.org', NULL, NULL, '2021-01-27 12:55:15', '2021-01-27 12:55:15'),
(1143, 3040, 161, NULL, '2021-03-08 00:00:00.000', 'In Process', 'Email sent to: Rajika.Reid@communityhealthchoice.org  Subject: Enrollment Status || Longpoint Medical Center || Jose, Julie, George, Jeemol & Abraham, Glory || Community Health Choice ||  Greetings,   Hope you are doing well. Please advise me the enrollment status for the below mentioned providers.   Practice Name: Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Name: Jose, Julie Provider NPI# 1447883061  Provider Name: George, Jeemol Provider NPI# 1497219067  Provider Name: Abraham, Glory Provider NPI# 1194206490  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-03-01 15:44:04', '2021-03-01 15:44:04'),
(1144, 3040, 161, NULL, '2021-03-26 00:00:00.000', 'In Process', 'Email sent to: Rajika.Reid@communityhealthchoice.org  Subject: Enrollment Status || Longpoint Medical Center || Jose, Julie, George, Jeemol & Abraham, Glory || Community Health Choice ||  Greetings,   Hope you are doing well. I just wanted to follow up regarding the enrollment status for the below mentioned providers.   Practice Name: Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Name: Jose, Julie Provider NPI# 1447883061  Provider Name: George, Jeemol Provider NPI# 1497219067  Provider Name: Abraham, Glory Provider NPI# 1194206490  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you  ', NULL, NULL, '2021-03-19 14:05:21', '2021-03-19 14:05:21'),
(1145, 3040, 161, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: CHC.Contracting@communityhealthchoice.org  Subject: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Community Health Choice for our group under the below locations.     Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 14:02:46', '2021-05-26 14:02:46'),
(1146, 3040, 161, NULL, '2021-06-21 00:00:00.000', 'On Hold', 'We have an ancillary contract with CHC. Location addition request sent out. For more details please see the group task. ', NULL, NULL, '2021-06-14 10:51:43', '2021-06-14 10:51:43'),
(1147, 3040, 161, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: Rajika.Reid@communityhealthchoice.org  Subject: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Hello Rajika,   Hope you are doing well. Please find the attached signed contract as per your request email for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  If you need any additional information please feel free to call or email me.  Thank you ', NULL, NULL, '2021-07-20 10:43:27', '2021-07-20 10:43:27'),
(1148, 11056, 161, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email sent to : Rajika.Reid@communityhealthchoice.org  Sub : FW: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Community Health Choice for our group under the below locations. And provide us with the updates regarding the signed contract which we have submitted to you in the month of June, 2021.    Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: George, Jeemol  Provider NPI# 1497219067     Provider 2:    Provider Name: Jose, Julie  Provider NPI# 1447883061     Provider 3:    Provider Name: Stephen, Ani  Provider NPI# 1588959118     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Brown, Brittany  Provider NPI# 1275163537     Provider 6:    Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956     Provider 7:    Provider Name: Abraham, Glory  Provider NPI# 1194206490     Provider 8:    Provider Name: Fernandus, Limy  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider NPI# 1497726202     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868     Provider 11:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560     Provider 12:    Provider Name: Thomas, Cini  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider NPI# 1467901587     Provider 14:    Provider Name: PAUL, SIGI   Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149     If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!  Have a great week ahead!', NULL, NULL, '2021-08-09 10:36:31', '2021-08-09 10:36:31'),
(1149, 3040, 161, NULL, '2021-08-24 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. For more details please see group task. ', NULL, NULL, '2021-08-17 13:58:06', '2021-08-17 13:58:06'),
(1150, 2027, 162, NULL, NULL, 'In Process', 'To: hpdemo@uhc.com  Subject: Need Status Update For Cini Thomas  Hello,   Hope you are doing great, I want to know about the current status of the provider. Following are the details:  Provider Name: Cini Thomas NPI# 1134777238  Group Name: Normandy Urgent Care Center Tax-ID: 27-0796429  Kindly update me how much time is required for the completion of this request.  Thanks.', NULL, NULL, '2020-06-17 14:34:30', '2020-06-17 14:34:30'),
(1151, 2027, 162, NULL, NULL, 'In Process', '	 From: United_Healthcare_Provider_Operations@uhc.com  To: mk@claimsmedinc.com  Sub: Reply for  provider status update  Thank you for submitting the attached request to update information within United Healthcare’s systems. We’ll begin working on the updates and will notify you when it’s completed or if additional information is needed. For your convenience, here are the request details:  Reference Number: PR-5342375  Received On: Jun 17, 2020 2:38:51 PM  If you have questions or need further assistance, please contact your Network Account Manager.  Thank you,  UnitedHealthcare Provider Operations', NULL, NULL, '2020-06-17 15:47:09', '2020-06-17 15:47:09'),
(1152, 2027, 162, NULL, NULL, 'In Process', 'From: United_Healthcare_Provider_Operations@uhc.com  To: mk@claimsmedinc.com  Sub: Need Status Update For Cini Thomas.    UnitedHealthcare Insurance Company   We’ve reviewed the provider/group updates you requested on Jun 17, 2020 2:38:50 PM and determined that your updates could not be completed. The subject of your original email submission was: Need Status Update For Cini Thomas.  The request was assigned this reference number: PR-5342375. Why couldn\'t we complete your request? Please contact your Network Account Manager for updates on previously submitted requests. .  Your original submission is attached for your reference.   Thank you.  UnitedHealthcare Provider Operations', NULL, NULL, '2020-06-18 16:35:04', '2020-06-18 16:35:04'),
(1153, 2027, 162, NULL, NULL, 'In Process', 'Talk to the representative his name is brain ref#  01699625 he said this provider is already in network and the effective date is 11/25/2019', NULL, NULL, '2020-06-24 14:06:08', '2020-06-24 14:06:08'),
(1154, 2027, 162, NULL, NULL, 'In Process', 'To: hpdemo@uhc.com  Sub: (Thomas, Cini)-(Normandy Urgent Care Center)-(United HealthCare - UHC)  Can i have the welcome letter for this provider as I have already confirmed with the representative his name is brain ref# 01699625 he said this provider is already in network with UHC and the effective date is 11/25/2019. Provider details are mentioned below: Provider Name: Cini Thomas Provider NPI#  1134777238  Group Name: Normandy Urgent Care Center Group Tax ID: 27-0796429 Thanks.', NULL, NULL, '2020-07-16 16:41:29', '2020-07-16 16:41:29'),
(1155, 2027, 162, NULL, NULL, 'In Process', 'From: United_Healthcare_Provider_Operations@uhc.com  Thank you for submitting the attached request to update information within United Healthcare’s systems. We’ll begin working on the updates and will notify you when it’s completed or if additional information is needed. For your convenience, here are the request details:  Reference Number: PR-5389731  Received On: Jul 16, 2020 4:44:01 PM  If you have questions or need further assistance, please contact your Network Account Manager.  Thank you,  UnitedHealthcare Provider Operations ', NULL, NULL, '2020-07-16 16:49:13', '2020-07-16 16:49:13'),
(1156, 2027, 162, NULL, NULL, 'In Process', 'Call to insurance: Talk to the representative her name is kattherine ref# 01744897 she said this provider is now in network and we may receive welcome letter in two weeks as i have requested again. ', NULL, NULL, '2020-07-22 12:07:10', '2020-07-22 12:07:10'),
(1157, 2027, 162, NULL, NULL, 'In Process', 'To: 	hpdemo@uhc.com  Sub: (Thomas, Cini)-(Normandy Urgent Care Center)-(United HealthCare - UHC)  Could you please send us the roster or welcome letter for the confirmation of the provider as she is showing in your network i have checked through the provider directory. Details of the provider are as follows: Provider Name: Thomas, Cini Provider NPI#  1134777238  Group Name:  Normandy Urgent Care Center  Group Tax ID:  27-0796429   Thanks.', NULL, NULL, '2020-07-24 15:32:09', '2020-07-24 15:32:09'),
(1158, 2027, 162, NULL, NULL, 'Approved', 'Provider is showing in network with effective date 11/25/2019 also roster is attached with the participating plans. ', NULL, NULL, '2020-07-28 10:10:47', '2020-07-28 10:10:47'),
(1159, 2027, 163, NULL, NULL, 'Approved', 'From: pso@cigna.com  All parties have completed Cigna Contract for TX, JEEMOL GEORGE, fnp, npi 1497219067 bid 11995866. Welcome letter received and attached in EMRBS', NULL, NULL, '2020-07-17 11:06:32', '2020-07-17 11:06:32'),
(1160, 3040, 164, NULL, '2021-06-28 00:00:00.000', 'Revalidation', 'Email sent to: MadirajuP@aetna.com  Subject:  Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello Phani,   Hope you are doing well. Can you please advise what I need to link the providers with First Health. If the given tin is not linked with First Health then how come the providers are participating.    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 16:18:11', '2021-06-21 16:18:11'),
(1161, 11056, 164, NULL, '2021-06-29 00:00:00.000', 'Revalidation', 'Email received from : MadirajuP@aetna.com>  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hi,     Good Evening!     Given request is to add Providers, However Provider’s DOB, Location, Phone & Fax#, Billing location Phone & Fax#, are missing, Please provider the missing information to process further.     Thank You,  Phani.', NULL, NULL, '2021-06-22 13:44:59', '2021-06-22 13:44:59'),
(1162, 11056, 164, NULL, '2021-06-29 00:00:00.000', 'Revalidation', 'Email sent to : MadirajuP@aetna.com  Sub:  Enrollment Information of the Providers - LPMC - First Health  Good Morning, Phani,  Hope you are doing well. Here is the information you need about the providers of the group enlisted below :-  Practice Info Practice Name : Longpoint Medical Center Practice NPI #  : 1770763815 Practice TIN #  :  76-0612416 Main Address   :  9504 LONG POINT RD STE E, Houston, TX 77055-4226  Providers Info: Main & Billing Address :  9504 LONG POINT RD STE E, Houston , TX 77055-4226  Main & Billing Fax # :  713-461-3518 Main & Billing Phone # :  (713) 461-3535  Provider 1:  Provider Name: George, Jeemol  Provider DOB: 04/13/1983  Provider NPI# 1497219067   Provider 2:    Provider Name: Jose, Julie  Provider DOB: 08/31/1977  Provider NPI# 1447883061    Provider 3:    Provider Name: Stephen, Ani  Provider DOB: 01/30/1980  Provider NPI# 1588959118    Provider 4:    Provider Name: Piccione JR, James M  Provider DOB: 09/01/1959  Provider NPI# 1356321509    Provider 5:    Provider Name: Brown, Brittany  Provider DOB: 05/10/1988  Provider NPI# 1275163537   Provider 6:    Provider Name: Chennemkara, Mini Philip  Provider DOB: 05/25/1970  Provider NPI# 1841755956    Provider 7:    Provider Name: Abraham, Glory  Provider DOB: 10/24/1977  Provider NPI# 1194206490      Provider 8:    Provider Name: Fernandus, Limy  Provider DOB: 07/03/1985  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider DOB: 05/28/1952  Provider NPI# 1497726202     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider DOB: 04/21/1981  Provider NPI# 1134525868     Provider 11:    Provider Name: Joseph, Vibitha  Provider DOB: 01/08/1982  Provider NPI# 1952931560     Provider 12:    Provider Name: Thomas, Cini  Provider DOB: 05/30/1974  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider DOB: 10/22/1979  Provider NPI# 1467901587     Provider 14:    Provider Name: PAUL, SIGI   Provider DOB: 05/25/1973  Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya  Provider DOB: 05/05/1973  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, '2021-06-22 13:58:51', '2021-06-22 13:58:51'),
(1163, 3040, 164, NULL, '2021-07-16 00:00:00.000', 'Revalidation', 'Email sent to: MadirajuP@aetna.com  Subject: Re: FW: [EXTERNAL] Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello Phani,   Hope you are doing well. Please advise me the enrollment status for the below mentioned providers as per your request I sent the information that you requested in your previous email.   Practice Details: Practice Name: Longpoint Medical Center Practice NPI# 1770763815 Practice TIN# 76-0612416 Main Address: 9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: 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 DOB: 04/21/1981 Provider NPI# 1134525868  Provider 11:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 12:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 13:   Provider Name: John, Jeny Provider NPI# 1073019493 D.O.B: 06/22/1974  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 15:11:24', '2021-07-09 15:11:24'),
(1164, 3040, 164, NULL, '2021-09-06 00:00:00.000', 'Revalidation', 'Email sent to: MadirajuP@aetna.com  Subject: Re: FW: [EXTERNAL] Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello Phani,   Hope you are doing well. Please find the attached email that was sent out to you as per your above email requested on 06/21/2021. Can you please advise the enrollment status for the below mentioned providers in First Health in our group under the below location.   Practice Details: Practice Name: Longpoint Medical Center Practice NPI# 1770763815 Practice TIN# 76-0612416 Main Address: 9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: 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: Abraham, Jeena Provider NPI# 1467901587  Provider 12:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 13:   Provider Name: John, Jeny Provider NPI# 1073019493  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-08-30 14:03:52', '2021-08-30 14:03:52'),
(1165, 10057, 164, NULL, '2021-11-09 00:00:00.000', 'Revalidation', 'Email Received From: MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hi,  Good Evening!  Please find the status of the Providers list attached.  Thank You,  Phani', NULL, NULL, '2021-11-02 14:03:34', '2021-11-02 14:03:34'),
(1166, 10057, 164, NULL, '2021-11-30 00:00:00.000', 'Revalidation', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello,  Thank you for reaching out. As per your given attached file providers not yet credentialed, are they in a credentialing process? If yes, then how long will it take more.  If not in a credentialing process then please let me know the process.  Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-23 13:58:30', '2021-11-23 13:58:30'),
(1167, 10057, 164, NULL, '2021-12-10 00:00:00.000', 'Revalidation', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello,  Hope this email finds you in good health. Could you please provide me with the latest update on the below mentioned request?  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-03 14:55:58', '2021-12-03 14:55:58'),
(1168, 10057, 164, NULL, '2021-12-20 00:00:00.000', 'Revalidation', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Good Morning,  Hope all is well. As per your given attached roster providers not yet credentialed, are they in a credentialing process? If yes, then how long will it take more. If not in a credentialing process then please let me know the process.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-10 11:38:19', '2021-12-10 11:38:19'),
(1169, 10057, 164, NULL, '2021-12-27 00:00:00.000', 'Revalidation', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Greetings for the day!  Any update on the below request. It is my SECOND REMINDER. Please get back to me ASAP.  Kind Regards, Steve Albert', NULL, NULL, '2021-12-20 13:11:57', '2021-12-20 13:11:57'),
(1170, 10057, 164, NULL, '2022-01-03 00:00:00.000', 'Revalidation', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Good Morning,  This is my THIRD REMINDER on the below mentioned request.  Your earliest response will be highly appreciated.  Regards,', NULL, NULL, '2021-12-27 11:20:35', '2021-12-27 11:20:35'),
(1171, 20067, 164, NULL, '2022-01-27 00:00:00.000', 'Revalidation', 'Email received from: pccdocsub@mitchell.com  Sub: Document Request [ ref:_00D30cy9._5007V1wTf8a:ref ]   Thank you for your recent call to Provider Customer Service. You are receiving this email because you will be submitting documents for review. To accurately complete our review, please reply to this email (do not forward) and do not change the Subject Line. We can only receive PDF Documents by email. This email has been created specifically for this request and will only be valid for five (5) business days. If a reply has not been received within that time, the case will be closed. This is an automated email program which cannot open password protected emails. If you are unable to send an email that is not password protected, please reach us at one of the numbers below for other options. **This is not a general intake box. Any emails sent to this box, not in response to an active case will not be responded to or worked. ** For additional Questions or concerns please reach us at the following: 800-370-0594 for Gallagher Bassett 800-937-6824 for all other Carriers. Thank you for allowing us to assist with this review.  Network/Product the provider is requesting to be contracted (Auto and/or Workers Comp): Provider full name: first, last (and middle initial if possible) or full entity name if not an individual: FTIN:  NPI number:  Provider Degree:  Provider Specialty:  Address (primary physical office address - no PO Box):  Provider phone number and fax number with area codes:  Provider e-mail Address:  Provider office contact name for follow up:  ref:_00D30cy9._5007V1wTf8a:ref', NULL, NULL, '2022-01-20 10:25:20', '2022-01-20 10:25:20'),
(1172, 20067, 164, NULL, '2022-01-27 00:00:00.000', 'Revalidation', 'Email sent to: pccdocsub@mitchell.com  Sub: Document Request    [ ref:_00D30cy9._5007V1wTf8a:ref ]  Good Morning!  Kindly see the attachments for the document requested. Let me know if anything is required.  Thanks and Regards Syed Ahad. ', NULL, NULL, '2022-01-20 10:29:28', '2022-01-20 10:29:28'),
(1173, 20067, 164, NULL, '2022-02-04 00:00:00.000', 'Revalidation', 'Email sent to:  pccdocsub@mitchell.com,MadirajuP@aetna.com  Sub: Re: Enrollment status || LONGPOINT MEDICAL CENTER || Group & Providers || First Health ||  Good Afternoon!  I would like to know the enrollment status of the below-mentioned providers.   Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Jeny John	1073019493 Molly Joseph	1396380077 SIGI PAUL	1033623616 Jaya Jacob	1194336149 Limy Fernandus	1972005189 Ani Stephen	1588959118 Jeena Abraham	1467901587 Glory Abraham	1194206490 James Piccione JR	1356321509 Mini Chennemkara	1841755956 Odette Korouma	1134525868 Abdur Rauf	1497726202 Jeemol George	1497219067  Thanks & Regards! Syed Ahad.', NULL, NULL, '2022-01-28 14:23:43', '2022-01-28 14:23:43'),
(1174, 20067, 164, NULL, '2022-03-21 00:00:00.000', 'Revalidation', 'Email sent to:  mmoreno@firsthealth.com, MadirajuP@aetna.com  Sub: Enrollment Status || Longpoint Medical Center || Jeemol George|| First Health ||   Hello,  Hope you had a great weekend. I want to confirm the revalidation Date for the provider Jeemol George, Information is listed below.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Jeemol George	1497219067  Thank you', NULL, NULL, '2022-03-14 17:02:49', '2022-03-14 17:02:49'),
(1175, 2027, 165, NULL, '2020-10-06 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  Sub; (George, Jeemol)-(Longpoint Medical Center)-(Humana)  May I know the current status of the below mentioned provider: Provider Name: George, Jeemol Provider NPI# 1497219067 Group Name: Longpoint Medical Center Group Tax-ID: 76-0612416  Thanks.', NULL, NULL, '2020-09-29 10:10:28', '2020-09-29 10:10:28'),
(1176, 2027, 165, NULL, '2020-10-06 00:00:00.000', 'In Process', 'From: KMoten4@humana.com  This provider is credentialed in our system. In order to be added to the group: please provide me the following information  Group Name Group TIN Location Address Phone Number Fax Number   Respectfully, Katherine Moten', NULL, NULL, '2020-09-29 10:38:51', '2020-09-29 10:38:51'),
(1177, 2027, 165, NULL, '2020-10-06 00:00:00.000', 'In Process', 'To: kmoten4@humana.com  Thanks for your quick response. The requested information is mention below:  Group Name: Longpoint Medical Center Group TIN: 76-0612416 Location Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226 Phone Number: (713) 461-3535 Fax Number: 7134613518', NULL, NULL, '2020-09-29 10:39:54', '2020-09-29 10:39:54'),
(1178, 2037, 165, NULL, '2020-11-03 00:00:00.000', 'In Process', 'Follow up email sent to HumanaHoustonPD@humana.com ------------------- Greetings, May I know the current status of the below mentioned provider:  Provider Name: George, Jeemol Provider NPI# 1497219067 Group Name: Longpoint Medical Center Group Tax-ID: 76-0612416', NULL, NULL, '2020-10-22 17:09:09', '2020-10-22 17:09:09'),
(1179, 2027, 165, NULL, '2020-11-11 00:00:00.000', 'Approved', 'From: HumanaHoustonPD@humana.com  Sub: (George, Jeemol)-(Longpoint Medical Center)-(Humana)  Provider is loaded and Linked to TIN retroactive to 4/22/2020', NULL, NULL, '2020-11-04 10:14:50', '2020-11-04 10:14:50'),
(1180, 2027, 169, NULL, '2020-10-16 00:00:00.000', 'In Process', 'To: Michele.Thomas-Martin@molinahealthcare.com  Sub: (George, Jeemol)-(Longpoint Medical Center)-(Molina Health)  Hello,   Hope you are doing well, I want to add a provider with molina please assist me how can I start the enrollment process. Details of the provider are mentioned below: Provider Name: George, Jeemol Provider NPI: 1497219067  Thanks. ', NULL, NULL, '2020-10-09 13:43:01', '2020-10-09 13:43:01'),
(1181, 2037, 169, NULL, '2020-11-25 00:00:00.000', 'In Process', 'Follow up email sent! ------------  3:44 PM (0 minutes ago) to Michele.Thomas-Martin, lpmc  Hello,  Hope you are doing well, I want to add a provider with molina please assist me how can I start the enrollment process. Details of the provider are mentioned below: Provider Name: George, Jeemol Provider NPI: 1497219067', NULL, NULL, '2020-10-26 15:48:35', '2020-10-26 15:48:35'),
(1182, 2037, 169, NULL, '2020-12-04 00:00:00.000', 'In Process', 'Response received need to allow more time. Reference email as follows: ----------------------  Thomas-Martin, Michele to me  Record # 171061     Good Afternoon,     Thank you for your inquiry.  The request for the below provider has been sent for loading in the billing system eff 12/1/2020.   Please allow more time for processing.     Thank You,     Michele Thomas-Martin  Associate Specialist, Provider Contracts  1-888-562-5442 Ext. 200042  www.MolinaHealthcare.com  Your Extended Family', NULL, NULL, '2020-11-25 13:08:05', '2020-11-25 13:08:05'),
(1183, 2037, 169, NULL, '2020-12-16 00:00:00.000', 'In Process', 'Need to allow more time for the welcome letter', NULL, NULL, '2020-12-07 14:36:15', '2020-12-07 14:36:15'),
(1184, 2037, 169, NULL, '2020-12-29 00:00:00.000', 'In Process', 'Inquiry email sent to Michele.Thomas-Martin@molinahealthcare.com for location confirmation: -------------------------------------------- Hi Michele, Thank you so much for the provided information.If you could kindly verify if the below mentioned service location addresses are reflecting in the Provider: Jeemol George\'s profile and with the same effective date as12/01/2020? Location 1:  9504 LONG POINT RD STE E                     Houston , TX 77055-4226. Location 2: 16272 IMPERIAL VALLEY DR STE K,                     Houston , TX 77060.', NULL, NULL, '2020-12-16 15:03:01', '2020-12-16 15:03:01'),
(1185, 2037, 169, NULL, '2021-01-25 00:00:00.000', 'In Process', 'Location addition initiated: ----------------- Thomas-Martin, Michele 9:19 AM (11 minutes ago) to me  Record # 171061  Provider: Jeemol George  Good Morning,   Thank you for your inquiry.  We have all the locations in the billing system but the above provider was only loaded under 779 Normandy St Suite 114.  The request only listed one location, please advise on the contract request forms going forward which locations the provider should be listed under.  I’ve created a new record # 173450 to add the provider under the 2nd and 3rd locations listed below.  Please allow 30 days for processing. ---------------------------------', NULL, NULL, '2020-12-23 10:36:11', '2020-12-23 10:36:11');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(1186, 1006, 169, NULL, '2021-02-01 00:00:00.000', 'In Process', 'W9 was requested for group, sent @ Provider contract coordination Fax ProvcontractCoordFax@molinahealthcare.com', NULL, NULL, '2021-01-19 17:46:26', '2021-01-19 17:46:26'),
(1187, 1006, 169, NULL, '2021-02-23 00:00:00.000', 'In Process', 'Submitted CRF & W9 again to Provider contract coordination Fax ProvcontractCoordFax@molinahealthcare.com ', NULL, NULL, '2021-02-16 18:08:12', '2021-02-16 18:08:12'),
(1188, 3040, 169, NULL, '2021-03-08 00:00:00.000', 'Approved', 'Jeemol George  - The provider has been loaded in the billing system effective 12/1/2020 ( 779 Normandy St.)  and 1/15/2021 under additional 2 service locations ( 9504 long Point Rd & 16272 IMPERIAL VALLEY DR ).  Please see the  attached welcome letters for the provider.', NULL, NULL, '2021-03-01 17:20:55', '2021-03-01 17:20:55'),
(1189, 2027, 170, NULL, '2020-09-17 00:00:00.000', 'Approved', 'Provider is linked with insurance and effective date is 06/11/2020. Screenshot from provider directory is attached', NULL, NULL, '2020-09-10 13:23:26', '2020-09-10 13:23:26'),
(1190, 2027, 172, NULL, '2020-08-31 00:00:00.000', 'In Process', 'To: Jillyan.Galindo@superiorhealthplan.com  Sub: (George, Jeemol)-(Longpoint Medical Center)-(Superior Health)  May i know the current status of the provider mentioned below: Provider Name-George, Jeemol Provider NPI#1497219067 Group Name-Longpoint Medical Center Group Tax-ID-76-0612416  Thanks.', NULL, NULL, '2020-08-24 14:50:19', '2020-08-24 14:50:19'),
(1191, 1005, 172, NULL, '2020-10-05 00:00:00.000', 'In Process', 'No response. Sent a reminder', NULL, NULL, '2020-09-24 15:06:25', '2020-09-24 15:06:25'),
(1192, 2037, 172, NULL, '2020-11-09 00:00:00.000', 'In Process', 'Follow up email Sent to Jillyan.', NULL, NULL, '2020-10-22 16:47:49', '2020-10-22 16:47:49'),
(1193, 2027, 172, NULL, '2020-11-16 00:00:00.000', 'In Process', 'To Jillyan.Galindo@superiorhealthplan.com  This is a follow up email. Please reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-11-09 14:51:12', '2020-11-09 14:51:12'),
(1194, 2037, 172, NULL, '2020-11-25 00:00:00.000', 'In Process', 'Follow up email sent to Jillian  (George, Jeemol)-(Longpoint Medical Center)-(Superior Health)', NULL, NULL, '2020-11-16 12:34:08', '2020-11-16 12:34:08'),
(1195, 2037, 172, NULL, '2020-12-10 00:00:00.000', 'In Process', 'Response received.Follow up sent for welcome letter ----------- Jillyan Galindo Nov 16, 2020, 2:18 PM (3 days ago) to me  Good Afternoon,  In our system shows this provider has completed the credentialing process. You should have received a Welcome Letter confirming the credentialing completion. If you have not please reach out to your Account Manager ( AM.Houston@superiorhealthplan.com  ) .    Blessings,  Jillyan Galindo  Project Coordinator I, Contract Management -------------- Greetings,  We have been notified that the below mentioned provider has completed the credentialing process. Following up for the welcome letter with the effective date.   Provider Name-George, Jeemol Provider NPI#1497219067 Group Name-Longpoint Medical Center Group Tax-ID-76-0612416', NULL, NULL, '2020-11-19 14:38:40', '2020-11-19 14:38:40'),
(1196, 2037, 172, NULL, '2020-12-10 00:00:00.000', 'In Process', 'Sherry Deen 2:16 PM (0 minutes ago) to lpmc, AM  Greetings,  Thank you for the provided document however this attachment is the copy of the executed contract for the group  Longpoint Medical Center. What we needed was the welcome letter for the individual provider who\'s credentialing process has recently been completed.  Provider Name-George, Jeemol Provider NPI#1497219067   ', NULL, NULL, '2020-11-20 15:20:40', '2020-11-20 15:20:40'),
(1197, 2037, 172, NULL, '2020-12-01 00:00:00.000', 'Approved', 'Received welcome letter from Superior for George Jeemol Effective date : 11/01/2020.Par Plan details updated in the notes.Notification Sent to the billing', NULL, NULL, '2020-11-24 10:41:34', '2020-11-24 10:41:34'),
(1198, 2027, 173, NULL, '2020-10-16 00:00:00.000', 'In Process', 'To: jxalanis@texaschildrens.org  Sub: (George, Jeemol)-(Longpoint Medical Center)-(Texas Children Health Plan)  Hello  Juanita,   I have checked through your provider directory that Normandy Urgent Care Center is already linked with (TCHP) and I want to add a provider in one of its existing locations. Details are mentioned below: Provider Name: George, Jeemol Provider NPI: 1497219067 Group Name: Normandy Urgent Care Center Group Location:  Normandy Urgent Care Center 9504 LONG POINT RD STE E Houston TX 77055-4226 Group Tax-ID: 27-0796429 Group NPI: 1407171077  Thanks.  ', NULL, NULL, '2020-10-09 14:15:56', '2020-10-09 14:15:56'),
(1199, 2027, 173, NULL, '2020-10-16 00:00:00.000', 'In Process', 'From; jxalanis@texaschildrens.org  Hi Mr. Rodriguez,  Please give me an effective date.  Thank you     Juanita Alanis  Provider Relations ', NULL, NULL, '2020-10-09 15:37:32', '2020-10-09 15:37:32'),
(1200, 2027, 173, NULL, '2020-10-16 00:00:00.000', 'In Process', 'To: jxalanis@texaschildrens.org  Effective date should be 06/01/2020.  Thanks.', NULL, NULL, '2020-10-09 15:38:18', '2020-10-09 15:38:18'),
(1201, 2037, 173, NULL, '2020-11-23 00:00:00.000', 'In Process', 'Follow up email sent', NULL, NULL, '2020-10-26 15:50:34', '2020-10-26 15:50:34'),
(1202, 2037, 173, NULL, '2020-11-23 00:00:00.000', 'In Process', 'Follow up email sent', NULL, NULL, '2020-10-26 15:50:35', '2020-10-26 15:50:35'),
(1203, 2027, 173, NULL, '2020-11-02 00:00:00.000', 'In Process', 'From: jxalanis@texaschildrens.org  Hi Sherry,  Provider George, Jeemol cannot be added to Normandy Urgent Care; provider is in the credentialing process.  Thank you     Juanita Alanis  Provider Relations ', NULL, NULL, '2020-10-26 17:51:30', '2020-10-26 17:51:30'),
(1204, 2027, 173, NULL, '2020-11-09 00:00:00.000', 'In Process', 'To; jxalanis@texaschildrens.org  Sub: (George, Jeemol)-(Longpoint Medical Center)-(Texas Children Health Plan)  Hello Juanita,  May I know the current status of the below mentioned provider: Provider Name: George, Jeemol Provider NPI# 1497219067 Group Name: Normandy Urgent Care Center  Group Tax-ID: 27-0796429   Thanks.  ', NULL, NULL, '2020-11-02 12:24:22', '2020-11-02 12:24:22'),
(1205, 2027, 173, NULL, '2020-11-16 00:00:00.000', 'In Process', 'To: jxalanis@texaschildrens.org  This is a follow up email. Please reply to me as soon as possible  Thanks.', NULL, NULL, '2020-11-09 14:55:06', '2020-11-09 14:55:06'),
(1206, 2037, 173, NULL, '2020-11-30 00:00:00.000', 'In Process', 'Received PIFs filled out and submitted back to \"tchpnetworkmanagement@texaschildrens.org\" with IVUC as the secondary Location.= and request.', NULL, NULL, '2020-11-16 12:40:40', '2020-11-16 12:40:40'),
(1207, 2037, 173, NULL, '2020-12-02 00:00:00.000', 'In Process', 'Received PIFs filled out and submitted back to \"tchpnetworkmanagement@texaschildrens.org\" with IVUC as the secondary Location.= and request.', NULL, NULL, '2020-11-16 12:50:14', '2020-11-16 12:50:14'),
(1208, 2037, 173, NULL, '2020-12-23 00:00:00.000', 'In Process', 'Credentialing is in process under Normandy. Will request to add location once the process finalizes.  ------------------------- Alanis, Juanita 11:39 AM (22 minutes ago) to me  Sherry,  These providers, Ani Stephen NPI: 1588959118, Jeemol George. NPI: 1497219067, Julie Jose, NPI: 1447883061 and Brittany Brown.  NPI: 1275163537 are not contracted with TCHP yet; there for cannot be added to the locations you are requesting. ', NULL, NULL, '2020-11-20 13:06:56', '2020-11-20 13:06:56'),
(1209, 2037, 173, NULL, '2021-01-05 00:00:00.000', 'In Process', 'Currently being credentialed under normandy.Need to allow a bit more time.', NULL, NULL, '2020-12-23 17:18:59', '2020-12-23 17:18:59'),
(1210, 1006, 173, NULL, '2021-02-03 00:00:00.000', 'New/Not Initiated', 'Follow up email sent for credentialing to jxalanis@texaschildrens.org', NULL, NULL, '2021-01-27 12:28:15', '2021-01-27 12:28:15'),
(1211, 1006, 173, NULL, '2021-02-03 00:00:00.000', 'In Process', 'Follow up email sent for credentialing to jxalanis@texaschildrens.org', NULL, NULL, '2021-01-27 12:30:33', '2021-01-27 12:30:33'),
(1212, 3040, 173, NULL, '2021-03-08 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org, jxalanis@texaschildrens.org  Subject: Enrollment Status || Longpoint Medical Center || Jose, Julie, George, Jeemol || TCHP  Greetings,  Hope you are doing well. Please advise me the enrollment status for the below mentioned providers.   Practice Name: Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Name: Jose, Julie Provider NPI# 1447883061  Provider Name: George, Jeemol Provider NPI# 1497219067  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-03-01 13:26:53', '2021-03-01 13:26:53'),
(1213, 3040, 173, NULL, '2021-03-26 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Location Addition || Longpoint Medical Center || Jose, Julie, George, Jeemol & Stephen, Ani || TCHP  Greetings,  Hope you are doing well. Please find the attached provider information form including the W9 for adding the providers in additional locations.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-19 10:59:00', '2021-03-19 10:59:00'),
(1214, 3040, 173, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: axhartma@texaschildrens.org   Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-31 15:48:53', '2021-05-31 15:48:53'),
(1215, 3040, 173, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-06-17 12:21:30', '2021-06-17 12:21:30'),
(1216, 3040, 173, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email rcvd from: tchpnetworkmanagement@texaschildrens.org  Subject; Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Normandy Urgent Care Center  Imperial Valley Urgent Care Center  Longpoint Medical Center  Are these groups in our network? If so, please reach out to you PR.  Thank you', NULL, NULL, '2021-07-06 13:39:17', '2021-07-06 13:39:17'),
(1217, 3040, 173, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject:Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. I called the above number that you sent to find out if the above groups are in-network with TCHP or not. I am unable to find out the information because the provider relations department is not available over the phone. Can you please advise me if there is any other way I can find out the information.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-06 13:42:41', '2021-07-06 13:42:41'),
(1218, 3040, 173, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Re: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,   I am still waiting for the PR contact information. Can you please forward it to me so I can contact the PR directly because our claims are getting denied by insurance.   Please look into this matter personally so we are able to resolve the issue. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-26 16:39:13', '2021-07-26 16:39:13'),
(1219, 11056, 173, NULL, '2021-08-21 00:00:00.000', 'In Process', 'Email received from : tchpnetworkmanagement@texaschildrens.org  Sub : FW: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello PR,  Group Normandy Urgent Care Center, would like to know who is their group PR.  Thank you', NULL, NULL, '2021-08-13 15:32:12', '2021-08-13 15:32:12'),
(1220, 3040, 173, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Email rcvd from: kdelam@texaschildrens.org  Subject: Provider Contracts  Hello Adil,  Attached is the Provider Information Form to add locations and a Provider Information Change Form changes to existing providers.  I have included a breakdown of the contracts under your TIN.  Please contact me directly if you have any concerns getting the additional updates needed from contracting.     Thank you,  Kim', NULL, NULL, '2021-08-26 08:45:46', '2021-08-26 08:45:46'),
(1221, 10057, 173, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Subject : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Good Afternoon,  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI George, Jeemo	1497219067 Jose, Julie	1447883061 Stephen, Ani	1588959118 Piccione JR, James M	1356321509 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Fernandus, Limy	1972005189 Abraham, Glory	1194206490 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Thomas, Cini	1134777238 Joseph, Vibitha	1952931560 Abraham, Jeena	1467901587 PAUL, SIGI	1033623616 Joseph, Molly	1073019493 Jacob, Jaya	1194336149  Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-08 13:56:04', '2021-10-08 13:56:04'),
(1222, 10057, 173, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org, kdelam@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Greetings!  Any update on below mentioned credentialing request?  Please get back to me as soon as you get a chance. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-21 11:03:36', '2021-10-21 11:03:36'),
(1223, 10057, 173, NULL, '2021-11-05 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello Liz/Kimberly,  It should be Kimberly\'s responsibility to update you and us rather than we are trying to reach her or you for an application. Can someone please check that and respond. Thanks  Regards, Alex', NULL, NULL, '2021-10-29 09:47:39', '2021-10-29 09:47:39'),
(1224, 10057, 173, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. Can I get the latest update on below mentioned providers enrollment status and facility contracts / agreements.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Joseph, Molly	1396380077 Thomas, Cini	1134777238 Rauf, Abdur	1497726202 Piccione JR, James M	1356321509 Jacob, Jaya	1194336149 PAUL, SIGI	1033623616 Fernandus, Limy	1972005189 Abraham, Jeena	1467901587 Chennemkara, Mini Philip	1841755956 Joseph, Vibitha	1952931560 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Brown, Brittany	1275163537 George, Jeemol	1497219067 Jose, Julie	1447883061  Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-22 13:42:17', '2021-11-22 13:42:17'),
(1225, 10057, 173, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Sure, for each provider please provide the date their application was submitted and which application did you submit (LOI or PIF).  Thank you', NULL, NULL, '2021-12-02 14:33:20', '2021-12-02 14:33:20'),
(1226, 10057, 173, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Thank you for reaching out. The person before me has resigned. I can see that he has submitted the LOI forms for those providers which are already approved.  Please check from your side which providers are enrolled and updated in the system. Rest let me know so I can submit the application again.  Kindly revert back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-09 11:54:56', '2021-12-09 11:54:56'),
(1227, 10057, 173, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  I can provide status on application.  To check which providers are in network or not, please reach out to your PR.  They should be able to provide you with a roster for the group.  Thank you  -Liz', NULL, NULL, '2021-12-16 14:57:40', '2021-12-16 14:57:40'),
(1228, 10057, 173, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Thank you for reaching out. Could you please provide me with the PR details. It will be highly appreciated.  Regards,', NULL, NULL, '2021-12-22 13:51:02', '2021-12-22 13:51:02'),
(1229, 10057, 173, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  If your group is PAR, you can reach out to your PR at Provider Relations providerrelations@texaschildrens.org  If you are not in our network, reach out to provider assistance 832-828-1004.', NULL, NULL, '2021-12-29 12:05:19', '2021-12-29 12:05:19'),
(1230, 20067, 173, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org  Sub: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good afternoon,  Hope this email finds you well. I would like to know the enrollment status of the below-mentioned providers under these locations  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Molly Joseph	1396380077 Mini Chennemkara	1841755956 Odette Kourouma	1134525868 Ani Stephen	1588959118 James Piccione JR	1356321509 Jeny John	1073019493 Abdur Rauf	1497726202 Cini THomas	1134777238 James Piccione JR	1356321509 Vibitha Joseph	1952931560 SIGI PAUL	1033623616 Jeena Abraham	1467901587 Jaya Jacob	1194336149 Limy fernandus	1972005189 Brittany Brown	1275163537 Jeemol George	1497219067 Julie Jose	1447883061   Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-12 15:01:37', '2022-01-12 15:01:37'),
(1231, 20067, 173, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org, tchpnetworkmanagement@texaschildrens.org   Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good Morning! Hope you are doing well. Any updates on the previous request?  Your Early response will be highly appreciated Thanks & Regards Syed Ahad.', NULL, NULL, '2022-01-19 09:58:56', '2022-01-19 09:58:56'),
(1232, 20067, 173, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org  Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good afternoon!  Hope this email finds you in good health. I would like to know the enrollment status of the below-mentioned groups and providers. Thanks & Regards, Syed Ahad', NULL, NULL, '2022-01-28 14:44:12', '2022-01-28 14:44:12'),
(1233, 2027, 174, NULL, '2020-10-16 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  Hi Katherine,  I want to add a provider in (Normandy Urgent Care Center) and this group is showing on the provider directory also. So I want to know how many locations are showing linked in your system for this group. Details are mentioned below: Group Name: Normandy Urgent Care Center Group Tax-ID: 27-0796429 Group NPI# 1407171077  Thanks. ', NULL, NULL, '2020-10-09 15:21:50', '2020-10-09 15:21:50'),
(1234, 2027, 174, NULL, '2020-10-19 00:00:00.000', 'In Process', 'From; KMoten4@humana.com  Hi Martin,     Please see attachment for all locations attached to TIN 270796429.        Respectfully,  Katherine Moten', NULL, NULL, '2020-10-12 09:37:13', '2020-10-12 09:37:13'),
(1235, 2027, 174, NULL, '2020-10-19 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  (George, Jeemol)-(Longpoint Medical Center)-(Tricare)  Hi Katherine,  Hope you are doing well, I want to add this below mentioned provider in the other two locations of (Normandy Urgent Care Center) i am also mentioning the locations below where I want to add this provider. Location (1) (Normandy Urgent Care Center  9504 LONG POINT RD STE E, Houston , TX 77055)  Location (2) (Normandy Urgent Care Center 16272 IMPERIAL VALLEY DR STE K, Houston , TX  77060)  Details of the provider: Provider Name: George, Jeemol Provider NPI# 1497219067 Group Name: (Normandy Urgent Care Center)    Group Tax-ID: 270796429  Thanks.', NULL, NULL, '2020-10-12 09:39:07', '2020-10-12 09:39:07'),
(1236, 1006, 174, NULL, '2020-11-02 00:00:00.000', 'In Process', 'Received an update from Katherine listing all addresses under NUCC group but no update for provider specific query, left her a voice message @ 502-318-5250 as well as Yvonne Wyatt @ (502) 318-5409. Waiting on response.   ', NULL, NULL, '2020-10-26 11:07:11', '2020-10-26 11:07:11'),
(1237, 2027, 174, NULL, '2020-11-09 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  Sub: (George, Jeemol)-(Longpoint Medical Center)-(Tricare)  Please confirm if this below mentioned provider is enrolled in all requested locations of (Normandy Urgent Care Center) Provider Name: George, Jeemol Provider NPI# 1497219067 Group Name: (Normandy Urgent Care Center)   Group Tax-ID: 270796429  Thanks.', NULL, NULL, '2020-11-02 12:28:20', '2020-11-02 12:28:20'),
(1238, 2027, 174, NULL, '2020-11-16 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  This is a follow up email. Please reply to me as soon as possible.  Thanks. ', NULL, NULL, '2020-11-09 15:18:15', '2020-11-09 15:18:15'),
(1239, 2037, 174, NULL, '2020-11-23 00:00:00.000', 'In Process', 'Follow up email sent to K moten', NULL, NULL, '2020-11-16 12:51:58', '2020-11-16 12:51:58'),
(1240, 2037, 174, NULL, '2020-11-30 00:00:00.000', 'In Process', 'Follow up email sent to K moten', NULL, NULL, '2020-11-23 17:28:03', '2020-11-23 17:28:03'),
(1241, 2037, 174, NULL, '2020-12-10 00:00:00.000', 'In Process', 'As per live call need to allow more time.', NULL, NULL, '2020-11-30 14:27:56', '2020-11-30 14:27:56'),
(1242, 2037, 174, NULL, '2020-12-18 00:00:00.000', 'In Process', 'Currently in process', NULL, NULL, '2020-12-11 16:42:37', '2020-12-11 16:42:37'),
(1243, 2037, 174, NULL, '2020-12-31 00:00:00.000', 'In Process', '	 Currently being processed', NULL, NULL, '2020-12-21 18:02:27', '2020-12-21 18:02:27'),
(1244, 1006, 174, NULL, '2021-02-03 00:00:00.000', 'In Process', 'Follow up email sent for credentialing to KMoten4@humana.com ', NULL, NULL, '2021-01-27 12:17:45', '2021-01-27 12:17:45'),
(1245, 1006, 174, NULL, '2021-02-03 00:00:00.000', 'In Process', 'Email received:  They are all credentialed and affiliated with the TIN’s you provided for each provider.  Email sent:  Can you please provide me their welcome letters or executed contracts? Are all the providers listed under the following location as in-network & certified under the following address? 9504 LONG POINT RD STE E, Houston , TX 77055-4226 ', NULL, NULL, '2021-01-27 14:00:06', '2021-01-27 14:00:06'),
(1246, 3040, 174, NULL, '2021-03-04 00:00:00.000', 'Approved', 'Jeemol George approved. Effective Date: 11/10/2020  Please see attachment. ', NULL, NULL, '2021-02-25 15:12:35', '2021-02-25 15:12:35'),
(1247, 2027, 175, NULL, '2020-10-05 00:00:00.000', 'Approved', 'Provider is now showing linked with the insurance and effective date is 6/25/2020. Screenshot is attached for confirmation', NULL, NULL, '2020-09-28 17:03:37', '2020-09-28 17:03:37'),
(1248, 2027, 177, NULL, '2020-08-31 00:00:00.000', 'In Process', 'To: 	pr.south@healthsmart.com  Sub: (George, Jeemol)-(Longpoint Medical Center)-(Health Smart)  May i know the current status of the provider mentioned below: Provider Name-George, Jeemol Provider NPI#1497219067 Group Name-Longpoint Medical Center Group Tax-ID-76-0612416  Thanks.', NULL, NULL, '2020-08-24 14:39:28', '2020-08-24 14:39:28'),
(1249, 2027, 177, NULL, '2020-09-02 00:00:00.000', 'In Process', 'Provider is showing in network and effective date is 3/11/2020', NULL, NULL, '2020-08-26 16:54:39', '2020-08-26 16:54:39'),
(1250, 2027, 177, NULL, '2020-09-02 00:00:00.000', 'Approved', 'Provider is showing in network and effective date is 3/11/2020', NULL, NULL, '2020-08-26 16:55:00', '2020-08-26 16:55:00'),
(1251, 2027, 178, NULL, '2020-10-06 00:00:00.000', 'In Process', 'To: mdiprsupport@healthsmart.com  May I know the current status of the below mentioned provider: Provider Name: Jose, Julie Provider NPI# 1447883061 Group Name: Longpoint Medical Center Group Tax-ID: 76-0612416  Thanks.', NULL, NULL, '2020-09-29 10:16:44', '2020-09-29 10:16:44'),
(1252, 2027, 178, NULL, '2020-10-08 00:00:00.000', 'Approved', 'From: mdiprsupport@healthsmart.com  Sub: (Jose, Julie)-(Longpoint Medical Center)-(Health Smart)  Hi,  Provider \'\' Jose, Julie NP \'\' is Effective \'\' 03/11/2020\'\'.  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com.   (Inventory Log ID :57724)  Thanks. HealthSmart Provider Relations.', NULL, NULL, '2020-10-01 09:08:39', '2020-10-01 09:08:39'),
(1253, 1006, 179, NULL, NULL, 'In Process', 'Received following reply from Hinkley, Richard E Richard.Hinkley@bswhealth.org:  Sub: SWHP- Contracting Request - Columbus Urgent Care PA  \"Good evening,     The contract and information you sent in has been verified and I have added your applicant information in our system. Your contract has been sent to credentialing. Please allow ninety days for this process to be completed so that you contract may be submitted for internal signatures and then later activated. I will keep you updated as the process moves forward. Please feel free though to contact me for updates/questions in the interim period. Please let me know if you have any questions or concerns.\"', NULL, NULL, '2020-06-17 09:33:49', '2020-06-17 09:33:49'),
(1254, 2027, 179, NULL, NULL, 'In Process', 'To: Richard.Hinkley@bswhealth.org  Sub: (Kourouma , Odette Tiranke)-(Columbus Urgent Care PA)-(Scott & White)  May I know the current credentialing status of the provider  Kourouma OdetteTiranke. Following are her details: Provider NPI#  1134525868  Tax ID: 471914151 Group Name: Columbus Urgent Care PA  Thanks. ', NULL, NULL, '2020-07-09 10:32:42', '2020-07-09 10:32:42'),
(1255, 2027, 179, NULL, '2020-10-15 00:00:00.000', 'In Process', 'To: Richard.Hinkley@bswhealth.org  Sub: (Kourouma , Odette Tiranke)-(Columbus Urgent Care PA)-(Scott & White)  May I know the current credentialing status of the provider  Kourouma OdetteTiranke. Following are her details: Provider NPI#  1134525868 Tax ID: 471914151 Group Name: Columbus Urgent Care PA  Thanks.', NULL, NULL, '2020-10-08 13:20:25', '2020-10-08 13:20:25'),
(1256, 2027, 179, NULL, '2020-10-15 00:00:00.000', 'In Process', 'From: Richard.Hinkley@bswhealth.org  Good afternoon,     Per my previous responses this provider was not being credentialed as she did not have a TPI for Medicaid associated with this role at the time the contract was sent to credentialing. It appears we have also updated our process and Urgent Care providers, even for Medicaid, are no longer credentialing directly. We are only credentialing the facility. It appears that the facility was previously sent to our CVO and is pending information for the provider. From the notes in the cred file they have requested a site survey (it was indicated in the app that one was completed 8/19) and COI. This request was sent 10/1/20.     Thank you,', NULL, NULL, '2020-10-08 14:47:50', '2020-10-08 14:47:50'),
(1257, 1006, 179, NULL, '2020-10-23 00:00:00.000', 'In Process', 'Sent a followup email to swhpregion2@bswhealth.org for updated status. ', NULL, NULL, '2020-10-16 14:32:26', '2020-10-16 14:32:26'),
(1258, 1006, 179, NULL, '2020-10-29 00:00:00.000', 'In Process', 'Received following update from SWHP REGION 2 SWHPREGION2@bswhealth.org>:  \"Hello,  Please see notes in blue/red.   Provider Name: Vibitha Joseph – shows active under TIN 270796429 NPI# 1952931560  Provider Name: Cini Thomas – Pending CVO review. NPI# 1134777238  Provider Name: Julie Jose – Applicant in review. NPI# 1447883061  Provider Name: Odette Tiranke Kourouma – No records found, when did you submit the request? NPI# 1134525868  Provider Name: Jeemol George - Applicant in review. NPI# 1497219067  Group Name: Columbus Urgent Care PA- Applicant in review. TIN# 47-1914151  Thanks,  Jennifer C. Provider Relations Representative cid:image001.png@01D42404.EBBCB8F0 1206 West Campus Dr | MS-A4-126 | Temple, TX  76502 254-298-3064 Office | 254-298-3044 Fax\"', NULL, NULL, '2020-10-23 19:01:41', '2020-10-23 19:01:41'),
(1259, 2027, 179, NULL, '2020-11-06 00:00:00.000', 'In Process', 'From: Richard.Hinkley@bswhealth.org  Sub: (Kourouma , Odette Tiranke)-(Columbus Urgent Care PA)-(Scott & White)  Good afternoon,     Per my previous responses this provider was not being credentialed as she did not have a TPI for Medicaid associated with this role at the time the contract was sent to credentialing. It appears we have also updated our process and Urgent Care providers, even for Medicaid, are no longer credentialing directly. We are only credentialing the facility. It appears that the facility was previously sent to our CVO and is pending information for the provider. From the notes in the cred file they have requested a site survey (it was indicated in the app that one was completed 8/19) and COI. This request was sent 10/1/20.     Thank you,     Rick Hinkley  Provider Relations Representative  Provider Network Management', NULL, NULL, '2020-10-30 10:35:15', '2020-10-30 10:35:15'),
(1260, 2027, 179, NULL, '2020-11-13 00:00:00.000', 'In Process', 'To: Richard.Hinkley@bswhealth.org  May I know the current status of this request.', NULL, NULL, '2020-11-06 15:27:11', '2020-11-06 15:27:11'),
(1261, 2027, 179, NULL, '2020-11-20 00:00:00.000', 'In Process', 'To: Richard.Hinkley@bswhealth.org  Please advise how can I enroll this below mention provider under the same practice with scott&white: Provider Name: Kourouma OdetteTiranke Provider NPI# 1134525868 Tax ID: 471914151 Group Name: Columbus Urgent Care PA  ', NULL, NULL, '2020-11-13 15:30:28', '2020-11-13 15:30:28'),
(1262, 2027, 179, NULL, '2020-11-27 00:00:00.000', 'In Process', 'To: Richard.Hinkley@bswhealth.org  This is a follow up email. Please reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-11-20 09:36:33', '2020-11-20 09:36:33'),
(1263, 2027, 179, NULL, '2020-12-07 00:00:00.000', 'In Process', 'To: Richard.Hinkley@bswhealth.org  This is a follow up email. Please reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-11-30 14:02:38', '2020-11-30 14:02:38'),
(1264, 2027, 179, NULL, '2020-12-09 00:00:00.000', 'Approved', 'From: Richard.Hinkley@bswhealth.org  Good morning,     Please see the attached contract for Columbus Urgent Care PA TIN: 471914751  This contract contains: HMO, PPO, EPO  You contract also includes Medicare Advantage & RightCare (Medicaid)     Congratulations on joining the health plan. I have attached your contract, portal activation materials, and the current Commercial Provider Manual. You can also visit our website at the following link to access the current quick reference guide as well as the most current versions of all provider materials you may need including claims and billing information, reimbursement policies, and authorization information: https://swhp.org/en-us/prov/provider-training-manual. Please also see this link for the most current quick reference guide for the health plan: https://swhp.org/Portals/0/Files/Forms/Prov_FormsGuides/SWHP-Provider-Reference-Guide.pdf. This is updated fairly regularly and contains quick links and guidelines for web resources, claims/appeals addresses and guidelines, prior auths, how to read ID cards, and other necessary information. This final link is the most current Medicare specific orientation information: https://swhp.org/Portals/0/Files/Forms/Providers/Provider_Orientation_Medicare_Advantage.pdf. Please let me know if you have any questions or concerns and I will do my best to assist you. As part of your introduction, let me know if you would like to schedule a new provider orientation where we can discuss these materials and I can try and answer any questions you may have about joining the health plan. I will also send along information on the RightCare Medicaid line of business in just a few minutes.     Thank you,', NULL, NULL, '2020-12-02 09:56:30', '2020-12-02 09:56:30'),
(1265, 2027, 181, NULL, NULL, 'Approved', 'From: Kris.Olier@communityhealthchoice.org  Hi Luis,     Vibitha Joseph has been added to Normandy Urgent Care effective 4/29/2020, see attached profile.     Kris  ', NULL, NULL, '2020-07-08 09:45:55', '2020-07-08 09:45:55'),
(1266, 2027, 182, NULL, NULL, 'In Process', 'To:	LakkakulaS@aetna.com  Sub: Need Status update for Provider Cini Thomas  Hello,   Hope you are doing great, I want to know about the current status of the provider. Following are the details:  Provider Name: Cini Thomas NPI# 1134777238 Group Name: Normandy Urgent Care Center Tax-ID: 27-0796429  Kindly update me how much time is required for the completion of this request.  Thanks.', NULL, NULL, '2020-06-17 15:30:39', '2020-06-17 15:30:39'),
(1267, 2027, 182, NULL, NULL, 'In Process', 'To: bharathb@aetna.com  I have a list of providers mentioned below who are under Normandy Urgent Care Center. I want to know their status of application. Also if there\'s anything missing regarding their documents for the enrollment process please let me know and i have already submitted the online application form of aetna.  Providers	NPI#	Tax ID	Insurance Brown, Brittany	1275163537	27-0796429	First Health Chennemkara, Mini Philip	1841755956	27-0796430	First Health George, Jeemol	1497219067	27-0796431	First Health Jose, Julie	1447883061	27-0796432	First Health Joseph, Vibitha	1447883061	27-0796433	First Health Kourouma , Odette Tiranke	1134525868	27-0796434	First Health Piccione JR, James M	1356321509	27-0796435	First Health Stephen, Ani	1588959118	27-0796436	First Health Thomas, Cini	1134777238	27-0796437	First Health', NULL, NULL, '2020-07-20 12:54:14', '2020-07-20 12:54:14'),
(1268, 2027, 182, NULL, '2020-09-29 00:00:00.000', 'In Process', 'Online application has been submitted', NULL, NULL, '2020-09-22 17:28:08', '2020-09-22 17:28:08'),
(1269, 2027, 182, NULL, '2020-10-28 00:00:00.000', 'In Process', 'To: bharathb@aetna.com  May I know the current enrollment status of the below mentioned providers:  Providers	NPI#	Group Name	Group Tax-ID Joseph, Vibitha	1952931560	Normandy Urgent Care Center	27-0796429 Kourouma , Odette Tiranke	1134525868	Normandy Urgent Care Center	27-0796429 Piccione JR, James M	1356321509	Normandy Urgent Care Center	27-0796429 Stephen, Ani	1588959118	Normandy Urgent Care Center	27-0796429 Thomas, Cini	1134777238	Normandy Urgent Care Center	27-0796429    Thanks.', NULL, NULL, '2020-10-21 17:36:17', '2020-10-21 17:36:17'),
(1270, 2037, 182, NULL, '2020-11-13 00:00:00.000', 'In Process', 'Follow up email sent to : bharathb@aetna.com', NULL, NULL, '2020-10-29 14:13:01', '2020-10-29 14:13:01'),
(1271, 2037, 182, NULL, '2020-11-20 00:00:00.000', 'In Process', 'Follow up email sent to AbhishekV@aetna.com, LakkakulaS@aetna.com, bharathb@aetna.com,  SidleyJ1@firsthealth.com,  ------------ Greetings, We have submitted online applications for the below mentioned providers for enrollment with first health.May I know if they have been received and are currently being processed? ProvidersProvider NPI#Group NameGroup Tax-IDBrown, Brittany1275163537Normandy Urgent Care Center27-0796429Chennemkara, Mini Philip1841755956Normandy Urgent Care Center27-0796429George, Jeemol1497219067Normandy Urgent Care Center27-0796429Jose, Julie1447883061Normandy Urgent Care Center27-0796429Joseph, Vibitha1952931560Normandy Urgent Care Center27-0796429Kourouma , Odette Tiranke1134525868Normandy Urgent Care Center27-0796429Piccione JR, James M1356321509Normandy Urgent Care Center27-0796429Stephen, Ani1588959118Normandy Urgent Care Center27-0796429Thomas, Cini1134777238Normandy Urgent Care Center27-0796429', NULL, NULL, '2020-11-13 16:51:13', '2020-11-13 16:51:13'),
(1272, 2037, 182, NULL, '2020-12-01 00:00:00.000', 'In Process', 'Another Follow up email sent to AbhishekV@aetna.com, LakkakulaS@aetna.com, bharathb@aetna.com,  SidleyJ1@firsthealth.com, ', NULL, NULL, '2020-11-20 11:00:00', '2020-11-20 11:00:00'),
(1273, 2037, 182, NULL, '2020-12-08 00:00:00.000', 'In Process', 'Follow up email sent to bharathb@aetna.com', NULL, NULL, '2020-12-01 10:04:17', '2020-12-01 10:04:17'),
(1274, 2037, 182, NULL, '2020-12-11 00:00:00.000', 'In Process', 'Follow up email sent to AbhishekV@aetna.com', NULL, NULL, '2020-12-08 13:44:42', '2020-12-08 13:44:42'),
(1275, 2037, 182, NULL, '2021-01-06 00:00:00.000', 'In Process', 'Follow up email sent to LakkakulaS@aetna.com', NULL, NULL, '2020-12-11 13:18:17', '2020-12-11 13:18:17'),
(1276, 3040, 182, NULL, '2021-03-05 00:00:00.000', 'In Process', 'Greetings,  Hope you are doing well. Please advise me the enrollment status for the below mentioned providers under both the locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Address: 779 Normandy St Ste 114 Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name: Brown, Brittany  Provide NPI# 1275163537   Provider Name: Chennemkara, Mini Philip  Provide NPI# 1841755956  Provider Name: George, Jeemol Provide NPI# 1497219067  Provider Name: Jose, Julie Provide NPI# 1447883061  Provider Name: Joseph, Vibitha Provide NPI# 1952931560  Provider Name: Kourouma , Odette Tiranke Provide NPI# 1134525868  Provider Name: Piccione JR, James M Provide NPI# 1356321509  Provider Name: Stephen, Ani Provide NPI# 1588959118  Provider Name: Thomas, Cini Provide NPI# 1134777238  If you need any additional information please feel to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-02-26 13:33:20', '2021-02-26 13:33:20'),
(1277, 3040, 182, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email sent to: AbhishekV@aetna.com, bharathb@aetna.com, SidleyJ1@firsthealth.com  Subject: Re: Enrollment Status || Providers || Normandy Urgent Care Center || First Health ||  Greetings,  This is a follow up email regarding the enrollment status for the below mentioned providers under both the locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Address: 779 Normandy St Ste 114 Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name: Brown, Brittany Provide NPI# 1275163537  Provider Name: Chennemkara, Mini Philip Provide NPI# 1841755956  Provider Name: George, Jeemol Provide NPI# 1497219067  Provider Name: Jose, Julie Provide NPI# 1447883061  Provider Name: Joseph, Vibitha Provide NPI# 1952931560  Provider Name: Kourouma , Odette Tiranke Provide NPI# 1134525868  Provider Name: Piccione JR, James M Provide NPI# 1356321509  Provider Name: Stephen, Ani Provide NPI# 1588959118  Provider Name: Thomas, Cini Provide NPI# 1134777238  Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-08 15:58:24', '2021-03-08 15:58:24'),
(1278, 3040, 182, NULL, '2021-03-26 00:00:00.000', 'In Process', 'Follow up email sent to 	pdsdallas@aetna.com  Subject: Enroll Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || First Health ||  Greetings,  Hope you are doing well. I had a word with a First Health representative and she advised me you need to credentialed the providers first with Aetna and after we can add the provider in First health.   In Aetna we already have an ancillary contract so still we need to credentialed the providers with Aetna.   Below are the practice details:   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Address: 779 Normandy St Ste 114 Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name: Brown, Brittany Provide NPI# 1275163537  Provider Name: Chennemkara, Mini Philip Provide NPI# 1841755956  Provider Name: George, Jeemol Provide NPI# 1497219067  Provider Name: Jose, Julie Provide NPI# 1447883061  Provider Name: Joseph, Vibitha Provide NPI# 1952931560  Provider Name: Kourouma , Odette Tiranke Provide NPI# 1134525868  Provider Name: Piccione JR, James M Provide NPI# 1356321509  Provider Name: Stephen, Ani Provide NPI# 1588959118  Provider Name: Thomas, Cini Provide NPI# 1134777238  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-03-19 13:52:05', '2021-03-19 13:52:05'),
(1279, 3040, 182, NULL, '2021-06-02 00:00:00.000', 'Approved', 'I had a word with First Health and she advised me we have an ancillary contract with Aetna so our provider is enrolled with First Health because First Health is the part of Aetna.   For Effective date please see group task.  ', NULL, NULL, '2021-05-26 17:03:21', '2021-05-26 17:03:21'),
(1280, 2027, 190, NULL, NULL, 'In Process', 'Call to insurance talk to the representative her name is leeh ref# 1205 she said this application is still in process and may take 60 to 70 more days to be completed.', NULL, NULL, '2020-06-30 15:17:45', '2020-06-30 15:17:45'),
(1281, 2027, 190, NULL, NULL, 'Approved', 'From: pso@cigna.com  Cigna contract received effective date is 07/02/2020 waiting for the welcome letter', NULL, NULL, '2020-07-08 10:39:09', '2020-07-08 10:39:09'),
(1282, 2027, 191, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-14 14:43:10', '2020-07-14 14:43:10'),
(1283, 2027, 191, NULL, '2020-09-24 00:00:00.000', 'Initiated', 'To; KMoten4@humana.com  Sub: (Joseph, Vibitha)-(Normandy Urgent Care Center)-(Tricare)  Hello, Hope you are doing well, I want to enroll a provider with tricare please confirm if the panels are open. Also send the required documents to me so i can start the enrollment process. Details of the provider are mentioned below: Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Group Name: Normandy Urgent Care Center Group Tax-ID: 27-0796429  Thanks.', NULL, NULL, '2020-09-17 13:29:19', '2020-09-17 13:29:19');
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
(1284, 2027, 191, NULL, '2020-09-25 00:00:00.000', 'In Process', 'From: KMoten4@humana.com  Hi Martin,     This provider is showing Certified in our system.     Now the next step is to complete the Credentialing Application. Please provide to me. Please see attached application and make sure to include all documents requested on the checklist.        Respectfully,  Katherine Moten', NULL, NULL, '2020-09-18 14:19:09', '2020-09-18 14:19:09'),
(1285, 2027, 191, NULL, '2020-09-25 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  Please find the credentialing application form attached in this email for vibitha joseph. details of the provider are mentioned below: Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Group Name: Normandy Urgent Care Center Group Tax-ID: 27-0796429  Thanks.', NULL, NULL, '2020-09-18 14:19:44', '2020-09-18 14:19:44'),
(1286, 2027, 191, NULL, '2020-09-28 00:00:00.000', 'In Process', 'From: KMoten4@humana.com  When you provide a Credentialing Application, you also need to provide the following documents for the provider: -CV -Malpractice Insurance -License -DEA  This must be provided with every Credentialing Application.  Thank you.', NULL, NULL, '2020-09-21 15:04:58', '2020-09-21 15:04:58'),
(1287, 2027, 191, NULL, '2020-09-28 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  Please find the remaining documents attached in this email which you have requested for: CV Malpractice Insurance License DEA-(N/A)', NULL, NULL, '2020-09-21 15:05:29', '2020-09-21 15:05:29'),
(1288, 2027, 191, NULL, '2020-09-29 00:00:00.000', 'In Process', 'From: KMoten4@humana.com  Good Morning,     The application and documents have been sent for processing. Please allow 90 days.     Thank you.        Respectfully,  Katherine Moten', NULL, NULL, '2020-09-22 09:18:49', '2020-09-22 09:18:49'),
(1289, 2027, 191, NULL, '2020-10-28 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  Sub: (Joseph, Vibitha)-(Normandy Urgent Care Center)-(Tricare)  May I know the current status of the provider mentioned below: Provider Name- Joseph, Vibitha Provider NPI# 1952931560 Group Name- Normandy Urgent Care Center Group Tax-ID- 27-0796429  Thanks.  ', NULL, NULL, '2020-10-21 16:56:17', '2020-10-21 16:56:17'),
(1290, 2027, 191, NULL, '2020-10-28 00:00:00.000', 'In Process', 'From: KMoten4@humana.com  I submitted the application on 9/22/2020; please allow 90 days for processing.     Thank you.', NULL, NULL, '2020-10-21 17:51:13', '2020-10-21 17:51:13'),
(1291, 1006, 191, NULL, '2020-11-10 00:00:00.000', 'In Process', 'Sent a follow-up email @ KMoten4@humana.com regarding enrollment status. ', NULL, NULL, '2020-10-28 17:57:20', '2020-10-28 17:57:20'),
(1292, 1006, 191, NULL, '2020-11-12 00:00:00.000', 'In Process', 'Received the following update from Katherine:  \"Good Morning,   Vibitha Joseph – still pending the credentialing process. Submitted application 9/22/20, please allow 90 days for processing.   Respectfully, Katherine Moten TRICARE Community Liaison II Humana T 502-318-5250 F 210-239-0401 kmoten4@humana.com HumanaMilitary.com\"', NULL, NULL, '2020-10-29 09:10:11', '2020-10-29 09:10:11'),
(1293, 2037, 191, NULL, '2020-11-26 00:00:00.000', 'In Process', 'Follow up email sent', NULL, NULL, '2020-11-12 10:57:30', '2020-11-12 10:57:30'),
(1294, 2037, 191, NULL, '2020-12-10 00:00:00.000', 'In Process', 'Follow up email sent to Katherine', NULL, NULL, '2020-11-30 17:53:20', '2020-11-30 17:53:20'),
(1295, 2037, 191, NULL, '2020-12-18 00:00:00.000', 'In Process', 'Currently being processed', NULL, NULL, '2020-12-11 16:43:27', '2020-12-11 16:43:27'),
(1296, 2037, 191, NULL, '2020-12-31 00:00:00.000', 'In Process', '	 Currently being processed', NULL, NULL, '2020-12-21 18:02:12', '2020-12-21 18:02:12'),
(1297, 3040, 191, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center|| Joseph, Vibitha || Tricare ||  Greetings,  Hope you are doing well. Please advise me the enrollment status for the below mentioned provider.   Practice 1: Practice Name: Normandy Urgent Care Center Practice NPI# 1407171077 Practice Tax ID# 27-0796429 Practice Address: 779 Normandy St Ste 114 Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice NPI# 1407171077 Practice Tax ID# 27-0796429 Practice Address: 16272 IMPERIAL VALLEY DR STE K Houston , TX 77060  Practice 2: Practice Name: Longpoint Medical Center Practice NPI# 1770763815 Practice Tax ID# 76-0612416 Practice Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name: Joseph, Vibitha Provider NPI# 1952931560  If you need any additional information please let me know. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-02-25 16:03:17', '2021-02-25 16:03:17'),
(1298, 3040, 191, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Email rcvd from: KMoten4@humana.com  Subject:  Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center|| Joseph, Vibitha || Tricare ||  Please allow 3 business days for updates to show. Provider will be showing under all 3 locations.   ', NULL, NULL, '2021-02-25 17:18:22', '2021-02-25 17:18:22'),
(1299, 3040, 191, NULL, '2021-03-23 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center|| Joseph, Vibitha || Tricare ||  Hello Katherine,  Hope you are doing well. Please note that I checked the Tricare provider portal and over there provider is not showing at 01 location. I attached the screenshot for your reference.  Under below address provider is not showing in the portal  Practice Name: Longpoint Medical Center Practice NPI# 1407171077 Practice Tax ID# 27-0796429 Practice Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226  Waiting to hear from you soon.  Thank you', NULL, NULL, '2021-03-16 16:52:24', '2021-03-16 16:52:24'),
(1300, 3040, 191, NULL, '2021-03-23 00:00:00.000', 'In Process', 'Email rcvd from: KMoten4@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center|| Joseph, Vibitha || Tricare ||  Please allow 3 business days for updates to show.  Provider will be showing under all 3 locations. ', NULL, NULL, '2021-03-16 16:53:20', '2021-03-16 16:53:20'),
(1301, 3040, 191, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Tricare ||  Hello Katherine,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Tricare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-07 15:48:53', '2021-06-07 15:48:53'),
(1302, 3040, 191, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Tricare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-22 09:45:54', '2021-06-22 09:45:54'),
(1303, 3040, 191, NULL, '2021-07-19 00:00:00.000', 'Approved', 'Email rcvd from: ywyatt@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Provider 11:    Provider Name: Joseph, Vibitha- Network under two locations need to submit a request to add her to the Long Point  Provider NPI# 1952931560', NULL, NULL, '2021-07-12 13:31:24', '2021-07-12 13:31:24'),
(1304, 3040, 194, NULL, '2021-07-16 00:00:00.000', 'Revalidation', 'Email sent to: ywyatt@humana.com  Subject: Additional Location || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Greetings,   Hope you are doing well. I wanted to add the location under the below mentioned providers in Tricare in our group under the below mentioned locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Jose, Julie Provider NPI# 1447883061 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 2:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 3:   Provider Name: Rauf, Abdur  Provider NPI# 1497726202 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 4:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 5:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238 Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226   Provider 7:   Provider Name: Abraham, Jeena  Provider NPI# 1467901587 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-07-09 14:33:12', '2021-07-09 14:33:12'),
(1305, 11056, 194, NULL, '2021-08-18 00:00:00.000', 'Revalidation', 'Email received from :    ywyatt@humana.com  Sub : Fwd: Additional Location || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Good Morning Adil,     To add a provider to a network location you need to complete the attached spreadsheet and email it to the HGB Roster team to process.     Send the completed spreadsheet to the following email address     HGBProviderRosters@Humana.com              Thanks,  Yvonne', NULL, NULL, '2021-08-11 11:32:16', '2021-08-11 11:32:16'),
(1306, 3040, 194, NULL, '2021-08-25 00:00:00.000', 'Revalidation', 'Email sent to: HGBProviderRosters@humana.com, ywyatt@humana.com  Subject: Re: Additional Location || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Received Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in an additional location in Tricare in our group under the below highlighted locations. We already submitted the roster for an additional location on 07/19/2021.   Practice Details: Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider 1:     Provider Name: Jose, Julie  Provider NPI# 1447883061  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 2:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 3:    Provider Name: Rauf, Abdur   Provider NPI# 1497726202  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 4:    Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 5:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 6:    Provider Name: Thomas, Cini   Provider NPI# 1134777238  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226   Provider 7:    Provider Name: Abraham, Jeena   Provider NPI# 1467901587  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you!! ', NULL, NULL, '2021-08-18 16:51:31', '2021-08-18 16:51:31'),
(1307, 3040, 194, NULL, '2021-08-27 00:00:00.000', 'Revalidation', 'Email rcvd from: ywyatt@humana.com  Subject: RE: Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good Morning Ahmed,  Please submit your request for network Group tax id / Providers to the HGB Roster Team email via spreadsheet first, the HGB Roster team has an automatic processing system, they will send you the status once it is complete. You may reach out to me if there is no resolution from the HGB Roster team. HGB Roster team has up to 60 days to process a request.  Here is the status:  Provider Name: Thomas, Cini, Provider NPI# 1134777238 – we show this Provider has been added , I will submit a request to Provider network to display on the Provider Portal  Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956, -  we show this Provider has been added , I will submit a request to Provider network to display on the Provider Portal  Thanks, Yvonne W. Wyatt, Humana Military TRICARE Community Liaison II Houston/Galveston 502-318-5409 Telephone 502-322-8018 Fax ywyatt@humana.com', NULL, NULL, '2021-08-20 14:38:07', '2021-08-20 14:38:07'),
(1308, 3040, 194, NULL, '2021-09-08 00:00:00.000', 'Revalidated', 'Email rcvd from: ywyatt@humana.com  Subject: RE: Additional Location || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Good Afternoon Adil,  We show the following.  This information is available on the Providers Portal or directory Highlighted is the link to check status. I have attached a copy of the spreadsheet of the Providers we show affiliated to these groups under this tax id.   https://infocenter.humana-military.com/provider/service/Account/Login  HumanaMilitary - Find care (goperspecta.com)  Provider 1:   Provider Name: Jose, Julie- Show has been added Provider NPI# 1447883061 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 2:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 – Show added Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226- Show not added yet  Provider 3:  Show Added Provider Name: Rauf, Abdur  Provider NPI# 1497726202 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 4:  Show added to both locations Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 5:  - Show added Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 6:   Provider Name: Thomas, Cini – show added to all three locations Provider NPI# 1134777238 Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 7:  - Show added. Provider Name: Abraham, Jeena  Provider NPI# 1467901587 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Thanks, Yvonne W. Wyatt, Humana Military TRICARE Community Liaison II Houston/Galveston 502-318-5409 Telephone 502-322-8018 Fax ywyatt@humana.com', NULL, NULL, '2021-09-01 13:08:12', '2021-09-01 13:08:12'),
(1309, 3040, 195, NULL, NULL, 'Revalidation', 'Provider is not certified with Tricare. We sent the provider certification from through fax @ 608-221-7535.  Please see attachment. ', NULL, NULL, '2021-05-10 15:01:08', '2021-05-10 15:01:08'),
(1310, 3040, 195, NULL, '2021-07-01 00:00:00.000', 'Revalidation', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Columbus Urgent Care PA || Thomas, Cini || Tricare ||  Hello Katherine,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in our group Columbus Urgent Care PA under the below location. We already sent the provider certification application through fax on 05/10/2021.   Practice Details: Group Name: Columbus Urgent Care PA Group NPI# 1215330501 Group TIN# 47-1914151 Group Address: 926 Walnut St, Columbus TX, 78934  Provider 1: Provider Name: Thomas, Cini Provider NPI# 1134777238  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-24 13:25:21', '2021-06-24 13:25:21'),
(1311, 3040, 195, NULL, '2021-07-20 00:00:00.000', 'Revalidation', 'Email rcvd from: KMoten4@humana.com  Subject: RE: Enrollment Status || Columbus Urgent Care PA || Thomas, Cini || Tricare ||  This provider is being credentialed for the group below. Please allow 90 days for processing.   Respectfully, Katherine Moten TRICARE Community Liaison II Humana T 502-318-5250 F 210-239-0401 kmoten4@humana.com HumanaMilitary.com', NULL, NULL, '2021-07-13 11:45:05', '2021-07-13 11:45:05'),
(1312, 3040, 195, NULL, '2021-07-20 00:00:00.000', 'Revalidated', 'Email rcvd from: KMoten4@humana.com  Subject: Enrollment Status || Columbus Urgent Care PA || Thomas, Cini || Tricare ||  Hello,  This provider is showing affiliated with location and is credentialed.  Respectfully, Katherine Moten TRICARE Community Liaison II Humana T 502-318-5250 F 210-239-0401 kmoten4@humana.com HumanaMilitary.com', NULL, NULL, '2021-07-13 13:59:55', '2021-07-13 13:59:55'),
(1313, 3040, 196, NULL, '2021-07-16 00:00:00.000', 'Revalidation', 'Email sent to: ywyatt@humana.com  Subject: Additional Location || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Greetings,   Hope you are doing well. I wanted to add the location under the below mentioned providers in Tricare in our group under the below mentioned locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Jose, Julie Provider NPI# 1447883061 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 2:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 3:   Provider Name: Rauf, Abdur  Provider NPI# 1497726202 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 4:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 5:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238 Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226   Provider 7:   Provider Name: Abraham, Jeena  Provider NPI# 1467901587 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-07-09 14:33:13', '2021-07-09 14:33:13'),
(1314, 11056, 196, NULL, '2021-08-18 00:00:00.000', 'Revalidation', 'Email received from :    ywyatt@humana.com  Sub : Fwd: Additional Location || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Good Morning Adil,     To add a provider to a network location you need to complete the attached spreadsheet and email it to the HGB Roster team to process.     Send the completed spreadsheet to the following email address     HGBProviderRosters@Humana.com              Thanks,  Yvonne', NULL, NULL, '2021-08-11 11:32:06', '2021-08-11 11:32:06'),
(1315, 3040, 196, NULL, '2021-08-25 00:00:00.000', 'Revalidation', 'Email sent to: HGBProviderRosters@humana.com, ywyatt@humana.com  Subject: Re: Additional Location || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Received Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in an additional location in Tricare in our group under the below highlighted locations. We already submitted the roster for an additional location on 07/19/2021.   Practice Details: Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider 1:     Provider Name: Jose, Julie  Provider NPI# 1447883061  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 2:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 3:    Provider Name: Rauf, Abdur   Provider NPI# 1497726202  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 4:    Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 5:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 6:    Provider Name: Thomas, Cini   Provider NPI# 1134777238  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226   Provider 7:    Provider Name: Abraham, Jeena   Provider NPI# 1467901587  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you!! ', NULL, NULL, '2021-08-18 16:51:34', '2021-08-18 16:51:34'),
(1316, 3040, 196, NULL, '2021-08-27 00:00:00.000', 'Revalidation', 'Email rcvd from: ywyatt@humana.com  Subject: RE: Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good Morning Ahmed,  Please submit your request for network Group tax id / Providers to the HGB Roster Team email via spreadsheet first, the HGB Roster team has an automatic processing system, they will send you the status once it is complete. You may reach out to me if there is no resolution from the HGB Roster team. HGB Roster team has up to 60 days to process a request.  Here is the status:  Provider Name: Thomas, Cini, Provider NPI# 1134777238 – we show this Provider has been added , I will submit a request to Provider network to display on the Provider Portal  Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956, -  we show this Provider has been added , I will submit a request to Provider network to display on the Provider Portal  Thanks, Yvonne W. Wyatt, Humana Military TRICARE Community Liaison II Houston/Galveston 502-318-5409 Telephone 502-322-8018 Fax ywyatt@humana.com', NULL, NULL, '2021-08-20 14:38:08', '2021-08-20 14:38:08'),
(1317, 3040, 196, NULL, '2021-09-08 00:00:00.000', 'Revalidated', 'Email rcvd from: ywyatt@humana.com  Subject: RE: Additional Location || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Good Afternoon Adil,  We show the following.  This information is available on the Providers Portal or directory Highlighted is the link to check status. I have attached a copy of the spreadsheet of the Providers we show affiliated to these groups under this tax id.   https://infocenter.humana-military.com/provider/service/Account/Login  HumanaMilitary - Find care (goperspecta.com)  Provider 1:   Provider Name: Jose, Julie- Show has been added Provider NPI# 1447883061 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 2:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 – Show added Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226- Show not added yet  Provider 3:  Show Added Provider Name: Rauf, Abdur  Provider NPI# 1497726202 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 4:  Show added to both locations Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 5:  - Show added Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 6:   Provider Name: Thomas, Cini – show added to all three locations Provider NPI# 1134777238 Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 7:  - Show added. Provider Name: Abraham, Jeena  Provider NPI# 1467901587 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Thanks, Yvonne W. Wyatt, Humana Military TRICARE Community Liaison II Houston/Galveston 502-318-5409 Telephone 502-322-8018 Fax ywyatt@humana.com', NULL, NULL, '2021-09-01 13:08:13', '2021-09-01 13:08:13'),
(1318, 2027, 197, NULL, NULL, 'In Process', 'From: HPCREDENTIALINGEXPEDITE@bswhealth.org   Last Name  First Name  NPI  TIN  ORG name  George  Jeemol  1497219067  27-0796429  Normandy Urgent Care Center PA  Jose  Julie  1447883061  27-0796429  Normandy Urgent Care Center PA  Joseph  Vibitha  1952931560  27-0796429  Normandy Urgent Care Center PA        Need information in the next 10 days (July 24, 2020).  No follow up email will be sent.     Here at Scott & White Health Plan (SWHP) and First Care Health Plan (FCHP) we take pride in working expeditiously to provide you with quality service in a timely and accurate manner. We have recently received a request to add a provider(s) to your existing SWHP or FCHP group agreement. In order for this to be accomplished, we will need your assistance in providing all documentation requested by our Provider Relations Dept. and our Credentialing Verification Organization (CVO), Aperture Credentialing.     Please forward, via email to HPCREDENTIALINGEXPEDITE@BSWHealth.org, with the subject line EXPEDITED and the attached documents before the above date so we can initiate the process to start your credentialing process.     Required:  1.      Provider Information Spreadsheet – This is not your credentialing application.  This provides us information to send to Aperture to get you started with their request.  If you use CAQH please ensure your information and attestations are up to date and that you have designated SWHP and/or FCHP as an authorized provider.  If you do not use CAQH please send us your Texas Standardized Credentialing Application (TSCA) and attachments.   2.       Copy of the W-9  If applicable:  3.       Privilege Exception/Mid-Level Form - If applicable  4.       CME Acknowledgement:  For any non-boarded PHYSICIANs, who are no longer in the eligibility period for certification, SWHP and FCHP requires additional CMEs annually.  To acknowledge this requirement please sign, date, and return the attached CME form.     This will be the only request sent from SWHP and FCHP requesting these items above to initiate the credentialing process. If the information above has not been received within 10 days, you will be required to re-apply through www.swhp.org     Once we have processed the initial information the Credentialing process will begin. Once credentialing is complete, we will contact you with your effective date. If you have any questions or concerns please contact your provider relations representatives.     Thank you,', NULL, NULL, '2020-07-13 14:51:55', '2020-07-13 14:51:55'),
(1319, 2027, 197, NULL, NULL, 'In Process', 'To: HPCREDENTIALINGEXPEDITE@bswhealth.org  Sub: EXPEDITED   Please Find the attached documents which you have requested for credentialing of these providers.  Name            NP#                      Tax-ID                           Group george  -  1497219067 -   27-0796429 -   Normandy Urgent Care Center PA   Jeemol    Jose     -    1447883061 -  27-0796429 -   Normandy Urgent Care Center PA    Julie    Joseph -    1952931560 -   27-0796429 -  Normandy Urgent Care Center PA    Vibitha        Thanks.', NULL, NULL, '2020-07-13 14:52:50', '2020-07-13 14:52:50'),
(1320, 2027, 197, NULL, '2020-08-24 00:00:00.000', 'In Process', 'From: HPCREDENTIALINGEXPEDITE@bswhealth.org  Good afternoon,     Attached is the credentialing approval letter for the above named provider. Please save for your reference.           Thank you,', NULL, NULL, '2020-08-17 10:49:54', '2020-08-17 10:49:54'),
(1321, 2027, 197, NULL, '2020-08-26 00:00:00.000', 'In Process', 'From: SWHPEXPEDITES@bswhealth.org  Sub: To add Jeemol George and Vibitha Joseph to Normandy Urgent Care Center PA  The provider information for Jeemol George and Vibitha Joseph to be added to Normandy Urgent Care Center PA has been received and is in process.     He/she has an effective date of 8/31/2020.  However, please allow 3-4 weeks before submitting claims to ensure he/she is completely configured in our system; otherwise, claims may deny.     Thank you and have a great day.        Provider Relations  Scott & White Health Plan', NULL, NULL, '2020-08-19 09:30:16', '2020-08-19 09:30:16'),
(1322, 2027, 197, NULL, '2020-08-26 00:00:00.000', 'In Process', 'To: SWHPEXPEDITES@bswhealth.org  Thanks for the confirmation. Can I have welcome letters or executed signed contracts for these providers?  Thanks.', NULL, NULL, '2020-08-19 09:30:57', '2020-08-19 09:30:57'),
(1323, 2027, 197, NULL, '2020-08-26 00:00:00.000', 'In Process', 'From: HPCREDENTIALINGEXPEDITE@bswhealth.org  Good morning,     The confirmation effective date is when the provider joins the network in which you may use as the welcome letter. If you are in need of credentialing approval letters I have included our credentialing department on the email in case you have not received them. Please keep in mind the credentialing approval date is not the effective date.      Thank you,  Vanessa', NULL, NULL, '2020-08-19 09:32:46', '2020-08-19 09:32:46'),
(1324, 2027, 197, NULL, '2020-09-15 00:00:00.000', 'In Process', 'To: SWHPEXPEDITES@bswhealth.org  May I know the current status of the provider mentioned below: Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Group Name: Normandy Urgent Care Center Group Tax-ID: 27-0796429  Thanks.', NULL, NULL, '2020-09-08 17:36:30', '2020-09-08 17:36:30'),
(1325, 2027, 197, NULL, '2020-09-16 00:00:00.000', 'Approved', 'Provider is now showing linked with the insurance and effective date is 8/31/2020. Screenshot of the confirmation email and approval letter is attached. ', NULL, NULL, '2020-09-09 09:52:57', '2020-09-09 09:52:57'),
(1326, 2027, 199, NULL, NULL, 'Approved', 'From: Michele.Thomas-Martin@molinahealthcare.com  Record # 166471 & 165924     Provider: Glory Abraham & Vibitha Joseph     Good Afternoon,     Thank you for your inquiry.  The provider has been loaded in the billing system under all plans effective 7/15/2020.  Please see the attached welcome letters.      Thank You,', NULL, NULL, '2020-07-15 13:00:03', '2020-07-15 13:00:03'),
(1327, 2027, 203, NULL, NULL, 'In Process', 'To: TCHPNetworkManagemen@texaschildrens.org  Sub: (Vibitha Joseph)-(Normandy Urgent Care Center)-(Texas Children Health Plan - TCHP)  May I know the current status of our request to add this provider in the existing group as in the network provider we have already sent the LOI and W9 in the last communication. Details of the provider are as follows. Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Group Name: Normandy Urgent Care Center Group Tax ID: 1952931560  Thanks.', NULL, NULL, '2020-07-14 16:47:51', '2020-07-14 16:47:51'),
(1328, 2027, 203, NULL, NULL, 'In Process', 'From; tchpnetworkmanagement@texaschildrens.org   Application under review, communication will be sent once review is complete. Thank you', NULL, NULL, '2020-07-14 16:52:05', '2020-07-14 16:52:05'),
(1329, 2027, 203, NULL, '2020-09-16 00:00:00.000', 'In Process', 'To: TCHPNetworkManagemen@texaschildrens.org  Sub: (Joseph, Vibitha)-(Normandy Urgent Care Center)-(Texas Children Health Plan)  May I know the current status of the provider mentioned below: Provider Name- Joseph, Vibitha Provider NPI# 1952931560 Group Name- Normandy Urgent Care Center Group Tax-ID- 27-0796429 Thanks.', NULL, NULL, '2020-09-09 15:45:22', '2020-09-09 15:45:22'),
(1330, 2027, 203, NULL, '2020-10-21 00:00:00.000', 'In Process', 'To; tchpnetworkmanagement@texaschildrens.org  Please find the (PIF and W9) attached in this email to link this provider under (Normandy Urgent Care Center)  Thanks.', NULL, NULL, '2020-10-14 10:41:51', '2020-10-14 10:41:51'),
(1331, 2037, 203, NULL, '2020-11-06 00:00:00.000', 'In Process', 'Follow up email sent @ tchpnetworkmanagement@texaschildrens.org.: -------------------------- May I know the current status of the provider mentioned below: Provider Name- Joseph, Vibitha Provider NPI# 1952931560 Group Name- Normandy Urgent Care Center Group Tax-ID- 27-0796429 Thanks.', NULL, NULL, '2020-10-26 17:25:37', '2020-10-26 17:25:37'),
(1332, 2027, 203, NULL, '2020-11-13 00:00:00.000', 'In Process', 'From: tchpnetworkmanagement@texaschildrens.org  Did you submit a provider information form for this provider as requested on 10/13?', NULL, NULL, '2020-11-06 14:50:34', '2020-11-06 14:50:34'),
(1333, 2027, 203, NULL, '2020-11-13 00:00:00.000', 'In Process', 'To: tchpnetworkmanagement@texaschildrens.org  Yes I have submitted that form.', NULL, NULL, '2020-11-06 14:51:06', '2020-11-06 14:51:06'),
(1334, 2037, 203, NULL, '2020-11-20 00:00:00.000', 'In Process', 'Follow up email sent for the submitted PIF', NULL, NULL, '2020-11-13 14:39:12', '2020-11-13 14:39:12'),
(1335, 2037, 203, NULL, '2020-12-08 00:00:00.000', 'In Process', 'Currently being processed .Need to allow more time', NULL, NULL, '2020-11-20 14:27:06', '2020-11-20 14:27:06'),
(1336, 2037, 203, NULL, '2020-12-15 00:00:00.000', 'In Process', 'Follow up email sent for the submitted PIF', NULL, NULL, '2020-12-08 14:51:05', '2020-12-08 14:51:05'),
(1337, 1006, 203, NULL, '2020-12-25 00:00:00.000', 'In Process', 'Sent a follow-up email to TCHP CA Contract Admin tchpnetworkmanagement@texaschildrens.org for an updated status of enrollment. ', NULL, NULL, '2020-12-15 18:11:42', '2020-12-15 18:11:42'),
(1338, 1006, 203, NULL, '2020-12-25 00:00:00.000', 'In Process', 'Sent a follow-up email to TCHP CA Contract Admin tchpnetworkmanagement@texaschildrens.org for an updated status of enrollment. ', NULL, NULL, '2020-12-15 18:11:54', '2020-12-15 18:11:54'),
(1339, 2037, 203, NULL, '2021-01-05 00:00:00.000', 'In Process', 'PIF submitted  Need to allow more time ', NULL, NULL, '2020-12-29 16:47:51', '2020-12-29 16:47:51'),
(1340, 1006, 203, NULL, '2021-02-08 00:00:00.000', 'In Process', 'Received the following reply from TCHP CA Contract Admin tchpnetworkmanagement@texaschildrens.org:  \"Provider Name: Vibitha Joseph –in process\" ', NULL, NULL, '2021-01-29 09:37:25', '2021-01-29 09:37:25'),
(1341, 1006, 203, NULL, '2021-02-23 00:00:00.000', 'In Process', 'Sent a follow-up email @ TCHP CA Contract Admin tchpnetworkmanagement@texaschildrens.org for updated status.  ', NULL, NULL, '2021-02-16 17:36:30', '2021-02-16 17:36:30'),
(1342, 1006, 203, NULL, '2021-03-01 00:00:00.000', 'In Process', 'Received the following reply from TCHP CA Contract Admin tchpnetworkmanagement@texaschildrens.org:  \"Hello,  PIF for provider Vibitha Joseph is in process.   Thank you  Self Note 20210115034283571\"', NULL, NULL, '2021-02-19 16:34:27', '2021-02-19 16:34:27'),
(1343, 3040, 203, NULL, '2021-03-08 00:00:00.000', 'In Process', 'Email sent to: 	TXCredentialing@amerigroup.com  Subject: Provider Enrollment Status - Normandy Urgent Care Center  Greetings,  Please advise me the enrollment status for the following providers under our group as their enrollment requests have been in process since the start of last year:   Practice Details: Practice Name: Normandy Urgent Care Center Practice NPI# 1407171077 Practice Tax ID# 27-0796429 Practice Address: 779 Normandy St Ste 114 Houston , TX 77015-3441  Practice Details: Practice Name: Imperial Valley Urgent Care Center Practice NPI# 1407171077 Practice Tax ID# 27-0796429 Practice Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider Name: Jose, Julie Provider NPI# 1447883061  Provider Name: George, Jeemol Provider NPI# 1497219067  Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider Name: Stephen, Ani Provider NPI# 1588959118  Please get back to me as soon as you get a chance. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-03-01 12:55:58', '2021-03-01 12:55:58'),
(1344, 3040, 203, NULL, '2021-03-08 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Provider Enrollment Status || Normandy Urgent Care Center || TCHP ||   Greetings,  Please advise me the enrollment status for the following providers under our group as their enrollment requests have been in process since last year:   Practice Details: Practice Name: Normandy Urgent Care Center Practice NPI# 1407171077 Practice Tax ID# 27-0796429 Practice Address: 779 Normandy St Ste 114 Houston , TX 77015-3441  Practice Details: Practice Name: Imperial Valley Urgent Care Center Practice NPI# 1407171077 Practice Tax ID# 27-0796429 Practice Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider Name: Jose, Julie Provider NPI# 1447883061  Provider Name: George, Jeemol Provider NPI# 1497219067  Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider Name: Stephen, Ani Provider NPI# 1588959118  Please get back to me as soon as you get a chance. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-03-01 13:00:09', '2021-03-01 13:00:09'),
(1345, 3040, 203, NULL, '2021-03-25 00:00:00.000', 'Approved', 'Email rcvd from: axhartma@texaschildrens.org  Subject: TCHP Welcome Letter - Vibitha P. Joseph, FNP - Normandy Urgent Care Center PA  Good Evening,  Welcome to TCHP. Vibitha P. Joseph, FNP is now participating with Texas Children’s Health Plan under Normandy Urgent Care Center PA. Attached you will find a welcome letter with an effective date for all contracted products as well as the contact information for your Provider Relations Representative.  Please reach out to your PR Rep or the main Contracting Department phone line at (832) 828-1063 with any questions.  Thank you,  Anna Hartmann Contract Specialist Texas Children\'s Health Plan *: axhartma@texaschildrens.org (: (832) 828-1063', NULL, NULL, '2021-03-18 12:47:59', '2021-03-18 12:47:59'),
(1346, 2027, 204, NULL, '2020-09-09 00:00:00.000', 'In Process', 'To: txcredentialing@amerigroup.com  Sub: (Joseph, Vibitha)-(Normandy Urgent Care Center)-(Amerigroup)  May I know the current status of the provider mentioned below: Provider Name- Joseph, Vibitha Provider NPI# 1952931560  Group Name- Normandy Urgent Care Center Group Tax-ID- 27-0796429  Thanks.', NULL, NULL, '2020-09-02 16:48:38', '2020-09-02 16:48:38'),
(1347, 2027, 204, NULL, '2020-09-28 00:00:00.000', 'In Process', 'To: txcredentialing@amerigroup.com Jason.Hughes@amerigroup.com  Sub: (Joseph, Vibitha)-(Normandy Urgent Care Center)-(Amerigroup)  May I know the current status of the provider mentioned below: Provider Name- Joseph, Vibitha Provider NPI# 1952931560 Group Name- Normandy Urgent Care Center Group Tax-ID- 27-0796429  Thanks.', NULL, NULL, '2020-09-21 13:25:54', '2020-09-21 13:25:54'),
(1348, 2027, 204, NULL, '2020-10-28 00:00:00.000', 'In Process', 'To: txcredentialing@amerigroup.com  May I know the current status of the provider mentioned below: Provider Name- Joseph, Vibitha Provider NPI# 1952931560 Group Name- Normandy Urgent Care Center Group Tax-ID- 27-0796429  Thanks.', NULL, NULL, '2020-10-21 15:00:55', '2020-10-21 15:00:55'),
(1349, 1006, 204, NULL, '2020-11-06 00:00:00.000', 'In Process', 'Sent a follow-up email to txcredentialing@amerigroup.com> & \"Hughes, Jason T.\" Jason.Hughes@amerigroup.com> regarding the current status of enrollment. ', NULL, NULL, '2020-10-28 18:11:14', '2020-10-28 18:11:14'),
(1350, 2027, 204, NULL, '2020-11-13 00:00:00.000', 'In Process', 'To: txcredentialing@amerigroup.com Jason.Hughes@amerigroup.com  This is a follow up email. Please reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-11-06 14:54:27', '2020-11-06 14:54:27'),
(1351, 2037, 204, NULL, '2020-11-27 00:00:00.000', 'In Process', 'Follow up email sent to txcredentialing@amerigroup.com and Jason.Hughes@amerigroup.com for the current status after the credentialing application Submission.', NULL, NULL, '2020-11-13 15:37:09', '2020-11-13 15:37:09'),
(1352, 2037, 204, NULL, '2020-12-09 00:00:00.000', 'In Process', 'Another follow up email sent', NULL, NULL, '2020-11-30 17:49:58', '2020-11-30 17:49:58'),
(1353, 2027, 204, NULL, '2020-12-17 00:00:00.000', 'In Process', 'To: txcredentialing@amerigroup.com  This is a follow up email. Please reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-12-10 14:47:50', '2020-12-10 14:47:50'),
(1354, 2037, 204, NULL, '2020-12-29 00:00:00.000', 'In Process', 'Follow up email sent', NULL, NULL, '2020-12-17 16:48:59', '2020-12-17 16:48:59'),
(1355, 2037, 204, NULL, '2021-01-05 00:00:00.000', 'In Process', 'Another 	 Follow up email sent', NULL, NULL, '2020-12-29 10:36:30', '2020-12-29 10:36:30'),
(1356, 1006, 204, NULL, '2021-01-27 00:00:00.000', 'In Process', 'Sent a follow-up email @ TX Credentialing txcredentialing@amerigroup.com & Jason.Hughes@amerigroup.com ', NULL, NULL, '2021-01-20 09:48:17', '2021-01-20 09:48:17'),
(1357, 1006, 204, NULL, '2021-02-23 00:00:00.000', 'In Process', 'Sent another follow-up @ TX Credentialing txcredentialing@amerigroup.com & Jason.Hughes@amerigroup.com ', NULL, NULL, '2021-02-16 15:20:32', '2021-02-16 15:20:32'),
(1358, 3040, 204, NULL, '2021-03-05 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Subject: Provider Enrollment Status - Normandy Urgent Care Center  Hello,   I want an update regarding the status of enrollment for the following providers under our group as their enrollment requests have been in process since the start of last year:   Practice Details: Practice Name: Normandy Urgent Care Center Practice NPI# 1407171077 Practice Tax ID# 27-0796429 Practice Address: 779 Normandy St Ste 114 Houston , TX 77015-3441  Practice Details: Practice Name: Imperial Valley Urgent Care Center Practice NPI# 1407171077 Practice Tax ID# 27-0796429 Practice Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name: Vibitha Joseph Provider NPI# 1952931560  Provider Name: Odette Kourouma Provider NPI# 1134525868  Provider Name: Jeena Abaham Provider NPI# 1467901587  Provider Name: Ani Stephen  Provider NPI# 1588959118  Provider Name: Chennemkara, Mini Philip Provider NPI#  1841755956  Please get back to me as soon as you get a chance. Waiting to hear from you soon.   Thank you. ', NULL, NULL, '2021-02-26 14:14:05', '2021-02-26 14:14:05');
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
(1359, 1006, 204, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Sent f/u email @ TX Credentialing TXCredentialing@amerigroup.com:  Sub: Enrollment Status - NUCC, IVUC, LPMC - Amerigroup  \"Hello,   I wanted to find out the enrollment status for the following providers, as well as what locations they are listed under for the following group:   Group Name: Normandy Urgent Care Center NPI# 1407171077 TIN# 27-0796429  Primary Address: 779 Normandy St Ste 114, Houston, TX 77015-3441 Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Tertiary Address: 9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider 1:Provider Name: George, Jeemol Provider NPI# 1497219067 Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061 Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956 Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490 Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238 Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616 Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-05-31 15:04:17', '2021-05-31 15:04:17'),
(1360, 11056, 204, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email Sent to : TXCredentialing@amerigroup.com  nucc@claimsmedinc.com  Subj : Enrollment Status - NUCC, IVUC, LPMC - Amerigroup  Good Morning!  I wanted to inquire about the enrollment status for the following providers, as well as what locations they are listed or added into under for the following group:  Practice Name: Normandy Urgent Care Center Practice NPI#: 1407171077 Practice TIN# : 27-0796429 Primary Address: 779 Normandy St Ste 114, Houston, TX 77015-3441 Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Tertiary Address:9504 LONG POINT RD STE E, Houston , TX 77055-4226-  Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider name : PAUL, SIGI Provider NPI # : 1033623616   Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider name : Joseph, Vibitha Provider NPI # : 1952931560   Provider name : Jose, Julie Provider NPI # : 1447883061  Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider name : George, Jeemol Provider NPI # : 1497219067  Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider name : Abraham, Glory Provider NPI # : 1194206490  Please get back to me as soon as you\'re able to.  Thank you!', NULL, NULL, '2021-06-17 12:20:02', '2021-06-17 12:20:02'),
(1361, 3040, 204, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: txcredentialing@amerigroup.com, Jason.Hughes@amerigroup.com,  Subject: Enrollment Status || Normandy Urgent Care Center - Amerigroup  Good Morning!  I wanted to inquire about the enrollment status for the following providers, as well as what locations they are listed under for the following group:  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Please get back to me as soon as you\'re able to.Waiting to hear from you soon.   Thank you!', NULL, NULL, '2021-07-06 09:58:54', '2021-07-06 09:58:54'),
(1362, 3040, 204, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Jason.Hughes@amerigroup.com,  Subject: Enrollment Status || Normandy Urgent Care Center - Amerigroup  Hello Jason,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Provider 17: Provider Name: John, Jeny Provider NPI #  1073019493  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks', NULL, NULL, '2021-07-26 15:24:41', '2021-07-26 15:24:41'),
(1363, 11056, 204, NULL, '2021-08-21 00:00:00.000', 'In Process', 'Email sent to : Jason.Hughes@amerigroup.com   &   TX Credentialing TXCredentialing@amerigroup.com  Sub : Fwd: Delivery Status Notification (Failure)  Good afternoon Jason!  Hope you are doing well. I want to inquire about the enrollment status for the below mentioned group and providers in our groups  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details:  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Provider 17: Provider Name: John, Jeny Provider NPI #  1073019493  If you need any documents or information feel free to reach out to me. Eagerly, waiting for your reply.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-13 14:12:32', '2021-08-13 14:12:32'),
(1364, 3040, 204, NULL, '2021-09-01 00:00:00.000', 'In Process', 'Email sent to: mpsweb@amerigroup.com  Subject: Delivery Status Notification (Failure)  Greetings!  Hope you are doing well. I want to inquire about the enrollment status for the below mentioned group and providers in our groups under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details:  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Provider 17: Provider Name: John, Jeny Provider NPI #  1073019493  If you need any documents or information feel free to reach out to me. Eagerly, waiting for your reply.  Thanks', NULL, NULL, '2021-08-25 15:00:11', '2021-08-25 15:00:11'),
(1365, 3040, 204, NULL, '2021-09-16 00:00:00.000', 'In Process', 'Email sent to: mpswebinquiries@amerigroup.com, Jason.Hughes@amerigroup.com, TXCredentialing@amerigroup.com  Subject: Need to Enroll || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || AMERIGROUP ||  Greetings,   Hope you are doing well. I received an email from your side in which you mentioned that our group &  providers are not contracted with Amerigroup under the below locations besides some of the providers are participating with Amerigroup but not under all the locations. I wanted to know how to enroll and add the additional locations for the below mentioned providers in Amerigroup under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Below are the providers need to enroll in Amerigroup:    Provider Name: Thomas, Cini  NPI: 1134777238  Tax ID: 270796429  Status: Non-Participating  Location: 16272 IMPERIAL VALLEY DR STE K,  Houston     Provider Name: Stephen, Ani  NPI: 1588959118  Tax ID: 270796429  Status: Non-Participating     Provider Name: Piccione JR, James  NPI: 1356321509  Tax ID: 270796429  Status: Non-Participating  Location: 9504 LONG POINT RD STE E  Houston     Provider Name: PAUL, SIGI  NPI: 1033623616  Tax ID: 270796429  Status: Non-Participating     Provider Name: Kourouma , Odette  NPI: 1134525868  Tax ID: 270796429  Status: Non-Participating     Provider/Group Name: Jacob, Jaya  NPI: 1194336149  Status: Non-Participating     Provider Name: Fernandus, Limy  NPI: 1972005189  Status: Non-Participating     Provider Name: Abraham, Jeena  NPI: 1467901587  Provider ID:  Status: Non-Participating     Provider Name: Chennemkara, Mini Philip  NPI: 1841755956  Tax ID: 270796429  Status: Non-Participating     Provider Name: Joseph, Molly  NPI: 1396380077  Status: Non-Participating     Provider Name: John, Jeny  NPI: 1073019493  Tax ID: 27-0796429  Status: Non-Participating     Provider Name: Rauf, Abdur   NPI: 1497726202  Tax ID: 27-0796429  Status: Non-Participating    Request to add the additional location for the below mentioned providers.     Provider Name: Joseph, Vibitha  NPI: 1952931560  Provider ID: 09743760  Tax ID: 760612416  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 9504 LONG POINT RD STE E  Houston  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Provider Name: Abraham, Glory  NPI: 1194206490  Provider ID: 07116206  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: Brown, Brittany  NPI: 1275163537  Provider ID: 09808410  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: George, Jeemol  NPI: 1497219067  Provider ID: 09805666  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: Jose, Julie  NPI: 1447883061  Provider ID: 09807037  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    If you need any additional information please feel free to call or email me. Please get back to me as soon as you can get a chance. Waiting to hear from you soon.     Thank you ', NULL, NULL, '2021-09-09 13:07:54', '2021-09-09 13:07:54'),
(1366, 10057, 204, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : mpswebinquiries@amerigroup.com, Jason.Hughes@amerigroup.com, TXCredentialing@amerigroup.com  Sub : Need to Enroll || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || AMERIGROUP ||  Good Evening,  Hope this email finds you well. I want to inquire about the enrollment status of the below mentioned providers and practices. Please get back to me as soon as you get a chance.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Looking forward to hearing from you. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-18 15:16:40', '2021-10-18 15:16:40'),
(1367, 10057, 204, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Hello,  Greetings for the day!  We want to enroll the below mentioned providers on an urgent basis with Amerigroup under below mentioned details. Also please find the attached LOI\'s for all providers.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441 Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Please get back to me with the update as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-11 13:01:20', '2021-11-11 13:01:20'),
(1368, 10057, 204, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Greetings!  Can I get the latest update on the below mentioned request.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-11-30 10:48:58', '2021-11-30 10:48:58'),
(1369, 10057, 204, NULL, '2021-12-14 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com, Jason.Hughes@amerigroup.com, mpswebinquiries@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Good Afternoon,  Hope this email finds you in good health. I\'m writing this email to check the status for the applications which we have submitted to enroll the providers with Amerigroup under the TIN\'s.  It is my second follow-up, please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-06 16:05:16', '2021-12-06 16:05:16'),
(1370, 10057, 204, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Called to check the status: 800 - 600 - 4441  Applications has been received and credentialing started on 11/11/2021. Still need 30 working days to finish the process. Once request will be completed, welcome letter will be issued accordingly.  Call Reference: I145695020 - Representative - Courtney', NULL, NULL, '2021-12-13 10:49:06', '2021-12-13 10:49:06'),
(1371, 10057, 204, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Please check previous Call Comments.  Will follow-up next week.', NULL, NULL, '2021-12-20 13:55:22', '2021-12-20 13:55:22'),
(1372, 10057, 204, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : latina.small@anthem.com  Sub : RE: {EXTERNAL} Re: Enrollment Queries || Providers || Amerigroup ||  Good Morning Latina,  We have send the LOI and group roster to credentialing dept, but no one from that department is responding back to us, its been more than 45 calender days we have send them the LOI and can you please get back to me with an update.  Regards, Alex Credentialing Manager', NULL, NULL, '2021-12-27 09:55:11', '2021-12-27 09:55:11'),
(1373, 10057, 204, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Received From : latina.small@Amerigroup.com & txcredentialing@amerigroup.com  Sub : RE: {EXTERNAL} Re: Enrollment Queries || Providers || Amerigroup ||  Good Morning,  You can respond directly to the credentialing  email for assistance with credentialing concerns. I have included them on the email as well.  Thank You in Advance,  Latina Small Provider Experience Consultant Amerigroup, Inc.', NULL, NULL, '2021-12-30 09:22:36', '2021-12-30 09:22:36'),
(1374, 19067, 204, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com, Jason.Hughes@amerigroup.com, mpswebinquiries@amerigroup.com  Subject: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||   Hello!  Hope you are having a productive day.  I would like to know the enrollment status of the following Providers & Groups.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Jeny John	1073019493	779 Normandy St STE 114, Houston, TX 77015-3441 Jeny John	1073019493	16272 Imperial Valley DR STE K, Houston, TX 77060 Molly Joseph	1396380077	779 Normandy St STE 114, Houston, TX 77015-3441 Molly Joseph	1396380077	16272 Imperial Valley DR STE K, Houston, TX 77060 Cini Thomas	1134777238	779 Normandy St STE 114, Houston, TX 77015-3441 Cini Thomas	1134777238	16272 Imperial Valley DR STE K, Houston, TX 77060 Ani Stephen	1588959118	779 Normandy St STE 114, Houston, TX 77015-3441 Ani Stephen	1588959118	16272 Imperial Valley DR STE K, Houston, TX 77060 Abdur Rauf	1497726202	779 Normandy St STE 114, Houston, TX 77015-3441 Abdur Rauf	1497726202	16272 Imperial Valley DR STE K, Houston, TX 77060 James Piccione JR	1356321509	779 Normandy St STE 114, Houston, TX 77015-3441 James Piccione JR	1356321509	16272 Imperial Valley DR STE K, Houston, TX 77060 Sigi Paul	1033623616	779 Normandy St STE 114, Houston, TX 77015-3441 Sigi Paul	1033623616	16272 Imperial Valley DR STE K, Houston, TX 77060 Odette Kourouma	1134525868	779 Normandy St STE 114, Houston, TX 77015-3441 Odette Kourouma	1134525868	16272 Imperial Valley DR STE K, Houston, TX 77060 Vibitha Joseph	1952931560	779 Normandy St STE 114, Houston, TX 77015-3441 Vibitha Joseph	1952931560	16272 Imperial Valley DR STE K, Houston, TX 77060 Julie Jose	1447883061	779 Normandy St STE 114, Houston, TX 77015-3441 Julie Jose	1447883061	16272 Imperial Valley DR STE K, Houston, TX 77060 Jaya Jacob	1194336149	779 Normandy St STE 114, Houston, TX 77015-3441 Jaya Jacob	1194336149	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeemol George	1497219067	16272 Imperial Valley DR STE K, Houston, TX 77060 Limy Fernandus	1972005189	779 Normandy St STE 114, Houston, TX 77015-3441 Limy Fernandus	1972005189	16272 Imperial Valley DR STE K, Houston, TX 77060 Brittany Brown	1275163537	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeena Abraham	1467901587	779 Normandy St STE 114, Houston, TX 77015-3441 Jeena Abraham	1467901587	16272 Imperial Valley DR STE K, Houston, TX 77060 Mini Chennemkara	1841755956	779 Normandy St STE 114, Houston, TX 77015-3441 Mini Chennemkara	1841755956	16272 Imperial Valley DR STE K, Houston, TX 77060  Kindly respond promptly.  Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 16:04:56', '2022-01-04 16:04:56'),
(1375, 20067, 204, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com, Jason.Hughes@amerigroup.com & mpswebinquiries@amerigroup.com  Sub: Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||   Good Morning! Hope this email finds you well. Any updates on the below-mentioned request?  Thanks and regards, Syed Ahad', NULL, NULL, '2022-01-14 10:32:53', '2022-01-14 10:32:53'),
(1376, 20067, 204, NULL, '2022-01-31 00:00:00.000', 'Approved', 'Kindly see the attachment of Directory  Effective Date: 11/11/2021', NULL, NULL, '2022-01-24 12:56:11', '2022-01-24 12:56:11'),
(1377, 3040, 206, NULL, '2021-06-24 00:00:00.000', 'Revalidation', 'Email sent to: registrar@multiplan.com  Subject: Location Addition || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers || Multiplan ||   Greetings,   Hope you are doing well. I wanted to add the location under the below mentioned providers in Multiplan for our group.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 01:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441    Provider 02:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 03:   Provider Name: Abraham, Glory Provider NPI# 1194206490 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  If you need any additional information please let me know. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-17 11:54:45', '2021-06-17 11:54:45'),
(1378, 3040, 206, NULL, '2021-07-13 00:00:00.000', 'Revalidation', 'I had a word with Dan Multiplan representative and he said under the group contract we have all three location  (NUCC, IVUC & LPMC). He advised to send the LOI through fax and they can process our request. Also he said LPMC is not contracted separately because that already coming under the NUCC tax ID .  Case # 7660656', NULL, NULL, '2021-07-06 11:57:32', '2021-07-06 11:57:32'),
(1379, 3040, 206, NULL, '2021-08-03 00:00:00.000', 'Revalidation', 'Email sent to: registrar@multiplan.com  Subject: Letter of Intent || NUCC, IVUC & LPMC || Providers || Multiplan ||  Greetings,   Hope you are doing well. Please find attached Letter of Intent as per request of (Sam) Multiplan representative and he advises to send it through email as per him Multiplan did not receive the fax.    Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 9:   Provider Name: Joseph, Molly  Provider NPI# 1396380077  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 12:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 13:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: John, Jeny Provider NPI# 1073019493   Thank you  ', NULL, NULL, '2021-07-27 16:42:05', '2021-07-27 16:42:05'),
(1380, 11056, 206, NULL, '2021-08-21 00:00:00.000', 'Revalidation', 'Email sent to : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good morning!  Hope you are doing well. I want to inquire about the enrollment status of the following providers and practices for the Multiplan.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider 1:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 9:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 12:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 13:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: John, Jeny Provider NPI# 1073019493  If you need any information or documents feel free to reach out to me. Waiting for your response.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-13 15:35:55', '2021-08-13 15:35:55'),
(1381, 3040, 206, NULL, '2021-08-27 00:00:00.000', 'Revalidated', 'Provider is participating with Multiplan. Please see attachment. ', NULL, NULL, '2021-08-20 16:46:09', '2021-08-20 16:46:09'),
(1382, 2027, 207, NULL, '2020-10-18 00:00:00.000', 'In Process', 'Check online status provider is still in process', NULL, NULL, '2020-10-11 17:24:06', '2020-10-11 17:24:06'),
(1383, 1006, 207, NULL, '2020-11-25 00:00:00.000', 'In Process', 'Additional research is required to complete your request  Please return to this tool after 30 calendar days with the reference number listed below to retrieve your PTAN information. Key in your reference number, local Medicare Administrative Contractor (MAC) PTAN, your NPI, and the last 5 digits of your tax identification number, and the tool will confirm that your PTAN is active. Reference Number :	20304001324 NPI :	1124282553 ', NULL, NULL, '2020-10-30 17:45:06', '2020-10-30 17:45:06'),
(1384, 2027, 207, NULL, '2020-12-02 00:00:00.000', 'In Process', 'Request is still in process', NULL, NULL, '2020-11-25 10:30:56', '2020-11-25 10:30:56'),
(1385, 2027, 207, NULL, '2020-12-09 00:00:00.000', 'Approved', 'Provider is now enrolled with medicare railroad and effective date is 06/20/2020', NULL, NULL, '2020-12-02 12:33:37', '2020-12-02 12:33:37'),
(1386, 2027, 208, NULL, NULL, 'Rejected', 'Application Rejected on 06/01/2020. Tracking Id: T042320200002181', NULL, NULL, '2020-06-23 13:59:38', '2020-06-23 13:59:38'),
(1387, 1006, 208, NULL, '2020-09-25 00:00:00.000', 'Initiated', 'Enrollment Tracking Information Applicant Name: CYNTHIA RODRIGUEZ   Tracking ID: T091820200000892  Submitted Date: FRI - SEPTEMBER18 2020 10:54:15 AM EST  Submitted By: Cynthia Rodriguez  Contact Email(s): VMUC@CLAIMSMEDINC.COM SINTHIA223@YAHOO.COM', NULL, NULL, '2020-09-18 09:55:47', '2020-09-18 09:55:47'),
(1388, 1005, 208, NULL, '2020-09-25 00:00:00.000', 'In Process', 'Sent: 09/18/2020 10:54 AM   This message is to confirm receipt of your Medicare enrollment application that was submitted from https://pecos.cms.hhs.gov. You are listed as the contact person for this application. The information provided below is for your future reference: ', NULL, NULL, '2020-09-18 12:16:12', '2020-09-18 12:16:12'),
(1389, 1006, 208, NULL, '2020-09-30 00:00:00.000', 'Approved', 'The request has been approved: \"Medicare Enrollment Information Individual Name: CYNTHIA RODRIGUEZ Individual Specialty: PHYSICIAN ASSISTANT Individual National Provider Identifier (NPI): 1124282553 Individual Provider Transaction Access Number (PTAN): 1H2296 Individual PTAN Effective Date: JUNE 20th, 2020 Employer Legal Business Name (LBN): VALLEY MED URGENT CARE PLLC Employer National Provider Identifier (NPI): 1518404631 Employer Provider Transaction Access Number (PTAN): 578343 Changed Information: ENROLLMENT APPLICATION CONTACT PERSON\"', NULL, NULL, '2020-09-23 14:09:07', '2020-09-23 14:09:07'),
(1390, 1006, 211, NULL, NULL, 'In Process', 'Received following email:   \"Hello Credentialing Contact,  I am credentialing Cynthia Rodriguez-NPI 1124282553 for network participation with Humana Military.  I am needing the following information to continue the credentialing process:  ·         There is a 10 month gap between the provider leaving Texas Federal Wellness Center 8/2018 and beginning at Valley Med Urgent Care PLLC on 6/11/2019. Please have a provider submit an explanation for the gap.  Please return the requested information to me via email or fax ASAP in order to continue the credentialing process.  If you have any questions, please contact me.     Beth Mings Humana Military 301 N. Hurstbourne Parkway, Forum 1, 2A Louisville, KY 40222   P (502) 313-9681 F (502) 508-6412 BMings@humana.com  Humana-Military.com\"  and replied:  \"Hey Beth,   Sure thing, I asked the provider and this is what she told me regarding her gap:   Edinburg Children\'s Clinic 4709 S Jackson Rd, Edinburg, TX 78539 Feb 2019 - May 2019 1982827143  On vacations with Kids Aug 2018 - Feb 2019   Please let me know if you have any questions and can you please give me an expected time-frame for when her credentialing/contracting will be completed?   Thanks. \" ', NULL, NULL, '2020-06-09 14:33:48', '2020-06-09 14:33:48'),
(1391, 1006, 211, NULL, NULL, 'In Process', 'Sent following email to KMoten4@humana.com:  Sub: Provider Status - Cynthia Rodriguez  \"Hey Katherine,   I hope you\'re doing well, I just wanted to check in with you regarding the status of enrollment for Cynthia Rodriguez (NPI# 1124282553), please get back to me as soon as you\'re able.   Thanks.\"', NULL, NULL, '2020-06-10 16:46:32', '2020-06-10 16:46:32'),
(1392, 2027, 211, NULL, NULL, 'In Process', 'To: 	KMoten4@humana.com  Sub: Need Status Update Of Provider Cynthia Rodriguez  Hello,   Hope you are doing great, I want to know the status of enrollment for Cynthia Rodriguez. Following are the details:  NPI# 1124282553 Group Name: Valley Med Urgent Care PLLC (Brownsville) Tax-ID: 81-5123542   Thanks.', NULL, NULL, '2020-06-22 12:51:26', '2020-06-22 12:51:26'),
(1393, 2027, 211, NULL, NULL, 'In Process', 'From: KMoten4@humana.com  To: mk@claimsmedinc.com  Good Afternoon,  This provider is showing credentialed eff: 6/9/2020.   Respectfully, Katherine Moten', NULL, NULL, '2020-06-22 17:33:54', '2020-06-22 17:33:54'),
(1394, 2027, 211, NULL, NULL, 'In Process', 'Email to Tricare to get the welcome letter as we have received the effective date- 06/09/2020 by them.', NULL, NULL, '2020-06-22 17:35:54', '2020-06-22 17:35:54'),
(1395, 2027, 211, NULL, NULL, 'In Process', 'To: KMoten4@humana.com  Sub: Need welcome letter for the provider  Hello, hope you are doing great. Last week i received your email regarding our provider  Cynthia Rodriguez NPI# 1124282553 under the group-Valley Med Urgent Care PLLC, Tax ID-81-5123542 in which you have confirmed that this provider is already credentialed eff: 6/9/2020. but the welcome letter was missing. Could you just send us the welcome letter for this provider.  Thanks.', NULL, NULL, '2020-06-29 12:38:20', '2020-06-29 12:38:20'),
(1396, 2027, 211, NULL, NULL, 'In Process', 'talk to the representative her name is alexis she said she will send the welcome letter within 48hours', NULL, NULL, '2020-07-06 15:32:05', '2020-07-06 15:32:05'),
(1397, 2027, 211, NULL, NULL, 'In Process', 'To: KMoten4@humana.com  Hello, hope you are doing great. Last week i received your email regarding our provider  Cynthia Rodriguez NPI# 1124282553 under the group-Valley Med Urgent Care PLLC, Tax ID-81-5123542 in which you have confirmed that this provider is already credentialed eff: 6/9/2020. but the welcome letter was missing. Could you just send us the welcome letter for this provider.  Thanks.', NULL, NULL, '2020-07-15 10:58:58', '2020-07-15 10:58:58'),
(1398, 2027, 211, NULL, NULL, 'In Process', 'To: KMoten4@humana.com, ywyatt@humana.com  Sub: (Rodriguez, Cynthia)-(Valley Med Urgent Care PLLC (Brownsville)-(Tricare)  May I know the current status of the provider Cynthia Rodriguez her details are mentioned below: Provider NPI#  1124282553   Group Name: Valley Med Urgent Care PLLC (Brownsville) Group Tax ID: 81-5123542  We have already submitted the application on 5/7/2020 and I am attaching the application for your reference. Kindly look into this matter and reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-07-16 14:42:02', '2020-07-16 14:42:02'),
(1399, 2027, 211, NULL, NULL, 'In Process', 'From: KMoten4@humana.com  This provider is showing credentialed as of 6/9/20.', NULL, NULL, '2020-07-16 15:18:42', '2020-07-16 15:18:42'),
(1400, 2027, 211, NULL, NULL, 'In Process', 'To: kmoten4@humana.com  Thanks for the confirmation. Now i need to add this provider in two new locations under the existing group contract with tricare how can i start the process, need your assistance.  Thanks. ', NULL, NULL, '2020-07-16 15:19:57', '2020-07-16 15:19:57'),
(1401, 2027, 211, NULL, NULL, 'In Process', 'From: KMoten4@humana.com  Hi Martin,  Please send me both locations along with phone and fax numbers. I will submit your request once provided.', NULL, NULL, '2020-07-16 15:21:18', '2020-07-16 15:21:18'),
(1402, 2027, 211, NULL, NULL, 'In Process', 'From: KMoten4@humana.com  Hi Martin,  Please send me both locations along with phone and fax numbers. I will submit your request once provided.   Respectfully, Katherine Moten', NULL, NULL, '2020-07-16 15:31:46', '2020-07-16 15:31:46'),
(1403, 2027, 211, NULL, NULL, 'In Process', 'To: kmoten4@humana.com  Thanks for your quick response. The locations, phone numbers and fax numbers are mentioned below: Location (1) 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Location (2) 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Location (1) Tel#-(956) 518-7444, Fax# (956) 546-2001 Location (2) Tel#-(956) 731-6699, Fax# (956) 546-2001  Thanks. ', NULL, NULL, '2020-07-16 15:33:21', '2020-07-16 15:33:21'),
(1404, 2027, 211, NULL, NULL, 'Approved', 'Provider is already in network as the group has an ancillary contract, group welcome letter attached task is approved  ', NULL, NULL, '2020-07-20 16:40:32', '2020-07-20 16:40:32'),
(1405, 3040, 211, NULL, NULL, 'Revalidation', 'Email sent to: kmoten4@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Hello Katherine,  Hope you doing well. Please advise me the enrollment status for the below mentioned providers for our group Valley Med Urgent Care PLLC in all three locations.  Practice Details: Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 2: Provider Name: Campos, Moses Provider NPI# 1558680009  Provider 3: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 4: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 5: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you', NULL, NULL, '2021-04-15 08:07:28', '2021-04-15 08:07:28'),
(1406, 3040, 211, NULL, NULL, 'Revalidated', 'Email rcvd from: KMoten4@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Provider 2: Provider Name: Campos, Moses - eff: 3/16/2021 (showing under all 3 locations) Provider NPI# 1558680009', NULL, NULL, '2021-04-15 10:23:31', '2021-04-15 10:23:31'),
(1407, 3040, 214, NULL, '2021-06-24 00:00:00.000', 'Revalidation', 'Email sent to: registrar@multiplan.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Multiplan ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Multiplan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 4:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 5:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 6:   Provider Name: Kourouma , Odette Tiranke 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, '2021-06-17 11:50:07', '2021-06-17 11:50:07'),
(1408, 3040, 214, NULL, '2021-07-13 00:00:00.000', 'Revalidation', 'I had a word with Dan Multiplan representative and he said under the group contract we have all three location  (NUCC, IVUC & LPMC). He advised to send the LOI through fax and they can process our request. Also he said LPMC is not contracted separately because that already coming under the NUCC tax ID .  Case # 7660656', NULL, NULL, '2021-07-06 11:57:31', '2021-07-06 11:57:31'),
(1409, 3040, 214, NULL, '2021-08-03 00:00:00.000', 'Revalidation', 'Email sent to: registrar@multiplan.com  Subject: Letter of Intent || NUCC, IVUC & LPMC || Providers || Multiplan ||  Greetings,   Hope you are doing well. Please find attached Letter of Intent as per request of (Sam) Multiplan representative and he advises to send it through email as per him Multiplan did not receive the fax.    Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 9:   Provider Name: Joseph, Molly  Provider NPI# 1396380077  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 12:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 13:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: John, Jeny Provider NPI# 1073019493   Thank you  ', NULL, NULL, '2021-07-27 16:42:05', '2021-07-27 16:42:05'),
(1410, 11056, 214, NULL, '2021-08-21 00:00:00.000', 'Revalidation', 'Email sent to : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good morning!  Hope you are doing well. I want to inquire about the enrollment status of the following providers and practices for the Multiplan.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider 1:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 9:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 12:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 13:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: John, Jeny Provider NPI# 1073019493  If you need any information or documents feel free to reach out to me. Waiting for your response.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-13 15:35:50', '2021-08-13 15:35:50');
